Dr. Pies Still Spinning

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

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

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

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

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

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

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

Dr. Pies continues:

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

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

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

But Dr. Pies circumvents this entire matter with two deceptive maneuvers.  Firstly – and almost unbelievably – he asserts that psychiatry never promoted the spurious chemical imbalance explanation.  On July 11, 2011, he wrote an article for Psychiatric Times titled Psychiatry’s New Brain-Mind and the Legend of the “Chemical Imbalance.  In that article he wrote:

“In truth, the ‘chemical imbalance’ notion was always a kind of urban legend – never a theory seriously propounded by well-informed psychiatrists.”

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

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

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

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

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

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

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

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

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

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

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

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

And so on throughout the manual.

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

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

* * * * *

This article appeared today on Philip Hickey’s website,
Behaviorism and Mental Health

61 COMMENTS

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

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

    Thank you for exposing his tautology, in excellent, thoroughly researched detail.

    From wiki on tautology
    http://en.m.wikipedia.org/wiki/Tautology_(rhetoric)

    “In rhetoric, a tautology (from Greek tauto, “the same” and logos, “word/idea”) is a logical argument constructed in such a way, generally by repeating the same concept or assertion using different phrasing or terminology, that the proposition as stated is logically irrefutable, while obscuring the lack of evidence or valid reasoning supporting the stated conclusion.”

    Also so pertinent:
    http://en.m.wikipedia.org/wiki/Tautology_(rhetoric)

  2. This is my first ever comment on MIA……trying being mad in the UK…..

    Marvellous, as usual, simple Simon met a Pieman, not withstanding…

    In the UK we are bombarded with ssris and take the wrong one at your peril
    Or, is the wrong one the right one, or, is the right one the wrong one.

    They have had their day. It is all over.
    No pharmaceutical company is investing any more money in an ti de press ants..it is over..end of..

    However, over it may be for them, it is not over for most of us normal folk who happened across an ssri and got seriously burnt in the process.

    It always was, and always will be a fraudulent practise based on a myth with seriously under-educated people, like, the psychiatric brigade, peddling their wares……

    Anyway, greetings from Scotland….you are my favourite reporter…apart from our very own David Healy…and, yippee, it is over, it is over, it is over….

    and, alternative therapies, are not on my agenda, as, I did not want an ‘orrible ‘istory’ in the first place…so, god, bless, America and keep up your smart and honourable pieces.

    Thank you for being eradite, or, was, it, era….dite 🙂

  3. You know Dr Hickey I will never be able to put a Pie in the microwave, watch it spin as it warms, and not think of Ol Porky again lol.

    “psychiatrists are subjected to invective and abuse that would never be tolerated if directed, say, at some ethnic or racial minority.”

    This quote from Dr Pies though caught my attention. They tried to pass involuntary sterilization laws here in Western Australia that on the surface were ‘neutral’. However, it is my belief that when one examined the criteria it would have resulted in mainly aboriginal people being subjected to these new psychiatric powers. So whilst the community did not allow this abuse of a racial minority, it certainly didn’t stop psychiatrists asking if they could.

    Once again, thank you for keeping an eye on these spin doctors. It’s one Hell of a left hook you have.

  4. Hi Simon
    When I was 20 I was diagnosed with the most serious ‘mental illness’.
    I cooperated with the medical approach (I had no choice) and I remained sick and disabled. I wanted what was best for myself so I approached things with an open mind. I tried the psychological approach to see what it could do for me, and I could see that it worked. So I stopped taking medication (very slowly), and I got better and returned to life.

    • Fiachra,
      I also was told I was seriously mentally ill and took the drugs. It caused me to endure many years of confused and weird thinking with terrible toxic side effects till one day I tapered off the drugs and returned to a much happier person drug free.

      If only psychiatry would stop their charade.

  5. Welcome Annie. And thank you again for speaking the truth, Dr. Hickey.

    “In truth, the ‘chemical imbalance’ premise was a kind of urban legend – never a theory propounded seriously by well informed psychiatrists.”

    I, for one, was told I had a ‘chemical imbalance.’ Anyone else here fed that coercive lie?

    • Someone else: I was told exactly that. I can’t say that I have a good explanation for everything that I have done in life. I think that maybe be some things in life defy explanation, and that an honest we don’t know is a better response than a contrived or bogus explanation.

      • Chrisreed,

        I agree, so much of life is still a mystery to all of mankind, and we certainly don’t need lunatics with bogus “bibles” of stigmatizations pretending they alone know all and dictate reality. Personally, I needed to know how and why such lunatics attacked and confused me. It was shocking to learn of the overwhelming betrayal, but chronologically typing up my medical records and researching medicine so I could understand what happened, was important for me. And to learn these lunatics are attacking and poisoning millions more people just for money and power is sickening. We need to learn to coexist kindly and respectfully with each other on this planet, and we don’t need doctors who pretend they understand the brain, but only know how to create mental illnesses in people with drugs, in charge of humanity.

  6. Dr. Pies, psychiatrists playing the victim is pretty stomach-turning. The invective comes from the knowledge that arrogant, blind people with no understanding of you (the “patient”) or your life whatsoever have legal power over you that they absolutely should not have. It is infuriating and unjust. Can you put yourself in our shoes and think about it from that perspective? Imagine being overpowered by someone who doesn’t understand you and doesn’t care for you– in a way that makes you want to fight back, fight for your life, in a way you know is SIMPLY WRONG. Yet the state has given the power to these blind, ignorant abusers to act as they will with you. Stop being (intentionally?) obtuse and twisting words like “illness.” Own up to the responsibility that the field of psychiatry has to come clean and admit it has been very wrong for a very long time. Have some integrity. If you honestly don’t realize how wrong you/your profession is, try LISTENING with a bit of humility to some of the more cogent arguments and you may just learn something. This nonsense, the nonsense and abuse of your profession, has gone on for far too long and we are tired of it.

    • *fight for your life, your DIGNITY, and the TRUTH.

      In other words Dr. Pies, I’m asking the members of your profession to show some *maturity* and *ethics.* Do you think that’s at all possible?

      If it’s not, I can only hope that those who can tell your profession what to do, namely the government, learns in a timely fashion that what you are up to is abusive nonsense and forces you to cease and desist, while making you pay for not voluntarily doing so.

      This is a total power struggle and a fight for social justice. Medical-model psychiatry is squarely on the wrong side of history and is going to occupy an embarrassing, shameful place in the history books. If you don’t see the light, you will be among those remembered as having been blind, ignorant, and wrong, factually and morally. Decide for yourself if that’s what you want.

      • It’s an unfortunate reality ssenerch that our politicians turn to psychiatrists for answers to social ‘problems’. So it becomes the psychiatrists telling the government what to do. The government simply provides the legal framework for them to achieve whatever ends they wish.

        It’s been fascinating watching the debate around the use of CTOs here in Australia. It’s like they gave the police the power to shoot any black man they didn’t like the look of, and then only asked the police if the new laws were working for the community. Answer being that crime is down and we have the data to show it.

        Happiness, were all in it together lmao.

      • “is going to occupy an embarrassing, shameful place in the history books.”
        It’s not like they don’t already have a chapter or two. I particularly recommend reading the one about the role the Nazi regime (interestingly the Otto Wagner Spital in Vienna in which I was imprisoned is one of the most infamous places and they sure run with this tradition to this day according to numerous press releases) but connection to CIA torture is also a good one. And there is lobotomy and electroshock.

  7. My my my. Why did I read this right before bedtime. A couple strong impulses:

    a. MIA is becoming very well known and, more significantly, feared by the system, so someone is starting to lose money somewhere. Again with the saying, “first they ignore you then they laugh at you then they attck you, then you win” — I believe we are about to experience the attacking stage, and I hope everyone at MIA is prepared to weather the storm if/when it does and not ask us alll to tone down for the sake of unity or something.

    b. The Orwellian abuse of language continues: calling psychiatrists victims of “hate speech” is like calling the Klan victims of “prejudice” on the part of anti-racists. The fact that Pies or anyone in this day & age thinks he can get away with such blatant double-think shows the contempt these people have for our intelligence. (Psychiatry, let us remember helped engineer the Holocaust, notice how they change the subject when you bring that up.) The sooner people call them on it the better.

    • Re attacking stage: We already have – anyone who challenges the system is attacked.

      Anyone who challenges the system in an intelligent, evidence based manner is attacked with all guns blazing. The system spent over £30k trying to remove the embarrasing irritation that was me trying to protect my son. (Of course they won’t spend it on psychological therapies) The lies that appeared in that assault were incredible. Three firms of lawyers and two barristers armed with a pack of lies to try and dislodge a parent who has simply decided ‘no more meds because they clearly don’t work’. There were between 8 and 10 people in the coutroom on three occasions and the only ones not on the public payroll were my wife and me representing ourselves.

      Why ?? To protect the lies would seem the only explanation.

      • Kudos for hanging in there, AngryDad. Dr. Peter Breggin has some stories of parents standing up for their kids against drug-happy school staff, mental health professionals, etc. in “Medication Madness”. I’ve been there myself, although apparently nowhere near the intensity of your situation. I was privileged to have a small supportive role in another woman’s heroic story in standing up for her son and saying “no more” in spite of threats of Child Protective Services–what a horrible irony, eh? I’ve summarized her son’s story in my article “From Adversity to Advocacy”, published earlier this year at the Foundation for Excellence in Mental Health Care website: http://www.mentalhealthexcellence.org/author/rstence/

          • Just read it and almost wish I hadn’t. Jesus.

            I believe that my son’s difficulties began as a result of either a succession of minor traumas or a suspected but as yet undisclosed major trauma, or both.

            What I know for certain is that his subsequent involvement with mental health services in the UK has not only compounded his original trauma but stacked so many layers of new ones on top he can’t yet get at the original.

            No police record, no history of violence, no history of attempted harm to self or others, yet dragged from his own home in handcuffs by 4 police officers, bundled into a van, locked up, and drugged against his and his family’s wishes.

            Oh, and then accused of being hostile towards staff. But of course in the mystical world of psychiatry, despite the fact that you have never been hostile in your life, this means you must also have a mood disorder and given more drugs.

            Don’t just imprison them, treat them to their own medicine.

          • Oh, I wonder why would anyone ever be “hostile towards staff”. Especially after being “dragged from his own home in handcuffs by 4 police officers, bundled into a van, locked up, and drugged against his and his family’s wishes”. Must be a hereditary irreversible brain disorder…

  8. Dr. Pies begins by discussing websites ” . . . that critically examine psychiatry.” The worst antipsychiatry Web sites, in my view, are veritable bastions of bigotry, in which psychiatrists are subjected to invective and abuse…

    This online abuse is a reaction not plain old action, what motivated this invective and abuse ?
    Some of my posts are real nasty because I was abused by psychiatry first.

    For example: If I disagree with the bipolar thing and reject the standard shuffle around nueroleptic pill overdose because I know damb well my ‘mania’ was alcohol withdrawals is it really necessary to threaten me with violation of my bodily integrity with violence and hypodermic needles full of real scary drugs that affect my breathing heart rate and consciousness and have a side effect of possible DEATH in a place with locked doors and no place to run ?

    I think a public apology from the APA and drug company friends for ALL their crimes against humanity is in order, then we can all play nice.

    “But these websites are abusive…” stop being cry babies , you all asked for it.

  9. After ceasing and desisting from the coercion and crimes against humanity, After an apology, than a walking tour of all the potter fields for all psychiatrists and pharma and government people including any untouchable “elites”responsible ,after a reading of all the names of the people buried in them ,and after a discussion about what happened to them.After reviewing the touring perpetrators personal career long crimes, After several touring international exhibits illustrating psychiatry and pharmas, and governments collusion in their crimes against humanity on going for more than decades ,now victimizing even the very youngest members of humanity, after trials are over ,sentences served ,present active victims protected , reparations paid , we can begin to talk about rehabilitation. Afterwards jobs may be found that do not put them in any position to control others. Thats light years nicer than they ever were to many millions of people.

  10. Yup, coercive lies here as well. Two different NHS consultant psychiatrists presented me with the chemical imbalance theory within the last 3 years. One of them even blathered the insulin analogy. He is not a stupid man, he is well published and I have read most of his papers. He has made two statements to me that he has demonstrated he knows not to be true. This is dishonest. Under such potentially disastrous circumstances ‘white lies’ for the sake of convenience are not only unjustifiably dishonest, they amount to gross misconduct: deliberately misinform to obtain or maintain consent ? Why ? Running scared for the validity of his actions ?

    Worse still, I have heard one or two of his other patients proudly broadcast that they have a chemical imbalance that is corrected by taking his lovely meds. Wonder where they got that from ? Poor sods.

  11. Pies is a funny man, though I wonder if he’ll get a big head simply for the fact that he’s had so many articles on Mad in America named after him!! (See my own ‘Too Much Pies’ https://www.madinamerica.com/2013/04/too-much-pies/ and ‘Slices of Pies’ here https://www.madinamerica.com/2013/04/slices-of-pies-a-dialogue-with-ronald-pies/!)

    He does seem to want to have it every which way. I attended a Grand Rounds at SUNY Upstate where Bob was speaking and where Pies (who is a Professor there) declined to go, yet he did e-mail the moderator right at the end and ask him to offer the audience his retort to Whitaker’s book (Anatomy).

    Does he ever emerge in person to have these arguments, or must they remain on paper by nature of his slippery strategy?

    • Sounds like the only thing they showed is that Ritalin has a direct impact on these eye movements. Of course, it can’t be a foolproof method for diagnosing “ADHD,” because there is no way to identify who has “ADHD” in the first place. So how can you know that this is “right?”

      Insanity…

      —- Steve

      • Even if some kids are “hyperactive” (whatever the definition) and you can somehow set an arbitrary line and call everyone who crosses it ADHD it still does not justify the drugs to control behaviour. Because that’s all these drugs do – there is no proof that they make kids do better academically or socially.

    • Vortex,

      Thanks for this.  Claims of this sort crop up in the psychiatric field every few months.  None survive scrutiny.

      “…the team found a direct correlation between ADHD and the inability to suppress eye movement in anticipation of visual stimuli.”

      But how can you rely on a correlation when one of the correlated items (a “diagnosis” of ADHD) is inherently unreliable?

      I’ve written extensively on the condition known as ADHD here and in other places at Behaviorism and Mental Health.

  12. Dr. Hickey, I just finished working through a book from UK sources on combatting Depersonalization and Feelings of Unreality. Although the material is still not spin-free, and fails to openly criticize the mainstream of psychiatry, they do bemoan misinformation and the catastrophizing attitudes associated with medicate. medicate, medicate arguments. They really soft-pedal that, actually, but it’s clear that they mean to suggest that client’s already have a hard enough time with symptoms before they are further encouraged in the wrong directions. Hence, this book was all about CBT methods for breaking feedback loops and reducing the problems that occur, and the worsening of the symptoms that occur, due to symptom monitoring.

    Yet the group still strongly pushes the concept of discrete disorders, warns you off of their approach of you DPAFU “is part of another disorder”, etc. This is clearly beside the point. Any kind of “psychiatric symptom” can happen to anyone from any number of causes, and the duration and intensity or causes can differ, overlap, assimilate to other causes and symptoms, change immediately once described, and so forth. At any rate, reading the book carefully, and comparing and contrasting with some things I did already helped me out. But the most important therapeutic factor was things the book did not do.

    It did not lock me in my house or in my room and did not require me at the nurses’s station and threaten me with state hospital time if I didn’t take my meds, and it didn’t tell me what I thought, felt, believed, or was intending.

    Except for the voiced opposition–like yours–that exists above and beyond the medical profession’s own forums, people like Dr. Pies get such a free ride after continually misinforming and denigrating people who originally came to the system for serious help. Most of the time, still, we are liable only to get the party line, the closed mind, and the incivility typical of the “clinical setting”.