October 10th is World Mental Health Day, a yearly item of awareness on the agenda since 1992. A few links:

• World Federation for Mental Health (WFMH)
• Mental Health Council of Australia
• Mental Health Foundation (UK)
• National Alliance on Mental Illness (NAMI, USA)
• National Institute of Mental Health (NIMH, USA)

On this day, I would like to draw your attention to an article (in the Vancouver Sun) this week on Dr Gary Greenberg, about the American Psychiatric Association‘s Diagnostic and Statistical Manual of Mental Disorders (DSM), the leading authority on mental health diagnosis and research. This document is used in the US, (Canada?) and UK for assessment/diagnosis.

Dr Greenberg makes the point that in recent times in particular, the number of classified “disorders” has skyrocketed, in general but also in particular in the realm of young children. A small child having a temper tantrum can now be classified as a disorder!

This in itself is of course already a problem. Obviously, not diagnosing something is detrimental. But from my perspective, lowering the bar too far and casting the net too wide has the potential to do a great deal of harm to the wellbeing of lots of people. I’d suggest that beyond not being helpful, it’s counterproductive.

Dr Greenberg also notes that with DSM regarded as authoritative, and diagnosis increasingly resulting in medication, the problem is exacerbated. When other organisations use DSM diagnoses as a reference point for policy, things go bad. Take for instance the forced medication of children based on ADHD diagnoses – it’s forced because the medication is a prerequisite for schools accepting them. Of course there will be kids with issues that merit some form of support and treatment. But you can see how the aforementioned trail from DSM to school authorities forces the child on medication, even though medication might not be the (most) appropriate avenue. Medicating everything is not the way – life is not a disease, and what’s considered “normal” has a pretty broad spectrum. Demanding narrow conformity and medicating everything outside that boundary is scary.

On the other hand, other support mechanisms (including education) hinges on diagnoses as well – so when a threshold is effectively raised, this might remove some people from the medication realm, but it also removes other support. So there it goes wrong again. Complicated matters.