GPs bullied on depression; YOUR SHOUT.

I WRITE regarding the plight of GPs, those driven by a high and caring purpose in the best Hippocratic tradition, who want to be left to get on with the job of caring for people's health to the best of their ability. I was prompted after the Lancet recently featured a University of Leicester study that GPs have difficulty spotting depression among patients.

GPs can be criticised, bullied or treated like "fringe" dwellers for practising traditional, workable, diagnostic medicine instead of bowing to pressures and prescribing psychiatric drugs for mental problems such as depression.

Many GPs have acknowledged there are numerous physical conditions that can cause emotional and behavioural problems, and the vital need to check for them first. It follows then that relying on psychiatric drugs to suppress emotional symptoms without first looking for and correcting a possible underlying physical illness could simply be giving patients a chemical fix, while leaving them with an illness that could worsen. In one study, 83% of people referred by clinics and social workers for psychiatric treatment had undiagnosed physical illnesses; in another, 42% of those diagnosed with psychoses were later found to be suffering from a physical illness.

There is a pervasiveness about the mental health thinking that appears in primary care medicine today. It is largely due to the "success" of psychiatry's diagnostic systems, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the mental diseases section of the International Classification of Diseases (ICD-10). These have been heavily promoted as vitally necessary standards for non-psychiatric doctors. In fact, in 1998, the World Psychiatric Association produced a Mental Disorders in Primary Care kit to induce GPs to diagnose mental illness.

While it may be good business, it's bad medicine. In 40 years, "biological psychiatry" has yet to validate a single psychiatric condition/diagnosis as an abnormality/disease, or as anything neurological, biological, chemically imbalanced or genetic. Professor Peter Tyrer from Imperial College London said, "If the diagnosis of depression cannot be agreed satisfactorily by the best minds in psychiatry, why should we expect the general practitioner to be a reliable assessor of the condition?" Beyond the many valid medical reasons for non-psychiatric doctors to resist the mental health vision of psychiatrists, there is also the matter of preserving their professional integrity. BRIAN DANIELS, Citizens Commission on Human Rights (United Kingdom) East Grinstead.

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