Sinaikin: One scientific article I read about the new childhood disorders sounds like a satire. Two well-respected "thought leaders" in psychiatry were debating the underlying pathology of a three-year-old girl who ran out in traffic. The first doctor believed her dangerous behavior was indicative of an Oppositional-Defiant disorder. The other doctor argued her impulsive act represented grandiose delusions where this girl believed she was special and cars could not harm her. She was, therefore, bipolar.
Rosenberg: Another shocker in your book is how everyday drug and alcohol addicts were recast as having psychiatric conditions for money.
Sinaikin: The insurance companies told the rehabs they would no longer pay for inpatient rehab for heroin, cocaine or alcohol unless there was also another Axis 1 psychiatric disorder like bipolar disorder or major depression. I was working in a drug treatment facility when the change happened. Since addicts typically complain of anxiety and depression, a completely understandable emotional response to their toxic lifestyles, it was "no problem" to add a new label and throw a few psychiatric drugs at their now relabeled "dual diagnosis". Of course the central tenet of recovery, taking personal responsibility, was buried by the new victim narrative of self-medicating a previously undiagnosed mental illness.
Rosenberg: Treating addiction with psychiatric drugs before or instead of seeking a higher power is antithetical to the 12 Steps of Alcoholics Anonymous.
Sinaikin: As I say throughout my book, human beings are indescribably complex. There are times when the dual-diagnosis concept is necessary and helpful but clearly not applicable to 100% of the cases of addiction as it is now applied. I believe that the 12 Step model is an ideal model of recovery. Patients can have the help whenever they are truly ready, not just when someone decides to foist it on them. Most importantly, the addicts helping other addicts are doing it to facilitate their own recovery and not for ulterior motives such as money. Amazingly, in a world gone profit crazy 12 Step recovery programs are still free. I conceptualize the 12 Steps as a distillation of the spiritual principles world's great religions but no one is forced to believe in anything including God.
Rosenberg: Given conflicts of interest at the American Psychiatric Association, which drives psychiatric diagnoses, in the FDA drug approval process itself and the legions of doctors willing to huckster for pharma as thought leaders or Key Opinion Leaders (KOLs), do you see any hope of rescuing people from Psychiatryland?
Sinaikin: The system is unbelievably bad and even worse than it looks. But, I think a goal that could be achieved would be a repeal of direct-to-consumer advertising. Patients now come into my office asking me if they have ADD or bipolar disorder or if they can have Cymbalta. When I began practicing psychiatry, long before direct-to-consumer advertising, this would never have happened.