Journal of Mental Health features special issue on diagnosing mental illness

Jul 27 2010

This month Journal of Mental Health features a special issue on diagnosing mental illness. The issue - which comes out just weeks after the eagerly-awaited new draft of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the global diagnostic 'bible' for the field of mental health medicine - includes a series of articles written by high profile mainstream personalities on what a diagnosis of mental illness has meant to them.

Best-selling British author Sir Terry Pratchett, former prime ministers of Australia and Norway, memoirist Mark Vonnegut (son of Kurt Vonnegut Jr.) and some of the world's top mental health experts are among the line-up of writers featured.

"Our journal is unique in emphasising the value of contributions from and with consumers as well as from esteemed clinical experts," explains Professor Til Wykes, Executive Editor of Journal of Mental Health. "The 'patient' papers in this month's issue reflect on how a mental health diagnosis has impacted the lives of these people."

"It is astonishing how long it takes some people to get diagnosed (I know because they write to me)," says Sir Terry Pratchett, best-selling author of the Discworld series. "I cannot help but wonder if this is because doctors are sometimes reluctant to give the patient the stigma of dementia since there is no cure."

"When in Paradise Lost Milton's Satan stood in the pit of hell and raged at heaven, he was merely a trifle miffed compared to how I felt that day," explains Pratchett, about the day that he was diagnosed. "I felt totally alone, with the world receding from me in every direction and you could have used my anger to weld steel."

"It seems that when you have cancer you are a brave battler against the disease, but when you have Alzheimer's you are an old fart," continues Pratchett. "That's how people see you. It makes you feel quite alone."

The extreme impact of a mental health diagnosis - and the stigma attached - puts enormous pressure on the whole field to ensure accurate and sensible diagnoses.

"The publication of the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is one of the most highly-anticipated events in the mental health field," explains Daniel Falatko, Managing Editor of Journal of Mental Health. "This is the first major rewrite of DSM in 16 years and history has warned us that even small changes to this manual can have extraordinary repercussions in the diagnosis and treatment of mental health issues."

DSM is published by the American Psychiatric Association (APA) and contains descriptions, symptoms, and other criteria for diagnosing mental disorders. These criteria provide a common language and clear definitions for professionals who treat patients with mental disorders, helping to ensure that their diagnoses are accurate and consistent, worldwide.

"However, critics of this issue of DSM are concerned with the classification of novelty conditions as psychological disorders. In the new edition, temper tantrums among toddlers and heartache over a lost spouse could now be defined as mental health conditions," explains Jerome Wakefield of New York University's Department of Psychiatry. "One of the most frightening scenarios is the potential for medicating people - particularly children - who haven't yet shown any signs of illness in a bid to 'treat' them for Psychosis Risk Syndrome, as identified by the new draft of DSM-5."

Indeed, there is reason for concern. Changes to the previous version (DSM-4) seem to have contributed to three false positive "epidemics" - high rates of attention deficit hyperactivity disorder, autistic disorder, and childhood bipolar disorders. Other factors also contributed to fanning the flames - in particular, drug companies marketing drugs for these diagnoses not just to doctors, but also to the general public. During the last decade, how many doctors were harangued by worried parents into giving drugs like Ritalin to children who didn't really need it?

One of the main controversies is that the further the guidelines are expanded, the easier the likelihood that nobody will classify as "normal". Technically, with the classification of so many new disorders, we will all have disorders. This may lead to the belief that many more of us 'need' drugs to treat our 'conditions'. Many of these drugs will have unpleasant or dangerous side effects.

What is it like to live with the side effects of anti-psychosis drugs? How does it feel to be labeled with a mental health illness? Does a situation where more people feel they have a problem make it better or worse for those who have been diagnosed with a mental health illness? Are we putting enough time, effort and money into 'cures' for this area of healthcare? What is it like to be diagnosed? These are some of the questions addressed by the articles in this month's Journal of Mental Health.