A couple of comments to finish last week's post. In their submission to the Senate enquiry into ADHD, the college of psychiatrists said they have a "unique and comprehensive understanding" of the biological, psychological and social factors involved. This comes from their website (scroll down to Psychiatry Training/Medical expertise), which says: "Psychiatrists ... understand the impact of ‘biological’, ‘psychological’ and ‘social’ factors on mental health and the causation of mental illness. This ‘bio-psycho-social’ model is a holistic approach ... "
I have written to the president of the college of psychiatrists asking her to send a copy of their "biopsychosocial model":
As the College's choice of its ‘bio-psycho-social’ model is so central to teaching and practice in this country, I imagine there must be many academic papers on the topic, and perhaps even a text book or two. I wonder if you would be good enough to send me specific references where the concept is set out in the form of a scientific model. In particular, I would like the name of the primary author and three or four seminal references where other authors have developed and tested the idea against reality.
I don't expect a sensible answer but will keep you posted.
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A colleague sent a paper from JAMA Psychiatry (one of the Big Five psychiatric journals) on the longer-term cardiovascular side effects of ADHD medication [1]. This came from Sweden, using their national in-patient and drug registers, and followed patients prescribed ADHD medication for up to 7yrs (range 2-7, median 4yrs). As with most Scandinavian studies, it seems beyond reproach. This research is important because a person prescribed the drugs at age seven may still be taking them seventy years later, so we need to know what the side effects are. Ideally, there should have been a twenty year study starting about in about 1990, when the drugs started to explode, but academics prefer results they can publish before they die. The Swedish study concluded:
This case-control study found that long-term exposure to ADHD medications was associated with an increased risk of cardiovascular disease, especially hypertension and arterial disease.
Adverse long-term side effects from a drug? Who could possibly have expected that? They suggested: "Clinicians should regularly and consistently monitor cardiovascular signs and symptoms throughout the course of treatment." They won't, we know that.
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"Conspiracy: n. a secret plan by a group to do something unlawful or harmful."
Conspiracies are getting a bad name these days, people are pooh-poohing the idea as ridiculous, fanciful and a sign of immaturity. It's hard to keep talking when somebody has sneeringly said "Oh, you're just another conspiracy theorist." This is a great pity and I imagine all the people who work so hard and diligently to set up their conspiracies are feeling rather hurt - "disrespected" as they now say. Strangely enough, there was a lot more talk of conspiracies early in the 19th Century than there is now, and they didn't even have the internet. Or communists. Or aliens, and viruses hadn't been discovered. And the other thing in those days was, they didn't do it in secret or unlawfully. If they were going to steal somebody's country, say the Great South Land, they had a big meeting in the Admiralty with lots of yelling and even a duel or two, and then changed a few laws so it was lawful, and off they went for a bit of sport blowing the natives away.
These days, conspiracies are marvellous things and people really don't appreciate how much work goes into a good, rip-roaring (read: profitable) conspiracy. Take Enron for example. This was an American energy trading company which came from nowhere to be huge. They got control of a large part of the California market (which is pretty big) so when LA was baking under yet another heat dome, Enron switched off a few of their generating plants for urgent service ("overloaded"). As a result, they had to buy power from their plants in another state, for which they could charge ten times as much. This meant they didn't even have to laugh their way to the bank, the banks came laughing to them.
There was the Gulf of Tonkin conspiracy, which moved the Vietnam War (that is itself a conspiracy; in Vietnam, it's called the American War) from a bit of skirmishing in the jungle to a full-scale invasion; the Weapons of Mass Destruction conspiracy, which launched the Iraq War (ditto in Iraq) and so on. They're a bit difficult to run because there are so many people involved and one of them is sure to get excited and blab to his friends what they're up to. The best conspiracies are the least: when nobody actually knows it's a conspiracy, or what is called "A conspiracy of the like-minded." This is when a group of people get together to plan a campaign who don't conspire to break the law, they already believe the law is unjust and they're doing the right thing, or something like that.
It's like all those happy tourists who made their way to the Capitol building in Washington on Jan 6th nearly 3 years ago. They didn't sit in a hunched group saying "We've got to keep this quiet," they were out there, waving flags and cheering because they all, every last one of them, believed fervently "We're on the side of righteousness, everybody who disagrees is wrong and evil and is likely to get hanged." They were there because of their unspoken agreement that they couldn't possibly be wrong. And the business with the college of psychiatrists and their unseen "biopsychosocial model" is the same thing: "Yes, we're experts; no, we don't need anybody asking silly questions; yes, of course we've got a model, all experts have their models; no, we're not going to give you a copy, if you had any brains, you'd get it yourself so stop bothering us or we'll get nasty."
How does this come about? Noam Chomsky gives the best account I've seen:
Still, in the universities or in any other institution, you can often find some dissidents hanging around in the woodwork—and they can survive in one fashion or another, particularly if they get community support. But if they become too disruptive or too obstreperous—or, you know, too effective—they’re likely to be kicked out. The standard thing, though, is that they won’t make it within the institutions in the first place, particularly if they were that way when they were young—they’ll simply be weeded out somewhere along the line. So in most cases, the people who make it through the institutions and are able to remain in them have already internalized the right kinds of beliefs: it’s not a problem for them to be obedient, they already are obedient, that’s how they got there. And that’s pretty much how the ideological control system perpetuates itself in the schools (Chomsky N. The Fate of an Honest Intellectual. Understanding Power, 2002. The New Press pp. 244-248) (for the record, I don't agree with a lot of what Chomsky says but, on this, I'd say he's right).
This is generally true. If you want to be a psychiatrist, you have to toe the party line. If you challenge everything the professors say, you will be kicked out of the training program as "unstable and unsuitable," or even as a "querulous paranoid," and the college of psychiatrists has everything stitched up: you cannot work as a psychiatrist in this country unless you're a member, and you can't be a member if you upset the professors who are convinced that they and they alone know what is right. For example, when Emeritus Professor Bruce Singh of Melbourne University says: "What no one can deny is that (Engel) did leave a towering edifice, the biopsychosocial approach ..." [2, p471], you'd better believe it, even if Singh can't actually produce a copy of any such model. Does Singh believe this? I presume so. Why does he? You'll have to ask him but if you get an answer, be sure to let me know because I couldn't.
That, however, is small stuff compared with the really big "conspiracy of the like-minded": rearranging the diagnoses in the diagnostic manuals to create more mental illness. Ten years ago, I wrote several chapters on how all the people previously diagnosed as having disordered personalities were being rediagnosed as suffering from "bipolar disorder" and were put on drugs [3]. Very powerful and highly addictive drugs with a huge range of side effects, including causing premature death [4]. Of course, nobody took any notice - or should I say, the people who did notice pooh-poohed it as "conspiracy theory." But these days, bipolar disorder is so very Millennial (born 1981-96), it's what your parents get, a bit like listening to Michael Jackson or Prince. What is needed is something up to the minute, something that will appeal to Generation Z (late 90s to early 2010s). For a while, it looked as though autism might do but there's no money in that and they don't cause much trouble so somebody remembered ADHD. A winner: rediagnose all the people with personality disorders as suffering the mental illness called ADHD, put them on powerful, addictive drugs and then sit back to watch the money roll in.
Was there a secret meeting where all of this was hammered out in the full knowledge that it was "something unlawful or harmful"? No, of courses not. It was all done in full daylight at dozens of psychiatric conferences and in a hundred university departments. Their "discussions" were published and then eager young researchers leapt into action to prove that what had previously been called "personality disorder," for which psychiatry has no treatment and doesn't make any money, is actually a dread mental disease that, untreated, will lead to ...
… relationship problems, family breakdown, poor academic achievement, increased unemployment, teenage pregnancy, abuse, anxiety, depression, eating disorders, substance misuse, suicide ideation and completion, accident and injury, criminality and incarceration, physical health problems, and decreased life expectancy [5].
That's enough to scare most parents silly. They're not going to argue but will drag their unwilling brood to see the psychiatrist who will solemnly declare: "Yes, a serious case, you need the drugs for life." Does the psychiatrist believe it? Of course: as Chomsky said, "it’s not a problem for them to be obedient, they already are obedient, that’s how they got there."
If you take a group of people who have been trained to believe practically everything an "authority" says; who are incentivised to keep themselves in business; who stand to make heaps of dough from something that takes no intellectual effort at all; that gets them lots of attention at meetings and in the media; and who are given a set of diagnostic criteria that are supposedly "scientific and objective" but are actually loose and highly subjective, and they have a choice of a diagnosis that will get them nothing (personality disorder), or one that will keep the patient coming back year after year (mental illness), what are they going to do? We know what they will do, as Upton Sinclair said years ago:
It's difficult to get a man to understand something when his salary depends on his not understanding it.
When it's not just his (or her) salary, it's the enormous prestige of being first in town to lead the way to saving innocent children from a genetic disaster, and the power to dominate people, not to mention huge rewards from drug companies, the outcome is so so predictable. In her regular Substack, author and reporter Caitlin Johnstone said "If you deny conspiracies exist, all you're saying is you believe all the rubbish that's fed to you." Too true. Secret conspiracies are a bit of a problem as they often come unstuck (like Enron), but the best ones are hiding in plain sight (like ADHD).
Referenc es:
1. Attention-Deficit/Hyperactivity Disorder Medications and Long-Term Risk of Cardiovascular Diseases. doi:10.1001/jamapsychiatry.2023.4294 (ten authors, all with PhDs).
2. Singh BS. George Engel: a personal reminiscence. Aust N Z J Psychiatry 2002; 36: 467-471.
3. McLaren N (2012). The Mind-Body Problem Explained: The Biocognitive Model for Psychiatry. Ann Arbor, MI: Future Psychiatry Press. Chapters 14-16.
4. World Health Organisation: Premature death among people with severe mental disorders. Geneva, 2015. This paper summarises the material.
5. Report of Senate Enquiry into ADHD: pt 2.7, p33: Australian ADHD Professionals Association (AADPA).
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