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Hullo again, life has been a bit frantic lately so I'm behind on these newsletters. My apologies.
An email from Dr Boris Vatel from Evansville State Hospital in Evansville Indiana, USA slowed me for a while:
"I hope you will consider answering a couple of questions inspired by your article and lying beyond the scope of the brief exchange we had in the comments section.
"If you accept the notion that the brain generates mental states your position cannot be far from that of mainstream psychiatry which states that abnormal brains generate abnormal mental states. That no consistent, disorder-specific lesion or set of lesions has been discovered so far may mean one of two things. Either there is no such lesion/s, meaning that the brains of mentally ill people are not diseased in the traditional understanding of that term - or that the discovery of such lesions is beyond the current reach of science. Since no one is able to predict what may be discovered tomorrow, what is wrong with concluding (at least as an as-yet unproven but plausible idea) that abnormal mental states not only of stroke and brain tumor patients but also of those suffering from psychoses may after all be productions of abnormal brains?
"If, as you imply, the brains of non-organic psychiatric patients are functioning as they should, can we consider psychiatric illness to be an illness at all, in the way that CAD or diabetes is an illness? A related question is whether those who specialize in the treatment of mental illness function as physicians in the narrow sense of that word. I assume that given your particular views on mental illness you treat your patients verbally rather than chemically. If effective treatment for mental symptoms is, indeed, verbal, do we need a medically-based psychiatry at all?
"Those of us frustrated by the lack of objective diagnostic tools in psychiatry had hoped that one day, barring the discovery of telepathic abilities, there would be found an imaging, electrical, or biochemical correlate of abnormal thought or internal experience. But perhaps this can never happen and the internal experience of another will always remain a black box to an outside observer. If this is the case, can one ever truly know enough of another's mental symptoms to treat them in the same sense of the word as a surgeon treats an appendicitis or a cardiologist does congestive heart failure?
"Many thanks in advance for your opinions."
My response:
Thank you for your careful probing of my views. I will take each question in turn.
Q: "If you accept the notion that the brain generates mental states your position cannot be far from that of mainstream psychiatry which states that abnormal brains generate abnormal mental states."
A: Orthodox psychiatry is of the view that a specific physical brain lesion is necessary and sufficient to cause each named mental disorder. That is, there cannot be a mental disorder without a brain lesion, and the presence of the lesion will always cause the mental disorder: you can't have one without the other, but the brain lesion comes first. I say this is wrong, like saying that violence is always and only caused by a brain lesion. That is, the statement "abnormal brains generate abnormal mental states" does not imply that all abnormal mental states are the result of abnormal brain states, which is what orthodox psychiatry says. There is plenty of room for abnormal mental states that are
not
the result of an abnormal brain state.
However, my argument against biologism doesn't follow the normal course seen in psychiatry. Starting from first principles, I argued that biological reductionism cannot explain the totality of human behaviour. The important and distinctive part of human behaviour is caused by brain activity of a certain kind, what we traditionally call mental life. Over a lengthy series of papers, elaborated and expanded in my various books, I argue that the mental life of humans is a real and natural thing, and is therefore capable of acting on the real world by principles that we can understand. That is, there are scientific (rational, natural) explanations of the nature of mind and of mind-body interaction (aka the mind-body problem). I propose that the nature of the mind just is information, so the solution of the mind-body problem lies exactly in the principles of physically-based computation explicated by Turing, Shannon and others in the middle third of the last century. As information, there is nothing magic about the concept of mind, and nothing magic about mind-body interaction. All those people who argued that dualism is necessarily magic forgot to take account of the irreducible duality of machine-based computation. My proposed resolution of the ancient problem of mind does not invoke any new principles (such as the very foolish idea of quantum computation in non-quantum machines) nor does it attempt to evade the essential mentality of the human mind, as tried by behaviorism, biological psychiatry, mind-body identity theory and so on.
So: mental states are generated by the brain and then act back upon the brain to influence its processing. This recursive loop is necessary otherwise we would all be automata. This model breaches no laws of physics as we presently understand them. Normal mental states arise from a normal brain, and abnormal brain states produce abnormal mental states, but not all abnormal mental states are caused by abnormal brain states (In logic, 'A implies B' does not mean that 'B implies A'). The actual argument is this: Anybody who accepts that informational states of the brain are a reality must also accept that primary disturbances of those informational states can occur in the absence of abnormal brain states. This can be because the data set contains errors (garbage in, garbage out) or the processing algorithms are in some way inconsistent or just plain wrong (bugs). It is not possible to claim that the brain is an information processor and also to claim that all disturbances of output are necessarily due to a physical perturbation of the underlying brain itself. That is an absurdity. It just happens to be the absurdity on which the whole of modern psychiatry is based.
Q: "That no consistent, disorder-specific lesion or set of lesions has been discovered so far may mean one of two things. Either there is no such lesion/s, meaning that the brains of mentally ill people are not diseased in the traditional understanding of that term - or that the discovery of such lesions is beyond the current reach of science."
A: This is perfectly correct; all we need to explain now is why orthodox psychiatry has put all its eggs in the second (biological) basket and is refusing to consider the possibility that the brain in mental disorder may be perfectly healthy. Some people object to this: "Oh come now," they say, "psychiatry pays close attention to the psychological component of mental disorder." This was said to me at a conference in Perth, WA, in June last year. Speaking in a forum, I said that psychiatry routinely ignores the possibility that psychological factors have a role to play in mental disorder. A (very conventional) psychiatrist on the panel said, "That's not true, the journals regularly publish papers on psychotherapy." Annoyed, I checked both the British and American Journals of Psychiatry for the years 2010-2011; between them, in something like 450 papers, not one of them directly addressed the question of the psychology of mental disorder. Not one.
However, my case goes further: I am saying that, as a matter of fact, not only is it false to claim that mental disorder is necessarily biological in nature, it is impossible for all mental disorder to be based in brain pathology. This is because errors in the data set or in the algorithms are not themselves reducible to brain pathology. It is
impossible for anybody to prove that all mental disorder can only be due to brain disorder. It is therefore absurd for psychiatry to focus its efforts so narrowly on brain disorder, and the NIMH Research Domain Criteria Project will necessarily fail, as surely as the Research Diagnostic Criteria project (basis of DSM III-IV-V) failed (see ref. 1).
Q: "Since no one is able to predict what may be discovered tomorrow, what is wrong with concluding (at least as an as-yet unproven but plausible idea) that abnormal mental states not only of stroke and brain tumor patients but also of those suffering from psychoses may after all be productions of abnormal brains?"
A: My response is simple: Why put all your eggs in such a fragile, ideological basket? Worldwide, we spend about $3billion a year on primary psychiatric research; why not spend, say, 10% of it on the psychology of mental disorder? Answer: because it wouldn't suit the agendas of the people who have taken control of modern psychiatry. That is the only reason.
In psychiatry, we are hardly interested in brain disturbances. Yes, American psychiatrists like to talk about concussion, epilepsy, intoxications and withdrawal states, focal and generalised brain damage, including dementias and various other hereditary (Huntington's) and acquired conditions (toxoplasmosis, HIV etc) but these are a tiny part of the sum total of mental disorder, they don't look anything like mainstream psychiatric syndromes and, as soon as we find cases like these, we refer them to neurologists or other specialists. By using these conditions as examples of mental disorder, biological psychiatrists are guilty of gross misrepresentation. Psychiatry
qua mental disorder is not about brain disorder.
Q: "If, as you imply, the brains of non-organic psychiatric patients are functioning as they should, can we consider psychiatric illness to be an illness at all, in the way that CAD or diabetes is an illness? A related question is whether those who specialize in the treatment of mental illness function as physicians in the narrow sense of that word. I assume that given your particular views on mental illness you treat your patients verbally rather than chemically. If effective treatment for mental symptoms is, indeed, verbal, do we need a medically-based psychiatry at all?"
A: I don't use the expression "psychiatric illness," mainly because I don't believe there is a shred of evidence to prove it is an illness in any useful sense of the word. Yes, a large part of my practice involves talking to people but I do use drugs. Can psychologists do it? No, I don't believe so. Sure, they can deal with the easy stuff but that doesn't interest me anyway. They probably could deal with personality disorder if they had a proper theory of it but they don't, and the proper theory is a theory of mind-body interaction. Because they don't know anything about bodies, they aren't in a good position to understand a theory of mind-body interaction. Do I use my medical knowledge in dealing with psychiatric patients? Yes, all the time. I couldn't get by without it. Another thing to remember: a person who knows nothing about the body is not in a strong position to say what is mental and what is not. Psychologists would be compelled to accept a secondary role, which they normally resent.
His last question: "Those of us frustrated by the lack of objective diagnostic tools in psychiatry had hoped that one day, barring the discovery of telepathic abilities, there would be found an imaging, electrical, or biochemical correlate of abnormal thought or internal experience. But perhaps this can never happen and the internal experience of another will always remain a black box to an outside observer. If this is the case, can one ever truly know enough of another's mental symptoms to treat them in the same sense of the word as a surgeon treats an appendicitis or a cardiologist does congestive heart failure?"
A: The question of "objective diagnostic tools in psychiatry" is a complete red herring. All of this pseudo-medical talk of "Does he have Bipolar II or is it really Dysthymic Disorder and comorbid Seasonal Affective Disorder?" (or something, I don't use those terms), all of it misses a critical point: the need for diagnostic precision is only necessary for somebody who believes that there are separate categories of mental disorder, where different categories imply different treatment, after the medical model. When you accept, as I do, that there are no categories of disorder, that they all blur across each other and people can move back and forth depending on life circumstances, that we deal in distress, not labels, then the need for "objective diagnostic tools in psychiatry" fades like the morning mist.
I had this problem in court recently. In some irritation, the lawyer asked: "But is he psychotic or isn't he?"
I replied: "Sometimes he is and sometimes he isn't. It's like if you were to ask, Is he angry or isn't he? The correct answer would be, Sometimes he is and sometimes he isn't. People aren't fixed, like toads in formalin, they are plastic and reactive. A person may be diabetic when he is overweight, eats badly and doesn't exercise but, when he corrects those factors, he is no longer diabetic." That didn't satisfy the lawyer, who could only think in terms of people shoved neatly in pigeonholes.
However, there is a more important question buried in that quote: "But perhaps this can never happen and the internal experience of another will always remain a black box to an outside observer."
There is one sense in which the internal experience of another person will always remain a mystery, a sense summarised by the philosophical "doctrine of privacy." This says that we are always separate individuals, that you cannot experience my experiences and vice versa. Even if we look at the same patch of red, we have no way of knowing whether what we experience is the same. Is your pain the same as mine? We both see the same event, you are appalled and I laugh uncontrollably.
That is one side to the question. The other is this: I don't need a superscanner to tell me what another person is experiencing, I am human too. I can tell grief and despair when I see it. Even when the person is trying to conceal it, I can pick it up without much trouble. I know how to get with a patient and stay with him, and no machine can duplicate that because only another sentient being can apprehend distress. A machine such as a polygraph may be able to record the concomitants of distress but it will never know what distress is and never be able to sniff it out purely on suspicion. In particular, I can talk to psychotic people which is something a machine could never do. In psychosis, the person is often doing his best to conceal his mental state but he gives it away with minor slips of the tongue, little mistakes or, crucially, by what he is
not talking about. A highly intelligent 29yo man I am seeing always tries to give the impression that he is doing well in life, he has solved his problems and should be discharged from his legal orders. But he isn't because he hasn't solved anything. How do I know? He never volunteers any information about his sexual life. He never makes the little jokes or observations that other people do. It is a closed book but you won't realise that if you are focused on making the correct diagnostic decision. He is smart enough to lead dozens of psychiatrists up the garden path, and has done so for years, because he can't discuss this most elementary part of life. Only another human being could detect that (and don't imagine you could do it stochistically).
This is why we do not treat "mental symptoms... in the same sense of the word as a surgeon treats an appendicitis or a cardiologist does congestive heart failure." Very often, simply understanding what another person is experiencing is enough for them to get over it. We don't treat as surgeons remove a diseased appendix, we treat in the sense that we help a person overcome Type II diabetes: follow this advice and you will get better. We don't kick people into health, the most we can do is guide them.
Agnotology
: New word for an old concept.
We have long had words such as biology, epistemology, philology, ontology and many others. Some time ago, I came across a new one, 'agnotology,' meaning the scientific or rational study of ignorance. This is not so dumb as it sounds: a vast amount of human destructiveness comes from our
not knowing what we ought to when we start on something. It immediately struck a chord: for years, I have been arguing that psychiatrists have never bothered to investigate the logical consequences of what they say and do, such as with the so-called 'biopsychosocial model.' Every psychiatrist knows, or ought to know, that this doesn't exist, as I showed in 1998. However, years later, we still have a highly influential psychiatrist who says this: "80% of psychiatrists follow a biopsychosocial approach." Evidence? He declined. So I was interested to see the following little article in Michael Quinion's laudable weekly newsletter,
World Wide Words.
:
"Agnotology is the study of culturally-induced ignorance.
Agnotology refocuses questions about "how we know" to include questions about what we do not know, and why not (Londa Schiebinger, Proc Amer Philosoph Soc, 1 Sep. 2005).
"Historians of science have tended to focus on the processes by which scientific knowledge gets accepted. In recent decades, some scholars have come to see that processes that impede or prevent acceptance of scientific findings are also important. Such processes include the very human desire to ignore unpleasant facts, media neglect of topics, corporate or government secrecy, and misrepresentation for a commercial or political end. They often generate controversy, much of it ill-informed. Examples include the health implications of tobacco and of genetically modified plants, the safety of nuclear power, the environmental consequences of hydraulic fracturing (fracking), and the existence or extent of man-made climate change.
"The word's earliest appearance seems to have been in a book of 1995, The Cancer Wars: How Politics Shapes What We Know and Don't Know About Cancer. This was by Robert Proctor, a historian of science at Stanford University in California. He coined it from the classical Greek agnÅsis, not knowing, plus the suffix -(o)logy, a subject of study, from Greek logos, word or speech."
Apparently, Proctor intended it as a bit of a joke but it is a joke with a deadly bite: how much devastation results from sheer, bloody-minded ignorance, if not outright deception?
The paper I published earlier this year (ref. 2) is exactly about this topic. It seems to show a culturally-determined ignorance of the truth about biological psychiatry: that nobody has ever bothered to sit down and prove that it has a chance of success. Everybody assumes that it has been done, and people spend a lot of time reassuring each other that it is the case, but that doesn't make it true: Truth is not established by dint of repetition of a falsehood. So here we have a very interesting sociological question: How is it that educated people can be so thoroughly fooled? Perhaps it has something to do with what the acerbic Upton Sinclair noted: "It's difficult to get a man to understand something when his salary depends on his not understanding it."
The people in charge of psychiatry these days are all making so much money from believing in the biological basis of psychiatry that any doubts are actively suppressed. I am satisfied that they are engaged in a program of mass deception. The question is: How can this message be spread so that newcomers to the profession actively question the basis of what they are being told? Suggestions are very welcome.
References:
1 McLaren N. 2011. Cells, circuits and syndromes. A critique of the NIMH RDoC project. Ethical Human Psychology and Psychiatry13: 229-236.
2 McLaren N. 2013. Psychiatry as Ideology, Ethical Human Psychology and Psychiatry 15: 7-18
