paint­ing by Wass­ily Kandinsky

Psy­chi­a­trists under fire in men­tal health bat­tle by Jamie Doward in the guardian

In a ground­break­ing move that has already prompted a fierce back­lash from psy­chi­a­trists, the British Psy­cho­log­i­cal Society’s divi­sion of clin­i­cal psy­chol­ogy (DCP) will on Mon­day issue a state­ment declar­ing that, given the lack of evi­dence, 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 DCP said its deci­sion to speak out “reflects fun­da­men­tal con­cerns about the devel­op­ment, per­sonal impact and core assump­tions of the (diag­no­sis) sys­tems”, used by psychiatry.

Dr Lucy John­stone, a con­sul­tant clin­i­cal psy­chol­o­gist who helped draw up the DCP’s 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. The provoca­tive state­ment by the DCP has been timed to come out shortly before the release of DSM-​5, the fifth edi­tion of the Amer­i­can Psy­chi­a­try Association’s Diag­nos­tic and Sta­tis­ti­cal Man­ual of Men­tal Disorders.

The man­ual 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 DSM is used in a num­ber of coun­tries to vary­ing degrees. Britain uses an alter­na­tive man­ual, the Inter­na­tional Clas­si­fi­ca­tion of Dis­eases (ICD) pub­lished by the World Health Organ­i­sa­tion, but the DSM is still hugely influ­en­tial – and controversial.

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.

Do we need to change the way we are think­ing about men­tal ill­ness? fol­low­ing quote by Oliver James in the Guardian

A stu­dent friend of mine once started claim­ing that she was being con­trolled by elec­tri­cal impulses beamed across the city by “author­i­tar­ian cap­i­tal­ists”. She spent hours in the bath, clean­ing herself.

Fol­low­ing her removal to an asy­lum, her par­ents arrived to col­lect her pos­ses­sions. Nearly all of her (mostly clean) clothes were deemed so “soiled” they would need to be burnt. The room was obses­sively cleaned. Her father was a health inspector.

Within the med­ical model of men­tal ill­ness, she had inher­ited genes pre­dis­pos­ing her to obses­sive rit­u­als and to psy­chosis. The model does not enter­tain the pos­si­bil­ity that the health inspector’s intru­sive­ness dis­tressed her or, as it turned out, that he had sex­u­ally abused her.

Yet 13 stud­ies find that more than half of schiz­o­phren­ics suf­fered child­hood abuse. Another review of 23 stud­ies shows that schiz­o­phren­ics are at least three times more likely to have been abused than non-​schizophrenics. It is becom­ing appar­ent that abuse is the major cause of psy­choses. It is also all too clear that the med­ical model is bust.

In the press release accom­pa­ny­ing pub­li­ca­tion of DSM-​5, David Kupfer, who over­saw its cre­ation, states: “We’ve been telling patients for sev­eral decades that we are wait­ing for bio­mark­ers. We’re still wait­ing.” This is an aston­ish­ing admis­sion that there are no reli­able genetic or neu­ro­log­i­cal mea­sure­ments that dis­tin­guish a per­son with men­tal illness.

While there is some evi­dence that the electro-​chemistry of dis­tressed peo­ple can be dif­fer­ent from the undis­tressed, the Human Genome Project seems to be prov­ing that genes play almost no part in caus­ing this. Eleven years of care­ful study of our DNA shows that dif­fer­ences in it do not explain men­tal ill­ness, hardly at all. If one sib­ling is anx­ious or depressed and another is not, at most, dif­fer­ences in DNA can only explain 1 – 5% of why it is one and not the other.

Of course, some researchers main­tain that, given more time (and money), they will still come up with sig­nif­i­cant results. But off the record, nearly all mol­e­c­u­lar geneti­cists admit that it now really does look as if dif­fer­ences in DNA will explain very little.

By con­trast, there is a huge body of evi­dence that our early child­hood expe­ri­ences com­bined with sub­se­quent expo­sure to adver­sity explain a very great deal. This is dose depen­dent: the more mal­treat­ment, the ear­lier you suf­fer it and the worse it is, the greater your risk of adult emo­tional dis­tress. These expe­ri­ences set our electro-​chemical thermostats.

So does sub­se­quent adult adver­sity. For instance, a per­son with six or more per­sonal debts is six times more likely to be men­tally ill than some­one with none, regard­less of their social class: the more debts, the greater the risk.

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.