Letters

Modernising mental health services

BMJ 1999; 318 doi: http://dx.doi.org/10.1136/bmj.318.7186.806a (Published 20 March 1999) Cite this as: BMJ 1999;318:806

Personality disorders are arbitrary medicalisation of human variation

  1. John Sharkey ([email protected]), Consultant psychiatrist.
  1. General Hospital, Jersey, Channel Islands JE2 3QS
  2. Berkshire Health Authority, Reading, Berkshire RG30 2BA
  3. University of Newcastle upon Tyne, Newcastle upon Tyne
  4. Chelsea and Westminster Hospital, London SW10 9NG
  5. Bradford Community Health Care, Bradford
  6. Institute of Psychiatry, London
  7. Belfast City Hospital, Belfast

    EDITOR—Over the past few months the issue of personality disorder has come up several times, most recently in Marshall's editorial on Modernising Mental Health Services.1 It seems that the reporting of the Michael Stone case fuelled the madness or badness argument to the point that the home secretary chose, in the usual populist rhetoric, “to take a pop” at psychiatrists.

    The difficulty with personality disorders is that, by their nature, they are an arbitrary and subjective medicalisation of human variation. It is hardly surprising that they are often not amenable to treatment. A supervising consultant psychiatrist once asked me to name any psychiatrist I knew who did not have a personality disorder. When I considered this poisoned chalice and declined to reply, he said a person without a personality disorder is a person without a personality.

    If personality disorder is sufficient legal grounds to detain someone, some questions need answering: when should he or she be released, and does the duration of detention fit the crimes committed or is it a value call for the psychiatrist? We find ourselves in difficult ideological times if society cannot cope with the less savoury aspects of human variation. The profession should be bigger than to fall for the myth, driven by tabloid headlines, of a safe society.

    References

    Strategy does not seem to be based on systematic evidence

    1. Paul Johnstone ([email protected]), Consultant in public health medicine.,
    2. Chrissy Allot, Librarian.
    1. General Hospital, Jersey, Channel Islands JE2 3QS
    2. Berkshire Health Authority, Reading, Berkshire RG30 2BA
    3. University of Newcastle upon Tyne, Newcastle upon Tyne
    4. Chelsea and Westminster Hospital, London SW10 9NG
    5. Bradford Community Health Care, Bradford
    6. Institute of Psychiatry, London
    7. Belfast City Hospital, Belfast

      EDITOR—We were surprised to see that the government's plans for modernising the NHS mental health services are not based on any of the findings from its own research and development programme.1 Although we appreciate that these are “emerging findings” …

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