Thursday, August 09, 2018

Institutional corruption in psychiatry

I've commented before on corruption within psychiatry (eg. see previous post). Dainius Pūras, the United Nations Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, who I have mentioned before (eg. see previous post), produced a report last year on corruption and the right to health, with a special focus on mental health. The World Psychiatric Association (WPA) objected strongly to the report (see letter sent to Dainius Pūras) and seems to be particularly complaining about the specific focus on psychiatry.

Robert Whitaker and Lisa Cosgrove in their book Psychiatry under the influence highlighted the institutional corruption due to over-marketing of stimulants for ADHD, the expansion of the notion of depression, the extension of SSRI antidepressants for other neurotic conditions besides depression and for children, and the promotion of mood stabilisers (see previous post). Perhaps WPA need to read this book to find the evidence for the statements in the Special Rapporteur's report.

There is no doubt that psychiatric power is misused for private gain. It seems reasonable that the Special Rapporteur should have a focus on corruption in mental health in this report, taking into account the context of his previous report, which raised the issue of the global burden of obstacles that persists in mental health care systems globally and how this hinders the realisation of the right to mental health. These obstacles include (1) the dominance of the biomedical model and the overuse of biomedical interventions, in particular psychotropic medications (2) power asymmetries and (3) the use of biased evidence.

Institutional corruption develops when systemic practices, which are legal, accepted and normative, nonetheless undermine the integrity of the institution. Disclosure is insufficient to control conflicts of interest (see previous post). In fact, there is little attempt to hide the commercialisation of psychiatry. Ironically being open about commercial interests does not purify psychiatric science but rather exposes its self-interest (see another previous post). The WPA does need to recognise and correct its own institutional corruption. The corrupting self-interests of psychiatry demand change in psychiatric practice.

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