Straight Talk from Lucy Johnstone

PCCS Books Ltd has recently published A Straight Talking Introduction to Psychiatric Diagnosis, by Lucy Johnstone, PhD.  Lucy is a consultant psychologist working in Wales, and has been an outspoken critic of psychiatry’s medical model.

Here are some quotes:

“…my own conclusion, based on extensive reading and clinical work and many enlightening discussions with service users, is that psychiatric diagnosis is not a valid or evidence-based way of understanding the difficulties and distress that people experience.”

“With the exception of a narrower set of criteria for autism spectrum disorder, the general effect of the DSM-5 revisions is to create a massive expansion of psychiatric ‘illness’.  It has been calculated that the new diagnosis of binge eating disorder will create more than ten million new psychiatric ‘patients’, while disruptive mood dysregulation disorder will label millions of children as mentally ill.  These changes lead to the increasing medicalization of everyday life, in which normal reactions and problems are turned into ‘illnesses’ to be treated by medication.”

“…UK clinical psychologists are saying that psychiatric diagnosis is not fit for purpose, and we need to develop other, non-medical ways of describing and understanding mental distress.”

“People typically collect a whole range of diagnoses as they progress through the system, and are often prescribed a whole range of different medications, on a basis that often seems like guesswork.  We can now see how this situation comes about.  If it seems like guesswork – well, that is pretty much what it is.”

“…the vast majority of psychiatric problems have no known biological causes.  This includes conditions such as ‘schizophrenia’, ‘bipolar disorder’, ‘clinical depression’, ‘personality disorder’, ‘paranoia’, ‘obsessive compulsive disorder’ (OCD), ‘anorexia nervosa’ and ‘ADHD’.  It also includes ‘psychosis’ which is an umbrella term for people who have unusual beliefs and experiences.”

“People sometimes say that they welcome a diagnosis because it gives them some kind of explanation.  This is entirely understandable – everyone wants an explanation.  My point is that psychiatric diagnosis does not actually explain anything.  Moreover, as I will discuss later, there are much better explanations on offer.”

“There is nothing wrong with searching for patterns in experiences of distress – indeed, it is essential.  The problem arises when we impose a preconceived classification system which does not account for people’s actual lived experiences and, moreover, does not even fit the evidence.”

“The simplest answer to the question of ‘What do we do instead of diagnosing people?’ is ‘Stop diagnosing people’.  The argument that we need a fully worked-out alternative system before we can abandon something that is admitted to be non-valid even by the people who invented it is, in my view, a complete red herring.  And the simplest current alternative is to ask people what their problems are, and start from there.”

“Whatever your view about the validity of psychiatric diagnosis, it is universally acknowledged that these labels lead to stigma and discrimination.”

“Psychiatry imposes a particular way of understanding your experiences.  For some people this model is a helpful one…For others it is more damaging than the problems which brought them into services in the first place.  It can be very hard to distance yourself from this powerful expert verdict which has such a profound effect on people’s lives.”

A Straight Talking Introduction to Psychiatric Diagnosis is a remarkable book.  Although it explores the most profound issues in the diagnosis debate, the language is simple and unpretentious.  There are numerous and informative quotes from people who have experienced the disempowering stigma of psychiatric “diagnoses”.  And there are uplifting stories of people who have found other ways of describing and thinking about themselves.

The book is small – literally – it will fit in your coat pocket.  It can be read straight through, or browsed every morning on the train.  It is brimful of ideas, and I cannot think of a single issue related to psychiatric “diagnosis” that is not addressed clearly and thoughtfully.

Please read it and tell others.

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I have no financial links to this book or to any books/materials endorsed on this site.

  • Anonymous

    Any resource which isn’t signing the tune of psychiatry has the potential to save lives. This sounds like a useful resource to newcomers to the idea of examining alternatives to psychiatry’s beliefs.

    British psychology will hopefully one day acknowledge the careless, offensive silencing of the victims and survivors of forced psychiatry that it regularly engages in, by using deceptive language such as the following, which all but erases the reality of state coercion…

    “the problems which brought them into services”

    “my own conclusion, based on extensive reading and clinical work and many enlightening discussions with service users”

    The average person reading such things, will be led to assume that the only people to consider here are the people seeking to use some kind of service, and seek out a service after having problems.

    Completely absent, completely concealed, is the violent, terrible reality of state psychiatry inflicted on hundreds of thousands of Britons in recent decades and today, against their will, constituting for many the gravest and most traumatizing assault of their entire lives. To frame the group of people targeted by the “service” as “users of it”, is disingenuous, exclusionary, and plain disrespectful to the humanity that is trodden on by these policies.

    I call upon British people that employ this phrase “service user”, to no longer mindlessly parrot it, and to think about the large cohort of people that did/do not have any interest in “using” the state’s so-called “service”, and were/are instead, violently, forcibly handed over to it, effectively OWNED by it, occupied biologically by strangers invading their bodies, raping their biology, and given stigmatizing labels and identities against their will. To frame these victims of state violence in such language as to convey to the listener that they are seeking to “use” a “service”, is a blatantly offensive thing, and this isn’t some politically correct word policing rant, this is simple decency. The people killed in Hitler’s euthanasia program were not “users” of the gassing vans they were forced into from 1939 onwards. The people screaming out in terror in UK psychiatric “wards” this hour, as they are stabbed with syringes are not “using” anything either.

    It is society, the state, and voters, that are “using” the people they force into psychiatry, as human toxic waste dumps, dehumanized receptacles for forced drugging and forced psychiatric labeling and indoctrination.

    If you wouldn’t use the term “lethal injection user” for someone on Death Row in a Texas prison, then why the hell do you think you can call the people forcibly drugged by psychiatry “service users”?

    That is what I ask British psychology. Stop being mindless rote repeaters of this exclusionary label, it undernames your alleged critique of other labels, and your alleged mission to stop discriminating.

  • cledwyn bulbs

    I very much doubt that, pace Phil, Mrs Johnstone has really covered every issue related to psychiatric diagnosis, partly because she, like almost every commentator on this issue, comes at it from their own personal professional perspective, which by no means commands a panoramic view of the subject. For that, the depth and range of one’s knowledge would have to exceed by far that which any of us are capable of bringing to bear on this issue.

    As long as we have these diagnoses, and the prejudice, violence and discrimination that attends upon them, society cannot possibly call itself free. That it does, like so many people call our society tolerant, is symptomatic of the general degradation and abasement of intellectual life that is one of the most salient features of modern society, in which the vast majority of people simply don’t possess a profound apprehension of the concepts they regularly pay a purely verbal homage to.

    Before I go any further, it is chiefly owing to this that the level of argumentation is so low generally on most subjects, and why those of us who can defend the grounds upon which our opinions rest are subjected to such abuse by those who can’t, and who try to compensate for this through the sheer vehemency and vituperation of the terms within which they defend the beliefs they have inherited without inquiring into the grounds of those beliefs, so that they come to hold them in the manner of irrational prejudices, even when those beliefs are true.

    One of the evils of psychiatric diagnoses, and the concepts upon whose empirically weak foundation the whole grisly apparatus of psychiatric despotism has been erected, is that they hedge about the individual, obstructing his mental and behavioral freedom, stunting his mental, intellectual and moral development, and establishing the kind of mindless deference to the authority of custom, convention, and received and authoritative opinion, which lies at the root of so much error and folly.

    They function like signposts marking the points beyond which one ventures at one’s peril; the individual who dares to be different, original, spontaneous, to follow the inclinations of his own nature, and go wherever his thoughts and imaginative flights take him, assuming his position and power doesn’t confer immunity, risks being tarred with the mad brush, sectioned under the mental health act, with all the narrowing of social and occupational opportunities, all the suffering and abuse, all the trauma, that this entails. This is barely touched upon by the critics of psychiatric diagnosis.

    It all serves to strengthen the kind of mindless, slavish deference to custom and convention and its corollary, intolerance and contempt for the outsider, which is one of the principal evils of human society, because such is the stigma which has attached itself to certain kinds of opinion, modes of being, and conduct, those who have the courage to break with convention suffer greatly for this, and a climate where everyone is vying with each other to be the most normal, the most mediocre, the most “cool”, the most trendy, is established, paving the way for the ascendancy of mediocrity.

    A symptom of this is the decline of human culture. It is not merely coincidental that the decline of human culture is largely coextensive with the rise of institutional psychiatry, its encroachment upon ever more areas human life and the consequent expansion of its empire.

    The role of institutional psychiatry in our age’s poverty of great intellectual and creative talent, our conspicuous lack of great thinkers, of great novelists, great composers, great filmmakers, and great dramatists, cannot be ignored, although blame on this issue, if it is to be apportioned fairly, must be distributed amongst all the many advocates of intolerance and the sanctimonious guises behind which it conceals its sinister operations, such as the proponents of political correctness, as well as the advocates and practitioners of therapeutic censorship and internet moderation, who can take their place along with the mental health movement in the gallery of rogues, on whose shoulders devolves the greatest responsibility for the intellectually and creatively stultifying climate whose insalubrious air we must all breathe and, alas, far too many of us, are content to breathe.

    The matrix, the sine qua non, of creative, moral, and intellectual progress, is diversity of opinion, taste, character, and conduct. Nothing could stand in greater opposition to this than the spirit and temper of the times in which we live, than the tendency of modern thought towards the support of the punishment and suppression of eccentricity, difference, and dissent, on political, social, psychiatric and legal grounds.

    Institutional psychiatry is a war on individuality and human difference, as is all the other supposedly philanthropic causes that have in reality for their object the suppression of heresy and the engineering of uniformity.

    You can see the baneful social, intellectual, cultural and moral consequences writ large in the most backwards parts of my country, where the stupidity and depravity of the mob are held up as examples after which men must fashion their own being, where difference of opinion, spontaneity, difference of conduct, difference of dress etc., are all subject to the malicious stares, violence, and derision of fools, and where everyone vies with the next man to be more stupid and vulgar than the next, because it is through the cultivation of these that one is rewarded, through these that one finds the sanctuary of popular acceptance; or in Nazi Germany.

  • cledwyn bulbousons

    That should be “You can see the baneful social, intellectual, cultural, and moral consequences OF THIS writ large in…”

  • Mark Eccles

    Regarding “People … welcome a diagnosis because it gives them some kind of explanation.” It relieves people of guilt, which can be a good thing or a bad thing. If someone is not functioning because of excessive guilt and a psychiatric diagnosis helps them enjoy life again , the diagnosis is “good”. If on the other hand, the psychiatric diagnosis locks someone into a terrible life (psychiatry never forgives) then the diagnosis is “bad”.

  • Phil_Hickey


    This is a good point, though it is my experience that comfort bought at the expense of truth ultimately proves to be a false bargain.

  • cledwyn goodpuds

    Much is made of the furor diagnosticus as it manifests itself in the diagnostic behavior of psychiatrists, but what of the mania for diagnosis amongst lay people?

    Everywhere people are labeling each other “mad”, “mentally ill”, “certifiably insane”. Little attention is given to this most disturbing cultural trend. No matter how much man, in his humbler moments, may acknowledge his own fallibility, the limitations of his own outlook, conditioned by the transient, ephemeral historical and cultural peculiarities of his age, his ultimate unshakeable sense of his own infallibility, albeit unconsciously, enters into his thought, language, and behavior.

    For this reason, certain outlooks and opinions strike him as “senseless”, as “mad”, and on this not-so granite basis he labels others insane, as if he were an omniscient observer, whose position commands a panoptic view of whatever subject he trains his eye upon, be it a human, a work of art, or nature.

    No matter how great the disproportion between our knowledge and the high idea we entertain of ourselves as super-enlightened beings, no matter how much our ignorance always, even amongst the wisest, preponderates over our knowledge, how grossly inappropriate our dogmatism given the limitations of our understanding, nothing can shake a man’s conviction in his own infallibility.

    Therein lies the root of man’s intolerance, whereupon we torment and oppress those who will not see things our way.

    Despite all the many surface discontinuities, the many different avatars of man’s intolerance of his fellow man, and the many different deities and symbols by whose supposed will it is sanctified (be it nature, god, science, history, reason etc.,), they all share this common essence, and converge on this point, viz. the conviction on the part of the intolerant oppressor that he has seen the light.

    It is this that lies at the heart of the mania for diagnosing others as insane, this unshakable sense of our own infallibility and of our own ways.

  • all to easy

    Look closer. When a person hears voices telling her to murder her parents because they are spies, how does that phenomenon involve the person’s appendix? What happens to the person’s femur that causes such a strange event? Is it a fracture or is it due to an infection? We just don’t know. It could be the femur needs therapy. Or the appendix is exhausted from trauma.

    What we do know is that these body parts never really succumb to the disease model. An infection and a crack are mere symptoms of something deeper. Fix them and we know the voices don’t subside. Even though we have biological markers for these things, for some reason, repairing them has no impact.

    How is that possible? Obviously, contrary to the antis, science hasn’t found the exact biochemical processes that cause the disturbance. Even removing a nose doesn’t help. Antis know the source of the malady is in the shoulder. Massaging the shoulders of such folks removes those voices. Of course they have no proof but they sell as many books, DVDs, tickets to conferences as possible because they donate all proceeds to train new shoulder masseuses. They hate money and you will never find a wealthy anti anywhere. Dr Baughman, Dr Whitaker and Breggin take a vow of poverty.