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Commentary

The Role of Psychiatrists Who Write for Popular


Media: Experts, Commentators, or Educators?

I t is fair to say that the public perception of the field of psychiatry, like mental illness
itself, is generally not positive. The stigma surrounding mental disorders seems
matched by the public’s suspicion of psychiatric practitioners and psychiatric science.
Most of what the public learns about our profession comes from the popular print
and electronic media coverage of mental health—coverage that is often technically ac-
curate but negatively biased. The old dictum “If it bleeds it leads” still determines what
is considered newsworthy. For example, a representative survey of 70 major U.S. news-
papers found in 2005 that 39% of all stories about the mentally ill focused on danger-
ousness—the single largest area of all mental health coverage (1).
Likewise, media coverage of psychiatric treatments often highlights the negative. For
example, the reported link between selective serotonin reuptake inhibitors and elevated
risk of suicidal symptoms received prominent media coverage, but the public learned lit-
tle, if anything, about the fact that the risk of antidepressant treatment is dwarfed by the
risk of actual suicide in untreated major depres-
sion. In the same vein, the serious metabolic ef-
fects of the new atypical antipsychotic drugs have “Unlike most journalists,
been covered in depth, but there were no front- who have to rely on
page stories about patients whose lives have been
second-hand accounts or
improved or even transformed by the positive ef-
fects of these same drugs. expert opinion,
Given these circumstances, is it surprising that physician-writers can
the public has a negative impression of psychia-
try and little understanding that we have a range
weigh in directly with
of effective and empirically proven treatments their advice, opinions,
for the major mental disorders? and expertise.”
My experience over the years as a regular con-
tributor to the New York Times, where I write on
behavior for the science section, has taught me that it does not have to be this way. There
is much that the psychiatric profession can do to engage and educate the public about
what we are working on, what psychiatrists actually do, and where the field is headed.
The public is intensely curious about human behavior and the psychiatric profession.
At the New York Times, pieces about behavior are consistently among the most widely
read and e-mailed in the paper. For a week last January, I did a blog for the science sec-
tion on mental health (2). My editor wanted to send me just a selection of readers’ ques-
tions, but I was curious to read all of them.
While it cannot be considered a representative survey of the public’s interest in men-
tal health, a few recurring themes emerged from the several thousand e-mails I read.
Perhaps the most common question focused on what was the optimal treatment for a
given mental disorder. Readers wanted to know how they could judge the quality of
their own treatments. There was also a lot of concern about the long-term safety of psy-
chotropic medications and skepticism about the validity of psychiatric disorders in
general. Many readers raised issues of trust related to stories they had read in the popu-
lar press about the self-serving relationship between psychiatric researchers and the
pharmaceutical industry.
I spent many hours that week considering how to connect with a faceless but curious
audience. How much detail would suffice? Should I cite studies? Should I correct read-
ers’ misperceptions? I tried to do all of these.

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COMMENTARY

What was clear from this experience is that physician-writers, and psychiatrists in
particular, have a potentially important role to play in educating the public about the
current state of the psychiatric field. Given their unique perspective as clinicians who
treat patients, physician-writers have to wrestle with the implications of new findings in
day-to-day medical practice. Unlike most journalists, who have to rely on second-hand
accounts or expert opinion, physician-writers can weigh in directly with their advice,
opinions, and expertise.
Beyond just making relevant information about mental illnesses and their treatments
available to the public, one can also speculate about the broader implications of new
findings that go beyond current data to consider new treatments that may lie ahead.
The question of how far to go is not so easy to answer. For example, I wrote a column
about the possibility of designing biologically personalized treatments for depression
(3). I speculated, from an intriguing animal study, about identifying human genetic
polymorphisms that might predict differential response to antidepressant drugs. Be-
cause depressed patients often have to endure multiple empirical trials of different an-
tidepressants before achieving a satisfactory response, the possibility of predicting indi-
vidual drug response has great appeal.
The reaction to my column was immediate and overwhelming. Many patients called
to ask where they could get this “new genetic test,” despite my attempt to make it clear
in the piece that this was just a future possibility. Likewise, several colleagues told me of
patients who had asked them why they did not know about this test and felt I had raised
false hopes in the column.
I can understand my colleagues’ concern. Speculation about the therapeutic implica-
tions of new research findings is commonplace in peer-reviewed journals, where a pro-
fessional audience sees it for what it is. In a newspaper, which is read by many sick and
even desperate patients, enthusiastic speculation may unwittingly lead to false opti-
mism, despite qualifications and disclaimers, because this is generally a vulnerable
population; those who are ill and searching for effective psychiatric treatment do not al-
ways have the luxury of detached analysis.
Perhaps, but I still think the public is capable of critical thinking, even when pre-
sented with conflicting data or speculation. I have heard repeatedly from readers who
distrust unqualified and blanket assertions by members of our profession about the
safety and efficacy of our treatments. For example, when the U.S. Food and Drug Ad-
ministration required that antidepressants carry a black-box warning about an in-
creased risk of suicidal symptoms, many readers expressed anger at clinicians who
brushed aside this data. As one patient put it succinctly in an e-mail, “Tell me the pros
and cons. I can make up my own mind.” My impression is that people want more, not
less, information and that they appreciate nuance and complexity, so long as we com-
municate clearly and without jargon.
The fact is that if we do not take a more active role in presenting and explaining our
field to the public, others will do it for us. The Internet, which has eclipsed the print me-
dia as an information source, has done much to blur the distinction between informa-
tion and expertise. With little or no editorial filter, anyone can appear to be an expert.
Thus, blogs and chat rooms abound with misinformation about the nature of mental
disorders and their treatments, something that must be familiar to all clinicians who
hear about it from their patients.
In contrast, reliable and authoritative web sites, like that of APA, offer useful general
information and resources, but they could do much more to provide guidance on issues
of the day that concern the public. News coverage of our field will inevitably raise more
questions than the popular media has the space or expertise to answer. We should seize
the opportunity to engage the public directly in print and electronic media and explain
the broad implications of our new research and clarify current controversies within our

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COMMENTARY

field that come to public attention. The public is very interested in what we are thinking
about and working on and what it might mean for them in their everyday lives.

References
1. Corrigan PW, Watson AC, Gracia G, Slopen N, Rasinski K, Hall LL: Newspaper stories as measures of structural
stigma. Psychiatr Serv 2005; 56:551–556
2. Friedman RA: A new you: Dr Richard A Friedman on mental health. New York Times, Jan 14, 2008 (http://
science.blogs.nytimes.com/2008/01/14/a-new-you-dr-richard-a-friedman-on-mental-health)
3. Friedman RA: On the horizon: personalized depression drugs. New York Times, June 19, 2007 (http://
www.nytimes.com/2007/06/19/health/psychology/19beha.html)

RICHARD A. FRIEDMAN, M.D.

Address correspondence and reprint requests to Dr. Friedman, Weill Cornell Medical College, 525 East 68th
Street, Box 140, New York, NY 10065; rafriedm@med.cornell.edu (e-mail). Commentary accepted for publica-
tion February 2009 (doi: 10.1176/appi.ajp.2009.08121847).

Dr. Friedman reports no competing interests.

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