Book Review:
Pseudoscience in Biological Psychiatry
by Colin A. Ross, M.D., & Alvin Pam, Ph.D., et al.
(John Wiley & Sons, Inc., New York, 1995)reviewed by Douglas A. Smith
"Biological psychiatry" is everything in psychiatry that is based on alleged biological abnormality in the body of the "patient" rather than events in the "patient's" life or the patient's unfulfilled psychological needs. While Pseudoscience in Biological Psychiatry is far from a comprehensive critique of biological psychiatry - for example, it includes very little about the harm done by psychiatric drugs or electroshock - it is one of the best books I have read attacking the alleged scientific foundations of biological psychiatry. The authors convincingly show that biological psychiatry is pseudoscience, or in other words, nonsense.
Unlike most books with more than one author, most chapters are written by a single author. The authors of the largest parts of the book are Colin Ross, M.D., who is director of the Dissociative Disorders Unit at Charter Hospital of Dallas, and Clinical Associate Professor of Psychiatry at Southwest Medical Center in Dallas, Texas - and Alvin Pam, Ph.D., Director of Internship Training at the Bronx Psychiatric Center, and Assistant Professor of Psychiatry at Albert Einstein College of Medicine in New York City.
In the Introduction, Dr. Pam says "The purpose of this book is to show that biological psychiatry - presently the dominant force within the discipline of psychiatry - is dominated by a reductionist ideology that distorts and misrepresents much of its research" (pp. 1-2). In later chapters he says "biological psychiatry cannot fulfill its mission properly because in the current state it has more the accoutrement of a scientific discipline than the substance. ... the methodology of biological psychiatry is sufficiently flawed as to call into doubt the preponderance of its accepted findings" (p. 8). Dr. Pam concludes that "The history of biological psychiatry can be depicted as a tale of 'promising' leads, closure on slender evidence, hyperbole as initial reception to new work, and ultimately unproductive results. ... following about a century of effort, a harsh assessment would be that no substantive results have been tendered for the pathogenesis of any major psychiatric disorder" (p. 42). He says "biological psychiatry does not come close to meeting scientific standards" (p. 69). In chapters he wrote, Dr. Ross, a psychiatrist, says "psychiatry has not acquired even a tiny fraction of the scientific foundation of internal medicine" (p. 88), that "At the present time, there is no proof that biology causes schizophrenia, bipolar mood disorder, or any other functional mental disorder" (p. 90), and "The ideology of bioreductionist psychiatry is that depression, schizophrenia, and other illnesses are biomedically distinct and genetically driven. Decades of fishing for supporting data have yielded nothing of substance, however" (p. 140). Dr. Ross says "Biological psychiatry has not made a single discovery of clinical relevance in the past 10 years, despite hundreds of millions of dollars of research funding" (p. 116)
Dr. Pam, a psychologist, alleges that virtually all so-called psychiatric disorders are caused by life experience rather than the theoretical biological abnormalities that biologically oriented psychiatrists say are the causes. Dr. Pam says "biological psychiatry tends to 'blame the body' for disturbed behavior, rather than the family or society. This perspective lets the social surround escape unscathed from any blame or responsibility, no matter how much psychological disorder is in its midst" that is in fact caused by the so-called patient's experiences in that family or society (p. 3). He says "Biological factors enter into all behavior, including symptoms, but only rarely are the cause and significance of a patient's behavior primarily biologically driven" (p. 4). He says "the biomedical model ignores the social conditions that give rise to psychopathology" (p. 6). Dr. Ross, a psychiatrist, expresses a similar view.
The book includes long, detailed critiques by both Dr. Pam and Dr. Ross of genetic (inheritance) theories of supposed mental illnesses such as schizophrenia and alcoholism. I've made the following argument for years: Religion runs in families, but does anyone suspect the existence of Roman Catholic or Baptist genes? No, nobody even suspects religion runs in families because of genetic inheritance. So why does anybody look for genes for so-called mental illnesses that also run in families? Dr. Ross argues: "Scientifically, the only conclusion that can be reached from studying the pattern of occurrence of a disorder in a pedigree [in a family] is an inversion of biological psychiatry's logical error: If there is no familial pattern, one can rule out an inherited cause. If there is a pattern of family transmission, on the other hand, there may be a purely inherited cause, a purely environmental cause, or a mixture of the two" (p. 89, italics in original). This fact does not however prevent pseudoscientific, biologically oriented, politically correct psychiatrists and others from talking about family patterns of so-called psychiatric "disorders" as evidence of genetic (biological) causation.
Belief that alcoholism is inherited or is biologically caused (is a "disease") is widespread today. A recovered alcoholic whose father was also alcoholic told me, "I inherited daddy's disease." A Connecticut lawyer who told me he as privately retained counsel had successfully prosecuted five civil commitments on behalf of families who wanted to involuntarily commit other family members, loudly told me my not believing alcoholism is a disease proves I am "ignorant." In a section titled ALCOHOLISM IS A DISEASE, Dr. Ross says "This doctrine [alcoholism is a disease] has been adopted throughout the chemical dependency field including Alcoholics Anonymous (AA), despite the fact that it has no scientific foundation and is logically incorrect. ... The idea that alcoholism is genetic is the leading example of the effective marketing of pseudoscience by biological psychiatry. ... There cannot be a gene for alcoholism, and alcoholism cannot be a biomedical illness, for logical reasons..." (p. 96.) In Dr. Pam's discussion of genetic theories of alcoholism, he says "American researchers typically ignore the work of Robin Murray, the leading British expert in the genetics of alcoholism; Murray found no difference in rates of alcoholism for MZ [mono-zygotic, or identical] and DZ [di-zygotic, or non-identical] twins, effectively ruling out a genetic hypothesis if these results are replicated by other researchers" (p. 52).
In a chapter by Harry Wiener, M.D., he asks "What is the nature of the predisposition to schizophrenia?" (p. 199). He concludes: "The results of these 80 years of research are clear and indisputable: nothing has come of it to date except utter confusion" (p. 200). He mocks biological psychiatry saying: "The belief that schizophrenia is a specific organic disease or a group of organic brain diseases has never been confirmed. We have been on the verge of confirming it since the dawn of modern psychiatry, and we are still on the verge" (pp. 193-194). He makes fun of genetic theories of mental illness by proposing the idea that impoliteness might be genetically transmitted and using the illogic of biological psychiatry to "prove" the hypothesis that impoliteness runs in families for genetic reasons. (pp. 194-197).
Among the most poignant insights in the book is Dr. Ross' argument against biological testing for "mental" illnesses. He says: "The dream of biological psychiatrists is that an 'objective' laboratory test for one of the major mental illnesses will be discovered. ... This dream is logically unsound and can never be realized. Although biological psychiatrists speak of external validation of psychiatric diagnoses by laboratory findings and specific markers, this can never happen. Why?" (p. 101): Suppose psychiatrists decided that people become depressed because of too much or too little of a particular chemical or enzyme in the body as shown by an examination of cerebrospinal fluid or a blood test or urine test or whatever. Suppose further that you tested positive for depression on this test but that you felt perfectly fine, cheerful, and happy? Would you nevertheless start taking (supposedly) anti-depressant drugs or electroshock therapy as treatment for the depression you were not experiencing? Similarly, suppose there were some kind of biological test for schizophrenia - however defined? Despite many other definitions that have been popular in previous decades, today schizophrenia is usually thought of as psychosis, i.e., hallucinations or delusions. Suppose psychiatrists concluded "schizophrenia" is caused by some biological factor the presence of which could be determined by X-ray or MRI or PET scan of the brain. In Dr. Ross' words: "According to this logic, it would be possible to be diagnosed and treated successfully for schizophrenia without ever having had any psychiatric symptoms" (p. 102). If you were a physician or other therapist and had a patient whose X-ray of the brain or MRI or PET brain scan showed the presence of schizophrenia, but who had no behavioral or perceptual symptoms of schizophrenia - i.e., no abnormal thinking, no hallucinations, and no delusions - would you start treating the patient for schizophrenia? The conclusion is obvious: A mental or behavioral "illness" can not be diagnosed with a biological test. It's not even theoretically possible.
Biological psychiatry is criticized from a sociological, political, and human rights standpoint in a chapter by Ellen M. Borges, Ph.D., a sociologist and faculty member at Goddard College in Plainfield, Vermont. In her chapter she examines "the relation of psychiatry to oppression" (p. 231). She says "Biological psychiatry redefines social deviance as a medical problem. By doing so, it transforms social norms, which are subjective and political, into medical norms, presumed to be objective and scientific. ... Medicalization of social deviance allows us a pretense of humanitarianism" for coercive measures against people whose behavior "deviates from expectations based on the dominant social class's ideology and viewpoint" (pp. 213, 217). She says "Psychiatry redefines a great deal of normal human behavior as medically deviant by pathologizing people who are socially marginal in any way" (p. 228). Among those she gives as examples of "socially marginal" people who have been oppressed by psychiatry are (1) homosexuals (when homosexuality was defined by the American Psychiatric Association as a mental disorder, which was prior to 1974), (2) slaves who tried to run away to freedom when there was negro slavery in America (whose desire for freedom was supposedly caused by a mental illness called drapetomania; see also Drapetomania - A Disease Called Freedom), and (3) political dissidents (such as those in the Soviet Union who were defined as schizophrenic because they opposed Communism). She says "Whereas discrimination and censorship are illegal methods of containing and controlling diversity, in this country [the U.S.A.] 'inappropriate behaviors,' including speech, can be attributed to biological misfortune and treated with drugs [involuntarily, of course - or with involuntary commitment]" (p. 228). Like Doctors Ross and Pam, Dr. Borges accuses biological psychiatry of ignoring the real causes of the supposed illnesses it is called upon to treat. In a discussion of racism she says: "A treatment bias in psychiatry is the tendency to assume a biological basis for symptoms that are caused by social-racial factors" (p. 225).
Among the gems in this book are the following observations by two psychiatrists. Dr. Ross says during his training to become a psychiatrist, when the "cognitive errors pervading clinical psychiatry [were] unwittingly demonstrated to me by my residency supervisors" he learned that not only medical students but even "psychiatrists rarely do the critical reading" that would make the nonsense they learn in their psychiatric training apparent for what it is (pp. 85, 87 - emphasis added). In a chapter by Susan S. Kemker, M.D., staff psychiatrist at North Central Bronx Hospital in New York City, she says "most of us [psychiatrists] have been taught to believe [that] biology is the science of psychiatry. That fact that I believed this dogma made Pam's (1990) critique of biological psychiatry especially unsettling. When I read his work, I felt that my entire education as a psychiatrist was subject to question" (p. 241). Speaking of herself and other psychiatrists, she says "our understanding of our own field remains naive" (p. 242 - italics in original). Statements like these from board-certified psychiatrists make me wonder if just by reading a book like Pseudoscience in Biological Psychiatry - or even just this book review - you know more about the "cognitive errors" that pervade modern biological psychiatry than many or even most psychiatrists.
Although Dr. Ross's criticisms of biological psychiatry are excellent and perceptive, he makes a completely erroneous statement in support of the so-called selective serotonin reuptake inhibitor or "serotonin blocker" drugs, the first and most popular of which is Prozac but which also includes Paxil, Zoloft, Luvox and Celexa. He says: "The new serotonin reuptake blockers are a major and highly beneficial development for psychiatric patients, and I prescribe them regularly - for dissociative identity disorder patients, among others. There is no disputing the fact that these medications are more effective than placebo" (p. 118). In his book Talking Back to Prozac, psychiatrist Peter Breggin, M.D., says: "Despite the current enthusiasm for Prozac, the FDA studies underscored the drug's lack of effectiveness, and recent analyses of literature indicate that antidepressants in general are no better than placebo" (St. Martin's Press, New York, 1994, p. 57). In the 1999 updates to Psychiatric Drugs: Cure or Quackery?, found on this web site, you will find a link to an article by journalist Thomas J. Moore, author of outstanding books such as Heart Failure and Prescription for Disaster, titled No prescription for happiness. In that article Mr. Moore reviews the studies the FDA required for approval of Prozac: "Lilly [manufacturer of Prozac] had conducted 10 such clinical trials for Prozac, according to FDA records. However, in six of these trials no measurable overall difference could be detected between those treated with Prozac and those who got the placebo. ... Failure to produce a measurable effect is a routine event in the testing of drugs for depression." It is also interesting to note that Dr. Ross says he prescribes serotonin reuptake blockers for dissociative identity disorder, because drugs in this group are approved as and advertised as anti-depressants. Like almost every psychiatric drug, Prozac and other "serotonin blockers" are used for almost every supposed psychiatric "illness." This should make any thoughtful person doubt the assertion that psychiatric drugs are specific treatments for any supposed psychiatric "illness."
This review would not be complete without mentioning something about this book that is truly amazing, and that is the price I paid for it: $95.00 (ninety five dollars). That is an unusual and very high price for a book of 294 pages (including the indexes). With sales tax I paid $102.84 for this book. Thinking the price tag had to be a mistake, before I made the purchase I asked a book store clerk to verify the price for me. After a few minutes she returned and told me that not only was the price of $95 correct, but that in the time since the store had purchased the book, the price had risen to $115.00 (not including sales tax). To me the book was worth $102.84 because I can afford it and have a vital interest in the subject and wanted to write this review of the book for this web site. You'll have to decide for yourself if it's worth that much to you. If you don't mind the price or can find the book in a library, I highly recommend it.
You can by this book from - Amazon.com ($85) or Barnes & Noble ($115)
(prices as of March 18, 2001)