Book review - Analysing psychiatry

Dr Jeremy Phipps reviews a controversial new book that questions whether psychiatry is overtreating patients.

It is unusual for any medical book's author to be interviewed in a prime slot on Radio 4's Today programme, as happened with Dr James Davies, author of Cracked: why psychiatry is doing more harm than good.

Disagreement about overdiagnosis of psychiatric disease and the perceived medicalisation of normal responses to life events precipitated his Radio 4 interview.

The details
Cracked: why psychiatry is doing more harm than good
by Dr James Davies is published by Icon Books, priced £10.99. ISBN 9781848315563

Dr Davies, a psychotherapist, has become increasingly concerned that psychiatrists, with the support of the Diagnostic and Statistical Manual of Mental Disorders (DSM), are mislabelling and overtreating variations of normal behaviour.

There has been a degree of dissent in the US and the UK regarding the latest version of this manual, DSM 5, and many healthcare professionals share his misgivings.

Concern about diagnosis

Dr Davies has written an engrossing book, full of interviews with patients and other professionals raising these concerns. His finding that psychiatry has few clear biochemical tests to support diagnoses in comparison with other medical fields will come as no shock to GPs, and his concern about the subjectivity of psychiatric diagnoses is well justified.

His tone can be self-aggrandising, wishing to be a champion of truth in the uncertainty of mental illness, but he always attempts to give supporting evidence from others in the field.

This evidence is sometimes anecdotal but the book moves briskly through these concerns, covering in particular the diagnosis and treatment of depression.

Although it is not always clear, I suspect more of these concerns cover healthcare in the US; certainly, I have never come across a diagnosis of premenstrual dysphoric disorder in this country.

One of the book's most important accusations is that over-reliance on medication has encouraged the development of psychiatric illness in developed countries and increasingly throughout the world. Interestingly, one of the key British experts lays the blame for this on GPs.

Dr Davies questions much of current psychiatric practice and the central view, that many social problems are mislabelled as illness, will have a degree of support in British general practice.

His comments are certainly pertinent to me each time I consider initiating antidepressants.

  • Dr Phipps is a GP in Lincolnshire

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