Anatomy of an Epidemic (41 page)

Franklin, who interviewed more than fifty leading psychiatrists for his series, called this new science “molecular psychiatry,” which was “capable of curing the mental diseases that afflict perhaps 20 percent of the population.” He was awarded the Pulitzer Prize for expository journalism for this work.

Books written by psychiatrists for the lay press at this time told a similar story. In
The Good News About Depression
, Yale University psychiatrist Mark Gold informed readers that “we who work in this new field call our science
biopsychiatry
, the new medicine of the mind…. It returns psychiatry to the medical model, incorporating
all the latest advances in scientific research, and for the first time in history, providing a systematic method of diagnosis, treatment, cure and even prevention of mental suffering.” In the past few years, Gold added, psychiatry had conducted “some of the most incredible medical research ever done…. We have probed the frontiers of science and human understanding wherein lie the ultimate comprehension and cure of all mental illnesses.”
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If there was one book that cemented this belief in the public’s mind, it was
The Broken Brain
. Published in 1984 and written by Nancy Andreasen, future editor of the
American Journal of Psychiatry
, it was touted as “the first comprehensive account of the biomedical revolution in the diagnosis and treatment of mental illness.” In it, Andreasen concisely set forth the tenets of biological psychiatry: “The major psychiatric illnesses are diseases. They should be considered medical illnesses just as diabetes, heart disease, and cancer are. The emphasis in this model is on carefully diagnosing each specific illness from which the patient suffers, just as an internist or neurologist would.”
⁴⁷

The broken brain
—hers was a book with a brilliant title, one that conveyed a bottom-line message that the public could easily grasp and remember. However, what most readers failed to notice was that Andreasen, in several places in her book, confessed that researchers had not yet actually
found
that people diagnosed with psychiatric disorders have broken brains. Researchers had new tools for investigating brain function, and they hoped this knowledge would come. “Nevertheless, the
spirit
of a revolution—the sense that we are going to change things dramatically, even if the process requires a number of years—is very much present,” Andreasen explained.
⁴⁸

Twenty-five years later, that breakthrough moment still lies in the future. The biological underpinnings of schizophrenia, depression, and bipolar disorder remain unknown. But the public has long since been convinced otherwise, and we can see now the marketing process that got this delusion under way. At the start of the 1980s, psychiatry was worried about its future. Sales of psychiatric drugs had notably declined in the past seven years, and few medical school graduates wanted to go into the field. In response, the APA
mounted a sophisticated marketing campaign to sell its medical model to the public, and a few years later the public could only gasp in awe at the apparent advances that were being made. A revolution was under way, psychiatrists were now “mind-fixers,” and as a Johns Hopkins “brain chemist,” Michael Kuhar, told Jon Franklin, this “explosion of new knowledge” was going to lead to new drugs and broad changes in society that would be “fantastic!”
⁴⁹

Psychiatrists were not the only ones in American society who were eager to tell of a biomedical revolution in psychiatry. During the 1980s, a powerful coalition of voices came together to tell this story, and this was a group with financial clout, intellectual prestige, and moral authority. Together they enjoyed all the resources and social status necessary to convince the public of almost anything, and this storytelling coalition has stayed intact ever since.

As we saw earlier, the financial interests of pharmaceutical companies and physicians became closely aligned in 1951, when Congress gave doctors their monopolistic prescribing privileges. But in the 1980s, the APA and the industry took this relationship one step further and essentially entered into a drug marketing “partnership.” The APA and psychiatrists at academic medical centers served as the front men in this arrangement, the public thereby seeing “men of science” on stage, while the pharmaceutical companies quietly provided the funds for this capitalistic enterprise.

The seed for this partnership was planted in 1974 when the APA formed a task force to assess the importance of pharmaceutical support for its future. The answer was “very,” and in 1980 that led the APA to institute a policy change of transformative importance. Up to that time, pharmaceutical companies had regularly put up fancy exhibits at the APA’s annual meeting and paid for social events, but they hadn’t been allowed to put on “scientific” talks. However, in 1980, the APA’s board of directors voted to allow pharmaceutical companies to start sponsoring scientific symposiums at its annual
meeting. The drug firms paid the APA a fee for this privilege, and soon the most well-attended events at its annual meeting were the industry-funded symposiums, which provided the attendees a sumptuous meal and featured presentations by a “panel of experts.” The speakers were paid handsomely to give the talks, and the drug companies made certain that their presentations went off without a hitch. “These symposia are meticulously prepared with rehearsals before the meeting, and they have excellent audio-visual content,” Sabshin explained.
⁵⁰

The door to a full-fledged “partnership” had been flung open, one that would sell the medical model and the benefits of psychiatric medications to the public, and the APA now began to regularly rely on pharmaceutical money to fund many of its activities. The drug companies began “endowing” continuing education programs and psychiatric grand rounds at hospitals, and, as one psychiatrist observed, the companies were “happy to cap them with free food and booze to sweeten the love of learning.”
⁵¹
When the APA launched a political action committee in 1982 to lobby Congress, this effort was funded by pharma. The industry helped pay for the APA’s media-training workshops. In 1985, APA secretary Fred Gottlieb observed that the APA was now receiving “millions of dollars of drug house money” each year.
⁵²
Two years later, an issue of the APA’s newsletter,
Psychiatric News
, featured a photo of Smith, Kline and French handing a check to APA president Robert Pasnau, which led one reader to quip that the APA had become the “American Psychopharmaceutical Association.”
⁵³
The APA was prospering financially now, with its revenues jumping from $10.5 million in 1980 to $21.4 million in 1987, and it settled into a fancy new building in Washington, D.C. It openly talked about “our partners in industry.”
⁵⁴

For the drug companies, the best part of this new partnership was that it enabled them to turn psychiatrists at top medical schools into “speakers,” even while those doctors considered themselves “independent.” The paid-for symposiums at the annual meetings greased this new relationship. The symposiums were said to be “educational” presentations, with the drug companies promising not to “control” what the experts said. Yet their presentations were
rehearsed
, and every speaker knew that if he broke from that script and started
talking about the drawbacks of psychiatric medications, he would not be invited back.
^*
There would be no industry-sponsored symposiums on “supersensitivity psychosis,” or the addictive effects of benzodiazepines, or how antidepressants were no more effective than active placebo. These speakers came to be known as “thought leaders,” their presence on the symposium panels elevating them to the status of “stars” in the field, and by the early 2000s, they were getting paid $2,000 to $10,000 per speech. “Some of us,” confessed E. Fuller Torrey, “believe that the present system is approaching a high-class form of prostitution.”
⁵⁵

These “thought leaders” also became the experts regularly quoted by the media, and they wrote the textbooks published by the APA. Psychiatry’s thought leaders shaped our society’s understanding of mental disorders, and once they began serving as paid speakers, the pharmaceutical companies sent money their way through multiple channels. As the
New England Journal of Medicine
observed in 2000, thought leaders “serve as consultants to companies whose products they are studying, join advisory boards and speakers’ bureaus, enter into patent and royalty arrangements, agree to be the listed authors of articles ghostwritten by interested companies, promote drugs and devices at company-sponsored symposiums, and allow themselves to be plied with expensive gifts and trips to luxurious settings.”
⁵⁶
Nor was it just a few psychiatrists from academia that pharma courted with its dollars. The drug industry understood this was a very effective way to market their drugs, and collectively the companies began paying money to virtually every well-known figure in the field. In 2000, when the
New England Journal of Medicine
tried to find an expert to write an editorial on depression, it “found very few who did not have financial ties to drug companies that make antidepressants.”

The NIMH also joined this storytelling coalition. The biological psychiatrists knew that they had successfully captured the NIMH when the Soteria Project was closed and Mosher was ousted, and during the 1980s the NIMH actively promoted the biological psychiatry story to the public, an effort that took wing under the leadership of Shervert Frazier. Prior to being picked to head the NIMH in 1984, Frazier directed the APA’s Commission on Public Affairs, which had run the media-training workshops underwritten by pharmaceutical firms, and soon Frazier was announcing that the NIMH, for the first time in its forty-year history, would launch a major educational campaign called the Depression Awareness, Recognition and Treatment (DART) program. This educational effort would inform the public that depressive disorders are “common, serious and treatable,” the NIMH said. Pharmaceutical companies would “contribute resources, knowledge and other forms of assistance to the project,” which the NIMH promised would run for at least a decade.
⁵⁷
As it helped expand the market for psychiatric medications, the NIMH even assured the public that the broken-brain story was true. “Two decades of research have shown that [psychiatric disorders] are diseases and illnesses like any other diseases and illnesses,” said NIMH director Lewis Judd in 1990, even though nobody had ever been able to explain the nature of the pathology.
⁵⁸

The final group to participate in this storytelling campaign was the National Alliance for the Mentally Ill. Founded in 1979 by two Wisconsin women, Beverly Young and Harriet Shelter, it arose as a grassroots protest to Freudian theories that blamed schizophrenia on “aloof, uncaring mothers and preoccupied mothers who were unable to bond with their infants,” a NAMI historian observed.
⁵⁹
NAMI was eager to embrace an ideology of a different kind, and the message it sought to spread, said former NAMI president Agnes Hatfield in 1991, was that “mental illness is not a mental health problem; it is a biological illness. There is considerable clarity on the part of families that they are focusing on a physical disease.”
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For the APA and pharma companies, the emergence of NAMI could not have come at a more opportune moment. This was a
parents’
group eager to embrace biological psychiatry, and both the APA and pharmaceutical firms pounced. In 1983, the APA “entered into an agreement with NAMI” to write a pamphlet on neuroleptic drugs, and soon the APA was encouraging its branches across the country “to foster collaborations with local chapters of the National Alliance for the Mentally Ill.”
⁶¹
The APA and NAMI joined together to lobby Congress to increase funding for biomedical research, and the beneficiary of that effort, the NIMH—which saw its research budget soar 84 percent during the 1980s—thanked the parents for it. “The NIMH in a very meaningful sense is NAMI’s institute,” Judd told NAMI president Laurie Flynn in a 1990 letter.
⁶²
By that time, NAMI had more than 125,000 members, most of whom were middle-class, and it was busily seeking to “educate the media, public officials, healthcare providers, educators, the business community, and the general public about the true nature of brain disorders,” said one NAMI leader.
⁶³
NAMI brought a powerful moral authority to the telling of the broken-brain story, and naturally pharmaceutical companies were eager to fund its educational programs, with eighteen firms giving NAMI $11.72 million from 1996 to 1999.
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In short, a powerful quartet of voices came together during the 1980s eager to inform the public that mental disorders were brain diseases. Pharmaceutical companies provided the financial muscle. The APA and psychiatrists at top medical schools conferred intellectual legitimacy upon the enterprise. The NIMH put the government’s stamp of approval on the story. NAMI provided a moral authority. This was a coalition that could convince American society of almost anything, and even better for the coalition, there was one other voice on the scene that, in its own way, helped make the story bulletproof in society’s eyes.

The story of a “psychopharmacology revolution” had first been told in the 1950s and 1960s, and then, as we’ve seen in this chapter, it was revived in the 1980s. However, the storytellers in the 1980s
were more vulnerable to criticism than the storytellers of the earlier decades simply because there was now twenty years of research that undermined their narrative. None of the drugs had proven to help people function well over the long term, and the chemical-imbalance theory of mental disorders was in the process of flaming out. As NIMH researchers had concluded in 1984, “elevations or decrements in the functioning of serotonergic systems per se are not likely to be associated with depression.” Close readers of
The Broken Brain
could also see that, in fact, no great new discoveries had been made. There was a Grand Canyon–sized gap between what the broken-brain storytellers were intimating was true and what was actually known, and that same gap would appear in their stories when Prozac and the other second-generation drugs came to market. But fortunately for the proponents of biological psychiatry, criticism of the medical model and of psychiatric drugs became associated, in the public mind, with Scientology.