Tuesday, July 11, 2006

A Culture of Whiners?

Please welcome Guest Blogger Peter Owens, Professor at UMass Dartmouth and author of Rips, Oil and Chemical Spills, and Teens: Health and Obesity; while Peter's not a psychiatrist, he is Dinah's friend.

First, some excepts from the article Peter wants to talk about.
In "Prescription by Psychiatry" (link below), Ashley Pettus writes:

“By medicalizing ordinary unhappiness,” says professor of psychiatry and medical anthropology Arthur Kleinman, who is also Rabb professor of anthropology, “we risk doing a disservice to those people who have severe mental illnesses.” Kleinman fears that including mild forms of anxiety and depression under an ever-widening umbrella of mental disorders will divert attention and resources from diseases like schizophrenia and major depression, which remain undertreated and stigmatized across much of the world. In his view, “We may turn off the public, who are a huge source of support for mental-health research, by telling them that half of them are mad.”

Kleinman believes the weaknesses of psychiatric measurement are detrimental not only to the severely mentally ill, but also to the rest of us. The expansion of illness categories, he says, risks turning the most profound human experiences into medical problems. Grief over the loss of a loved one, or sadness in the face of death, for example, can look like depressive disorder, according to a checklist of DSM criteria. Doctors now routinely prescribe antidepressants to terminal patients on cancer wards and to bereaved family members whose grief symptoms persist beyond the DSM’s “normal” two-month period. By making the emotions that accompany loss and dying into disease, Kleinman says, we are in danger as a society of flattening out our moral life. “The intent may be: why should anyone have to feel any degree of suffering?” he says. “And the result may be: if you make it difficult for people to engage suffering, you may actually change the nature of the world we live in.”

Peter writes:

I was thinking about posing a question to your blog. The most recent Harvard Magazine has an article, Psychiatry by Prescription, about the moral/ethical tension between using designer drugs to treat the growing number of psychological disorders (social anxiety, mood disorders, impulse disorders, ADHD etc.) versus paying greater attention to the most serious and intractable diseases such as schizophrenia and bipolar disorder that tend to go untreated far more often.

I think the article underplays the consequences of these seeming "life problem" conditions, but it raises interesting questions. I also think the article fails to equate survivable disorders with useful correlaries in physical medicine. Most of us could survive a sprained ankle without medical treatment, but few of us would doubt the wisdom of seeking medical care. Most of us can survive headaches but think nothing of the moral implications of taking an aspirin. But someone taking an SSRI for persistent anxiety and chronic depression is considered morally suspect. There's a stern Puritanical subtext to these critiques that border on evangelicalism.

Ok, so what do you shrinks think about the whole designer drug, disorder de jour, chemical treatment of life's little problems critiques bouncing around the profession and FOX News? Have we become a culture of whiners, and are shrinks the enablers? Are you prescribing drugs that replace the moral grit and confrontation with personal honesty that used to be the hallmarks of psychoanalysis and talk therapy?