'Grief and anxiety are not mental illnesses'

 
An unhappy young woman Everyday anxieties could become targets for medical treatment in an updated US psychiatric manual

The forthcoming edition of an American psychiatric manual will increase the number of people in the general population diagnosed with a mental illness - but what they need is help and understanding, not labels and medication.

Many people experience a profound and long-lasting grieving process following the death of a loved one. Many soldiers returning from conflict suffer from trauma. Many of us are shy and anxious in social situations or unmotivated and pessimistic if we're unemployed or dislike our jobs.

For a few of us, our experiences of abuse or failure lead us to feel that life is not worth living. We need to recognise these human truths and we need to offer help. But we should not regard these human experiences as symptoms of a mental illness.

Psychiatric diagnoses are not only scientifically invalid, they are harmful too. The language of illness implies that the roots of such emotional distress lie in abnormalities in our brain and biology, usually known as "chemical imbalances".

This leads us to be blind to the social and psychological causes of distress.

More importantly, we tend to prescribe medical solutions - anti-depressants and anti-psychotic medication - despite significant side-effects and poor evidence of their effectiveness.

Start Quote

The criteria for "generalised anxiety disorder" would be significantly relaxed, making the worries of everyday life into targets for medical treatment.”

End Quote Prof Peter Kinderman

This is wrong. We should not be diagnosing many more people with meaningless "mental illnesses", telling them these stem from brain abnormalities, and prescribing medication.

Sex addiction

An extremely influential American psychiatric manual used by clinicians and researchers to diagnose and classify mental disorders has been updated for publication in May 2013.

But this latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual, or DSM-5, will only make a bad situation worse because it will lower many diagnostic thresholds and increase the number of people in the general population seen as having a mental illness.

  • The new diagnosis of "disruptive mood dysregulation disorder" will turn childhood temper tantrums into symptoms of a mental illness
  • Normal grief will become "major depressive disorder", meaning people will turn to diagnosis and prescription as a response to bereavement
  • The criteria for "generalised anxiety disorder" will be significantly relaxed, making the worries of everyday life into targets for medical treatment
  • Lower diagnostic thresholds will see more diagnoses of "adult attention deficit disorder", which could lead to widespread prescription of stimulant drugs
  • A wide range of unfortunate human behaviours, the subject of many new year's resolutions, will become mental illnesses - excessive eating will become "binge eating disorder", and the category of "behavioural addictions" will widen significantly to include such "disorders" as "internet addiction" and "sex addiction"
Stigma of diagnosis

Standard psychiatric diagnoses are notoriously invalid - they do not correspond to meaningful clusters of symptoms in the real world, despite the obvious importance that they should. Diagnoses fail to predict the effectiveness of particular treatments and they do not map neatly onto biological processes.

In current mental-health systems, diagnosis is often seen as necessary for accessing services. However, it also sets the scene for the misuse and overuse of medical interventions such as anti-psychotic and anti-depressant drugs, which have worrying long-term side-effects.

Scientific evidence strongly suggests distressing experiences result not from "faulty brains", but from complex interactions between biological, but more importantly, social and psychological factors.

But diagnosis and the language of biological illness obscure the causal role of factors such as abuse, poverty and social deprivation. The result is often further stigma, discrimination and social exclusion.

Therapeutic approach

There are humane and effective alternatives to traditional psychiatric diagnoses.

It is relatively straightforward to generate a simple list of problems that can be reliably and validly defined. There is no reason to assume that these phenomena cluster into diagnostic categories or are the consequences of underlying illnesses.

We can then use medical and psychological science to understand how problems might have originated, and recommend therapeutic solutions.

This approach would yield all the benefits of the current diagnosis-and-treatment approach without its many inadequacies and dangers.

Prof Peter Kinderman is head of the Institute of Psychology, Health and Society at the University of Liverpool.

 

More on This Story

The BBC is not responsible for the content of external Internet sites

Comments

This entry is now closed for comments

Jump to comments pagination
 
  • rate this
    0

    Comment number 329.

    "126. Martin
    As a neuroscience student I was told to skim through the DSM to identify how many mental illnesses I suffer from. I found 7."

    Try reading the first chapter of "Three Men In a Boat" - the author describes skimming through a Medical Dictionary:

    "I plodded conscientiously through the twenty-six letters, and the only malady I could conclude I had not got was housemaid’s knee."

  • Comment number 328.

    All this user's posts have been removed.Why?

  • rate this
    +1

    Comment number 327.

    There is a 'no-mans land' between GP's and mental health professionals that many, if not tens of thousands of people, would greatly benefit from. It is slowly but surely becoming accepted that there is this gap in the medical world, however neither set of these professionals are the ones to provide it. Our GP's can't do it and now the US suggest medication. Wrong, we need another form of help.

  • rate this
    +1

    Comment number 326.

    PTSD, OCD, anxiety or even obesity and gambling addiction are now viewed as psychiatric disorders requiring treatment.

    The NHS can't afford to treat these people along with treating people with major depression, bipolar disorder and schizophrenia.

    Counselling is expensive and limited so most get (inadequately) treated with drugs but serious psychiatric illness deserves more attention.

  • rate this
    0

    Comment number 325.

    we should attempt to indeed distinguish real mental disorders from common negative states brought about by, for example, bereavement. But attempting to bring too many negative states into the normality of life, it s precluding access to help for those people who really need it. Without drugs (medication) I would not have been able to survive enough to get myself to a PC to type these words.

 

Comments 5 of 329

 

More Health stories

RSS

Features & Analysis

  • Stained glass of man with swordFrance 1 England 0

    The most important battle you have probably never heard of


  • Golden retriever10 things

    Dogs get jealous, and nine more nuggets from the week's news


  • Pro-Israel demonstrators shout slogans while protesting in Berlin - 25 July 2014Holocaust guilt

    Gaza conflict leaves Germans confused over who to support


  • The emir of Kuwait Sheikh Sabah al-Ahmad al-Jaber al-SabahFreedoms fear

    Growing concern for rights as Kuwait revokes citizenships


BBC Future

(SPL)

How to learn while you sleep

Enhance memory with your eyes shut Read more...

Programmes

  • Leader of Hamas Khaled MeshaalHARDtalk Watch

    BBC exclusive: Hamas leader on the eagerness to end bloodshed in Gaza

BBC © 2014 The BBC is not responsible for the content of external sites. Read more.

This page is best viewed in an up-to-date web browser with style sheets (CSS) enabled. While you will be able to view the content of this page in your current browser, you will not be able to get the full visual experience. Please consider upgrading your browser software or enabling style sheets (CSS) if you are able to do so.