The subjective nature of psychiatric diagnosis

Medicalising natural and normal responses to life experiences is a dangerous game.

This may be the year that makes you mad. A new psychiatrist’s bible will be published in May and already it’s mired in controversy. Many see it as a pretext for scandalous over-diagnosis and drug-pushing.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, has enormous influence in shaping the way mental health research is carried out worldwide. It was first published in 1952 and the most recent edition appeared in 2000. It has taken over 12 years to agree on the contents of the fifth edition, DSM5.

One problem that people have with DSM5is that it will be oldfashioned: it will make no attempt to link behaviour or feelings to what is known about the physical states of the brain, in an era when neuroscience has made enormous advances in relating physiological issues with behavioural issues.

Take grief. Functional magnetic resonance imaging (fMRI) studies show that grieving people have higher activity in various regions of the brain, including the cerebellum and the posterior brainstem. We’ve all seen the results of this in ourselves or others: low mood, low motivation, loss of appetite.

Here’s the next problem: DSM5 will make it easier to medicalise natural human experience. After the new manual is published, psychiatrists will be able to diagnose people who have had two continuous weeks of this as suffering from depression, even if they are recently bereaved. What was normal behaviour last year will become a medical crisis.

The British Psychological Society and the American Psychological Association are among the mental health organisations that have raised concerns about such moves. Medicalising natural and normal responses to life experiences is a dangerous game. So far, more than 14,000 people have signed an open letter to the team drafting DSM5, expressing concern about some of the proposed changes “that have no basis in the scientific literature”. The letter argues that the changes “pose substantial risks to patients/clients, practitioners and the mental health professions in general”.

The pharma says

Particularly vulnerable, they argue, are children and the elderly. That’s because they are most at risk of having pharmaceutical solutions – many of which can have severe adverse side effects – foisted on them. And there’ll be more people and more conditions for which to prescribe drugs. DSM5 will lower the threshold of what it takes to get diagnosed with a disorder and will offer some new disorders, such as “disruptive mood dysregulation disorder”, a diagnosis for children who exhibit temper tantrums and get upset out of proportion to a situation.

Each positive diagnosis will be a candidate for drug treatment, which makes it particularly worrying that a study published in March last year identified strong ties between the pharmaceutical industry and those drafting DSM5.

The subjective nature of the psychiatric diagnosis has always been a problem. Freud knew this but his 1895 attempt at a “project for a scientific psychology” failed miserably. Back then, science had told us very little about the physiology and function of the brain. In 2013, it has revealed a lot more but there are still far too many gaps to claim that subjective analysis is redundant. Neuroscience is advancing fast; let’s hope we won’t need DSM6.

Michael Brooks’s “The Secret Anarchy of Science” is published by Profile Books (£8.99)

The new psychiatrist's bible is seen by many as a pretext for drug-pushing. Photograph: Getty Images

Michael Brooks holds a PhD in quantum physics. He writes a weekly science column for the New Statesman, and his most recent book is At the Edge of Uncertainty: 11 Discoveries Taking Science by Surprise.

This article first appeared in the 07 January 2013 issue of the New Statesman, 2013: the year the cuts finally bite

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Brexit confusion is scuppering my show – what next?

My week, from spinning records with Baconface, Brexit block and visiting comedy graves.

I am a stand-up comedian, and I am in the process of previewing a new live show, which I hope to tour until early 2018. It was supposed to be about how the digital, free-market society is reshaping the idea of the individual, but we are in the pre-Brexit events whirlpool, and there has never been a worse time to try to assemble a show that will still mean anything in 18 months’ time.



A joke written six weeks ago about dep­orting eastern Europeans, intended to be an exaggeration for comic effect, suddenly just reads like an Amber Rudd speech – or, as James O’Brien pointed out on LBC, an extract from Mein Kampf.

A rude riff on Sarah Vine and 2 Girls 1 Cup runs aground because there are fewer people now who remember Vine than recall the briefly notorious Brazilian video clip. I realise that something that gets a cheer on a Tuesday in Harrogate, or Glasgow, or Oxford, could get me lynched the next night in Lincoln. Perhaps I’ll go into the fruit-picking business. I hear there’s about to be some vacancies.



I sit and stare at blocks of text, wondering how to knit them into a homogeneous whole. But it’s Sunday afternoon, a time for supervising homework and finding sports kit. My 11-year-old daughter has a school project on the Victorians and she has decided to do it on dead 19th-century comedians, as we had recently been on a Music Hall Guild tour of their graves at the local cemetery. I wonder if, secretly, she wished I would join them.

I have found living with the background noise of this project depressing. The headstones that she photographed show that most of the performers – even the well-known Champagne Charlie – barely made it past 40, while the owners of the halls outlived them. Herbert Campbell’s obelisk is vast and has the word “comedian” written on it in gold leaf, but it’s in the bushes and he is no longer remembered. Neither are many of the acts I loved in the 1980s – Johnny Immaterial, Paul Ramone, the Iceman.



I would have liked to do some more work on the live show but, one Monday a month, I go to the studios of the largely volunteer-run arts radio station Resonance FM in Borough, south London. Each Wednesday night at 11pm, the masked Canadian stand-up comedian Baconface presents selections from his late brother’s collection of 1950s, 1960s and 1970s jazz, psychedelia, folk, blues and experimental music. I go in to help him pre-record the programmes.

Baconface is a fascinating character, whom I first met at the Cantaloupes Comedy Club in Kamloops in British Columbia in 1994. He sees the radio show as an attempt to atone for his part in his brother’s death, which was the result of a prank gone wrong involving nudity and bacon, though he is often unable to conceal his contempt for the music that he is compelled to play.

The show is recorded in a small, hot room and Baconface doesn’t change the bacon that his mask is made of very often, so the experience can be quite claustrophobic. Whenever we lose tapes or the old vinyl is too warped to play, he just sits back and utters his resigned, philosophical catchphrase, “It’s all bacon!” – which I now find myself using, as I watch the news, with ­depressing regularity.



After the kids go to sleep, I sit up alone and finally watch The Lady in the Van. Last year, I walked along the street in Camden where it was being filmed, and Alan Bennett talked to me, which was amazing.

About a month later, on the same street, we saw Jonathan Miller skirting some dog’s mess and he told me and the kids how annoyed it made him. I tried to explain to them afterwards who Jonathan Miller was, but to the five-year-old the satire pioneer will always be the Shouting Dog’s Mess Man.



I have the second of the final three preview shows at the intimate Leicester Square Theatre in London before the new show, Content Provider, does a week in big rooms around the country. Today, I was supposed to do a BBC Radio 3 show about improvised music but both of the kids were off school with a bug and I had to stay home mopping up. In between the vomiting, in the psychic shadow of the improvisers, I had something of a breakthrough. The guitarist Derek Bailey, for example, would embrace his problems and make them part of the performance.



I drank half a bottle of wine before going on stage, to give me the guts to take some risks. It’s not a long-term strategy for creative problem-solving, and that way lies wandering around Southend with a pet chicken. But by binning the words that I’d written and trying to repoint them, in the moment, to be about how the Brexit confusion is blocking my route to the show I wanted to write, I can suddenly see a way forward. The designer is in, with samples of a nice coat that she is making for me, intended to replicate the clothing of the central figure in Caspar David Friedrich’s 1818 German masterpiece Wanderer Above a Sea of Fog.



Richard Branson is on the internet and, just as I’d problem-solved my way around writing about it, he’s suggesting that Brexit might not happen. I drop the kids off and sit in a café reading Alan Moore’s new novel, Jerusalem. I am interviewing him about it for the Guardian in two weeks’ time. It’s 1,174 pages long, but what with the show falling apart I have read only 293 pages. Next week is half-term. I’ll nail it. It’s great, by the way, and seems to be about the small lives of undocumented individuals, buffeted by the random events of their times.

Stewart Lee’s show “Content Provider” will be on in London from 8 November. For more details, visit:

This article first appeared in the 27 October 2016 issue of the New Statesman, American Rage