Neuroscientists Financially Entangled With Biotech Device Makers Produce Flawed Studies

On the week I am writing this post auto-scheduled for later publication, I am observing what so often goes on in news reporting about science: a host of science news sites mindlessly parroting the unjustified claims of a university press release.  You would think that by now our science journalists might have learned the lesson that university press releases these days are often notorious for their hype, errors and misinformation, and that the claims of such press releases should be subjected to critical scrutiny. 

The unfounded claim this week is one that at-home magnetic brain stimulation "shows promise" for treating depression. The claims come from a Kings College press release here, which is entitled "At home brain stimulation for depression found to be safe and effective." We have a discussion of a new study testing at-home head gadgets using something called transcranial direct current stimulation (tDCS),

The press release states this:

"Transcranial direct current stimulation (tDCS) is a form of self-administered, non-invasive brain stimulation that applies a weak, direct current of between 0.5 to 2 milliampere to the scalp via two electrodes. It is not electroconvulsive therapy (ECT), which delivers about 800 milliamperes to the brain causing a generalised seizure and can only be conducted under strict supervision. 

174 participants aged 18 and over, and with a diagnosis of at least moderate depression were randomly assigned to one of two treatment arms; 'active' tDCS or 'inactive' tDCS which was the same device but did not provide a current. Participants had a 10-week course of treatment, initially having five 30-minute sessions a week for the first three weeks, followed by three 30-minute sessions a week for the following seven weeks.

Researchers found that participants in the active arm of the trial showed significant improvements in the severity of their depression, as well as the overall clinical response and remission compared to those in the ‘inactive’ placebo control arm. The rates of treatment response and remission were three times higher in the active treatment arm compared to the placebo arm, where 44.9% in the active arm demonstrated a remission rate compared to 21.8% of the control group."

A study like this attempts to follow the conventions of randomized controlled trials (RCT) using placebos.  In such studies patients are randomly assigned to either a medication group or a placebo group. Typically the medication group gets some medicine being tested, and the placebo group gets only a similar-looking placebo pill that is something like a sugar pill that looks just like the real medicine. The patient does not know which group he belongs to, and does not know  whether the pill he is being given is just a placebo sugar pill. Such a lack of knowledge is called an example of blinding. Such a randomized control trial attempts to see some medical outcome in the group getting the real medication that is superior to the medical outcome reported in the placebo group. When both a doctor or scientist and the patient are unaware (for at least part of the time)  whether particular patients belong to the get-the-real-treatment group or the placebo control group, such a study is called a "double-blind" study. 

The press release quoted above refers to the study here, entitled "Home-based transcranial direct current stimulation treatment for major depressive disorder: a fully remote phase 2 randomized sham-controlled trial." The study claims to have been a double-blind study, saying that it was a "fully remote, multisite, double-blind, placebo-controlled, randomized superiority trial."  But the claim about being double-blind is not correct. The patients who were supposed to be blind as to whether or not they were getting the real magnetic stimulation were  not really blind about such a thing. 

The failure of the blinding protocol to achieve real blindness (a lack of knowledge by subjects about whether they were receiving the real treatment) is shown by the section of the paper entitled "Analysis of study blinding and unblinding." There we read this:

"Before unblinding at week 10 (end of trial), participants were asked to guess whether they thought they were receiving the active or sham tDCS device and their level of certainty, rating from ‘1’ for ‘very uncertain’ to ‘5’ for to ‘very certain’. A guess of active tDCS was made by 77.6% in the active treatment arm and 59.3% in the sham treatment arm; the difference was significant (P = 0.01)."

This is a very big difference. 77% of the people getting the real treatment thought they were getting the real treatment, but only 59% of the people in the "no treatment" placebo group thought they were getting the real treatment.  This indicates a very major effect in which the people getting the real treatment were much more likely to think that they were getting the real treatment than those not getting the real treatment. In a randomized control trial that achieves an effective level of blinding, there will be no difference between the percentage of real-treatment subjects and placebo or sham treatment subjects who thought they were getting the real treatment. 

Analyzing the paper, it's easy to see why patients who were not getting the real treatment would have been been better able to figure out whether they were getting the real treatment. We read this:

"Active stimulation consisted of 2 mA direct current stimulation for 30 min with gradual ramp up over 120 s at the start and ramp down over 15 s at end of the session. Sham stimulation with the same device and app was used to resemble the active intervention and to receive the treatment schedule. An initial ramp up from 0 to 1 mA over 30 s then ramp down to 0 mA over 15 s was repeated at the end of the session to cause a tingling sensation that mimics active stimulation."

So the people getting the real treatment got 30 minutes of real direct current stimulation of their head, but the people getting the sham or placebo treatment got only about 30 seconds of real direct current stimulation. Such a big difference helps explains why a much higher percentage of those getting the real treatment thought they were getting the real treatment. 

That much higher percentage is enough to explain the difference in the reported relief of depression symptoms, even while assuming that the head device had zero real effectiveness in treating depression. Being much more likely to think that they had got some possibly effective  real brain zapping effect, the people in the real treatment group were much more likely to get a placebo effect that was largely the power of suggestion. Similarly, assign two groups of patients sugar-pill placebos, telling the first group that the pill is a powerful anti-depressant, and the second that the pill is just a vitamin, then the first group will probably report significant improvement in their depression, because of placebo effects and the power of suggestion. 

Nowadays biotech companies may have a very large incentive to fund and/or promote poorly designed and executed brain research, particularly whenever such research helps to promote some device that such companies sell. Biotech companies include very many companies such as the manufacturers of MRI devices, the manufacturers of EEG equipment, the manufacturers of implantable medical devices, and the manufacturers of noninvasive brain-related devices that a person may put on his head. The biotech industry is a trillion-dollar industry, and many billions of that involves brain-related products. 

Neuroscientists these days are thoroughly entangled with pharmaceutical companies and the manufacturers of biotech devices. The entanglement casts great doubt on the objectivity of any such scientists doing studies relating to the effectiveness of any brain-related medicine or any brain-related medical device. These entanglements and their pernicious effects on the objectivity of neuroscientists is discussed in my post "How the Academia-Cyberspace-Pharmaceutical-Biotech-Publishing Complex Incentivizes Bad Brain Research," which you can read here. 

The diagram below illustrates some of the entanglements and conflicts of interest going on:

Whenever you read a science paper that seems to promote some medicine or medical device, it is always a good idea to study the "Competing Interests" section of the paper, in which scientists are supposed to reveal possible conflicts of interest that may have affected their objectivity. When you examine that "Competing Interests" section of the paper being discussed, all kinds of alarm bells should go off. Here it is:

"C.H.Y.F. reports the following competing interests: research grant funding on behalf of the University of East London from Flow Neuroscience (no. R102696); research grant funding from NIMH (no. R01MH134236), the Baszucki Brain Research Fund Milken Institute (no. BD0000009), the Rosetrees Trust (no. CF20212104), the International Psychoanalytic Society (no. 158102845), the MRC (no. G0802594), NARSAD and the Wellcome Trust. She is Associate Editor of Psychoradiology and Section Editor of the Brain Research Bulletin. A.H.Y. reports the following competing interests: paid lectures and advisory boards for the following companies with therapies used in affective and related disorders: Flow Neuroscience, Novartis, Roche, Janssen, Takeda, Noema Pharma, Compass, AstraZeneca, Boehringer Ingelheim, Eli Lilly, LivaNova, Lundbeck, Sunovion, Servier, LivaNova, Janssen, Allegan, Bionomics, Sumitomo Dainippon Pharma, Sage, Novartis and Neurocentrx. He is principal investigator for the following studies: the Restore-Life VNS registry study funded by LivaNova; ESKETINTRD3004: ‘An Open-label, Long-term, Safety and Efficacy Study of Intranasal Esketamine in Treatment-resistant Depression’; The Effects of Psilocybin on Cognitive Function in Healthy Participants; The Safety and Efficacy of Psilocybin in Participants with Treatment-Resistant Depression (P-TRD); A Double-Blind, Randomized, Parallel-Group Study with Quetiapine Extended Release as Comparator to Evaluate the Efficacy and Safety of Seltorexant 20 mg as Adjunctive Therapy to Antidepressants in Adult and Elderly Patients with Major Depressive Disorder with Insomnia Symptoms Who Have Responded Inadequately to Antidepressant Therapy (Janssen); An Open-label, Long-term, Safety and Efficacy Study of Aticaprant as Adjunctive Therapy in Adult and Elderly Participants with Major Depressive Disorder (MDD) (Janssen); A Randomized, Double-blind, Multicentre, Parallel-group, Placebo-controlled Study to Evaluate the Efficacy, Safety, and Tolerability of Aticaprant 10 mg as Adjunctive Therapy in Adult Participants with Major Depressive Disorder (MDD) with Moderate-to-severe Anhedonia and Inadequate Response to Current Antidepressant Therapy; A Study of Disease Characteristics and Real-life Standard of Care Effectiveness in Patients with Major Depressive Disorder (MDD) With Anhedonia and Inadequate Response to Current Antidepressant Therapy Including an SSRI or SNR (Janssen). He is UK Chief Investigator for the following studies: Novartis MDD study no. MIJ821A12201; Compass; and the COMP006 and COMP007 studies. Grant funding (past and present) includes: NIMH (USA); CIHR (Canada); NARSAD (USA); the Stanley Medical Research Institute (USA); MRC (UK); the Wellcome Trust (UK); the Royal College of Physicians of Edinburgh; the British Medical Association (UK); the VGH & UBC Foundation (Canada); WEDC (Canada); the CCS Depression Research Fund (Canada); the Michael Smith Foundation for Health Research (Canada); NIHR (UK). Janssen (UK) and EU Horizon 2020. He is the Editor of the Journal of Psychopharmacology and Deputy Editor of BJPsych Open. He has no shareholdings in pharmaceutical companies. S.S. reports the following competing interests: research grant funding on behalf of the University of Texas Health Science Center at Houston from Flow Neuroscience; paid advisory boards for the following companies: Worldwide Clinical Trials and Inversago; and Vicore Pharma. He is a full-time employee of Intra-Cellular Therapies. He has received grants and research support from NIMH (USA) (no. 1R21MH119441-01A1), NIMH (no. 1R21MH129888-01A1), NICHD (no. 1R21HD106779-01A1), SAMHSA (no. 6H79FG000470-01M003) and Fizer foundation. He has received research funding as a principal investigator or study/subinvestigator from or participated as consultant/speaker for Flow Neuroscience, COMPASS Pathways, LivaNova, Janssen, Relmada and the Psychiatry Education Forum. Intra-Cellular Therapies or National Institutes of Health (NIH) or SAMHSA or any other organizations had no role in study design and conduct; the collection, management, analysis and interpretation of the data; the preparation, review or approval of the manuscript; and the decision to submit the manuscript for publication. The study’s content is solely the responsibility of the authors and does not necessarily represent the official views of the Intra-Cellular Therapies or NIH or SAMHSA. R.M-V. has received consulting fees from Eurofarma Pharmaceuticals, Abbott and BioStrategies group; has research contracts with Boerhinger Ingelheim and Janssen Pharmaceuticals; and has received speaker fees from Otsuka, EMS and Cristalia. He is a member of the scientific boards of Symbinas Pharmaceuticals and Allergan. He is also the principal investigator for the following grants: NIH (nos. R21HD106779 and R21MH129888), Milken Institute (no. BD-0000000081). D.M. and L.H. work for Biomedical Statistical Consulting; they provide statistical support to MCRA and received payments from Flow Neuroscience. A.-R.G.-N., G.S., H.H., J.C.S., M.R., N.L., P.J.L., P.O., R.D.W. and S.S.K. declare no competing interests."

What is this Flow Neuroscience we keep hearing about? It is a manufacturer of a head-zapping device marketed as an aid for depression -- exactly the type of device being promoted by this poorly designed and unconvincing study. We should not expect scientists taking lots of money from some manufacturer to produce unbiased studies evaluating a device of such a manufacturer. 

Under the assumptions of materialism, the idea that you could improve your health by zapping your brain with electricity or magnetism makes no sense. Under the assumptions of materialists, we might expect that zapping your brain might disrupt the "delicate brain mechanism of memory storage" that materialists believe in.  Luckily such devices probably don't harm your memories, because such memories  are not actually stored in your brain.  It is ironic for neuroscientists to be promoting devices doing brain-zapping that make no sense under the assumptions of such neuroscientists.  Maybe when they promote such devices, somehow they are recalling the utter failure of neuroscientists to present a credible theory of brain memory storage or brain instant recall, and the utter failure of neuroscientists to find any trace of learned human knowledge by microscopic examination of brain tissue. 

They are "in bed with each other"

Postscript: A slightly different method uses alternate current rather than direct current, and is called Transcranial Alternate Current Stimulation or tACS.  A year 2025 review paper states, " Overall, tACS has minimal impact on working memory improvement, but it shows potential under certain conditions. "

How the Academia-Cyberspace-Pharmaceutical-Biotech-Publishing Complex Incentivizes Bad Brain Research

Countless times on this blog, I have discussed poor quality research about brains. An interesting question to ponder is: why is there so much bad research done about brains? Why do we see so many studies guilty of Questionable Research Practices such as way-too-small study group sizes and a lack of blinding protocols? Why do many scientific papers make claims about their observations that are not justified by any observations reported in the paper? Why do we have so many misleading stories in the press claiming that some brain research showed something that it did not actually show?

In my previous post "Why the Academia Cyberspace Profit Complex Keeps Giving Misleading Brain Research" I made a fairly good start at answering such questions. I identified a social network I called the academia cyberspace profit complex, and I explained some of the reasons why that complex incentivizes poor quality but interesting-sounding brain research.  Among the factors I identified were these:

• Professors tend to be judged these days by the "easy-to-quantify" metrics of the number of papers they have written or co-written, and the number of citations such papers get, rather than a "hard-to-quantify" metric of  the quality of the research procedures they followed. 
• The more "quick and dirty" studies scientists publish (studies that are relatively easy to produce, but do not involve very high standards of research quality), the higher a "papers published count" a scientist will have. 
• Scientific journals these days have a high bias called "publication bias," a tendency to prefer to publish papers reporting some supposed "positive effect" supposedly involving some causal relation rather than a null result reporting no such causal relation. 
• The more interesting-sounding or important-sounding a paper may be, the greater the likelihood that it will be cited by other scientists, and the higher the "citation count" of the scientist authors will be. 
• The desire to produce interesting-sounding or important-sounding papers reporting "positive effects" rather than null results tends to bias the way papers are written and the way studies are designed and performed, creating an incentive for study designs likely to end up with some "positive result" rather than a null result.  Among the resulting effects is often "cherry picking" of data, so that the paper ends up with a "publishable" positive effect rather than a null result.
• Once a study has been published in a scientific journal, it is announced to the public by means of a university press release or college press release. Nowadays university press offices are notorious for their hype and exaggeration, and routinely make interesting-sounding claims about new research that are not justified by the observations in the scientific paper being announced.  An abundance of such hype helps to glorify universities, keep them in the public's eyes, and helps to justify the very high tuition rates of universities. Misstatements in press releases come both from press office copywriters who are encouraged to glorify and hype new research, but also from scientists quoted in the press releases, who often make unwarranted or false claims about their own research, in an effort to maximize the attention such research will get. 
• There is nowadays an extremely large cyberspace industry that has an incentive to uncritically parrot university press releases, and an additional incentive to further exaggerate and hype the results reported by such press releases.  The incentive comes in the form of web pages containing ads that generate revenue for the owners of web pages.  So we see an enormous "clickbait" effect, in which sensational-sounding headlines appear on web pages, with the headlines being hyperlinks that take the reader to a page filled with ads.  Every time a page with such ads is viewed, money is generated for the owner of the web site.  The "clickbait" headlines often take you to pages discussing research that never justifies the sensational clickbait headline. For example, you may see on some web page a headline "Scientists Make Giant Leap in Understanding Memory." Clicking on that headline will typically take you to some story about merely another very poorly designed study using mice, something that is no actual progress in understanding memory. 
• "Quick and dirty" scientific research helps science journalists fill their quotas of science stories. Knowing that web sites prefer to publish stories with sensational-sounding headlines, science journalists are incentivized to "go with the hype" rather than critically discussing poorly designed research. 
• The increase in "papers published" counts and citation counts resulting from "quick and dirty" research helps scientists meet paper count quotas and citation quotas that may be informally required for their promotion or advancement, and increases their chances of getting profit from things such as book deals and consulting contracts. 

My previous post discussed many of the factors that incentivize poorly designed and executed scientific research. But I left out a discussion of several very important additional factors:

• Nowadays pharmaceutical companies may have a very large incentive to fund and/or promote poorly designed and executed brain research, particularly whenever such research helps to promote some pill that such companies sell. The mental health  pharmaceutical industry is estimated to be a 36 billion dollar industry. 
• Nowadays biotech companies may have a very large incentive to fund and/or promote poorly designed and executed brain research, particularly whenever such research helps to promote some device that such companies sell. Biotech companies include very many companies such as the manufacturers of MRI devices, the manufacturers of EEG equipment, the manufacturers of implantable medical devices, and the manufacturers of noninvasive brain-related devices that a person may put on his head. The biotech industry is a trillion-dollar industry, and many billions of that involves brain-related products. 
• Nowadays the publishers of scientific papers have a very large incentive to publish poorly designed and executed brain research, simply because a profusion of such "quick and dirty" papers means more available newly written papers that can be published. The more papers published, the more journals can be published, and the more journal subscription fees can be charged.  According to one site, "The worldwide revenue from academic publishing stands at over $19 billion per year," and that "out of this figure, over 50% is attributed to 5 major publishing companies – Elsevier, John Wiley & Sons, Taylor & Francis, Springer Nature, and SAGE."
• Scientists doing brain research often have conflicts of interest, such as the ownership of shares of corporations that may increase in value if the research reports a particular type of result, or something like a relationship in which the scientists get consulting fees from some corporation whose fate may be affected by the research they are doing. 
• Nowadays much of brain-related research is funded largely or mainly by private corporations interested in having the research find some particular result. 
• The relationship between private industry and brain-related research is so strong that many scientific papers are essentially "ghost written" by anonymous employees of corporations standing to benefit if the research reports a particular result. 

To diagram these complex relations and financial motivations, I must present a diagram much larger than the relation diagram that I presented in my earlier post. The revised diagram is below:

The diagram shows a complex stream of profits that results from scientists starting out by doing "quick and dirty" poorly designed research.  The result is a set of winners and losers.  

The Winners

These are the winners from "quick and dirty" brain-related research:

• The scientists who get some additional paper with their name on it to increase their "papers published" count, and also may get some more of the highly coveted paper citations. Many of these scientists are heavy investors in pharmaceutical companies or biotech companies (or recipients of income from such sources), and indirectly profit when such companies profit in the ways described below. 
• The universities who can announce important-sounding research by some exaggerating press release, thereby helping to maintain their prominent public profile, and their reputation as a center of "cutting edge" research. 
• The science journalists who get some new sensational-sounding press release that they can use as the basis for some interesting-sounding article that will help them fill their quota of articles written. 
• The owners of web pages that will announce the results using clickbait headlines leading to pages containing ads that generate money for the people running the web sites. 
• The pharmaceutical companies that may benefit when a specific product of theirs is favorably mentioned by the new scientific paper, and who also in general benefit when literature keeps people thinking that brains are the source of our minds and our mental problems, and keeps people thinking that the way to solve psychological problems is by taking pills. 
• The biotech device  companies that may benefit when a specific product of theirs is favorably mentioned by the new scientific paper, and who also in general benefit when literature keeps people thinking that brains are the source of our minds and our mental problems, and keeps people thinking that brain-related devices can help solve mental problems or mood problems. 
• The publishers of expensive scientific journals, who can meet their monthly quotas of papers to be published (for such publishers it is financially better for there to be written in any month 800 poorly-written papers describing poorly designed papers and 200 well-written papers describing well-designed papers, than for there to be written in the same month 100 poorly-written papers describing poorly designed papers and 300 well-written papers describing well-designed papers).

The Losers

These are the losers from "quick and dirty" brain-related research:

• All the people in the general public, who keep being misled by "science news" headlines giving them the wrong idea about the source of their minds and the storage place of their memories, and who keep reading research reports which give them the wrong idea that they are mere brains rather than souls, minds or spirits. The resulting psychological, moral and spiritual harm is enormous but incalculable. 
• Very many people with psychological problems or emotional problems or learning problems who are given the wrong idea that the way to help such problems is by fiddling with brains or brain chemistry, rather than by improving education techniques and educational literature, improving access to education and counseling,  improving social conditions, improving social justice, improving family relations or improving worldviews and positive attitudes about selves by properly educating people so that they learn about the most important facts and observations related to who they are and how they got here. 

In a classic essay, the distinguished military officer Smedley Butler stated this: "War is a racket...It is conducted for the benefit of the very few, at the expense of the very many." It is true to say exactly that about junk science research.  The production of such research is a racket, for the benefit of the few beneficiaries listed above, at the expense of everyone else. 

Long story short, if you want to know why so much junk research gets published about brains, follow the money and ponder who profits. But it would be an oversimplification to suggest that financial interests and career advancement offers a full explanation for why we see so much bad brain-related research and so much bad reporting about such research. Another important factor is that poorly-designed, poorly-executed and poorly-described research relating to brains helps to provide what can be regarded as belief system justification. We should not forget that those behind such research are members of a belief community with cherished dogmas that they keep claiming are facts but which are very much unproven, such as the dogma that your brain produces your mind and thinking, and the dogma that your brain stores your beliefs and memories.  Members of such a community get a non-financial mental reward whenever there appears research which they can claim as evidence their beliefs are correct. In cases when unfounded beliefs are held and cherished,  poorly-designed poorly-executed and inaccurately-described research can provide a comforting feeling of assurance that well-designed well-executed and accurately-described research might never be able to provide. 

Pharmaceutical Company Entanglements Cloud the Objectivity of Neuroscientists and Psychiatrists

One of the biggest mistakes that people make considering the conclusions of an expert is to imagine the expert as some objective, disinterested person weighing truth like some impartial judge or impartial jury.  There are all kinds of reasons why an expert may have "skin in the game" so that he is more like a juror who was bribed to reach a particular conclusion. The largest reason why experts lack impartiality is that they tend to be members of expert communities in which particular opinions are expected because of belief and behavior traditions and speech customs in such communities. 

Let's imagine the difference between two experts, Joe and Jack. Existing outside of a community and using his own savings for funding, Joe spends years studying some subject, enough time to become an expert on that topic. But Joe gets no paycheck related to his activity, and no funding from any group tending to encourage him to think in some particular way. Now Joe will tend to reach opinions on the area of his expertise that are impartial and unbiased.  Not dependent on any kind of funding, Joe knows that he can state whatever opinions he wants on his topic of expertise without fear of a negative financial impact. Joe knows he will never face some kind of performance review or committee hearing in which he will be judged by how well he conforms to the belief customs of some community of experts. In this regard I bear some resemblance to Joe, as I have never taken a cent from anyone except for government agencies (for example, things like tax refunds) and employers that paid me long ago for work such as computer programming work. 

Conversely, Jack becomes an expert in a way that leaves him very much an "organization man." Making a big financial investment in graduate school tuition, Jack studies to be a neuroscientist. His progress in getting his Master's Degree and PhD will depend on how well he conforms with the belief customs of neuroscientists who are teaching him. He can't write a PhD thesis defying the dogmas of such people, unless he wants to take a huge gamble. Then, after getting his PhD, Jack faces a long climb up a career ladder stretching from newly minted PhD to postdoctoral research associate to lecturer/assistant professor to reader/associate professor to full professor. His progress up each step will depend on his conformity to the belief customs and speech traditions of his fellow neuroscientists. At each step there are academic committees who reward conformity and punish nonconformity. So how can Jack possibly think of himself as some kind of unbiased judge on matters such as the capabilities of the human brain?  Throughout his ivory-tower odyssey, Jack will be more like a bribed juror than an impartial judge, because Jack will have more and more of a vested interest in conforming to the speech customs of his peers and superiors. 

There's another way in which the objectivity of neuroscientists is tainted: the fact that they need to get research funding that is abundantly available to neuroscientists conforming to neuroscientist speech customs, but scarcely available to those defying such customs.  Where does most neuroscience funding come from? In the paper "Financial Anatomy of Neuroscience Research,"  we read that "pharmaceutical industry and the largest biotechnology and medical device firms accounted for 58% of total funding." What kind of funding would such players fund? Only research based on assumptions that our brains are the source of our minds and the storage place of our memories.  

As for psychiatrists, they are up-to-their necks in pharmaceutical company entanglements. Pharmaceutical companies bombard psychiatrists with literature claiming that certain categories of mental distress can be treated with particular pills. The psychiatrist constantly given such claims will have a temptation to (a) categorize patients in some category corresponding to an available pill, and (b) prescribe such a pill. Often this may involve buying into some underlying assumption that is dubious or controversial. 

Consider the case of major depression. Strongly encouraged by pharmaceutical companies, psychiatrists and neuroscientists for decades pushed a very dubious claim that depression was caused by a brain chemistry imbalance such as a serotonin shortage.  There was never any very good evidence for such a claim. A study analyzing more than 1800 patients who had been brain-scanned stated, "We provide a large-scale, multimodal analysis of univariate biological differences between MDD [major depressive disorder] patients and controls and show that even under near-ideal conditions and for maximum biological differences, deviations are remarkably small, and similarity dominates." 

An article by Bruce E. Levine cites some reasons for thinking the pharmaceutical companies' "yes-men" psychiatrists have failed:

"In 2011, Thomas Insel, director of the National Institute of Mental Health (NIMH) from 2002-2015, acknowledged: 'Whatever we’ve been doing for five de­cades, it ain’t working. When I look at the numbers—the number of sui­cides, the number of disabilities, the mortality data—it’s abysmal, and it’s not getting any better.' In 2017, Insel told Wired: 'I spent 13 years at NIMH really pushing on the neuroscience and genetics of mental disorders, and when I look back on that I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness.' In 2021, New York Times reporter Benedict Carey, after covering psychiatry for twenty years, concluded that psychiatry had done 'little to improve the lives of the millions of people living with persistent mental distress. Almost every measure of our collective mental health—rates of suicide, anxiety, depression, addiction deaths, psychiatric prescription use—went the wrong direc­tion, even as access to services expanded greatly' ... In 2022, CBS reported: “Depression is Not Caused by Low Levels of Serotonin, New Study Suggests.” Receiving widespread attention in the mainstream media was the July 2022 research review article 'The Serotonin Theory of Depression: A Systematic Umbrella Review of the Evidence,' published in the journal Molecular Psychiatry. In it, Joanna Moncrieff, co-chairperson of the Critical Psychiatry Network, and her co-researchers examined hundreds of different types of studies that attempted to detect a relationship between depression and serotonin, and concluded that there is no evidence of a link between low levels of serotonin and depression, stating: 'We suggest it is time to acknowledge that the serotonin theory of depression is not empirically substantiated.' "

In a recent paper a neuroscientist seems to confess the lack of evidence for assumptions that mental illness is caused by brain abnormalities, stating this:

"Yet, despite three decades of intense neuroimaging research, we still lack a neurobiological account for any psychiatric condition. Likewise, functional neuroimaging plays no role in clinical decision making." 

Dubious claims of a neurological cause for problems such as depression and anxiety divert people from focusing on the life history causes and social injustice causes and social influence causes of such problems, such as people being poorly treated by others now and in their past,  people being homeless or in poverty largely because of unfair social structures and laws that benefit the rich, people living under threats such as nuclear war, and people living in a society in which materialist professors seem hell-bent on depicting humans as mere accidents of nature or mere epiphenomena of brain chemistry rather than souls who are meaningful participants in some grand divine plan. Acting against all of the evidence, which suggests in a very loud voice that we are physically enormously purposeful arrangements of matter in a purposeful fine-tuned universe, with minds that cannot be explained by such arrangements of matter, our materialist professors act as if they were trying as hard as they could to depict us in the most depressing way, as meaningless accidental animals; and then they think to themselves,  "Why are so many people so depressed? It must be their brain chemistry." 

Many complain about the arbitrary categories of the "Bible of psychiatry," the DSM, a text that displays a great number of cultural conventions that seem to lack scientific objectivity. Complaining that there is no objective physical test for almost all psychiatric diagnoses (something comparable to a COVID-19 test), the author of a book about misdiagnoses states this:

"DSM diagnoses, they're lists of symptoms created by mental health professionals sitting around a table. They're based on opinions and theories, not hard data, and published in a book. That's all they are. The real danger is that we believe they're something other than what they are."  

Who are the experts who create and update this DSM "diagnosis bible" of psychiatrists? Experts often under heavy influence by pharmaceutical companies. The DSM often tells a dubious tale that is music to the ears of some pharmaceutical company executives, who cross their fingers while wishing that the experts will keep saying that Condition X is objective reality, when the company makes Pill Y claimed to help with Condition X.  Although it does not recommend specific medications, the DSM manual ends up indirectly being a goldmine for the pharmaceutical companies, who return the favor by shoveling money towards the writers of the DSM manual, in forms such as research grants. The pharmaceutical companies profit because they make drugs they claim are treatment for specific conditions listed in the DSM. 

The DSM manual often contains diagnoses that seem like arbitrary social constructs of a psychiatrist belief community or committee, such as describing an alleged disorder called "Social (Pragmatic) Communication Disorder," which the manual characterizes by using vague, wooly terms such as "deficits in using communications for social purposes" and "difficulties following rules for conversation and storytelling, such as taking turns in conversation." On many pages the DSM manual seems to end up medicalizing and pathologizing nonconformity, and on such pages the DSM manual sounds more like something written by some Ministry of Social Conformity rather than something inspired by hard science.