No reader can finish social anthropologist James Davies' Cracked: The Unhappy Truth About Psychiatry, without a profound distrust of the medicalization of the mental
health industry. Many books and articles have been published in the past twenty
years about the ubiquity of the pharmaceutical industry's psychoactive drug market in our everyday lives, but this book is outstanding for its exposé of deceptive research and opportunistic marketing practices deployed by the major pharmaceutical companies that are household names to most of us. Davies discovers the reason that these companies are household names, noting that the U.S. and New Zealand are the only countries in the world in which it is legal for pharmaceuticals to market directly to consumers. Far from ensuring product transparency, these direct marketing campaigns are buttressed by medical misinformation about the efficacy of antidepressants and antipsychotic medication. Davies' hypothesis is that psychiatry has
created a huge market for psychiatric treatments. The preferred treatments are pharmaceutical treatments such as antidepressants and antipsychotics. But the emerging reality is that these treatments don't actually work in the way most people believe. In the case of antidepressants, mostly they have placebo effects, negative effects, and sometimes mind-numbing effects. But never can we assume they have curing effects, largely because for the vast majority of disorders listed in the DSM there is no discernable 'disease' that these pills target and treat. (172)
Davies uses an investigative journalism approach to uncover the facts in support of his hypothesis. The most compelling chapters in this regard are Chapter Four, "The Depressing Truth About Happy Pills," Chapter Seven, "Bio-Babble?," Chapter Eight, "Money and Power Ruling Head and Heart," and Chapter Nine, "But They Make Us Rich." Chapter Four begins with an interview of Dr. Irving Kirsch, one of the most internationally known figures in antidepressant research. Kirsch had appealed through the Freedom of Information Act to get the pharmaceutical industry's unpublished trials included in his meta-analysis of all the clinical trials that compared the effects of antidepressants to the effects of placebos on depressed patients. The result of this meta-analysis showed that the new wave of antidepressants worked no better than placebos for the vast majority of patients in the trials (54). The argument in Chapter Seven disproves the prevalent myth that there are genetic disorders or brain chemistry imbalances that cause, or are even correlated with depression and other mood disorders as these are described by the prevalent standard diagnostic tools, Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and the International Classification of Diseases (ICD). In this chapter, Davies surveys the various brain chemistry deficiency claims that have been used by the American Psychiatric Association and the biomedical and pharmaceutical industry to market antidepression medication. He shows the flaws in the standard deductive arguments deployed by these entities, by virtue of the arguments' violation of basic neuroscience tenets as to how neuotransmitters work. The chapter's finale lies in its review of the recent and most definitive meta-analysis of all antidepressant clinical studies, published in the New England Journal of Medicine, revealing that there is not one convincing piece of evidence to support any version of the chemical imbalance theory.
Chapters Eight and Nine tell the disheartening and alarming story of how nearly all psychiatric drug research is sponsored and manipulated by the pharmaceutical industry, and the profitable complicity in this manipulation by the Food and Drug Administration, doctors, and academic researchers. No reader can read the evidence presented here and continue to believe that medical drug trials meet the highest supervisory and ethical standards or that psychiatric drug prescriptions induce results beneficial to the patient. The list of pharmaceutical industry deception strategies and actual examples of these deceptions is long and convincing. The list includes non-disclosure of negative results in clinical trials (120-121); "information laundering" in professional journals (122-123); "cherry picking data" that is positive from the data sets and ignoring the rest (124-127); "salami slicing" by hiding negative results and reiterative publishing of positive data (127-128); "pooled analyses" that select positive results in meta-analyses of the clinical literature (128); and "washing out" that eliminates people who react well to placebos prior to the start of the official trials (128).
The triumph of the medicalization of mental health takes complicity on a grand scale. To see this scale, Davies looks at the financial ties between DSM task force members and the pharmaceutical industry, and he interviews Congressional Senator Chuck Grassley, who supports intensified regulation of the mental health industry and the moral reform of corporate America. Predictably, 21 out of 29 the DSM-V task force members received substantial contributions in the form of research funding, consultancy fees and honoraria. Grassley's investigations range from following up on an FDA whistleblower of the Merck-Vioxx cover-up of the nearly140,000 heart attacks caused by Vioxx, to research universities' negligence in tracking the conflicts of interest between its faculty researchers and the pharmaceutical funds accepted to support drug research. Because the National Institute of Health exerts no pressure to report conflicts of interest, American universities in turn exert no vigilance or sanctions in the matter. Rather, Davies chronicles, by virtue of Grassley's investigations, a multitude of academic research institutions and lead researchers that provide the sorts of aforementioned strategies, at great financial benefit to themselves as individuals and to their academic departments (138-142). Grassley found that there is no U.S. or United Kingdom law prohibiting psychiatrists or doctors from inaccurately reporting their discretionary earnings, so serious questions about universities' double-edged relationship with pharmaceutical industry money are not addressed by their administrations.
Other chapters in Cracked cover the history of the politicized growth of successive editions of the DSM, the manufactured mental health epidemics parasitic on the expansion of DSM categories, the globalized importation of the medicalized American mental health model, and the reductive biological vision of human emotional suffering that is contagious with the global medicalization of mental health. Davies credits the literature on these topics that precedes his book, but works to dissuade readers away from acceptance of psychiatric drugs, per se. No one should discount the evidence provided by Davies. This book, because of its journalistic tone, is an arresting experience to read. It is indispensable for anyone considering whether to accept a psychiatric diagnosis or prescription. Cracked would be excellent assigned reading in any high school or college course that considers the cultural, political, ethical, or scientific implications of contemporary mental health diagnostic and treatment systems.
© 2014 Kate Mehuron
Kate Mehuron, Associate Dean of Programs and Professor of Philosophy, Eastern Michigan University. Correspondence: [email protected]