An Open Letter to Matt Lauer

Your interview with Tom Cruise is an evocative tour de force. You were criticized, admonished and belittled. Is it possible for someone to be condescending squared? You maintained total composure and continued to elicit additional information and opinion. You aroused in him the passion he feels about this subject. You weren’t critical but you shared from your experience enough to hopefully leave the viewer with the idea – Matt seems reasonable and Tom seems over the top.

Imagine yourself sitting in an emergency room as part of your training to be a psychiatrist. Tom Cruise is brought in by two sheriff’s deputies. His family has gone to a mental illness court and convinced a judge that there is sufficient evidence of a mental disorder and that he could be potentially dangerous to self or others. As a psychiatric resident in training it is your job to evaluate his mental status and decide whether he needs to be committed. During the interview he tells you that you are "glib". He says, "you don’t understand, I do". He tells you he doesn’t agree with psychiatry and never has. He generalizes that antidepressants and stimulants are antipsychotics. He says, "you don’t know the history, I do and there’s no such thing as a chemical imbalance". He tells you that you are irresponsible when you say that some people have been helped by these types of medication.

You, of course know that religion is based on faith. You accept it or you don’t. Philosophy is based on logic – it invites argument and discussion. Science is based on hypotheses/theories and invites data. If new data comes out that doesn’t support the hypotheses/theory further careful research confirms the new data – you modify the theory. An example of science is the blood pressure range that is considered normal. When new data found that systolic pressure of 130-140, or diastolic of 80-90 was associated with increased heart disease the standard for blood pressure was lowered.

Covey talks about principles that are timeless and unassailable. He compares these principles to the direction north. If you and I are lost and we disagree as to which way is north – one of us may be more persuasive or passionate, or we could take a vote but that wouldn’t change the fact that north is north.

An example of an unarguable principle is that prejudice and racism is wrong. Harming someone because of their color, religion, or sexual preference has always been and will always be wrong. Is it possible that I’m wrong? No, I feel passionate about that – not because it’s science but because it is an ethical principle. Tom Cruise treats religion, philosophy, and science as though they all follow the same rules.

Cruise says that psychiatry is pseudoscience, that medication "masks the problem" and that postpartum depression and other mental health problems can be better solved with vitamins and exercise.

Go back to our emergency room scene. You ask Mr. Cruise, "is it possible that you’re wrong?" He would of course reply in an agitated voice, "absolutely not"! An opinion or belief that is adamantly defended as a fact is a delusion.

Now you have a patient who is agitated and delusional. Your next question, "is he likely to do harm to himself or others?" He’s a celebrity. He has a huge fan base. He seems knowledgeable and speaks with authority. There may be many people who might think, "he’s right", and stop their medication. The consequences could be harmful or even deadly.

As a responsible physician your only choice is to hospitalize him. He would obviously refuse medication – especially antipsychotics. He accuses you of being part of a plot to control the world with medication (Brave New World). You know medication would help him. You also know that he will sue you if you force him to take it. You don’t know what to do. A nurse approaches you – "Dr. Lauer, there is a mob of people surrounding the hospital. They have come to set Tom free. They are threatening to break in. They are threatening you".

You decide, "this is not worth it!" He won’t let me treat him anyway. You write the order to let him go. His fans cheer. The crowd dissipates. Fortunately they didn’t know which car was yours so it’s still in one piece. You sit quietly pondering your day. Suddenly you have an epiphany. You go to the director of training. You say, "I am resigning from my psychiatry residency. I’ve decided to become a television news show anchorman!"

P.S. I don’t think he’s really psychotic, but too much narcissism where intelligence and accurate information would serve him better.