Has Psychiatry Gone Uniquely Astray?By Henry Bauer
Science, medical science included, and their applications in technology and in medical practices, have seen huge progress in recent decades. Those needing medical care have experienced much benefit. Robert Gallo, a well-known public hero of HIV and AIDS research, credits this to “an increased understanding of and reliance upon the scientific method” (p. 2 in Gallo’s memoir, Virus Hunting, Basic Books 1991). The scientific method consists, of course, of going where the evidence leads, accepting explanations and theories only when they have been tested against what happens in the real world. That’s why science and science-based medicine have offered such reliable understanding and guidance.
Followers of the Mad in America website and its blogs know, however, that these encomiums do not extend to contemporary psychiatry, neither its theory nor the associated practice. Against mountains of evidence, the reigning “consensus” blames all mental or emotional dysfunction on physicochemical circumstances in the brain and prescribes drug treatment accordingly. And that consensus remains impervious to the wealth of contrary evidence fully documented in many books and other works by highly competent, even distinguished individual psychiatrists, as well as investigative science writers, journalists, and personal testimonials from patients.
Evidently psychiatry has not benefited from the scientific method in the manner that medicine generally, and science itself, have benefited. Science is supposed to be evidence-respecting and thereby open-minded; psychiatry is presently not.
But is psychiatry really unique in this respect? Is it the only field of medicine where dogmatically held theories contrary to evidence have held sway for long periods?
Not at all. But that fact is known only to handfuls of academic specialists in such fields as the history of science, the sociology of science, or the umbrella discipline of Science & Technology Studies (STS). The insights gained in these specialties have made little impression even on the overall discipline of history, let alone on what most students or the general public learn about how science has worked and changed over the decades and centuries. Popular beliefs about science, shared by most of the public, the media, pundits, even science writers and journalists, are sorely mistaken about contemporary science.
The fact is, it’s commonplace for dogmatically held theories contrary to evidence to hold sway for sometimes long periods, in medicine but also in science generally.
For one example, in 1976 a Nobel Prize was awarded for the discovery that the degenerative brain disease kuru, akin to mad-cow diseases, is caused by a “slow virus” that remains somehow dormant for years before wreaking its harm. Some two decades later, though, a Nobel Prize was awarded (in 1997) for demonstrating that the cause is not a virus at all, be it a slow one or a fast one, but rather by a misshaped protein given the designation of “prion.” Medical science and the associated practices were dogmatically wrong for a couple of decades, and during that time the proponents of the prion hypothesis were largely ignored, and laughed at and denigrated when not ignored.
Again, medical science and associated practices were quite certain that stomach ulcers are caused by stress and stomach acid. For several decades, the Australian doctors who had observed in the early 1980s the presence of Helicobacter pylori bacteria in stomach ulcers were ignored, dismissed, or actively denigrated. Belatedly, in 2005, Marshall and Warren were awarded the Nobel Prize for discovering the role of H. pylori in gastric disease including ulcers.
It is not only ignorance of the real histories of science and medicine that conspires to maintain a general belief in the great reliability of the consensus in those fields, it is also that the repudiation of earlier dogmatically held theories is not emphasized when Nobel Prizes are awarded with respect to prions or ulcer-causing bacteria or other major advances. Rather, the good news of discovery and progress is hyped: Stanley Prusiner accomplished a scientific revolution by showing that prions could be responsible for infectious disease; Marshall and Warren brought revolutionary progress in medicine by indicting bacteria for many gastric ailments.
Much popular and much technical discourse cites Thomas Kuhn’s description of progress in science via scientific revolutions, emphasizing the progress, the advance. But every such revolution deserves its naming because it overturns earlier beliefs. Scientific revolutions are not only milestones on the road of progress, they are also gravestones of earlier theories that, more often than not, were held dogmatically and were defended vigorously against dissenters who were ignored, dismissed, or actively persecuted.
By emphasizing progress and not the repudiation of previous belief, the impression of science as certifiably reliable at any given time becomes reinforced.
The alternative viewpoint makes for a very different attitude, namely, that every contemporary belief in medicine and in science is reliable only insofar as it has not yet been overturned in a scientific revolution. History obviously cannot provide any example of a belief that will never be overturned, it can only offer instances of beliefs that have not yet been found wanting.
More instructively, the history of science and of medicine teach that in the run-ups to scientific revolutions, any researchers who foreshadow the future revolution by drawing attention to the flaws in current beliefs, the evidence against current theory, are treated shabbily, to put it in the mildest possible terms.
Here, then, is the prime insight to be drawn from the fact that the practices of contemporary psychiatry are at odds with popular ideas about the reliability and progress of science and science-based medicine:
Popular ideas about how science works are highly misleading. The so-called scientific method does not produce immediately reliable findings. Competent dissenters from current theories may in the future turn out to have been right — or at least more right than the current theories — even as these dissenters may at present be called crackpots, cranks, denialists, Flat-Earthers, ignoramuses, and the like.
So where did popular ideas about science come from, that I assert to be misleading?
They came from how science used to be, by contrast to what it is like nowadays. One would be hard put to overemphasize the sea change in scientific activities that is apparent when contrasting contemporary science with science before World War II.
In a drastically oversimplified nutshell, one might describe pre-WWII science as a cottage industry carried on by independent intellectual entrepreneurs motivated primarily by curiosity in seeking truths about the natural world, not beholden to patrons and subsisting typically in ivory towers undisturbed by social, political, commercial interference; science was free to be its own thing.
By contrast, contemporary science is at the mercy of those who provide the enormous resources now needed to penetrate further into Nature’s mysteries. Modern-day science is competitively cutthroat and subject to pervasive conflicts of interest, beholden to the providers of resources: governments, businesses, industries, foundations, all of which aim to harness science to their own benefit.
These assertions are described and documented more fully in my new book, Science Is Not What You Think—How it has changed, Why we can’t trust it, How it can be fixed. The book addresses common misunderstandings about the scientific method, replicability of scientific findings, peer review, and more. The “fix” it suggests is the possible establishment of a Science Court to adjudicate expert differences over technical issues. That was first suggested more than half a century ago when the experts were at loggerheads and arguing publicly over whether power could be generated safely using nuclear reactors. More recently, some legal scholars have pointed out that such an institution could help the legal system to cope with cases where technical issues play an important role.
Beyond that, I suggest that a Science Court is needed to force the prevailing “scientific consensus” to respond substantively to substantive critiques from dissenters. If, for example, a Science Court were to adjudicate over the benefits and costs of antidepressant drugs, there would be an open, public display of all the relevant data from all trials, and expert witnesses would need to defend their views under cross-examination. The Court’s independent, disinterested weighing of all the evidence would indirectly benefit society as a whole by being directly helpful to psychiatrists, their patients, and policy makers concerned with health care overall.