Hey Norto...

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Doc Samson

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...or anyone else who's interested.

I was chatting with one of my supervisors about our discussion of if psychotherapy can (or should) be evidence based, and he pointed to a series of articles from the early 1990s that came to be known as the Stone-Klerman debate. It all revolves around a case of a nephrologist who sued a psychoanalytic hospital in the 1970s for not using "evidence based" tx to treat his depression and focusing only on therapy for his narcissistic personality DO.
Dr. Klerman (at Cornell at the time, previously at Mass Mental) wrote an article in favor of the need to adherence of evidence-based treatment over empiric clinical experience.
Dr. Stone (then at McLean, now Professor at Harvard Law - and writing movie reviews for the psychiatric times) wrote a rebuttal which, among other things, emphasized that empiric clinical experience is based on decades of work, while even the best "evidence" in psychiatry can be uncertain.
The initial articles are good reading, but the series of letters to the editor that follow get pretty emphatic (and funny). Even the patient chimes in (perhaps underscoring the dx of narcissistic PDO). if you've got the time, well worth it.


Klerman GL. The psychiatric patient's right to effective treatment: implications of Osheroff v. Chestnut Lodge. Am J Psychiatry. 1990 Apr;147(4):409-18.

Stone AA. Law, science, and psychiatric malpractice: a response to Klerman's indictment of psychoanalytic psychiatry. Am J Psychiatry. 1990 Apr;147(4):419-27.
 
Doc Samson said:
...or anyone else who's interested.

I was chatting with one of my supervisors about our discussion of if psychotherapy can (or should) be evidence based, and he pointed to a series of articles from the early 1990s that came to be known as the Stone-Klerman debate. It all revolves around a case of a nephrologist who sued a psychoanalytic hospital in the 1970s for not using "evidence based" tx to treat his depression and focusing only on therapy for his narcissistic personality DO.
Dr. Klerman (at Cornell at the time, previously at Mass Mental) wrote an article in favor of the need to adherence of evidence-based treatment over empiric clinical experience.
Dr. Stone (then at McLean, now Professor at Harvard Law - and writing movie reviews for the psychiatric times) wrote a rebuttal which, among other things, emphasized that empiric clinical experience is based on decades of work, while even the best "evidence" in psychiatry can be uncertain.
The initial articles are good reading, but the series of letters to the editor that follow get pretty emphatic (and funny). Even the patient chimes in (perhaps underscoring the dx of narcissistic PDO). if you've got the time, well worth it.


Klerman GL. The psychiatric patient's right to effective treatment: implications of Osheroff v. Chestnut Lodge. Am J Psychiatry. 1990 Apr;147(4):409-18.

Stone AA. Law, science, and psychiatric malpractice: a response to Klerman's indictment of psychoanalytic psychiatry. Am J Psychiatry. 1990 Apr;147(4):419-27.

Thanks Doc. Sounds fascinating. I'll get the articles on my next trip to the library and let you know what I think.
 
nortomaso said:
Thanks Doc. Sounds fascinating. I'll get the articles on my next trip to the library and let you know what I think.


In the meantime, I reread the account given by Shorter in his "History of Psychiatry":

"In 1979, Osheroff, a 42 year-old physician from Alexandria, Virginia was admitted to Chestnut Lodge with the symptoms of psychotic depression. In the course of his seven-month stay at 'The Lodge' he was treated with four sessions of intensive psychotherapy a week and denied medication despite his own requests, on the apparent grounds that his clinicians wanted him to regress back to the point in childhood at which the initial trauma occured and then 'build' back from there."
 
nortomaso said:
In the meantime, I reread the account given by Shorter in his "History of Psychiatry":

"In 1979, Osheroff, a 42 year-old physician from Alexandria, Virginia was admitted to Chestnut Lodge with the symptoms of psychotic depression. In the course of his seven-month stay at 'The Lodge' he was treated with four sessions of intensive psychotherapy a week and denied medication despite his own requests, on the apparent grounds that his clinicians wanted him to regress back to the point in childhood at which the initial trauma occured and then 'build' back from there."


Right, that's pretty much how Klerman spins it too. Stone fleshes out the clinical picture a little more, especially the Axis II stuff.
 

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