When the diagnostic thresholds are lowered, being normal
ends up being as unachievable as the supermodel on the catwalk, according to
Lars Fredrik Svendsen, who is a professor of philosophy at the University of
Bergen.
In Norway, the diagnostic manual for mental disorders
(ICD-10) is strongly influenced by the DSM system developed by the American
Psychiatric Association. The DSM editions are criticised for constantly
lowering the thresholds for qualifying for a psychiatric diagnosis.
When psychiatrists redefine what is normal and abnormal
this is not contained in a closed session, but holds wider cultural
significance. The steady downgrading of the diagnostic thresholds does
something to how human beings view themselves.
"We are in the process of turning the disease into
the norm and where the normal becomes the exception. If this continues, we will
eventually see that what we deem normal is put on what I call the mental
catwalk," says Professor Lars Fredrik Svendsen at the University of
Bergen's (UiB) Department of Philosophy.
Biological
power diagnosis
Just like the super models on the catwalk we risk seeing
the normal as an aberration and it becomes something that lies beyond what's
humanly achievable, the philosophy professor suggests.
In practise this may imply that more people deviate from
the norm and that more people will want to submit to medical treatment simply
to approach some semblance of normality. Not unlike the way perfect bodies are
being photo-shopped in lifestyle magazines.
The diagnostic manuals hold a lot of sway, creating
biologically determined diagnoses, Svendsen believes. "These manuals shape
our lives in unprecedented ways.
Paradoxically we are becoming less tolerant of deviations
at the same time as many more of us are deemed to be deviants."
"I believe there is good reason to discuss whether
the criteria we use to discuss what is normal and abnormal are reasonable at
any given time," he notes.
Only
slightly less abnormal
DSM-5, which is scheduled for publication later in 2013,
is not just offering new diagnoses, but also sub threshold mental disorders. If
a patient does reach the required criteria for a proper diagnosis, he or she
will not necessarily fall below the pathological threshold. Instead he or she
will be considered only slightly less abnormal.
A proposal that is hotly debated is the diagnosis known
as "psychosis risk syndrome." The idea behind this diagnosis is to
identify people who may be developing schizophrenia early on, so that the
patient may receive treatment at a younger age.
The public debate on issues surrounding diagnostic
manuals has become so intense that even Allen Frances, chair of DSM-5's precursor
DSM-IV's task force, in 2009 stated that this could easily turn into a
"bonanza for the pharmaceutical industry but at a huge cost to the new
false positive patients caught in the excessively wide DSM-5 net."
Not
fit for normal life
Many critics of the diagnostic manuals believe that a
number of general human features have become pathologised over the last few
years. For example, in a proposal submitted to DSM-5 it is argued that
post-death grief qualifies as an unconditional symptom of depression.
" It has become far too easy to be diagnosed for
depression, Svendsen argues. - One has to remember that depression is
classified as one of our most severe diseases by the World Health Organization
(WHO) and is considered as debilitating as blindness or Down's syndrome."
According to Svendsen, there has been a gradual shift
away from seeing ourselves as relatively resourceful people with an ability to
handle life to being chronically vulnerable.
"We are in the process of creating people who are
unfit to live life," Svendsen suggests.
A
strong identity
Svendsen believes that we should generally be cautious in
making a diagnosis, and that a diagnosis is a label that creates an image of
who and what you are.
"There is the danger that your diagnosis becomes
your identity when the thresholds are lowered. But what we should keep in mind
is that the diagnosis says nothing about the positive beliefs and resources
inherent in a human being," says Lars Fredrik Svendsen.
Source: ScienceDaily
Image Source: http://www.sxc.hu/photo/1379289
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