Breaking the Biological Grip: The Not Broken Project.

These posts explore the themes developed in my monograph, Narcisso-Fascism, which is itself a real-world test of the central concepts of the Biocognitive Model of Mind for psychiatry.

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In addition to their weekly newsletter, Mad in America now posts on Substack. Their posts are brief comments on matters they may have dealt with in the main blog or shorter articles of interest. Two this week concerned antidepressants, essentially how they don’t actually work. The first post, by psychologist Peter Simon, looks at psychiatry’s latest fad, “precision psychiatry.” As always, this is a term pinched from mainstream medicine in the hope that it will do something to give a scientific foundation to psychiatry’s hit-or-miss approach to mental disorder. The idea is that genetic studies will reveal which group of people are likely to respond or not to antidepressants, and whether people likely to be troubled by side effects can be predicted in advance and steered to some other form of treatment. All very laudable, and it echoes what I’ve been saying for years: that as soon as mainstream medicine comes up with a new idea, psychiatry grabs it and begins applying it without any understanding of what is involved. Nothing ever comes from it and each failed fad is quickly forgotten when the next one comes along.

In the second post, MIA’s founder, science journalist and author Bob Whitaker, is drawn back to his old bête noire, the notorious and hugely expensive study called STAR*D. This was a vast, 6 year, multicentre project from 20 years ago that, from memory, cost about US$35million. It was touted as proof that antidepressants cure 70% of people, you’ve just got to try a few drugs. Mainstream psychiatry and their friends in the drug industry were delighted and wrote these results into textbooks and training programs of various sorts. They were less thrilled when a research group moved heaven and earth to get the original figures from the project managers and reanalysed them. They showed that the 12 month “cure rate” was closer to 3%, meaning that the drugs were more or less useless. Whitaker has been on the case for about 10 years now but the editors of the American Journal of Psychiatry, where the original study was published, consistently ignore calls for them to retract the paper.

This revelation was a bit of a shock to the mainstream but, as always, they coped with the bad news that what they’re doing is no help by developing a new fad. Their “precision psychiatry” is just another ploy, except that it too doesn’t work. Will that cause any angst in the professorial suites? I doubt it, they have form when it comes to ignoring bad news. It’s just on 30 years since I first locked horns with the psychiatric establishment in this country by pointing out that their favourite approach, the “biopsychosocial model,” didn’t exist [1]. From the beginning, the mainstream have done their level best to suppress this bit of bad news. Publication of the paper was delayed two years; when it appeared, it was accompanied by two highly critical commentaries that managed to miss the central point, that their chosen model was a mirage; I had never seen the commentaries before they were published and was denied the right of reply. Just six months later, they announced on the college website that modern psychiatry is driven by the biopsychosocial model, although they didn’t bother providing references because, as they knew perfectly well, there were none. Six years later, it was taken down with no discussion that I saw. This has gone back and forth for decades. From 2013-25, the college website proudly proclaimed:

Medical expertise: Psychiatrists apply their medical knowledge, specialist clinical skills and acumen in the provision of person-centred care. They understand the impact of ‘biological’, ‘psychological’ and ‘social’ factors on mental health and the causation of mental illness. This ‘bio-psycho-social’ model is a holistic approach that recognises the impact of social adversity and physical health on mental well-being [2]

In a letter, the then-president stated: “... the biopsychosocial model (is) ...the predominant theoretical framework underpinning contemporary psychiatry ... a relevant and useful component of training and practice ... “ (Moore, E. correspondence, Nov. 20th 2023). Typically, she refused to respond to requests to provide published material that could support her claim. Her successor also refused, saying she had “nothing to add,” i.e. nothing to add to nothing. However, something has changed. The current iteration of PS 80, from May 2025, doesn’t mention “biopsychosocial.” Once more, it’s been quietly dropped. Instead, we learn that:

Psychiatrists ... Are medical specialists who are highly qualified and able to provide psychiatric expertise founded in concepts of medical knowledge... Advances in early intervention, new medications, and therapies have improved mental health outcomes.

This is just nonsense: all medical specialists are highly qualified, that’s what specialist means. We learn that psychiatrists are highly qualified in psychiatry, and psychiatry is based in medical concepts. Which concepts? Specifically, what is the name of the model of mental disorder they are qualified in? If they haven’t got a model of mental disorder, it’s not a science, and if it’s not a science, then their “medical concepts” don’t apply. As for “improved mental health outcomes,” that’s simply not true. Every indicator is that despite huge expenditures on drugs and hospitals, outcomes are no different or worse than in the past. Here we go again, heading off in circles.

This is not accidental. This is yet another deliberate attempt to conceal the fact that, for all their bluster, psychiatrists are groping in the dark. This is precisely why we have debacles like the deceptive STAR*D report and blind poking in the genome hoping to find a reason why their drugs fail. I’ll tell you why they fail: they have never shown that mental disorder can be understood through “concepts of medical knowledge,” any more than, say, cricket can be understood through “concepts of medical knowledge.” What we call medical knowledge, aka “medical model,” is reductionist. Reductionism says we can understand complex things by reducing them to their fundamental physical elements and seeing how they interact. A proper reductionist explanation of a machine shows precisely how matter and energy flow through it, how they interact according to the laws of physics to produce their outcome. That’s fine, it works very well for things like microbes and trees and livers and cars, all of which are “just machines.” Thus, we can show why a car produces heat and exhaust gases in the process of moving, and we can also show why it can’t produce a fried egg.

When it comes to the human machine, we have an understanding at the molecular level of how everything fits together and how it uses the energy in food to produce growth and motion. We can explain how we play cricket, but what reductionism can’t explain is the WHY in human activity. The reason is very simple: mental matters, like why I went to the beach or why I was annoyed by the news, are not physical in nature. The mind is not controlled by the laws of physics, it has its own laws and they have nothing to do with gravity or chemistry. Even the laws of time don’t apply in the mental realm (fortunately). Given this, the project to explain mental disorder in terms of “concepts of medical knowledge” is doomed just because medicine’s core doctrine of reductionism doesn’t apply to the mnd. Granted there are plenty of people who are sure it does but they have never once produced a remotely plausible argument as to why it should. All we ever hear is boring, repetitious opinions. This is why we need projects like one that has just been announced by Adelaide’s Critical and Ethical Mental Health Centre (CEMH), headed by Prof. Jon Jureidini at Adelaide University:

The Not Broken Project advocates for a fundamental shift in how Australia understands and treats mental distress — away from a medication-first model, and toward the social, environmental, and developmental roots of human suffering.

Their central point is that people suffering mental troubles are not the owners of a “chemically broken brain.” In particular, the “chemical imbalance of the brain” trope “...was never supported by scientific evidence.” Instead, they propose: “Social, environmental, and developmental factors play a major role in mental distress. Drugs don’t address these roots.” As an example of their approach, they offer this little vignette of a fairly typical case:

Amy wasn’t suffering from depression caused by abandonment. Rather, she was suffering from abandonment in a way that fit the pattern of depression. Depression was the manifestation, not the explanation.

This point is critical: a description is not an explanation, an elementary truth that mainstream psychiatry simply cannot grasp. We can extend this to different conditions:

Bill wasn’t suffering from the disease of alcoholism. Instead, he was anxious as a result of his disturbed childhood and learned early that alcohol calmed him and helped him cope with life.

Rachel wasn’t suffering from depression leading to an unhappy marriage. Rather, she was suffering from the unhappy marriage in a way that fit the pattern of depression. Depression was the manifestation of her distress, not the explanation.

Simon hadn’t inherited ADHD from his father. Rather, his father couldn’t hold jobs due to arguing with supervisors, so they moved frequently and Simon had fallen behind. While he was bright, he couldn’t bring himself to admit he didn’t actually know the work so he played up to distract attention from his failing.

That’s neat, except it forces us to ask: Are these people suffering “conditions” in any interesting sense of the word, or are they individuals who have to be understood in the context of their lives? Put that way, it’s a pretty dumb question. People only “suffer conditions” when we don’t know enough about them as humans to make sense of their problems. So far, I’m totally in sympathy with the Not Broken Project but, when you see what they’re up against, we can be sure it won’t achieve anything. They may say (and I agree) that mental disorder (loosely defined) has mental causes but there is a deeply entrenched and, quite frankly, ruthless opposition who say “Mental disorder is always and only the result of physical causes in the brain.” Take one mild-mannered and courteous spokesman for the biological school, who said in an interview:

Psychiatrist: ... you are depressed. That’s why you’re having trouble with intimate relationships, kids, work, finances ...

Interviewer: It’s not that your work stress is causing your depression? You’re having issues at work because you’re depressed ... a lot of people do think that depression is caused by life events.

Psychiatrist: This is the number one myth ... The depression came first ... (but the crisis in life) is not the cause (of the depression), it’s the consequence.

Here, Prof. Ian Hickie, of Sydney, was quoting their large, international genetic survey that appeared to show that having “depressive genes” predisposes people to having bad childhoods and lots of adverse events in life [3]. I don’t believe that for one minute but that’s what the Adelaide group are up against. The mainstream in psychiatry doesn’t have a model of mental disorder. Instead, they have a firmly held belief system or ideology that says it’s all physical so only physical treatments count [4, Chap.2]. Sure, they make a few polite noises about considering social and cultural factors but that’s window dressing only. With few exceptions, they believe that all mental disorder is physical and must have physical treatment (drugs, ECT etc) to the extent that any patient who disagrees will simply be detained under the mental health act and will get the treatment regardless. Their ideology overrides anything patients may know about themselves.

In this, academic and private psychiatrists are firmly backed by the immensely powerful drug industry working closely with private hospitals, presenting a united front to governments who don’t give a damn about mental people because there are no votes in being nice to the deranged. Governments can lose votes if there’s any trouble so when a well-organised lobby like psychiatry says they have all the answers, all they need is a bit more money, governments shove it at them and push them out the door. As it stands, they will not take any notice of the nice people from Adelaide who want to discard the simplistic biological model that even the dimmest legislators can grasp, in favour of something airy-fairy that starts with “Let’s be nice to the mentally-afflicted.” Let’s go to a parliamentary enquiry regarding grant allocations. Remember, there’s big money involved and lots of careers to make or break depending on the outcome. First group are the biological psychiatrists, half a dozen eminent professors in elegant suits who enter with loud and jovial greetings and firm handshakes all round. “Yes, doctor,” says the committee chairman as the professors settle like a flock of eager crows chancing upon an ailing sheep, “can you explain to us why you should get the bulk of the research funds?” The leader of the contingent takes the microphone:

We are highly qualified medical specialists whose psychiatric expertise is founded in proven scientific concepts of medical knowledge. We employ the latest scientific technology to find causes and treatments for mental disorders that arise when the brain is broken. These include molecular neurophysiology to study chemical imbalances in the brain, very large scale international genetic studies, advanced scanning techniques such as positron emission tomography and other radionuclide techniques, and so on. We are developing precision psychiatry to bring rapid advances in early intervention, new medications, and therapies to improve mental health outcomes.

“That sounds very exciting, professor,” chortles the chairman as his colleagues nod in approval. “Can you just explain what you mean by improved mental health outcomes? Will that lead to more people getting back to work and off pensions?”

“That’s not our primary goal, sir,” booms the professor. “We are clinical scientists searching for abstract knowledge but yes, that will happen. We stand on the verge of major breakthroughs in understanding mental disorder. Armed with the biomedical model and, of course, the biopsychosocial model, we understand the impact of ‘biological’, ‘psychological’ and ‘social’ factors on mental health and the causation of mental illness. This ‘bio-psycho-social’ model is a holistic approach that recognises the impact of social adversity and physical health on mental well-being.”

“Thank you so much,” beams the chairman, “but we’ll have to hurry. Next group are the critical psychiatrists. Ah, come in, doctors, please have a seat. Can you explain briefly your fundamental approach to mental disorder to justify getting a share of the loot? I mean funds.”

“Sentiment,” replies the group’s leader.

“Sentiment?”

“Yes,” he continues, quoting from a well-known website. “We advocate for a fundamental shift in how Australia understands and treats mental distress — away from a medication-first model, and toward the social, environmental, and developmental roots of human suffering. These factors play a major role in mental distress. Drugs don’t address these roots. And withdrawing from them can be profoundly difficult.”

“Do you have a technology to study these conditions?”

“No, we talk to people. Telling someone their brain is broken for life is stigmatising and — in most cases — scientifically false. Validation of symptoms should not become a sentence.”

“A model of mental disorder?”

“Not as such. Our goal is to change government policies to reduce the personal, social, and economic costs of ignoring what patients — and science — are telling us about how distress should be understood and treated.”

“Do you have a theory of mind? No? A theory of personality? A model of personality disorder? Well, thank you indeed, doctor. You can show yourselves out, I’m sure. Don’t call us, we’ll call you.”

The only way out of this impasse is to heed the rather eccentric Buckminster Fuller (1895-1983), who said: “You never change something by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.” OK, you say, that’s fairly easy. All we have to do is convince the government that mainstream psychiatry doesn’t have a model of mental disorder and doesn’t actually know what it’s doing. Slow down, that’s not so easy. As the saga of the biopsychosocial non-model shows, mainstream psychiatry can string this business out for decades: “Yes, we have a model, no we don’t need to produce it so don’t ask, but we’re highly qualified specialists with lots of big medical words to sway things our way.”

The people behind the Not Broken Project are genuine but after psychiatry has spent the last fifty years pushing its biological barrow, I don’t think they can swing public opinion very far. An articulated model of mental disorder that actually says mental disorder is psychological, not biological, would be a good start. I could rephrase that: Without a model of mental disorder, any attempt to dethrone the biological approach is a non-starter. For example, the biocognitive model [5] says anxiety states are wholly psychological in origin, They are caused when the normal “fight or flight response” to the perception of a threat gets caught in a recursive loop [6]. Very simple, and nothing wrong with the brain. Moreover, it says depression is the response to the perception of a loss. The most common by far is the loss of any pleasure or hope in life due to anxiety. Dealing with the anxiety relieves the depression without drugs or ECT. As an explanation, that’s easy to understand, even for politicians. Now, all we have to do is convince people to read it.

References:

1. McLaren N (1998). A critical review of the biopsychosocial model. Australian and New Zealand Journal of Psychiatry. 32; 86-92. Revised version: McLaren N (2024).

2. RANZCP (2013). Position Statement No. 80: The role of the psychiatrist in Australia and New Zealand. RANZCP Website. Accessed Nov 3rd 2023.

3. Crouse J et al (2024). Patterns of stressful life events and polygenic scores for five mental disorders and neuroticism among adults with depression. Molecular Psychiatry (2024) 29:2765–2773; https://doi.org/10.1038/s41380-024-02492-x

4. McLaren N (2024). Theories in Psychiatry

5. McLaren N (2021): Natural Dualism and Mental Disorder: The biocognitive model for psychiatry.

6. McLaren N (2018). Anxiety: The Inside Story.

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My critical works are best approached in this order:

The case against mainstream psychiatry:

McLaren N (2024). Theories in Psychiatry: building a post-positivist psychiatry. Ann Arbor, MI: Future Psychiatry Press. Amazon (this also covers a range of modern philosophers, showing that their work cannot be extended to account for mental disorder).

Development and justification of the biocognitive model:

McLaren N (2021): Natural Dualism and Mental Disorder: The biocognitive model for psychiatry. London, Routledge. At Amazon.

Clinical application of the biocognitive model:

McLaren N (2018). Anxiety: The Inside Story. Ann Arbor, MI: Future Psychiatry Press. At Amazon.

Testing the biocognitive model in an unrelated field:

McLaren N (2023): Narcisso-Fascism: The psychopathology of right wing extremism. Ann Arbor, MI: Future Psychiatry Press. At Amazon.

The whole of this work is copyright but may be copied or retransmitted provided the author is acknowledged.