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Mental health 'labels' criticised


Large numbers of “normal” people are at risk of being labelled as psychiatric patients, British experts have warned.

Sweeping changes to a diagnostic “bible” that influences practitioners around the world could make it far easier to be labelled with a psychological problem, it is claimed.

One suggestion of the US authors is a new diagnosis of “Psychosis Risk Syndrome” which singles out people thought to be at risk of developing a psychotic illness such as schizophrenia.

Individuals falling into this category might experience occasional mood changes, feelings of distress, anxiety or paranoia, or fleeting episodes of hearing voices.

In the past they might have been considered difficult or eccentric. Under the new proposals they could receive a diagnosis that affects their future lives and job prospects. Yet they may never develop “full blown” psychosis.

Other diagnoses under consideration include “mixed anxiety depression”, “binge eating, and “temper dysregulation disorder with dysphoria”.

In addition, the bar could be lowered on some common existing disorders, such as depression, so that more people are considered to have symptoms that warrant a diagnosis.

Professor Til Wykes, from the Institute of Psychiatry at King’s College London, today spoke of a trend that was “leaking into normality”.

She said: “It shrinks the pool of normality to a puddle, and there are going to be fewer people who won’t end up having a diagnosis of mental illness.”

Prof Wykes edits the Journal of Mental Health which carries a “health warning” about the proposals in its latest issue.

The changes have been put forward for discussion by a powerful group of US experts working on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).


Readers' comments (9)

  • Marjorie Lloyd

    this is the problem with mental illness in that anyone could potentially obtain a label with or without their consent, that can have far reaching consequences on their life. I prefer Thomas Szasz's definition of 'problems with living' which pretty much covers just about everything;-) But of course the medical insurance companies would not cough up for that so in order to make a 'claim' we do in fact need more labels not less.

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  • I don't see what the problem is , it has been happening in general practice for years for predicting heart disease vulnerability etc. I see it as a tool to help people to make lifestyle changes in their favour.

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  • Maybe that's worth us looking at too then Alison, the over medicalisation of normality and normal aging processes. Any way of looking at and framing people in their lives can either be a tool or a smoking gun, depends on who has it in their hands and how then intend to use it, if at all. Where does it stop being helpful to aide understanding and start becoming a box to organise people at our convenience?
    I find this a very interesting and potentially insightful subject into how we are encouraged to think and then bring that into the world in what we do.

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  • Come back R.D. Laing - all is forgiven. (But then, I always thought he made quite a bit of sense.)

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  • focault had a good idea on this....."you only name someone as mad to justify your own sanity"

    but in all seriousness its the emergence of personality disorder i don't agree with (how many types are there? antisocial, borderline, narcassitic, schizoid etc etc)

    I understand that alot of people will not agree and i genuinely apologise as I am broadley generalising...but personaility disorder is usually the last label someone gets when every other mental illness dosen't quite fit.

    its the word RMNs use (me as much as anyone else so im not trying to be whiter than white) when a patient gets your nerves for reasons that cant be attributed to 'mental illness'.

    but i know alot of people wont agree with me but are a group of people that act like arseholes and with little consideration for others and consequences actually mentally ill?

    alot of people i know with these diagnoses can be dangerous and are a risk to themselves and the general public...but is this illness, how often do you hear the phrase "behavioral" mentioned.

    when somebody puts a window through on the ward or assults someone for no other reason than they wanted is this illness.

    alot of these people have had shit lives, many sexually abused and no they shouldnt be turned away from mental health services...there just should be a different model.

    alot of trusts are promoting improved access to psychological services in hope of reducing admissions to hospital...its brilliant, i think its great.

    however a large number of patients have this diagnoses of PD on the acute ward i work on and acually want to be in hospital.

    they know how to manipulate circumstances basically threats if im not admitted i'l kill myself...and when in hosital are the ones bringing drugs, booze etc onto the ward.

    its not fair on them...the money ploughed into primary mental health (depression, anxiety etc) would have been just as well used on this section of patients...theres no where for them to just say they have a pd and whack em in hospital for containment.
    i dont know what the answer is but diagnosing a flaw with someones personaility surely isnt right..the fundemental aspect of who you are as a mental illness...what a bloody society

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  • It's a pity the exaggeration of mental illness through the 1 in 4 agenda wasn't questioned too, there again our friends at the Maudsley, IoP and their partners in the mental health poverty industry did pretty well out of that Government policy didn't they? as the media campaigns made all but the shittiest type of enduring mental health issues ' sexy'.

    But anon's depiction of abused and damaged people as arseholes surely warrants further research. Perhaps we could rape, bugger and torture anon's kids and then see whether their obviously superior genetic makeup enables them to evolve stable middle class values and naturally excel in life or turn out to be arseholes too.

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  • Fair point, but that wasn't what i was trying to say...i probably didnt express what i meant properly....but PD is not necessarily a mental illness but has been made into one to put a name to something that cannot be explained as from the norm behaviour.

    I shouldnt have used the word arsehole....but i meant in the manner of people behaving recklessly and with the traits of PD in no more than "unormal" behaviour..this pherhaps is resultant from how crap society is and these people are the losers of thatchers meritocracy not because of chemical reactions in the brain.

    I just don't think theres any sort of provided care for people witht this diagnoses.....and its because people just dont give a shit about them.

    please dont pretend that you havent ever been annoyed with this ection of the client not proud of it but moire than a few times i flipently think ...they are just a pain in the arse and remind myself to take a step back and remember what i chose to do this job.

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  • Brutal honesty is important but often the key to understanding any problem is to reverse all the variables and try to see things from the other guys point of view. We can see how positive upbringing , stability, education, encouragement and love lead to a greater sense of belonging, self-worth and purpose in life. Those who miss out on these and are socialised' through abuse, abandonment and violence are very challenging , they challenge us to be better human beings with all our advantages and to perhaps understand that we need to create therapeutic and supportive approaches , communities and spaces that better address their needs. Mental health institutions clearly aren't designed to do that and its perverse that we pretend really damaged people are beyond our help in this society because they aren't really ' mentally ill' .

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  • The DSM is an American Manual which may fit American problematics and personalities but here the ICD is the European Manual which should be used as a guideline to mental health disorders seen in Europe but neither should be used to label any individual or the psychiatrists and others working in the field of mental health should be labelled as well. There is nothing to say that those 'working in this field' are 'normal'.

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