On Fighting the Existing Reality

The phony one.

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.

If you like what you read, please click the “like” button at the bottom of the text, it helps spread the posts to new readers. If you want to comment, please use the link at the end rather than email me as they get lost and nobody sees them.

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After last week’s post, a reader emailed:

These scholarly posts are all very well and have the ring of truth, but the question that arises is, now what? Where is the call to action? Otherwise, they may help to increase the sales of your books, and good luck to you with this, but where does it lead us? You are either preaching to the converted, or are one of several voices crying in the wilderness. Do you hope that by a process of attrition, in a few decades orthodox psychiatry will fade away? I hope it will, and soon. We need to call for the disestablishment of orthodox psychiatry and the banning of so-called psychiatric drugs, except in a few well-defined circumstances such as benzodiazepines for short-term use in acute mania. As I have said before, psychiatric so-called diagnoses have no objective basis and mental distress should be treated with psychotherapy, not drugging.

It’s a bit disappointing that this stuff has only a “ring of truth,” I would like to think the arguments are unassailable but there you are. Also, royalties from the books would barely feed a small pet rat for the year, which is true of practically all technical books but we soldier on. As for preaching to the converted, yes, to a large extent that’s true as mainstream psychiatrists and their keen supporters don’t read critical material but they’re not my audience. Their minds are made up, they resent uncomfortable facts getting in the way and react angrily to questioning. From the point of view of critical developments within psychiatry, they’re a lost cause, as the renowned nuclear physicist Max Planck described:

A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it (The philosophy of physics, 1936).

In particular, psychiatry’s mainstream, who are practically all devout biological psychiatrists, control the narrative. They decide who is allowed to speak at conferences, whose papers get published, who can teach medical students and trainees (residents), who sits on the college board, who gets the various posts in the college etc., and they’re ruthless in their control. There are so many examples, I wouldn’t know where to start but one from history is illuminating. Readers will be aware that it is about a century since convulsive techniques were first used in psychiatry, for the explicit purpose of inducing diffuse, low grade brain damage. Almost as soon as insulin was isolated, it was used to cause convulsions by lowering blood sugar and it quickly became very popular among psychiatrists. However, it was very demanding of staff time so it turned out that a small group of patients were getting up to 90% of the time and effort while the rest sat in the back wards twiddling their thumbs.

In 1953, a registrar (trainee) in London published a statistical analysis in Lancet showing that all the benefits attributed to insulin therapy were, in fact, pure placebo [1]; it was the staff attention that was doing the job, not the insulin. The establishment of British psychiatry were incensed: how dare this young upstart think that his figures could disprove their long clinical experience and their impeccable judgement? They made sure he couldn’t get work so he had to leave the country for New Zealand, where he was very popular (BTW, that also happened to philosopher Karl Popper, who was both German and Jewish by descent. He went to the UK in 1936 but couldn’t get work so he went to Christchurch and survived the war, to our lasting benefit). It took years for psychiatrists to accept that their “insulin therapy” had nothing to do with whether patients got better, the old generation had to retire and make room for more open minds. This illustrates the point made by Richard Buckminster Fuller (1895-1983), an American architect, designer and futurist (and relentless self-publicist):

You never change something by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.

My experience is that fighting the “reality” purveyed by the psychiatric establishment is a compete waste of effort. They are so firmly stuck in their particular way of thinking that criticism simply bounces off. Take one of my sore spots: the spurious biopsychosocial model (BPSM). As you’re probably tired of reading, this is essentially written into the RANZCP’s charter. According to the then president of the college, the BPSM is the basis of teaching and clinical practice in Australia and New Zealand, with similar sentiment in the UK and other places. That is a lie. At the time she wrote that, she knew perfectly well that it didn’t exist [2]. She and her successor have refused to provide any evidence to show that it does exist, they don’t even respond to letters. Moreover, they’re protected from any consequences, all the way up. It is impossible to get anybody to take the matter seriously as they’re all complicit, all the boards and supervisory agencies are stacked with their friends, the top professors in the country ring the important politicians who are thrilled to be on first name terms with the top professors in the country, and so on.

This sort of intellectual incest is not a freak case, this is NORMAL, this is how these people run their empire. They’re like Trump: he lies and lies and gets away with it but it raises a question: do they know they’re lying? If all your friends are saying the same thing, are you lying to repeat it or just a a sheep following the flock because it’s safer? The same thing is true of their so-called “biomedical model,” the one that justifies all the drugs and decides who gets the influential posts and the big research money. This runs the show, it’s behind the signs in public toilets: “Feeling anxious or depressed? See your doctor” (who will give you tablets). Again, it doesn’t exist [3]. Every attempt I’ve made to get one of its supporters to provide a copy has failed.

You would think that they’d be very keen to prove a critic wrong: if you believe your model is the basis of good practice, shouldn’t you send it to doubters to bring them back on the path of righteousness? Apparently not, which is exactly what Buckminster Fuller had in mind: Don’t waste your time “fighting the existing reality.” Having built their lives around either of these phony “models,” psychiatrists are so heavily invested in their version of reality that they’re incapable of considering an alternative. Facts, figures, carefully argued cases, they just bounce off the walls of armourplate the establishment has built over the years because doubt is too scary for them. That’s human, nobody likes looking stupid so we move to the second part of Fuller’s injunction: build a model to replace the existing reality. After forty years of effort, that’s now been done [4] so now I can sit back and wait for the honours and royalties to roll in. But nothing happens. The establishment’s walls are so thick that they don’t even know there’s “a new model that makes the existing model obsolete.” They don’t know because they don’t want to know. Journals won’t review it; complementary copies are sent to bigwigs but don’t get a response, science reporters on TV and big papers don’t answer, on and on. This is normal, this is how science is conducted, as science writer and general practitioner, Robert Youngson, noted:

The idea that (scientists) are engaged in a calmly disinterested search for truth and are totally unaffected by such unworthy considerations as personal pride, competitiveness and envy is a dream of adolescent idealism [5, p60].

According to the experts, the critical psychiatry movement is doing everything right. We have highly qualified people investigating the claims made by conventional psychiatrists, examining their figures and showing exactly how and where they’ve fudged the results. John Read in London studies ECT [6]; Joanna Moncreiff and her team look into antidepressants [7], Mark Horowitz and colleagues show that psychiatric drugs are addictive and how to get off them [8], Jon Jureidini and Co. in Adelaide [9] dredge through clinical studies to show how the claims aren’t substantiated, and so on but who listens? There is a regular international conference on overdiagnosis and overprescription; I’ve been to several but you just see the same old faces each time, and nothing changes, as Robert Youngson noted (rather sadly):

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].

He was talking about conventional sciences, such as physics and chemistry but remember that psychiatry is hardly mainstream science. It’s not even mainstream medicine and a large part of the problem is that psychiatrists themselves don’t know what to focus on. Does psychiatry deal with the mind or does it not? If we assume it does, then it opens a Pandora’s box of woes: What is the nature of the mind, how does it arise, how does it interact with the body, how does it become disordered, does free will exist, where are the boundaries of disorder, where is the borderline of morality, what is personality, and thence personality disorder…? There’s no limit. Oh, and the biggest one of all: who should deal with mental trouble? Should it be physicians, priests, secular moralists, poets and playwrights, school teachers, sports trainers, militarists and disciplinarians, prison guards…? And how: punishment, drugs, surgery, spells, criticism, holidays, sex and other indulgences…? Again, no limit.

I can state straight away: psychiatrists aren’t fit even to begin answering those types of questions. That’s far above their pay grade so it was a godsend when, in 1929, the positivist cavalry rode in and, with a firm proclamation, put a stop to all the headachey stuff [10]. Henceforth, they announced, science is about what we can see, measure and duplicate. If you want to be seen as a serious scientist, give up all that mimsy stuff, put on a white lab coat and march to our stern drumbeat to the uplands of sober rationality. But if certainty is not your scene, then join the poets and philosophers over there bickering about flowers and fairies and never coming to a conclusion.

“Excuse us, good sir rationalists,” said the psychiatrists, “but we want to talk about minds and yet stay with our medical colleagues. Can we have a dispensation and a clean white coat?”

“Can you see the mind?” demanded the imperious voice. “Can you measure it? Can you bring us the leg of a superego, can you distil essence of guilt in a bottle? No? Then off you go, join the shamans and thaumaturges with their ouija boards and tarot cards, their meridians and crystals, and don’t waste our precious time.”

It was not a good day for psychiatry. Forlornly, they gathered their bits and pieces and made ready to cross the bridge to the land called Fantasy until suddenly, somebody pushed through the crowd and stood boldly before the officers of positivism. “You’re mistaken, sirrah,” said the confident young voice. “We psychiatrists claim our right to march behind the banners of science. Our field is not, as people suspect, matters of whimsy such as mind and emotions, hopes and ambitions, no, we are scientists of the brain. Out with the ego, in with the microscope and bunsen burner and onward to the brave new world of clinical neuroscience.” With a ragged cheer, the psychiatrists scuttled back to the join the quiet and disciplined lines of physicians, there to hide behind the neurologists and immunologists, close to the pharmacologists where they were soon harnessed with a bit shoved in their mouths by the drug companies. So it has continued to this day, with each generation of medical students and psychiatry trainees dipped head first in a bucket of biological Kool-Aid and left there until they drank the lot.

That’s a bit poetic but the message is quite clear. Positivism, the ruling doctine in modern science actively excludes any and all non-empirical matters, i.e. anything that cannot be directly traced to experience. All frankly mental matters such as morality, art, religion, ethics, creativity and so on, meaning everything that distinguishes us from animals, is excluded from the purview of science. In particular, this means philosophy of mind is excluded. Logic gets through as it’s sort of mathematical, but nobody in psychiatry talks about the mental medium in which the logical processes take place. We end up with a group of people granted extraordinary civil power by society who know nothing about the moral or other limits to that power. Above all, they resent being questioned because they don’t recognise the right of anybody to question them on matters that their own (very restricted) frame of reference tells them are meaningless. If you try to ask a psychiatrist about the difference between science and pseudoscience, a very important issue in philosophy of science [11], they just change the subject or stamp off. Or start accusing you of being aggressive.

If you say, as Thomas Insel, former long-time director of the US NIMH, says, that the techniques and processes of ordinary laboratory science will tell us all we need to know about mental disorder [12], then you have made a metaphysical decision, meaning a matter that has to be argued from first principles because there is no observational evidence that can bear on it. That is, you have made a philosophical decision. But if you have previously decided that no matters of philosophy count, then you’re stuck because you can’t tell if your decision was wrong. The only knowledge that can convince biological psychiatrists they are wrong is knowledge they have already ruled inadmissible. By this means, science degenerates into dogma. This, of course, is the basis of their supreme confidence, confidence that comes across as unfettered arrogance. In fact, it is the arrogance of sublime ignorance.

If anybody knows how to break through that wall (by legal means), let me know because everything I’ve tried has gone nowhere. We’ve reached peak biological psychiatry, the promises remain unfulfilled, the repetitious rhetoric no longer impresses. All we can do is create enough noise to let the rising generation know that all is not well in psychiatry and hope they run with that. I think it will happen but first, they have to free themselves of the strait jacket of naïve positivism. That’s a hoot: psychiatrists in a strait jacket, but it’s true.

References:

1. Bourne, H. (1953). The insulin myth. Lancet. ii. (Nov 7 ) 265 (6798): 964–8.

2. McLaren N (2023). The Biopsychosocial Model and Scientific Deception. Ethical Human Psychology and Psychiatry, 25: 106-118.doi:10.1891/EHPP-2023-0008.

3. McLaren N (2013). Psychiatry as Ideology. Ethical Human Psychology and Psychiatry 15: 7-18. 10.1891/1559-4343.15.1.7

4. McLaren N (2021): Natural Dualism and Mental Disorder: The biocognitive model for psychiatry. London: Routledge. Amazon

5. Youngson, R (1988). Scientific blunders: a brief history of how wrong scientists can sometimes be. London: Robinson.

6. Read J, Ross C, Timimi S (2022). A study of ECT on 278 children and adolescents; methodological, conceptual, and ethical concerns. Brain and Behaviour 26 December 2022 https://doi.org/10.1002/brb3.2866.

7. Moncrieff, J., Cooper, R.E., Stockmann, T. et al. (2022) The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry Published online July 20th 2022. https://doi.org/10.1038/s41380-022-01661-0

8. Taylor D, Horowitz M (2024). The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs.London: Wiley-Blackwell.

9. Aboustate N et al (2025). Restoring TADS: RIAT reanalysis of the Treatment for Adolescents with Depression Study. Int J Risk Saf Med. N/S, p1-20. DOI: 10.1177/09246479251337879

10. Hahn H, Neurath O, Carnap R (1929). The Scientific Conception of the World: The Vienna Circle. Ernst Mach Society, University of Vienna.

11. Pigliucci M, Boudry M (2022). Philosophy of Pseudoscience: Reconsidering the Demarcation Problem. Chicago: University Press.

12. Insel TR, Freund M (2012). Shedding light on brain circuits. Biological Psychiatry; 71:1028-9.

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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.