Tag Archives: chemical imbalance theory

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.

 

More Psychiatric ‘Myth’ Debunking

On July 15, I wrote a post called Psychiatry Debunks the ‘Myths.’  In that article I focused on the myth-debunking of Cognitive Psychiatry of Chapel Hill, but in researching the topic for that post, I came across a psychiatry resident named Shan (no last name) who blogs on a website called Exploratory Encephalotomy.

With regards to the name of the website, Dr. Shan explains on his About the blog page:

“…’exploratory encephalotomy’ implies opening up somebody’s brain in order to search for something.  To the best of my knowledge, it’s not a real medical procedure yet…”

On February 13, 2013, Dr. Shan posted an article titled 6 common misconceptions about psychiatryHere are four of his six myth debunkings interspersed with my comments.

“Myth: Psychiatrists treat and counsel people regarding their emotional problems

Psychiatrists are medical doctors who diagnose and treat medical illnesses that affect the brain and the mind.  These illnesses can often cause emotional problems (just like any other medical illness can cause emotional problems), but the psychiatrist’s role is to treat the illness, not to tell the patient how to deal with life concerns.  In fact, most psychiatrists try to avoid providing counseling, except as it relates to a patient’s medical therapy.

Psychologists and counselors, by contrast, may counsel people regarding emotional problems.  These professionals, however, are not medically trained, so they do not treat medical illnesses.”

Not much ambiguity there.  Standard bio-bio-bio-psychiatry.

“Myth: Psychiatrists talk to a patient about their deeper conflicts while they lie on a couch and face the other direction 

This process, known as psychodynamic psychotherapy, was invented by Sigmund Freud in the 1800′s.  Freud is famous because he was the first psychiatrist; however, his methods have very little evidence-based support.  In the modern age of evidence-based medicine, this approach has fallen out of favor.  In the middle of the 20th century, a group of scientists at Washington University in St. Louis started a charge towards an increase in evidence-based practice in psychiatry.  Since then, the psychiatry world has developed objective diagnostic systems and advanced treatment methods that involve pharmacological therapy as well as surgical/procedural therapy.”

The inaccuracies about Dr. Freud we can let go.  But in other regards, Dr. Shan is telling it like he’s been told:  “objective” diagnostic systems; “advanced” treatment methods including drugs, surgery (lobotomies?) and procedures (electric shocks?).

Myth: Psychiatric illnesses are caused by emotional conflicts

There was a time when it was widely believed that psychiatric illnesses are emotional in nature.  Modern advances in genetics have helped to disprove this notion.  We now know that a predisposition towards mental illness is largely influenced by your genetic makeup.  This can be exacerbated by mental stress, much like in most medical illnesses – for instance, if you have a strong family history of diabetes, you can prevent/delay the onset of the disease by eating well and exercising a lot, but that doesn’t change the fact that it’s a biological disease with biological consequences.”

There it is – “psychiatric illnesses” are real illnesses – just like diabetes: biological diseases with biological consequences.

Myth: Psychiatrists only treat crazy people 

This is false in the same way that the statement ‘cardiologists only treat failing hearts’ is false.  Most psychiatric patients have a genuine illness that is caused by a defective balance between different compounds in their brains (much like diabetes with insulin and sugar).  When that balance is corrected, they are no longer ill.  The illness may manifest as depression, anxiety, or a variety of other features that can make a person feel “sick,” but wont’ make them act ‘crazy.’

Other illnesses, such as mania and schizophrenia, may affect a person’s ability to function within societal norms, but we can usually treat them and allow the person to go back to their previous level of functioning.  This is a big change from the days of big “mental asylums” and the like – instead of hiding people who are just ‘crazy,’ we can now treat people who are ‘sick’ and allow them to go back to real life.  As a result of that, words like ‘crazy’ have become antiquated.”

Here we see clearly articulated the chemical imbalance theory, which the eminent psychiatrist Ronald Pies, MD, assures us that no well-informed psychiatrists ever promoted.  And we even have the assurance that when the balance is “corrected” – “they are no longer ill.”  (Corrected, presumably, by the drugs, the surgeries, and the other unspecified procedures.)

Obviously Dr. Shan has completely accepted, presumably from his med school teachers, the medical model of human distress.

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To me, and I imagine to most of us on this side of the debate, the logical and evidentiary shortcomings of psychiatry are glaringly obvious.  I have often wondered how it is that people with sufficient intelligence to complete a medical degree not only don’t see through the fraud and the travesty, but actually embrace it with apparent fervor and dedication.

I realize, of course, that once a psychiatrist has been practicing for a number of years, the need to make a living can effectively eclipse any reservations he or she may have on the subject.  But it’s harder to understand why people, nearing the end of their medical training, who presumably have a wide range of choices, would set their sights on the only medical specialty that invents, rather than discovers, the “illnesses” that it treats.

Dr. Shan’s website provides, I think, some insights into this matter.  Here are some quotes.  The first is from the About page linked above.

“Soon after I started medical school, I found myself stuffing my mind into the proverbial box that I so detested in the past.  I surprised even myself at how quickly I’d acquiesced to the stringent rules of the medical field as they attempted to execute a subtle Machiavellian attack on my hopes to continue my young writing career.  Before long, I started to notice the gradual corrosion of the unique outlook that I’ve developed thanks to my scientific training combined with my interest in the social sciences and the amalgam of cultural settings around which I was reared.  This outlook was slowly being replaced by the guidelines of your favorite local medical board; in an attempt to ensure quality healthcare, those guidelines find a way to become ingrained into the medical student’s mind while extinguishing any iota of creativity and independent thought.”

And from a post Re-introduction, dated August 2012:

“I was soon to find out that medicine is not just a subject to study or a set of ideas to learn.  It is an entire frame of mind to which a student must adhere.”

“At first, I felt like a robot, relying entirely on the memory centers in my brain while completely disregarding any remaining smidgen of independent thought.  As optimistic as I may have been about the ultimate destination, it seemed like the journey asked for my humanity as a toll.  I began to come to terms with the idea that in order to be a Doctor, I must first cease to be a human.  I had to think in flowcharts, not ideas.”

“After a few years in medical training, I’ve finally started to understand where that outlook comes from: in the process of learning medicine, it is strikingly difficult not to let one’s mind turn into a hard drive.  It happened to me after a while too.”

In other words, if I’m reading Dr. Shan correctly, in order to become a physician, one has to switch off one’s own critical thinking ability, and accept the tablets of stone as handed down by the lecturers and professors.  This model may have some merit in the teaching of anatomy, physiology, etc., and even in the specialties like nephrology, cardiology, etc…  After all, there is a great deal of factual material to be learned, and a pedagogical approach is probably economical and effective.

But it is disastrous as a method of preparing people for a career in the alleviation of distress, despondency, painful memories, feelings of inadequacy, etc…

Whatever initial thoughts or orientations trainees might have, in order to become qualified in, and practice, psychiatry, they must internalize the illness mantra, the spuriousness of which is evident to anyone with an ounce of critical thinking.  They must dish out the pills.  And they must never question or challenge the orthodoxy.  They must never say that the Emperor has no clothes, because once that admission is made, the whole charade comes tumbling down.

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

Psychiatry doesn’t just damage its victims.  It takes its toll on the practitioners also.  A human being cannot internalize this nonsense and inflict it on his/her fellow travelers day in and day out for years on end, without doing profound violence to his/her own humanity.

Psychiatry Debunks the ‘Myths’

Psychiatry has always had its share of critics, but in the past two decades these criticisms have increased in frequency and intensity.  Psychiatry’s underlying concepts are being denounced as spurious to the point of inanity, and its practices are being accurately and forcefully exposed as destructive, disempowering, and stigmatizing.

Psychiatry has no rational or logical response to these criticisms.  Its leadership and its rank and file remain stubbornly blind to the arbitrariness and invalidity of its so-called diagnoses, the unquestioning adoption of which distorts their perceptions of people and their problems.

Psychiatrists no longer perceive childhood misbehavior as a problem that needs to be corrected through normal parental discipline and correction – but rather as a manifestation of a pediatric illness:  conduct disorder, or oppositional defiant disorder, or attention deficit/hyperactivity disorder, or disruptive mood dysregulation disorder.

They no longer perceive human despondency as the normal response to oppression, misery, poverty, discrimination, victimization, overwork, or an empty, purposeless lifestyle, – but rather as major depressive illness.  They have convinced themselves that they can treat, and even cure, depression by tinkering irresponsibly with people’s internal chemistry, while blithely ignoring the circumstances and context that created and maintain the negative feelings.

Painful memories, with which the human species has dealt successfully since we were hunter gatherers on the plains of Africa, are now also illnesses which can, by some amazing coincidence, also be cured by tinkering with people’s internal chemistry.

Psychiatrists betray no trace of insight into the fact that they “see” these illnesses because of their dogmatic conviction that they exist, in the same way that the early microscopists “saw,” and even drew pictures of, homunculi in human sperm.

Psychiatrists, enthralled as they are in their own self-congratulatory rhetoric, are blinded to the obvious reality that giving people the false message that they are damaged, and need to be “treated,” by psychiatrists for problems that previous generations took in their stride, is inherently crushing and disempowering.  Falsely telling people that they are broken, breaks them.

Humanity is so much more than the crippled caricature of helplessness and dependency that psychiatry has self-servingly invented, and which, with pharma promotion, is tragically becoming the norm for countless millions of people worldwide.

And psychiatry has no defense.  They hitched their wagon to pharma decades ago.  They willingly and knowingly became drug pushers, no different in essence from those that work the street corners, and they developed an elaborate web of rationalizing deceptions from which there is no way out.  All they can do now is find new ways to promote their spurious doctrines and, of course, to regurgitate their criticisms of those of us who dare to speak out against their sacred scriptures and their shameless “treatments.”

A standard part of the latter endeavor is the contention that all criticisms of psychiatry are myths, and, on a fairly regular basis, one of their number undertakes to “debunk” these “misguided” notions.

On June 19, 2014, Cognitive Psychiatry of Chapel Hill (CPCH) published 10 Common Myths About Psychiatry.  From their website, it would appear that CPCH consists of two psychiatrists:  Jennie Byrne, MD, PhD, and Nicola Gray, MD.  Both Drs. Byrne and Gray are published and widely experienced, and I think by any conventional standards would be considered well-informed and knowledgeable psychiatrists.

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

Here are some of the myths that they “debunk,” interspersed with my comments.

“Mental Illness Diagnoses Are Labels For Normal Behavior
We have been asked quite often over the years, where Psychiatrists draw the line between normal behavior and mental illness. Where someone who is a little shy, becomes a case of anxiety, or where someone who gets sad, has depression. Much like a benign tumor, vs. cancer, we determine a diagnosis when the behavior becomes debilitating and the patient can no longer go about their daily lives as they have in the past.”

This particular “debunking” is standard DSM fare.  A problem becomes a mental illness when it causes either:

a) significant distress

or

b) significant disability in social, occupational, or other important activities.

There are two problems with this definition of a mental illness.  Firstly, there is no reliable way to assess the term “significant.”  A “diagnosis” of “mental illness” always and inevitably hinges on the subjective judgment of a psychiatrist, who, incidentally, always has a vested interest in the outcome.  Secondly, a problem that is not an illness doesn’t become an illness simply by becoming more severe.  The only human problems that are illnesses are those that entail biological pathology.  This is what the word “illness” means!  Apart, obviously, from those conditions labeled “due to a general medical condition,” no psychiatric diagnosis has been definitively linked to a biological pathology.  In the words of Thomas Insel, MD, Director of NIMH, DSM is “…a dictionary, creating a set of labels and defining each.”  It is emphatically not a list of illnesses.

. . . . . . . . . . . . . . . . . 

Psychiatrists Will Force Medication On You
Every patient is different, as are his or her needs. A good Psychiatrist will never force medications on their patient. Patients should have a treatment that is completely unique to them, and a practiced Psychiatrist will work with them to find that exact treatment they need.”

This is not only false, but is also, I suggest, offensive to the millions of people worldwide who have been committed to mental hospitals and forcibly drugged.  Unless, of course, Drs. Byrne and Gray are saying that only bad psychiatrists engage in that sort of practice?  “Psychiatrists will force medication on you” is certainly not a myth.  Note the spelling of psychiatrist with a capital P!

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

Psychiatry Only Involves ‘Crazy’ People
Actually, the majority of patients we see have an actual illness or imbalance (much like diabetes), that with the proper treatment, the imbalance is corrected and they are no longer ill…”

This is the old, never-confirmed-and-in-fact-much-refuted-chemical-imbalance-theory that, according to the confident assertions of the eminent psychiatrist Ronald Pies, MD, was never subscribed to or promoted by any well-informed or knowledgeable psychiatrists.

Well, the spurious, simplistic theory is still very much alive, at least in Chapel Hill, NC.  Note even the “much like diabetes” deception, and the sheer intellectual effrontery:  “…with the proper treatment, the imbalance is corrected and they are no longer ill.”

This is particularly troubling in that there are no psychiatry-pharma products that correct any neural imbalance of any kind.  All psychiatric drugs are neurotoxins that produce their effects by creating a pathological state within the brain.  The quote is even more troubling, in that it is clearly aimed at potential clients, and as such constitutes recklessly false advertizing.

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

And in case there is any doubt as to CPCH’s intended meaning:

The Mentally Ill Will Never Recover
As we discussed in our 3rd myth, many patients that see a Psychiatrist actually have an illness or imbalance that is causing a mental discrepancy. Once this imbalance is corrected, they are, in fact, cured of their mental illness. However, there are still some cases that involve life-long treatment and monitoring.”

So, the “mental discrepancy” is caused by an imbalance, which can be “corrected” by psychiatrists, which effects a “cure.”  Perhaps Dr. Pies needs to pay a visit to Chapel Hill.

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

Mental Illness is Uncommon
This is one myth we wish were true. However, one in every five Americans will be diagnosed or touched by a mental illness in their lifetimes, according to the National Institute of Mental Health.”

Again, this is standard psychiatric fare, though they’ve got the numbers wrong – it’s fully 50% of us poor, broken, disempowered Americans who will be “diagnosed with mental illness” in our lifetimes.  The one in five figure is the official prevalence at any given point in time!

Of course, the reason these prevalence figures are so high is because for the past sixty years, psychiatry has steadily expanded its “diagnostic” net by two simple expedients: increasing the number of “mental illnesses”; and lowering the thresholds for each.  Unlike real medicine, psychiatrists don’t discover their illnesses, they just decide, usually by a vote, that a problem that hitherto had been one of the ordinary challenges of life is now, by psychiatric fiat, an illness.  This is disease-mongering without even a pretense of legitimacy.

. . . . . . . . . . . . . . . . 

Psychiatric Drugs Will Change Your Personality
Any medication out there can cause negative effects for a patient if taken too long or given the wrong dosage. The way we see it, is this; if someone with depression overcomes it through their medication, their personality will be changed, yes – they will be free from negative thoughts, anti-social behavior, and feelings of defeat, which is a definite change in personality – a positive change. The same can be said for an illness like Schizophrenia, with the right treatment plan, their minds will become less consumed by hallucinations, delusions, and irrational anxieties – another healthy and positive personality change.”

Note the implication, which is, incidentally, false, that negative effects only occur if the drug is taken for “…too long or at the wrong dosage.”  And then the spin:  antidepressants liberate the user from negative thoughts, anti-social behavior (Department of Corrections take note), and feelings of defeat.  And the glorious prospect for people suffering from the “illness” called schizophrenia, if they follow the “right treatment plan” (and I wonder what that would be): their craziness will fade like a morning mist under a summer sun – “another healthy and positive personality change.”  What planet do these psychiatrists live on?  Have they ever even seen a person ravaged by tardive dyskinesia or akathisia?

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

But it gets worse.  On June 27, Psychiatric Times linked on their Facebook site to the 10 Common Myths article by CPCH.  Here’s what Psychiatric Times said:

“There are many stigmas out there regarding Psychiatry, both good and bad.  Today, Cognitive Psychiatry will debunk 10 myths revolving around their practice.”

I can’t even imagine what’s meant by “…stigmas…both good and bad…”.  But setting that aside, it is clear that Psychiatric Times is endorsing CPCH’s efforts at myth debunking, and is also, presumably, endorsing the contents of the article – chemical imbalances (just like diabetes), and all.

And who, or what, one might ask, is Psychiatric Times?

Here’s what Wikipedia says:

“Psychiatric Times is a medical trade publication written for an audience involved in the profession of psychiatry.”

“Psychiatric Times was first published in January 1985 as a 16-page bimonthly publication. It was founded by psychiatrist John L. Schwartz and originally edited by Ronald Pies.” [Emphasis added]

On Psychiatric Times’ home page there’s a link called “Editorial Board.”  It you open this you’ll see that the second name on the list is none other than the very eminent psychiatrist Ronald Pies, MD.  He is also listed as one of the three editors-in-chief emeriti.

And this is the same Dr. Pies who described the chemical imbalance theory as “…a kind of urban legend – never a theory seriously propounded by well-informed psychiatrists.”

Well, as an “urban legend,” it’s proving remarkably resilient.  And it’s proving resilient because it has indeed been promoted by psychiatrists.  And it is still being promoted by psychiatrists, including, at least in this instance, the Psychiatric Times editors.

On one matter, however, I am in complete agreement with Dr. Pies.  The psychiatrists concerned are definitely not well-informed.

Psychiatry DID Promote the Chemical Imbalance Theory

On April 15, Ronald Pies, MD, an eminent and widely published psychiatrist, wrote an article for Medscape.com.  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.

And

“…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!

And

“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.”

RESPONSE TO DR. PIES

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.

DISSENTING PSYCHIATRISTS

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.

PSYCHIATRIC TEXTBOOKS

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.

CONSUMER GROUPS

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:

CABF:

“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

DBSA:

“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

MHA:

“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)

NAMI:

“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?

PSYCHIATRISTS’ LINKS TO PHARMA

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.)

SUMMARY

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.