Are Psychiatrists Betraying Their Patients?

"I Want No Part of It Anymore"

The trouble began in the late 1970s when I conducted a controversial study: I opened a program--Soteria House--where newly diagnosed schizophrenic patients lived medication-free with a young, nonprofessional staff trained to listen to and understand them and provide companionship. The idea was that schizophrenia can often be overcome with the help of meaningful relationships, rather than with drugs, and that such treatment would eventually lead to unquestionably healthier lives.

The experiment worked better than expected. Over the initial six weeks, patients recovered as quickly as those treated with medication in hospitals.

The results of the study were published in scores of psychiatric journals, nursing journals and books, but the project lost its funding and the facility was closed. Amid the storm of controversy that followed, control of the research project was taken out of my hands. I also faced an investigation into my behavior as chief of the National Institute of Mental Health's Center for Studies of Schizophrenia and was excluded from prestigious academic events. By 1980, I was removed from my post altogether. All of this occurred because of my strong stand against the overuse of medication and disregard for drug-free, psychological interventions to treat psychological disorders.

I soon found a less politically sensitive position at the Uniformed Services University of the Health Sciences in Maryland. Eight years later, I re-entered the political arena as the head of the public mental health system in Montgomery County, Md., but not without a fight from friends of the drug industry. The Maryland Psychiatric Society asked that a state pharmacy committee review my credentials and prescribing practices to make sure that Montgomery County patients would receive proper--read: drug--treatments. In addition, a pro-drug family advocacy organization arranged for more than 250 furious letters to be sent to the elected county executive who had hired me. Fortunately, my employers were not drug-industry-dominated, so I kept my position.

Why does the world of psychiatry find me so threatening? Because drug companies pour millions of dollars into the pockets of psychiatrists around the country, making them reluctant to recognize that drugs may not always be in the best interest of their patients. They are too busy enjoying drug company perks: consultant gigs, research grants, fine wine and fancy meals.

Pharmaceutical companies pay through the nose to get their message across to psychiatrists across the country. They finance major symposia at the two predominant annual psychiatric conventions, offer yummy treats and music to conventioneers, and pay $1,000-$2,000 per speaker to hock their wares. It is estimated that, in total, drug companies spend an average of $10,000 per physician, per year, on education.

And, of course, the doctors-for-hire tell only half the story. How widely is it known, for example, that Prozac and its successor antidepressants cause sexual dysfunction in as many as 70% of people taking them?

What's even scarier is the greed that is directing a good deal of drug testing today. It is estimated that drug manufacturers have, on average, 12 years to recoup costs and make profits on a given medication before a generic form can be made. So pressure to test new drugs mounts. In the field of psychiatric drug testing, organizations make a profit of as much as $40,000 for every patient who successfully completes a trial. And university psychiatry departments, private research clinics and some individual doctors live on this money.

The good news is that the press is catching on. The New York Times, Dallas News, Milwaukee Journal Sentinel and New York Post have recently run articles or series on how pharmaceutical companies use cash incentives to encourage doctors to prescribe their drugs.