Psychiatry DID Promote the Chemical Imbalance Theory

On April 15, Ronald Pies, MD, an eminent and widely published psychiatrist, wrote an article for  The piece is titled Nuances, Narratives, and the ‘Chemical Imbalance’ Debate in Psychiatry.

The main thrust of the article is that:

“…the ‘chemical imbalance theory’ was never a real theory, nor was it widely propounded by responsible practitioners in the field of psychiatry.”

This is not the first time that Dr. Pies has made this claim,  On July 11, 2011, he wrote an article for Psychiatric Times titled Psychiatry’s New Brain-Mind and the Legend of the “Chemical Imbalance.”  In that article he wrote:

“In truth, the ‘chemical imbalance’ notion was always a kind of urban legend- – never a theory seriously propounded by well-informed psychiatrists.”

And on September 2, 2011, in the comments section of the above post:

“But I stand by my claim that no respected representatives of the profession seriously asserted a simple, “chemical imbalance” theory of mental illness in general.”

At the present time psychiatry, because of intense pressure from its critics, is retreating somewhat from the chemical imbalance theory.  But instead of acknowledging that this notion was flawed, that they knew it was flawed, and that they promoted it for self-gain, they are claiming that they never really said it in the first place.

Dr. Pies is a major spokesman for this particular piece of spin:

“In the narrative of the antipsychiatry movement, a monolithic entity called ‘Psychiatry’ has deliberately misled the public as to the causes of mental illness, by failing to debunk the chemical imbalance hypothesis. Indeed, this narrative insists that, by promoting this little white lie, psychiatry betrayed the public trust and made it seem as if psychiatrists had magic bullets for psychiatric disorders. (Lurking in the back-story, of course, is Big Pharma, said to be in cahoots with Psychiatry so as to sell more drugs).”

Note the euphemism “little white lie.”  Great big black whopper would be more accurate.  And it was a betrayal of the public trust; and it did create the impression that psychiatrists had magic bullets for depression and other human problems; and it did induce people, who might not otherwise have done so, to take psychiatric drugs; and Big Pharma was, and still is, in cahoots with psychiatry.  (69% of the DSM-5 Task Force had financial links to pharma!)

Dr. Pies continues:

“But then, why do antipsychiatry groups and bloggers fail to note the nuances of what psychiatrists have been saying for at least the past decade? My guess is that doing so would undermine the derogatory narrative they wish to promote. And, of course, nuanced statements do not gin up public opinion or sell books.”

Note the ad hominem attack.  We antipsychiatry groups and bloggers simply want to promote a “derogatory narrative,” gin up public opinion, and sell books.  This kind of attack is so much easier than actually addressing the issues that we raise.


“…but it’s probably true that some psychiatrists did hold a purely biocentric view; and, alas, some undoubtedly used the expression ‘chemical imbalance’ in their clinical practice, without putting it into a broader context for their patients.”

A few bad eggs.  Tsk, Tsk!


“That said, I am not aware of any concerted effort by academic psychiatrists, psychiatric textbooks, or official psychiatric organizations to promote a simplistic chemical imbalance hypothesis of mental illness.”

In conclusion, Dr. Pies embarks on the daunting task of demonstrating that the biopsychosocial model has been the essential underpinning of psychiatric theory (and presumably practice) since the 1980’s.  He quotes passages from Theodore Nadelson, MD, Eric Kandel, MD, and from his own writings.

Commenting on Dr. Nadelson’s writing, Dr. Pies says:

“Ted Nadelson understood that the brain is the crucible in which all the elements of human life intermingle, including our genetic makeup; our brain chemistry; and the influences of parents, culture, ethnicity, and even diet. Derangements, deficiencies or abnormalities in any of these biopsychosocial elements can lead to what we call, for lack of a better term, mental illness, which often represents the end result of innumerable interacting ‘pathogens.'”

Note the truly exquisite piece of spin – “…what we call, for lack of a better term, mental illness….”  The primary issue in the present debate is that the various problems of thinking, feeling, and/or behaving that psychiatry labels mental illnesses are not illnesses.  That’s the kernel of the debate.  Dr. Pies is obviously aware of this, but in characteristic psychiatric style, he ducks the issue and pretends that they just call them illnesses “for want of a better term.”  If he would actually read some of the anti-psychiatry material that he dismisses so perfunctorily, he would come across a great many better terms, e.g.: human distress; painful memories; loneliness; sadness; despondency; feeling overwhelmed; feeling underappreciated; being a victim of abuse; sense of powerlessness; loss of hope; frustration; anger; etc..  Or how about:  problems of thinking, feeling, and/or behaving?  Or how about just asking the client to describe the problem in his/her own words?

Psychiatrists call all significant problems of thinking, feeling, and/or behaving illnesses, not for want of a better term, but rather to establish their professional turf and to legitimize their role in the distribution of psychoactive drugs.  For the past 60 years this has been their primary agenda, to which they have routinely subordinated considerations of cogency, scientific validity, ethical practice, and human respect.

Dr. Pies’ quote from Dr. Kandel is particularly interesting:

“‘…all mental processes, even the most complex psychological processes, derive from operations of the brain…as a corollary, behavioral disorders that characterize psychiatric illness are disturbances of brain function, even in those cases where the causes of the disturbances are clearly environmental in origin.’…But in practice, Kandel is no biological reductionist. He is certainly no fan of a chemical imbalance hypothesis! Rather, Kandel paints a picture of the new psychiatry, in which psychoanalytic and biological constructs complement and reinforce one another.” [Emphasis added]

It seems to me that the quote from Dr. Kandel refutes Dr. Pies’ contention.  Dr. Kandel says quite clearly that “… behavioral disorders that characterize psychiatric illness are disturbances of brain function even in those cases where the causes of the disturbances are clearly environmental in origin.” [Emphasis added].

Dr. Pies concludes his article:

“It is time for psychiatry’s critics to drop the conspiratorial narrative of the ‘chemical imbalance’ and acknowledge psychiatry’s efforts at integrating biological and psychosocial insights.”


As is often the case in critiquing psychiatric claims, it’s difficult to know where to start or, indeed, where to finish.  What’s perhaps most surprising about Dr. Pies’ current paper is that he wrote it at all.  Most of psychiatry’s so-called thought leaders are just letting this particularly shameful episode of their history die a natural death.

The fact is that psychiatry, at both the organized and individual level, did promote, in characteristically dogmatic fashion, the notion that depression and other significant problems of thinking, feeling, and/or behaving are caused by chemical imbalances in the brain, and are best treated by drugs and other somatic measures.  Nor was this an innocent error.  They promoted this fiction even though they knew that it was false, because it suited their purposes and the purposes of their pharmaceutical allies.

This falsehood was promoted vigorously by psychiatrists and by pharma, and tragically has been accepted as fact by two generations in western countries and increasingly in other parts of the world.  Here are some unambiguous quotes from eminent psychiatrists, whom one might reasonably expect to have been “well-informed.”

“In the last decade, neuroscience and psychiatric research has begun to unlock the brain’s secrets.  We now know that mental illnesses – such as depression or schizophrenia – are not “moral weaknesses” or “imagined” but real diseases caused by abnormalities of brain structure and imbalances of chemicals in the brain.”  Unlocking the Brain’s Secrets, by Richard Harding, MD, then President of the APA, in Family Circle magazine, November 20, 2001, p 62.

 “More serious depression, or depression that is quickly getting worse, should be treated with medication. Antidepressants are not “uppers” and they have no effect on normal mood.  They restore brain chemistry to normal.”  About Depression in Women, by Nada L. Stotland, MD, Professor, Departments of Psychiatry and Obstetrics/Gynecology, Rush Medical College Chicago, and subsequently President of the APA.  Op.Cit., p 65.

“ADHD often runs in families.  Parents of ADHD youth often have ADHD themselves.  The disorder is related to an inadequate supply of chemical messengers of the nerve cells in specific regions of the brain related to attention, activity, inhibitions, and mental operations.”  Paying Attention to ADHD, by Timothy Wilens, MD, Associate Professor of Psychiatry at Harvard Medical School, and Psychiatrist at Massachusetts General Hospital.  Op. Cit., p 65

As noted, the three passages quoted above did not occur in peer reviewed journals or in a psychiatry trade magazine.  They occurred in Family Circle magazine, with the obvious intention of selling this theory to mothers.  This was no accident.  The articles in question were part of a “special advertizing feature” and were interlaced with ads for Paxil (paroxetine) and Metadate (methylphenidate).  This was a deliberate move to lend psychiatric support to the advertisers, and to dupe the readership.  Dr. Harding makes the point explicitly:  “Woman, especially, can lead the way in identifying mental disease in their families, friends, and loved ones – and in themselves.”

Dr. Wilens continues the theme:  “Contrary to what most parents think, medication is one of the most important treatments for ADHD and is essential for long-term success of these kids.”

But let’s hear from another eminent promoter of the chemical imbalance theory, Jeffrey Lieberman, MD:

“…the way nerves talk to each other, and communicate, is through the secretion of a chemical called a neurotransmitter, which stimulates the circuit to be activated.  And when this regulation of chemical neurotransmission is disturbed, you have the alterations in the functions that those brain areas are supposed to, to mediate.  So in a condition like depression, or mania, which occurs in bipolar disorder, you have a disturbance in the neurochemistry in the part of the brain that regulates emotion.”  Causes of Depression, a video by Jeffrey Lieberman, MD, Psychiatrist-in-Chief at NewYork Presbyterian/Columbia University Medical Center, and then President-elect of the APA.  Video made by The University Hospital of Columbia and Cornell. (June 19, 2012)

The chemical imbalance theory was also given clear and forceful expression in Nancy Andreasen’s book The Broken Brain: The Biological Revolution in Psychiatry (1984).  Here are some quotes:

“When we talk, think, feel, or dream, each of these mental functions is due to electrical impulses passing through the complicated and highly specialized electrical circuits that make up the human brain.  The messages passed along these circuits are transmitted and modulated primarily through chemical processes.  Mental illnesses are due to disruptions in the normal flow of messages through this circuitry, and these ‘breaks’ in the brain can occur in many different ways.  The nerves forming command centers may become ill or wear out and die.  The wires may lose their insulation.  Some neurons may in a sense become ‘overheated’ and send or receive too many chemical messages.  Short circuits may occur so that new connections are formed that should not be there, or command centers may become disconnected from one another through the loss of the wiring between them.” (p 219) [Emphases added]

“The various forms of mental illness are due to many different types of brain abnormalities, including the loss of nerve cells and excesses and deficits in chemical transmission between neurons; sometimes the fault may be in the pattern of the wiring or circuitry, sometimes in the command centers, and sometimes in the way messages move along the wires.” (p 221) [Emphasis added]

And psychotherapy is relegated to the task of helping people adjust to the consequences of having a brain illness:

“While the patient may require a somatic therapy to correct an underlying chemical imbalance, he may also need psychotherapy to deal with the personal and social consequences of his illness.  He may need help with his marriage, with learning to find a new type of work, or simply with learning to live with the fact that he has had an episode of mental illness.” (p 256)

Nancy Andreasen, MD, PhD, is an eminent psychiatrist.  She is currently Chair of Psychiatry at the University of Iowa.  She served on the DSM-III and DSM-IV Task Forces, and reportedly wrote the definition of PTSD for DSM-III.  She is past president of the American Psychopathological Association and the Psychiatric Research Society.  She has received numerous awards and, according to Wikipedia, is “one of the world’s foremost authorities on schizophrenia.”

The Broken Brain  was well received by psychiatry.  In May 1985, a book review written by Hagop S. Akiskal, MD appeared in the American Journal of Psychiatry.  This review was extremely positive.  Here’s a quote:

“Dr. Andreasen’s brilliant exposition effectively counters those who believe that psychiatric illness represents moral turpitude, inadequacy, eccentricity, or social marginality, as well as the lay belief to the effect that the professionals who treat such ills lack moral fiber.  The accuracy of her analysis of the history of ideas and current trends, coupled with her compelling prose, renders The Broken Brain the most cogent single work on what psychiatry is about.  It should be required reading in high schools, colleges, and medical schools.” [Emphasis added]

Dr. Akiskal is also an eminent psychiatrist.  According to his bio, he was Professor of Psychiatry and Psychopharmacology at the University of Tennessee from 1972 to 1990, and was the Senior Science Advisor to the Director of NIMH from 1990 to 1994.  He is currently Professor of Psychiatry at the University of California at San Diego, and since 1996 has been Editor-in-Chief of the Journal of Affective Disorders.  He has received several awards, including the Jean Delay Prize for international collaborative research from the World Psychiatry Association.

Morris Lipton, PhD, MD, wrote an opinion piece for the American Journal of Psychiatry (September, 1970, p 133).  The article is titled Affective Disorders:  Progress, But Some Unresolved Questions Remain.  Here’s a quote:

“Since the pharmacological agents that ameliorate depression and mania appear to act upon and alter the concentration and metabolism of the biogenic amines in what are presumably corrective directions, it may be inferred that in the affective disorders there exists a chemical pathology related to these compounds…positive evidence is slowly accumulating and negative evidence is thus far lacking.” [Emphasis added]

The late Dr. Lipton was a psychiatrist who had served on the faculty at both the University of Chicago and Northwestern University, and at the time of writing was Professor and Chair of Psychiatry at the University of North Carolina at Chapel Hill.

Daniel Amen, MD, is a very successful American psychiatrist.  He is the author of more than 30 books, five of which have been on the NY Times bestsellers list.  Here are two quotes from Change Your Brain, Change Your Life (1998), one of his bestsellers.

“Depression is known to be caused by a deficit of certain neurochemicals or neurotransmitters, especially norepinephrine and serotonin.” (p 47)

“Through the SPECT [single photon emission computed tomography] research done in my clinic, along with the brain imaging and genetic work done by others, we have found that ADD is basically a genetically inherited disorder of the pfc [pre-frontal cortex] due in part to a deficiency of the neurotransmitter dopamine.” (p 117)

Dr. Amen is certified by the American Board of Psychiatry and Neurology in both General Psychiatry and in Child and Adolescent Psychiatry.  He is CEO and Medical Director of the six Amen Clinics.  Dr. Amen has had many critics, including some psychiatrists.  But these criticisms have focused on his use of SPECT scans to confirm psychiatric “diagnoses” and to monitor treatment progress.  I have not been able to find a single psychiatrist who criticized Dr. Amen for the kinds of chemical imbalance claims quoted above.  Indeed, when psychiatrist Andrew Leuchter wrote a book review for the American Journal of Psychiatry (May 2009) on Dr. Amen’s book Healing the Hardware of the Soul,  he criticized what he felt was unwarranted use of SPECT scans, but also stated:

“Dr. Amen makes a good case for the use of brain imaging to explain and medicalize mental disorders.” [Emphasis added]

“While these imaging studies undoubtedly educate patients and families about the fact that psychiatric disorders are bona fide medical illnesses, it is not clear how the SPECT image provides reliable information that informs clinical decisions.” [Emphasis added]

In addition, it should be noted that Dr. Amen is a Distinguished Fellow of the APA.

It should also be noted that Dr. Leuchter is a Psychiatry Professor at the University of California at Los Angeles.  According to his UCLA bio, he is a frequently published author, and is a reviewer for a number of scientific journals.


Although the great majority of psychiatrists adopted the chemical imbalance theory enthusiastically, there were a few dissenters, and some of these expressions of dissent provide a telling contrast to Dr. Pies’ claim.

Elio Frattaroli, MD, Assistant Clinical Professor of Psychiatry at the University of Pennsylvania, spoke at the APA’s 52nd Institute on Psychiatric Services (October 2000).  Here’s a quote from the printed summary on page 66:

“Over the last quarter century there has been a dramatic erosion of psychotherapeutic training and practice in psychiatry, caused largely by a change in our philosophical beliefs.  Psychopharmacology has replaced psychotherapy because brain has replaced soul – i.e., chemical imbalance has replaced inner conflict – as the philosophical basis for psychiatric explanation. We no longer consider it important to trouble ourselves with the inner lives of our patients – the nuances of thought, feeling, impulse, and imagery in their minds and souls.  We consider these private experiences that are of such deep concern to our patients to be largely irrelevant to their symptoms and personality problems, which we believe are caused directly by chemical imbalances in the brain.” (p 66) [Emphasis added]

And the late Loren Mosher’s 1998 letter of resignation from the APA contains the following:

“No longer do we seek to understand whole persons in their social contexts – – rather we are there to realign our patients’ neurotransmitters.”

Loren Mosher, MD, (1933-2004) received his medical and psychiatric training at Harvard.  He taught psychiatry at Yale.  He was Chief of NIMH’s Center for Studies of Schizophrenia.  He founded the journal Schizophrenia Bulletin.  He was a Professor of Psychiatry at Uniformed Services University, Bethesda, and at the University of California, San Diego.

And Steven Sharfstein, MD, President of the APA (2005-2006), writing in Psychiatric News on August 19, 2005:

“As we address these Big Pharma issues, we must examine the fact that as a profession, we have allowed the biopsychosocial model to become the bio-bio-bio model.” [Emphasis added]

It is clear that all these psychiatrists quoted above are confirming and lamenting the fact that psychiatric practice is dominated by exclusively biological perspectives.


Dr. Pies is correct on one specific matter:  psychiatric textbooks generally don’t endorse or promote a simplistic chemical imbalance theory.  Textbooks, by their very nature, discuss controversial subject matter from various aspects, and seldom come down heavily in favor of a specific theory.  However, I did find this passage in Tasman, Kay, and Lieberman (eds.), Psychiatry (2003).  It’s on page 290, Volume 1.  The chapter was written by Robert Freedman, MD, Professor and Chairman, Department of Psychiatry, University of Colorado.

“A final reason for studying the mechanisms of psychopathology is to inform our patients, their families, and society of the causes of mental illness.  At some time in the course of their illness, most patients and families need some explanation of what has happened and why.  Sometimes the explanation is as simplistic as ‘a chemical imbalance,’ while other patients and families may request brain imaging so that they can see the possible psychopathology or genetic analyses to calculate genetic risk.”

The passage is not very clear, but does seem to suggest that it’s OK to tell clients and their families the chemical imbalance falsehood, if they ask for an explanation,

. . . . . . . . . . . . . . .

In the light of all of which, it’s difficult to afford credence to Dr. Pies’ contention that “…the ‘chemical imbalance’ theory was never a real theory, nor was it widely propounded by responsible practitioners in the field.”

And I need to stress, firstly, that it did not take a great deal of searching to find the passages quoted above, and secondly, that I limited my search to psychiatrists who had achieved a measure of eminence or stature within their profession.  A less stringent search would have uncovered a great many more proponents of this theory.  I constrained my search in this way because that was the challenge that Dr. Pies laid down.  But in fact it’s a pointless restriction.  A psychiatrist who is irresponsible, ill-informed, or unrespected can disseminate falsehoods as readily and as effectively as psychiatrists of standing.

And further, it should be mentioned that psychiatry’s promotion of this theory was never any secret.  I have personally heard it proclaimed by many psychiatrists, both in private conversations and in public speeches.  I have also heard literally hundreds of clients say that they had been assured by their psychiatrists that they had a “chemical imbalance” in their brains, to remediate which they needed to take psychiatric drugs.  Fred Baughman, MD, retired neurologist, critiqued the Family Circle articles mentioned above in June 2005.


Another way that organized psychiatry has promoted the chemical imbalance notion is through the so-called consumer groups.  In a 2014 brochure under the tab “links for more information,” the APA lists a number of “Resources” including the following:

  • Child & Adolescent Bipolar Foundation (CABF, now known as The Balanced Mind Foundation/Parent Network)
  • Depression and Bipolar Support Alliance (DBSA)
  • Mental Health America (MHA)
  • National Alliance for the Mentally Ill (NAMI

Each of these organizations has endorsed the chemical imbalance theory wholeheartedly.

Here are some quotes from documents on their webpages:


“Depression is a medical illness caused by a chemical imbalance in the brain.” (here)

“Antidepressant medications work to restore proper chemical balance in the brain.” (here)

“Bipolar disorder is a chemical imbalance, which means someone with bipolar needs medicine to regulate his or her moods.” (here)

The Balanced Mind Parent Network Scientific Advisory Council consists of 26 psychiatrists, including:

  • Joseph Biederman, MD, Professor of Psychiatry at Harvard Medical School, Chief, Clinical and Research Programs in Pediatric Psychopharmacology Massachusetts General Hospital and McLean Hospital
  • Gabrielle Carlson, MD, Professor of Psychiatry and Pediatrics, Director of Child and Adolescent Psychiatry, Stonybrook State University
  • Kiki Chang, MD, Associate Professor and Director of Pediatric Bipolar Disorders Program, Child and Adolescent Psychiatry, Stanford University
  • Melissa DelBello, MD, MS, Professor of Psychiatry and Pediatrics, Vice Chair of Clinical Research, Co-Director, Division of Bipolar Disorders Research, University of Cincinnati
  • Robert L. Findling, MD, Director Child and Adolescent Psychiatry, University Hospitals of Cleveland; Professor of Child & Adolescent Psychiatry, Case Western Reserve University
  • Janet Wozniak, MD, Director, Pediatric Bipolar Disorder Research Program; Assistant Professor of Psychiatry, Harvard Medical School and Massachusetts General Hospital


“Depression is caused by a chemical imbalance in the brain.”(here)

“Scientists believe that depression and bipolar disorder are caused by an imbalance of brain chemicals called neurotransmitters.”(here)

“People with depression have an imbalance of certain brain chemicals known as neurotransmitters.”(here)

DBSA has a Scientific Advisory Board, the membership of which includes the following eminent, and presumably “well-informed” psychiatrists:

  • Gregory E. Simon, MD, MPH, Psychiatrist and Senior Investigator, GroupHealth Research Institute, Seattle
  • Michael E. Thase, MD, Professor of Psychiatry. University of Pittsburgh
  • Mark S. Bauer, MD, Associate Professor of Psychiatry, Brown University School of Medicine
  • Joseph R. Calabrese, MD, Professor of Psychiatry and Director of Mood Disorders Program, Case Western Reserve University
  • David J. Kupfer, MD, Professor & Chairman Department of Psychiatry, University of Pittsburgh (and Chair of the DSM-5 taskforce)
  • George S. Alexopoulos, MD, Professor of Psychiatry, Cornell University
  • Gary Sachs, MD, Director, Bipolar Research Program, Harvard University
  • Mark A. Frye, MD, Professor of Psychiatry, Mayo Clinic
  • J. Raymond DePaulo Jr. MD, Professor of Psychiatry, Johns Hopkins
  • William Beardslee, MD, Psychiatrist-in-Chief, Children’s Hospital, Boston


“People with schizophrenia have a chemical imbalance of brain chemicals (serotonin and dopamine) which are neurotransmitters.”(here)

“The presence of bipolar disorder indicates a biochemical imbalance which alters a person’s moods.”(here)

“…the disorder [ADHD] is genetically transmitted and is caused by an imbalance or deficiency in certain chemicals that regulate the efficiency with which the brain controls behavior.”(here)


“Scientists believe that if there is a chemical imbalance in these neurotransmitters [norepinephrine, serotonin, dopamine], then clinical states of depression result.” (here)

“A large body of scientific evidence suggests that OCD results from a chemical imbalance in the brain.”(here)

“…despite the knowledge that most mental illnesses are caused by chemical imbalances…there is a stigma surrounding mental illness.” (here)

The most recent list of NAMI’s Scientific Council includes the following eminent and presumably “well-informed” psychiatrists:

  • Nancy Andreasen, MD, PhD:  Chair of Psychiatry and Director of the Mental Health Clinical Research Center at The University of Iowa College of Medicine.
  • Ellen Frank, PhD:  Professor of Psychiatry and Psychology at the University ofPittsburgh School of Medicine; member of the Mood Disorders Workgroup of the DSM-5 Task Force.
  • David Kupfer, MD:  Professor of Psychiatry and Professor of Neuroscience, University of Pittsburgh School of Medicine; Chair of the DSM-5 Task Force.
  • Jeffrey Lieberman, MD:  Chair of Psychiatry, Columbia University; Director of the New York State Psychiatric Institute; Psychiatrist in Chief at NewYork-Presbyterian Hospital – Columbia University Medical Center; immediate Past President of the APA.
  • Henry Nasrallah, MD:  Associate Dean; Professor of Psychiatry and Neuroscience, Director of the Schizophrenia Program, University of Cincinnati.
  • Charles Nemeroff, MD:  Chair of Psychiatry and Behavioral Sciences and Director, Center on Aging, University of Miami Health System.
  • S. Charles Schulz, MD:  Professor and Chair, Department of Psychiatry, University of Minnesota Medical School.

NAMI’s Medical Director is Kenneth Duckworth, MD, Assistant Clinical Professor at Harvard University Medical School.

Is it not reasonable to assume that all these eminent psychiatrists endorse the chemical imbalance illness theory so clearly set out in the above quotes?  If these psychiatrists were as skeptical of this theory as Dr. Pies implies, shouldn’t they have taken steps to have the brochures changed?  Or was this just a “little white lie?”  What’s the point of having a scientific advisory board, if it doesn’t provide scientific advice?

And remember, all four of these organizations are on the APA’s “Links for more information” tab.  If the APA does not, in fact, endorse the chemical imbalance theory, wouldn’t it be more appropriate to label this tab:  “Links for disinformation”?  The chemical imbalance theory, as Dr. Pies so rightly states, is simplistic nonsense.  So why does the APA promote these organizations on its website?  Isn’t it, at the very least, a reasonable conjecture that the APA leaves these links in place from considerations of self-interest?  Has there ever been an attempt by the APA or any of its members to educate these organizations on these matters?

At the foot of the 2014 Resources document, the APA have inserted the disclaimer:  “These links are provided as a convenience and do not imply endorsement.”  But if they are not endorsing the various organizations’ stance on the chemical imbalance theory, why in the world would they list them as a resource for “more information?”  And isn’t it obvious that a person clicking on the “Links for more information” tab will likely go to these links, and will likely not go to the bottom of the page to read the disclaimer?  If the APA genuinely wanted to disavow the spurious chemical imbalance theory, wouldn’t they have put the disclaimer at the top of the page, or removed the links altogether?

Dr. Pies has not himself, as far as I can tell, ever promoted the chemical imbalance theory.  He recognizes it as nonsense, and is anxious to distance his chosen profession from this deception.  And this perhaps understandable human desire is blinding him to some unsavory realities.  What he is doing essentially, is cherry-picking references to support his contention, while ignoring the very large body of contrary evidence.

But he’s also doing something else.  By drawing us into a debate as to whether or not psychiatrists promoted the chemical imbalance lie, he is deflecting attention from the much more fundamental lie:  that all problems of thinking, feeling, and/or behaving are illnesses.  In comparison with this monstrous falsehood, the specifics of the putative illness are trivial.

Dr. Pies has not only promoted this monstrous falsehood, he has insulated this falsehood from any possibility of rebuttal by the simple expedient of redefining the word disease.  In his paper Context Does Not Determine ‘Disorderness’ or Normality, (April 2013) he states:

“Regardless of context, once a certain threshold of suffering and incapacity is crossed, physicians justifiably apply the term ‘disease’ (or ‘disorder’) to the person’s condition. (For purposes of this discussion, I am using the terms ‘disease’ and ‘disorder’ more or less synonymously, although the medical literature is remarkably inconsistent in how these terms are applied.…) This is also true of maladaptive symptoms attributed to the patient’s developmental context….  It is of course true that temper tantrums in a 2-year-old—or moodiness and impulsivity in an adolescent—are very often developmentally normal. But once a certain threshold of suffering and incapacity is crossed, we rightly impute disorderness to the child’s condition, make a diagnosis, and offer appropriate treatment. That the child’s symptoms occur in an understandable context does not render our diagnosis a ‘false positive.’ Context helps explain pathology—it does not annul it.”

And in case there might be any residual ambiguity, in April 2013 in Psychiatry and the Myth of ‘Medicalization’, he wrote:

“So long as the patient is experiencing a substantial or enduring state of suffering and incapacity, the patient has disease….”

So if a person is significantly suffering and incapacitated, from any cause – not just physical pathology – he has a disease.  Dr. Pies acknowledges that all three terms – significantly, suffering, and incapacitated – defy definition and measurement.  But he promptly dismisses these concerns, and focuses instead on “…the first duty of all physicians is to relieve pronounced or prolonged suffering and incapacity.”

But what he ignores entirely is that this is not the normal meaning of the word “disease.”  In its normal usage, the word “disease” implies physical pathology.  Indeed, even psychiatrists acknowledged this implicitly when, for decades, they told their clients that depression was an illness “just like diabetes.”  The phrase “just like diabetes” makes it perfectly clear that they were not using the word “illness” in Dr. Pies’ arbitrary and esoteric sense, but rather in the conventional sense of organic pathology – and this is how psychiatric clients and the public generally interpret this statement.

Dr. Pies’ statement above that “…the first duty of all physicians is to relieve pronounced or prolonged suffering and incapacity” is seductively convincing, but in fact is false.  It is a physician’s business to relieve suffering and incapacity that is caused by organic pathology.  I think this is how the great majority of non-psychiatric physicians would conceptualize their role.  I’m not saying that physicians shouldn’t be allowed to branch out into other areas.  Plumbers can do carpentry work.  In fact, most plumbers have to do some carpentry to expose pipes and tidy up afterwards, etc…  But a plumber who conceptualized all carpentry problems as leaks, and tried to fix these problems with copper pipe and solder, would not be very successful.  In the same way, physicians who conceptualize non-medical problems as illnesses do more harm than good.

Dr. Pies’ definition of disease is just one more attempt on the part of psychiatry to prolong the destructive deception:  that all problems of thinking, feeling, and/or behaving are illnesses.

This is emphatically not an academic debate. The illness/disease concept is the fundamental underpinning and justification for the administration of drugs and other somatic “treatments.”  If the illness lie collapses, then psychiatrists are exposed as the frauds and drug pushers that they are.  The “illness” lie is actually a mechanism that psychiatrists use to overcome clients’ resistance to taking psychoactive chemicals, and as a marketing tactic it has been extraordinarily successful.  The fact is that psychiatric drugs distort and impair neural functioning.  But if people can be convinced that the opposite is the case – that the drugs actually correct a neurochemical imbalance, or a neural circuitry anomaly, or whatever, then consumer resistance diminishes, and the marketing battle is as good as won.

Fortunately, the neurotransmitter imbalance deception has been so discredited in recent years that, as mentioned earlier, it is being quietly slipped to the wings, but the notion that all problems of thinking, feeling, and/or behaving are illnesses is alive and well, and is still being actively promoted by psychiatry.  In 2005, the APA published an “educational” brochure titled Let’s Talk Facts About Depression.  Here’s the opening sentence:

“Depression is a serious medical illness that negatively affects how you feel, the way you think and how you act.” [Emphasis added]

In 2014, nine years later, they produced another brochure, this one titled simply Depression.  Here’s the opening sentence:

“Depression is a serious medical illness that negatively affects how you feel, the way you think and how you act.”

Apparently not much had changed between 2005 and 2014.  Incidentally, there’s a truly delightful piece of psychiatric side-shuffle in the closing paragraph in the 2005 paper mentioned above.

“This brochure was developed for educational purposes and does not necessarily reflect opinion or policy of the American Psychiatric Association.”

Why in the world would a professional association put a disclaimer of that sort on an educational brochure?  What are they saying?  Our educational material does not necessarily reflect our opinion or our policy?  We know that there are some lies in here, and we will repudiate them in the future if it becomes expedient to do so?


In one of the passages quoted earlier, Dr. Pies mockingly rejected the notion that psychiatry was “in cahoots” with Big Pharma.  In fact, of the 31 psychiatrists mentioned in this post as promoting the chemical imbalance theory, or of being on the advisory boards of consumer organizations that promote this theory, 19 (61%) have, or had, financial ties to one or more pharmaceutical companies.  (Sources: Dollars for Docs and journal article disclosures.)


So to recap, Dr. Pies’ insistence that the chemical imbalance theory was never “…widely propounded by responsible practitioners in the field of psychiatry” is simply false.  (unless, of course, the statement is meant to reflect the paucity of responsible psychiatrists).

But it is also a red herring.  The central issue is psychiatry’s spurious assertion that all problems of thinking, feeling, and/or behaving are illnesses.  Whether these putative illnesses are caused by an excess of “black bile,” a serotonin imbalance, or a neural circuitry anomaly, or whatever the next fad will be, is very much a secondary issue.

We have seen how the APA endorses the illness notion, as does Dr. Pies himself.  Dr. Pies even manages to define disease in such a way that psychiatry’s subject matter must always be considered illness, regardless of any future empirical findings.  For Dr. Pies, any condition or circumstance that entails significant distress and impairment is a disease.  Dr. Pies offers no arguments or proof in support of his position.  He simply – in the best psychiatric tradition – proclaims it to be true.  And within the framework of psychiatric logic, that makes it true.  He defines disease in such a way that it embraces virtually all significant problems of thinking, feeling, and/or behaving, and then proclaims, as if it were a significant fact or discovery, that all these problems are diseases.

But Dr. Pies is by no means alone.  The notion that all significant problems of thinking, feeling, and/or behaving are illnesses is an integral part of psychiatric dogma, and has been enshrined in the APA’s definition of a mental disorder since DSM-III.  But there is no coherent or convincing statement of pathology to support this contention.  Like so much else in psychiatry, it is considered true because psychiatrists say so.  And they say so because it’s good for business.  The chemical imbalance theory is arguably the most destructive hoax ever perpetrated.

  • Francesca Allan

    Thanks for the great article, Phil. I just had a few questions and comments about
    some of the quotes you gathered:

    Pies: “ … note the nuances of what psychiatrists have been saying for at least the
    past decade …. ” What nuances? I’ve seen dozens of psychiatrists over the last decade and not one of them has alluded to anything beyond neurochemical imbalances.

    Kandel: “ … behavioral disorders that characterize psychiatric illness are disturbances of brain function …. ” Here, the problem might be semantics so maybe Kandel isn’t so smug and ill-informed as he appears. It is a rather trite observation to note that the brain is responsible for every thought, feeling, sensation, etc. that you have. The issue is what is causing these various brain states, i.e. what is causing these thoughts, feelings, sensations.

    Stotland: “ … antidepressants are not “uppers” and they have no effect on normal mood …. “ Yes, one of my profs trotted this one out in an introductory psychology course last year. First of all, if antidepressants are said to correct a depressed person’s brain, then it would follow that once the person is no longer depressed the imbalance must have been corrected. But for those of us who blew through normal mood and entered the stratosphere of mania for the first time, clearly the antidepressants did have an effect on normal mood. Secondly, when you’re depressed, you are keenly aware that something is wrong that you want to fix and it has been shown that the placebo effect is a huge part of improvement. However, when you’re experiencing normal mood, there is no such motivation for the placebo effect to cure.

    Andreasen: “ … mental illnesses are due to disruptions in the normal flow of messages through this circuitry …. “ Again, depends on what you mean by “due to.” Yes, mental distress follows neural disruptions, however neural disruption isn’t where the process starts.

    Lipton: “ … since the pharmacological agents that ameliorate depression and mania appear to act upon and alter the concentration and metabolism of the biogenic amines in what are presumably corrective directions, it may be inferred that in the affective disorders there exists a chemical pathology related to these compounds …. ” Okay, this guy gets an F in logic, I’m afraid. The only evidence that mood stabilizers “appear to act upon and alter …. ” is that taking them can smooth out mood swings. However, this theory rests upon the rather reckless assumption that mood swings are due to alterations in biogenic amines.

    Freedman: “ … patients and families may request brain imaging so that they can see
    the possible psychopathology or genetic analyses to calculate genetic risk … ” Has there been a technological advance that I’m not aware of? There is no brain imaging available to detect psychopathology and genetic analysis so far can only determine that
    mental illness, like socioeconomic status, tends to run in families.

  • S Randolph Kretchmar

    This is a compelling article, and it should be widely promoted and distributed. Phil! You may be the best crusader for truth since Tom Szasz…

  • Phil_Hickey


    Thanks for coming in.

    Dr. Pies: Occasionally one finds psychiatrists who discuss these matters in a nuanced way – but most don’t.

    Dr. Kandel: Yes – you’ve hit the nail on the head. The critical point for me is that a “broken” brain can produce a disturbing thought or feeling, but not all disturbing thoughts and feelings are caused by a broken brain.

    Dr. Stotland: Yes – psychiatrists insist that their drugs are essentially different from alcohol and street drugs – but they’re not. They all impair normal neural functioning.

    Dr. Andreasen: Exactly.

    Dr. Lipton: This is psychiatric logic. Not Aristotelian.

    Dr. Freedman: Dr. Freedman was lapsing into Amen and his SPECT scan notions.

    Best wishes.

  • Dr. Terry Lynch

    Great article Phil. I’ve done a lot of research myself on this topic and you are right on the money. They should not get away with so grossly misinforming the public. Terry

  • Francesca Allan

    On a not unrelated note, Bob Whitaker’s CBC interview is available here:

    Please note the comment section underneath the piece is still open if anybody wants to chime in.

  • The Right Hon. Cledwyn B’Stard

    I see some outraged psychiatrist has graced the comments section under your article on MIA with his unrestrained splenetic outpourings.

    He says,

    “Everyone rails about psychiatrists…”

    If only everyone railed about psychiatrists! Nevertheless, I sympathize with him; it is hard, when anger reaches its highest pitch, to concentrate and think clearly, and your article has clearly brought the poor man’s bile to boiling point! What he writes after that is barely intelligible, the poor enraged egotist.

    His comments furnish further proof that a degree is no insurance against stupidity, but what his arguments lack in logical force, he more than compensates for with the vehemency of the terms he uses to express himself.

    He says people come into “treatment venues” just wanting drugs. Well of course they do, because of the inculcation from infancy of the idea that certain emotional states and behaviours are symptomatic of diseased mental states.

    One of the fundamental attributes of power is the ability to shape and influence the thoughts of the people over whom that power is exercised, mostly obviating the need for force and which is achieved through numerous channels, such as the use of the mass audio-visual media; such as the education system; such as the usurpation of scientific authority for propagandistic and rhetorical purposes in a society where science, even where it is only science in appearance and not in substance, possesses a certain mystique, so that the invocation of its authority and use and abuse of its methodology and language is nevertheless sufficient to fill the human mind with a wondrous impression, of almost religious awe, equivalent in force to a revelation in the influence it exercises on the mind, lending, in this case, what is actually a creed, an appearance of incontrovertible certainty, and thus greater persuasive power; such as the abuse of doctoral authority, deference to which is carefully cultivated in our societies; such as a pervasive “take your meds, son” culture which pressures people in to seeking “help” for their emotional and behavioural heresies, so that it comes to seem that social salvation lies only in surrendering yourself to the authority of the psychiatrist.

    Organized psychiatry has become so powerful that it has managed to successfully interpose its ideas and values between the individual and the phenomenal world whilst controlling the narratives we create about our ourselves, ergo it should not occasion surprise that so many people are inundating “treatment venues” in their search for the magic pills they have been misled into believing will alleviate or even cure their distress.

    I myself originally went to a psychiatrist of my own volition when I was 18, and learned the hard way what a complete and utter scam this profession is, and how remiss professionals are in their duty to tell the patient all the information about the drugs they peddle in propitiation of their masters, and with what shameful opportunism the profession takes advantage of people at their most vulnerable and most desperate, especially the many people who are too young to be conversant with the truth underneath all the lies and deception; the people too old (and therefore often of a generation totally out of pace) with the modern world to be expected to think independently about things that lie entirely outside their sphere of expertise and knowledge; and anyone else anyone else might care to add.

    This doesn’t mean that people shouldn’t shoulder some of the responsibility for the decisions they have made, even when there are external forces operating on them, especially once people have crossed the threshold of adulthood, but nor does this relieve organized psychiatry of the burden of guilt. For example, if a man sells some particularly toxic amphetamine to someone, without full disclosure of this, then he is still morally responsible for his actions, and still worthy of contempt, for making money endangering the lives of others. The people in Graham Greene’s novel and the Carol Reed film of the same name, “The Third Man”, wanted penicilin, that doesn’t exonerate Harry Lime responsibility for selling them it diluted.

    In anticipation of criticism, some might say that the psychiatrists are ignorant. This might apply to the youngest, but once they pass a certain age, they are either willfully ignorant, or so remiss in the duty, incumbent upon them, of doing the requisite research in order to insure that they do not violate the Hippocratic injunction. If they are merely ignorant, then, in an age of unprecedented access to information, this is an endictment of their apathy.

    Apart from the very youngest, they have no excuse to be ignorant. Isn’t it well documented that even after the APA sent out information to practitioners about tardive dyskinesia (which had nothing to do with ethical concern and was more a pragmatic move in response to the threat of legal action, correct me if I’m wrong), this stll didn’t change the practice of withholding the truth, something which continues to this day. This goes to show how cautious we must be in ascribing ignorance.

    He also uses the term “antipsychiatry” as an umbrella term for the subsumption of a whole range of disparate and often conflicting views which most certainly do not converge on the conviction that psychiatry must be done away with.

    He compares the blanket criticism of state psychiatrists to criticism of all who work in the police profession, which is actually quite an illuminating comparison, but not for the reasons he thinks. Apart from the police power psychiatrists posess, another point of contact between the two institutions is that those who work in it are only as good as the rules and laws that regulate their conduct, and that in both institutions, it is the system that shapes the individual, and not the other way round.

    If the institution is rotten, and corruption floats in the air of its halllways like a miasma, then those who work in it will be contaminated, and implicated in its corruption, because the institution shapes the individual, and not the other way round. Psychiatrists are not autonomous agents within the confines of the facilities they work in, and although they do have discretionary powers, even these exist within a framework of general circumscription of conduct and thought whereby one must learn to play by the rules of the game, and to internalize those rules and the institutionally sponsored ideal of thought and behaviour in order to secure one’s position or advance one’s career.

    Hence why generalizations are understandable with state psychiatrists; because they are mere state functionaries. Regardless of the intentions of the individual psychiatrist, he is just a cog in a mechanism, upholding the status quo, enforcing discriminatory laws, attaching stigmatizing labels, prescribing the “treatments” he has to because it is his job, a job that stipulates he discharges his duties if he wants to remain in that position. If you think there is something wrong with state psychiatry as it is currently constituted and practiced in western societies, then generalizations are often correct.

    For this reason, the further analogies he makes wilt under even distant scrutiny, basically saying that what he calls the ” villainization” of psychiatrists en bloc is comparable to what happened in Nazi Germany with the Jewish people, an absurd comparison, that once again endeavours to cast psychiatrists in the role of poor victims, victims of societal prejudice. Obviously there is no comparison between their situation and that of Jewish people. Jewish people were living in a country where they were utterly powerless, abandoned both by their own and the world community, though i fairness, I don’t think this is his point.

    For the reasons enumerated in preceding paragraphs, generalizations regarding state psychiatrists are acceptable in a way that they would not be for Jewish people, because Jewish people are linked by ethnicity and religion only, whereas state psychiatrists are linked by their collective responsibility in the stigmatization, coercion, detention, deception, and poisoning of a group of people united by their experience with the system as patients. Why do I use the term collective responsbility? Because they are all bloody doing it and implicated in it, not because of some conspiracy, but because this is their jobs, at least that is what they are all doing in my country, I can speak less for other countries, but know that it is also at least mostly the case in other european countries, for example.

    He says “everybody wants a scapegoat when things don’t go as planned”! Oh, hark at the psychiatrist, obviously a renowned Girardian scholar. He should know about scapegoating, the profession he is a part of scapegoats “seriously mentally ill” people and “serious mental illness” for the violence of society when as a group, and on the historical scales of violence, the violence committed by psychiatrists preponderates emphatically over that committed by mental patients. They also scapegoat powerless deviants and distressed people for the lunacy that resides in the minds of everyman when in truth the line seperating sanity from insanity is a line that runs not through human society, but through the psyche of every human being.

    Once again, none of this precludes the attachment of blame in the cases of many patients for the choices they have made when they really cannot plead ignorance, but the culpability of organized psychiatry does not diminish in consequence of this.

  • The Right Honorable Cledwyn B

    The bracket should obviously come after “the modern world” and that shouldn’t be “so remiss in their duties…” but merely “remiss in their duties…”, and that shouldn’t be “when in truth the line seperating..”, but “because the line seperating…”

  • Francesca Allan

    I assume you’re referring to Joel Hassman (or whatever his name is). I must say your comment piqued my interest so I wandered over to MiA to see what Hassman had to say and now I’m embarrassed for him. He’s feeling picked on? He’s feeling persecuted? The fault is ours? The bossy patients are demanding their antipsychotics? The poor psychiatrists powerless behind their desks?

  • Nick Stuart

    Another fine article Phil. I wonder what Dr Pies thinks of psychiatric drugs such as SSRIs and what they have been designed to do. Surely they have been invented to correct the chemical ‘imbalance’? And why has he been precribing them for years? See here..

  • Phil_Hickey


    Thanks for your encouraging words.

  • Phil_Hickey


    Yes, that is what they were invented for. And that’s what they were claimed to do – by pharma and by psychiatrists. So “why has he been prescribing them for years?” Because that’s what psychiatrists do. Everybody knows this –
    including Dr. Pies – but the sordid reality – of psychiatrists as drug pushers –
    has to be suppressed.

    Thanks for the link to the interview. It reads like a drug ad.

  • The Right Hon. Cledwyn B’Stard

    Yeah, him. It was off-topic, but it needed to be said. No wonder he and so many others feel the need to announce their credentials to the world; otherwise people might realize the stupidity of what they are saying.

    Yeah, it’s always someone else’s fault. Anyone who says any different, is a scapegoater and a bigot.

    They remind me of Nazis like Hans Frank at the Nuremberg Trials who played the played the victim card, harping on about their personal tragedy, about how hard it was for them, whilst not a word was said about the people they played a huge role in killing, and not a tear shed in their name. Likewise, psychiatrists seem to have little thought for the lives they destroy, which is commonly found amongst people who oppress and harm others.

    Part of this is because we are now living in an age when everyone feels like a victim; symptomatic of the decline of personal responsibility, everyone’s assuming this role, all the way down the line, from the worst bully, to the most tormented individual, who really is a victim.

  • The Right Hon. Cledwyn B’Stard

    As for Pies, he seems like a man who has withdrawn into a world of fantasy and delusion because of reality’s stubborn refusal to accommodate his desires, a process facilitated by the writing of articles such as this. Experience has taught me that human beings deceive themselves best when they put deceptions on paper, obliterating with the stroke of a pen any doubts, residual or otherwise, they may harbour.

  • Phil_Hickey


    Good point. At present, there’s an almost desperate quality to psychiatry’s claims. They have no genuine answer to the criticisms that they are receiving, so they either vilify us or go on repeating the same old falsehoods.

  • Francesca Allan

    I actually believe the tide is turning and Joe Public is starting to become skeptical. Perhaps Sluggish Cognitive Tempo Disorder was just too much. We are now scraping the bottom of the diagnostic barrel.

  • The Right Hon. Cledwyn B’Stard

    The problem is, they, unlike their patients, are free to indulge their imaginations without let or hindrance, which is why so many of us who’ve been harmed are so angry, because we are having to read this self-serving crap all the time!

    The kind of pressures delusional patients have to undergo in maintaining their fantasies don’t exist for psychiatrists, although every now and then something forces them to acknowledge that they have been wrong, usually after decades of ignoring research which shows how utterly useless and toxic their “treatments” are.

    Organized psychiatry recognizes no obstacles in the pursuit of its interests.

    If the history doesn’t suit them, they rewrite it, like Pies has done in his article.

    If the meaning of a word doesn’t suit them, they just change it, like Pies does when he claims that the sovereign criterion for determining inclusion in the class of diseases is “distress and suffering”, thereby, and surely without realizing, excluding many people with empirically corroborated diseases like cancer, which unlike psychiatry’s diseases (whose existence rests enitirely on the authority, power and prestige of the diagnostician), can be viewed at the cellular level under a microscope, at the structual level in a CT scan, and at the metabolic level in a PET scan ; after all, people can have cancer for years without experiencing any suffering or distress, even when it has metastasized to distant regions (apart that is from the suffering one might experience through knowledge that one has the disease, which hardly qualifies as a symptom; then again, people often have cancer without even knowing they have it for many years).

    If the patient complains about his treatment, they just blame it on his so-called illness, whilst nevertheless respecting their testimony when they show retrospective gratitude for being coerced, when they say the drugs help, or anything else that, in their desire to believe, they believe.

    If the science doesn’t suit them, they just distort the evidence, or evolve a system whereby they manage to live in complete ignorance of any information that might shatter their delusions, as is the case with Pies, who seems totally oblivious to the extent of Big Pharma’s control of the profession, and by extension, its role in furthering its interests.

    Any ethical obstacles are just brushed aside by appeals to necessity and emergency; through a euphemistic pseudo-medical camouflage; and by the successful propagation of the porkie that psychiatry “obviously” does more good than harm, because psychiatrists and the mental health faithful see what they want to see (I mean, these people, confronted with the corpse of a patient and the testimony of a medical expert showing without a doubt that the psychiatric “treatment” was the cause of his death, would nevertheless still probably tell themselves that death is preferable to untreated mental illness, which in psychiatric demonology is the worst evil of all, ergo they have done good).

    Still on the subject of psychiatry “doing more harm than good” and its use in overcoming ethical obstacles and objections, this is just further proof that the line seperating delusional thought from rational thought runs not through human societies but through the human psyche itself.

    Anyway, this is a kind of perverse utilitarianism, whereby great evil is justified by reference to the supposedly greater good being done, which couldn’t happen without doing the evil.

    According to this logic, which Dostoevsky criticised in “Crime and Punishment” through Raskolnikov’s murder of an old woman, justified on the grounds of redistributing her wealth, and perhaps prophesizing the service such logic would be conscripted into supporting Utopian state ideologies such as communism and of mental health ideology; according to this logic, evil can be justified if by doing it you manage to do a greater amount of good.

    Belief in the validity of this logic grants special dispensation to psychiatrists collectively to commit otherwise forbidden acts in the pursuit of a Mental Health Utopia, as long as they convince themselves and others that they are doing less harm than good.

    The fact that there is not a shred of evidence for this assertion and that psychiatrists and the faithful are so biased that even when confronted with a fat, socially isolated, diabetic patient, suffering from iatrogenic dementia and facially disfigured from years of “treatment”, they nevertheless tell themselves that that person has been helped; these facts are nevertheless powerless to stop the spread of this delusion, whose example is regularly encountered, and used to trivialize evil and sweep aside ethical objections, as well as calls for the abolition of state psychiatry itself.

  • Francesca Allan

    Frankly, it’s their everlasting conviction that they are doing good that I find so frightening. I would much rather deal with a drug addict who robs banks to feed his habit. He knows he’s doing harm and he’s honest about it. It’s the self-serving twisted justifications of psychiatrists that make them so dangerous.

  • T.A. Anderson

    A long time ago in a galaxy far, far away . . .

  • Laura

    In 1985, my brother started acting in ways that the rest of his family considered “strange” and ways that concerned and embarrassed us. Our GP told my parents they “had a very sick boy” but that we would have to “wait until he harmed himself or others before we could get him help”. We hyped up our fear (consciously and subconsciously) and eventually got him committed. My parents at the time understood what had happening in terms of a “nervous breakdown” and something that he would get over, but the first thing that a psychiatrist told us was “no you are wrong this isn’t a “nervous breakdown”, you son is “very ill”, he has a chemical imbalance of the brain and will need medication to balance this out for the rest of his life.

    For nearly 25 years that was my framework for seeing, thinking about and “helping my brother. If he cried “it’s his illness”, if he got drunk “its his illness”. When they changed his medication from a typical (after 16 years he was on such a small dose of “anti-psychotic” medication that it could be considered negligible – he was back at work, had a a social life he enjoyed etc) but the psychiatrist decided that for his “illness” a change to an atypical would be good. They changed it and he got “ill” again – after that he was sectioned 8 times over many years, lost his friends his job etc. During this time all we say was “illness” and we trusted the professionals. I could go on but in summary I have no doubt that the damage of this bad and illogical idea – i.e. that there is such a thing as “mental illness” – is causing and of it’s devastating and I am sure unintended consequences. Bad ideas are dangerous things…

    My ideas changed (about many things not just psychiatry) mainly thanks to Szasz. I no longer see my brother with lens, I am left with sadness for his stolen life and guilt for not opening my eyes and challenging the “professional” and mainstream view.

    THANK YOU PHIL for the energy and skill that you put into to speaking the truth and the credible way that you are able to challenge – your efforts keep me motivated to try and change things.

  • Anonymous

    Thank you for sharing that story. There are millions of lives that have been stolen by psychiatry’s ridiculous beliefs. I’m glad that the greatest mind to ever consider these issues, Szasz himself, helped you understand the reality of what transpired. I speak as somebody that was able to escape psychiatry’s heinous and unforgivable violence, referred to by some as so called “sectioning”, and as somebody that was able to escape psychiatry’s ideology. It’s very hard to escape. It is often the case that people haven’t worked out their original problems, and the ‘cork’ that was their first style of tranquilizer drug they were on, is changed to a different tranquilizer drug years down the line, and their problems come to the fore once more. This doesn’t indicate to me a pharmacological etiology to the problems, but indicates a rougher ride from the original problems when the mollifying tranquilizer drugs are pulled like a rug from underneath without appropriate rectifying of the original problems in living or thinking ever having taken place. Like a heavy drinker whose drink of choice has been vodka all his life, switches to beer and starts to get more violent or something. If there’s one thing psychiatrists know how to do, it’s trash innocent lives.

  • Laura

    Absolutely agree.

  • Anonymous

    Highest praise there is in this thing. Mr. Hickey will be touched.

  • Laura

    Thank you for responding. Yes I am so glad that I finally came across Szasz, I would much rather have my eyes open to the truth and the reality.

    I am glad that you escaped.

    When we see it all through “illness”.the thinking mainly means that there is no need to consider or even see any original problems as significant – i.e. people are met with lets sort the “illness” out first perhaps then we can think about any emotional issues, difficult life experiences etc . So damaging!

    I know that now I would try and keep anyone I could away from this “help”.

  • I entered into a debate with Dr Pies sometime ago.

    Read the comment section.

  • Phil_Hickey


    Good point about painless cancer! Also, on the other side of the coin, a person in prison who finds his incarceration distressing and limiting (and who wouldn’t?) is by Dr. Pies’ definition diseased.

  • Phil_Hickey


    Thanks for your encouragement, and best wishes in your endeavors.

  • The Right Hon. Cledwyn B’Stard

    I know, it’s ridiculous. I regularly encounter psychiatrists on the net, and nurses, and other mental health professionals, saying things like, “I’ve known thousands of people whose lives have been saved by these drugs”!

    How can you reason with people speaking such self-evident nonsense? One even said he’s known millions!

    I don’t think anyone actually knows thousands of people. The amount of people we actually know (as in really know) is usually limited to a very small number. Also, without objective markers, psychiatrists and the mental health faithful are free to define improvement however they please.

    Psychiatrists may see lots of patients, but they don’t actually know any of them, I mean, these are not people they go out drinking with or anything, nor are they people they would choose to go out drinking with or anything.

    The desire for anything that they can use to their advantage, their terror of information that casts them rightly in a bad light, and their desperation given the enormity of the crimes they are implicated in, as always, predetermines their judgement, and makes of them unreliable witnesses to the reality on this issue.

    Truth, reason, logic and justice have long since abandoned the mental health movement, so, and as Phil rightly points out, they resort to increasingly desperate measures, such as randomly stigmatizing criticism as “dangerous”, or making grandiose claims they could never back up (such as “it does more good than harm”, which someone recently described as a fact, baked in certainty, capitalizing the letters for emphasis, as if calling something a fact and capitalizing the letters lends that something greater persuasive power), or demonizing the critics.

  • Phil_Hickey


    Thanks for coming in, and for the interesting link. I think Dr. Pies is simply not receptive to the notion that his profession has done, and continues to do, enormous damage.

  • The Right Hon. Cledwyn B’Stard

    I know, it’s a definition sufficiently broad enough to pretty much encompass everyone at some point in their lives.

    Also, what about all the people who are diagnosed “seriously mentally ill”, for breaching socio-ethical norms and annoying others, people who are committed and force “treated” not because they are undergoing extreme, persistent suffering, but because they in some way contribute to the suffering of others (which is of course not the same as saying the problem lies with them; I contribute to the suffering and distress of others with my opinions, or my refusal to say or do what others want me to do, but that is not my problem)?

  • Anonymous
  • The Hitchslap is back

    The neurochemical hypothesis of mental disorders is universally accepted in modern psychiatry and academia. It is quite ridiculous to say otherwise, and the pharmacological treatment that used in almost every clinical practice is based upon this theory.
    A common theme the author of this piece uses are Marxist ideas, and I would like him to explain his thesis on this aspect of his work, especially in regard to pharmacology. I would also like to hear his ideas on why he considers psychiatry to be unscientific.

  • Francesca Allan

    The whole of focus of this blog is questioning WHY the neurochemical hypothesis is so widely accepted. (It can’t be described as universally accepted because many respectable researchers dispute the hypothesis.)

    There are several unscientific aspects to psychiatry. Here are just a few:
    – the neurochemical hypothesis is just assumed to be true despite overwhelming evidence to the contrary
    – psychiatric research is of appalling quality and most of it is funded by pharmaceutical manufacturers
    – there are no objective tests for any mental illnesses so diagnoses are completely subjective and frequently fluid and arbitrary
    – whether or not a condition is considered a mental illness is decided by majority vote of the APA’s DSM committee
    – disagreement with a psychiatrist’s diagnosis is assumed to be evidence of further mental illness
    – in general, outcomes are worse with psychiatric treatment

  • Phil_Hickey

    The Hitchslap,

    If there are Marxist ideas in my writings, I’m not aware of them. The focus of this site is the spurious philosophy and destructive practices that characterize psychiatric activity. I don’t discuss political topics at all.

    As to my grounds for asserting that psychiatry is unscientific, I think you’ve provided a good answer yourself. The chemical imbalance theory was never
    proven – in fact was disproven very early in its history, but – as you so correctly point out – continues to be psychiatry’s main cornerstone.

    In this regard, there is much else about psychiatry that is unscientific and illogical. For instance, the psychiatric research mill that churned out results –to-order in return for pharmaceutical largesse. Please feel free to browse the site – there’s lots more! Also, see Francesca’s response below.

  • The Hitchslap is back

    These are simply incoherent Marxist conspiracy theories. Science is based on reason, not dogma. In clinical practices psychiatrists do not treat mental disorders based upon pharmacology and research in biological psychology and neuroscience. Cognitive behavioural therapy is the most widely used psychotherapy, and is based upon cognitive psychology. Outcomes are not “worse with psychiatric treatment” and there are studies which show psychotropic medicines have a far higher efficacy rate than placebo and psychotherapy – it is the most effective treatment.
    There are of course debates in the philosophy of science as to whether the social sciences can be considered scientific, and this includes some aspects of psychology. However, biological psychology and psychiatry belong to the natural sciences, and several research methods, including those in neuroscience, provide testable and falsifiable hypotheses.

  • Francesca Allan

    Hi, Hitchslap. I’m not sure where you are in the world but in North America psychiatrists most certainly do treat mental disorders via pharmacology. CBT is in the domain of psychology, not psychiatry.

    For mood disorders, it is clear that SSRIs are at best minimally more effective than placebo. For psychotic disorders, long-term outcomes are far better without medication.

    There are no falsifiable hypotheses in psychiatry. Mental disorders are simply assumed to be neurochemical imbalances. The “proof” of the neurochemical imbalance is … well … the mental disorder. Could you give me just one example of a falsifiable psychiatric theory?

    I know nothing about political theory so I can’t comment on whether my point of view is Marxist but I can certainly assure you that I don’t subscribe to conspiracy theories.

  • Francesca Allan

    Also, since you state you’re finding my comments “incoherent,” please let me know specifically what you can’t understand and I’ll try to rephrase for you.

  • The Hitchslap is back

    Science is based on falsifiability and the refutation of hypotheses. A falsifiable hypothesis is one that is a testable particular (or singular) statement, for example the hypothesis “in psychoses there is an increase in the neurotransmitter dopamine” is a testable hypothesis. By studying psychotic disorders through the effect of certain medications and methods in neuroscience, we can compare the levels of dopamine in normal people and people with schizophrenia during psychosis. If evidence were found to contradict this hypothesis, the theory would be falsified. An example of an falsifiable hypothesis is Freudian psychology, as nothing can be measured empirically at all.
    The only demarcation between psychiatry and the study of psychopathology in psychology is perhaps that psychiatry is specifically for the treatment of mental disorders, and CBT (alongside other psychotherapies) is indeed almost always used in conjunction to medication. Marxism (despite popular now for political aspects) is a sociological theory, and states that the working classes are controlled by the upper classes. I will not go into the sociology of medicine here, but you can look at some sources on sociology elsewhere.

  • The Hitchslap is back

    I meant to say “unfalsifiable” hypothesis is relation to psychoanalysis.

  • Francesca Allan

    Hi, again. Yes, I’m aware of how science works and what falsifiability means. My point was that biological psychiatry often fails the criteria. First episode mania in response to SSRIs is generally hypothesized to be the result of pre-existing bipolar disorder. That’s a perfectly unfalsifiable hypothesis.

    If I become violently ill after eating chicken strips, I would tend to assume that I was suffering from food poisoning, Sure, it’s possible that I had pre-existing asymptomatic influenza but, in the absence of any evidence, that’s a pretty wild assumption and it’s along the lines of how psychiatrists respond to antidepressant-induced mania.

    I had been under the impression that the dopamine theory of schizophrenia rested on the observation that drugs which reduce dopamine levels can reduce the symptoms of psychosis. I wasn’t aware that neurotransmitter levels could be measured in living human brains. Is this a new development? And if there is a correlation between dopamine levels and psychosis, would it be clear we were looking at a causal relationship?

    As for Marxism, I’m not interested enough to go look it up but I am curious why you condemned my point of view as nothing but incoherent Marxist conspiracy theories when I said nothing whatever about the working classes or the upper classes. Indeed, I said nothing whatever about socioeconomics.

    Again, not sure where in the world you are but in North America, mental disorders are typically attacked with medication alone. It is quite rare to be offered CBT or any other form of psychotherapy.

  • The Hitchslap is back

    No, your argument was based on the institution of pharmacology as a means of production and the ability of the upper classes to make capital.
    The title of this website “behaviourism and mental health” is quite misleading. The author of most of these articles deals with explicitly an attack on biological psychiatry, mixing in some of psychoanalysis and cognitive psychology incoherently. I have not seen one piece where he makes any original ideas or hypotheses backed by evidence on behaviourism and psychopathology.
    This is a popular anti-psychiatry sociological theory claiming mental disorders do not exist. It is kept alive today by scientologists and sites like these. I highly recommend Edward Shorter’s book “A History of Psychiatry”.
    Furthermore, this site is also highly inconsistent. The author claims bipolar disorder is not a real illness, that the neurochemistry of psychiatric disorders does not exist. Saying schizophrenia is a bad “label” is wrong. Schizophrenia involves distressing hallucinations and delusions, and completely destroys the use of language and coherence. Dopamine antagonists treats these symptoms and it is marvellous that their so effective. (This is not so for negative schizophrenia, unfortunately.)
    The idea of causation in neurochemistry is a matter of developmental psychopathology and biological factors.

  • Francesca Allan

    “No, your argument was based on the institution of pharmacology as a means of production and the ability of the upper classes to make capital.”

    Have you perhaps confused me with another commenter? I am mystified why you keep incorrectly attributing arguments to me.

    “The author of most of these articles deals with explicitly an attack on biological psychiatry, mixing in some of psychoanalysis and cognitive psychology incoherently.”

    You really don’t use the word “incoherently” very well. You throw it out there whenever you disagree with what’s being said. “Eggplant catastrophe sunflowers” is incoherent; “I dispute the biological model of mental illness” is not.

    Very, very few people claim mental disorders do not exist. The debate is about what mental disorders are and how best to assist those who suffer from them. The fact that mental disorders can be highly distressing does not indicate they are diseases. Poverty and heartbreak are also highly distressing conditions but unlikely to be termed illnesses.

    Antipsychotics are actually not terribly effective. Much of their effect is due to their tranquilizing properties and long-term outcomes tend to be better without them. Overall, they tend to make patients fat and obedient which of course makes them easier to deal with but that’s not to say that they’re better off in that condition.

    I notice you decline to answer whether dopamine can be measured in a living human brain (I believe it cannot). Without such measurement, we can’t even determine correlation, never mind causation. You’re just choosing to assert
    that it all belongs under the vague term “psychopathology.” Merely saying something over and over doesn’t make it so. What pathology are you referring to?

    As with the “pre-existing” bipolar disorder scenario, these theories are pretty weak and there’s much evidence against them. Perhaps the biggest thing to consider is how people can make such spectacular recoveries without tinkering with their neurochemicals. By contrast, not many Type I diabetics recover without insulin.

  • Francesca Allan

    I’d be unlikely to purchase and read a book by a children’s electroshock advocate. Edward Shorter’s work is absolutely steeped in biobabble.

  • The Hitchslap is back

    “Psychopathology” is not a vague term, it means “the study of mental disorders”. By incoherence I mean arguments with no premises or conclusions. And your language is so imprecise and irrational I doubt your little conspiracy theories will work out. And what does “biobabble” mean? Seems like a nonsensical salad word. Shorter is a fine historian of science, and he gives an accurate history of psychiatry. And yes, the creator of this website is completely inconsistent. He says bipolar disorder does not exist and still discusses it. “we cant determine correlation”, seriously? Simply look at childhood abuse and its correlation to adult psychiatric disorder. I know you and no one else on this website has any training of any kind in psychology, but I suggest you join scientology.

  • Francesca Allan

    Okay, you are correct: The definition of the word is not vague. However, to lump various manifestations of emotional distress all together as mental disorders and thus bring them all under the umbrella of psychopathology IS a very vague, unscientific approach.

    I’ve yet to see an argument here without a premise or a conclusion. I don’t believe my language is either imprecise or irrational, nor do I subscribe to any conspiracy theories. What I do know is that you exhibit passive-aggressive traits and appear to be unable or unwilling to engage in civil discussion.

    Biobabble is the biological equivalent of psychobabble. It refers to the roundabout method that psychiatry uses to attempt to make itself a legitimate branch of medicine. Not being familiar with a word doesn’t make it irrational.

    Edward Shorter is a child electroshock advocate. Enough said about Edward Shorter.

    Phil Hickey is not inconsistent. You are, however, a very poor reader. Hickey’s point is that bipolar disorder is not a DISEASE; he never claims that it doesn’t exist.

    When I questioned our ability to determine correlation, I was clearly referring to dopamine levels vs. psychosis. I am fully aware of the relationship between childhood abuse (especially sexual abuse) and later psychiatric labelling.

    No, you don’t “know” whether or not I have any training in psychology and I really have no idea why you throw the predictable and tedious Scientology insult out.

    Would you care to forgo the personal attacks in favour of actually confronting what’s been raised in the discussion? Are you willing to discuss whether dopamine levels can be measured in a living brain? Are you willing to discuss whether mania need indicate pre-existing bipolar disorder? Are you willing to discuss the environmental factors of psychological disorders? Are you willing to discuss relative outcomes on/off psychiatric medication?

    No, I thought not.

  • Phil_Hickey


    “in psychoses there is an increase in the neurotransmitter dopamine” is emphatically not a testable statement for the following reasons:

    1. There is no definition of psychosis or psychoses that can uniquely identify this phenomenon.
    2. Neurotransmitter levels in the brain are subject to considerable fluctuation in ordinary day-to-day activity. So you would need to specify the baseline from which the putative increase has deviated. At present there is no agreement among neuroscientists as to what constitutes baseline levels for any neurotransmitter, for any person or group of persons, in any circumstances.

    “we can compare the levels of dopamine in normal people and people with schizophrenia during psychosis.”

    1. Define “normal people.”
    2. Specifically what do you mean by their dopamine levels?
    3. How would you go about measuring these levels?
    4. There is no definition of “schizophrenia” that can be applied with even reasonable reliability. DSM-5 Field Trial Kappa was only 0.46 (Figure 1)

    Incidentally, the notion that the condition which psychiatrists call schizophrenia is caused by excessive dopamine activity in the brain has never been proven, and in fact was effectively debunked in 1999 by the eminent neuroscientist Elliot Valenstein (Blaming the Brain, pp 113-124). There are numerous references in this text. If you know of any study that supports the dopamine hypothesis of “schizophrenia,” please send me the references, and I’d be glad to have a look.

  • Francesca Allan

    Hitchslap, here’s a starter kit for you on what the term biobabble means:

    Interesting that rather than take 3 seconds to search it on Google, you prefer to declare my language “nonsensical salad,” a term very commonly used to describe schizophrenic speech.

  • Paul

    The following text is from the Royal College of Psychiatrists’ page on Schizoaffective Disorder. I retrieved it this morning (August 23 2014) use Google Cache because, for some reason, their website is down. The Google cache declares it to be: “a snapshot of the page as it appeared on Aug 22, 2014 02:07:17 GMT”


    What are the causes of schizoaffective disorder?

    The exact cause is not known, but we do know that there is a chemical imbalance in people affected by schizoaffective disorder.

    Genes: research has shown that the same genes may be responsible for schizophrenia, schizoaffective disorder and bipolar disorder. People with this disorder are more likely to have family members who have been diagnosed with these conditions.

    Stress: stress can contribute to the start of an episode of schizoaffective disorder, such as a bereavement, physical illness, car accident or family/relationship problems. In particular, traumatic experiences in childhood can increase the chances of developing this condition in the future.


    This is the link to the page. I’m not sure why the website is down. I’ve saved a copy of the cache.

  • Phil_Hickey


    Thanks for this. They’ve been removing the “chemical imbalance” references from their statements on depression, but I guess they forgot about “schizoaffective”!

  • neverdiss

    Finding the proper psychiatric medications and dosages as a result of being treated at Dr. Daniel Amen’s clinic in Reston, VA and specifically by Dr. Joseph Annibelli, saved me from a life during which I spent half the time depressed. Debilitating depression, caused by undiagnosed bipolar II disorder, plagued me from the age of nine until 52, when I visited the Amen Clinic.

    Were it not for the drugs I take daily, perhaps I would have committed suicide by now. Instead, for the first time in more than 40 years, I have spent more than 9 months without once being bedridden with depression.

    Depression and accompanying undiagnosed ADHD, which was first discovered at the Amen clinic, kept me from being able to be as financially stable as most people with my educational background are.

    I have my life back, a happiness I haven’t experienced since I was a young child. I’ve tried mediation (which, as a Buddhist, I still do), diet (which I always try to be healthy about), exercise (which I also continue to engage in for its health benefits). But NOTHING except my meds cured my depression.

    In my opinion, having been on the brink of suicide several times as a young adult, it is utterly irresponsible for anyone to suggest that psychiatric medications are all crap. That crap literally gave me back the life I longed to live for all of my adulthood. This may not be true for all people with mental conditions. But, I suspect that for many, sticking to trying to find the right meds and dosages is worth the effort.

    Amen’s idea is simple: Mental illnesses have their root in the unhealthy functioning of the body’s most important organ, the brain. Cure the brain, cure the illness. This method worked for me 1,000,000 percent.

    If you have a mental illness, please keep trying to find the correct treatment until you find it. It definitely exists. Don’t let anyone convince you that a certain method is wrong, including medications. You’ll never know what works for you until you try it.

  • all too easy

    Outstanding confirmation that chemicals have nothing to do with the complaints about the side effects from taking psychotropic drugs.

  • frank mack

    A single dose of a popular class of psychiatric drug used to treat depression can alter the brain’s architecture within hours, even though most patients usually don’t report improvement for weeks, a new study suggests.

    More than 1 in 10 adults in the U.S. use these drugs, which adjust the availability of a chemical transmitter in the brain, serotonin, by blocking the way it is reabsorbed. The so-called Selective Serotonin Reuptake Inhibitors, or SSRIs, include Prozac, Lexapro, Celexa, Paxil and Zoloft.A s

    Researchers at the Max Planck Institute in Leipzig, Germany, used a magnetic resonance imaging machine to compare connections in the gray matter of those who took SSRIs and those who did not. They were particularly interested in what goes on when the brain is doing nothing in particular.

    They created 3-D maps of connections that “matter” to gray matter: interdependence, not just anatomical connection. They relied on a discovery in the late 1990s that low-frequency brain signaling during relative inactivity, such as daydreaming, is a good indicator of functional connectivity.

    When more serotonin was available, this resting state functional connectivity decreased on a broad scale, the study found. This finding was not particularly surprising — other studies have shown a similar effect in brain regions strongly associated with mood regulation.

    Sept 14, 2014 LATIMES

  • frank mack

    “Like so much else in psychiatry, it is considered true because psychiatrists say so. And they say so because it’s good for business. The chemical imbalance theory is arguably the most destructive hoax ever perpetrated.”

    Drumming up business for themselves by rejecting the power of psychiatric meds to bring relief to the sufferer, has failed terribly as a strategy to increase the number of customers seeking help from practitioners who don’t know what they’re doing.

  • Rachel Evelyn Nichols

    A major problem I have with psychiatry, Laura, as a survivor–still slightly drug dependent :(–is not just that it coerces people to take drugs that don’t work. It’s not just that it actively promotes scapegoating with stigmatory labels. Perhaps the worst part of psychiatrists is they tacitly encourage and enable bad, self-destructive behaviors in those called “mentally ill.” It’s okay to go around feeling sorry for yourself–you can’t help yourself, you have major depression. You can’t help it you have violent behaviors, you are bipolar. All you need to do is take some pills.

  • Phil_Hickey


    That is so on the mark! They peddle dependence and disempowerment, and are undermining our cultural resilience. And all to feather their own nests: money and prestige.

    Best wishes.