‘Grief and anxiety are not mental illnesses’

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.

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

http://www.bbc.co.uk/news/health-20986796

This is an article I found in the BBC News. I don’t completely agree with Mr.  Kinderman. In my opinion he’s very categorical when he says that anxiety can’t be treated by psychiatrists (well, he’s a psychologist…). In severe cases the use of drugs can be helpful.

However, I found this topic interesting: the boundary between Psychology and Psychiatry. Grief can be treated only with psychoterapy, or also with drugs? Why is the DSM so controversial? Do psychiatrists prescribe too much? Is the “post-vacation blues” an invention to earn money? Are all the people susceptible to be diagnosed as a mental patient?

I do believe that Psychiatry focuses on mental diseases with a biological base, but sometimes is difficult to establish when somebody is healthy or sick.

Maybe we can debate about these questions, or any idea it comes to your mind!

Vocabulary:

Label: a short word or phrase descriptive of a person, group,intellectual movement, etc.

Threshold: the point at which astimulus is of sufficient intensity to begin to produce an effect, or any place or point of entering or beginning:

Tantrum: a violent demonstration of rage or frustration; a sudden burst of ill temper.

Binge: a period or bout, usually brief, of excessive indulgence, as ineating, drinking alcoholic beverages, etc.

Yield: to produce or furnish (payment, profit, or interest).

BELÉN ZAPATA QUINTELA

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9 respuestas a ‘Grief and anxiety are not mental illnesses’

  1. IRIS LUENGO ARROYO dijo:

    Here we have two different points of view which are difficult to agree with each other: psychologists and psychiatrists. In my opinion, they both are right in their different ways of thinking.
    The kind of treatment we will use in each case will depend on the severity of the disease. In some cases a psychologist therapy will be enough, meanwhile other patients will need a medicament support. So an acquired and correct diagnosis should be our main aim. That is possible by getting to know the patients and providing them the comprehension they are expecting from us.

    Limits between psychology and psychiatry are vague, as Belen and the article have shown. They can be defined anyway, with a correct method and praxis. I do not believe that “post-vacation blues” is an invention, I neither think a treatment is always required.

    I also would like to tell you about other article I read about. It suggests the fact that Prozac (an anti-depressant drug) usually acts as a placebo in patients with minor depressions. That same placebo effect was also guarantee by a good doctor-patient relationship. We should work on this so that make it achievable.
    I wanted to share that example with you to make it clear what I mean: when it comes to a mental disease what we have to do is take care of the patient’s mental dimension. It can be necessary drug support, though. Therefore, and answering to Belen’s question, I think that sometimes psychiatrists are prescribing more than they should. Talking to the patients takes much more time than our Health System is able to provide, so prescriptions are the easiest and the fastest ways.

    IRIS LUENGO ARROYO

  2. ANA NARBONA dijo:

    In my opinion, and being such the ambiguity of some psychological and psychiatric diseases, we shouldn’t be trying to classify each into some specific defined limits but maybe trying to act on the syntoms, exploring all its posible causes and leading with them as well. Quite often some specialities share patients, this means that some patients could go to one or another different specialty and he would be equally well treated. This happens with psychiatry and psychology, but also with othorrinolaryngology and maxillofacial or endocrinology and internal medicine as some examples. When this occurs problems and discussions are frequent, and unfortunately the most affected will be the patient. I believe that the different specialties should respect each other and learn to work together.
    ANA NARBONA DIEZ

  3. SANDRA dijo:

    In my point of view, in some cases, prescribing drugs and psychotherapy could be the complement of the other one. Sometimes psychiatrists aren’t able to do more than prescribing drugs; I mean, if there is a depressive person with no job, psychiatrists couldn’t give jobs; so they prescribe drugs, for at least, to improve the symptoms. And then, it would be great for the patient to do psychotherapy.

    On the other hand, sometimes psychotherapy isn’t enough for a depressive person. That could be for many reasons, and one of them could be because his/her mental illness has nothing to do with his/her social life. Then, the use of drugs would be the best option.

    However, there are some cases which have a little bit of each situation. So I think that each case should be seen individually, carefully and take nothing for granted in order not to cause more problems to the patient. So to conclude, I think that in difficult situations where is complicated to make a specific diagnosis, doctors of any specialty must obtain an accurate and thorough medical history trying to find the main reason of patient’s state; because if this wasn’t done well, they could cause mala praxis and prescribe the wrong treatment to the patient.

    SANDRA SORIANO SÁNCHEZ

  4. MAIALEN IÑIGUEZ DE HEREDIA dijo:

    When I was a child I had a confusión between a psychologist and a psychiatrist. One day I was reading a newspaper and I found this. I think is usefull to understand the difference “The fundamental difference is the same as between a software programmer (psychologist) and a computer repairman (psychiatrist).
    The issue is the psychologist works on the “software” of the brain, associations undesirable feelings that come up, patterns of behaviour that are motivated by traumatic experiences (or not), and so on.
    A psychiatrist is a doctor whose studies are the disfunction of the brain, as an organ. Mostly they are who resort more to pharmacology.”

    I also would like to tell that I agree with my classmate, Ana. That they are two specialities and often they have to work together, so it is very important they respect each other. Because there are some diseases which need the both treatment, drugs and psychoterapy.

  5. LUCÍA PÉREZ SILVESTRE dijo:

    I totally agree with what my classmates have said above, plus I think that Maialen has written a good definition of psychiatry and psychology.
    Often it is difficult to make a difference between psychiatrists and psychologists. Everyone knows that psychiatrists can prescribe drugs unlike psychologists, but as the article shows, the boundaries between psychiatry and psychology are tenuous.
    The type of treatment used depends on each case. Often is enough with psychotherapy, but in some cases, the drugs are necessary. Still, it is important that both know how to work together since there are many mental disorders that need to be medicated but at the same time have some very important emotional and sentimental components.

    LUCÍA PÉREZ SILVESTRE

  6. Belén Leal Mora dijo:

    I feel this article Belén has found in the BBC news is about a very interesting and current issue that put face to face two kind of mental health professionals: psychologists and psychiatrists. Which are their differences and which is the boundary between these disciplines?
    In our society, having a psychiatric consultation it is not as socially approved as going to the psychologist; most people avoid going to the psychiatrist to the extent possible because it is commonly thought that if a person visits a psychiatrist, he or she is insane, crazy, nuts, mad, nutty or screwy. So, which is the reason of this wrong way of thinking?
    Firstly, a psychologist is a person who has studied Psychology’s degree and then he or she starts working in a clinic or in a private office, and his/her main aim is to assess and treat patients who suffer from psychological problems by analyzing their origin and causes. In this way, these workers try to help their patients by listening to them and providing them some techniques and skills that can be so useful to improve their psychological well-being and also to achieve their personal goals in the consultation.
    Secondly, a psychiatric is a person who has achieved his Medicine degree, and then he has specialized in the Psychiatric branch. These kind of workers are able to do similar task as psychologist do, but they tend to focus their work in evaluating the physiology and the chemistry of the psychological problems, so they are aimed to the medical and pharmacological area of the mental disorders.
    According to this, we can get a vague idea of the complexity of this aim, and after all, everyone is different from others, so this is the reason why it is need to include every factor involved in the psychological well-being of a person. Thus, it is certain that reading the manual of clinical diagnosis, there are a lot of symptoms and signs that become part of mental disorders, but their simple appearance in a person does not mean that he or she is suffering from a mental illness. Therefore, being mistrustful of somebody does not mean being a paranoid person nor be frightened of a plane does not imply having a phobia. To conclude with this, I could say that it makes no sense prescribing anti-depressant and anti-psychotic medication if people really don’t need it, just because of their significant side-effects as well as poor evidence of their effectiveness. As the author of the text has said, “there are humane and effective alternatives to traditional psychiatric diagnoses ”, and there are also alternatives to anti-depressant and anti-psychotic drugs. Maybe, if it changes, the wrong thought people have about going to a psychiatrist’s appointment can also change.

  7. MARTA SOJO ELIAS dijo:

    The difference between psychiatrist and psychologist has been always a controversial topic. As we know, psychologists only use the art of talking to their patients and try to open their eyes. Only when this patients can´t solve their mental illness the psychiatrist appears. This one could prescribe drugs.

    In my opinion the best option would be both working together but several times people think that if doctors prescribe them drugs have better results than psychoteraphy, and this is a wrong argument.
    Most people take drugs such as aspirins, as if there were candies and that’s what we have to change, we take a lot of unnecessary tablets.

    Finally, I think psychiatrist and psychologist are important in our society, but also social assistants, because several times it’s not a mental problem but also a problem of relationship with others, where this kind of specialists could also help.

  8. Carolina Pérez Benito dijo:

    One of the phrases that caught my attention the text was ‘mentally ill patients need help and understanding, not labels’.
    The diagnosis of a mental illness is very important because it can help or can do much damage.
    Generally, when a patient comes to the consultation and explain your symptoms, then are categorized as depression and treated with antidepressants. This is not good as the boundaries of these mental illnesses are not defined.
    Therapies that are used depend on the characteristics of each patient and should not generalize treatments.
    There are mental illnesses that are temporary and therefore not have to prescribe drug treatment for life.
    It is demonstrated, and as mentioned in the article, many of the assumptions that mental patients really need to talk, be heard and helped in whatever they need.
    In conclusion, my opinion is that both paths are joined and that both psychologists and psychiatrists must agree for the benefit of the patient. I think that must be linked and that one goes after the other: the first is to try to understand why the disease occurs, try to solve it without resorting to medication and choose the second option in cases that are essential to take drugs.

  9. CRISTINA dijo:

    I find this article very interesting because I like Psychiatry a lot.
    Lately, there is a struggle between psychiatrists and psychologists. I find this situation unnecessary, because I think that there is a considerable difference between those two practices.
    On the one hand, Psychiatry is a specialty that treats mental illness that have a pathological basis and where patients need drugs to treat their diseases. On the other hand, psychologists don´t treat mental illness, they help people to deal with the problems of their lives and with some upset symptoms that aren´t very pathological and can be solved without medication.
    So there is a big and main difference: psychiatrists can diagnose and prescribe medication, psychologists not.
    In this article, a psychologist say that sometimes psychiatrists invade their field, but in my opinion that´s not true because to diagnose a mental illness you have to follow a guideline that define a serial symptoms and signs that must have a patient to be treated by a psychiatrist.
    I think that instead of fighting, they could be more professionals and they can help each other because in many situations their works are interconnected and to benefit their patients, they shouldn´t waste time competing.

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