In the 1970s, psychiatrist Dr. Robert Spitzer was embarrassed.

In his mind, psychiatry wasn’t as respectable as neurology or oncology. It was rather like something out of ancient Greece, with the various feuding schools— Freudian analysis, cognitive therapy, behaviorism— all vying for authority, with no hard science to decide among them.

Spitzer and his colleagues felt change was urgently needed: psychiatrists must no longer diagnose by theory from one school of thought. In their view the early versions of the DSM I and II, were too psychoanalytic. The older way of diagnosing people — the interpretation of a story— was to them embarrassing because three psychiatrists could interview the same patient, but one doctor would blame a sexual conflict, and the other, a fear of independence.

Dr. Spitzer pointed out that this was a failure of inter-rater reliability. Which means that if three doctors diagnosing (rating) a patient disagree, their opinions aren’t reliable. So, anxious that they all agree, he ushered in the DSM III. Which took a new approach to diagnosis: it a) threw all the theories out, b) ignored causation, and ignored the origin of any problem entirely, and c) reduced diagnosis to a statistical tally of surface-level symptoms.

But the problem with this was that those shoddy theories were our only connection to understanding the causes of mental illness. In clinical psychology, although a theory can’t ever be strictly proven, it’s our only connection to understanding the causes of a problem.

By ignoring totally the original, childhood or other causes of mental illness, Spitzer believed he could re-fashion psychiatry into a more respectable scientific discipline.

But has it worked? Is psychiatry more respectable?

I would argue most people today do not in fact respect my profession. Trust in physicians in general has eroded since 2020, according to surveys… but the problem is worse in psychiatry. Everyone now knows that psychiatrists simply tally symptoms and score them according to an algorithm that is readily available online. Some of the causes of depression may be touched on, but most psychiatrists do not really try to get to the bottom of anything. Instead, most of them opt for mere descriptive statements like “you have a chemical imbalance.”  But this a lame excuse for a cause. And it also happens to be a scientific myth, even as a descriptive statement. But it’s nevertheless the blather that most patients hear.

Prior to the 1980s, psychoanalysts often spoke of childhood, of introjection, of “anger turned inwards”, of mother attachments, immaturity, fixations, and a lot else. However, these are the concepts that were banished from the DSM-III.

It isn’t mentioned publicly much, but today, many people have an unspoken frustration with the way psychiatry is being practiced.

“Happy is he that knows the causes of things.” -Virgil.

Virgil understood people better than many doctors do today. All humans naturally desire to know the causes of things, and above all the causes of our personal problems. But a depressed person who sees a doctor today feels somehow profoundly disappointed. But he cannot articulate why. Today’s practice of psychiatry—with its intentional refusal to find the specific cause of mental illness—is throwing thousands of people into a quiet despair.

And what is worse:  the patient’s disappointment in psychiatry may be absorbed into the very symptom pattern for which they’ve sought help. Their disappointment is interpreted as just another symptom of depression. In other words, “it just is.” And “it’s just what you have.” But “hopefully it will go away with medication.”

Ironically this non-causational approach is profoundly inhuman, and unscientific. Since when did it become more scientific to ignore causation

The steps taken in the 1970s may have been misguided. But the stage was set much earlier: from its inception in the 1800s, psychiatry had a longstanding inferiority complex. Internal medicine relied on blood tests, whereas psychiatry only relied on stories. But personal stories aren’t scientifically impressive in the way anatomy and chemistry are impressive. William James acknowledged this in 1892 when he called psychology “not a science; but only the hope of a science.”

That is, psychology is a dirty, impure science. The bastard child of Greek philosophy, and a hodgepodge of half-baked modern science. It is a science mixed in Aristotle, with ancient theories of mind, theories of instinct, the unconscious, and free will. Such ideas are way beyond the scope of any hard science, because many of them are contradictory.

Aristotle said that a science with a low subject matter can be precise, but a science with an exalted subject matter cannot be precise. The object of psychology is the most exalted thing imaginable: the human soul. Thus, precision in psychology may be impossible. If doctors disagree, it shouldn’t surprise us.

We can be very precise about caterpillars. And we can be sure that lepidopterists (experts on caterpillars) are very proud of the fact. But what do we say to lepidopterists (those very solemn men) when they begin ridiculing psychology for its inexactitude?

Or what do you say to your psychiatrist, if he blurts out— say, in a moment of frustration— that he wishes you were as understandable as a caterpillar?

To quote Aristotle: “Knowledge of any kind is a thing to be prized… either [1] by reason of its greater exactness or [2] of a higher dignity and greater wonderfulness in its object.” (De Anima). The knowledge of caterpillars can be prized for its exactness, but does psychology need to be prized for this? It is *already* a noble discipline by a “greater wonderfulness in its object.”

Thus it shouldn’t surprise us there are dozens of schools of psychology, from behaviorism, to Freudian analysis, to cognitive, to Gestalt.

Humans are important enough to argue over.

Dr. Spitzer’s attempt in the 1970s may have been to unify psychiatry, and to make psychiatrists argue less, but there’s an obvious problem: how do we make them agree? We aren’t counting white blood cells, or measuring fever. Anxiety and depression have no temperature, color, or size. There aren’t yardsticks to measure a mind with. The only way is to listen to a story. And laboratory technicians don’t ask the best questions… only an interested person does. This is the only science where the student is identical with the object of his study. Lepidopterists certainly know a lot about caterpillars, but it would be admittedly strange if lepidopterists became experts by interviewing caterpillars. (I do vaguely remember an especially arrogant one, sitting on a mushroom, blowing smoke in Alice’s face.)

Nor are caterpillars known to be untruthful. Humans on the other hand, rarely say what they mean or mean what they say. The most interesting information on humans is hard to come by. In psychology the scientist talks directly to his data, in a manner of speaking. He uses himself as an instrument for data collection.

G.K. Chesterton said:

“The human soul is the only thing that one cannot properly study, because it is at once both the study, and the student. We can analyze a beetle by looking through a microscope, but we cannot analyze a beetle by looking through a beetle.”

“A mystery is a problem that encroaches on its own data.” – Gabriel Marcel.

The French philosopher Gabriel Marcel viewed psychology as totally different than the hard sciences, which solves “problems” with objective techniques. Instead, psychology studies “mysteries” and a mystery, according to Marcel, is that which resists becoming an object of study.

Does this happen in any other area of science? Do red blood cells tell evasive stories? Does an appendix change its shape, or pretend to be healthy as it’s being observed? Most of the sciences tackle problems that are solved with more observation. But in psychology, the observation itself actually alters the data. Not unlike in quantum physics where the act of observation changes how a particle behaves.

In psychiatry, only warm, curious interviewers get reliable info.

Harry Stack Sullivan pointed this out in the 1950s. He taught that only a ‘participant observer’ is a true observer of a human. In other words, only someone willing to shrink themselves, can be “shrink” for someone else. Only someone willing to go down the rabbit hole like Alice. But when you coldly survey a patient, all you get is low quality info. E.g. “Do you have much hope for the future?” when asked in a distant way, gets the response: “Yeah, I guess so… like everyone I suppose”. But if a warm, curious inquirer asks, the patient bursts into tears, explaining how infertility stole meaning from her life. Many of today’s mental health workers do not understand this. They speak in monotone. They’re providers of an algorithm. They carry out the hypnotic spell of manualized medicine. The DSM-V saps all connection and spontaneity from the interview. “Was your elevated mood for only one week, or two? …Next question… Do you lack concentration? … Finally, do you wake up with low energy?”

Nauseating drivel.

The patient already knows the checklist. It is on the internet. The whole exercise has an element of futility to it. A silly ruse, and the patient knows it.

Today we have a situation where most psychiatrists all get the same info, but it’s garbage info. Who cares if every doctor agrees if they all have superficial info? Agreement on such terms means little.

In the 1970s psychiatry dumbed itself down, and called it science. But I’d say the changes were more self-serving than scientific. Do we really need doctors to congratulate themselves that they all agree? A patient needs one doctor, not ten. The entire diagnostic process in psychiatry has been cheapened by a misguided wish for consensus. Our latest diagnostic manual, the DSM-V, was revised and published not by the most well-reasoned arguments, but by vote. It is literally true that in psychiatry, science occurs by vote. The vote is held by the board of trustees of the American Psychiatric Association.

And now we can see that the phrase scientific consensus has a darker, more disturbing meaning: it means something other than science is going on.

The scientists have turned themselves, and turned their opinions, into raw data, as if dissolving themselves into their subject matter. Science-byvote ironically regards each scientist as himself or herself a unique data point.

But surely this is an utter rejection of the scientific method. A scientist is by definition a person who is always ready to reject their ideas as utterly and completely false. Surely the idea that every scientist’s opinion is a unique data point, is the very antithesis of science.

Another chilling effect of science-by-vote is that doctors may become terrified of disagreeing with one another, as if their disagreement goes against the vote, and against a preponderance of the evidence.

I am on the front lines of private practice, and I can tell you this is a big problem. Psychiatrists are indeed reluctant to disagree with one another. An indication of this can be taken in the fact that many patients carry diagnoses for decades. Rarely are people undiagnosed. A recent young man who saw me in Honolulu had taken Lexapro for three months, at 19 years old. He visited me at 21 yrs old, explaining that he was turned down by three separate doctors for an Air Force clearance exam. He had no symptoms whatsoever… yet one family doctor and two psychiatrists refused to remove the diagnosis.

This is consensus medicine at work. Diagnoses are carried forward irrationally, and perpetually, like the game of telephone, after which point the consensus emerges… which is really nothing more than an unintelligent blob of bad documentation. A slimy film of regurgitated information. Not unlike the pulsating amoeba that swallows countless people in the classic horror film, The Blob.

Much of my work consists in extracting people from the Blob: the science-by-vote culture of easy diagnosis that sticks to a patient forever, from which she never gets un-stuck.

Science-by-vote is a menace, and it is happening outside of psychiatry, too.

Today, you can see a furious insistence on consensus in many areas of science and medicine. In 2020 we heard about consensus often in the media in response to dissenting views on the vaccine and the COVID lockdown. Nevermind the fact that the consensus—like the blob—is always changing. The word consensus itself became a menace, to crush dissent. Doctors such as Jay Bhattacharya with dissenting opinions on the COVID lockdowns were censored on social media and ostracized.

Michael Crichton— author of Jurassic Park, and physician— saw the problem as early as 2003. His speech on scientific consensus is brilliant.

Crichton’s best insight was that “consensus is only invoked when the science is weak.” No one invokes consensus to prove the earth is 90 million miles from the sun. But only to squash alternative ways of managing COVID. “Consensus is the business of politics… In science, consensus is irrelevant. The greatest scientists in history are great precisely because they broke with the consensus. There is no such thing as consensus science. If it’s consensus, it isn’t science. If it’s science, it isn’t consensus. Period… Whenever you hear the consensus of scientists agrees on something or other, reach for your wallet, because you’re being had.”

Crichton cites several historical examples when the consensus was dead wrong:

In 1848, Ignatz Semmelweis believed women dying after childbirth from fevers were in fact dying from infection. He strenuously insisted that obstetricians wash their hands. Doctors felt that by advancing a theory of infection, Semmelweis was blaming them for maternal death. Instead of debating

Semmelweis, they ostracized him from the medical community, stripped his license, and called him a Jew in the press. He was finally thrown in an asylum, where he was beaten to death. Then, forty years after his death, the medical establishment admitted he was right.

True story.

Crichton gives another example:

In 1920, the geologist Alfred Wegener first proposed the idea that South America fits neatly inside of Africa. Today we all recognize this as the theory of continental drift. But in his day, most experts in geology mocked Wegener openly. It was only long after his death, in the 1960s, that geology as a discipline recognized he was correct. As the physicist Max Planck said, “Science advances one funeral at a time.” What Planck meant, was that older scientists must literally die off before new theories even have a chance, no matter how much evidence in their favor.

There are many more such stories in the history of science:

Dr. Alice Stewart, a British physician first discovered in the 1950s that an X-ray of a pregnant woman’s belly could cause leukemia in her child. Her discovery was met with furious skepticism. X-rays of pregnant women continued until the 1970s. The scientific consensus (i.e. the blob) couldn’t stomach her discovery.

Scientists and physicians are emotional They aren’t pure. The idea that scientific culture is automatically self-correcting, humble, data-driven—an idea promoted by Richard Dawkins, and other atheists and science enthusiasts— just isn’t true. It’s an illusion. I’d even call it a moral delusion. Why does it surprise us that scientists can be competitive, envious, and back-stabbing?

In 2012 the British Medical Journal revealed that, according to a survey, “One in seven UK based scientists or doctors has witnessed colleagues intentionally altering or fabricating data during their research.”  Why are we perpetually shocked by this? I am not aware the IRS has found scientists any less likely to lie on their tax returns…

“Science is a belief in the ignorance of experts.” -R. Feynman.

This fierce definition of science was given by the Nobel prize winning physicist, Richard Feynman.

Good mental health treatment is, likewise, a belief in the ignorance of experts. As I have mentioned much of my work consists in rescuing people from The Blob, undoing errors made by officially sanctioned run-of-the-mill care. Patients come to me burdened with a diagnosis they carried for years. Usually it was based on a couple of shoddy, manualized interviews.

You aren’t ever going to truly understand yourself by any consensus document like the DSM. But only with the help of a warm, curious person.

And one who isn’t afraid to disagree with his or her colleagues.