Lancet: Let’s Stop Fighting, Assume the Best about Psychiatrists’ Intentions


If there is one downside to the field of mental health, declares an editorial in The Lancet Psychiatry, “it is the failure of pleasant, intelligent, and thoughtful individuals to find any common ground in debate, and the subsequent descent of such discussions into bitter, and frequently personal, acrimony.” The editorial cites a comment thread in The Conversation that included Michael O’Donovan, a co-author of the recent high-profile schizophrenia-gene study, the University of Liverpool’s David Pilgrim, and MIA Foreign Correspondent Joanna Moncrieff.

“[T]oo often in mental health, one sees not the engagement of minds, but the performance of immutable opinions. Views are not so much diametrically opposed as existing in different dimensions,” says the Lancet editorial. “To take one example, the recent Nature paper ‘Biological insights from 108 schizophrenia-associated genetic loci’ was accompanied by a blog in which Prof Michael O’Donovan, one of the authors, set out the basic principles of the study and what he saw as the benefits… The discussion that followed publication of this blog was less about the finer points of Prof O’Donovan’s research, and more about whether he and his colleagues should have bothered in the first place.”

The editorial writer complains that Pilgrim made inflammatory links between psychiatry, gene studies, eugenics and Nazism. The writer calls such remarks from Pilgrim “below-the-line comments.”

In the original comment thread Pilgrim wrote, “Science is not politically neutral but always reveals a history of economic and ideological interests (in this case including the professional interests of psychiatry as a fragile and fragmenting medical specialty). Playing the open minded disinterested scientist role fools some of the people all of the time but not all of us all of the time. Being frank about vested interests in relation to biological studies of ‘schizophrenia’ takes us inevitably back to 19th century eugenics, a respectable movement across the political spectrum until Nazism gave it a bad name. (In 1988 the British Eugenics Society euphemised its facade by adopting the name of the Galton Society). This is not a slur — just history.”

The Lancet editorial does not comment on any of those points. However, the editorial writer makes various suggestions for improving community dialogue in the mental health field. “The first is to assume the best of one’s opponent: that their argument proceeds not from self-interest, financial interest, or wilful ignorance, but from genuine curiosity and a desire to improve the lives of people with mental health problems.”

The editorial writer acknowledges that, “There is always potential in the discussion of mental health issues to trigger distress, as everyone, patient or professional, has an unseen personal history and sensitivity.” The writer therefore calls for “space” for being heard to be given not to just psychiatrists and psychologists, but also to nurses, social workers and patients “in all their diversity.”

Duel diagnosis (The Lancet Psychiatry, Volume 1, Issue 4, Page 245, September 2014. doi:10.1016/S2215-0366(14)70363-3)

For the original comment thread, see:

Hundreds of genes and link to immune system found in largest genetic schizophrenia study (The Conversation, July 22, 2014)


  1. It seems that “space” for all perspectives to be heard would include room being made for the sharing of the historical trajectories of whatever is being discussed. The historical pathways of “schizophrenia” studies may seem “inflammatory” to some because it is an unattractive history. Should we then censor that history because it makes us feel uncomfortable? This history represents a fundamental part of any in depth understanding of this often oversimplified classification – as is any history about any other matter that is highly complex and seriously debated. Its conceptual validity is commonly misrepresented in the scientific literature (Boyle, 2003) and this, too, should absolutely be a part of the conversation. Genetic studies will always, and should always, cause some measure of thoughtful concern and pause. That unattractive, “inflammatory” history demonstrates the potentially harmful implications of research that focuses on such a sloppy “disease” construct – it speaks to the dangerous meanings that may emerge from reckless and oversimplified “gene” talk. It seems a very important perspective that should not be silenced.

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  2. I didn’t find the debate in the original article to be particularly bitter or acrimonious. It appeared to be an attempt to put the findings in historical (Pilgrim) and scientific (Moncreif) as well as personal perspective. It is passing strange that we have something that is an associated risk factor at the 85% or so level (childhood trauma) which can actually be addressed both preventively and therapeutically, and yet we spend huge amounts of money on something that has an associated risk factor at the 3-4% level and which is completely immutable to human intervention (inherited genes). Assuming “the best intentions” does nothing to address that issue. I am sure the author really believes he’s acting in the best interests of his clients, but he is apparently blind to the wasted energy and effort he is engaged in which will likely supply absolutely nothing of consequence.

    Perhaps the real starting point is for the mainstream psychiatrists to assume the best of intentions on the part of its critics, instead of labeling rational dissent and information as “bitter” and “acrimonious.”

    —- Steve

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    Quoting the author Ben Peck below:

    In 1971, gay activist Frank Kameny stormed the American Psychiatric Association’s annual conference, held that year in a Washington ballroom. Pushing his way past shocked elderly psychiatrists, he seized the microphone and shouted: “Psychiatry is the enemy incarnate. Psychiatry has waged a relentless war of extermination against us. You may take this as a declaration of war against you.”

    Remaining “pleasant” will not facilitate change. “Below the line” comments like Pilgrim’s are what is needed.

    I think we all know what happens when you “assume” something. (Oops, I guess that’s a below the line comment as well.)

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    • An idea for the next APA meeting protest? It seems to be very effective for other groups (as you mention, also for people fighting for money out of politics or anti-war activists). Maybe we should start sneaking in their conferences and meetings and shaming them and filming these protests and putting them on-line/sending to media?

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  4. Ooo, psychiatrist frayed nerve endings. Scared of getting “triggered”. I will keep that in mind when ignoring your nonsense. It’s elevator music and chamomile tea from here on out for you, kid. A picturesque view of the cow pasture outside of the hospital window. I just think there are too many dual and more diagnoses now, and too few duel diagnoses. The duel diagnoses we can live with, as long as the psychiatrists are the ones taking the shots.

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