What’s Mad?

In my thirty years of practising clinical psychology in psychiatric hospitals, abroad and at home, in communities and in private practice I have encountered many individuals who have found themselves entrapped in a psychiatric system that offers no hope but, nonetheless, exercises major legal and therapeutic control. There might be some justification for the latter control were it the case that psychiatry was strongly experimentally established and that clinical interventions made some difference to the lives of those who seek out psychiatric help. The reality is that the revolving door – in psychiatric hospitals or psychiatric wards in general hospitals or in clinics located in the community – continues to swing as much as ever. There is no intention here to be critical of psychiatrists – I have no doubt that most of them practice in good faith – but I do have serious issues with psychiatry itself.

Psychiatry establishes its credibility on three main assumptions:

  • that there are discrete psychiatric conditions, such as schizophrenia, bi-polar depression …..
  • that psychiatric disorders are genetic in origin
  • that psychiatric illness is a brain dysfunction or disease

When I worked in psychiatric hospitals it was disturbing to observe that psychiatrists rarely agreed with each other on a particular diagnosis! In a new book, Doctoring the Mind: Is Our Current Treatment of Madness Really Any Good?, that closely examines the evidence for psychiatry, the author Richard Bentall cites studies that demonstrate an alarming level of disagreement among psychiatrists in how they diagnose psychiatric disorders, despite employing what are supposed to be the most valid and reliable diagnostic systems available, most notably DSM III.

A further contradiction to the notion that there are discrete psychiatric conditions is that the symptoms of psychoses are to be commonly found in the general population! Yet another nail in the coffin of this fundamental issue is that many individuals presenting with symptoms meet the criterion for more than one psychiatric label! Taking all the evidence into consideration, psychiatric diagnoses, which determine the drugs prescribed, does not even remotely identify specific diseases.

Bentall also challenges the second fundamental underpinning psychiatry – that schizophrenia and bi-polar depression are primarily genetic in origin. He believes that there has been ‘markedly dishonest’ and often repeated ‘statistical tricks’ used to support the genetic hypothesis, but the reality is that the claims have been hugely inflated. However, Bentall says that when environmental factors are considered – which is rarely done in psychiatric diagnosis – there is considerable evidence that these factors are very strongly linked to particular symptoms of what have been called ‘mental disorders’ – for example, early childhood traumatic influences and sustained stress. Bentall argues that the circumstances leading to ‘psychiatric’ symptoms are complex and diverse and that it is naïve to imagine that there are genes for any particular set of psychiatric symptoms.

Psychiatry has long based its argument for its existence as a profession and as a reductionist understanding of human distress on the research that shows that there are anatomical differences in the brains of individuals suffering from mental disorders. However, these studies are contradicted by other findings that show that many factors can affect the shape of the human brain, not least disturbing life experiences. For instance, the brains of individuals who experienced sexual abuse in childhood, compared to the brains of other people, show structural change in much the same region of the brains as individuals labelled ‘psychiatric’. In a similar fashion, Bentall debunks the notion that it is neurochemical differences that account for mental disorders – these too can be traced to human distress. It is something I have asserted for many years – where’s the horse and where’s the cart?

Using very sophisticated research techniques, Richard Bentall effectively demolishes psychiatry as a profession. An important question is: will psychiatry now step down from its powerful legal and therapeutic position within mental health services and pass the baton to models of care that have a sound experimental basis? Furthermore, will other professions who are members of the multi-disciplinary teams led by Consultant Psychiatrists refuse to continue to support a profession that has no solid foundation? And what about the Department of Health – will it read the evidence that is there and introduce and support alternative models of care? And, finally, will the legal profession now challenge the legal power that has been vested in the psychiatric profession? The individuals in our society who are deeply distressed deserve effective therapeutic responses that have been tried and tested. Psychiatry has been tried and tested for over two hundred years and research often has shown that it has not measured up to these tests – it is time for an honest withdrawal. An important question that we are left with: is there an alternative to orthodox psychiatry? I will address this issue next week.

Dr. Tony Humphreys practices as a clinical psychologist and is author of several books on practical psychology including The Power of ‘Negative’ Thinking.