Lumpers vs Splitters

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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When it comes to explanations, we’re all either lumpers or splitters. Splitters like to separate things into ever small categories while lumpers (I’m one) push apparently different things into ever larger groups by finding common elements. Kangaroos (large, peaceful, bipedal herbivores) look very different from small, aggressive, quadrupedal and carnivorous Tasmanian devils but, as marsupials, they’re more like each other than kangaroos are like deer or devils are like lynxes. The lumpers won that round.

In April this year, the US FDA published an executive order authorising accelerated research in hallucinogenic drugs for mental disorders, especially psilocybin (from mushrooms) for depression and methylone (related to MDMA or ecstasy) for PTSD. Politico reports this week that the Health Secretary, Mr RFK Jr, wants these drugs for mentally-troubled military veterans, of whom the US has several million among its 16million or so veterans (this is the same person who blocked research on RNA viruses). This was announced last week at a 3 day conference in New York, organised by a group of drug and health companies.

We have seen the same pressure techniques here. Veteran organisations are troubled by the excessive rates of suicide in former military members, about 18 per day in the US, nearly twice the rate of the adult civilian population. Drug companies and private psychiatric facilities tell them these drugs are verging on miraculous; they pressure their reps in Congress, especially veterans, of whom there are about 100, nearly a fifth of the total; in turn, they squeeze the administration which looks at the voting profile of the vets (mainly right wing) and approves it; and so the feeding frenzy begins. Even the Texas government has approved $50million for research although they can’t afford school lunches. Two years ago, under Biden, the FDA rejected an application for “drug assisted psychotherapy,” on the basis that the figures didn’t say which component worked (why pay for two components if only one works?). The new approach is to use the drugs alone: you want talking, buy a parrot.

This time, everybody has joined the party, including Dr Nora Volkow, the director of the National Institute of Drug Abuse since 2003, a granddaughter of Leon Trotsky and fanatical supporter of the biological ethos in psychiatry. Previously, she didn’t like the idea of issuing drugs of abuse to millions of disturbed people but now she’s on the Trump bus, cheering it on (he can sack her if the fancy strikes him, no reasons needed).

Is this a good idea? It’s not that long since there was an “epidemic” of opiate abuse in just this population, urged on by a combination of unscrupulous drug companies, private pharmacy companies and pliable physicians. Sure, it started as treatment of chronic pain, a major problem among veterans, but it soon spread. Part of the trouble was that during service, anybody who complained of pain was given oxycodone, usually six months supply at a time, which they carried in their packs and used as they liked. Needless to say, there was an explosion of addiction among recently discharged veterans and tens of thousands of deaths. A few drug company executives have been convicted but only the small players. Granted, hallucinogens aren’t as toxic as opiates but they’re classed as drugs of addiction for a good reason and are routinely abused; we can only wait and see what emerges.

Two questions are worth asking. First, if military service is such a mental health hazard, wouldn’t it be better to avoid starting wars? It would. It would be better for the poorly-educated rural youths who join the military because there’s nothing else available (the ‘poverty draft’) and it would definitely be better for the unfortunates who find their country has drawn the straw to host the latest round in the Global War On Everybody. However, permanent war is a major pillar of the American economy so that’s not going to change soon.

Second question is this: if drugs that mimic psychosis are the latest hot idea, what does that say about psychiatry? Two recent, comprehensive histories, Anne Harrington’s Mind Fixers [1] and Andrew Scull’s Desperate Remedies [2], recount in quite chilling detail how psychiatry lurches from one sure fire cure to another, with nothing other than enthusiasm to justify them and no apologies when they fail. As they all do. The reason they fail is the same reason you don’t walk out of your house with a shovel and start digging for gold, you have to go to where the gold is. Same with depression: you can’t say “We’re digging to find the biological cure for depression” without first showing it’s a biological kind of thing. That’s elementary but it’s never been done. People need to sit down and examine everything we know about emotions in humans and decide whether mental trouble is the sort of thing that could have a biological cause or not.

I recently mentioned Thomas Insel, former director of NIMH, who said: “… the biological model (of mental disorder) is sufficiently entrenched to ignore criticism and commit psychiatry to a new reductionist program ...” [3]. That is the exact opposite of the proper attitude in science. Nothing is beyond criticism, that’s how we get progress. The renowned astrophysicist Carl Sagan (1934-1996) put it perfectly:

It seems to me what is called for is an exquisite balance between two conflicting needs: the most sceptical scrutiny of all the hypotheses that are served up to us and, at the same time, a great openness to new ideas. If you are only sceptical, then no new ideas make it through to you. You never learn anything new. You become a crotchety old person convinced that nonsense is ruling the world (there is, of course, much data to support you). On the other hand, if you are open to the point of gullibility and have not an ounce of sceptical sense in you, then you cannot distinguish useful ideas from worthless ones. If all ideas have equal validity, then you are lost; because then it seems to me, no ideas have any validity at all [4].

Psychiatry’s record is crystal clear: it is incapable of distinguishing useful ideas from worthless ones just because it’s committed to an ideology, that all mental disorder is a biological disorder of the brain. Anything that sounds remotely biological will be supported, everything else bounces off the case-hardened skulls of the Key Opinion Leaders who control research grants and appointments. There is, however, a strong reason known as the principle of parsimony why this shouldn’t happen. Briefly, the number of explanatory entities must not expand beyond the minimum that can do the job. For example, don’t invent two forces if one can account for the observations. It goes back about 700 years, or maybe to Aristotle, nobody’s quite sure, but it’s known as Occam’s razor, after William of Ockham (who didn’t actually say it).

Psychiatry needs a good pruning with the razor because, driven by diagnostic splitters, the number of entities keeps expanding. We now have 357 separate diagnoses in DSM5; according to biological doctrine, each of these must have a distinct biological cause as a defect in the genome. None of them have ever been found but that doesn’t matter, ideology is more important than facts. 357 diagnoses, 357 unseen chemical causes and no sign that anybody thinks this is too much. I do, I think it’s silly as we can replace this jostling army of phantom causes with a single one called ‘psychology.’ We can take all the separate anxiety diagnoses and lump them together under a single psychological explanation: the sufferer has perceived a threat. Anxiety is mediated by biology, of course, but that’s just the mechanism, not the cause. The perception of a threat is entirely a mental phenomenon. Similarly, all the depressive states can be explained by the single idea that the person has experienced a loss. They’re not exclusive, of course, when it comes to something like military PTSD, the veteran feels constantly threatened and ends up losing everything in a self-reinforcing cycle. It’s all a mental matter, which tells us how it’s to be managed.

Modern psychiatry doesn’t like this one little bit. They’re wedded to the idea that mental disorder is biological, although they can’t explain why they hold this idea and have no clues as to how it could be true. All they know is that if it’s mental, it isn’t scientific so don’t talk about it. As Thomas Insel said, this belief system is entrenched, meaning dug in, set in concrete, impervious to criticism or questioning. That’s the very antithesis of the scientific attitude, as Carl Sagan saw it: “Skeptical scrutiny is the means, in both science and religion, by which deep thoughts can be winnowed from deep nonsense.” That is, you could end up believing a load of deep nonsense but because you’re impervious to criticism, you can’t correct it.

If you believe you’re beyond criticism, you’ve put yourself in the class of ideologies, of religions, so it’s no surprise that psychiatry is now reaching for that old standby of shamans, hallucinogens. Do they work on mental disorder? I don’t know, where I worked, I had very little to do with them but I seriously doubt it. They won’t work any better than standard “treatments” for depression, ECT, TCMS, a range of drugs, brain surgery, dental extractions and all the other things that have been tried, meaning hardly better than no treatment while producing lots of side effects. Will this bother psychiatrists? Not in the slightest. They’re impervious to criticism as they proceed merrily on their project of splitting mental disorder into a swarm of little, unrelated bits, the better to profit from the veterans. Before they die, that is.

References:

1. Harrington A (2020). Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness. New York: Norton.

2. Scull A (2022) Desperate Remedies: Psychiatry and the mysteries of mental illness. London: Penguin.

3. Insel TR, Cuthbert BN, Garvey M, et al (2010). Research Domain Criteria (RDoC): toward a new classification framework for research on mental disorders. Commentary. American Journal of Psychiatry, 167: 748-751.

4. Sagan C (1987) The Burden of Skepticism in Skeptical Inquirer Vol. 12, Issue 1 (Fall 1987)

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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 (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.

Clinical application of the biocognitive model:

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

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.

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