There is an old adage that when the only tool you have is a hammer, all problems start to look like nails. The rise of the medical model over the last 50 years has increasingly made every problem people have a medical “nail” and hence solved by the “hammer” of a pill.
The latest human “nail” is nomophobia, which is a fear of being without your mobile phone. A British survey showed 66% of people fear losing or being without their phone. Most people have some anxiety about losing possessions whether it is their phone or car or wallet. It is hardly an illness.
And yes some people like to have their phone nearby 24/7. It does not appeal to me but it is not a disease, which requires “treatment” which in severe cases includes medication.
Interestingly the pharmaceutical company Pfizer has just withdrawn an application to have an antidepressant (Pristiq) approved for use in menopausal symptoms. Menopause is not a disease either. It is a part of life. Whilst some women experience symptoms, which are quite real, once again this does not constitute medical disease.
We also know many women suffer symptoms in the lead up to their monthly period. Terms like Pre menstrual stress or tension describe these phenomena. Again it is quite real but not a disease. Yet there is a push to list Premenstrual Dysphoric Disorder (PMDD) as a disease.
Oppositional defiance disorder (where a child disobeys parents or acts in an annoying way) is also not a disease but is already listed as such.
This trend is getting out of hand with the fifth edition of the psychiatry bible (the DSM V due out in 2013) expected to add many new “nails” into the mix. Reuters reports; “Many people who are shy, bereaved, eccentric, or have unconventional romantic lives will suddenly find themselves labeled as mentally ill,” said Peter Kinderman, head of Liverpool University’s Institute of Psychology at a briefing in London about widespread concerns over the manual.
“Conditions” like apathy disorder and internet addiction are but two additions currently being considered. Some people are apathetic and some spend too much time on the internet. These things exist but are not diseases or disorders. Hence they do not need a medical solution.
Furthermore providing medical labels can cause two additional problems.
Firstly it allows people to absolve themselves of any responsibility for their actions. It is not up to me to get off the couch-I have apathy disorder. This is a convenient medical excuse to not take responsibility for ones action if ever there was one.
Conversely a label can stop people looking for the real source of the problem. This is best demonstrated in ADHD where the label once applied means a child can be drugged and no further effort need be made to find out what the real needs of the child are. And this is despite the fact that the drugs are not a “cure” and there is no long-term benefit to those taking them.
David Pilgrim of Britain’s University of Central Lancashire said on Reuters it was “hard to avoid the conclusion that DSM-5 will help the interests of the drug companies. Madness and misery exist but they come in many shapes and sizes,” he said. “We risk treating the experience and conduct of people as if they are botanical specimens waiting to be identified and categorized in rigid boxes.”
Another sign of things getting out of hand is that students are “faking” ADHD symptoms so as to get prescriptions for amphetamine like drugs. Whilst not a cure for anything, these drugs can improve concentration and are seen as a form of performance enhancement for students wanting to enter institutions like Harvard. In sports, use of any performance-enhancing drug is outlawed but somehow in academia it is OK.
Having the label of a “disease” adds “legitimacy “ for use of medication or provides an “excuse” for bad behaviour. The sting in the tail for those happy to have a label applied where none applies is that job prospects and insurance can be affected. For children putting a label of disease on them can alter their view of themselves and impact self-esteem. Hence not only is the label not helping, it can make things worse.
Human existence has a breadth and depth. Included in this are good times and bad. Some experiences are enjoyable whilst others may be painful. It is these latter ones, which provide lessons and opportunity for growth.
We all have problems in life. They are not all diseases and do not need labels and pills.
Medical Doctor, author, speaker, media presenter and health industry consultant, Dr Joe Kosterich wants you to be healthy and get the most out of life.
Joe writes for numerous medical and mainstream publications, is clinical editor at Medical Forum Magazine, and is also a regular on radio and television.
Joe is Medical Advisor to Medicinal Cannabis Company Little Green Pharma, Chairman of Australian Tobacco Harm Reduction Association and sits on the board of Arthritis and Osteoporosis WA. He is often called to give opinions in medico legal cases.
He has self-published two books: Dr Joe’s DIY Health and 60 Minutes To Better Health.
Through all this he continues to see patients as a GP each week.