Who’s to Blame for the Lost Soul of Psychiatry?

An interview between Drs. Aftab and Pies reveals a deep mistrust of patients' reports of their own experiences, and devolves into a game of semantics in an attempt to prove psychiatry's relevance.

Philip Hickey, PhD
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On June 30, 2020, Awais Aftab, MD, psychiatrist, published an interview with Ronald W. Pies, MD, also a psychiatrist, in Psychiatric Times.

As an interview, the piece is somewhat unusual in that Dr. Aftab, as interviewer, does not confine his role to asking questions, but actually contributes substantially to the dialogue.  So the piece is more like a conversation than an interview, and both parties express their positions fairly freely on the topics discussed.

Dr Pies will be no stranger to my readers.  I have critiqued various aspects of his work here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, and here.  We go way back.

I critiqued one of Dr. Aftab’s essays (Mental Illness vs Brain Disorders: From Szasz to DSM-5), here on March 14, 2014.

The title of the present interview/conversation is The Battle for the Soul of Psychiatry: Ronald W. Pies, MD.

“The Battle” is a lengthy piece, and for this reason, I will confine this critique to the more salient/egregious contentions.

CRITICISM OF PSYCHIATRY

Early in the conversation, the two eminent doctors express general agreement that some criticisms of psychiatry are legitimate, while others are not.  Dr. Aftab describes the latter as “hostile, ill-conceived, rhetorical, sentimental, and divorced from any meaningful science.”  Dr. Pies, in general agreement, points out that:

“…there are ‘critics’ whose hostile and vituperative rhetoric is clearly aimed at discrediting psychiatry as a medical discipline. These critics, in my view, fall under the rubric of ‘anti-psychiatry,'”

Dr. Pies continues by deploring “how little they [the “hostile” critics] understand of general medical nosology and praxis, or of the history of medicine – which leads them fallaciously to marginalize psychiatry from the other medical disciplines.”

I suppose this interaction between the two eminent psychiatrists could be construed as a kind of pre-conversation bonding exercise, and as such, probably serves some ill-defined emotional need.  But what strikes me most forcibly is why neither participant makes any attempt to identify the cads in question or to address any of the issues that these dreadful people raise.  If their contentions are simply expressions of vituperative ignorance, why not address these contentions and demolish them out in the open for all of us to see.  Why not educate us so that we can identify these miscreants and not be misled by their hateful rhetoric, their lack of science, and their ignorance of medical nosology?  Give us their names and websites so that we may assess for ourselves the validity or otherwise of their assertions.

It takes no great effort or courage to denounce one’s unnamed critics in vague, generalized terms and to insinuate questionable motives to their contentions.  But by the same token, little is gained by the process.  So, I encourage Dr. Pies and Dr. Aftab to have the courage of their convictions and to denounce these ignorant wretches by name, and with clear details of their nefarious endeavors.

CHEMICAL IMBALANCE

With the bonding exercise complete, Dr. Aftab loses no time in raising the issue of the chemical imbalance, beloved brainchild of psychiatrists everywhere.

“I think you are right that the 1970s and 1980s—the period when psychiatrists of your generation were trained—were probably the ‘golden’ years of AJE [Alexandrian-Jasperian-Engelian] tradition, but I think the agenda was hijacked pretty quickly afterwards. The explosion of pharmaceutical development in the 1990s and early 2000s with the development of SSRIs and atypical antipsychotics resulted in the reductionistic, caricaturish portrayal of psychiatric disorders as ‘chemical imbalance’ in the public imagination; there was a large influx of money into neuroscience research with an undelivered faith that neuroscience will soon revolutionize the field, and then managed care knocked out whatever wind was left in clinical practice. When I see bio-psycho-social thinking described as the ‘solid center,’ I cannot help but think of the famous phrase from W.B. Yeats, ‘The center cannot hold.’ Do you also share this sense that the solid center has somehow fallen apart?”  [This question is addressed to Dr. Pies]

Dr. Aftab’s paragraph is complicated, so let’s open it up.  The “explosion” of pharmaceutical development began much earlier than the 1990’s and 2000’s.  The production of the major tranquilizers in the 1950’s and the benzodiazepines in the 1960’s were every bit as significant as the second generation neuroleptics and the SSRI’s in later decades.  In this regard, it needs to be noted that although pharmaceutical advertizing promoted the benzodiazepines as adjuncts to therapy, it didn’t take psychiatry long to embrace them as therapeutic agents in their own rights.  It is also noteworthy that psychiatrists routinely dismissed, and in many cases actually denied, the obvious reality that these products are highly addictive.  Given that the damage done by this blatant falsehood is still with us, it is understandable that Dr. Aftab might want to brush it aside.

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

“…resulted in the reductionistic, caricaturish portrayal of psychiatric disorders as ‘chemical imbalance’ in the public imagination…”

Gaze in awe, my dear readers, at the exquisite side-shuffle:  the development of the antipsychotics “…resulted in…”.   It just sort of – you know – happened.  Pharma developed the drugs and voila, out of nowhere came this

“reductionistic, caricaturish portrayal of psychiatric disorders as ‘chemical imbalance’ in the public imagination…”

So the chemical imbalance theory – using the word “theory” in the dictionary-endorsed sense of guess or conjecture, or in this special case, deception – somehow resulted from pharma developments – and despite its reductionistic and caricaturish features, became embedded in the public imagination, without any help from psychiatry.  Just ol’ John and Jane Q. Public and their over-active imaginations.  Well isn’t that the most convenient thing you ever heard of!  Nobody’s to blame.  It just happened.  One of the most successful and most deceptive marketing devices in history just happened.  Once pharma had developed the drugs in question, the drugs developed a life of their own.  What could psychiatry do?  What could anyone do?

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

And there’s more:

“…there was a large influx of money into neuroscience research with an undelivered faith that neuroscience will soon revolutionize the field…”

Well there was indeed a large influx of money – mostly from pharma.  Dr. Aftab is silent as to the recipients of this money, though he must surely know that most of it went to research psychiatrists and their departments.  And there was indeed a profound – almost religious – belief that research would soon provide proof of the chemical imbalance theory (i.e., guess, conjecture, deception).  But – and this is critical – psychiatry was pushing the chemical imbalance theory on their clients, the media, and government entities almost since the theory was first proposed, and in many contexts, continue to do so today.  They didn’t wait to see what the evidence would say.  Who needs evidence when one already knows “the truth”?  For an excellent account of this whole matter, see Terry Lynch’s book Depression Delusion, (2015)

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

“…and then managed care knocked out whatever wind was left in clinical practice.”

It’s not clear what this means, but here’s my best guess:  we psychiatrists would really like to be providing therapy and devoting adequate time to each customer because we’re really good guys and gals, but managed care prevents us from doing so.  If this is Dr. Aftab’s intended meaning, then it’s nonsense.  It was psychiatric endorsement of the all-mental-problems-are-brain-illnesses-and for every-brain-illness-we-have-a pill-or-a-shock-machine perspective that enabled pharma and the managed care companies to exert the influence that they do.  Psychiatrists needed the pills and the shock machines to establish themselves as real doctors.  Pharma provided the pills, and psychiatry sold the package to managed care as a more efficient way to “treat mental illness”.  Besides, psychiatrists who wish to opt out of these systems can do so, but it will impact their earning potential significantly.

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

Dr. Pies’ response to all this is interesting, though largely predictable.

“…I have argued repeatedly that the so-called ‘chemical imbalance theory’ was never a bona fide ‘theory’ in the strict, scientific sense.”

Dr. Pies trots out this gem of pedantic irrelevancy whenever this topic is raised.  But in fact, it makes no difference whether the chemical imbalance theory is a “bona fide theory in the strict scientific sense of the term” or not.  It was never more than a guess  or conjecture or speculation, all of which can be found in most dictionaries as synonyms for the word “theory”.  Laboring the precise “scientific” meaning of the term serves no purpose except to demonstrate how wise and eminent Dr. Pies is – a contention that, as far as I am concerned, was never in dispute.  I have stated many times that Dr. Pies is probably one of the wisest and most eminent psychiatrists in the US.

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

“Nor was it a model embraced by most academic psychiatrists or, importantly, by the pioneers of the biogenic amine hypothesis.4

Reference 4 is Schildkraut and Kety (Science, 1967), whom Dr. Pies routinely, and mistakenly, considers the pioneers of the biogenic amine hypothesis.  In fact, the theory/guess/conjecture 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”.   Saunders, Kline, Vaisberg et al is Chapter 24, titled “Psychic Energizers”.  “Psychic energizers” was the original name for anti-depressants.

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

It is also noteworthy that in other writings, Joseph Schildkraut expressed a great deal more support for the chemical imbalance theory/guess/conjecture than Dr. Pies suggests was the case.  For instance:

“Thus, although lacking direct experimental confirmation, the catecholamine hypothesis [AKA chemical imbalance theory/guess/conjecture] 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) [Emphasis added] (The Catecholamine Hypothesis of Affective Disorders: A review of supporting evidence. Am J Psych, 1965 Nov: 122(5): 509-22)

Note in particular the caveat:

“…lacking direct experimental confirmation…”

but also:

“…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.” [Emphasis added]

all of which strikes me as downplaying the caveat, and stressing that other biochemical matters will need to be integrated into the guess/conjecture.  In other words, the chemical imbalance theory (guess/conjecture/deception) is too simple.  We need to add lots more bio-chemicals into the mix if we want to have a “comprehensive formulation of the affective disorders”.  So it’s not really any different.  There’s no recognition of the obvious fact that people – living sentient beings – feel sad because sad things happen to them.  Rather, it is contended that their sadness, provided it meets certain arbitrary and intrinsically vague thresholds of duration, degree, and impact, is caused by a complex interplay of pathophysiological processes.

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

Then Dr. Pies makes what seems an unusual admission:

“I think it is incontestable that, since the heyday of psychoanalysis (ca. late 1950s-1960s), the field of psychiatry took a fairly sharp turn toward the ‘biological’ in the period from roughly 1978 to 1998, which, to a considerable degree, persists to this day.”

I would have said an extremely sharp turn, but we can let that go, because Dr. Pies’ next two sentences effectively exculpate psychiatry:

“But we were far from alone in taking this turn, as witnessed by U.S. President George H.W. Bush’s proclaiming the decade from 1990-1999, ‘The Decade of the Brain.’ And there is no question that the movement toward the biological/biochemical has been heavily influenced by the pharmaceutical industry.”

So there it is:  from ’78 to ’98, psychiatry took a fairly sharp turn toward the “biological” (which for some unknown reason Dr. Pies puts inside quotation marks) which, to a considerable degree persists to this day. [Emphasis added]

But psychiatry, he assures us, isn’t wholly to blame for this because:

  1. The US President himself proclaimed the nineties as the Decade of the Brain, and
  2. The move was “heavily influenced” by the pharma industry.

So there you have it.  What could the poor misfortunate psychiatrists do?   Poor lambs, they had to just – you know – go along with all this pressure.  Who could resist the combined pressure of a US President and the pharma industry?

Are we really being asked to take this contention seriously?

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

Nevertheless, Dr. Pies isn’t ready to throw in the towel completely.  He can still cheer-lead.

“Nonetheless,” he writes “what I have called the ‘Alexandrian-Jasperian-Engelian (AJE) integrative tradition’ has remained central to academic psychiatry, alongside Engel’s Biopsychosocial Model (BPSM). You and I and Dr Ghaemi have had a fruitful debate on the merits, demerits, and validity of the BPSM, and I won’t rehash that discussion.  I will simply say that, while the AJE/BPSM framework has struggled to remain a central part of psychiatric practice—pushing back against powerful market forces that favor brief ‘med checks’ and provision of psychotherapy by non-physicians—the ‘integrative impulse’ is alive and well in our profession.”

The above paragraph is light on content, but excellent cheerleading.

Also note the limited extent of his claim:

“…the ‘Alexandrian-Jasperian-Engelian (AJE) integrative tradition’ has remained central to academic psychiatry, alongside Engel’s Biopsychosocial Model (BPSM).” [Emphasis added]

Dr. Pies’ assertion concerning the central place of “the integrative tradition” applies only to the ivory towers of academic psychiatry.  But what about psychiatric practice, where the rubber, so to speak, meets the road?

“…while the AJE/BPSM framework has struggled to remain a central part of psychiatric practice…” [Emphasis added]

Struggled against what or whom?

“…pushing back against powerful market forces…”

What powerful forces?

“…market forces that favor brief ‘med checks’ and provision of psychotherapy by non-physicians…”

So psychiatry, which for decades has embraced the simplistic, deceptive chemical imbalance theory/guess/conjecture, and sold it to the general public as literal truth, is now stuck with the fact that the insurance companies are actually expecting them to live up to their promises to medicalize every significant problem of thinking, feeling, and/or behaving, and to prescribe “evidence-based” pills and electric shocks to cure these problems.  Isn’t that a shame!  The poor psychiatrists – stalked relentlessly by the ghosts of their own deceptions.  Is there no justice?

Is there no hope?  Are the long-suffering psychiatrists doomed to trudge the dreary med check gold mine for the duration of their careers?

No!  Because:

“…the ‘integrative impulse’ is alive and well in our profession.”

Phew!  What a relief.

But how, my dear readers, do we know that this “integrative impulse” is alive and well?  Because the eminent Dr. Pies tells us so.  Which is very convenient, because there has been little or no evidence of a lively “integrative impulse” in psychiatry for many, many years.  And without Dr. Pies’ assurance, we would never have known.

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

But almost as soon as Dr. Pies has raised our hopes concerning psychiatric practice, he dashes them again by retreating to the comfort and familiarity of his ivory towers.

“My own department at SUNY Upstate Medical University [at Syracuse, NY] emphasizes the integration of psychopharmacology and psychotherapy and explicitly endorses ‘the biopsychosocial approach.'”

And not only the State University of New York, but also:

“…at the University of Rochester, where Engel taught and practiced.”

And finally:

“In short, I believe the AJE/BPSM center is still ‘holding,’ but it is surrounded by powerful forces that threaten its integrity.” [Emphasis added]

So Dr. Pies tells us that he believes that the AJE/BPSM center is still holding, even though surrounded by “powerful forces” that threaten its integrity.  And the clear implication is that Dr. Pies considers his beliefs on this matter, based as they are on his observations of two psychiatry departments in upstate New York, should carry some persuasive influence on his readers.  This is the same Dr. Pies who but a few short paragraphs earlier, condemned psychiatry’s critics, whom he lacks the courage to name, for allegedly basing the opposite premise on quotes from “this or that” notable psychiatrist who used the phrase “chemical imbalance”.  In fact, those of us on this side of the issue have based these kinds of statements on an enormous reservoir of personal experience in which psychiatrists who expressed even minor reservations about the chemical imbalance theory/conjecture were a tiny minority in a profession which had long since boarded the chemical imbalance bandwagon en masse.

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

And even the eminent Dr. Aftab appears to align himself with the anti-psychiatry position on this matter.  Here’s how he responded to Dr. Pies:

“Generally, I agree with you that the chemical imbalance was never accepted as the ‘truth’ by academic psychiatry or by our professional organizations. It was likely an advertisement strategy by pharmaceutical companies that took on a life of its own. However, I am not sure I am ready to exonerate our profession. At best, it seems like we were silent spectators, watching as this misleading idea spread like wildfire in the society (including among our patients and patient advocacy groups), doing little to nothing to correct these public misperceptions. At worst, it seems like at least some of us were participants. Ken Kendler writes in a 2019 JAMA Psychiatry commentary, ‘I would commonly see patients who would say some version of ‘my psychiatrist said I have a chemical imbalance in my brain.’’10 I have had a very similar experience myself. Either way, surely as a profession, we could have done a better job of educating our patients and the public?”

This is certainly interesting, coming, as it does, from a psychiatrist.  But let’s take a closer look.

“…that the chemical imbalance was never accepted as the ‘truth’ by academic psychiatry or by our professional organizations.”

In my June 2014 post Psychiatry DID Promote the Chemical Imbalance Theory, I quoted eight eminent, academic psychiatrists who had unambiguously promoted this theory/guess/conjecture.  These were:

Richard Harding, MD, University of South Carolina;
Nada Stotland, MD, Rush Medical College, Chicago;
Timothy Wilens, MD, Harvard Medical School;
Jeffrey Lieberman, MD, Columbia University;
Nancy Andreason, MD, PhD, University of Iowa;
Hagop Akiskal, MD, University of Tennessee, subsequently UC San Diego;
Andrew Leuchter, MD, University of California at Los Angeles;
and the late Morris Lipton, MD, PhD, University of North Carolina at Chapel Hill

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

“It was likely an advertisement strategy by pharmaceutical companies that took on a life of its own.”

So the blatant and destructive falsehood was the fault of pharma, but was also, apparently, the fault of the chemical imbalance theory itself, which spontaneously took on a life of its own.  No, Dr. Aftab, the chemical imbalance deception did not take on a life of its own.  It was, rather, a deliberate and self-serving lie promoted actively by psychiatry to legitimize the harmful drugging and shocking, and to promote their prestige and financial rewards.  Pharma was certainly involved in this process, but they were, at every turn, led and assisted by psychiatrists.  And, by the same token, could have been stopped in their tracks at any time by a direct, honest, and concerted rebuttal from organized psychiatry and from the rank and file.  But no such rebuttal was forthcoming, until the hoax was exposed by members of the anti-psychiatry movement and other critics of psychiatry.  But the exposure is by no means complete.  Chemical imbalance narratives are still widely endorsed by practitioners and facilities, and, tragically, are still widely accepted by psychiatry’s “patients”.

My recollections of the period in question are that the early pharma ads promoted the pills as adjuncts to psychotherapy – they would help the clients communicate with their psychiatrists.  The chemical imbalance nonsense itself was initially promoted by psychiatrists, and in due course, not surprisingly, pharma climbed aboard.

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

“However, I am not sure I am ready to exonerate our profession.”

H’m.  A rift in paradise?

“At best, it seems like we were silent spectators, watching as this misleading idea spread like wildfire in the society (including among our patients and patient advocacy groups), doing little to nothing to correct these public misperceptions.”

“…we were silent spectators…”

In fact, psychiatrists were anything but silent in this matter.  Rather, they promoted the chemical imbalance theory/guess/deception with all the guile and resources at their disposal, including vigorous ridiculing of anyone who dared to challenge this most sacred of all psychiatric doctrines. In staff meetings throughout the country, and probably overseas also, staff members who proposed psychosocial perspectives in particular cases were routinely and condescendingly told:  “First we must treat the depression”; meaning, first, we must start the pills or the shocks.

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

“… watching as this misleading idea spread like wildfire in the society (including among our patients and patient advocacy groups), doing little to nothing to correct these public misperceptions.”

Well, the misleading idea, which I prefer to call a blatant and destructive lie, did indeed spread widely in our society, particularly among psychiatry’s “patients” and “patient” advocacy groups.  But Dr. Aftab neglects to mention (or perhaps is unaware) that these advocacy groups were, until recently, given space and endorsement on the APA website to promote this deception.

“…these public misperceptions…”

The implication here is that the public misperceived the message.  In fact, there was no misperception.  The message was clear, was correctly perceived by the public, by the media, and by government agencies, and has resulted in untold damage to millions of people worldwide.  In addition, the deception is still very much in play in virtually all segments of society, including Dr. Aftab’s workplace website, where as of today (November 5, 2020) you can still find the assertion that “metal illnesses” are “biologically based brain disorders”.

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

“At worst, it seems like at least some of us were participants.”

My recollection is that the vast majority of psychiatrists were participants.

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

“Ken Kendler writes in a 2019 JAMA Psychiatry commentary, ‘I would commonly see patients who would say some version of ‘my psychiatrist said I have a chemical imbalance in my brain.’10 I have had a very similar experience myself.”

I couldn’t begin to estimate the number of times I’ve heard this.

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

“Either way, surely as a profession, we could have done a better job of educating our patients and the public?”

Of course psychiatry could have done a better job of educating their “patients” and the public and the media and government agencies.  They could, for instance, even now, take out full-page ads in all the major newspapers, acknowledging and apologizing for their deceptions.

But they haven’t done so, because the deception served, and continues to serve, their interests.  It created the impression that they were real doctors; it legitimized the rampant prescribing of mood-altering drugs and destructive electric shocks; it enhanced the psychiatrists’ prestige, and improved their earning power.  And psychiatry is drawing down the benefits of this hoax to this very day.

The purpose of the chemical imbalance theory/guess/conjecture/deception was to break down the widespread and sensible reluctance on the part of the general public to ingest pills as a substitute for dealing with life’s problems.  And, tragically, it has been remarkably successful.

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

At this point, Dr. Pies expresses agreement with Dr. Aftab’s position; but immediately transfers the guilt to Mad Men (i.e. the advertizing executives on Madison Avenue).

“Yes, I agree that we—all of us—could have done a better job of counteracting the so-called ‘chemical imbalance’ trope, which, as your comments imply, was more a creature of ‘Mad Men’ than of men and women who study madness!”

Notice the word “trope” – “a literary device…that consists in the use of words in other than their literal sense” (Random House College Dictionary 1990).  What Dr. Pies is asserting here is that the chemical imbalance theory/guess/conjecture/deception was never meant to be taken literally.  It was just an advertizing metaphor.  However, in all the times I’ve heard or read of psychiatrists promoting this theory, I never heard even one explain that it was just a metaphor and was not to be taken seriously.  Rather, they routinely doubled down on their assertions by claiming that “mental illnesses” were real illnesses just like diabetes; that the drugs/shocks were required to correct the “imbalances”, or “aberrant circuitry”, or other biological anomalies in the brain; and would probably need to be taken for years or even for life.

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

Then Dr. Pies shifts the blame to the psychiatric “patients”:

“And, yes—we often hear anecdotes concerning patients who tell their current clinician some version of, ‘My psychiatrist said I have a chemical imbalance . . .’ But where is the evidence that this is what patients were actually told? Who has contacted the patient’s psychiatrist, or reviewed his/her case notes, to see if that was really what the patient was told? To my knowledge, there has never been a study examining the ‘other side of the story’—and, to be clear: patients are not infallible recorders of what their doctors tell them. So, we are really left to speculate, and with the knowledge that about 80% of antidepressant prescriptions are written not by psychiatrists, but by primary care physicians and family practitioners. Who knows what these doctors told their patients? So, I consider this really a fruitless debate, unless and until I see contemporaneous documentation of what patients were actually told by their psychiatrists; or, failing that, a large ‘N’ of psychiatrists confirm that they regularly used the ‘chemical imbalance’ trope to explain the nature of their patients’ problem. I will add that, in my own practice over 25 years or more, I did include a discussion of neurotransmitters in my explanations to patients, but always in the context of ‘bio-psycho-social’ causes and risk factors.

So, “patients” can’t be trusted; nobody has done a controlled study of this matter; 80% of prescriptions are written by GP’s; we need contemporaneous documentation of what “patients” were actually told by their psychiatrists; or we need a great many psychiatrists confirming that they regularly used the chemical imbalance deception to “explain the matter to the ‘patients'”.

Note in particular:

“I did include a discussion of neurotransmitters in my explanations to patients, but always in the context of ‘bio-psycho-social’ causes and risk factors.[Emphasis in original]

But how credible is Dr. Pies on this matter, given that in a letter to the editor of the American Journal of Psychiatry published in March 1992, he proposed his very own chemical imbalance theory (guess/conjecture/speculation) of self-injurious behavior?  I have quoted his letter in full elsewhere.  In the letter, Dr. Pies distinguishes two types of self-injurious behavior, type 1 and type 2.  Here are two quotes from the letter:

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 Ddysfunction predominant).  Dopamine agonists would tend to worsen this type of self-injurious behavior, which may respond to conventional antipsychotics.”

and

“…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.”

So, we know that in 1992, Dr. Pies had developed his own chemical imbalance theory/guess/conjecture concerning self-injurious behavior, and had even fleshed out this conjecture with specific drug recommendations!  Fortunately the conjecture was not well received and, to the best of my knowledge, went no further.  But the question arises:  did Dr. Pies ever present this conjecture to his customers?  Did he prescribe the drugs in question for the problems identified?  Has anybody seen his contemporaneous documentation on these matters?  Has anybody surveyed a large number of his self-injurious “patients” as to what they were actually told?  Is there some evidence that psychiatrists are generally more credible in these matters than their clients?

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

It’s pretty clear at this point in the interview that Dr. Pies’ comments concerning the credibility of psychiatry’s “patients” have the potential to backfire, not only on himself, but on the profession generally.  Dr. Aftab sees this clearly and throws Dr. Pies a lifeline.

 “I understand that there is no conclusive evidence, but this is not a court of law…”

“My fear is that many patients who will read what you have said will feel ignored and invalidated, and their trust in psychiatrists may be further eroded.”

“I don’t believe that is what you intend, so I want to give you an opportunity to reassure such readers who may find your words alarming.”

We can only speculate as to how Dr. Aftab could know what Dr. Pies’ intentions were, but Dr. Pies, being the eminent and scholarly psychiatrist that he is, gets the message.

“Thank you for letting me clarify my comments, Dr Aftab. First, you are wise to take your patients’ reports and recollections seriously—and to treat such reports respectfully. Without mutual respect, the therapeutic alliance is doomed.  [This from a person who has just displayed an almost total lack of respect for his own “patients.”]  My somewhat testy comments regarding, ‘Where is the evidence that this is what patients were actually told?’ were offered in the context of rebutting dubious claims by various antipsychiatry blogs, websites, and organizations. In the clinical context—sitting with my patients—I would never challenge a report like, ‘My psychiatrist [family practitioner, general physician, etc.] said I have a chemical imbalance . . .’ Rather, I would likely reply by asking the patient, ‘Can you tell me more about that meeting with your doctor, and how you felt when you heard what he/she said?’ I would draw the patient out on what ‘message’ he or she took from the encounter; eg, did apparent mention of a ‘chemical imbalance’ leave the patient feeling relieved or anxious? More worried or less? etc. (Some patients react badly when given a purely ‘biochemical explanation’ of their problem). Note that an interaction of this type does not prejudge the patient’s recollection or reach a final conclusion regarding what the patient was actually told by the psychiatrist or other physician. Remember: listening seriously and respectfully is not the same as listening credulously.”

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

Let’s examine this response in detail.

“My somewhat testy comments regarding, ‘Where is the evidence that this is what patients were actually told?’ were offered in the context of rebutting dubious claims by various antipsychiatry blogs, websites, and organizations.”

So his “somewhat testy comments” were not directed at his “patients”, but rather at “the dubious claims” of “antipsychiatry blogs, website and organizations”.  This is a slick side-shuffle because his earlier “somewhat testy comments” were most certainly directed at his “patients”.

“…we often hear anecdotes concerning patients [my emphasis] who tell their current clinician some version of, ‘My psychiatrist said I have a chemical imbalance . . .’ But where is the evidence that this is what patients [my emphasis] were actually told?” [Dr. Pies’ emphasis]

So although he acknowledges that these “anecdotes”, which he could just as easily have called “reports” or “accounts”, are often heard, he still calls for evidence that this is what his “patients” were actually [emphasis is Dr. Pies’] told.  He is clearly drawing a credibility gap between what the customers were “actually” told and what they say they were told.

In other words, they [the “patients”] can’t be trusted.

There is no hint that the untrustworthiness is meant to apply to “various antipsychiatry blogs, websites, and organizations.”

and

“Who has contacted the patient’s psychiatrist…”

The psychiatrist, of course, being the final arbiter of truth in such matters.

“…or reviewed his/her case notes…”

Case notes were written by the psychiatrist, so they must be truthful and accurate.

“To my knowledge, there has never been a study examining ‘the other side of the story'”

Actually, there has never been a study of the “patients'” side of the story either, though psychiatrists could easily have undertaken such a study any time in the past fifty years.  But they chose not to, devoting their research energies instead to the search for proof of their long-cherished chemical imbalance theory/guess/conjecture/deception or other biological explanations.  Proof, incidentally, that has never materialized.

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

He then vents his spleen on GP’s and family doctors:

“Who knows what these doctors told their patients?”

It’s difficult not to detect a note of disdain in this rhetorical question.

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

and finally:

“…I consider this really a fruitless debate, unless and until I see contemporaneous documentation of what patients were actually told by their psychiatrists; or, failing that, a large ‘N’ of psychiatrists confirm that they regularly used the ‘chemical imbalance’ trope to explain the nature of their patients’ problem.”

I would definitely call this client-bashing, and it reveals a very fundamental problem within psychiatry:

Psychiatric “patients” are widely disbelieved by psychiatrists.

It’s seldom that one sees it quite so graphically illustrated, but perhaps Dr. Pies’ “testiness” eclipsed his usually careful presentation.  What he doesn’t seem to realize, however, is that clients almost always know when they are being disbelieved, and they talk about it, but not usually in the presence of the psychiatrist from a justifiable fear of retaliation.

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

At this point Dr. Pies makes an almost plaintive attempt to draw a parallel between the stigma and marginalization experienced by psychiatric “patients” and that experienced by psychiatrists themselves.

“And keep in mind that while people with mental illness have indeed been marginalized and stigmatized, so have those of us who care for them. Among other factors, derogatory portrayals of psychiatry and psychiatrists in the media have contributed to stigma against psychiatrists and mental health professionals.”

The primary source of psychiatry’s negative image stems from their deceptions; prolific drugging; and the use of electric shock machines.  The primary source of the negative image of their “patients” stems from the false psychiatric assertion that they have incurable brain illnesses.

DEFINITION OF DISEASE

The remainder of the interview focuses on the concept of disease/disorder and how these concepts should be conceptualized and defined.

Dr. Pies, of course, has long insisted that the essential definition of disease is the presence of suffering and impairment to a significant degree.  This is broadly in line with the notion of “disorder” as presented in successive editions of DSM from DSM III to the current DSM-5.  In the interview, Dr. Aftab presents various challenges to this notion, all of which are deflected by Dr. Pies.

The discussion is interesting but the general topic has long become tiresome.  The fact is that the terms “disease” or “sickness” or “disorder”, all of which are more or less synonymous, are consistently used in common speech and by real doctors to indicate the presence of a biological or anatomical pathology.

So when psychiatrists contend that an episode of depression, say, which meets or surpasses certain vague and arbitrary thresholds of intensity, duration and impact constitutes an illness, they are using the term “illness” in a strained and ambiguous fashion.

When they present this notion to their customers, they leave them with the impression that they (the customers) have some kind of neural pathology that the psychiatrists’ understand, and can effectively cure.  In the past, the majority of psychiatrists reinforced this absurdity by telling the “patient” that his/her depression was a real illness just like diabetes.  Since the fallacy was outed by the anti-psychiatry movement, psychiatrists have been more circumspect on these topics, but the pseudo fact was so widely disseminated and promoted that it continues to be heard and to exert a profoundly negative influence in these matters.

All of this could be cleared up very simply if psychiatrists would clean up their language.  If, instead of telling their customers that they (the customers) have an illness called major depression, they said something like:  you are experiencing a number of thoughts/feelings, and behaviors that we psychiatrists choose to call an illness in order to increase our prestige and earnings. But it’s not an illness in the normal sense of biological/anatomical pathology, but rather in the specific psychiatric sense of impairment and/or distress.

But they won’t do this because the notion of real illness, just like diabetes is the essential ingredient of the psychiatric hoax that has been drawing “patients” into its destructive drug-pushing web for decades.

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

Here are some of Dr. Pies’ quotes from the remainder of the interview, interspersed with my comments/responses.

“The issue of bias, misrepresentation, and ‘conflict of interest’ in the medical literature is very important—but the problem is not confined to psychiatry, and the blame cannot be laid entirely at the feet of the pharmaceutical industry. As one recent review by E.H. Turner noted, the responsibility for pervasive publication bias lies with various parties such as authors, journals, academia, industry, news media.19

Turner suggests several possible remedies, including a requirement that ‘…results should be excluded from review until after a preliminary judgment of study scientific quality has been rendered, based on the original study protocol.’19 As a teacher of psychopharmacology, I think it is equally important to train our residents (and more senior clinicians) to recognize substantial biases in published papers, and to appreciate the critical importance of randomization in medical research. [Emphasis Dr. Pies’]

So Dr. Pies acknowledges that there are problems of bias, misrepresentation and “conflicts of interest” in the medical literature, and that these problems are “very important”.  This strikes me as extreme understatement.  Bias and misrepresentation essentially indicates falsification of findings, while conflict of interest usually refers to writing/publishing material that routinely subordinates considerations of fact to one’s own financial interests.  This is a very serious admission and leaves one wondering is there anything in this literature that can be trusted.

But Dr. Pies immediately attempts to rescue his beloved psychiatry from the worst of the censure:

“…but the problem is not confined to psychiatry, and the blame cannot be laid entirely at the feet of the pharmaceutical industry.”

In other words, one can find bias, misrepresentation, and conflict of interest in the literature of real medical specialties, and, apparently, Dr. Pies is of the opinion that this somehow mitigates psychiatry’s active role in these areas.

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

Back to the Aftab-Pies interview:  here’s a quote from Dr. Pies with respect to defining the term disease  or disorder.

“…I believe our ‘ordinary language’ is as good a guide as any, with respect to defining these terms. In our ordinary parlance, when someone shows evidence of prolonged or severe suffering and incapacity that is not due to an obvious wound (eg, a bullet wound), we are perfectly justified in saying that the person is ‘ill’; has some kind of ‘disorder’; or is ‘diseased.’ No labs or imaging needed! Indeed, the concept of disease (dis-ease) arose to explain just such instances of suffering and incapacity. In short, ‘disease’ is a pre-biological, pre-scientific construct.” [Emphasis Dr. Pies’]

I think the most charitable way to interpret this passage is to remember that Dr. Pies has spent most of his career in the rarified atmosphere of psychiatry’s ivory towers, where apparently “ordinary language” is not ordinary at all.

The fact that the concept of disease might have arisen to explain instances of suffering and incapacity, has no bearing whatever on how the word is used in the present time.  In former times, people, even medical practitioners, had little knowledge of the causes of diseases.  Today, living as we do, in the biological and scientific era, the words “disease”, “sickness”, “disorder”, etc. entail the clearly understood denotation of biological or anatomical pathology.  In some diseases, e.g. tuberculosis, kidney failure, Wegener’s Granulomatosis, etc, the disease process is well understood; in other cases, it’s not.  But in all cases, the need to identify the underlying pathology is considered by real doctors to be of paramount – indeed essential – importance.

Relying on an archaic, pre-biological, pre-scientific understanding of these critical concepts is on a par with the promotion of flat Earth theories, the destruction of crops by witches, the geo-centered solar system, and references to women as the weaker sex.  In short, it’s nonsense.

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

Back to Dr. Pies:

“By way of analogy: let’s imagine that an elderly man with known coronary artery disease is hiking along a woodland trail, when suddenly, a 9-foot grizzly bear appears in front of him. The man is gripped by terror and suffers a myocardial infarction. Would any physician exclude the diagnosis of myocardial infarction (MI) because it occurred in the context of ‘stress’? I don’t think so. Nor is the MI rendered a non-MI because it is ‘understandable’ under such circumstances—I have called this, ‘the fallacy of misplaced empathy’.  An MI is an MI, and a major depressive episode is a major depressive episode; ie, if you have all the signs, symptoms, distress and incapacity, you own the disorder!”

This is nothing more than verbal chicanery.  A myocardial infarction (heart attack) is a real illness.  It is a real illness because it entails a clearly defined biological pathology.  It is, unfortunately, fairly common and can be identified pre- and post-mortem with little ambiguity or error.  In addition, there is a clear causal link between the pathology, and the signs and symptoms.

By contrast, here’s how Dr. Pies justifies psychiatry’s insistence that what they call “major depressive disorder” is a real illness:

“The cardiologists tell us that there are at least 5 different types of MI, including a primary coronary event, such as plaque rupture; coronary spasm, coronary embolism, and others. But all have in common the production of myocardial ischemia and myocardial-cell death. By the same token, with people who meet full DSM-5 symptom, severity, and duration criteria for a major depressive episode [MDE], we can again enumerate different etiologies and ‘contextual types’; for example, MDE arising in the context of a chronic medical illness, like cancer; in the context of a relationship breaking up; or after sudden job loss. Yet the ‘family resemblances’ (I will resist the lure of a Platonic ‘essence’) that unite these diverse contextual types consist in what you rightly call the ‘relevant pathological and clinical features.’ These are the well-known findings of depressed mood; changes in sleep and appetite; low energy; loss of interest or pleasure in usual activities; impaired concentration, etc. Often, feelings of guilt, worthlessness, or hopelessness accompany these features. Taken together, these features produce varying degrees of ‘suffering and incapacity.'”

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

This is very obscure, so let’s see if we can open it up:

“…people who meet full DSM-5 symptom, severity, and duration criteria for a major depressive episode [MDE]…”

The problem here is that because of the inherent vagueness of the criteria, these people cannot be reliably identified.  Cohen’s kappa for “major depressive disorder” in the DSM-5 trials was only 0.28 (here).  So any statements that Dr. Pies, or any other psychiatrist, makes about these individuals are inevitably a distortion.  A Cohen’s kappa of 0.28 means that the individuals using the term don’t actually know what they are talking about – literally.

“…we can again enumerate different etiologies and ‘contextual types’…”

So Dr. Pies tells us that he can enumerate different etiologies for these cases of “major depressive disorder”.  But if we recall that the word etiology means the cause of a disease, it is clear that he is assuming that “major depressive disorder” is a disease in the very process of proving that this is so.  His conclusion is hidden in his premise: a logical fallacy known to logicians as “begging the question”, or “assuming the conclusion”.

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

“Yet the ‘family resemblances’ (I will resist the lure of a Platonic ‘essence’) that unite these diverse contextual types consist in what you rightly call the ‘relevant pathological and clinical features.’ These are the well-known findings of depressed mood; changes in sleep and appetite; low energy; loss of interest or pleasure in usual activities; impaired concentration, etc. Often, feelings of guilt, worthlessness, or hopelessness accompany these features.”

Note again how Dr. Pies has slipped in the medical words “pathological” and “clinical”.  “Pathological” means altered or caused by disease.  (It comes from the word pathology, which means:  “…the study of the essential nature of diseases and especially of the structural and functional changes produced by them.” (Merriam-Webster).  Tabers Cyclopedic Medical Dictionary (2013) defines pathology as:  “The study of the nature and cause of disease which involves changes in structure and function.”  Tabers defines “pathologist” as:  “A medical professional trained to examine tissues, cells, and specimens of body fluids for evidence of disease.”

The word clinical simply means pertaining to a clinic.  It is an informal word routinely used by psychiatrists to create the impression of disease without actually committing themselves to an outright falsehood.

So what “relevant pathological…features” of a “major depressive episode” is Dr. Pies adducing in the present interview?

“These are the well-known findings of depressed mood; changes in sleep and appetite; low energy; loss of interest or pleasure in usual activities; impaired concentration, etc. Often, feelings of guilt, worthlessness, or hopelessness accompany these features. Taken together, these features produce varying degrees of ‘suffering and incapacity.’ It is this dyad that constitutes the ‘disorder-ness’ that separates clinical depression from grief.

Dr. Pies’ list, of course, constitutes the “symptoms” of a major depressive episode in successive editions of the DSM.  By referring to these thoughts, feelings, and behaviors as pathological, Dr. Pies is once again begging the question.  It is also clear that Dr. Pies is not using the word illness in its standard “ordinary language” sense.  Rather, he has dragged the term “pathological features” into the discussion (as he did earlier with the term “etiological”), to convey the impression of illness where, in fact, none exists.

In the final analysis, his argument amounts to this:  depression which crosses arbitrary and vaguely-defined thresholds of severity, impact, and duration is an illness because it entails suffering and incapacity.  Suffering and incapacity are the defining features of illness, disorder, disease, etc. because I and “this or that” other eminent psychiatrists say so, and – most extraordinarily – because of linguistic conventions established in the pre-biological, pre-scientific era.

Nonsensical as it sounds, there is nothing more to psychiatry’s claims that they treat real illnesses.

Dr. Pies continues by stating that nosologists who claim that psychiatric “illnesses” are “really problems of living”

“…are mistakenly classifying a bona fide depressive disorder as merely a ‘problem of living,’ with no clear evidentiary justification, potentially to the detriment of their patients.”

To which I could just as readily respond that psychiatrists who classify bona fide problems of living as illnesses with no clear evidentiary justification do enormous harm to the victims of this unconscionable hoax.  And let us not forget that in real science (as opposed to psychiatric science), the burden of proof lies with the party making the extreme claim.

And it needs to be stressed that neither Dr. Pies nor any other psychiatrist has ever produced evidence in support of this position.  Like some modern politicians, they repeat their falsehoods over and over, as if this process carried some evidentiary weight.

Then Dr. Pies makes this noteworthy statement:

“That said, I agree with you that disorder attribution ‘serves pragmatic functions within a social context,’ which may vary from culture to culture…This reminds us yet again that medical judgments are not ‘value-free,’ even though they may draw on ‘objective,’ clinical data. Zachar and Kendler note, for example, that a central controversy in the bereavement debate revolved around the question: which is more important when assessing depression: avoiding false positives or avoiding false negatives? Ultimately, this depends on which ‘pragmatic functions’ a society wishes to promote and underwrite, and this is clearly a matter of societal values.” [Emphasis Dr. Pies’]

In other words, if I’m understanding this correctly, if the general public wants us to diagnose illnesses and prescribe pills and shocks, then that is what we will do!  We will attribute disorders (i.e. we will diagnose illnesses) in accordance with which “pragmatic functions” society wishes us to promote and underwrite.  This is clearly a matter of societal values, and not (though Dr. Pies fails to articulate this explicitly) a matter of science or logic.  It also displays an extraordinary degree of arrogance on the part of psychiatrists to assume that they themselves have some special insights into the wishes/wants of society.  Have they received some specific and valid training on these matters?  Or have they, as a profession, developed a reliable body of pertinent research data?

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

Dr. Aftab:  “What are your hopes for the future of psychiatry?”

Dr. Pies’ response to this question is interesting, even alarming.  Here’s his full response:

“One of the most perceptive and heuristically useful comments about psychiatry that I have ever heard came from one of my residency mentors, Dr Robert Daly. Bob once said that in psychiatry, ‘You can do biology in the morning and theology in the afternoon.’ That comment from nearly 40 years ago has always stuck with me. It speaks to the holistic and pluralistic nature of the psychiatric enterprise, which I wholeheartedly endorse, and which has radically shaped my entire career. So my chief hope for ‘the future of psychiatry’ is that it recover its pluralistic ‘core’—what I earlier described as the AJE tradition. I say ‘recover’ because, as I noted earlier, I believe that psychiatry’s ‘solid center’ is besieged by market-driven forces that would like to reduce us to ‘writing scripts’ and ‘turfing’ psychosocial interventions to less costly non-physicians. We need to push back hard against those trends! At the same time, I would like to see psychiatry achieve much better integration with neurology and general medicine, in what has been called ‘collaborative care.’ I also think psychiatry has to do a much better job of ‘public outreach,’ whereby we go out into the community in a proactive way, so that the general public has a better understanding of who we are and what we do. We can’t afford to let antipsychiatry define us in the public mind. The stakes for our profession and the well-being of our patients are far too high.”

This closing paragraph of the interview raises several issues:

  1. What does the eminent Dr. Pies mean by doing theology? Is this the same as preaching? Or discussing abstruse theological matters?  Or seeking meaning in life through religion?  It is clear that Dr. Pies has put great store in the expression, and that it has stuck with him for forty years.  But is it what people expect when they present themselves for psychiatric “treatment”, or is Dr. Pies foisting his own agenda on his hapless victims?  We can only guess.
  2. “It speaks to the holistic and pluralistic nature of the psychiatric enterprise, which I wholeheartedly endorse, and which has radically shaped my entire career.” Actually, depending on what Dr. Pies means by “doing theology”, it could mean the exact opposite – using his position as a psychiatrist to preach theological dogma.
  3. Pies clearly hopes for some revival of “doing” theology within psychiatric practice. “So my chief hope for ‘the future of psychiatry’ is that it recover its pluralistic ‘core’—what I earlier described as the AJE tradition.”
  4. “…I believe that psychiatry’s ‘solid center’ is besieged by market-driven forces that would like to reduce us to ‘writing scripts’ and ‘turfing’ psychosocial interventions to less costly non-physicians.” Actually, the siege is over.  Psychiatry’s “solid center”, if indeed it ever existed, has long since been swept away.  Writing scripts for mood-altering drugs and intra-cranial shocks is pretty much the sum total of psychiatric activity at present.
  5. “…I would like to see psychiatry achieve much better integration with neurology and general medicine, in what has been called ‘collaborative care.'” To some extent psychiatry has had some success in this area.  Readers who are Medicare recipients will have noticed that they are being routinely screened for depression in recent years.  This stems from a conscious and calculated effort on the part of psychiatry to spread its tentacles into every aspect of our lives.
  6. “We can’t afford to let antipsychiatry define us in the public mind. The stakes for our profession and the well-being of our patients are far too high.”  Note that his concern for the profession of psychiatry takes precedence over his concern for his “patients”.  And, of course, in the final analysis, psychiatry is defining itself as the arch-purveyor of chicanery and deception.
CONCLUSION

It is clear from the comments of Dr. Pies in this interview that his primary concern at the present time is to discredit and marginalize the anti-psychiatry movement.  He denies the fundamental legitimacy of the movement as a vital corrective to psychiatry’s invention and promotion of bogus illnesses, and to its blatant and harmful pushing of drugs and electric shocks.

The most striking feature of Dr. Pies’ assertions in this area is his failure to understand the modern meaning of the words illness and disease, and his stubborn reliance on archaic “pre-scientific”, “pre-biological” definitions of these terms as a ploy to sell the false notion that psychiatric “illnesses” have the same ontological status as the illnesses treated by real doctors.

Like modern politicians who confuse repetition with truth, he continues to beat the same worn-out tunes on the same old drum.

***

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.

103 COMMENTS

    • I was thinking similar thoughts. Generally, even though all of us engage in BS at points in our lives, there are those that get into it so deep that they just can’t come out. And curiously, it’s the mind involved 🙂 which is in itself ironic.
      I like Phil’s idea of that HUGE newspaper headline. Admitting their lies, their propaganda. I would even consider reconciliation. Like a pardon. Not to continue on or even pretend to know, or understand what they are observing, but rather a chance at a new job.

    • Intellectually dishonest, emotionally laden misdirected hyberbole fails suffering humanity. Never one shy to critique our collective failure to provide adequate responses for mental distress I note that this article fails itself by sparing utterly the most egregious offenders in this ongoing scandel while attacking those with some insightful commentary that may in time prove fruitful.

      • I see no harm in critiquing psychiatric practice, it has after all played havoc with many lives including mine but maybe helps many too or so they claim. But why spare the powerful interest of pharma or the supporting role of advertising, marketing, insurance practices, media promotions, political decisions enabling paying for what is characterised as the bio-bí-bio model – somewhat disengenuously but not entirely – Or indeed a wider societal failure to support the provision of resources (housing, education, healthcare, welfare) sufficient for sustained recovery. Or indeed spare patients (whom you call customers! Customers of what exactly? ) from their responsibility for believing credulous bullshit, if that’s what it is, you seem to be left I’ve so.

        • I’m going to let myself off the hook for that last bit – believing credulous bullshit. I was never a customer of psychiatry, always a patient…. sometimes voluntary, often involuntary. I was intelligent enough to poke holes in the logic of what these people were saying to me – that (the speaking up) led directly to more abuse. The societal pressure to “listen to your doctors” and “be compliant” (nothing worse than an unmedicated, non compliant borderline running around, was the general feeling) was immense. I don’t think we should let anyone in a position of power off the hook (certainly not the FDA, which has done nothing to protect US citizens from these poisons they call psychiatric medications. But psychiatrists, as, technically, medical doctors, took an oath to do no harm and to put the well being of the patient above their own self interest, and in both of these they continue to fail miserably.

          • Oldhead, are we to take it that you believe that the victims/ clients/patients/ survivors of the use and or abuse of psychiatry have been spared from ever believing something that upon examination turns out to be wrong?

          • If I leave my wallet where someone can take it I may be responsible for being overly trusting, but if they do they are responsible for being a criminal.

            Though I don’t carry a wallet actually, bad for the spine.

          • Sorry to hear you lost your wallet! I trust you didn’t have to break the bank trying to retrieve it?
            Are we to take it that describing victims/survivors/client/patient of MHS as ‘customers’ is a victim blaming description?

          • No, doctors are the experts in solving problems – they are not motivated by greed, wrath, credulity or all the other problems by and large. Don’t you think that mostly people encounter psychiatry already overwhelmed by difficulties? Many find a system that works with them to arrive at solutions to their problems. However for many, like me, the efforts to help become part of their problems, stigmatising diagnosis and pressures to collude with false labels, ineffective treatments and discounting your own needs in addition to what might include objectifying othering leads me to think that psychiatry is often part of the problem. However, still the primary offences are external to the system but exert their influence on it nonetheless.
            Philip Hickey is quite correct to suggest psychiatrists should show more courage in resisting such pressures.

  1. “And keep in mind that while people with mental illness have indeed been marginalized and stigmatized, so have those of us who care for them. Among other factors, derogatory portrayals of psychiatry and psychiatrists in the media have contributed to stigma against psychiatrists and mental health professionals.”

    “We can’t afford to let antipsychiatry define us in the public mind. The stakes for our profession and the well-being of our patients are far too high.”

      • Yes, rather sad. I’ve never seen the heart specialists have to deal with the anti-heart folks. What :well being” is he speaking of? The wellbeing that despite all their interventions actually becomes worse?
        It is the worsening, damage and millions of deaths that he is trying to defend. It is that worsening itself that exposed them. He refers to that damage as “AP”. But he will absolutely not engage with them, not privately and certainly not in a national inquest. He will not engage because his “arguments” would be destroyed.

      • Have you noticed how so called anti stigma campaigns while well meaning attempts mostly attempt to mostly destigmatise psychiatric interventions. And then compound the error in priorities by promoting beliefs that are known to compound the stigma, ie biological causality.
        You say we shouldn’t be ashamed to be called ‘schizoprenic’ for instance, well don’t use that diagnosis then, refer instead to our multiple adversities, deprivation and traumas! And try fighting for the provision of resources that are actually shown to promote recovery.

  2. “…lacking direct experimental confirmation…”

    That’s not how science works. To test a hypothesis you try to prove it wrong. You don’t confirm it.

    Also the chemical imbalance theory dates back to the 4 humors in ancient greece.

    Who let these pseudointelectuals anywhere near a university?

  3. Dr Hickey. Amazing work from one of the truly wise and honest men….Because your honor and income do not depend on spouting nonsense disguised as being a doctor that deals in illnesses. So thank you for your intellect which you share fearlessly.
    And thanks to MIA for letting readers have access to quality articles.
    You give Dr Pies a lot of credit by calling him wise. I see him as sly, or more so, that he thinks of himself as sly enough to deceive.
    I’m really rather shocked at his speech. Now if I were a shrink, I would, or would have been taught to be alarmed at his language, his “explanations” and the contradictions. And there are many disorders that the DSM contains that apply to that kind of speech.

    “And keep in mind that while people with mental illness have indeed been marginalized and stigmatized, so have those of us who care for them. Among other factors, derogatory portrayals of psychiatry and psychiatrists in the media have contributed to stigma against psychiatrists and mental health professionals.”

    Ohh the “stigma” word. Another smoke screen. What he is really pissed at is that survivors could actually make a difference. The lack of respect towards shrinks is a result of “patient” dissatisfaction due to harms, NOTHING else. In fact, the AP movement is rather silenced compared to psychiatry, so it goes to show that there is a lot more going on. It is a general awakening and an attempt by society to think again.

    “We can’t afford to let antipsychiatry define us in the public mind. The stakes for our profession and the well-being of our patients are far too high.”
    Of course. The “patients” should rather be defined by shrinks. Lucky public. PFFT “wellbeing”.
    The man is stubborn, not so sly and definitely not wise. It is worded like a car salesman, or worse, a spoiled brat. I mean the man has it good, why is he whining?

    “collaborative care”. LOL, I’m at the end of that schtick. It’s actually quite old and is EXACTLY what is causing the same fate to medicine as it is doing to psychiatry. I mean it looks really bad to say that a large percentage of MD’s are prescribing psych drugs and then say that we need more collaborative care. Medicine is having it’s own problems due to having indulged in psych drugs. It is a doctor’s go to when he does not want to be bothered, but also due to being involved in medicine with awful drugs and lacking science, which is becoming the big headache for them. Lack of science, aging people, promises of pharm, insulated and protected, yet a fear of liability, and a huge fear that stems from being indoctrinated into a club of colleagues who pressure. Ask doctors how they like medicine. So no, MD’s get into psych because of pressure within a cult, because of threats that are unspoken. The same threats patient’s feel. Psych has it’s claws there already, they are at the moment simply protecting what is being exposed and they will do ANYTHING, even harm children. And Dr pies teaches pharmacology? I guess he teaches that children should have drugs.
    And since it’s probably words from dissatisfied patients harming DR Pies, I very much doubt any child ever made him look bad, but they will, eventually and there will be many.
    I wonder what Dr Pies writes in the child’s history? I wonder what he tells the parents? What does he say about his drug dealing?

      • And invoke fear that was not there, or further terrorize because every single patient finds out the hard way that the true “stigma” is really “discrimination” directed towards the very people they themselves labeled.
        And all this medical personel blames the public for it.,,,, “educating” them on “stigma”.

        And doctors will say, “yes I’m so sorry you felt “stigmatized” 🙂 They might even write something sinister like “patient feels paranoid that the world is against them” Convenient and very nasty.

      • Yes, or in my case, it meant being referred to a pain doctor by my neurologist, and the pain doctor demanding that he would only grant me an appointment if it were “coordinated with your psychiatrist.”. When I asked why, the woman on the phone said, “because of some things in your file.”. I said I didn’t need an appointment with the pain doctor as I will never again have a psychiatrist and then called the rheumatologist office to reiterate what I had already said about being a psychiatric survivor. Coordinated care didn’t exist, for decades, and then it was finally implemented to show that they were all against me and I would never be believed.

          • Thank you, Sam. If I didn’t have this site to read and share about these experiences, I don’t know what I’d do. It’s often the only validation I can find.

          • They never refused “care” with me. It was the “care” itself that was abusive. So I stopped seeking “care”. Possibly the only place one ever gets a whole approach to whole person care is in a palliative setting.
            Many people qualify for “palliative”, since chronic stuff is essentially being “palliated”, yet again, that is where common sense left their heads, since they consider palliative to be having something that will kill a person within 6 months.
            There are scores of conditions and disease that are ongoing “palliative”, yet those people get some of the worst care. They do not look at the “psychosocial” needs, they look at “psychiatric” needs.
            Funny how in a palliative care unit, the psychosocial is acknowledged. Such as spiritual needs, concerns, fears, existential fears etc. If one is lucky to get a good team. But I’m guessing that even in a palliative care unit, one’s “diagnosis” would be an obstacle.
            They seem to only want brave people who don’t whine.

          • Registered,
            I told them in that phone call that I didn’t need an appointment with the pain doctor and then I called and canceled my upcoming appointment with the rheumatologist (the referring doctor in the same system. I don’t know why I said neurologist in my earlier comment, it was a rheumatologist who referred me to the pain doctor, but I didn’t know she was doing that. I only made an appointment with her because I wanted her to order blood work, which even that I would have done on my own and looked into it, but paying out of pocket for blood work it turns out is very expensive) because of what the pain doctor’s office said. The rheumatologist did call me back and left a message asking me to call her so that we could “discuss your concerns”, and I give her credit for that. I don’t know what that conversation would have looked like but at that point I decided to move away and start up with new doctors in a different system. So I’ve gone from Connecticut to Western Massachusetts and already found a primary care doctor. Of course she wants my records from the other system and I already told her that they are going to contain derogatory things about me. She said she’d take it with a grain of salt.
            At the time that that demand was made, I didn’t even have a psychiatrist. I fired the last psychiatrist I had about 3 months prior to that phone call from the pain doctor’s office. So meeting the demand would have meant going out and finding another psychiatrist who would be willing to coordinate my appointment with the pain doctor, which I don’t even know what that means, like, at all. I just know that any attempt I made to meet their demand would have resulted in a s*** show and then that s*** show would have been blamed on me. That’s how it’s been for the last however many decades.

    • “Medicine is having it’s own problems due to having indulged in psych drugs. It is a doctor’s go to when he does not want to be bothered,” or wants to cover up his and/or her’s easily recognized malpractice, and/or medical evidence of child abuse.

      And covering up child abuse is the primary actual societal function of both the psychiatric and psychological communities, and this is all by DSM design.

      https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
      https://www.madinamerica.com/2016/04/heal-for-life/
      https://www.psychologytoday.com/intl/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

      I love your sense of humor, Philip, and your stinging criticism of psychiatry. Thank you so much for all of your blogs, and your truth telling, Philip. Your work, and writings, are staggeringly important, and much appreciated by me, and I would imagine, by most on MiA.

  4. “So there you have it. What could the poor misfortunate psychiatrists do? Poor lambs, they had to just – you know – ” put a kid on ritalin and get him strung out then follow up with neuroleptics, and when the parents suddenly realize “holy shit, we’re drugging our kid!” get child protective services involved and the schools involved as well.

    Oh wait, this article isn’t about child psychiatry. Does child psychiatry even exist?

  5. Phil, thank you for another excellent post. These psychiatrists’ attempts to revise history by exonerating their profession from promoting the chemical imbalance hoax must not be allowed to stand. It is still happening to this day.

    In the article you critiqued, Dr. Aftab said, “Generally, I agree with you that the chemical imbalance was never accepted as the ‘truth’ by academic psychiatry or by our professional organizations. It was likely an advertisement strategy by pharmaceutical companies that took on a life of its own.”

    Here is a link to The Royal Australia and New Zealand College of Psychiatrists website page on the topic of “Medication for Mental Illness”: https://www.yourhealthinmind.org/treatments-medication/medication.

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

    Nothing has changed.

    I’d also like to speak to the biopsychosocial (BPS) model Pies venerates. If you read Engel’s famous article, he never actually articulates such a model but instead denigrates medicine in general and psychiatry in particular for being overly biological and paying only lip service to the psychological and social. I would expect that Pies’ favored version of the BPS involves physical pathology (e.g., chemical imbalance) plus psychosocial factors. And if so, that makes “mental disorders” fundamentally medical diseases. Psychosocial factors are relevant to cancer and diabetes, but these are literal diseases of the body, and it is understood that despite their relevance psychosocial factors do not alter the obvious reality that the condition in question is a medical illness. This is what I expect Pies and other psychiatrists who fancy themselves enlightened for adhering to the BPS do – construe psychological struggles as medical diseases caused by physical pathology but also acknowledge the relevance of psychosocial factors. From this perspective, the BPS is not fundamentally different than the disease model. You can put lipstick on a a pig but it’s still a pig.

  6. I encourage Dr. Pies and Dr. Aftab to have the courage of their convictions and to denounce these ignorant wretches by name

    Here here! Hoping to receive such an honor from Dr. Pies!

    I have stated many times that Dr. Pies is probably one of the wisest and most eminent psychiatrists in the US.

    If only he weren’t engaged in evil.

  7. But psychiatry, he assures us, isn’t wholly to blame for this because:

    The US President himself proclaimed the nineties as the Decade of the Brain, and the move was “heavily influenced” by the pharma industry.

    So there you have it. What could the poor misfortunate psychiatrists do?

    Nothing to add, just love the way Dr. Hickey puts it. 🙂

  8. Well, the misleading idea, which I prefer to call a blatant and destructive lie, did indeed spread widely in our society, particularly among psychiatry’s “patients” and “patient” advocacy groups.

    Let’s clarify. This “chemical imbalance” crap was NEVER promoted by legitimate survivor-led anti-psychiatry groups. The “patient advocacy” groupings Phil speaks of were system sponsored and coopted entities such as NAMI and the so-called “consumer” groups, which were complicit with such lies. The Mental Patients Liberation Movement thoroughly rejected all this, as have and as do all true anti-psychiatry organizations.

    • “system sponsored and coopted entities” aka ‘coolers’.

      In fact, I find that using the argot of the criminal world when speaking about psychiatry really shows what a racket it really is.

      They’re not “patients” but “marks”, the “chemical imbalance” nothing but a sleight of hand (and a lazy one at that), and one that at times requires the services of a “cooler” to silence the person whose brain has been damaged and has figured out they have been “taken”.

      Imagine being given the ability to have police snatch citizens from their homes and force them into a three card monte. A con mans wet dream.

    • Dr pies tries to pretend he does not believe in chemical imbalance yet spouts sciency sounding mumbojumbo.
      Plus he prescribes chemicals. So what do the chemicals that he prescribes do? He has no clue what they do since they affect EVERY single cell in brain and body, hence the result of harm.
      He is just a stubborn old fool who really dislikes the fact that he is in a draconian and old fashioned practice.
      He knows EXACTLY what his “diagnosis” do to people and how it does not lead to “collaborative” “care”, but rather collaborative discrimination, right across every facet of life that the labeled will engage in.

  9. I assume you have read Goffmans work “On cooling the mark out” Dr Hickey?

    http://infofranpro.wikidot.com/19520101-on-cooling

    “the cooler has the job of handling persons who have been caught out on a limb‑persons whose expectations and self‑conceptions have been built up and then shattered. The mark is a person who has compromised himself, in his own eyes if not in the eyes of others.

    Although the term, mark, is commonly applied to a person who is given short-lived expectations by operators who have intentionally misrepresented the facts, a less restricted definition is desirable in analyzing the larger social scene.”

    “Misrepresented facts”, “expectations and self-conceptions shattered”?

    These guys are operating as ‘coolers’ in the interview you have torn to shreds. You recognise as much in your comment:

    “But they haven’t done so, because the deception served, and continues to serve, their interests. It created the impression that they were real doctors; it legitimized the rampant prescribing of mood-altering drugs and destructive electric shocks; it enhanced the psychiatrists’ prestige, and improved their earning power. And psychiatry is drawing down the benefits of this hoax to this very day.”

    (to quote John Lydon, “ever get the feelin you’ve been cheated?”)

    The aim of ‘cooling’ is to ensure the ‘operators’ are not exposed, and the ‘game’ can continue on any street corner out of view of the authorities who could put an end to it any any moment. It has been quite a feat to ensure that those ‘squawkers’ (of which there are many, and more each day) have been effectively silenced.

    I’ll copy my comment to your website …… just in case your expose of the ‘con’ (and the attempted ‘cooling’) is removed.

    Once again, thank you Dr Hickey.

  10. Marxists/monotheistic materialists -monism. A connection of religion and science, without psyche. They stole the soul.

    “My war – and I have yet to win a decisive battle – is with the modes of thought and conditioned feelings that prevail in psychology and therefore also in the way we think and feel about our being. Of these conditions none are more tyrannical than the convictions that clamp the mind and heart into positivistic science (geneticism and computerism), economics (bottom-line capitalism), and single-minded faith (fundamentalism).”
    ― James Hillman

    “Of course, a culture as manically and massively materialistic as ours creates materialistic behavior in its people, especially in those people who’ve been subjected to nothing but the destruction of imagination that this culture calls education, the destruction of autonomy it calls work, and the destruction of activity it calls entertainment.”
    ― James Hillman, We’ve Had a Hundred Years of Psychotherapy & the World’s Getting Worse

    https://www.youtube.com/watch?v=kyyZHnpXp5g
    ———————
    James Hillman “Re-visioning psychology”.

  11. Great article and deconstruction of this interview. Thank you, Dr. Hickey.
    I wonder if these men ever tire of their own BS. I can’t imagine how exhausting it is, keeping up this ruse. Or maybe I’m giving them too much credit… maybe it would only be exhausting for people who value honesty.
    As far as these *doctors’* failures/refusals to name the antipsychiatry miscreants who are causing the profession so much trouble…one obvious reason for the vagueness comes to mind. As Sam and others allude to, many of the people who are most outspoken about what a fraud psychiatry is are former psych patients. The drs can’t come right out and admit they have zero respect for patients even though they know damn well that the experience of being a psych patient is what led a large percentage of “troublemakers” to become vocal about what a fraud the profession is, to become vocal about the human rights abuses psych patients are subjected to. They have to pretend to care about patients (even former patients) or their house of cards will fall down. They seem to feel comfortable enough to attack whistle blowers with a lot of ad hominem b.s., but imagine if they did that to former psych patients – like people who have bravely shared their stories on this and other websites about the damage psychiatry had done to them… about how they barely escaped with their lives? If Pies and his co-horts came after these people, they’d reveal themselves as the monsters they really are. But they know damn well that many antipsychiatry voices are voices of ex-patients.

  12. I see no harm in critiquing psychiatric practice, it has after all played havoc with many lives including mine but maybe helps many too or so they claim. But why spare they powerful interest of pharma or the supporting role of advertising, marketing, insurance practices, media promotions, political decisions enabling paying for what is characterised as the bio-bí-bio model – somewhat disengenuously but not entirely – Or indeed a wider societal failure to support the provision of resources (housing, education, healthcare, welfare) sufficient for sustained recovery. Or indeed spare patients (whom you call customers! Customers of what exactly? ) from their responsibility for believing credulous bullshit, if that’s what it is, you seem to believe so.

      • I had a professor object to me talking before the classroom once because what I had to say was seen by him, of course, as anecdotal. I feel certain that if we could have a few of these academics thrown into the loony bin for an extended period of time, they might begin to change their tunes. This kind of science, however, presents us with a complicated challenge. The elite knows, of course, designing the studies, while everybody else is talking through both sides of their mouths. I look up the nostrils that say see my importance and your own utter insignificance. I don’t see it though. In the somebody versus nobody dispute, any big number is made up of a lot of smaller numbers. I really don’t think the guy was as big and powerful (shades of Oz) as apparently he thought he was. Oh, well, such is hubris. I’d call it a variation on a theme, “Everything about you, without you.”

  13. “Us” (psychiatrists) versus “them” (critics of psychiatry), huh? Ronald Pies is anything but impartial. He has made it his task to defend his profession. Doing so, he ends up defending the indefensible. He and his are so implicated in the excessive drugging of psychiatric inmates it’s not, if it ever was, funny. Certainly non-psychiatrists might be able to develop a more balanced view of this phenomenon than it’s most virulent adherents and converts. Pies wants us to excuse psychiatry and blame the drug companies, but we know what’s going on here. The drug companies would be nowhere without their # 1 pill pushers, in a nutshell, psychiatrists.

    The theological arguments are also a bit distressing. Science under the rule of religion? Really?! Do your “soul healers” actually have any “soul”? I dunno…What is the fraction of an ounce or so change between life and death? Not much. Captain Kirk and crew are still in the dark when it comes to meeting any supreme deity in their travels. We’ve got, nonetheless, metaphysical physicians, certainly a contradiction in terms, to do his bidding here on earth. If they aren’t, as so many people are, out to deceive as many people as possible about their real aims in the process.

    Great article, Dr. Hickey. Keep ’em coming.

  14. The moment the title was etched into the digital stone, “Who’s to Blame for the Lost Soul of Psychiatry”, the idea of Soul present in the corporate would become a killer. And surely, by Hickey’s words “The explosion of pharmaceutical development in the 1990s” suggests actions that were anything but balanced, respectful or even sustainable in the world of commerce. I would submit gradual, orderly growth as well as decline is a challenge to understand if we wish to realize smoother transitions. Which somehow, the beliefs stay in place as to what might be better, not more, but better modalities of engaged healing, driven by the citizen.

    The nature of this insight and comments might carry more weight in a juried publication, though essentially when people have lost their lives in the physical institution, then where is the critique that really understands the history before we become history?

  15. Sam Plover and everyone: Here’s an historic reminder about all doctors and how they received the “quack” designation. It goes back to the great Bubonic Plague in the fourteenth century. Let me see, according to this sidebar I read in a book called “Perfumes, Splashes, and Colognes” by Nancy M. Booth on page 3; when doctors visited patients during the plague wore false noses mad of leather or papier-mache which had a sponge soaked in aromatic vinegar on the tip. These “masks” looked like bird-beaks; thus they became known as “quacks.” Let me see, it’s well known that it was actually the fleas on the sewer rats that caused the deadly bubonic plague. It was not truly contagious. When they finally got rid of these sewer rats, the plague was gone. Well, maybe, the vinegar-soaked sponge scared away the fleas; but, I think sewer rats are like the opossum; well known to eat absolutely anything. So you see, the “medical profession” has had its difficulties since at least the middle ages, and seems to have been going downhill from there despite it all. Actually, on the whole, almost any progress made in medicine has occurred in the most apparently unlikely place, the battlefield. Thank you.

  16. Well, when something horrible has been going on at your apartment building for nearly a year, keeping you from getting your sleep, and the hospital administrator is your landlord who doesn’t want to deal with it, the psychiatrist has a conflict of interest and you’ll get diagnosed as suffering from psychoses real fast. Never mind that other tenants were having problems too. I didn’t have psychoses, the psychiatrist did. And so did the landlord. Yes, I’m anti-psychiatry – because they have a god complex. They think they know you’re lying when you’re telling the truth. Putting me on psychiatric dope wasn’t going to change anything. I was dealing with a very real situation with noise day after day night after night. It wasn’t my imagination, and it wasn’t my neighbor’s imagination. It wasn’t a fictitious character having a water fight (or soda) with the neighbor across the way one night – another neighbor thought was a stampede. Psychiatrists need to address their god complexes and stop prescribing for conditions that don’t exist. They can’t be trusted. This is what happens when there is no biological disease. The diagnoses are all cooked up in their heads. Like I say, they’re the ones with psychoses.

  17. Where is the soul in this discussion? I appreciate all of the patient, hard work Dr. Hickey but I can’t help but wonder if we were all connected to our soul selves, to the transcendent power, we could be able to co create new solutions to the problem of the psyche-soul schism. The soul may be lost in psychiatry but the soul is eternal.

  18. First I believe the opinions stated in this blog are not just that of the author Dr. Hickey but likely millions of patients worldwide. When my younger brother, an engineer, musician and physically fit mountain climber was sad after a sad event of his marriage breakup his family doctor referred him to a psychiatrist. After he started the toxic drugs he went downhill and died. That was how he got “helped” by psychiatry.

    Thank you and bless you Dr. Hickey for meticulously dissecting the deception, spin and absurdity of psychiatry. Dr. Pies obviously realizes the “hostile” critics DO understand the sham of psychiatry and he therefore desperately clings to some sense of righteousness.

    As for the “silent spectators” it’s well known ‘silence is complicity’. So then the blame game must be employed but it was deplorable that Dr. Pies so squarely placed blame on the victims of psychiatry. Could he go any lower?
    As for Dr. Pies being wise, hmmm yes but more in keeping with how a crafty fox is wise is how I see it. Then comes the garbage pertaining to context and how Dr. Pies calls it “the fallacy of misplaced empathy”’. Wow I guess he can go lower as this certainly takes the cake.
    I agree Dr. Hickey it is very alarming that Dr. Pies wants to see psychiatry go out into the community to carry out more deception and brain washing. This is clearly all about the “stakes of the profession” and certainly not in the patient’s interests.

    • Hi Rosalee,
      Again, I’m sorry you lost your brother.
      I liken psychiatry and the whole concept of the “gazing look”, the idea of an “objective observer” as in a professional setting deeply disturbing.
      The damages and deaths of psychiatry are insidious. It can happen very slowly so that the family is blindsided, until many years later. And at first your mind goes back and forth, trying to come up with satisfactory answers,
      but it is a hard pill to swallow.

      • Thanks Sam, and that is exactly how it goes, your mind tries to believe there must have been something really “wrong” with the person for being sad as geez even an ‘expert’ couldn’t “help” them. It was not until my own encounter with a shallow, haughty ignorant young psychiatrist while in cancer treatment who pushed every imaginable psych drug at me and mocked me for the side effects (while I was already weakened and ill from chemo) that I realized what a travesty was done to my brother.

      • I liken psychiatry and the whole concept of the “gazing look”, the idea of an “objective observer” as in a professional setting deeply disturbing.

        This evokes quantum theory, which holds that there is no such thing as an objective observer, as the very presence of an observer changes the nature of that being observed.

        • Looking back at my, “time in treatment” (journey through hell), this dynamic makes so much sense and the realization makes me nauseous. I was familiar with the concept of the male gaze, but wasn’t strong enough/didn’t trust myself enough to make the connection.
          Most of the psychiatrists who were “treating” me were older men. I wonder if I became less interesting to them as I aged (following the ECT/borderline diagnosis/onset of polypharmacy, I aged quite rapidly). At a certain point, I became a freak to them. One of them whispered into my ear at the end of a “medication consult, “How many psychiatrists have you seen?” Ah, they are all gross, and I hope they do see some form of punishment.

          • Gender, race, ethnicity, class, sexualutt, poverty, status, credentials and disability – All the usual suspects, with stigmatising diagnosis can be and are employed to double down on prejudice, discrimination, discounting, denying or ignoring a person’s own subjective reality and the manifest denial of adversity, trauma and deprivation.

  19. At any rate Dr. Hickey,

    Suffering is a very real thing. Anyone who thinks otherwise has never experienced crippling depression, intrusive thoughts, panic attacks and the like. The problem is what they do or anyone does about them.

    I remember a person here who wrote about his ghastly experiences with hearing voices and how an anti-psychotic gave him relief. He was of the opinion that nothing is wrong with the DSM. There are plenty of people like that.

    There are also plenty of families frustrated with the behaviour of other family members who also see their solutions in psychiatry (even if that’s in some cases deceptive gaslighting for their own ends, while in other cases families really have good intentions).

    Antipsychiatry will not be taken seriously in the public eye with taglines like “mental illness is a myth” (even if it is true) until and unless people of the antipsychiatry variety are actually able to fix real world problems and find solutions to the issues that people have. They do have solutions sometimes. But it’s miniscule compared to the power of psychiatry.

    One must keep in mind that shrinks still have something to offer to someone (sometimes positive as in the aforementioned example), even if it’s problematic (sometimes horribly). You have to be realistic about this.

    If a man is suffering severely and a psychiatrist with the power of the pen and the prescription pad ends up fixing his issue, why will he bother about antipsychiatry? He’ll think everyone here are fools.

    Also, in a moment of acute pain, the only thing one thinks about is how to end their misery, no matter what form it takes. You are, for the most part, literally incapable of planning 10 or 20 years ahead.

    When people end up suffering due to psychiatry, they end up here, but it’s a still a niche minority.

    Also, I’ve noticed for the last many years, it’s the same old commenters (including myself) who post here. Lots of comments. But very few commenters. Hardly a drop in a massive ocean.

    Compare this to psychiatry sites which have memberships in the thousands, tens of thousands or hundreds of thousands.

    You’re drowned out.

    • For eons things like domestic violence, incest, slavery, and government control of homosexuality was condoned. People would have not spoken up.
      A human society is constantly reinventing itself. They could not have gotten anywhere if not for overtaking indigenous lands and lives, stealing people for slavery. Was that okay? It must have been because no one spoke up. The ones who thought it was a problem were those without power.

      I might not have a problem with psychiatry if they dressed according to their jobs. Uniforms of power, proper identification. What EXACTLY does a shrink do that you cannot? Use language and have power over the public through use of the title “doctor”. There is absolutely NOTHING doctor about them.
      What does a psychiatrist choose to use in order to impress upon the public that “mental illness” is real? He does not use “grieving disorder”. He uses the word “schizophrenia”. And he does so in front of an audience because he knows the audience believes in that.
      How did dealing with adults morph into “treating” masses of children for invented “disorders”? Psychiatry removed masses of children from homes and put them into loveless environments, along with a brain altering substance for the child. Because they care?

      There are literally thousands of ways that families could be helped. Psychiatry is preventing that from becoming the new normal. So I guess we will just accept their shitty institutions? Because we have nothing else? Women put up with lots of beatings in marriages because there was no one or nothing else.
      It might be a good thing to just drug these beaten women and children. Just so they behave and are not “depressed”.

      You are correct, people suffer. And psychiatry takes good care of them? Fulfilling the need? The need is chemicals? Even though the “chemical” theory was debunked? Because that IS what psychiatry does. When a wife is depressed, why is it that the family or spouse is more than willing to send that woman off to a shrink or counselor?
      And how many people now think that suffering is abnormal? Who taught people that? Who taught them that depression is like a medical condition? Who taught teenagers that being panicky and having angst, fears, are “mental disorders”?
      Who is still handing out chemicals and neurotoxins even though psychiatry themselves says it’s not a chemical problem?
      And even if a certain chemical happened more in a depressed person, that would have been a result not the cause.
      Suffering will never ever be made better by psychiatry.

  20. Dr. Hickey,

    Have any of you or like minded colleagues ever thought of starting something like a Journal of Antipsychiatry? Something that does proper research of the kind that psychiatry might never do in the interest of self-preservation? It would be blasted on release but you just have to roll with the punches.

    What research exists on issues like gaslighting or socio-legal problems that psychiatry creates or the incidence of revolving door syndrome in psychiatry and the like?

  21. Please remember that you can not lose what you don’t have, i.e. a soul. Well, maybe some had a soul before they started “practicing” or maybe when they were children. Or, they, those little bullies in the school playground who always stole the other children’s lunches or pushed the other children off the swings and monkey bars, so they could “comfort” them and make themselves look “good” to their teachers? Thank you.

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