Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform
Robert Whitaker and Linda Cosgrove
Palgrave Macmillan 2015
Psychiatry Under the Influence is the third in a series of books by Robert Whitaker about mental illness and the drugs and methods used to treat its various forms in America. In his earlier works, Mad in America and Anatomy of an Epidemic (both previously reviewed in these pages), Whitaker unmasks a subject usually depicted in horror movies, and exposes the shameful side of the psychiatry profession. This is a profession in league with the pharmaceutical industry, which has disabused the mentally ill of their personhood in the last century. Can you imagine hacking into a person’s brain with an ice pick in the name of psychiatry? Electroshock, lobotomies, torture-like water treatments and mind-numbing drugs are not just the stuff of movies but stark realities for the mentally ill. In Psychiatry Under the Influence, Whitaker and Cosgrove strip off the white coat and expose the shame, greed and scandal of a profession that has become the handmaiden and enabler of a multi-million dollar drug industry. Why do physicians who pledge to do no harm actually buy into the malarkey? It’s a well-laid out, complex and perfectly executed plan where fame, power and money can turn a doctor’s head. Some are persuaded to deceive. In several studies that polled doctors and asked them about accepting benefits, doctors had convinced themselves that most of these practices were acceptable, but worried that the benefits might influence the prescription habits of their fellow physicians.
But because of psychiatry’s group consensus and approval, society has condoned and even paid for the treatment of the mentally ill, first as monsters in chains, then as prisoners locked up in mental institutions and group homes, or even as foster children maintained and tamed on mind-destroying drugs. We accept the premise that psychiatrists are experts, know best and will cure us of our demons. This is far from the truth, say the authors, who describe the deception that is rampant in bringing drugs to market. It is not enough that the drugs are approved. There must be a demand created for their use.
In this book, the authors peel the onion, layer by layer, dissecting and documenting how psychiatry and the drug companies built a powerful industry funded by public tax dollars, the federal government and other bodies, and advanced the agenda that every man, woman and child could be mentally ill or psychiatrically imperfect in some way—and hence in need of a psychotropic drug.
Perhaps one of the saddest stories surrounds the period in the 1990s when antidepressants were brought to market. The target soon became children, adolescents and young adults. Studies soon showed that these pills were dangerous and that kids taking antidepressants were killing themselves. The warning was real but swept under the rug. Kids of this age put on antidepressants are at a high risk for suicide. Please, if you are a parent, grandparent, patient, or health care professional, do your homework: read this book and others like it, and search pubmed.org (of the National Library of Medicine), a user-friendly investigative tool, and other places for answers.
The psychiatric profession and drug companies are partners in an easy camaraderie under which they developed a model allowing each drug they bring to market to climb to the top of the charts as the drug of choice for that condition. Even though there may be a drug which was formerly deemed the best, another drug company will bring a similar one to market and this drug makes the ascent to the top of the ladder. Each has its time in the sun and share of the earnings pie.
But psychiatry was not always so profitable. Before the blockbuster psychiatric drugs came on the market and psychiatrists had few tools, they were relegated to working in mental asylums where they received no respect. After the asylums started to close, a change was needed to advance the field. To achieve this goal, psychiatry looked to the other medical specialties, their disease model, and the related book of diagnostic codes, The International Classification of Diseases, now in its tenth revision. The ICD-10 defines all medical conditions and prescribes a medication or treatment for each. That code is submitted to insurance companies to pay for the treatment, and gives the medical profession a strong semblance of legitimacy, order and authority. No code, no payment. Psychiatrists took notice and said, in effect, “We want that, too.”
The American Psychiatric Association (APA), the grounding organization for psychiatry, took the profession in hand in the 1980s, adopted the medical model, and gave it a new look and new direction. Up to that time psychiatry was suffering an identity problem, not only from the asylum days, but because of their Freudian bent in diagnosis, which was losing popularity. Insurance companies were complaining. There was no detailed guide to psychiatry.
The APA started by rewriting the basic foundational document of the profession, The Diagnostic and Statistical Manual of Mental Disorders (DSM), which defines all the diagnoses of mentally ill patients. The DSM-3 described two hundred sixty-five psychiatric disorders, vastly increased from the few disorders reported in prior volumes. Presenting all these disorders as discrete illnesses gave the psychiatrist legitimacy as a medical specialist, and the field plenty of room for new drug development. The DSM-3 expanded the market, and gave greater rationale for treating children with a range of drugs. Few of life’s problems escaped coverage under some rubric of mental disease.
However, things were not perfect in paradise. In the field, the DSM-3 tested poorly on reliability and was not any better than DSM-1 or DSM-2. There was no evidence of reliability in follow-up studies. Most of the two hundred sixty-five disorders required validation because they were based on clinical judgments. But that didn’t matter, and ultimately nothing was done. Psychiatry marches on.
The development of this manual laid the fertile ground for the corruption that followed. With the development of each succeeding DSM, the task forces pushed the envelope a bit further. For DMS-4 and now DSM-5 the majority of the authors have strong ties to industry. Everyone had an agenda. Diagnostic boundaries were expanded so that more people could be included under the banner. For example, premenstrual dysphoric disorder became a full–fledged disorder with its own criteria and drug prescription.
The DSM-5 in 2013, was surrounded in controversy. After it was released even the most vocal in the field and former task members on prior DSMs called the manual “dangerous,” and many offered harsh criticism of DSM-5. Dr. Allen Francis, a former chairman of DSM-4, said about DSM-5: “This is the saddest moment in my forty-five-year career of studying, practicing and teaching psychiatry. The Board of Trustees of the American Psychiatric Association has given its final approval to a deeply flawed DSM-5 containing many changes that seem clearly unsafe and scientifically unsound. . . Our patients deserve better, society deserves better and the mental health professions deserve better.”
The ever-broadening diagnoses leave wide open the possibility for drug development. Before drugs are brought to market they undergo clinical trials, in which psychiatrists lead the drug testing. These researchers receive generous grants from the government or drug companies to conduct the trials. Psychiatrists publish the trial results in medical journals. Often they don’t have to write the articles, and merely lend their names to articles ghost written by anonymous authors of the drug company’s choosing. After publication, prominent psychiatrists hold news conferences, and appear on the covers of Time and Newsweek extolling merits of the drug. Others conduct continuing education programs about the specific drug and give lectures at APA and other conferences. Drug reps provide free samples to physicians. Drug advertising floods the airwaves. And voilà, the drug’s supposed efficacy becomes fact.
This is the typical path of each drug to market and the model appears effective in guiding the drug’s way onto the practitioner’s prescription pad. The doctor on the front lines doesn’t really know the side effects and/or efficacy of the drug because those leading the drug trials find ways to bend or cherry pick data, indulge in doublespeak, and creatively misreport so that the results will fit the desired outcome. Results in drug trials can be covered up or disguised through study design, statistics and selective reporting. In many cases, the drug under study is no different from the prior drug du jour, which was found to be ineffective after all. Whitaker and Cosgrove show us in case after case where this pattern was effective in getting drugs approved.
A busy practitioner does not have time to study medical journals. And if a doctor observes that the drug is not helping, he may change the drug, think the patient is an outlier (one of those for whom it does not work), or that the patient is not complying with instructions. It would be hard for a doctor to believe that he was deliberately misled about the efficacy of the drug.
But the inane methods of the mad men who are psychiatrists do not cease. The wounded warriors who have experienced post-traumatic stress disorder in large numbers in the Middle East are being electroshocked as the treatment of choice. Even pregnant women receive electroshock and antidepressants. Babies are born with antidepressants running through their veins. These antidepressants are approved for breastfeeding moms and for their newborns getting mother’s milk. Children no older than two are given speed, such as Ritalin, as well as antidepressant cocktails. But it’s all okay, say the psychiatrists and those who fund them, even though studies have shown time and again that these methods do not help but decidedly do harm.
Mr. Whitaker shows how undergoing psychiatric treatment is not something to be taken lightly. Serious side effects can occur. Drugs can permanently change the brain chemistry and cause things like “extrapyramidal movement disorders” and “tardive dyskinesia.” Often physicians who dispense drugs have not received proper training and do not recognize the many different manifestations of these disorders. It is especially troublesome because “these conditions can be particularly difficult to recognize in children, even for those with specific training.” The longer they go unrecognized, the greater likelihood they will become permanent.
Psychiatry Under the Influence is a serious read, empowering and frightening at the same time. For those who would like a challenge, I heartily recommend this book and give it a strong thumbs up.
This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly journal of the Weston A. Price Foundation, Spring 2016