'Grief and anxiety are not mental illnesses'

An unhappy young woman Everyday anxieties could become targets for medical treatment in an updated US psychiatric manual

The forthcoming edition of an American psychiatric manual will increase the number of people in the general population diagnosed with a mental illness - but what they need is help and understanding, not labels and medication.

Many people experience a profound and long-lasting grieving process following the death of a loved one. Many soldiers returning from conflict suffer from trauma. Many of us are shy and anxious in social situations or unmotivated and pessimistic if we're unemployed or dislike our jobs.

For a few of us, our experiences of abuse or failure lead us to feel that life is not worth living. We need to recognise these human truths and we need to offer help. But we should not regard these human experiences as symptoms of a mental illness.

Psychiatric diagnoses are not only scientifically invalid, they are harmful too. The language of illness implies that the roots of such emotional distress lie in abnormalities in our brain and biology, usually known as "chemical imbalances".

This leads us to be blind to the social and psychological causes of distress.

More importantly, we tend to prescribe medical solutions - anti-depressants and anti-psychotic medication - despite significant side-effects and poor evidence of their effectiveness.

Start Quote

The criteria for "generalised anxiety disorder" would be significantly relaxed, making the worries of everyday life into targets for medical treatment.”

End Quote Prof Peter Kinderman

This is wrong. We should not be diagnosing many more people with meaningless "mental illnesses", telling them these stem from brain abnormalities, and prescribing medication.

Sex addiction

An extremely influential American psychiatric manual used by clinicians and researchers to diagnose and classify mental disorders has been updated for publication in May 2013.

But this latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual, or DSM-5, will only make a bad situation worse because it will lower many diagnostic thresholds and increase the number of people in the general population seen as having a mental illness.

  • The new diagnosis of "disruptive mood dysregulation disorder" will turn childhood temper tantrums into symptoms of a mental illness
  • Normal grief will become "major depressive disorder", meaning people will turn to diagnosis and prescription as a response to bereavement
  • The criteria for "generalised anxiety disorder" will be significantly relaxed, making the worries of everyday life into targets for medical treatment
  • Lower diagnostic thresholds will see more diagnoses of "adult attention deficit disorder", which could lead to widespread prescription of stimulant drugs
  • A wide range of unfortunate human behaviours, the subject of many new year's resolutions, will become mental illnesses - excessive eating will become "binge eating disorder", and the category of "behavioural addictions" will widen significantly to include such "disorders" as "internet addiction" and "sex addiction"
Stigma of diagnosis

Standard psychiatric diagnoses are notoriously invalid - they do not correspond to meaningful clusters of symptoms in the real world, despite the obvious importance that they should. Diagnoses fail to predict the effectiveness of particular treatments and they do not map neatly onto biological processes.

In current mental-health systems, diagnosis is often seen as necessary for accessing services. However, it also sets the scene for the misuse and overuse of medical interventions such as anti-psychotic and anti-depressant drugs, which have worrying long-term side-effects.

Scientific evidence strongly suggests distressing experiences result not from "faulty brains", but from complex interactions between biological, but more importantly, social and psychological factors.

But diagnosis and the language of biological illness obscure the causal role of factors such as abuse, poverty and social deprivation. The result is often further stigma, discrimination and social exclusion.

Therapeutic approach

There are humane and effective alternatives to traditional psychiatric diagnoses.

It is relatively straightforward to generate a simple list of problems that can be reliably and validly defined. There is no reason to assume that these phenomena cluster into diagnostic categories or are the consequences of underlying illnesses.

We can then use medical and psychological science to understand how problems might have originated, and recommend therapeutic solutions.

This approach would yield all the benefits of the current diagnosis-and-treatment approach without its many inadequacies and dangers.

Prof Peter Kinderman is head of the Institute of Psychology, Health and Society at the University of Liverpool.


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  • rate this

    Comment number 49.

    At what point does a "trait" become an illness? A socially awkward teen is perhaps a fairly ordinary phenomenon - but what if the result is a lonely middle aged person who never got a chance to fulfill their career aspirations and desire for a partner and family. A "disease" must surely be defined by its impact on your chance to live a normal fulfilled life. We are terrible at diagnosing ourselves

  • rate this

    Comment number 48.

    To an extent I would agree that in certain areas there is a tendency to over diagnose mental illness, but there is also in other areas a tendency to under diagnose. Kids with ADHT is one area where they over diagnose, due to the amount of attention focused on kids. However in Britain today there has been a focus on small state and saving money for so long that under diagnosis is occuring hugely.

  • rate this

    Comment number 47.

    I'm not surprised that most people are effected by grief & anxiety in Britain. Life is very hard for the majority of British folk - lack of job prospects, low pay, expensive housing and generally being trodden upon by those in power or/and with money. I and many family members and friends have experience it no matter how hard we work we are still treated like dirt.

  • rate this

    Comment number 46.

    DSM-4 is is regularly used by non-qualified amateur psychologists who construct internet tests and dish out information offering a diagnosis on pretty much everything from having a bad day to an original thought. I think the field of psychology is undermined by this, and with more diagnoses DSM-5 can only make this irresponsible trend of amateur shrinks to label everyone a whole lot worse.

  • rate this

    Comment number 45.

    15 Minutes ago

    Depression causes symptoms which stop you fighting the cause of the depression.


    Yep, if you ain't had 'real' depression, you'll never understand. My family don't see that I can't just 'pull myself together' ..

  • rate this

    Comment number 44.

    As an anxiety sufferer ( Generalised Anxiety Disorder ) , I would never class myself as having a mental illness. Yes I have anxiety, however I am normally sound of mind event though dealing with anxiety on a daily basis. Anxiety is not a mental illness.

  • rate this

    Comment number 43.

    All this confirms my belief in the wisdom of the 12 step methodology that we use at our rehab clinic in Scotland (Castle Craig), where we only use drugs for a few days of detox and the rest of the addiction treatment time -- sometimes as longs as 8 months -- is looking at the psychological issues that surround addiction; depression, low self esteem, anxiety, trauma. Problem is that you need time.

  • rate this

    Comment number 42.

    I am a schizophrenic, a condition for which nowadays I am treated by effective medication, though this wasn't always the case. Side effects are annoying but much the lesser of two evils.
    Obviously grief at the loss of a loved one is not a medical condition, as much as anxiety can be, but Prof. Kinderman has thrown the baby out with the bathwater, much as does, similarly, Rufus May, whom I know.

  • rate this

    Comment number 41.

    I am a mental health nurse consultant assessing and treating patients in an emergency department setting. In my experience the vast majority of people present under their own volition and activelly seek 'labels' in an effort to conceptualize and understand their symptoms. The most common question seems to be "whats wrong with me", rather than "what can I do to feel better."

  • rate this

    Comment number 40.

    Dr. Allen Fraces (one of the chairmen responsible for the release of DSM 4) “DSM5 would create tens of millions of newly misidentified false positive ‘patients’... There would be massive over-treatment with medications that are unnecessary, expensive, and often quite harmful. It's what we have most feared – the inclusion of many normal variants under the rubric of mental illness

  • rate this

    Comment number 39.

    This an area in which there is still a lot of guesswork.
    All I know is, in a dark alley at night I would rather meet a neurotic than a psychotic.

  • rate this

    Comment number 38.

    The clue is in the Professor's name. We need more kinder men and women in our society - and more kindness and compassion towards ourselves. Nurture for the neglected 'inner child' and connection with the life of the spirit and with nature can help us cure all manner of ills.

  • rate this

    Comment number 37.

    I think all this has a lot to do with the commercial practices of the drug companies. They encourage medics and hospitals to prescribe their drugs by rewarding those that do.
    More people who meet the criteria for mental illness means more opportunities to prescribe drugs.
    Yet another example of low morality from companies driven to generate profit for shareholders and nothing else.

  • rate this

    Comment number 36.

    Some years ago I developed a "Floating Anxiety".
    I have heard people laugh at Anxiety as being a debilitating illness.
    What I went through was pure Hell culminating in a very serious suicide attempt and a prolonged stay in a psychiatric ward.
    I was lucky. Through the shear the hard word of my Wife and Doctor I found a medication which helped me. Thousands don't. One dat, it could be you!

  • rate this

    Comment number 35.

    23.Chewho - it was realising the destructive nature of psychiatry that stopped me being a psychiatric nurse. It isn't all the fault of our system, but it is a particularly bad system due to the degree of snobbery in it. But in the end who wants to go to work feeling that you are a device the state is using to perpetuate and hide its worst aspects? Telling people with no food they're wrong stinks.

  • Comment number 34.

    All this user's posts have been removed.Why?

  • rate this

    Comment number 33.

    Farcry 3 gives an insight into mental illness.
    For example, the defination of insanity:
    "doing the exact same "jolly" thing over and over again, expecting "Stuff" to change. That. Is. Crazy.

    And yes, Jolly and stuff have replaced the original swear words in that speech. Wound't want old mother beeb getting their knickers in a twist now would we!

  • rate this

    Comment number 32.

    I laughed when I walked past a room full of "so-called" psychiatrists at a swank hotel in Vienna and noticed the subject of their workshop.... Restless Leg Syndrome. I mean, pull the other one :-)

  • rate this

    Comment number 31.

    Hi BBC, can you add where a professor holds his or her chair ? Google reveals you have a respected Liverpool University professor, but thanks to the American habit of calling all and sundry professor it'd be good to confirm you have a 'proper' one.

  • rate this

    Comment number 30.

    Professor Kinderman - have you so little confidence in your article that you have to try to jazz it up by using "Sex addiction" as one of the subtitles of your piece when it bears almost no relation of that part of the article - or any other part.
    Your report is very interesting but please edit that sub-title with something more relevant rather than just an attention-grabbing tabloid trick.


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