Dr Caroline Leaf and the nonsense of ‘negative’ thinking.

Screen Shot 2016-02-09 at 7.08.49 PM

The power of positive thinking. It’s like rust on our collective consciousness, an idea that’s seems virtually impossible to eradicate, slowly eating away at our collective psyche. The idea has become so ingrained in our culture that it’s part of our folklore and our idiom, and it continues to be deliberately perpetuated by success coaches, business leaders and others who make a very tidy living by peddling baseless optimism. It’s been repeated so often that the ‘power of positive thinking’ has become an Availability Cascade (a self-reinforcing process by which an idea gains plausibility through repetition).

Herbert and Forman summarise it nicely, “The ideas that thoughts and beliefs lead directly to feelings and behavior, and that to change one’s maladaptive behavior and subjective sense of well-being one must first change one’s cognitions, are central themes of Western folk psychology. We encourage friends to ‘look on the bright side’ of difficult situations in order to improve their distress. We seek to cultivate “positive attitudes” in our children in the belief that this will lead to better academic or athletic performance. Traditional cognitively-oriented models of CBT (e.g., CT, stress inoculation training, and rational emotive behavior therapy) build on these culturally sanctioned ideas by describing causal effects of cognitions on affect and behavior, and by interventions targeting distorted, dysfunctional, or otherwise maladaptive cognitions.” [1]

Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist. She is one of the many that continue to perpetuate the myth of positive and negative thinking.

Today’s social media meme was yet another promotion of this misguided idea, and to top it off, she misquoted scripture again in an attempt to reinforce it.

“If you randomly allow any negative thought into your mind damage can ensue on a mental & physical level. ‘We destroy every proud obstacle that keeps people from knowing God. We capture their rebellious thoughts and teach them to obey Christ.’ 2 Corinthians 10:5 NLT”

Lets quickly break meme down to see exactly why Dr Leaf is, yet again, misleading her audience.

1. The mind does not control the brain

Dr Leaf’s meme implies that negative thought damages us mentally and physically. The problem with that is that the mind doesn’t control our brain or our body, so negative thought can’t damage us mentally or physically.

Instead, it’s our brain that gives rise to, and controls our thoughts and feelings. We don’t see what goes on ‘under the hood’ so to speak, we only experience our thoughts and feelings, so we assume that regulate each other. But it’s our brain and a number of other processes that are responsible for generating both our thoughts and feelings (CAP blog).

‘Negative’ thoughts can sometimes be the result of damage to our brain, but ‘negative’ thoughts don’t damage the brain.

In fact, often the so-called ‘negative’ thoughts are actually good for us.

2. Negative thinking is normal and healthy

Dr Leaf’s meme also implies that we control the content of our thoughts by suggesting that we ‘allow’ negative thoughts into our minds. But negative thoughts are meant to be there, which is why we have them. ‘Negative’ thoughts have a positive function. We need them to survive.

For example, we have a fear response to prevent us from continually putting ourselves in danger. We have an anger response to motivate us through difficult obstacles. We have feelings of embarrassment to help maintain social cohesion. As Skinner and Zimmer-Gembeck state, “adaptive coping does not rely exclusively on positive emotions nor on constant dampening of emotional reactions. In fact, emotions like anger have important adaptive functions, such as readying a person to sweep away an obstacle, as well communicating these intentions to others. Adaptive coping profits from flexible access to a range of genuine emotions as well as the ongoing cooperation of emotions with other components of the action system.” [2]

Dr Leaf isn’t helping anyone with her meme today. She’s simply promoting an outdated and unscientific notion, encouraging her audience to suppress normal, helpful adaptive functions for fear of harm that’s not scientifically possible.

Then as if to add insult to injury, she follows up her misleading meme with an equally misleading misrepresentation of 2 Corinthians 10:5.

3. Taking every thought captive?

2 Corinthians 10:5 is Pauls famous scripture about taking every thought captive, a concept which seems to support Dr Leaf’s ideas, except that Paul isn’t speaking generally to us, but specifically about the Corinthian church. Look at the verse in context:

“By the humility and gentleness of Christ, I appeal to you – I, Paul, who am ‘timid’ when face to face with you, but ‘bold’ towards you when away! I beg you that when I come I may not have to be as bold as I expect to be towards some people who think that we live by the standards of this world. For though we live in the world, we do not wage war as the world does. The weapons we fight with are not the weapons of the world. On the contrary, they have divine power to demolish strongholds. We demolish arguments and every pretension that sets itself up against the knowledge of God, and we take captive every thought to make it obedient to Christ. And we will be ready to punish every act of disobedience, once your obedience is complete.
You are judging by appearances. If anyone is confident that they belong to Christ, they should consider again that we belong to Christ just as much as they do. So even if I boast somewhat freely about the authority the Lord gave us for building you up rather than tearing you down, I will not be ashamed of it. I do not want to seem to be trying to frighten you with my letters. For some say, ‘His letters are weighty and forceful, but in person he is unimpressive and his speaking amounts to nothing.’ Such people should realise that what we are in our letters when we are absent, we will be in our actions when we are present.” (NIV UK, 2 Corinthians 10:1-11)

This chapter is a specific rebuke to some of the Christians within the church at Corinth, and also a defence against some of the murmurings and accusations that some in that church were levelling at Paul. For example, in verse 2, “I beg you that when I come I may not have to be as bold as I expect to be towards some people who think that we live by the standards of this world.”

Verses 3-6 are a specific and authoritative rebuttal against the accusations levelled at Paul, paraphrased as, “You may speak against us and the church, but we have weapons that smash strongholds, and we’re coming to take down those pretensions of yours and take every thought of yours captive to make it obedient to Christ, and punish every act of disobedience …”

The specific nature of the verse is also supported by some Bible commentary: “But how does St. Paul meet the charge of being carnally minded in his high office? “Though we walk in the flesh [live a corporeal life], we do not war after the flesh,” or “according to the flesh,” the contrast being in the words “in” and “according.” And forthwith he proceeds to show the difference between walking in the flesh and warring according to the flesh. A warrior he is, an open and avowed warrior – a warrior who was to cast down imaginations and every high thing that exalteth itself against the knowledge of God, and bring into captivity every thought to the obedience of Christ; a warrior too who would punish these Judaizers if they continued their disorganizing work; but a prudent and considerate warrior, deferring the avenging blow till “I am assured of your submission” (Stanley) “that I may not confound the innocent with the guilty, the dupes with the deceivers.” What kind of a preacher he was he had shown long before; what kind of an apostle he was among apostles as to independence, self-support, and resignation of official rights in earthly matters, he had also shown; further yet, what kind of a sufferer and martyr he was had been portrayed.” (C. Lipscomb – http://biblehub.com/commentaries/homiletics/2_corinthians/10.htm)

Similarly, the translation from the original text is more specific than general. The verb used for “bringing into captivity” is aichmalōtízō, “to make captive: – lead away captive, bring into captivity” which is in the Present Active Participle form of the verb. The present tense represents a simple statement of fact or reality viewed as occurring in actual time. The active voice represents the subject as the doer or performer of the action. The Greek participle corresponds for the most part to the English participle, reflecting “-ing” or “-ed” being suffixed to the basic verb form. Actions completed but ongoing or commands are different verb tenses (see https://www.blueletterbible.org/help/greekverbs.cfm for a better explanation). So Paul wasn’t making a general statement, but a specific statement about what he would do in his present time, not the future.

So, Paul isn’t telling us to “bring every thought captive into obedience to Christ”. Dr Leaf is perpetuating a common scriptural misunderstanding.

A verse which better clarifies what God wants for our thought life is Paul’s exhortation to the Philippian church in Philippians 4:8, “Finally, brothers and sisters, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable – if anything is excellent or praiseworthy – think about such things.” Both the context, and the form of the verb, suggest that this is an ongoing command. And it makes better sense too. If we spend all of our time trying to fight against every thought that comes into our head, we’d become exhausted, but we can divert attention to those things that are worthy of our attention. And in many ways, what Paul is encouraging is what would be considered now as simple meditation, which is more scientific than the power of positive thinking.

The moral of this story … ‘negative’ thoughts and feelings don’t do us damage, but trying to unnecessarily suppress them does.

References

[1]     Herbert, J.D. and Forman, E.M., The Evolution of Cognitive Behavior Therapy: The Rise of Psychological Acceptance and Mindfulness, in Acceptance and Mindfulness in Cognitive Behavior Therapy. 2011, John Wiley & Sons, Inc. p. 1-25.
[2]     Skinner EA, Zimmer-Gembeck MJ. The development of coping. Annual review of psychology 2007;58:119-44.

Dr Caroline Leaf’s war on drugs

Today, Dr Leaf posted this on her social media feeds.  It’s clearly meant to shock and enrage her followers.

Screen Shot 2015-12-12 at 11.56.44 AM

Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist.  She’s also cast herself as an expert on mental health.

To the detriment of her followers, and sadly, to the rest of the Christian church, most people believe her.

Her most recent book, and her social media memes for the last couple of months, have made it clear that Dr Leaf is pursuing her own personal war on drugs … but prescription psychiatric drugs not the illicit kind.

Unfortunately, her attacks on prescription psychiatric drugs have amounted to nothing more than a hysterically illogical smear campaign under the guise of her concern for public safety.

Today’s offering follows the same pattern of narrow-minded hysteria.

Her main quote from was from Robert Whitaker, “Twenty years ago, our society began regularly prescribing psychiatric drugs to children and adolescents, and now one out of every fifteen Americans enters adulthood with a ‘serious mental illness’.”

Whitaker, like Dr Leaf, is an outspoken critic of modern psychiatric treatment with a poor understanding of how psychiatric medications actually work.  The statement that Dr Leaf quotes is remarkable for it’s poor logic.  The quote implies that the rise in childhood mental health is because of the rise in psychotropic medication use in children.  But correlation does not equal causation.  Even if one in fifteen Americans enters adulthood with a ‘serious mental illness’, and twenty years ago our society began regularly prescribing psychiatric drugs to children and adolescents, there’s no evidence that the psychiatric medications are actually causing the psychiatric problems.

Then there’s Dr Leaf’s emotionally charged statement that “They are even prescribing these psychoactive substances to infants!”

The New York Times article that she linked to discusses the case of Andrew Rios, a child suffering from severe epilepsy, having his first seizure at 5 months.  Though it’s clearly more complicated than just “simple” epilepsy – he’s pictured wearing a helmet which suggests that he has myoclonic epilepsy which is clearly uncontrolled. It’s also clear from the article that the child was having mood swings and violent behaviour before the anti-psychotic was given. The history of early seizures with ongoing poor control and violent behavior means that this unfortunate young boy likely has a severe and complicated neurological syndrome, quite possibly because of an underlying abnormality of his brain. And the symptoms he had which the mother claimed were from the antipsychotic were just as likely to have been night terrors, a common problem in two year olds.

In the end, who really knows?  But there’s certainly not enough in this article to clearly convict antipsychotics of being toxic or evil.

Neither is the use of antipsychotics for infants widespread.  20,000 prescriptions for antipsychotic medications sounds like a travesty, but according to the article, the real numbers are probably much less, or about 10,000, since not every prescription is filled.  Even 10,000 sounds like a lot, but that represents 0.0002% of all prescriptions in the US, and most of those scripts are not actually being taken by the child, but by their uninsured parent(s).

Indeed, as the article itself said, “In interviews, a dozen experts in child psychiatry and neurology said that they had never heard of a child younger than 3 receiving such medication, and struggled to explain it.”

So the prescribing of antipsychotics to infants is extremely rare, almost unheard of, and is only likely to be done in extreme cases where all other options have been exhausted.

That’s certainly not the impression you get from Dr Leaf’s post, which is just another misinformed smear against anti-psychotic medications.

Dr Leaf’s war against psychiatric medications is reckless.  When people who need psychiatric medications don’t take them, suffering increases, as do suicides.

It’s time Dr Leaf stopped spreading needless fear about these medications.  They help more people than they harm, people who already suffer from the stigma of having a severe mental illness.  They don’t need any more suffering stemming from Dr Leaf’s so-called “expertise”.

Does our attitude towards aging increase Alzheimer Dementia?

“I think I’m forgetting something …”
Does our attitude towards aging increase Alzheimer Dementia?

For the last few years, I’ve worked as a doctor for a number of my local nursing homes.  On my morning rounds, I would literally reintroduce myself to every second patient, because even though I’d seen them every week for the previous few months, they still couldn’t remember who I was.

And it’s not just because I have a less than memorable face.  Most of my nursing home residents had dementia.

While there are many different causes for dementia, the one first described by Mr Alzheimer in the (early 1900’s) is the best known and most feared.  It is also the most common, and is a significant drain on the nation’s economy as well as the quality of life in the twilight of years.

Recently, an article was published by a group of researchers from Yale University in the US which claimed to show that the attitude a person had towards aging contributes to their chances of Alzheimer Disease.  I first saw it yesterday on the social media feed of Dr Caroline Leaf, communication pathologist and self-titled cognitive neuroscientist.  Dr Leaf is known for her scientifically dubious assumptions that the mind changes the brain, not the other way around, and has previously publically stated that dementia was caused by toxic thinking.  This article seems to vindicate her assumptions.

Screen Shot 2015-12-10 at 6.08.55 PM

However, this article also made it onto Facebook’s trending list ands was picked up by news site all over the world (such as this article in the Australian http://goo.gl/RavbMl), so the interest wasn’t just from Dr Leaf, but also from the broader public.  And I can understand why.  No one wants to ‘grow old and senile’, or to ‘lose our marbles’.  Any potential cure or prevention for Alzheimer Dementia is worth paying attention to.

I admit, the headline intrigued me too, both personally and professionally.  I wasn’t aware that one’s attitude towards aging would contribute to Alzheimers, since Alzheimers is predominantly genetic, and the other associated risk factors have more to do with physical health (like diabetes, high blood pressure etc).  Psychological stress is a risk factor for Alzheimers in mice, but good evidence in humans has been lacking [1].

So, does negative attitudes to aging really cause stress which then leads to Alzheimers as the report suggested, or is there a much better explanation?

The scientific article that the news reports were based on is A Culture-Brain Link: Negative Age Stereotypes Predict Alzheimer’s Disease Biomarkers [2].  This study was done in two stages.  Volunteers were recruited from a larger study called the Baltimore Longitudinal Study of Aging.  At entry point, the participants answered a questionnaire about their attitudes towards aging.  This was about 25 years before the participants were actively studied.

The first study examined the change in volume of a part of the brain called the hippocampus (which plays an essential part in our memory system).  The second part of the study examined the volunteers’ brains at autopsy for markers of Alzheimer Dementia, namely ‘plaques’ and ‘tangles’.  The number of plaques tangles were combined to form a single composite score, which was then compared to the baseline attitude towards aging score.

In the first study, the researchers reported that those people who held negative views of aging were more likely to have a smaller hippocampus which more rapidly decreased in size over time.

In the second study, the researchers reported that those people who held negative views of aging were more likely to have more plaques and tangles in their brain.

On the surface, this seems to suggest that people who hold negative views on aging contribute to the development of Alzheimer Dementia, and certainly this is how the different news agencies seemed to interpret the outcomes of the study.  Though on deeper palpation, a number of questions arise about how the researchers did the study and chose to interpret the results.

For example, the aging attitude survey was only done once, which means there’s a 25 year gap or longer between the questionnaire and the active studies. That’s a long time, and the attitudes of the volunteers may have improved or worsened in that time, but that doesn’t seem to have been considered

Levy and her researchers also report that the average size of the hippocampus changed significantly when they averaged the size of the left and the right hippocampus.  But when they analyzed the two sides separately, there was no significant change over time.  So this makes me wonder about the validity of their analysis too – if the volume of each side separately doesn’t change much at all, then how can the average volume of the two sides change so much?

I’m not much of a statistician, but I wonder if the secret’s in their modeling.  They used a linear regression model to compare their data to their hypothesis, a legitimate statistical method, but which involves adjustment for other variables.  If you do enough adjusting, you can get a significant result statistically, but according to their numbers, their Cohen’s d was 0.29, which is considered a weak effect overall.

Then there’s the question of clinical significance.  Even if the hippocampus did shrink in those who thought aging was negative two decades ago, was the shrinkage enough to contribute to the cognitive impairment seen in Alzheimer Dementia?  When compared to other studies, probably not.  Looking at Levy’s graph, the “negative” attitudes group changed about 150mm3 over the 10 year follow up period, or about 5%.  A recent study also showed that the the hippocampal size of subjects with mild memory loss is about 12% less than a healthy age matched control [3].

The same problems are seen in study 2 – Levy and her researchers reported an increase in the number of plaques and tangles in the “aging is bad” group.  But her numbers are small, and not statistically strong.  And again, the question of clinical significance arises.  Plaques and tangles represent biomarkers of Alzheimer Dementia, not necessarily a diagnosis.  Normal aging brains without dementia also have plaques and tangles, and it’s the number of tangles that seem more significant for developing cognitive impairment [4, 5], not the combined score that they used in this study.

And when all is said and done, all Levy and colleagues have shown is a correlation between attitude to aging and changes in the brain.  But correlation does not equal causation.  Just because two things are associated does not mean that one causes the other.  There maybe another variable or factor that causes both observations to co-occur.

In Levy’s case, the common connecting cause could easily be neuroticism, which they discussed as a co-variant but did not say if or how they corrected for it.  The other thing they did not examine in this study is the ApoE gene subtypes, which contribute significantly to the onset of Alzheimer Dementia [6].  The action of ApoE subtypes in the brain may contribute to both negative attitudes and Alzheimers changes?

The bottom line is that Levy’s study shows a weak correlation between a single historical sample of attitude towards aging, and some changes in the brain that are known to be markers for Alzheimer Dementia some three decades later.

They’ve certainly NOT shown that stress, or a person’s attitude to aging, in anyway causes Alzheimer Dementia.  They did not correct for genetics in this study which is the major contributor to the risk of developing Alzheimers.  So the results mean very little as it stands, and further research is required to delineate the cause and effect relationship here.

So don’t stress.  It’s not definitely proven that how you view the aging process determines your risk of dementia.  There will be those like Dr Leaf who will trot out this cherry-picked little titbit of information in the future to try and justify their pretense that thought can change our brain and impact our mental health, but what the press release says and what the study shows appear to be two different things altogether.

References

[1]       Reitz C, Brayne C, Mayeux R. Epidemiology of Alzheimer disease. Nat Rev Neurol 2011 Mar;7(3):137-52.
[2]       Levy BR, Slade MD, Ferrucci L, Zonderman AB, Troncoso J, Resnick SM. A Culture-Brain Link: Negative Age Stereotypes Predict Alzheimer’s Disease Biomarkers. Psychology and Aging 2015;30(4).
[3]       Apostolova LG, Green AE, Babakchanian S, et al. Hippocampal atrophy and ventricular enlargement in normal aging, mild cognitive impairment (MCI), and Alzheimer Disease. Alzheimer Dis Assoc Disord 2012 Jan-Mar;26(1):17-27.
[4]       Nelson PT, Alafuzoff I, Bigio EH, et al. Correlation of Alzheimer disease neuropathologic changes with cognitive status: a review of the literature. J Neuropathol Exp Neurol 2012 May;71(5):362-81.
[5]       Jansen WJ, Ossenkoppele R, Knol DL, et al. Prevalence of cerebral amyloid pathology in persons without dementia: a meta-analysis. JAMA : the journal of the American Medical Association 2015 May 19;313(19):1924-38.
[6]       Liu CC, Kanekiyo T, Xu H, Bu G. Apolipoprotein E and Alzheimer disease: risk, mechanisms and therapy. Nat Rev Neurol 2013 Feb;9(2):106-18.

Dr Caroline Leaf – The mystery of he said/she said is no longer a mystery

This weeks edition of New Scientist magazine carried an article entitled “Scans prove there’s no such thing as a ‘male’ or ‘female’ brain” [1].  The article was inspired by a journal article published in the PNAS last month [2], which reviewed the scans of 1400 different people to see if there were specific differences in the neuroanatomy of the brains of men and women (i.e., are there ‘male’ and ‘female’ brains, or are the commonly accepted male/female differences just a myth, or a cultural, not biological phenomenon?)

According to the article, there is an “extensive overlap between the distributions of females and males for all gray matter, white matter, and connections assessed. Moreover, analyses of internal consistency reveal that brains with features that are consistently at one end of the ‘maleness-femaleness’ continuum are rare. Rather, most brains are comprised of unique ‘mosaics’ of features.” [2]

So essentially, there’s no strong biological basis for gender differences after all.  “This means that, averaged across many people, sex differences in brain structure do exist, but an individual brain is likely to be just that: individual, with a mix of features. ‘There are not two types of brain,’ says Joel.” [1]

This news is a blow to one of Dr Leaf’s less renowned books, “Who switched off your brain? Solving the mystery of he said/she said” [3].

Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist.  Her ‘he said/she said’ book is based on the idea that there are definitive characteristics of the male and female brain which define each gender.  From her conclusion on page 211,

“Men and women are different.  Both the physical anatomy and functional strategy of our brains are different.  We can’t attribute this to social engineering, cultural norms or our up-bringing.  We’ve been created different – it’s in our fundamental design.  Our parents, our communities, and the cultural context of our childhood and adolescence certainly have a prominent developmental role in each of our lives.  But your brain has been fashioned in a specific way that shapes your ‘true you’ long before any of these other factors have had the opportunity to exercise their influence on you.”

As a quick aside, this quote shows the confusion in Dr Leaf’s teaching.  As I’ve discussed before in other blogs, Dr Leaf contradicts herself by claiming that our brain determines our gifts and our behaviours in some books (like ‘He said/she said’ and ‘The gift in you’) but then claims that our thought life controls our brains and our physical reality in the rest of her teaching.  So which is it?

But this quote also sounds the death knell for her book, in light of the recent scientific evidence to the contrary.  Which is a shame, since out of all of her books, this one initially seemed the most scientifically robust.

Even though the book is based on a now defunct theory, I wonder if the thrust of her book still holds true to a point.  We’ve all been created to be different, and we should celebrate those differences and how they complement other people around us.  It just so happens that those differences aren’t inherent to our gender, but to us as individuals, uniquely designed by God “for good works, which God prepared in advance for us to do” (Ephesians 2:10).

So, yes, the mystery of he said/she said has been solved, but not quite as Dr Leaf envisaged.

References

[1]        Hamzelou J. Scans prove there’s no such thing as a ‘male’ or ‘female’ brain. New Scientist. 2015 Dec 5.
[2]        Joel D, Berman Z, Tavor I, et al. Sex beyond the genitalia: The human brain mosaic. Proceedings of the National Academy of Sciences of the United States of America 2015 Nov 30.
[3]        Leaf CM. Who swithced off your brain: Solving the mystery of he said/she said. Texas, USA: Inprov, Ltd, 2011.

Dr Caroline Leaf and the Me-Too approach to mental health

Screen Shot 2015-11-13 at 3.44.33 pm

Since her recent less-than-successful attempt at portraying herself as a mental health expert, Dr Leaf has been laying low on social media, sticking to bland, innocuous quotes or passages of scripture.

Today, she thought it was safe enough to pop her head up from the trenches to fire off another opinionated volley on mental well-being, with a quote from one of her favourite authors, Peter Kinderman:

“It’s our framework of understanding the world, not our brains and not even the events that happen to us – not nature and not nurture – that determines our thoughts, emotions, behaviours and, therefore, our mental health.”

Dr Leaf is a communication pathologist and self-titled cognitive neuroscientist. Without any training or professional experience in mental illness, she has also taken it upon herself to act as an expert on mental health within the Christian church.

Unfortunately, posting quotes like today’s offering only further destroys her flagging credibility among those with professional psychiatric experience, and adds to the confusion of the rest of the Christian church when it comes to understanding mental illness.

There are two main problems with Dr Leaf’s meme: the quote itself and it’s source.

The quote itself is wafer-thin, unable to stand up to even the most basic interrogation. For example, we know through basic common sense that the brain changes how we think, our moods, our emotions and our behaviours. We change our mood, our emotions and our alertness every time we have a cup of coffee, or a glass of wine. Hallucinogenic medications like LSD definitely change our framework of understanding the world. Coffee, alcohol, and illicit substances like LSD all change the mood or experience of the person using them because they all temporarily alter the function of the users brain.

Though it’s not just external substances that change how we experience our external and internal worlds, but our own internal hormonal ecosystem changes our emotions, our moods, our thoughts and our behaviours. This isn’t so obvious for most men as our hormones are fairly constant, though testicular failure is known to result in reduced energy, vitality, or stamina; depressed mood or diminished sense of well-being; increased irritability; and difficulty concentrating and other cognitive problems. For the female gender, monthly hormonal changes can sometimes result in sudden, marked changes in emotions, moods, thoughts and behaviours.

There are a lot of other reasons why the brain controls the mind, and our mental health, which I’ve also discussed numerous times in other blogs (here, here and here)

If you aren’t satisfied with a common sense approach, then consider the scientific evidence that personality, the name that we give to our inbuilt ‘framework of understanding the world’ is largely genetic, and dependent on the function of various neurotransmitter systems [1-4].

So to suggest that the brain is not responsible for our moods, our emotions, our thoughts and our behaviours isn’t supported by the weight of scientific evidence.

The quote by Kinderman doesn’t stop there, but suggests that “not even the events that happen to us … determines our thoughts, emotions, behaviours”, something that also flies in the face of current scientific evidence. For example, the other forty percent of personality is determined by our environment (specifically the ‘non-shared’ environment, the environment outside of our parental influence) [5, 6]. And common psychiatric illnesses are associated with early childhood adversity, such as schizophrenia [7] and ADHD [8]. So again, the quote is unscientific.

Who then is this Kinderman guy, and why does he disagree with the scientific literature?

Peter Kinderman is a Professor of Psychology at University of Liverpool, and the President-elect of the British Psychological Society. He’s a highly outspoken critic of modern psychiatry and what he perceives to be the medicalisation of normal moods and emotions and overuse of medications to treat these non-existent diagnoses. Kinderman believes that it’s our learning history that shapes the paths that our lives take, and so if we simply understand our personal models of the world and how they were shaped by the events and experiences to which we’ve been exposed, we can simply think our way out of any disease process [9].

Kinderman has come out in favour of talking treatments for psychosis in schizophrenia instead of medication, when there’s no scientific proof of benefit for psychosocial therapies in schizophrenia [10, 11] (and here).

This, and his staunch opposition of the DSM5 as invalid, makes me concerned about his bias against modern psychiatry, despite it’s many advances, scientifically and clinically.

However, I’m surprised that Kinderman would make such a statement because it’s such an asinine argument, I find it hard to believe that it came from a professor of psychology. Kinderman would surely recognise the role of biology in our mental health and wellbeing, even if he doesn’t agree with how it’s managed. Perhaps there’s an alternative explanation. Perhaps Kinderman didn’t say what Dr Leaf has claimed?

The answer is, he does, and he doesn’t.

Dr Leaf has quoted Kinderman correctly. Today’s quote is taken directly out of Kindermans 2014 book, “The New Laws of Psychology” [9], on the penultimate page of his introduction. So he does say that our brains and our experiences aren’t relevant for our mental health. But then again, in a blog on the militant anti-psychiatry blog ‘Mad in America’, Kinderman wrote this:

“I’ve spent much of my professional life studying psychological aspects of mental health problems. Inevitably, this has also meant discussing the role of biology. I hope I’ve made some progress in understanding these issues, in working out how the two relate to each other, and the implications for services. That’s my academic day-job. But it’s not just academic for me. I’m probably not untypical of most people reading this; I can see clear examples of how my experiences may have affected my own mental health, but I can also see reasons to suspect biological, heritable, traits. As in all aspects of human behaviour, both nature and nurture are involved and they have been intimately entwined in a complex interactive dance throughout my childhood and adult life.” http://www.madinamerica.com/2015/03/brain-baked-beans/

So he seems confused, both recognising that biological traits influence psychiatric illness, then denying it.

Personally, I disagree with the quote from his book, although I’m just a suburban GP from Australia, so what would I know, right? Though I think the evidence I’ve cited is on my side, and Kinderman is not without his critics who are more than his academic equal.

It also concerns me because the logical conclusion of this line of thinking is that psychiatric illnesses have no biological basis, and therefore psychiatric medications have no place in treatment of them. But as I outlined previously, there is good evidence for the beneficial effects of medications for schizophrenia and ADHD amongst other mental health disorders.

Dr Leaf continues to ignore the scientific evidence for the biological basis for mental ill-health, medications for their treatment, and even the most basic of all that our mind is a product of our brain. Instead, she’s nailed her colours to her mast and aligned herself with outspoken authors on the fringe of modern neuroscience. Rather than addressing the science behind her opposition to modern psychiatry and neuroscience, she has resorted to hiding behind their quotes, a ‘me-too’ commentator, rather than an actual expert.

Of more importance is the confusion that this brings to the vulnerable Christians who follow her social media “fan sites”. The more Dr Leaf criticises psychiatric medications and condemns their prescription and usage, the more likely it is that someone will come to serious harm when they inappropriately cease their medications. And if Dr Leaf won’t come to her senses, our church leaders are going to have to take action, before it’s too late.

References

[1]        Vinkhuyzen AA, Pedersen NL, Yang J, et al. Common SNPs explain some of the variation in the personality dimensions of neuroticism and extraversion. Translational psychiatry 2012;2:e102.
[2]        Chen C, Chen C, Moyzis R, et al. Contributions of dopamine-related genes and environmental factors to highly sensitive personality: a multi-step neuronal system-level approach. PloS one 2011;6(7):e21636.
[3]        Caspi A, Hariri AR, Holmes A, Uher R, Moffitt TE. Genetic sensitivity to the environment: the case of the serotonin transporter gene and its implications for studying complex diseases and traits. The American journal of psychiatry 2010 May;167(5):509-27.
[4]        Felten A, Montag C, Markett S, Walter NT, Reuter M. Genetically determined dopamine availability predicts disposition for depression. Brain and behavior 2011 Nov;1(2):109-18.
[5]        Krueger RF, South S, Johnson W, Iacono W. The heritability of personality is not always 50%: gene-environment interactions and correlations between personality and parenting. Journal of personality 2008 Dec;76(6):1485-522.
[6]        Johnson W, Turkheimer E, Gottesman, II, Bouchard TJ, Jr. Beyond Heritability: Twin Studies in Behavioral Research. Current directions in psychological science 2010 Aug 1;18(4):217-20.
[7]        Howes OD, Murray RM. Schizophrenia: an integrated sociodevelopmental-cognitive model. Lancet 2014 May 10;383(9929):1677-87.
[8]        Thapar A, Cooper M, Eyre O, Langley K. What have we learnt about the causes of ADHD? Journal of child psychology and psychiatry, and allied disciplines 2013 Jan;54(1):3-16.
[9]        Kinderman P. The New Laws of Psychology: Why Nature and Nurture Alone Can’t Explain Human Behaviour: Robinson, 2014.
[10]      Buckley LA, Maayan N, Soares-Weiser K, Adams CE. Supportive therapy for schizophrenia. The Cochrane database of systematic reviews 2015;4:CD004716.
[11]      Jones C, Hacker D, Cormac I, Meaden A, Irving CB. Cognitive behaviour therapy versus other psychosocial treatments for schizophrenia. The Cochrane database of systematic reviews 2012;4:CD008712.

Dr Caroline Leaf and the Myth of the Chemical Imbalance Myth

Screen Shot 2015-10-27 at 2.49.38 am

There are lots of medical myths that people believe.

“I have acne because I eat too much chocolate, or my face isn’t clean enough”

“Stomach ulcers are because of stress”

“I coughed up some yellow phlegm, so I must need antibiotics right?”

“My baby’s fevers are because of teething.”

Is the “chemical imbalance” theory one of them?

Dr Leaf is a communication pathologist and self-titled cognitive neuroscientist. A couple of weeks ago she opened a proverbial can of worms by quoting the out-spoken Peter Gøtzsche, claiming that psychiatric drugs are the third leading cause of death after heart disease and cancer. This did not go down well, and Dr Leaf had to issue three separate statements on social media to try and justify herself and attempt to rescue her rapidly deteriorating credibility.

Not that she issued an apology, mind you, or retracted her statement.

Today, Dr Leaf published a blog on psychiatric medications … but again, not to apologise but to further justify why she’s right, and nearly every other doctor and scientist in the world is not. Worse than that, she went so far as to accuse doctors of deliberately prescribing “clearly dangerous” drugs, which she claims have no therapeutic effects, just because of some overcooked drug-company sponsored dinner and a few pens. More on that later.

Her post is a defiant deflection, a logically flawed and factually inaccurate criticism of modern psychiatry and psychopharmacology – not fueled by research, but largely based on the books of disgruntled fringe psychiatrists and researchers with an axe to grind.

Dr Leaf doesn’t discuss the actual science of the medications that she’s so against, but simply tries to create a smokescreen of distrust.

A good example of all that is wrong with this post is contained in the opening paragraph.

Today, it has become commonplace to say that people have chemical imbalances in their brain, most notably a disruption in the proper production of dopamine (for “diseases” like ADHD) and serotonin (for “diseases” like depression). These people, it is supposed, need drugs to “cure” these chemical imbalances, hence the terms “antipsychotics” or “antidepressants”.

The first thing to note is how Dr Leaf uses the term “cure”. No doctor ever uses the word “cure”, especially when talking about complex diseases. This is a pejorative term implying that modern medicine is only interested in permanently fixing things. But it’s a straw man fallacy, a false premise that Dr Leaf then uses to cast the medical model as impotent and futile. Nice try, but no one in medicine ever promises cure, and no doctor in their right mind would ever be so narrow-minded as to suggest that drugs are the only treatment for every condition. That doesn’t mean that drugs aren’t useful, nor that the medical model is broken. As we’ll discuss soon, medications are extremely helpful for certain conditions, when used carefully, as are non-drug treatments like CBT.

Dr Leaf also puts inverted commas around the word “diseases” as if to suggest that ADHD and depression aren’t diseases, an act which smacks of petulance and willful ignorance, and is insulting to those who have or who have ever suffered from ADHD and depression.   Last week, Dr Leaf was happy to share that her eldest daughter suffered from bulimia and depression, but now she’s suggesting that depression isn’t really a disease. So what is it then? Malingering? Personal weakness? Bad parenting?

It’s really surprising that someone claiming to be a cognitive neuroscientist would ignore strong scientific evidence.  For example, ADHD is associated with dopamine dysfunction as well as the dysfunction a number of other neurotransmitters [1-3]. And depression is associated with a decrease in the growth factor BDNF, (known as the neurotrophic hypothesis of depression) [4-6]. Schizophrenia, which Dr Leaf conveniently failed to mention, is clearly related to dopamine dysfunction in nerve cells of the pre-frontal cortex and the striatum, two parts of the brain that are incredibly important for how your brain processes incoming and outgoing signals [7-9].

There’s nothing to suppose here .. there’s ample evidence that psychiatric diseases are related to dysfunction within the brain, commonly with the function of neurotransmitters among other things. Call it whatever you like, the truth doesn’t change. “Chemical imbalance” is just an easy phrase for the general public to remember.

Dr Leaf then tries to suggest that psychiatric drugs don’t fix chemical imbalances but create them, citing the 1950’s observations of French researchers Deniker and Delay who noted that the first anti-psychotic, chlorpromazine, caused symptoms of Parkinson’s Disease. And indeed it did, but this wasn’t a new disease, just evidence that it worked.

Psychosis, a pathological state involving hallucinations and delusions, is because of an excess of the neurotransmitter called dopamine. Dopamine is the neurotransmitter that’s used by the nerve cells deep in the brain in a part called the basal ganglia, which acts like a central mail delivery centre for incoming and outgoing signals from other parts of the brain. The function of the nerves in one part of the basal ganglia are responsible for sending sensory signals to the frontal lobes of the brain. In another part, the signals are important for smooth movements of our muscles. Proper function depends on just the right amount of dopamine – too much and you get psychosis. Not enough and you get Parkinson’s disease symptoms.

The French researchers were simply noting the side-effects of too much medication blocking the action of dopamine in the basal ganglia – the psychosis had improved, but the blockade of dopamine was just too much in some patients, who had the opposite symptoms.

Again, Dr Leaf’s position is diametrically opposed to the published science [10, 11], and if anything, her claim contradicts her fundamental argument. After all, if chemical imbalances are myths, then how can chlorpromazine create a “new neurological syndrome” because of a chemical imbalance?

Dr Leaf then launches into a discussion on the history of the DSM and psychiatric medications. This is just the first in her ad hominem attacks on the medical profession –  playing the man, not the ball if you will. If she can discredit the doctors that prescribe the medication, then she indirectly discredits the medications.  This appears desperate and ultimately serves to weaken her case.

“It was just assumed that since these drugs affected brain chemistry in a certain way, the opposite reaction must be the result of the disease, notwithstanding the fact that this has never been adequately proven.”

The history of medicine is littered with cures being found without the disease being fully understood. Take Edward Jenner, for example, who is the founder of the modern technique of vaccination. He didn’t know why his smallpox vaccine worked, only that it did. Electron microscopes and a modern understanding of the immune system were centuries away, but Jenner saved billions of lives through his observation that prior vaccination with a small sample of cowpox virus would protect against smallpox [12].

When amphetamines, known to increase dopamine concentrations in the brain, caused psychotic symptoms and reserpine, a dopamine blocker, improved psychosis, it stood to reason that dopamine was a good candidate as a cause of psychosis and schizophrenia. Decades of research have gone on to further confirm and delineate the link [7]. Again, this is not “an overly simplistic explanation of chemical imbalances”. It is well proven, and rather complex.

Dr Leaf also makes the astounding accusation that psychiatrists inflicted suffering and caused “a public health disaster” by creating the DSM. The DSM, the ‘Diagnostic and Statistical Manual’ is an agreed-upon standard classification for psychiatric diagnoses. It is nothing more than a system of classification. It allows psychiatrists and researchers to speak a common language and attempt some coherence among their diagnoses.

Dr Leaf wrote, “… institutions like the American Psychiatric Association and the DSM would define what is normal, in turn telling us what it means to suffer and, essentially, what it means to be human. They medicalized misery, and today millions are suffering because of their actions, creating a public health disaster.”

That’s like saying that classifying the different types of cancer causes cancer. And that millions of people are suffering from cancer because doctors know to call it ‘cancer’. People have been suffering long before the DSM came along. The DSM doesn’t tell people they’re suffering, and it certainly doesn’t define what it is to be human. Such statements are disingenuous and melodramatic.

But wait, there’s more. “Today a psychiatrist can be praised for drugging a depressed person with mind-altering substances and, if these do not work, institutionalizing them and shocking their brain with ECT (electroconvulsive therapy). It is even an acceptable and commonplace practice to imprison mentally ill persons, drug them and lock them in solitary confinement, compelling them to live their days marinating in their own excrement.”

Dr Leaf is again playing to the fears of the public who have watched too many movies and only think of ‘One Flew Over the Cuckoo’s Nest’, ‘Shutter Island’ or scenes from ’12 Monkeys’. There are more oversight boards and lawyers than there are psychiatric patients, and the only people who are institutionalised are those who are clearly a danger to themselves or others. And while institutionalised, they are not subjected to random bouts of electrical shock as if some doctor is wandering around with a medical grade cattle prod, zapping people and laughing maniacally. Nor is anyone locked in solitary confinement and forced “to live their days marinating in their own excrement”.

The paranoid accusations continue some more. Dr Leaf accuses all psychiatrists of ignorance, and then accuses primary care physicians of negligence, by claiming that we prescribe medications that we do not understand because of the bribes and a pretty smile from a pharmaceutical rep.

Again, Dr Leaf contradicts her own argument:

Despite the recognition amongst many psychiatrists and medical health professionals that the chemical imbalance theory is not valid, drug companies like Eli Lilly still claim that ‘antipsychotic medicines are believed to work by balancing the chemical found naturally in the brain’.

Except that antipsychotic medications DO balance the naturally occurring chemical in the brain (dopamine) as we discussed earlier. What the … a drug company telling doctors how their drug works! How dare they tell the truth!

I find it disturbing that Dr Leaf would stoop so low as to insult the entire medical profession, especially every GP and family physician the world over.

Hey, I’m not above criticism. It’s important to have a good long look at ourselves from time to time, to review our practice, and make sure we’re treating our patients in the best possible way. The RACGP, the peak body of Australian GP’s, invited Prof Gøtzsche to present his opinions on anti-depressant medications so that GP’s could decide for themselves if they should adjust their prescribing.

But to suggest that primary care physicians are stupid, ignorant, incompetent and money hungry … that we would sell our soul for a drug company branded pen … is insulting. Though the irony of her statement, “we do not ask ourselves if these doctors really understand all the implications of using these substances. Not even the psychiatrists understand these drugs” is clearly lost on Dr Leaf.  It’s certainly clear from the rest of her essay that Dr Leaf has no idea how these medications work or what benefits they have for those who suffer from mental ill-health.

There’s a lot more to discuss in response to Dr Leaf’s diatribe, but for the sake of brevity, I’ll try and discuss just a couple of other important themes.

Dr Leaf continues to try to make the medications sound useless and poisonous. She has several paragraphs on the placebo effect, making the false argument that the effect of the medications is just because someone tells you it will work. Of course, the placebo effect is part of the therapeutic effect, but that’s the same for all treatments, even Dr Leaf’s programs … “So, if the pastor or cell-group leader says that these programs are safe and will fix your toxic thinking, even though they get most of their information from the author, we believe wholeheartedly in what he or she may say and are more inclined to believe the program will work for us. These beliefs, which ignore actual scientific results, are buttressed by a flood of distorted and biased news reports, press releases and scientific journal articles on supposed toxic thoughts, and have transformed the theory into church dogma. So, obviously, if we experience negative side effects and do not feel the program is working, it must be something wrong with us, not the program.” Is that a fair statement?

Dr Leaf then plays the fear card again by listing all of the potential side effects from psychiatric medications. Dr Leaf is right in saying that psychiatric medications have serious proven long term side effects, and we should be careful.

For instance, if you knew that thrombocytopenia, anaphylaxis, cutaneous hypersensitivity reactions including skin rashes, angioedema and Stevens Johnson syndrome, bronchospasm and hepatic dysfunction were the potential side effects for a medication, would you take it? Most people wouldn’t.  Reading the list makes that drug sound really dangerous.  We should be up in arms about such a potentially harmful drug being put up for sale … except that this list of side effects isn’t a psychiatric drug at all, but’s actually the side effect profile of paracetamol (acetaminophen in the US). People take paracetamol all the time without even thinking about it.

Saying that we shouldn’t take medications because of potential side effects is a scarecrow argument, a scary sounding straw man fallacy. All drugs have serious proven long term side effects. Licencing and prescribing a medication depends on the overall balance of the good and the harm that a medication does. And no one has ever hidden these side effects from the public as if there is a giant conspiracy from the doctors and the pharmaceutical companies. They’re right there in the product information (here is the product information for fluoxetine. See for yourself).

Whilst it’s true that these side effects do happen, we know that they happen infrequently, just like we know that people win lotteries infrequently. Even so, the medications are not just doled out like sweets at a candy store. You require a minimum of ten years of university level education to be able to prescribe them.

Patients ALWAYS have a right to ask questions about possible benefits and side effects, and in my practice, I tell my patients the pros and the cons before prescribing, and I give them the choice of whether they want them or not. No one is ever forced into taking them.

Finally, Dr Leaf makes a number of irrational statements and flawed arguments in her final page of ranting. Let me quickly go through some of the honourable mentions:

* “Most people recover from depression without antidepressants” – true, because most cases of depression are mild. That doesn’t mean to say that antidepressants shouldn’t be used for severe depression, just like most people recover from upper respiratory infections without antibiotics, but that doesn’t mean that we shouldn’t use antibiotics for severe tonsillitis or pneumonia.
* “Antidepressants are no better than placebos” – It’s a controversial topic right now. There are many pushing the barrow that SSRI medications are no better than a sugar pill. But Dr Leaf has conveniently ignored several Cochrane reviews (the best of medical evidence) that shows anti-depressants work for a variety of disorders [13-15], but that psychological therapy might not [16].
* Equating antidepressants and antipsychotics with illicit drugs, and claiming that “more people die from overdoses of psychiatric drugs than illicit drugs” – This is Reductio ad absurdum – the logical conclusion from this argument is that illicit drugs are safer than psychiatric drugs. And therefore we should not give people psychiatric drugs since we don’t give people the ‘safer’ illicit drugs. But that conclusion is absurd, and when you think about it, the whole thing is based on hidden false premises – people rarely die of illicit drug overdoses because they’re illegal and are hard to come by. And also, people who use illicit drugs are not usually suicidal, whereas those given psychiatric medications sometimes are suicidal, and sometimes use them to try and commit suicide. But modern psychiatric drugs are much less dangerous in overdose than their old counterparts.  It should also be noted here that more overdose suicide attempts are with paracetamol or ibuprofen than with psychiatric medications [19], but I don’t see paracetamol or ibuprofen being demonised.
* Psychiatric medications are part of a neo-liberal capitalist plot to keep the rich, richer and the poor, poorer – To me, this looks like Dr Leaf clutching at straws. Her statement, “By emphasizing that the problem lies within an individual’s biology, we are less inclined to look at their experiences and the social context of why they are feeling the way they feel. We look at the mythical chemical imbalance instead of economic exploitation, violence and inept political structures” is false.   Schizophrenia is often seriously discussed in terms of neurodevelopment and not just ‘chemical imbalances’ [17, 18]. So it’s just plain wrong to suggest that researchers don’t look at the “economic exploitation, violence and inept political structures”. Oh, and Dr Leaf suggests that foster children are abused because they’re all forced to take psychiatric medication, and implies that ADHD children are abused by being force-fed Ritalin because they “move a lot in class”. Again, these are emotional over-generalisations that have no basis in reality.

Dr Leaf seems lost.  She’s ignored solid published medical and scientific evidence in coming to an opinion based on the discontented rumblings of a few vocal but outspoken critics. In order to make her arguments, she has had to resort to borderline-slanderous ad hominem attacks on scientists and the medical profession, and purely emotional arguments based on fear and mistrust.

And this was only part one.  If Dr Leaf’s promised second part is anything like the first, we’re in for a real treat.

Though as if that wasn’t enough, by suggesting that psychiatric drugs cause changes in your brain, cause chemical imbalances, and cause that slew of negative side effects, Dr Leaf is admitting that it’s your brain that changes your thought life, which directly contradicts her most recent teachings. After all, if thought was the dominant force in your neurology and your mind controlled your brain, then the medications would have no effect since they’re physical and aren’t connected to our mind.

So which is it? Because if the brain controls our mind, then her best-seller needs to be pulped and refunds offered to the hundred of thousands of people who bought it. But on the other hand, if the mind really does control the brain, then her entire argument against psychiatric medications implodes.

Dr Leaf has painted herself into a corner and there’s still part two to come.

References

[1]        Prince J. Catecholamine dysfunction in attention-deficit/hyperactivity disorder: an update. J Clin Psychopharmacol 2008 Jun;28(3 Suppl 2):S39-45.
[2]        Del Campo N, Chamberlain SR, Sahakian BJ, Robbins TW. The roles of dopamine and noradrenaline in the pathophysiology and treatment of attention-deficit/hyperactivity disorder. Biological psychiatry 2011 Jun 15;69(12):e145-57.
[3]        Cortese S. The neurobiology and genetics of Attention-Deficit/Hyperactivity Disorder (ADHD): what every clinician should know. European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society 2012 Sep;16(5):422-33.
[4]        Haase J, Brown E. Integrating the monoamine, neurotrophin and cytokine hypotheses of depression–a central role for the serotonin transporter? Pharmacol Ther 2015 Mar;147:1-11.
[5]        Bus BA, Molendijk ML, Tendolkar I, et al. Chronic depression is associated with a pronounced decrease in serum brain-derived neurotrophic factor over time. Molecular psychiatry 2015 May;20(5):602-8.
[6]        Sousa CN, Meneses LN, Vasconcelos GS, et al. Reversal of corticosterone-induced BDNF alterations by the natural antioxidant alpha-lipoic acid alone and combined with desvenlafaxine: Emphasis on the neurotrophic hypothesis of depression. Psychiatry research 2015 Sep 1.
[7]        Howes OD, Fusar-Poli P, Bloomfield M, Selvaraj S, McGuire P. From the prodrome to chronic schizophrenia: the neurobiology underlying psychotic symptoms and cognitive impairments. Curr Pharm Des 2012;18(4):459-65.
[8]        Williams GV, Castner SA. Under the curve: critical issues for elucidating D1 receptor function in working memory. Neuroscience 2006 Apr 28;139(1):263-76.
[9]        Der-Avakian A, Markou A. The neurobiology of anhedonia and other reward-related deficits. Trends Neurosci 2012 Jan;35(1):68-77.
[10]      Leucht S, Tardy M, Komossa K, et al. Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. Lancet 2012 Jun 2;379(9831):2063-71.
[11]      Torniainen M, Mittendorfer-Rutz E, Tanskanen A, et al. Antipsychotic treatment and mortality in schizophrenia. Schizophrenia bulletin 2015 May;41(3):656-63.
[12]      Riedel S. Edward Jenner and the history of smallpox and vaccination. Proc (Bayl Univ Med Cent) 2005 Jan;18(1):21-5.
[13]      Arroll B, Elley CR, Fishman T, et al. Antidepressants versus placebo for depression in primary care. The Cochrane database of systematic reviews 2009(3):CD007954.
[14]      Soomro GM, Altman D, Rajagopal S, Oakley-Browne M. Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). The Cochrane database of systematic reviews 2008(1):CD001765.
[15]      Kapczinski F, Lima MS, Souza JS, Schmitt R. Antidepressants for generalized anxiety disorder. The Cochrane database of systematic reviews 2003(2):CD003592.
[16]      Jakobsen JC, Lindschou Hansen J, Storebo OJ, Simonsen E, Gluud C. The effects of cognitive therapy versus ‘treatment as usual’ in patients with major depressive disorder. PloS one 2011;6(8):e22890.
[17]      van Os J, Linscott RJ, Myin-Germeys I, Delespaul P, Krabbendam L. A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychological medicine 2009 Feb;39(2):179-95.
[18]      Howes OD, Murray RM. Schizophrenia: an integrated sociodevelopmental-cognitive model. Lancet 2014 May 10;383(9929):1677-87.
[19]     Prescott K, Stratton R, Freyer A, Hall I, Le Jeune I. Detailed analyses of self-poisoning episodes presenting to a large regional teaching hospital in the UK. Br J Clin Pharmacol 2009 Aug;68(2):260-8.

Disclaimer

  1. Do not abruptly stop any medications that you are taking. Talk to your licenced physician first. They’re not all money-hungry, imbecilic drug-company bitches. Most of them actually know what they’re talking about.
  2. For the record, I declare that I have no connection with any pharmaceutical company. I do not accept gratuities of any form from any sales representative. I don’t eat their food, I don’t take their pens, and I don’t listen to their sales pitches

Dr Caroline Leaf and the can of worms – UPDATE

Yesterday, Dr Leaf opened a proverbial can of worms with her quote from Gøtzsche, that “Psychiatric Drugs are the third leading cause of death, after heart disease and cancer.”

Dr Caroline Leaf is a communication pathologist and a cognitive neuroscientist. Clearly scrambling, she attempted to placate her growing number of detractors with an unprecedented explanatory statement. But rather than distancing herself from her comments, she still chose to portray psychiatric medications as harmful and ungodly.

Instead of quelling the fire, this seems to have thrown fuel on it. Dr Leaf has continued to try and justify her comments with a further two statements today. Neither of them contain a retraction or an apology.

Earlier today, she wrote:

Screen Shot 2015-10-19 at 7.02.14 pm

Dear all, regarding the recent two posts I put up on mental health and medications and the flood of positive and negative responses that followed, I would love you to hear my heart: all my posts are lovingly crafted, designed to help, based on my years of extensive research and experience in the field of mind, learning and mental health, including within my immediate and extended family..and {sic} most importantly, they are Holy Spirit led. I work with a team of professionals, that include medical doctors, neurosurgeons, neurologists, neuroscientists, theologians, pastors and historians in order to provide excellent information. I am a messenger: I teach and provide information and encourage you, in turn, not to be reactive, but to read, do your own research and think. To this end, I provide as much help as I can on my web page and TV shows and resources with information and research links and citations. I DO believe in using general medications and surgeries when managed correctly and not abused, I myself have been helped by surgery and used medications when necessary, as have my family. I DO NOT judge anyone. I believe in your right to choose; I DO NOT tell anyone to go off their meds, I recommend supported and supervised withdrawal if this is what you choose; I DO encourage you to make Holy Spirit led educated choices about your choices, I DO encourage you to use your love, power and sound mind – your intellect, will and emotions, the way God designed these to be used – led by Him continuously. Please watch this incredible and touching video by Laura Delano on You Tube, which highlights why I do what I do. https://m.youtube.com/watch?list=PLK_W1lA1BNLk2vbBH2XetI80LDpmaGTUG&params=OAFIAVgF&v=b6ZljUs4Xos&mode=NORMAL Many blessings to you all and my prayer for you is: “Beloved, I pray that you may prosper in every way and [that your body) may keep well, even as [I know) your soul keeps well and prospers.” 3 John 1:2 AMP see http://www.drleaf.com scientific FAQ’s for more information, citations and links

then later in the day:

Screen Shot 2015-10-19 at 7.02.56 pm

Dear all, some of you have questioned whether or not I have ever dealt with people experiencing severe mental health issues. As someone who has specialized in the mind over the past 30 years, I have been given the opportunity to work, first hand, with people experiencing mental and physical pain in the most terrible life situations, from severe traumatic brain injuries to rape, murder and abysmal poverty. I have seen these individuals choose with their minds not to allow their life circumstances to take control over their identity… through the power of God, love and community they overcame what life threw their way. But, on a more personal level, my eldest daughter (@therascalcook) was severely bulimic, suicidal and depressed for most of her early years due to a chronic illness and traumatic bullying. I have been in hospitals, crying beside her bed when she nearly died. I have experienced her pain…I am crying as I write this. But as a family we supported her and loved her through it, as did her friends and many of our loved ones, (it was not easy but it was worth it!). She never took a single medication nor was she institutionalized, even though doctors were telling me she would never recover if she didn’t. Yet today, after rejecting God and life for many years, she is a graduate student in historical theology, whose life goal is to bring a piece of heaven to earth through sustainable farming communities in disadvantaged areas. There is hope, God is greater than anything, and magic bullets are never the answer. You are not a label or a faulty biological machine. You are a child of God, as we all are. Unless all of us realize what it truly means to be the church, to bring heaven to earth as we love our God and people, to be the community of love that this world is so desperately crying out for, people will continue to have mental health issues, be labeled {sic}, face stigma and suffer. We all have this responsibility, and none of us can do it alone. We were created by God to help each other. Jessica used to call me her Sam. We all need a Sam, because we all know what it is like to be Frodo.

Kudos to Dr Leaf for the bravery and vulnerability that sharing such a personal story took. I’m genuinely happy that Jessica found her way through those dark and distressing days and has once again found peace and success. I have been through the same dank and destructive times of depression, and I know what it feels like. I wouldn’t wish it on anyone. When I hear stories of people who have overcome, I truly appreciate their joy.

I also recovered from my depression without ever using medications. What helped me enormously was a psychologist who listened to me without judgement as I unloaded years of emotional turmoil and distress. To this day, I don’t remember what we actually talked about in my first session with him. All I remember is getting ten minutes in and then crying almost uncontrollably for the next forty. Thankfully, I did more talking and less crying over the few months as my mood lifted and I grew to accept my brokenness, just like God does.

Clearly, the story of Jessica Leaf is heart-warming and uplifting. Dr Leaf clearly understands the pain and distress that severe mental illness brings to those who suffer with it, and their families. But all emotions aside, Dr Leaf has still left important issues unresolved. Indeed, those who are more cynical might see such an emotional recollection as a play for sympathy and a distraction from the lingering questions surrounding Dr Leaf’s handling of this issue, and of her expertise in mental health.

Dr Leaf’s expertise, revisited.

Dr Leaf’s experience during those darkest of times may give her a legitimate platform to discuss what worked for her daughter and her family, but however moving, it does not qualify her as an expert in mental health more broadly. Science isn’t about generalising from your personal experience. It’s about looking at the evidence from a number of rigorously designed trials with a minimum of bias, conducted across a broad range of participants.

When women come to see me in the few weeks after giving birth, they’re usually confused. Nearly every woman that’s ever given birth sometime in the last century believes their experience automatically qualifies them as experts in breast feeding and infant health. But their ‘helpful’ advice, given with the best of intentions, often conflicts with the opinion of every other self-proclaimed motherhood expert. By the time the poor new mother comes to see me, they’ve been given so many pieces of conflicting advice that they’re completely lost.

Just living through an experience doesn’t qualify you as an expert. So I don’t claim to be an expert in mental health just because I’ve lived through prolonged periods of anxiety and depression. Nor should Dr Leaf.

Dr Leaf can’t use the fact that she has worked with people who have mental health problems as a claim to expertise either. She may been given the opportunity to work, first hand, with “people experiencing mental and physical pain in the most terrible life situations, from severe traumatic brain injuries to rape, murder and abysmal poverty.” That doesn’t make her an expert in mental health any more than seeing female patients makes me a gynaecologist.

That’s because expertise in medical fields requires specific training. You can read surgical textbooks for thirty years but that doesn’t quality you as a surgeon. You can learn a bit of anatomy and physiology in the same lab as some medical students, but that doesn’t make you equivalent to a medical doctor. You might do some research involving some neurobiology, but that doesn’t make you a neuroscientist.

Dr Leaf is a communication pathologist who completed a PhD which included some educational psychology. She is not a counsellor, she is not a psychologist, she is not a medical doctor and she isn’t even a cognitive neuroscientist. Dr Leaf is not qualified to provide an expert opinion on the risks and harms of psychiatric medication.

Dr Leaf’s heart

Coming back to Dr Leaf’s first statement today, Dr Leaf said that she wanted to share her heart:

all my posts are lovingly crafted, designed to help, based on my years of extensive research and experience in the field of mind, learning and mental health, including within my immediate and extended family..and {sic} most importantly, they are Holy Spirit led

If I were Dr Leaf, I’d be careful about blaming the Holy Spirit for her posts. I have rebutted and debunked scores of Dr Leaf’s memes over the last couple of years. The Holy Spirit is the ‘Spirit of all truth’, not of half-baked facts and misquotes.

Dr Leaf goes on to say

I teach and provide information and encourage you, in turn, not to be reactive, but to read, do your own research and think. To this end, I provide as much help as I can on my web page and TV shows and resources with information and research links and citations.

I respectfully disagree. Dr Leaf rarely references her social media memes, and until recently, her website was bereft of citations. I have never seen her encourage critical thinking before. And if Dr Leaf really wanted to encourage thinking amongst her followers, then why does her team actively block people on social media who dare to disagree with her? That’s not encouraging free thinking, that’s presenting an illusion of conformity.

Dr Leaf’s Do’s and Don’ts

To clarify her position on several issues, Dr Leaf stated:

I DO believe in using general medications and surgeries when managed correctly and not abused, I myself have been helped by surgery and used medications when necessary, as have my family. I DO NOT judge anyone. I believe in your right to choose; I DO NOT tell anyone to go off their meds, I recommend supported and supervised withdrawal if this is what you choose; I DO encourage you to make Holy Spirit led educated choices about your choices, I DO encourage you to use your love, power and sound mind – your intellect, will and emotions, the way God designed these to be used – led by Him continuously.

Dr Leaf may say that she doesn’t tell anyone to go off their meds, but I think that’s a little disingenuous.

Sure, Dr Leaf never directly said to stop taking their medications. She just said that psychiatric medications were unscientific and unbiblical [1: p31-32], that psychiatric medications are the third most common cause of death after heart disease and cancer, and admonished her followers to “Take all thoughts into captivity, not drug all thoughts into captivity.” And just yesterday, she also linked psychiatric medications with evolutionary theory and said that they strip 15-25 years off your lifespan.

So it’s more like, “I DO NOT tell anyone to go off their meds, I just scare them by telling them the drugs are unholy poison”.

That’s not encouraging “Holy Spirit led educated choices”, it’s encouraging fear-driven poor choices.

Dr Leaf’s support team

One last point. Dr Leaf stated,

I work with a team of professionals, that include medical doctors, neurosurgeons, neurologists, neuroscientists, theologians, pastors and historians in order to provide excellent information.

Really? Dr Leaf’s work consistently conflicts with basic medical and psychological science, and she regularly misquotes scripture. Would they be willing to be named? Because either they’re providing Dr Leaf with terrible oversight or Dr Leaf is ignoring everything they say.

Dr Leaf still hasn’t apologised for, or retracted her statements

It’s no secret that I disagree with Dr Leaf’s teaching, and I have outlined why I think some of her statements today are disingenuous. You may agree with me, or not. I don’t mind. Hey, I could be wrong.

Though when you get down to brass tacks, the most important issue is that Dr Leaf remains legally vulnerable.

Since she opened up the can of worms with her Gøtzsche quote, she has made three separate statements, none of which apologise for potentially misleading nearly 150,000 people about the true risks and benefits of psychiatric medications. Nor has she issued any retraction or taken the posts down.

When Dr Leaf says that psychiatric medications are unbiblical and poisonous, people on psychiatric medications will want to come off them. She may not have said the words “Stop your medications”, but people will still want to come off them because they’re afraid, or because of the stigma, or because of their desire to live true to God. And as I discussed yesterday, there is a very real chance that some of those people who were stable on their medications but who unnecessarily cease them because Dr Leaf told them to, may harm themselves or take their own life, since that’s what the studies tell us [2, 3]. At the very least, they are likely to have a shorter life expectancy because of it [4, 5]. This may open Dr Leaf to law suits, as well as the possibility of having someone’s death on her conscience.

No one wants that scenario. But the only way to avoid it is to:

  1. Take the offending posts down
  2. Issue an apology
  3. Specifically direct those of her followers on psychiatric medications to stay on them until they have spoken to their doctors,
  4. In future, provide a balanced view of the benefits of psychiatric medications as well as their harms.
  5. Better yet, unless Dr Leaf gets a medical degree, it may be better not to publically discuss psychiatric medication at all.

Again, I implore Dr Leaf, for her sake and for the sake of her ministry and those who follow her, please unequivocally apologise, retract your statement, and encourage people to see their doctors if they have concerns about their medication, or their mental health.

This is not a game: people’s lives are at stake. I hope that Dr Leaf sees this before it’s too late.

References
[1]        Leaf CM. Switch On Your Brain : The Key to Peak Happiness, Thinking, and Health. Grand Rapids, Michigan: Baker Books, 2013.
[2]        Correll CU, Detraux J, De Lepeleire J, De Hert M. Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World psychiatry : official journal of the World Psychiatric Association 2015 Jun;14(2):119-36.
[3]        Tiihonen J, Suokas JT, Suvisaari JM, Haukka J, Korhonen P. Polypharmacy with antipsychotics, antidepressants, or benzodiazepines and mortality in schizophrenia. Archives of general psychiatry 2012 May;69(5):476-83.
[4]        Tiihonen J, Lonnqvist J, Wahlbeck K, et al. 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 2009 Aug 22;374(9690):620-7.
[5]        Torniainen M, Mittendorfer-Rutz E, Tanskanen A, et al. Antipsychotic treatment and mortality in schizophrenia. Schizophrenia bulletin 2015 May;41(3):656-63.

Remember: This article is a rebuttal of Dr Leaf’s opinion regarding psychiatric medication.  This blog doesn’t constitute individual medical advice.  If you do not like your medication or think you should come off it, please talk to your own GP or psychiatrist.  Do not stop it abruptly or without adequate medical advice.