No, that is not a grammatical error.
On March 18th, Ronald Pies, a psychiatrist based in Lexington, Massachusetts, wrote a letter to the New York Times. He argued in favor of the usefulness and harmlessness (when well used) of psychiatric diagnosis and wondered as to the misgivings so many seem to have toward this hallmark of his profession.
The Times invited its readership to participate in a dialogue by submitting responses to Pies’s piece. I have no idea how many replies were received, but Laura Delano, Paula Caplan, and I were among the relative few who managed to get our voices heard on the web and/or in print in the Sunday paper on March 24th. Pies had the last word, though. That last word was written when the Times afforded him the opportunity to respond to our replies in the same printing, and so concluded that particular dialogue. I suppose I should be pleased he acknowledged my letter in his reply, but he gave just two short sentences to my dispatchment, and as such, summarily disregarded so many years of pain and loss and abuse of power. You can read the whole exchange here.
Here’s the funniest part, though. As alluded to above, one of the central points to the 186 words I was so allotted was to speak to the power that is wrapped up in the process of diagnosis. As I stated in my recent post, Anti-Anti-Stigma, people regularly lose jobs, homes, children, health and freedom based on the process of diagnosis and what so often follows. Pies’s response? Well, basically, he claimed, “It’s not fair.” One could almost hear the stomping of his feet. Specifically, he said:
“Nor is it fair to blame psychiatric “labels” for the abridgment of civil liberties, as Ms. Davidow does. Psychiatrists, like all physicians, are governed by civil law and judicial oversight.”
What’s funny about that, you ask? Well, after being afforded the final word in the New York Times, Pies still wasn’t satisfied. No, he needed more ‘last words,’ and he apparently needed them to be largely uninterrupted. And so he left New York in favor of Psychiatric. Times, that is.
Apparently, Mr. Pies is the editor-in-chief of a publication called the Psychiatric Times. He posted, at length, about how his original letter had been misunderstood while essentially re-asserting the same points. But here’s where it really gets good. While one can sign up to read Mr. Pies’s article, one is not permitted to respond unless one is a (and I quote) ”qualified healthcare professional,” (which apparently must be proven by submission of one’s license number, amongst other details).
So funny (in a not so ‘ha ha’ sort of way) that he would dismiss my claims of power issues, and then flee at first opportunity to an arena where there is no denying the privilege afforded to those deemed doctor.
Is it so hard to understand how the power represented in the exclusivity of this domain and the obvious silencing of those not deemed worthy mirrors the power behind diagnosis and the structure of the whole psychiatric system?
Mr. Pies claims that psychiatrists are governed by law and judicial oversight. Yes, in theory; but theory is often where that ends. I worked in a provider role and I have seen many things I wish weren’t true. I have personally witnessed defense lawyers seeking conference with the ‘other side’’ in commitment hearings because they don’t regard the person they’re representing as competent and are seeking guidance from those they see as ‘the professionals.’ I have seen providers sit together in meetings and strategize on how to agitate someone to the point where they could argue for commitment to a short-term hospital as but step one in a broader plot to see them committed to a long-term one. I have known people’s parental rights to be called into question before they’ve even left the hospital with their new baby based primarily on the diagnoses written in their file. I have seen laws (like the Roger’s Order in Massachusetts) twisted and warped from their original forms to allow for dramatically increased latitude in sectioning people off to the hospital. I have seen police, providers and lawyers work together in ways not supported by law to coerce people in directions they would otherwise not go and in ways that would certainly earn them (at the very least) the label of ‘manipulative’ by any well-reasoned and objective onlooker. I have my own stories of trauma experienced in hospitals where I was sent when someone decided that – based on my diagnosis and instances of decidedly non-lethal self-injury – I needed to be committed ‘for my own good.’
No, the stories I speak of do not come from just one small circle of deranged professionals lurking in the shadows of an otherwise well-functioning system. These stories hail from multiple states with multiple providers and multiple hospitals. There is story upon story upon story to be heard of how power has been abused. And, why? Although it is surely more complex than just this, much of it goes back to labels. One is labeled with psychiatric diagnosis and the other is labeled with a medical degree and initials after their name. Perhaps what is most telling is that when I recount these things I’ve seen, most people who have been diagnosed, hospitalized, etc… Well, they’re not surprised.
No, I am not suggesting that these abuses happen to everyone, but they happen enough and without notice or apparent recourse to suggest a real problem about how our society regards those who have been diagnosed. No, I am not suggesting that all people who work in provider roles are power hungry and abusive. More often than not, they are well intended and just as misguided as most everyone else. Largely, they don’t even see the power they are wielding; and if they do, they consider it benevolent.
So, again, how strange, that Mr. Pies should take his debate to a place where his power rings with such clarity as to silence us all. And so I conclude with a personal invitation:
Dear Mr. Pies,
I would like to issue you an invitation to join in a real dialogue. This will be one where we are limited not by numbers of words and frequency of reply, nor by our respective titles and licensure (or lack thereof). Join me – us – here on this blog on Mad in America where anyone is free to comment.
Until then, if you have genuinely good intent –- or any sense of irony -– please speak no more about the benevolence of psychiatry or the process of diagnosis.
I hope to see you here soon.
Copied to Ronald Pies at his Suny e-mail address on Wednesday, April 10, 2013 at 9:17 pm
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
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