Goodbye, critical psychiatry

It was fun while it lasted.

Like practically everybody else of his time, the American soldier, journalist, author and misanthrope, Ambrose Bierce (1842-?1914), had no scientific education at all but he didn’t miss much. In his Devil’s Dictionary, from about 1905, he offered this definition:

Gravitation: the tendency of all bodies to approach one another with a strength proportional to the amount of matter they contain – the quantity of matter being ascertained by the strength of their tendency to approach one another. This is a lovely and edifying illustration of how science proceeds, having made A the proof of B, makes B the proof of A.

After a seriously unhappy childhood as the tenth of thirteen children born in a log cabin in Outer Ohio, Bierce served with distinction in the US Civil War before drifting across to San Fransisco and into an equally unhappy marriage and journalism. Following a life replete with misery and failure, he announced he was going to Mexico to report on the revolution. He was never seen again and presumably met the sort of sticky end that would have appealed to his gothic sense of despair. I mention him because the ad blocker on my computer came due and, before I got around to renewing it, I was showered with brain dead advertisements. The specimen below was one of a series appearing every few minutes in The Economist. Not wishing to be driven nuts by spam, I didn’t click on it to find out who was paying for them:

Unfortunately, I can’t read the fine script so I won’t be able to reveal what “gardening skills” have to do with ADHD. Another one in the series said: “Hypersexuality is not infidelity. It is an ADHD response.” That’s why I was reminded of Ambrose Bierce. Bierce was a highly original and critical thinker and put his finger on a well-known trap in science, circular reasoning. Of all fields claiming to be scientific, psychiatry probably is the worst in this respect. So-called ADHD is a classic example: “His concentration is poor, which proves he has ADHD, and his ADHD explains why he has poor concentration.”

However, the ADHD adverts are so garbled they don’t even reach that level. Based on my series of two, they appear to be saying “You get the diagnosis of ADHD based on your behaviour, and the diagnosis then explains and (crucially) excuses all your bad behaviour.” I’m sure all the sexual predators out there will be delighted to know the ADHD industry wants to hand them a Get Out Of Jail card, although I don’t have a clue what they mean by “Hypersexuality is an ADHD response.” First they tell us that ADHD is depression, then that screwing around is due to ADHD so, by a basic rule of logic, screwing around is due to depression. Except everybody knows that depression doesn’t increase libido, it reduces it.

I think we can dismiss these adverts as just another bunch of unscrupulous turds trying to make money out of people’s worries (like the Sackler family who made billions out of telling the world that slow release oxycodone (Oxycontin) was somehow not addictive, when they knew perfectly well it was, which caused half a million deaths; see here for further such crimes). Ho hum, you say, that’s capitalism. In order to be sure all the good ideas are heard, we have to accept that a few bad ideas will slip through as well. Bad ideas, the neolibs assure us, won’t survive in the market place, the normal cut-and-thrust of debate will soon sort them out. Except it doesn’t. Bad ideas or false beliefs can take hold of the public perception quite as easily, if not more easily, than good ideas. People would rather believe a simple falsehood than bother themselves with a complex truth, especially where the lies fit comfortably with their prejudices (there is a reason for this, I’ve expanded on it in Chapter 12 in Theories in Psychiatry, on philosopher Donald Davidson, published in August).

I believe that the concept of “ADHD” is false, a bad idea that people would rather believe than deal with the truth that, for whatever reason, their behaviour is at fault. Sexual predators, for example, would rather believe that they have an irresistible mental disorder than accept that they are cruel and selfish people who prey on the defenceless. Some teachers, for example, would rather believe that distractible children in their classes have a mental disorder that needs drugs rather than accept that they are actually younger and therefore need extra attention. Some parents, for example, would rather believe that their Johnny has a genetic disease of the brain and has to take tablets rather than accept that their constant drinking and arguing upsets him.

Coupled with this, the capitalist arena, where bad ideas are led out for the lions of critical thinking to devour, certainly isn’t level. There’s so much money involved that bad ideas can survive and grow until they take control of the public discourse and become cemented in place as The Received Truth. To complete the analogy, once that happens, the brave lions are quietly dragged out and strangled. However, when we come to psychiatry, there’s more than mere money involved, there’s ego. And not just any old ego, we’re dealing with far and away the most dangerous type, with the longest and most unforgiving memories known, academic egos. That’s fine, you say, we just chip away at the edifice and slowly bad ideas are eliminated. Really? Look at Jay Joseph, diligent critic of the hugely influential genetic idea of personality. He’s spent about 30yrs chipping away at that superstructure, with very little effect. The entire idea has no valid basis but it won’t die, mostly because of the academic careers that have been built on it. Similarly, the story that antidepressants are safe, cheap, reliable, effective, non-addictive and so on also refuses to go away. The notorious STAR*D trial has been shown to be false in practically every detail but it is still widely quoted and, worst of all, taught to medical students as gospel.

My own, quarter century saga of trying to expose the biopsychosocial model as a fraud is the same. You’d think this one would be dead easy: either it exists or it doesn’t, either all these clever academics have a copy of it or they don’t. In fact, a complaint of scientific fraud is deadly serious business. You might expect that any credible institution receiving one would drop everything to conduct an “urgent, scrupulous and transparent” investigation of the matter, to settle it definitively before the media get hold of it. The only way to avoid holding an investigation is to show that, from the beginning, the complaint is impossible. If, for example, Smith complains that Brown has killed his family’s cat, then Brown’s absolute (necessary and sufficient) defence is to produce Puss, alive and well but rather fat from the scraps Brown’s children feed him.

So when the current president of the RANZCP says that 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), the complaint of fraud can be killed on the spot by producing a copy. She refuses to do so. Similarly, when Emeritus Professor Bruce Singh, of Melbourne University, claims that the biopsychosocial model (he prefers ‘approach’) is a “towering edifice” [2], the only way he can stop it being a tower of bullshit is to send a copy. He refuses to do so. The egos involved are enormous and, ominously, they support each other because they dread that if one charge of scientific fraud sticks to their lily-white fingers, then there will be a heap more coming their way.

Readers are possibly bored with being told this model doesn’t exist, that it’s smoke and mirrors and probably amounts to scientific fraud (but not as bored with it as I am) but there is something else happening in this country that puts the entire critical psychiatry movement at risk. After a life time in politics, and despite having the imagination and leadership qualities of a garden slug, the current prime minister, one Anthony Albanese, has acquired the stealth and survival instincts of a hungry rat. Since our mate Albo, as he likes to be known, has a good chance of being dumped at the next election, he has devised a scheme to head off a lot of the criticism he deserves. The government has launched a bill called the “Combatting Misinformation and Disinformation” Bill 2024. This will make online media companies liable for anything that …

… contains information that is reasonably verifiable as false, misleading or deceptive, and is reasonably likely to cause or contribute to serious harm of a specified type (misinformation and disinformation)…

The explanatory memorandum available from that site, all 143 pages of it, defines dis- and misinformation and “harm” so broadly, and imposes what are surely the most draconian penalties for infringements (fines of up to 2% of the company’s world-wide revenues) that, if passed, it will simply turn online media into neutered propaganda machines, a cross between Joseph Goebbels and Brave New World soma. The dangerous bit is this: Who decides what is false or fake news? Answer: A government committee. Not a court, not even the court of public opinion, which is what capitalism dictates, but a committee carefully selected by the government, silently beavering away, hidden from prying busybodies, who will decide what they like and don’t like and that’s it. And, of course, they will silently take guidance from their political masters.

Now that’s bad enough: I, for example, do not believe that China poses a military threat to this country and that the so-called AUKUS nuclear submarines plan will turn into a monstrously expensive failure but if somebody complains that my view could cause “serious harm” to this country in any form, or feels personally threatened, then I’m for the high jump. OK, that’s politics, I take my chances with the flags I wave but psychiatry’s different. Consider this example: I publish on my Substack file an article saying “ADHD is not a valid scientific diagnosis and the drugs are unnecessary and dangerous.” As a result, some kid somewhere refuses to take his drugs. His parents could then lodge a complaint under this legislation, saying my “disinformation” had caused their child “serious harm” (e.g. poor performance at school due to drug withdrawal) and I would be liable. Why? Because the secret committee to determine truth and falsity know stuff all about ADHD or models of mental disorder, so they quickly ring around for a “consensus opinion.”

The “experts” they call are the usual hearty bunch of totally compromised, captive academics who have made their careers (and fortunes) out of manufacturing new “mental diseases” to terrify the population (and to thrill drug manufacturers). The phone call is a waste of time: we know exactly what they will say. In their search for “the truth about ADHD,” the committee could, for example, call Prof. David Coghill, who holds the Financial Markets Foundation Chair of Developmental Mental Health, Depts of Psychiatry and Paediatrics, Melbourne University, or Dr Roger Paterson, psychiatrist, of Perth, West Australia, both of whom (according to their videos) appear to believe that everything psychiatric is actually ADHD in disguise and can be fixed with a script for stimulant drugs (which, they claim, are not addictive). They will tell the Committee for the Received Truth that I am guilty of misinformation and need to be hung out to dry. Most assuredly, critics will definitely not be invited to submit their opinions to the committee. The committee will not, for example, call Dr Martin Whitely, also of Perth, a long-time critic of the ADHD industry who knows more about it than the rest of them put together and doesn’t get any drug company kickbacks.

The principle is this: the people who hold power and wealth will be the very people who decide what is true or false. If this legislation is passed, it’s the end of critical psychiatry. And of critical economics, the conservation movement (blocking the fossil fuel industry will definitely harm the economy), the peace movement and a dozen other worthies as well. What insecure politicians don’t get (and don’t want to get) is that without criticism, there is no scientific progress, or any progress at all. Anything, such as this Bill, that tends to obstruct or diminish criticism is anathema (n: a person or thing cursed or condemned by God; something or someone that one vehemently dislikes). We can be certain that if it is passed, it will be used by the rich and powerful against the poor and dispossessed.  Dr David Brin, astrophysicist and renowned sci-fi writer, summarised it neatly:

In all of history, we have found just one cure for error—a partial antidote against making and repeating grand, foolish mistakes, a remedy against self-deception. That antidote is criticism.

PS. Why should anybody bother with what happens in Australia? Because all over the world, They will be watching this little experiment to see if They can get away with it.

References:

1.      Lugg W. The biopsychosocial model – history, contro­versy and Engel. Australasian Psychiatry 2021 on line publication .doi.org/10.1177/10398562211037333

2.      Singh BS (2002). George Engel: a personal reminiscence. Australian and New Zealand Journal of Psychiatry. 36: 467-471.