Tell that to the patients who run the National Depressive and
Manic-Depressive Association, for whom medication, often combined with
psychotherapy, has made the difference between a shadow-like existence on
the margins of life and the high-level functioning necessary to sustain a
successful organization.
Tell that to the thousands of social workers, psychologists and
psychiatrists who work with the seriously mentally ill every day and who
know from their own experience that without medications, their patients
could not engage with them in the difficult psychological work of
recovery.
Don't forget that before the psychopharmacology revolution, our
state hospitals were filled with hundreds of thousands of individuals
trapped in their psychosis, the victims of what modern research has
clearly shown to be brain disorders. Today only the tiniest fraction of
the mentally ill still require involuntary hospitalization. Why ?
Primarily because of modern medications. Throughout the long history of
psychiatry and psychology during the pre-drug era, countless heroic
efforts to treat severe mental illness with psychotherapy alone ended in
frustration, a frustration keenly felt by patients, families and
caregivers alike.
Mosher suggests that the pharmaceutical industry is a monolithic
force. In reality, a variety of drug companies compete with one another
for market share, and clinicians seem to be able to sift through
competing claims and counterclaims.
While our ability to treat these disorders has improved
dramatically over the last 30 years, there is still much to be done. The
development of novel drugs will continue to be essential to improving
treatment options. Pharmaceutical innovation depends on lively
competition in the industry, adequate capitalization of what is a
high-risk business and, most importantly, a close working relationship
between industry, government and academia. The procedures and safeguards
needed to ensure the integrity of this process require continued
discussion. But it needs to be conducted seriously.
A Response By Frederick K. Goodwin
"We Advocate For the Patient and For Quality Treatment"
Dr. Mosher raises an issue of great concern for all of medicine:
the commercial influence on medical education. The APA supports the
rigorous stands taken by both the American Medical Association and the
Accreditation Council for Continuing Medical Education (ACCME) in this
area, and has instituted a careful review and monitoring process,
ensuring that sessions supported by the pharmaceutical industry at our
meetings present solid scientific information in an unbiased
manner.
We control all aspects of this process: We choose the topics and
the speakers, and we control the logistics and evaluation.
These sponsored sessions represent only a small percentage of the
program and are routinely well-attended and highly rated for scientific
content and lack of bias. Companies are charged a fee (though not "rent,"
as the writer indicates), much of which covers the cost of reviewing and
monitoring the presentations.
No advertising is permitted and the company's name is mentioned as
required by the ACCME guidelines. It would be pointless to exclude
industry from our meetings altogether because this would empower them;
they would set up independent symposia at the time and location of our
meetings, but outside of our control.
In addition, throughout APA programs and publications,
nonpharmaceutical treatments for mental disorders are explored,
emphasized and, in many cases, recommended.
A major APA commission focuses on the application and efficacy of
psychotherapy. Our practice guidelines--prepared with no commercial
support whatsoever--include recommendations on psychotherapy and other
nonmedication-based treatments, and we continue to recommend
psychotherapy training for residents. As with any medical specialty, our
members have varying attitudes about treatment modalities, but the APA
supports the use of a wide variety of therapeutic options geared toward
the needs of the particular patient and continues, above all, to advocate
for the patient and for quality treatment.
A Response By the American Psychiatric Association
"The Time for Helplessness And Bitterness Is Past"
It would be tragic if Dr. Mosher's personal history prevented
anyone with mental illness from obtaining effective treatment. In the
years since Mosher has been active in research, a revolution has
occurred. In place of medications with questionable efficacy and major
negative side effects, or unproven and expensive psychotherapies, we now
have a variety of safe and effective medications and psychotherapies for
most mental illnesses.
The National Institute of Mental Health, with public funds, has
overseen this quiet revolution and has funded its own studies to make
sure that the new mood stabilizers, antidepressants and antipsychotics
work for Americans with mental illness. While much remains to be done,
the time for helplessness and bitterness is past.
A Response by the National Institute of Mental Health
"All People Should Have The Right to Make Their Own
Decisions"
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