Are we “over-medicalising” mental health?
14:47 Share

Every day, thousands of Comcast engineers and technologists create connectivity solutions that change the way we work, live, and play. Like Kunle, a Comcast engineer who is focused on revolutionizing the in-home Wi-Fi experience today and for the next generation.

Kunle builds powerful Xfinity Wi-Fi devices that deliver a fast, reliable connection with capacity to connect hundreds of high-bandwidth devices at once and next-level latency for the applications of the future, like augmented and virtual reality and cloud gaming. Learn more at comcastcorporation.com slash Wi-Fi.

Tony Blair, the former Prime Minister of the UK, was speaking over the weekend on a podcast called Jimmy's Jobs and he raised concerns about what he called the over-medicalisation of the ups and downs of life. Take a listen. I think we have become very, very focused on mental health

And with people self-diagnosing on mental health, I think we need a proper public conversation about that because, you know, I think it's a very, very difficult...

We're spending vastly more on mental health now than we did a few years ago. And it's hard to see what the objective reasons for that are. And if we're not careful, we get into a position where people, you know, life has its ups and downs and everybody experiences those. And you've got to be careful of encouraging people to think they've got some sort of condition other than

you know, simply confronting the challenges of life. And so I, you know, we need a proper public conversation about this because you really cannot afford to be spending the amount of money we're spending on mental health and the ramp up of that.

That was Tony Blair, former UK Prime Minister, speaking on a podcast over the weekend. Brendan Kelly is with me now. He's Professor of Psychiatry at Trinity College, Dublin, and the author of Resilience Lessons from Sir William Wilder, Life After Covid. Brendan, it's always good to see you. How are you? Thanks for having me. So do you think, I mean, Tony, there's a bit to unpack there. Some of it is around kind of economic policy and budgetary constraints and that, but that's more of a UK issue from what we set that aside. In terms of

How he described kind of the medicalisation of the ups and downs of life. Does he have a point? He does have a point about that. And it's important we don't medicalise, over-medicalise things. Now, Ciarán, I'm a medical doctor, I'm a psychiatrist. So I do tend to see people with severe conditions, severe illnesses, and I do tend to diagnose some people. But the question is, where is the line in the sand?

And I think what Tony Blair was saying was that he believes there is an over-medicalisation of the ups and downs of life. That the problems we face from day to day, problems at work, problems with other people, they're not necessarily mental health issues or mental illnesses. And he seems to be concerned about

that there is an over-enthusiasm for declaring things to be mental health problems when they're the problems of life. Now, I do disagree with the point he's coming from. He seems to be coming from an economic point of view, saying we have to rethink this because it costs too much. Now, I'm not terribly interested in that, but I do think we need to think carefully

carefully so that we don't disempower people from finding solutions to problems in their lives by suddenly declaring that they are mentally ill. And is that the danger, is it? And he talked about that actually in the podcast as well, about people maybe losing a sense of agency because they've got a diagnosis now. Yeah, and that is a real concern. And it's important that diagnosis or declaring someone to have a mental health

problem, mental health issue, mental illness, mental disorders, there's a whole load of phrases, that that happens when the condition is severe, when the person is disabled by it in some way, and when it leads to understanding, it leads to treatment, it leads to resolution.

Now, you know, this is quite clear for things like severe depression, maybe for bipolar disorder and schizophrenia. But we start to get into other territory then when we get to the problems of life. And one of the big concerns I have about this is when someone who has stress at work is

is told that this is a mental disorder. Now, for some people, it can develop into that. But that is not to say the solution lies with the person. I mean, if you are in a difficult work situation that is making you stressed,

The correct course of action is not to announce you have a mental disorder or a mental health issue. You know, if you need to put on an emotional hard hat just to go to work or a full suit of psychological body armour to get through the day at work, the problem is your workplace. It's a circumstance, it's a condition that needs to be fixed. The problem isn't you, it's not a lack of resilience, it's not a mental health issue.

problem that you have, it can be a circumstance. And I think that's what Tony Blair was getting at, that some problems in life, the ups and downs of life, some of the stresses, some of the relationship problems and their consequences aren't mental health problems, they're life problems. And there's very little benefit from suddenly declaring everything to be a mental health issue. How much of this is born of a kind of a blurring of the lines that exists between

kind of wellness at one end of the spectrum and then into kind of mental health and then mental illness. Yeah, so there is a blurring of these boundaries going on. So recent years have seen increased discussion about mental health problems, mental illness, and this is good. This has been a very positive development.

But one of the consequences is that almost every problem people encounter, I hear it described as a mental health issue, when it is not necessarily that. It might be something in life that causes the person to have a negative emotion. What I'm saying is stuff that makes you sad. That's right.

That doesn't necessarily mean that you are depressed. It means that you are sad. And for a diagnosis of depression, for example, you would be looking to see if someone's mood low, for sure, but also their sleep disturbed, their appetite disturbed, maybe a loss of weight, a sense of hopelessness, a sense of helplessness, all these other symptoms. And the reason why we look for these symptoms before diagnosing something is because the evidence base is

For example, for cognitive therapy, like, you know, Ciarán, if you came to me and said you were feeling low, your mood was low, your appetite was poor, you had no energy, you had no interest, you were hopeless, then I might feel you were depressed. And I could tell you that cognitive behaviour therapy, that's a talking therapy, psychological therapy, I could tell you there's about a 70% chance that will help you.

And the reason I can say that is because there is a condition called depression that was used to test these treatments. However, if we start calling every negative emotion a mental health issue, we don't really have an evidence base for the next treatment.

So, you know, it is important that there is a line in the sand, but it is always a line in the sand and it can move. Do people have unrealistic expectations of what life is now? And I know this is maybe a question about society and culture and social media to a degree, but, you know, that people think they should never be sad.

Yeah, I mean, I think there is reduced tolerance for sadness. And one of the features of some psychotherapies is to improve what's called distress tolerance. In other words, to help people manage negative emotions and negative states of mind in a more healthy way, rather than doing sort of maladaptive things like drinking, taking drugs or even self-harm. But of course, distress

tolerating distress, we should only be able to tolerate a certain amount of it. There comes a point where you do need extra help from other people or from professionals. So again, there is a threshold that gets reached here. But in answer to your question, yes, I think there is reduced

a tolerance of negative emotions and a reduced awareness that there will be unhappiness in life, there will be sadness in life. And in a sense, that is what makes the happy days happy. Because without the sad ones, we wouldn't really appreciate when things are going well. And

This is the ups and downs of life. This is not necessarily a mental health issue. Or to put it another way, there's no benefit from labelling all of this to be mental health issues. It doesn't empower the person to find solutions. And if anything, it seems to disempower some people. And is one of the consequences then that

you know, in a system where resources are finite, as all systems are, that the people then who need help maybe don't get it. I know there was a story in the papers last week about Ireland's mental health services wherein only maybe the most acute were kind of being seen in a timely fashion because services were so stretched. I mean, if they're stretched by people...

And you don't necessarily need them. I guess that's part of the issue, is it? Yeah, it can be. Let's not pretend it's the only one, but it must form part of the picture. What's important is that we stratify things. People with severe unhappiness and stress and anxiety and that, a lot of them will benefit from sort of counselling or if they have a medical card, the counselling and primary care service. In other words, seeing someone for six or eight sessions of counselling can be supportive and helpful. It's not necessary to be diagnosed with a mental health issue as such.

for that. So it's important the response is proportionate. For more severe conditions, people with more severe depression, maybe obsessive compulsive disorder, thoughts of self-harm, more is needed. So we do need a range of responses because, you know, the unhappiness of everyday life, it is unhappiness.

And most of us will do something when we're unhappy. And it's important that we talk to our friends, talk to our family. But maybe it's also important that we don't... that there isn't a label readily available that will somehow deter us from finding our own solutions. And of course...

You know, social conditions as well, political, economic conditions, they all contribute. So people who are struggling financially, people who can't pay mortgages, people who can't get mortgages, perhaps more pertinently now, can often feel stressed and depressed by that.

That's not necessarily a mental illness or a mental health issue, unless, of course, it develops more symptoms and becomes more severe. But at root, it is a problem with society. And there sometimes is a tendency to blame individuals or heap responsibility on individuals who are in dysfunctional systems, be they workplaces or dysfunctional societies. But sometimes it's those individuals themselves who seek the labour. I mean, it's a crutch, right?

Well, it can be really helpful. So this is, in my line of work in mental health care, diagnosing is a very powerful thing to do and it can be done very well or it can be done very poorly. So some people find a diagnosis of something to be helpful

helpful for self-understanding, for validation. It helps them reach out, talk to other people with similar conditions. We see this a lot with attention deficit hyperactivity disorder, ADHD, where people who have had symptoms for a long time, they meet a professional who does a proper assessment, makes a proper diagnosis, and there can be a huge feeling of relief. There can be self-understanding, there can be community, there can be treatment and real progress.

However, other people experience it quite differently, as if they're being put into a box, being categorised, being labelled, as if they're not a unique individual, they're just getting this sort of term applied to them. So how and if diagnosis happens is really powerful. And it's something that my profession, the mental health profession, needs to take very, very seriously and ask ourselves regularly.

you know, does this person really have this diagnosis? How will diagnosis help them? Will it be empowering or disempowering? Will it help them find solutions with us or on their own? Or will it be disempowering? You could hear it in Tony Blair's voice, the acknowledgement as well, and he said this expressly about how kind of

careful you have to be in the conversation and I wonder to a degree is part of the kind of medicalisation or over-medicalisation been just an over-correction that we had this stigma and everything for so long and it was a thing that people didn't talk about and didn't acknowledge and they self-medicalised without realising maybe they were doing it with a bottle or what have you and

that the overcorrection has manifested in a lack of willingness maybe to kind of, I don't say kind of questions people's self-diagnosis, not that it's for me to kind of say to somebody who says they're depressed, no, you're not. You know, but

But to just kind of take at face value people's description of their own mental health when they're not a professional. I think it's really important when someone is self-diagnosing or believes they have a condition or whatever, that we, that's again mental health professionals such as myself, we talk to them and say, OK, you're depressed. Tell me what you understand by that. Tell me what you mean by that. Can you see causes for that? Have you thought about solutions for that? Here's what I think. And I'll ask a bunch of other questions about other symptoms. So we do need to have a discussion about

about diagnosis, including self-diagnosis, to make sure there's a shared understanding and it leads to something positive. It leads to a path forward rather than simply labelling vast swathes of the population with conditions. Would you, and obviously you can't betray confidence this year, so this is a general question, but would

When you maybe are met with somebody who describes themselves as depressed and you have this conversation and you maybe come to the conclusion you're just kind of going through a kind of a low period. This is not depression, though, in the clinical sense. Is that met with relief or is it sometimes met with a bit of frustration that...

Well, you know, you haven't given me the label I was looking for. Well, firstly, an awful lot of it depends on the tone of the conversation and the relationship. And if you get that right, you know, very little else matters because the person who comes saying that they are depressed, but let's say what they have is some kind of existential concern about life. And in fact, they're functioning fine. Their relationships are good. Their sleep, their appetite, their energy, their biological symptoms just aren't there. And they are nonetheless troubled.

And we would never, and we would always validate that because this is a problem in the person's life. They're not coming to me for nothing. So we don't say, oh, you're fine, just carry on. We always try and offer some kind of support, some kind of guidance, some kind of direction, using the language most appropriate to the person. You know, most of us are very aware of the risks of over-medicalising human distress when people

solutions rooted in families and communities are often better. It's probably worth saying as well that, you know, there's a medicalisation of all kinds of things, not just mental health going on. All kinds of stuff is being medicalised. People are taking...

medications when they don't have any symptoms for all kinds of stuff. So it's not unique to the mental health area, but it is certainly a big feature, a feature of it. It's something we need to be aware of. You know, Tony Blair is not wrong. He's coming from an economic argument, which I've no interest in at all. I'm far more interested in how people feel and how we can help them. Listen, that was a really interesting chat and thanks a million for coming in to us, Brendan. Thank you. Brendan Caddy is a professor of psychiatry at Trinity College, Dublin.

The Hard Shoulder with Kieran Cudahy. With the MG Hybrid and Electric range. Weekdays from 4 on Newstalk. Every day, thousands of Comcast engineers and technologists create connectivity solutions that change the way we work, live, and play. Like Kunle, a Comcast engineer who is focused on revolutionizing the in-home Wi-Fi experience today and for the next generation.

Kunle builds powerful Xfinity Wi-Fi devices that deliver a fast, reliable connection with capacity to connect hundreds of high-bandwidth devices at once and next-level latency for the applications of the future, like augmented and virtual reality and cloud gaming. Learn more at comcastcorporation.com slash Wi-Fi.