I agree with Summerfield (1) that " ....the diagnosis of post-traumatic
stress disorder (PTSD) has become almost totemic." It is clear that as a
diagnostic category it attracts great pecunary interest from a variety of
quarters.
Pecunary interests have also attached themselves to mainstream psychiatry
in recent years. An interest that invests considerable research money in
the development and promotion of newer and better drugs for the treatment
of depression and psychosis. The result is a dominant biochemical model
that is intolerant of qualitative concerns.
Summerfield argues that PTSD is a construction of our time and that it
would not have existing in neolithic (or any other)times. He is right that
it would not have been called PTSD, but madness, badness, anxiety and
unhappiness are present and have been present in all societies and they
have been constructed and continue to be constructed in many different
ways. He is wrong to assume that psychiatrists have a monopoly on
diagnostic categories and that DSM 4 is immutable. His statement that "To
conflate normality and pathology devalues the currency of true illness,
promotes abnormal illness behaviour and incurs unnecessary public costs,"
is confused. Is he really in a position to decide? Is emotional pain, for
instance, not a "true illness"? And if so, how does he know? When is an
illness not an illness? When is an illness a disease?
The real issue with PTSD is that is inhabits the borderlands of mental ill
-health. Psychiatrists increasingly are distancing themselves from these
areas of practice. One suspects it is because they are uneasy in a climate
that promotes neurotransmitters at the expense of good old fashioned
caring. Unfortunately the available structures do not support the latter.
Luckily, as with everything else, primary care is ideally placed to deal
with these problems, but it is a scandal that community mental health
teams in many parts of the country will only accept a psychiatric
diagnosis if a patient is to gain access to the service.
Jim Hardy. General practitioner.
Bethnal green Health Centre, Florida Street, London E2 6LL.
Rapid Response:
Psychiatrists are also a construction
Editor,
I agree with Summerfield (1) that " ....the diagnosis of post-traumatic
stress disorder (PTSD) has become almost totemic." It is clear that as a
diagnostic category it attracts great pecunary interest from a variety of
quarters.
Pecunary interests have also attached themselves to mainstream psychiatry
in recent years. An interest that invests considerable research money in
the development and promotion of newer and better drugs for the treatment
of depression and psychosis. The result is a dominant biochemical model
that is intolerant of qualitative concerns.
Summerfield argues that PTSD is a construction of our time and that it
would not have existing in neolithic (or any other)times. He is right that
it would not have been called PTSD, but madness, badness, anxiety and
unhappiness are present and have been present in all societies and they
have been constructed and continue to be constructed in many different
ways. He is wrong to assume that psychiatrists have a monopoly on
diagnostic categories and that DSM 4 is immutable. His statement that "To
conflate normality and pathology devalues the currency of true illness,
promotes abnormal illness behaviour and incurs unnecessary public costs,"
is confused. Is he really in a position to decide? Is emotional pain, for
instance, not a "true illness"? And if so, how does he know? When is an
illness not an illness? When is an illness a disease?
The real issue with PTSD is that is inhabits the borderlands of mental ill
-health. Psychiatrists increasingly are distancing themselves from these
areas of practice. One suspects it is because they are uneasy in a climate
that promotes neurotransmitters at the expense of good old fashioned
caring. Unfortunately the available structures do not support the latter.
Luckily, as with everything else, primary care is ideally placed to deal
with these problems, but it is a scandal that community mental health
teams in many parts of the country will only accept a psychiatric
diagnosis if a patient is to gain access to the service.
Jim Hardy.
General practitioner.
Bethnal green Health Centre, Florida Street, London E2 6LL.
jameshardy@doctors.net.uk
Competing interests; none
Competing interests: No competing interests