Psychiatrists under fire in mental health battle

British Psychological Society to launch attack on rival profession, casting doubt on biomedical model of mental illness

• Jamie Doward
• The Observer, Sunday 12 May 2013

British psychologists are to say that current psychiatric diagnoses such as bipolar disorder are useless. Photograph: Justin Paget/Fuse/Getty

 

There is no scientific evidence that psychiatric diagnoses such as schizophrenia and bipolar disorder are valid or useful, according to the leading body representing Britain's clinical psychologists.
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.

Writing in today's Observer, James declares: "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."

But Professor Sir Simon Wessely, a member of the Royal College of Psychiatrists and chair of psychological medicine at King's College London, said it was wrong to suggest psychiatry was focused only on the biological causes of mental distress. And in an accompanying Observer article he defends the need to create classification systems for mental disorder.

"A classification system is like a map," Wessely explains. "And just as any map is only provisional, ready to be changed as the landscape changes, so does classification."

Fiction takes you to places that life can't

Philip Hensher in The Independent:

It takes a novelist, not a psychologist, to explain why people sometimes behave out of character

Saturday, 9 July 2011

 

What's it like to die? There's no answer to this cheerful question, or there shouldn't be.

People have told us what it's like nearly to die, to come back from the brink. The external process of death has been gone over in great detail. But no one has definitively returned from the other side, to tell us what it's like to feel the last breath leaving your body. We don't know anything about it.

Or rather, we shouldn't know anything about it. In 1886, Tolstoy published a short story called "The Death of Ivan Ilych", which follows a fairly unremarkable man to the complete extinction of life. After reading that, you feel you know what death will be like: "Suddenly some force struck him in the chest and side, making it still harder to breathe, and he fell through the hole and there at the bottom was a light. What had happened to him was like the sensation one sometimes experiences in a railway carriage when one thinks one is going backwards while one is really going forwards and suddenly becomes aware of the real direction." How could Tolstoy possibly know that? You will read any number of academic studies of the processes of death without coming near the novelist's instinctive understanding.

A wonderful Canadian academic and psychologist, Keith Oatley, has carried out some research on readers and non-readers of fiction, and has questioned this widespread assumption. Speaking to the Today programme this week, he shared his conclusion that habitual readers of novels were much better at coping with social situations and with a wide range of human beings. The usual image of the thick-lensed bookworm who can't cope with people – Philip Larkin's character who says "when getting my nose in a book/cured most things short of school" – is far from reality.

Well, all of us Dewey-botherers knew that. I guess from day one, I had a general sense that novels were going to introduce me to more sorts of people than life would. There was Mummy and Daddy and my big sister; there was Mr and Mrs Griffiths next door, and there were the Skittles at the end of the garden. On the other hand, if you opened a book, there wasDorothy and her friends the lion and the tinman and a boy called Tip, later transformed into Princess Glinda of Oz.

Later on, there were girls who went away to a super school called Malory Towers, not very much like anyone I knew; there were robots and Boy Detectives and a talking spider called Charlotte (who died) and a foul-tempered talking pudding and a larrikin koala, some rather intimidating children called Bastable and a boy called Philip Pirrip.

Whenever I hear someone say "I don't read novels – I prefer to read about the truth," I wonder about their notion of "the truth". The conviction that reading fiction is a dispensable part of a rich, full life is a widely held one. Members of my own family, to this day, will say to me if they find me engrossed in a thriller, "If you're not doing anything...".

The saddest expression of this attitude must be Quentin Crisp's famous landlady, who was always commenting on his actions. If she came across him having his lunch, she would say "Eating." If she saw him sewing a button on, she would say "Mending. Once, she found him reading a novel. She looked at him, and said "Waiting."

I don't suppose any reader complains for a moment that his life is failing to introduce him to as interesting a collection of people as he will find in 10 minutes in the nearest bookshop. On the other hand, real life has a way of intruding itself. You can't live your life entirely within the pages of a novel, as much as some of us attempt to. And when real life starts to expand beyond the small domestic circle, then your reading of novels is going to prepare you for what life can hold. India is not completely strange if you have read Narayan; nor is old age after Elizabeth Taylor's Mrs Palfrey at the Claremont.

Fiction won't tell you the whole story, but it will take you to places that life won't – Sicilian ducal houses, 13th-century convents, cities in Calvino that never existed. And sometimes with a shock of recognition, you meet in real life a friend from a book. I have a dear old German friend who, the very first time I met him, I thought "Snufkin". He really was Tove Jansson's charismatic, silent, solitary wanderer to the life. I wouldn't have known what to make of him without those magical novels.

How do novelists do it? They throw themselves into lives very unlike their own; their imaginative reconstructions are as apt to be as convincing as reports back from experience. Tolstoy knows what it is like to die; Stephen Crane tells us what war is like in The Red Badge of Courage, only experiencing battle after writing it. Conrad undoubtedly knew what it was like to endure a stupendous tropical storm. Thousands of sailors went through events like the ones described in Typhoon, but only one had the imaginative sympathy to write it down.

As Martin Amis has said, we still have no real idea what it is like to go into space. No one who has done so has had the ability to write well about the experience. Whatever systematic analysis is undertaken of a human experience, still the novelist's human spread seems the most substantial, authentic, accurate account.
Psychologists can offer explanations of behaviour, but they can't explain why people sometimes act out of character, or against their own interests. Even so subtle an analyst of behaviour as Erving Goffman, say, would struggle to account for the moment at the end of Vanity Fair where Becky Sharp hands Amelia Osborne the letter, destroying her own interests. And yet we know it to be true in the deepest sense.

The writer Marc Abrahams has shared an amusing encounter with a psychologist, who told him: "Whenever any group of really good research psychologists gets together socially, after a few drinks they always – and I do mean always – talk about why novelists are so much better at it than we are."

It's true. No psychologist is as good a psychologist as Graham Greene, let alone Tolstoy. And it's also true that no social life contains the range and interest of a shelf of novels. We love our friends: human beings fascinate us endlessly; and to teach us how they work, there are always novels. I've never met anyone remotely like Emma Bovary, Miss Flite, or Belinda, the madcap genius of the Fourth Form at Malory Towers. But one day, they'll come along, and when they do, I'll recognise them instantly.