Thoughts on Brexit for British psychiatry

On the 23rd of June Britain voted to leave the EU. It will take many years before we ultimately know how things turn out. Here I will only discuss certain possible implications for psychiatry. Whilst issues surrounding funding of British research and collaboration with European research have been discussed in the media, there may also be an impact on the nature of mental illness itself.

The media is often calling Brexit the biggest decision in UK politics in the last fifty years. Philosophers of psychiatry rightly emphasise that people with mental illnesses are social beings living in a social environment. Even if there are set biological or psychological causes of many DSM diagnosis individuals with those diagnosis will still be affected by the social environment they are in. Consequently, different social environments could mean mental illnesses turn out differently. Now, exactly how much this is the case is difficult to judge, it is certainly very easy to focus too heavily on people as just being their abstract diagnosis disembodied from the environment but equally it is easy to just simply see mental illness as a social phenomena. Exactly how much weight we should place on each is difficult to say, and this may vary both for different diagnosis and for individuals with the same diagnosis. However, I do think it is credible to say social factors are important and can with some regularity make mental illness turn out differently. To the degree there are significant social changes then, for symptoms with social causes, there could be differences in which symptoms are expressed or in how they are expressed. For example, if there was an economic downturn then this could reduce the quality of life of many people, pushing many over the threshold for a diagnosis of anxiety or depression. Equally, it might mean people who are currently diagnosed now face new challenge and thus express symptoms in different ways. It may impact comparisons of studies taken from different decades, and impact ongoing longitudinal studies, if there are significant changes in the population of the UK. It could also impact comparisons with studies done in Europe.

It also raises more deeper philosophical questions. If mental illness can be influenced by social factors, should we have classificatory systems like the DSM and ICD which are typically treated as universal? I think this is a question which would need be informed by empirical research, studies of exactly how mental illness manifests in different settings, and even after that the decision would be influenced by difficult practical questions. If universal classificatory systems were rejected, then how broad should they be? Do we want to be part of the American classificatory system, the European one or have a unique British one? Of course, for better or for worse, the American and European systems are very similar, so in that reguard any detachment from Europe does not leave a binary choice between choosing between contrary American and European systems.

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