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.
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.”
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.