A review of Lucy Johnstone's book 'A Straight Talking Introduction to Psychiatric Diagnosis'
I have a diagnosis of schizophrenia, which I have long since rejected because it did not reflect the reality of my life - it made no sense to continue to believe in it. However, I am still affected by that label. I have always held the medical profession in high regard, to the point where I believed for years that psychiatrists knew something about me that I did not, that I was fundamentally flawed, and now it is hard to reverse that thinking.
I have taken renewed courage though, since reading this book, written by a mental health professional who tells me and others like me that accepting psychiatric diagnosis should be a choice. A Straight Talking Introduction to Psychiatric Diagnosis is a short, concise work which combines scholarship with humanity and compassion. It provides a unique resource for those of us who have been harmed by the workings of psychiatry and want to prevent future harm to others. The author, a consultant clinical psychologist, acknowledges the fact that, 'Mental distress is very real' but, as she says
Psychiatric diagnosis is not a valid or evidence-based way of understanding the difficulties and distress that people experience
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Challenging the veracity of psychiatric diagnosis might sound shocking, but Johnstone makes her argument in a clear and balanced manner. Psychiatrists, as she points out, would have us believe that their pronouncements are based on firm science, but this is never the case, because there are no medical tests to ascertain the existence or absence of any sort of 'mental illness'. Rather, diagnosis is made by observation of symptoms alone - often without even listening to the story of the patient; without even asking what has happened to bring him or her to the point of emotional collapse. And, as Johnstone states,
Not all human suffering is best understood as a disease process
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The author continues,
We need to acknowledge people's suffering and lack of control in many areas of their lives, while at the same time building on their strengths so that they can, with the right support, move towards recovery
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In order to understand the importance of the debate about the validity of psychiatric diagnoses, it is necessary to comprehend the scale of the damage such labels can do to the individual. As the mental health system stands, such diagnoses are often required in order to access services and benefits - I certainly used mine for such purposes for a number of years. However, what seems compassionate at the outset becomes a trap. The lifelong stigma of a diagnosis of schizophrenia, for example, is a terrible thing to inflict on a person. Less severe diagnoses can be equally harmful.
It is vital to understand that psychiatric labels do not help psychiatrists to decide the appropriate treatment for patients in the same way that medical diagnoses help doctors to do. Psychiatric medications are not tailored to individual conditions and even psychiatrists do not claim that these drugs cure the 'diseases' they are intended to treat, they only mask the symptoms. As Johnstone points out,
There are many powerful vested interests in preserving the diagnostic system, not least the pharmaceutical companies whose influence is felt in every area of mental health work
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The author does not simply criticise the current status quo, she suggests alternatives. She writes about the use of psychological formulations, which are made in a collaborative manner with the patient, addressing the question of 'What happened to you?' rather than the more judgemental 'What is wrong with you?' She suggests next steps for service users who want to explore alternatives to diagnosis, providing guidance for those who wish to write their recovery story and play a part in their own healing.
In my case, Johnstone's book preaches to the converted but it has the potential to make a difference to the lives of many people. It deserves a wide audience and I sincerely hope that it will gain one.