As a Whorfian, who believes that the language we use to describe it shapes our thought about any endeavor, I have often written about the profound impact of the diagnostic system used in psychiatry, codified in the ‘bible’ (or perhaps it would be more apt to say ‘Chinese restaurant menu’) called the DSM (Diagnostic and Statistical Manual). Among other things, it cements the hegemony of the biological psychiatrists over the mental health field. Now a new study (by a non-psychiatrist, a clinical psychologist) reveals that “every psychiatric expert involved in writing the standard diagnostic criteria for disorders such as depression and schizophrenia has had financial ties to drug companies that sell medications for those illnesses”. The study dovetails my concern with classificatory schemes to another of my rants about modern psychiatry — how it is in the hip pocket of the pharmaceutical industry’s profit machine.
But it is not as if Big Pharma planted its hired guns on the DSM authorship committee to do its bidding, and the study does not establish whether the experts’ financial ties to the industry predated and shaped their involvement in the DSM or resulted from their visibility and achievement. I think it is more likely the latter. The psychotropic drug manufacturers tend to offer their perks — paid speaking engagements, research and consulting contracts — to established authorities in the field. For example, Eli Lily would be interested in subsidizing psychiatrists whose research serves its interests, such as someone who supports the notion that certain premenstrual problems deserve codification as psychaitric disorders when it is interested in using its drug Prozac to treat those disorders. Given that corporate penetration into psychiatric nosology has grown explosively in the past two decades or so, the planned fifth revision of the DSM due out in around five years will be the first to be appreciably tainted by this issue. The American Psychiatric Association (publisher of the DSM)’s decision to require its authors to disclose their financial ties, if there is any honesty about those disclosures, should at least answer the chicken-and-egg question of whether industry subsidy is in place at the time of a psychiatrist’s contribution to the DSM.
The weaker dismissal of concern, such as influential psychiatrist John Kane’s comment that the work of his subpanel on schizophrenia was driven only by science —
— is embarrassing. given that behavioral science research design goes to such lengths to eliminate subtle unconscious biases that shape outcomes. Perhaps it should be seen as the effort to drive the final nail into the coffin of the psychoanalytic roots of psychiatry, Freud’s notion of the mysterious and opaque power of unconscious processes?
Kane and others suggest that the mere revelation of financial ties should not undermine the public’s confidence in psychiatry. In a sense he is right; confidence has long ago been undermined. This, however, may be one of the last straws. Psychiatric care is about helping patietns to take appropriate responsibility for their actions. Physician, heal thyself.
