Fact Checking Psychiatry

A Model Without Limits

A Model Without Limits

by Chuck Ruby, PhD


On April 28, 2024, psychiatrist Awais Aftab ridiculed efforts to challenge the medical model in his blog post, "People Are Stumbling From One Misguided Narrative About the Medical Model to Another." In it, he discounted critical psychology/psychiatry criticisms about the orthodox mental health industry's insistence on turning personal distress and behaviors into illnesses rooted in individual dysfunction. The title of his post suggests those criticisms are clumsy and ignorant views of a "diverse and dynamic" matter.

He starts by explaining his displeasure with the term "medical model"; not necessarily the "medical" part of the term, but the "model" part. He complains that it "takes something diverse and dynamic—the theory and practice of medicine—and turns it into something circumscribed, fixed, and static...." He seems to be saying that we shouldn't establish models with which to understand phenomena. If this is so, he is supporting an unbridled mental health industry that has no bounds in its ever-increasing interest in overseeing the many problems we experience throughout life. This necessarily leads to a similarly boundless and unspecified construct of mental illness - it is what we say it is.

We can debate the legitimacy of models, and (in contrast to what Dr. Aftab seems to suggest) we can adjust them as we go so they fit the data and do not become "fixed and static." However, we must have models just as we must have definitions. If we didn't use them to "circumscribe" ideas, utter chaos would ensue when discussing the issues involved and any profession that renounced clear models and definitions would not be "circumscribed," allowing it to claim dominion over increasing swaths of human life.

This isn't just an academic matter. Such a boundless model being applied to the problems of human values, meaning, choice, distress, and action has grave consequences. If the alleged illness is of mental functioning, then the diagnosed person's grasp of reality and decision-making would be compromised. This invites the diagnosing clinical professionals to step in as arbiters of human freedom. I wouldn't have as much a problem with this model if those professionals honored their ethical obligation to provide full information to the person so affected, and then obtain that person's full consent prior to doing anything. But that is not the way it works in practice. There is only a token nod to informed consent. The claim that mentality is ill or dysfunctional is the foundation of the widespread coercion, lack of due process, authoritarianism, and human rights violations so common throughout the history of the mental health industry to this very day.

Dr. Aftab has a particular problem with the American Psychological Association's (APA) definition of the medical model (So do I, but for different reasons - see below). First, in contrast to the APA's definition that the medical model is "the concept that mental and emotional problems are analogous to biological problems," he thinks it “would be more accurate to say that the medical model considers mental and emotional problems to be analogous to problems encountered in general medicine."

But what problems are encountered in general medicine? Does this mean that any complaint brought by a patient to a GP is a matter for medicine? Keep in mind that people have long been trained by the mental health and drug industries to see mental disorder behind every distressing thing. Therefore, they are very likely to approach their GP with all sorts of problems merely because they hurt. This seems self-serving for the mental health industry since it means all feelings of unease, even those without a basis in individual dysfunction, are to be assessed and treated via the medical model, thus making medicine the expert in those problems. So, even though Dr. Aftab doesn't like the term "medical model," he uses it here, but defines it in a way that doesn't "circumscribe" the matters to which it applies.

His second concern with the APA's definition is its view that the medical model involves detectable and specific physiological causes. He says this "restricts the range of possible options... when in reality, medicine deals with a very wide range of problems." (italics in the original). As with his first concern with the APA's definition, as well as his hesitation with circumscribing medicine with a model, this one reveals his interest in removing walls that would form the boundary between medical problems and non-medical problems.

I'm not sure if Dr. Aftab's criticism of the APA's definition of the medical model assumes that those within the critical psychology/psychiatry movement agree with the APA. I know many who don't, and I am among them. The APA has become just as medicalized and paternalistic as the other APA (American Psychiatric Association). To us, the important issue with the medical model, as conventionally used, isn't that it points to biological problems or specific and detectable physiological causes.

Instead, our critique is against the unfounded claim that all experiential and behavioral problems in life are pathological and the result of internal dysfunction to be assessed (judged) and treated (corrected). This claim persists despite the fact that the alleged pathology and dysfunction in the individual has eluded scientific inquiry for more than two centuries. How many more centuries must pass without such evidence of pathological origins before the mental health industry gives up?

But wait, they are forced to give up when pathology is found. That is because in these instances, the illness becomes a target for neurology, endocrinology, nutritional science, or the other medical specialties regarding that real pathology. Ironically, as long as no evidence exists, conventional psychiatry, clinical psychology, and the other clinical professions can survive.

Furthermore, critical psychology/psychiatry does not deny the complexity of those problems that get diagnosed as mental disorder, just as we wouldn't deny the complexity of physiological pathology. And, as far as I know, we have never suggested that the physiology doesn’t affect psychology, or vice versa. But this reality doesn’t justify conflating the two and pulling them within the bailiwick of the mental health industry any more than it justifies giving the clinical professions dominion over politics and economics just because they are also determinants of human problems.

In his essay, Dr. Aftab uses the example of a recent story published in the Guardian about survivor Rose Cartwright to point out how people misunderstand the medical model (and, thus, criticisms of it are said to be "misguided"). Specifically, he claims that the model is popularly, yet falsely, thought to be an essentialist approach to mental disorder. This is the belief that each mental disorder category has an underlying essence, rooted in biological or psychological features. Each category has a unique essence common to all who are diagnosed with it.

But I know of no critical psychologist or psychiatrist who thinks this. In fact, we hold the opposite and reject the essentialist view. The different diagnostic categories seriously overlap, making it difficult if not impossible to use the specific DSM criteria to distinguish one from another. This is why the DSM's categories are admittedly unreliable and invalid.

Ms. Cartwright's revelation was not about essentialism. Instead, it was about finding out that OCD, and by extension all other mental disorders, weren't brain dysfunctions. According to her: “This is what I think is wrong with the medical model: a failure to understand mental health in context. An assumption that a disorder is a [pathological] ‘thing’ that an individual has, that can be measured, independent of subjective experience.”

It is commonplace within the conventional mental health industry, and characteristic of the medical model, to claim internal dysfunction responsible for a host of problems and research efforts have been underway to support this claim. However, as mentioned earlier, those efforts have consistently failed. At best, they have shown differences in physiology and psychology, not dysfunction or pathology. It is absurd to claim something is a medical matter based only on differences.

Demonstrating that the brains or genes of people who have been diagnosed with a mental disorder are different in function than those not diagnosed is not a demonstration of a dysfunction. Likewise, demonstrating a difference in psychological functioning between those with diagnoses and those without is not a demonstration of a dysfunction. To do so in either case would be to claim dysfunction in people for a plethora of otherwise normal things such as playing the piano, holding conservative political views, and regularly exercising. But despite this failure of psychiatric research, the “theories” have survived. In no other area of medical science has this happened and there are many examples when theories were discarded because they lacked evidence (e.g., animal magnetism, miasma theory, humorism).

Those of us in the critical psychology and psychiatry movement suggest that for anything to be legitimately handled with a medical model, it must at least have good theoretical grounding in an internal pathological process (the DSM euphemistically calls this “a dysfunction in the individual”) that is responsible for the illness, and that such theory survives ongoing research attempts to disprove it. Without this, the mental health industry opens the door to Orwellian control. Medical authorities step in where religious authorities once reigned, and where legal authorities fear to tread.

The conventional medical model makes a priori moral judgments about what actions and experiences are unwanted, inconvenient, or uncomfortable, and then it dubs them illnesses. Then it sits back and ignores the long line of research results that fail to support the notion of an internal dysfunction, perpetually claiming evidence is just around the corner.


Chuck Ruby, PhD, is a psychologist who has been in private practice for the past 25 years, after a 20-year career with the U.S. Air Force. You can read more about him at his personal website. He is the author of Smoke and Mirrors: How You Are Being Fooled About Mental Illness - An Insider's Warning to Consumers. Dr. Ruby is the past Chairperson of the Board for ISEPP and has been the Executive Director since 2015.

 

RIP Functionalism – The Legacy of a Key Functionalist

RIP Functionalism – The Legacy of a Key Functionalist

by Niall McLaren, MBBS, FRANZCP


The philosopher, Daniel Dennett, of Tufts University, Boston, died last week, aged 82. Dennett was openly contemptuous of the concept of dualism, the idea that mind and brain are of different orders of nature. His goal was to build a biological account of mind, to replace the "green slime" of mentalism. "Somehow," he said, "the brain must be the mind.” Needless to say, the devil lay in the details of "somehow." When it came time to insert the last link in the causative chain between neuron and mind, he opted for a "virtual machine." That is, he had to rely on an insubstantial, unlocalised, causally-efficacious entity that is not subject to the laws of the physical realm, and for which he offered no provenance, no medium, and no governing laws. It doesn't get much more dualist than that. On this basis, I say that his life's work failed.

I contacted him some time ago to ask for a comment on this critique but got a very dismissive response. I've since heard that somebody else referred him to the video of a talk I gave last year to the Philosophy Department, University of Queensland, which gives more detail. His response was: "The fellow (i.e. me) doesn't know what he is talking about." I understand he wasn't well at the time but that's not how it's done. He could have asked one of his many adoring fans to respond on his behalf but he didn't, so we'll have to wait and see where the debate goes. At present, I stand by my conclusion: the late Daniel Dennett was a closet dualist. To complete his functionalist account of mind, he relied on a frankly dualist model, one which lurches perilously close to magic. His goal of a reductive account of mind joins the long list of failed positivist attempts to write the mentality out of the mind (when it's put like that, it's patently absurd but they're doing it, not me).

What's the significance of this for psychiatry? Just this: modern biological psychiatry is based on the notion that "somehow," the mind will reduce to the brain. A full account of the brain will give a full account of the mind with no interesting questions unanswered. Perforce, that includes mental disorder. The collapse of yet another attempt to write an antidualist "theory of mind" means that mainstream psychiatry is practising without a theoretical warrant. The hostile antidualism bred by the positivist urge in philosophy and science is on its last legs.

A reader asked: "Your thoughts on anxiety linked to bipolar are curious. Have you written directly on this? On the surface the two ways of feeling/existing/experiencing the world seem very different. Any reading recommendation or link to further reading would be appreciated."

This is actually a big question that goes to the heart of the debate over the nature of mental disorder, but remember that, for the overwhelming majority of psychiatrists in the world, there is no debate. The issue was settled in 1980 with the publication of DSMIII when, on zero convincing evidence, psychiatry was booted into the biological camp. Samuel Guze, who was one of the most influential architects in psychiatry's biological epiphany, said: " ... there is no such thing as a psychiatry which is too biological".1 He offered no proof, but that Brave New World trope still dominates the ideological echo chamber that passes for psychiatry's collective intelligence.

I disagree totally with the notion that the mind reduces to the brain; my case will be set out a the forthcoming volume on theories in psychiatry. However, it's not enough to disagree; Buckminster Fuller (1895-1983) warned: "You never change something by fighting the existing reality. To change something, build a new model that makes the existing model obsolete." That's been done2; a rational case for the psychological causation of major mental disorder exists. All that remains is for mainstream psychiatry to acknowledge that education is not just indoctrination and to read it. However, asking your typical psychiatrist to read something on the nature of mind is asking too much: they don't, partly because they don't believe they need to, that it would be silly, but also because most of them can't. The idea that in the head there resides an infinitely complex thing called "mind" cannot be grasped.

Putting that aside, the notion that linking anxiety to bipolar disorder is "curious" rests on the major assumption built into DSMIII, and in every version since. This says that mental disorders are distinct categories, just as dogs and cats are distinct categories, and can be sorted reliably into their groups by ticking a few boxes. First objection: this is not a scientific claim. Without exception, mental constructs or parameters distribute dimensionally, not categorically. What this means is that any element of mental life, be it intellect, happiness/unhappiness, shyness, suspicion, aggression and so on, does not form a distinct and separate group from normality. Every mental parameter runs smoothly from normal to abnormal, just as measures such as height and weight range from normal to abnormal with no cut off. To announce that a mental state is "abnormal" is a value judgement, not a scientific decision.

Why would anybody bother trying to build a classification of mental disorder on a false premise? Because they desperately wanted it to be biological, as Guze said. As good positivists (but without having a clue what that meant2), they had to write the mind out of psychiatry because science can't cope with unobservables. If psychiatry wanted to be a serious science like the rest of medicine, they had to replace the unobservable mentality with observables, such as genes and neurotransmitters. The hope was that the core symptoms of each mental disorder would map directly to a specific defect in the genome. Subsequently, drugs could be developed to target each genetic defect, thereby curing all mental disorder. It's a bit like the change that overtook medicine when Louis Pasteur developed the "germ theory" of illness: for each illness, people hoped to find a specific germ that could be managed. Except there wasn't, and in the intellectual space he opened grew the immeasurably complex and far-reaching science of immunology that makes sense of the loose ends of infections (and opens up whole new vistas of unimagined science, an infinita scientia).

For psychiatry, the intellectual appeal of the search for the elusive "schizococcus" (modern version: the schizogenic single nucleotide polymorphism) is obvious, an effortless psychiatry in which the complexity of human mental life is reduced to a few lines on a laboratory report. It also meant eager young psychiatrists could make their names by "discovering" a particular genetic defect, and drug companies could make their fortunes with their concoctions, along with a few discreetly-placed kickbacks. It's pie in the sky, of course, but that was the covert agenda.

Without that agenda, nobody would bother with the idea that, say, anxiety and depression are unrelated, as a paper published last week shows.3 Working with Joanna Moncrieff in London, John Jureidini and his group in Adelaide reanalysed data from a very influential study on antidepressants in adolescents. They showed that the patients and their carers regularly guessed whether they were prescribed the active drug (fluoxetine, or Prozac) or a placebo (inactive tablet). Their guesses influenced the outcome: if they thought they were getting the active drug, they got better quicker than if they thought they were on the placebo, regardless of what they were getting. Just as the discovery of germs led to the huge science of immunology, this result demands that psychiatry analyse the role of expectation in the causes of mental disorder. And, despite all the hopes for a biological psychiatry, this means taking the patient's belief system into account, which is pure mentalism. Tough luck, all you positivists out there: in the intellectual space opened by proper analysis of drug studies, we need to grow a new and immeasurably complex science of mentality that makes sense of all the loose ends. And I mean "science," where the causal chain between a neuron and an action or emotion is defined precisely, with no gaps filled by an undefined (read: magical) "virtual machine."

The problem is that the vast majority of psychiatrists cannot conceive of mental disorder having a mental cause. To them, it's simple: "You're depressed means take antidepressants. See you in a month." What they need is:

1 - liberation from the simplistic notion that there can't be a science of mentality, and

2 - an understanding of how complex and far-reaching such a science will necessarily be.

The trouble is, in the war between a biological and a humanist psychiatry, philosophers have been useless. I give a lot more detail in the new book but there will be no progress until we can show a formal mental mechanism by which chronic anxiety can cause depression, such that alleviation of the anxiety resolves the depression (as in "I feel better already, just from knowing this wonderful tablet is going to cure me"). In order to turn this picture from pie in the sky to reality we need:

1 - an articulated mentalist (non-reductionist) theory of mind incorporating mental mechanisms sufficient to account for rational human behaviour, and ...

2 - a formal model of mental disorder based in plausible errors in just those mechanisms leading to disturbed human behaviour, aka mental disorder (and politics).

This model distinguishes very clearly between the actual mental mechanisms by which behaviour is computed, and the mental contents those mechanisms work on, i.e. the difference between a scientific psychiatry and an art of psychiatry. By 'mental mechanisms,' I don't mean Freudian ego mechanisms of defence, I mean something much more basic than these concepts which, while interesting and helpful, are purely descriptive. My proposals to satisfy these needs are set out in4; as an example of mental mechanisms we can turn to the next chapter in the search for a post-positivist psychiatry.

1Guze SB (1989). Biological psychiatry: is there any other kind? Psychological Medicine, 19: 315-323. p315.
2McLaren N (2023). Diagnosing psychiatry's failure: The need for a post-positivist psychiatry. Chapter 4 in: Cantu A et al (eds): Theoretical Alternatives to the Psychiatric Model of Mental Disorder Labelling: Contemporary Frameworks, Taxonomies, and Models. London: Ethics International Press: Critical Psychology and Critical Psychiatry Series, Vol III.
3Jureidini J et al (2024). Treatment guesses in the Treatment for Adolescents with Depression Study: Accuracy, unblinding and influences on outcomes. Aust.NZ J Psychiat.58(4): 355-364. doi: 10.1177/00048674231218623.

4McLaren N (2021): Natural Dualism and Mental Disorder: The biocognitive model for psychiatry. London, Routledge. (paperback and ebk).


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.

Demystifying Mental Illness and Its Treatment

Demystifying Mental Illness and Its Treatment

by Al Galves, PhD


I have this desire to demystify mental illness.  Why is that?  What makes me want to demystify mental illness?  What makes me want to do it is my sense that over the past 20 or 30 years mental illness has taken on a mysterious quality.  It seems to me that people believe mental illness just comes on people, comes out of the blue, as if it is something alien to the person, something visited upon them, an alien visitation.

What makes me believe this is the case?  Here are three pieces of evidence:

The first is the case of Simon Biles.  Biles won the Olympic gold medal in female gymnastics at the 2018 winter games.  She was the best gymnast in the world.  At the 2022 winter games she was a member of the United States Olympic team.  She told her teammates that there was so much pressure on her that she was not going to be able to perform well and, therefore, was not going to perform.  In the aftermath of that decision, the word went out that she was suffering from a mental illness and everyone seemed to accept that.  But wait.  Why add the idea or belief that this is a mental illness?  What she did was perfectly understandable and “normal” without adding the trope of “mental illness” to it.  She was under a lot of stress, so much that it was going to affect her ability to perform.  What is the purpose of adding the idea of mental illness?  Does it take away some of her agency?  She couldn’t help it.  She was under the influence of a mental illness.  Does it absolve her of responsibility for her decision?  When the idea of “mental illness” is added to it, it takes on the patina of something other than a reasonable decision by a woman who is under a lot of pressure and believes it will affect her ability to perform well.

The second piece of evidence is a series of interviews I did.  This wasn’t a scientific sample.  I sat in the back of a coffee shop and offered to interview patrons about mental illness.  Some of the ten interviewees were friends.  I asked them what they thought caused mental illness.  All of them gave me some kind of physiological answer.  It was a brain disorder, a chemical imbalance, a genetic anomaly.  I then asked them what they thought had triggered the change in the brain, the chemistry, the genetics.  They hadn’t been mentally ill and then they were.  What had happened?  They all said something happened to the person.  But, I said, you just told me mental illness was caused by some physiological dynamic and now you’re telling me it is caused by something happening to the person.  What is it?  They were all non-plussed, taken aback, chastened.  So I asked them all the third question.  Do you think there is a difference between how a person is reacting to a life situation and to concerns she has about her life, on the one hand, and a diagnosable mental illness, on the other?  They all said “Yes”.

The third piece of evidence is reports I have read about the confusion of college students when they begin to feel down, depressed, agitated, manic, anxious.  When they begin to feel that way, they ask themselves: is this a response to my life situation, to what is going on in my life and my concerns about that or is this a mental illness?  They think there is a difference between those two things.
This is evidence of confusion in the general public about the nature of mental illness.  Is it a mysterious state of being that comes out of the blue, just happens to people and is caused by some kind of physiological dynamic?  Or is it a “normal” and understandable reaction to a person’s life situation, to concerns the person has about his life and himself, to what has happened to him?

This is not just an academic question.  How people understand the states of being, moods, emotions, thoughts, intentions and behaviors associated with diagnoses of mental illnesses is going to have a big impact on their lives.  It is going to determine how they understand themselves, how they manage themselves, the kind of treatment they seek.  And the kind of treatment they seek and receive is going to determine the degree to which they recover and go on to live healthy, productive and satisfying lives.

So there are two main ways in which we can understand the states of being, moods, thoughts, emotions and behaviors associated with diagnoses of mental illness.  We can understand them as caused by physiological dynamics, i.e. chemical imbalances, genetic anomalies, brain disorders, as coming out of the blue with no discernable connection to our lives or experiences, an alien visitation upon a person.  Or we can understand them as understandable and “normal” reactions to a person’s life experience, life situation and to concerns the person has about his or her life and self, i.e. as emotional distress, a life crisis, a difficult dilemma, a spiritual emergency, a manifestation of fear, terror and overwhelm.

What are the implications of those different ways of understanding mental illness?  For starters, there is a problem with understanding mental illness as essentially physiological in nature.  If you follow that belief out to its logical conclusion, you believe that human beings have no control over their thoughts, emotions, intentions, perceptions and behavior and, therefore, have no control over their lives.  The logic goes like this:

Mental illnesses are caused by brain disorders, chemical imbalances and genetic anomalies.

Mental illnesses are states of being, moods, emotions, thoughts, intentions and behaviors.

Therefore, states of being, moods, emotions, thoughts, intentions and behaviors are caused by brain disorders, chemical imbalances and genetic anomalies.

Human beings don’t have control over their brain function, biochemistry or genetic dynamics.

Therefore, human beings have no control over their states of being, moods, thoughts, intentions, emotions and behaviors.

Since human beings use their thoughts, emotions, intentions and behaviors to lead their lives, they have no control over their lives.

That is a very cynical and disempowering belief.  It takes away agency and leaves people at the mercy of forces over which they have no control.  It absolves people of responsibility for their lives and makes it less likely they will seek help in learning how to manage themselves in healthier ways.

If, on the other hand, people believe that mental illnesses are how they are reacting to their life situations and to concerns they have about themselves and their lives, they believe they do have control over their lives and are responsible for their behavior and are more likely to seek help in becoming healthier. 

Let me try to explain more about this idea that mental illnesses are how people are reacting to their life experience and life situation.  In order to be mentally healthy, people have to be able to love the way they want to love, express themselves the way they want to express themselves and enjoy life the way they want to enjoy life.  When they can’t do that, haven’t been able to do it for a long time and are afraid they’ll never be able to do it, when they suffer significant loss or feel extremely helpless and inadequate, they become agitated, manic, angry, panicked, obsessive, depressed, anxious and psychotic.  They become mentally ill.  There is nothing mysterious or alien about it.  It makes sense that when people are afraid they will never be able to live the way they want to live, afraid they are fundamentally flawed, inadequate, not smart, personable, strategic, connected enough to make it in this life, they would become depressed, anxious, panicky, manic, obsessive, unable to sleep, dissociated, even psychotic.  Of course, every human being is a unique individual so how a person reacts to her life situation and to concerns she has about herself and her life will be unique.  But the following are some general ideas about how life experiences and concerns are associated with mental illnesses:

Depression happens when a person loses something very valuable or has deep concerns about her life.  It doesn’t have to be the loss of a person.  It can also be the loss of a sense of security, a feeling of adequacy, a sense of certainty, a relationship, financial security, a job.  When a person has deep concerns about her life, depression can be helpful.  It forces the person to stop doing what they are doing, stop focusing outside in the world and, rather, take some time to focus inside, to deal in a serious way with issues of life. 

Social anxiety disorder happens when people don’t want to be around other people out of fear they will be rejected, put down, abused, misunderstood or fear about how they will react to any interaction.  In the case of one of my patients, her social anxiety was caused by the fact that, since she had been mistreated by people all of her life, she wanted to hurt other people and knew that wouldn’t work out well.

Mania occurs when a person has had a lot of pressure put on him to be very successful, exalted, outstanding and is unable to do that.  The manic episode gives the person the illusion of being very powerful, successful and exalted.  They can do anything and everything.  They are amazingly powerful, smart, capable. Or it may be a move out of the drudgery of everyday existence.  The person is tired of having to make the decisions we all have to make every day.  What am I going to do with my time, energy and money? The possibilities are endless.  But I can only do one thing at a time.  In a manic episode, the person believes he can do it all.  He doesn’t have to make those difficult choices.  For some people mania is an opportunity to get in touch with a divinity, with the divine nature of existence in which one doesn’t have to deal with the everyday world.

Panic disorder happens when a person is facing a difficult dilemma, a dilemma that doesn’t have a good solution.  It may have a better solution but not a good one.  It is such a difficult dilemma that the person doesn’t even want to be aware of it.  But the body is aware of it.  So the body gets revved up to deal with it and causes the symptoms of panic disorder.  Here’s an example - a woman came to see me with her husband.  She was suffering from panic attacks.  I asked her if there was anything going on in her life that could account for them.  She said “No.”  We kept on talking.  It turned out that her son was about to be involved in the invasion of Iraq.  He was a foot soldier, would be engaged in mortal battle, at serious risk of being killed.  When she said that she began to cry.  She cried for a long time.  I helped her to be aware of her fear, to be with it and give in to it.  She never came back in.

Obsessive-compulsive disorder happens when a person overcontrols what he can control as a way of repressing the fear of knowing that the things which can really hurt him are out of his control.  The obsessive behavior is a way of gaining the illusion of control.  The excessive hand washing, ordering and checking may be a way of dealing with the uncomfortable truth that we don’t have any control over the things that we really need to be afraid of.  We don’t, for example, have control over other drivers whose behavior may maim or kill us, over other kinds of accidents and disasters that are outside of our control, over the safety of an airplane flight when we are on one, even over dangerous illnesses such as heart attacks, strokes, cancer and diabetes.  So the repetitive behavior gives him the illusion of having control over things so that he doesn’t have to experience the discomfort of realizing that he actually doesn’t.

As for the intrusive thoughts, perhaps they are useful in that they enable a person to avoid having to take responsibility for making decisions and addressing the difficult, real problems of everyday life – dealing with love relationships, jobs, co-workers, bosses, children, financial difficulties, moral dilemmas, competing priorities.  Since we deal with these kinds of problems all the time, perhaps we lose sight of how difficult they can be.  They often involve conflict with other people.  They often require us to make decisions and choices that involve necessary losses and understandable regret.  Carl Jung one time defined mental illness as “the avoidance of suffering.”  Some human beings will go to great lengths to avoid dealing with the difficulties of the real world.

Post-Traumatic Stress Disorder (PTSD) happens when a person has an experience in which she thought she was going to die and was unable to fight back or escape.  The symptoms associated with PTSD - recurrent and intrusive recollections of the event, efforts to avoid, activities, places or people which arouse recollections of the event, feelings of detachment or estrangement from others, hypervigilance - appear to be designed to help the person avoid the psychic and physical pain of the traumatic experience and to avoid a reoccurrence of trauma.  They also appear to enable the person to relive the experience.  It makes sense that people would want to relive traumatic experience.  Typically, people who suffer trauma carry some (usually irrational) guilt about it, believing that they somehow contributed to it happening or that they could have done something about it.  Reliving the experience holds out the possibility of resolving the guilt or imagining a different outcome, somehow making more sense out of the incident and coming to a more realistic appraisal of it.

Psychosis happens when a person who has been hurt badly – discounted, dishonored, rejected, made to feel inadequate, abused physically, verbally, emotionally – attaches his psychic energy to a deeper, more powerful but imaginary part of his psyche.  That move which is initiated by a deeper, healthier part of the psyche than the rational part is a move towards survival, healing and recovery.  In the words of John Weir Perry, a psychologist who spent a lot of time trying to understand the psyches of persons diagnosed with schizophrenia, “the psychotic process puts this power-oriented form of the self through a transformation that awakens the potential for relationship and gives it its rightful place in the structure of the personality and in the style of life.”

What evidence is there to support this idea that mental illnesses are how people are reacting to their lives and to concerns they have about their lives and themselves?  Here is one piece of evidence.  People who have certain characteristics are more likely to be diagnosed with certain mental illnesses than other people.  So people who have the following characteristics are more likely or less likely to be diagnosed with depression than other people:

People who derive their sense of self-worth from social relationships and have experienced an interpersonal loss;

Women who use a ruminating style of thinking;

People who score low on self-esteem and high on stress;

Persons who score high on a Self-Defeating Personality Scale;

Persons who suffer from chronic pain;

Persons with more emotional strength and resiliency and a higher level of ego control are less likely to be depressed;

Persons who experienced poorer pre-morbid functioning – particularly adolescent social functioning.

The following are the characteristics of persons who are more likely to be diagnosed with bipolar disorder:

Difficulty in realistic goal-setting;

Low in persistence and conscientiousness, high in neuroticism and openness to experience on the Eysensenk Scale;

Low in self-complexity and, therefore, more susceptible to mood swings in response to live events – especially intensely dependent relationships which are disrupted;

Deficient in tasks  requiring response inhibition, delayed gratification and sustained attention;

The ability to hold antithetical and contradictory ideas or concepts in their minds at the same time;

Tendency to deny the experience and necessity of loss;

Tendency to see things as either black or white, good or bad, not able to see the greyness of things, thus vulnerable to extreme swings of mood in response to minor triggers in the environment;

Has been betrayed by a significant parent figure and is compelled to force the parent to love him again;

Has lost the esteem of a loved person and denies it through regression to a state of not having to make the choices that are required in maturation.

The following are the characteristics of people who are more likely to be diagnosed with psychosis than other people:

People who have suffered physical or sexual abuse, especially in childhood;

People who have experienced 7 or more adverse childhood experiences, i.e. childhood physical abuse, childhood sexual abuse, childhood emotional neglect, parental loss, mental illness in household, substance abuse in household, , criminality in household.

This is evidence that the experiences people have had and the personality characteristics which have resulted from those experiences have a significant impact on their chances of being diagnosed with a mental illness. This is evidence that the states of being, moods, behaviors, thoughts, intentions and emotions associated with diagnoses of mental illness are not alien visitations.  They are understandable and meaningful reactions to peoples’ life experiences, life situations and concerns they have about their lives, the world and themselves.

There is another reason why how people understand mental illness makes a difference.  How they understand mental illness determines the kind of treatment they seek.  If they think it is an alien visitation, something that came out of the blue, the result of a chemical imbalance, brain disorder or genetic anomaly, they are likely to seek treatment in the form of medication and less likely to seek treatment in the form of psychotherapy.  If they think it has something to do with their life and concerns they have about their life and themselves, they are more likely to seek psychotherapy for treatment.

In my opinion, the benefit-risk ratio of treatment with psychotherapy is much better than the benefit-risk ratio of treatment with medication (Full Disclosure: I am a psychotherapist).  Here is my assessment of those benefit-risk ratios:

Psychiatric medication may help you feel better, more alive or be less agitated and more grounded.  (But one might ask if it is a good idea to feel good when you have lost something very valuable or your life is a mess). On the risk side, you are likely to experience numbing of emotions, sexual dysfunction, akathisia, increased risk of suicide and violence and, in the case of antipsychotics, tardive dyskinesia (Parkinson’s) brain shrinkage, cognitive impairment, increased risk of diabetes and early death.  When and if you stop using the medication you are likely to relapse and/or have a difficult time withdrawing.

Effective psychotherapy will help you to learn about yourself and begin the lifelong task of developing a good relationship with yourself.  It may help you learn how to use your thoughts, emotions, intentions, perceptions and behavior to live more the way you want to live and provide you with self-management skills and knowledge you can use for the rest of your life.  On the risk side, you may go through some painful feelings, go down the wrong path for a while and waste some time and money.

On balance, it seems to me that the potential benefits of psychotherapy are so large that it becomes the much better option.

There is evidence that treatment with psychotherapy is more effective than treatment with medicine.  In the case of depression patients treated with psychotherapy and medicine report similar levels of improvement but the ones treated with psychotherapy have a much lower relapse rate and their improvement is more long-lasting.  In the case of people experiencing psychosis the evidence tells us that people who never take the medicine or stop taking it have a much higher rate of recovery than people who take the medicine and stay on it.

This battle between people who believe mental illnesses are essentially physiological and those who believe they are psychological has been going on for 250 years.  Given the present state of scientific sophistication, we are not able to determine through scientific investigation which is the most scientifically valid way of understanding mental illness.  Therefore, perhaps the best answer to this dilemma is one suggested by Bradley Lewis in his book Moving Beyond Prozac, DSM and the New Psychiatry: The Birth of Postpsychiatry.  When faced with research findings for which there are various interpretations, Lewis says, we should choose the interpretation which is associated with the best outcomes for patients.  We should take a practical approach in the good, old tradition of American pragmatism.

If we did that, we would clearly choose to understand the states of being, moods, thoughts, emotions, intentions and behaviors associated with the diagnoses of mental illnesses as reactions to life experiences and life circumstances and concerns that people have about their lives and themselves and we would treat them with various forms of psychotherapy.


Dr. Galves is a clinical psychologist in New Mexico and Colorado. He has worked as a psychotherapist in community mental health centers, in health clinics, and as a school psychologist in public schools. He is a board member of MindFreedom International and the author of Harness Your Dark Side:  Mastering Jealousy, Rage, Frustration and Other Negative Emotions. Dr. Galves was the ISEPP Executive Director from 2011 to 2013.

 

Another Misleading Report: ADHD Increases Risk of Dementia

Another Misleading Report: ADHD Increases Risk of Dementia

by Chuck Ruby, PhD


An October 2023 JAMA Network Open article titled “Adult Attention-Deficit/Hyperactivity Disorder and the Risk of Dementia” concludes that an “adult ADHD diagnosis was associated with a 2.77-fold increased dementia risk” and there was “no clear increase in the risk of dementia associated with adult ADHD among those who received psychostimulant medication.” In this study, more than 100,000 subjects were followed over a 17-year period and identified as having been diagnosed with ADHD, dementia, or both ADHD and dementia during that time.

The study was also covered by the Washington Post with the headline: “Adult ADHD may take a toll on the brain.” The Post article also pointed out the claim that stimulant drugs can lessen the risk.

This is one of many such announcements by professional journals and public news outlets that are misleading and that perpetuate the myth of mental illness as a brain disorder. Based on the data in this study, it is not justified, and might very well be harmful, to publicly proclaim that those who have been diagnosed with ADHD are at increased risk of getting dementia as a result of some negative affect that ADHD has on the brain. Not only does it encourage the false belief that ADHD is a real neurodevelopmental disorder - some kind of brain dysfunction - similar to dementia, it also promotes alarm and leads people to think stimulant drugs can prevent dementia for those who have been diagnosed with ADHD. 

There are two serious problems with the study’s conclusions. The first is that correlation does not equal causation. We are continually cautioned about this; nevertheless, many people, especially the lay public, hear causal implications in correlational results. In the present study, the manner in which the information is presented clearly suggests that ADHD causes an increased risk of dementia. But this is not a justified interpretation. Whereas they could have something to do with each other (see below), it also could be that ADHD and dementia have nothing to do with each other. Instead, they could be spuriously correlated because of their independent association with other variables. Consider as examples the many strong yet spurious (and quite silly) correlations at http://www.tylervigen.com/spurious-correlations.

Furthermore, the study reported a 2.77-fold increased dementia risk. This means those who were diagnosed with ADHD had a 177% higher risk of getting dementia than those who were not diagnosed with ADHD. However, the 177% is misleading. Whereas it is accurate, it is a relative risk figure. In other words, it is measuring the difference between two relatively low absolute risk figures: a 7% risk of dementia for those never diagnosed with ADHD; and 13.2% risk for those diagnosed with ADHD.* In actuality, the absolute percentage point increase for those diagnosed with ADHD is only 6.2%, a far less serious message than saying there is a 177% increase in the risk.

The second problem is that the symptoms of dementia are very similar to the diagnostic criteria of ADHD. This weakens the confidence we can have that a diagnosis of either is accurate and has resulted in discriminative validity problems. See https://www.frontiersin.org/articles/10.3389/fnagi.2017.00260/full and https://wchh.onlinelibrary.wiley.com/doi/full/10.1002/pnp.784. Think about how much overlap there is among the following symptoms (from the Mayo Clinic website for dementia and ADHD) and how a practitioner could interpret them as indicative of either problem. 

Dementia ADHD
Trouble with planning and organizing Disorganization and problems prioritizing; poor planning
Agitation and inappropriate behavior Hot temper and impulsiveness, low frustration tolerance
Confusion and disorientation and trouble performing complex tasks Problems focusing on task and problems following through and completing tasks
Personality changes Frequent mood swings
Anxiety Excessive activity or restlessness

 

In other words, someone who is developing dementia might be mistakenly diagnosed with ADHD. Likewise, someone who doesn’t have dementia, but who is demonstrating the criteria for ADHD, might be mistakenly diagnosed with dementia. This would explain the correlation between the two found in the JAMA study. In essence, rather than interpreting the correlation as indicative of one condition increasing the risk of the other, one is the other. 

Relatedly, the finding of no increased dementia risk for those diagnosed with ADHD and who used stimulant drugs, merely demonstrates that stimulants increase one’s attention abilities. They help one focus better on tasks. But that is what stimulants do - for all people. Anyone who is a coffee aficionado knows this. Those who used stimulant drugs would have artificially enhanced their attention capacity to the point of reaching sub-threshold levels of ADHD criteria, and thus, it would be less probable that they would have been mistaken as dementia patients.

These kind of studies, whether they are about ADHD, depression, bipolar disorder, or any other mental disorder category, are replete with similar problems. Those problems are based largely in how language is used to imply that mental disorder is some type of “dysfunction within the individual,” as is claimed in the DSM (p. 20), how this “disease-ifies” common difficulties, and how statistics are used to inflate the practical importance of the results. We must be on guard to call out these announcements. 

*The 177% increased risk is based on the adjusted hazard ratio of 2.77 presented in the study, even though the actual relative risk increase between the absolute risks of dementia for those diagnosed with ADHD and those with no diagnosis is 189% (13.2% / 7%).


Chuck Ruby, PhD, is a psychologist who has been in private practice for the past 25 years, after a 20-year career with the U.S. Air Force. You can read more about him at his personal website. He is the author of Smoke and Mirrors: How You Are Being Fooled About Mental Illness - An Insider's Warning to Consumers. Dr. Ruby is the past Chairperson of the Board for ISEPP and has been the Executive Director since 2015.

What Is Disease/Illness?

What Is Disease/Illness?

by Chuck Ruby, PhD


The thrust of the argument in The Social Construction of “Disease,” about whether disease/illness is a normative or naturalist matter is off the mark. The article argues that a definition based on social norms can be legitimate, and that physiological defect doesn’t need to be present in order for something to be considered a disease or illness. But the crucial question isn’t how to define disease/illness, it is whether those who claim to treat disease/illness, however defined, are qualified to do so and what are the social implications. From the article:

“Normativists argue that the classification of a condition as a disorder depends in an essential way on some sort of evaluative judgement. Naturalists argue that this classification depends primarily on natural facts, such as facts about statistical deviation from species typical functioning or failure of mechanisms to perform functions for which they are naturally selected.”

This essentially says disease/illness can be based in societal judgments about appropriate experiences and behaviors. But it sets up a distracting dichotomy between those who argue in favor of disease being defined with social norms (normativist) or disease being defined with evidence of physiological dysfunction (naturalist). It obscures the far more important issue that both normativist and naturalist approaches are evaluative judgments in themselves about the proper role of medical professionals. It comes down to what a society wants the medical profession to handle, even if the problem being handled has nothing to do with defects of bodily functioning. 

I addressed this in my book, Smoke and Mirrors, with the intent of pointing out its crucial effects on critical psychology and psychiatry efforts:

“It must be remembered that definitions are not absolute or “God-given.” They all reflect the values of those doing the defining. So if we, as a society, value the idea that any feelings of unease brought on by life struggles are illnesses to be subjected to medical forms of oversight and care, even without evidence or theory of disease processes underlying those feelings of unease, then “mental illness” would rightly fit the definition of illness and I would stop writing this book.” (p.4.)

So the important point is, regardless of how we define disease and illness, do we want medical professionals to apply supposed medical expertise to those problems. If we are to value medical professionals treating people not only for physiological dysfunction but also for being emotionally distraught or acting in unwanted ways, then so be it. But let the buyer beware. We would be opening the door for medical professionals to morph into moral guides - no, not just guides, but rulers.

Furthermore, so-called mental illness has a different status than other illness with the former allegedly involving mental compromise. If this weren’t the case, there would be no reason to distinguish it as a separate kind of illness. In other words, the story goes that those so afflicted do not have the full benefit of a healthy mind, thus, decision-making is suspect. And this is without any evidence of a dysfunctional brain or other physiological structure, as there is with Alzheimer’s disease, lead poisoning, and hypothyroidism. Psychiatrists (and other clinical professionals) would then have society’s permission to act as paternalistic monitors, judging people for their experiences and actions, and prescribing (demanding) “corrective” experiences and actions.

Therefore, those who would invite a medical professional to treat them for a mental illness are essentially risking their right to self-determination. The cherished principles of informed consent and “first do no harm” go out the window with mental illness. This is not to say that all people diagnosed mentally ill are denied that right to self-determination. But, it would be very naive to think it is a guarantee. Our experiences have shown us that the right is frequently and capriciously denied, especially when the prescribed treatment is ineffective. The moral guide takes charge of that person’s decision-making.


Chuck Ruby, PhD, is a psychologist who has been in private practice for the past 25 years, after a 20-year career with the U.S. Air Force. You can read more about him at his personal website. He is the author of Smoke and Mirrors: How You Are Being Fooled About Mental Illness - An Insider's Warning to Consumers. Dr. Ruby is the past Chairperson of the Board for ISEPP and has been the Executive Director since 2015.

ISEPP’s 25th Annual Conference – Afterword

ISEPP’s 25th Annual Conference – Afterword

by Chuck Ruby, PhD, ISEPP Executive Director


With another year's conference come and gone, my thoughts about it, and ISEPP in general, have swirled about me like the wake of a familiar and powerful ship passing by. I thought I'd pen these swirling thoughts, just to help me capture them more clearly for myself but also for the benefit of others. I would be grateful to hear your thoughts too.

ISEPP was created many years ago with the primary purpose of offering a haven to those of us who disagree with and rebel against the orthodoxy of the bio-medical-pathology model of human suffering and all the harmful consequences of such a model. We are professionals who recognize non-medical, safe, and respectful ways to help people in the throes of despair and confusion. We are also the consuming public who seek help, merely demanding that we be treated with basic dignity and not viewed as defective annoyances to be silenced or taken away and secluded out of sight. 

This was the 25th time we've convened for camaraderie, expression, and reassurance that each of us is not alone in our difficult struggle with mainstream psychiatry and the clinical versions of psychology, social work, counseling, and yes, even sometimes coaching. Each time, we hear from phenomenal speakers, telling us about the continuing harm of the orthodox model. Each time, we hear how baseless that model is - how the emperor wears no clothes. Each time, we hear about how this model is an ideology, not a science. Each time, we hear about alternative ways to help our fellow humans who face, as we all do, the inevitable challenges of living a human life. Each time we hear the message that human suffering is not a sickness, abnormality, defect, deficiency, or dysfunction. It is an expression of meaningful living.

During this most recent conference, we once again shared our criticisms of this failed, yet still entrenched, model:

David Healy, MD, FRCPsych, addressed the so-called gold-standard randomized controlled trials (RCTs) as a problem in plain sight, suggesting that their results are scientifically illiterate. They tell us something about the average effects of a treatment and this may be useful for regulators called on to license a drug. But no person seeking our help is average.

Arnold Cantú, LCSW, presented his comprehensive critique of the DSM and his ideas about a replacement framework, borrowing from the field of social work, and accompanied by examples of how the field can move away from the biomedical model. He proposed the development of an alternative non-medicalized, psychosocial, and codified descriptive problem-based taxonomy as an alternative.

David Walker, PhD, shared some of the ways Native Americans continue to survive and thrive in the face of innumerable adversities and oppression. He presented the “Twelve Virtues of Níix Ttáwaxt” (neek TAUwaukT, "good growth to maturity") as a means of support for the wellbeing of Native American youth as well as for all people regardless of background.

Lynn Cunningham introduced the film Medicating Normal. After viewing it, three of the "stars" of the film, David Cohen, PhD, Mary Neal Vieten, PhD, ABPP, and Angie Peacock, MSW, CPC, discussed their experiences making the film and their views on the present-day system's continued reliance on chemical means as the first line of offense to subdue normal emotional distress.

Angie Peacock, MSW, CPC, later presented her experiences as a patient in this system, eventually abandoning it, along with its psychiatric drugs. She described the challenges of doing so, including self-doubt and judgments from others. She encourages people who choose to follow in her footsteps, to redefine their relationships with the “experts” and re-conceptualize their life experiences that have been labeled "symptoms."

The conference culminated with a captivating discussion between Joe Tarantolo, MD and David Cohen, PhD, a long-time psychiatrist and long-time social work academic, respectively. They tried to delineate how, in the current era of "evidence-based psychotherapy" and "behavioral health," the two disciplines approach a variety of topics related to diagnoses, psychotherapy, and the very nature of human suffering.

Yet, despite the value of these conference presentations, as well as our long history of other powerful and uplifting experiences during our annual gathering, the orthodoxy is still firmly in place, calling the shots about people's rights to self-determination. Under the guise of healthcare, that orthodoxy dictates morally-derived standards of appropriate ways to act, feel, and think. Moreover, when we step outside the boundaries of those vague moral norms, we are at risk of losing our very essence of self and freedom by being subjected to long-term and coercive chemical (and less so, electrical and surgical) abuses, and involuntary confinement away from the very support systems so vital for restoration. Both of these reactions by the orthodoxy do nothing but exacerbate the problem by forcing further escape from the realities in our worlds - seeing escape as the answer, rather than engagement with our worlds despite the pain. Escaping merely serves to further distance us from possible solutions that would eventually reap a sense of meaning and contentment.

What are we to do? We have run the gamut from Congressional contact, peer-reviewed research and writings, consumer-driven demands for rights, one-on-one contact with other professionals and potential consumers, and both mainstream and social media attempts to share our critique with the rest of the world. But is it working? We try to stay connected to other like-minded organizations, and have considered the possibility of coalescing into one large consortium that can speak against these insults with a louder and more powerful voice against mainstream psychiatry. But are these organizations able, or willing, to put away parochial interests for the benefit of this strategy of a unified voice? Or, are we so diverse in our organizing principles that finding solidarity is nearly impossible.

As we get ready for ISEPP's 26th Annual Conference (tentatively set for Virginia Beach in the fall of 2024), I want to reflect on where we've been and how we can (and if we can) adjust ISEPP to have a greater impact on the current state of the clinical industries. I think such an organizational refinement that is based on historical experiences is needed for any group, if that group wants to retain, and even extend, its significance.


Chuck Ruby, Ph.D., is a psychologist who has been in private practice for the past 25 years, after a 20-year career with the U.S. Air Force. You can read more about him at his personal website. He is the author of Smoke and Mirrors: How You Are Being Fooled About Mental Illness - An Insider's Warning to Consumers. Dr. Ruby is the past Chairperson of the Board for ISEPP and has been the Executive Director since 2015.

On the Human Rights of “Mental” People

On the Human Rights of “Mental” People

by Niall McLaren, MBBS, FRANZCP


Over the weekend, I forced myself to watch the final lectures in the "ADHD Masterclass" series issued by the college of psychiatrists in October 2022. Anything I could say now would probably be actionable so I'll think about it for a while. Since then, and much more interesting, I watched the launch of the joint WHO and UN Human Rights Commission guidelines on human rights and mental health legislation. Yes, it's dry and out there but... it's so important. This is the definitive statement from the most authoritative agencies in the world on how mental health acts are to be shaped and written. Speakers, who included the Director-General of the WHO and the HR Commissioner, saw three areas that needed urgent attention:

1. The world-wide reliance on detention and involuntary treatment in institutions rather than voluntary, community-based preventive care;



2. Closely associated, the dominance of the so-called "biomedical model" which debases the human experience; and



3. The failure to allow people with mental disorders be involved in decision-making.



Until these matters are rectified, nothing will change. Institutions will continue to gobble up the bulk of the mental health budget despite deteriorating mental health statistics; more and more people will become dependent on (i.e. addicted to) psychiatric drugs for life, with all their dire complications; and ever-growing legions of people around the world will be converted into shuffling queues of drug-addled, disempowered numbers. And we can be sure that any changes to the status quo will provoke a mighty shriek of outrage from psychiatrists, who will (correctly) feel they are losing their autonomy (read: power to do what they like to whom they like with no fear of recrimination; see New Zealand's shameful Lake Alice scandal).

The guidelines are over 200 pages and arrived late last night so I haven't done more than flick through them, but I want to focus on point 2 above, the "biomedical model." I put this in quotes because, ten years ago this month, my paper Psychiatry as Ideology,1 showed that no psychiatrist, psychologist, philosopher or neuroscientist had ever written anything that would amount to an explanation of mental disorder as a biological disturbance of brain function, i.e. a "biomedical" model. Despite billions of dollars spent on basic biological research in psychiatry, it is also true that nobody has written anything of interest since that could remotely fill that gap.2 I have challenged a number of influential psychiatrists to produce their so-called model but, after that challenge, there is a deathly silence, broken only by the sound of the lids slamming shut on their rabbit holes. There is only one conclusion to be drawn from this "omission":

Modern psychiatry is driven, not by a scientific model of mental disorder as a biological disturbance of brain function, but by an ideology which dictates that mentally-disturbed people are less than human and can be treated as such.

How did this come about? Why does the UN even need to produce guidelines saying "The mentally-troubled have rights, too"? By coincidence, I have just submitted a paper for publication that addresses exactly that point. It follows on from a discussion on the philosophical doctrine of positivism. As a reminder, positivism is the foundation of western science as it exists today. While the underlying notions had been bumping around for several hundred years, the doctrine burst on the scene nearly a century ago as "the scientific conception of the world"3.

Its goal was to eliminate all the airy-fairy stuff from science, to strip it down to its essentials by starting with just the evidence that could be positively confirmed - in brief, "If we can't see it and measure it, it doesn't exist." Any facts used to build a science had to be in the here and now, real observations of something tangible that could be checked and confirmed, even by people who didn't want to believe it. The new conception of science was that it had to be independent of anything we humans would like to believe about ourselves and the universe. Thus, they resolved the conflict between different religions by rejecting them all as "unprovable metaphysics." Trouble is, metaphysics is the branch of philosophy which deals with ultimate questions, such as the nature of being, the concept of mind or of causation, and so on, so we can't escape it. People who say "I make no metaphysical assumptions" are, in fact, making a very big one.

As it happened, when the positivist manifesto was proclaimed in 1929, medicine was already a long way down the objectivist path. Physicians were aware that the microscope and the pathology laboratory were revealing far more than the Bible or other religious texts ever would, so they didn't need much urging to join the movement. But, and this is a very big but, if unobservables can't form the basis of a science, and the mind is in principle unobservable, how can we talk about disturbances of the mind without lurching into "unprovable metaphysics"? For biology and general medicine, the problem was quickly solved by the psychological field known as behaviorism.

This started with a bang in 1913 when an American psychologist, John B. Watson, declared that all talk of the mind was strangling psychology by leading into unprovable arguments.4 Therefore, he declared, we will expel the mind from the science of psychology. Instead of "metaphysical musing" (aka "armchair philosophy"), observable behaviour will become the necessary and sufficient evidence to explain human activity ('necessary' means we can't explain humans without it, and 'sufficient' says that we need nothing more).

Without knowing very much about it, Watson proposed that the principle of conditioning, discovered by the Russian psychologist, Ivan Pavlov, would be the building block for a new scientific psychology. Equipped with the concept of the conditioned reflex, behaviorist psychologists were ready to explain everything. Ever since, generations of students have been taught about conditioning and reinforcement and so on, with just one small problem: there's no truth in any of it.

Ivan Pavlov was not a psychologist, he was a physiologist and he didn't think much of psychologists. In the second last paper published in his long life time,5 he described them as little more than a bunch of amateurs. Second, he didn't describe a process of conditioning, he described a technique for studying physiological actions, such as salivation in the dog. As a process, conditioning doesn't exist; the whole thing is a myth but it sounded very impressive so people were able to string it out for the next 75 years. Finally, it doesn't explain anything. To say that somebody has been "conditioned" to do something says no more than "That person does just that." Pavlov himself knew all this: "I reject point blank and have a strong dislike for any theory which claims a complete inclusion of all that makes up our subjective world" (p. 122). That is, he did not believe the doctrine of behaviorism could explain human mental life. But he died soon after and his prescient paper was completely ignored by the very people who were so keen to talk about "Pavlovian conditioning."

Meantime, on a planet far far away, psychiatrists were happily messing with people's brains and minds. Messing with brains, as in shocking them with various chemicals and electricity, or cutting them as in "leucotomy/lobotomy" (see PBS American Experience: The Lobotomist); messing with minds as in "You've got a bad case of penis envy, my good woman." Now if psychiatry wanted to join the happy scientific throng (read: get all the benefits), it had to abandon any notion that it could meaningfully talk about the mind, so out it went. Human mentality joined religion in the waste paper bin out the back. In the new psychiatry, when a person says "I feel so sad and hopeless, I may as well be dead," he's actually talking in metaphor. It's the same as saying "The sun's going down." No, the sun isn't going anywhere, that's just an impression that our science shows to be false.

Same with emotions: when a person says "I'm anxious," all she's doing is indicating in her quaint human way that her neurotransmitters are playing up. As a good positivist, the psychiatrist recognises this and, without letting his emotions or her prejudices get in the way, prescribes treatment to fix those pesky imbalanced chemicals. What the patient says is not to be taken at face value, it doesn't invite an emotional response as it is simply an indicator of the true state of affairs beneath the surface. The patient, of course, can't possibly know about but the keen-eyed and sharp-witted psychiatrist does: "Yes dear, of course you're sad, that's the nature of your illness, so here's your tablets, come back in a month next please." To put it differently, psychiatry removed any and all spiritual element from mental disorder. And that will provoke another howl of outrage, so we'll pause to consider it.

The concept of humans as spiritual creatures goes back forever: recent findings in South Africa indicate that a small hominin called Homo naledi, which was separate from our lineage, was ritually burying its dead 300,000 years ago. Maybe the little creatures had some religious sense, maybe they didn't, but humans do, centred around the notion of a spirit or soul, something above and beyond the "mere meat" of the body and brain. Now this is where it gets a bit murky because practically every human who has ever lived thinks of spirits or souls as having magical properties, such as immortality, or being able to act on the world without being part of it. Science can't deal with magical properties so this is precisely what positivism is designed to eradicate. For naive positivists, such as the Vienna Circle in 1929 or psychiatrists in 2023, mental = spiritual = magical = nonsense.

From that flows the idea that mentally-troubled people don't need to be taken at face value. For example, if they talk about their feelings, they're talking nonsense, especially when they're saying "I feel you people aren't listening. I don't want to be in your stinking hospital, I don't want your drugs and shock treatment. I want my clothes back and I want somebody who knows how to listen. I want to be treated with respect." And this is exactly what the UN is saying: the field of mental disorder has been coopted for purposes that suit the state and the psychiatric industry, not for purposes that suit the sufferers. Therefore this needs to be rectified. Now, not in the nebulous future. And, with their guidelines, they show just how it is to be done, except psychiatry isn't listening.

The institution of psychiatry is continuing along its old path of medicalising normality, of reducing psychosocial factors to tokens, of paying lip-service to the concepts of the Universal Declaration of Human Rights and the Convention on the Rights of People with Disabilities, and so on. We see this in the three lectures sponsored by the Royal Australian and New Zealand College of Psychiatrists which aim to put 5% of children on dangerous and addictive drugs without any understanding of what has happened to those children. 80% of people started on ADHD drugs as teenagers and young adults choose to stop them within five years. Doesn't that say something? Psychiatry claims to be "evidence-based." Isn't that evidence of something? Yes, it is evidence of selectively filtering the evidence to get rid of all the material that doesn't confirm your position. Similarly, where is the evidence that locking innocent people up in the very long term and drugging them insensible is better than other forms of management, or even no management at all? There is no evidence, that's why the UN says it's time to stop and reconsider.

My paper argues that we can write a science of mental disorder which gives full credit to the idea of humans as mentally-capable beings (I use the word spirituality but with no supernatural connotations). It is not meaningless to claim that mental symptoms can and do arise purely as the result of psychological and social pressures in a perfectly healthy brain. We need to reintegrate the concept of humans as mental/spiritual beings into psychiatry, as the first step to implementing a human-centred, rights-based approach to mental disorder.

While psychiatrists can wave the positivist manifesto (which none of them have read) at their critics, then we're in for a long, hard slog to change things. We may as well start now.

1 McLaren N (2013). Psychiatry as Ideology. Ethical Human Psychology and Psychiatry 15: 7-18.
doi: 10.1891/1559-4343.15.1.7
2McLaren N (2021): Natural Dualism and Mental Disorder: The biocognitive model for psychiatry. London, Routledge.
3Hahn H, Neurath O, Carnap R (1929). The Scientific Conception of the World: The Vienna Circle. Ernst Mach Society, University of Vienna.
4Watson JB. Psychology as the behaviourist views it. Psychological Review, 1913; 20:158-177.
5Pavlov IP (1932). The reply of a physiologist to psychologists. Psychological Review, 39:91-127.


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.

How’s Business?

How’s Business?

by Randy Cima, PhD


Business has never been better, thanks for asking. As long as the public — you and I — continue to demand newer and better quick-fix chemicals, we act as a sales force for this huge industry. The peddling of psychiatric chemicals, like all businesses, is subject to market pressure. Right now, there is continuing pressure to create more and more chemicals for more and more of our discomforts. Our demand is met, happily, by Big Pharma’s supply.

Here’s an example. ADHD (Attention Deficit Hyperactive Disorder) has been increasing five to six percent a year for the past few decades. Currently, there are more than six million children nationwide diagnosed with this brain disorder1. That means — like no other country on earth — one of every ten American children between the ages of 3 and 17 can be prescribed “speed” (central nervous system stimulants) to “treat” their ADHD.

And there’s this. In their unending quest to expand their customer base, about two decades ago psychiatry and their Big Pharma cohorts started funding studies to convince us this fake condition was somehow infecting adults too. Like the well-oiled machine it is, it has worked stupendously well. From MedMD, July 13, 2022:

It’s estimated that adult ADHD affects more than 8 million adults (or up to 5% of Americans). Many of them don’t even know it. Several studies suggest less than 20% of adults with ADHD are aware that they have it. And only about a fourth of those who do know are getting treatment for it.2

That’s a total of 14 million people with this preposterous diagnosis. And, as if not already enough, Big Pharma and knowledgeable professionals routinely caution us at every turn, to make sure we understand, and to make sure we let our family, friends, and neighbors know, there’s likely many, many, many others who are “un-diagnosed,” and “unreported.” So please, dear customer, keep spreading the word.

Your psychiatrist can choose from 61 different chemicals for ADHD — with more on the horizon. There are 78 chemicals for depression, and there are 15 kinds of depression. Antipsychotics? 26. There are 12 chemicals to treat autism, the most maligned of all children (see A Story About Autism: here). Anxiety disorder of some sort? There are 188 chemicals in 9 different “topics” to help you if you are too anxious. Anxiety relief, as you can tell, is a big seller.3

Market Size
Let’s take a quick picture of the growth of this industry in the past 70 years.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is psychiatry’s book of fictitious diseases.4 In 1952, there were 106 diseases. In 1968, the second edition of DSM was published, and there were 182. The third edition, published in 1980, named 265, and then revised in 1987 to 292. In 1994, the fourth edition of the DSM increased the number of psychiatric diseases to 410 diseases.5

The DSM 5 was released in 2013. It was designed to replace its 20-year-old, very dated predecessor. Since its release 10 years ago — and even before its release — DSM 5 had been roundly criticized by nearly everyone, including psychiatrists and other mental health professionals, the NIH (National Institutes of Health), and the British Psychological Society (who do not use it), to name a few. They have good reasons to criticize this scientific debacle. (You can read more about this here.) The newest edition, DSM 5TR, has expanded the number of diseases even more.

Every professional I’ve known in the past 45 years uses the DSM as a billing device, nothing else. It has no therapeutic value. It doesn’t provide any treatment suggestions and it doesn’t provide any clues to etiology — a fancy word for the pseudo-causes of these pseudo-diseases. The DSM only provides a name and number to the mental health professional, or agency, so they can bill their insurance provider. Once a diagnosis is chosen, no professional I’ve known ever refers to the DSM again. There’s no reason to do so.

However, as a billing device, it is essential. Everyone uses it. By everyone I mean local, state, and federal governments, big business, non-profits, academia, all mental health providers, all hospitals, all schools — everyone. Without a diagnosis from the DSM, treatment cannot be funded by private or public insurance providers. So, as you can see, it pays to be in the book.

How do you get in the book?
Very briefly. After completing rigorous scientific requirements, a Big Pharma company presents a new disease for consideration to the carefully selected, 28-member DSM Task Force of the American Psychiatric Association (APA). Then, the 28 members vote. Majority wins. If you win, a new disease is born, and is now eligible to be funded by insurance companies, including Medicare. If you’re not successful this year, fear not. You can submit again next year

Given the huge financial advantages for having one of your disorders selected to be in the book, there’s a lot of controversy about this process, not the least of which is this:

The financial association of DSM-5 panel members with industry continues to be a concern for financial conflict of interest. Of the DSM-5 task force members, 69% report having ties to the pharmaceutical industry, an increase from the 57% of DSM-IV task force members.6

Who are the winners?
Academia and Big Pharma are the winners, and it’s very competitive. Universities and massive corporations stand in line to reap the rewards. If you can get an unwanted behavior proclaimed a disease by the disease proclaimers, then doctors, universities and corporations will be enriched because, well, we all stand in another line, so we can give them fistfuls of money for their products.

You should also know this. Big Pharma’s most important customer is the psychiatrist, not you. Psychiatrists are the ones who push their products to us. While these companies aim their endless advertisements to entice you, it’s the psychiatrist who grants permission. Big Pharma “field reps” are forever enticing doctors to try their latest concoction, or to provide them with evidence their old concoctions are even effective with other false disorders. The math is easy. More diagnoses, more prescriptions. Big Pharma and the medical profession work in tandem towards a mutually beneficial end.

Where Are We Going?
I trust you know by now, psychiatry in America is a vibrant commodity. That makes you a consumer. By the time you finish this book, you will be much more adept at asking questions about those chemicals your psychiatrist is prescribing for you or your child, and you will be much more able to measure the psychiatrist’s answers. By the way, you can purchase these chemicals — where else — at the local chemical store. As you already know, chemicals can be very, very expensive, especially those requiring a note from a medic.

You can, of course, purchase the same chemicals from a variety of illegal sources, and they are everywhere. They will be able to provide you with one or more of the 10 or so illegal chemicals you can’t buy over the counter, with or without a note from your doctor. You may be surprised to learn the chemicals found at your drugstore and the chemicals found at your corner connection are exactly the same. Exactly. Others are so similar chemically only a chemist could tell you the difference. The effects on a human being are identical. And please recall, it’s the chemical’s physiological effects we are interested in, whether legal or illegal.

1https://www.cdc.gov/ncbddd/adhd/data.html

2https://www.webmd.com/add-adhd/adult-adhd-facts-statistics#:~:text=ADHD%20is%20among%20the%20most,aware%20that%20they%20have%20it.

3See Drugs.com: https://www.drugs.com

4Or: disorders, deficiencies, delays, disabilities, derangements, disturbances, dysfunctions.

5https://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders#Early_versions_(20th_century)

6https://en.wikipedia.org/wiki/DSM-5#Financial_Conflicts_of_Interest_and_Perverse_Dependencies


Randy Cima, Ph.D., is a psychologist by training. He was the Executive Director for several mental health agencies for children. He is avid opponent of psychotropic chemicals for children, and his efforts have successfully reduced and even eliminated chemicals in his work in helping them with a variety of problems. He also teaches, writes, and lectures on these matters.

Read All About It, Miracle Cures In Psychiatry….

Read All About It, Miracle Cures In Psychiatry….

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.

Talk About Downers: The Insidious and Cruel Psychiatric Practice of Medicating Sadness and Despair

Talk About Downers: The Insidious and Cruel Psychiatric Practice of Medicating Sadness and Despair

by Randy Cima, Ph.D.


Briefly
Psychiatry sells us four kinds of chemicals for our psychiatric disorders. Three chemicals really, though they have been experimenting for decades to find a use for the fourth, to no avail, so far.1 Each of the four has distinguishable, physiological effects on all earthlings, healthy or otherwise.

The four kinds of chemicals, and their effects, are: (1) Tranquilizers (downers), (2) Stimulants (uppers), (3) Analgesics (anesthetics/pain relief), and (4) Hallucinogens (consciousness altering), each with their own story.

This story is about psychiatry’s misuse of the first of these — tranquilizers — or what is commonly known as “downers.”

Downers
The first man-made tranquilizer, Chlorpromazine (CPZ), became available to the public in 1954. It was popular among professionals due to its ease of use and versatility — they used it for everything — and it was a huge financial boon to Big Pharma. By the mid-1960’s fifty million people around the planet had used CPZ. The formula was in place. (See Zombie Theory Part 3.2)

Since then, psychiatric science has simply reimagined the many ways they can produce, develop, and market similar tranquilizers. They have also used a variety of different names for these same chemicals during the past 70 years, including SSRI’s, benzodiazepines, antidepressants, anti-psychotics, anxiolytics, and many, many more. Regardless of terminology, they are all tranquilizers, and represent one of several kinds of central nervous system depressants.

In varying degrees, tranquilizers slow down our breathing, our heartbeat, and in general, our physical activity, including brain activity. Within a short period of time after ingesting a tranquilizer of some kind, you can feel your muscles relax and tensions lessen. Your life-stressors seem less impactful, and there’s even a sense of euphoria for a short period of time. You feel a little better than you did, for a while. And that, dear reader, is the dirty little secret no one talks about. This is how they “work,” and why they really don’t work at all.

Another thought or two
I think about half of adults (I’m guessing) who take these “meds” understand the particular tranquilizer they’re taking is just that: a tranquilizer. Because of the pressures of life, they seek tranquility. They like the calming effects of the pill, at least in the beginning. If someone takes Prozac as a way to find some tranquility for six months to help get over a divorce or another life stressor, and if in this way it works for them, that’s okay with me. It is a tranquilizer, not medicine. Some people consume alcohol to lower their stress and anxiety. Others exercise or meditate. There are a variety of ways to ease stressful, ongoing life situations.

Some take a tranquilizer — or two — when necessary. If, as the stress decreases, and use of the tranquilizer decreases too, then it’s no-harm-no foul as far as I’m concerned. Please be cautious. There are physical risks for using a tranquilizer too often, or for too long. They are toxic, they can become habitual, and they do not “treat a brain disease.” They provide us tranquility for stress and anxiety in our lives. With or without these cautions, as an adult, it’s your business.

However, for the other half (more or less), this is about life and death. They are desperate. They are not seeking tranquility. They are thinking about ending their life if they don’t feel better soon. A doctor — and society in general — convinces them they have a disease that is causing their deep depression and can only be helped with one, or more, of the many, many tranquilizers — downers — from which doctors have to choose.

With this introduction, and with these thoughts in mind, please consider the following story.

···

Insidious and Cruel
Imagine you’re a 30 something young man or woman, and you’ve been fighting a deep sadness for a few years. Life has dealt you a few blows. You have reason to be depressed. As a result, you’ve been isolating yourself for some time. You feel you’re a burden to the few friends and family members you still see. There’s no joy in your life. You have no energy, and no need for energy. Days are becoming more and more burdensome. Your thoughts and feelings are as dark as your mood. You try to exercise and mingle, like you’ve been advised, but you just don’t feel like it. You don’t want to be around anyone.

You started therapy a year ago. It helped for a while. You like your therapist and you confide in him. He knows you’ve had thoughts of ending your life, among other things. You were optimistic when you started. But now, it’s been a year, and you feel worse. Your therapist is frustrated too. You know he cares about you. He reminds you he suggested you see a psychiatrist six months earlier, but you declined. Maybe he’s right. Maybe there is something biological going on, you concede. After all, that’s what everyone has been telling you for a very long time. Your friends and family love you, and they all want you to get some medical help.

You’re desperate enough now. You haven’t really told anyone just how bad you feel, and how often you think about ending your life. You now prefer isolation. You’re depressed all the time, from the moment you get up in the morning until you go to bed, only to face another restless night. You’re still young, but you look old and you feel old. The future will only provide more of the same. So, with the prayers and support of family and friends, you’re finally willing to go to a doctor to address this long held, sinking feeling. You must put a stop to your overwhelming despair, and an end to those thoughts of self-harm. More and more often, in your most private thoughts, suicide is becoming a better option. You make an appointment.

You meet your psychiatrist. She already knows about you. You were referred by your therapist. You thought you were going to have a conversation about your life. Instead, it’s an interview. Within 20 minutes — maybe 30 — she tells you you’re clinically depressed, maybe bi-polar. She takes some time explaining, as best she could, how this medication will help treat the brain disease that is causing your depression. She gives you a prescription to treat your symptoms — she already told you there’s no cure for the brain disease you have. She gives you Zoloft, or Prozac, or Xanax, or another SSRI or benzodiazepine. In short, she tells you to ingest a particular dose of a particular tranquilizer.

You go home to follow doctor’s orders. You’re at least relieved to know you have something that can be treated — finally. Nothing has changed in your life, of course, but you take your first tranquilizer in the morning, and again in the evening. You’re trying to be optimistic.

It’s been two weeks, and you don’t feel any better. You were expecting something in the first week. The doctor warned you that you could feel worse before you feel better — it’s common she said — and she was right. You feel worse. You’re even more lethargic, less energetic, and your mood is worse too, and so are your thoughts and feelings. You call the office like the doctor told you, and you report the side effects of the tranquilizer. The office tells you it’s normal.

In the meantime, life happens, and other life stressors occur. You’re getting overwhelmed again. Perhaps you waited too long to see a psychiatrist. Perhaps your disease is that hard to manage. This time, a few weeks later, you go to the office. The doctor changes the dose to see if that works. If that doesn’t help, she told you, she may try another tranquilizer in a few months. You can’t wait a few months.

On your own, desperately, you double the dose of your tranquilizer. Nothing. You’re not even frightened anymore. You’re numb. You’ve taken more than you should, and it just makes you feel more depressed, more lethargic, more alone. You’ve confirmed, in your own mind, what you thought was true anyway. Therapy didn’t help and the doctor’s medicine has made it worse. There is no help coming. You’re destined to more misery, and you know you’re a constant worry to those who love you. Everyone will be better off, eventually, you reason. With a deep sorrow, and with a sense of peace, you make, given the circumstances, a principled, private decision. You end your story.

I think this is insidious and cruel. Do you?

1 The use of hallucinogens has been the subject of many experimental studies for many decades, with little to no results. Yet, the pursuit continues. Here’s the latest study from Johns Hopkins Medicine: Psychedelics Research and Psilocybin Therapyhttps://www.hopkinsmedicine.org/psychiatry/research/psychedelics-research.html

2 Zombie Theory Part 3: https://medium.com/@randycima/the-zombie-theory-part-3-3573b3920cc5


Randy Cima, Ph.D., is a psychologist by training. He was the Executive Director for several mental health agencies for children. He is avid opponent of psychotropic chemicals for children, and his efforts have successfully reduced and even eliminated chemicals in his work in helping them with a variety of problems. He also teaches, writes, and lectures on these matters.