“THERE is no such thing as depression,” says Dr Lucy Johnstone. Johnstone is a clinical psychologist, trainer, speaker and writer, and a longstanding critic of biomedical model psychiatry. “There is no medical illness ‘depression’”, she elaborates. “Neither are there conditions such as schizophrenia, or psychosis. Telling people they have borderline personality disorder is unethical, unscientific, unprofessional, inexcusable.

“Biomedical clinical psychiatry is an ideology and it is wrong for professionals to impose this on people.”

She is supported in this view, albeit a little less stridently, by Mary Boyle, emeritus professor of clinical psychology at the University of East London.

Read more: Some psychiatrists too have concerned about labelling mental health conditions

People have been told illnesses are the result of "faulty" brain chemistry, but there is far more evidence for the role of other factors – such as poverty, neglect, abuse or some history of trauma.

“There is no evidence base for schizophrenia. Nobody has demonstrated a biochemical imbalance to explain it, for instance, despite much effort,” Boyle says. “But the money spent on looking unsuccessfully for these things completely dwarfs that spent on researching the influence of people’s prior experiences.”

Case study: I've become more critical of the whole system

Drugs are presented by drug companies and by clinicians as a cure for problems, but this is more marketing than science, she claims: “They have general effects and sometimes people find them helpful. But they are not cures, and in the longer term can have really serious side-effects. People are not being told the truth about these drugs.”

While treatments, services and resources are much discussed, discussion of the causes is minimal. “When we talk about physical health we almost always consider the causes. But we have an epidemic of distress among young people, even in loving families. One factor is the structures of society – normal working practise cause stress and pressure. Social norms are narrow and oppressive, but when we are talking about mental health, we rarely look at those causes.”

Those critical of the mainstream clinical approach to mental health believe there are two main reasons why it is not questioned. One is the influence of big pharma, the drug companies which have a clear vested interest in perpetuating the idea of mental health as a set of distinct and diagnosable conditions which can be treated with the most appropriate medications, and the psychiatrists who have spent careers training and working in within this model.

The other reason may be that the alternative is expensive and politically challenging: understanding and addressing the trauma or other important experiences in the past lives of people who suffer mental health crisis, the events which lie behind their distress.

Johnstone and Boyle are the lead authors of a would-be revolutionary new document published by the clinical psychology division of the British Psychological Society.

Read more: Students face crisis in mental health as debts rise

The Power Threat Meaning Framework (PTMF) sets out an alternative to treating the symptoms exhibited by patients experiencing distress.

This approach is founded on the assumption that mental health conditions are always "threat responses", feelings of distress, confusion fear or despair or troubling behaviour arising from difficult life experiences.

One way or another, this is rooted in issues of power – more usually powerlessness. The power wielded by an abusive relative over a child, a bullying boss or co-worker, or the domestic violence from a partner, for example.

Under PTMF an individual would be urged to put together a personal narrative to help understand what has happened to them. What was the power dynamic, and what was the threat (how did it affect you), what sense did you make of it, and what did you have to do to survive (the “threat response” – currently commonly described as ‘symptoms’).

The PTMF identifies a range of “patterns” helpful in understanding the way trauma and other life experiences affect us all.

Read more: Some psychiatrists too have concerned about labelling mental health conditions

The document identifies seven patterns. One relates to behaviour or distress caused by trauma, neglect or rejection in childhood. Another deals with separation or identity confusion, a third to defeat, loss or “entrapment”.

Loosely, the first encompasses conditions such as ADHD, self-harm, and anxiety, the second schizophrenia, psychosis and eating disorders, the third depression.

But what is important is the light these patterns of reaction shed on someone’s current health, not the labels, which are often damaging, according to Johnstone. “You might be depressed, but we wouldn’t say ‘you have Depression’,” she says. “The switch from ‘I’m sad and miserable’ to ‘I’ve got depression’ is absolutely toxic.”.

Both authors acknowledge that people who are struggling may well want to seek out a diagnosis. Being diagnosed can be a gateway to services, or benefits. Refusing a label may be unwise.

“If you say ‘I haven’t got schizophrenia’ you could find yourself in a lot of trouble’,” Boyle says. “But you don’t have to be defined by it. People don’t have to accept what their GP tells them.”

These ideas, while challenging, are gaining currency. Boyle and Johnstone were recently in Glasgow, speaking to Scottish members of the British Psychological Society.

Case study: I've become more critical of the whole system

Consultant clinical psychologist Morag Slesser says they were well received: “We’re trying to get the message out there to the public that there are other ways to make sense of mental health problems that can leave the sense of control with the person –rather than to medicalise symptoms and expect the doctor to fix them or you,” she explains.

Trisha Hall, of the Scottish Association of Social Work is another enthusiast. Many social workers are unhappy at their twin role, she says, both assessing people with mental health issues for the risks they may pose, while too overburdened with paperwork to do the relationship-based work they got into the profession to do.

“There is a risk of us colluding with a system that is increasingly biomedical,” she says. “We can no longer justify an approach with is based on people being risk assessed, diagnosed, offered a little package of treatment, and off you go.”

Herald View: New approach needed on mental health



Alistair Brown is a mental health officer – a social worker with specialist training and experience in mental health, and a member of Mental Health Tribunal Scotland.

“There is considerable evidence that people with a psychiatric diagnosis are disproportionately adults who have experienced trauma, and children who have been in care, or have experiences such as extreme poverty, violence or sexual abuse in their background,” he says. “We are in danger of perpetuating something that is really not working for people.”