On the illusions of psychiatry

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:

  1. After 1950 and especially during the 1980s, psychiatrists made a conscious effort to adopt a biological model.
  2. In so doing, psychiatry was able to claim legitimacy as a truly scientific discipline.
  3. 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.

2 thoughts on “On the illusions of psychiatry

  1. like many opinionated generalizations, this is flat-out wrong. like many macro claims, this one often fails at micro levels. i need one counter-example to prove that the proposition is not true: me.

    i have been treated for lifelong major depression for 33 of my 60+ years. i’m still moderately to severely depressed most every day. if i stop my meds, i go into crisis in about two weeks’ time. i’ve had 12 years of talk-therapy; it took 4 years to find relief, but it didn’t last. i’ve had 20 years of drug therapy; i obtained total relief in 4 days the first time, but it didn’t last. i’ve gone through long periods of vigorous exercise; it gives me relief for about an hour afterward if and only if i exercise hard and long enough, not otherwise. my father, who had even worse depression, had ECT under a world-famous psychiatrist; it didn’t last, and he lost his short-term memory.

    i am no friend of big pharma of corporatism. i’ve tried most of BP’s products for depression – anti-depressants, anti-anxieties, mood stabilizers, some anti-psychotics. some helped a little or for awhile; some had no discernible effect. some regimens cost $4 a month. some cost $900 a month. that is an outrageous state in which to live an ethical life.

    you have publicized incorrect generalizations that may be harmful to some of your audience, if not dangerous, based on your self-reporting or the experiences of others known to you. please stop.

    you now have at least one counter-example, but there are many others in similar or much worse situations. thank the gods that i’ve never been suicidal.

    BTW, i love your website and career strategy.


    1. I’m sorry to hear about your difficulties, M. It sounds as though things have not been easy.

      I’m a little confused, though, about your qualms with the generalizations. To begin with, I’m simply summarizing an article. Second, the author–so far as I’m aware–doesn’t dismiss drug therapy. Her case is only that drug therapy has been over-applied: too many people, too indiscriminately in too many cases. I’m also not an opponent to the use of drug therapy in cases where the causes are biological and chemical and for individuals where the evidence suggests that it does help. Hopefully, my reply to your excellent objection clarifies where the author stands and, more importantly, where I stand.

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