On the Edges of Science

Science as a Candle in the Dark (Carl Sagan)

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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Anybody with a mental disorder or a troubled relative or friend wants to know that safe and effective help is readily available at reasonable cost with minimal disturbance to life. That’s a basic human right. If you listen to mainstream psychiatry, you will hear that, as a valid medical speciality, modern psychiatry stands right behind you. Firmly based in the latest scientific advances, psychiatry is racing ahead in the fight to free humanity from the scourge of mental disorder. Here in the land of Oz and internationally, psychiatrists of the highest repute regularly announce that their work is guided by either a biomedical model (BMM) or a biopsychosocial model (BPSM). For example, Position Statement No. 80 of the Royal Australian and New Zealand College of Psychiatrists (RANZCP), currently in force, states:

Medical expertise: Psychiatrists apply their medical knowledge, specialist clinical skills and acumen in the provision of person-centred care. They 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 that recognises the impact of social adversity and physical health on mental well-being [1].

In a letter dated Nov. 20th 2023, the then-RANZCP president stated: “... the biopsychosocial model (is) ...the predominant theoretical framework underpinning contemporary psychiatry ... a relevant and useful component of training and practice ... “ This refers to the paper published in 1977 by the late George Engel, a gastroenterologist of Rochester, NY [2]. However, readers will probably know that, since 1998, I have been saying that this model doesn’t exist. Similarly, an extensive search of the literature in 2013 showed no evidence that their BMM exists, either. That is, psychiatry lacks the essential element of any field claiming scientific status, an articulated, publically-available model of their field of interest. Psychiatry therefore has no basis in science and is protoscience at best or, more likely, pseudoscience (summarised in [3]).

This doesn’t go down very well with the mainstream who regularly accuse me of being outrageous, prejudiced, dangerous, ignorant, biased, ridiculous or anti-psychiatry, or all of the above, and that’s fine. They’re entitled to their opinions but, when asked to provide proof of their chosen model, they suddenly go quiet. All I want is a copy of their model so we can move on, but I never hear from them again, including that RANZCP prez and her successor. Now this is a bit strange. You’d think it would be the easiest thing of all to prove their scientific credentials, just pull out a copy of the model and hold it up. Bizarrely, that doesn’t happen. They don’t respond to repeated emails or to copies of my papers canning their supposed models. Silence reigns, which I take to be the silence of ignorance exposed – or deception.

While we’re waiting for them to reply, I’ll mention a reader this week who wondered whether faecal microbiome transplants (FMT) would be the “next big thing for psychiatry.” In this procedure, bowel material with its zillions of bacteria from a healthy person is inserted into the bowel of somebody suffering some disorder to repopulate their bowel flora. Mostly, it’s used where a dangerous or damaging bug has taken over for some reason, including over-use of antibiotics, but FMT has been tried for other condtions as well. For psychiatry, the story is that bowel material from a healthy person can relieve anxiety or depression, but the process can be reversed: a transplant from a mentally-troubled person will produce the same symptoms in the recipient.

How was this remarkable discovery made? Who decided to give it a try? That I don’t know or care; all that counts is their justification because without that, it isn’t science. In fact, there isn’t one. It’s all supposition, a few chance associations combined with studies in mice and rats. Truly. Apart from some suggestions that, for good and for ill, immune and brain functions are influenced by the state of the bowel, nobody has any idea how this would work. In any event, it appears to work for only a short period; any improvement has faded within a few months, which suggests depression and anxiety influence the bowel rather than vice versa. I don’t think that’s earth shattering. Moreover, anybody who wants to make something of it has to deal with the notorious publication bias: results that support an idea are more likely to be published than negative results. There could have been half a dozen suppressed failures for every successful project published. As we see with the so-called “biopsychosocial model,” editors are hostile to anything that exposes their favourite idea as a mirage.

Some time ago, I mentioned a study that “proved” depression isn’t caused by bad life experiences [4]. According to the prime author, depression is caused by genes, and it’s the genes that give you bad life experiences. That will be news to teenagers in Ukraine who have been exposed to the fighting: about 15% of over 5,000 young people reported high levels of depression, post-traumatic symptoms, other anxiety problems, and high levels of suicidal thinking. The same has been found in children in Gaza: up to 80% report they would rather be dead than endure the bombings and destruction of their lives. Who’s right? Is mental disorder all genetic or do life experiences have an effect? This is why the argument over the scientific status of psychiatry counts: it’s not just hair-splitting, we’re talking of people’s lives.

Moving on, we bump into yet another giant study of the “genetics” of mental disorder [5]. Written by the usual 50 or 60 authors from around the world, it combined the genetic results of about a million patients with 14 separate disorders, put them through the usual impenetrable statistical analysis:

We used multivariate GWAS within genomic SEM34 to identify SNPs associated with the factors from the five-factor model or the p-factor in the hierarchical model. Similar to the Q_Trait metric, we estimated factor-specific Q_SNP heterogeneity statistics. This indexes SNPs that deviate strongly from the factor structure, due to either disorder-specific or directionally discordant effects. We defined genomic hits for the factors as those that were significant after Bonferroni correction (P < 5 × 10−8/6 genomic factors) and did not overlap with Q_SNP hits for that factor. Most hits were identified for the SB (n = 102) and Internalizing (n = 150) factors (p3).

They found… well, hang on, what did they find? Does it explain why children become agitated and distressed after somebody has been throwing bombs at them? No. It doesn’t explain anything. They may find an association between some genetic structure and a particular mental state but these studies all overlook the fact that most people with the mental problem don’t have that gene structure, and most people with the gene structure don’t develop the mental problem. Life experiences are a far better predictor of mental state than some arcane genomic study could ever be. This is not science.

Well, say the geneticists, we’re exploring possibilities; that doesn’t mean psychiatry is a pseudoscience. For example, as the poo-swapping advocate pointed out, people were inoculated with cow pox to prevent smallpox for a hundred years before anybody knew about viruses. It was effective, therefore it was science. Same for preventing scurvy by eating a lime a day. Nobody knew about Vitamin C but they knew lime juice stopped your teeth falling out, so that was science, not pseudoscience, and psychiatry is in the same boat. We may not know how drugs work but we can trust the results, so that means psychiatry is a science.

No. Wrong again. There’s a profound difference between knowing that something works, and knowing why it works, and that just is the difference between non-science and science. For most of human history, medicine was a mixture of magic, religion and old wives’ tales. Some of it worked, most didn’t. For example, the Aboriginal people of northern Australia used an infusion of melaleuca leaves (paperbark) to treat skin infections, wounds etc. It’s since been found that the oil of the leaves has mild antibacterial properties, now sold as cajeput oil (even if it doesn’t actually work, it smells like it should). However, the locals who used it knew nothing about germs or healing. They didn’t know why it worked, only that it worked, i.e. it was a folk remedy. Maybe they had some sort of explanation or maybe they didn’t but it didn’t change anything: it was still a folk remedy.

Same goes for Edward Jenner when, in 1796, he infected 8 year old James Phipps with pus from a cowpox blister. The good doctor knew nothing about immunology, or about viruses or anything that we would now consider fundamental to health. That was not a scientific experiment. It was an experiment in folk medicine that turned out to have a good result. Ten million other folk remedies didn’t do any good or, like bleeding, even killed the patient (e.g. George Washington). It’s not science just because it has a good outcome, that’s called luck. Science is when you know what you’re doing, you’re aware of the risks and you press ahead and, if it fails, you can explain why and improve next time. A child mixing vinegar and carb soda to make a bang is not conducting science. Science is not what scientists do, it’s what they think.

Question then arises: do psychiatrists know what they’re doing? Do they have a formal, articulated theoretical base that justifies what they do? By using ECT, are they conducting a scientific treatment or is this just a folk remedy that happens to work? (my case is that it doesn’t work, that it’s unnecessary and it’s mercenary [6]). When people’s brains were being cut willy-nilly in what was called “psychosurgery” (talk about an oxymoron), was that science? Absolutely not even though, at the time and long after, it was touted as a major scientific breakthrough. The history of that episode is simply appalling [7; see here for a chilling video]. When phenothiazines were discovered, as an accident of research in antihistamines, they were marketed as producing a “chemical lobotomy.” They were found because they sedated rats that had been given electric shocks through their feet (rats have very sensitive feet) so somebody thought it would be a good idea to try them on mental patients. The idea that they are specific antipsychotic drugs, like aspirin is specific for fever, came much later (see Joanna Moncrieff on how they were marketed). Same goes for ECT (killing pigs) or when Egas Moniz saw a chimp with parts of its brain missing and “borrowed” some mental patients to try it on them. This is the standard tradition of psychiatry: find two data points, connect them with a thick wodge of obscure jargon and convince a grants committee, who either don’t know any better or are already on side, to shell out the loot. See last week’s post for the same sort of thing on SSRIs and aggression.

There is a difference between a valid treatment based in a formal web of science, versus a folk remedy that works. The whole point of modern science is that the scientist or technologist works within a vast network of knowledge (i.e. justified true belief). Nothing exists in isolation. A few minutes ago, I put some antibiotic drops in my eyes following recent surgery. The antibiotic is manufactured either by a tightly controlled fermentation process, or by direct synthesis from precursors. All of this rests on more science: bacteriology, how to make stainless steel retorts, the production of electricity and its distribution over the grid, on and on. The anaesthetic wasn’t just a matter of “try this,” it was a highly disciplined application of precisely manufacured chemicals controlled by machines like ECG, pulse oximeter, etc. The surgeon was using an electronically-controlled operating microscope to take 0.5mm specimens that were assayed for surface antigens to see if it would respond to monoclonal antibodies; the PET scan was clear; so now I’m getting rituximab and I’m fine. All of this is the web of science, nothing exists in isolation. By way of comparison, what does psychiatry have to offer?

Nothing. Just the same weary cliché, a “chemical imbalance of the brain” that is used to explain everything. Nobody has ever proven this exists (even the RANZCP has had to acknowledge it doesn’t exist) but anyway, if it explains everything, it explains nothing. That pseudoscientific claim was simply a case of working backwards from the effect: “We gave him a serotonin-booster; he seemed to pick up; therefore he must have had a serotonin deficit. Hey, everybody, we’ve discovered the cause of depression.” This isn’t a joke, this is what passes for “reasoning” in psychiatry (it’s called argumentum ex iuuantibus, and was known to the Romans). When it comes to the genetic studies that are all the go these days (at truly stupefying cost), there is no theory or model linking genes to thoughts or emotions. While these studies have all the trappings of science, it’s just blind poking, no better than poo transplants: “We’ve got the technology, let’s see what it can find.”

Despite all the time, money, effort and fanfare, genetics has contributed nothing to psychiatry. My view is that their results are pure artefact, i.e. they get the results they are looking for because their technique, based in the DSM system, produces results to confirm their hypothesis, but that’s a separate matter. What counts is this: there is a difference between a scientific remedy (such as the monoclonal antibody rituximab for non-Hodgkins lymphoma) and a folk remedy that happens to work. The folk remedy has no justification beyond “It seems to work.” This is true of practically every “treatment” used in psychiatry (it’s called “evidence-based psychiatry”) and is a further reason to state: “Modern psychiatry is a pseudoscience.”

(For medical and other students: Medicine is a technology, i.e. applied science, firmly grounded at every point in established scientific knowledge. Everything we do is justified by reference to the empirical knowledge base which exists independently of medical practice. There are no gaps in the causal sequence from fundamental scientific knowledge to approved practice. Psychiatry does not meet these criteria. The mind-body gap remains as real today as it was in the time of René Descartes, 400 years ago. It will not be resolved by fiat; see [8]).

References:

1. RANZCP (2013). Position Statement No. 80: The role of the psychiatrist in Australia and New Zealand. RANZCP Website.

2. Engel GL (1977). The need for a new medical model: a challenge for biomedicine. Science; 196:129-136.

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

4. Crouse J et al (2024). Patterns of stressful life events and polygenic scores for five mental disorders and neuroticism among adults with depression. Molecular Psychiatry (2024) 29:2765–2773; https://doi.org/10.1038/s41380-024-02492-x

5. Grotzinger AD et al (2025). Mapping the genetic landscape across 14 psychiatric disorders. Nature online https://doi.org/10.1038/s41586-025-09820-3

6. McLaren N (2017). Electroconvulsive Therapy: A Critical Perspective. Ethical Human Psychology and Psychiatry 19: 91-104. DOI: 10.1891/1559-4343.19.2.91

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

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

9. Sagan C (1997) The Demon-Haunted World: Science as a Candle in the Dark. London: Hodder/Headline.

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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.