The Myth of Neuropsychiatry
A Look At Paradoxes, Physics, and the Human Brain
Donald Mender, M.D.
reviewed by Mira de Vries
The title of this book is as unoriginal as it is unmelodious. What’s worse, it doesn’t make sense.
When, 33 years earlier, Thomas Szasz titled what was to become a classic in its kind, The Myth of Mental Illness, you didn’t have to wonder what he meant. Obviously Szasz believes that mental illness doesn’t exist. You would know this even if you read only the title, and nothing in the book contradicts it. Szasz does not deny the existence of the profession of psychiatry, but posits that as a medical specialty it is based on fraud since mental illness doesn't exist.
Mender can’t very well believe that neuropsychiatry doesn’t exist, because it too is a profession. He could mean that the profession is based on fraud. Indeed, Mender provides some good arguments for this position. But is he opposed to neuropsychiatry?
Apparently not. Although he briefly quotes from Szasz’s The Myth of Mental Illness, elsewhere in the book he talks about schizophrenia, manic depression, personality disorders, and other psychiatric labels without any sign of skepticism regarding their reality. His portrayal of the mentally ill is cliché, as though the two brief fictional case histories he relates are representative of millions of psychiatrized people. He claims that drugs, and even lobotomy and electroshock, do help some mentally ill people. In a footnote he reveals that he accepts the dopamine theory of faulty brain chemistry, as well as a genetic basis. In another footnote, by way of excuse for his views, he suggests that somatic illness isn’t really so straightforward either, and has multiple causes. So what, exactly, is Mender trying to say?
His writing style is one of the aspects that makes this book difficult to understand. Although there are few direct quotes, practically every paragraph is laced with reference numbers. The impression is of a collage of views, none of which can be unambiguously identified as his own. The reference notes in the back comprise almost a third of the book.
There’s also a great deal of namedropping. Several chapters list strings of famous mathematicians and physicists, complete with mini-biographies, the relevance of which remains unclear. It looks like he is trying to impress upon us how many mathematicians there are, when in fact there are very few mathematicians, compared to, say, physicians. Mender implies that the proliferation of these professions, along with computer science and other technical advances, influenced psychiatrists to use mathematical, physical, and technical approaches to their patients. He is right that psychiatrists mimic the jargon of real sciences, but one can hardly blame the real scientists for that. They are the ones doing an honest day’s work without dominating anybody.
In the next to last chapter, Mender discusses market influences on medicine in general and psychiatry in particular. Now maybe he’s getting somewhere. He alludes to the murky world of murderous competition among different professions for private philanthropy, government grants, and third party payments. The bodies emerging most victorious are the physicians, who enjoy power over the lives of other people, and the pharmaceutical industry, which enjoys stupendous profits, Mender states. None of this has much to do with the supposed beneficiary, the patient, who is but a pawn, a prop in the mêlée of the mighty.
I disagree that these market forces are free. Private philanthropy, such as the Rockefellers gave to support "eugenics," nowadays has little influence on the direction research takes. Government and the industries with which it maintains close ties are not free market forces. There’s competition all right, but it has nothing to do with freedom. It rather resembles sibling rivalry. I do agree that:
…[B]iological psychiatry is sliding into financial and administrative control of mental health care. Disturbing tendencies may lurk behind its hunger for medical technology as a means of judging and controlling human behavior. The illusory prospect of infinite malleability in human nature feeds the sense of power that a psychosurgeon or pharmacologist can exercise over other individuals.It is even more true today than when Mender wrote these words. So far so good, but then he goes on in the next sentence:
In the right hands and for the right reasons of course, brain operations and psychoactive drugs can decrease human suffering.Which hands and reasons are the right ones? Whose suffering is relieved by lobotomy and Haldol? There’s nothing “of course” about it. Even if it were true that these mistreatments sometimes benefit the people on whom they are inflicted, without tools to identify those rare people who are allegedly going to benefit, obviously most people will be grossly harmed. Some mathematics here could be illuminating.
Mender dedicates his last chapter to Freud and kind, conceding that they didn’t always get things exactly right, but suggesting that they came pretty close.
So what is Mender trying to say? I sent him an e-mail, asking him whether his position in the book can be summed up thusly: He is not opposed to neuropsychiatry, however, he believes that neuropsychiatry alone cannot meet all the needs of the mentally ill. It should be combined with psychological approaches. He was so kind as to reply promptly. Indeed, he confirmed, this was what he was saying in the book.
To him, then, neuropsychiatry is not a myth but a valid profession, as long as psychology is thrown in too. Does Mender think psychologists are less likely to lust for the power they can exercise over other individuals? Jeffrey Masson’s book Against Therapy could have provided him with a much needed cold shower.
For those of us laboring to expose the fraud that psychiatry is, The Myth of Neuropsychiatry contains some quite quotable passages, provided the contradictory statements around them are clipped away.