One of the most admirable traits in another person is humility. We’re drawn to people who don’t have to be right all the time, who have an accurate view of themselves, who can acknowledge their own foibles and even misdeeds. And yet for all the respect we might feel for the humble man, achieving a genuine humility ourselves is uphill climb. Even when acknowledging something we’ve done that was a wrong by any parameter, we explain it, justify it. That’s why there’s no line outside the police station for people coming to turn themselves in for their own crimes [if such a person shows up, they’re usually sent for a psychological evaluation]. And the IRS doesn’t need a department to process letters in the form, "Last year, I cheated on my taxes. A check is enclosed." That internal system we call "Self" "Esteem" can be a double edged sword. We don’t do well without it. Admitting a wrong, flat out, with no further comment, is an unusual thing indeed – a hard thing to do.
I struggle with that as a psychiatrist. I think it’s time for the body of Psychiatry to look back on the last thirty years, particularly the last twenty, and acknowledge that there has been a lot of just outright wrong: producing and accepting lousy science; signing on to lousy science produced by others; colluding with the Pharmaceutical Industry in recommendations and prescriptions; corruption involving ghost-writing, guest authoring, conflicts of interest, direct drug promotion, downplaying or ignoring adverse effects. And then there were some really big sins – TMAP comes to mind. It’s a great big collective blemish, maybe more like an open festering wound. And yet I can’t really seem to talk about it without laying the blame elsewhere – PHARMA, Managed Care, KOLs, Neuroscientists, Psychopharmacologists, the Analysts [before I became one], the DSM committees, the APA. And it’s hard to say I’m sorry to patients harmed, without quickly adding, "but I didn’t do that with my patients."
Even though that last comment is true in so far as I know it, it still doesn’t help with a background discomfort that lingers, transcending any disavowals that pass through my mind. Is it guilt? personal shame? self-righteous anger at my colleagues who brought shame on our profession? a narcissistic wound? And when someone comments here with one of those usual accusations against psychiatrists – labeling, pathologizing, not considering how patients feel, over-medicating – I wince and immediately feel defensive – wanting to say, "not me!" – though I can usually let it pass without comment. But I can also feel that background discomfort I’m trying to talk about at those times. I think I know why I feel that guilt [or whatever it is] personally. At the risk of picking a grotesque example, I think I feel like the Germans who lived in Nazi Germany and did not participate in Hitler’s craziness, but who knew that there was something pretty horrible going on – maybe didn’t know exactly what, but knew enough to know it was pretty bad. People who just went about their lives without looking further because they didn’t want to get involved, or were afraid to get involved, or maybe knew there was nothing they could do even if they were involved. In the literature about childhood sexual abuse, they’re known as the Silent Witnesses – people who knew what was happening, or should have known what was happening, but did nothing and didn’t make the effort to investigate further.
Tough column to write. I cannot speak for anyone else but me, I just can’t get over how so many people I have worked with since my internship were either afraid, indifferent, or rudely callous in not addressing transgressions by colleagues. And now after almost 20 years on my own, I feel it is fair to conclude, until pleasantly proven otherwise, psychiatrists have too many whores and cowards amongst us.
I know this comment is harsh, rude, and generalizing. But, I have not met a size able portion of physicians who have shown me otherwise.
Read a Time magazine article back in the mid 1990s about a little girl who was repeatedly abused terribly by her mother until she died by mom’s hands, and so many people knew what was going on and yet said or did nothing. The title of the article, “Silence is death” still resonates in me today.
Why do so many still belong to the APA? The obligatory 20% who are entrenched cronies and cohorts I understand. But, it is not a measily 20%,but still more. If the majority of colleagues care, let’s make that organization irrelevant by terminating membership, and setting example to physicians in training, hmmm?
Thank you Mickey. Respect.
I’m not sure whether to take you behind the woodshed for a well deserve whooping…or just to thank you for your candid openness, humility, & honesty…I’ll let you choose Mickey…lol
THANK YOU, I feel you carry an undue burden by feeling this much remorse over what clearly others in the field never cared at all about…it really made me think just now that the group who were part of my daughter’s early psychiatry “help” should actually apologize to her, not to me, to HER. That won’t ever happen, which really highlights to me how enormous this post is, how truly genuine and deeply meant. Thanks for all you do.
I appreciate your sharing your professional experience and your expertise. More than that, I am grateful that you are also sharing your personal sense of betrayal and ultimately, your acceptance of a personal responsibility to do what you can now—Be wary of morbid reflection, for your own sake—doing what you can now–matters more that questioning why did you not know sooner, etc… I count on reading your blog and it helps a great deal to know there are good eggs, like yourself. Writing this blog has been a painful and transformative process for you; it is courageous and generous of you to share yourself so freely—Thank you.
Mickey,
Just when I think you can’t write a better column, you outdo yourself.
As one who feels my life has been greatly destroyed by being on psych meds, I thank you profusely for what you wrote.
We all make mistakes. The issue is you are humble enough to recognize that.
You are a great human being.
You could find redemption in a book; exposing the professions misdeeds and wayward path to a wider audience. Too much off what happened is unseen.
This post should be embraced by all of medicine. An issue as a child was blow out of proportion and resolved by an old knowing doctor. Today I still deal with doctors who make, what can best be described as ignorant statements that simply embarrass themselves, and show a lack of knowledge.
I have had more than one doctor physically block the door with the ultimate statement being that I have insurance and they have drugs.
GP’s push into psychiatry is frightening to those of us who have watched them justify medicating for profit. While the drug and device companies can sell it is ultimately the doctor who writes the prescription. Vioxx, fen-phen, and the drum beat of other drugs have all been met with great excitement only to lead to death and injury.
Equally disturbing are doctors who ask what you are taking and are willing to continue those medications with no question as to appropriateness. For my wife and myself, we are met with great scorn and serious questions that, with insurance, why we are not medicated.
This post moves well beyond psychiatry and reflects medicine as it is practiced in the US today.
Steve Lucas
Mickey—
Thanks for such a personal reflection. beautifully expressed. I have always had a great deal of difficulty offering apologies (to family, friends, co-workers). To simply say “I’m sorry†is almost beyond my ability. I invariably couch an apology with, “I’m sorry, BUT . . .†Then comes the explanation: I didn’t know, I couldn’t have known, I didn’t mean to, I didn’t see, etc. To excuse my rationalization, I claim ‘human-ness’ and/or self-preservation. But I’ve lived with someone for a long time who has the grace to admit error with a succinct apology: I’m sorry. And then he lives his life in a manner that proves his contrition, and with acts that reveal he is working diligently to NOT repeat the mistake, and to educate others so they won’t make the same mistake. He leads by example . . . as do you. Again, thanks.
Melody
This pediatrician could benefit from a similar self-examination. Thank you, Mickey
Joel—
You reveal some of the current problem: captured physicians (not just psychiatrists) who get on the merry-go-round of profit, prestige and power. Whores? Cowards? Maybe. But I recently had interaction with a young (by my standards) woman who, in her mid-30’s, decided that her calling was medicine for the underserved & under-privileged. With a B.A. in fine arts, she had much remediation to accomplish before being admitted to medical school. Plunked down amidst a population of recent graduates (early 20-year-olds) she was dumbstruck by their sycophancy and greed. They, for the most part, were more concerned with life after med school . . . where were the most prestigious internships, where were the locations for most profitable practices. In discussing specialties, those who considered general practice or family medicine were ‘clowns.’ Cosmetic surgery, dermatology, radiology . . . whatever specialty provided the greatest ROI were the fields these youngsters were chasing. So (from my lay perspective) the problem is deeply rooted, and how to change that is for people far above my pay grade . . . but if it isn’t changed, we are merely pursuing the definition of insanity.
As a psychiatrist, sadly i don’t think we CAN change things within the body of academic or “professional organisation” psychiatry. I see simply leaving the APA as a self-preservation move – you can’t argue with that kind of money, corruption, self-deceipt. Blogging as you’re doing, meticulously documenting the appalling state of affairs in this ongoing way is a VERY great service. Giving similar voices eg Anatomy of an Epidemic, Pharmageddon also Web prominence is a great service. Writing such heart felt personal reflection also a very great service. Thanks, Mickey.
Thank you for speaking up. It cannot have been easy but your name will go down on the right side of the history books alongside names like John E. Fryer MD.
I agree with Dr Flea
Thank you, Mickey. I am deeply touched and continue to be grateful and continue to hope you’ll put this in a book. And I agree it’s not just psychiatry. Just read in the paper today about books by Nortin Hadler, professor of medicine at UNC. Will have to check out his books regarding our “overtreated society.”
Mickey, I personally thank God that you did “drop out†and keep yourself away from the evil overtaking your profession. Had you not done so for a time could you really cast such a clear, cool eye today on the state of affairs in Psychiatry? I wonder…. You return to the debate as an “elder statesmanâ€, untainted by the day-to-day-incremental diminishment of your profession. You see what was, what should have been, and what could still be. This rare and much-needed perspective enables you to write important and insightful blogs like the one above. Keep up the great work Buddy!
Thank you, sir.
Duane
Mickey,
I am a long-time reader and an occasional commenter (using my real name). I’m also a senior psychiatry resident. I write anonymously today because, as luck would have it, I was recently disciplined by my residency program for openly questioning the prescribing practices of one faculty member. I won’t offer more details here, except to point out that you (and I) have a LOT of work to do, to reverse the damage that you and I (but, apparently, not everyone) believe has been done.
“Outright wrong” is clearly in the eye of the beholder, and our voices can be easily silenced.
Tip to anonymous resident: having learned this lesson the rough way, take heed to thinking about where you want to practice after residency. You can win a battle and lose a war. Make sure you have access to a savvy lawyer should your program decide to question your training.
Hey, it happened to me. Oh, and how coincidental no one allied with me. Got to experience that again about seven years later out on my own. The politics of psychiatry is as ruthless as that in DC.
Recently disciplined? (to the anon regular reader resident) that’s incredible, I hope you aren’t considering retaining a job where you are disciplined for looking out for patients that way, instead they should be thanking you for questioning the prescribing practices. If you were to take a permanent job there, you (speaking generally) become one of them, and the place reflects on the employees, that’s just the way it is, like being one of them.Don’t go there!