The Drugs Don’t Work

15 Jul

Instead of asking what is wrong with you, we need to ask what has happened to you.

– Dr Lucy Johnstone

Recently the British Psychological Society called bullshit on those claiming the efficacy of the arbitrary psychiatric diagnoses in the DSM†, and the drug based treatments in which they usually result.

They have released a report whose abstract reads:

The DCP believes there is need to move away from psychiatric diagnoses such as schizophrenia, Attention Deficit Hyperactivity Disorder, personality disorder and conduct disorder, which have significant conceptual and empirical limitations, and develop alternative approaches which recognise the centrality of the complex range of life experiences in the emergence of mental distress, and the personal impact of social and relational circumstances including trauma.

The best overview of the report comes from this short interview with Johnstone on Radio 4, which is well worth the listen. I’ve added an abridged version of the interview text below.

Of course the BPS are not the only ones to hold this view. The National Institute of Mental Health issued an inflammatory press release criticizing current psychiatry for being “brainless and invalid“. Plenty of others have been publicly pushing this, and much stronger views, for many decades. For example, in the sixties, notable luminaries such as RD Laing and Michael Foucault, not to mention many “survivors” groups.

The Interview
John Humphries: “Schizophrenia is a terrible disease. It destroys many lives, the people who suffer and those who have to live with them, and yet there is no scientific evidence that a diagnosis of it is vital or useful. That is the view of the British Psychological Society itself. The same goes for bipolar disease.

I’m joined by Dr Lucy Johnstone who’s a Consultant clinical psychologist, and she’s on the working party that drew up that statement.

Dr Lucy Johnstone: “This isn’t an argument between psychologists and psychiatrists. Many psychologists, many psychiatrists and many health professionals are united in saying that the evidence for the current way of understanding mental distress, just doesn’t exist“.

The DCP [Division of Clinical Psychology, part of the BPS] has issued this consensus statement: there is actually no evidence for the current view – and we agree with many senior psychiatrists in saying that – we do have an overwhelming amount of evidence that even severe psychiatric breakdown is actually the end result of a complex mix of social and psychological circumstances. People who have suffered things like bereavement, loss, discrimination, poverty, trauma, abuse, domestic violence, in other words things that have happened to you.

John: “So where does that leave us in terms of treating it? Because there is no question that it is a disease. Schizophrenia is a horrible thing?

Lucy: “Well actually that’s exactly what we are questioning. We are questioning the disease model, along with many psychiatrists. Of course the distress is very real.

John: “Doesn’t that make it a disease? If you are desperately distressed, to the point sometimes of killing yourself, or harming somebody else perhaps, doesn’t that make it a disease?

Lucy: “Well there’s no evidence that it does. We are told a great deal of stuff about genes or biochemical imbalances, and as one of America’s most senior psychiatrists said only a couple of weeks ago, we have been telling patients for several decades that we are waiting for biomarkers, in other words evidence for a disease process. We are still waiting. So these are very serious problems, but there is an increasing amount of evidence that there is a way of understanding them, for example very often as the end result, not always, of extremely severe trauma.

John: “But you can’t turn back the clock, you can’t remove that trauma or make it never happen, so how do you deal with this, whatever you call it, disorder?

Lucy: “We would probably not want to use the term disorder. It does bring into question all the traditional vocabulary. We are actually calling for a change of language among other things.

John: “How does this understanding change the way you treat it?

Lucy: “It changes it in a very helpful and ultimately very productive way: in essence, instead of asking what is wrong with you, we need to ask what has happened to you? People break down for reasons, those reasons aren’t always immediately obvious, it can take quite a while to put the pieces together, but once we know those reasons we can offer them the right help to recover.

John: “Which would probably be counseling rather than drugs would it?

Lucy: “Well drugs might well play a part but i think we have to be clear about the role of medication. If we’re talking about the end result of complex social and relationship problems, by definition medication can’t solve those. It can certainly help keep people going, it can certainly help with some of the more overwhelming themes of distress. But essentially, what psychologists would say, we use a jargon word, which is formulation, which is a way of putting together the psychological evidence about the impact of very difficult life experiences, understanding how those affected the person in front of you, the personal meaning of those events, and on that basis you draw up an individual plan which will actually have a very good chance of helping that person recover.

John: “Well that’s encouraging. Dr Lucy Johnstone, thank you very much indeed.

As a close friend of mine with first hand experience of such issues said: “I sincerely hope that this discussion will eventually go on to reduce a lot of unnecessary suffering“.

† The DSM is the  Diagnostic and Statistical Manual of Mental Disorders, containing definitions of certain states of mind from depression to “Disruptive Mood Dysregulation disorder”, with has implications on how people are diagnosed and hence treated. I’ve referred to this previously.


6 Responses to “The Drugs Don’t Work”

  1. Rik August 1, 2013 at 8:52 am #

    “Instead of asking what is wrong with you, we need to ask what has happened to you.”

    This statement basically says it all and has been a long time in the coming.

    Another aspect which causes a tremendous amount of unnecessary suffering, primarily by the biomedical approach, and needs to be challenged, is the perception that depression is “fully curable” by one form of therapy or another.

    Phrases such as depression is “fully treatable”, (note fully curable is never used) yet fully treatable as the same connotation for most. Another choice phrase which perpetuates the myth is “treatment resistant depression”. This again implies that it can be cured as all you have to do is just fight it’s resistance a bit harder. The words most and majority preceding will benefit. Again implies that only a very few may not benefit.

    Even the most optimistic clinical trials held under optimum conditions never ever report 100% remission for all participants. From what I have read the most optimistic trials still report up to 30% who do not respond to a range of treatments. What are these people meant to do? There is never any proposals put forward, by all who offer treatment for depression, to what can be or should be done for those where treatment is ineffective.

    This leaves those who have very complex drivers for their depression on a never ending nightmare of a merry go round. One treatment to the next to the next until they are back to the beginning again. The longer this goes on the more they are perceived as the cause of the failure of the treatment(s). That it is their fault and theirs alone. A typical locked in scenario which of all things can exacerbate depressive thoughts!

    The challenge put forward most certainly needs to be rigorously debated. “What has happened to you” is fundamentally the most important question to ask. I am absolutely sure by consistently asking this question that more will be understand about why some people get depressed and other’s don’t when faced with similar challenges. And for that matter why an individual can be depressed about one circumstance and yet not about another which on the surface appears to be the same.

    Anyway I apologise for my poor grammar and for rambling on. It’s just that I have been trying for 7 years to help somebody who has suffered appallingly from the prevailing misleading and misguided policies.

  2. Christoph Dollis January 20, 2014 at 2:41 am #


    You’ll want to listen to this recent interview of Dr. Lucy Johnstone by Dr. Peter Breggin, I believe.

    • 5i5i February 5, 2014 at 9:14 am #

      You believe correctly – great discussion. Thanks for that Christoph.


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