Ronald Pies In Psychiatryland

One of the biggest clown doctors going at the present moment has got to be Ronald Pies. It would be remiss of me to claim that in his latest post, Nuances, Narratives, and the ‘Chemical Imbalance’ Debate in Psychiatry, he has outdone himself. If there was anyone destined for a pie in the face that anyone has got to be Ronald Pies. I would be honored, in fact, to bestow upon Dr. Pies the moniker Ronald “Pie In The Face” Pies for all posterity. Ronald Pies is a marvel of nonsensical shrink think. In his latest escapade into the theory and practice of shrinkery, Pies, by some disingenuous twist of convoluted illogic, would blame “the chemical imbalance theory” on that bug-a-boo and will-o-the-wisp of modern psychiatry, antipsychiatry. Go figure.

Now, if you were to give credence to a recent online polemic posing as investigative journalism, you would probably choose the first or second statement. In the narrative of the antipsychiatry movement, a monolithic entity called “Psychiatry” has deliberately misled the public as to the causes of mental illness, by failing to debunk the chemical imbalance hypothesis. Indeed, this narrative insists that, by promoting this little white lie, psychiatry betrayed the public trust and made it seem as if psychiatrists had magic bullets for psychiatric disorders. (Lurking in the back-story, of course, is Big Pharma, said to be in cahoots with Psychiatry so as to sell more drugs).

Those first two statements Pies alludes to here would be those that indicate either “mental illnesses” were caused by “chemical imbalances” in the brain, or merely that more “serious mental illnesses” were caused by “chemical imbalances” in the brain. What we don’t get out of this story is precisely who was responsible for promoting and spreading this “chemical imbalance theory” that these people in some antipsychiatry movement would be exposing. Where is psychiatry here? Defending itself from those who would be exposing a discredited theory. Certainly it is not defending itself from the ones who would be promulgating that theory. Curious indeed.

Among his more bizarre notions is the notion that this “chemical imbalance” theory has more to do with some catecholamine hypothesis from many years back than it does with the development, marketing and advertising of those trendy psychiatric drugs still surging strong on the market of today.

To the extent the “chemical imbalance” notion took hold in our popular culture, it was due mainly to distorted or oversimplified versions of the catecholamine hypothesis. These were often depicted in drug company ads; pop psychology magazines; and, in recent years, on misinformed Websites and blogs. In short, the “chemical imbalance theory” was never a real theory, nor was it widely propounded by responsible practitioners in the field of psychiatry.

Does Dr. Pies mean that psychiatrists don’t use, or shouldn’t use, those drugs that would be advertised as purporting to correct some kind of postulated and theoretical “chemical imbalance”?  I think not. This leads to another question. To what extent has psychiatry, or the majority of its practitioners, colluded with pharmaceutical companies in producing an atmosphere that now has commercial interests in the media peddling pills, not just to medical professionals, but to the entire buying public perceived and re-envisioned as consumers who will purchase anything at the provocation of the most mesmerizing sound bite?

Psychiatry’s critics also conveniently omit reference to what was arguably the most prevalent paradigm in academic psychiatry, during the 1980s and beyond: the biopsychosocial model (BPSM) of Dr. George Engel. The BPSM has been subjected to much criticism, and some would argue that few psychiatrists nowadays use the BPSM in a systematic, evidence-based manner. And in recent years, several prominent psychiatrists have warned that “…pharmacotherapy and psychotherapy, the major treatment modalities in psychiatry, have become fragmented from one another, creating an artificial separation of the psychosocial and biological domains in psychiatry.”

In the latex gloved mitts of Dr. Pies, our babble here has degenerated into very nuanced babble indeed. If you will notice, despite the nip at bio babble unrefined, bio still has top billing in the theoretical credits. I don’t think this is entirely because of the order of words in the alphabet, or accidental. The mad doctor has shown himself sufficiently proficient in blurring the lines between disciplines to earn himself a rank of major distinction in the therapeutic circus. If criticism equals antipsychiatry, well, there you go. The message is coming in loud and clear. Don’t criticize psychiatry or you must be promoting the discredited “chemical imbalance theory”, too. Clown psychiatry rules!

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