13 April 2009

Our Medical Culture and Mental Disorder Overdiagnosis

There's growing dissent in the mental health industry concerning the over-diagnosis of mental disorders, particularly Post Traumatic Stress Disorder. Its strongest dissenters are US veterans.
In 2006, soon after returning from military service in Ramadi, Iraq, during the bloodiest period of the war, Captain Matt Stevens of the Vermont National Guard began to have a problem with PTSD, or post-traumatic stress disorder. Stevens's problem was not that he had PTSD. It was that he began to have doubts about PTSD: the condition was real enough, but as a diagnosis he saw it being wildly, even dangerously, overextended.

Stevens led the medics tending an armoured brigade of 800 soldiers, and his team patched together GIs and Iraqi citizens almost every day. He saw horrific things. Once home, he said he had his share of "nights where I'd wake up and it would be clear I wasn't going to sleep again."

He was not surprised: "I would expect people to have nightmares for a while when they came back." But as he kept track of his unit in the U.S., he saw troops greeted by both a larger culture and a medical culture especially in the Veterans Administration (VA) that seemed reflexively to view bad memories, nightmares and any other sign of distress as an indicator of PTSD.

"Clinicians aren't separating the few who really have PTSD from those who are experiencing things like depression or anxiety or social and reintegration problems or who are just taking some time getting over it," Stevens says. He worries that many of these men and women are being pulled into a treatment and disability regime that will mire them in a self-fulfilling vision of a brain rewired, a psyche permanently haunted.

It's not only PTSD which gets over-diagnosed in North America. When an entire industry devotes itself to looking for evidence of deviation from a norm - that norm itself defined in increasingly narrow terms and by that very same industry -, people of the commons should be alarmed. WE are the subject pool, after all, over which the industry turns its diagnostic eye.

Not only does psychiatric over-diagnosis do harm to individuals. It harms entire cultures. It creates a society in which too many individuals who are going through normal processes in response to atypical conditions come to view themselves, and get treated as sick. This in turn deflects attention from the social and environmental factors causing these atypical conditions and so politicians, whose policies allow such conditions to thrive, are not held accountable and the conditions continue or worsen.

Wearing sickness labels can do irrevocable harm, by diminishing our view of ourselves in terms of our strengths. If there are very many of us out there who shouldn't have been diagnosed with a mental disorder, that harm also diminishes society's potential to advance to the benefit of all. Harm is also done to those who do have a verifiable mental disorder: treatment may be withheld due to the over-extension of the system.

In fact, the only ones who benefit from over-diagnosis is the industry doing the over-diagnoses.

It's long overdue for the psychiatric industry to undergo a thorough mental health examination.

Recall the book and film The Corporation, which notes the psychopathic nature of corporations. One might suppose the same with respect to an industry whose robust continuance and flourishing depends on the sickness of others, as diagnosed by itself.

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