Questions About Jeffrey Lieberman’s “Notorious Past and Bright Future of Psychiatry”

Julia Rucklidge, PhD
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This question was for you, Bob Whitaker.

I just attended my first American Psychiatric Association (APA) meeting even though it has been going for 168 years. I was invited to join a symposium on vitamin-mineral combinations as primary treatment of psychiatric symptoms. It was booked on the last day at the last time slot.

This conference is huge. Fourteen thousand attendees. There are over 500 different sessions with 150 rooms being used to accommodate the meeting. Topics vary greatly although I have been surprised about how few there are describing new and innovative treatments.

There was one talk I decided to attend, not because I was particularly interested in the topic, but because it would give me an opportunity to ask a question.

After having listened to the CBC interview between Michael Enright and Dr Jeffery Lieberman where Dr Lieberman publically dismissed Robert Whitaker as a “menace to society,” I decided to attend his talk entitled “The Notorious Past and Bright Future of Psychiatry.” It was held in a massive room (I guess they expected a huge attendance), maybe 200 people attended. Dr Lieberman faithfully went through the history of psychiatry, reminiscing about some of the torturous treatments psychiatrists used to engage in like ice pick lobotomies and insulin shock. He then pointed to the year 1973 as a turning point for the profession. In this year, at the APA meeting, it was apparently stated that “our profession has been brought to the edge of extinction.”

This fear of extinction apparently led to an uprising of scientific endeavours including imaging, genetics, drugs, and neuroscience. DSM became “scientifically driven” with Robert Spitzer at the head and Lieberman stated that the profession was entering a golden era with “hope and change for our medical colleagues.” He said that despite the bad portrayals in the media and the constant unfair criticism the profession was receiving from journalists, he is inspired by the path psychiatry is on, discussed specific cases of lives turned around by psychiatry and medications. He ended by stating that “our time has come, the golden age of our field.”

I nervously went up to the microphone, was first in line, and I asked something like: “Dr Lieberman, thank you for your talk. You have ended with a discussion of the bright future of medications and how many people they have helped. Of course we know that the published studies show benefit of medications over placebo in the short term. But what about the long-term effects of medications? Are there any published studies that show that in the long term people maintain these initial benefits?” For those who have read Robert Whitaker’s blog on MIA, this was the question (or a variation of it), that Bob asked publicly of Lieberman after his CBC radio interview last month.

Here was Lieberman’s reply. He first asked who I was; I replied, a clinical psychologist. He stated he thought I couldn’t be a psychiatrist as all psychiatrists would know from clinical practice that patients stay well in the long-term. He asked if I had read Elyn Saks’s book about her marvellous recovery with psychiatric medications from schizophrenia and then stated that it was unethical to do a study of medications in the long-term.

I then gently brought to his attention the many studies that have been published, mentioning Harrow’s work, and Mulder’s analysis of the last 50 years of treatment with antidepressants showing that relapse rates and recovery rates are no better now than they were 50 years before the advent of medications, to which he responded that such a comparison is simply not justified, implying that they can’t tell us anything about the efficacy of antidepressants. I mentioned Wunderink’s study and longterm studies of stimulants. He had no studies to cite that showed longterm benefit of drugs, except anecdote and vast clinical experience. And those studies I mentioned? He dismissed them.

So there you go, Robert Whitaker, your question has been answered.

More interesting, however, was the number of people who came up to me afterwards to thank me for asking the question. Does no one ask this question within the profession?

And why not?

Ultimately it would be nice if we could bring down the barriers of profession and really focus on one of the most important questions facing all health care professionals and society at large – how do we help those people who don’t want or don’t respond to medications? We know there are lots of them out there, they need a voice, and it is a voice that needs to be heard.

50 COMMENTS

  1. Thanks for your courage in taking on Dr. Lieberman. What an arrogant SOB. If all clinicians who prescribed fish oil capsules said they worked based on their clinical experience, there is no way they would get away with making those types of proclamations and nor should they. But yet, it is ok for psychiatrists to do this without vigorous scientific studies?

    If psychiatry wanted to, they would find ways to compare the effectiveness of being medicated vs. being off meds without doing anything unethical. They just chose not to do so for obvious reasons.

    Other folks don’t speak up because they fear reprisals.

    Anyway, thanks again.

  2. Thank you. Well questioned on behalf of the many, many thousands with severe iatro-genic brain injuries resulting from enforced and or coerced long term “medication” with these grotesquely toxic “psycho-tropic” drugs.

    Can this really be “their finest hour?”

  3. I love this, great job! I once got a free ticket to a NAMI conference, and cornered the then-APA prez (don’t remember his name, this was 2007-8, I think, in San Francisco) in the corridor and asked him why they were so obsessed with medication when there are sooooo many safe and natural ways to heal from anything, and tried to tell him how I had done this, myself, after feeling only tortured from meds and withdrawal. He was also patronizing, dismissive, and making it up as he went along, as was absolutely every single psychiatrist I challenged during the conference. It’s the only language they seem to speak!

    I read Elyn Saks’ The Center Cannot Hold and called her right after. I had a pretty long phone chat with her. Very nice person, and extremely courageous, honest, transparent, and obviously hard-working, but she suffers and is dependent. I don’t care if she has an MD and Law degree, that’s not a measure of health, well-being, and mental clarity, not in the slightest. This is not an example of success, but purely of cultural indoctrination.

    Thank you for this exquisitely enlightening report, and for your brave work on the line. This is the kind of thing I really love to see. Fantastic activism 🙂

    • Oh, and to briefly address the question why psychiatrists are not more readily questioned? From my experience, I’d say it’s because their responses (or better said, non-responses) are designed to make you feel small or crazy or both. Remember that the next time you try to dialogue with a psychiatrist, as I have over and over again, with the same results. And what is the definition of insanity again?

      This is why people resist questioning them–it will drive you insane to do so. Better to just move along, sometimes. That’s why you are brave, and breaking ground.

    • We should record these kinds of interactions and put them up on the internet – it’s perfectly legal (they are addressed in public spaces as public persons) and it can do wonders to expose their arrogance and lack of knowledge.

  4. Thank you for using your 5 min and facing the fear and the possibility of ridicule and spite. You can imagine our children’s fear while being civally committed and medicated for life. Our young adult children who are ‘treatment resistant’ as if there is such a thing have co-habitated with those who have been on the drugs long term with little benefit to show other than the ability to shiffle from bed to breakfast to the tv viewing area. They are not like Elyn Saks and many of them have lack of cognition, blunted emotion, TD, obesity and a shocking lack of friends. I suggest that people start visiting their clients and family members in these foster homes and supported housing facilities on a regular basis then get a scale of this population of people in their communities who need lifetime assistance to function and the cost of caring for these people who must be those who Dr. Lieberman consider to be the shing example of success and recovery and success and question why our childre and their parents are not taking to the streets demanding better treatment options as when gay people demanded federal research for AIDS? Since when did we parents settle for so little for our children?

  5. I heard Lieberman being interviewed on NPR Science Friday – when asked about the “over-prescription of drugs for “psychiatric conditions” he basically asserted that other medical professions over-prescribe (e.g. over-use of antibiotics) and then went on to say its mostly general practitioners that do the over-prescribing – a great DEFER and DEFLECT strategy.
    Gary

    • According to the commentators, Ira Flatow, the host, never once challenged Lieberman on anything he said. Guess there is a reason NPR is called National Psychiatric Radio since they also refuse to interview Bob Whitaker.

  6. I am so glad you were there and asked that question, and it doesn’t surprise me that many people appreciated your doing so. I think the answers he gave are less important than the meta-message, which the people in the audience who were really listening are sure to have heard: 1) he has no real answer to your question; 2) he doesn’t care about the real answer, and 3) when attacked, he will resort to platitudes and ad hominem attacks rather than the actual data. Of course, there were many in the audience who are just the same and agree with his authoritarian approach, but there are many others who are open to ideas and have now heard about Harrow and Wunderlink and Whitaker and the long-term data that stimulants don’t improve outcomes. I am guessing not a few attendees got on the internet and looked up some research as a result.

    Well done for planting some seeds, and for standing up in the belly of the beast and speaking truth to power!

    —- Steve

  7. Thank you so much for your courage and the response you got from other people is truly inspiring.

    I often think that Elyn Saks could be a great support to the reformer movement because she is as Alex says a ‘ Very nice person, and extremely courageous, honest, transparent, and obviously hard-working’ I think her idea of coercive treatment is based on the idea that ‘HER former self would have wanted to be given drugs as, in her case, she was restored to her former self’ . However if she studied the state of the research now -I think she wrote her book a number of years ago – and saw the research about how many more people recovered without medication, how many people remain on medication despite the fact that they remain very ill, and how psychiatrists do not know which people might have the pattern of recovery that she had – then I am sure she would be not be supportive of the current state of coercive medication.

    I have often wondered if someone very versed in the literature and the issues – well I guess I have wondered if Robert Whitaker and Sandra Steingard would ever approach her to see if she would study the current state of the field and revisit some of her ideas in light of the current research ………….. Once coersion is gone and uncertainty is recognized; particularly by the psychiatric community who currently has the dominant voice, .then the research, the problem solving , the resources and structure will certainly start to snowball on, as Julia says ‘how we help those people who don’t want or don’t respond to medications? ‘

    • I think I didn’t say that very well. What I meant is …….if Elyn Saks could be asked to study and talk or write some more about the issues in light of the concerns that have been brought up by current research etc.

      After all she is a law professor, doctor and someone with lived experience…….

        • I did think so -but I am reading other’s comments further down on this post who have read her book and I guess I really don’t know. I must confess I have only seen her ted talk and some writings about her opinions of the ethics of psychiatric treatment. I guess I thought since she did write about the ethics of psychiatry she would see this as her area – and if there was new information that shed a different light on long term drug treatment – she seems like the kind of ethical person who would want the information she has disseminated to be as accurate as possible. She seems to me someone who would be very concerned that the individual rights of patients were not being in any way violated. What do you think?

        • Alex I just watched the u tube you pvcosted. Although she talks many times about the importance of early treatment, I do not know why she would not see open dialogue approaches as valid given the research…..although she talks about how important pharmacology was to her recovery, I do not see why she wouldn’t consider those whose condition worsened after medication etc. She speaks loudly about the importance of social structures and support and therapy etc,,,,,,,,,,,,, and there is more and more awareness of the ‘uncertainty’ of treatment approach and research in other areas such as nutrition?? However I do noticed this was a recent video in 2013.

          • I chose that clip because it is fairly recent, and also because in just 3 minutes, she repeats the psychiatric party line, down the line. Plus, a lot doesn’t make sense to me, seems paradoxical. I’d prefer to not going into this in detail, out of respect for Dr. Saks. I do really admire how she was able to work with a support system to achieve what she has.

            She is very fortunate to have had such support, continuously. Not everyone does, nor do they have the financial resources she has had. From having read her book, from what I remember, she was always quite comfortable and had no money woes. That is CRITICAL when considering these issues, and where power imbalances permeate the mental health field, in general. I noticed this as far back as graduate school.

            At the same time, she is most definitely part of the mainstream establishment, which I find incredibly blurry at this time, hard to trust in any respect. So much of that culture (and there are others, aside from what we call ‘mainstream’) is built on programming and simply repeating what one has been told, without question. And now we are finding that it is all bogus, which is why it has been doing more harm than good, despite anyone’s best intentions.

            These programs don’t go away easily. As they dissolve, we are left questioning our beliefs and behaviors up to now. That’s a void to experience. It’s like deprogramming from a cult, all these beliefs slanted in favor of some fabricated doctrine or to honor some false prophet, etc. Many ways these false beliefs have come into being, but the point is that we know they are false and completely dualistic, and they continue to be taught and profited from.

            I think that’s going to be hard to relinquish for many who think and speak like Dr. Saks. From what she says in those few minutes, she sounds like quite a firm believer in the way things are done now, and this is exactly what we are saying NO to. The flexibility of her mind and heart, along with anyone else’s, is what is always most uncertain to me when I begin my own personal art of persuasion away from these myths.

  8. The new epigenetic research could be a game changer by preventing slow metabolizers from receiving harmful neurotoxins in the first place with disastrous results. Or it could be another rabbit hole, money pit or worse yet another guilded turd like second generation atypicals cleverly marketed to appear successful when in fact they are not. Better early intervention such allowing people to work through a psychotic state in a safe and supportive environment without using the nuclear bomb option: injecting them with mega doses of Haldol at a time when they most need their executive reasonong, desire, and willpower These options could in part stem the flow of bodies getting thrown in upriver but it will not address the issue of how to compassionately proceed with those who have been incapacitated by decades of harmful psychiatric ‘treatment’. While we proceed to shift the paradigm of care for those experiencing extreme states for the first time, let’s focus lots of effort on building non professional non ‘therapeutic’ relationships with people in foster homes and supportive housing facilities. Let’s enrich our lives with bountiful contact with these folks until we cure ourselves of the delusion of us and them or normality if there is such a thing. These relationships are rewarding and rich not taxingvunless you are getting paid to cultivate the relationship and the relationship is sullied by expectations of reward and return. Let’s stop asking ourselves how we can benefit those who are institutionalized when we visit and spend time with them but how they can benefit us. After all, our liberation is intertwined

  9. I just cant, and will probably never be able to understand why they keep getting away with causing so many harms and deaths. Just because they are supposedly doctors? I’d like to think that if some non-doctor stuck your kid with some haldol injections and gave him a permanent involuntary movement disorder, that you’d do something about it, legal or not… yet I’ve still yet to hear of a single case of a psychiatrist being brought to justice. Why is it any different when they do it? The harm is the same regardless of their “credentials”, in every way, shape and form.

    • Jeffery,
      My prescribing psychiatrist broke down in tears apologizing for drugging me wrongly for years. Rather than feeling relived to hear this I was afraid, now I was a liability. It was fear that kept me from suing him plus my friends said the repercussions against me might be worse in the long run. How to find a lawyer who would take the case, how to be in court being asked questions so personal. At the time I was tapering off numerous psyche drugs and in no condition to handle this. I now wish I had sued him because he’s still over prescribing and wrongly diagnosing others.

      • One more victim of the abusive system:
        http://www.democracynow.org/2015/5/20/sgt_james_brown_26_survived_two

        Not only police brutality but also, instead of real medical care, an injection of psych drugs:

        “”I’m choking on my blood!” said Sergeant James Brown. As his condition deteriorates, as he’s carried to an infirmary and has a mask placed over his face, he’s then given an injection. He begs for water and is given half a Dixie cup as he heaves. Sergeant Brown repeatedly states he’s having severe trouble breathing.”

        “AMY GOODMAN: One last question: Do we know what your son was injected with? In that video, we see him injected at least once by the guards.

        DINETTA SCOTT: According to the report, it was [Haloperidol] and Ativan, combination. I am not sure on the exact amount that was given to him, but according to the jail report, that is what they state they gave him.”

        Tell me again how psychiatry and their wonder drugs are medicine and not at all social control and instruments of torture?

  10. Thank you for speaking up. I am puzzled by a few things that Lieberman said. One is about how well people do on medication in the long run. If that is so, how is it that in 2014, 80% of the mentally ill population in the United States were unemployed? I gather that NAMI, which purports to be the largest grassroots organization for the mentally ill is alarmed at this figure, so I wonder how Lieberman would soothe their membership.
    See The High Cost of Cutting Mental Health,” accessed, November 26, 2014, http://www.nami.org/Template.cfm?Section=About_the_Issue&Template=/ContentManagement/ContentDisplay.cfm&ContentID=114540
    Second, I’ve read Ely Sak’s book, and I never got the impression from either reading her book or listening to her speeches that (a) she is recovered, and (b) the meds have made this happen. She struggles with symptoms, on or off the meds. Elyn Saks is an outlier in that she is a person to point to if you are trying to point to someone with a diagnosis of schizophrenia who has, by all appearances made a success of herself, but she is not symptom free. As I recall, she finally got on medication after resisting it for many years, and I assume that the medication at least calmed her down, but she still struggles. Her book is not a tribute to medication as so many people glibly claim, and I think she was finally talked into it by friends. People know so little about medication, and see what they want to see in it. Lieberman is in a perfect position to make all kinds of glib statements that people will take as gospel.

    • Rossa, my memory of her memoir is slightly different than yours. She embraces a very nuanced viewpoint. She did experience multiple attempts at withdrawing from her meds with near disastrous results. Her friends convinced her on several occasions to check into the ER and get back on meds during those periods because she became paranoid, withdrawn in her apartment, disorganized, stopped bathing, and nearly starved herself. She has experienced stigma and discrimination while seeking care and was subjected to dehumanizing restraints (which she legally opposes) and was nearly killed by a doctor who mistook the symptoms of a severe hemmoraging of the brain, akin to a stroke, with a psychiatric crisis in an ER setting. Her friends intervened quickly and she got the urgent life saving care that she needed. admits that her symptoms can only be managed with an older typical anti psychotic which carries a higher risk profile and she accepts this as a trade off of her ‘recovery’. Yes, she is the darling of the psychiatric profession because she is the picture of a person who can function at a high level, conform to society’s expectations of what constitutes success while not questioning the standard of care or the fact that alternative treatment options simply do not exist, which is really a human rights problem. She readily admits ‘I have a brain disease and medications are the only way I can manage my symptoms’ and stays very aloof from the controversies that are plaguing psychiatry. If someone were to ask her about her thoughts about the Harrow and the Wunderlink and Harding studies she would probably respond: “I do what I do best, psychotherapy and law, while I leave those medical research issues up to the experts in the field of psychiatry.” This is a big disappointment. In an interview, spitefully recounted how someone tried to convince her that she could manage all of her symptoms with mega doses of Vitamin C. Her reaction was so spiteful that one could loosely interpret her spite as being a strong critic of orthomolecular approaches in general. A pity. Like Glenn Close, she gives much propoganda value to the status quo while barely nibbling around the edges of authentic scientific corruption.

      • Hi, madmom, After reading your comment, t I opened her book and briefly refreshed myself on its contents. My comment wasn’t clear and leaves the impression that she was never on drugs until she finally decided to take them as prescribed. It is clear from the book that she always resisted staying on drugs, and went off them as soon as she could. She would manage for a while, and then end up back in the hospital and the cycle repeated itself. Her being on and off drugs continued for 15 years until she finally decided she needed them to function. Your comment made me reread my review of her book http://tinyurl.com/pfpw8u7 and prompts me to make some changes there. My impression of Elyn Saks is that she never looked into alternative treatments other than Kleinian psychotherapy and she used her work and her friend as her life raft. This seemed to work well for her in terms of being able to build a career but this narrow focus didn’t do much to cure her symptoms. It takes time and commitment to investigate and commit to other avenues of help.

        • First off all if she went of the drugs cold turkey no wonder why she “needs” them. At which point can you differentiate what are the symptoms of drug withdrawal and what is the original psychosis? My guess is if she tapered off the drugs she would be in the same exact place now or even better.

          The problem is that nearly all people who experience psychosis are put on these drugs and very few manage to get off them without the return of psychosis. That has been documented and discussed by Robert in his book.

  11. Well done for asking this question.

    I have a question: Did anyone else ask questions that challenged his “rewriting of the past, present and future” for psychiatry? If so do you remember any particularly interesting details.

    I agree with other commenters who said that anyone at these type of conferences with the interest should hold his feet to the fire. Denial and avoidance can only work so long in the face of determined opposition.

  12. Nicely done. To be honest, I’m uneducated regarding this man and his writings, so I’m ill-equipped to debate this topic academically. But I do consider myself to be a “patient” who has *not* done “well over the long-term.” I find the information revealed in this post to be enlightening. And so I offer comment, merely as an interested reader:

    This guy is full of it.

    Thanks.

  13. Just to raise something else with the drugs, there’s murmurings around that sometimes the filler/binding agents/coating of the medications can also be bad.

    For instance there seems to be pushback against the use of phthalates in enteric coating/time release medications.