On the illusions of psychiatry
by Andrew Taggart
In this 2nd piece of a 2-part series on the history and practice of psychiatry, Marcia Angell critically examines the players and forces behind psychiatry’s cozy relationship with big pharma. She argues:
- After 1950 and especially during the 1980s, psychiatrists made a conscious effort to adopt a biological model.
- In so doing, psychiatry was able to claim legitimacy as a truly scientific discipline.
- 1. and 2. led, in turn, to psychiatry’s willingness to work with, and benefit from, big pharma.
In essence, we can chart the shift from talk therapy to drug therapy over the past 30 years. The pivot point, according to Angell, is the introduction of DSM-III in 1980. (DSM-V is set to appear some time in 2013.). The piece ends–this is the penultimate paragraph–on this cautionary note:
At the very least, we need to stop thinking of psychoactive drugs as the best, and often the only, treatment for mental illness or emotional distress. Both psychotherapy and exercise have been shown to be as effective as drugs for depression, and their effects are longer-lasting, but unfortunately, there is no industry to push these alternatives and Americans have come to believe that pills must be more potent. More research is needed to study alternatives to psychoactive drugs, and the results should be included in medical education.
Addendum (6/22/11 – afternoon)
A few readers have voiced objections (one is included in the comments section below) to the effect that drug therapy can be and has been effective in the treatment of certain types of mental illness. I wouldn’t disagree. The evidence on this score is clear enough. I take Angell’s point to be one about “hubris”: psychiatry moving away from an art–seeing this person in these terms in this case with these needs–and has fancied itself a science–diagnosing according to pat criteria (DSM), overprescribing medicine, not taking responsibility when appropriate, too often profiting from its close working relationship with the pharmaceutical industry. The case I’d make is that moderation, measure, and reflection are well past due.
In short, let’s not throw drug treatment out the window; let’s simply put it next to other treatments that may also be as effective, if not more effective.