Spreading the Word

And collecting the money

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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“(Philosopher of science, Thomas) Kuhn was Toto, pulling back the curtain and exposing the Wizards of Oz: are our great and powerful scientists just dazzling humbugs whose power derives from persuading other people to believe?”

Kurt Andersen (b. 1954), Fantasyland, chap.23; his emphasis.

In the 1930s, France built the Maginot Line, a series of deeply-entrenched and hugely expensive fortifications along its eastern borders. Nobody could invade through the Alps to the south but this would prevent yet another German invasion across the flat northern European plains. Following suit, the Belgians built a number of massive forts on their border that could withstand any artillery and bombs known, after which they felt secure. As history showed, they got it completely wrong. On General Mannstein’s advice, Hitler directed the attack through the hilly Ardennes forests, which allowed them to sweep up behind the Maginot Line and neutralise it. The other point the French hadn’t considered was that the lightning fast German advance was lightning fast because the Wehrmacht was stoked on amphetamines (see here for review of interesting book). For the smug Belgians, the Germans had an even more diabolical trick. They managed to land some troops on the top of the conical fortresses and then sent a message to the commanders, letting them know that if they didn’t surrender, they would drop poison gas down the air intakes and that would be that. They surrendered. The best laid plans of men and mice, as they say…

But what has this to do with critical psychiatry? Not much, except that it often feels like we’re sitting in a field, trying to lob shells on the fortress of mainstream biological psychiatry, only to watch them bounce harmlessly off the enemy’s armour-plating. Problem is, even when we do manage to hit them where it hurts, as with the extensive expose of antidepressants for young people [1], they pretend it didn’t happen. This is a war of public opinion and, unfortunately, it’s not a fair battle and they’re winning. They’ve got all the big university and media guns on their side, they’ve got the general public following them with rings through their noses, they have the money to entertain the politicians to keep the money flowing but all we’ve got is boring facts. What we need is some way of scaling their fortresses with a bag of rat poison to force a surrender. Sad to say, I don’t have one otherwise I’d use it but it’s important to remember that they’re not actually in a fortress, it only seems like that. They get their funding by constantly shouting how they’re racing ahead, a blitzkreig powered by the latest science, they’ve finally got mental disorder in their sights and all they need is a bit more money (actually, can you make that a lot of money?) and the battle for humanity’s sanity will be over. In a war of propaganda, we’re not just fighting experts in spinning stories, the other side actually believe their own stories. That’s why they can dismiss criticism without losing any sleep.

It’s always seemed clear to me that The Other Side are perfectly sincere in their belief that biology will explain the whole of mental disorder, with no interesting questions unanswered. They believe it as surely as they believe that night follows day. They constantly tell each other this is the case, they have hundreds of prestigious journals pumping out the same message, they go to conferences where The Great and The Good of psychiatry repeat the same message of galloping progress in the science of mental disorder … all that’s lacking is proof. They forgot that bit or, more to the point, that’s also part of the narrative: “The fact that mental disorder is always and only a product of brain disorder is so elementary that, like night following day, it doesn’t require proof. Sensible people would never question it.” When you’re trying to talk to them, you bang into this attitude like turning a corner and banging your nose on a brick wall. You get nowhere but, if you persist, it will be turned against you. It’s as the American writer and broadcaster, Kurt Andersen, asked: Is the “science of mental disorder” just a matter of who shouts loudest, who spins the most plausible story? Recall what Hitler said about propaganda: the general public are stupid so the message has to be short, simple and repeated over and over, squeezing out any other facts [2, pp119-120]. Sounds just like psychiatry, doesn’t it (it’s worth mentioning that in 1988, Andersen described Donald Trump as a “short-fingered vulgarian”).

This raises a critically important question in science, in sociology and in philosophy itself: Is there some corpus of knowledge that is bigger and more durable than humans that we can (or need to) discover, or is knowledge just a function of the strongest person in the room? Is knowledge, as the post-modernists tell us, all relative, just a function of the social power structure because if it is, then the drug companies have the battle stitched up. They need society to believe that mental disorder is biological otherwise they can’t sell their stuff. And pace Herr Hitler, the great unwashed always have a modicum of suspicion about them, they don’t believe everything they’re told so the drug companies need tame experts to sell their story for them. And who could be tamer and more expert than the director of the US National Institute of Mental Health? It’s probably the pre-eminent post for a psychiatrist even though most of us couldn’t name the current one (acting director here; she got the job because RFK Jr booted out the previous one and installed his choice; she has a PhD in molecular neuroscience and worked as a researcher at GSK, a huge drug major; and she’s acting in more ways than one). However, she hasn’t said much so we’ll go back a few years to one who loved the cameras, Dr Thomas Insel.

Insel was director from 2002-2015, a record. He qualified in psychiatry but never practised it; he got his reputation through research on voles, little beasties like mice; and he got the job through his connections with some very powerful psychiatrists like Alan Schatzberg, Charles Nemeroff and Joseph Biedermeyer, each of whom was seriously tainted in the “money for drugs” scams, e.g. from Wikipedia on Biederman, who died 2yrs ago:

According to Gardiner Harris, in his exposé of Johnson & Johnson No More Tears, Beiderman was paid millions of undisclosed dollars by the pharmaceutical company to support his research and enrich himself [68]. Many of his studies have been found to be dubious, along with his overt bias in supporting J&J’s drugs when they had been shown to be of no benefit for children and actually caused serious harms.

You can tell a man by the company he keeps. Despite the laundering job in Wikipedia, Biederman was unquestionably a raging psychopath. Starting in about 2010, Insel tried to change the direction of psychiatry, away from its obsession with genes and neurotransmitters, to something he called “neural circuit disorders.” It was still biology but he wanted psychiatrists to become something called “clinical neuroscientists.” From the public’s point of view, this was a case of Tweedledum vs Tweedledee, but he gave his progam a name and a clumsy acronym: the Research Domain Criteria, or RDoC. His first task was to convince mainstream psychiatry to give up their obsession with diagnoses, i.e. that mental disorders can be reliably and validly grouped in distinct categories, à la DSM-5. In 2015, just before he left NIMH for the lucrative pastures of Silicon Valley, Insel published an opinion piece in the prestigious journal Science [1]. In the competitive world of scientific publishing, Science would be equal first in the world, so if you can get your opinions published there, you’re laughing.

Starting with the title, the article pushed Insel’s Brave New World vision of psychiatry as “clinical neuroscience”: Brain disorders? Precisely. Precision medicine comes to psychiatry. Precision medicine is what I’ve mentioned a couple of times recently, the precise identification of particular cell lines and their surface markers or antigens, leading to the development of drugs able to target just those markers and practically nothing else (there’s a bit about it on the GSK website). Writing with his long-time collaborator, Bruce Cuthbert, a PhD biological psychologist, Insel bagged the idea that the symptoms alone could lead to a correct diagnosis:

Clinicians rightly pride themselves on their empathic listening and well-honed observational skills. But recently psychiatry has undergone a tectonic shift as the intellectual foundation of the discipline begins to incorporate the concepts of modern biology, especially contemporary cognitive, affective, and social neuroscience … syndromes once considered exclusively as “mental” are being reconsidered as ‘brain” disorders—or, to be more precise, as syndromes of disrupted neural, cognitive, and behavioral systems.

They agreed this would require extensive knowledge of neurophysiology but without it, we can’t hope to understand mental disorder; in particular, the DSM diagnostic groups had no support or justification from other fields: “Shifting from the language of ‘mental disorders’ to ‘brain disorders’ or ‘neural circuit disorders’ may seem premature…” True, it does, but he had an example, ADHD. Previous attempts to create a unitary diagnosis for all cases hadn’t gone far; genomics, for example, might be able to split cases into three groups which may have significance for treatment in due course. He ended on a promising note: “As new diagnostics will likely be redefining ‘mental disorders’ as ‘brain circuit disorders,’ new therapeutics will likely focus on tuning these circuits.” While precision drugs and invasive brain stimulation developed for the new groups would possibly help where the old, blunderbuss type drugs discovered last century could not, it emerges that, amazingly, the most powerful method of “tuning brain circuits” may just be … talking to people, aka psychotherapy:

Paradoxically, one of the most powerful and precise interventions to alter such activity may be

targeted psychotherapy … which uses the brain’s intrinsic plasticity to alter neural circuits and as a consequence, deleterious thoughts and behavior.

Instead of simply handing out pills or searching for magic bullets, psychiatry has to start to consider how chronic physical illnesses such as diabetes are managed, such as individualised packages comprising “medications, devices, mobile health apps, social support, education, and team care… built around patient choice, and individualized based on each person’s needs and specific neural pathology.”

That’s pretty dramatic, really, imagine treating mental people as individuals, working out with them what they need and then providing it rather than just jabbing everybody in the bum and locking up those who object. Phew, you can see why Insel’s a millionaire, can’t you. On the other hand, the whole article is just advertising, for and on behalf of the drug industry without actually taking money from specific companies (which is how the three stooges mentioned above came unstuck). Despite the high-sounding language, the whole article actually says nothing. Everything hinges on this thing called a “neural circuit” but it’s undefined and, in particular, can’t be defined without invoking the concept of information. That is, his whole biological program is just dualism in disguise, as he admits at the end when he says “Psychotherapy can change our thoughts and behaviour.” I mean, how radical, who could possibly have known that without a couple of honorary doctorates? Well, if he’d read my critique of his RDoC program, from four years before [3], he wouldn’t have wasted everybody’s time and money. But then he wouldn’t have made any money or got his cushy job with Google, so you can see his point. Their article is propaganda from beginning to end, firmly cast in the mould described by the 35yo Hitler when he was in Landsberg Prison in 1924:

The aim of propaganda is not to try to pass judgment on conflicting rights, giving each its due, but exclusively to emphasize the right which we are asserting. Propaganda must not investigate the truth objectively… The broad masses of the people are not made up of diplomats or professors of public jurisprudence nor simply of persons who are able to form reasoned judgment in given cases, but a vacillating crowd of human children who are constantly wavering between one idea and another [2, p121].

Precision psychiatry? Precision propaganda, more likely. Which reader of Science knows that the term “neural circuits” has no meaning apart from the information they may carry, or that “fine-tuning” them with drugs and ECT is exactly the same as what happens in mental hospitals today? Certainly not the editors of Science, that’s for sure. When it comes to propaganda, the drug companies leave the Nazis in the dust. Have a look at the GSK website, scroll down a bit to the figures on deaths from different conditions. Seven million deaths a year from respiratory diseases; about 10million from cancer; 40million people are HIV positive; and one death in six is caused by infectious disease: GSK is doing wonders to find drugs to treat all this. What they don’t say is that 90% of respiratory deaths are caused by industrial pollution and smoking; half of all cancers, such as breast, prostate, skin and bowel, are readily preventable by free screening programs; Trump cancelled USAID which financed drug treatment for millions of HIV carriers; and most of the infectious diseases could be prevented by providing safe drinking water at a cost of about $115billion a year. However, the world needs to spend $2.75trillion (55 times as much) on the military each year, so there’s nothing left over to stop kids dying of salmonella.

It doesn’t stop there: “Clinicians rightly pride themselves on their empathic listening and well-honed observational skills.” What crap, when did a psychiatrist in a mental hospital listen? Often they hardly see the patients, too busy writing reports. Psychiatry’s having “… a tectonic shift as (it) begins to incorporate the concepts of modern biology…” That’s completely false. Most psychiatrists don’t know any neurobiology. And then, of course, he opts for thoughts and beliefs as major factors in mental trouble, which is the exact antithesis of biological psychiatry.

So does Thomas Insel believe his propaganda? I’d say he does, you have to believe before you can write that sort of stuff, so he can’t really be accused of insincerity. However, it leaves him open to the more serious charge of being intellectually too lazy to attend to his basic duty as a scientist: to question every belief he brings to the job, as astrophysicist Carl Sagan (1934-96) observed:

...at the heart of science is an essential balance between two seemingly contradictory attitudes – an openness to new ideas, no matter how bizarre or counterintuitive, and the most ruthlessly sceptical scrutiny of all ideas, old and new. This is how deep truths are winnowed from deep nonsense.

If Insel proposes a new and vastly expensive program called RDoC, it is his inescapable duty to respond to criticisms, even from one of the world’s most isolated psychiatrists (as I was in 2011). As Thomas Kuhn also pointed out [4], scientific revolutions almost never come from the mainstream. They come from outsiders, from people new to the field, or from surly curmudgeons who snort and sneer at the great and good. Insel’s RDoC program is nothing new, not a revolution, just old wine in high-sounding and very expensive new bottles. Propaganda, in other words.

(More propaganda: The 500 richest people in world gained $2.2trillion in 2025, taking their net worth to $11.9trillion. https://www.commondreams.org/news/billionaire-list-2025

A June 2024 report from French economist and EU Tax Observatory director Gabriel Zucman—prepared for the G20’s Brazilian presidency—estimated that a global 2% minimum tax on the wealth of 3,000 billionaires could generate about $250 billion. They wouldn’t even notice).

References:

1. Le Noury J et al (2015) Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence. BMJ 2015; At: https://www.bmj.com/content/351/bmj.h4320

2. Hitler, Adolf (1925). Mein Kampf. Tr. James Murphy, 1939. Facsimile edition (2011): Henley in Arden: Coda Books.

3. McLaren N (2011). Cells, circuits and syndromes. A critique of the NIMH Research Domain Criteria project. Ethical Human Psychology and Psychiatry 13: 229-236 DOI: 10.1891/1559-4343.13.3.229

4. Kuhn TS (1962/1970). The Structure of Scientific Revolutions. 2^nd Edition, 1970. Chicago, Ill: University Press (International Encyclopedia of Unified Science, Vol. 2, No. 2).

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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.