DAVID HEALY is a respected historian of psychiatry who has written a book that should spark a major debate. He identifies current trends towards the abandonment of independent research into treatments for mental illness, the demand for Randomised Control Trials as the only acceptable measure of whether a treatment works, and the chilling control pharmaceutical companies now exert over psychiatry.
There may be worse to come. US corporate "managed care" is moving into health systems throughout the world, with a sharp division between medically- trained (and well-paid) physicians who prescribe drugs and (moderately- paid) therapists. As Healey's exquisitely detailed history makes clear, the most effective treatments have been a mixture of both.
Now that the more debilitating mental illnesses are managed through chemical treatments, he cautions that psychiatry is moving towards managing personality. "Why should a physician with no ethical training have the ability to decide whether taking a pill that makes one less sensitive to work-related stress is a good idea?" Physicians prescribing, for example, Ritalin to children, do not think of the social consequences.
These changes, he argues, result from developments in psychiatry that have led North America and Europe to a dangerous place: "we are becoming less rather than more rational".
One form this irrationality takes is that drugs are prescribed to treat the symptoms of a psychiatric syndrome without having been proven effective. …