In yesterday’s blog post I raised the question “are we over-diagnosing the worried well?” According to Dr Peter Gotzsche, Co-founder of Cochrane (one of the worlds largest health research organisations) the answer is YES.
It’s now easier than ever to get a mental health diagnosis. Take grief for example: you could experience the tragedy of loosing a loved one, and only 2 weeks later be diagnosed with depression. It’s astounding!
In this post I want to explore diagnosis a little further and look at psychiatry’s diagnostic bible: The Diagnostic and Statistical Manual of Mental Disorders (DSM).
“The DSM is published by the American Psychiatric Association (APA) and offers a common language and standard criteria for the classification of mental disorders. It is used by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies, the legal system, and policy makers” (source)
Such a manual is probably very helpful in the understanding and treatment of mental illness. There’s no doubt that therapists need some sort of common language and structure when tackling the challenges and complexities of mental disorders.
The problem with the DSM is that you can’t back up a diagnosis with scientific proof. The DSM is a description of common behaviors & symptoms. There are no lab tests, brain scans or blood tests that prove someone has a particular mental illness. The diagnosis is based on a conversation between patient and doctor and the observation of common behaviors. There’s a certain degree of opinion involved.
Imagine you had pain in your foot and you went to the doctor to find out what’s wrong. Without any tests the doctor asks you about the nature of the pain and you describe how it’s a continuous throb near your big toe. The doctor looks up the common causes of foot pain and concludes you have arthritis. You go to another doctor and they send you for an x-ray: your toe is broken. A surgeon fixes it and then it heals. All is well. Imagine being diagnosed with arthritis because there was no x-ray ordered?
Now just because we can’t prove something exists doesn’t mean it doesn’t.. there’s a reason we have a mental health industry and have made these behavioral observations. Clearly some people are mentally unwell. But since at this stage we don’t have reliable tests or scans we can’t treat a mental illness diagnosis with the same level of conviction that we might a diagnosis for a testable illness. We can’t trust the DSM as much as say a test result for diabetes.
The other major problem with the DSM is that it’s always changing. Disorders come and go and criteria boundaries continuously change. Consider this.
Up until 1987 homosexuality was listed in the DSM as a mental disorder.
Yes you read that correctly, psychiatrists used to believe being gay was an illness. Before it was removed from the DSM therapists employed aversion therapy which typically involved showing patients pictures of naked men while giving them electric shocks or drugs to make them vomit.
I wonder what “disorders”of today we will look back on with the same sense of bewilderment. Is this how we might see anxiety? Will we look back and reflect on the era of psychology where we medicalised worry, where we medicated the worried well?
Which leads me to the title of this post.. and sorry it’s taken me so long to arrive here. Who are the worried well? Where do you draw the line between excessive worry and illness? If you worry a lot about your sore foot because it’s broken is that valid? Do you need psych meds for that?
I think sometimes you’ve got to go within for those answers as they apply to you. You can seek professional opinions and soundboard them against your own inner guidance but at the end of the day you’ve got to make your own best guess… and if I had to take a guess, at who the “worried well” are I would say it’s vast majority of us.
We’re a stressed culture. We behave on mass like maniacs. We’re well enough to go to work, but we’re overworked. We can function today but at the expense of tomorrow. We’re overly stimulated, high on caffeine and our brains are on continuous overdrive. We’re frantically seeking more more .. bigger, better faster, stronger but too much is never enough for us. Some of us are exhausted. Some of us are over it. We’re looking for something different. We’re worried we won’t find it.
So whose pockets would you prefer to fill on your quest to attain greater health? Big Pharma or your local counselor? Corporate health or your cousin the fitness coach. Transnational medical or your your aunt the nutritionist.
The choice is yours.
The Truth about Mental Health blog is an affiliate of Dr Kelly Brogan, Holistic Woman’s Health Psychiatrist. Check out her 44 day online course that explores holistic interventions like diet, meditation, exercise and mindset.