Preface.

In my other work,Natural Dualism and Mental Disorder: the biocognitive model for psychiatry, I build a dualist model to replace the existing, reductionist-biological concept of mental disorder [1]. My goal in this book is to provide the intellectual basis to dispose of biological psychiatry forever.

This book replaces my four earlier books with a tighter focus on theories in the field of mental disorder. In the fifteen years since the first volume was published, there have been many developments which need to be brought into any discussion of psychiatry, psychology and social work. However, the field of mental disorder is so large that all I can hope to do is start a long-overdue debate, one that psychiatry itself has carefully avoided throughout its history.

My starting position is that mental disorder is real, which also meanst the mind is real. Mental disorder means something yet, despite anything you may see in the media, there is no explanation. Most psychiatrists today believe mental disorder is always and only caused by a disturbance of brain function at the level of neurotransmitters, hence the widespread trope, “a chemical imbalance of the brain.” After a hundred and fifty years, this remains an unproven hypothesis. Most emphatically, do not be swayed by biological psychiatrists who proclaim that we are “on the cusp of a breakthrough in mental disorder.” That’s just public relations.

There are still a few psychiatrists who say mental disorder is wholly a matter of psychology, including faulty learning, faulty parenting or faulty life experiences. The remainder hedge their bets by saying it is caused by a mix of biological, psychological and social factors, but they can’t be more specific than that. In an ideal world, treatment would flow from the model of mental disorder but because there isn’t an agreed model, almost all mentally-troubled people who come in contact with psychiatry will be given drugs and other physical forms of treatment. Why? Because drugs (and the belief system that goes with them) now define psychiatry, separating it from psychology.

Despite this lack of a formal theory of mental disorder, psychiatrists have a peculiar grip on the public mind. Thirty years ago, the lawyer and historian, Eric Dean raised the question of psychiatrists as “moral entrepreneurs.” The term comes from the 1963 book,Outsiders: Studies in the Sociology of Deviance, by the sociologist Howard Becker. He defined a moral entrepreneur as “an individual, group or organization that seeks to influence a group or society to maintain a particular norm or adopt a new one, the goal being either to reinforce or alter the boundaries of morality, including altruism, deviance, duty or compassion.” Dean continued:

This impression of scientific certitude in the midst of substantial and potentially crippling problems is a tribute to the ability of psychologists and the psychiatric profession to acquire and wield power ... the salient point is that the mental health professions have a track record of advancing diagnostic categories that lack clear underlying unity based on scientific evidence, but that, nonetheless, have the effect of responding to popular needs and aggrandizing the power and authority of mental health professionals [2, pp200-202]

In his series entitledCan’t get you out of my head, the remarkable documentary maker, Adam Curtis (2021,BBC Film), looks at the life of a man in the 1970s who decided on the then-radical step of transitioning from male to female. Having already lived as a woman for some time, she was referred to a psychiatrist for assessment and management. After endless delays and fiddling around, she decided to have breast implants performed privately. At the next appointment, when she revealed the operation, the psychiatrist was furious. Starting at about 23 minutes, the unseen psychiatrist speaks in a cold and demeaning voice, bitterly critical of his patient’s action, before ab