Views & Reviews From the Frontline

The psychiatric oligarchs who medicalise normality

BMJ 2012; 344 doi: (Published 02 May 2012) Cite this as: BMJ 2012;344:e3135
  1. Des Spence, general practitioner, Glasgow
  1. destwo{at}

Mental health should be a priority for all societies and its stigma always challenged. However, the US Centers for Disease Control and Prevention (CDC) reports that a staggering 25% of people in the United States have a “mental illness.”1 This is so large a figure that there can be only one conclusion: psychiatry is medicalising normality. The definition of a “mental illness” is one of opinion. These opinions are drawn from a small group of psychiatric oligarchs who author the Diagnostic and Statistical Manual of Mental Disorders (DSM). Their opinions are polluted, however: 75% of the authors of the new, fifth edition of the DSM report conflicts of interest.2

The DSM mental health model is a reductionist biological one: behaviours are explained away as “chemical imbalance” and of course open to drug treatment. Thus, tens of millions of normal but inattentive, disruptive, unruly, moody, or shy children are labelled for life as mentally ill. Boys are disproportionately coerced into chemical control. Figures from North Carolina show that 15.6% of children are labelled as having attention-deficit/hyperactivity disorder.3 In New Jersey one in 30 boys is considered to have autistic spectrum disorder,4 and bipolar illness in children rose 40-fold in a decade in the US.5 Such numbers are hailed as “better” diagnosis, not the obvious calamity of overdiagnosis and childhoods lost. How will these labels affect future employment, relationships, and esteem?

So, will the DSM-5 seek to reverse overdiagnosis? No. New proposals will see bereavement reclassified as clinical “depression” should it last a mere two weeks.6 The definition of ADHD is being loosened further and will consume ever more.7 A new condition, “disruptive mood dysregulation disorder,” is defined.8 Three “temper outbursts” a week and being negative, “irritable, and angry” are enough for children to be labelled forever. In adults the new “attenuated psychosis syndrome”9 attempts to label people at high risk of developing psychosis, this despite recent research indicating that only 8% of those at high risk develop a psychotic illness.10 These changes defy common sense and will serve only to undermine psychiatry’s professional standing. It is yet more industrial mass production psychiatry to serve the drug industry, for which mental ill health is the profit nirvana of lifelong multiple medications.

To be critical of psychiatry is often conflated with dismissing suffering. It is not. Psychiatrists have a duty to the sick but also to the well, and we are in a mental health disaster zone. DSM-5 (and psychiatry) is riddled with conflicts of interest; its definitions are soft, non-specific, and seem counterintuitive. I know that many psychiatrists believe this too, so it is time to take a stand against the mayhem of modern psychiatry.


Cite this as: BMJ 2012;344:e3135



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