
Medicalising everyday life doesn't help anyone's mental health - imperio59
https://www.theguardian.com/commentisfree/2019/jun/24/medicalising-mental-health-ilnness-nhs
======
throwaway55254
I wonder about this as well. I see lists of anxiety symptoms shared and I meet
every one of them, but I don't consider myself to have anxiety. Isn't it
normal to be anxious in stressful situations or to be depressed when things
are going poorly. Then I do some reading about it and I wonder maybe its not
normal, maybe I'm not supposed to feel this way.

I'm sure there are people with mental health conditions that do need
treatment, I won't argue that at all. I do think pinning down what is "normal"
and should be just waited out and what is abnormal and should be medically
treated, although easy at the extreme edges, is very difficult in the middle
of the spectrum.

I agree with the article that we are trying to narrow the normal distribution
of human traits by medicalising things that are a common occurrence for at
least a subset of the population. I'm not sure where this stems from though.
Is it the desire for extreme corporate efficiency and competition for
resources. Is it a misguided medical system trying to make patients out of
more people? Like anything sufficiently complicated its probably a huge
confluence of factors.

~~~
klodolph
Well, first of all, only certain professionals are licensed to administer
those tests, and for good reason, because otherwise people would self-diagnose
too much or too little.

> […] I don't consider myself to have anxiety.

Everyone has anxiety. Some people have anxiety disorders.

> Isn't it normal to be anxious in stressful situations […]

People with anxiety disorders are anxious in normal, non-stressful situations.
They can panic when asking a bus driver which stop they should get off at,
when talking to a new coworker, or in other ordinary circumstances. People
with depressive disorders are depressed at times even when things are going
well. People with severe depression can have a hard time just getting out of
bed in the morning, feeding themselves, and going through the motions of
ordinary life.

~~~
wutbrodo
I don't think this was intended as a general purpose argument against ever
treating mood disorders. Rather, the parent comment is describing the fact
that anxiety and depression are conflated with their corresponding disorders
too often.

I can somewhat relate from experience: I went to a doctor for terrible trouble
sleeping, to the point that it was affecting my physical health, that we
assumed was caused by anxiety/depression[1]. I was pretty shocked at the
rapidity with which she suggested going on antidepressants, particularly
considering the tapering periods and the seriousness of the dependency and
side effects that they cause.

I pushed back a little but it turns out that my doctor's cavalier attitude
towards antidepressants isn't out of the norm: they're considered a "try it
and see what happens" first line of defense, without trying to get a better
sense of the patient's specific issues and whether therapy or other
interventions, sans medication, would be a better fit (though I should note
that the doctor recommended that I go to therapy if possible in conjunction).

Tangentially, this fits with a larger disillusionment I have with the medical
system: a combination of screwy incentives, bad lines of communication between
generalists and specialists, and a serious institutional/cultural case of a
God complex leading to a lack of critical thinking means that I'm at the point
where I pretty much keep anything a doctor tells me as just another unreliable
information source, weighted more heavily perhaps than my layman's
understanding of the research but on categorically the same level.

Ive seen the same disillusionment kick in among my doctor family members: in
our conversations over the years, my sister and her husband have gone from a
central case of said God complex to as much as telling me not to take doctors'
advice without a heavy dose of skepticism.

I should note that I don't actually consider this a criticism of any
individual physicians as much as the realities of the system. One of the
biggest factors is that the average person showing up at the doctor is
simultaneously incredibly dumb and incredibly confident in their understanding
of the medical problem. It makes sense for doctors to be a somewhat heavy-
handed and reductive, and once you build those habits into your institutions
and pedagogy, it's hard to turn it off.

[1] Turns out it was the other way around: consistently not sleeping causes
some pretty crappy psychological problems

~~~
klodolph
> Rather, the parent comment is describing the fact that anxiety and
> depression are conflated with their corresponding disorders too often.

Agreed, and I would say that the answer to this is to have the licensed
professionals guide the diagnosis. Don’t just self-diagnose or read a
Wikipedia page and think you have an anxiety disorder. (It’s a good _starting
point_ and you can take your self-diagnosis to a psych{olog,iatr}ist and
explain why you think you have a particular disorder.)

You hit the nail on the head with poor communication between generalists and
specialists. This is why it looks like drugs are the first line of
defense—because you went to the doctor first. If you had gone to a therapist
first, the first line of defense would have been therapy. The doctor
understands medication as a lever that they can pull, they can guide you
through the process of finding a medication that alleviates your symptoms
without bad side effects, and do it all safely. The doctor generally doesn’t
understand the process of therapy or its outcomes because it’s not something
they administer (except some psychiatrists). I would add that the side effects
of modern antidepressants are surprisingly manageable.

This is reasonable to me. Like if you have complaints about your husband and
talk to a divorce lawyer, you’ll get a different set of recommendations than
if you go to your therapist, your best friend, some strangers online, or a
priest.

Sleep problems in particular are troublesome, because so often they are caused
by a complex set of factors that we have varying degrees of control over. The
doctor’s ability to prescribe you medicine is one of the very limited number
of ways that the doctor can help you get sleep. The other ways to help you get
sleep might involve moving, modifying your house/apartment, changing your
daily habits regarding exercise/eating/alcohol/screen use, therapy,
accommodations at work, or a hundred other things.

I could just as easily diagnose myself with “having a crappy boss” and switch
jobs, but the doctor (usually) won’t tell you to switch jobs. That treatment
option comes with a hell of a lot of side effects, too.

> [1] Turns out it was the other way around: consistently not sleeping causes
> some pretty crappy psychological problems

That may be the case for you, but psychological problems do cause sleep
problems for many people (including myself). There’s often some positive
feedback loop / death spiral involved in any ongoing problem.

~~~
wutbrodo
> You hit the nail on the head with poor communication between generalists and
> specialists. This is why it looks like drugs are the first line of
> defense—because you went to the doctor first. If you had gone to a therapist
> first, the first line of defense would have been therapy.

IMO and IME this is a really bad idea. My experience with specialists is that
they're far, far more myopic than generalists: eg if you have symptoms that
manifest in the feet, podiatrists or foot orthopedists won't solve your foot
problems, they'll provide foot solutions, whether or not these solutions are
relevant or helpful. This stems from the same rotten root of the endemic
myopia and lack of critical thinking among medical professionals[1].

As I mentioned above, the problem didn't even end up being with anxiety, so
going to a therapist would have been worse than useless for me. My complaint
is that my conversation with my doctor was very brief, during which I
mentioned fairly strong symptoms of anxiety, and the doctor was immediately
gung-ho about anti-depressants. I should also note that this was a GP who (at
least nominally) was somewhat specialized in mental healthcare issues, so it's
not like this was throwing a case at a random doctor and expecting them to be
a specialist. On top of that,using a GP as an entry point to the healthcare
system is, roughly speaking, their _only_ job, and what's shocking is how
widespread a basic lack of competency at this sole task is.

> The doctor understands medication as a lever that they can pull, they can
> guide you through the process of finding a medication that alleviates your
> symptoms without bad side effects, and do it all safely. The doctor
> generally doesn’t understand the process of therapy or its outcomes because
> it’s not something they administer (except some psychiatrists). I would add
> that the side effects of modern antidepressants are surprisingly manageable.

I may have failed expressed myself clearly, but this is sort of my point: the
bar that I'm setting is one that I think anyone with fundamental critical
thinking skills could clear, barring a gross case of apathy towards patient
welfare. It's been my unfortunate experience that this minimal combination is
pretty lacking when it comes to doctors, either specialist or generalist. The
notion that a doctor should jump to prescribing medicine because it's all they
know how to do is insane to me, since it completely rules out the possibility
of understanding the patient's case further instead of grabbing whatever
hammer happens to be lying around.

Now granted, I have a fairly limited sample size personally, but I've seen the
same thing play out with family members whose care I've been involved in, and
my empirical anecdota are theoretically supported by conversations I've had
with doctor friends/family over the years. At the very least, I've
_personally_ decided to treat doctors as nothing more than legal impediments
to prescription medicine, an incomplete chatbot UI to medical knowledge, and
an occasional source of novel medical information. This has worked out _far_
better for me than the alternative of assuming that a typical GP has a
baseline of competence (I've made more progress on my sleep issues in the last
year than the previous half decade by taking this approach, and dealt with
some niggling minor medical issues that every GP I've ever had completely
failed to address).

> Like if you have complaints about your husband and talk to a divorce lawyer,
> you’ll get a different set of recommendations than if you go to your
> therapist, your best friend, some strangers online, or a priest.

Just to reiterate, the complaint is not that your best friend would have
something different to say from your priest, but that either of them would
respond with a stock answer instead of listening to you and thinking about it.
If your pastor says "Say ten hail marys" to any person's request for advice,
the problem isn't that he has a narrow view but that he's a shitty priest. If
you can replace a doctor, or a priest, or a best friend with a post-it note or
a first-page Google search, it seems almost tautological that they're somewhat
incompetent.

[1] (though again, I don't think this is because they're dumber than the
average person or anything like that; rather, the institutional pushes in the
other direction that they get are strong enough that the only doctors I know
(sadly, not as a patient) that do think critically about their patients'
issues are the very-intelligent ones that would probably excel in most
fields).

~~~
vinceguidry
> _As I mentioned above, the problem didn 't even end up being with anxiety,
> so going to a therapist would have been worse than useless for me._

I wouldn't go that far. Therapy is a broadly-useful non-medical intervention
that can increase across-the-board mental health. It bridges the gap between
medical intervention, where specialists act as necessary gatekeepers to
otherwise-dangerous courses of action, not that they're always successful at
reducing the danger, and self-help, which is thoroughly hit-or-miss.

There is an established body of psychological research that the therapist
brings you in contact with that the medical community is only tangentially
aware of. Sure, you could read up on this stuff yourself. But it's the talk
therapist's _job_ to know about it. And even if you don't find purchase on
your stated problem, you might find other problems that you didn't realize
you'd had.

If you can afford it or get it covered, I highly recommend regular sessions
for a few years.

~~~
wutbrodo
Yea, I wasn't making a blanket indictment of therapy; I have plenty of friends
who passionately describe it as something that anyone could benefit from, and
I'm inclined to believe them. A combination of a familial mental health
history and some childhood trauma due to same means that I'm sure I'm not a
paragon of mental perfection (but again, no one is). But I don't think it's
unreasonable to say that the time and expense of a treatment that wasn't
relevant wouldn't have been a good thing during an overwhelmingly pressing
medical issue, at the very least to the extent that it was time spent not
addressing or investigating the real problem, exacerbated by the fact that
impaired executive function was one of the biggest challenges of addressing a
sleeping disorder.

------
cs02rm0
I couldn't get a vitamin B12 injection, the materials cost of which is less
than £1 with no negative side effects, more often than every 12 weeks from my
doctor. Despite feeling awful at 8 weeks onwards, to the point of not being
able to work, and better again every time I had the injection.

I didn't care if it was placebo (although why it would be placebo at 8 weeks
but deemed not a placebo at 12 weeks I struggle to understand), I felt I
needed it more often and eventually found a doctor willing to try it. For me,
it works.

What got to me though, is while the doctor wasn't willing to try a vitamin
slightly more frequently, he offered anti-depressants at the drop of a hat. He
couldn't have been more forwards in offering them and didn't take the hint
when I told him I didn't really want them - I had to give him a firm _no_ in
the end!

~~~
ip26
Curious, why do you need an injection? I thought only vegans had issues with
B12, and only if they weren't paying attention to what they ate.

~~~
cs02rm0
I've heard it's possible due to poor diet, but I'm not vegan and even then
it's very rare - AIUI your body stores some 2-5 years worth of what you need,
so if you're low it's probably because your body isn't absorbing it. Which
also means supplements aren't going to work for me.

Why it's not absorbed varies, I was tested for pernicious anaemia which is a
relatively common cause but I don't have that. That seems to be the end of the
line for investigations on the UK NHS, they pretty much just said you can't
get it from your diet, it doesn't matter why, so we'll inject it.

~~~
ip26
It's still worth at least quickly evaluating your diet to check. You probably
know already, but generally speaking B12 comes from fish, meat, poultry, eggs,
and dairy. Nothing else.

~~~
cs02rm0
Thanks, I think I'm in the clear there. I had milk on my cereal which happens
to be fortified with B12, some chicken bite things for a snack, scrambled eggs
for lunch and beef burgers for tea just yesterday. (With some fruit and veg).
That's not an atypical day for me.

That my mother and siblings, and we all live apart, also have it and they
don't seem short of dietary B12 either seems to add to the picture.

------
fromthestart
Alternative take: some mental illnesses, anxiety disorders in particular, are
exacerbated by knowledge of them and their immediate effects. Anxiety is much
easier to deal with when you're not anxious about the fact that you are or
will be anxious.

Maintaining a "stiff upper lip" means learning to ignore unpleasant symptoms,
which can both reduce their frequency and severity. There is usefulness in
"manning up", to use an increasingly unpopular turn of phrase. I disagree with
the increasingly common idea that suppressing one's negative emotions is
generally harmful.

~~~
AstralStorm
It can also increase severity while reducing frequency, or cause transfer onto
others or psychosomatic.

You cannot recommend it without an actual trial, it is not safe.

------
mi100hael
_> One of the things that is most protective to mental health is not to spend
too much of our lives consciously obsessing about it._

That last statement is rather asinine and seems at odds with the rest of the
article. I think it's fair to say negative emotions aren't the same as mental
illness, but ignoring those negative emotions and keeping a "stiff upper lip"
can lead to much bigger emotional problems down the road. There's a middle
ground that involves accepting & experiencing the lows along with the highs as
a part of life.

~~~
cousin_it
> _ignoring those negative emotions and keeping a "stiff upper lip" can lead
> to much bigger emotional problems down the road_

To me, keeping a "stiff upper lip" isn't so much about ignoring negative
emotions, but more about behaving in the right way even when emotions pull you
the wrong way. In my experience, exercising that skill doesn't create
emotional problems, but solves them.

~~~
ozzyman700
This is what I feel is meant by stiff upper lip:

Be like a rocky promontory against which the restless surf continuously
pounds; it stands fast while the churning sea is lulled to sleep at its feet.
I hear you say, "How unlucky that this should happen to me!" Not at all! Say
instead, "How lucky I am that I am not broken by what has happened and am not
afraid of what is about to happen. The same blow might have struck any one,
but not many would have absorbed it without capitulation and complaint."

~~~
AstralStorm
And thus status quo, however evil or bad, is kept.

This stance is immoral in many ethical systems. Not to mention everyone has a
breaking point.

------
hangonhn
I don't know how much he knows about mental health or how it's practice in the
US. But in the US there are things that are classified as clinical and those
that aren't. The DSM-V is a guidebook to those issues and people who make
those determinations has to go through a graduate program (Masters, Ph.D. etc)
with a certain period of training akin to residency (these requirements do
vary from state to state but in California it is fairly extensive and strict).
I can't speak to what's going on in the UK but one can't simply show up to a
therapist or psychiatrist because one's having a bad day and start getting
drugs or some long term therapy program.

------
tylfin
Author seemed to have some valid points - issues that are part of the normal
healing process are being diagnosed & treated via antidepressants.

The part I'm not so sure I agree with is the "system is too jammed up so don't
come," sentiment.

I think if someone is having a hard time & they want to reach out to a medical
professional that's probably for the best.

Unfortunately that does shift the burden onto the system to train
professionals to determine the difference between prescribing antidepressants
or talk and time therapy. It's a lot easier to write someone that prescription
than hear them out.

~~~
rjf72
He's talking from the perspective of the UK, where he is a physician. The
public health system in the UK has been under extreme and increasing stress.
It's underfunded, understaffed, overburdened, and things are getting worse.

In a related article [1], it was mentioned that 70% of children with mental
issues do not receive treatment because lack of resources - high rates of
mental illness mean there's simply not enough healthcare to go around. Even
those that do receive treatment end up facing "unacceptably long waits." The
current ambitious goal in restructuring the system would still leave some 65%
of those with diagnosed medical conditions, without treatment. Wiki also has a
number of decent citations for further information. [2]

When things are provided through public funding there is an obligation of
society to ensure that they are utilized in a sustainable way. If that
obligation is not met, the systems become, quite tautologically,
unsustainable.

[1] - [https://www.independent.co.uk/news/health/mental-health-
cris...](https://www.independent.co.uk/news/health/mental-health-crisis-nhs-
counselling-waiting-time-children-mp-public-accounts-committee-a8721646.html)

[2] -
[https://en.wikipedia.org/wiki/National_Health_Service#Fundin...](https://en.wikipedia.org/wiki/National_Health_Service#Funding)

------
dkarl
Does anyone feel like their scraped knees and head colds are "medicalized"
because there's treatment available and medical terminology for talking about
it? You can take your scraped knee to your family doctor or an urgent care
clinic and get a bandage applied to it, but people rarely do, and having the
option doesn't freak anyone out.

So why are people bothered by their anxiety or reoccurring blue moods being
"medicalized?" As far as I can tell, it's just the stubborn lingering stigma
associated with mental illness. The fact that a person's cold is a physical
illness feels harmless to them, but the idea that they might be suffering from
a "mental" illness, even a mild and common one, feels way more momentous and
scary than it should.

 _Clearly I am not alone in my sense that we have already hit the boundaries
of how far we can sensibly apply the paradigm of mental health as a means of
understanding and addressing human misfortunes._

This is ridiculous. We certainly haven't gone far enough when people identify
"mental health" with an inability to function without professional support.
How ridiculous would it be if people denied having a physical injury when they
had a scraped knee, because they felt denial was the only way to avoid seeing
a doctor? How ridiculous would it be if people didn't brush their teeth
because they didn't want to give up their precious self-reliance to "dental
health" professionals? We reduce our reliance on professionals by applying
knowledge from those professions, not by denying their relevance.

------
astazangasta
I have the greatest problem with this in early childhood. The extent of
psychiatric involvement in the classroom, including drug interventions, is
really alarming. Diagnosis, which is extremely inconsistent and forms disease
categories with extremely thin bases, has a formal place and is required for
special learning dispensations. Future generations will look back in horror at
all this.

------
ficklepickle
I have never seen a group of less mentally-healthy people in my life. Mentally
healthy people don't drink that much.

The whole stiff upper lip nonsense is the problem. Neglecting and suppressing
emotions for long periods of time cause mental health issues.

The problem is that we don't have a clue about mental health in general, the
blind are leading the blind.

Antidepressants don't cure depression. In fact, they can make it harder to
process emotions. They reduce the symptoms and make it easier to ignore the
environmental issues that are causing it.

Actually treating depression requires understanding and addressing the true
cause. And the true cause is not a chemical imbalance or people not being
tough enough.

Self-pity or using issues as a crutch does not help, but it is also not the
cause.

------
namirez
Reminds of this paragraph of Mark Fisher in Capitalist Realism:

"I want to argue that it is necessary to reframe the growing problem of stress
(and distress) in capitalist societies. Instead of treating it as incumbent on
individuals to resolve their own psychological distress, instead, that is, of
accepting the vast privatization of tress that has taken place over the last
thirty years, we need to ask: how has it become acceptable that so many
people, and especially so many young people, are ill? The 'mental health
plague' in capitalist societies would suggest that, instead of being the only
social system that works, capitalism is inherently dysfunctional, and that the
cost of it appearing to work is very high".

~~~
YorkshireSeason
Mark Fisher's entire work can be summarised without much loss by saying _"
It's all capitalism's fault!"_ How is this interesting? I met him personally a
couple of times, I don't think he would have been able even to say what e.g.
fractional reserve banking was, or the labour theory of value, not to mention
Böhm-Bawerk's famous critique.

Anyway, since I've just violated _de mortuis nil nisi bonum_ , let me finish
by saying that Fisher had good taste in music.

~~~
namirez
I just know that in our economic system, humans are capital and anything that
compromises their economic productivity is pathologized. Who Fisher was or
what he did is irrelevant to this discussion.

~~~
YorkshireSeason
Soldiers, children and old-age pensioners are not productive, yet not
pathologised.

Whole swathes of jobs are not truly productive, e.g. marketing and
advertising, psychologists, priests, yoga-teachers.

~~~
namirez
Aging has surely been pathologized. Childhood is an inevitable stage of
development but the prevalence of ADHD and learning disabilities indicate how
we have defined our priorities.

~~~
YorkshireSeason
Aging and death was considered unpleasant long before the emergence of
'capitalism' and will be long after its demise. Indeed the very word
"pathology" is from Greek, πάθος (páthos, “disease”) and -λογία (-logía,
“study of”). Both ADHD and learning disabilities are merely new names for
ancient concepts:

\- ADHD = boredom

\- Learning disabilities = stupid

Again, no connection with capitalism.

------
sewercake
Could it be that people aren't _just_ becoming more sensitive, but that
aspects of modern society are _causing_ mental health issues to appear at
higher rates? I won't say 'capitalism is making everyone mentally ill', but it
does seem that a large blind-spot in most discourse around mental health is
environment. In this sense, 'medicalising' everyday does, in fact, provide a
useful lens to examine mental illness.

Just food for thought.

~~~
sosborn
I would bet that the higher rates are about mental health issues becoming more
widely known and less stigmatized.

~~~
ozzyman700
Would you tend to feel that mental health issues are a result of nature, and
not nurture then?

~~~
sosborn
I think it is a mix of both, but I also feel that we are much better at
nurturing than we used to be.

------
dreen
A friend of mine is affected by this, combined with her innate hypochondriac
tendencies it makes her life very difficult and her sense of self-worth and
confidence very low.

However, I am at a loss as to how to approach her to help her. Trying to
convey this to her would sound more like an accusation of hypochondria.

~~~
klyrs
This sounds very much like my ex. I thought I could help them. For a long
time, I did... think I was helping. When a sequence of tragedies struck, I
found myself needing help. We deteriorated quickly, as their self-worth was
propped upon mine, which was defined in large part by my ability to help. We
didn't have external support and we both crumbled.

I wish I could tell you how to help your friend. What my spouse needed was
therapy from a professional, who could maintain appropriate boundaries -- I
wasn't, and couldn't.

The awful thing I learned about 'hypochondria' is that psychosomatic effects,
and stress, can have real physical consequences. I never did learn how to
navigate that conversation without causing distress

------
coffeemug
Alternatively: we can stop referring to these as medicines and treat them like
iodized salt, fluoridated water, or cell phones. They seem to be completely
safe in short and long term. They make people’s lives better. How do you tell
articles like this apart from luddite stigma?

------
rjvehn
It is sad that British society is losing the belief in a stiff upper lip.

I think it is becoming accepted to make excuses everywhere. For individuals
and groups, it is now seen as as okay to not to aim higher.

There are so many hard working people who were never handed anything, have
actual physical disabilities, and they still work extreme hours to take care
of their families and not be a burden.

I always think of how we construct Kobayashi Marus to tell ourselves and
others that there are no-win scenarios, in some odd attempt to justify
limiting ourselves to only grim options and schadenfreude for those who fail
to echo acceptance.

What if this belief in a gritty realpolitik is an excuse for not wanting to
think harder to achieve what is right? That individuals and groups willingly
believe in a local maxima, because the hill climbing required to get the right
outcome is accepted as fantasy?

~~~
Dumblydorr
What's your point? Is your thesis that those with mental illness make excuses
everywhere?

~~~
rjvehn
My point is that excuses are being legitimized.

