Minnesota psychiatry news, and a note about reference groups

Carl Elliott posted at Mad in America yesterday (“To Honor or to Investigate?”) about the University of Minnesota’s press release announcing that Charles Schulz, head of the psychiatry department, is receiving the 2014 Stanley Dean Award for Research in Schizophrenia from the American College of Psychiatrists. “The timing of this announcement is intriguing,” he writes.

For the past month, a petition to investigate psychiatric research misconduct at the university has been quietly gathering momentum. It is not often that you will find an issue on which the editors of The Lancet and Guinea Pig Zero agree, but the need to investigate the University of Minnesota is one of them. MindFreedom International has endorsed the petition; so have 200 academic experts in health law, clinical research and medical ethics, including former editors of The New England Journal of Medicine. Many alumni of the university have left distraught comments on the petition....

Elliott wonders who will prevail – those lauding these practices or those seeking to stop them. For me, this particular contrast brought to mind the sociological concept of the reference group. A reference group is

the group to which the individual relates or aspires to relate himself or herself psychologically. It becomes the individual's frame of reference and source for ordering his or her experiences, perceptions, cognition, and ideas of self. It is important for determining a person's self-identity, attitudes, and social ties. It becomes the basis of reference in making comparisons or contrasts and in evaluating one's appearance and performance.

…Reference groups act as a frame of reference to which people always refer to evaluate their achievements, their role performance, aspirations and ambitions.

When seeking to understand what could lead people to act in the ways described in the post, we tend to focus a lot on financial corruption and careerism. But thinking about reference groups can add another important dimension. It seems to me that virtually the only reference group available to most people seeking to enter psychiatry or related fields in many countries is the complex of corporations, professional organizations, and government and academic institutions that support adjustment psychiatry, the brain-disease-drug model, and a strong corporate role. In their education and professional life, people entering these fields are socialized within this system and come to regard the people in it as the only real or meaningful set of reference groups. They don’t just provide financial incentives, and financial rewards (or punishments) wouldn’t be enough to keep people enthusiastically involved in any case. They provide the social basis for the construction of a professional identity – social rewards, a culture of achievement (however dubious), a professional status and network, an ideology into which one’s work fits, and so on.

Not only do the alternatives seem limited, but they’re often viewed as threatening to the professions themselves and to the professional’s very identity. Happily, there are growing movements within psychiatry and psychology that can provide different frames of reference and visions of professional development. I hope that the movement for humanistic psychiatry continues to take form and to grow, and that more people wishing to do this sort of work come to be aware that they can choose and advance an entirely different political and professional role - one they can be proud of and fulfilled by.

The groups that embody the dominant model will continue to use their immense power and resources and to offer their accolades; their opportunities for professional status, career advancement, and social engagement; their comforting notion of the psychiatrist’s social role;... But as more and more people become aware of the scientific, ethical, and political problems with this model and of the history and existence of real alternatives, an organized humanistic movement can offer a meaningfully different and positive reference group.