Letter to my Classmates on our 40th Reunion

Sandra Steingard, MD
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My college publishes a book for each class celebrating a five year reunion.  We are invited to submit an essay. This is mine.

Hello Classmates,

A few years ago, someone sitting in my office looked up at the diplomas on my wall and said, “You went to Harvard? I didn’t know you were smart!”

I mention that not only to brag about how stealth I am with keeping any bit of intelligence I might possess under wraps but also to acknowledge — before I launch into what may seem like a rant — that I understand that I have benefited in small and big ways from my Harvard education. Part of the tirade to follow focuses on my impression that we have come to live in a world of branding where a superficial gloss of information overtakes substance. That bothers me deeply even though I am aware of the extent to which I have benefited from my associations with one of the greatest brands there is. Yet, this institution disappoints me. It is hard for me to feel celebratory on the occasion of our 40th reunion. As my career winds down, I feel more disappointment and dismay than the glow of lifelong achievement.

My story is not an uncommon one. My grandparents were all immigrants and I come from one of those hard-working, striving families who benefited enormously from the American promise. Nevertheless, my admission to Harvard was an unexpected surprise. I came to our freshman year with a hopeful sense of awe at my great luck to be among you. I quickly learned that it was not the Harvard way to show one’s awe or aspiration or striving. I was a photographer on The Crimson and I recall a certain disdain my colleagues held for someone who was considering applying to medical school because it reflected an overt ambition. I recall that now with bemusement given that among my fellow Crimeds were some of the most ambitious people I have ever met.

But kudos to them. Many have done remarkable work and I congratulate them. As for me, I did end up in medical school, as seemed somehow preordained for me, and I struggled to use my ambition to do good. I felt a certain sense of burden and responsibility from the legacy of my grandparents’ struggles. They gave up so much and it seemed to be in the service of my success in life. As I write this, I think how naïve and earnest this all sounds. I would have been embarrassed to share these thoughts with you until now.

Given my education, my intellectual skills, and my desire to be worthy of my grandparents’ sacrifices, I probably should have pursued some sort of academic research career. But for reasons that are far more interesting to me than to others, this is where I landed: I have been a psychiatrist for people who have psychotic experiences — hearing voices others do not hear, believing things that no one else tends to believe. I work in public mental health with people who depend on small government stipends to survive. For most of my career, I have derived great satisfaction from this work, I am paid well, and I was able to have the flexibility I wanted when my children were young, so there was no great sacrifice in many respects. However, this is decidedly not a glamour field in medicine or even in psychiatry (which is not a glamour field in medicine!). By choosing to use the great gift of my education to help such a discounted and underserved group of people, it seemed I was honoring my family’s sacrifice on my behalf.

So why the outrage? This is how my career unfolded.

To a casual observer, the narrative of modern psychiatry is that it has undergone a remarkable evolution in the past 30 years. We have shuttered most of our large mental hospitals and the common wisdom is that this was due to the power and effective drugs psychiatrists prescribe. These drugs have helped not only those who, in another era, might have been institutionalized but also those who were functioning — in some cases quite well — but suffering with sadness, worry, distraction. To hear this version of the story, I am in a great profession for ambitious strivers who want to do good.

But this is how I experienced this transformation. When new drugs were introduced in the late 1980s and 1990s, I was optimistic. There was room for improvement. But I quickly observed that, in the clinic, these drugs did not live up to their hype. Of even more concern is that their hype did not match what was documented in the studies that had been done to gain their approval from regulatory bodies. And what bothered me the most is that the institutions that I would have looked toward to counter the commercial interests — our academic institutions, including our alma mater — seemed to be the ones who were doing most of the promotion.

At this point I may begin to sound like one of my patients — someone who has beliefs that are not shared by others. But my experience and observation is that medical academia has been captured by commercial interests. While most physicians seem to believe that their scientific training protects them from bias — that they are able to look behind the promotion — this is not what I observe. I see arrogance and a lack of humility at our limitations to overcome bias. When challenged, many seem to agree generally with this observation but see it more in others than in themselves. So non-psychiatrists might see the problem in my field but not in their own, or among other doctors but not in themselves.

My concerns go beyond medicine. As an example, industrial agriculture is an environmental disaster. It sometimes seems that we sell drugs to farmers so they can raise livestock in horrific conditions so they produce more food that makes people sick so we can sell more drugs. And while this may not have been a conspiratorial plan hatched in some back room, once in place the obstacles to change appear insurmountable.

We live in an oligarchy. The moneyed interests control our world.

I have no doubt that I am not alone in feeling horrified by our current political leadership. But my outrage precedes this administration. In some ways, our current president seems to be the apotheosis of a culture that values style and hype over substance. The line between analysis and gritty, basic journalism has become terribly blurred. The desire for clickbait seems to supersede the desire to report the news. It doesn’t shock me that Trump exists. It disappoints me that so many people like him. But he seemed to exploit this weakness in our journalistic structure. He was too seductive.

We are the privileged ones. Many of us have reaped the rewards of this era. Do any of you share my outrage? What is to be done?

I will end with an appreciation of a classmate I admire. We met once, and only briefly, so much of what I know of him is from his writing and advocacy work.

David Oaks was hospitalized against his will at McLean Hospital when he was an undergraduate. He recognized, long before I did, the serious flaws in my profession. He could have buried this and gone on to a more comfortable life but he devoted himself to advocacy. He co-founded an organization called MindFreedom International and he has been an outspoken activist and critic for his entire adult life. He is now working on environmental issues. David had a serious accident several years ago and is now disabled from that. That has not kept him quiet! Kudos to you, David Oaks! I am proud to be your classmate.

And yes, I have a husband and two daughters. I love them dearly and they are the center of my life. I worry about the future for my daughters but they are strong, courageous people and that recognition provides me some comfort. I still experience awe, and now it is for them.

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14 COMMENTS

  1. Sandra

    WOW! What a powerful letter that is eloquently brimming over with an appropriate level of moral outrage and resistance against all the backward and harmful trends within your profession and also extending out to the broader world surrounding us.

    I have consistently (in my blogs and comments at MIA) been challenging doctors and others, working within the ‘System’ and their professions, to take risks and find ways to challenge “business as usual” within an oppressive status quo. This is a powerful example of how various professionals can find creative ways to do this.

    Sandra, you have found a unique and important way to express your own moral outrage, and also challenge others at the same time to raise their heads and look around at the dangerous scientific and political trends manifesting themselves around us. I salute your courageous efforts here and challenge other professional to follow in your wake.

    Respectfully, Richard

  2. Fast food chains BY LAW have their hooks in institutions of higher education in the state where I live, and probably most others. This is, of course, only the outer most tip of the corporate influence iceberg.

    Success in our country is often equated with the wealth that comes of working for corporate interests. Because of this equation, many schools of higher education in this country resemble nothing so much as glorified business schools, and business interests, of course, are anything but impartial and scientifically sound.

    There is a more noble path, through the academy, but it is a path that doesn’t sell itself out to the highest bidder, and it is also a path, fraught with perils, that involves seeking rewards elsewhere than in purely material terms. I hope in the future that perhaps more students will be able to take this better path.

    What you say about David Oaks is very true, Sandra. I think many of us feel a personal debt of sorts to him for all he has done, despite his Harvard education. David, if you are out there, I’m sorry I haven’t paid you visit out there on the west coast yet, but I hope to do so someday if I am able. Know that you’ve been on my mind.

    Thanks for writing this post, Sandra. For once, there are many things I am in agreement with you about.

  3. Harvard Medical school probably never had what you might have hoped. Many years ago, on the old NBC Tomorrow show, Mark Vonnegut (now MD) had an enlightening story about applying to Harvard Medical school shortly after his autobiographical book about when he went psychotic big time in British Columbia. He related his episode to the School, but the admissions office accepted him anyway: although he was diagnosed schizophrenic in BC, he was accepted, even though the School didn’t accept prior schizophrenics- he’d recovered, which the school believed to be impossible; therefore, he couldn’t be schizophrenic, as they were incurable. Should you be surprised the school fell in with the legal dope pushers later?

  4. Hi Sandra-thanks for the post. I tell all my students about your course on antipsychotics. I do think the message will get out eventually. With regard to the pharmaceutical houses capturing medical education, I think this message comes out loud and clear in the video by Andrew Kolodny on the opioid epidemic. (It can be viewed from the pharmedout website under the advocacy tab.) If all the doctors can be convinced by the pharmaceutical companies that opioids aren’t addictive in pain patients, then there is no limit to the gullibility. Perhaps med schools will be embarrassed and change their ways.

  5. “And while this may not have been a conspiratorial plan hatched in some back room,….”….
    Glad to see that you’re allowing for the possibility that it *MAY* *HAVE* *BEEN* a “plan hatched in some back room”….
    I call them the “GREG B.s” – The “Global Ruling Elites, and Global Banksters”….
    Once you start doing your research, it’s hard NOT to see how controlled the world is.
    Do you really think money-greed was the ONLY driving force behind our current state of gross over-prescribing?
    It’s not only money that the GREG B.’s are greedy for. It’s also Power, Control, and Domination. Money is a means to get and keep the power and control, and keep score. Look at the current debate over “forced treatment”. That’s more about POWER, than profit. Why are rich people NEVER the victims of “forced treatment”?

  6. Read this out loud in the kitchen this morning while Steven cooked breakfast. Lucky strong and courageous daughters, lucky strong courageous mom. So fortunate for us to read your blogs and to share your ‘slow psychiatry’ with others in BC. Thanks for your tribute to David.

  7. Thanks for the round of applause, Dr. Steingard. I have been reflecting a great deal about our 40th reunion at Harvard. Yes, a few very minor corrections, but important to me: I co-created MindFreedom, there were a bunch of other folks. Also, please note there is no space between “Mind” and “Freedom” which can be read metaphorically.

    But mainly I do very much appreciate the encouragement. Yes, I do focus more on the environment, and this is because I seriously am exploring how to support nonviolent revolution. I have spent my career on the first amendment, but if this one doesn’t work I do believe there are some people working somewhere on the second amendment. I would prefer to launch the revolution via the first amendment, if at all possible. Please note that my reference to the second amendment is general, and I have no specific info about people and their guns. However, I will note that one of the popular songs on YouTube features African-American singers who dance to the song, “You Better Run, We Got the Guillotine!”

    Seriously, back at Harvard I experienced being locked into a psychiatric facility about five times. I am proud that I decided to throw my lot into the under class and marginalized groups of those of us considered “psychotic.” This is a very challenging closet to come out of!

    I used to blog at Mad in America, and many of the bloggers are friends. However, because of my interests I have needed to suspend submitting blogs there. I do not have time right now to explain, however, a root for my decision is because of my concern about religious discrimination. I am a Unitarian Universalist, so I tend not to experience a lot of prejudice. However, there are some individuals who may experience discrimination here who follow excluded, minority religions. Again, I do not have time at the moment to adequately explain my concerns, but I will note that I encourage dialogue about this and other topics.

    In the meantime please find my blog by googling the phrase, I like to use Search Engine Term Inquities or SETI rather than URL’s: david w oaks blog

    Thanks again for the support. I would like to be there in Cambridge for our 40th, but that would take bringing into the 1% and/or getting a camera onto a drone I guess during the ceremonies.

    In the meantime, thanks to Phillips Brooks House, as you probably know they have helped place many interns, and their placement of me in my senior year led to my career, they have posted a brief summary of that a few years ago.

    You or others who are supportive, or just want to have dialogue, are encouraged to contact me via email at [email protected] or via Facebook (which is a bit less reliable).

    I would like to read your whole column and reflect on this, which I hope to do very soon.

  8. Thanks for this Sandra! I envy your ability to speak out clearly and strongly to your fellow peers. I still don’t know how that would go with my college peers. My school was very business orientated like a folks went straight into CPA work and or MBA. The rest of us humanities folks were in the minority.
    BTW. Whatever happened to the medical ethics trend in medicine? Cleveland Clinic did have a designated medical ethics professional on staff who once taught at my college and I actually was in his class. Talk about Upside/Down world. I was being treated by unethical psychiatrists and I was the one with the college credit in medical ethics taught by leader of ethics at a major hospital chain. Way to go medicine!
    Again, thanks. I appreciate your trying though having been on both sides I can get frustrated with process. This was a great effort.

  9. I, of course, share your outrage, at all the misinformation being taught in and spewed by the universities, the pharmaceutical industry, the government, the media, the psychiatrists, and the mainstream medical community. Being from a banking family, I’m also appalled at the grotesque mismanagement of our monetary and banking industries in recent decades. And, of course, as one who had the common symptoms of antidepressant discontinuation syndrome misdiagnosed as “bipolar” by psychiatrists, because I knew 9/11/2001 would take our country to the brink of WWIII, just after 9/11, which everyone else is now just figuring out. Gosh, when did being insightful become a mental illness? But this means I’m also disgusted with the never ending wars against … a concept. Wars that have basically bankrupted our nation while killing millions of innocents, thus benefitting no one, except the military industrial complex, the war profiteering globalist banksters, their puppets in DC, and the unmentionable country.

    I will agree, some Harvard doctors do need to curb their arrogance, like the Dr. Joseph Biederman, the self proclaimed “second only to God,” the father of the ‘childhood bipolar epidemic,’ yes, a tad less hubris is in order. Especially since today’s “bipolar” drug cocktail recommendations, particularly combining the antidepressants and/or antipsychotics, can create the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome, and they also create the positive symptoms of “schizophrenia,” via anticholinergic toxidrome. And since these toxidrome/syndrome are not in the DSM, out of sight out of mind, the “mental health professionals” are largely ignorant of this fact. Yes, you could say I’m highly disappointed in psychiatry.

    But I’m even more disappointed at today’s psychiatric and psychological industries for making possible a big problem that our society is soon going to need to deal with, pedogate. Today, “the prevalence of childhood trauma exposure within borderline personality disorder patients has been evidenced to be as high as 92% (Yen et al., 2002). Within individuals diagnosed with psychotic or affective disorders, it reaches 82% (Larsson et al., 2012).” The psychiatric and psychological industries for decades, according to an ethical pastor of mine, have been covering up child abuse, by turning the child abuse victims into mental patients with the psychiatric drugs, en mass, while helping the to keep the child molesters on the streets raping more children. Thus, you’ve empowered the child molesters, you’ve made them above the law, resulting apparently in massive, international, child trafficking rings, and a whole host of other disgusting crimes.

    I do hope the psychological and psychiatric industries some day learn that child abuse is a crime, there are mandatory reporting laws in the US, defamation and drugs do not cure disgust at child abuse, and when you empower the child molesters you end up with a country ruled by psychopathic pedophiles (I’m not saying Trump is one, he seems to like pretty women more than children). Thank you psychological and psychiatric industries, sarcastically of course.

  10. The whole “Community Mental Health Center” scheme is a fraudulent scam. It’s true, unstated purpose was to dramatically increase the number of persons to whom psych drugs could be sold – paid for by Uncle Sam, via Medicare & Medicaid. That meant employing lots of psychiatrists, to KEEP SELLING all the drugs PhRMA had in the pipeline. Today in 2017, psychs are seriously trying to figure out how to “diagnoses”, and “medicate” FETUSES. I bet when Sandra was at Harvard 40 years ago, she never would have imagined *that*…..
    Without even trying, and not as part of my job – I know 3 women who were sexually abused/molested when they were little girls, by their Fathers. When they got old enough to “spill the beans”, Dad took them to shrinks, and had them labelled and drugged, so nobody would believe them. One guy ended up on the Sex Offender Registry anyway….. And the County Attorney who put him there, is now, as a judge, FORCING the girl to take drugs she doesn’t want, and doesn’t need. Can’t you see the CARNAGE the pseudoscience drug racket known as psychiatry has done, Sandra?…. CMHC’s are a form of distributed concentration camps….. It’s not barbed wire and guard dogs which keeps the prisoners in – it’s psych drugs….. and ACT teams….