I knew it was bad. From all the research I did for Part 3 of my book, “What We Learned About Psychiatry,” I knew psychiatry had issues. It relied too heavily on Big Pharma for continuing education for its psychiatrists. It created the DSM-III and subsequent editions to expand the definition of “mental illness.” It excommunicated members who came up with effective, non-medical approaches to caring for mentally distressed people.
But I didn’t grasp the extent of the corruption until I read Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform by Robert Whitaker and Lisa Cosgrove.
Whitaker and Cosgrove wrote this groundbreaking book as a result of their fellowships at the Edmond J. Safra Research Lab at Harvard University, which was established to study institutional corruption. This is a key backdrop to understanding this book, and the authors do a phenomenal job explaining the difference between institutional corruption and individual corruption. (Bad barrel vs. bad apple.)
This resonated with me. I never felt that my daughter Rebecka’s psychiatrists were corrupt—or bad people. I repeatedly point out in talks and interviews that I believe they had her best interest in mind. Rather, my sense is that they were misguided—caught up in the discourse that says that medication is the answer for mental distress.
Psychiatry Under the Influence explains why psychiatry—as an institution—is not able to keep patients’ best interests in mind. It is due to two “economies of influence”:
- Guild interests (the legitimacy of psychiatry and the need to establish itself as a medical profession, thereby relying on the disease model of mental distress)
- Pharmaceutical money (Big Pharma sponsoring continuing education, etc.)
I knew about the second economy of influence, but I wasn’t quite as clear about the first—and, according to the authors, more important—issue of guild interests. The deception instigated by the American Psychiatry Association (APA) is immense. It all started in 1980 with the publication of the DSM-III. (The DSM stands for “Diagnostic and Statistical Manual” and is used by clinicians all over the world to diagnose mental disorders.) DSM-III was in part a response to questions about psychiatry’s reliability and antipsychiatry sentiments:
By adopting a disease model and asserting that psychiatric disorders were discrete illnesses, the APA had addressed both antipsychiatry critiques and its image problem. Metaphorically speaking, psychiatry had donned a white coat. It was presenting itself to the public as a medical specialty . . .
The list of financial benefits of the DSM-III goes on and on. For example, by creating discrete diseases, “research would focus on identifying their underlying pathologies and on developing treatments for the symptoms of these diseases, which was research that physicians could be expected to lead.”
Thus began an effort to validate psychiatry’s diagnostic manual through scientific research—the search for chemical imbalances. As early as 1984, the National Institute of Mental Health concluded: “Elevations or decrements in the functioning of serotonergic systems per se are not likely to be associated with depression.”
That was over thirty years ago! And subsequent research has found no evidence that any mental disorder is caused by a chemical imbalance. Yet, the APA has continued to lead the public to believe that depression and other disorders are caused by a chemical imbalance—with Big Pharma’s help.
This is just one example of the vast deception that has taken place over the past 35 years in this country and beyond as the DSM has been exported to many other countries.
I think the most fascinating point of the book, though, is the “social injury” this corruption has caused. (Dr. Peter C. Gotzsche calls the use of unnecessary pills a medical “holocaust.”*) The completely unscientific disease model has caused our “society to ignore social factors that may create mental difficulties for so many.” In other words (in the context of foster children),
Society is no longer prompted to ask what happened to the child; instead, a diagnosis is made to designate what is wrong with the child. The child is informed that he or she is broken and “mentally ill.” Medication is offered as the solution, and this is so even though the medication may squelch the child’s emotions and capacity to interact with the world.
This was exactly our experience with Rebecka. As soon as she was identified as a “patient,” she immediately started on a quest to figure out what was wrong with her. She read psychology books. She tried to match her symptoms du jour (mostly side effects of her medication) to the disorders she’d read about. She waited for a diagnosis. We were all caught up in the disease model narrative—a narrative that has been actively and intentionally marketed by the APA and Big Pharma for most of my lifetime.
The authors go on to describe the same conclusion I reached in Her Lost Year:
The disease model encourages society to turn a blind eye to the social injustices that may cause mental distress to so many. If anxiety, depression, or aggressive behaviors are due to a chemical imbalance, or a brain illness of some kind, then questions about lousy schools, poor wages, poverty, racism, and crime-filled neighborhoods can be dismissed. If a school doesn’t set aside time for gym, art, or music, and the child gets antsy sitting in a chair all day, then that is the child’s fault, and not the fault of a society that would create such a child-unfriendly school day.
We’ve been duped folks. And this deception runs so deep and is so ingrained in our psyches that many people still buy into the outdated disease model (although this is changing).
It’s time for a paradigm shift.
And that’s exactly what the authors call for at the conclusion of the book—the prescription for reform. The bio-psycho-social model of care is a start. The name implies that there is more to the mental distress story than biology. This in turn means that psychiatry alone cannot provide this care. We need psychologists, social workers, and sociologists (not to mention nutritionists, yoga instructors, holistic healers, etc.) working together with psychiatrists to provide holistic care. Further, we need to look at society as a factor in promoting mental health. For example,
if a significant percentage of youth are having difficulty focusing in the classroom, perhaps it is the classroom environment that needs to be changed.
Holistic care and social change would go far to change the trajectory of mental distress in our society.
I can’t recommend Psychiatry Under the Influence enough. It is well-researched, methodical, and balanced. Be prepared to be enlightened, infuriated, and inspired to make change happen.
It’s bad, but it can change.
*”Does long term use of psychiatric drugs cause more harm than good?” BMJ 2015;350:h2435