say no to psychiatry foundation for truth in reality

Psychiatry and the
Psycho-Pharmaceutical Complex

This article discusses the relationship of psychiatry with the Drug Industry. Psychiatry is only one segment of the field of "medicine", and similar relationships, alliances and collusion can also be found in the areas of cancer, AIDS, and "medicine" in general. The Drug Industry is an international power spanning the planet which controls and directs the philosophy, education, studies, research and methods of the entire modern field of "medicine". The modern medical viewpoint of drugs and surgery originated in Germany, as also did modern psychology and the drug industry itself.

It acts as a monopoly, and as such, intends and actively ensures that it remains the "only show in town". It's motive is power and money, and never has been "health", "truth", "curing disease" or any other benevolent notion. As an arm of a larger power structure, comprised of a handful of incredibly powerful members and groups (the international banking elite - who own and control the drug companies), psychiatry may serve another more insidious purpose - the eventual drugging and psychosocial control of entire nations.

There are numerous relationships and connections between the drug companies (both national and international), IG Farben (a mammoth German drug company with numerous cartel agreements throughout the world), FDA (Food and Drug Administration), AMA (American Medical Association), APA (American Psychiatric Association), various "professional" journals and publications, research companies and organizations, philanthropic foundations, government organizations (NIMH - National Institutes of Mental Health), international organizations (WHO - World Health Organization) and the medical schools. The common factor in each is the presence of representatives of the "drug" approach to handling "illness". The drug companies are at the "top" of the hierarchy and they call the shots. Why? Because they are the source of the funding in all cases. He who pays the piper calls the tune.

This is difficult for most people to accept because "modern medicine" is a major social institution which we all naturally assume to be directed by the human values of "honesty", "decency", and "a sincere intetnion to help". Sadly, this is just not the way it is. It hasn't been that way for at least 100 years.

While some aspects of modern medicine do appear to "help", this is not so with psychiatry, whose sole methods of addressing human problems is force. Physical force in the form of involuntary commitment, lobotomy (brain surgery), straight jackets and restraints; electrical force in the form of electric shock treatments; and chemical force in the form of addictive and damaging psychotropic drugs.

(This is taken from Chapter 15 of Peter Breggin's book, Toxic Psychiatry.)

The contacts of psychiatry with the pharmaceutical industry have been so overwhelmingly beneficial that it would be well-nigh criminal to jeopardize them. - Psychiatrist and psychopharmacologist Nathan S. Kline

"In Bed Together at the Market: Psychiatry and the Pharmaceutical Industry - Title of an editorial by Matthew Dumont, M.D., in the American Journal of Orthopsychiatry, October 1990

As we saw in chapter 11, Upjohn produces the most frequently prescribed minor tranquilizer, Xanax. Despite its drawbacks and dangers Xanax recently became the first drug to win approval from the FDA for use in so-called panic disorder or recurrent anxiety. Since panic disorder is a faddish diagnosis among psychiatrists and patients, this FDA imprimatur is worth a fortune. How did this happen? The previously untold story of how Upjohn has curried favor with organized psychiatry provides a model for understanding what I call the psycho-pharmaceutical complex.

The American Psychiatric Association

The best way to influence psychiatry is to earn the goodwill of the American Psychiatric Association. APA represents more than thirty-five tlousand of the approximately forty-thousand American psychiatrists. In recent years APA has developed legislative and promotional departments to increase the power and influence of psychiatry. It spends money to win over the public, the press, and state and federal governments. As we have seen, it periodically issues task force reports on such subjects as shock treatment and tardive dyskinesia, formulating the conclusions to support the profession against lawsuits, public criticism, and nonmedical competition. The task forces that deal with treatment never include skeptics or even mild critics. APA publishes journals and a newspaper which usually support a biopsychiatric orientation.

APA and the Pharmaceutical Industry

The drug companies provide the backbone of financial support for APA and for most of organized psychiatry. The psychiatric newspapers and journals, including those published by APA, are largely paid for by drug company advertising. In 1987, for example, the APA newspaper Psychiatric News had a surplus of $1,311,554, largely the result of drug ads. In recent years, according to its annual reports published each October in the American Journal of Psychiatry, 15 to 20 percent of APA's total revenue has come from drug company advertising.

That 15 to 20 percent is but the tip of the pharmaceutical iceberg. APA's national conferences are underwritten by drug company monies to the tune of several million dollars a year. They literally could not take place without the drug company booths and drug company-sponsored seminars and entertainment. The drug companies also support special political projects, such as APA's annual meetings on how to lobby for favorable legislation. They underwrite conferences in which biopsychiatric leaders get together and promote themselves as well as drug products. The "President's Fund," the APA Auxiliary, and even individual psychiatrists on fellowships at the national headquarters are supported by drug company funds.

Of course, as physician Stanley Wohl points out in The Medical Industrial Complex (1984), organized medicine in general is underwritten by the drug companies. This was recognized even earlier by Morton Mintz in The Therapeutic Nightmare (1965), when he excoriated the American Psychiatric Association for failing to speak out "on the abuses of Psychiatric drugs, abuses affecting millions." And this was before the plague of tardive dyskinesia had been discovered.

While it's true that the American Medical Association collects its own unholy share of drug company funds, there is something even more insidious about APA's ties to the pharmaceutical houses. First, it is more ultimate and more thorough. Second, the "illnesses" being treated with drugs are not, in reality, diseases. Third, the APA-drug company collusion sponsors a very narrow band of approaches, namely the psychoactive drugs and shock treatment, which also requires the use of medications. And finally, while many medical drugs have great worth, psychiatric ones have few redeeming features.

If any picture is worth a thousand words, it is the photograph of a smiling APA president Robert Pasnau on the front page of the January 2, 1987, Psychiatric News. The caption explains that Pasnau is taking a check for an unspecified amount from a representative of Smith Kline and French, who is smiling even more broadly than the APA president. More significant than the check itself, the transaction took place at the annual meeting of the APA board of trustees; not even the deepest recesses of the association are off limits to influence peddling.

APA and the Upjohn Company

The Upjohn Company manufactures and sells only two psychiatric drugs, the minor tranquilizers Halcion and Xanax. Both are noteworthy in being short-acting and therefore highly addictive, and both have drawn more than their share of adverse publicity in the media for their dangerous side effects, including mental dysfunction and death (see chapter 11). But Upjohn spends multimillions to guarantee that its two products are well received by psychiatry.

The April 3, 1987, Psychiatric News reports that APA held a Public Affairs Institute, a conference on how to get more influence, money, and patients for psychiatry. It was underwritten by several drug companies, including Upjohn. Upjohn produced an expensive 35-mm slide show used by psychiatrists to woo referrals from other doctors. As a part of the same outreach PR program, APA's Division of Public Affairs created a calendar with cartoons aimed at helping psychiatrists relate to the colleagues who might refer patients to them. The calendar was produced by Upjohn.

APA president Pasnau then sent out a letter on May 4, 1987, to all APA members telling them about the calendar and making it easy for them to meet with the Upjohn sales representatives in order to get it:

Soon, your local Upjohn Representative will call on you to deliver your free copy of the calendar, which supports my presidential theme, "Psychiatry in Medicine/Medicine in Psychiatry.". . . For your convenience in establishing a suitable meeting date with your Upjohn Representative, I have enclosed a self-addressed, stamped postcard.

It is astonishing that Pasnau, in his official capacity as APA president, could affront the principles of conflict of interest by serving a company's interests in this manner. It indicates the degree to which organized psychiatry has come to accept this kind of back scratching as routine business. Following the 1988 APA national convention, now former APA president Pasnau sent out a twenty-page expensively packaged glossy booklet on Consequences of Anxiety. In the letter to all APA members, written by Pasnau as professor of psychiatry at UCLA, he boasted that three breakfast symposia on anxiety at the recent national convention had drawn more than twelve hundred psychiatrists. The free events were sponsored by UCLA with financial support from Pasnau's old friend, the Upjohn Company. The fancy booklet itself was "made possible by an educational grant from The Upjohn Company."

Upjohn also pays for something called the Anxiety Disorders Resource Center, "as a service to science writers." An August 1987 press release from the center is written by professor of psychiatry Arthur Rifkin, who states that panic attacks "have been solidly related to biological or genetic factors." As a treatment for panic attacks Rifkin, not surprisingly, singles out an Upjohn product, alprazolam (Xanax), from among the many available and mostly interchangeable minor tranquilizers. He makes the nearly miraculous claim that the drug "completely eliminated panic attacks in 85% of a group of 27 patients"; but we can't corroborate his statement, because he does not identify the study.

The editorial board of the center includes such biopsychiatric luminaries as former NIMH director Gerald Klerman and drug advocate Donald Klein, director of research at the New York State Psychiatric Institute. Presumably these individuals are compensated for their services.

Following their seminars on anxiety at the 1988 APA national meeting, Upjohn sent out still another promotional packet for its medication. The package, sent to all thirty-five thousand APA members, came with a "Dear Colleague" letter from two former directors of NIMH, Shervert Frazier and Gerald Klerman. Frazier and Klerman, two leading psychiatrists, co-chaired the Upjohn-sponsored APA workshop. The large envelope contained four glossy reprints of articles favorable toward Xanax as well as an eighteen-page booklet with many charts.(1)

Upjohn continues to cement its financial relationship with APA. The January 20, 1989, issue of Psychiatric News reports:

A recent $1.5 million agreement between APA and the Upjohn Company will bear fruit in the form of three public audience mental illness videos, a new medical education workshop for nonpsychiatric physicians and health-care gatekeepers, an exhibit and symposia program that will reach out to other medical specialty societies, and faculty support for the 1989 APA Public Affairs Network Institute.

On top of all this, Upjohn advertises heavily in APA and other medical and psychiatric publications.

Upjohn Pays Top Dollar for a Psychiatrist

Upjohn's Xanax is probably the most addictive drug commonly used in the United States today, by one estimate causing 1.5 million addictions a year (see chapter 11). As suggested in chapter II, the Xanax studies that led to FDA approval for panic disorder should have led instead to its rejection as a treatment. The investigations showed that the main effect of the drug is sedation and that it produces many alcohol-like side effects, such as slurred speech and impaired coordination, as well as a withdrawal syndrome similar to that following chronic alcohol abuse. Moreover, the overall results of the eight-week drug trial were so negative (placebo did better) that Upjohn ended up citing only the first four weeks of the trial in its advertising. Despite the short trial period, most of the patients had withdrawal problems getting off the drug, including a worsening of anxiety.

In late 1990 Upjohn nonetheless got FDA approval. The key figure in promoting the Xanax studies does not appear among the long lists of official investigators. He is Gerald Klerman,(2) former director of NIMH (1971 to 1975) and former director of the superstructure that includes NIMH and NIDA, the Alcohol, Drug Abuse, and Mental Health Administration (ADA, MHA) (1977 to 1980). Klerman is now professor of psychiatry at Cornell University. This is the same man who was associated with Upjohn projects as an editorial board member of the company's Anxiety Disorders Resource Center and as an expert at Upjohn-sponsored seminars at the annual meetings of the APA.

Years earlier Klerman was responsible for the badly flawed NIMH studies that led the profession and the public mistakenly to believe that neuroleptics have a specifically helpful impact on the symptoms of socalled schizophrenia, such as delusions and hallucinations (see chapter 3). Now Klerman was hired by Upjohn to organize and promote the Xanax studies required by the FDA.

Klerman wrote a lengthy introductory statement to the FDA Xanax studies in the May 1988 Archives of General Psychiatry describing the apparent great lengths to which Upjohn had gone in order to guarantee objectivity and high scientific quality. Entitled "Overview of the Cross-National Collaborative Panic Study," Klerman's report is really an unqualified, enthusiastic endorsement of both Upjohn and its studies. What the reader has no way of knowing is that it was a paid endorsement in the sense that Klerman is a highly paid consultant to Upjohn. The only credential listed by Klerman in the appropriate footnote at the beginning of the article is his affiliation with Cornell University Medical School. There is no mention of his financial arrangements or his longstanding relationship with Upjohn. Within the article itself, however, there is a passing mention of "G.L.K." (Klerman) as one of three members of a "steering committee" for the Xanax project.

It was rumored from several professional sources that Kierman was paid $1 million by Upjohn for his role in the Xanax panic disorder studies required by the FDA. Klerman himself, in a lengthy telephone interview with me on January 8, 1991, specifically denied that he had been paid "anywhere near a million dollars" but refused to divulge the actual figure. He explained that the rules at Cornell University, where he has been a professor for several years, specify that faculty members are allowed to work only one day per week as outside consultants. He said that he has had an "ongoing" relationship as a consultant to Upjohn for "no more than one day a week" since 1982 or 1983, and that he was hired specifically to help develop the overall package of Xanax studies for FDA approval.

Klerman at first said to me that he had identified himself as a paid consultant to Upjohn in the Archives report, but on reflection he decided he has begun to do so only more recently. Klerman said, however, that he had "never hidden" his relationship to Upjohn. Nonetheless, as late as July 1989 Klerman defended the Xanax studies in a lengthy letter published in the Archives without mentioning the existence of his ongoing financial agreement with Upjohn. Klerman sees no inherent conflict of interest in his role and defends it on the grounds that "our society" wants drugs and other medical therapies developed "in the private sector governed by the profit motive."

Klerman's introductory assessment of the Xanax studies in the Archives of General Psychiatry is especially important because his stance is that of a disinterested scientist writing a report in a medical journal. Since he is not listed as one of the actual participants in the drug studies, the reader gets the impression that this well-known psychopharmacologist, professor, and former director of NIMH and ADAMHA, is lending his independent, objective support to the research and its conclusions. Indeed, I have spoken to well-informed researchers who to this day know nothing about Klerman being on the Upjohn payroll.

Klerman remains one of America's most esteemed psychiatrists. The American Psychiatric Association awarded him its 1990 Distinguished Service Award.

The good-old-boy network that connects medicine in general to the pharmaceutical industry is illustrated again by Upjohn, whose chief executive officer, president, and board chairman is Theodore Cooper. Cooper is former assistant secretary for health in the Department of Health, Education and Welfare (DHEW) and former dean of Cornell Medical School. Klerman attributes to Cooper, a fellow physician, what Klerman calls the company's "progressive" attitude in utilizing consultants like himself.

The May 18, 1990, American Medical News, put out by the AMA, reports that Upjohn's first-quarter earnings increased 10 percent to $114 million on sales of $773 million.

Upjohn and the Archives

But what about the journal itself in which the studies were published? Could Upjohn money have reached into the Archives of General Psychiatry as well? In fact, Upjohn money greased the biggest wheel of all at the Archives, psychiatrist Daniel X. Freedman, its editor in chief for the past twenty years. Fifteen years earlier, when the first report on the seriousness of the tardive dyskinesia epidemic had come out in the 1973 Archives, Freedman had appended a most unusual editorial, warning people not to exaggerate the importance of the drug-induced disease or to allow the negative publicity to interfere with the federal funding of psychiatry. Now in 1988 Freedman took on a remarkable dual role: editor of the journal publishing the Upjohn-sponsored Xanax studies and paid consultant to Upjohn as chairman of the company's oversight committee supervising "ethical and safety issues" in regard to the studies.

In an "Editorial Note" at the conclusion of Klerman's report on Xanax, Freedman informs us that his self-described role as consultant and assistant to the "Division of Medical Affairs of the Upjohn Company" in no way influenced the journal's handling of the papers. But psychiatrist Isaac M. Marks of the Institute of Psychiatry in London believes otherwise. Marks is one of the world's most respected researchers in the field of anxiety and drugs, and indeed, a book and an article of his are cited in Klerman's report. He is the senior author of the letter written by the international group of eleven psychiatrists and psychologists to the Archives in July 1989 in criticism of the Xanax studies (see chapter 11). In a telephone interview with me in January 1991, Marks said that Freedman had tried to obstruct publication of the letter in his journal. According to Marks, at first Freedman refused to look at the letter and later turned it down, despite its distinguished group authorship. When Marks called to find out what the problem might be, Freedman's secretary informed him that the margin settings were not standard and that the names of all eleven authors did not appear on the same page. Freedman then wrote a letter to Marks that Marks characterized as "insulting" in tone. The letter attempted to discredit the criticism made by the experts. After that Freedman refused to publish the most important part of the letter, what Marks called a "damning table" showing that Xanax was "almost ineffective" at eight weeks. Publication of the letter was delayed until fourteen months after the original article, significantly reducing its impact.

Freedman himself has his own version of the story surrounding the publication of the letter and an entirely different viewpoint on the overall relationship between drug company money and drug company influence. In a February 27, 1991, interview with me, Freedman stated that the "damning table" had not been included in the original letter received from Marks; but Freedman could not explain why the table was not included for publication along with the letter when the alleged mistake was corrected by Marks months ahead of the publication date. He emphatically denied obstructing publication of the letter and dismissed Marks as a "complainer."(3)

Freedman rejected as unfounded any skepticism about his own dual role as a consultant to Upjohn and editor in chief of the journal publishing the Upjohn-sponsored research. At first he said he wrote the editorial note mentioning his business relationship to Upjohn in order to avoid any "appearance of conflict of interest"; but then he denied there was even an appearance. He is a "scientist," he said, and "the three P's in science are far more powerful and compelling than money." The three "P's," he explained, "are priority, prestige, and publicity."(4) While he admitted to being a paid consultant to Upjohn for three years during the Xanax studies, the amount of money involved, he said, was "trivial" compared to his overall income. He would not, however, venture to estimate the amount he was paid or the percentage of his income it represented.

I pointed out to Freedman that the 1988 Archives publication on the efficacy of Xanax - under his editorship - seemed misleading because the introductory abstract described only the more encouraging first four weeks of the study without even mentioning that it had gone on for an additional month with much less promising results. Freedman replied that he was sure there was no intention to mislead anyone; but he could not explain how or why the abstract had been written in that manner. He ridiculed the idea that readers of the journal might sometimes rely on the abstract without studying the complete text. Then, as if to exonerate his journal, he reminded me that the FDA had approved the drug.

During the interview, without personally criticizing me, Freedman applied the labels "Marxist" and "paranoid" to concerns about drug company influence over research. He felt that Upjohn should be praised for establishing the oversight committee that he chaired. Overall, Freedman believes that the funds pumped into the psychiatric profession by drug companies such as Upjohn do not encourage any bias on the part of investigators or psychiatry in general.

APA joins the Xanax Celebration

Given Upjohn's bountiful financing of the American Psychiatric Association, it's no surprise that the January 4, 1991, issue of Psychiatric News describes the approval of Xanax for panic disorder in terms at least as laudatory as the drug company's own advertising. The drug is reported effective at four weeks. No mention is made of the fact that the study went eight weeks. The thousands of psychiatrists who regularly read the APA newspaper would have no idea that the drug became ineffective within eight weeks and, compared to placebo, produced many severe side effects, including an increase in anxiety and panic. Gerald Klerman is cited as calling for gradual drug reduction in order to avoid withdrawal symptoms, but the study itself shows that this was of little or no help. Klerman is described as a "researcher" and not as a paid employee of Upjohn.

The Xanax Doctors Are Not Alone

I had the opportunity to discuss the funding of the Xanax doctors with a nationally known American psychopharmacologist,(5) who freely admitted to receiving money from another pharmaceutical company with with a competing product. Somewhat defensively, he told me, "I believe it's okay to take the money, but I speak the facts as I see them." He explained about psychopharmacology researchers in general: "We're all supported by somebody. The question is how much do you let it blur your judgment." He went to great lengths to explain to me that the payments he received did not affect his views on the drug; and yet throughout the conversation he minimized the dangerousness of his product while freely discussing the negative effects of its competitors. Indeed, one of his research reviews concludes with several paragraphs of near idolatrous praise for his patron drug company's product, and as usual, there's no footnote to indicate that he is a paid consultant to the company.

Nonetheless, this psychopharmacologist was critical of others in his field for their excessive devotion to the products of their sponsors. "Listen, I'll tell you that 'my drug' isn't always the best choice, but he [a Xanax study author] acts as if his drug is the only one. He gives lectures on how Xanax isn't anywhere near as addictive as it really is."

The psychopharmacologist went on to describe professional conferences as competitions at which the various doctors take sides on behalf of their patron drug companies. One expert would be defending Xanax while another was promoting Valium or BuSpar, and each was known to be a paid consultant to the respective drug company.

An extremely well known European psychiatrist and psychopharmacologist (who asked not to be named) told me that Upjohn "paid tens of millions of dollars" worldwide in consulting fees, honoraria, research grants, and gifts to influence psychiatrists around the world in order to affect the outcome of the Xanax studies and their reception by the profession. "Money talks," he said, adding that sometimes it seemed as if "the entire profession was working for Upjohn in one way or another." Nonetheless, he said that Upjohn's spending spree, while perhaps more extreme than many other pharmaceutical companies, is typical of drug company sponsorship of psychiatry and psychopharmacology.

Upjohn Is Not Alone

Most pharmaceutical firms that produce psychiatric medications are much larger than Upjohn and some very likely spend even more on making friends with the profession. Companies that help to support psychiatry include Smith Kline and French Laboratories, Mead Johnson (a Bristol-Meyers company), Dorsey (a division of Sandoz), Merrell Dow, Roerig (a division of Pfizer), Ives Laboratories, ER Squibb and Sons, Dista Products (a division of Ell Lilly), Boots Pharmaceuticals, Burroughs Wellcome, and Lederle Laboratories. In defense of Upjohn, Klerman cites Mead Johnson as an example of other companies that also spend lavishly on the psychiatric community. Not surprisingly, Mead Johnson is a competitor to Klerman's patron company. It makes the minor tranquilizer BuSpar as well as an antidepressant.

APA Decides to Take From the Drug Companies

The American Psychiatric Association's governing body made a conscious decision to rely more heavily on drug company funding for its activities, and that decision most likely influenced individual doctors to line up as well for the handouts. In the early 1970s APA was in financial trouble. It was losing membership and its total income was $2 to $4 million per year, compared to its current income of over $21 million. The newspapers and journals were operating in the red instead of generating huge surpluses through drug company advertising. In general psychiatry was losing badly in the competition with psychologists, social workers, counselors, family therapists, and other nonmedical professionals who charge lower fees for psychotherapy patients. Psychiatric journals and newspapers were filled with gloom, lamenting that psychiatrists could no longer easily fill their workweeks. At the same time, psychiatry was coming under increasing criticism about psychosurgery, electroshock, and the newly publicized drug-induced disease, tardive dyskinesia.

A turning point was the conflict over whether or not to divest from drug company influence. In April 1974 the American Journal of Psychiatry reported that "the matter of APA's relationship with industry, especially the pharmaceutical companies, was becoming a concern for some members of the board of trustees, who felt that "APA's relationships with pharmaceutical companies were going beyond the bounds of professionalism, were compromising our principles, and in some instances were involving members in conflicts of interest." These doubts were being raised about a degree of involvement that looks petty by today's standards.

In response to the doubters, APA formed the Task Force to Study the Impact of the Potential Loss of Pharmaceutical Support. Its very title suggests the fear that independence from the drug companies struck in the hearts of the leadership. The task force concluded that many local APA member organizations as well as various training programs would fold without the "lifeblood" support of the drug companies. Continued support for seminars at the national conventions also was found acceptable, provided that it was not credited directly to individual drug companies.

The floodgates of drug company influence were opened and would grow wider each year. Nowadays dozens of seminars are supported by the drug companies, and the individual names of the companies are honored conspicuously with advertisements in psychiatric journals and newspapers prior to the meetings

A lonely voice, Robert Seidenberg, clinical professor of psychiatry at the State University of New York, Upstate Medical Center in Syracuse, protested the APA's decision to cozy up to the drug companies in a November 2, 1979, letter to Psychiatric News. He calls the policy of drug company dependence "the nadir of ethical behavior."

Still struggling to make ends meet, in 1980 the APA board of directors threw ethical caution to the winds and "voted to encourage pharmaceutical companies to support scientific or cultural activities rather than strictly social activities as a part of the Annual Meeting program. . . . " In other words, give us more than coffee and entertainment; give direct support to our major professional and scientific activities.

In the following years, APA went on to develop a Political Action Committee (PAC) and special departments aimed at influencing Congress, state legislators, the media, and the public to hold psychiatry in higher esteem and to support its economic interests. Many of these promotional efforts are now supported by drug companies.

Some of the motivation for psychiatry's new political thrust was expressed by the speaker-elect in his report published in the October 1984 issue of the American Journal of Psychiatry. The PAC, he tries to explain, was not "buying votes," but trying to better public policy. Meanwhile, he compares the rivalry between psychiatrists and psychologists to Star Wars, lamenting "an oversupply of competitive practitioners" that resulted in "a galaxy of turf wars."

Whatever function APA had ever fulfilled as a professional organization was now superseded by its function as political advocate for the advancement of psychiatric and pharmaceutical business interests. Continually reiterated is the conviction that only a medical or biological image can enable psychiatry to compete economically.

Protesting the Selling of Psychiatry

As organized psychiatry and individual leaders in psychiatry became increasingly intimate with the drug companies, a few voices of concern were expressed within the establishment. In the October 1984 American Journal of Psychiatry the APA speaker-elect, Fred Gottlieb, entitled his report ironically, "Better Living Through Chemistry: Industry Money for Education and Amenities." In it he notes that APA's Scientific Program Committee had written recently to the APA president about drug cornpany influence on scientific programming. The committee questioned drug company funding of many aspects of the national conferences, including payment to members who participate in drug company-sponsored events.

Gottlieb cited research demonstrating "the powerful influence of commercial [drug company] sources on the non-rational prescribing behavior of physicians." In taking money from the pharmaceutical industry, he pointed out, "Our inherent conflict of interest is obvious" (p. 1333).

Gottlieb went on to subtitle one of his commentaries "Implications of APA's Expanded Funding Sources: He Who Pays the Piper . . . You Can't Have Your Cake and . . . or Can You, With Continuing Vigilance?" He declares, "The issue is to make sure such conflicts of interest are not hidden but are openly and carefully examined, as well as kept to a minimum" (p. 1333).

One year later, in October 1985 Gottlieb continued his warnings in his speaker's report. He says he previously "wrote about the millions of dollars of drug house money we receive annually from advertising and commercial exhibits and for awarded lectureships and social functions." Now he has been "startled to learn that our [APA] Federal Legislative Institute is similarly supported." He explains:

I do not suggest that either they [the drug companies] or we are evil folks. But I continue to believe that accepting such money is, in the long run, inimical to our independent functioning. We have evolved a somewhat casual and quite cordial relationship with the drug houses, taking their money readily.... We seem to discount available data that drug advertising promotes irrational prescribing practices. We seem to think that we as psychiatrists are immune from the kinds of unconscious emotional bias in favor of those who are overtly friendly toward us.... We persist in ignoring an inherent conflict of interest. (P. 1248)

Gottlieb voices regret over the APA's use of a Political Action Committee on the grounds that PACs serve a narrow self-interest rather than the long-range good of the profession or the public.

While Gottlieb was a significant voice of protest, the 1985 annual report makes clear that the APA board of directors has launched itself headlong into the era of dependency on the drug companies. It authorizes accepting money from a drug company to support subscriptions for one of its journals and most incredibly tightens up its policy on giving members information on financial and budget matters, including "pharmaceutical industry support" (p. 1247). Indeed, such information became and remains largely unavailable. The board also voted to hire a "marketing" consultant at $150,000 per year.

Gofflieb's concerns were steamrollered by APA leadership - no further criticisms were made by APA officials in following years, and drug company dependence has grown ever more rapidly. So has the APA policy of financial aggrandizement. The motivation was made clear in the report by treasurer George Pollock in the October 1986 American Journal of Psychiatry. He warns that "the national economy has placed pressure on APA through the field of psychiatry as a whole as well as through our individual members." The treasurer then unabashedly declares, "In fact, the field of psychiatry has become an economically driven profession" (p. 1 340).

The "economically driven profession" now devoted increased expenditures for "various economic affairs," including "government relations, public affairs, and education," always with a biopsychiatric thrust aimed at regaining dominance in the mental health field. One direct result has been the swell of positive media coverage in response to pronouncements from APA and NIMH about alleged breakthroughs in biopsychiatry. Another has been increased federal support for psychiatry. While other federal budgets are being cut, NIMH's has again been growing. Still another is the public's growing acceptance of catchword phrases like biochemical imbalance and genetic predisposition.

A Drug Company Circus

By 1987 the APA annual meeting had become a drug company circus.(6) Everywhere one turned there was drug company sponsorship. The Daily Bulletin for the conference was provided by one drug company and the "Message and Information Locator" by another. Even the shiny silver package of registration materials handed to each participant was marked "Provided by a grant from McNeil Pharmaceuticals, makers of Haldol (haloperidol) Decanoate." The CME seminars, where APA members can obtain their required continuing medical education credits, were credited as being supported by the drug companies. One irate psychiatrist, H. Steven Moffic, wrote to Psychiatric News on June 19, 1987, suggesting that APA was beginning to stand for the "American Psychopharmaceutical Association."

Psychiatrist Loren Mosher wrote an unpublished letter in August 1987 to APA treasurer Alan Levenson in reflection on his membership. Mosher observed about APA:

Its dependence on drug company support for its annual meeting, journals, newspaper and organization itself has reached, as far as I'm concerned, an unacceptable level. This organizational behavior is leading psychiatrists to be perceived by outsiders as principally prescription writers. The narrowing of our professional role that occurs in part as a result of dependence on drug company money will, I believe, be harmful to the profession in the long run. Hence, I believe APA's policies with regard to accepting drug company money should be changed. At the very least the membership should receive a complete accounting of drug company income and how it is expended.

That accounting of drug company influence has never been given. Nor will it ever be - without the intervention of Congress or the courts.

Debating the APA President on Oprah

Psychiatry's contempt for conflict of interest was brought home to me when I debated APA president-elect Paul Fink on television on the "Oprah Winfrey Show" on August 17, 1987. In my opening remarks I focused on the scandal of drug company funding of APA and pointed out that Fink himself had been head of APA's Public Affairs Division, which was drug company funded.(7) We then had the following exchange:

DR. BREGGIN: No, the Psychiatric Association is not beholden to the patients now, it's beholden to the drug companies. And we need a "Psychogate" investigation of this. Congress should investigate this, Oprah, and I ask Dr. Fink as the president to come clean next year and talk about the millions of dollars being channeled through the American Psychiatric Association.
WINFREY: Well, Dr. Fink is fuming now.
DR. FINK: Yes, he is.
WINFREY: He is fuming.
DR. FINK: I'm glad you said that.
WINFREY: Okay, okay, go ahead.
DR. FINK: Well, I think the --
DR. BREGGIN: Can you deny anything I just said?
DR. FINK: Can I deny that we get money --
DR. BREGGIN: Millions of dollars are being pumped through the Psychiatric Association by the drug companies.
DR. FINK: No. I can't deny that we get millions of dollars of support from the drug companies. I also can't deny that that seems to be tangential to the issue of whether the drugs that are used are of value, and they are --
DR. BREGGIN: Your scientific meetings are funded by the drug companies.
DR. FINK: I don't -- that's irrelevant. That's irrelevant.
DR. BREGGIN: How is that irrelevant?
DR. FINK: It's absolutely irrelevant, because the doctor on the street, the psychiatrist in the communities, is not affected by the fact we get some support -- minimal, I might add, in terms of the entire budget --
DR. BREGGIN: Twenty percent is from drug company advertising.
DR. FINK: Ten percent.
DR. BREGGIN: Twenty percent in the last three budgets, and if you want, I'll go out and get the figures during the next segment.

I had the official APA reports ready in the waiting area. The actual figures for the previous two years had been 19.69 percent in 1985 and 19.92 percent in 1984.

DR. FINK: Go ahead. I have the figures, as the president-elect.
DR. BREGGIN: Twenty percent of the revenues.
DR. FINK: The point is, whether it's 10 percent or 20 percent. . . .
WINFREY: Let him speak, Dr. Breggin, please.
DR. FINK: It's not really the relevant issue. The relevant issue is, are the drugs valuable? Yes, they are.

Judi Chamberlin had been invited by me to participate on the show as a psychiatric survivor representative. A short time after my exchange with Fink she brought us back to the topic, declaring, "But how can you have a scientific debate as to whether drugs are good or bad if the drug companies are underwriting the discussion? It skews everything."

DR. FINK: The assumption is that we're unconscionable and therefore we don't -- we don't --
DR. BREGGIN: But you're a psychiatrist, you understand self-interest. If you go to a convention and everywhere it says "Supported by this drug company, supported by that drug company --"
DR. FINK: I don't understand. I don't understand.

Indeed, Fink seemed not to understand. He came back to the subject later in the show, displaying visible frustration:

DR. FINK: . . . you're worried about a couple million dollars from the drug companies, and that 33,000 psychiatrists are just a bunch of rats who are just thinking we got that money from the drug companies. It's kind of outrageous, it's very outrageous that the first thing you want to talk about is the fact that we are underwritten to a certain --
DR. BREGGIN: The profession is now underwritten --
DR. FINK: -- to a certain extent, by a faction of the pharmaceutical industry.

Fink may have understood more about money and self-interest than he was letting on. Here is what he had declared in his candidacy statement for the APA presidency, published in the December 19, 1986, Psychiatric News:

"It is the task of APA to protect the earning power of psychiatrists."

As the president of APA, Fink went on to sign the previously mentioned ground-breaking 1989 contract with Upjohn that delivers $1.5 million to APA's coffers for the promotion of psychiatry.

NIMH and the Psycho-Pharmaceutical Complex

In recent years the National Institute of Mental Health has become dominated by biopsychiatry. When I was a full-time consultant with NIMH in 1967 and 1968, biological psychiatry was a relatively small section within the institute; now it is the institute. The outgoing head, psychiatrist Lewis Judd, like his immediate predecessors, was wholly devoted to the brain rather than the mind as the legitimate subject of psychiatric research and treatments Politically he moved NIMH very close to becoming a lab science institute; and inside sources during his tenure were unanimous in telling me that he wanted to get rid of those services that defend patients' rights (protection and advocacy programs) or support innovative consumer approaches (community support programs).

NIMH exerts control over the mental health marketplace by setting trends, pushing biopsychiatric treatments, giving grants to individuals and institutions for research, supporting training, holding conferences, conducting its own research, and generally promoting biopsychiatry through the media. For example, when one flimsy study suggested that manic-depression might be linked to a gene, NIMH leaped forward to hold a press conference. As we saw in chapter 7, the study's status and value among researchers quickly dwindled, but its media impact did not. Similarly, the media have also promoted the DART program, which aims at getting more people to consider themselves depressed and to take drugs and shock treatment. *

'The National Institutes of Health (NIH), a separate bureaucracy from NIMH, uses drug companies to sponsor some of its continuing-education programs. For example, NIH periodically holds updates in psychopharmacology for the practicing psychiatrist. In October 1987 its program at the Hyatt Regency in Bethesda, Maryland, acknowledged the support of Abbot Laboratories, Bristol-Meyers, Hoechst-Roussel Pharmaceuticals, and Warner Lambert.

The FDA

As attorney James Turner wrote in The Chemical Feast (1970), it has long been known that the FDA is hardly the consumer watchdog it's supposed to be. It gets thrown too many bones from the pharmaceutical industry to bite the hand that feeds it. Earlier, in 1965, Morton Mintz of the Washington Post wrote The Therapeutic Nightmare, documenting the mutual, supportive relationships among the FDA, APA, and the drug companies. As an example, the FDA came close to permanently withdrawing Parnate, an MAOI antidepressant, from the market, because the drug was proving to be extremely dangerous with little evidence for effectiveness; but the FDA reversed itself under pressure from the APA and cancelled its planned hearings. Nonetheless, many psychiatrists rejected the drug and it fell into disfavor for a few years. However, in the current biopsychiatric climate Parnate and similar drugs are enjoying a brisk revival (see chapter 8).

In general the FDA has done little to monitor or control the use of psychiatric technologies or to highlight their damaging effects. It has backed off from requiring research on the safety of electroshock (see chapter 9) and it never did do anything about lobotomy and other forms of psychosurgery. While an unusual FDA regulation has required that drug companies show more honesty about the dangers of tardive dyskinesia, it was too little, too late. The 1985 intervention by the FDA came many years after the drug-induced disease had become a documented epidemic. And patients and doctors reading the FDA-mandated drug company advertising for neuroleptics would have no idea that rates of the disease approach and exceed 50 percent in long term use.

Mostly the FDA lends authority to the use of psychiatric drugs and electroshock by approving them, and in the case of psychosurgery it gives tacit legitimacy by not even investigating it. The public is lulled into believing that regulatory agencies are busy at work protecting them. In depositions when I am critical of the use of a specific psychiatric drug, opposing attorneys sometimes challenge me, "But wasn't it approved for that by the FDA?" When I am being deposed by the drug companies themselves, their attorneys always try to relieve their clients of responsibility by pointing to FDA regulation. The pharmaceutical companies and their attorneys hope that people sitting on juries will exonerate companies because they operate under the FDA umbrella.

Furthermore, as we've seen in regard to Prozac and Xanax, FDA approval of a drug misleads the public into thinking that thousands of patients have been tested in controlled studies for months or years, when the in reality a few hundred are tested for a few weeks. In regard to neuroleptic Clozaril (clozapine), the recent FDA approval is especially misleading. Parents, doctors, and patients anticipate that this drug is to be administered for years at a time, even for the lifetime of many patients, and frequently against the patient's wishes. Yet the FDA controlled trials for this extremely brain-disabling and sometimes life-threatening drug lasted only six weeks!

Similarly the newly approved drug for obsessive-compulsive disorder, Anafranil (clomipramine), was studied for only ten weeks, when it, too, frequently will be administered for months or years. The FDA warns: "Because clomipramine has not been systematically evaluated for long-term use (more than ten weeks), physicians should periodically reevaluate the long-term usefulness of the drug for individual patients." Published in the obscure FDA Drug Bulletin, this warning will go unheeded.

As we've also seen in regard to Xanax, FDA approval does not mean that the drug trials have really demonstrated either safety or efficacy. The FDA can bend over backward to accommodate the drug industry and its financially captive psychiatric experts.

Regulatory agencies are notorious for coming under the control of the industries they regulate because the giant corporations have the power and money with which to buy influence and to obtain favors from government bureaucrats and politicians. By comparison, the consumers have almost no voice at all. Recently Washington was rocked by disclosures of corruption in HUD, including housing industry influence over decision-making processes. Less known was a similarly outrageous scandal at the FDA, described by John Schwartz in "Corruption and Chaos Uncovered in the FDA Generics Approval Process," in the July 1989 issue of the Psychiatric Times, and by an ongoing series of disclosures in the general press." It is tempting to retell the lurid details of drug companies buying favors from FDA bureaucrats, but "corruption" really isn't the main problem. The real problem, as we have seen, lies in the normal functioning of the FDA as it misleads the public into believing that psychiatric drugs are safe and efficacious when in fact they are neither.

"Toxic Parents" Join Toxic Psychiatry

Finally, there is the growing family movement, led by the National Alliance for the Mentally Ill (NAMI), with a rapidly expanding membership surpassing 100,000. It and its state affiliates consider all severe psychosocial disorders to be biochemical in origin and advocate lobotomy, electroshock, and drugs. It resists the growing movement of psychiatric survivors and supporters of patients' rights in general.(8)

APA and NIMH work hand-in-glove with NAMI. They lobby Congress together and meet the press together. NAMI leaders have direct access to the leadership of APA and NIMH, and they help plan national campaigns on behalf of biopsychiatry. NAMI recently published a letter it received from outgoing NIMH director Lewis Judd in which he spoke of the "dedication and shared purpose which has forged a unique and strong relationship and collaboration between NAMI and NIMH." With no apparent awareness of the inappropriateness of handing a federal agency over to a self-serving parent lobbying group, Judd declared, "NIMH, in a very meaningful sense, is NAMI's Institute." He then went on to repeat their shared but wholly unproven credo: "During the last 15 years, we have unequivocally established that mental illnesses are brain related disorders, which often involve strong genetic influences." The public's false impression of breakthroughs in biological psychiatry is based on the repetition of these unfounded slogans.

NAMI is not content to support its own viewpoint. As already noted, it personally attacks critics of biopsychiatry and advocates of psychosocial approaches. It lobbies against the funding of psychosocial research, most vehemently opposing any project that implicates parents in the problems of their offspring. Thus it has tried to stop funding of relatively non-controversial studies indicating that the improvement of communication in families helps in the recovery of their mentally disabled members."

NAMI has helped to develop and direct several high-profile media campaigns whose hidden agenda is convincing the public that the children of NAMI parents have diseases that cannot be blamed on the parents. It has co-founded the National Alliance for Research on Schizophrenia and Depression, which funds research in psychiatry. Research investigators thereby become dependent for their livelihood on funding from an organization that compulsively opposes psychosocial viewpoints and vehemently supports biopsychiatric ones.

Like the APA and its local branches, NAMI and some of its state organizations actively solicit and obtain support money from the drug companies. The fall 1990 issue of the Journal, the official publication of California Alliance for the Mentally Ill (CAMI), expresses gratitude for "generous financial contributions" from Sandoz Pharmaceuticals, Eli Lilly, and Upjohn. Earlier we noted that Sandoz has given NAMI parents "scholarships" to pay for the newly approved and dangerous neuroleptic Clozaril (clozapine) for their offspring. The March 1990 issue of NAMI's national journal Advocate has an ad for Clozaril, plus an article describing the Sandoz scholarships, promoting the drug, and providing phone numbers to make it easier for physicians to get started using it. However, pressure on Sandoz more recently has caused the company to make it somewhat easier and cheaper to prescribe the drug.

Medical Schools and Professorships

Medical school departments of psychiatry have gone largely biopsychiatric and often take money from the drug companies. Nowadays some heads of psychiatry departments are biochemists and nearly all are heavily biopsychiatric. Psychologically oriented department heads have gone the way of the California condor. Naturally, as a central part of the medical establishment, medical schools want to support biological approaches.

The schools also receive money from the drug companies in the form of research grants, sponsored professorships, and support for various projects. Indeed, the amounts probably far exceed those involved in supporting the APA. Professors at medical schools sit on the boards or act as consultants to research and development companies attempting to create and market new psychiatric drugs. Bright young researchers may go directly from working on a drug company grant at the university to joining the drug company's staff.

Health Insurers

Health insurers play a largely unexplored role in reinforcing the psychopharmaceutical complex. They tend to reimburse well for drugs, electroshock, and psychiatric hospitalization. On the other hand, they pay relatively little or nothing for psychotherapy and other forms of social rehabilitation, such as halfway houses, crisis centers, and residential homes, which ultimately can be more effective and less costly. Private practitioners, including psychologists and other non-medical therapists, increasingly find themselves pressured by health insurers to give or to encourage drugs rather than to lose reimbursement for the treatment of specific patients. One colleague of mine, a psychologist, has been told by an insurance company to give one of his patients drugs for anxiety or the patient's coverage for the treatment will be terminated.

The practice of psychotherapy has been vastly curtailed by insurance company policies and successful psychosocial innovations for severely impaired people have withered from lack of support (see chapter 16). There is hope, however. I talked to the director of a corporation that manages several health insurance programs. He was against psychiatric hospitalization as too costly and often damaging and was considering plans to pay for intensive, even daily, psychotherapy as an alternative. In my experience, a month's worth of very frequent psychotherapy would be much more useful to most acutely disturbed patients than hospitalization, and far less expensive or dangerous.

The Psycho-Pharmaceutical Complex

What we have been examining is a giant combine similar to the military industrial complex and involving the psychiatric profession (APA), government (NIMH and FDA), private industry (drug companies and health insurers), education (medical schools), and organizations representing the parents of patients (NAMI and other family groups). But the psychopharmaceutical complex is not a "conspiracy" in the usual sense of a wholly secret or covert collaboration. Much of it involves aboveboard, frank cooperation among like-minded, self-interested parties. Nonetheless, much of it also remains largely hidden from scrutiny, including the amounts of money paid by the drug companies to the APA and to leading psychiatrists. And whether it constitutes a legal conspiracy remains untested.

The only interest group not included in the psycho-pharmaceutical complex is the true consumers - the patients and victims of biopsychiatry - as represented by the National Association of Psychiatric Survivors (NAPS; see appendix A). Not surprisingly, the patients and ex-patient leaders have no significant voice in the psychiatric power structure.

Given the power of the psycho-pharmaceutical complex, it is no wonder that the public hears so little criticism of the biopsychiatric approach and almost nothing about psychosocial, human service alternatives.(9)

The Psycho-Pharmaceutical Complex Zeros In

As reporter Vince Bielski discloses in "The Assault on Patients' Rights" in the July 4, 1990, San Francisco Bay Guardian, the psycho-pharmaceutical complex is willing to bring its weight to bear on local issues. A 1989 California court decision, Riese v. St. Mary's, expanded the right of legally competent psychiatric patients to give informed consent or to refuse antipsychotic drugs. Perhaps because California tends to be a trend setter, this decision brought much of the psycho-pharmaceutical complex into the fray. The California branch of NAMI (CAMI) put pressure on state legislators to reverse the patients' rights decision. CAMI's attempt to make it easier to control its offspring was not surprising. As expected, the California Psychiatric Society also lent its considerable lobbying weight to reversing the court decision with new legislation. According to Bielski, state assemblyman Bruce Bronzan, the leading advocate of gutting the Reise decision, turned out to be the recipient of vast psycho-pharmaceutical complex largess, including:

contributions and honoraria from dozens of psychiatric and hospital associations, and pharmaceutical manufacturers, the Northern California and Central California Psychiatric Society, CA Hospitals, the Pharmaceutical Manufacturers Association, Sandoz Pharmaceuticals Corporation (maker of the neuroleptic Mellaril); Ciba Geigy Corporation (maker of Ludiomil and other psychiatric drugs) and Parke Davis (maker of Nardit and other psychiatric drugs).

Thus even national. pharmaceutical firms were supporting the assault on patients' rights. The psycho-pharmaceutical industry is one of the few American enterprises heavily supported by totally involuntary consumers.

Why is there so much interest in preventing legally competent patients from rejecting highly toxic drugs? After mentioning the unrealistic fear of chaos on the psychiatric wards,(10) Bielski observes, "Moreover, now that drugs have become the basic tools of psychiatry, hospitals, psychiatrists and drug companies stand to lose money if patients refuse to swallow their prescriptions."

Psychiatry as Big Business

Implicit in all of this is the reality that organized psychiatry is big business more than it is a profession. As a big business, managed by APA and NIMH, it develops media relationships, hires PR firms, develops its medical image, holds press conferences to publicize its products, lobbies on behalf of its interests, and issues "scientific" reports that protect it's members from malpractice suits by lending legitimacy to brain-damaging technologies. It tries to increase not only its share of the market, but also the size of the whole market.

One way to increase the overall size of the market is to convince the government, society, and individual citizens that its services are needed. From this motivation grows "official estimates" of the "prevalence of mental illness" that the media latch onto in their stories about the need for psychiatric treatment.

The APA's Division of Public Affairs and Joint Commission on Public Affairs have the task of increasing business. They publish a "Fact Sheet" to help psychiatrists sell themselves to the public. The Group for the Advancement of Psychiatry (GAP) is a private group made up of leaders in the field. In 1987 GAP published Speaking Out for Psychiatry: A Handbook for Involvement with the Mass Media, in which they reprint the "Fact Sheet." Here are the estimates for how many Americans are in need of psychiatric services:

Anxiety disorders: I 1. I million
Depression: 9.4 million
Schizophrenia: 1. 5 million
Substance and alcohol abuse: 25.5 million
Emotional and developmental problems in children: 12 million

These five estimates add up to 59.5 million Americans, and that's not including some of the more popular diagnostic categories, such as eating disorders, sexual dysfunctions, and organic brain disorders. Even assuming some inevitable overlap among the groups, 59.5 million potential consumers is a lot of business, more than enough to keep busy a mere forty thousand psychiatrists! Indeed, GAP's estimate that 15 to 25 percent of the elderly have "significant" mental illness would be enough to keep the entire profession occupied.

Perhaps not having added up its own figures, GAP estimates that a mere one in five Americans need psychiatric treatment; but that's 20 percent of the population, or approximately fifty million Americans. Not content with 20 percent of Americans, NIMH has recently decided that one in five Americans suffers a mental problem in any six-month period. A Washington Post staff writer passes this on as the gospel truth in the June 27, 1989, Health magazine supplement.

Too Many or Too Few Psychiatrists?

There is an especially misleading aspect to these repeated attempts to inflate the numbers of allegedly mentally ill in need of psychiatric treatment. The PR line is that there aren't enough psychiatrists to help all of these people and that the profession must continue to grow in size and importance in the coming years. Thus the December 1990 Clinical Psychiatry News displays the front-page headline SHORTAGE OF PSYCHIATRISTS EXPECTED TO CONTINUE.

But is there really a shortage of psychiatrists? That is, are psychiatrists overburdened with too many patients? No, the article admits, the opposite is true. Despite intensive promotional efforts by NIMH and APA to get people to go to psychiatrists, there are too many psychiatrists vying for too few patients. According to the Clinical Psychiatry News report, "the low demand for the services of adult and child psychiatrists may make it seem as if there is an oversupply of these physicians, but more Americans need to use their services, and would if they could afford them. . . ." This "low demand" for psychiatrists indicates that psychiatrists are continning to fall behind in their competition with nonmedical therapists - psychologists, social workers, counselors, and family therapists.

Thus while psychiatrists continue to have too few patients to maintain their professional incomes at the desired level, their national organizations speak of a shortage of psychiatrists in order to convince the public, the federal government, and health insurance companies to give more support to the profession. The continued failure of psychiatry to attract voluntary patients is the main impetus behind the biopsychiatric propaganda we have been examining in this book.

Enforcing the Psychiatric Monopoly

In addition to the psycho-pharmaceutical complex, psychiatry also draws support from its complex relationship to the state and the judiciary. Psychiatrists, as physicians, are licensed to practice medicine by the individual states. Within the mental health marketplace this gives psychiatrists the unique power not only to prescribe physical treatments, such as drugs and shock, but also to dominate mental health practices in the hospital system, including state hospitals, general hospital psychiatric wards, and private hospitals. It gives them the all-important authority to use physical force to make consumers accept their services through involuntary treatment.

No other professional, indeed no other person, in Western society can exert such personal power over clients or consumers. Imagine if other physicians could force patients into treatment on the grounds that they were in need of it. No one would be allowed to die of cancer without the "services" of the local surgeon or radiologist. Or imagine if lawyers or priests could exercise this kind of power over anyone they designated as their consumers or clients. Because psychiatry can compel patients into treatment, it frequently abuses them and loses its incentive to develop more appealing treatment approaches.

Some psychologists, with their Ph. D. s rather than M. D.s, are becoming increasingly envious of psychiatric medical power. Instead of promoting the psychosocial model and resisting the medical and biopsychiatric model, they are going to court and to legislatures to demand nearly all the rights of psychiatrists, including the right to prescribe drugs. The drug companies are underwriting some of these efforts by sponsoring seminars at national meetings to discuss the possibilities and advantages of psychologists prescribing drugs.(11)

Psychiatrists also have a pronounced advantage over non-medical therapists when it comes to health insurance reimbursements for their services. In the past, especially, health insurers were prone to pay for bills generated by psychiatrists but not by other mental health professionals. In order to qualify for reimbursements from health insurers, these other professions have tried increasingly to make themselves over in the image of psychiatry. In a field where innovation and variety should have top priority, limiting health insurance reimbursement to traditional look-alikes stultifies the field.

The requirement for CME credits at first glance looks to be in the public interest. Continuing medical education is supposed to keep psychiatrists on their toes by requiring them to go to seminars each year in order to qualify for state licensure or membership in professional organizations. Actually the CME programs enforce conformity to the prevailing biopsychiatric viewpoint. The easiest way to get CMEs is to go to conferences sponsored by APA, NIH, mental hospitals, and medical schools - programs typically underwritten by drug companies.

Because the drug companies are not likely to pay for CME seminars that train doctors in psychosocial theories and practices, or that criticize drugs, the requirement for CME credits has become a powerful force toward biopsychiatric conformity.

Psychiatrists also exert enormous monopoly powers through the courts, where they are recognized as the experts in a variety of spheres, including the critical input on court decisions that declare people incompetent to stand trial or not guilty by reason of insanity.

When psychiatrists are sued for malpractice, who appears in court to testify as to whether or not the accused doctor actually performed in a negligent manner? Other psychiatrists. Since professional retaliation can be brutal, trying to get one psychiatrist to testify against another is like trying to get Mafia members to rat on one another. I have seen cases where dangerous combinations and gross overdoses of psychiatric drugs have nearly killed patients, leaving them comatose or crippled, but no psychiatrists within the state could be found to testify on the patients' behalf Attorneys frequently complain, "Several psychiatrists have said that it was obvious negligence but that they didn't dare testify against their colleagues."

Biopsychiatrists have begun to turn on their psychosocial colleagues in a way not previously seen. In print they are recommending that doctors who fail to use drugs can be guilty of malpractice. Recently a famous private psychiatric hospital settled out of court for failing to give an antidepressant to a man who later claimed he was saved by the drug at another institution.

Threats of malpractice actions are intimidating social workers, counselors, psychologists, and other mental health professionals who are unable or unwilling to give drugs. More and more frequently nonmedical therapists are referring their clients to psychiatrists for medication, even though the use of drugs may be at odds with the psychosocial approach taken by these professionals.

The picture I have drawn looks overwhelming, yet it is not an exaggeration. Psychiatry is a giant industry, protected by a state monopoly and promoted by a psycho-pharmaceutical complex with multi-billion dollar power.

Despite these enormous advantages, psychiatry is not doing well financially and must struggle continually to maintain its monopoly power. This clearly indicates that psychiatry would lose out entirely in a genuine competition with psychological and social alternatives. In almost every arena in which psychiatry operates, psychosocial interventions - to which we now turn-are much less harmful, often less expensive, and far more appealing and helpful to suffering human beings.

Footnotes:

1. My research assistant at the time, Wade Hudson, obtained estimates on the cost of printing the materials that came to roughly $70,000. This did not include producing the materials (editing, design, and so on) or collating, packaging, and mailing. Nor did it include any possible payments to the physicians involved.

2. I first met Klerman around 1957-58 when I was working with the Harvard-Radcliffe Mental Hospital College Volunteer Program and he was a young psychiatrist at the Massachusetts Mental Health Center. We talked amicably about my interests in going to medical school to become a psychiatrist, and I explained my desire to learn more and eventually to contribute to our knowledge about human nature, human psychology, and psychosocial therapy. He advised me that I was headed in the wrong direction and that psychiatry was moving toward drugs and computerized diagnosis and treatment. At least in regard to drugs, he helped make that prediction come true. Meanwhile, despite much experimenting, computerized psychiatry has as yet failed to materialize.

3. I found Marks sincerely concerned about the problem of drug company influence in psychiatry. I also agreed with him that the tone of Freedman's letter to him was insulting.

4. When I described Freedman's "three P's" to one of my students at George Mason University, Louise Massoud, she declared with dismay, "He didn't include patients in his 'three P's.' Indeed, patients do seem far removed from the motivation of psychiatric researchers.

5. He gave me permission to use his name, but I don't believe he is aware of the extent of the potential backlash, and so I have withheld his name.

6. Subsequent meetings have grown still worse.

7. I didn't mention that he was chief medical editor of a glossy monthly magazine put out by Merrell Dow.

8. Recently I have heard of at least one local exception to this rule. Furthermore, not all NAMI Parents have caused their children's problems, but the NAMI leadership has aggressively sought to suppress those with whom it disagrees.

9. In December 1990 Senator Ted Kennedy held hearings on the buying of doctors by drug companies through "lavish vacations, gifts and cash payments." As reported by Warren Leary in the December 12, 1990, New York Times, Kennedy observed that pharmaceutical firms Ire spending four times what they did in 1975 to promote drugs. However, it appears that the Psycho-pharmaceutical complex and psychiatry have escaped scrutiny at these hearings.

10. As I describe in Psychiatric Drugs: Hazards to the Brain (New York: Springer, 1983), theo fear of psychiatric wards going wild has never materialized in states like Massachusetts th-q@ recognize the right to refuse treatment. Yet it is raised frequently by the psychiatric establishmen as a means of thwarting public support for increased patients' rights.

11. As of January 1991 1 became one of the few psychiatrists accepted for full membership in the American Psychological Association. One of my aims in joining the American Psychological Association was to encourage it to remain free of the psycho-pharmaceutical complex. Another was to help support the independence of psychologists from psychiatrists in conducting Psychosocial therapies. Psychiatry has always tried to limit the rights of psychologists to practice independently. Meanwhile, as a psychiatrist. I have been a member of the American Psychiatric Association for several decades.

For more information on this subject and psychiatry and drugs in general get yourself a copy of Toxic Psychiatry : Why Therapy, Empathy, and Love Must Replace the Drugs, Electroshock, and Biochemical Theories of the New Psychiatry by Peter R. Breggin, M.D., the book from which this information was excerpted.

Peter Breggin's Home Site - Peter R. Breggin, M.D. founded The International Center for the Study of Psychiatry and Psychology (ICSPP) as a nonprofit research and educational network concerned with the impact of mental health theory and practices upon individual well-being, personal freedom, and family and community values. For 25 years ICSPP has been informing the professions, media and the public about the potential dangers of drugs, electroshock, psychosurgery, and the biological theories of psychiatry.

Suggested Reading:

Drugs & The Psychiatric Industry

Brain-Disabling Treatments in Psychiatry : Drugs, Electroshock, and the Role of the FDA Today! by Peter R. Breggin, M.D.

Toxic Psychiatry : Why Therapy, Empathy, and Love Must Replace the Drugs, Electroshock, and Biochemical Theories of the New Psychiatry by Peter R. Breggin, M.D.

The Manufacture of Madness : A Comparative Study of the Inquisition and the Mental Health Movements by Thomas S. Szasz, M.D., Professor

Law, Liberty, and Psychiatry : An Inquiry into the Social Uses of Mental Health Practices by Thomas S. Szasz, M.D., Professor

Bedlam : Greed, Profiteering, and Fraud in a Mental Health System Gone Crazy by Joe Sharkey

The Limits of Biological Treatments for Psychological Distress by Seymour Fisher and Roger P. Greenberg

Physician's Desk Reference (PDR)

Psychiatric Drugs: Hazards to the Brain by Peter R. Breggin, M.D.

Drugs, FDA, Corporate & Government Collusion

The Healing of Cancer: The Cures the Cover-Ups and the Solution Now! by Barry Lynes - Read how the American Cancer Society misleads the American public and collects over 350 million dollars a year in contributions, and how part of the money is used against innovative cancer researchers, how the FDA conspires to stop promising treatments, and how so many victims undergo torture because of medical profiteering, outmoded thinking and a corrupt politics.

The Cancer Cure That Worked: 50 Years of Suppression by Barry Lynes - Office of Alter. Medicine in Wash,D.C. knows about Royal Rife. They continue to ignore - while 10,000 Americans die of cancer every week! Murder by bureaucratic autocracy and inertia. National Cancer Institute and FDA are equally aware and continue to lie about Rife and his remarkable cancer-curing approach. Shame on all the so-called "experts" keeping their heads in the sand in order to protect their privileges and outdated chemo-drug-surgery "culture."

World Without Cancer: The Story of Vitamin B17 by G. Edward Griffin - Provides an excellent exposť of an alternative natural way to prevent and cure cancer through nutrition, and the forces in government and in large pharmaceutical firms that are fighting to keep the secret from us. This book serves as an eye opener to anybody who has ever wondered why there has been so little progress in the fight against cancer, despite the vast sums of money being invested.

The Cancer Industry: The Classic Expose on the Cancer Establishment by Ralph W. Moss - An ex-cancer insider at the Sloan Kettering institute details all of the alternative therapies which have been railroaded by the cancer establishment. An interesting read for anyone who has the nagging feeling that the cancer war is being lost because pharmaceutical companies are avoiding possible natural, non patentable cures.

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