Part 2: How an Overvalued Belief Captured Medicine – Paul McHugh Explains More (#46)
At ninety-three, Johns Hopkins psychiatrist Dr Paul McHugh — who trained at London's Maudsley Hospital — returns to Beyond Gender to draw lessons from psychiatry's most embarrassing episodes. His concept of "overvalued beliefs" explains how multiple personality disorder became an epidemic in the 1980s, how recovered memory therapy destroyed families, and how similar dynamics may be at work in today's gender medicine. For British listeners watching the NHS rebuild after Tavistock and the Cass Review, McHugh's forensic account of how a profession loses its empirical bearings is both diagnosis and, quietly, a map towards recovery.
Dr Paul McHugh is not a peripheral figure in the history of psychiatry. For nearly three decades he ran the department at Johns Hopkins, one of the most influential medical schools in the English-speaking world, and he trained under Sir Aubrey Lewis at the Maudsley Hospital in London — the institution that shaped British psychiatry for generations. Now ninety-three, he returns for a second conversation with the hosts of Beyond Gender, ranging across the careers and controversies that have defined his field. The episode opens in the nineteen-fifties, when a young McHugh found himself unconvinced by the Freudian orthodoxy that dominated psychiatric training. His mentor George Thorne directed him instead towards the brain — towards what McHugh calls an inductive, bottom-up way of practising medicine, building outwards from evidence rather than deducing patient outcomes from a pre-existing theoretical framework. That distinction, apparently technical, proves to be the thread that runs through everything that follows. What followed, in mid-career, was the epidemic of multiple personality disorder. McHugh describes how a condition that had barely featured in the clinical literature in 1970 had generated hundreds of diagnoses by the nineteen-eighties, complete with elaborate recovered memories of ritual abuse. The False Memory Syndrome Foundation, on whose scientific advisory board he served, documented the wreckage: destroyed families, damaged patients, clinicians who had allowed theory to override observation. The epidemic collapsed once serious scrutiny was applied, but the damage had already been done. McHugh's concept of "overvalued beliefs" is the analytical gift this episode offers. These are not delusions — the person holding them can, in principle, be reasoned with — but they are ideas pursued with an intensity that makes ordinary clinical scepticism feel like hostility or even prejudice. Once an overvalued belief takes hold of a profession, it recruits allies, suppresses dissent, and begins to look like settled consensus. McHugh draws a direct line between the multiple personality disorder epidemic and today's gender medicine, and the comparison will be uncomfortable for those who have insisted that affirming a young person's stated identity is simply good clinical practice. British listeners will hear that comparison against a specific backdrop. The Cass Review found that the evidence base for paediatric gender transition was strikingly thin, that social contagion effects had not been adequately investigated, and that children presenting to the Tavistock were not receiving the rigorous assessment that any other vulnerable group would be given. The NHS has since halted routine prescribing of puberty blockers outside clinical trials. McHugh's account of how an earlier psychiatric consensus was built on assumption rather than evidence, and how a small group of determined clinicians eventually dismantled it, offers both explanation and, cautiously, hope. The institutions that allowed overvalued beliefs to dominate British gender services were not uniquely negligent — they were doing what institutions do when a powerful idea goes unchallenged for long enough. The lesson McHugh draws is that empirical medicine is not the default condition of a profession; it has to be actively defended, generation by generation.
