Robert, thank you for taking the time to reflect and articulate so beautifully the ways that Aviv’s New Yorker article failed to capture the issues and perpetuated the mainstream media dodging of the problems of the current psychiatric paradigm. So disappointing. I wrote a letter to the editor of the New Yorker which, unsurprisingly, was not published. Since I took the trouble to write it, I am sharing it below, preaching to the choir: In “Bitter Pill”, the prominent psychiatrist Ron Pies is quoted as saying, “…most psychiatrists who use this expression”—that the pills fix chemical imbalances—“feel uncomfortable and a little embarrassed when they do so. It’s kind of a bumper-sticker phrase that saves time.” And Wayne Goodman, former chair of the FDA Psychopharmacologic Drugs Advisory Committee, is quoted as regarding the notion of a chemical imbalance as a “useful metaphor”. The casually disingenuous stance represented by the above statements is actively harmful and manipulative, representing a failure of the profession of psychiatry to provide the transparency required for patients to meaningfully participate in decisions about taking psychiatric medications. The idea of a chemical imbalance, though unsubstantiated, is still believed to be literal by a majority of the population and by a great many mental health professionals, slipping under patients’ defenses and providing authoritative leverage for the kind of psychiatric medication abuse experienced by Ms Delano. While psychiatrists may feel “a little embarrassed” allowing the myth of the chemical imbalance to pervade their prescribing practice, credulous patients are denied autonomy to make informed decisions. Patients may, for example, be unaware that by taking an SSRI they are risking a profound loss of the ability to experience sexual feelings and sensations, and for an unknown number of patients this loss may persist after stopping the medications. Or some, despite best efforts, may never be able to stop taking the medications due to intractable withdrawal symptoms. If a privileged Harvard student getting the best psychiatric care available believed a chemical imbalance was being precisely recalibrated for over a decade and through 19 different disabling medications, what chance does the average patient or their family have of receiving accurate informed consent? Psychiatric survivors themselves have filled a tremendous gap in public health by bringing every day harms and protracted withdrawal phenomena to public attention. When will the profession of psychiatry, other prescribing professionals, as well as the allied health professionals who refer patients to an opaque and potentially harmful system step up and take responsibility to deliver appropriate informed consent?