22 Dec 2015

How James Bond is helping mental health diagnosis

From Nine To Noon, 9:36 am on 22 December 2015

He has a license to kill and he's not shy about using it. But is James Bond a psychopath, and why are mental health researchers studying him?

Daniel Craig as James Bond in Spectre

Daniel Craig as James Bond. Photo: AFP

As well as being a secret agent, James Bond has some well-documented problems with alchohol, gambling and violence, so it's perhaps not surprising  that his latest starring role is as a subject for a mental health study.

The paper, The  psychopathology of James Bond, and its implications for the revision of the DSM-007, has just won first prize in the Australian Medical Journal's Christmas edition.

But while the tongue-in-cheek study of Bond may seem light-hearted, it has a serious message: it wants to stop diagnostic creep.

Its authors, from the University of Auckland, hope it will help halt the overdiagnosis of mental disorders, and the stigma attached to diagnostic labelling.

According to the paper's senior author, Bruce Arroll, there has been a massive expansion in mental health diagnosis - and yet people haven't got sicker.

They believe that there is over-diagnosis of mental disorders.

To stop "the psychologising of everyday life", Mr Arroll and his team have reduced the number of mental health diagnosis down to two; the Bond Adequacy Disorder (BAD) and Normality Disorder.

"The DSM is the statistical diagnostic manual of the American Psychiatric Association, and in 1968 there were 182 diagnoses, in the latest one, the DSM-5, there's 550, so something odd is happening there, so that was one of our concerns," Mr Arroll said.

Daniel Craig acting as James Bond in the latest film, Spectre

Craig in the Bond film Spectre. Photo: AFP

The DSM lists criteria that clinicians have to meet to have a diagnosis - for example, for depression there are eight criteria.

"It was developed to help clinicians be consistent in their diagnoses, and also for research purposes, but it's done by committee and I think the fact that the numbers of diagnoses are expanding is a sign of it having been put together by a committee," he said.

But the team believe clinicians shouldn't be medicalising normal life and it would be better if more effort went into therapy than diagnosis.

The Bond study began as an examination of the ACC costs of the violence in the movies, but the authors - who did all the work in their own time, Mr Arroll hastened to point out - decided to broaden it out and see if they could get it published in a Christmas journal.

""We looked at the psychopathology and then someone came up with the diagnosis 'normality disorder', which we think is quite a contribution to modern mental health diagnoses, so that's how we got started on it."

There are eight behaviours that comprise the BAD: having a sense of entitlement, using bad puns and/or sexual innuendos, seeking admiration and being very self-centred, sexual promiscuity, looking for a fight no matter what the odds, frequently risking their life and the lives of others, engaging in excessive thrill-seeking and killing people.

"They're the eight minimum criteria - if you don't have all eight then you have normality disorder," Mr Arroll said.

"I think a lot of people have normality disorder. It's pretty prevalent, in fact we rather like the diagnosis, we think probably everybody should aspire to normality disorder."

Mr Arroll and his team also came up with a screening scale in the paper, the Bond Additive Descriptors of Anti-Sociality Scale (BADASS).

"We think that's also a contribution to the research literature too."

"So we now actually have a criteria, so if you don't have BAD disorder, then you have normality disorder. So we think it's making it much simpler for mental health professionals and I think for the public, I think the public will relish being able to self-diagnose," Mr Arroll said.

The team had to sit down and rigorously watch the Bond movies, which was a lot harder than it might sound: Mr Aroll had Dr No and From Russia With Love.

"When I was a child I watched them and I was enthralled but when I went back to watch them they were absolutely awful, they were racist, sexist, the story was weak and it wasn't particularly enjoyable - actually it was quite hard work, I have to say."

Listen to Bruce Arroll on Nine to Noon: