Monday, March 9, 2015

Psych News 2: Battling opeds and the chemical-imbalance-myth myth

“What other medical specialty would be asked to endure an anthropologist opining on the scientific validity of its diagnoses? None, except psychiatry. Psychiatry has the dubious distinction of being the only medical specialty with an anti-movement. There is an anti-psychiatry movement. You have never heard of an anti-cardiology movement, an anti-dermatology movement, or an anti-orthopedics movement.” – Jeffrey Lieberman, former president of the APA
The second recent story in psychiatric news concerns a January oped in the New York Times by anthropologist Tanya Luhrmann, “Redefining Mental Illness.” I’m not a fan of Luhrmann’s writing in the Times (I hope her academic work is better, but the sponsorship of the odious Templeton Foundation doesn’t inspire confidence). I have low expectations for her opeds, which this one met. It’s sloppy, focuses on two sources who are making different arguments, and is far too indulgent in summarizing the history of the APA (“For decades, American psychiatric science took diagnosis to be fundamental. These categories — depression, schizophrenia, post-traumatic stress disorder — were assumed to represent biologically distinct diseases, and the goal of the research was to figure out the biology of the disease. That didn’t pan out.”) and uncritical in presenting Thomas Insel’s RDoC project (“one of the most interesting and radical experiments in scientific research in years”).

But the basic gist of the piece – suggesting that biopsychiatry is built on sand – is correct, and it is what has aroused the ire of the psychiatric priesthood, provoking a nasty response from APA president Paul Summergrad and an embarrassing rant from former APA president Jeffrey Lieberman. Lieberman asks, on the basis of the Times’ publication of Luhrmann’s oped, “What Does the New York Times Have against Psychiatry?” It’s an amusing question, given the Times’ history of writing on the topic. Even the public acknowledgment in 2013 by Insel and the APA itself that psychiatric diagnoses had no scientific validity wasn’t enough to lead them to a truly critical journalistic stance. In fact, their publication of this information was immediately followed by an outrageous and paternalistic editorial intended to mute the public reaction to these revelations and urge readers to continue to have faith in the APA and their model. Articles since then have ignored the facts printed in the paper itself and continued to speak of these diagnoses as capturing real diseases or disorders and of psychiatric drugs as medications treating these conditions. Writers there have continued to take the position that the problem is one of “overdiagnosis” and “overmedication,” as though science is a matter of finding a compromise between “extreme” positions rather than of determining what position the evidence supports (an analogy would be if they proffered a position that AGW was real but that temperature rises probably fall below those indicated by climate researchers). (To be sure, this problem likely stems less from a fondness for psychiatry or the APA than from an interest in continuing pharma ad revenues.)

Lieberman’s diatribe is discussed here, in a post that led to a lively discussion in the comments. It’s bizarre to me that I spend years in various forums attempting to show people that psychiatric diagnoses are scientifically invalid, often surrounded by those who are absolutely convinced of chemical-imbalance claims, only to enter other forums where people seeking to “defend” psychiatry insist – against the overwhelming evidence – that psychiatry as a profession never held to or publicly claimed any such thing and that it’s a myth created by psychiatry’s opponents. (Even stranger, the same people asserting that psychiatry hasn’t publicly promoted such claims then often acknowledge that, well, the claims have been made by some people, but those people were marginal, or misleading “patients” for good reasons. Or they seek to put all of the blame on the drug companies, as if pharma and psychiatry are wholly separate enterprises. Strangest of all, they often begin to suggest that the dubious claims that psychiatry totally hasn’t been making actually do have some truth to them.)

The people making the blatantly false (and so absurdly ignorant or dishonest) claim that psychiatry hasn’t promoted the idea that they’ve uncovered real diseases or disorders with distinctive chemical or other biomarkers oddly don’t seem to comprehend that, while this might briefly deflect attention, ultimately it just points to the giant evidentiary hole at the center of psychiatry. As Brett Deacon argues in the comments:
I think it’s a bit more complicated that claiming this [chemical imbalance] story is about the past, is a straw man, or is a source of controversy drudged up by Scientologists. The reality is that this story was presented as fact (not just a simplified metaphor) by many psychiatrists (among others) and was taken as fact as a result by patients and the public. Its exposure as obvious pseudoscience creates a genuine problem for psychiatrists willing to confront their profession’s enthusiastic adoption of pseudoscience, and for patients who grapple with the realization that they were told they had a literal brain abnormality/defect/disease that turns out not to exist. I firmly believe that we need to understand the lessons of the past lest we repeat them. [emphasis added]
I really want the people who are making the ridiculous argument that the chemical-imbalance story or the larger claims of brain pathologies corrected by psychiatric drugs are a myth created by the anti-psychiatry movement and never promoted by psychiatry to take their “defense” of psychiatry to the other forums – the ones full of people who believe they suffer from enduring neurotransmitter imbalances. I want them to enter those forums, which are everywhere, and tell those people that this false idea was never seriously believed or promoted by psychiatry.