Ny bok: A straight talking guide to psychiatric diagnosis

‘A straight talking guide to psychiatric diagnosis’
Lucy Johnstone PCCS Books 2014 

Do you still need your psychiatric diagnosis? The answer for practical purposes is probably ‘Yes.’ In the current system, diagnosis is essential for accessing services and benefits and for covering your treatment costs. But do you need to believe in your diagnosis? Do you have to accept this particular attempt to explain your difficulties, and to take it on as part of your identity by becoming one of the ‘mentally ill’? In the words of the blurb for my book, one of the excellent ‘Straight-talking introductionto….’ series:

A revolution is underway in mental health. If the authors of the diagnostic manuals are admitting that psychiatric diagnoses are not supported by evidence, then no one should be forced to accept them. If many mental health workers are openly questioning diagnosis and saying we need a different and better system, then service users and carers should be allowed to do so too. This book is about choice. It is about giving people the information to make up their own minds, and exploring alternatives for those who wish to do so.

As far as I am aware, this is the first book to provide a concise, accessible and inexpensive summary for service users, carers and others which:

• Summarises the complex debates for and against psychiatric diagnosis
• Looks at the impact of psychiatric diagnosis at every level from the individual upwards
• Outlines the alternatives to diagnosis, which in essence come down to various versions of finding your own story
• Supplies a lists of reading, resources and organisations which can help you to think about alternatives for yourself if you decide to do so.

I believe that service users have the right to make up their own minds about how they wish to describe their difficulties – but in order to do this, they need to know about the evidence for this way of thinking, the strengths and limitations, and the alternatives. Some will decide that diagnosis is what makes most sense to them. Many or most will need to hang onto these terms in order to access services and perhaps avoid unhelpful conflict with mental health professionals. However, I do not believe it is professionally, scientifically or ethically justifiable to present psychiatric diagnosis to service users and carers as an undisputed fact or truth. The Chair of DSM IV has described the manual as ‘deeply flawed and scientifically unsound’ and the Chair of DSM 5 has admitted there are no biomarkers to validate the categories; the former NIMH (the National Institute for Mental Health in the USA) director has described DSM as ‘totally wrong, an absolute scientific nightmare’ while the current one confirms that its categories ‘lack validity’; and NIMH has embarked on a massive project to re-write the diagnostic manuals from scratch. We should no longer conceal these vital debates from service users and carry on as before.

It is time for people to be offered an informed choice about whether to accept, or at least whether to believe, a psychiatric diagnosis with all its subsequent consequences, both positive and negative. I hope this book will be a contribution to that process.

Lucy Johnstone

@ClinpsychLucy on Twitter

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New book: A prescription for psychiatry

Thank you for the opportunity to bring my new book to your readers.

The idea that our more distressing emotions can best be understood as symptoms of physical illnesses is pervasive and seductive. But in my view it is also a myth, and a harmful one. In ‘A Prescription for Psychiatry’ I explain how our present approach to helping vulnerable people in acute emotional distress is severely hampered by old-fashioned, inhumane and fundamentally unscientific ideas about the nature and origins of mental health problems and argue that we need wholesale and radical change, not only in how we understand mental health problems, but also in how we design and commission mental health services.

I argue that we should turn from the diagnosis of illness and the pursuit of aetiology and instead identify and understand the causal mechanisms of operationally defined psychological phenomena. Our health services should sharply reduce our reliance on medication to address emotional distress. We should not look to medication to ‘cure’ or even ‘manage’ non-existent underlying ‘illnesses’. We must offer services that help people to help themselves and each other rather than disempowering them: services that facilitate personal ‘agency’ in psychological jargon. That means involving a wide range of community workers and psychologists in multidisciplinary teams, and promoting psychosocial rather than medical solutions. Where individual therapy is needed, effective, formulation-based (and therefore individually tailored) psychological therapies should be available to all. When people are in acute crisis, residential care may be needed, but this should not be seen as a medical issue. Since a ‘disease model’ is inappropriate, it is also inappropriate to care for people in hospital wards; a different model of care is needed.

Adopting this approach would result in a fundamental shift from a medical to a psychosocial focus.  It would see a move from hospital to residential social care and a substantial reduction in the prescription of medication. And because experiences of neglect, rejection and abuse are hugely important in the genesis of many problems, we need to redouble our efforts to address the underlying issues of abuse, discrimination and social inequity. This is an unequivocal call for a revolution in the way we conceptualise mental health and in how we provide services for people in distress. But I believe it’s a revolution that’s already underway.

‘A Prescription for Psychiatry: Why We Need a Whole New Approach to Mental Health and Wellbeing’ by Peter Kinderman (ISBN: 9781137408709) is published by Palgrave Macmillan.

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About me: I am professor of Clinical Psychology and Head of the Institute of Psychology, Health and Society at the University of Liverpool in the UK. In addition to this book, I have recently launched a free, online, open-access course exploring our understanding of mental health and well-being.

Follow me on Twitter as @peterkinderman

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New Book: Madness Contested: Power and Practice

Thank you for the opportunity to join the blog and to give an outline of the recent book Madness Contested. My belief is that we need to radically rethink how we make sense of people who experience extreme emotional states, are distressed, and have beliefs, or act in ways that other people find hard to understand. Despite sustained criticisms from academia, survivor groups and practitioners, the biogenetic model of madness prevails, shaping our very notions of what madness is, who the mad are and how to respond. This narrow view, at the heart of the psychiatric system, is misinformed, misleading and fraught with tensions between the provision of care and the function of social control. I believe we can, and should, evolve and develop more creative and humane ways to provide support to people in need.

Madness Contested questions how we currently make sense of and respond to madness, and explores alternative and creative ways to understand and support people. It brings together nurses, survivors, psychiatrists, psychologists, practitioners, and service users who discuss and explore these areas. The first section analyses and questions the multiple functions, processes, forms of power and interest at play in maintaining dominant theories and practices. The second section explores alternative conceptualisations of madness, placing emphasis on practice that incorporates openness, modesty and a desire for equality. The book is available from http://  PCCS Books  and Amazon.

If you would like to discuss these issues further, I am on Twitter @Steven_Coles_ or I can be e-mailed on madness.contested@gmail.com or through this blog.

Warm wishes

Steven Coles

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