{"id":19967,"date":"2012-02-20T21:33:55","date_gmt":"2012-02-21T02:33:55","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=19967"},"modified":"2012-02-20T22:38:59","modified_gmt":"2012-02-21T03:38:59","slug":"no-further-comment","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/02\/20\/no-further-comment\/","title":{"rendered":"no further comment…"},"content":{"rendered":"\n

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.<\/p>\n

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<\/u> patients."<\/p>\n

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<\/em> – people who knew <\/em>what was happening, or should have known<\/em> <\/em>what was happening, but did nothing<\/em> and didn’t make the effort to investigate further.<\/p>\n

I did the same thing. I left Academic Medicine when the drug company funded research and the focus on medications came along. I didn’t involve myself with Managed Care or Insurance Panels. I stopped going to meetings and stopped reading journals when they started filling up with endless clinical trials and banal drug talk. I saw that patients who were referred to me had been on bizarre medication regimens previously. But I didn’t investigate. Like many of the non-participating Germans in 1930s and 1940s Germany, I avoided finding out what was happening. Instead, I went on strike. A lot of us did. And that’s why no amount of explaining or talking about what I didn’t know back then ever takes away that background bad feeling. I was a Silent Witness<\/em> to something pretty rotten, and I didn’t take the time or put in the effort to scope it out. So I share in the shame. Like a lot of us, I quit the APA instead of going to the meetings and offering an opposing and questioning voice. I am truly sorry about that. No further comment to follow…<\/div>\n","protected":false},"excerpt":{"rendered":"

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 […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-19967","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/19967","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=19967"}],"version-history":[{"count":17,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/19967\/revisions"}],"predecessor-version":[{"id":19984,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/19967\/revisions\/19984"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=19967"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=19967"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=19967"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}