Monday, March 31, 2014

Who said it? Can you tell biopsychiatry’s “bashers” from its proponents?

In a post yesterday, I suggested that someone “could take statements from the strongest critics of biopsychiatry, mix them with those of leading psychiatric representatives, and people would be at a loss to identify which group the source came from.” I’d like to test that out. Can you guess, for each of the following statements related to the scientific validity of psychiatric diagnoses, whether it came from a critic or an advocate?

1. “No biological markers [for any mental disorders in the DSM (other than the organic disorders epilepsy, Alzheimer’s, and Huntington’s)] have been identified.”

2. “Additional experience has not confirmed the monoamine depletion [serotonin deficiency] hypothesis [of depression].”

3. “[T]here is no clear and convincing evidence that monoamine deficiency accounts for depression; that is, there is no ‘real’ monoamine deficit.”

4. “[N]otions of mental disorders as chemical imbalances…are beginning to look antiquated.”

5. “I know of no serious psychiatrist who believes that psychotropic drugs ‘fix chemical imbalances in the brains’ of their patients.”

6. Serotonin deficiency is “an outdated and disproven chemical imbalance theory of depression.”

7. “Chemical imbalance rhetoric always seems to ignore one huge fact and that is Eric Kandel's classic article on plasticity in 1979 in the New England Journal of Medicine. Certainly any psychiatrist who saw that article has never bought into a ‘chemical imbalance’ idea…”

8. “[T]he ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.”

9. “[T]he field has…failed to identify a single neurobiological phenotypic marker or gene that is useful in making a diagnosis of a major psychiatric disorder or for predicting response to psychopharmacological treatment.”

10. “[N]ot even one biological test is ready for inclusion in the criteria sets for DSM‐V.”

11. “[S]cientists [and] clinicians [cannot] point to readily discernible pathologic lesions or genetic abnormalities that in and of themselves serve as reliable or predictive biomarkers of a given mental disorder or mental disorders as a group.”

12. “[T]he disorders [in the DSM] are not generally treated as heuristic, but to a great degree have become reified. Disorders within the DSM-IV or ICD-10 are often treated as if they were natural kinds, real entities that exist independently of any particular rater.”

13. “The molecular and cellular underpinnings of psychiatric disorders [are] unknown;…psychiatric diagnoses seem arbitrary and lack objective tests; and there are no validated biomarkers with which to judge the success of clinical trials.”

14. Psychiatry has been waiting for biomarkers for several decades; they’re “still waiting.”

15. “The weakness [of the DSM] is its lack of validity. Unlike…definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”

16. “Every marketer’s dream is to find an unidentified or unknown market and develop it. That’s what [Paxil marketers] were able to do with social anxiety disorder.”

17. “There is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it.”












None of these is from a critic - they’re all from proponents of biopsychiatry, many from its highest ranks. Here are the sources:

1. Robert Spitzer, Chair of DSM-III Task Force, interviewed by James Davies for Cracked

2. American Psychiatric Press Textbook of Clinical Psychiatry, quoted in Lacasse and Leo 2005

3. Essential Psychopharmacology, quoted in Lacasse and Leo 2005

4. Thomas Insel, Director of the National Institute of Mental Health, 2011, source here

5. Abraham Nussbaum, 2011, source here

6. Richard Friedman and Andrew Nierenberg, 2011, source here

7. George Dawson of Real Psychiatry, 2014, source here

8. Ronald Pies, editor-in-chief emeritus of the Psychiatric Times, 2011, source here

9. Michael First, Editor, DSM-IV, quoted in Deacon 2013, linked here

10. Allen Frances, Chair of DSM-IV Task Force , quoted in Deacon 2013, linked here

11. American Psychiatric Association, quoted in Deacon 2013, linked here

12. Steven Hyman, former Director of NIMH (1996-2001), quoted in Deacon 2013, linked here

13. Steven Hyman, former Director of NIMH (1996-2001), source here

14. David Kupfer, Chair of DSM-5 Task Force, 2013, source here

15. Thomas Insel, Director of NIMH, 2013, source here

16. Barry Brand, product director for Paxil, in Advertising Age, quoted in Christopher Lane, Shyness

17. Allen Frances, Chair of DSM-IV Task Force, to Gary Greenberg, 2011, quoted in Mad Science

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