Jeffrey Lieberman, MD, is president-elect of the APA, and is scheduled to take over the reins from Dr. Dilip Jeste this month. Never in its history has the APA been subject to such scrutiny or criticism from such diverse sources, and one might reasonably have expected Dr. Lieberman to open on a conciliatory note, promising investigations, reforms, etc….
But no! He’s in the ring slugging furiously from the opening bell. Two days ago (May 20) he published an article in Scientific American titled DSM-5: Caught between Mental Illness Stigma and Anti-Psychiatry Prejudice.
Readers may remember Dr. Lieberman as a joint author (with Thomas Insel, Director of NIMH) of a May 13 statement of reconciliation between the APA and NIMH. At the time, I expressed the view that the statement was more spin than science. In the Scientific American piece, Dr. Lieberman continues in the same vein.
Dr. Lieberman opens by announcing that he was “amazed” by the debates surrounding DSM-5. “Never before has a thick medical text of diagnostic nomenclature been the subject of so much attention.”
When the guys (and gals) on Madison Avenue want you to buy more of a particular soft drink, say, they show you pictures of beautiful people in fabulous cars wearing fabulous clothes and, of course, drinking this particular drink.
What Dr. Lieberman is doing in the above quote is connecting the DSM with the image of a “thick medical text of diagnostic nomenclatures,” i.e. a genuine medical textbook. You know that drinking that brand of soft drink isn’t going to get you the car, but advertisers know that juxtaposing these images creates an enhanced perception of the value of the product. Bio-psychiatry has always been more about advertizing and spin than science, and apparently Dr. Lieberman believes that Madison Avenue techniques may serve his purpose here – especially since he hasn’t any science to pitch at us.
Dr. Lieberman goes on to state that DSM-5 “…offers an up-to-the-minute diagnostic GPS…” I kid you not: an up-to-the-minute diagnostic GPS! This is the same DSM that Thomas Insel described as having no validity, and whose field trials, conducted by the APA themselves, were so abysmal. And yet it’s an up-to-the-minute GPS. Note again, the juxtaposition of something positive (GPS) with the object being promoted (DSM). This guy thinks we’re not too bright.
Dr. Lieberman goes on to tell us that he was “…alarmed at the harsh criticism of the field of psychiatry and the APA.” Consequently, he wants to educate his readers concerning:
“…the difference between thoughtful, legitimate debate, and the inevitable outcry from a small group of critics –made louder by social media and support from dubious sources —who have relentlessly sought to undermine the credibility of psychiatric medicine and question the validity of mental illness…”
Why, I wonder, does he describe our outcry as “inevitable”? Wouldn’t an outcry only be inevitable if indeed there was something terribly amiss with the object under discussion? And who are the “dubious sources”? Sinister men lurking in dark corners with sharp knives “… who have relentlessly sought to undermine the credibility of psychiatric medicine…”? There it is again – we’re real doctors – really! Honestly! And here he goes over the top: “… question the validity of mental illness…” There it is! How dare we! Such cads. But hang on – isn’t questioning an essential (perhaps the essential) component of science? Anyway, we’re obviously a dissolute pack of rogues and villains, and we need to be given a good talking to and put to bed hungry.
Dr. Lieberman briefly alludes to “meaningful discourse” and contrasts this starkly with criticism that comes from “…groups who are actually proud to identify themselves as ‘anti-psychiatry’.” These dreadful people “…don’t want to improve mental healthcare, unlike the dozens of psychiatrists, psychologists, social workers and patient advocates who have labored for years to revise the DSM, rigorously and responsibly.” (He doesn’t mention that 70% of these ardent toilers were on pharma payrolls!) He goes on to point out:
“Instead…[these uncouth villains]… are against the diagnosis and treatment of mental illnesses – which improves, and in some cases, saves, millions of lives every year – and ‘against’ the very idea of psychiatry, and its practices of psychotherapy and psychopharmacology.”
We are, to Dr Lieberman’s mind, “…misguided and misleading ideologues and self-promoters who are spreading scientific anarchy.” There goes my self-esteem.
Dr. Lieberman goes on to liken being against psychiatry as akin to being against cardiology or other medical specialties. He then laments the fact that “No other medical specialty is targeted by such an ‘anti’ movement.” And this, of course, is true. It would have been fruitful at this point if Dr. Lieberman had devoted some energy towards finding out why his profession is taking such a beating. But no. His strategy is to beat up his critics, and he will not be deflected.
Up till this point it’s been the straightforward ad hominem nonsense that we’ve come to expect from defensive psychiatry. But here he crosses a truly unbelievable line:
“This relatively small ‘anti-psychiatry’ movement fuels the much larger segment of the world that is prejudiced against people with disorders of the brain and mind and the professions that treat them. Like most prejudice, this one is largely based on ignorance or fear–no different than racism, or society’s initial reactions to illnesses from leprosy to AIDS. And many people made uncomfortable by mental illness and psychiatry, don’t recognize their feelings as prejudice. But that is what they are.”
What he is saying here is that those of us who criticize psychiatry are fuelling prejudice against the clients.
And note the last but one sentence – “…many people made uncomfortable by mental illness and psychiatry, don’t recognize their feelings as prejudice.” So when I, and other writers, say there are no mental illnesses or that the concept of mental illness is spurious and circular, or that the concept of mental illness has no explanatory value, we are actually expressing prejudice against clients and we don’t even realize that we’re prejudiced! How pathetically we wallow in our own ignorance!
And Dr. Lieberman goes on to help us understand our deeply rooted prejudices against clients. There is “historical fear” of mental illness, he tells us, which stems from the bad old days when “these diseases” were considered manifestations of demonic possession and later as moral defects.
So we critics of psychiatry are on a par with the witch hunters of bygone days. I need to discard my copy of Malleus Maleficarum (a fifteenth century witch hunters’ manual) and pick up the DSM, for therein is righteousness and, of course, a GPS!
He then takes a swipe at primary care doctors who have criticized the DSM, suggesting that they’re trying to muscle in on psychiatric turf! He wants them to come back into the fold, however, pointing out that the “anti-psychiatry forces” are “against them too.”
The first rule of spin is deny; second is deflect; third is attack. We’ve been seeing a lot of it from psychiatry lately. Dr. Lieberman is not particularly good at it, but what he lacks in finesse, he makes up for in vigor and enthusiasm. I, and those like me, who critique psychiatry know that we’re opening ourselves up to attack, and we accept this because we believe that psychiatry is destructive and that the evidence supports us. His article is just one more piece of spin in a long series of similar articles.
But in his last three paragraphs, I suggest, Dr. Lieberman goes too far:
“Only recently, I was at a meeting of medical school leadership at my university, where we discussed how to counsel medical students about choosing which specialty to pursue. One senior faculty member quipped ‘tell all students who get low scores on their board exams not to worry, they just need to change their career plans and go into psychiatry.’
A few months later, the same faculty member called me late one night, asking if I would see his wife, who was having a ‘psychiatric problem.’
The urgency of his request belied any awareness that the joke he made at psychiatry’s expense in that meeting undermined our ability to deliver the kind of quality care that his wife now needed. But it can, and it does.”
So, to score a vengeful point on a colleague, he has breached the confidentiality of the colleague’s spouse! Everyone who attended that meeting now knows that the senior faculty member’s wife is receiving mental health care.
And this is the person that the APA membership has elected to be their president! These are sorry times!