Care not chemicals

20th July 2007 at 01:00
Oliver James argues that drug companies are rewriting mental illness to boost sales

I was recently in the local branch of a leading chain of chemists when I came across a booklet about ADHD "published in association with the British Medical Association". It asserts that "it is genetic make-up, not the way a child is brought up, which seems to be the major factor in determining whether a child will suffer from ADHD." It also claims the illness is not in any way the consequence of the way the parent cares for the child.

What about the buckets of evidence that show early nurture is critical? What about the well-established questionability of the genetic evidence? I am surprised the BMA should put its name to such an account.

This medicalisation of mental illness is of huge significance. If the parents of your pupils are being fed this sort of information, they will see their child's behaviour as an inevitable destiny, making it harder to involve themselves. Indeed, parents who see themselves as having little influence on how their kids turn out are more liable to maltreat them. Similarly, teachers who see their pupils as unalterable are likely to be less effective.

The reason for the medical and genetic spin is the drug companies. Their profits are dictating what is regarded as a mental illness, and even how it is defined. Just as we are pattern-bombed with claims of an epidemic of ADHD and the need for amphetamine-based drugs to control it, so with depression.

Psychiatrist David Healy argued in his book The Antidepressant Era that the criteria for depression have changed in the past 40 years to fit with the drugs the companies could offer. With the arrival of the most modern concoctions, (known as selective serotonin reuptake inhibitors or SSRIs), he says, definitions were altered to fit what the drug could do.

It's the same with schizophrenia and bipolar (bouncing between mania and depression) disorders. Never mind that many studies have proved these are far from being the discrete, easily separated illnesses they are cracked up to be (with the unwitting help from the likes of Stephen Fry in his BBC series on the subject earlier this year), people with this range of symptoms are told they have an illness and that is largely caused by genes ergo, they must take the pills. Yet the evidence of a major role for family upbringing in causing these problems gets no mention and hardly any talking therapy for exploring this is on offer.

In his book Models of Madness, John Read provides powerful evidence that at least half of schizophrenia, and possibly bipolar disorder as well, is explained by abuse. Forty different studies have found that the majority of psychiatric patients have experienced sexual or physical abuse.

Read has demonstrated to many of his peers' satisfaction that the hallucinations of these patients are often a form of post-traumatic stress disorder, not a consequence of genes.

Interestingly, because the drug companies are all too aware of the importance of persuading us of the genetic story (because it implies their pills are the answer), there have been no fewer than 37 international studies done of public beliefs about the causes of mental illness. Much to the drug companies' horror, they usually find that people believe life events, such as divorce or poor parenting, are more important causes than genes.

The public also prefers talking therapies to pills.

To counteract these attitudes, psychiatric puppets are regularly lined up to spout the drug company geneticism, often sliding it into supposedly independent TV or newspaper commentary.

As a teacher, it must often be tempting to want to wash your hands of that hyperactive hooligan who screws up your class and to wish they would give him some pills.

As a parent, since none of us much like facing up to the mess we all make (to greater or lesser degrees) of our children, it's reassuring to hear the doctor say he's got a chemical solution and that it's not our fault. As a politician, how much cheaper and easier to see it that way.

But the public is right. Those are not the best ways forward. In our increasingly mechanised, chemically-coshed society, we must campaign for real therapy and real politics to address the real causes of mental illness

Oliver James is the author of Affluenza How to be successful and stay sane. The second edition of his They F*** You Up How to survive family life is out now


ADHD pamphlet: Terril, C et al, Understanding ADHD (Family Doctor Publications)

Buckets of evidence for nurture of ADHD: pp 203-4, James, OW, They F*** You Up

Maltreatment by Parents: Bugental, D.B. et al, 1989, Developmental Psychology, 25, 532-9

SchizophreniaBipolar Disorder not discrete illnesses: Bentall, R., 2006, Madness Explained

Studies of public beliefs: Read, J. et al, 2006, Acta Psychiatrica Scandinavica, 113, 1-16

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