More controversy over the diagnosis of mental illness in the DSM V

Controversy over the diagnosis of mental illness in the DSM V

The British Psychological Society’s Division of Clinical Psychology has issued a number of statements over recent months that raise their concerns over the issue of psychiatric diagnosis, asserting that the medical model of mental illness may be overused.

“The statement argues that “psychiatric diagnosis is often presented as an objective statement of fact, but is, in essence, a clinical judgment based on observation and interpretation of behaviour and self-report, and thus subject to variation and bias”.

young depressed woman in a straight jacket
A young depressed woman in a straight jacket because she is getting the wrong treatment

The Division of Clinical Psychology has suggested that diagnosis is not the scientific truth people believe it is but rather it is a statement of opinion that is not only unscientific but unhelpful and unnecessary.

“Strange though it may sound, you do not need a diagnosis to treat people with mental health problems,” said Dr Lucy Johnstone, a consultant clinical psychologist who helped to draw up the DCP’s statement.

“We are not denying that these people are very distressed and in need of help. However, there is no evidence that these experiences are best understood 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.”

Self help for depression and anxiety

I echo these concerns and my own research has demonstrated quite adequately that the most common illnesses: the depressive disorders and the family of anxiety disorders are very well treated using psychological methods, and most notably cognitive behavioural therapy (CBT).

My research (and that of many others) however has taken things further and demonstrated that it may not matter very much how the psychological treatment is delivered. A computer system using the right programs is often more than able to deliver a clinically useful treatment for depression and anxiety. In a recent paper we published we interviewed people after using Blues Begone they actually liked using the program. There were no side effects other than some disappointment when the program was completed.

Effective and enjoyable self help

There seems to be a strong human need to classify and label things. And, of course this has its uses. It also has its weaknesses. When we use any system blindly without mindful care and attention then the needs of the system can take precedent over the human need. But you know, in the end I wouldn’t mind if the medical model really delivered on patient well being. It is estimated that Prescriptions for antidepressants rose by 9.6% in 2011 to 46 million prescription (BMJ 2013;346:f191). That is a lot of medical treatments of what is actually a psychological problem.

antidepressant use is increasing
Antidepressant use is increasing

To the many millions of people who struggle with psychological problems every day their GP and psychiatrist may be their only point of access to any possible clinical treatment. And of course these professionals can only offer what there is on offer. The medical model upon which the DSM V and the profession of psychiatry is predicated does have its value. But let’s not forget that psychological problems are best treated with psychological solutions and often less well treated by medical solutions. Maybe the medicalization of normal human variation has gone too far and in some cases become actually unhelpful


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