'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 329.

    "126. Martin
    As a neuroscience student I was told to skim through the DSM to identify how many mental illnesses I suffer from. I found 7."

    Try reading the first chapter of "Three Men In a Boat" - the author describes skimming through a Medical Dictionary:

    "I plodded conscientiously through the twenty-six letters, and the only malady I could conclude I had not got was housemaid’s knee."

  • Comment number 328.

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

  • rate this

    Comment number 327.

    There is a 'no-mans land' between GP's and mental health professionals that many, if not tens of thousands of people, would greatly benefit from. It is slowly but surely becoming accepted that there is this gap in the medical world, however neither set of these professionals are the ones to provide it. Our GP's can't do it and now the US suggest medication. Wrong, we need another form of help.

  • rate this

    Comment number 326.

    PTSD, OCD, anxiety or even obesity and gambling addiction are now viewed as psychiatric disorders requiring treatment.

    The NHS can't afford to treat these people along with treating people with major depression, bipolar disorder and schizophrenia.

    Counselling is expensive and limited so most get (inadequately) treated with drugs but serious psychiatric illness deserves more attention.

  • rate this

    Comment number 325.

    we should attempt to indeed distinguish real mental disorders from common negative states brought about by, for example, bereavement. But attempting to bring too many negative states into the normality of life, it s precluding access to help for those people who really need it. Without drugs (medication) I would not have been able to survive enough to get myself to a PC to type these words.

  • rate this

    Comment number 324.

    306. PaulRM - BiPolar treatment with lithium works just some patients have problems where the dosage has to be adjusted. For individuals with truly manic/depressive disease and their families it is a miracle drug.

    By true BiPolar, person I know who had it fluctuated between light-speed energy & spending weeks at a time in a room in the dark.

  • rate this

    Comment number 323.

    One of the biggest problems for anyone suffering from grief and being able to get over it (and any depression that happens) is of feeling totally alone and not being able to express how one feels. There is a need out there for some form of help and support which someone can turn to. Bottling it up and trying to 'pull oneself together' may just cause mental health problems later in life.

  • rate this

    Comment number 322.

    We are all 'normal' in acceptable society. This report suggests that it''s just the paid doctrines of society that consider some of us more 'normal' than others?
    Speaking as somebody who's parents literally took it in turns to get E.C.T and were incapacitated by drugs throughout their lives and my childhood and currently analyses blood samples from post mortems, it is the norm.
    Why stigmatise?

  • rate this

    Comment number 321.

    To be afficted with a depressive psychological condition is a terrible fate .

    However, we need to beware of creating new pseudo conditions which in reality are part of the normal range of the human condition.

    'Pulling oneself together' maybe an age old adage but it remains valid. Let's not kid others into a reliance on others.

  • rate this

    Comment number 320.

    My personal experiences of coping with grief and what appeared to be depression which followed relied upon the 'pull yourself together - keep a stiff upper lip' regime that I assumed one had to use to get over it. Time has passed and I thought I was well over my condition. However like many people every now and again something triggers a 'mini' version to return.

    I should have got treatment.

  • rate this

    Comment number 319.

    So glad this is being given the courage it deserves. I gave a TED talk recently about how grief is not depression. I also talked about how antidepressants do not "cure" grief and that grief needs no cure. http://www.youtube.com/watch?v=juET61B1P98

  • rate this

    Comment number 318.

    I've got several mental conditions & it's helpful to me to know what the hell I've got wrong with me. I have anxiety, depression, phobias, compulsions & suicidal tendencies. And dyspraxia. I wouldn't be alive if it weren't for drugs, which I will probably have to take for life. All because my maternal family were abusive in all manners. Diagnoses mean I can explain to people why I'm so weird.

  • rate this

    Comment number 317.

    Quote Prof Peter Kinderman: "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"

    Very worrying when professionals doubt their own profession.

  • rate this

    Comment number 316.

    // 314.
    6 Minutes ago

    After all he did and wrote Darwin did get into heaven, but God said he had to go as monkey ... //

    That will be why he is rolling around on the floor laughing at us then. Got rid of all the baggage and can now see the truth of what we have become :)

    Also goes to show what a vindictive Lord so many feel the need to create from pure thought.

  • rate this

    Comment number 315.

    309.Simon Attwood
    "While the present system is flawed, the main flaw is in its interpretation and that's a human flaw."
    Did you read what I said ?
    The alternative exists already, but BIG BUISNESS and POWER are involved so things are going to get nastier.
    It's all about CASH NEXUS, POWER, and CONTROL.
    Where's the altruism, the care, the honesty, the empathy ?
    Do you think our society is 'healthy' ?

  • rate this

    Comment number 314.

    After all he did and wrote Darwin did get into heaven, but God said he had to go as monkey ...

  • rate this

    Comment number 313.

    'Grief and anxiety are not mental illnesses'
    By Peter Kinderman
    truly excellent article,I know the suffering I have experienced with mental health problems.& to all those quick to criticize people like me,I would just say I would not wish my experiences on my worst enemy!I have taken every anti depressant and anxiety drug on the market.?the psychiatric help I have received as been at best poor

  • rate this

    Comment number 312.

    Given that nearly everything now has a medical label I wonder how the human race ever got off the Serengeti and evolved any form of social structure to deliver us to today!

    Darwin must be rolling around on the floor laughing ;)

  • rate this

    Comment number 311.

    Recommended reading on how the DSM works: Shyness How Normal Behaviour Became a Sickness by Christopher Lane.

  • rate this

    Comment number 310.

    243 little_old _me
    All I said was that counselling and intervension may not work in all cases and the stiff upper lip and soldering on can have a lot going for it.
    I never said they were cures for clinical depression. I didn't even mention clinical depression.
    Also I am entitled to my opinion whether I know something about it or not.


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