Depressing Propaganda
These posts examine modern psychiatry from a critical point of view. Unfortunately, mainstream psychiatrists usually react badly to any sort of critical analysis of their activities, labelling critics as “anti-psychiatry,” whatever that is. Regardless, criticism is an integral part of any scientific field and psychiatry is no different. As it emerges, there is a lot to be critical about.
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Last week, I mentioned the risks of people not keeping up with their diphtheria immunisation, or even opposing it, as appears to be the MAHA (Make America Healthy Again) case with RFK Jr, US Secretary for Health. Almost on cue came reports of an outbreak of this deadly disease among inadequately immunised people in remote communities in the Northern Territory, one third of them children. Diphtheria is lethal and preventable. Tetanus is lethal and preventable, as are polio, measles, whooping cough, Covid and so on. Practically all immunisations in this country are free because they should be but also because the cost of successfully treating one case of pulmonary diphtheria would pay for at least 5,000 immunisations. For the family, the cost of failed treatment is immeasurable.
Recently, and as he had repeatedly promised, Mr K has turned his attention to psychiatric drugs, especially in childhood. Now it has to be remembered that on a cost-benefit analysis, psychiatric treatment isn’t in the same class as mass immunisation, even though we now spend vastly more on psychiatric drugs than we do on immunity. Assume that 15% of Australians over 16 take the drugs; that’s 3.3million; a dozen scripts each per year at $20 per script gives the princely sum of nearly $800million a year (it’s probably a lot more). That’s a lot of money but are there other costs? Yes, there are many other costs, mainly weight gain and other metabolic disturbances, neurologic side effects such as akathisia and tardive dyskinesia, the risks of a manic attack, and the intangible cost of losing sexual interest and drive.
After all that expense, what’s the benefit of so many people taking all these drugs? This is where the problems start because the answer is: precious little. Are people better off for being fat and sexually inert, do they function better, are there fewer suicides and so on? More to the point, could we get by without them? Could people do something different to get a better outcome? The answer is yes, they would but there’s one problem that stands in the way. It’s called psychiatry. Predictably, psychiatrists have reacted badly to the suggestion that they are “overprescribing, overmedicating, overmedicalising” and so on, even though the evidence is very clear. Trouble is, it threatens their business model which is based on putting ever more people on ever more powerful and expensive drugs for longer and longer. When the drugs are of a type that induces dependency, then their business model is a winner. But is it science? When it comes to the class of stimulant drugs handed out for alleged ADHD, about 600,000 people are taking them, over ten times as many as 20 years ago (brand name Ritalin costs about $100 for 60x10mg tablets, $500 a year, $300million a year and rising fast; in the US, it’s 3-5 times as much). Is that science? Well, we know one thing: trying to prevent people questioning this, trying to suppress open debate, as mainstream psychiatry routinely does, is most definitely not science.
It didn’t take long for the mainstream to react to Mr Kennedy. Coincidently, a major opinion piece surfaced in the British Journal of Psychiatry, reporting on about a year’s work on deprescribing in affective disorder, meaning depression and bipolar disorder [1]. Using what is called a Delphi study, some 45 carefully selected experts offered their views on how and when people should be taken off psychiatric drugs. The Delphi process circulates a series of questions to the group and, after several rounds, assembles a group opinion that they can all agree with. They concluded that most people should stay on their drugs in the long term but a few could be gingerly reduced as an experiment. Given that the people they chose were all absolutely convinced that drugs are the only way to go, and given their conflicts of interest, they were never going to say anything else.
Another psychiatrist whose response to the MAHA move was very predictable writes regularly for Psychiatric Times and has his own blog. Awais Aftab was at Tufts Medical School in Boston, also the home of Ronald Pies, the long-term editor in chief of Psych Times, but has recently moved to Ohio. As far as I know, his background was Pakistani but he writes in English better than most which may explain why reporters commonly seek his opinion on such matters as the MAHA position on overprescribing. However, it’s important to remember that it doesn’t matter how well you write, you will not get a job with Psych Times by criticising mainstream psychiatry, because the mainstream and its affiliated drug industry pay the bills. Thus when he saw Kennedy’s opening shots against psychiatric drug, he was fairly sure that it was the result of an unholy alliance with various “antipsychiatry” elements, particularly Bob Whitaker (also in Boston) and Joanna Moncrieff, in London, conspiring to push a false picture of psychiatry as dehumanising.
Aftab has published a fairly long article on this point, attracting a response from Bob Whitaker, but unless you know the people involved and their particular points of view, it’s not very enlightening. The real issue is the vision of psychiatry that Aftab presents. Critics of psychiatry, he says, have drawn a phony picture of mainstream psychiatry as brutal and demeaning, when the reality is completely different. The false picture of psychiatry put about by critics is that psychiatry thinks all mental disorder is due to a physical disorder of the brain that can only be treated by drugs and physical methods such as ECT. “Untrue,” he cries, “psychiatry is far more subtle than that.” The medical model, he argues, is not a rigid reductionist approach that labels people, assigns them a particular chemical imbalance of the brain and then prescribes physical treatment. Instead, the real medical model is broad-based in biology, psychology and sociology, and physicians take all these factors into account when planning treatment. Psychiatry does the same, he says. It has its biopsychosocial model but also uses …
Various strands of explanatory and methodological pluralism and theoretical developments like embodied cognition, enactivism, complex dynamic systems, phenomenological psychopathology, psychodynamic psychiatry, social determinants of health, etc… They are scientifically grounded, neuroscientifically and psychologically informed, philosophically aware, humanistically oriented, and deeply skeptical of reductionism.
Therefore, he says, critics are wrong to say psychiatry is dehumanising and, by wanting to reduce the rates of diagnosis and prescription, Kennedy is being led astray by a false model fed to him by bad actors. Per Aftab, psychiatrists are really nice, aware people who use the latest science to help people and wouldn’t hurt a fly. However, we should be careful before we take this on board. One of the leading propagandists of the last century made this very clear:
The receptive powers of the masses are very restricted, and their understanding is feeble. On the other hand, they quickly forget. Such being the case, all effective propaganda must be confined to a few bare essentials and those must be expressed as far as possible in stereotyped formulas. These slogans should be persistently repeated until the very last individual has come to grasp the idea that has been put forward…. Propaganda must not investigate the truth objectively… The broad masses of the people are … but a vacillating crowd of human children who are constantly wavering between one idea and another [2, p119, 120].
The soft-focus picture of a caring, sensitive psychiatry that Aftab paints is just propaganda. Adolf would applaud. I’ve actually been in the hospital in Boston where he worked and it was the same as all the rest. There may be a few “philosophically aware, humanistically oriented” psychiatrists around but the great bulk are impatient technicians, totally committed to the line that “mental disorder is brain disorder, a genetically determined chemical imbalance of the brain, nothing to do with life experiences, take these and come back in a month.” Well may Aftab expostulate: “Psychiatric conditions have simultaneous neurophysiological, experiential, existential, and sociocultural dimensions. We know this!” but the grim reality is tablets, tablets and more tablets. As the distilled opinions of the 45 “experts on affective disorder” confirmed. Similarly, the great bulk of research in psychiatry is biological in nature: genes, neurotransmitters, scans and the like. Psychological and social factors rarely get a mention, as acknowledged by Thomas Insel after he finished as director of NIMH:
I spent 13yrs at NIMH really pushing on the neuroscience and genetics of mental disorders, and when I look back on that, I realise that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs - I think $20billion - I don’t think we moved the needle in reducing suicide, reducing hospitalisations, improving recovery for the tens of millions of people who have mental illness [3].
Is mental trouble an “illness” in any realistic sense of the word? If it is then fine, “treatment” in the medical sense may be appropriate, that would need to be investigated, but if it’s not, then we need to stop and take a long, critical look at the whole field. Even the very term “mental illness” begs the question, i.e. it assumes the truth of the point that needs to be proven. Trouble is, the defenders of current mainstream psychiatry are not dispassionate students of human affairs, they are committed to an ideology of mental disorder that tells them what to see, what to study and what to do. But it also tells them what to tell the general public, how to keep them quiet: “Yes, psychiatry is guided by a very liberal medical model and also by the biopsychosocial model… a humanist science, we like to think.” That is absolutely false. There is no such thing as a medical or biomedical model in psychiatry. George Engel never wrote his “biopsychosocial model.” He named a space for one and said it would be a good idea but that’s all he did (amazingly, he ate out on his “non-model” for years and was essentially beatified but I think that was because it put no intellectual demands on the shrinks). These are just words thrown around to keep critics quiet and make psychiatrists think they’re really cool.
Psychiatry as it exists today has no basis in an articulated, publically-available model of mental disorder that has been subject to the usual criticism. Anybody who disagrees, including Dr Aftab, can send me a copy of an article or book where one or other or both of those models is set out in a recognisable scientific form. Until that’s done, psychiatry’s critics are on strong grounds and Mr Kennedy may even be on to something important. That doesn’t say he’s actually thought about it, it’s just that his weirdo health ideas got into bed with his mania for proving everybody wrong but just by chance, he may have hit a bullseye. However, don’t put too much hope on it. The drug companies and their captive academics are experts in dealing with difficult politicians. They know they only have to string this out for a while and Mr RFK Jr will be out on his ear, either because he offended somebody important or an election upends the whole Trumpian shemozzle. For myself, I think it’s possible some good may come from it but the risk is that if and when the political climate in Washington changes, Big Pharma and Big Psychiatry will come roaring back to claim what they believe is their territory. Amply lubricated by money, they are in the grip of Big Idea on the nature of mental disorder. It’s all biology, they keep repeating, anything else is fairy tales. Granted, the nature of mental disorder is very complex but, as Henry Mencken said, “For every complex problem there is an answer that is clear, simple, and wrong.” Reductive biological psychiatry is “clear, simple, and wrong.”
The slogan that “mental illness is brain illness” is leading huge numbers of people to take expensive, addictive and troublesome drugs that don’t address the problem. The most common cause of a persistent or recurrent depressive state is not genes or wobbly brain chemistry but an unsuspected anxiety state. It’s unsuspected because psychiatrists think anxiety is trivial, just the “worried well,” and can’t conceive of how a serious biological disorder like depression could have a trivial cause like anxiety. Their model doesn’t allow the concept of recursion, that mental problems can amplify themselves, so they don’t ask. But being anxious is terrible, it wrecks people’s lives and eventually, they reach the point where they can’t go on. That we can call depression and it may become so bad that they can’t get out of it. Tablets and other things may help for a while but they don’t address the cause, the anxiety, so, after a while, the misery comes back. And back. That’s why depression seems hard to treat and convinces psychiatrists (who don’t need much convincing) that it’s all biological, whereas treating anxiety is straightforward. Unfortunately, due to decades of propaganda on biological causes of mental problems, a lot of people now will not accept the idea it may be psychological in origin. They see anxiety as a moral failing, so they’re happy to take drugs for a geneticc defect. Then they get addicted. If Kennedy can do something about that, all power to him.
References:
1. Goldberg JF et al (2026). The American Society of Clinical Psychopharmacology (ASCP) task force on the deprescribing of psychotropic medications for mood disorders: Delphi expert consensus. British Journal of Psychiatry doi: 10.1192/bjp.2026.10580.
2. Hitler, Adolf (1925). Mein Kampf. Tr. James Murphy, 1939. Facsimile edition (2011): Henley in Arden: Coda Books.
3. Rogers A (2017). Wired Science May 11 2017. https://www.wired.com/2017/05/star-neuroscientist-tom-insel-leaves-google-spawned-verily-startup/ (this link a bit dicky).
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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.