Yes, we’re pathologizing everyday life. But that also makes it easier to ask for — and get — help.There’s a nice column on PsychCentral today asking the question, “Are we over-diagnosed and over-medicated?” Author Linda Sapadin isn’t asking whether we are diagnosing people who fail to actually meet diagnostic criteria; that’s also worth debating, but not the point here. She’s challenging the diagnostic criteria themselves. Her voice adds to the chorus of those concerned about changes coming in the DSM-5 this May, particularly those that will make it easier to diagnose a grieving person as having major depressive disorder.
There are clear downsides to broadening the diagnostic criteria for any mental health disorder. Such a shift means that more people who are functioning within normal ranges (which is not to say they are functioning well, mind you; we’re talking about people who are still suffering, it is just that the suffering is common) will qualify for a diagnosis and then receive treatment. This adds to our growing healthcare costs. It arouses skepticism of the overall legitimacy of mental health care, leading some to wonder whether these changes are driven (at least in part) by pharmaceutical companies looking for new people to sell drugs to. It also risks sending the message to more people that they are mentally ill, that there is something wrong with them, when in actuality their functioning is quite normal and their suffering would possibly resolve on its own without treatment.
But such discussion is incomplete unless we also look at the upside of broadening diagnostic criteria. Just because a person’s suffering is within normal ranges does not mean we should refuse, as a mental health field, to make help available. Bereavement is a prime example. Not everyone who is grieving the loss of a loved one needs medication. But for those who cannot seem to resolve their grief, those who feel genuine struggle and suffering, those who want treatment to help them function better — broader diagnostic criteria makes it more likely that they will be able to get treatment and have it paid for through their insurance.
It’s also possible that having broader diagnostic criteria can help reduce the stigma of a mental health diagnosis. If we looked at these diagnoses as more like colds (almost everyone gets them sometimes) and less like the plague (rare and frightening), it would be easier to publicly discuss one’s mental health struggles without shame.
I realize there is more to this, and I’ll confess I’m not yet sure where I land on many of the DSM-5 changes. There are reasonable questions to be asked about whether someone should be able to receive mental health treatment (particularly on someone else’s dime, whether that someone else is the taxpayer or other members of their health plan) simply because they feel they need it. Widespread use of psychotropic medications has serious public health and environmental consequences. And the national shortage of well-trained mental health workers means our system is already strained by current diagnostic criteria. But anyone who presumes that broader diagnostic criteria are automatically bad is failing to consider the whole picture. There are some potential benefits of allowing more people who at the edges of normal functioning to qualify for diagnoses.
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The DSM-5 comes out in May; you can learn more about it here. Your comments are welcome. You can email me at ben[at]bencaldwell[dot]com, post a comment below, or find me on Twitter @benjamincaldwel.