The name and formal sounding definition don’t really convey the level of discomfort that comes with Cognitive Dissonance. I had a patient once who had a term for the way her mother was that comes much closer – crazy making. You think you know something that’s just part of your being, and suddenly you’re confronted by another thing that shows you unequivocally that you were wrong. The conflict undermines the mind and you feel as nutty as a fruitcake as they say.
I was raised in the South, luckily in a home where racial segregation was seen as a bad thing, an unfortunate piece of history that needed to be righted. But I was a proud southerner too. The impossibility of the world around me wasn’t that apparent to me as a child. It was just the world I knew. When the Civil Rights Movement came in the mid-1950s, it was something that was happening that I was somewhat involved in. But then one Monday [September 16th, 1963], I was eating at a lunch counter and picked up a loose newspaper and read about the 16th Street Baptist Church being bombed in Birmingham killing four little girls, and whatever Cognitive Dissonance means hit me like a ton of bricks. I went back to work in a fog. My world had been turned upside down and I couldn’t ever see the South of my childhood the same way again. I had a similar experience when one evening in the early 1980s I was looking at the news and saw a colleague that I had known and worked with for several years, someone I considered a friend, plastered on the television set as a longtime pedophile who had finally been busted that day. It took days to regain my equilibrium. I had Cognitive Dissonance in 2005, when I realized that our Invasion of Iraq was based on nothing and unrelated to 9/11. In each of these instances, the effect was like what traumatized people describe – the experience changed me. I became a Civil Rights Activist. I’ll never look at a kindly older religious man helping children without my radar going to DefCon 4. I started this blog in 2005 and became obsessed with the Iraq War and related matters. I don’t know if I have a Cognitive Dissonance Sensitivity Disorder or if it’s that way for most people. It’s obviously that way for me.
The massive changes in psychiatry after 1980 had a huge impact on my personal life, but there was no Cognitive Dissonance that I can recall. I guess I felt like an official who had been voted out of office after only one term. I left academia peacefully, I hope gracefully, and found something else to do with myself. It wasn’t what I wanted or planned, but I made the best of it and life continued. I saw the devastating impact of Managed Care on psychiatry and my colleagues, but I was insulated in a number of way so it didn’t bother me much personally. I saw the rise of psychopharmacology, neuroscience, the dramatic changes in our literature, but I just avoided meetings and the general psychiatry journals. Back then, we got CME credit for teaching which I did a lot of, so that’s how I filled my requirements – that and some psychoanalytic meetings. In my mind, I could see why the insurers were down on paying for long term therapy. I could also see why the were pointing to the lowest bidders – not psychiatrists. I was on no insurance panels, and didn’t charge very high fees. I guess I coasted at a time when many were living out the Myth of Sisyphus. The chairman of the department I was associated with was Charlie Nemeroff who I rarely saw, and then only from afar. I thought he was puffed up guy riding the waves of a psychopharmacology boom – an opportunist. I didn’t know about the "boss of bosses" thing or the layers of deceit. I felt sorry for my colleagues reduced to being medication doctors and attributed it to the evils of managed care. I retired at the end of 2003 and built a small barn.
After Dr. Nemeroff got defrocked as editor in 2006, I got a re-interested in the goings on in psychiatry. When he got busted by Senator Grassley in 2008, I got much more interested. After he stepped down, I began to learn more and began to blog about what I was learning. I had two Cognitive Dissonance moments. The first was when I reviewed Seroquel’s trip through the FDA and realized that Dr. Richard Borison had authored one of the articles that came from a trial that got Seroquel approved. I had met him in the 1980s and heard him speak. He was a crook from a football field away. He had just come to the Medical College of Georgia and gave a Grand Rounds for us in Atlanta. When I realized that our new chairman wasn’t as outraged as I was that Borison’s talk was such an obvious infomercial, I first started thinking about leaving. When Borison got thrown into prison in the 1990s from the position of Chairman for massive fraud in Clinical Trials, I thought "finally! good riddance!" But when I saw that he’d authored that Seroquel article, it went from an isolated event to an "Oh my god!" and it changed my whole perspective. I began to realize that things were globally awry.
There was another such Cognitive Dissonance moment. I had read Allen Jones narrative about TMAP and his experiences discovering the level of fraud in TMAP. But when I got hold of the Rothman Report, a document prepared for the coming trial, I walked around feeling moderately dazed for a day or two. It was crazy making. By then, I’d become aware of the magnitude of the pharmaceutical invasion of psychiatry and was getting kind of used to rethinking my whole history and the history of my specialty. But the details of the Rothman Report took things to a new level. It was days after I first read it that I was able to reread it. They say "the devil’s in the details" – certainly true in this case.
Rothman’s report on J&J is painfully reminscent of what companies like GlaxoSmithKline, Eli Lilly, Pfizer and Forest Labs did to make their antidepressants blockbuster drugs [which I wrote about in Side Effects]. I suspect Rothman’s detailed findings are part of what led a South Carolina Judge earlier this summer to call J&J’s actions in deceiving the public about Risperdal “detestable” in his $327 million ruling against the company — see Pharmalot. Even so, Rothman’s 86-page report makes for disturbing reading. It is an indictment not only of J&J but of academic psychiatry and all the doctors and patient advocacy groups who were all too willing to sell their soul for money.
My own conflicts in this story are from having been a psychiatrist through this period watching the tools of the trade evaporate – hospitalization for very disturbed, psychotic, or suicidal patients; frequent contact for patients who need it; referral resources disappearing at an alarming rate; watching my most competent colleagues get painted into a corner and making compromises they were uncomfortable with while others, less right-thinking, adapted easily. There was no place to be that wasn’t the object of constant criticism. Providing the kind of attention patients wanted and actually needed was not "cost-effective" – not "evidence-based." Relying on medications and brief contact was being a detached, insensitive pill doctor. And I frankly still believe that psychiatry was hardest hit by managed care because it could be. There was fat to be trimmed, sure enough, but they cut out the very heart and soul in the process. They opened the door for the pharmaceutical industry who jumped at the opportunity and ran with it to places I didn’t even know were possible, finding partners within psychiatry – both willing and reluctant. The other side for me is all over this post. There is no set of circumstances that justifies the stories in Alison Bass’ Side Effects, the Rothman Report, Allen Jones‘s narrative, or the numerous other examples on this and other blogs. Nor is there anything that justified the adverse effects or withdrawal symptoms patients experienced from the drugs without being warned. So seeing that this has been a system selecting for the survival of the least fit offers no comfort. And if you’re any part of such a system, it’s impossible not to be afflicted by it in some way. No one escapes unscathed, even the psychiatrists who have stayed on course. When people asked me why I decided to retire at 62, they added, "I’m surprised. I didn’t think you’d ever retire." I didn’t really know why either then. Now I know a lot more.
I’m not sure we’ve even scratched the surface in terms of looking at the amount of fraud that has taken place in psychiatry; and the lives that were turned upside down because of this fraud…
There may be plenty of psychiatrists who become fully cognizant of ‘crazy making’ when they come to the realization that they not only perpetuated the “myth of the chemical cure” (to quote Joanna Moncrieff, M.D.), but that they FORCED people to take these drugs… and passed them out like candy to children.
Crazy making?
I think we’re going to see some docs go “crazy” as their minds have that much-needed appointment with conscience.
May God have mercy on their souls.
Literally.
Duane
From the other side of the therapeutic encounter, many patients experience a related but more localised cognitive dissonance; it’s when that first medication that worked so well eventually fails and one suddenly realises – after a more detailed exploration of the psychiatry story – that the rhetoric and promise of pharmacotherapy very rarely matches the outcome, particularly over time.
Once again, I find your post so informative and inspiring. Your experiences that you so eloquently write about are seemingly similar to my own. I left the Minneapolis-St Paul area for the North Woods on Minnesota about 30 years ago, thinking I could escape Managed Care and still practice psychodynamic psychotherapy. To some extent it has worked our for me, but will term 65 in April and often think about retirement…ashamed of so called “modern psychiatry” today. But your blog, Alison Bass, Ed Silverman, Danny Carlat, Soulful Sepulcher, and many others do motivate me to continue on. So I can put up with the dissonance, knowing there are others I greatly respect who seem to share my practice style and have not succumbed to BigPharma $$$$ and the “Med Checker” model. I appreciate your posts ever so much. Sincerely, David Bransford
You can see from comments on blogs critical of psychiatry — such as yours, Dr. Mickey — that some doctors are indeed troubled by the situation and may go toward changing their beliefs. But from what I’ve seen, psychiatrists as a group have perfected justifying, blaming, and denying — they teach it to each other, and they teach it to other medical specialties. For example, defending trial-and-error psychiatric medication is justified by such nonsense as “all brains are different.” (Calling Obviousman!)
Perhaps because they are supposed to be experts on the delusions of others, psychiatrists resolutely resist examining their own delusions. From a patient’s point of view, it’s quite amazing.
You can sit in a psychiatrist’s office shaking and sweating, saying it’s a drug reaction, presenting your little printouts of scholarly articles you’ve found on the Web, and the psychiatrist will not only chide you for reading up about your condition but prescribe yet another trial-and-error medication for your supposed anxiety.
Psychiatrist Delusion Disorder should be a DSM diagnosis. I’m afraid the generation now in medical school will be so thoroughly saturated with the Kool-Aid (and cynical about making a living) they’ll never twig to the pervasive intellectual dishonesty of the field.
I really wish psychiatrists who have changed their attitudes, beliefs, and actions would form their own organization, or a psychiatry wing of the American Psychological Association or International Society for Ethical Psychology and Psychiatry, to encourage each other and share information such as how to safely taper people off psychiatric drugs. (And, in protest, stop paying dues to the American Psychiatric Association.)
And, please, Dr. Mickey and Dr. Bransford, do not stop blogging! Information, especially of the dissident sort, gets around the Web in a most effective way.
As in any political environment, joining together is the way to effect larger change. I know doctors aren’t joiners, but this is the way to do it. Isolated, each person feels powerless and becomes discouraged.
I want to give a concrete example of Psychiatrist Delusion Disorder.
This was just posted by a member of my site who was hospitalized (in Denmark), suffering from antidepressant withdrawal syndrome. The psychiatry staff examined him extensively but couldn’t find any obvious mental disorder.
Finally, they told him if he wasn’t willing to take an antipsychotic, he’d have to leave the hospital. He writes:
The idea of giving me antipsychotics is one of the most surreal things about the hospital. This is translated directly from the last page of my hospital journal:
“Patient was discussed at the afternoon conference. It is ward manager Henrik Lublin’s understanding, that the patient suffers from paranoia, and should be offered anti-psychotic medicine. If the patient refuses, he must be discharged from the ward.”
This conclusion was made by a person, who never even met me. I never spoke a single word with that person (Henrik), and he made this decision based on hearsay. I almost couldn’t believe it. I was always logical and receptive in my arguments, I pleaded for them to read the articles I brought them, I asked them to read other peoples testimonials which I brought to them nicely printed, I asked them to read the back label of the drug they gave me. But they refused. As they couldn’t dismiss any of my arguments, the easiest solution was for them to have SOMEONE ELSE label me as crazy. They didn’t even have the balls to tell me in person. Just disgusting really. So my criticism against their brain altering chemicals was dismissed as paranoia.