Is Psychiatry or Psychology a Science? Letters

 Neurodivergence has become a bandwagon, so overladen as to devalue cruelly the plight of the much smaller numbers of adults and children whose sometimes grave mental difficulties struggle for definition amid the careless use of words and phrases such as autistic, clinically depressed, attention deficit hyperactivity disorder (ADHD) and bipolar. You now hear people talking about these things in pubs and coffee shops...

 

In its reach into our popular culture, "mental health" is an exploding branch of the discipline it believes itself to be  a part of: medical science... But is psychiatry ( the study of diagnosis and treatment) a science at all? Does psychology (the study of the mind and behaviour) deserve the name of science? These questions matter as government struggles for ways of pushing, pulling or nudging our fellow citizens back into work. More than nine million of us are now "economically inactive" - choosing not to work.

There are many good reasons why people may do so, but the fastest growing  group within this inactive cohort are those including mental health disorders in their claim for a personal independence payment (PIP: the substantially enhanced welfare benefit for people medically unfit for work). Such maladies having no visible symptoms are almost impossible to disprove.

Patients waiting to See the Doctor, with Figures Representing Their Fears
Rosemary Carson (b. 1962)
Photo Credit: Wellcome Collection [CC By]

As numbers of such people swell so does the number of therapists and counsellors who cater for them; so does the frequency with which journalists write about mental health issues, and so do the online sites for self-diagnosis in an ever-widening range of mental disorders. And so, naturally, do the calls for more government funding for mental health treatment within the NHS...

Can the success of treatments for physical ailments be measured? Yes. But where are the results for therapies in the field of mental health? ... In an attempt at scientific methodology, a study asked a number of therapists individually and separately to diagnose the same patient, without comparing notes. Their diagnoses differed widely...

There's nothing wrong in trying to be a science, trying to posit a theory of the mind ... But that is where we're at: in the very low foothills of anything approaching a scientific discipline. The mental health industry is cheating a gullible public, hungry for diagnosis, explanation and a set of named disorders, by pretending to a status it should not be claiming. And hard-squeezed NHS funding should follow results, not the 21st-century equivalent of witch doctors. Until we can measure, we should not believe.

(Matthew Parris, The Times, 2024)

In the first edition of Diagnostic and Statistical Manual of Mental Disorders (DSM) published in 1952 it listed and described 106 disorders including homosexuality. The latest edition lists more than 400. What are the factors contributing to this increase? Is one of them the power and influence of the pharmaceutical  industry? And what are the reasons for the increase in the numbers of people who are experiencing mental disorders?

Sir, Matthew Parris has noticed a real problem. There is a deeper problem in medicine in that modern medicine has thrown all its energy into providing panaceas to people. This works in reaction to the presence of an illness and its symptoms. The problem with this view is that it sees health as the outcome of medical treatment. Hence, you need to be treated to get better. And to get treatment you must have a symptom as an entry ticket.

In other words, the system draws people and symptoms into itself. There is no balancing view of how to live life positively, in a way that promotes personal, social and environmental flourishing, and in such a way that the illnesses and symptoms do not emerge in the first place. What is called health promotion is really fear-filled, irritable disease avoidance.

We are going round and round on a symptom- diagnosis- treatment loop that is gaining a momentum of its own, so Parris is right to question this process.

(Dr Peter Davies, GP, Halifax, W Yorks, The Times,2024)

Sir, Many of us who trained in the disciplines of psychiatry will agree with Matthew Parris that the "worried well", and those who support them by recently coined labelling and talking therapies, have distorted the priorities of the nation's health and social security budgets. Worse, all too many tragic events have shown that mental hospital and expert aftercare treatment resources for patients who are truly mentally ill, notably those who are chronically disabled by schizophrenia and manic disorders, are inadequate in quantity and quality.

One has every sympathy for people who are burdened by unhappiness, frustration, disappointment and personal distress, but their interests are not honestly served by reinforcing their belief that such emotional feelings are symptoms of mental ill health. Those who receive payment for counselling and advice have a duty to differentiate between their own and their clients' interests.

(Richard Lingham, Former member, Mental Health Review Tribunal; Truro, The Times, 2024)

Sir, Matthew Parris has hit the nail on the head with his condemnation of synthetic mental health diagnoses, but he underestimates their societal impact and costs. Few claims in the medico-legal industry are seemingly now complete without the obligatory statement of mental trauma for personal injury or clinical error, however minor and self-limiting the consequences of those events. The cost of processing these inflationary claims is borne by many others in the wider community, including the taxpayer through the NHS and the vehicle owner through inflated  motor insurance premiums.

(David Rew, Consultant general surgeon, Southampton Hospitals, The Times, 2024)

Sir, Professor Sir Simon Wessely highlights the need to differentiate between mental wellbeing and mental illness in public and political discourse.

Increased awareness about mental health has been important, but the group least represented in this effort has been those living with and recovering from severe, life-altering mental illness. It is vital that, alongside discussions about possible overdiagnosis of some conditions, we recognise the very real and disabling effect that mental illness can have.

(Charlotte Willer, Assington, Suffolk, The Times, 2024)

For further articles on this theme see: Too many pills published on July 23 2022 and Sadness or Depression, Resilience or Mental Illness published on April 20, 2021.