Psychiatrists who’ve been irritated by decades of criticism and insults from anti-psychiatry coalitions can be excused for savoring recent press coverage of the American Psychological Association’s colossal cock-up (APA). The psychologists’ professional association recently released the findings of an independent investigation that vindicated Jean Arrigo, Stephen Soldz, Steven Reisner and the Coalition for an Ethical Psychology. They’d been whistle-blowing about prominent APA members colluding with government agencies that torture captives, and about high-level APA employees covering it up. Dr. Arrigo in particular endured some pretty nasty recriminations for her persistence, and her guts.
The director of APA’s ethics office, who, according to then-COO Michael Honaker, was hired to take ethics education beyond the primitive practice of “punishing people after they get in trouble,” got in trouble and was punished with loss of employment. Michael Honaker and two others were fired or resigned.
For once, psychiatrists looked like the good guys, but not for long. I’m afraid my houseguest, warthog and ethologist Dr. Evie, is as good at digging up information as she is at digging up gardens. She found some documents online that suggest a former president of the other APA, the American Psychiatric Association, is an advocate of physical interventions considered inhuman and degrading not only by the United Nations’ Special Rapporteur on Torture, but by the New York Police Department.
Dr. Evie nothing if not bold, so she emailed him to find out if he was willing to discuss her finds. She didn’t hear back, but she did run into him yesterday after a talk she gave at the New School. She says he took off like a wildebeest, noting a surprising fact: wildebeest are faster than gazelle. She gave chase, but only as far as a loading dock from which she saw him leap (almost exactly as a wildebeest would, she said).
Upon landing, the panicked pill proponent hailed a northbound cab, and within 15 minutes he’d found and blocked her on Facebook, Instagram, Pinterest, Tumblr, Snap Chat, MySpace, Disqus, AIM and Twitter. In the same 15 minute period, Dr. Evie texted one of her oldest friends, a Xhosa sangoma, a shaman of South Africa’s Xhosa people, and asked that J. A. Lieberman’s spirit be compelled to talk with her on Skype while his body slept that night. Knowing her fine character, the sangoma agreed to make it happen without feeling the need to ask any questions.
What follows strains credulity, but I was there. We saw something in Dr. Evie’s Skype window. It looked like the prodromal migraine symptom, scintillating scotoma, but in the shape of a popsicle, or a corn dog on a stick. Maybe it was her monitor, but she’s had no problems with it before or since. In any case, something was typing. Here’s the transcript from the Skype session that night. I hope the humble shrink doesn’t deny it happened.
[Skype alert is heard, indicating an incoming call]
Dr. Evie: Evie Sounder. Is that Jeff Lieberman?
Migraine Aura: Jeffrey. What am I doing?
Dr. Evie: Hi Jeffrey. Evie Sounder. I’m editor-at-large for ExaminingMedicine.com, and I wanted to talk to you about your public image, and torture.
Migraine Aura: Those are both fine with me. But this wasn’t on my calendar.
Dr. Evie: Well, we’re here, so why not get started? [shares her screen]
Dr. Evie: People seem to really hate you. I certainly do. Do you know why that is?
Migraine Aura: That’s the stupidest thing I’ve ever heard anyone say. I’m not going to answer it. Ask a serious question.
Dr. Edie: It was a serious question.
Migraine Aura: There are some mentally ill people in need of treatment that reach out to prominent medical doctors and scientists for help on Twitter and elsewhere. It’s very sad but those tweets don’t mean anything. Like your uninformed talk about mental illness in zoo animals.
Dr. Evie: You missed the point of my talk, and like the worst psychiatrists, locate the problem in the patient. If there’s any pathology in zoos it arises from confinement and controlled lives. Back to your public image, though. Nelllie searched for comments made about Eric Kandel and Danny Kahneman on Twitter. They don’t look like yours.
Migraine Aura: Kahnemann’s an economist, and that last Tweet was you. So what.
Dr. Evie: I’m not the only warthog on Twitter, and the last Tweet is correct. Solomon isn’t qualified to write about medicine. Even psychology’s a stretch, given where he got his degree. Two of the patients whose stories he told were in acute antidepressant withdrawal, not relapse, and of them one was obviously bipolar. He didn’t mention her heavy drinking, though it’s front and center when he discusses her in his book. He downplayed the uncontroversial risks of antidepressants in pregnancy and didn’t address newborns’ forced withdrawal from whatever the mother was taking. Your bosom buddy thinks this is a way to start life?
Withdrawal symptoms occurred in a male neonate after maternal use of venlafaxine for depression during pregnancy. The symptoms were restlessness, hypertonia, jitteriness, irritability and poor feeding*. The diagnosis was confirmed by a temporary improvement after administration of a low dose of venlafaxine to the boy. Eventually the symptoms began to decline spontaneously, and ceased after 8 days.
*Hypertonia is an abnormal increase in muscle tension caused by injury to motor pathways in the central nervous system.
Migraine Aura: Whatever.
Dr. Evie: You and Solomon seem to be great friends now. Is that why he has a faculty position is Columbia’s medical school?
Migraine Aura: His father got it for him.
Dr. Evie: I hope you’re kidding. Moving on, here’s a question from one of my graduate students. She wants to know if your next book will cover the Ritalin studies you carried out on first-episode psychosis patients. Bruce Levine wrote about it for Alternet.org in May.
Migraine Aura: Bruce Levine can shove it. He’s a psychologist, not a scientist. He got it wrong because he has no idea what he’s talking about. I’m open to discussion but not with an idiot.
Dr. Evie: I’ll let him know. Meanwhile, why did you inject in-patients as young as 14 with Ritalin when they’d just come down from a first psychotic episode? Is that really the time to increase their distress?
Migraine Aura: To see what would happen, whether their reactions would predict who’d relapse first. Of course it was just a matter of when. They all relapse when they’re not on an appropriate medication–Risperdal in those studies.
Dr. Evie: I’m no champion of chemical straightjackets, but are you saying you deprived traumatized young people of a tranquilizer and shot them up with a central nervous system stimulant?
Migraine Aura: Yes, in that order. We found that subjects who showed the most dyskinesia before the Ritalin had the strongest reaction to it, in terms of motor activity, and indeed relapsed earlier than the others. We replicated it three times, I believe.
Dr. Evie: That wasn’t even an experiment, and you could have done it without the Ritalin.
Migraine Aura: Yes, of course. It was easy enough to predict outcomes from symptom severity at baseline. But we wouldn’t have got funding or published anything without the Ritalin. You probably don’t understand. You’re thinking of applied research, like making a better mousetrap or a better antipsychotic. If scientists had to worry about making things better, none of us would get tenure. I’d like to talk about my book now.
Dr. Evie: Sure. Everyone I know says it was facile, sloppy, wrong in many places, biased, and self-promoting. You get that a lot, don’t you?
Migraine Aura: I’d like to see the proof of that. I’ve read all the reviews, in some cases before they went to press. The New York Times review alone bumped my Amazon rank 14% closer to the top.
Dr. Evie: Your book sucks, Jeffrey. One of my most astute Twitter followers said it’s #12,500 on Amazon. Apparently there are people who aren’t interested in you or your weird job — in particular, our readership. Correction–that was weeks ago. Nellie just checked, and it’s #61,704. [Ed.: On August 16, 2016 the $12.00 paperback was was #306,084; Robert Whitaker and Lisa Cosgrove’s Psychiatry Under the Influence, $34.00 in paperback, was #190,839.]
Migraine Aura: You’re antipsychiatry, aren’t you? You’re attacking me for writing an engaging and accessible pop history, and I bet you’ve never written a book. What are you? Professional Hog-hugger? Warthog-whisperer? You’re not qualified to hold an opinion on my field. Would you mind interviewing me like a scholar?
Dr. Evie: If Shrinks were a scholarly work, I would. But like everything you say in public, it’s your hollow opinion resting on a cloud of hot air. Why don’t we get into torture now?
Migraine Aura: Now we’re on the same page. Behnke threatened legal action? Moron. When you’re changing a code of ethics to allow torture and you’re going to lie about it later, you allow lying while you’re at it. The best one is Seligman, though. He wouldn’t talk to them. Had to do it all by email. He’s been a prick since 1966–
Dr. Evie: Excuse me. Jeffrey. That’s not what I meant to discuss. It’s this: on December 9, 2013, you, Dr. Saul Levin, and Dr. Pedro Ruiz wrote to the United Nations’ Special Rapporteur on Torture about his position paper on the rights of the disabled. You expressed great concern about his definition of torture because it encompassed practices psychiatrists use. You provided a paragraph-by-paragraph response to the paper, a list of recommendations, and a list of the American Psychiatric Association’s relevant position statements.
Migraine Aura: Did you say 2003?
Dr. Evie: No, I didn’t. The Special Rapporteur’s report states that medical necessity cannot be invoked to legitimate or justify any violation of the terms of the Convention on the Rights of Persons with Disabilities, whether through coercion or discrimination. Do you recall your response to that?
Migraine Aura: This is, of course, very…very interesting, but I don’t think we really sent that letter. It was a joke, a goof. This is quite remarkable…Did I sign it? I’ll have to call Saul…
Dr. Evie: Yes, do…call Saul. So, you said “medical necessity is a cornerstone of insuring that involuntary treatment is used only when appropriate.” Would you like me to translate that for you?
Migraine Aura: No. I explained it to Saul and Pedro. If I say it’s necessary, it’s also appropriate, and if it’s appropriate, I can restrain or sedate the patient and perform the treatment.
Dr. Evie: Let’s say I accepted that logic. Define medical necessity, and good luck. Do you know anything about the Special Rapporteur? Juan Mendez was an attorney in Argentina who represented political prisoners until he became one. The Argentine military detained and tortured him for 18 months. Amnesty International declared him a Prisoner of Conscience. He made it to safety in the United States in 1977. Do you think he’s going to bend laws whose meaning was carved into his flesh for a year and a half so American psychiatrists can do anything they like to anyone they arbitrarily deem mentally incompetent?
Migraine Aura: You have me all wrong. I’m not Dr. Establishment. I took LSD in the 60s. I’m a humble scientist. That’s why I study the brain, and it’s why I experimented on mentally ill teenagers–to get as many Americans into treatment as I can. I’m on Twitter every day to educate and enlighten. I try to reach Americans with mental illnesses, some of whom might not even know they’re mentally ill, and that’s true in 50% of cases. I want the 40% of Americans who are mentally ill, half of whom have no idea how much they are suffering, to be treated.
That’s why I wrote to Mr. Valdez. If Juan Valdez suffers from a personality disorder, for instance – and there might be some narcissism there, some attention-seeking, in defending political prisoners despite the risks – if he has any anxieties or difficulty sleeping, related to his, uh, experiences, I would recommend a treatment. I’m not just a scientist. I’m a doctor.
Dr. Evie: I don’t suppose you read Mr. Mendez’s response? It’s elegant and incisive – a very nice piece of writing. You know that he finds you ridiculous, don’t you? He as much as says the APA’s policies, in the context of loosely-enforced public protection laws, mean this country, thanks to authoritarians like you, abuses disabled people and violates human rights.
Migraine Aura: Can you email me a copy of that?
Dr. Evie: I’ll be sending you a binder, because there’s more. Remember New York Times, 1987? Nice dose of racism at the end, too. Yes, I added the photo, but you wrote the letter.
Dr. Evie: Still conscious, scintillating corn dog? Here’s the late Commissioner’s reply, again with a photo I added. Your goose is cooked.
Migraine Aura: At least you admit your goal is to destroy me. It’s because I work with mental illness and mental illness is stigmatized. No one tries to destroy cardiologists.
Dr. Evie: Tell that to Lisa Rosenbaum, the cardiologist whose dots have been nicely re-connected in recent –
[Skype alert is heard, indicating that the other party ended the call]
That was all we got from the scintillating corndog that night.