un·retraction watch…

Posted on Thursday 27 March 2014

That last reference is to a newer post on Retraction Watch. Speak, Memory [AKA When Psychiatry Battled the Devil] has been un·retracted now for a week, and has gotten its good share of comments at Psychiatric Times. Most addressed, incredulously, that such a thing happened and/or the motives of those involved. As in the historical story of the Salem Witch Trials  or the oft-mentioned story of the Emperor’s New Clothes, in retrospect, such things do seem incredible, particularly when they’re of such a magnitude.

And as in this case, it’s easy to decry what happened through a lens of history. But that doesn’t fully do justice to what happened back there. And it doesn’t address the related phenomena all around us. In our film industry, this is hot stuff – vampires, horror films, aliens – the list goes on and on. In the westerns of my youth, there were good guys and bad guys [often identifiable by hat color]. And this metaphor that can be counted on in crime shows, murder mysteries, science fiction, and the current vampire/zombie productions that populate our cable channels. Embodiments of evil are all around us in our entertainment world, our political wranglings, our wars and their rhetoric.

I saw only one of these identified cases, in consultation. It was a long time ago, but she didn’t strike me as a person who was coming to see me for help with something – she seemed more to be looking for someone to go crazy with her. I passed on the offer. I doubt that such an n=1 example in any way characterizes the patients who were part of this story. Many seem to be like the passive and shy Sybil, caught up in her therapist’s story, desperate for an attachment. Truthfully, I can’t even speculate about the range of patient therapist dyads or groups involved because of limited to no experience, but the phenomena is certainly familiar. There are two kinds of injunctions in this regard. The first, "Listen to your patients. Don’t discount their stories." On the other side is something like, "Don’t take everything at face value. Everyone is looking for a champion." Freud’s answer was "neutrality." Stay in the middle, equidistant from the various possibilities without  joining any particular side. That’s a lot easier to say than do sometimes.

I once made up something I called my rule for living, "Never accept an invitation to go crazy." It was only partially tongue in cheek. I was dead serious too. The offers are everywhere, particularly in the mental health field, and this story of the SRA craze is an example of what happens if you don’t live by it, if we don’t live by it. I won’t go into why I was moved to make up such a rule, but it has to do with being willing to take on patients who struggle with more primitive mechanisms for living. They are often heroic indications for therapy, and success is never guaranteed – but very rewarding if achieved. But the rule stuck with me. My family even had it made into a coffee cup and bumper sticker because I say it so often.

Richard Noll has brought up a huge topic with this story. All of us have seen couples who have gone crazy together. We know about the Salem Witch Trials, Hitler’s Nazis, Religious Cults, Political Extremism, etc. We all watch some version of the good guy/bad guy media. If you’re a therapist and you can’t recall going crazy with some patient, you haven’t really put your feet in the water. It’s only through a retrospective look at our own stories that we can gain the skills to even approach our impossible profession with integrity. One thing I learned along the way. Whenever I felt the pull [whatever that means], I insisted on a consultation with someone [not in my inner circle]. And I did a lot of those consultations myself. It’s amazing how much a third pair of eyes can see when the fog of such things is in play between two people or within a group, something like a historical review [an outside opinion]. Secrecy or a closed shop is a real breeding ground for craziness becoming institutionalized.

I think I figured out why this particular topic is so interesting to me – to me specifically. I think of it is an explanation for what happened in psychiatry at large. Right now, there are plenty of people who would put all psychiatrists as a group into the category of satanic cults – motivated only by greed or worse.  And because of the subjective nature of the topic, we are particularly vulnerable to such. I wince when people write, "psychiatry thinks…" or when someone comments as if I think fill in the blank because I’m a psychiatrist [as we all think the same wrong things]. But that’s not what I was referring to. Mainstream psychiatry itself has been largely focused on the evil biology that afflicts humanity, and on a quest to root it out – even though it remains elusively out of view, to be uncovered in the future. There are a lot of very thoughtful biological psychiatrists and neuroscientists who are interested in and pursuing the biological underpinnings of some of the mental illnesses, but they have been marginalized by a larger group of people caught up in a craze – abetted by industrial forces and sexy new technology. Were I myself one of those biological psychiatrists, I would be furious at being trivialized by association with the people caught up in the monomaniacal crusade.

Perhaps, by looking back at why so many mental health types and patients went crazy together in the SRA era [and they did], we might learn some things about how to approach them in the future. And it’s  not just by looking at the leaders that we will learn what we need to know. There are always such charismatic leaders around to follow. We would learn the most from the people in the audience who were captured by the craze, who accepted the invitation. Most of all, we need to know how to detect when there’s a mass hysteria or mass delusion in the making and bring it to the light of day when it is just getting started…
    March 27, 2014 | 6:56 PM

    In the meantime, it’s still not at all unusual for a psychiatrist to diagnose bipolar II if a patient has an adverse reaction to an antidepressant, as though there was no such thing as adverse reactions.

    March 27, 2014 | 7:27 PM


    Fortunately, I don’t see as much of that as I did five years ago. But when I see someone on Depakote or Lithium, plus an atypical antipsychotic,plus an SSRI – I take a detailed history looking for the kind of timeline that leads to what you’re talking about. I agree that it happens with psychiatrists [and in my world, a “tele-psychiatrist” in a nearby clinic]. But I see it in cases medicated by Primary Care docs too.

    March 27, 2014 | 7:36 PM

    Multiple personality disorder occurred to me before you said it. The crusade, to some degree, could be noble; but once immersed in the frame of biological determinism most is pretty much lost, especially when the creed requires one to disregard what a person has to say about their own states.

    I’m curious about any studies that may have been done about the damage that forensic psychiatrists, psychiatrists who serve as witnesses, and those who are quick to require patients to be forcefully drugged on an outpatient basis merely because of the opinion they have on the patient’s disease as an entity that defines the patient more than their actual history or present condition.

    This isn’t limited to psychiatry— think shaken baby syndrome. Most people still believe that it’s real and people are still being put away for it, because there isn’t a tenth of the energy going into retractions as there was in the vilification of people who suddenly, inexplicably, had a dead infant on their hands— one of the most brutal experiences a caring adult can have, no matter whether it was their baby, or not.

    Same with arson investigators who talk about “fire talking to them,” which they learned from a movie, while helping to convict an innocent man who was put to death before real experts could determine that the fire was indeed caused by faulty lights on a Christmas tree, just like he said; but he died with everyone believing that he was a cold, hard killer. Witnesses also thought they knew what a person should look like after finding out that their family burned to death.

    We need another court system in which all these “experts” are put to the test before they’re allowed to sell a jury on melodramatic bunk— which is somehow to often pinned on women who don’t live up to impossible ideals.

    It’s dangerous when people embrace bunk, it’s most dangerous when “experts” do and convince the public to do so as well. I’ve found it impossible to get most people I agree with philosophically and politically to even consider that what they think of settled science might be wrong. They’re cock sure that they’re scientifically minded and don’t have a superstitious bone in their bodies ,yet they seem incapable of questioning what they’ve considered to be settled science and no more than rumor and advertising.

    March 27, 2014 | 7:43 PM

    That’s what happened to me Altostrata. It was unlike any state i’ve ever been in, before or since. It was a drug induced state, but because I was suffering so much from “depression” (which was an iron deficiency) I was terrified of feeling like that again, and let them convince me that I had to stay on a cocktail for life or end up being a full-blown manic depressive.

    After having my first psychotic episode at the age of fifty, my conclusion is that preventing was no worth ten years on rotating cocktails to treat the effects of a med given for the effects of a med, for the effects…

    I’ d be happy to try a low dose of lithium, but they don’t make them small enough for low doses and what they call “therapeutic” I call “second only to pernicious anemia in its debilitating effects.

    March 27, 2014 | 10:31 PM

    Dr. Mickey, it’s true that PCPs sometimes make like mental health experts, diagnose serious psychiatric disorders, and brew up ad hoc drug cocktails. (I call this the sorcerer’s apprentice effect.) But when psychiatrists see an adverse drug reaction as diagnostic of a psychiatric disorder, it’s something of a mass delusion.

    You may recall the death of 3-year-old Rebecca Riley http://www.ahrp.org/cms/content/view/667/52/ involved a fatal drug cocktail and a bullspit diagnosis of pediatric bipolar disorder — surely another modern-day hysteria among psychiatrists, shaped by Biederman and the bio-bio-bio Harvard Psychiatry atmosphere in Boston.

    Are you following the Justina Pelletier case? Phil Hickey sees the shadow of Biederman and Harvard Psychiatry looming over this http://www.behaviorismandmentalhealth.com/2014/03/06/justina-pelletier-and-boston-childrens-hospital/ Also see http://www.bostonglobe.com/lifestyle/health-wellness/2014/03/25/permanent-custody-justina-pelletier-awarded-state-massachusetts/puyPhesGkKE6rGLid2VM2L/story.html and http://bostonherald.com/news_opinion/opinion/op_ed/2014/03/graham_why_did_pelletiers_lose_custody

    There certainly is some craziness circulating in psychiatry these days, with Boston as its locus.

    March 27, 2014 | 10:59 PM

    What a nightmare. How did a psychiatrist override a diagnosis by one of the rare experts in mitochondrial disorders, prevent another from looking at the girl, and convince a judge to treat the parents as if they had “Munchausen by Proxy” which is too often what child and family services types and doctors; who hate women who pretend to know their own child better than a case manager(!) or a doctor(1). These stupid parents don’t have degrees— what do they know. Sure, it happens but it’s rare and most of the time it’s punishment for one or more parents who won’t accept a wrong diagnosis or treatment that isn’t working for their child or that makes their child’s condition worse.

    With the evidence contrary to the “all in your head” interpretation, this should never have left the psychiatrist’s mouth, much less been used to vilify the girls parents and to deny actual medical care for her. Her condition can be very painful, and to have a rare medical condition as drastic as that and be told that it’s all in her head and her parents just made it up— I cannot imagine the medieval nonsense this girl must be dealing with.

    It should not be legally possible for this to happen.

    March 28, 2014 | 7:15 AM

    “It should not be legally possible for this to happen”

    Ah, but it occurs all the time Wiley and no one gives a d-mm. I know people want to blame this on liberal MA but these abuses have been occurring in red and blue states.

    The ramifications of this are mind blowing. Any parent, particularly ones with a kid with a rare illness, are going to be scared to death to take them to a hospital or doctor out of fear a similar situation will occur. But the lack of necessary medical care could be deadly.

    It is a horrible situation.

    March 28, 2014 | 7:23 AM

    You are kind, humble, and wise. The question remains for me – is there something about psychiatry that makes us more vulnerable to this problem? I have been interested in reading histories about other branches of medicine and other areas of science; certainly stories of firmly held beliefs held by the experts only later to be disproved are common. But I remain unsure and deeply troubled as to whether our profession is exceptional in this regard. At the time this occurred, I put the blame on psychoanalytic thinking where no hypothesis could ever be disproved. But as you well know, the intervening years have showed us that there were problems (an understatement) in the “biological” psychiatry camp as well.

    Steve Lucas
    March 28, 2014 | 10:04 AM

    I can tell you from personal experience that being the adult in the room is not fun. When you have a person whose behavior is outside the norm, and you have measurable data to prove their behavior is having a negative impact on the organization, the very first thing you are told is: You don’t understand.

    I have to believe that we as a society have given up on passing judgment, setting limits, or even questioning behavior in an attempt to be fair and understanding. The rights of the one out weight the rights of the many, and if you do not believe that we have a lawyer that will tie you up for years in litigation.

    The audience and group think is what has me confused.

    Steve Lucas

    March 28, 2014 | 5:09 PM

    Steve, are you saying the adults in the room are the Boston Children’s Hospital psychiatrists who decided to supplant a specialist’s questionable diagnosis with one of their own?

    The girl is not doing better health-wise incarcerated in a locked psychiatric ward.

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