Psychiatry as Ideology

Ethical Human Psychology and PsychiatryAn International Journal

of Critical Inquiry

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Ethical Human Psychology and Psychiatry, Volume 15, Number 1, 2013

© 2013 Springer Publishing Company 7http://dx.doi.org/10.1891/1559-4343.15.1.7

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Psychiatry as Ideology

Niall McLaren, MBBS, FRANZCPQueensland, Australia

Background: The current psychiatric literature carries numerous papers arguing that the correct approach to mental disorder is to see it as a special form of brain disorder, whose precise biochemical and genetic causes will be revealed by the normal methods of labora-tory science. In particular, these claims are repeated in numerous papers outlining and advocating the new Research Domain Criteria project of the U.S. National Institute of Mental Health.Material: An extensive search of the literature shows that not one of these biologically oriented papers ever provides citations or references to authorities such that the claim “mental disorder is brain disorder” is established to the standard required of valid scientific claims.Discussion: As it stands, the notion that mental disorder is brain disorder is unsubstanti-ated. In particular, no authorities in the field of biological psychiatry have ever demon-strated that they have a formal theory of mental disorder, or a model of mental disorder to guide their daily practice, their teaching or their research.Conclusion: This means that biological psychiatry has the status of an ideology only, and the many papers arguing its case meet the definition of propaganda.

The premier funding agency in psychiatry has recently determined a new direction for psychiatric research, the goal being to establish a formal biological basis for clinical psychiatry. However, this project seems to rest on a major, unverified assumption

concerning the nature of mental disorder and the proper means of investigating it.

BACKGROUND: A NEW DIRECTION FOR PSYCHIATRY

In July 2009, a meeting was held at the headquarters of the U.S. National Institute of Men-tal Heath (NIMH) in Bethesda, Maryland. Present were senior executives of the NIMH, the American Psychiatric Association (APA), and the Psychiatry Division of the World Health Organization. The purpose of the meeting was to coordinate a new direction for psychiatric research, the Research Domain Criteria (RDoC) project. It was acknowledged that the previous project, known as the Research Diagnostic Criteria, from which arose the current form of the APA’s Diagnostic and Statistical Manual for Mental Disorders (now DSM-IV), was not expected to fulfill its original goals. RDoC represented a major change in orientation and emphasis, to what the Director of NIMH, Dr. Thomas Insel, has char-acterized as a new basis for a scientific psychiatry.

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In a commentary in the American Journal of Psychiatry, he and his colleagues outlined their vision: “Diagnostic categories based on clinical consensus fail to align with findings emerging from clinical neuroscience and genetics. The boundaries of these categories have not been predictive of treatment response . . . (they) . . . may not capture fundamental underlying mechanisms of dysfunction.” Accordingly, they continued,

. . . the question now becomes one of when and how to build a long-term framework for research that can yield classification based on discoveries in genomics and neuroscience . . . to create a framework for research on pathophysiology, especially for genomics and neuroscience, (to) inform future classification schemes.

Underpinning these changes were several essential notions:

First, the RDoC framework conceptualizes mental illnesses as brain disorders . . . Second, (it) assumes that the dysfunction in neural circuits can be identified with the tools of clinical neuroscience. . . . Third, (it) assumes that data from genetics and clinical neuroscience will yield biosignatures that will augment clinical symptoms and signs for clinical management. (Insel et al., 2010)

Based on their outline in this and in numerous other publications (Cuthbert & Insel, 2010; Insel, 2009; Insel, 2010; Insel & Freund, 2012; Kaffman & Krystal, 2012; Mor-ris & Cuthbert, 2012; Sanislow et al., 2010; Yan, 2010), it is clear that there are major problems in the entire notion of RDoC. These have been detailed in a previous paper (McLaren 2011, 2012) which concluded that, because of intractable logical problems, the RDoC program is probably unachievable. In briefest terms, the program is essentially undefined, it is so broad as to be verging on meaningless and it cannot be operationalized. However, in searching the literature for the RDoC critique, it became clear that its funda-mental concepts enjoy the very widest support in psychiatry and are no longer questioned. In other fields of science, this is unusual but not remarkable. It could be argued that the biological basis of psychiatry is so firmly grounded as to be considered indubitable. While it may in fact be correct, the biological program outlined by the NIMH in the papers men-tioned earlier was presented without reference. At no point in any of these papers did the NIMH group offer a justification of their claim that “mental disorder is brain disorder, and can be investigated by the normal methods of biological science.” This is cause for concern because their research program for the next few decades rests on this point alone. The question therefore arises: Is the belief that mental disorder is brain disorder sufficiently supported by scientific evidence to support an entire scientific program?

How to Conceptualize Mental Disorder

The polemicist, Thomas Szasz, was totally opposed to the NIMH claims regarding the nature of mental disorder. In his view, it doesn’t exist: “. . . mental illness is a nonexistent or fictitious condition” (Szasz, 1987, p. 107). That is, there is no objective physical basis to the types of behaviors termed psychiatric diseases. He was equally explicit that the notion of deviance is wholly moral in nature. His work is peppered with comments that show he saw “psychiatric patients” as acting deceitfully with the intent of manipulating their sur-roundings: “What was wrong with these ‘nervous patients’? . . . the patients pretended they were ill, because they malingered or faked illness” (Szasz, 1979, p. 96). “. . . Patients with . . . most so-called mental illnesses do not make ‘appropriate efforts’ to get well. Indeed,


Psychiatry as Ideology 9

they usually make no such efforts at all, and try, instead, to be authenticated as ‘sick’ . . .” (Szasz, 1974, p. 197). However, their psychiatrists are acting dishonestly as well: “All this (psychiatry) is fakery and pretence whose purpose it to ‘medicalize’ certain aspects of the study and control of human behavior” (Szasz, 1974, p. 4). “I have long considered lying as one of the most important phenomena in psychiatry . . . the patients, like children, lie to the doctor. And the physicians, like parents, lie to the patients” (Szasz, 1974, p. 223). That is, he saw the phenomena of “so-called mental disorder” as wholly moral in nature. Questions which more conventional psychiatrists see as ineffably complex were, in Szasz’s adamantine views, mere charlatanry—on both sides (for a detailed analysis and critique of Szasz’s basic premises, see McLaren, 2012).

Antedating Szasz, psychoanalysts took a different view. While Freud started his career as a neurologist and hoped to provide a brain-based science of mental disorder, his premature Project for a Scientific Psychology (Freud, 1895) failed to influence his theory. Almost from the beginning, psychoanalysis conceptualized mental disorder as wholly mental in nature, with no reference to the brain as an organ. As the movement evolved and nonmedical analysts were accepted, the question of the contribution of brain disease to mental disor-der drifted into irrelevancy. It is fair to say that to an analyst, and in the many types of dynamic therapies that followed, mental disorder is conceived as wholly psychological in nature. This is also true of modern cognitive therapy although mainstream forms of cogni-tive therapy accept the biological causation of the psychotic disorders (e.g., Beck, Rector, Stolar, & Grant, 2009).

At much the same time as Freud was gaining attention, psychology rebelled against its mentalist tradition as a red herring. In 1913, J. B. Watson declared that mentalism kept psychology “bound hand and foot” and thus unable to make progress:

I can state my position here no better than by saying that I should like to bring my students up in the same ignorance of (the mind-body problem) as one finds among the students of other branches of science. (Watson, 1913)

Perhaps without knowing it, Watson was rejecting one ontology in favor of another, but his aggressive nihilism did not survive the century (McKenzie, 1977).

Today, psychiatrists can choose from four mutually exclusive approaches to the nature and causation of mental disorder:

1. Biological psychiatry: “Mental disorder is wholly brain disorder.”2. Freudian psychiatry: “Mental disorder is wholly psychological disorder.”3. Szaszian psychiatry: “So-called Mental disorder is wholly moral disorder.”4. Behaviorism: “There is nothing mental to be disordered.”

It may also be that some psychiatrists adopt a spiritualist model of mental disorder (e.g., possession states) but these are too idiosyncratic to take seriously. Others may attempt to adopt an eclectic view, such as Engel’s (1977) “biopsychosocial model” without realizing that it doesn’t exist (McLaren, 1998, 2007, 2010). Of course, the four themes mentioned earlier are not new ideas. The moral concept of mental disorder is ancient and has always been closely associated with religious views. Szasz’s version is unusual in that he had no articulated theory of mind. Unlike the behaviorists, who argued that the entire concept of mind is nonscientific (McLaren, 2007), he accepted without demur the essential mental


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basis of human behavior. Since he violently rejected the notion that mental disorder is a brain “illness,” he had no option but to see the phenomena in moral terms but he never argued his position. From the very beginning of his published works, he maintained an unshakable conviction that any and all psychiatric versions of mental disorder are both fool-ish and dishonest. The reader either accepts this opinion, or stops reading (McLaren, 2012).

The notion that mental disorder is wholly psychological in origin is equally old; Freud’s was just the most elaborate attempt to formulate a nonmoralistic approach. Mental dis-order, he opined, is caused by hidden psychological mechanisms that we can understand, thereby arriving at a form of treatment: Psychological causation demands psychological treatment. Again, this was never argued but was accepted as an article of faith (Fenichel, 1946, Chapters 4 to 6). Nobody who doubted this point could undergo the rigorous train-ing to become an analyst, and analysts did not accept criticism from people who had not had a training analysis. In truth, they did not accept criticism from anybody, which was one factor that led Popper (1972a, 1972b) to conclude that Freudian psychology had no basis in science.

In biological psychiatry, the aphorism “mental disease is brain disease” has been vari-ously attributed to Benjamin Rush (1746–1813) in the United States and Henry Maudsley (1835–1918) in the United Kingdom, but this notion is also ancient. The idea that some form of physical disturbance underlies all mental problems was well-known to the Greeks, and probably every other civilization as well. On the rare occasions that modern advo-cates of a biological psychiatry ever refer to a source, it will be to psychiatrists such as Michael Trimble (1988) or the late Samuel Guze (1989, 1992), or to neurophysiologists such as Jean-Pierre Changeux (1985) or the 2000 Nobel Prize winner, Eric Kandel (2005). The validity of the views of the first three of these authors has been critically reviewed (McLaren, 1992, 2007). As the most recent and most widely cited “final authority” on the biological basis of mental disorder, it is often claimed that Kandel is especially influential as he is a psychiatrist himself.

Kandel’s oft-quoted 2005 book consists of eight papers and essays published between 1978 and 2001, together with his introduction and afterward, and invited commentaries by eight eminent neurophysiologists and psychiatrists. His theme is that an undefined “radical reductionism” will “transform psychoanalysis into a scientifically grounded dis-cipline.” He looks to the brain-based neurosciences “. . . to create a unified view, from mind to molecules . . . (a) new biology of mind. . . .” This “unified psychoanalytic and biological perspective” can provide “a new science of the mind” from which would emerge “. . . a great unification into one intellectual framework of behavioral psychology, cogni-tive psychology, neuroscience and molecular biology.” The means of uniting the disparate fields of “biologic and psychologic explanations of behavior” is by explicating the “biology of human mental processes.” In essence, this means using molecular and genetic biology to provide “a new level of mechanistic understanding,” thereby confirming his view that “the basis for the new intellectual framework for psychiatry is that all mental processes are biological. . . .”

This credo is constantly repeated throughout this book, as well as his autobiography (Kandel, 2006) and his large and influential texts (Kandel, Schwartz, & Jessell, 1995, 2000). He emphasizes that the proper means of investigating the mind is by reductionist biology. Biological investigation of the brain will allow us to “. . . understand the physi-cal mechanisms of mentation and therefore of mental disorders.” He sees no limits to the capacity of biology to explain human behavior: “All the behavioral disorders that



characterize psychiatric illness . . . are disorders of brain function. The task of neural sci-ence is to explain behavior in terms of the activities of the brain.” Biology can transform psychiatry and psychoanalysis, turning them into a unitary scientific endeavor. Regret-tably, not one of these claims is argued. They are proffered as bald opinions only, albeit in a neurophysiological context that tends to suggest his opinions carry the same weight as his empirical research. The question of what could justify the claim is fascinating but quite beyond the scope of this paper. For the record, Eric Kandel is registered as a physi-cian in the state of New York (No. 083481 from 11/27/59) but not as a psychiatrist with the American Board of Medical Specialties. His autobiography (Kandel, 2006) shows he began training in psychiatry but never completed the course (probably because he was rarely there), and he has never practiced psychiatry since.

Epistemology: Why a Theory Is Not a Model

The competing views listed earlier—that mental disorder is variously moral, psychologi-cal, or biological in nature—are metaphysical claims, that is, assertions regarding the fun-damental nature of things. Metaphysical questions cannot be settled empirically. That is, the four claims competing for our allegiance are of equal, undetermined status. Epistemo-logically, the opinions of the Nobel laureate neurophysiologist, Eric Kandel, carry no more weight than the century-old opinions of Freud, Watson, and Szasz.

This leaves young psychiatrists in a difficult position. With at least three incompat-ible options on the nature of mental disorder, which should they choose and why? These are not trivial questions as a great deal hangs on them. Even though, practically, every senior figure in modern psychiatry endorses the biological claims, the question is not to be decided by weight of authority: Authority was not able to prove Galileo wrong. We therefore need to consider how these types of claims are assessed.

The factual question of what we know is the stuff of empirical science, but questions such as “What can we possibly know?” or “How do we know anything?” constitute the field of epistemology, the study of knowledge and justified belief. Epistemology therefore has real and immediate applications to all areas of intellectual effort. Knowing how we know is logi-cally prior to what we know because the truth or falsity of what we believe depends on how we can know anything. In empirical science, epistemological analysis allows us to sort our opinions from empirical fact; unfortunately, the former are all too often immune to facts and may even influence what we see as facts. That is, opinions can become self-reinforcing.

Knowledge consists of a set of propositions, and scientific knowledge consists of a set of scientific propositions. Two of the most influential philosophers of science in the last cen-tury focused on the nature of fundamental belief systems in science, Karl Popper (1972a) on what we should accept as reliable and Thomas Kuhn (1970) on how we change from one system to another. While we would like all scientific propositions to be free of opin-ion, our most basic, fundamental beliefs about the nature of the universe are beyond empirical study, now and perhaps forever as, logically, they determine the nature of the evidence that we see. All scientific propositions carry the implicit warning: “Given what we believe about the nature of the universe, X is true.” Errors in the basic belief system, or ontology, are troublesome indeed as their cascading effects can undermine what appears to be reliable science. Regrettably, scientists are inclined to forget this and often act as though their belief system is not just true but is the only possible view (Morone & Wood-house, 1989).


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It should be understood that no belief exists in isolation. Every statement comes nested in a system of beliefs that can and should be separated and examined individually. This is tedious but, as the misadventures of psychoanalysis (Popper, 1972b) and behaviorism (McKenzie, 1977) show, it can save a great deal of time and effort, not to mention effects on the lives of many millions of people who are mentally disordered.

The first step in any research project is to determine the ontological position: What is the nature of the universe, how should we approach it, what can we know about it, and so forth? As physicians, psychiatrists train in the immensely powerful, Western scientific tra-dition and we usually assume it is the only way of looking at things. In psychiatry, we pro-visionally accept a dualist ontology, that is, that the universe consists of a material realm and a mental realm (as in Manual of Mental Disorders). Unfortunately, this means that the mind is beyond the reach of our material science. Watson’s response to this dilemma was to dismiss the mental life as irrelevant to a proper science of behavior. Szasz accepted the reality of the mental life and its primacy over the physical body but saw it as a simple exer-cise in rationality. Freud also gave priority to mental life, but as a hugely complex struggle between the flimsy forces of reason and violent, primeval urges. However, psychoanalysis led to intractable epistemological problems and biological psychiatry can be seen as a rationalist reaction to them. Its ontological position is that, by reconceptualizing mental disorder as a form of brain disorder, investigation of the mind becomes amenable to stan-dard laboratory techniques. Just as reductionist science has conquered so many physical diseases, modern psychiatry believes that this move will give an objective solution to the problem of mental illness.

Given an ontological position, the next step is to take a series of observations that the ontology says are significant, and try to explain them. This means postulating an ontologi-cally consistent but hidden mechanism, one dimension removed from the observations, which can plausibly generate them. This amounts to a theory of the observations, where theory means “proposed unseen rational causative mechanism.” Note that the theory exists as an idea only. Even when written down, it consists of nothing more than thoughts about what might be happening out of sight. As ideas, theories need to be translated into the real world, for which we use models (McLaren, 2007, Chapter 6). A model is a real system based on a truncated or stripped down version of the theory to demonstrate it in action. A theory is an idea in somebody’s mind but models, including computerized mathematical models (e.g., climate models), are real mechanisms. They are tangible structures showing a point-to-point relationship, with the essential features of the theory but capable of acting on or in the real world. Thus, we can have a theory of heavier-than-air flight but we need a model airplane to test it. Necessarily, the theory precedes the model: There is no model without a theory, but a theory without a model is unproductive. Armed with the model, we then formulate predictions about how it should behave under certain test conditions. The model’s performance allows us to adjust our theories according to novel observations, or even to discard the theory and start again. Bearing in mind Popper’s (1972a, 1972b) concerns regarding asymmetry of test results, the performance of the model in the experi-ment indicates whether the theory is valid or not. Sometimes experiments work, and the theory gains credibility; sometimes they don’t and the theory must be modified. However, one failure doesn’t disprove a theory; it may have been a poor or lazy experiment.

In a theory of knowledge, the ontology comes first: We need a belief system before we can even begin to say what we see happening around us, or what is important. Since obser-vations rarely tell us their causes, we then suggest an unseen causative mechanism, an idea



known as a theory, that can account for the observations within the terms of the ontology. Next, we use the idea to build a model, a simplified but real mechanism instantiating the theory’s essential features and, finally, we test it in experiments.

Theories of Mental Disorder. We psychiatrists believe in the mind as a real thing, mean-ing our ontological position is dualist, that is, the universe consists of a material realm and a mental realm. Most emphatically, this does not imply magical or substance dualism (McLaren, 2010, 2012): It is a grievous error to equate dualism with supernaturalism, as did Dennett (1993, 2003) and Searle (1999, 2000). However, the problem Watson identi-fied a century ago is still with us, how to reconceptualize what appear to be insubstantial matters (of mental disorder) to bring them within range of the otherwise brilliantly suc-cessful “tools of clinical neuroscience.” Psychiatry’s resolution has been to equate or iden-tify mental disorder with brain disorder while making no claims on the nature of mind itself. Philosophically, this is clumsy as it means we see normal mental function as dualist and abnormal as monist, but the problem has been solved by reclassifying the ontologi-cal proposition: “Mental disorder is brain disorder” as a theory of mental disorder, not an ontology. This is consistent with the rest of medicine, with its germ theory and its theory of neoplasia, and so forth. However, as a theory, it has to be argued, not assumed.

Moving on, the next step is to construct a model of mental disorder. This is not the same as identifying potential neurochemical lesions as these do not describe a mechanism by which brain disorders cause mental disorders. This step is critical because the essential function of a model is demonstrating the hypothetical mechanism in action. The theory directs us where to look, for example, it may point to the genome or to diet or inflamma-tory reactions, but the model gives us the actual means of seeing the theory in action. The model is then examined in a range of tests to see whether the theory correctly predicts the outcome. If it doesn’t, it indicates the theory is wrong. In the absence of a formal, articu-lated model of its topic, a theory simply cannot be tested (McLaren, 2007, Chapter 6).

I have argued that attempts to identify mental disorder with brain disorder cannot suc-ceed (McLaren, 1992, 2007). Similarly, the notion that mental disorder can be explained in a reductionist framework fails for logical reasons (McLaren, 2010, 2011). These are philosophical objections to the psychiatric research program; unsurprisingly, they have not slowed the rush to biologism. But mainstream psychiatry now accepts there are prob-lems, as when Insel and colleagues discreetly signalled the end of the RDC program (Insel et al., 2010). Can the RDoC project succeed where RDC failed? Not if it follows the same path, of trying to investigate mental disorder without a valid model of its subject matter.

Where Is Our Model of Mental Disorder?

The notion of a monist science of mental disorder in a dualist ontology is incoherent, especially given the absence of a theory of mind, because there can be no delineation between mental normality and abnormality. However, my concern here lies further down the logical chain: Does psychiatry have a model of mental disorder? If it does not, then it does not meet the minimal requirements of a science (Kuhn, 1970). As indicated earlier, not one of the papers from NIMH refers to anything that could be taken as a model. An extensive search of each citation for each paper showed no evidence of a formal scientific model of mental disorder. Accordingly, each author of the papers was searched through PubMed for anything that would amount to a description of a model with predictive value.


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Some authors (e.g., Insel) are cited up to 50 times a year but not one of them has ever referred to anything that would approximate a model of mental disorder.

Medline searches of terms related to models of mental disorder were undertaken but again, the results were negative. There was nothing of value in the search results that could be taken as justification of the broad claims of biological psychiatry as cited earlier. Finally, it was decided to check some of the most important psychiatric journals to see if this would yield an answer. Eleven major journals were chosen as having the scope, the resources, and the duty to ensure that papers they published would meet minimal scientific standards (see Table 1). The period covered was 11 years from January 2001 to December 2011. Each index was physically searched for papers that seemed likely to meet the minimal criteria for a scientific model, that is, material referenced directly to a reductionist model of mental dis-order in the biological orientation; readily available to all psychiatrists; in a form with pre-dictive value; and open to public criticism (McLaren, 2007, Chapter 6). Correspondence

TABLE 1. Analysis of Published Journals 2001–2011.

Journal Total Issues PagesEditorials &Comments Reviews

OriginalPapers

BriefReports

TotalArticles

American Journal of Psychiatry 132 20,865 382 208 1,614 465 2,669

Archives of General Psychiatry 132 13,750 70 39 1,252 — 1,361

British Journal of Psychiatry 132 13,200 381a 192 1,383 159 2,115

Psychological Medicine 132 20,325 81 115 1,582 61 1,839

Biological Psychiatry 264 17,800 190 176 1,831 237 2,434

Comprehensive Psychiatry 66 6,310 — — 1,215 — 1,215

Journal of Nervous and Mental

Disease 132 10,900 38 11 1,114 380 1,543

Acta Psychiatrica Scandinavica 132 11,740 178 193 1,107 137 1,615

Schizophrenia Bulletin 54 10,800 116 106 866 115 1,203

Schizophrenia Research 246 24,830 9 27 2,718 — 2,754

Philosophy, Psychiatry, &

Psychology 43 3,425 370 18 98 — 486

TOTAL 1,465 153,945 1,815 1,085 14,780 1,554 19,234aExcludes debates.



and nontechnical articles were excluded to leave a corpus of scientifically significant mate-rial in which the formal basis of modern psychiatry was most likely to be found.

The results are shown in Table 1. In more than 19,000 original papers, reviews, editori-als, and reports occupying some 150,000 pages of text, there was nothing to suggest that psychiatry has articulated a model of mental disorder to form the basis of a research program of the type outlined by NIMH. Given that the perhaps 20,000 authors include every major figure in the profession, it is fair to conclude that modern psychiatry does not have a model of its field; alternatively, the suggestion that it does is untenable. Psychiatrists have never established that mental disorders can be conceptualized as brain disorders and can thus be investigated by the normal methods and tools of biological science: What they claim, and what is justified based on normal academic standards, are two quite separate things.

CONCLUSION

This preliminary survey indicates that not one paper of a biological orientation referred to a reliable source to justify its claim that mental disorder is fundamentally biological in nature. Orthodox psychiatry has not provided a formal model of mental disorder. Thus, it lacks the most elementary requirement of any field claiming scientific status (Kuhn, 1970). The psychiatric profession has not followed due process in proving a factual basis to its major claim, that mental disorders can be conceptualized as brain disorders and investigated using the methods and tools of reductionist biology: What they claim and what is established fact are two quite separate things. All such claims amount to opinion as they have no demonstrated scientific backing. Since these beliefs are held with quite passionate intensity (e.g., the exchange between Crow and colleagues, 2008), they meet the criteria for an ideology, that is, a “set of beliefs that is false, misleading or held for the wrong reasons but is believed with such conviction as to be irrefutable.”

These opinion papers regularly appear in our specialist journals, as well as other highly influential journals of scientific record such as Nature, Behavioral and Brain Sciences, JAMA, Lancet, and so forth, yet they add nothing to our scientific knowledge base. The problem is that, once published, they enter the scientific corpus and can be quoted as though they were empirical science when, as a matter of verifiable fact, they are not. As they stand, these papers represent firmly held, highly partisan opinions with no convincing basis. They use rhetorical language to present an excessively simplified and one-sided view of a complex question in such a manner as to induce people to think that the matter has been resolved when, in fact, it has not. That is, while failing the criteria for scientific literature, they sat-isfy the definition of propaganda. Regrettably, orthodox psychiatry conducts its campaign to convince people of its value using the same polemical techniques as Thomas Szasz.

Annually, our journals publish thousands of papers directed at a biological account of men-tal disorder but normal standards of scientific discourse are not followed. Editors do not require authors to prove their case by full reference to the literature. The question of how this remark-able state of affairs has arisen is beyond the scope of this paper, but my impression is that everybody assumes somebody else has done it: it is an urban myth. The view that a biological psychiatry is necessarily the only choice for a scientific psychiatry represents the work of an exclusive elite, striving to convince the world that, in the field of mental health, there is only one possible scientific view, theirs (Morone & Woodhouse, 1989). It is incumbent on the profession to examine its scientific credentials, certainly before somebody else does it for us.


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Correspondence regarding this article should be directed to Niall McLaren, MBBS, FRANZCP, Psy-chiatrist, PO Box 1030, Indooroopilly, Queensland, 4068, Australia. E-mail: [email protected]


Psychiatry as Ideology

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