https://www.psychologytoday.com/us/blog/suffer-the-children/201505/psychiatry-under-the-influence
Marilyn Wedge interviewing Robert Whitaker and Lisa
Cosgrove
New York Times bestselling author Robert Whitaker and
University of Massachusetts Professor Lisa Cosgrove have
written an important new book in the field of mental
health, Psychiatry Under the Influence: Institutional
Corruption, Social Injury and Prescriptions for Reform. I
interviewed them last week.
MW: How did you become interested in the topic of
institutional corruption?
LC: I was doing research on how academic-industry
relationships can affect psychiatric research and
practice. Then I was advised that the Edmond J. Safra
Center for Ethics (Harvard University) was starting a lab
on institutional corruption which would focus
on how such industry influences can corrupt an
institution. I was a residential fellow in 2010-2011, the
first year of the lab, and retained a relationship with
the lab through its five years of existence.
RW: After Lisa read Anatomy of an Epidemic, she asked me
if I would like to apply to the Safra Center to
collaborate on writing a monograph on the American
Psychiatric Association as viewed through the lens of
institutional corruption. As we worked on that topic,
during the fellowship year 2011-2012, we decided to
expand it into a book-length study of the institution of
psychiatry. We look at both the influence of
pharmaceutical money and guild interests on the
institution. For the purposes of this study, we
conceptualized the institution as being comprised of the
American Psychiatric Association and academic psychiatry.
MW: What is the difference between institutional
corruption and individual corruption?
LC and RW: Individual corruption is quid pro quo
corruption, where an individual engages in clearly
unethical and often illegal behavior. A state official
taking a bribe would be a classic example of quid pro quo
corruption.
Institutional corruption is of a different sortits
about the bad barrel rather than the bad apple. It is
systemic corruption. As the result of economies of
influence that act on the institution. The
institution, in its collective behavior, then turns away
from its mission to serve the public in an ethical
manner. The economies of influence normalize
behaviors within the institution that those outside the
institution would see as ethically dubious, or wrong.
(For example, a psychiatrist serves as a member of a
panel that develops a clinical practice guideline. That
psychiatrist also serves on a speakers bureau for a
drug company that manufacturers a drug treatment which
the panel then recommends as a first-line treatment in
its guidelines).
MW: Most people believe that psychiatric and mental
health diagnoses are based on actual science. Is this
belief correct?
LC and RW: There is an attempt within psychiatry to use a
scientific method to diagnose and treat emotional
distress. However, understanding the origins of emotional
distress and other psychiatric problems, and then
treating these problems, is very different from trying to
understand the origins of heart disease, cancer etc. and
treating these illnesses. Psychiatry is different from
other medical specialties because there are no biomarkers
for any psychiatric disorder. Most people are not aware
of the fact that there is no blood test or scanning
technique that can be used to identify any DSM
disorder--even ones that are assumed to be
neuro-biologically based such as schizophrenia and
bipolar disorder.
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Even so, the public has been led to believe that these
diagnoses have been scientifically validated as real
diseases. However, as psychiatrists who are experts in
diagnosis will admit, the diagnoses are constructs,
and research has failed to validate them. So the science
that has been done has, in fact, revealed that the DSM
lacks validity which a diagnostic manual
should provide if it is going to be useful.
MW: Psychiatrys core mission is to help patients.
How did that mission become corrupted?
LC and RW: In 1980, when the APA published the third
edition of its Diagnostic and Statistical Manual, it
adopted a disease model for diagnosing and
treating psychiatric disorders. At that point, the APA
launched a public relations effort to sell this new model
to the public. Ever since then, the APA has been telling
the public of the validity of its disorders, of advances
in understanding the biology of these disorders, and of
safe and effective new drug treatments for
the disorders.
The problem is that psychiatrys own research didnt
support the story of discovery and progress. In truth,
research failed to validate the disorders; the field made
very little progress in discovering the pathology of the
disorders (the chemical imbalance theory failed to pan
out); and clinical studies failed to show that the second
generation drugs were any better than the first
generation drugs.
Many studies also suggested that the drugs may impair
patient outcomes in the long-term. Psychiatry had an
ethical duty to tell the public of these scientific
findings. Howeverand this is due to the influence
of its own guild interests and pharmaceutical influenceit
has instead relentlessly promoted its public-relations
success story. Psychiatrys mission
became corrupted because of the need to protect its guild
interests. .
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MW: Did the authors of the various iterations of the DSM
since the DSM-III in 1980 believe that the diagnoses they
created were based on scientific research?
Yes, at least to a certain extent. They knew the
diagnoses were constructs; but at the same time they
believed there was a scientific rationale behind their
constructs. They reasoned that they were grouping people
with similar symptoms together. They may have
found some loose genetic associations and they charted
the course of those with a similar diagnosis.
They conducted epidemiological studies to assess the
prevalence of the various diseases.
This was research that at least provided the trappings of
science, and of course the creators of the DSM were
invested in the idea that theirs was a scientific
enterprise.
MW: How has organized psychiatry shaped our conception of
childhood such that the ADHD diagnosis has spread to 6
million children in the United States?
LC and RW: Starting with DSM III and then in successive
iterations of the DSM, the APA set forth diagnostic
criteria for ADHD that made it easy to diagnose any child
who was fidgeting in class, or not paying attention, or
simply not doing well in school. Such symptoms
are of course fairly common in children, and thus the
diagnostic boundaries were set in a way that they
described a significant percentage of children. The point
here is that fidgeting and being inattentive, rather than
being understood to be behavioral problems that show up
in school environments, were re-conceptualized as
symptoms of a disease. That is a radically different
understanding of childhood from what we had before DSM
III.
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MW: To establish a new paradigm for mental health
treatment, how would psychiatry programs in medical
schools have to change?
Psychiatry programs would need to foster critical
thinking in medical students, which the students could
then apply to diagnoses, research findings, and drug
results. They would also need to foster an awareness of
the professions own guild interests. In short,
medical schools would need to nurture psychiatrists who
could think critically instead of simply mastering the
conventional wisdom. The problem with current training is
that the conventional wisdom is out of sync with the
scientific literature.
Marilyn Wedge is the author of A Disease called
Childhood: Why ADHD became an American Epidemic.
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