learning from mistakes…

Posted on Tuesday 28 January 2014

There’s a story that’s compelling to me. Well, that’s only half right. It’s the story about the story that’s compelling [the unforgotten unremembered…, the twilight zone…]. Richard Noll, a psychologist scholar at DeSales University wrote an article called When Psychiatry Battled the Devil [online full text on Gary Greenberg’s site]. It’s about the strangest of episodes in psychiatry since I’ve been around [and there have been a lot of contenders]. Here are the bare bones from Dr. Noll’s article:
Just 25 years ago, American psychiatry was infected by a psychic pandemic that originated outside the profession. In 1983 it broke out of a reservoir of religious, legal, psychotherapeutic, and mass media mixing bowls. Children in US day care centers and adults in psychotherapy told 2 distinct versions of their malady. By 1988 some elite members of the American Psychiatric Association [APA] were making it worse. They had become its vectors. Then other elite psychiatrists stepped in to quarantine the profession. Eventually, just like the last wave of the influenza pandemic, after 1994 it ended as suddenly and incomprehensibly as it had started…

In the 1980s thousands of patients insisted that they were recovering childhood memories of physical and sexual abuse during Satanic cult rituals. In addition to the red or black robes of the abusers and other paraphernalia of devil worship familiar to any horror film devotee, these memories often included the ritual sacrificial murder of children, blood-drinking, cannibalism, bestiality, and incest. Famous believers in SRA ranged from Gloria Steinem to Pat Robertson. A prominent historian of religion has argued that “the emergence of SRA motifs” served as “a kind of feminist and evangelical Christian pornography”…
At the time, it was a big deal with people really getting involved in treating these patients – a specialty of sorts. One was sent to me as a consult and spent an hour trying to captivate me with her fanciful stories. At 4AM, she called me at home to "chat," because I "seemed interesting." She had taken her therapist hostage and I wasn’t interested in joining, spending my time instead helping her MSW therapist set some boundaries and get her life back. One of our candidates in the analytic institute had become involved on the side of reason [Historical vs. Narrative Truth – George Ganaway MD] and was on a panel with Dr. Noll, then a young psychologist discussing the pros and cons at a national conference. So it came in a great flurry in the late 1980s, and the Multiple Personality diagnosis made it into the DSM-IIIR. And then in the mid 1990s, it went away as quickly as it appeared. Dr. Noll’s article asks the obvious questions – Where did it come from? Where did it go? Isn’t it about time for us to revisit that whole story and figure out what it was about? Why did we forget it? I know I sure did. So that’s the story in his article. There were some leaders in psychiatry taken with these cases and active in promoting the Multiple Personality Disorder diagnosis that was part of the gestalt:
The research of 3 psychiatrists in particular caught the profession’s attention: Richard P. Kluft of the Institute of the Pennsylvania Hospital in Philadelphia; Frank W. Putnam of the National Institute of Mental Health; and Bennett G. Braun of Chicago’s Rush Medical College.
In 1993, the False Memory Syndrome Foundation came into being with Ganaway and other noted scientists, and:
Its newsletters vilified clinicians such as Bennett Braun and others who had done so much to legitimize the paranoid mass delusion of Satanic cults.
And then in 1994 it was gone. So Dr. Noll suggests that enough time has passed, and perhaps we can do a retrospective and see what all of that was about – thus When Psychiatry Battled the Devil in the Psychiatric Times – well written and definitely fascinating. Then the article disappeared. I thought it was a glitch in my browser, but no – it was just gone. I was looking to write about it, but nothing was there to write about. Then I found out it had been pulled. It seemed they were concerned about liability. They had sent it to Dr. Kluft, and apparently he raised a stink of some kind, though it’s hard to figure out why – it’s a very matter-of-fact recounting of the story. So, the Psychiatric Times has gone back and forth several times, but the most recent report is that the article is on hold – a big sleep kind of hold. I don’t know the details, nor does Richard. But it appears that his article has disappeared just like the whole Satanic Ritual Abuse issue did twenty years ago.

It’s snowing here in Georgia. Cold, like the cold that requires a fire in the fireplace. Which, of course lead to a long winter’s nap. And on awakening, there’s a Huffington Post piece about Richard’s article in my in-box by Allen Frances [Sex and Satanic Abuse: A Fad Revisited]. He had an interesting vantage for that piece of history, as it came in his DSM-IV Chairmanship. Another good story.

So I’ll pick up where I was headed before the nap. We’re apparently not taken with the idea of learning from our past in psychiatry. Living in the world of subjectivity has us traveling some mighty peculiar byways, and sometimes our detours go too far unchecked. Our critics delight in pointing out the absence of firm objective anchors, absent lab tests, disease markers, pathognomonic signs and symptoms, clearly visible tracks in the primordial ooze. They say it makes psychiatry a non-science, witchcraft like this bizarre story we’re reading here – chasing Satanic Cults living in the shadows. I see it differently. I was drawn from the labs of hard science to the subjectivity of my patients. It was where they felt their pain, and untangling their stories was more like feeling one’s way through an unexplored labyrinth than following well defined road signs. It was filled with false starts and surprises, paradoxes to decipher, no two cases the same. It was a little like my research career – starting with hunches, but it required learning how to reject the many that weren’t on target, and following those that were  – learning how to navigate in the twist and turns of a life.

One of the essential tools was history – the patient’s history, my history, the history of the therapy, being able to see the mistakes along every path – often more in retrospect than at the time. So I’m particularly put off by the recent reticence to re-examine our history with the kind of microscope it deserves. We need to look at the last quarter century of psychiatry getting stuck in some kind of biological dream with the medicines. We need to carefully examine why we were so vulnerable to the invasion of the marketing arm of the pharmaceutical industry. We need to figure out how we let the needs of the insurance industry paint us into such a small and stifling corner – "med checks." And we need to understand why, except for people like a younger Richard Noll, George Ganaway, and some others, a subsegment of psychiatrists went much further down the Salem Witch Trials road than seems rational.

It doesn’t matter if Drs. Braun and Kluft are embarrassed, or we’d rather not revisit the lobotomy days or the outrageous era we seem to be finally escaping where a subset of our higher ups went along with the kind of hanky-panky that gave us Paxil Study 329 and TMAP. Gullibility is part and parcel of traveling subjective pathways, and it may well be embarrassing, but if we always re-evaluate our misfires, we iterate back to the path we need to travel. Only a small number engaged the battle with the devil, but the majority of us didn’t react fast enough to prevent that outbreak of mass hysteria from doing some damage. And it doesn’t matter if it’s awkward to look back on this Kupfer Affaire I’ve been writing about and learn what we need to learn about Conflicts of Interest in high places [why? again…]. It’s what we need to do. It’s the way we learn.

So Richard is right when he asks:
Are we ready now to reopen a discussion on this moral panic? Will both clinicians and historians of psychiatry be willing to be on record? Shall we continue to silence memory, or allow it to speak?
No time like the present. Read When Psychiatry Battled the Devil. It wouldn’t hurt to take a look at his most recent book as well, American Madness: The Rise and Fall of Dementia Praecox
    January 29, 2014 | 4:17 PM

    The Satanic Ritual Abuse witch hunt worked like all other witch hunts. Psychiatry was the clergy this time. It’s awfully convenient to forget about it and the fact that the field has not gone out of its way to exonerate and vindicate all the victims of the moral panic they sustained tells us all we need to know about how the “it” of psychiatry cares about it’s victims.

    January 29, 2014 | 11:20 PM

    How exciting to see psychiatry reexamining its role in the “satanic ritual abuse” moral panic. I blog about the Little Rascals Day Care case at littlerascalsdaycarecase.org …. Because Little Rascals happened to involve more psychologists, pediatricians and “therapists” of unknown pedigree than psychiatrists, my efforts have focused on petitioning social science journals to retract their articles that so enthusiastically validated the mania. Not one editor has expressed any interest in setting the record straight. Shame, shame….

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