Mainstream psychiatry is built on myths that are harmful for patients. I described 10 of them in an article for a Danish newspaper on Jan. 6, 2014, which I published in English two weeks later on psychiatrist David Healy’s website as “Psychiatry Gone Astray” (1).
On Jan. 17, three Danish professors in psychiatry responded to my article, claiming they represented all professors in psychiatry (which trick moral philosopher Arthur Schopenhauer calls an “appeal to authority rather than reason”), in the same newspaper. I responded to the eminences in a new article four days later called “Leading Psychiatrists Have Still Gone Astray.”
As they could not win with scientific arguments, the Danish Psychiatric Association (DPA) attempted character assassination two months later and almost succeeded (2). They wrote to the leadership of the Cochrane Collaboration, which I co-founded in 1993, and found a willing instrument in Cochrane’s CEO, journalist Mark Wilson, who has never liked my reform work for patients (3), although Cochrane is about helping patients make evidence-based decisions. With his help, the DPA caused an uproar in the Danish establishment, and the Minister of Health threatened that I could get fired (2). Thou shalt not question the new clothes of psychiatry without eliciting the emperor’s rage!
One year later, I documented in great detail in my book about psychiatry why the 10 myths are myths (2).
The first myth I mentioned is also the worst: the one about chemical imbalance. Psychiatrists routinely tell their patients that they are ill because they have a chemical imbalance in the brain and they will receive a drug that fixes this. When I confronted a Danish professor of psychiatry about this nonsense back then, he declared in a newspaper that the psychiatrists had abandoned this hypothesis decades ago. However, a few weeks later the same professor spoke about chemical imbalance at a meeting where I also lectured. Clearly, the myth about chemical imbalance is only a thing of the past when challenged.
Last summer, one of my researchers and I collected information about depression from 39 popular websites in 10 countries, and we found that 29 (74%) websites attributed depression to a chemical imbalance or claimed that antidepressants could fix or correct that imbalance (submitted for publication).
It has never been possible to show that common mental disorders start with a chemical imbalance in the brain. The studies that have claimed this are all unreliable (2). A difference in dopamine levels, for example, between patients with schizophrenia and healthy people cannot tell us anything about what started the psychosis. If a house burns down and we find ashes, it doesn’t mean that it was the ashes that set the house on fire. Similarly, if a lion attacks us, we get terribly frightened and produce stress hormones, but this does not prove that it was the stress hormones that made us scared. People with psychoses have often suffered traumatic experiences in the past, so we should see these traumas as contributing causal factors and not reduce suffering to some biochemical imbalance that, if it exists at all, is more likely to be the result of the psychosis rather than its cause (4).
The myth about chemical imbalance is very harmful. It makes people believe there is something seriously wrong with them, and sometimes they are even told that it is hereditary. The result of this is that patients continue to take harmful drugs, year after year, perhaps even for the entirety of their lives. They fear what would happen if they stopped, particularly when the psychiatrists have told them that their situation is like patients with diabetes needing insulin. The Danish professor I alluded to before is considered one of the best in my country when it comes to depression, but he has also used the misleading comparison with diabetes by saying: “Who would stop taking insulin?”
Issues with mental health, ranging from mild anxiety to severe psychosis, are not caused by a chemical imbalance. In some cases, we don’t know what the cause is, but very often, it is a response to unhealthy living conditions. Most psychiatric disorders are related to anxiety and often start that way (5). When the anxiety becomes worse and hinders normal life, it can progress to depression or psychosis with delusional thoughts about people watching your every step. When people cannot live normal lives because of their anxiety, it is no wonder that a test for depression turns out positive. By not taking a complete history, going carefully and patiently many years back in time, psychiatrists and other doctors often miss the real problem completely and fail to see that they should address their patients’ anxiety with psychotherapy, not their “depression” with drugs, which do not solve any problems.
A psychiatrist I respect highly, who only uses psychiatric drugs in rare cases as an aid when he withdraws drugs his colleagues have instituted (6), has said that most people are depressed because they live depressing lives. No drug can help them live better lives. It has never been shown in placebo-controlled trials that a psychiatric drug can improve people’s lives — e.g., help them return to work, improve their social relationships or performance at school, or prevent crime and delinquency. The drugs worsen people’s lives, at least in the long run (2).
If doctors take their time at the first consultation, they will find that even severe psychoses are often related to previous trauma (7). Obviously, pills cannot heal severe trauma, although they can be useful in the hyperacute phase as an aid for falling asleep and calming down. But antipsychotics are not needed for this; benzodiazepines perform better (8).
Antipsychotics have no specific effects at all on psychosis (2). They should therefore be called their original name: major tranquilizers. This is what they do. They knock people down and render them passive. They surely create a “chemical imbalance.”
Professor Peter C. Gøtzsche, MD, co-founded the Cochrane Collaboration. He has published more than 70 papers in the top five general medical journals and six books, most recently, Death of a Whistleblower and Cochrane’s Moral Collapse. He recently launched the new Institute for Scientific Freedom with the goal of preserving honesty and integrity in science.
REFERENCES
- Gøtzsche PC. Psychiatry gone astray. 21 Jan. 2014. DavidHealy.org. Available here.
- Gøtzsche PC. Deadly psychiatry and organised denial. Copenhagen: People’s Press, 2015.
- Gøtzsche PC. Death of a whistleblower and Cochrane’s moral collapse. Copenhagen: People’s Press, 2019.
- Gøtzsche PC. Psychopharmacology is not evidence-based medicine. In: James D (ed.). The sedated society. The causes and harms of our psychiatric drug epidemic. London: Palgrave Macmillan, 2017.
- McLaren N. Anxiety, the inside story. How biological psychiatry got it wrong. Ann Arbor: Future Psychiatry Press, 2018.
- Breggin P. Psychiatric drug withdrawal: a guide for prescribers, therapists, patients, and their families. New York: Springer Publishing Company, 2013.
- Varese F, Smeets F, Drukker M, et al. Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophr Bull. 38(2012): 661-71.
- Dold M, Li C, Tardy M, et al. Benzodiazepines for schizophrenia. Cochrane Database Syst Rev. 11(2012): CD006391.
Comments on The Harmful Myth About the Chemical Imbalance Causing Psychiatric Disorders
The conflation of cause with effect reminds me of the somatic mutation theory of cancer.
Is it time for a "Metabolic Theory of Mental Illness?"
Strangely, a google search for that phrase doesn't yield anything. As with cancer, type-two diabetes and obesity both increase the risk of mental illness. And consider failures of anti-depressant drugs, the proven anti-depressive benefits of exercise, and the roles of both impaired glucose metabolism and inflammation in promoting mental illness.
We all experience trauma. It is a fact of life. I would never discount trauma's importance. On the other hand, some bounce back, or even benefit from, traumatic experiences, whereas others remain irreparably affected. Might the deeper cause then be trauma combined with metabolic pathology and the attendant chronic inflammation and chronically elevated insulin and/or glucose?
Just a conjecture, at this point.
There you go again, poking the hornets nest. Good job Greg, we love you for getting us to think deeper and to shake off popular convention. Goetze is clearly the victim of Marxist tactics which is all too common in academia and science today. When they can’t argue with the facts, attract the character with innuendos.
I know, it’s Gí¸tzsche
I wish Crossfit would stick to WODs.
1. You have one article by Goetze and one on fallacies in collecting data. Goetze’s opinion is far from data. He is a controversial figure expelled from the research organization he founded for disruptive behavior and legal issues. He is against mammograms and HPV vaccine. Anyone have family members with breast cancer or cervical cancer? Does Crossfit advocate all female participants should follow that advice too or is Goetze only sometimes correct, sometimes off the deep end?
2. There are great functional MRI studies of brains with schizophrenia, bipolar disorder etc on and off meds and you can see the difference when they are well controlled and able to hold jobs, maintain relationships etc. so “no evidence for meds” is as false as Coca Cola ads on health benefits
3. Come down to the psych ER and see decompensated patients 3 weeks off their meds that were doing great before(or a family member) and we can talk about the value medical treatment
4. You want to talk about poor evidence: psychotherapy. The entire field is possibly based on a fallacy. Freud initially presented the theory that anxiety, depression etc was due to abuse. He was laughed out of medical societies for implying Austrian gentry would abuse their children. He came back with Oedipal complex and Id/ego etc that the daughters fantasized about their fathers. Data today shows 1 in 4 women deal with some form of sexual abuse in their life time.
Primary care providers may have done many people a disservice misdiagnosing their psychiatric condition and Rxing antidepressants inappropriately, but don’t encourage people with severe diagnoses to stop treatment based on one man’s fringe opinion.
Let’s stick with core strength and flexibility articles.
Are you suggesting that Cognitive Behavioral Therapy, as a form of psychotherapy, is without strong evidence?
Wouldn’t the fittest individuals apply to not just the physical but the mental as well? One of my favorite things about crossfitting is that my body follows what my mind allows. I think it’s great to use the platform they have created to apply critical thinking to not just movement, but life in general. I didn’t take away from the article that was written that they were recommending stopping taking all medication. I also don’t think simply because the author is forward thinking and has opinions regarding health that may not be widely accepted is reason to disregard anything he says. There is plenty of data now, but even common sense could tell you that a mammogram is potentially harmful and carcinogenic... damaging soft tissue and radiate it a bunch. And then repeat. I think throwing words around like cult and conspiracy theory should be done carefully. I think it’s great to challenge a paradigm, how else would improvements happen?
Theo,
I offer this public endorsement of Gí¸tzsche excerpted from a letter sent by John Ioannidis to Denmark’s Minister of Health 16 November, 2018:
“I am a tenured professor at Stanford University and the current rate of citations of my work in the scientific literature (>3,000 times per month) is the highest among all physicians in the world and among the 10 highest across all scientists in the world. I have unconditional admiration for Peter Gí¸tzsche. Peter is undoubtedly a giant, one of the greatest scientists of our times and one of the most influential, impactful, and useful voices in medicine at large. I cherish enormously his contributions. I believe he is the most recognizable and prominent scientists that Denmark currently has. His dismissal from the Cochrane board two months ago came as a total shock to me. The possibility of compounding this shock with his dismissal also from the Rigshospitalet would deal a severe blow to medicine, democracy, freedom of thought, and justice.”
I would also like to introduce to you two books published by Peter Gí¸tzsche:
First, “Mammography Screening - Truth, Lies, and Controversy”, Radcliffe Publishing, 2012. Iona Heath, President of the Royal College of General Practitioners said of this work: “If you care about breast cancer, and we all should, you must read this book.” Fran Visco, President of the National Breast Cancer Coalition, The United States, contributed, “We need to take the time to understand the science of health outcomes for women. We need to take the time to understand the science and the basis for health recommendations we receive, both in the healthy populations and in those diagnosed with breast cancer. This book will help us get there.”
Second, “Rational Diagnosis and Treatment”, Fourth Edition, Wiley, 2007. This book for 31 years and in four editions endeavored to, in the words of the author of the first edition, “..show that work at the bedside can present just as great an intellectual challenge and yield even more satisfaction than work in the laboratory. Clinical reasoning can be as rigorous and as logical as that in any other academic discipline.”
I highly recommend both books. “Rational Diagnosis and Treatment” so impressed me that I’ve purchased a sealed mint-condition copy for my library. It would be hard to imagine a more thoughtful gift to anyone seriously committed to clinical practice.
I offer all of this to encourage you, Theo, to reconsider your hastily drawn conclusions about Dr. Gí¸tzsche and his work. Your assessments are not only sloppy but irresponsible to the aim of honest and useful conversation.
This began with your exhortation, “I wish CrossFit would stick to WOD’s”. Sir, I’ll never tire of that refrain. And, while I’ll not say, “I wish Dr. A would stick with dermatology”, I will ask you to up your game here on these pages. You don’t have to be a scientist to think clearly nor to do a little research before weighing in.
Back to WOD’s.
Thank you for this. Why such a backlash? Is it a paradigm shift, a consumer need for a quick fix, or something more sinister?
No, I think CBT is completely legit, behavioral conditioning=parenting etc, but the patient has to be in a place where you can talk to them. It is not my recommendation for someone in a raging psychosis. In schizophrenia etc CBT it is a helpful adjunct for comorbid anxieties and personality disorders or some belief modifications. I am talking about classic Freudian psychoanalysis having foundational origin issues.
But mainly my issue is with Crossfit introducing cult like conspiracy theories from questionable individuals with marginalized ideas and checkered pasts instead of sticking to making the fittest people, which is its stated mission.
The Harmful Myth About the Chemical Imbalance Causing Psychiatric Disorders
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