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Name and shame

MagazineAugust 2005 (Vol. 16 Issue 5)Name and shame

In a list of the most shameful aspects of modern medicine, psychiatry must come at the top of the heap

In a list of the most shameful aspects of modern medicine, psychiatry must come at the top of the heap. This is the discipline that has given us - in the name of 'first-do-no-harm' hippocratic medicine - electric shock treatment, the lobotomy, forced incarceration, prescription-drug addiction in many guises, false-memory syndrome, the drugging of healthy children and the suppression of spirited women. Just think of T.S. Eliot's first wife, who spent her life in a mental institution when her only problem, it eventually turned out, was a severe case of premenstrual tension.

This, above any other branch of medicine, is the sector that has given us the label.

Given that their sphere of influence is a slippery one like the mind, which doesn't lend itself to hard-and-fast biological examination like a mole, an ear or even an internal organ like the liver, psychiatrists have had to improvise when attempting to determine why someone is staring blankly into space, throwing a toaster out the window or even refusing to sit still in class. To fit all these strange anomalous behaviours into tidy little categories, psychiatrists have had to create tidy little labels.

Doing so is a rather informal exercise. Periodically, the great and good among the American psychiatric community assemble and systematically (often by a show of hands) include new syndromes, constructed and labelled entirely from behavioural symptoms, to the psychiatric bible - the Diagnostic and Statistical Manual of Mental Disorders II.

Created as it is by opinion, this fatuous and largely arbitrary 'manual' casts a wider and wider net over what exactly constitutes mental disorder or insanity, redefining any particular workaday glitch that doesn't fit the doctor's view of 'normal' as a mental disorder.

A scan through the DSM is instructive. With a straight face, it regards as mental illness such conditions as 'caffeine intoxication' (telling symptoms are restlessness and nervousness). Also worthy of "clinical attention" are 'malingering' (acting ill to get out of military service or criminal prosecution) and non-compliance with psychiatric treatment.

Nowhere are the labels more potentially destructive than when used on children. As our special report shows, ADHD is now so elastic that it embraces any child who is bored at school. Even worse, babies and children are now included in the expanding definition of 'bipolar disorder'.

The heart of the problem is the notion of mental illness as a sick brain only treatable by drugs when, in truth, there is not only no diagnostic evidence of such imbalance, but no criteria on which to base an appropriate 'balance'. No blood tests, screening tests, X-rays or biological tests of any variety can verify a psychiatrist's label.

In 2003, the then newly created New Freedom Commission on Mental Health in America reported back to Congress that the best way to improve mental health in the US was to institute a universal mental-health screening programme, including universal screening of all high-school students.

Despite the public outcry caused by this recommendation, it has now been enacted into law. In response, some states have adopted Columbia University's 'TeenScreen' programme. This questionnaire, handed out to teenagers, asks such innocent sounding questions as: 'Has there been a time when nothing was fun for you and you just weren't interested in anything?' Enough ticks on this questionnaire will result in a second one, which screens the child for 18 possible psychiatric illnesses. Outrageously, the TeenScreen programme enlists the participation of students by offering coupons for free movies or pizzas, or school credit.

Small wonder that psychiatric prescriptions among children have increased by 500 per cent in the US. And, as with all things American, Britain is rushing to stay shoulder to shoulder.

Lynne McTaggart


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