No smoke without fire

In trying to explain why the portrayal of psychiatry on YouTube might be predominantly negative, Gordon et al ¹ fail to consider the obvious – that the producers of negative videos may actually have a point.

It is hard to disagree with any of the accusations about overuse of drugs made by the lawyer featured in the first video on their list. Of the many speakers in the second clip, a couple make slightly exaggerated statements, but its main message, that the Diagnostic and Statistical Manual of Mental Disorders ² is an arbitrary and harmful construct, is entirely correct. The third and final negative video on the authors' list follows in this vein.

It is notable that some speakers in these videos doubt the existence of, say, schizophrenia, by virtue of the fact that it is listed in the same book as nonsensical diseases such as conduct disorder or compulsive buying disorder. Who can blame them? Similarly, others might doubt that bipolar affective disorder exists at all because the diagnostic criteria for one of its forms are so wide they have no face validity. When the public's intelligence is insulted by the psychiatric establishment in such a manner, how can it be expected to believe the basic facts about what we really do know?

Psychiatry has become the slave of its pharmaceutical masters, with diseases and pathophysiologies invented and widened to create a market for drugs. ^3,4 Psychiatrists have been complicit in this. Yet Gordon et al refer to people like me, who endeavour to expose this truth and make positive changes to practice in the interests of our patients, as ‘disgruntled psychiatrists’; they suggest waging a media war by posting more positive videos. But this will get us nowhere.

If we want the outside world to be kind to us, we need to get our own house in order first. We need to dispense with absurd disorders from our classifications, narrow our definitions of serious illness, focus on those endogenous diseases for which we have clear meta-analytic evidence of effective treatment and restrict provision of pharmacological treatment to patients who are actually ill.