Psychiatry Has the Moral High Ground (According to Jeffrey Lieberman)

BACKGROUND

As I suppose everyone knows by now, psychiatry has been on the receiving end of some very serious criticism in recent years.  The criticism has come from many sources, including: survivors of psychiatric “treatment,” non-psychiatric mental health practitioners, journalists, the general public, and even from some psychiatrists themselves.

The content of the criticisms has been equally varied, and includes:  that the concept of mental illness is fundamentally spurious and devoid of explanatory significance; that psychiatric “treatment” (i.e. drugging people) is ineffective, physically damaging and disempowering; that psychiatry has forged and continues to maintain corrupt and corrupting relationships with the pharmaceutical industry with regards to the peddling of drugs and the hijacking of research for commercial ends; etc…

By any standard, these are very serious criticisms.  I cannot recall ever seeing another profession take such a hammering, but I believe that if a bona fide profession did receive such criticism, they would take it seriously, conduct investigations, and start cleaning house.  This kind of honest self-appraisal has been almost totally lacking in psychiatry’s case.  Instead, we’ve received spin, spin, and more spin.

JEFFREY LIEBERMAN, MD

Dr. Lieberman is the recently installed president of the APA.  On June 18, he posted an article on Psychiatric News, the online journal of the APA.  The article, What It Means to Be President, is a response to the recent criticism.  Or more accurately, it purports to be a response.  In fact, it addresses not one substantive issue.  The general tone is:  why won’t you bad people stop picking on us good psychiatrists?

My first inclination was to ignore the piece.  There are more important issues to write about.  But Dr. Lieberman is the president of the APA.  This is as close as it gets to psychiatry’s “official” response to its critics.  For this reason, I believe that Dr. Lieberman’s rhetoric should receive some scrutiny.

ANALYSIS

Dr. Lieberman begins by telling us that he was moved by a recent ceremony in San Francisco for swearing in the APA’s latest batch of distinguished fellows.  He attributes his emotionality on this occasion to the “current challenges” facing psychiatry.  He provides a list of these challenges:

1. undelivered healthcare reform
2.  continuing stigma
3.  wanton criticism of psychiatry and the APA, and
4.  an enormuous burden of illness caused by mental illness and unmet clinical need for treatment.

It’s not clear what Dr. Lieberman means by undelivered healthcare reform.  With regards to stigma, I presume that he’s talking about the stigma of clients.  He doesn’t seem to realize, however, that promoting the idea that “mental illnesses” are biological actually increases the degree of stigma (Angermeyer et al 2011).

My 2009 edition of Merriam-Webster’s dictionary, under the definition of “wanton,” includes the following:

wanton (adj) ….merciless, inhumane; having no just foundation or provocation, malicious …

By using the word “wanton” in this context, Dr. Lieberman is saying that our criticisms are unwarranted and malicious.  Isn’t this the way children argue with each other in the schoolyard?  Did so!  Did not!  You have cooties!  Do not!

Given his position and his history, I suppose it’s reasonable that Dr. Lieberman would challenge our criticisms, but by the same token (his position and his history), it would also have been reasonable to expect something along the lines of logical discourse and factual evidence.  Simply denouncing our criticisms as “wanton” seems, if anything, to add weight to our side of the argument.

I’m not sure what Dr. Lieberman means by the “enormous burden of illness caused by mental illness”.  The putative “unmet clinical need for treatment” is something we’ve heard before, and is difficult to square with the fact that at the present time in the US, antidepressants are the second most prescribed drugs, second only to antibiotics.  That hardly sounds like unmet needs.

Dr. Lieberman goes on to remind us that “we are living in a moment of unprecedented scientific progress and with an array of therapeutic interventions with extraordinary effectiveness.”

The holy grail of psychiatric research for the past three or four decades has been the neurobiological underpinning for its various “diagnoses.”  Literally billions of dollars and centuries of manpower have been poured into this endeavor, but the only way to honestly describe the outcome is:  a total failure.  Even Thomas Insel, MD, who is certainly not one of biopsychiatry’s wanton critics, has admitted this.

So if Dr. Lieberman is aware of some “unprecedented scientific progress” that lends support to psychiatry’s medicalization of virtually all human problems, this might have been a good time to unveil it.

Similarly, with regards to the “therapeutic interventions with extraordinary effectiveness,” it would have been nice to learn what these are.  Perhaps he means neuroleptic drugs that shrink brain volume and lead to poorer long-term outcomes?  Or perhaps he means antidepressants whose effectiveness is about on a par with placebos?  Or perhaps he means electric shock “treatment” that reportedly “works” by obliterating people’s memories?

Dr. Lieberman concedes that it is easy to lose sight of the positive aspects of psychiatry because of:

1.  the recession
2.  the mass shootings
3.  the criticism directed against DSM-5, which incidentally, was “aided and abetted” by the media.

Of course I would suggest that the reason that it is so easy to lose sight of the positive aspects of psychiatry is that they are so few and far between.  But undoubtedly that’s just another example of my wantonness!  And how in the world is the economic recession casting psychiatry in a bad light?

Incidentally, doesn’t the term “aided and abetted” contain a slight suggesting of nefariousness?  Those wicked journalists!

Dr. Lieberman tells us that neither he nor his colleagues could have foreseen any of these dreadful developments.  This strikes me as odd, because the general themes have been out there for decades.  Presumably his attention was elsewhere.  And then – in what I can only describe as a plaintive bleat – he says:  “…they [the criticisms] certainly were not what we signed up for when we decided to pursue a career in psychiatric medicine.”  Poor lamb.  And note the final word – “medicine.”  In other words:  we’re real doctors – really!  Why won’t anyone believe me?

Dr. Lieberman continues:  “…the stigma directed at mental illness and psychiatry continues to be perpetuated by the media disseminating exploitative and misleading information.”  The meaning here is a little veiled, but I guess the gist is that the wretched media have been spreading lies about psychiatrists.  Here again, he might have served his cause better if he’d actually refuted one or two of these “lies.”

At this point, Dr. Lieberman issues his rallying cry:  “…it is time for psychiatrists, and led by the APA, to stand up for our patients and our field.”  This sounds more like a cheerleader than the president of a professional association.

Psychiatry, Dr. Lieberman goes on to tell us, has – and I’m not making this up:

1.  scientific momentum
2.  public health imperative
3.  moral high ground

Momentum, of course, as any student of physics knows, is a directional variable.  It can be forward or backward.  So here I am actually in total agreement with Dr. Lieberman.  Psychiatry does indeed have enormous momentum – but it’s so far backwards that it could accurately be described as pre-scientific.

I’m not sure what public health imperative means.  Something to do with epidemics?

But I do understand the concept of moral high ground, and I find it difficult to reconcile Dr. Lieberman’s claim with the numerous reports of corrupt relationships between “eminent” psychiatrists and the pharmaceutical industry, and with the fact that the APA routinely endorses for continuing educational credit, pharmaceutical presentations that even psychiatrists acknowledge are nothing more than marketing sessions.

In this context, I think it is also noteworthy that Dr. Lieberman has, or has had, financial relationships with:  Allon; GlaxoSmithKline; Janssen Pharmaceutica Products, L.P. (US); Merck & Co., Inc; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Sepracor Inc.; Targacept; Bioline; GlaxoSmithKline; Intra-Cellular Therapies, Inc.; Eli Lilly and Company; Pierre Fabre; Psychogenics; and Repligen Corporation.  According to ProPublica, in 2012, he received $43,204 from Eli Lilly alone.  But, of course, none of these relationships has ever influenced his professional judgment in the slightest.

If Dr. Lieberman genuinely wants to occupy the moral high ground (as opposed to just talking about it), he needs to introduce sweeping anti-corruption reforms in his own organization, and he needs to start now!

Then we have some more cheerleading.  Dr. Lieberman exhorts his constituents not to be defensive or even timid.  They must raise the awareness of the public and other physicians about – get this – “…the true nature and inherent value of psychiatric treatment and mental health care.”

Can you imagine the president of the kidney doctors association, or the lung doctors association, – or any bona fide medical specialty – spewing this kind of tripe?  People who have kidney failure or lung failure know the value of these treatments.  We don’t need speeches.  We don’t need to have our consciousness raised.  Psychiatry is the only medical specialty that needs spin.

And then it gets even worse:

“So while on one hand I have a healthy dose of frustration and outrage, on the other hand I am very optimistic and bullish on our profession.”

His profession is being criticized severely from several quarters on various issues, all of which have merit.  Dr. Lieberman tells us that this induces in him feelings of frustration and outrage.  These are strong terms.  Is it not almost the essence of maturity that one can listen to criticism with an open mind?  Not according to the president of the APA.  He assures us that his feelings of frustration and outrage are healthy.  In other words, it’s our fault that he’s feeling frustration and outrage.

The inmates I worked with back in the prison, used to call this “flip the script” (attributing the blame for one’s failings onto one’s accusers).

Finally, Dr. Lieberman recounts his goosebump moment as he administered the pledge to the distinguished fellows:

“I suddenly realized that the best strategy to respond to the challenges and criticisms that we faced was to rededicate ourselves to the principles and values that inspired our profession and that the pledge of Distinguished Fellowship beautifully articulated these precepts.”

Dr. Lieberman wraps up his article by quoting the pledge in full.  And it really is a wonderful pledge – replete with lofty goals and aspirations.  One might, however, have a little difficulty mapping it to current psychiatric practice, e.g. “I will faithfully dedicate myself above all to the welfare of my patients…” and “I further pledge to avoid commercialism in my professional life; …and to avoid any financial practice whatsoever that might debase my profession.”

SUMMARY

The gist of Dr. Lieberman’s article is:  we psychiatrists are good guys because we have a really good pledge.  Those scoundrels who criticize us are cads and bounders.  And the reason I know they are cads and bounders is because they criticize us good guys.

So far, this is just funny in a pathetic sort of way.  But we need to remember that for Dr. Lieberman, rededicating himself and his psychiatric colleagues to this “beautifully articulated” pledge is: “…the best strategy to respond to the challenges and criticisms” that have been directed against psychiatry.

So, to other mental health practitioners like myself who criticize psychiatry as spurious in concepts and destructive in practice, Dr. Lieberman’s response is: we’re rededicating ourselves to our pledge!

And to those journalists who have seen through the self-serving lies and the facile “logic,” and repeatedly exposed the destructive and disempowering practices, Dr. Lieberman’s response is:  we’re rededicating ourselves to our pledge!

And to the survivors of psychiatric “treatment” who are coming out in increasing numbers and conscientiously cataloging the abuse and stigma and disempowerment they received at the hands of psychiatry, Dr. Lieberman’s response is:  we are rededicating ourselves to our pledge!

And to the heart-broken parents of children who have taken their own lives under the influence of psychiatrically prescribed drugs, Dr. Lieberman’s response is:  we are rededicating ourselves to our pledge!

And remember, dear readers, Dr. Lieberman is the president of the APA.

  • Sweet63

    I just finished a biography of the poet Sylvia Plath. I’ve long thought that Rx drugs were more a cause than a symptom of her depression since reading about her first attempt at suicide in the Bell Jar. The author confirmed that she was put on an antidepressant shortly before her suicide in 1963. What kind of AD would that have been? I didn’t know they had them then. She did pop sleeping pills a lot, and that stuff will really bring you down over time.

    She left two little kids and a fabulous career behind.

  • Phil_Hickey

    Sweet63,

    Thanks for coming back. A tragic story!

    The approximate timeline for development of the early
    “anti-depressants” is:

    1956 Monoamine Oxydase Inhibitors (MAO-I), e.g. iproniazid (Marsilid)

    1958-61 Tricyclic antidepressants (TAD’s), e.g. imipramine
    (Tofranil); amytriptyline (Elavil)

    Best wishes.

  • acidpop5

    The stigma against mental illness and psychiatry… this statement really bothers me. Psychiatry has done more than its share to establish that stigma. The nonchalance in which he uses the term stigma is clarification enough for me that he has no idea the real weight of that stigma. Someone should advise him that the general distrust of psychiatry is not associated with any stigma. It’s based on repeat accusations and weighty evidence.

  • Phil_Hickey

    acidpop5,

    Thanks for coming in. Dr. Lieberman is extraordinarily unreceptive to any kind of criticism of psychiatry. He chooses to ignore the “weighty evidence” that you correctly mention, and instead whines about stigma. He also ignores the fact that psychiatric theories contribute to the stigma. [There is an article about this on Mad in America today.]

  • acidpop5

    Only a person who has never really been effected by the stigma of mental illness could be so cavalier about it.

  • acidpop5

    Sylvia’s suicidal ideation goes back further than that. In lady Lazarus, she notes, “one year in every ten I manage it” (going by memory). From personal experience, I can tell you it’s like a skip in a record. You try to fill your life with anything to keep you distracted, buy you always come back to the same place. There are so many truly ugly accusations against her husband and children being to blame, but the reality is, it’s a constant struggle. You should read, Mother by Frieda Hughes. She is Sylvia’s surviving child as her son killed himself a few years ago. Her anger and perspective on the way people use her mother is very enlightening. It also gives a more complete view to Sylvia’s story. She wore the poem in response to criticism in her refusal to allow movie producers to use her mother’s work.

  • The Right Honorable Cledwyn B

    Lieberman, the high priest of organized psychiatry, rarely wastes an opportunity to fulminate a few anathemas against the critics (most of them patients harmed by the profession). How much longer must people suffer the imprecations of this puffed up, power-mad tyrant, whose sovereign motive in acquiring power seems to have been the desire to avenge himself on the obviously impertinent, cynical critics, who see excrement where he sees gold?

    I heard Liberman believes in god. Yeah, he sees him everytime he looks in the mirror.

  • anonymous
  • The Right Honorable Cledwyn B

    The career of this puffed-up ponce bears ample testimony to the fact that a man rarely gets to the top through merit. Then again, getting to the top of the hierarchy of an abortion at birth like psychiatry (notwithstanding the claims of people who say that psychiatry only really bartered its soul when it prostituted itself and whatever conscience it supposedly had to Pharmas Big) through meritorious deeds would be about as plausible as getting to the top of the Mafia or the Nazi Party heirarchy through noble actions and beliefs.

    Power attracts the darker potentialities nestled within a man’s nature with such gravitational force that even the wisest struggle to inoculate themselves against its cankerous influence, including Abe Lincoln probably, who was more of a political opportunist, blowing like a reed back and forth in the winds of popular opinion, than some people think, though no doubt he yields probably to every other President in this regards. Little wonder then that someone as challenged in the brain department as the Right Honorable Sir Jeffrey Lieberman has been utterly corrupted right down to the smallest atom of his being and hurled headlong into the moral abyss by the power he holds. Then again, this presupposes he wasn’t all ready corrupt, which he must have been to have aspired to be president of the APA, who have all been utterly at the mercy of the libido dominandi, the lust for power.

    What Phil says about “flipping the script” is all too true. Every ideological or intergroup conflict is fought on the battlefield of morality, with each side trying to plant its flag on the moral high ground, rarely doing so by virtue of moral superiority, but by sheer superiority of power. Righteousness is rarely to be found among the righteous, but always among the wicked, examples of which the historical record is replete with.

    None of the main malefactors on this issue, such as mental health workers, policy and law makers, family members who consign their loved ones to total institutions or within the so-called sanctity of the home to be raped in perpetuity if they refuse to comply, abandoning them to the medicalized predations of psychiatrists and their lackeys who have been granted special dispensation to torture, con and kill people (in the name of fighting mental illness, which is of course the sovereign evil for the true believer in psychiatric scripture); none of these (and that list was obviously far from exhaustive) people are in any doubt that they have the moral ground, and when doubt does creep in, they can just comfort themselves through the age-old trick of trying to bring your accuser down to your own level, dragging us down into the moral gutter with them.

    Thomas Szasz for example has been accused, by that Goebbelsian rabble-rouser, E Full of You Know What Torrey, of being the eminence grise behind deinsitutionalization. He has also accused the “anti-psychiatry” movement of being responsible for 500,000 suicides (lies, damned lies, psychiatric lies, and statistics), all in an attempt to render more pleasant to the mind his own bloodied conscience. We are also supposedly responsible for the plight of the homeless.

    Lieberman is doing the same by putting stigma at our door. Yes, of course, questioning concepts that historically and contemporarily have rendered a service in laying the groundwork for the social exclusion, control, dehumanization, degradation, moral exclusion, torture and destruction of tens of millions of people, maybe more, is so utterly morally reprehensible as to being unworthy of further comment.

    Stendhal was right when he said, apropos of the relationship of power and mendacity, “I am convinced, almost instinctively, that as soon as he opens his mouth every man in power begins to lie, and so much more when he writes.”