The Scientific Journals

By : John Horgan


The first thing one notices on entering New York City’s cavernous Jacob Javits Center, site of the 149th annual meeting of the American Psychiatric Association, is the Eli Lilly exhibit. The golden, shrinelike tower emblazoned with “Prozac” in Day-Glo red stands amid interactive video screens and fiercely cheerful Lilly salespeople touting the wonders of the best-selling antidepressant (sales topped $2 billion last year).

Some 16,000 people—including psychiatrists, psychotherapists, researchers and drug-company representatives—have gathered here in early May for lectures on everything from “Kids Who Kill” and “The Psychobiology of Binge Eating” to emerging markets for psychiatric services. One “area of opportunity,” reveals Melvin Sabshin, medical director of the APA, is forensic psychiatry. “We have more people with psychiatric disorders in jails and prisons than in hospitals,” he explains.


A big buzzword is “parity”—the principle that insurance companies should provide the same coverage for mental disorders as they do for physical ones. A bill calling for mentalhealth parity won approval from the Senate in April after heavy lobbying by the APA but still has to run the gauntlet of the House. “This is about fairness,” declares Marge Roukema—a Republican representative from New Jersey and a fierce advocate of parity—to a cheering audience. Most people who see therapists, argues Roukema (who happens to be married to a psychoanalyst), are not self-absorbed neurotics like the ones depicted in Woody Allen films but people with a real need.

Psychiatrists here voice concern about the encroachment of psychologists and social workers, who usually  charge less than psychiatrists do. On the other hand, psychiatrists are M.D.’s and can prescribe drugs, which are cheaper than protracted talk therapy. And psychiatrists flock to breakfasts and dinners featuring lectures on the latest drugs for insomnia and depression—meals sponsored by Pfizer, SmithKline Beecham and other pharmaceutical firms.

Not every attendee embraces the better-living-through-chemistry philosophy. At a session entitled “The Future of Psychotherapy,” which is attended by only 20 or so people, Gene L. Usdin, a psychiatrist at the Ochsner Clinic in New Orleans, frets that “we are selling our souls” to the drug companies. Another dissenter is a sales rep for Somatics, which has a modest booth in the shadow of the Prozac pavilion. His company, he claims, provides a far more effective treatment for severely depressed patients: electroconvulsive therapy.