I learned a valuable lesson from a garage door today that I thought I would pass along to some posters who think they know something about psychiatry and psychiatrists.....
I came home early this afternoon and hit my garage door remote, like I had done thousands of times in the past. This time the door went up and seemed to hesitate and drop back about 2 inches, then it went all the way up. I stepped out and noticed a bolt laying on the floor. I picked it up and it was a 5/8 x 1 1/2 inch self-tapping bolt. Looking around, I noticed that it has fallen out of the plate that fastens the garage door to the door itself. The plate was bent and there was only one bolt left holding the door. I grabbed a socket wrench and a ladder and headed up to where the door was suspended to fix it - about 5 or 6 feet off the floor. It was immediately evident that the plate was bent at such an angle that I could not gain any purchase in the door with the free end of the bolt - or it was stripped. Without thinking, I thought I would pull the emergency door release hanging just to my right to give me just enough slack to fasten the bolt.
In an instant, the arm assembly jerked my left hand very hard toward the door opening as the door crashed from fully open to fully closed in a less than a second. I was propelled about ten feet through the air landing on the floor at the base of the door with some serious neck strain and a few sprains but otherwise, none the worse for wear. I was somewhat stunned by all of this. When I looked up I noticed the coil spring over the left side of the double garage door was snapped in half. Directly in front of me was a warning that I had read many times before:
I should probably define at least part of what I consider inappropriate criticism and what a poster here has touched on as important dynamic. On the sites where it is common for psychiatrists to post or sites that claim some legitimacy in the area of criticism, there are also some thoroughly hostile and malignant posts that are at the minimum inappropriate and at their worst pathological. I have received a few directly here last week, but have decided that posts such as these will not appear on this blog. I am aware that some people think that anyone should be allowed to criticize psychiatrists in any manner. They are wrong. People suggesting that I should "burn in the hottest part of hell" of course would be one example, but there are many more.
The garage door incident is instructive for at least some of them. I recently saw a number of anonymous posts saying that psychiatrists can "just say anything" and that psychiatric credibility could be "shredded" in forensic settings. Interspersing those arguments among supposedly legitimate critics takes the level of their arguments way down. If these types of posts were always the case, it would be very easy to ignore a thread inhabited by barbarians. I could certainly come up with a neat little definition of the barbarians but what is the point? A related question is why those sites feel compelled to include this posts? I don't think that is a passive or well thought out decision. Once the discussion has headed into abusive, threatening, or irrational territory and it remains in fair play - that says a lot about the intent of the administrator. At the very minimum, the intent is no longer a reasonable discussion. Granted that it is often difficult to determine what is reasonable, given the overall tenor of the site. For example, if I wrote a book bashing all psychiatrists and was promoting it on a site, why wouldn't I include every possible irrational post as evidence that I am correct?
It is much more instructive to look at the garage door example and what it implies for the basic argument that there is no such thing as mental illness and the closely related arguments - psychiatrists are not needed for the diagnosis and treatment of mental illness or that they have simply made up mental illness so that they can all be rich and drive expensive cars (another e-mail from one of the fans). The garage door is a simple scenario with three critical points of information that any experienced person could observe - arm plate screw missing, arm plate bent, and left main garage door coiled spring snapped in half. As an additional historical point I should add that in my experience these springs snap about every 15 years and this one was only 5 years old. I observed 2/3 of the points thought I could make the repair and nearly had a catastrophic result.
In the case of a psychiatrist seeing a new patient, there are hundreds of relevant points that all have to be acquired and examined in the initial evaluation. The total number of critical points is unknown, but to use just the example of a basic instrument for the assessment of suicide potential they number in at least the 20-30 range. This assumes that the patient is able to respond appropriately to the questions. There are at least another 20 or 30 points when it comes to the prescription of medications and coming up with a treatment plan. As any affected family member can attest, severe mental illness or addiction is at least as serious as a crashing garage door that knocks you off a ladder. It leads to trying to shake off the acute effects and prevent any long term harm. In that event many people are seen and treated successfully by psychiatrists. As I have posted here before, we are the people who are trained to see significant problems and the psychiatrists I know do a good job.
In practically all of the irrational criticism of psychiatry, none of these information points are covered. People seem quite content to tar and feather psychiatrists with whatever seems fashionable at the time. So this lesson is really one about the information content not typically being covered and how missing even a small point in any information set can be potentially problematic, and in my analogy, not just in terms of my own safety but the liability issue if anyone had been working with me.
I know that this lesson may be a stretch for some and in that case consider this a public service announcement for not trying to fix your own garage door. Do not try it at home like I did. Leave it to the professionals.
Oh - and I am not sorry to disappoint those who would have just as soon seen another psychiatrist bite the dust.
As far as I know - I am OK.
George Dawson, MD, DFAPA
