Professor Sir Simon Wessely is a British psychiatrist who works at the Institute of Psychiatry, King’s College, London. He is also the new President of the Royal College of Psychiatrists, and in that capacity, he recently wrote his first blog, titled, appropriately enough, My First Blog (May 24, 2014). The article is essentially a perusal of, and commentary on, the program for the RCP’s Annual Congress, about which Sir Simon expresses considerable enthusiasm. He also engages in a little cheerleading.
“…we [the RCP] are the most democratic of colleges. We welcome the views of patients and carers…”
This statement struck me as odd, because it’s not so long ago (December 20, 2013) that I read a post by British psychiatrist Joanna Moncrieff, Psychiatry has its head in the sand: Royal College of Psychiatrists rejects discussion of crucial research on antipsychotics. In this article, Dr. Moncrieff describes how she approached the RCP 2014 Conference planning committee, and asked that a symposium on “Re-evaluating antipsychotics – time to change practice” be included in the program. To her surprise, this proposal was rejected on the grounds that there were too many competing suggestions.
Dr. Moncrieff’s proposal was based on two ground-breaking studies (Ho, BC, Andreasen, NC, et al; and Wunderink L, et al.), both of which, at the very least, raise serious concerns about psychiatry’s current use of neuroleptic drugs. This certainly seems important, but in fairness to the RCP, perhaps there were topics of even greater moment, and Dr. Moncrieff’s suggestion simply couldn’t be accommodated.
Curious as to what these topics might be, I took a look at the conference schedule, and found a few entries that might conceivably have been nudged aside for Dr. Moncrieff’s proposed symposium. These include:
- Developing your teaching portfolio
- Succeeding as a new consultant
- Leadership development for the jobbing psychiatrist – what we all need to know
- Private practice
- Advanced communication skills for public engagement
- Making parity a reality
- How to get into Academic Psychiatry
And just possibly:
- Debate – Hamlet’s Ophelia: was it suicide?
In fairness to Prof. Wessely, he probably didn’t have much hand in the design of the program. (He’s the incoming President.) But he must have been aware of the College’s rejection of Dr. Moncrieff’s suggestion, and he might have expressed some regrets about this matter rather than asserting platitudinously that the RCP is the “most democratic of colleges,” that welcomes the “…views of patients and carers.”
Anyway, there’s lots more cheerleading in Prof. Wessely’s post, including:
“…psychiatry, like all branches of medicine…”
“We do not shy away from controversy…”
“[Attenders] will be left in no doubt about the prevalence and public health impact of the illnesses that lie at the heart of psychiatry.”
“…the endless fascination of psychiatry.”
“…the state of psychiatry is good.”
“…the importance of psychiatry in the modern health service.”
This is the kind of thing that we’ve come to expect from organized psychiatry in recent years, and it adds little to the current debate. But there was one statement in Dr. Wessely’s article that I would like to address in more detail:
“Any lingering doubts that psychiatry is not scientific will hopefully be dispelled, since the science of psychiatry is on constant display from the start to the finish of the conference.”
I think it would be accurate to say that the most fundamental principle in modern psychiatry is that all significant problems of thinking, feeling, and/or behaving are illnesses, caused by chemical imbalances or other putative neurological anomalies. The first part of this principle has been enshrined explicitly in the DSM’s definition of a mental disorder since DSM-III, and implicitly since DSM-II. The second part has been promoted vigorously by psychiatry for decades. This proposition is fundamental in the sense that from it, everything that psychiatry does, and stands for, flows.
The statement is also an assumption, proof of which has never been provided. Nor is the assumption self-evident. In fact, as those of us on this side of the issue have contended for decades, there are more parsimonious, and more helpful, ways to conceptualize these problems. The inattention, hyperactivity, and impulsivity characteristic of the condition labeled ADHD, for instance, can be conceptualized simply as a failure on the child’ part to acquire certain skills and habits that are considered appropriate for his age. Depression can be conceptualized as a normal response to loss, or to an unfulfilling, treadmill kind of life. And so on.
In science, of course, it’s perfectly OK to start off with an assumption (scientists call them hypotheses), and to design and execute experiments/studies to test their truth or falsity. But psychiatry has never established the truth of its core assumption. In fact, all attempts in this area have failed! So – instead of debunking this cherished assumption, as real scientists would have done, they have simply assumed it to be true, and have steadily promoted its acceptance through endless repetition, manipulation of the media, and vigorous condemnation of critics.
Then, to create the impression of science, they have conducted vast numbers of studies and trials, all designed to test various peripheral matters, but all ultimately depending for their validity on the core assumption. This isn’t science. It is nonsense, dressed up as science.
To illustrate this, let’s consider another assumption that is nonsensical: that all criminal activity is ultimately the result of alien abduction during infancy. Let’s suppose that I, basking in the narcissistic, error-prone grandiosity of which supporters of psychiatry sometimes accuse me, subscribe to this belief. Let’s further suppose that, to promote and study this core assumption, I start a new scientific discipline, which for want of a better term, I’ll call E.T.ology.
So I build a website, and attract a following, and we set about conducting E.T.ology studies to support our contention. We produce numerous papers showing that crime is most prevalent in areas where UFO sightings are most frequent. We demonstrate, through various statistical analyses, that criminals received less than average parental supervision during infancy, rendering them more vulnerable to alien abduction. And so on. And we publish these studies in our very own Journal of E.T.ology. We also speculate as to what the aliens actually do to their victims to instill the seeds of future lawlessness, and in this regard our scientists use colorful pictures of criminals’ brains to demonstrate chemical imbalances, neural circuitry anomalies, and other evidence of tampering. We develop and publish a manual for the early detection of abduction victims. The manual lists items like: failure to conform to age-appropriate social norms, deceitfulness, impulsivity, irritability and aggressiveness, recklessness, spitefulness, defiance, etc…
We have impressive-looking graphs and tables in our journal articles. We use statistical terms like correlation-coefficient, standard deviation, confidence interval, risk ratios, etc., with an easy familiarity, and we dismiss the protests of dissenting voices as the bigoted railings of anti-science deniers. We construct a sophisticated propaganda apparatus, and in our annual conferences, we have sessions on “advanced communication skills for public engagement” and related topics. We develop close ties with politicians from all branches of government, and from all corners of the political spectrum, and we advocate relentlessly for the creation of “space-shields” to protect infants from these alien invaders, who are robbing our children of their future.
We also, and entirely coincidentally, receive considerable financial support from the manufacturers of space-shield technology.
In this analogy, it’s easy to see that what we have created is not science, but a travesty. It is a travesty because we will not subject our core assumption to serious scrutiny, and because we routinely allow our commitment to this assumption to direct and taint our discussions and our research efforts. What we have built is a sandcastle, which however, impressive it may seem, has no defense against a flowing tide, and must ultimately collapse.
Similarly, psychiatry, despite decades of failed attempts at validation, continues to cling to its core assumption –that all significant problems of thinking, feeling, and/or behaving are illnesses. This spurious assumption underlies, drives, and ultimately invalidates everything they do, and stand for.
It is also the fundamental justification for their existence as a profession. If the core assumption were to go away, as eventually it must, then psychiatry, as it presently operates, will cease to have any relevance or purpose, and will simply collapse. In fact, it would have collapsed long ago, but for the massive, ongoing financial support that it receives directly and indirectly from its symbiotic, and incidentally corrupt, relationship with pharma.
So when Professor Wessely writes that “…the science of psychiatry is on constant display from the start to the finish of the conference,” he’s referring to the sandcastle. He’s admiring the well-sculpted towers and turrets, the arched windows, and the pennants streaming in the sea breeze. But he’s ignoring the fact that the edifice, of which he is so proud, has no foundation. And he also, apparently, hasn’t noticed that the tide is coming in.
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This article has also been posted at the Mad in America site