Are we all mad? Or is it just the psychiatrists?

May 13, 2013 by
Filed under: Social Brain 

Today, the Division of Clinical Psychology has issued a statement that essentially says that our system for diagnosing mental illness is unreliable, lacks validity and is not fit for purpose. This follows a similar statement from the American National Institute for Mental Health last week in which it was announced that NIMH would not be using the new DSM-V (the prescribing manual for mental disorders) because of concerns about its validity and use value. These two announcements are of tremendous significance, and could herald the beginning of a bona fide revolution in how we respond to and treat mental illness.

I think that mental health services will change so radically within my lifetime that they will be unrecognisable to the children of my generation

For several years I’ve been saying, albeit tentatively, that I think that mental health services will change so radically within my lifetime that they will be unrecognisable to the children of my generation. I really hope these recent announcements are the beginning of that transformation.

Arguments about the revisions to the DSM have been simmering for a long time, and the new issue is already several years later in being published than expected. You could look at this as a predictable and relatively insignificant resurgence of the long held divisions between psychology (which assumes mental distress is caused by traumatic life events) and psychiatry (which treats mental illness like any other physical condition, and assumes causes are biological).

You could regard it as being politically driven – in both the UK and US, the cost of mental illness is utterly unsustainable, and anyone who’s ever taken time to look at the figures will know that a majority of prison inmates have a history of mental illness. As Barack Obama put it rather starkly, it’s easier for a mentally ill person to buy a gun than to get proper treatment in the US. In the UK, the political narratives are spun separately, with few people joining the dots to see what’s really going on.

it’s easier for a mentally ill person to buy a gun than to get proper treatment in the US

On the one hand, mental illness is on the rise. It costs us £36 billion a year, in sickness absence, unemployment, not to mention treatment. The pharmaceutical industry produces more and more psychotropic medications, most of which are incredibly expensive, and all of which are developed on relatively limited understandings of how they work or why they work (if they work, which, frequently, they don’t). On the other hand, the voices of mental health service users are finally started to be heard, and the resounding message is that things need to be done differently. In support of that, both the critical psychology movement, and critical psychiatry movement have both been asking questions with increasing urgency. Running alongside are parallel problems around mental illness and employment; mental illness and education, and mental illness and social exclusion. All of this needs unpicking and exploring in a lot more detail.

This week is mental health awareness week, and the focus is on physical activity and its benefits for mental health. I’m fully in support of this, and a firm believer in the importance of physical health for mental health. But it strikes me that there are bigger and more important issues happening too.

My PhD thesis, Making sense of mental illness: The importance of Inclusive Dialogue, goes into some of these arguments in a lot more detail, some of which I hope to return to and develop in another blog post.


  • Benjamin D

    Emma – In my limited understanding, hasn’t there been a regular swing between more a rigid process of diagnosis and (to use a label) the anti-psychiatric movement in the past 40-50 years? Do you think we are now on a definite path toward a new view of Mental Health – or could this be another swing of the pendulum?

  • John Mappin-Camelot Castle
  • Kiljoy

    I was, I think it fair to say, for the greater part if my youth, a rather dispirited, frustrated, disillusioned perhaps even depressed (I’m wary of that term) person.
    I’m stubborn and though I’ve wavered a little over this issue of cause and effect I’ve been primarily convinced that my troubles have reasonable enough explanation, I mean hell, If I said the idea that depression just comes out of nowhere is a complete load of rubbish and that denial is really the product of a guilty conscience. A lot of people would no doubt be angered by that. Maybe even fall into depression. I was perceived as being insensitive, they have no great difficulty identifying the cause.

    Maybe a day later they might more or less forget this, a lot of people are evidently not in the habit of tracking these things (let alone inclined to soul searching) though the resentment will smoulder on and maybe find displacement/projection onto a handy scapegoat.

    Life is largely what others make it. Whilst there is quite enough in my past to torment me with guilt I think I’ve responded, for the most part appropriately and have made the necessary changes. However, the problem of ‘others’ still predominates.

    To repeat a quote from Pride and Prejudice:

    “It was an union that must have been to the advantage of both; by her ease and liveliness, his mind might have been softened, his manners improved, and from his judgment, information, and knowledge of the world, she must have received benefit of greater rimportance. But no such happy marriage could now teach the admiring multitude what connubial felicity really was. An union of a different tendency, and precluding the possibility of the other, was soon to be formed in their family.”


    “How Wickham and Lydia were to be supported in tolerable independence, she could not imagine. But how little of permanent happiness could belong to a couple who were only brought together because their passions were stronger than their virtue, she could easily conjecture.”

    This really captures well humanity’s big problem. As Rabbi Jonathan Sacks has said, the Bible’s concern with human (primarily sexual) relations is given priority chronologically because it is the axiological priority.

    Anyone who could even remotely doubt this wisdom is frankly deluded but far more probably in wilful denial. ‘No strings attached’ sex is just way too much fun, too addictive, too all consuming for most people to honestly acknowledged it for what it is, deeply subversive and perverting of the better angels of our nature.

    Are you feeling depressed about this?