It has been a rough year for American psychiatry. In June 2008, Congressional investigators exposed the financial relationships between drug companies and several high-profile psychiatrists. And on July 12, 2008, the New York Times reported, "Now the profession itself is under attack in Congress," as psychiatry's premier professional organization -- the American Psychiatric Association -- was exposed as being heavily dependent on drug company money.
However, Congress and the New York Times have neglected the more significant story: The corruption of psychiatry by Big Pharma has resulted in the suppression of effective treatment options and has marginalized courageous, innovative, and non-corrupt psychiatrists.
First, a summary of the Congressional investigation of Big Pharma's corruption of psychiatry, which has been covered in a series of articles by New York Times reporters Benedict Carey and Gardiner Harris.
Congressional investigators initially focused on the financial relationships between drug companies and individual psychiatrists. One high-profile example is Joseph Biederman, about whom the New York Times reported: "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." Congressional investigators stated that Biederman and two of his colleagues in the psychiatry department at Harvard Medical School (who received an additional $2.6 million from drug companies from 2000 to 2007), by failing to report income from drug companies while at the same time receiving federal funds from the National Institutes of Health, violated rules designed to police conflicts of interest.
Congress then investigated the American Psychiatric Association, which the New York Times called "the voice of establishment psychiatry." The American Psychiatric Association is the primary lobbying organization for American psychiatry, and it also publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is the standard diagnostic manual. The New York Times reported:
"In 2006, the latest year for which numbers are available, the drug industry accounted for about 30 percent of the association's $62.5 million in financing. About half of that money went to drug advertisements in psychiatric journals and exhibits at the annual meeting, and the other half to sponsor fellowships, conferences and industry symposiums at the annual meeting."
Congressional investigators also discovered that the president-elect of the American Psychiatric Association (Alan Schatzberg of Stanford University) has $4.8 million stock holdings in a drug development company.
My hope is that Congress and the New York Times eventually get around to the more important issue of how Big Pharma corruption of psychiatry has eliminated options for people with severe emotional problems and who have been failed by establishment psychiatry.
One such option that was eliminated is Soteria House, the creation of psychiatrist Loren Mosher (1933-2004), chief of the National Institute of Mental Health's Center for the Study of Schizophrenia from 1968 to 1980. Mosher hoped to create an effective and more humane way to help psychiatry's most seriously troubled patients. Using National Institute of Mental Health funds, Mosher opened the first Soteria House in Santa Clara, California in 1971.
Mosher's Soteria House experiment is detailed by former Boston Globe reporter Robert Whitaker in Mad in America. In Soteria House, newly diagnosed schizophrenic patients lived medication-free with a young, nonprofessional staff trained to listen to and understand them and provide companionship. Mosher tested his idea that "schizophrenia can often be overcome with the help of meaningful relationships rather than with drugs, and that such treatment would eventually lead to unquestionably healthier lives."
The Soteria House experiment worked better than Mosher had expected. Over the initial six weeks, patients recovered as quickly as those treated with medication in hospitals. Whitaker notes, "Even more striking, the Soteria patients were staying well longer. Relapse rates were lower for the Soteria group at both one-year and two-year follow-ups. The Soteria patients were also functioning better socially -- better able to hold jobs and attend schools."
Mosher's success with nonprofessional caregivers and without drugs embarrassed establishment psychiatry and Big Pharma. The National Institute of Mental Health choked off Soteria House funding causing it to close down. By 1998 Mosher was so disgusted with establishment psychiatry that he wrote a widely publicized letter of resignation from the American Psychiatric Association.
Loren Mosher remains a hero for many consumer and patient rights organizations such as MindFreedom. MindFreedom does not advocate abolishing the option of drug treatment but instead advocates for truly informed choice as well as for alternatives beyond establishment psychiatric treatments -- alternatives such as Soteria House. The good news is that a new Soteria House is being created by attorney Jim Gottstein and other patient rights activists in Anchorage, Alaska.
In a genuine democracy people would be asking questions. Do Americans have mental health treatment choices that are informed choices? Why, when Big Pharma corruption has long been known, does it take Congressional investigations for the mainstream media to inform Americans of the financial relationships that drug companies have with high-profile psychiatrists and major psychiatry institutions? And most importantly, when will Americans get real choices when it comes to their mental health?
A real choice is not a choice between Prozac or Zoloft, not between Zyprexa or Risperdal. An example of a real choice is the choice between establishment psychiatry or Soteria House.
Bruce E. Levine, Ph.D., is a clinical psychologist and author of Surviving America's Depression Epidemic: How to Find Morale, Energy, and Community in a World Gone Crazy (Chelsea Green Publishing, 2007). www.brucelevine.net