Vox Populi

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Daniel Burston: Corruption in the Mental Health Professions — Psychology, Psychiatry and the “New Normal” 

                 

The Social Psychology of Corruption

Ask yourself the following question; “What is the most corrupt place in the world?” Forget Sodom and Gomorrah. Forget Caligula’s Rome. Forget the mind-boggling intrigues of medieval and Renaissance Popes and potentates. Focus on the present. Is it the city of Naples or the island of Sicily? Is it a post-colonial country whose brief fling with democracy ended badly, issuing in successive waves of kleptocracy, like Haiti or the Philippines? Or is it a far flung country across the globe with no history of democracy – Russia, Afghanistan, Somalia or Burma?

Transparency International rates Somalia as the most corrupt country in the world, but by all accounts, it has a lot of competition. And besides, in the final analysis, there is no way of determining objectively which of these festering places is really the most corrupt, because criteria, definitions and perceptions of corruption vary considerably from one country, and one continent, to the next. Cash gifts or favors that constitute bribes in our culture are considered a normal part of the cost of doing business in many places, while the pay levels of American CEOs seem utterly absurd to their European counterparts. That being so, there is no universally agreed upon method for quantifying the extent of corruption in any given locale. But judging from the historical record and the present state of the world, certain generalizations are possible.

First, whether it occurs at the local, municipal level or at the highest level of national office, corruption is a powerful anti-democratic force which undermines or perverts the rule of law and blunts or distorts civic mindedness. Indeed, it often sets the stage for oligarchic-authoritarian takeovers of a nominally democratic body politic. And like cancer, it has a tendency to spread, enveloping the lives of increasing numbers of people, often without their knowledge.

Second, if experience is any indication, corruption takes root among believers and unbelievers, people on the Left and the Right, fanatics and moderates alike. It may take different forms in each case, but no one is immune to it by virtue of their beliefs (or lack thereof.) Because it is so distressingly familiar nowadays, many are tempted to imagine that corruption is just as ageless and implacable as our old adversary, Original Sin. But that is actually not the case. Hunter-gatherer tribes and subsistence farming communities, like the Amish, do not generate the kind of economic surplus necessary to facilitate the dishonesty and exploitation that characterize “corrupt” behavior. And that is the kernel of truth behind the old saying “The love of money is the root of all evil.”

Clearly then, human nature is not the whole story. While there is something in our make-up that makes us prone to secrecy and deception, collusion and conspiracy, and so on, social and environmental conditions play a significant role in promoting the spread of corruption as well. Time and again, we see societies where corruption is present but not yet widespread embrace policies and practices that foster the spread of corruption, making it an ingrained and intractable feature of everyday life. The kind of corruption we find in a tribal-theocratic milieu, like Iraq or Afghanistan for example, is not particularly new or surprising. But it is much more virulent now than formerly, owing to the vast quantities of guns, drugs and oil that are produced and exchanged in these countries toxic relationships with foreign powers. There is even some question whether a genuine democracy can ever flourish in circumstances like these.

Conversely, we also know that corruption diminishes to the extent that there is a stable and flourishing middle class who are civically minded, a well functioning and independent judiciary, and a democratic political structure in which elected officials are more responsive – and in the final analysis, more beholden – to their constituents than they are to their political overlords and to special interests. By contrast, corruption tends to intensify in societies where the middle class is enfeebled or disintegrating, where apathy or fatalism take hold, and where the independence of law enforcement, the judiciary and of politicians are compromised by the easy money provided by patrons – whether they be billionaires, corporations or lobby groups of one kind and another. The form patronage takes may be illegal, e.g. money given secretly by drug lords and organized crime, or perfectly legal – particularly when legislators pass laws that enable, legitimate, and normalize practices that more balanced and judicious democracies would never countenance. Among contemporary leaders, Silvio Berlusconi furnishes a vivid example of a symbiotic relationship between legal and illegal forms of patronage, and between Right wing politics and a sleazy, collusive relationship between organized crime and law enforcement. Then again, the sordid career of media magnate Rupert Murdoch reminds us that corruption can compromise the integrity of politicians on either side of the political spectrum, from the bottom to the top of the Parliamentary hierarchy.

The social costs of corruption are quite high. Despite occasional outcries from British celebrities and Royalty, as we now know, Rupert Murdoch and his minions got away with illegal wiretaps for decades because these practices had become, in effect, the “new normal”, and were tacitly sanctioned by the police. In societies like Italy, where corruption is even more prevalent and entrenched, increasing numbers of young people loose their moral compass and revert to the mentality of teen aged gang members – a bleak outlook on life that they retain into adulthood, and pass on to their children in turn. Instead of admiring those with the courage of their convictions, they start to admire criminals and cunning politicians who override, circumvent or bend an increasingly broken system to their will. Younger people who experience their world as irremediably corrupt see life and the world as a big game, whose real rules are unwritten, and not reflected in society’s legal code. And if not supplied with alternative role models, they often admire the “winners”, and view people like these as their heroes.

The tendency to admire those who use bribery and intimidation to refashion local communities so that they conform to their will and wishes promotes a diffuse cult of the “strongman” evidenced, among other things, in the many popular movies that Hollywood makes about gangsters and politicians of this stripe. Strongmen often misappropriate public funds for private purposes, or engage in sordid sexual activities, but are able to get away with it because they inspire so much fear (and/or maintain an impeccable facade.) Admiration for strongmen goes hand in hand with another attitude, namely, the need to revile and reject the “losers” – the victims or prey – whose lack of power provokes thinly veiled contempt.

However, in between the “winners” and the “losers”, i.e. the strongmen and their most abject victims, a corrupt culture always contains a much larger group of passive and increasingly indifferent people who simply “go along” with the status quo, and maintain a façade of normalcy and respectability in the process. Unlike the strongmen and their lackeys, the numbed and generally silent majority tries to avoid becoming targets of violence or foul play by “playing along.” In so doing, of course, they do not inspire fear, nor conspire against the general public. Instead, they seek to avoid losing what they already have by not opposing the powers that be, and by offering them bribes or “cover”, when necessary. The temptation to take the path of least resistance is more prevalent the more people in one’s own milieu have already adopted it. Silent compliance becomes the “new normal”, and in due course, so routine that it becomes completely unconscious – a tacitly accepted part of prevailing social and cultural mores. Even when they are complicit in hiding or abetting a conspiracy of some kind, people like this often angrily disavow any wrong-doing, because they have deluded themselves into thinking that slack conformity with prevailing cultural expectations makes them “good” people.

So, for people who embrace it, this strategy of “adjustment” saves lives and livelihoods, protects families and their social status – all of which are understandable objectives. Unfortunately, however, it also promotes a climate of dishonesty that spreads into all spheres of life, and compromises the integrity of those who compromise routinely with a broken and corrupt system. It erodes their ability to think critically, fostering complacency, suggestibility, intellectual laziness and a haze of brazen lies and subtle mystification masquerading as logic or “common sense.” It creates “good” people who may be fiercely defensive of their good reputation and intentions, but who clearly lack a moral compass. Even when they are undeceived about the way things really are, they lack the willingness or desire to resist evil in its more active, agentic forms.

While not consciously conflicted about their survival strategies, in the final analysis, people in milieus like this are also victims – although by giving their consent to the status quo, they become complicit in their own victimization, and are sometimes rewarded handsomely for it. But like victims everywhere, they harbor feelings of unconscious self-loathing, which they then assuage by indulging in a defense mechanism called “identification with the aggressor”, in which they unconsciously idealize their oppressors, and internalize their attitudes towards the less fortunate – those at the bottom of the social ladder, or those who ran afoul of the implicit power structure. As a result, they share the strongmen’s sadistic contempt for the weak and oppressed, and often experience vicarious thrills when their overlords humiliate or injure those who are naive or foolish enough to cross them. This phenomenon was clearly evident among Jewish kapos in the Nazi concentration camps who were gratuitously violent toward their fellow Jews, attempting to mimic or exceed their Nazi overlords in displays of hatred and contempt for human life. But this example is extreme, and could be dismissed as irrelevant. The point I am making is that same sort of attitude in a much less virulent form underlies the thinly disguised contempt for the underdog embedded in the hearts of thoroughly “respectable” people, and instead of abetting overt sadism, furnishes the perfect pretext for passivity and indifference to the victimization of others (passive aggression.)

Examples of this sort of thing are not hard to find. The attitude that the victim of exploitation or violence really “had it coming” was actually quite prevalent in America’s “Gilded Age”, and inscribed in the ideology of Social Darwinism. Hitler also embraced social Darwinism with great fervor, and used it as an overarching justification for all his heinous crimes (Hitler, 1924.) Nowadays, Social Darwinism has been discredited scientifically, and become unfashionable in the public square because of its overtly racist and imperialist implications (Gould, 1981), which are vigorously discouraged in public discourse – even when they are still nourished secretly in the recesses of the collective psyche. But whether we indulge in racist and imperialist rhetoric or not, some version of Social Darwinism – in which the strong consume the weak, and the spectacle inspires indifference or admiration among onlookers, rather than righteous indignation or horror – is embraced or enacted every time the culture of corruption takes hold.

Previous generations of social psychologists attributed the socially patterned defects we’re describing here to the prevalence of something called the “authoritarian character” (Erich Fromm) or the “authoritarian personality” (Theodor Adorno.) While the “authoritarian personality” is a social psychological construct that has been challenged on empirical grounds – and with good reason– it nevertheless draws attention to a widespread phenomenon that occurs in societies where corruption is prevalent and intense. That is the tendency to worship and defer to irrational authority – or authority that is vested in unscrupulous, opportunistic or frankly destructive leaders (Burston, 2009). This trait is obvious among blinkered fanatics who attribute traits like honesty, omniscience and a loving (or at least disinterested) concern for the welfare of the people to blood thirsty tyrants bent on self-aggrandizement – a Hitler or a Stalin, for example. This sort of thing is well known, well documented, and relatively transparent, especially in retrospect.

More problematic, because more difficult to detect or address is the low-key authoritarianism found among normal, well adjusted people, i.e. those who are not driven by ideological zeal. People like these idealize corrupt leaders in less florid and obviously irrational ways. According to them, their (dishonest or criminal) leaders are not saviors or saints. On the contrary, they readily concede that their leaders are fallible like the rest of us, no doubt. But they will still insist they are basically well intended, frequently judicious and relatively free from dishonesty and malice. For low-intensity authoritarians, as well as for fanatics, calling attention to their leaders’ lies or contradictions is not evidence of patriotism, but its opposite. They charge their leaders’ critics with paranoia, ill will or a secret antipathy to the status quo and society at large, rather than an accurate and unflinching appraisal of the leaders’ words and deeds. We saw this phenomenon on a frightening scale in the period leading up to the American invasion of Iraq, and in the aftermath of the horrifying disclosures from Abu Ghraib prison. People who questioned the wisdom or the honesty of Bush, Cheney and Rumsfeld or denounced the use of torture were abused and threatened by the no-longer-silent majority, and not just by the administration or its lackeys in the media.

Looking back on this troubling episode in American history, it becomes apparent that people who are prone to distort reality, and to persecute those who oppose irrational authority, use defense mechanisms like minimization and denial to sustain their idealized conception of their corrupt leaders, whom they depict as the victims of excessive or unprincipled attacks. Moreover, they accuse honest critics of exaggeration and malice to avoid the acute discomfort of facing reality, and their own culpability, without illusions.

Sadly, in situations of crisis, the more “moderate” and “mainstream” low-intensity authoritarian types join forces with the fanatics, silencing real patriots in the roar of the crowd (and their media masters and proxies.) Even when they don’t comprise the majority in a given society, their ability to shatter or silence the opposition enables them to consolidate their hold on power, enabling their corrupt leaders to gather the mantle of respectability around their shoulders, and to operate unhindered as “wolves in sheep’s clothing.” 

Gazing in the Mirror

With this overview in mind, the question I would like to address now is whether the same – or any rate, very similar – processes occur within the mental health professions. Social psychology can contribute a great deal to our understanding of the social and cultural dynamics of corruption in specific countries or cultures. But that does not mean that our profession is immune from the kinds of processes it theorizes about. Though a professional body is not a nation or a culture, and is not confined to specific geographical region, it is a sub-culture that has internal traits and characteristics, and is not impervious to external influences from the culture or country of which it is a part.

Before we address recent developments in the United States, let me remind you of an intriguing experiment conducted by psychologist Maurice Temerlin, published in 1968, called “Suggestion Effects in Psychiatric Diagnoses” (Temerlin, 1968.) In the experiment 25 psychiatrists, 25 psychologists and 45 graduate students in psychology were asked to make a diagnosis based on a sound recording of a normal, healthy man who was being interviewed by a psychiatrist. The man in question was not a patient, but a professional actor impersonating someone devoid of symptoms who is happy and successful at work, has a stable marriage, a gratifying sex life, and who quickly established a relaxed and friendly rapport with the diagnosing clinician. The actor knew he was being recorded, but did not know the reason why he was being recorded, or that the recording would be “diagnosed” subsequently. Nor did he know that prior to auditing the recording, the psychologists and graduate students would hear a world famous clinician, a confederate of the experimenter, say in an authoritative tone of voice that the man being interviewed was an interesting case, because while seemingly neurotic, he was actually quite psychotic. The psychiatrists, by contrast, were told that two board certified psychiatrists and a psychoanalyst had characterized the actor’s performance in precisely the same way.

As you’ve probably gathered by now, the point of this experiment was to see whether (or to what extent) a high ranking authority’s expressed opinion would influence the experimental group, which consisted of clinicians and students from three different cities. Subjects were selected on a “stratified random basis” to include people employed in clinics, state mental hospitals, Veteran’s hospitals and private practice. The graduate students were culled from APA accredited programs in clinical psychology. After listening to the interview, all the subjects indicated their diagnoses on a data sheet which listed 10 psychoses, 10 neuroses and 10 miscellaneous personality types. After circling the items that best described the pseudo-patient, they were instructed to provide a brief rationale for their diagnosis using as little jargon and as much specific symptoms as possible.

Before we describe the results of this experiment, it is important to note that in addition to the experimental group, there were four separate control groups in Temerlin’s study. One was asked to furnish a diagnosis from the tape recording without a prior pronouncement from authoritative figures. Another was asked to furnish a diagnosis, but the prestige suggestion was reversed. A third group based their diagnoses on a slightly modified version of the tape-recording, which was presented to them as a job interview rather than a diagnostic one. A fourth one witnessed a mock up of a sanity hearing in which a panel of lay jurors selected at random were asked to appraise the pseudo-patient’s sanity before they rendered their own diagnoses.

Temerlin’s findings were quite striking. Among the experimental group, 15 out of 25 psychiatrists diagnosed the pseudo-patient as psychotic, the remainder as neurotic. Not one single psychiatric characterized the pseudo-patient as healthy. Of the clinical psychologists, merely 7 said he was psychotic, while 15 said he was neurotic, and 3 insisted that he was healthy, in clear disagreement with the expert opinion they’d been offered. Ironically, it turns out, the graduate students were the least suggestible of all. Only 5 pronounced the actor psychotic, 35 said he was merely neurotic and 5 said he was completely healthy. Not surprisingly, the only ones whose rationale for rendering a diagnosis was cogent, credible and jargon free were those who pronounced the actor completely sane – namely, 3 psychologists and 5 graduate students.

Needless to say, these findings are open to interpretation. Temerlin suggested three factors to account for the fact that psychiatrists, as a group, were more suggestible than psychologists or psychologists in training. First, the fact that psychiatrists are doctors, first and foremost, may make them inclining to follow an implicit rule that says, in effect, “when in doubt, diagnose illness”, because this kind of bias is less fraught with risk than diagnosing health when illness is actually lurking beneath the surface. Second, said Temerlin, psychiatry as a profession has highly differentiated status and role hierarchies which probably make psychiatrists more deferential to authority figures, while psychology, being more allied with philosophy the social sciences, values critical thinking more. Third, psychiatrists see many more psychotic patients than psychologists do, and accordingly were expecting to be presented with a psychotic patient even before hearing the “prestige suggestion.”

Personally, I find Temerlin’s third suggestion completely unpersuasive. If they were trained properly, the fact that psychiatrists see more psychotic patients than psychologists, as a rule, ought to sensitize them to signs of sanity, as well as symptoms of acute disturbance. And the first explanation, that by virtue of their medical backgrounds, doctors are risk averse, and prefer to err on the side of caution, is extremely doubtful. Why? Well, because as Temerlin informs us, none of the psychiatrists in this experiment furnished a plausible explanation for their diagnostic appraisals. A professional appraisal that is based on little or no evidence, and supported by faulty or incoherent reasoning, is hardly prudent, especially if you imperil someone’s well-being by rendering a diagnosis that could easily get him committed to a mental hospital against his will, and for no good reason. Reading between the lines, as it were, one almost gets the impression that in making this claim, Temerlin was actually thinking more about avoiding potential risks to the doctor’s reputation, rather than risks to the prospective patient’s mental health.

The second explanation Temerlin offers, namely that psychology values critical thinking, while psychiatry is a more hierarchical profession, and rewards deference to authority is the most plausible. But even this explanation does not explain why the graduate students’ judgments of the test-stimulus were more often accurate than those of licensed clinical psychologists. Perhaps inculcating deference to arbitrary and irrational authority is a feature of training in clinical psychology as well, so that the longer you have been trained, the more likely you are to be swayed by “prestige suggestions.” Or perhaps training in clinical psychology is merely less likely to crush or eliminate trainees’ spontaneous ability to think critically, and to exercise autonomous judgment. This is a disagreeable and disquieting inference that most psychologists would be offended by. And in fairness to them, I not suggesting that this or any other sweeping conclusions are justified by a single experiment, no matter how flawlessly executed. I am merely claiming that this is the most parsimonious and straightforward interpretation of the data at hand, and that Temerlin neglected the obvious, probably for reasons of his own.

In any case, I call this experiment to your attention because suggestibility and “prestige”, which Temerlin treated as discreet traits or tendencies, are integral features of authoritarian social movements, and closely associated with a climate of corruption. Admittedly, I cannot predict what the results would be if Temerlin’s experiment were replicated today. But if I were to venture a guess, I imagine that the results for psychiatrists would be very similar, but that the gap between psychiatrists and the psychologists would be smaller than it was in 1968. Why?

First, please remember that ever since Prozac was approved by the FDA in 1988, increasing numbers of American psychologists have been clamoring for what are called “prescription privileges.” In short, they are not content to diagnose and to treat mental disorders with psychotherapy. They want to be or behave more like psychiatrists do in the clinical arena, despite the fact that the influence Big Pharma has severely compromised the integrity of psychiatric care on a number of different levels.

Also, remember that since the year 2000, we’ve been witness to some startling revelations about the politics of the mental health professions, which indicate that a culture of corruption and a climate of “groupthink” (Janis, 1982) are present in psychiatry and psychology, and to an alarming degree. If we lack clarity and the courage to address these problems frankly, then it is very likely that these trends will persist, and/or morph into new and possibly more pervasive kinds of corruption.

For the sake of convenience, let’s start with psychiatry. In 2008 Senator Charles Grassley, the ranking Republican on the Senate Finance committee, brought to light several high profile instances of collusion between Big Pharma and the psychiatric profession. In early 2008, he convened a series of hearings into the finances of Dr. Joseph Biederman, the head of Pediatric Psychopharmacology at Harvard, Dr. Allan Schatzberg, Head of Stanford University’s Psychiatry Department and President elect of the American Psychiatric Association, and Dr. Charles Nemeroff, the Chair of Psychiatry at Emory University. All three were principal investigators for research on the impact of pharmacological agents. All three collected enormous fees for speaking engagements sponsored by drug corporations.

To use an earlier metaphor, Biederman, Schatzberg and Nemeroff (and their associates) are psychiatric strongmen. They had reached the top of the psychiatric “food chain”, where they broke or bent the rules with impunity, receiving millions in corporate sponsorship for their “research”, stock dividends in the companies that sponsored their research, plus gratuities of various kinds. And who benefited? Certainly not patients or the public at large. Their tainted “research” sanctioned the excessive or inappropriate use of potent and potentially dangerous drugs on millions of innocent patients, many of them children, who have suffered irreversible harm as a consequence of their greed and dishonesty (Burston, 2010.)

Nemeroff was guilty of not disclosing personal gifts from pharmaceutical companies to the tune of $500, 000 (Angell, 2009.) Biedermann did not declare most of the 1.6 million in income and gifts that he received from Big Pharma. But of these three psychiatrists, the case of Alan Schatzberg is probably the most disturbing. Schatzberg, please recall, is a former President of the American Psychiatric Association, and Grassley discovered that he controlled more than $6 million worth of stock in Corcept Therapeutics, a company he co-founded, while in office. At the same time, Schatzberg was the principal investigator on an NIMH grant that included research on a drug Corcept Therapeutics was testing as a treatment for psychotic depression, and a co-author of three papers on the subject. Stanford University, Schatzberg’s employer, professed to see nothing wrong with this state of affairs (Angell, 2009.)

Now, as a psychologist, I can’t help wondering whether Schatzberg and his associates at Stanford were engaging in conscious hypocrisy, or whether they really believed their own flimsy rationalizations. And for the life of me, I still cannot decide which scenario is more bizarre and disturbing. Either way, this disclosure illustrates the extent to which conflict of interest and plain old corruption has infiltrated the highest levels of the psychiatric profession. It also suggests that instead of being an anomaly, or a source of astonishment and outrage, conflict of interest has become the “new normal.”

Timely as it was, Senator Grassley’s investigation only uncovered some of the most egregious cases. As Marcia Angell points out, about two thirds of academic medical centers hold equity interest in companies that sponsor research within the same institution. And a recent study of medical school chairs found that two thirds received departmental income from drug companies, and three fifths received personal income of some kind (Angell, 2009.).

If this isn’t corruption, what is? And if I did not know better, I would insist that no rational person will trust any research conducted in such cozy and corrupt circumstances. But look at the facts. In 2005, one in 10 American citizens had a prescription for anti-depressant medication, and by a hundred and sixty four million prescriptions were written for anti-depressants, and sales totaled 9.6 billion dollars (Menand, 2010.) And that is just anti-depressants! Nowadays, one if five American adults is taking psychiatric medications. So two relevant questions for social psychology now are 1) why the demand for anti-depressants (and other drugs) continues to climb in the wake of recent revelations about conflict of interest and shoddy research practices, and 2) what is the relationship between corruption and the phenomenon of “groupthink” elucidated so persuasively by Yale psychologist Irving Janis. (Clearly, the two are related in some fashion.)

Meanwhile, with a few notable exceptions like Lisa Cosgrove (e.g. Cosgrove & Bursztajn, 2009), very few psychologists in America are active in the effort to expose conflict of interest issues in psychiatry. Meanwhile, many more are clamoring for “prescription privileges” so that they too can mediate patients as well. Another possible explanation for the widespread indifference one encounters among clinical psychologists in the USA is that many are complicit in this culture of corruption, and therefore reluctant to antagonize their psychiatric colleagues, lest they be excluded from the thousands of NIMH and corporate funded research grants that employ psychologists among their investigators and staff. I am not saying this is the only explanation, of course – especially for clinicians in private practice. Simple laziness contributes to this state of affairs too; the widespread perception that addressing and exposing corruption is not part of our professional duty, but the domain of investigative journalists and crusading Senators.

In any case, in my experience, when presented with evidence of corruption in psychiatry, the response among psychologists is often tepid. It lacks the sense of horror and indignation one would hope for or expect. Is a sense of smug complacency a part of this problem? Perhaps, it is. So lest psychologists feel tempted to congratulate themselves, let us remember that in the wake of the Iraq invasion in 2003, the American Psychiatric Association came out squarely in opposition to the use of torture in the interrogation of suspected terrorists or “enemy combatants”, and forbade psychiatrists from participating in such practices. By contrast, the American Psychological Association took until mid-April, 2008 to condemn the use of torture in interrogation, and to forbid psychologists from participating in interrogations were torture is being used. Worse still, between 2003 and 2008, the American Psychological Association’s two governing bodies, its Board of Directors and Council of Representatives, made a concerted effort to hide the fact that several well-known military psychologists, including Dr. Bruce Jessen and Dr. James Mitchell, were responsible for designing and implementing many of the torture techniques used at Guantanamo and other nameless detention sites around the world (Leopold and Kaye, 2011.) The fog of mystification issuing from high-ranking officials in this dark time was dense and demoralizing. Many said that psychologists should be present on such sites, because they will invariably prevent real torture from occurring – a straightforward lie, on the face of it. One Board member even ventured to suggest that critics of military psychologists activities is tantamount to racism, because one of the ranking military psychologists who was implicated in the growing controversy happened to be African American. At the time, these specious accusations passed for a principled defense of an indefensible cover-up.

On a personal note, I recall that in the spring of 2004 I was a member of division 32 of the APA, and an active participant on a lively list-serve for members of that division. Many of us were discussing the horrors of Abu Ghraib and the role of high ranking government officials in enabling these abuses – which is now a matter of public record, but was angrily denied at the time – when the list-serve administrator abruptly informed us that APA Board of Directors simply forbade such talk online. According to our governing body, we simply could not engage in discussions of a political nature in portions of cyberspace supported by the American Psychological Association. If we did, we would promptly be excluded from the list-serve, and the division as a whole might be subject to censure of some kind. In seeking clarification for this odious decision, I discovered that the APA had not yet taken a stand against torture, and allowed my membership to lapse.

Meanwhile, thankfully, active APA members took up the struggle against torture in a vigorous and principled way, among them Dr. Alan Kazdin, Dr. Steven Reisner and Dr. Bryant Welch. Welch had the advantage of already being an APA insider, having served for almost 20 years as the Executive Director of the APA Practice Directorate, and having briefly chaired the APA’s Board of Professional Affairs and sat on APA Council of Representatives. In a book entitled State of Confusion: Political Manipulation and the Assault on the American Mind, published in 2008, Dr. Welch gave us an illuminating analysis of the people and the problems that gave rise to APA’s docility and compliance with the Bush administration’s agenda, including (but not limited to) the APA’s longstanding ties to the American military. And while I can not summarize his arguments in detail, the terms “authoritarianism” and “groupthink” spring to mind repeatedly as you digest the specifics of his narrative – which is also a memoir, of sorts.

In addition to writing an important book on the subject, Dr. Welch made some very astute predictions early in July of 2008. Writing on the webpage for Counterpunch, Welch noted that the majority of APA’s rank and file were at odds with APA’s Board of Directors and Council of Representatives, and predicted that their policies would be repudiated by a mail in ballot on the subject – a vote which took place, at long last, on September 18, 2008. And so they were, thankfully, by a vote of 8,792 to 6,157. But Welch also predicted that the APA would only release its new policy guidelines after the November Presidential election took place – presumably to avoid offending George Bush and Company, or to subject the issue to further “spin” in the unlikely event that he actually won the election. And that is precisely what happened. Welch also predicted that the new policy would be worded emphatically and in such a way that any naïve and uninformed reader would imagine that psychology’s opposition had been clear and consistent throughout. Once again, Welch was right. The current policy statement reads as follows:

The American Psychological Association’s (APA) position on torture is clear and unequivocal: Any direct or indirect participation in any act of torture or other forms of cruel, degrading or inhuman treatment or punishment by psychologists is strictly prohibited. There are no exceptions. Such acts as waterboarding, sexual humiliation, stress positions and exploitation of phobias are clear violations of APA’s no torture/no abuse policy.

My goodness! How convenient! No one who reads this new policy would ever imagine a handful of APA licensed psychologists devised the various torture techniques alluded to here, and that they enjoyed the tacit approval and protection of the APA’s top brass for 5 years.

Finally, in 2008, Welch made another dire prediction, namely, that APA functionaries would re-write history to make it appear as if the organization was heading (slowly) in the right direction all along. So now, almost three years later, the question arises – will the APA do the honorable thing and “come clean”, or will it present the world with an expurgated, selective and revisionist account of this shameful episode in its history? Only time will tell. But a complete whitewash is almost out of the question now, because APA’s division for the History of Psychology (Div 26), no doubt inspired by Welch’s critique, has published an online timeline of the events chronicled in his book.

Needless to say, I take some solace from the fact that the rank and file of APA defied, and in due course, overturned the judgment of their governing body on this burning issue, and that the History Division of APA undertook to hold the APA brass accountable for their actions and utterances in this dark time. And though it may sound partisan of me to say so, I really cannot imagine American psychiatrists admonishing their APA to tackle the conflict of interest issues that bedevil their relationships with Big Pharma – whether at the top of the research “food chain”, or in the more mundane routines of clinical psychiatry. And that, in short, is why I oppose many psychologists avid pursuit of prescription privileges. If we are really more ethical than psychiatry, or more receptive to critical thinking, as many of us like to imagine, it is only because we are an autonomous profession. If our clinical roles blend indistinguishably with those of psychiatry, we will become sunk in a morass of corruption much deeper and more difficult to change than anything we are involved in now. And here is a curious and suggestive fact. The first American psychologists to get prescribing privileges were – can you guess? – military psychologists. One wonders how often these prescription privileges were used in the service of torture, or alleviating the effects of torture, between 2003-2008.

Our 21st century is less than two decades old, and many 20th century trends still persist. Psychiatrists are still accustomed to claiming that their clinical training is vastly superior to psychologists’, while psychologists often congratulate themselves on being ethically superior to their medically trained counter-parts. Unfortunately, that kind of collective preening and complacency, while gratifying to our self-esteem, is vacuous and potentially harmful if it promotes passive acquiescence in the face of corruption elsewhere in the mental health field, or a tendency to turn a blind eye to our own historic shortcomings. If psychologists are going to be better or more ethical, as they claim, it will only be because we are able to apply the concepts gleaned in the study of authoritarianism and corruption to our own organizational history, and let the proverbial chips fall where they may.

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References:

Anderson, D., Sharp-Sabatino, C., Lucia, L. and Lochtfeld, A. “APA Complicit in Torture” Project Censored: Media Democracy in Action

http://www.projectcensored.org/top-stories/articles/10-apa-complicit-in-cia-torture/

Angell, M. 2009. “Drug Companies and Doctors: A Story of Corruption.” The New York Review of Books, January 15.

Burston, D. 2009. “The Authoritarian Personality.” The Encyclopedia of Psychology and Religion, ed. David Leeming, New York: Springer Press, vol 1.

Burston, D. 2010. “Pediatric Bipolar Disorder: Myths, Realities and Consequences.” Journal for the History and Philosophy of Psychology, 12 (2) 1-10.

Cosgrove, L. and Bursztajn, H.J. 2009. “Toward Credible Conflict of Interest Policies in Clinical Psychiatry.” Psychiatric Times, 26 (1).

Gould, S.J. 1977. Ontogeny and Phylogeny. Cambridge: Harvard University Press.

Hitler, A. 1924. Mein Kampf. Translated by Ralph Manheim, New York: Houghton Miflin, 1999.

Janis, I. 1982. Groupthink. Boston: Houghton Mifflin.

Leopold, J. and Kaye, J. 2011. “CIA Psychologist’s Notes Reveal True Purpose Behind Bush’s Torture Program.” (http://www.truth-out.org), March 22.

Temerlin, M. 1968. “Suggestion Effects in Psychiatric Diagnosis.” Journal of Nervous and Mental Disease. Vol. 147, #4, pp. 349-353.

Welch, B., 2008. “Why Did They Do It? Torture, Political Manipulation and the American Psychological Association” Counterpunch, July 28, 2008.

Welch, B., 2008, State of Confusion: Political Manipulation and the Assault on the American Mind, St Martin’s Press.

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Daniel Burston

2 comments on “Daniel Burston: Corruption in the Mental Health Professions — Psychology, Psychiatry and the “New Normal” 

  1. katherinejlegry
    December 21, 2014

    Reblogged this on SKINNY NECK and commented:
    This is one of the best articles I’ve read in a long time and a brilliant source of information.

    Like

  2. lostinmist
    December 18, 2014

    Reblogged this on Mindfire Cantata.

    Like

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This entry was posted on December 18, 2014 by in Opinion Leaders and tagged , , , , , , , .

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