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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Last Saturday afternoon, I was busy in the kitchen when I heard our resident butcherbirds giving their alarm call. We live in the semi-rural outskirts of Brisbane, on a 1ha block (2.5ac) that slopes down to dense scrub and trees along a creek. The butcherbirds, which are one of the world’s great songbirds, like to perch on the verandah railing so they can find grasshoppers and skinks in the gardens and lawns below. With the warmer weather, this is snake season so I went out to check. Sure enough, they were all looking down and squawking at a large eastern brown snake (Pseudonaja textilis) mooching around near a retaining wall. This is regarded as the second most venomous snake in the world so I grabbed my boots and my snake pole and ran downstairs. It had moved into a small garden alcove about 5mx2m with high walls on three sides, so it was neatly penned in but it was aware there was no cover and was trying to get out. While my daughter rang the snake catcher from her vantage point on the verandah, I managed to convince it to go to the back wall but it was agitated and kept darting this way and that, adopting a strike pose or trying to scale the sheer brick walls. Finally, it went into a clump of ferns and coiled up, obviously aware I was there and a threat to it but prepared to wait.
After half an hour of watching it tasting the air, the snake catcher arrived and quickly grabbed it. He caught it by a head hold which I thought was exceedingly dangerous, about on a par with juggling a chainsaw blindfolded, but he soon had it bagged. Just then, the butcherbirds started up again; my daughter went to check and called out: “There’s another one.” Sure enough, there was another about the same size. While the snake man was getting his gear, I managed to head it off but it darted across the lawn. He caught it by the tail and held it up at arm’s length with its head resting on the ground. He was tall so it was close to 1.8m (6ft) long and very annoyed. He explained there must be a female nearby attracting them; he soon found the ideal place for her to hide, in a seepage drain that extends under the house. Apparently, the males can detect the pheromones up to 500m away, which is why I’ve seen 3 or 4 in the same spot over the past few years. We’ll trap her and take her to a nice spot up in the hills; I like the pythons and other friendly snakes at our place but eastern browns are seriously dangerous creatures to have loose in your garden.
I mention this because a recent drug company handout was on anxiety [1]; strangely, of ten papers reviewed by the psychiatrist-editor, nine did not involve drugs. One (with 29 authors) described educating psychiatrists about, of all things, an evolutionary approach to anxiety. I was immediately interested: in 2007, my first book had a chapter on the evolutionary approach to anxiety [1, Chap. 15]. I’ve given that chapter as background reading to many hundreds of people since then, which they found very helpful, much more so than talk about genes and brain chemicals. What is called anxiety is correctly seen as the standard human threat response that has slipped out of control, not as a “disease state.”
So on Saturday afternoon, we had a case demonstration of three unrelated species showing their differing threat responses, birds, reptile and mammals. When birds are alarmed, they fly to a nearby branch and call loudly; interestingly, other species recognise each other’s alarm call and come to investigate. A passing goshawk can expect to be mobbed by magpies, butcherbirds, miners and crows, all responding to a call from a single bird. The snake’s response was first to freeze and check the environment by tasting the air but this species also has good eyesight so they lift their heads like a periscope and look around. For humans, the alarm response is to become mentally alert and quickly scan the environment. The heart rate increases to pump extra blood flow to muscles and heart, muscles may start to tremble slightly, skin a bit sweaty, stomach churning, bit short of breath, etc. All this is very familiar.
The role of the alerting or “fight or flight” response is to prepare the animal to deal with the threat. Every species on earth has a specific threat response: snails withdraw into their shells, sea slugs exude a sticky slime, rabbits bolt to their burrows, dogs stand and snarl ... If an animal doesn’t respond to a threat, it won’t survive to pass on its genes. The threat response has a very strong biological basis; we can control it with training but it never goes away, it is never disabled unless by drugs. It is not in any meaningful sense of the word a disease but, like other safety mechanisms such as blood clotting or the immune response, it can get out of control by becoming stuck in a negative feedback loop. We may then call it a disease but in the case of anxiety, it is in fact the body doing exactly what it is told to do, to respond to a threat. For anxious people, the core of the problem is that they see too many threats, they misclassify events as dangerous and respond accordingly. That’s the definition of an anxious personality: a person who responds to neutral events in the environment as though they were a threat. Mainstream psychiatry doesn’t acknowledge the anxious personality as such, they give them silly names such as Dependent PD or Schizotypal or Obsessive-Compulsive or Alcohol or Drugs or whatever. The underlying mechanism of self-perpetuating anxiety is the same in each case, all that changes is how the sufferers try to control the unpleasant emotion.
Some important points to remember about the threat response, commonly known as anxiety in Homo sapiens. First, it’s universal. Every living creature from nematodes up has some sort of standard reaction to threats. Biologically and behaviourally, ours is more or less the same as the other great apes. Second, anxiety is far and away the most powerful emotion, the only emotion with no upper limit. We can only laugh for so long, then it becomes painful; anger wears off eventually, grief slowly fades and so on. Only anxiety builds up and up until you do what it wants, which is get away from the threat. A full-blown panic attack is said to be the worst experience a human can have and still survive, and I’d say it’s true. Third, it’s the only recursive emotion, meaning it acts back to reinforce itself, which is the basis of human anxiety states. Finally, all other animals need a direct awareness of the threat – sight, scent, sound and so on – but humans can perceive and react to a threat purely by information about a future state that hasn’t yet happened. This is the basis of the two-step process that is our undoing.
We may start to get nervous when we realise that something big is on tomorrow, which is Step One in generating a pathological state of fear. Step Two is that we can then panic over our own panic response. For example, people look at the clock, realise they may miss the bus and start to get anxious. Some however will notice that their heart is beating faster or they’re starting to shake and so they panic over that: “Oh dear, I’m going to have one of my dreadful turns.” That is, and just because it is so bad, they panic over their own panic reaction, and so the vicious circle closes on them. This is true of all of what is called “generalised anxiety disorder” and the specific phobias, such as frogs, snakes and public speaking. People who are scared of frogs are not scared of frogs per se as frogs are the most harmless creatures on earth. They’re scared of how they’ll feel when they go near a frog because they know from long experience that how they’ll feel is terrible beyond words.
Anticipating a scary event causes agitation, which then causes more agitation in a step-wise, self-reinforcing process. I one saw a woman in her early 40s who’d had about 25yrs of failed treatment for depression. I asked her why she was feeling sad: “Oh,” she replied, “it’s my depression, it always does it.” The history showed she was actually severely anxious. I showed her the list of symptoms and fears and explained the reason the antidepressants and ECT and hospitals hadn’t worked was because she had a severe anxiety state. “Anxiety?” she shrieked, clutching her throat. “Oh no, that’s terrifying.” True, it is, but it’s better not to panic over it.
None of this is rocket science. Every one of hundreds and hundreds of patients who read this chapter could understand it and felt better from knowing it, so why are psychiatrists so far behind the times? How come it’s taken them at least 80 years to start to realise all their talk of “anxiety genes” has no substance? The answer is again straightforward: mainstream psychiatry is an ideology (n: a strongly held set of beliefs and values that determines how the individual interprets the total environment). They refuse to allow the possibility that a mental disorder can have a mental cause; for them, all mental disorder must have a physical cause in some sort of brain pathology. This is what defines psychiatry and distinguishes it from psychology and other disciplines, this is how they justify their jobs and money.
This is why the recent drug handout is so different: the mere existence of a handout on anxiety that doesn’t mention drugs is an admission that the biological approach is finally reaching its use-by date. Rephrase that: psychiatrists are finally, reluctantly, being forced to acknowledge that they’ve spent decades and billions pushing a theory they couldn’t justify. Hundreds of millions of people have been subjected to dangerous and addictive drugs and a lot worse with no formal justification. Effective treatment must be based in a formal theory of mind and an articulated model of mental disorder. The reductionist biological approach to mental disorder is not a model as they’ve never written it; if they tried, they would realise they can’t do it. The proper approach to anxiety is a mix of evolution and comparative biology: every living creature has an alarm response. Mostly, it’s activated in response to the direct perception of a threat but after one or two exposures, most animals can learn that a threat is on the way. Twice a year, our family cat is grabbed at breakfast and put in her carrier. On the way to the vet, she knows what’s coming and shows her displeasure (actually, it’s the rectal thermometer that she doesn’t like, gets very indignant). Because of our capacity for language, humans can become anxious in anticipation of an event even if they have no experience of it.
The model of anxiety outlined above can account for all the phenomena of the huge cluster of anxiety problems that plague humanity. The machinery of anxiety is hard-wired into us, just as it is in baboons and rats. Do they feel anxious in the same way we do? Mainstream biology sneers at that sort of question, animals have no mental life, they scoff, so don’t anthropomorphise them. They don’t? There are four objections to that statement:
1. Can you prove animals are zombies while other humans are not? (they can’t).
2. Animals show the same sort of anxiety-driven behaviour as humans.
3. Animals have the same physiology as humans; most basic research on the neurophysiology of anxiety is done on animals.
4. Evolution builds on what went before; it is risible to suggest that, entirely without precedent, human mental lives were suddenly switched on with the birth of the first little H. sapiens.
I have no problem with the idea that animals have mental lives. I do have a problem with species-supremacist humans who assert, with no evidence, that they don’t. Putting that aside, what would a formal, reductionist biological model of anxiety look like? For all their braying and posturing, mainstream psychiatrists have never written one, so can we do it for them? The short answer is No, we can’t. The neurophysiology of arousal is fairly well understood; we can all agree that its normal structure and function is under tight genetic control, just as with every other organ of the body. However, as mentioned, it has no upper limit, which leads to the well-known Yerkes-Dodson curve. This says that too much arousal is bad for you (that’s not a very enlightening statement; too much of anything is bad for you because that’s what ‘too much’ means). An over-aroused person starts to malfunction, they make mistakes, drop things and misperceive the environment (especially other people’s intentions). Crucially, the mistakes and misperceptions can cause further arousal.
Over-arousal thus becomes self-reinforcing as a psychological phenomenon, and that’s what biological psychiatry can’t accept, but there is no conceivable non-cognitive model of anxiety that can account for this fact. In particular, the measures people take to reduce their anxiety are the product of their early life experiences. One person decides to retreat and hide while the next comes out swinging; one decides that the only way to deal with a scary environment is to be perfect at everything while another works out early that alcohol or drugs will do the trick. There’s no limit, and it’s also true that most anxious people try different ways of dealing with it, depending on what’s happening and how they’re feeling. Trying to account for this using genetics would be like trying to give a genetic explanation for the language a person speaks. Genetics gives each of us the machinery of language; experience determines what we say and in what language. Likewise, genetics gives each of us the machinery of anxiety; experience determines how bad it is and what we will do to control it.
A psychological approach to anxiety, such as the biocognitive model, is far simpler than the almost impossible “genetic” approach. It says humans are different from other animals in that we can scare ourselves but not so different: remember that if we invoke genetic “diseases” to explain human mental disorder, we’d then have to explain why no other species on earth suffers the same problem. Better still, the biocognitive model leads directly to effective treatment without using addictive drugs. Oh, and it’s free because it didn’t involve 29 authors or any government grants. Also, it tells you what to do when you come across a venomous snake: don’t panic, because anxiety is the most communicable of emotions, even from humans to animals.
Reference:
1. Psychiatry Research Review Issue 106 Anxiety focus https://www.researchreview.com.au/publications/psychiatry-research-review-issue-106-anxiety-focus
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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.
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