The Big Story mental health the US, psychiatrists (who are seeing an influx of victims of the Wall Street meltdown) are dispensing with dealing with patients’ inner lives and going for short consultations geared towards ‘management’ with medication.

Yet for decades, this increasing medicalization has been resisted by a vocal psychiatric survivors’ movement, who decry unfeeling ‘care’ by professionals, the chemical cosh of ill-considered medication, and the assumption that their lives must be reduced to and arranged around a series of problems or ‘symptoms’. They are in search of more caring therapies, appropriate medication (when it is needed) and more meaningful ways of interpreting their experiences.

But the tide in the other direction is advancing at an astonishing pace. One area is in the irresponsible peddling of powerful antipsychotic drugs, now widely prescribed for children (often to control their ‘unruliness’), adults with bipolar diagnoses and elderly people with dementia. These drugs were never designed for such ‘conditions’ and many of the studies advancing them are first conceived in marketing departments, with the outcomes preplanned. Data is then gathered and interpreted selectively, written up by ghost-writers and signed off by prominent physicians.1 Unethical promotion is rife: in the US, Pfizer paid more than 250 child psychiatrists to promote its antipsychotic, Geodon, at a time when it was only approved for adults. Serious side-effects can be talked down or just lied about, with sales reps trained to rebut such concerns. Eli Lilly created a video called the ‘The Myth of Diabetes’ to promote Zyprexa, which has been shown to cause… diabetes (and other metabolic problems).1

he long-term use of antipsychotics (studied among people with schizophrenia for whom the drugs were originally designed) was recently shown to shrink brain volume. Previously, this shrinkage was assumed to be associated with the disorder itself and was correlated with worsening symptoms and impaired functioning. Now that it looks like the medication causes such shrinkage, it is no longer being paired with the negative effects.2 At the very least, a vigorous risk-benefit debate of such medication is needed.

even from within the mental health services community, is fierce, with groups as far afield as the Society of Indian Psychologists calling for radical changes. DSM-5 will further the tendency of reducing the mind, as one writer put it, ‘to a batter of chemicals we carry around in the mixing bowl of our skulls’.3 Its global influence will be enormous.

US research tends to dominate the mental health field through its sheer volume and published output. An unfortunate result has been a universalizing view of mental distress and illness which is actually an American view. Common sense suggests this must be nonsense; different cultures can have different ways of expressing and enacting emotion and mental illness. More dangerously, Western treatment models become accepted as ‘standard’ even when they may not be as effective, or are underresourced.

Over 30 years, beginning in the early 1970s, the World Health Organization (WHO) carried out three large international studies which delivered a startling finding: people with schizophrenia in the Majority World had better long-term prospects than in the US and Europe, with much lower relapse rates. So did all the specialist care available in the rich world make no helpful difference? One possible explanation offered was that even unscientific beliefs about the cause of illness, such as spirit possession, had the benefit of keeping the affected individual within their social group and allowed a contained view of their problem that was distinct from their identity.3

We are back at stigma. One cannot suggest that mentally ill people are always better treated in the Majority World; instances of cruelty abound. But research suggests that biological

Different cultures have different ways of expressing and enacting emotion and mental illness, yet Western treatment models have become accepted as ‘standard’

Institutional medicine: patients line up to receive their pills from a nurse at a psychiatric hospital in Changzhi, north China's Shanxi province. The regimented conditions are self-evident.

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St r i n g e rC h

A universe of disorders The online publication of the draft of the fifth edition of the US psychiatrist’s bible Diagnostic and Statistical Manual of Mental Disorders (DSM-5, due to appear in print in May 2013) has caused uproar with its proposed huge expansion of what is considered mental illness – to include teenage rebelliousness. With a widened range of human behaviours pathologized, the door is open to further overprescription of psychiatric drugs. Opposition,

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