Reacting Aggressively
to pointless research
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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A friend assiduously scans the psychiatric literature and regularly flicks me papers she thinks are even more outrageous or braindead than the usual fare. One that caught her attention this week has been getting lots of favourable publicity – from the study authors, as it happens. This was a long term project to see if giving antidepressants to men convicted of violent offences led to improved behaviour [1]. Their reason was that impulsivity and aggression are related to low levels of the neurotransmitter 5-HT (aka serotonin) although the evidence is very indirect.
In general, programs to reduce violence or recurrent offending have dismal outcomes, not least because people generally don’t stay in them very long (that’s what impulsive means). Also, rates of violent offending seem to be rising in many parts of the world, especially domestic violence. However, studying this population is notoriously difficult for many reasons, such as their suspicion of authority, their tendency to move around a lot, dislike of psychiatry and its drugs, difficulty getting a representative sample, and so on. To get around this, the researchers assembled a large team who worked closely with the NSW forensic and probation services, which allowed them to get the numbers they needed to get a statistically meaningful result. There were about fifteen centres involved, and they also relied on various services to provide mental health support, etc, so it was a big project requiring a lot of organisation.
They collected their subjects over nearly eight years, screening some 1738 individuals in order to get 630 who met the criteria and agreed to participate. All were assessed by a psychiatrist and saw a psychologist to complete no less than seven different questionnaires. They were divided in two groups, those who took the SSRI drug sertraline 100mg a day and those who got a placebo. All the participants saw support services throughout, and had access to phone support as needed. Most people convicted of violent offences don’t get anything like this level of attention. They were reassessed at twelve months and their police records checked to see who had been up to what in that time. However, over two thirds of the subjects dropped out, which is more or less what you’d expect for aggressive young men (average age 32yrs) with criminal records.
This was a very big study. Fifteen centres, eight years, twenty authors listed on the paper plus heaps of other staff providing services, the coordination involved would have kept a couple of secretaries going full time. Unsurprisingly, it cost heaps, apparently about $6.9million but it had to stop when they ran out of money. So what did we get for this prodigious expenditure of academic time and government money? Nothing new:
22.6% of those on sertraline who could be tracked had reoffended, compared with 22.5% on the placebo. “Sertraline did not significantly reduce the risk of violent reoffending compared with placebo.”
After twelve months, the drug had no measurable effect although they felt there was a slight reduction in domestic violence over two years. However, the article they published in an opinion mag was very excited about this result: “Giving men a common antidepressant could help tackle domestic violence: world-first study,” their headline trumpeted. They continued:
Our trial demonstrated this approach is cost-effective: at about A$7,000 per participant annually versus $150,000 for incarceration … We do not claim our approach to be a silver bullet, but it deserves serious consideration as a proven intervention in the domestic violence prevention ecosystem, and could be implemented now.
Wow. An ecosystem, whatever that means, but it’s also about $6,999 more support than most offenders get. They gave a couple of breathless quotes from participants to show what a great idea it is but there was no mention of the 426 who dropped out of the study. Did they stop because they didn’t like the drug side effects such as weight gain or loss of libido? Probably, or they forgot, or somebody made fun of them, or they got on the booze, on and on. And before we rush out and start building this prodigiously expensive program, how much goes to the women and children involved in DV? Not much, as it happens. More to the point, we can in fact get a better result, cheaper, with far fewer side effects, based on much stronger grounds than a few chance associations.
The group of drugs called beta adrenaline blockers are very specific at blocking the sudden bursts of rage and agitation that lead to impulsive violence. They can transform a person’s life at a cost of about 30c a day, with no weight gain, no addiction, no impotence, no mental clouding etc. Beta blockers can make the difference between keeping a job and losing it, and they reduce admissions to hospital. They also reduce the need to drink, as alcohol is also very effective at reducing the agitation, until they get too much. So why aren’t these drugs used more? You’d have to ask the researchers why they didn’t do a trial comparing sertraline to, say, propranolol, but I doubt you’ll get an answer so I’ll tell you. They’re not interested in it because beta blockers block anxiety, and their idea is that aggression is due to low levels of serotonin somewhere in the brain, even though they don’t know where or have a clue how this could come about. They don’t want to hear that anxiety produces aggression because, to them, anxiety is trivial, just the “worried well” carrying on, and also because that might mean aggression is a psychological phenomenon, not biological, which is anathema. That is, their research program is ideologically-driven, not empirically.
Once again, we see psychiatry chasing biological shadows, burning money and lives in the pursuit of the hope that, one fine day, biology will tell us everything we need to know about the mind with no significant questions unanswered. The Nobel prize winning neurophysiologist, Erik Kandel, who is adored by the biological mob, put this neatly in his autobiography. He grew up in pre-war Vienna, not far from the Freud family home and was always convinced that psychoanalysis was gospel:
… my insistence that … biology can transform psychoanalysis into a scientifically grounded discipline [2, pxxi] … in the near future, neurobiology will address a matter of more general and fundamental importance: the biology of human mental processes… Psychology and psychiatry can illuminate and define for biology the mental functions that need to be studied if we are to have a meaningful and sophisticated understanding of the biology of the human mind [2, p7].
He restated his biological ambitions in an edited version of some of his more influential papers and chapters:
… to understand behavior, one had to apply to it the same type of radical reductionist approach that had proved so effective in other areas of biology [3, p236] … the underlying precept of the new science of mind is that all mental processes are biological ... Therefore, any disorder or alteration of those processes must also have a biological basis [3, p336]…
He used this term “radical reductionism” frequently, meaning that the mind can be fully explained in biological terms without any loose ends. Howver, and despite vast expenditure over decades, the program to explain the mind in biological terms is going precisely nowhere, and the reason is simple: the biological brain is just the mechanism of mind, not the mind itself. It’s the same as how I can explain a car in mechanical terms but I can’t use its mechanicals to explain cars as status symbols. Mind arises from physical processes in the brain, it is an emergent phenomenon, dependent upon but not reducible to the physical structure of the brain. Given this elementary fact, it’s worth asking when all the biological psychiatrists will finally admit that their search is not going to give them what they want. When do you give up on a search? That has to be defined early in the piece otherwise people become so committed, so determined to find the pot of gold at the end of the rainbow – fanatics, in other words – that they can’t stop. They can’t bring themselves to admit what everybody else can see, that the program is a waste of time and money, as the astronomer, Carl Sagan, noted:
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.
After seventy years of trying to hammer mental disorder into a biological box, what have we got to show for it? Just some expensive drugs that were discovered by chance, that have severe side effects, and that appear to be driving an increase in mental disorder [4]. As for intellectual justification, there’s none. Seventy years of effort has not produced anything beyond a hope that biology will ride to the rescue. It we look at what mainstream biology has produced in that time, the contrast could not be clearer. For example, conventional cytotoxic chemotherapy is pretty dreadful. It consists of injecting controlled doses of what are essentially poisons into the body to kill off rapidly dividing cells. These includes the cancer itself but also hair follicles, blood-forming marrow, the lining of the bowel and respiratory tract etc, as well as giving the brain a good pounding. Chemo has come a long way and is much more effective than it used to be but the ultimate has now arrived, in the form of immune therapy.
On the surface of every cell in the body there are proteins called antigens, and it’s possible to form antibodies to those proteins, which is the basis of the autoimmune diseases such as SLE, scleroderma, rheumatoid arthritis etc. The antibody neutralises the antibody, which signals the cell to kill itself (apoptosis), resulting in severe inflammation and loss of function. However, tumour cells also have specific antigens, so the goal has been to find the specific antibody for that particular cell, mass-produce it and inject it to kill the tumour cells without affecting any other parts of the body. That’s all been done. The precise molecular mechanism sitting on the walls of a particular class of cells has been described down to the last atom; cells that produce an antibody to just that molecule and no other have been isolated and cultured, and the antibody reproduced in essentially unlimited quantities. The nett effect is safe, effective chemotherapy for certain classes of tumours with minimal side effects. Instead of being disabled for months, patient can drive themselves to the clinic, get their infusion and drive home with minimal interruption to life.
In the same time period, with access to the same technology and unlimited money, what has psychiatry produced? Nothing. Decades later, psychiatry is still hiding behind that tired old trope, “Chemical imbalance of the brain.” There are no new drugs in the pipeline, drug companies have largely given up on original research in psychiatry and are now just manipulating old drugs to get new patents. 25 years ago, the human genome was all the go, it was going to tell us everything we needed to know. Well, we’re still waiting but they seem to have lost interest and are pinning their hopes on inflammation as “The Cause.” What happens is that when a new technology arrives, such as genome sequencing or immune therapy, psychiatry grabs it, tells the world that this is it, this will sort out mental disorder once and for all; everybody rushes around getting grants or jetting off to conferences, breathlessly announcing the millenium, and then it slowly fades. Gradually, the drama subsides until the next “breakthrough” arrives and the sequence starts again.
This project on violence was a little different in that it fits with what I see as psychiatry’s long term project of reclassifying personality problems, for which psychiatry has nothing to offer, turning them into “mental illnesses,” putting the people on drugs and thus gaining vast new markets for themselves [5]. I see this as profoundly disingenuous, the result of psychiatry not having models of mental disorder or personality disorder, and therefore able to shift patients around the board as it suits them.
When we take all the additional staff costs into account, the study on aggression and sertraline would have cost close to $10million. They should have asked me, I could have told them it wouldn’t work. But that won’t stop them. They’ll make the most of the publicity then come up with another plan, “to build on the earlier results,” and so it will go on. They can get away with it because psychiatrists are so committed to their biological program that they can’t conceive it could be wrong. All the people on the grants committees, all the editorial boards, the professors and examiners, the college bigwigs and mental health services directors, each and every one of them is wedded to a biological explanation of mental disorder. Regardless of what they may think late at night, not one of them is prepared to be the first to ask: “Is this going to work? Do we actually have a plan or is this just blind faith?” As I said years ago, this is an ideology of mental disorder, but it’s not a scientific program [6]. Maybe the new generation can break free of the chains of group think that bind today’s “key opinion leaders.”
References:
1. Butler T et al (2025). Sertraline to reduce recidivism in impulsive violent offenders (ReINVEST): a randomised double blind clinical trial. eClinicalMedicine 2025;90: 103668.
2. Kandel ER (2005). Psychiatry, psychoanalysis and the new biology of mind. Washington, DC: American Psychiatric Publishing.
3. Kandel ER (2006). In search of memory: the emergence of a new science of mind. New York: Norton.
4. Whitaker R (2009). Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America. New York: Random House.
5. McLaren N (2012). Chaps 14-16 in The Mind-Body Problem Explained: The Biocognitive Model for Psychiatry. Ann Arbor, MI: Future Psychiatry Press.
6. McLaren N (2013). Psychiatry as Ideology. Ethical Human Psychology and Psychiatry 15: 7-18. 10.1891/1559-4343.15.1.7
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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.