Reprising Mesmer

Nothing new under the sun

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 few weeks ago, the helpful people at Psychiatric Times reported on a new neurostimulatory device approved by the FDA for use in PTSD (May 26^th). This little widget is the Modius Spero which uses two electrodes placed behind the ears trickling low voltage DC to stimulate the vestibular nerves on each side. This nerve feeds information to the brain stem from the tiny vestibular apparatus, or semicircular canals, in the ear that control balance and orientation. According to the company release, “The at-home therapy uses skin electrodes behind both ears. Patients can read, watch TV, or engage in other activities during treatment for 30 minutes a day.” There is no explanation that I can find of how balance influences explosive fears or rages, nightmares or suicidal impulses, but the manufacturers have managed to convince the US Veterans’ Affairs Dept. that their 13million PTSD sufferers should have access to this little gizmo, at about US$1200 each. Bearing in mind that it probably costs about $100 to make (in China, of course), they could do well out of this.

In a Substack post (June 5^th), MIA’s resident psychological sleuth, Peter Simons, looked into it further, pointing out that it has simply been authorised for sale by the FDA, not approved for treatment of a named condition. Authorised means only that it’s unlikely to kill you but doesn’t say it will do the job. Since Mr RFK Jr got to work on the FDA and Dept of Health early last year, it’s quite likely that no properly qualified staff have actually looked at this thing. The same device is marketed for about $2000 as a cure for insomnia and that hardy standby, “stress.” Everything available says it hasn’t been through anything like a rigorous process of investigation. The “study” the FDA used is really an exercise in how not to investigate health claims.

The Psychiatric Times article is simply a rehash of the company’s press release. We’d like to know, and we’re entitled to know, just how this works. Crucially, what’s their theory that justifies it? Why does it help people sleep when, attached to a child’s head, the same sort of gadget is used to “treat” ADHD? Reading that article reminded me of Dr Franz Anton Mesmer (1734-1815), a German physician who, on being involved in a scandal in Vienna, decamped to Paris and set up treating the rich with his new technique of “animal magnetism.” Mesmer seemed to have had a fairly leisurely life, finally graduating in medicine at age 32 with a dissertation (in Latin, of course) titled: On the Influence of the Planets on the Human Body. After reading Newton’s theory of how the moon and sun influence tides, he got the idea that they also influenced a tide in the body of a fluid of sorts that permeates the entire universe.

With time, Mesmer constructed an elaborate theory of how this form of natural energy maintained life forms in balance. When it flowed smoothly through the body, all was well but if it was blocked in some organ or another, disease ensued. There were, he believed, helpful people who built up stores of animal magnetism in their bodies, especially in the hands, and they could influence the sick and ailing by manipulating their disordered energy flows. By waving his hands over the afflicted organs or limbs, he claimed he could restore the energetic balances, curing the illness. In that age, medicine hardly existed so anybody who promised to cure people using a novel method was guaranteed an eager clientele. Mesmer soon had too many patients so he devised a way of spreading his energy around using a huge pot with iron bars poking out of it. That was enormously popular but the party ended when he had to leave Vienna rather suddenly.

The worldly-wise Parisiens weren’t so easily impressed. In 1784, the king appointed a commission to investigate whether Mesmer’s cosmic fluid actually existed. Members included Antoine Lavoisier, the leading chemist of his age, the new American ambassador, Ben Franklin, already famous for risking electrocution with a kite in a thunderstorm, and the eminent Dr Guillotin, after the machine of the same name. They quickly decided that there was no such fluid (although it was around for another century as the ‘luminiferous aether’) and devised a simple test for Mesmer’s “treatment.” Using blindfolds, they found that the only factor that counted was whether the patients believed they were getting the genuine hand-waving or not. In what was apparently the first case of a blinded investigation in medicine, they concluded the whole thing was imagination. They then asked the very sensible question: “Can we harness imagination to use it constructively in treating sick people?” That was academic as Mesmer was invited to leave Paris so he went back to Germany and faded out but his name lived on as “mesmerism,” now known as “hypnosis.” And we’re still asking the same questions: How does a belief state affect the physical or mental state? We know that it can, that the placebo effect is real, but what’s its mechanism? Is tickling your vestibular nerve just placebo? There is, however, a far bigger question: does this indicate we have reached “peak drugs”?

Because psychiatry doesn’t have a theory of mind or model of mental disorder, it is unusually susceptible to fads. We’re in the middle of a big one now, where everybody who wants a diagnosis can have one for the asking, or even just for a quick peek at the endlessly obliging Dr Google. Fifty years ago, people didn’t want to be labelled as mentally disturbed, it was seen as intensely humiliating, disempowering and alienating. Now, half the population want to be seen as “neurodiverse” or “transgender” or “ADHD” or “ASD” or something because it allows them to control the dialogue instead of being controlled by it. But it’s not just the “patients” who follow fads, it’s the psychiatrists. The moment some new physical investigation or form of treatment becomes available, psychiatrists grab it and try to apply it to their field. After a while, it emerges that it doesn’t work so they quietly drop it and reach for a new plaything. We’ve had decades of drugs, drugs and more drugs and now it’s becoming clear they aren’t everything people wanted them to be. A recent article on deprescribing antidepressants in the Australian Journal of General Practice puts this very clearly to the people who actually prescribe most of these drugs. That would not have happened even ten years ago but it leaves a gap: what should be done with all the people proudly walking around with their diagnoses pinned to their chests? At first glance, a diagnosis with no treatment seems rather pointless, although the social effects may be sufficient reward. Enter the device makers: Award yourself a diagnosis and buy our expensive little gewgaw to complete your wardrobe.

Most of these machines will end up gathering dust in a cupboard but a few people will swear by them, which was also true of Dr Mesmer’s clientele 250 years ago. They will be enough to keep the argument – and sales – going. The companies will use those few excited “true believers” to reinforce its argument that it is using “evidence-based practice” to sell its wares, hoping that nobody asks about placebos. The problem for genuine sufferers is this: nobody can tell the companies not to do it, that it can’t possibly work because balance has nothing to do with core beliefs. This was how they got rid of the enterprising Dr Mesmer, by showing that his supposed “fluid” didn’t, couldn’t, exist and the whole thing had to be imagination. He was probably lucky: a few years later, Lavoisier met a quick end on one of Dr Guillotin’s inventions, per order of the Committee of Public Safety, aka the Reign of Terror.

There are, however, two imaginations involved, the patient and the doctor. This raises the crucial point on which Thomas Szasz hung his ideas. Szasz said all psychiatry is a fraud. The patient pretends to be ill and the psychiatrist makes pretend diagnoses and gives pretend treatment. Each side knows the whole thing is a racket. I’ve argued that this glib approach is completely wrong as it is based on his early life experiences of being a medical fraud himself, and his historical parallels with the medieval witchcraft craze are misapplied [1]. The overwhelming majority of people who complain of mental symptoms are not imagining it. They are genuinely troubled and want somebody to do something to make them better. Psychiatrists, however, imagine they have a model of mental disorder that justifies whatever treatment they decide on. Moreover, they’re full of confidence because all doctors believe in what they’re doing, otherwise they’d do something else. It doesn’t matter what it is, they believe in it: cutting the brain; sticking electrodes in the brain; electrifying or magnetising it; total dental clearance or gall bladder removal to eradicate “foci of infection” that are poisoning the patient from within; hyperbaric therapy (high pressure oxygen); heat therapy; cold therapy; any number of diets or dietary additives; acupuncture; various sorts of massage; deep sleep; and all of the above as an exercise in self-indulgence (like this one. It must cost a packet).

Straight away, the scene is set for an exercise in self-deception. On the one hand, we have the sufferers, who are troubled and confused by what is happening to them. Mostly, they don’t know what’s gone wrong. Nothing they’ve tried seems to work; willpower and faith go nowhere, so does this mean they’re damned for life? On the other hand, we have a group of professionals who radiate confidence, who say they have a science of mental disorder that gives them the necessary “tools” (they like that word, so business-like) to sort out the patients so take a deep breath, lie back and we’ll get you on your way. “What a relief,” breathes the patient, “I thought I was doomed.” As soon as they say that, all the mysterious and frightening physical symptoms start to abate, the whirring terrors of insanity start to settle, and both patient and doctor are convinced it was the treatment wot dunnit. No, it’s not. It’s not the drugs, it’s not the ECT or the TCMS, it’s simply the relief of anxiety, aka placebo effect.

The problem is that anxiety/fear is the most powerful of all human emotions [2]. It has to be, it has to override all other emotions and sensations to do its job of saving your bacon. To this end, it is the only recursive or self-reinforcing human emotion. All other emotions such as humour, anger and grief eventually wear off but anxiety doesn’t: it gets more and more intense until you give in and do what it wants, which is to get away from the source of fear. However, if the source of your fear is one of the symptoms of anxiety itself, then you’re trapped in a self-reinforcing loop that you can not escape, any more than you can run away from your shadow. It can only get worse, leading to what is known as a panic attack.This is not a separate “illness,” it exists on a single axis ranging from “mild concern” to “mind-bending terror.” When people’s minds are bending under the strain of terror, all sorts of strange things happen. Naturally enough, they can’t sleep, so sleep deprivation becomes a real factor. They’re confused and forgetful, they experience sensory distortions up to and including active hallucinations, and they get strange ideas as they try to make sense of what is going on, usually called “delusions.”

But it’s all fear. An example from many years ago when I was working as a GP: early one Sunday morning, I was called to see a young woman whose husband was sure she was dying. She was lying in her disshevelled bed, absolutely panic-stricken, sweating, jerking, hyperventilating wildly, barely able to speak. I reached into my bag for one of the paper bags we carried for just this. After a minute of rebreathing, she sat up, clearly better and very impressed. I explained what was happening and told them what to do for further treatment. That afternoon, she called to say she needed another of my paper bags. She had accidentally torn the one I gave her and none of the bags they had at home did the job. The message is: it’s all what you believe. If you believe you will have a panic attack if you go near a frog, that’s what will happen. You’ll blame the poor little froggy, of course, but it’s actually your scary belief doing the damage: “If I go near that frog, I will feel terrible, the worst possible feeling. And here it comes, oh no, I’m about to have one of my dreadful turns. Quick, call the ambulance.” The thought of having a dreadful turn is itself the scary thought that brings on the dreadful turn. QED. Moreover, and more to today’s point, if you believe that a little electrical jigger attached to your ears will calm your agitation, that’s what will happen because anxiety is the psychological response to the perception of a threat. It is not a physical disease of the brain. Yes, there are many physical symptoms of anxiety but they’re secondary to the primary psychological cause, namely, a perception interacting with a belief state. Further, if you believe that a machine or amulet or spell or ritual or diet or exercise etc., will remove the threat, you will feel better. QED.

Psychiatry pooh-poohs anxiety as “the worried well, not a serious mental illness,” and therefore can’t see its leading role in other conditions, especially depression. Lacking a theory of mind, that part of the chain of causation of mental disturbance is a blank so psychiatry fills it with fantasied “chemical imbalances” and “genetic causes” (see Jay Joseph in this week’s MIA for another chapter in his demolition of psychiatric genetics). It would help if they had a model of mental disorder but they haven’t, just a bare ideology of biological reduction, meaning biological psychiatry is doomed to endlessly chasing after fads. It means they can never give a proper account either of the role of anxiety in mental life or of such secondary effects as the placebo effect. The biocognitive model does all this without inventing biochemical or genetic causes that can never be found, just because they aren’t there. The model specifically says that in mental disorder, the brain is normal, it is precisely following its orders. The orders are wrong, that’s all, caught in a self-reinforcing loop, which is why amulets seem to work so well.

PS For some reason, Mr RFK Jr wants people to drink raw (unpasteurised) milk. When the cost-benefit ratio comes home to roost, this isn’t always such a bright idea, as this law firm makes clear.

References:

1. McLaren N (2012). Critique of Thomas Szasz. Chaps 12-13, in The Mind-Body Problem Explained: The Biocognitive Model for Psychiatry. Ann Arbor, MI: Future Psychiatry Press.

2. McLaren N (2018). Anxiety: The Inside Story.

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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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