On Smelly Corpses

They can’t be concealed forever.

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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About fifteen years ago, I gave a lecture at a prestigious university in Boston. I had been invited by the deputy director of the department and was introduced to the director just beforehand. They sat in the front row, directly opposite the lecturn. Within a few minutes, when the direction of my talk was becoming clear, I could see that the director was becoming quite agitated. Once or twice, he muttered to his deputy then, after about ten minutes, he jumped to his feet, rushed to the lecturn and snatched the microphone to deliver a long, impassioned rant to the audience. After about five minutes, he muttered something about “making that clear” (which it hadn’t) and resumed his seat. I didn’t know what to say but it was clear that everybody in the lecture theatre was embarrassed so I just continued with my talk as though nothing had happened. It’s a bit surprising then to see a couple of articles in the online mag Psychiatric Times from an influential psychiatrist in Boston, arguing that American psychiatry is little short of a disaster:

DSM itself is vague and meaningless, and it is intended to be so, although the profession has been in denial about this fact … the leaders of DSM-III defended their approach by saying it was atheoretical—which means it is meaningless. If you have no theory, then you have no idea what you are thinking or saying.

Has he been reading my stuff? If so, he’s in danger of being run out of town. In the second article, he was even less polite: the DSM system killed psychopathology: “We have been living with a smelly corpse ever since. That is modern psychiatry.” Wow, psychiatry stinks? Who would have guessed? If I’d submitted something like that, it would have gone straight in the bin, but the authors are good friends of the editors. But maybe this signals something, that after half a century of propaganda on how wonderful psychiatry is, the mainstream is (very reluctantly) coming to see that there is something seriously wrong with the whole deal. However, it’s not just the DSM system, although we’ve known forever that it’s artificial [1]. It’s not just the lack of a formal theory [2], it goes much deeper, right to the very foundations on which psychiatry as a medical discipline (I use the term advisedly) is built. Understanding how this came about requires some knowledge of psychiatry’s truly appalling history [3,4] but even that skims over the real issue as the pressures came from outside medicine and outside psychology.

Every culture studied has shown that people recognise when a person is “not right in the head.” They understand that some children fail to develop at that same rate and are incapable of taking full adult responsibilities. In traditional Aboriginal societies, handicapped children could not undergo the initiation ceremonies leading to adulthood. Many of them practised infanticide just because the nomadic tribes could not be held back by one child. At the other end of life, people have always recognised that elderly people can lose their minds, slipping back to a “second childhood” until they finally expire. Mental changes after head injuries or chronic epilepsy were clearly understood, as well as the apparently random deterioration in teenage years we now know as schizophrenia (previously dementia praecox, or precocious dementia). I think every culture has recognised nervous people, and suicide has been with us forever.

Recognising mental disturbance is one thing; explaining it something else again. There have always been two schools of thought. The first, which goes far back, is what we would call the psychological school, that the disturbance is entirely a mental phenomenon brought about by mental activity. It might be moral, in that the person has knowingly behaved in an immoral way and now has to suffer to make up for it, or what we would call a personality defect, that the person is missing some vital component of the well-rounded person and will never amount to much. Somewhere in this is the (probably older) idea that mental disturbance can be inflicted on a previously normal person by some sort of supernatural means, either a magic spell or possession by an alien spirit.

The second and currently dominant idea is that mental disturbance is the result of some sort of physical change in the body, traditionally something in the diet. While the Greeks were strong on the idea of moral suffering, the more practical Romans were fairly sure it was all dietary and could be cured by what you eat. Thai traditional medicine is based on the idea of internal winds blowing in the wrong place, for which massage is necessary in order to squeeze the breezes back to their proper order. They use very little in the way of herbals or other remedies, unlike say Chinese traditional medicine, which uses a lot. Other cultures practised trepanning, drilling holes in the head for different reasons such as to release blood accumulations, or to relieve headaches or mental disorder, or to let evil spirits out.

Western societies have always accepted the reality of mental disorder but have never been able to decide on a cause or a form of treatment. Is it psychological/moral or is mental disorder just a special case of physical illness of the body? The idea that it is physical and therefore needs a physical cure has always been dominant but it was never clearly defined. Benjamin Rush (1745-1813), one of the signatories of the US Declaration of Independence, a physician now lauded as the “father of American psychiatry” was convinced it was physical: “Mental disease is brain disease,” but he firmly believed that fear played a big part in treatment. The more terrified the patient, the better the outcome, so he made sure they were scared witless. They didn’t come back for more, which convinced him they had been cured, so he cranked it up for the next lot.

Similarly, the idea that mental disorder represented some kind of “brain degeneration” was strong in Europe. Generally it was seen as hereditary but it could also be triggered by intemperance, such as alcohol or gambling, a bad fright but also masturbation [5]. In the main, physicians working in public mental asylums believed in physical causes and physical treatments while private practice tended to the moral. Then along came Freud. Sigmund Freud (1856-1939) was a Viennese neurologist who went to Paris to study under the great Jean-Martin Charcot (1825-1893), best known now for his studies on hysteria but he was a neurologist first and last. Charcot believed hysteria was a familial degeneration of the brain and used hypnosis to study and treat it, which blurred the issue.

When Freud returned to Vienna, he started a private practice but he was not a good hypnotist so he eventually settled on getting people to talk. Based on his results, and probably on a great deal of what we would call manipulation of his data [6], he constructed an enormously complex psychological model of human mental life. However, from the beginning, he saw himself as a scientist working with the brain, and was convinced that biology would one day explain psychology. In 1895, he published a long paper in which he tried to explain mental life in physical terms:

The intention of this project is to furnish us with a psychology which shall be a natural science: its aim, that is, is to represent psychical processes as quantitatively determined states of specifiable material particles and so to make them plain and void of contradictions [7].

It didn’t work, of course, his model of mental function was essentially that of the science of the day, hydrodynamics. He talked of pressure in neurons as a direct cause of mental disturbances: high pressure in the nerves led to lots of talking and agitation, while low pressure caused the apathy of depression. It went nowhere, of course, it was a century too early and entirely the wrong model but, armed with the simplistic idea of pressures of the mind, his followers abandoned biology and took off into the blue. With no ties to verifiable reality, his ideas became dominant in American academic and private psychiatry so that DSM-II, from about 1952, was written in psychoanalytic terms. The problem was that no two psychiatrists agreed on what those terms meant, and so American psychiatry drifted toward the rocks. Then psychiatric drugs were invented so, by about 1970, there was talk of revolution. Psychiatry had to be brought into line with ordinary scientific standards otherwise it could collapse into scandal.

So what were those standards? Well, this is the bit the Psych Times articles from Boston left out. For fifty years while Freudian psychiatry had been happily peering up its id, real science was roaring ahead on all fronts, powered by a set of perfectly rational but rigid rules. These were set out in a manifesto in 1929 by a group of physicists, mathematicians and logicians, mainly in Vienna, so they are always known as the Vienna Circle of positivist science [8]. Science, they said, must be firmly anchored in reality, and the anchors are observation and measurement. If it can’t be observed, if it can’t be measured, then science has no business with it. By that stage, of course, the hard sciences such as physics, chemistry, mathematics and so on were already on board. Biology quickly dumped all its old metaphysical pretensions and has never looked back, to the extent that today, nobody actually remembers that it was ever any different. Hardly anybody in mainstream science has heard of the Vienna Circle or their revolutionary positivist manifesto. As I’ve probably mentioned, my high school course was weighted toward science and maths, followed by six years of medical school, later four years of psychiatry, followed by several years of philosophy, including philosophy of science but nobody, not one person ever said to me: “What you are studying is positivist science.” As far as they were all concerned, there was only one sort of science so it didn’t need a name. But it does, because after a hundred years, the manifesto is out of date. Science has expanded and engulfed new territories, and this is why modern psychiatry is a stinking corpse waiting to be buried.

Justifying all these claims would take several large books; I can only outline the important points. First, the positivist ethos is that science is about observables. Anything unobservable must be put aside, which is why people these days are so adamant that animals don’t have minds. That’s unproven, of course, an ideological stance, because if they do, we shouldn’t torture them in laboratories or eat them. Second, the early positivists were taken in by Freud’s talk of reducing the mind to biology, so they gave him a cap that said “Chief scientist of the mind,” and let his seriously disreputable followers through the door. There were warnings, of course, but they were ignored. Philosopher Karl Popper regarded psychoanalysts as charlatans as did, oddly enough, the novelist Vladimir Nabokov, of Lolita fame. Or infamy, seeing that Epstein’s plane was known as the Lolita Express. Anyway, everybody quickly forgot Freud’s foray into the biology of mind, meaning psychoanalytic-type psychiatry was able to integrate itself into medicine without any biological foundation.

By 1970, what had seemed like a really bright move had degenerated into a sort of midlife crisis, so psychiatry abruptly decided to reinvent itself as a rigidly biological “science of the mind.” Driven by the dictates of positivist philosophy (which I doubt any of them had read), they firmly applied the rule that anything unobservable must be put aside which, of course, includes the mind. Just as the early psychoanalysts tried to build a psychiatry divorced from biology, so the moderns have tried to build a psychiatry with no points of contact with psychology. That doesn’t seem to make any sense: mental troubles are all about the mind. If you take away the mental component, there’s nothing left. Aha, said the clever doctors, not so fast. What you mental people think is a statement about your minds, such as “I feel so sad,” is actually a statement about your brain, as in “My serotonin is getting a bit low.” And we’ve got just the pill for you. Next please.

When it’s put that way, it doesn’t make any sense but they were caught up in a sort of frenzy, whipped up by the idea that one find day, science would come riding to the rescue and explain it all. This is known as promissory materialism and, as they should have known, it’s the weakest basis of all for a scientific program. In terms of psychiatry, as I’ve been shouting for decades, it’s potentially a recipe for disaster in that nobody has ever shown how knowing about the brain can explain anything interesting about the person. As a society, we now put people on huge amounts of drugs for life without knowing what the drugs are doing or their long term effects, and so the disaster is now upon us (see this week’s MIA re a good article on drugs and “ADHD”; also one on antidepressants).

The historical reasons for all this are quite clear. A hundred years ago, psychiatrists were wandering in circles. Suddenly, Freud’s arcane psychological theories seemed to promise a clear path forward, so they leapt aboard his train, leaving biology on the platform. Fifty years ago, the wheels were falling off the psychoanalytic express so psychiatrists jumped off and straight onto a biological train going in the opposite direction, but without checking to see whether it would ever get near where they wanted. It hasn’t delivered. Instead, it has consumed resources, research effort, patients’ lives and community credibility but still it roars on through the darkness, whistle blaring, with no sign that the drivers know where they’re going. “Trust us,” they say, “we’re experts. Just have another pill and lie back, it can’t be far now.” But it is, because it’s heading in the wrong direction.

A psychiatry divorced from biology is a psychiatry without limits. There is nothing to stop the adventurers and dreamers (and the crooks, because they exist) from wandering into the supernatural, and that’s what happens. It was a small step from Freud’s sexual obsessions to Carl Jung’s weird “collective unconscious” and spiritual powers. However, a psychiatry divorced from mental life is dehumanising, a sterile process of hammering people into little diagnostic boxes and drugging them until they stop complaining. Everything human is stripped away, leading to ever-expanding lists of diagnoses and toxic, expensive drugs with no end in sight. As Thorsten Veblen said “Nothing could be more profoundly and meticulously deliberate than the measured footsteps of a man who no longer knows where he is going, though he is on his way” (1915).

As it exists today, psychiatric pseudoscience is a hindrance to apprehending human distress: “If you have no theory, then you have no idea what you are thinking or saying.” It’s time for a change. The whole point of a religious or political education is to do exactly as your teachers say. The whole point of a scientific education is to overthrow your teachers.

I’ll be having a break next week. We can only hope for a better 2026.

References:

1. McLaren N (2007). The categorical system of diagnosis: Personality Disorder. Chapter 8 in Humanizing Madness: Psychiatry and the Cognitive Neurosciences.; Ann Arbor, Mi.: Future Psychiatry Press.

2. McLaren N (2024). Theories in Psychiatry: building a post-positivist psychiatry. Ann Arbor, MI: Future Psychiatry Press. Amazon.

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

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

5. Zachar P, Kendler K (2023). Masturbatory insanity: the history of an idea, revisited. Psychological Medicine 53: 3777–3782. https://doi.org/10.1017/S0033291723001435

6. Masson JM (1984). The Assault on Truth: Freud’s suppression of the seduction theory. New York: Simon and Schuster.

7. Freud S (1895). Project for a Scientific Psychology. https://www.scribd.com/doc/205134470/Project-for-a-Scientific-Psychology-by-Sigmund-Freud

8. Hahn H, Neurath O, Carnap R (1929). The Scientific Conception of the World: The Vienna Circle. Ernst Mach Society, University of Vienna. http://rreece.github.io/philosophy-reading-list/docs/the-scientific-conception-of-the-world-the-vienna-circle.pdf

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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.