Viva La Revolución

Bring it on.

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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The world is back on fire again. In truth, it’s been on fire every day of my life but it’s definitely getting worse, to the point you’d ask who’s actually mad in all this? Is it the quiet, helpless people locked in mental hospitals or sitting mute at home or in school, drugged to the eyeballs, or is it the people firing missiles at primary schools? In fact, with one notable exception, the people organising and doing the shooting are not mentally disturbed in any way. They are fully conscious, in control of their faculties and aware of what they’re doing. We could argue that they have no awareness of the long-term consquences of their actions but that’s their choice. The information on global warming, nuclear winter, desertification, pandemics, famine, civil war and so on is freely available but, in their lust for power and wealth, they choose to ignore it.

The exception, of course, is the fairly rapidly dementing Donald Trump, from whom all the scoundrels in the world are taking their cues. In my view, he should be removed from office immediately but that’s a matter for the US power elite. Unfortunately, since so many of them are making so much money from his term, they don’t want to derail the gravy train. One who probably isn’t making heaps of money from his office is the secretary for Health and Human Services (HHS) Mr RF Kennedy Jr. He’s been in office a year and Lancet, one of the leading medical journals in the world, marked the occasion with an editorial, calling it: “One Year of Failure.” In order to get approved for his position, he made numerous promises over what he would and wouldn’t do but, as the editorial shows, he has broken most of those and is working on the rest.

There are two sides to the impact he has had. The first and most obvious is the effect on people’s health and, given his obsession with immunisation, that means children dying of readily preventable diseases. In this, he is driven by his good friend and fellow fanatic, the notorious former surgeon Andrew Wakefield. The second, less obvious but possibly more consequential, is his destruction of the huge and very successful American biomedical research program. Long term programs such as the diabetic study have been cancelled after 30yrs, mRNA research ditched, even though it led to the Covid immunisation in record time, cardiac studies and so on. Essentially, he has wrecked American research, leaving the field wide open to the diabolical Chinese who, needless to say, are racing ahead. Fortunately, he hasn’t said much about psychiatry or mental disorder but his influence is seeping through. Peter Simons, a psychologist with Mad in America, reports on a new drug for schizophrenia which has been approved without any clinical trials.

Vanda Pharmaceuticals, the manufacturer, had a patent on iloperidone for schizophrenia and bipolar disorder (approved in Australia but rarely used as too expensive). That was approved in the normal way years ago but their patent was due to expire, so they applied for a new drug registration based on the active metabolite of the drug. However, they didn’t submit any new information, all they did was show that when iloperidone is taken, it is quickly metabolised to milsaperidone which is an active agent, so the original studies were actually about it. They were granted a patent on the basis milsaperidone is a new drug but were not required to follow the procedure for testing and proving new drugs as the FDA said the two chemicals were interchangeable so it wasn’t new. This is ridiculous: either it’s new and they can have a patent but must jump through all the regulatory hoops, or it’s not new so they don’t have to do the tests but then can’t have a patent. That nonsense would never have happened under the old regime at the FDA but all the boring old sticklers for procedure on the various committees have been dumped and replaced by Trump and RFK loyalists. Two questions arise: Why is this happening, and will they start on the wholesale drugging and shocking of people with mental troubles? There have been a few whispers but nothing much.

The question of why this is happening is not a scientific question. It isn’t, as some people have suggested, an example of a genuine scientific revolution, as originally described by philosopher Thomas Kuhn. Until Kuhn published his ideas just over 60 years ago [1], the general idea was that scientific progress is essentially a straight line from primitive darkness to the sunny uplands, driven by indomitable human rationality. Kuhn said that’s not true. Scientists spend an awful lot of time groping in the dark, following false leads, researching nonsense and squabbling over incompatible belief systems. Every now and then, he said, problems in a particular field build up to the point where it’s in chaos, full of contradictions and unable to explain anything properly, with no clues as to how it can be improved. Then it all changes. Somebody, often an outsider or newcomer to the field, announces that the whole approach is wrong and proposes a completely different way of looking at things. This forces a revolution as the old idea and a lot of its champions are thrown out, and the younger generation takes over and starts to build a new science in its place.

Kuhn’s favourite example was the Copernican revolution where the ancient notion that the earth is the centre of the universe was discarded in favour of the heliocentric model, placing the sun at the centre with earth spinning far out in the darkness. This was truly revolutionary, it forced people to accept that the universe is inconceivably large and we’re just a very small part of it. However, as Galileo discovered when he published a fairly mild defence of the Copernican system, a lot of very powerful people didn’t like that idea. Nonetheless, the new model made sense of a lot of troubling observations and allowed the science of astronomy to race ahead so, after a great deal of snapping and snarling, the old fogeys were eventually shoved aside. This appears to be generally true. Bishop Niels Steensen showed that the earth is ancient and that fossils are the remains of animals that no longer exist, which upset the creationists. The great Louis Pasteur showed how sicknesses were caused by microscopically small bugs, not by noxious vapours rising from swamps. Darwin, of course, turned biology upside down but there were so many others: Marie Curie’s work on radioactivity, Einstein’s relativity, the idea of continental drift, etc. Which brings us to psychiatry.

As you know, psychiatry wants to be seen as a normal part of today’s scientific medicine. Mainstream medicine, however, is firmly fixed in mainstream science which says that we can’t talk about unobservables. If it can’t be seen and measured and duplicated, it isn’t the province of science. Psychiatry wants to deal with the mind. The mind can’t be seen or measured, therefore the mind with all its emotions and mixed up beliefs is not the province of science. Impasse. Psychiatry’s escape from this trap is to say: “Aha, but we’re not really talking about the mind. It may sound as though we are but we’re actually talking about the brain.” Everything that makes up a human mind, emotions, beliefs and the like, is stripped out of what has been called their “clinical neuroscience,” leaving only a shell of a person waiting for somebody to do something to his brain to bring life back to normal.

Instead of focussing on the person, psychiatry pushes ahead on two fronts. The first and oldest is to find some sort of physical remedy to kickstart the brain, to reboot it to normal mode. The history of all the blind poking to find a physical cure for mental disorder is simply chilling [2] but that doesn’t slow anybody. The belief “Mental disease/disorder is brain disease/disorder” comes first, it dictates the research program: “If mental disorder is brain disorder, there must be a physical cure. OK, let’s find it.” So they start searching, but they can only search using the available technology. In fact, all psychiatric drugs have been discovered by chance. One episode that should have more attention was pushed by a financier, not psychiatrists. Jack Dreyfus (1913-2009) was one of the first to develop mutual funds and became extremely wealthy. In about 1966, his GP prescribed the anticonvulsant drug, phenytoin (Dilantin), even though Dreyfus wasn’t epileptic. Instead, he had a truly filthy temper and exploded in rage at anybody and everybody, so perhaps the GP was getting a bit desperate.

Phenytoin is a powerfully sedating drug which numbs emotions. Dreyfus was delighted with this and wrote a book which he published and sent to many thousands of doctors throughout the US. From this came the idea of using anticonvulsants for what is called bipolar disorder. Phenytoin is fairly toxic so they soon started using carbamazepine then grabbed valproate when it was released and the rest is history. There’s no justification for this; it quietened the psychopathic Dreyfus so nw everybody gets it. The entire history of psychiatric drugs follows this tradition; something seems to work, therefore it is widely used and after the event, people manufacture a story about how it works. The so-called serotonin hypothesis of depression is another example, now debunked [3].

Shock treatment, of course, were developed in the search for something that would cause widespread low-grade brain damage. It was believed, on no evidence as all, that brain damage was protective against psychosis, and since seizures produced low grade brain damage, therefore seizures should protect against psychosis. Hence ECT and all the other electrical and magnetic toys that are used to make money from misery. That’s one of psychiatry’s two fronts. The other is to find something in the brain that would qualify as a “cause” of mental disorder.

Sixty years ago or more, it was all chemicals and electrical impulses because that was the limit of the technology. In the 1950s, somebody decided that people with schizophrenia were secreting a toxic chemical; after a bit of searching, they found a blue chemical which was named taraxein. If they gave it to spiders, they weaved misshapen webs; if they gave it to prisoners, they became psychotic. This had a huge impact, everybody was terribly excited but it soon emerged that nobody could replicate their results. Eventually, it was shown that their method was leaching a chemical out of their plastic laboratory equipment, so that idea fell in a heap. Another researcher decided that people with psychosis were having seizures in a deep brain structure called the nucleus accumbens; he was fond of sticking needles deep into brains to record the EEG patterns but that as too dangerous so it didn’t go far.

Technology has advanced considerably since then, far beyond mere chemicals and brain waves. Molecular genomics is the frontier, so that’s where eager psychiatrists gravitate. When the human genome project was finally published, nearly 25 years ago, everybody predicted that this would be the greatest breakthrough of all time, it would give us the secrets of mental disorder and how to make drugs to correct it. After that, psychiatry would be simply tidying the bookcases. Needless to say, it didn’t happen so genomic research in psychiatry is quietly sliding from centrestage, preparatory to being whisked into the memory hole along with taraxein and iced water therapy.

A recent paper on the genetics of depression starts: “Major depressive disorder (MDD) is a debilitating neuropsychiatric disease associated with high risk of death by suicide …” [4]. Firstly, that tells us what they’re thinking: “It’s all biology.” The term ‘neuropsychiatric’ has absolutely no meaning, it’s just a way of making the speaker sound important. And who says being depressed is a ‘disease’ in any meaningful sense of the word? Nobody. Anyway, they move on. Very large scale genetic studies of depression have revealed … nothing. The number of genetic loci thought to be involved in depression is approaching 750, meaning their individual contribution to feeling miserable is immeasurably small, if it exists at all. Compounding this, a lot of the potential influences are epigenetic, meaning they are minor changes outside the DNA that affect how it is expressed without altering the genetic code. That is, it’s all guesswork.

Given this gloomy outcome to decades of very expensive research (we’re talking tens of billions), this is all a little underwhelming but one thing about biological psychiatrists is they never give up. Neurotransmitters have failed us? Don’t worry, there’s a new technology called genomics, let’s try that. Oh dear, not looking encouraging is it? Don’t worry, they’ve discovered all these amazing inflammatory chemicals, let’s give them a bash. It won’t work. Depression is not the result of brain inflammation, it is the product of life experiences, some current and some long past but that has to be sorted out by talking to the sufferer.

So genomics is going nowhere fast, neurotransmitters have let us down, cytokines aren’t sparking much interest, and they’re even being forced to admit that their drugs are addictive. In the broader picture, the one Thomas Kuhn drew, what does this say? It says the contradictions are building up. After a hundred years or more, biological research in psychiatry is going nowhere. It has produced no interesting results and answered no significant questions about the nature or causes of mental disorder. Biological psychiatry cannot make any interesting predictions about the course or content of mental disorder; it has no basic theory [4, Chap. 2]; there are no fancy new drugs in the pipeline so all the manufacturers can do is repackage old stuff and get their friends in admin to issue a new licence; and the more treatment people get, the worse the outcome. At this stage, after biologists have held centre stage for well over half a century, it’s time to call a halt.

What we require of biological psychiatrists is a statement from them as to when they will give up and admit they’ve been on the wrong path. If they don’t do give that, they are not practising science, they are ideologues. Which we know anyway but is there any chance of this happening, any chance of them standing back to give somebody else a go? No way. The whole process of research in psychiatry has been dictated by the sorts of people who put RFK Jr in the driver’s seat. Bean counters have replaced people with experience and imagination. Massive surveys by questionnaire have replaced in-depth understanding of individuals, and for researchers, computation has replaced contemplation.

The people running psychiatry today are entrepreneurs, busy people who dart from one meeting to the next grants application by way of jetting off to present the same paper at a different conference. They make money, build networks of influence, trade favours, fast track their friends and, by controlling the publishing industry, quietly sabotage any ideas they don’t like. They are, in fact, the result of forcing the study of mental disorder into the procrustean neoliberal economic model, of discarding such wishy-washy concepts as “mental distress” in favour of the world of mission statements and key outcome parameters, budgets and time lines, corporate plans and human resource units.

Biological psychiatry is reaching the end of the line. A revolution is due. But don’t think change is going to come from within the psychiatric establishment. People who have committed themselves for 20 or 30 years to a particular “vision” of mental disorder will not wake up one day and say “Looks as though we’ve been completely wrong all these years. Why don’t we go back and talk to people about their mental lives?” That doesn’t happen. There was an opportunity a year ago when Kennedy was appointed to his job. He could have said to the director of NIMH: “Can you let me have a copy of your concept of mind and your model of mental disorder, and why you believe biology will tell us all we need to know about mental disorder? After all the money you’ve spent, you must have this somewhere, just slip it on my desk tomorrow, thanks, ” He could have said that and there would have been a long, embarrassed silence followed by lots of feet shuffling because they don’t have it. They’ve never bothered. That’s like NASA not having a plan of where the moon is or how they’re going to reach it but spending heaps on what they’re going to do when they get there. Meantime, Kennedy has spent his time wrecking things that can’t be replaced, so there’s little reason to believe change will come from him. And unless he or somebody like him applies the screws, there’s no chance of revolutionary change coming from the mainstream. Lord Lister (1827-1912) said:

I remember at an early period of my own life showing to a man of high reputation as a teacher some matters which I happened to have observed. And I was very much struck and grieved to find that, while all the facts lay equally clear before him, only those that squared with his previous theories seemed to affect his organs of vision.

He could have been talking about biological psychiatrists. Time for a big change.

References:

1. Kuhn TS (1962/1970). The Structure of Scientific Revolutions. 2^nd Edition, 1970. Chicago, Ill: University Press (International Encyclopedia of Unified Science, Vol. 2, No. 2).

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

3. Moncrieff, J., Cooper, R.E., Stockmann, T. et al. (2022) The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry Published online July 20th 2022. https://doi.org/10.1038/s41380-022-01661-0

4. Zallar LJ, Dupont MB (2026), Brain and Blood Biomarkers of Major Depressive Disorder. A Systematic Review. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2025.4613

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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.