Apple’s CEO Tim Cook came up with quote last week and I thought it was
a good one:
“I’m not running for office. I
don’t need your vote. I have to feel
myself doing what’s right. If I’m the arbiter of that instead of letting the guy
on TV be that or someone who doesn’t know me at all, then I think that’s a much
better way to live.”
The original article began with an introduction about how Steve Jobs
took a lot of heat and a lot of praise to protect the executives focused on
Apple’s business and products. Observers
also note the activities of so-called “activist investors” trying to influence
the management of the company into buying back stock for a quick short-term
gain. Cook is clear that he is all about
long-term results and he is accountable for those results. The same logic applies to what I do and have
done for the past 30 years. On the
financial message boards there is constant noise with news and analysis of
whether the stock price is going up or down.
After watching those trends it is clear that nobody knows the trends and
that far fewer people know anything about the technology. Many of those posts are placed there to manipulate opinion. The critics don't know Tim Cook and the critics don't know me and clearly seem to have never met the psychiatrists that I know and work with. Let’s take a look at how the so-called
critics of psychiatry compare with the critics that Cook is addressing. They can be broken down into several classes:
1. The professional critic –
criticism generally takes the form that I
have special knowledge that no other psychiatrist has. That knowledge can vary from the totally
absurd (there is no such thing as mental
illness or I am the only person to
keep psychiatry honest) to more plausible exaggerations (I am the only person who can do this
therapy, detect this side effect, prescribe this medication, etc.). There is some legitimate criticism but it
tends to be very rare. I think the sheer
number of internet articles by the same author saying the same thing may be an
indication of volume substituting for quality. The obvious message in many of these articles is
that I am unique and everyone else is
either ignorant, crooked, or stupid.
There are varying levels of conflict of interest (books, speaking
engagements, the hero worship of various hate groups). These critics are magnets for the haters of
psychiatry who see them as modern day heroes and generally ignore the conflict
of interest issues that their heroes use to criticize others.
2. The journalist looking for an angle – the overall bias of journalism against psychiatry is well documented and wide spread. Looking to sell papers or in these days mouse
clicks is an obvious motivator. In some
cases the journalists just jump to books and web sites as sources of revenues
and fame. Even the most charitable
interpretation of their work will note the obvious flaws. Considering the DSM-5 a treatment manual or
overestimating the impact of the DSM-5 when in fact most primary care
physicians never use it are good examples.
While telling psychiatrists what
their problems are when they have completely ignored the biggest stories in
mental health for the past three decades that really have nothing to do with psychiatrists.
Those stories are how managed care companies and state and local
governments have decimated the care for people with severe mental illnesses and
addictions. They have only recently
picked up on stories related to incarcerating the mentally ill and trying to
provide them psychiatric services in jail. Not a stellar job of mental health reporting
over the past 30 years. As in the first category, some rare legitimate criticism exists.
3. The injured patient –
certainly the treatment of psychiatric patients has the potential to cause injury like any other medical treatment and injuries do occur. As I have posted several times on this blog,
anyone who takes a medication that is FDA approved is at risk for side effects
up to and including death. As I have pointed out here (where you will not
see in many other places) – the FDA decision can be purely political rather
than scientific. As a result, any
medical or psychiatric treatment should be entered into very cautiously. I have also posted here (and you will not
see this in many places) that nobody wants to take a non-addictive medication and that people
are generally hopeful that it will provide relief from a miserable
condition. I do not believe that people
take any medications, especially psychiatric medications lightly. I have outlined my clinical method to minimize side effects and adverse events.
Even with that high level of caution, side effects and adverse events
will occur. There are no shortage of
remedies that can be pursued at multiple levels. Most people resolve the problem immediately with their physician. In the case where medical organizations are involved there can be direct
complaints to the medical administration, hospital authority, or patient advocates. At the state and licensing level complaints to the
state medical boards and in some cases complaints to a mental health ombudsman can be made.
There are obviously malpractice
attorneys. Injuries caused by medical treatment are legitimate reasons for complaints and criticism but at some point I would hope that it would lead to a
solution to a real problem. I would also hope that nobody is compelled to sacrifice their medical confidentiality for the purpose of a complaint.
4. The severely personality
disordered – there is no good way to say it, but there are people who are very hostile to other people. In many cases they aggregate around
psychiatrists because that is where everyone else tends to send them when they
cannot be dealt with. Like any group of
people in contact with psychiatrists, the vast majority of people with
personality disorders are able to work on their problems in a productive way
and do not turn treatment into a series of personal attacks. But there are also the small fraction that
do. In many cases they target
psychiatrists (and others) and their anonymous criticism is frequently
irrational, heated and in some cases threatening. They can attract like-minded people.
5. The professional critic who
is not a psychiatrist. I posted my
earliest experience of an irrational response by an attending physician when he
learned that I was going into psychiatry.
In today’s politically correct landscape it would be classified as
harassment and abuse. Practically all of the
psychiatrists I know have similar stories.
In fact, I personally have several more.
The unexamined irrational hatred
of psychiatrists is just a fact that any psychiatrist has to deal with. But when I hear a medical professional come
up with some blanket statement about psychiatrists that is what it is all
about. I have examined in a previous post the basis for these generalizations. Most physicians
are at least are circumspect about why they did not go into psychiatry. Most
of them tell me they don’t want to deal with lethal violence or deal with the
severely personality disordered. Unless
somebody points out this unexamined irrational thought pattern for what it is –
it will never be corrected. See my
previous comment about it. Or as the
kids say these days haters be hatin' and
leave it at that.
6. The people who bristle when
psychiatrists speak out against irrational criticism or even offer an alternate
explanation are an interesting lot. Some blogs seems to attract a lot of them, but I don’t frequent the more hateful
blogs. They are a self- righteous lot
that looks as far as their own information.
They generally ignore any
contradictory information and stick to their story or accusations.
They will attempt to bury any psychiatrist pointing that out with
righteous indignation and sophistry usually by invoking victimhood ("Noooo we are not antipsychiatrists – stop
calling us that name!"), hero worship
("You just aren’t as good as the psychiatrists who we agree with!") or the usual
appeals to emotion ("It is so pathetic that these psychiatrists are just so
(ignorant, evil, etc) and they just can’t accept our “facts”"). You can apparently
say anything and really believe it is true.
Just so nobody forgets – it is true that psychiatrists are bogeymen.
Boo!
I am an experienced psychiatrist with 30 years of experience. I have specialized in treating the toughest
problems and the problem of lethal violence and severe mental disorders, often
with significant medical comorbidity. Like
a neurosurgeon said to me at a serious point: “You guys treat the toughest
problems that nobody else in medicine wants to treat.” I have treated many more people than are
mentioned in “case reports” and at this point in entire clinical trials. I have as much experience as anyone in the
safe and effective treatment of these disorders. I encourage people to not tolerate side
effects, use psychotherapy, and to be comfortable with the idea that I should
be able to answer any questions they might have about my assessment or
treatment recommendations. Like all physicians I have
much higher levels of accountability than most other professionals. Like all physicians there is a rare day where
I am not being harassed by someone who thinks they know how to do my job better
than I do usually because it suits their business interests. And I am the one with no conflicts of
interest. This is a non-commercial
blog. I have no books to sell. I have no financial connections to any
industry. I couldn't care less if anybody
ever paid me for my opinion. So it
should not be too surprising when I say:
I don’t need your vote. I know
what I am doing and that has been substantiated time after time – tens of
thousands of times. Further, I know how
to read research and interpret the findings as opposed to the general lack of
scholarship from those who assume they know more about my job than I do. There are a handful of psychiatric experts
that I consider to be authoritative and none of them are the usual media
critics. In fact, some of the media
critics aren’t even psychiatrists and it
shows. But the best part is I am no
different from my other colleagues that I consult and collaborate with every day.
They don’t need your vote either.
They don’t need your vote either.
George Dawson, MD, DFAPA