The Science Isn’t There

In my December 2011 post on “Nutrition and the Argument from Uncertainty” I cited and applauded the work of science writer Gary Taubes for unearthing the truth about nutrition science. The upshot was that the science just isn’t there for the conventional wisdom recommending a low fat diet and lots of exercise to protect us against obesity, diabetes, and heart disease. The science instead shows sugars and starches to be the most likely villains.

In a remarkable similarity of investigative journalism, science writer Robert Whitaker, in Anatomy of an Epidemic, demonstrates that the science isn’t there either for the chemical imbalance theory of biopsychiatry. In fact, the evidence in the psychiatric profession’s own literature shows that drug usage for depression, anxiety, and so-called schizophrenia causes more harm than help. In place of a genetic or chemical imbalance theory, Whitaker cites numerous studies supporting psychosocial issues as the causes of psychological problems and psychosocial treatment as the preferred technique to help victims of such problems improve.

To begin the presentation of Whittaker’s argument, let me repeat a point from last month’s post in which I reviewed his earlier work Mad in America: in the pre-drug era of the 1930s and ‘40s analysis of 1400 autopsied brains found no differences between the normal and the psychotic. Given this statement as a sort of prelude, what does Whittaker’s new book say about the chemical imbalance theory?

The theory for both depression and schizophrenia, as it has been tendered by the psychiatric profession, is quite simple. For depression, there is too little serotonin in the brain; for schizophrenia, there is too much dopamine. The drugs, therefore, according to the theory, should increase serotonin to combat depression and reduce dopamine to treat schizophrenia. Measurement of these neurotransmitters in cerebrospinal fluid is the benchmark for both existence and cure of alleged chemical imbalances.

What does the science show? For depression (pp. 71-75 in Whittaker*):

• Studies in 1969 and 1971 revealed no significant difference between serotonin levels of normal and depressed subjects.
• In 1974, serotonin levels were normal for unmedicated depressives.
• Similar results were found repeatedly in subsequent years, leading to this statement (in PLoS Medicine, 2005) by Stanford psychiatrist David Burns: “I spent the first  several years of my career doing full-time research on brain serotonin metabolism, but I never saw any convincing evidence that any psychiatric disorder, including depression, results from a deficiency of brain serotonin.”
• And this pointed conclusion by psychiatrist David Healy (in a PLoS Medicine news release, 2005): “The serotonin theory of depression is comparable to the masturbatory theory of insanity.”

A comparable pattern occurred in the studies of schizophrenia (pp. 75-79):

• No difference between normal and schizophrenic dopamine levels (1974) and no abnormal level of dopamine in unmedicated schizophrenics (1982).
• Similar results were found repeatedly in subsequent years, leading Steve Hyman, neuroscientist, former National Institute of Mental Health director and former provost of Harvard University, to conclude: “There is no compelling evidence that a lesion in the dopamine system is a primary cause of schizophrenia” (in Molecular Neuropharmacology, 2002).
• And: “The evidence does not support any of the biochemical theories of mental illness.” Elliot Valenstein, U. of Michigan neuroscientist, in Blaming the Brain (1998).

How do the psychotropic drugs work? They “create perturbations in neurotransmitter functions.” The brain tries to compensate by doing the opposite of what the drug is striving to do. After a few weeks, the attempts at adaptation break down. The brain becomes “qualitatively as well as quantitatively different from the normal state.” Steve Hyman, American Journal of Psychiatry (1996). The drugs, in other words, make the brain abnormal. [Whittaker, pp. 83-84]

The drugs also worsen long-term outcomes. In schizophrenics relapse rates of psychosis increase when neuroleptics are stopped. When on the drug, the brain becomes supersensitive to dopamine, furiously trying to produce more. Upon sudden drug withdrawal, out-of-control, rapid firing of dopaminergic neurons in both the basal ganglia and limbic areas of the brain produce tics, agitation (sometimes leading to thoughts of violence or suicide), and psychotic relapse. The drug then must be brought back. Continued long-term use, however, at some point makes the wild firing of neurons irreversible. Tardive dyskinesia, frontal lobe shrinkage, and permanent psychosis result. (Guy Chouinard, physician, McGill University, in various psychiatric journals 1978-1991). [Whittaker, pp. 105-07]

Whittaker does not stop at depression and schizophrenia. He meticulously documents similarly flawed science and destructive outcomes of drugs for anxiety (the benzodiazepines, such as Valium and Xanax), bipolar disorder (Lithium), and so-called ADHD (Ritalin and its relatives).

Evidence for psychosocial causes of mental illness and the effectiveness of psychosocial treatment?

• World Health Organization cross-cultural studies in 1969, 1978, 1997 have shown that medicated schizophrenic patients in the US and five other developed countries fared much more poorly—short term and long term—than the mostly unmedicated patients in India, Nigeria, and Columbia. [Whittaker, pp. 110-11]
• In the pre-drug era, the majority of first episode schizophrenics were dismissed from their hospitals within a year, 50 percent as cured, 30 percent as relieved. Twenty percent or fewer needed continual hospitalization. Today, the recovery rate is 36 percent and patients over a ten-year period require three times as many hospitalizations as their counterparts a century ago. The mentally ill die 15-25 years earlier than normal and their death rate has dramatically increased in the last 15 years. [Whittaker, p. 335]
• In Tornio, Finland (western Lapland), “open-dialogue” family-centered therapy has reduced first-episode schizophrenia by 90% since the 1980s. Psychotic symptoms often retreat within a month. Drugs are seldom used; if necessary, they are used in modest dosages and short term. One ward of the hospital is empty because schizophrenia is disappearing from the region! (More here: 1, 2, 3). [Whittaker, pp. 336-44]

Bottom line: the science is not there for biopsychiatry. And the above is merely the tip of Whittaker’s iceberg of evidence.

The science is not there for biopsychiatry, just as it is not there for low fat diets. But nor is it there for zero-rate interest and “quantitative easing” in economics as cure of our current Great Recession. What bothers me in particular about psychiatry is the immediate and concrete self-evidence that the drugs cause harm, such as flattened affect, subdued behavior, and the appearance in patients of looking and acting drugged.

One can argue that economic thinking is abstract and the chains of reasoning long. Therefore, failure to understand its arguments may be excused (despite the harm caused by the boom/bust cycle of the 2000’s). But psychiatry, where the effects of the practitioners’ actions are immediately evident? Where the effects of a legal drug show little difference from the effects of an illegal one? That I do not understand.

Whittaker has performed profound service to science by writing Anatomy of an Epidemic. As with the work of Gary Taubes, I urge you to read Robert Whittaker for the science he has uncovered, for the meticulousness of his method, that is, for his epistemology, and for his courage to expose a profession that refuses to examine itself.




*Page references are to Whittaker. Full journal citations are in Whittaker’s notes. For a concise, bullet-point presentation of source documents in both of Whittaker’s books, see this web page.

Kindness versus “Hard Science”

In my previous post I cited Peter Breggin’s Toxic Psychiatry as evidence to call modern psychiatric medical science both dictatorial and devastatingly harmful. Robert Whitaker’s very readable 2002 book Mad in America provides a great deal more detail about how the insane have been cared for in US history.

In the eighteenth century, for example, the insane were not considered human; they were wild beasts that had to be tamed. Hence the prison-like atmosphere, restraints and beatings, the blood-letting, the spinning chair, the dunking in water to the point of nearly drowning, and the administration of powerful emetics. These techniques were used repeatedly, day after day, sometimes for months. The aim of the mad-doctors, as psychiatrists were called prior to the late nineteenth century, was to terrorize patients, to break their will and supposedly knock the insanity out of them.

The twentieth century, as I mentioned in last month’s post, had its eugenics episode, and it is chronicled in detail by Whitaker, but the century also gave us shock therapies: insulin-coma, metrazol (camphor), and electro-convulsive. Administered perhaps hundreds of times, the purpose was to induce seizure, to supposedly shock the delusions and hallucinations out of patients. “Brain-damaging therapeutics” (Whitaker, p. 96), as these techniques were called, produced effects similar to brain trauma.

Transorbital lobotomy, performed with ice picks in the 1940s by the flamboyant Walter Freeman,* was called “surgically induced childhood” (p. 122). And because masturbation was still believed to be a cause of insanity, clitoridectomy was performed until 1950 (p. 79). In 1954 the drug era then began with the introduction of Thorazine.

But what happened in the nineteenth century? To be sure, many of the same cruel and inhumane techniques continued to be used. The Quakers, however, had a better idea, one that spawned the “moral treatment” movement in mental health (pp. 30-38). Recognizing that mental illness was not physiological, that it resulted from being overwhelmed by certain life events, they insisted that kindness, attention, listening, and talking were key to helping the mentally ill.

Fed well and allowed to sew, garden, read, write, and play games, the patients in the Pennsylvania Hospital that opened outside of Philadelphia in 1841 enjoyed a “pastoral comfort.” The hospital included a dining room, a greenhouse, a library, and a museum. The patients were encouraged to develop friendships, dress well, and rethink their behavior. They were urged to exercise free will and, not unlike Glasser’s Choice Theory, choose to be sane. Needless to say, they were neither chained nor beaten.

By 1890 all trace of moral treatment of the mentally ill was gone. The explosive growth of state-run, i.e., bureaucratic, hospitals made it impossible to train attendants in the spirit of kindness and empathy. What really killed moral treatment, though, was the ridicule and condescension put forth by medical doctors, especially the neurologists. They all considered themselves to be “men of hard science” and the moral treatment advocates were just old-fashioned, religious “gardeners and farmers” (p. 37). In the name of science straitjackets and cruelty were brought back; kindness and empathy were out.

The short-lived pastoral comfort of moral treatment brings to mind the “one brief shining moment” phrase from the title song in Camelot. Somewhat similar to King Arthur’s humanitarian moment in legendary history, moral treatment was eclipsed. It was stamped out by “hard science.”

Robert Whittaker is an award-winning investigative journalist. Before writing Mad in America, he subscribed to the conventional wisdom that psychiatry, especially the use of modern neuroleptic drugs, was good for the mentally ill. That is, until he stumbled on “symptom-exacerbation” experiments, conducted well into the 1990s, in which psychiatric researchers were giving patients drugs (such as ketamine, chemical cousin of angel dust) in order to worsen their psychotic symptoms. After this discovery, Whitaker in earnest began researching his book.

Psychiatric reviewers of Mad in America, not surprisingly, were unhappy campers. The reviews in fact were so negative that Whitaker’s editor advised him, if he wanted to make a living as a writer, to stay away from the field of psychiatry. He did so for awhile, writing two unrelated books, but psychiatric survivor groups kept contacting him. As a result in 2010 he wrote Anatomy of an Epidemic, the story behind the tripling of mental health disabilities from 1987-2007—this tripling despite increased usage of the alleged miracle drugs.

I have not yet read Whitaker’s latest book, but in a podcast interview about it with Peter Breggin, Whitaker relates three attempts by the psychiatric profession to silence him with ad hominem attacks and character assassinations. Here’s his response to one of the attempts. The profession, he stated in the interview, has succeeded in keeping him out of magazines where he used to write regularly.

This is how privileged “men of hard science” react when their monopoly and livelihood are threatened by facts. Fortunately, Whitaker has had the courage and independence to press on.

Many years ago William Glasser was denied a position at UCLA because he refused to buy into the medical model. In the 1980s Peter Breggin was threatened with having his license revoked because of comments he made on an Oprah Winfrey television show. (He won his case in court.) From outside the psychiatric establishment, Whitaker now joins this admirable pair.

Gentlemen, I raise a glass to you.



*It is worth noting that prior to taking up the ice pick, Freeman analyzed 1400 autopsied brains and found no differences between the normal and the schizophrenic (p. 115).


Postscript. One of the many tragic ironies in the history of science is the story of Ignaz Semmelweis who discovered the significance of and recommended—futilely in his lifetime—the use of antiseptic procedures in childbirth.

Semmelweis died a brutal death in an insane asylum.

Suffering in 1865 either from a breakdown because none of the “men of hard science” would listen to him or from Alzheimer’s disease or from syphilis, he was deceptively lured to a mental hospital. When he tried to leave, he was severely beaten, put in a straitjacket in a dark cell, doused with cold water, and given castor oil. Two weeks later he died . . . of septicemia, or blood poisoning, which he had argued was the cause of childbed fever and that the poisoning could readily have been prevented by washing the hands with chlorine.