Saturday, 18 May 2013
by Frank Furedi
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has just been published and the contents of this book should really be of interest to you. The DSM is not simply a medical handbook that provides a list of conditions worthy of the diagnosis of mental illness. It is also a secular bible that instructs people how to make sense of their predicament through the language of medicine.
With every edition of the DSM, the number of conditions diagnosed as a problem suitable for psychiatric intervention expands. You, dear reader, may be suffering from a mental illness that you never knew existed. So if like me you really get angry now and then, the DSM suggests that you may be suffering from “disruptive mood dysregulation disorder”. Or if you have the occasional senior moment, you may well be afflicted with the new diagnosis of “mild neurocognitive disorder”. And if you really feel anxious and scared about experiencing pain and discomfort, you may have “somatic symptom disorder”.
The eccentric loner, the shy stranger lacking in social skills, the naughty child, anyone who eats too much or the sexually confused teenager have all become candidates for the psychiatrist’s couch. What’s important about the DSM is that it provides a language and narrative through which the problems of existence become medicalised. And in a world where a medical diagnosis represents a claim for resources, what the DSM says really matters. The verdict of the DSM not only affects insurance and drug companies interested in their bottom line but also anxious parents who rely on a diagnosis to gain special help for their child.
Not surprisingly, the latest edition of the DSM has become a subject of controversy. Different groups of medics and psychiatrists have questioned the scientific reliability of some of the new diagnostic categories. Some have queried the dropping of the category of Asperger’s syndromeand the decision to include it under a general autism diagnosis. Others argue that the psychiatric lobby has become a captive of the pharmaceutical industry. But what is not at issue is the ethos of medicalisation promoted through this influential manual.
The term medicalisation refers to the cultural process through which a range of human experience is reinterpreted through the language of medicine. In recent decades, many everyday experiences have become redefined as issues of health that require medical intervention. Through reinterpreting existential problems such as loneliness, shyness, fear, anxiety, loss of control or grief as medical ones, the meaning people attach to them fundamentally alters.
Medical problems require treatment and rely on professional intervention to cure the patient’s illness. But why should grief or shyness or even anger be treated as a disease? And why should professionals possess a monopoly on how to interpret the pain and disappointment that people experience at different stages of their lives? The real threat posed by the expansion of mental health diagnosis is that it takes away from people the confidence that they need to make sense and give meaning to their personal experience.
The problem is not that professional advice is always misguided, but that it short-circuits the process through which people can learn how to deal with problems through their own experience. Intuition and insight gained from experience are continually compromised by professional knowledge. This has the unintentional consequence of estranging people from their own feelings and instincts since such reactions require the affirmation of the expert. In such circumstances, people’s capacity to handle relationships and to have confidence in their relationships diminishes further. In turn, this creates new opportunities for professional intervention in everyday life.
The manner in which emotional problems have become diagnosed as a form of disorder raises questions about the ability of the individual to deal with disappointment, misfortune, adversity or even the challenge of everyday life. And, sadly, when people are continually invited to make sense of their troubles through the medium of therapeutics, it severely undermines their resilience.
Once the diagnosis of illness is systematically offered as an interpretative guide for making sense of distress, people are far more likely to perceive themselves as ill. That is one reason why in Western society the number of people diagnosed as suffering from mental illness has risen exponentially. The explanation for this trend lies not in the fields of epidemiology, but in the realm of culture that invites people to classify themselves as infirm.
Recently, the British Psychological Society’s division of clinical psychology has attacked the psychiatric profession for offering a biomedical model for understanding mental distress. But its criticism was not directed at the ethos of medicalisation as such, but only at the tendency to associate mental illness with biological causes. What it offered was an alternative model of medicalisation – one where mental illness was represented as the outcome of social and psychological cause. It seems that medicalisation has become so deeply entrenched that even critics of the DSM accept its premise.
The problems of life can be painful. But this experience of existential agony must not be rebranded as an illness. Medicalisation empties experience of its creative content and assigns human beings the status of permanent patients. The promiscuous expansion of diagnosis also trivialises mental illness. Learning to distinguish between normal suffering and illness is a mark of a mature and confident culture.
Frank Furedi is a sociologist whose books include ‘Therapy Culture’
Friday, 17 May 2013
Noah Smith recently offered an interesting take on the real reasons austerity garners so much support from elites, no matter how badly it fails in practice. Elites, he argues, see economic distress as an opportunity to push through “reforms” — which basically means changes they want, which may or may not actually serve the interest of promoting economic growth — and oppose any policies that might mitigate crisis without the need for these changes:
I conjecture that “austerians” are concerned that anti-recessionary macro policy will allow a country to “muddle through” a crisis without improving its institutions. In other words, they fear that a successful stimulus would be wasting a good crisis.…If people really do think that the danger of stimulus is not that it might fail, but that it might succeed, they need to say so. Only then, I believe, can we have an optimal public discussion about costs and benefits.
As he notes, the day after he wrote that post, Steven Pearlstein of the Washington Post made exactly that argument for austerity.
What Smith didn’t note, somewhat surprisingly, is that his argument is very close to Naomi Klein’s Shock Doctrine, with its argument that elites systematically exploit disasters to push through neoliberal policies even if these policies are essentially irrelevant to the sources of disaster. I have to admit that I was predisposed to dislike Klein’s book when it came out, probably out of professional turf-defending and whatever — but her thesis really helps explain a lot about what’s going on in Europe in particular.
And the lineage goes back even further. Two and a half years ago Mike Konczal reminded us of a classic 1943 (!) essay by Michal Kalecki, who suggested that business interests hate Keynesian economics because they fear that it might work — and in so doing mean that politicians would no longer have to abase themselves before businessmen in the name of preserving confidence. This is pretty close to the argument that we must have austerity, because stimulus might remove the incentive for structural reform that, you guessed it, gives businesses the confidence they need before deigning to produce recovery.
And sure enough, in my inbox this morning I see a piece more or less deploring the early signs of success for Abenomics: Abenomics is working — but it had better not work too well. Because if it works, how will we get structural reform?
So one way to see the drive for austerity is as an application of a sort of reverse Hippocratic oath: “First, do nothing to mitigate harm”. For the people must suffer if neoliberal reforms are to prosper.
Thursday, 16 May 2013
Retirement can cause a drastic decline in health, according to a study released today.
Research found that both mental and physical health can suffer, said the Institute of Economic Affairs and the Age Endeavour Fellowship, who claim the Government should help people work longer and raise the state pension ages.
The study - Work Longer, Live Healthier: The Relationship Between Economic Activity, Health And Government Policy - shows there is a small boost in health immediately after retirement but that, over the longer term, there is a significant deterioration.
It suggests retirement increases the likelihood of suffering from clinical depression by 40% and the chance of having at least one diagnosed physical condition by about 60%. The probability of taking medication for such a condition rises by about 60% as well, according to the findings. People who are retired are 40% less likely than others to describe themselves as being in very good or excellent health.
The length of time spent in retirement can also cause further disadvantages, the study found.
It concluded that, for men and women alike, "there seem to exist longer-term health benefits of employment among older people".
Its authors said: "This, in turn, indicates that politicians do not face a trade-off between improving the health of the older population, increasing economic growth, decreasing health spending among the elderly and producing solvent pension systems.
"The policy implication is that impediments to continuing paid word in old age should be decreased. This does not necessarily mean that people should be expected to work full-time until they die, but rather that public policy should remove the strong financial incentives to retire at earlier ages."
Philip Booth, editorial and programme director at the Institute of Economic Affairs, said: "Over several decades, governments have failed to deal with the 'demographic time bomb'.
"There is now general agreement that state pension ages should be raised. The Government should take firmer action here and also deregulate labour markets. Working longer will not only be an economic necessity, it also helps people to live healthier lives."
Edward Datnow, chairman of the Age Endeavour Fellowship, said: "In highlighting the positive link between work and health in old age, this research is a wake-up call for the UK's extensive and well-funded retirement lobbies.
"More emphasis needs to be given to ways of enabling a work-life balance beyond today's normal retirement age with legislative discouragements to extending working life being replaced with incentives. There should be no 'normal' retirement age in future.
"More employers need to consider how they will capitalise on Britain's untapped grey potential and those seeking to retire should think very hard about whether it is their best option."
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- I believe - The great are great only because we are on our knees. Let us rise! - A contented mind is a continual feast. - Truth is a pathless land. - Some of the best things in life are immoral, illegal or fattening. - Love is a gross exaggeration of the difference between one person and everybody else. - There are more things in heaven and earth than are in any philosophy. - Part of life is to plant trees that other people will sit under. Somebody planted a tree for me long ago in the form of an educational institution and I sat under that tree, metaphorically. The same happened in one area after another in my life. (Warren Buffett)