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Friday, May 2, 2014

A Review of Dr. Nassir Ghaemi's article: Fallacies of Psychiatry

You should read this article because it brings to light the underlying rationale for psychiatry providing chemo-therapies for mental health problems, like depression. Dr. Ghaemi's original Article can be found here: http://www.medscape.com/viewarticle/811956_2

Dr. Nassir Ghaemi is Professor and Principal Investigator in the Department of Psychiatry at Tufts Medical Center, Boston, Massachusetts. He "served as a director, officer, partner, employee, advisor, consultant, or trustee" (not sure which) for Pfizer Inc., and Sunovion Pharmaceuticals. He also received at least one research grant from Pfizer Inc and Takeda Pharmaceuticals North America, Inc..**

In his article, Dr. Ghaemi uses the term, reductionist; this refers to the idea that the cause human experiences, like depression or anxiety, can be reduced to biological factors, like neurotransmitters or genes; many psychiatrists believe this idea and are thus called "reductionists."

Dr. Ghaemi begins with what he calls two psychological fallacies:
     1. psychologists and sociologists claim that psychiatrists have "medicalized everyday life," (through reductionism), and that,
     2. That psychologists and sociologists claim that "psychiatry simply diagnoses everyone with such conditions as depression, while ignoring the many 'causes' in life that produce those symptoms." (implying that a diagnosis of depression means that it is caused by biological factors).

Dr. Ghaemi admits that "[psychiatrists] do overpathologize (sic), and always have..." and he counters this with: "For a century, psychoanalysts (therapists) overpathologized even though they were anything but biologically reductionistic..." and finally, he writes, "there is no worse risk in psychology [or] psychiatry than the psychological fallacy."

Dr. Ghaemi writes that he has seen other mental health providers, "downplay a mood illness diagnosis because they were associated with many psychosocial stressors?"

Dr. Ghaemi asserts that "These psychological judgments (that depression is caused by life stressors) are essentially made on the basis of common sense... if common sense were enough to explain things, then our patients would have convinced themselves, or been convinced by their friends and family [that their depression was caused by stress].


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Dr. Ghaemi writes: "The question should not be why those life events cause depression, but why they [stressors] don't cause depression in the 90% of the population that never experiences a severe clinical depressive episode... Obviously, something else is at work. Contrary to all the hopes and wishes of psychologizers, there is such a thing as biology."

Dr. Ghaemi compares: "The ultimate proofs of the psychological fallacy are the split-brain experiments." People who had the connection between their hemispheres severed, they no longer could explain how they acquired perceptual information, so they made-up a reason for how they got it. "The patient confabulated. That is what the human brain does ... the brain is a rationalizing machine. We come up with reasons for everything. Sometimes we're right, sometimes we're not, and we don't know which is which in any one case." Dr. Ghaemi concludes that because we can prove that people make-up false reasons to explain certain experiences, that when people attribute their depression to stress, it is a false rationale. 

Dr. Ghaemi makes the claim, "Psychosocial life events can influence the timing of a depressive episode, but if someone has repeated depression, biology is the underlying cause of the predisposition to those episodes."

REBUTTAL:
Dr. Ghaemi's argument is summed-up here:
1. 90% of people who have life stress do not become depressed. 
2. Few people become repeatedly depressed from life stress.
3. People who have a severed corpus collosum make up false explanations of how they      
    acquired information (split-brain studies).
4. That depression is caused by life stress is a "common sense" argument.
5. If people who were depressed believed it was caused by stress, then they wouldn't come         to see a psychiatrist.
6. Because people with split-brain procedures make-up explanations for their problems,  
     people under stress who become depressed are falsely blaming their depression on 
     stress.
 Therefore, repeated episodes of depression in an individual are a biological disease.

     To begin with, Dr. Ghaemi's conclusion that depression is caused by biological factors is not based on any medical science. He offered not one piece of scientific data to further this point. Compare this to a real medical disease, like diabetes. How do we know that diabetes has a biological basis, because we can concretely measure sugar and insulin levels in the bloodstream. 
     The absence of biological evidence of depression in Dr. Ghaemi's argument is glaringly obvious, and I shouldn't have to go any further with my rebuttal because there are no other diagnostic standards in medicine other than these types of measurements. There is not a single lab test, biopsy, or scan that can show someone has "depression" or that can be administered to show that someone is coming down with or could develop depression. For example, there is diabetes type I and II; type II is a measurement of blood sugar that indicates a strong risk for developing type I, or insulin dependent diabetes. 

     Dr. Ghaemi's premise that because people with a severed corpus collosum make-up false explanations means that people under stress who have depression must also be making-up false explanations for their depression is a non-sequitur. I find it ironic that he is arguing about fallacies in psychology by using a fallacy himself. Just because people make-up false reasons in one circumstance certainly doesn't mean that people with depression are making-up false reasons for the cause of their depression. Most importantly, even if this were true (that depressed people made-up false explanations for the cause of their depression), it does not qualify as a medical test (e.g., "Your explanation for your depression is false, therefore, your depression is biologically caused").

    Dr. Ghaemi's point that because so many people who have life stressors don't become depressed also does not qualify as a medical test. For example, 50% of people who smoke cigarettes their entire life will never develop lung cancer; but, this does not mean that I can go on to say that cigarettes must not be the cause of lung cancer. In this case, Dr. Ghaemi has, albeit unwittingly, pointed out the weakness of biological argument. Stress is a risk factor for depression, but risk factors are only one side of the coin. 
    The other side are protective factors. This would include general health, income, supportive family members, and the like. All people have life stress, but some people have more protective factors than others, and some people have more risk factors than others. For example, we know that lack of sleep and exercise contribute to depression. So, the combination of stress, poor sleep, and lack of exercise may affect the 10% more than the other 90%. There also the issue of time - some people have more stress for longer period of time, as well as chronically poor sleep, and a chronic lack of exercise. 
   Another dimension is the intensity of life stress; some people experience the same life stressors, but more intensely. For example, I knew one mother who lost her child to suicide. Will 9/10 mothers who lose their child to suicide not become depressed, perhaps; but, this one particular mother witnessed the horror of her son's suicide by handgun to his head; not every mother will witness this. I don't think I need to elaborate on why this could lead to more depression, in addition to other problems.

    Dr. Ghaemi's point that if people still seek help for depression after thinking it is caused by life stress, then it must be caused by biological factors is not a sound argument. Knowing what caused your depression (stress), doesn't mean that you can fix it. For example, I know that I have flat tire on my car caused by a nail, but I can't fix a flat. It's common sense, but it's still true. Just because the cause of depression is life stress doesn't mean that people will not be willing to take drugs to cope - perhaps they just want legal drugs instead of illegal drugs. Anti-depressants are marketed as cures for depression. In our society, we provide no quarter for people to under stress; regardless of how much life stress you have - you remain under pressure to continue to work or attend school. So, for many people, they see drugs as a necessity in order to continue to function. Additionally, pharmaceutical corporations and psychiatrists have been telling people for decades that their depression is caused by a chemical imbalance or genetics; so, many people believe that their depression is caused by chemicals and thus treated with chemicals, regardless of the lack of evidence to support the biological hypothesis.

   One of the first things that must be done when making an argument is to define terms. I will do here what Dr. Ghaemi neglected to do. Depression is a clinical or medical term; it represents a syndrome which, as the DSM, NIMH, and APA all state, its cause is unknown. In simple terms, depression is persistent sadness. You can't have depression without sadness. There are other "symptoms" that occur with the sadness, but without sadness, you have no depression. Also, you must have difficulty functioning or be distressed by the sadness, and finally, the symptoms, which include sadness, must be present for at least two weeks. The definition of depression also includes a lack of enjoyment in activities that you normally enjoy (anhedonia). You technically can be labeled as depressed if you have no sadness but severe enough anhedonia.

What causes sadness? What causes persistent sadness?
    Sadness is the emotional phenomenon that occurs when we believe that we will never get what we want or we are incapable or helpless to get what we want. Sandess is an emotion that is accompanied by feelings of emptiness. The function of sadness has been lost on Americans. The function of sadness was to solicit help. The facial expression of sadness and tears lead observers to come to the aid of the individual. In our society, however, we have become so hyper-individualized, that we are not permitted to cry in public or even in front of family members without discomfort. So, we lose our connectedness; we cry alone in our bedrooms; sadness and crying have become so foreign to us that we can now call them a disease. Where is the real pathology: in the sad individual or in the society that reproaches her for her sadness?

NOTES:

** Most consumers are not aware that nearly all pharmaceutical corporations hire medical doctors to represent their products in academic environments; they are paid speaking fees, research grants, and paid to write journal articles; they are sometimes paid to ghost write text books and journal articles (this is where the pharmaceutical corporation writes the article or book and then pays the doctor(s) to sign their name to it). Dr. Ghaemi has been paid at least $322, 560 to do research for Pfizer, $639 for travel by Pfizer, and $4,000 for "consultation" from Pfizer, since 2009. http://projects.propublica.org/docdollars/search?utf8=%E2%9C%93&term=Ghaemi&state%5Bid%5D=&company%5Bid%5D=&period%5B%5D=&services%5B%5D=  Some psychiatrists who conduct research for corporations are referred to as Key Opinion Leaders. They paid speaking fees to present corporate research to other psychiatrists. Pharmaceutical corporations fund about 7 of 10 studies of their drugs. These studies tend to be biased in favor of their drug, and the doctors who conduct the studies seem to be as well.



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