It’s rather ironic that psychiatry appears to have a fundamental problem facing reality. At least that seems to be the conclusion Bob Whitaker has been reaching in a body of well reasoned and meticulously documented writing on the field.
In his recent reflections on what he learned when writing Psychiatry Under the Influence with Lisa Cosgrove, Bob offers us the hopeful observation that the pharmaceutical industry’s influence over psychiatry is being brought under control. And while they are no longer able to buy allegiance with overt gifts and financial handouts disguised as consulting fees, I found myself shaking my head at his optimism. It reminded me of Bob dubiously shaking his own head in 2004 as Loren Mosher opined that the new warning labels on the SSRIs would lead to their no longer being casually prescribed.
Big Pharma has done their job so well that they no longer need to bribe doctors with cash to get them to tout the party line. Their neurobiological belief system — that complex mental states can be meaningfully reduced to neurological structures and biochemical processes — is now so well entrenched in our culture it is becoming more and more difficult to find folks who doubt it, especially in medical schools and in departments of psychiatry. While MIA and similar efforts may be making headway in challenging the notion that drugs are a safe, effective response to life’s problems, the underlying belief in the brain chemistry explanation of human experience is still becoming more, not less solidly rooted in our culture.
Within the boundaries of their new, self-imposed restraint, the pharmaceutical companies can still support research, psychiatric training, departments of psychiatry, and continuing education without disguised cash handouts directly to prescribers. So while I doubt that they will lose their hold on psychiatry due to some cosmetic policy changes, they will eventually lose their pernicious influence. I believe there is hope; in fact, I am confident that as Shakespeare’s Launcelot said, “In the end truth will out.”
There is a solid principle underlying my faith. It is the principle underlying all science, which as Thomas Kuhn elucidated does not simply advance with new evidence and insight. Science is riddled with political struggle and ideological commitments to various theories and beliefs. Such commitments and beliefs die hard.
Though we may actually come to understand more about the relationship between our brains and our psychological experience, in the end truth will out and clinical, pharmaceutical biopsychiatry as it is understood and practiced today will be a thing of the past. Indeed, MIA is part of the political struggle that will enable reality to triumph over fiction in our collective understanding. This is how science progresses. Unfortunately, I believe that the struggle will be long and hard fought before most minds are won over. But truth will triumph in the end.
My favorite expression of the all-powerful principle that will yield this outcome was formulated by Philip K. Dick, a visionary who struggled with and explored the boundaries between reality, psychosis, and the manic depressive diagnosis given him by the doctors at the Orange County Medical Hospital. Dick said, “Reality is that which, when you stop believing in it, doesn’t go away.”
And while psychiatry has been tonguing and spitting out the bitter pill of reality, it won’t go away. In the end, they will have to swallow the bitter pill and face reality.