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.
“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.
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.