Over the Rainbow

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.

****

Many years ago, during my training, I wrote a paper on a series of nine cases of people diagnosed by other psychiatrists as suffering from schizophrenia who had dramatically improved following slow reduction of their drugs and insight-directed psychotherapy. Follow-up was two years but the paper was rejected on the basis that manifestly, not one of them was schizophrenic. Why were the editors so confident? Because they knew that it was impossible for people with this diagnosis to get better with psychotherapy and without drugs. I’d forgotten about this but it came back this week when an article appeared in the drug company flier, Medscape, titled: “A Single Dose of Short-Acting Psychedelic Rapidly Eases Major Depression.” They used dimethyltryptamine, a close analogue of 5-hydroxytryptamine (5HT), commonly known as serotonin. To me, it’s clear: either they weren’t depressed, or everything psychiatry believes about depression is wrong. Or both.

There are at least 14 different 5HT receptors, widely distributed throughout the body and brain: 90-95% of the body’s 5HT is actually produced in the small bowel. In the brain, they populate some of the most complex regions of all. To say that there is a 1-1 relationship between brain levels of this chemical and mood betrays a gross ignorance of how the brain works. There are now half a dozen hallucinogenic drugs being prescribed for depression, including the anaesthetic ketamine, psilocybin, cannabinoids (from marijuana), LSD is having a rerun, and so on.

How many different forms of “treatment” of depression are out there, competing for the consumer’s dollar? Heaps. There’s ECT, of course, although it isn’t clear whether it’s the electricity coursing through the brain that does the job or the convulsion. I have argued that every claim made for ECT is false [1] but psychiatrists swear it’s essential – except when they don’t get paid for giving it, then they seem to lose interest. The original plan of all the “convulsive” techniques was to cause diffuse, low grade brain damage; nobody talks about that now. ECT is slowly being superseded by that old standby, magnetising the head (TCMS), delivered at great cost by private psychiatrists with precious little evidence that it does anything that much cheaper treatments can’t do. There are also various sorts of electronic brain ticklers being licensed in the US for DIY enthusiasts which are leaking into different markets. There’s one from a company called Exomind, although I’m not sure why anybody would want their mind wandering loose at night.

Then there are all the drugs, including the original monoamine oxidase inhibitors (MAOI) and the very toxic tricyclics such as amitriptylline, which should have been banned decades ago. The SSRIs, introduced from about 1990 on, have been an absolute goldmine for the drug companies as anything up to 15% of the adult population are now taking them. However, there is zero evidence that they have actually done anything to alter the incidence or trajectory of depression apart from making it worse. They’re supposed to reduce suicides but they don’t. There is also increasing evidence that they actually cause suicidal and/or homicidal impulses or actions, probably through their side effect of akathisia. It’s important to remember that practically all of these drugs were discovered by chance.

Now, we have more interesting approaches. I’ve previously mentioned how people are using faecal transplants to lift the mood, which is relatively harmless compared with vagal nerve stimulation via implants. The vagus or 10^th cranial nerve is the “calming” nerve that opposes the flight or fight response throughout the body. Stimulating it blocks the alerting or panic reaction, producing a calming effect. However, it has no direct effect on mood. Then there’s exercise, which appears to be as effective as most other things although the fact that it takes place in a group probably has a lot to do with it. And there are more, but it all adds up to the fact that depression is now a big industry. However, it would have to be the world’s weirdest industry because all the people making money from it agree on only one point: that depression is a physical “disease” of the brain even though none of them has the faintest clue how this could come about. Moreover, nobody can put up a remotely convincing case as to why it can’t be just a psychological state.

Why does depression have to be physical? Well, if you want to get a seat on the gravy train, that’s what you have to believe but there is actually a reason, although precious few psychiatrists know it. As I’ve often said, it’s a legacy of the leap to a positivist science one hundred years ago. Anything that couldn’t be seen or measured had to be discarded; the mind can’t be seen or measured; therefore the mind must be discarded. QED. Hence today’s “mindless” psychiatry, where the human experience is reduced to genes and chemicals bumping in the dark. Who you are, how you got to be caught in the machinery of the mental health industry, what you want for your life and all that squishy stuff is simply ignored. And it’s all going nowhere. You can’t have a dozen different and contradictory treatments and still insist you know what you’re doing to the extent of being handed people’s lives and suspending practically all their human rights.

“But,” psychiatrists say, “we do know what we’re doing. We’re guided by the biomedical model with the biopsychosocial model to plug the gaps.” No they don’t, this is a “mere assertion.” These things don’t exist [2], they’re part of a gigantic con job that is kept alive by the ever-elusive goal of reducing the mind to the brain. The claim is that studying the brain will tell us all we need to know about the mind. When it’s put like that, it’s clearly nonsensical: studying the physical structure of a book, its size and weight and the chemistry of paper and ink, will tell us nothing about what is actually written in the book. The informational content of the book is not explained by its physical structure just because information is not reducible to matter and energy. This was made clear in 1948 by the rather unusual mathematician, Norbert Wiener, in his little book that started the cybernetics revolution:

The mechanical brain does not secrete thought ‘as the liver does bile,’ as the earlier materialists claimed, nor does it put it out in the form of energy, as the muscle puts out its activity. Information is information, not matter or energy. No materialism which does not admit this can survive at the present day [3]

He mentioned the liver secreting bile as that was a favourite of the many people who had convinced themselves there would be a physical solution to the question of mind: “The brain secretes thoughts as the liver secretes bile.” Wiener was pointing to the important point that the brain is simply the mechanism of production of mental life but it is not the mental life itself. Eighty years later, people still make the mistake of thinking that a mechanism and what it produces are one and the same thing. Thoughts and other mental elements emerge from the brain by a rational process but they are not identical with the brain itself [4]. This is the same as for the computer I’m using or the phone in your pocket. It has a physical structure that generates an informational state, the computer chips are the mechanism but they don’t determine what is written in that informational state. This is equally true of the brain. Our DNA gives us the capacity for language but it doesn’t determine what language we will speak or what we will say or believe in that language.

I’ve said depression is wholly a mental state emerging from the brain but there is no disease, no “chemical imbalance,” no bad genes causing it: it is simply the brain doing what it’s told to do. Depression is the predictable reaction to adverse life events but in order to move beyond the “mere assertion” that it’s all psychology, we need to propose a mechanism. We can use anxiety as the exemplar, not least because mainstream psychiatry doesn’t take seriously. We can define anxiety as the response to the perception of a threat [5; this clarifies why it isn’t a circular definition]. Anxiety is not a disease state, it is simply a case of the mind perceiving a threat and the brain reacting in the way 500million years of evolution have told them to act. Practically every living creature has a threat response of some form or another which is highly standardised throughout the animal kingdom: the critter sees or senses something that doesn’t seem right and immediately, it becomes highly alert and focussed on the potential threat. It’s body switches from its quiet, peaceful mode, maybe eating or picking its fleas, to a state of high arousal. The heart beats faster, blood flow is diverted to muscle, heart and brain, breathing accelerates and so on. The reaction to a threat is very fast because a slow threat response wouldn’t go its job. We’d get eaten before we were ready to run.

The trigger for a startle reaction/threat response etc. is a mental perception and, in that respect, we’re no different from other animals. However, humans have an extra step that gives us grief: we can use our intellect to predict trouble for ourselves, and we react to it as though it were real. If I think something bad is going to happen tomorrow, I will get edgy and jittery today. Animals can’t do that, they can only react to the direct perception of a threat whereas, to our detriment, we can predict without any direct stimulus. If, however, the threat I perceive is itself part of my startle response, I’m trapped. Something makes my heart beat a bit faster but I take that as a threat in itself: “Oh dear, my heart is racing, that must mean I’m about to have a heart attack. Call the ambulance!” More commonly, it’s something like:

I have to give a talk shortly. I hate giving talks, the thought of it makes me shake and sweat. People will see I’m shaking and sweating, they’ll think I’m a fool, they’ll laugh at me and that thought is making me shake and sweat more. I can’t do this, I’ll die of humiliation, I have to cancel it.

This is so simple, it all makes perfect sense so why doesn’t psychiatry adopt this approach instead of wasting time and money looking for the genetic cause of anxiety? Because the mentalist account doesn’t fit with their materialist ideology, the one they haven’t sorted out. That’s the only reason, even though this cognitive model applies to all emotions, including misery.

In the case of sadness, the triggering event is the perception of a loss. This is not uniquely human; many animals show a similar reaction to a loss. The mechanism, as I suggested last week, is that the perception of a loss blocks the so-called “pleasure circuits,” meaning life becomes colourless and tasteless. Nothing is interesting, nothing exciting, nothing worth bothering with because it won’t bring back whatever has been lost. All we want to do is find somewhere quiet and disappear. After millions of years of evolution, this is how we deal with losses. So far, so predictable: this is the model of a standard grief reaction. It doesn’t require any fancy chemical imbalances or such like. If, however, that reaction is combined with other psychological factors, particularly self-esteem and the perception of the world, then we can account for practically the whole of the phenomena of depression. For example, as a child, Smith experienced a terrible loss, after which life never got back to any sort of normal. He has reached adulthood essentially waiting for things to go wrong; when anything bad happens, his first thought is: “I am going to go through what I went through years ago. That nearly killed me, I can’t face it. But if I get over this, it’s only going to happen again. Might as well finish it now.” That is not a “chemical disease of the brain,” that is the entirely predictable reaction of a sentient being to adverse life events. The problem is that every time he thinks of his loss, he sends another signal to repress all pleasure in life so that the misery seems continuous, never a break.

Similarly, Jones had a seriously disturbed childhood, bounced from one “carer” to another so he never felt wanted. Every time anything went wrong, he was blamed so he has grown up constantly frightened he is doing something wrong, that he will get into trouble and will be unable to defend himself as he panics. He thinks he is unlovable, a useless individual that nobody wants. As a result of childhood experiences, people will actually say this. When asked: “How do you rate your self-esteem, how do you see yourself as a person?” they will reply: “I’m useless, I can’t do anything right.” That’s their default mental state, that’s what goes through their minds when they’re alone. If something else goes wrong and they experience a further loss, they fall to thinking:

I’m a total waste of space, I can’t do anything right. Nothing feels good but good feelings never last anyway. Nobody can help, nobody is interested in me. It’s always been like this, it’s not going to change. I don’t see any point going on.

That constellation is called depression but it is not a disease. It is the predictable reaction to a loss in a person with poor self-esteem. You could say that early life experiences have sensitised them to losses, that they over-react but if you make the effort to understand their lives from the inside, it all makes sense. Another person, Brown, had a similar early life but learned he could cope by working hard, keeping his guard up and the occasional fight. He thinks: “I’m OK, I can get things done but the world is a cruel, punishing place and everybody is against me. If I trust people, I’ll only get hurt.” If he experiences a loss, he reacts with anger:

I did everything right and look what happens, I get nothing and they walk away laughing. This doesn’t happen to others, only me. People get a kick out of putting me down, they talk about it and plan it, I know because they stop talking when I come in the room. I have to get in first, I have to protect myself because nobody else ever will.

As a result, he rubs people the wrong way and things steadily get worse but he doesn’t believe it’s his fault. One day, he decides he’s had enough and will “check out,” as they say but he is so full of hatred that he wants to spread it around and make some of them suffer as he feels he has suffered. As he has.

None of this is complicated. It’s easy to get this sort of information just by taking a proper history but if you believe the person sitting in front of you is just a fancy chemical soup, you won’t ask:

“Right, Mr Brown, do you have the feeling people are talking about you behind your back?”

“Er, yes, they are.”

“I see” (ticks box for ‘paranoid ideas’).

“Aren’t you going to ask why?”

“No, I don’t need to. You’ve got a chemical imbalance of the brain. We’ll give you some tablets to fix it.”

“I have the feeling you don’t believe me, like I’m some sort of fancy chemical soup.”

“Well, if you think that, you’ve clearly got a very bad case so you’ll need an injection and some more tablets. You don’t want it? You’d rather talk it out? Very serious lack of insight. Wait here while I sign this detention order and you’ll get it anyway.”

If psychiatry wants to be taken seriously, it has a number of crucial questions to answer: Is the mind a real thing? Can mental events have mental causes? Can the mind malfunction in the presence of a perfectly healthy brain? These are real questions, which psychiatry (and psychology and a few others) have been avoiding for a century. The biocognitive model [4] says the mind is a real thing that emerges from the brain via rational processes that we can understand in principle, if not all the details. It’s real because it can act on the real world, but a different sort of real thing than rocks and cyclones, which can also act on the world but are controlled entirely by the laws of physics. This brings up another important point for biological psychiatrists: if mind reduces to elementary particles in the brain, what happens to free will? Do we control ourselves or are we governed by the same laws of physics? That would mean our lives are fully determined at the moment of birth, or even at the time of the Big Bang, whereas all our system of laws and society are built on the notion that we can choose what we do. Mainstream psychiatry avoids these matters as they don’t have a theory of mind but they also don’t want anybody to know that.

The biocognitive model says that the mind is an informational state so the question of free will is a pushover. I can see something start to happen, such as a small child starts to walk toward an open door at the top of the stairs. In a split second, I can generate an image of the likely outcome: child falls down the stairs. Immediately, I do something to change that outcome, like distract the child while closing the door. That is the central point of mind as an informational space: we can generate alternative futures and choose between them without upsetting the laws of physics (full details in [4]). Without that, we’re automata, just perambulated bags of fancy chemical soup.

Depression is a reaction to life events. The mental event of misery is the reaction to losses, just as anxiety is the reaction to threats. Sustained sadness is not a “disease” of the brain and DNA has practically nothing to do with it. It is caused by repeated losses, which may be long past or recent but are complicated by personality factors. The most common cause of recurrent or persistent depression is anxiety, which is why vagal nerve stimulation appears to work. In civilian life, 95% of anxiety comes from early life. Anxiety wrecks life and makes people feel they have lost any chance of enjoyment, now and in the future. That’s the ultimate loss. After a long period of struggling against this terrible idea, they give up hope for themselves and quietly disappear. But that’s not a disease. It could happen to any of us. Searching for a biological cause for psychological events is like searching for the end of a rainbow. One day, psychiatry will be forced to accept this but you know what they’ll do? They’ll pretend, as they always do, that that was never their goal.

References:

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

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

3. Wiener N (1948, Rev. Ed. 1965). Cybernetics, or control and communication in the animal and the machine. Cambridge, MA: MIT Press.

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

5. McLaren N (2018). Anxiety: The Inside Story. Ann Arbor, MI: Future Psychiatry Press. Amazon.

****

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.