Psychiatry as Pseudoscience

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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For those not familiar with it, the website Mad in America was started about 15 years ago by Boston science journalist and author, Bob Whitaker. It was named after his book on the history of schizophrenia in the US, first published in 2001 and recently revised. I think it’s essential reading for anybody working in the field of mental health, and MIA is now one of the biggest alternative mental health sites, definitely worth following. Last week, they published another report on the continuing study of ECT lead by psychology professor John Read, of University of East London. He’s been studying ECT for twenty years or more, concluding that there is no reliable evidence to say it does the job it’s supposed to do, and a steadily growing body of evidence to say it does a lot of damage, possibly more damage than good.

This article, by psychologist Chris Harrop, is based on their survey of 1144 ECT patients or their relatives in 44 countries. A previous paper looked at whether people were given proper information prior to getting it; overwhelmingly, they weren’t [1]. The survey evidence is perfectly clear: if they were told anything, patients and their families heard that ECT is the correct treatment for their particular condition, it’s safe, reliably effective and has minimal side effects. It’s none of those things, as my own review from a few years ago showed [2]. It is an unnecessary and expensive form of “treatment” which generates huge and effortless financial returns for the hospitals and practitioners. In Australia, at least, that’s the primary reason it is so popular. Another point to consider is that, in practice, it is impossible for a patient to complain about ECT after the event or to gain any sort of recompense. The psychiatrist will say “Ah yes, but he didn’t know his own mind. His complaint just proves how sick he was.” Unless it is a very gross abuse, medical boards will never find against a psychiatrist using ECT, not least because the “independent experts” they ask for an opinion all use it themselves.

In particular, patients are never given the information they need to give “informed consent.” They’re told, and we presume the psychiatrist believes, that ECT is essential, life-saving and prevents suicide. None of that is true, especially the first point. ECT is certainly not essential as there are plenty of places in the world where it’s not used, and they get along just fine. Patients are never told this. It would be easy to say: “Putting that aside, let’s ask whether it works,” but in fact, that can’t be put aside as it says something terribly important about the modern institution of psychiatry.

Harrop’s article is based on responses to the very straightforward question: Did ECT work for you? [3]. Briefly summarising what is a brief summary of their research paper, the answer for nearly two thirds of people was: No, it didn’t work. They were no better off or even worse for the experience. Moreover, it adversely affected the quality of their lives and made a small but significant number more suicidal, not less. In Australia, the US and other places, they would also be a lot poorer but the survey didn’t ask about that.

Coincidentally, the history of what are called convulsive techniques in psychiatry started in Budapest just a hundred years ago. At the time, practically everybody working in what is now called mental health believed that epilepsy somehow protected against schizophrenia. A pathologist named Ladislav Meduna noticed a difference between the brains of people who died of chronic epilepsy and people who died with schizophrenia. Epileptic brains showed wide-spread, low-grade changes where neurons had died and been replaced by glial cells, or scarring. Meduna therefore decided to induce seizures in patients with schizophrenia with the express purpose of causing diffuse, low-grade brain damage as a treatment. That was his intent, although psychiatric texts somehow manage to overlook this point. Fifty years later, when I was training, people still believed it even though surveys had shown that a chronic psychotic state was more common in long-standing epilepsy, not less [5].

Anyway, Meduna experimented with a number of chemicals and settled on a derivative of camphor but patients hated it and it was unreliable in causing seizures. A dozen years later, an Italian psychiatrist named Ugo Cerletti happened to chance upon an abattoir when a group of pigs were being slaughtered. He saw how the pigs were stunned by a shock delivered by electrodes on their heads, so he decided to try it on his patients. After much trial and error, he found a way of inducing seizures much quicker and more reliably than using chemicals, and so the ECT industry was born.

Over the next 15 years or so, and even though it had a bad safety record, ECT was adopted by mental hospitals around the world. It was given for every conceivable diagnosis, but especially to make aggressive or agitated people more tractable. From the beginning until today, women have made up two thirds of people getting it even though they weren’t as aggressive. More to the point, as Andrew Scull shows in his very readable history, it was used as punishment [4, Chaps. 7,8]. Many years ago, I recall seeing a woman of about 38 who had been in the security ward of the mental hospital more or less continuously since age 16. When I went through her file, I counted she had had at least 740 ECT. When she was about 24, and even though she had been in the locked ward throughout, she had surprised everybody by delivering a healthy baby. The baby was promptly taken away as she “couldn’t possibly” care for it, and she was given another 50 ECT in rapid succession for “aggression and agitation.” Possibly if she had been able to care for her baby in proper surroundings, she would have been fine but I’m also sure part of the ECT was punishment for making them all look stupid.

That, however, was the early 1960s, at “peak ECT”; thereafter, it declined slowly. In the UK, for example, once a bastion of ECT, in the 30years from 1985, its use declined by 90% [3]. Not so in Australia where private psychiatry makes a killing from ECT. In Western Australia between 2007-16, ECT usage surged a completely improbable 190%. Just those two figures alone mean all claims about its “scientific basis” are nonsense, but it’s actually worse in that ECT machines have never been subjected to the same standards of testing as other medical technologies. Proper follow-up, of the type undertaken by John Read and his team (of psychologists, BTW), has never been done. The few randomised, placebo-controlled clinical trials of ECT from decades ago fail to meet standard. Instead, all we get from psychiatrists is loud claims about how effective and safe it is and how patients are sooo grateful. Propaganda, in other words. Any criticism, as I know and I’m sure Read’s group will have discovered, is met with a barrage of dismissive abuse. Two questions that have bothered me for decades is: How does psychiatry get away with this, and why do they bother?

The question of why they bother is easily dealt with: intellectual insecurity. Given that the subject matter of psychiatry is disorders of the mind, the fact is that not one of them has anything like a theory of mind, and precious few have even any education in what that expression might mean. If we say that one sort of mental state is abnormal, doesn’t that imply a clear understanding of where normality stops and abnormality takes over? It should but, lacking a theory of mind, there isn’t so it falls back to a committee making the decision and imposing it on the world. If the committee were neutral on the subject, we could perhaps accept that every now and then, they got it wrong but the people who manage to get themselves on these committees are anything but neutral. Most of them stand to make big money from having their opinions accepted as “standard practice,” not to mention pushing themselves up the status ladder. Conflicts of interest are the norm in psychiatry; compare this with Read’s little group of intrepid researchers who declared as their funding source: Nil. They did it all from their own resources.

By rights, psychiatrists should say: “Society distinguishes between mad and bad. We don’t know what this means, we have no theory to account for it but society wants something done so we’ll do whatever works.” That would be called an “evidence-based psychiatry,” but the problem is their evidence is collected according to a bias. Case in point: ECT was developed because it was thought that schizophrenia and epilepsy were incompatible, but it turns out that was wrong. Chronic epilepsy predisposes to psychotic states [5]. That may explain why it didn’t work, as the case of the lady with 740 ECT on her record shows. After a while, psychiatry stopped talking about using ECT for psychosis and started touting it for depression. Except most depression gets better by itself with a bit of support, or it used to until antdepressants came along, so they invented “treatment-resistant depression,” even though that actually means “wrong treatment.”

Psychiatrists desperately want to be seen as having the same intellectual status as the rest of medicine, but that can’t happen without a proper theory of mind and a model of their subject matter, mental disorder. Rather than admit this and settle down to the hard work of actually writing these theories, they conceal their intellectual insecurity under layers of pseudo-scientific bluster. Do they actually believe what they say? Well, they certainly get very angry when anybody questions them so that probably says something.

The question then is: How do they keep getting away with this? In one sentence, it’s layer upon layer of pseudo-scientific bluster spiced with personal abuse of anybody who dares to question the party line backed up by the threat of legal action. One form of legal action which the general public doesn’t know about is the weaponisation of the disciplinary powers of medical boards and professional bodies. Take it from me, complaining against a professor or college president will bring you no joy although it may earn you a couple of counter-complaints, conveniently investigated by their friends.

The bluster starts with endless repetition of the high-sounding claim: “Psychiatry is guided by the biomedical and biopsychosocial models.” This is a total falsehood. These so-called models do not exist in any form other than their names. Moreover, with perhaps a few exceptions, each and every person who makes these claims knows perfectly well, or ought to know, that there is no truth in them. Case in point: in a letter, the then-president of RANZCP said: “... the biopsychosocial model (is) ...the predominant theoretical framework underpinning contemporary psychiatry ... a relevant and useful component of training and practice ...” (Moore, E. correspondence, Nov. 20th 2023). She was asked to provide the sort of material used in training, such as texts, reading lists from the journals, lecture and tutorial programs etc. Despite repeated requests, she refused to respond so the latest president was asked to provide it. She sent a message saying she had nothing to add to the previous president’s response, i.e. nothing to add to nothing. Are they lying, or are they just stupid? More to the point, should the peak professional body for a field as important as psychiatry be run by people about whom that question even arises?

When falsehoods don’t work, the next ploy is silence. Psychiatry never revisits its ghastly past. It all vanishes in the memory hole, as Orwell foretold: “Everything faded into mist. The past was erased, the erasure was forgotten, the lie became truth” (1984, p68). I was present at one of the last of what was laughingly called psychosurgery operations in Perth, West Australia, many years ago. Normally, neurosurgeons are fastidious in conserving brain tissue. For this operation, known as leucotomy or lobotomy, after drilling burrholes in the vault of the skull, the surgeon shoved in what looked like a Parker biro until it hit the bone over the back of the orbit (eye socket). He then wiggled it around forcefully, and repeated it on the other side. That’s it. Patient is wheeled out. JFK’s elder sister, Rosemary, who suffered (preventable) brain damage at birth underwent this procedure. It destroyed her life. At the time, it was touted as the very last word in scientific psychiatry but it was straight-out butchery (if you haven’t seen this video, you should). These days, nobody talks about it. There were no apologies. Silence reigns. The lie of a caring psychiatry has become the unquestioned truth.

Filling the intellectual vacuum, we get the pseudoscience but this is a huge topic and would fill books. There are hundreds of psychiatry journals, and if psychology, nursing, social work and others are included, probably thousands, all stuffed full of impenetrable gobbledygook that changes nothing. The fault lies in what gets published and what’s rejected. It’s been said that the modern editor’s job is to sort the wheat from the chaff, and make sure only the chaff gets published. Negative results simply don’t get published; even the stuff that does is all too often manipulated to support the authors’ ideological position [e.g. 6,7]. As for critical analysis, forget it. Psychiatrists are deeply resentful of criticism but, crucially, they never answer it. Their only response to criticism is to attack the critic as “anti-psychiatry” while ignoring the actual content of the criticism. As a result, psychiatry continues to colonise vast areas of human life, converting eccentricity or even normality into psychopathology and starting people on drugs they can never stop.

This is very serious. People’s lives depend on psychiatrists getting it right but there is very little evidence that they’re even making the attempt to meet the minimum criteria of a scientific discipline. Instead, their public behaviour is consistent with pseudoscience although they are, of course making lots of money and getting heaps of status and attention. That means there is no impetus from within the profession to change anything. Pressure to change can only come from outside which, predictably, will be met with resentment and hostility. That’s no reason to give up.

References:

1. Read J et al (2025). A large exploratory survey of electroconvulsive therapy recipients, family members and friends: what information do they recall being given? J Med Ethics; 0:1–8. doi:10.1136/jme-2024-110629

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

3. Read J et al (2025). A Survey of 1144 ECT Recipients, Family Members and Friends: Does ECT Work? Int J Ment Health Nursing, 34:e70109 https://doi.org/10.1111/inm.70109

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

5. Slater E, Beard A, Glithero E (1963). The schizophrenia-like psychoses of epilepsy. Br J Psychiatry 109:95-150. doi: 10.1192/bjp.109.458.95.

6. Le Noury J et al (2015) Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence. BMJ 2015; At: https://www.bmj.com/content/351/bmj.h4320

7. Whitaker R (2023). The STAR*D Scandal: scientific misconduct on a grand scale. Mad in America, Sept. 9th 2023, at: https://www.madinamerica.com/2023/09/the-stard-scandal-scientific-misconduct-on-a-grand-scale/

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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.