Economies of Influence

Abstract

As the Edmond J. Safra Center for Ethics has developed its lens for studying institutional corruption, it has focused on the need for researchers to identify the “improper dependencies”—or, alternatively described, the “economies of influence”—that may have proven corrupting to the institution. In the previous chapter, we looked at how, with the publication of DSM-III, a potential conflict arose between the APA’s guild interests and its ethical obligations as a medical discipline. The APA had a guild interest in promoting its new disease model, and yet, at the same time, it had an ethical obligation to inform the public, in a thorough and balanced way, what research was revealing about the nature of psychiatric disorders and the drugs used to treat them. In this chapter, we begin our inquiry into the conduct of the APA and organized psychiatry since that seminal moment in 1980, and, as a first step, it is necessary to detail the rise and growth of “economies of influence” that may have shaped psychiatry’s behavior during the past 35 years. In this way, it is possible to see the financial influences that have been present during this period, and may have affected psychiatry’s conduct.

Dependence upon funders produces a subtle, understated, camouflaged bending to keep the funders happy … they become in the words of the X Files, “shape shifters” as they constantly adjust their views.

—Lawrence Lessig, 2013¹