Are We Over-treating Mental Health Issues?

Growing up, did you know many kids at your school with ADHD? I knew of a few fellow students with this diagnosis, but it was only a fraction of what we’re seeing today. The U.S. Centers for Disease Control recently estimated that nearly 6.5 million children between the ages of 4 and 17 had been diagnosed with ADHD at some point in their lives. This figure has grown by 41 percent in the past decade. Today, 11 percent of all U.S. children have an ADHD diagnosis.

You can view this in two ways. First, it may be a catch-all diagnosis handed out indiscriminately, causing a child to be labeled and stigmatized unnecessarily and prescribed medications when there are less-invasive measures available.

On the other hand, it may be the best effort of health or mental health specialists to relieve an increasing amount of suffering and incapacity in today’s youth.

So there you have both ends of the spectrum. Let’s take a closer look, and you can decide for yourself.

Side 1: Mental Health is Being Over-diagnosed and Over-treated

Medicalization is the process of defining, diagnosing, and treating certain human conditions as medical issues, and some people believe we’re doing far too much of this when it comes to mental health. They may refer to this as “disease mongering,” a term coined to describe the rising problem in the field of psychiatry wherein normal conditions are treated as if they are illnesses.

This issue was brought to the forefront with the passage of DSM 5 several years ago, which continues to be controversial. The DSM 5—or “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition”—was updated in 2013, superseding the 2000 version. It is published by the American Psychiatric Association and serves as the guiding authority for making psychiatric diagnoses.

It was widely criticized, with some scientists arguing that it steers mental health providers toward unnecessarily medicalizing a broad range of conditions. This can lead to a formal diagnosis of challenges that are simply a part of “normal life” and the prescribing of medications for conditions that could be better treated without drugs.

Many argue that this manual was created with an “agenda” skewed in favor of the pharmaceutical industry, citing a number of contributors to the manual who had strong ties to this industry. Thus, they believe that the manual was skewed by rampant conflicts of interest.

They contend that standard shyness is being wrongly classified as “social anxiety disorder” and the grief process typical to the human experience is being labeled as “major depressive disorder.” As a result, detractors say that doctors are more apt to prescribe drugs for these “disorders” rather than treat them through counseling, etc.

This trend toward over-diagnosing has extended to bipolar disorder, anxiety disorders, autism spectrum disorder, etc. Some people have referred to this phenomenon as “selling sickness” and warned that we are careening toward a mental health dystopia.

What’s the solution?

Organizations within the mental health community are pushing for greater transparency in research to eliminate spin and conflicts of interest. They have called for all clinical trials to be officially registered and data to be reported and shared so that clinicians can see the full range of advantages and disadvantages to different interventions. They assert that greater transparency and clarity can help doctors make the most informed decisions based on real science—not science with an agenda.

At the same time, many in these organizations acknowledge that just as there is over-diagnosis of certain mental health conditions, there is also under-recognition of others. According to the medical journal Lancet, nearly one-fourth of the world’s disability burden is now attributable to mental and behavioral disorders (including depression, anxiety, Alzheimer’s disease, and schizophrenia). In spite of this staggering statistic, mental health remains under-diagnosed and under-treated in many parts of the world, particularly in underdeveloped countries.

The challenge is trying to reduce one extreme without hurting the other on the over-diagnosis vs. under-recognition teeter-totter.

Side 2: Mental Health is Being Treated Appropriately to Relieve the Discomfort and Incapacity from a Rising Tide of Mental Health Issues

While professionals on this side of the argument may agree that the move to decrease the use of psychotropic medicine has merits, they believe that it’s not that simple. They argue that the vocal critics of medicalization don’t produce helpful change. Rather, they:

• Exaggerate the problem
• Stigmatize psychiatry professionals
• Tell people that their condition is “normal” without examining the extent of their suffering or incapacity
• Desire to define a “normal state,” which is an impossibility because there are so many variables between people.
• Undermine physicians’ abilities to address their patients’ needs

These professionals contend that a mental health professional’s job is not to make a determination of what is normal and treat the patient accordingly, but to examine the patient and their degree of suffering and see how they can help relieve it as effectively as possible.

Consider this quote from Dr. Ronald Pies (professor of psychiatry at Tuft’s University) in Psychiatric Times: “We find ourselves faced with a waiting room full of distressed and often incapacitated human beings who, in ordinary circumstances, are voluntarily seeking our help. We do our best to respond to them not as specimens of abnormality, but as suffering individuals—and as fellow human beings.”

The Takeaway

If you or someone you love is dealing with mental health challenges, it’s a good idea to get multiple opinions on their diagnosis and treatment. As you can see from this article, there is a wide range of philosophies within the field. With multiple professional opinions, you will be better prepared to compare and contrast and decide which is the best course for you or your loved one to follow.