The Chief Peril Is Not a DSM Diagnosis but the Polarized Mind

This article calls on organized psychiatry and psychology to wake up and address a major underappreciated discrepancy. This is the discrepancy between diagnostic nomenclature for therapy clients and the nonpathologizing or even glorifying nomenclature for many throughout history who are abusive, degrading, and massively destructive. While the former, typically clinical population, may be referred to as the “diagnosed” and the latter, typically nonclinical population, as the “undiagnosed,” I show how the compartmentalization of our current psychiatric diagnostic system prevents us from seeing the larger problems with mental health in our country and beyond and show that these problems require an alternative framework. Such a framework would address both that which we conventionally term mental disorder as well as the disorder of cultures, which so often forms the basis for that which we term mental disorders. I propose that the phenomenologically based framework that I call “the polarized mind” is one such alternative that might help us more equitably treat suffering, whether individual or collective.

Curing Financial Conflicts of Interest in Psychiatric Professional Organizations

Most of the attention to the problem of financial conflicts of interest (FCOI) in psychiatry has centered on the actions of individuals. But what if the problem is much larger, and has infected entire organizations? Using the conceptual, and normative framework of “institutional corruption,” we describe how organized psychiatry has developed values, norms, and practices that have undermined its public health mission. Specifically, we argue that institutionalized FCOI have distorted the evidence base upon which psychiatric research, diagnosis, and treatment depends. We argue that current strategies such as simple transparency of commercial ties and “managing” FCOI are insufficient and vulnerable to gamesmanship. Following the IOM’s most recent (2011) recommendations for preventing bias when there are academic–industry relationships, we offer ideas for responding to the ethical and intellectual crisis in psychiatry, and emphasize the importance of training practitioners to think critically when assessing the evidence base of industry-sponsored research.