humility about now…

Posted on Thursday 27 June 2013

I had put the APA Meetings behind me and hadn’t read Dr. Lieberman’s speech past this opening subheading:
The new APA president cites astonishing advances in psychiatric research and a broad acceptance of the importance of mental health as reasons to be optimistic.
That was enough for me. But then Joel and Tom mentioned it in the comments, and Sandra Steingard posted about it at Mad in America, so I thought I’d take a look:
Psychiatric News
by Mark Moran
June 13, 2013

The new APA president cites astonishing advances in psychiatric research and a broad acceptance of the importance of mental health as reasons to be optimistic. This is “our time,” said incoming APA President Jeffrey Lieberman, M.D. — time for psychiatry to seize on its advantages and realize a long-deferred dream of equity and recovery for people with mental illness.

Speaking at the Opening Session of APA’s 2013 annual meeting in San Francisco last month, Lieberman said he was angry about the continued stigma associated with mental illness and disparagement of psychiatry in some quarters. Quoting the 1976 movie “Network,” he said he was “mad as hell and not going to take it” anymore. “Although I saw this movie 37 years ago, I have recently thought about that scene in ‘Network’ because as I view what is happening to the field of psychiatry and all of mental health care, I feel ‘mad as hell, and I don’t want to take it anymore.’ The truth be told, that is why I 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 and our patients.

“Throughout my career, I have been acutely sensitive to the stigma associated with mental illness, the disparities in mental health care, and the lack of respect toward psychiatry as a medical specialty,” Lieberman said. “I suppose there might have been a time when psychiatry wasn’t as scientifically based as it should have been. But that was then, and now is now. For such attitudes and practices to persist in the 21st century is nothing short of discriminatory and prejudicial.” But persist they do, he said. Lieberman noted that the mental health parity law was signed in 2008, yet no final rule on its implementation has been issued. He added that the recession of 2008 has gutted public mental health systems and encouraged private and voluntary hospitals to cut psychiatric services, as at Cedars Sinai Hospital in Los Angeles, which closed its psychiatry department.

“The pharmaceutical industry has all but abandoned the development of novel psychotropic drugs,” he said. “And DSM-5 has become a lightning rod for self-styled critics and the antipsychiatry movement. Mental illness is alternatively feared too much or not taken seriously enough, and psychiatry continues to be a punch line for jokes”…
I have to stop here. His borrowing those classic lines from the movie Network felt profane, close to sacrilege. Sandra penned the essence of my reaction:
My recollection is that the famous rant in that movie was in part directed at an industry that pursued profit above all else.
It was time for a rest when Lieberman said angrily. "The pharmaceutical industry has all but abandoned the development of novel psychotropic drugs," he said. "And DSM-5 has become a lightning rod for self-styled critics and the antipsychiatry movement." At the risk of using an esoteric analogy, he sounds like a novice trainee whose client is argumentative and critical of what he says, and he’s explaining it to you as her innate hostility. But what you as a supervisor hear and are trying to figure out how to help him hear is that his patient is telling him that he doesn’t know what in the hell he’s doing in the only way she knows how. He can’t expect his patient to let him explore her foibles if he can’t acknowledge his own, or can’t hear what’s right about her criticisms? And he won’t gain a position of authority because of the plaque on his wall or the sign on his office door. He earns it by demonstrated expertise, often expertise in listening, in hearing, and in self-examination. Jeffrey Lieberman’s speech lacks that kind of that basic expertise, and it’s really almost impossible not to just rant back at him.

This is no time to whine about the exiting pharmaceutical industry. It just confirms that organized and academic psychiatry have been shamefully riding on their coat-tails, and it betrays a striking lack of insight into the reasons why they’re pulling out. It’s sure a mistake to stay on the "astonishing advances in psychiatric research" bandwagon – it’s a tired and tiring rally cry that has outlived its use. Likewise, it’s absurd to hide behind the stigma faced by the mentally ill when we’ve created such a unique stigma all on our own. Nor is it the place for a contemptuous response to critics of the DSM-5 [which basically includes everyone on the planet who knows what it is except the Task Force and a few APA Moguls]. But beyond those obvious points, Sandra has eloquently put her finger on the pulse of our current Achilles Heel:
… we can not move forward until we acknowledge the role psychiatrists, including leading academic psychiatrists, have played in distorting the evidence base that we so proudly promote.
And along with that, how about a commitment to reforming Conflicts of Interest policies, defining the meaning of Authorship, supporting Data Transparency, a sober examination of Continuing Medical Education, and an exploration of the spirit of the recent proposal of the Critical Psychiatric Network [Psychiatry beyond the current paradigm]. It’s a time to look in the mirror, not to point at the surrounding landscape.

But in the spirit of listening for what Dr. Lieberman has to say that’s right, his kick-ass-and-take-names approach is actually appropriate on a couple of fronts. "Lieberman noted that the mental health parity law was signed in 2008, yet no final rule on its implementation has been issued. He added that the recession of 2008 has gutted public mental health systems and encouraged private and voluntary hospitals to cut psychiatric services." Third Party Carriers have painted psychiatrists into an impossible situation – doing brief med checks without a thorough evaluation and little chance for comprehensive follow-up. They’ve made voluntary hospital treatment of the severe mental illnesses virtually impossible, yet provided no real support for an intensive community based alternative. Mental Health Parity is actually a vital piece of internal psychiatric reform. We can’t be expected to do it right, when the whole system is organized around supporting us only when we do it wrong.

And the fate of the chronic mental patient in the public system is tragic. We live in a much more accepting world now than in earlier times. One thing we learned during "deinstitutionalization" is that society is much more tolerant of having the severely mentally ill living among us. But watching the Community Mental Health Act expire also taught us that without the needed services, that doesn’t go very well. America’s abandonment of those patients is a shameful tragedy, and they are in no position to mount their own campaigns. Unlike every other social democracy, we just left them to their own devices, which too often means prison – the ultimate form of involuntary treatment. And besides failing to insist on adequate services for these patients, modern psychiatry fuels their mistreatment with it’s cry of "astonishing advances in psychiatric research." With polio, we didn’t just sit around waiting for the vaccine that mercifully came, we took good care of the afflicted. Even with the AIDS epidemic with its stigma, we’ve come to provide care in lieu of waiting for a cure. But with the long known chronic psychoses, we’re waiting for the silver bullet instead of caring for the sick. Dr. Lieberman is an expert on Schizophrenia and that may be the one place where he’s right about stigma. So in my book, he can rant about our failure to address the problems of the severely mentally ill as long as he wants to and kick-ass-and-take-names to his hearts content. We could use some softer, gentler medications, sure enough. But until they come along, let’s use the ones we have much more judiciously, and focus on championing adequate community care for a second "deinstitutionalization" [in the tradition of Phillipe Pinel].

Pick your battles carefully Dr. Jeffrey Lieberman. You’re not coming from a position of strength. Righteous indignation is only effective in the service of righteous causes, and even then, something to use wisely. Your organization, if anything, could use a heavy dose of humility about now, and maybe a long needed dash of atonement…
    June 27, 2013 | 5:04 PM

    Society has to treat a middle-class— or wealthier— white man with unconditional deference for a long time in order to make a Lieberman. He’ll go kicking and screaming, confusing his fall with the failure of those around him to recognize his greatness; when it was the failure of those around him to challenge him in the first place that is at fault as much as he is.

    Not repeating this pattern ad nauseum should be a priority for the field, which will require a lot of introspection on the part of professionals on all levels in the field of psychiatry and related fields.

    June 27, 2013 | 5:22 PM

    If Lieberman and the APA want respect, they can gain it the old fashioned way… They can earn it!

    Until such time…


    June 27, 2013 | 5:27 PM

    Re: Lieberman’s approach to “kick-ass-and-take-names”

    It seems to me that’s what’s happening to Lieberman and the APA.
    Getting their ass kicked!
    And it just couldn’t happen to a kinder, gentler bunch!


    June 27, 2013 | 6:26 PM
    June 27, 2013 | 7:23 PM

    Hello! Would you mind if I share your blog with my facebook
    group? There’s a lot of folks that I think would really enjoy your content. Please let me know. Thank you

    June 27, 2013 | 8:31 PM

    Thank you for this. As you know, I have enormous respect for your work.
    I work in the community mental health system and if I have a specialty, it is in the treatment of those who experience psychosis. Perhaps because I work in a state (Vermont) which has worked to build a strong community system, I do not see this in quite the same light as you. However, the focus from the mainstream of psychiatry on a drug based system of care, has led in part to a de-emphasis on other approaches that could be of much benefit. I am not just talking about getting people housed and keeping them out of jail, I am talking about valuable and effective interventions that increase the chances of recovery.
    Also, although I support parity, I also worry that it comes at the price of viewing everything within the framework of the medial/illness perspective.

    June 27, 2013 | 8:34 PM

    A projected diagnosis to create high value research subjects?

    June 27, 2013 | 10:49 PM

    Wow. That sets new standards for arrogance. Dr. Lieberman is lucky we don’t engage in back-seat diagnostics here, or we’d all be going to town on his Narcissistic Personality Disorder. Oh wait, is that still a disease?

    It is particularly sleazy for him to complain about the dismantling of community mental health, remembering how biological psychiatry joined hands with the insurance industry in the 70s and 80s to throw counseling under the bus. That was Fuller Torrey and NAMI’s brainstorm: draw some imaginary bright line between “real medical illnesses” and “problems of living”, and cut off payment for the latter so that the True Brain Diseases could get the funding. (Of course the upshot of that was that drug companies and doctors got busy re-defining everything from shyness to bad luck with boyfriends as a True Brain Disease — and brought on the pills.)

    Oh well … on an optimistic note, it can’t be good for his cause for him to be behaving like this out in public. It is NOT a sign of strength for his team.

    June 28, 2013 | 4:31 AM

    Dr. Lieberman, I will start respecting psychiatry when they lead efforts to stop patients from being tortured in mental hospitals. Yes, you heard right as it is torture to hold someone down and force them take meds against their will. It is also torture to restrain patients whose only crime is speaking out against their brutal treatment as an inpatient.

    I will start respecting psychiatry when it is honest about the side effects that it prescribes without a second thought and stops blowing off patient concerns because they have the misfortune to be diagnosed with an MI label.

    I will start respecting psychiatry when they truly start helping patients get off of psych meds that they no longer wish to take instead of leaving them hanging to dry.

    I will start respecting psychiatry when they stop diagnosing every patient they see with a mental illness within 5 minutes and start acting like true doctors in trying to find out what is wrong with their patients.

    I will start respecting psychiatry when they are totally honest about the financial conflicts that occur in the drugs industry and make moves to reform this movement.

    Until then, I will continue to speak out against psychiatry. You may call that being an antipsychiatry nut. I call it telling the truth.

    June 28, 2013 | 10:28 AM


    I guess you won’t be respecting psychiatry any time soon.
    Maybe it’s time the profession was replaced.
    Then ‘respect’ becomes irrelevant.


    June 28, 2013 | 3:38 PM

    Now we’re at one in two:
    “One American in two develops a mental illness at some point in their lives.”
    Soon to rival death and taxes?
    Well, if obesity is now to a be a disease….
    Living as “diseased” soon to reach 100% of the population?

    July 1, 2013 | 2:59 AM

    Maybe Lieberman needs to consider using a different phrase other than ‘anti-psychiatry’ for a label of smart people who speak out after often decades of time passing without one single solitary drug aiding those who doctors feel need medication. If the psychotropics worked, they’d all be well… wouldn’t they? the hospitals would be empty and no one would hear voices or have delusions or act out, and all of the other reasons antipsychotics are thrown at ‘symptoms’.
    Perhaps Lieberman’s 40 million dollar SZ trial didn’t shine a light bright enough for him to see the path in front of him: his way isn’t working. Time to find something else, and stop pointing blame at defunct billing manuals (DSM5) and outspoken advocates and patients, and taking some accountability or even yes, just some humility and admitting “we don’t know how to treat this S*it”. People are suffering and there is no cure or treatment!

Sorry, the comment form is closed at this time.