Humanizing Madness E-Book

Niall McLaren

• Herausgeber: Modern History Press
• Kategorie: Geisteswissenschaft
• Sprache: Englisch
• Veröffentlichungsjahr: 2007

Seitenzahl: 634

Beschreibung

An application of the philosophy of science to psychiatry

Although it's been 140 years since Maudley's groundbreaking treatise, modern psychiatry is in a state of intellectual collapse. No psychiatrist practicing today can point to a universally agreed model of mental disorder which explains the common observations of mental disorder, dictates a research program and ordains a form of management.
This book, the result of thirty years research in the philosophy of science, takes each of the major theories in psychiatry and demonstrates conclusively that it is so flawed as to be beyond salvation. It goes further, in that the author outlines a model of mental function which both satisfies the essential requirements of any scientific model, and shows how the phenomena of mental disorder can be described in a parsimonious dualist model which leads directly to a humanist form of management of the most widespread form of disability in the world today.
"This book is a tour de force. It demonstrates a tremendous amount of erudition, intelligence and application in the writer. It advances an interesting and plausible mechanism for many forms of human distress. It is an important work that deserves to take its place among the classics in books about About the Author
Niall McLaren has been an M.D. and practicing psychiatrist since 1977. Since then, he has undertaken a far-reaching research program, some of which has previously been published. For six years, while working in the Kimberley Region of Western Australia, he was the world's most isolated psychiatrist. He is married with two children and lives in a tropical house hidden in the bush near Darwin, Australia.
an imprint of Loving Healing Press

Leseprobe

HUMANIZINGMADNESS:

PSYCHIATRY ANDTHE COGNITIVENEUROSCIENCES

By Niall McLaren, M.D.

An application of the philosophy of science to psychiatry

Copyright© 2007 Niall McLaren. All Rights Reserved

No part of this publication may be reproduced, transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or other otherwise, or stored in a retrieval system, without the prior written consent of the publisher.

Library of Congress Cataloging-in-Publication Data

McLaren, Niall, 1947-

Humanizing madness : psychiatry and the cognitive neurosciences : an application of the philosophy of science to psychiatry / by Niall McLaren.

p.; cm.

Includes bibliographical references and index.

ISBN-13: 978-1-932690-39-2 (trade paper : alk. paper)

ISBN-10: 1-932690-39-5 (trade paper : alk. paper)

ISBN-13: 978-1-932690-40-8 (hardcover : alk. paper)

ISBN-10: 1-932690-40-9 (hardcover : alk. paper)

1. Psychiatry--Philosophy. I. Title.

[DNLM: 1. Psychiatry. 2. Mind-Body Relations (Metaphysics) 3. Philosophy, Medical. 4. Psychological Theory. 5. Psychophysiology. WM 100 M4786h 2007]

RC437.5.M43 2007

616.89′001--dc22

                                                          2007016021

Distributed by: Baker & Taylor, Ingram Book Group, Quality BooksFuture Psychiatry Press is an imprint ofLoving Healing Press5145 Pontiac TrailAnn Arbor, MI 48105USA

http://www.LovingHealing.com [email protected] [phone]

Future Psychiatry Press

Acclaim for Humanizing Madness

“Dr. McLaren brilliantly wields the sword of philosophy to refute the modern theories of psychiatry with an analysis that is sharp and deadly. His own proposed novel theory could be the dawn of a new revolution in the medicine of mental illness.”

—Andrew R. Kaufman, MD Chief Resident of Emergency Psychiatry Duke University Medical Center

“With Humanizing Madness, Dr. Niall McLaren has endangered the foundations of contemporary mainstream psychiatry while, at the same time, creating a rescue channel.”

—Ernest Dempsey, editor of The Audience Review

“This book is a tour de force. It demonstrates a tremendous amount of erudition, intelligence and application in the writer. It advances an interesting and plausible mechanism for many forms of human distress. It is an important work that deserves to take its place among the classics in books about psychiatry.”

—Robert Rich, PhD, AnxietyAndDepression-Help.com

“I found Humanizing Madness to be an incredibly well-written and thought-provoking. It is not, by any means, easy reading. It is also not for someone who doesn't have some form of background in understanding the various psychological theories and mental health conditions. I think that this would make an excellent textbook for a graduate class that allows students to question the theories that we already have.”

—Paige Lovitt for Reader Views

“It is impossible to do justice to this ambitious, erudite, and intrepid attempt to dictate to psychiatry a new, ‘scientifically-correct’ model theory. The author offers a devastating critique of the shortcomings and pretensions of psychiatry, not least its all-pervasive, jargon-camouflaged nescience.

Sam Vaknin, PhD, author Malignant Self Love: Narcissism Revisited

“This is an academic book about psychiatric methods. As a psychology graduate as well as a user of the various services, I find this a fascinating subject. It's not for a beginner, but for someone who has some experience of the mental health services, it's interesting and thought-provoking. I love the idea of Future Psychiatry anyway, we need to get over the stigma attached to mental health and see it on the same level as physical health issues. It's not a new theory, but more of an overview of what has gone before and where the future direction of psychiatry should lead.”

Josie Henley-Einion, author of Silence

Table of Contents

Introduction

I-1. Personal Preliminaries

I-2. What Is Psychiatry?

I-3. Theoretical Preliminaries

I-4. Summary of Part I: Psychiatry in Crisis: Intellectual Failure in the Science of Mental Disorder

I-5. Summary Of Part II: The Working Mind

I-6. Summary Of Part III: Toward The Future Of Psychiatry

Part I: Psychiatry in Crisis: Intellectual Failure in the Science of Mental Disorder

Chapter 1 - Brain Disease, Mental Disease, and The Limits to Biological Psychiatry

1-1. Introduction

1-2. Biological Psychiatry in Practice

1-2(A). Restricted Biological Psychiatry

1-2(B). Unrestricted Biological Psychiatry

1-2(C). Unlimited Biologism: Extreme Reductionism

1-3. Biological Psychiatry and Mind-Brain Identity Theory

1-4. Reductionism as the Logic of Biomedicine

1-5. Mental Illness in the Reductionist Biomedical Framework

1-6. Objections to Biological Reductionism in Psychiatry

1-7. Conclusion

Chapter 2 - Behaviorism from the Psychiatric Perspective

2-1. Introduction

2-2. Early Behaviorism

2-3. Skinner's Radical Behaviorism

2-4. Pavlov's Conditioning Model

2-5. Eysenck and the Decline of Behaviorism

2-6. Conclusion

Chapter 3. Mentalism in Psychiatry: Psychoanalysis and Cognitive Psychology

3-1. Introduction

3-2. The Logical Status of Freudian Psychoanalytic Theory

3-3. Saving Freudian Theory

3-4. Critique of the Apologists

3-5. Other Logical Errors in the Freudian Model

3-6. Modern Mentalism: Cognitive Psychology

3-7. Conclusion

Chapter 4 - Classic Dualism: Selves and Brains

4-1. Introduction

4-2. Popper's Case for Dualist Interaction

4-3. Eccles’ Outline of Dualist Interaction

4-4. Metaphysics and Dualist Interaction

4-5. A Note On Skinner's Anti-Dualism

4-6. Conclusion

Chapter 5 - The Concept of An Eclectic Psychiatry

5-1. Introduction

5-2. Eclecticism as a Virtue

5-3. Eclecticism as a Vice

5-4. Theoretical Eclecticism

5-5. Eclectic Research

5-6. An Eclectic Psychiatry in Practice

5-7. Conclusion

Chapter 6 - The Biopsychosocial Model In Psychiatry

6-1. Introduction

6-2. The Need for a Moderate Approach

6-3. The Role of Models in Science

6-4. The Biopsychosocial Model

6-5. The Concept of a Model

6-6. The End of the Biopsychosocial Model

6-7. Conclusion

Chapter 7 - The Categorical System Of Diagnosis: Personality Disorder

7-1. Introduction

7-2. The Psychiatric Concept of Categories

7-3. Categories of Personality Disorder

7-4. Discussion of Categories of Personality Disorder

7-5. Alternatives to Categories: The Dimensional Approach

7-6. The Limits of Dimensional Models

7-7. Conclusion

Chapter 8 - When Does Self-Deception Become Culpable?

8-1. Introduction and Review

8-2. Caveats

8-3. The Place of Criticism in Psychiatry

8-4. The Biopsychosocial Model in Contemporary Psychiatry

8-5. Critique of the Place of Biopsychosocialism in Psychiatry

8-6. Conclusion

Part II: The Working Mind

Chapter 9 - Functionalism And The Nature Of Control In Human Behavior

9-1. Introduction

9-2. Functionalism

9-3. Problems of Functionalism

9-4. Getting Around the Problems

9-5. Experience and Functionalism

9-6. Conclusions: Functionalism Fails

Chapter 10 - Dualism

10-1: Introduction: Dualism Re-emergent

10-2. Property Dualism

10-3: Expanding Materialist Science

10-4. Consciousness as a Category Error

10-5. The Paradox of Phenomenal Judgment

10-6: Future Directions

10-7. Conclusion

Chapter 11 - The Effable And The Ineffable: Property Dualism And Self-Control.

11-1. Introduction

11-2. The Phenomenal and the Psychological

11-3. The Psychological Realm in Action

11-4. The Phenomenal Realm in Action

11-5. The Psychological and the Phenomenal in Concert

11-6. The Sense of Self

11-7. Conclusion

Chapter 12 - Interactive Dualism As A Partial Solution To The Mind-Brain Problem

12-1. Introduction

12-2. Functionalism

12-3. Natural Dualism

12-4. Tasks of a Theory of Mind

12-5. Turing's Automated, Non-Conscious Decision-Maker

12-6. Generating Conscious Experience

12-7. The Emergence of a Biocognitive Model

12-8. Conclusion

Part III: Toward the Future of Psychiatry

Chapter 13 - Personality Disorder

13-1. Defining the Problem

13-2. Solving the Problem

13-3. Personality Disorder

13-4. Conclusion

Chapter 14 - Anxiety

14-1. Introduction

14-2. Explaining Normal Anxiety

14-3. The Psychophysiology of Normal Anxiety

14-4. The Descriptive Psychophysiology of Abnormal Anxiety

14-5. Explaining Abnormal Anxiety Responses

14-6. Conclusion

Chapter 15 - Depression

15-1. Introduction

15-2. The Depressive Syndrome as Absence of Pleasure

15-3. Depression as the Final Common Pathway

15-4. Conclusion

Chapter 16 - Psychosis

16-1. Introduction

16-2. The Category Of Psychosis

16-3 Conclusion: Everybody is Right

Chapter 17 - Other Myths in Psychiatry

17-1. Introduction

17-2. Dissociative Disorders

17-3. Eating Disorders

17-4. Addictions and Compulsive Behaviors

17-5. The Placebo Effect

17-6. Conclusion

Notes and References

Index

TO SEE ILLUSTRATIVE CASES AND OTHER CLINICAL MATERIAL, VISIT WWW.FUTUREPSYCHIATRY.COM.

Introduction

“A change to a new type of music is something to beware of as a hazard to all our fortunes. For the modes of music are never disturbed without an unsettling of the most fundamental political and social conventions.”

—Plato

I-1. Personal Preliminaries

The purpose of this book is to show what a scientific theory of psychiatry should look like. Unfortunately, a lot of psychiatrists think this to be a rather silly objective, pointing to what they believe are several perfectly adequate theories already available. My response is that the mere existence of a number of different theories confirms what the cynics have long known: the more theories there are, the less likely any of them is right. Cynical or not, my view is that all the theories used in psychiatry in the late 20th Century are wrong.

In the 1970s, when I trained, psychiatry in Australia was somewhat different from what was on offer overseas. Rather than adopt the hard-line Freudian view of American psychiatry, the very biological approach common in Britain and Scandinavia, or the ascetic behaviorist line, Australians tried melding all the available schools into a benign and non-doctrinaire ‘eclectic psychiatry. Eclecticism, which means picking the best bits of a range of offerings, was seen as, if not morally superior (Australians don't like extremism), then certainly a vastly more practical notion. Good eclectic psychiatrists could do more for their patients by adopting whatever approach seemed likely to give the best results.

Thus, depressed people were diagnosed as suffering a biological disorder and given tricyclic antidepressant drugs and Electro-Convulsive Therapy (ECT). Adolescents were awarded complex Freudian formulations which lent themselves to long-winded courses of psychotherapy. Middle-aged housewives with their phobias and obsessions were seen as suffering learned disorders and were treated by behaviorist methods. Schizophrenia and manic-depressive psychosis, of course, were seen as biological disorders, while people with personality disorders were preferably not seen at all.

Unfortunately, the psychiatry in which I trained was neither intellectually demanding for the trainee nor, I suggest, very helpful for the patients. Yet it was clearly an improvement on what had gone before. The old mental hospitals were still there, still full, their walls gone but the bars still on the windows. In many places, the patients still wore uniforms while the staff, also in uniform, bore heavy, jangling key rings and defensively custodial attitudes.

Yet it was a time of ferment, of change too rapid for the orthodoxy to manage. In a few short years after, say, 1970, a strongly humanist and anti-institutional influence spread, mainly from the USA but also from centers in Britain. The revolutionary idea that, merely by being caught up in the mental hospital system, people could be, if not driven mad, then certainly kept mad, quickly gained a following. Polemical writers such as Thomas Szasz in the US and Ronald Laing in Britain were widely read, and not just by people working in the mental health field. Anybody with intellectual pretensions had to be familiar with these writers. While this was going on, the psychiatric establishment seemed to have nothing new to say in response. In 1973, when Science published the startling paper On Being Sane in Insane Places, the establishment was enraged but not pensive. Down on ground level, as I then was, it seemed that the orthodoxy had overnight been rendered irrelevant, all their rigid theories of illness turned into yesterday's news by the simple idea of looking at the mentally-ill just as ordinary folk with a few problems.

It all seemed so very clear, so very superior, that learning the old theories would soon turn out to be a waste of time. And that, I suppose, is what adolescence is all about, whether it be in a family or in a profession. People entering a profession need that particular sense that the millennium is just around the corner. If they didn't have the roseate myopia that goes with it, if they knew just how hard the work would be, then they would probably all take up surfing or play guitars under trees.

On my first morning in psychiatry, my registrar (now a senior professor) took me to his office and, for about two hours, talked about psychoanalytic theory. At the end, I reeled out, stunned by his vast and effortless scholarship, by his untroubled familiarity with the arcane Freudian labyrinth. I wandered off to have cup of tea, asking myself: “How can anybody know all of that?” What I meant was not: “How could anybody know that much?” because, after studying medicine for six years, I knew that vast scholarship cost just a few more years’ study. Instead, I had in mind the rather deeper question of: “How can anybody know that all that stuff is true? He believes it, but can he prove it?”

For anybody trained in philosophy, that is hardly a revolutionary question but, for a junior doctor trained during the materialist sixties, it was a bit radical. Everybody knew that if it was science, it had to be right, and Freudians invariably claimed that theirs was the only true science of mental life. So there could be no argument. Several times over the next few weeks, I essayed questions of this type but was quickly put in my place by my registrar's confident manner. He could answer any and every objection I raised, and I couldn't argue with his ever-ready answers. Freud surely was the man for all questions.

But at the same time, I was also very interested in the biology of mental life, if there is such a thing. In those days, there definitely seemed such a thing. To anybody studying biology after Watson and Crick, it seemed just a matter of time before the True Theory of Mind rolled off the scientific production line. Compounding this confidence, I had arrived at psychiatry via the unusual path of first wanting to study neurosurgery. Unfortunately, neurosurgery wasn't as interesting as I had hoped, but a term in psychiatry seemed to offer the chance of intense intellectual stimulation combined with getting to know people as people.

Consequently, I had to balance Freud on the one hand with reductionist, materialist biology on the other. In 1970s eclectic Australia, being able to jump from Freud to brain transmitters in the same sentence was seen as a virtue. But it soon became clear to me that something was wrong. In talking of mental disorders, my seniors would often talk about brain structure and function in outmoded terms. Or they might talk about neurotransmitters in mental illness when I knew perfectly well that nobody knew enough about them in health to say what they would be doing in illness.

This was a worry. In the burns unit or the cardiology department, when the consultant said this or that, then it was not going to be wrong. But in psychiatry, people could talk in terms which I knew intuitively were unprovable or just plain wrong, and nobody said anything. Indeed, the more outrageous the claim, the more awed people seemed and the less inclined they were to argue. I recall one professor confidently saying that a middle-aged man was depressed because he had had a gastrectomy and could no longer absorb Vitamin B6. But I had already spoken to the man and knew he'd had a vagotomy and pyloroplasty, not a gastrectomy; his vitamin levels were all normal; and he was a most offensively obsessional man whose family had finally tired of his demanding and domineering ways, hence his depression. And, despite the professor's sublime confidence in his own assessment, gastrectomy causes low VitB12, not B6. So much for academic psychiatry.

However, the first project in psychiatric training is to tackle the vast reading lists, which tends to subdue even the most fractious of trainees. For me and my peculiar quest for certainty, it made things worse. How can one talk of narrowing the search for the faulty neurotransmitters in schizophrenia, and at the same time have people writing purely psychological accounts of the disorder—and even have others saying that it doesn't exist, that it is invented by psychiatrists to keep mental hospitals full? They couldn't all be right. But my registrar had an answer for this, too. He announced that the essence of a good psychiatrist is to be able to tolerate ambiguity. That shut me up for a good week, I recall, until I realized that it licensed the very opposite of scientific certainty, it made a virtue of being too weak-willed to take a stand.

Perhaps the easiest solution seemed to be what most psychiatrists did, which was to ignore, politely but always firmly, what one didn't believe in. Except there was another problem: if psychiatry is a science, it isn't possible to jump from one theory to another. At best, only one theory can be right and all others are necessarily wrong. In my own puritanical way, belief couldn't and didn't enter the debate. I would accept what the facts dictated, not what faith or fantasy demanded.

Before long, I had decided that if anybody in psychiatry genuinely knew what he was talking about, I certainly hadn't met him. By April, 1975, twelve months after starting my training, my original plans to become a psychoanalyst had been abandoned. From my reading and from intuition, I knew that nobody could ever know what Freudians routinely claimed to know. I was also deterred more than a little by their habit of quoting from the master, analyzing the quote, then winding up with another quote which proved it all again—just like Christians and Marxists.

At the end of that year, I was warned by A Very Senior Psychiatrist that unless I straightened my ideas, I didn't have a future in psychiatry and, just to emphasize the point, was told not to apply for another post with his hospital. That was quite shocking: what are ideas for, if not to tear to bits? In due course, I passed my psychiatry finals and was let loose upon the unsuspecting public. Within a week of my last exam, I had decided to spend a little time clearing up the point of what constitutes the scientific theory of psychiatry. That was nearly thirty years ago, and what follows is my preliminary outline of what is wrong with the state of theorizing in modern psychiatry.

My style of writing has been constrained by two pressures. On the one hand, I like to present things briefly but people sometimes object that the work isn't clear. However, spelling everything out in detail tends to sound polemical. Confusion or polemics, there's a conflict I haven't resolved. As a matter of style, I don't adopt the spurious objectivity of modern scientific writing. I use the first person personal pronoun in two ways. Firstly, I use it to distinguish very clearly between my views and other people's. I never use expressions like “It is suggested…” when I mean “I suggest…” Secondly, I use the philosophical I, which means that if I can experience or do something, so can every other living human of reasonable intellect. It means: “This is common to human experience and doesn't need to be argued.” These different uses should be quite clear.

I-2. What Is Psychiatry?

Before we start, it will help to describe what psychiatry is. Firstly, psychiatry is a medical specialty. You cannot call yourself a psychiatrist in Australia unless you have the degree of Fellowship of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) or its equivalent. To become a psychiatrist, you will have to pass a medical course (normally six years in this country) and then work several years as a medical officer in a teaching hospital before applying to join one of the psychiatry training programs. All training programs in Australia are organized by the RANZCP. Once you're accepted into training, and assuming all goes well, you will get your specialist degree after a heap of exams spread over another five years. This means about thirteen years of study since leaving school, sometimes more.

Psychiatrists believe that people have minds in their heads, and that disordered minds produce disordered behavior. By talking to people, asking them questions about how they think and feel, and by watching them, psychiatrists decide what's wrong in the head and prescribe treatments of various sorts. Because psychiatry is a medical specialty, and because medicine is based in biology, so the orthodox psychiatric concept of the mind and its disorders also has its foundations in biology. It is now standard psychiatric theory in most countries that the mind becomes disordered because the brain is disordered. Most psychiatrists accept that mental disease just is brain disease, that mental symptoms are nothing more than brain illnesses manifest in a particular way.

Consequently, the proper way of relieving these peculiar symptoms is to correct the underlying disturbance of brain function using physical treatments such as drugs, ECT or, in extreme cases, brain surgery. Thus, a depressed person who sees a psychiatrist will almost certainly be told: “You have a chemical imbalance of the brain, and these antidepressant tablets will cure you.” If the depression doesn't get better, the patient (not client) may well be admitted to hospital for a course of ECT. It is all very rational and intellectually not very demanding but, as I will argue, it is all very wrong.

One thing has to be understood: psychiatry is not a branch of psychology. Psychology is a completely different subject. It is a university course, often part of the Arts Faculty, and has a totally different orientation from psychiatry. Whereas psychiatry is a very practical field, much more concerned with results than theories, psychology had its beginnings in philosophy departments over a hundred years ago and still has an intensely academic orientation. I don't think that will ever change. Psychiatry is about getting mentally-ill people better, and whatever works will be used. Psychology is essentially a research program aimed at working out the principals and mechanisms of normal mental life. Its practical aspects are secondary. If psychiatrists know anything about normal mental life, it is largely accidental. Psychologists, on the other hand, start with theories about normal behavior and work from there.

Psychiatrists work mainly in general hospitals, in mental hospitals, in university departments attached to hospitals, and in private practice. The sorts of disorders seen in psychiatric practice include every sort of mental disturbance, with the emphasis on the more severe types. Typically, psychiatrists see psychotic people, people with severe anxiety or depressive states, and the huge, blurred borderland between general medicine and mental life.

Years ago, it would have been said that mental hospitals treated mad people (“psychotics”) against their will using physical methods of treatment based in a biological theory of insanity while private psychiatrists mostly treated miserable or frightened people (“neurotics”) by talking to them. General hospitals did a bit of everything, especially if they had a university department of psychiatry, in which case they would probably use a lot of what are called behaviorist methods (as well as ECT). The theory of behaviorism argues that abnormal behavior is learned by the same principles as normal behavior, and can just as readily be unlearned (“cured”). It is (or was) a central theory in psychology, and psychiatrists simply borrowed it because it promised results. Also, it didn't clash with the biological theories of mental illness, which made life easier. Nowadays, that very simple division of labor has broken down.

I-3. Theoretical Preliminaries

This book is about theories. Why theories? Without theories, the practice of psychiatry drifts. Treatment becomes a mish-mash, heavily influenced by the latest charismatic writer (and psychiatry has plenty) and passing fads. A rational form of treatment should flow from the theory so that it becomes a rule-governed process, rather than hit-and-miss. Too often, existing theories have done little more than obstruct the proper development of ideas. In Part I, my intention is to show that they have long-outlived their usefulness. Bad theories waste resources by dictating the wrong research programs. Theories stand or fall on their content, and my conclusion is that each of them is so flawed as to be beyond salvation.

Part II consists of the much more interesting task of writing the “design specifications” of a new theory of human mental function for psychiatry. This approach is completely different from the way most of our theories have arisen, which is by elaboration on a chance discovery. We have to start at the beginning, with no preconceived ideas, using just the observable behavior and experiences of Citizen Joe Blow. If our definition of science excludes certain essential aspects of human life (as the behaviorists tried to do), then we have to change our model of science. All of this is explained along the way, every step is set out clearly with no hidden premises, so readers can see why I have taken a particular path and can agree or disagree with the move. However, there will be errors in this section but at least they should be more obvious than the errors buried in the old theories. The essence of Part II is this: No hidden premises. If there are any, I would like to hear of them.

Finally, Part III models the theory to the area of human mental disorder. This is the interesting bit, as my theory is meant to dictate treatment, not the other way around. I appreciate that, until now, available treatments have always dictated the theory, but it will bring us into line with the rest of medicine.

I-4. Summary of Part I: Psychiatry in Crisis: Intellectual Failure in the Science of Mental Disorder

It is a hallmark of a mature science that there is an agreed theoretical basis which gives rise to an accepted research program. Psychiatry is not such a science. While there is a measure of agreement as to the subject matter of psychiatry and what psychiatrists are allowed to do, that's about the limit of it. Of course, that limit does no more than define a technology. On the theoretical basis of psychiatry, there is no agreement. Granted, the dominant approach to mental disorder today is what is termed biological psychiatry but it merely dominates the research program and, anyway, that's just what is happening today. Tomorrow could see yet another of the vertiginous swings which have characterized psychiatry for the past one hundred years. These types of swings have led some perfectly sensible people to ask why they should take psychiatry seriously.

Given the array of theories available to every practitioner in psychiatry, we need some sort of standard to assess them. The process of abstractly comparing theories against an independent standard is known as meta-analysis. In the older, more formal sense, meta-analysis means the dispassionate comparison of the form of different theories which, for want of a better term, means philosophy, the love of knowledge. If we are comparing scientific theories or talking about what constitutes a science, we are talking about the philosophy of science. A large part of the philosophy of science consists of the derivation of different standards by which we can decide whether to take a theory seriously or not. As Joan Robinson didn't quite say, “The purpose of studying theory in psychiatry is to learn how to avoid being deceived by psychiatrists.”

In the main, errors made by psychiatric theorists are fairly obvious because, all too often, ordinary common sense was lacking when the theory was written. The authors thought they were on to a good thing and their audiences were desperate for anything that sounded convincing. I am absolutely convinced that modern psychiatry is dying from the head up. Whether my work remains convincing after reading is up to you, the reader.

I-5. Summary Of Part II: The Working Mind

Since the beginning of recorded history, three questions seem to have occupied as much of our time as any others: How did we get here? Where are we going? How do we do it? No, that's probably an exaggeration. There are more pressing questions, such as: Where's our next meal coming from? How can we clobber our neighbors? Who's going to sleep with me tonight? Food, shelter and sex always take priority, but as soon as there was a relative degree of security and comfort, people's minds turned to questions of the mind. I also imagine that, as soon as people could start to think about minds in abstract, they started to think about madness.

In an ideal world, a theory of mental disorder would flow directly from a theory of mind. That is, a theory of mind is logically prior to a theory of disturbed mind, although anybody looking objectively at modern psychiatry would have no reason to suspect this. In my training in the 1970s, we were not given any instruction in concepts of mind. I remember enquiring about this once. The lecturer looked at me blankly and asked: “Why?”

Why indeed.

Should psychiatrists have any concept of mind? The gloomy survey in Part I implies that there might be some advantage in it. Part II starts the process of deriving a theory of mind suitable for psychiatry.

I-6. Summary Of Part III: Toward The Future Of Psychiatry

In the final chapters, I want to use the model derived in Part II to understand the crucial questions of mental disorder. That is, I want to develop a rational explanatory model of mental disorder. Since 1980, when the American DSM-III was published, psychiatry has not had an explanatory model of mental disorder, rational or otherwise. The entire nosology is avowedly atheoretical, meaning it assumes nothing about mental disorder but simply clumps it into separate categories. It should be understood that this amounts to an admission that psychiatry has no scientific basis. If there were a proper scientific theory for psychiatry, then it would necessarily be the basis of the nosology; it wouldn't be possible to have an agreed theory and not use it. If there isn't a proper theory, then the nosology can be no more than a prelude to science, an introductory clearing of the decks, as it were. Psychiatrists can't have it both ways. They can't claim on the one hand to be functioning within a scientific framework yet, on the other, also claim that their diagnostic system is atheoretical. There is no such thing as a non-theoretical science as a science is necessarily committed to a theory; science just is the process of explicating and testing a theory.

In any event, there are two objections to the notion that there can be an atheoretical nosology. Firstly, it isn't atheoretical at all, because if a researcher assumes the different sorts of mental disorder are categorically distinct, then he has made a major theoretical assumption. This needs to be proved, not simply accepted ex vacuo.

Secondly, there is an important principle in science which the DSM, with its endlessly proliferating categories of mental disorder, cheerfully breaches. This is the principle of parsimony or Occam's razor, named after Bishop William of Ockham who died in 1347. The principle, which has a number of variants (and may well have antedated him), states that the number of explanatory entities must not expand beyond the minimum necessary. Because the DSM system is based upon superficial appearances only, and says nothing about possible underlying mental mechanisms, it is not an explanatory system. Purists could therefore argue that the Razor doesn't apply, but the counter-objection is simple: why bother? If the huge numbers of separate diagnoses don't have some deeper significance, who needs them? This is especially the case when the different diagnoses can only be treated with the same small range of drugs. Orthodox psychiatry has become a sort of modern Scholasticism where researchers pore feverishly over the data, trying to find every conceivable point on which reality can be fractured into hundreds of entities with no significance beyond their names.

This section moves beyond mere description. I intend to look beyond the surface appearances, using the hidden mechanisms of mental life to explain the appearances rather than simply leaving them as isolated curiosities for biochemists to pick over. This will necessarily involve readjusting the borders so laboriously (and, at times, bitterly) drawn by the huge DSM committees but, if we want to move from “mere description” to an explanatory account of mental disorder, it is inevitable. It would be akin to the move from a structural classification of diseases (say, all lung diseases vs. all renal diseases) to an etiological system (all infectious diseases vs. all neoplastic diseases). Change inevitably breeds resistance, as the philosopher, Thomas Kuhn, warned.

In this context, the views of Air Chief Marshall Sir Hugh Dowding, victor of the Battle of Britain, are of particular interest. In his memoirs, Twelve Legions of Angels (1946), he wondered why, when they entered military service, some of the best brains in Britain “seem to lose their critical faculty.” In a chapter entitled Why are senior officers so stupid? he noted: “If a junior officer puts forward a suggestion, the implication is that a senior officer might have thought of it, ought to have thought of it, and didn't think of it … After being squashed a sufficient number of times, according to his tenacity, the junior officer ceases to put forward unwelcome suggestions….”

Replacing the word officer with psychiatrist indicates a universal application to Dowding's opinion which resonates with Kuhn's hypothesis. People who have spent thirty or forty years looking at mental disorder through a descriptive lens are not suddenly going to throw it out for another, because that would imply their model was never any good but they said nothing. That's asking a bit much of ordinary people and, after all, most psychiatrists are very ordinary, very conventional people.

My intention in the final Part is simply to sketch an outline of how a rational theory of psychiatry should be derived from a definitive model of mind. By answering the question, What causes mental disorder? I will show that a non-biological account of the major psychiatric syndromes is neither fanciful not counter-intuitive. Rather, it shows how to integrate the normal and the abnormal, how an understanding of the pathological flows directly from a detailed model of normal function.

Accordingly, I will not be giving many references in Part III as the argument should be self-evident. If it isn't, then all the references in the world won't save it.

—Niall McLarenwww.FuturePsychiatry.com

Darwin, Australia,February, 2007.

Part I: Psychiatry in Crisis:Intellectual Failure in theScience of Mental Disorder

1Brain Disease, Mental Disease And The Limits To Biological Psychiatry

1-1. Introduction

There is an ancient and universal notion that there is something we can add to or subtract from the diet that will cure all sorts of mental woes. In a sense, this is what biological psychiatry is all about, because underlying this particular belief is the concept that, even if there is an immortal and immaterial human soul that separates us from the beasts of the field, it has a very touchy stomach. Ultimately, they say, a man is what he eats. Generations of grandmothers have believed that constipation causes an accumulation of toxins in the bloodstream, which in turn affect the mind, causing all sorts of niggly behavior—but only in children. While grandmothers may become niggly themselves, it is always for good reason.

The principle is simple. Whatever the mind is, it can get sick just like everything else on earth. Despite thousands of years of religious indoctrination, there has always been a fifth column of old women frightening children with the idea that the mind sickens if they can't produce a good bowel action each day. But in biological psychiatry, this notion is extended to cover the complete state of the body as the final determinant of the mental state.

Now this is not Descartes’ concept of the mind immaterial and unextended, the ethereal mental captain of the physical ship, as it were, but it is a widespread and very powerful notion. In every culture, people take drugs to feel or think better or to arouse or still various passions. In this context, “drug” means any physical agent introduced to the human body with the purpose of inducing a change. Drugs are therefore not the same as talismans or spells, which effect changes by supernatural means. Folk medicine as practiced by grandmothers is very largely built upon the concepts underlying modern biological psychiatry. So what are they?

Unfortunately, and despite the vast sums of money being spent on the biological research program in psychiatry, I am not aware that the principles underlying biological psychiatry have ever been explicated by its practitioners. In the main, biological psychiatrists have accepted as true all the materialist concepts that form the basis of general medicine. Central to these is the idea of reductionism, the belief that higher or more complex functions or entities can be reduced to or explained away as the outcome of activity or processes at less complex levels. This notion is certainly not new, and underlies all of the more orthodox sciences such as physics, chemistry and biology. Thus, we say that a towel dries in the sun, not because the sun spirit sucks the water out of it, but because water molecules trapped in its fibers acquire energy from the sun and, as explained by the kinetic theory of heat, break free of their mutual attraction and drift off. Cars move because of chemical energy in petrol, antibiotics safely destroy bacteria in the body, ‘sunrise” is the impression given by the earth's rotation, and so on. What we see is the outcome of unseen processes among invisible particles. Reductionism “explains away” the appearances.

So too with the mind: biological reductionism argues that all thoughts, all mental activity or events of all kinds, result directly from certain neurophysiological events, and that a perfect understanding of all human affairs will automatically follow from a perfect understanding of the brain. Over the past hundred or more years, people have increasingly tended to accept that reductionism will explain human affairs just as it explains, say, ape affairs or cabbage affairs. I believe that this confidence has been misplaced (even in apes), but the set of beliefs and attitudes known as biological psychiatry depend very closely on reductionist concepts.

1-2. Biological Psychiatry in Practice

So what is biological psychiatry? Moving from the restricted to the general, three themes are seen in the literature:

1. “Biological psychiatry investigates possible pathophysiological bases to mental disorder” [1].

2. “Mental disorder is brain disorder” [2].

3. “All mental events are brain events” [3].

Since each of these themes defines a field of study and limits the means of investigation, they constitute research programs. In each case, the field of study is mental disorder, which is to be viewed and investigated from the standpoint of the established biological sciences. Unfortunately, the field of mental disorder is rather difficult to define, especially at its edges (e.g. separating normality from personality disorder), but mainstream mental illness is sufficiently well-defined to leave no doubt. Similarly, there is general agreement as to the nature of questions that can be asked in biological research, the form in which they must be cast, and the methods of investigation.

With few exceptions, research in all areas of biological psychiatry adheres closely to accepted methodologies. Techniques are borrowed from other, successful disciplines, adapted as necessary to human research, and then applied in a standard form. Necessarily, psychiatry lags a little behind the latest research in biology, as it takes time to understand the significance of recent developments and somewhat longer to apply these to questions in psychiatry (as well as the inevitable delays in funding). But while these aspects of research in the biology of psychiatry may be unexceptionable, there is another, more problematic, element, namely the nature and form of the questions being asked. Unlike a field with an agreed scientific methodology, there is no formal means of deciding whether questions in psychiatry are of a form suitable for this type of research. They derive informally from the researcher's overall view of the subject matter, meaning his apprehension or ontology of the nature of mental disorder. Unfortunately, my apprehension may well seem a misapprehension to you.

1-2(A). Restricted Biological Psychiatry

The references quoted above represent three quite divergent views on the nature of mental disorder. The first reference, by Berger and Brodie, is taken from a large, respected textbook of psychiatry. It is based on the empirical evidence that some sorts of brain disease can result in recognized syndromes of mental illness. The different contributors to that section of the handbook carefully avoided any particular theoretical commitments, as the conclusion to the section on schizophrenia shows: “…studies of the biology of schizophrenia have produced many findings of CNS dysfunction, none specific for this disease and none shared by everyone with the diagnosis … Direct evidence for a specific neurotransmitter or receptor abnormality is not yet available. One hopes that as knowledge of normal CNS anatomy and physiology expands and new methods for exploring aberrations from normal become available, new insights into the cause or causes of this very devastating illness will be possible” [1, p 449].

This is a commendably cautious stance in an area fraught with conceptual and methodological difficulties. Only a person who denies that disturbances of brain function can affect mental function (hardly a tenable position) could take exception to this attempt to map out an area of research. As they noted, the results of this research program have been remarkably slow coming.

1-2(B). Unrestricted Biological Psychiatry

The second reference, from a textbook by the British psychiatrist Michael Trimble, represents a very much harder line on the nature of mental disorder, as his opening quote shows: “Mental disorders are neither more nor less than nervous diseases in which mental symptoms predominate, and their entire separation from other nervous diseases has been a sad hindrance to progress” (attributed to Henry Maudsley, 1870). Later, he quoted the German psychiatrist Griesinger as “…reflecting the essential nature of biological psychiatry … ‘Insanity being a disease, and that disease being an affection of the brain…’” (p11).

Trimble quickly dismissed the possibility that psychological factors can cause mental illness. He approvingly quoted Maudsley's acerbic dismissal of metaphysics (p21-3), immediately labeling psychoanalysis (and all psychodynamic theories) as metaphysics. He continued: “The distractions of psychoanalysis for present-day psychiatry cannot be over-emphasized. To base theories of etiology, pathogenesis and treatment on ideas that were dominant nearly a hundred years ago makes little sense … Psychiatry … tenaciously accepts so much of the old dogma, and so reluctantly embraces the new.” Psychiatry, he insisted, is “…concerned with behavior in its widest sense, and has continually searched for knowledge of brain-behavior relationships and somatic underpinnings of psychopathology.”

We can conclude from this that Trimble's position is as follows:

All mental disorder is brain disorder;Psychiatry is essentially a biological discipline;Psychodynamics is outmoded and empty metaphysics.

These are fairly blunt statements of intent, but they are certainly not unusual. These ideas dominate psychiatry in the late twentieth century, especially in Britain, Scandinavia and, more recently, the United States. In fact, one of the doyens of American psychiatry, Samuel Guze, recently asked whether there is any other kind of psychiatry besides the biological, adding: “…there is no such thing as a psychiatry which is too biological” [4, p315]. Stated as baldly as this, we can see why some people have started to worry about “hegemonistic biologism” in psychiatry [5].

The greater part of Trimble's text consists of detailed accounts of biological research in a wide variety of mental disorders. Oddly enough, and in clear contrast with the moderate stance seen in Berger and Brodie, neither the book itself nor any of its chapters contains a summary, almost as though the author believed that the research material spoke for itself. To my mind, this is a serious omission, one which makes sense only if its readers accept the basic premises of his case as outlined above. In Trimble's schema, all pathological mind-body interaction goes but one way, from the body to the mind, a view most psychiatrists would reject. The concept of psychosomatics rests on the notion that the mind can influence the body.

The unanswered question in Trimble's approach to psychiatry is clear: Is it a fact that all mental disorder is brain disease? This is certainly not trivial as the whole objective of clinical and theoretical psychiatry is to understand the nature of the phenomena of mental disorder. However, regardless of how many professors line up behind the biological banners, the matter cannot be resolved by fiat. In this type of question, mere weight of opinion counts for nothing. Unfortunately, Trimble shows no awareness that there may be an issue at stake here. Mental disorder is brain disorder; therefore, as hollow metaphysics, all other considerations lie outside the purview of psychiatry and, by intimation, of rational thought. But Maudsley's nineteenth century dictum is the critical issue here, and the following argument will show some of its weaknesses.

Consider Maudsley's proposition:

Proposition P1: All mental disorder is (just a special form of) brain disorder.

In the first place, there is no logical way of proving this assertion true as it is not a necessary truth. At best, it could be an empirical truth, inductively true but thereby open to refutation by finding a single case of psychologically-determined mental disorder. This point is important. If Trimble asserts that it is impossible for mental disorder to be caused by anything other than brain disease, then he is making the same type of wild and unsupported statement of which he finds psychoanalysts guilty. But if he allows that there may be cases of mental disorder that do not result from brain disease, then he had no grounds for making his assertion in the first place.

Nonetheless, we can disprove P1 by considering the truth value of its negation, as follows:

P2: No cases of mental disorder are not also cases of brain disease.

This sounds a little clumsy, so it can be rephrased as follows:

P2a: There are no cases of psychologically-determined mental disorder.

But, as the diagnostic category of Post-Traumatic Stress Disorder explicitly recognizes, Proposition P2a is empirically false so Trimble's basic proposition, P1, is false. Despite his assertion, not all mental disorder is due to brain disease. A complete list of all brain diseases (known and unknown: we're talking hypothetically here) would not account for all mental disorders. There will always be some left over as examples of pure psychological disorder. He is therefore unwarranted in his remaining assertions, that psychodynamics is outmoded and empty metaphysics, and that psychiatry is essentially a biological discipline.

Returning to P1, there is another way of tackling Trimble's metaphysical stance on mental disorder, which is to look at the nature of the “human machine.” In any complex machine (i.e. one that controls its own output by means of its information-processing capabilities), the disordered output resulting from an unseen physical disturbance of one sort or another can always be mimicked by a programming error. For people, what this means is that any and all disturbed behavior can in principle have either physical or psychological causes. Every psychiatrist keeps this critical point in mind all day: “Is what I am seeing a genuine psychological disorder, or is it really a physical illness such as a tumor, or is it just clever acting?” For anybody who takes the job seriously, this question is a ceaseless worry because there is no reliable rule of thumb.

For these two reasons, I assert that Trimble's case for biological psychiatry must fail. It seems to me that Trimble could only have overlooked these quite elementary considerations if he had assumed a more general position with respect to the mind. His basic proposition, P1, would become valid under the following, specific condition. Assume that:

P3: All mental events are brain events.

Given this very broad assumption, it would then follow that, as a subset of the universal set of mental events, all abnormal mental events (the stuff of mental disorder) will necessarily be brain events. Assuming that one is justified in judging brain events normal or abnormal according to whether their associated mental events are normal or not (and I don't believe this assumption is justified), it would therefore follow that:

P1: All mental disorder is brain disorder.

Accepting this argument would validate Trimble's thesis, but P3 is part of a much larger question, namely, metaphysics. At its most basic level, a successful account of mental disorder depends on a successful account of mind. Were Maudsley, or Trimble, or Guze, or any other biological psychiatrist ever aware of that? It seems to me that psychiatrists simply assumed that whatever worked in biology would automatically work in human psychology.

This principle was never questioned. It was accepted as part of the world-view, the ontology, on which reductionist biology depends, as Guze noted: “Most of us who adhere to the medical model believe that the fullest understanding of human health and illness, including psychiatric conditions, will depend increasingly on growing knowledge in biology … this explains the redefinition of many personal and social problems into concerns of medicine” [6, p7]. This implies that a complete understanding of human biology will give a complete understanding of personal and social problems. I see no evidence to support this extreme position.

I asked whether we are justified in judging brain events normal or abnormal according to whether their associated mental events are normal or not. If, for the purposes of the argument, we accept that mental events just are brain events, how then should we judge the brain events if we decide that the mental event is abnormal? The question is simple: can a normal brain event still constitute an abnormal mental event. I would say yes, it can. Consider the example of grief. When we experience a massive loss of one sort or other, we typically go through a particular response known as the grief reaction. This is sufficiently common in its incidence and form to be regarded as a normal event. But grief, as we all know, is horrible; life would be far easier if we didn't have to feel it. So is grief normal or abnormal, and how should we classify the brain events underlying it? It depends on how you look at it, which is, of course, no basis for determining brain events abnormal.

It is perfectly legitimate to allow that abnormal mental events could be the outcome of normal mental events, because nobody has ever proven a strict one-to-one relationship between mental events and their (assumed) underlying brain events. People tend to use the analogy of computers to explain the difference between normal and abnormal mental and brain events. The machinery of a computer (its hardware) may be perfectly normal yet it persists in producing an abnormal output. We explain this by saying that its programs (software) are defective. By analogy, people argue that while the brain's physical machinery (its “wetware”) may be perfectly normal, its programs (belief systems and information) may be disorganized, thereby producing an incoherent output (weird behavior). This is an interesting analogy, but there is nothing to say that brains and computers run by the same principles.

Putting all this aside for the moment, and taking Trimble's book at face value, it can fairly be said that he has not proven that a single mental disorder is due to physical disease of the brain. All he did was to indicate that for each major mental disorder, certain laboratory findings are somewhat suggestive of the thesis that some of the classic mental disorders might be due to physical disease of the brain.

1-2(C). Unlimited Biologism: Extreme Reductionism

Turning to reference [3], from J-P Changeux’ Neuronal Man, we find Trimble's unspoken assumption stated quite explicitly: “There is no justification for a split between mental and neuronal activity. What is the point of speaking of ‘mind’ or ‘spirit’? It is only that there are two ‘aspects’ of a single event … It seems quite legitimate to consider that mental states and physiological or physicochemical states of the brain are identical.” Oddly enough, one must wait almost to the end of the book to read this clear statement of Changeux’ beliefs. At the beginning, he announced: “It is not my intention to identify the brain with a clock, to treat the nerve cells as cogwheels, or even to make the organization of neuronal networks resemble at all costs the circuits of a computer or any other artificial mechanism” (p38). However, having said that, he repeatedly referred to the “cerebral machinery” and, on p58, spoke approvingly of “the metaphor of the brain as a computer.”

There are numerous examples of this quirk, which occur at points of tension in his work. He wants to say that humans are unique creatures with singular mental gifts, yet these gifts are also entirely explicable in reductionist terms: “A global activity can thus be reduced to physico-chemical properties and can be described in the same terms as those employed by the physicist or the chemist” (p95). The clear implication is that it really isn't so singular after all. But whereas he argues at length that science can encompass spiritual qualities, spiritual entities are specifically and repeatedly dismissed as fanciful.

Like Trimble, Changeux bluntly dismisses suggestions that the mind cannot be investigated by objective science, arguing at length that the neurosciences have progressed grandly towards a materialist vision: “Animal spirits could now be identified as movements of atoms and molecules. The science of the nervous system had become molecular” (p34-36). Later, he said: “Man no longer has need for ‘Spirit’: it is enough for him to be Neuronal Man” (p169). But in taking this extreme position, he has made a major mistake, that of believing that any ‘spiritual” entity is necessarily self-delusory mysticism, whereas desirable “human” (spiritual?) attributes are always reducible to neurology. This is too arbitrary to be science. He would have been better to have stated his central idea at the outset instead of letting it emerge by degrees, because the empirical evidence he adduces in support of his case is irrelevant to his metaphysical assertion that mental states are brain states. This question cannot be answered empirically.

To demonstrate this point, a great deal of the evidence Changeux quoted as favorable to his materialist position was used years before by Eccles [7] in support of precisely the opposite conclusion, namely, that the human mind exists as an immaterial entity with supernatural powers. Both authors made the same mistake, of believing that empirical evidence could decide a metaphysical question. These types of questions must be argued from first principles, as they are of a form on which no empirical evidence can be brought to bear. The evidence is true, but in each case, it is quite beside the point, as irrelevant as last year's telephone book. Its truth or falsity does not determine the truth of the metaphysical question.

As mentioned, all that counts in Changeux’ work is the notion that mental states are brain states, a well-known question in philosophy. Can “modern biological and genetic science” explain, as Guze believed [4, p322], such matters as social environment and culture? If so, psychiatry's claims to be a separate discipline would dissolve. Psychiatry would become just a branch of clinical neuroscience, just as has been advocated from time to time [8].

I have already argued that mental illness cannot be identified with brain disease, but we need to look at the broader proposition (P3). It can be rephrased to read:

P3a: Mental events are identical with brain events.

This is one of a range of theories developed by philosophers arguing the materialist case. Materialism states that there is nothing in the Universe above or beyond matter and energy and their interaction. With few exceptions, it explicitly denies emergent phenomena, i.e. those that cannot ultimately be reduced to matters of particles and energy. While materialism has been outstandingly successful in fields such as particle physics, molecular biology and astronomy, it has never been able to give an adequate account of the persistent notion that minds exist as immaterial entities with causal significance in the material realm.

1-3. Biological Psychiatry and Mind-Brain Identity Theory

One approach to this problem has been the concept of Epiphenomenalism, the view that minds may well exist but they are no more significant causally than the cloud of steam over a factory (attributed to TH Huxley, Charles Darwin's cousin). This concept, however, does not stand up to close examination. One can readily devise little experiments to show that something with all the properties of a mind can be causally significant. Thus, materialists have tried another approach, now known as Mind-Brain Identity Theory (MBIT). Taking as their starting point an uncompromising materialism, Smart [9], Armstrong [10], Place [11] and others have argued that mental events certainly occur but, as a matter of contingent fact, they are nothing more than brain events. The question of causal significance loses some of its impact in this formulation as there is no problem over the junction of mind and body.

In Smart's opinion, “…it seems that even the behavior of man himself will one day be explicable in mechanistic terms … (there is) … nothing in the world but increasingly complex arrangements of physical constituents” [9]. Armstrong agreed: “…the sole cause of mind-betokening behavior in man and the higher animals is the physico-chemical workings of the CNS” [10]. Sensations and all other mental events, he insisted, are brain events as a case of strict identity.

In my view, it is no coincidence that, albeit unwittingly, biological psychiatrists have adopted MBIT. As psychiatrists, we are concerned with disorders of the mind (insofar as they can be distinguished from disorders of the CNS, the field of neurology), yet biology closes some of the available options for accounting for the readily observable properties of mind. Firstly, as a materialist discipline, biology denies that immaterial minds can exist, and secondly, as reductionist empiricism, it rejects the possibility that minds may be emergent phenomena. The biological psychiatrist is thus forced to see minds as real, causally significant and yet capable of a complete reductionist analysis. Only MBIT can satisfy these very restrictive requirements.

Unfortunately, powerful arguments have been erected against MBIT. Over fifty years ago, Norman Malcolm countered the central notions of MBIT [12]. Firstly, he argued that as an empirical fact, MBIT would be unintelligible as it is irrefutable. The only convincing test of whether thoughts and brain events are identical would be to identify thoughts positively, i.e. independently of the subject's reports of them. Clearly, that would be impossible.

Secondly, Malcolm demonstrated that there are emergent (i.e. irreducible) laws and properties. Examples include the rule that hearsay evidence is inadmissible, the annualized national current account deficit, or the doctrinal beliefs underlying Holy Communion. These matters govern human behavior yet they cannot be reduced simply to matters of molecules or fundamental particles. Explanations of these, and a host of similar notions, always rely on the concept of an Intelligent Observer to render the account plausible.

This criticism is very important because, as will be discussed in Chapter 3 (Behaviorism), a key element in the reductionist program is to eradicate all abstract notions, replacing them with accounts of “mere particles in action.” When you or I talk in “mentalese” (the language of “folk psychology”) of “wanting to do this” or “fearing to see that”, we are relying on the concept of ourselves as sentient, intelligent beings. That is, we see ourselves as beings with a mind of some sort, with free will and abstract reasoning, who are at least one step above mere beasts. Now because wishes, wants, hopes and plans etc. can't be measured in any way, orthodox science doesn't admit them as proper objects of study. Reductionist biology therefore had to get rid of them, and one of the most far-reaching attempts to do so was seen in Skinner's Radical Behaviorism (see Ch.3).