Thursday, November 3, 2011

On psychiatry

A longer---and syntactically corrected version by Greg Johnson---of this article can be found here.




Why psychiatry is a false science

by César Tort

Abstract

Psychiatry is not a science. As a Popperian philosopher of science would easily notice, the way psychiatrists present their hypotheses on the diverse neuroses and psychoses—biological diseases “of unknown etiologies”—makes them non-falsifiable or irrefutable biological hypotheses.

Thus, an irrefutable hypothesis is a sure-fire sign of a pseudoscience.

—Terence Hines [1]


Debunking psychiatry

According to Ron Leifer, there have been four parallel critiques of psychiatry: Thomas Szasz’s conceptual and logical critique of the mental illness idea; Leifer’s own parallel critique of social control through psychiatry; Peter Breggin’s medical evaluation of the assaults on the brain with drugs, electroshock and lobotomy; and the cry of those who have been harmed by it.[2]

Another way to question the validity of psychiatry is to examine the scientific basis of biological psychiatry. This fifth parallel critique, which I would call the evaluation of the scientific status of psychiatry, takes psychiatry to task on its own theoretical base. Exponents of this late strategy have focused on the various bioreductionist claims and logical fallacies in psychiatry; [3] on the dubious science behind psychopharmacology, [4] and on statistical analyses that show that poor countries with few psychiatric drugs called neuroleptics (“antipsychotics”) fare much better in the treatment of people in psychotic crisis than the rich countries.[5] In this article I shall present an apparently innovative way to call into question the scientific status of biological psychiatry.

However odd it may seem, biopsychiatry has not been attacked from the most classic criteria to spot pseudosciences: Karl Popper’s test that distinguishes between real and false science, and the principle known in science as Occam’s razor. Both of these principles have been very useful in the debunking of paranormal claims, as well as biological pseudosciences such as phrenology.[6] I will argue that it is in this latter framework of biological pseudosciences that psychiatry can be recognized and understood.


Bunge’s argument

Mario Bunge, the philosopher of science, maintains that all pseudosciences are sterile. Despite of its multimillion-dollar sponsoring by the pharmaceutical companies, biological psychiatry remains a sterile profession today.[7]

Despite its long history of biological theories since 1884 when Johann Thudichum, the founder of modern neurochemistry, believed the cause of madness were “poisons fermented in the body” to the current dopamine theory of schizophrenia, psychiatrists have been unable to find the biological cause of the major disorders listed in the Diagnostic and Statistical Manual of Mental Disorders.[8] This lack of progress was to be expected. If the biologicistic postulate on which psychiatry lays its foundational edifice is an error, that is to say, if the cause of mental disorders is not somatogenic but psychogenic, real progress can never occur in biological psychiatry; and the subject of mental disorders should not belong to medical science but to psychology. Nancy Andreasen, the editor of the American Journal of Psychiatry, the most financed and influential journal of psychiatry, recognizes in Brave New Brain, a book published in 2001, that:

❍ there has not been found any physiological pathology behind mental disorders;
❍ nor chemical imbalances have been found in those diagnosed with a mental illness;
❍ nor genes responsible for a mental illness have been found;
❍ there is no laboratory test that determines who is mentally ill and who is not;
❍ some mental disorders may have a psychosocial origin.[9]

A better proof of sterility in biopsychiatry can hardly be found. It is worth saying that Andreasen’s book has been tagged as “the most important psychiatry book in the last twenty years.”[10]

The above points show us why, since its origins, psychiatry and neurology are separated. While neurology deals with authentic brain biology, we can assume that psychiatry may be searching for a biological mirage.


Popper’s “litmus paper” test

In The Logic of Scientific Discovery philosopher of science Karl Popper tells us that the difference between science and pseudosciences lies in the power of refutability of a hypothesis.[11] Despite its academic, governmental and impressive financial backing in the private sector, psychiatry does not rest on a body of discoveries experimentally falsifiable or refutable. In fact, the central entity in psychiatry, the concept of mental illness—say “schizophrenia”—cannot be put forward as a falsifiable or refutable hypothesis.

Let us consider the claim that psychiatrists use the drugs called neuroleptics to restore the brain chemical imbalance of a schizophrenic. A Popperian would immediately ask the questions: (1) What is exactly a brain chemical imbalance? (2) How is this neurological condition recognized among those who you call schizophrenics and which lab tests are used to diagnose it? (3) Which evidence can you present to explain that the chemical imbalance of the so-called schizophrenic has been balanced—or has not been balanced—as a result of taking the neuroleptic?

Before these questions the psychiatrist answers in such a way that he who is unfamiliar with the logic of scientific discovery will have great difficulties in detecting a trick. For instance, Andreasen has acknowledged that there have not been found biochemical imbalances in those diagnosed with a mental illness and that there is no laboratory test that determines who is mentally ill and who is not. That is to say, Andreasen is recognizing that her profession is incapable of responding to the second and third questions above. How, then, does Andreasen and her colleagues have convinced themselves that neuroleptics restore to balance the “chemically unbalanced” brains of schizophrenics? Furthermore, why does Andreasen have stated so confidently at the beginning of the section in Brave New Brain that addresses the question of what causes schizophrenia that the disorder “is not a disease that parents cause”?

Speaking in Popperian terms the answer is: by contriving a non-falsifiable or irrefutable hypothesis. In contrast to neurologists, who can demonstrate the physiopathology, histopathology or the presence of pathogen microorganisms, Andreasen and other psychiatrists recognize that they cannot demonstrate these biological markers (faulty genes or biochemical imbalances) that they postulate in the major disorders classified in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-IV. If they could do it, psychiatry as a specialty would have disappeared and its body of knowledge merged in neurological science. What psychiatrists do is to state that after almost a century of research in, for instance, schizophrenia, the medical etiology of the “disease” is still “unknown,” and they claim the same of many others DSM-IV behaviors. As Thomas Szasz has observed, in real medical science physicians observe the pathological alterations in the organs, tissue and cells as well as the microbial invasions, and the naming of the disease comes only after that. Psychiatry inverts the sequence. First it baptizes a purported illness, be it schizophrenia or any other, and the existence of a biological marker is never discovered, though it is dogmatically postulated.[12] A postulate is a proposition that is accepted without proof. Only by postulating that these disorders are basically genetic and that the environment merely plays a “triggering” role can psychiatrists justify to treat them by physical means. But if neuroses and psychoses are caused by parental abuse, to treat them with drugs, electroshock or lobotomy only “re-victimizes” the victim.[13]

In the 1930s, 40s, 50s and 60s tens of thousands of lobotomies were performed in the United States, [14] but since the advent of neuroleptics only about two hundred chirurgical lobotomies are performed each year in the world. About 100,000 people are being electro-shocked every year in the United States alone, many against their will.[15] North America consumes about 90 per cent of the world’s Ritalin for American and Canadian children. Many parents, teachers, politicians, physicians and almost all psychiatrists believe in these “medical model” treatments for unwanted behaviors in children and teenagers.

On the other hand, the “trauma model” is an expression that appears in the writings of non-biological psychiatrists such as Colin Ross. Professionals who work in the model of trauma try to understand neurosis and even psychosis as an injury to the inner self inflicted by abusive parents during their childhood.[16] The psyche of a child is very vulnerable to persistent abuse while in the process of ego formation. Although some books of the proponents of the old existential and “schizophrenogenic” mother are still in print, [17] today the model is better explained in the case-stories writings of compassionate psychologists such as Alice Miller.[18] In a moving and yet scholarly autobiography John Modrow maintains that an all-out emotional attack by his parents caused a psychotic crisis in his adolescence.[19] Despite claims to the contrary, the trauma model of psychosis is still alive. Only in 2004 two academic books were released on the subject, [20] and in the Journal of Psychohistory Lloyd deMause still suggest that the gamut of mental disorders, from the dissociative states and psychoses of ancient times to the neuroses of today, are consequence of child abuse.[21]

Let us take as an example an article published in a July 2002 Time magazine. The author used the case of Rodney Yoder, abused during his childhood and as adult hospitalized in a psychiatric hospital in Chester, Illinois. From the hospital Yoder has undertaken an internet campaign for his liberation. Catching on the favorite phrases of psychiatrists the Time writer tells us: “Scientists are decades away [my emphasis] from being able to use a brain scan to diagnose something like Yoder’s alleged personality disorders.” [22] In the same line of thinking, Rodrigo Muñoz, a former president of the American Psychiatric Association in the 1990s, stated in an interview: “We are gradually advancing to the point when we will be able [my emphasis] to pinpoint functional and structural changes in the brain that are related to schizophrenia.” [23] That is to say, psychiatrists recognize that at present they cannot understand a mental disorder through purely physical means, though they have enormous faith they will in the near future. Hence it is understandable what another psychiatrist told the Washington Post: “Psychiatric diagnosis is descriptive. We don’t really understand psychiatric disorders at a biological level.” [24] Psychiatrists only rely on conduct, not on the individual’s body, to say that there is an illness. Child psychiatrist Luis Méndez Cárdenas, the director of the only public psychiatric hospital in Mexico which specializes in committing children, told me in a 2002 interview: “Since the cause of any disorder is unknown, the diagnosis is clinical.”

More to the point, in February 2002 I debated psychiatrist Gerard Heinze, the director of the Instituto Nacional de Psiquiatría (the Mexican equivalent to the American National Institute of Mental Health or NIMH.) Arguing with Heinze I rose the question of the lack of biological markers in his profession. Heinze answered enumerating two or three diseases that medical science has not fully understood; he tried to make the point that mental disorders are in this category of still incomprehensible diseases. For example, until 2006 the Hutchinson-Gilford syndrome, which makes some children start to age since their childhood, was an authentic biomedical disease of unknown etiology. But its existence was not controversial before 2006: it was enough to see the poor aged children to know that their problem was clearly somatic. On the other hand, diagnoses of the alleged psychiatric disorders are so subjective that their inclusion in the DSM has to be decided by votes in congresses of influential psychiatrists. Heinze’s point would not have strained my credulity to the breaking point if most of the 374 DSM-IV diagnoses were already proven biomedical illnesses with only a few of them remaining as mysterious diseases. But we are asked to believe that virtually all of the DSM behaviors are mysterious diseases “of unknown etiology”.

One last example related to a 2003 hunger strike of psychiatric survivors in Pasadena, California, who demanded scientific proof of mental illness as a genuine biomedical disease, will illustrate this attitude.[25]

The hunger strikers’ demand was addressed to the American Psychiatric Association and the offices of the Surgeon General. Psychiatrist Ron Sterling dismissed the strikers’ demand for positive scientific proof describing the mental health field in the following way: “The field is like cardiology before cardiologists could do procedures like electrocardiograms, open-heart surgery, angiograms and ultrasound [...]. Since brain structure and physiology are so complex, the understanding of its circuitry and biology are in its infancy.”[26] The Surgeon General Office did not even bother to respond. However, in a statement released in September 2003 the American Psychiatric Association conceded that:

“Brain science has not advanced to the point where scientists or clinicians can point to readily discernible pathologic lesions or genetic abnormalities that in and of themselves serve as reliable or predictive biomarkers of a given mental disorder or mental disorders as a group […]. Mental disorders will likely be proven [my emphasis] to represent disorders of intracellular communication; or of disrupted neural circuitry.”


The trick to be noticed in the above public statements is that psychiatrists, physicians all things considered, are stating that even though the etiology of mental disorders is unknown such etiology is, by definition, biological, and that it is only a matter of time that it will likely be proven. This is the hidden meaning of the code word “of unknown etiology.” By doing this psychiatrists dismiss in toto the work of the many researchers who have postulated a psychogenic origin of mental distress and disorders.

Although it is more parsimonious to consider a psychological cause for a mental disturbance that has no known biological markers, with its somatogenic dogma orthodox psychiatry ignores the simplest hypothesis, the model of trauma. To inquire into Yoder’s childhood, for instance, is axiomatically dismissed in a science that clings to only one hypothesis. In other words, by talking of unknown etiologies that will be discovered in the future by medical science —never by psychologists—, these physicians have presented us a biological hypothesis of mental disorders in such a way that, even if wrong, cannot be refuted.

Conversely, if psychiatrists were true scientists they would present their biological hypothesis under the falsifiability protocol that Popper observed in hard sciences.

Let us consider the hypothesis: “At sea level water boils at 40º C.” This is a scientific hypothesis in spite of the fact that the proposition is false (water does not boil at 40º but at 100º C). The hypothesis is scientific because it is presented in such a way that it just takes putting it to the test in our kitchen with a thermometer to see if it is true or not: if water does not boil at 40º C, the hypothesis is false. In other words, according to Popper the scientific quality of a hypothesis does not depend on whether the hypothesis is true, but however paradoxical it may seem, it depends on whether the hypothesis may be refuted assuming it is false. Thus the hypothesis that at present water boils at 40º C can be refuted: it is a scientific hypothesis. On the other hand, the hypothesis that schizophrenia and the other major mental disorders are biological and that this “will likely be proven,” the words of the American Psychiatric Association, cannot be refuted: it is not a scientific hypothesis. Against this biological hypothesis there is no possible evidence at present, that is, there is no empirical evidence which can show that the hypothesis is wrong.

This is the sure-fire sign of a pseudoscience.


Conclusion

True scientists, say, geologists or biologists, never postulate their central hypotheses, tectonic plates and the principle of natural selection, as non-falsifiable hypotheses that “will likely be proven.” It is the futuristic stance of psychiatrists what gives the lie to the claim that their belief system is scientific.

A pseudo-science is a belief system that pretends to be scientific. Psychiatry is not the only biological pseudoscience, but it exhibits the same unequivocal signs of pseudoscience present in every system that pretends to be scientific. Other biological pseudoscientists such as phrenologists or the communist proponents of Lysenko-Michurinism did not comply with the Popperian requirement of presenting their conjectures in falsifiable form either. In this article I cannot deal with communist pseudoscience. Be it enough to say that all pseudosciences, biological or paranormal, have four things in common. Just as its biological sisters (phrenology and Lysenko-Michurinism) and its paranormal cousins (e. g., parapsychology and UFOlogy), psychiatry is a “science” that (1) presents its central hypothesis in a non-falsifiable way; (2) idolizes in perpetuity that sole hypothesis; (3) violates the economy principle by ignoring the more parsimonious alternative, and (4) is completely sterile. After decades of research neither phrenologists nor psychiatrists nor parapsychologists nor ufologists have demonstrated the existence of the (alleged) phenomena they study.

In other words, psychiatrists do not have medical or scientific evidence to back their claims. Psychiatrists’ recognition that they cannot tell us anything about the above-mentioned question—with which lab tests do you diagnose this so-called neurological condition?—demonstrates that their schizophrenia hypothesis is unscientific. The same can be said of ADHD, bipolar “illness,” depression and the other major DSM disorders.

In a nutshell, psychiatry is not a science.

Since the middle 1950s the lack of a mental health science in the medical profession has been compensated by an invasive marketing and the aggressive sales of psychiatric drugs by the pharmaceutical companies.[27]


References

[1] Terence Hines, Pseudoscience and the paranormal: a critical examination of the evidence. New York: Prometheus Books, 1988, p. 2.

[2] Ron Leifer, “A critique of medical coercive psychiatry, and an invitation to dialogue,” Ethical Human Sciences and Services, 2001, 3 (3), 161-173 (the journal has been renamed Ethical Human Psychology and Psychiatry).

[3] Colin Ross & Alvin Pam, Pseudoscience in biological psychiatry: blaming the body. New York: Wiley & Sons, 1995.

[4] Elliot Valenstein, Blaming the brain: the truth about drugs and mental health. New York: Free Press, 1998.

[5] Robert Whitaker, Mad in America: bad science, bad medicine, and the enduring mistreatment of the mentally ill. Cambridge, Massachusetts: Perseus, 2001.

[6] The Committee for the Scientific Inquiry, that publishes the bimonthly Skeptical Inquirer and whose members included luminaries such as Martin Gardner, Isaac Asimov and Carl Sagan, has been a think tank in the debunking of pseudosciences since 1976.

[7] Ethical Human Psychology and Psychiatry, a journal by a group of mental health professionals, specializes in criticizing biopsychiatry.

[8] For a critical review of the dopamine theory of schizophrenia see for example Valenstein, Blaming the brain, pp. 82-89; Ross and Pam, Pseudoscience, pp. 106-109.

[9] Nancy Andreasen, Brave new brain: conquering mental illness in the era of the genome. New York: Oxford University Press, 2001.

[10] Ty Colbert, book review in Ethical Human Sciences and Services, 2001, 3 (3), p. 213.

[11] Karl Popper, The Logic of Scientific Discovery. New York: Routledge, 2002, chapters 4 and 6 esp.

[12] See for example Thomas Szasz, Pharmacracy: medicine and politics in America. Connecticut: Praeger, 2001.

[13] César Tort, "Cómo asesinar el alma de tu hijo" in Hojas Susurrantes, 2011, pp. 115-227.

[14] As to date Whitaker’s Mad in America is the most readable exposé I know of the darkest period in American psychiatry.

[15] Ibid.

[16] See for example Silvano Arieti, Interpretation of schizophrenia. New Jersey: Aronson, 1994. Originally published in 1955, this celebrated treatise is worth revisiting.

[17] See for example Ronald Laing, The divided self: an existential study in sanity and madness (Selected works of R.D. Laing, 1). New York: Routledge, 1999.

[18] Alice Miller. For your own good: hidden cruelty in child-rearing and the roots of violence. New York: Farrar, Straus and Giroux, 1983. See also Miller’s Breaking down the wall of silence: the liberating experience of facing painful truth. New York: Dutton, 1987.

[19] John Modrow, How to become a schizophrenic: the case against biological psychiatry. New York: Writers Club Press, 2003.

[20] Colin Ross, Schizophrenia: an innovative approach to diagnosis and treatment. New York: Haworth Press, 2004. See also John Read, Loren Mosher and Richard Bentall, Models of madness. New York: Routledge, 2004.

[21] See Lloyd deMause’s chapter “The Evolution of the Psyche and Society” in The Emotional Life of Nations. New York: Other Press, 2002.

[22] John Cloud, “They call him crazy,” Time, 15 July 2002.

[23] Rodrigo Muñoz, quoted in Jeanette De Wyze, “Still crazy after all these years,” San Diego Weekly Reader, 9 January 2003.

[24] Thomas Laughren, quoted in Shankar Vedantam, “Against depression, a sugar pill is hard to beat: placebos improve mood, change biochemistry in majority of trials of antidepressants,” Washington Post, 6 May 2002.

[25] Fred Baughman, Peter Breggin, Mary Boyle, David Cohen, Ty Colbert, Pat Deegan, Al Galves, Thomas Greening, David Jacobs, Jay Joseph, Jonathan Leo, Bruce Levine, Loren Mosher and Stuart Shipko, “15 December 2003 reply by scientific panel of the Fast for Freedom in Mental Health to the 26 September statement by the American Psychiatric Association” (I read it in mindfreedom.org).

[26] Ron Sterling, “Hoeller does a disservice to professionals,” op-ed rebuttal, The Seattle Post-Intelligencer, 9 September 2003.

[27] Valenstein, Blaming the brain.

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