The Chemical Imbalance Theory: Dr. Pies Returns, Again


On April 30, 2019, the very eminent and learned psychiatrist Ronald Pies, MD published a piece in the Psychiatric Times titled “Debunking the Two Chemical Imbalance Myths, Again.”

Here’s the opening paragraph:

“Like the legendary Count Dracula, who could be killed only by driving a stake through his heart, some myths seem almost immortal. For more than eight years now, I have tried to drive a stake through the heart of two myths regarding the so-called ‘chemical imbalance theory’1-3—but with only limited success, as a recent piece in The New Yorker brought home to me.4″


Dr. Pies tells us that the first myth holds that “…mental illnesses (psychiatric disorders) in general are caused by ‘a chemical imbalance’ in the brain—the so-called ‘chemical imbalance theory’ (CIT)”. The second myth holds “…that ‘Psychiatry’ as a profession endorsed the first myth, deliberately and knowingly ‘lying’ to countless, unsuspecting patients.”


“Ironically, anti-psychiatry groups are quite right in heaping scorn on the ‘chemical imbalance theory’ of mental illness, but not for the reasons they usually give. (I hasten to add that debunking the CIT is not to deny that biological factors play an important role in serious mental illness, including but not limited to major depression, bipolar disorder, and schizophrenia—see below).”


“The fact is, there could never have been a scientifically based ‘chemical imbalance theory’ of mental illness, because a genuine theory requires an integrated network of well-supported, interlinked hypotheses. And yes, the frequently ignored distinction between a theory and a hypothesis is crucial. It is the key to understanding why claims by antipsychiatry bloggers regarding the CIT nearly always crash and burn.”


When Dr. Pies says so.

In just about everything Dr. Pies has written on this topic, he belabors the point that the chemical imbalance theory of depression and other “mental illnesses” is not really a theory in the formal scientific sense of the term.

This, of course, is wonderfully interesting, and serves to support the notion, which I’ve long promoted, that Dr. Pies is extraordinarily learned and erudite. But it adds nothing to the discussion, and serves only to distract from the real issue.

Besides, the word theory, which has been in use since about 1600, has a wide range of uses. Here’s what my 2009 Merriam Webster’s Dictionary gives:

1: the analysis of a set of facts in their relation to one another  2: abstract thought: SPECULATION  3: the general or abstract principles of a body of fact, a science, or an art <music ~>  4a: a belief, policy, or procedure proposed or followed as the basis of action <her method is based on the ~ that all children want to learn>  b: an ideal or hypothetical set of facts, principles, or circumstances — often used in the phrase in theory <in ~ we have always advocated freedom for all>  5: a plausible or scientifically acceptable general principle or body of principles offered to explain phenomena <the wave ~ of light> 6a: a hypothesis assumed for the sake of argument or investigation  b: an unproved assumption: CONJECTURE  c: a body of theorems presenting a concise systematic view of a subject <~ of equations>  syn see HYPOTHESIS”

Similarly wide ranges of meaning can be found in Random House (1992) and New World (1988) dictionaries. The former includes “…a guess or conjecture,” and the latter “…a speculative idea or plan as to how something might be done.” So, when we anti-psychiatry bloggers refer to psychiatry’s chemical imbalance theory, we are, despite Dr. Pies’ tedious assertions to the contrary, well within the dictionary definition of the term.

But that’s neither here nor there. As I mentioned earlier, Dr. Pies’ carping at us for using what he, as self-appointed arbiter of such matters, considers the wrong term, is a distraction. It’s a bit like a person accused of embezzlement arguing that it wasn’t embezzlement, it was fraud.

It doesn’t matter a rodent’s posterior whether we call it a theory, a hypothesis, a guess, or a conjecture, the fact is that it was a lie, and psychiatry did promote it, knowing that it was groundless. In addition, it was, and still is, widely accepted, and it did induce millions of people who would not otherwise have taken the drugs or the shocks to do so. So, for psychiatrists and for their pharma allies, it was a very profitable lie.


I thought that I had laid this question to rest in my post “Psychiatry DID Promote the Chemical Imbalance Theory” (June 2014), but here comes Dr. Pies again.

“Scientifically speaking, there never was a network of validated hypotheses capable of sustaining a full-blown, global ‘chemical imbalance theory’ of mental illness in general. Moreover—and here we come back to Myth #2—psychiatry as a profession and medical specialty never endorsed such a bogus ‘theory,’ when judged by its professional organizations; its peer-reviewed publications; its standard textbooks5 or its official pronouncements. Furthermore, the whole notion of some looming, monolithic “Psychiatry” is absurd on its face, as my colleague, Dr George Dawson,6 has cogently argued.”

There are three critical points in the “Scientifically speaking…” paragraph quoted above.  Firstly, it is important not to get hung up on the term “chemical imbalance.” This phrase was pushed strongly by psychiatry in the 80’s. But the essential issue is psychiatry’s unfounded insistence that the loose clusters of vaguely-defined thoughts, feelings, and behaviors which they call mental illnesses are real illnesses, caused by real physiological pathology. The phrase “chemical imbalance” and synonymous variations are still widely used, but psychiatry’s simplistic and spurious biological explanations have been promoted in many forms and guises. Secondly, Dr. Pies is attempting, once again, to restrict the debate by declaring, arbitrarily, that only statements from professional organizations, peer reviewed journals, standard textbooks, or official pronouncements are admissible. In reality, the philosophy and perspectives of a profession are more reliably identified in the practices and statements of its individual members than in its official pronouncements. Thirdly, Dr. Pies uses the caricature of some “looming, monolithic ‘Psychiatry'” to undermine the perfectly valid notion that one can make meaningful statements about a profession generally, even though there may be individual dissidents within the ranks, and even within the leadership.

. . . . . . . . . . . . . . . .

Here’s another quote from the “Debunking” article:

“To be sure: what many psychiatrists in the 1980s and 1990s did promote was some version of the biogenic amine (or catecholamine) hypothesis of mood disorders, focusing mainly on the neurotransmitters norepinephrine and serotonin. (Schizophrenia was conventionally explained by the now outdated ‘dopamine hypothesis.’). And, in truth, the significance of serotonin was considerably over-emphasized—owing to what Roger S. McIntyre, MD has facetiously called, ‘Psychiatry’s High School Crush.’7 Furthermore, the ‘SSRIs’ were accorded a rock-star status as effective antidepressants that they did not deserve. Most troubling from the standpoint of misleading the general public, pharmaceutical companies heavily promoted the ‘chemical imbalance’ trope in their direct-to-consumer advertising.8 But to be clear: there was no concerted attempt by ‘Psychiatry’ as a profession to promote a causal or etiological theory of mental illness in general, based solely on ‘chemical imbalances.’ Neither did the originators of the biogenic amine hypothesis—psychiatrists Joseph J. Schildkraut and Seymour S. Kety—promote such a view in the 1960s.9 Indeed, in 1965, Dr Schildkraut stated,

‘A rigorous extrapolation from pharmacological studies to pathophysiology clearly cannot be made. Clinical studies relevant to the catecholamine hypothesis are limited and the findings are inconclusive. It is not possible, therefore, to confirm definitively or to reject the catecholamine hypothesis on the basis of data currently available.’9

There’s a lot in here, so let’s open it up. Firstly, it is noteworthy that Dr. Pies is admitting that many psychiatrists in the 1980s and 1990s did promote the “biogenic amine (or catecholamine) hypothesis” of depression and elation. Secondly, this theory did not originate with Drs. Schildkraut and Kety, as Dr. Pies asserts. Rather, the idea was first suggested in 1958 by two groups of researchers acting, as far as I know, independently. The first group was Guy Everett, PhD, James Toman, PhD, and several assistants from Chicago. The second group was John Saunders, MD, Nathan Kline, MD, Maurice Vaisberg, MD, et al from Rockland State Hospital, Orangeburg, New York.

Each group presented a paper at the scientific sessions of the Society of Biological Psychiatry, San Francisco, May, 1958. The proceedings were published under the title “Biological Psychiatry,” by Grune & Stratton (1959), edited by Jules H. Masserman, MD, who at the time was president of the society. The Everett and Toman proposal can be found in Chapter 6: “Mode of Action of Rauwolfia Alkaloids and Motor Activity.” Here are two quotes:

“The fact that essentially similar reversal of deserpidine effects with desoxyephedrine or DOPA was also observed in rats and monkeys leads to speculation regarding the same mechanisms in man. One may speculate on the possible role of centrally active amines present in the brain in the normal activity and general responsiveness of an individual. An excess of these might result in irritability, restlessness and aggressiveness. In the opposite direction, a deficiency of these substances would result in depressions and general lassitude.” (p 80)


“It would be presumptuous to expect that so simple a scheme would account for all the variations of motor behavior and reactivity of man in health and disease, but the evidence thus far obtained in animals has been highly reproducible and suggests that we may indeed be dealing with a biochemical area of major importance in the understanding of animal and human behavior.” (p 80)

It is interesting that the cautionary note expressed in the second quote above is promptly eclipsed by the expression of optimism that the theory may have “…major importance in the understanding of animal and human behavior.”

The Saunders, Kline, et al proposal can be found in the same volume, Chapter 24: “Psychic Energizers” (p 306). In the 1950’s, the term “psychic energizers” was commonly used for what today would be called antidepressants. Here’s the pertinent quote:

“The search for compounds other than iproniazid to act as psychic energizers continues. Our efforts to elucidate and evaluate compounds as psychic energizers emphasize that there are distinct differences between energizers and stimulants, probably even greater than between sedatives and ataractics. The mechanism of action of this clinical difference is of utmost importance since the etiology of this disease of affect, depression, may be related, to a disturbance of metabolic equilibrium of several amines.11, 12” (p 309) [Emphasis added]

Note that there are two references (11 and 12) cited in support of this proposal. Reference 11 was not entirely clear, but reference 12 is a gem. It’s Saunders, JC: Psychiatric Research Reports, No. 8, December 1957, Discussion, p 184.  Here’s the quote:

“It has been said that if there is a twist in the mind of man there is a twist in the molecule. I would like to refute that statement. I believe there is a difference in the biochemical balance or equilibrium and not in the molecule per se.”

Incidentally, or perhaps not, Dr. Everett, at the time of publication, was Group Leader in Neuropharmacology, Abbott Laboratories, North Chicago, Illinois (Biological Psychiatry, same volume, p xi); Dr. Toman was an Associate Professor of Physiology and Pharmacology, Chicago Medical School, Chicago, Illinois (same volume, p xiii); and Abbott Laboratories was working on an antidepressant — CS 293 (same volume, p 306).

The Saunders et al team were based at Rockland State Hospital, New York, and had been conducting trials on several experimental compounds:

“A number of experimental compounds are presently in clinical trial at Rockland State Hospital to evaluate their usefulness as psychoactivating (psychoanaleptic) agents. These preparations are: Warner-Chilcott, W-1544; Lakeside, JB-516; Hoffmann-La Roche, Ro 4-1018; Geigy, imipramine (G 22355); Bristol, phenyltoloxamine (PRN) and methonalide (BLM 188); Riker, Deaner (deanol, DMAE); and Abbott, CS 293.” (same volume, p 306)

I apologize for laboring this matter, but the critical point is that the chemical imbalance theory of depression/elation was first proposed at about the same time by two groups of psychiatric researchers, both of whom were working closely with pharmaceutical companies in the development of antidepressants, and both of whom were members of the Society of Biological Psychiatry. Incidentally, the Society of Biological Psychiatry was founded in 1946, and is still very active today.

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Back to Dr. Pies’ “Debunking” article:

“Schizophrenia was conventionally explained by the now outdated ‘dopamine hypothesis.'”

Even by Dr. Pies’ standards for exonerating psychiatry, this is an extraordinary statement. The essence of the dopamine hypothesis was that people “with schizophrenia” had too much dopamine activity in their brains, and that this could be corrected with neuroleptic drugs. It is a chemical imbalance theory, and despite a great deal of highly motivated, and lavishly funded, research on the part of psychiatry, there has never been any convincing evidence for its validity. Nevertheless, it was promoted by psychiatrists and their pharma allies in their attempts to legitimize the use of major tranquilizers and to persuade their customers to take them.

And to describe this self-serving mendacity on the part of his colleagues, Dr. Pies uses the passive voice construction: “…was conventionally explained…” So it wasn’t a case of self-serving deception on the part of psychiatrists, but rather a nebulous, disembodied convention that led people so widely astray. Furthermore, the assertion that the dopamine hypothesis is “now outdated” implies that formerly it had some validity. In reality, there was never any evidence for this chemical imbalance theory, and its dissemination by psychiatry over several decades is nothing less than a hoax. I have discussed this matter in more detail in an earlier post.

. . . . . . . . . . . . . . . .

And then it gets even worse:

“And, in truth, the significance of serotonin was considerably over-emphasized—owing to what Roger S. McIntyre, MD has facetiously called, ‘Psychiatry’s High School Crush.’7

For decades psychiatry pushed these false, destructive, disempowering, and stigmatizing chemical imbalance theories on their trusting customers, often with disastrous results, and here’s Dr. Pies excusing the whole shabby enterprise as a high school crush! So an entire, monolithic, so-called medical profession was operating at the cognitive and emotional level of a love-smitten teenager. And by Dr. Pies’ assessment, that excuses the deception and the damage!

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“Furthermore, the ‘SSRIs’ were accorded a rock-star status as effective antidepressants that they did not deserve.”

Again, the poor immature psychiatrists, infatuated as they were, could not resist dancing to the tune of their rhinestone-festooned products and their pharma cheerleaders. The poor little babes in the woods, stalked and exploited by colorful pills and their manufacturers! For three decades, psychiatry has been promoting these products as safe and effective, and has dismissed anti-psychiatry’s contentions to the contrary as unfounded. Now here’s Dr. Pies back-handedly conceding that we were correct all along, but dismissing the deception as rock-star idolatry!

. . . . . . . . . . . . . . . .

“Most troubling from the standpoint of misleading the general public, pharmaceutical companies heavily promoted the ‘chemical imbalance’ trope in their direct-to-consumer advertising.8

It was psychiatrists who originated, developed, and promoted the chemical imbalance theory. They did not present it as a trope, but rather as neurochemical fact, even though the evidence for the theory was not to hand, and abundant contrary evidence was readily available. The correct word for this kind of presentation is hoax. Psychiatrists gambled their entire professional status on the hope that evidence for the theory would materialize, and they could become real doctors, treating real illnesses with real medicine.

Against these obvious and well-known historical realities, the eminent Dr. Pies is trying to persuade us that the chemical imbalance theory was just a trope — something not meant to be taken literally — and blaming the dissemination of this hoax on pharma.

Certainly pharma helped in the process, but at any time in the past fifty years psychiatry could have stopped the deception in its tracks. But the hoax suited psychiatry’s purpose, and they promoted it, and in many cases still promote it, with all the resources at their disposal.

. . . . . . . . . . . . . . . .

“Neither did the originators of the biogenic amine hypothesis—psychiatrists Joseph J. Schildkraut and Seymour S. Kety—promote such a view in the 1960s.9 Indeed, in 1965, Dr Schildkraut stated,

‘A rigorous extrapolation from pharmacological studies to pathophysiology clearly cannot be made. Clinical studies relevant to the catecholamine hypothesis are limited and the findings are inconclusive. It is not possible, therefore, to confirm definitively or to reject the catecholamine hypothesis on the basis of data currently available.’9

Actually, as I mentioned earlier, the originators of the biogenic amine theory of depression were Guy Everett and James Toman (1959) and John Saunders, et al (1959). But Drs. Schildkraut and Kety did give the theory an enormous push. And the paragraph that Dr. Pies cites (“A rigorous extrapolation…”) can indeed be found in the Conclusion section of Dr. Schildkraut’s 1965 paper: “The Catecholamine Hypothesis of Affective Disorders: A review of supporting evidence.” And the paragraph does point out that definitive evidence for the theory is not “currently available.”

However, most of the Conclusion section appears more supportive of the catecholamine theory. For instance:

“Thus, although lacking direct experimental confirmation, the catecholamine hypothesis currently seems to be the strongest and most useful pathophysiological hypothesis of affective disorders. It must be stressed, however, that this hypothesis is undoubtedly, at best, a reductionistic over-simplification of a very complex biological state and that the simultaneous effects of the indoleamines, other biogenic amines, hormones and ionic changes will ultimately have to be included in any comprehensive formulation of the biochemistry of the affective disorders. In our present state of knowledge, however, the catecholamine hypothesis is of considerable heuristic value, providing the investigator and the clinician with a frame of reference integrating much of our experience with those psychopharmacological agents which produce alterations in human affective states.” (p 517)

And here’s a quote from the Summary Section of the article:

“The ‘catecholamine hypothesis of affective disorders’ proposes that some, if not all, depressions are associated with an absolute or relative decrease in catecholamines, particularly norepinephrine, available at central adrenergic receptor sites.  Elation, conversely, may be associated with an excess of such amines.” (p 518)

And, Dr. Schildkraut’s paper had an enormous impact in the promotion of the chemical imbalance theory of depression and elation. According to Google Scholar, his paper has been cited over 3930 times.

There is an article on Dr. Schildkraut in Encyclopaedia Britannica. Here’s a quote:

“Joseph Jacob Schildkraut . . . was a pioneering researcher in the field of biological psychiatry. He was widely known for his research paper ‘The Catecholamine Hypothesis of Affective Disorders,’ published in the American Journal of Psychiatry in 1965, which helped establish a biochemical basis for depression and other mood disorders.” [Emphasis added]

Seymour Kety died in 2000, and in 2003, the National Academy of Sciences published a biographical memoir written by Louis Sokoloff, MD, a neuroscientist at NIMH.

“Although no definitive evidence of a biochemical defect linked to schizophrenia was derived from these studies, they did serve to organize Seymour’s thinking about the subject and led to his publication of several critical and heuristic papers in Science that almost certainly laid the foundation for modern biological psychiatry.” [Emphasis added]

So whether Dr. Schildkraut promoted the chemical imbalance theory of depression, as I suggest, or did not, as Dr. Pies believes, is a topic that could be debated at length. Dr. Schildkraut did acknowledge “…the importance of psychological factors in the etiology of at least some depressions,” and in a subsequent paper in the April ’67 issue of Science, he and his co-author Seymour Kety re-emphasized the importance of “…environmental or psychological…” factors in the etiology of depression.  But their references to these factors are complicated. Here’s the quote:

“Confirmation of this hypothesis must ultimately depend upon direct demonstration of the biochemical abnormality in the naturally occurring illness. It should be emphasized, however, that the demonstration of such a biochemical abnormality would not necessarily imply a genetic or constitutional, rather than an environmental or psychological, etiology of depression. Whereas specific genetic factors may be of importance in the etiology of some, and possibly all, depressions, it is equally conceivable that early experiences of the infant or child may cause enduring biochemical changes and that these may predispose some individuals to depressions in adulthood.”

The key point here is the word “enduring” in the last sentence. Essentially what Drs. Schildkraut and Kety are saying is that early experiences may cause lasting neurochemical changes, which is obviously true. But they are also implying that these changes are pathological in nature, solely on the grounds that they might contribute to feelings of despondency or sadness in later life.

And that’s the flaw in the logic. The reality is that all experiences, whether good, bad, or indifferent, produce lasting changes in our brains. That’s how we learn and remember. Some such changes are indeed pathological (e.g., a serious head injury), but most are not. A major loss during childhood, for instance, will usually leave us with a feeling of sadness which might persist long into adulthood. And this enduring feeling of sadness is indeed a reflection of the neurological changes. But these changes, these neurological bases for memory and learning, and emotion, are no more pathological than the neurological bases for pleasant feelings such as joy and success. It is frequently asserted that children “get over” major losses that occur during childhood. Sometimes this is true. Some children retain the memory of the loss, but the feeling of sadness recedes with time. Other children retain the feeling of sadness, and the attendant pessimistic outlook, for years and even decades. But — and this is the crucial point — the presence of despondency, at any time of life, no more confirms the existence of neurological pathology than the seeing of a particularly horrific incident confirms pathology in the visual apparatus. Sadness is the natural, non-pathological response to loss and/or adverse circumstances.

A detailed discussion of these issues would take us very far afield, but what is beyond debate is the fact that the work of Dr. Schildkraut, a psychiatrist, and Dr. Kety, a psychiatric neuroscientist, gave the simplistic and false chemical imbalance theory of depression an enormous boost, and was widely received by psychiatry as an endorsement of this spurious and destructive perspective, and of the increased prescribing of psychiatric drugs.

Perhaps the most noteworthy point of the entire matter is that Dr. Schildkraut’s and Dr. Kety’s reservations in both the 1965 and 1967 papers were largely ignored by the psychiatric profession. In 2005 the APA published on their website a brochure called “Let’s Talk Facts About Depression.” The brochure was offered free for downloading, and paper versions were sold in bundles of fifty for $29.95 (here). The document has since been taken down, but can still be found in various locations by searching for the title.

“Antidepressants may be prescribed to correct imbalances in the levels of chemicals in the brain. These medications are not sedatives, ‘uppers’ or tranquilizers. Neither are they habit-forming.” (Let’s Talk Facts About Depression) [Emphasis added]

This is a very clear endorsement of the spurious chemical imbalance theory of depression, with nothing to suggest a metaphysical or otherwise non-literal intention. And, incidentally, the notion that antidepressants are not habit-forming is questionable at the very least.

In the same document, under the heading Conclusion, the APA asserts:

“Depression is never normal and always produces needless suffering.”

This is the kernel of the entire self-serving hoax, because depression is the natural and expectable reaction to loss and/or abiding adverse circumstances. Not only is depression normal in this sense, it is actually adaptive. It alerts friends and family to the fact that we are experiencing difficulties; it encourages us to share our concerns; and it provides an incentive to make appropriate changes. Depression becomes intractable when the individual is unable — for whatever reason — to take appropriate remedial action. Eating pills to suppress this adaptive mechanism is analogous to sticking a piece of duct tape over the “check engine” light on a car’s dashboard. The pills may block or obscure the message, but in many cases, the issues remain unresolved, and when/if the pills are stopped, the depression returns. Psychiatry, ever creative in the promotion of its own interests, calls this treatment-resistant depression, and here’s what the APA has to say about that:

“Psychiatrists usually recommend that patients continue to take medication for six or more months after symptoms have improved. After two or three episodes of major depression, long-term maintenance treatment may be suggested to decrease the risk of future episodes.” (same document)

So, pills for life, with all the collateral damage, reduced expectations, disempowerment, and stigma that this entails, for a result that is only marginally better than placebo. And not one whit of energy or resources is expended in trying to help the customer identify or ameliorate the true source or sources of the despondency. In fact, the customer is told the grotesque lie that the true source of the despondency is a neurochemical imbalance that the pills correct!


Back to Dr. Pies’ present “Debunking” paper:

“…psychiatry as a profession and medical specialty never endorsed such a bogus ‘theory,’ when judged by its professional organizations; its peer-reviewed publications; its standard textbooks5 or its official pronouncements.

In an earlier article on this topic (2014) Dr. Pies had stated:

“…I am not aware of any concerted effort by academic psychiatrists, psychiatric textbooks, or official psychiatric organizations to promote a simplistic chemical imbalance hypothesis of mental illness.”

It is particularly interesting that in the more recent paper Dr. Pies has dropped academic psychiatrists from this list. Indeed, it could be described as a prudent move on his part, in that academic psychiatrists have probably been more ardent than any other group in the promotion of chemical imbalance theories and other bio-bio-bio perspectives that dominate psychiatric practice today.

In previous posts, I have cited examples of this kind of promotion on the part of academic psychiatrists, and could readily cite more examples here. But perhaps one further example will suffice:

The March 1992 issue of the American Journal of Psychiatry published the following letter to the editor on page 420. The letter was written by Dr. Ronald Pies himself.

“Proposed Model for Self-Injurious Behavior

Sir: The excellent review of self-injurious behavior by Ronald M Winchel, M.D., and Michael Stanley, PhD.(1) makes clear that we have no unifying theory or model for self-injurious behavior. Rather, it is approached from a variety of perspectives, including the affected population, putative psycho-dynamic issues, and possible neurotransmitter abnormalities. I wish to propose a heuristic model in which two broad types of self-injurious behavior are distinguished.

In type I, onset is usually during early adulthood, and the self-injurious behavior entails one or more isolated but serious acts. The lesion is frequently ‘ablative’ (e.g., autocastration) and associated with either a circumscribed somatic delusion or a severe identity disturbance. Such self-injurious behavior is generally seen in schizophrenic or other psychotic patients. I hypothesize that a primary excess of dopaminergic function is the principal neurotransmitter abnormality in type I and that both D2 and D1 receptors are implicated (possibly with D2 dysfunction predominant). Dopamine agonists would tend to worsen this type of self-injurious behavior, which may respond to conventional antipsychotics.

In contrast, type II has its usual onset in childhood or adolescence, in association with a variety of neurodevelopmental and character disorders, for example, Tourette’s disorder, autism, attention deficit hyperactivity disorder, and Lesch-Nyhan syndrome. Some individuals with borderline personality disorder and ‘obsessive spectrum’ disorders also fit the type II pattern. Self-injury is usually chronic, repetitive, and ‘irritative’ rather than ablative. The lesion is usually not ‘symbolic’ (as in autocastration) but is associated with a more general relief of tension, anxiety, or anger. Clear secondary gain is sometimes involved, as when a patient with borderline personality disorder engages in low-lethality wrist cutting to delay discharge from the hospital. Although endogenous opiate dysregulation may be involved, I postulate two principal neurotransmitter abnormalities in type II self-injurious behavior: a primary dopamine deficiency which, over time, may lead to secondary dopamine receptor hyper-sensitivity and/or a dysregulation of serotonergic systems (1-4).  D1 receptors –– possibly in nigrostriatal more than in mesolimbic tracts –– are involved preferentially. Treatment with either dopamine agonists or antagonists may be helpful, depending on the point of ‘transition’ between primary dopamine deficiency and dopamine receptor hypersensitivity. Serotonergic agents (e.g., fluoxetine, clomipramine) are also helpful in this type, particularly in patients with ‘obsessive spectrum’ symptoms such as trichotillomania (5).

I propose this dichotomy as a spur to the development of a unified theory of self-injurious behavior and not as the definitive statement on this complex condition.


    1. Winchel RM, Stanley M: Self-injurious behavior: a review of the behavior and biology of self-mutilation. Am J Psychiatry 1991; 148:306-317
    2. Goldstein M, Meller E: The role of central dopamine in movement disorders, in Receptors and Ligands in Neurological Disorders. Edited by Sen AK, Lee T. Cambridge, Cambridge University Press, 1988
    3. Breese GR, Criswell HE, Duncan GE, Mueller RA: Dopamine deficiency in self-injurious behavior.  Psychopharmacol Bull 1989; 25: 353-357
    4. Ratey JR, Sovner R, Parks A, Rogentine K: Buspirone treatment of aggression and anxiety in mentally retarded patients: a multiple-baseline, placebo lead-in study. J Clin psychiatry 1991; 52: 159-162
    5. Pollard CA, Ibe IO, Krojanker DN, Kitchen AD, Bronson SS, Flynn TM: Clomipramine treatment of trichotillomania: a follow-up report on four cases. J Clin Psychiatry 1991; 52: 128-130

Ronald Pies, MD
Boston Mass.”

This letter is a very good example of a chemical imbalance theory (using the word “theory” in the dictionary-endorsed sense of guess  or conjecture). Note the following components:  1. the dismissal of psychodynamic issues; 2. the promotion of unproven “neurotransmitter abnormalities” as explanations; 3. the suggestion that the “abnormalities” may be resolvable by means of psychiatric drugs; and 4. the expression of hope, that the theory will be improved (“unified”) at some time in the future, with no intimation that any psychosocial factors would need to be included. The brief reference to secondary gains is very much in the nature of an incidental aside.

In addition, the last sentence in the third paragraph is particularly interesting:

“Serotonergic agents (e.g., fluoxetine, clomipramine) are also helpful in this type, particularly in patients with ‘obsessive spectrum’ symptoms such as trichotillomania (5).”

Firstly, note the definitiveness of the assertion: Serotonergic agents (e.g. fluoxetine, clomipramine) are helpful in this type. Secondly, note the reference number 5 at the end of the sentence. Ordinarily, this would denote that reference 5 provides some proof or evidence for the assertion in question. From the reference list we can see that reference 5 is Pollard et al, 1991. But Pollard et al in fact offers no proof for Dr. Pies’ assertion. Indeed the opposite is the case. Here’s the abstract:

“Four consecutive patients treated for trichotillomania (hair pulling) with clomipramine reported initially dramatic reductions in symptoms. However, three of the four patients had relapsed completely at 3-month follow-up, although all four were still taking previously effective levels of the drug. The fourth patient relapsed for about 2 weeks but regained initial treatment benefits. Implications for the treatment of trichotillomania are discussed.” (p 128) [Emphasis added]

And here’s a quote from the Discussion section:

“These four cases provide preliminary evidence that the short-term beneficial effects of clomipramine may not be maintained in the treatment of trichotillomania.  Interestingly, a similar pattern of initial benefit followed by relapse was evident in another trichotillomanic patient treated in our clinic with fluoxetine, another potent serotonin reuptake blocker (unpublished report, 1990). However, our present report should be interpreted with caution. More definitive conclusions must await reports on the long-term outcome of larger numbers of trichotillomanic patients treated with clomipramine.” (p 129) [Emphasis added]

And, surprise surprise!

“At the time their hair pulling returned, each of the three relapsed patients was experiencing substantial emotional turmoil. Specifically, two patients had been involved in conflict with significant others and the third patient had returned to school, which she found anxiety provoking. Notably, these patients were not receiving concomitant psychological treatment. Resumption of hair pulling might have been prevented by adjunctive therapy that, for example, taught these patients how to manage anxiety more effectively, or how to deal with interpersonal relationships in a more productive fashion. Of course, it is also possible that some alternative pharmacologic intervention would have been helpful. Although further increases in the dosages of clomipramine were either rejected or ineffective, the addition of an anxiolytic or another medication might also have circumvented relapse.” (p 129)

Note the reluctance to accept the obvious explanations, and the almost desperate attempts to salvage the pharmacological approach.

. . . . . . . . . . . . . . . .


An additional, and perhaps most important, consideration in this general area is the fact that the medical model, effective as it is in the treatment of real illness, is not helpful, and is usually counter-productive, in addressing problems of thinking, feeling, and/or behaving. The critical difference here is that real illnesses have a relatively large degree of homogeneity with regards to their origins, etiology, course, outcome, and appropriate treatment. Individual variations, though sometimes critical, are usually secondary. Pneumonia, for instance, is caused by germs in the lungs, and the treatment consists essentially of eliminating those germs. By contrast, the kinds of life problems that psychiatry purports to address do not have this homogeneous core. The sources of despondency are as varied as the individuals who experience it.

Whereas it makes perfect sense to ask how do people get pneumonia, it makes no sense to ask how do people get self-injurious behavior, or despondency, or temper tantrums. One gets pneumonia because the germs successfully establish a colony in the lung tissue. But people engage in self-injurious behavior, or become despondent, or rant and rage, for an extremely wide range of reasons, even though the presentations may seem superficially similar. In matters of thinking, feeling, and behaving, there are always multiple paths to the same place, and conversely, superficially similar antecedents can lead to very different outcomes. The notion that psychiatry can develop criteria for “diagnosing” depression, and guidelines for “treating” it, in the same way that real doctors do for real illnesses is a fundamental error. It is on their self-serving refusal to acknowledge these simple and obvious facts that psychiatry’s attempts to impose a medical model on problems of thinking, feeling, and behaving always have, and always will, founder, to the endless detriment of their customers.

. . . . . . . . . . . . . . . .

The subtitle of Dr. Pies’ Debunking article is:

“‘A little learning is a dangerous thing.’—Alexander Pope”

And indeed it is. But it is not nearly as dangerous as a psychiatrist with a head full of spurious diagnoses and a ready prescription pad.

Psychiatry is flawed at its very core, and is simply irremediable. The damage it has done, and continues to do, is profound and everywhere to be seen.


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.


Mad in America has made some changes to the commenting process. You no longer need to login or create an account on our site to comment. The only information needed is your name, email and comment text. Comments made with an account prior to this change will remain visible on the site.


  1. Interesting how the conventional proponents of biochemical imbalances in the brain don’t pay attention to imbalances in the rest of the body that could affect brain functioning. One of the most striking of these are the thyroid irregularities, where low thyroid can instigate depressed moods and intellectual functioning, while high thyroid leads to a state of anxiety and fretfulness. No psych drug on earth can effectively treat these aforementioned states.

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  2. I was told by a child rape covering up psychologist, apparently denying and covering up child abuse has been a primary function of the psychologists for over a century,

    that I had a “chemical imbalance.” So the “mental health” minion are certainly spewing the “chemical imbalance” lie in practice. And they are espousing the “chemical imbalance” lie in peer training sessions still.

    “I hasten to add that debunking the CIT is not to deny that biological factors play an important role in serious mental illness, including but not limited to major depression, bipolar disorder, and schizophrenia—see below).”

    I’m quite certain Robert Whitaker did a good job in pointing out two of the iatrogenic (not “genetic” or “biological”) pathways to a bipolar misdiagnosis in his book “Anatomy of an Epidemic.” The ADHD drugs and antidepressants both can create the “bipolar” symptoms.

    The psychiatrists apparently were angry with Whitaker for pointing out their massive in scope iatrogenic harm of millions of people, so they took this disclaimer completely out of their DSM5, to ensure a lot more malpractice by the DSM “bible” believers.

    “Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.”

    If the psychiatrists had any ethics whatsoever, they would have added the ADHD drugs to that disclaimer, not removed the disclaimer all together from the DSM5.

    In my medical research, I found the medical proof that the antipsychotics/neuroleptics, the schizophrenia treatments, create both the negative and positive symptoms of “schizophrenia.” The negative symptoms are created via neuroleptic induced deficit syndrome. And psychosis and hallucinations, the positive symptoms of “schizophrenia,” are created via antipsychotic and/or antidepressant induced anticholinergic toxidrome.

    One does have to wonder how long it will take for the psychiatrists, and their millions of DSM “bible” worshipping “mental health” minion, to wake up. And realize the psychiatrists wrote a DSM “bible” describing the iatrogenic illnesses that their psychiatric drugs can create, rather than a “bible” of “real, life long incurable, genetic mental illnesses.”

    “Psychiatry is flawed at its very core, and is simply irremediable. The damage it has done, and continues to do, is profound and everywhere to be seen.” Thanks, as always, for speaking the truth, Dr. Hickey.

    Psychiatry loves to have psychiatric holocaust, after psychiatric holocaust, after psychiatric holocaust. When will the doctors, psychiatrists, and their “mental health” minion, learn that murdering millions of innocent people with the psychiatric drugs is not acceptable human behavior?

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  3. Ever notice how a lot of articles from psychiatrists’ journals contain literary allusions and quotes from poets? To my knowledge they are the only medical specialty that does this regularly.

    Pies is really ticked off at all the people claiming psychiatrists actually believe in the chemical imbalance.
    Kudos to all his tireless efforts at putting out PSA’s and going on speaking tours to educate the public so they know better and how he used professional influence to stop NAMI from printing misleading brochures. Lol.

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  4. Super cool how you routinely erase the experiences of those who *have* found meds helpful, many of whom, myself included, are highly critical of traditional psychiatry. If you’re going to demand that those harmed by psych treatment not have their stories ignored and erased, and to be clear you absolutely should, then maybe don’t do the exact same thing to others?

    Beyond that, and numerous other problems in your argument, the claim that everyone agrees that other medical diagnoses are entirely homogenous with clear cut etiologies is absurd. I’d suggest you read up on the literatures in medical anthropology & sociology, medical humanities, science and technology studies and disability studies. There is a wealth of great scholarship challenging that claim, not to mention the biomedical fields themselves which, while often far too reductive, would at the very least complicate any such assertion.

    It strikes me that there is a broader problem in much of antipsychiatry today of ignoring philosophy, critical theory, feminist theory, etc, or at the very least refusing to go beyond what those fields were saying in the 90s. So instead we get a rehashing of the same stale arguments ad nauseum with little to no articulation of a coherent alternative vision. Instead there’s an implicit, and sometimes explicit, doubling down on neo-Kantian dualisms grounded in eurocentric (read: white supremacist, patriarchal, settler-colonial) ontologies. The result is far too often ableist, neuro-normative arguments dismissive of anyone whose experiences with psych & meds are too nuanced to fit into this black and white thinking.

    I really hope antipsychiatry can do better, but right now y’all bear a striking resemblance to psychiatric institutions you hate so much.

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    • Johnbitz,
      Thank you for articulating what I often find challenging in Dr. Hickey’s writing. While I find much of value and with which I agree, his idealization of “real” medicine is one area that undermines some of his argument. At the same time, I find Pies’ tortured defense of old, failed hypotheses and failure to acknowledge the way that the psychiatric professional failed to explicitly name these limitations remains troubling for me.

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      • Sandra,

        As a psychiatrist whom I respect greatly, I’d be very pleased to hear whether you have seen psychiatrists or the APA promoting the “chemical imbalance” or “brain disorder” hypothesis. It’s hard for me to imagine you have not heard this being put out there all the time, as I ran into it frequently just in the foster care system. What’s your experience?

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      • Sandra,

        I don’t idealize real medicine. My general point is that real medicine discovers its illnesses in nature; psychiatry invents its “illnesses”, and its “treatment” of these “illnesses” differs little from street drug pushing. Real medicine is a valid, bona fide profession. Psychiatry is a hoax.

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        • Thoroughly enjoy your writing as always, Phil — for me it’s often like some sort of intellectual-satirical-political dark comedy! 🙂

          And can anyone please tell me how Pies has managed to miss the fact that, still today, he’s one of a very tiny percentage of psychiatrists who actively and publicly renounce the biochemical imbalance theory??!!

          On the particular issue being raised in these comments right here, though, I want to say, perhaps some confusion/disagreement is arising for good reason. Because, I think it’s important to note, mainstream medicine is actually becoming increasingly like bad psychiatry and not vice versa. Witness the themes of the “Selling Sickness” conferences etc, where profound questions are raised about “the cholesterol hypothesis” and statin drugs, and about over-screening, over-diagnosing, and over-treating of nebulously defined “hypertension” and “gastrointestinal disorders” etc etc. And these are some of the most common diagnoses and top-selling drugs today.

          So I think it’s becoming increasingly unclear in our culture what “real” medicine actually is or involves, and more and more difficult to use the idea as a self-evident counterpoint to the excesses of psychiatry.

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          • Rob, these are excellent points.

            “.. mainstream medicine is actually becoming increasingly like bad psychiatry and not vice versa”.

            I agree. “Selling sickness” includes all you mentioned and I would include cancer treatments as well. They know chemotherapy is nearly ineffective and does more harm than anything. You are more likely to die from the chemo than from cancer but they push these super expensive toxic drugs on people anyway.

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    • johnbitz,

      I don’t, routinely or otherwise, “erase the experiences of those who *have* found meds helpful”, though I do challenge the notion that psychiatric drugs can be considered meds.

      I have never claimed that “everyone agrees that other medical diagnoses are entirely homogenous with clear cut etiologies”.

      My position is really very simple: that the loose collections of vaguely-defined problems of thinking, feeling, and behaving that psychiatry calls mental illnesses are not illnesses in any ordinary sense of the term, and that the drugs that psychiatry dispenses so liberally to “treat” these so-called illnesses almost always do more harm than good, especially in the long term.

      Feel free to critique my work, but please confine your critiques to material that I have actually written. I make myself very clear.

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      • Phil: I find it nauseating, the use of the words “meds”, and “medications” in medicine in general, and in the psychiatry/”mental health” fields in particular. I see it as a deceptive euphemism, which only furthers the drug racket fraud of psychiatry. It also serves to separate “street drugs” from “medicines”, or “meds”. But I ONLY say “drugs”, because drugs are drugs are drugs are drugs are drugs…. And so-called “meds” ARE DRUGS!….
        “So-called “mental illnesses” are exactly as “real” as presents from Santa Claus, but NOT more “real”. The DSM is in fact a catalog of billing codes. EVERYTHING in it was either invented or created. NOTHING in it was discovered. Drugs were created to sell to make money. And psychiatry was created to $ELL DRUG$…. Period. End of story.
        (Being a true pseudoscience like Phrenology, psychiatry also serves as a means of social control.) KEEP UP the GOOD WORK, Phil!
        But your work debunking the shill Dr. Pies remains crucial….

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    • I really hope antipsychiatry can do better, but right now y’all bear a striking resemblance to psychiatric institutions you hate so much.

      Not sure what sources you refer to in order to ascertain the present state of anti-psychiatry. Unless you can be more specific regarding the objects of your ire this comes across as random and generally-directed hostility. Since you “other” us when you refer to anti-psych folk as “y’all” you are implicitly NOT AP yourself, so I’m unclear as to the impetus for your concern.

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  5. What’s the abbreviation for the word, “PROPAGANDA”?….. It’s: “Pies”….
    EVERY so-called, alleged “diagnosis” in the DSM was INVENTED, or CREATED, but NOT “discovered”….
    I’d like to see Dr. Propaganda Pies” discuss *THAT*!….
    (To be fair, the “chemical imbalance” LIE that psychiatry promotes was INVENTED by PhRMA’s marketing folks….)….

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  6. Great article.

    It is refreshing to read such crystal clear statements of truth in such straightforward and simple language. It should be obvious to every honest and reasonable mind and to every compassionate and loving heart that the “chemical imbalance” hoax has been one of the most destructive tools of the pseudo-scientific system of slavery that is more commonly known as “psychiatry.” The myth of “mental illness” and the attendant “chemical imbalance” hoax have caused the suffering and death of untold numbers of innocent people, including helpless children, the homeless, and the elderly. What makes psychiatry more evil than the most blatant of evils is that it masquerades as a medical profession and purports to heal, care for, or treat its unsuspecting victims.

    Dr. Hickey hits the nail so squarely on the head that even the most unfeeling and retrograde reader cannot help but be moved by the force and lucidity of his logic. Thank you Dr. Hickey. May you be blessed with long life, good health, and joyful increase for your relentless efforts to bring to light the truth about, and to defend the innocent victims of, psychiatry.

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  7. Thank you, Phil, for this article, which I plan to send to psychiatric professionals. The biochemical, neurotransmitter hoax is very much alive and well, as I know from speaking both with psychiatrists and nurses.

    It used to be implicit, before serotonin became a household word, that for instance in the case of what you so correctly call “despondency” (aka “depression”) professionals attempted to differentiate between so-called endogenous and exogenous depression. (I’m sure you remember this!) While exogenous depression was considered to have arisen because of an externally depressing event or series of events, the supposedly “more serious” so-called endogenous depression was considered “biological” because no obvious external factors seemed to account for it. Now of course we know that the occurrence is widespread of both ACEs and of sexual abuse or harassment to mention only two externally “depressing” traumas, both of which would have likely gone under tHe radar of anyone diagnosing endogenous depression, largely because it was not supposed to be spoken about (sexual abuse etc) or the possible relation to later “depression” was not known, in the case of ACEs…I do not mean that either of these external factors cause despondency, only that if abuse is occurring or has occurred, and you cannot talk about it and be taken seriously, surely one natural response, just one of many, would be to grow sad.

    It is too bad that most people cannot or do not want to acknowledge that depression I.e. sadness, etc is a natural response to trauma and adverse events. And that “psychosis” only means that the doctor doesn’t understand what you are saying, not that it is In and of itself a bad thing or pathological. We at MIA like to think that our understanding is far more widespread than it sadly is. For most people I know, when I say such things as mental illness is not a real illness, only want to jump up and tell me how ill they are or were, and how it is of course biological, what else could it be?

    The damage both to individuals and to society caused by these never proven theories is enormous, and so far as I can tell, continues to influence everything under the sun even today. I cannot help but think that Pies’s disavowal and defense of psychiatry is not just self-serving but also deliberate. After all, if there is really no chemical imbalance, and the world was told and believed the truth, many powerful individuals who have made their life from the lie would not only lose their income, but the source of their prestige and power. Income is one thing, but for many in the profession of psychiatry power (and social control) is the name of the game.

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    • Phoebe,

      Thanks for coming in. You’re absolutely right – sadness is the natural response to loss and adverse experiences. The distinction between “endogenous depression” and “exogenous depression” was always a hoax. Endogenous depression was, by definition, sadness for which psychiatrists couldn’t identify a precipitating event(s). It was a very pure kind of arrogance (unique, I think, to psychiatry) to conclude that therefore no precipitating source of the sadness exists. As you so correctly say, they didn’t find these sources because they didn’t look hard enough. And they didn’t look hard enough because it suited their purpose not to find them. As you say: money and power.

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      • Apparently, psychiatrists are on the hook to pharmaceutical companies. If shrinks couldn’t find the proper precipitating events, it wouldn’t pay for them to look further if it meant their parent companies couldn’t receive financial benefits from patented drugs, particularly if proper treatments for these states didn’t involve the use of their patented drugs at all.

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    • Thanks, Pheobe! I was well into my 20’s, before I described my childhood as anything other than “basically normal”. It was only in my 30’s that I began to realize that the relatively minor abuse I endured as a child really WAS the root of most of my problems. Um, besides being wrongly diagnosed and grossly over-medicated by quack psychiatrists!….

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        • And now I find that these same people are trying to promote giving MDMA to those labeled as having ~autism~ in order to deal with “Social Anxiety”.

          Like Bertram P. Karon says, the usual argument for psychiatric drugging is, “Here, this will make you passably acceptable to most people most of the time.”

          Well the same people promoting acceptance of this ~neurodiversity~ label, are also promoting the use of MDMA. I guess it is because once someone has accepted the idea of ~neurological difference~ then they will be fearful that they might be offending people.

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          • Drugs did NOT make me passably acceptable to people.

            Doubling body weight, tics, inability to observe social cues or hold a job…not passably acceptable in our society. So that in itself is a bald faced lie.

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          • But usually that “passably acceptable argument”, as Bertram Karon states it, is part of the justification used for writing the prescription, and getting the client to do the voluntary ingestions.

            I know a man who has been convinced that he has ~Bipolar 2~ and he has been given ~medications~. First it was just one at a very low does, but the dosages and the number these lethal drugs has increased. He even has an extra one which he can ingest when he feels any anxiety.

            He has even talked about suing the county for his original low dosage. It is less than what the Physician’s Desk Reference specifies.

            To me his complaint seems absurd. If one has to ingest such neurotoxins, then of course you just do the bare minimum. Going lower than PDR does not do any harm. It is not harmful, unless one really believes that the drugs are a necessity to go on living.

            But my friend clearly wants these narcotics to mask his experiences. I tell him to dump them. He always says in response, “But I want to enjoy my life”.

            What he seems to mean is that he wants to be drugged into zombie hood, and this is what he means by enjoying his life.

            He wants these drugs to completely mask his negative experiences.

            He then goes on to invoke a negative stereotype of a homeless man, and he says that the only thing keeping him from becoming like that, are these drugs.

            This is sad. He thinks the drugs keep him “socially functional”. And it is this which I believe Bertram Karon was calling out when he spoke of “passably acceptable to most people most of the time”.

            Its the kind of an idea which you would find in someone who has totally submitted to the ideas of the ~mental health~ system, and those being essentially the same as those advanced by the Middle-Class Family.

            And so to make it clear, here what I am referring to is it being done with people who are already facing huge and ongoing social harassment, over this imaginary issue of a ~neurological difference~. To be more clear, it is being directed at those who have been convinced that they have ~Autism – Aspergers~, but instead of admitting that this imaginary ailment has no objective basis, as Sami Timimi says, “no biological markers”, and “Autism does not exist.”

            And these survivors are being told, in effect, that they can be made passably acceptable to most people most of the time, by MDMA.

            Now the originator of this, Nick Walker at the California Institute of Integral Studies in San Francisco, says that it is to deal with “social anxiety”.

            Walker and his MIA colleague believe that this ~neurodiverstiy~, and in a radicalized form, something which there is zero evidence for, somehow benefit by accepting the label, and by then proclaiming the doctrine of “Cognitive Liberty”.

            I consider this to be a high level of abuse, and something which has to be responded to.

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  8. Wonderful article as usual, Phil. I appreciate you and the great work you do. Regarding Dr. Pies’ “myth” that psychiatry as a profession endorsed the chemical imbalance theory, here is a quote from the Royal Australian and New Zealand College of Psychiatrists (RANZCP) official website:

    “How do medications treat mental illness? Medications work by rebalancing the chemicals in the brain.” (

    The Australian government, presumably in concert with the RANZCP, also promotes the chemical imbalance theory. For example, this Department of Health pamphlet claims, “Depressive disorders are thought to be due, in part, to a chemical imbalance in the brain. Anti-depressant medication treats this imbalance.” ($File/whatdep2.pdf).

    Nothing has changed.

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  9. Hi Phil,

    You stated: ““The fact is, there could never have been a scientifically based ‘chemical imbalance theory’ of mental illness, because a genuine theory requires an integrated network of well-supported, interlinked hypotheses. And yes, the frequently ignored distinction between a theory and a hypothesis is crucial. It is the key to understanding why claims by antipsychiatry bloggers regarding the CIT nearly always crash and burn.””

    You forgot a key point, that I learnt while attending a lecture presented by Dr. Joanna Moncrieff in March 2016, at Leeds University, during the “History of Mental Health Conference”:

    In the 1990s, the “Chemical Imbalance” has been turned from a scientific hypothesis into an efficient “marketing slogan”.

    The major marketing managers’ task is not to prove that a scientific hypothesis is right; it is to convince people to buy and to consume more of their company products for their profit.

    In order to convince people to believe in their slogan, on the US market, they have a marketing budget of US$ 5 billion dollars per year, and on the European market, an additional budget of some 5 billion Euros per year…

    Marketing directors of big-pharma do not care about science; they care about using two words only, i.e. “Chemical Imbalance”, as a slogan to make more money.

    No matter how good their arguments could be to demonstrate the flaw of the chemical imbalance hypothesis, no scientist, no psychologist can beat that slogan, that budget.

    If you want to beat that slogan, there is only one way: to cut the flow of money from psych-drugs consumers to big-pharma.

    In order to achieve that, you got to offer to these Consumers a higher Quality of psychiatric products and services at a lower Price.

    The rule of the Q-10 applies: If you can offer to Consumers a Quality/Price ratio at least 10 times better, they will be quick to switch to the innovation.

    As you may know, the “Open Dialogue Therapy” offers just that: about Quality, it can cure 80 to 85% of the sufferers of psychosis, versus 0% with the existing psychiatry, and, depending on the point of application, in families or communities, at a Price 15 to 30 times cheaper than the existing psychiatry.

    In your conclusion, you perceive it right: “After all, if there is really no chemical imbalance, and the world was told and believed the truth, many powerful individuals who have made their life from the lie would not only lose their income, but the source of their prestige and power.”

    You have to hit where it hurts: cut the flow of money from consumers to super-rich shareholders. Shareholders will not become poor. They will only become a little less rich, and then, they will switch their investments towards other opportunities.


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  10. Ronald Pies is putting himself forward as a defender of psychiatry from what he would see as false accusations. I guess you could sort of conceive of him as a defense attorney for a psychiatry profession on trial and perhaps in crisis. One potential false claim is that psychiatry has promoted the “chemical imbalance theory”. Oh, excuse me! The “chemical imbalance hypothesis”. The second has to do with the profession of psychiatry “intentionally and deliberately” lying about the matter of promoting the “chemical imbalance” whatever. Okay. The promoters of the “chemical imbalance” whatever, except for a brief aside about pharmaceutical companies, remain in this article unmentioned. So Ronald Pies says, on the one hand, psychiatry has not been behind, nor promoting, any “chemical imbalance theory”, and, on the other, that “antipsychiatry bloggers” are, in part, responsible for these false allegations being made against psychiatry. The question then becomes, who, if not psychiatry, has been promoting this notion of a “chemical imbalance”. We’ve got the defense attorney speaking, and here he is trying, of course, to raise a “reasonable doubt” when it comes to the culpability of his client, his profession. Question is, if psychiatry is not one of the guilty parties, who are the guilty parties? My view is that these “antipsychiatry bloggers” Pies mentions are certainly not guilty of promoting any “chemical imbalance theory”. Who then has been guilty of promoting such a position? It doesn’t really pass my smell test. We know that these psychiatrists and the pharmaceutical industry are often, for profit, position, or status, in cahoots. It isn’t psychiatry alone, nor the pharmaceutical industry alone, that has been behind this promotion, but they are there. I don’t think it is the best defense one could raise. I guess that means somebody must be perjuring themselves, and, therefore, one of these myths is not as much of a myth as the other. I know Pies would like to blame both of these “myths” on antipsychiatry, if that is the usual suspect, but I’d also have to say that that is something of a laugh. If psychiatry really were on trial, he’s going to need a much better argument than that to win his case. Antipsychiatry invented the “chemical imbalance theory”, and then laid it on psychiatry, claiming that psychiatrists had endorsed this notion when they had not done so. Clearly somebody is lying. Do you really think they are going to be able to bust antipsychiatry over this one? Antipsychiatry is guilty of diagnosing and treating “chemical imbalances”? Since when? Somebody is lying, sure. Somebody is guilty, sure. I don’t, however, think that the guilty party is antipsychiatry, nor do I think that psychiatry has been exonerated of having committed any wrong doing.

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  11. Wow, Dr. Hickey what an outstanding and detailed presentation to rebut the ongoing corruption and lies of psychiatry! So very many well defined and well-stated examples that prove the facts and rebut the lies! The corruption in this field is astounding. They lie about their lies.

    Thank you SO much for your ongoing work and dedication in speaking truth to power and standing up for those who are victimized by psychiatry. God bless you!

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  12. Interesting and hard look research Phil. Thanks. If I had known of these articles I never would have tried to walk into the MH world. The writing reeks of total robotic mind.
    My father was a physician and he said at the end he would do it over again and go into molecular biology but he thought in a humane way and had no respect for psychiatry. He would have been fascinated by the Cascade phenomena in medical crisis situations and the fact more neurons are located in the digestive system than anywhere else. So they had a finger in the door and blew it all to smithereens.
    Phoebe yes the old definition of depression. I talked to a Georgetown psychiatrist resident about a client from a state institution whom he had dx as endgenously depressed. State institution for the Developmentally Disabled no understanding of well yeah.
    To Ann. RIP. Another Georgetown student who missed the mark among way too many.
    Stockholders- very difficult to know because of BUNDLING. I once asked to see what social justice stocks I could put my retirement fund in and CVS was the stock of choice. So in terms of fighting the opioid and other Big Pharma by Wall Street means the greeders – new name let’s label them for what they all are had the con going with the start of mutual funds. The shell game played not on the street or county or state fairs but nationally and globally and
    we all walked by eating the cotton candy and fried hot dogs.
    Even those in the field who were decent had issues and were unable to cope with them in a best case scenario way. Bruno Bettelheim who did wonderful writing was a WWII Concentrstion Camp or refugee and there were big issues in his work. Trauma defines us all and if we cannot dialogue and acknowledge the issues we all carry on our backs the effects of trauma will grow exponentially.
    We need tools just like technology. Without ethics and a moral code and constant dialogue it becomes another nine headed monster.

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      • Perhaps the concept of trauma centers with some medical professions out of the loop completely.
        And then the concept of those who experience alternative realties which most indengenious populations had or have in terms of a certain clan. The Hebrew Levi families and Cohn? In the “ priest” category.
        Don’t even deal with the pull concept. X them out of the board game and up to individuals if they choose with true informed consent.
        Like a cancer support agency I know of all sorts of supports and intergenerational but chemotherapy or not out of the loop.

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  13. Methinks Pies doth protest too much. If psychiatry never did and still doesn’t promote the chemical imbalance concept, why then do the websites of the National Institute of Mental Health, medical websites such as Mayo Clinic, and popular health websites such as WebMD? Why does NAMI? Why do so many practicing doctors and psychiatrists? Did they pull the concept out of thin air?

    And if psychiatry doesn’t promote the idea of chemical imbalance, what are Pies and others going to do to rectify this error, beyond writing occasional articles in academic journals? How about a mass media tour to correct the record? No? Didn’t think so.

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    • …As medical professionals, we cannot afford to view our patients’ afflictions in emotional or humanizing terms. Nor can we afford the luxury of supposing that the only treatment we offer causes permanent incapacity and premature cessation of physiological vitality.

      The best evidence suggests that focusing solely on the modality of treatment (whether pharmaceutical agents, ECT, or a synergistic combination of both with compliance enforcing therapy) is more important than the outcomes themselves.

      Needless to say, we must take precautions against plunging heedlessly into the maze of spontaneous eclecticism in our modalities. If we recommend therapy or treatment for actual (physical) diseases we may undermine the credibility of our science.

      We must allow ourselves to be guided by studies designed to prove the effectiveness of the treatments we offer and the evidence carefully selected to support the same….

      It is time to consign this “chemical imbalance” metaphor to the dunghill of vicious cartoons. As medical practitioners of a legitimate science it is an outrage that people actually think we believe the nonsense which we publicly promote.

      ~from “Professional Outrage of a Well-Informed Liar”

      Don’t bother searching the archives of the APA Journal. This is a satire.

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  14. We should talk abouts psyche in psychological language. Science is for scientists. Psychology is for psyche.
    Monotheistic thinking is a danger for polytheistic psyche.
    We are using pseudo scientific language to confirm the theological assumptions about psyche. This is a tragedy. Thanks for this article.

    Biological thinking about psyche means nothing without seeing the individual image of psychological reality. Without seeing the individual patterns of thinking, individual psychological reality, biological theories are only a way of destruction, a way of control or a way of dehumanization.

    James Hillman “Re- Visioning psychology”.

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  15. Damn Phil! My eyes are dropping out, maybe your articles should have a Part 1 and Part 2.

    Anyway, calling ’em as I see ’em here…

    It doesn’t matter a rodent’s posterior whether we call it a theory, a hypothesis, a guess, or a conjecture, the fact is that it was a lie, and psychiatry did promote it, knowing that it was groundless.

    Nothing to add, I just think this bears endless repetition. As with

    the essential issue is psychiatry’s unfounded insistence that the loose clusters of vaguely-defined thoughts, feelings, and behaviors which they call mental illnesses are real illnesses, caused by real physiological pathology.

    I’ll repeat: “Loose clusters of vaguely-defined thoughts, feelings, and behaviors” — this is the best description of the phenomena labeled “mental illnesses” I’ve ever seen. It is not only descriptive but eschews the idea that there are consistent categories of human thought feeling and behavior, which can be identified as such or named. It’s important to understand that just changing the name from “mental illness” to something else simply perpetuates the essential problem, i.e. the idea that there are true scientific/medical categories being considered.

    It follows that if mental illness does not exist “it” cannot be “caused” by anything. We are dealing with an endless plethora of individual experiences, each of which is unique and not subject to categorization.

    Pies: “there was no concerted attempt by ‘Psychiatry’ as a profession to promote a causal or etiological theory of mental illness in general, based solely on ‘chemical imbalances’”

    As it turned out there was no need for psy/pharm to construct a more detailed or (seemingly) more sophisticated “theory” via which to peddle its wares, as the vague and imprecise allusions to “chemical imbalances” were sufficient to convince a trusting public that there was something “scientific” (or in today’s lingo “evidence-based”) going on, and that they should take their prescribed drugs without thinking about it too hard.

    The correct word for this kind of presentation is hoax. Psychiatrists gambled their entire professional status on the hope that evidence for the theory would materialize, and they could become real doctors, treating real illnesses with real medicine.

    Touche. Problem is they have so much illegitimate social and political power behind them that they either don’t realize they’ve been exposed or have no reason to care.

    Thanks Phil, to be continued I hope. Still would like to dialogue w/you regarding the notion of “alternatives.”

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    • Good point about the name changing, OH. “Mental distress” (have PTSD, are “chemically imbalanced”, etc.) is nearly as bad as “mentally ill”, only the use of the expression can’t really decide whether we are dealing with a confusion or a pathology. As such it serves as just another lame excuse for intervention. The idea is that there is something fundamentally wrong with some people when there could be something fundamentally right about those same people. Criminals enter the house of corrections for breaking the law. Do we really need a parallel “house of corrections” for people who are deemed “wrong” although they have nonetheless “broken no laws”? That’s what we’ve got with the mental hospital system.

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        • Mental health law represents a loophole in rule of law, a way around the law, for dealing with people bearing psychiatric labels, their special scapegoats. You can only close the loophole by getting rid of mental health law. Mental health law allows the mental health authorities to treat their captives, “patients”, the way it would be illegal to treat anybody else. Illegal, that is, if it weren’t for mental health law.

          Better humor a hypochondriac by providing phony treatment for phony illness than imprison a person who has a committed no crime, a person who is innocent in every sense of the word, and claim that your imprisonment, and the torture that goes along with it, seeking a confession of “mental illness”, is some kind of medical treatment.

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          • The point I would be making here, OldHead, is that psychiatry is as much a branch of pseudo-law-enforcement as it is pseudo-medicine, and I don’t think our position is improved by pitching the pseudo-law end of it. “Actually”, its neither, but if you want to look at psychiatry as a branch of law enforcement, its law enforcement, if you want to look at it as a branch of medicine, its medicine. Of course, there should be quotation marks around both “law enforcement” and “medicine”. Deadly medicine or illegal law, your pick.

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          • If you have problems with the term “law enforcement” you might substitute the term “domestic repression” to describe the objective function of psychiatry. As for “illegal laws,” that’s pretty subjective — what laws are “legal” and “illegal” depends on who wields the power (and the guns).

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        • OldHead, we have mental health law on top of criminal law so that the mental health authorities can do things to people with diagnostic labels that they’d get arrested for doing to people without diagnostic labels (i.e. abduction, false imprisonment, assault, drugging, etc.) Without mental health law they wouldn’t be able to do so. Not legally anyway. Many laws, including mental health law, work in opposition to the protections provided by the Bill of Rights of the US Constitution. I’m calling, in this instance, such unconstitutional law, illegal law, because technically, it is illegal. If mental patients, on the other hand, are second or third class, say, non-citizens, or non-human beings, no problem, huh? Like chattel slaves, or caged critters, the law doesn’t cover them, and it wasn’t meant to do so.

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          • Psychiatry doesn’t enforce laws. Psychiatry aids law enforcement in enforcing laws that are already on the books. In some places the opinion of two psychiatrists is required to civilly commit a person, but this requirement is a matter of law, not medical procedure. I have a problem with how the issues are being framed here. Civil commitment is the real problem. I think all the rest of the legal squabbles in the “mental health” field revolve around this locking up of innocent people. You have a “right to treatment” but no right to decline or refuse treatment. It seems to me that most of the would-be protective laws derive from the fact of locking people up in the first place. Stop locking people up, and the necessity for having such protections disintegrates. Since when were your captives ever guaranteed “life, liberty, and the pursuit of happiness”? Uh, oh, yeah. I guess since about 1776 or thereabouts. I wonder whatever could have gone so horribly wrong.

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  16. above Rachel777 wrote, “…As medical professionals, we cannot afford to view our patients’ afflictions in emotional or humanizing terms.”

    But the problem here with the entire mental health system is that underlying it all is a Moral Improvement Model. And that is based on the idea that there is a patient or client who has “afflictions” rather than needing to learn how to politically organize to fight back against injustice.

    The Psychotherapist is there to listen to you, and then turn what you say around and make it your affliction, rather than a legitimate political and legal issue.

    This turning it back at you is what Freud called transference. Because it is when the client can first start to see that the therapist is not their comrade.

    Your psychotherapist is not going to storm any Bastilles, Raid Harper’s Ferry, or start any slave revolts with you.

    As Jeffrey Masson explains, everything which is talked about in the therapist’s office should instead be getting talked about in some other venue.

    Anyone here, tell me of something which would get talked about in the office of a psychotherapist that would not better be talked about in some other venue?

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  17. Sir, you are delightfully relentless. Of all the writing on MIA, I confess I enjoy yours the most. Your skill at not just detecting BS, but calling it out, dissecting it, refuting it, and thus beating the BS-er over the head with it, it unparalleled. I’m sure Pies’ has fits of private rage every time he hears you’ve responded to him AGAIN. Bravo as always.

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