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Cute Psychiatric Word Games

Those of us who seek to expose the fraudulent bases of psychiatry would probably be assisted by a good understanding of some of their terminology. I don't think it's worth the trouble to try to grasp every specialized term, since new terminology is invented daily, and each of the many versions of psychiatry and psychology has its own buzzwords.

But certain terms recur again and again in the literature (both pro and anti-psychiatry) that we encounter when we read about the subject. Also, if we try to tell people the truth about psychiatry, we are likely to get some of those terms thrown back at us, usually in large, rapid streams of big words, with the intention of overwhelming all possible opposition. Such onslaughts are easier to withstand if we know what the words mean. This is especially true of the terms used by psychiatrists and pharmaceutical representatives to suggest that their products are useful or are not harmful.

In this essay, I define a few of the more basic terms, say as clearly as I can (without big words or jargon) what they mean to psychiatrists, and, in most cases, why they don't mean what the psychiatrists say they mean. Here goes:

STUDY (noun): When a psychiatrist refers to a "study", he usually means an experiment, a test run to see if some drug or other treatment is "effective". Typical study: To see if a new drug is effective in knocking out depression, the psychiatrist advertises for depressed people to participate in a study.

He rounds up a bunch of people who consider themselves depressed. (You can find ads in magazines and newspapers, inviting people to participate in experiments, get free medication, etc.) Usually he administers some test to see if they are "really" depressed: Asks them a set of questions and, according to their answers, decides how they rate on some scale that is supposed to show whether or not someone is depressed. Maybe he also observes them. (Some studies are more intelligently done than others; occasionally some observation occurs.) He picks people for his study, maybe eliminating some where there's legal risk if they do poorly. For example, studies usually don't include pregnant women or kids. (Big inconsistency: After not testing something on pregnant women, they will still recommend it for them once it's approved by the FDA.)

Then he divides the people into groups: Those who receive the drug being tested and those who receive some sort of pill that is supposed to do nothing (a "placebo" [pleh-see-bow], Latin for "I shall please", meaning a pill given a patient just to humor him, typically a pill containing nothing but sugar). Sometimes there are more than two groups. For example, a third group might receive some other anti-depressant that's already on the market, in hopes of showing that the new one is better.

Then over a period of time (usually a few weeks) the people in each group are given their pills or placebos, theoretically, not knowing which they are receiving. During this period, they are observed (maybe) and questioned, and at the end of this period, they are questioned, given tests. Then the people running the study go over all the data collected and work out whether the new drug is "significantly more effective" than the placebo (or other drugs given) or not.

Now, when a psychiatrist says that "studies have shown...", there are many things you should know that the psychiatrist is hoping no one will notice. The general concept of "a study" sounds so scientific that mentions of studies are almost hypnotic. Here are a few of the things that the psychiatrist usually isn't saying:

1. You can find studies that prove almost anything. The reason is that MANY studies are done for each drug (or therapy), and, by the law of averages, some of them are likely to show that the drug works. The drug companies usually publish only the studies that make their drugs look good. Also, a drug can be made to seem effective when, for example, three small studies show that it is effective, while one huge study shows that it's not. When a "meta-study" is done (one that considers all the data from all available studies and considers their relative reliability -- whether or not they were done right), often it shows that a supposedly effective drug is NOT effective.

Suppose in each of three studies there were 10 subjects (people taking the pill), 5 in each group getting the real pill. Suppose in each of these studies, 4 taking the real drug said they felt better, while only 2 taking placebos said they felt better. But then there's a 3rd study, with 100 subjects, 50 of whom got the real drug. In that study, 20 of the people on the real drug felt better, but 45 of those on the placebo felt better. So the psychiatrist says, "3 of the 4 studies showed our drug effective. The "meta-study" results show, by combining the results of the 4 studies, that 32 taking the drug said they felt better, while 51 taking the placebo felt better, so the drug isn't effective. More people got better by taking NO drug than by taking the new drug.

2. Most of the studies are paid for by the pharmaceutical companies, who have already invested millions in the drug and want to see positive results. The guys doing the study make their living getting paid by the pharmaceutical companies to get good results for them. Thus, there's a huge bias in favor of finding the drug effective. The studies are not done to TEST the drugs, but to prove they work. That's bad science. Often ineffectiveness is exposed when someone NOT on the pharmaceutical company payroll does a new study.

3. Most of the studies last for a few weeks. This means no test is done of long term effects of the drugs. Yet the drugs are designed and marketed and prescribed to be used indefinitely. They are known to cure nothing, only to suppress symptoms, and it is known that if the user stops taking the drug, the symptoms return, often worse than they were in the first place. Therefore, these drugs are intended (by their makers) to be taken for life. So when, after several 3-week or 6-week tests, the drug makers claim that these drugs have only mild side effects, actually, they have no idea what the long-range side effects are. That means they do not know that the drugs will be safe when "taken as directed". Also, they don't test the drugs on children or pregnant women or various other groups who might be particularly vulnerable. If, for example, a pregnant woman is harmed by an experimental drug, she might sue. But once the drug is approved by the FDA, it can be prescribed to all these groups – on whom it has never been tested.

4. The FDA theory is that if there are bad effects, they'll be reported to the the pharmaceutical company by doctors, and the company will report these to the FDA. In other words, if a doctor prescribes a drug for you and you come in a day later with a whopping migraine or a sudden suicide obsession, the doctor is supposed to report this. However, various studies (interviews with thousands of doctors) have shown that most doctors don't know this, don't know how to report, and simply have never done it. A small percentage of doctors (under 10 %) do occasionally report – to the pharmaceutical company. But the pharmaceutical companies don't relay most of these reports to the FDA. They look at the reports and, in many cases, say, "There's no way to prove that our drug caused that" or "that was obviously caused by the original condition, not our drug." For example, a guy is depressed after his girlfriend leaves him, goes to a doctor, gets put on an anti-depressant, says he feels suicidal. The drug company gets the report, dismisses it by saying, "How do we know that's the drug? He probably feels suicidal because his girl friend left him." (This ignores the fact that he DIDN'T feel suicidal before being given the drug.)

Using this justification, the company doesn't report the data to the FDA. Thus, for every thousand bad side effect observed by doctors, a small percentage get reported to the pharmaceutical company (maybe 10, maybe fewer), and for every thousand reports that get to the pharmaceutical company, only a small percentage gets recorded as a side effect and reported to the FDA. So we end up with maybe 10% of 2% (0.5%) of observed bad effects getting reported – or some such figure. So we never do find out what the effects of long-term use is. When a drug used by millions accumulates 2,000 negative reports, that's a huge number, because it represents a far larger number of other incidents that weren't reported (hundreds of thousands).

5. Often people are put on several different drugs at a time (psychiatric and medical). But no one has tested these combinations of drugs or shown that they are safe in combination. There are millions of possible combinations, none of which have been tested and found safe.

6. Studies can show invalid results for all sorts of reasons. It's not hard to mess up the statistics and cover up the mess with jargon. Here are some examples:

Sometimes the psychiatrists give people tests to find out how suggestible they are, then remove the most suggestible from the study. (Suggestible: Easily influenced by others, good subjects for hypnotism, etc.) The idea is that suggestible people are more likely to get better if given the placebo. If lots of people get better on the placebo, then the drug won't look as good. The drug looks good if lots of people get better on the drug, and few get better on the placebo. So by removing the suggestible people ahead of time, the researchers are trying to make the study favor the drug.

In one case (and I've simplified the numbers here, but the principle is the same), before the study began (that is, before the people were given the drugs and placebos), one of the subjects had "suicidal ideation" (thoughts about committing suicide). At that time, subjects had not been assigned to groups (placebo group, drug group). Shortly after the study was over, one of the people who'd received the drug got suicidal. DURING the study, 2 people on the placebo felt suicidal and 3 people on the drug felt suicidal. The psychiatrists reported that the drug was effective, because 4 people felt suicidal on the placebo, and only 3 felt suicidal on the drug. How did they come up with this? After-the-fact, they assigned the 2 guys who'd had suicidal ideation just before and just after the study to the placebo group. How did they reason? These two had suicidal ideation when not receiving the drug, and that's the same as being on the placebo. They ignored the fact that (1) they weren't on the placebo OR the drug; (2) the post-study guy had been receiving the drug during the study, and was probably feeling suicidal as a symptom of withdrawal from the drug.

In another study, they claimed (with similar faulty reasoning) that more in the placebo group had suicidal ideation than in the drug group. In this case, besides the juggled numbers, there was this distortion: They did not report that in the placebo group, there was ONLY suicidal ideation, while in the drug group, two of those suicidal people had actually committed suicide!

In some studies, results are reported only for subjects who complete the study. If several people drop out of the study, they are simply not counted. But when such studies are looked into, it is usually discovered that the people who dropped out did so because the drug made them ill or suicidal. In other words, vital evidence of the drug being dangerous is not reported in the study, because the subjects "dropped out of the study."

A much bigger factor is the use of INACTIVE PLACEBOS. As I said, a placebo is usually a sugar pill or salt or something not likely to have any strong, observable effect. That is what's meant by an "inactive placebo." The problem with this is that the subjects are not supposed to know whether they are getting the placebo or the drug. Some flawless studies have shown that when a placebo doesn't do anything, a high percentage of those receiving the placebo realize that they aren't getting the real drug. Since the whole point of a placebo is to see whether people are getting better because the drug helps them or because they just expect to get better when they are given medication, an inactive placebo destroys validity. They won't get better on a placebo when they know it is a placebo. A placebo is not a placebo unless the person receiving it thinks he is getting medicine.

The whole point is, a placebo is something that doesn't do ANYTHING – doesn't help. So if the subjects know they're getting a placebo, they know that it isn't helping them. The solution to this difficulty is to use an ACTIVE PLACEBO. This is something not thought to help with depression (or anxiety or whatever is supposed to be handled by the drug being tested), but that creates some obvious side effects. Niacin, for example, will create a flush, and many other substances will create side effects (a dry mouth, for example). Studies have shown that if an active placebo is used, people feel some side effects, so think they are getting the real drug, so get better in far greater numbers. (This is like a child knowing he's being helped because the medicine tastes awful.)

Most of the studies favorable to psych drugs used inactive placebos. Most such studies, if favorable, were not highly favorable. The difference between the drug and the placebo is more than wiped out by the difference between the results gotten by an inactive placebo and an active placebo. For example, if, with an inactive placebo, 40 out of 50 said they felt better on the drug, and 35 out of 50 said they felt better on the inactive placebo, then something like 45 would have felt better on an active placebo, making the placebo better than the drug.

Not all drugs are tested with placebos. For example, long ago (1974) Ritalin was tested and said to be effective. Those studies were lost by the FDA long ago (some administrative or logistic mess). Thus, we have no way to look at the data and how it was obtained. However, because Ritalin has been declared effective, many studies since then have not tested the new drug against a placebo. They've tested it against Ritalin (one group gets the new drug, the other group gets Ritalin), the idea being that if Ritalin is effective, they just have to show that the new drug does better than Ritalin – or does as well, without some bad side effect. So here's a drug tested with inactive placebos decades ago, and all the new drugs are compared only to it.

The first study presented to the public showing Magnetic Resonance Imaging (MRI) of brains of people with ADHD (Attention Deficit Hyper Active Disorder) claimed to show that the brains of ADHD people were abnormal, smaller than the brains of "normal" people. When the psychiatrists did press conferences on this discovery, they failed to mention that the ADHD people with the smaller brains had already been on psych. drugs before these images were made, and those drugs are known to have that effect on brains. In other words, they attributed to the made-up mental illness (ADHD) effects that were created by the psych. drugs.

After this was exposed (but the exposure given very little press), a second study came out that claimed to have used ADHD people who had never been given psych. drugs. When MRIs of their brains were compared with "normal" subjects, the so-called ADHD brains were smaller, even though they hadn't been given drugs. What the researchers failed to mention was that the "normal" subjects averaged 2 years older than the ADHD subjects. All of the subjects were children, at ages where the 2-year difference accounted for the difference in brain size. (I guess they had trouble finding older "ADHD" kids who hadn't already been drugged.) Since then, there have been more MRI studies, but none are considered valid science by MRI experts, for reasons that are beyond my technical scope.

There's a great deal more you can find (in various books) on this subject. The point is, when a psychiatrist mentions "a study", don't back down or assume that it means anything. There are all sorts of questions you can ask, and chances are, he won't have the answers. ("Who paid for the study?" "Did it use an inactive placebo?" Etc.)

Note: Of course, all of the points above are minor compared to some more basic points: How can you test people suffering from a mental illness called "depression" when there is no such illness? Also, the scientific method, properly applied, does not set out to prove that one's product works. What a good scientist, having a theory, does is try his best to DISPROVE his theory. If the theory stands up to such an assault, it is considered likely to be useful. It's bad science to hire people to prove that your drugs work or to have the testing of these drugs paid for by the people who need and want them to work. Also, how do psychiatrists decide who is depressed? And how do they decide who has improved? Can they spot someone who is no longer in grief, but is in apathy, no longer ABLE to grieve? Do they depend on what the subjects tell them? (You can bet that the method used is the one most likely to make the drugs look good.)

TRIAL: The studies described above are also called "trials" (tests) or "drug trials." Actually, study is a broader term. Not all studies are drug trials. For example, someone could do a study of the medical records of people on a particular drug or a study of people who go to church and people who don't go to church to see which live longer. But usually psychiatrists who speak of studies in the current debates are referring to drug trials or to later studies that attempt to verify ("replicate") the results of the trials.

DOUBLE BLIND: Psychiatrists like to refer to "double blind studies". This means that not only do the subjects not know whether they are getting the placebo or the drug; also the people running the study don't know. So the researchers set up elaborate precautions to make sure of this. That way, supposedly, the psychiatrists will be objective, not try to weigh the results in favor of the drug. There are several holes in this:

1. Since most of the studies have used inactive placebos, many of the people on placebos KNEW they were on placebos, and those on the drugs (getting side effects from using them) knew they were on the drugs.

2. Even if the study itself is done objectively, when the time comes to present the results to the world in an article, the researchers know exactly who got what, and can now do their best to juggle the statistics to make the drug look good. The effectiveness of these drugs, in most cases, has more to do with how the results are analyzed and presented than with the way the studies are conducted. Researchers can even reinterpret actions or responses of participants in the experiment, and reclassify people who got better on the placebo as having gotten worse or people who got worse on the drug as having gotten better. After all, there's are numerous psychiatric labels for any conceivable sort of behavior, and these labels can be used to reclassify someone as having improved or gotten worse.

3. A true double-blind study is elaborate and requires people who know what they're doing. It's easy to see how this would be complicated: 50 or 60 people have to be given their drugs and placebos every day. The right people have to get the right thing (drug or placebo) every time. The people running the experiment must not know which are getting which. The people receiving their pills must not know which they are getting. That's not so easy to pull off. A few years ago a big Wall Street Journal article revealed that many of the companies doing these tests for drug companies were extremely unprofessional, with studies being run by untrained secretaries, insufficient supervision, etc.

RANDOMIZED: To randomize things is to arrange them in no particular order or in such a way that it is impossible to predict which thing goes where. For example, suppose a drug trial is going to involve 100 subjects, and these subjects are to be divided up into two groups of 50. One group is to receive the drug being tested. The other group is to receive a placebo. One could bias the results in favor of the drug by putting in the placebo group all the people in the worst shape and putting in the drug group all the people who seem most likely to be able to improve. And there are many other ways of grouping subjects to get a desired result. A fair test requires some more random way of selecting the two groups. Usually all the subjects are first divided up into groups according to such factors as age and sex, and then an attempt is made to divide up each of these groups randomly. That way, the groups that result will be similar (for example, have the same proportion of males and females, the same age distribution).

The current psychiatric buzzword is that some drugs effectiveness was "shown in large randomized double-blind trials". A large trial might have several thousand subjects. This sounds very impressive. However, you've seen how easily the results from smaller trials can be distorted by statistical finagling. The larger the trial, the easier it is to distort the results.

Here's how it works: With a small trial (for example, 20 subjects), it's more difficult to hide a bad result, because the data tables aren't huge and overwhelming. It's easy to see, for example, that 5 of the 10 people on the placebo got better. But the results of small trials aren't considered reliable: Two small a sampling. The argument is that different people respond differently to any drug, and that to get a good overview of the drug's effects, one needs to study a large sample. The larger the sample, the more likely the results will apply to the whole population. Thus, if 40 % of the people in the small study (4 people) get better on the drug, that isn't enough data to predict that 40% of the population will get better on the drug. But if 40% of 2000 people get better on the drug, one can be more certain that 40 % of the general population will also get better on the drug. The researchers will express this as a probability, and say that the 40% effectiveness is 95% likely to apply to the general population -- or 80% or whatever. They have mathematical formulas for determining this probability that the results of the trial will apply to everyone. One of the factors these formulas take into consideration is the size of the trial: How many people were studied.

The trouble with that theory is that it assumes the researchers analyze the results honestly and correctly. In fact, the larger the study, the more difficult it is for those who review the study to spot cheating or errors. A study with thousands of subjects will produce many pages of tables of numbers. Typically, those who review the studies only review summaries of the studies (called "abstracts"). They seldom have the time or desire to go through all the data. When people critical of large studies DO go through all the data -- and track down more data when things don't make sense, they often find that the studies did NOT produce the claimed results. In the case of psychiatric drug trials, most of the original trials are flawed. I've given examples of the sorts of distortion found above. The additional point I'm making here is that, the bigger the study, the more likely such distortions will be found.

The small studies aren't considered reliable, and the big studies shouldn't be considered reliable. As long as studies are done with the intention of getting the results the pharmaceutical companies want to get, size and degree of randomization are no assurance of reliability. (Of course, if the drug simply kills most of the users within 24 hours, that won't be hidden, and the drug will be abandoned. Some things are too hard to hide.)

PEER-REVIEWED: Psychiatrists like to refer to "peer-reviewed studies", as if this were a guarantee of validity. A "peer" is an equal. So a psychiatrist's peer is another psychiatrist of comparable status in the psychiatric world. Peer-reviewed means that some psychiatrists did a study, and some other psychiatrists looked it over to see if it was properly done. It does NOT say how closely these reviewers looked at the findings, whether the reviewers were independent of the pharmaceutical company that funded the study or were also getting funding from it or from other similar companies, etc. It MAY mean that the study got a good going over. But it may also mean that the study got a pat on the back from members of the good-old-boy network. Also there's the back-scratching phenomenon: "You give my study good marks, and I'll give your study good marks." Also, when the peer review is ordered by the publisher of a big-name medical journal as a requirement before the article is approved for publication, the editors may assign as reviewer someone sure to give the article a favorable review, since these publications usually depend on money from pharmaceutical company ads.

MENTAL ILLNESS, MENTAL DISEASE, PHOBIA, MANIA, DISORDER, DYSFUNCTION, SYNDROME, etc.: All words used to describe sets of conditions and imply that they are illnesses with biological causes (such as "chemical imbalances in the brain"). When we say there are no mental illnesses, we don't mean that the conditions don't exist, just that they aren't illnesses. Why aren't they illnesses? The idea of "illness" comes from the field of medicine. In medicine, an illness is established to be an illness when some cause for it is found (by experiment). For example, if a certain germ is always present when the symptoms (signs of illness) are present and if when that germ is eliminated, the illness always goes away, that indicates that that illness is caused by that germ. (Of course, there may be other causes as well, but at least there's some use to going after the germ.) If a certain set of symptoms is always caused by salt deficiency and remedied by taking salt, we have an illness (a deficiency that is making someone ill.)

But suppose someone has a headache. That is not an illness. Why not? Because there are many things that can cause a headache. Suppose we assume that it's being caused by a salt deficiency and give the guy lots of salt, but never test to see if he has a brain tumor – and he does! The salt won't handle it. Suppose we assume he has a brain tumor and open him up – and find there's no tumor. Then we find out he was deficient in salt! That's why "headache" is not an illness. It's not specific enough to be tied to a single cause. Similarly, if a kid isn't paying attention in school, there could be hundreds of different causes (sugary diet, boredom, trouble at home, allergy, vitamin deficiency, misunderstood words, pain...). Since the symptoms of ADHD could be caused by any of these and many other things, ADHD is not an illness (mental or otherwise). It's a variety of conditions with a variety of causes, all lumped together by psychiatry -- a good way to make sure no one ever finds the right cause in a particular case.

But a psychiatrist will say, it doesn't matter, because the drug works on many people (helps many people). Apart from the doubtfulness of this statement (many of the people who say it works do not seem to be better off, and certainly it can't help their livers to be taking toxic substances every day), there's the implied fallacy that, if a drug helps a condition, that must mean that drug is good for that condition. In fact, ANY drug, in small enough doses, is a stimulant, and will likely perk someone up who is depressed -- and also will perk up someone who is NOT depressed; and ANY drug, in large enough doses, is a narcotic and will tend to sedate someone who is anxious, manic, etc. Here's a simple analogy: Let's say you want to handle people who are terribly anxious and upset. You can do this, in most cases, by giving them a lot of whisky to drink. Eventually they'll be sleepy and not moving much. Does this mean that they all suffered from the same "illness"? In other words, does the fact that whisky calms down a lot of people mean that the source of their anxiety was the same in each case? Hitting them on the head hard with a baseball bat would also calm them down. Does that mean that all anxiety comes from a single cause? (Being alive?) You're tired: Putting you in a cage with a tiger will probably wake you up. This will occur whether your tiredness is from lack of sleep, from being told that a project you've worked on for months has to be done over, from a vitamin deficiency – whatever. The tiger's growl will have you wide awake. Does this mean that all tiredness is from a single cause?

The thing to remember about all the "illness" and "disorder" jargon is that it all describes conditions. The fact that the conditions exist does not indicate that any of them are illnesses.

Some of the terms have additional meanings. For example, a phobia is a fear. A dysfunction is an inability to do something – for example a sexual dysfunction might be inability of a man to get an erection. But basically they are all conditions, and few, if any, are illnesses. Some of them are sometimes caused by regular medical (non-psychiatric) illnesses. In other words, some of the fake psych. illnesses are caused by actual medical illnesses. Physical pain from an injury is making someone act crazy, or some vitamin deficiency is making someone depressed. So a mental illness is NOT an illness; it's a list of conditions or symptoms, but some of the people who have those symptoms have them because of a real physical illness.

All this confuses people. We say "There are no mental illnesses" and someone thinks we are saying the conditions don't exist. But the conditions DO exist. Some people are depressed (or sad, as we used to say). Some are anxious. But, we explain, the conditions are not illnesses. Then we say, look at all the possible causes of these conditions, including this or that illness. But didn't we say they aren't illnesses? That's right, they aren't MENTAL illnesses, but sometimes they are caused by regular medical illness. That's a complicated line of reasoning, and psychiatrists muddle it up on purpose.

STIGMATIZE: To mark or brand a person, usually with a mark indicating disgrace. The mark, scar, burn or whatever is called a stigma. (There are other related definitions. For example, Christ's wounds are called "the Stigmata".) A simple definition is "a mark of shame". Psychiatrists use the word in connection with the following argument: It is important to recognize that mental conditions are just illnesses, like tuberculosis or diabetes, something the ill person can't help. And the best way to treat illnesses (they argue) is with the appropriate miracle drug. When someone opposes this view, the psychiatrist says that those who deny the validity of mental illnesses are "stigmatizing the mentally ill". How are they doing this? By denying that these people are simply ill, implying that there's something wrong with them, that they are nuts. And this is a bad thing, because it means that people who feel mentally ill will be afraid to get treatment, lest they be "stigmatized" for admitting they are depressed, anxious or whatever.

That, of course, makes little sense, since labeling someone mentally ill is a far worse stigma than saying that someone is sad or anxious. Would you rather be called "sad" or "clinically depressed"? People aren't refused for service in the army because they've been sad. They are, often, refused for service because they've been on psychiatric medications. Which is more likely to "brand" or "stigmatize" you: The fact that you feel bad for a long time after a big loss, or the psychiatric label that says you have a brain condition that makes your brain abnormal and that may be genetic in origin and for which there is no cure, only relief if you keep taking your medication?

In Europe, for centuries, being (and appearing to be) a Jew was a stigma, and Jews were often massacred for their alleged beliefs and customs. But usually Jews would be spared if they converted to Christianity. In the 20th Century, German and other psychiatrists (often called "eugenicists," but usually with their degrees in psychiatry) labeled Jews a distinct genetic group, physically different from "real" Aryans (Germans and other northern White groups). This meant that Jews couldn't help but be Jews, that they had, in a sense, an incurable illness (Jewishness). Now conversion did them no good. Under NAZI laws the only "solution" was to sterilize them or kill them.

My question is, which was the greater stigma: Holding Jewish beliefs and attitudes and behaving in certain ways and having some choice about being or not being Jewish? Or being permanently Jewish by genetic heritage, having no choice in the matter, having "Jewishness" the way psychiatrists say that sad people have "chemically imbalanced brains"?

Of course, the psychiatric approach these days is to drug the people they thus stigmatize, not to sterilize or gas them. And instead of enforcing this treatment, sometimes they use lies to persuade people to ask for it. (Though, often they do enforce medication on people, calling this "an intervention.") But otherwise the principle is the same. (Note: It wasn't long ago that psychiatrists in this country considered sterilization of the insane the best course of action. Many of their drugs -- for example, the anti-depressants -- do tend to make people lose interest in sex.)

So whenever a psychiatrist accuses opponents of "stigmatizing" the "unfortunate sufferers afflicted with mental illness", realize that he means, "don't suggest that the person himself can do anything to help himself; and don;t do anything to make a person less willing to come to us for drugs."

CHEMICAL IMBALANCE: If, for example, you have too much sugar in your blood or too much salt and not enough potassium in your system or too much calcium and not enough magnesium, these are all chemical imbalances. There are many "balanced" sets of chemicals that work together in the body. For example, if you take huge amounts of B Complex, you need to balance that with some form of calcium that the body can absorb, because B1 leeches calcium from the body. In other words, it's not enough just to take "all the right vitamins and minerals". You must also take the right amounts of them required to keep them in the proper balance. If one chemical relaxes muscles and another tenses them, too much of one gives you muscle cramps, and too much of the other makes you limp. You have to achieve a balance.

The brain has tens or hundreds of thousands of chemicals interacting, and some of the most complex and least understood chemicals are the neuro-transmitters, chemicals that carry impulses from one nerve to another. The famous serotonin is one neuro-transmitter chemical. Epinephrin is another. There are thousands of other known neuro-transmitters, and probably many that have not yet been discovered.

The clever thing about attributing "mental illnesses" to chemical imbalances in the brain is that it's almost impossible to prove or disprove that such things exist, but it all sounds very scientific. I mean, I wouldn't recognize one of these molecules if I saw it walking down the street. The pharmaceutical companies have chemists who can actually find these things in brains – that alone takes all sorts of science and lab equipment. None of that science is psychiatry. It's physics and chemistry – neuro-physics and neuro-chemistry. But when psychiatrists toss around the chemical words, people get the impression that psychiatry is a science.

The idea that some sort of chemical imbalance is the source of mental illness is based on unscientific assumptions and studies. For example, someone classifies a bunch of people as depressed, studies their brains, and finds them deficient in serotonin. So that means depression is caused by a deficiency of serotonin? What's wrong with this?

First of all, it was done backwards. In other words, someone at Eli Lilly took a drug being researched for some other purpose (I think to handle ulcers), noticed that it didn't do that, but some of the subjects looked happier, so Lilly decided to make it an anti-depressant, and then chemists found that it increased the amount of serotonin available to the nerve endings in the brain, so some marketing genius said, ah, the lack of serotonin must be the cause of depression, so this new drug (Prozac) must fix that. Then someone did research to see if he could find a serotonin deficiency in depressed people, and claimed to have found one. That's backwards science. It's finding what you're looking for because you want to find it, not discovery.

Second, it failed to account for the fact that some depressed people had plenty of serotonin.

Third, even if it were true that depressed people had lower serotonin, that wouldn't establish a CAUSE. Suppose someone attacks you at work, invalidates all your efforts, and you feel depressed about that. It may be that part of feeling depressed is that serotonin levels go down. Does that mean that the CAUSE of the depression is the serotonin levels going down? Suppose we find that all tired people have trouble keeping their eyes open. Does that mean that the cause of tiredness is weak eye muscles? Suppose that all people hit on the head hard with a baseball bat have dented skulls. Does that mean that a dented skull is the cause of the head pain? (You could remove dents day after day and not help the person if someone continued to hit him with a baseball bat.)

Fourth, again, there are thousands of neuro-transmitters in the brain, all involved in fantastically complex and interdependent chemistry. No one has figured out what Prozac (or any of the other psych. drugs) actually do in the brain. Each of them affects thousands of different chemical reactions in the brain and elsewhere in the body. Lilly hit on the serotonin rationale, because it was the first effect they documented. The scientific reasoning here is along these lines: You throw a grenade into a group of people. It explodes. They're dead meat. Now you examine them and notice that in each case, their shoes have blown off their feet. You conclude that what a grenade does is blows someone's shoes off his feet. So you get a bright idea: Let's market grenades to people who have arthritic hands and have difficulty taking their shoes off! You haven't yet figured out that grenades also kill people.

Note: Another anti-depressant, Effexor, was marketed as better than Prozac because it increased the supply of TWO neuro-transmitters, not just one. This was hype, since all of these chemicals influence hundreds or thousands of neuro-transmitters. It's just that no one knows which they influence or in what ways, or whether any of the influences is actually a good thing.

Fifth, the correct or optimal balance of brain chemicals (if there is one) is not known. Chemical reactions happen rapidly, thousands of them every second. The words "chemical imbalance" imply that some exact balance is known and to be obtained.

Sixth, the best evidence is that the psychiatric drugs in use create obvious chemical imbalances – that is, leave people with huge obvious deficiencies or excesses. While we may not know some exact ideal balance, we know when things are far from normal. For example, the current anti-depressants are SSRI: Selective Serotonin Reuptake Inhibitors. What this is means is: Serotonin is supposed to carry certain signals from nerve-ending to nerve-ending. For this to happen, serotonin has to be available between the nerve endings. When a serotonin molecule has carried a message from one nerve to another, the molecule is ‘taken up" into the nerve, pulled out of circulation. Prozac, Zoloft, etc., are believed to inhibit (stop or slow) this "reuptake" so that the serotonin stays available between nerve endings to carry more messages. This is believed to increase the flood of messages (those particular messages associated with serotonin) in the brain, and that's supposed to stimulate the depressed person, make him less depressed.

But what happens is that when a person has been on the drug for months, it ceases to work for him, so the dose has to be increased (and the "side effects" also increase, of course). And if the person comes off the drug, having, for months or years, more or less force-fed serotonin into the brain by preventing the brain from taking up the serotonin – now, without the drug, he can't produce serotonin, so is truly deficient in a vital neuro-transmitter. Often, when some outside mechanism by-passes the body to create some effect, over time the body itself loses the ability to create that effect.

Notice that the first S in SSRI is an out-and-out lie. There's scientific evidence that these drugs inhibit reuptake of serotonin. But there's no evidence that this is selective, that only serotonin is affected, that no deficiencies or surpluses are created in other brain chemicals. The word "selective" is simply pseudo-scientific jargon. Serotonin is real stuff. And thousands of other chemicals are known and real. The reuptake mechanism is pretty well-known. But the "selective" part is just wishful thinking. It's like saying that when you throw that hand grenade into a crowd, it "selectively" blows their shoes off.

EFFECTIVE: Psychiatrists like to use this word. But they seldom define it or explain (in their studies) what their criteria were for judging a drug effective. Often they seem to be relying on what their test subjects tell them, what they say in answer to questions. Perhaps they have other means (some actual observation), but you'd have to do a close reading of the studies to figure this out. Most people just assume that when they say a study was effective, they mean something reasonable by "effective".

With ADHD, we know psychiatrists (and teachers and parents) often consider the drugs effective if the child sits still and appears to listen. Though there's no evidence that the child's understanding or grades (except in behavior) have improved, they assume that this stillness proves effectiveness. It may simply indicate apathy, not-there-ness, deadness.

Relying on what test subjects say (for example, that they've been helped) raises many questions:

Do they look at the person's actual productivity before and after being drugged? What statistics do they look at? Do they question the person's family and friends to see what they think? Do they test the person's intelligence or creativity or zest for life before and after treatment?

Since psychiatrists often refer to people who say they've been helped by the drugs, let's take a look at psychiatrists' own view of the reliability of what people say: If a psychiatrist says you have some disorder or illness (one of the ones listed in their Diagnostic and Statistical Manual or DSM), and you say, "No, I'm fine. I feel great." – the psychiatrist has a label for that (I've forgotten the exact jargon). Basically, the current psychiatric argument is that one of the symptoms of mental illness is that the mentally ill person thinks he's fine, doesn't know he's ill. Of course, this doesn't stop them from calling people mentally ill who SAY they are mentally ill. They've got you either way. The point is, they do argue (and mostly agree) that someone who is nuts will think and say that he is sane. But when they drug someone, and that person says he/she has been helped and is now quite well on the drug (for example Brooke Shields), the psychiatrist doesn't say "This person must be nuts, because she says she's well." Instead they cite him/her as an example of effective treatment.

In fact, there are other conditions (known to psychiatrists) that might better explain why many psychiatric patients say they've been helped. One is the placebo factor – they've been told they've been given medicine and that it will help. Mama has said "I'll kiss it and make it well", so now the child feels better. Similarly, the doctor says, "Take this, and you'll feel better," so they do.

Another is the Stockholm Syndrome: That's supposed to describe how, when a person has been taken hostage by kidnappers long enough, that person will begin to identify with the kidnappers, feel he/she is part of their family, sympathize with them, hope they don't get caught, etc. This phenomenon (it does happen) became big news decades ago when Patty Hearst was kidnapped by a radical group, and, after first being a weepy victim, became the lover of one of her kidnappers and participated with the group in one or more bank robberies. I think psychiatric patients are also psychiatric hostages, and tend to go into sympathy with their kidnappers. We tend to become what overwhelms us.

Another reason is that many people are pleased to accept the psychiatric idea that their problems are caused by an illness of the brain, because this means that they have no personal responsibility for their condition and don't have to confront the things in their lives they don't want to confront. This is, at least initially, a relief for them, so they feel better. For example, someone may be deeply depressed partly because of the things he/she has done to others. If so, a good way to avoid looking at that is to say, "I couldn't help it -- I'm sick" and take a pill.

Another reason people say the drugs help them is because in some ways the drugs do seem to help them. Heroin helps a drug user get high. So does cocaine. All drugs suppress some unpleasantness, decrease awareness, including unpleasant awarenesses, etc. The big fallacy in effectiveness claims is that they disregard the long-term trade-offs: The toxicity of any drug (very hard on the liver, for example), the increasing lack or woodenness of emotion, the withdrawal difficulties, the monetary expense (for individuals, governments, insurance companies) – and, of course, all the really weird and violent side effects that come up in many cases. For some reason, psychiatrists, by and large, are not defending drunkenness, though millions of drunks will attest that alcohol helps them, is necessary to them.

This brings up another aspect of the "science" of psychiatry (really of chemistry): Why is Prozac or Ritalin considered medicine, while heroin or cocaine is considered a dangerous drug? It's partly dosage and the way it's administered. Really, Ritalin is pretty much the same as Cocaine (probably stronger), but supposedly the dosage and the way it's usually taken (as a capsule) eliminate some of the obvious evils of cocaine. For example, you don't destroy the inside of your nose from sniffing it. (On the street, however, Ritalin is sniffed). Sometimes there really is little difference between an "evil" street drug and a "good" medical drug. Ritalin is one example. And, actually, heroin and most other street drugs are examples, because most of them (heroin, for one) were first marketed as miracle psychiatric or medical drugs, before it was decided they were actually dangerous, deadly drugs. Then they became street drugs. Today, many current psychiatric drugs are also street drugs. (The psychiatrists would say that they are "abused" as street drugs.)

But the big difference is that most of the street drugs (for example, heroin and crack) create sudden and obvious effects that are evident to others. For example, a drug user often can't work, can't hold a job, etc. As long as he's on the drug, he feels good (even terrific), but is often "out of it" – in another world. Much of the chemical science behind psych drugs deals with the question, "How can we make someone feel good in such a way that he appears normal?" Some drug makes people feel good, but they seem a bit crazy. So chemists experiment and find a variation of the drug that makes him feel better, but no obvious craziness appears to most observers. So we get Prozac. Or a drug like Methadone, more addictive than heroin, but with most of the "high" eliminated, so the guy can be on it, but hold a menial job -- or at least not upset passersby by acting up.

What's wrong with that? The fact that no obvious craziness appears is not necessarily a good thing, if the drug is eating away inside, suppressing feelings, putting the person out of touch with others, hollowing out the being. Isn't that how people always describe the latest serial killer: "He was such a quiet, polite person! I can't believe he could have killed those people!"

What psychiatrists really mean by "effective" is that the drug suppresses certain symptoms, behaviors, thoughts, etc., without making the person appear to be nuts. There's a lot of chemical science in the cosmetics of tinkering with the drugs to eliminate unwanted effects. But what does this do? You give a guy a drug to suppress his feelings. His feelings show up in some non-optimal way, so you come up with an "improved" drug that suppresses that non-optimal "side effect." Some other "side effect" comes up, so we "improve" the drug again to suppress that. Each step is sweeping something else under the rug. Stuff is really piling up under there. But the users look more and more normal, "just like the rest of us". (Remember Invasion of the Body Snatchers?)

It's important to remember, when we criticize drugs for producing all sorts of bad side effects, that the worst effects created by these drugs are the intended effects, the things they do to people when they are really "effective." These people who find the drugs effective are the one's who are being most thoroughly removed from their own feelings and who will have the most difficult time ever getting back to and confronting the things in their lives that caused their problems in the first place.

A TV special about kids on Ritalin talked about side effects (feeling like a zombie, stunted growth, suicide, etc.), but the main thing the kids interviewed stressed was that even when other people thought they were doing better, what felt worst was that they weren't themselves. The drug had substituted something for them. They felt they weren't themselves when on the drug. That is not a side effect. That is the intended effect. Some have more difficulty recognizing it than others.

SIGNIFICANT: Psychiatrists always stress this word. A drug has been effective in a significant percentage of cases. One drug is significantly more effective than another. In every day use, "significant" is a broad term, meaning "to a great extent" or "to a noticeable extent." Psychiatrists use it (although often sloppily) in a technical sense. "Significance" is a statistical concept. In any study, finding "significant" results means that the result found (for example, that the drug is more effective than the placebo) is striking enough, strong enough to be considered significant. And that significance is determined by mathematical formulas. There are MANY different mathematical tests for significance. And some tests are more appropriate to a particular data set (the set of numbers, the results of the study) than others. For example, some tests give accurate results when used on small amounts of data, but are less useful for large amounts of data and vice versa. Some tests are more useful for data that is bunched into one area (no one did great or terribly bad; everyone did pretty well), while other tests are more reliable for widely distributed data. And so forth. And by applying the wrong test to the data, one can get the desired results. You'd need to spend some time studying math and statistics to understand specific cases, but you'll avoid misunderstanding psychiatrists if you understand that when a psychiatrist uses the word "significant", he's usually talking about a mathematical concept that is complex enough to subvert.

Here's a very simple example of significance: If your study includes only two people, any result you get won't be significant: Not enough subjects, not a large enough sample. Of course, if both of them are given the drug, and both commit suicide within 24 hours, you'd think that would be useful data to have. But it could easily be suppressed, because it isn't "significant."

Or a particular test of significance requires dropping out (not counting) the extreme cases -- for example, those who score very low or very high on some scale. But that test is only supposed to be applied to certain arrangements of data. The researcher may apply this test inappropriately to drop out of his calculations most of the people who got worse on the drug or got better on the placebo.

Basically, "significance" as a statistical concept is another of the tools used by psychiatrists to bend the results of studies to suit the pharmaceutical companies. It's a concept from mathematics and statistics, intended to make science rigorous, but is used by psychiatrists to make science all too flexible.

METHODOLOGY: A big word that means, simply, how a study is done, how it is organized (for example, double blind), how the subjects were selected, what tests were used to establish significance -- and so on. Most of the big "break through" studies that supposedly validate psychiatric theories about chemical imbalance, the existence of genes for mental illnesses, etc., fall apart when their methodology is examined by someone who knows what to look for. Some psychiatrists understand methodology, but many are simply bluffing, so that if you say to them, "Yes, but I understand that study was later found to have faulty methodology", they'll simply back down.

Of course, it's even better to know your studies and know your methodology, but most likely you won't ever be debating specific studies with psychiatrists, since the basic flaws are so apparent: The studies are paid for by those who want a favorable result, and they claim to show the effectiveness of various treatments for illnesses that don't exist. That alone makes psychiatry a pseudo-science. Still, if you understand the points above, you're less likely to be daunted when a psychiatrist starts talking about significant results, effectiveness, peer-reviewed double-blind studies, etc. At least you won't go blank from all the strange words and strange uses of familiar words.

There are many more psychiatric terms, but I think those above are the key ones for the current controversies. Many psychiatric terms are simply jargon -- difficult words that have simple meanings, but are preferred for their impressive sound. For example "modalities of treatment" just means types of treatment. Thus, talk therapy is one modality, drug therapy is another. Much of the "science" of psychiatry consists of such pompous uses of words.

I hope this clarifies some of the most common areas of confusion in psychiatric pronouncements. The next time a defender of psychiatry talks about the many peer-reviewed, double-blind studies that validate psychiatric claims, I hope you'll have a better idea of what's being said...and what's NOT being said.




copyright c. 2005 by Dean Blehert. ALL RIGHTS RESERVED

Last updated: July 21, 2005