Intended for healthcare professionals

Rapid response to:

Feature Medicalisation

A new deal on disease definition

BMJ 2011; 342 doi: (Published 03 May 2011) Cite this as: BMJ 2011;342:d2548

Rapid Response:

Disease Definition or Dis-ease Discrimination?

Moynihan (1) is right in that the issue of over-diagnosis is
important. In psychiatry the line between variants of 'normal' and
deviancy is oft debated. The political consequences of this division has
been seen in history, and continues through to the present in debates on
substance use, emotional regulation, and attention. However we must not
confuse a moral rectitude over mental weakness with certainty of the
absence of evidence.

It is unfortunate that the issues cover places an illness with such
devastating consequences as Bipolar disorder in the same light as female
sexual dysfunction. The former costs the NHS ?199 million a year, or to
put a human face on it, led to frequent incarceration of Spike Milligan in
a secure hospital.

The search for pathology or aetiology may be imperfect but do not let
stigma against mental illness obscure the need to better understand, or
impede the search for better treatment.

(1) BMJ 2011; 342:d2548

Competing interests: No competing interests

19 May 2011
M E Jan Wise
Consultant Pychiatrist
CNWL NHS Foundation Trust