35 Psychiatrization of society: a wake-up call for debate. (20th August 2018)

• Record Type: Journal Article
• Authors: Beeker, Timo; Thoma, Samuel; Heinze, Martin; Peter, Sebastian von
• Is Part Of: BMJ evidence-based medicine. Volume 23:Supplement 2(2018)
• Page Start: A15
• Page End: A16
• Publication Date: 2018-08-20
• Subjects: Evidence-based medicine -- Periodicals; 616.005
• DOI: 10.1136/bmjebm-2018-111070.35
• Languages: English
• ISSNs: 2515-446X

Abstract

Abstract : Over the last decades, there has been a marked increase in diagnosed psychiatric disorders worldwide causing a growing burden for health-care systems and society. In the USA, a full half of the population is claimed to meet the criteria for a DSM-IV disorder over the course of their lives. Typical explanations are that advancing destigmatization of mental illness and psychiatric treatment may be uncovering the real number of mental disorders for the first time. Also, contemporary working and living conditions are held responsible for causing a massive increase in psychiatric morbidity. On the other hand, changes in epidemiology, inflation of psychiatric diagnoses and widespread overdiagnosis are criticized as having substantially contributed to this increase. Although all of these factors seem relevant, the question remains, if there could be a more general, higher-order process behind these developments, both connecting and explaining them. We identify this process as a progressing psychiatrization of society, which causes as well as reflects the rising diagnoses of mental disorders. Psychiatrization and its various sub-processes are increasingly relevant in the light of ongoing and profound social changes in countries of the Global North, which coincide with a reorientation of psychiatric services (e.g. through digitalization and gradual substitution of inpatient-care with outpatient services). Simultaneously, Western psychiatric concepts and mental health services are exported to the Global South widely unchallenged. In this context, there is an urgent need for a broad debate about psychiatrization and its numerous negative consequences: On an individual level, these are mainly related to overdiagnosis and overtreatment, e.g. medication adverse effects and harms from long term use. Through pathologization of minor disturbances of psychological wellbeing and various life issues, psychiatrization can also promote disempowering changes to subjectivity and sense of the self, co-produce avoidable patient careers and create dependencies on mental health services. On a societal level, psychiatrization predetermines preferences for ineffective and short-term medical interventions which require individuals to cope with social problems, instead of finding collective long-term solutions. These would be located rather in the political than the medical field. From a public health point of view, psychiatrization might stimulate a further adaptation of mental health services to the needs of the 'worried well' and borderline cases while the provision of care for the severely and chronically ill is reduced. Objectives: Our aim is to stimulate debate and research about psychiatrization as a highly complex, diverse, globally effective process of great importance for society as a whole. Its effects can be harmful to individuals in many ways and detrimental to society and public healthcare systems. Empirical preliminary studies on psychiatrization processes and their effects are largely missing. Theoretical work on single aspects can be found essentially outside of psychiatric research itself, i.e. in the canon of antipsychiatric literature of the 1960s and 70 s or sociological studies on medicalization. Further studies will need to update theoretical understanding of psychiatrization and fill conceptual gaps in order to initiate a theory-led, transdisciplinary research program, which can empirically establish its various manifestations and consequences. Additionally, further research will have to acknowledge the vast body of experience of (anti-)psychiatric researchers and organizations through collaborative projects between professionals and service users.