Extremism and Psychiatry
I will be giving a talk on March 27th, considering the question: “Can there be a biological psychiatry?” According to Betteridge’s Law, the answer is No, so we’ll see what emerges. It will be at 12.30pm Perth time (GMT+8), meaning 3.30pm Eastern daylight Saving, 2.30pm Qld, unfortunately 12.30am New York time. Log in details to follow.
*****
Last week, I listened to a lecture with the snappy title “Radicalisation in Adolescents and Youth: mental health considerations for clinicians” by a child psychiatrist working in adolescent forensic psychiatry division. It was largely based on a paper published late last year [1], with reviews of some papers from here and overseas. The first part of the talk described incidents from last year. In the first, a youth in Sydney stabbed a priest during a live-streamed service because of comments the priest had previously made about the youth’s religion. Police quickly rounded up a dozen of the youth’s associates who have since been charged with terrorism offences. In the second, in Perth, a 16yo youth who had spent two years in a program for countering extremism was shot dead by police after he stabbed a stranger, then ran at police with a knife. For both incidents, there was considerable detail regarding the offenders in both the talk and the paper.
The second part of the talk reviewed a number of papers by psychiatrists on radicalisation in adolescents. Naturally enough, psychiatrists want to show that everybody whose beliefs or behaviour lie more than two standard deviations from normal is ipso facto “mentally ill” and in need of drugs. This didn’t happen. In one of the papers quoted, the incidence of diagnosable mental disorder ranged from 0-57%, which tends to undermine the value of psychiatrists. Nonetheless, the speaker concluded (as does his paper) with an appeal for psychiatrists to play a significant role in managing radicalised youths.
I see two major problems with the speaker’s opinion, each of which would require a book to discuss properly, but the preliminary is the concept of “radicalisation” for which we need some definitions.
Terrorism is the use of indiscriminate violence to induce a state of terror in a civilian population for political purposes. It has to be indiscriminate, like a bomb left on a bus; it has to be directed at civilians, regardless of whether they have any control over the political goal; and it is to force the government to yield on a particular political issue. Some people say it must serve an ideology but this clouds the issue: all governments are driven by ideology, so all this says is “…serve an ideology the government doesn’t like.”
Extreme means just that: at the limits of human experience, the point beyond which there is no return. Unfortunately, people use this word all the time to mean ‘rather’ or ‘somewhat’ or ‘more than me.’ It should be used extremely rarely. Politically, extremism means ‘far beyond anything that ordinary people would dream of.’ That means it’s relative, and we’ll expand this shortly.
The word ‘radical’ comes from Latin, for root, and is taken to mean working on the roots, as it were, to induce massive change. Radicalisation is any process by which a person moves from a moderate set of beliefs to a much more extreme position. This takes time, and it takes an input, which can be other people or just a solitary person reading inflammatory material. It can also be some incident leading to the realisation that things are bad and radical change/revolution is necessary but it won’t come peacefully.
Violent extremism means just that, a person decides to engage in violence to bring about radical change. That is, a person can hold radical political or social views, meaning sees the need for massive change, but may only be active within normal socio-political channels (activists), or may just feel too overwhelmed to get anything done (passivists?).
The first and, to me, most striking point was what the lecture didn’t talk about: the relentless radicalisation of the entire population by the state, directed at a particular political viewpoint. In addition, there is the somewhat more focussed, countervailing efforts by the huge range of groups commonly known as “conspiratorialists” who push “conspiracy theories” which cast the state as evil and repressive so it must be fought. As an example of state radicalisation, consider the constant barrage of material which urges every right thinking adult in this country to see our major trading partner as an existential threat. A senior US general announced two years ago that the US would be at war with China by 2025 (this year, as it happens; no sign of it yet); no reasons were given. YouTube hosts any number of alarmist and jingoistic bits and pieces, the goal of which is to accustom the apathetic to the idea that we have to spend vast sums on military gear that will eventually join the Leopard tanks and so many other “essentials” in Korean or even Chinese blast furnaces. As an example of state radicalisation, watch this video on China by a person who actually knows what he is talking about. Fortunately, Herr Drumpf seems to have cut off the propaganda outlets at the knees.
While this material can be avoided by ignoring anything that starts with Murdoch, the cyberworld groans under a deluge of material ranging from RF Kennedy’s anything-but-harmless anti-vaxxer stuff to the raging insanity of the QAnon chatrooms [3]. Here, the explicit purpose is to radicalise huge sections of the population to the idea that they have to take over the government by force to prevent some apocalypse or other. In another setting, this sort of process would be called grooming. While the lecture itself discussed only the (statistically insignificant) radicalisation of a tiny group of disaffected and ineffectual Muslim youth, it needed to show some sort of balance. What is called ‘radical’ or ‘terrorism’ or ‘extremist’ depends on the colour of the government: “One person’s terrorist is another person’s freedom fighter.” The Mau-Mau in Kenya were called terrorists until the colonists were forced out, same with the FLN in Algeria, fighting the repressive French occupation. However, balance doesn’t help in applying for funds to run counter-radicalisation programs etc.
The idea that extremism is relative is important, as today’s standard belief system (ideology) readily becomes tomorrow’s abhorrent nightmare. The best example is slavery. To us, the idea of owning another person as we own our pets is incomprehensible, yet it’s not that long since the US fought a brutal civil war over just this point. In the South, people who helped slaves escape were hunted and, if they were lucky, shot on the spot. They were radicals, trying to force massive social change on a society that was very comfortable with the way it was. Slaves who ran away were said to be suffering a mental illness called drapetomania, because only a sick slave would want to leave the luxury of the plantation.
In the early 1970s, gay men imprisoned in California were diagnosed with the mental illness of homosexuality and injected with fluphenazine. These days, anybody who advocates that sort of thing is rightly deemed an extremist. In the USSR, political dissidents were diagnosed with “sluggish schizophrenia” and put in harsh mental hospitals because only a crazy person could possibly find fault with the Workers’ Paradise, but mainly to stop the idea spreading. In British Palestine in the 1940s, there were groups of Jewish militants who called themselves terrorists as they wanted to cause such terror among the indigenous population that the place would become ungovernable. Their plan, as Nahum Goldmann said, was so soon after the Nazi defeat, the British would be forced either to start shooting Jews or leave. They left, and two of the most notorious terrorist leaders, Menachim Begin and Yitzak Shamir, later become prime ministers. It’s all relative.
The second problem in the speaker’s position was that psychiatrists should be very much involved in this type of work. I believe this is wrong. I believe the great bulk of psychiatrists should keep right away from this type of political matter unless there is clear evidence that a mental disorder is present and influencing the behaviour. The problem for psychiatry is that it doesn’t think in relative terms, only absolutes. As the speaker’s paper concludes:
Adolescent radicalisation arises from a multimodal landscape, with mental disorder(s), developmental immaturity, personality factors, familial influences, societal factors and/or environmental contributors all potentially playing a role.
Now while that sounds impressive, especially to politicians who know nothing, it’s hollow talk: psychiatry rattles on about “other factors” but it has no idea of how to deal with them. For a start, notice how mental disorder, which is not a big deal in offenders, comes first. This is because psychiatry’s “biomedical model” looks at putative “chemical imbalances” only, it has nothing worthwhile to say about social or other factors. And it doesn’t exist [4]. Moreover, their widely touted “biopsychosocial model” is an illusion anyway, so the “other factors” he mentioned are just window dressing [5]. In particular, very few psychiatrists know anything about personality as they don’t even have a model of it. As for social and other factors, psychiatry doesn’t look at causes, only at the present state because for them, the symptoms assign the cause, and the cause is genetic. In brief, psychiatrists are simply not equipped to play more than a minor supporting role for a small percentage of the few amateurish kids who are picked up for doing dumb things that were doomed from the beginning. Serious radicals will not be caught, and psychiatry has nothing to say about them anyway.
That said, there is a very strong reason to keep psychiatrists on a short rope, as Churchill grumbled:
I am sure it would be sensible to restrict as much as possible the work of these gentleman, who are capable of doing an immense amount of harm with what may very easily degenerate into charlatanry. The tightest hand should be kept over them, and they should not be allowed to quarter themselves in large numbers upon the Fighting Services at the public expense … There are quite enough hangers-on and camp followers already.
“…may very easily degenerate into charlatanry.” In fact, the risks are worse and to see why, we need a little history, from Churchill’s era. As I’ve mentioned before, during the 1930s, everybody who was anybody was an unashamed racist. Racism was the default position for everybody with any education, or money, or status or influence or what they like to call “breeding.” Nobody doubted that God had ordained there should be a hierarchy of races, with northern and western Europeans at the peak, Mediterraneans one or two rungs down, and all the other races holding up the ladder. Surprising as it may sound today, there was also a hierarchy of sexes, with men bravely leading the way and women tripping along behind. That was normal. Nobody argued with it, there were no tribunals to appeal to, no complaints boards and certainly no damages awards for being called names.
Flowing from that was the idea that higher races could be contaminated by lower, to the point where they would lose all their vitality and sink, as Hitler firmly believed, into a new dark age (it was never mentioned that all the “racial contamination” was by men imposing on women of the supposedly inferior races). This led directly to race laws intended to preserve the purity of the superior race at the expense of the inferior and here, the US of A led the way. Regardless of where they were born or who their fathers were, people of African heritage or from the colonies, such as the Philippines, were not citizens of the US and could not vote (also true of Aboriginals in Australia until 1967, a standard colonial ploy). Certain jobs were closed, education, health and public services such as transport, even churches, were segregated, on and on. There were laws against mixed marriages and there were also eugenic laws relating to racial health, in that mentally-disturbed or intellectually handicapped people could be sterilised, along with prostitutes, alcoholics and persistent criminals.
These laws were used as the template for Germany’s Nuremberg race laws of 1936 which legalised the persecution of Jews, Romany, Slavs, gays and so many others, and for the eugenics program to rid Germany of “inferior classes” of people. Initially, this was by sterilisation but, from September 1939, the method was involuntary euthanasia, aka mass murder. By the end of the European war, up to 300,000 people had been killed under the Aktion T4 program, at first by lethal injection but when this was too slow, by gassing. The “success” of the gassings, i.e. the ease of despatching groups of people without troubling the staff, then became the model of the mass killings of the Holocaust.
The point here is this: the idea of gassing entire races of people did not pop out of the blue one fine morning. It started with and developed from the widely accepted concept of racial superiority, which led to the idea of racial contamination, which then led to laws prohibiting it, then to laws for eliminating “defective germ plasm” by sterilisation, then by murder, initially individually, then in groups, then to the concentration camps, and finally to purpose-built extermination camps. Step by legal step. At all times, psychiatrists were right in the thick of it, nothing they did was illegal. Most of the laws relating to mental hospitals existed when the Nazis came to power and the rest were borrowed from the helpful white people in Kentucky and Alabama who had worked out how to keep the blacks happily in their place at the bottom of the social ladder. .
We see a similar process unfolding in the US today. The Trump administration has exhumed a law from 1798 (truly) which allows it to deport undesirable aliens in war time. If the “alien” happens to have residency, a green card and an American wife but has broken no laws, as in the case of Mahmoud Khalil, then the residency permit is summarily cancelled and the newly-birthed alien can legally be given the boot. Of course, it depends on your definition of legal but people like the reptilian Stephen Miller can always be trusted to find one to meet the occasion (brief video here). This process is expanding rapidly.
Now if psychiatrists get involved in dealing with “radicalised” people held on charges under some rushed terrorism act or other, they will want to be in charge because psychiatrists. Once that happens, the risk of the alleged offender acquiring a diagnosis is close to 100%, as the psychiatrist’s values will contaminate what is supposed to be an objective process, e.g. “Of course your phone isn’t bugged, you need more tablets.” Once diagnosed, drugs follow as night follows day. If the person refuses the drugs, which is quite likely, then he/she will be detained and will get them anyway. The detention order will go to the mental health tribunal for review, but it always sides with the psychiatrist because the psychiatric member of the tribunal is of the same biological orientation as the hospital psychiatrist who applied for the order. Tribunal hearings are secret and even the most irrelevant material (e.g. the location of the toilets in the building) can be declared secret by the president of the tribunal with zero chances of a successful appeal. Tribunal decisions can be appealed to a branch of the supreme court but the court is advised by two psychiatrists who will never find against the hospitals where they have worked or disagree with the psychiatrists they have taught. Once in the high security wing of the mental hospital, the new patient’s relatives and friends can be banned if they “upset” anybody for any unstated reason. If the patient refuses drugs or doesn’t accept the diagnosis, then that shows lack of insight which is used to keep renewing the detention order, indefinitely. And all of this is secret, not even the alleged offender himself can publicise it. So be warned: the machinery already exists for people to disappear into the system for life. All it takes is a Trump wannabe and an autocratic psychiatrist and you’re sunk.
People may say “Oh, you’re over-reacting again, we can trust the good intentions of all the people involved.” No, you can’t. When people who have no good intentions get power, well-intentioned people are first out the door. If you ever could trust, which I don’t believe, you certainly can’t any more.
Be warned. Be scared.
References:
1. Kasinathan J, Parsons A (2024). Radicalisation in adolescents: mental health considerations for violent extremism. Australasian Psychiatry, 33(1): 57–63. DOI: 10.1177/1039856224
2. Peels R (2024). Towards a fruitful concept of radicalisation: a synthesis. J Contemp European Studies 32: 610–624 https://doi.org/10.1080/14782804.2023.2185594.
3, Bloom M, Moskalenko S (2021). Pastels and Pedophiles: Inside the Mind of QAnon. Stanford, CA: Redwood Press.
4. McLaren N (2021). Biological Psychiatry: Reductio ad Absurdum. Chapter 2 in Natural Dualism and Mental Disorder: The biocognitive model for psychiatry. London, Routledge.
5. McLaren N (2023). The Biopsychosocial Model and Scientific Deception. Ethical Human Psychology and Psychiatry, 25: 106-118.doi:10.1891/EHPP-2023-0008.