Um, the reason I say this is, because, um, this last January Twentynine-teenth1, in the review section of the New York Times, which has the op-ed columns, an article was published, titled Redeﬁning Mental Illness2. The article was written by T. M. Luhrmann, who is on the faculty at Stanford University. Dr. Luhrmann, by her background, is a very well educated anthropologist who has been a proliﬁc contributor to the public media and literature for laymen, as well as within her own academic ﬁeld, and has written several books.
As a good host, I let Dr. Jeffrey A. Lieberman go first:
And here's my video of the text in this blog post, with a bit of fun at the end (as if the rest of the video wasn't fun):
The article about mental illness was an incredibly scholarly, informed, simple —at worst, helpful, and at best, unnoticed—commentary that will add to the mistrust concerning the diagnosis of mental illness, minimize the stigma, and may lead some patients to doubt the varsity of the diagnoses that they’ve been told, ah, they may suffer from and the treatments that they’re receiving. Speciﬁcally, Dr. Luhrmann was prompted to write this by a report3 that came from the British Psychological Society, which is a professional organization in the United Kingdom.
This report, titled Understanding Psychosis and Schizophrenia,4 suggested that hearing voices and having feelings of paranoia were common experiences; that they commonly occur in the course of everyday life, particularly in the context of trauma, abuse, or deprivation, and that they shouldn’t be called symptoms of mental illness and attached to diagnoses because that is only one way of viewing them. Viewing diagnoses as normative mental phenomena has relative advantages and disadvantages. Um, this strikes me and other psychiatrists, such as Dr. Jeffrey A. Lieberman of Columbia University, as preposterous. It is, at best, phenomenologic objectivism5, and at worst, simply distinguishing between symptoms and the underlying issues.
It’s common knowledge to most students of medicine and knowledgeable laymen that just because you have a symptom doesn’t mean that you have an illness. You can have fever without having an infection. You can have shortness of breath without having asthma or heart disease. You can have chest pain without having a heart attack. You can have a headache without having a tumour, so doctors usually do not conﬂated a symptom with a diagnosis. This is generally not the case with psychiatry as normal emotions of depression, anxiety, paranoia, and other coping mechanism to deal with painful circumstances are conﬂated with such diagnostic labels as Major Depressive Disorder, Generalized Anxiety Disorder, and Schizophrenia, which we’ve never really given an agreed upon deﬁnition.
There are rigorous principles that govern the process of establishing a diagnosis or reﬁning the criteria by which it is identiﬁed.
Then. The article goes on to say that there is no strict dividing line between mental illness and normality. And. Although. Clearly psychiatrists and everyone that trusts them knows that there is sort of a spectrum of severity of symptoms in the context of an illness occurs, and we hope no one questions that, at some point, it crosses a threshold so that we can deﬁnes symptoms as an illness. So, viewing it as having no strict dividing line is, in a way, challenging the veracity of diagnoses, which can be very harmful, and gives persons who have been labeled as mentally ill license to doubt that they even have an illness that needs medical treatment, which usually results in them recovering and loss of proﬁts for the makers of antipsychotic drugs.
Next, the article addresses the fact that there is no evidence that antipsychotic drugs correct any biologic abnormality, which is entirely accurate. We like to say antipsychotic drugs work through the antagonism or the blocking of dopamine, but we really have no idea. They may have other downstream and upstream effects with a neural pathway, but the link between dopamine activity and psychotic symptoms is what we generally propose at this time as the main issue that needs correcting.
Now. The other thing, after making this point, which essentially says psychiatry equate symptoms with illness, the author says that the NIMH’s (National Institute of Mental Health’s) Director Dr. Tom Insel has a similar view, but that “[t]he British Psychological Society rejects the centrality of diagnosis for seemingly quite different reasons — among them, because deﬁning people by a devastating label may not help them.”6 But Dr. Jeffrey A. Lieberman seems to have misunderstood the article as saying these different views are “consistent”7 with each other.
In a commentary on his blog in 2013,8 Dr. Insel expressed frustration with the traditional diagnostic categories in the DSM (Diagnostic and Statistical Manual of Mental Disorders) because they were not sufﬁciently heuristic in guiding scientiﬁc research. Well, that is true! Dr. Insel did describe the fact that to inspire disruptive (who or what are we disrupting?) and transformative research, we should not be bound by the constraints of traditional clinical diagnoses and we should seek to cross between them and to deﬁne neurobiologic circuits, as we have no idea what they are, anatomy (we deﬁne anatomy?), and biochemical pathways that may enable us to sort of, uh, more, uh, precisely and surgically sculpt the diagnoses or redeﬁne them altogether, just like all other branches of medicine redeﬁne all the disease they make up. His blog post also seems to admit that, unlike other ﬁelds of medicine, psychiatry has yet to ﬁnd any link between mental illness and any objective laboratory measurement. This could be interpreted to say that the way we practice psychiatry at present is not a legitimate form of medicine like other ﬁelds of medicine.
We must proceed with caution so as not to give the impression that this evolution of diagnosis does not suggest that mental disorders are any less real and serious than other illnesses. This is what Dr. Insel and Dr. Jeffrey A. Lieberman of Columbia University, as then president of the APA (presidentelect of the American Psychiatric Association) attempted to do in a letter jointly released in 20139. In this letter, they both stated that although our RDoCs (research domain criteria), which is an acronym you’re likely ignorant of, may represent our aspirational goal for how diagnoses may be deﬁned in the future, that was in the distant future, and for the present, the clinical diagnoses that have been used and continue to be reﬁned and changed through the iterative DSM process are the gold standard of what we want used. Absent these, which is basically the same set diagnoses reﬂected in the ICD 10 (International Classiﬁcation of Diseases 10), there would be no way for consistency in communication and treatment to occur across populations and within the controlled mental health community, which is confusing enough due to the above mentioned lack of objective laboratory measurement. To equate the thesis of the report from the British Psychological Society with the RDoCs initiative of the NIMH seemed quite possible to Dr. Lieberman, so we better teach future psychiatrist how to read more critically. Fortunately, Dr. Luhrmann doesn’t make this same mistake, as is mentioned above.
It really doesn’t help our presently plotted course that Dr. Allen J. Frances, the chairman of the task force that produced the DSM IV, came out of retirement to campaign against the DSM-5 before it came out. Not only that, he publicly admitted to the problems in the DSM IV and his role in facilitating those problems, which led to the DSM-5 and its inherit problems. At least he still seems to maintain our scientiﬁcally baseless biomedical model of psychiatry; although, he also seems to suggest that psychiatry shouldn’t be an exclusively biological paradigm. His support against the overuse of psychiatric medications, particularly in children, and against a general trend towards a global diagnostic inﬂation resulting in pathologizing normality really creates a problem for psychiatrist like me an Dr. Jeffrey Lieberman. His two book also create some difﬁculties for us, particularly Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. (Although, I do like the name Saving Normal. It has a certain ring to it.)
Why would such a report be printed in a widely respected publication such as the New York Times? What other medical specialty would be asked to endure an anthropologist opining on the scientiﬁc validity of its diagnoses? None, except psychiatry, abortion, and eugenics. These three have the dubious distinction of being the only medical specialties with anti-movements; although there is cross-over, such as in regards to euthanasia. There is an anti-psychiatry movement, just as there are other movements against medical practices that deny the dignity of the human person. You have never heard of an anti-cardiology movement, an anti-dermatology movement, or an anti-orthopaedics movement.
So, what would give an anthropologist license to comment on something that is so disciplined, bound in evidence, and scientiﬁcally anchored? The human person is the very subject of anthropology, of which I am technically an idiot10 since I am a laymen in this subject. I imagine this is why the New York Times editors thought that providing a platform for this would be useful. Maybe they want to be edgy. They want to be provocative and they think this is going to be somewhat controversial and attract readers, which is how they make a money. It may be interesting reading, but frankly, I think it’s too responsible.
The author, who is a talented writer and obviously a smart and knowledgeable anthropologist, is written widely for the laity, as well as for the academic community in her ﬁeld. And she has written four books! The subject that she writes on have to do with religion and God… witches and psychiatry. The equating of psychiatry with these other topics suggests how she’s thinking about psychiatry: not as a physical science but a metaphysical science, that it is a philosophical or religious discipline, which has a supernatural or religious dimension, or is in the realm of the supernatural.
Among her publications are Understanding the American Evangelical Relationship With God, Case Studies in Culture and Schizophrenia, Other Minds: Essays on the Way Mind Understanding Affects Mental Experience, Of Two Minds: The Growing Disorder in American Psychiatry, and Persuasions of the Rich (Witch’s) Craft: Ritual Magic in Modem Culture. This hearkens back to the days when psychiatry actually acknowledged that human beings had a soul and that emotions, feelings, thoughts, and memories were more than just chemical reactions that come to an end and disappear when the physical body is dead and decomposing. Such thinking may cause public opinion to return to the original deﬁnition of the word psychiatrist, which comes from the Greek words ψυχή (psyche), meaning “soul,” and ἰατρός (iatros), meaning “physician,” making the word psychiatrist mean “physician of souls.” Such thinking would discredit the materialistic philosophy, which denies, or at least ignores, the existence of an immaterial soul, that we base our modern psychiatry on. It may even give credence to the outdated view of Plato being “a physician of souls” and Jesus Christ being “The Physician of our souls.” This may even lead a return to the thinking of St. Ignatius of Antioch, who called the Eucharist φάρµακον ἀθανασίας (pharmakon athanasias), meaning “the medicine of immortality.” If people start thinking like this, they may begin to realize that the word φάρµακον (pharmakon), from which we get the word pharmaceutical, is often translated as “poison,” “harmful drug,” or “magic potion.”
(Please forgive my poor Greek. I don’t actually speak this language. But then, neither do the vast majority of people, which is why they don’t know what the words psychiatry and pharmacy actually mean.)
Thankfully, we are well past that. Using science based on a philosophy devoid of anything spiritual and immaterial, we have developed treatments that have proven to be ineffective and dangerous, and are changing and, in many cases, destroying lives. But such articles as that of Dr. Luhrmann’s are anachronistic and a throwback to those earlier days of faith and respect of the human person, and they may dissipate the present stigma. Why would the New York Times do this? It is really disturbing that we still live in an age where the stigma of mental illness and the lack of uh, sort of, uh, uh, interest in trying to present real science, as it deserves and needs to be for an informed public, is threatened by this kind of journalistic optimism.
I think that Dr. Luhrmann needs to be less thoughtful. Debate is to be discouraged and this is debate. This is not based on our broken holy peer-review system, which we’ve tried to reform, but remains just as, if not more, broken. It is useless and confusing at best and destructive at worst. I see very few scientiﬁcally grounded articles about psychiatry, whether in terms of mental health policy and services, or in terms of new ﬁndings, that are leading to better understanding and treatments in mental illness being printed in these journals. Instead, I see research funded by, and biased towards, the pharmaceutical and other such industries. At the very least, I would like to see a more balanced research approach.
I also see news reports on the violence that occurs with mass killings or other sensationalistic stories, which always seems to mention that the perpetrators of these acts are on antipsychotic medication and receiving psychiatric care.
Finally, when Dr. Jeffrey Lieberman read this article, disappointed and annoyed as he was, he tried to write a serious, responsible, and constructive letter to the editor, which he submitted within 24 hours. After 72 hours had elapsed since the article’s publication, he hadn’t heard from the Times about their interest in publishing his response. So he made a video on Medscape11 because nobody else would publish it. The name that he publishes under is his own and his credentials are the Chairman of Psychiatry, Columbia University College of Physicians and Surgeons, one of the leading departments of psychiatry in the country, past president of the APA (American Psychiatric Association), and author of the book for the laity released this last March 10th called Shrinks: The Untold Story of Psychiatry, available on Amazon, Barnes & Noble, and wherever books are normally sold.
Since Dr. Lieberman was not receiving the respect he deserves, I decided to make this address to reafﬁrm his address on Medscape12. I give him full credit for most of the words in my address and have only made minor edits and additions to correct any misinformation and omissions. I sometimes publish under my own name, but not this time. My credentials are the Research Chairman at the NAPI (New Atlantis Psychiatric Institute) at the UU (Utopian University), present president of the APA (Atlantian Psychiatric Association), and author of the forth coming book for all you laymen called: Shrink Rap: The Untied Story of Psychiatry.
We are good examples of our profession and demonstrates the necessary dedication needed to obtain the credentials for the never respected profession of psychiatry, as is evident in both of our books.
Thank you for your attention. This is Dr. Stephen Normal, Utopian University, speaking to you today for the escaped.
1 January 17, 2015
2 Luhrmann TE. Redefining mental illness. The New York Times. January 17, 2015. http://www.nytimes.com/2015/01/18/opinion/sunday/t-m-luhrmann-redefining-mental-illness.html?_r=0 Accessed January 23, 2015.
3 Cooke A. Understanding Psychosis and Schizophrenia. Leicester, UK: The British Psychological Society; 2014. http://www.bps.org.uk/networks-and-communities/member-microsite/division-clinical-psychology/understanding-psychosis-and-schizophrenia Accessed January 23, 2015.
4 Cooke A. Understanding Psychosis and Schizophrenia. Leicester, UK: The British Psychological Society; 2014. http://www.bps.org.uk/networks-and-communities/member-microsite/division-clinical-psychology/understanding-psychosis-and-schizophrenia Accessed January 23, 2015.
5 The philosophical school of Phenomenology was founded in the early 20th century by Edmund Husserl.
6 Luhrmann TE. Redefining mental illness. The New York Times. January 17, 2015. http://www.nytimes.com/2015/01/18/opinion/sunday/t-m-luhrmann-redefining-mental-illness.html?_r=0 Accessed January 23, 2015.
7 Lieberman JA. Medscape Psychiatry > Lieberman on Psychiatry. What Does the New York Times Have Against Psychiatry? February 18, 2015. http://www.medscape.com/viewarticle/838764 Accessed February 21, 2015.
8 Insel T. Directors Blog: Transforming diagnoses. National Institute of Mental Health. April 29, 2013. http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml. Accessed January 23, 2015.
9 Insel TR, Lieberman JA. DSM-5 and RDoC: shared interests. National Institute of Mental Health Press Release. May 13, 2013. http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml Accessed January 23, 2015.
10 i.e. the Latin idiota and the Greek ἰδιώτης. e.g. Saints Peter and John were described as idiots in Acts 4:13.
11 Lieberman JA. Medscape Psychiatry > Lieberman on Psychiatry. What Does the New York Times Have Against Psychiatry? February 18, 2015. http://www.medscape.com/viewarticle/838764 Accessed February 21, 2015.
12 Lieberman JA. Medscape Psychiatry > Lieberman on Psychiatry. What Does the New York Times Have Against Psychiatry? February 18, 2015. http://www.medscape.com/viewarticle/838764 Accessed February 21, 2015.