On August 19, 2018, an article titled The Reality of Mental Illness was published on Psychology Today. The authors were Ronald Pies, MD, and Mark Ruffalo, LCSW. Dr. Pies is a professor of psychiatry at Tufts and at SUNY. Professor Ruffalo has a private psychotherapy practice in Tampa, Florida. He is also an instructor of medical education (psychiatry) at the University of Central Florida, an adjunct professor of social work at University of South Florida, and a voluntary associate professor of psychiatry at Centerstone, “…a not-for-profit healthcare organization…[that]…provides mental health and substance abuse treatment, education and support to communities in Florida, Illinois, Indiana, Kentucky, and Tennessee and additionally offers individuals with intellectual and developmental disabilities life skills development, employment and housing services.”
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Here’s the opening paragraph:
“Psychiatry is unique among the medical specialties in the sense that it has a very active and vocal countermovement known loosely as antipsychiatry. What started in the 1960s with the writings of psychiatrists Thomas Szasz and R.D. Laing, among others, has since broadened to include a whole host of ideas and philosophies subsumed under ‘antipsychiatry.'”
This introductory paragraph isn’t entirely accurate. What is generally opposed by those of us in the anti-psychiatry movement is the bio-bio-bio travesty, with its consequent destructiveness and disempowerment, that underpins and drives almost all psychiatric activity today. And the opposition to this spurious and destructive philosophy predates the work of Thomas Szasz and R.D. Laing.
In the asylums, the bio-bio-bio concepts had held sway from about the middle of the 1800’s, as management of these institutions was increasingly assigned to psychiatrists. The idea was that having a medical professional in charge would produce a more humane milieu and would improve effectiveness. In reality, most of the “treatments” devised by these individuals consisted essentially of torture, and discharge rates declined steadily.
By about 1900, however, the medical model was being seriously challenged. This was partly because of the inhumane “treatments”, but was also a reflection of the fact that, apart from general paresis and a few other organic conditions, research persistently failed to identify any consistent correlation between organic pathology and psychiatry’s putative illnesses.
By 1920, the psychoanalytic model developed by Sigmund Freud and others was well established in Europe and North America. The techniques derived from that model were being practiced widely by community-based psychiatrists, and were even making some minor inroads in the asylums.
In the period between 1920 and 1960, various other models for conceptualizing human problems were developed. These included the humanistic, interpersonal, and existential perspectives, each attracting wide followings.
Although the psychoanalytic and other psychosocial schools represented formidable challenges to biological psychiatry, they were not seen as anti-psychiatry as such, for the simple reason that they were widely embraced by psychiatrists themselves, especially those working in the community.
So, although the term anti-psychiatry didn’t emerge until later, there was a great deal of opposition to psychiatry’s bio-bio-bio perspective at least as early as 1920. This was reflected clearly by the use of the term “reaction” throughout DSM-I, 1952 (schizophrenic reaction, depressive reaction, etc.). The various “mental disorders” were conceptualized, not as disease entities in themselves, but rather as reactions of the individual to psychological, social, and biological factors.
Although there was widespread enthusiasm among psychiatrists for the psychoanalytic and other psychosocial approaches, there was also a strong sense that the problems being addressed weren’t really illnesses, which they weren’t, that the remedial activities weren’t really medical in nature, which they weren’t, and that the psychiatrists who followed these approaches weren’t really practicing medicine, which they weren’t.
This sense of inferiority created a vulnerability within psychiatry, and when the psychoactive drugs began to come on stream in the 1950’s, and increasingly in the 60’s and 70’s, psychiatrists recognized the opportunity for increased credibility, prestige, and remuneration. In this context, they began to abandon the humanistic eclecticism of former decades and revert to the bio-bio-bio perspective, staking everything on the gamble that the evidence to support this position would soon be found, which, of course, it hasn’t. The term reaction was eliminated in DSM-II, 1968, formalizing psychiatry’s return to the bio-bio-bio perspective.
But the transition was neither smooth nor immediate. A great many psychiatrists opposed the escalation in the use of drugs, and had to be “softened up” by peer pressure and pharma marketing. It is largely forgotten today, but many pharma ads in psychiatric journals in the 60’s and 70’s did not promote the notion of the drugs as treatment, but rather as aids to psychotherapy – they would help the client to start talking about his/her problems.
Here is a two-page ad for Valium, July 1974:
And an ad for Serax, October 1972:
And a two-page ad for Elavil, May 1974:
These were all taken from the American Journal of Psychiatry, the APA’s own journal, for the years 1972 and 1974.
The general point here is that opposition to the illness model predates the writings of Drs. Szasz and Laing, and was promoted by various individuals and professions, including psychiatry itself. The history of how this opposition was muted within psychiatry and of how the vast majority of psychiatrists came to align themselves with the pharma-APA orthodoxy has not yet been fully written, but will probably emerge in the coming years, as increasing numbers of retiring psychiatrists speak out against the hoax and the recruitment methods used to promote it. We do know that pharma poured enormous sums of money into this endeavor. Daniel Carlat’s book Unhinged (2010) provides interesting insights in this area, though from a later time-frame.
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Today, there is, of course, an active, vocal, and growing movement called anti-psychiatry, of which I am proud to consider myself a member. This movement exists for the following reasons:
- Psychiatry’s definition of a mental disorder/illness is so wide that it embraces virtually every significant problem of thinking, feeling, and/or behaving, and psychiatry uses this definition to spuriously medicalize a growing range of problems that are not medical in nature.
- Psychiatry routinely presents their “diagnoses” as the causes of the specific problems, when in fact they are merely labels with no explanatory significance. These so-called illnesses are not discovered in nature as real illnesses are. Rather, they are invented by psychiatry, as are the facile checklists that psychiatry uses to “diagnose” them.
The lack of explanatory value can be readily demonstrated by the following hypothetical conversation:
Customer: Why am I so depressed, off my food, unable to sleep, tired all the time, and not interested in doing anything?
Psychiatrist: Because you have an illness called major depressive disorder.
Customer: How do you know I have this illness?
Psychiatrist: Because you are depressed, off your food, unable to sleep, tired all the time, and not interested in doing anything.
The only evidence for the so-called illness are the very thoughts, actions, and feelings that it pretends to explain. The “diagnosis” of “major depressive disorder” adds absolutely nothing to an understanding of the issues, sheds no light on its causes or precipitants, and provides no insights that might help ameliorate the problem. It merely serves to provide the appearance of legitimacy to the administration of drugs and/or electric shocks. It’s a monumental and shameful hoax.
Real-life versions of the above hypothetical conversation should occur in psychiatric offices and facilities every day. But they don’t, because they are too transparent, and would give the hoax away. The conversations that actually occur run along these lines:
Customer: Why am I so depressed, off my food, unable to sleep, tired all the time, and not interested in doing anything?
Psychiatrist: Because you have an illness called major depressive disorder.
Customer: How do you know I have this illness?
Psychiatrist: Because you meet the scientifically validated criteria.
But in fact, the criteria (five hits out of nine on the facile checklist) are not validated and cannot be validated because there is no definition of major depressive disorder other than five hits out of nine on the facile checklist. Essentially, the only really honest answer to the customer’s how-do-you-know question is: because we psychiatrists say so. Similar considerations apply to psychiatry’s other “diagnoses”.
- Psychiatry has routinely deceived their clients, the public, the media, and government agencies, that these loose clusters of vaguely defined problems are in fact illnesses with known neural pathology. To explain away profound human suffering that stems from exploitation, poverty, abuse, over-crowding, unrelieved drudgery, depersonalization, disempowerment, bereavement, loss, etc., as neuro-pathology, in the absence of any evidence for same, is stigmatizing, offensive, and insulting.
- Psychiatry has blatantly promoted drugs as corrective measures for these “illnesses”, when in fact it is well-known in pharmacological circles that no psychiatric drug corrects any neural pathology. In fact, the opposite is the case. All psychiatric drugs exert their effect by distorting or suppressing normal functioning.
- Psychiatry has worked hand-in-glove with the pharmaceutical industry in the creation of a large body of unreplicated, contradictory, and misleading research, all designed to “prove” the ontological reality of the “illnesses” and the efficacy and safety of the pharma products.
- A great many psychiatrists have shamelessly accepted large sums of pharma money for very questionable activities. These activities include the widespread presentation of infomercials in the guise of CEUs; the ghost-writing of books and papers which were actually written by pharma employees, including at least one psychiatric textbook (here); acting as paid psychiatric “thought leaders” who promote new drugs and diagnoses for pharma; etc., etc…
- Psychiatry’s spurious diagnoses are inherently disempowering. To tell a person, who in fact has no biological pathology, that he or she has an incurable illness which necessitates psychiatric drugs and/or high-voltage electric shocks, sometimes for life, is an intrinsically immoral and disempowering act which falsely robs people of hope, and encourages them to settle for a life of drug-induced dependency and mediocrity.
- Psychiatry’s “treatments”, though they may sometimes induce transient feelings of well-being, are almost always destructive and damaging in the long-term, and are frequently administered without informed consent. In my experience, it is rare to encounter a psychiatric “patient” who has been fully informed concerning the adverse consequences of the drugs and shocks.
- Psychiatry’s spurious and self-serving medicalization of every significant problem of thinking, feeling, and/or behaving, effectively undermines human resilience, and fosters a culture of powerlessness, uncertainty, and dependency. Fallaciously relabeling as illnesses, problems which previous generations accepted as matters to be addressed and worked on, and harnessing billions of pharma dollars to promote this false message, is morally repugnant.
In addition to these general deceptions and malfeasances, psychiatry has committed numerous specific acts in which the welfare of their clients has been subordinated to their own guild interests. For instance:
- In 2013, with the publication of DSM-5, the APA eliminated the bereavement exclusion (p 161) which had effectively discouraged the assignment of a “diagnosis” of “major depressive disorder” to a bereaved person. Since DSM-5, however, people in the throes of mourning can be told the grotesque lie that the death of their loved one was merely a trigger, and that their sadness is really the result of a brain illness, for which psychiatry has “safe and effective” treatments. (i.e. drugs and electric shocks).
- Also in DSM-5, the APA eliminated the antidepressant-induced mania exclusion. This exclusion, which was clearly articulated in DSM-IV (p 332), had prohibited a “diagnosis” of “bipolar disorder” in cases where the manic behavior was caused by antidepressant treatment (drugs or shocks). Since DSM-5, this “diagnosis” can be assigned if the mania persists “…beyond the physiological effect…” of the “treatment”, a condition that is impossible to determine.
In short, psychiatry is intellectually and morally bankrupt. The critical question is not why would a person be anti-psychiatry, but rather why would a person not. Or as Ted Chabasinski more elegantly put it in his 2013 post: Of Course I’m Anti-Psychiatry. Aren’t You? Auntie Psychiatry has used the same phrase as the title of her 2017 book.
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Here are some further excerpts from the Dr. Pies/Prof. Ruffalo paper, interspersed with my comments and reflections.
[Other critics of psychiatry] “…seem to harbor a visceral hatred for ‘all things psychiatry’…One has to look no further than the comments left by some on antipsychiatry websites, calling for violence against psychiatrists and others in the field.”
What Dr. Pies and Prof. Ruffalo need to recognize here is that there is anger on both sides of this issue. It is hypocritical of Dr. Pies and Prof. Ruffalo to decry the expressions of anger directed at psychiatry while ignoring the steady stream of vituperation and invective that is directed towards members of the anti-psychiatry movement.
It should also be borne in mind that a great many of the individuals who critique psychiatry have suffered profound, and often irreversible, damage from psychiatric “treatments”. Dr. Pies and Prof. Ruffalo might benefit from reading some of these first-hand accounts, in the light of the obvious reality that anger is a normal human response to hurt. I think it’s unlikely that either Dr. Pies or Prof. Ruffalo has lost large segments of their personal memories to high-voltage electric shocks to the brain. I think it’s also unlikely that either has experienced the agonies of neuroleptic-induced akathisia.
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“Perhaps the most pervasive — and harmful — claim made by antipsychiatry is that mental illness doesn’t really exist, and that the treatments for mental illness are merely concealed attempts to exert social control over the population. (A related claim is that all psychiatric medications ‘do more harm than good’ and are driving an ‘epidemic’ of mental illness. Paradoxically, the latter claim contradicts the notion that mental illness doesn’t exist — see Pies, 2015).”
This paragraph is confusing. Notice that the first sentence contains two assertions: 1. antipsychiatry claims that mental illness doesn’t really exist; and 2. antipsychiatry claims that psychiatric “treatments” are merely concealed attempts to exert social control over the population.
And Dr. Pies and Prof. Ruffalo are telling us that this dual assertion is the most pervasive and harmful claim made by anti-psychiatry.
So let’s see if we can unravel the issues. Firstly, the assertion that “mental illness doesn’t really exist” is woefully ambiguous. What the majority of anti-psychiatry writers say is something quite different: that the thoughts, feelings, and behaviors which psychiatry labels as illnesses, are not illnesses, though the thoughts, feelings and behaviors themselves are very real, and can sometimes be devastating to the individuals concerned. Most of us also take pains to exclude from this assertion those entries in the DSM which are due to a general medical condition.
The problem with the Pies/Ruffalo statement is that it fails to distinguish between the thoughts, feelings and behaviors which are indeed real, and the putative illnesses, which are not. In this regard, Dr. Pies and Prof. Ruffalo are sowing seeds of confusion among their own adherents.
Secondly, the assertion that “treatments for mental illness are merely concealed attempts to exert social control over the population” is not, in my experience, particularly pervasive in anti-psychiatry circles, though it probably occurs from time to time. What it says essentially is that psychiatrists, going about their day-to-day work, are covertly attempting to exert social control over the population.
In my experience, the primary motivation behind most psychiatric activity is making a living and gaining prestige and advancement. At the same time, it is an obvious fact that psychiatry, whose main function is the chemical and electrical numbing of legitimate human distress, plays a critical role in the maintenance of many of the exploitations and injustices that characterize our society. But I doubt if many psychiatrists actually conceptualize their role in these terms. In my entire career, I have heard only one psychiatrist state unambiguously that psychiatry is an arm of law enforcement. The vast majority have bought the illness theory, and cling to the fiction that they are real doctors battling bravely against real illnesses.
The issue is not the deliberate exertion of social control over the population, but rather the promotion of the falsehood that despondency/distress arising from adverse events and/or persistent adverse circumstances is really the result of chemical or electrical malfunctions in the affected individuals’ brains. It is an obvious fact that this falsehood constitutes a de facto condoning of the institutionalized injustices, and a passive collusion with the perpetrators. But it is a fact to which psychiatrists generally seem particularly oblivious. Even when the drugs are clearly being administered for management/control purposes (e.g. in nursing homes, group homes, foster homes, etc.), I think most psychiatrists still manage to convince themselves that they are battling illness and improving quality of life. The rationalizing mind is an extraordinarily creative faculty.
Thirdly, psychiatric drugs do indeed effect more harm than good, especially in the long-term. We are seeing this with increasing clarity in recent years, as more and more individuals who have been damaged by psychiatric drugs and electric shocks are speaking out concerning the harm they have suffered. And it should also be borne in mind that the reason we hadn’t heard much from these people in former years is that their voices were systematically stifled by psychiatric condescension: it’s just your illness talking, or threats: this shot of haloperidol will have you feeling like your old self again.
In addition, psychiatry, on whom the burden of proving efficacy squarely lies, has never managed to produce convincing evidence of substantive long-term efficacy, and has studiously avoided the issue of long-term harm. With regards to the latter, there is a large body of prima facie evidence linking psychiatric drugs with the enormous increase in apparently unmotivated suicides and mass murders. But, to the best of my knowledge, psychiatry has never undertaken a definitive study to clarify this connection. In the 2016 US legislative session, the late Senator John McCain and Congressman David Jolly introduced bills in their respective chambers which mandated post-mortem screenings for psychiatric drugs in all veterans who died by suicide. The bills, which were not supported by psychiatry, failed. Now why in the world would psychiatry not support such measures? Why is psychiatry not actively pushing for the reintroduction of these or similar bills today? Could it be that they know full well what the results of such autopsies would show? Could it be that psychiatrists, despite the unabashed praise that they bestow so unstintingly on themselves, are at heart more concerned with their own guild interests than with the welfare of their clients? Shouldn’t psychiatry’s failure to objectively investigate this pressing matter be considered malfeasance of a most grievous nature?
The concern that these drugs precipitate violent and suicidal behavior is not new. In 1991, a group of Yale researchers, most of whom were psychiatrists (Robert King et al) published a paper titled Emergence of Self-Destructive Phenomena in Children and Adolescents during Fluoxetine Treatment. (Fluoxetine is an SSRI, marketed as Prozac.) Here’s a quote from their abstract:
“Self-injurious ideation or behavior appeared de novo or intensified during fluoxetine treatment of obsessive-compulsive disorder in six patients, age 10 to 17 years old, who were among 42 young patients receiving fluoxetine for obsessive-compulsive disorder at a university clinical research center.”
And here are two quotes from the body of the paper:
“A…most intriguing possibility is that the emergence or intensification of self-destructive behavior and ideation during treatment is due to a specific effect of fluoxetine on the regulation of aggression directed either outward or toward the self. Alterations in serotonergic metabolism have been implicated in a variety of violent phenomena, including, in animals, certain types of aggressive behavior (Olivier et al., 1990) and, in humans, completed suicide, suicide attempts, impulsive violent acts, and obsessions of violence (Coccaro, 1989; Brown et al., 1990; Leckman et al., 1990; Roy and Linnoila, 1990)”
and
“Additional clinical and neurobiological research is needed to characterize more carefully those children and adults who experience adverse responses to fluoxetine.”
That was 28 years ago. Since then there has been a very large increase in the prescribing of these drugs and a corresponding increase in apparently unmotivated suicides and murders. There is also a large body of anecdotal evidence linking SSRI’s to these tragedies (e.g. AntiDepAware). But the definitive study on this matter has still not been done. Perhaps psychiatrists are too busy writing prescriptions? Or perhaps the results of such a study would have too severe an impact on their business? Or perhaps the study has been done, and the results suppressed? In any event, the unfulfilled call by King et al twenty-eight years ago stands as a challenge to psychiatry’s persistent claim that their drugs are safe and effective and that they have their clients’ best interest at heart.
Many other researchers and writers have noted the link between SSRI’s and suicide/violence. Joseph Glenmullen, MD, a psychiatrist, summarized these in his book Prozac Backlash, 2000:
“In every instance, the stories are remarkably similar: a dramatic, noticeable change occurred in an individual soon after starting the drug. Phrases like ‘severely anxious and agitated,’ ‘felt like jumping out of her skin,’ and ‘couldn’t sleep, pacing all night’ were recurring themes. The suicide attempts and violence toward others were described as ‘shocking,’ ‘completely out of character.'” (p 138)
Fourthly, psychiatry is indeed creating an epidemic of “mental illness”. In the past forty years, we have seen a truly bewildering array of non-medical human problems arbitrarily and groundlessly converted to “mental illnesses” by the fiat of the APA. Here is a short list:
Fifthly. “Paradoxically, the latter claim contradicts the notion that mental illness doesn’t exist…” This is pure sophistry of the sort that has come to characterize the speeches of politicians, where the scoring of points takes precedence over promoting the truth. It is disappointing, though perhaps not surprising, to find Dr. Pies stooping to such depths. The epidemic in question stems from the twin facts that psychiatry routinely creates new “mental illnesses”, (note the quotation marks indicating the spurious nature of the term); and that psychiatric drugs and electric shocks, taken for extended periods, often induce persistent depression and other serious adverse effects. So, there’s no paradox and no contradiction; just facile and partisan disingenuousness from Dr. Pies and Prof. Ruffalo.
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“The claims of antipsychiatry require careful philosophical investigation, since they have serious consequences for those we treat.”
This is absolutely true. I wonder if this means that Dr. Pies and Prof. Ruffalo are about to take a serious and honest look at anti-psychiatry’s contentions. Probably not.
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The authors next focus their attention on “six common claims made by antipsychiatry”. They refer to these claims as “myths”.
Myth #1: Mental illness is not a real disease, because no biological abnormality has ever been consistently demonstrated in supposedly mentally ill persons. The term “mental illness” is thus nothing more than a metaphor.
Dr. Pies and Prof. Ruffalo delve briefly into the history of this “myth”, and then:
“The history of medicine tells us that the presence of an anatomical lesion or physiological abnormality — Szasz’s ‘gold standard’ for identifying disease — is merely one way to identify and conceptualize disease. Indeed, such findings are neither necessary nor sufficient to establish clinically meaningful disease or illness. A person may have an abnormally shaped ear lobe or an unusually high serum albumin level and not be ‘diseased’ or ‘ill’ in any clinically relevant sense. Historically, the concept of ‘disease’ (dis-ease) is intimately linked with some combination of suffering and incapacity“
Well this, of course, is the old Piesian chestnut, illness-does-not-require-anatomical-or-physiological-pathology-but-merely-suffering-and-incapacity, which Dr. Pies trots out whenever this issue is broached.
So let’s see if we can cut to the chase. For decades, psychiatry at both leadership and rank and file levels has avidly promoted the notion that depression which crosses arbitrary and subjectively-assessed levels of severity, frequency, duration, and impact is an illness or disease caused by a neurochemical imbalance. Psychiatrists assured, and still assure, their customers and the general public that because of this “chemical imbalance”, depression is a real disease, just like diabetes, and needs to be treated with drugs and high-voltage electric shocks to the brain. Similar claims have been made concerning psychiatry’s other so-called illnesses.
At this point, the debate becomes a little tenuous, because Dr. Pies has repeatedly insisted that psychiatry has never made any such claim. So it’s a bit like trying to discuss the history of the American Civil War with someone who believes that slavery never existed. The fact is that psychiatry did promote the chemical imbalance theory of depression, and routinely extends that same spurious theory to other so-called mental illnesses, e.g., ADHD. For a thorough consideration of psychiatry’s chemical imbalance theory, see Terry Lynch’s book Depression Delusion (2015).
The critical question in all of this is: what do psychiatrists mean when they say that depression is a real illness just like diabetes. Do they mean that depression is caused by an inability of the pancreas to secrete sufficient insulin to process the sugar in the blood? Hardly. Do they mean that depression entails an increased risk of gangrene and amputations? Again, hardly!
No. What psychiatrists mean when they describe depression as “a real illness just like diabetes”, is that depression is caused by actual physical pathology: an aberration in the structure or function of the brain. This is the message that psychiatry intended to promote. It is the message that was received by millions of customers worldwide, and by the media, and by government officials. And, most importantly, it is the message that persuaded millions of individuals, who otherwise would not have taken the pills, to do so.
If this were not psychiatry’s intention, why have they not been screaming their true intentions to the very heavens? Why have they allowed the falsehood to stand? Why are they not saying: No. No. That’s not what we meant. We just meant the presence of suffering and incapacity?
In addition, it needs to be stated that if all that psychiatry meant by illness is the presence of suffering and incapacity, the entire issue becomes moot. If psychiatrists are saying to their customers:
You have what we call major depressive disorder by virtue of five out of nine hits on this little checklist that we made up. We consider depression an illness, not because there’s anything actually going wrong with your brain or other organs, which is the normal meaning of the term illness, but simply to reflect, admittedly misleadingly, that the depression is causing you suffering and incapacity.
then there would be no issue, other than the plain silliness of the thing.
But psychiatrists won’t say that because they need to maintain the falsehood that their various “diagnoses” constitute real illnesses in order to justify the use of drugs and electric shocks which have, by their own choosing, become their only stock-in-trade.
It also needs to be pointed out that, from a purely logical perspective, suffering and incapacity do not constitute an acceptable definition of illness. There are many illnesses that do not entail suffering and incapacity (e.g. early stage cancers) and many activities that do entail suffering and incapacity that are not illnesses (e.g. wearing shoes that are too tight).
The fact of the matter is that psychiatry blatantly, deliberately, and self-servingly misled their customers and the general public on this matter. Since the anti-psychiatry movement exposed the hoax, psychiatrists have been a little more circumspect with regards to the chemical imbalance theory, but they continue to push it.
For instance, here’s what the Mayo Clinic has to say on their website concerning chemical imbalance as a cause of depression:
“Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.” [Emphasis added]
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Mayo Clinic also has a page on the causes of “mental illness” generally. Here’s the paragraph on brain chemistry:
“Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that carry signals to other parts of your brain and body. When the neural networks involving these chemicals are impaired, the function of nerve receptors and nerve systems change, leading to depression.” [Emphases added]
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Tufts University, where the very learned Dr. Pies teaches, has this to say about anti-anxiety drugs:
“The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way you think, feel, or act. People with anxiety may have too little or too much of some of these chemicals. Antianxiety medicines help treat the imbalance of chemicals.” [Emphases added]
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And here’s a quote from SUNY’s School of Public Health website:
“…psychiatrists can order diagnostic tests and prescribe medication to help a patient through depression or mood disorders or correct chemical imbalances that cause some mental illnesses.” [Emphasis added]
Dr. Pies is also on the faculty at SUNY.
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Back to the Pies-Ruffalo article.
“Nor is it accurate to assert that mental illness has not been associated with physiological abnormalities in the brain. On the contrary, there is abundant and growing evidence that serious psychiatric illnesses, like schizophrenia, major depressive disorder, and bipolar disorder, are associated with specific structural and functional abnormalities in the brain — and that these abnormalities may be seen even in ‘drug-naïve’ (never medicated) patients (Karkal et al., 2018; Ren et al., 2013; Cui et al., 2018; Machado-Vieira et al., 2017).”
So, having belabored the patently spurious assertion that neither physiological malfunctions nor anatomical malformations are necessary for the presence of illness, the authors now cite some research claiming that there is “abundant and growing evidence that serious psychiatric illnesses…are associated with specific structural and functional abnormalities in the brain”. [Emphasis added]
The impression created by this quote is that psychiatry has found its long-sought “holy grail” – the putative, but elusive, physiological/anatomical basis of psychiatric “illness”. But note the phrase “…associated with…” which occurs twice in the quote, and the word “abnormalities” which also occurs twice. The critical point here is that “associated with” is not equivalent to caused by, and “abnormalities” are not necessarily pathological.
Let’s take a look at the four references in the Pies-Ruffalo quote above.
Karkal et al, 2018, concluded:
“A correlation between sensory gating parameters and measures of psychopathology strengthens the hypothesis that abnormal response to sensory input may contribute to the psychopatholgy in SCZ [schizophrenia].” [Emphasis added]
Note the cautious wording – strengthens the hypothesis and may contribute – which, I suggest, doesn’t quite rise to the level of the “…abundant and growing evidence…” claimed by Dr. Pies and Prof. Ruffalo.
The second Pies-Ruffalo reference, Ren et al, 2013, was also tentative in its conclusions:
“Findings from the present study, along with future work clarifying the causes of the functional and structural changes reported and their dissociation, may provide new insight into the underlying neuropathology of the early course of schizophrenia.” (Emphasis added)
Note the word “may”.
The third reference, Cui et al 2018, is similarly non-committal:
“The results indicate that aberrant FC [functional connectivity] patterns of insula-centered sensorimotor circuit may account for the pathophysiology of MDD.” [Emphasis added]
and
“…our findings suggest that disrupted FCs in the insula-centered sensorimotor circuit may play a central role in the pathophysiology of MDD [Major depressive disorder].” [Emphasis added]
Similarly with the fourth reference, Machado-Vieira et al, 2017:
“This is the first report of increased CC lactate in patients with bipolar depression and lower levels after lithium monotherapy for 6 weeks. These findings indicate a shift to anaerobic metabolism and a role for lactate as a state marker during mood episodes. Energy and redox dysfunction may represent key targets for lithium’s therapeutic actions.” [Emphasis added]
and
“The present findings reinforce that lactate may be a state biomarker in BD and that mitochondrial modulators might offer promising treatment targets in the illness, especially in long-term treatment.” (Emphases added)
It’s difficult to recognize any of these studies as the “abundant and growing evidence” touted in the Pies-Ruffalo paper. And bear in mind that the search for the biological causes of “mental illness” – psychiatry’s holy grail – has been lavishly funded across five or six decades. And the best they’ve come up with are mights and maybes. But they still have the gall to promote the illness hoax as fact, and to castigate those of us who cry foul.
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A detailed look at the other five myths would take us too far afield, but the overall conclusion drawn by Dr. Pies and Prof. Ruffalo is worth examining.
“Psychiatry and the related mental health professions face attacks from a relatively small but influential movement known as ‘antipsychiatry’. While most of what is asserted by antipsychiatry is easily refuted by the scientific evidence, philosophical claims regarding the meaning and nature of mental illness require careful consideration and response. The most harmful of these claims is that mental illness is a ‘myth.’ Such a view is not only at odds with medical reality and everyday human experience, it also leads to the gross undertreatment and harm of the most gravely ill in our society (see Frances & Ruffalo, 2018).”
Let’s open this up:
“Psychiatry and the related mental health professions face attacks from a relatively small but influential movement known as ‘antipsychiatry.'”
The “related mental health professions” cited here presumably embrace social workers, counselors, vocational trainers, case managers, job coaches, psychologists, etc.. By using the phrase “psychiatry and the related mental health professions”, Dr. Pies and Prof. Ruffalo are creating the impression that these groups constitute a coherent and united block. This is not the case. Many members of these “related” professions are profoundly unhappy with the destructive biochemical illness dogma which dominates the mental health landscape, but are often reluctant to speak out for fear of incurring censure or even losing their jobs. The assertion that these individuals “face attacks” from antipsychiatry is false. In reality, the existence and growth of the anti-psychiatry movement gives many of these individuals hope that the destructive, disempowering, and stigmatizing psychiatric hoax is being successfully challenged in a wide range of areas and venues.
“…a relatively small but influential movement…”
Perhaps not as small as Dr. Pies and Prof. Ruffalo would like, but definitely influential.
“While most of what is asserted by antipsychiatry is easily refuted by the scientific evidence…”
Then why, I wonder, do the authors not refute it? For instance, the anti-psychiatry movement has successfully debunked the chemical imbalance theory. Dr. Pies’ oft-repeated response to this debunking is that psychiatry never promoted the chemical imbalance theory in the first place, a position that is clearly false. As I have pointed out above, some of the leading psychiatric centers in the US continue to promote the theory in their online brochures and other materials.
I have stated many times in my writings that if psychiatry were to produce definitive proof that the loose groupings of vaguely-defined thoughts, feelings, and behaviors listed in their catalog are indeed illnesses, and that the drugs and shocks constitute safe and effective treatments, I would readily apologize for my errors, quit the field, and turn my attention to other matters. But such proof has never been presented. All that we have heard from psychiatry in this regard are repetitions of their self-serving dogma, a steady stream of unreplicated and contradictory studies, many of which are pharma-funded, promises that the evidence will soon be to hand, and attacks on anti-psychiatry adherents for daring to challenge the destructive, disempowering, and stigmatizing psychiatric orthodoxy.
“The most harmful of these claims is that mental illness is a ‘myth.'”
For the sake of clarity, and with apologies for the repetition, the vast majority of anti-psychiatry writers acknowledge that the thoughts, feelings, perceptions, and behaviors in question are real, but they do not constitute illnesses in any ordinary sense of the word.
“Such a view [that mental illness is a myth] is not only at odds with medical reality…”
Inherent in this contention is the claim that there is some “medical reality” that proves that psychiatry’s labels are bona fide illnesses with the same ontological significance and implications as real illnesses, such as pneumonia, influenza, diabetes, etc. But in fact, no such “medical reality” exists. The various versions of the chemical imbalance theory would, if validated, constitute such a medical reality. But no version of the chemical imbalance theory has ever been validated. Psychiatrists, of course, have been promoting this spurious notion for decades, and it is perhaps understandable that they have come to believe it themselves. But it’s still a hoax.
“Such a view [that mental illness is a myth] is…at odds with…everyday human experience…”
Actually, it’s not. What everyday human experience tells us is that sadness, even extreme sadness, is the normal, and incidentally adaptive, human response to loss and/or abiding adverse circumstances. Sadness becomes persistent and enduring when the individual can find no way out of his/her predicament. The psychiatric claim that sadness which crosses arbitrary thresholds of severity, duration, and impact is “really” the result of a neurological brain illness that needs to be “treated” with drugs and high-voltage electric shocks to the brain is an obvious hoax. But it is a hoax to which psychiatrists cling desperately as the sole justification for their existence as a profession.
“Such a view [that mental illness is a myth]… also leads to the gross undertreatment and harm of the most gravely ill in our society.”
The assertion that the activities of the world-wide anti-psychiatry movement are effectively reducing the amount of psychiatric “treatment” being delivered is very good news indeed. The notion that such reductions are harming people is just another example of the kind of unsubstantiated accusation that psychiatry routinely uses in a futile attempt to deflect attention from the fact that its concepts have been exposed as fraudulent and its practices as destructive, disempowering, and stigmatizing. They malign us because they have no rational response to our criticisms.
SUMMARY
Psychiatry is not something good that needs minor adjustments. Rather, it is something fundamentally flawed and rotten. Based on spurious premises, and devoid of even a semblance of critical self-scrutiny, it is utterly and totally irremediable. It has locked itself into the falsehood that every-problem-is-an-illness-and-for-every-illness-there’s-a-drug from which it cannot extricate itself. It is nothing more than legalized drug-pushing, endlessly attempting to mask its guilt by proclaiming its innocence, vilifying its critics, and calling for more “treatment”. It has built into itself the seeds of its own destruction, and will eventually fade away as its credibility dwindles, and more and more potential recruits recognize the sordid reality and seek careers in genuine, ethically-driven medicine.