Quote: "Today we make ADHD history"

So said Sen. J Steele-John as he officiated at the launch of the report of the Senate enquiry into ADHD. Glowing exultantly, he continued:

Today marks a new chapter for the one million Australians with ADHD.... This is a historic moment that acknowledges what so many in our community know firsthand: ADHD is deeply misunderstood and that misunderstanding and stigma is embedded all throughout the systems that folks must navigate for help.

The report itself is 308 pages so I'll read it when I get around to it because we all know what it's going to say: "Look out, ADHD is everywhere, we sufferers are mistreated and misunderstood by all the neurotypicals who hold the reins of power and stop us getting the drugs and pensions and benefits we think we should get." Ho hum, more of the same.

Meantime, my proposal to write an article for one of the local psychiatry journals on the WHO/OHCHR Guidance on Mental Health Legislation (see this file, October 10th), which is really important and has the potential to transform mental health practice, was rejected by the editors in a record 45 minutes. It tells you where the priorities lie.

BTW, while we were wasting thousands of hours of parliamentary and public service time on this foolish enquiry, we weren't having enquiries into Covid, or the nuclear submarines we can't afford and can't run or service, or climate change, the illegal conduct of the former prime minister and the current Governor-General, the housing problems, off-shore tax havens and tax evasion by multinational corporations, Iraq and Afghanistan war crimes, massive subsidies to Australia's fossil fuel industry and global warming, corporatisation of universities, loss of biodiversity, abuse of disabled people by public trustees and a dozen other pressing issues. No doubt parliament has them on its busy agenda.

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It's been said that the job of the modern journal editor is to sort the wheat from the chaff, and make sure only the chaff gets published. Richard Smith, who was with the British Medical Journal from 1979-2004, including 13 years as editor in chief, wrote a book after he left called The Trouble with Medical Journals (also as a short paper here; worth reading). He has described medical journals as little more than the publishing arm of the drug industry, which is even more true of psychiatric journals. The multinational publishing companies that own most medical journals make enormous profits, a large part of which they plow back into the medical profession to maintain loyalty. There are few things that would please me more than to see an online, self-sustaining publishing industry that would put them out of business, but it isn't going to happen this week.

That's by way of saying October was a bad month for having papers rejected: four, in fact. Two rejections a month is pretty normal but four gets a bit wearing, especially when we see the torrents of chaff that appear in most journals. Who remembers papers from ten years ago? Almost nobody but the authors. How many papers actually influence the practice of medicine? Practically none. There are so many things wrong with the medical publishing industry that it would take several books to describe them but one of main problems is the pretence that it's all objective and above-board and fair and so on. It's none of those things, but it's actually worse because everybody involved walks around saying how objective and above-board and fair it is when everybody knows it is highly subjective, underhand and biased but nobody is allowed to say it. Like the emperor's new clothes, everybody has to pretend how wonderful it is.

So what has stirred my ire? Two events. First, my paper on the biopsychosocial model and scientific deception (aka fraud) was published overseas a few weeks ago, but barely a week later, I was asked by one of the local journals to review a submission for them. Act as a reviewer? Are you serious? In nearly fifty years, I've published probably more than 90% of Australia's psychiatrists but I've been asked only two (2) times by local journals to review a submission. The first was years ago, the paper was absolute rubbish and I quickly ticked "Reject" but I soon worked out who the author was, the golden-haired boy of one of the Really Big Names in psychiatry. Obviously, the editors were scared to reject it themselves, so they sent it to me knowing what I'd say. That way, they could blame the reviewer rather than tell the heavy-duty psychiatrist they weren't going to publish his pet project.

My second chance of glory arrived this week, asked to review a paper saying what a wonderful thing the biopsychosocial model was and how it should be expanded to suit the IT era. Truly. This time, the editors were serious, they wanted it approved. OK, the authors hadn't seen my latest paper but they had seen all the others, and misquoted some of them. The editors also hadn't seen it but they saw an earlier version and rejected it. I sent the submission back as "Reject" along with a snarly letter to the editors suggesting that if they couldn't tell pseudoscience when it was served to them on a platter, they needed another job. I'll probably have to wait another 25 years to be asked again, but all this confirms exactly what Richard Smith has been saying for nearly twenty years: the medical publishing industry is rotten. Except that's not news.

The second event was a paper rejected twice, but not by psychiatry journals. Instead, the two editors suggested it wasn't quite their field and should go to psychiatry or psychology journals. That was a bit annoying as I'd already told them that mainstream psychiatry journals wouldn't touch it because of a word in the title: Spirituality. Now before everybody starts squealing about fairies and demons and telepathy and all that stuff, understand there is a big difference between 'spirituality' and 'spiritualism.' A universe of difference. Spiritualism means all sorts of magic beings and forces that certain gifted and/or malicious people can contact and/or manipulate at will. Magic is taken to mean "able to influence the world by non-natural means; not subject to the laws of the physical universe," and it is exactly what science was meant to eliminate.

I've mentioned the philosophical doctrine of positivism at various points; this is the central doctrine behind the notion of a "biological psychiatry." Positivism says: The only evidence we can use in science is what we can see and measure. It doesn't say that nothing else exists, only that it can't be used because as soon as you let one unobservable through the door, all the rest will stampede madly through, too. That worked very well for physics and chemistry, geology and astronomy and so on, and those fields roared ahead but there was a battle in biology over "life forces." This concept said that physics and chemistry cannot explain living material as there is something else involved, a special élan vitale which activates inert material to produce living matter. Eventually, it was shown that the new field of biochemistry could explain the properties of living matter without any extra forces involved, and so biology threw out unobservables and joined the mainstream of positivist science.

That's all very well; we can build a very large edifice of science on the basis of a bare positivism, and that's what has happened. Jets, computers, satellites, cardiac pacemakers, vaccines and so on, all are products of the positivist revolution. However, and quite clearly, the mind is unobservable. Therefore, positivist science can't study it. If you don't allow mental events in your new science, there are only two paths available. Either you can say, as behaviorists like BF Skinner said, there is no mind (actually, he could never make up his mind over that, sometimes he said there isn't and sometimes he said there is but it's irrelevant) or you can say "What we experience as a magic show in our heads is not magic at all, it's just molecules bumping in the dark." Unfortunately, a lot of people confuse what it is they're trying to explain.

In the case of the early biologists, they had to explain movement and growth and such like. The concept of the élan vitale was an attempt to explain those observations. The observations were real, the explanation was unreal. However, when it comes to explaining the mind, people confuse the issue. They think that the mind is an unreal explanation that has to be eliminated, when in fact the mind is the observation that has to be explained. I look outside my window just now at a baby magpie demanding to be fed. You may say "Well, that's all biological, brain chemicals explain it, so there's no problem involved."

In fact, the biology hasn't explained anything at all. I don't dispute mental life is based in biology, but ordinary biology isn't a complete explanation. There is still something more, some element that cannot be explained by chemistry, and that is what we can call the mental or spiritual element. That is not spiritualism, it simply says: a physical explanation of the human being still leaves lots of things unexplained, such as pain, ambitions, likes and dislikes and so on. The biocognitive model of mind (my answer to the biopsychosocial non-model) says that all this is based in information and can be understood in the same way as, say, a virtual bank and so on (but a lot more complicated).

When it comes to psychiatry, the positivist message has been perverted. Biological psychiatrists say "Yes, complaints of depression are real, but their cause is a chemical imbalance of the brain. There are no other factors involved, and definitely no mental factors because they're magical and can't work on the real world." That's wrong on two counts. It isn't what the original positivists said, and there is no proof that mental disturbances can't have a mental cause. Absence of proof isn't proof of absence.

My case in the paper that was rejected is this:

The mind as we experience it is a real thing that has to be explained (that includes mental trouble such as depression and panic, etc);

Ordinary reductive science can't explain the mentality of mental life (it is the squawk of a baby magpie, that extra or non-biological perception, that I want explained);

That extra bit is rightly called mental or spiritual, which only means "non-physical";

Information is both non-physical and real; it cannot be explained by the laws of physics;

If we allow a non-reductive informational (mental or spiritual) element in human life (and my paper is designed to explain just that), then we open a new world of explanation: mental events, including mental trouble, can be fully explained by prior mental events, with no magic involved;

Therefore, a psychiatry which talks of mental causes of mental disturbances is real, not magical. This says that psychotherapy is the correct approach to treatment of mental disorder; giving drugs simply suppresses the mental causes so they just sit there and cause trouble later on.

Unfortunately, that's not a popular message. The popular message is "It's all chemical, take your tablets and keep quiet." I'm sure the Senate ADHD report will say just that but I'll read it and let you know in due course.

Maybe I should just take that word out of the title.