A tiring week. My 20 page submission (it kept growing) to the Senate enquiry into ADHD went in last week, even though their online portal wasn't working. I rang their office and told them. "Oh yes," said the bright spark on the other end, "we've had other complaints about that." It hasn't been uploaded to their site yet (mustn't rush them), I'll post the link when it appears.
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The playwright and novelist, George Bernard Shaw (1856-1950) said: “Until there is a practical alternative to blind trust in the doctor, the truth about the doctor is so terrible that we dare not face it.” Shaw, who was avowedly anti-capitalist and pro-social reform, loathed doctors. On very good evidence, he believed that spending money on proper housing, clean water and safe sewerage for the working classes, in order to prevent illness, would save more lives and lead to better quality lives than all the money spent on doctors to treat illness. Shaw wanted the financial drive taken out of medicine and, decades before it became Labour policy, foresaw a national health service providing for the whole population, not just for those who could afford it.
A lot of this can be seen in his play from 1903, The Doctor's Dilemma, which is still right on the mark but the central question remains unanswered today: What is the truth of the medical profession? More to our point, what is the truth of the specialty of psychiatry? Trouble is, if you ask a question like that, somebody somewhere will start screeching "Conspiracy theorist!" which is another way of saying "Don't you dare believe that, I know the truth and you don't!" That's a problem, because there certainly are lots of conspiracies floating around. Caitlin Johnstone, an Australian reporter living in New York, says that if anybody tries to say that conspiracies must not be believed just because they're conspiracies, all they're saying is that they believe everything said to them. Trouble is, it's reaching the point where we can no longer tell truth from fabrication from deluded drivel.
In law, a conspiracy involves people secretly planning and carrying out an action to break the law, and is generally related to fraud. They have to know that what they're doing is wrong, which is why they keep it secret. For example, the unfolding drama over the big international accounting firm PwC and its contracts with the Australian government. They were busy advising the government (at huge cost) on how to deal with the massive problem of international tax avoidance yet at the same time, they were selling that information to their many international clients so they could avoid paying Australian taxes. At first, they tried to say it was one bad egg in the company (it's not actually a company, it's a partnership, which allows them to avoid all sorts of sticky company laws); then it turned out it included about 58 of their most senior people and probably spread overseas. Same as the Robodebt scandal: all the politicians and very senior public servants knew perfectly well it was crooked, and they went to great lengths to conceal it from the public. It was only the growing list of suicides that blew their cover.
But there's conspiracies and conspiracies. The UFO plot has just had its 83rd resurrection. To the delight of conspiracists everywhere, some ex-USAF intelligence officer has claimed that the US Air Force has evidence of visits by aliens in flying saucers but has suppressed it. If that were true, it would be very exciting but, unfortunately, I don't think it is. So there are lots of people who have harmless but crackpot beliefs, like believing in fairies (fairies were the aliens of the 19th Century, complete with falsified photos) or bunyips or yetis and so on. The answer is: Believe away, wake me when you get some evidence. These merge into "harmful beliefs," like telling people that drinking bleach or shining UV light down your trachea (windpipe) can cure Covid, to the "pretty dangerous" ("The election was stolen from me"), to the frankly crazy, like "Lizard people are taking over the government." If you believe something fervently, by definition, you're not part of a conspiracy but if society doesn't like the idea, you run the risk of being labelled insane and locked up.
Hidden among all these odd and whacky True Believers are the many people who say they believe something, but just happen to be making a killing out of it. For all time, religions have been attacked on the basis that Ambrose Bierce (1842-~1914) saw. In his Devil's Dictionary, he defined a clergyman as "A man who undertakes the management of our spiritual affairs as a method of bettering his temporal ones." Upton Sinclair (1878-1968) was a bit more polite: "It's difficult to get a man to understand something when his salary depends on his not understanding it." But the legendary economist Adam Smith (1723-1790) put his finger on it: "People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public." Smith is worshipped by neoliberals although they don't mention that bit.
So what do you get when you find people who are "True Believers" in some unproven (and unproveable) notion who are also making a handsome profit from selling their ideas? Psychiatrists. Ha ha, bad joke, except it's not funny. Older readers will recall the Hungarian-American psychiatrist, Thomas Szasz (1920-2012) who argued that modern psychiatry is nothing but an enormous conspiracy. The patients, he believed, have nothing wrong with them but they want some benefit from being labelled "sick." He used the example of soldiers complaining of nervous symptoms: they were just trying to evade their duty. Psychiatrists are also part of the racket. They know there’s nothing wrong with their patients but they're making heaps from going along with it, and from a side line of locking up nuisances that the government wants off the streets. The whole thing, he said, is the modern version of the medieval witch hunts, in which the religious authorities combined with the civil power to eliminate troublesome and/or superfluous mouths, mainly old women but also a lot of annoying clergy.
I think his historical analogy is completely wrong: nobody would ever accuse the medieval church of running a racket to get rich from burning old women. The witch hunters believed fervently that they were on a mission from God, and the general population believed in witches and demons because that's what they were told. However, he was right in one respect: psychiatry is indeed a large-scale conspiracy to fool people, except it wasn't the conspiracy he thought it was. The goal has been to fool people into believing that psychiatrists actually know what they are doing when they say "All mental disorder is brain disorder." They believe it, but is it true? And this is where the science comes in, to sort the truth from the self-serving fantasies. The astrophysicist Carl Sagan (1934-1996) put it neatly:
...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 (from The Demon-Haunted World: Science as a candle in the dark, published in 1997, just after he died from a leukaemic disorder).
This doesn't apply only to science, it's across the board, especially politics and religion, but the standard way the powerful have of dealing with criticism is to outlaw it. This is what the Church did, about 538 years ago: everybody was ordered to believe in witches. People who scoffed at the idea were rounded up and treated as "agents of the devil," which meant a short life. In politics, we saw the example of the McCarthyist era in the US, when everybody was required to believe that communists were infiltrating the nation and had to be rooted out. If you didn't believe that, you were a communist-sympathiser and all sorts of trouble followed.
The medieval Church had another thing going, selling what were called "indulgences." This meant that if you paid the local bishop, he would sign a receipt granting you a shorter stay in purgatory (I'm not sure if they could get people out of a trip to the really hot place). They told their congregations how the afterlife was structured and that the wages of sin are eternal, but a few gold ducats or crowns would fix the problem. In essence, what they were saying was "We scare you to death, then you must pay us for our services and our talisman to relieve your fears." Martin Luther's "ruthless skepticism" about this racket was one of many that tipped him against Rome, leading to the Reformation and thence to the Hundred Years War, but that's history.
It is the "ruthless skeptical scrutiny of all ideas, old and new" that is missing from psychiatry and, as a result, a lot of "deep nonsense" gets elevated to "received wisdom" and people get hurt. The ADHD industry is a perfect example: parents are told "Your little Johnny is at risk. Without our treatment, Johnny's looking at a life of failure, crime, drugs and alcohol, madness and suicide. Yes, we take all cards." In other words: "We scare you to death, then you must pay us for our services and our talisman to relieve your fears."
Not surprisingly, parents take this seriously; after all, they say, it comes from the doctor, and the doctor has our best interests at heart. Which is precisely what Shaw didn't believe, and all the others quoted above: if people are making a fortune from your misfortunes, how can you tell whether what they are saying is deep truth, or deep nonsense? As Shaw said, it's either blind faith, or face the terrible fear that the doctors don't actually know what they're talking about. And if they don't, who's on your side? Do they know what they're talking about? Answer: Show us the evidence. Let's see your evidence that all mental disorder is brain disorder. And there isn't any. That's the problem, it's like being taught that there's a place called Hell, but the only evidence you'll ever have is after you're dead, so pay up now and trust us. Same goes for psychiatric research into the biology of mental disorder: No, we haven't found anything yet but we're sure it's there, just send more money. Thomas Insel, long-time director of the US National Institute for Mental Health, said, two years after he had left:
I spent 13yrs at NIMH really pushing on the neuroscience and genetics of mental disorders, and when I look back on that, I realise that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs - I think $20billion - I don't think we moved the needle in reducing suicide, reducing hospitalisations, improving recovery for the tens of millions of people who have mental illness. I hold myself accountable for that.
Twenty billion is a lot of money, and brings us back to where we started: Who should we believe? If the general public knew all that money had been wasted, there'ld be hell to pay, that's why the drug and academic industries are so keen on controlling the narrative. Criticism of mainstream psychiatry is almost never published in mainstream psychiatric journals, so it's difficult for psychiatrists themselves to sort out what's true and what's nonsense. Most simply give in and believe what they're told, but it's impossible for the general public to know. And politicians.
That's enough for one day. The take-home message: Conspiracies are real but, as Gary Greenburg said in his Book of Woe: The DSM and the unmaking of psychiatry, "I don’t think there is a conspiracy in which drug companies pay doctors to create diseases for which they can then sell the cure. But who needs conspiracies when you have capitalism?”
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My research seminar at University of Queensland Philosophy Dept from May 19th is available on their Youtube channel (it starts at 1.50, we had trouble with my screen).
The title is Can there be a positivist psychiatry? and it's about theories. My answer is No, there can't, we must have a mentalist psychiatry. I'm waiting for the biological people to try to prove me wrong.
Interested to hear your thoughts on the popularity of Neurodiversity which people see as a legitimate and more positive way to describe their “conditions” like ADHD, autism, but also constructs such as dyslexia, dyspraxia or any psychological difference basically.
The onus of the movement (that is what it is as it has no theory behind it, just a neologism trying to ape biodiversity (itself a neologism)), sees differences such as ADHD as part of the natural variation of human diversity and as positives, types of cognition to be embraced rather than disorder/illness. At first glance it seems promising, but like the biopsychosocial model, it has no theory behind it just the assumption that labelling previous conditions under the umbrella term neurodiversity will make society more accepting of them- which it actually seems to have done in some circles.
However, it has no model of mind or mental disorder (although it does not recognise mental disorder) and reeks of simple reductionism/behaviourism and circularity (why are you neurodiverse-because I have ADHD. Why do you have ADHD- because I am neurodiverse). It considers the individual able to large extent as the definer of their “condition” and free to seek treatment (drugs if they choose) or not any treatment at all as there is nothing wrong with them (they are just neurodiverse).
It has a lot of traction (in England anyway) and does seemingly move away from biological reductionism, but to me it seems contradictory as it rests on the veracity of the conditions it tries to redefine. But people want to be labelled ADHD, they want these conditions, as it certainly helps them in educational settings (extra time for tests, different test conditions etc) and to explain any cognitive differences they experience. And people are embracing it. Adults especially, with women adults feeling their ADHD and autism is not being recognised as much as it is in men.
For me, it is a dangerous combination of social movements masquerading as equality movements infiltrating science, trying to redefine psychiatric conditions, resulting in a more “fairer society” (who says women don’t have ADHD as much as men) but doing nothing to critically examine the legitimacy of the constructs they now see as neurodiverse.
Ah, I look forward to these each week.