Dr. Lieberman’s Latest

On September 12, Jeffry Lieberman, MD, President of the APA, posted an article on Psychiatric News titled IPS to Feature Patrick Kennedy, Celebrate Community Psychiatry.

The article is a preview of an APA conference scheduled for October 10-13 in Philadelphia: “Transforming Psychiatric Practice, Reforming Health Care Delivery.”

Dr. Lieberman tells us that he is very excited about the conference, and that the theme is particularly relevant

“…given the changes we are experiencing in the profession and some of the exciting program events that I hope will support APA’s goal of being in the forefront of changes in the profession under health care reform.”

I find this sentence a little difficult to follow, but in any event, it is clear that Dr. Lieberman is excited and that this excitement has something to do with “Transforming Psychiatric Practice.”

But I am also puzzled.  As many of my readers will be aware, I am an avid follower of Dr. Lieberman’s writings, and it is has long been my impression that as far as Dr. Lieberman was concerned, psychiatry was perfectly OK the way it was.

He has insisted that psychiatry has “…nothing to be defensive about.”

He stated that he ran for APA president

“…because I felt mad and wanted to use all of the power and influence of APA to speak up and stick up for our profession.”

Dr. Lieberman has also written that:

“We have the scientific momentum, public-health imperative, and moral high ground. We must not be defensive or even timid…”

So what’s got me puzzled is:  from Dr. Lieberman’s perspective, why in the world would psychiatry need to be transformed, and why would the prospects of such transformation precipitate such feelings of excitement in the president of the APA?

Dr. Lieberman goes on to sketch out some of the main themes that will be covered in the conference.  One in particular caught my attention:

“Several sessions on mental health recovery, including how psychiatrists can be involved.”

In my opinion, emphasizing this theme seems to represent a huge departure from psychiatry’s insistence over the past four decades that the “illnesses” they “treat” are essentially incurable and can only be kept in remission by the uninterrupted ingestion of psychoactive pharmaceutical products as prescribed by a psychiatrist.

In fact, one of the primary items of contention between psychiatry and those of us on this side of the debate has been this very issue.  Many survivors’ self-help groups have demonstrated clearly that recovery is possible, and there has been a good deal of evidence to support the notion that reduction or cessation in the use of the drugs is a useful first step in this process.

Now if Dr. Lieberman were sincere in wanting to transform psychiatric practice, and if he genuinely wanted to take on board the lessons learned by those individuals who have embraced the recovery model, wouldn’t you think he would apologize profoundly for psychiatry’s past errors, and start reaching out humbly towards recovery model programs?

But no.  What he’s doing instead is trying to co-opt the concept of recovery.  Note the phrase: “…how psychiatrists can be involved.”

So the question is:  can psychiatry be involved in recovery?  Can a profession that has relentlessly promoted its own self-serving, erroneous, and destructive ideas about human suffering and human problems ever cross the divide and become a significant promoter of recovery?  The question is pertinent today, given the inexorable expansion of psychiatric “diagnoses,” and the routine prescribing of psychoactive products to ever-increasing segments of the population.

I found it particularly interesting that there is nothing in Dr. Lieberman’s article to suggest that there will be any input from psychiatric survivors at the conference, even though it is arguable that these individuals know more about recovery than anybody else.

As an interesting contrast, two days after Dr. Lieberman’s article, thanks to Steven Coles on Twitter, I came across an article, Psychiatry beyond the current paradigm, by Jacqui N.  It’s a description of a conference that took place on September 2-4 in Nottingham, England, organized by the Critical Psychiatry Network and Asylum Associates.  It’s a nice article, which I strongly recommend.  Here’s a brief quote, summarizing some of the points made by one of the speakers (Jacqui Dillon, writer, activist, international speaker & trainer on trauma, abuse, dissociation, ‘psychosis’ and recovery, Chair of the Hearing Voices Network):

“And what if we phased out psychiatry completely? What would the world look like then? Again, a few of Jacqui’s ideas:

  • Develop non-medicated coping strategies.
  • Create a range of self-help support (sharing books, setting up groups).
  • Survivor-run crisis houses based on the Soteria model.
  • Phase out mental health professionals and give basic skills to people – around active listening, being looked after, and sitting with people in distress.”

Here’s another quote, summarizing comments made by Hugh Middleton, MD, a British psychiatrist:

“He said that doctors of any sort only have authority to practice if there is clear evidence that it results in good rather than harm, and many now question whether psychiatrists fall into that category.”

This sounds refreshingly honest.

In my view, there is a gulf between psychiatric practice, (certainly here in America), and the reality of human suffering that can never be closed, unless and until the psychiatrists recognize that drugs are a part of the problem, not part of the solution.  As long as they conceptualize their role as promoting fictitious illnesses and marketing psycho-pharmaceutical products, they will never have a positive contribution to make – Dr. Lieberman’s excitement notwithstanding.

 

  • ssenerch

    Love it!

  • Phil_Hickey

    ssenerch,

    Thanks for the encouraging words.

  • megalomani

    So psychoactive substances never do any good?

  • Phil_Hickey

    megalomani,

    Thanks for coming in. You raise an interesting and very pertinent question. In my view, psycho-pharma products are more like street drugs than medication in any meaningful sense of the term. People take psycho-pharma drugs either because they like them, or because somebody has told them that they should take them and they believe that person, or because they are forced to, by the legal system. They have three things in common with street drugs: they alter brain functioning; they cause damage; and they often have serious side effects.

    The reason I say that psycho-pharma products are not
    medications is because the conditions for which they are prescribed are not illnesses.

    But your question is: do they ever do any good? And of course, “good” is in the eye of the beholder. I have known people who expressed the belief that a little cocaine, or a little marijuana, or a little heroin did them “good.” I have heard people say that Prozac, Valium, and other psycho-pharma products did them “good.” And ultimately, who am I to argue. These are decisions that people have to make for themselves.

    SSRI antidepressants don’t really make people happy. They don’t restore a sense of joy or serenity or peace or any of the kinds of things you might consider the opposite of depression. What they seem to generate in people is more like a kind of numb, neutral feeling. I suppose if a person’s life is truly dreadful or he/she is troubled by horrendous memories, maybe numb/neutral seems “good.”

    What I will say, however, is this: in all psycho-pharma products, there is a toxic effect, and this is usually identical with the therapeutic effect. In other words, these products “work” not by correcting brain anomalies as is often claimed, but rather by impairing brain function.

    So, again, to try to answer your question, I think on balance they do more harm than good. But if a person is stuck in a job he hates, or is alienated from his family, or is chronically ill, or has just lost a loved one – well, a little something to blunt the pain might seem good to him.

    What I primarily object to in all of this is the standard psychiatric lie – that life’s problems are illnesses and that psycho-pharma
    products are medications that will make things right.

    Again, thanks for coming in, and best wishes.

  • Javier Monteagudo

    Nailed it on the ball there Phil