Manufacturing Pathology

Mental illness stigma often takes the form of dismissing the experience of those living with mental illness, but it can also take a subtler form. When normal emotions like sadness and anxiousness are spoken of as if they are on par with mood or anxiety disorders, this can result in those illnesses being viewed as just a common occurrence who importance is exaggerated. Many people lack the vocabulary and knowledge to be able to to distinguish between occasionally feeling depressed and having a depressive disorder, or occasionally feeling anxious and having an anxiety disorder.

I've seen a couple documentaries recently that got me thinking some more about the issue of creating pathology out of normal human experience. This type of stigma is likely not apparent to the majority of people consuming these types of messages, which makes it even more important for those of us living with mental illness to speak up and differentiate "normal" experience from the experience of serious mental illness.

'The Age of Anxiety'

A Canadian documentary called The Age of Anxiety comments that "The medical definition of what constitutes an anxiety disorder is expanding to include so many aspects of normal human behaviour that we're in danger of turning half the population into psychiatric patients." As part of the film, a group of friends was shown having a dinner party during which they essentially engaged in self-diagnosis based on the Diagnostic and Statistical Manual (DSM). They concluded that most people would meet the diagnostic criteria for an anxiety disorder.

I would argue that it's irresponsible for this to be included in the documentary, as the DSM was never intended to be a check-list for untrained people to diagnose themselves or even society in general. For all diagnoses clinical judgment is required to determine whether any "symptoms" actually result in a pathological level of impairment.

For people who have no frame of reference to contextualize this, the boundary between normal; and disorder can appear very murky. It's not uncommon for the DSM to be criticized as pathologizing normalcy. The fact that homosexuality was previously included as a diagnosis is a prime example of valid criticism. Other concerns are not as valid. When the latest version of the DSM, the DSM-5, came out, many expressed concern that grief was removed as an exclusion criterion for the diagnosis of major depressive disorder. However, the DSM-5 specifically addresses and cautions against this, and it's not realistic to think that anyone who is grieving is likely to be diagnosed with depression.

If there is overdiagnosis occurring, it may have something to do with how physicians get paid. Billing is typically done using diagnostic codes. Insurance plans may have greater coverage for medications than for psychotherapy, which may well affect treatment planning.

According to pharmacy staff interviewed, "about 3/4 of what we have is for anxiety," and it was all for situational anxiety and depression. Whether that is accurate or not (and I suspect not), such attitudes are disturbing.

'Take Your Pills'

The Netflix documentary Take Your Pills focuses on the use of prescription stimulants for the purpose of enhancing mental performance. It presents stimulant misuse as being a common; occurrence on university campuses and in the tech and finance sectors. One millennial interviewed said that it would be impossible to avoid stimulants.

The film implies that ADHD was for the most part something that was created by drug companies as part of their advertising campaigns. The Age of Anxiety made a similar argument for the antidepressant Paxil and social anxiety. However, inappropriate marketing has no bearing on the validity of the medical condition itself, and to make that a direct correlation is simply inaccurate.

Those who should know better sometimes only further contribute to the problem. One researcher interviewed shared that he had tried Ritalin, and it was a very positive experience, which is perhaps not the best thing for a researcher to be saying in a documentary. What is far more disturbing, though, is the psychotherapist who likens ADHD medication to crystal methamphetamine, saying there was only a minor chemical difference between the two. Perhaps unsurprisingly, this psychotherapist seems to have very limited knowledge of chemistry, and does not appear to understand that unlike prescription stimulants, crystal meth is a direct neurotoxin.

Not all of those interviewed talked nonsense. One student expressed concerns about suggestions that everyone has some ADHD, and the effect this could have of delegitimizing the actual illness.

Mental illness is a very serious thing. In the fight against stigma, we need to find a balance between normalizing it sufficiently so that people are willing to talk about it but not so much that it's seen as something that happens to everyone. There is to be something in between everyone has a little ADHD and mentally ill people are violent mass killers. Unfortunately, it's easy for either extreme to overshadow the reality of the illness, making it all the more important that we speak up and share our stories.