Psychiatry under the influence: institutional corruption, social injury, and prescriptions for reform

This pioneering book explores the fears many critics have felt for a long time; that all is not well in the world of psychiatry. Psychiatry Under the Influence provides one of the first critical deconstructions of the story of the American Psychiatric Association and the way in which it has been influenced by power. One of the many strengths of this book is the sheer amount of data it provides to back up its arguments. The book is written with an academic tone but is accessible to a wide range of readers as the authors are skilled at breaking down complex arguments so that they can be easily understood. It is not necessary to have prior knowledge of the topic before reading this book although the more you already know, the more interesting you may find it; it is likely to appear on future academic reading lists as a pertinent text within mental health training. The book is based upon the entwined relationships between the American Psychiatric Association, the pharmaceutical industry and the Diagnostic and Statistical Manual of Mental Disorders. In the United Kingdom and other member states of the World Health Organisation, the equivalent diagnostic manual is the International Classification of Diseases and it is directly influenced by the Diagnostic and Statistical Manual of Mental Disorders, meaning that this book has international relevance (5).

Psychiatry Under the Influence is divided into three main sections starting with how the ‘seeds of corruption’ were sown, then moving onto ‘the economies of influence’ and finishing with a ‘search for solutions’. The book begins with a brief history of the profession including an interesting look back at the theories for the aetiology of common mental disorders, exploring the divisions between psychological and psychiatric perspectives. The first edition of the Diagnostic and Statistical Manual of Mental Disorders started with the idea that ‘There was no longer a clear line that divided the mentally well from the mentally ill’ (13). This psychological (as opposed to medical) perspective assumed the cause of all non-organic mental disorders was a ‘psychological failure to adapt to one’s environment’ (13). This adjustment failure could be remedied by psychotherapy. The authors explain that this soon changed, not because of a change in data or evidence, but because of the emergence of a new theory of a chemical imbalance, one that could be remedied by the pharmaceutical industry who could ‘re-balance’ these chemicals with new medications ‘like insulin for diabetes’ (157). This concept could also be understood as ‘Pharmaceuticalisation’ which is defined as the transformation of human conditions into opportunities for pharmaceutical intervention (Williams, Martin, and Gabe 2011, 711). Although this is not explicitly labelled within the book, it is described through the collaboration of psychiatrists and pharmaceutical companies within the wider context of a neoliberal, capitalist society.

The second section of the book presents an in-depth analysis of the past 35 years within the American Psychiatric Association. This was clearly researched meticulously because it investigates the data from multiple studies and explores critical questions about the health of the research itself, such as: what level of scientific validity is needed; who decides which medications get approved; and if the data is corrupted then how does that influence ‘evidence-based medicine’ (135)? The authors do not shy away from asking these difficult questions. The third section of the book explores the ideas of social injury and iatrogenic harm and the way this could contradict non-maleficence, the oath of ‘first do no harm’. The authors argue that the corruption is not as straightforward as a lie or a mistake, it is more nuanced, an implicit bias which has infiltrated the whole system. They note the cognitive dissonance which makes it harder for those involved to recognise the corruption (183). They suggest that in order for psychiatry to heal, it needs a paradigm shift which leads a cultural and systemic change in the way we perceive and treat mental health difficulties. The prescription for reform section of the book is a good start but it perhaps needs its own book: a call to action.

The authors of Psychiatry Under the Influence are not alone in advocating for change within psychiatry. Many service users and professionals such as psychologists and social workers encourage social and psychological approaches which understand and de-medicalise distress through the lens of trauma and adversity as opposed to pathology (British Psychological Society 2014; Johnstone 2014). This approach fits with the consistent research demonstrating that childhood trauma increases the risk of developing any mental disorder (Grant and Lappin 2017). Furthermore, the United Nations recently published a report highlighting the ‘urgent need for a shift in approach’, stating that mental health policy should move away from the ‘biased use of evidence’ and should ‘target social determinants and abandon the predominant medical model’ (Puras 2017, 19). A prominent psychologist, Dr Longden, who also experiences hearing voices, says that ‘“Psychiatry should be asking what happened to you?” As opposed to “What is wrong with you?”’ (Longden 2013, 65). Perhaps this could be the philosophy for the paradigm shift psychiatry needs.

Rebecca Regler
Independent Scholar, Oxford, UK
[email protected]
© 2017 Rebecca Regler
https://doi.org/10.1080/09687599.2017.1362182