Ethical Human Psychology and Psychiatry, Volume 18, Number 1, 2016

Psychiatry as Bullshit
Niall McLaren, MBBS, FRANZCP
Northern Psychiatric Services, Brisbane, Australia
Objective: As part of the philosophical project of distinguishing science and nonscience,
an ancient concept, bullshit, has recently been redefined and explored. This is not science
or does it meet a strict definition of pseudoscience. This article explores the extent to
which this concept pervades psychiatry. Conclusion: By even the most charitable interpretation of the concept, the institution of modern psychiatry is replete with bullshit.

Keywords: philosophy of science; psychiatry and pseudoscience; psychiatry and

bullshit; ECT

ne of the major concerns of the philosophy of science is to distinguish science from

nonscience (Pigliucci & Boudrey, 2013). Nonscience includes religion, art, technology, entertainment, politics, war, sport, pornography, and so forth, which consumes far
more human effort than science. This leaves a very diverse range of intellectual activity, which
has in common a commitment to a rational, rule-governed process of open, critical inquiry.
These include the sciences proper, as well as mathematics, philosophy, logic, and so forth. The
(relatively small) scientific arena is further divided into experimental sciences and the historical and nonhistorical field sciences. The archetypes of the experimental sciences are physics
and molecular biology; historical field sciences include history itself, paleontology, archaeology, geology, historical linguistics, and so on. Nonhistorical field sciences include such fields as
seismology, climatology, anthropology, and other sociological fields such as political science.
Hovering on the periphery of science, we now recognize different classes of nonscience
with scientific pretensions, such as pseudoscience, bad science, premature science, proto- or
prescience, scientific fraud, mistaken science, boring science, heterodox science, and just
plain dumbheadedness. Adding to the list, philosophers are now defining another important field, skata taurou in the original Greek. A short article some 30 years ago by the
Princeton philosopher, Harry Frankfurt, opened the debate with some of the most memorable lines in modern philosophy: One of the most salient features of our culture is that there
is so much bullshit. Everyone knows this (Frankfurt, 1986). After analyzing the various
elements involved, he concluded that Bullshit is neither pseudoscience nor fraud but constitutes a field in its own right. The liar, he argued, is intimately concerned with the truth.
He knows the truth but he hopes to lead us away from it and from the fact that he knows it:
Telling a lie is an act with a sharp focus. It is designed to insert a particular falsehood at a specific
point in a set or system of beliefs, in order to avoid the consequences of having that point occupied by the truth. This requires a degree of craftsmanship . . .

Although lying is subject to . . . austere and rigorous demands . . . , the Bullshit

artist, on the other hand, has no regard for the truth. His productions are . . . more
expansive and independent, with mare spacious opportunities for improvisation, color,
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2016 Springer Publishing Company

http://dx.doi.org/10.1891/1559-4343.18.1.48

Psychiatry as Bullshit49

and imaginative play. This is less a matter of craft than of art. As such, they are neither
necessarily true nor necessarily false but are designed to create a particular impression in
the audience. Bullshit is expansive and creative, which is possibly why we do not regard
it as so malevolent as an outright lie. We are enraged if we believe somebody is lying to us
but we tend to be amused or disdainful, or at least less fussed, if we determine the speaker
is simply spinning a line of bull.
In 2005, Frankfurt republished his article as a short monograph, thereby achieving the
award for best-selling philosophy book of the year. The next year, he published a sequel,
On Truth, noting in the introduction the apparent contradiction that although plenty of
people argue over whether truth exists, everybody seems to agree there is a lot of bullshit
about. Using a series of case examples, this article will argue that psychiatry is especially
stuffed with bullshit.

BIOLOGICAL PSYCHIATRY
Modern psychiatry is seen as essentially a biological project, specifically directed at finding
physical (brain-based) causes and treatments for mental disorder. In brief, mental disorder is
brain disorder. I have summarized the possibilities for this elsewhere (McLaren, 2007, 2009,
2013), rejecting it on the basis that there is no known philosophical route by which the
claim could be justified. The lack of a valid means of getting from the mental to the physical is no deterrent to the belief, as the National Institute of Mental Health (NIMH) shows,
First, the Research Domain Criteria 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, pp. 748751)

Their fundamental commitment to a biological understanding of mental disorder is clear:

Mental disorders are brain disorders . . . By Congressional proclamation, the 1990s were designated
the Decade of the Brain . . . that decade marked an end to a three-century division between
mind and brain. Increasingly, the most complex aspects of the mind were being addressed through
studies of neural activity . . . the focus on mental activity as neural activity has widened to include
a focus on mental disorders as neural disorders. (Insel et al., 2010, p. 749)

A quick perusal of the psychiatric literature finds many hundreds of such claims but
they definitely reach criteria for bullshit: Not one of these claims is of a form that can be
classified either as truth or as falsehood yet they are clearly designed to sway the audience,
as the last sentence in these quotes shows:
Increasingly, the most complex aspects of the mind were being addressed through studies of neural activity . . . the focus on mental activity as neural activity has widened to include a focus on
mental disorders as neural disorders.

It is the case that funding agencies are paying researchers who claim their studies
of the brain will settle complex aspects of mind; all that remains is to decide whether

50 McLaren

they ought to. Anybody reading that type of work would reasonably assume that this question has been answered but that assumption would be mistaken: It has never once been
addressed, let alone justified, in the psychiatric literature (McLaren, 2013). That is, the
claims by some of the most senior people in NIMH are wholly without foundation. But
they are not thereby false statements, . . . designed to insert a particular falsehood at a
specific point in a set or system of beliefs, in order to avoid the consequences of having
that point occupied by the truth. Rather, they simply omit to mention that a critical element of the research program is missing. The point is left unaddressed, allowing the reader
to assume that such eminent people would have done their homework. It is a matter of
demonstrated fact that they have not. Readers, being in the main reasonable people, tend
to give the benefit of the doubt to senior researchers from prestigious institutions; very few
would think to question their bona fides but, in this case, they should have.
How does it arise that such a serious, indeed critical, gap in the understanding of mental
disorder could arise? I suggest two possibilities, neither very complementary to psychiatry.
Among the readers, there is a strong tendency not to appear foolish by revealing ignorance
of something so utterly basic. The fable of the emperors new clothes is germane. Among
the researchers, this also applies but there is another element, known colloquially as the
Campers Nightmare: But I thought you were bringing the can opener? In the corridors
of psychiatric power, everybody assumes somebody else has shown that mental activity can
properly be seen as neural activity, amenable to investigation by scanners, genetic studies,
and the like. This assumption is wholly without warrant. It matters not that every senior
psychiatrist in the world appears to believe the claim, it remains bullshit of the very highest order, worse because it is embraced by the people who like to see themselves as key
opinion leaders. The higher one goes up the academic ladder, the heavier the burden of
responsibility to ensure that the basic facts are in place.
With the aid of a sociological lens, we can see a little further. Chomsky sees a malign
process in the way peoples views are homogenized:
Still, in the universities or in any other institution, you can often find some dissidents hanging
around in the woodworkand they can survive in one fashion or another, particularly if they get
community support. But if they become too disruptive or too obstreperousor, you know, too
effectivetheyre likely to be kicked out. The standard thing, though, is that they wont make
it within the institutions in the first place, particularly if they were that way when they were
youngtheyll simply be weeded out somewhere along the line. So in most cases, the people who
make it through the institutions and are able to remain in them have already internalized the
right kinds of beliefs: its not a problem for them to be obedient, they already are obedient, thats
how they got there. And thats pretty much how the ideological control system perpetuates itself
in the schools. (Chomsky, 2002, pp. 244248)

That is, within specialist fields, there is an active process of detecting and eliminating
deviant or heterodox views.

THE BIOPSYCHOSOCIAL MODEL

In 1977, George Engel, a gastroenterologist from Rochester, New York, published
an article in the prestigious journal, Science, entitled The Need for a New Medical

Psychiatry as Bullshit51

Model: A Challenge for Biomedicine. He named his model the biopsychosocial

model. Subsequently, he published a series of articles showing how his model would
work in practice. Although it was actually directed at mainstream physical medicine,
it had an immediate appeal to psychiatry which felt the need for a rational, integrative model of mindbody. Over the years, it has become a mainstay of psychiatrys
self-identity (a detailed summary of its widespread acceptance is available at McLaren
2010, Chapter 7). A recent search of PubMed database showed 1,482 articles have
been published on the topic of the biopsychosocial model since 2002; almost all of
them strongly approving of the concept.
Going back in time, in October 1998, the Royal Australian and New Zealand College
of Psychiatrists (RANZCP) put a definition of psychiatry and of psychiatrists on its official
website that specified us essentially as specialists in the application of this model. After
Engel died in 1999, the Australian and New Zealand Journal of Psychiatry (ANZJP) published four solicited articles on Engels contribution to medicine in general and psychiatry
in particular. These were almost fawningly favorable to his work: Engels biopsychosocial
model . . . stands as one of the most influential ideas in Medicine in the 20th Century.
What no one can deny is that he did leave a towering edifice . . . (see McLaren 2010 for
full quotes and references).
This is a little alarming because in April 1998, I published an article (in the ANZJP,
no less) showing that the biopsychosocial model did not exist (McLaren, 1998). Engel
outlined a case for such an integrative model but, unsurprisingly, he never wrote it because
he couldnt. It relied on a resolution of the mindbody problem which, of course, he didnt
have. Complicating matters, he used the concept of a general systems theory (GST),
attributed to von Bertalanffy, but this was entirely spurious. He did not argue the case as
to why this theory should apply but simply cited references giving favorable mention to
GST. In fact, these all referred back to a book published in 1954, The Vital Balance, by Karl
Menninger, which briefly opined that, one day, GST may give a better understanding of
how mind and body relate (the story of how Menninger and von Bertalanffy met is interesting but beside the point).
In the 1998 article, I argued that this would never happen because GST was no more
than truism. Insofar as it made any specific claims (few and far between), they were either
wrong or could not be implemented; when it didnt make such claims, it was vapid. Specifically, the matterenergy transfer functions, which were at the core of von Bertalanffys
concept, could not apply to the mindbrain nexus because, as demanded by the theory,
there was no means of framing mind in mathematical terms.
Amazingly, such is psychiatrys thirst for a model of its own that this hasnt
deterred anybody. A recent article on the topic (Benning, 2015) agrees that the concept has limits but feels it is necessary to prevent psychiatry . . . from being hijacked
by partial or monolithic perspectives . . . (i.e., reductionist biological psychiatry).
Effectively, the author argued that a model that exists in name only is better than
nothing at all. I cannot agree. I believe the illusory biopsychosocial model lulls our
trainees and junior psychiatrists into believing that there is a model somewhere
and they dont have to think too hard about the critical issues because they have all
been sorted out by much smarter people. I am of the view that this is bullshit of a very
high order. Not formal deception, as Frankfurt defined it, just the fear of questioning
the status quo (again) mated to a desperate need to conceal psychiatrys intellectual
inadequacies.

52 McLaren

A CHEMICAL IMBALANCE
Ask practically anybody in the English-speaking world what causes depression, and
something like 85% will reply A chemical imbalance of the brain (Haslam, 2014). It is
certainly not clear when or how this concept arose. In 1974, when I began my psychiatric
training in Perth, Western Australia, we were told quite emphatically that depression
was caused by an imbalance of biogenic amines in the hypothalamus. Presumably, our
teachers didnt make this up with the intent of deceiving their trainees. That is, they were
not lying or engaged in fraud but were simply repeating without demur something they
had heard elsewhere. However, having changed from training in neurosurgery to begin
psychiatric training, I knew full well that nobody knew enough about the forbiddingly
complex hypothalamus to make such claims.
Since then, however, the trope has gained ground and is now bandied around in the
daily press, on television, and the Internet. The American Psychiatric Associations
website topic information on depression (accessed via For Patients and Families) states,
Depression (major depressive disorder) is a common and serious medical illness . . . It does
not say psychological disorder. Until recently, under Lets Talk Facts About Depression,
it stated . . . abnormalities in two chemicals in the brain, serotonin and norepinephrine,
might contribute to symptoms of depression . . . antidepressants may be prescribed to correct imbalances in the levels of chemicals in the brain.
It is important to understand the reality behind this type of claim. Joanna Moncrieff is
perfectly blunt:
For decades now, people have been told that depression is a chemical imbalance and that antidepressants work by correcting that imbalance. This view is not supported by evidence, and is
misleading as to the nature and effects of antidepressant drugs. (Moncrieff, 2015, p. 303)

Instead, we have clear evidence that psychiatry is colonizing, as it were, normal psychological states and reactions and claiming them as mental illnesses (Horwitz & Wakefield,
2007; Whitaker, 2009; Whitely, 2010). A state of discomfort, such as grief, is converted
by fiat to a mental disease for which drugs are de rigueur, but that is not the point here.
We can presume patients and the general public did not invent the expression chemical
imbalance of the brain to describe the cause of the various mental disorders. We can be
fairly sure it did not come from the older psychiatrists trained in psychoanalytic or other
psychodynamic approaches, nor the few who wholeheartedly adopted the behaviorist
model. By a process of exclusion, it had to arise in the complex of academic psychiatrists
and drug companies who so strongly advocated the biological model (Whitaker &
Cosgrove, 2015).
However, it demonstrates another point about skata taurou, which Shackel (2005)
named the motte and bailey doctrine. In medieval times, a motte was a solidly built
stone tower surrounded by an area of land, the bailey, which was usually protected by a
ditch. The inhabitants worked the sheltered land, but if assailed, they would retreat to
the tower and wait until the attackers lost interest and went home. By this means, the
inhabitants were able to occupy and work at a much larger area than they could actually
defendprovided they didnt mind occasionally sitting in a cramped dungeon while their
cottages were torched. That is, there was an outer, dangerously exciting but profitable
region surrounding a defensible but dull core of territory. In debates, a motte and bailey

Psychiatry as Bullshit53

doctrine is . . . used to insinuate an exciting falsehood, which is a desired doctrine, yet

permit retreat to the trivial truth when pressed by an opponent.
People who claim that mental disorder is a chemical imbalance of the brain appear to
be making a major claim on the nature of mental disorder, but they are not saying anything
interesting. Asked to elaborate, they talk airily about neurotransmitters and various brain
chemicals. Pressed for specifics, they tend to mutter about how psychotropic drugs affect
neural transmission in mice before abruptly changing the subject or scuttling away. That
is, as long as nobody challenges them, they claim a very large territory; under attack, they
retreat to a cluster of trivial truths which add nothing to our understanding of mental
disorder. It is the case that the tens of billions of dollars spent on biological research in
mental disorder over the past half century have not had any effect whatsoever on how
mental disorder is managed. In Shackels terms, the so-called chemical imbalance theory
of mental disorder (which isnt a theory, but thats another story) is an exceedingly large
and insecure bailey surrounding a small and boring motte.
But it doesnt stop there. The psychiatric columnist, Ronald Pies, former editor of
Psychiatric Times, is moved to anger by claims that psychiatrists would actually believe
such nonsense:
In the past 30 years, I dont believe I have ever heard a knowledgeable, well-trained psychiatrist
make such a preposterous claim, except perhaps to mock it. On the other hand, the chemical
imbalance trope has been tossed around a great deal by opponents of psychiatry, who mendaciously attribute the phrase to psychiatrists themselves . . . In truth, the chemical imbalance
notion was always a kind of urban legendnever a theory seriously propounded by well-informed
psychiatrists. (Pies, 2014)

For Pies, the trivial truth to which he retreats is that sensible psychiatrists never
repeated this bit of bullshit or, if they did, twas but in jest. Indeed, they probably didnt
say it, because they didnt have to; as Chomsky noted earlier, they were all so firmly indoctrinated that there was no need. In psychiatric circles, it was on a par with announcing
that the sun rises in the east. But if they didnt really believe it, why were they saying it
to patients? In any event, that doesnt stop the drug manufacturers spreading it around
because it is indeed an exciting falsehood trading [sic] on a trivial truth.
Pies little polemic shows another very successful ploy from the repertoire:
Fortunately, recent advances in cognitive psychology and neuroscience are now converging, with
the result that psychiatry may be on the brink of a unified model of so-called mental illness.

Here, we see a statement that is neither true nor false but is intended to create a
particular impression in its audience, that is, bullshit in pure form. It is neither true nor
false just because it hasnt happened: It is a claim about the future. Forecasts of future
events are often exciting but they have no truth content because the concept of truth
does not apply to events that havent happened. That is, a person who sticks to roseate
views of what he hopes to see cannot be accused of lying. A claim on the future carries
the implication I believe . . . , meaning the speaker is fully covered. If his prediction
transpires, he can luxuriate in his prescience but if it doesnt, he can easily distract his
audience with another of his triumphant visions. One thing psychiatrists never do is talk
about their ghastly past (Whitaker, 2002). Nota bene how Pies hedges his prediction:
. . . psychiatry may be on the brink . . . Keynote lectures at psychiatric conferences

54 McLaren

routinely use this conditional form, also popular with the manufacturers of vitamin
drinks and penis enlargers.

ELECTROCONVULSIVE TREATMENT
In common with many other professional organizations, from time to time, the RANZCP
issues official position statements on contentious or otherwise important matters. Position
Statement 74, concerning electroconvulsive therapy (ECT), issued March 2014, states at
Item 7.2,
[ECTs] primary purpose is to quickly and significantly alleviate psychiatric symptoms . . . ECT
remains a useful and essential treatment option that should be available to all patients in whom
its use is clinically indicated.

This sounds impressive and eminently reasonable but it actually says nothing. It is the
case that the use of ECT varies very dramatically around this country and around the
world but that is true of many different medical procedures. A commentary in The Economist (August 15, 2015) showed that the use of cesarian section is rising rapidly throughout
the world. In the United States, it is about 33% of all deliveries whereas in some hospitals,
it is approaching 90%. Indeed, women must make a booking to have a baby, meaning
cesarean section is all but mandatory. In the late 1980s, in the Kimberley Health Region
(KHR) of Western Australia, which is about as remote as it gets in the English-speaking
world, the incidence of cesarean sections was about 20%. This was for a population almost
exclusively of young Aboriginal women whose general and obstetric health, despite superhuman efforts by the district nurses, was on a par with many so-called Third World countries. At the same time, the incidence of cesarean sections in the wealthy eastern suburbs
of Sydney, where medical services and standards of maternal health are the equal of anything in the world, was about 40%. It is not possible to say that this inequity is clinically
indicated. Sadly, the most important determinant of who will or will not get a cesarean is
not the health of the mother but the wealth of the mother. For the record, the Regional
Obstetrician in KHR was paid an annual salary with no bonus.
When we turn to ECT, we find much the same inequity of distribution. It is the case that
some psychiatrists use ECT very often whereas others, such as myself, use it rarely or never.
For many years, I have worked in remote areas, generally with no support services of any sort
(McLaren, 1995). Twice, I was appointed head of department of urban general hospital psychiatric units where ECT had been in regular use. On both occasions, 1 of 5-year duration, the
other of 3 years, ECT was not used while I held the post. During that time in each hospital, the
bed occupancy rate, the admission rate, and the mean duration of stay dropped dramatically.
For the past 20 years, my private practice in psychiatry has been financed by Medicare,
the national insurer. I see about 400 new cases a year, many of whom are pensioners and
unemployed people who would normally go to the public mental health services. The
patients I see in private practice are much the same in background and level of disturbance
as those I have seen in my many years in public practice. However, in the public setting,
many of them would be highly likely to be given ECT.
I have not used ECT since 1977. I claim that if I can work alone in the Kimberley
Health Region, and in public and private practice and not use ECT, then so, too, can all

Psychiatry as Bullshit55

the psychiatrists who do use it. It is most emphatically not an essential treatment. It is an
option and, as the figures show, a very expensive and disruptive option at that. The specific
element of bullshit in the RANZCP Position Statement is this: ECT . . . should be available to all patients in whom its use is clinically indicated. It is clinically indicated, only
when the psychiatrist says it is, so this actually says, ECT can be used if the psychiatrist
feels like it. But my figures show it is never clinically indicated. Some psychiatrists
object that my experience is anecdotal, meaning they want to ignore it. It is not anecdotal. Covering some 15,000 patients over nearly 40 years in various settings, my series is
probably the largest and longest running naturalistic study of ECT in history. Not using
ECT also constitutes a study of ECT.

PSYCHIATRIC MEDICATION
Take away the drugs and ECT and what does psychiatry have left? The general public, governments, and funding agencies have been convinced that the correct response to feeling a
bit off color is to reach for the pill bottle. I have summarized (McLaren, 2012) how the levels of disability caused by mental disorders are tracking remorselessly higher, for example:
In the UK, the number of days of disability due to depression and neurotic disorders rose from
38 million in 1984 to 117 million in 1995, i.e. far from causing an improvement, the rapidly growing use of antidepressants was associated with 200% increase in disability.

For decades, doctors have been subject to a tidal wave of disinformation regarding psychiatric drugs. We are told they are safe, effective, nonaddictive so that withholding
them is negligent. However, we now know this is false: A prolonged investigation of the
so-called Study 329 (Le Noury et al., 2015) has revealed that the manufacturers of the
antidepressant paroxetine actually falsified their results so they could make this claim.
In fact, the drug is not safe, it is not effective and it meets every known definition of
addictive. The company was fined U.S. $3 billion for this little escapade but it didnt
bother them much, they made more than 10 times that amount from sales. The manufacturers of risperidone, an antipsychotic, did much the same thing (Brill, 2015).
There is now a copious and rapidly growing literature to show that psychiatric drugs
are dangerous and ineffective and people who start them seldom manage to get off them.
To cap it off, we know that people who take psychiatric drugs in the long-term die, on average, 19 years younger than their undrugged peers (Frances, 2014). This probably satisfies
most definitions of dangerous. This is probably outright criminal fraud but the millions
of doctors, psychiatrists included, who calmly parroted the drug companies propaganda
were, at the very least, guilty of feeding bullshit to their patients.

THE VERY MODEL OF A MENTAL DISORDER

All fields that claim to be scientific share one feature in common: a model of their field
of study. A scientific model must be rational, articulated, publicly available, capable of
making testable predictions, and of a form that can be criticized. It is not widely known,

56 McLaren

certainly not by psychiatrists, that there is currently no model of mental disorder that
meets these criteria. Doubters should ask any psychiatrist they meet the following
question:
What is the name of the model of mental disorder you use in your daily practice, your teaching,
and research? Specify the original publication in which the model is set out as a series of testable
propositions and three seminal works in which its application is tested against the canons of science and in practice.

You will not get an answer, just because there is no such model. That is not entirely
the fault of psychiatry; we dont yet have a model of mental order (otherwise known as a
model of mind) so a model of mental disorder is necessarily not in sight. However, psychiatrists always act and speak as though they have a very firm grip on the nature of mental
disorder. To paraphrase the Nobel laureate immunologist, Peter Medawar, they can be
excused of dishonesty only on the grounds that, before deceiving others, they have taken
great pains to deceive themselves (Medawar, 1961, p. 106).

CONCLUSION
The renowned cosmologist, Carl Sagan (1996), said, . . . at the heart of science is an
essential balance between two seemingly contradictory attitudesan openness to new
ideas, no matter how bizarre or counterintuitive, and the most ruthlessly sceptical scrutiny
of all ideas, old and new. This is how deep truths are winnowed from deep nonsense.
Psychiatry, as I have briefly shown, is stuffed full of deep nonsense, better known
as bullshit. I believe it is now appropriate to label the drive to find a biological basis for
mental disorder as pseudoscience, just because the huge endeavor hangs from little more
than blind hope. It would be very nice to see psychiatrists expose their own ideas to the
most ruthlessly skeptical scrutiny but there are now so many academic and other careers
dependent on this industry that it would take a revolution to clear the air.

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Niall McLaren is a psychiatrist with extensive experience in remote area, military and post-traumatic
psychiatry. He has published many papers and books in the application of the philosophy of science
to psychiatry.
Correspondence regarding this article should be directed to Niall McLaren, MBBS, FRANZCP,
Northern Psychiatric Services, PO Box 5346, Kenmore East, QLD 4069. E-mail: jockmclaren@
gmail.com