Part 2: How an Overvalued Belief Captured Medicine – Paul McHugh Explains More (#46)
8 November 2025
With Paul McHugh
Global
Dr Paul McHugh trained at London's Maudsley Hospital before leading psychiatry at Johns Hopkins for over two decades. Now 93, he argues that medicine repeatedly falls prey to 'overvalued beliefs' — convictions that override clinical evidence. Drawing on first-hand battles against multiple personality disorder and recovered memory therapy, he traces a pattern of harm that the Cass Review's own findings suggest is now playing out in gender medicine, helping explain how NHS gender clinics came to provide interventions that lacked an adequate evidence base.
Dr Paul McHugh spent part of his early training at the Maudsley Hospital in London — the same institution that shaped a generation of rigorous British psychiatrists — before going on to serve as Psychiatrist-in-Chief at Johns Hopkins Hospital from 1975 to 2001. Now 93, he brings decades of hard experience to a question that sits at the heart of current debates in UK medicine: how does a respectable scientific discipline come to adopt practices that later prove harmful? The answer McHugh offers is the concept of the 'overvalued belief' — an idea that acquires such moral and professional weight within a field that dissent becomes dangerous and evidence is subordinated to conviction. He traces this pattern through two episodes he witnessed directly: the epidemic of multiple personality disorder in the 1980s and 1990s, and the recovered memory movement that accompanied it. Both spread rapidly through clinical networks, generated a therapeutic industry, and caused serious harm to patients before being discredited. Neither rested on a reliable evidence base, and both required sustained institutional courage to challenge. McHugh's account of those battles is not merely historical. He argues explicitly that he sees the same dynamics at work in today's approach to gender dysphoria in young people. The clinical community moved from a cautious, watchful posture to widespread affirmation and medical intervention, often without the longitudinal evidence that would normally be required before treating a population of children and adolescents. A field that had learned, painfully, to question recovered memory was now affirming a different set of patient self-reports without equivalent scrutiny. The resonance with British experience is direct. The Cass Review, published in April 2024, found that the evidence base for puberty blockers and cross-sex hormones in under-18s was remarkably weak and that NHS gender services had operated for years without adequate follow-up data, peer review, or the safeguards that normally govern the introduction of novel treatments. Cass explicitly identified a culture in which clinicians felt unable to raise questions without being accused of bad faith — a description that maps closely onto the environment McHugh describes from the recovered memory era. In this second conversation with the Beyond Gender hosts, McHugh also reflects on the broader intellectual history that made these captures possible — from the influence of Freudian deductive thinking, which starts from theory and fits evidence around it, to philosopher Paul Ricoeur's 'schools of suspicion,' which taught a generation to distrust surface meanings. He contrasts that tradition with the inductive, brain-based approach he learned from his mentors, and which he believes psychiatry must recover. For anyone trying to understand how well-intentioned clinicians, regulators and professional bodies in the UK came to endorse practices now being unwound by NHS England, his long view offers something rare: a structural explanation that goes beyond individual failings.
