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The Forum > Article Comments > Deficient definitions of mental illness > Comments

Deficient definitions of mental illness : Comments

By Tanveer Ahmed, published 5/2/2013

The Diagnostic and Statistical Manual of mental illness often owes more to politics than biology.

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"Deficient definitions of mental illness" is an arousing title, but the author completely ignores the ultimate and lethal 'deficient definition of mental illnes' which pervades Australia.

Most Australians are aware of the much stated (mainly by those who know its untruth) fact that "one in five Australians has a mental illness". The stastic postulated is, then,4.5 million people in Australia are mentally ill: this horrific figure totally belies the state of mental health in this country and is the cause of thousands of premature natural deaths and suicides.

Constantly, knowingly, deliberately... mental disorder and mental illness are conflated...always, medically and financially, to the detriment of the severely mentally ill (SMI). We have, in fact, some 4 million Australians with a mental disorder, treatable, curable and with a minuscule death rate; we have some 650,000 Australians with
a severe mental illness which is treatable but incurable. Their life expectancy is some 55-60 years, one third less than we expect to enjoy, because of premature natural deaths and deaths by suicide. Fewer than 40% of our SMI receive any of the highly specialised medical, psycho-therapeutic or social therapies necessary for as full and long a life as possible. This figure was reported by the Mental Health Council of Australia in 2009, a body which also questions the figures of Australian Bureau of Statistics(ABS) for deaths by suicide; figures for 2012 (population 22.6 million), for example, are calculated from 2001 (population 19.4 million).

SMI life expectancy rates will become lower and suicide rates higher unless funding is increased by a government and a nation aware of the difference between mental disorder and severe mental illness. The deficiency of our definitions and consequent funding needs unite to cause unnecessary deaths.
Posted by carol83, Tuesday, 5 February 2013 12:30:42 PM
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Thanks, Tanveer. As you mentioned the problem for Psychiatrists and Psychologists particularly, it is that DSM or similar is the official language of the courts and Insurance companies and it is difficult to do without a classification system in these circumstances. Otherwise there is often no need to create a classification for the average patient as long as an appropriate treatment is enacted. I thought you might have mentioned the dramatic rise in the diagnosis of Bipolar Disorder which also appears to be related to non-mental health factors. I can see a switch to the ICD classification of disorders coming for many.
Posted by Atman, Tuesday, 5 February 2013 5:16:51 PM
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Tanveer's thoughtful concerns about DSM are shared by many practising clinicians. Emeritus Professor Sid Lovibond, one of the Australian founders of evidence-based psychotherapy, described psychology's adoption of DSM as a regrettable mistake. The notion that a pattern of signs and symptoms may accurately identify the nature of a disease, and hence its causal factors and current best treatment, may work in medicine (outside my expertise) but fails in regard to psychological problems because of the phenomenon of multifinality. Simply, this means that two people presenting with apparently the same problem can have developed it in response to significantly different mixtures of biological, psychological and social factors. Each requires an individually tailored treatment plan that addresses the personally relevant causal factors that are open to treatment. To do this, an appropriately trained clinician (psychologist or psychiatrist) does a case formulation, identifying the biological, psychological and social factors currently maintaining the individual's problem/s, identifying which are open to intervention, and then applying current best practice, evidence-based therapy to those factors. A DSM-style diagnosis serves no such useful purposes. Even the increasing reliability of DSM diagnoses, mentioned by Tanveer, has been achieved by increasing the objectivity and number of diagnostic signs that may be used in arriving at a diagnosis. Two people given the same DSM diagnosis may have significantly different causal factors and require significantly different treatment. Putting people with broadly similar problems into the same box is a scientific error. Giving them all the same treatment is woefully poor practice, however much it may simplify the lazy clinician's job (and fatten the profits of big pharma). The individual case formulation approach has scientific validity, avoids denigratory labelling and the implicit assumption of pathology, and facilitates effective interventions. It implies true collaboration between the medical and psychological professions, something frequently espoused but, in my observation, still only occasionally practised. Come on, my medical colleagues, it's time we shared our respective expertise and collaborated in the interests of our patients. Meanwhile we should stop the insurance companies and lawyers from imposing their distorting and damaging wants on our attempts to meet human needs.
Posted by drbobmontgomery, Tuesday, 5 February 2013 11:54:45 PM
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