Tuesday, April 15, 2014

“Nor do I recall anyone believing that.”

Earlier this month, Rachel Maddow did a segment on Errol Morris’ latest documentary, The Unknown Known, which profiles Donald Rumsfeld.*

As Morris expresses in the film itself and in his interview with Maddow, and as Maddow herself noted, what’s striking is Rumsfeld’s utter unwillingness to be truthful about his past actions or to accept responsibility for them. When Morris says that many in the US had come to suspect or believe that that Saddam Hussein was involved with Al Qaeda and the 9-11 attacks, Rumsfeld responds that “It was very clear that the direct planning for 9-11 was done by Osama Bin Laden’s people, Al Qaeda, and in Afghanistan. I don’t think the American people were confused about that.” After Morris presents him with a 2003 Washington Post poll showing that 69% of the US public believed Saddam Hussein was personally involved in the attacks carried out by Al Qaeda, Rumsfeld answers: “I don’t recall anyone in the Bush administration saying anything like that. Nor do I recall anyone believing that.”

Morris shows a 2003 press conference in which Rumsfeld mocks Saddam Hussein’s denial of involvement as a tale told by a liar. Maddow then produces evidence of Rumsfeld’s explicit public claims about a link between Iraq and Al Qaeda and the 9-11 attacks. Maddow is naturally amazed not only by Rumsfeld’s denial that he knew the US public ever believed in the connection but by his denial “that he had any role in propagating that idea” in the plain face of the evidence that he did. Rumsfeld’s shamelessness reminds me of psychiatry’s latest presentation of the chemical imbalance myth. I’ve been posting about this fairly regularly over the years because I’ve found the blatant hypocrisy exasperating.

The claim that depression, “schizophrenia,” and so on are caused by an imbalance of neurotransmitters in the brain – which has provided the basis for viewing psychological problems as “illnesses” and a justification and mechanism of action for psychiatric drugs - is false. To be very clear: This notion hasn’t been built upon by more sophisticated models of the biological underpinnings of mental illness. First, the chemical imbalance hypothesis (I use the term loosely) has been rejected. There’s nothing to build upon. Second, nothing has replaced it. There is no evidence for the existence of the illnesses claimed in the various DSMs, nor of a biological or genetic pathology causing psychological problems, including the most persistent and extreme.

Moreover, it’s well documented that this has been known in psychiatry for decades. I quoted Robert Whitaker in an earlier post, and it’s worth reading the longer quotation (and in fact the entire interview) in full, but I’ll quote one portion again:
[W]hat 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.

By doing so, psychiatry allowed a “little white lie” to take hold in the public mind, which helped sell drugs and of course made it seem that psychiatry had magic bullets for psychiatric disorders. That is an astonishing betrayal of the trust that the public puts in a medical discipline; we don’t expect to be misled in such a basic way.
So that’s the history: like the mythical link between Saddam Hussein and the 9-11 attacks, the chemical imbalance claim was false. It was nevertheless promoted to the public, and very successfully, in order to influence their understanding of their problems and their choices about their health. At the very least, psychiatry has done virtually nothing to disabuse anyone of this notion. The myth has served psychiatry’s claims to scientific status, the power of psychiatrists, and the multi-billion-dollar psychopharmacology industry. The human impact of this lie has been and continues to be enormous.

As Whitaker suggests, it’s become virtually impossible to try to sustain the myth. But what biopsychiatry’s proponents seem to have realized is that it’s become largely self-sustaining – unless they’re directly confronted with questions about the truth of the myth, which rarely happens, they can remain silent and people will continue to believe in some version of it. Or, they can sit back and imply that neurotransmitters are part of a larger set of causal biological mechanisms which still aren’t fully understood (or that the uninitiated aren’t capable of understanding). Meanwhile, others will continue to suggest that it’s true.

Now, all of this is infuriating enough. “Astonishing betrayal of trust” is an understatement for the active and passive perpetuation of such a damaging lie. Even more galling, some openly admit that they mislead patients or the public or condone others doing so (with some help from the media, filmmakers, and others). I’ll repeat: they’ve admitted that the chemical imbalance notion isn’t supported by the evidence and that they’ve misled people with full consciousness that they’re doing so, obviously believing that the public won’t be appalled by this. Even Rumsfeld and company don’t think they can get away with publicly admitting to paternalistic or self-serving lies.

Others, brazenly, try to turn the claim’s falsehood against…their critics. The most egregious example I think I’ve seen was in Richard Friedman and Andrew Nierenberg’s response to Marcia Angell’s two articles in the New Yorker in 2011. Angell had stated, correctly, that:
The shift from “talk therapy” to drugs as the dominant mode of treatment coincides with the emergence over the past four decades of the theory [sic] that mental illness is caused primarily by chemical imbalances in the brain that can be corrected by specific drugs.

…But the main problem with the theory [sic] is that after decades of trying to prove it, researchers have still come up empty-handed.
Friedman and Nierenberg actually try to criticize Angell for using “an outdated and disproven chemical imbalance theory of depression (i.e., serotonin deficiency) as a straw man…” Unfortunately for them, as Angell noted in her reply, another critical response appearing just above theirs by John Oldham, president of the American Psychiatric Association, had implied that this remained a serious hypothesis: “Although psychotropic medications have been found to alter the balance of neurotransmitters in the brain, there is no consensus on whether these imbalances are causes of mental disorders or symptoms of them.”** The neurotransmitter-imbalance notion is hardly a straw man: Angell’s statement that she “still hear[s] it invoked frequently” understates the situation.

But the latest, and worst, psychiatric tactic goes beyond even the claims that the myth is still somehow true or useful, or the suggestion that it’s now outdated and therefore illegitimate to hold against the profession at present. This is the “admission” that no serious psychiatrist ever believed it, the claim that the public probably never really believed it, and the assertion that if belief in it can be shown to be widespread in the past or present, well, the psychiatric profession hasn’t really had a hand in that.

I mentioned a couple such statements in an earlier post. For example, Ronald Pies, editor-in-chief emeritus of the Psychiatric Times, in 2011: “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.” Or consider George Dawson’s response to Peter Gøtschze’s recent debunking of common psychiatric myths, the first of which debunked was “Your disease is caused by a chemical imbalance in the brain.” It’s worth quoting Dawson’s response again:
This is a red herring that is frequently marched out in the media and often connected with a conspiracy theory that psychiatrists are tools of pharmaceutical companies who probably originated this idea. What are the facts? …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 and I can recall mocking the idea when pharmaceutical companies presented it to my colleagues and I [sic] in medical school.
So,… Pies and Dawson aren’t trying to keep the zombie myth alive (“Saddam Hussein really was behind the 9-11 attacks in some way”); they’re not just trying to suggest that, while they know it to be false now, the profession believed it earlier and with good reason (“We thought we had good evidence of the links between Iraq and Al Qaeda, but it turned out not to be correct”), or to use the myth’s discrediting against their critics; they’re not trying to justify the lie retrospectively (“We knew the link didn’t exist, but it was a noble lie because we saw the urgency of overthrowing this evil dictator”). We’re fully into “I don’t recall anyone in the Bush administration saying anything like that. Nor do I recall anyone believing that” territory.

They are shamelessly and arrogantly stating – directly in the face of decades of public evidence - that the myth of chemical imbalances wasn’t ever really a significant myth at all. That the whole idea is a “red herring,” part of a “conspiracy theory,” a sort of “rhetoric” used not by psychiatrists but by those trying to discredit psychiatry. It’s an “urban legend,”*** an idea “never seriously propounded” by reputable psychiatrists. Serious psychiatrists never believed it – it was worthy of mockery as early as the 1980s. Really, it’s questionable whether anyone has believed it, they’ve seen no real evidence of that, and if they were to be presented with such evidence they would have no explanation for how that might have come about.

It is, as Whitaker says, a “remarkable confession” when read in light of the historical evidence: they knew it was a lie from the beginning. But the confession is cleverly folded into a denial. Like Rumsfeld, they believe they can acknowledge that the claim was false and still avoid any accountability because they can claim that they don’t recall (or have convinced themselves that they don’t recall) the profession ever really holding or promoting it and don’t accept that it was ever a widespread belief at all. It’s a denial of the plainest historical evidence, a refusal to acknowledge the fundamental implications of the falseness of this myth for psychiatry and psychiatric drugs, and a dismissal of the profound harm done via the perpetuation of this myth. The “astonishing betrayal of…trust” Whitaker describes continues with this offensive and insulting tactic.

* The segment’s impetus and focus was on the possible declassification of a portion of a Senate Intelligence Committee report on CIA interrogation and torture, and how it will bring to public light a history the Bush administration would like to keep buried comfortably in the past.

** This sentence is actually preceded by: “Dr. Angell and the authors she reviews also suggest that psychiatry, in general, regards mental illnesses through the reductionist lens of an imbalance of chemicals in the brain.” Now, I’ve long stopped imagining that such convoluted arguments on the part of psychiatrists are due to poor communication skills and have come to assume deliberate obfuscation. Oldham describes the chemical imbalance idea as reductionist, and then in the next sentence falsely implies that chemical imbalances do exist and are related to “mental disorders” in some way (apparently, the reader is now to understand that the notion of an imbalance as either a cause or a symptom wouldn’t be reductionist; while neither is in fact true – no chemical imbalances, or balances for that matter, have been found - the notion of chemical imbalances as causes of psychological problems is in fact the notion that has been promoted by pharma and psychiatry). It’s all mindbendingly intellectually dishonest.

*** Note the doublespeak: “Urban legend” here is left ambiguous – does it refer to belief within the profession, public beliefs, the fact that psychiatry promoted the myth, or all three?

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