Is Over-Medicalisation Good For Mental Health?

"French Cafe" by Tony Lobl
“French Cafe” by Tony Lobl

Pivotal legislation before parliament could free a swathe of “mental health” outcasts to serve as MPs, jurors and company directors. A private members bill from Tory MP Gavin Barwell seeks to roll back decades of discrimination against those who may have been diagnosed as mentally ill, yet are competent to play a normal role in “civil society”.

It has just enjoyed its second reading in the House of Commons. A time for celebration? Not quite yet perhaps, but certainly cause for significant optimism.

Writing in Independent Voices, Ilona Burton said: “Today, I grinned as I learnt that it was ‘ayes’ all round in the Commons; the Bill now through to committee stage and changes to the law becoming tantalisingly close”.

For instance, as the law currently stands, someone deemed mentally ill and who “regularly attends for treatment by a medical practitioner” is automatically ineligible for jury service. The new bill seeks to rectify this. Barwell’s bill could not have come at a better time because this trend is about to accelerate.

A so-called “mental health bible” is undergoing a significant revision that will further expand the boundaries of what constitutes mental illness. The tome, relied on by professionals around the world, was first published by the American Psychiatric Association in 1952. Since then it has been revised four times and its fifth draft revision has attracted a storm of criticism.

British mental health practitioners were so concerned when they saw a draft version they called a press conference in February to warn of the damage it could do. In fact what they said about the upcoming revision of the US diagnostic and statistical manual of mental disorders (DSM) was described by Reuters as a “a damning analysis”.

The news agency’s Health and Science Correspondent Kate Kelland said as a result many of those that “most people would consider normal or just mildly eccentric” could face being medicalised for mental illness alongside the genuinely unwell”.

“The psychologists, psychiatrists and other experts said new categories of mental illness identified in the book were ‘at best ‘silly’ and at worst ‘worrying and dangerous,’” she reported.

The head of Liverpool University’s Institute of Psychology, Peter Kinderman pulled no punches either. “Many people who are shy, bereaved, eccentric, or have unconventional romantic lives will suddenly find themselves labeled as mentally ill. It’s not humane, it’s not scientific, and it won’t help decide what help a person needs.”

The APA released a statement in response to the British healthcare workers press conference in which they said: “Mental disorders are beyond most people’s everyday experiences. A careful reading of the DSM diagnostic criteria will show that many factors distinguish a mental disorder from everyday experience – the number of symptoms a person must have, their severity, and how long they have lasted, for example.”

“We now have a better understanding of mental illnesses than we did in 1994 when DSM-IV was originally published, and can now include in DSM information that provides better definitions and more reliable diagnostic practices as a result. DSM-5 most likely will not have more diagnoses than the current edition. Many of the proposed changes help to better characterize groups of people who are currently seeking treatment but are not well-defined by the current manual. Our hope is that more accurately defining disorders and diagnoses will improve clinical care and facilitate new research to deepen our understanding of mental disorders.”

Since then, the DSM-5 Task Force has reviewed the protests and made some adjustments. It should be noted that manual is still being drafted and subject to changes and will not be published until next year.

However, they have not managed to assuage the serious concerns held by 14,000 “mental health professionals and others”, who signed a petition supporting an open letter from the Society for Humanistic Psychology. Expressing “substantial reservations”, it calls for halting and re-thinking the “development and revision” of the manual’s latest edition. More than 50 international mental health organisations have endorsed the letter, including the British Psychological Association and the United Kingdom Council for Psychotherapy.

Amongst the criticisms of this review is that it comes “dangerously close to pathologising normal behaviour” that will likely result in increasing drug dependency.

Educational psychologist Andrew Verrijdt wrote: “Unfortunately, just including the category often leads people to believe that the category is real and react accordingly. It is referred to as the problem of “reification”. It is a tricky thing to wrap one’s head around, so let me summarise it in brutal brevity – if someone in authority says a disorder exists, it is only a matter of time before people who think they have that disorder start coming out of the woodwork to try to get help for it.”

Is that really healthy for the individual or society? The many medical commentators concerned at how overdosed we have already become suggests it is not. But if we face mental turmoil – however it is or is not labelled – we want to get beyond managing it, to find freedom from it. If drugs aren’t always the answer what else might fill the gap?

US research on people with serious mental illness concluded that “alternative practices seem to promote a recovery process beyond the management of emotional and cognitive impairments”. Among the care practices with “perceived benefits” were “religious or spiritual activities such as prayer, worship attendance, and religious or spiritual reading”.

Many like me feel that way through dealing with more modest episodes of anxiety or depression – that glimpsing and valuing our underlying spiritual worth has proved to be a powerful healing agent to either calm or uplift thought. At no time would such an episode have impaired the ability to fulfill civil functions. So like others, I will cheer the Mental Health Discrimination bill as it sails on through parliament in time to forestall any further fallout from the fifth edition of the diagnostic and statistical manual.

But I would celebrate even more heartily if the tides of mental health medicalisation were to roll back so that this compassionate legislation was no longer deemed necessary.

This was first published in The Independent as: Is it time for the over-medicalisation of mental health to recede?

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