{"id":56591,"date":"2015-05-05T10:53:11","date_gmt":"2015-05-05T14:53:11","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=56591"},"modified":"2015-05-05T10:53:11","modified_gmt":"2015-05-05T14:53:11","slug":"in-a-guilded-cage","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2015\/05\/05\/in-a-guilded-cage\/","title":{"rendered":"in a guilded cage&#8230;"},"content":{"rendered":"<div align=\"justify\" class=\"small\">There is much to say about the semi-debate documented in <a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2015\/05\/03\/guilding-the-lilly\/\">guilding the lily&hellip;<\/a> [in fact, this is my third attempt at writing what comes next]. I think I&#8217;d like to frame the essence of the issue being debated. That&#8217;s most easily done in this quote from the first article:<\/div>\n<ul>\n<li>\n<div align=\"justify\" class=\"small\"><em><a target=\"_blank\" href=\"http:\/\/www.truth-out.org\/news\/item\/22266-psychiatry-now-admits-its-been-wrong-in-big-ways-but-can-it-change-a-conversation-with-investigative-reporter-robert-whitaker\">Psychiatry Now Admits It&rsquo;s Been Wrong in Big Ways &ndash; But Can It Change? <\/a><\/em><br \/>                       <strong><font color=\"#200020\">Truthout<\/font><\/strong>; by Bruce Levine; March 5, 2014.<\/div>\n<\/li>\n<p>                      <\/p>\n<div align=\"justify\" class=\"small\"><em><u><strong><font color=\"#200020\">Bruce Levine&#8217;s Question<\/font><\/strong><\/u><strong><font color=\"#200020\">:<\/font><\/strong><\/em> <font color=\"#200020\">In <em>Anatomy of an Epidemic<\/em>, you also discussed the  pseudoscience behind the &quot;chemical imbalance&quot; theories of mental illness  &#8211; theories that made it easy to sell psychiatric drugs. In the last few  years, I&#8217;ve noticed establishment psychiatry figures doing some major  backpedaling on these chemical imbalance theories. For example, Ronald  Pies, editor-in-chief emeritus of the <em>Psychiatric Times<\/em> <a href=\"http:\/\/www.psychiatrictimes.com\/blogs\/couch-crisis\/psychiatry%e2%80%99s-new-brain-mind-and-legend-%e2%80%9cchemical-imbalance%e2%80%9d\" target=\"_blank\">stated<\/a>  in 2011, &quot;In truth, the &lsquo;chemical imbalance&#8217; notion was always a kind  of urban legend &#8211; never a theory seriously propounded by well-informed  psychiatrists.&quot; What&#8217;s your take on this?<\/font><\/div>\n<p align=\"justify\" class=\"small\"><em><strong><font color=\"#200020\"><u>Robert Whitaker&#8217;s Answer<\/u>:<\/font><\/strong><\/em> <font color=\"#200020\">This is quite interesting and revealing, I would say. In a sense,  Ronald Pies is right. Those psychiatrists who were &quot;well informed&quot; about  investigations into the chemical imbalance theory of mental disorders  knew it hadn&#8217;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?<\/font><\/p>\n<div align=\"justify\" class=\"small\"><font color=\"#200020\">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 &quot;well informed&quot; 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&#8217;t really there to support the chemical  imbalance notion, that it was a hypothesis that hadn&#8217;t panned out, and  yet psychiatry failed to inform the public of that crucial fact&#8230;<\/font><\/div>\n<\/ul>\n<div align=\"justify\" class=\"small\">After that, the articles are a back and forth about the place of Institutional Psychiatry in the whole issue of &quot;Chemical Imbalance&quot; 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 <em>psychiatry<\/em>:  <\/div>\n<ul><span class=\"small\">                       <\/p>\n<li>\n<div align=\"justify\"><em><a href=\"http:\/\/www.medscape.com\/viewarticle\/823368\" target=\"_blank\">Nuances, Narratives, and the &lsquo;Chemical Imbalance&rsquo; Debate in Psychiatry<\/a><\/em><br \/>                             <sup><strong><font color=\"#200020\">Medscape<\/font><\/strong>; by Ronald Pies; April 15, 2014.<\/sup><\/div>\n<\/li>\n<li>\n<div align=\"justify\"><em><a href=\"http:\/\/slatestarcodex.com\/2015\/04\/05\/chemical-imbalance\/\" target=\"_blank\">Chemical Imbalance<\/a><\/em><br \/>                             <sup><strong><font color=\"#200020\">Slate Star Codex<\/font><\/strong>; by Scott Alexander; April 5, 2015.<\/sup><\/div>\n<\/li>\n<p>                       <\/span><\/ul>\n<div class=\"small\">Each countered by Philip Hickey of <a target=\"_blank\" href=\"http:\/\/www.behaviorismandmentalhealth.com\/\">Behaviorism and Mental Health<\/a> and <a target=\"_blank\" href=\"http:\/\/www.madinamerica.com\/author\/philip-hickey\/\">Mad in America<\/a> with examples:<\/div>\n<ul><span class=\"small\">                       <\/p>\n<li>\n<div align=\"justify\"><em><a href=\"http:\/\/www.madinamerica.com\/2014\/06\/psychiatry-promote-chemical-imbalance-theory\/\">Psychiatry DID Promote the Chemical Imbalance Theory<\/a><\/em><br \/>                            <sup><strong><font color=\"#200020\">Mad in America<\/font><\/strong>; by Philip Hickey; June 6, 2014.<\/sup><\/div>\n<\/li>\n<li>\n<div align=\"justify\"><em><a href=\"http:\/\/www.madinamerica.com\/2015\/04\/spurious-chemical-imbalance-theory-still-alive-well\/\" target=\"_blank\">The Spurious Chemical Imbalance Theory is Still Alive and Well<\/a><\/em><br \/>                            <sup><strong><font color=\"#200020\">Mad in America<\/font><\/strong>; by Philip Hickey; April 27, 2015.<\/sup><\/div>\n<\/li>\n<p>                      <\/span><\/ul>\n<div class=\"small\">Whitaker further clarified his perspective in his <a href=\"http:\/\/1boringoldman.com\/index.php\/2015\/04\/28\/just-stop\/#comment-261509\" target=\"_blank\">comment<\/a> on this blog last week:<\/div>\n<blockquote>\n<div align=\"justify\">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&mdash;the  institution of  psychiatry we were asked to study &mdash; were corrupted by  psychiatry&rsquo;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  &ldquo;institution of  psychiatry&rdquo; 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. <\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">Whitaker is talking about the <a target=\"_blank\" href=\"http:\/\/ethics.harvard.edu\/search\/site\/whitaker\">Safra Center<\/a>  at Harvard where he and LIsa Cosgrove did fellowships [see <a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2013\/10\/07\/a-heady-collection\/\">a heady collection&hellip;]<\/a>. That&#8217;s also  where Paul Thacker went when he left POGO and Senator Grassley&#8217;s staff. I  got this today from Roy Poses of Healthcare Renewal: <\/div>\n<blockquote>\n<div align=\"center\"><a target=\"_blank\" href=\"http:\/\/hcrenewal.blogspot.com\/2015\/05\/innovations-form-safra-center-ending.html\">Innovations form the Safra Center Ending iCorruption Conference<\/a><\/div>\n<div align=\"justify\">It   is really too bad the project on institutional corruption was only   meant to last five years.&nbsp; 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.&nbsp; The   project produced some innovations &#8211; a word that has become overused   business-speak, but is appropriate in this case &#8211; to improve disclosure   and even somewhat discourage conflicts of interest, and some good ideas  &#8211;  that are unfortunately unlikely to gain any traction &#8211; to reduce   corruption.&nbsp; If only this torch will be picked up now that the project   is over.&nbsp; And if only there could be other projects like this in the US   and around the world.&nbsp; But corruption produces a lot of money with  which  to sustain itself, and the honest are increasingly poor these  days.<\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">It&#8217;s unlikely that either of the defensive articles [Pies and Alexander] listed will win many new followers. We&#8217;ve all been around through these last decades and we know that the Serotonin hypothesis or the &quot;Chemical Imbalance&quot; meme have lasted for years. I still see patients who say, &quot;<em><font color=\"#200020\">I&#8217;ve been told I have a chemical imbalance.<\/font><\/em>&quot; And, surely by now, there&#8217;s no one reading this blog who couldn&#8217;t wax eloquent about institutional corruption in the upper echelon of psychiatry in dealings with the pharmaceutical industry.<\/div>\n<p align=\"justify\" class=\"small\"><img loading=\"lazy\" decoding=\"async\" width=\"160\" hspace=\"4\" height=\"160\" border=\"0\" align=\"right\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/ru\/0\/0f\/Spy_vs._Spy.png\" \/>Although the title of his new book [<a href=\"http:\/\/www.palgrave.com\/page\/detail\/psychiatry-under-the-influence-robert-whitaker\/?K=9781137506948\" target=\"_blank\">Psychiatry Under the Influence<\/a>] suggests some outside force; he says, &quot;<em><font color=\"#200020\">the  real focus of  the book is how the APA and academic psychiatry &mdash; the   institution of  psychiatry we were asked to study &mdash; were corrupted by   psychiatry&rsquo;s own  guild interests since the publication of DSM-III.<\/font><\/em>&quot; 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&#8217;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.<\/p>\n<div align=\"justify\" class=\"small\">Speaking of guilds, it was an outburst by Jeffrey&nbsp; Lieberman, recent past President of the APA, that got this discussion started [see <a href=\"http:\/\/1boringoldman.com\/index.php\/2015\/04\/28\/just-stop\/\" target=\"_blank\">just stop&hellip;<\/a>]:<\/div>\n<blockquote>\n<div align=\"justify\"><em>&ldquo;Is [Whitaker] wrong? What he  says is preposterous. He&rsquo;s a menace  to society because he&rsquo;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&rsquo;re taking an  antidepressant and you go off it and you get sick  again&hellip; the same thing  could be said about insulin for diabetes and  asthma medication&hellip;  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&rsquo;s no, what he  calls research is simply his opinion and his  construction of  information&quot;&#8230;<\/em><\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">Lieberman said that in a radio interview promoting his own book, but I wouldn&#8217;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 <font color=\"#200020\">&laquo;psychiatry&raquo;<\/font> as if it represents a personified unitary entity, but I&#8217;ll clarify that point later. Right now, I think he&#8217;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&#8217;s carping]. The new book [<a href=\"http:\/\/www.palgrave.com\/page\/detail\/psychiatry-under-the-influence-robert-whitaker\/?K=9781137506948\" target=\"_blank\">Psychiatry Under the Influence<\/a>] is out now [with a hefty $100 price tag!]&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>There is much to say about the semi-debate documented in guilding the lily&hellip; [in fact, this is my third attempt at writing what comes next]. I think I&#8217;d like to frame the essence of the issue being debated. That&#8217;s most easily done in this quote from the first article: Psychiatry Now Admits It&rsquo;s Been Wrong [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-56591","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/56591","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=56591"}],"version-history":[{"count":35,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/56591\/revisions"}],"predecessor-version":[{"id":56626,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/56591\/revisions\/56626"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=56591"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=56591"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=56591"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}