In Australia, the issue of over-diagnosis is increasingly effecting both patient care and funding, as a piece on OnlineOpinion, Medicalising the Human by Peta Cox, proposed recently. Here’s a guest post today, first published on Huffington Post UK, by Tony Lobl, my counterpart in the UK, who emphasises a very important point – that health is our normal condition, not illness.
The “Medicalisation of Normality” or the Normalisation of Health? Let’s Choose Wisely
Yesterday you were shy, bereaved, apathetic, eccentric.
Today you are mentally ill.
But don’t worry. Nothing has changed except some new labelling appearing in the upcoming edition of a manual of mental disorders to be published by the American Psychiatric Association.
Or should we worry? The volume in question is internationally “influential” and many psychologists and psychiatrists are unhappy about its proposed new listings of mental illness. Some gathered at a briefing here in London last week to say so.
They claimed categories newly identified in the diagnostic manual were at best “silly” and at worst “worrying and dangerous”, according to Reuters. “It’s not humane, it’s not scientific, and it won’t help decide what help a person needs” said Peter Kinderman, who heads Liverpool University’s Institute of Psychology.
As the diagnostic net is being cast ever wider a study has shown that using “medicalese” to label a “recently medicalised disorder” leads to a change in the public’s perception of that condition.
Karin Humphreys, assistant professor in McMaster’s Department of Psychology, Neuroscience & Behaviour – one of the study’s authors - said ”lots of conditions have recently become medicalised, some of them possibly through the influence of pharmaceutical companies, who want to make you think that you have a disease that will need to be treated with a drug”.
That is not always the wise course of action. As a British Medical Journal feature put it: “a growing scrutiny of the seemingly well meaning march of medicalisation suggests we may sometimes be pushing boundaries too wide, and setting treatment thresholds so low, that people with mild problems or modest risks are exposed to the harms and costs of treatment with little or no benefit.”
An LA Times opinion piece by medical professor H. Gilbert Welch concurs with that view, and adds: “Low diagnostic thresholds lead people who feel well to be labeled as unwell. Not surprisingly, some subsequently feel less well.”
If simply being labeled as “unwell” sometimes make it so, that points to an influence our minds can have on our bodies. And, indeed, researchers are increasingly exploring the impact of patient expectancy on health outcomes.
But if a mental shift can make us sick, could a change of thought accomplish the reverse, and prevent sickness?
How often, for instance, do we find ourselves thinking “I’m going to catch a cold” based on a set of circumstances which medical opinion and our experience have trained us to associate with that outcome?
What might happen if, instead, we were to catch the thought when it first tries to cross our mental threshold and “agree to disagree” with it?
This pithy but powerful phrase is advice on how to deal with approaching symptoms of disease based on a spiritual model of health as normal. They are from author Mary Baker Eddy, built on words spoken by Jesus.
Soon after first reading about this approach to spiritual self-care, I tried applying it when familiar symptoms were stirring, promising a streaming cold in the days ahead.
I paused what I was doing, noted the fear presenting itself in my thought, and decided I had an equal right, and opportunity, to bar the door of thought to that “prophecy” of things to come.
That was all it took and that cold never developed. Those first symptoms quickly dropped away.
It hasn’t always been that easy. I haven’t always caught the thought as it approaches, or slammed shut the mental door when I do see it coming. But in two decades since, I’ve experienced colds far less frequently – grateful for the physical freedom and for what that has suggested to me: health is normal.
It’s clearly not wrong to want to become less timid, to break free of grief or to shake off urges to be a couch potato. And appropriate action is certainly needed if such conditions become acute or chronic.
But the “medicalisation of normality” – as a BBC programme described it – is not inevitable. The inherent capacity and right to recognise health as a normal condition – our spiritual status quo – will sooner or later bring out the opposite tendency for more and more conditions to be met by a change of mind than by prescribing a range of drugs.
