Who needs science?

A reader sent this link, which arrived in the midst of watching the next video on ADHD from the college of psychiatrists. The link to "ADHD A-listers" hopes to convince us that a retired astronaut with four trips to space over a total of 520 days is suffering a genetic mental disorder. The video was on "pharmacotherapy," meaning how to drug not just children and teenagers but everybody. I've had my fill of ADHD this week so we'll leave it for another day.

Now I know nothing about the selection and training of astronauts in the US but I'm sure of one thing: it would be absolutely the most detailed and exhaustive process that they could devise, almost certainly the most demanding in human history. It would be impossible for a person to get through that and become commander of a series of multi-billion dollar flights with half a dozen lives in his hands if there were even the slightest doubt as to his stability. The idea that he or Paris Hilton are mentally ill is a travesty and a grievous insult to people who are genuinely troubled and unable to function at their potential.

That's on top of this lecture telling us, in essence, that ADHD is everywhere, and anybody who wants stimulant drugs should have them as well as a whole lot more people who don't. It's also in addition to trying to convince the wider population that everybody is autistic or bipolar or neurodiverse or depressed or anorexic or whatever. You can't even go into a public toilet these days without a blast of propaganda: "Are YOU anxious? Are you depressed? Go and see your doctor."

Bizarrely, and unlike during the pandemic, nobody is objecting. Everybody is quietly shuffling into line and going along with the program to give psychiatric labels and drugs to most of the population. Where are the angry mobs chaining themselves to the doors of mental hospitals to stop people being dragged in and drugged against their will? Worn out from their exertions over Covid, obviously. This raises a crucial question that the psychiatric industry does not want anybody to ask: Do psychiatrists know what they are doing? This goes to the very heart of the enterprise and we can only touch on it today but the best place to start is the basics.

It doesn't matter where you go in the world, at any time in human history or any class of society, everybody understands that, even though they're physically fit, there are people who just can't get it together. All societies recognise a few types of being "untogether." First, there is the child that is born slow. The siblings are fine but this one just can't walk or talk or do anything as well as normal children and needs constant care and supervision. We call that congenital intellectual handicap, which has many different causes. Another group of people were going along normally in life until something happened, an infection, a bang on the head, near-drowning and ever after, they're not the same, they lose skills and can't manage as before. Everybody understands brain damage.

The picture of granny going gaga is universal. Every society understands that at the end of life, people can lose their memories and can't look after themselves. They may even go a bit potty, accusing people of things then forgetting it a moment later. There is also the group of people who, throughout life, are trouble of one form or another. The Greeks recognised it and built their drama around what we now call personality disorder. Next group is always unhappy for some reason, maybe anxious and jumpy or mournful but they tend to have good times and bad and can usually cope. Finally, there's the small group who were fine as children and young teenagers, then in late teens, they go off. They talk to spirits or demons, they don't look after themselves and nobody can follow what they're talking about. That was known as dementia praecox or adolescent dementia, but now we call it schizophrenia.

These observations are universal and they have to be explained. It's no point pretending they're not there, or that it's all a huge hoax, as Thomas Szasz insisted, because they are there and it's real. What is needed is an explanation. The oldest by far and probably still the most widespread explanation blames the supernatural. The child is slow? That's God's will, can't argue with that. Feeling a bit glum today? That's demons, sacrifice a chook and cast them out. That is, knowing it's a spell or spirits leads to a treatment program which usually involves some specialist in dealing with the supernatural, which probably won't be cheap. The beauty of the supernatural is that it seems to explain everything. The downside is that, in explaining everything, it explains nothing. We are none the wiser so, centuries ago, western science decided to leave demons out of the equation.

The second big theme in explaining mental disorder is the idea that it's some sort of physical disease state. It's either too much of something toxic or not enough of something vital, or something growing in the wrong place or making a bad connection, but it all leads to a treatment program: diagnose the error and correct it physically. If you think that mental disorder is due to too much hot blood in the brain, cool the patient. Hence the ice baths for the unfortunate, who had to be strapped in strait jackets before being dumped in an ice slurry for an hour or so. That would not have been fun in winter in Europe or America.

Another enterprising soul believed all mental disorder could be cured by heat treatment. Julius Wagner-Juaregg apparently got this idea during medical school in the 1870s, and persisted trying to treat everybody by heating them. However, he was in luck as some of his patients had tertiary syphilis and were dementing rapidly. It happens that the syphilis bug is very sensitive to heat so, purely by chance, he found a treatment when it was considered a death sentence. In 1927, he was given the Nobel Prize but that was already at the tail end of the fad. But it hasn't gone away. Every now and then, somebody gets the idea of trying pyrotherapy again.

Mainly, physical treatment takes the form of adding chemicals to the diet or subtracting something to restore the imaginary balance, except people who believe this don't accept it's imagined. They are totally convinced, beyond any conceivable doubt, that mental disorder has a physical cause. The Philadelphia physician, Benjamin Rush, one of the signatories of the US Declaration of Independence, was adamant that mental disorder was physical and needed physical treatments. In the UK in the 1870s, Henry Maudsley announced: "Mental disease is brain disease," and treated his patients accordingly. This led to intensive studies of the brain to try to find the cause of what were generally regarded as "hereditary degenerations" but, when that failed, they moved on to searching for a bacterium as the cause. This is generally derided as "the search for the elusive schizococcus," but it lives on in various forms.

A variation was the notion that people could be shocked out of their mental disease by sheer terror. Benjamin Rush was strong on this idea, which morphed into giving people convulsions, initially by injecting a camphor-based chemical which induced states of terror before the patient had a seizure, then by electricity, which is still used today. The justification has changed but the method is the same. Along the way, there was the travesty of "psychosurgery," of cutting the brain or cooking part of it to "cure" the patient's suffering. Andrew Scull has given a good account of this, as has Anne Harrington [1, 2]. That idea still hangs around in academic circles although anybody who knew its history would want to know why.

The final possibility is the idea that mental disorder is a result of inner conflict of some form or other. Often, this took the form of it being punishment for some sort of psychological excess, such as greed, or pride, or sexual indulgence, so the sufferer had to undergo some sort of ritual cleansing or absolution. Teenage boys had to sleep with their hands tied behind their back but women could be "cured" by clitoridectomy. In the early 1900s, Sigmund Freud took the idea a lot further when he built an enormously complex model of mental life, in which early conflicts lived on, producing mental trouble years down the track. His model said the conflicts could be cured by talking but his program of psychoanalysis slowly faded out as too expensive, although modified forms live on.

As you know, today, everything in psychiatry is biological. That's it. So, as we saw last week, if you have a certain cluster of symptoms, then you have ADHD. It doesn't matter what happened to you earlier in life to cause it, the symptoms mean the genetic disease and the genetic disease means drug treatment. This week's ADHD video special starts with the lines: "Is stimulant medication the first line of treatment for ADHD? Yes." And, as the show progresses, it is also the last, as well. That's nice, but how do we know? Given psychiatry's truly ghastly record of blunders, butchery and stuff-ups, can we trust the doctor? It's not like cardiology, where anybody can inspect a heart and find exactly what the physicians say should be there, or surgery, where you can diagnose appendicitis on the history and, voila, find an inflamed appendix (occasionally, it doesn't work. I once confidently diagnosed acute appendicitis and booked the patient for theatre. With the surgeon watching the cricket in the lounge next door, I opened the patient and found ... he had a matchstick poking through a Meckel's diverticulum. At least it cured him of his habit of chewing matchsticks). But the proof is there, anybody can duplicate the experiments.

So where is the proof in psychiatry? Well, there isn't any. Psychiatry is a matter of belief. If you believe all mental disorder is possession states, you're on strong grounds because guess what? Nobody can prove you're wrong. And this is the cut-off point for science, or the demarcation criterion, as it's called. If a statement can't be proven wrong, i.e. if it's irrefutable, then it isn't science. The reason is that an experiment that turns out right may be just a fluke shot; you don't know if the next time you try it, it will work or not. But if it fails, then you know for certain that you're not dealing with a general truth.

This is also true of physical causes of mental disorder. After a hundred years of searching, at about US$2.5B a year, what have they found? Nothing. Given there is not a single scrap of evidence to support the idea that mental disorder is due to physical disturbances of the brain, why continue the program? Because the "Key Opinion Leaders" in psychiatry have all built their careers and reputations on the single proposition: "All mental disorder is brain disorder," and they can't conceive of being wrong. Is that how science should be conducted? Definitely not. In his intriguing little book, Robert Youngson [3] said:

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 (p60) ... The whole history of science, right up to the present, is a story of refusal to accept fundamental new ideas; of determined adherence to the status quo; of the invention of acceptable explanations, however ridiculous, for uncomfortable facts; of older people of scientific eminence dying in confirmed possession of their life-long beliefs; and of painful readjustment of younger people to new concepts. (p293)

So why does psychiatry not try the psychological path again? Well, that's an interesting story for another day. In between, I shall bite the bullet and watch ADHD video No. 3. But at this stage, I think the college's "Masterclass on ADHD" is turning out to be a masterwork of self- and public deception. Science? They wouldn't know science if it bit them.