Has Psychiatry Become Faust?

Has psychiatry sold its soul to the pharmaceutical industry? This is a question being asked a lot of late with reports of numerous studies published in top medical journals and even textbooks being ghostwritten by the pharmaceutical industry. The New York Times, Wall Street Journal, San Jose Mercury News, and other major news outlets have been reporting on this in recent months (and years) and it has even been the subject, broadly defined, of a recent popular romantic drama, Love and Other Drugs. Recently I was asked to write a book review by a professional journal on the new book, Unhinged: The trouble with psychiatry - A doctor's revelations about a profession in crisis by Daniel Carlat, M.D that addresses these issues in great detail.

First off, you may be familiar with the well known German legend, Faust, which is also a very popular opera. Faust was an elderly scholar unhappy with his life. He makes a deal with the Devil that gives him unlimited knowledge and pleasure for the price of his soul. This arrangement results in many unintended consequences that include the tragic death of a lovely young woman who Faust falls in love with as well as even more life unhappiness for Faust until finally the Devil comes to collect his payment, his soul. Faust (and the adjective Faustian) has since been used to describe an arrangement where an ambitious person compromises his or her ethics (especially their moral integrity) to achieve power, pleasure, prestige, and success and thus the phrase "a deal with the devil" was born.

Not satisfied with the success, power, financial incentives, and prestige of their primarily psychotherapy and modest medication use, the field of psychiatry in recent years (and perhaps decades), according to Dr. Carlat (a practicing psychiatrist in Boston himself), has abandoned their moral integrity, the welfare of their patients, and their identity as an independent professional health care professional. Psychiatrists, in his view, now too often seek to enrich themselves by blindly following the demands of the for- profit pharmaceutical industry. Psychiatry has become Faust - selling its soul to the Devil.

It should be noted that Dr. Carlat isn't stating that all psychiatric medication use is ill advised and only due to the for profit motive of the greedy drug companies and all too willing psychiatrists. He admits that there are plenty of occasions where psychotropic medications can be effectively used to help patients improve the quality of their lives. The problem is that medications are too often overused with other more likely sources of helpful interventions such as psychotherapy and additional psychosocial interventions not offered. Additionally, pressure and various industry incentives encourage aggressive medication use when it isn't clinical indicated or scientifically supported.

Recent press accounts have highlighted the updating of the psychiatric "bible", the highly profitable Diagnostic and Statistical Manual with a 5th edition due to be released during May 2013. As the diagnostic manual has evolved over the years, more and more "disorders" are being added with drugs being their primary mode of treatment. You may have seen press reports stating that half of the personality disorders are being removed such as Narcissistic Personality Disorder which curiously tends to include those disorders that can't really be treated by drugs while those that remain in the new manual (e.g., Obsessive Compulsive Personality Disorder) often are treated by medications. Hummm...could this important document be ghostwritten by Big Pharma?

Several years ago my wife and I were hosting a dinner party with several academic psychiatrists included. We have been good friends for many years and talk candidly. One mentioned that he and his wife were on their way to Europe where he was presenting a lecture. He said that the plane tickets were first class, they were staying for a full week at the Ritz Carlton hotel, and that all expenses were being paid for by a pharmaceutical company. As someone who writes on and teaches courses on ethics I mentioned the many ethical conflicts of accepting such a lavish arrangement. He stated that he saw no ethical conflict at all since he refused to use the presentation slides that the company wanted to provide but would develop his own slides for the presentation. Somehow in his mind, providing his own slides negated any ethical conflicts in the deal. I laughed and said that there still appears to be more than enough ethical issues with the arrangements and went a step further stating that psychiatry has sadly become a whore to the pharmaceutical industry. After a few laughs, he and the other psychiatrist actually agreed with my provocative observation. While they still felt that their own behavior in relationship to the pharmaceutical industry was ethical they agreed with the statement that the field of psychiatry as a whole is now the applied wing of the pharmaceutical industry. Sadly, in their view, psychiatry had become merely an extension of the pharmaceutical industry.

It is sad and disturbing if psychiatry has become Faust. They (as well as perhaps all of us) will likely regret it and suffer greatly in the end. You don't sell your soul to the Devil and win.

Psychiatry really needs to do all that they can do to turn this around and do the right thing. They really must put patient care first and base their interventions on quality scientific research findings that has not been corrupted by big pharma influence. They must avoid conflcits of interest at all costs. Otherwise, their soul has been lost to the devil and they can't be trusted at all.

What do you think?