The medicalization movement: how real human emotions are being mistaken for disease.
The origin of our emotions can be a great mystery to most of us. However, what may be even more complicated for us to grasp is how they can spiral into such painful extremes and manifest so outwardly in our daily lives. And the unfortunate truth is that we, as a society, have found ourselves part of a system that favors labeling and pathologizing human suffering as disease over allowing us to navigate and feel the emotions as part of an authentic human experience.
In March 2011 a doctor by the name of Richard Morrow conducted a broad study of one million Canadian schoolchildren, observing the medical diagnoses that all children received within a period of one year. He specifically studied those children between the ages of six and 12 who had been diagnosed with ADHD. He found that the boys who were born at the end of the calendar year were 30% more likely to be diagnosed with ADHD than boys who were born at the beginning of the year. For girls, those born in December were 70% more likely to be diagnosed than those born in January. (1) What could be the reason for this?
The answer is simpler than you think. Children in the same year at school have the potential to be almost an entire year apart in their physical age. Which means that girls born in January have 11 months’ advantage in their development over the girls born in December. An 11 month gap at this age in a child’s life equates to a huge difference in mental and emotional maturity.
What Morrow discovered is that younger children in the same academic year were more likely to be diagnosed with ADHD due to their relative developmental differences in maturity, which were being mistaken for symptoms of ADHD. This is but one example of the negative implications of the medicalization phenomenon in the way we categorize and diagnose mental illness.
Medicalization is defined by when a human experience is diagnosed pathological in origin and therefore treated as a medical condition. And it’s a topic that sets the stage for many of the challenges associated with diagnosing, preventing, and treating mental illness.
Psychiatry has been accused more often than any other medical specialization of incorrectly medicalizing the human condition. The concern with mental illness is that it is traditionally assessed based on symptoms alone, and without first analyzing the possible causes of such, which may be due to someone’s upbringing as a child, to their current workplace and career stressors, or to abrupt, yet very real and poignant, traumatic events.
Nadiya was just like any 21 year old who had just moved to New York. She recently graduated from college with a degree in hospitality and management and after moving across the country she landed her first job working for a boutique hotel. She was starting her life, making new friends, and finally began paying off her student loans. Then her mother was suddenly diagnosed with stage IV ovarian cancer, and the life she was leading turned on its head. Nadiya spent the first months struggling with the choice of either staying in New York or leaving everything behind to move back to Sacramento and take care of her mother. She had trouble sleeping, she couldn’t concentrate on her new job, and she stopped answering calls from her new friends. Her indecision to move back home came at a cost — her mother passed away after only four short months of first receiving her diagnosis. Nadiya’s suffering was unbearable, as would be expected for such a terrible loss. One month later, given this loss and the previous months of her outwardly depressive behavior, her friend suggested that she see a psychiatrist. At her first psychiatry appointment Nadiya proceeded to describe her feelings and behavioral symptoms beginning at the time of her mother’s cancer diagnosis.
Diagnosis based on symptoms can be highly problematic. A catalyst of medicalization is the bible of psychiatry: The DSM. The Diagnostic and Statistical Manual of Mental Disorders is used by psychiatrists to diagnose mental health disorders in both adults and children. The latest version, the DSM-5, was published in 2013 by the American Psychiatric Association. An entire book can be written on the history, validity, and overall impact of this manual in the field of modern psychiatry (and indeed many books have been produced on this topic), but in the context of this article it’s important to know that the DSM plays a huge role in shaping our perception of mental illness.
The New York City-based psychiatrist Robert Spitzer, an instrumental voice in the development of the DSM, accurately summarized the problem, “We made estimates of prevalence of mental disorders totally descriptively, without considering that many of these conditions might be normal reactions which are not really disorders.” (2) Which means that Spitzer and the other authors of the DSM cared less about the contextual factors that would contribute to a person’s relative unhappiness and anxiety, and instead favored analyzing the physical symptoms of a particular disorder without regard to the notion that these reactions may in fact be normal, human reactions to difficult life situations.
Back to Nadiya from New York. The psychiatrist diagnosed her with one of the depressive disorders currently listed in the DSM-5: major depressive disorder. For context, the full list in the category of depressive disorders are: disruptive mood dysregulation disorder, major depressive disorder (including major depressive episode), persistent depressive disorder (dysthymia), premenstrual dysphoric disorder, substance/medication-induced depressive disorder, depressive disorder due to another medical condition, other specified depressive disorder, and unspecified depressive disorder. In the DSM-5, to be diagnosed with major depressive disorder, you have to have at least five of the following symptoms in the same two-week period (and at least one of the symptoms must be diminished interest/pleasure or depressed mood):
- Depressed mood: For children and adolescents, this can also be an irritable mood
- Diminished interest or loss of pleasure in almost all activities
- Significant weight change or appetite disturbance: For children, this can be failure to achieve expected weight gain
- Sleep disturbance (insomnia or hypersomnia)
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Feelings of worthlessness
- Diminished ability to think or concentrate; indecisiveness
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide
Nadiya was easily able to check off a number of these symptoms, and she obviously had reported having experienced similar feelings for the past two weeks. In fact, these symptoms had been going on for months now. After her 35 minute evaluation she was diagnosed with major depressive disorder and given a prescription for antidepressants.
That’s all it took for Nadiya’s suffering, that resulting from the loss of her mother, and of all the life changes that come with it, to become medicalized. What is often not counted during these medical evaluations, often not even with a psychiatrist but with merely a general practitioner, are your life circumstances, many of which may not be in top shape. Like Nadiya, you may have experienced an abrupt loss of a loved one, or you may have gotten fired from your job, or you might be lonely and overwhelmed by having moved to a new city far away from home. Or it could be a combination of the three, or any number of difficult realities that come with being an adult human in 2019.
In the DSM-5, the exclusion of bereavement from major depressive disorder was eliminated. Experiencing grief for an extended period of time is no longer considered a normal behavior. The natural feelings of deep sadness, loss, sleeplessness, crying, the inability to concentrate, tiredness, and low appetite after suffering a traumatic loss now warrants the diagnosis of depression if these symptoms continue for more than two weeks.
This also means that Nadiya was now, from an official medical standpoint, considered mentally ill, and was given a course of antidepressants to help alleviate her pain.
Ignoring everyday human suffering and mental and emotional development is at the heart of the medicalization issue. From a seven-year boy in Canada who, by virtue of their November birth month, has been mistakenly diagnosed with ADHD to Nadiya who, while mourning the recent death of her parent, is labeled as having a significant depressive disorder, we see the range of assumptions that the field of psychiatry that the DSM makes and in doing so, contributes to a harmful over-medicalisation of Western society. Are we really all suffering from a pathological mental disease, or are we being told that having human negative feelings are so wrong that they warrant us going down the rabbit hole to a world of medication, social discrimination, and possible isolation from our community as a consequence of extra-special treatment?
Perhaps you or someone you know is suffering right now. There is no doubt that suffering is real — it hurts, yet it is part of what makes us human. But we need to consider if labeling and medicalizing our suffering is society’s way to simplify the human condition. The questions that arise from diagnosing an illness based on symptoms alone are questions that should matter to all of us.
To the medical community I ask, when people are in extreme pain and know that they need to seek support from not only their family and friends but from professionals whom they can trust, how can we use such tools as the DSM to more accurately diagnose people?
To the policymakers, who have the agency in creating a safe space for people who need help both physically and mentally, I ask at what point does medicalization tip the balance between wellness and illness in our society?
And for all of us, how can we educate ourselves so that we are prepared to handle moments that may come to pass where we feel that we’ve exhausted all our other options and we need medical attention? How can we be better enabled to think critically of our diagnosis and subsequent treatment, which may include prescription drug medication?
The purpose of my bringing attention to the history and context of medicalizing human emotion is so that we can be armed with the facts in order to find solutions, on both an individual and a societal level. And the questions I ask matter to us all because as people, we have known and felt pain before. And we can relate to even those who may feel that pain more strongly and more often than others. We are all individuals with different needs, and we have a choice on how we want to move forward on our path to healing.
(1). Richard L Morrow, “Influence of relative age on diagnosis and treatment of attention-deficit/hyperactivity disorder in children,”CMAJ 2012 Apr 17; 184(7): 755–762.
(2). James Davies, Cracked: How Psychiatry is Doing More Harm than Good, (UK, Icon Books, 2013), 47.
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I.ÁM a mental health advocate, writer, community builder, and a proud human in progress. How can I help? I.AM@amaiou.com. More of my projects and writing can be found on my website at http://amandaefthimiou.squarespace.com/.