For decades, the understanding and treatment of severe mental illness has been trapped in a philosophical and medical stalemate. A provocative experiment in the 1970s seemed to expose the field's deepest flaws, but now, a new synthesis of science promises a revolutionary way forward.
The Experiment that Shook Psychiatry
In 1973, American psychologist David Rosenhan published a study that would become legendary. He sent eight healthy 'pseudo-patients' to psychiatric hospitals, where they reported hearing the words 'empty', 'hollow', and 'thud'. All were admitted and diagnosed with conditions like schizophrenia. Once inside, they acted normally, yet were kept for an average of 19 days, with one held for 52 days.
When challenged, Rosenhan told staff at another hospital that fake patients would try to gain admission over the next three months. The staff identified 41 patients they suspected were impostors. Rosenhan then revealed his masterstroke: he had sent no one at all. The experiment, later questioned for its authenticity by journalist Susannah Cahalan in 2019, nonetheless cemented a public perception of psychiatry as an unreliable, almost pseudoscientific discipline.
The Enduring 'Original Schism'
As explored in Professor Edward Bullmore's new book, The Divided Mind, this crisis highlighted a fundamental rift. Bullmore, a professor of psychiatry, traces this back to a Cartesian divide between mind and body, which cleaves psychiatry from the rest of medicine.
This schism created two warring tribes within the field. On one side were the 'mindless', like German psychiatrist Emil Kraepelin, who believed mental illness was purely biological, a physical disease awaiting its discovered 'germ'. On the other were the 'brainless', like Sigmund Freud and his followers, who sought answers in psychology, upbringing, and trauma, often sidelining biology.
The pendulum swung violently between these poles throughout the 20th century, influenced less by pure science and more by historical tides, including the horrific Nazi perversion of biological psychiatry which led to the murder of approximately 260,000 asylum inmates.
A New Synthesis on the Horizon
Today, Bullmore argues we are on the cusp of a monumental transformation, particularly in understanding schizophrenia (once termed 'dementia praecox' by Kraepelin). The rigid categories are breaking down thanks to an avalanche of data from disparate fields.
Advances in scanning, mathematics, genomics and immunology have converged to paint a clearer, more integrated picture. The emerging model suggests schizophrenia likely stems from abnormal brain network development in youth, influenced by immune system dysfunction. This, in turn, is driven by variations across a broad range of genes interacting with environmental 'triggers' such as infection, trauma, social stress, or drug use.
This model finally marries biology and lived experience, suggesting promising new avenues for prevention. The focus is shifting towards early intervention, including bolstering health and social services for mothers and young children.
Reckoning with the Past, Building the Future
Bullmore does not shy from psychiatry's dark history, arguing that the field must talk about its trauma to recover. While acknowledging the compelling critiques of figures like R.D. Laing—who saw psychosis as a rational response to an 'unliveable' world—he is clear that the new science offers a more complete path forward.
The task now is to translate this hard-won scientific understanding into tangible better outcomes for patients. The Divided Mind: A New Way of Thinking About Mental Health by Edward Bullmore is published by New River (£20). It charts a course out of the ideological wilderness, guided by evidence and a profound desire to understand.
