FacebookTwitterGoogle+RedditEmail

Psychiatry’s Manufacture of Consent

Edward Herman and Noam Chomsky’s book title Manufacturing Consent derives from presidential advisor and journalist Walter Lippmann’s phrase “the manufacture of consent”—a necessity for Lippmann, who believed that the general public is incompetent in discerning what’s truly best for them, and so their opinion must be molded by a benevolent elite who does know what’s best for them.

Starting in the 1990s—despite research findings that levels of the neurotransmitter serotonin were unrelated to depression—Americans began to be exposed to highly effective television commercials for antidepressants that portrayed depression as caused by a “chemical imbalance” of low levels of serotonin and which could be treated with “chemically balancing” antidepressants such as Prozac, Zoloft, Paxil, and other selective serotonin reuptake inhibitors (SSRIs).

Why has the American public not heard psychiatrists in positions of influence on the mass media debunking the chemical imbalance theory? Big Pharma’s corruption of psychiatry is only part of the explanation. Many psychiatrists, acting in the manner of a benevolent elite, did not alert the general public because they believed that the chemical imbalance theory was a useful fiction to get patients to accept their mental illness and take their medication. In other words, the chemical imbalance theory was an excellent way to manufacture consent.

In January 2012, National Public Radio correspondent Alix Spiegel began her piece with the following personal story about being prescribed Prozac when she was a teenager:

When I was 17 years old, I got so depressed that what felt like an enormous black hole appeared in my chest. Everywhere I went, the black hole went too. So to address the black-hole issue, my parents took me to a psychiatrist at Johns Hopkins Hospital. She did an evaluation and then told me this story: “The problem with you, she explained, “is that you have a chemical imbalance. It’s biological, just like diabetes, but it’s in your brain. This chemical in your brain called serotonin is too, too low. There’s not enough of it, and that’s what’s causing the chemical imbalance. We need to give you medication to correct that.” Then she handed my mother a prescription for Prozac.

This chemical imbalance story, countlessly repeated on antidepressant commercials and by psychiatrists from prestigious institutions, has been so effective that it comes as a surprise to many Americans—including Alix Spiegel— to discover that the psychiatric establishment now claims that it has always known that this theory was not true or “urban legend,” the term used by Ronald Pies, Editor-in-Chief Emeritus of the Psychiatric Times. Pies stated in 2011, “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.”

Truly well-informed psychiatrists have long known that research showed that low serotonin (or other neurotransmitter) levels were not the cause of depression. The American Medical Association Essential Guide to Depression in 1998 stated: “The link between low levels of serotonin and depressive illness is unclear, as some depressed people have too much serotonin.” But the vast majority of Americans—who didn’t read this textbook—never heard this.

In the 1990s, Pedro Delgado (the current chair of the psychiatry department at University of Texas) published research that showed  if nondepressed people are depleted of serotonin, they will not become depressed. Elliot Valenstein, professor emeritus of psychology and neuroscience at the University of Michigan, in Blaming the Brain (1998) detailed research that showed it is just as likely for people with normal serotonin levels to feel depressed as it is for people with abnormal serotonin levels, and that it is just as likely for people with abnormally high serotonin levels to feel depressed as it is for people with abnormally low serotonin levels. Valenstein concluded, “Furthermore, there is no convincing evidence that depressed people have a serotonin or norepinephrine deficiency.” But how many Americans heard about this?

Editor-in-Chief Emeritus of the Psychiatric Times Ronald Pies, a staunch defender of psychiatry and the American Psychiatric Association, believes that the APA fulfilled its obligation to inform the general public of the truth with a 2005 statement for the general public about depression that begins: “The exact causes of mental disorders are unknown, but an explosive growth of research has brought us closer to the answers.” But how many Americans read APA statements? And even if they had read that statement, they would not necessarily have come to the conclusion that the chemical imbalance theory was fiction and that drug commercials were deceptive. Even Pies admitted on April 15, 2014, “But still, shouldn’t psychiatrists in positions of influence have made greater efforts to knock down the chemical imbalance hypothesis, and to present a more sophisticated understanding of mental illness to the general public? Probably so.”

Thomas Insel, director of the National Institute of Mental Health (NIMH), in recent years has been increasingly critical of some of psychiatry’s theories and practices. In a February 25, 2007 interview with Newsweek, Insel did more explicitly tell the American people the truth that depression is not caused by low levels of the neurotransmitters serotonin or norepinephrine. However, he did not proclaim that drug commercials’ depiction of the cause of depression as patently false.

Given the drug commercial propaganda onslaught, for the American people to become aware of the truth, psychiatrists in positions of influence would have had to zealously publicize that the research had rejected the chemical imbalance theory, and they would have had to use the mass media to proclaim that the drug commercials are false. That never occurred. Why? NPR correspondent Alix Spiegel, as part of her January 2012 story, also interviewed several well-informed psychiatrists in positions of influence, and we get a clue as to the reason.

Alan Frazer, professor of pharmacology and psychiatry and chairman of the pharmacology department at the University of Texas Health Sciences Center, told NPR that by framing depression as a deficiency—something that needed to be returned to normal—patients felt more comfortable taking antidepressants. Frazer told NPR, “If there was this biological reason for them being depressed, some deficiency that the drug was correcting, then taking a drug was OK.” For Frazer, the story that depressed people have a chemical imbalance and that the antidepressant is correcting that imbalance is a story that has enabled many people to come out of the closet about being depressed.

And even Pedro Delgado, whose research helped debunk the serotonin deficiency theory of depression, agreed with Frazer that the fiction of the chemical imbalance theory has benefits. Delgado pointed to research showing that uncertainty itself can be harmful to people; and so simple and clear explanations, regardless of how inaccurate, can for Delgado be more helpful than complex truthful explanations.

Prior to the chemical imbalance campaign, many Americans were reluctant to take antidepressants—or to give them to their children. But the idea that depression is caused by a chemical imbalance which can be corrected with SSRI antidepressants sounded like taking insulin for diabetes. Correcting a chemical imbalance seemed like a reasonable thing to do, and so the use of SSRI antidepressants skyrocketed.

The U.S. Centers for Disease Control and Prevention (CDC) reported in 2011 that antidepressant use in the United States increased nearly 400 percent between 1988 and 2008, making antidepressants the most frequently used class of medications by Americans ages 18-44. By 2008, among Americans 12 years and older, 11 percent were taking antidepressants, and 23 percent of women ages 40–59 were taking them.

SSRIs skyrocketed despite the research which showed that SSRIs such as Prozac, Paxil, and Zolfot were not any more effective in reducing depression than the older tricyclic antidepressants such as Elavil. While for some antidepressant users, SSRIs had fewer adverse effects than the tricyclics, for many others, the adverse effects were just different and sometimes even worse (for example, the Food and Drug Administration forced SSRI manufactures to label SSRIs with “black box warnings” stating that SSRIs caused increased suicidality for patients under the age of 25). While SSRIs are neither more effective nor safer than the older tricylics, what is different was that tricyclics were never been marketed as correcting a chemical brain imbalance.

The chemical imbalance theory of mental illness has made Big Pharma billions of dollars by making it easier to sell SSRIs and other psychiatric drugs, and Big Pharma spread some of that money around to their favorite psychiatrists. And some well-informed psychiatrists in position of influence, not on Big Pharma’s payroll, have maintained the biochemical imbalance theory of mental illness to manufacture consent, because these psychiatrists have believed that it was in their patients’ best interest—making it easier for them to accept their depression and take their medication.

Bruce E. Levine, a practicing clinical psychologist, writes and speaks about how society, culture, politics and psychology intersect. His latest book is Get Up, Stand Up: Uniting Populists, Energizing the Defeated, and Battling the Corporate Elite. His Web site is www.brucelevine.net

More articles by:

Bruce E. Levine, a practicing clinical psychologist often at odds with the mainstream of his profession, writes and speaks about how society, culture, politics and psychology intersect. His most recent book is Resisting Illegitimate Authority: A Thinking Person’s Guide to Being an Anti-Authoritarian―Strategies, Tools, and Models(AK Press, September, 2018). His Web site is brucelevine.net

Weekend Edition
June 22, 2018
Friday - Sunday
Karl Grossman
Star Wars Redux: Trump’s Space Force
Andrew Levine
Strange Bedfellows
Jeffrey St. Clair
Intolerable Opinions in an Intolerant Time
Paul Street
None of Us are Free, One of Us is Chained
Edward Curtin
Slow Suicide and the Abandonment of the World
Celina Stien-della Croce
The ‘Soft Coup’ and the Attack on the Brazilian People 
James Bovard
Pro-War Media Deserve Slamming, Not Sainthood
Louisa Willcox
My Friend Margot Kidder: Sharing a Love of Dogs, the Wild, and Speaking Truth to Power
David Rosen
Trump’s War on Sex
Mir Alikhan
Trump, North Korea, and the Death of IR Theory
Christopher Jones
Neoliberalism, Pipelines, and Canadian Political Economy
Barbara Nimri Aziz
Why is Tariq Ramadan Imprisoned?
Robert Fantina
MAGA, Trump Style
Linn Washington Jr.
Justice System Abuses Mothers with No Apologies
Martha Rosenberg
Questions About a Popular Antibiotic Class
Ida Audeh
A Watershed Moment in Palestinian History: Interview with Jamal Juma’
Edward Hunt
The Afghan War is Killing More People Than Ever
Geoff Dutton
Electrocuting Oral Tradition
Don Fitz
When Cuban Polyclinics Were Born
Ramzy Baroud
End the Wars to Halt the Refugee Crisis
Ralph Nader
The Unsurpassed Power trip by an Insuperable Control Freak
Lara Merling
The Pain of Puerto Ricans is a Profit Source for Creditors
James Jordan
Struggle and Defiance at Colombia’s Feast of Pestilence
Tamara Pearson
Indifference to a Hellish World
Kathy Kelly
Hungering for Nuclear Disarmament
Jessicah Pierre
Celebrating the End of Slavery, With One Big Asterisk
Rohullah Naderi
The Ever-Shrinking Space for Hazara Ethnic Group
Binoy Kampmark
Leaving the UN Human Rights Council
Nomi Prins 
How Trump’s Trade Wars Could Lead to a Great Depression
Robert Fisk
Can Former Lebanese MP Mustafa Alloush Turn Even the Coldest of Middle Eastern Sceptics into an Optimist?
Franklin Lamb
Could “Tough Love” Salvage Lebanon?
George Ochenski
Why Wild Horse Island is Still Wild
Ann Garrison
Nikki Haley: Damn the UNHRC and the Rest of You Too
Jonah Raskin
What’s Hippie Food? A Culinary Quest for the Real Deal
Raouf Halaby
Give It Up, Ya Mahmoud
Brian Wakamo
We Subsidize the Wrong Kind of Agriculture
Patrick Higgins
Children in Cages Create Glimmers of the Moral Reserve
Patrick Bobilin
What Does Optimism Look Like Now?
Don Qaswa
A Reduction of Economic Warfare and Bombing Might Help 
Robin Carver
Why We Still Need Pride Parades
Jill Richardson
Immigrant Kids are Suffering From Trauma That Will Last for Years
Thomas Mountain
USA’s “Soft” Coup in Ethiopia?
Jim Hightower
Big Oil’s Man in Foreign Policy
Louis Proyect
Civilization and Its Absence
David Yearsley
Midsummer Music Even the Nazis Couldn’t Stamp Out
FacebookTwitterGoogle+RedditEmail