House of Eratosthenes

Marvin We learn via BBC News that a troublesome mental health professional has gone on record and made the startling claim that depression is being over-diagnosed.

Too many people are being diagnosed with depression when all they are is unhappy, a leading psychiatrist says.

Professor Gordon Parker claims the threshold for clinical depression is too low and risks treating normal emotional states as illness.

Writing in the British Medical Journal, he calls depression a “catch-all” diagnosis driven by clever marketing.
:
The professor, who carried out a 15-year study of 242 teachers, found that more than three-quarters of them met the current criteria for depression.

He writes in the BMJ that almost everyone had symptoms such as “feeling sad, blue or down in the dumps” at some point in their lives – but this was not the same as clinical depression which required treatment.

He said prescribing medication may raise false hopes and might not be effective as there was nothing biologically wrong with the patient.

He said: “Over the last 30 years the formal definitions for defining clinical depression have expanded into the territory of normal depression, and the real risk is that the milder, more common experiences risk being pathologised.”

Hell’s bells, I coulda told you that. The signs are all there. “Ask your doctor about” commercials on the teevee. Speaking just for myself, this is damning evidence in the courtroom between my two ears. Sure, developing a new drug or medicine is an expensive and financially risky proposition, and once you’ve secured the patent you’ve got a right to recoup your investment just like any other good capitalist. But there’s something terribly wrong with sending flocks of potential patients into doctors’ offices to “ask about” things, especially things specifically designed to alter an emotional state. Somehow, that just rubs me the wrong way.

But there are other things. There’s all this subtle lecturing about the clinical state of depression, with an implication that those of us who have not suffered from it are unfit to comment on it or form reasoned opinions about it. Well, that is probably true in some cases. What about some of the other cases? Do we have safeguards in place to make sure people are not placed on mind-altering prescriptions, when all they are is unhappy? You don’t have to interact with people for too many years at all, before you meet some folks who are genuinely unhappy and don’t know why, because their life experiences have been too narrow and they lack the emotional depth required to figure out what might make them truly happy.

The subtle “it’s a valid medical diagnosis” lecturing is sufficiently exuberant to reach pro-active status — as in “just in case anyone thinks there’s nothing to this, they need to MYOB.” I wouldn’t have too much difficulty at all finding examples of that. But I have yet to see anyone say something like “just in case anyone thinks we’re not doing anything to keep this from being over-diagnosed, here’s what we’re doing to prevent that.” The abundance of one with a complete dearth of the other, raises my red flags.

Is over-diagnosis at least possible? It strikes me as incredibly awkward to try to mount an argument that it could not be. Sure, you can achieve genuine happiness without reaching emotional maturity, but it seems self-evident that you can’t identify genuine happiness without reaching that maturity. False happiness is incredibly deceptive.

In fact, there’s something about spending too much time or energy worrying about happiness, that strikes me as a possible sign of that lack of emotional maturity. I’ve often heard some folks say “the four years I spent in San Francisco, was the one time I was really happy,” or if they come from broken homes they might say “the time we lived in Albuquerque, was the one time that as a family we were happy.”

Personally, I haven’t been able to do this too much — point back to some eon in my own life story, and say “that there is when I was happy.” I can single out some stretches and say “that’s when I had it really good, but I didn’t realize it until I made some dreadful mistake and brought it to an inglorious end.” I can certainly do that a handful of times. But I can’t come up with a single moment when I was sitting around contemplating how deliriously happy I was. Exquisitely miserable, yeah. But on those occasions, if I could march into some doctor’s office and ask about some goop that would make me all happy-happy-joy-joy, I wouldn’t have been interested. I knew what was making me miserable and it wasn’t something any goop would fix.

But here’s what really scares me: How come I have to wait until late 2007 to see a sawbones with some balls point out that this over-diagnosis is a possibility? How come when you run an article going the other way…”depression is real, so if you think you suffer from it be sure to contact your doctor and ask about medication”…it’s okay to print it up without including the opposing point of view. Whereas, with this guy pointing out the possibility of a diagnosis, by the time you get to the fourth paragraph they’re already running the obligatory devil’s advocate, and one gathers the impression there would be an unpleasant conversation with someone somewhere if they did not:

But another psychiatrist writing in the journal contradicts his views, praising the increased diagnosis of depression.

Professor Ian Hickie writes that an increased diagnosis and treatment of depression has led to a reduction in suicides and removal of the old stigma surrounding mental illness.
:
…Professor Hickie said if only the most severe cases were treated, people would die unnecessarily.

So you have to include an opposing view if you dare to run an article in the BBC News, and apparently in the British Medical Journal as well, poo-pooing the crescendoing diagnosis of depression. But it seems a safe assumption if you run an article praising it instead, no opposing view is necessary.

Why is that? Well…we could say if you are suffering from diagnosis and you fail to get a prescription of what you need, your life might be in danger. But your life might be in danger, as well, if you’re suffering from what Dr. Parker calls “the milder, more common experiences” and actually acquire a prescription you don’t really need. I mean, mightn’t it? I’m not a doctor or a suicide counselor, but it seems a safe assumption to make.

Whereas, people make money when things are prescribed, and they don’t when they’re not.

So what I’m seeing here, is an industry with a need to police itself, failing to do so. Until I see evidence that there’s something else going on. Skepticism like Dr. Parker’s, if there are no concrete facts to directly contradict it, shouldn’t be so occasional. Something’s wrong here.

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Depression is Over-DiagnosedFriday, August 17th, 2007

Depression is Over-Diagnosed
Friday, August 17th, 2007