Psychiatry Bewitched.

On fads and moral panics

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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In 1486, a book was published in Germany that, for nearly 300 years, had a major effect on life throughout Europe, especially for women. The Malleus Maleficarum or “Hammer of the Witches” was written by one Heinrich Kramer (1430-1505), a Dominican priest who was renowned as a fiery preacher with a bizarre obsession with female sexuality. In about 1484, he had been booted out of Innsbruck as “senile and crazy” and the book is widely regarded as his form of revenge. However, it took off and long outlived him. He advanced the case that witches are real because the devil is real; witches are mostly women because women are lustful and weak-minded; and they are recruited by the devil to advance his cause and bring about the ruination of Christendom. Or something, that bit’s not clear but he was very clear on one point: taking his cue from Exodus 22:18 (“Thou shalt not suffer a witch to live”), he believed they had to be exterminated, preferably by burning. They could have a trial but the more they protested their innocence, even under torture, the more likely they were to be clever witches who were even more dangerous. Similarly, people who claimed there were no such things as witches were clearly agents of the devil and needed the same fate.

Regardless of anything various popes and other leaders had to say, the witchcraft craze took control of society. Gutenberg’s invention of the printing press in about 1450 certainly was a major factor in its spread as books travelled much faster and influenced far more people than itinerate preachers could manage. In German-speaking regions, there was a particular obsession with midwives. If a baby was born weak, sickly or deformed, which was very common then, the family often claimed that the midwife had swapped their healthy baby for a weakling or Wechselkind and would use their child as a sacrifice or for cannibalism. As a result, by mid-16^th Century, there were practically no midwives left alive in the entire region which, or course, meant more children were born deformed or injured.

While there had always been a low-grade belief in sorceresses, women who could manipulate spirits and other forces into doing what they wanted, they were not generally regarded as a threat to society itself. The basis of the witchcraft mania was that they were no longer seen as people who could get things done (for a fee) but as agents of the satanic force to delay the Second Coming. The point is that the belief becomes self-sustaining, it creates its own evidence. Thus, a woman who was being tortured who cursed the priests and their helpers was obviously evil because God would never permit an innocent person to be convicted of witchcraft. Many priests (and popes) had children on the side, or choirboys who conveniently didn’t get pregnant, but people who accused them of acting out their sexual obsessions were obviously evil agents of the devil and were given a ticket to the bonfires.

History shows that what starts as one person’s bizarre obsession or delusion quickly spreads and becomes a moral panic. The British author Stanley Cohen described how panics develop. People are made aware of some threat to the fundamental basis of society, coming from within the society itself, not outside, so that it is largely invisible and can’t be denied on factual grounds. It is therefore easily manipulated and amplified by people who stand to gain in some sense from building a crusade to oppose it. These days, people scoff at these historical cases: “Hohoho, look at how those primitives acted. We’re far too modern and sophisticated to fall for that nonsense.” Don’t believe it. The Red Scare of McCarthyism was a classic example of how the population can be frightened into supporting actions they would normally not endorse. The current anti-immigrant, anti-Muslim “global war on terror” is just the latest in a long and sordid history of such panics in which people are told that society is in danger and they have to employ extraordinary measures to prevent its collapse. The American socialist, Eugene Debs (1855-1926) said:

For in every age it has been the tyrant, the oppressor and the exploiter who has wrapped himself in the cloak of patriotism or religion or both to deceive and overawe the people.

If he were speaking today, he would say “the cloak of patriotism or religion or health or all three to deceive and overawe the people and convince them to hand over their savings.”

All this comes to mind because of an announcement by a group calling themselves the American Professional Society of ADHD and Related Disorders (APSARD) are on the verge of releasing their Guidelines for Adult ADHD. This will “ ... provide comprehensive, evidence-informed recommendations for the screening, diagnosis, and treatment of attention-deficit/hyperactivity disorder (ADHD) in adults.” Everything you need to know in a snappy edition of “multiple hundreds of pages” to manage the 6.8% of adults [1] who have the disorder (that’s up from zero a few years ago). That will no doubt make it easier for the swarms of private psychiatrists who are charging $3000 or more to hand the diagnosis to anybody who walks through their doors and asks for it.

My attention is wandering at the mere thought of it but the question remains: How can what was promoted as a childhood disorder suddenly afflict 6.8% of adults? There is a sense in which it could because if, as mainstream psychiatry claims, all mental disorder is genetic, then it isn’t going to suddenly get better just because the “patient” turns 18. Illness is never so obliging but we can be sure that with the looming publication of their “guidelines,” the rate of diagnosis will go through the roof. Just as publication of the Malleus 540 years ago meant that people suddenly started seeing witches lurking in every corner, the diagnosis of “ADHD” has all the features of a moral panic. First, the threat is to our children and then to struggling adults: if we don’t do the right thing by them, they’ll fail in life and it will be our fault because we didn’t listen to the experts. The threat is genetic, it’s in us so it’s not like Covid, which we could prevent by drinking bleach or shining UV light down our gullets (he wasn’t joking; he has no sense of humour).

The threat is always invisible, intangible, moving among us and thus the more dangerous as it adds a sense of betrayal, which triggers rage. The witch was the querulous woman next door; the communist was the smiling worker at the next bench or desk; the Islamist terrorist is the helpful man in the fruit shop plotting to hide a hand grenade in your potatoes. In the case of ADHD, the danger is our DNA, silent, unseen until it explodes and takes control of our children’s lives. It possesses them, you could say. That’s pretty threatening but the hidden threat is easily massaged and amplified by what are called moral entrepreneurs, people who double as heralds and saviours, the Dominicans half a milllenium ago, psychiatrists today: “We know the problem and we can fix it. Trust us, hand us your money and all will be well.” Their proposal is to change the entire moral basis of the society to suit their ends. For example, medieval society was convinced that burning women, even your own mother, was no longer abhorrent but was doing God’s will. In the 1950s and again today, societies are being convinced to surrender basic human and civil rights in order to counter the “extraordinary threats” of “monolithic international communism” or “terrorism” or, latest cab off the rank, “antisemitism.” Similarly, psychiatry wants the society to regard drugging children as normal, or failure to drug them as a moral failing.

A moral panic is broad-based and long-term, and is urged along by people who believe firmly in it but who also stand to gain from the movement. It’s not the same as what used to be called “mass hysteria” or “epidemic anxiety,” e.g. Royal Free Disease, from London in the mid-1950s (now claimed by the CFS/ME crowd). That’s the rapid spread of anxiety largely among young people over some unseen threat that triggers somatic symptoms but quickly settles, e.g. a scare of gas near a school, etc.

The current rapid spread of ADHD under its various labels has all the features of a moral panic, not of a valid scientific entity. It has become a vast and self-sustaining industry in its own right, endlessly productive and ever-alert to attack anybody who challenges it. The idea behind a set of guides hundreds of pages long is not to set out the evidence for a confirmed diagnosis but to crush any potential opposition from the beginning. Courts, schools, parliaments, police, welfare officers and public guardians are incapable of reading the sort of pseudoscientific claptrap that pours forth these days to justify drugging children and deciding which parent will or will not have custody or access. They’re swayed, meaning over-awed, by “the weight of evidence,” not by the facts set out in the evidence. A huge book by hundreds of people making millions from the diagnosis invariably overwhelms a report by a single practitioner. Historian and lawyer Eric Dean said:

This impression of scientific certitude in the midst of substantial and potentially crippling problems is a tribute to the ability of psychologists and the psychiatric profession to acquire and wield power ... the salient point is that the mental health professions have a track record of advancing diagnostic categories that lack clear underlying unity based on scientific evidence, but that, nonetheless, have the effect of responding to popular needs and aggrandizing the power and authority of mental health professionals [2, pp200-202].

I am utterly unconvinced that there is a valid diagnosis of ADHD which can reliably be recognised by psychiatrists (and psychologists and social workers and schools and everybody else on the gravy train) and for which treatment with addictive drugs is essential. My primary school in the country in West Australia many years ago had about 400 children. We all knew each other, saw each other all the time, knew where everybody lived and their families; that’s normal in country towns. There was one boy with severe epilepsy who was eventually sent to a special school in the city, one with cardiac disease who died, some who were barely able to read but stayed because there was nothing else, but not one child ever showed the features now thought to afflict up to 20% of children. You did not speak out of turn, you did not get up from your desk without permission and bothering other children meant a trip to the headmaster’s office. Same in high school, except the 30% of kids who didn’t want to be at school left after Year 9 and started work, and life got a bit dull for the rest of us.

In the medieval witch hunts, the burden of proof was reversed: once the allegation was made, it was up to the victim to prove it wasn’t true, that she was not a satanic agent. Needless to say, that was impossible. The point is germane: there is no evidence any person can produce to prove that the so-called “ADHD epidemic” is not a moral panic. The burden of proving that it is not simply another moral panic rests on those who claim it is a valid clinical entity: it is not my job to prove that it is a panicky fad, but theirs to prove it is not. Until that not insignificant point is cleared up, we should not be exposing our children to toxic and addictive drugs [1], just as psychiatrists should not have been allowed to cut people’s brains but convinced society and themselves that they knew what they were doing. However, as Upton Sinclair commented, “It’s difficult to get a man to understand something when his salary depends on his not understanding it.”

References:

1. Oliva HNP et al (2026). Pharmacotherapies for Co-Occurring Stimulant Use Disorder and ADHD: a network meta-analysis. J Clin. Psychiat. 87(4): 26r16478.

2. Dean ET. Shook over hell: Post-traumatic stress, Vietnam and the Civil War. Harvard: University Press, 1997.

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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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