We live in an age of fraud. Businessmen are frauds, politicians are frauds, influencers are frauds, televangelists are frauds, Big Tech spreads a fraudulent message that you're getting a free service when they're selling your data to government, on and on. If you say this out loud, of course, you are quickly labelled a "conspiracy theorist," which is fine for the people working the frauds but guess what? Yes, Virginia, there are indeed conspiracies. Your job is to sort the boring facts from the glamorous or exciting or scary fictions the fraudsters are busy spreading. And psychiatry? Oh yes, they've had more than their fair share of frauds over the years.

In October, I gave the keynote address to the annual conference of the International Society for Ethical Psychology and Psychiatry (ISEPP) (by Zoom). The theme of the conference was “Paradigm Shift: From Pathologizing to Valuing Emotions” and it fell to me to give some background on the concept of paradigm shift. The term was introduced by the historian and philosopher of science, Thomas Kuhn (1922-1996), in his work The Structure of Scientific Revolutions or SSR, first published in 1962. Kuhn gained a BSc and PhD in physics from Harvard, graduating in 1949. Soon after, he was asked to teach a course in the history of science to history students, from which he developed an interest in the philosophy of science. In 1956, he moved to Berkeley where, a few years later, he published his most famous work in the form of an extended essay. At first, it didn't have much impact but then it took off and is now regarded as one of the most influential books in philosophy of science. That's quite remarkable because it is not primarily a work of philosophy, it is metahistory, better known as historiography. In it, he more or less redefined the word paradigm and thus it entered common parlance.

Paradigm relates to your perception and understanding of a field of study. The highest and most abstract level of perception is one's ontology, which is essentially how you see the universe and place in it. For most people, most of history, the ontology was dualist, meaning there are two parts to the universe, the visible physical universe and an unseen but causally effective spiritual or divine universe which exists in parallel. Modern western science says "We can't talk about unseen things, how do we know they aren't just imaginary? Science is only concerned with what we can measure." So their ontology is what is now known as physicalism, that there is nothing in the universe beyond matter and energy and their interaction. I say that's a bit restrictive, that it includes matter and energy and the informational states controlling them but that's open to debate.

One level below ontology is the paradigm, which is more or less your total understanding of a field of study (geology, finance, psychology, nutrition, etc), how it relates to the ontology and to other fields around it, how it should be approached and studied, what is valid science and what isn't, and so on. Kuhn showed that over time, paradigms change, and he used the shift from the Ptolemaic geocentric concept of the universe to the Copernican heliocentric model. Louis Pasteur forced a paradigm shift, when he showed that infections were due to bacteria, not miasmas or "bad air" (which is what mal-aria actually means, bad air from swamps). In physics, the shift from a Newtonian or mechanistic model to the relativistic model pioneered by Einstein was huge, tectonic, as they say, and even that word comes from another paradigm shift. Classically, it was thought that the world was created in one form and would never change, but in about 1670, a Danish scientist, Niels Stensen (also known by his Latin name of Nicolaus Steno), presented field work to show that mountains had once been under the ocean but had been lifted up. In about 1912, Alfred Wegener, a German geologist, argued that the continents actually drifted across the surface of the planet. At first, the establishment sneered and it took another half-century before it was accepted that yes, the tectonic plates of continents actually float on the liquid interior of the planet.

And that tells us something else that Kuhn described: the hostile resistance of the Establishment to dramatic change. People, including scientists, who are educated and trained in a particular paradigm will fight to the bitter end to prevent their concepts being overthrown and replaced. They forget that that's how science progresses, by challenging the status quo, showing where it is wrong and proposing a better paradigm, meaning one that can account for the facts better and make better predictions for testing. The great physicist, Max Planck, who died in 1949, said:

A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it ... (from Philosophy of Physics, 1936).

Somebody summarised that as: Science progresses, one funeral at a time.

The next conceptual level down from the paradigm is the theory. This widely-misused word means a proposal of a mechanism one explanatory dimension removed from the observations that can account for them within the paradigm. A theory is what you think could be going on beneath the surface to produce what you see but it is, by definition, hypothetical. Two important theories we deal with are the theory of gravity and the theory of evolution. For gravity, the observation is that things fall, or planets are held in orbit, or stars rotate, and so on. The theory is that there is an invisible force of attraction extending from every physical thing to everything else. So Newton's classic insight about the apple falling was not just that the earth attracted the apple, but, and this was the revolutionary bit that even he struggled to accept, the apple also attracted and moved the earth. Crazy, everybody scoffed, he's off his rocker, the earth was fixed in place by God and that's the end of it. So gravity is the observation we need to explain, and the theory of gravity is the proposed unseen mechanism to explain that observation.

With evolution, the fact that species change and die out and new ones take their place is the fact that has to be explained. The theory of evolution proposed by Darwin said that life is a struggle, and only the fit survive to reproduce. Thus, there is a hidden process of natural selection, of weeding out the unfit and replacing them by the fitter. The fact of evolution cannot be denied: before there were humans, there were protohumans, which is the basis of the answer to the ancient question, "What came first, the chicken or the egg?" Answer: A different sort of chicken. Darwin's insight is now backed up by the science of molecular genetics, and it's unassailable. If you would like to watch an experiment showing evolution of drug resistance in bacteria in action, watch this:

Last concept on the list, below ontology, paradigm and theory is the model. In science, a model is a real thing cobbled together to test a theory in real life (it has nothing to do with people wearing ridiculous clothes). So there is a theory called "heavier-than-air flight," of how heavy things can generate lift, and this is tested in model aircraft. A model is a cut-down version of the theory put into physical form, although nowadays, a lot of the work is done with computers. You don't need to make a physical model of a new plane to test it in wind tunnels, it can all be done on computers. The theory of atmospherics is tested in computer models of cyclones and polar vortices and so on. You don't have to get wet to test a model of a storm. Same goes for models of spread of infections, a lot of it doesn't involve unhappy lab white rats, it can be done with cell cultures and even on computers alone.

So what has this to do with mental disorder? Actually, it has a lot, and we'll go through each level. The ontology of western science is physicalist, and if we want a science of mental disorder, it has to be within the physicalist ontology, meaning no spirits, no spells or possession states and so on. For psychiatry, which very much wants to be seen as scientific, the dominant paradigm is materialist, that is, disturbances of mental life can be explained as a matter of physical brain function, also known as "biological psychiatry." Now this is where it gets a bit sticky because the paradigm also means that "the whole of mental life can be explained in terms of physical brain function," except nobody has ever shown how this could happen. But very few psychiatrists know anything about normal mental function so they ignore that bit and concentrate on talking up their "science of mental disorder," meaning flooding the airwaves with talk of neurotransmitters and genes and drugs and physical treatment and so on.

Moving on, the theory of mental disorder consists only of talk about brain chemicals except this is not a theory in any meaningful sense. Nobody on earth knows enough about brain chemicals to say anything worth listening to. Recently, I was having trouble with the clutch in my car. I took it to the mechanics and told them what I'd noticed. If they'd said only: "Wow, sounds like the clutch is broken," I would have gone to another workshop. But that is the level of so-called theorising in psychiatry:

"My mental life is a mess."

"Wow, sounds like your serotonin's broken."

This is baby-talk, designed not to illuminate but to stop the discussion. Psychiatry does not have anything like a theory of mental disorder. About ten years ago, I did an extensive search of the psychiatric literature to see if somebody, anybody, anywhere, had ever written anything that could qualify as a formal theory of mental disorder. No, they hadn't. Biological psychiatry is a paradigm dangling from a skyhook, an ideology of mental disorder which has never been justified [1].

And so to the last stop on the line, the actual model of mental disorder. If any field of study wants to be classed as a science, they first need a model of their topic, meaning an actual instantiation of the theory. In psychiatry, there isn't one. Oh, but wait, what about the Biopsychosocial Model? Well, that takes us back to the title of this little essay, Fraud, which was the second part of my talk to ISEPP. We'll talk more next week.

I am regularly contacted by people asking for advice on how to get off psychiatric drugs. I've retired, so I can't give any advice to anybody, especially if I haven't assessed them myself, but the important message is: Do not under any circumstances stop psychiatric drugs abruptly. Almost certainly, you will go into a severe withdrawal state, and that can be very dangerous. They can only be reduced under close supervision.

1. McLaren N (2013). Psychiatry as Ideology. Ethical Human Psychology and Psychiatry 15: 7-18 (for a copy, email me).