Dr Caroline Leaf – Increasing the stigma of mental illness again

Posted on March 19, 2016 by cedwardpitt

Let me tell you a story.

A couple of years ago, one of my patients was an elderly gentleman in his late seventies. He was living in a nursing home at the time, but because of his history of psychosis, he remained on a treatment order – a requirement by law that if he was to remain outside of a mental facility, he had to have regular anti-psychotic medication every few weeks.

This man was on a treatment order because his disease caused him to have delusions. He misinterpreted what was going on around him, and would not consider that he could be wrong. In his particular case, he was convinced that his next-door neighbour was a paedophile, and he was planning to ambush his neighbour and castrate him. Luckily the police had taken my patient into custody before he got the opportunity. With treatment, my patient had clear thoughts, although needed close supervision. Without his medication, he became confused and violent.

According to a post on the blog Mad in America and promoted by Dr Caroline Leaf, my patient’s diagnosis was spurious, and he was denied his basic human rights by being forced to take medications.

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist. She is also a self-declared expert in mental health, despite not having any professional training in medicine, psychiatry, psychology or even cognitive neuroscience for that matter.

Indeed, if she had any experience or expertise in mental health, she would have recognised the basic factual errors and logical fallacies that riddled the post she quoted from.

Take the quote that Dr Leaf posted on social media. The full quote from the Mad in America post is:

“Despite the fact that no one in history, not even the omnipotent American Psychiatric Association – which produces and profits mightily from the ‘Bible’ of mental disorders — has come up with a halfway good definition of “mental illness,” and despite the fact that the process of creating and applying the labels of mental illness is unscientific, any of those labels can be used to deprive the person so labeled of their human rights. This is terrifying. It ought to terrify those who are so labeled and those who are not, because deprivation of human rights on totally arbitrary grounds is inhumane and immoral.”

This is the same tired, emotionally laden and misleading rhetoric that’s so often barked in fervent paroxysms through the foaming lips of those opposed to modern psychiatric practice:

There is no good definition of ‘mental illness’
The American Psychiatric Association is just a profit-driven cabal
The DSM5 (which the author alludes to as the ‘Bible’ of mental disorders) is unscientific
Psychiatric diagnoses are unscientific
Any psychiatric diagnosis can be used as a trigger to force people into unwanted treatments or incarceration
Therefore psychiatric diagnosis and treatment is against basic humans rights and is inhumane and immoral.

Inhumane and immoral hey? Tell that to my patients neighbour who almost became a eunuch except for that “inhumane and immoral treatment” of my former patient.

Caplan claims just don’t stand up to any rational scrutiny.

There are lots of good definitions of mental illness … modern psychiatry critics just don’t like them. But take the definition used by the CDC, “Mental illness is defined as … ‘health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.’” There’s nothing wrong with this definition. It describes mental illness and helps differentiate mental illness from variations of mood, thought and behaviour that are part of the everyday human experience.

The American Psychiatric Association isn’t the only group to have created a classification of psychiatric illnesses. The World Health Organisation publishes the International Classification of Diseases, or the ICD, which is also used for psychiatric diagnosis. Is the WHO an evil profit-driven junta too?

The DSM, the ICD, and any other system of diagnosis, are simply different classification systems. Over the last century, clinicians have noted clusters of symptoms and have tried to classify them into common groups. How is that unscientific? It’s no different to scientists looking at the different characteristics of various animals and creating a taxonomy, to provide a common system and language for clinicians and researchers across disciplines and across countries.The DSM system isn’t perfect, but what system ever is? As knowledge of neuroscience grows, the classifications are reviewed and tightened in an ongoing process of improvement. If those who oppose the DSM want to come up with something better, they’re welcome to put something forward.

The old saying goes that medicine is an art and a science. Human beings, as nuanced as we are, often don’t fit into diagnostic criteria as easily as we would like. That doesn’t invalidate the diagnostic criteria or make the process unscientific as critics of modern psychiatry would have us believe, just like an unusual and hard-to-classify form of cancer doesn’t invalidate the other cancer classifications that are well defined. Psychiatry, by it’s nature, relies on verbal report from patients rather than a clean-cut blood test or piece of tissue under a microscope, so at this stage in history, it seems imprecise. That doesn’t make it any less scientific.

The allegation that any psychiatric diagnosis can any be used to deprive the person so labeled of their human rights is utter nonsense. It’s a giant scarecrow – it seems really scary, but on closer inspection, it’s just a tarted-up mound of straw.People are never forced into treatments unless they really are “dangerous to themselves and/or others”. This rule can’t be invoked willy-nilly. There are multiple checks and balances, and a whole school of civil rights lawyers expectantly circling, ready for the whiff of blood in the water (http://www.mhrt.qld.gov.au/?page_id=2 is an example of the process in my home state, but each jurisdiction has their own version).

Caplan rightly pointed out that those with mental illness were less likely to be the perpetrators of violence and more likely to be the victims, but that doesn’t negate the need for protection of the community from those with mental illness who have shown violent intent and no capacity to control their behaviour.

If you want to find a group that really are suffering from inhumane and immoral deprivations of their human rights, then that would be Christians. Around the globe, millions of Christians are oppressed, imprisoned, tortured, raped, and murdered every year.

Time and space preclude a full analysis of Caplan’s post, but what’s really important is that both the American Psychiatric Association and the U.S. Department of Health and Human Services’s Office of Civil Rights, an independent ombudsman, dismissed formal appeals by Caplan relating to her hysterical claims of inhumane forced psychiatric treatment. Dr Leaf conveniently left that out of her social media post.

Instead, Dr Leaf chose to publish one of the most alarming quotes from an article heavy on scaremongering, from a disaffected author on an extremist blog. If Dr Leaf was a real expert on mental health instead of being a self-declared one, she would have easily seen how nonsensical Caplan’s post was.

By posting this quote on social media today, it’s highly likely that Dr Leaf has caused harm to thousands of vulnerable Christians by unnecessarily increasing the stigma and fear of a mental health diagnosis. This, in turn, is likely to lead to these same vulnerable Christians missing out on (drug and non-drug) treatment which would help them rise to their true potential in God and in life, leaving them trapped and suffering in their mental destitution.

Dr Leaf has a track record of misinformation when it comes to mental health. Christians suffering mental illness need more support, not more stigma. It’s time Dr Leaf stepped aside, and stopped making things worse.

Dr Caroline Leaf – Rogue Notion

Posted on February 12, 2016 by cedwardpitt

According to a new study by Rutgers University, “Learning new cognitive skills can help reduce overwhelming negative thoughts”. So said Dr Caroline Leaf, communication pathologist and self-titled cognitive neuroscientist. She also advised that “Intentionally bringing those rogue thoughts under control is essential to mind health! And learn something new every day – develop your mind!”

So … negative thoughts are what, like an evil spy organisation, running around causing wanton destruction, overwhelming your capacity to function?

If that’s the case, then new cognitive skills must be like Tom Cruise, running, jumping, shooting and kicking their way through the negative thoughts, saving the world and getting the girl.

It’s a popular concept. As I discussed in my previous post, the power of positive thinking is culturally sanctioned Western folk psychology. We implicitly accept the idea that we have to harness positive thoughts and stop negative thoughts if we’re to overcome life’s obstacles.

However, the only rogue notions here are Dr Leaf’s.

Dr Leaf’s post sounds authoritative and sciency, but is nothing else. It’s vague, and with a bit of deeper palpation, it’s actually wrong.

Dr Leaf has gone back to her bad habit of obfuscating her references, maybe because she’s getting lost in her own hubris, or more likely, it’s much easier for her audience to see that she’s just cut-and-pasted the opening by-line of a press release again if she actually disclosed her source.

In fact, the article is about a study from Rutgers which studied two behavioural interventions (not cognitive ones), a form of mindfulness meditation and aerobic exercise. The original publication is in the journal Translational Psychiatry [1], if you want to check it out for yourself. This article isn’t about learning cognitive skills at all. Exercise and mindfulness meditation are tried and true behavioural methods of improving mood disorders like depression, which the authors combined to assess the benefit or otherwise. Neither intervention involved challenging or fighting thoughts, or suppressing ‘negative’ thoughts, or “intentionally bringing those rogue thoughts under control”.

Indeed, the mindfulness meditation used involves “the practice of attending to the present moment and allowing thoughts and emotions to pass without judgment.” [1] Mindfulness doesn’t try to control anything. Rather than supporting Dr Leaf’s declaration that intentionally bringing thoughts under control is essential to mind health, this study contradicts it.

Cutting and pasting doesn’t make you an expert. It’s easy to take a sciency-sounding tag line and put it in a pretty little graphic. Everyone does it. 90% of Instagram and Facebook posts these days are faux-authoritative pseudo-science memes that aren’t worth the bytes they’re made of.

Junk science is like junk food. If that’s all you consume, then you eventually become an intellectual blob of lard, stuffed full of mistruths and logical fallacies, and incapable of understanding scientific truth for yourself. Dr Leaf’s audience deserves better than junk science and it’s about time that Dr Leaf stopped pretending to be an expert, and started acting like one.

Reference

[1] Alderman BL, Olson RL, Brush CJ, Shors TJ. MAP training: combining meditation and aerobic exercise reduces depression and rumination while enhancing synchronized brain activity. Transl Psychiatry 2016;6:e726.

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

Posted on February 9, 2016 by cedwardpitt

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.

Christian male modelling

Posted on January 28, 2016 by cedwardpitt

Some love him. Some hate him. It doesn’t change the fact that he was still “ridiculously good looking”.

Zoolander was one of those cult movies that polarised people into “absolutely love it” or “absolutely loathe it” camps. I admit, I’m one of the former. (“Moisture is the essence of wetness, and wetness is the essence of beauty” … It still cracks me up!)

For those who aren’t familiar with the story, Derek Zoolander was a top male model who was famous for his different looks: “Blue Steel”, “Ferrari”, “Le Tigre” and the famous “Magnum”. They were all the same pose, of course, but everyone thought they were different. Except for evil fashion designer, Mugatu, who in a burst of rage at the climax of the movie, yells, “Who cares about Derek Zoolander anyway? The man has only one look … Blue Steel? Ferrari? Le Tigra? They’re the same face! Doesn’t anybody notice this? I feel like I’m taking crazy pills!”

There are times when I read Dr Leaf’s social media posts, and I feel the same as Mugatu.

“Dr Leaf isn’t a scientific expert … ‘When we think, we learn because we are changing our genes and creating new ones’ … That’s not scientifically possible! Doesn’t anybody notice this? I feel like I’m taking crazy pills!”

Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist. If Dr Leaf was a legitimate scientist, she would know that our genes do not change when we process new information. Our genes are stable. They do not change unless there’s a mutation, which occurs in one out of every 30 million or so genes. We do not make new genes at will. Last year, scientists at MIT were reported to have shown that DNA breaks when new things are learnt, but in a normal nerve cell, these breaks are quickly repaired. That’s certainly interesting, but that’s not changing the DNA or making new genes. Making claims that we make new genes to hold new information is like saying that pigs fly.

Dr Leaf’s supporters would likely make a counter-argument that she probably didn’t mean that genes really change, or we make new genes, she’s just not worded her meme properly. Well, there are two responses to that, neither of which are any better for Dr Leaf. Because scientists who really are experts don’t make errors so large that you can spelunk through them. And, this isn’t the first time that Dr Leaf has made claims about how our genes fluctuate. She made a similar claim back in September 2014. Saying the same thing several times isn’t a mistake, it shows she really believes that we change our DNA code by the power of our thoughts.

Whether someone thinks DNA is changeable isn’t likely to cause any great harm to that person, but what is concerning is that Dr Leaf has been given her own show on the Christian cable TV network TBN to discuss mental health. She’s already proven that her knowledge of psychiatric medications is dangerously flawed. If Dr Leaf doesn’t know the basics of DNA, then giving her a platform to preach something that can effect whether a person might live or die is particularly perilous.

Dr Leaf’s rise is also a worrying symptom of a Christian church that is intellectually imploding. In a 2013 blog for the Huffington Post, Charles Reid wrote,

“Christians must provide effective witness against both extremes. But before Christianity can engage atheism it must first address the scientific illiteracy in its own house. For the greatest danger Christianity confronts at the present moment is not incipient persecution, but increasing marginalization and irrelevance. If Christians cannot engage reasonably and responsibly with science, there will be no place for them in the public life of advanced societies.”

Reid was paying particular attention to Ken Ham in this blog, but the principle remains the same. Scientifically illiterate Christians quickly lose credibility with people. We can’t meaningfully engage with a person who has a rudimentary understanding of biology by proudly tell them that we create new genes with the power of thought. That makes us sound like a male model.

For the sake of other Christians health and well-being, and for the sake of our credibility and our witness, we need to critically assess Dr Leaf’s work, not promote it as another gospel.

Mobile phone mothering – one more thing for mums to feel unnecessarily guilty about

Posted on January 9, 2016 by cedwardpitt

Mothers. They are probably the single most important group of people in the world.

It’s not that I’m belittling the role of fatherhood, or demeaning the amazing work that fathers do for their children, but simply put, we wouldn’t be here if it wasn’t for the tireless patience and sacrifice of our mums. Nine months of nausea, sore breasts, swollen appendages and having your organs used as punching bags. Then there’s the trauma of birth itself, which is rewarded with the full-time care of a screaming, incessantly ravenous alimentary canal which has taken the form of a baby. Over the years, the screaming and the pooping become slightly more manageable, but most mothers remain the head chef, playmate, laundromat, ironing lady, teacher, taxi-driver, nurse and drill sergeant for their offspring.

Despite these daily feats of amazement, most mothers are haunted by this nagging sense of not being good enough – Mother Guilt. As author Mia Redrick wrote,

“Mother’s guilt is real. Nearly all of us experience it. We are racked with guilt, feeling that our best isn’t good enough. We struggle when work commitments prevent us from attending school events and we are crushed by the looks of disappointment on our children’s faces. We wonder if choices we have made, such as what school to send our kids to, have not had far-reaching negative consequences, if a different path would have resulted in happier, more well-adjusted kids. We moms might feel guilty when we can’t afford something for our kids or are nagged by the feeling that we simply don’t spend enough time with them.”

Mothers seems to feel guilty about anything, and everything, for the whole day …

“The kids are in the bed again. I was sure I shushed them back to their beds at 2am, they must have snuck in during the wee hours. Tonight I will make sure they sleep all night in their own beds. How will they ever learn to sleep if I keep letting them come in to my bed?”
“Whose children get only eight hours of sleep a night? I am sure at this age they are meant to be getting 12 – 14 hours sleep. I am going to damage then for life. Maybe I should let them sleep in my bed so they get more sleep?”
“Oh so much sugar in EVERYTHING. Don’t you read the articles? Don’t you hear the “experts”? Don’t you see those diagrams with spoonful upon spoonful of the deadly substance displayed, a visual representation of poison imprinted on your mind each and every time you take the bran flakes from the cupboard?”

And so it goes on.

Today, Dr Leaf added one more thing for mothers to feel guilty about – smartphones.

“Mothers, put down your smartphones when caring for your babies! That’s the message from researchers, who have found that fragmented and chaotic maternal care can disrupt proper brain development, which can lead to emotional disorders later in life.”

She then exhorted her followers, “Lets get some real eye-to-eye contact going – dads included!”

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist. Credit where credit’s due – in the past, Dr Leaf has pathologically avoided citing her references, but today, she cited the article itself and the news story that promoted it.

But again, like the meme she posted a couple of days ago about sadness making people sick, Dr Leaf has posted the opening paragraph of a promotional PR puff piece and made it sound like a scientific pronouncement. When you actually read the journal article that the news story is promoting, it has nothing to do with smartphones. Or indeed, human beings.

The research was performed entirely on rats.

The research itself, by Molet and colleagues [1], seemed entirely legitimate. The rat pups raised in a more chaotic way appeared to have higher levels of anhedonia, because they didn’t engage as much in the things that rats normally find pleasurable, namely, drinking sugar water or playing with their rat buddies.

I’m not sure if you’ve ever seen a mother rat on a smartphone. I certainly haven’t, which means that news article Dr Leaf took her meme from, the one published on Science Direct, made some pretty tenuous assumptions:

Chaotic mothering to rat pups is the cause of rat anhedonia
Rat mothering and human mothering have similar outcomes
Smartphone use causes fragmented and chaotic maternal care
Not using smartphones would improve outcomes.

There’s no evidence from this study, or any work that I know of, that definitively proves any one of these things. There are a number of alternative explanations as to why those rat pups weren’t as happy as the control group, but even if the chaotic nurturing of the rat babies was THE cause of their unhappiness, human beings are completely different to rats in cages. And there are many things, other than smartphones, that can strain the mother-baby relationship. Excessive mother guilt for one.

Dr Leaf’s meme is a good example of just how misinformation can spread quickly through the internet. The PR department of a university writes a puff piece on the article to promote the university and its research. But no one wants to read about depressed rats – they need a better hook. There’s a love-hate relationship with smartphones in our culture, and lots of Mommy-guilt, so they use a sentence about smartphones and mothering to grab people’s attention, even though the journal article had nothing to do with either.

Science Direct then simply republished the press release from the university without filtering it, where it’s then picked up by wannabe scientists and self-titled experts like Dr Leaf, who pass on the misinformation to hundreds of thousands of their followers. Pretty soon, mothers everywhere are feeling guilty about looking at their phone instead of their children’s eyes, when it probably doesn’t make a blime bit of difference.

The take home messages:

Unless you’re a rat, there’s no evidence that using your smartphone makes you a bad mother.
Be wary of social media memes, and what you read on the internet.
Dr Leaf is hurting her own credibility by reposting the opening paragraphs of sciencey promotional PR articles instead of reading the actual article first. We need experts to reduce the amount of misinformation clogging the internet, not increase it.

References

[1] Molet J, Heins K, Zhuo X, et al. Fragmentation and high entropy of neonatal experience predict adolescent emotional outcome. Translational psychiatry 2016;6:e702.

Does sadness make you sick?

Posted on January 7, 2016 by cedwardpitt

We’ve all heard of being “homesick”, or “heartsick”, or “lovesick”. Sometimes when we’re extremely sad, we feel the knot in our stomachs, the pressure in our chests, or the confusion and distraction in our minds as the waves of sadness wash over and discombobulate us.

But can being sad really make you physically ill as well as emotionally distraught?

Dr Caroline Leaf declared today on her social media platforms that “Feeling sad can alter levels of stress-related opioids in the brain and increase levels of inflammatory proteins in the blood that are linked to increased risk of comorbid diseases including heart disease, stroke and metabolic syndrome.”

Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist. She believes that our cognitive stream of thought determines our physical and mental health, and can even influence physical matter through the power of our minds.

She also added some further interpretation to her meme: “So this is more evidence that our thoughts do count: they have major epigenetic effects on the brain and body! We need to apply the principles in the Bible and listen to the Holy Spirit – no excuses this year!”

With all due respect to Dr Leaf, the study she quotes doesn’t prove anything of the sort.

Dr Leaf’s meme is a copy and paste of the opening paragraph of a news report published by the university’s PR people to promote their faculty. This isn’t a scientific summary, it’s a hook to draw attention to an article which amounts to a PR puff piece. If Dr Leaf had read further into the article, I don’t think she would have been quite so bold in claiming what she did.

The article discussed a study by Prossin and colleagues, published in Molecular Psychiatry [1]. You can read the original study here. The study specifically measured the change in the level of the activity of the opioid neurotransmitter system and the amount of a pro-inflammatory cytokine IL-18 across two experimental mood states, and in two different groups of volunteers, people with depression, and those without.

For a start, it’s important to note that the study isn’t referring to normal day-to-day sadness. This was an experimentally induced condition in which a sad memory was rehearsed so that the same feeling could be reproduced in a scanner, and the study was looking at the effect of this sad “mood” on people who were pathologically sad, that is, people diagnosed with major depression.

It’s well known that people with depression are at a higher risk of major illnesses, such as heart attacks, strokes and diabetes [2] The current study by Prossin et al looked experimentally at one possible link in the chain, a link between a neurotransmitter system that’s thought to change with emotional states, and one of the chemical mediators of inflammation.

They found that:

> Depressed people were much sadder to start with, and remained so throughout the different conditions. The depressed people stayed sadder in the ‘neutral’ phase, and the healthy cohort couldn’t catch them in the ‘sad’ phase.
> Depressed people had a much higher level of the inflammatory marker to start with, and interestingly, this level dropped significantly with the induction of the neutral phase and the sad phase. What was also interesting was that the level of the inflammatory marker was about the same in the baseline and the sad phase for the healthy volunteers.
> A completely different pattern of neurotransmitter release was seen in the two different groups. People with depression had an increase in the neurotransmitter release over a large number of areas of the brain, whereas in the healthy controls with normal mood, the sad state actually resulted in a decreased amount of neurotransmitter release, and in a much smaller area within the brain. This suggests that the opioid neurotransmitter system in the brains of depressed people is dysfunctional.

Affect/Sadness Scores – Prossin et al Molecular psychiatry 2015 Aug 18.

IL18 v Mood state/diagnosis – Prossin et al Molecular psychiatry 2015 Aug 18.

Effectively, the results of the study reflect what’s already known – the emotional dysregulation seen in people with depression is because of an underlying problem with the brain, not the other way around. And, sadness in normal people is not associated with a significant change in the evil pro-inflammatory cytokine.

So, according to Prossin’s article,

normal sadness in normal people is not associated with physical illnesses.
sadness is abnormally processed in people who are depressed, which maybe related to an abnormal inflammatory response, which might explain the known link between depression and increased risk of illness

The article is not “more evidence that our thoughts do count.” If anything, it shows that underlying biological processes are responsible for our thoughts and emotions and their downstream effects, not the thoughts and emotions themselves.

And unfortunately, it appears that Dr Leaf hasn’t got past the opening paragraph of a puff piece article before jumping to a conclusion which only fits her worldview, not the actual science.

References

[1] Prossin AR, Koch AE, Campbell PL, Barichello T, Zalcman SS, Zubieta JK. Acute experimental changes in mood state regulate immune function in relation to central opioid neurotransmission: a model of human CNS-peripheral inflammatory interaction. Molecular psychiatry 2015 Aug 18.
[2] Clarke DM, Currie KC. Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence. Med J Aust 2009 Apr 6;190(7 Suppl):S54-60.

Dr Caroline Leaf’s war on drugs

Posted on December 12, 2015 by cedwardpitt

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

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”.

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

Posted on December 4, 2015 by cedwardpitt

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

Posted on November 13, 2015 by cedwardpitt

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

Posted on October 26, 2015 by cedwardpitt

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

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.
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.

Dr C. Edward Pitt

Faith, Hope, Love, Science.

Tag Archives: criticism

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