A nasty case of misery

BBC Radio 4 has a short but excellent programme on the increasing medicalisation of human sadness which notes that even everyday talk about difficult but necessary life events is being increasingly couched in medical terms.

The writer and presenter of the piece, journalist Mary Kenny, notes, for example, how the concept of trauma is being increasingly applied to mourning, previously considered a painful but normal response to tragic circumstances. She also tackles how this tendency is being reflecting in the ongoing widening of the criteria for mental illness.

Kenny’s piece neither relies on tired simplifications of ‘evil drug companies’ nor falls back on simple explanations for mental illness and makes for a insightful short analysis of how our understanding of human distress is changing.

Unfortunately, you can only listen to a streamed version of the piece and it will disappear in four days, so catch it while you can.

Link to ‘Medicalising Melancholy’ on BBC Radio 4.
Link to article on BBC News website based on the programme.

5 thoughts on “A nasty case of misery”

  1. Very interesting topic.

    Something I’ve wondered ever since discovering Thomas Szasz in college (when his ideas were fresh and less polluted by Scientology and other anti-psychiatry propaganda). How much overlap is there really between “everyday melancholy” and “clinical depression?” Between “everyday worries” and “anxiety disorders?” Between “being creepy” and “personality disorders.”

    Obviously some groups have reasons to emphasize the overlap and others have reason to emphasize the distinction. How well do we really distinguish the clinically significant from the range of ordinary human experience.

    I remember when various authors argued that schizophenia was just a way of saying someone was overwhelmed. How much progress have we made understanding the real boundaries of clinical psychological illness since then? Or do we still have a long way to go?

  2. She was indeed more nuanced than others, worth the listen. Yet I wonder about a complaint that’s frequently voiced but never contextualized: the DSM’s list of mental ailments continues to expand. True. But is it due merely to illness creep, and is expansion necessarily bad? Plausible hypotheses. To get traction on the issues, we might start by comparing mental illness expansion to the expansion of physical ailments. What’s the total count of diagnosable physical illnesses, and is it increasing or decreasing?

    Who has this info? To contextualize and genuinely move the discussion forward, it would be nice to know what percentage of the pie of physical illness is due to (a) physicians’ mission creep, (b) pharmaceuticals’ remedy creep, (c) the public’s “gimme a pill, I can’t be bothered to exercise and eat right” creep, (d) agribusiness and advertisers that entice when not tricking us in to polluting our bodies more than we would on our own anyway ‘creep’, (e) the happily identified, wonderfully differentiated diseases that our ancestors suffered from but couldn’t put a finger on or even if so couldn’t put a stop to ‘creep’, and (f) X number of other pie slices. Yum-yum!

    Point is, until we calculate and compare all the relevant factors, simply moaning about the DSM increase in mental illnesses takes us as much toward confusion, and alas, melancholy, as it does toward panoramic insight. For instance, it could turn out that mental illnesses are being differentiated at about the same rate as physical ones, or that mental illness diagnoses outpace the physical but it’s only natural since the brain is still such a medical frontier. Not to mention the brainmind. And the micro-abyss between brain and mind that still mocks us.

    Or, secret schadenfreuders exult: it may turn out that mental illness creep is indeed a diagnosable disorder. Imagine posted like a giant cigarette warning on the side of DSM-5. ‘The contents of this book and the medical industry behind it are dangerously obese and may be harmful to your health’.

    How’s that for a start? Let the scientific data be collected!

  3. The Loss of Sadness: How psychiatry transformed normal sorrow into depressive disorder by Allan V. Horwitz and Jerome C. Wakefield
    – is quite a good look at this area.

  4. On a personal level, I would certainly make the case that what many call depression is having a few bad days at best, dysthymia at worst. In the US, DTC drug ads hurt more than they help, IMHO.

    As ä bipolar II pt with a very strong tendency toward the depressive side, I have benefited greatly from CBT, Li, and other drugs over many years. The problem is that it just takes so long to find the right mix.

    And, don’t forget – DSM is put together by a bunch of American psychs, some of whom may have ties to Big Pharma.

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