When Psychiatry Won't Listen

Patient Expert

Do you ever get one of those days when you want to grab Psychiatry by the neck and wring it? I’m having one of them right now.

Don’t get me wrong. I get along very well with the psychiatric profession. My 16-year journalist-to-expert collaboration has been extremely fruitful. Its practitioners have gone out their way to inform me and support me. A very elite group of them even presented me with an international award.

But in all that time, with one or two exceptions, they have never showed an inclination to want to learn anything from me. It’s been a one-way street. I could go on and on about the absurdity of this state of affairs. Instead, allow me to relate this little story …

The other day, here on HealthCentral, I posted a piece, This Just In - Psychiatry is Still Dead. The piece was a response to one by Ronald Pies, an enlightened psychiatrist who averred on Psychiatric Times that psychiatry was alive.

His piece, in turn, was a response to an earlier “psychiatry is dead” piece of mine. When I attempted to post a cordial message, I was confronted by a notice to the effect that only mental health professionals were allowed to post comments. The absurdity of professionals talking to professionals about us without our input proved my point in a way no lengthy rebuttal ever could. As I concluded in my second piece: “I rest my case.”

My account brought out a strong case of deja vu in one of my readers, Willa Goodfellow. Willa is one of my favorite people, who brings great wisdom and insight to her blog Prozac Monologues. Her blog is in hiatus right now, but I strongly encourage you to spend a leisurely hour or two checking out her old posts.

In her comment to my most recent post, Willa brought up her experience in commenting to a Dr Pies piece from 2012. Is Suicide Immoral? read the provocative title to his commentary. The title, of course, is wholly arrogant and insensitive. Had he consulted just one patient beforehand, I’m guessing he never would have used it.

In the comment thread, Dr Pies attempted to explain away the title along the grounds that it wasn’t meant to be taken literally, but - honestly - the nonliteral meanings totally elude me.

Dr Pies was writing from the point of view of a family member devastated, along with the rest of his family, from the suicide of his uncle two decades earlier. He and his family are still haunted.

A good many of us can strongly identify with Dr Pies. Not a day goes by without my being visited by the memories of a dear friend who threw himself in front of a train seven years ago. Why? I can only keep thinking.

We will never know why, of course. But we can tap into the wisdom and insight of our own community. If you are like me, you know it’s a miracle you are still alive right now. We are the lucky ones. I can’t place myself in the mind of my dear friend that terrible morning, but I can certainly recall my own state of mind those numerous times when ending the pain was the only logical choice.

Make no mistake about it: On this issue, we are the experts. Not the people with degrees talking amongst themselves. And as an expert, I can say with no equivocation that suicide is not a choice. It’s nonvolitional. We don’t commit the act. The act commits us.

In a 2012 blog post titled Suicide Immoral? WTF? Willa recounts the face-off on the comments thread from Dr Pies’ post:

In one corner, psychiatrists puffed on their pipes and discussed the philosophical question, whether it is morally defensible to jump out of a high-story building, given the potential collateral damage to loved ones and passers by. … In the other corner were people who have experienced serious suicidal ideation. In ever increasingly strident terms, they tried to insert a relevant piece of data into the philosophical discussion. Excuse me?  Surely it matters that the building out of which jumpers are jumping is on fire!

According to Willa, soon after, the accounts from those who had experienced suicidal ideation disappeared. Up went the “Professionals only” sign. For some reason, Willa’s comment remained, together with Dr Pies’ reply to her comment. Here’s the money quote from Willa:

But suicidal persons are not morally responsible for reflexive attempts to escape pain they cannot endure.

And here is the pith of Dr Pies’ response:

However: if we say that the person in severe emotional pain who kills herself had no "choice" at all in the matter, then logic compels us to say that if she had elected to live, in precisely the same state of pain, this, too, would not have been a “choice."

As I said earlier, Dr Pies is an enlightened psychiatrist. But sadly, in this case, he is guilty of a showy alpha display of his professional feathers. His tortured angels-on-the-head-a-pin argument simply does not merit a response.

Even the so-called experts need to acknowledge their limitations. Earth to Psychiatry: There are times when the wisest choice is to breathe through your nose and have the humility to listen to the real experts.