This is available on another page, but I think it’s worth repeating.
Question: What is Big Pharma and why do you write about it so much? There are a number of interrelated reasons:
- Big Pharma, that is, the 50 or so biggest pharmaceutical companies, is an enormously powerful force in government and medicine, and I think people need to understand the depth of this. They have the power to control which “peer-reviewed” research gets published, this in turn has an influence on which drugs get prescribed, and in addition to this they have the power to wage billion-dollar advertising campaigns. They have a tremendous power to influence the very way we think about mental health. They have billions and billions of dollars.
- A group of psychologists are pushing very actively for prescription privileges (RxP), the right to prescribe antidepressants, mood stabilizers, antipsychotics, etc. I have mixed feelings about this initiative. It is not something that the membership of the American Psychological Association has had the opportunity to vote on, yet it is being pushed very aggressively. And, state by state, it is being achieved. I have heard some naive thinking on the part of some proponents of RxP regarding the power of BIg Pharma to influence their clinical decisions.
- The current climate in mental health is one that favors biological explanations — this view of mental health tends to favor drug interventions. Psychologists prescribing only adds to tilting the view of mental health as simply a function of physiological processes. The whole “I have a chemical imbalance” philosophy — and an SSRI can cure that. I believe that this view is not only false, but detracts from the real benefits that talk therapy can achieve. The biological view is the one that gets a lot of play in the media. A more balanced view is that of the “biopsychosocial” model — taking in the biological, psychological, and social factors that influence mental health.
- I think this further erodes psychology’s emphasis on the subjective experience of the people we work with. As more psychologists prescribe, inevitably they will take to doing more 15-minute drug consults. It’s just economics. You make a lot more money that way. But it has a lot less to do with the subjective world of the client. Prescribing is not just another specialty, like, say psychological testing, which should serve to understand the subjective experience of the client. Focusing on the subjective experience of patients is what makes psychology unique.
- Psychoactive medications, particularly antidepressants and atypical antipsychotics, are being over-prescribed. They should not be the first line of treatment when someone is feeling sad, mournful, or unhappy about the direction their life is taking. They should not be the treatment of choice when someone is at a challenging stage in their personal development, needing a new job, watching their kids go off to college, getting a divorce, or entering old age, or struggling with their identity. These are problems of living that psychotherapy is very effective in addressing.
- In the end, I am not opposed to the use of psychoactive drugs. In severe cases of depression, or bipolar disorder (manic depression), or schizophrenia these medications can be life-saving. My only concern is that they are prescribed judiciously, and prescribed based on the best research that is out there, not the smile of a drug rep, free samples, distorted research findings, or state treatment protocols that have been unduly influenced by pharmaceutical money.
I have written a number of posts that address these issues, and will be adding links to them on the “big pharma” tab at the top of the blog. In the meantime, you can look at the “categories” sidebar and click on the appropriate topic. That should bring up a host of relevant articles. The “Big Pharma” category should cover a number of the issues at once.
- Big Pharma.
- Prescription Privileges.
- Biological explanations.
- Subjective experience in psychotherapy.
Kalea Chapman, Psy.D.