'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 69.

    One problem is that modern society and the state don't give people sufficient time to grieve. Amateur psychologists come up to you and tell you to "pull your socks up", whilst the State believes you can work, when you clearly cannot.

  • Comment number 68.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 67.

    Diagnosed as Bi Polar a few years ago and also suffering from severe panic attacks and anxiety, I get really annoyed with people claiming they are suffering with depression when in fact they are just feeling stressed out. Trust me I would love to swap my condition with someone for just one day to give me a rest. I have to deal with it for the rest of my life

  • rate this

    Comment number 66.

    Anyone who has had a "real" mental illness or who has lived with someone who has will know the difference between depression and feeling low, feeling stressed or really paranoid etc. Those who are ill need help, the others just need to get on with life.

  • rate this

    Comment number 65.

    We're all human, & humans need names for things, it brings comfort (& problematically sometimes unwarranted excuses). It'd be better however if the names could be more accurate, & reflect the huge varying degrees between experiences. I now know how to combat my random unexpected bouts of anxiety, all due to a name, through changes in my diet & habits. YAY to less medication, NAY to less diagnosis.

  • rate this

    Comment number 64.

    We KNOW that the best treatment for social anxieties, grief and low level depression is talking therapies.
    We KNOW that there are long lasting and damaging (side?) effects of anti-depressant and antipsychotic medication.
    We KNOW that there is no evidence to suggest that the Serotonin level of depressed people is depleted (NIMH, 1983 !!).
    This is all about profit by pathologising humanity !!

  • rate this

    Comment number 63.

    Research has found that many "high acheivers" in our society are people who do not feel properly or have emotional "intelligence". It makes it easier for them to insist targets are met which may destroy the lives of their staff.

    I think what many haven't thought about though is the problems which occur when people like that are allowed to much rein. Costs actually go up due to dysfunction caused.

  • rate this

    Comment number 62.

    61. The difficulty is distinguishing a true mental health problem, from an unpleasant or upsetting, but entirely normal emotional state of mind. For example, a teenager undergoing difficult exams at school may feel stressed, anxious or otherwise "low" - but that is normal. Exams aren't very nice, and they produce unpleasant emotional responses.

  • rate this

    Comment number 61.

    Classifying mental health problems and illnesses are really only an aid for treatment. Why is mental health so different from physical health. We all get stomach upsets etc that are mild and treatable and mental health problems can be the same. However, when I was diagnosed with a personality disorder I was elated to understand why I behaved like I did and get treatment to help with it.

  • rate this

    Comment number 60.

    ''...we should not regard these human experiences as symptoms of a mental illness.''

    A comment designed to patronise those that is does not dismiss - a deft trick.

  • rate this

    Comment number 59.

    @50. BdV "Isn't it quite NORMAL to have problems in a dehumanised society ruled by unleashed liberal economics? It is our economy-society which is SICK!"

    Yes,and: "It is no measure of health to be well adjusted to a profoundly sick society." (Krishnamurti) The real nut jobs are those "highly successful" politicians, economists, banksters and CEOs driving the whole sorry show over the cliff.

  • rate this

    Comment number 58.

    54. absolutely. we do not praise or encourage emotional strength enough any more. evolution has ensured that human beings ARE able to cope with stress and difficult emotional situations, however, it is unpleasant and difficult to do so, and requires courage and hard work. some people seek to avoid this by labelling themselves as suffering from a "disorder" or "disease".

  • rate this

    Comment number 57.

    There are different kinds of depression! Our system has a great deal to do with depression. I have been struggling inthe last few days to defend trans people against a journalist who has a strong desire to persecute and tell lies about trans people. It's not the fighting the causes depression, it's when it looks like its a problem that can never be conquered. There is much bigotry in Britain.

  • rate this

    Comment number 56.

    "Peter Kinderman Professor of Clinical **Psychology**"

    If it's al the same to him, I'll listen to the psychiatrists, not psychology pseudo-science. As a carer for someone with moderate/severe mental health issues (I'm no expert, but after 10 years you do pick up a thing or two) I find what Kinderman has to say somewhat simplistic, almost naive.

  • rate this

    Comment number 55.

    mental illness and 'personality disorders' remain problematic. There's precious little scientific evidence for Freud's theories yet they are still used. Cognitive behaviour therapy fails if it explains the problem but the patient still can't change; it's also slow and expensive. However, today's drugs improved my life when nothing else helped. The brain is inescapably a physical organ.

  • rate this

    Comment number 54.

    What is presently offered to people labelled as "depressed" is nothing short of damaging to their long-term welfare. Sympathy is appropriate in given circumstances, but what those who are offered it need more than anything is the good old saying "Pull Yourself Together". All this softly-softly touchy-feely approach does is weaken spirit and resolve, and make the vulnerable more so.

  • rate this

    Comment number 53.

    I still say there are various levels of Anxiety and at its most extreme it is a very serious illness which the average individual cannot cope with un-aided. Everyday worries and stresses are not extreme Anxiety and should not be confused with such. Severe Anxiety can and does kill!

  • rate this

    Comment number 52.

    A friend was unemployed for a while and was (naturally) not in a great place (struggling financially, losing motivation about the job situation). a doctor put the friend on antidepressants. I didn't understand why - obviously it is natural to go feel low when you're in that position. I thought the distinction of "clinical depression" is feeling very low, but without normal emotional cause.

  • rate this

    Comment number 51.

    I don't claim to be an expert by any means but the word depression is probably overused just like when people say they have the flu when they clearly only have a cold.

  • rate this

    Comment number 50.

    This is the next step to generalised 'SOMA': Better buy pharma shares quickly!
    It's all about control, subjugation and division through classificationand dependence. Isn't it quite NORMAL to have problems in a dehumanised society ruled by unleashed liberal economics?
    90% of those diagnosed with depression, etc. are having a REACTION to their environment.
    It is our economy-society which is SICK!


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