Today is the American Psychological Association’s “Blog Party” in recognition of May being mental health month. The marketing effort behind designating a specific month a time to recognize and help increase awareness of a certain disease, disorder or condition is intended to help people learn more about various medical and mental health concerns.
But a few weeks ago, physician H. Gilbert Welch wrote an op-ed in the LA Times that questioned whether the pendulum has swung too far the other way. Have we become a nation of people who will get diagnosed for all sorts of sub-clinical problems at the drop of a hat?
Indeed, I think there is a very real danger of that becoming the case. And nowhere is that more likely than in mental health.
Dr. Ron Pies talked about some of these same issues in his article a year and a half ago, Is Grief a Mental Disorder? No, But it May Become One! We, as a society, are in danger of medicalizing and turning everyday human experiences into disorders and diseases needing treatment.
Mental health concerns are at greater risk than most medical diseases because the signs and symptoms of mental disorders are almost always behavioral and self-reported in nature. You have depression when you self-report your symptoms meet the fairly arbitrary line drawn in the sand by mental health experts.
That line, now pretty clearly delineated by meeting a specific number of criteria for a particular disorder, is about to get a lot fuzzier. In the latest proposed revision of the reference book used to diagnose mental disorders — the Diagnostic and Statistical Manual of Mental Disorders (the DSM) — there is a movement to make virtually all major mental disorders diagnosable on a spectrum.
So even if you don’t meet the actual criteria for a disorder, you might be diagnosed with “sub-clinical” depression, because you’re missing just one more symptom to meet the criteria. Professionals already sometimes do this in practice, because of their gut clinical feelings about a person and their belief that person is in need of care.
It is, however, a slippery slope. Generally the research isn’t robust enough for most disorders to justify going too far down this road. We are in danger of giving people labels and diagnoses for problems that can be often just the normal ups and downs of life and living — that just happen to meet the expanded and easier-to-meet symptom criteria. And in disorders where it makes the most sense, such a spectrum is already available and in use (such as the severity level for major depression disorder).
If professionals may be a little too willing to find something wrong with us, many people seem to want something wrong to be diagnosed. They see the commercials on TV about undiagnosed depression or bipolar disorder, and it actually does motivate a few people to talk to their doctor about something that may not even be a clinical problem. Parents see their child not doing as well in school as they think he should be, and wonder, “Does he have ADHD?”
Awareness of mental health issues is fine. But the line between being aware of something and worrying that we may all be at risk for it is a fine, faint one. I worry it’s getting fainter all the time.
So during this mental health awareness month, I offer a word of caution. We live in a world that is increasingly focused on identifying and labeling any and all kinds of aberrant behavior — even when that behavior isn’t significant impacting a person’s life, or is transient in nature. We must tread more cautiously into our future, especially as the DSM-5 gets closer an closer to publication in a couple more years.
For an alternative view, check out John Gever’s article, Does the DSM-5 medicalize normal behavior?.
10 comments
It is all about MONEY! A Mental Disorder is assigned to everyone how talks to a therapist, because the insurance will not pay for the therapy session without a diagnosis.
The sad part of this is people who are mentally ill, can’t work and therefor don’t have insurance; They can’t get help.
Perhaps the problem is more of one created and dictated by the major pharmaceutical manufacturers rather than a desire for people to be diagnosed or for doctors to over-diagnose. If we didn’t see a medication commercial on every single website and tv station every 3 minutes, maybe people wouldn’t think they have something wrong with them for perfectly ordinary feelings or behaviors.
I think increased awareness of the reality of mental health is a really good thing. I don’t, however, see that it has made much of a positive change in people’s perceptions of those who actually have a mental illness. I still live in a world where I cannot just tell people “hey, this is something I cannot handle because of my mental problems”… but if it were me saying “this is too much because of this or that physical problem” people would be (usually) sympathetic and understanding. So, it seems like increased awareness may help push people who would otherwise not try to get help find it, but it doesn’t seem like it really creates a more mental health friendly environment.
People’s jaws still hit the floor if they hear me say “my psychiatrist” blah, blah, blah…
(I receive medication management and psychotherapy from my psychiatrist.)
I find that having to add that is necessary when I say something about my treatment and only mention a psychiatrist. People seem to have the impression that I must be really bad off to have to see a psychiatrist as opposed to a psychologist. I do believe psychiatrists used to treat their patients and provide them with medications. I think this is a far most holistic approach if your needs require both meds and therapy.
There are many people out there who need serious psychiatric intervention who never get it or don’t stay with treatment if they are caught in time. Unfortunately they are the ones who end up on the news because they’ve gone on a shooting rampage or pushed someone off a subway platform, etc. Privacy laws have become a hinderance as well because those who encounter these individuals in schools believe that they can’t report them to authorities.
In my opinion, this is actually *partially* good- I don’t want to see ‘normal’ behavior medicalized, but it would be helpful if the public’s perception of mental illness could be shifted from those with diagnoses being this great big “other”, to “these people are like us, as these traits exist in everyone to one extent or another; the difference is just that they are further along on a spectrum.” I think this conception of mental illness could help foster understanding.
Too many GPs are not skilled enough to be doing a mental illness diagnosis and mental illness requires a specialist. Many illnesses are missing diagnosed and many discomforts in life cannot be brought to a medical clinics or emergency departments for assistance, repair or cure. Life is not comfortable and often unhappy. Pain is a good thing and can provide information but because there is pain and discomfort it does not always mean it needs to be resolved right away. If the pain will resolve without intervention then leave it alone or provide self-management options. Most doctors hold the hand of medicine and physical intervention as a means of addressing human illness. Many human problems cannot be addressed in the best way with a disease model and that includes mental and emotional balance. We are not about health or wellness but more about balance and unbalanced. Our society and way of life within it is by the very nature of the economy and value trends, actually creating much that is unbalanced and not a good fit for human wellness. Humans have needs that are natural and balanced and the best we can do for each other is to acknowledge and respect those before we shift the focus and deny the needs that many humans are not having met. The cures are complex and medication is not the only answer. Since we live in a society that has such high value for money and what we often are told is happiness, it is not surprising we are overly focused on the quick fix. We have much to learn about our minds and our bodies. What I have learned from neuroscience and biology is that all doctors are limited in what they know for sure. Confidence does not equal knowledge. Whenever possible we must ask for more than one opinion and ask as many questions as we can. The problem with documents like the DSM is that it needs to be clearly noted that it is only part and not whole and only what we think so far. The human body is not a car….much more complex…..and in addition, there are countless individual differences.
Thank for the grammar and spelling check. Too much rush and screen too small for writing.
Grief as an illness? Isn’t it part of a normal response on the loss of a loved one? Do we want all uncomfortable experiences to be deemed a “condition”? These days there are so many events that we are exposed to as never before because of media that we are in a constant state of discomfort. What happened to coping skills? Are young ones being coddled so much that they totally fall apart whenever they encounter something serious they are devastated? They live lives of instant gratification, sheltered from the realities of standing up for themselves, never losing, earning a living, being responsible, dealing with difficult situations, etc? Just because you can’t cope doesn’t mean you fall into the definition of a condition. At some point you have to become an adult. You can’t live as a perpetual adolescent. In real life not everyone will indulge your desires and protect you from disappointment. That is part of being a grown up.
More awareness may save save lives. In that, it’s a good thing. I was so good at hiding behind achievements that I was not diagnosed with manic-depression until my late 40s. My life would have been much easier if a friend or family member had seen the symptoms earlier & known what they meant. But due to stigma & shame in the 1950s/1960s/70s, I got very good at hiding the symptoms. Finally diagnosed, treated, my life is so much more manageable. But we must be sure to find a reliable MD psychiatrist for diagnosis. Not just anyone can do this. I had therapists who told me “You’re just super creative! Rejoice in that!” Yes, I am creative but I was suffering horribly from manias that left me w/out sleep for months. So the pendulum swinging toward more awareness is a good thing, in my opinion
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