Since the onset of the pandemic, misery and mental disorder have increased, raising considerable concern about mental health. It has become obvious that we need to be better at addressing issues related to our psychological well-being. A well-substantiated body of scientific research argues for rejecting psychiatry’s biological/medical paradigm for mental health and mental disorder and replacing it with a social/psychological paradigm.
In 2014, a report from the World Health Organization of the United Nations concluded with the following summary:
A growing research base has produced evidence that the status quo, preoccupied with biomedical interventions, including psychotropic medications and non-consensual measures, is no longer defenseless in the context of improving mental health…Public policies continue to neglect the importance of pre-conditions of poor mental health, such as violence and the breakdown of communities, systematic socioeconomic disadvantage and harmful conditions at work and in schools…Reductive biomedical approaches to treatment that do not adequately address contexts and relationships can no longer be considered congruent with the right to health.
In short, ten years ago the WHO called for a paradigm shift in mental health care. That has not happened. Mental health care is under the control of powerful entities: the profession of psychiatry, drug companies, NIMH, primary care doctors, and insurance companies. They are all committed to a biological/medical model, and they all have turned a deaf ear to the idea of this paradigm shift. Ideology and economic interests furnish the explanation for this resistance.
If the paradigm is to shift the most crucial members on this list are primary care doctors. Primary care doctors are the rank and file of health care. Right now, they believe they have reason to be committed to a biological/medical orientation for their patients’ mental health care as well as for their treatment of physical illness.
Both paradigms are bound by the requirements of the scientific method. Scientific research has verified the value of a biological/medical orientation for physical illnesses. From the Spanish flu in 1918 to Covid-19 in 2019, life expectancy has doubled. The onset of Covid-19 led to more than a million deaths in this country alone, generating a concerted effort to combat this illness by applying the biological/medical paradigm. And because Covid-19 also stirred up increased awareness of problems related to mental health, it provides a tutorial on the science related to both of these paradigms.
The discovery of a successful treatment for the virus responsible for Covid-19 resulted from a long line of research on the nucleic acids, DNA and RNA. Laboratory studies provided the scientific basis for the development of a vaccine. Basic biological research originating in James Watson and Francis Crick’s laboratory led to the discovery of DNA. DNA is the basis for heredity and for constructing the body’s proteins. Proteins keep us alive. Other researchers continued this line of research, leading to the discovery in 1981 of how DNA’s instructions are transferred to RNA and produce proteins. The first major treatment derived from these findings occurred in 1984 when researchers in France and the United States published their research on RNA, which enabled them to develop a drug that coded RNA for the HIV virus, stimulating an immune response for this illness. In 2020, RNA was coded for Covid-19’s protein, resulting in a drug that stimulated the immune response for Covid-19.
However, this successful application of the biological/medical paradigm to our physical health was accompanied by a worsening of our mental health. Because Covid-19 is highly infectious, an important means of curtailing its spread is social isolation. People were urged to work at home and to attend class virtually at home. We stopped going to public places and events; we hunkered down. As social animals, isolation has negative consequences. Sadness, anxiety, and depression increased alarmingly. The solution for a physical illness exacerbated the heightened anxiety and sadness induced by Covid-19, requiring a psychological solution—and that psychological solution was missing. An important lesson of the pandemic is that physical illness and mental disorder are governed by different rules and they require different solutions.
In medical school, medical students are taught lessons based on the biological/medical paradigm—lessons that are confirmed for physical illnesses when these doctors are in practice. It is easy to understand why they would view mental disorder in these same terms. Consequently, primary care doctors are the prime prescribers of psychiatric drugs for patients they view as having a mental disorder.
An examination of the relevant research shows that primary care doctors have been misled. Whereas the scientific story they learned about physical illness is one of respectable science, the story they have been told about mental disorder is a confidence game masquerading as science. They do not know that responsible researchers looking for a biological basis for mental disorder have repeatedly failed. An Editor-in-Chief of the New England Journal of Medicine, Marcia Angell, after reviewing psychiatry’s efforts to verify the biological/medical paradigm, concluded, “They have come up empty-handed.”
Primary care doctors do not know of the evidence I review in my book which shows that the “science” psychiatrists cite for their medical practices has been created out of whole cloth. They do not know that Kenneth Kendler, the premier medical researcher who spent his career studying the origin of mental disorder concluded that psychological trauma, principally experiences of loss, is the cause of mental disorder, not biology, not genetics. The bottom line is that primary care doctors do not know that the results of scientific research support the WHO’s call for a paradigm shift to a social/psychological model for mental health care.
There is an important dictum in science: Absence of evidence is not evidence of absence. We need to be careful when we cite absence of evidence as conclusive. We must have very good reasons for doing so. When the WHO called for this paradigm shift, did they have compelling evidence? They did. Here is why:
First, is psychiatry’s utter failure to find a biological cause for the great majority of mental disorders. Only Down syndrome, dementia, and brain damage from alcohol and drug abuse fit psychiatry’s biological/medical paradigm. This is a very short list, easily recognized as physical. None of the problems we think about when we think about mental disorder—mainly depression and the anxiety disorders—are explained by psychiatry’s biological/medical paradigm, and not for want of trying. Psychiatry’s efforts to validate this paradigm have been unabated for more than a century. Their efforts have consumed many tens of billions of research dollars, to no avail. To put this in context, researchers studying physical illnesses, who also faced significant challenges, have in this same time discovered how to explain and treat not only HIV and Covid-19, but the flu, polio, measles, the mumps, diabetes, hepatitis, tuberculosis, heart disease, cancer…I’ll stop adding to this list, you get the point. The outcome of these two fields of health care is off the chart—in opposite directions. Dr. Thomas Insel, after retiring from his dozen years as director of the NIMH, spending 20 billion dollars on biological research, admitted that he had not been able to improve psychiatric treatment outcomes, reduce hospitalizations, or reduce suicide. What he failed to acknowledge was that all these measures of mental health had worsened with his excessive research funding effort to seek confirmation of the biological/medical paradigm for mental disorder. Perhaps the most revealing truth about psychiatry’s long and expensive effort to find verification for a biological/medical model for mental disorder is that after all these years and all this expense, psychiatry cannot distinguish biologically one mental disorder from another or from normality—or offer medical treatments whose success exceeds placebo.
Second, is psychiatry’s scientifically damning record of malfeasance in the reporting of the results they allege support their medical practices. Data, not assumptions, must dictate conclusions, including conclusions that conflict with the experimenter’s predictions or preferences. When conclusions from research follow directly from the data and not to support a scientist’s beliefs, or worse yet, are deliberately falsified to do so, then, and only then do they meet scientific standards of acceptability. Objective reviews of the record reveal that many studies psychiatrists cite for their practices fail this most foundational requirement of science. Depression is the #1 psychiatric diagnosis. It is treated mainly be drugs. The STAR*D study, published in 2006, is the largest and most expensive study ever done to determine the effectiveness of drug treatments for depression. For decades psychiatrists have pointed to this study whose authors claimed nearly 70% of the patients got better on the drugs. But as early as 2010 that claim was shown to be false: the results had been manipulated to make them appear to be positive. When measured correctly, the short-term benefit of the drugs was no better than placebo in other studies. When measured long-term, the patients did worse than patients on placebo in other studies. The researchers, some of whom were branch chiefs at the NIMH, reported the results fraudulently. Only in the last week has a psychiatric publication acknowledged that the results reported for this foundational study were completely misrepresented and major newspapers still have not reported this story. A fuller picture of psychiatry’ scientific fraud is provided by Eric Turner’s research. Turner reviewed all the drug outcome studies published during the two decades that followed psychiatry’s adoption in 1980 of their biological/medical paradigm. He found 74 publications of twelve different antidepressant drugs. Psychiatric researchers claimed 94% had positive results, but the FDA’s review of these studies found positive results for only half that number. Turner showed how psychiatric researchers had “spun” the negative results to make them positive by substituting secondary measures as if they had been primary. Their fabrications to make the results positive ranged from 11% to 69%. Psychiatrists know the chemicals in their drugs don’t work. They have made certain you don’t know it.
Third, there is an abundance of scientific evidence that human behavior is primarily a product of learning, not the biology of instinct or illness. We are who we are largely because of our learning experiences. Behavioral psychologists have focused their research on how learning takes place. This has led to the discovery of principles of learning. Importantly, this research has shown that disordered behaviors follow the same predictable rules as other behaviors. Despite miniscule funding compared to the financing of the biological/medical paradigm, behavioral researchers have produced a coherent body of validated, empirical evidence for the cause of mental disorder. They have specified how these dysfunctional behaviors are acquired by reinforcement, how they are maintained, and how they can be treated successfully. Behavioral psychology began with Ivan Pavlov’s study in 1897 of the conditioning of a dog to salivate to a bell. A neutral stimulus (the bell) acquired the response (salivation) previously only occurring physiologically. He called this learning process classical conditioning. Pavlov’s research launched considerable basic and applied research exploring the ramifications of this form of learning. Advertising is built on this principle. Classical conditioning is the science behind all those TV ads you watch that rake in big bucks by featuring dancing, joyous people using their products. At the top of the list of advertisers are the drug companies, who although financing psychiatry’s failed biological/medical stance, know that the way to promote their products is by applying verified social/psychological science. Among the mental disorders, phobias are learned by classical conditioning. The best treatment for phobias is systematic desensitization, which is based on applying classical conditioning principles to treat this mental disorder. B. F. Skinner’s research explains a second basis for learning, which he called operant conditioning. This form of learning plays an even larger role in our lives. A response that is followed by something we value causes that response to occur more frequently. It is the science validating praise and the rewarding of good behavior, a process called positive reinforcement. The frequency of a response also can be increased if the response removes something we dislike. This is called negative reinforcement, and it explains avoidance behavior which is the most verified basis for the cause of many mental disorders and supplies the key to our most effective psychological treatments. Alcohol and drug abuse are examples of mental disorders caused by positive reinforcement. OCD is an example of a mental disorder under the control of negative reinforcement. There is evidence that negative reinforcement is central to depression. A third form of learning is called Observational Learning, which occurs when we copy someone else’s behavior. We owe many of our valued skills to this form of learning. An aspiring artist goes to an art museum to copy a work of art. This form of learning is suspected to be largely responsible for psychopathic behavior. Behavioral psychology recognizes that we are social animals, and the reinforcement systems governing learning are rooted in our biology. However, unlike lower animals, an abundance of research verifies that our behavior is primarily a function of learning. Dysfunctional learning, not biology, furnishes the explanation for mental disorder and behavioral treatments have been shown to be the most effective treatments for depression and the anxiety disorders—the most frequently diagnosed mental disorders—with outcomes that exceed the placebo effect and get better with time. Behavioral psychology originated as a protest against popular psychological theories that had no empirical verification. And the same hard-nosed insistence on scientific substantiation is now challenging psychiatry’s biological/medical paradigm. It is this body of fine-grained scientific evidence—psychological, not biological—that informs the justification for the WHO’s call for a paradigm shift to a social/psychological explanation for mental disorder. Quite clearly, these behavioral studies are not nearly as advanced or as informative as the biological research I reviewed related to Covid-19. But they follow the same, scientifically respectable path and they point the way to studies that need to come next for mental disorder to be more fully understood and treated more successfully. Most importantly for this discussion, this methodology is an empirically verified social/psychological paradigm that is the product of science, not chicanery.
In sum, the greater effectiveness of behavioral treatments over psychiatric “care” should not be surprising. Behavioral science informs the behaviors we engage in on a daily basis—behaviors we know will work for us. Their value is so well accepted and so prevalent that we barely acknowledge our reliance on them and our confidence in them, viewing them as common sense. Only psychiatry has rejected this truth in favor of drugs that have no scientific justification, choosing to peddle snake oil instead. We are being snookered. As Irving Kirsch, the world’s leading expert on the placebo effect, has written, psychiatric mental health “care” is today’s rendition of The Emperor With No Clothes.
The WHO’s call in 2014 for paradigm change has been answered by some important allies, one even outside of the mental health community. A highly regarded book by two economists, Angus Case and Anne Deaton, describes how psychological trauma—social/psychological factors—leads to mental disorder. In an article in MIA last month, “Mental Disorder has Roots in Trauma and Inequality, not Biology,” I cited some other recent voices challenging psychiatry’s biological/medical paradigm. The latest article is by Elizabeth Svoboda in this month’s Scientific American. She details the benefit of a behavioral intervention with teenagers as a means of preventing depression. Ordinarily behavior therapy is directed at those diagnosed with a mental disorder, helping them to replace dysfunctional behaviors with functional behaviors. This study demonstrates how teenagers can be taught functional behaviors preemptively. We need to ask: What might these results suggest for the design of additional studies to improve our success in addressing the social isolation that will be made necessary by a future outbreak of a highly infectious pandemic? The article also is informative in another way. It illustrates how even those who recognize the greater value of behavioral treatment can have a problem understanding the basis for this superiority. Rather than citing the scientifically validated behavioral research that led to the development of this form of treatment, the author cites images of brain changes as if that is what is necessary for verification.
The media regularly carries stories aligned with the biological/medical paradigm, plainly preferring it, thereby contributing significantly to people being enamored of brain “explanations” for mental disorder. Beginning with our parents, authority figures shape many of our beliefs, sometimes to our detriment. Paradigms are beliefs. In behavioral terms, beliefs are cognitions and cognitions are behaviors. In scientific terms, beliefs are hypotheses to be tested by collecting data according to the rules of the scientific method. The scientific record supports a social/psychological paradigm, not a biological/medical paradigm for mental disorder.
Behavioral research, tested by the scientific method, has found that once a behavior has been established, it is resistant to change. Paradigm shifts are not easily accomplished. The WHO’s call has not been answered and many people continue to be victimized by psychiatry’s adherence to a model that exists to satisfy guild interests, not science. This is a tragedy. History suggests that as the compelling evidence continues to grow, as it surely will, truth eventually will win out.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
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