When I was a child, someone was only mad if they thought they were Napoleon or a teapot, and everyone else was ‘normal’. Thankfully, things are a little more nuanced now, but how far from ‘normal’ do you have to get before you have a ‘condition’? The answer seems to be: not very far at all.
The latest edition of Diagnostic and Statistical Manual of Mental Disorders (DSM) was published last month. It lists mental disorders and symptoms, and every edition is fatter than the last.
Society is increasingly medicalising ordinary behavior and this is beginning to worry health specialists. The head of Liverpool University’s Institute of Psychology, Peter Kinderman: “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..”
Why is there this boom in new disorders?
One reason is that researchers, doctors and academics love to categorise, and it’s quite clear that some of the so-called ‘syndromes’ are artificial constructs: clusters of symptoms that result in a muddy, confusing, overlapping concepts that are no help to anyone.
Another reason for the syndrome boom is financial. Were there’s a cure, there’s cash – and you can’t have a cure without a disease, so let’s have some more diseases and conditions, please. As Ben Goldachre explains in his book, Bad Pharma: if you have a drug that has already gone through an extremely expensive development process, you don’t want it to just treat one condition, when it could treat three or four. Viagra was given to men for erectile dysfunction. But hang on, can’t we sell this stuff to women, too? Enter Female Sexual Dysfunction. If you’ve got a pill that’s passed its A Levels in safety, then make sure there are plenty of conditions it can treat.
It’s not just the big nasty drug companies that are doing this, of course. The nasty alternative outfits are doing it too, and are probably even better at it. I found something called Adrenaline Fatigue, and it’s on several of the more ‘organic’ websites. According to one site, ‘80% of adults suffer from some sort of Adrenaline Fatigue.’ That’s good marketing, because you don’t want to be selling pills to a mere 1% of people when you can sell them to nearly everyone. (Incidentally, I think I may have this disorder because I have two of the symptoms: Feeling of sleepiness and cloudy thinking in the afternoon between about 2 and 4pm, and: frequent sighing. You couldn’t make it up.)
The onslaught of over-medicalisation (or disease-mongering) doesn’t start or end with psychological problems. The Curing Elite is diagnosing ‘pre-conditions’ and ‘sub-clinical’ states that didn’t exist ten years ago. Pre-cancer, for example, it a ‘condition’ even though in the vast majority of cases, it doesn’t lead to cancer. Ivan Oranksy (Executive Editor at Reuters, Health) sites something called pre-acne. What is pre-acne? It’s the possibility of having acne. In other words, it’s not having acne. And yes, you can buy a treatment for it.
As technology advances, we are becoming more able to assess the risk factors in various diseases, and potentially take action to avoid getting those illnesses. But is screening perfectly healthy people always a good thing? Here’s a rather shocking statement from Otis Brawley, the chief medical officer of the American Cancer Society, “It is still conceivable that prostate-cancer screening kills more people than it saves.” Knowing the probabilities that you may get a disease may result in unnecessary and risky medical intervention, depression or even suicide.
Doctors are under pressure. They are bombarded by marketing from pharmaceutical companies about new treatments for new conditions. And patients who have read about the latest disorder want treatment, often in the form of a convenient pill. It is estimated that 10 per cent of British people take anti-depressants and 10 per cent of American children take Ritalin to control their behavior
And it isn’t just the clinicians who are over-medicalising. It’s us. We casually medicalise each other. That friend who ‘won’t commit’? Rather than accept that they have a preference for independent living, or ‘aren’t that into you’ it may be preferable to think of them as a ‘commitment phobe’.
Many of us want a word to describe a myriad of unpleasant recurrent feelings from shyness to feeling sad, bored or lonely, and it’s this need that helps keep the wheel of diagnosis going. After all, a diagnosis can bring many apparent benefits: a feeling that it isn’t really our fault that we feel sad, or keep behaving badly. It’s the condition’s fault, and we can’t help it. Another apparent benefit of a diagnosis is that you usually need one in order to access medical help, often in the form of a bottle of pills.
But where’s the harm? What’s so terrible about giving something a label, even if it’s an artificial construct?
Well, it might stop us from tackling the real problems. If your child is behaving badly you could try to get diagnosis. Little Tommy might have Attention Deficit and Hyperactivity Disorder, main symptom: being naughty, or Pathological Demand Avoidance, main symptom: not doing as one is told, or Ganser Syndrome, main symptom: doing things incorrectly. If Little Tommy has any of these conditions, you may be less likely to look at other ways of helping him: re-assessing your parenting skills, looking at how he is being taught, his class size, whether he’s being abused or bullied. Peter Kinderman again: ‘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.’
When I was 13 I was casally diagnosed with dyslexia. As a result, I stopped trying to spell better, because, I surmised, I had a ‘condition’ – and therefore my efforts would be pointless. The medicalization of my bad spelling made me feel I had an excuse – virtually a license – to spell badly.
Not every diagnosis of dyslexia has a deleterious outcome, and the way dyslexics are taught has improved a lot since I was a spotty teenager who came bottom in English. But more and more behaviour is becoming medicalised, and in the process it may be encouraging us to behave in accordance with the condition that our genes, chemical imbalances or ‘hard wiring’ has ordained.
As well as robbing us of responsibility the Therapeutic State is robbing us of money. Treatments, preventions and tests don’t come cheap. The USA spend two trillion dollars a year on health. And it can also rob us of life: a conservative estimate, 100,000 Americans die every year, not because of the diseases, but because of the treatment.
Not for a minute am I suggesting that people with problems should not be helped. What they don’t need, in many cases, is a diagnosis. Many genuine conditions are under-diagnosed, but over-diagnosis is not the solution.
Rather than fearing the Nanny State, or Orwell’s totalitarianism, I fear Medocracy: rule by an over-zealous Curing Elite. In the medocratic state of the future, everything we do is a symptom of something, everyone is receiving treatment for a disease they either have, or might get. No one is healthy and wellness is an illusion.
Hang on, wait a second… This fear could simply be a condition called White Coat Syndrome, or latrophobia.
(The therapeutic state is one of the themes of my novel Brian Gulliver’s Travels in which Brian goes to a medocracy, a country ruled by doctors. But if you’re interested in this subject, go to Peter Kinderman’s website.)