I want to be clear about what I mean by the biomedical model. Criticism of the biomedical model is commonly deflected by suggesting that what is being attacked is not really held by most psychiatrists. In particular, many psychiatrists say that they are more eclectic in their approach to the factors in the aetiology of mental illness than merely relying on the biological.

It is true that some psychiatrists are more biomedical than others. The basic tenets may be held with varying degrees of conviction and awareness. Some clearly identify themselves as biological psychiatrists. Samuel Guze (1989), for example, says there is no other kind of psychiatry.

E Fuller Torrey also, as another example, has no doubt that schizophrenia is a disease of the brain (Torrey & Kress, 2004). As far as he is concerned, scientific advances since 1975 have proven beyond reasonable doubt that schizophrenia is a disease of the brain. He notes that the 1959 American handbook of psychiatry (Arieti, 1959), by contrast, saw schizophrenia as 'a specific reaction to an extreme state of anxiety, originated in childhood and reactivated later in life by psychological factors'. This handbook described various psychoanalytic explanations of the origins of schizophrenia. According to Torrey, researchers stopped 'groping in the dark' with the publication of the first computerised axial tomography (CT) scan study of schizophrenia that revealed the enlarged cerebral ventricles of people diagnosed as schizophrenic compared to controls (Johnstone et al, 1976). He points to the evidence for neurological, neuropsychological, neurophysiological and cerebral metabolic abnormalities, as well as structural abnormalities. However, he does acknowledge that none of the potential abnormalities are specific for schizophrenia.

Torrey's belief in this evidence must explain the remarkable change in his understanding of the nature of mental illness. At the time of his book, The death of psychiatry (Torrey, 1974), Torrey agreed with Szasz's criticism of the concept of mental illness and was opposed, like Szasz, to involuntary psychiatric interventions and the insanity defense (Szasz, 2004b). He began his book with the dramatic statement, 'Psychiatry is dying', and by this he meant the medical model of human behaviour. Yet by the time he was writing Surviving schizophrenia (Torrey, 1983), he thought that schizophrenia is 'a brain disease, now definitely known to be such'. Biological psychiatry seems to have revived and Torrey is at the forefront of that resurrection. He is currently one of the most prominent advocates for forced psychiatric treatment in the United States. His change of heart, it has been suggested, may have been reinforced by the fortune donated by a wealthy couple with a mentally ill son to set up the Stanley Foundation (Carlson, 2001). Torrey became executive director of the Stanley Medical Research Institute.

My main reason for using Fuller Torrey as an illustration is the thoroughgoing nature of his biomedical perspective. He can see little reason for considering social and cultural factors in the aetiology of mental illness. He actually believes there has been a 'plague of brain dysfunction' that has occurred since the 18^th century (Torrey & Miller, 2001). As far as he is concerned, asylums were not built for social or economic reasons, but merely to respond to the epidemic. The implication is that the mental hospitals should not have been emptied without ensuring adequate treatment to control the epidemic. His theory is that an infectious agent, or some other concomitant factor of industrialisation and urbanisation, causes schizophrenia. He is explicit that nonbiological factors play no part in aetiology, although they may influence the expression of symptoms. Schizophrenia and bipolar disorder are diseases of the brain, just as are Parkinson’s disease and Alzheimer’s disease.

This position may have the advantage of simplifying the relationship between mental illness and social and cultural factors. It also provides a logical consistency about the role of biological factors. The problem is to justify it conceptually and from the evidence. This book has thoroughly rehearsed the arguments against this biomedical hypothesis.