How do we distinguish between the normal emotional upheavals of life and something that can be defined as a “mental health” problem? I recently heard the jockey Sir Tony McCoy speaking on the radio of his difficulty in adjusting to retirement after horse racing. The headline of the report was that large numbers of people facing retirement are suffering from mental health issues. I know that many of my friends and clients have found it difficult to adjust, as McCoy has, to retirement. They miss the structure, purpose, social life and status of work. However, this is generally a fairly natural period of bereavement when there will be an inevitable cycle of loss. And what I am questioning is the ease with which people seem to be given labels of mental illness these days. Could it not be that they might be experiencing the fairly typical emotions of just being human and going through a difficult patch?
Don’t get me wrong, I am delighted that mental health issues are being spoken of in a more transparent way. I remember a close family member who had recovered from a nervous breakdown saying that she wished people had been able to see her illness in the way they can see a broken arm. Luckily we are now gaining more understanding, although a cure for psychological problems is still quite hard to find.
But at the same time, I worry about the burgeoning number of mental health labels that are given as diagnoses of emotional problems. The number of disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, the diagnostic tool published by the American Psychiatric Association (APA), increases year by year. In the United States, the DSM serves as a universal authority for psychiatric diagnoses but according to recent surveys some 46.5% of Americans will have a diagnosable mental illness in their lifetimes, based on this manual. Really?
Let’s look at these labels – grief can be packaged as ‘Adjustment Disorder’, a child’s temper tantrum as ‘Disruptive Mood Dysregulation Disorder’, shyness can be defined as a mental health illness, where it was a totally natural, if uncomfortable, experience when I was a child. Three to five people in every 100 are estimated to be diagnosed with ‘personality disorders’ in the UK, with one to three in every 100 living with ‘schizophrenia’. Are these diagnoses accurately differentiating real mental illness, which can be life-threatening, from a transitional period of emotional disturbance? Is it that people are now expecting to feel ok all the time? Is there some new intolerance to feeling miserable, uncertain, sad, uncomfortable that leads people to seek a fix that in previous times they might just have to have accepted as a phase of life? A pill for every ill rather than accepting emotional distress? Have we always been mentally sick or are the labels increasingly embracing what would previously have been perceived as normal?