Reinventing the Wheel

It saves on thinking.

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.

If you like what you read, please click the “like” button at the bottom of the text, it helps spread the posts to new readers. If you want to comment, please use the link at the end rather than email me as they get lost and nobody sees them.

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Prof. Peter Gøtzsche of Copenhagen is a physician, not a psychiatrist, but he knows more about psychiatric drugs than practically all psychiatrists. In 1993, he and a sizeable group of international researchers formed the Cochrane Collaboration, their goal being to analyse published medical results so practitioners could get unbiased information in order to improve their clinical decisions. This sort of work is arduous, mainly slogging through piles of medical papers, checking statistics and research methods to uncover all the little slips and slides that allow researchers to get the results they want or to conceal results they don’t like. The Collaboration quickly gained an enviable reputation for the integrity of their work, especially the Nordic Centre which Peter Gøtzsche directed.

However, about 10 years ago, a new director was appointed, who changed the orientation toward a for-profit consultancy. After protracted brawls, Gøtzsche was expelled so he set up his own centre, the Institute for Scientific Freedom, whose goal is “to preserve honesty and integrity in science” (I’m a member). One of his pet hates is antidepressants, which he calls “depression pills” because they are no more than pills given to depressed people; they don’t consistently relieve depression but they have a very long list of unpleasant and/or dangerous side effects, and often makes things worse. Their stated purpose is to reduce depression and thereby to reduce suicide but that isn’t working. As the rate of consumption of these drugs rises, so too does the suicide rate. The fact that up to 18% of the adult population in Western countries take them is a miracle of advertising, not of their clinical efficacy.

In his Substack post this week, Gøtzsche assailed a dramatic article in a slick trade journal written by two academics, They are agitated that the US Secretary of Health, Mr RFK Jr, is “coming for another important medical tool: antidepressants.” Just over 20 years ago, the US FDA required manufacturers to give a “black box” warning that antidepressants could increase suicidal ideas in young people. There was strong evidence for this, particularly as the manufacturers had actively concealed adverse outcomes in their initial trials [1]. In their current article, Stephen Soumerai and Christine Lu quoted a paper they had published a few years ago [2] which, they said, showed that those warnings had prevented large numbers of depressed teenagers getting “essential mental health care” (drugs), resulting in nearly 6,000 excess deaths by suicide in about seven years. What they didn’t show was how many of those who ended their lives early had been taking psychiatric drugs at the time. There is an excellent critique of their original paper by Patrick Hahn in this week’s Mad in America.

The authors say we live in “…a time when adolescent depression, anxiety, and suicide rates are at record highs,” therefore, we need more drugs, not less. Kennedy’s record, they say, is that he will make it more difficult for people to get them and lives will be lost. Now this is very important: every youth suicide is tragic (but not, as the authors claim, a “catastrophe,” as society survives) but before we start wide-scale treating, surely the logical first step is to ask: Is it true that these statistics are at “record highs,” and if so, why? On the face of it, it doesn’t make sense. For the 25 years from 1929-54, life for practically everybody on earth was very much tougher than it is today but they coped. They had to, so why is everything going wrong for possibly the most pampered generation in human history? And how does their notion that there is an “epidemic” of depression and suicide fit with the standard view that mental disorder is a genetically-determined disease of the brain? Human genetics don’t change that quickly but, even if they did, why should we leap to drugs and not to, say, exercise?

To me, these sorts of questions are basic but they’ve never been answered. Nearly 40 years after SSRIs were released, we’re still arguing over whether they are safe and effective, and I think the reason is perfectly clear: psychiatry’s approach to fundamental research on the nature of mental disorder and its causes is decided not by objective science but by a mix of profit-driven drug companies and ideologically-driven academic researchers. All too often, the essential studies were never done or the research was biased by the drug companies that stood to make untold billions from their chemicals. Where we should have a program of completely objective research, we have swarms of under-employed academics picking over huge numbers of seriously flawed and/or actively misleading studies, almost all financed by drug companies. As a result, two contradictory narratives emerge: on one side “More people need to take more drugs for longer,” (from the Soumerai and Lu article: “The time has come for over-the-counter antidepressants”), opposed by: “Too many people are taking too many drugs for too long for no good reason.” The mere fact that on such an important matter we can have two incompatible views says there is something wrong with the whole debate, that psychiatrists don’t actually know what they’re talking about. That is what has to be tackled. Arguing over whether people should have more antidepressants or less completely misses the point of psychiatry’s lack of a scientific basis.

There are, however, plenty of psychiatrists who object very strongly to that conclusion. They point to their huge statistical surveys, their genetic studies, all the research on drugs in brains and so on, and say: “There. What’s that if it’s not science?” Take, for example, Prof. Ian Hickie, a prolific and devout biological psychiatrist from Sydney University. He has a very productive two-way thing going with the mainstream media here: if they have a question on psychiatry, they ring him as he always answers, and if he wants some publicity, which he always does, one phone call and they’re around like a flash. A week ago, he announced a major discovery: antidepressants don’t work on everybody. OMG, who could possibly have expected that? The article starts and ends with pictures of a radiantly happy young woman who was so depressed that “At times, she struggled to leave her house.” It is based on a paper in Biological Psychiatry which analysed 15,000 people in a genetics of depression survey and found 3,000 of them didn’t recover [3]. That probably doesn’t include the 40% of people who stopped the drugs due to side effects etc. They concluded:

This large genetically-informative study supports the neurobiological and clinical validity of atypical depression, demonstrating distinct clinical and genetic risk profiles alongside differential antidepressant responses.

Now this is a bit strange because in pre-DSM-III days, there was already a diagnosis called “atypical depression,” but it was dumped in 1980. Nice to see it’s back but from the sound of it, nothing has changed. People with this diagnosis were anxious with panic attacks and various phobias etc., and commonly housebound. They were weepy, panicky, sick of themselves and the world, but they all showed the same feature in their histories: their anxiety had long preceded the depression, usually going back to childhood. They had often come from good families, mostly nothing much had gone wrong in their lives but they had always been anxious. Their depression was a reaction to being disabled by anxiety, not the other way around as mainstream psychiatry demands. They did not see themselves as bad or useless people. The other point about them was that they didn’t respond to standard antidepressants, so they were given some old fashioned ones called monoamine oxidase inhibitors (not by me, I should point out). Anyway, after spending huge amounts of money, it looks as though Hickie and his intrepid team have reached back fifty years to reinvent the wheel.

The problem again is that they can’t see beyond depression. Depression is what their concept of mental disorder tells them to find so that’s what they find. Once they find that, it then has to be mapped back to the genome because that’s what reductionist biology says. So that’s what they do. At vast expense, and yet nothing changes. The rules of psychiatric genetic research are that geneticists always find what they’re looking for, and nothing ever changes. The reason is simple, and I was reminded of it by a Substack post by a New York psychologist, Roger McFillin PhD, posting as Radically Genuine (worth reading). He is concerned about moves to introduce compulsory “mental health” screening of primary school children on the basis that it is likely to cause children to develop the very disorders they’re asked about. He uses the example of the gastro-intestinal hormone, ghrelin, to illustrate the point.

Some years ago, nutrition researchers worked out that people react to food according to what they’re told, what they think they’re eating, and not so much to what they actually eat. All parents know that, so you don’t tell the little darlings what they’re eating. This study goes further as they found that ghrelin, the so-called “hunger” hormone which should signal satiety, was dramatically influenced by what people thought they were eating rather than the actual sugar content of their food. We are suggestible creatures, he didn’t quite say, which again is not exactly rocket science but it’s nice to have hard, indisputable figures to prove it. McFillin asks:

If belief can change how your body metabolizes a milkshake, what else can belief change? If your hormones respond not to reality but to your perception of reality, what are the boundaries of that phenomenon?

That’s a critically important question but note that biological psychiatry can’t answer it as their model says only physical things count, not airy-fairy stuff like beliefs, hopes, fears, self-esteem and so on. Armed with this data, he argues that simply asking children to reinterpret their daily experience as signs of depression or anxiety is likely to induce a certain proportion of them, probably the insecure ones, to start to see themselves as mentally-troubled, and will thus produce the symptoms they were asked about. Again, this is not new. There is ample evidence that hormones are significantly affected by what we think and believe, i.e. that the mind controls the body in subtle ways.

My other file, Narcisso-Fascism, is built on the idea that what we expect to happen produces a surge of the very hormone we need to make it happen. Testosterone is an important hormone with widespread activity in the body. It is powerfully anabolic, meaning it builds muscles, bones, tendons and the like; it has a strong effect on the emotional state, producing a sense of power, confidence and well-being, and an urge to dominate; and it’s essential for male sexual function. Taken together, it allows the male to dominate the field and breed. A male facing a competition of any sort will experience a surge of testosterone, which primes him to meet the challenge; without it, he won’t have the strength or confidence to stand his ground. If he wins the competition, he experiences another surge and he struts around feeling great; if he loses, his hormonal levels drop, he loses confidence, feels tired and defeated and slinks away. At least nine times out of ten, a surge of testosterone is generated by the urge to win alone, of dominating but with no sexual sensation or interest. Soldiers facing a battle are charged and ready to go because of this hormone but they are not sexually aroused at all. If they win, that’s what they’ll think about but if they lose, sex is the last thing on their mind.

It is beyond question that in different bodily systems, what we believe is about to happen will produce a surge of the specific hormone needed. This is exclusively a mental phenomenon: the belief triggers a defined physiological response, but this is the exact opposite of what biological psychiatry says, it’s body, body all the way. Since reductionists write the mind out of the equation, they are left clutching at genetic straws. As for the woman in Hickie’s publicity piece (who is employed by them), they were unable to see that she was housebound purely as a psychological phenomenon. They heard her say: “I was feeling terrible, I couldn’t go out of the house,” which they interpreted as: “Feeling terrible means depression, and depression means can’t go out.” That’s back to front. The correct story is something like:

I’ve been anxious most of my life. Things weren’t going well, I was getting panicky whenever I had to go out. I became scared that if I went out, I would have a panic attack. Panic attacks are truly dreadful, you really think you’re going to die and that’s terrifying. The thought of a panic attack started to bring one on so I had to stay home. I felt useless and a failure but if I’m not anxious, I’m fine.

The expectation produced the feared outcome, because that’s the nature of anxiety: it is the only self-reinforcing emotion . Anxiety acts recursively, in that the symptoms of anxiety become the new feared object in a vicious circle. This is the basis of panics and phobias:

I have to go to the shops but if I go out that door, I’m sure I’ll start to feel terrible. My heart will race dreadfully and I may have a heart attack. My mother died of a heart attack, I don’t want to die. Oh dear, that thought is making my heart race, which means I’m likely to have a full panic so I’ll have to stay home.

Similarly, people with a true phobia of frogs aren’t scared of frogs. They’re scared of how they will feel if they go near a frog, because it’s happened before and they dread it happening again. But dread just is fear, and uncontrolled fear just is panic. Even though the panic is biting the heart and stomach and legs and everything, it starts in the head as a thought. Biological psychiatry, the type that Bro. Hickie touts, can’t see that simple truth. Their model refuses to make room for thoughts and expectations, it tries to reduce humans to the level of lab rats so it grabs the latest technology hoping that will do the trick. These days, that means it’s stuck trying to find the answer to mental disorder in the genome but he answer isn’t there, just like it wasn’t in neurotransmitters or neural circuits and so on. Or spirits or spells, while we’re at it.

Another example: there is great excitement about using vagal nerve stimulation to “treat treatment resistant depression.” The vagus or 10^th cranial nerve is a vital part of the autonomic nervous system, specifically the parasympathetic. The vagus nerve mediates the “feed and breed, rest and digest” side of things, which is the opposite of the “fight or flight” sympathetic system (it means ‘acting together’). It carries signals from the lower part of the brain to the cardiac, respiratory and digestive systems, and takes information back to the brain for processing. Somebody found that stimulating the nerve with electrodes would reduce depression but they can’t explain it. The answer is simple: the vagus slows the heart, reduces gastric motility and various other features of the “fight or flight” reaction, otherwise known as panic. If the panic is blocked, the anxious person can go to the shops and to school or work; the sense of uselessness and despair goes away and hey presto, another magic cure for depression rolls off the production line. There’s a competition to see who can come up with the loopiest explanation for this but the real answer involves those forbidden thoughts so they won’t go down that path.

Genes program us to have a brain, they don’t say anything about what we will do with it. For example, our DNA gives us the ability to speak and understand language, but it doesn’t say what language we will speak, what we will say or what we will believe. Experience does that, which has nothing to do with the genome. The answer to mental disorder is buried in the thoughts, but that’s true of practically everything we do. Biological psychiatry, which pretends otherwise, just goes round and round in circles, rediscovering what we all knew fifty years ago.

References:

1. Aboustate N et al (2025). Restoring TADS: RIAT reanalysis of the Treatment for Adolescents with Depression Study. Int J Risk Saf Med. N/S, p1-20. DOI: 10.1177/09246479251337879

2. Lu CY et al (2020) Increases in Suicide Deaths Among Adolescents and Young Adults Following US Food and Drug Administration Antidepressant Boxed Warnings and Declines in Depression Care. Psych Res Clin Pract. 2:43–52; doi: 10.1176/appi.prcp.20200012

3. Shin M. and another 15 authors (2026). Atypical depression is associated with a distinct clinical, neurobiological, treatment response and polygenic risk profile, Biological Psychiatry https://www.biologicalpsychiatryjournal.com/article/S0006-3223(26)00004-1/fulltext

4. McLaren N (2018). Anxiety: The Inside Story. Ann Arbor, MI: Future Psychiatry Press. At Amazon.

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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.