Why psychiatry is a false science
Provided as a public service by
Gary Konigsberg of http://totalitarian-pseudoscience.org
Why psychiatry is a false science
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 (1988, p. 2)
Introduction
According to Ron Leifer, there have been four parallel critiques of psychiatry: (1) Thomas Szasz’s conceptual and logical critique of the mental illness idea; (2) Leifer’s own parallel critique of social control through psychiatry; (3) Peter Breggin’s evaluation of the assaults on the brain with drugs, electroshock and lobotomy; and (4) the cry of those who have been harmed by it (Leifer, 2001). Another way to question the validity of psychiatry is to examine the conceptual basis of biological psychiatry itself. This fifth parallel critique, which I would call (5) 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 (Ross and Pam, 1995); on the dubious science behind psychopharmacology (Valenstein, 2002), 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 (Whitaker, 2001). 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 criterion 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 and nazi eugenics (for a critical review of the eugenics movement, see Whitaker, 2001). I will argue that it is in this latter framework of biological pseudosciences that biopsychiatry can be recognized and understood (how psychiatry violates Occam’s principle will have to be fully dealt in another article).
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. The ubiquitous propaganda by the companies and the media system in the last decades have deceived society into believing in a continuous series of breakthroughs in biopsychiatry (see Valenstein, 2002). However, there has been no real scientific progress in the profession (see e.g. Arieti, 1994; Whitaker, 2001; Modrow, 2003 and an entire journal devoted to the debunking of biopsych, Ethical Human Psychology and Psychiatry, created by psychiatrist Peter Breggin). 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 any behavior of the Diagnostic and Statistical Manual of Mental Disorders (for a critical review of the dopamine theory of schizophrenia see e.g. Valenstein, 2002, pp. 82-89; Ross and Pam, 1995, pp. 106-109, Modrow 2003). 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 organic but psychosocial, 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.
A better proof of sterility in biopsychiatry can hardly be found. It is worth saying that Andreasen’s book (Andreasen, 2001) has been tagged as “the most important psychiatry book in the last twenty years” (Colbert, 2001, p. 213).
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 an hypothesis (Popper 2002, chapters 4 and 6 esp.). 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 an 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 (the Popperian touch)— as a result of taking the neuroleptic? Before these questions the psychiatrist answers in such a way that he who is not familiar with the logic of scientific discovery will have great difficulties in detecting a trick. For instance, Andreasen acknowledged that there have not been found biochemical unbalances 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 I asked in this paragraph. How, then, does Andreasen and her colleagues have convinced themselves that neuroleptics restore to balance the “chemically unbalanced” brains of “schizophrenics”? Furthermore, why Andreasen has 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, whether faulty genes or biochemical imbalances, that they postulate in the 374 human behaviors 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 would have 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 the other hundreds of DSM 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 (see e.g. Szasz, 2001). A postulate is a proposition that is accepted without proof. Only by postulating that these disorders are basically biological and that the environment merely plays a “triggering” rol can psychiatrists justify to treat them by physical means. On the other hand, if neuroses and psychosis have a psychosocial cause it makes no sense to treat them with drugs, electroshock or lobotomy.
Lobotomy is still performed in the United States. About 100,000 people are being electroshocked every year only in that country, many against their will (see Whitaker, 2001). In addition, millions of healthy children are being given psychiatric drugs in the U.S., which consumes about 90 per cent of the world’s Ritalin, a meta-amphetamine (see e.g. Breggin, 1991, pp. 269-315). Almost all psychiatrists believe in these “medical model” treatments of socially unwanted behaviors.
On the other hand, the “trauma model” is an expression that appears in the writings of non biological psychiatrists such as Colin Ross, who has even written a book with that title. In few words, non biological psychiatrists and 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 (see Arieti, 1994). The psyche of a child is very vulnerable to persistent abuse while in the process of ego formation. Although the writings of the proponents of the old existential and “schizophrenogenic” mother are still in print (e.g., Laing, 1999), today the model is better explained in the case-stories writings of compassionate psychologists such as Alice Miller (see e.g. Miller, 1983, 1992, 1997). 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 (Modrow, 2003). Despite claims of the contrary, the trauma model of psychosis is so alive that two books have been recently released on the subject (Ross 2004; see also Read, Mosher and Bentall 2004).
Let us take as an example an article published in a July 2002 Time magazine. The feature writer took the case of Rodney Yoder, who was abused during his childhood and as an adult is furious (“personality disorder” in DSM Newspeak) for having been 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” (Cloud, 2002). In the same line of thinking, Rodrigo Muñoz, a 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” (Muñoz, quoted in De Wyze, 2003). 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” (Thomas Laughren, quoted in Vedantam, 2002). Psychiatrists only rely on conduct, not on the individual’s body, to say that there is an illness. Child psychiatrist Luis Mendez 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 with psychiatrist Gerard Heinze, the director of the Instituto Nacional de Psiquiatría (National Institute of Psychiatry), which is supported by the Mexican government and is a large state of several buildings in Mexico City (there are only two other similar psychiatric institutes in the world: one in the United States, the other in Europe). 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 tell me that mental disorders are in this category of still incomprehensible diseases. For example, the Hutchinson-Gilford syndrome, which makes some children start to age since their childhood, is an authentic biomedical disease of unknown etiology. But its existence is not controversial: it is enough to see the poor aged children to know that their problem is clearly somatic. On the other hand, diagnoses of the alleged psychiatric disorders “of unknown etiology” 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, with the exception of the Post-Traumatic Stress Disorder, the remaining 373 DSM behaviors are mysterious biomedical 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 (see e.g. Baughman et al, 2003), will illustrate this attitude. 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” (Sterling, 2003). The American Psychiatric Association (APA) did not provide a reasonable answer to the questions that the hunger strikers sent them concerning the scientific status of biopsychiatry; the Surgeon General Office did not even bother to respond. However, in a statement released in September 2003 the APA 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 aprioristically and in bloc dismiss the work of the many researchers who have postulated a psychogenic origin of mental distress and disorders. Even though it is more commonsensical to consider a psychological cause for a mental disturbance that has no known biological markers, with its somatogenic dogma orthodox psychiatry ignores the alternative hypothesis, the model of trauma. To inquire into Yoder’s childhood, for instance, is thus axiomatically dismissed in this 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, it cannot be refuted.
Conversely, if psychiatrists were true scientists they would present their idolized biological hypothesis under the falsifiability protocol that Popper observed in hard sciences. Let us consider the hypothesis: “At sea level water boils at 70º C”. This is a scientific hypothesis in spite of the fact that the proposition is false (water does not boil at 70º but at 100º C). The hypothesis is scientific because it is presented in such a way that it just takes to try it in our kitchen with a thermometer to see if it is true or not: if water does not boil at 70º C, the hypothesis is false. In other words, according to Popper the scientific quality of an 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 70º C can be refuted: it is a scientific hypothesis. On the other hand, the hypothesis that schizophrenia and the other 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 but is not. 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, the nazi eugenicists or the anti-Mendel geneticists of Stalin did not comply with the Popperian requirement of presenting their conjectures in falsifiable form either. In this article I cannot deal with the nazi and communist pseudosciences. Be it enough to say that all pseudosciences, biological or paranormal, have four things in common. Just as its biological sisters (phrenology and nazi eugenics) 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 most parsimonious alternative, and (4) is completely sterile. After decades of research neither eugenicists nor 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 autism, bipolar “illness”, major depression and the other 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 aggressive sales of psychiatric drugs by the pharmaceutical companies (see Valenstein, 2002).
REFERENCES
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————— 1991. Breaking down the wall of silence: the liberating experience of facing painful truth. New York: Dutton.
————— 1997. Banished knowledge: facing childhood injuries. New York: Anchor Press.
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karellen@antipsiquiatria.org