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Dr Pies is Professor in the psychiatry departments of SUNY Upstate Medical University, Syracuse, NY and Tufts University School of Medicine, Boston. He is Editor in Chief Emeritus of Psychiatric Times (2007 to 2010).
A little learning is a dangerous thing.
— Alexander Pope1
Like the legendary Count Dracula, who could be killed only by driving a stake through his heart, some myths seem almost immortal. For more than 8 years now, I have tried to drive a stake through the heart of two myths regarding the so-called “chemical imbalance theory”—but with only limited success, as a recent piece in the New Yorker brought home to me.2-5
And, yes, there are really two myths to debunk. The first holds that mental illnesses (psychiatric disorders) in general are caused by “a chemical imbalance” in the brain—the so-called “chemical imbalance theory.” The second myth holds that “Psychiatry” as a profession endorsed the first myth, deliberately and knowingly lying to countless, unsuspecting patients. Depending on which anti-psychiatry group, blogger, or website you investigate, you will find a number of corollaries to the second myth; for example, “Psychiatrists lied to patients in order to justify giving them medication,” or “Psychiatrists were corrupted by Big Pharma, and stood to make a lot of money by promoting the chemical imbalance theory” (Sidebar). Rebuttals of these claims are almost always dismissed as, “Psychiatry defending its guild interests” (as if the purveyors of anti-psychiatry animus have no self-serving motives).
Ironically, anti-psychiatry groups are quite right in heaping scorn on the chemical imbalance theory of mental illness, but not for the reasons they usually give. (I hasten to add that debunking the chemical imbalance theory is not to deny that biological factors play an important role in serious mental illness, including but not limited to major depression, bipolar disorder, and schizophrenia). The fact is, there could never have been a scientifically based, chemical imbalance theory of mental illness, because a genuine theory requires an integrated network of well-supported, interlinked hypotheses. And yes, the frequently ignored distinction between a theory and a hypothesis is crucial. It is the key to understanding why claims by antipsychiatry bloggers regarding the chemical imbalance theory nearly always crash and burn.
The theory that never was
Scientifically speaking, there never was a network of validated hypotheses capable of sustaining a full-blown, global chemical imbalance theory of mental illness. Moreover—and here we come back to Myth 2—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. Furthermore, the whole notion of some looming, monolithic “Psychiatry” is absurd on its face, as my colleague, George Dawson has argued.6
To be sure: what many psychiatrists in the 1980s and 1990s did promote was some version of the biogenic amine (or catecholamine) hypothesis of mood disorders, focusing mainly on the neurotransmitters norepinephrine and serotonin. (Schizophrenia was conventionally explained by the now outdated “dopamine hypothesis.”) And, in truth, the significance of serotonin was considerably over-emphasized—owing to what Roger S. McIntyre, MD has facetiously called, “Psychiatry’s High School Crush.”7
Furthermore, the SSRIs were accorded a rock-star status as effective antidepressants that they did not deserve. Most troubling from the standpoint of misleading the general public, pharmaceutical companies heavily promoted the “chemical imbalance” trope in their direct-to-consumer advertising. There was no concerted attempt by our profession to promote a causal or etiological theory of mental illness in general, based solely on chemical imbalances. Neither did the originators of the biogenic amine hypothesis—psychiatrists Joseph J. Schildkraut and Seymour S. Kety—promote such a view in the 1960s.8 Indeed, in 1965, Dr Schildkraut stated:
A rigorous extrapolation from pharmacological studies to pathophysiology clearly cannot be made. Clinical studies relevant to the catecholamine hypothesis are limited and the findings are inconclusive. It is not possible, therefore, to confirm definitively or to reject the catecholamine hypothesis on the basis of data currently available.
The author reports no conflict of interest concerning the subject matter of this article.
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[Note: I am quoted without context or source in this piece. The source of the quote is: http://psychcentral.com/blog/archives/2011/08/04/doctor-is-my-mood-disorder-due-to-a-chemical-imbalance]
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