Psychiatrist Ronald Pies shocked shocked shocked by "chemical imbalance" allegations

[Altostrata]

Dr. Pies claims no decent psychiatrist ever propounded the "chemical imbalance" theory, it was all a plot by the drug companies, and critics "mendaciously attribute" it to poor misunderstood psychiatry.

 

In a revisionist parry, the editor-in-chief of Psychiatry Times suggests psychiatry has been moving towards a revolutionary "biosocial" model -- addressing the patient's history and environment as a cause for problems.

 

You may recognize Dr. Pies as a ubiquitous, good-natured defender of psychiatry wherever it might be criticized on the Web.

 

His e-mail address is ronpies (at) massmed.org

 

Psychiatry’s New Brain-Mind and the Legend of the “Chemical Imbalance”

By Ronald Pies, MD Psychiatric Times July 11, 2011

 

....

I am not one who easily loses his temper, but I confess to experiencing markedly increased limbic activity whenever I hear someone proclaim, “Psychiatrists think all mental disorders are due to a chemical imbalance!” In the past 30 years, I don’t believe I have ever heard a knowledgeable, well-trained psychiatrist make such a preposterous claim, except perhaps to mock it. On the other hand, the “chemical imbalance” trope has been tossed around a great deal by opponents of psychiatry, who mendaciously attribute the phrase to psychiatrists themselves.2 And, yes—the “chemical imbalance” image has been vigorously promoted by some pharmaceutical companies, often to the detriment of our patients’ understanding.3 In truth, the “chemical imbalance” notion was always a kind of urban legend- - never a theory seriously propounded by well-informed psychiatrists.

 

Fortunately, recent advances in cognitive psychology and neuroscience are now converging, with the result that psychiatry may be on the brink of a unified model of so-called mental illness. (The term itself, as we shall see, is belied by the new research). As described at the APA’s 2011 annual meeting by NIMH Director Thomas Insel, MD, neuropsychiatric research is pointing to a complex interplay between factors traditionally dichotomized as “biological” and “psychosocial”.4

 

As Insel describes the new model, conditions such as schizophrenia or bipolar disorder are attributable to rare, but highly potent, genetic variations that lead to dysfunction in multiple, complex brain circuits. However, the particular symptomatic manifestations in a given individual-—the disease phenotype—is partly dependent on the person’s experiences and environment. We may hypothesize (and this is my view, not necessarily Dr. Insel’s) that given developmentally-based “biases” in various neurocircuits, the young boy or girl may be predisposed to the use of certain dysfunctional cognitive strategies; for example, viewing everyone in the environment as uniformly threatening or “rejecting.” These tendencies could easily be exacerbated by, say, childhood traumata or parental neglect.

 

We can imagine that the “irrational cognitions” so prized by cognitive therapists may develop on this abnormal, biogenetic substrate, and eventually become woven into the very fabric of the individual’s personality and world-view.

 

....

 

In short, we cannot afford to view our patients’ afflictions in the balkanized terms of “mental” vs. “physical”, “mind” vs. “body”, “psyche” vs. “soma”. Neither can we afford the luxury of supposing that only one type of treatment—medication or psychotherapy—will be effective for the illnesses we treat. On the contrary, the best available evidence suggests that each modality, or their synergistic combination, may be effective—depending on the specific illness. To be sure, as my colleague, Nassir Ghaemi MD, has cautioned, we must not be drawn into a haze of promiscuous eclecticism in our treatment; rather, we must be guided by well-designed studies and the best available evidence.6 Nonetheless, there is room in our work for both motives and molecules, poetry and pharmacology. The legend of the “chemical imbalance” should be consigned to the dust-bin of ill-informed and malicious caricatures. Psychiatry must now confront the mysteries and miseries of the brain-mind.

 

References:

1. Durant W. The Story of Philosophy. New York: Pocket Books;1953.

2. See, eg, “The cornerstone of psychiatry’s disease model today is the theory that a brain-based, chemical imbalance causes mental illness.” http://www.cchr.org/sites/default/files/Blaming_The_Brain_The_Chemical Imbalance_Fraud.pdf

3. Lacasse JR, Leo J. Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature. PLoS Med. 2005; 2(12): e392. doi:10.1371/journal.pmed.0020392

4. Moran M. Brain, Gene Discoveries Drive New Concept of Mental Illness. Psychiatric News. June 17, 2011.

5. Stein DJ. Philosophy of Psychopharmacology. Cambridge: Cambridge University Press; 2008: x.

6. Ghaemi SN. The Rise and Fall of the Biopsychosocial Model: Reconciling Art and Science in Psychiatry. Baltimore: Johns Hopkins University Press; 2009.

 

 

http://www.psychiatrictimes.com/blog/couchincrisis/content/article/10168/1902106

[compsports]

""You may recognize Dr. Pies as a ubiquitous, good-natured defender of psychiatry wherever it might be criticized on the Web.""

 

To keep this forum a civil place, I won't repeat what I think of Dr. Pies. But let's just say he is one of my least favorite psychiatrists.

 

"""I am not one who easily loses his temper, but I confess to experiencing markedly increased limbic activity whenever I hear someone proclaim, “Psychiatrists think all mental disorders are due to a chemical imbalance!” In the past 30 years, I don’t believe I have ever heard a knowledgeable, well-trained psychiatrist make such a preposterous claim, except perhaps to mock it. On the other hand, the “chemical imbalance” trope has been tossed around a great deal by opponents of psychiatry, who mendaciously attribute the phrase to psychiatrists themselves.2 And, yes—the “chemical imbalance” image has been vigorously promoted by some pharmaceutical companies, often to the detriment of our patients’ understanding.3 In truth, the “chemical imbalance” notion was always a kind of urban legend- - never a theory seriously propounded by well-informed psychiatrists.""

 

Yeah, Dr. Pies, I guess all those folks who reported their psychiatrists making this claim are liars. Yup, you can't trust folks with a mental illness label to report the facts accurately.

 

""As Insel describes the new model, conditions such as schizophrenia or bipolar disorder are attributable to rare, but highly potent, genetic variations that lead to dysfunction in multiple, complex brain circuits. However, the particular symptomatic manifestations in a given individual-—the disease phenotype—is partly dependent on the person’s experiences and environment. We may hypothesize (and this is my view, not necessarily Dr. Insel’s) that given developmentally-based “biases” in various neurocircuits, the young boy or girl may be predisposed to the use of certain dysfunctional cognitive strategies; for example, viewing everyone in the environment as uniformly threatening or “rejecting.” These tendencies could easily be exacerbated by, say, childhood traumata or parental neglect.""

 

Interestingly, many people who have claimed that schizophrenia is the result of trauma have been blown of by mainstream psychiatry. By the way, I am not claiming that trauma is the sole cause of this disorder but it seems in reading the above information, that maybe they aren't as off base as psychiatry had made them out to be.

 

But then again, if a peon or someone with a mental illness label states something, they need to be blown off. If a psychiatrist makes the same claim, it is then a true fact.

 

""In short, we cannot afford to view our patients’ afflictions in the balkanized terms of “mental” vs. “physical”, “mind” vs. “body”, “psyche” vs. “soma”. Neither can we afford the luxury of supposing that only one type of treatment—medication or psychotherapy—will be effective for the illnesses we treat. On the contrary, the best available evidence suggests that each modality, or their synergistic combination, may be effective—depending on the specific illness. To be sure, as my colleague, Nassir Ghaemi MD, has cautioned, we must not be drawn into a haze of promiscuous eclecticism in our treatment; rather, we must be guided by well-designed studies and the best available evidence.6 Nonetheless, there is room in our work for both motives and molecules, poetry and pharmacology. The legend of the “chemical imbalance” should be consigned to the dust-bin of ill-informed and malicious caricatures. Psychiatry must now confront the mysteries and miseries of the brain-mind.""

 

Good luck Dr. Pies with finding well designed studies. The one you all greatly prized, the Star D Study, was shown to be fraudulent by one of your colleagues on the 1Boring Old Man blog.

 

CS

[bells]

On the other hand, the “chemical imbalance” trope has been tossed around a great deal by opponents of psychiatry, who mendaciously attribute the phrase to psychiatrists themselves.

 

Blame shifting.

 

Psychiatry has been so eager to find labels for everybody else that they have failed to recognize their own deep seated issues.

 

I find this guy's response almost worse than the one you would get from one of those blissfully ignorant drug pusher types. If the chemical imbalance theory was being perpetuated wrongly, it was psychiatry's responsibility to address it. They are the "experts" and no word carries more weight in the media than theirs. But they didn't.

 

His position is quite suspicious because now he is saying they all knew it garbage (as some people suspected) and what? they just didn't do anything about it? Because it was the easy option, the easy, lucrative way to treat mental illness and the pharmaceutical companies just made it so irresistible for them.

 

I remember they were very quick to condemn Tom Cruise, calling him a dangerous quack when he stated there was no such thing as a chemical imbalance etc. Psychiatrists gave rebuttal after rebuttal about how safe, effective and life saving medications were and how they were based on good science.

 

The psychiatrists who knew it was a lie had a responsibility to "enlighten" the rest of us. I mean what noble purpose would there be in holding it back...

 

I hate this guy.

[Baxter]

I am not one who easily loses his temper, but I confess to experiencing markedly increased limbic activity whenever I hear someone proclaim, “Psychiatrists think all mental disorders are due to a chemical imbalance!” In the past 30 years, I don’t believe I have ever heard a knowledgeable, well-trained psychiatrist make such a preposterous claim, except perhaps to mock it.

 

If he is correct/truthful, then my personal experience with this story line is even more egregious. I thought my former psychiatrist was simply out of date. Apparently all psychiatrists knew the idea was total nonsense from the git but repeated it to their patients anyway. Why? Because we're too dimwitted to actually understand what is going on. BTW, the last time I saw the chemical imbalance explanation in print was in the annual four-color handout I received from Blue Cross Blue Shield in June.

[Baxter]

The article made me so mad I didn't read others' comments before blasting off.

[Altostrata]

He's throwing his colleagues under the bus -- they all said this.

 

Revisionism at its finest! Did you really think psychiatrists would say, "We apologize, we were wrong"?

 

Send him mail at ronpies (at) massmed.org

 

He's the editor-in-chief of Psychiatry Today -- doesn't permit non-doctor comments on his site.

[Baxter]

I just spent 20 minutes googling Pies.

 

I didn't expect psychiatrists to apologize for being wrong...but I didn't expect Pies's Stalinesque rewriting of history either. I would have predicted a non-response and a quiet discarding of the chemical balance line, rather than the ol' throw 'em all under the bus action. But I based my assumptions on how managers in my past dropped topics/plans/projects/buzzwords without explanation when they were empirically proven wrong.

[cinephile]

'Whoo boy. Here we go:

 

I don't believe I have ever heard a knowledgeable, well-trained psychiatrist make such a preposterous claim, except perhaps to mock it.

Oh really? Then what about none other than psychiatrist Dan Carlat admitting this in his book UNHINGED:

 

While it is true that most of our drugs affect neurotransmitters in various ways, when psychiatrists start using what I call neurobabble, beware, because we rarely know what we are talking about... When I find myself using phrases like, "chemical imbalance" and "serotonin deficiency," it is usually because I'm trying to convince a reluctant patient to take a medication.

And what about what you say here, Ron?

 

In truth, the "chemical imbalance" notion was always a kind of urban legend- - never a theory seriously propounded by well-informed psychiatrists.

Then psychiatry sure could've done a much better job debunking that "urban legend." For example, look at these widely circulated TMAP handouts which were given to psych patients in Texas. These handouts were posted online until as recently as 2008 and continue that "urban legend" that psych disorders like depression and schizophrenia can be attributed to chemical imbalances:

 

http://web.archive.org/web/20041019144337/http://www.dshs.state.tx.us/mhprograms/SCZFact.pdf

http://web.archive.org/web/20041019142900/http://www.dshs.state.tx.us/mhprograms/MDDFact.pdf

 

Nonetheless, there is room in our work for both motives and molecules, poetry and pharmacology. The legend of the "chemical imbalance" should be consigned to the dust-bin of ill-informed and malicious caricatures. Psychiatry must now confront the mysteries and miseries of the brain-mind.

Wow, Ron's sure had his share of media training! Love those media-ready sound bites: "There is room in our work for both motives and molecules" and "the mysteries and miseries of the brain-mind." He must have been taking notes from his BFF Tom Insel, director of the NIMH. Below are some choice snippets from Insel's blog post about the future of psychiatry:

 

For today's students intrigued with the mysteries of the mind, neuroscience has increasingly become the royal road to the unconscious...Some residents in this generation [of upcoming psychiatrists and researchers] are bringing an extraordinary set of tools and talents to the profession. Imagine a new discipline, clinical neuroscience that brings the best science of brain and behavior to the compassionate care of those with serious mental illnesses. Who would not want to be part of this revolution? What better way to live up to our commitments?

And speaking of Insel, take a look at this Nothing like a little scandal involving none other than Charles Nemeroff to enhance one's image.

[Altostrata]

Seriously, guys, send him a thoughtful e-mail: ronpies (at) massmed.org

[journey]

Hey, Im from New Zealand and all Psy docs love the chemical imbalance theory.   Everyone of them tell their patients that because its easy.  I challenged one, he admitted it was more complex than that and that I did have a point.  I think they think ,we are thick and that we need the simplest easy to swallow answer.  If we agree with that theory we are much easier to treat.  Its like having diabetes, your medicine is your insulin.  prescribe pills on to the next patient. What a croc!!