Can Psychiatrists Say They Are Sorry?
By Alen J. Salerian, MD
I have a simple question for my 50,000 and some psychiatric colleagues who gathered in San Diego at the annual American Psychiatric Association’s meeting: Does it matter to say, “I’m sorry?”
The capacity to acknowledge past error is a reliable measure of human progress. Modern Germany acknowledged their wrong against Jews, Gypsies and homosexuals. Americans acknowledged past wrongs against Japanese Americans during World War II. Neither modern nor Turkey nor modern psychiatry ever said, “I am sorry”.
As a practicing psychiatrist in Washington, DC, I still feel guilty for my past errors, and in particular for the pain I caused as a young doctor pontificating to the parents of the mentally ill by suggesting that their parental failings handicapped their loved ones with schizophrenia, schizoaffective disorder or bipolar disorder.
At least until the mid-1980’s, myself and many of my colleagues believed that toxic parenting produced psychotic offspring. I am ashamed to recall that part of my message was subtle, unspoken yet powerfully conveyed: Had you done your job better, your son or daughter would not have developed schizophrenia or bipolar disorder.
Neuroscience has now proven that severe psychiatric disorders are almost always caused by highly complex genetic and environmental factors including psychological events, but rarely caused by parental failures. Since the mid-1980’s, neuroscience proved that it is bad genes and unlucky biology in combination with complex environmental factors including psychosocial forces that contribute to the development of severe psychiatric disorders.
Despite the certainty that bad parenting is not responsible for severe psychiatric disorders, APA has never publicly acknowledged our collective past failings.
Sadly, I had my own painful and unnerving experience with psychiatric colleagues who were ignorant of their own prejudicial attitudes toward families of the mentally ill. A few years ago I had my first encounter with modern psychiatry.
Soon after my book of cartoons “Honest Moments with Dr. Shrink” was published, I had become the target of an investigation by the Washington Psychiatric Society, the local chapter of the American Psychiatric Association. Dr. Shrink, my fictional arrogant, self-centered contemporary version of Archie Bunker attempting to expolse modern psychiatry’s failings, and myself, the creator of Dr. Shrink were accused of insanity.
The APA sent a polite, guarded, senior psychoanalyst to see the exhibition of my cartoons at the Watergate Gallery and to talk with me. He meticulously scrutinized every cartoon and then interrogated me personally. I still recall that blank flatness of his expression as he struggled to find any humor in the cartoons I had drawn.
One in particular depicted Dr. Shrink praying, “My Lord, forgive all analysts for torture, for abuse and the guilt-induced deaths of mothers of the insane.”
“I can not find any humor in your creative work, Dr. Salerian,” the visiting psychiatrist said, his eyes glued to Dr. Shrink and the cartoon where a patient was asking Dr. Shrink, “Are you really weird, Doc? Or do you only act weird when I see you in public?”
“Your sense of humor is beyond me,” he commented. “What is your point?”
Luckily in the end I, and maybe even Dr. Shrink were found sane by the APA representative.
As a member of the APA and as a psychiatrist, I am sorry for my failings, and I publicly want to say as much to all the family members of my patients whom I offended by suggesting that they were responsible for their relatives’ mental illness. I kindly request their forgiveness. I also request that my colleagues at the APA formally acknowledge their past wrongs and the harm they caused to millions of Americans with severe psychiatric disabilities and their families.
Any APA meeting, without an appropriate apology for past wrongs, will be a failure now or in the near future.