The Fox and the Chicken Coop
A Robert Whitaker blog title, Psychiatry Through the Lens of Institutional Corruption, recently got my attention.
I first heard of Robert Whitaker when Glasser told me about a book Whitaker wrote called Mad in America. Glasser was particularly excited about the book, which led to me buying the book for myself, and which further led to me strongly agreeing with Glasser’s assessment of it. Mad in America was a really well-written book on the history of mental illness and the bad medicine and science that has attempted to treat it.
My interviews with Glasser, which took place between late 2003 and early 2008, often began with him catching me up on what his latest brainstorm was or what his latest idea for a project was or what article or book had caught his attention. Mad in America was such a book. Glasser’s biography includes several illustrations and quotes from Whitaker’s book as the two men, although not colleagues who had worked together or communicated at all, and although looking at the topic from very different perspectives actually saw mental health in very similar ways.
Whitaker’s Mad in America, published in 2002, and Glasser’s Warning, which came out in 2003, were highly complimentary views on what ailed the mental health industry. Both Whitaker and Glasser saw psychiatry as part of the problem, rather than contributing to the solution. Glasser pointed out in Warning that “The unwillingness of the medical profession to come to grips with the creativity of an unhappy brain costs billions of dollars every year. If we wait for the medical profession to take the lead here, we will wait forever.” Warning took direct aim at psychiatry and at the pharmaceuticals that benefitted from psychiatry’s treatment strategies, but it was a role Glasser didn’t relish. He was more into the good fight of mental health than the bad fight of mental illness. During one of our interviews when I questioned him about not staying in a more aggressive stance, he explained that “I’m damning psychiatry as much as I’m gonna damn it. I’m saying they diagnose diseases that don’t exist, they give drugs that can harm you, and they tell you that you can’t help yourself. That’s about as good as I can do.”
Glasser came to believe that psychiatry was perpetrating a medical fraud on the American people, a belief that Whitaker appears to have arrived at as well. In his 2015 book, Psychiatry Under the Influence, Whitaker writes about his investigation of the American Psychiatric Association through the lens of institutional corruption. Working with Lisa Cosgrove, a professor at UMASS Boston, through a grant to the Safra Center for Ethics at Harvard University, he looked at the bigger picture of the APA’s role in current practice.
“The basic concept of institutional corruption is this,” Whitaker explained. “There are economies of influence that create incentives for behaviors by members of the institution that are antithetical to the institution’s public mission. When this happens, the corrupt behavior may become normative, and even go unrecognized as problematic by those within the institution.”
The year 1980 was significant for the APA in that, due to the 3rd edition of the DSM being published, it became the year in which they created a disease model for diagnosing and treating psychiatric disorders. Once the disease model was adopted, it laid claim to having societal authority over three domains: 1) diagnosis of psychiatric disorders, 2) research into their biological causes, and 3) drug treatments.
1. Diagnosis of psychiatric disorders
2. Research into their biological causes
3. Drug treatments
These domains created economies of influence that included the influence of the pharmaceutical industry, and the influence of psychiatry’s own guild (profession) interests. This guild then had a need to inform the public its diagnoses were valid, that its research was producing an understanding of the biology of psychiatric disorders, and that its drugs were effective. In other words, the psychiatric “fox” was now guarding the psychiatric “chicken coop.”
This is a big deal. “If science supported these stories,” Whitaker points out, “there would be no problem. But if science did not support the stories, then the [psychiatric] guild would be tempted to tell society stories that were out of sync with science and betray its public mission.” This is what is meant by corruption. His investigation was not over whether psychiatric disorders are real, or about the risks vs benefits of psychiatric drugs. Instead, Whitaker’s inquiry focuses on whether the institution is fulfilling its duty to the public.
Whitaker concludes with “The institution of psychiatry, with its disease model, has dramatically changed our society over the past 35 years. It has given us a new philosophy of being, and altered how we view children and teenagers, and their struggles. It has touched every corner of our society, and this societal change has arisen because of a story told to the public that has been shaped by guild and pharmaceutical influences, as opposed to a record of good science. That is the nature of the harm done: our society has organized itself around a ‘corrupt’ narrative.”
This is what Glasser was trying to tell us when he wrote the Warning book. This is why he wanted us to see mental illness as a public health issue centered around education rather than drugs. Using a baseball metaphor, Glasser kept his eye on the ball throughout his career. Writers like Robert Whitaker are helping us keep our eyes on the ball, too.
Click on the book to access the Glasser biography through Amazon.