Within the field of mental health there has always been something of a tension between what we might accept as a natural and predictable outcome of negative circumstances and the point when this is embraced by psychiatry as symptomatic of mental illness. An example of this can be found in my Sharepost entitled ‘Is grief a mental illness?’ Proposed revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) suggest that if the symptoms of grief extend beyond a two-week period following the loss of a loved one, a diagnosis of depression could be made. At present we regard the period following bereavement as normal grief. Fortunately, in my view at least, many objectors see the proposals as simplistic, unnecessary and silly; but this doesn't mean they won't go ahead.
Recently, I read Lindsay Abrams article, Is Anxiety Overdiagnosed? in The Atlantic, where she questions whether the tendency to jump to a psychiatric diagnosis stops us from examining the conditions surrounding the diagnosis. I was interested because I'd previously mentioned Dr. Judith Baer's findings in a post GAD: it's all about context. Baer’s question was simple, why are women in the greatest financial difficulties more likely to be diagnosed with GAD? Her conclusion was remarkably sensible in that the anxiety seen in poor mothers is a result of poverty itself, not mental illness.
This is a good example of how too much focus on symptoms rather than their causes can distort our perceptions. If we confine ourselves to the diagnostic criteria for GAD outlined in the DSM, then all the symptoms will manifest themselves. But as Baer points out the criteria fails to include “an evaluation of the social contextual environment in which symptoms occur.” Baer goes on to say, “we have to be careful if we suggest to people, ‘Oh you’re disordered because you’re feeling anxious.’”
There is a basic danger in medicalizing the effect of a problem rather than its cause and that is we go on to 'treat' the effect - rather than the cause. Giving someone pills because it’s easier than addressing poverty is a case in point, but even in this example a person may benefit far more from some kind of counseling or other type of social support, even though of itself it cannot solve the practical problem of poverty.
The fifth edition of the DSM, due out next year, says it will broaden the parameters in the definition of GAD. Unfortunately this broadening appears not to take into account the social circumstances of the individual so much as reducing the number of symptoms a person has to exhibit for the diagnosis to be given. In this case patients will only need to exhibit the symptoms of restlessness and muscle tension for a period of three months. If this is the case it seems the most we can look forward to is a spike in the numbers of psychiatric diagnoses.
Published On: September 14, 2012