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Psychiatry, Fraud, and the Case for a Class-Action Lawsuit P4


By Robert Whitaker

August 13, 2022

Photo / Image Source: Unsplash,



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The criticism that stung the most was that psychiatrists were not “real doctors.” There was an obvious solution that beckoned: if they adopted a disease model, they could present themselves as physicians who treated real diseases. This would enable them to don the “white coat”—both figuratively and literally—that society recognized as the garb of “real” doctors.


DSM III, said APA president Jack Weinberg in 1977, would “clarify to anyone who may be in doubt that we regard psychiatry as a specialty of medicine.”3


Once DSM III was published, the APA set out to market its new disease model to the public. In 1981, it established a “division of publications and marketing” to “deepen the medical identification of psychiatrists.” That same year it established a press to bring “psychiatry’s best talent and current knowledge before the reading public.” It developed a nationwide roster of experts to promote this disease model, and it set up a “public affairs institute” to run workshops that trained its members “in techniques for dealing with radio and television.”4


This PR effort told of a revolution in psychiatry, with the media informed that researchers were discovering the very “molecules” that caused psychiatric symptoms. The APA held “media days” to promote this understanding, with awards given to media that reported on this revolution, and soon newspapers and magazines were writing stories about extraordinary advances that heralded a day when mental disorders could be “cured.”


The Baltimore Sun, in a seven-part series titled “The Mind-Fixers,” which won a Pulitzer Prize for expository journalism in 1984, described the revolution in this way:


“For a decade and more, research psychiatrists have been working quietly in laboratories, dissecting the brains of mice and men and teasing out the chemical formulas that unlock the secrets of the mind. Now, in the 1980s, their work is paying off. They are rapidly identifying the interlocking molecules that produce human thought and emotion . . . As a result, psychiatry today stands on the threshold of becoming an exact science, as precise and quantifiable as molecular genetics. Ahead lies an era of psychic engineering, and the development of specialized drugs and therapies.”5


Pharmaceutical companies, of course, were thrilled with the APA’s adoption of a disease model, for they understood it would greatly expand the market for their drugs, and they began funneling money to the APA and to psychiatrists at academic medical centers to support this PR effort.


The chemical imbalance story served, in essence, as the soundbite that could best sell this disease model to the public. It was a claim that fit into a larger societal narrative about the march of medicine in the 20th century: insulin as a treatment for diabetes, antibiotics for infectious diseases, a vaccine for polio, and so forth. Now it was psychiatry’s turn to take its place at the head of this parade.


The public began hearing this soundbite immediately after DSM III was published. In 1981, an Associated Press article featuring an interview with University of Chicago psychiatrist Herbert Meltzer informed readers that “researchers believe clinical depression is caused by a chemical imbalance in the brain,” and that there were already two drugs in development that “restore the chemical imbalance” to normal.6


...the new understanding in psychiatry, she (Nancy A.) wrote, was that the “major psychiatric illnesses are diseases,” and that each “different illness has a different specific cause . . . there are many hints that mental illness is due to chemical imbalances in their brain and that treatment involves correcting these chemical imbalances.”7


Eli Lilly brought Prozac to market in 1988, and soon the public was hearing that this  “selective serotonin reuptake inhibitor” restored serotonin to normal levels, and thus was like “insulin for diabetes.” New York magazine featured the pill on its cover: “Bye, Bye Blues” declared the headline.8 Newsweek’s did as well, with this headline atop the pill:  “Prozac, A Breakthrough Drug for Depression.”9


Magazine and newspaper stories told of how patients were feeling better than ever. In the spring of 1990, the New York Times, in an article by Natalie Angier, who arguably was the nation’s most well-known science writer, informed readers that “all antidepressants work by restoring the balance of neurotransmitter activity in the brain, correcting an abnormal excess or inhibition of the electrochemical signals that control mood, thoughts, appetite, pain, and other sensations.” This new drug, Dr. Francis Mondimore told Angier, “is not like alcohol or Valium. It’s like antibiotics.”


Television shows weighed in with a similar message, and on 60 Minutes, Lesley Stahl told the inspiring story of a woman, Maria Romero, who, after a decade of horrible depression, had been reborn on Prozac. “Somebody, something left my body and another person came in,” Romero said. Stahl explained the biological cure that was at work: “Most doctors believe that chronic depression like Romero’s is caused by a chemical imbalance in the brain. To correct it, the doctors prescribed Prozac.”10


Sales of Prozac soared, and as other drug companies brought new “SSRI” antidepressants to market—Zoloft, Paxil, Celexa, Lexapro, and so forth—they relied on the chemical imbalance soundbite to market their products. The National Alliance on Mental Illness grew in prominence during this period, and its core message was that psychiatric disorders were diseases caused by chemical imbalances in the brain, and that psychiatric drugs fixed those imbalances.


The American population, and populations around the globe, came to understand this story as scientific truth. The new millennium arrived, and although the APA’s own textbook had declared the low-serotonin theory dead and buried, the APA publicly doubled-down on the chemical imbalance story, informing the public that it was now proven.


“In the last decade, neuroscience and psychiatric research has begun to unleash the brain’s secrets,” wrote APA president Richard Harding, in a 2001 article published in Family Circle. “We now know that mental illnesses—such as depression or schizophrenia—are not ‘moral weaknesses’ or ‘imagined’, but real diseases caused by abnormalities of brain structure and imbalances of chemicals in the brain.”11


In the same issue, future APA president Nada Stotland informed readers that antidepressants “restore brain chemistry to normal.”


And the public believed. On May 4, 2005, the APA issued a press release celebrating the fact that a survey it conducted had found that “75 percent of consumers believe that mental illnesses are usually caused by a chemical imbalance in the brain.” This, said APA president Steven Sharfstein, was evidence of “good news for [public] understanding of mental health.” A psychiatrist, the press release helpfully noted, was “a specialist specifically trained to diagnose and treat chemical imbalances.”


That same year, the APA published its “Let’s Talk Facts about Depression” brochure, which delivered the same message: “Antidepressants may be prescribed to correct imbalances in the levels of chemicals in the brain.”


The APA’s “public education website” continued to tell of chemical imbalances for the next 16 years. Finally, in early 2021, Ronald Pies wrote that he had, at last, managed to get the APA to “delete” that message.


Even so, the APA website still tells the public a limited version of that story. Visitors to a page titled “What is Depression” learn that “brain chemistry may contribute to an individual’s depression and may factor into their treatment. For this reason, antidepressants may be prescribed to modify one’s brain chemistry.”




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