Sunday, November 30, 2014
Why Psychiatry Holds Enormous Power in Society Despite Losing Scientific Credibility
It helps to be funded by Big Pharma.
By Bruce Levine / AlterNet
January 6, 2015
“What’s a guy gotta do around here to lose a little credibility?” asked ProPublica reporter Jesse Eisinger in a 2012 piece about top Wall Street executives who created the financial meltdown but remain top executives, continue to sit on corporate and nonprofit boards, serve as regulators, and whose opinions are sought out by prominent op-ed pages and talk shows.
Wall Street is not the only arena where one can be completely wrong and still retain powerful influence. Influential “thought leader” psychiatrists and major psychiatry institutions, by their own recent admissions, have been repeatedly wrong about illness/disorder validity, biochemical causes and drug treatments. In several cases, they have been discovered to be on the take from drug companies, yet continue to be taken seriously by the mainstream media.
While Big Pharma financial backing is one reason psychiatry is able to retain its clout, this is not the only reason. More insidiously, psychiatry retains influence because of the needs of the larger power structure that rules us. And perhaps most troubling, psychiatry retains influence because of us—and our increasing fears that have resulted in our expanding needs for coercion.
But before discussing these three reasons, some documentation of psychiatry’s lost scientific credibility in several critical areas.
Psychiatry’s Lost Scientific Credibility
DSM Invalidity. In 2013, the American Psychiatric Association’s diagnostic bible, the DSM, was slammed by the pillars of the psychiatry establishment. Thomas Insel, director of the National Institute of Mental Health (NIMH) and the highest U.S. governmental mental health official, offered a harsh rebuke of theDSM, announcing that the DSM’s diagnostic categories lack validity, and he stated that “NIMH will be re-orienting its research away from DSM categories.” Also in 2013, Allen Frances, the former chair of the DSM-4 taskforce, published his book, Saving Normal: An Insider's Revolt against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life.
Biochemical Imbalance Theory Debunked. It was a great surprise for NPR reporter Alix Spiegelin 2012 to discover that the psychiatric establishment now claims it has always known that the biochemical imbalance theory of depression was not true. Ronald Pies, editor-in-chief emeritus of the Psychiatric Times stated in 2011, “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.” NIMH director Insel had already told Newsweekin 2007 that depression is not caused by low levels of neurotransmitters such as serotonin. However, psychiatry made no serious attempt to publicize the fact that the research had rejected this chemical imbalance theory, a theory effectively used in commercials to sell antidepressants as correcting this chemical imbalance—an imbalance psychiatry knew did not exist.
Rethinking the Effectiveness of Antipsychotic and Antidepressant Drug Treatments. In 2013, NIMH director Insel announced that psychiatry’s standard treatment for people diagnosed with schizophrenia and other psychoses has not been helpful to many people and needs to change so as to better reflect the diversity in this population. Citing long-term treatment studies, Insel concluded that in the long-term, many individuals who have been diagnosed with psychosis actually do better without antipsychotic medication. With respect to antidepressants, “60 Minutes” in 2012 reported on what antidepressant researchers have long known: placebos do almost as well as antidepressants even in drug-company studies that are biased in favor of the antidepressants. The “60 Minutes” report focused on research psychologist Irving Kirsch who used the Freedom of Information Act to study published and nonpublished drug company studies involving 6,944 patients from the FDA database trials of the six most popular antidepressants (Prozac, Paxil, Zoloft, Effexor, Celexa, and Serzone).
Psychiatric Treatments May Cause Increased Suicide.The FDA —despite protests by the psychiatric establishment—has issued “black box warnings” about the potential for increased suicidality for patients under the age of 25 who use antidepressants. In 2014, AlterNet reported about a University of Copenhagen study comparing Danish individuals who committed suicide to matched controls between the years 1996 and 2009. The researchers found that taking psychiatric medications in a prior year was linked to a 5.8 times increase in suicide; contact with a psychiatric outpatient clinic was associated with an 8.2 times increase; visiting a psychiatric emergency room was linked to a 27.9 times increase; and admission to a psychiatric hospital was linked to a 44.3 times increase in suicide.
While correlation by itself does not necessarily mean causation, an accompanying editorial in the same journal where the article was published pointed out that associations with the features detailed in this particular study indicate a good possibility of a causal relationship. Among the reasons why psychiatric treatment could well cause increased suicide, besides the adverse effects of medication, is the stigma and trauma of treatment, as the editorial authors state: “It is therefore entirely plausible that the stigma and trauma inherent in (particularly involuntary) psychiatric treatment might, in already vulnerable individuals, contribute to some suicides.”
Creating Stigma with Biochemical Defect Theories. In the psychiatry establishment, it has long been proclaimed that framing mental illness as a brain disease or a biochemical defect would result in less stigmatization. But the Canadian Health Services Research Foundation (CHSRF), in a review of the research reported in 2012: “Despite good intentions, evidence actually shows that anti-stigma campaigns emphasizing the biological nature of mental illness have not been effective, and have often made the problem worse.” One example is a 2010 study in Psychiatry Research that reported for the general public, the acceptance of the “biogenetic model of mental illness” was associated with a desire for a greater social distance from the mentally ill. The CHSRF review states: “The evidence shows us that while the public may assign less blame to individuals for their biologically determined mental illness, the very idea that their actions may be beyond their conscious control can create fear of their unpredictability and thus the perception that those with mental illnesses are dangerous...leading to avoidance.”
Corruption of Psychiatry by Big Pharma.Big Pharma heavily funds university psychiatry departments, sponsors conferences and continuing education for psychiatrists, advertises in their professional journals, and pays well-known clinicians and researchers to be speakers and consultants. I documented in 2007 and updated in 2012 how virtually every way the public and doctors get information about mental health has been corrupted by drug company dollars. In 2008, congressional investigations of psychiatry revealed that major psychiatry institutions such as the American Psychiatric Association and several “thought leader” psychiatrists, including Harvard psychiatrist Joseph Biederman, were on the take from drug companies, creating obvious conflicts of interest and further damaging psychiatry’s credibility.
The New York Times reported the following about Biederman: “A world-renowned Harvard child psychiatrist whose work has helped fuel an explosion in the use of powerful antipsychotic medicines in children earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007”; and the Times later reported that Biederman had pitched Johnson & Johnson that his proposed research studies on its antipsychotic drug Risperdal would turn out favorably for Johnson & Johnson—and then delivered the goods. Biederman was only one of several thought leader psychiatrists exposed by congressional investigations. TheDSM diagnostic manual is published by the American Psychiatric Association (APA), and according to the journal PLOS Medicine, “69% of the DSM -5 task force members report having ties to the pharmaceutical industry.”
Why Psychiatry Retains Power Despite Lost Credibility
Drug companies need the general public to take psychiatric drug prescribers seriously, and so Big Pharma financially supports psychiatry institutions and thought leaders. And Big Pharma has huge clout over the mainstream media via the media’s dependency on Big Pharma’s advertising dollars. While Big Pharma is the most obvious reason psychiatry retains power despite a loss of scientific credibility, it may not be the most important reason. Psychiatry serves the needs of the power structure in general. And in our increasingly fear-based society, psychiatry meets our own increasing needs for coercion.
Meeting the Coercion Needs of the Power Structure
Ruling elites and power structures, from monarchies to military dictatorships to the U.S. corporatocracy, have routinely used “professionals” to control the population from rebelling against economic inequalities and social injustices so as to maintain the status quo. Power structures routinely rely on police and clergy, and today the U.S. power structure also uses mental health professionals. Medication and behavior modification treatments have been used to subvert resistance to a dehumanizing status quo, be it in a family or in the larger society. The following are a few examples of how both psychiatry and psychology have met the needs of the power structure in return for status and money.
MKULTRA: A piece of American history sounds like the rant of a crackpot conspiracy theorist but ultimately was confirmed decades later by the U.S. Congress’ Church Committee investigations, acknowledged by the U.S. Supreme Court, and documented in The Search for the "Manchurian Candidate" by former State Department officer John Marks. Ewen Cameron, president of the American Psychiatric Association in 1953, sought powerful ways to break down patient resistance, and he experimented with LSD as well as with electroshock and sensory deprivation. The CIA, under a project code-named MKULTRA, eager to learn more about Cameron’s techniques, funded him as well as other renowned psychiatrists in the 1950s and 1960s to conduct brainwashing experiments.
Assistance in Interrogation/Torture: Shortly after the tragic events of 9/11, the American Psychological Association made high-level efforts to nurture relationships with the U.S. Department of Defense, the Central Intelligence Agency, and other government agencies. As Truthout reported in 2014, the APA aimed “to position psychology and behavioral scientists as key players in U.S. counterterrorism and counterintelligence activities.” The APA not only condoned but actually applauded psychologists’ assistance in interrogation/torture in Guantánamo and elsewhere.
Subverting Resistance by U.S. Soldiers: Psychiatrists and psychologists have subverted resistance by U.S. soldiers in the wars in Iraq and Afghanistan via psychiatric drug treatments and behavioral manipulations. According to theNavy Times in 2010, one in six U.S. armed service members were taking at least one psychiatric drug, many of these medicated soldiers in combat zones. Martin Seligman, a former president of the American Psychological Association, has consulted with the U.S. Army’s Comprehensive Soldier Fitness positive psychology program (as I reported on AlterNet in 2010). Seligman achieved not only “social position and rank” for himself but several million dollars for his University of Pennsylvania Positive Psychology Center, according to the Philadelphia Inquirer, which quoted Seligman saying, “We’re after creating an indomitable military.”
Pathologizing and Medicating Noncompliance: Both psychiatrists and psychologists pathologize and medicate anti-authoritarianism and noncompliance, which I described on AlterNet in 2012. Many individuals diagnosed with mental disorders are essentially anti-authoritarians, and a potentially large army of anti-authoritarian activists are being kept off democracy battlefields by mental health professionals who have pathologized and depoliticized their pain.
Meeting Our Needs for Coercion
“It seems to me that this coercive function is what society and most people actually appreciate most about psychiatry....Psychiatry has never ever needed scientific evidence to spread its ideas and practices, and possibly never will.” —David Cohen, co-author of Mad Science.
For two years early in my career, I worked as a psychiatry emergency room therapist. I observed countless instances of police dragging agitated people into the ER who were then forcibly placed in restraints. Some of those police officers emained in the ER to watch—in both admiration and envy—to see how quickly an injection of Haldol or some other antipsychotic drug could calm the person.
All societies, communities and families coerce and control members who frighten them. However, the kinds of behavior that frightens people varies enormously, and thus what is permissible to control and coerce varies enormously. So, while it would be fairly universal for a society to coerce and control someone who is physically attacking another of its members, it is quite historically exceptional—as is done in U.S. society—to use antipsychotic drugs to subdue a bored seven-year-old who is resisting classroom controls.
In December 2012, the Archives of General Psychiatry (renamed JAMA Psychiatry) reported that, between 1993-2009, there was a seven-fold increase of children 13 years and younger being prescribed antipsychotic drugs, and that nonpsychotic conditions such as “disruptive behavior disorders” were the most common diagnoses in children medicated with antipsychotics, accounting for 63% of those medicated.
The dramatic growth of antipsychotic drugs in the United States is largely about ever-increasing societal acceptance of using drugs to control unwanted behaviors. Antipsychotics grossed over $18 billion a year in the United States by 2011, and by 2013 one antipsychotic drug, Abilify, was the highest grossing of all drugs in the United States with nearly $6.5 billion in sales. In addition to children—especially foster children—the burgeoning U.S. antipsychotic market includes the elderly in nursing homes and inmates in prisons and jails, where antipsychotic drugs are a relatively inexpensive way to subdue and more easily manage these populations.
In a 2014 article, David Cohen, in the tradition of Michel Foucault’s Madness and Civilization, updates how the societal need for psychiatry’s “extra-legal police function” compels society to be blind to psychiatry’s complete lack of scientific validity. Cohen notes: “Society’s appreciation for psychiatric coercion subtly, but radically, imbalances the playing field. Because of psychiatric coercion, society gives psychiatric theories a free pass. These theories never need to pass any rigorously devised tests (as we expect other important scientific theories to pass), they only need to be asserted.”
Thus, journalists’ continued exposure of psychiatry’s lack of science and its corruption by Big Pharma has had virtually no impact on reducing psychiatry’s influence. Substantive mental health reform will not come about unless society itself is reformed to be less fearful and less in need of controls and coercions. For example, if society could return to the idea that there are many extremely intelligent adolescents who are not “academics” and who do not need extended standard schooling but some other form of education to succeed in many occupations, then adolescent rebellion against standard schooling would not be so frightening for parents, and the compulsion to coerce and control via behavioral manipulations and psychiatric medications would disappear.
Cohen concludes, “Let’s face it: No one cares that psychiatric research of the past 50 years failed to turn up one finding of use for a scientific clinical psychiatry.”
Of course, Cohen cares, and so do all genuine scientists, but Cohen is right that as long as society needs the “extra-legal” coercion that psychiatry provides, society needs to remain in denial about the scientific illegitimacy of psychiatry. Without a decreased societal demand for coercion, psychiatry abolitionists should beware that if psychiatry ever does lose its clout, another coercive institution will likely fill the vacuum.
Bruce E. Levine, a practicing clinical psychologist, writes and speaks about how society, culture, politics and psychology intersect. His latest book is Get Up, Stand Up: Uniting Populists, Energizing the Defeated, and Battling the Corporate Elite. His web site is www.brucelevine.net