The human condition: Stop messing with my mind

'Cookbook psychiatry' has spawned an epidemic of misdiagnosis and a generation of patients lobotomised by drugs, claims a new book. Roger Dobson reports

WHEN Margaret Jensvold complained about sexual harassment at work she was packed off to a psychiatrist to discover what on earth could be wrong with her. Back came the diagnosis that she was suffering from Self- Defeating Personality Disorder, a condition where the female sufferers opt for careers or relationships that are likely to disappoint. Or put another way, she, and women in general, are responsible for their own victimisation.

Jensvold rejected the mumbo jumbo diagnosis, sued her employers (who happened, ironically, to be the American National Institute for Mental Health) for sexual discrimination and won, and SDPD is now no longer a formal diagnosis. According to psychiatrist Dr Sydney Walker, director of the Southern California Neuro-Psychiatric Institute, it never should have been. "The only reason it was ever included was that three psychiatrists thought up the label while on a fishing trip. They persuaded colleagues to carry out a study, and Voila! an entirely new mental illness was born," he says.

But SDPD is not the only questionable mental disorder around, he suggests. How about Narcissistic Personality Disorder (people who take advantage of others), or Nightmare Disorder (bad dreams), or Primary Hypersomnia (oversleeping), or Conversion Disorder (hysteria), or, for that matter, any one of a host of other diagnostic labels handed down by psychiatrists along with prescriptions for mind-changing drugs? And, of course, there is depression and its stable mate anxiety, the giants of the psychiatric disorder business, both responsible for multi-million pound drug industries.

Well, says Dr Walker, depression isn't a disorder at all, it's a symptom, just like anxiety... or spots. "Saying someone is depressed or anxious is a long way from finding out what causes the depression or anxiety. It's comparable to a pediatrician saying a child has a rash without bothering to find out whether they are caused by measles, poison ivy or staphylococcus," he says. "A psychiatrist who believes that all depressed patients are alike is as misguided as someone who thinks that all people called Jim are alike," he fumes. "People who have been diagnosed as having manic depression, anxiety disorder, attention deficit hyperactivity disorder, and so on, haven't been diagnosed at all, they have merely been described."

Dr Walker, it hardly needs to be said, is mightily unimpressed by many of his colleagues, a band of medics who get by, he suggests, by practising a pseudo-science not dissimilar to the approach of witch doctors, and who only went in for the job because after years of medical training they found they didn't like touching sick people.

In a fierce condemnation of modern psychiatry, he says that too many psychiatrists practise what he calls cookbook psychiatry, matching symptoms with a list of diseases in the bibles of the trade, aka the Diagnostic and Statistical Manual and the International Classification of Diseases book. As a result, he argues, many psychiatrists now simply mix and match symptoms and diseases rather than diagnosing what's really wrong. They simply pick a disorder from the manual, he argues, write a prescription, and send the patient away again.

"The precise science of diagnosis has given way to the imprecise and inaccurate pseudo-science of labelling, a change that altered the course of psychiatry and in effect removed it from the field of medicine," he charges in his new book on the subject A Dose of Sanity. Simply giving symptoms a label, he acknowledges, does have a therapeutic effect, whether it's a psychiatrist diagnosing depression or a witch doctor diagnosing possession by evil spirits. In both cases the patient is happier because their disorder has been given a name, but in neither case is the real problem tackled.

What also worries Walker are the drugs given to millions of people which, he says, only mask the symptoms rather than tackling what's wrong. "Almost all depressed patients are prescribed anti-depressants and psychotherapy, even though some really have lupus, others have low thyroid hormone levels, still others have Lyme disease, and some have nothing wrong at all. Almost all hyperactive children get Ritalin, even though they may actually suffer from lead poisoning, worms, low insulin levels, iron deficiency or cardiac problems. Each year hundreds of thousands of people are misdiagnosed," he says. He can quote the figures to prove it: American research by Dr Robert Hoffman showed that 41 per cent of people admitted to one psychiatric hospital were later rediagnosed. Separate research at the Manhattan Psychiatric Centre resulted in an even higher figure of 75 per cent misdiagnosis.

Walker goes further: "More than 20 million people in the USA alone take Prozac, Ritalin, Xanax, Valium and other potent psychotropic drugs. Most of these patients and their physicians honestly believe that the drugs constitute treatment. But many patients would be better off receiving no treatment at all." He points out that psychotropic drugs don't cure brain dysfunction and their sole purpose is to suppress symptoms: "But a symptom is a signal that something is wrong and suppressing it won't make the problem go away. The patient on Halcion who commits suicide, the child on Ritalin who feels like a zombie, and the anxious parent who becomes addicted to Valium, all have suffered unnecessarily if their symptoms were caused by physical disorders," he says.

And it is this lack of attention to diagnosis which has led psychiatrists astray, he says, because with cookbook psychiatry, no effort is put into finding out what is causing the symptoms. "Patients don't suffer from Nightmare Disorder or Hypersomnia, or Conversion Disorder, or Depersonalization Disorder. These labels, although they sound impressive, are medically naive. Patients suffer from real brain diseases and dysfunctions, and they need real help," he says. Like doctors in the last century labelled hundreds of diseases consumption or fever, cookbook psychiatrists, he says, lump very dissimilar patients into arbitrary groups simply because they have the same symptoms.

Stress, or rather the psychiatric approach to it, comes in for a hammering too. People who lived through plague epidemics, world wars, inquisitions, and the like, wouldn't have much patience with the popular belief that late twentieth- century life is more stressful than it used to be. Stress is also good for us, he argues, and the popular perception that it's bad for us is simply propaganda pedalled by the drug industry.

"Stress as an abnormal condition to be treated with a pill has been, for the most part, a creation of the drug industry, which promotes sales by convincing doctors that patients coping with difficult life situations must take medication to dull their responses. If stress is intolerable, a doctor must ask why, and ask what else is going on with the patient," he says. Even Acute Stress Disorder, the lifeblood of the armies of psychiatrists and psychologists and others who pour in to offer counselling after almost any incident, from bombings and fires, to tornadoes and floods, is suspect. "Research raises questions as to whether the hordes of psychiatrists and psychologists who descend on flood or earthquake towns do good, or simply add to the problems by labelling people as victims," he suggests. The anxiety and fear people experience following a trauma are nature's way of getting us to take all possible steps to avoid similar events in the future. The reactions may be painful, but they are not pathological or abnormal, nor do they require therapy.

But whether the symptoms are stress, anxiety, depression, or any other condition, at all costs, he says, don't accept cookbook diagnoses from psychiatrists who don't bother to find out what's wrong. If you get a diagnosis after 15 minutes without being prodded and examined, forget it, he urges. As he points out, it won't be the first time psychiatrists have been found wanting. After all, it's not that long ago that patients were being given ecstasy for insight therapy, autistic children were being psychoanalysed, schizophrenic patients were being lobotomised, and patients with the nutritional disorder pellagra were being confined to mental institutions for life.

'A Dose of Sanity' by Sydney Walker, is published by John Wiley on 6th May at pounds 9.99