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Wake-up call for British psychiatry: responses

Published online by Cambridge University Press:  02 January 2018

Phil Barker
Faculty of Medicine, Dentistry and Nursing, University of Dundee, Scotland, UK. Email:
Poppy Buchanan-Barker
Clan Unity International, Fife
Fran Biley
University of Bournemouth
Ben Davidson
Priory House, Leatherhead
Lawrie Elliott
Centre for Integrated Healthcare Research and the School of Community Health, Napier University, Edinburgh
Alec Grant
University of Brighton
Hugh McKenna
Faculty of Health and Life Sciences, University of Ulster
Shaun McNeil
Voices of Experience, Glasgow
Steve Onyett
Care Services Improvement Partnership, Bridgwater
Richard Peacocke
Dorset Mental Health Forum, Dorchester
Mark Radcliffe
University of Southampton
Angela Simpson
Seebohm Rowntree Building, University of York, UK
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Copyright © Royal College of Psychiatrists, 2008 

Craddock et al Reference Craddock, Antebi, Attenburrow, Bailey, Carson, Cowen, Craddock, Eagles, Ebmeier, Farmer, Fazel, Ferrier, Geddes, Goodwin, Harrison, Hawton, Hunter, Jacoby, Jones, Keedwell, Kerr, Mackin, McGuffin, MacIntyre, McConville, Mountain, O'Donovan, Owen, Oyebode, Phillips, Price, Shah, Smith, Walters, Woodruff, Young and Zammit1 call for the restoration of the ‘core values’ of biomedicine – diagnosis, aetiology and prognosis – despite evidence that such concepts have delivered little more than stigma and helplessness. Reference Kirk and Kutchins2 A generation ago, Mosher demonstrated that contrary to received opinion, the recovery of people with schizophrenia could be enabled with no more than sophisticated psychosocial support. Reference Bola and Mosher3 Since then the role of personal, social and environmental factors in generating ‘breakdowns’ and ‘fostering recovery’ has become widely accepted. The ‘mental well-being’ train has left the station and in many places is close to its destination.

Craddock et al advocate a ‘more positive and self-confident view of psychiatry’, but complain that ‘many people…have developed exaggerated and unrealistic expectations’. Clearly, psychiatry's reification of diagnosis, with the implication of effective treatment, fostered such expectations. The comparison of mood disorders with heart disease serves as an illustration. Much of the emergent distress within high-income nations has more to do with lifestyle, values and other psychosocial factors, than anything resembling biomedical pathology. If the global burden of depression is to be lifted, it will require more than specifying more ‘clearly the key role of psychiatrists’.

Although Craddock et al were clearly offended by talk of mental health and well-being, this focus is long overdue. Talk of ‘mental illness’ and ‘our patients’ is regressive and paternalistic. On the 60th anniversary of the NHS it should be unnecessary to advocate well-being as the purpose of healthcare. Mental health advocacy joins the abolition of slavery, votes for women, feminism and gay rights as another example of emancipation within Western society. The ‘service user’ title may be unsatisfactory, but is another linguistic step towards acknowledging that people are the agents of their lives. They must be addressed as persons if genuine emancipatory mental healthcare is to become a reality.

The learning disabilities field provides a precedent. A generation ago, most people with significant forms of ‘mental sub-normality/deficiency’ lived in hospitals under the care of psychiatrists. Today, despite the influence of genetic anomalies or organic disorders such people live in natural communities, albeit with broad-based psychosocial support. Some may have occasional need to consult physicians, but their lives no longer revolve around their diagnosis. This change in philosophy did not devalue psychiatry but did acknowledge that all problems in human living affect persons. All talk of psychiatric treatment should follow suit, embracing the word's original meaning: the ‘manner of behaving towards or dealing with a person’. 4

Regrettably, Craddock et al's rallying call will be offensive to many service users who have struggled to detach themselves from the more unfortunate aspects of traditional psychiatry. It will also be dispiriting to many of their colleagues. Craddock et al may be surprised to discover that nurses have already joined psychiatrists as statutory prescribers of medication, 5 and some clinical teams recognise the virtue of electing the professional best qualified to inspire and nurture the team. Reference Rosen and Callaly6 Time, perhaps, to wake up and smell the coffee.


1 Craddock, N, Antebi, D, Attenburrow, M-J, Bailey, A, Carson, A, Cowen, P, Craddock, B, Eagles, J, Ebmeier, K, Farmer, A, Fazel, S, Ferrier, N, Geddes, J, Goodwin, G, Harrison, P, Hawton, K, Hunter, S, Jacoby, R, Jones, I, Keedwell, P, Kerr, M, Mackin, P, McGuffin, P, MacIntyre, DJ, McConville, P, Mountain, D, O'Donovan, MC, Owen, MJ, Oyebode, F, Phillips, M, Price, J, Shah, P, Smith, DJ, Walters, J, Woodruff, P, Young, A, Zammit, S. Wake-up call for British psychiatry. Br J Psychiatry 2008; 193: 69.CrossRefGoogle ScholarPubMed
2 Kirk, SA, Kutchins, H. Making Us Crazy: DSM – The Psychiatric Bible and the Creation of Mental Disorders. Free Press, 1997.Google Scholar
3 Bola, JR, Mosher, LR Treatment of acute psychosis without neuroleptics: two-year outcomes from the Soteria project. J Nerv Ment Dis 2003; 191: 219–29.CrossRefGoogle ScholarPubMed
4 Oxford Dictionaries. Shorter Oxford English Dictionary (5th edn). Oxford University Press, 2002.Google Scholar
5 Department of Health. Improving Patients' Access to Medicines. A Guide to Implementing Nurse and Pharmacist Prescribing within the NHS in England. Department of Health, 2006.Google Scholar
6 Rosen, A, Callaly, T Interdisciplinary teamwork and leadership: issues for psychiatrists. Australas Psychiatry 2005; 13: 234–40.CrossRefGoogle ScholarPubMed
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