Ronald Pies’ Response to Criticism

Kermit Cole
12
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Saying that he had been “unclear”, Ronald Pies, whose letter to the NY Times Sunday Dialogue occasioned much response therein and herein, goes on to say that “many comments in the blogosphere ranged from the dismissive to the abusive. Predictably, some critics trotted out the old war horses of anti-psychiatry… psychiatry is not ‘scientific,’ because it doesn’t have verifiable laboratory tests or biomarkers for its disorders; psychiatric diagnoses are just the ‘subjective impressions’ of the clinician; psychiatry amounts to ‘totalitarian oppression,’ etc.”

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected]

12 COMMENTS

  1. “… many comments in the blogosphere ranged from the dismissive to the abusive.… These canards and slurs have been addressed in many other contexts…” – Ronald Pies

    No! This is… unimaginable! Unprecedented! An almost-unbelievable episode shattering our faith in the fair exchange of views over networked media in a calm manner veritably bathed in the spirit of equanimity and compassion!

    … Dude, it’s the Internet. Posturing as Rip van Shrinkle is not going to win any credibility with anybody who’s spent more than 10 minutes involved with the blogwars, OK?

    *sigh*

    Sadly, I can’t leave a comment on the article because I am not a “qualified health professional”. Mostly, I would note that psychiatric would have a better reputation if its practioners would stick with the facts when they’re making diagnoses and offering testimony in court, and if they were met with stern measures – when they fail to do so – to guarantee that diagnostic criteria (imperfect as they may be) are at least applied HONESTLY.

    Sincerely,
    – bonzie anne

  2. I almost commented, but couldn’t bring myself to become a “member” of the Psychiatric Times. Of course, he resorts to the usual approach of stating his conclusions with no evidence, and engaging in ad hominem attacks on his detractors. He didn’t even address Moffic’s comment, which hardly even qualifies as critical. And his view of what the “average psychiatrist” does in his office is tremendously distorted! I am always stunned when a psychiatrist shows the slightest interest in the context of a person’s “symptoms,” and more so if they show any inclination to explore the client’s worldview, because the first is very rare, and the second almost never happens.

    Arrogance and ignorance don’t mix well…

    —- Steve

  3. I forwarded to Ron Pies my letter to the NY Times with my own experience but he never replied back. I wanted to post it in the comments section of the above article but I would have had to “lie” and identify myself as a mental health professional. Not worth it.

    Needless to say, people like him do what they know best: when they are unable to argue on the substance, they argue the semantics and they hide behind safe firewalls where they know that their nonsense will go unchallenged.

  4. Does Ronald Pies really consider himself abused by comments made by folks online? I really resent when professionals have or feign such sensitivity, but then when patients demonstrate such sensitivity to coercive power or abuse (which I’ll define as “is the improper usage or treatment for a bad purpose, often to unfairly or improperly gain benefit”), it is often used as a criterion to meeting a threshold to diagnosis that compounds that abuse.

  5. Health industry group: Replace psychiatrists with vending machines
    Measure to reduce health care costs

    1 April 2013 Health Insurance Times (Dubuque, Iowa) A health care industry thinktank, US Health Insurance Consortium on Cost, advocates replacing psychiatrists and other doctors with vending machines to prescribe and dispense antidepressants.

    “We believe this will cut the cost of psychiatric services significantly,” Uli Arnowsky, spokesperson for USHICost, said. “Our studies show the diagnosis and prescription process can be automated, with no loss in quality of care. Specialist costs are just not necessary for this type of treatment, and psychiatrists are overworked anyway.”

    USHICost’s plan is to make the Psychiatric Diagnostic Screening Questionnaire (PDSQ), based on the new diagnostic manual DSM-5, available online to health plan members. Answers would be captured in a database and analyzed to produce a recommendation for a prescription. A psychiatric nurse reviews the recommendations and authorizes the prescription, which is then attached to the patient’s database record.

    Vending machines, in convenient medical center locations and on a secure network, would be stocked with the most common generic antidepressants.

    “We prefer the generics,” Arnowsky said. “They’re part of the cost-cutting. Our studies show they’re just as effective as the name-brand drugs.”

    According to Arnowsky, to get a prescription filled, a patient would input a health plan ID and a password at a vending machine. The machine would look in the database, dispense the authorized prescription, and charge the copay to a credit card on file in the patient’s health plan record.

    “We really like the way this system keeps electronic medical records, too,” Aronowsky said. “It’s a win-win-win for all concerned.”

    Patients reporting side effects would be advised to see their doctors, who could then adjust the prescription if needed.

    “There’s a lot of trial and error in prescribing antidepressants already,” he said. “This system is no more error-prone than present prescribing practices. In fact, we put fuzzy logic in the system to rotate prescriptions among the antidepressants, because we’ve found doctors prescribe them in an almost random fashion. We built the human element right into the system — it thinks just like a doctor about these drugs.”

    He stated that USHICost’s studies had shown diagnosis by PDSQ was at least as accurate as by doctors, including psychiatrists. “This will take a big burden off primary care physicians, too, who are bearing the brunt of prescribing antidepressants,” he noted.

  6. Madness, Please be careful because I don’t want you outed from the web site.

    I think you made some very wise observations about how psychiatry invalidates what their so called patients say when stigmatizing and drugging them. Then, the so called treated victim is either sane or insane, free or unfree depending on whether they agree with their abuser, tormenter with total power over them.

    As you point out, using anecdotes from such psychiatric slaves robbed of even freedom of speech by their tormentor jailers to pretend that some of their patients prove that treatment works because they are forced to agree with the bully to escape him/her and some prove that their so called mental illness prevents them from seeing they need a bogus, life destroying stigma and poison drugs to make their horrific environmental stressors all the worse. This takes lots of gaul, which psychiatry has in abundance.

    Here’s an article about how family LABELLING can cause lifelong feuds I thought was pretty funny plus it shows what lifelong labeling can do to individuals, families and societies. Since you seem to have a good sense of humor, what do you think, Madness?

    FAMILY LABELS GIVE BIRTH TO LIFELONG FEUDS by Robert Chipkin

    When my Aunt Rhoda was born in the first decade of the last century to a family of immigrants on the lower East Side of New York, she was unofficially christened the “baby” and she has stayed that way for the last 87 years. Such early labeling was not unusual. A few years earlier, my Uncle Milton had suffered a scary bout of scarlet fever as a child and was declared frail for every second thereafter until he finally reached the hereafter nine decades later.

    Ditto, my Uncle Lou, the athlete; and my Uncle Sid, the smart cookie (which was quite a bit different from being smart, implying a knowledge of the ways of the world, at times bordering on the criminal). Some years after her ordination as “the baby” but still below the age of potty training, “the baby” added the title of “the beauty” to her family resume, the way British royalty acquire Dukedoms. This was probably about the time my father, two streets over, was dubbed “the student,” based largely on his nearsightedness. This was enough to spare him a future in the soda water business and deposit him squarely on the road to medical school.

    The point, which has been instinctively known by every dictator from the pigs of “Animal Farm” to the Fuhrer himself, being that if you say something early enough and often enough, it acquires the ring of truth.

    In modern times, this immigrant notion was given an aura of respectability by brain mapping. It has also been dressed up nicely in the clothes of child psychology to become gospel to an uneasy generation of baby boom parents who seemed to need manuals and talk show experts to raise their children.

    So in a family where one child is a good student, another becomes the athlete. An introvert will find herself sister to the belle of the ball and one brother will be born seemingly knowing how to clean a carburetor while the other won’t know what a carburetor is even after overpaying mechanics to unclog them all his automotive life.

    To be kind, it’s not exactly that parents consciously label their children, only that the labels are so available that it is a rare parent who can avoid them as they rush their children out the door to piano lessons, baseball practice, or dance school.

    The odd thing, of course, is that even when the labels bump into a cold dose of reality, they still seem to stick. So it is possible for one sister to be the beauty while the other, the practical one even as the years prove them to look pretty much alike and making about the same number of foolish choices. Children grow up and shed their labels in every way that matters to the outside world only to re-acquire them instantly the moment they once again share the same roof for more than a weekend.

    I notice this again recently when we attend a family reunion on my wife’s side to find her five great-aunts bickering and jockeying for family position in a way that would make a toddler blush.

    “You go first,” said one to the other in mock politeness as they waited in line for hot dogs at a barbecue in which the kebab was far from the only thing being skewered. “Age before beauty.”

    “First of all” said the elder, “you are only 18 months younger than I, which, since we are both now over 80, turns out to make you less than 2 percent my junior. I’m quite confident my nose job, eye tuck and some recent ‘work,’ which I am too much of a lady to mention, is enough to vault me past you in the beauty department. So, please, you go first.”

    “Isn’t she the Brainiac,” said the third. “You should have seen her in third grade, always at the top of her class. Why, I remember the year she won first place in penmanship.”

    “As if penmanship required any brains,” said the fourth. “Don’t you know she got that award because one of the nuns felt sorry for her. Everyone knows that when a nun tells a student she has good penmanship it is her way of saying she’s not too bright.”

    “Now, that’s not a very nice thing to say,” said the first, rising to her sister’s defense. “I’m sure that if the nun gave her the award for penmanship it wasn’t out of pity.”

    “Because pity was in such short supply in our school?” said the beauty.

    “Because the nuns were never wrong. Once they decided who you were; that’s who you stayed. Like the year I won ‘Miss Popularity.’

    “Which probably explains your four marriages. I doubt the nuns would have been inclined to call you ‘Miss Slutty.’”

    “Now, now girls,” said the middle aunt who had always taken on the role of peace maker. “Can’t we get along for one afternoon, and enjoy the barbecue? Here, try some of my homemade beans. The recipe came straight from mama.”

    “As if you could cook,” came a chorus so uncharitable that it was now impossible to tell which aunt was talking. “You only got the recipe for beans because you couldn’t be trusted with anything else.”

    Finally my wife jumped in.

    “Please. Everything you’re saying happened long ago and anyone who gave you those labels is long dead. But we’re right here, right now and together for one afternoon. Can’t we forget about the labels for once and just accept each other the way you are?”

    “I suppose we could,” said the family matriarch. “But what kind of family gathering would that be?” 

    • Just for the record, in keeping with Matt’s understanding that subversive humor can help when trying to change oppressive systems, I thought this article on family “labeling” was in keeping with the subject of DSM labels that cling to individuals for life while it was a light and humorous approach to the subject that shared human foibles typical of all of us.

      It was my further hope that such a light hearted article would help us to keep our spirits up despite the very depressing, discouraging news that has been coming our way in droves lately.

  7. There is no dialogue in being so blatantly dismissive of views that don’t support your own. I don’t know about the New York Times, but obviously, Ronald Pies, chief editor of Psychiatric Times, was not really inviting people to dialogue.

    Any thorough going criticism of the present DSM revision process as a whole is shuttled off as illegitimately belonging to those “old war horses of anti-psychiatry”. He confuses honest criticism and difference of opinion with antipathy and ill will. “I won’t belabour their fallacious assumptions”, he says.

    I say, please, if fallacies are involved, indicate what those fallacies are. I hardy think Dr. Pies above error himself, and I’d like for him to permit the expression of differences of opinion rather than stifling them with the suggestion of some kind of ultimate methodological superiority on his own part.

    A genuine dialogue involves discourse between individuals on a subject involving many different opinions and perspectives. Dr. Pies should have warned us in advance that this was not the kind of discussion he intended for us to have. He would have preferred some kind of conversation between people who were more or less in agreement with everything he said.

    Let this one-sided conversation serve as an object lesson for those of us in pursuit of genuine dialogue. Sometimes dialogue is a euphemism for choir duty in the Church of Biological Psychiatry of which many of us are either not members or disbelievers. If you are of another denomination, hold your tongue. You are only going to be disparaged, if not ignored, by your “host”.

  8. How absolutely infuriating that Pies has taken his ‘dialogue’ to a realm where most of us can only read, and not reply. As one of the responders who got published and was summarily dismissed in less than one line by Mr. Pies, I’m itching to re-join this dialogue with him. How ironic that he chooses to offer up his thoughts about my and the many other responses he received about psychiatry – to defend its person centeredness, its goodness, its not being an abuse of power – in a place where the only way to have a voice is to be a psychiatrist…

    And for those of you who are wondering about signing up in order to respond… I tried that! (I respect that some of you aren’t willing to lie that you’re a ‘healthcare provider’ just to get access, but I was willing!) Doesn’t work. At least, it didn’t work on my first try. I believe you actually need to be a doctor with a license number to enter in order to ‘pass,’ and be worthy of a voice.

    Honestly, simply by choosing that forum, Pies goes some of the distance to proving my points about diagnosis, the psychiatric system and the power issues involved with it all.

    Thanks, Pies.

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