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Mental illness: the claim that abuse is behind psychosis is irresponsible Mental illness: the claim that abuse is behind psychosis is irresponsible
(4 months later)
In more than 30 years of clinical practice, mostly in general practice, I have encountered much mental illness and experienced it in family members also. To polarise the debate between organic psychiatry looking for elusive biomarkers and promoting drug-based treatments versus Oliver James's assertion that "abuse is the major cause of psychosis" is unhelpful ("Medicine's big new battleground: does mental illness really exist?", News).In more than 30 years of clinical practice, mostly in general practice, I have encountered much mental illness and experienced it in family members also. To polarise the debate between organic psychiatry looking for elusive biomarkers and promoting drug-based treatments versus Oliver James's assertion that "abuse is the major cause of psychosis" is unhelpful ("Medicine's big new battleground: does mental illness really exist?", News).
Primary-care physicians, who see and treat the vast majority of mental illness in the UK, are trained to see presentations of illness in biological, psychological and social terms. All are relevant. To classify abnormal behaviours as distinctly separable "disorders" or "diagnoses", as the Diagnostic and Statistical Manual seems to be trying to do, is as unhelpful as, say, classifying diabetes as an eating disorder.Primary-care physicians, who see and treat the vast majority of mental illness in the UK, are trained to see presentations of illness in biological, psychological and social terms. All are relevant. To classify abnormal behaviours as distinctly separable "disorders" or "diagnoses", as the Diagnostic and Statistical Manual seems to be trying to do, is as unhelpful as, say, classifying diabetes as an eating disorder.
In The Spirit Level: Why More Equal Societies Almost Always Do Better, Wilkinson and Pickett demonstrate quite clearly that health and social problems, particularly the prevalence of mental illness and drug and alcohol use, are highest in those countries with the greatest income inequality. The UK rates very badly in this respect. This realisation, and action to tackle it, is the "paradigm shift" that is needed, not a sterile debate about nomenclature.In The Spirit Level: Why More Equal Societies Almost Always Do Better, Wilkinson and Pickett demonstrate quite clearly that health and social problems, particularly the prevalence of mental illness and drug and alcohol use, are highest in those countries with the greatest income inequality. The UK rates very badly in this respect. This realisation, and action to tackle it, is the "paradigm shift" that is needed, not a sterile debate about nomenclature.
Dr Ed Morris Dr Ed Morris
WitneyWitney
Oliver James claims that "it is becoming apparent that abuse is the major cause of psychoses". Unless accompanied by strong evidence, that statement is highly irresponsible, given that it points suspicion at the families of people suffering from an often devastating disorder. Such families, often already mistakenly burdened with shame, do not need yet another witch hunt. There is some evidence that rates of exposure to abuse are elevated in people who develop some forms of psychosis, but that is far from evidence that abuse is "the major cause".Oliver James claims that "it is becoming apparent that abuse is the major cause of psychoses". Unless accompanied by strong evidence, that statement is highly irresponsible, given that it points suspicion at the families of people suffering from an often devastating disorder. Such families, often already mistakenly burdened with shame, do not need yet another witch hunt. There is some evidence that rates of exposure to abuse are elevated in people who develop some forms of psychosis, but that is far from evidence that abuse is "the major cause".
Although he is unknown in the scientific community as a researcher into the origins of psychosis, James must know very well that correlation does not equal causation and that the sort of study he mentions cannot make it "apparent" that abuse makes any causal contribution. That he then attributes a causal link between abuse and psychosis to an unspecified and, as far as I know, non-existent mechanism he calls our "electro-chemical thermostats" does not change that.Although he is unknown in the scientific community as a researcher into the origins of psychosis, James must know very well that correlation does not equal causation and that the sort of study he mentions cannot make it "apparent" that abuse makes any causal contribution. That he then attributes a causal link between abuse and psychosis to an unspecified and, as far as I know, non-existent mechanism he calls our "electro-chemical thermostats" does not change that.
Michael O'DonovanMichael O'Donovan
Professor of psychiatric genetics/honorary consultant psychiatristProfessor of psychiatric genetics/honorary consultant psychiatrist
Cardiff UniversityCardiff University
The argument about whether mental illness exists or is a construct of the psychiatric profession is a retrograde step. It is not helpful to the thousands of people who contact Sane and who struggle with mental ill-health, or to those who are responsible for their care. Nor does it advance research into understanding underlying causes.The argument about whether mental illness exists or is a construct of the psychiatric profession is a retrograde step. It is not helpful to the thousands of people who contact Sane and who struggle with mental ill-health, or to those who are responsible for their care. Nor does it advance research into understanding underlying causes.
We do not ask similar questions about the existence of cancer, heart disease or diabetes. There, the focus is on the search for more effective treatments and cures.We do not ask similar questions about the existence of cancer, heart disease or diabetes. There, the focus is on the search for more effective treatments and cures.
Marjorie WallaceMarjorie Wallace
Chief executive, SaneChief executive, Sane
London E1London E1
No one has identified the real villains of the piece. In the US, the insurance giants rule the mental health world and it is they that require a diagnostic map to enable them to determine who gets treated for what, by whom and for how long. The clinician assesses the client and informs the insurer, which pays him/her, including a DSM diagnosis. The insurer then ticks boxes and replies something like "six sessions of cognitive-behavioural therapy". I found that approach appalling.No one has identified the real villains of the piece. In the US, the insurance giants rule the mental health world and it is they that require a diagnostic map to enable them to determine who gets treated for what, by whom and for how long. The clinician assesses the client and informs the insurer, which pays him/her, including a DSM diagnosis. The insurer then ticks boxes and replies something like "six sessions of cognitive-behavioural therapy". I found that approach appalling.
In this country, psychiatrists leading large multidisciplinary teams make these decisions and are hardly likely to relinquish the power and enormous salaries they enjoy should any model other than the medical be used. I find that approach pretty dreadful too.In this country, psychiatrists leading large multidisciplinary teams make these decisions and are hardly likely to relinquish the power and enormous salaries they enjoy should any model other than the medical be used. I find that approach pretty dreadful too.
Dr Mary Wrightson Dr Mary Wrightson
OundleOundle
NorthamptonshireNorthamptonshire
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