Is the American Psychiatric Association
in Bed with Big Pharma?

Written by Ralph E. Stone. Posted in Opinion

Published on November 29, 2011 with 8 Comments

By Ralph E. Stone

November 29, 2011

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association. The DSM provides a common language and standard criteria for the classification of mental disorders, which is used in the United States and to some extent internationally, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies, and policy makers. The DSM is produced by a panel of psychiatrists, many of whom have financial ties to the pharmaceutical industry. It is considered the “bible” of American psychiatry. The latest edition — DSM-IV — was published in 1994.

In 1952, the DSM was a small, spiral-bound handbook (DSM-I), but the latest edition (DSM-IV), is a 943-page magnum opus. Over time, psychiatric diagnoses have increased in the American population and in turn, drugs that affect mental states are then used to treat them. The theory that psychiatric conditions are caused by a biochemical imbalance is often used as a justification for their widespread use, even though the theory in unproven. Since there are no objective tests for mental illness and what is normal and abnormal is often unclear, psychiatry is a particularly fertile field for creating new diagnoses or broadening old ones.

Medications are widely used to treat the symptoms of mental disorders such as schizophrenia, depression, bipolar disorder, anxiety disorders, and attention deficit-hyperactivity disorder. Sometimes medications are used with other treatments such as psychotherapy.

While I am sure research in mental disorders account for some of this increase, I cannot help but believe that there is a certain amount of disease-peddling going on. That is, instead of promoting drugs to treat diseases, diseases are promoted to fit the drugs. For example, shyness as a psychiatric illness made its debut as “social phobia” in DSM-III in 1980, but was said to be rare. By 1994, when DSM-IV was published, it had become “social anxiety disorder,” now said to be extremely common, thus, boosting sales of antidepressants. Now, social anxiety disorder is “a severe medical condition.” In 1999, the FDA approved a drug for social anxiety disorder. After a successful marketing campaign, the sales of Paxil soared.

Presently, a revised version of the DSM is set for publication in 2013. The proposed revision has proven quite controversial. A group of psychologists with the Society for Humanistic Psychology, for examle, has filed a petition objecting to many of the revisions, arguing that they broaden the definition of mental health disorders, which, in turn, could lead to over treatment with drugs. Some, but not all, of the objections of the Society — along with the British Psychological Society and the American Counseling Association — to the proposed DSM-V include:

- The proposed DSM “fails to explicitly state that deviant behavior and primary conflicts between the individual and society are not mental disorders. Given lack of consensus as to the ‘primary’ causes of mental distress, this proposed change may result in the labeling of sociopolitical deviance as mental disorder.”

- “Several new proposals with little empirical basis also warrant hesitation: For example, ‘Apathy Syndrome,’ ‘Internet Addiction Disorder,’ and ‘Parental Alienation Syndrome’ have virtually no basis in the empirical literature.”

- “…clients and the general public are negatively affected by the continued and continuous medicalization of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation.”

Do we really need more mental disorder diagnoses creating the need for more drugs in a society that some would say is already over-medicated? Let’s look at some statistics. According to the Centers for Disease Control and Prevention (CDC) the percentage of Americans who took at least one prescription drug in the past month increased from 44 percent to 48 percent over the past ten years. The use of two or more drugs increased from 25 percent to 31 percent. The use of five or more drugs increased from 6 percent to 11 percent. And in 2007-2008, 1 out of every 5 children and 9 out of 10 older Americans reported using at least one prescription drug in the past month.

And Americans are spending more on drugs. According to the CDC, spending for prescription drugs in the U.S. was $234.1 billion in 2008, which was more than double what was spent in 1999.

And the pharmaceutical industry is profiting. According to Fortune 500 (May 3, 2010 issue date), the profits for the twelve largest pharmaceutical companies was almost $64 billion in 2010. Clearly, Pharma has a financial interest in a DSM with more mental disorders because it will mean a demand for more drugs to treat them.

The critics — and the public too — have a stake in the proposed DSM-V. More mental disorders may mean just more drugs in our over-medicated society.

Supreme Court Justice Oliver Wendell Holmes once quipped, “If all the drugs were thrown in the ocean, everyone would be better-off . . . except for the fish.” While this is a an overstatement, it does contain a grain of truth.

Ralph E. Stone

Ralph E. Stone

I was born in Massachusetts; graduated from Middlebury College and Suffolk Law School; served as an officer in the Vietnam war; retired from the Federal Trade Commission (consumer and antitrust law); travel extensively with my wife Judi; and since retirement involved in domestic violence prevention and consumer issues.

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  • Bernet

    Hi Ralph: You raise some good points regarding the overuse of psychotropic medication. In the process, however, you quoted the Society for Humanistic Psychology, to the effect that there is “no basis in the empirical literature” for the proposal that parental alienation syndrome be included in DSM-5. When my committee submitted our proposal regarding parental alienation and DSM-5, we supplied a bibliography with more than 500 references regarding parental alienation from the professional literature of 30 countries. There is a mountain of research from the “empirical literature” regarding parental alienation. If you contact me at william.bernet@vanderbilt.edu, I will send you the proposal with the 500 references. Or, you can look at our book, Parental Alienation, DSM-5, ICD-11. If you want to do some investigative reporting, you should contact the Society for Humanistic Psychology and try to find out why they are spreading false information about parental alienation and our proposal. That might make a very interesting blog.

  • ThisIsMyPost

    You stated, “shyness as a psychiatric illness made its debut as ‘social phobia’,” in your article. However, there is a huge difference between shyness – a personality trait – and social phobia/social anxiety – an anxiety disorder in the same class as OCD (Obsessive-Compulsive Disorder), PTSD (Post-Traumatic Stress Disorder), specific phobias (i.e. fear of heights), etc. There is nothing wrong with being shy. It is normal. It isn’t treated with medication. It doesn’t produce anxiety attacks, panic attacks, severe pain, etc. – but social anxiety does. Social anxiety is sometimes treated/managed with medication. It isn’t normal. There is something wrong when you have an anxiety disorder.

    The fear of falling from somewhere high up is completely normal but having an anxiety/panic attack because of said fear is not normal. Having shyness as a character trait is normal, but having actual anxiety because of social situations – anything from just being seen (or possibly seen) by another person to thinking one is being whispered about by others to meeting new people to speaking in public – is not normal. Shyness does differ from many of the symptoms of social anxiety, as well. They are two different things.

    Someone who is shy will be quiet, possibly hide away during a gathering, etc. but they don’t suffer physical problems due to the social situation. Someone who has social anxiety issues can go into a full-blown anxiety attack, can suffer from severe pain (i.e. back pain so bad it hurts to breathe), etc. over a simple social situation (such as talking to a single person, going shopping, going to a gathering, etc.).

    Somebody who has social anxiety can actually be a person who has an extroverted personality; a person with social anxiety does not necessarily have an introverted personality, whereas every shy person is an introvert as a matter of definition.

    Social anxiety is a very valid anxiety disorder. Shyness and social anxiety are two very different things.

  • Pingback: American Psychiatric Association and Big Pharma – too ‘close’ for comfort? #mentalhealth « Dawn Willis sharing the News & Views of the Mentally Wealthy

  • http://www.afamilysheartbreak.com mike jeffries

    The DSM is full of relational and short-term adjustment issues that mental health professionals can address without prescribing drugs. Parental alienation, as Dr. Bernet pointed out above, is one of those issues as well as being an issue with plenty of imperical data to back up its inclusion in the next edition of the DSM.

    While the DSM has evolved into a document professionals refer to in order to get reimbursed for their services from insurance companies, let’s remember that its primary purpose is to help professionals identify and address a wide-range of mental health issues. It should be updated based on the kind of imperical data that Dr. Bernet put together for parental alienation, and not based on the lobbying of any special interest group.

    Sincerely,

    mike jeffries

  • Ralph

    The preliminary draft revisions of DSM-V are now available for public review. The Society for Humanistic Psychology (SHP) has filed a petition with more than 7,000 signatures criticizing many changes/additions to the proposed DSM. And this petition has the support of San Francisco’s Saybrook University, with roughly 60 faculty members who emphasize a holistic approach to treating mental illnesses. As I mentioned in my article, the British Psychological Society and the American Counseling Association join SHP in criticism of the inclusion of “Parental Alienation Syndrome” as a mental disorder. After the public review period, the American Psychiatric Association, not I, will have to reconcile all the public comments before publishing DSM-V. After all, much is at stake to get it right as the DSM-V will become the new “bible” of American psychiatry.

    As for my comment that “shyness” has over the years been rebranded as a mental illness called social phobia with many different medications used for its treatment, I wonder if a handful of psychiatrists together with leading drug companies were complicit in rebranding shyness as a social phobia. In other words, has a borderline mental illness become a mental disorder resulting in people taking medications that they really don’t need?

  • Ralph

    A general comment: Pharma is in the business of selling pharmaceuticals, including prescription drugs. To do so, an incestuous relationship has developed over the years between ;physicians who prescribe drugs and Pharma who makes them. Pharma paid out more than $250 million to some 17,000 physicians and nurses in 2009 and 2010. Nearly 400 of these physicians received payments of $100,000 or more to promote drugs, serve as medical consultants, speak at conferences, and enroll patients in trials. In addition, there are complaints that some Pharma companies exert undue influence over key advisory committees tasked with approving vaccines for mandated health-care programs. And the conflict of interest rules of the FDA and CDC are considered weak.

    When someone tells me that a mental disorder is supported by research, I would ask that person to point out which research was funded wholely or in part by a Pharma company, and which, if any, negative studies were selected out or are just re-hashes of positive ones.

  • David Nixon

    The degree of corruption among the psychiatric community is breathtaking. Keep in mind, psychiatric diseases are not discovered, they are invented: there is no blood test, no urine test, nothing that could be confused with legitimate science. Disorders are made up and voted upon: if the condition gets enough votes it is a disorder, like “oppositional defiant disorder”. You know, a young person, defiant of authority, a troublemaker; in short, a teenager, has now been given the status of a disorder and a four or five digit number assigned that will be written in the insurance claim form causing the claim to be paid and the money machine to roll on and a young life begins a long course of powerful medication. And who are the people who invent these diseases? Well, for the current version, the DSM-IV, 56% of the psychiatrists had direct financial ties to at least one pharmaceutical company. The DSM-V is now being put together and is due out in 2012. No less than 68% of these psychiatrists have direct financial ties to at least one pharmaceutical company.

    To be fair, the DSM-V committee has been the object of harsh criticism from within the psychiatric community. Recently, Allen Frances, M.D., the former chair of the DSM-IV Task Force, wrote in Psychology Today that to have any credibility, the DSM-V must be given a critical scientific review that is open, independent, systematic and rigorous. The current task force provides none of these essential requirements, he wrote. It is suggestive of just how bad things are in American psychiatry that Dr. Frances, didn’t even mention that having 68% of the task force members getting kick-backs and bribes from the pharmaceutical industry might also have something to do with its credibility.

  • Richmondman

    What about Dr’s who give medical marijuana prescriptions. There is big money in medical marijuana now. I don’t see a lot of difference, except the general public doesn’t take medical marijuana seriously.

  • Eric Brooks

    We should remember that until very recently in U.S. history, previous versions of the DSM classified homosexuality as a mental illness. This meant that 11% of the population was declared ill by only one entry in the DSM (a proportion that in a -real- disease would be considered an extreme epidemic). This would be equivalent to declaring being left handed or African American a raging epidemic disease. Such a declaration would of course be laughed out of the room now that we are living in the 21st century.

    And yet, so called mass ‘mental illnesses’ like ‘depression’, ‘anxiety’, ‘ADHD’ and ‘ODD’ supposedly exist in similar epidemic proportions, many in far -higher- proportions than 11%.

    The CDC has reported that, “Approximately 9.5% or 5.4 million children 4-17 years of age have ever been diagnosed with ADHD, as of 2007.”, and that TWO THIRDS of those children are on medication for their ‘disease’. And TeenDepression.org reports, “About 20 percent of teens will experience teen depression before they reach adulthood.”

    For comparison, the -real- swine flu epidemic in 2009 infected 6% of the U.S. population.

    So modern medicine is suddenly outrageously declaring to us that scores of NONCOMMUNICABLE mental diseases are effecting epidemic proportions of our population in higher numbers than THE FLU which is AIRBORN…

    The reality of course, is that by no stretch of the imagination, does any true mental disorder effect such epidemic proportions of people, anywhere. The very idea is completely ludicrous.

    All claimed ‘mental illnesses’ in these vast proportions are clearly manufactured imaginary excuses to unjustifiably and unnecessarily, place massive numbers of people on incredibly profitable (and dangerous) pharmaceuticals.