1 Boring Old Man

he·gem·o·ny [hj-mn]   noun     1: preponderant influence or authority over others: domination     2: the social, cultural, ideological, or economic influence exerted by a dominant group

Psychiatry is approaching a crisis. For thirty years, it has been dominated by the inertia of the coup d’etat in 1980, the DSM-III revision that became a virtual Declaration of Independence from its domination by a small but powerful subgroup – the psychoanalysts. While claiming to redefine its own destiny, it has been increasingly shaped by other powerful forces – the Insurance/Hospital Industries in a variety of incarnations and the well-heeled Pharmaceutical Industry, soon to be joined by an emerging third power – the government.

Like the Star Wars series or the cowboy movies which take place primarily in systems at the edge of the things, psychiatry has always operated at the outer rim of the medical galaxy – dealing, as we do, with the most complex and least understandable of organ systems. The analysts had their shot at the software side followed now by the biologists who focused on the hardware. But what we still don’t know about both is painfully clear to us all [and everyone else] – keeping us wandering in the wilderness prey to the chaos of a frontier culture. While that makes for excellent fiction, it’s a difficult and volatile academic enterprise and we have recurrent he·gem·o·ny problems.

^{… but the fact of the matter is that this does not mean that the academic medical community and physician investigators should not or cannot be actively involved collaboratively in the drug discovery and development process. Indeed, this type of interaction and collaboration is not just helpful but is essential if we are going to sustain medical progress in developing treatments for human disease…}

^{"When we established the limits on income from industry sources, we looked to make them more stringent than requirements for staff at the National Institutes of Health, members of advisory committees for the Food and Drug Administration, and most academic departments," he answered. Dr. Kupfer added that each member agreed to follow these limits at the start of their work on DSM-5 — and to continue following them as long as they are involved in the development of the manual. "APA has looked to strengthen these policies even further for new clinical practice guidelines in development…"}