After I received my 50-year distinguished fellow award at APA's 2004 annual
meeting in May, there was time for thought on the flight back to New Mexico
and my practice. APA has become a polarized organization, perhaps a reflection
of the larger society, but it has tilted too far toward the advocacy of
unsupported "biologic" diagnostic and treatment practices that
corrode its efficacy and leadership.
We have trained a generation of psychiatrists who are "one-trick
ponies," with no arrows in their quiver after pharmacy and"
rational polypharmacy" fail their patients. Perhaps that is why
we are so threatened now that New Mexico and Louisiana have granted
prescription privileges to psychologists.
It is ironic that we are witnessing serious challenges to the scientific
integrity of studies supporting the FDA approval of the SSRI class of
antidepressants at a time when an unsilent majority of us go along with the
pretense that this is evidence-based psychiatry. The editors of
Lancet wrote in the April 4 issue that "selective reporting of
favourable research should be unimaginable."
It is too easy to fault the drug companies. There are too many of us whose
integrity has been compromised by grant support or honoraria for the rest of
us to be able to trust their advice. The late George Engel, M.D., whom many of
us consider the primary advocate of the biopsychosocial approach, would
consider current statements about neuro-bio-chemical-genetic causality of
mental disorders regressive.
I consider myself fortunate to be able to continue to practice psychiatry
now that I am retired from teaching and lucky that I received my award before
the name of APA changes, perhaps to the American Bipolar Association.