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Dr. Lucy Johnstone is a consultant clinical psychologist, author, lecturer and trainer who has worked in Adult Mental Health settings for many years. She explains that what concerns her about our contemporary paradigm of diagnosing and treating mental disorders. Western psychiatry is based on the idea that the various forms of distress that people can suffer from, such as very low mood, extreme anxiety, hearing voices, unusual beliefs, suicidal impulses, self-starvation and so on—are best understood as medical illnesses with mainly biological causes in our genes and biochemistry. As a result, we expect such people to receive a diagnosis, and to be treated with medication, prescribed by doctors and administered by nurses.This idea has taken hold so strongly that it can seem bizarre to question it. But in fact there has never been any evidence for the so-called biomedical model of mental distress. Obviously all human experience has biological aspects, but despite what you may have read or been told, no one has ever been able to identify the genes or chemicals that are said to cause 'mental illness.’ On the other hand, we do have a mountain of research to confirm that all kinds of social and relationship adversities massively increase the likelihood of experiencing mental distress.
One of the worst consequences of traditional psychiatric models is the growing amount of research showing that psychiatric drugs tend to increase, not reduce, disability in the long term. Combine over-prescription of drugs with the stigmatizing effect of receiving a psychiatric diagnosis, and the end result is often to introduce someone to a lifelong career as a psychiatric patient.
Johnstone is involved in efforts to help practitioners better understand and better employ “psychological formulation.” She explains, it is the process of making sense of a person's difficulties in the context of their relationships, social circumstances, life events, and the sense that they have made of them. It is a bit like a personal narrative that a psychologist or other professional draws up with an individual and, in some cases, their family and the people who care for them. The professional contributes their clinical experience and their knowledge of the evidence—for example, about the impact of trauma. The client or service user brings their personal experience and the sense they have made of it. The end result of putting these two essential aspects together, in written or diagrammatic form, is called a formulation. Unlike diagnosis, this is not about making an expert judgment. It is a shared, evolving, collaborative process which also includes the person's strengths, and which suggests the best route towards recovery.
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Source material from Psychology today