Psychiatry: 60 Years in an Increasingly Corrupt Specialty
Dr. Nathaniel S. Lehrman, M.D. I started in psychiatry in 1947, after graduating from Harvard College in 1942, Albany Medical College in 1946, and a year’s rotating internship. I then spent a year at Bellevue, served two years as an army psychiatrist, and finished my training at Hillside Hospital and Creedmoor State Hospital (now “Psychiatric Center” - PC). I was certified in psychiatry by the American Board of Psychiatry and Neurology in 1953, and was graduated the following year from the New York Medical College - Flower and Fifth Avenue Hospitals’ Comprehensive Course in Psychoanalysis. (I was also certified in Administrative Psychiatry in 1977).
For ten years, beginning in 1953, I had a full time office practice in psychotherapy in Great Neck NY. In February of 1973, I was chosen, through civil service examination, as Clinical Director of Kingsboro Psychiatric Center in Brooklyn. In September, 1978, when I reached 55, had accrued 20 years of pension credit and was fed up with the administrative nonsense involved in that position, I retired. While working in the public sector, I had also been practicing part-time in an office in my home.
After retiring from Kingsboro, I took a half-time job at a Creedmoor after-care clinic, providing direct patient care to long-term patients. I was also appointed attending psychiatrist at a nearby general hospital, thus helping to rebuild my private practice. My efforts with Creedmoor’s chronic aftercare patients were the most exciting and satisfying work I had ever done; I gradually reduced their medications and worked with them on individual goals through which they could take increasing responsibility for themselves. I presented a preliminary report on results with over a hundred such patients at the 1980 American Psychiatric Association meeting in San Francisco, which was published two years later in the relatively little-read American Journal of Psychoanalysis, as “Effective Psychotherapy of Chronic Schizophrenia.” But as the old psychoanalytic joke goes, “who listens?”
Over the years, I have been writing about many aspects of psychiatry, such as (1) the nature of mental illness and its treatment – including the gradual elimination of psychiatry’s most effective therapeutic instrument - the doctor-patient relationship – by drug-pushing; (2) how care for the mentally disabled should be properly and effectively organized; (3) the relationship between religion and psychiatry; (4) ideals of sexual behavior and deviations from them, and other topics.
In 1984, I read a paper on “The Prostitution of Psychiatry: 1930’s Germany, 1980’s America” in Israel, since I could find nowhere in America to present it. Since then, that situation has markedly worsened. The latest outrage is the “screening” of youngsters for “mental illness” - which means putting normal kids on brain-altering and -damaging drugs.
Recommended reading with this interview:
This accessible study about the collusion between medical science and the drug industry emphasizes how drug companies market their products by either redefining problems as diseases (like female sexual dysfunction) or redefining a condition to encompass a greater percentage of the population. Moynihan, a health journalist for the New England Journal of Medicine and the Lancet, and Cassels, a Canadian science writer, note, for instance, that eight of the nine specialists who wrote the 2004 federal guideline on high cholesterol, which substantially increased the number of people in that category, have multiple financial ties to drug manufacturers.
Physicians now routinely prescribe cholesterol-lowering pills (statins) that may have perilous side effects, when many people could lower their risk of heart attack with less costly and dangerous steps, such as exercise and improved diet. Through aggressive merchandising, funding of medical conferences and expensive perks, drug companies win doctors over to diagnosing these "diseases" and prescribing drugs for them.
Questions and Answers
by Trung Nguyen
Thank-you for taking the time from your busy schedule to do this interview.
What is your overall opinion of the pharmaceutical industry and psychiatry? Are they working together to define the mental health field?
After sixty years in psychiatry, I have concluded that the heart of effective psychiatric care is the therapist-patient relationship, and the understanding of both present and past evoked within it. Medications can be useful to help sleepless patients, and in other ways when they are upset, but medications’ therapeutic role is secondary at most, and the possibilities of overuse and dependency/addiction remains a constant danger.
Over the past fifty years, this primary treatment role in psychiatry has gradually been taken over by medication – first for psychotics and now for everyone else with psychological symptoms, both grave and trivial. The result has been horrendous. As Robert Whitaker has shown, the incidence of psychiatric disability, as measured by Social Security disability statistics, has risen five to six times since the tranquilizers came in 50 years ago. At the moment, therefore, the pharmaceutical industry and psychiatry, like obstetricians in Ignaz Semmelweis‘s time, are harming the patients they are charged with helping.
Can you explain what “TeenScreen” is and the rationale behind it? Do you think that Big Pharma or/and the APA (American Psychiatric Association) is/are behind it?
Teen Screen is an effort to recruit youngsters into the ranks of drug-takers by grossly exaggerating the allegedly harmful significance of the emotional experiences all teen-ages (and older people too) go thru. It’s a gross fraud in which the APA is the whore and Big Pharma the pimp.
Here are some facts about the pharmaceutical industry:
-- It is the most profitable industry in the world measured by Return on Equity (ROE) and Return on Investment (ROI)
-- 40% of TV ad revenues in the U.S. come from the pharmaceutical industry.
-- Big Pharma and Big Oil are the biggest political contributors in the U.S.
Many doctors are now writing prescription pills for almost every illness, disease, and minor problem. Because of Big Pharma’s influence, do you think that the relationship between doctor and patient is somewhat compromised?
The doctor- patient relationship, which is important throughout medicine, but supremely important in psychiatry, has been completely destroyed in the latter field when, as is increasingly the case, the doctor does nothing but push pills while ignoring the patient’s problems.
Are there financial incentives for doctors to prescribe medication to their patients?
The media report that many specialty leaders are being bribed in this way.
What is your view on the theory that most mental illnesses are the result of a chemical imbalance in the brain?
Total nonsense; a big lie which is increasingly believed by dint of frequent repetition
Despite hundreds of millions of dollars in research every year, the pharmaceutical industry has not found a single cure for a disease or mental illness. Do you think that they are favoring the strategies of management and treatment because they’re more profitable in the long-run?
There’s lots of money in keeping patients on medication indefinitely, rather than gradually reducing dosages to zero as the patient improves and returns to normal functioning. Indeed, indefinitely remaining on medication interferes with return to normal functioning.
In your opinion, do you think that the pharmaceutical industry deliberately creates dependency in their products (pills) to generate recurring revenues?
What other reason is there?
Every prescription pill has side effects. Where do the side effects come from?
From the drug’s unknown effects.
You’ve worked with patients to reduce their medications. How was this done and what was the success rate?
After I got to know a patient, and his life was relatively stable, I would start reducing medication – between 10% and 25% at a time. I would warn him that the medication reduction might cause reappearance of earlier symptoms, and it was his choice whether to try to weather this or to return to the original dosage level. If the dosage reduction was successful, I would then try to reduce dosages again - another 10% - 25% - six or eight weeks later. If the initial dosage reduction did not succeed, I would try a smaller reduction after several weeks. I made it clear to the patient that continuing on medication could harm him, so that reducing it became our joint task. I have no specific figures on success, but I believe this dosage reduction plan helped the overwhelming majority of my patients – perhaps 80% or more.
What are your views on the primary causes of following:
Depression: primarily a reaction to perceived failure
Bipolar: failure to learn how to control oneself when things have gone well, plus the false belief that the marked mood-swings many people have, which they should learn to control, instead represent illness which is beyond their control.
ADD / ADHD: with Fred Baughmann, I doubt their existence.
Schizophrenia: psychological disorganization due to a welter of increasingly distressing unsolved problems, and increasingly futile efforts to deal with them.
Addiction: seeking pleasure from drugs rather than from accomplishments during life.
A recent study shows that there has been a 40 fold increase in the number of children who were diagnosed with bipolar from 1993-2004. Children as young as 4 are now being diagnosed with bipolar. What do you think is contributing to this increase, seeing that it’s almost impossible for 4 year olds to exhibit some symptoms (shopping sprees, promiscuous sex, etc.) of bipolar?
Another example of the Big Lie; kids with temper tantrums, for example, which have always been common, are now being given psychiatric labels and drugs.
How has “drugs destroyed psychiatry”? What was the original intend of psychiatry?
Psychiatry began with the treatment of the insane – those who were seriously disabled mentally. Freudian psychoanalysis extended its scope to sufferers from problems of daily living, who were then given psychiatric “diagnoses.” The specialty can indeed help many troubled people – both the disabled and the merely distressed – by examining and helping to correct their attitudes, relationships and behavior, as I’ve done for years. But when pill-pushing eclipses examining a patient’s life problems, the situations often worsen.
Let’s say a person is diagnosed with depression, bipolar, or ADD / ADHD. What treatment methods would you recommend or you’ve found to be effective?
Talk with him to understand and address his problems.
What do you see are some of the dangers of SSRI (Selective Serotonin Reuptake Inhibitors) drugs, such as Prozac and Zoloft? Are there alternatives to them?
These drugs are dangerous. Not only do they increase suicidal risk, but they harm brain and endocrine systems.Small amounts of sedative medications , such as the barbiturates, may be useful for short periods when acutely upset patients are unable to sleep.
There are about 100,000 deaths each year caused by prescription pills. Are you aware of any product that has caused that many deaths, or even remotely close to it, and the government hasn’t pulled it off the shelf? Is there an exception being made for the pharmaceutical industry?
Any parting words for our readers?
Psychiatry, a formerly-honest medical specialty, which tried to help patients with the problems causing their symptoms, is now dedicated almost entirely to drugging them for their symptoms and ignoring their problems. One result has been a five-fold increase, since the introduction of these drugs fifty years ago, in psychiatric disability, as measured by Social Security disability statistics. In the mid-1800’s, Dr. Ignaz Semmelweis recognized how physicians produced childbirth fever in the women they delivered – for failing to wash their hands. Psychiatry’s current focus on symptoms and drugs, while ignoring problems and “side-effects,” is causing similar harm to those it treats.