Wednesday, July 06, 2005

Dr John Read "Models of Madness"

'In the vast majority of cases for diagnoses of schizophrenia, anxiety, depression, eating disorders, sexual dysfunction and attention deficit disorder, the causes will be primarily social,' says Dr John Read, clinical psychologist at the University of Auckland and editor of the book, Models of Madness.

Dr Read, who has worked for 20 years with people diagnosed with schizophrenia and studied the relationship between life events and hallucinations and delusions, says that for the last 30 years there has been a growing dependence on medication and a decreasing willingness among mental health professionals to simply ask people what has gone on in their lives.

'Whenever you have been able to establish a decent relationship with a patient they will tell you their life history,' says Read, 'and more often than not, it has got some fairly horrendous things in it. The patients usually believe that there is a link between what has gone on in their life and the difficulties they have.'

Child abuse, for example, is very strongly related to depression and suicide. A New Zealand survey of several thousand people showed that women who had been sexually abused as children were 20 times more likely to kill themselves as adults than people who hadn't been sexually abused. Worryingly, when researchers interviewed people using mental-health services, they found that only 20 per cent of them who had been abused in childhood had been identified as having such a history by the services.

'At the moment,' says Dr Read, 'we have got this whole movement pushed partly by the drugs companies and partly by some sectors of psychiatry arguing that depression, for example, is really some kind of illness which is genetic and primarily biological. I'm afraid it's just plain wrong. The research that claims that these are genetic disorders is very, very weak methodologically. Because something runs in families does not prove that it's genetic. If you grow up as a child and both your mum and dad are depressed, that in itself is very depressing.'

Just because medication is able to shift chemical processes back to normal in someone who is depressed, it does not prove that the depression was a biological event, he says. 'It's like saying that Aspirin works for headaches and headaches are caused by a lack of Aspirin in the body.'

While people will find comfort in labels, Read argues that they are ultimately damaging. If a child has been diagnosed with attention deficit disorder, for example, it disguises the causes of the problem that need to be addressed if the child and family are going to find a solution. 'If a child is having a problem, 90 per cent of the time you can guarantee that the family needs some help. It's become almost a taboo issue to talk about families driving people mad or causing depression. That's a shame because it gets in the way of families getting the help that they need.'

Not all agree with Dr Read. Robin Murray is professor of psychiatry at the Institute of Psychiatry and a consultant psychiatrist at the Maudsley Hospital in south London. He says: 'What we know is that these disorders on the whole are an interaction between one's vulnerability and social adversity. In the last few years there have been a number of genes that have been discovered which don't cause the illness, they just make one more vulnerable. My view is that the people who believe these are just brain diseases are wrong and the people who say they are just social conditions are equally blinkered. ' n

'Models of Madness' is published by Brunner-Routledge, priced pounds 19.99. To order a copy for pounds 19.99 (including p&p), call Independent Books Direct on 08700 798 897

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