This review was written for and first published by Bookmunch.
“My concern is that in our current desire to dispense and identify with a diagnostic label that explains some elements of our experience, we are starting to narrow the concept of normal, to limit our sense of who we are and how we live our lives, to reduce our conception of humanity in all its infinite, individual variations.”
Dr Alastair Santhouse has specialised in psychiatry at a London hospital for over a quarter of a century. As one would expect in any medical discipline, he has seen significant changes in attitudes and treatment over that time. What concerns him, and is the subject of this book, is how the concept of normal within the sphere of mental health has been transformed. From being prescribed following evidence gathered during in-depth consultations, leading to a diagnosis by specialists, treatments are now often driven by social trends at the behest of the patient. This is perhaps currently most notable in those who believe they may have ADHD or autism having completed some tests ordered on-line. Waiting lists to access mental health services have risen exponentially as more people consider themselves on such a spectrum, apparently proud to own a diagnostic label and therefore deserving of attention and accommodations. The label has become ‘a facet of a person’s social identity’.
After an interesting introduction that discusses changes in mental health treatments, and how diagnoses have changed over the years, chapters then explore in more detail various conditions and increasing rates of presentation. Unlike many medical issues, most mental illnesses cannot readily be observed through scans and imaging. Various drugs have been found to offer relief but even these have limitations.
“Antidepressants cannot treat the weight of the twenty-first century and its inequities, nor can they treat thwarted ambition or messy and unfulfilled lives.”
Lest anyone think otherwise, this is a book full of heart and understanding. The author has vast experience in dealing with the complexities inherent in a contemporary human. He wants to be of help. What he cannot do in good conscience is agree a diagnosis without being first convinced it is correct. Despite the direction in which psychiatry is heading – often due to modern blame culture – he does not regard ticking boxes as the best way to reach a properly considered outcome and appropriate treatment.
“Our culture has become increasingly one of self-care, which can tip into self-obsession. Put together with a profit motive, this is a recipe for trouble.”
The strap-line in the book’s title, Mental Health in an Age of Over-Diagnosis, acts as a warning to the reader that some opinions expressed may prove controversial. Nevertheless I found the arguments presented to be carefully considered with conclusions convincingly explained. This came through clearly when he made the brave decision to include transgender issues.
“The topic has become too highly charged. There are those who have advocated a rigid rejection of the very idea of transgender and, by contrast, those who have encouraged automatic acceptance and affirmation. The Royal College of Psychiatrists recommended a neutral approach, advocating for further research.”
In the author’s personal experience, gender need only be focused on if it is central to the reason for referral. The case studies used, as throughout the book, helped highlight that Dr Santhouse is trying to offer help, improvement if not a cure, with any mental health issues he finds. The cause of these is not always what may seem obvious, even to the patient and, most especially, their families.
“In some cases, autistic traits and personality variables influence an individual’s sense of self, and this can involve gender, although changing gender does not always resolve the inner turmoil.”
It is tempting to look for: a quick fix; a succinct explanation for mental pain; a tribe who appear to understand and accept, who will advocate for certain treatment that may have helped them. In applying labels there is a concern that these will come to define a person who is more than just that one thing, and for whom key problems may arise elsewhere.
This came through clearly when the author looked at grief following the death of a loved one. Labelling grief as a disorder to be managed, that it may perhaps minimise inconvenience, denies that it is a normal if challenging stage in everyone’s life.
“The real objection was the medicalisation of grief. It was the feeling that something universally experienced, framed and understood throughout the centuries as part of religion, humanity and the rich tapestry of life was now being subject to a medical reductionism. People feared that they might not be seen as grieving but rather depressed. […] the anaesthetising of the pain of grief, was not something to be readily embraced.”
I have tried here to present some of the ideas from a wide ranging and fascinating study of many aspects of mental health issues and their treatments. While not all readers may agree with the author’s views, what he provides are well reasoned opinions – a rarity in our increasingly polarised society. That he makes these so accessible is testament to his skills as a writer.
Any Cop?: Given the controversies that surround so many of the topics covered it was refreshing to find someone willing to discuss in detail the thinking behind these mental illnesses and treatments. The huge backlogs that exist now make sense. This may not provide a solution for individuals seeking specialist treatment, but may offer pause for thought as to why they believe it will help.
Jackie Law
