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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There was an unusual incident some years ago at an estate in (I think) France. People arrived for a weekend party and enjoyed the owner’s expansive wine cellars. When it was time to leave, a couple could not be found. People searched everywhere but there was no sign of them. Three days later, they were found in a small room deep in the cellars that nobody had checked, both dead. The door was not locked. It seemed they had snuck in for a quickie but heard the door click shut and thought they were trapped, so they tried digging their way out of the wall, with no luck. Before long, they ran out of oxygen. However, if they had pushed on the door, they could have survived.
This isn’t surprising. If people think something can’t be done, they won’t try. If the larger society says something is impossible, people will actually prevent anybody trying to do it (religions specialise in that). I may have mentioned the eminent British physicist Lord Kelvin (1824-1907) who, in 1895, pronounced that heavier than air flying machines were impossible. I don’t know how he accounted for large birds like swans, which are decidedly heavier than air but remarkably graceful in flight. But before we laugh at such folly, just remember that psychiatry resolutely refuses to push on the door marked “This way to non-biological treatments.” The received view is that all mental disorder is biological, so that’s where all the research money goes and nobody so much as glances behind that door to see what’s going on in the world of mentality.
Just to be clear, I don’t mean that modern psychology equates with the concept of the mind as a mental entity. The entire industry of behaviorist psychology was built on the idea that we can’t talk about minds as such. Burrhus F Skinner, for example, the most influential psychologist of the last century, never quite made up his mind (sic). Sometimes he said minds exist but we can’t talk about them, other times that they exist but are irrelevant to a science of psychology, and the rest he sneered and said they don’t exist.
Philosopher Daniel Dennett was even more contemptuous, scorning mentalist talk as medieval nonsense. “Somehow,” he puffed, “the brain must be the mind.” After about 65 years, his research program completely failed because, to make sense of it, he inserted something called a “virtual machine” that did everything minds do [1, Chap. 8]. Nor do I mean that psychology equals that dumbed-down procedure called “CBT” which treats the complexity of human mentality as a pocket calculator. I mean a theory that says mental troubles have mental causes that have to be uncovered by careful digging. Trouble is, mainstream psychiatry is determined to prove that mental problems have physical causes, so that’s where all the effort goes. A couple of papers this week show that.
The first one is a report on a trial [2] where anxious people were given a single dose of LSD (100mcg, usual party dose is 2-5 times as much) . This produced “... a significant and lasting reduction in anxiety symptoms ... with benefits emerging within days of dosing and holding through the 12-week trial period.” A control group given a placebo didn’t show much change, although it’s not clear how they were supposed not to know they hadn’t been given LSD. The trial has produced great excitement and the drug has been given “... FDA Breakthrough Therapy designation for Generalised Anxiety Disorder.”
I have to say I seriously doubt these results: if LSD reduced anxiety so quickly and effectively, Timothy Leary would have yelled it from the rooftops and not got himself arrested 36 times. We’ll have to wait and see but the real question is: If anxiety is so effectively treated by modern SSRIs and benzos, why are we going back to the 1950s for the latest hot research? Answer is they’re not effective, they don’t work and they’re actually dangerous. There is clear evidence that they can increase the risks of suicide and/or homicide, as well as being seriously unpleasant. There is a major homicide trial in the US at present which, on the face of it, could be drug-induced but it’s definitely not the only issue.
A paper from Finland [3] reported that high and prolonged use of benzos results in higher than expected mortality, meaning a shorter life span. We know that’s true of antipsychotic drugs but benzos? Aren’t they supposed to be harmless? Finnish statistics are very good, they have enviable national data bases and are accomplished number crunchers. They showed a dose-related curve, i.e. the higher the dose, the greater the risk of premature death, including suicides and accidents. Taking more than one benzo or combining them with other drugs greatly increased the risk whereas people taking low doses had little or no added risk of falling off their perches. This is real: in the US and UK, about one adult in eight is taking these drugs, often in the long to very long term, and mostly the more addictive ones such as alprazolam and lorazepam. It’s also true that there’s a huge black market in them, especially among people abusing opiates and amphetamines, all of which increases the risks.
Antidepressants, of course, are widely prescribed for anxiety but they control symptoms, they’re not seen as curative. An anxious person having a bad spell may take them for a while then try to stop them when things improve, only to discover a new problem called drug withdrawal. Drug manufacturers and mainstream psychiatrists prefer to say “discontinuation symptoms” because drug withdrawal smacks of addiction, and nobody wants to mention psych drugs and addiction in the same sentence. However, they meet all criteria for addiction except one: they don’t normally induce euphoria, but then nor does tobacco, one of the most addictive drugs known.
Trouble is, they’re easy to prescribe and take, they don’t interfere with life like regular visits to a psychologist, and they generate vast sums of money. They have a further, powerful benefit in that they allow people to avoid personal responsibility for their mental troubles: “There’s nothing wrong with me, it’s just my brain playing up again.” Psychologist Fritz Perls (1893-1970), a big wheel in the gestalt therapy world, used to say that many people didn’t go to therapy in order to change, they just wanted to feel better about their neuroses. This is a fortiori true of taking prescribed psychiatric drugs.
The main problem, of course, is that psychiatry doesn’t have any idea of what anxiety actually is: if it’s abnormal and unpleasant, it’s a mental illness and needs drugs, end of story. That doesn’t explain anything. The proper explanation for anxiety is at the level of psychology, meaning as a function of mental life. Anxiety is a normal human mental function, an emotion of the same order as humour, anger, sadness and so on. It’s perfectly normal to get a bit anxious from time to time. It’s only abnormal if people become anxious too often, too intensely, for too long or over the wrong things. Even the very word “anxiety” implies some sort of deviance. If we give it it’s proper name, the threat response, we can see it for what it is: a normal reaction to life events that has got out of control. People commonly refer to it as an adrenaline rush, because that’s what it is: a sudden blast of the alerting hormone.
Every animal on earth has some sort of threat response. That’s not news, if they didn’t, they’d end up as somebody’s breakfast. We humans are no different, we all react to threats with a stereotyped response: the mental perception of the threat comes first, the reaction is second. In humans, the reaction has two clear parts. First, there is the very obvious physical effect which takes the form of shaking, sweating, pounding heart, shortness of breath, churning stomach, dry mouth, stumbling over speech etc. The mental component consists of racing thoughts, poor concentration and memory, and mental confusion. Together, these are commonly known as the “fight or flight” reaction, meaning the state of heightened arousal that allows somebody to deal with a threat. A threat is always coming at you, it’s always in the future, looming and scary. We can’t be scared of the past. The only way we differ from other animals is that we can anticipate threats long before there is any actual sign of them. We can worry about tomorrow whereas animals don’t have that bother. If, however, the looming threat just is part of the anxiety response, then we’re trapped in a vicious circle, as in:
I have to give a talk tomorrow but I’m scared I’ll shake and sweat and dribble and they’ll think I’m an idiot, and that thought is scaring me right now so I’m starting to shake and sweat and dribble and I think I’d better cancel.
Anticipating a disabling anxiety response is a self-fulfilling prophecy in a normal brain. This is the mechanism of all anxiety states, including phobias and panic states. They are not separate categories of “mental disease,” i.e. distinct, genetically-determined, “chemical imbalances” of the brain, they are simply variations on a common theme. Anxious people are accidentally switching on their threat response and then maintaining it by fearing their response itself. This is a purely mentalist explanation with no basis in physiology at all and tells us how to treat it. However, that door is permanently closed to mainstream psychiatry. They’re all trying to push through the door marked “This way to biology” because wafting out of that door is the enticing aroma of piles of cash.
If that’s all, why not use a drug to calm the shaking and racing heart? One class of drugs, beta-adrenergic blockers, does just that. If you read the standard psychiatric literature, you will be told that the main one, propranolol, has a weak and unpredictable effect on anxiety, including phobias and panic attacks. It is not recommended for anxiety, either by itself or in combination as it has too many side effects, including causing depression. That’s a bit strange because a survey of symphony musicians and other performers found that a quarter of them used propranolol to calm their “stage nerves” before the show. For people with isolated fears, like public speaking, flying and so on, taking one non-sedating, non-addicting tablet an hour before the show transforms their lives. In fact, it’s not strange because beta blockers are off patent, and drug companies have a very powerful vested interest in making sure cheap drugs are never marketed. Moreover, their captive academic psychiatrists work to ensure nobody ever looks behind the door marked “psychology.” Their ideology says all mental disorder is biological so a drug that works via its psychological effect is anathema.
This I know full well as I probably prescribed more beta blockers for anxiety states than anybody else, certainly in this country and possibly in the world. Over about 40years, I would have accumulated well over 5,000 cases, many of whom were almost tearfully grateful. One case was a young policeman whose wife was about 8 months pregnant with their first baby. He was attacked at work and thought he was going to die. During the assault, his only concern was that he wouldn’t live to see their baby born; after, he was left with major post-traumatic anxiety. He was admitted to hospitals twice under renowned professors and was recommended for ECT which, he knew, meant he would be discharged from the police, so he insisted on a third opinion and got me. He was prescribed propranolol at the first interview and after a week, said his life was transformed: “I’ve spent five months in those big hospitals seeing all those bigwig psychiatrists, and one bloke who doesn’t even wear a tie fixed it all with a $10 bottle of pills.”
This is normal. If the patients are selected after a proper assessment, then beta blockers can be almost magical but it must be combined with cognitive psychotherapy. By using these drugs in a veterans’ hospital, we were able to reduce the admission rate and the bed occupancy by about 50%, eventually closing a ward (for which the medical superintendent was also almost tearfully grateful). The drugs are ideal for situational anxiety. The policeman was fine on his rostered days off but got anxious the night before returning to duty and couldn’t sleep, then it was on.
Similarly, a young anaesthetist at my hospital requested a private consultation as he was frightened he would be referred to the medical board for drug addiction (in the old days, that was a real problem with anaesthetists). He had to take several small doses of diazepam per day otherwise he started to “withdraw.” Between operations, operating theatres are quite busy, people rushing about cleaning floors, nurses dropping things or gossiping, trolleys coming in and out. Then the patient is wheeled in and everybody goes quiet and watches the anaesthetist insert the cannulae. He was working in the cardiac unit so there were several complex procedures that only he could do. That was the bit he couldn’t handle: if he made a mistake, everybody would see and laugh at him.
That was a big deal. He was first generation immigrant from a war-torn country and his family had sacrificed a lot to get him to medical school. If he were suspended for drug use, he would lose everything. In fact, it was classic situational anxiety. Public humiliation was a big deal in his culture (and in Australian male culture), so the thought of making a mistake made him anxious and shaky, which greatly increased the risks of making a mess of the various cannulae. He was told he wasn’t addicted as he didn’t take the drugs on weekends or holidays; a week of propranolol convinced him, and so another grateful patient rolled off the production line at a total cost of a few hundred dollars.
I had thousands of such cases which was the reason I prescribed antidepressants in no more than about 2% of new cases. The average in this country is about 60%. Also, I never used ECT and beta blockers were a major factor in that. However, I was never able to get these figures published. As a solo practitioner in remote areas, I didn’t have the resources to organise the sort of research project editors demanded, and never even bothered applying for grants as I knew what would happen. Compounding it, I found that psychiatrists who were losing work to my practice were telling patients and general practitioners that propranolol was ineffective and one was actually saying it was dangerous. What was his evidence? He had none.
They will, however, be happy to see another paper from a few years ago which analysed propranolol in suicides [4]. Of nearly 4,500 suicides in England, Wales and Nthn Ireland, 297 or 6.6% involved propranolol. In most of these it was not the main drug, either something the patient was taking at the time, or something within reach. Typically, a considerable number had not been prescribed the drug. It is common for people who find it effective to give some to their friends who, unsurprisingly, don’t find it as helpful. My experience was that after proper assessment and with carefully supervised brief cognitive therapy, overdoses were not just uncommon but rare, perhaps one person in a thousand, mainly people with a record of impulsive overdoses following minor social upsets. There were no suicides of people taking propranolol, so the answer is: drugs should only be prescribed after careful assessment, and should be followed closely. If beta blockers are given indiscriminately, it won’t work. The old “Take these and come back in a month” story is simply inviting trouble.
What’s the moral of the story? As long as psychiatrists who profit from the “biomedical model” story are running the show, there is no prospect of psychiatry pushing open the door marked “Here for psychology,” to explore its options. General practitioner and historian Robert Youngson summarised it pithily:
The whole history of science, right up to the present, is a story of refusal to accept fundamental new ideas; of determined adherence to the status quo; of the invention of acceptable explanations, however ridiculous, for uncomfortable facts; of older people of scientific eminence dying in confirmed possession of their life-long beliefs; and of painful readjustment of younger people to new concepts [5, p293].
Science progresses, one funeral at a time. We can hope.
References:
1. McLaren N (2024). Dennett’s dysfunctional Functionalism. Chap 8 in Theories in Psychiatry: building a post-positivist psychiatry. See below.
2. Duerr H-A. DT120 (Lysergide) Shows Rapid, Lasting Relief for Generalized Anxiety in Phase 3 Trial. Psychiatric Times, Aug 12th 2026.
3. Särkilä H et al (2026). Benzodiazepine Use and Mortality Risk: A Nationwide Cohort Study on New Benzodiazepine Users With a 5-Year Follow-Up. Acta Psychiatrica Scandinavica, 2026; 0:1–10. https://onlinelibrary.wiley.com/doi/10.1111/acps.70121
4. Gorton HC et al (2024). Involvement of propranolol in suicides: crosssectional study using coroner-reported data. BJPsych Open, 10: e127, 1–7. doi: 10.1192/bjo.2024.714
5. Youngson R (1998). Scientific Blunders. London: Robinson.
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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.