Saturday, July 2, 2022

Comments by Niall McLaren

Showing 19 of 20 comments. Show all.

  • You put your finger on the central problem, which is that mainstream psychiatry doesn’t have a model that can incorporate the various facets of human existence. All they have is a reductionist biological model which says that only biology counts. Sure, some psychiatrists pay lip service to the so-called biopsychosocial model (the one that Engel never wrote) but they don’t know what this means. How are psychological factors to be incorporated in a model that doesn’t recognise psychological factors? If you ask a psychiatrist this, any psychiatrist, they will simply stare at you blankly then change the subject (and probably give you the label “borderline”, even though practically none of them know what the border was or how the expression arose).
    They don’t even have a means of assessing people as individuals, I have stood in hospitals in half a dozen countries and watched nurses going through a check-list, ticking boxes and then handing the form to a psychiatrist who quickly scans it, maybe asks one or two brief questions, scribbles a diagnosis somewhere, writes a script and walks away, job done. That’s not psychiatry. This is entirely driven by psychiatry’s inability to deal with the mental aspect of humans, they don’t even have a model of mind, let alone a model of mental disorder, or personality or of personality disorder. And this they call the “science of mental illness.”

  • McLaren N (2017). Electroconvulsive Therapy: A Critical Perspective. Ethical Human Psychology and Psychiatry 19: 91-104. DOI: 10.1891/1559-4343.19.2.91

    McLaren N (2021). Letter: Why should psychiatrists advocate for ECT? Australian and New Zealand Journal of Psychiatry, 55:1020-21.
    https://journals.sagepub.com/eprint/JZSZPV9HZMNJXQE9PQGI/full

    Every claim made on behalf of ECT by its supporters has been refuted, yet still they use it.

  • I don’t accept the term “illness” in relation to mental distress or disturbance, it begs the question of causation. I don’t accept the categorical system of diagnosis (see Chap. 8 of “Humanizing Madness” from 2007). I don’t accept that psychiatric “illnesses” are valid, i.e. they reflect the underlying reality, nor that the criteria are reliable; nor that they are the sorts of things for which drugs and ECT are the appropriate response, nor that these “treatments” are effective. Apart from that, Dr Ghaemi is a nice chap.

  • This was an interview, I did not control the questions. For a consideration of the role of money in the present system, you will need to wait a few months until my study of right wing extremism in the light of the biocognitive model. “Narcisso-Fascism: the psychopathology of right wing extremism” should be published in about November this year. It includes a section comparing the work of Karl Polanyi and the libertarian doctrines of Friedrich Hayek. Polanyi showed that so-called neoliberalism must result in the destruction of society itself and of the natural environment. I believe he was right but you’ll have to judge my case yourself.

  • See my piece on “Why do we lock people up,” MIA 21.03.2022 . My critique of Szasz consists of two chapters in (2012). The Mind-Body Problem Explained: The Biocognitive Model for Psychiatry. He was, by any estimation, a seriously flawed character, full of contradictions. Despite the claims made on his behalf, he had no positive effect on psychiatry as it exists, I think he actually made things worse because it hardened attitudes all round. We’ll have to wait for history’s judgement on him but it won’t be as kind as he and his disciples believe.

  • Logic is the study of valid inference. I use the concept of dual-valued logic pioneered by Leibnitz and brought to modern form by George Boole (a heroic figure) to build the basis of the biocognitive model. Trouble is, human logical processes are inherently biased, so we have to take that into account to build a model of mind, then of mental disorder. That applies to the political establishment just as much as to anybody else, the fact that they live in big houses doesn’t guarantee they make sense. But that’s the system in force now, that’s what we have to deal with.

  • In my 44yrs as a graduated psychiatrist, I was head of a unit authorised to receive detained patients for 3 yrs only. In that time, I dramatically reduced the bed occupancy and the mean duration of admission, to the point where it was possible to close one ward. Also, no ECT was used. However, my position was made untenable by, among many others, the nursing union who saw jobs disappearing. When I left, everything went back to normal. It is possible to practice public psychiatry with minimal reliance on detention but the forces arrayed behind the current concept of “mental disease” are enormous, there are untold hundreds of billions at stake, share prices, union jobs, professional jealousies (yes, that includes psychologists), and above all, the egos of the legions of academic psychiatrists who are making a killing with their so-called “biomedical model.” The one that doesn’t exist. And governments just go along with this, as long as it doesn’t get on 60 Minutes, they don’t care what happens. Governments cannot gain votes by being nice to criminals and mental patients, they can only lose them.

  • This paper does not have a mechanism for integration of the various factors in B, P and S. For that reason, it is not a model in the terms demanded by philosophy of science. However, mainstream psychiatry tells the world that “Yes, we have a model, here it is, Engel wrote it in 1977.” That stops the criticism. But that claim is false, they don’t have the model because it doesn’t exist. So no amount of embellishing or fancy names or anything will alter that fact. These authors were trying to build a superstructure on a mirage.

  • This was an interview, I did not choose the questions. The biocognitive model is offered as a complete alternative to the so- called biomedical model which is just an excuse for psychiatrists to pal up with drug companies. You are probably aware there is no such thing as a “biomedical model,” it does not exist, I showed that in Psychiatry as Ideology. Ethical Human Psychology and Psychiatry 2013, 15: 7-18. Likewise, the so-called biopsychosocial model attributed to George Engel is a mirage, bordering on fraud, as it was never written. The absence of a guiding model of mental disorder allows psychiatry and their drug company allies to operate in an “anything goes” atmosphere, where drugs of addiction are touted as the latest, sure-fire “cure” of the “disease” of depression, at the same time as they are pushing TCMS, anti-inflammatories and still more drugs. My model specifically says that mental disorder is almost entirely psychological so psychological methods of management are the only viable option. However, mainstream psychiatry has sold itself as having a reductionist science of mental disorder and there can be no withdrawal from this position without swarms of professors being forced to admit they were wrong. My experience of professors is they would rather pull their tongues out with pliers than admit they were wrong. But the good news is this: for the first time in its history, psychiatry has an articulated, publicly-available and testable model of mental disorder. Only time will tell whether it gets 1% of the air-time given to the “biopsychosocial Model” and the incompatible “biomedical model.”

  • This is actually a very important question: how come this institution holds power, supremely immune to criticism, able to convince everybody from governments to GPs to commentators and parents that drugs are not just the way to go, but the only way to go. It is a critically important question for the sociology of science. I’m trying to work on it but other things, like drivel from the RANZCP, keep getting in the way.

  • Bramble’s comments are correct. As a trainee, I was told “It’s your turn to give the ECT today.” We didn’t know the patients nor why they were getting it, and it would have been impossible to qualify by refusing to do it. I don’t recall that a consultant ever attended, it was always the senior registrars (residents) who instructed but after the first day or two, there was no further supervision. That’s how it was.

  • Try these:
    McLaren N 2013 Psychiatry as Ideology. Ethical Human Psychology and Psychiatry 15: 7-18.
    McLaren N (2016). Psychiatry as Bullshit. Ethical Human Psychology and Psychiatry 18: 48-57.

    I practice psychiatry because mental disorder is a real thing and people get trapped in terrible states. Every day, people get better but NOT by relying on drugs and ECT.
    I am perfectly aware that Szasz said there is no such thing as mental disorder, that people who claim to be disturbed are pretending but I disagree. See Chaps. 12-13 of:
    McLaren N 2012. The Mind-Body Problem Explained: The Biocognitive Model for Psychiatry. Ann Arbor, MI: Future Psychiatry Press. ISBN 978-1-61599-171-6

  • β€œDespite decades of research, the role serotonin plays in depressive phenotypes has not been conclusively determined,” write the researchers, led by Paul Andrews, a professor of evolutionary psychology at McMaster University.

    This is a classic example of bullshit in psychiatry. What Andrews actually meant was “Nobody has the faintest clue of the role of serotonin (or any other of the 100 or so neurotransmitters that have been identified) in generating the experience of normal emotion, let alone of what we like to think of as pathological states.”

  • The notion that the biopsychosocial model doesn’t exist is quite shocking to people who have long relied on it as a counter to reductionist biopsychiatry (remember that Engel used the term biomedicine).
    A model is a series of propositions relating to an hypothesised mechanism which exists one dimension removed from the observations to be explained. The propositions must be in testable form and must be capable of refutation before it qualifies as a scientific model. Engel did not write it. He outlined a case for it but never actually set down the propositions necessary to allow for a model of mind-body interaction. His concept of mind (which he never specified in detail) was essentially Freudian in concept; nobody these days would accept it as valid science.
    That paper is in Australian and New Zealand Journal of Psychiatry 1998; if you can’t get a copy, email me and I will send one. A revised version is Chap. 8 in my book from 2007, Humanizing Madness.
    The problem for many psychiatrists who endorse Engel’s work is that, without it, what do they have? They use it to fend off the depradations of biopsychiatry but much better models of mind-body interaction are now available, including interaction at the molecular level.

  • This paper was published in “Ethical Human Psychology and Psychiatry” in June this year. It should now be available through medical and other libraries.
    The goal of this work is to hedge the spurious biopsychiatry industry in using its own methods. They say they want fully indexed, reliable scientific work only? OK, let’s see if they meet their own standards. In fact, as we have all known for decades, they don’t. DSM is a scientific farce and cannot ever be rectified. Drug trials are profoundly dishonest (see the irreplaceable Erick Turner’s latest paper, Publication bias in psychiatry: causes and solutions, CNS Drugs (2013) 27:457–468 DOI 10.1007/s40263-013-0067-9, May 22, 2013), ECT is truly medieval in concept and effect, and so on. I have found the same problems in a variety of other areas of biopsychiatry; the good news is that the rising generation of residents (trainees) and medical students are becoming heartily sick of being told everything is a chemical imbalance of the brain. We need to be able to break through the wall of propaganda emitted by NIMH-Big Pharma-Big Academia and show it for what it is. That requires grassroots activity.