Saturday, May 11, 2013

It is a mad mad world...or is it?

There is no scientific evidence that psychiatric diagnoses such as schizophrenia and bipolar disorder are valid or useful, according to the British Psychological Society, the leading body representing Britain's clinical psychologists. It stated that it is time for a "paradigm shift" in how the issues of mental health are understood. The statement effectively casts doubt on psychiatry's predominantly biomedical model of mental distress – the idea that people are suffering from illnesses that are treatable by doctors using drugs. The Division of Clinical Psychology (DCP), which represents more than 10,000 practitioners is calling for the abandonment of psychiatric diagnosis and the development of alternatives which do not use the language of "illness" or "disorder".
The statement claims: "Psychiatric diagnosis is often presented as an objective statement of fact, but is, in essence, a clinical judgment based on observation and interpretation of behaviour and self-report, and thus subject to variation and bias."
Dr Lucy Johnstone, a consultant clinical psychologist who helped draw up the the statement said it was unhelpful to see mental health issues as illnesses with biological causes.

"On the contrary, there is now overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse," Johnstone said. “Strange though it may sound, you do not need a diagnosis to treat people with mental health problems,"

Mary Boyle, emeritus professor at the Univerity of East London, believes that "The statement isn't just an account of the many problems of psychiatric diagnosis and the lack of evidence to support it," she said. "It's a call for a completely different way of thinking about mental health problems, away from the idea that they are illnesses with primarily biological causes."

The American Psychiatry Association's Diagnostic and Statistical Manual of Mental Disorders has been attacked for expanding the range of mental health issues that are classified as disorders. For example, the fifth edition of the book, the first for two decades, will classify manifestations of grief, temper tantrums and worrying about physical ill-health as the mental illnesses of major depressive disorder, disruptive mood dysregulation disorder and somatic symptom disorder, respectively. Some of the manual's omissions are just as controversial as the manual's inclusions. The term "Asperger's disorder" will not appear in the new manual, and instead its symptoms will come under the newly added "autism spectrum disorder".

The writer Oliver James, who trained as a clinical psychologist, welcomed the DCP's decision to speak out against psychiatric diagnosis and stressed the need to move away from a biomedical model of mental distress to one that examined societal and personal factors. James declares: "We need fundamental changes in how our society is organised to give parents the best chance of meeting the needs of children and to prevent the amount of adult adversity...Britons and Americans have exactly twice the amount of mental illness of mainland western Europeans (23% versus 11.5%). Thirty years of Thatcher and "Blatcher" turned us into a nation of "affluenza"-stricken, shop-till-you-drop, "it could be you", credit-fuelled consumer junkies. Personal debt – a major stressor for adults – rose from £200bn in 1980 to £1,400bn in 2006. After 1979, the amount of mental illness mushroomed. Forget about genes. We would halve the amount of emotional distress in this country if we had the more equal, relatively cohesive, less debt-ridden political economics of our European neighbours.”

Professor Sir Simon Wessely, a member of the Royal College of Psychiatrists and chair of psychological medicine at King's College London, said it was wrong to suggest psychiatry was focused only on the biological causes of mental distress. “Psychiatry is the study of the brain and the mind. Psychiatrists look at the whole person, and indeed beyond the person to their family, and to society. That is why even as a medical student I knew that psychiatry was for me – it was about biology, but it was also about psychology, and sociology, ethics, politics and much else. Psychiatrists react to the tired arguments about biology versus psychology in the same way as geneticists react to sterile debates about nature versus nurture – it's both. Mindless psychiatry is as unhelpful as brainless psychiatry, and the psychiatrist who ignores the social environment is, well, not a psychiatrist. Political decisions about the economy in, for example, Greece or Russia have had serious consequences on some, but not all, mental disorders.”
Prescriptions of anti-depressants increased nearly 30% in England between 2008 and 2011, the latest available data. A recent article in the online edition of the British Medical Journal suggested "that only one in seven people actually benefits" from anti-depressants and claimed that three-quarters of the experts who wrote the definitions of mental illness had links to drug companies.
“The idea that we are part of a conspiracy to medicalise normality will seem frankly laughable as we struggle to protect services for those whose disorders are all too evident under any classification system.” Prof. Wessely explained

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