Editor—In their riposte to my critique of post-traumatic stress disorder Mezey and Robbins cite me as advocating a “stiff upper lip” approach to adversity.^1,2 This is disingenuous: I was pointing to the tension between aspects of British identity traditionally grounded in stoicism and composure and the emergent demands of an expressive individualism.

Mezey and Robbins pay lip service to the role of social factors, but their argument runs the other way. Their core defence is institutional: post-traumatic stress disorder must be valid because it is in the books—in psychiatric classification systems such as the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). By this token they would happily have diagnosed homosexuality as a mental illness during the years when it was classified as such in the ICD or DSM.

Psychiatrists serve neither society nor patients with psychiatric difficulties when they uncritically endorse the medicalisation of life (though they may well serve the pharmaceutical industry, with its vested interest in the medicalisation of the human predicament: some antidepressants are now being specifically marketed for post-traumatic stress disorder). It is academic shallowness and complacency that may permit sociocultural (and often political) values and expectations to be dressed up as medicopsychiatric facts.

What comes to be presented as psychiatric knowledge is as much constructed as discovered. The ICD and the DSM categorise phenomenological constellations, but this is not synonymous with scientific validation. The classifications are not atheoretical and value free—for example, they contain ontological notions of what constitutes a real disorder, epistemological notions about what counts as scientific evidence, and methodological notions about how research should be conducted.³ They are contemporary cultural documents. Awareness of this helps refine our clinical gaze.