Are we medicalising normal experience?

Anthony J McElveen

doi:10.3399/bjgp13X660670

Sometimes in clinical practice the most difficult thing is to do nothing. As a grizzled old professor of mine used to say, ‘Less is more’.

There is a real danger that as gatekeepers to the ‘sick role’, we can be pressured into labelling people with diagnoses that are unnecessary and downright harmful. In my role as both a psychiatrist and a practising GP, I am increasingly seeing colleagues in both disciplines labelling normal life experiences as mental illness. They then appear to peddle the hope that a tablet (often an antidepressant) will sort out the patient’s alcoholic husband and noisy neighbours.

Should we be reconceiving normal human experiences as being in need of medical intervention?

DSM-5 is due out next year. For those of you who are unaware, this is the American Psychiatric Association’s standard reference work on mental disorders; the Diagnostic and Statistical Manual (DSM). There is a lot of money riding on it.

If it isn’t in DSM then the insurance companies generally won’t pay for treatment of it. We tend to follow the lead of the Americans and when the ICD-11 (International Classification of Diseases) is revamped in 2015 they will look to the DSM for ideas.

It is widely expected that the diagnostic net will be cast even wider, with bereavement for as little as 2 weeks being labelled as clinical depression. When will we come to our senses and see this for the lie that it is?

Let me take this opportunity to encourage you not to be afraid to inform a patient when appropriate, that you can acknowledge that they have difficulties in life but that it is not a mental illness.

Frederick II, King of Prussia is supposed to have shouted to his men as he led them into battle:

‘What’s wrong, you dogs! Do you want to live forever?’

I have little doubt that had he been a doctor he would not have over diagnosed mental illness.