by Randy Cima, PhD
Business has never been better, thanks for asking. As long as the public — you and I — continue to demand newer and better quick-fix chemicals, we act as a sales force for this huge industry. The peddling of psychiatric chemicals, like all businesses, is subject to market pressure. Right now, there is continuing pressure to create more and more chemicals for more and more of our discomforts. Our demand is met, happily, by Big Pharma’s supply.
Here’s an example. ADHD (Attention Deficit Hyperactive Disorder) has been increasing five to six percent a year for the past few decades. Currently, there are more than six million children nationwide diagnosed with this brain disorder1. That means — like no other country on earth — one of every ten American children between the ages of 3 and 17 can be prescribed “speed” (central nervous system stimulants) to “treat” their ADHD.
And there’s this. In their unending quest to expand their customer base, about two decades ago psychiatry and their Big Pharma cohorts started funding studies to convince us this fake condition was somehow infecting adults too. Like the well-oiled machine it is, it has worked stupendously well. From MedMD, July 13, 2022:
It’s estimated that adult ADHD affects more than 8 million adults (or up to 5% of Americans). Many of them don’t even know it. Several studies suggest less than 20% of adults with ADHD are aware that they have it. And only about a fourth of those who do know are getting treatment for it.2
That’s a total of 14 million people with this preposterous diagnosis. And, as if not already enough, Big Pharma and knowledgeable professionals routinely caution us at every turn, to make sure we understand, and to make sure we let our family, friends, and neighbors know, there’s likely many, many, many others who are “un-diagnosed,” and “unreported.” So please, dear customer, keep spreading the word.
Your psychiatrist can choose from 61 different chemicals for ADHD — with more on the horizon. There are 78 chemicals for depression, and there are 15 kinds of depression. Antipsychotics? 26. There are 12 chemicals to treat autism, the most maligned of all children (see A Story About Autism: here). Anxiety disorder of some sort? There are 188 chemicals in 9 different “topics” to help you if you are too anxious. Anxiety relief, as you can tell, is a big seller.3
Let’s take a quick picture of the growth of this industry in the past 70 years.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is psychiatry’s book of fictitious diseases.4 In 1952, there were 106 diseases. In 1968, the second edition of DSM was published, and there were 182. The third edition, published in 1980, named 265, and then revised in 1987 to 292. In 1994, the fourth edition of the DSM increased the number of psychiatric diseases to 410 diseases.5
The DSM 5 was released in 2013. It was designed to replace its 20-year-old, very dated predecessor. Since its release 10 years ago — and even before its release — DSM 5 had been roundly criticized by nearly everyone, including psychiatrists and other mental health professionals, the NIH (National Institutes of Health), and the British Psychological Society (who do not use it), to name a few. They have good reasons to criticize this scientific debacle. (You can read more about this here.) The newest edition, DSM 5TR, has expanded the number of diseases even more.
Every professional I’ve known in the past 45 years uses the DSM as a billing device, nothing else. It has no therapeutic value. It doesn’t provide any treatment suggestions and it doesn’t provide any clues to etiology — a fancy word for the pseudo-causes of these pseudo-diseases. The DSM only provides a name and number to the mental health professional, or agency, so they can bill their insurance provider. Once a diagnosis is chosen, no professional I’ve known ever refers to the DSM again. There’s no reason to do so.
However, as a billing device, it is essential. Everyone uses it. By everyone I mean local, state, and federal governments, big business, non-profits, academia, all mental health providers, all hospitals, all schools — everyone. Without a diagnosis from the DSM, treatment cannot be funded by private or public insurance providers. So, as you can see, it pays to be in the book.
How do you get in the book?
Very briefly. After completing rigorous scientific requirements, a Big Pharma company presents a new disease for consideration to the carefully selected, 28-member DSM Task Force of the American Psychiatric Association (APA). Then, the 28 members vote. Majority wins. If you win, a new disease is born, and is now eligible to be funded by insurance companies, including Medicare. If you’re not successful this year, fear not. You can submit again next year
Given the huge financial advantages for having one of your disorders selected to be in the book, there’s a lot of controversy about this process, not the least of which is this:
The financial association of DSM-5 panel members with industry continues to be a concern for financial conflict of interest. Of the DSM-5 task force members, 69% report having ties to the pharmaceutical industry, an increase from the 57% of DSM-IV task force members.6
Who are the winners?
Academia and Big Pharma are the winners, and it’s very competitive. Universities and massive corporations stand in line to reap the rewards. If you can get an unwanted behavior proclaimed a disease by the disease proclaimers, then doctors, universities and corporations will be enriched because, well, we all stand in another line, so we can give them fistfuls of money for their products.
You should also know this. Big Pharma’s most important customer is the psychiatrist, not you. Psychiatrists are the ones who push their products to us. While these companies aim their endless advertisements to entice you, it’s the psychiatrist who grants permission. Big Pharma “field reps” are forever enticing doctors to try their latest concoction, or to provide them with evidence their old concoctions are even effective with other false disorders. The math is easy. More diagnoses, more prescriptions. Big Pharma and the medical profession work in tandem towards a mutually beneficial end.
Where Are We Going?
I trust you know by now, psychiatry in America is a vibrant commodity. That makes you a consumer. By the time you finish this book, you will be much more adept at asking questions about those chemicals your psychiatrist is prescribing for you or your child, and you will be much more able to measure the psychiatrist’s answers. By the way, you can purchase these chemicals — where else — at the local chemical store. As you already know, chemicals can be very, very expensive, especially those requiring a note from a medic.
You can, of course, purchase the same chemicals from a variety of illegal sources, and they are everywhere. They will be able to provide you with one or more of the 10 or so illegal chemicals you can’t buy over the counter, with or without a note from your doctor. You may be surprised to learn the chemicals found at your drugstore and the chemicals found at your corner connection are exactly the same. Exactly. Others are so similar chemically only a chemist could tell you the difference. The effects on a human being are identical. And please recall, it’s the chemical’s physiological effects we are interested in, whether legal or illegal.
4Or: disorders, deficiencies, delays, disabilities, derangements, disturbances, dysfunctions.
Randy Cima, Ph.D., is a psychologist by training. He was the Executive Director for several mental health agencies for children. He is avid opponent of psychotropic chemicals for children, and his efforts have successfully reduced and even eliminated chemicals in his work in helping them with a variety of problems. He also teaches, writes, and lectures on these matters.