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Monday, 15 January, 2001, 10:22 GMT
A suitable case for treatment
Once anxiety and stress were problems. Now they are illnesses. But a backlash is brewing. A new report says post-traumatic stress disorder is a "non-disease", writes Chris Horrie.
Hardly a week goes by without dramatic news of a medical breakthrough in fighting disease.
But do we actually feel healthier? Sometimes it seems that for every illness we learn to treat, a new malady crops up.
But sceptics balk at the suggestion GAD and many other "illnesses" are, in fact, medical conditions.
Controversially, they claim that difficulties previously explained as moral, political or social problems - or plain bad luck - are now defined as types of mental illness.
Experts call it the "medicalisation of human distress" - the trend to treat any sort of human unhappiness as a form of personal psychiatric injury which may need treatment and, almost certainly, is somebody else's fault.
The complete picture
The World Health Organisation's definition of "health" is a state of "complete physical, mental and social well-being". Anything less than this and you are ill.
Thankfully, it was a joke, intended to satirise the fact that what previous generations would have thought of as simple unhappiness can now be defined as one of a range new-fangled psychiatric conditions ranging from post-traumatic stress disorder to post-abortion syndrome.
And then there is general anxiety disorder, which manifests itself through worries about work problems, household chores, lack of money and other health issues.
Researchers looking into this condition say Piglet, the diminutive character from the Winnie the Pooh stories who was always afraid of meeting a "Heffalump", was the classic sufferer.
Piglet was a "seriously troubled individual", according to Canadian researchers quoted in The Sun newspaper.
Experts say the "medicalisation" trend has its roots in modern culture as well as business and medicine.
In the past, people might have blamed society for their woes and looked for political solutions. But the "Me Generation" is more likely to seek an individual quick fix - in the form of a pill, if at all possible.
Others blame "psychiatric imperialism" - the alleged tendency of psychologists to push their way into more and more areas of life.
Joanna Moncrieff, specialist registrar in psychiatry at Chelsea and Westminster Hospital, says the 1992 Defeat Depression Campaign, launched by the Royal College of Psychiatrists, was the start of the current boom.
The campaign, which was based on the idea that 10% of people are suffering from depression at any given time, came at a time when Prozac was gaining popularity.
Pharmaceutical companies, Ms Moncrieff said in a recent report, wanted to "suggest that a large proportion of human unhappiness is biologically based and can similarly be corrected".
Medical commentator Dr James Le Fanu also sees important commercial considerations involved in the "medicalisation" trend.
Having failed to come up with cures for what he describes as "serious" diseases such as cancer and dementia, Dr Le Fanu says the pharmaceutical industry switched its attention to what he calls "lifestyle" problems - unhappiness, obesity, baldness and forgetfulness.
One idea, he says, is to get more and more conditions defined as medical disorders so that drugs can be produced and prescribed in the same way.
But the stance is seen as extreme by some people at least. Critics say conditions such as depression and obesity are more serious than "lifestyle" concerns - an estimated 15% of those who suffer from clinical depression will attempt suicide.
In his book, The Greatest Benefit to Mankind - The Medical History of Humanity, historian Roy Porter says medicine has gone beyond the original passive and negative activity of healing the sick and turned into a positive project of health promotion.
The result, he says, has been the creation of "the therapeutic state", where almost every type of social or political problem is seen as a type of mental illness capable of individual therapeutic treatment.
Boom and decay
The boom in the therapy industry has matched the decline in political involvement and the decay of many public institutions.
The best example of the "medicalisation" of politics, many say, is the case of "post-abortion syndrome".
The mental condition, which was said to lead women into specific kinds of depression after terminating a pregnancy, was described at a psychology conference last year as an "invention" of anti-abortion campaigners.
A major statistical study showed no connection between abortion and the types of depression said to make up the "syndrome". What had happened, researchers said, was that anti-abortion campaigners, feeling that their case was not gaining enough support, had resorted to "medicalising" the moral decisions involved.
The current edition of the British Medical Journal carries a withering attack on post-traumatic stress disorder.
The illness has been the cause of a growing number of compensation claims in recent years and is seen by many as the clearest example of "medicalisation" of unhappiness.
Dr Derek Summerfield, of St George's Hospital Medical School, London, criticises the "disorder", calling it a "non-disease" which has been invented for social and political, not psychiatric or medical reasons.
The disorder, he says, was invented as America's way of dealing with the aftermath of defeat in the Vietnam War in the 1970s. It was invented by critics of the war, who saw American soldiers as psychological "victims" of the US military establishment.
"Thus the misery and horror of war is reduced to a technical issue tailored to Western approaches to mental health," Dr Summerfield says.
Unpleasant but ordinary
At the same time, he adds, there has been a "conflation" of distress with trauma that has passed into everyday language.
Dr Summerfield says claiming to have been traumatised, "has become the means by which people seek victim status in pursuit of recognition and compensation".
The original idea of psychological trauma has been extended to cover extremely unpleasant but otherwise "ordinary" events like being mugged or suffering a serious traffic accident, he says.
This new band of victims are supported by what Dr Summerfield calls "a veritable trauma industry" consisting of an army of experts, lawyers, advocates, claimants and other interested parties.
The workplace, he says, is more and more seen as a "traumaogenic environment".
The popularity of post-traumatic stress disorder and other types of "medicalised" unhappiness, he says, comes from a feeling that nothing can be done about the social or economic causes of unhappiness - such as poverty or social injustice.
Post-Traumatic Stress Disorder, he concludes, "is the diagnosis for an age of disenchantment".
05 Jan 01 | Background
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20 Dec 00 | Medical notes
Post-traumatic stress disorder
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20 Dec 00 | Health
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