Dr. Pies’ Non-Apology

Philip Hickey, PhD
25
937
INTRODUCTION

On June 23, 2020, Awais Aftab, MD, a clinical professor of psychiatry at Case Western, interviewed Ronald Pies, MD, also a psychiatrist, and a professor at Tufts and SUNY.

During the interview, Dr. Aftab stated:

“I have followed the controversy surrounding ‘chemical imbalance’ with some interest over the years, including the multiple articles you have written on this issue. 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?”

To which Dr. Pies responded:

“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! I wish I had tackled the issue earlier than my 2011 article.11

“Mad Men”, incidentally, for those not familiar with the term, means people who work in the advertising industry in Madison Avenue, New York.

“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.

This struck me as an egregious display of disrespect towards the people on whom the great and learned doctor depends for a living, and on November 5, 2020, I wrote a post critiquing many of the positions Dr. Pies promoted in the interview, especially the expressions of disrespect that he had directed towards psychiatric customers.

The Aftab-Pies interview was about seven months ago, and to the best of my knowledge, Dr. Pies made no public comment on the interview until January 12, 2021.  On that date, he published on Psychiatric Times a piece titled What We Tell Patients about Depression, and What They Say They Have Been Told (subtitle:  Is there a way to find balance in discussing the chemical imbalance theory of depression?).  On first glance, I thought that this was going to be an apology.  But I was mistaken.  Here are the two opening paragraphs:

“Since my interview with Awais Aftab, MD, I have received a good deal of feedback on my positions, both pro and con. Upon further reflection, I would like to clarify my position regarding the following comments I made in the interview:”

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.

Notice the word “clarify” in the first paragraph.  So the piece is not an apology; it’s a “clarification”.  But more importantly, notice that he has omitted more than half of the second paragraph.  Compare the second quote above to the full paragraph quoted by me earlier.  He has omitted everything from:

“So, we are really left to speculate…”  to  “causes and risk factors.

It could be argued that this was merely an oversight on Dr. Pies’ part, but the vituperative tone of the omitted material casts doubt on such an interpretation.  Difficult as it may be for us to countenance, it seems credible that the omission stems more from an effort to whitewash his earlier remarks than from an oversight.

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

Then he continues:

“I regret that I did not state my point more clearly.”

Actually, I thought he stated his point with total clarity:

Clients can’t be trusted to tell the truth, unless their statements are confirmed by their psychiatrists.

Back to the non-apology article:

“In particular, I inadvertently implied that the psychiatrist’s recollections or case notes are, in some sense, always dispositive regarding what patients were actually or really told, as if psychiatrists were infallible recorders of what was said in a session.”

Note the “inadvertently implied”.  And glance back at what he said in the interview.  It is difficult to believe that the latter represented a series of inadvertent slips of the tongue rather than his heartfelt, petulant, and prejudicial beliefs.

  • We often hear anecdotes;
  • Where is the evidence…?
  • Who has contacted the psychiatrist?
  • Who has reviewed the case notes?
  • to see if that was really what the patient was told?
  • There has never been a study;
  • patients are not infallible recorders of what their doctors tell them;
  • I consider this really a fruitless debate;
  • unless and until I see contemporaneous documentation of what patients were actually told by their psychiatrists;
  • a large ‘N’ of psychiatrists confirm; etc.

None of this sounds remotely inadvertent.  Rather, it sounds pretty much like a very specific, well-rehearsed, and disrespectful client-bashing narrative.

In addition, Dr. Pies’ meaning was not lost on Dr. Aftab, whose response to Dr. Pies’ outburst included the following:

“You have already stated that you would need a high level of evidence to change your mind,”

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

From there, the present non-apology piece goes steadily downhill.

“This was not my intention, nor is it my belief.”

It seems clear from all this that Dr. Pies’ priority in this matter is to remove from his reputation the stain left by his earlier attack on the credibility of his clients.

“My point in the interview was that any valid claim or report regarding what patients have been told about so-called ‘chemical imbalances’ must take into account not only the patient’s recollection, but also: what psychiatrists themselves recall saying; what they intended to convey; and in what context the term chemical imbalance was used.”

This was most emphatically NOT the point that the eminent doctor made in the interview.

The point that he made in the interview was simple and clear:  psychiatric clients are not credible unless their statements are confirmed by the psychiatrist.

It should also be noted that it is not at all unusual – at least in my experience – for psychiatrists to dismiss, and even ridicule, the statements and assertions of clients as not credible, especially if these reports are critical, or even questioning, of psychiatrists, or their methods.  Critical self-scrutiny is a rare quality in the psychiatric community.

GASLIGHTING

Back to the non-apology paper:

“For example, did the psychiatrist say something like, ‘Your illness is definitely caused by a chemical imbalance’? Or was it more like, ‘We don’t know the precise causes of depression, but chemical changes in the brain may play some role, along with psychological, social, and environmental factors’?”

Which to my reading smacks a little of:  come now, my dear (or sir), are you sure that the psychiatrist didn’t say something along the lines of….

This is pure gaslighting.  Are you sure that you’re not misremembering?  Are you sure that the psychiatrist said those exact words?  Perhaps he (or she) explained the matter in more detail?  Didn’t he (or she) mention psychological or social factors such as …?  Didn’t he (or she) stress the importance of environmental matters? …

So, not only is Dr. Pies failing to apologize for his earlier expressions of disrespect, he’s actually piling on more!

DOCUMENTED MALINGERING

Back to the non-apology:

“In addition, the therapeutic alliance is built on trust. Accordingly, our patients’ reports should always be considered prima facie credible, absent extraordinarily compelling evidence to the contrary (eg, obvious delusions, documented malingering, and so on). But credible – ie, worthy of belief or confidence – does not necessarily mean factually correct in all aspects and details. The same may be said, of course, of claims made by clinicians.”

Note the phrase “documented malingering”, which raises the question:  documented by whom?  We’re back presumably to the psychiatrists’ case notes, which in Dr. Pies’ world are clearly the preferential source of truth.

BELIEF ABOUT THE CAUSES OF DEPRESSION

Dr. Pies then cites a recent study which “…evaluated the prevalence of etiological beliefs about depression in a sample of acutely distressed psychiatric patients in an intensive hospital treatment program.”  The study cited is Schroder et al Stressors and chemical imbalances: Beliefs about the causes of depression in an acute psychiatric treatment sample, Journal of Affective Disorders 276 (2020) 537–545.  The study was conducted at McLean Hospital and Harvard Medical School.  Here’s what Dr. Pies wrote about the study:

“The study found that the most commonly endorsed explanation for depression was not one invoking the chemical imbalance notion; rather, psychosocial explanations of depression were the most commonly endorsed etiology, with the chemical imbalance belief coming in second. The authors noted that popular beliefs about what causes depression ‘may be adopted from a variety of external sources, including television advertisements, anti-stigma campaigns promoting biogenetic explanations, and discussions with treatment providers.1‘”

This summary of Dr. Pies’, however, is extremely misleading.  Here are some quotes from elsewhere in Schroder et al:

“In current times, as the medical model of psychiatry has risen in popularity in the United States, conceptions of mental distress as stemming primarily from biological, chemical, or genetic abnormalities – what we refer to here as biogenetic explanations – have become increasingly widespread.” (p 537)

“The most well-known biogenetic explanation is the ‘chemical imbalance theory’, according to which depression is caused by an imbalance in neurotransmitters.” (p 537)

“The chemical imbalance belief is the most widely endorsed biogenetic explanation of depression. In one study of 262 undergraduate students taking a psychology course (France et al., 2007), nearly all (91.6%) participants were familiar with the chemical imbalance explanation, which was endorsed as a potential cause of depression by 84.7% of participants vs. 61.8% who endorsed the genetics/inherited belief. Additionally, in a study of 1829 people who were using or had recently used prescription antidepressants, 84.8% agreed that a chemical imbalance was a likely cause of depression, whereas 77.4% agreed that heredity played a role, and 70.7% agreed that depression was caused by a disorder of the brain (Read et al., 2014). To summarize, although psychosocial explanations of depression are the most commonly endorsed, biogenetic explanations – especially the chemical imbalance explanation – have risen in recent years, especially in the United States.” (p 538)

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

And here are some quotes from Schroder et al concerning their recent study:

“Patients rated the likelihood that depression was caused by psychogenic causes (ongoing stressors and childhood adversity) and biogenetic causes (chemical imbalances and genetic problems)” (p 538)

So Schroder et al used two factors to assess the prevalence of psychogenic causal beliefs (ongoing stressors and childhood adversity) and two factors (chemical imbalances and genetic problems) to assess the prevalence of biogenetic causes, and found:

“Consistent with past findings, the most strongly endorsed belief was the ongoing stressor belief, followed by the chemical imbalance belief, genetic belief, and finally the childhood belief.” (p 540)

However,

“Endorsement of the chemical imbalance belief was not significantly different from the ongoing stressor belief…p = .15…” (p 540) [Emphasis added]

“…compared with psychogenic beliefs, chemical imbalance beliefs were endorsed nearly as strongly (ongoing stressor explanation) or more strongly (childhood events explanation).” (p 540)

and:

“…when examining individual predictors in Step 2, the chemical imbalance belief predicted significantly more depressive symptoms at discharge. None of the other belief items were significant predictors of discharge PHQ-9 scores…” (p 542) [Emphasis added]    (The PHQ-9 is the nine-item Patient Health Questionnaire and is widely used as a measure of depressive “symptoms”.)

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

DR. PIES’ FURTHER DISTORTION OF SCHRODER ET AL’S FINDINGS

Here’s the actual quote that Dr. Pies took from the study:

[These viewpoints, as to what causes depression] “may be adopted from a variety of external sources, including television advertisements, antistigma campaigns promoting biogenetic explanations, and discussions with treatment providers.” (p 543) [Emphasis in original]

After which, Dr. Pies continues with a discussion of potential internal sources of belief.

But, and this is the critical distortion, Dr. Pies skipped about two column inches between “discussions with treatment providers” and the “internal sources” material.  And those two column inches are the most critical part of Schroder et al from the present perspective.  Here’s what was omitted:

“The latter [discussions with treatment providers] is likely to have had an effect in the present sample, as the patients here had significant inpatient hospitalization experience – where medical terms and assessments are abundant. Indeed, in the present data, the number of prior inpatient hospitalizations was associated with endorsement of both the chemical imbalance belief and the genetic belief but not the psychogenic belief items.  Although these are correlational data, these findings may suggest that further or deeper experience with intensive psychiatric treatment fosters the adoption of more biogenetic beliefs. Further, nearly all patients were prescribed at least one psychiatric medication, and merely taking medication may reinforce the putative biochemical origins of the problem. If so, extensive psychiatric care may reinforce biogenetic beliefs in highly depressed patients – those most sensitive to the negative consequences of the beliefs.” (p 543) [Emphasis added]

It is, of course, entirely possible that Dr. Pies merely overlooked the critical two column inches, and also overlooked the fact that the finding he cited did not even come close to statistical significance, though it is difficult to reconcile such an interpretation with his reputation as a great thinker and scholar, and the critical importance of the omitted material.

One is compelled to wonder whether Dr. Pies actually read Schroder et al, or merely skimmed through, looking for a quote to support his preconceived position.

Dr. Pies continues his non-apology:

“All of this is simply to note that popularization of the chemical imbalance canard is almost certainly an over-determined effect, in which the role of psychiatrists (or other clinicians) is but 1 possible causal factor.”

In this paragraph, Dr. Pies appears to be attributing this conclusion to Schroder et al, but he is omitting any reference to the two column inches that he “conveniently” ignored, and to other material from Schroder et al that he also “conveniently” ignored.  Schroder et al do not assert, or even imply, that the role of psychiatrists “is but 1 possible causal factor”.  On the contrary, they suggest, based on the very research that Dr. Pies himself has introduced into the discussion, that psychiatric input of the chemical imbalance message may be the most important causal factor, and that this input in turn may have a deleterious effect on treatment efficacy.

Here are Schroder et al’s actual conclusions as given in their final paragraph under the heading Limitations and Conclusions:

“As we noted at the outset, public perceptions of mental distress have changed over the course of history. Sociologists have documented the various consequences of these etiological perceptions – including what we would now consider to be unethical treatments (Conrad and Schneider, 1980). As the public is increasingly exposed to and accepting of biogenetic explanations of mental distress, it is paramount to acknowledge some unintended consequences of this narrative. Our findings are in line with accumulating evidence that some biogenetic beliefs, like the chemical imbalance belief, are linked with poorer expectations for improvement, especially among those with the most troubling symptoms. Further research is warranted to understand the etiology and rising popularity of these beliefs, particularly in clinical settings, and to promote alternative messaging that may help foster more positive feelings toward treatment.” (p 544)

Note in particular the clear statement:

“Our findings are in line with accumulating evidence that some biogenetic beliefs, like the chemical imbalance belief, are linked with poorer expectations for improvement, especially among those with the most troubling symptoms”,

which when read in conjunction with the earlier Schroder et al excerpt [“The latter is likely to…”] means that psychiatrists for about the past fifty years have been effectively encouraging clients to expect poor outcomes in the psychiatric “treatment” of depression.  And, unsurprisingly, poor outcomes is precisely what they all too frequently receive.

BACK TO THE ISSUE IN HAND

All this, of course, is wonderfully heartening, but actually has nothing to do with the issue in hand.

The issue in hand is the dismissive and frankly insulting way that Dr. Pies vilified psychiatric clients as lacking in credibility unless their statements could be verified by their psychiatrists.

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

Not only has Dr. Pies failed to address the main issue, he opens up another self-exculpatory avenue.

“I believe that in the near decade since I described the chemical imbalance notion as a kind of urban legend,2 psychiatry has matured and deepened in its mode of explanation to patients – though research on that point is sorely needed.”

So, over the past ten years or so, Dr. Pies tells us:

“…psychiatry has matured and deepened in its mode of explanation to patients…”

The only interpretation I can put on this last assertion is that Dr. Pies is conceding that psychiatry’s “mode of explanation to patients” is improving (maturing and deepening).  And given the context of the discussion, the only kind of improvement that makes any sense would be a shift from chemical imbalance explanations, to something more accurate.  So Dr. Pies is apparently conceding that back in those bad old days (ten years ago), the explanations of their “disorders” that psychiatrists were giving to their customers were based on the chemical imbalance deception or possibly other biogenetic theories.

And, although in the Urban Legend piece (2011) Dr. Pies stated categorically that:

“In the past 30 years, I don’t believe I have ever heard a knowledgeable, well-trained psychiatrist make such a preposterous claim [the chemical imbalance theory], except perhaps to mock it.”

he now seems to be acknowledging that psychiatrists were at that same time explaining depression to their clients in chemical imbalance terms.

He then goes on to make things even worse:

“For now, the best explanation we have is that clinically significant depression is the outcome of biological, psychosocial, environmental, and even spiritual causes.3 The relative contribution of any single component almost certainly varies from patient to patient, and case to case. I believe that well-informed psychiatrists have known and embraced that holistic view for decades.  The remaining challenge lies in communicating it clearly and consistently to our patients—and on that score, we can all do better.”

So, if we stay with the narrative here, well-informed psychiatrists have known for decades that the chemical imbalance explanation is nonsense, but nevertheless went on dishing it out to their “patients”.  Or I suppose there could be another interpretation:  there were remarkably few well-informed psychiatrists in those bad old days.  So which is better, to be a deceiver or to be ill-informed?

The bottom line in all of this is very simple:  psychiatrists, including Dr. Pies himself, promoted the chemical imbalance deception of depression, even though they knew it to be false, and had every reason to recognize that it is associated with poorer expectations for improvement.  Indeed, it’s not a huge leap to attribute psychiatry’s frequently-endorsed injunction, that anti-depressants had to be taken for life, to this deception, that was, and still is, being avidly and self-servingly promoted by psychiatrists.  After all, if one’s neurotransmitters are “unbalanced”, and this affliction is corrected by drugs, isn’t it reasonable to infer that, as the drugs are metabolized, they will need to be topped up indefinitely?

AND FINALLY

I printed a copy of Dr. Pies’ non-apology shortly after it was published on January 12, 2021.  At that time, the final words in the text were:  “…and  on that score, we can all do better.”  However, when I opened the article again on February 2, an additional two paragraphs had been added:

“I am aware that the American Psychiatric Association once had a statement posted on their public education website that referred to ‘imbalances in brain chemistry.’ I am happy to report that, in response to my conferring with the APA, the old statement has been deleted and replaced with the following:”

“‘While the precise mechanism of action of psychiatric medications is not fully understood, they may beneficially modulate chemical signaling and communication within the brain, which may reduce some symptoms of psychiatric disorders.'”

Here’s a screenshot of what was formerly the final paragraph, with the two-paragraph addition:

 

It is clear that Dr. Pies is pleased with this change, though it still seems very like chemical imbalance to me.  But much more importantly, Dr. Pies doesn’t seem to realize that it gives the lie to his frequent assertion that no official psychiatric body had ever endorsed the chemical imbalance theory of depression.  For instance;

“Moreover…psychiatry as a profession and medical specialty never endorsed such a bogus ‘theory,’ when judged by its professional organizations, its peer-reviewed publications, its standard textbooks, or its official pronouncements.” (here) [Emphasis added]

and

“Yes, our critics tirelessly quote this or that notable psychiatrist who used the phrase, ‘chemical imbalance,’ but this doesn’t mean the psychiatric profession as a whole ever embraced the chemical imbalance theory. Nor was it ever a model espoused by academic psychiatrists, or the official position of our professional organizations.” (here) [Emphasis added]

Yet here he admits that he himself had approached the APA and persuaded them to delete from their public education website a reference to “imbalances in brain chemistry”.

He is probably just confused.

ACKNOWLEDGEMENT

In his non-apology piece, Dr. Pies thanks Joe Pierre, MD, for referring the Schroder et al piece to him.  Given what Schroder et al found, I feel that I should also extend my thanks to Dr. Pierre, and indeed to our eminent scholar Dr. Pies himself, for providing this important support to the anti-psychiatry movement.  May their pens never cease to flow.

 

***

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.

25 COMMENTS

  1. Well, the first thing overlooked was that depression isn’t a disease at all, but a syndrome-a collection of signs and symptoms that can have any of multiple origins as causes. This is why antidepressants are frequently useless or harmful, particularly for “PPD”, which is frequently brought on by copper excess, or “dysperceptive depression”, where the doctor doesn’t notice, or ignores his/her patient’s perceptual status and ongoing perceptual distortions and/or irregularities.

  2. My initial thought is, how about we just start citing Pies as our documentation every time we debunk the chemical imbalance hypothesis? He should be happy to comply.

    I notice the notion of what the term “medical model” is as used by Schroder et al. is different from what Szasz meant by the term. ALL psychiatry is a “medical model,” as it is based on the notion of “mental illness” as an actual disease and requires an M.D. to practice. The use of “medical model” to describe the increased use of psychiatric neurotoxins — what some refer to as “biological psychiatry” — is not what Szasz meant by “medical model,” nor is it what I mean. Schroder uses the phrase “medical model of psychiatry,” however Szasz was not referring to models of psychiatry; he was referring to the psychiatric model of emotional distress.

    • I think that is an important distinction. The conceptualization of emotional distress as existing in the BODY of the distressed person is the central evil that psychiatry is based on. The rest is all footnotes to blaming the patient/client for their own suffering. If it’s in their bodies, then it’s not something the powerful (or anyone) in society needs to worry or think about.

      • The conceptualization of emotional distress as existing in the BODY of the distressed person is the central evil that psychiatry is based on.

        Not what I mean. The ESSENTIAL fallacy of psychiatry is that the “mind” — an abstraction — can be “ill,” which any of the relatively few people left who understand what metaphors are should clearly understand. (Though even Chomsky’s linguistic understanding seems to lapse when it comes to psychiatry.)

        Anyway psychiatry’s “central evil” is the blatant absurdity that “mental illness” can exist at all, other than in bad poetry. So-called “biological psychiatry” is a permutation which takes this basic falsehood a step further by postulating that unwanted emotional states are caused by the wayward interactions of brain chemicals — which if true would represent a physical disease — yet they still speak of “mental” illness. So again, the very existence of “mental” illness is the cornerstone of psychiatry, which is what Szasz meant by the “medical model.”

        I think the key distinction I made above was in the last sentence:

        Schroder uses the phrase “medical model of psychiatry,” however Szasz was not referring to models of psychiatry; he was referring to the psychiatric model of emotional distress.

  3. “It seems clear from all this that Dr. Pies’ priority in this matter is to remove from his reputation the stain left by his earlier attack on the credibility of his clients.” I’m pretty certain the goal of too many of the psychiatrists is to “attack the credibility” of their clients, since none of their DSM disorders, have any scientific “validity,” whatsoever.

    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

    “psychiatric clients are not credible unless their statements are confirmed by the psychiatrist.” Well, my entire life was declared “a credible fictional story,” by a psychiatrist who freely admitted within his medical records, “not believed by doctor,” and he got all his misinformation about me from child rape cover uppers and pedophiles, according to my family’s medical records, as well.

    “This is pure gaslighting,” yes, that is what the majority of the psychiatric and psychological industries are all about.

    “But credible – ie, worthy of belief or confidence – does not necessarily mean factually correct in all aspects and details. The same may be said, of course, of claims made by clinicians.”

    Since few of them seemingly know the ADHD drugs and antidepressants can create the “bipolar” symptoms. Thus over a million children have already had the common adverse, and withdrawal, symptoms of those drug classes misdiagnosed, as “bipolar.”

    https://www.alternet.org/2010/04/are_prozac_and_other_psychiatric_drugs_causing_the_astonishing_rise_of_mental_illness_in_america/

    And I found in my medical research, that the “schizophrenia” treatments, which will be given to most those misdiagnosed “bipolar” children. Can create both the positive and negative symptoms of “schizophrenia,” via anticholinergic toxidrome, and neuroleptic induced deficit disorder.

    https://en.wikipedia.org/wiki/Toxidrome
    https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome

    “In one study of 262 undergraduate students taking a psychology course (France et al., 2007), nearly all (91.6%) participants were familiar with the chemical imbalance explanation, which was endorsed as a potential cause of depression by 84.7% of participants vs. 61.8% who endorsed the genetics/inherited belief.”

    Yet I know from dealing with “mental health” workers in real life, that they believe in both in the “genetics/inherited belief,” and when that doesn’t work, they espouse the “chemical imbalance” theory.

    “To summarize, although psychosocial explanations of depression are the most commonly endorsed, biogenetic explanations – especially the chemical imbalance explanation – have risen in recent years, especially in the United States.”

    America needs to make scientific fraud based pharmaceutical advertising illegal. We were told it was illegal, in our marketing schools, but our government made it legal.

    “Consistent with past findings, the most strongly endorsed belief was the ongoing stressor belief, followed by the chemical imbalance belief, genetic belief, and finally the childhood belief.”

    Which is highly hypocritical, given the reality that over 80% of those defamed with the DSM disorders are, in fact, child abuse survivors, NOT dangerous criminals. And the psychological industries have been systemic child abuse cover uppers, for over a century.

    https://www.madinamerica.com/2016/04/heal-for-life/
    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo

    “psychiatrists for about the past fifty years have been effectively encouraging clients to expect poor outcomes in the psychiatric ‘treatment’ of depression.”

    And they’re systemic crimes have come to fruition.

    “For now, the best explanation we have is that clinically significant depression is the outcome of biological, psychosocial, environmental, and even spiritual causes.3 The relative contribution of any single component almost certainly varies from patient to patient, and case to case. I believe that well-informed psychiatrists have known and embraced that holistic view for decades.”

    Not my psychologist and psychiatrists, they were all Holy Spirit blasphemers, according to my medical records.

    “Moreover…psychiatry as a profession and medical specialty never endorsed such a bogus ‘theory,’” yes they did. And many psychiatrists and psychologists chose to act like Holy Spirit blaspheming, unrepentant nut cases, while raping our entire economy for their malpractice insurance.

    Criminals, who, if there actually is a God, will likely be following Satan to the lake of fire. Since, they had “delusions of grandeur” they were the judges of all of humanity, rather than God.

    Thank you, as always, Philip, for speaking the truth. I’m so grateful some psychologists and psychiatrists are NOT on the side of Satan, and are speaking the truth. And seemingly understand they shouldn’t have been given the right to play judge, jury and executioner to anyone, by our governments.

    Especially since the psychiatric industry is murdering “8 million” people, EVERY year, with their “invalid” DSM disorders, and their neurotoxic psychiatric drugs.

    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2015/mortality-and-mental-disorders.shtml

    Thank God, for the decent psychologists, Philip.

  4. I consider the “bio-psycho-social” model of psychiatry merely a rationalizing of the “biological” model of psychiatry that is so prevalent today. If psychiatrists didn’t believe in some version of the “chemical imbalance theory” they wouldn’t be damaging their client/patients by giving them harmful psychotropic drugs. One thing psychiatrists within the public mental health system seldom do, and I figure it would be done if they weren’t so thoroughly under the spell of the drug industry, is to allow client/patients the option of going without psychiatric drugs. Even the arguments Dr. Ronald Pies is trying to make that we doctors don’t really say that sort of flies in the face of the fact that regardless of what they say they really do that sort of thing (strive to control behaviors with drugs) all the time.

    I feel that the so-called “bio-psycho-social” model of treatment, in the main, is just more “bio-bio-bio” psychiatry trying to cover for itself.

    Thanks for disputing Dr. Pies claims and for generating discussion on the issue.

    • Right essential their response is, “we don’t say there is a chemical imbalance because we say there is a biological defect and stress and social factors. Now take this drug that corrects a chemical imbalance.”

      They keep saying despite all evidence opposing them that “mental illness” is caused by genetics and biology. It doesn’t matter if they tack on a “social factors also contribute” they are still lying and the research shows their lies cause massive harm.

  5. Thanks so much Phil. Have you had tea yet with Dr Pies? 🙂 And can we come?

    “In addition, the therapeutic alliance is built on trust. Accordingly, our patients’ reports should always be considered prima facie credible, absent extraordinarily compelling evidence to the contrary (eg, obvious delusions, documented malingering, and so on). But credible – ie, worthy of belief or confidence – does not necessarily mean factually correct in all aspects and details. The same may be said, of course, of claims made by clinicians.”

    This made me snicker. What a politician. And a crappy one at that.

  6. But psychiatry doesn’t often even get hold of a patient until after the family doctor has already drugged them. Referrals to psychiatrists include a huge number of people who are ALREADY DRUGGED! I wasn’t referred to a psychiatrist until several months after my family doctor had poly drugged me for fibromyalgia. My bipolar diagnosis came from the SSRI-induced suicide attempt. And I’d already had several drug changes at that point, so in addition to being used as a punching bag by my husband, I was going through sudden withdrawals and effects of new drugs. What happened to me was a crime, and it wasn’t the fault of a psychiatrist (yet). My family doctor’s specialty was in gynecology! And even then, when I became so emotionally volatile from the drugs combined with current spousal abuse, that I started opening up about childhood traumas, he couldn’t get me out of there fast enough because his colleague in the practice was my mother’s business partner and financier of her businesses! If there was anyone I ever should have sued, it was that wreckless asshole!

    But as for Dr Pies, I have an entire binder full of papers from various hospitalizations talking about the chemical imbalance. It’s what we learned in our required “medication education” groups both inpatient and outpatient. We were given pill boxes with the names of psych drugs on them to fill with our medications to help us keep track of taking our “meds”.

    Everyone talked about “better living through chemistry” and all you ever heard in the news was some horrific thing somebody did when they “went off their meds”. The entire culture of mental health is built up around the theory that some people “have” this thing called “severe mental illness” and they are “dangerous” when they’re “off their meds”. And I don’t know about anyone else, but I’m fucking done being the cultural boogeyman so that the people who cause and perpetuate so very much harm can continue to get away with it.

    There will never be any redemption for the likes of Dr Pies and his ilk. He’s trying to rewrite history to assuage his own guilt and he go to Hell.

  7. Here are two statements that stand out to me : “poorer expectations for improvement” and “psychiatric clients are not credible unless the statements are by the psychiatrist.” The latter one was so important to the author of this article, it was printed in bold type. But, I will confront the first statement, first… I noticed in my way too many years as a “psychiatric client” how this statement became more and more true in the eyes of the mental illness providers. In fact those who, without a doubt, swore by this statement, were now migrating into what we call regular or traditional medicine. So, what is the only rational thought a patient/client might have, “Why go to the any medical professional? I am not going to get better anyway.” But, what is even more important here is how this type of statement fortifies the psychiatrist or any M.D.’s decision to keep the patient in the “drug diapers” forever. This also includes other types of therapies or treatments that keep one dependent on them. Now, the latter statement shows Hubris, to the nth degree and also fortifies the statement regarding “poorer expectations for improvement.” I am not sure what else to say, except that if you choose to go to a “mental illness provider” you lose and more and more each day; if you choose to go to a traditional medical provider, you are more likely to lose. Total reform is necessary, including the abolishment especially of psychiatry; but, how can that be accomplished when so many subscribe to the old adage, “My mind is made up, don’t confuse me with the facts.” Thank you.

    • Total reform is necessary, including the abolishment especially of psychiatry; but, how can that be accomplished when so many subscribe to the old adage, “My mind is made up, don’t confuse me with the facts.”

      Don’t want to bug you Rebel but there are answers to that you won’t be finding at MIA, at least not any time soon. But there are forums for such strategizing and we look forward to seeing you there whenever you feel ready.
      (P.S. We’re not a cult!) 🙂

      BTW “reform” and “abolition” are opposites.

      Consider that often the most destructive aspect of psychiatry is not the “treatment” but the inculcation of the self-limiting belief that one is “diseased” or “broken,” when he/she in fact reacting naturally to unnatural circumstances.

    • I wonder even if a lot of psych survivors don’t get or understand how deeply entrenched in the psych theories, regular medicine is. But then, you have to have been there for it to mean something.

      I’m starting to understand though that these psych practices regular medicine (real medicine) engages in, is not because they have an actual belief in it, but because it is convenient to get rid of the clients that are chronic. But even for new patients, doctors are more and more ready and armed, to get rid of you. I think because becoming a doctor is so often related to heredity, and privilege and not because “my passion is getting to know people and how to help them better”.
      I have asked quite a few young ones why they went into medicine and the answers are rather concerning. and so I think you are correct that they go by “My mind is made up, don’t confuse me with the fact”. So not so much about them actually subscribing to theory, but much more about the power to find protected ways to get rid of people.
      This is also what the educational system does with kids that annoy teachers, or with old people who annoy healthcare aides and nurses, or prisoners.

  8. Dr. Hickey, “whitewash” is a very fitting word for how Dr. Pies keeps trying to cover up his harmful tracks. Some psychiatrists are very adept at being ‘spin doctors’ and Dr. Pies is trying to be the best spin doctor out there. These whitewashing tactics would be laughable if they weren’t so devious and destructive to trusting and vulnerable patients.

    Thank you for your brilliant blogs that so clearly expose the ongoing whitewashing and self-serving deceptions.

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