Mad vs Bad

The baddies are winning.

(We’re under a cyclone warning, which is a bit unusual for Brisbane, they normally stay further north, so I’m writing in between rushing around tying stuff down or shoving it in the over-full shed. The forecast is for 400mm (16”) of rain over next four days, so we’ll probably be cut off for a few days. Went out to get fuel and extra bread etc this morning, long queues at the petrol station and the supermarket. Why get fuel if the roads are going to be cut? Dunno, force of habit, but now fully stocked so we sit and wait.)

In the post for Feb 18^th, I summarised the program approved by the new US Secretary for Health, RFK Jr, particularly how he wants to shift attention from drugging children to psychosocial interventions. I also mentioned that he would be up against some immensely powerful vested interests who, having donated to the Trump campaign, will be waiting for the pro quo for all their quids (an old pun: a quid was slang for one pound in pre-decimal currency, now $2.00). Unfortunately, Mr Kennedy also embraces some fringe views, such as opposing immunisation for children. His tenure is not off to a good start as there is an outbreak of measles in Texas, home to a large population of anti-vaxxers, and one unimmunised child has already died, the first measles death in the US for ten years.

In a group email, somebody mentioned that if Kennedy stands up to Big Pharma and to the ADHD industry, some good may come from it. I replied: “My enemy’s enemy is my friend. Even if he’s a crackpot.” I was quickly admonished for making a “partisan political rant.” That was a bit surprising as eleven words hardly qualifies as a “rant” (vb: speak or shout at length in an angry, impassioned way; n. a tirade) and Kennedy’s more extreme views label him as “a foolish or eccentric fellow.” Be that as it may, what follows is probably a rant, but deliberately so.

In a report on the Gaza negotiations, a reporter from an Anglo-Indian site, Janta Ka, described the perpetrators of the current blockade of food and fuel as “mentally ill” (here, at 1.05). That’s wrong, completely wrong. Not a single person in the huge cast who are planning and acquitting the military action in Gaza could claim to be “mentally ill” or any other term such as mad, crazy or insane. With just two exceptions, they are all in perfect control of themselves, making their decisions in clear consciousness, with no mental impairment of any sort. In law, they are fully responsible for their actions. The exceptions are Trump and Biden who both show clear evidence of early cognitive decline but nobody has made any attempt to declare them unfit or incapable in law. It’s the same as the Nuremberg trials: apart from Rudolph Hess, none of the defendants attempted to plead Not Guilty on grounds of insanity.

I don’t think the reporter was attempting to excuse what has been classed as “plausible genocide.” Instead, he was expressing the same bewilderment common to so many others who see humans acting in what used to be called a “bestial” way, even though beasts are never so horrific as humans. What he was saying was “I can’t comprehend this. It’s so far outside the bounds of decency that these people must be lacking some essential human element.” It’s an old move, since witchcraft went out of fashion, people have always labelled “different” as “sick, crazy, insane.” For example, homosexuality moved from being demonic to an abomination to sickness and finally to “just different.”

Violence, however, isn’t an “all or none” phenomenon, as in “you are or you aren’t,” it grades imperceptibly from the mildest little mouse tip-toeing through life, to a raging tyrant. Psychiatrists should have something important to say here, helping to distinguish between “normal behaviour” and “all the rest,” but they can’t. They would need a clear line between the concepts of normal mental function, mental disorder and personality disorder. Even though psychiatrists spend all day, every day, dealing with these concepts, they have no more than an intuitive understanding of the concepts involved, with no reliable way of separating them. It all goes back to the lack of any genuine understanding of what goes on between people’s ears. Despite thousands of years of effort, the human mind remains too complex, too mysterious for us to grasp. As ever, the question remains: How do we make sense of something we can’t see?

For a time, Freud’s psychoanalysis seemed to be making some progress. Sigmund Freud started his career as a researcher in neurology, which means he came at mental life from a particular point of view. Part of his appeal was that he didn’t exclude anything on the basis that nice people didn’t talk about it. Freud wasn’t a particularly nice person himself, but he was armed with the fixed belief that what he was doing was science. For him, talking about boys having sexual desires for their mothers was no different than talking about faeces or the biology of reproduction. He also didn’t try to build a wall between “us normal people” and “them crazy or immoral people.” We all have the same mental mechanisms, he said, we can talk about them abstractly and non-judgementally, and even study them in ourselves. In fact, he said, we have to be careful because our feelings can affect us in unexpected ways, we’re not as rational as we like to say. Well, didn’t that cause upset among the upper classes, who were firmly convinced they were gifted in ways that the poor and foreigners were not. They were not just convinced they were morally superior, they needed to believe it.

As a theory of mental disorder, psychoanalysis was doomed from the beginning because it relied too much on what the analyst believed, so it couldn’t be separated from the wilder ideas that swirl around human society. Thus, when a group of physicists and philosophers in Vienna proclaimed that science had to be based firmly in what we can see and measure, its days were numbered. Psychologists took that to mean “None of this mental talk,” which spawned the behaviorist revolution, but psychiatrists were in a bit of a bind. Mental talk is what psychiatry is, it’s only about mental stuff, there isn’t anything else. They solved the problem by announcing that, yes, people can talk about their mental lives but we psychiatrists really know they’re just talking about their brains. Even though the patients don’t know it, we know that all this talk of feeling sad or scared is just code for “My serotonin is down today, can you boost it a bit?” As for emotional involvement, psychiatrists should have no more feelings for their patients than a lab scientist has for his white rats. The belief that, at base, mental trouble is just biology has condemned psychiatry to wandering aimlessly across the landscape for a hundred years.

I mentioned a little while ago how, in a group email, I had said there was no such thing as a “biomedical model” for psychiatry. This provoked a professor at a prestigious university to reach for his keyboard:

It’s ridiculous to say there is no biomedical model. You may think they are wrong, but there are many biomedical models of psychiatric phenomena … anyone who has heard a theory that argues depression is caused by a chemical imbalance can say with certainty at least one biomedical model of mental disorder exists. It may not be true, but it exists.

The worthy professor was invited to send the name of the biomedical model he uses in his daily practice, his teaching and his research, including the name of the primary author and several references where the model has been developed and expanded. Predictably, there has been no response. If you want to stop psychiatrists talking, just ask them: “What’s the name of the scientific model of mental disorder you use?” Similarly, Position Statement No. 80 of the Royal Australian and New Zealand College of Psychiatrists, currently in force, states:

Medical expertise: Psychiatrists apply their medical knowledge, specialist clinical skills and acumen in the provision of person-centred care. They understand the impact of ‘biological’, ‘psychological’ and ‘social’ factors on mental health and the causation of mental illness. This ‘bio-psycho-social’ model is a holistic approach that recognises the impact of social adversity and physical health on mental well-being [1].

Some fifteen months ago, I wrote to the president, pointing out that in fact, there is no such thing as a “biopsychosocial model,” hyphenated or not. She replied: “... the biopsychosocial model (is) ...the predominant theoretical framework underpinning contemporary psychiatry ... a relevant and useful component of training and practice ... " (Moore, E. correspondence, Nov. 20th 2023). She was asked to send a copy of her model, plus details of the teaching material used in the college training process. Despite several reminders, not a word has been heard. I conclude that their “theoretical framework” exists as a name only, and she doesn’t have any training material. Psychiatry is flying blind: the whole thing is as real as Santa Claus.

What this says is that modern psychiatry has no way of reliably separating mental disorder from the sort of wickedness we see around the world. To me, that’s very important. Evil is when a person puts his interests before all other people’s interests, and stops at nothing to get his own way. That’s not mental disorder. The truly evil are very sane and well-organised. While it’s true that mentally-disturbed people do break the law, it’s not as much as the newspapers say, and mostly it’s fairly trivial. Complicating that, we have the very real problem of the largely unknown effects of the side effects of psychiatric drugs, especially akathisia and emotional numbing, and the largely unknown effects of drug withdrawal. Mentally-troubled people have enough to deal with without being blamed for the world’s evil.

So was Hitler insane? No, definitely not. The pilots dropping 2000lb bunker-buster bombs on schools crowded with refugees, and the politicians and generals issuing the orders, are not mentally ill. They know exactly what they’re doing, and they enjoy it. That’s evil.

1. RANZCP (2013). Position Statement No. 80: The role of the psychiatrist in Australia and New Zealand. RANZCP Website. Accessed Nov 3rd 2023.

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