Dr Caroline Leaf and the Myth of the Chemical Imbalance Myth

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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

Update – 8 August 2016.

Dr Leaf has since taken the offending post from her blog page, and re-gifted it as an answer on her “Scientific” FAQ page (“Chemical Imbalances and Mental Health” http://drleaf.com/about/scientific-faqs/).  It remains as unbalanced and inaccurate as it’s former iteration.  It’s unfortunate that Dr Leaf continues to make such preposterous claims in the face of overwhelming scientific evidence to the contrary.

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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:

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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:

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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.