A psychiatric revolution

The historian and sociologist, Andrew Scull, muses about his studies of psychiatry over the decades in the Lancet a little over a year ago. I never saw it then. The below is an excerpt. The final paragraph is precisely what we are seeing today.

From the Lancet:

But while I was busy in the archives, the contemporary psychiatric enterprise was undergoing a transformation as dramatic and fundamental as can readily be imagined. When I began to explore its past, psychiatry, at least in its American guise, was dominated by psychoanalysis. The Freudian movement had first risen to prominence during World War II, in the treatment of “war neurosis”. Through the 1960s, its hold over the profession and the public imagination steadily grew. With scarcely an exception, the departments of psychiatry at the major medical schools were headed by psychoanalysts or psychoanalytic fellow-travellers. The “refrigerator mother” was blamed for the seeming epidemic of schizophrenia. Although Freud himself had questioned the relevance of psychoanalysis in the treatment of psychosis, his more optimistic American epigones were undeterred. If they reluctantly began to use the first generation of antipsychotic drugs, they saw them merely as useful therapeutic adjuncts to calm down florid symptomatology so that the “real” work of psychotherapy could proceed. Hollywood dramatised the miracles of the talk cure in movies like Suddenly Last Summer and I Never Promised You a Rose Garden. Anxious American parents turned to Dr Benjamin Spock for enlightenment, and were rewarded with a bowdlerised version of Freud’s theory of child development. Best-seller lists saw the appearance of pot-boilers such as Robert Lindner’s The Fifty Minute Hour, titillating the masses with tales of the secrets of the couch. Psychoanalysis ruled the roost.

And then it didn’t….

…The US National Institute of Mental Health proclaimed the 1990s “the decade of the brain”. A simplistic biological reductionism increasingly ruled the psychiatric roost. Patients and their families learned to attribute mental illness to faulty brain biochemistry, defects of dopamine, or a shortage of seratonin. It was biobabble as deeply misleading and unscientific as the psychobabble it replaced, but as marketing copy it was priceless. Meantime, the psychiatric profession was seduced and bought off with boatloads of research funding. Where once shrinks had been the most marginal of medical men, existing in a twilight zone on the margins of professional respectability, now they were the darlings of medical school deans, the millions upon millions of their grants and indirect cost recoveries helping to finance the expansion of the medical-industrial complex.

This paragraph pretty much sums up what is happening now with brilliant conciseness.

And so to scandal. He who pays the piper calls the tune, and to a quite extraordinary extent, drug money has come to dominate psychiatry. It underwrites psychiatric journals and psychiatric conferences (where the omnipresence of pharmaceutical loot startles the naive outsider). It makes psychiatric careers, and many of those whose careers it fosters become shills for their paymasters, zealously promoting lucrative off-label uses for drugs whose initial approval for prescription was awarded on quite other grounds. It ensures that when scandals surface universities will mainly turn a blind eye to the transgressions of those members of their staff who engage in these unethical practices. And it controls psychiatric knowledge in multiple ways. Its ghostwriters produce peer-reviewed “science” that surfaces in even the most prestigious journals, with the most eminent names in the field collaborating in the deception. Researchers sign confidentiality agreements, and inconvenient data never see the light of day. The very categories within which we think about cognitive and emotional troubles are manipulated and transformed to match the requirements of the psychiatric marketplace. Side-effects, even profound, permanent, perhaps fatal side-effects, are ignored or minimised. Fines may be levied when somnolent regulators are finally prompted into action, or damages paid where aggressive class action lawyers force hitherto suppressed findings into the public arena, but the profits already booked far exceed these costs of doing business. For a historian of psychiatry to live through such revolutionary times is remarkable indeed. (read the entire article) —  PDF file here

Books by Andrew Scull:


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