Is It All in Your Head?

Sandra Steingard, MD
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In a recent NPR story, there was a discussion of the serotonin theory of depression.  It was acknowledged by the scientists who were interviewed that there is no evidence of a serotonin deficiency in the brains of people who are depressed.  In this piece and in related commentaries this notion is referred to as a “chemical imbalance” and psychiatry was criticized for not being honest about the lack of evidence to support this notion.

I share the criticism of those who argue that psychiatry has had an overly cozy relationship with the pharmaceutical companies.  I also agree that the efficacy of a wide variety of agents has been overstated.  However, there is a component of the current round of criticism  with which I disagree: specifically, the assumption that if there is no evidence of neurotransmitter abnormalities then conditions such as schizophrenia do not involve alterations of brain function. This idea is often linked to a related assumption that, therefore, medications could  not be effective treatments.

Are the symptoms of schizophrenia a reflection of brain function?

I approach this argument from the philosophical perspective of a monist. That is, I take as a given that cognition, emotion, and perception are brain functions.  If someone reading this is a dualist (i.e., believes that there is something other than the material world from which these experience airs) then we have deeper disagreements that I will not address here.

When someone hears a voice, parts of the brain have been activated to create the experience of that voice.  That is true regardless of whether or not that experience was a response to a set of sounds produced by another person’s vocal chords.  Similarly, people who have lost limbs often experience pain and other sensations in them, despite the fact that they have been amputated.  The experience of the limb is as it would be if the extremity were still present.

The experience of hearing a voice that no one around you can hear is reflective of a set of brain processes. It may not be due to “excess dopamine” but it nevertheless is due to the way the brain is working.  Something has happened in that brain to create the experience of that voice despite the fact that there is no  external stimulus that caused it.  It is  a reasonable, interesting, and valid question for research to understand what happens in such a  person’s brain when that voice is heard.

Can medications, in theory, be effective for problems of thought, mood or cognition?

Even if there is no dopamine excess in the brain, that does not mean that medications that alter dopamine function in the brain cannot a priori be effective.  The effective treatment of a condition is not necessarily linked to its cause.  If a condition is thought to be due to a genetic or structural abnormality then it is commonly thought to be “biological” and therefore more amenable to treatment with a “biological” treatment such as a medication.  If something is due to environmental effects such as trauma, then it is thought to be more responsive to “environmental” treatments such as psychotherapy.   But these are false distinctions.  ALL treatments are biological.  Psychotherapy is as “biological” a treatment as medications. If someone, for instance, learns meditation and is able to feel less anxious, that change is mediated by changes in the brain.

If someone participates in Open Dialogue because he is hearing voices and over time the voices go away or the person is less bothered by them, then some change has occurred in his brain to which that change is attributable. If someone takes a medication that blocks dopamine receptors and he no longer hears voices, a change has occurred in his brain. Maybe it is the same change. Maybe it is different. Maybe the changes effected by Open Dialogue are safer or more long-lasting. Maybe the efficacy of our currently available medications have been exaggerated.  The point is that there is nothing inherent to the symptom or its the hypothesized etiology  that in itself allows one to know what sort of treatment will  be most effective. That is always an empiric question and all potentially effective treatments deserve the same critical scrutiny.

46 COMMENTS

  1. Sandra Steingard, M.D. wrote:

    […]

    The experience of hearing a voice that no one around you can hear is reflective of a set of brain processes. It may not be due to “excess dopamine” but it nevertheless is due to the way the brain is working. Something has happened in that brain to create the experience of that voice despite the fact that there is no external stimulus that caused it.

    […]

    “If someone … is hearing voices and over time the voices go away or the person is less bothered by them, then some change has occurred in his brain to which that change is attributable. If someone takes a medication … and he no longer hears voices, a change has occurred in his brain.”

    […]

    ————

    Prove it!

    Where is the evidence (not more arguments to attempt to make your either) to both back up and prove these theories as well as leap of faith you have taken and expect others to believe as if it is indeed fact when it is merely an opinion based on certain assumptions you have accepted?

    Do not attempt to bounce it back my way or then make assumptions of what my positions might be or not be in the subject either.

    These are declarations of yours and, as such are yours to prove, not for me or anyone else to have to disprove.

    Either that or maybe you should exercise some rewording, rephrasing or further clarification on these matters.

    Whatever the case is however, do not expect others to have to swallow these myths er, opinions of yours whole like some pill you might prescribe for such.

  2. I think whether one agrees/ disagrees or believes/doesn’t believe in the biological basis- meaning brain functioning may not be quite the point to focus on in the broader discussion of medication use and efficacy. My concern is this – to relieve voices that are distressing with medication does MORE than (possibly) relieve distressing voices. Our heads/brains are not disconnected from the rest of our bodies. Medications as of yet do not target one area with effecting other areas — thus the existence of side effects. .
    The slippery slope of the brain illness discussion becomes the focus on the brain at the expense of the rest of the person. Therefore, relieving voices via medication has also proven to increase the risk of diabetes, heart conditions, high blood pressure and significantly higher rates of early death than the general population. But how often do we think about how meditation and yoga have side effects too lowering blood pressure, heart rate and breathing— comparitevly not too shabby.
    We cannot (in my opinion) have conversations about the brain without including the rest of the body. In relation to medications i fear the consequences are entirely too high.
    I appreciate you wrestling with these ideas and working through how to approach this topic in your field and practice.
    Keris

    • My blog is not intended to credit or discredit medications. It is not intended to promote the brain over the whole person. It is not intended to be a discussion of “illness” – a word I specifically did not use. I would like any help or suggestion in using language that minimizes stigma.

      I agree that the serious side effects of neuroleptic medications need to be considered when talking about treatment. I agree that yoga and meditation can be enormously helpful in multiple ways. I am open to using and learning anything that will help to reduce suffering, promote recovery, and improve the quality of the lives of the people with whom I work.

      I have found your story to be inspiring. Thank you for sharing it and thank you for the work you do.

      I appreciate your comments.

      Sandy Steingard

      • Sandy-
        I’m finding that when we talk about brain, medications and voices, we have entered into a world where much hurt and harm has occurred/is occurring. Honestly my initial reaction is anger (when is the conversation going to move from the brain to what happens to a person, what’s the meaning for the person and heck “the person” in general) and then I step back and try my best to review the conversation from multiple sides so that we can dialogue together and come up with solutions/approaches. So thank you for engaging in the dialogue- I’m in it with you!
        I’d love to hear how doctor’s explore meaning in people’s lives, use multiple approaches and resources to support a person through their recovery and develop relationships in which then person receiving services can lead (imagine a dance in which one person is leading and the other/provider gliding alongside). And wouldn’t it be great if a doctor used a prescription pad to write an Rx of peer support, yoga, mindfulness meditation etc.
        What do you think??
        Keris

        • I realize from your and other comments that the language I use may trigger reactions that I did not intend. I think we can work on two levels – acknowedging that there is a brain basis to our perceptions and thoughts but also understanding that putting meaning into our lives may not come from an understanding of those processes.
          I recommend yoga, mindfulness, peer supports almost every day (to myself and others).
          Thanks again.
          Sandy

      • The best way to reduce stigma is to stop the mental death profession from stigmatizing people with fraud invented VOTED IN stigmas from the junk science DSM to push their lethal poisons in bed with BIG PHARMA and corrupt government hacks. Whos does Dr. Steinberg think she is kidding? She is all too well aware of the evil and fraud she is committing with bogus biological psychiatry and its life destroying stigmas and lethal drugs that cause permanent social and physical disability, despair and ruin. Little wonder why their victims frequently commit suicide as is true of victims of the other Nazi holocausts. But these psychopaths have it covered. Your destroyed life, health, career and suicide are all part of your mental illness!!

        Neat trick typical of psychopathic malignant narcissists.

  3. I do agree. All thoughts, feelings and behaviors have their origin in the brain. However, the brain is like a computer processor. It accepts incoming data and processes it. The environment and a persons experiences in life could still very likely be the cause of even the most severe of mental illness symptoms, and just because not all people who go through the same experiences don’t develop the same problems doesn’t disprove that theory. And even if the brains of some people who in fact malfunctioning in a way that caused “normal” environmental stimuli to become torturous to a person, the problem could still be seen as the environment since it doesn’t exist without it. Besides that, the brain can make “mistakes” without being broken. I know there have been many of times my computer has acted out when the CPU was perfectly fine, even though it wasn’t correctly performing it’s functions. I think that’s a pretty good analogy.

  4. I find this article typical of biological psychiatry and very self serving in that Robert Whitaker has exposed how bogus all psych drugs are and all the evil lies used to FORCE them on vulnerable people with emotional distress, life crises or abuse related trauma, etc.

    I believe that many family counselors and psychitrists of the past pinpointed crazymaking, soul murdering, double bind families scapegoating the “identified patient” as a cause of the garbage can diagnosis of schizophrenia. Whitaker exposes how so called mental patients were and are treated like animals with no human rights by what I now call the mental death profession.

    The author’s sole focus on biological psychiatry is everything that is wrong with this so called profession professing only lies and crimes against humanity throughout its sordid history. This includes its huge role in creating the Nazi Holocaust with its evil eugenics theories first used to gas those they stigmatized as mentally ill and therefore, subhumans to be deprived of all civil and human rights, which THEY proposed to Hitler and not the other way around though Hitler is deemed evil incarnate!

    Anyway, for this author to try to promote horrific biological, reductionist psychiatry to the many who have suffered so greatly at their hands with their life destroying bogus stigmas and toxic drugs in the guise of help that destroyed so many NORMAL people with normal life problems they invalidated and denied to pretend to practice medicine to improve their own status is a crime and totally opposed to all the facts in the excellent books, MAD IN AMERICAN and ANATOMY OF AN EPIDEMIC not to mention the excellent work of Dr. Peter Breggin and other psychiatrists and medical experts who have a conscience and a soul.

    We are made up of mind, body, soul/spirit and not mere neurotranmittors as the noble Dr. Loren Mosher said in his resignation in disgust letter from The APA still online.

    Needless to say, I find this author very offensive since rather than pushing lethal psych drugs here, she should be apologizing for all the lies and crimes of her horrible profession.

    • I didn’t find the Doctor’s statements to be “offensive”

      And I do appreciate her taking a risk and being open to looking at previously/currently held assumptions. That’s not always easy to do. I also appreciate your thoughts. You seem very passionate to me.

      I’m intrigued by the Dr’s key point, doesn’t everything involve the brain at some level? She mentioned the monism vs. dualism debate that many would like to belive is “settled” but in my opinion is still very ripe for discussion. Or friend Dr. Szasz has been a steady voice for this type of discussion for fifty years.

      I, for one, hope the Dr continue her process and posts as we’re still in a discussion phase when it comes to existence/nature of “mental illnesses” I caution all of us from believing we “know” because that can tend to lead to an ideological back and forth that shuts down productive discussion and thought.

      • Actually, it has been “discovered” that one’s GUT has many nerve and other reactions to emotional distress, so one’s whole body must be taken into account since stress takes its toll on every human organ just like the drugs of the mental death profession.

        I disagree that the reductionist biological psychiatry menace should be condoned in any way since it medicalizes normal human reactions to stressful unjust environments and aids and abets their fellow abusers to maintain the status quo in the power elite’s growing totalitarian dictatorship. The most heinous betrayal occurs when a normal person suffering trauma and or stress breakdown from abuse/bulying/mobbing goes to a mental death expert unknowingly for validation and advice. Thanks to bogus biological psychiatry, the victim is automatically blamed as having a mental illness/sick brain providing more ammunition for the victim’s abusers while making the victime more powerless, dicredited, silenced and stigmatized/drugged into horrified submission.

        For this blogger to keep on insisting on unproven brain chemical or other imbalances of the brain in her so called patients shows that she is the most imbalanced of all! I think she knows this all too well, but is intent on defending the indefensible for her own profit and status at the expense of vulnerable people suffering emotional distress from environmental abuse already. As Dr. Judith Herman, author of the classic book, TRAUMA AND RECOVERY, exposes like many others, mot in the mental death profession know all too well that those they encounter have suffered abuse related trauma, but they lie and deny it. The DSM by its very nature lies and denies the impact of any and all environment factors for the perfect victim blaming crime by the latest nazi doctors.

        The authors of the latest bogus DSM now plan to make grief a mental illness and I am thrilled because it shows how sick and debased this whole evil enterprise is.

        I suggest the author of this blog look for the abuse, divorce, job loss, loss of loved ones and other GENES or brain chemical imbalances since these are known to be the great stressors that must be attributed to the faulty genes of the so called patient to justify destroying them with bogus stigmas and lethl drugs leading to job loss, divorce, isolation, custody loss, death 25 years earlier if not driven to suicide by the mental death profession’s horrific betray and retraumization, etc. But, like all other iatrogenic effects of these criminals, they have them all listed aspart of the victim’s “mental illness” with the lateset fraud fad bipiolar disorder expposed by Dr. David Healy, Dr. Carole Warshaw and many others. This author’s arrogance among psych “survivors” or family members of such “survivors” is unbelievable.

        Also, why isn’t psycchiatry focusing on the major threats to society: the growing epidemics of psychopathy and narcissism? Answer: It hits too close to home! See Dr. Robert Hare, Dr. Martha Stout, Dr. John Clarke, etc.

        • Donna… I think you’re exactly right! A lot of busy-bodies here will attempt to stifle and suppress you but I think you are actually right on. I understand where your passion and emotion are coming from – having one’s life unjustly threatened and having everyone complicit in that, will do that to a person. I’m reading TRAUMA AND RECOVERY right now and really appreciating it. Every mental health worker should read this book and really understand it.

    • Hi Donna! I don’t believe the author was deliberately trying to offend psychiatric survivors/ex-patients, nor that by espousing monism one necessarily commits oneself to racist doctrines and in doing so also condones genocidal actions and/or crimes against humanity.

      As I understand, you’re defending a sort of a dualist position (although in your argument you also mention a third entity: the soul/spirit) but, from a philosophical perspective, I can’t see it is an a priori truth that there two completely different kind of entities in this world: physical and mental.

      If you desire to probe deeper into this question, I suggest that a visit to the pages on “Dualism” in the Stanford Encyclopedia of Philosophy is a good start as one is given a good overview of issues on this topic (+ there’s a long list of references and links to other philosophical perspectives on the is-the-mind-the-brain problem!).

      • I am not being dualist in the least bit. I protest against this typical biological reductionist practitioner of bogus theories to reduce all humans to mere animals to be brought to their ignominious slaughter. Just because they choose to act like animals with no conscience, empathy, compassion, decency, ethics, honesty or anything else that makes us human, it doesn’t mean I should be forced to condone it. From my extensive research, I believe this bogus profession is made up of psychopaths and narcisssits for the most part which would explain their penchant to lying, conning, manipulating, exploiting, abusing and destroying vulnerable people with impunity.

        By soul and spirit I really mean the best characteristics that make us human apart from mere animals acting only on instinct. Further, even if I am dualist, it doesn’t make this blogger’s biological reductionist world view any more scientific, proven or superior, but rather, the opposite when you consider that she completely ignores the humanity of her would be victims. Notice, she does not even mention the horrific health /brain damaging effects of her lethal treatments not to mention her bogus life destroying stigmas she pretends is medical diagnosis. It would be laughable if she did not have BIG PHARMA’s billions forcing this monstrosity on so many unsuspecting victims. Dr. Szasz if right in saying one has a responsibility of learning about the social institutions of one’s society especially in this case. He is also right in saying that to be an expert in biolgical psychiatry is like that of being an expert in unicorns, witches and astrology. Sadly, he also exposes these inquistors are very quick to burn their victims at the stake of their therapeutic state cult/religion into their psychiatric slavery and science of lies!

  5. “”It is a reasonable, interesting, and valid question for research to understand what happens in such a person’s brain when that voice is heard.””

    Psychiatry could start with not blowing people off when they want to talk about what their voices are saying. You might learn something.

    By the way, as one who has been greatly harmed by psych meds and feels they have destroyed my life, I appreciate your attempts to work through the issues on this blog. I know it is not easy for doctors to change what they have been taught and I can see your attempts to do so.

    I agree with you about critically scrutinizing everything but if I remember my statistics correctly (someone can correct me if I am wrong) antipsychotics only work for about 25 to 30% of all people. And even for the people that they work for, as Keris so wonderfully pointed out, the question that needs to be asked instead of what you are asking is do the high cost of side effects justify treatment and what other options are there?

    For example, if I were a psychiatrist, I would be contacting Dr. Dan Fisher who on a podcast with Will Hall talked about implementing an open dialogue program. I would also find other therapists such as Daniel Meckler who have worked with people with psychosis and treated them without medication.

    AA

    • Thanks for your comments. In my next post, I talk about what percentage of people appear to benefit from neuroleptics and our estimates are close.
      I have been in contact with Dan Fisher, Daniel Meckler, and others and I am trying to learn more about Open Dialogue.
      However, I am not ready to completely stop using neuroleptics. I recognize that is not a popular position on this particular website but I am trying to sort through the data to make the best recommendation to my patients.
      Sandy

  6. Dr. Steingard, you do not need to be a physician to be familiar with the doctrine of primum non nocere.

    Even if the pathophysiology of Schizophrenia were well worked out; Even if the Dopamine hypothesis were supported by the experimental data; Even THEN, the harms done by anti-psychotic medications would have to be reckoned with. And these harms are not reckoned with in a meaningful way.

    But we know NOTHING of the pathology or pathophysiology of Schizophrenia and there is NO experimental data whatsoever that anti-psychotic medications demonstrating that correct or mitigate the putative lesion. Until there is pathology and pathophysiology there can be no such demonstration.

    • Notice how Dr. Steinberg talks of patients (victims) of hers who APPEAR to benefit, which means that the victims of abusers, bullies, mobbers, social injustice and probable other traumas now has her bogus DSM junk science stigmas and BIG PHARMA dictated lethal drugs in addition to their stress breakdown caused by the original abusers to make them more docile, manageable, silenced, discredited, invalidated, disempowered and on the path to total destruction having faced the worst abuser of all, Dr. Steinburg.

      Bogus junk science DSM stigmas bought and paid for by BIG PHARMA to push its lethal drugs to give psychiatry the pretense of practicing medicine when Freudian analaysis waned have certainly BENEFITED so called biolgical psychiatrists like Dr. Steinberg beyond their wildest psychopathic dreams. Such benefits only accruing to the mental death profession by using typical NAZI tactics of bogus eugenics and other fraud theories while spreading BIG PHARMA irrational hate and fear of those they falsely stigmatize as “mentally ill,” an evil, false, linguistic impossible metaphor to degrade others as subhuman enough so that they can exploit, rob and destroy them with impunity

      I think that Dr. Steinberg should be subjected to her own so called “treatments” and probably will if she ends up in a nursing home with a majority of the elderly now being assaulted with antipsychotics to silence them and make them more manageable while helping them die far more quickly. Perhaps this is karma for all those who stood by silently and/or encouraged the forced stigmatizing, involuntary commitments and poison drugging of others despite Dr. Steinburg’s and others’ atheism. Who would have thought the powerful NAZI war machine would topple with the now insane dictator Hitler hiding in a bunker. Ironically, his own personal doctor probably did more than anyone to help destroy him than his world enemies. What comes around goes around. Be careful what you wish for.

  7. My understanding is that your brain changes when you learn a new skill, like playing the piano. The fact that consciousness has become its own entity doesn’t negate the fact that it is your brain’s structure and functioning that support that consciousness. I never got into it, but there are plenty of people who argue about the origin of consciousness with no mention of mental illness at all. I question if medications could ever work, in practice.

    Anyway, I have bipolar disorder, and it cycles based on the seasons, pretty much, utterly divorced from any positive or negative experiences in my life. So I find it very difficult to believe there is any explanation other than a biological one *of some kind.*

    Maybe it was some kind of learning, that gave me these problems, but learning MUST occur in the brain – where else could it happen? How can the brain store data if it does not change in some way, in order to store it? Of course, no pill will be able to selective change some kind of adverse learning that has occurred (such as from abuse).

    I am no fan of the medications, that’s for sure. They were a disaster for me.

    I allow that maybe I missed the entire point of this discussion.

    • What is the evidence you have bipolar? Read Dr. David Healy’s MANIA: A SHORT HISTORY OF BIPOLAR DISORDER to see how the latest fraud fad garbage can stigma explosion evolved from so called manic depression, which used to be very rare and a so called illness from which most recovered completely mostly without lethal antipsychotics. This was just a joint BIG PHARMA/mental death profession/govenment hacks psychopathic ploy to push their lethal poisons on vulnerable people from the cradle to the grave literally a la such paid shill predators like “Dr.” Joseph Biederman for greed, power, status and euthanasia, a global mission by the power elite using what one authors calls THE SHOCK DOCTRINE now happening in the USA!

    • You say that your so called bipolar comes and goes with changes of seasons. I read this is a frequent cause of someone getting the bogus stigma of bipolar when the causes of the symptoms could be seasonal allergies, lack of adequate sunlight and Vitamin D3 and other factors that depend on seasonal changes.

      Regardless of the symptoms or causes, they don’t justify a literal ax driven into the brain in the form of antipsychotic poisons or the sledgehammer of a life destroying bogus stigma.

      As Dr. Thomas Szasz points out, “When someone hits another in the head with a sledgehammer it is easy to recognize him as the thug he is, but when psychiatry gives a bogus stigma to someone, which is the equivalent of hitting someone in the head with a sledgehammer, they are not so readily recognized as such, but they are just as much murderous thugs as those with other sledgehammers smashing others’ brains, health and survival.

      • Thanks for answering. What I meant was whether you espoused the idea that metal states are identical to brain states (reductive monism) or that although mental states are caused by physical states, mental states can’t be reduced to the latter. But from your answer to Keris, it’s plain that you endorse the non-reductive variety.

        • That is a very clear explanation of the distinction. I would have put myself in the fomrer category so it is interesting what you say about my comment to Keris. At this point, I am not sure. The dualism/momism distinction is very clear to me and important. Beyond that, it seems we are talking about how we use language to explain our “sense” of our mental processes. Does that make any sense to you?

  8. “And even if the brains of some people who in fact malfunctioning in a way that caused “normal” environmental stimuli to become torturous to a person, the problem could still be seen as the environment since it doesn’t exist without it”

    I want to clarify something. I was talking about people tortured by their environment due to some neurological problem. I, myself, could not/can not stand certain textures, smells and sounds. Particularly paper, denim, pencils on paper, and stuff of that sort. It’s absolutely torturous to me, and can make me uncontrollably violent. There’s no way to convince my body that I’m not in danger when it’s happening, even though my mind knows I’m not.

    Anyway, I’m quite sure there is something wrong with my brain, but since I was on psych drugs since BEFORE this happened, including mellaril (age 6-7, this all began at age 7), I am quite sure it is drug induced.

    In any case, I don’t see how the environment can not be equally considered the problem. If you’re driving down the road and it’s so bumpy that you cant keep control of the car, do you blame the tires? The suspension? Especially if everyone else is driving trucks, going over the bumps without a problem, and assuring you that there is no problem? The road is still a mess.

    With psychiatry and the brain, it always seems that psychiatry is not working for the patients, but the others. The teachers, the parents, society. That was always my experience. Growing up, the psychiatrists never even talked to me, they only cared what other people had to say about how I was behaving. This cant be proper medicine in my very strong opinion. The very definition of medicine is the restoration of health. How does catering to the social desires of one group by subduing another group lead to a restoration of health?

    • Absolutely! Dr. Peter Breggin, the conscience of psychiatry since it doesn’t have one, has exposed that the mental death profession preys on the vulnerable like children and many women to aid and bet their abusers with more power in his great books, TOXIC PSYCHIATRY, RECLAIMING OUR CHILDREN and many others.The author should read his books like Brain Disabling Drugs in Pscychiatry, Dr. Grace Jackson’s RETHINKING PSYCHIATRIC DRUGS and THE PERFECT CRIME, Dr. Johanna Montcrieff’s THE MYTH OF THE CHEMICAL CURE, Dr. Timothy Scott, AMERICA FOOLED and countless others exposing the fraud and dangers of bogus biological psychiatry and its lethal “treatments” of social control, medicalization of human suffering, torture and death in the guise of medicine.

      But, I am sure she like others in her ignoble profession is all too well aware that she is making profit centers of her soon to be destroyed “patients.”

  9. I think that the brain is involved in everything we do, and certainly everything we think and feel. Every change we expereince is mirrored in the brain. The brain creates an sensation of the world around us.

    So yes, hearing voices will be reflected in the brain, as will not hearing voices, as will language skills and playing the piano. Some of this may even show up on brain scans.

    Psychoactive drugs such as alcohol or psychiatric drugs undoubtedly effect the brain in sometimes useful and sometimes not useful and sometimes dangerous ways.

    However it may not be necessary to have this knowledge or world view to help people facing mental distress. For as long as human beings have existed people have helped people who are extremely mentally distresssed, for most of human history without any knowledge of the brain. Even in cultures where the brain is know about and it’s links to the mind people who are mentally distressed are taken care of.

    This link between the brain and human thought and human distress and human happiness may well be interesting but it is not necersarry to know to help people who are in distress. It may or may not be useful in improving treatments, that I agree is open to debate. I think that some people may find these ideas useful, just as some people find ideas of God or Spirits or Astrology or other even more idiosyncratic ideas helpful.

    to me they are useful and interesting ideas in other contexts, in exploring the link between the brain and the person, or in understanding brain injury or dementia, but in dealing with mental distress I find other ideas more useful.

    • As Robert Whitaker demonstrates with several studies and successful programs, those not preyed upon by bougus lethal biological psychiatry in third world countries or those in the past before the invention of this monstrosity were far more inclined to recover from even the worst breakdowns. The evidence is more than obvious that biological psychiatry does nothing but harm just by their evil, bogus, invented, VOTED in life destroying stigmas with the latest fraud fad garbage can diagnosis of bipolar disorder to destroy anyone experiencing social or other distress, abuse, trauma, etc. Goffman in his books like ASYLUM and STIGMA: SPOILED IDENTITY exposes the social horrors of the stigmatized. BIG PHARMA in bed with the mental death profession and corrupt government hacks did all their evil bogus pretense campaigns to remove stigma of the so called mentally ill to push their stigmas and lethal drugs while these psychopathic malignant narcissists were scheming to stigmatize any vulernable person who had the misfortune to fall into their evil clutches. Their bogus screening campaigns from the cradle to the grave are designed to create a BRAVE NEW WORLD of apathetic, chemically lobotomized robots who won’t protest the ongoing thefts and rape by the power elite. This was to totally destroy the person by not only labelling them crazy but also using the stigmatized to create fear and hysteria witch hunts in the mob society to force their lethal treatments on those they did stigmaztize to force more lethal treatments for their neverending greed, profit, status, power and sadism. Dr. Paula Caplan exposes the fraud of the DSM junk science in her great book, THEY SAY YOU’RE CRAZY, one of many exposing the fraud. She has also exposed the “elephant in the living room” that the mental death profession has played a huge role in the obesity epidemic and diabetes with their lethal atypical antipsychotics and other poisons that has remained mostly unknown to the public while these fiends recommend removing obese children from parental custody typical of their victim blaming and creating the problems they pretend to solve. This is also true of their pretense of preventing violence with their lethal forced commitments and drugging while most school and other public shooters were on SSRI antidepressants KNOWN to cause violence, suicide, mania, and other dangerous effects. A recent list of the 25 top drugs causing violence mainly consisted of psychiatric drugs including SSRI’s and antipsychotics.

      So, to say one doesn’t need to know the cause of human suffering is certainly untrue. Just the removal of the mental death profession would end untold human suffering, trauma and loss and save tax payers the billions they rob with their bogus treatments and the lifelong payments that have to be made to those they permanently disable.

  10. I am very much enjoying following this discussion and hope Dr. Steingard will continue to take the time to write.

    My hope is that the entire field of medicine would become more transparent with the factual data for any type of treatment; how often is it that we see ads for pharmaceuticals, only to learn later of their side effects and/or ineffectiveness? This is not just in the specialty of psychiatry.

    For those interested, the book “The Brain That Changes Itself” by Norman Doidge is quite fascinating – worth a look.

    • As Dr. David Healy points out, BIG PHARMA like its twin predecessor, BIG TOBACCO, kept their evil death machine going by the science of DOUBT. This is done by burying the tons of damaging proven evidence that a drug like SSRI antidepressants are linked to suicide and many other harmful effects. But, by claiming their bogus studies also set up and reported to hide the lethal effects do not show such evidence and giving patients a total runaround, they can keep the fraud and menace to the public going for decades until evidence of the latest pathological holocaust against vulnerable humans has produced too many dead bodies and huge lawsuits since money is all that counts with such psychopaths.

      The mental death profession has done almost from the start that their drugs were lethal with especially antipsychotics causing brain damage, tardive dyskinesia and tons of other lethal effects they deliberately hid from patient and public and when obvious justified such evil abuse by falsely claiming the benefits outweighed the harm. As Whitaker proves this evidence has been widely available for decades with biological psychiatrists like the NAZI DOCTORS of Germany wearing blinders to harm those they deemed subhuman after they imposed bogus stigmas. With all the studies done, there is no justification for using any current bogus psych stigmas, the fraud junk science DSM or any poison useless but deadly psych drugs.

  11. Because of the dangers of neuroleptics, I feel all alternative options and naturopathic treatments should be exhausted before trying pharmaceuticals. Diet and environmental conditions play a huge part in our overall health and wellness -physically, mentally and emotionally. There are many ways to alter chemistry with food and suppliments. Niacin, for example can be very helpful for people who experiencing extreme states of consciousness, and who are often given the label of schizophrenic (when in actuality they are a human being experiencing something outside the norm). Looking at the health of the Gut, and the intestinal flora – and often increasing it with probiotics – can often restore people to health. The gut determines the ability to absorb and integrate nutrients, and the health of the gut has a HUGE impact on the health of the brain and neurology. When I was the guinea pig being “diagnosed” with all kinds of conditions, including schizophrenia, not one health professional suggested suppliments, dietary or environmental changes. And I was at some of the most prominent mental health facilities in the country. I speak from personal experience.

  12. Dear Sandra, I certainly don’t agree that its all in the head.

    “That is, I take as a given that cognition, emotion, and perception are brain functions.”

    I find astonishing that this quick, easy and misleading assumption that perceptual experience is a function of brain activity alone, is so pervasive in our increasingly “cognitive” culture. Why is there no reference to the body and its nervous system feedback signals in these conceptual arguments about mental disorder? I understand the religious aversion to awareness of our evolved animal nature, but I find the educated academic resistance truly frustrating. Although I guess its understandable when one’s life and source of income is invested in the conceptual, more than the felt sense of being.

    There seems to be an almost demonic aversion to any discussion of the “involuntary,” unconscious reactions that are involved in such experiences as PTSD. As a person with a 31 year history of what is cognitively categorized as bipolar type 1 disorder, managed mostly without psychotropic medications. I have found it more than helpful to understand my experience in terms of whole body/brain function, with first a self education into the unconscious reactivity of my autonomic nervous system, and then a slow return to a more holistic thought/felt sense balance. Its been a process of re-conditioning my habitual autonomic reactions at the unconscious level of sensation experience.

    I recall a TV program in Australia, of organized public debate on mental health. I’ll never forget the intellectual answers given to a young woman who’d froze when facing of a shotgun, during an armed robbery, and was tortured by flashback memory, guilt and shame about her own reaction. It was all very rational and cognitive in terms of trying to sooth her torment, all very mind based awareness stuff.

    I sat wondering why no one pointed out that she’d had an involuntary reaction, that was completely beyond her conscious control and was not a sign of weakness. If she had allowed the instinctual, physical impulse to complete its intention, she would have fainted , and more than likely the gunman would have quickly moved his attention to other sources of possible threat. Instead she instinctively froze, and simultaneously fought for conscious control, drawing out the agony of a fright/freeze moment. One moment in time that came to haunt her for years to come.

    Dr Stephen Porges “The Polyvagal Theory,” has been the most helpful in my “cognitive” awareness of unconscious processes that involve whole body/brain electro-chemical reactivity, not rationalized reason. A daily mindful awareness practice has allowed me to integrate new knowledge into a deeper self awareness. There a saying some attribute to the CIA that “deception is the art of plausibility,” and perhaps we prefer the easy self deception of quick and plausible explanations like, “chemical imbalance within the brain” to deeper self awareness?

    Here is an extract and link for a talk Dr Porges gave on the polyvagal theory and its implications for clinical practice; “The polyvagal theory basically emphasizes that our nervous system has more than one defense strategy and the selection of whether we use a mobilized flight/flight or an immobilization shutdown defense strategy is not a voluntary decision. Outside the realm of our conscious awareness, our nervous system is continuously evaluating risk in the environment, making judgments, and setting up priorities for behaviors that are adaptive, but are not cognitive.” http://www.childhood.org.au/Assets/Files/618688a6-c955-4a1d-9608-ce33e945cc1e.pdf The Polyvagal Theory for Treating Trauma. A Teleseminar Session with Stephen W. Porges, PhD and Ruth Buczynski, PhD

  13. Many thanks to Rob for this excellent work.
    I am a bipoalr I Psychiatric Survivors, connected with other 1000 user / patient, founder of a web group in Italy.
    I was diagnosed in 1987 and for 26 years I have never taken psychiatric drugs.
    For a period of 6 years I was always with one stabilizer at time but my situation was worse.

    Looking at many other patients I come to the same conclusion by Rob: psychiatric drugs can make worse chronic mental illness.
    A large percentage of these people I have seen, problems have clear organic result of abuse and poisoning by drugs and other substances.
    I think the disease should be considered in a holistic key, and how to deal with drugs is only one aspect of many, the worst remedy that we can find.

    I think it makes little sense to debate the origins of mental illness. If I have a poisoned arrow, I would like to remove the arrow before I know who has shooted.

    Drugs are a way to remove the arrow, but is the wrong way.
    Dr. Pauling and Dr.Hoffer have found the right way even before the drugs era, with orthomolecular medicine.
    Must wonder why these so promising studies have been followed.
    Fortunately, their ideas are used successfully by thousands of e survivors in the new world, who have realized that their problem was on drugs treatment.

    • The poisoned arrow theory may be okay when the cause of an illness is unknown in some obvious cases like removing a poisoned arrow or bullet without having to know the name of the shooter.

      However, when one is suffering traumatic stress symptoms from an abusive, toxic environment, removing the abusers or the abused is the ONLY CURE. Stigmatizing and poisoning the victims is the worstkind of betrayal because suffering inflicted by one’s supposed fellow humans is far more traumatic than natural disasters. The fact that biological psyciatry lies and denies abuse related trauma is the most lethal form of betrayal, retraumatization and human evil perpetrated against abuse trauma victims in the guise of help. The court system is equally lethal in blaming the victims with psychiatry acting as the current SS thugs of our growing police state. Psychiatry has nothing to do with medicine or curing the so called patients, but rather intimidating, punishing, silencing, discrediting, disempowering, torturing and destroying anyone who poses any threat to the power elite including stress/trauma symptoms from their abusive enslaving social institutions including marriage or any dissidents protesting their many criminal social injustices.

      Ironically, the book, THE PROTEST PSYCHOSIS, exposes how once again psychiatry VOTED in new symptoms for schizophrenia that coincidentally stigmatized angry black men in the view of the racist, misogynist SS thugs of the white male old boy network of psychiatry of course.

      This web site now has an article about how schizophrenia is “diagnosed” far more frequently in blacks just as women and children are far more inclined to be stigmatized as mentally ill than men. But, this blogger would have us all believe that she practices in a profession with claims to the most scientific methods. This is just a replacement for drapetomania, that mental illness of blacks who desired to escape their abusive enslavers or oppressors just like the mental death profession has a stigma in its bogus junk science bible of revelation rather than science that any would be escapees from their psychiatric slavery, oppression and torture is also a mental illness. Like homosexuality, these great scientific labels and fables can be voted in and out depending on current politics and which lethal drugs are on patent still. Only a bunch of psychopaths could come up with such dirty tricks as the intraspecies predators they truly are.

  14. Quote: “Maybe the changes effected by Open Dialogue are safer or more long-lasting. Maybe the efficacy of our currently available medications have been exaggerated.”

    MAYBE???

    Quote: “If someone reading this is a dualist (i.e., believes that there is something other than the material world from which these experience airs) then we have deeper disagreements that I will not address here.”
    We have a deeper disagreement. I’d think that there are scientific research outcomes, that point in the direction of what you call ‘dualism’, too.

    Quote: “Even if there is no dopamine excess in the brain, that does not mean that medications that alter dopamine function in the brain cannot a priori be effective. The effective treatment of a condition is not necessarily linked to its cause.”
    I guess that depends on what you call ‘effective’. I think that a person is a whole being. You may find a medication that produces an effect that stops a certain ‘symptom’. But if that medication in the meantime damages other areas of the person or his organism, we can wonder if the treatment can truly be seen as ‘effective’. ‘Effective’ as I see it would mean a restoration of balance that allows the person to be healthy, feeling well, and functioning more or less well in a social enviromment. To be honest I cannot say that I know anyone who took psychiatric meds who feels these meds allow them to really do that. All people I know who take psychiatric drugs would rather be off meds and seem to intuitively sense that the meds are slowly destroying their well being. Of course a ‘monist’ may not value intuition, though.

    • I was quite surprised to find out that our first president did not die from the great medical practice of his time, bloodletting. Rather, he died from mercury poisoning, which was THOUGHT to be therapeutic at the time.

      Notice that most if not all claims by the mental death profession/BIG PHARMA/courrupt government hacks speak in such sneaky terms as “thought to be caused by…..,” it is theorized by experts that……..” and other garbage fraud claims made to appear as proven science by so called experts on a brain washed public. That is what this blogger does time after time to justify her cruel infliction of life destroying stigmas and lethal drugs for power, profit and status while perpetrating irrevocable harm on countless victims.

      Psychiatry has more than proven it can not predict who will be violent. And when violence is most predictable as with psychopathic malignant narcissist wife abusers and similar cases, they refuse to act. This was obvious in the latest case of the man who obviouslly murdered his wife and followed up recently by blowing up his children. But, going after fellow dangerous abusers like themselves is not such safe, easy profit as going after the vulnerable, abused, traumatized and others so easy to abuse, betray, retraumatize, mob, bully, and rob of all human and civil rights.

      Again, there is no justication for biological psychiatry other than to rob citizens of a pretense of a democracy of all democratic, civil and human rights. Perhaps this author should study the fate of those in Nazi Germany and Niehbur’s lament that “First they came for the Commmunists and I didn’t speak out because I was not a Communist, Then they came for the Catholics and I didn’t speak out because I wasn’t a Catholic….Then they came for me and there was nobody left to speak for me.

  15. Thank you for your comments. I do value intuition but with reservations. Daniel Kahneman’s book, “Thinking, Fast and Slow” is an excellent book that discusses the value and pitfalls of intuitive thinking. This is based on over 40 years of research by Professor Kahneman and other cognitive psychologists. This is a 400 page book so it is hard to summarize but the short version is that, in general, our intuitive abilities are excellent but can lead us astray. You know many people who complain about the effects of medications. I believe you. I know many people who are convinced they have derived enormous benefit from medications. If you read my other blogs you know that I agree that the overall benefits of medications are exaggerated and I spend quite a bit of time talking to my patients about this. Trying to determine who does and who does not benefit is challenging, in my opinion, and I will write more about this in my next post.

    • You know what the problem is here? Putting scientists in charge of dealing with people’s emotions and social problems. That is an absolutely terrible idea as many of these scientists (and scientfically trained doctors – trained to deal strictly with the physical realm) seem to be quite clueless when it comes to emotions, social life, the space between people – and what to do about it.

  16. Though the author is quick to imply that anyone else judging medications is biased even if for or against them, she conveniently ignores all the books and articles that prove in studies and trials that all psych drugs are useless except for a possible placeboy effect while having many lethal “side effects,” which are actually the only effects causing huge iatrogenic harm, which is the topic of ANATOMY OF AN EPIDEMIC. Though Robert Whitaker leaves this psychopathic criminal enterprise open to debate among those who have the same ethics as those in the tobacco industry pretending their products weren’t lethal for decades depite all evidence to the contrary, those who have been directly harm by these criminals are not so inclined to give them the benefit of the doubt since they have experienced their narcissistic abuse, deceit, cruelty, violence and betrayal first hand. Their pathological lying to the public and their victims is so egregious they are the ones who should be locked up and forcibly poisoned with their own lethal treatments while awaiting their own Nuremburg Trials.

  17. http://psychiatryonline.org/newsArticle.aspx?articleid=104895&RelatedWidgetArticles=true

    Here is a hyperlink to an article in PSYCHIATRIC TIMES about Dr. Carole Warshaw, Psychiatrist and Domestic Violence Expert, about how the mental death profession harms and destroys women and child victims of domestic and other abuse with bogus stigmas like bipolar, ADHD, paranoia, etc. She puts it much more kindly than me that the mental death profession ignores the contributing factors of one’s environment due to their training to only look at the victim’s symptoms rather than the symptoms of an unjust, evil, corrupt, abusive, oppressive society with such deadly institutions as the mental death profession to maintain totalitarian control in our growing police state and dictatorship pretending to be a democracy. Those uppity women and children must be kept in line while the mental death profession robs all they can from their health insurance to destroy them so the white male misogynist, racist old boy network power elite can prevail always. It is sad to see evil women gleefully joining this horror show.