Personality disorders are arbitrary medicalisation of human variation

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.

Strategy does not seem to be based on systematic evidence

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” …