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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Where I come from, a big male kangaroo is called a boomer because of the sound their big feet make. When a boomer is chased by a dog, he has a way of dealing with the problem. They can outrun dogs but dogs are persistence hunters, they keep at it until the quarry is exhausted, so kangaroos have a different ploy. They bound into a river or lake and wait for the dog to swim after them, then they grab it with their very strong forelimbs, shove it underwater and drown it. Problem solved.
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As soon as Trump was appointed president in January this year, he began signing a flood of executive orders to implement the radical plan for pruning and restructuring the US Government that had been set out in Project 2025 (the plan he said he knew nothing about). Order 14212 of Feb 13th established the President’s Make America Healthy Again Commission, an almost comically top heavy committee to reshape the country’s dismal health industry. The commission had 100 days to produce a preliminary assessment of national health followed by a national strategy 80 days later. Anybody who knows anything about producing and implementing health plans knows that reports like this take forever to prepare, especially as Mr RFK Jr, the new Secretary of Health, was wholly a political appointment with no qualifications at all for the post.
The assessment arrived on time, 77 pages detailing how the US spent at least twice as much per capita on health as similar countries but had much worse outcomes, but we all knew that. Apart from early death, there is not a single health parameter on which the US comes first. In fact, due to the opioid “epidemic” and COVID pandemic, life expectancy in the US has actually declined, apparently the first time this has happened in a modern society not at war. Children are particularly at risk, with rising rates of cancer, asthma, allergies, cardiac disease and, above all, mental disorder. Obviously, there is a lot for the commission to do, and the assessment set out their targets: fast food, lack of exercise and obesity, prescription drugs, chemicals in the environment, excessive screen time, poor sleep and something called “stress.” In particular, they promised to sort out the problem of autism by September, although they didn’t say which year.
If they’d made a list of all the really powerful lobbies in the US, very few on that list wouldn’t be named as major offenders in their poor standards of health. Anyway, the National Strategy, Make Our Children Healthy Again (MOCHA), has now arrived, with four ogres to be chopped down to size. They are: Poor diet; chemical exposure; lack of physical activity and chronic stress; and overmedicalisation. Remember that all of this was decided before Mr Musk had performed his Amazing Shrinking Trick on the vast American public service, especially health, environment and education, three departments at the core of the changes they’re now proposing. And, shamefully, no sign of the cause of autism, which got only two lines at the bottom of p4. Regardless, they will press on, to “Pursue rigorous, gold-standard scientific research to help ensure informed decisions that promote healthy outcomes for American children and families, as well as drive innovative solutions.”
This is all a bit strange: wasn’t health research in the US at a fairly high standard last year? Apparently not, but having dumped huge numbers of research projects and their staff in all three departments, Mr Kennedy is confident he has cleared enough dead wood to get the country firing on all cylinders again. As far as weaning children off junk food, getting them off their screens and off their couches to run around the local park without being poisoned by chemical pollution, I agree with him but good luck with it as the lobbies are armed and ready. The interesting bit is overmedicalisation, which can be taken to mean too many diagnoses, too many prescription drugs and too many immunisations. This puts Mr Kennedy eyeball to eyeball with the most powerful cluster of the country’s myriad lobbies, health: the pharmaceutical industry, the AMA and APA, private hospitals and laboratories, private health insurers, 20,000 “consumer” organisations, and a dozen others. These are some of the wealthiest and most deeply entrenched vested interests in the country, and he thinks he can whip them into line in the next three years? Crazy, just crazy, especially as the opposition has started.
Within a few days of publication of the “strategy,” the opposition fired back. In an opinion piece in JAMA Pediatrics, Mark Olfson, a professor of psychiatry from Columbia University, NY, offered a sober rebuttal of most of the points it made about psychotropic drugs. Bear in mind that this article represents the combined, approved view of the entire body of paediatricians and child psychiatrists in the US. You don’t get to write that sort of thing if you’re the slightest bit unpredictable. Point by point, he argues that the figures are all wrong, the risks of drugs in young people overstated and the benefits minimised. Anybody reading it could be excused for deciding “Well, that settles that. Kennedy should pull his head in and let the experts get on with helping our children.” This was exactly their intention in publishing it, except it’s all crap. All they’re doing is what the big boomer does, luring the enemy into territory where it’s out of its depth and then holding it under until it surrenders. And believe this: the gigantic American health industry, about 18% of GDP, is well-versed in strangling its opponents. Olfson’s article opens:
In a section on drivers of childhood chronic disease, the report exaggerates trends in antipsychotic, stimulant, and antidepressant prescriptions by using extraneous and outdated data.
As part of their case for wider prescription of psychiatric drugs, Olfson quotes a major study on antidepressants from 20 years ago which established the baseline for treatment of adolescent depression:
Downplaying the established effectiveness of psychotropic medications for children and adolescents, while overstating their risks, can lead to serious consequences… The NIMH Treatment for Adolescents With Depression Study (TADS) demonstrated that fluoxetine, especially when combined with cognitive behavioral therapy, can reduce suicidal thoughts (pE1).
That would appear to settle it: anybody who wants to argue against that conclusion has to go back to the original data and analyse the whole study from beginning to end. The problem for the new bosses of health in the US, who, BTW, are committed to “Ensuring scientific and medical freedom” (MOCHA, p10), is that they’ve sacked all the people with the skills and dogged determination to do that sort of work, replacing them with amateurs and ideologues. In any event, nobody did it in 20 years so surely that shows Kennedy is beating a straw man? Not so fast; the reanalysis has actually been done, finally published many years after the event, although Prof. Olfson may not have seen it. It was part of a program called Restoring Invisible and Abandoned Trials (RIAT), this one conducted mainly by the Critical and Ethical Mental Health research group at the University of Adelaide [1].
Reanalysis of clinical trials is tedious at best but is much more difficult when the authors of the orginal study refuse to cooperate. After years of work, the Adelaide group concluded that the sunny optimism of the original study, which more or less mandated antidepressants for glum teenagers in the US and many other places, was misplaced. Whereas the original TADS project said that fluoxetine (Prozac) was safe and effective for adolescent depression, the RIAT study concluded:
Our reanalysis confirms the original reported findings that superiority over placebo was not demonstrated for fluoxetine. Contrary to original TADS Team’s reporting, we have uncovered a higher, clinically significant level of harm, including 11 additional suicide-related adverse events (p17).
This is critically important. In opposition to current psychiatric practice, official US Government policy is to reduce over-diagnosis and over-prescription of children and adolescents, which I’m sure most readers support. However, the psychiatrists doing the diagnosing and prescribing are pushing back, saying “Here are the long-term studies that show we’re doing the right thing. We’ve got the science on our side.” The problem is that their science is seriously flawed, to the point where it appears the original TADS team may have falsified their results, but none of the people Kennedy has installed in the US Health and Human Services Department (HHS) has the skills (or the diligence) to trawl through complex statistical analyses to find the exact flaws. To win this battle, the psychiatric establishment needs only to lure the Kennedy amateurs into the depths of statistics and neurobiology and push their heads under until they admit defeat. With that, battle is joined, the battle for psychiatry’s soul.
On the one side, we’ve got the enthusiastic Kennedy amateur ideologues, lusting to prove they know everything and that their opponents are black-hearted scoundrels. On the other, we have the deeply-entrenched psychiatric establishment who have nailed their careers to the idea that mental trouble is a chemical thing in the brain, and they’re not going to let any outsiders threaten their status (or their incomes). As the RIAT analysis shows, psychiatrists are experts at hiding unhelpful results but that raises the question: What does it mean to say “unhelpful” results? Surely science is objective, it takes results as they come and adjusts its beliefs to fit the results, not the other way around? Not at all, as historian and retired general practitioner, Robert Youngson, commented:
The idea that (scientists) are engaged in a calmly disinterested search for truth and are totally unaffected by such unworthy considerations as personal pride, competitiveness and envy is a dream of adolescent idealism [2, p60].
The TADS team adjusted their results to fit their beliefs but it took 20 years for this to be exposed. We could then ask: How come nobody in the US discovered this? They’ve got the resources, the computers, the eager young staff itching to struggle up the academic ladder, why was it left to a crew in far-off Adelaide? That’s a question of the sociology of science but I suggest it was about struggling to get up the academic ladder. In simple terms, if you want to get a leg up the ladder, keep your mouth closed.
Who, then, will win the battle? Will Kennedy deliver on his promise to reveal the “cause” of “autism”, to rein in the drug and chemical and fast food and all the other rapacious industries that make money from poor health? I don’t think so. They know how to deal with upstarts but it may be that politics will be on their side. I’ve been saying all year that I don’t think Herr Drumpf will be watching the New Year’s Eve fireworks from the White House in 2026, the dementia will get him before then. If he goes, the entire Administration will collapse into a gigantic cat fight and government will grind to a halt. However, with recent developments in the Epstein files saga, it may be that he’s not even going to make it to the end of this year, who knows? We just have to sit and watch.
If that happens, Kennedy’s chance to rearrange the mental health market will be sidelined. He will never discover the real conspiracy in the mental health industry, that it’s all make believe. Practically the whole edifice of modern psychiatry is smoke and mirrors as it has no basis in a theory of mind or a model of mental disorder. All the talk about biomedical models and biopsychosocial models is just hot air, designed to fool everybody. It’s very effective, that’s for sure but, as the Romans understood very well, Mundus vult decipi, ergo decipiatur. The world wants to be deceived, so let it be deceived. Tough about the kids but when adults surrender their responsibilities in order to get richer or higher in status, kids don’t rate.
References:
1. Aboustate N et al (2025). Restoring TADS: RIAT reanalysis of the Treatment for Adolescents with Depression Study. International Journal of Risk & Safety in Medicine. DOI: 10.1177/09246479251337879 https://pubmed.ncbi.nlm.nih.gov/17135984/
2. Youngson, R (1988). Scientific blunders: a brief history of how wrong scientists can sometimes be. London: Robinson.
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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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