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If we therefore accept that the biological myth of mental disorders is overplayed and oversold in psychiatry, the question follows as to why this may be. I believe if we have any hope of reaching an answer, it is necessary that we move away from psychiatry momentarily in order to investigate one of the most powerful industries in contemporary society: the pharmaceutical industry. What precise role has that industry played in promoting the biological theory of mental distress and for what end? Furthermore, who has that promotion really benefited—patients, psychiatry, or the industry itself?

To those thorny questions I now turn.

MONEY AND POWER RULING
HEAD AND HEART

I
n May 2011, British journalist Sue Reid broke a story that would shock a nation.
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It concerned a young boy from a small English village nestled in the sedentary hills of Cumbria. His name was Harry Hucknall. And from initial accounts he was your average kid: he liked football, computer games, and playing in the park. He had friends and was dearly loved by his family. There was not much to mark him out, not really. But on a Sunday night in September, that would change for good.

That evening Harry kissed his mother, Jane, and older brother, David, good night—carefully telling them that he loved them. He then went upstairs to his bedroom, locked his door behind him, took out a belt, tied it to his bunk bed, and hung himself. He was found after an hour, and later died in hospital. Harry was just ten years old.
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At the inquest into Harry's death the coroner, Ian Smith, reported that Harry had at the time been taking “two powerful mind-altering drugs”—Ritalin and Prozac. More important, the coroner had found more drugs in Harry's system than you would expect to find in an adult suffering from the same problem. It turns out that Harry was first given Ritalin by a child psychiatrist to help him with his poor concentration at school. He'd also been prescribed Prozac to help manage his feelings of depression.

As the inquest continued, the image of Harry as a happy boy began to disintegrate slowly. The authorities revealed that Harry had at one point self-harmed, and was also being bullied at school (he was held down and threatened with a screwdriver on one occasion). The drugs, it seems, were prescribed to help Harry manage the powerful feelings which, presumably, his situation had stoked.

Harry's father (who had amicably separated from Harry's mother when Harry was three) was one of the last people to find out about the drugs: “Harry was put on Prozac first, and without my knowledge,” he told Sue Reid emotionally. “I only found out about it when he came to stay for the weekend and his mother told me what dose to give him: one in the morning and one at night. ‘Are you crazy?' I asked her. ‘That's an antidepressant.' I can go to work every day and pay for my child's keep, but it seems I have little say when it comes to things like the authorities deciding to give my son drugs.”

Harry's father was always unconvinced that his son's problems were psychiatric. “He was just a kid,” he said to Reid, exasperated. “There was nothing wrong with him. He may have had some problems, but they were overstated.” For example, at school meetings about Harry, his teachers had said he was quiet. “My son had just recently moved house and been put into a new school where he didn't know anybody. What did they expect? Another teacher said Harry didn't laugh at his jokes. I asked Harry about that. He told me they weren't very funny.”

Reid also reports how at the inquest Harry's father challenged the psychiatrist who treated his son as to why he prescribed such powerful drugs. “This doctor said that my son had a chemical imbalance in his brain. I asked him, ‘How do you know? Did you take chemicals from his brain?' He told me it was a theory. So based on a theory—and seeing my son five times at the most—he decided to put him on this drug Ritalin, which is as powerful as cocaine.”

Harry's father was convinced his son's difficulties had been wrongly medicalized and medicated. Sure, Harry had problems. But they were due to the various upheavals the boy had undergone (Harry had moved houses no less than fourteen times), not due to deficiencies in his brain. Harry's father also believed that the drugs, rather than helping his son, had been “a major contribution” to his suicide, stating that his son had “never mentioned he wanted to kill himself before the tablets.”
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The coroner at the inquest seemed to have sympathy for Harry's father's claims, especially since we know that Prozac can, paradoxically enough, heighten suicidal tendencies.
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The coroner, however, could not confirm that the
pills
had caused Harry's death. This was largely because it is nearly impossible to establish retrospectively in suicide cases whether it was the person's depression or the drugs they were taking or the two combined that led them to take their life. All the coroner could say in general terms was that the combined influences of Ritalin and Prozac could not be excluded as a factor in Harry's death, and that therefore doctors should be extremely careful when prescribing these pills to 10-year-old boys.

A few months after Reid broke this story, an independent report into the events pertaining to Harry's suicide was published. Its verdict was that not only had the authorities demonstrably failed to improve Harry's situation, but that there was “evidence of poor practice throughout, which included both single-agency failings and generally poor interagency communication and collaborative working.” It also stated that the interventions Harry had received were “largely adult rather than child-focused” and that there was “no evidence of Child F's [Harry's] voice being heard or his wishes and feelings taken into account by professionals working with him and his family.”
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Furthermore, even though Harry was given exceptionally high doses of Ritalin and Prozac, he had still never been given a psychiatric assessment and had never been classed as a “high risk” patient—this, said the report, had been a mistake. Finally, the report implicates Harry's parents, concluding that one reason why Harry was “extremely vulnerable” and felt “unloved and unwanted” was possibly due to his parents not putting Harry's needs before their own.

In short, and perhaps quite predictably, the report ends up leveling accusations of negligence in many directions: at Harry's parents, at Harry's psychiatrist, at the various bodies charged with Harry's care, including the local agency responsible for children's mental health (CAMHS). And this is what you'd expect in a case as complex as this: a report whose authors claim that numerous acts of neglect, rather than a single culprit, were responsible.

What you'd also expect from the report is some reference to the role psychiatric drugs played in the tragedy. But here the report is suddenly cautious: “The issues in relation to the use of such medication and the complexities involved in treating co-morbidities remain unresolved. This is clearly a national issue and central government guidance is needed to inform and direct future medical practice.” In other words, the report's authors assumed it was beyond their jurisdiction to comment upon whether the drugs were prescribed responsibly. They also declined to comment upon whether the actual chemical properties of the drugs were a causal factor in Harry's death.
After all, the report's compilers were not in a position to undertake a scientific assessment of their own.

But even if they were, why on earth would they? The testing of pills is a rigorous, peer-reviewed scientific process overseen by independent regulators. Surely the people who ratified drugs like Ritalin and Prozac for public use, including those undertaking the manifold clinical trials through which such drugs pass, will have therefore identified all possible dangers the drug may pose. And this information, no doubt, will be passed on to prescribing clinicians. We are talking about medical drugs, after all, and so those who supervise their development and testing cleave to the highest ethical standards, overseeing processes in which we can all confidently trust.

If this were what the authors of the report supposed, then most of us would think the supposition fairly correct. In fact, most of the time
it would be
correct—that is,
most
of the time. But there are occasions when such suppositions are fundamentally contradicted by the facts. Indeed, such occasions, as will now become clear, appear with disconcerting frequency in the realm of psychiatry.

2

In chapter 5, we encountered research showing that antidepressants work almost no better than dummy pills for the majority of patients.
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We also heard how these findings were the result of researchers like Irving Kirsch and Walter Brown performing “meta-analyses” that assessed both published and unpublished data about the efficacy of psychiatric drugs. The fact that most of the unpublished data happened to be negative may have led you to wonder whether companies were actively suppressing results that didn't serve their financial interests.

In this chapter it is time to enter that tricky area directly, by acknowledging that pharmaceutical companies have histories of concealing evidence that they deem inconvenient. I will show that, whether this concealment is achieved by crudely suppressing negative data or by subtly manipulating research to show their drugs in the most positive light, the unpalatable truth about psychiatric drugs is that manipulation of research has been a critical reason for their popular success.

So many inconvenient facts have been sidelined or completely hidden that public debates that need to take place (about drugs inducing odd states, or long-term pathological states, or suicide states, as may have occurred in Harry's case, as well as placebo effects) are sidelined too. This chapter is therefore about what the compilers of the report into Harry's death either did not know or assumed they were not in a position to address. It's about how nearly all research into psychiatric drugs is today sponsored by the pharmaceutical industry and about how this arrangement has led to the compromise of basic scientific standards, and at worst to the outright manipulation of research with the aim of maintaining or increasing company profits
.
The following sad procession of industry deceptions will illustrate what I mean.
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The first concerns the British pharmaceutical giant GlaxoSmithKline, who conducted three studies of its antidepressant that is called Paxil in the United States and Seroxat in the UK. These studies investigated whether this drug could reduce major depression in adolescents. But the trials were highly inconclusive. One trial showed mixed results, another trial showed that Paxil/Seroxat was no more effective than a placebo, and the third suggested that the placebo may be more effective with certain children. Despite these mixed results, the company published only the most positive study, publically declaring that the drug is effective for major depression in children.

This would have gone unnoticed had an internal company document not been leaked to the
Canadian Medical Association. This showed that company officials had actively suppressed negative results from one study because, as they said, “It would be commercially unacceptable to include a statement that the efficacy had not been demonstrated, as this would undermine the profile of paroxetine [Paxil/Seroxat].” Once this information came to light, a lawsuit was filed against GlaxoSmithKline in 2004 for intentionally hiding negative findings. This was settled out of court two months later when the company paid $2.5 million for charges of consumer fraud; it is a meager sum, considering that GlaxoSmithKline made $4.97 billion in worldwide sales from the drug in 2003 alone.
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In a separate class-action suit in 2009, the pharmaceutical company Forest Laboratories was charged by the US Justice Department for defrauding the government of millions of dollars. It appeared that top executives at the company had for several years hidden a clinical study showing that their antidepressants Celexa and Lexapro were not effective in children and might even pose dangerous risks to them. At worst, these risks included causing some children to become suicidal.
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Prosecutors said that by failing to disclose the negative results, Forest had kept crucial information hidden from physicians and the wider public, preventing them from having all the information they require to make the right treatment decisions for young children.

And again, in 2010 an article in the
British Medical Journal
showed that the drug reboxetine, marketed as Edronax by the drug giant Pfizer, is no more effective at countering major depression than is a placebo sugar pill. Pfizer, however, withheld negative trials from publication. In fact, data on 74 percent of patients the article surveyed were actually left unpublished. The authors concluded that if the excluded data had been included, the evidence would have shown that the risks of taking the drug far exceeded the benefits. Reboxetine has been approved for marketing in many European countries (for example, the United Kingdom and Germany) since 1997, however, and is still being taken by thousands of people in the UK today.
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My final example concerns an article published by
The New England Journal of Medicine
in 2008 that confirmed in graphic terms precisely how widespread the suppression of negative data for psychiatric drugs actually is.
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The authors reviewed over seventy major studies of antidepressants' efficacy, asking whether all of these studies had been published. The answer was unnerving. Out of all the studies the article surveyed, 38 showed positive results for antidepressants, and nearly every one of these positive studies had been published. But the remaining 36 studies actually showed negative results, and out of these a full 22 had been buried, 11 had been published in a form that conveyed a positive outcome, and only 3 had been published accurately.
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In other words, a total of 33 negative studies had either been buried or manipulated to convey a positive outcome.

This last article is so important because it not only shows the extent to which negative data never sees the light of day but also because it reveals that psychiatric drug research is being regularly manipulated to make negative data look positive.
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This in turn means that companies are engaging in strategies of deception greatly more sophisticated than merely hiding negative studies.