Journal oJ Menlalli/'alfh Coun$l'linRVolum/' JIINllmber 410cwber ZOO9/Pllge) ZlJJ-JON

PROFESSIONAL EXCHANGE

The Loss of Client Agency into thePsychopharmaceutical-Industrial Complex

Thomas L. 1\lurray, Jr,

Th"l'sychophllrmIICt'lIlicul illduSlri,,1 compl<'X (l'PIC) amI ilS mil"''''llce 10 Ih" di.l<'I1.'" model p"n"",I".,nWillstrellm C1,[ture </ml I:'"atly IfIIIHlU5I'sycholl",r"p" CO""''1'IeIlI/Y. Ih,- dji:c/S of Ihe PPIC mol' ho""",.w/lt'd ill some psychi"lrk C''''S",ner.' adopli"g disell.l·e-m"dd IIIn.'ag..... I" way•.•imilar 10 1'1111 imlll<"'Irmalloll. C"IIS,,,,,,'r m/"plloll of Ih" dlwas,' mudd ('(m create Ob)·lark. 10 (f('IIIIIU'/il \I h,'n hop" is lim·damelPlul. III 1IIIs Imide, / drm'- pllfall,'ls b,'IIl'e,'" 1'1111 i'liloorill<llioll ,/lid PPIC le,'hlli'lue.' "'11/1101<'simi/arili,',< m-11l'eell cull members rlml COIlSllmers ',,/io rill' ,'ullI"'lIble 10 I<J.!Ulg Ih"1f ide,II,li,'" 10 Ihe{'PIC 5Ugl!e.I·liolls for 11,1' pro/,'s5ioll 01 men/llilil'll/ih 1"00l1ls<'imx 1UIiIIhos,' ,w"king wllh Ihe,,,, COIl­SIUIIl'r.' cOlldude Ihe arliele,

More than $24 billion wonh of antidepressants and antipsychotic drugs weredispensed in 2008-almost a 48-fold increase since 1986 (Pringle, 2006; Elias,2009). Such expenditure would employ 240,000 psychotherapists earning anannual income of SI00.000 to provide 6 million hours of psychotherapy aver·aging 25 client-hours a week. These figures do not include what would be pos­sible using the additional revenue generated by the sales of antianxiety. hyp­notic, and psychostimulant medications.

How has the disease model for emotional disorders become the dominant dis­course causing so many people to usc neurophanmlceuticals as the best defenseagainst emotional and behavioral symptoms? The purpose of Ihis article is to

ofTer an explanation, although not an absolute one. to account for how clienlscome to accept the disease model of emotional distress and to ofTer suggestionsfor working with them.

Th"mas L Murray. Jr i., alJilill{(·d wilh Ihi' VIlI"t'I',I'ily of N()flh Cwvlilla Sch(J{)/ of Iht' A,,/;' III

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JOURNAl. Of' MENTAL IJJ~ALTl1COUNSEUNG

Several assumptions guide the examination of this question:

I. Psychiatry is part of a larger system, the psyehophannaceutical-industrialcomplex (PPIC), which is primarily driven by capitalism.

2. Power dynamics are inherent in thc doctor-consumer relationship.3. The many subsystems of the PPIC arc motivatcd by good intentions, but

their behavior and its consequences may not reflect the goodness of thoseintentions.

4. Under certain conditions consumers can adopt explanations for their diag­noses that make them impervious to other explanations in ways similar tocult indoctrination.

In using these assumptions to answcr the question, I will describe the PPIC,the parallel between the PPIC and cult-like phenomena, and how cult suscepti­bility factors mirror characteristics of psychiatric consumers. I conclude thispaper with suggestions on how to reconstruct the loss of self that is a productof the PPIC.

Til E PSYCHOPHJ\ RMACEUTICAL·INDUSTRIAL C01\II'LEX

Duhl and Cummings (1987) identified the emergence ofa mental health com­plex that has parallcls with the military-industrial complex described byPresident Eisenhower (1960) and the medical-industrial complex identified byRclman (1980). Breggill (1991) used the teml psychophannaceutical complexto describe the economic influences therein. Though these authors provideimportant contributions to our understanding of the flow of resources alllongthese entities. there has not been a comprehensive conceptualization to describethe process that involves our clients' interaction with the PPIC and the effectsthereof.

The PPIC is a symbiotic system composed of the American PsychiatricAssociation (primarily administrative and research psychiatry), the phannaeeu­tical industry, public relations and advertising finns, patient support organiza­tions (e.g.. the National Alliance on Mental Illness [NAMI] and Children andAdults with Attention Deficit/Hyperactivity Disorder [CHADD]), the NationalInstitute of Mental Health (NIMH), managed care organizations, and the llowof resources and money among these groups.

To further understand the PPIC, a systcmic perspective provides a conceptualframework in which the focus is on II"h(l/ happened and hoII'. when. and whereit happened, avoiding any preoccupation with \l'h)' It happened (Bowen, 1978).In other words. throughout this paper, I will address the processes involved inthe PPIC, acknowledging that there arc no saints or sinners but that all parts arcinterdependent entities motivated by survival needs (how to make a profit and

Murray / !>SYCIlOl'flARMACEUT/('AJANDUSl'RIt\J, COMn,EX 185

how to make more profit---eapitalism). Procecding without blaming is espe­cially important given the volatility and emotional intensity that the PPICevokes. Therefore, as with all systems and their subsystems, a metaview pro­vides a different perspective about how these parts become interdependent andspeak a common language.

So that the PPIC can survive and thrive within a capitalistic society, the sys­tem has organized itself around a single simple assumption: mental disordersare a chronic condition resulting from a diseased brain that requires expertmedical treatment in the foml of mass-produced phannaceuticals (Kuppin &Carpiano, 2006). This belief system gives purpose to all parts of the system.Pharmaceutical companies develop a continuous flow of medications and pro~

vide funding to NIMH and patient support organizations like NAMI andCHADD, both of which rely on the phannaceutical industry for funding,directly and indirectly. In tum, NIMH and patient support organizationsendorse the disease model and its effects (medication research and education).Patient support organizations, with funding from the phannaceutical industry,lobby policy makers to fund psychiatric research through NIMH. The psychi­atric establishment depends increasingly on the phannaceutical industry notonly for education and promotional materials (continuing education credits,honorariums, lunches, frcc office supplies, and medication samples) but alsofor the flow of consumers who need medication evaluations and managementfor their "chronic disease." The phamlaceutical industry relies 011 academicpsychiatrists to produce evidence that supports their medications. Academicpsychiatry depends on the phamlaceutical industry for research grants, drawsup treatment protocols, and sets the agenda for the psychiatric professionspecifically and the mental health profession in gencral. Insurance companiesrely on phanllaccuticals to contain costs (and limit psychotherapy scssions),and reimbursement depends on a diagnosis of a diseased brain. Figure I illus­trates how this system operates.

All thcse groups work to provide, in thcir vicw, vital scrvices for olle another,with the goal bcing improved mental health for cveryonc. As a capitalistic sys­tem with a drive toward greater profits, modem healthcare has evolved into asickncss care system. For example, the currcnt dynamic is such that the PPICmakes more profit by keeping consumcrs in the system and stands to lose whenconsumcrs discontinue psychiatric medications. Thcre are, of course, con­sumers who enter and exit the mental health care system successfully and arcbetter because of it. However, my most difficult cases involve clients who havein csscnce been drawn into the PPIC and have bccomc resigned to the diseascmodel with little sense ofempowcnl1cnt to overcome their emotional problems.These are the consumers who have linle self-efficacy and linle hope that theyhave options othcr than to sufTer. And these are the cascs about which I want toknow more. What is involved in their personal seduction into the complex?

JOURNAl. 0'" Mf.'NTI\L I1I::M.TII COUNSELING

Figure 1. How the Psychopharmaceutical-Industrial Complex Operates

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CUl.l~L1KE: 1'1-1 E.'l:O'\ ENA OF Til E: "PIC

The inference that the pmctices and effccb of the PPIC resemble cull-likephenomcna produces a \ isceral reaction of outright rejcction m both profcs­sionals and laypersons. Nc\cnheless. c10scr e:<amination of the cult literaturepro' ides a number of parallels wonh considcrlng-mosl notably_ how peoplebecome seduced by cults. West (1993) pro\ lded a psychiatric conceptualizationfor understanding the characteristics ofcults and the charactcrisucs thai cxplaincult-mcmbers' scduction and subscquclll indoctrination. West wrOle. "Undcrcenain kinds of stress or duress. indh lduals can bc made to comply with thedemands of those in I>ower" (1993. p. I). I looked to this anicle to understandmy clients' apparent resignation to the disease model of mental illncss soemphasized in mainstream lllld protcssiol1l11 arcnas. As West suggested, thequestion of power is par3mount in this investigation.

Crossley (2004) positioned the power of the psychiatnc establishmcnt asbeing a symbolic po\\ er to dcfine, namc. categorize and diagnose: to locate par­ticular types of menIal distress and dc\ ianec \\ ithin a mcdicalmodel of illness;and 10 cnsurc. on thIS basis. thai indl'idual.. failing withm thcse calegories aretreatcd "appropriately," I rcturn, thcn. to \\''"~t (1993) for inslghl illlo a contextIn \~ hieh this IXmer ma111fcsts itself:

Murmy / 1'St'C!101'11ARMACEUTICAL-1NDUS'1'Rl,\L COM1'LEX 287

Cult (totalist typel: a group or movelllem exhibiting a great or exeessi,'C d"votion or dedicationto somc perwn, idca, or thmg, and employing unethical. mampulatl\C. or coercive t«lmiques of

persuasion and control (e ,g.. isolation from fonner friends and family. debilitmion. usc of spe'cial methods to hcighten suggestibility and ~ubsef\icnce. rowerful group pressures. infonnatiun

management. promotion of tota] dependency on the group and fear of leaving it. suspen~ion ofindi 'iduality and critical judgment. etc. I. designed to advance the goals of the group's leaders.

to the possible or actual detriments of members. their families. or the community (p. 8).

Using West's definition of cults as a framework for understanding thc PPICand its impact on these difficult cases, I therefore examine (a) dedication to thedisease model ofbchavioral disorders; (b) unethical. manipulative. or coercivetechniques of persuasion and control; (c) dependency development and fear;and (d) the mcans by which the aforemcntioned tcchniqucs ultimately advancethe agenda of the PPIC.

Dedicatioll to the Disea~'e1MedicalModelI propose that there are similarities betwcen cult-like phenomena of a devo­

tion to an idea (West. (993) and the adoption of biological reductionism (thediscasc model) by those within the psychiatric profession known as the NewPsychiatry movement (Lccman, 2007; Lewis. 2006) and by others (c.g..nonpsychiatric prescribers. mental hcalth professionals, and laypersons).Though the evolution of psychiatry over the last 130 years is beyond thc scopcof this paper. thcrc arc some aspects wonh noting. Most importantly. thc dis­ease model can be viewed as bookending the story that is psychiatry.

The disease model was the foundation of early psychiatry: after aiL SigmundFreud was a neurologist. Howcver. that model gavc way to the psychoanalytictmdition throughout much of the twenticth ccmury. In fact. most psychiatristswcrc trained in psychoanalysis as pan of their medical education. Concurrently.psychiatry bcgan facing an idcntity crisis. which provided momentum for apendulum swing at mid-century (Andreason, 2006). Rcscareh and administra­tive psychiatrists wanted to be viewed like their medical brethren and focus onidentifying organic causes of psychopathology. The pressurc trickled downthrough the profession and, aeeording to Leeman (2007), frontlinc physicians"were expccted to follow suit" (p. 182). This movement culminated with thethird edition of the Diagnostic al/d St(/fistica/ Mal/ual (DSM-lll; AmericanPsychiatric Association. 1980). which was lauded as more scientific and athc­oretical than its predecessors (Andreason. 2006; Lewis. 2006). New Psychiatryprovidcd scientific cenainty about thc etiology of psychopathology find aboutthc lesser. if any. relevanee of soeiological and psychological factors(Andreason. 2006).

Because uf New Psychiatry'S emphasis on the disease model, as wcll as thedrive for professional parity with other medical specialties, the profession iseasily seduced by all things claimed as scicnce (Lcwis. 2006), cspccially when

188 JOURNAl. Of- MENTAL HEAl-HI COVNSELING

produced by members of the psychiatric establishment and used as a means toadvance psychiatry. Thus, New Psychiatry has relied solely on the productionand dissemination of medications to relieve human suffering (Wall, 2007), giv­ing little attention to nonpharmacological interventions. [n fact, disease modeladherents rarely obtain continuing education about llonphamlacological inter­ventions to help people resolve anxiety. suffering, :md grief (Lewis, 2006).Psychiatric training programs have either dramatically decreased comprehen­sive psychotherapeutic education or discontinued it altogether (Drell, 2007),probably driven by capitalistic forces (e.g., morc profit is made by providingmedication evaluation and management Oil a IS-minute schedule) and the ccr­tainty that cmotional disorders arc a function of a diseased brain.

Psychiatrist Bruce Lachter. after accepting the certainty offered by the NewPsychiatry, recalled an experience offrustration while working with a man whohad lillIe insight into his depression. Lachter wrote. "Such powerful knowledgeof the facts of the brain gave tne just the certainty that this unfortunate patientlacked" (Lachter. 2001. p, 3 11). Lewis (2006) suggested that such adherents ofthc disease model are likely to (a) naturalize and rcify "mental illness""; (b) feedinto the medicalization ofdeviance; (c) feed into psychiatry as an agent of nor­malization. statc control. and multicultural oppression; (d) feed into the phar­maceutical industry boondoggle; and (I) rest on a natural-science approach tohumans that excludes other approaches and multiple approaches. With the cer­tainty that comes with New Psychiatry and its contribution to the PPIC, the dis­ease model allows for a number of approachcs to mental disorders that parallelthe activities of cults. particularly tcchniqucs of indoctrination.

Persuasion Tec/JlIiqlle~'

West (1993) stated that cults usc a number of persuasion techniques. such as(a) isolation from fomlcr friends and family. (b) debilitation. (c) use of specialmethods 10 heighten suggestibility and subsen'ienee. (d) powerful group pres­sures, (e) infonnation management. (I) promotion of total dependency on thegroup and fear of leaving it, and (g) suspension of individuality and criticaljudgment. [n this section [ look at the relevancc of these techniques to the PPIC.

Isola/iollCults usc isolation to 111IllII11IZe influence from those outside the group

who may contaminate the vulnerable beliefs of cult members and to increasedependency on cult leadcrs. Similarly. evidence suggests that some iatrogcnicisolation occurs as a result of the PPIC that has profound consequences forconsumers.

The disease model can be quite detrimental for the psychiatric consumer,who becomes increasingly isolated due to the unintended increase in socialstigma (Lam & Salkovskis. 2007; Lam. Salkovskis. & Warwick. 2005; Read &

Murray I PSYCJlOPllAHMAC£UTlCAI--INDUSTRJAI- COMPLEX 189

Harre, 2001). The adoption of New Psychiatry's disease model results in thegeneral public believing that psychiatric consumers, who have a brain disease,arc dangerous and unpredictable (Read & Harre, 2001). In fact, Henman(2001) suggested that professionals and lay people arc more likely to believethat emotional problems arc incurable if they believe that the causes arc entirelybiological. Such an assumption establishes that a greater authority (psychiatry)must intervene to provide safety and security. Consequelllly, consumers orga­nize their life around their role as psychiatric consumer (Williams & Collins,2002) with little hope of recovery.

Psychiatrists arc not immune to the isolationism that is a consequence of theiradoption of the disease model. Like the general population they experienceemotional distress within the prevailing social construction of the diseasemodel; according to Balon (2007), "a considerable number of psychiatristswould not [accept medication for} themselves for depression, possibly becauseof fear of stigma or fear of a pemlanent record" (p. 306). [n other words, a sig­nificant number of the psychiatrists Bolan surveyed would not seck psychiatriccare personally for fear of the stigma attached to help-seeking.

Debitila/iOIl

Cults use all the tcchniques listed by West (1993) to emotionally, behav­iorally, and socially debilitate members. By discmpowerillg their members,they have continuing significant influence over how the members function.Likewise, I assert, the PP[C has cult-like debilitating effects, particularlywith regard to the locus of control and the debilitating effects of psychiatricmedications.

People who believe that they eontroltheir own destiny have an intemallocusof control. It is generally understood that such people have greater health, suc­cess, and well-being (Marshall. 1991). Similarly, an extemal loclls of eontrol­the belief that one has little control over one's circumstances---has been linkedto psychopathology (Smith, Pryer, & Distefano, 1971). One would assume thatNew Psychiatry would highly encourage an intemallocus of control. However,an intemallocus of control has been linked with poor insight into one's psychi­atric diagnosis (Williams & Collins, 2002). If consumers arc to be consideredinsightful, they must agree with the perception of the evaluator (Diesfeld &Sjostrom, 2007). As applied in New Psychiatry, insight is qualified as theacceptance of a diseased brain abollt which the consumer has little independentcontrol (i.e., an extemalloeus of control) and, by extension, for which medicalintervention and authority is required.

Not only is PPIC unintentionally debilitating psychologically but. Breggill(2006) suggests, much dcbilitation results from the actual medicationsprescribed for psychiatric disorders because these suppress nonnal brainfunctioning. Breggill proposed that psychiatric consumers undergo a

JOURNAL or MENTAL IIE~lLTIICOUNSELING

spellbinding effect-intoxication anosognosia from psychoactive medica­tions. Anosognosia. a neuropsychological tenn. is the lack of awarcness ofonc's dcficits (Adair. Schwartz. & Barrcll. 2003). According to Breggin. intox­ication anosogllosia cxplains thc pcrsistcncc that psychiatric consumers dcmon­stratc when they continue psychiatric mcdications evcn whcn mcntal andbchavioral side cffeets become scvere and disabling. Mental health providersmay bc most familiar with this phcnomcnon as part of substancc abusc trcat­mcnt. As Moncricff (2007) wrotc. "In chronic alcoholism and other substanccdcpcndencics, it is also recognized that people deny the degree to which theirsubstancc usc is adverscly affceting their functioning and their relationships'"(p 171). Relating this phenomenon to psychiatric mcdications, many consumcrsmay not identify subtle blll equally serious side effects because of inadequateinfonncd conscnt (Breggin & Cohcn. 1999).

Breggin (1997) dctailed 11 brain-disabling principles in his book. Braill-dis­abling Trealmenls ill Ps)"chially. Four principles directly address the issue ofmcdication-induccd debilitation: (a) all psychophannaccUlicals disrupt nonl1albrain function without improving brain function; (b) all psyehopharmaceutiealswork by causing generalized brain dysfunction. afTecting both emotional andcognitive functioning; (c) psychophannaeeuticals '"help·· by impairing higherhuman functions. ineluding emotional responsiveness. social sensitivity. self­awarencss or self-insight. 'lutollomy. and self-determination: and (d) psy­chopharmaceuticals produce the same disabling clTcet on all pcoplc. with orwithout psychiatric diagnoses. Rcaders should note that Breggin's writings arcnot widely acceptcd among psychophannacologists. Ncw Psychiatry adhcrcnts.and others who value the disease model as a IIseful lens through which tounderstand human suffering. Nevertheless. increasingly the literature seems 10providc support for his principles (Jackson. 2005; Murray. 2006).

Suhservience and Suggestihiliry TechniquesCults portray membcrs as victims of the greater oppressive socicty and

promise thcm respite through the eult indoctrination process. Moreover. mem­bers can devclop pscudoidentities if the only way to obtain relicf and under­standing is 10 adopt the charaetcristics demanded (West 1993). Similarly.Williams and Collins (2002) and McCay and colleagues (2006) arguc that psy­chiatric conSUTllers arc prone to engulfment: the lifestyle of a psychiatric con­SUTller (and the related psychosocial interventions) result in consumers relin­quishing signilieant personal authority to thc mcdical authority, a parallel tocult indoctrination. This process is facilitated whcn practitioners refer to con­sumcrs by their diagnoses (e.g.. "I-!c's bipolar/schizophrenic/OeD"), whichconveys penllanency and limits thc prospect of hope and recovery.

Thc PPIC uses a number of suggestible techniques to furthcr thc diseascmodel agenda. with each subsystem participating in its own way. For example.

Murray /I'SYCHOI."ARMACEU1'IC,\L-INOUS'I'RI,\L COMI'LEX 29/

Murray (2006) reviewed a number of ways psychiatric researchcrs suggestgreater support and efficacy for psychiatric mcdications, including publishingthc samc rcsults in multi pic journals to give the appearance of more empiricalsupport. Recently, thc drug maker Merck & Company gained considerableattention, although for a nonpsychiatry journal. for working with publisherElsevier to distributc an industry-sponsored, non-pecr-reviewed journal thatmirrored more reputable counterparts (Associated Press, 2009).

Other means arc especially pronounced when occurring within the context ofconsumers becoming dependent, as in cults, on their providers for meeting bothphysical and psychological necds if they arc to survive (West, 1993). For exam­ple, there is a prevailing assumption. supported by minimal cvidcncc, thatuntreated psychosis damages the brain (Liebemlan, Sheilman. & Kinon. 1997;Wyatt, 1991). which has led psychiatric practitioners to develop treatment com­pliance stratcgies.

Trealll1elll compliance. West (1993) defined brainwashing as "any procedureemployed to induce compliant bchaviors" (I" 2). Thc PPlC cmphasizes medica­tion compliance among psychiatric consumers. In fact, a number of theoreticaland programmatic initiatives (e.g.. motivational interviewing) have becn uscdto pcrsuade eonsumcrs first to submit to psychiatric medication and then to stayon it (Fernandez. Evans, Griffiths, & Mostacchi, 2006; Ginsberg, 2006;Kavanagh, Duncan-McConnell, Grecnwood. Trivcdi. & Wykes, 2003; Riillsch& Corrigan, 2002). For example. nurses are encouraged to work toward med­ication adhcrcncc and usc a varicty of mcthods for increasing compliancc(Fcrnandez et aL). Consumers may also bc told, "The reason you fcel sad all thctimc is bccausc you're not taking your medication:' as a means to pcrsuade aconsumer to become compliant. This circular logic avoids any implication thatmood may be the result of ncgative lifc experiences.

Other suggestibility tcchniques occur whcn prcseribcrs inform consumersthat if the medication is discontinucd. the diseasc will rcturn. When consumersdiscontinuc the mcdication, thcy oftcn cxpcrience withdrawal symptoms thatmimic symptoms similar to the diagnosis. thus creating a confirnlatory bias.They return to medication to alleviate the withdrawal symptoms, which rein­forces beliefs in thc discasc modcl (Glel1nmullen, 2005). These and similarapproaches have the effect of invalidating the person's cxpericncc by discount­ing environmental contributions. Moreover. the assumption is that it is notneccssary to make changcs to the cnvironmcnt bccause medication is enough.

Howevcr, recovery may bc jeopardized when consumers cxpect too muchfrom their medication. Basoglu. Marks. Kilil;, Brewin, and Swinson (1994)found thai consumers who attributcd thcir recovery to the powcr of the mcdica­tion and felt less confidcnt of their ability to managc the symptoms wcre atgreater risk orrclapse. Those who attributed improvemcnt to personal strcngthand rcsources expericnced fcwer relapses. Funhennorc. Biondi and Picardi

191 JOURNAl. Of" MENTAl. IIf;AI.TII COUNSELING

(2003) found that consumers who predicted that remission and medication wererelated had higher relapse raiCS. and those who did not believe that the two wcrclinked did not relapse. In fact. nonc of tile participants who held the laller viewrelapsed after medication was discontinued \0 observe for the effect. Thoughthe sample size was extremely small, the findings mise important treatmentconsiderations. Biondi and Picardi (2003) wrote. "Working on patients' attribu­tions with the aim of favoring a shift toward a more intcmal orientation is con­sidered essential in the trealment of phobic patients" (p. [10). I would arguethat morc research needs to examine this thoroughly in lenns of all psychiatricdiagnoses for which medication is considered.

One final note about treatment compliance: A significant difference betweencults and the cult-like phenomenon of the PPIC is that the latter suggests thatconsumers arc oppressed by their own defective biology (e.g., biochemicalimbalances, gcnetie disorders, or pathophysiology of the brain; Murray, 2006;Wah1. 1999), for which expert authority and treatment is needed. Cults, 011 theother hand, focus on the impact of an external oppressor. Thus, unlike cultmembers, psychiatric consumers can ncver find freedom from the oppressor,because the oppressor is within.

POlI'erfil1 Gmul) PressuresConfonnity is a powerful process that molds the beliefs of individuals to

reflect those of the group (Kassin, 1998). Cults capitalize on this group processas well as being impacted by groupthillk (where members of a group convincethemselves that their beliefs arc correct). Groupthink can suppress personaldoubts without the person realizing that this is happening (Kassin). Finally,"group members harbor an illusion of invulnerability, an illusion of unanimity,and an exaggerated belief in the morality of their views" (Kassin, p. 50S).Likewise, the PPIC uses "science" 10 create a protective shield from criticalexamination of its fundamental assumptions llnd excludes anyone who lTlayexpress these criticisms (Kirk & Kutchins, 1992; Lewis, 2006}-particularlywhen the criticisms come from within the group (Caplan, 1995), This ulti­mately leads to the appearance of unanimity. Those professionals who do notadopt the disease model arc kept from contributing to the discourse (Malik &Beutler. 2002).

Group pressures also exist in other areas of the PPIC-rnost notably withinpatient support organizations. Typically these organizations, also knownas advocacy coalitions. arc highly supportive of thc disease model of mentalillness, which corresponds with many consumers' acceptance of the model­after all, the PPIC oftcn uses the model to explain the etiology of symptoms(Crossley, 2004). However, unbeknownst to most peoplc there is a symbioticrclationship between the phannaecutieal industry and paticnt support organiza­tions like the NAMI and CHADD (Ginsberg, 2006). Many corporations arc

Murray / PSYCHOIWARMACEUTlCAL·INDUSTRIAL COMPLEX 293

instrumental in promoting these grassroots organizations for their perceivedcredibility among consumers (Beder, Gosden, & Mosher, 2003). In fact, Rose(1991) wrote, "Any institution with a vested commercial inlerest in the OUl·

come of an issue has a natural credibility barrier to overcome with the public,and often with the media" (p. 28). Once established, patient support organiza·tions like NAMI and CHADD get up to 91 percent of their funding from thephannaceutical indust!)' (Ginsberg). This creates a powerful team advocatingfor simplistic biological explanations for mental disorders (Healy & Le Nou!)',2007; Smoyak, 2004), as well as giving the appearance of widespread consen·sus. Those organizations that criticize the indust!)' or the disease model mayexperience a loss of indust!)' support (Ginsberg). Any curso!)' examination ofnewsletters and brochures from these organizations yields ve!)' little evidencethat consideration is given to plausible nondisease theories of etiology,

Group pressures within the PPIC appear to influence what is or is not dis·closed to the public, Ginsberg's expose (2006) of various patient support orga·nizations found that they (a) rarely disclosed their tics with the phannaceuticalindust!)', (b) were slow to educate their members about new concerns abolllmedications typically used by their members but quick to publicize treatment"breakthroughs," and (c) rarely questioned drug prices. I contend that theseinfluences naturally have an impact on consumer indoctrination. These rela·tionships have recently been the focus of inquiry by United States SenatorCharles Grassley (Giles, 2009). Grassley recently requested that NAMI dis·close its financial tics with the pharnUleeutieal industry. The executive director,Michael Fitzpatrick, has since disclosed that 56% of NAMI's operating budgetis supported by the industry. This is of great concern in part because NAMJ isnow the largest purveyor of mental health educational programs in the US,which arc generally peer-directed and designed to educate consumers' families,service providers, service users, and community members (Burland & Nemec,2007), Much of patient education, publications, and other media is highly sup·portive oflhe phannaeeutical industry and the disease model; psychothempy israrely promoted with any vigor.

Injormatio" MallagememIn addition to the infomlation management already mentioned, the PPIC

also manages infonnation elsewhere. Because of the closed systems in whichpsychiatric infonnation is developed and disseminated (Beder, Gosden, &Mosher, 2003; Jackson, 2005; Murray, 2006), medication infonnation is passedfrom the phannaceutical industry to psychiatric professionals. Not only is thisinfonnation in favor of the drug company (and disparaging about competitivebrands), but few consumers arc given this (mis)infonnation through the conscntprocess (Schachter & Kleinman, 2004). Moreover, the phannaceutical industryis ve!)' secretive (Lexchin, 2007); it tends to release trial data only when they

JOURNAL Of' MEN1AJ. llf:ALTll COUNSEUNG

support the product (Lancel, 2001; Turner, Mallhews, Linardotos, Tell. &Rosenthal. 2007). Recently, Vedantam (2009) broke a story that AstraZcnccahad buried the findings of a 1997 study 011 the antipsychotic Scroquel. knownas Study 15, which showed increased rates of weight gain and diabetes amongthe participants. In 2004. growing concerns lcd thc Food and DrugAdministration to place a black box warning on antipsychotic medications thathighlighted cOllcems about iatrogenically induccd diabetes.

When such important information is suppressed, consent can never be fullyinfornlcd. As Geppert (2005) acknowledged, "Much of the consent we [psychi­atrists] obtain from our patlcnts for pharmacotherapy is woefully uninformed"(I'. 55). "As an ethicist. 1review many charts and if they were Ihe only evidenceavailable, we could never recreate even the outline of the doctrine of infomledconsent" (I'. 56).

Not only can consumcrs be misinformed hlll information management andlack of informed consent call also result ill researchers misinterpreting data. Forexample. Kessing, Hansen. Dcmyllenacrc. and Bech (2005) asked participantsabout their perccptions ahout depression and antidepressants. The authorsreported that the study's participants had a number of··erroneous·· beliefs abouttheir psychiatric treatment, specitically antidepressant llsage. For example.42.2% of the sample had the erroneous belief that discontinuing antidepressantswas difficult if they had bcen taken for a long period. Murray (2006) found con­siderable evidence to support the beliefs ofthesc participants-antidcpressantsarc associated with a discontinuation syndrome. Kessing and colleaguesappeared to have had an a priori bias toward medication and were apparentlyunaware oflhe disconfirnling literature on psychopharmacology and thus con­cluded that accurate pcrceptions wcre crroneous.

Adl'eniscmelHs. Thc ('PIC includes public relations and advcrtising firmsthat market to the phannaeeutical industry. promoting how they can recruitpotcntial Cllstomers (Bedcr, Gosdcn, & Mosher, 2003). Ronit Ridberg (2006)produccd a documentary. Big Bllcks. Big Plwrma: Markelillg Disease &Pushing Dl"IIgs, which elucidated the relationships between the phannaccuticalindustry and advertising linns. Beder. Gosden, and Mosher, as well as Ridberg,explain that mass media work perfectly for the discase model by providingexplanations for mcntal disorders using \irtual sound bites that promisequick fixes. If someone has a chcmical imbalance. thell l\ makes sense to usc achcmieal to balance it.

Unlike traditional capitalism, wherc necessity was the mothcr of invention,within the PPJC invcntion is the mOl her of necessity. With the explosion ofncwdiagnostic categories with each edition of thc DSM, thcre is a presumed needfor more medications to trcat thcse disorders. Disease-mongering. a form ofmass marketing, is the process of creating a need for a pharmaceutical productwithout demand for that product hiding its development (Dear & Webb. 2007;

Murray I PSYCHOI"'ARMACEUHCAI.-1NDWiTRlt\L COMPLEX 195

Ridberg, 2006). [n short, phannaccutical production stimulatcs nccd throughnlllSS advcrtising (Lewis, 2006). Oncc thc dmg is prescribed, consumcrs maybe encouragcd to take the drug prophylactically with no hopc of future rccov­ery (Hea[y, 2006).

Tow! DepelldellLY alld FearCurtis and Curtis (1993) offered several observations about techniques cults

use to ensure member reliance. Primarily, cult membcrs become "strongly con­ditioned by a powerful type of negative reinforccmcnt, namcly adhercnce tospecific belicfs-no matter how irrational-serves to reduce painful affectivestates" (p. 457). Cults offer a "cure or anesthesia to emotional and physicalpain" (p. 457). Many cult members arc reminded of the dangers to which theywould be exposed if they left the cult. Thesc messages arc repeatcd regularly.[t is the 'hreal of injury, rather than direct injury by the cult, that maintains astrong hold. It is as if the cult promises to alleviate pain and suffering now andin the future for as long as the member remains a part of the cult. 'This seemsto involve a rather encompassing cognitive manipulation and stmeturingprocess in which previous attitudes. beliefs. and values arc radically trans­fonned to match those ofthcir captors" (p. 457).

The PPIC offers anesthesia for emotional and physical pain through psychi­atric medications. Consumers arc routincly warned about the negative conse­quences of discontinuing a medication. They arc led 10 believe that their brainsmay suffer if they discontinue medication or that it will cause undue hardshipon their families. Moreover. if they stop taking the medication, the disease willreturn. Ironically, the withdrawal syndrome that is associated with psydiatricmedications is often confused with a retum of the original symptoms (e.g.,depression). Breggin (2006) also wamed that consumers can begin to feciworse after starting medication but identify the side effects as signs of a dcclil1~

ing mental condition.

Ad.'OI1C;lIg the PsyL'llOphttrmuccuticu/-lmlllsrriul ComplexThe primary mission of a cult is sci f-perpetuation (Enroth. 1977). A similar

argulllent can be madc about the PP[C. The PPIC must adhere 10 the diseasemodel as a function of survival, whieh inl1uences how model proponentsexplain conSUlller symptoms, which in turn inl1uences how consumers explainsymptoms to those around thcm (Lam, Sfllkovskis, & Warwick, 2005).Moreover. as consumers arc bombardcd with diseasc model messages throughtelevision, magazines, and phanna-sponsorcd promotional materials, "thesevarious advertising tools work to ereatc a samencss and repctition in the mindsof psychiatrists and thcir consumers. The generalized mcssage is, .Psychiatristsgive you dmgs, and that is good'" (Lewis, 2006. p. 57). Of course, it must benoted that most psychiatric medications arc prescribed not by psychiatrists but

196 JOURNAL OF MENTAL IlEAI.TII COUNSELING

by other medical doctors, nurse practitioners, and physician assistants(Whitaker, 2007).

Not only does the phannacculical industry shape the discourse about mentaldisorders, but the American Psychiatric Association Press is a major gatekeeperof materials that advance the PPIC, as well as constraining opposing views andultimately conveying that there is a broad consensus about the disease model(Lewis, 2006). Brcggin countered that the claims based on the disease modelare "unethical, if not fraudulent, and sen'e ol/fy /0 pe/pc/llate the influence ojfhe profession alld individual practitioners [italics added]" (1991, pp.408-409).

Finally, unparalleled secrecy and conflicts of interest continue with regard tothe next edition of the DSM, which is schedulcd for release in 2012. Spitzer(2009) reported that the DSM-V drafters have gone to great lengths to keep pro­ceedings from public view and to restrict infomwtion about the D$M-V'sdevelopment. For example, all D$M-V participants must sign confidentialityagreements that prohibit discussion about

all work product, unpublishl'd m~nuscript5 and drafts and olher prepublieanon materials. group

discussions, internal correspondence. informal ion about the development process and any olherwrillen or unwriucn infonn~tion in any fonnlhal cm~n~ICS from or relales 10 [mcmber'5] work

with the APA Task Force or Workgroup ($pil7-er. paragmgh 6).

Regarding the task force participants, Cosgrove and Bursztajn (2009) foundthat 68% report direct phamlaeeutical industry tics. Given that diagnosisinfomls treatment decisions for most mental health professionals, these con­flicts of interests arc of great concern.

SUSCEPTIBI L1TY TO TU E PSYCIWPIIAR~IACEUTICAl·INDUSTRIAL

COi\'IPlEX

If the PPIC's devotion to the disease model uses a number of persuasion tech­niques to foster its messages, what detennines the susceptibility to the mes­sages of those on the receiving end of those techniques? And how does thisresult in consumers who lose their identities (Czuchta & Johnson, 1998) andaccept the messages offered by the PPIC? In this section, I review six factorsthat Curtis and Curtis (1993) implicated in cult susceptibility. For each I drawparallcls with the psychiatric consumer.

Generalized ego-weakness al/d emutiul/al lIulnerability. Galanter (1989)stated that people generally join cults to relieve neurotic distress, obtain con­tentment, or as rcspitc from perceived social oppression and its intolerable con­sequences. As a rule, emotional distress is the impetus for psychiatric con­sumers to seek help. They feel little self-efficacy for managing the problemwith their own resources. Not only do psychiatric consumers seck help while

Murray /1>SYCJl01'1/ARMACEUTlCAI.-/,vOUSTRIAL COM1'1.EX '"feeling emOlionally vulnerable but neuroleptic medications may exacerbateemotional vulnerability through a process called "neuroleptic dysphoria"(Ballard, Basso, Gallagher. et al., 2007; Gerlach & Larsen, 1999). Jackson (per­sonal communication. March 10.2009) believes that this dysphoria also occurswith anxiolytics and some antidepressants by boosting "Y-(gamma) amino­butyric acid (GABA) levels and GABA transmission. as well as bluntingdopamine. Cults (Curtis & Curtis, 1993) and the mental health establishment(Levilt, Butler, & Hill, 2006) respond to these periods of ego weakness andemotional vulnerability by offering security, protection, and belonging.

Suspension ojcritical thillki"g. Cults create an atmosphere in which vulner­able members surrender critical thinking in favor of the psychological reliefthat cult indoctrination promises. The propensity to do so makes it more dim·cult for people to critically examine the cult·s presumptive benefits becausetheir rational judgment is suspended (Curtis & Curtis, 1993). Similarly, psychi.atric consumers unknowingly accept the misleading and deceptive promisesinherent in the presumptive benefits of the disease mode\. especially when suchinformation is delivered by somcone with presumed authority (a la StanleyMilgram's obedience to authority experiments, 1%3. 1965). For example,anecdotal evidence suggests that psychiatric consumers rarely criticize thechemical imbalance theory despite not having their chemicals measured, aswould be done with diabetes, to verify that there is indeed a brain imbalance.Furthermore, suspension of critical thinking may increase the likelihood forengulfment described earlier (see Williams & Collins, 2002).

I"adequateJamily alld social support systems. Cult members experiencc tcn­uous. deteriomted. or nonexistent family relations and social support systems,which contribute to their feeling ·'worthless. isolated, disoriented, helpless, andperhaps terrified" (Curtis & Curtis. 1993. p. 454). Inadequate family and socialsupport increases adherence to the cult by offering amelioration of these feel­ings and rescue from feelings of abandonment and rejection. Members ofcultsare also expcrted to relinquish thcir idcntity to the leader. which makes them"disoriented, helpless, and out of control" (Curtis & Curtis, p. 458). Cults iso­late members from outside sources of information and instead repeat factuallyincorrect information to furthcr strengthen indoctrination.

Inadequate family and social support systems have long been linked to emo­tional disorders, just as strong family and social support has been linkedto mental health (Murray, 2005). Psychiatric consumers seck care to relieveemotional pain by being accepted and understood. However, consumers mayactually experience increased stigmatization and isolation (Lam & Salkovskis.2007; Lam, Salkovskis, & Warwick. 2005; Read & Harre, 2001) as a result ofthe repetitive and factually incorrcct monocausal view of mental disorders.Worse. psychiatric medications have been linked to disorientation. helpless·ness. and impulse control problems (Breggin. 2006: Jackson, 2005; Murray,

198 JOUH"!H. 0,.. fllI~NTAL IIEALTIf COUNSt:UNG

2006), \\hich Impactlhc consumer's dynamIc relationships \\ith others.Inudeq/late meflllS ofdealillg lIith tile exigencies ofSlIn';I'(JI. Cults oOer a

"type of shortcut or quick fix for thClf own sun ;\31. Cull members arc gener­ally discouraged from developmg autonomous, lIldcpcndcnI. and self-sufficientbeha\ ior" (Curtis & Curtis. 1993. p. 45-1). Psychiatric consumers afC routinelylold Ihal thelf \cry survival depends on their compliance with mc<hcal;on(Healy. 1006). A consumer who suggests no longer needing mcdicaI;on or isrcady to decrease lhe dosage is looked upon \\ ith skepticism and alano by thcfamily or prescriber. In most clements of psychology. Ihis c\idcncc of an inlcr­nallocus ofcontrol is viewed as a \ Ital aspect of mental health: ho\\e\er. \~ ithillthe psychl:l1ric literature. an inlemal locus of control is linked \\ ith "poorinsight"" and medication noncompliance (Kampman et al.. 2002; Voils. Stcffens.Flint. & Bosworth. 2005; Williams & Collins. 2002). The PP[C may inadver­tently e;luse more helplessness among consumers through the usc of cenainmcdications (Ballard et 'II.. 2007).

UI/II/al/ageable alld debilitating .\"I·lI/oliol/ol .\"lr(;'s.~ (I//(/ ("I";.I"e.\". Cults olTcr"immcdiate relief through llIopian promises" (Cunis & Curtis. 1993. p. 456).People arc most vulnerable to the offerings of cults during times of strcss andcrisis. "[t seems logical that individuals suffering from inordinme strcss scekout a varicty ofquick fi.'(cs. and will be II1crcasingly \'ulnemble to the sl,."ductivcpromlSCs offercd by cults" (CUl1is & CurtiS. p. 456).

Thc PPIC promotes two messages: (a) medications can make one happier.and (b) suffenng is uselcss and thereforc should be avoided. llistorically. psy­chiatric medications wcre used only for thc truly debilitated (O·l3arr. 2007).Now. the phannaccutical industry markets and health care prO\ lden; prescribepsychiatnc medications as quick fixcs (Whitaker. 2007). "cmotlOnal bnghten­ers:' or a mcans to tolerate oppressl\c relatIOnships or li\ing conditions(Dworklll. 2006; Lexchin. 2006) III short. for many. psychiatric mcdicationsha\c Ix-come "Iifestylc drugs:'

Imolemh!l''Wcioecollomic ("ofuliflOl/I·. Those who expencnce desperatesocioeconomic conditions are more, ulncrable to culls as all opportunity tocxperience rclicf from their situation because they offer practical solutions forsunival (iloffer. 1966. as cited in Curtis & Curtis. 1993). Lewis (2006) identi­fied three major groups who make up the bulk of psychiatric cOllsumers:women. the poor. and minoritics. Despitc New Psychiatry's almostllollexistcntacknowlcdgemcl1t of the socioeconomic oppression these groups cndure.cxperienccs of oppression propel the natural inclination to seek relief (Kiesler.1999; Lcwis. 2(06). Howcvcr. WlIlokur and Clayton wrote. "We [psychiatrists)arc not intercsted in the 'psyche.' We arc interested in specific psychiatric ill­nesses" (1986. pp. ix-.'(). Such pcrspcclI\es may lead to prescriblllg for symp­toms that arc better scned by iTllcrvcll1ng al thc sociclallcvel (Kiesler. 19(9).

DcspllC e" Psyehiatry's 19nomllee of SOCiOCCOIlOlnlC '-ariablcs. these

MU"QJ'II~')'CIIOI'f/AH"'ACEunCAL-IN1JUS1'HIAL COMI'I.E/I: 299

factors do influence menial health and medication usage. This is especiallydisconcerting when it eomcs to our most \'ulnerable population--children. Fore'tample. foster children and children of low socioeconomic stalUs ha\e anextremely high rate of psychiatric drug consumption (Bro\\nell. Mayer. &Chateau. 2006). In Oregon 300, of children in foster care are on psychiatricmedIcations compared to 6'·. of childrcn outsidc of foster care (AssociatedPress. 2007). lagnado (2007) speculated that the phannaceuticalmdustry mar­kets dircctly to the poor and elderly because services are p.1id for by federal and!>tatc go"emments through Medicaid and Medicare. This indiscnmmant usc ofpsychiatric medications on our most \'ulnerable populations-children. elderly.minorities. and women-may make this a fundamental issue requiring greaterallentionto those who advocate for social justice.

EXITING t'RO;\l TIlE l'l'le AND REDISCOVERING SELF

If the parallels between cults tlild the PPIC arc rcal. then as West (1993)wrote. "At any given lime most of their members are either not yet aW;lre lhatIhey arc being exploited or. having come 10 realize it. lhey are unable to expresssuch awareness because of fear. uncertainty. shame. or impainnent of will" (p.17). Therefore. mental health counselors (MHCs) who work wilh clientsresigned to the disease modcl must de"c1op strategies to expand client aware­ness. In this section. I identify deeonditioning strategies recommended by cultexperts and mental health professionals.

CurtIS (1982) suggcsted th;1t the following elements arc e~selltlal for assist­mg consumers: (a) identification of unlabeled emotions and beliefs. (b) label­ing of unrccognized emolions and beliefs. (c) articulation or gettmg in touch\\ lth contributory emotions and beliefs. (d) expression and diSCUSSIOn of feel­lllgS and beliefs. (c) cxtema1izallon and \entilatiOIl of pent-up emotions andbeliefs. (0 validation of clients' emotions and beliefs. and (g) acccptancc ofclients' cmotions and beliefs. Curtis and Curtis (1993) added that mdoctrinatedbeliefs arc resislam 10 extinction and require repetition. tenacity. and loleranceduring exit counseling.

C.o;uchta and Johnson (1998) also encouraged mental health profeSSIonals 10remind consumers thaI (a) reeo\ery is not only possible but docs occur, and (b)mcntal disordcrs arc a loss of self for which the recovery process includes lherediscovery of self. Strauss (1994) believes that this process has four b;lsicaspects: (I) discovering the possibility of possessing a more aClive sense ofself. (2) taking stock of the strengths and weaknesses of thi~ self and a~scssing

possibilities for change. (3) pUlling into action some aspects of the self and intc­gr.ning lhe results. and (4) u~ing the cnhanced sense of self 10 pro\ ide somedegree of refuge from the illness (as cited in Czuchta & Johnson).

MHCs are also ad\ ised to educate themsehcs on psychophamlacology and

300 JOURNAL Of' MENTA/~ IIEALTII COUNSELING

the ethics thereof (Murray, 2006; Murray & Murray, 2007) as a means to offersupport, encouragement, and education to consumers who have had negativeexperiences with psychiatric trealmenl. HappelL Manias. and Roper (2004)described a number of these experiences. which included (a) feeling frustratedthat there was no indication of the length of time that medication was neces­sary, thus decreasing the amount of controllhcy felt over their hcalthcarc; (b)psychiatrists prescribing medications under false pretenses and later becomingangry after learning more aboullhc medication; (e) hcalthcarc providers being1110rc interested in medication compliance than observing for and asking ques­tions about side effects; (d) feeling blamed if their symptoms did not improve,and that healthcare providers did not question treatment appropriateness: (c)healthcare providers, panicularly in inpaticnt settings, ignoring the consumer'sinterest in nonphamlacologieal treatments and emphasizing medication stabi­lization: and (f) their opinions and requests for infomlation being "frequentlydismissed as symptomatic of mental illncss rather than the legitimate claim forknowledge" (p. 247). If consumers present with these or similar experiences.MHCs arc advised to proceed using the recommcndations of Cunis (1982)described above.

IMPLICATIONS ,"'OR MENTAL IIJ::ALTII PROFESSIONALS

The major implications of the issues discussed for MIICs involve (a) rccx­amining thc role of the disease model withinmcntal healthcare, (b) advocatingfor recovery model approaches as an effective therapy. and (c) addressing mis­leading or deceptive proclamations within mainstream media.

The mental health profession's commitment to the diseasc modeL and byextension the PPIC, has hurt the profession and those we serve. (incidentally.psychiatry is the only medical profession with a substantial opposition move­ment led by psychiatric survivors [Lewis, 2006]). Yet the disease model docshave some merit. Psychiatrists, who have expertise in medical conditions, pos­sess the necessary skills to screen for the lTlany conditions that can aOect mcn­tal health (e.g., infections, intracranial stmctural defects, endocrinopathies.hypoxia-ischemia, dcmyelinating disease. autoimmune disease. metabolicabnonnalities. dietary abnomlalities, or exposure to neurotoxins).

Moreover, psychiatrists and MHCs arc in a unique position to advocate forpublic mental health and illness prevention (Glasser. 2005; Kieslcr, 1999;Sowers & Thompson. 2007). For example, psychiatry must draw up a researchagenda to hclp consumers recover from the damage done by neuropharmaceu­ticals; curremly. there is no infrastmcturc within mainstream medical practicethat otTers support for discontinuing medication, recovering from its damagingetTects, and recovering without medication (Jackson. 2007. personal cOlTlmuni­cation; Sower & Thompson. 2007). The American Association for Community

Murray / I'SYCJ/OPHARMAC£UTlCAIANDUSTRIAL COMJ>I.£X 301

Psychiatrists (httpJlwww.eomm.psych.pitt.edul) oITers a number of areas(leadership, training, and advocacy) in which psychiatry can rehabilitate theprofession. MHCs can also take the lead in rehabilitating our profession in sim­ilar ways.

Leadership. To my knowledge. no major mental health professional organi­zation (e.g.. American Counseling Association, American PsychologicalAssociation. ational Association of Social Workers. American Mental HealthCounselors Association. American Association for Marriage and FamilyTherapy. and. of course. American Psychiatric Association) has spoken outagainst the reduetionist, monocausal disease model and more forcefully advo­cated psychotherapy. I press upon thc leadership of the counscling profcssionto lead the way. We have a great heritage grounded in our recognition thatbehavioral problems arc best understood within the context of culture and rela­tionships rather than the belief that clients arc flawed by some genetic anomalyor I1curodefonnity-especially when neither has been shown to exist.

Training. Counselor education training programs must reconsider how weteach issues of psychopathology and psychophannacology to current studentsand practicing counselors. Rather than organizing training content solely byDSM nosology. such courses should also provide students with content criticalof New Psychiatry (e.g., readings that question the validity and reliability ofpsychiatric diagnoses. critique the biological etiology. and critique the use ofpsychiatric medications). However. counselors arc best served when they havecomprehensive training in behavioral neuroscience, including psyehophanna­cology. and research methodologies. Such training is necessary 10 a profes­sional"s abilily to speak the prevailing language while critically analyzing thedata. which may help counselors to ofTer clients conceptual ahemalives.

AdlYxacy. MHCs arc encouraged to examine how best to advocate for theprofession by emphasizing the unique contributions we have to ofTer to ourclients and community. To do so may mean shedding our allegiance to the sta­tus quo and thinking creatively. Our inability to "provide an equally simple andcompelling counter idea" (Leeman. 2007. p. 184) has only contributed to ourcollusion wilh the PPIC by (a) minimizing collaboration with one another. and(b) accepting money from the phannaeeutical industry to sponsor professionalconferences or to advertise in their publications with little regard for accuracy.

Instcad. MHCs arc invited to advocate for an ernpOWenllelll model thaIemphasizes recovery as possible and expected for even the most seriouspsychiatric disabilities. The National Empowerment Center (NEC:www.powcr2u.org). partially funded by the Substance Abuse and MentalHealth Services Administration (SAMHSA). has recommended its PACE pro­gram: Personal Assistance in Community Existence. The PACE program wasconstructed in part by examining the heroic accounts ofothers who have recov­ered from psychiatric disabilities. These individuals identified key clements in

302 JOURNAL Of' MENTAL JlEA!]JI COUNSf:UNG

thcir recovcry. such as (a) having someone around who believed in their recov­ery and in them: (b) IHlving someone who projected hope: (c) having someoncprovide a relationship in which they could lecl safe and trusted; (d) having acounsclor who was "able to be human:' which ineluded being open to correc­tion; and (c) leaming skills in self-care, forgivcness. taking responsibility, andsctting goals.

All these arc skills at which MIiCs arc adcpt. It is precisely our ability tounderstand our elicnts' symptoms psychologically that Icads to our successes.Therapists who hold a psychological view have been found to be more effec­tive than those who hold a medical view (Blatt, Sanislow. Zurofl'. & Pilkonis,1996).

Another area where MHCs can advocate for thc profession and their clientsis by addressing misleading or deceptive proelamations about the etiology ofmental disorders within mainstream media. Leo and Lacasse (2007) found thatmcdia outlets continue to promote the disease model with little investigativereporting on the merits of disease model assulTlptions. M1-ICs are encouraged towrite leiters to newspaper editors and other media outlets about the misleadinginfercnces that mental disorders are a product of a diseased brain. Finally.MHCs are encoumged to write articles for local newspapers and other publica­tions that promote psyehothempy and the muhicausal view ofmcntal disorders.

The latler view acknowledges that complex intcractions of psychological.social. and biological factors influence the dcvelopmcnt of emotional problems.Too oftcn. howcvcr. wc emphasizc one ovcr the othcr-particularly biologicalconsidcmtions. Bccause humans arc biological crcatures. all of our expcrieneesarc a function of chcmical and electrical proeesscs in our brains. However. thisshould not be intcrpretcd to mcan that our cmotional problems arc a product ofsomc biological disease, dcfieit. disorder. or dysfunction: thcy Illay mcrely bcunderstandable reactions to dillicult lifc situations. As with <lny system, whenthere is an intervcntion in any part of the system. the other parts respondaccordingly. For example. psychotherapy. like all forms of hUllllln interaction.has a direct impact on our biology. including ncural plasticity, and our socialrclationships (Fishbanc. 2007: Siegel. 2006).

Ultimately. consumers must be given a diversity of infonllatiol1 to becomefully informed about their treatment options.

CONCLUSION

Although many consumcrs cnter ,md exit the psychiatric system without anydelcterious cflects. too many lose their idcntity in thc process. Once inside,these conSUlllers are confronted with infOIll1lLtioll that C,ll1not be independentlyverified but that must be accepted in ordcr to reccive carc. and a new identitymust be adopted. Despitc bcing told they have a chemical imbalance. like dia-

Murray / I'SYCIIOI'HAHM,\CEUTICAL-INDUSTRIAL COMI'LEX JOJ

betes. or a genetic defecl. no biological teslS are offered as evidence: nor canconsumers prove the disease does not exisl. Nevertheless. the consumer isencouraged to try a number of medication cocktails to find the right one. Noone suggests that difficulty in finding the right combination may be evidencethat there is no biological abnomlality. The search for the right medication con­tinues until the symptoms meet the expectation of the prescriber. Thus praise isgi' en to the superiority of the medication rather than thc courage of the con­sumer. Rarely. however. do the symptoms abate forever; thus the cycle beginsanew. The cycle is organized around the disease model espoused by the PPIC.Vulnerable consumers become indoctrinated in ways similar to cults where "the{consulller}. having 10 seck definition as acutely sick and helpless in order toachieve a measure of public validation for his illness ... submerge[sJ himself inthe sick definition pemlanently" (Erikson, 1957. p. 271).

The disease model has failed the mental health consumer by eliminating hopefor recovery and increasing soci:!l stigma. isolation, and fear. Hill and Bale's(1981) remarks arc slill relevant today:

NOI only has the attempt 10 have the public vicw deviant behavior as symp­tomatic of illness failed. but the premise that such a view would increase pub­lic acceptance of the person engaging in such behavior seems to have been adubious one to begin with. The notion Ihat psychological problems are similarto physical ailments creates the image of some phenomenon o,er whicharnicted individuals have no cOlllrol and thereby renders their behavior appar­ently unpredictable (pp. 289 290).

The process of instilling hope of relief from emotional pain and the conceptthat suffering is not inherently pcmlanent is something importanl MIICs canofTer (Abramson. Mctalsky. & Alloy. 1989: Czuchta & Johnson. 1998).However. they may find it difficult to instill hope when working with diemswho have become resigned to Ihe disease modeL MHCs arc called upon nOI tocollude with the PPIC but instead to offer hope thai recovery is possible byadvocating for and eliciting personal resilience and empo\\cnnenl. To do this.they must advocate for their profession and develop psychologically relevantways to help clients expand their awareness of the nature of their emolions andbehaviors by rediscovering sci f and exiting the PPlC.

Rt:FERENCES

Abrnmson. L. Y.. Metalsky. G I. & Alloy. L U (1989/. Hopelessness dCl"fc.sion' A theory-based5ubtypc ofdcprcssion. Psychological R,""I'M. 96. 861 865,

AdaIr. J. C. SCh.......nz. R. L. & Barrell. A M (2003). Anosognosl3 In K M Hellman & E.Valenslem (Eds.). ClinicuJ nl'uropsnhology (4th ed_. PI". 185 214). Ne.... York' OxfordUn"'CTS'ly Press.

Amcnean Ps~hlatnc AssoclatlOll. (t98O) DlOgm}S/1l and stutUltcal ",u"'lOl "r mentaJ dl:wnl/'n(}nI I'd; Washmglon. DC: Author.

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