This month’s Lancet contains a short, romping, and highly readable essay on the history of psychiatry. It’s written by Andrew Scull, professor of sociology at the University of California, San Diego, who has steeped himself in the topic for four decades.
Scull talks about how psychiatry has revolutionized itself during the span of his career. The Freudian movement dominated the field through the 1960s — a period, he notes, when mental illnesses like schizophrenia were often attributed to such now discredited causes as the “refrigerator mother.”
Then, “more swiftly and silently than the Cheshire cat, psychoanalytic hegemony vanished,” writes Scull. Its replacement: drugs, the “new Holy Grail of the profession.”
But has this Holy Grail turned out to be yet another false icon? Here’s Scull’s scathing conclusion:
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.
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.