More on Conspiracies …
… because they’re never ending.
Following last week’s post, a couple of readers raised the issue of the overt conspiracy by Big Pharma to market drugs which aren’t as effective as claimed or have more adverse effects than they reveal. Yes, we’ll get to that but first need to consider why they can get away with it. Another reader mentioned that while a few psychiatrists at the top may be consciously manipulating the narrative, the majority probably aren’t. They believe what they’re told and work diligently within the limits of the models they’ve been taught: “…theirs is possibly more ignorance than deceit … the majority of psychiatrists are bewildered when you say they don’t have a model… they don’t know what your issue is.” Yes, I agree. It is indeed normal for psychiatrists to use high-sounding expressions without knowing what they mean, but one of the duties of anybody working within the very broad fields of science and of human services (in fact, every citizen’s duty) is to question what you’re told. The astrophysicist Carl Sagan (1934-1996) nailed the scientific attitude precisely:
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 skeptical, 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 skeptical 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 (1987).
He reiterated this point in his last book, The Demon-Haunted World: “There are no forbidden questions in science, no matters too sensitive or delicate to be probed, no sacred truths. That openness to new ideas, combined with the most rigorous, skeptical scrutiny of all ideas, sifts the wheat from the chaff” [1, p35; I prefer the Greek spelling, with k, rather than the French with c, as sceptique is pronounced “septic,” which is not quite the same in English]. From decades of experience, I can state that most psychiatrists react badly to criticism or even questioning, however mild. This points to the central problem in medicine: we are trained to memorize, to soak up what we are told, but we are not trained to think critically.
I experienced this first-hand when, aged 34, a senior consultant and head of department of psychiatry in a Veterans’ Affairs hospital, I went back to university to study philosophy. On the strength of my publications, I was put in second year (which I now see as a mistake) with a class of rowdy 18 year olds, who were quite amused to have a shrink sitting with them. After the first week, I went home in some despair and said: “I can’t do this, I’ll have to pull out. Those kids can think better than I can.” Fortunately, I didn’t but the price of learning their language was steady alienation from the mainstream of psychiatrists.
Training in medicine, including psychiatry, requires students to memorize vast quantities of material, especially in the basic medical sciences such as anatomy, physiology, biochemistry etc. At undergraduate level, the science has been done, there’s nothing left to question so don’t argue. In the clinical years, in medicine, surgery, paediatrics, O & G, etc., students are still not encouraged to question anything but for a different reason. In the clinical years, what they are taught is safe practice, so questions are definitely out of place. Psychiatry professors come equipped with the same attitude, that questions are not welcome, but without having either foundation. That is, they do not have the science they claim they have, and psychiatric practice is mostly hit-and-miss, largely a matter of drug company marketing or personal choice. Their intellectual insecurity leads to a neuralgic response to being questioned or criticized.
The point is this: it’s not good enough for people with the power psychiatrists have simply to soak up all the crap they’re taught and then act as though it’s gospel. Everything they’re told has to be questioned. For example, over the past 18 months, I have repeatedly asked the current president of RANZCP, a Dr Elizabeth Moore from Canberra, to justify what she says of the biopsychosocial model in training and practice in Australia and New Zealand:
... 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).
All I want from her is a list of texts, a reading list of journal articles, a schedule of lectures and tutorials, the names of lecturers, etc., the sort of routine stuff that any teaching program is built on. She refuses even to acknowledge the emails and letters (as a little test, I went to the site of the engineering department at University of Queensland to see what detail they give on their courses; here, just as you would expect from a reputable body anxious to protect its reputation). However, everybody has to understand: Dr Moore’s response to being put on the spot is absolutely normal. It’s a case of “I’m in charge, how dare you question me?” Even when, as my recently rejected letter to ANZJP showed, some of the most senior psychiatrists in the country are talking shit, and they know it, criticism is rejected as “anti-psychiatry” rather than accepted as an essential part of a scientific training. Every psychiatrist in the country has the inescapable duty to question the president’s statement and she is duty bound to respond. For the record, I do not accept that she is unaware the biopsychosocial model doesn’t exist: her silence speaks volumes.
The point is that truth is not established by dint of repetition of a falsehood. Psychiatrists, however, live in an intellectual bubble where they reinforce each other’s false beliefs and angrily reject criticism as “anti-psychiatry.” If you're pro-psychiatry, you're balanced and objective; if you're critical of psychiatry, you're biased. They demonstrate perfectly Tolstoy’s observation:
I know that most men, including those at ease with problems of the greatest complexity, can seldom accept the simplest and most obvious truth if it be such as would oblige them to admit the falsity of conclusions which they have proudly taught to others, and which they have woven, thread by thread, into the fabrics of their lives.
If psychiatrists still don’t know what the criticism is about, they should stop circling the wagons and shooting at the messengers [2].
That aside, I mentioned last week there are factual or proven conspiracies, conspiracy theories, which have to be investigated, and conspiracy fictions or fantasies which are immune to investigation. When it comes to drug companies, they fall in the first category: proven liars. The list of drug companies fined for ethical and criminal offences grows steadily. The record shows that they simply cannot be trusted to protect the interests of the consumer. The temptation to use their position to boost their profits at the community’s expense is irresistible. Bearing in mind that most of the original research on which they base their drugs is sponsored by governments, they’re laughing all the way to the bank. In my view, the duty of running drug trials should be taken away from the companies and handed to an independent, statutory authority. They wouldn’t know who is testing their products or where until the results were sent to them. Needless to say, they’d squeal that they couldn’t get their money back soon enough but that’s the whole point: their rush to get rich quick produces their dishonesty.
There is, however, a further point, namely the size of the psychiatric drug industry and its power over psychiatry, which takes us over the line from proven conspiracies to conspiracy theory: are mainstream psychiatrists conspiring with drug companies to mislead the general public (and governments, regulators, insurers etc.)? This crucial issue was covered in considerable detail by Bob Whitaker and Lisa Cosgrove in Psychiatry Under the Influence [3], from ten years ago. Despite their efforts, nothing much has changed, as a recent study concluded:
Conflicts of interest among panel members of DSM-5-TR were prevalent. Because of the enormous influence of diagnostic and treatment guidelines, the standards for participation on a guideline development panel should be high. A rebuttable presumption should exist for the Diagnostic and Statistical Manual of Mental Disorders to prohibit conflicts of interest among its panel and task force members [4].
When challenged, psychiatrists with proven links to drug companies immediately protest that of course they wouldn’t allow such minor matters as money or advancing their careers or influence to affect their work but I don’t think anybody should take that at face value. In a matter of such critical importance as releasing brain-altering drugs for widespread, long-term consumption, the burden of proof has to be reversed: psychiatrists are presumed to be biased until they can prove otherwise. The reason is very simple: there’s nothing in the theory or practice of psychiatry to stop them being biased.
I don’t mean regulations or ethical rules or any of that bureaucratic stuff, I mean the core of the scientific ethos: that you actually have to know what you’re doing. A quick glance at psychiatry’s brutal history of faddish and unscientific treatments [5,6] shows that the only constant is their unwavering conviction that they’ve finally got a firm grip on mental disorder. The way they say it, they’ve got the proper understanding and are now perfecting their treatments so it won’t be long before they’re lining up for their Nobel Prizes. Nothing could be further from the truth. The conviction that mental disorder is a biological phenomenon has no formal justification, in neuroscience or in philosophy. It is an ideological belief [7] which is kept aloft by constant, confident repetition. In view of its lack of foundation, we have to ask why so many educated people support it. Is it a conspiracy?
There are, of course, two sides to any possible conspiracy. There is the group of people in the know who may or may not be up to no good, and there are the outsiders who are trying to work out what’s going on. There’s the obvious type, where a group of people secretly plot an action they know is wrong with the intention of gaining a benefit they couldn’t get if the public knew what they were up to. Then there’s the type of conspiracy seen among people who already in basic agreement so they don’t need to talk. Theirs is a conspiracy of the like-minded, whose real value is plausible deniability. Because they all know what to do, there’s no need for a paper trail so there’s no evidence of them conspiring. In mainstream psychiatry, the basic agreement is “Pass it on, it’s all biological.” When it comes to justification, there isn’t any [7].
In Australia and a few other countries, there are two groups, the wholly biological and the biopsychosocial, but they have a tacit agreement not to criticise each other. This starts at the top and flows down the hierarchy. For example, the editorial boards of psychiatric journals do not require authors to provide evidence of things called “the biomedical model” or “the biopsychosocial model.” Like gravity or day and night, these things are accepted as established facts that don’t even need citations, but any attempt to question or criticise them will be rejected. That’s an example of a “conspiracy of the like-minded”: if you question these things, you won’t be invited to sit on the editorial boards. Medical students and trainees simply grow into the intellectual space prepared for them. Tolstoy again:
The most difficult subjects can be explained to the most slow-witted man if he has not formed any idea of them already; but the simplest thing cannot be made clear to the most intelligent man if he is firmly persuaded that he knows already, without a shadow of doubt, what is laid before him.
Given this state of affairs within psychiatry, the next question concerns the profession’s relationship with drug companies. The business of drug companies is staying in business. Their duty is to their shareholders, not to the general public. There are numerous regulations but these are only administrative hurdles on the path to getting their products licensed and have nothing to do with morality. The only laws stopping them selling cyanide toothpaste are product liability laws, i.e. they can be sued for bumping people off, as happened with thalidomide and with oxycodone in the US (tobacco companies can’t even be sued).
In order to succeed in business, they need a market but for drug sales, the target is prescribers, not consumers. Therefore, drug companies put all their efforts into shaping psychiatrists’ opinions in the direction of seeing all mental disorder as a physical disorder of the brain, for which only drugs can be effective. Psychiatrists, who are desperately keen to be seen as respectable members of the biomedical community, are only too pleased to assist, thereby setting up a “conspiracy of the like-minded.” There is a total agreement among the drug companies and the academic psychiatrists taking drug company money that nobody will question the basics. Everything they do is based on 110% agreement that:
(a) they have a firm grip on the basic science of mental disorder and
(b) what they are doing is A-grade safe practice.
There is a further unspoken agreement that anybody who is so indecent as to question what they’re doing has to be attacked as “anti-psychiatry” to make sure the contagion of doubting such high-minded and selfless people doesn’t spread. In particular, they do not want that contagion to spread to medical students and psychiatry trainees (residents). It leads directly to claims such as by Prof. Ian Hickie, who said in an interview:
Hickie: ... you are depressed. That's why you're having trouble with intimate relationships, kids, work, finances ...
Interviewer: ...it's not that your work stress is causing your depression. You're having issues at work because you're depressed ... a lot of people do think that depression is caused by life events.
Hickie: This is the number one myth ... The depression came first ... (but the crisis in life) is not the cause (of the depression), it's the consequence.
He justifies this counter-intuitive belief by referring to a paper published in the journal Molecular Psychiatry last year [8] which, in my view, doesn’t prove what he said but that’s for another day. However, his view perfectly reinforces the biological ethos (that’s why they got all that money to spend on the project) and is now cemented into the scientific literature. It will be used to silence questions so we’re stuck with it until they lose interest and move on to other things. It will probably lead to widespread genetic testing of self-involved people who can afford it but that’s their problem. My concern is people who have no choice in what is done to them, either through lack of money or being detained, because what happens to them is the product of what seems to be a conspiracy.
This is, of course, the antithesis of the scientific attitude but the marketing divisions of drug companies probably don’t know that and wouldn’t care anyway. Among psychiatrists, it should be known but isn’t. Where they should have the critical frame of mind Carl Sagan described, their attitude is: “How dare you question us?” or “It’s ridiculous to claim there is no biomedical model.” Let me give a small personal example. When I arrived in Brisbane, 12 years ago, there was no psychiatry philosophy group, so I contacted the college office, got a couple of names and we organised one.
After a couple of years of somewhat underwhelming interest, it happened that I lodged a submission with the Human Rights Commission’s enquiry into the Optional Protocol to the Convention Against Torture (OPCAT; my submission here). I pointed out that the Convention applied to all detained people, which includes mental patients; that torture is defined by the victim, not by the perpetrator; and that it covered “treatment” in the broadest possible sense. Detained mental patients undergo “treatment” which many describe as “torture,” so the Convention automatically applies to them. If and when the OPCAT became law, psychiatry in this country would have to adjust very quickly.
Well, didn’t that throw the cat among the psychiatric pigeons? For the heinous crime of daring to say that some people didn’t like being locked up and jabbed, and without any warning or even a pretence of an “investigation” of my crime, I was booted out of the philosophy group. I wasn’t present at the meeting where this was decided, but I’m sure there was no argument, no question of letting the offender state his case because they were all in full agreement, a conspiracy of the like-minded (I have other examples; I’m just lucky that hemlock doesn’t grow here). For another example of psychiatry’s various conspiracies of the like-minded, you really can’t go past the place of women in psychiatry [9]. However, that will have to wait another day (as always, say the women in psychiatry).
For a good account of conspiracies in psychiatry, see Peter Simons’ detailed article on genetic testing and addictions in this week’s Mad in America. Next week, we will look at conspiracy fantasies, or fictions. I feel weak at the thought of it.
References:
1. Sagan C (1995) The Demon-Haunted World: Science as a Candle in the Dark. London: Hodder/Headline.
2. Menkes, D, Dharmawardene, V, (2019). Anti-psychiatry in 2019, and why it matters. Australian and New Zealand Journal of Psychiatry 53: 921-922. https://doi.org/10.1177/0004867419868791
3. Whitaker R, Cosgrove L (2015). Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform. New York: Palgrave MacMillan.
4. Davis LC et al. Undisclosed financial conflicts of interest in DSM-5-TR: cross sectional analysis. BMJ 2024;384:e076902. https://www.bmj.com/content/384/bmj-2023-076902
5. Harrington A (2020). Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness. New York: Norton.
6. Scull A (2022) Desperate Remedies: Psychiatry and the mysteries of mental illness. London: Penguin.
7. McLaren N (2013). Psychiatry as Ideology. Ethical Human Psychology and Psychiatry 15: 7-18. DOI 10.1891/1559-4343.15.1.7
8. Crouse JJ et al (2024). Patterns of stressful life events and polygenic scores for five mental disorders and neuroticism among adults with depression.
9. Quadrio C (1991). Women in Australian and New Zealand Psychiatry: The Fat Lady Sings. Aust. NZ J Psychiat. At: https://doi.org/10.3109/00048679109077723
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