Seduced by biology: The BBC, black dog and biological bias

Sue Holttum suggests that biological explanations for distress may easily be over-emphasised

Do brains turn our heads?
Photo: Helmut Januschka

A couple of mornings ago (Tuesday 18th Feb) there was an item on Radio 4’s Today programme about depression. Specifically, it related to the discovery that teenage boys with mild (non-clinical) depression, and higher-than-usual levels of the stress hormone cortisol, were 14 times more likely to develop clinical depression than other boys of similar age. Presenter, Evan Davis, interviewed respected neuroscientist, Prof Barbara Sahakian, from Cambridge University. Instead of asking the obvious question about why these youngsters are suffering enough stress to raise cortisol levels and be mildly depressed, Mr Davis asked about possibly correcting cortisol levels and whether cortisol was the cause of the depression.

Is shaming the 'pill-shamers' shutting down debate?

Leigh Emery

‘Whatever is begun in anger ends in shame.’- Benjamin Franklin

Keep taking the tablets. But
maybe keep quiet about it?

Over the past year I've immersed myself in Twitter. Like many I started tentatively, following the usual parade of news sites and comedians. It didn't take long though to realise the value of Twitter for discussing mental health. It’s packed to the rafters with campaigners, professionals and service-users. It’s also, famously, a place where people feel free to say more or less whatever they want. Put all these elements together and the result is a powerful (if dissonant) mix of voices in social media and in mental health.

Recently, some Twitter followers have turned their attention to several articles in the national press which critique the use of psychiatric medication. These articles, one by novelist Will Self, another by commentator Giles Fraser and a third by psychiatrist Joanna Moncrieff, broadly say the same thing: life’s ups and downs are being pathologised and psychiatric drugs are being wildly overused.

Guest blog: I believe in diagnosis but the DSM is just a door-stop

Over the last few months we’ve regularly featured pieces taking a critical line on the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and on psychiatric diagnosis more generally. We are nonetheless committed to offering a range of views on mental health. Today we feature an article taking a more pro-diagnosis position and offering a (possibly surprising) view on why the DSM is not always relevant to the consideration of distress. The author, Alex Langford, is a psychiatrist with clear views on both the value of diagnosis and the limits of classification schemes. What do you make of what he has to say? Alex has agreed to respond to comments over the next few days.

Is the nature of most mental health
problems obvious?
Illustration: catcher0frye

The heat from the release of the “psychiatric Bible” (DSM-5) is thankfully simmering down. In recent months, you couldn't throw a metaphorical brick on Twitter without hitting someone who had a strong opinion and wasn't shy of sharing it. I found this debate stimulating, frustrating and eventually repetitive. Rarely however, did I find it clinically relevant.

There may be a number of reasons for this. For one thing, DSM-5 is an American book; we use a different classification (ICD-10) here in Britain. Also, I currently work in an area of psychiatry that deals heavily with an illness that DSM doesn’t have a definitive role in, namely dementia. But mostly, I wasn’t too bothered because, to the probable surprise of non-medics and the public, most psychiatrists don’t really care about the finer points of classification.

Am I Still Bipolar? Emerging from the Shadow of the DSM

Fay Thomas

What if it's not our brains
that are the problem?
Photo: Bohlega et al 

I am excited. Almost as excited as I was the day the Berlin wall fell or Nelson Mandela was released from jail. For me, the current debate around the utility of the DSM5 and psychiatric diagnosis feels that big. It feels that big because I have been personally touched by a madness from which I was told I would never recover. My only sibling has likewise lived in the shadows of diagnosis, similarly labelled and without any real hope for much of his life. I was labelled bipolar 1 and he as schizophrenic. Of the two labels, I must confess to preferring mine. Bipolar is somehow a bit sexier than is schizophrenia - in these days of celebrity confession, anyway.

But a quarter of a century ago when I was first given my diagnosis, I was a manic depressive and there didn't seem much that was glamorous about that. Celebrities did not then come out of the closet and admit to their diagnoses or discuss their trials in Hello. It was only historical geniuses like Virginia Woolf and Hemingway who were found on lists of the similarly afflicted. And that was only because they were dead. 

Guest Blog: Bipolar or Not?

Psychiatric labels can be both helpful and confusing. In the light of the current DSM debate, guest blogger Fay Thomas writes about her struggle to hold onto a normal response to personal grief having been diagnosed with bipolar disorder some years ago.

Being labelled bipolar
casts a long shadow
Photo: SigmaOne

'Are you suicidal?' asked the doctor, peering at me kindly as she offered tissues for my tears. I wanted to answer truthfully, but it felt difficult. I hoped the answer was no, because I would not have done anything to harm myself, but my mind was full of dark thoughts. So I answered no, which seemed dishonest, especially since I had failed to tell her my history.

As a much younger, highly-distressed woman, I was given a label of 'bipolar mood disorder type 1' to describe my see-sawing moods. They cycled between delusional elation and the depths of despair. Aged 28, I had made a serious attempt to kill myself which led to a traumatic series of hospitalisations. My memories of those years are grim, painful and still difficult to articulate. I believe some of the treatment decisions made on my behalf were not in my best interests. Incarcerated and robbed of my own voice and power, it would be hard to trust medics again, especially with my mental health.

Prior to my GP visit, it had been 23 years since I'd experienced serious mood deterioration. For thirteen of those, I had been medication-free - unusual for someone with the bipolar label. Recovery had been a long, hard slog which presented serious risks. It had meant doing my own reading and acting on my own hunches despite the warnings of doctors.