James Peter Davies

It has taken me a while to get around to writing this review because I felt that I needed time to do it justice. In many ways this is a scary book and I feel that I might need to read something that puts the other side of the story to really feel that I have a reasonable grasp of the issues.
Essentially, my take on this book is that the author points a dammning finger at the psychiatric profession and the drug companies that support them. James Davies is a qualified psychotherapist and has worked with the British NHS. He has a Phd in medical and social anthropology (whatever that actually is). Well I actually googled his thesis and found an interesting interview with him (see: https://www.psychologytoday.com/us/blog/rethinking-mental-health/201604/james-da....) and this is what he has to say about his thesis:
"In other words, trainings are places where persons are socialised to uphold the values and beliefs of the particular tradition into which they are being initiated. What is good for the ‘patient’ is often less important than what will ensure the longevity of the therapeutic tribe upon which one’s status and livelihood will come to depend. So I tried to expose anthropologically the tacit institutional devices used in training to transform persons into celebrants and defenders of the tradition (often in ways, and unbeknown to practitioners themselves, that are at the expense of the ‘patient’)".
In this book "Cracked", Davies argues along the following lines:
1. The DSM (Diagnostic and Statistical Manual of Mental Disorders) is the book listing all the psychiatric disorders that psychiatrists believe to exist. It began as a modest 130 page version in 1952 and is now 886 pages long. It is, effectively, the bible of psychiatrists.
2. However, Davies investigated how the disorders found their way into the DSM and it seems that they are there because of a vote by a committee (and not necessarily a unanimous vote). There appears to be no (or almost no) objective biological tests that can be used to identify any particular mental illness.
3. The DSM has gone through a number of editions and each time numbers of "new" mental illnesses have been added to the book (82 new illnesses from DSM3 to DSM4). So what are all these "new" mental illnesses.
4. One has to question the validity of the DSM when (by a relatively close vote of the US Psychiatric Society) homosexuality was removed from the DSM as a psychiatric illness. And one must also question the validity of ADHD diagnostics when in Canada there was an explosion of diagnosis of kids with ADHD and it was found that it was highly correlated with the month of the year. What had happened was the kids in the one class could be over a year different in actual age and the younger kids had lower attention spans.
5. So the illnesses defined in the DSM are deeply suspect and the criteria used to define them are deeply suspect but worse, the DSM has led to a situation where the drug companies have medicalised the illnesses and produced drugs to treat these "illnesses".
6. The theory is that the psychiatric illness is caused by some sort of imbalance in brain chemistry and the drugs will correct this imbalance. However, the imbalance has never been shown to exist. Even in the case of depression the evidence is pretty clear ...as the following citation indicates:
"Patients have been diagnosed with chemical imbalances, despite the fact that no test exists to support such a claim, and that there is no real conception of what a correct chemical balance would look like ". Dr David Kaiser, Psychiatric Times). So, according to Davies, after nearly 50 years of investigation into the chemical imbalance theory, there is not one piece of convincing evidence that the theory is correct.
7. However, that has not stopped the prescription of drugs to "correct" these imbalance.
8. Davies shows that there is an unholy alliance between the drug companies and the psychiatric industry. Drug companies have cherry picked their results (only publishing the favourable results). They have ignored the placebo effect which seems to show that there is no real benefit from most of the drugs over a placebo. They have compromised academic researchers by funding psychiatric departments, research, publications, conferences etc and withholding funds from non-conformers. They have marketed the same drug for different psychiatric illnesses...Prozac for example packaged-up for treating a pre-mestrual "Illness". (Which other societies regard as just a normal condition). And they have marketed various drugs with all the skills and techniques of modern consumer marketing without regard to either effectiveness (especially over the long term) or side effects.
9. The drug revolution saved psychiatry from the legacy of embarassing failures: shock therapy, lobotomies, putting patients into comas etc. After all Psychiatrists in the 70's -90's were now the only professionals who had legal authority to assign psychiatric diagnoses and prescribe psychiatric drugs. So long as these remained in their hands, their authority and distinctiveness was assured. Furthermore they now had a powerful new ally in the drug companies.
10. Davies seems to side with the view that some form of suffering is natural for humans and the best way to treat it is through social measures or simply managing it. He suggests a path forward for the profession which has four steps:
a). Psychiatry needs to develop greater modesty about what it can actually hope to achieve
b) there needs to be more thorough regulation and transparency regarding psychiatry's financial ties to the pharmaceutical industry
c) The training of future psychiatrists must install greater awareness of psychiatry's scientific failings and current excesses as well as how to manage patients outside the medical model.
d). The public needs to become better informed about the current crisis in psychiatry.
I think this is a really important book. As Peter Hitchens (Mail on Sunday) put it...this "Should be read by every doctor....by everyone in politics and the media, not to mention any concerned citizen".
And as Will Self (The Guardian) put it....it is "Chilling reading".
I give it 5 stars and hope that it does get a much wider reading. Since writing the review I started searching out a bit more information on the author and found that he was one of the founders of the Council for Evidence Based Psychiatry and their web site....particularly the section on little known facts..... is really worth some attention. See: http://cepuk.org/ I also read some of the other reviews of the book and it is interesting how polarised the views are. Clearly Davies has touched a raw nerve with some people. I tend to agree that his "solution" for psychiatric problems seems to be a bit weak ....kind of "tough it out' or get some friends sort of solutions. But maybe the people who are so opposed to his views are the prescribers of the drugs that Davies says do not cure. Still see no reason to alter my rating.… (mais)