Monday, June 6, 2022

The Effects of Mothers with a History of Depression on Their Offspring

Judith Morgan, Ph.D.

University of Pittsburg 

As my readers surely know, the nature-nurture debate in science continues unabated. Especially in psychiatry. When it comes to certain repetitive emotional reactions shown by a given individual, many in the field prefer to believe that the individual was just born that way. The truth, as described in Robert Sopolsky excellent book Behave,  is that we have hundreds or even thousands of genes that make certain behaviors either a little more or a little less likely. No complex human behavior is determined entirely by a gene or group of genes. We are also strongly programmed to tend to react in certain ways to the behavior of our kin group, although we can still make the difficult choice not to once we reach a certain age.

There is without a doubt a strong genetic component to true brain diseases like Major Depressive Disorder or schizophrenia, but the situation for other emotional reaction patterns is that they, IMO, are far more affected by the family environment than by any specific genes.

Some studies sure do point in this direction. For example, in a recent study published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, Judith Morgan, Ph.D., recruited 49 children aged six to eight without a history of psychiatric illness. Half the kids' mothers had a history of clinical depression, and half had no psychiatric history. To measure reward-related brain activity, children played a video game in which they guessed which of two doors contained a hidden token while they underwent functional magnetic resonance imaging (fMRI).

Depression may disrupt parents' capacity for emotional socialization, a process by which kids learn from their parents' reactions to their emotional responses. Positive socialization responses include acknowledgment, imitation, and elaboration, whereas negative or emotionally dampening parental responses may be dismissive, invalidating, or punitive.

Mothers participating in the study completed an extensive questionnaire designed to measure parental emotional socialization by presenting a dozen situational vignettes of children's displays of positive emotions and collecting parents' reactions to them. Children with a maternal history of depression were more likely to have reduced reward-related activity in a part of their brains that handles this, but only if their mothers reported less enthusiastic and more dampening responses to their children's positive emotions, the researchers found.

"In our study, mothers' own history of depression by itself was not related to altered brain responses to reward in early school-age children," said Dr. Morgan. "Instead, this history had an influence on children's brain responses only in combination with mothers' parenting behavior, such as the ability to acknowledge, imitate, or elaborate on their child's positive emotions."

Tuesday, May 10, 2022

Family Roles: A Form of Method Acting


When I was teaching psychotherapy techniques to psychiatry residents and psychology interns, one piece of advice I gave them ran counter to the advice most frequently given by other supervisors. I told them, when doing therapy with patients with personality disorders, to pay more attention to the words that the patient/client verbalizes than to their non-verbal expressions and body language. 

In general, body language is in fact usually more important than what a person says in determining how they really feel or what they really believe. This is true because, biologically, non-verbal communication evolved in our species long before language did, and became a more primal representation of what is going on inside of us.


So why do I give trainees the opposite advice? The fact that non-verbal behavior conveys more and more accurate information to another person than verbal behavior is precisely the point. People who have personality disorders are playing roles in their family. In a sense, they are acting! These people have developed a false self or persona that is one of the various roles I have described in prior posts – savior, avenger, go-between, spoiler, defective, loser, monster, covert caretaker, etc. In order to do this most effectively, one has to be a good actor, and therefore hide one’s true self – one’s actual beliefs and feelings which are not part of the act! Because role players have to be convincing, they are purposely giving off the wrong impression with their body language. How do they know to do that? Probably through trial and error.


Why do they become such good method actors? The simple explanation is that for them, playing the role as well as possible seems to be nearly a matter of life or death. Not playing the role leads to a form of existential terror called groundlessness. A person nonetheless does have the power to go ahead and exhibit their true selves in spite of this, but in dysfunctional families, doing so is terrifying. One of the things I learned in dealing with spoilers (borderline personality disorder) is that, whenever they feel that what they are doing is not working, that is when they start to self injure (cutting and burning themselves).

So what about their verbal behavior? Shouldn’t that also be misleading for the same reasons? Well yes it is. But there is a peculiarity of language that leads to my second piece of advice to beginning therapists: whenever patients say something that is a little ambiguous – when there is more than one way to interpret it – I tell them to at least think about the less obvious one. This is also the secret to solving the New York Times Sunday crossword puzzle, in which a lot of the clues can be interpreted in a bunch of different ways to throw solvers off.

For example, the mother of a nurse yelled at her, “I can’t believe you talk to doctors that way!” The nurse was far more outspoken than most people in her situation and often surprisingly got away with it. Of course, the nurse interpreted the mother’s remark as a criticism because of her tone of voice. But the words themselves contain no value judgment at all! I think the mother actually admired her daughter for being outspoken because she couldn’t be herself, but could not admit it. 

I also think the nurse knew that because she was in fact acting out successfully in that regard, and the mother was vicariously living through her. The reason the nurse got upset when Mom yelled at her was because the mother was now seemingly upset with her for doing the very thing that the mother seemed to want her to do in the first place. The ambiguity in the words Mom chose can give clues as to what Mom's real feelings are.

Thursday, April 14, 2022

Are People with Borderline Personality Disorders Defective at Reading Others, Or Superior?

One of the current theories about what creates borderline personality disorder is that somehow they are defective in their ability to mentalize, or have an accurate “theory of mind.” This means they do a poor job of figuring out what is going on in the heads of other people. In studies, this is mostly found on tests where they are supposed to read faces or interpret videos of people in various activities. 

I always thought this idea was very amusing in light of the fact that, in my extensive experience speaking with other therapists as well as in my own experiences, these very same people are so good at drawing three particular responses from therapists: a sense of anxious guilt, anxious helplessness, or fury. They are so good at it that they make most therapists hate them. They can ascertain the therapist’s weak points, and then go right for the jugular. How can they be bad mentalizers if they can do that?

When you live in an unstable, confusing environment in which double messages are flying back and forth and you can’t really predict what mood a parent is going to be in when they drop in on you, you become better at reading others than most people so you can quickly adjust to any new contingencies. And as I have repeatedly pointed out, error management theory would predict that you would err on the over-reacting rather than under-reacting, because the consequences of minimizing parental guilt and hostility are so frightful. This normal tendency is then mistakenly seen as something pathological.

Another big issue in research in personality disorders that bears upon this issue is that when patients are in studies responding to various stimuli in the study situation, they may be responding with a false self or persona (as described by psychoanalysts Jung and Winnecott)—in this case, the spoiler. This is, as my readers know, a role I believe they are playing to maintain smooth family functioning (family homeostasis). This makes them look impaired when in fact they are not. Performance is not the same as ability, as I described in a previous post. If you are not a good actor in situations in which fooling people is paramount, you wouldn’t be very good at doing so.

And to effectively play the role of spoiler, you have to make yourself to be way more impaired than you actually are. In particular, you have to pretend that you lack the ability to see both the good and bad in people simultaneously (so-called “splitting”), or evaluate both their strengths belied by their reputation among therapists for being master manipulators!! Deficient mentalization, huh?

One new study (Bora, “A meta-analysis of theory of mind and 'mentalization' in borderline personality disorder: a true neuro-social-cognitive or  meta-social-cognitive impairment?, Psychological Medicine. 51(15):2541-2551, 2021 11). of so-called mentalization “abnormalities” was based on a review of the existing literature. The author just assumes that what the studies see is “maladaptive” and therefore abnormal, but found no evidence of any primary neuro-social cognitive deficit! Hardly surprising in light of what I just wrote about. Instead, the author attributes the imaginary abnormality to their “meta-social cognitive style,” whatever that is. Again, it’s as if these patients exist in some social vacuum where certain assumptions would always be completely highly adaptive for anyone who didn’t have a deficient “theory of mind.”

A second study (McLaren, V. et. al. "Hypermentalizing and Borderline Personality Disorder: a Meta-Analytic Review, American Journal of Psychotherapy 75(1): 21-31) looked at "hypermentalizing" - the tendency to overattribute mental states to other - and found it was common in a wide range of disorders rather than in borderline personality disorder in particular. 

Tuesday, March 22, 2022

Medication for Symptoms of Borderline Personality Disorder

A recent review of the literature on the use of medications in cases of people with borderline personality (BPD) disorder (“Pharmacological Treatments for Borderline Personality Disorder: A Systematic Review and Meta-Analysis.”  CNS Drugs. 35(10):1053-1067, 2021 10) concluded that “Despite the common use of pharmacotherapies for patients with BPD, the available evidence does not support the efficacy of pharmacotherapies alone to reduce the severity of BPD.” Additionally, “Second-generation antipsychotics, anticonvulsants, and antidepressants were not able to consistently reduce the severity of BPD.”

Well, duh. This is hardly surprising in light of the fact that personality disorders are primarily disorders of relationships and their subsequent effect on the mental state of participants in problematic interactions. Last I checked, medications do not fix relationships.

So are medications not indicated at all for people with this relatively common disorder? Well that’s nonsense as well, because sufferers often have other co-existing anxiety and mood syndromes (comorbid disorders) for which meds are most useful. The most common one in this population is panic disorder. One study showed that 40% of these people experienced panic attacks, but I think it’s much higher than that, at least in the patients who came to a psychiatrist like me for psychotherapy. It’s also true that rage attacks—another symptom of the disorder—are physiologically identical to panic attacks. You know, fight or flight.

I found out relatively early on that self injurious behavior like self-cutting or burning or bulimia often occurred when a patient found themselves in a hopeless bind in their families in which they felt it was imperative to do something to “fix” the situation but they felt helpless to do so. I discovered this the hard way. 

A patient would call me, often late at night, asking me what to do about something when they knew very well that I did not yet know enough about their situation to make any suggestions which would actually be helpful. If I dared to offer most anything, they immediately would know that I was full of crap. Talk about a sense of helplessness. I later figured out the best response in this situation was to say, “You don’t have to do anything right now. From what you’ve told me, this crisis will soon pass and be replaced by another crisis in short order.” Patients found this comment had a calming effect.

So what medications can reduce the chances of self injurious behavior by lowering the frequency of panic attacks? Oddly, when I first started private practice way back in 1979, a psychoanalyst (of all people) told me the secret: a combination of an antidepressant drug called an MAO inhibitor (this was before there were any Prozac-like drugs, which also fill the bill) with a long acting benzodiazepine like Clonazepam. Prescribing these worked far more quickly for reducing or even stopping self injurious behavior episodes than months of dialectical behavior therapy, and was quite effective.

Naturally, I was criticized for prescribing this combination. With MAOI’s, the patient would have to avoid certain foods and drugs which interact with these medications and cause an attack of severe high blood pressure. (Luckily with the Prozac-like SSRI’s, this is no longer an issue). “You mean you trusted these people to keep to the diet?!? I was asked. My answer, “Yes I do if they tell me they will stick to the diet.” Yes, and if they told me that, lo and behold, they did! I had only one patient take a proscribed medication, ending up in the ER, and I took him off the MAOI immediately.

“And benzo’s can be abused!” was the next attack. Yes, so can pretty much anything. Once again, if the patient agreed to take the meds as prescribed, and I prescribed an adequate dose (patients who were given sub-therapeutic doses tended to raise the dose on their own), seemed not to abuse them. I received further confirmation of this belief when states started to produce a data base of prescriptions for drugs of abuse, and I saw that my patients were only rarely getting them from another doc (in which case I immediately tapered them off the drug). Luckily, with the exception of Xanax and in methadone treatment centers, there is no large street market offering my patients benzo’s.

So are there studies that prove this combination is effective in the way I say? Well I’ve been on the lookout for such studies for decades, and there literally aren’t any! The closest that come are those that study SSRI’s by themselves in this population without the necessary augmentation. They show some very small effects on self-injury, but nothing substantial. Oddly, I asked the guy who did most of these studies if he ever considered doing the add-on one, and he looked at me as if he didn’t understand what I was talking about. He later gave a talk on BPD and chemicals (neurotransmitters) that help brain cells communicate, and he discussed several of them. Except one —GABA—which is the most important one in anxiety and the target of benzo drugs.

Verrrrry interrrresssssting.

Monday, February 28, 2022

Hidden Altruism in Repetitive Family Interactions


In a recent Dear Abby advice column from 10/26/21,  a mother who had been an addict when her daughter was young complains about the guilt trips the daughter always seems to lay on her. Abby’s interpretation as to the possible motives for the daughter’s behavior is the seemingly common-sense one that most people – and most psychotherapists for that matter - would come up with: that the daughter was acting out of selfish needs.


Being the contrarian that I am, I discovered that selfishness is often actually a cover for altruistic self-sacrifice, and that the daughter is giving mom what mom seems to need from her. The mother’s obsessive guilt and her repeatedly and nearly constantly trying to fix her daughter might very well be the reason the daughter is doing this.


Now of course, from just a paragraph description in a letter I can’t be certain of my interpretation in this particular case, and there might be several other issues operating simultaneously that might be making this situation far more complicated than my formulation would suggest. The daughters’ brothers being perceived as the favorites, which is mentioned in the letter, might be one of them. The mother may have gender issues which might conceivably be involved.  And we don’t know anything about Mom’s former behavior, let alone her family dynamics

But if we could get the truth out of these people – always an iffy proposition -  I’d be willing to bet that I am at the very least on the right track. I have put in italics the part of the letter that I think gives it away. My hypothesis would be my starting point as her therapist in trying to understand what exactly is going on, and why.


ABBY: I'm the mother of a 36-year-old daughter. She claims I treat her younger brothers better than I treat her. I am a recovering addict -- clean for 20-plus years. I was in active addiction for nine years when she was a teenager, and she has never let that go. She constantly tells me how "unfair" I am, that I never make time for her and that I don't validate her feelings. I have apologized many times and tried to show her I don't treat her siblings differently. I schedule "us" time, but this is an ongoing battle, and I'm at a loss about how to fix it. How do I show her there's no difference in the way I treat any of them? How do I reassure her that her feelings are validated? This has caused me many tearful nights. -- WANTING SERENITY BACK


In reply Abby says she thinks this mother “created an emptiness in her daughter “that the mom may not be able to fill,” and that the daughter is “punishing” the mom for her former behavior. I submit that the daughter is actually giving Mom what Mom's endless guilt seems to be begging for: More and more guilt! Mom’s obsessive apologies would then trigger this pattern again and again, leading to the daughter heaping on more and more guilt leading to more apologies and so on in a vicious circle.


Each member of the duo thinks the other one needs this interaction while discounting their own contribution to the pattern. They have to cover up their own role in order to continue playing it effectively, both for the stabilization of a parent. Mom’s history of substance abuse and neglecting children would, under this scenario, be a role she was playing for her parents.

Tuesday, February 8, 2022

Review: Everybody Lies: Big Data, New Data and What the Internet Tells us About Who We Really Are by Seth Stephens-Davidowitz


One of the big problems in both psychiatric and psychological research that I have written about extensively is the tendency of researchers to think that their subjects are usually being truthful, especially when it come to things like family dysfunction, marital maladjustment and child abuse. 

Most people who know that people often are not truthful about these matters think it’s mostly a matter of personal shame and embarrassment, whereas I think that, while that is sometimes the case, the lies are more often about protecting the reputation of their families of origin.


We of course have very little truly objective research data in these fields because:

1. We can’t read minds.

2. People are good actors, leading to falsehoods in the observations of the researchers.

3. People not only lie to others, but lie to themselves as well. This is a part of the  willful  blindness characteristic of groupthink, which we need in order to maintain group cohesion with our kin and ethnic groups. Logic evolved not to reach the truth, but to justify group norms, as Gregg Henriques has pointed out.


The author of this book states, “People lie about how many drinks they had on the way home. They lie about how often they go to the gym, how much those new shoes cost, whether they read that last book. They call in sick when they’re not…They say they’re happy when they’re in the dumps. They say they like women when they really like men…People lie to their friends. They lie to their kids. They lie to parents. They lie to doctors…They lie to themselves. And they damn sure lie to surveys.”  


Stephens-Davidowitz’s book discusses one way we can get around this. We now have "big data" which can monitor not only the internet sites we visit but the questions we have in our own minds. People have little incentive to lie in the context of a Google search because no one they know will be aware of what they are doing when they do, say, a search for lesbian sex on Pornhub. The author refers to the internet as “digital truth serum.”


He talks about how this data helps us spot patterns of human thinking and behavior as well as predict how one variable will affect another. This data contains many surprises. For example, if you check into what follows most often when you type in “it’s normal to want to kill…” the most common inquiry is “my family.” 

Human sexual behavior, predictably, is a big area for surprises. Among the top searches on Pornhub by women is sex featuring violence against women, with such searches as “extreme brutal gangbang.” On Google, there are twice as many complaints by women than by men about a lack of sex in their relationship.


Some human activities that are thought by most people to be productive may actually backfire. When president Obama gave a speech about tolerance, searches for “kill Muslims” actually tripled during the speech.


One of my favorite facts was that after the release of particularly violent but popular movies (incorporating data from FBI hourly crime data, box office numbers, and a measure of violence in the particular movies), violent acts actually declined that weekend, rather than rise as conventional wisdom might suggest.


Now of course even with big data there are some questions which cannot be clarified, and the author gives us a wonderful discussion of some of the hazards in using it to draw conclusions.


Another of my frequently blogged about topics is the illogical assumptions made about studies in which one variable seems to correlate with another, like high schoolers who smoke pot getting poor grades. We all should know that correlation is not causation, but you’d never know that from looking at studies, in spite of all the hedging and disclaimers. 

I learned that there are actually names for some of the fallacies I've been writing about. “Reverse causation” is when variable A is correlated with variable B, leading to the idea that A causes B when in fact, B causes A. “Omitted variable bias” is when a third, ignored factor is something else that leads to increases in both A and B. Maybe kids from difficult homes have a tendency to both use drugs and get bad grades.


A big one in the genetics vs. environment debate is something called “dimensionality.” The human genome differs in literally millions of ways. If you test for a lot of different genes, some will correlate with the trait in question, but it’s just by chance. This is similar to flipping 500 coins and finding one that turns up heads 15 times in a row, and assuming the reason that it’s some sort of special coin. When such studies are repeated, the usual result is that the correlation disappears.


This book is funny and well written. I highly recommend it.

Thursday, January 6, 2022

Book Review: the Deepest Well by Nadine Burke Harris

Every mental health professional should know that adverse childhood experiences (especially with parents who are abusive, neglectful, are perpetrators or victims of domestic violence, have multiple partners, or have substance abuse issues) are a major risk factor for developing almost every psychiatric disorder imaginable. Yet therapists and psychiatrists often ignore this issue in favor of theories about some sort of genetically-caused, pre-existing brain disorder.

In her amazing and surprisingly entertaining book, pediatrician Nadine Burke Harris (now surgeon general of California) outlines in vivid detail how ACE’s are toxic stressors that impact our bodies biologically and put us at higher risk for a variety of physical, not just psychological illnesses over the course of our entire lifetime. She points out that this does not only effect those who live poor neighborhoods, but can happen anywhere,

She covers the issue of epigenetics (how the environment turns genes off and on) as well as differentiating the effects of ongoing as opposed to time-limited stress. She zeroes in on the amygdala (the part of the brain that is responsible for fight or flight reactions) and how it can inhibit cognitive functioning, and on the sometimes toxic effect of stress hormones like cortisol.

In her observations as a crusader in the medical field, she came to realize that the reason physicians were often unaware of how this was taking place resulted from the fact that they never asked about it. As I have often said, it’s a case of don’t ask, don’t tell. Which is also the reason that psychodynamic and CBT therapists aren’t aware of the role of ongoing family interactions in their patients’ symptoms.

Also discussed in detail is how, in public discussions and meetings, parents can be resistant to various plans to confront ACE’s (due to what the author calls “hateration”) for fear that doctors would be stigmatizing their children as being brain damaged.  I think a bigger fear in the public is stigmatizing parents. As I often write about, you cannot call any type of parenting a problem these days anywhere without being attacked.

Last but not least, she talks about the intergenerational issues involved in chronic family stress. Here, the author seems to be on the right track, but I’m not clear if she, too, is unaware of the role of ongoing repetitive dysfunctional family interactions with their extended family members among both adults and children - particularly the role of grandparents in, unintentionally or intentionally, reinforcing problematic parenting practices and marital issues. 

For example, she cites the case of a woman who put up with verbal abuse from her husband and who stayed because she blamed herself and told herself she had to put up with it for the sake of the kids. Were her parents alive? If so, did they know what was going on? What did they have to say about it? If they didn’t know, why hadn’t she told them? Was she afraid they’d tell her it was her fault and she needed to stick it out for the sake of the kids? It sounds like this might possibly have been a case of don’t ask, don’t tell.

The closest she comes to discussing extended family is when she gives an example of how the aunt of a child who was a patient of hers seem to undo a lot of the therapeutic work that she had done with the child and the child’s mother.

It is true that certain early fear tracks in the amygdala are formed during the interactions of mothers with their babies, as she correctly points out. It is also true that these tracks are highly resistant to the usual process of neural plasticity that might fix issues caused by trauma. Scientists often seem to assume that the tracts are permanently damaged. However, perhaps it is true that the tracts remain strong because they are constantly being triggered and reinforced by the attachment figures throughout life.

If indeed the author is not aware of all of the forces at play here, she is hardly alone. So even with this possible and understandable omission, I cannot recommend this book highly enough. 

Monday, December 13, 2021

Psychotherapists Ignore Powerful Groupthink Forces


One thing that is a major theme in this blog is that many if not most therapists seem to think that most people’s problems are “all in their heads” and have nothing to do with the ongoing reinforcement of problematic behaviors through interaction with kin and ethnic group members. Groupthink is clearly one of the most powerful, if not the most powerful psychological force in everyday life. 


To see this clearly, think about what is going on in the USA today that is a constant focus in the press, talk shows, podcasts, and other media venues: the polarization of political life. Just look at the almost cult-like behavior on both sides, from the QAnon conspiracy theories on the right to the habitually offended community of social justice warriors on the left. Free speech, supposedly a cornerstone of the United States ethos, is attacked relentlessly by both sides without any irony or sense of awareness of the inherent contradictory nature of some of their viewpoints.


Yet so many therapists just ignore groupthink. The only exception is those who believe in family systems therapy, which was big in the 80's and 90's but has since fallen out of favor, particularly with psychologists. The problem with many family systems therapists, however, is the opposite: they seemed to have lost the individual. Although many people do not do it, they  are perfectly capable of employing critical thinking and coming up with their own thoughts, and behaving according to their idiosyncratic desires, if they are brave enough to do so. 

The current state of affairs would be amazing if it weren’t so sad. 


When I first started looking for clues about what was really going on in the lives of my patients when they were free associating in the psychoanalytic sense (back then, most psychiatrists still did psychotherapy and were analysts), I began to focus in on such things as logical fallacies. I, like most people, just thought those were common, somewhat accidental errors of thinking. I would start to express confusion about what the patient was actually meaning to say, and eventually happened upon information patients had not before volunteered. This lead me to start asking questions that my psychoanalytic supervisors never taught me to ask, like “what does your mother think about this?” – and I meant in the present, not when the patient was a kid.


What I didn’t know then was that the use of logical fallacies is one of the hallmarks of groupthink, so when I questioned them I was really finding a way to get at what they really thought, not what they were supposed to think. As my colleague Gregg Henriques points out, logic evolved not to get to the truth, but to justify group norms.


The more I got into it, the more I realized there were a whole lot of other “markers” that told me when I was hearing family groupthink and not the patients’ true thoughts and feelings. The following is a list of them, and there may certainly be other ones:


·       Logical fallacies

·       Defense mechanisms (as listed by psychoanalysts)

·       Irrational, self-scaring thoughts (as listed by cognitive therapists)>

·       Willful blindness (the refusal to even look at data which may challenge the group’s “wisdom”).

·       Plot holes (like when you are seeing  a movie and you get the feeling that such characters would never have said something like they did in the script, or that one of characters seems to know something they should have no way of knowing).

·       Ambiguous language (in which a sentence can mean two completely different or even opposite meanings, or a word has several different definitions and I couldn’t be certain which one the patient was using). This phenomenon is very familiar to people who work crossword puzzles.

·       Going off on tangents without returning to a main point or issue.

·       Circular reasoning

·       Spouting proverbs or maxims to justify behavior, such as “the grass is always greener…”  Often a marker for a family myth.

·       Mixed messages such as those exhibited by the infamous, so-called “help-rejecting complainer.”

It is interesting that when I bring up the ideas about group processes at professional meetings or in my books, no one actually disagrees or even argues with me. Instead, they just change the subject - or ignore the issue entirely.

Thursday, November 18, 2021

The Science of Spin: Big Pharma Propaganda Techniques

IMO, industry uses psychology to get people to change their behavior far more effectively and scientifically than psychotherapists. In an article in Environmental Health, (2021; 20: 33. Goldberg and Vandenberg describe 28 unique tactics used by industries to manufacture doubt or confusion about science when it serves their interests. These messages are then frequently amplified by perpetuators of doubt – journalists, bloggers, citizen scientists, and lay-people – who, on their own without direct funding, unwittingly disseminate and spread pro-industry spin. The Pharma industry tactics used to manufacture doubt are:


Attack Study Design

Emphasize study design flaws in negative studies that have only minimal effects on outcomes. Flaws include issues related to bias, confounding, or sample size


Gain Support from Reputable Individuals

Recruit experts or influential people in certain fields (politicians, industry, journals, doctors, scientists, health officials) to defend their biases in order to gain broader support


Misrepresent Data

Cherry-pick data, design studies to fail, or conduct meta-analyses to dilute the work of critics


Suppress Incriminating Information

Hide information that runs counter to their interests


Contribute Misleading Literature

Use literature published in journals or the media to deliberately misinform, or use peripheral topics as a distraction


Host Conferences or Seminars

Organize conferences for scientists or relevant stakeholders to provide a space for dissemination of only information in line with their economic interests.


Avoid/Abuse Peer-Review

Avoid the peer-review process to publish poor literature, publish without revealing funding sources, use the journal name to add weight to claims, or minimize need for peer-review among lay audiences


Employ Hyperbolic or Absolutist Language

Discuss scientific findings in absolutist terms or with hyperbole, using buzzwords to differentiate between “strong” and “poor” science (i.e. sound science, junk science, etc.),


Blame Other Causes

Find related, alternative causes for any negative effects that are reported or observed


Invoke Liberties/Censorship/


Invoke laws to emphasize equality and rights for expression of their preferred data or interpretations thereof, despite differences in evidence quality


Define How to Measure Outcome/Exposure

Attempt to set guidelines for ‘proper’ measurement of exposures or outcomes, while undermining guidelines not in line with what they want.


Take Advantage of Scientific Illiteracy (media/individuals)

Emphasize scientific obscurity to confuse lay audiences, or deliberately disseminate unscientific or false but easily digestible information


Pose as a Defender of Health or Truth

Represent their goals as health-conscious or dedicated to truth


Obscure involvement

Ghostwrite, create shell companies, use attorney client privilege to hide the true source of their data 


Develop a PR Strategy

Devise methods for specifically reaching public audiences to spread their messages


Appeal to Mass Media

Appealing to journalistic balance, developing relationships with media personnel, preparing information for media personnel, invoking the Fairness Doctrine


Take Advantage of Victim’s Lack of Money/Influence

Silence or abuse critical individuals by out-spending or exploiting a power imbalance


Normalize Negative Outcomes

Normalize the presence of negative effects of their products to reduce their apparent importance and make them seem inevitable


Impede Government Regulation

Overwhelm governmental regulatory agencies to slow or stop their function


Alter Product to Seem Healthier

Make modifications to harmful product to reduce public appreciation of their negative effects


Influence Government/Laws

Gain inappropriate proximity to regulatory bodies and encourage pro-company policies


Attack Opponents (scientifically/personally)

Conduct targeted attacks on opponents by undermining their professional or personal reputations


Appeal to Emotion

Manipulate an audiences’ emotions to draw support for their claims in the absence of facts


Inappropriately Question Causality

Argue that correlation does not equal causation despite the presence of strong evidence


Make Straw Man Arguments

Publicly refute an argument that was not even made by the opposition


Abuse Credentials

Use qualifications in one discipline to assume authority in another discipline


Abuse Data Access Requests

Requesting access to data in order to misrepresent and attack, employing Shelby Amendment, Freedom of Information Act, etc..


Claim Slippery Slope

Illogically or falsely claiming that there will be disastrous consequences if their ideology is not supported