Psychiatry Fights Back – With More PR

About six months ago, I wrote a post called Health Care Reform and Psychiatry.  In that article, I gave a brief account of the APA’s Council on Communications, and I expressed the belief that the council seemed more concerned with PR (in the most tawdry sense of the term) than with any serious examination or reform of psychiatric practices.

Lately, I was browsing the APA blog Healthy Minds, Healthy Lives, and it seemed that a good deal of what I was reading seemed to have a fairly heavy PR component.  So I opened the Council on Communications tab and found that their lead page is pretty much as it was six months ago.

“The council is charged with transforming public attitudes towards psychiatry by:

  • Connecting the public emotionally to psychiatrists, ·
  • Creating excitement about psychiatrists’ ability to prevent and treat mental illness, and ·
  • Branding psychiatrists as the mental health and physician specialists with the most knowledge, training, and experience in the field.” 

Of course, public attitudes towards psychiatry are at a low ebb.  The survivor movement continues to grow, both in numbers and in outspokenness.  Psychiatry’s concepts and practices are being critiqued with increasing frequency on the Internet and in the mainstream media.  And even some psychiatrists are starting to speak out.  It’s understandable that the APA is concerned about public attitudes towards psychiatry.

But they’re not going to address this problem by mending their ways.  No.  That would require a degree of critical self-scrutiny that is entirely foreign to organized psychiatry.

They’re not going to improve their image by cleaning up their act.  Instead, they’re going to: connect the public emotionally to psychiatrists; create excitement about their skills and abilities; and brand themselves as the great healing experts that they aren’t.

I’ve commented on this drivel before, and I was truly surprised to find that it’s still prominently displayed on their site.  Is there nobody in the APA leadership who can see this inane, insultingly condescending nonsense for what it is?

What does “connecting the public emotionally to psychiatrists” even mean?  As my readers well know, I’m a concrete sort of a guy.  I think in pictures and little stories.

Sometimes on Thursday morning, I go over to McDonalds for a cup of coffee, which incidentally, in deference to my advanced years, they give me for 50 cents.  There’s always a bunch of other old geezers in there, and we talk about the weather, and our bladders, and the price of footwear, and so on.  It’s all very congenial.  So what I’m imagining is something like this.

Me:  “Guys, I’m getting very emotional about psychiatrists.”
Other geezer:   “You are?  I thought that was just me.”
Third geezer:  “Yeah, me too.  Every time I see Dr. Lieberman on the TV, a lump comes to my throat.”
Me:  “Whenever I read his articles in Psychiatric News, I want to cry.  In fact, sometimes I just bawl my eyes out.”
Other geezer:  “I thought I was the only one.”
Third geezer:  “No, we’re all connected emotionally to psychiatry.  It’s like one big happy family.”

And “creating excitement” about psychiatrists’ abilities conjured up this little scenario:

Me:  “What did you think of that final touchdown on Sunday?”
Second geezer:  “Never mind touchdowns.  Did you see Dr. Drugs-Galore sign that prescription?  The flourish!  The light glinting off his pen!  They must have done ten replays on EPsyN.  He’s got to be the greatest.”
Third geezer:  “Did you see that Dr. Fastlabel just broke the record for the number of diagnoses made in one day?”
Me:  “No. How many did he do?”
Third geezer:  “Eighteen!
Second geezer:  “Wow.  That is so exciting.” 

And don’t even get me going about psychiatrists “branding” themselves!

But seriously – what they’re actually saying here is:  We, the great and mighty psychiatrists, are going to manipulate the thoughts and attitudes of the little people (the public).  We are going to play upon their brains like the practiced magicians that we are, and transform their sadly mistaken misperceptions and evaluations of psychiatry into profound feelings of excitement and admiration.

And apparently nobody at the APA can see how insulting and patronizing this is.  Psychiatry is a great disrespecter of people.

Anyway, that’s the way they are.  But I thought I’d take a look at their blog and see how they were getting along with the task of transforming our attitudes.

The first post I found was How Psychotherapy Changes the Brain, by Serina Deen, MD.  (Thanks to Steve Hawkins on Facebook for the link.)  Dr. Deen is an Assistant Clinical Professor of Psychiatry at the University of San Francisco.  Her blog bio lists mindfulness, psychotherapy, and medical education as her interests.  She is a member of the APA’s Council on Communications, so presumably she’s committed to the council’s mission of getting us all excited about psychiatry.

Her post begins:

“When I first see patients for evaluation, they often tell me that they’ve debated starting a ‘biological’ treatment such as medication, versus a ‘psychological’ treatment such as psychotherapy. I’m happy to report that as brain imaging technology advances, we’re finding that this distinction may be obsolete.”

By any standards, this seems like an extraordinary claim:  the distinction between talk therapy and drugs is becoming obsolete?  How can this be?

“Psychotherapy is also ‘biological’ in that it can lead to real functional and structural changes in the brain.   In fact, sometimes psychotherapy and medication produce surprisingly similar changes in the brain.”

Dr. Deen provides no references in support of this position, but she does mention that researchers at UCLA

“…found that people who suffered from depression had abnormally high activity in an area of the brain called the prefrontal cortex.  Those who got better after they were treated with a type of therapy called interpersonal therapy (IPT) showed a decrease in activity in the prefrontal cortex after treatment.  In other words, IPT seemed to ‘normalize’ brain activity in this hyperactive region.”

The fact is that anything a person does, including talking to a therapist, produces changes in the brain.  It is also the case that the brain regulates our thoughts, feelings, and behavior.  So the brain activity of a person who is feeling contented and happy will, other things being equal, be different, in some characteristic ways, from the brain of a person who is feeling down.  These differences will be detectable in scans, provided the equipment is sufficiently sensitive.

Similarly, if a depressed person starts to feel better, whether through talking about his concerns in a supportive, non-judgmental context or by ingesting drugs, the brain activity will become more like “happy” brain activity.  This is not Earth-shattering.  In fact, it’s obvious.  The characteristic brain activity that elicits hunger pangs is reduced by eating food or by the introduction of appetite suppressant drugs.  But administration of the drug is not the same thing as eating.

Similarly, the alleviation of depression through personal interactions, problem-solving, empowerment, etc., is fundamentally different from taking a happy pill.  In addition, talking through one’s difficulties with a supportive and competent listener does not produce the kind of adverse events commonly associated with anti-depressants.

Dr. Deen’s article is spin.  The message is:  psychotherapy and drugs are basically the same thing.  She even has three insultingly simplistic drawings of brains embedded in the post, presumably to lend credence to her thesis.  Superficially the article gives the impression of balance.

“Even though we know that both medication and psychotherapy can change our brain, we still have a long way to go in learning exactly how that happens and when to use what treatment.”

But note the subtlety:  “…both medication and psychotherapy can change our brain…”.  People don’t go to a therapist to have their brains changed.  They go to a therapist to talk person to person about matters that are troubling them or causing them distress.  By couching the matter in terms of brains, Dr. Deen, while giving the appearance of impartiality, is in fact loading the dice in favor of drugs – which, after all, are promoted (spuriously) as cures for neurochemical imbalances, neural circuitry anomalies, etc…

I suggest that Dr. Deen was wearing her Council on Communications hat when she wrote this article.  Stressing the effect that psychotherapy has on the brain is actually a neatly-disguised ploy to undermine psychotherapy, and to “rebrand” psychiatry’s long-standing infatuation with chemical “solutions” for life’s problems.

I did some searching on the ‘net and I believe I have found the study to which Dr. Deen is referring.  It’s titled Regional brain metabolic changes in patients with major depression treated with either paroxetine or interpersonal therapy: preliminary findings, by Brody A.L. et al (2001).  The authors were markedly more cautious in their conclusions than Dr. Deen:

“These results should be interpreted with caution because of study limitations (small sample size, lack of random assignment to treatment groups, and differential treatment response between treatment subgroups).”

I think it’s also noteworthy that although the Brody et al study was published 13 years ago (2001), there has, as far as I can ascertain, been no large-scale replication.  I did, however, find an interesting meta-analysis by D.E.J. Linden – How psychotherapy changes the brain – the contribution of functional neuroimaging (2006).  Dr. Linden reviewed the research on this subject with regards to OCD, phobias, and depression.  He reviewed three studies in the depression section.  These were Brody et al (2001), which I’ve already mentioned; Martin et al (2001); and Goldapple et al (2004).  Dr. Linden’s conclusions with regards to depression were:

“Findings in depression, where both decreases and increases in prefrontal metabolism after treatment and considerable differences between pharmacological and psychological interventions were reported, seem still too heterogeneous to allow for an integrative account, but point to important differences between the mechanisms through which these interventions attain their clinical effects.”

But spin and PR pay no allegiance to logic or to facts.

  • Anonymous

    They are disgusting human beings. Addicted to the word “clinical”, if they saw the brain of a fish, or a whale, “change”, they’d be claiming they “treated a disease”. Absolutely infantile thinkers, these failed M.Ds, who essentially flushed their medical education down the toilet, have the most childish philosophy of mind, it is just stunning. It would be a sick joke if they were not so dangerous to society. Psychiatry is very dangerous. Duping hundreds of millions of people to believe their brains are diseased? Doling out massive amounts of brain “changing” drugs based on nothing but bullshit theories? It’s utterly pathetic.

    They really are childish. It’s almost a “brain change” animism. It should be the most obvious point by now, that every single moment of a person’s life, a troubled person’s life, a happy person’s life, has a corresponding molecular state that the brain organ is in, moment to moment. THE POINT BEING THIS PIECE OF GARBAGE QUACK PROFESSION HAS NEVER, EVER, EVER, EVER, EVER, BEEN ABLE TO PRODUCE ANY HARD EVIDENCE THAT THE BRAIN OF A TROUBLED PERSON IS PATHOLOGICALLY DISEASED, NEVER BEEN ABLE TO DEMONSTRATE BIOLOGICAL ETIOLOGY OF ANY KIND, AND THE ENTIRE PROFESSION IS A BIOLOGICAL DETERMINIST DELUSION.

    They literally believe they are real doctors treating real diseases in real patients.

    What they are, is indoctrinated biological determinist fanatics, weened on a diet of DSM quackery and brain blaming in the dark, who have a centuries-long record of disgusting human rights abuses that taken altogether equal the darkest atrocities of human history, a profession of easily led fools, who see mankind’s life as nothing but a series of “brain changes”. A group of people so utterly intellectually bankrupt, that when a complex violent crime happens, they blame an internal organ of the body that they don’t even examine. They are truly a brain blaming cult hiding in plain sight. They are unsophisticated thinkers, sheer unimpressive “rote learners”, without an original thought of their own, they have not earned the right to even use the word “diagnosis” or “patient” like their actually impressive cousins, the REAL DOCTORS, you know, the ones who treat real disease that can be demonstrated in real bodies of real patients with real diagnoses.

    They make me sick. And people wonder how these delusional “brain change” worshiping cult members can rape the brains of kids and adults? How they can drug the living brains of growing children?

    It’s because psychiatrists look at these children as not human beings, not people, but bubbling cauldrons of “brain changes”. They don’t see a kid worthy of human dignity, they look through the kid’s eyes, not into them. Past the kid’s eyes, and see a faith based assumption of “disordered nerve cells”.

    Make no mistake, psychiatrists have a sickeningly dehumanizing view of mankind, this is what enabled them to gas the “mental patients” of Nazi Germany, this is what allows them to force drug so many millions in the present day, this is what allows them to thoughtlessly sentence a growing kid to years on toxic brain disabling drugs.

    They are, put simply, quite possibly the most dangerous religion on the planet. When a religion hides inside the prestige of modern science, BOY! can it do some damage. It’s probably only getting started. The mindset that allowed this disgusting ideologues, these brain blaming freaks, to shove metal tools behind the eyelids of human beings and scoop out part of their frontal lobes and call it a “treatment”, is still alive and well. These people do not take prisoners. They will not stop themselves. They will not temper themselves. They will not restrain themselves. Society, if it is going to protect itself from this menace, will have to clip psychiatry’s wings.

    Only right now, society doesn’t have eyes to see. Maybe one day it will. One thing is for sure, growing numbers of people can see psychiatry looking past us, past our eyes, not into them, we can see psychiatry doesn’t see who we really are, and consequently we now see who psychiatry is, it’s a lethal ideology of quackery, a total menace, something to be exposed, watched, and feared.

  • Jake

    Great article. The fact that they are responding to criticism with PR campaigns shows they are screwed.

  • Francesca Allan

    I sure hope so.

  • Phil_Hickey

    Jake,

    Yes – they have nothing substantive to offer.