Friday 24 May 2013

Unconventional Wisdom: Are the mainstream ideas underpinning mental illness diagnosis as sound as we presume?

In case you are wondering – “where have the wonderful plasticine pictures gone?” - then let me explain. Jackie has temporally handed the "blog reins" over to me for this week’s blog, and artistic I am not.

So instead you get a picture of my hero, Thomas Szasz, who sadly died last year on September 8th 2012, My hero because his ideas changed the way I think about a lot of things in life, and his picture because of a debate that seems to be becoming more prevalent. 

In my earlier blog this year I talked about the mobile phone restriction at our local psychiatric hospital, no comments yet I can only tell (fool) myself that you are reading in silence.  Today I just want to start to explore the question:  Are the mainstream ideas underpinning mental illness diagnosis as sound as we presume?

This week was a very interesting one for me, there seems to have been something in the air (certainly not summer), I have been involved in many stimulating conversations with colleagues from across Powys discussing the validity of mental illness diagnosis. 

Well Jackie got us going! In her last blog, she mentioned an interview with Dr Lucy Johnstone on the Today Programme in which she discussed new research suggesting that there is no scientific evidence that psychiatric diagnoses are valid.  

Eleanor Longden talked at a conference we organised in Powys (more information here) last year and one underpinning idea that I took away was that we need for more debate on the validity of mental illness diagnosis. 

The American Psychiatric Association's publication of Diagnostic and Statistical Manual of Mental Disorders 5 (DSM5) has sparked controversy. It has led to the creation of the International DSM5 Response Committee and their world-wide online petition arguing that DSM5 should not be adopted and used. 

So what would all this mean? What if the mainstream ideas underpinning mental illness diagnosis are just not correct? Within our lifetime will we see a paradigm shift in the conventional wisdom surrounding mental distress? 

What would this shift look like? Would it start with us changing the question that underpins the mainstream mental health services from "what is wrong with you" to "what has happened to you"?

What would that mean to those of us that perhaps take benefit from finally being given a reason, a medical diagnosis, from the experts for why things have been so difficult?  How would people access services, support, welfare benefits if there were no diagnosis for mental distress?  In schools how would children access the extra support they need, again if there were no mental illness diagnosis? Would this change the justification supporting the Mental Health Act and some of the ideas underpinning it around personal responsibility? 

Just some of the many questions that spring to mind!  I’d love to hear what you think and whether this is a debate that you are having with people close to you? 

I'll sign off now with a hope for some sun this weekend and with a quote that feels very relevant to this debate: 
 "There are only two mistakes one can make along the road to truth; not going all the way, and not starting" Buddha


  1. Lots of interesting questions Laura. As a counsellor, this bit resonated with me: not "what is wrong with you" but "what has happened to you"?

    I think diagnoses / labels can be helpful in some respects because they can point us to relevant information and increase our understanding of what someone MIGHT be experiencing and what MIGHT help.

    However everyone is unique, as are their circumstances and the way they react to them so of course categorisation is too generic and in some cases extremely unhelpful.

    1. Dear Sorelle - I personally really like the idea of the honesty of the word might - this is what might be happening, this is what might help, this is what you might you be experiencing. I think that I understand that labels might be helpful to some of us, but this does not make them truthful. Thank you so much for your comments. Laura

  2. Thomas Szasz definitely seems to be in "the air" this week! The debate continues over on The Guardian webpages, where Nathan Emmerich posts a blog here - Appreciating the politics of psychiatry

  3. Thanks Jackie. Interesting but I am afraid Nathan loses me I have to admit. Despite that I understood enough to disagree with Nathan on two points relating to Szasz. Not sure whether he has truly misunderstood him or whether he finds it convenient to misunderstand his ideas. Firstly, Nathan implies that Szasz was an anti-psychiatrist, this is just not the case. Szasz was not opposed to the practice of psychiatry if it is non-coercive. Szasz maintained that psychiatry should be a contractual service between consenting adults with no state involvement. I would also question his statement that Szasz was "overly polemical", my understanding is that Szarz set out to establish the truth and he used logic without apology to explain this truth.

  4. Is R D Laing worth a mention on this theme? Whatever approach one takes to the psy- sciences the psychiatric hierarchy issue Laura mentions seems pertinent- especially in relation to the question of distinct diagnoses with correlating medications are used as blanket response to illness and distress.
    Another recent Guardian article ( contains the useful counter that the relationship between diagnosis and condition is like a map that constantly needs updating. Where that leaves 'conventional wisdom' is a truly interesting question.
    My own tuppence worth is that if you can't be sure what is causing problems for a person then several (and holistic) strategies need to be used to help empower those that suffer.

    1. Really interesting, thank you. I hadn't seen this article.
      It is great at least to see a debate emerging about this.

      R D Laing - I have to admit that I personally have always struggled to read his work, it always felt a bit over my head (hope it is OK to admit that!) and I have struggled to get to the explicit ideas underpinning his views. Having said that,

      I agree, very relevant to this debate.
      Within this complex area I think that people having access to information (what we do know and what we don't) and choices, as you say several strategies could be useful.

      Thanks for commenting. Laura

  5. Hi Laura,

    The problem with the Psychiatric diagnosis of the various conditions and what not, is that there is no proven theory or evidence whatsoever to back up that these are illnesses caused by an imbalance of chemicals in the brain. However what has been proven is that the medication itself does cause an imbalance.

    Any one of us could go through a DSM and find our own diagnosis to fit us. The problem is that it is based more on the subject opinions of how those professionals have interpreted a so called objective view of someone struggling with these problems of the mind, body and/or soul. How often is nutrition and other factors considered before diagnosis?

    The reality is that it generally costs secondary medical services too much money and time to sit with someone and explore what they truly need help with on many levels. This is why talking therapy is not the first and foremost choice of care to help those who suffer. If we were to put our fellow human first, before the need of something which isn't even alive, then we would be heading in the right direction.

    On top of that, we have medications which cause the problems outlined under those diagnoses found in the DSM. The drug can often be the problem leading to diagnosis and then further lead to something exacerbated down the line.

    While contemporary Psychiatry has some sort of place, I'm sure it will be looked back on in future generations as a tragedy more than a success.

    1. Dear Lee Thank you so much for you very useful comments. Food for thought indeed. I think that the issues you raise regarding psychiatric medication, their role in treatment, evidence underpinning their effectiveness in helping people. evidence about their known effects on the functioning of the brain and physical health and the complex role that the effects of medication can play in mental health diagnosis is another debate that is truly needed. Watch this space ....

  6. I have to say that this is one of the best blogs I have ever read. I will follow to support for you.


  7. Very interesting debate...

    Some of the comments above suggest that diagnosis of a 'mental illness' can be useful to people as a diagnosis increases our understanding and guides us to explore the best options to 'help' the individual.

    This throws up a few questions for me:

    Do people find the diagnosis/label helpful because it genuinely cuts to the heart of 'what's wrong' with that person?

    Or, in the current climate, is a diagnosis the ONLY way in which an individual experiencing mental distress can actually access any type of meaningful support? ...and if this support must come with a label, so be it?

    It seems to me that diagnosis is a prerequisite to anybody taking mental distress seriously, and as such, people feel it is the only option. It's not.

  8. my name joe im weating to be dixxxx with bipola .my mam had manic depreion my brother has bipola and his son.wanting my kids tested
    so it must be inheredit sorry for the speling. hav not had much sleep
    my e mail is

    1. Dear Joe,

      I personally, though there are many other people that hold the same view as I, do not believe in the validity of mental illness diagnosis. I do not think that people’s experiences, emotions and behaviours can be explained as symptoms (e.g. depression, mania, psychosis) of mental illness.

      I do think that there are organic causes that can explain these symptoms in some people (e.g. auto immune, B12 deficiency etc) but if an organic cause is found this to my mind makes the cause a physical illness or biological condition.

      So where there is no organic cause, so no physical illness or condition, our mainstream idea means that we diagnose people with a “mental illness” such as bipolar. I personally believe that in these cases people’s very real distress, suffering and difficulties have their roots in emotional struggles/trying to deal with and make sense of trauma/stress/adversity rather than being caused by “mental illness”. So I do not believe that there is something wrong (i.e. a mental illness) with people, rather that they are responding naturally, as any of us might faced with the same difficulties that they are facing/have faced in life. So it isn’t that there is something wrong with the person (i.e. a mental illness) rather they are reacting in a natural way to stress, trauma and adversity. So I do believe very much in people’s suffering and experience but I do not believe it can be explained away as “mental illness”.

      Having said all that, if I do accept for a minute the idea of mental illness and look at the evidence that underpins the link between mental illness and genetics. The idea that bipolar disorder has a genetic cause and therefore runs in families is just a hypothesis. So this idea is just a theory. That is, it is something that some experts “believe” to be true but they do not know it to be true as the evidence underpinning this idea, proving this idea to be true, is not there.

      Read again the information that you have that states there is a genetic link to bipolar, you will find that the words they use in this information do not say we know for sure there is a link, they can only say they believe there to be a link, or that there is some evidence that suggests etc etc.

      I would be interested if you have any information that says there is no doubt that bipolar has a genetic link.

      There is more evidence underpinning the idea that stress, trauma and adversity suffered within families and even through generations of families are the cause of the “symptoms” (e.g. distress, mania etc) that we categorise as a bipolar disorder.

      I am really sorry that you are having trouble sleeping and I do hope that you find the answers and support that you need. I can only give you my truth on this subject, please come back to me if you want to ask more about my opinions on this or if I can link you to further information exploring these ideas.

      Thank you for reading and commenting on the blog.