ALL IN YOUR HEAD, NOT YOUR BRAIN:

"I think that psychiatry as an institution is based on a fundamental misconception: that mental illness is a real, physical bodily illness. I don't think it is. That is not to say there isn't a role for some sort of medical intervention - some drug treatment can be useful in some circumstances. But I think it's important to use those drugs very carefully and very knowledgeably.'

And there's the rub for Joanna Moncrieff, a senior lecturer at University College London and a practising consultant psychiatrist. Antipsychotics, the drugs used to treat people suffering from some forms of psychosis, are neither being used carefully nor knowledgeably. They are, she tells me, increasingly being given to people enduring little more than the 'ups and downs' of life - a diagnosis which could apply to 'absolutely anyone'.

As Moncrieff explains in her enthralling sequel to The Myth of the Chemical Cure, The Bitterest Pills: The Troubling Story of Antipsychotic Drugs, the almost all-purpose prescription of antipsychotics for what amounts to everyday emotional distress is a new phenomenon. [...]

So what is going on? Why are there so many more people being given a diagnosis that demands the prescription of powerful antipsychotics?

Moncrieff is quick to answer: 'That's an easy one - it's the pharmaceutical industry. The new range of antipsychotics started to appear on the market in the 1990s, and the first target was to get the new drugs to replace the old antipsychotics used to treat people with severe disorders like schizophrenia. Once that had been achieved, the pharmaceutical companies started looking for new markets for these drugs. And that is when they started trying to expand the definitions of schizophrenia and psychosis to try to pull more people into the diagnostic ambit of those serious conditions. And this was done partly by the transformation of one diagnosis in particular: bipolar disorder.'

Given the eagerness on the part of too many people to proclaim themselves 'bipolar', Moncrieff's description is illuminating: 'Twenty years ago, bipolar disorder used to be known as manic depression. It was a very serious condition which almost always led to the sufferer ending up in hospital when they had an episode. But it has been transformed over the last few years into something which consists of mood variability - of ups and downs - and which could therefore apply to absolutely anyone.'  Little wonder pharmaceutical companies were so keen to gain a licence to use antipsychotics to treat this changing version of bipolar disorder: 'It enabled them to market the drugs to anyone who has suffered ups and downs.' That is a pretty big market.

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