利益扭曲下的美国精神医学 序言

Psychiatry Under the Influence

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Psychiatry Under the Influence

Institutional Corruption, Social Injury, and Prescriptions for Reform

Robert Whitaker
and
Lisa Cosgrove

PSYCHIATRY UNDER THE INFLUENCE

Copyright @ Robert Whitaker and Lisa Cosgrove, 2015.

To the Edmond J. Safra Research Lab on Institutional Corruption at Harvard University, which made this book possible

Other books by Robert Whitaker

 
Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill (2002)

The Mapmaker’s Wife: A True Tale of Love, Murder, and Survival in the Amazon (2004)

On the Laps of Gods: The Red Summer of 1919 and the Struggle for Justice that Remade a Nation (2008)

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America (2010)

Other books by Lisa Cosgrove

 
The Ethics of Pharmaceutical Industry Influence in Medicine (coauthored with O. S. Haque, J. De Freitas, H. J. Bursztajn, A. Gopal, R. Paul, I. Shuv-Ami, and S. Wolfman, S., 2013).

Bias in Psychiatric Diagnosis (coedited with P. J. Caplan, 2004).

前言
劳伦斯·莱斯格*

哈佛法学院Roy L.Furman讲席法律与领导力教授；哈佛大学埃德蒙德·萨夫拉道德中心主任。

2010年，哈佛大学爱德蒙·J·萨夫拉伦理中心（Edmond J.Safra Center for Ethics）启动了一个“实验室”，研究“制度腐败”。我们的目标不是针对作恶的单个个人。相反，我们感兴趣的腐败是更为普遍、更为常规的制度。这是一系列利益相关的产物，在经济利益扭曲下，削弱了特定制度的有效性，特别是损害了公众信任。

通过我对美国国会功能失调的反思，我被这种腐败概念所吸引。国会里没有罪犯。然而，很明显，该组织允许竞选资金的影响削弱了其制度有效运行，当然也削弱了公众信任。我自己的工作将国会的分析发展为“制度腐败”的一个案例。事实上，在我看来，这个案例是典型的。

但在实验室的早期，Lisa Cosgrove教授描述了精神医学领域的类似情况。正如她在演讲和写作中所解释的，精神医学也让自己受到了一种利益扭曲，这种利益扭曲破坏了其帮助患者的核心使命。腐败的情况与国会的不同。但正如她所相信的，这个故事可以用类似的术语来理解。她描述说，该领域很容易受到制药公司的商业影响。她认为，这种影响的故事可能是“制度腐败”的另一个典型案例。

这本书证明她是对的。丽莎·科斯格罗夫（Lisa Cosgrove）和罗伯特·惠特克（Robert Whitaker）以一个令人难以置信的、令人信服的叙述展示了美国的精神医学行业为何会受到制药行业的利益扭曲，以及被扭曲的方式。这样做，他们很可能描述了比国会更清晰的制度腐败案例。这个故事中的演员并不是邪恶的，即使有少数人愿意用这个词来形容。相反，他们是在应对可以理解的压力（或者说是乏味的）。但是，通过缓慢的（如果明显的话）进展，该领域的目标变得与一种利益扭曲相关联，这种扭曲与医学机构帮助患者的核心目标相冲突。这场冲突的后果是，精神医学行业的医疗实践，消耗了6.3%的医疗费用，却对患者几乎没有明显的益处（除了最极端的情况外）。

毫无疑问，这本书将导致前所未有的审查。事实上，考虑到利益相关，它肯定会受到攻击，其作者也是如此。但科斯格罗夫的学术和专业经验，再加上惠特克强有力的调查报道，将提供给公正的读者一个令人惊讶的故事。当他们提出的论点被接受时，他们将启发我们进行精神健康领域的根本变革。无论是否有借口解释精神医学的这种大面积沦陷，现在几乎没有理由不去理会它。

F O R E W O R D

Lawrence Lessig*

Roy L. Furman Professor of Law and Leadership, Harvard Law School; Director, Edmond J. Safra Center for Ethics, Harvard University.

In 2010, Harvard’s Edmond J. Safra Center for Ethics launched a “Lab” to study “institutional corruption.” Our aim was not to target bad souls doing bad things. Instead, the corruption that we were interested in was more ordinary, or regular. It was the product of a set of influences, within economies of influence, that weaken the effectiveness of the particular institution, especially by weakening public trust.

I was drawn to this conception of corruption through my own reflections on the dysfunction of Congress. Congress is not filled with criminals. Yet it seems clear enough that the institution has allowed the influence of campaign funding to weaken its effectiveness, and certainly weaken its public trust. My own work developed the analysis of Congress as an example of “institutional corruption.” Indeed, in my view, the example was paradigmatic.

But early in the life of the Lab, Professor Lisa Cosgrove described a similar dynamic within the the field of psychiatry. As she explained it in presentations and in her writings, psychiatry too had allowed itself to be affected by an influence that had corrupted its core mission—to help patients. The dynamic of that corruption was different from the dynamic in Congress. But as she believed, the story could be understood in similar terms. The field had been vulnerable, she described, to the commercial influence of pharmaceutical companies. And the story of that influence, she argued, could be another paradigmatic case for “institutional corruption.”

This book proves that she was right. In an incredibly compelling and convincing account, Lisa Cosgrove and Robert Whitaker show just how and why psychiatry has been corrupted by the influence of the pharmaceutical industry. And in so doing, they may well have described an even clearer case of institutional corruption than Congress. The actors in this story are not evil, even if there are a few one would be tempted to use that term to describe. They are instead responding to understandable, if pedestrian, pressures. But through a slow, if pronounced, progress, the very aim of the field becomes linked to an influence that conflicts with the core purpose of any institution within medicine—to help the patient. And the 

consequence of that conflict is a practice and an industry that consumes 6.3 percent of health care costs, with, except for the most extreme cases, very little demonstrable benefit to the patient.

No doubt this book will attract incredible scrutiny. And indeed, given the interests at stake, it is certain to be attacked, as will its authors. But Cosgrove’s academic and professional experience, combined with Whitaker’s powerful investigative reporting, provide an account that will astonish the fair reader. And when the arguments they make are accepted, as they will be, they will induce a fundamental change in how we approach the field of mental health. Whether or not there was an excuse for what broad swaths of psychiatry became, there can be little excuse for leaving it untouched now.