Pies’ Polemic and the Question of Theories in Psychiatry, Again

Niall McLaren
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In a recent publication, “Debunking the Two Chemical Imbalance Myths, Again,” psychiatrist and editor Ronald Pies returned to his theme of insisting that psychiatrists and the institution of psychiatry have never embraced or supported a “chemical imbalance theory” of mental disorder:

“…psychiatry as a profession and medical specialty never endorsed such a bogus “theory,” when judged by its professional organizations; its peer-reviewed publications; its standard textbooks or its official pronouncements.” (emphasis in original)

Instead, he states:

“…academic psychiatry—for at least the past 30 years—has advocated a ‘bio-psycho-social’ model of mental illness, as originally proposed by Dr George Engel, and as reflected in the 1978 APA statement quoted above. This position has been quite consistent.”

In his conclusion, he noted:

“The (catecholamine) hypothesis (of affective disorders) has since been modified and corrected to reflect more complex biological mechanisms in major mood disorders. These disorders are best understood using a bio-psycho-sociocultural model, which has been the mainstay of academic psychiatry for over 30 years.” (emphasis added)

In a detailed critique, “The Chemical Imbalance Theory: Dr. Pies Returns, Again,” psychologist Philip Hickey has taken Pies to task, leaving little doubt that his protestations are, at best, disingenuous. Given the contents of a letter published by Pies in 1992 in the American Journal of Psychiatry (March 1992, p420), which Hickey uncovered, it is difficult to avoid the suspicion that Pies is trying to have it both ways, i.e. using the concept of a chemical imbalance while denying it amounts to a theory. Be that as it may, we need to look more closely at his claim that the concept of a “chemical imbalance theory of mental disorder” has never guided psychiatric practice, teaching or research, and that, at the very least, it is mischievous to suggest otherwise.

In the UK at present, 16% of the adult population (one in six) take antidepressants. In the US, that figure is 13%, and in Australia, 12%, up from 9.8% just three years ago, and a bare 1% in 1991. Significantly, the length of time people take these drugs is growing, meaning that once they start, they don’t stop. The consumption of these drugs is a social phenomenon, not a disease phenomenon: there is zero evidence to say that the actual incidence of depression in Australia has increased 1200% in one generation. Certainly, they don’t appear to be very effective as the suicide rate in this country has been rising for years and recently hit a peak.

We are forced to ask: What medical fact drives the explosive growth in the consumption of psychotropic drugs? The ultimate explanation is just that psychiatrists and general practitioners prescribe them and, despite their many unpleasant and/or dangerous side effects, are able to convince their patients to take them to the point where they find it difficult to stop. So why do they prescribe them? They prescribe them because they believe it is the correct response to a diagnosis of depression, which Pies affirms vehemently:

“…the clinical reality is that antidepressants are effective in many patients with severe, acute major depression.”

This is tendentious because the clinical reality is that the overwhelming majority of patients taking these drugs had mild to moderate cases of depression, if they were depressed at all (a large proportion of the drugs are prescribed for anxiety states or as hypnotics), and they take them in the long to very long term, meaning decades (i.e. non-acutely), even though all psychotropics were approved on the basis of short term trials of weeks to months at most.

Now we get to the core of the matter, but first we need to digress somewhat to try to understand what is going on in this debate. On the one hand, we see the relentlessly expanding use of psychotropic drugs based in what amounts to an urban myth, the “chemical imbalance” concept of mental disorder. On the other hand, it is true, as Pies claims, that no psychiatrist has ever published anything that would amount to a “chemical imbalance theory of mental disorder.” I suggest that what we are seeing here is an example of what philosophers of science call the “motte and bailey” doctrine (I don’t know why it is called a doctrine; it is actually a technique but no matter). It is sometimes called a logical fallacy although it is probably better characterised as a sophisticated “bait and switch” maneuvre. This is attributed to the British philosopher of science Nicholas Shackel who introduced it thus:

“One of the difficulties of getting people to behave better epistemically is that, whilst intellectual dishonesty is wrong, it is difficult to convict people of intellectual wrongs… there are indefinitely many ways of cheating intellectually (yet) there is no simple way to put one’s finger on how the cheat is effected.”1

He bases the term on the medieval notion of a defensible castle, the motte, surrounded by indefensible fields and pastures, the bailey. When there was no danger, the villagers lived in lightly-built huts outside the motte and worked the fields. However, when danger loomed, they abandoned their fields and even their cottages and retreated into the motte where they could not be budged. There they waited until the raiders tired of the game and left, perhaps taking the fields of cabbages with them.

The parallel in philosophy is seen when people who advocate a particular position stake out a large territory for themselves (as in “all mental disorder is a chemical imbalance of the brain”) for which they have no defence whatsoever. As long as nobody challenges their bailey, they continue to make hay from it, but under threat, they retreat into the motte or defensible position: “But we never claimed there is a chemical imbalance theory of mental disorder.” True, they didn’t, but they were very happy to profit from everybody thinking they had. This leads to the crucial but unstated point behind Pies’ polemic: If the “Chemical Imbalance Theory of Mental Disorder” is a mirage, if not a frank deception, then what theory are psychiatrists using to justify prescribing their drugs?

That is, what is the current accepted theory or model of mental disorder by which psychiatry justifies not just its extensive and unequalled powers, but its very existence? I exclude at the outset such notions as demonic possession, any idea involving astrological bodies, or anything to do with meridians, gravity, morality, sunspots or solar flares, faith, tides, red food coloring, masturbation, homeopathy and so on. This doesn’t leave a lot of contestants for what we could call the Standard Modern Theory of Mental Disorder, the one that justifies the unprecedented use of psychotropic drugs. Fortunately, Pies has defined theories for us:

“…a genuine theory requires an integrated network of well-supported, interlinked hypotheses.” (emphasis in original)

There’s more to a scientific theory than that but his definition will do. We can quickly dispense with one of the main contenders from the last century, Freud’s Psychoanalytic Theory. While Freud claimed his theory was original, universal and scientific, we now know that it was none of these. It was not original but was largely lifted from the Kabalah. It was not universal as it was based entirely on his study of a minuscule fraction of the world’s population and cultures, and it was not scientific just because it was irrefutable (I summarised most of this in 19872). In any event, psychoanalysis was a psychological theory of mental disorder, and was strongly opposed to the profligate use of drugs and other physical treatments. Since its demise, there has been precious little intellectual effort applied to the question of whether mental disorder can be explained in psychological or mental terms, certainly among psychiatrists, many of whom who are openly dismissive of the idea.

The other major contribution from the last century was behaviorism, in its various forms. Talking of stakes being hammered through misbegotten hearts, as Pies did, behaviorism never recovered from Chomsky’s devastating critique of Skinner’s Verbal Behavior (1957)3, although the corpse took some time to fall to the ground. For a brief historical survey of the philosophical failings of behaviorism, see chapter three in my book Humanizing Madness: Psychiatry and the Cognitive Neurosciences,4 but the point surely is that behaviorism was wholly a psychological model of mental disorder. It specifically excluded any and all ‘intervening variables,’ which includes brain chemicals and, of course, mentalist constructs. Psychiatrists therefore cannot appeal to that approach to mental disorder as their justification for widespread drugging of the population, so what’s left? As it happens, not much.

The major alternative is summarised in the aphorism, variously attributed to Benjamin Rush and Henry Maudsley, that “All Mental Disorder is Brain Disorder.” That is, it relies on the physicalist notion that the behavior or properties of a higher-order entity can be reduced to and thus fully explained by the behavior or properties of the lower-order entities of which it is composed.5 In brief, biological reductionism avers that for every mental disorder, there is a physical disorder of the brain which is both necessary and sufficient for that mental disorder (necessary means that the mental disorder won’t appear without the underlying physical disorder, while sufficient means that every time the physical disorder is present, the mental disorder will also be present). It says that a full understanding of the brain will explain all there is to know about mental disorder, with no questions left unanswered.

This is the unstated justification for the allegedly atheoretical DSM model of categorical classification of mental disorder, that every surface manifestation of mental disorder will ultimately map down to a specific error in the genome, for which (ideally) there will be a single, discrete biological treatment. Nearly thirty years ago, I showed that this project must fail.6 Moreover, even in its latest iteration, the Research Domain Criteria project, it cannot succeed but will simply be another hugely expensive wild goose chase.7 Given these ontological problems, why does biological reductionism persist? Its major justification appears to be that it seems more scientific than mentalist theories, in the sense that it has a beginning, whereas we don’t even know where to start with mentalism. By default, the research funds flow to reductionist models.

In case anybody should think that dismissing biological theories on theoretical grounds is a little hasty, it remains the case that there is no extant reductionist model of mental disorder.8 No psychiatrist has ever written anything that could possibly count as an articulated theory or model of mental disorder as biology. The proposition “All Mental Disorder is Brain Disorder” is metaphysical, purely an ideological claim, and not of a form that empirical science can investigate.

The field is now looking a little bleak, but Pies has ridden to the rescue, as it were, with his concept of “…a bio-psycho-sociocultural model, which has been the mainstay of academic psychiatry for over 30 years.” He uses a recent publication from the APA to show that mainstream psychiatry’s understanding of the causation of depression includes biochemical, genetic, personality and environmental factors. He notes that the original formulation of the biopsychosocial model (BPSM) by George Engel, in 1977, has attracted criticism, but he then gives a number of examples of how the biological understanding of mental disorder is powering ahead. Ultimately, the BPSM will allow us to provide “holistic, comprehensive psychiatric care.”

Regrettably, Pies’ program runs into the very practical difficulty that there is no such thing as a “biopsychosocial model” of mental disorder. It doesn’t exist. George Engel certainly didn’t write one,9 and nobody else has. In a number of settings, including lectures and publications, I have stated that anybody who claims that such a model exists is exposed to accusations of culpable deception, with no conceivable defence.

As it happens, I watch the literature on this topic quite closely but I may have missed a paper that actually gives such a model. However, it seems highly unlikely, just because a genuinely “bio-psycho-sociocultural model” must first resolve the mind-body problem. On this point, be assured there has been no progress since the late René Descartes, who left us in 1650. Alternatively, before one can solve the mind-body problem, one needs a formal model of mind, which psychiatry has long since discarded. So I feel I am on strong grounds if I say that the claim above, that such a model “…has been the mainstay of academic psychiatry for over 30 years,” is false and without warrant.

Nonetheless, I am prepared to admit that Dr. Pies may be right and I may be wrong. It is feasible that psychiatry has quietly pulled a metaphysical rabbit out of an empirical hat, developing an integrative theory of body and mind to replace the wholly spurious “chemical imbalance trope,” as he rightly puts it. In fact, I’d be delighted to be proven wrong. If Dr. Pies can name the actual model of mental disorder he has championed in his article (including “…an integrated network of well-supported, interlinked hypotheses“), citing the original author’s primary publication, and give three seminal references in which the model is developed as a series of testable propositions, then I will fall to my knees in gratitude, not least because it will sound the death-knell for psychiatry’s biological hegemon.

If, however, he can’t do that, then I don’t see how he could defend himself and, by extension, his profession (and mine) against a charge of culpable deception, if not of frank scientific fraud.

Show 9 footnotes

  1. Shackel N. (2016). Motte and Bailey Doctrines. Reality and Rationality.  https://realityandrationality.blogspot.com/2016/12/motte-and-bailey-doctrines.html ↩
  2. McLaren N. Science and psychoanalysis. Australian and New Zealand Journal of Psychiatry 1987; 21:648-53. ↩
  3. Chomsky N.1959. Review of B. F. Skinner’s Verbal Behavior in Language. 35 (1): 26-58. ↩
  4. McLaren N. (2007). Behaviorism from the psychiatric perspective. Chap 3 in Humanizing Madness: Psychiatry and the Cognitive Neurosciences. Ann Arbor, MI: Future Psychiatry Press. ↩
  5. Stoljar D. (2010). Physicalism. Oxford: Routledge. ↩
  6. McLaren N. Is mental disease just brain disease? The limits to biological psychiatry. Australian and New Zealand Journal of Psychiatry 1992; 26: 270-276. ↩
  7. McLaren N. (2011). Cells, circuits and syndromes. A critique of the NIMH Research Domain Criteria project. Ethical Human Psychology and Psychiatry 13: 229-236. ↩
  8. McLaren N. (2013). Psychiatry as Ideology. Ethical Human Psychology and Psychiatry 15: 7-18. ↩
  9. McLaren N. A critical review of the biopsychosocial model. Australian and New Zealand Journal of Psychiatry 1998: 32; 86-92. ↩

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53 COMMENTS

  2. I have an undeveloped intuition about the nature vs nurture, biology vs environment, culture vs individual question which seems to be at the core of debates about all human problems, including those which are termed mental illness.

    I don’t believe these can or will be resolved by any alternative which tries to incorporate the other polarity. I have a feeling that a third problem will always keep everyone arguing for a position between these two poles, but with a strong preference for one side or the other.

    What I’m starting to wonder is if the unacknowledged elephant in the room is the nature of consciousness itself.

    What I am starting to suspect is that as long as this is left unaddressed we will always be doomed to be chasing our own ideological tails.

        • I have no problem with that framing. The problem is that the DSM categories have nothing to do with biology – literally NOTHING AT ALL to do with biology. If you have a thyroid problem, or anemia, or syphilis, you’d better get medical treatment! But that has zero correlation with any DSM category – they are real medical problems that are treatable, unlike the DSM labels. Other issues like food, sleep, exercise, physical pain, all can contribute to feeling bad or being confused or whatever. Those are biological. “Depression” is not biological, “Anxiety disorders” are not biological. They are catchall phrases made up for lazy clinicians who don’t want to bother to actually figure out what’s going on.

          • They are both important. You focus on getting good sleep, eating well, working with supportive providers to address any possible physiological problems. But you make sure that they have a real way to TEST for these problems, rather than just telling you that you “have a disorder” because you meet some biological checklist of criteria voted on in some meeting at the APA convention. AND you focus on environmental factors, managing stress, deciding on healthy vs. unhealthy relationships, creating the kind of life you want, staying away from destructive people, etc. AND you focus on social things – connecting with other people, making sure you are engaged in productive activity that has meaning for you, etc. They are all important. The problem with the DSM is that it ASSUMES biological cause without testing it out, and at the same time minimizes the impact of the psychological, social and spiritual issues that create most of the “mental health” issues that are “diagnosed.” I say this as a person who used to be VERY anxious much of the time, who had frequent thoughts of suicide when under stress, who was tremendously shy and isolated as a child with really limited social skills. But now I’m very easy to talk with, have excellent social skills in most situations, am willing to engage with total strangers, have learned how to have difficult conversations with hostile people – LOTS of things that I could never do before. Do I get anxious sometimes? Sure. Depressed? Absolutely. But I know what to do about it now, and I don’t get stuck there.

            I managed all of this with no “treatment” except for 15 months of weekly therapy in my 20s. The rest I learned by reading and sharing with others and by challenging myself to do things I was scared of through my employment and my drive to improve myself. I have learned that lack of sleep leads me to being more depressed and anxious. That’s biological. But I don’t need a drug, I need SLEEP! And when I get it, I find it easier to deal with stress. It doesn’t cure it, but it makes it easier.

            So I do believe it’s all of the above, but I don’t believe, based on research and observation and stories from others, that the psychiatrists have the slightest idea what might be “biologically” wrong with someone who is anxious or depressed or whatever, if anything. Their claims about ‘chemical imbalances’ are outright lies, and some (like Ron Pies) admit that this is the case. Yet they still try to tell you it’s all because of your “bad brain.” I see the system as being corrupt and misleading and very destructive. Each of us has to come up with our own approach that works for us. Any therapy or other help should be focused on helping YOU find YOUR path rather than telling you what they think is wrong with you and providing false explanations in order to sell drugs.

      • And psychiatry’s solution to the mind vs. brain debate, is to make believe the mind and consciousness don’t exist whatsoever. “All Mental Disorder is Brain Disorder.” Zero discussion at all.

        Thanks for pointing all this out, Niall. Those of us who’ve dealt with “mental health” workers within the past 30 years know, for a fact, “…a bio-psycho-sociocultural model, which has been the mainstay of academic psychiatry for over 30 years” is a blatant lie. It’s been “bio-bio-bio” only.

        Absolutely, it’s past time to “sound the death-knell for psychiatry’s biological hegemony.” Because psychiatry is “frank scientific fraud.”

      • As a firm believer in the supernatural world I call it a soul.

        It is not a “separate substance from the brain” as one monist described this belief. The soul is not a substance at all.

        This belief cannot be proven scientifically. Neither can psychiatry’s dogma that their drugs “work.”

        • I am still “agnostic” but find this concept totally feasible. It is the assumption that the “mind” or the “spirit” is a known quantity and is generated and controlled by the brain on which the entire edifice of psychiatry is based. Admitting that the mind is a mystery destroys their entire philosophical structure.

          • I’m surprised that you call yourself “agnostic” Steve, I thought you were firmly of the belief of something greater than ourselves, or that which connects us all, higher self, etc. You certainly channel quite a bit of light, I’m sure all would agree about that. I certainly perceive you as spiritually aware and evolved. Would you not own that?

            I think it’s a feeling and it’s personal and individual. “Waking up” implies inherently that one had previously been “asleep.” (From unconscious to conscious). That’s like a light going on, and it is a feeling in our bodies, and it does eventually influence our perspective and perception of things, and eventually, our personal realities.

            It’s an experiential thing, one has to know it by lived experience, we gather our own data as per following the thread of our emotions to whatever awareness it brings us from moment to moment. Absolutely impossible for anyone to know another’s experience in this regard, it’s so personal and involves personal data that is meticulous and entirely individual, like a fingerprint.

            In this case, I’d call it a “soul print.” We each have one, and they are all unique. To me it makes sense, stands to reason, and rings true. More than that, I wouldn’t know how to argue about it, but perhaps some master teacher would. For me, it just works in a practical way, to get this.

            It’s why we don’t want to dull or numb our emotions with these toxic drugs, or anything else. The evidence is in what happens when people go off the drugs and continue onward, creating in their light, finally. We are growing in numbers by leaps and bounds. MiA has been instrumental in this, several of us participate here, so for that I’m grateful to it.

            This has my experience of it and absolutely everyone else whom I know has gone through that particular experience of awakening, whether it involves psychiatry and drugs or not, that’s just one way of doing it. But waking up to our own light is how we bring light to the planet, and everyone has their own path to that, and it begins with a feeling. It’s emotional, that’s vital to awakening. When people have heart openings from awakening, they tend to weep, it’s so profound and loving.

            It may not be in maisnstream science journals or the creed of academia, but it is in tons and tons of highly respected and discussed literature throughout the ages, up to and including today.

            And in fact, it is increasing today–there is so much out there now that is accessible regarding integrating the light with our physical existence and the implication of that–because we need this more than ever now, new ways of thinking, expansive to include the spiritual, which brings light to new possibilities for solutions to all kinds of wicked problems in the world today, which is what Marianne Williamson is trying to do. We’re trying to wake up here…

        • Psychiatry is based on materialism but materialism is only one level of focus. Consciousness can manifest as physical matter when we are limited to physical bodies and only 5 senses with which to perceive reality, but it is not created by matter. Thus, on a physical plane consciousness is mediated by a physical “switchboard,” i.e. the brain. But in my view (how’s that Steve?) the brain is a function of the mind, not vice versa. There are non-physical levels of consciousness as well, which exist independently of bodies and brains. Prove me wrong.

          • That’s pretty much where I’m coming to Oldhead. Really interested to hear you say it and good to know I’m not entirely out on a limb.

            This isn’t an interesting abstraction for me, something to bat backwards and forwards in a philosophy class. (I say that because I remember doing just that a few years ago).
            But actually understanding and questioning everyday life differently. A big change.

          • @Out — This is sure to baffle and outrage Marxists who see “materialism” as the be all and end all, and Marxism makes sense on a material plane. But materialism as we know it follows different rules once it transcends its familiar parameters, like sound waves becoming visible just as a plane breaks the sound barrier. Quantum theory opens up a new realm of possibilities, and to remain relevant revolutionary theorists need to incorporate this into their perspectives.

          • They don’t actually.

            Psychiatry did NOT help me fit in at all.

            Segregation in the HUD ghetto is the exact opposite of fitting in!

            More like whittling at a square peg till its a tiny splinter that won’t fit into anything at all and is completely useless and unwanted so they toss it out with the trash.

            Putting blue dye into brown eyes only blinds them. It does not change the color.

      • I’m reading an autobiography of an activist, an amazing woman and it begins with the question: “Where did my ‘madness’ begin”.

        What I like in the vignettes of her life leading up to hospitalisation is that they aren’t of the stereotypic ‘trauma-breaks-mind’ narrative that has become a kind of archetype of the ‘nurture/environment’ pole but are more like snapshots a sensitive child trying to make sense of her experience, of life, of what is happening within and without. It reads as a narrative of not significantly shutting-down, unseeing, or buying-in, of allowing herself to be.

    • Chasing our ideological tails? Cogito ergo sum. Isnt this to put Descartes before the horse?
      Come on Dr McLaren, no need for theories, hypotheses, treatments, cures or any of that stuff when the three pillars of psychiatry (negligence, fraud and slander) will keep the plebians in their place for centuries to come. And the rather underdeveloped nature of ethics in our young country sees us in a land of opportunity. Got a signed letter here from the Minister for Health stating that torture and kidnapping are now called referral and detention. Must look pretty stupid to the people who have looked at the documents i have and know what im saying is true. Still, you know the routine, cover up and unintentionally negatively outcome the victim, and threaten their family. The show must go on.

    • I’m not saying the pre Pharma kind was better Oldhead. But surely you agree the newer model is more dangerous and has done more harm.

      People used to look at psychiatry with skepticism. They laughed at the bearded old man asking you for graphic dream descriptions. (Preferably dreams of nudity.)

      Then in the early nineties it all changed. They told us scientists had discovered why people acted weird and felt prolonged emotional pain. AND luckily they now had magic bullets to fix your brain. “Just like insulin for diabetes.”

      The “chemical imbalance” legend is believed by nearly everyone I meet offline. A lie impossible to disprove because people prefer sound bites and TV medical/police procedural dramas to wading through hundreds of articles and dozens of books like I did.

  6. Psychiatry is a rotten fruit of monotheistic hatred for psyche. For monotheistic culture of egoic or spiritual psychopaths,human psyche is evil or satan.

    Monotheistic medicine/science is theological hatred in medical disguise. Theology, church and monotheistic culture of saint haters is against psyche.

    James Hillman “Re -Visioning psychology”
    ————————————————————————————————————————
    Monotheistic and dumb science means nothing compared to human psyche.

    Rationalism? Forget about it.
    It is pure religious hatred in medical disguise.

    • In polytheistic society, it is impossible for psychiatry to survive.Psychiatry would be destroyed by humans for whom their pathology is a value. Now, in spiritual era of egoic psychopats we, as humans, do not even have a roots.

      The problem with monotheistic society is that hey have no guts to deal with death and pathology. The want to believe that death does not exists or that death or illness is an enemy and that psyche and pathology is pure evil.

      So we have an utopia of health ruled by good god which means everything, and on the other side we have evil psyche and somatic illnesses which belongs to satan and hell.

      That is why we do not have a roots. Because we are against our true nature. We are too weak to deal with death and pathology. Society of materialists is a usually a very weak society, in which, power means money. Pathology and illnesses are the main part of life. We have to deal with it. This is real power. To accept death and pathology.And we want to get rid of this part of our nature because of the main need, which is convenient life without so called “problems”. Which are not even a problems to be solved.

      This is Sparta.
      No. This is psyche.

      That is why monotheistic world will be destroyed. Because monotheism have destroyed humanity, first. Human psyche is not evil.Illness is not evil. They are necessities. We do not need health fundamentalism in the place of the truth.

      —————————————————————————————————————-
      We do not need psychiatrists, we need courageous thinking and courageous people.
      We do not need lame psychiatry in the lame monotheistic society. We need psyche in psychological society.
      ———————————————————————————————————————
      We do not need the lame egoic pseudo scientific search for a victims of the psyche.
      We do not need this.

  7. It’s Nice to see you back Dr Niall,

    A lot of people say it’s life that causes “depression”.

    I have a friend who experienced “Mental Unwellness” throughout his life. In his 50s he retrained in Cognitive Behavioural Therapy and practices this professionally now.

    According to him ‘it’s not possible to be depressed without thinking depressed thoughts’. But over the years I have known him he appears happier and happier.

    I overcame my own compulsive anxiety (and melancholy) through Practical Psychotherapy, after withdrawing in the 1980s, from (LAI) drugs suitable for “Schizophrenia”.

    I can easily describe the Psychotherapy Process that worked for me. Most Psychologists are probably trained a long these lines.

    (In the UK 10 times more 2nd generation Afro Caribbean men “get” “Schizophrenia” than do Indigeneous White Men. In my opinion the medical Treatment and Approach is causing this “Schizophrenia”).

  9. Thanks Dr. McLaren for your work! A great piece, very well stated and summarized.

    Per Pies… “Ultimately, the BPSM will allow us to provide “holistic, comprehensive psychiatric care.”
    That’s enough to make a person gag as psychiatry would not know “holistic care” from a hole in the ground.

    Pies states in his piece in Psychiatric Times: “Rebuttals of these claims are almost always dismissed as “Psychiatry defending its guild interests” (as if the purveyors of anti-psychiatry animus have no self-serving motives).”

    The “self-serving motives” of anti-psychiatry I believe are ‘self-preservation’ and preserving the lives and well being of their loved ones and others who are being severely harmed by psychiatry.

  13. Regarding the “bio-psycho-sociocultural model” – there is a newly published article that sheds much light into this issue. It has a section focused on psychiatry as well – here’s the article:

    Karunamuni, N., Imayama, I., Goonetilleke, D. (2020). Pathways to Well-being: Untangling the Causal Relationships Among Biopsychosocial Variables. Social Science & Medicine.

  14. I don’t agree with Niall that “no progress” has been made to resolve the mind-body problem since René Descartes.
    It just hasn’t been made in psychiatry (except for Ian Stevenson’s work). So those who hope to find such a resolution by perusing the psych journals will be disappointed.
    As might be expected, the advances made in resolving the mind-body problem were seen as sufficiently disruptive to Medicine in general that they were strictly ignored, or invalidated if they were ever mentioned. That includes Stevenson’s work, most assuredly.
    In terms of walking forward into a real and workable understanding of mind, the mainstream has a tough problem: As it turns out, that understanding undermines many basic stable data that so many hold dear. The list only starts with “you only live once!”
    I would really like to see a change in this in my lifetime. A lot of hard work has been put into it. Perhaps we are closer to a breakthrough than it seems. I certainly hope so. Those atom bombs have been waiting patiently in their silos for all these years waiting for humanity to grow up and realize it didn’t need them any more. How much longer will their patience last?

    • True. Scientists do not want to move away from the idea that somehow the ‘mind’ is located inside the head. They ignore not only research related to NDEs, but as you say the work of Dr. Ian Stevenson, Jim Tucker and many other researchers – these investigations involved thousands of children and not just a handful.

      • There is really nothing “scientific” about the idea that the mind is synonymous with the brain. It’s a philosophical position posing as a scientific one. A real scientific approach would be to postulate what would predictably result if the mind WERE inside the brain and what would predictably result if it were NOT insde the brain, and then start reasoning from your observations. But since no one can truly define WHAT the mind is, let alone WHERE it resides, the proper scientific knowledge in the sphere is simply, “We don’t know.”

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