Intended for healthcare professionals

Head To Head Maudsley Debate

Has psychiatric diagnosis labelled rather than enabled patients?

BMJ 2013; 347 doi: (Published 25 July 2013) Cite this as: BMJ 2013;347:f4312
  1. Felicity Callard, senior lecturer in social science for medical humanities1,
  2. Pat Bracken, clinical director2,
  3. Anthony S David, professor of cognitive neuropsychiatry3,
  4. Norman Sartorius, president 4
  1. 1Durham University, Durham, UK
  2. 2West Cork Mental Health Service, Bantry, Co Cork, Ireland
  3. 3 Institute of Psychiatry, King’s College London, UK
  4. 4Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
  1. Correspondence to: F Callard felicity.callard{at}, A S David anthony.david{at}

Felicity Callard and Pat Bracken argue that a psychiatric diagnosis can disempower people rather than help them, but Anthony David and Norman Sartorius think that the diagnostic framework ensures that resources are allocated appropriately

Yes—Felicity Callard and Pat Bracken

A Head to Head about diagnosis? Are we serious? It is hard to imagine cardiologists or endocrinologists debating whether medical diagnosis has enabled or labelled their patients. Is the fact that we are debating the benefits of diagnosis in 2013, shortly after the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), a sign of psychiatry’s infancy as a science? Are psychiatrists doomed to be regarded as poor doctors? We argue not. These debates might be a sign that psychiatry is really starting to grapple with the complexity of its role as a medical discipline. Indeed, we argue that psychiatry’s contributions to the enablement of patients lie—in both the past and the future— outside of the development and use of diagnostic classifications.

Enablement does not require diagnosis

To enable a person is to empower her, to support her in exerting her capacities. However, psychiatric diagnosis is not fundamental to the enablement of people with mental illness. As the title of Sayce’s From Psychiatric Patient to Citizen1 made clear, the route to empowerment lies through socially just welfare systems, appropriate forms of support for people with disabilities, and legal frameworks that protect people’s rights and combat discrimination.2

The rise of the service user movement, alongside peer support and voluntary sector initiatives, has been central.3 4 Although many psychiatrists have promoted or contributed to such developments, use of psychiatric diagnoses has too often contributed to maintaining people as “psychiatric patients.” In addition, within the mental health system, the interventions that have arguably empowered people the most, such as innovative community services, have not been …

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