The Rigours of Science.

A reader sent a link to an article on the gut microbiome in schizophrenia with the lurid title: “Gut microbiome breakthroughs revolutionise schizophrenia treatment” (microbiome means the many types of bacteria that live in the large bowel). In fact, it does nothing of the sort. It was a sensationalised article about some obscure findings that are probably the result of drug treatment, not the cause of the mental problems. Another paper came my way, a newly-published and highly complex report on the genetics of depression [1].

At first glance, this doesn’t make sense: one group is spending heaps trying to find genes for depression while the other one is patiently poking through piles of poo looking for the elusive schizococcus. We have to ask: Is mental disorder genetic, or is it toxic, or is it neither? This is a fairly basic question but it has never been answered [2]. Instead, both papers represent an important point: very largely, psychiatric research is driven, not by any insight into the nature of mental disorder, but by technology borrowed from other fields. Today’s hot technology is genetic sequencing, which is now cheap enough for people to get it done just for fun so, in the absence of a model of mental disorder, that’s what eager psychiatrists turn to.

Even though genetics makes for fairly dull reading, the genetics paper isn’t free of sensationalism, starting with the title and intro:

Trans-ancestry genome-wide study of depression identifies 697 associations implicating cell types and pharmacotherapies … This study represents the largest and most inclusive genome-wide association study of major depression to date, identifying 697 independent single nucleotide polymorphism associations (SNPs) located within 635 independent genetic loci and evidence that neuronal differentiation and receptor clustering are involved in the aetiology of the disorder. 286 high-confidence gene associations were identified.

Wow, that sounds like real progress. The paper comes from a large international group called the Psychiatric Genomics Consortium which has about 800 members scattered through 36 countries. The Consortium collects and analyses genetic data from huge DNA data bases. Its website doesn’t give any indication of how much it spends but the whole genomics project is now a huge (and hugely expensive) industry. Apparently, 400 of them wrote this paper, possibly a record, which studied the genomes of about 5 million people from 20 countries. It concluded that “the proportion of variation in liability to (depression) explained in European ancestry case-control studies also showed a considerable increase from an R² of 3.2% in our previous analyses to 5.8% using SBayesR” (p7).

First thing to note: this arcane paper was reported in usual breathless style by the ABC, which means it was fed to one of their tame stenographers by the research team in their endless quest for more research grants: “The research (said the ABC)… suggested existing drugs, including several anti-cancer therapies and medications used to manage daytime sleepiness, pain, and anxiety, could be repurposed to treat depression.” Sorry to be a wet sock but what the paper actually said was: “The test for drug enrichment is not directional and may indicate compounds that confer (i.e. increase) risk of (depression) or exacerbate depressive symptoms…” That is, the drugs seem to use similar enzyme systems as their tests indicated, and could well make things worse. Not quite the same.

Without getting side-tracked into arguments over statistics, it would appear that the genetic contribution to depression is 5.8%, meaning 94.2% isn’t genetic. Moreover, that “contribution” is divided among 697 trivial abnormalities scattered across 308 genes, some of which aren’t connected with the brain. This seems a very flimsy basis for predicting anything, so what does this mean? The problem is that the people involved in this sort of research are academic statisticians and epidemiologists with very few actual psychiatrists, and even they don’t see patients. Most practising psychiatrists can’t and don’t read this sort of stuff and just accept what they’re told. The few who can read it were convinced from the beginning of their training that mental disorder is biological, which is why they went into genetics in the first place. The whole thing is self-reinforcing, which brings us to the main point.

A few years ago, the RANZCP published what they called their “Clinical practice guidelines” for mood disorders, with the emphasis on depression [3]. Essentially, it was 110 pages of drugs, drugs and more drugs, which upset the psychiatrists who practise psychotherapy. Eventually, and after considerable animosity, including forcing a special general meeting, the college commissioned a review of the place of psychodynamic psychotherapy in treating depression. For some reason, this was done by the Anna Freud Centre in London, named after Sigmund Freud’s daughter who became highly influential in her own right. A year or so later, the report came back and was duly attacked in an editorial by some of the authors of the original, drug-oriented report (coincidentally also editors of the journal), who commented tartly:

In the 21st century, facts should be established through rigorous scientific enquiry, not popular vote [4].

Now that’s an interesting admission: where, for example, was the “rigorous scientific enquiry” into the genetic basis of mental disorder? A lot of it, as we know, stems from Nazi “race science” but why stop there? Who proved that mental disorder is the sort of thing that genetics can explain or drugs can treat? Where was there a proper investigation of the question of whether mental disorder has mental causes or physical? There never was one. As the editors know perfectly well, these vital questions were decided by “popular vote” of a clique of influential insiders.

Psychiatry has always been torn by the dispute over the nature of mind: is it a material thing that can be understood and studied with the methods of material science, or is it sui generis, a thing unto itself that emerges from the brain but is then independent of the laws of the physical universe (for fascinating histories, see [5, 6])? This is the very base of our efforts to understand mental disorder but mainstream psychiatry continues on its hugely expensive biological path, blithely unaware that its most important question was resolved by nothing more substantial than “popular vote.”

Moreover, the entire DSM system was adopted by popular vote. Every change in every diagnosis is decided by a vote in committee, which then goes to a bigger committee, which votes, and so to the final committee where the real brawling starts. Tier after tier of people bursting to get their new disease listed or their point of view enshrined; starting on page 897 of my 2013 copy of DSM-5 are twenty closely-typed pages, two columns per page, of people who had a finger in the pie. Thousands of them, and it’s all done by … voting. Surely the two-term former editor of the RANZCP’s premier journal knows this? He does, he knows far better than I do the mysterious processes by which psychiatric diagnoses arise from the depths of academia like bubbles in a stygian cesspool.

Just in case he and his friends don’t recall the process, let’s look at a particular pie in which quite a number of them have poked more than just a finger. Position Statement No. 80 of the RANZCP, currently in force, states:

Medical expertise: Psychiatrists apply their medical knowledge, specialist clinical skills and acumen in the provision of person-centred care. They understand the impact of ‘biological’, ‘psychological’ and ‘social’ factors on mental health and the causation of mental illness. This ‘bio-psycho-social’ model is a holistic approach that recognises the impact of social adversity and physical health on mental well-being [7].

In a letter, the current president stated: "... the biopsychosocial model (is) ...the predominant theoretical framework underpinning contemporary psychiatry ... a relevant and useful component of training and practice ... " (Moore, E. correspondence, Nov. 20th 2023). This is important: backed by the authority of the board of directors, she has essentially defined psychiatrists as people who study and practice according to a particular model.

Was this adopted after “rigorous scientific enquiry” or was it by a vote? The only enquiry of any substance into the biopsychosocial model was the one I started nearly thirty years ago. That showed there was no such thing as an integrative model of body and mind for psychiatry, but it has been totally ignored [8]. So much for the “rigour” of their enquiry. Was there ever a public discussion or debate on this matter? No, all decisions have been taken in secret by small groups of “key opinion leaders” whose primary motive is to make sure people don’t realise psychiatry is flying blind. Even a phantom model is better than admitting there is no model, which works as long as nobody is able to read the evidence that proves it is a phantom.

I have several times invited the president to forward me copies of their training material, including the reading lists, tutorials, texts, records of conferences, journals and so on that you would expect for psychiatry’s theoretical foundation, but she resolutely refuses. I conclude from this that there is no such material and that her statement was designed to mislead people into believing psychiatry has an adequate intellectual basis when it does not. They want everybody – patients, their families, other medicos, governments, funding and regulatory agencies and, above all, medical students and psychiatric trainees (residents) – to believe that they’ve got a firm grip on mental disorder and, with just a few more grants, will finally deliver the answer to mental disorder.

As for the value of the genetic research, it all hangs on one thing: showing how genes can influence the mental state. This is the sine qua non of reductionist biological research in psychiatry: without some sort of mechanism, the billions and billions of dollars are wasted. How do genes cause depression? What is the mechanism by which a gene is able to induce a state of sadness and despair in an otherwise healthy and intelligent person? Genes code for proteins, not for ideas or beliefs. Biological psychiatrists don’t bother with this as they believe that one fine day, the answer will fall out of a test tube. This is called promissory materialism, the weakest of all intellectual cases. Spoiler alert: it doesn’t work. You have to have some idea of a potential mechanism, otherwise you will keep poking in the dark and never know whether there is one or not.

In fact, it’s already been done. The biocognitive model proposes a solution to the mind-body problem [9] and uses a particular example of gene activation to show how human emotions and behaviour are influenced in a general direction by specific thought patterns. The thought patterns activate the genes, not the other way around. All the clever biological psychiatrists have put the cart before the horse. So when the energetic Prof. Ian Hickie (who is part of the Consortium, of course) said that it’s your disease of depression that causes all the bad events in your life, he had it back to front. Bad events cause a sense of loss which, in turn, produces the state we call depression. The biocognitive model says that awareness of loss induces specific brain changes by gene induction such that the depressive state continues after the events have faded. It’s all very straight forward, nothing magic about it. The only mystery is why mainstream psychiatry, such as the authors of the petulant editorial, has voted to block a “rigorous scientific enquiry” of these matters. Actually, we do know: they can’t bring themselves to admit their approach may be wrong. As academics, they are ipso facto locked in the eternal struggle to get to the top of the hierarchy and throttle the competition. Just as the biocognitive model predicts.

Biological psychiatry will not deliver us from mental disorder. Psychiatrists dart from one “amazing breakthrough” to another, constantly hoping nobody looks too closely at the details. After forty years of today’s “wonder drugs,” we’re now learning that (a) they don’t work as advertised and (b) they have serious side effects, but don’t worry, the next hot field of research, genomics, is ready to roll:

The clearer association of genetic variants with altered gene expression and the enrichment of antidepressant targets provide confidence that genetic association findings will be relevant to the development, deployment, or repurposing of pharmacotherapies. Critically, these findings suggest genetic associations will point to new drug targets and more effective therapies that may reduce the considerable disability caused by depression [1, p7].

That’s what they always say (it’s code for “keep sending the money”) but I wonder why nobody ever looks into the genetics of stupidity?

References:

1. Major Depressive Disorder Working Group of the Psychiatric Genomics Consortium (2025). Trans-ancestry genome-wide study of depression identifies 697 associations implicating cell types and pharmacotherapies. Cell 188: 1–13. https://doi.org/10.1016/j.cell.2024.12.002

2. McLaren N (2013). Psychiatry as Ideology. Ethical Human Psychology and Psychiatry 15: 7-18.

3. Malhi GS, Bell E, Bassett D, et al. (2021) The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Australian and New Zealand Journal of Psychiatry 55: 7–117.

4. Kisely S, Malhi G (2025): Concerns over the process and outcomes of the review by the Royal Australian and New Zealand College of Psychiatrists into long-term psychodynamic psychotherapy ANZJP Dec 24, 2024; https://doi.org/10.1177/00048674241308371

5. Scull A (2022) Desperate Remedies: Psychiatry and the mysteries of mental illness. London: Penguin.

6. Harrington A (2020). Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness. New York: Norton.

7. RANZCP (2013). Position Statement No. 80: The role of the psychiatrist in Australia and New Zealand. RANZCP Website. Accessed Nov 3rd 2023.

8. McLaren N (2023). The Biopsychosocial Model and Scientific Deception. Ethical Human Psychology and Psychiatry, 25: 106-118

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

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