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Sunday, January 18, 2009

An Interview with Joanna Moncrieff: The Myth of the Chemical Cure

Thanks to one of my readers, Ruth, for passing this on to me.

It's an interview with Joanna Moncrieff, author of the book, 'The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment'

I shall re-publish the entire interview here for you all to read. The original page can be found here.


In this interview she responds to questions about this so – called "chemical imbalance" and the treatment of depression.

1) Dr. Moncrieff, first of all, what led you to write this about about "the myth of the chemical cure"?

What is written in textbooks about psychiatric drugs and how they work never seemed to match up to reality to me. So I started to look carefully at the research on drugs and gradually I came to realise that there was no evidence that they were acting specifically- that they were reversing the basis of a disease- as it was claimed. At the same time I was interested in how drugs came to be so highly regarded in psychiatry- how they came to be the dominant form of treatment. I realised that it was because they were believed to be specific that they were seen as so important, because the idea that they are specific underpins the idea that psychiatry is a medical activity, concerned with reversing medical diseases.

So I began to try and trace how the idea- the myth as I believed it - that they are specific treatments was constructed.

2) I would think that when people have to deal with the death of a mother/father, brother/sister, or even a pet, I think that it is natural and normal to feel depressed. When did we start giving anti-depressant medication for the normal transitions of life that we all have to endure?

The modern concept of depression, as a common condition in need of medical treatment, was invented and promoted in order to market the earliest antidepressants in the 1960s. However, it was when the market for benzodiazepines collapsed in the late 1990s that the pharmaceutical industry turned to depression to create a mass market.

It was during the 1990s that the idea that depression affects up to 1 in 4 of the population and other such figures were publicised and the motive was to create a market for the new and profitable antidepressants known as SSRIs.

3) How exactly do psychiatrists find out if there is a real chemical imbalance in the brain? Or are they just experimenting with patients?

Psychiatrists have no way of telling that someone has a chemical imbalance. The idea that depression is caused by a chemical imbalance is simply a hypothesis. There is no consistent evidence that there is any biochemical abnormality in people diagnosed as depressed. The idea has been promoted by drug companies and professional organisations, but the evidence base for it is almost non existent. Most experts say that the fact that people improve when you give them antidepressants is the strongest evidence that there is a chemical imbalance. But there are other ways of explaining this- antidepressants are psychoactive drugs, that may suppress emotional feelings, or just sedate people.

Anyway, as recent research shows, people improve barely more with antidepressant than they do with a placebo.

4) The number of pills for a wide variety of so- called " mental illnesses " seems to have skyrocketed. Someone is making a lot of money pushing these pills. Is it all about money?

Partly, but it is also about professional status. Psychiatrists push pills because it bolsters their position as doctors. Also governments have supported medical interventions like drugs because they look like simple solutions to otherwise complex and intractable problems. Also we live at a time when big business is very powerful, and governments are unwilling to reign it in.

5) I know there are some violent, aggressive, assaultive patients who either have to be physically restrained, or put in a special room, or a straight jacket. In such instances, are we simply sedating the patient or are we really treating them?

I think everyone would admit that at times like these we are simply sedating them, or using chemical restraint. What is more open to dispute is what we are doing to people whose behaviour is chronically antisocial, disturbing and maybe irrational. People like this are usually diagnosed as having chronic schizophrenia, or some other mental disorder. In this case, the drug treatment they are inevitably given on a long-term basis is dressed up as a treatment, but is often aimed at controlling their behaviour.

6) Are there germs, bacteria, viruses, and things that can be seen under a microscope that cause "mental illness"?

No- there are no proven physical causes of any mental illnesses.

7) We all have to deal with anxiety- we have to work, take tests, deal with disgruntled people- why do some people need anti-anxiety pills for the problems that we all have to face---and do these folks have some type of chemical imbalance?

Everyone is different and some people find stress harder to deal with than others.

This is partly due to upbringing and environment, but some of it is probably due to the variation in our biological makeup. However, I don't think it is something you can pinpoint, like a chemical imbalance.

It's just that we are all different, biologically as well as psychologically. You can't "correct" these differences (assuming you could identify them, which I don't think you will ever be able to do) without eradicating individuality itself.

8) Is there really such a disease as attention deficit disorder or is this just a bunch of symptoms that have been lumped together in some fashion?

Its not my specialist area, but child psychiatrists I know say that they can always find a better explanation for a child's behaviour than calling it ADHD. ADHD is a label that locates the problem in the individual child, whereas I suspect the problem really often lies in the family and the wider environment. The only reason for giving someone the label of ADHD, of course, is in order to justify giving the child stimulants. There is a big debate about whether these are useful- and if so whether they are worthwhile. They can make a child pay attention at first, but whether this is really beneficial is unclear. Also their effects probably wear off (like most drugs taken for long periods)- and the latest 3 year follow up of the biggest randomized trial of stimulants shows no benefits over non drug treatment at three years.

9) I have read some crazy stuff on the Internet about statins being given to 8 year old children. Is there any sane, reasonable, rational, realistic reason to give an 8 year old child a statin?

I don't know about the wisdom of giving children statins, but childhood obesity (not a nice word) is certainly an indication that there is something very wrong with our society. It is also caused of course by drugs like the new antipsychotics, which are being more commonly prescribed to children. So some childhood obesity is being caused by drugs in the first place.

10) Here in the United States, we once had a commercial that said " relief is just a swallow away". Have the pharmaceuticals taken this mass drugging way too far?

Everyone is looking for a magic bullet for everything nowadays. The pharmaceutical industry have certainly helped create this situation, but again I think it is the broader political climate that has encouraged this to happen. Popping pills to solve your problems is a perfect consumerist activity, and it helps keep people so worried that they don't have time to challenge the system. Accepting life's ups and downs is not a good recipe for keeping people working their guts out to buy more stuff.

11) I often see individuals who seem to have no coping skills, low frustration tolerance and a lack of thinking skills. Should not these people get training and counseling, rather than some pill for their alleged " chemical disorder"?

Yes, these would be better, but often there is no individual solution. We have to ask why some people get this way, and what changes we can make to society to prevent it happening and to help them when it does.

12) Are there any psychiatric diagnosis which in your mind, are true "chemical imbalances" for example chronic schizophrenia?

No. Organic conditions like dementia and learning disability have a physical basis (but not a simple chemical imbalance). For mental illnesses like schizophrenia, manic depression and others, no physical cause has ever been proven. It is often said that we have evidence that they are genetic- but this evidence is much weaker than presented (Jay Joseph gives a good deconstruction of this). It is said that people with schizophrenia have different shaped brains- but again the evidence is weak and inconsistent and drug induced effects have not been ruled out.

13) Do you have a web site where we can get more information?

The Critical Psychiatry Network has a website where there are many interesting papers posted and other information. The address is

14) What question have I neglected to ask?

Whatever mental illnesses consist of, and we do not know, but have no good evidence at present to think they are caused by specific brain diseases like real neurological conditions, when we treat them with drugs we are merely drugging people. This may suppress the symptoms, which may be helpful for a while, but obviously there are adverse consequences. If you are drugged you are usually slower and less emotionally sensitive than if you are not under the influence of drugs. Psychiatrists need to be more honest about this- but so do politicians and society as a whole. We are pretending to treat or cure people with mental illness because that makes us feel alright about controlling them. Sometimes we need to control them but we should at least be honest about what we are doing. Pharmaceutical companies are cashing in on our dishonesty.

Published August 7, 2008

Read the new book, The Evidence, However, Is Clear...The Seroxat Scandal