“The psychiatric oligarchs who medicalise normality.” « International Society for Ethical Psychology and Psychiatry (ISEPP) Blog
“The psychiatric oligarchs who medicalise normality.”
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Mental health should be a priority for all societies and its stigma always challenged. However, the US Centers for Disease Control and Prevention (CDC) reports that a staggering 25% of people in the United States have a “mental illness.”1 This is so large a figure that there can be only one conclusion: psychiatry is medicalising normality. The definition of a “mental illness” is one of opinion. These opinions are drawn from a small group of psychiatric oligarchs who author the Diagnostic and Statistical Manual of Mental Disorders (DSM). Their opinions are polluted, however: …
BMJ 2012;344:e3135 (Published 02 May 2012)
Des Spence 10.1136/bmj.e3135 22551806 ...
______________________________________________________________
Courtesy of
Ken Pope, Ph.D.
The new issue of
*British Medical Journal* includes an article: “The psychiatric oligarchs who medicalise normality.”
The author is Des Spence, a general practitioner from Galasgow.
destwo@yahoo.co.uk
Here are some excerpts:
[begin excerpts]
Mental health should be a priority for all societies and its stigma always challenged. However, the US Centers for Disease Control and Prevention (CDC) reports that a staggering 25% of people in the United States have a “mental illness.”1 This is so large a figure that there can be only one conclusion: psychiatry is medicalising normality. The definition of a “mental illness” is one of opinion.
These opinions are drawn from a small group of psychiatric oligarchs who author the Diagnostic and Statistical Manual of Mental Disorders (DSM). Their opinions are polluted, however: 75% of the authors of the new, fifth edition of the DSM report conflicts of interest.2
< snip>
Thus, tens of millions of normal but inattentive, disruptive, unruly, moody, or shy children are labelled for life as mentally ill.
Boys are disproportionately coerced into chemical control. Figures from North Carolina show that 15.6% of children are labelled as having attention-deficit/hyperactivity disorder.3 In New Jersey one in 30 boys is considered to have autistic spectrum disorder,4 and bipolar illness in children rose 40-fold in a decade in the US.5
Such numbers are hailed as “better” diagnosis, not the obvious calamity of overdiagnosis and childhoods lost. How will these labels affect future employment, relationships, and esteem? So, will the DSM-5 seek to reverse overdiagnosis? No. New proposals will see bereavement reclassified as clinical “depression” should it last a mere two weeks.6 The definition of ADHD is being loosened further and will consume ever more.7 A new condition, “disruptive mood dysregulation disorder,” is defined.8 Three “temper outbursts” a week and being negative, “irritable, and angry” are enough for children to be labelled forever.
< snip>
These changes defy common sense and will serve only to undermine psychiatry’s professional standing.
< snip>
DSM-5 (and psychiatry) is riddled with conflicts of interest; its definitions are soft, non-specific, and seem counterintuitive. I know that many psychiatrists believe this too, so it is time to take a stand against the mayhem of modern psychiatry.
[end excerpts]
The article is online — but requires a subscription — at:
<http://bit.ly/KenPopeBMJCritiqueOfDSMV>
Ken Pope
From the comment section of the BMJ:
‘No More Psychiatric Labels’ petition
5 May 2012
Well done again to Des Spence. There are indeed many mental health professionals, including psychiatrists such as myself, who are deeply concerned about the direction of travel in our profession. We have moved away from what it is that is unique that we bring to health care, which is an understanding that meaning, relationships, and social context are all central to a deeper understanding of suffering (mental and physical) and its alleviation. Instead we have been promoting pale imitation of a simplistic ‘diagnostic’ medical model that is not supported by any strong and consistent evidence base. This has resulted, at least in part, from an unnecessary insecurity about our identity as doctors and from a shameful ‘cosying’ up to the pharmaceutical industry.
There are now active movements campaigning against DSM 5 (see for example
http://www.ipetitions.com/petition/dsm5, which includes affiliations from many large international psychological and psychotherapeutic organisations), and I have started a petition to the UK Royal College of Psychiatrists entitled ‘No More Psychiatric Labels’ and calling for the abolition of using formal psychiatric systems like DSM and ICD (see
http://www.change.org/petitions/royal-college-of-psychiatrists-abolish-u… ).
The petition sets out the evidence based reasons for concluding that: Psychiatric diagnoses are not valid, use of psychiatric diagnosis increases stigma, using psychiatric diagnosis does not aid treatment decisions, long term prognosis for mental health problems has got worse, psychiatric diagnosis imposes Western beliefs about mental distress on other cultures, and alternative evidence based models for organizing effective mental health care are available.
To read the full evidence based arguments view the ‘No More Psychiatric Labels’ paper at
http://www.criticalpsychiatry.net/?p=527 or view the petition letter.
5 May 2012
Des Spence once again vents his low opinion of psychiatry. The confidence of his assertions indicates that he clearly knows best. Unfortunately, his attitudes are only too familiar to those of us working in mental health services; prejudice dressed up as concern for patients and academic rigour.
I really don’t recognise Spence’s “Front line”. He uses examples that have little relevance to mental health care practised by jobbing psychiatrists in the UK to support his opinion that we are in a mental health disaster zone. He clearly does not value psychiatrists and he is entitled to his opinions. However, as he is writing in an important medical journal I would encourage him to curb his prejudices and to write, for a change, about some of the enormous advances made in mental health care over the last 20 years. More effective medications and psychological treatments delivered by improved services including assertive outreach and crisis teams as well as early intervention in psychosis.
He should stop airing his selectively informed opinions for the sake of combative prose and think about patients.
Competing interests:None declared
4 May 2012
Des Spence is correct in stating that the definition of “mental disorder” is one of opinion. A surely foundational question for psychiatry is what a “mental disorder” actually is.
One attempt at a definition would be the one used in the UK Mental Health Act–this might be expected to be rigorous since it legitimates involuntary detention: a mental disorder is “any disorder or disability of mind.” This is no definition at all, merely a tautology.
In fact psychiatry has no answer to the question “what is a mental disorder?”, and instead exalts a way of working it has devised: if there are sufficient phenomena at sufficient threshold, a mental disorder is declared to exist! This is as much alchemy as science.
Competing interests:None declared
Courtesy of Ken Pope, Ph.D. The new issue of *British Medical Journal* includes an article: “The psychiatric oligarchs who medicalise normality.” The author is Des Spence, a general practitioner from Galasgow.
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