Post-World War II psychiatry: 70 years of momentous change

Pharmaceutical industry debacle
Few industries have fallen so far from grace in the eyes of psychiatric profes­sionals and the public as the manufac­turers of psychotropic drugs.

At the dawn of the psychophar­macology era (the 1950s, 1960s, and 1970s) pharmaceutical companies were respected and regarded by phy­sicians and patients as a vital partner in health care for their discovery and development of medications to treat psychiatric disorders. That image was tarnished in the 1990s, however, with the approval and release of several atypical antipsychotics. Cutthroat competition, questionable publication methods, concealment of negative findings, and excessive spending on marketing, including FDA-approved educational programs for clinicians on efficacy, safety, and dosing, all con­tributed to escalating cynicism about the industry. Academic faculty who received research grants to conduct FDA-required clinical trials of new agents were painted with the same brush.

Disclosure of potential conflict of interest became a mandatory proce­dure at universities and for NIMH grant applicants and journal pub­lishers. Class-action lawsuits against companies that manufacture second-generation antipsychotics—filed for lack of transparency about metabolic side effects—exacerbated the inten­sity of criticism and condemnation.

Although new drug develop­ment has become measurably more rigorous and ethical because of self-regulation, combined with vigorous government scrutiny and regulation, demonization of the pharmaceuti­cal industry remains unabated. That might be the reason why several major pharmaceutical companies have abandoned research and devel­opment of psychotropic drugs. That is likely to impede progress in psy­chopharmacotherapeutics; after all, no other private or government entity develops drugs for patients who have a psychiatric illness. The need for such agents is great: There is no FDA-indicated drug for the majority of DSM-5 diagnoses.

We entrust the future to next generations
Momentous events have transformed psychiatry during the lifespan of Baby Boomers like me and many of you. Because the cohort of 80 million Baby Boomers has comprised a significant percentage of the nation’s scientists, media representatives, members of the American Psychiatric Association, academicians, and community lead­ers over the past few decades, it is conceivable that the Baby Boomer generation helped trigger most of the transformative changes in psychiatry we have seen over the past 70 years.

I can only wonder: What direc­tion will psychiatry take in the age of Generation X, Generation Y, and the Millennials? Only this is certain: Psychiatry will continue to evolve— long after Baby Boomers are gone.