On February 15, 2022, Daniel Morehead, MD, a psychiatrist and director of training at Tufts Medical Center in Boston, published an article in Psychiatric Times. The title is Just Because We Do Not Know Everything Does Not Mean We Do Not Know Anything. The article is designated Episode 1 of a new series, and the subtitle is “Exploring how to approach the criticisms of psychiatry.”
Perhaps the most noteworthy thing about this piece is the title: Just Because We Do Not Know Everything Does Not Mean We Do Not Know Anything. There is, I suggest, an implication here that psychiatry has been accused of not knowing anything. I’m fairly familiar with most of the criticisms that have been levelled against psychiatry, but I have never heard or read any criticism of psychiatry that entailed allegations of such profound ignorance. I think the vast majority of psychiatry’s critics would acknowledge that psychiatrists know how to tie their shoes, drive their cars, conduct themselves in social situations, etc… So why would Dr. Morehead choose to open his affirmation of psychiatry – his defense of his chosen profession – with this undermining caricature of his profession’s critics?
Perhaps the answer to this question is found in his first paragraph:
“It is all too easy to be negative. It is far easier to criticize than contribute—easier to tear down than to build up. Positivity fades, but negativity seems to build on itself.1 ‘Friends come and go; enemies accumulate,’ as Mark Twain put it.”
It is by the same token easier to score cheap and invalid points against one’s critics than to expend the time and energy necessary to examine their criticisms.
In his second paragraph, Dr. Morehead continues this theme:
“It is easy to be negative because it is natural to be negative. As human beings—indeed as mammals—our nervous systems give more weight, more attention, and more energy to negative and threatening experiences than to positive ones1. So at a time when many medical and scientific authorities are viewed with suspicion, negativity about psychiatry is hardly shocking. Even vaccines have become a hard sell in our polarized and angry public culture.”
The essential point here is that it is “natural to be negative”. The reference that Dr. Morehead quotes is Rozin and Royzman, Negativity Bias, Negativity Dominance, and Contagion (Personality and Social Psychology Review, Nov 2001) This is a complex paper, but on at least one point, the authors are abundantly clear:
“Although negativity bias is often striking, it is far from universal. On the contrary, there is sufficient evidence for a positive bias that an entire book, The Polyanna Principle (Matlin & Stang, 1978), has amply documented the wide range of positive biases. These appear in higher frequency of positive words, positive experiences, and positive views of the world, and in other domains. This puts us in the peculiar position of describing what we believe to be a basic tendency in the face of documented evidence for the opposite tendency, as well.” (p 297)
Like I said, it’s a complex paper, and certainly can’t be summed up by the simplistic slogan “it is natural to be negative”. But psychiatrists have always been strong on mindless slogans, e.g. “Treatment Works”; “Real Illness Just Like Diabetes”; “End the Stigma”; etc.
Note also the way Dr. Morehead includes psychiatrists in the group “medical and scientific authorities”, ignoring the reality that most critiques of psychiatry are founded on the fact that in its essential nature, psychiatry is neither medical nor scientific.
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“Psychiatry has always been subject to more criticism and abuse than any other medical specialty.”
Note first the unwarranted pairing of criticism and abuse, with its subtle innuendo that all critics of psychiatry are also “abusers” of psychiatry.
But more to the point, if psychiatry has been subject to more criticism than any other medical specialty, shouldn’t psychiatry be taking this seriously? Shouldn’t they be looking impartially at the criticisms, evaluating objectively their merits and demerits? Wouldn’t that be a scientific approach? One would think so. But Dr. Morehead will have none of that. He likens our critiques to “the elevator music of our professional pursuits” – something of no consequence and best to be ignored. “Negativity about psychiatry has become a long-running and tacitly accepted tradition, both inside and outside psychiatry.”
I have to say that I haven’t encountered much criticism of psychiatry coming from within psychiatry, but Dr. Morehead is, I imagine, in a better position to judge this than I am. If he had thought to include some examples of this in his paper, his claims might have a measure of credibility.
Note also that Dr. Morehead is betraying his prejudices by referring to criticism of psychiatry as negativity about psychiatry.
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“Contemporary critics assert that psychiatrists make diagnoses on the basis of a pseudoscientific and self-serving DSM, and that we go about treatment through the use of dangerous and unjustified overprescribing. Because we lack a firm scientific grounding (they say), self-interest runs rampant. As psychiatrists, our arbitrary definitions of mental illness expand to include more and more ‘patients,’ while drug companies push treatments for newer and more expansive ‘disorders.’3,4“
Actually, that’s not a bad summary of the main points of contention, but these are usually presented with a good deal more nuance than we’re seeing here.
Psychiatry is, at its very core, unscientific. It does not discover its illnesses in nature through painstaking research. Rather, it just makes them up on the basis of superficial loose groupings and their dogmatic fiats. Sometimes they have to resort to voting to settle disagreements! (See DSM-III-R, page xx under heading Advisory Committees. “However, several controversies, particularly in the areas of childhood, psychotic, anxiety, and sleep disorders, could be resolved only by actually polling committee members.”) I would be hard put to conjure up something less scientific. Oh. Hang on – the infamous chemical imbalance theory of depression, avidly and mendaciously promoted by psychiatry, was indeed less scientific. And if Dr. Morehead would like to have a serious debate on this issue, he could read my post Psychiatry DID Promote The Chemical Imbalance Theory on Mad in America and write a response. I welcome critical comment.
It’s difficult to avoid the self-serving aspect of psychiatry, but it does not stem specifically from their lack of science. It’s just plain old-fashioned greed. And the arbitrarily adopted psychiatric “illnesses” have been expanding steadily since DSM-III.
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“Negativity about psychiatry is a major impediment to the mental health of this country. What do we do? We do not oppose negativity with more negativity. Our world has grown weary of flame wars. Instead, we oppose negativity with positivity. We oppose distortion with clarity. We do not deny the problems of psychiatry; we demonstrate its strengths. We accept legitimate criticisms of psychiatry, but place them in a wider and more affirmative context. In short, we show why psychiatric illness is medically real and psychiatric treatment is medically legitimate.”
So according to Dr. Morehead, psychiatrists do not deny the problems of psychiatry. Actually, they do. And Dr. Morehead has given us several examples in this essay. But more to the point, if Dr. Morehead is claiming that he and his psychiatric colleagues do not deny the problems of psychiatry, why doesn’t he just scrap his present attempt to justify psychiatry and instead give us his list of psychiatry’s problems. Perhaps we’d find some common ground!
And if he can show why psychiatric illness is medically real, then why not do so. I, for one, would be “all ears”.
“As psychiatrists, the fundamentally benign nature of what we do has been too obvious for words. Few of us have wasted time debating it amongst ourselves. Instead, when we have spoken of psychiatry in the abstract, we have routinely spoken of its problems and limitations. Now, for the sake of the rest of the world, we need to habituate ourselves to explaining and affirming our field. We need to articulate a basic sense of what we are doing with each other, our patients, and the wider communities of which we are a part.”
Our intuition seldom alerts us to our own failings. So Dr. Morehead’s notion that the fundamentally benign nature of what psychiatrists do has been too obvious for words, smacks a little of narcissistic delusion. The rest of this paragraph trails off into incomprehensibility. “Now, for the sake of the rest of the world, we need to habituate ourselves to explaining and affirming our field.” For the sake of the rest of the world!!! Is this some perverted form of neo-colonialism? And “we need to clarify what we are doing with each other, with our patients and with the wider communities”. I can find neither rhyme nor reason here. But then it gets worse.
“I believe we can answer the questions that dog psychiatry in a way that is honest, satisfying, and relatable to the public. I believe it is time for psychiatry to find its voice in a new way. We have nothing to hide and no need to patronize. We need not deal in denial, rationalization, or intellectualization. The truth will do nicely for our interests and for those we serve. We are psychiatrists, after all.”
This refers to the future episodes that Dr. Morehead is planning to publish. It all sounds great, and I look forward to some good reading.
But what are we to make of his final sentence?
“We are psychiatrists, after all.”
Is this a boast or a confession? Narcissism or humility. I truly can’t tell, but probably narcissism.