Lucy Johnstone and Jo Watson propose a radical alternative to the biomedical thinking that they believe is creeping into counselling.
The narrative of emotional distress as ‘illness’ and ‘disorder’ is everywhere: promoted by anti-stigma campaigns, disseminated in the media, and given added credibility by celebrities such as Stephen Fry and Ruby Wax. Somehow, despite all our knowledge about attachment, trauma and relationships, many counsellors and psychotherapists have ended up accepting the message that people in emotional distress are medically ‘ill’.
As therapists working independently and in the NHS, we have seen more and more clients coming to us with the label ‘bipolar’, ‘personality disorder’ or ‘schizophrenia’, and attributing their ‘illness’ to faulty genes and biochemical imbalances. Many have internalised this as part of their identity, along with the belief these are lifelong conditions that can only be managed with medication. Others have accepted the message, again widespread in the media, that crippling anxiety and low mood come out of nowhere, unrelated to what’s happened (or happening) in their lives.
What is most extraordinary is that the current system of psychiatric diagnosis, embodied in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases, has been openly discredited by the world’s most eminent psychiatrists, including the very people who chaired the committees that wrote these manuals. This is something of which the general public and many professionals are largely unaware. For example, Dr Allen Frances, who chaired the committee that produced the fourth edition of DSM, has criticised the fifth and current edition in the strongest terms, saying: ‘There is no reason to believe that DSM-5 is safe or scientifically sound.’1 In the same article, he writes: ‘… disappointingly, 30 years of advancing knowledge has had no impact whatever on psychiatric diagnosis or treatment… DSM-5 hoped to include biological markers that might reflect past research and promote future research. This was a premature and unrealisable ambition: the science simply isn’t there now.’
Even the chair of the DSM-5 committee, Dr David Kupfer, has admitted: ‘We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting.’2 (‘Biomarkers’ are the biological indicators of genetic or other physiological flaws that are used in general medicine to validate diagnoses.) Not only does the notion of biochemical imbalances as the cause of mental ‘illnesses’ lack evidence – some psychiatrists are denying that this theory was ever promoted in the first place.