Tuesday 4 June 2013


Prof David Kupfer, Pittsburgh University

Really interesting discussion this morning between Radio 4's John Humphrys and Professor David Kupfer, the author of DSM5 - the "psychiatrists' bible" here (2hrs 36mins in). The prof was defending DSM5 from the widespread criticism that it invites psychiatry to interfere with normal feelings and behaviour like grief, sadness and childhood naughtiness.

He half convinces me that you can't blame his book if it's misused by practitioners but the fact remains that this text can be used to dress up normal conditions with fancy diagnoses.

And it is not just a matter of interfering with normal conditions - it's also about lazily over-simplifying real conditions.

Many people have quite severe symptoms of mental illness for which there is no easy diagnosis, still less a meaningful label. In these cases it is necessary for clinicians to take time to analyse the set of symptoms and carefully explain them back to the patient and work through options to treat them whether with psychological or medical treatments or life changes which can alleviate the problems. This takes time.

An alternative approach is to get rid of the patient quickly by deploying a simplistic and vaguely scientific-sounding diagnosis like "Generalised Anxiety Disorder" and giving them a prescription for "happy pills".

If you are told by a doctor that you have G.A.D. how sure can you be that he/she doesn't really mean "I don't know what is wrong with you and I haven't time to find out. In fact I have a private consultation in two minutes time where I will get £300 for ten minutes work so that an overworked high flier can blag some Ritalin in order to shut their boisterous toddler up (diagnosis "Conduct Disorder"). Here are some pills and now please get out of my office"?