Let’s apply Sagan’s Razor to psychiatry
Dr Jess asks how we came to trust psychiatry without any evidence
I’m sat in the hair salon.
My mind is whirring, as usual.
In philosophy, a razor is a principle or rule of thumb that allows one to eliminate unlikely explanations for a phenomenon, or avoid unnecessary actions.
Have you ever heard of Sagan’s Razor?
Sagan's Razor: Extraordinary claims require extraordinary evidence.
‘The weight of proof rests with the person making a claim, and the more unusual the assertion, the more substantial the evidence needed.’
So I’m sat here, thinking… what happens if we apply Sagan’s Razor to psychiatry and mental disorders?
Psychiatry as a concept, as a discipline, is making a HUGE claim. An EXTRAORDINARY claim.
The claim being made is that human behaviour change is caused by a set of mental disorders and mental illnesses that reside in the brain/mind somewhere.
Psychiatry theorises that these illnesses are similar to other diseases and illnesses. They suggest they are caused by genetic issues, chemical imbalances in the brain, or the development of some sort of mental illness by other means.
Pretty extraordinary claims.
Claims that would require extraordinary evidence, right?
And yet, we have none.
Here are some things I teach that shock people when I am lecturing:
We have never found a gene that explains or underpins a single ‘mental disorder’ in the DSM
We have never found a single bio marker for mental illness or mental health issues
We have never found proof that mental disorders are caused by neurotransmitter imbalances
We have never found any differences between the brain structure of people with and without diagnosed psychiatric disorders
We cannot use any scans for diagnostic tests or measurement of mental disorders
We have never found or been able to use a blood test to diagnose or measure mental disorders
We have no ‘cures’ for any mental disorders
We still have absolutely no idea what an ‘ideal’ level of serotonin or dopamine would even be in the brain, in order to claim what the imbalanced levels would be
We don’t have any proof of what would constitute the difference between ‘neurotypical’ and ‘neurodivergent’ - there is no defined neurotypical brain
We cannot use brain scans or blood tests in courtrooms as admissible legal evidence to prove a victim or a suspect is mentally ill - we can only use ‘expert opinion’ - because there is nothing else
Mental disorder diagnoses are subjective, historically, culturally and geographically situated ideas - they don’t even exist in every country in the world
And so, as far as I can see, if we apply Sagan’s Razor, we have never been presented with any ‘extraordinary evidence’ to back up these extraordinary claims from psychiatry.
What evidence has ever been put forward that any mental disorders exist? Even the APA Presidents have clearly given repeated statements saying that we have no biomarkers or biological evidence of the basis of mental disorders.
Wouldn’t it make more sense to describe ‘mental disorders’ as concepts? As ideas? As theories? Lenses to understand via?
They are certainly nothing more than that.
And yet, it is psychiatry that has convinced and groomed our populations to believe that these disorders and illnesses are settled science - that they not only exist, but they can test for them. They can reliably test for them, and differentiate between people. Not only that, but they have developed medications and treatments for these ‘disorders’ that do not require a single test to diagnose.
But criticising this discipline lands so many of us in hot water. We are not supposed to point out that the Emperor has no clothes on.
So let me get this straight for a minute:
Some professionals claim that there are hundreds of mental disorders in the brain. They claim there are thousands of symptoms and they all overlap. They claim they might be caused by genetics, but can’t find a gene. Might be caused by chemical imbalances, but can’t find any proof. Might be innate, but can’t prove it. Might be transmissible, but can’t prove that either. They can’t develop any tests and never have done. No brain scans or blood tests can differentiate anyone. They claim that toxic medication, imprisonment, and electrical currents directly to the brain will help people with these disorders.
ON THE OTHER HAND:
Another opposing group of professionals claim that this seems far-fetched, and it’s much more likely that humans go through hard times and traumas in their lives which change their thinking, behaviours and emotions. Extreme traumas cause extreme changes, trauma responses and coping mechanisms to kick in for survival. They don’t advocate for any medications or dangerous treatments. They don’t agree that people should be locked up for months or years. They don’t suggest that there are any definitive tests, because everyone is so unique.
And yet it’s the SECOND group of professionals (the group I belong to) who are seen as radical, unscientific, dangerous, conspiracy theorists and unprofessional.
Can you see how twisted this has become?
The group claiming there are hundreds of unprovable mental illnesses that require cocktails of medications, imprisonment and ECT are framed as the ‘safe’ professionals, but the ones suggesting we should listen to humans and try to help them without further harming them are the ‘unsafe’ professionals.
The ones giving their patients more and more drugs, increasing dosages, playing trial and error with human bodies and lives are the ‘trusted professionals’ - but the ones suggesting that maybe there is nothing biologically wrong with the patient, and they are traumatised or distressed and need compassion and support are ‘grifters’ and ‘dangerous’.
This is how powerful the grooming is around this topic.
The person being paid to diagnose people with unproven mental disorders and then prescribe harmful medications and treatments whilst ignoring their trauma is a ‘professional’ - but the person advocating for careful, humanistic approaches where we validate and listen to people’s distress is ‘unprofessional’.
Sagan’s Razor would suggest that we reject psychiatry until it can provide substantial evidence of these disorders existing.
Sagan’s Razor would suggest on the other hand, that trauma-informed approaches to human suffering are probably correct. We have enormous, global evidence of the impact of distress and trauma on the mind and the body.
Anyway, I had better go, my toner is nearly developed now.
What do you think?
When you put it like this, something that springs to mind is the way that a group establishing authority in this way uses fear mongering about the most extreme possible outcomes to garner some of the support they can't get because of the evidence they don't have. So, people learned to (think they) need psychiatry and it's tools to deal with extreme symptoms - words like psychopathy and psychosis, which in reality for most people are a distant concept, but which I think represent what scares people about this in that way that "the other" always scares people. I do wonder how those things are weaponised to open the door to let the idea in, so that no one ever notices Sagan's Razor.
It's not terribly unlike weight loss science, in that way.
Jess this is brilliant. Absolutely amazing. You've summarized psychiatry's flawed fundamentals accurately, elegantly and dispassionately. There used to be an "anti-psychiatry" movement. The film "One flew over the cuckoo's nest" grew out of it. But that was in the 1980's. In the meantime, psychiatry has got stronger because, I think, of Big Pharma. And because the sum total of human knowledge about how people function (or not) still has a long way to go. But there have been huge gains. Advances in the technology enable us to see inside the living brain, the Romanian orphans and advances in neuroscience have generated a different view. It's time to stop using the term "mental health." It's time for a paradigm-shift: rather than "What's wrong with you?" it's now "What happened to you?" (Ironically enough, from child psychiatrist, Dr Bruce Perry).