Tag Archives: DSM

Who Is Normal, Anyway? Part IV

15 Nov

Crazy people are considered mad by the rest of the society only because their intelligence isn’t understood

– Weihui Zhou

IV – Psychiatry and the DSM

For someone working to help people deal with these conditions, it is helpful to look at specific symptoms, to classify, and to find common causes, and hence common solutions for these symptoms, if they are problematic for the person.

Systematising in this way is what we do well, and gives us our understanding of the world we have, so I don’t have a problem with it. In fact I fully support it.

However, with the failed biological model, this means that symptoms are given arbitrary disorder names and drugs applied to ‘fix’ them. The mainstream approach is predicated on an often unproven assumption of biological cause which leads to harmful decisions.

It also often means people give up responsibility for their conditions, and even for their actions. While this avoids blame it unfortunately goes further and avoids responsibility, resulting in people giving up and just living with their ‘condition’.

Tom Stafford sayswe know that self-efficacy is one of the best predictors of recovery, so denying people’s role in their own decisions just undermines one of their most important tools for recovery“.

The approach I’m advocating here is that you can take responsibility, and that you can change. It means empowering the individual to change for the better if they want to.

So much has been written on the problems with the DSM and approach of many psychiatrists that I don’t need to detail it here.

One purported disorder is pee-shyness, then there’s “caffeine intoxication disorder” and another is “intermittent explosive disorder“.

As you can see, “having some psychiatric symptoms is part of the human condition and does not by itself indicate the presence of mental disorder. The boundary between the worried well and the psychiatrically ill is fuzzy; arbitrary, and subjective—there is no biological test.

Tom Stafford saysThe fact that the most senior psychiatric researchers in the US are now openly and persistently highlighting that the DSM is not fit for the purpose of advancing science and psychiatric treatment is a damning condemnation of the manual.

Neuroskeptic says that “many people are now being prescribed antidepressants for emotional and personal issues which wouldn’t have been considered medical illnesses until quite recently“. He adds that they don’t work very well either.

We really do have a lot to learn about the brain. It was only 60 years ago that Freeman and Watts went around sticking a rod up people’s eye sockets and wriggling it about to mess up their frontal cortex. The frontal lobotomy certainly made them tractable, but left them in a terrible state, usually mentally and physically retarded and sometimes dead. These guys had sod-all idea of what they were doing. Some may say, ‘ah but today we have such a clear understanding of these issues, science has come so far‘. But some of these drugs are like a blunderbuss to the brain. I think that in another 60 years time many of these drugs will be considered an abhorrent way of treating people.

It’s not a question of whether or not these behaviours exist. It a question of whether the psychiatric approach and classifications are helpful. The disease model is fundamentally flawed. And many psychiatrists recognise this.

Final part – What Does Work in the next post

Part III – Stigma in the previous post.


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.

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