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?.