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Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.


Thursday, May 21, 2015

Because I Couldn't Resist

I just read an interview with Jeffrey Lieberman in the May edition of Psychiatric Times, and I couldn't stop myself from writing about the nonsense he spouts.

For example, he's asked why mental illness and psychiatry are still stigmatized, and he replies:

Originally no one understood what the causes of mental illnesses were. It was thought that mental illness was due to some supernatural phenomena, demon possession, being cursed by the gods, or so forth. 
Beginning in the 19th century, there were efforts to try to understand the neurologic basis of the illness. But the tools and technology of the time were inadequate. 
Then Freud came along. As compelling and intuitively interesting as his theories were, they did not explain why somebody was schizophrenic, manic-depressive, or depressed; or had OCD or panic disorder; or was autistic or demented. 
It was not until the latter part of the 20th century that psychiatry began to radically change, and we started to acquire a scientific foundation. But, even though things have changed dramatically in recent decades, old attitudes still prevail and mental illness is still considered different from other types of medical illnesses and psychiatry is considered a step-child of medicine. 

I'm not sure how to think about what he says. Does Lieberman believe we now understand what causes schizophrenia, etc., just because we have brain imaging? Does he not believe it but want to imply it, and that's why he answered cagily? He mentions a "scientific foundation". What does he understand science to be?

The notion of "sciencey-ness" certainly exists-machines that whir and light up and produce pretty pictures of the brain, lab equipment with bubbling liquids, numbers and percentages thrown into paragraphs for good measure, Latinate terms bandied about. 

Those are all "sciencey".

But science, real science, is how a toddler figures out that holding onto a helium balloon does not prevent him from falling on his butt. 

I think "sciencey-ness", not science, is what Lieberman is referring to, and I'm very concerned that he doesn't know the difference between the two. 

He claims, "We do have effective treatments...as effective as treatments in any other field of medicine." But, he says, people don't get these treatments because of shame or stigma or poor government policy. 

Does he really believe that if only everyone had access to psychiatric medications and CBT, suffering from mental illness would all but cease?

To put it bluntly, is he lying, deluded, or stupid?

And I know I don't need to worry about retribution for writing that, since he'll never read it. I can't seem to get him to engage in any exchange, no matter how provoking I am. But maybe this one will get through, somehow.

The other topic that came up in this interview that is greatly concerning is Lieberman's understanding of suffering. He states:

When we talk about mental illness, we're not talking about the "worried well" or problems in living. We're talking about what might be considered to be brain disorders, which include traditional mental illnesses, addictions, and intellectual disabilities...The number of people affected by mental illness is enormous, and the costs of neglecting their treatment is staggering. 

Now, I'm not trying to minimize the misery of people with schizophrenia or bipolar disorder or depression, or their difficulties obtaining care outside the penal system. But in a room filled with 100 random people, on average, one will have schizophrenia. How many will have "problems in living"? Troubles with work, or family, or romantic partners. Debilitating troubles. Troubles that cause pain to themselves and those around them. And why doesn't their suffering matter?






2 comments:

  1. "To put it bluntly, is he lying, deluded, or stupid?"

    As effective does not mean great. The process involves overidealizing general medical treatment and devaluing psychiatric care. Leucht's study in the Br. J. Psychiatry illustrated this, but in large part because medical treatments are no great shakes either. Common illnesses like asthma are still poorly controlled with all conventional treatments. The vast majority of asthmatics are still symptomatic with poorly controlled wheezing and asthma still kills people.

    As effective means providing mediocre care like the rest of medicine not attaining some gold standard.

    ReplyDelete
    Replies
    1. "Common illnesses like asthma are still poorly controlled with all conventional treatments."

      As you know well.

      Delete