Monday, July 25, 2011

McMan's First Annual (Or Whenever) Psychiatric Exasperater Awards

One of the things I love about my job is the challenge of chasing a moving target. There are no certainties. Every idea is on the table. In place of what we now call psychiatry, a whole new science of the mind is beginning to emerge. A quick scroll through my blog pieces over the last year reveals just a small sample of highly dedicated scientists who are are changing the way we think:

Jill Bolte Taylor, Nora Volkow, Husseini Manji, Hagop Akiskal, Marsha Linehan, Fred Gage, David Braff, Nancy Andreasen ...

Likewise, hats off to the authors and commentators and film-makers who connect the dots and challenge us to connect our own: Robert Whitaker, Pete Earley, John Gartner, Jonah Lehrer, Katie Cadigan ...

Not to mention some of my favorite bloggers: Therese Borchard, Willa Goodfellow, Gina Pera ...

Plus no end of the unsung, those in the trenches, responding to the call, refusing to take no for an answer, rolling up their sleeves and doing - doing, doing ...

But scroll through my recent blog pieces and you will also encounter a number of individuals I have felt duty-bound to call out for their flagrant violation of the facts. Spirited and even heated discussion has a way of moving the conversation forward, but only when the facts are honored. In some strange and ineffable way, we move closer to an ever-elusive truth. Humanity is served.

The individuals I have singled only seem to serve themselves. Coincidentally, these individuals happen to be psychiatrists. So, without further ado, my first annual (or whenever) Psychiatric Exasperater Awards ...

Andrew Nierenberg

Earlier this year, Andrew Nierenberg, professor of psychiatry at Harvard and a prominent researcher into mood disorders, purported to “repudiate” and “refute” compelling evidence raised against indiscriminate use of antidepressants and antipsychotics by Robert Whitaker, author of “Anatomy of an Epidemic.”

Had Dr Nierenberg accomplished but one one-hundredth of his stated mission, I would have thanked him for profusely for adding his learned voice to a badly needed dialogue. Instead, Nierenberg - obviously without having even read Whitaker’s book - resorted to ad hominem attacks (comparing Whitaker, whom he referred to as “ignorant,” to Sarah Palin), faulty marshaling of facts (such as misrepresenting one key study as “retrospective” when it was in fact prospective), and a very sick attempt at humor (such as showing a slide with a fake insulting black box warning appended to Whitaker’s book).

In the end, the only thing that Nierenberg proved was his own intellectual bankruptcy. As for Whitaker, we are still awaiting a credible response from someone with an MD.

(See Whitaker vs Quack Psychiatry - Part II.)

Peter Kramer

Earlier this month, Peter Kramer, clinical professor of psychiatry and human behavior at Brown University, published an article in the NY Times, entitled “In Defense of Antidepressants.” Dr Kramer is author of the 1993 “Listening to Prozac,” the product of a far more credulous age when researchers and clinicians and patients alike believed in miracle treatments for illnesses we actually still know next to nothing about.

In his article, Dr Kramer presumed to respond to an uncontradicted scientific study with his own speculation. Just that - speculation, no facts, no science. Moreover, Dr Kramer willfully ignored both the leading real-world clinical trial that cast considerable doubt on treating depressed patients like guinea pigs, as well as very strong evidence of the very harmful effects of prescribing antidepressants to substantial portions of the population.

We would all benefit enormously from an intelligent discourse on when and when not to use antidepressants. On that vital point, Dr Kramer had nothing to contribute. Instead, in defiance of both reality and “first do no harm,” Dr Kramer would have the general public believe it is still 1993.

(See Peter Kramer and Antidepressants - Oy!)

Stuart Kaplan

The June 19 Newsweek contained an article by Stuart Kaplan, clinical professor of psychiatry at Penn State. The article - “Mommy, Am I Really Bipolar?” - is adapted from his new book, “Your Child Does Not Have Bipolar Disorder.” Asserted Kaplan: “There is no scientific evidence to support the belief that bipolar disorder surfaces in childhood.”

Except, of course, for a whole bunch of kids who cycle in and out of depression and mania.

Well, no, says Kaplan. These kids are really ADHD or oppositionally defiant. Or have something called “temper dysregulation disorder.” Anything but bipolar. The following flat-out misstatement screams for the return of the Star Chamber: “The description of childhood bipolar disorder by its advocates is dramatically different [from adult bipolar].”

No it’s not.

Had Dr Kaplan stuck to the facts, he could have assisted us in our understanding of how best to improve the lives of kids in obvious distress, not to mention their families. Instead, by dogmatically clinging to an absolutist position, Dr Kaplan came across as the head cheer-leader in an academic food fight. Unfortunately, this food fight involves the well-being of our children.

(See The Child Bipolar Diagnosis is Under Attack - Yet Again.)

Allen Frances

Reading Allen Frances on Psychology Today and the Psychiatric Times is as painful as viewing a painting by Thomas Kinkade. Dr Francis, professor emeritus at Duke University, headed up the DSM-IV of 1994. With the unveiling of the draft DSM-5 in Feb 2010, Dr Frances returned to the spotlight as its loudest and most inept critic.

Essentially, there are two Dr Frances - the one who fell in love with his 1994 opus and will brook no changes, and the one who feels he has sinned against humanity for his 1994 opus and likewise will brook no changes. In either case, his arguments come across as disordered and bizarre.

In citing numerous experts critical of DSM-5 changes, Dr Frances overlooks the obvious, namely that most of the problems faced by those working on the DSM-5 are the direct result of the Frances-led failures in bringing the DSM-IV into some kind of alignment with clinical reality back in 1994. The critics of the DSM-IV are justifiably legion. Not a peep from Dr Frances on this.

Dr Frances, by virtue of his elder statesman status, was in the enviable position of setting the tone for the debate, and thus informing us all on the challenges of taking diagnostic psychiatry into a new era. As it happened, intelligent expert commentary never materialized. Present and future generations of those seeking professional help will end up paying dearly.

(See The Dimensional Side to Personality.)

Final Word

With a major paradigm shift underway, we are living in an age of both inspiration and exasperation. The “inspirators,” though clearly the wave of the future, are by no means infallible - hence the need for spirited conversations. The “exasperaters” see themselves as guardians of the old paradigm and are often right a lot of the time, hence - again - the need for spirited conversations.

Unfortunately the exasperaters cited here add nothing to the conversation. To the contrary, they come across as authoritarian, anti-intellectual, and as maladaptive reactors to their changing environments. Hysterical reactionism is always a response to progress, which is good news. The bad news is that as the paradigm further shifts, we are likely to witness much more of this type of behavior.

Stay tuned for my next crop of annual awardees. I guarantee you won’t have to wait a year.


Addy Bell said...

I read "Mommy, Am I Really Bipolar?" and was just disgusted. His premise seemed to be that bipolar disorder doesn't exist in children because it's only a valid diagnosis for adults. Hmmm. Circular reasoning much?

I found the article to be a blatant, clumsy appeal to emotion. Sadly, that probably means his book, and his thesis, will get a ton of press badly distorting a conversation we really need to have as a society.

Tony the cretin said...

A balanced critique by an MD of Whitaker's book was given by Daniel Carlat on his blog. His book, "Unhinged" is a good critique of today's psychiatric practice.

John McManamy said...

Hey, Tony. Thanks for pointing this out. In Feb, I did do two blogs on Carlat's two blogs:

Carlat was mostly critical of Whitaker, but on solid grounds, and he strongly recommended Whitaker's book. I applauded Carlat as the beginning of a needed discussion. Carlat made many interesting points, but in two blogs the best one can do is the once-over-lightly treatment.

At least five blogs are required for an in-depth response. My initial output of blogs in response to Whitaker totaled 15. And I have done a lot more since. Plus his book inspired me to do other pieces on the topics he raised.

At a bipolar conference in Pittsburgh, I urged a prominent researcher - one who is strongly critical of antidepressants - to critique Whitaker. Whitaker certainly deserves a thoughtful and in-depth response. And if Whitaker is weighed and measured and found wanting, that's okay.

For right now, the best response we have is from Carlat, but it was only superficial and therefore, in my opinion, not credible.

Meanwhile, from the patient community, we get a lot of mindless hero-worship.

Funny thing about Whitaker, though. He keeps talking about the need for a dialogue. I know people have brought my blogs to his attention, but he has made no attempt to respond to the points I have made. Maybe he is enjoying the mindless hero-worship too much.

John McManamy said...

Hey, Tony. One more thing. I neglected to mention the anonymous author of the blog Ruminations on Madness did some in-depth and learned critiques on Whitaker. To my knowledge, besides myself this is the only in-depth critique of Whitaker and again it did not come from the medical profession.

John McManamy said...

Hey, Addy. Many thanks for validating my view. I am hesitant to criticize an author when I haven't read his book, but this was a clear case of the author exposing himself by virtue of his own words in an article he wrote in a prominent magazine. He can't exactly claim he was misquoted.

I would love to see him spout his crap face to face with the parents I've talked to. But you won't see these self-promoting quacks out in the real world.

Bi said...

Hi John,
I came across this article on the New Scientist website and am interested to see what your thoughts on it are.

John McManamy said...

Hey, Bi. Thanks for your interest. The New Scientist article came out around the same time as the Newsweek article, which meant I couldn't ignore the topic. So if you go to the bottom in my Scott Kaplan section of this blog post, you will see a link to my earlier piece, "The Child Bipolar Child Diagnosis is Under Attack - Yet Again."

In that piece, I spare no kind thoughts for author Jon Ronson. He is a respected journalist and author, but in this case he has seriously strayed from his journalistic principles.

Since this current article was about psychiatrists gone wild, I did not include him here. Should I do a hall of shame on journalists who disregard the facts, Ronson will be included.

Gina Pera said...


Congrats on nailing Frances perfectly!