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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You wouldn’t buy a car without a test drive. You wouldn’t buy a car that wasn’t even in the country, or on sale anywhere and, in fact, hadn’t even been built. I’ll take that back a bit as 9 years ago, 1000 rich idiots each paid Herr Musk $250,000 deposit for a roadster that still hasn’t been built. Let’s say sensible people would want to be able to kick its tyres before dishing out their hard-earned cash. Psychiatry, however, finds itself in the gloomy position of the dopes who have been taken in by sharp talkers – and by their own gullibility.
The story goes back sixty years to major international studies in psychiatry sponsored by WHO. A comparison of diagnoses in London and New York showed that in assessing schizophrenia, American psychiatrists were only marginally more consistent than people in the street. This led to a major study in 9 countries, the International Pilot Study on Schizophrenia, IPSS, which began in about 1966 and was finally published in several volumes in 1974. This was hugely embarrassing to the APA and led to attempts to standardise psychiatric diagnoses. The first had arrived in 1972, a set of diagnostic criteria intended for research or RDC, always known as the Feighner criteria after John Feighner (1936-2006), the lead author, then aged 36yrs.
At the time, these were fairly shocking because the process reduced psychiatry to the level of questionnaires that practically anybody could administer. The project was sponsored and pushed hard by a group of psychiatrists in St Louis, MS, who were implacably convinced that all mental disorder is biological. There was no discussion: Freudian theory was already on the way out, behaviorism had practically nothing to say about mental disorder and the criteria seemed to make the idea of a biological psychiatry so ... attainable. That’s the word. None of this blather about Oedipus complexes or mysterious id impulses, just hard, verifiable facts that shifted psychiatry away from the world of fantasy into the laboratory. This soon became the basis of the DSM system that gets bigger every few years but otherwise is unchanged.
In the fifty years since, practically the whole of psychiatry’s research effort has been directed at finding some reliable fact about the brain that would justify the sublime confidence that yes, we’ve got mental disorder on the run, won’t be long now and we’ll have it completely sorted. For years, neurotransmitters were The Big Thing but, despite huge sums of money, that went nowhere. Drugs do something to the mind, that’s been clear since booze was invented, but what and why, nobody could say. When the human genome project got underway, everybody jumped ship. New machines meant that DNA analysis became so cheap that private labs were set up to indulge people’s curiosity – not catering to a need, just for fun. Very large scale research projects probed genes in hundreds of thousands of people and came up with ... nothing.
In about 2009, the then director of NIMH, Thomas Insel, threw the cat among the pigeons with a direct challenge to DSM. After decades of research, he said, psychiatry still had no biological basis and needed a new direction. At different times, he criticised the belief system that spawned “some very simplistic notion that will take our subjective experience and turn it into molecules...” (TED talk, at 6.51). The lecture was titled Toward a new understanding of mental illness and, secure in his bully pulpit, he proposed that the real problem in mental disorder is malfunctions in brain circuits. He set up a new program to reorient psychiatry called the Research Domain Criteria, RDoC [1]: “RDoC is an attempt to create a new kind of taxonomy for mental disorders by bringing the power of modern research approaches in genetics, neuroscience, and behavioral science to the problem of mental illness.”
Money flowed but, predictably, results didn’t [2]. Now, nearly 20 years after Insel’s challenge, a researcher landed an interview with the reliable folks at Psychiatric Times to discuss a recent paper [3]. They use some fairly high-powered technology to map how excitatory and inhibitory neurons interact in living mouse brain tissue. He concluded:
I am very hopeful that connectomics, and circuit neuroscience research more generally, will enable us to link the bottom-up molecular and cellular views of the brain with top-down systems and psychological views. We want to advance the technology and conceptual approaches that allow us to investigate from the ground up how brain circuits give rise to behavior and function and how they’re disrupted in disease. Essentially, we want to discover the secret of how the brain becomes so much more than the sum of its parts.
“Hopeful.” That’s a great basis for spending lots of public money. His first sentence is gobbledygook dressed in an impressive jargon. It says only that blind poking in the brain might tell us something interesting about mental disorder. The next two sentences show that it won’t work, i.e. “We’ve got the technology, now we need to work out a concept to justify it.” The problem for him is that the “conceptual approaches” will be psychological, not biological, and it’s already been done. The biocognitive model for psychiatry says that depression is the reaction of a normal brain to the perception of a loss. Presumably, the various brain centres that are involved in pleasant emotions are paralysed by an inhibitory blockade but the specific trigger is a psychological event. As a result, people are unable to experience any pleasure, everything that previously they enjoyed seems flat and lifeless and they lose hope life will ever improve. Biological research can’t deal with psychology. The idea that this immensely complex response will reduce to a single “chemical imbalance of the brain” or a “depressive gene” is ludicrous, but that’s how these people think. There are over a hundred known neurotransmitters, and many of them can be either excitatory or inhibitory depending on their location. Peering at bits of mouse brain isn’t going to tell us much about why humans see an event as a loss.
However, the real giveaway is his last sentence: “We want to discover the secret of how the brain becomes so much more than the sum of its parts.” I could ask “Who doesn’t?” but surely they can see that the extra part, the bit that makes the difference between a mouse brain and a human brain, is not itself physical? It’s called psychology or mental life, but they don’t want to know about mental life because it doesn’t fit with their rigid preconceptions. To them, science is what you can see and measure, therefore studying the brain will tell us all we need to know about psychology just because there’s nothing else. When it’s put like that, the folly of this type of research is obvious. They’re like the silly people who paid for Musk’s non-existent roadster and have yet to see one.
A scientific program needs a goal and a methodology, but they never bothered with it. All they have is a devout conviction that microscopes and scanners will tell us all we need to know about mental disorder. This particular paper [3] looks at brain circuits, trying to measure how much activity there is certain circuits, but that’s nonsense, looking at a circuit tells us nothing. It’s like looking at a mail centre, watching all the letters and parcels come in and how they’re sorted and where they go, but unless you open the letters to read them, you’ll never know what any of it means: “The secret of how the brain becomes so much more the sum of its parts” is called meaning, and meaning is not reducible to the brain because the brain is the mechanism of meaning but it has no meaning in itself. This is elementary but these people are so confident that, as Thomas Insel said, they don’t need to worry about criticism. They just keep pushing ahead with their ever-more sophisticated and expensive technology but when today’s brilliant idea fails to deliver, they simply move on to the next one. Meantime, for the poor people suffering mental disorders, nothing changes.
This raises a most important point in the sociology of psychiatry: how can a group that claims to be operating within science declare themselves immune to criticism? That’s what religions and political parties do. In his book, The Demon-Haunted World: Science as a Candle in the Dark, astrophysicist Carl Sagan said:
One of the saddest lessons of history is this: if we’ve been bamboozled long enough, we tend to reject any evidence of the bamboozle. We’re no longer interested in finding out the truth. The bamboozle has captured us. It’s simply too painful to acknowledge, even to ourselves, that we’ve been taken. Once you give a charlatan power over you, you almost never get it back. So the old bamboozles tend to persist as the new ones rise.
Is mainstream psychiatry just a case of (sophisticated) charlatanry? Answering that would be a large book but I think that case can be made, not least because psychiatrists who publish rubbish almost never respond to questions or critiques. Do psychiatrists have power over people? They certainly have statutory power although it has never been shown that they should have it or that they exercise it responsibly. They also have the power to shape public discourse, e.g. the explosion in diagnoses of ADHD and ASD. Entire swathes of the population are being converted into mental patients without anything like a proper public debate, and anybody who dares to question this can expect to be haunted by very persistent demons who fear their incomes are threatened. And no, that’s not science, it’s ideology.
References:
1. Cuthbert BN, Insel TR, (2010). Toward New Approaches to Psychotic Disorders: The NIMH Research Domain Criteria Project Schizophrenia Bulletin 36(6): 1061–1062.
2. McLaren N. 2011. Cells, circuits and syndromes. A critique of the NIMH RDoC project. Ethical Human Psychology and Psychiatry 13: 229-236
3. Kuan AT, Bondanelli G, Driscoll LN, et al. Synaptic wiring motifs in posterior parietal cortex support decision-making. Nature. 2024;627(8003):367-373.
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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. (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
Clinical application of the biocognitive model:
McLaren N (2018). Anxiety: The Inside Story. Ann Arbor, MI: Future Psychiatry Press.
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.
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