Medical Notes: Not clinical wisdom but simple prejudice

IT MIGHT be that, six months after the death of someone close to you, you talk to your GP about the way you feel lost and sad, and find it hard to eat or sleep properly: or it might be that you feel you ought to be more assertive in your work and personal relationships, and you arrange to see a therapist privately with your health insurance covering the fee: or it might be that, in making a claim for you for damages following an accident, your solicitor wants to include something to cover psychological distress and sends you to a psychiatrist for a report.

These are ordinary, though distressing, experiences, yet, in the process of dealing with them, you have acquired a psychiatric diagnosis which satisfies the needs of GP records (Major Depressive Disorder, Single Episode), health insurance payments (Dependent Personality Disorder) and the courts (Post-traumatic Stress Disorder). These diagnoses come from the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and label you in a way which is inappropriate and which could have a deleterious effect on your career, but there is nothing you can do about it. DSM-IV is now a major tool in the way they look at us.

The profession of medicine has always been concerned with classifying diseases in the way that the natural sciences have classified plants and animals. Psychiatrists, whose profession is based on the assumption that there are mental illnesses analogous to physical illnesses, have sought to develop a similar classificatory system. The term "disorder" is better than the term "illness" because it allows the inclusion of every form of human distress. When we are distressed we are not very orderly.

No physical basis has been found for any psychiatric disorder. The "chemical imbalance of the brain" is a fictitious explanation of the cause of depression. Too little is known about the normal functioning of the brain for a worthwhile hypothesis about an abnormal state which invariably precedes depression to be made, much less proved. Genes, so geneticists constantly point out, cannot account for complex behaviour.

DSM-IV does not define "disorder" but lists the kinds of disorder. All human life - including yours - is there. Disorders are what psychiatrists deem them to be. Psychiatry is big business, and it is inextricably linked to an even bigger business, the pharmaceutical industry. It is in the interest of those who profit from these businesses that there be a burgeoning of disorders, so much so that Herb Kutchins and Stuart Kirk, American professors who have made a special study of the history and use of the DSM, entitled their latest book Making Us Crazy. As they record, to create a disorder all the committee of psychiatrists concerned with the DSM has to do is

pick a label, provide a general description based on clinical wisdom, develop a menu of diagnostic criteria, check the proposed criteria with advocates for the new category, decide how many must be met to use the diagnosis, counter opposition (if any), and presto - you have a new mental disorder.

For "clinical wisdom" read "prejudice", and then you can understand how the DSM, as Kutchins and Kirk record, makes it possible for victims to be blamed, ordinary behaviour turned into pathology, homosexuality changed from being a disorder to not being a disorder, the effects of trauma to be ignored and then turned into a pathology, modest, compliant women to be diagnosed as mentally ill for being what society expects them to be, aggressive, sexist men to be protected from the stigma of mental illness, difficult patients to be punished and racial prejudice to masquerade as science.

The makers of the DSM are not concerned with validity, that is, whether their system reflects anything real, but only with reliability, that is, agreement amongst psychiatrists. The DSM says nothing about the causes of human distress. This is not science, nor is it humane.

Dorothy Rowe is the author of the audiobook `Understanding Depression and Finding Freedom' (Thorsons, pounds 8.99)