Lucy Johnstone: Why Underlying Causes of Emotional Distress are Often Unexplored


This week, we talk with Doctor Lucy Johnstone who is a clinical Psychologist, trainer, speaker and writer, and a long-standing critic of the biomedical model of psychiatry. She has worked in adult mental health settings for many years, alternating with academic posts. Lucy has authored a number of books, including ‘Users and Abusers of Psychiatry, and ‘A straight talking introduction to psychiatric diagnosis’ as well as a number of articles and chapters on topics such as psychiatric diagnosis, formulation, the psychological effects of ECT, and the role of trauma in breakdown. I was keen to talk to Dr. Johnstone about our reliance on the concept of diagnosis and how that doesn’t fit well with psychological or emotional distress and how a predominantly biomedical view of tends to lead to a purely medication centred approach to mental healthcare.

In this episode we discuss:

  • The difference between a clinical Psychologist and a Psychiatrist
  • How Lucy became interested in the way we live and how that contributes to states of extreme distress
  • How Lucy’s books follow a theme of being critical of the concept of diagnosis
  • Why diagnosis is not the right lens through which to look at emotional or psychological distress
  • How we turn people with problems into patients with illnesses
  • How it is generally accepted that mental health issues are medical illnesses when there is no basis for this and it is an assumption
  • We need a more sophisticated approach and better language to help us understand trauma and emotional distress
  • That a medical illness view is sold as a fact when it really is not scientifically or ethically justified
  • How it can be looked down on to question your diagnosis
  • That we realise that a diagnosis is often necessary for practical help like benefits or sick notes but this needn’t always be the case
  • How the Diagnostic and Statistical Manual (DSM) is constructed and the most recent version is DSM V
  • That there is a great deal of controversy because it is including more and more behaviours that are becoming classified as illnesses with no evidence that they are illnesses
  • Even the people that are putting together the DSM acknowledge that we need a better system
  • How many Psychiatrists are backing away now from theories like the chemical imbalance
  • Some of the alternatives to diagnosis that allow the service user to express themselves
  • How formulation works as one possible alternative to diagnosis, although not the only one, and that the conversation shouldn’t not just be ‘what is wrong with you’
  • It should be a normalising not a pathologising message
  • That diagnosis often disguises the social drivers whereas best practice formation or discussion will include the social issues like poverty or inequality that are leading to emotional distress
  • That diagnosis and medication encourages us to locate the problem within the individual for their predicament rather than confront the fact that societal concerns are causing the huge increase in emotional or psychological distress
  • Why chemical imbalances don’t explain the link between antidepressant prescribing and poverty
  • Why a psychosocial approach to mental distress would reduce psychiatric prescribing
  • That there is more and more evidence to suggest that overall, psychiatric drugs lead to disability in the long term rather than fix any problem

Relevant links

Psychological formulation