Dr. Pies Still Spinning

On July 1, the very eminent psychiatrist Ronald Pies, MD, wrote an article for Psychiatric Times titled Positivism, Humanism and the Case for Psychiatric Diagnosis.  The article also appeared in Medscape on August 20.

Dr. Pies begins by discussing websites “…that critically examine psychiatry.”  These websites, he tells us,

“…vary from the viscerally enraged, to the politely skeptical, to the constructively critical, and everything in between. The worst antipsychiatry Web sites, in my view, are veritable bastions of bigotry, in which psychiatrists are subjected to invective and abuse that would never be tolerated if directed, say, at some ethnic or racial minority.”

I have expressed the belief before – indeed on several occasions – that Dr. Pies is psychiatry’s master of spin, and the above quote from his paper is a wonderful demonstration of his gifts in this area.  By presenting anti-psychiatry invective and expressions of racial hatred side by side in the same sentence, he is attempting to convey the impression that these activities are essentially on a par.

But, in fact, this is simply not the case.  Racially motivated invective and abuse are directed against people purely and simply on the basis of their skin color.  Anti-psychiatry invective and abuse, however, are based on the activities of psychiatrists.

Criticism based purely on skin color is indeed bigoted and unfair.  But criticism based on an assessment that a person has acted in a destructive or deceptive manner is not in the same category. Whether the criticism is couched in expressive language or in the measured tones of academic debate is very much a secondary issue.

Dr. Pies’ attempt to liken invective and abuse directed at psychiatry with invective and abuse aimed at racial or ethnic minorities is nothing more than a cheap ploy to marginalize his detractors.

Dr. Pies continues:

“If you look for something resembling a philosophical position on the more vituperative Web sites, you usually find objections to psychiatric diagnosis and treatment based on one or more of 3 basic claims:

  • Only physical (bodily) illness, demonstrated by the presence of a lesion or physiological abnormality, constitutes ‘real disease.’ Psychiatry doesn’t deal with real diseases, but with invented ones; therefore, its diagnoses and ‘treatments’ are bogus.
  • Whatever their claims to science, psychiatric treatments are either useless or harmful.
  • Psychiatry is inherently coercive; it stigmatizes people with pejorative labels and forces its (bogus) treatments on unwilling victims, who, in many cases, are hospitalized against their will.”

The illness vs. invented illness issue is a great deal more complex than Dr. Pies suggests, but also, and more importantly, has to be seen in its proper context.  And the proper context is that for the past several decades, psychiatrists have been telling their clients, and the general public, and journalists, that virtually all significant problems of thinking, feeling, and/or behaving are caused by chemical imbalances in the brain.  They have stated clearly and unambiguously that these putative imbalances constitute “real illnesses, just like diabetes,” and that the imbalances are corrected by psychiatric drugs.  The phrase “a real illness, just like diabetes” entails, I suggest, the assertion that these “illnesses” involve real biological pathology.  And this is certainly how the message is received.  So when we mental illness “deniers” point out that the various problems of thinking, feeling, and/or behaving listed in the DSM are not real illnesses, we are actually using the term illness in the same sense as is entailed in psychiatry’s scandalously deceptive assertion.

But Dr. Pies circumvents this entire matter with two deceptive maneuvers.  Firstly – and almost unbelievably – he asserts that psychiatry never promoted the spurious chemical imbalance explanation.  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.”

I have dealt with this in an earlier post – Psychiatry DID Promote the Chemical Imbalance Theory – in which I provided abundant quotes from eminent psychiatrists in which they asserted the chemical imbalance theory clearly and forcefully. To the best of my knowledge, Dr. Pies has never retracted his position, and so presumably continues to deny what is common knowledge:  that the vast majority of psychiatrists did indeed routinely lie to their clients on this matter, and did indeed promote the chemical imbalance theory as a justification for prescribing psychiatric drugs.  On March 11, 2014, Dr. Pies did refer to this deception as “this little white lie.  (Psychiatric Times, Nuances, Narratives and the ‘Chemical Imbalance” Debate in Psychiatry.)  A month later, however, the phrase was changed to “simplistic notion.”  A Medscape article of the same name, dated April 15, still refers to the “little white lie.”  (Nuances, Narratives and the ‘Chemical Imbalance’ Debate in Psychiatry)

Secondly, Dr. Pies simply eliminates the presence of biological pathology from the essential definition of illness.

Now this is really slick.  For decades, the foundation of pharmacological psychiatry was that problems such as depression, inattention, anxiety, etc., are caused by chemical imbalances in the brain, and are therefore to be considered illnesses best “treated” by drugs.  Then the chemical imbalance theory went down the drain.  (Well, it was always down the drain, but was deceptively promoted by psychiatrists as valid science.  What happened in the last ten or fifteen years is that the hoax has been so exposed that it has become untenable.)

But, Dr. Pies to the rescue:  illness doesn’t require pathology.  All that’s needed, to assert the presence of illness or disease, is “prolonged or intense suffering and incapacity.”  And, in fairness to Dr Pies, he presents five very compelling arguments, including references, in support of this position.  These arguments are summarized briefly, but, I believe, accurately below:

  1. Dr. Pies himself has said so. On Myths and Countermyths, Arch Gen Psych, 1979: 33: 139-144
  1. Dr. Pies himself has said so again: Moving beyond the “myth” of mental illness. In: Schaler JA, ed. Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics. Chicago: Open Court Publishing Company; 2004:327-353.
  1. M.S. Moore, JD, (who at the time of writing was a Fellow in Law and Humanities, Harvard University) has said so: Some myths about “mental illness.” Arch Gen Psychiatry. 1975;32:1483-1497.
  1. L.S. King, MD, (a pathologist and medical historian) has said so: What is disease? Philos Sci. 1954;21:193-203.
  1. G.W. Thorn, MD, (physician who dealt with kidney and adrenal gland disorders), R.D. Adams, MD (neurologist and neuropathologist), K.J. Isselbacher, MD, (gastroenterologist), E. Braunwald, MD (cardiologist), R.G. Petersdorf, MD (infectious diseases physician) (editors) have said so:  Harrison’s Principles of Internal Medicine. 8th ed. New York: McGraw-Hill; 1977.

And there it is – just as it has always been:  every significant problem of thinking, feeling, and/or behaving is an illness, because psychiatrists (and incidentally some other physicians) say so!

Of course, psychiatrists are free to use words any way they choose.  But playing around with words doesn’t alter fundamental realities. And the fundamental reality in this context is the fact that disease (in-the-sense-of-a-physical-pathology-within-the-organism) is not the conceptual, or indeed physical, equivalent of disease (in-the-sense-of-marked-distress-or-functional-impairment).

For Dr. Pies, or other psychiatrists, to assert that these two phenomena are essentially the same, and should be treated as functionally equivalent, isn’t just false, it’s nonsense.  All that they are doing is making dogmatic statements about the meaning of words!  If the words “illness” or “disease” merely mean a condition that entails significant distress or functional impairment, then it is the case that all the DSM entities are indeed illnesses – because that’s how they are written.  Every DSM “diagnosis” has, as one of its criteria, the presence of distress or functional impairment.

Criterion H for dysthymia, for instance, states:  “The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.” (p 168)

Criterion G for social anxiety disorder states:  “The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.” (p 203)

Criterion A for somatic symptom disorder states:  “One or more somatic symptoms that are distressing or result in significant disruption of daily life.” (p 311)

Criterion B for obsessive compulsive disorder states:  “The obsessions or compulsions…cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.” (p 237).

And so on throughout the manual.

So when Dr. Pies asserts that these conditions are illnesses, all he’s actually saying is that:  conditions whose definitions entail distress or functional impairment, are conditions that entail distress or functional impairment.  And somehow in all of this, Dr. Pies seems to believe that his assertions constitute constructive dialogue.

It’s not quantum physics; it’s logic 101.

 

  • Francesca Allan

    I don’t know why but I still find myself feeling embarrassed for psychiatrists when they portray themselves as victims. All that Pies and Stotland et al can say coherently about racism versus skepticism is that *if* the two phenomena were the same, then they *would* be similar. All right, then. Glad we got that cleared up.

  • Anon

    Pathetic spokesman of a pathetic profession. A quack that was obviously more at home in a world where people couldn’t go home and easily look up what psychiatry’s critics have to say. Mountains of information psychiatry used to be able to conceal from the public pre-internet, can no longer be controlled by psychiatry. After generations of psychiatrists being able to control the narrative, they’ve lost control.

    That control is never coming back to them. Millions each year lose the good faith and trust they once had in psychiatry, and this clown likes to pretend that’s because of the “bigots” that no longer believe psychiatry’s lies, producing content online. Cause and effect never was psychiatry’s strong suit, so it shouldn’t surprise that when they burn their own credibility to the ground, they aren’t able to accurately determine the cause of the phenomena.

    Medical students are declining to specialize in psychiatry in droves, most see it as the quackery that it is, and don’t want to flush their lives down the toilet harming people and doling out spurious labels and drugs. The suicide rate of psychiatrists is well known to be much higher than in real doctors.

    It’s psychiatry’s credibility that is slowing going down the toilet, the “giant sucking sound” Pies hears leads him to late in life have a few more tries at playing Pied Piper, but fewer and fewer people pay attention to him. Some garbage profession that says being sad for too long after your spouse dies is a disease, some drug pushing profession that drugs millions of kids and doesn’t possess a single biological test to prove any of its assertions, it’s just a joke. Pies is a punchline. It’s just pathetic.

  • cledwyn bulbs

    Psychiatrists like him, and certain psychiatrists on MIA, take offense because they have learned that in the current climate when certain people do this, there is usually a pay-off. It’s also a strategy designed to enlist the sympathy of others, to manipulate people’s emotions, and to influence the decision-making of people in consequential positions.

    Without the right to offend others, the concepts of freedom of speech and expression lose all point.

    How conceited can these people get? Take a certain psychiatrist on MIA. Not only does this person think she has the right to force toxins into people’s bodies (something I speak on with the authority vested in me by experience, especially the experience of the long-term biological and mental ravages of this particular species of poisoning), she also thinks she has the right to not be offended by the anger of the victims of people in her position, for which this Trojan horse has been showered with praise within the community.

    As Michael Foley said, to paraphrase, the beauty of taking offense is that it presents the threats of the bully as the protestations of the victim, allowing the ego to bask in virtue, while the ID exults in vice. For this reason, tyrants of all stripes are taking umbrage with those of their critics, who in their criticisms refuse to be contained within the limits the tyrant stipulates as a condition of debate.

    Canny operators such as Pies know exactly what they are doing; using offense to their own advantage. He may be laughing now, exulting in the advantages his position affords, but fate takes pleasure in knocking pillocks like Pies off their perches constructed atop the heights of their Olympian self-regard.

    Unable to counter what their most intransigent critics are saying, people like Pies take offense, which in the current age is increasingly being used in lieu of the injunction, “censor these people”, or the demand of an apology. In this case, offense can be strategically taken safe in the knowledge that even most of our so-called advocates will privilege their voice over their victims.

    Obviously we are infringing their right not to be offended, rights which are mostly the preserve of the powerful, which have never extended to people like myself.

    Psychiatrists like Pies are like celebrities, who, in their boundless amour-propre, can’t handle real criticism without taking umbrage, which is why praise never did anybody any good. What people like Pies are really saying is, “how dare you speak to me like that!” They’ve got their heads wedged so far up their own arses they can taste the hairspray.

    This culture of offense-taking constitutes the matrix of fashionable forms of censorship like internet moderation, which is increasingly being used as another front on which the war on heretics and iconoclasts like myself is being waged. What such people don’t understand is that, for those of us who revel in desecrating the shrines erected for the worship of idols sculpted from human flesh; for those of us who flout the conventional pieties of the age, and who delight in breaking taboos and violating norms so as to shine a light on the low-tolerance threshold of the herd and its shepherds, is that we do so largely to piss you off, to afflict the comfortable and jolt them out of their complacency, a desire that only increases with frustration.

    Learning to live with and tolerate the insults of others (and we all have to put up with this, just as we all deal them out, although some of us are good at camouflaging it behind the unctuous phraseology of bourgeois hypocrites, who place no more value on sincerity in their relations with others than Iago, such as many moderators I have encountered, who discriminate against you and attack you whilst pretending to be your friend, as is the custom amongst your modern day oppressor, of which your state psychiatrist is another example) is an essential part of our maturational growth. An attitude of intolerance towards insults only encourages a sense of entitlement that is lamentably one of the most salient features of our age.

    As for the accusation of bigotry and the comparison with racially and ethnically motivated hatred, as you say, that’s absurd, like comparing apples and oranges. What Pies doesn’t say is that almost always this kind of criticism comes from people for whom this issue stirs up such intense feelings of anger and frustration because of personal involvement in it as victims of that which men like Pies profit from.

  • Spamlet

    It is actually quite telling that Pies appeal to be treated as a victim minority, significantly, did not include a religious minority. This, is, of course, in effect, what psychiatrists, and their belief system, amount to: so Pies couldn’t say it.

  • Phil_Hickey

    Spamlet,

    Thanks for coming in. Interesting insight!

  • Jorge_Videla

    veritable bastions of bigotry

    stopped reading there.

    this guy is a MORON.

  • cledwyn bulbs

    To understand why people like Pies are saying what they are saying about the critics, some knowledge of the current cultural climate is required, a climate so charged with intolerance, that demagogues are sprouting up all the place, trying to harness this intolerance to triumph in their conflicts with others.

    In modern society, tolerance is in limited supply. This is none the less true because no-one admits to being intolerant.

    The concept of tolerance, because of its immense rhetorical power, has been usurped by advocates of intolerance, and for this reason has undergone a radical semantic transformation.

    Everywhere people proclaim their tolerance, be it people who support psychiatric sanctions against schizos, be it people who support political correctness, or be it people who support censorship (which often goes under the name of internet moderation). Nevertheless, such people, in order to continue indulging their delusions of prelapsarian innocence (modern man is truly a sanctimonious predator), deny their intolerance, champion free speech, claim to be “anti-oppression”, and utter all manner of pious incantations.

    People support the classical liberal ideal of tolerance insofar as it suits them to, and for this reason there is a certain selectivity in its application.

    We are also living in the age of psychiatric intolerance. As psychiatry’s empire expands, its capacity to tolerate heretics decreases. In this sense, the Psychiatric Church invites comparison with the Catholic Church in medieval/early modern times, in that the latter’s capacity to tolerate heretical thought decreased as its power increased.

    Indeed, it could be said that there is an inverse relationship between power and intolerance. The more of the former one has, the less of the latter.

    One of the reasons why I am such an advocate of tolerance of heretical ideas, and freedom of speech and expression (and we are very much an endangered species I fear) is, because I understand they are weapons of the powerless. Conversely, ideas and norms in a culture that limit their scope such as the tenets of political correctness, and cultural support for the fashionable policing of thought, hunting of heretics and banning of speech which is euphemistically described as “internet moderation”, are always weapons of the powerful (yet such is the age we live, the interests of the powerless are invoked in support of the doctrines. What is inwardly evil, on the modern age, almost is outwardly righteous).

    An understanding of all this is important, I think, if the strategic utterances of men like Pies are to be understood.

  • cledwyn bulbs

    In the seventh paragraph that should be “tolerance”, not “intolerance”.

  • cledwyn bulbs

    And in the penultimate paragraph that should read, “What is inwardly, IN the modern age, almost always is outwardly righteous”

    It is no wonder that Camus said that in modern times, it is the innocent who must justify themselves..

  • Sally

    I subscribe to the Psychiatric Times online, to keep an eye on what the orthodoxy is up to in the US. I was staggered to read Ron Pies (re-posted) article maintaining that he (and his colleagues) had never believed in the chemical imbalance theory of mental illness. Leaving aside its astoundingly patronising tone, the crudeness of the repositioning was almost embarrassing. However, I thought it was also sinister. It is, presumably, a tacit admittance that the evidence against the theory is now so solid that the psychiatric establishment are unable to deny it. I would find that a reason for optimism, were it not for the fact that last week a young friend who is going through a severe depression, was told that her brain chemicals were disordered – by her GP, as he wrote out a prescription for two different antidepressants for her. The drugs would, he said, sort out the dysfunction. So, here in the UK, the brain chemical theory is alive and kicking all too well.

    And cledwyn’s point about the silencing of heretical voices is being played out here, as David Healy faces real danger. I fear for him, as all establishments: political, commercial, academic and medical, protect their own interests first and foremost – and have very powerful ways of so doing. Professor Healy is writing about what is happening in his blog, and on the Rxisk website under the heading “The Persecution of Heretics”. Read and be scared.

  • Phil_Hickey

    Sally,

    Thanks for coming in. In fact, the evidence has been there from the start. The chemical imbalance theory of depression was never more than a tentative hypothesis, and there has been an abundance of conflicting information pretty much from the time it was first proposed. Psychiatry’s promotion of this theory was no error. It was a lie – plain and simple – and some even admit this. Dr. Pies himself called it “the little white lie”!

    And yes, astonishingly, it’s still being promoted, on both sides of the Atlantic – in fact, worldwide.

    Again, thanks for coming in, and best wishes.

  • Cledwyn Gallows Buffoon

    There are broadly speaking two kinds of people who insult and abuse (if that is the right word) you verbally; those who make no attempt to dissimulate their depths, and contain their vitriol within the limits prescribed by propriety, and those who do.

    Myself, I prefer the former, because whilst to have a man, without dissimulation, slather his spiteful spittle all over you can, indeed, be quite annoying, few things are more maddening than to see a man laying claim to sentiments he doesn’t feel, whilst he freely indulges the worst in himself.

    The community of the mental health faithful often opt for the latter. They make use of a backhanded phraseology, whereof the phrase, “you need help”, or some such variation thereof, is a depressing demonstration, presenting the insults of the enemy as the solicitude of a friend, and which reflected thus in the consciousness of he who utters it, allows a man to be vile whilst thinking well of himself, and to sleep the sleep of the innocent.

    The civilization of the species consists largely in this, that is, not in effecting some alchemical transformation of our substance, which we are powerless to do, but in merely directing vileness, the sewage of consciousness, into the proper surreptitious channels, and allowing it only to surface under disguise, so that evil in all its manifestations must now walk abroad in the garb of its opposite if it is to evade detection, in which respects it is so successful that not only has it allowed a cult of humanity to develop, but also, that symptom of our self-estrangement, to wit, the belief in progress, has perhaps never been so strong.

    The same broadly applies to madness, which is only allowed to surface under the disguises afforded by custom and convention, and which must be channeled into the proper forms if it is to evade detection and inclusion in the DSM, which for reasons of political expediency, amongst many other reasons, does not include the organized madness of religion (of which institutional psychiatry is itself a species, albeit of the secular variety), or any of the innumerable examples of mass-produced madness, such as optimism, romantic love, patriotism, hero-worshipping, moral panics, fanaticism, and other assorted lunacies whose prevalence and persistence reduces to a rather depressing joke the whole Enlightenment project, whilst lending certain of the liberal humanist pieties current in contemporary society a frankly absurd complexion.

  • Cledwyn Gallows Buffoon

    “On the day when crime dons the apparel of innocence – through a curious transposition peculiar to our times – it is innocence that is called upon to justify itself.”

    Albert Camus

    In an age when the mechanisms for concealing vileness become progressively more sophisticated, little wonder that the more gimlet-eyed observers of the human comedy are so pessimistic about the future of our species; it is perhaps only in those mechanisms, that is, in the surface of human life, that progress consists.

    Nevertheless, Schopenhauer said, “a man of correct insight among those who are duped and deluded resembles one whose watch is right while all the clocks in the town tell the wrong time”; and, I might add, a man whose watch tells the right time in a town of broken clocks is always a madman, or so it seems to the somnambulant masses, sleepwalking under the influence of the mass hypnosis of whatever are the errors, hopes and delusions that they cherish and drive them ever forwards across the emotional tightrope they must walk, careful not to stop and think, lest they lose their precarious balance.

    So such people can always be dismissed as deranged, which indeed we are, for every man has a share in the lunacy to which all human flesh is heir.

    Or is it, perhaps, not that these mechanisms for the concealment of vileness have become more sophisticated, but that simply fashions change, so that just as the clothes with which we conceal the impropriety and ugliness of our bodies change from age to age, so does the attire wherewith men conceal their ugly depths? If a man clothes his intolerance of free speech in a call for the censorship of the opinions of others, this no longer being fashionable, he’ll be dismissed as an enemy of free speech; but on the other hand, if he is able to keep pace with the latest fashions for concealing vileness, and attires himself in such au courant outfits as calls for the “moderation” or “treatment” of his enemies afford, then, irrespective of whether he fulfills his objective, he’ll rarely be dismissed as an enemy of free speech, and his intolerance and vindictiveness will likely go unnoticed.

    So, perhaps, being civilized can be said to largely consist in the ability to keep pace with the latest fashions for pretending to be what we are not and for concealing what we are.

    The point is is that it is always, au fond, the same drama being enacted. It’s merely the costumes, the dialogue, the actors, and the fake scenery, that changes.

    All the great evils of the past are, essentially, in evidence in the present, it merely requires someone well versed in the art of cryptography to understand this. They may not be equally distributed through the ages, but they are always there.

    Nevertheless, I could be wrong, obviously. We should try not to fall prey to the fallacy identified by Montaigne as measuring the limits of possibility by our own capacities.

    Incapable of conceiving of the possibility that he is wrong, and so given to expressing his opinions as facts, and thus losing all sight of the distinction therebetween – since the arrogance with which we express ourselves easily carries itself over to our thoughts – the average man is ever a prey to this fallacy, as can be seen in political debate and aesthetic criticism, especially amongst lay people. Yet those who think they are never wrong, are almost always so.

    So I must concede that just because one cannot conceive of the possibility that we are moving forward, does not mean we aren’t.

    Though I doubt it….