{"id":61542,"date":"2015-11-19T10:59:17","date_gmt":"2015-11-19T15:59:17","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=61542"},"modified":"2015-11-19T18:33:08","modified_gmt":"2015-11-19T23:33:08","slug":"redemption","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2015\/11\/19\/redemption\/","title":{"rendered":"redemption?…"},"content":{"rendered":"\n
The author of the blog Psych Practice<\/a> and I are psychoanalysts who have lived through the massive changes in psychiatry [and psychoanalysis] in the span of our times. By any measure, Psych Practice<\/a> is a good blog to follow, but I found this post particularly well framed – Lieberman Speaks<\/a>. It’s about a panel held at the William Alanson White Institute<\/a> about the book, Shrinks: The Untold Story of Psychiatry<\/a>, with author Jeffrey Lieberman on the panel. Psych Practice has had several other posts about the book – Analytic Evidence<\/a>, "Shrinks" Review-Introduction<\/a>, Shrinks: The Untold Story of Jeffrey Lieberman’s Oedipal Victory Over Papa Freud<\/a> – and adds this earlier quote to this post:<\/div>\n
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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.<\/em><\/div>\n<\/blockquote>\n
I can’t imagine that there’s a psychoanalyst alive who hasn’t had a similar thought. For that matter, I expect many non-psychoanalysts had some version of that thought too. It’s hard to even skim through this book and take it at face value without wondering what’s behind<\/font><\/em> its writing, even if you agree with Lieberman’s version of history.<\/div>\n

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<\/font><\/em> 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.<\/p>\n

And since I’m absolutely sure I have no therapeutic intent<\/font><\/em> when it comes to Jeffrey Lieberman, I’ll skip to the end of Psych Practice’s report – the question and answer period:<\/div>\n
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… 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.<\/div>\n

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?<\/font><\/strong><\/p>\n

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<\/font><\/strong>. 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…<\/div>\n<\/blockquote>\n
This panel was in part a failed attempt to inform Dr. Lieberman of what psychoanalysis has become in his absence – a vibrant enterprise separated from psychiatry now primarily teaching psychodynamic psychotherapy to an eager audience [from all academic disciplines including psychiatry]. It is becoming what it should’ve been well before 1980, where many of us tried to move it even back then. But that’s another history for another time and perhaps another author.<\/div>\n

The book Shrinks<\/font> 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.<\/font><\/em>" The story-line of psychoanalysis capturing psychiatry, and its liberation with the coming of the DSM-III, medicalization<\/font><\/em>, the newer psychotropic drugs, and the advances in neuro-matters<\/em><\/font> 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?<\/font><\/strong><\/em>"<\/p>\n

It’s the redemption<\/font><\/em> 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?<\/font><\/em>" 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<\/font><\/strong><\/em>." 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<\/font><\/em> – by any stretch.<\/p>\n

In science, paradigm shifts occur when a dominant paradigm become more known by its exceptions than its explanatory powers. When some new conceptual model comes along, the former paradigm doesn’t disappear but rather endures by becoming refined and more limited – "right-sized." Meanwhile, the new model begins its expandsive, then contracting journey on the same predictable arc. Dr. Lieberman’s Shrinks<\/font> is written more on the template of Sodom and Gomorrah followed by the New Jerusalem, or perhaps Armageddon leading to the Rapture. His inability [or unwillingness?] to address the dark side and limitations of his particular brand of psychiatry jumps from the pages of his writings and presentations in spite of his attempts to shout it down.<\/div>\n","protected":false},"excerpt":{"rendered":"

The author of the blog Psych Practice and I are psychoanalysts who have lived through the massive changes in psychiatry [and psychoanalysis] in the span of our times. By any measure, Psych Practice is a good blog to follow, but I found this post particularly well framed – Lieberman Speaks. It’s about a panel held […]<\/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_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-61542","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/61542","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=61542"}],"version-history":[{"count":28,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/61542\/revisions"}],"predecessor-version":[{"id":61587,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/61542\/revisions\/61587"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=61542"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=61542"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=61542"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}