How Big Pharma Lost its Moxie, Psychiatry lost Faith in its Bible, and Psychiatry’s Biological Revolution lost its Way

In the early 1980s, American psychiatry declared a biological revolution. The Freudian ideas, that had dominated understanding and treatment since at least World War II, were denounced as unscientific and retrograde. Drugs, brain science and genes were declared the future of mental health care.

Thirty years later, there are clear signs that this so-called revolution is running into the sand. Far from flocking to psychiatry, many pharmaceutical companies have been fleeing it, as the prospects for new and potentially lucrative psychiatric drugs have dimmed. The DSM diagnostic manual on which profession has rested so much of its biological authority has come under sharp attack, not just by cranky outsiders but by informed insiders committed to the mission.

To understand why this has happened, we need to realize that the extraordinarily rapid changes in understandings of mental illness in the 1980s did not happen because new science triumphed over ossified dogmatism. The so-called 1980s biological revolution in psychiatry is instead best understood as an actor’s category. We confuse ourselves if we try invoking it to make analytic sense of developments in this period, simply because the period was not marked by any revolutionary new understandings of the biology of mental illness. If, though, we understand that we are dealing with a vision of psychiatry’s identity and destiny that was summoned rhetorically into existence in the 1980s, then we can start asking questions about why it was summoned, and all the ways in which it became a critically important mindset and belief system under which all sorts of stakeholders carried out—and still carry out—their business. We can also understand why it left behind such an unsatisfactory legacy.