Bruce Levine: Psychiatry Under the Influence attempts to understand psychiatry’s denial and refusal to accept blame for its failures. So, for example, Ronald Pies, editor-in-chief of Psychiatric Times, refuses to blame psychiatry for the dissemination of the disproven chemical imbalance theory of mental illness (which fueled the dramatic rise of antidepressant use). Pies claims that the chemical imbalance theory “was always a kind of urban legend—never seriously propounded by well-informed psychiatrists,” and he blames Americans’ widespread belief in it on drug companies. You attribute much of psychiatry’s denial and evasion of responsibility to “cognitive dissonance theory”—can you speak about this?Worth the read
Robert Whitaker: Again, this is part of the “institutional corruption” lens we were using to study the institution of psychiatry and its behavior. The assumption is that individuals within the institution can’t see that their behavior has been corrupted by “economies of influence.” And so, when those outside the institution begin pointing out the corruption in it, those within it may construct a narrative that protects their self-image. In this case, psychiatrists need to protect their image as honest researchers and as physicians who put the interests of their patients first. Cognitive dissonance theory reveals that there are a myriad of ways that people protect themselves in this manner.
We can see that cognitive dissonance quite clearly in Ronald Pies’ claim that the “chemical imbalance” theory was always a kind of urban legend. The fact that psychiatrists, for a long period of time, regularly told patients that the drugs fix chemical imbalances in the brain represented a fundamental betrayal of those patients. So once the chemical imbalance story fell apart publicly, what does Pies do? Does he admit, even in his own mind, that psychiatrists told this false story to patients for decades? No, he says well-informed psychiatrists never said it, and places the blame on the pharmaceutical companies for telling that false story. Pies makes this argument even though it is easy to document that the leaders of the APA often told this chemical imbalance story to the public, and that, even today, many prominent psychiatrists serve on advisory boards of patient advocacy groups that continue to tell it to the public.
Lisa Cosgrove: One of my favorite quotes is by Carol Tavris: “Mistakes were made, but not by me.” None of us are immune to cognitive dissonance. It is part of the human condition to have implicit biases and remain blissfully ignorant of them.