by Niall McLaren, MBBS, FRANZCP

At the end of this past May, the American Psychiatric Association (APA, not to be confused with their competition, the American Psychological Association, also APA) held their annual jamboree in San Francisco. The theme was Innovate, Collaborate, Motivate: Charting the Future of Mental Health. This is huge, something over 12,000 attendees and lots more demonstrating on the pavement outside who weren't allowed in. There were over 600 presentations of a dozen different types, all on the same topic (no criticism, of course): Mental Disorder is Brain Disorder.

It's also Big Business, costing members over US$1,100, but it is much bigger business for the drug companies. They could get a 23-page prospectus outlining the mouth-watering business opportunities of having an advertising stand in the convention centre . Starting with a 10'x10' booth, about 9 square meters, costs ranged from US$3,700 for the four days, to about US$18,000. Who pays this sort of money? Everybody: drug companies, device manufacturers (ECT etc), book publishers, IT companies, recruiting agencies, hospital and insurance companies, universities, the military ... There's money in psychiatry, that's for sure.

And for those of us too disadvantaged or churlish to attend, there were daily briefings direct to your email box from Psychiatric Times and others, all breathlessly announcing yet another stirring advance in the War on Mental Disorder. For example, anorexia and bulimia have now been targeted by the people who make "neuromodulatory" devices, magnetic field generators for transcranial and what is called deep brain stimulation. These machines aren't cheap, they start at about US$40,000 and quickly go up but the real expense is running them (staff, facilities, etc), which is why TCMS is so expensive.

The article mentioned a number of papers over the past few years where these machines had been used, but the studies were generally poor quality with small numbers and indifferent results. Compounding it, there was no agreement over which deep parts of the brain should be stimulated, although all researchers were sure that they were on the right track. Nonetheless, the author was optimistic that more research would be helpful. There was, of course, no discussion of why eating disorders should be regarded as brain disorders needing physical treatment of the brain, and not primary psychological problems for which talking is the correct approach. Mainstream psychiatry, which the APA conference represents, doesn't believe in mental causes of mental disorder, it's all physical, meaning lots of physical treatment and no time wasted on idle chat. That's why all the drug and device manufacturers and etc. flock to the APA annual conference: "There's money in them thar ills." (Sorry, bad joke).

Just to prove that there's nothing new under the sun, we have been treated to the latest, er, considered treatment for ADHD. Diet. This is true. Fifty years after the Feingold Diet was quietly smothered and buried by the manufacturers of stimulant drugs, we learn that diet is back:

There has been increasing interest in the role that diet and supplements play in the treatment of attention-deficit/hyperactivity disorder (ADHD) symptoms, from patients and researchers alike.

For those too young to remember the 1970s, the Fiengold Diet was developed by a Dr Feingold from California, a paediatric allergist who decided that what is now called ADHD represents an allergy to chemicals in the diet (unsurprisingly, that's what allergists do). The chemicals he chose were the group of salicylates, natural and artificial. Salicylic acid, universally known as aspirin, was originally discovered in the bark of willow trees (Latin name: Salix) but similar chemicals are widespread in nature. Dr Feingold, who graduated in 1924, decided that these were the offending agents and devised a diet that would eliminate them. He published a couple of books on the subject, including the best-selling The Feingold Diet for Hyperactive Children (1973), and immediately achieved near-superstar status among his devoted fan base. He died in 1982, just as the results were coming: the diet had no scientific basis and the results were woeful.

Unfortunately, Dr F. had based all his ideas on what was the original research on natural salicylates, from the late 19th century. All the figures were wrong, which meant his diet was little better than a random elimination diet. It was also difficult to follow as it put a lot of work on mothers preparing special meals at home and lunches for school but, most important, it was boring and the kids didn't keep to it. Finally, well-funded research (sponsored mainly by drug companies) soon found it was essentially useless but you couldn't tell the mothers. No way. Back when our children were still having birthday parties, each round of invitations would result in a dozen messages saying we had to make sure their little darlings didn't go near the red cordial, chocolate ice cream, little red saveloys (for some reason, they're called Cheerios here) and so on. As though we could stop them. But we had plenty of land and a pool so the kids could run screaming through the bush and jump in and out of the pool all afternoon, then sleep on the way home in the car, meaning the parents were happy and thought we'd done wonders.

But as I said, diets are back, which is generally an indicator that there is growing awareness the magic drugs aren't doing what they're supposed to do. This time, the prime offender isn't salicylates, it's... wait for it ... the Western diet of hamburgers, chips and fizzy drinks. Researchers have noted that as the diet of highly processed food, with high levels of salt, sugar and fat, spreads around the world, so the incidence of obesity in children rises, and in adults, along with diabetes, high blood pressure, bowel cancer, heart disease. And arthritis. Mustn't forget the relentless increase in arthritis of hips, knees and low back in the 150kg bodies designed for 70kg.

The researchers considered all sorts of possibilities, including what is known as the gut biome, meaning the trillions of bacteria that normally live in the large bowel. With a diet high in fibre and complex natural sugars, and low in animal protein and fat diet, i.e. the diet of hunter-gatherers, the large bowel has a stable population of fairly harmless bugs who mostly behave themselves and contribute to digestion. However, with the high fat/sugar/salt, low physical activity diet that is gradually taking over, the bowel flora changes dramatically. The nice bugs get shoved aside and nasties take over, leading to all sorts of odd chemicals flowing into the body. These include inflammatory chemicals such as cytokines, hence psychiatry's interest in whether mental disorder is due to these chemicals affecting the brain (there's no evidence for it yet but that doesn't stop anybody).

They also looked at some more way-out causes, including heavy metal intoxication (aka poisoning). These include chromium, lead, mercury, arsenic, nickel, manganese and selenium, all of which are found in the air, dust and water of mining and industrial cities. Entire generations of children have been exposed to these elements, even though they have long been known to be toxic to developing brains, lead in particular. Once absorbed, heavy metals stay in the body long term and many are concentrated in nervous tissues. Chronic low-grade lead poisoning in children, often starting during pregnancy and breast-feeding, results in measurable loss of IQ, as well as behaviour disturbances which, with a bit of massage, can meet the criteria for ADHD. Higher levels of lead poisoning, of course, are even more serious with mental impairment and coordination problems, up to coma, convulsions and death, so it's very serious.

However, it's rarely a problem of the wealthy as heavy metal poisoning is largely a problem of poor and minority children whose parents have to live and work near mines and refineries. The city of Flint, a post-industrial wasteland in Michigan, had a large scale experiment a few years ago when the city decided to save money by using water from the Flint River rather than from dams inland. The river is acid, so it dissolved the lead in the ancient water pipes that they'd never quite got around to replacing (Flint is poor and black), which meant the water was dangerous. However, in order to prevent public panic, the city authorities kindly suppressed the news. In Australia, refineries in Mt Isa (Qld) and Whyalla (SA) have been spewing tons of these chemicals into the air for decades. When the risks were finally made public, mothers were given helpful advice from health departments:

Don't wear shoes inside. Wash outdoor toys often. Don't hang washing out if there's a northwesterly blowing. In fact, try not to be outside at all if there's a northwesterly. Don't vacuum while your children are in the room. Don't drink rainwater. Or cook with it. Especially don't use it to make baby's formula. Don't let toddlers put their hands in their mouths or play on the grass.

These people were serious. Trouble is, the diagnosis of ADHD is not made so much in poor or disadvantaged children (unless they're in state care) as in middle to upper socioeconomic groups, so that doesn't work. Yes, heavy metal poisoning is a major public health issue in many parts of the world; no, it has absolutely nothing whatsoever to do with the "epidemic" of ADHD in Western countries; no, that news will not deter the brigades of concerned parents who will demand their little darlings be tested, at huge public expense, for heavy metals; and yes, the researchers end their little paper with a call for more research (read: more money):
... more research is required in order to better understand the efficacy and underlying mechanisms of dietary strategies for ADHD.

So while they're chasing the effects of bowel bugs on brains, have they given any thought to the possibility that so-called ADHD may have something to do with parenting? With the school environment? With family pathology producing just plain unhappy kids? Of course not, what a silly suggestion, everybody knows it's biological. Anyway, there's no money in that.
For children, their diet just is a parenting matter. Yes, there are pressures affecting what poorer parents can give their children but the fact that advertisers can spend taxpayer-subsidised millions on boosting the latest McRooster burger with cola and chips has to be taken into account. Also there are massive subsidies in the US for farmers to grow corn, which is then converted to vast quantities of corn syrup which has to be sold to cover the costs of the subsidies. Corn syrup is very high in sugar (about 780gm per litre, meaning the sticky goo is an astounding 78% pure sugar). It goes into everything. If you buy any ready-made food of any sort in the US, it's dripping with corn syrup. That is the sort of food the poor buy just because it keeps the kids quiet, especially in cold weather.

McDonalds used to give plastic toys with what they called their "Happy Meal": why didn't they hand out free medicine measures and other useful things? That's not their job, they reply: "Our job is to satisfy our shareholders." Sure, and the community and government pick up the bits (for tax purposes, McDonalds Australia is domiciled overseas and pays itself hundreds of millions a year in "royalties," thereby reducing its tax bill; the rest are just as bad).

So back to the APA annual gabfest. The entire orientation is directed at finding a biological "cause" for mental troubles, when common sense says the quality of life must have something to do with it. And that's modern psychiatry: as I have said (many times, in fact), modern psychiatry does not have a science of mental disorder. Instead, it is an ideology of mental disorder, a cluster of beliefs or a false or unproven narrative put about by the controlling elite for the purpose of safeguarding their interests. Because if they relax for one minute and allow that, yes, life experiences (including being detained and treated against one's will) may have something to do with mental disorder, then hordes of psychologists, social workers and other pond life will swarm in and the power elite will lose control of what they see as their industry.

The ADHD industry is more or less emblematic of everything that is wrong with psychiatry. If you can think of something that psychiatrists have got wrong or are doing wrong, it'll be in there. That's not a very flattering assessment of modern psychiatry; if somebody can prove me wrong, we'll publish it.

Niall (Jock) McLaren is an Australian psychiatrist who recently retired after 50 years of practice. He has extensive experience in military, forensic and remote area psychiatry, all at the rough and unglamorous end of psychiatry. As a specialist, he went back to university to study philosophy and has published a number of monographs on the application of the philosophy of science to mental disorder, most recently brought together as the biocognitive model for psychiatry. This is based in the concept of natural dualism, and provides a working model for mental disorder as a primary psychological matter, with no reason to suspect brain pathology. He lives in the rural outskirts of Brisbane with his family and keeps busy growing trees.