Signs of the Apocalypse: When We Are All “Mentally Ill”

BBC News offers an article on the upcoming release of the new version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and a number of concerns associated with it.  One of the largest concern it seems is the potential that it is too broad in defining mental illness and that it could risk putting just about everyone in some degree of classification.  The DSM is a very important tool for modern psychiatry and psychology and it seems important that the fields of medicine and science have a way of determining potential mental ailments, but is there not a great risk in a too broadly encompassing categorization?  I want to note, that I write this post as a “Signs of the Apocalypse” not trying to suggest that mental illness itself is an apocalyptic harbinger (I take the whole topic of mental illness very seriously), but instead that issues in classification can have a number of negative repercussions that can very possibly drastically effect our society. 

So what is the exact risk of over classification of mental illness?  Isn’t it true that there are a number of major mental illnesses that pose serious issues for individuals and society?  Shouldn’t the aim be to treat the broadest range of ailments?  It would seem that psychiatry, as a medical science, has assumed a noble goal of offering treatment and comfort of those who suffer from various mental health issues.  In many areas this has proven successful and beneficial. However, the science and study of the mind is still a relatively young field and there is much for humanity to still learn.  Unquestionably there are many people who suffer the terrible effects of mental illness and a desire to provide them with aid is a good cause.  But a big problem is determine just how debilitating a mental illness is, and just how necessary treatments might be.

Mental illness is different that other ailments, like infectious disease or injury, in that the exact nature can very well be elusive, and treatment may vary greatly.  Mental illness is not like a cut that can have  a band-aid thrown on it, or a cold for which some cough medicine and good rest can help get rid of it.  The wide variety of mental illness symptoms and effects can make them difficult to treat in traditional sense.  Pair with that continuing debate on causes and diagnosis of mental illnesses and we have a dizzying experience.  The risk of too broadly categorizing is that then there must be questions asked about providing treatment and providing comfort and aid.

What concerns me (and has concerned me for some time) is where is the line?  What constitutes a diagnosable mental illness versus just a personality oddity or quark (or is there really any difference at all)?  Thinking pragmatically I’d say that first and foremost we consider mental illnesses in regards to risk factors (for both the individuals and society as a whole).  Does  a certain mental illness present real possibilities of causing harm to the individual afflicted or those around them? Note that harm does not necessarily, in this case, need to be physical, but can include, and is not limited to, issues like causing social stresses, issues to functioning in society, family issues, etc.  If the risk factor for harmful consequences of a mental ailment are present then there becomes a pertinence of offering forms of treatment and relief.  But considering that, what then do we make of possible mental states that might be defined as “not-normal” but are also not posing any certain rick of harm? Do we have to assume that all mental variances are potentials for risk?  And if so then do we proceed with a universal approach to treatment?

The concept of “normal” is one that is often tied to mental health but a very real problem with it is deciding just what “normal” is.  Some mental illnesses are better known and understood.  Illnesses like bipolar disorder or schizophrenia have been long studied, diagnosed and provided with a range of treatments.  They are seen as being outside the scope of “normal.”  But what are we to make of classifications like “mixed anxiety depression, psychosis risk syndrome and temper dysregulation disorder” (as mentioned in the BBC piece)?  certainly the DSM will contain clarification of what these terms refer to, but are we too willingly pushing the envelope of what is not “normal?”

Defining “normal” in regards to mental states and processes is made partially difficult (if not impossible) in that we can never know, with full certainty, just what other people are thinking.  Thus we rely on social consensus to agree upon what things are or are not “normal” or otherwise.  Now an issue like a person talking to a non-existent person might immediately throw up some flags of “non-normalcy.”  And if we rule out that they are just being silly (basically we conclude that they honestly believe that they are talking to somebody who is not actually there), then we can address issues of how this might produce negative effects (or potential for harm).  But what about somebody who feels stressed out on occasion, or looses his or her appetite, etc.?

How far does an action or presentation have to go before it crosses a threshold from maybe just being odd or irregular, to being “not-normal” and a potential mental ailment.  I mean all of these as serious considerations.  At what point to we deem some form of treatment necessary?  I am honestly curios.

I am also a little concerned.  I don’t want to say that I am universally against medication, but I do count myself as being somewhat skeptical of what often seems to be our cultures great reliance on “popping pills” as panaceas.  certainly some medicines provide benefits, but many also pose very real risks.  If too broad a definition of mental illness is applied could that further contribute to more medication use?  And is this a good or bad thing?

Honestly, considering all of this while I write, I think I am really looking to see what other people are thinking.  Leave me a comment, keep the discussion alive (but keep it respectful please, especially considering that this is a very real and potentially sensitive subject matter).

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~ by Nathaniel on July 28, 2010.

3 Responses to “Signs of the Apocalypse: When We Are All “Mentally Ill””

  1. Is the broadening of the definition of “mental illness” a very clever way to justify locking up anyone whose behavior is not “normal”?

    I am now taking off my tin foil hat and going to smoke.

    • It is definitely something that I think would be a risk. Unfortunately just the term “mentally ill” carries some heavy stigmas with it and can cause people to react in a number of ways As the BBC points out, there is concern, especially about the effect of informing some people that they may have a form of mental illness, as such an act could cause more problematic implications than the “illness” itself was.

      And it is a concern that when we too rigorously try to set the terms of “normal” that those who do not fall within the percieved norm can be persecuted. Look at Germany prior to the 1940s . . . they paid a lot of attention to the concept of what it meant to be “normal.” Hitler had no qualms having people sterilized and removed from society for failing to meet the Nazi standards of “normal” (not to mention, of course, the holocaust itself). Now, of course, Nazi Germany is an extreme case, and I think, as a whole, our medical professionals work with the utmost adherence to ethical values to avoid causeing addition issues for patients caused by bias and misunderstanding. But still, the idea of the risk inherent is definitely worth thinking about.

      Thanks for the comment.

  2. Particularly relevant (and almost eeriely timely) I found that my RSS reader had a feed link from the Standford Encyclopedia of Philosophy for its article on “Philosophy of Psychiatry.” It is well worth the read to get a good philosophical perspecive on a lot of what is discussed throughout this post. Particularly valuable is section 2.2 “The DSM Conception of Mental Illness And Its Critics.” Anyways, just thought I’d pass it along for those who are interested.

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