The politics of expedience

Harvard Magazine has an article on the increasing willingness of psychiatrists to prescribe medication for distressing but relatively common life problems and whether this is blurring the boundaries between mental illness and mental health.

Using an ever-expanding arsenal of neurochemical drugs, physicians now treat variants of mood and temperament that previous generations viewed as an inescapable part of life. In an earlier era, James’s fears might have forced him to change professions. Today, the exceptionally shy and the overly anxious, the hyperactive and the chronically unhappy can seek relief from their suffering though medical intervention. And the parameters of what constitutes a “mental disorder” have swelled. An estimated 22 million Americans currently take psychotropic medications—most for relatively mild conditions.

This widespread embrace of biological remedies to life’s problems raises troubling questions for psychiatry. Paradoxically, even though psychopharmaceutical sales have soared in the United States during the past 20 years, only half of those with severe disorders receive adequate treatment. Clinicians and researchers disagree over what the priorities of the field should be and whom they should count as mentally ill. Are we over-treating the normal at the expense of the truly disturbed? Can we adequately distinguish illness from idiosyncrasy, disease from discontent? And are we allowing pharmaceutical companies and insurers to define the boundary between illness and health?

Freud famously made a distinction between unhappiness and mental illness, and wanted his therapy to transform “hysterical misery into common unhappiness”.

As with many medical treatments (such as plastic surgery), mind-altering drugs are now being used on those without previously recognisable medical problems in an attempt to improve quality of life.

So-called ‘smart drugs’, ‘cognitive enhancers’ and the use of psychiatric drugs to help with life stresses are examples of something psychiatrist Peter Kramer has called “cosmetic pharmacology”.

The Harvard Magazine article looks at whether this trend is actually negatively affecting the understanding and treatment of major mental illness, and warping the diagnostic systems upon which psychiatry relies.

Link to article ‘Psychiatry by Prescription’ via (3Quarks).