Talking About Corruption

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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In a rather audacious move, the Harvard University journal, Health and Human Rights, has just published a special edition on the topic Institutional Corruption and Human Rights in Mental Health. There are ten articles, including one from Bob Whitaker, founder of Mad In America, and another by Lithuanian professor of psychiatry, Dainius Puras, former UNHRC Special Rapporteur on mental health. By corruption, they don’t necessarily mean public servants being slipped brown paper bags stuffed with used banknotes, i.e. a problem of corrupt individuals, because corruption goes a lot further. The term means “turning aside,” that the primary goal of the idea of mental health services is not being met because of factors built into “the system.” This failure does not self-correct as people within the system who are not its intended beneficiaries are profiting and thus resist change.

As you might expect, these are all rather wordy articles with lots of references to UN reports and statistical surveys but they’re a valuable source of figures and references. I say audacious because Harvard University, specifically its Dept of Psychiatry, has had a lot to do with the tentacles of corruption spreading through the field of mental health. However, they didn’t start it and it’s not going to stop in a hurry. As I know. I’ve been complaining for decades about corruption in psychiatry [1]. Dainius Puras and Julie Hannah, a human rights expert, have no doubts where the problems lie:

The roots of such institutional corruption lie in embedded systemic obstacles, including an overreliance on the biomedical model and pharmacological interventions, entrenched power asymmetries, and the production and use of biased evidence (p216).

The figures they cite are crystal clear: the more “mental health treatment” there is, the worse the outcomes, but that doesn’t seem to slow the juggernaut. Figures released by Australia’s Pharmaceutical Benefits Scheme, which subsidises most medication, show that the amphetamine Vyvanse is now the fastest-growing prescription drug in the country. Last year, there were 2.2million subsidised scripts, an increase of 650,000 in just one year, costing the PBS a neat $167,625,000. Do we need this? According to mainstream psychiatry, we definitely do need it and probably heaps more to satisfy the hordes of people banging on their doors and demanding treatment for their (largely self-diagnosed) “ADHD.” Are people any better off for being drugged for life? No, there is no clear evidence to say that the diagnosis, which didn’t exist thirty years ago, or the drugs, are producing any benefit for them or the community, and plenty of evidence to say the drugs are more trouble than they’re worth.

This is what is meant by institutional corruption: an institution, such as psychiatry, has control of an entire sector of public life and runs it to suit itself. The nett effect is, as Puras and Hannah described in post-Soviet Eastern Europe, that the institution is given or takes control of any efforts to clean it up, so nothing changes. In Puras’ Lithuania, for example, a small, comparatively wealthy and well-behaved country with high levels of education, Soviet-era psychiatry had been repressive and dehumanising. The official view was that since Soviet society was perfect, with none of the distortions of capitalist society, anybody who wasn’t happy with things must have had a physical disorder of the brain. Treatment therefore relied heavily on coercion, detention in dark and fearsome hospitals, lots of ECT and drugs, and little or no talking because there was nothing to talk about. In the 35 years since the collapse of the USSR, Puras and Hannah feel very little has changed:

Despite considerable investment, only the facade of the mental health system has been redecorated, while its institutional culture continues to be marked by social exclusion, institutionalization, overmedicalization, and discriminatory practices … Resistance to meaningful change comes not only from government authorities but also from influential figures within the psychiatric profession (p219-20).

That, I would say, is exactly how it is across the world. Ten years ago, Bob Whitaker and Lisa Cosgrove (who also contributed an article) published their book showing how the American Psychiatric Association (APA) functions like a medieval guild, protecting the interests of its members with scant attention to the effects on their patients or the community [2]. It does this mainly through convincing the population that mental distress or disorder of any sort has to be seen as a brain disease, for which physical treatments are obligatory, even or especially if the patient disagrees. Conveniently, standing behind them is a wealthy and powerful pharmacology industry that has all the drugs that will be needed, and who are very generous in channelling some of their profits back to the people who prescribe their drugs: you scratch my back and I’ll scratch yours. They, psychiatrists and drug companies, work together to persuade politicians and bureaucrats that theirs is the only valid model of mental disorder, while anybody who objects is “antipsychiatry” and must be ignored or preferably silenced. It’s not just politicians, they work on various “thought leaders” in academia and the community. Thirty years ago, the medical historian, Edward Shorter, of Toronto, leapt into the fray to silence opposition: “If there is one central intellectual reality at the end of the twentieth century, it is that the biological approach to psychiatry … has been a smashing success” [3, pvii]. Since then, he has backpedalled considerably but it’s too late, the damage has been done.

Lisa Cosgrove refers to the nexus between psychiatry and Big Pharma as “medical neoliberalism,” but that needs a bit of explaining. I often go on about the influence of the philosophical movement called positivism on modern science, which burst on the world in 1929 in a startling manifesto by a group of mathematicians, logicians and physicists in Vienna, known to history as the Vienna Circle [4]. This says that science has to be based very strictly on what can be seen and measured. If it can’t be seen or it can’t be measured (and duplicated) then it isn’t science. That doesn’t mean it doesn’t exist, only that scientists aren’t allowed to talk about it. Their purpose was to strip out all the fanciful and/or loopy thinking, especially about biology, and stick to the facts. That’s fine, positivist science has brought enormous progress (as well as nuclear weapons) and it has a long way to go before it reaches the end of its road. However, it also means that people who want to call themselves scientists can’t talk about the mind. Modern medicine is firmly based in standard science; psychiatry wants to be seen as an integral part of a scientific medicine; therefore psychiatry can’t talk about the mind. QED.

But psychiatry just is about the mind, that’s its home territory so they had to find a way around the road block. In order to do that, they went back in history, to when everybody believed in witches and black magic. Six hundred years ago, whenever somebody said “I hear voices in my head,” that meant he was possessed by demons and needed a quick exorcism. If somebody (especially a woman) said “I feel sad,” everybody understood that to mean “The devil is poking his fingers in me” and she need a quick bonfire. Statements about one’s mental state were immediately translated into demon-talk. These days, we’re much more sophisticated that that. Now, when somebody says “I hear voices” or “I feel sad,” we know they’re not talking about their minds, they’re talking about their brain chemicals:

“I hear voices” = “My dopamine is high.” High dopamine needs a DA blocker; take this injection and keep quiet.

“I feel sad” = “My serotonin is low.” Low serotonin needs a boost; these tablets will boost it; come back in a month.

That satisfies positivism’s need to write the mind out of science. On the other side, neoliberalism is positivism applied to economics, i.e. if you can’t see it and measure it, it doesn’t exist. That is, emotions can play no part in economics. Homo economicus weighs up the factors and makes rational decisions about what’s best for itself and its family, unswayed by emotion. Humans are bland “work and consumption units” that go about their daily lives like little robots on rails. That’s what Thatcher meant when she screeched “There’s no such thing as society.” To neoliberals, society is an emotive fantasy, a juvenile daydream, but that also has the nifty side effect of meaning mental distress can’t be caused by social factors. To neoliberals, if you work hard, you will always get ahead; conversely, if you’re not ahead, it’s because you’re not working hard, i.e. a parasite. Anybody who is unhappy because they feel crushed by unemployment, overcrowding, inequality, social despair, drugs and alcohol, family breakdown and crime is therefore a moral failure and needs punishment (as if being unemployed and homeless isn’t punishment enough, but let that pass).

This is the Soviet argument recycled: since society is perfect, the cause of any mental symptoms must be located inside the individual, not outside, i.e. it is either a moral failing or a disease of the brain. Neoliberal economics and biological psychiatry snuggle together and reinforce each other, dismissing criticism as “emotive and irrational.” In their worldview, if they’re not just scheming to get a pension, which was Thomas Szasz’s libertarian belief [4], people claiming to suffer mental distress need to see an expert on diseases of the brain that affect the mental state, meaning a psychiatrist. The psychiatrist will then tell us just which disease it is and what to do about it because they’re experts and all of society has to listen to them. Why are they experts? Because they know all about brains and how brains go wrong. But that’s the fatal flaw in this otherwise armour-plated argument: by their own admission, psychiatrists don’t deal with silly (unobservable, unmeasurable) stuff such as feelings caused by unhappy family lives or work but, at the same time, they most emphatically are not experts in brains. All the talk by people like Thomas Insel of psychiatrists becoming “clinical neuroscientists” is baseless propaganda, just because their so-called biomedical model simply does not exist [6]. Lisa Cosgrove nailed it neatly:

Although mental ill health is inseparable from capitalism and racism, a distinguishing feature of medical neoliberalism is the assumption that emotional distress is best conceptualized and treated as a disease. Such conceptualizations take suffering out of its “moral and political context” and lead to one-size-fits-all psychological and psychotropic interventions (p180).

Biological psychiatry and neoliberal economics are both based in the same impoverished, positivist model of mind, that says human emotions don’t count. They reinforce each other and, together, they make lots of money for needy drug companies, private hospitals and private psychiatrists, not to mention all the menial jobs in mental hospitals that would disappear with a community-based, human rights-based psychiatry. Historian Andrew Scull observed that biological psychiatry in the US “…left those with serious mental illness to struggle in a world that deified the marketplace and had a little place and less sympathy for those who lacked the resources or capacity to purchase the services they needed” [7, p2762]. Anybody who wants to boot psychiatry out of its biological cul-de-sac and force it to take the more difficult but productive path of mentalism is fighting an uphill battle. There are some very dark forces hiding in the shadows of the mental hospital.

The good news is that the positivist model of science was out of date almost before the ink was dry, because an entirely novel science of unobservables was on its way. In dribs and drabs, in laboratories in different countries, the science we now know as information technology struggled into the world. It has opened to rational investigation entirely new vistas that the members of the Vienna Circle hadn’t suspected. That doesn’t belittle their contribution: they had to use what was on hand, and their solution to the problem of unobservables was to expel the lot of them, witches, egos and all. The idea of information, on the other hand, anchors certain classes of unobservables firmly in the natural world. Information is not supernatural, but it’s also not matter or energy, as Norbert Wiener said in 1949.

As a result, we can now consign biological psychiatry with its phantom “biomedical model” to the history books. The biocognitive model [8] takes the principles of information theory, integrates them with modern concepts of neurophysiology, and produces an emergent, dualist theory of mind. This quickly gives an account of personality, and leads directly to models of mental disorder and of personality disorder and how to tell them apart. However, it also says mental distress is not mental disorder, and mental disorder is not biological so, if this approach ever takes over, the market for psychiatric drugs, and ECT and TCMS machines, and most mental hospitals, would simply disappear. After hundreds of years of failed attempts at shoving mental disorder into little biological boxes, perhaps it’s time to try something new.

References:

1. McLaren N (2023). The Biopsychosocial Model and Scientific Deception. Ethical Human Psychology and Psychiatry, 25: 106-118.doi:10.1891/EHPP-2023-0008

2. Whitaker R, Cosgrove L (2015). Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform. New York: Palgrave MacMillan.

3. Shorter E (1997) A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. New York: Wiley.

4. Hahn H, Neurath O, Carnap R (1929). The Scientific Conception of the World: The Vienna Circle. Ernst Mach Society, University of Vienna.

5. McLaren N (2012). Chapters12, 13 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

7. Scull A (2021). American psychiatry in the new millennium: a critical appraisal. Psychological Medicine 51: 2762–2770. https://doi.org/10.1017/S0033291721001975

8. McLaren N (2021): Natural Dualism and Mental Disorder: The biocognitive model for psychiatry. London: Routledge. 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.