Criticising psychiatry is still not ‘anti-psychiatry’

Menckes and Dharmawardene (2019) took the strongest possible exception to my defence of the report of the UN Special Rapporteur on the rights of the mentally ill (McLaren, 2019a). I had argued that criticising psychiatry is not ‘anti-psychiatry’, whatever that may be, but they insisted my ‘… fundamental anti-psychiatry bias remains both unmissable and dangerous’ (sic).

A further report has just been released by the Special Rapporteur (UN Human Rights Council [UNHRC], 2019) but, before leaping to the barricades, it is most important that psychiatrists fully understand the meaning and significance of these reports. First, the Special Rapporteur, appointed in 2014, is Prof. Dainius Puras, a distinguished Lithuanian child and adolescent psychiatrist and epidemiologist and a person with the highest international credentials to chair this type of project. It is factually wrong to see these reports as open to the ‘bias’ of a single individual and, as a working psychiatrist, it is not rational to belittle his conclusions as ‘anti-psychiatry’. It is nonetheless true that he is resolutely opposed to bad psychiatry, a position I vigorously applaud.

Second, for readers in Australia and New Zealand, his conclusions must be seen in the context of the often bitter criticism of mainstream psychiatry drawn forth by two current enquiries, the Australian Productivity Commission Enquiry into Mental Health (2019) and the Victorian Royal Commission into Mental Health (2019). Psychiatrists who believe they are offering the best of all possible treatments for the best of all possible reasons, and are thus above criticism, urgently need to read the public submissions before delving into the latest UNHRC report.

Turning to the question of a ‘biomedical model’ of mental disorder, Menckes and Dharmawardene stated, ‘McLaren … makes the astonishing assertion that the biomedical model of mental illness ‘doesn’t exist’’ (their emphasis). Their astonishment may have been ameliorated had they read my cited study from 2013, which showed that mainstream psychiatry does not have an articulated model of mental disorder to guide its treatment, research and teaching. For that reason alone, modern psychiatry cannot claim to be a science of mental disorder. Instead, as that paper shows, it has all the features of an ideology of mental disorder.

We see the same phenomenon in the United States at present. In an increasingly fractious exchange, Ronald Pies (2019), editor of Psychiatric Times, has insisted that no sensible psychiatrist has ever used the expression ‘chemical imbalance of the brain’, that there never was a ‘chemical imbalance theory of mental disorder’. Instead, he says, psychiatry has been guided for decades by the biopsychosocial model of mental disorder, attributed to the late George Engel. This is a little surprising, as I showed in 1998 that Engel never got around to writing his model. Pies has been challenged to produce his model or face charges of culpable deception, if not of scientific fraud (McLaren, 2019b).

My research shows that psychiatry has never developed a formal model of mental disorder, so I am intrigued to learn that somebody could still be ‘astonished’ to learn their favored ‘biomedical model of mental disorder’ is a mirage. If Menckes and Dharmawardene can produce a copy of their vaunted model, I will immediately amend my ‘extreme’ views. If they could oblige with the name of the primary author and the title and date of the seminal publication which sets out the model, as well as three subsequent works which develop it as a set of testable propositions of proven heuristic value, then we can dismiss the Special Rapporteur’s criticism and press ahead with a biologically driven psychiatry.

If, however, they can’t do this, then psychiatry is in a most serious position. It would mean that mainstream psychiatry in Australia and New Zealand is exposed to charges of culpable deception, if not of scientific fraud, charges from which the institution may not recover. The ‘international anti-psychiatry conspiracists’ would have the last laugh but, as a psychiatrist of 45 years standing, I wouldn’t be laughing with them.