For many years, Mental Health Europe has been calling for wider recognition of the crisis of confidence in the increasingly biological/neurological approach taken by Western psychiatry as well as for action in order to change this culture within mental health services. Although MHE mainly operates at European level, we believe that promotion of positive mental health is a universal value that calls for the international sharing of best practices and a strong sense of community.
For the past few months, we have been working on the forthcoming revision of the International Classification of Diseases (ICD 10) which will become ICD-11 when it is adopted by the World Health Assembly in 2018. Together with experts, psychiatrists and service users we have reflected and debated on the ongoing revision. We have shared our views through the publication of a detailed position paper as well as a call for action addressed to the World Health Organization (WHO) and the European Union (EU)..
According to the WHO definition, the ICD “is the standard diagnostic tool for epidemiology, health management and clinical purposes. This includes the analysis of the general health situation of population groups. It is used to monitor the incidence and prevalence of diseases and other health problems”. Although we are not opposed to diagnostic manuals as we know they can be of great benefit to practitioners in their work and are important in helping governments develop responsive health systems, we believe that they should be compiled and used with caution. Diagnostic manuals are not “holy writ” and the worldwide outcry from service users and professionals about DSM-V was the culmination of increasing concern that the construction of categories was running far ahead of scientific evidence and sometimes flying in the face of both science and common sense as well as concerns about the influence of the pharmaceutical industry on these categories.
On this basis, we have been calling for safeguards to be put in place to ensure that diagnostic manuals, like the ICD, are understood to be a tool that should be used in an equal relationship of dialogue between the individual and the clinician. Such safeguards include transparency in the process, the involvement of people with lived experience as equal partners in the construction process, the development of more user and carer friendly language and upfront and honest guidance on the use of these manuals. We have also identified some flaws in the current revision process including:
- Little to no meaningful involvement of users, carers or civil society
- A lack of transparency
- The prioritisation of health systems over the individual
- Reinforcement of the biomedical model
- Prioritising global knowledge over local knowledge
In light of these concerns, we have called on the World Health Organization to make the revision process truly participatory by involving users, carers and civil society in a meaningful and constructive way. We also recommended the development, in partnership with representative organisations, of more user and carer friendly language. We need to ensure transparency at all levels of the revision process as well as ensuring that the identities and allegiances of health professionals who take part in the Global Clinical Practice Network are verified to prevent any conflict of interest.
Finally, we also called on the WHO to ensure that guidance on the use of the ICD is clear and honest, positioning the use of diagnostics as a valuable tool in an equal relationship of dialogue between the user and the clinician and emphasising the need to recognise the value and validity of local understandings, practices and cultural norms.
Following on from this work, we are now circulating an online questionnaire to seek the views of the international mental health community on the ICD 10 revision, including mental health professionals, organisations active in the field of mental health, users of mental health and their families and carers. We would like to invite members of the Mad in America community who are familiar with the ICD-10 Revision process to take the time to answer the questionnaire if they would like to help and contribute to the dialogue regarding the revision process. International voices and perspectives are crucial to ensure that the ICD-10 revision is transparent, and this is a chance for your voice to be heard on a European platform. We believe that people with lived experience should be treated as equal partners in the construction of such processes, and encourage you to add your many voices to ours.
We are looking forward to hearing from fellow Mad in America’s readers!
Mental Health Europe website: http://www.mhe-sme.org/
Our position on the ongoing ICD 10 Revision: www.bit.ly/1lDVNBp
Our Call for Action: www.bit.ly/1kShVXq
Our Questionnaire: www.svy.mk/1IUpPvj
Editors Note: This blog is part of our growing coverage of promising initiatives that work to change our current drug-centered paradigm of care. You can find our expanding Initiatives section here. If you are aware of any initiatives that you believe should be highlighted on Mad In America, please send us your suggestions.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
I personally hope it is acknowledged that today’s “gold standard” treatment recommendations for “bipolar,” which include combining the antidepressants, antipsychotics, and benzos. Is, in fact, a recipe for how to create “psychosis,” via anticholinergic toxidrome.
And the medical community of today claims that the neuroleptics could never cause the symptoms of “schizophrenia.” However, this is the opposite of the truth. The neuroleptics can create the negative symptoms of “schizophrenia” via neuroleptic induced deficit syndrome. And they can create the positive symptoms of “scizophrenia,” via the central symptoms of neuroleptic induced anticholinergic intoxication syndrome.
But since the psychiatrists and doctors think the antipsychotics are “wonder drugs,” and these drug induced disorders are not even mentioned in the psychiatric “bibles,” these drug induced illnesses are almost always misdiagnosed as “bipolar” or “schizophrenia.”
By the way, I love how you point out that the psychiatric practitioners are not included as members of “civil society.”
Thank you for having the courage to post this here. Here is my comment that I submitted to your questionnaire:
I come from a perspective outside of what you are looking for. My recovery was enabled via complete rejection of the diagnostic model. It is well known among psychiatric survivors that there is no validity and poor reliability in psychiatric classifications such as the ICD and DSM: No amount of tinkering is going to fix this problem. Therefore it would be better if the DSM and ICD were abolished. Thomas Insel here in the USA has already taken the first step by admitting that the DSM categories are useless for research. The ICD should follow suit and admit that all its work has come to nothing. The only reason it does not is because of the financial and stakeholder interests involved, and because people are scared of losing their jobs if they were to admit that their classification system is essentially fraudulent. So you are faced with a choice: keep your jobs and keep the money coming in, or be honest about the total lack of scientific basis for these classifications and about what is really best for service users, most of whom do not want to be labeled with these meaningless stigmatizing words. What are you going to choose? Lastly, I wish to note that there are alternatives to your diagnostic model such as Formulation (British) and Open Dialogue (Finland). Consider looking into these.
I hope the ICD dies sooner rather than later.
‘Service user involvement’ is no magic bullet that can improve projects retrograde in their very nature (such as DSM and ICD). As Theodor Adorno famously said – “Wrong life cannot be lived rightly.” In the context of what you are trying to do here – this means that fundamentally wrong approaches cannot be rightly applied.
I really did not expect this site to platform these kinds of intiatives.