Mental Disorders Are Real, Diagnosis Or Not

The need for diagnosis before compassion shames us

If headlines are to be believed, we are facing a crisis in mental health of epidemic proportions. In the UK and the US, lifetime prevalence rates are estimated to be roughly 1 in 6 and rising. What explains these rates and what ought we to do about them?  An important, preliminary point is that the distribution across the population is not even. A disproportionate burden falls on women and those who suffer socio-economic disadvantage and other forms of adversity and hardship. Equally, the increase is not uniformly distributed across kinds of disorder. Rates of autism, schizophrenia, and bipolar disorder are relatively stable, with lifetime prevalence estimated to be roughly 1 in 100. The increase lies predominantly with anxiety disorders, depression, and addictions.

There are three possible and related explanations for these rates. The first is that the social stigma surrounding these mental disorders is decreasing. Today’s patients are more able to be open about their prob

Continue reading

Enjoy unlimited access to the world's leading thinkers.

Start by exploring our subscription options or joining our mailing list today.

Start Free Trial

Already a subscriber? Log in

Join the conversation

Allan Olley 19 April 2018

"There are therefore fewer cases of undiagnosed disorder, less discrimination, and better access to and quality of care. If this is the explanation, we should not be alarmed by the rates. We should simply keep up the good work."

This just seems fallacious. There could be a reducing rate of mental disorder and we still might be neglecting the social and political actions we could take that would be reducing the suffering associated with those disorders mentioned later in the article. So the opening seems to be posing a false trichotomy. Although it seems like it is unintentional since it it opens saying "There are three possible and related explanations for these rates."

In terms of the main point of the article it seems to me that the author misses two points about how we medicalize things.

First we medicalize in terms of what care/treatment is appropriate. So we should give antibiotics to people with tertiary syphilis suffering paranoia, but not to those with paranoia but no bacterial infections. So part of categorization are just about what form of care is appropriate. So part of saying X is a mental disorder could just be saying X should be cared for (partially or fully) by a method that denies responsibility and blame (like antibiotics or psychoanalysis or cognitive behavioural therapy or whatever). And we naturally just deal (or think we should deal) with quotidian mental anguish with methods of emotional support like those mentioned in terms of responsibility without blame or in terms of socio-political stuff mentioned (we can make people's life better by reducing economic inequality etc.).

So in terms of this it is not clear that the problems suggested are not that we are just failing to care enough for quotidian mental anguish and failing to recognize how non-medical interventions (responsibility without blame, reducing wealth inequality etc.) would help those we categorized as suffering from a mental disorder. So we just need to rebalance our existing ethics of care rather than overcoming some reductive oversimplification.

Second there is the fact that part of how we medicalize is in terms of acuteness of condition. So mental anguish that fails to debiltate or disable is just not called a disease/disorder for that very reason. Similarly brain tumors are more disease than the occassional mild tension headache, just because brain tumours may kill, or severly disable, but otherwise both cause suffering and both have a physical basis. Further it seems like we have a threshold for action such that if the suffering, danger etc. is not acute enough we are less liable to act. So even if minor headaches being common cause masses of suffering we may not act to care proportionate to that because, each individual case is below our threshold whereas every brain tumour is well above our threshold so we are sensitive to that and are more willing to care. So our lack of care for quotidian mental anguish may be about that sort of threshold issue rather than our failing to categorize it as morally relevant suffering.