Part IX. Should Professionals Speak out Regarding Trump: Frances vs. Dodes and Gartner

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Early Saturday morning, DT fired off four reckless and alarming tweets accusing President Obama of having tapped his phones prior to the election. With zero evidence, this is likely the most serious, earth-shaking charge ever made by a sitting president against his predecessor. Then without skipping a beat, DT flitted to a childish tweet rebuking Arnold Schwartzenegger for ruining his TV show, before heading out for a brisk round of golf, leaving us all staggered by the incomprehensible turn of events.

Against this very dangerous political backdrop, Americans everywhere are in urgent need of explanations for the inexplicable. But the mental health profession is sharply divided about whether to address the startling questions of DT’s psychological instability.

On the side of silence, psychiatrist Allen Frances is a prominent voice insisting that psychologists and psychiatrists not speak up. And yet largely unknown allegations from his past cast extraordinary doubt on granting Frances one scintilla of credibility on anything pertaining to mental health issues.

Beginning in 1995, Frances is alleged to have engaged in a highly unethical marketing scheme with Johnson & Johnson to promote their new anti-psychotic drug, Risperdal, under the pretense of scientific investigation. Tens of billions of dollars were at stake to gain market share from other medications. The long and sordid tale of Frances’ alleged ethical breaches is summarized at length in a scathing expose by Dr. Paula Caplan, a psychologist a former colleague of Frances. Though Frances responded disparagingly to Caplan’s charges as theatrical, attention-seeking, self-promoting, and emanating from a 20-year grudge, he completely dodged the damning, unequivocal charges made in expert testimony when Johnson & Johnson was sued by the state of Texas in 2010 for massive deception and fraud in hard-selling Risperdal.

(Among the vast array of the drug’s side effects is frequent large breast development in males. I currently work with a man in his late twenties who was prescribed the drug as an 11 year-old. He suffered massive weight gain and breast development. He is now very fit and athletic, but has never been able to rid himself entirely of the vestigial breasts caused by Risperdal.)

The meticulous 86-page expert witness report was compiled by Dr. David Rothman, a leading national authority on medicine-industry relationships. Though there are numerous references to Frances’ alleged unscrupulous involvement, the following excerpt from the report captures the gist of the accusations:

“Not only were Frances, Docherty and Kahn ready to violate standards of conflicts of interest in mixing guideline preparation with marketing for J&J, but also in publicizing the guidelines in coordination with J&J. The three men established Expert Knowledge Systems (EKS). The purpose of this organization was to use J&J money to market the guidelines and bring financial benefits to Frances, Doherty, and Kahn.”

The charges are presented, not as possibilities, but as documented facts. In 2012, two lawsuits by the state of Texas (both using the Rothman Report,) for fraud and deception against J&J settled for $158 million and $181 million respectively. Subsequent lawsuits have brought the total to $2 billion and counting as of 2015 in penalties and settlements, though the total profit at that time for J&J was estimated at $18 billion. Crime appears to have paid very well.

When a law suit is settled, it is common for sums of money to be agreed upon in exchange for the defendants not to have to acknowledge actual guilt and to be immunized against public criticism by the plaintiff. It is unclear whether this accounts for the fact that Frances has seemingly been able to fly under the radar of public opprobrium.

What is clear is that prior to the damning Texas lawsuit, Frances appears to have undergone a full-scale transformation. Once at the very pinnacle of academic psychiatry and its close, ethically murky relationship to Big Pharma, he began portraying himself as an intense critic of both, decrying the evils of an overdiagnosed and overmedicated society. To this day, he launches regular vitriolic, mocking attacks exemplified by:

“There is no definition of a mental disorder. It’s bullshit. I mean you just can’t define it.”

Similarly, he also called the effort of mental health professionals to help educate and warn the public regarding DT “bullshit.” Given that Frances argues that the definition of mental disorders is bullshit, it of course follows that speaking up about DT is just another instance of bullshit.

If indeed Rothman’s assertions have any merit, just how Frances has managed to preserve his voice as authoritative is a puzzle. A respectable case might be made for psychologists and psychiatrists not to speak up to educate and warn the public (e.g., establishing a precedent for reckless and irresponsible evaluation of other public figures). But if a fraction of the charges against Mr. Frances are true, he has disgraced himself and his profession and he is the very last person to speak with any authority about anything.

On the side of speaking up to educate and warn the American public, more and more mental health professionals are mobilizing. Psychologist John Gartner has circulated a petition with over 30,000 signatures of social workers, psychologists, and psychiatrists declaring DT unfit for office and calling for his removal. Similarly, psychiatrist Lance Dodes has written a letter to the New York Times, signed by 33 colleagues, carrying the same message.

DT’s tweets on Saturday morning are deeply concerning and highly suggestive of severe paranoia. We must never forget that his man has the ability at 2 am in the morning to incinerate the planet in under five minutes, with no procedures in place to stop him. Mental health professionals have a deep responsibility to provide the public with information that will elucidate just who we are dealing with. Is he being, “crazy like a fox,” as Mr. Frances would have us believe, creating a clever distraction from the Russian investigation and inciting his red-meat base who will believe anything he says? Or is this something far more sinister in that he is “crazy like a crazy,” and actually believes Obama tapped his phones? If the latter is true, this foreshadows very perilous times ahead where the existential stakes for the world couldn’t possibly be higher.

Chicago, IL