2 June 2014
In the last couple of weeks, I’ve had several interesting conversations with clients who have a history of mental health diagnoses such as depression and anxiety. In each case, the client has expressed some doubt over whether their diagnosis was accurate, and consequently, whether the treatment they were prescribed – usually an antidepressant medication; sometimes a mood stabiliser or atypical antipsychotic – was appropriate and helpful for them.
Over my 19 years of clinical practice, I’ve frequently wondered the same thing: how much trust should we place in the labels that are applied to our states of mind when we’re feeling less-than-wonderful, such as ‘depression’, ‘anxiety disorder’,’bipolar’ or ‘borderline personality disorder’?
Are these valid diagnoses based on genuine and meaningful criteria, in the same way that a diagnosis of diabetes is based on your blood glucose level, and reflects a disturbance in your body’s energy metabolism; or a diagnosis of pneumonia is based on a lung x-ray and reflects an inflammatory condition of the lungs?
Or are they simply subjective assessments that reflect assumptions and value judgments that those tasked with diagnosing the patient may not even be aware of?
It seems I’m not alone in my misgivings. No less august a body than the National Institutes for Mental Health (NIMH), the US government agency that provides grants for the study of mental illness, has dumped the “bible” of psychiatric diagnosis, the DSM (Diagnostic and Statistical Manual), which is published by the American Psychiatric Asssociation.
The DSM is one of the 2 manuals used by doctors in Australia to diagnose mental and psychological disorders based on symptoms, descriptions and markers of conditions. From this diagnosis flows a raft of consequences, including treatment plans, provision of special education services to diagnosed children, and even decisions in legal cases.
So why is the NIMH, in the words of its director Thomas Insel, “re-orienting its research away from DSM categories”? Quite simply, because the criteria used for diagnosis of the conditions the DSM describes suffer from a “lack of validity”.
Yes, you read that correctly. The director of the most powerful mental health research funding agency in the world says that the psychiatrists’ ‘bible’ is more like a fairy story than a textbook.
Insel went on to say,
“Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment. Patients with mental disorders deserve better”.
Transforming Diagnosis
The timing of Insel’s announcement was most interesting, coming as it did just weeks before the fifth edition of the DSM (DSM-5) was published. DSM-5 has been widely criticised for turning all sorts of normal human experiences, such as prolonged grief after losing a loved one, and toddlers’ temper tantrums, into ‘mental disorders’.
Which brings me back to the questions raised by my clients. When people are going through an extremely challenging time in their lives – perhaps because of a messy divorce, workplace bullying, caring for a seriously ill or disabled child, the death of a beloved partner of parent, or maybe a whole slew of stressful life events hitting at the same time – is it really helpful to tell them that they are mentally ill, have a ‘chemical imbalance’ in their brain (a totally discredited notion with no basis in science) and require a drug to cure their ‘disease’?
Or does this diagnostic process, in the words of the International Society for Ethical Psychology and Psychiatry (ISEPP),
“assault… self-worth and self-efficacy, and undermin[e] reestablishment of positive life-striving by inducing ‘behaviors to label’ among people who have been so labeled” (2)?
ISEPP goes on to state:
“DSM supports the perpetuation of myths about mental, emotional, and behavioral disturbances in individuals which favor pseudoscientific, biological explanations and disregard their lived context. The evolving editions of the DSM have been remarkable in expanding psychiatric labels for alleged ‘mental illnesses’ with no scientifically substantiated biological etiologies.”
OK, so you might reject the notion that feelings of overwhelm, difficulty with regulating your emotions, or prolonged grief are ‘mental illnesses’, but surely taking an antidepressant or anti-anxiety medication might help you get back on your feet faster?
Unfortunately, research shows the opposite is true. As Robert Whitaker has meticulously documented in his book Anatomy of an Epidemic, putting people on SSRIs, MAOIs, benzodiazepines and other psychoactive drugs actually:
- Delays recovery;
- Worsens their clinical outcomes;
- Increases the risk that their temporary condition will become chronic; and
- Frequently results in them becoming unable to perform their social roles and hold down a job.
(Read the studies that inform Whitaker’s conclusions here.)
One of my clients spoke glowingly of the psychotherapy she received when hospitalised for what, in days gone by, would have been called a ‘nervous breakdown’. She told me still uses the skills she was taught in the therapy process to help her cope with life stresses.
But she also confided that the antidepressant she was prescribed completely changed her personality, inducing aggression and hostility. She had enormous difficulty getting off the medication, and has never felt like her old self since.
Now, I’m not saying that people diagnosed with ‘mental illness’ aren’t genuinely suffering, or that biology plays no role in mental health (see my previous post on the finding that depressed people shown signs of systemic inflammation, for instance).
I’m also not denying that some people feel better when they take antidepressants – although as Irving Kirsch has argued convincingly in his book The Emperor’s New Drugs, careful study of clinical trials of antidepressant drugs indicates that they are no more effective than placebos.
What I am saying is that there are many people who have been improperly and unhelpfully labelled as ‘mentally ill’, when in reality they are having understandable emotional reactions to extreme life stress.
What they need is comprehensive support in establishing a holistic lifestyle plan incorporating
- A nutrient-dense diet (see my articles Good mood food and Want to feel happier? Change what’s on your plate!);
- Regular exercise;
- Restoration of normal sleep-wake patterns;
- Exposure to full spectrum light; and
- Psychotherapy focussed on helping them manage their thoughts and feelings.
I favour Emotional Freedom Technique (EFT) for the latter, as I find it works faster than cognitive behavioural therapy (CBT, which I used before learning EFT), goes deeper in terms of addressing the causes of their emotional distress, and is easier for clients to do by themselves at home in between sessions.
Is depression dragging you down? Do you need skilled and experienced guidance to develop a holistic lifestyle plan to overcome it?
Apply for a Roadmap to Optimal Health Consultation to discover how I can help you get out from under the dark cloud of depression and embrace your full potential for emotional well-being and physical health.
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