Read more: “Trials highlight worrying flaws in psychiatry ‘bible’“

“LABEL jars, not people” and “stop medicalising the normal symptoms of life” read placards, as hundreds of protesters – including former patients, academics and doctors – gathered to lobby the American Psychiatric Association’s (APA) annual meeting.

The demonstration aimed to highlight the harm the protesters believe psychiatry is perpetrating in the name of healing. One concern is that while psychiatric medications are more widely prescribed than almost any drugs in history, they often don’t work well and have debilitating side effects. Psychiatry also professes to respect human rights, while regularly treating people against their will. Finally, psychiatry keeps expanding its list of disorders without solid scientific justification.

At the heart of the issue is the Diagnostic and Statistical Manual of Mental Disorders (DSM) – psychiatry’s diagnostic “bible” (see main story). Allen Frances, who headed the last major rewrite of the manual – DSM-IV – fears that the revised version will undermine the profession’s credibility. “What concerns me most,” he says, “is that its publication will dramatically expand the realm of psychiatry and narrow the realm of normality.”

Among the revisions he believes will be most damaging are those to generalised anxiety disorder, which threatens to turn the pains and disappointments of everyday life into mental illness, while “disruptive mood dysregulation disorder” will see children’s temper tantrums become symptoms of a disorder.

Drug alternatives

One protester, Harvard graduate and writer Laura Delano, started taking psychiatric medication at age 14, after a bipolar diagnosis. She felt this worsened her state until, in 2004, she attempted suicide. It was only once she had rejected her treatment and her identity as a psychiatric patient that things began to get better.

Many of the protesters want reform in the shape of alternatives to drug treatment. As protest organiser Susan Rogers explained: “People here are for choice, for the right to decline as well as choose treatment. We want sufferers to know there are alternatives to hospitals and medication – they can go into peer support run by people like themselves.”

“The best success rate for a diagnosis of schizophrenia is in rural Finland, where there is a slogan that problems aren’t in our heads, but between our heads,” says fellow organiser David Oaks. “They emphasise the importance of peer support in recovery.”

Talking to psychiatrists as they filed past the protest, there was quite a lot of sympathy. “These voices have to be heard. We are seeing a manifestation of some legitimate concerns,” said one.

Another was nearly as militant as the protesters: “Psychiatrists usually take 15 minutes to give a diagnosis, so we shouldn’t be surprised if we are getting it wrong. These 15-minute sessions are a form of malpractice.”

The APA’s response was to say: “Many of the proposed changes help to better characterise people currently seeking treatment but who are not well defined by DSM-IV. It is unfortunate there are instances in which people do not feel they have benefited, but these circumstances cannot discredit the clinical practice of psychiatry, or those helped by mental healthcare.”

It is significant that the protests exposed once again the lines of division not just between protesters and the establishment, but within the establishment too. Meanwhile, patients are still caught in the middle, sometimes to their detriment.

LAST year, the BBC News website published an article that questioned if psychological therapies were enough to tackle the rise of depression in the UK. “Is it time,” asked the author, “to question our seeming obsession with talking treatments? I want to stand up for the very important role medication can play in the treatment of mental illness.”

What stood out for me was not just the pro-pill stance, but an endnote that its author, Richard Gray, a professor in nursing research at the University of East Anglia, Norwich, had “given lectures on behalf of a number of pharmaceutical companies”. It did not state he had been paid for them, or that he had received fees and honoraria from antidepressant manufacturers, including AstraZeneca and Eli Lilly, for consultancy work.

This kind of omission happens all the time, so why single out this case? Primarily because the site is run by the BBC, a global media corporation. And the thousands reading the article could not judge its impartiality because they did not know about the payments.

After trying to get a comment for some time, the BBC agreed to amend the endnote. But at medical journals such as The Lancet failure to disclose payments would have breached editorial codes. In the UK, we rely on codes, in the US, media outlets are legally obliged to declare potential vested interests.

Sophie Corlett of Mind, a UK mental health charity, thinks we should take this seriously. “People experiencing mental health problems look to professionals… for many, this includes information that filters through the media. The responsibility to inform readers of issues which may affect the impartiality of a published piece lies with… news outlets and contributing authors. Mind has long campaigned for medical information to be conveyed in an open and balanced manner… we encourage… disclosure of interests.”

This is happening at a time when concern is mounting over industry influence on psychiatric research and practice, and on public opinion. Trials of antidepressants are mostly funded, and often analysed and directed, by pharmaceutical companies. Some 60 per cent of the task force behind DSM-IV (the psychiatrists’ diagnostics handbook) received money from pharma, as have most research centres and many heads of psychiatry schools. Of the 29 experts writing DSM-5, 21 received honoraria, consultancy fees or funding from pharma.

The BBC defends its coverage: “It’s common for the BBC to speak to people with expertise in a particular subject. We do so under clear editorial guidelines that contributors associated with a particular viewpoint or with a commercial interest in a subject should be clearly signposted… Nothing has been put to us which suggests that there has been any conflict of interest.”

So the BBC aims to ensure articles are signposted. In this case one slipped through the net and was duly amended. But it must be more alert to contentious topics and conflicts of interest. Perhaps its code needs tightening – or we should consider a law.