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."
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