Monday 13 February 2012


Take a look at this important story about the American Psychiatric Association's new edition of their "bible" called the Diagnostic and Statistical Manual of Mental Disorders (the next edition of which is usually referred to as the sinister-sounding "DSM-5"). What's that got to do with us, you may ask, and the answer is quite a lot because it is used in the UK and in all parts of the world as the main reference point for diagnosis of mental illness.

But it has a much more significant influence beyond defining terms. Specifically it defines what is a mental disorder and therefore what areas psychiatrists - and in effect all mental health services - can meddle in.

Hafal's good friend Professor Nick Craddock, from Cardiff University, who is one of the world’s leading experts on bipolar disorder, said DSM-5 will include more categories, which will mean more aspects of human behaviours and emotions are classified as problematic. He said this was tantamount to "medicalising normal human behaviours".

"At the moment, if someone has an episode of severe low mood, if it has certain symptoms and severity it would meet the accepted diagnostic criteria for depression. If it follows a bereavement, that would be an exclusion for depression because we would regard it as normal that someone would feel low. But in DSM-5, they are planning to remove that exclusion and it would mean someone having what most people would regard as a normal reaction would then attract the label of having a depressive illness. It seems to be an unhelpful direction of travel."

And Richard Bentall, chair of clinical psychology at the University of Bangor, said: "Like earlier editions, this version of the manual is not based on coherent research into the causes or nature of mental illness.

"It seems likely that the main beneficiaries will be mental health practitioners seeking to justify expanding practices, and pharmaceutical companies looking for new markets for their products."

But it isn't just about medicine: it's about the whole question of what is the business of mental health services. There is a considerable similarity between the American Psychiatric Association's point of view and that of those involved in mental health services who believe that they have something useful to say about how the public should lead their lives and pursue their happiness and fulfilment.

In fact those of us who provide mental health services have only a very little to offer to the public, mainly focused on helping people to recognise symptoms in themselves and others and to respond intelligently and without prejudice to these. The last thing we should seek to do is to start applying mental health terminology and treatment (however modern or progressive), let alone medicine, to matters such as uncomplicated bereavement.

The most pernicious aspect of spreading mental health services' ideas around is the disempowering nature of the language used. Where once people said they were unhappy or sad if they experienced tough times today many say they are depressed; where once people said they were anxious or worried about real problems ahead of them many now say they are stressed.

Of course some people do have difficulty with depression and stress but we should not encourage people to reach straight for such words without first using the ordinary language of unhappiness or anxiety which invites them to look for the reasons why they are sad or anxious and to look for practical solutions which may best be found not with a doctor or therapist but with the CAB, family, or friends.

The latest manifestation of this unhealthy recourse to the language of mental health services is people without any diagnosis of illness describing themselves as "a bit bipolar". Now they may have a real problem to deal with but they are unlikely to make progress in resolving it if they use that sort of language.