The impact of labelling and biomedical therapies
As we know, one of the many barriers to recognizing, understanding, and treating psychological disorders, or mental health issues, is stigma. Thankfully, it is becoming increasingly clear that many psychological disorders and diseases of the brain have biological, social, and psychological explanations, and are not failures of character.
However, as we engage with this project of increasing mental health awareness, there are factors which must be considered in order to avoid potentially harmful results. The first is labelling. Labelling a disorder is crucial because it enables professionals to categorize and apply appropriate treatment. One tool psychiatrists use to classify and diagnose psychological disorders is the American Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, updated in 2013 (DSM-V).
Labelling is a necessary step towards the treatment of psychological disorders, but it can also bias our perception. For example, between 1930 and 1960, dissociative identity disorder (DID, formerly known as multiple personality disorder) was diagnosed only twice in North America per decade. In the 1980s, when it was added to the DSM-V, the number of diagnoses increased to more than 20,000. The average number of personalities per patient also increased from three to 12. Of course, other variables, such as an increased awareness and recognition of the disorder, may have caused this increase. But DID is a controversial example, and many professionals are sceptical that DID is even a genuine disorder. If this is the case, then many have been prescribed medication who do not need it. Regardless, it shows that labelling can have a powerful influence on the prevalence and diagnosis of psychological disorders.
Second, over-diagnosis can be a major caveat to diagnosis and treatment of mental illnesses. For example, similar to DID, in the decade following 1987 the proportion of American children diagnosed and treated for ADHD nearly quadrupled. Many argue that an energetic child in an unstimulating school environment will often lead to ADHD over-diagnosis. The problem with over-diagnosis is that these powerful anti-depressant or anti-psychotic drugs can cause adverse health effects in the long-run, and prescribing them to adults or children who don’t need them could result in avoidable health issues. Critics also note that the use of medication for certain disorders may only treats the symptoms and not the problem itself. In the case of children with ADHD, prescribing drugs that enable them to sit all day, instead of first providing a stimulating learning environment, may be detrimental.
Many are also unaware that common symptoms of disorders such as depression or anxiety can be treated with the same effectiveness as anti-depressants (depending on the severity of the disorder) by simply making healthier life-style choices, such as proper nutrition and exercise habits. This is especially relevant in a university context. The university lifestyle is often defined by poor nutrition, high-stress, lack of sleep, lack of exercise, and an over-consumption of alcohol – factors known to increase one’s risk for disorders such as depression. It is therefore inevitable that many students will suffer from symptoms of depression or anxiety at some point in their academic careers, so it is important to stress that milder forms of such disorders can be successfully treated without the use of medication.
An increased awareness, recognition, and treatment of mental health issues should not equate to an increased use of medication. While the use of medication may increase with more recognition of severe cases of mental health, medication should be a resort for only the most severe cases. It is important to recognize the relevance of a healthy lifestyle in relation to mental health, but it is also important to recognize that healthy living is not a panacea for all mental health issues. Many with severe forms of psychoses or mood disorders, who would otherwise continue to suffer needlessly, have found great relief in medical treatment. There is a place for biomedical therapy in our discourse and treatment of mental health; we simply need to be aware of the risks and the limitations.