Historical and Cultural Forces Behind the Bio-Psychiatric Juggernaut

11/14/2018        0 Comments

Al Galves, Ph.D.

What are the forces that have driven the dramatic increase in the use of psychotropic drugs by the American public?  The most common candidates are the drive of the pharmaceutical companies to make money and mainstream psychiatrists to finally become “real medical practitioners.”

This article suggests that there are larger historical and cultural forces that are behind this phenomenon, among them the following:

  • The age of reason.
  • The rise of scientism.
  • The cult of professionalism.
  • The industrial and technical revolutions.
  • The myth of the heroic American.
  • The myth of equal opportunity.
  • The myth of progress.

The forces are briefly described and an argument made for addressing them.

The power and speed with which Americans have embraced psychotropic drugs as the response to troubling emotions and thoughts is dramatic and arguably without precedent.  The combined sales of antidepressant and antipsychotic drugs jumped from $500 million in 1986 to nearly $20 billion in 2004, a 40-fold increase.1

The frequency of antipsychotic prescriptions for children increased from 8.6 per 1000 children in 1995-96 to 39.4 per 1000 children in 2001-2.2

The use of methylphenidate, a stimulant similar to cocaine, was more than 7 doses per 1000 persons in 2004.  This compares with less than 1 dose per 1000 persons in the United Kingdom, Germany and Australia.3

This fact is all the more amazing in view of the evidence that the drugs are very harmful to human beings, causing impairment of the ability to walk and control muscles, heart disease, diabetes, mania, psychotic symptoms, impaired immune function and early death4; and that they disable the fine-tuned emotional faculty that has been evolving over millions of years to enable humans to know what is important, what is threatening, what is precious and what needs to be protected.

What are the forces that have driven this phenomenon?  Can it be attributed wholly to the drive of pharmaceutical companies to make money and of mainstream psychiatrists to finally become “real medical practitioners?”   Or are there other forces at work here?   

This article is an attempt to name and describe some of the historical and cultural forces behind the zeal and credulousness with which consumers are using mind-altering drugs and which might explain how a newspaper editor would fashion the following headline for a story about a randomized, double-blind clinical trial which found a placebo to be more effective in treating depression than either Zoloft or St. John’s wort: “Antidepressant Outdoes St. John’s Wort in Treating Depression.”

First, there is the Age of Reason, which has been ascendant with minor eclipses for the past 800 years.  This movement that celebrates and honors the rational faculty has dishonored and discounted the emotional and intentional faculties that are just as crucial to healthy human functioning.  If you want proof of this, spend some time in a typical American public school.  You will find almost total focus on developing the rational faculty.  Some lip service is paid to emotional development but it consists mainly of browbeating children into believing that certain emotions – love, happiness and kindness – are good and should be favored and others – anger, jealousy and sadness – are bad and should be extinguished.   And you’ll find virtually no attention paid to the development of the intentional faculty, the wills of children.  In fact, you would think that human beings didn’t have wills, at least not ones worthy of attention or development.

I propose that this overvaluing of the rational faculty and discounting of the emotional and intentional faculties makes it easier for people to use drugs that impair their emotional processing.  Since they don’t value the intricate, fine-tuned emotional processing mechanism that has been evolving over millions of years, there is little resistance to disabling it with drugs.  One wonders if consumers would be as ready to take drugs which impaired their rational functioning.

Second, there is the Rise of Scientism.  “Scientism” is defined by Webster’s New Collegiate Dictionary as “an exaggerated trust in the efficacy of the methods of natural science to explain social or psychological phenomena, to solve pressing human problems, or to provide a comprehensive unified picture of the meaning of the cosmos.”  Scientism has convinced us to discount anything that can’t be quantified, measured, touched, seen or physically manipulated.  No wonder then that we put so much faith in a pill and are so skeptical of the value of learning to manage our emotions, integrate the parts of ourselves we don’t like, become more objective in our thinking, use the stress response to address things that are threatening us and develop our assertiveness skills.

Along with the Rise of Scientism has come the Cult of Professionalism, the idea that people with degrees and credentials are smarter and more effective than we are, that they have a mysterious hold on a fount of knowledge and skill to which we are not privy.  This has caused people to lose faith in their bodies and their minds.  It has taken away their sense of agency, of being able to figure things out for themselves.  It has caused them to become overly dependent on experts.

In his book The Coming of Post-Industrial Society, Daniel Bell predicted that the major conflict of the 21st century would be between professionals and non-professionals.5   That it appears there will be no such contest is testimony to the power of credentialism and the higher education industry and the inability of non-professionals to organize in any meaningful way.

And there’s the Industrial Revolution, which turned people from craftsmen who took responsibility for an entire piece of work from start to finish to assembly line workers who are small cogs in a big machine.  Again, a force that takes away the sense of agency and dependence on oneself.

And the Technological Revolution which reinforced the belief that the important things are the things outside of ourselves – machines and computers.

The combination of these forces has caused people to lose faith in their bodies and minds.  Since they can’t see their immune system and understand how it functions, they would rather depend on an antibiotic, which they can see and understand.  Instead of understanding that fever and vomiting and mucous build-up are evidence of healing mechanisms, they use substances to counteract them.  Instead of appreciating the value of shutting down for a while and using an internal focus to take a look at their lives, do a mid-course appraisal and, perhaps, adopt a creative change of course, they take an antidepressant.  Instead of trusting themselves and their organisms, they trust the expert.

Here is Theodore Roszak’s description of the forces at hand:

“The same revolutionary movement that made the universe safe for democracy made it no fit home for such archaic superstitions as “sanctity” of any kind, because sanctity is no empirical finding, no verifiable hypothesis.  Rather, it is an intuition of the sacramental.  We are dealing here in political mysteries that trace back to the charisma of kings, the taboo of tribal priests…. Whenever humanistic spirits rush forward to defend our personal dignity from invasion or insult, though they may not know it, they invoke an authority which we inherit from priest and prophet.  They are asserting the personality as a locus of magical powers.  But the idea has been cut off at its historical and psychological roots, because the severely logical eye, obedient to the best scientific standards, finds no place for magic in the universe; it simply cannot admit the legitimacy of sacramental experience…. In this, then, we find the darkest irony of the revolutionary tradition.  The justified anticlericalism of the Age of Reason has become a sweeping rejection of all sacramental experience.”6

One of the pieces of “magic” that is being ignored and discounted is the self-healing power of the human organism.

There are also some uniquely American forces at work.  One is the Myth of the Heroic American.  We have received a barrage of messages telling us that we are a favored people, the greatest country on earth, anointed by God as the only remaining superpower on the planet, the shining city on the hill.  This puts pressure on us – pressure to be successful, happy, rich and prosperous.  It’s really not OK to be sad, down, depressed, unhappy and upset.  What’s wrong with us?  We live in the greatest country on earth.  What more do we want?   So, if we’re not rich, exalted, famous or outstanding we attribute it to our shortcomings.  I guess I’m just not good enough.  I couldn’t make it. We get down on ourselves, become anxious and depressed and grab for the quickest and easiest remedy - psychotropic drugs.

There’s another force which reinforces that pressure: The Myth of Equal Opportunity.  We are constantly told that Americans are equal before the law, that, unlike other, more traditional societies, we all have an opportunity to be rich, famous, good-looking, happy and successful.  If we aren’t, it’s our own fault.  We just aren’t good enough.  There’s something wrong with us.  We’re deficient.  

In other societies, there are explanations which are less pejorative.  If I am not doing well in India, it is because of the caste I was born into.  If I am dissatisfied with my status in Great Britain, I can attribute it to the class, neighborhood, family into which I was born.  What do you expect from me?  I don’t even speak with the right accent.

This is the message of Michael Moore’s film Bowling for Columbine.  Moore asks why there is so much violence in the United States.  He dismisses the pat answer – more guns – by disclosing that there are more guns per capita in Canada and the murder rate in Canada is one-twentieth of the murder rate in the United States.  After considering other explanations, he comes down to the insight that this is not a very compassionate country.  And the compassion that is lacking is not so much for other people as it is for ourselves.  People who lack compassion for themselves are prone to violence.

Because of these two myths, Americans are allergic to “blaming” themselves for their “shortcomings.”  They are especially reluctant to take responsibility for whatever deficiencies or doubts they might have about themselves.  So if they are feeling sad, agitated, upset, angry, anxious, down, discouraged it’s much easier to blame it on chemical imbalances that result from genetic inheritance than it is to blame it on anything they have control over.  Instead of taking a good look at myself, doing some self-reflection and some repair work, I’ll just take this pill that will correct my chemical imbalance.

Finally, there is the Myth of Progress.  These psychotropic drugs fit nicely into that myth.  Isn’t scientific medicine wonderful?  Look, we cured malaria and polio.  We do heart transplants and artificial hips.  Now there are medicines that cure mental illnesses.  Amazing.  What will they come up with next?

This is my short list of historical and cultural forces:

  • The Age of Reason
  • The Scientific Revolution
  • The Cult of Professionalism
  • The Industrial and Technological Revolutions
  • The Myth of the Heroic American
  • The Myth of Equal Opportunity
  • The Myth of Progress

There may be other, more important forces at work.  Something is going on that is bigger than the power of the pharmaceutical companies and mainstream psychiatry.  I encourage readers to wonder and search.

But suppose it is true that these forces are driving the movement to embrace psychotropic drugs as the answer to these painful states which, being devoid of clear physiological etiology, are called “mental illness.”  What can we do about the forces?  They are large and inchoate.  

How do we counter them?  I think we chip away at them little by little in the same way that dissidents chipped away at the former Soviet Union.  When the Soviet Union collapsed in 1989, it seemed to happen rapidly, almost overnight.  But the seeds of that demise were being planted and fertilized over the previous 60 years by ordinary Russians telling jokes about the system, talking to each other behind closed doors and, in some courageous cases, protesting in public.   I think that is how the biopsychiatric juggernaut will eventually be brought down – through a constant, even if often dim, shining of light on the harm done by psychotropic drugs and their lack of effectiveness and through the slow, steady development of more safe, humane and effective ways of helping people who want help in their effort to overcome suffering.

Morris Berman describes the characteristics of American culture that mark it as a culture in the process of dying, dying because we have lost track of what is important, we have allowed unconscionable inequalities to exist, we are squandering our resources on killing people, we are losing our common sense, our wisdom and our spiritual awareness.  And he asks: what recourse is available to those who see what is happening and who want to protect and nurture what is being lost?

His answer is that they should do what the monks did in their monasteries during the Dark Ages.  During that period between the Greek and Roman empires and the Renaissance, the monks scribed the works of the great Greek and Roman philosophers, clerics and scientists so they would be available to future generations.  Berman suggests that those who are aware of what is happening and who want to protect what is being lost do so by living their lives according to what they know to be true and by continuing to speak that truth in all the ways they can.7

Organizations like the International Society for Ethical Psychology and Psychiatry, the International Society for Psychological and Social Approaches to Psychosis, and MindFreedom International are important and valuable mediators and repositories of that truth.

The other thing people can do is reform our public schools so they become places in which young persons can learn to use their wills, emotions and critical faculties to make up their own minds, find their own answers and pursue their own truth free from the oppressive mantle of the educational establishment, an establishment which is the paradigmatic reflection of,  and a major propagator of the Age of Reason, the Rise of Scientism, and the Cult of Professionalism.


1Whitaker, R. (2003). Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. Cambridge, MA: Perseus Publishing Group.

2Cooper, W.O., Arbogast, P.C., Ding, H., Hickson, G.B., Fuchs, D.C. & Ray, W.A. (2006). Trends in prescribing of antipsychotic medication for U.S. children. Ambulatory Pediatrician, 2006, No. 6, 79-63.
3Aldhouse, P. (2006). Prescribing of hyperactivity drugs is out of control. New Scientist, March 31, 2006.
4Jackson, G. E. (2005). Rethinking Psychiatric Drugs: A Guide for Informed Consent. Bloomington, IN: AuthorHouse.
5Bell, D. (1973). The Coming of Post-Industrial Society: A Venture in Social Forecasting. New York: Basic Books.
6Roszak, T. (1978). Person/Planet: The Creative Disintegration of Industrial Society. Garden City, NY: Anchor Press/Doubleday, p. 101.
7Berman, M. (2000). The Twilight of American Culture. New York: Norton.












The Zombie Theory: Why Modern Day Psychiatry Should Be Ridiculed and Discarded (Part 1)

11/14/2018        0 Comments
R. L. Cima, Ph.D.
“The body of man has in itself blood, phlegm, yellow bile and black bile; these make up the nature of this body, and through these he feels pain or enjoys health. Now he enjoys the most perfect health when these elements are duly proportioned to one another in respect of compounding, power and bulk, and when they are perfectly mingled.” 

- Hippocrates, On the Nature of Man, circa 5th century BC

Part 1 - A Balancing Act

21st Century schools of medicine teach their graduates human behavior – what I do in my own body in the next moment of my life – is understood by microscopically studying invented and invisible anatomical brain centers, each center equipped with miraculous behavioral functions.  Students of psychiatry are instructed that undesirable behavior (psychiatry’s “symptoms”) is caused by a chemical imbalance effecting the brain centers.  Treatment, then, is to prescribe laboratory chemicals to balance natural body chemicals that are, somehow, out of balance.  Worth noting, the Psychiatric Medical Model Theory (PMMT) offers no definition, or explanation, of “balance.”

Practitioners of the PMMT believe you and I are victims of our excessive or insufficient chemicals – usually serotonin or dopamine – as well as our faulty “connectors” that negatively impact the brain centers where all behavior is neatly stored. Thus, psychiatric patients learn undesirable and life altering behaviors are caused by a deficiency, or derangement, or disease, or disorder, or disability, or disturbance, or dysfunction (the 7 D’s of the PMMT).  Patients inadvertently suffer the consequences of these brain flaws. “It’s not you,” the doctor confidently instructs the patient, “it’s your disorder that’s causing you to experience the undesirable behavior.”  Hence the title:  The Zombie Theory.  

Humankind has witnessed miraculous progress in medical science during the past 100 years.  Thanks to new discoveries, medicines and procedures, we have benefitted greatly when it comes to our physical well-being.  Especially true in modern countries, we live longer, our quality of life is better, our physical maladies better treated.  Our flesh, blood and bones have never been in better hands.  However, when it comes to human conduct, medicine has failed miserably throughout human history, up to and including today, without exception.

Medicine as Art1

Twenty-five hundred years ago, the Hippocratic School of Medicine began to understand medicine as an art form, and healers as practicing artists. Disease was no longer divine wrath, nor was healing a gift from God.  Over time, heavenly punishments and gifts were replaced with cause and effect, providing the underpinnings for the burgeoning artform to become a rational science in the physical world.  Along the way, medical ethics and standards of care were crafted, both keystones of the ancient Greeks that continue to guide modern day medicine.  Most important, three primary conditions were identified and interconnected:  the disease, the patient and the healer. 

Healers were trained in the Seven Natural Factors in this holistic system of medicine: The Four Elements, The Four Humors, The Four Temperaments, The Four Faculties,The Vital Principles, The Organs and Parts and The Forces.  The underlying theory was simple.  When there is balance and harmony within the Seven Natural Factors, there is health. When they are not in balance, there is dysfunction and disease.  When any one of the Seven Natural Factors ceases to function, there is death.  Balance then, as it is now, was the pursuit.

For the first time detailed experiments were conceived and conducted, data was collected, results were assessed and treatments were formalized.  Six healing pathways emerged, from mild to severely invasive.  The first treatment of choice?  Diet, considered the most gentle and safest path to restore balance.  Second in this formal progression of treatment paths focused on altering the patient’s lifestyle and hygiene habits that were causing the imbalance of body humors (fluids).  Only when the first two treatments were found to be ineffective did the healer select the third treatment path:  medicine.  Chemical concoctions with inherent healing powers were dispensed in the form of supplements, potions, tonics and herbs.  These first three paths were self-administered, under the guidance of a healer.  

Paths four, five and six were administered by the healer.  The first of these, physiotherapy, included heat treatments to induce sweating, massages with medicated oils, and a variety of muscle, bone and other body manipulations designed to release trapped toxins.  Physiotherapy was often a preparative stage for detoxification, the fifth path of treatment.  Common purification methods included emetics (to induce vomiting), enemas, diuretics and, frequently, bloodletting.  Only when the first five paths fail does the healer turn to surgery, the last treatment path.  Surgery was seen as the most invasive and, except for immediate trauma and other emergencies, the last resort for the trained healer.

Also historic, diseases were systematically classified according to similarities and differences as the disciplines of etiology and pathology began to emerge.  The goal was to ensure the healers diagnosis and choice of treatment was based on fact-based information.  As momentous, individualized treatment was a core value.  “It's more important,” professed Hippocrates in one of his famous aphorisms,“to know what kind of person has a disease than what kind of disease a person has.”  Healers were trained to understand individual patients as living in a dynamic relationship with their environment.  This new art form treated the patient, not just the disease.

What About Madness?

For epochs before this new medicine ancient civilizations viewed madness as punishment from an angry God for divine trespasses.  The healers of 10,000 years ago treated their patients with music, prayer, charms, spells and other incantations.  This new school of medicine professed madness to be the result of natural occurrences in the brain, centered around the four essential humors.  To treat madness, patients would routinely be bled from the forehead, or from a large vein in the arm or leg or rectum to draw corrupted humors away from the brain in order to bring the body back to balance. 

Thus, Greek medicine began with two interrelated principles.  The first is to provide the body its natural beneficial cravings:  a wholesome diet, healthy habits, adequate exercise, and sufficient rest and sleep.  The second is to cleanse the body of wastes and pathogenic matter inside and out, creating a healthy body balance.  Though form and fashion may be different, modern medicine embraces these same principles. Unfortunately, as you will see, so does modern psychiatry.

Primum Non Nocere – “First, do no harm"2

The Hippocratic Oath is the first expression of medical ethics in human history and it remains a rite of passage for medical graduates around the globe.  This oath reminds the healer to be aware of the possible harm that can occur from any kind of intervention.  “Practice two things in your dealings with disease,” reiterated Thomas Inman, a 19thcentury Liverpool surgeon, “either help or do not harm the patient.”  Nonetheless, history has many examples of this oath being violated, and much harm done. 

Here’s the longest lasting. 


For more than two millennia the treatment of choice for healers around the world was bloodletting, mainly because of its versatility.  In addition to madness, this medical technique was prescribed for acne, asthma, cancer, cholera, coma, convulsions, diabetes, epilepsy, gangrene, gout, herpes, indigestion, jaundice, leprosy, ophthalmia, plague, pneumonia, scurvy, smallpox, stroke, tetanus, tuberculosis and a hundred more – including heartsickness, and heartbreak.   

The Talmud was cited by healers to proclaim the most beneficial days and times of the month to use this procedure.  Christian healers gave guidance to their followers by declaring the specific Saints' Days favorable for this medical technique.  Islamic healers too heralded bloodletting, particularly for fevers.  During medieval times bleeding charts were common, designating specific bleeding sites on the body.  The vein in the right hand, for example, was bled for liver problems, the vein in the left hand for spleen problems.  “Do-it-yourself" instructions were created and distributed worldwide. 

Bloodletting was in its heyday during the Middle Ages, prescribed by healers as both a curative and preventative medical procedure.  The actual procedure was often done by a trained barber-surgeon, the red and white barber pole symbols of blood and bandages.  There were a variety of techniques too.  A phlebotomy occurred when blood was drawn from the larger external veins, an arteriotomy from arteries usually from the temple.  Some healers used a scarificator, a specially crafted tool cast in a brass case that enclosed a spring-loaded mechanism with blades of steel.  Leeches were commonly used too.

Bloodletting theory – the science of how it “works” – was based on two ideas; (1) blood did not circulate and would "stagnate" in the extremities; (2) removal was done to attain humoral balance to fight off illness and to restore health.  The more severe the disease, the more blood that needed to be drained, fevers requiring the largest amount of drainage.  Importantly, six hundred years later Galen, a philosopher-physician from the Roman Empire, revitalized, reinvented and “rebooted” Hippocratic humoralism as a meticulously detailed, rational, technique-focused medical theory that retained its popularity in cultures around the world for another seventeen centuries.

The End of Bloodletting    

The 19thcentury was revolutionary for medical science.  During the first half a British chemist discovered the anesthetic properties of nitrous oxide, a French doctor invented the stethoscope, and a British obstetrician performed the first successful blood transfusion.  In the fourth decade an American surgeon used ether for the first time, and a Hungarian doctor discovered disinfecting the hands of medics, midwives and nurses drastically reduced the incidence of death from childbed fever that was killing nearly a third of infected mothers.

The second half of the century was equally impressive.  A British surgeon introduced phenol to clean wounds and to sterilize surgical instruments.  Louis Pasteur published the Germ Theory of Disease in 1970 and within 12 years his labs produced vaccines for chicken cholera, anthrax and rabies.  The first Nobel Prize in Medicine was awarded to Emil von Behring, a German physiologist, for creating vaccines for diphtheria and tetanus.  X-rays were discovered by German physicist Wilhelm Conrad earning him the Nobel Prize in Physics.  Finally, in 1897, a German pharmaceutical company, Bayer AG, created a new wonder-drug:  aspirin.  Within two years aspirin was a global phenomenon.

The successes of this maturing art of medicine spelled the end to the ancient and barbarous practice of bloodletting.  Centuries old theories as well as healer and patient testimonials could not stand up to the new and emerging regimen found in science.  By the end of the 19thcentury Bloodletting was nearly extinguished worldwide (though not completely!). 

In its place a new awakening was unfolding:  modern medical science. 

NEXT TIME:  Part 2:  The Era of Medical “Experimentalism”


Life is short; and the art long.

 - Hippocrates

1History of Greek Medicine:

2Interestingly, the Hippocratic Oath does not include the words “First, do no harm.”  The oath is nearly 400 words and certainly includes the sentiment. The actual quote is attributed to a Parisian pathologist and clinician Auguste François Chomel (1788–1858).  Please see the entire oath here:

The Problem with Believing That Mental Illnesses Are Physiological Disorders

8/31/2018        0 Comments

Al Galves, Ph.D.

I read somewhere recently that when Millenials are feeling upset, agitated, down, confused, hopeless, exhausted, or out-of-sorts, they wonder if they are just going through a hard time, just struggling with concerns about themselves and their lives or if they are suffering from a mental illness. No wonder. Since they have been able to understand language they have been bombarded by what I call the Biopsychiatric Belief System (BBS)

They have been told that mental illnesses are caused by chemical imbalances, genetic anomalies, and brain disorders, that they are not different from diabetes, cancer, or acid reflux. They have been told not to be ashamed of such conditions, after all they have no control over them and they should not be objects of stigma for having them. They have been told that an appropriate response is to take pills that will make them feel better. During their lifetime, the number of Americans using psychotropic drugs has increased dramatically.

The Millenials are the victims of a belief system which is cynical, harmful, and erroneous. And this is a case in which what you believe can be very harmful to you. If you believe that how you feel and behave is controlled by biochemistry, genetic dynamics, and brain anomalies, you believe that you have no control over your thoughts, emotions, intentions, reactions, and behavior. That’s pretty cynical and dangerous. It turns you into the helpless victim of forces over which you have no control.

If you subscribe to the BBS, you are unlikely to enthusiastically and wholeheartedly pursue some form of psychotherapy. That is harmful because psychotherapy writ large is far and away the best way of responding to the states of being that are diagnosed as mental illness.

The research which supports the BBS runs afoul of the confusion between correlation and causation. Believing in it is a form of scientism, “an exaggerated trust in the efficacy of the methods of natural science to explain social or psychological phenomena” (Webster’s New Collegiate Dictionary). Erroneous indeed.

Here is the answer to the Millenials’ dilemma. There is no difference between mental illness and reactions to troubling and difficult life circumstances and deep concerns about oneself and one’s life. They are one and the same thing.

The great majority of mental illnesses, including the most serious ones, are reactions to life crises, emotional distress, spiritual emergencies, difficult dilemmas, inner conflicts, and various forms of overwhelm, including trauma. Mental illnesses are essentially how people avoid emotional pain, protect themselves, feel more adequate and powerful, and gain the illusion of control in a world in which the most dangerous things are outside of our control.

Mental illnesses are reactions to significant loss and to concerns about one’s ability to live the way one wants to live. They are wake-up calls, signals that something is wrong and needs to be dealt with. Mental illnesses are the painful, uncomfortable, dangerous, and debilitating emotions, thoughts, and behavior that people experience in the course of dealing with the problems of life. Mental illnesses are reactions to difficult, scary, terrifying, rage-creating life situations. They are reactions to things that have happened to the person. They are caused by the following kinds of concerns:

Am I going to be able to live the way I want to?

Am I going to be able to connect with other people in satisfying ways?

Will I be able to build a love relationship that will enable me to have a satisfying love life and family life?

Am I going to be able to find a job that is satisfying and which pays enough to support me?

Am I smart, strong, personable, attractive, creative, resilient, flexible enough to be able to live the way I want to live?

Am I adequate or inadequate?

Am I going to be able to do what I want to do or am I going to have to shrink myself to fit into the only roles, jobs, relationships that are available to me?

Am I okay the way I am?

Am I worthy of living?

How people conceive of mental illness is important because it will determine the kind of treatment they seek.  If they believe that mental illnesses are essentially physiological problems of biochemistry, genetic dynamics and brain functions, they are likely to turn to drugs for help and less likely to enter wholeheartedly into psychotherapy. 

By psychotherapy I mean all forms of psychotherapy: cognitive-behavioral therapy, hypnotherapy, body-centered therapy, trauma-informed therapy, narrative therapy, solution-focused therapy, group psychotherapy, art and music therapy, mindfulness meditation, yoga, nutrition, exercise, support groups, supported housing, 12-step groups. These all help with love relationships and family relationships, help with finding satisfying and rewarding work, and help with finding enjoyable and healthy ways of expressing oneself.

Here are the comparable benefits and risks of treatment with drugs and treatment with psychotherapy.

Treatment with drugs


You may feel somewhat more energetic and alive if you take an upper like Prozac, Paxil, Adderall, or Ritalin or somewhat less anxious and agitated if you take a downer like Atavan, Xanax, Zyprexa, or Risperdal.  In the case of antidepressants the research says that the feeling better is largely due to the placebo effect but, nevertheless you may be feeling better. 


You’ll suffer from serious “side effects” including increased incidence and risk of:

-Sexual dysfunction

-Akathisia – extremely uncomfortable and dangerous restlessness




-Emotional blunting – loss of conscience and caring

-Depersonalization – a sense of loss of contact with yourself

In the case of antipsychotics like Zyprexa, Abilify, Geodon, and Risperdal, “side effects” include:

-Tardive diskinesia – a Parkinson-like loss of control over muscles and gait.

-Cognitive impairment

-Brain shrinkage

-Early death – persons who take antipsychotics die on average 25 years younger than people who don’t take them

If and when you stop taking the drug you will suffer serious withdrawal effects.  In the case of anti-anxiety drugs such as Atavan and Xanax, that can involve years of debilitating recovery.  This is because the drugs have caused your brain to compensate for its changed condition so when you stop taking the drugs, your brain will be in a dysfunctional state.  Since the drugs you are taking act on the brain in the same way that cocaine, heroin, and methamphetamines act on the brain, you will suffer the same kind of withdrawal effects as do persons who use illegal drugs.

If and when you stop taking the drug you are likely to experience a relapse of the symptoms that led you to seek treatment.

You will have bought into a very cynical and unhealthy message.  When you are feeling bad, take a drug.

Treatment with psychotherapy


You will gain self-management skills and knowledge that you will be able to use for the rest of your life to stay healthy and happy: 

-The meaning of your symptoms and how you can use them to become healthier and happier;

-What makes you tick;

-Why you do what you do and don’t do what you don’t do;

-What you want and don’t want;

-Develop compassion for yourself;

-Become aware of the beliefs, assumptions, attitudes and habits which drive your behavior but which lie below the level of your consciousness;

-Learn how to deal with the difficult dilemmas we all face from time to time;

-Become able to connect with others in satisfying ways without giving up too much of yourself, 

-Manage your fears so that you can avoid what you need to avoid and walk with the fears you need to walk with;

-Become more accepting and comfortable with parts of yourself that are scary, painful and shameful and which have been taking lots of energy to hide from yourself and others;

-Learn how to become more aware of what you want and how to get it without threatening your relationships and;

-Become more able to use your strengths, talents and faculties in satisfying and contributing ways. 

As you learn how to manage your thoughts, feelings, intentions and perceptions in healthier ways, your brain will change in beneficial ways.


You might waste some time and money.

You might receive some advice or messages that will get in the way of you becoming healthier and which might send you down the wrong path for a while.

But what about the scientific evidence? Isn’t there evidence through brain scans that mental illnesses are caused by chemical imbalances and brain disorders? Of course, all human behavior involves biochemistry and brain function. But that doesn’t mean that the chemistry or the brain function causes anything. From what we know about how the mind and body function together it is more likely that the biochemical and brain changes are reactions to what is happening to the person, what the person is perceiving, the difficulty the person is having, the concerns the person has. 

That is what happens in the stress response, the most widely studied and best understood of the human mind-body dynamics.  The stress response is a profound biochemical dynamic which includes the secretion of neurotransmitters such as norepinephrine and noradrenaline. But it doesn’t come out of the blue. It doesn’t just happen. Rather, it is a response by the person to some threat or to some demand that is placed upon her or him. It is a reaction to something that has happened to the person. This is in keeping with what we know about human beings. Human beings are not random organisms. They are meaning-making, desiring beings who live with a purpose. States of being such as mental illnesses don’t just come on them out of the blue. Rather, they are reactions to something that has happened, to some kind of concern, fear, need, thwarted desire, frustration.

So the good news is that you do have control over your psyche - your thoughts, intentions, reactions, and behavior. You do have the ability to heed the wake-up call, to deal with, learn from and recover from emotional distress, life crises, spiritual emergencies, difficult dilemmas, trauma, and overwhelm. The bad news is that you now have to deal with this perverse issue of blame. One of the reasons for the popularity of the Biopsychiatric Belief System is that it takes away blame. You are not to blame for your genes, brain or biochemical system going awry.

Apparently, the obverse thought is that, if you have control over your psyche and if your psyche is in bad shape, you are to blame for it. That has never made sense to me. How can I blame people for the states of their psyches? People have no control over their early experience. That experience is essentially under the control of their parent(s). And what happens to them during the first 18 or so years of their lives has a powerful impact on the rest of their lives and on their ability to manage their psyches effectively. If a person does not receive the care, support, affirmation, attunement – love, if you will – that a person needs in order to grow into a healthy adult, s/he is going to have a hard time managing her or his psyche. S/he may learn how to do that but it is going to take a lot of hard work and help from others. How, then, could I blame someone for having a hard time managing his or her psyche? So I would encourage all of us, including the Millenials, to remove the word “blame” from our vocabularies when we are talking about psychological difficulty.

The bottom line is that what you believe about mental illness and mental health can make a big difference in your life.  Think about it.

  • I use the term “mental illness” in this essay because I think mental health professionals and the general public have a fairly common understanding of what it means and I think we have a fairly accurate conception of it as a state of being. So I use it as a literary device, a common terminology. I think there are big problems with the term “mental illness”. Although many “mental illnesses” are illnesses in the sense that they impair the ability of people to function well and to live full and satisfying lives, the states of being that are diagnosed as “mental illnesses” are much more than illnesses. They are also wake-up calls, opportunities for learning and growth, protective moves by threatened psyches, numinous experiences of connection with the divine and moves towards reconstitution of selves which have been discounted, abused and traumatized. To see them just as illnesses and as essentially physiological disorders is a damaging distortion.

Mental Illness Again Implicated in Violence


David Katz, the Jacksonville shooter, is the latest in a long line of scapegoats for an apparent epidemic of violence. Just this past Sunday he opened fire at a e-sports tournament, wounding 10 and killing three, including himself. Katz' motives are still under investigation, but people are already implicating the bogeyman of mental illness. See CNN's reporting today - Jacksonville shooter had a history of mental illness and police visits to family home.

According to the report, Katz was prescribed "a number of psychiatric medications," including antidepressants and antipsychotics. He also was said to have seen "a succession of psychiatrists." These statements imply that Katz' a mysterious alien entity residing with him, called "mental illness," was the culprit. There is even current quibbling over what the "correct" diagnosis was.

A more reasonable explanation would be that Katz had been struggling with several real personal dilemmas, he wasn't infected with a nonsensical illness of the mind. Just one example is that he had to witness his parents' vicious divorce and custody battle over him. Instead of following the suggestion of his father for peer-based support group assistance during middle school, there was the default turn toward psychiatric treatment, as if there was something in him to truly treat via medical means.

If the treatment went as it typically does, this would have meant increasing focus on him as the problem, rather than his circumstances. Being subjected to a "succession of psychiatrists" means that one superficial attempt after another didn't work, so he was shuffled to the next psychiatrist in line. He likely felt the increasing sense of being misunderstood and persecute by those medical attempts to sedate him.

This is just the last in a long and continuing line of horrific episodes. It will continue. It will continue because the authorities are not looking at the causes of these events. They are trying to find a scapegoat. Three hundred years ago that scapegoat would have been witchcraft or demons. Now, it is the internal infection of "mental illness."

To make matters worse, the alleged treatment for that infection is typically to coerce the person into compliance. In other words, it is to get them to stop complaining about the problems (euphemistically called "symptoms reduction"). And the icing on the cake is that psychiatric drugging into a state of agitation clearly increases the chances of impulsive outbursts of violence. See ISEPP's White Paper on the link between psychiatric drugs and violence.

Mind Doctors?

8/28/2018        0 Comments

Chuck Ruby, Ph.D.

There is no evidence supporting the claim that mental illness is caused by disease of the brain or body. More importantly, if such evidence were ever discovered we wouldn’t call the problem mental illness. We’d just call it illness, and it would fall within the scope of neurology or other subspecialties of medicine, such as nutritional science, immunology, and gastroenterology. So, ironically, discovering evidence of a disease basis for mental illness would threaten the existence of the mental health industry.

The defenders of the myth of mental illness will sometimes admit there is no evidence of disease. Yet they still consider themselves medical specialists, healthcare providers, and that mental illness is a matter of literal health and illness.

In 1812, Benjamin Rush published a textbook that sparked the birth of psychiatry and by extension the allied mental health professions. Its title was: Observations and Inquiries Upon the Diseases of the Mind. Rush was claiming the mind, not the brain, as psychiatry’s area of expertise. This is like how astrologists’ claim that constellations are their area of expertise, not the planets, stars, and galaxies themselves.

Still, notwithstanding their status of “mind doctors,” they desperately hold on to the brain as their organ of interest. This is because in order to be considered a legitimate medical specialty they must have a bodily organ or system identified as their focus.

So because mind appears to emanate from the brain, the defenders of the myth of mental illness continue to look for it in that three-pound mass of squishy matter located in our heads. This is similar to how astrologists continue to look for the meaning of earthly affairs by examining the heavens.

Disease of the mind has always been the mental health industry’s raison d'être. This has been the case ever since those early days when psychiatry took over the jurisdiction of troublesome people from religious authorities and it continues into the modern era of the medical model. So, despite the search for mental illness in the brain since then, there has always been the tacit belief that the disease wasn’t in the brain, but in the mind.

But this doesn’t make any sense. The brain is vastly different from the mind. The brain is an object, a material thing. It is located in three-dimensional space. You can pick it up, hand it to someone, see it, and feel its weight and texture. It is organic and has parts that can grow tumors, be damaged, and get infected.

In stark contrast to the brain, the mind is a subjective experience of consciousness that is not material in nature and has no location. The “contents” of mind, such as memories, thoughts, and feelings, are not substances and they are not located in the brain. They are not things that exist in nature like neurons, blood vessels, trees, rocks, and stars. Likewise, there are no “parts” of the mind that can break, get diseased, or become defective.

The mind can’t be heard, seen, touched, tasted, or smelled. We can never find it even though it seems to be omnipresent and located somewhere behind our eyes and between our ears. But go ahead and try. You won’t find it by looking there. Neither will you find thoughts, perceptions, images, sounds, wishes, or desires.

All these mind things are quite elusive and yet they are very real and powerful. This phenomenon of consciousness, or mind, is arguably the most mysterious thing about human life. But how can the mind, which is not of material substance and has no location, be literally diseased?

You might object to my reasoning that mind cannot be diseased by pointing out the example physical pain. For instance, the experience of pain from arthritis is an element that belongs to mind, not body. The pain itself has no location or material substance. It is purely an experience. Yet physicians treat it.

But the experience of arthritis pain is a symptom of a disease, not the disease itself. The disease is pathological joint inflammation. If the disease can be successfully treated, the associated experience of pain can be lessened. We would hope, though, that the primary focus of treatment is the disease and not just the pain. The root of the problem is the disease, even when the disease is incurable.

On the other hand, mental illness is about emotional pain that is not caused by disease, but by meaningful life experiences. Prescribing Valium to calm a person’s extreme distress is not medical treatment of a diseased mind. It merely masks the pain for comfort sake.

Using the chemical properties of a drug to prevent a person from feeling pain, whether physical or emotional, is fundamentally indistinguishable from suggesting he stop at the local bar and order a double shot of vodka. It is not treating a disease. Rather, it prevents the experience of pain. Experience itself cannot be diseased. It can only be a symptom of a disease.

If we opened up the definitional gates to the extent that any painful human experience is considered a symptom of a diseased mind, not only would it be nonsensical, it would also lead to inhumane results. The mental health industry would become dictatorial and any unwanted human experience would then be dragged into its paternalistic clutches.

But isn't this already happening?


“I Want To Die” – Take 2

"I Want To Die” - Take 2

In my previous commentary concerning suicide (see July 21, 2017) I made the point that even though suicidal thinking is quite common, actual suicidal death is not; it’s only 1.5% of all deaths in the U.S. (2015 statistics). One “expert” (I’ve forgotten who it was) claimed it was 250 thinkers of suicide to 1 doer. It’s even greater than that when one realizes that suicidal thoughts are often camouflaged. “I’m sick and tired…,” “I hate my life,” “Life sucks!” But WOW does suicide make headlines, particularly when the rich and famous do it: of late, Anthony Bourdain, the world-traveling chef/social commentator, and Kate Spade, the billionaire handbag entrepreneur. Both hung themselves. Why so much interest? Well, perhaps it’s as in the old Broadway song from Camelot “What do the simple folk do?” Well, “They sit around and wonder what Royal folk would do!”

No, there is more to it.

We are shocked, I think, because: (1) we project on those who seem to have everything (fame, fortune, beauty, brilliance) great happiness, and (2) we (the public) tend to see suicide as a consequence of mental illness. Thus, “We didn’t know that _____ was mentally ill!” There is a dearth of existential thinking in our culture. Our fascination with suicide has really more to do, I think, with our perplexity about life. WHO AM I? WHAT AM I DOING HERE? Facing meaninglessness and/or chronic pain is or can be tortuous.

99.9% of the time suicide is a very private affair. The suicide takes place alone in a hotel room, behind the shed, the privacy of one’s own room, or home when everyone has gone out. The other 0.1% is a grand performance usually to make some profound statement. I recall with horror watching on TV the Buddhist monks in Vietnam self-immolate to protest the goddamned WAR! More recently, a gentle person, environmentalist, David Buckel, on April 14, 2017, imitated the Buddhist monks this time in Prospect Park Brooklyn: “My early death by fossil fuel reflects what we are doing to ourselves,” he wrote in his final email. Perhaps as therapists we must always be looking for the underlying message, whether it be a socially redeeming commentary or a “Fuck YOU to all who hurt me!!”

Steve Pinker in his new book Enlightenment Now: The Case for Reason, Science, Humanism and Progress ( 2018, Viking Press) takes on the issue of happiness (see chapter 18) and examines the suicide rates of three countries for which there is the best historical data (US, Switzerland, England). There are various peaks and troughs these last 150 years with all three countries showing the highest rates during the Great Depression (Switzerland ~25.6/100,000; US ~17/100,000; England ~20/100,000). He has no explanation for the current bump in the US suicide rate from about 10 in 1960 to about 11 in 2000 to about 13 currently. Nor does he find evidence of an increase in depression. We really can’t use the disability numbers because there are economic incentives to declare oneself depressed. The current psychiatric profession helps this along by being quick to diagnose this “brain disease.” Nor is there evidence of any increase in serious mental illness or for that matter of loneliness. And although he feels Americans“should” (page 284) be happier given how “amazing our world has become” he also acknowledges that the increase in anxiety is not pathological. In fact, “anxiety has always been a perquisite of adulthood.”

So, my worried friends, family, colleagues: welcome to maturity.

My Country ‘Tis of Hate

My Country 'Tis of Hate

Coincidence. I read with horror the NY Times exposé by Ron Nixon and Michael D. Shear, “Over 700 Children Taken from Parents at Border” (April 20, 2018) within a few hours of starting to read D. H. Dilbeck ‘s biography “Frederick Douglas, America’s Prophet” (2018 Chapel Hill Press). “The mere whim of a master could separate forever a child from his family,” (p. 13) Douglas is quoted from his autobiography “My Bondage My Freedom.” Six-year-old Frederick was the beloved of his grandmother guardian, also a slave. She was ordered by her master, however, to give him up, and simply disappear from his life. "…granmammy gone! granmammy gone!" “Frederick franticly searched the kitchen. When he realized his grandmother had left, he collapsed in a fit of inconsolable tears. He sobbed himself to sleep that night.” This was the first of many “traumatic terror(s)” inflicted by slavery on Frederick.

We ISEPP members call ourselves a society concerned about “ethical practices” in the mental health field. We are expert in our understanding of the vicissitudes of Attachment and Separation. So, as experts, even putting aside moral and ethical principles, we understand the damage that America’s terrible immigration policies can inflict.

ISEPP members, should we not speak out?

It seems the administration fears that some immigrants commit fraud by using minors, not their own, to bolster their case for admission when seeking asylum from political violence. Alright. I understand desperate people will lie to survive. But our system of justice is based on due process, and as Ben Franklin once said, ”Better that a hundred guilty Persons should escape than one innocent Person should suffer.” This issue, I think, is related to those who criticize psychiatry’s power to commit a person deemed dangerous even if he has committed no crime. I am making a connection here. I am positing that what many members of ISEPP hate about psychiatry is not a psychiatry problem but rather an insidious social/cultural stain directly in contradiction of our avowed ideal that “all men are created equal.” The Eugenics movement of the late 19th century was essentially a continuation of a slave economy justified by the notion that Africans are inferior creatures. An illustration: In 1851 a physician, Samuel A. Cartwright of Louisiana in his book “Diseases and Peculiarities of the Negro Race,” proposed a disease entity, drapetomania, a running away mania, a particular disease entity of Negroes who ran away from their servitude.” The cure was “whipping the devil out of them.” (see Wikipedia, Drapetomania) Of course God is the source, according to Cartwright, of the righteousness of slavery, the white race domination of the black. Please note when our President demeans migrants fleeing for their lives, referring to them as murderers and rapists, he puts us all back into the scientism of the mid-19th century thus justifying their mistreatment.

ISEPP members. Should we not speak out against this madness?

Five Depressed Women, Depressed?

Five Depressed Women, Depressed?

What is depression? A state of being, a feeling, a diagnosis, an affliction, a disease? I find no easy answer to this question despite the fact that I am a so-called expert. As one learns more and more about a subject, any subject, one realizes how little one knows. For over 40 years I have been treating depression in my office. I’m not even sure “treating” is the right word. Maybe “sitting with” or “confronting” or “exploring” or “observing” or “struggling with” would be better terms. Clearly “curing” depression is a foolish notion. Everyone gets depressed in some way. Do we cure being human? So, allow me to explicate the mystery with some very recent on-going cases. Yeah, I know, “case”, such a medical term. Forgive.


Do we treat people or do we treat diagnoses? I think the former!


Woman #1: “J.” I saw J. with her husband several decades ago, a childless couple with difficulties not at all unusual: miscommunications, sexual complaints, nothing eccentric or peculiar. When they moved north with hopes of early retirement, they presented me with a lovely clock which I still have in my office, the clock that determines when “time’s up.” J. contacted me last year. Her husband had died of lung cancer 6 years earlier and now she was confined, because of a chronic neurological disease, to a wheel chair. She was forlorn. I encouraged her to get into therapy. I also told her I thought of her every day (an exaggeration) because of the clock. “You’ve made my day,” she exclaimed, really more of a whisper. She is unable to speak loudly because of her neurological condition. Six months later, she again contacted me, “There are no good therapists in the state of ___.” She asked me (begged me?) to have phone sessions with her. I agreed: a hard of hearing psychiatrist and a whispering patient. I did hear one statement clearly, “I’m lonely, so sad, all memories.”

Woman #2: “A.” I started seeing A. shortly after she got married. I initially treated her in combined individual/group therapy and then only in a weekly 2-hour group therapy session. She was a star in the group, beloved of the other members because of her skill in ridiculing the group leader (me), shining a bright light on my every shortfall, inconsistency, and therapeutic blunder. This fireball began falling apart – not a good idiom – a year ago as she approached her perimenopausal “change of life” – a rather useful idiom. A. switched from being highly psychologically-minded to being a woman obsessed with vague and, for her, frightening, physical symptoms: dizziness, headache-like fullness, constriction in her throat, loss of appetite, changes in sleep pattern (less sleep), increased sexual desire, tinnitus. She consulted doctor after doctor: acupuncturist, holistic, GYN, ENT, neurologist, internist. She peeked into her chart when the last physician with whom she consulted left the room. It said “Hypochondriac, refuses to take her antidepressant.” I told her I disagreed with the diagnosis. “There is an old-fashioned term,” I said, “It’s called ‘masked depression’ whereby physical symptoms mask the underlying emotional struggle.” “Well, dammit,” she retorted, the old fireball, “You have to help me figure out what is that emotional stuff!” Indeed.

Woman #3: “Y.” Y. came to my office once a couple of years ago. It was a painful experience for her, for me, and for her husband. Barely able to walk even with her walker, she struggled up the 3 steps to my office, cursing and complaining. We never got beyond the waiting room! She had a left-sided (right-brained) stroke 6 years ago; her family complains that this 83-year old woman doesn’t try hard enough to get better. Coming to my office for weekly sessions would be horrible (for patient and therapist). So, after convincing me to reduce my fee (I don’t participate in the Medicare program. see previous blog), I agreed to phone sessions. Every session begins the same, “I’m worse every day, I’m scared, it’s hopeless.” She never misses a session. She always thanks me at the end of a session. By most clinical measurements her case would be considered a therapeutic failure. It’s not. I validate her, I challenge her – “You’re another day closer to death” – I explore her unsatisfying, painful relationship to her long gone mother. I recommended a book, “Tuesdays With Morrie” by Mitch Albom. Morrie is/was (now deceased) an extraordinary character who decided to embrace his terminal illness, Amyotrophic Lateral Sclerosis; Morrie has become Y.’s ego ideal. So Y. makes baby steps toward coming to grips with death and the indignities of extreme disability. She wrestles with her rage and guilt and shame. I receive a check in the mail promptly, 2 days after every session, from her husband. Evidently, he too values the respite from complaint that the session provides.

Woman #4: “H.” Every session begins the same, “I’m possessed by the devil. I’m trapped in my body. I can’t take care of myself. I want to die.” She lives in an extended care facility, refuses to drive, and has not worked (as a dental assistant) for 6 years. She may be a victim of psychopharmacological poisoning. When she first sought help for “depression” from her GP and then a psychiatrist, she was drugged with antidepressants and neuroleptics. She developed a movement disorder, tremors, and shaking throughout her body. To my amazement, after reviewing her medical records, no one, including NIH mavens, considered this an iatrogenic problem. It was after or during a 6-week hospitalization at a prominent Maryland psychiatric hospital, that she decided she was possessed. It took me 9 months to wean her off of her drugs. Was this a dementia? I sent her for neurological and psychoneurological testing. The tester concluded that she had profound deficits in executive functioning, probably could not take care of herself, and had a “structural apraxia.” Brain scan, EEG, and neurological physical exam were all essentially normal. Embarrassed, not knowing the answer to a question that I should be able to answer as the expert, I asked her, “H., do you think your problem is physical or psychological?” “Both,” she answers. Why do I continue to fall for the body/mind split? It’s always both. Sessions with H. are bawdy and rambunctious, often singing silly songs. “Who you gonna call? Ghost Busters!” She’s very nosy, “What are you going to do this weekend,” she asks. “None of your fucking business,” I answer. Gales of laughter! I tell her, “You know what the devil hates?” “No,” she replies, “what?” “He hates it when you laugh.”

Woman #5: “L.” “You’re the first psychiatrist in 35 years who ever talked to us (she and her husband). They [other psychiatrists] would just check off the symptoms and write a prescription.” L. has suffered from panicky depressions since before her marriage, controlled (suppressed is a better term) by drugs. She had been prescribed more than 20 different antidepressants and neuroleptics. Finally, a year earlier, she paid the piper. The drugs stopped working. So, on to ECT X 18 treatments. - BTW, did you know that each ECT treatment costs between $2,000 - $2,500? You can make quite a nice living off of damaging the brain – No benefit. More enlightened members of her extended family found me through ISEPP. Because she lived 200 miles away we needed to set up phone sessions with monthly in-person meetings.

Have the drugs poisoned her? I don’t know. But what I know drugging has done is seduce her and her husband away from self-examination. For help in this case, I have referred to Bert Karon’s classic (I think) paper on treating depression with psychoanalysis without drugs. (“Recurrent Psychotic Depression is Treatable by Psychoanalytic Therapy Without Medication” Ethical Human Psychology and Psychiatry, Vol 7 #1, Spring 2005) This is not really a technical paper but rather an exhortation. Bert projects 2 not usual psychoanalytic qualities: persistence and optimism. These patients are “geniuses” he says in convincing therapists that their “lives are hopeless and therapy is of no value.” (page 46) He forthrightly counters their pessimism, telling them, (paraphrase) “If you cooperate, meet frequently (2 to 4 times a week) you will get better.” Further, he makes it clear that whatever they are feeling, anger, shame, sadness, that these are the result of real happenings in their life, conscious or unconscious, present or past. Bert makes only one mistake: “… patients are more likely to make optimal progress without the use of medication or with temporary medication which is withdrawn as rapidly as the patient can tolerate.” (page 45) On the face of it, this statement is correct. The problem is when someone has been drugged for long periods of time, one is (I am) never sure what is happening. Is the drug making them feel worse or better? Is withdrawal making them feel worse or better? Is a setback in therapy due to a therapeutic blunder or is the therapeutic intervention irrelevant to what the drugging or the withdrawal of the drugging is doing to the patient? To paraphrase Freud, “A toothache takes precedence over neurotic anxiety.”

My imperfect approach to this dilemma is to assure the patient that it is in their long-term interest to be drug free. While they’re moving through this arduous process, they must practice “good mothering” to themselves with regular exercise, meditation, gentle calming herbs, tea, and dietary supplements.

Genetic Language Smokescreen

Genetic Language Smokescreen

Chuck Ruby, Ph.D.

The online magazine Science published a study titled "Shared molecular neuropathology across major psychiatric disorders parallels polygenic overlap," which purports to show genetic underpinnings of several mental disorders. It claims a breakthrough in understanding the genetic causes of these "disorders." 

I’m not a geneticist but my read of this research suggests it is another language smokescreen that obscures a simpler, more humane, and non-disease description of human problems. It is a way to continue on the charade of the myth of mental illness through a verbal sleight of hand trick. The genetic and medical terms used sound impressive (e.g., transcriptomic, phenotypes, pleiotropic) but they are euphemisms that refer to far more common, non-disease matters. Yet because they are used, they give the flavor of real disease.

Just a quick look at the study's abstract demonstrates this deceptive ploy:

"The predisposition to neuropsychiatric disease involves a complex, polygenic, and pleiotropic genetic architecture. However, little is known about how genetic variants impart brain dysfunction or pathology. We used transcriptomic profiling as a quantitative readout of molecular brain-based phenotypes across five major psychiatric disorders—autism, schizophrenia, bipolar disorder, depression, and alcoholism—compared with matched controls. We identified patterns of shared and distinct gene-expression perturbations across these conditions. The degree of sharing of transcriptional dysregulation is related to polygenic (single-nucleotide polymorphism–based) overlap across disorders, suggesting a substantial causal genetic component. This comprehensive systems-level view of the neurobiological architecture of major neuropsychiatric illness demonstrates pathways of molecular convergence and specificity.”

  • neuropsychiatric disease, polygenic, pleiotropic,architecture, dysfunction, pathology, transcriptomic, phenotypes, perturbations, dysregulation, polymorphism, and molecular convergence and specificity??

Now doesn't that sound impressive? I'm certain that most people will glaze over about half way through it and stop reading, and instead just accept the claims like this headline:

"Major mental illnesses unexpectedly share brain gene activity, raising hope for better diagnostics and therapies."

I’ve taken the time to wade through the abstract's wording and replace all that nifty medicaleze and substituting more common and humane terms:

"Behaviors have a genetic substrata. However, we don’t know how that substrata causes those behaviors. We examined cellular RNA activity to see how they varied across different types of behaviors. This showed differences and similarities among those behaviors, suggesting they have a genetic substrata.”

All this research says is there are genes being expressed as people experience the problems we call “mental illness” and that genetic expression is shared to some degrees across different types of problems, but also retains a degree of differences across those problems.

Didn’t we already know this?

Further, don't we already know that any human activity or experience is going to be represented by underlying gene expressions? What does that have to do with verifying something as an illness? Ans. Nothing. Looking from the outside, this smokescreen gives the impression of precision science identifying and confirming that mental illnesses are about genetic anomalies. But on the inside, once the smokescreen is blown away, it is merely pointing out that gene activity is going on during any human behavior.


Ignoring the Real World of Depression

Ignoring the Real World of Depression

Chuck Ruby, Ph.D.

The Observer published a January 7th article by Johann Hari entitled, "Is Everything You Think You Know About Depression Wrong?" In it he questions the prevailing views about depression being caused by a chemical imbalance, among other things, such as the grief exception in the DSM5. One day later, Dean Burnett, identified as a "doctor of neuroscience," critiqued Hari in one called, "Is Everything Johann Hari Knows About Depression Is Wrong?" Dr. Burnett's piece addresses Hari's claims by, first, denigrating him, and then by basically claiming the bulk of what Hari said was either not true or that it is common knowledge and, thus, inconsequential. But there are some huge problems with Dr. Burnett's critique.

Whereas considering one's reputation is important in assessing an author's credibility, still the validity of the material is an independent matter. Disreputable people can claim valid facts. Ad hominem attacks are never helpful. Ending the opening section after having denigrated Hari with a comment to imply something like, "Let's see what he has to say anyway" ("...assume Hari has written this article with 100% good intentions and practices.") Dr. Burnett doesn't negate the preemptive negative effect of questioning his credibility.

Dr. Burnett avoids, as do most advocates of the medical model of human suffering, the big question: Is depression (and all other so-called "mental illnesses) a brain illness as supported by scientific evidence? Demonstrating biological underpinnings of depression obfuscates the issue. All things human are accompanied by biological underpinnings without being considered illness. Take for example hair color, height, temperament, athleticism, and cognitive ability. All these things are possible because of their biological underpinnings. But none are considered illnesses. It is only when we can scientifically demonstrate some lesion, malfunction, or defect in that biology that leads us to a conclusion of illness. For instance, we can demonstrate dangerous blood glucose levels with diabetes; detect damage to bones in a broken leg; and observe the ravenous onslaught of cancer. There is no such thing happening to the biology that underlies depression (or any other mental illness). Given this lack of evidence, medical treatment is not appropriate, and potentially dangerous.

And please don't counter with the worn-out "but things like chronic fatigue syndrome and restless leg syndrome don't have evidence of pathology either." First, you're right. But I question whether these "syndromes" are actually physiological illness, since they can be explained by other means. But second, this lack-of-evidence problem doesn't apply to a whole grouping of disease entities in real medicine. The so-called mental illnesses are all this way. Imagine if all pulmonary diseases were created without any evidence!

The chemical imbalance theory of mental illness does not need to be "challenged." One cannot challenge a theory that has no supporting evidence, other than to point out it has no supporting evidence. Science doesn't work by proving negatives; i.e., that there is no chemical imbalance. Those who assert the hypothesis are obligated to provide the evidence, and they haven't. There has never been any evidence presented that demonstrates a chemical imbalance (or any other bodily malfunction) causes depression or that depression is an illness. Keep in mind the term "imbalance": an imbalance vs. a balance must be demonstrated. Not just neurochemical changes that occur when a person is depressed. Neurochemical changes occur for every human experience and activity. And this empty theory has been going on since the 1950's when the drug industry and psychiatry stumbled upon chemical "cures." The convenience of this coincidence cannot be ignored.

Despite pointing out that Wikipedia outlines "several factors widely considered to be important" in depression, physicians, psychiatrists, and drug companies (at least as of last night when I watched the Abilify commercial) still encourage people to think it is a chemical imbalance. People don't go to Wikipedia for depression; they go to their doctor. Those of us in the business know first hand that those doctors tell people they have a chemical imbalance, sometimes for life, and sidestep "bio-psycho-social" factors as mostly irrelevant (actually, and not surprisingly, they do give some attention to the "bio-" part).

They also do not explain how drugs work, what they do, what they don't do, and the harmful effects of taking them, especially in combination with other drugs and over a long period of time. In my 20 years of doing this work I have never heard of even one example of such an explanation.

All this despite what NHS, NIMH, NAMI, CDC, or any other organizations may display on their websites and despite what faculty and students talk about in universities. The truth is that where the rubber meets the road it is explained as a chemical imbalance and pills are pushed, and the psycho-social part is just portrayed as an afterthought. The widespread belief in this chemical imbalance by the lay public attests to what they are being told.

While it is clear Hari's exaggerated use of depression being diagnosed one minute after the loss of a baby was intended for effect, any currently practicing psychotherapist, psychologist, psychiatrist, or physician knows full well that it doesn't take weeks of complaints before a person is diagnosed with depression. That can happen within minutes of walking into a doc's office for the first time and complaining about the so-called symptoms of depression. We who actually do this work on a daily basis hear about examples from the victims themselves. And the typical response by the doc is a prescription for antidepressants, or worse yet, benzodiazepines. "Oh, and yes, it would be a good idea to talk to someone."

It is not about what Dr. Burnett knows that is important. It is about what happens to that "average person” he talks about when they seek out help in real life. And what happens to them is a shame. That is why what he knows and what they know is wildly different, as he points out.

And, finally, people do not get depression in their brain. Depression is a meaningful dilemma that resides in experience. It is not a medical matter, nor a matter to be drugged, anymore than a rough day should be drugged with a stiff drink. But then, we don't consider stiff drinks as medicine and we don't think of bartenders as doctors.