There is much to say about the semi-debate documented in guilding the lily… [in fact, this is my third attempt at writing what comes next]. I think I’d like to frame the essence of the issue being debated. That’s most easily done in this quote from the first article:
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Psychiatry Now Admits It’s Been Wrong in Big Ways – But Can It Change?
Truthout; by Bruce Levine; March 5, 2014.
Bruce Levine’s Question: In Anatomy of an Epidemic, you also discussed the pseudoscience behind the "chemical imbalance" theories of mental illness – theories that made it easy to sell psychiatric drugs. In the last few years, I’ve noticed establishment psychiatry figures doing some major backpedaling on these chemical imbalance theories. For example, Ronald Pies, editor-in-chief emeritus of the Psychiatric Times stated in 2011, "In truth, the ‘chemical imbalance’ notion was always a kind of urban legend – never a theory seriously propounded by well-informed psychiatrists." What’s your take on this?
Robert Whitaker’s Answer: This is quite interesting and revealing, I would say. In a sense, Ronald Pies is right. Those psychiatrists who were "well informed" about investigations into the chemical imbalance theory of mental disorders knew it hadn’t really panned out, with such findings dating back to the late 1970s and early 1980s. But why, then, did we as a society come to believe that mental disorders were due to chemical imbalances, which were then fixed by the drugs?
Dr. Pies puts the blame on the drug companies. But if you track the rise of this belief, it is easy to see that the American Psychiatric Association promoted it in some of their promotional materials to the public and that "well informed" psychiatrists often spoke of this metaphor in their interviews with the media. So what you find in this statement by Dr. Pies is a remarkable confession: Psychiatry, all along, knew that the evidence wasn’t really there to support the chemical imbalance notion, that it was a hypothesis that hadn’t panned out, and yet psychiatry failed to inform the public of that crucial fact…
After that, the articles are a back and forth about the place of Institutional Psychiatry in the whole issue of "Chemical Imbalance" and Serotonin depletion. Did Institutional Psychiatry promulgate it? Ignore it? Fail to refute it? Is it an example of Institutional Corruption? Was it PHARMA? There are two articles in the series that defend psychiatry:
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Nuances, Narratives, and the ‘Chemical Imbalance’ Debate in Psychiatry
Medscape; by Ronald Pies; April 15, 2014. -
Chemical Imbalance
Slate Star Codex; by Scott Alexander; April 5, 2015.
Each countered by Philip Hickey of Behaviorism and Mental Health and Mad in America with examples:
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Psychiatry DID Promote the Chemical Imbalance Theory
Mad in America; by Philip Hickey; June 6, 2014. -
The Spurious Chemical Imbalance Theory is Still Alive and Well
Mad in America; by Philip Hickey; April 27, 2015.
Whitaker further clarified his perspective in his comment on this blog last week:
As for my new book, co-written with Lisa Cosgrove, Psychiatry Under the Influence, this came out of a fellowship I had at Harvard University, in a lab devoted to studying institutional corruption. And while we do write about pharmaceutical influence on psychiatry, the real focus of the book is how the APA and academic psychiatry—the institution of psychiatry we were asked to study — were corrupted by psychiatry’s own guild interests since the publication of DSM-III. The pharmaceutical influence is a distraction from this internal problem within the profession, and I have to say, we believe that the “institution of psychiatry” remains quite oblivious to how this guild influence has corrupted its behavior, in terms of fulfilling its ethical duties to serve the public, over the past 35 years.
Whitaker is talking about the Safra Center at Harvard where he and LIsa Cosgrove did fellowships [see a heady collection…]. That’s also where Paul Thacker went when he left POGO and Senator Grassley’s staff. I got this today from Roy Poses of Healthcare Renewal:
It is really too bad the project on institutional corruption was only meant to last five years. It was the only game in town, and one of the few concerted academic initiatives to address systemic corruption, specifically including health care corruption, of which I know. The project produced some innovations – a word that has become overused business-speak, but is appropriate in this case – to improve disclosure and even somewhat discourage conflicts of interest, and some good ideas – that are unfortunately unlikely to gain any traction – to reduce corruption. If only this torch will be picked up now that the project is over. And if only there could be other projects like this in the US and around the world. But corruption produces a lot of money with which to sustain itself, and the honest are increasingly poor these days.
It’s unlikely that either of the defensive articles [Pies and Alexander] listed will win many new followers. We’ve all been around through these last decades and we know that the Serotonin hypothesis or the "Chemical Imbalance" meme have lasted for years. I still see patients who say, "I’ve been told I have a chemical imbalance." And, surely by now, there’s no one reading this blog who couldn’t wax eloquent about institutional corruption in the upper echelon of psychiatry in dealings with the pharmaceutical industry.
Although the title of his new book [Psychiatry Under the Influence] suggests some outside force; he says, "the real focus of the book is how the APA and academic psychiatry — the institution of psychiatry we were asked to study — were corrupted by psychiatry’s own guild interests since the publication of DSM-III." And he sees attempts to move the blame for the Chemical Imbalance meme to PHARMA as an attempt at weaseling out of responsibility. Some of Whitaker’s critics propose that his criticism is motivated by his own alliance with other guilds or movements [like in the old Spy vs Spy cartoons in MAD]. Guild vs Guild. I tend to agree with both perspectives.
Speaking of guilds, it was an outburst by Jeffrey Lieberman, recent past President of the APA, that got this discussion started [see just stop…]:
“Is [Whitaker] wrong? What he says is preposterous. He’s a menace to society because he’s basically fomenting misinformation and misunderstanding about mental illness and the nature of treatment. What he just said in that clip you ran about, if you’re taking an antidepressant and you go off it and you get sick again… the same thing could be said about insulin for diabetes and asthma medication… Whitaker, he ostensibly considers himself to have been a journalist, God help the publication that employed him, but he has an ideological grudge against psychiatry for whatever reason and there’s no, what he calls research is simply his opinion and his construction of information"…
Lieberman said that in a radio interview promoting his own book, but I wouldn’t be surprised if he sold more books for Whitaker than himself that day. Robert Whitaker has inserted himself squarely into the national dialog about psychiatry and its practices over the last decades, a force to be reckoned with. My own complaint about Whitaker and his followers is that they use the word «psychiatry» as if it represents a personified unitary entity, but I’ll clarify that point later. Right now, I think he’s earned the right to be listened to and is unlikely to be dissuaded by articles downplaying the behavior of academic and organized psychiatry in the current mess [or, for that matter, Lieberman’s carping]. The new book [Psychiatry Under the Influence] is out now [with a hefty $100 price tag!]…
….paper back version is only around 26.00……. 😉
I have a question about these books, and maybe Robert Whitaker can answer it. I have heard that publishers typically pay the author about a dollar per copy sold. Given the numbers on a niche book like these how does the author ever recover enough to make it worth the time and effort? Or is it just a labor of love unless you clear 100,000 copies?
I’ll answer that question: Writing books is one of the dumbest ways to try to earn a living imaginable, and writing a book like this one, which is being published by an academic press, and thus is slotted as a niche book, is even dumber from a financial standpoint.
Thank you for that input. I’ve had some books in mind myself but either I’m too busy or I come to my senses. Reminds me of the old axiom in the music business about the artists getting a dollar an album but it’s even worse than books because the record company demands a ridiculous recoup.
One other note: as far as my being aligned with some other guild, I am not sure what that guild would be. In fact, I am quite sure there are guild interests present in psychology and other guilds present in our modern therapeutic society.
I wonder if Dr. Lieberman is aware of the Streisand effect…he may be about to experience it…
RE: Guild interests present in psychology.
The scandal of the American Psychological Association providing cover for the CIA’s torture programs is definite evidence of something, guild or otherwise. Even the reviled American Psychiatric Association has not stooped so low.