Customer Reviews

Humanizing Madness: Psychiatry and the Cognitive Neurosciences

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Inaccurate on ME ("CFS"). ME is a severe neuro-immune disease. Pls correct this. Refer to 2011 ME International Consensus Criteria and 2003 ME/CFS Canadian Consensus Criteria. Neuro-immune diseases are not Madness and the author's approach is dehumanizing.

I bought this book to read McLaren's views on the mind-body problem and to better understand the supposed flaws in the biopsychosocial model. While in general it is very well written and he has obviously put acknowledgeable effort into it, I believe that some of the content falls short in important areas. McLaren previously wrote a paper titled "Interactive dualism as a partial solution to the mind-brain problem for psychiatry" (N McLaren, Medical Hypotheses 2006:66:1165-1173), and the phrase "partial solution" is an accurate description of this book as well, as it is a partially successful attempt at reintroducing the mind back into mental illness but not a complete foundation for the entire "future of psychiatry".

McLaren does a good job at highlighting the major historical and current problems facing psychiatry and philosophy of mind, with concise descriptions of the essential issues. He delivers several major blows to the perceived intellectual status of the psychiatric profession; that is, a lack of underlying scientific theory of mind and therefore also for mental illness. He also raises other interesting and important points along the way (such as; over-biologising by psychiatrists of aberrant mental function, and problems with eclecticism in psychiatry). McLaren attacks the biopsychosocial model used in psychiatry, by exposing it's foundation and questioning it's scientific status (rather than by denying the role of psychological and social factors in mental illness). I had previously wondered what guides researchers and academics on the specific relevance of, or interaction between, each aspect to the biopsychosocial paradigm; now I suspect that there is little or none that isn't arbitrated by individual preference. McLaren outlines the importance of understanding automated processing of information in the brain, and then proposes a form of properties dualism. I'm not convinced that properties dualism will be the ultimate solution to the mind-body problem, but it suits the mentalistic view of psychiatry that McLaren endorses, and he presents a decent starting proposal that should interest some academic psychiatrists.

However, I think the application of this proposal needs more work. McLaren clearly dislikes biological psychiatry and (understandably) attempts to put the "mind" back into psychiatric illness; but although I'm not necessarily a biological reductionist, I think he over-stretches the mark. His account of psychiatric illness is too clean cut; he essentially attributes all mental illness to psychological causes, except perhaps in the case of brain disease, but even then its implied to be a psychological response to the limitations imposed by the brain disease. In general, it seems that he has taken a plausible contributing factor in each mental illness but inflated it to be the only main relevant factor in that illness. McLaren assumes that nearly all major psychiatric conditions are caused solely by an interaction between 3 themes: (i) abnormal personality factors or beliefs, (ii) chronic anxiety, and (iii) lack of insight on behalf of the patient. Although he presents a good understanding and plausible suggestions, he applies them too universally and in some cases too simplistically, which is probably the outcome of his interpretation of properties dualism. Here are some examples:

(a) He skilfully rips apart the current classification system of personality disorders employed in the DSM and explains personality as a set of psychologically acquired rules; this is a reasonable position, but there is a lack of discussion of the biological factors or variations between individuals which could influence their acquirement of rules. While he briefly mentions genetics and personality, he simply concludes that such discussion can't proceed without a more coherent definition of personality than what is currently used in research; this may be a valid point, but then the issue is essentially ignored rather than compensated for. I perceived a sort of hidden assumption that as long as there is no brain disease, everyone's "wetware" is potentially functionally identical.

(b) When describing anxiety-driven hypochondriac states, McLaren casually lumps in illnesses such as "benign meningoencephalomyelitis" (which I assume is benign myalgic encephalomyelitis) and chronic fatigue syndrome; however, anxiety isn't a defining characteristic or diagnostic criterion of these illnesses, and the research fails to demonstrate anxiety disorders in the majority of these patients; he is either unaware of this, or perhaps believes that the patients are denying their anxiety or they lack the insight to realise they are simply just anxious and/or depressed. It would also be problematic to associate post-exertional symptoms to phobias or the Yerkes-Dodson curve for similar reasons. Losing yet another supposed "psychosomatic" illness to other fields of medicine will only further reduce psychiatry's historically poor credibility in this area.

(c) When describing depression, McLaren starts off with a decent description but then rejects the notion of depression as a negative mood and simply attributes the state of depression to an acquired anhedonia. His explanation of depression (anhedonia caused by a loss of interest in life, sustained by personality factors and chronic anxiety) is too restrictive, mostly on grounds that depression and anhedonia aren't the same state and can occur without the other, and also on grounds that pleasure and interest aren't synonymous either (liking and wanting aren't the same). Furthermore, while he has a point that the relevance of anxiety is (potentially) being underestimated in depression, he is probably overestimating it by essentially blaming all depression on anxiety. This isn't to say all these aspects aren't interactive, or that McLaren's suggestion should be dismissed; but I don't think this is the best explanation of depression, the only mode of anhedonia, or the only theme in which depression can arise.

(d) McLaren's account of compulsion/addiction and drug withdrawal bizarrely implies that it is *purely* a self-fulfilling belief-based reverse placebo effect. Obviously the fear of withdrawal plays some role, but again, this is seemingly presented as the only relevant factor. Furthermore, when considering that the placebo effect itself may involve the brains opioid system, using saline injections to trick an opiate addicted patient into temporarily believing they've scored isn't conclusive evidence that withdrawal itself is simply a phobia.

Reading this book actually weakened my previous support for properties dualism and strengthened my support for John Searle's arguments against it, because in my opinion McLaren's practical application doesn't completely account for the "grey-area" within the mind-body problem and can lead to over-simplifications. I'm not saying the position, that the mind is an informational system dependent on but distinct from the brain, is unreasonable; on the contrary, it indeed deserves further consideration. The above criticism isn't meant to derail the overall merit of this book as a highly recommended read.

from p.192:

"Hypochondriacal States
...The term indicates a person with an unhealthy preoccupation with matters of health, illness, etc., who is convinced he has an illness, but who has no evidence at all of physical illness...However, in dealing with these patients, we have to be very careful because if the psychiatrist doesn't take a patient's complaints of illness seriously, then the next person to do so may be the pathologist...
The same cycle of self-reinforcing panic can be seen in opiate addicts... Simply giving them an injection causes them immediate relief for which they are often pathetically grateful...
Some of the names for it are benign meningoencephalomyelitis (which is more benign than it sounds), total allergy syndrome or twentieth century allergy, chronic fatigue syndrome, adrenal exhaustion and a huge range of poisonings and toxicities not forgetting effort syndrome, Agent Orange and Gulf War Syndrome.
The symptoms of these protean disorders just are the symptoms of anxiety and the grumbling depression caused by chronic anxiety. The same symptoms are up for grabs for anybody who needs a label to conceal the fact that he is anxious."

There are several thousand studies which show immune system abnormalities, cardiac insufficiency, grey and white matter reductions in the brain, and many other multi-system physiological issues.

The author needs to research the subject matter more thoroughly before making such sweeping and inaccurate statements about disease processes he obviously knows nothing about.

This viewpoint on ME/CFS is decades out of date and is rather analogous to how MS patients were labeled in the earlier part of the last century with "Malingerers Syndrome"

This book demonstrates a dangerous ignorance of science and the biological underpinnings of serious diseases, while promoting what is essentially a superstitious notion of dualism.
Addiction, stress, anxiety and depression cause serious biological changes in the body (which includes the brain) which this author seems to wish to deny.
The author can't even get the name of Myalgic Encephalomyelitis, a disease recognised and officially categorised by the WHO as a serious neurological and immunological disease, correct. Perhaps that is why he couldn't find any of the 4600 odd papers published which demonstrate serious biological abnormalities in this disease in an internet search?

Altogether; Dangerous, biased, uneducated and completely unwilling to acknowledge or study any real Science.

Inaccurate on ME ("CFS"), adrenal exhaustion, MCS, Gulf War Syndrome and even agent orange posioning, labeling these all as hypochondriasis. ME is a severe neuro-immune disease. Pls correct this. Refer to 2011 ME International Consensus Criteria and 2003 ME/CFS Canadian Consensus Criteria. Neuro-immune diseases are not Madness and the author's approach is hardly Humanizing.

from p.192:

"Hypochondriacal States
...The term indicates a person with an unhealthy preoccupation with matters of health, illness, etc., who is convinced he has an illness, but who has no evidence at all of physical illness...However, in dealing with these patients, we have to be very careful because if the psychiatrist doesn't take a patient's complaints of illness seriously, then the next person to do so may be the pathologist...

The same cycle of self-reinforcing panic can be seen in opiate addicts... Simply giving them an injection causes them immediate relief for which they are often pathetically grateful...

Some of the names for it are benign meningoencephalomyelitis (which is more benign than it sounds), total allergy syndrome or twentieth century allergy, chronic fatigue syndrome, adrenal exhaustion and a huge range of poisonings and toxicities not forgetting effort syndrome, Agent Orange and Gulf War Syndrome.

The symptoms of these protean disorders just are the symptoms of anxiety and the grumbling depression caused by chronic anxiety. The same symptoms are up for grabs for anybody who needs a label to conceal the fact that he is anxious."

(The author somehow got my earlier review removed from Amazon without telling me, I just happened to stumble upon this and notice it was missing. Pls don't delete this one (or at least alert me).)

This author has spent too much time in the bush and not enough time finding out what is going on in clinical and research labs regarding the disease ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome), aka Chronic Fatigue Syndrome. In October 2011, the Journal of Internal Medicine published an article entitled "Myalgic Encephalomyelitis: International Consensus Criteria." This article was authored by 26 ME/CFS researchers/clinicians from 13 different countries: Australia, Belgium, USA, UK, Canada, New Zealand, Norway, Italy, Ireland, Korea, Chile, Japan, and Latvia. Collectively, these authors have approximately 400 years of both clinical and teaching experience, authored hundreds of peer reviewed publications, and diagnosed or treated approximately 50,000 ME/CFS patients. Their definition of this disease and their consensus criteria are based on the more recent research and clinical experience that strongly point to widespread inflammation and multisystemic neuropathology. They define ME/CFS as a complex disease involving profound dysregulation of the central nervous system and immune system, dysfunction of cellular energy metabolism and ion transport, and cardiovascular abnormalities. This is consistent with the neurological classification of ME in the World Health Organization's International Classification of Diseases (ICD G93.3). Anyone interested in finding out more about the true nature of ME/CFS (Chronic Fatigue Syndrome) would do well to read this article and the 119 references upon which it is based. They are listed at the end of the article.

Myalgic Encephalomyelitis has never been classified as a mental health disorder;it is is a debilitating acquired neurological disease which has been recognised by the World Health Organisation (WHO) since 1969 as a distinct organic neurological disorder with the code G.93.3.

An inaccurate and insensitive trivializing view of ME, which over 4000 peer reviewed published studies have shown to be a biological illness. Vastly insulting to me and the other 1 million ME sufferers in the US.

After recently completing quite a few psychology classes, only one thing remains a common thread across each: it seems no psychologist agrees with another. There are so many schools of thought and barely any common themes.
Dr. McLaren outlines in this 30-year-research-result the flaws in some of the most popular and well accepted schools of thought and practice.
Even though I do not sport an M.D. after my name, I understood and thoroughly enjoyed this frank and prod at what many professionals blindly accept as fact. Using the scientific model to grind down the frivolities of many schools of psychology, Dr. McLaren gets to the "nitty gritty" of modern psychology. The scientific model helps us understand some of the most common mental disabilities today without writing them off to Freudian fantasies. Dualism is an enlightening concept and to me, strikes as the most practical and rational approach one can have to a situation. Mind over matter sounds so cliché, but the relationship between mind and matter is a road to explore for most mental handicaps, not just an adage.

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.