Psychiatry's Current Greatest Controversy, Fraud, Bullsh*t, or What?

madinamerica
Bruce Levine, PhD

This article was recently published by AlterNet with the title Proven Wrong About Many of Its Assertions, Is Psychiatry Bullsh*t?

In the current issue of the journal Ethical Human Psychology and Psychiatry, Australian dissident psychiatrist Niall McLaren titles his article, “Psychiatry as Bullshit” and makes a case for just that.

The great controversies in psychiatry are no longer about its chemical-imbalance theory of mental illness or its DSMdiagnostic system, both of which have now been declared invalid even by the pillars of the psychiatry establishment.

In 2011, Ronald Pies, editor-in-chief emeritus of the Psychiatric Times, stated, “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.” And in 2013, Thomas Insel, then director of the National Institute of Mental Health (NIMH), offered a harsh rebuke of the DSM, announcing that because the DSM diagnostic system lacks validity, the “NIMH will be re-orienting its research away from DSM categories.”

So, the great controversy today has now become just how psychiatry can be most fairly characterized given its record of being proven wrong about virtually all of its assertions, most notably about its classifications of behaviors, theories of “mental illness,” and treatment effectiveness/adverse effects.

Among critics, one of the gentlest characterizations of psychiatry is a “false narrative,” the phrase used by investigative reporter Robert Whitaker (who won the 2010 Investigative Reporters and Editors Book Award for Anatomy of an Epidemic) to describe the story told by psychiatrists’ guild, the American Psychiatric Association (APA).

In “Psychiatry as Bullshit,”McClaren begins by considering several different categories of “nonscience with scientific pretensions” such as “pseudoscience” and “scientific fraud.”

“Pseudoscience” is commonly defined as a collection of beliefs and practices promulgated as scientific but in reality mistakenly regarded as being based on scientific method. The NIMH director ultimately rejected the DSM because of its lack of validity, which is crucial to the scientific method. In theDSM, psychiatric illnesses are created by an APA committee, 69 percent of whom have financial ties to Big Pharma. The criteria for DSM illness are not objective biological ones but non-scientific subjective ones (which is why homosexuality was a DSM mental illness until the early 1970s). Besides lack of scientific validity, the DSM lacks scientific reliability, as clinicians routinely disagree on diagnoses because patients act differently in different circumstance and because of the subjective nature of the criteria.

“Fraud” is a misrepresentation, a deception intended for personal gain, and implies an intention to deceive others of the truth—or “lying.” Drug companies, including those that manufacture psychiatric drugs, have been convicted of fraud; and high profile psychiatrists (as well as other doctors) have been convicted of fraud. Human rights activist and attorney Jim Gottstein offers an argument as to why the APA is a “fraudulent enterprise”; however, the APA has not been legally convicted of fraud.

To best characterize psychiatry, McClaren considers the category of “bullshit,” invoking philosopher Harry Frankfurt’s 1986 journal article “On Bullshit” (which became a New York Times best-selling book in 2005).

Defining Bullshit

What is the essence of bullshit? For Frankfurt, “This lack of connection to a concern with truth—this indifference to how things really are—that I regard as of the essence of bullshit.”

Frankfurt devotes a good deal of “On Bullshit” to differentiating between a liar and a bullshitter. Both the liar and the bullshitter misrepresent themselves, representing themselves as attempting to be honest and truthful. But there is a difference between the liar and the bullshitter.

The liar knows the truth, and the liar’s goal is to conceal it.

The goal of bullshitters is not necessarily to lie about the truth but to persuade their audience of a specific impression so as to advance their agenda. So, bullshitters are committed to neither truths nor untruths, uncommitted to neither facts nor fiction. It’s actually not in bullshitters’ interest to know what is true and what is false, as that knowledge can hinder their capacity to bullshit.

Frankfurt tells us that liars hides that they are “attempting to lead us away from a correct apprehension of reality.” In contrast, the bullshitters hide that “the truth-values of his statements are of no central interest to him.”

Are Psychiatrists Bullshitters?

Recall establishment psychiatrist Pies assertion: “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.” What Pies omits is the reality that the vast majority of psychiatrists have been promulgating this theory. Were they liars or simply not well-informed? And if not well-informed, were they purposely not well-informed?

If one wants to bullshit oneself and the general public that psychiatry is a genuinely scientific medical specialty, there’s a great incentive to be unconcerned with the truth or falseness of the chemical imbalance theory of depression. Bullshitters immediately recognize how powerful this chemical imbalance notion is in gaining prestige for their profession and themselves as well as making their job both more lucrative and easier, increasing patient volume by turning virtually all patient visits into quick prescribing ones.

Prior to the chemical imbalance bullshit campaign, most Americans were reluctant to take antidepressants—or to give them to their children. But the idea that depression is caused by a chemical imbalance which can be corrected with Prozac, Paxil, Zoloft and selective serotonin reuptake inhibitor (SSRI) antidepressants sounded like taking insulin for diabetes. Correcting a chemical imbalance seemed like a reasonable thing to do, and so the use of SSRI antidepressants skyrocketed.

In 2012, National Public Radio correspondent Alix Spiegel began her piece about the disproven chemical imbalance theory with the following personal story about being prescribed Prozac when she was a depressed teenager:

My parents took me to a psychiatrist at Johns Hopkins Hospital. She did an evaluation and then told me this story: “The problem with you, she explained, “is that you have a chemical imbalance. It’s biological, just like diabetes, but it’s in your brain. This chemical in your brain called serotonin is too, too low. There’s not enough of it, and that’s what’s causing the chemical imbalance. We need to give you medication to correct that.” Then she handed my mother a prescription for Prozac.

When NPR reporter Spiegel discovered that the chemical imbalance theory was untrue, she sought to discover why this truth had been covered up, and so she interviewed researchers who did know the truth. Alan Frazer, professor of pharmacology and psychiatry and chairman of the pharmacology department at the University of Texas Health Sciences Center, told Spiegel that by framing depression as a deficiency—something that needed to be returned to normal—patients felt more comfortable taking antidepressants. Frazer stated, “If there was this biological reason for them being depressed, some deficiency that the drug was correcting, then taking a drug was OK.” For Frazer, the story that depressed people have a chemical imbalance enabled many people to come out of the closet about being depressed.

Frazer’s rationale reminds us of Edward Herman and Noam Chomsky’s book Manufacturing Consent, the title deriving from presidential advisor and journalist Walter Lippmann’s phrase “the manufacture of consent”—a necessity for Lippmann, who believed that the general public is incompetent in discerning what’s truly best for them, and so their opinion must be molded by a benevolent elite who does know what’s best for them.

There are some psychiatrists who view the chemical imbalance is a well-meaning lie by a benevolent elite to ensure resistant patients do what is best for them, but my experience is that there are actually extremely few such “well-meaning liars.” Most simply don’t know the truth because they have put little effort in discerning it.

I believe that McClaren is correct in concluding that the vast majority of psychiatrists are bullshitters, uncommitted to either facts or fiction. Most psychiatrists would certainly have been happy if the chemical-imbalance theory was true but obviously have not needed it to be true in order to promulgate it. For truth seekers, the falseness of the chemical imbalance theory has been easily available, but most psychiatrists have not been truth seekers. It is not in the bullshitters’ interest to know what is true and what is false, as that knowledge of what is a fact and what is fiction hinders the capacity to use any and all powerful persuasion. Simply put, a commitment to the truth hinders the capacity to bullshit.

Bruce Levine, PhD

Commonsense Rebellion: Bruce E. Levine, a practicing clinical psychologist, writes and speaks about how society, culture, politics and psychology intersect. His latest book is Get Up, Stand Up: Uniting Populists, Energizing the Defeated, and Battling the Corporate Elite. His Web site is www.brucelevine.net

Thank You Dr Levine and MIA.

Not Science. Not Medicine. Not Legal.

We don't own a DSM V, because a 12 pack of Charmin is considerably cheaper.

We do own a pocket reference of the DSM IV, and have accessed behavenet numerous times.

If it truly was beneficial, if it truly was medicinal, if it truly contained Anything at all of curative value, . . . WHY does it contain a Hands Off warning about copyright. DO NOT reproduce this material, . . blah blah blah.

One would be not only tempted but correct to think that the Mental Health of its targets was not its purpose.

Potential patients would look up just what being 'Mentally Ill' was and take precautionary, preventative measures to avoid becoming 'Mentally Ill' . . . if they were Allowed to know the warning signs.

Fraud and Bullshit. In-damn-deed.

Psychiatry's Manufacture Of Consent: The Chemical Imbalance Theory And The Antidepressant Explosion

by Dr Bruce Levine;
Psychiatry's Manufacture Of Consent: The Chemical Imbalance Theory And The Antidepressant Explosion

By Bruce Levine on May 14, 2014

Edward Herman and Noam Chomsky’s book title Manufacturing Consent derives from presidential advisor and journalist Walter Lippmann’s phrase “the manufacture of consent”—a necessity for Lippmann, who believed that the general public is incompetent in discerning what’s truly best for them, and so their opinion must be molded by a benevolent elite who does know what’s best for them.

Starting in the 1990s—despite research findings that levels of the neurotransmitter serotonin were unrelated to depression—Americans began to be exposed to highly effective television commercials for antidepressants that portrayed depression as caused by a “chemical imbalance” of low levels of serotonin and which could be treated with “chemically balancing” antidepressants such as Prozac, Zoloft, Paxil, and other selective serotonin reuptake inhibitors (SSRIs).

Why has the American public not heard psychiatrists in positions of influence on the mass media debunking the chemical imbalance theory? Big Pharma’s corruption of psychiatry is only part of the explanation. Many psychiatrists, acting in the manner of a benevolent elite, did not alert the general public because they believed that the chemical imbalance theory was a useful fiction to get patients to accept their mental illness and take their medication. In other words, the chemical imbalance theory was an excellent way to manufacture consent.

In January 2012, National Public Radio correspondent Alix Spiegel began her piece with the following personal story about being prescribed Prozac when she was a teenager:

When I was 17 years old, I got so depressed that what felt like an enormous black hole appeared in my chest. Everywhere I went, the black hole went too. So to address the black-hole issue, my parents took me to a psychiatrist at Johns Hopkins Hospital. She did an evaluation and then told me this story: “The problem with you, she explained, “is that you have a chemical imbalance. It’s biological, just like diabetes, but it’s in your brain. This chemical in your brain called serotonin is too, too low. There’s not enough of it, and that’s what’s causing the chemical imbalance. We need to give you medication to correct that.” Then she handed my mother a prescription for Prozac.

This chemical imbalance story, countlessly repeated on antidepressant commercials and by psychiatrists from prestigious institutions, has been so effective that it comes as a surprise to many Americans—including Alix Spiegel— to discover that the psychiatric establishment now claims that it has always known that this theory was not true or “urban legend,” the term used by Ronald Pies, Editor-in-Chief Emeritus of the Psychiatric Times. Pies stated in 2011, “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.”

Truly well-informed psychiatrists have long known that research showed that low serotonin (or other neurotransmitter) levels were not the cause of depression. The American Medical Association Essential Guide to Depression in 1998 stated: “The link between low levels of serotonin and depressive illness is unclear, as some depressed people have too much serotonin.” But the vast majority of Americans—who didn’t read this textbook—never heard this.

In the 1990s, Pedro Delgado (the current chair of the psychiatry department at University of Texas) published research that showed if nondepressed people are depleted of serotonin, they will not become depressed. Elliot Valenstein, professor emeritus of psychology and neuroscience at the University of Michigan, in Blaming the Brain (1998) detailed research that showed it is just as likely for people with normal serotonin levels to feel depressed as it is for people with abnormal serotonin levels, and that it is just as likely for people with abnormallyhigh serotonin levels to feel depressed as it is for people with abnormally low serotonin levels. Valenstein concluded, “Furthermore, there is no convincing evidence that depressed people have a serotonin or norepinephrine deficiency.” But how many Americans heard about this?

Editor-in-Chief Emeritus of the Psychiatric Times Ronald Pies, a staunch defender of psychiatry and the American Psychiatric Association, believes that the APA fulfilled its obligation to inform the general public of the truth with a 2005 statement for the general public about depression that begins: “The exact causes of mental disorders are unknown, but an explosive growth of research has brought us closer to the answers.” But how many Americans read APA statements? And even if they had read that statement, they would not necessarily have come to the conclusion that the chemical imbalance theory was fiction and that drug commercials were deceptive. Even Pies admitted on April 15, 2014, “But still, shouldn’t psychiatrists in positions of influence have made greater efforts to knock down the chemical imbalance hypothesis, and to present a more sophisticated understanding of mental illness to the general public? Probably so.”

Thomas Insel, director of the National Institute of Mental Health (NIMH), in recent years has been increasingly critical of some of psychiatry’s theories and practices. In a February 25, 2007 interview with Newsweek, Insel did more explicitly tell the American people the truth that depression is not caused by low levels of the neurotransmitters serotonin or norepinephrine. However, he did not proclaim that drug commercials’ depiction of the cause of depression as patently false.

Given the drug commercial propaganda onslaught, for the American people to become aware of the truth, psychiatrists in positions of influence would have had to zealously publicize that the research had rejected the chemical imbalance theory, and they would have had to use the mass media to proclaim that the drug commercials are false. That never occurred. Why? NPR correspondent Alix Spiegel, as part of her January 2012 story, alsointerviewed several well-informed psychiatrists in positions of influence, and we get a clue as to the reason.

Alan Frazer, professor of pharmacology and psychiatry and chairman of the pharmacology department at the University of Texas Health Sciences Center, told NPR that by framing depression as a deficiency—something that needed to be returned to normal—patients felt more comfortable taking antidepressants. Frazer told NPR, “If there was this biological reason for them being depressed, some deficiency that the drug was correcting, then taking a drug was OK.” For Frazer, the story that depressed people have a chemical imbalance and that the antidepressant is correcting that imbalance is a story that has enabled many people to come out of the closet about being depressed.

And even Pedro Delgado, whose research helped debunk the serotonin deficiency theory of depression, agreed with Frazer that the fiction of the chemical imbalance theory has benefits. Delgado pointed to research showing that uncertainty itself can be harmful to people; and so simple and clear explanations, regardless of how inaccurate, can for Delgado be more helpful than complex truthful explanations.

Prior to the chemical imbalance campaign, many Americans were reluctant to take antidepressants—or to give them to their children. But the idea that depression is caused by a chemical imbalance which can be corrected with SSRI antidepressants sounded like taking insulin for diabetes. Correcting a chemical imbalance seemed like a reasonable thing to do, and so the use of SSRI antidepressants skyrocketed.

The U.S. Centers for Disease Control and Prevention (CDC) reported in 2011 that antidepressant use in the United States increased nearly 400 percent between 1988 and 2008, making antidepressants the most frequently used class of medications by Americans ages 18-44. By 2008, among Americans 12 years and older, 11 percent were taking antidepressants, and 23 percent of women ages 40–59 were taking them.

SSRIs skyrocketed despite the research which showed that SSRIs such as Prozac, Paxil, and Zolfot were not any more effective in reducing depression than the older tricyclic antidepressants such as Elavil. While for some antidepressant users, SSRIs had fewer adverse effects than the tricyclics, for many others, the adverse effects were just different and sometimes even worse (for example, the Food and Drug Administration forced SSRI manufactures to label SSRIs with “black box warnings” stating that SSRIs caused increased suicidality for patients under the age of 25). While SSRIs are neither more effective nor safer than the older tricylics, what is different was that tricyclics were never been marketed as correcting a chemical brain imbalance.

The chemical imbalance theory of mental illness has made Big Pharma billions of dollars by making it easier to sell SSRIs and other psychiatric drugs, and Big Pharma spread some of that money around to their favorite psychiatrists. And some well-informed psychiatrists in position of influence, not on Big Pharma’s payroll, have maintained the biochemical imbalance theory of mental illness to manufacture consent, because these psychiatrists have believed that it was in their patients’ best interest—making it easier for them to accept their depression and take their medication.

Thank You Dr Levine.