More on the Chemical Imbalance Theory

In an email to Mad in America, sent on November 4, 2015, Dr. Pies refutes assertions in this post, saying that it “contains incorrect and misleading information re: my views, as well as an unsupported claim re: supposed ‘conflicts of interest.’ Dr. Pies’ email is respectfully reproduced below, as well as here.

On October 23, 2015, Jeffrey Lacasse, PhD, and Jonathan Leo, PhD, published an interesting article on Florida State University’s DigiNole Commons.  The title is Antidepressants and the Chemical Imbalance Theory of Depression: A Reflection and Update on the Discourse.  Dr. Lacasse is assistant professor in the College of Social Work at Florida State University; Dr. Leo is Chair of Anatomy and Professor of Neuroanatomy at Lincoln Memorial University.  The article was originally published in the Behavior Therapist in the October 2015 issue, pages 206-213.

The article provides a concise overview of the chemical imbalance theory from its inception, through its vigorous promotion by pharma-psychiatry, to its present reduced, but not quite dead, state.

Here are some quotes from the article, interspersed with my comments:

“In the early 2000s, the serotonin metaphor of depression was widely advertised by the makers of antidepressants, including advertisements for citalopram, escitalopram, fluoxetine, paroxetine, and sertraline…In particular, Zoloft(sertraline) advertisements featuring the miserable ovoid creature were unavoidable in U.S. television and magazines.  An on-line repository of direct-to-consumer advertisements for psychiatric drugs lists many from 1997–2007 referring to a chemical imbalance, across many drugs and diagnostic categories (Hansen, 2015a, 2015b).”

The Hansen references mentioned in the above quote are worth examining.  Ben Hansen is the well-known psychopharmacological savant Dr. Bonkers.  The Bonkers Institute is always worth a visit.  The links for the above quote are 2015a, and 2015b.

. . . . .

“Since chemical imbalance is often presented as a rationale for taking SSRIs, some such patients now understandably feel lied to by their clinicians. Levine (2014) calls this ‘Psychiatry’s Manufacture of Consent.'”

“… in a rare controlled experiment on this topic, one group of depressed students were told they had a confirmed serotonin imbalance underlying their depression, while a control group was not (Kemp, Lickel, & Deacon, 2014). The group who was told they had abnormal serotonin levels found medication more credible than psychotherapy and expected it to be more effective. They also had more pessimism about their prognosis and a lower perceived ability to regulate negative mood states, yet experienced no reduction in self-blame. These results suggest that the chemical imbalance explanation may indeed be helpful in persuading patients to take medication but that this is likely accompanied by undesirable effects.” [Emphasis added]

The Kemp, Lickel & Deacon (2014) article is, in my view, one of the most important pieces of research in this field.  It provides clear evidence that falsely informing people that they have a brain abnormality is disempowering and damaging.  The article can be accessed here.  The truly compelling aspect of this matter is that such a piece of research needed to be done at all. Isn’t it obvious that lying to people in this way would be disempowering and destructive?  Would any legitimate medical specialty routinely operate in this way?

. . . . .

“Perhaps the most interesting part about both of these NPR pieces [that were referred to earlier in the article] is that neither reporter questioned the experts about the ethics of telling a falsehood to patients because you think it is good for them.”

“It is easy to imagine that a single prominent academic psychiatrist, authoring an Op-Ed in The New York Times, could have set the record straight on serotonin imbalance decades ago. Yet, to our knowledge, no one did so.”

If psychiatry were anything other than a branch of medicine (and I realize that’s debatable), it would have been mauled to destruction by the mainstream media long ago.  But the media and the general public have a great respect for medicine, and psychiatry has been afforded an undeserved share of this respect.  But, as I’ve mentioned in earlier posts, the mainstream media are beginning to see through the façade, and are finally reporting on the “diagnostic” proliferation, the false claims, and the destructive treatments.

. . . . .

“When our physicians are educating us, we prefer they not tell us any lies, white or otherwise.  Unfortunately, characterizing the chemical imbalance metaphor as a ‘little white lie’ communicates a paternalistic, hierarchical approach that sounds suspiciously like the days of medicine that we thought we had left behind.  It’s a ‘little white lie’ if you’re a psychiatrist; if you’re a confused, vulnerable depressed person who agrees to take an SSRI after hearing it, you might not consider it so little.  After all, if your trusted physician tells you that you have a chemical imbalance in your brain that can be corrected with medication, not doing so sounds foolish, if not scary (Lacasse, 2005).  How many patients with reservations about SSRIs have agreed to take medication after being told this ‘little white lie’?”

The “little white lie” is, of course, a reference to the 2014 article by the very eminent and influential psychiatrist Ronald Pies, MD.  In that article, Dr. Pies characterizes the chemical imbalance theory as “…this little white lie…”

Dr. Pies has also insisted – arguably delusionally – that psychiatry never promoted the chemical imbalance theory of mental illness.  In a 2011 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.”

In the article in hand, Drs. Lacasse and Leo provide clear and abundant evidence to the contrary.  They also, incidentally, provide a summary of Dr. Pies’ past financial relationships with pharmaceutical companies.  Apparently the eminent doctor has received funding from Glaxo Smith Kline, Abbot Laboratories, and Janssen Pharmaceutica.  He has also consulted for Apothe Com, a medical communications agency that assists pharma in the commercialization and promotion of new drugs.

“Pies blames the drug companies for running misleading advertisements about chemical imbalance, belatedly admits he should have said something sooner, but fails to mention that he was paid to help them promote their products at the time the advertisements were running.”

“We previously argued that the propagation of misleading advertising ‘is only possible in the absence of vigorous government regulation . . . or outcry from professional associations’…That outcry never came, and these issues weren’t addressed publicly until the patents for most blockbuster SSRIs had expired, and Big Pharma moved onto mood stabilizers and atypical antipsychotics. While we are hesitant to overemphasize conflicts-of-interest as an explanation for what has occurred, we can’t help but notice that the silence of psychiatry regarding chemical imbalance only ended when the profits had been extracted from the SSRI marketplace.”

Now that’s an interesting coincidence!

“Many mental health clients find it unacceptable, and perhaps a violation of ethical informed consent, for clinicians to give patients metaphorical explanations for their mental health problems and promote them as scientific truth.”

The chemical imbalance hoax, which was diligently and self-servingly promoted by pharma-psychiatry for decades, is perhaps the most destructive and far-reaching scandal of the modern era.  As a theory it was refuted almost from its inception, but was nevertheless promoted by psychiatrists and by massive advertizing campaigns, and served to increase sales of psychiatric drugs in every corner of the globe.  There is no way to calculate the number of lives that have been lost, or severely compromised, as a result of this activity.

Now, anti-psychiatry groups are exposing the truth, and pharma-psychiatry are quietly altering their message.  But there have been no apologies; no congressional hearings; no indictments; no CEO’s fired; no psychiatrists censured.  Just business as usual, as the pharma-psychiatry leaders prepare their next “great breakthrough” message.

This is an insightful article, on a very important topic, by two highly respected scholars.  It is well worth reading, and passing along.

* * * * *

Dr. Pies’ response:

Message sent by: Ronald Pies MD

Message: Dear Mr. Cole: 

Philip Hickey’s blog, “More on the Chemical Imbalance Theory” — posted on your website — references a recent paper by Lacasse & Leo (“Antidepressants and the Chemical Imbalance Theory of Depression”) which contains incorrect and misleading information re: my views, as well as an unsupported claim re: supposed “conflicts of interest”  Lacasse & Leo impute to me. These misstatements by Lacasse & Leo are, unfortunately, repeated in Hickey’s blog.  This is unacceptable and must be publicly corrected. In brief, Lacasse and Leo’s misrepresentations are as follows:

1. They misattribute the phrase “little white lie” to me, with regard to the so-called “chemical imbalance theory.” In reality, this unfortunate phrase was originally used by Mr. Robert Whitaker in an interview with Bruce Levine. The link is:

In the article I subsequently wrote, cited by Lacasse & Leo (, my use of that phrase was in direct reference to Whitaker’s interview and to his own choice of words. I made this clear as far back as April, 2014, in a comment I posted beneath my Medscape article (available online). Careful scholars would surely have observed this and not falsely attributed Whitaker\’s phrase to me. The Medscape article has since been corrected. 

2. Citing information properly disclosed by me over a decade ago, Lacasse & Leo allege that I was “paid to help [pharmaceutical companies] promote their products…” This is categorically false. The allegation by Lacasse & Leo was not based on any direct knowledge of my professional or contractual arrangements dating back to 2003.  Never, at any time, have I accepted any monies from pharmaceutical companies (or anyone else) with the intent or purpose of promoting their products. Nor have I ever had any ongoing financial relationships with any pharmaceutical companies.  

A detailed rejoinder to Lacasse & Leo will appear in the winter issue of “The Behavior Therapist,” where the Lacasse & Leo article originally appeared. However, I respectfully request that you run a correction on your website as soon as possible; e.g., by posting this communication. I consider this a matter that impinges on my professional reputation, and I reserve all rights in pursuit of a just resolution.  

Ronald Pies MD
Professor of Psychiatry

Jonathan Leo and Jeffrey Lacasse write, on November 6, 2015:

This morning, MIA published a response from Dr. Ronald Pies to our recent article  in The Behavior Therapist. Dr. Pies has also sent a letter to The Behavior Therapist, and we have written a reply. Both letters will be published in the next issue of the journal, which will be published in mid-December 2015.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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  1. Thank you Jeffrey Lacasse, Jonathon Leo, and Philip Hickey for the community service of challenging the pseudoscience of the harmful medical model.

    The chemical imbalance theory is a “little white lie” to Dr. Pies because it is the main support for psychiatry and it is a lie. The legitimacy of psychiatry hangs in the balance between this discounted theory and an effort to craft a better biological theory of mental distress.

    Best wished, Steve

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  2. Thanks for this expose Dr. Hickey. Jonathan Leo is a good writer who I believe has also done work exposing false genetic theories of “mental illness”.

    As you predicted, psychiatrists are now trying to move onto other false theories of mental illness, like genetic and alternative biological explanations. These attempts are also doomed because there are no separable mental illnesses to find genetic or biological causes for; individual human suffering does not work in the way their reductionistic-linear ways of thinking presume.

    But the idea behind this research, research which many psychiatrists must sense will fail, is to continually shift to some new deceptive theory about supposed mental illness while concealing the past failures. The ultimate goal is to enable continued extraction of billions of dollars from indoctrinated consumers for as long as the deceptions can be maintained.

    A major X-factor in these ongoing conflicts between psychiatrists, reformists, and abolitionists is the internet… the internet is enabling the spreading of information and learning by the everyday person at a scale and pace never before seen in human history. In the 80s and 90s, anti-psychiatry writing and ideas rarely reached the everyday person, being limited mainly to a few printed books and newsletters. But now anyone can cheaply and quickly find penetrating analyses of how psychiatrists have lied about diagnoses, drugging, chemical imbalances, genetic and biological explanations, etc.

    Hopefully this availability will start to outweigh the propaganda spread by drug companies. Much of the blame for the current state of affairs must be put on one country and people – America and American healthcare professionals – and its lack of protections against false advertising by capitalist corporations.

    Since American psychiatrists for the most part will not admit their profession’s lies, other Americans need to step up to confront and challenge one of the worst mental health care systems in the world. Also, I might add one of the worst health care systems in the world – one which costs on average about twice as much as other advanced nations’ health care systems, but achieves nothing additional in terms of increased life expectancy or greater wellbeing for its citizens. Here are some charts exposing just how horrible American healthcare is:

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    • bpdtransformation,

      Thanks for coming in. The Internet is certainly a game-changer. It has been said that here in the US, we have the best government that money can buy, and certainly the pharmaceutical industry have pumped obscene amounts of money into the system. And psychiatry is hand-in-glove with pharma.

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  3. Thank you so much for stating it as it is. It never ceases to amaze me that the crimes of big pharma and the psychiatry profession are very much known to those who can definitely change things for the better, but don’t. When are the majority of the psychiatrists going to put in the ethics of those within their own profession? I have worked very closely with anti-psychiatry groups and I am proud that they proceed in the darkness of those who wish to destroy without any fear of doing so. I once asked a psychiatrist how he can just work with those who he states in his own blog, are unethical and hurt people. His answer was that he just keeps his head down and does his work because he could be destroyed if he really makes it known about what they do. No wonder there a lack of people wanting to go to school to be psychiatrists.

    Fluffy over and out

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  4. Does seem crazy how little psychiatrists seem to really know. Take this “visual snow” stuff. People have only recently been talking about it but it’s supposed to be an indicator for anxiety and depression. A study suggests it might be a part of the brain “hyper metabolising”.

    Something i’ve had for as long as I can remember /shrug.

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  5. Here are the relevant Medical Board of Australia carefully written “informed consent” guidelines. It would seem very worthwhile to present, point by point, American and other “informed consent” guidelines for physicians, and see to what degree mainstream psychiatric practice is regularly breaching these carefully outlined statutory guidelines regarding legal obligations to disclose information to patients. It seems to me that they are breached on many points in Australia.

    Medical Board of Australia
    3.5 Informed consent
    Informed consent is a person’s voluntary decision about medical care that is made with knowledge and understanding of the benefits and risks involved. The information that doctors need to give to patients is detailed in guidelines issued by the National Health and Medical Research Council (NHMRC).8
    Doctors should normally discuss the following information with their patients:5
    • the possible or likely nature of the illness or disease;
    • the proposed approach to investigation, diagnosis and treatment:
    – what the proposed approach entails
    – the expected benefits
    – common side effects and material risks of any intervention6
    – whether the intervention is conventional or experimental
    – who will undertake the intervention
    • other options for investigation, diagnosis and treatment;
    • the degree of uncertainty of any diagnosis arrived at;
    • the degree of uncertainty about the therapeutic outcome;
    • the likely consequences of not choosing the proposed diagnostic procedure
    or treatment, or of not having any procedure or treatment at all;
    • any significant long term physical, emotional, mental, social, sexual, or other
    outcome which may be associated with a proposed intervention;
    • the time involved; and
    • the costs involved, including out of pocket costs.

    Doctors should give information about the risks of any intervention, especially those that are likely to influence the patient’s decisions. Known risks should be disclosed when an adverse outcome is common even though the detriment is slight, or when an adverse outcome is severe even though its occurrence is rare. A doctor’s judgement about how to convey risks will be influenced by:
    • the seriousness of the patient’s condition; for example, the manner of giving information might need to be modified if the patient were too ill or badly injured to digest a detailed explanation;
    • the nature of the intervention; for example, whether it is complex or straightforward, or whether it is necessary or purely discretionary. Complex interventions require more information, as do interventions where the patient has no illness;7
    • the likelihood of harm and the degree of possible harm more information is required the greater the risk of harm and the more serious it is likely to be the questions the patient asks; when giving information, doctors should encourage the patient to ask questions and should answer them as fully as possible. Such questions will help the doctor to find out what is important to the patient;
    • the patient’s temperament, attitude and level of understanding; every patient is entitled to information, but these characteristics may provide guidance to the form it takes; and
    • current accepted medical practice.8

    The way the doctor gives information should help a patient understand the illness, management options, and the reasons for any intervention. It may sometimes be helpful to convey information in more than one session. The doctor should:
    • communicate information and opinions in a form the patient should be able to understand;
    • allow the patient sufficient time to make a decision. The patient should be encouraged to reflect on opinions, ask more questions, consult with the family, a friend or advisor. The patient should be assisted in seeking other medical opinion where this is requested;
    • repeat key information to help the patient understand and remember it;
    • give written information or use diagrams, where appropriate, in addition to talking to the patient;
    • pay careful attention to the patient’s responses to help identify what has or has not been understood; and
    • use a competent interpreter when the patient is not fluent in English.9
    Information should be withheld in very limited circumstances only:
    • if the doctor judges on reasonable grounds that the patient’s physical or mental health might be seriously harmed by the information;10 or
    • if the patient expressly directs the doctor to make the decisions, and does not want the offered information. Even in this case, the doctor should give the patient basic information about the illness and the proposed intervention.11
    In an emergency, when immediate intervention is necessary to preserve life or Prevent serious harm, it may not be possible to provide information.

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    • Ever see the Marx Brothers doing “There ain’t no Sanity Clause”. The whole guidelines are flushed down the toilet once saying “no” constitutes an “emergency”.

      So like the Marx Brother, “everybody knows there ain’t no right to consent” lol

      Another great article Dr Hickey, like watching a cat play with a mouse. Does anyone have plans of pinning Dr Pies down at some point?

      Another thing I would ask is have you been following the biological linking of Foetal Alcohol Spectrum Disorder to ADHD? More biological explanations? Just seemed strange to me that the target is the middle class with disposable incomes for ‘treatment’.

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    • Hi Rob,
      Thanks for the data, but you see here in America the code of ethics for these guys will never get off the ground. You gotta spend more than 5 minutes with a patient to start off with which is something that the American psychs just can’t seem to do.

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  6. Thank you, Philip, for pointing out this insightful article, I agree it is a good one. And there definitely is a method to the psycho pharmaceutical industries’ greed inspired madness.

    “… patents for most blockbuster SSRIs had expired, and Big Pharma moved onto mood stabilizers and atypical antipsychotics” – the supposed “cure” for “bipolar.” And Joseph Biederman was quite outspoken about the scientific validity of misdiagnosing children, who were suffering from the common adverse symptoms / reactions to antidepressants and ADHD drugs as “bipolar,” despite this being specifically prohibited in the DSM-IV-TR.

    Today’s “gold standard” treatment for “bipolar,” according to the Mayo Clinic:

    “A number of medications are used to treat bipolar disorder. The types and doses of medications prescribed are based on your particular symptoms.

    “Medications may include:

    “Mood stabilizers … Antipsychotics … Antidepressants … Antidepressant-antipsychotic … Anti-anxiety medications.”

    This despite the fact it is known by the medical community that combining these drug classes (especially the antidepressants, antipsychotics, or benzos) can actually create “psychosis,” via the central symptoms of anticholinergic intoxication syndrome, aka anticholinergic toxidrome.

    “Central symptoms [of anticholinergic intoxication syndrome] may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

    And the knowledge that …

    “Substances that may cause [anticholinergic] toxidrome include the four ‘anti’s of antihistamines, antipsychotics, antidepressants, and antiparkinsonian drugs[3] as well as atropine, benztropine, datura, and scopolamine.”

    Why are drug combinations, medically known to cause “psychosis” and “hallucinations,” the “gold standard treatment” for “bipolar” today?

    I would imagine it’s highly likely most so called “bipolar” today, is actually the completely iatrogenic anticholinergic intoxication syndrome. “The love of money is the root of all evil.”

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  7. Philip Hickey writes awesome articles. And he seems almost ‘human’ if you judge by the questions he asks!
    What seperates him from psychiatrists is probably the paycheck, it isn’t coming from Pharma, so he asks the obvious questions psychiatrists turned a blind Eye towards.
    And yes, the toll patients have been paying is enormous.

    Perhaps Another year dr. Hickey could follow R. Whitaker and Delano to Gothenburg, for the filmfestival I just attended, I wanna shake his hand too!

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  8. Of course my primary concern is preserving” dr.” Pies reputation and in order to facilitate a just resolution in line with his pursuits we have leased space in the hull of a freighter for” dr.” Pies and all his “thought leader” comrades including “dr.” Frances and “dr. Lieberman . Safe passage will be provided directly to Dr. Frankenstein’s castle in Transylvania where Igor personally will drive the “good doctors ” the final mile and a half by horse drawn coach to the castle. Along with big pharma” thought leaders” who arrived last week to modernize the lab with Igor’s assistance “dr.” Pies and company will have a jim dandy laboratory to continue their experiments . We can hardly wait .

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