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: http://brucelevine.net/psychiatry-admits-its-been-wrong-in-big-ways-but-can-it-change-a-chat-with-robert-whi/
In the article I subsequently wrote, cited by Lacasse & Leo (http://www.medscape.com/viewarticle/823368), 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.“