1 Boring Old Man

Lieberman, [or maybe it’s Ogas] writes with particular vehemence about the period when most psychiatrists did analytic training. It made me wonder if he was rejected from a training program at one point, or if he was in an analysis that he quit because he found it intolerable. I have absolutely no basis for these thoughts- they’re just conjecture.

Speculating about the self-serving motives of others isn’t all that hard. We almost all do it – particularly when we disagree with what the other person is saying. In the process, we are discounting what’s being said, sometimes for valid reasons, sometimes colored by self-serving motives of our own. Speculating with therapeutic intent is a different enterprise. The speculation itself is only of value if it’s confirmed by some positive change in attitude, understanding, or behavior. Many psychoanalysts of yore died on the vine by treating their speculations as having an intrinsic value outside of that context.

… Then it was my turn, and I was the last questioner, which suited me fine because the room had cleared out a lot by then. I’m a pretty comfortable public speaker, so I was surprised to note how much my voice was shaking, until I realized it was rage, not stage-fright.

I told him I had read his book, that there’s a lot more evidence for PSA than he’s allowing for, and I paraphrased the passage where he states that if Willem Reich’s patient were alive today, she would be diagnosed with an anxiety disorder and treated with an SRI and CBT, which made it sound easy. I pointed out that he was concerned about gaining credibility by fessing up to psychiatry’s history, but the fessing up was selective, and that nowhere does he mention the difficulties with treatment, including things like metabolic effects of antipsychotics, or Paxil Study 329, and how does he mean to engender trust in the public by omitting those kinds of facts?

I know I was far less eloquent in my phrasing, and what I just wrote is not so great to begin with. I think he cut me off towards the end, because I never said anything about the severe limits of what we actually know about mental illness. He rolled his eyes and said, "Medications have side effects. Am I supposed to list every side effect in the book?" I have the impression he was still yelling something, but I could be wrong…

The book Shrinks is billed on Amazon.com as "The fascinating story of psychiatry’s origins, demise, and redemption, by the former President of the American Psychiatric Association." The story-line of psychoanalysis capturing psychiatry, and its liberation with the coming of the DSM-III, medicalization, the newer psychotropic drugs, and the advances in neuro-matters has been with us for three plus decades, delivered by Dr. Lieberman with an unusually heavy dose of contempt. But it’s his response, or perhaps his non-response, to the question at the end of Psych Practice’s comment that deserves attention: "… and that nowhere does he mention the difficulties with treatment, including things like metabolic effects of antipsychotics, or Paxil Study 329, and how does he mean to engender trust in the public by omitting those kinds of facts?"

It’s the redemption part of Dr. Lieberman’s playbill that doesn’t pass muster. And his eye-rolling sarcastic "Medications have side effects. Am I supposed to list every side effect in the book?" doesn’t address the question asked. What about the academic·pharmaceutical complex with its guest authors, ghost authors, conflicts of interest, speaker’s bureaus, commercially oriented CME, and its jury-rigged or invisible clinical trials? How about the minimized adverse effects of the drugs – the metabolic syndrome, akathisia with violence, the withdrawal symptoms, tardive dyskinesia, addiction, etc? And then there’s the part of the question Psych Practice didn’t get to ask, "…he cut me off towards the end, because I never said anything about the severe limits of what we actually know about mental illness." Dr. Lieberman’s and his colleagues’ over-simplification of the complex human experiences we call mental illness imply an unsupportable level of mastery. So this is hardly a period of redemption – by any stretch.