Institutional corruption in psychiatry: Case analyses and solutions for reform

Researchers have documented psychiatry's crisis of credibility and called for transparency and reform, yet current solutions do not go beyond timid acceptance. The conceptual and normative framework of institutional corruption highlights the various economies of influence (e.g., industry's capture of regulatory bodies and medical journals) that need to be mitigated. Case analyses of (a) the process by which the latest antidepressant, vortioxetine, came to market, and (b) the promotion of a heavily conflicted guideline for “mixed depression” illustrate how industry is shaping the scientific evidence base and practice in psychiatry, and why systemic, policy-oriented solutions are needed. We offer solutions for reform that intend to go beyond simple transparency and address the root causes and systemic nature of the problems in the field. These include developing rating systems for clinical practice guidelines and medical journals, a stepped-care, contextual approach to diagnosis and treatment, addressing perverse incentive structures within universities, and a shift towards a rights-based paradigm of care with genuine stakeholder involvement.