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Number 9: Winter 2013

Cracked: Why Psychiatry is Doing More Harm Than Good By James Davies

Alan Pope

Davies’ approach to his investigation combines classic research strategies of mega-analysis with those of the investigative journalist.  The journalistic aspect is very enlightening because he was able to interview leading figures in the psychiatric world in the USA and in Britain. I suspect his academic credentials got him access to figures like Robert Spitzer, the father of DSM-III and the man who really put it on the map.  It may also account for why Davies’ interviewees were so candid with him.

What Davies discovers is a cozy cabal of project groups that come up with new disorders and then decide what symptoms constitute them.  Spitzer in his interview is completely open about this and acknowledges there was nothing scientific about it.  It would be easy to dismiss this as a problem for the USA as in Britain we use the ICD (International Statistical Classification of Diseases and Related Health Problems).  Or do we? NICE (National Institute for Clinical Excellence) prefers the DSM for its evidence base for treatments and IAPT (Improving Access to Psychological Therapies) even more so.  There is an irony here as both IAPT and NICE, with their emphasis on ‘evidence based treatments’, favour CBT as their treatment of choice. However, CBT being diagnostic and symptom based cannot operate without the DSM diagnoses, which Davies illustrates has little or no scientific evidence to support it.

Of course, Davies is not the first to raise these concerns but they are more widespread than I had realised.  A recent exchange with a retired GP confirmed this. She asked me what I was doing now that I had retired from the NHS. I told her that I had been doing some writing around the DSM-V and without pausing for breath she retorted, “Fiction!”  However, she retired early from the NHS and before its almost pathological obsession with monitoring and data collection.  Perhaps current GPs would be less sceptical. Davies is not claiming original research apart from the interviews which flesh out already published material. However, the interviews give an immediacy that research often does not convey. Bringing the evidence together in one book, perhaps for the first time, makes for a powerful challenge to the psychiatric orthodoxy.

In the latter half of the book, Davies moves on to examine the pharmaceutical industry and its claims for effectively being able to treat common mental health problems. It is very easy to take a stand against antidepressants on a philosophical basis and I’m sure that Davies would do this too but what he presents cogently is the woeful lack of evidence of their efficacy. However, he doesn’t stop there: he goes on to show research that challenges some received notions about brain chemistry that have entered into not only the public domain but the public psyche too.