Why is mental illness so controversial? Part 1 – Recent examples

Media coverage of medicine is usually positive, often about advances in understanding or therapeutic breakthroughs. In contrast, psychiatry reportage tends to be negative. Some of this can be attributed to the stigmatisation of people with mental illness, but much of the criticism is aimed at psychiatrists and indeed the whole field of psychiatry. Most of this seems to centre around two core issues: whether diagnostic categories have value and whether treatments work.

In 2014, for example, the Schizophrenia group of the Psychiatric Genetics Consortium published a landmark report in Nature, the worlds’ leading scientific journal, that they had found 108 genetic regions which were associated with schizophrenia by the typical standards of gene-finding studies. This makes schizophrenia arguably the most successful such topic in the whole of genetics. In any other branch of medicine this would be seen as the major breakthrough it is, and it did get favourable press coverage, but the on-line comments soon degenerated into accusations from some that the researchers were Nazi’s.[1]

Almost exactly a year ago the British Psychological Society released a report on psychosis and schizophrenia which is itself balanced and even-handed. It stated for example that some people with psychosis thought a diagnosis had helped and others didn’t, and that some found antipsychotic drugs helpful and others didn’t.[2] Yet, when discussing the report, various commentators used it as a vehicle to criticise the whole firmament of psychiatry, with various diagnosis and treatment bashing statements.[3]

If diagnosis is controversial, treatment and in particular whether it should be by drugs or psycho-therapy is downright contentious. Last summer, a paper published in the Lancet showed that some patients with schizophrenia who were not taking antipsychotic medication improved with Cognitive Behavioural Therapy. This prompted headlines such as ‘time to flush the meds?’,[4] even though the article itself was careful to say that ‘the findings should not be interpreted to mean that all patients suffering from schizophrenia can or should go off their meds’. Initial coverage on BBC News on-line that ‘talking therapies as effective as medication’ was quickly reduced in impact to ‘talking therapies moderately effective’.[5] These are probably examples of sub-editors devising catchy headlines to attract reader attention. But, of course, they fan the flames of controversy.

But by far the worst deliberately provocative statements in the past year have come from Dr Peter Gotzsche, an academic general practitioner. In a letter in the BMJ, he wrote: ‘Psychiatric drugs kill more than half a million people every year in the Western world, and if we used only 2% of the drugs that we currently use, we would have healthier and longer lived populations and would spare tens of millions of people from becoming mentally crippled’. [6] These statements were referenced to a 2015 book which is not yet widely available and it is difficult to guess how such gross distortions of the evidence-base can be justified. Whilst antipsychotics and other treatments are associated with sudden cardiac death, they are about as effective as most treatments in medicine and likely to be life-savers overall. [7] Even Dr Gotzsche’s Nordic Cochrane Collaboration colleagues have distanced themselves from his remarks.

So, what is it about psychiatry that garners such free floating criticism? Part 2 will address this….

REFERENCES

[1] Editorial. Duel diagnosis. Lancet Psychiatry 2014; 1: 245. http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2814%2970363-3/fulltext

[2] BPS Division of Clinical Psychology entitled ‘Understanding psychosis and schizophrenia: why people sometimes hear voices, believe things that others find strange, or appear out of touch with reality, and what can help’. BPS, 2014. http://www.bps.org.uk/networks-and-communities/member-microsite/division-clinical-psychology/understanding-psychosis-and-schizophrenia

[3] TM Luhrmann. Redefining Mental Illness. New York Times, Jan 17, 2015. http://www.nytimes.com/2015/01/18/opinion/sunday/t-m-luhrmann-redefining-mental-illness.html?_r=0

[4] Michael Balter.  Schizophrenia: Time to Flush the Meds? Science 5 February 2014.  http://news.sciencemag.org/brain-behavior/2014/02/schizophrenia-time-flush-meds

[5] James Gallagher. Schizophrenia: Talking therapies moderately effective. BBC News on-line, 6 February 2014. http://www.bbc.co.uk/news/health-26046228

[6] PC Gotzsche. Authors reply. BMJ. 2015 Jun 2; 350: h2955. http://www.bmj.com/content/350/bmj.h2955.long

[7] http://mentalhealth.mvm.ed.ac.uk/2015/03/treatment-for-mental-illness-works-if-people-get-it/

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