e-Interview

Dr Niall (Jock) McLaren studied medicine at the University of Western Australia, in Perth, and then trained in psychiatry. He has worked in prisons, armies and mental hospitals, in general hospitals, in a major city, in Asia and in the remote isolation of the Australian outback. After 25 years in Australia's far north, he has just moved to Brisbane. He has published extensively on the application of the philosophy of science to psychiatry. He is working on his fifth book, which shows how a rational cognitive model of mind generates a formal theory of mental disorder.

What are you working on today?

I have nearly completed the next book in the series, the object being to show how in the biocognitive approach, the mind/body problem resolves at a molecular level. Obviously, there will be some gaps in the explanatory chain but, for the first time in the history of psychiatry, we will have a model of mind, derived a priori, which generates a formal model of mental disorder. My problem now is to convince people that it is not a joke or just another crackpot scheme but it is highly developed and has passed every test thrown at it so far.

What is your idea of a perfect mental health service?

The model I developed while working in the Kimberley Health Region, in the far north of Western Australia, needs wider application. It can be applied in urban areas with the greatest of ease. In one long sentence: get the psychiatrists out into the community, out of their giant hospitals and universities; ‘decorporatised’ (if there be such a word); stripped of unnecessary bureaucracy; out of the stifling teams that insulate them from the community and dissipate their energies; away from the endless, pointless paperwork that serves bureaucrats and not the mentally ill; make them readily available without months of delays in getting appointments, and let them do the work they trained for. As Mao did not quite say, psychiatrists should move among the community as a fish swims through the paddy field.

Which psychiatrist, living or dead, do you most admire?

Peter Breggin shows a remarkable resilience in adversity and an intellectual rigour which cannot be bought. Such a pity more of our ‘key opinion leaders’ are not cast in the same mould.

What do you consider to be your greatest achievement?

Coming from a tiny town in the wheatbelt of Western Australia, where we had no running water or sewers, and electricity for only a few hours a day, to presenting papers on the philosophy of science at international psychiatric conferences, is not too bad. My first school had just three classrooms for children of seven grades. Until 1960, I went to school barefooted, summer and winter. I had never seen a university when I arrived at the University of Western Australia in 1965.

What has been your most controversial idea?

Showing that modern psychiatry has no formal, scientific basis, mainly due to the fact that it has no model of mind and no model of mental disorder, has caused me the most grief. For example, in Britain today, the biopsychosocial model attributed to George Engel has widespread currency. In 1998, I showed that Engel never actually wrote his model, that it did not exist, but my little discovery was totally ignored. In 2004, I felt moved to say that anybody who used this idea was open to accusations of scientific fraud with no possible defence, but still nobody took any notice.

What frustrates you most about working in psychiatry?

I work as a psychiatrist, but in total isolation. I write quite extensively in the area of the application of the philosophy of science and mind to psychiatry, but psychiatrists rarely read that sort of work and rarely want to talk about it. They prefer anodyne platitudes or to lose themselves in statistics or talk about epigenetics that none of them understand because they do not have a model of mind or a model of mental disorder. It is, I suppose, the intellectual immaturity of this profession that brings me the closest to despair.

What is the most important lesson that working with youth has taught you?

Listen to them. Find ways of getting them to talk and listen to them, however difficult it is.

If you could graduate again tomorrow, how would your career path be different?

As soon as I could afford it, I would start studying philosophy formally, instead of spending years teaching myself. I would then move from Australia, which is virulently conservative and rejecting of newcomers, to a centre which had a record of accepting radical ideas. And then I would not waste a quarter of a century politely submitting my stuff and waiting patiently for somebody to notice it. I now know that courtesy is taken as a sign of weakness.

What has been your biggest disappointment?

Open any journal you like and it will be stuffed full of pseudoscience, and now we learn that up to half the stuff submitted to journals is ghost-written by drug companies. That just about brings me to despair. We are not used car dealers, nor even vets. Our patients (not clients; ‘patient’ means ‘the one who suffers’) deserve better than the self-serving pap that fills our literature.

What are you reading at the moment?

I usually read three or four books at once, so today, I am working through Extreme Money, by Satyajit Das, Robert Whitaker's Anatomy of an Epidemic (again), The White Tiger, by Aravind Adiga, and Gödel's Proof, by Ernst Nagel, James Newman and Douglas Hofstadter. And yes, I do have a liking for the Indian diaspora.

How would you like to be remembered?

Napoleon said, ‘Glory is brief, but obscurity is forever’. After decades of being ignored, I think being remembered at all would be an achievement. But the peak would be for people to say, ‘Yes, he helped start the process of turning psychiatry around’.