Historically the medical field has had a variety of ways of dealing with what is commonly called mental illness. Early on, there was a belief that such illness was caused by an imbalance in the humours 1 within the body, which could be dealt with by bleeding patients with knives or leeches. They also believed that organs like the stomach, spleen, and tonsils were the cause of mental issues, so these organs would be removed. Later it was determined that surgical procedures such as lobotomy would be successful in helping to deal with such problems; however, it was later discovered that such surgery did not work the way it was intended.
One of the earliest statements made regarding psychological illness was that it was the result of an imbalance of brain chemicals, namely serotonin and dopamine; however, there is no way to prove this scientifically. If a patient visits an oncologist and is determined to have cancer, the physician can prescribe certain medications and can actually see if this medication is having any beneficial impact based upon a reduction in the number of cancer cells or a recognizable remission of the disease. There is no scientific way to test if the psychotropic drugs that patients are given is having any positive impact.
Benjamin Rush (1746-1813), one of the leading physicians of his day and professor of Medical Theory at the University of Pennsylvania, actually postulated that medical illness was the result of too much blood in the head. His theory was that this excess blood should be removed by whatever means necessary. These means included cold showers and others which would be deemed inhumane by today’s standards.
For many years, psychiatrists were not considered to be “real” doctors because they were not able to actually cure any of their patients. Psychiatrists working in mental institutions were considered to the attendants, rather than actual staff physicians. In fact, many physicians considered psychiatrists to be “almost a doctor” because they were not engaging in what the mainstream medical profession would consider a field of scientific endeavor.
As a result psychiatrists began prescribing medication to their patients as a way of proving to the medical community that they truly are doctors. Initially these psychiatrists were prescribing morphine and opium in an effort to control emotional outbursts among inmates. Not only did these drugs not have the intended effect, but they are also highly addictive which only served to make the patient worse in many cases.
Since there was no curative power to either morphine or opium and the mental health facilities still needed to be able to control those patients who were displaying emotional outbursts, psychiatrists next turned to cocaine and heroin as their “wonder drugs”. Sigmund Freud actually spoke out in favor of the euphoric effects of these drugs; however, what Freud did not tell those he was speaking to was that he was been paid by two pharmaceutical giants, Merck and Park Davis, in order to help them market their new cocaine extracts.
Instead of curing anyone of emotional outbursts, these medications actually lead to a major cocaine and heroin epidemic at the beginning of the twentieth century. As a result, a new drug was hailed as a “wonder drug” and the cycle started all over again. Initially these drugs would be touted as a medical breakthrough and very slowly the public would become aware of the major side effects associated with these drugs. Then when the pharmaceutical companies could no longer deny the dangers of this so called “wonder drug” they would simply abandon it and come up with a new medication.
In 1954, psychiatry believed that they had finally come up with the wonder drug which would change the world for the better with the introduction of Thorazine. One of its initial uses was as an anti-parasitic in swine (it was designed to kill parasites); however, the pharmaceutical companies found that a side effect was that if actually shut down motor controls in humans and made them more compliant. Thorazine itself proved so lucrative that the drug companies actually promoted it through what would now be considered a major mass marketing campaign sponsored by SmithKline and French, the makers of Thorazine.
However, Thorazine led to an illness which actually causes an extreme muscular disorder known as tardive dyskinesia which is similar to the late stages of Parkinson’s disease. The next major drug was Miltown which was being promoted in medical journals and by psychiatrists to others in the medical field. This became the first blockbuster psychiatric drug which was marketed to the general public instead of simply for use by those in psychiatric facilities.
By the 1960s, 200 million prescriptions for this drug were filled and it became a huge financial boon for the pharmaceutical companies. Miltown was eventually determined to be more addictive than either cocaine or heroin and quickly fell out of use.
The next major drug was Valium. This medication was prescribed to so many homemakers in the United States to help them manage their anxiety that it actually earned the name, “Mother’s Little Helper”. The challenge with these various drugs was that the patient was rarely, if ever, informed of the possible long-term or even short-term negative side effects.
In Section two of this paper I will discuss the relationship between psychiatrists and the pharmaceutical industry. In Section three will discuss the claims of psychiatry regarding the effectiveness of such medications as well as the safety of such medication. In Section four I will discuss the facts regarding such medications and Section five will provide a conclusion.
II. Psychiatry and the Pharmaceutical Industry
As a result of the rise in the various numbers of psychotropic drugs, psychiatrists were no longer considered care takers, but actual doctors. Mental distress was no longer consider psychological, but symptoms of disease and psychiatrists could use their ability to write a prescription in order to provide their patient with a “happy pill” to in order to help them to manage their illness, since they were, are still are, unable to offer a cure.
By the 1980s, Valium had become the most prescribed drug in the Western world with over 2.3 billion tablets sold. This was enough to medicate one half of the entire world population.
The next “wonder drug” to come on the market was Prozac. While Valium was promoted as a medication for anxiety, Prozac was being marketed as a depression medication. Interestingly, once this drug came on the market the number of people diagnosed with depression went up substantially. Prozac was initially hailed as a cure for depression with no side effects or addictive properties. Given the “curative properties” of drugs like Prozac and others which later entered the market, mainstream psychiatry abandoned psychotherapy for psychopharmacology forever. It was easier to simply write a prescription for a “wonder drug” than to have to engage the patient in helping them to get to the root cause of their illness.
Within ten years after the introduction of Prozac, there were numerous side effects brought forth. Once the patent expired on the medications, when the drug companies were no longer able to have a monopoly over the medication, they finally admitted that there were serious side effects; however, by this point they had already move on to their next “wonder drug”.
The next illness which the psychiatric field and pharmaceutical companies were addressing was a little known illness entitled bi-polar disorder, formerly known as manic/depressive disorder. Obesity, diabetes, and heart problems were among the major side effects of the drugs used to treat bi-polar disorder; however, the patients were rarely, if ever, informed about these potential problems.
If the basis of the doctor-patient relationship is trust and one of the hallmarks of this relationship is informed consent, then why would the psychiatrists not tell their patients about the long-term or short-term negative side effects which they will have to deal with once they begin taking this medication? The answer is money!
The psychiatric field benefits substantially from their connection to the pharmaceutical industry. Each year, physicians are required to take part in Continuing Medical Education (CME) courses which are recognized by the state where that physician is licensed in order to allow them to keep practicing medicine within that state. The vast majority of the groups which run these CME courses are actually either owned by or have a very strong relationship with the pharmaceutical companies. These groups hire psychiatrists as consultants and pay them up to $3,000 per conference to speak to physicians about the latest psychotropic medication and how that particular physician can benefit by introducing this particular medication into their daily practice.
Another factor which connected these two industries was the introduction of the first Diagnostic and Statistical Manual for Mental Disorders (DSM-I) in 1952. It described 112 mental disorders. The classification of these “disorders” was not based upon any actual science, but a write-in ballot mailed to ten percent of the psychiatrists belonging to the American Psychiatric Association (APA). The release of DSM-II brought the list of “disorders” up to 145. None of these new disorder diagnoses were based upon actual science either. Instead the DSM-II was filled with theories on the origin of these illnesses.
The rise in the sale of psychotropic drugs such as Miltown and Valium meant that the psychiatric community needed to come up with a biological reason in order to justify prescribing these drugs. They found what they were looking for in a paper written by Joseph Schildkraut, M.D. (1934-2006) entitled “The Catecholamine Hypothesis of Affective Disorders”, published in the American Journal of Psychiatry in 1965. While he had no scientific proof to support his theory, Dr. Schildkraut postulated that mental disorders might be caused by a chemical imbalance of the neurotransmitters in the brain. This was purely a hypothesis. There are no lab tests to determine what “normal” chemical levels in the brain look like. The only identifiable chemical imbalance is one that comes from putting a medication into one’s system which will impact their brain.
Another challenge was that psychiatrists often could not tell the difference between someone who was sane and someone who was insane. In 1972, the famous Rosenhan experiment involved a total of eight perfectly healthy volunteers presented who themselves at a mental institution. They each claimed to hear voices in their head which only said the words: empty, hollow, or thud. No other symptoms were ever discussed and the result was that all of the volunteers, including Dr. David Rosenhan, were immediately committed into the institution. The moment they entered the hospital they each abandoned their symptom and wanted to see if anyone could detect that they were sane. The answer was no. No one in the institution could determine that they were sane. All but one was diagnosed as schizophrenic and they were all discharged only after they admitted that they were, in fact, mentally ill but were in remission. The psychiatric community was furious after learning of this experiment. One hospital challenged Dr. Rosenhan to send in more volunteers and that they would catch every one of the fake patients. Three months later this hospital announced that of the 193 patients presenting themselves they had turned away 41 who were pretending to be mentally ill and determined that another 42 were suspect. The problem was that Dr. Rosenhan never sent any volunteers to that hospital.
Emil Kraepelin, M.D. (1856-1926), a German psychiatrist, concluded at the turn of the twentieth century that psychiatry could not determine sanity from insanity. Seventy years later, Dr. Rosenhan proved that his statement was correct.
Following the Rosenhan experiment, the third edition of the Diagnostic and Statistical Manual (DSM-III) took a more “brain based” approach to mental disorders. They assumed that mental problems derived from physical abnormalities in the brain, which they could not scientifically prove, and the DSM-III did not discuss causes, but instead provided clinicians with a checklist of symptoms. The challenge was that these symptoms were broad enough that they could apply to anyone at any point in their life. Since there was no science to back up these symptoms, they were subject to heated debate among various members of the APA. What tended to happen at these meetings was that the person who shouted the loudest was often the one who was heard.
The members of the APA actually vote on what goes into the DSM and what does not. If thirty people are in the room and twenty-two people vote in favor of this proposed “disease”, it is included in the next edition of the DSM. There is no examination of scientific studies or other data to determine if this truly is a disease, since no data exists, so instead they rely upon a vote of the membership. As part of a discussion on the proposed symptoms for Masochistic Personality Disorder, the wife of Robert Spitzer, M.D., editor of the DSM-III protested against one of the symptoms. Dr. Spitzer’s response was, “Simply leave it out.” Does that sound like science?
Once a “disease” goes into the DSM it is very difficult to remove it. However, since these “diseases” are voted on by human beings who can be influenced by political and/or social pressure it is not impossible to remove a disease. Such was the case of “homosexuality”. Homosexuality was listed as a mental disorder in both DSM-I and DSM-II; however, after gay rights activists picketed the 1973 APA convention, the members gave in to political pressure and decided to remove it from DSM-III.
The DSM-IV has tripled the number of diseases (374) that that were present in DSM-I. Once a disease goes into the manual, there is an entire growth industry built up around it. These diseases enter the professional curricula, specialists emerge to treat it, conferences are organized around it, publications cover it, doctors formulate patient symptoms to correspond to it, and drugs are prescribed to deal with it. These are not medical diseases because they have no medical pathology.
The information in the DSM is used in law, insurance, child custody decisions, criminal sentencing and other areas. Based upon the DSM anyone of us could be declared mentally ill. One Harvard professor stated, “No one is truly normal.”
DSM-V is supposed to be released in 2012. Some of the new disorders they are considering include Internet Addiction Disorder, which was originally presented as a spoof in a 1997 article in The New Yorker magazine. According to the APA, some 25 million people may qualify as “compulsive surfers”. Compulsive Shopping Disorder is another proposed “disease”. So are Binge Eating Disorder, Apathy Disorder, Parental Alienation Syndrome, Relational Disorder, and Intermittent Explosive Disorder (Road Rage). These are all potential categories with psychotropic drugs waiting to be assigned to them.
According to the APA, nineteen of the twenty seven members of the panel determining what illnesses are to be listed in the next edition of the DSM have financial ties to pharmaceutical companies. This got so bad that both Dr. Robert Spitzer, editor of DSM-III, and Dr. Allen Frances, editor of DSM-IV, warned that that the APA may be accused of a conflict of interest because it appears that the DSM-V is being fashioned to create new patients for psychiatrists and new customers for pharmaceutical companies. Psychiatric drugging brings in over $80 billion a year for pharmaceutical companies, so given the psychiatrists direct relationship to these companies it should not be surprising that the APA refused to address the issue of any possible conflict of interest.
For years it was determined that a diagnosis of bi-polar disorder would never be made on a person under the age of eighteen. Now there are children as young as four years old that have been diagnosed with bi-polar disorder and placed on psychotropic medication. What was normally considered a temper tantrum on the part of a four year old child can now be diagnosed as bi-polar disorder which then classifies this child as mentally ill.
From a medical standpoint, there is no such thing as bi-polar disorder since there is no way to prove it through any medical tests. Today, nearly 1 million children are diagnosed as bi-polar, making it more common than autism and diabetes combined. In 2007, 500,000 children and teenagers received at least one prescription for an anti-psychotic medication, including 20,000 children under the age of six. These anti-psychotic drugs were originally given to the most severely mentally troubled. However, the pharmaceutical industry is now earning about $22.8 billion annually through sales of these medications.
The DSM is very reductionist in its approach to classifying diseases. This makes it much easier for pharmaceutical companies to come up with drugs to deal with the symptoms of these “diseases” and that, in turn, inspires psychiatrists to write prescriptions for these medications. The only thing left out of this entire equation is the long term impact on the actual patient.
According to psychiatrists at the World Health Organization, some 450 million people worldwide have a mental disorder. In 1999, Americans were bombarded with advertisements and other information telling them about a new disease where you sweat, blush, shake, and even find it difficult to breathe. The tag line for these ads was “Imagine being allergic to people?” The disease was called Social Anxiety Disorder (SAD) and it was claimed to impact about 13.3% of the US population.
In order to find out more about this disease, the readers were instructed to contact the Social Anxiety Disorder Coalition. What the people did not know was that both the advertisements and the coalition itself were the creation of a public relations agency and funded by a pharmaceutical company, named SmithKline Beecham. Later that year, Paxil came on the market after being approved by the FDA as the treatment for SAD. As a result of this, Paxil went from third place in its drug class to first place. The marketing company later boasted that the company was able to find an unknown market, create a need, and then sell their product by inventing SAD as an illness.
Pfizer Pharmaceuticals did the same thing following the FDA approval of their drug, Zoloft, which they marketed for Post-Traumatic Stress Disorder (PTSD). Like SmithKline, they began a major marketing campaign and created their own front group which people could contact via the internet to find out more information about this disease. This campaign claimed that 1 in 13 people would develop PTSD over the course of a lifetime. Both they and SmithKline hired psychiatrists to go out and promote their new drugs among other medical professionals.
This practice is known as Disease Mongering, which can be defined as “trying to convince essentially well people that they are sick or slightly sick people that they are very ill.” On Madison Avenue, this is done through a process known as Condition Branding where medical diseases are “pitched” in the same way that cars, beer, or any other product would be pitched. This is very easy when it comes to anxiety or depression, because they are rarely, if ever, based upon measurable physical symptoms and therefore open to conceptual definition, according to experts in this area of marketing.
Prior to the introduction of anti-depressants, even psychiatrists acknowledged that depression effected about 100 people per million. Since the introduction of these drugs, the APA states that depression impacts as many as 100,000 per million. This is a 1000x increase following the introduction of such medication. When bi-polar disorder was introduced into the DSM it was quite rare, effecting about 1/10 of 1% of the population. Today, it is believe that it affects as much as 10% of the population. This is a 100x increase. Pediatric Bi-Polar Disorder was not even in the DSM when studies were being done claiming that childhood mood swings was not normal behavior, but actually, a mental illness. This campaign worked. In the last decade alone, the rate of children diagnosed with bi-polar disorder has gone up over 4,000%. What the parents were not told was that 25 drug companies had underwritten these studies. This was not revealed until 2006, when a United States Senate commission fined Joseph Biederman, M.D., a Harvard psychiatrist and author of the studies, for failing to report more than $1.6 million in pharmaceutical income. In spite of this, pediatric bi-polar is now an acceptable diagnosis and this diagnosis is being applied to younger and younger children.
How do they get the consumers to believe that they might be suffering from such an illness? The first step is to convince the public that a minor or temporary problem is much worse than it really is. The second step is to redefining a disease. This involves taking an ordinary state of mind and recasting it as a disease which now must be treated with drugs. For example, the winter blues, which many people struggle with, stems from the decrease of sunlight during the winter months. Now it is defined as Seasonal Affective Disorder and medication is given to patients to help them to deal with this “disease”. Another such issue would be the mood swings associated with a woman’s menstrual cycle. This is a very common occurrence. Now it is known as Premenstrual Dysphoric Disorder (PMDD) and there is a psychotropic drug to deal with this. PMDD was not a medical diagnosis, but was created by the marketing department of pharmaceutical giant, Eli Lilly, once their patent ran out on Prozac. They created a new drug, Sarafem, which is actually Prozac, and marketed it as the new wonder drug for PMDD. The third market strategy is to create a new disorder for an unmet market need. For example, Compulsive Shopping Disorder, which is a “disease” discussed in a paper by Jack Gorman, M.D., a psychiatrist. He claims that a recent study indicated that as many as 20 million Americans suffer from this disease. What he did not mention was that this study was completely funded by Forest Laboratories, maker of Celexa, and that he was a paid consultant to at least thirteen pharmaceutical companies.
One study in the Journal of the American Medical Association entitled “Escitalopram and Problem-Solving Therapy for Prevention of Post-stroke Depression” suggested that patients take an anti-depressant whether they were depressed or not in order to prevent depression. It was later learned that the authors of the study had an undisclosed financial relationship with the makers of the drug, Lexapro. Such “preventive drugging” will become the wave of the future.
As a result of these marketing campaigns and the willingness of psychiatrists and other doctors to place their patients on such medication, there are now over 100 million people worldwide taken psychotropic medication. These drug companies are earning $150,000 every minute from the sale of such medications.
In conclusion, the fact psychiatrists and the pharmaceutical companies do not want the public to know about their financial relationship and that many of these so-called diseases are products of Madison Avenue marketing campaigns, should lead the public to wonder what such drugs will do to them once they are on them and whether it is even worthwhile going on them to begin with.
1The theory of the four humours is quite ancient. It is based upon the belief that the body has four states (phlegmatic, sanguine, choleric, and melancholy) which need to be in balance in order to function properly. These states are related to the blood and one way that they were kept in balance was through the use of various herbs which we meant to impact each humour individually.
3 Sydney Walker III A Dose of Sanity (NJ: John Wiley & Sons, Inc., 1996), p. 14
4 Lorrin M. Koran Medical Evaluation Field Manual, Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, CA, 1991, p. 4
5 Tomas Bjorkman “Many Wrongs in Psychiatric Care,” Dagens Nyheter, Jan. 25, 1998
6 Thomas Dorman “Toxic Psychiatry,” Thomas Dorman’s website, 29 Jan. 2002, http://www.dormanpub.com/ Accessed: Feb. 22, 2011
7 “Controlling the diagnosis and treatment of hyperactive children in Europe” Parliamentary Assembly Council of Europe Preliminary Draft Report, Mar. 2002
8 “Controlling the Diagnosis”, point 19
9 Walker, p. 14
10 Marla Cones “Cause for Alarm over Chemicals,” Los Angeles Times, 20 Apr. 2003
11 Walker, p. 6
12 Mary Ann Block No More ADHD (TX: Block Books, 2001), p. 84
13 Raymond M. Lombardi “ADHD A Modern Malady,” Nutrition Science News, Aug. 2000
14 Cones, “Cause for Alarm”
15 Becky Gillette “Breaking the Diet - ADD Link,” E Magazine, 5 Mar. 2003
16 Walker, p. 6
17 Samuel Blumenfeld “Tom Cruise victimized by ‘Dick and Jane’?” www.WorldNetDaily.com July 23, 2003
18 Walker, p. 6
19 Blumenfeld; Rebecca Chrisinger, letter to Nancy Rogers, Evidence before CCHR’s Commission Hearing held in Los Angeles, Nov. 1997
20 Walker, p. 165
21 Walker, p. 160
22 Walker, p.102
23 David W. Tanton A Drug Free Approach to Healthcare (OR: Soaring Heights Publishing, 2005), p. 101
24 Tanton, p. 139
25 Joan Mathews Larson Depression-Free, Naturally (NY: The Ballantine Publishing Group, 1999), p. 138
26 Janet Ginsburg “Diseases of the Mind,” Newsweek, December 1, 2002
27 Ty C. Colbert Rape of the Soul, How the Chemical Imbalance Model of Modern Psychiatry has Failed its Patients (CA: Kevco Publishing, 2001), p. 244
28 Larson, p. 173
29 Larson, p. 22
30 Henrietta L. Leonard “Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections: Clinical Description of the First 50 Cases” American Journal of Psychiatry, 155:264-271: Feb. 1998
31 Paul D. Arnold and Margaret A. Richter “Is Obsessive Compulsive Disorder an Autoimmune Disease?” Canadian Medical Association Journal Nov. 13, 2001:165 (10)
32 “Depression in children and young people, Identification and management in primary, community and secondary care,” National Institute for Health and Clinical Excellence, National Health Service, Sept. 2005, pp. 18, 28
33 “Grouchiness Happens: Walk It Off,” www.washingtonpost.com 1/31/02
Paul D. Arnold and Margaret A. Richter “Is Obsessive Compulsive Disorder an Autoimmune Disease?” Canadian Medical Association Journal Nov. 13, 2001:165 (10)
Tomas Bjorkman “Many Wrongs in Psychiatric Care,” Dagens Nyheter, Jan. 25, 1998
Mary Ann Block No More ADHD (TX: Block Books, 2001)
Samuel Blumenfeld “Tom Cruise victimized by ‘Dick and Jane’?” www.WorldNetDaily.com July 23, 2003
Citizen’s Commission on Human Rights http://www.cchr.org/
Ty C. Colbert Rape of the Soul, How the Chemical Imbalance Model of Modern Psychiatry has Failed its Patients (CA: Kevco Publishing, 2001)
Marla Cones “Cause for Alarm over Chemicals,” Los Angeles Times, April 20, 2003
Thomas Dorman “Toxic Psychiatry,” Thomas Dorman’s website, Jan.29, 2002, http://www.dormanpub.com/ Accessed: Feb. 22, 2011
Becky Gillette “Breaking The Diet - ADD Link,” E Magazine, March 5, 2003
Janet Ginsburg “Diseases of the Mind,” Newsweek, December 1, 2002
Lorrin M. Koran Medical Evaluation Field Manual, Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, California, 1991
Joan Mathews Larson Depression-Free, Naturally (NY: The Ballantine Publishing Group, 1999)
Henrietta L. Leonard “Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections: Clinical Description of the First 50 Cases” American Journal of Psychiatry, 155:264-271: Feb. 1998
David W. Tanton A Drug Free Approach to Healthcare (OR: Soaring Heights Publishing, 2005)
Sydney Walker III A Dose of Sanity (NJ: John Wiley & Sons, Inc., 1996)