So that was a textbook case of how to handle a mistake. And here’s the textbook case on how not to.

Richard Noll is a professor of psychology at DeSales University. He’s that rare thing–a mental health worker who understands history. His most recent book, American Madness: The Rise and Fall of Dementia Praecox, is terrific. When psychiatrists finally discover, as I am sure they will eventually, that schizophrenia is not a single disease or anything like a single disease, they will have to acknowledge Noll as one of the first people to say so.

Noll is no stranger to controversy. He wrote a book in 1994 called The Jung Cult: Origins of a Charismatic Movement. The book was published by Princeton University Press, which was pleased enough with it to submit it for a Pulitzer. It didn’t win, but the Association of American Publishers gave it its Best Book in Psychology award for that year. Princeton is also the publisher of Jung’s collected works, which is a beautiful and expensive multivolume set, one that most likely yields substantial financial rewards for both the press and the Jung family. So it’s no surprise that when the Jung family objected to Noll’s book, which made a splash in popular media, Princeton U Press decided to dump Noll, and pulled the plug on another Jung project he was editing for them, which was already in page proofs. I guess they decided it had been a mistake to let Noll bite the hand that was feeding them.

Full disclosure here: my wife wrote her dissertation on people who claimed to have been abducted by extraterrestrials, and back in the late 80s-early 90s, had some contact with Noll, who was also interested in that topic. She recently confessed that she liked him–although, she reassures me, not THAT way–and that makes me like him, because I like her. Noll’s interest in ET abduction was part of his larger interest in dissociation, the phenomenon whereby consciousness is split such that two separate selves can exist in the same body. It’s a weird occurrence, and an unusual one, thought mostly to be caused by extreme trauma, but I have no doubt it happens.

You may remember that at the end of the 1980s, about the time that my wife was crushing on him, the country was riveted by accounts of Satanic Ritual Abuse. In a word, there was a sudden outbreak of people, mostly children, claiming to have been forced by Satanic cults to witness and/or participate in heinous acts, like cutting out babies’ hearts and eating them, often in day care centers. The stories were disturbing and implausible, but they could not be refuted, because it is impossible to prove a negative. They were perfect fodder for a moral panic, and that is indeed what happened. The results included the jailing of over 100 day care providers (some of whom remain imprisoned), the sundering of some communities, and  children unalterably confused about what had happened (or not happened) to them.

That’s a pretty lame summary, and I apologize, but I don’t want to get sidetracked by this fascinating example of the witch hunts Americans seem so good at. If you want more, there are plenty of good books on the topic, including this one and this one.  What you can’t do, however, is to read the excellent article that Noll wrote  on the subject very recently for Psychiatric Times–an article, as he explained, that he wrote because he felt that psychiatry’s role in the epidemic was in danger of being forgotten.

Despite the discomfort it brings, we owe it to the current generation of clinicians to remember that
an elite minority within the American psychiatric profession played a small but ultimately decisive
role in the cultural validation, and then reduction, of the Satanism moral panic between 1988 and
1994. Indeed, what can we all learn from American psychiatry’s involvement in the moral panic?

The article was short but comprehensive, well documented and informed by personal experience. He singles out two psychiatrists–Bennett Braun, and RIchard Kluft– who were instrumental in giving legitimacy to the SRA accounts. They helped change the DSM to make Multiple Personality Disorder (thought to be caused by the abuse) seem more common, they started the International Society for the Study of Multiple Personality and Dissociation, and they founded a journal called Dissociation.

Noll was one of the earliest mental health professionals to try to cast doubt on these outlandish tales. In the article, he reocounted his appearance at the 1990 ISSMP&D annual meeting, a conference attended by, among others, Gloria Steinem.

The 4 members of the plenary session panel were [psychiatrist Frank] Putnam, [psychiatrist] George Ganaway, anthropologist Sherrill Mulhern, and me. Putnam had read my Dissociation critique and wanted me to present my argument in person. Putnam and Ganaway presented carefully balanced arguments that did not directly reject the reality of SRA. Instead they expressed concerns about the linkage of MPD to such controversial claims, noting it would hurt future research on child abuse and trauma.

Mulhern and I were strident in our outright rejection of the veracity of SRA claims. She cited
anthropological and sociological research while I hammered home the view of historians that ancient
accounts of bizarre cult practices had to be read in context. Along with my fellow panelists, I too
mentioned the October 1989 preliminary report of an investigation by Supervisory Special Agent Ken
Lanning from the FBI Behavioral Science Unit at Quantico which found no corroborating evidence of
the existence of Satanic cults engaged in any criminal activity, let alone kidnapping and ritually
sacrificing thousands of American babies. Lanning’s findings had emboldened Putnam to organize
the special plenary session and go public with his private skepticism. The full FBI report appeared 3
years later.

Gloria Steinem approached me after my talk and suggested materials to read which she felt would
help me change my opinion of SRA accounts. During the conference I attended one of [psychiatrist] Bennett Braun’s legendary SRA workshops (“See the Satanism!” he screamed as he pointed to a patient’s red crayon scratching on a sketch pad. “There it is!”). Several persons—all licensed mental health professionals—approached me and let me know I wasn’t fooling them. They knew I was a witch or a member of a Satanic cult who was there to spread disinformation. But apparently the panel
presentations had a different effect on others. As one conference attendee, an SRA believer, later
wrote, “Mulhern and Noll cut a line through the therapeutic community. A minority joined them in
refusing to believe sacrificial murder was going on; the majority still believed their patients’
accounts.”

Noll sent the article to Psychiatric Times, an independent online and print journal that provides comprehensive coverage of the profession. The editor’s response was enthusiastic. “We all think your essay is terrific,” she wrote. Not only would they love to publish it on the web, she added, but “I thought right away that it would work in print.” Indeed, she wrote, “We all love the article and are thinking of using it as one of the cover stories for our January issue.”

On Dec. 6, the article was posted on the PT website. It almost immediately earned a complimentary tweet from Allen Frances and a mention on h-madness, a website for psychiatric history buffs. The editor made some suggestions for the print version and asked for Noll to finish them by Dec. 16. But then on Dec. 14, Noll discovered that his article  had vanished from the website. He made gentle inquiries and determined that it wasn’t a glitch, but that PT had intentionally taken down the article. The reasons were vague–something about how they didn’t like the title (which they had chosen), and how they didn’t like the fact that he had named names. But whatever the reason, the article was gone.

Earlier this week, Noll finally demanded a full explanation. And he got one.

Dear Dr. Noll,

I don’t blame you for being miffed at the inexplicable disappearance of your article, and the long delay in getting back to you with an explanation. I’d like to offer a sincere apology for the delay, and to explain what happened. It hasn’t helped that our offices were closed most of last week and that communications between editorial board members and staff have been generally slow because of vacations.

As you know, Professor [redacted] is the final arbiter of History of Psychiatry columns, so our staff enthusiastically went ahead and posted your article. I read it the weekend it was posted, however, and grew immediately concerned that it raised potential liability issues—possibly for you and, by extension, for Psychiatric Times. I therefore thought it prudent to hide the piece from public view until I could get some guidance from our editorial board. The board did support these concerns, and it was suggested that I consider obtaining corporate legal advice. There was also the suggestion that Drs. Kluft and Braun and some others discussed in your essay needed to be given the opportunity to respond to claims made in the piece. However, there was also general consensus that the piece “may be of some historical interest, but not particularly relevant to the problems facing psychiatry today.” Ultimately, it was the board’s recommendation that we not publish the piece.

We respect your expertise and previous contributions to Psychiatric Times. The scenario is a first for us. I’m so sorry it happened this way. We will return your copyright form and hope that you find another venue for the piece.

This explanation is so far to the stoat end of the weasel scale that it’s hard to know where to begin–particularly given PT’s reputation (deserved, as near as I can make out) for not flinching from controversy. (After all, they gave Al Frances the launching pad for his jihad against DSM-5.) Blaming the enthusiasm on Professor [redacted]? Claiming to have been unaware of the article until after it was posted, and then immediately smelling a rat? Mentioning lawyers without mentioning whether or not they were actually consulted? Suggesting that it was somehow too late to get rebuttals? A board recommendation to not publish an article that had already been published? Sorry that it happened this way, as if it would have been okay to do this if they’d been nicer about it?  I mean, my God, as if the removal of the article wasn’t contemptuous enough, the least they could have done was to come up with a story that showed some respect for Noll, and for readers, and for history, and for all those poor schmucks still in jail for feeding baby hearts to children.

Whatever, the point is that suddenly the essay wasn’t so terrific. It wasn’t cover story material. It wasn’t even worthy of being left on the website. It needed to be removed, forgotten, repressed.

You can read the article here. It’s definitely worth your time. But you can trust me on this. I’ve gone through some really grueling legal reviews  conducted by expensive New York lawyers who smell lawsuits the way blue tick hounds smell raccoons. And I’ve taken on, in pretty abrasive terms, some very deep-pocketed people. So I have some sense of what is actionable and what is not. And I just don’t see the “potential liability issues.” It’s a nice, concise, simple history of a less than stellar moment in the history of psychiatry. Every statement is documented; most are taken from public records, and the rest are from Noll’s direct experience. All he is saying is that psychiatry made a mistake and needs to learn from it, and he’s pretty darned gentlemanly about it, especially for someone who blew the whistle early on. This is about as strong as it gets:

The resounding silence of the elite psychiatrists could only be interpreted in three ways by those of us “in the trenches” who looked up to them for guidance: these Satanic cults were real (despite the lack of corroborating physical or forensic evidence); the experts did not know if they were real and were afraid of insulting the patients; or there was an abject failure of ethical leadership.

Of course, I’m not a lawyer and I don’t play one on tv. So I could be wrong. Maybe some lawyer somewhere could find a way to sue him for libel or defamation. But, especially given that the journal loved the article enough to publish it, isn’t it at least the sporting thing to tell Noll what the liability worries are and allow him to address them? And as for the “not particularly relevant” excuse, well, that’s just laughable, given how enthused they were with the article. So what’s the real story?

Noll is way too much of a mensch, and of a careful scholar, to speculate out loud. But no one wants to be reminded of an abject failure, least of all a profession that sometimes seems to specialize in them (did you see the reports this week that the studies proving that stimulants were the best treatment for ADHD were flawed?), and even less the individuals who made the mistakes and who, after the edifice collapsed, brushed off the dust and got on with their professional lives. I’m figuring that Noll embarrassed some influential people, and they had more pull than he did with Psychiatric Times, which reacted by expunging him, in exactly the same way that the mind, confronted with something it can’t tolerate, pushes it into the unconscious.

 

So mistakes were made, all right. And unlike PsycCritiques, Psychiatric Times has done everything in its power to deny responsibility for it.  LIke I said, a textbook case.

One of the reasons Al Frances is a hero in so many people’s books (including, at least in some ways, mine), is that he has tried to take responsibility for abject failures of ethical leadership, or at least has been honest enough to admit they have occurred. That this kind of candor is so rare within psychiatry is a signal that there is something rotten deep within its professional culture.

This entry was posted on Monday, December 30th, 2013 at 8:47 pm and is filed under Posts. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.