Distinguishing mental illness in primary care

doi:10.1136/bmj.321.7273.1412

BMJ 2000;321:1412 ( 2 December )

Letters

Distinguishing mental illness in primary care

Mental illness or mental distress?

Nature of psychological illness in primary care needs to be defined

Psychiatric classification is not a problem

Definitions are not facts

Authors' reply

Mental illness or mental distress?

The first 150 words of the full text of this article appear below.

EDITOR $---$ In their editorial Middleton and Shaw set up a false dichotomy between mental illness, which in primary care shouldbe treated with drugs and psychological therapy, and generaliseddistress, which needs to be treated with empathy, social support,and understanding.¹ Only generalised distress, they assert,represents a failure to respond adaptively to social challenge.If only it were thatsimple.

The 1995 survey of the Office of Population Censuses and Surveys and numerous surveys in primary care have used the generalhealth questionnaire and the clinical interview schedule to detectmental disorders as they are defined by both the InternationalClassification of Disease and the Diagnostic and Statistical Manualof the American Psychiatric Association. ² ³ But all suchpatients require empathy, support, and understanding, and mostcommon mental disorders are at least in part reactive to socialcircumstances. The doctor must first detect that the patient isemotionally distressed and . . . [Full text of this article]

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