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Number 9: Winter 2013

Cracked: Why Psychiatry is Doing More Harm Than Good By James Davies

Alan Pope

The final part of the book is about the economics of the pharmaceutical industry and their involvement at both institutional and individual level with the psychiatric fraternity. None of it is surprising but the extent is shocking and the amount of money is staggering.  Perhaps it is this section of the book that could lay Davies open to accusations of conspiracy theory.  I would challenge this and would say that he has been very careful to back up any claims with evidence. In examining what he calls ‘psychiatric imperialism’ or the spreading of diagnoses internationally he reveals how this opens up the market for ‘Big Pharma’.

It is also important to contextualise Cracked with other contemporary events, in particular one of which is recorded in the book and one that is not.  Davies is writing about psychiatry and not about clinical psychology.  Nevertheless, I think it should be noted that at the consultation stage of DSM-V the BPS (British Psychological Society) responded officially with grave concerns about the DSM’s ever increasing number of disorders.4 In the book Davies records that there was to be an editorial in the British Journal of Psychiatry written by 29 eminent consultant psychiatrists expressing concern over the current state of psychiatry and how it is not working and advocates a more social and less biological approach.  This runs counter to the view expressed in this journal which generally calls for more medication of ‘brain based’ mental diseases and more diagnoses as a way to resolve the current crisis.  To find out more Davies interviews Professor Sue Bailey President of the Royal College of Psychiatrists and this is where he encounters the most hostility. His interview with her is quoted from extensively. Her responses are both aggressive and defensive.  She partly has a point when she says that GPs are responsible for over prescribing of antidepressants but one of the major factors for this overprescribing is the PHQ9 (Patient Health Questionnaire 9) which was devised by Robert Spitzer and is copyrighted by Pfizer Inc., the Pharmaceutical giant. So over prescribing by GPs is ultimately on the advice from psychiatrists and they must take responsibility for this.  Professor Bailey accuses her colleagues who are questioning the status quo of being zealots whilst claiming that she, and presumably she includes the rest of her colleagues, is being more eclectic!  Whatever the truth of the matter Cracked has certainly exposed a crack! This challenge has now been published but not as an editorial, rather as a special article.5 What this change means is open to conjecture but to me it indicates a distancing by the Royal College of Psychiatrists from these views.

  1. Kinderman, Peter et al (2011), Response to the DSM-V, London: British Psychological Society 

  2. Pat Bracken, Philip Thomas, Sami Timimi, Eia Asen, Graham Behr, Carl Beuster, Seth Bhunnoo, Ivor Browne, Navjyoat Chhina, Duncan Double, Simon Downer, Chris Evans, Suman Fernando, Malcolm R. Garland, William Hopkins, Rhodri Huws, Bob Johnson, Brian Martindale, Hugh Middleton, Daniel Moldavsky, Joanna Moncrieff, Simon Mullins, Julia Nelki, Matteo Pizzo, James Rodger, Marcellino Smyth, Derek Summerfield, Jeremy Wallace, and David Yeomans (2012) ‘Psychiatry beyond the current paradigm’ British Journal of Psychiatry, December 2012 201:430-434; doi:10.1192/bjp.bp.112.109447.