Sad, mad or dangerous to diagnose?

The New York Review of Books has a wonderful article that ostensibly reviews three books about mental illness but is also a powerful summary of some of the most important criticisms of modern psychiatry.

One of the key points of debate is the extent to which distressing yet common mental states such as shyness or feeling low are being classified as mental illnesses such as social phobia or depression.

This is currently a hot topic. The British Medical Journal hosted a recent debate on whether depression is overdiagnosed with Ian Hickie arguing that it needs to be recognised more widely to stop people missing out on lifesaving treatment and Gordon Parker arguing that normal sadness is being excessively labelled as a medical disorder.

Drug companies have an obvious interest in getting more people diagnosed, but less obviously, although equally as pervasive, is their interest in pushing for new diagnoses.

On the level of the individual patient, medicalising a problem often shifts people’s thinking so they feel less empowered to make a difference to their lives – it becomes an illness to be dealt with by medical experts.

In the US, however, where insurance payments are often only guaranteed when a medical diagnosis is made, people might only be able to get relief from their mental distress if their problem is medicalised.

Unlike in socialised health systems, insurance-based healthcare can pressure professionals not to help people with non-specific or difficult to diagnose problems, meaning the existing categories are often stretched to allow such people to be treated.

Treatment has traditionally been medication, which means drug companies have a strong financial incentive to push for the changes to the classification of mental illness and promote theories which best support their treatments.

In contrast, cognitive behavioural therapy, a type of psychological therapy, is known to be as effective as drugs (the most effective treatment is both medication and therapy), and is better at preventing relapse.

However, because it isn’t a ‘product’, there is no corporate marketing machine behind it, meaning it is typically under-recognised and under-used.

The ‘promotion’ of psychological therapies is left to mental health charities (such as the recent We Need to Talk campaign) which pales in comparison to the billions spent by drug companies.

So, the extent to which mental and emotional distress should be treated as a medical disorder effects everything from the personal to the political.

The New York Review of Books article does a fantastic job of covering how these processes work, both at the medical and corporate level, and how they impact on our individual health care.

Link to article ‘Talking Back to Prozac’ (via MeFi).