10 ms·

Medicalising everyday life doesn't help anyone's mental health

92 points by imperio59 7y ago

throwaway55254 7y ago
I wonder about this as well. I see lists of anxiety symptoms shared and I meet every one of them, but I don't consider myself to have anxiety. Isn't it normal to be anxious in stressful situations or to be depressed when things are going poorly. Then I do some reading about it and I wonder maybe its not normal, maybe I'm not supposed to feel this way. I'm sure there are people with mental health conditions that do need treatment, I won't argue that at all. I do think pinning down what is "normal" and should be just waited out and what is abnormal and should be medically treated, although easy at the extreme edges, is very difficult in the middle of the spectrum. I agree with the article that we are trying to narrow the normal distribution of human traits by medicalising things that are a common occurrence for at least a subset of the population. I'm not sure where this stems from though. Is it the desire for extreme corporate efficiency and competition for resources. Is it a misguided medical system trying to make patients out of more people? Like anything sufficiently complicated its probably a huge confluence of factors.
- klodolph 7y ago
  Well, first of all, only certain professionals are licensed to administer those tests, and for good reason, because otherwise people would self-diagnose too much or too little. > […] I don't consider myself to have anxiety. Everyone has anxiety. Some people have anxiety disorders. > Isn't it normal to be anxious in stressful situations […] People with anxiety disorders are anxious in normal, non-stressful situations. They can panic when asking a bus driver which stop they should get off at, when talking to a new coworker, or in other ordinary circumstances. People with depressive disorders are depressed at times even when things are going well. People with severe depression can have a hard time just getting out of bed in the morning, feeding themselves, and going through the motions of ordinary life.
  - deleted 7y ago
    [deleted]
  - wutbrodo 7y ago
    I don't think this was intended as a general purpose argument against ever treating mood disorders. Rather, the parent comment is describing the fact that anxiety and depression are conflated with their corresponding disorders too often. I can somewhat relate from experience: I went to a doctor for terrible trouble sleeping, to the point that it was affecting my physical health, that we assumed was caused by anxiety/depression[1]. I was pretty shocked at the rapidity with which she suggested going on antidepressants, particularly considering the tapering periods and the seriousness of the dependency and side effects that they cause. I pushed back a little but it turns out that my doctor's cavalier attitude towards antidepressants isn't out of the norm: they're considered a "try it and see what happens" first line of defense, without trying to get a better sense of the patient's specific issues and whether therapy or other interventions, sans medication, would be a better fit (though I should note that the doctor recommended that I go to therapy if possible in conjunction). Tangentially, this fits with a larger disillusionment I have with the medical system: a combination of screwy incentives, bad lines of communication between generalists and specialists, and a serious institutional/cultural case of a God complex leading to a lack of critical thinking means that I'm at the point where I pretty much keep anything a doctor tells me as just another unreliable information source, weighted more heavily perhaps than my layman's understanding of the research but on categorically the same level. Ive seen the same disillusionment kick in among my doctor family members: in our conversations over the years, my sister and her husband have gone from a central case of said God complex to as much as telling me not to take doctors' advice without a heavy dose of skepticism. I should note that I don't actually consider this a criticism of any individual physicians as much as the realities of the system. One of the biggest factors is that the average person showing up at the doctor is simultaneously incredibly dumb and incredibly confident in their understanding of the medical problem. It makes sense for doctors to be a somewhat heavy-handed and reductive, and once you build those habits into your institutions and pedagogy, it's hard to turn it off. [1] Turns out it was the other way around: consistently not sleeping causes some pretty crappy psychological problems
    - 7y ago
- wool_gather 7y ago
  I think you're right to question. The rule of thumb I've heard, which seems sensible to me, is is the condition/symptom negatively affecting your ability to go about your day-to-day life. If not, then whatever you're experiencing is probably "normal enough". There's no great mass of people with completely by-the-book mental processes; everyone's a little "weird" in some way. On the other hand, I suppose you may not be able to evaluate that question fully yourself. It's hard to see your own mind clearly.
  - throwaway55254 7y ago
    > is the condition/symptom negatively affecting your ability to go about your day-to-day life I wonder though, is this even too broad? Perhaps people need to overcome some of this adversity. Not everything is painless in life nor should it be.
    - fwip 7y ago
      Part of the point is that it's not something you're overcoming. If you're worried about it, but you do it anyway, you still have the ability to go about your life. When my anxiety was super bad (before therapy and medication), there were weeks when I was too anxious to go to the grocery store and started skipping dinner because there wasn't any food in the house. I hadn't seen a dentist in 8 years because my phone anxiety was too high to make an appointment - and my social anxiety was terrified that they'd be mean to me about my teeth. I'm doing much better now, but there are still some times that my anxiety acts as a total blocker to something I have to (or sincerely want to) do.
    - SketchySeaBeast 7y ago
      > Not everything is painless in life nor should it be. No, but a lot of things should be. Leaving the house SHOULD be, but for some people it isn't. If it's causing you so much dread you can't bring yourself to do it, that's not just "overcoming adversity" - that's adversity where there shouldn't be any.
    - wool_gather 7y ago
      I mean, maybe I'm misunderstanding what you're saying, but you "overcome" it by getting treatment if it's bad enough.
- mruts 7y ago
  I don’t think anyone really knows if other people experience anything that is similar. I go back and forth on that a lot. But in terms of medicalizing things, who cares if it’s normal. It’s not about being normal, it’s about being better. I get prescribed a lot more medication than I need. I don’t take it often, but I like the options having anti-depressants, sleeping pills, stimulants, and anti-anxiety medication provide. Wirh it I have the ability to easily control my mental and physical state depending on I want to feel and what is required of me. Do I need to crush code for 48 hours? No problem. Sleeping on a plane, no problem. Etc etc. Not saying this would work for everyone, and if I took the time, maybe I could use meditation or whatever to achieve the same results. But I’m busy and have things to do, I suppose.
  - throwaway55254 7y ago
    Better living through chemistry. Not at all what I was thinking when I wrote this post, but I love this take on it. I think if that is truly the drive behind the medicalisation of every day life we would be better off dropping the facade just allow people to live their best life through chemical augmentation, if they so desire. My mind takes the wide application of this to a scary dystopian conclusion, but perhaps it doesn't have to be this way. Or conversely perhaps we are already there.
    - AstralStorm 7y ago
      The thing is most people do not have the necessary critical thinking education, chemistry and biology knowledge to even approach taking random untested formulations for any reason, much less for prolonged time. Even medicine oftentimes lacks reliable data for specific case or long term use...
- sterkekoffie 7y ago
  Looking up symptoms of anxiety to determine if you have GAD is a bit like looking up symptoms of hunger to determine if you're malnourished.
- dragonsky67 7y ago
  The problem with continuous anxiety is that long term exposure can have a debilitating physical impact. This is not a joke and if you find that you are continually stressed or anxious you should take some active measures to get it under control.
tylfin 7y ago
Author seemed to have some valid points - issues that are part of the normal healing process are being diagnosed & treated via antidepressants. The part I'm not so sure I agree with is the "system is too jammed up so don't come," sentiment. I think if someone is having a hard time & they want to reach out to a medical professional that's probably for the best. Unfortunately that does shift the burden onto the system to train professionals to determine the difference between prescribing antidepressants or talk and time therapy. It's a lot easier to write someone that prescription than hear them out.
- rjf72 7y ago
  He's talking from the perspective of the UK, where he is a physician. The public health system in the UK has been under extreme and increasing stress. It's underfunded, understaffed, overburdened, and things are getting worse. In a related article [1], it was mentioned that 70% of children with mental issues do not receive treatment because lack of resources - high rates of mental illness mean there's simply not enough healthcare to go around. Even those that do receive treatment end up facing "unacceptably long waits." The current ambitious goal in restructuring the system would still leave some 65% of those with diagnosed medical conditions, without treatment. Wiki also has a number of decent citations for further information. [2] When things are provided through public funding there is an obligation of society to ensure that they are utilized in a sustainable way. If that obligation is not met, the systems become, quite tautologically, unsustainable. [1] - https://www.independent.co.uk/news/health/mental-health-crisis-nhs-counselling-waiting-time-children-mp-public-accounts-committee-a8721646.html https://www.independent.co.uk/news/health/mental-health-cris... [2] - https://en.wikipedia.org/wiki/National_Health_Service#Funding https://en.wikipedia.org/wiki/National_Health_Service#Fundin...
namirez 7y ago
Reminds of this paragraph of Mark Fisher in Capitalist Realism: "I want to argue that it is necessary to reframe the growing problem of stress (and distress) in capitalist societies. Instead of treating it as incumbent on individuals to resolve their own psychological distress, instead, that is, of accepting the vast privatization of tress that has taken place over the last thirty years, we need to ask: how has it become acceptable that so many people, and especially so many young people, are ill? The 'mental health plague' in capitalist societies would suggest that, instead of being the only social system that works, capitalism is inherently dysfunctional, and that the cost of it appearing to work is very high".
- YorkshireSeason 7y ago
  Mark Fisher's entire work can be summarised without much loss by saying "It's all capitalism's fault!" How is this interesting? I met him personally a couple of times, I don't think he would have been able even to say what e.g. fractional reserve banking was, or the labour theory of value, not to mention Böhm-Bawerk's famous critique. Anyway, since I've just violated de mortuis nil nisi bonum, let me finish by saying that Fisher had good taste in music.
  - namirez 7y ago
    I just know that in our economic system, humans are capital and anything that compromises their economic productivity is pathologized. Who Fisher was or what he did is irrelevant to this discussion.
    - YorkshireSeason 7y ago
      Soldiers, children and old-age pensioners are not productive, yet not pathologised. Whole swathes of jobs are not truly productive, e.g. marketing and advertising, psychologists, priests, yoga-teachers.
      - AstralStorm 7y ago
        These are support jobs and in the longer run they can be productive or unproductive, by enhancing productivity of others.
sewercake 7y ago
Could it be that people aren't _just_ becoming more sensitive, but that aspects of modern society are _causing_ mental health issues to appear at higher rates? I won't say 'capitalism is making everyone mentally ill', but it does seem that a large blind-spot in most discourse around mental health is environment. In this sense, 'medicalising' everyday does, in fact, provide a useful lens to examine mental illness. Just food for thought.
- sosborn 7y ago
  I would bet that the higher rates are about mental health issues becoming more widely known and less stigmatized.
  - ozzyman700 7y ago
    Would you tend to feel that mental health issues are a result of nature, and not nurture then?
    - sosborn 7y ago
      I think it is a mix of both, but I also feel that we are much better at nurturing than we used to be.
- the-dude 7y ago
  Over the last 3 yrs I think I have discovered my supposed (very real and intense) hayfever started when I started 'real' school ( 12 yrs+ ), worsened when I attended uni and started 'working'. Couple of years ago I started to go outside for long periods of time, at the start of the season, all season. Biking and laying about at the waterside with my nose in the grass. First year, first months, I had symptoms. But after like 2 months of exposure I started to become free of symptoms. Up to my 'real' school we played outside extensively and I never had symptoms. When I was about 15 years I was prescribed pills and whatnot. If I go outside 'enough', I consider myself 'cured'. Not mental, but I felt it was related.
astazangasta 7y ago
I have the greatest problem with this in early childhood. The extent of psychiatric involvement in the classroom, including drug interventions, is really alarming. Diagnosis, which is extremely inconsistent and forms disease categories with extremely thin bases, has a formal place and is required for special learning dispensations. Future generations will look back in horror at all this.
dreen 7y ago
A friend of mine is affected by this, combined with her innate hypochondriac tendencies it makes her life very difficult and her sense of self-worth and confidence very low. However, I am at a loss as to how to approach her to help her. Trying to convey this to her would sound more like an accusation of hypochondria.
- hinkley 7y ago
  From what I understand, it can be helpful to get people to think about themselves in the third person. We can be much harder on ourselves than we would ever be on a friend, and if you can get her to think about her own set of problems as if they were yours, what sort of advice would she offer you? We get wrapped up in a set of outcomes and every setback feels like a harbinger of doom. I saw a retweet recently from someone with chronic fatigue who wished they could go back in time and use their dwindling energy to set themselves up for the future instead of spending everything on trying to 'get back to normal so they could start their life again'. Look at where you are. What could you do this week or month to get to something you could live with or even enjoy? Don't let the perfect be the enemy of the good. He says, realizing he needs to follow the same advice...
- klyrs 7y ago
  This sounds very much like my ex. I thought I could help them. For a long time, I did... think I was helping. When a sequence of tragedies struck, I found myself needing help. We deteriorated quickly, as their self-worth was propped upon mine, which was defined in large part by my ability to help. We didn't have external support and we both crumbled. I wish I could tell you how to help your friend. What my spouse needed was therapy from a professional, who could maintain appropriate boundaries -- I wasn't, and couldn't. The awful thing I learned about 'hypochondria' is that psychosomatic effects, and stress, can have real physical consequences. I never did learn how to navigate that conversation without causing distress
mi100hael 7y ago
> One of the things that is most protective to mental health is not to spend too much of our lives consciously obsessing about it. That last statement is rather asinine and seems at odds with the rest of the article. I think it's fair to say negative emotions aren't the same as mental illness, but ignoring those negative emotions and keeping a "stiff upper lip" can lead to much bigger emotional problems down the road. There's a middle ground that involves accepting & experiencing the lows along with the highs as a part of life.
- cousin_it 7y ago
  > ignoring those negative emotions and keeping a "stiff upper lip" can lead to much bigger emotional problems down the road To me, keeping a "stiff upper lip" isn't so much about ignoring negative emotions, but more about behaving in the right way even when emotions pull you the wrong way. In my experience, exercising that skill doesn't create emotional problems, but solves them.
  - ozzyman700 7y ago
    This is what I feel is meant by stiff upper lip: Be like a rocky promontory against which the restless surf continuously pounds; it stands fast while the churning sea is lulled to sleep at its feet. I hear you say, "How unlucky that this should happen to me!" Not at all! Say instead, "How lucky I am that I am not broken by what has happened and am not afraid of what is about to happen. The same blow might have struck any one, but not many would have absorbed it without capitulation and complaint."
    - AstralStorm 7y ago
      And thus status quo, however evil or bad, is kept. This stance is immoral in many ethical systems. Not to mention everyone has a breaking point.
- jschwartzi 7y ago
  Well the author is certainly privileged to not have to think about his own mental health very much, considering who he is and what he does for a living. The real thing that's happening with mental health in the US and probably the UK is that people aren't so much deciding that their personal problems are diagnosable psychiatric conditions as they are deciding that they would like to become mentally healthier and are seeking help. And the medical profession, being ill-equipped to actually provide a means to change, is turning to psychiatric medicines to control what are essentially patterns of thinking and being. At the gym it would be like people seeking to become better and instead of receiving personal training they would be given steroids. I was one of those people who wanted to change how I thought about things and how I acted. And so I sought therapy not necessarily because I had a clinical disorder, but because there were a lot of probably sub-clinical issues I was having with my thinking, and having someone rational and well-trained helped me change my thinking and my behavior so it was no longer causing problems for me. Frankly I was nearing a meltdown of some sort. It's not the same as needing psychiatric care for a personality disorder or for Schizophrenia or for any number of treatable, identifiable psychiatric disorders. But he's standing up this straw man that people like me are just wimps and they just need to suck it up and have a cup of tea or something. It's pretty patronizing.
cs02rm0 7y ago
I couldn't get a vitamin B12 injection, the materials cost of which is less than £1 with no negative side effects, more often than every 12 weeks from my doctor. Despite feeling awful at 8 weeks onwards, to the point of not being able to work, and better again every time I had the injection. I didn't care if it was placebo (although why it would be placebo at 8 weeks but deemed not a placebo at 12 weeks I struggle to understand), I felt I needed it more often and eventually found a doctor willing to try it. For me, it works. What got to me though, is while the doctor wasn't willing to try a vitamin slightly more frequently, he offered anti-depressants at the drop of a hat. He couldn't have been more forwards in offering them and didn't take the hint when I told him I didn't really want them - I had to give him a firm no in the end!
- JamesBarney 7y ago
  There is some evidence high serum levels of b12 are a risk for cancer. http://sciencenordic.com/high-levels-vitamin-b12-can-increase-lung-cancer-risk http://sciencenordic.com/high-levels-vitamin-b12-can-increas...
- nutjob2 7y ago
  > although why it would be placebo at 8 weeks but deemed not a placebo at 12 weeks I struggle to understand Because the placebo effect fades over time. The doctor has concluded that you'd be safely clear of it at 12 weeks.
- ip26 7y ago
  Curious, why do you need an injection? I thought only vegans had issues with B12, and only if they weren't paying attention to what they ate.
  - 52-6F-62 7y ago
    I'm a ~30 year old meat-eating male in a family with a history of anemia on my mother's side (including my sister). It was discovered sometime within the past few years during a routine blood test that I had low hemoglobin from a moderate-to-severe Iron/B12 deficiency (no full blown other condition, though) I was never recommended injections, however. Doctor told me to take an off-the-shelf supplement and to eat more red meat. (I rarely did) When I don't follow through with those items I do notice. Following his advice has greatly improved my overall feeling of well-being. I would otherwise feel tired, foggy-headed, weak, faint, anxious, nauseous at times—sometimes a mix of all of the above. Used to think my blood sugar was just low.
hangonhn 7y ago
I don't know how much he knows about mental health or how it's practice in the US. But in the US there are things that are classified as clinical and those that aren't. The DSM-V is a guidebook to those issues and people who make those determinations has to go through a graduate program (Masters, Ph.D. etc) with a certain period of training akin to residency (these requirements do vary from state to state but in California it is fairly extensive and strict). I can't speak to what's going on in the UK but one can't simply show up to a therapist or psychiatrist because one's having a bad day and start getting drugs or some long term therapy program.
rjvehn 7y ago
It is sad that British society is losing the belief in a stiff upper lip. I think it is becoming accepted to make excuses everywhere. For individuals and groups, it is now seen as as okay to not to aim higher. There are so many hard working people who were never handed anything, have actual physical disabilities, and they still work extreme hours to take care of their families and not be a burden. I always think of how we construct Kobayashi Marus to tell ourselves and others that there are no-win scenarios, in some odd attempt to justify limiting ourselves to only grim options and schadenfreude for those who fail to echo acceptance. What if this belief in a gritty realpolitik is an excuse for not wanting to think harder to achieve what is right? That individuals and groups willingly believe in a local maxima, because the hill climbing required to get the right outcome is accepted as fantasy?
- Dumblydorr 7y ago
  What's your point? Is your thesis that those with mental illness make excuses everywhere?
  - rjvehn 7y ago
    My point is that excuses are being legitimized.
fromthestart 7y ago
Alternative take: some mental illnesses, anxiety disorders in particular, are exacerbated by knowledge of them and their immediate effects. Anxiety is much easier to deal with when you're not anxious about the fact that you are or will be anxious. Maintaining a "stiff upper lip" means learning to ignore unpleasant symptoms, which can both reduce their frequency and severity. There is usefulness in "manning up", to use an increasingly unpopular turn of phrase. I disagree with the increasingly common idea that suppressing one's negative emotions is generally harmful.
- AstralStorm 7y ago
  It can also increase severity while reducing frequency, or cause transfer onto others or psychosomatic. You cannot recommend it without an actual trial, it is not safe.
ficklepickle 7y ago
I have never seen a group of less mentally-healthy people in my life. Mentally healthy people don't drink that much. The whole stiff upper lip nonsense is the problem. Neglecting and suppressing emotions for long periods of time cause mental health issues. The problem is that we don't have a clue about mental health in general, the blind are leading the blind. Antidepressants don't cure depression. In fact, they can make it harder to process emotions. They reduce the symptoms and make it easier to ignore the environmental issues that are causing it. Actually treating depression requires understanding and addressing the true cause. And the true cause is not a chemical imbalance or people not being tough enough. Self-pity or using issues as a crutch does not help, but it is also not the cause.
chewabLMorphine 7y ago
One of the least enviable things I've ever witnessed in my life was a pair of co-workers who bonded over their medical problems. It was a really strange thing to notice, and at first, it just seemed like small talk or polite conversation. But then it kept going, and while there was nothing particularly repugnant about the details, the undertones that developed were unsavory. It was like they relished being sad about their invalidity, like it was one big sick day that gave them an excuse to stay home from school. As if to say, "thank god my body is failing me again, and everyone is powerless to make demands of me." They would bond over the similar things their doctors would put them through, about the noises of MRI machines, about side effects and being incapacitated by medicines, about being laid up for extended periods of time. Bad news was greeted with a sort of malign enthusiasm, like getting to take the ride again. "Oh yeah, my doctor just told me my tests are bad again." You had to wonder if they were harming themselves to get back on the radar. These two individuals weren't stupid, and it seemed within the realm of believability that they'd try to maximize all the physical therapy and weird attention that a medical problem would garner them. Their problems were distinct and different, but with the way they locked in on each other, sharing tips and tricks as it were, it seemed like maybe without any other reason to talk to one another, the way they enjoyed such discussions bordered on perverse. The tone of each, finding excitement in the other's words, lent an uncanny color to the details I learned by being a fly on the wall. Like hot pink syringes and neon green day glow catheter crazy straws. On second thought, maybe the bigger problem was the open office floor plan, and the fact that I was forced to listen to conversations that I just didn't want to hear.
coffeemug 7y ago
Alternatively: we can stop referring to these as medicines and treat them like iodized salt, fluoridated water, or cell phones. They seem to be completely safe in short and long term. They make people’s lives better. How do you tell articles like this apart from luddite stigma?
dkarl 7y ago
Does anyone feel like their scraped knees and head colds are "medicalized" because there's treatment available and medical terminology for talking about it? You can take your scraped knee to your family doctor or an urgent care clinic and get a bandage applied to it, but people rarely do, and having the option doesn't freak anyone out. So why are people bothered by their anxiety or reoccurring blue moods being "medicalized?" As far as I can tell, it's just the stubborn lingering stigma associated with mental illness. The fact that a person's cold is a physical illness feels harmless to them, but the idea that they might be suffering from a "mental" illness, even a mild and common one, feels way more momentous and scary than it should. Clearly I am not alone in my sense that we have already hit the boundaries of how far we can sensibly apply the paradigm of mental health as a means of understanding and addressing human misfortunes. This is ridiculous. We certainly haven't gone far enough when people identify "mental health" with an inability to function without professional support. How ridiculous would it be if people denied having a physical injury when they had a scraped knee, because they felt denial was the only way to avoid seeing a doctor? How ridiculous would it be if people didn't brush their teeth because they didn't want to give up their precious self-reliance to "dental health" professionals? We reduce our reliance on professionals by applying knowledge from those professions, not by denying their relevance.
FatDrunknStupid 7y ago
The real problem is the 'professionals' actually have very little clue what's actually going on - and a magic pill will fix everything (including a kick back for the prescribing doctor, maybe-ish). I'm a programmer, can't take the medication and do the job - dumped by UK healthcare as no-one has a clue. So Fuck it, I'll be fucking fine thaanks.
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92 points by imperio59 7y ago

I wonder about this as well. I see lists of anxiety symptoms shared and I meet every one of them, but I don't consider myself to have anxiety. Isn't it normal to be anxious in stressful situations or to be depressed when things are going poorly. Then I do some reading about it and I wonder maybe its not normal, maybe I'm not supposed to feel this way. I'm sure there are people with mental health conditions that do need treatment, I won't argue that at all. I do think pinning down what is "normal" and should be just waited out and what is abnormal and should be medically treated, although easy at the extreme edges, is very difficult in the middle of the spectrum. I agree with the article that we are trying to narrow the normal distribution of human traits by medicalising things that are a common occurrence for at least a subset of the population. I'm not sure where this stems from though. Is it the desire for extreme corporate efficiency and competition for resources. Is it a misguided medical system trying to make patients out of more people? Like anything sufficiently complicated its probably a huge confluence of factors.

klodolph 7y ago
Well, first of all, only certain professionals are licensed to administer those tests, and for good reason, because otherwise people would self-diagnose too much or too little. > […] I don't consider myself to have anxiety. Everyone has anxiety. Some people have anxiety disorders. > Isn't it normal to be anxious in stressful situations […] People with anxiety disorders are anxious in normal, non-stressful situations. They can panic when asking a bus driver which stop they should get off at, when talking to a new coworker, or in other ordinary circumstances. People with depressive disorders are depressed at times even when things are going well. People with severe depression can have a hard time just getting out of bed in the morning, feeding themselves, and going through the motions of ordinary life.
- deleted 7y ago
  [deleted]
- wutbrodo 7y ago
  I don't think this was intended as a general purpose argument against ever treating mood disorders. Rather, the parent comment is describing the fact that anxiety and depression are conflated with their corresponding disorders too often. I can somewhat relate from experience: I went to a doctor for terrible trouble sleeping, to the point that it was affecting my physical health, that we assumed was caused by anxiety/depression[1]. I was pretty shocked at the rapidity with which she suggested going on antidepressants, particularly considering the tapering periods and the seriousness of the dependency and side effects that they cause. I pushed back a little but it turns out that my doctor's cavalier attitude towards antidepressants isn't out of the norm: they're considered a "try it and see what happens" first line of defense, without trying to get a better sense of the patient's specific issues and whether therapy or other interventions, sans medication, would be a better fit (though I should note that the doctor recommended that I go to therapy if possible in conjunction). Tangentially, this fits with a larger disillusionment I have with the medical system: a combination of screwy incentives, bad lines of communication between generalists and specialists, and a serious institutional/cultural case of a God complex leading to a lack of critical thinking means that I'm at the point where I pretty much keep anything a doctor tells me as just another unreliable information source, weighted more heavily perhaps than my layman's understanding of the research but on categorically the same level. Ive seen the same disillusionment kick in among my doctor family members: in our conversations over the years, my sister and her husband have gone from a central case of said God complex to as much as telling me not to take doctors' advice without a heavy dose of skepticism. I should note that I don't actually consider this a criticism of any individual physicians as much as the realities of the system. One of the biggest factors is that the average person showing up at the doctor is simultaneously incredibly dumb and incredibly confident in their understanding of the medical problem. It makes sense for doctors to be a somewhat heavy-handed and reductive, and once you build those habits into your institutions and pedagogy, it's hard to turn it off. [1] Turns out it was the other way around: consistently not sleeping causes some pretty crappy psychological problems
  - 7y ago
wool_gather 7y ago
I think you're right to question. The rule of thumb I've heard, which seems sensible to me, is is the condition/symptom negatively affecting your ability to go about your day-to-day life. If not, then whatever you're experiencing is probably "normal enough". There's no great mass of people with completely by-the-book mental processes; everyone's a little "weird" in some way. On the other hand, I suppose you may not be able to evaluate that question fully yourself. It's hard to see your own mind clearly.
- throwaway55254 7y ago
  > is the condition/symptom negatively affecting your ability to go about your day-to-day life I wonder though, is this even too broad? Perhaps people need to overcome some of this adversity. Not everything is painless in life nor should it be.
  - fwip 7y ago
    Part of the point is that it's not something you're overcoming. If you're worried about it, but you do it anyway, you still have the ability to go about your life. When my anxiety was super bad (before therapy and medication), there were weeks when I was too anxious to go to the grocery store and started skipping dinner because there wasn't any food in the house. I hadn't seen a dentist in 8 years because my phone anxiety was too high to make an appointment - and my social anxiety was terrified that they'd be mean to me about my teeth. I'm doing much better now, but there are still some times that my anxiety acts as a total blocker to something I have to (or sincerely want to) do.
  - SketchySeaBeast 7y ago
    > Not everything is painless in life nor should it be. No, but a lot of things should be. Leaving the house SHOULD be, but for some people it isn't. If it's causing you so much dread you can't bring yourself to do it, that's not just "overcoming adversity" - that's adversity where there shouldn't be any.
  - wool_gather 7y ago
    I mean, maybe I'm misunderstanding what you're saying, but you "overcome" it by getting treatment if it's bad enough.
mruts 7y ago
I don’t think anyone really knows if other people experience anything that is similar. I go back and forth on that a lot. But in terms of medicalizing things, who cares if it’s normal. It’s not about being normal, it’s about being better. I get prescribed a lot more medication than I need. I don’t take it often, but I like the options having anti-depressants, sleeping pills, stimulants, and anti-anxiety medication provide. Wirh it I have the ability to easily control my mental and physical state depending on I want to feel and what is required of me. Do I need to crush code for 48 hours? No problem. Sleeping on a plane, no problem. Etc etc. Not saying this would work for everyone, and if I took the time, maybe I could use meditation or whatever to achieve the same results. But I’m busy and have things to do, I suppose.
- throwaway55254 7y ago
  Better living through chemistry. Not at all what I was thinking when I wrote this post, but I love this take on it. I think if that is truly the drive behind the medicalisation of every day life we would be better off dropping the facade just allow people to live their best life through chemical augmentation, if they so desire. My mind takes the wide application of this to a scary dystopian conclusion, but perhaps it doesn't have to be this way. Or conversely perhaps we are already there.
  - AstralStorm 7y ago
    The thing is most people do not have the necessary critical thinking education, chemistry and biology knowledge to even approach taking random untested formulations for any reason, much less for prolonged time. Even medicine oftentimes lacks reliable data for specific case or long term use...
sterkekoffie 7y ago
Looking up symptoms of anxiety to determine if you have GAD is a bit like looking up symptoms of hunger to determine if you're malnourished.
dragonsky67 7y ago
The problem with continuous anxiety is that long term exposure can have a debilitating physical impact. This is not a joke and if you find that you are continually stressed or anxious you should take some active measures to get it under control.

tylfin 7y ago

Author seemed to have some valid points - issues that are part of the normal healing process are being diagnosed & treated via antidepressants. The part I'm not so sure I agree with is the "system is too jammed up so don't come," sentiment. I think if someone is having a hard time & they want to reach out to a medical professional that's probably for the best. Unfortunately that does shift the burden onto the system to train professionals to determine the difference between prescribing antidepressants or talk and time therapy. It's a lot easier to write someone that prescription than hear them out.

rjf72 7y ago
He's talking from the perspective of the UK, where he is a physician. The public health system in the UK has been under extreme and increasing stress. It's underfunded, understaffed, overburdened, and things are getting worse. In a related article [1], it was mentioned that 70% of children with mental issues do not receive treatment because lack of resources - high rates of mental illness mean there's simply not enough healthcare to go around. Even those that do receive treatment end up facing "unacceptably long waits." The current ambitious goal in restructuring the system would still leave some 65% of those with diagnosed medical conditions, without treatment. Wiki also has a number of decent citations for further information. [2] When things are provided through public funding there is an obligation of society to ensure that they are utilized in a sustainable way. If that obligation is not met, the systems become, quite tautologically, unsustainable. [1] - https://www.independent.co.uk/news/health/mental-health-crisis-nhs-counselling-waiting-time-children-mp-public-accounts-committee-a8721646.html https://www.independent.co.uk/news/health/mental-health-cris... [2] - https://en.wikipedia.org/wiki/National_Health_Service#Funding https://en.wikipedia.org/wiki/National_Health_Service#Fundin...

namirez 7y ago

Reminds of this paragraph of Mark Fisher in Capitalist Realism: "I want to argue that it is necessary to reframe the growing problem of stress (and distress) in capitalist societies. Instead of treating it as incumbent on individuals to resolve their own psychological distress, instead, that is, of accepting the vast privatization of tress that has taken place over the last thirty years, we need to ask: how has it become acceptable that so many people, and especially so many young people, are ill? The 'mental health plague' in capitalist societies would suggest that, instead of being the only social system that works, capitalism is inherently dysfunctional, and that the cost of it appearing to work is very high".

YorkshireSeason 7y ago
Mark Fisher's entire work can be summarised without much loss by saying "It's all capitalism's fault!" How is this interesting? I met him personally a couple of times, I don't think he would have been able even to say what e.g. fractional reserve banking was, or the labour theory of value, not to mention Böhm-Bawerk's famous critique. Anyway, since I've just violated de mortuis nil nisi bonum, let me finish by saying that Fisher had good taste in music.
- namirez 7y ago
  I just know that in our economic system, humans are capital and anything that compromises their economic productivity is pathologized. Who Fisher was or what he did is irrelevant to this discussion.
  - YorkshireSeason 7y ago
    Soldiers, children and old-age pensioners are not productive, yet not pathologised. Whole swathes of jobs are not truly productive, e.g. marketing and advertising, psychologists, priests, yoga-teachers.
    - AstralStorm 7y ago
      These are support jobs and in the longer run they can be productive or unproductive, by enhancing productivity of others.

sewercake 7y ago

Could it be that people aren't _just_ becoming more sensitive, but that aspects of modern society are _causing_ mental health issues to appear at higher rates? I won't say 'capitalism is making everyone mentally ill', but it does seem that a large blind-spot in most discourse around mental health is environment. In this sense, 'medicalising' everyday does, in fact, provide a useful lens to examine mental illness. Just food for thought.

sosborn 7y ago
I would bet that the higher rates are about mental health issues becoming more widely known and less stigmatized.
- ozzyman700 7y ago
  Would you tend to feel that mental health issues are a result of nature, and not nurture then?
  - sosborn 7y ago
    I think it is a mix of both, but I also feel that we are much better at nurturing than we used to be.
the-dude 7y ago
Over the last 3 yrs I think I have discovered my supposed (very real and intense) hayfever started when I started 'real' school ( 12 yrs+ ), worsened when I attended uni and started 'working'. Couple of years ago I started to go outside for long periods of time, at the start of the season, all season. Biking and laying about at the waterside with my nose in the grass. First year, first months, I had symptoms. But after like 2 months of exposure I started to become free of symptoms. Up to my 'real' school we played outside extensively and I never had symptoms. When I was about 15 years I was prescribed pills and whatnot. If I go outside 'enough', I consider myself 'cured'. Not mental, but I felt it was related.

astazangasta 7y ago

I have the greatest problem with this in early childhood. The extent of psychiatric involvement in the classroom, including drug interventions, is really alarming. Diagnosis, which is extremely inconsistent and forms disease categories with extremely thin bases, has a formal place and is required for special learning dispensations. Future generations will look back in horror at all this.

dreen 7y ago

A friend of mine is affected by this, combined with her innate hypochondriac tendencies it makes her life very difficult and her sense of self-worth and confidence very low. However, I am at a loss as to how to approach her to help her. Trying to convey this to her would sound more like an accusation of hypochondria.

hinkley 7y ago
From what I understand, it can be helpful to get people to think about themselves in the third person. We can be much harder on ourselves than we would ever be on a friend, and if you can get her to think about her own set of problems as if they were yours, what sort of advice would she offer you? We get wrapped up in a set of outcomes and every setback feels like a harbinger of doom. I saw a retweet recently from someone with chronic fatigue who wished they could go back in time and use their dwindling energy to set themselves up for the future instead of spending everything on trying to 'get back to normal so they could start their life again'. Look at where you are. What could you do this week or month to get to something you could live with or even enjoy? Don't let the perfect be the enemy of the good. He says, realizing he needs to follow the same advice...
klyrs 7y ago
This sounds very much like my ex. I thought I could help them. For a long time, I did... think I was helping. When a sequence of tragedies struck, I found myself needing help. We deteriorated quickly, as their self-worth was propped upon mine, which was defined in large part by my ability to help. We didn't have external support and we both crumbled. I wish I could tell you how to help your friend. What my spouse needed was therapy from a professional, who could maintain appropriate boundaries -- I wasn't, and couldn't. The awful thing I learned about 'hypochondria' is that psychosomatic effects, and stress, can have real physical consequences. I never did learn how to navigate that conversation without causing distress

mi100hael 7y ago

> One of the things that is most protective to mental health is not to spend too much of our lives consciously obsessing about it. That last statement is rather asinine and seems at odds with the rest of the article. I think it's fair to say negative emotions aren't the same as mental illness, but ignoring those negative emotions and keeping a "stiff upper lip" can lead to much bigger emotional problems down the road. There's a middle ground that involves accepting & experiencing the lows along with the highs as a part of life.

cousin_it 7y ago
> ignoring those negative emotions and keeping a "stiff upper lip" can lead to much bigger emotional problems down the road To me, keeping a "stiff upper lip" isn't so much about ignoring negative emotions, but more about behaving in the right way even when emotions pull you the wrong way. In my experience, exercising that skill doesn't create emotional problems, but solves them.
- ozzyman700 7y ago
  This is what I feel is meant by stiff upper lip: Be like a rocky promontory against which the restless surf continuously pounds; it stands fast while the churning sea is lulled to sleep at its feet. I hear you say, "How unlucky that this should happen to me!" Not at all! Say instead, "How lucky I am that I am not broken by what has happened and am not afraid of what is about to happen. The same blow might have struck any one, but not many would have absorbed it without capitulation and complaint."
  - AstralStorm 7y ago
    And thus status quo, however evil or bad, is kept. This stance is immoral in many ethical systems. Not to mention everyone has a breaking point.
jschwartzi 7y ago
Well the author is certainly privileged to not have to think about his own mental health very much, considering who he is and what he does for a living. The real thing that's happening with mental health in the US and probably the UK is that people aren't so much deciding that their personal problems are diagnosable psychiatric conditions as they are deciding that they would like to become mentally healthier and are seeking help. And the medical profession, being ill-equipped to actually provide a means to change, is turning to psychiatric medicines to control what are essentially patterns of thinking and being. At the gym it would be like people seeking to become better and instead of receiving personal training they would be given steroids. I was one of those people who wanted to change how I thought about things and how I acted. And so I sought therapy not necessarily because I had a clinical disorder, but because there were a lot of probably sub-clinical issues I was having with my thinking, and having someone rational and well-trained helped me change my thinking and my behavior so it was no longer causing problems for me. Frankly I was nearing a meltdown of some sort. It's not the same as needing psychiatric care for a personality disorder or for Schizophrenia or for any number of treatable, identifiable psychiatric disorders. But he's standing up this straw man that people like me are just wimps and they just need to suck it up and have a cup of tea or something. It's pretty patronizing.

cs02rm0 7y ago

I couldn't get a vitamin B12 injection, the materials cost of which is less than £1 with no negative side effects, more often than every 12 weeks from my doctor. Despite feeling awful at 8 weeks onwards, to the point of not being able to work, and better again every time I had the injection. I didn't care if it was placebo (although why it would be placebo at 8 weeks but deemed not a placebo at 12 weeks I struggle to understand), I felt I needed it more often and eventually found a doctor willing to try it. For me, it works. What got to me though, is while the doctor wasn't willing to try a vitamin slightly more frequently, he offered anti-depressants at the drop of a hat. He couldn't have been more forwards in offering them and didn't take the hint when I told him I didn't really want them - I had to give him a firm no in the end!

JamesBarney 7y ago
There is some evidence high serum levels of b12 are a risk for cancer. http://sciencenordic.com/high-levels-vitamin-b12-can-increase-lung-cancer-risk http://sciencenordic.com/high-levels-vitamin-b12-can-increas...
nutjob2 7y ago
> although why it would be placebo at 8 weeks but deemed not a placebo at 12 weeks I struggle to understand Because the placebo effect fades over time. The doctor has concluded that you'd be safely clear of it at 12 weeks.
ip26 7y ago
Curious, why do you need an injection? I thought only vegans had issues with B12, and only if they weren't paying attention to what they ate.
- 52-6F-62 7y ago
  I'm a ~30 year old meat-eating male in a family with a history of anemia on my mother's side (including my sister). It was discovered sometime within the past few years during a routine blood test that I had low hemoglobin from a moderate-to-severe Iron/B12 deficiency (no full blown other condition, though) I was never recommended injections, however. Doctor told me to take an off-the-shelf supplement and to eat more red meat. (I rarely did) When I don't follow through with those items I do notice. Following his advice has greatly improved my overall feeling of well-being. I would otherwise feel tired, foggy-headed, weak, faint, anxious, nauseous at times—sometimes a mix of all of the above. Used to think my blood sugar was just low.

hangonhn 7y ago

I don't know how much he knows about mental health or how it's practice in the US. But in the US there are things that are classified as clinical and those that aren't. The DSM-V is a guidebook to those issues and people who make those determinations has to go through a graduate program (Masters, Ph.D. etc) with a certain period of training akin to residency (these requirements do vary from state to state but in California it is fairly extensive and strict). I can't speak to what's going on in the UK but one can't simply show up to a therapist or psychiatrist because one's having a bad day and start getting drugs or some long term therapy program.

rjvehn 7y ago

It is sad that British society is losing the belief in a stiff upper lip. I think it is becoming accepted to make excuses everywhere. For individuals and groups, it is now seen as as okay to not to aim higher. There are so many hard working people who were never handed anything, have actual physical disabilities, and they still work extreme hours to take care of their families and not be a burden. I always think of how we construct Kobayashi Marus to tell ourselves and others that there are no-win scenarios, in some odd attempt to justify limiting ourselves to only grim options and schadenfreude for those who fail to echo acceptance. What if this belief in a gritty realpolitik is an excuse for not wanting to think harder to achieve what is right? That individuals and groups willingly believe in a local maxima, because the hill climbing required to get the right outcome is accepted as fantasy?

Dumblydorr 7y ago
What's your point? Is your thesis that those with mental illness make excuses everywhere?
- rjvehn 7y ago
  My point is that excuses are being legitimized.

fromthestart 7y ago

Alternative take: some mental illnesses, anxiety disorders in particular, are exacerbated by knowledge of them and their immediate effects. Anxiety is much easier to deal with when you're not anxious about the fact that you are or will be anxious. Maintaining a "stiff upper lip" means learning to ignore unpleasant symptoms, which can both reduce their frequency and severity. There is usefulness in "manning up", to use an increasingly unpopular turn of phrase. I disagree with the increasingly common idea that suppressing one's negative emotions is generally harmful.

AstralStorm 7y ago
It can also increase severity while reducing frequency, or cause transfer onto others or psychosomatic. You cannot recommend it without an actual trial, it is not safe.

ficklepickle 7y ago

I have never seen a group of less mentally-healthy people in my life. Mentally healthy people don't drink that much. The whole stiff upper lip nonsense is the problem. Neglecting and suppressing emotions for long periods of time cause mental health issues. The problem is that we don't have a clue about mental health in general, the blind are leading the blind. Antidepressants don't cure depression. In fact, they can make it harder to process emotions. They reduce the symptoms and make it easier to ignore the environmental issues that are causing it. Actually treating depression requires understanding and addressing the true cause. And the true cause is not a chemical imbalance or people not being tough enough. Self-pity or using issues as a crutch does not help, but it is also not the cause.

chewabLMorphine 7y ago

One of the least enviable things I've ever witnessed in my life was a pair of co-workers who bonded over their medical problems. It was a really strange thing to notice, and at first, it just seemed like small talk or polite conversation. But then it kept going, and while there was nothing particularly repugnant about the details, the undertones that developed were unsavory. It was like they relished being sad about their invalidity, like it was one big sick day that gave them an excuse to stay home from school. As if to say, "thank god my body is failing me again, and everyone is powerless to make demands of me." They would bond over the similar things their doctors would put them through, about the noises of MRI machines, about side effects and being incapacitated by medicines, about being laid up for extended periods of time. Bad news was greeted with a sort of malign enthusiasm, like getting to take the ride again. "Oh yeah, my doctor just told me my tests are bad again." You had to wonder if they were harming themselves to get back on the radar. These two individuals weren't stupid, and it seemed within the realm of believability that they'd try to maximize all the physical therapy and weird attention that a medical problem would garner them. Their problems were distinct and different, but with the way they locked in on each other, sharing tips and tricks as it were, it seemed like maybe without any other reason to talk to one another, the way they enjoyed such discussions bordered on perverse. The tone of each, finding excitement in the other's words, lent an uncanny color to the details I learned by being a fly on the wall. Like hot pink syringes and neon green day glow catheter crazy straws. On second thought, maybe the bigger problem was the open office floor plan, and the fact that I was forced to listen to conversations that I just didn't want to hear.

coffeemug 7y ago

Alternatively: we can stop referring to these as medicines and treat them like iodized salt, fluoridated water, or cell phones. They seem to be completely safe in short and long term. They make people’s lives better. How do you tell articles like this apart from luddite stigma?

dkarl 7y ago

Does anyone feel like their scraped knees and head colds are "medicalized" because there's treatment available and medical terminology for talking about it? You can take your scraped knee to your family doctor or an urgent care clinic and get a bandage applied to it, but people rarely do, and having the option doesn't freak anyone out. So why are people bothered by their anxiety or reoccurring blue moods being "medicalized?" As far as I can tell, it's just the stubborn lingering stigma associated with mental illness. The fact that a person's cold is a physical illness feels harmless to them, but the idea that they might be suffering from a "mental" illness, even a mild and common one, feels way more momentous and scary than it should. Clearly I am not alone in my sense that we have already hit the boundaries of how far we can sensibly apply the paradigm of mental health as a means of understanding and addressing human misfortunes. This is ridiculous. We certainly haven't gone far enough when people identify "mental health" with an inability to function without professional support. How ridiculous would it be if people denied having a physical injury when they had a scraped knee, because they felt denial was the only way to avoid seeing a doctor? How ridiculous would it be if people didn't brush their teeth because they didn't want to give up their precious self-reliance to "dental health" professionals? We reduce our reliance on professionals by applying knowledge from those professions, not by denying their relevance.

FatDrunknStupid 7y ago

The real problem is the 'professionals' actually have very little clue what's actually going on - and a magic pill will fix everything (including a kick back for the prescribing doctor, maybe-ish). I'm a programmer, can't take the medication and do the job - dumped by UK healthcare as no-one has a clue. So Fuck it, I'll be fucking fine thaanks.

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