Australasian Science: Australia's authority on science since 1938

Is “Mentally Ill” the New Normal?

By Gloria Wright

Drug treatments for behaviours that were previously not considered mental health conditions raise several unintended consequences.

If we are to believe federal Health Minister Peter Dutton, 46% of us will develop a mental illness in our lifetimes – a staggering increase. Almost half of us will qualify to log in to Dutton’s new online support forum SANE.

As the near majority of us can expect to have our individual identities relabelled as treatable disorders, the Fifth Edition of the Diagnostic and Statistical Manual offers an ever-widening selection of “conditions” from which to choose – “illnesses” that previous generations may have seen as human dilemmas rather than mental disorders.

We are riding a wave driven by a medical framework investing in ever-finer layers of distinction of human categorisation. In 1952 the first DSMV catalogued 60 mental health disorders. By 1994 the fourth edition listed 297 dis­orders and 400 specific psychiatric diagnoses. In 2013 the fifth edition continued this expansion by broadening the definitions of “conditions” and widening the array of diagnosable disorders.

This expansion provoked the early attention of sociologists like Erving Goffman, who detailed the “career” of the mental health patient in his 1962 book Asylums. While we celebrate the end to asylums, the phenomenon of “medicalisation”, first introduced in 1976 by Prof Peter Conrad of Brandeis University in Boston, highlights how the insidious process of “creating” mental illness, including children’s behaviour, is expanding worldwide. A growing number of academics and social critiques are building on Conrad’s pioneering framework.

I have been interested in the medicalisation of human dilemmas for at least a decade. The arising questions concern the drivers of medicalisation, its beneficiaries and its victims.

How do we grapple with genuine mental illness while depriving big business of creating “designer labels” of mental illness to apply from childhood to old age? We boast of replacing the asylums with newfound acceptance, but have we created different new age asylums – digitally recorded mental health pedigrees available to almost anyone?

Let us not be so sure that new ways are in our best interests. How do we feel, for example, when Australians as young as three are being diagnosed as mentally ill and given psychotropic medication, leaving them with a relieved mother in tow, perhaps a slightly better resourced pre-school, and a mental illness label digitally recorded for their lifetime? Satisfied?

What are we to think when our 83-year-old grandmother’s unique identity is redefined as a mental illness? Gratified? And what of our pimply faced contrarian 14-year-old son, who now thinks he’s a “weirdo” because he has a diagnosis of a mental illness? Cool?

Why do we feel the need to “diagnose” human troubles of all kinds. We can derive a clue from the example of school funding in Australia and many other developed economies. Resource-starved schools vie for additional dollars to support students with particular learning and behavioural needs. They gain sympathy and success by using the most powerful and possibly the only serious currency available to them – mental health diagnoses in children.

Public resources, being sought after by competing forces, are dealt out “fairly” on the strength of medical diagnoses. But such diagnoses are no more solid than water in a twisting stream. Dr Google often sets the course, desperate parents seek help and resource-stretched teachers are grateful – and humanitarian health professionals feel that they have helped.

Forget the spurious means of obtaining diagnoses – the end justifies the means. Correct? The arising meta-themes are far too complex to explore here, but the central question remains: is being “mentally ill” the new normal?

Perhaps we can join Dutton in SANE with a host of well-meaning medical professionals. Perhaps not.

Let’s talk.

Gloria Wright is Director of Learning Solutions, an Honorary Associate at the University of Sydney, and author of The Medicalisation Trap.