Once I finished my psychiatric training at Massachusetts General Hospital I set up a shingle in a small town north of Boston. Like most of my colleagues, I became a “psychopharmacologist,” meaning that I specialized in prescribing drugs.
In 2002, a drug rep from Wyeth asked me to speak for the company to push their new antidepressant, Effexor XR. Flattered, I signed up, and what I experienced over the next year profoundly changed the way I viewed my field. I realized that not only were drug companies expecting doctors to deceive other doctors for pay, but that among all specialties psychiatrists seemed to be the most likely to sell their professional reputations for a few $1000 checks. After a year, I quit Wyeth’s speaker’s program, and started a new publication, The Carlat Psychiatry Report, to provide a non-drug company funded alternative for psychiatrists seeking unbiased information on the latest treatments. Because there was nothing similar, the newsletter quickly became popular with my colleagues seeking an honest alternative to pharmaceutical company marketing copy.
In November of 2007, I wrote a memoir reflecting on my experiences in 2002 working as a hired gun for the pharmaceutical industry. It was published in the New York Times Magazine and became one of several influential documents leading to much needed reforms in the excessively cozy relationships between drug companies and doctors. Now, most of the leading medical schools have banned their faculty members from accepting gifts from drug companies or from giving marketing talks.
One psychiatrist who subscribes to my newsletter is married to a book agent, Raphael ("Rafe") Sagalyn, of the Sagalyn Literary Agency. Rafe read some copies of the newsletter and e-mailed me one day to ask if I had ever thought about writing a book about psychiatry for the general public. While I had written professional textbooks, his idea for a more accessible book intrigued me. After several false starts, I hit on the idea of writing about some of psychiatry’s serious problems, because the profession did not seem interested in reforming itself. My hope is that Unhinged will educate the public about the crisis in my field, and will generate pressure that will force psychiatry to take a close look at itself.