• Frank Furedi
  • Frank Furedi
  • Sociologist, commentator and author

Individual difference suffers in the neverending explosion of mental illness

You may be suffering from a mental illness that you never realised existed. The American Psychiatric Association has just published a draft version of the updated edition of its Diagnostic and Statistical Manual. According to this diagnostic bible, called DSM-5, shyness in children and confusion over gender is likely to be labelled as a mental disorder.

The eccentric loner, the incomprehensible maverick or the shy stranger lacking in social skills have become candidates for the psychiatrist’s couch.

Those of us who are lonely are not just faced with an existential problem; they can now be diagnosed as suffering from chronic depressive disorder.

So too could people who have experienced the sadness that inevitably accompanies bereavement. Those who like to fantasise and frequently think about sex may now be diagnosed with hypersexual disorder.

Virtually every bad habit now has a psychological label. It is proposed that “gambling disorder”, “oppositional defiant disorder” and “internet addiction” be added to the constantly growing list of mental health labels.

As Simon Wessely of the Institute of Psychiatry at King’s College London reminds us, it is easy to forget that there was a time when you could count on one hand the number of mental disorders. By 1917, the American Psychiatric Association recognised 59 disorders. The number rose to 128 in 1959. Since that time there has been a veritable explosion of disorders, rising to 350 in 2000. With the proposed expansion of the number of disorders it is likely that mental illness will become the new normal.

Even former advocates of the DSM have become disturbed by this manual’s promiscuous definition of a disorder. Allen Frances of Duke University, and chairman of the committee that oversaw the previous DSM revision, noted that DSM-5 would “radically and recklessly expand the boundaries of psychiatry”. He stated that it is likely to result in the “lexicalisation of normality, individual difference, and criminality”.

The proliferation of mental health diagnosis has important consequences. It has helped create a worldview where increasingly the problems of everyday life are interpreted as expressions of mental health deficits.

The manner in which emotional problems have become diagnosed as a form of disorder raises questions about the ability of the individual to deal with disappointment, misfortune, adversity or even the challenge of everyday life. And when people are continually invited to make sense of their troubles through the medium of therapeutics it severely undermines their resilience.

Once the diagnosis of illness is systematically offered as an interpretative guide for making sense of distress, people are far more likely to perceive themselves as ill. That is one reason why in Australia the number of adults on disability because of a psychiatric disorder increased from 140,965 in 2001 to 227,420 in 2010. The rapid increase in the number of Australians who perceive themselves as stressed expresses a similar pattern of increase. The explanation for this trend lies not in the fields of epidemiology, but in the realm of culture that invites people to classify themselves as infirm.

In January last year, navy reservist Surgeon Commander Doug McKenzie attacked what he called the “mental illness gravy train” that was manipulated by Defence personnel. This senior military medic sought to expose the epidemic of post-traumatic stress disorder that was sweeping the military.

He claimed that as much 90 per cent of mental illness pension claims could be false.

No doubt McKenzie pointed to a disturbing tendency to gain benefits through playing the system. However, the individual demand for financial compensation for psychological pain is also underwritten by powerful cultural and institutional forces that legitimise such claims. If you go on the website of the Police Association of NSW, you will read about PTSD: “The silent epidemic destroying the careers of hundreds of Australian police every year”.

The website does not simply provide a dramatic health warning, but also directs police officers who “would like to speak to someone regarding PTSD” to a 24-hour crisis support group. No doubt the provision of this information is designed to raise awareness of a potential problem. But a warning of a silent epidemic is likely to dispose many to interpret their everyday distress in a way not dissimilar to the individuals that McKenzie warned about.

“Helpful” warnings about an impending mental health crisis inevitably influence the way people respond and handle adversity. So was it really necessary last April for Rural Mental Health Australia to issue a warning that PTSD caused by Queensland’s summer of disasters has led to an epidemic of suicide in farming communities? Such claims are not only speculative, but by normalising the act of suicide they actually overlook the potential for resilience in communities facing hardship.

Indeed, scaremongering about a future crisis of mental health has become a regular theme of the campaigning literature of advocacy groups. So last August, a report from the Climate Institute warned that climate change would have a devastating impact on Australian people’s mental health. It claimed that “the emerging burden of climate-related impacts on community morale and mental health-bereavement, depression, post-event stress disorders, and the tragedy of self-harm - is large, especially in vulnerable rural areas”.

The reality is that the relentless promotion of the idea that Australians face an epidemic of mental health problems can become a self-fulfilling prophecy. Such warnings encourage people to develop a heightened sense of powerlessness and fatalism. People can become discouraged from developing their own emotional and moral resources to deal with their problems and come to understand their circumstances through the metaphor of a diagnosis.

After all, in a world where we all struggle to make sense of life, a diagnosis through the DSM bible at least has the merit of providing a definition.

Paradoxically, the rise of therapy culture does a disservice to those who are genuinely mentally ill.

The promiscuous expansion of diagnosis trivialises the condition faced by the mentally ill. It also diminishes our capacity for resilience - which is why we need to be sceptical towards this year’s super new disorders.

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