Fads in Psychiatry.

Last week, I steeled myself and enrolled to watch the "campaign update" on the ADHD enquiry conducted by WA Greens Sen. Jordan Steele-John, the current leader of the stampede to diagnose and drug everybody in the country. After an intro by a member of "Team Jordan" (truly), who announced "My name is Betty and my pronouns are she/her..." the admittedly excited team leader reminded us his pronouns are "he/him" before launching into a breathless account of all the wondrous things the enquiry is achieving although he was a bit miffed by "this weird rule about confidentiality" the committee insists on. As other speakers described their amazing experiences as "neurodiverses" giving evidence to the enquiry, the revivalist atmosphere built up and up, and I was reminded of this from long ago.

Back to Bro. Jordan, who mentioned that if any members of the parliamentary enquiry look as though they won't be sufficiently supportive of whatever he and Team Jordan want, he will distribute their email addresses for everybody to put pressure on them. What do they want? Anybody and everybody who wants amphetamines should be allowed to have them at government expense without all the stupid bureaucracy, like having to see a psychiatrist first. Second, they want access to benefits via the National Disability Insurance Scheme (NDIS) for anybody with a primary diagnosis of ADHD. Forget that bit about needing to be disabled, they want their benefits on the diagnosis alone. Unstated but lurking in the background was the idea that "sufferers" would also be able to get the Disability Pension for their diagnosis. Not for a disability, nobody mentioned that: one speaker announced that "she/her" is a post-doctoral researcher in mental health. That doesn't exactly scream "Disabled, handle with care."

After an hour, I'd heard enough and switched off. One part of me said "This is beyond ridiculous, it's another pseudoscientific cult and it has to be stopped," while the other part said "You can't fight fads, if they want the drugs, they can have them." But this is not just any old cult, where scoundrels rip money off the poor to buy private jets, this one is different. It's one thing for consenting adults to send money to televangelists, and here, it's something else again to take children and adolescents with no demonstrated pathology, label them "deviant" and put them on addictive drugs for life. At unlimited government expense (see endnote).

But I'm quite sure that if I managed to corner Bro. Jordan and asked him, he would insist that what they are doing is applying the science of mental disorder to relieve an enormous burden of disability in the community, and that a whole lot of people, and thence the community, will be so much better off for what their movement is doing. And that raises an important point, that everything psychiatry does is for the good of the recipient, whether he/she/it realises it or not. This includes its many fads, which brings a further question: Why does psychiatry have fads? We'll come back to that after looking at just one, the drive to find a genetic basis to mental disorder.

When I was training in the 1970s, all of the professors and teachers had trained at the Institute of Psychiatry at the Maudsley Hospital, in London. To a man (there were no women), they were convinced mental disorder is wholly a matter of biology, and genetics would clear the way. We were fed a diet of books and articles on genetics and brain chemistry, including the papers of American psychiatrist Franz Kallman. According to our professors, Kallman had said everything that needed to be said about schizophrenia, with a post-script on the disease of homosexuality. By studying twins, Kallman had decided that schizophrenia was almost entirely a genetic disease of the brain. He had died years before I started psychiatry; what was not said was that he was born in Germany and had been an ardent supporter of the eugenics movement before, being Jewish, he fled Germany for the US in 1936.

What movement? you ask. Good question. Nobody talks about it now but eugenics was A Big Deal in Europe (yes, that includes Britain) and the US in the 1930s, until it had an unfortunate brush with the Nazis and everybody quickly forgot how they had supported it. Eugenics means controlled breeding of the human race to eliminate hereditary disease and disabilities in order to improve the genetic stock, physically and mentally. It got its strength from the long-standing fear of the wealthy classes that, buried in their slums, the poor were breeding like rabbits. Although that was helpful in providing workers for the factories and keeping wages down, it was also bad in Darwinian terms because it meant that defectives were outbreeding the superior classes who, because of their brains, beauty and sagacity, were the rightful rulers of the nation. And rightful keepers of the national treasure, they didn't need to remind each other.

There were eugenics societies in each major country in Western Europe and in most states of the US, as well as Australia (if you haven't read this article, please do). Their goal was to enact legislation allowing the state to sterilise undesirables, which here meant "...slum dwellers, homosexuals, prostitutes, alcoholics, as well as those with small heads and with low IQs (and) the Aboriginal population ..." Such laws were passed in many countries and many parts of the US, and an unknown number of people were sterilised without anybody asking them what they wanted. In Germany, the laws were passed as part of the Nuremberg race laws, based on race laws already in force in either Kentucky or Tennessee (I forget which), and were, of course, applied with Teutonic efficiency. Before he left Germany in a hurry, Kallman had been advocating sterilising a whole range of people including all those with "hereditary degenerations," such as schizophrenia and manic depressive psychosis, and their relatives, but also hereditary intellectual deficiency, alcoholism, homosexuality, criminality, and so on. But the Nuremberg racial hygeine laws also targeted Jews, so perhaps Kallman left Germany with one hand clutching the family jewels.

Now the Institute of Psychiatry in London is important because it has a strong tie to Australia: it was largely set up by an Australian psychiatrist, Aubrey Lewis, of Adelaide (not to be confused with Aubrey Beardsley, as I once did, thereby losing even more points with the professor, who thought Lewis was a saint). And, as we were not told, Aubrey Lewis was a very strong supporter of eugenics. In 1934, he contributed a chapter to a book entitled The Chances of Morbid Inheritance, edited by Prof. CP Blacker, MC, MA, MD, MRCP, general secretary of the British Eugenics Society (it wasn't a Royal society but I'm sure they could have had that for the asking).

Lewis wrote Chapter 4, Inheritance of Mental Disorders, and quoted extensively from German research, as German researchers were then world leaders in everything they touched. In particular, he quotes from a Dr Ernst Rüdin, director of the Institute for Psychiatric Research in Munich, which was then the leading international centre for research on genetics and mental disorder (including intellectual handicap). From 1935-45, Rüdin was president of the Society of German Neurologists and Psychiatrists and had been Kallman's mentor prior to his sudden departure. His centre received large grants from the Rockefeller Foundation in the US, which paid for most of their building. The Foundation also arranged for bright young psychiatrists from different countries to visit Munich to study under Rüdin. One such eager student was a protege of Lewis in London, a Dr Eliot Slater, who went to Munich in 1939. Why would such a foundation be interested in mental disorder? Well, eugenics is the bastard offspring of social Darwinism, and the Rockefellers were social Darwinists to a T, meaning they believed they deserved their wealth because they were superior sorts, and not because they were related to one of the most egregiously awful robber barons of 19th Century Murica.

Post-war, Slater became very influential; he was editor in chief of the British Journal of Psychiatry, co-edited the main British textbook of psychiatry and trained generations of psychiatrists from around the world. So what? Well, his esteemed teacher, Ernst Rüdin, had a major input in formulating the racial hygeine laws (to prevent interbreeding between the master race and inferior races, such as Jews), and later started the program to sterilise mental patients. I don't know how many were sterilised in Germany and the occupied countries under his program, many hundreds of thousands, but he didn't stop there. His life's ambition was to purify the Aryan race, and the best place to start was by eradicating inferior beings, such as mental patients, homosexuals, the intellectually-handicapped, alcoholics, recidivist criminals and so on. Early in the war, he organised the first program to kill these people in mental hospitals; by the end of the war, about a quarter of a million defenceless people had been murdered. His justification was simple, as he had stated in a lecture in 1934:

Whoever is not physically or mentally fit must not pass on his defects to his children. The state must take care that only the fit produce children. Conversely, it must be regarded as reprehensible to withhold healthy children from the state.

His methods of mass murder were so effective that they were taken up by the nice people in Himmler's SS, who modelled their extermination camps on those set up in mental hospitals by Rüdin and his "racially-conscious" (read: fanatical) friends. Post-war, Rüdin was put on trial by the Allies but received only a 500mark fine, possibly because his student and friend, Franz Kallman, gave evidence that he was really a nice chap who was only interested in pure science. In the late 1990s, the psychiatric geneticist and current editor of the British journal, Psychological Medicine (one of the Big 5 psychiatric journals), Prof. Kenneth Kendler of the Virginia Commonwealth University, teamed up with Rüdin's daughter to try to rehabilitate his name but it didn't go very well.

So what does this have to do with modern psychiatry in Australia? Answer: Don't trust psychiatry's fads. You never know where they might end. Did any of the educated people in the Eugenics Society in Melbourne suspect their doctrines would lead to the methodical slaughter of ten million Slavs, six million Jews and unknown numbers of Romani and other groups? Probably not, but that's what happened. But the ultimate irony is that, having killed or castrated every person with schizophrenia or bipolar disorder that they could get their hands on, no children were born to these people after about 1937. During the 1950s and 60s, Germany should have been able to close its mental hospitals because there were no mental-disorder genes left. That is, by wiping out an entire section of the gene pool, did they eradicate these disorders? No, not a word of it. It had no effect. Their vast and diabolically evil experiment was a total failure. But we certainly weren't told that during our lectures on the Genetics of Mental Disorders.

And why does psychiatry have fads? Consider this: a few years ago, when the resident "very stable genius" in the White House declared people should drink bleach or shine UV light down their windpipes to destroy Covid virus, scientists were able to say "That's scientifically wrong. Don't do it." That's because they had a model of their field of study, which psychiatry doesn't have. Because psychiatry has no basis in science, anybody can scratch up a few figures then claim what they like, even invent entire new "diseases," and there's nothing anybody can do to stop it. Except we are (reread endnote).

The push to loosen diagnostic criteria for ADHD and to make highly addictive drugs freely available to anybody who asks, and to pay people to nominate themselves as "sufferers," is not science. This business isn't going to end this week just because we say it should, or even next week, but we can be certain about one thing: It will end badly. Badly for the individuals, badly for the society but, like Herr Professor Dr Rüdin, the perpetrators will be let off with a fully-suspended slap on the wrist. And they'll get to keep all the money, like Joseph Biederman. Oh, you don't know about him? We'll talk about him another day. Meantime, maybe we need to sing along with this.

Note: for a frightening personal account of what happens when you confront the ADHD industry, see the article by Watson and Antonuccio in this week's Mad in America.