Distinguishing mental illness in primary careBMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7247.1420 (Published 27 May 2000) Cite this as: BMJ 2000;320:1420
We need to separate proper syndromes from generalised distress
- Hugh Middleton, senior lecturer,
- Ian Shaw, deputy director
- Nottingham University Division of Psychiatry, Duncan Macmillan House, Nottingham NG3 6AA.
- Centre for Research in Medical Sociology and Health Policy, School of Sociology and Social Policy, University of Nottingham, Nottingham NG7 2RD
Two studies in the BMJ last year make challenging reading set alongside one another. Kessler et al reported that over half the patients attending general practice surgeries are depressed,1 and the Norwegian naturalistic treatment study of depression in general practice concluded that the best treatment for depression in primary care is a combination of antidepressant medication and counselling.2 Read uncritically, these findings imply that half of all general practice patients should be taking antidepressants and undergoing counselling. Clearly few people would agree with this, but the apparent folly does draw attention to a gap in our understanding of mental ill health in primary care.3
Uncertainties about the best way to provide for such patients, and indeed questions about the propriety of doing so at all within the NHS, have a long history. These uncertainties largely revolve around differences between medical and sociological approaches to psychological distress. The medical approach argues that such distress reflects an underlying illness which merits treatment. The sociological perspective argues that it is the consequence of a failure to respond adaptively to social challenge. The former focuses …