Disorders Without Borders
Summary: 18th Aubrey Lewis Lecture Disorders Without Borders: the expanding scope of psychiatric practice. Are some psychiatric disorders over-diagnosed and over medicated? Are doctors and psychiatrists too ready to diagnose depression, attention deficit hyperactivity disorder or personality disorder for variations in mood or conduct that would once have been considered part of the normal ups and downs of life? And does that have something to do with the fact that for each of these diagnoses, pharmaceutical companies now claim to have effective drug treatments. Or is it, perhaps, that we in the West have become too soft, too ready to reach for quick fixes to the difficulties of our children, to our own unhappiness, or to the troublesome behaviour of others? Are we seeing, in the increasing use of psychiatric drugs for such conditions ’on the borders’ of normality, a hint of a worrying future, in which the moods, desires and conduct of adults and children are routinely managed, even engineered, with psychiatric drugs? Whereas in the past such drugs were termed "chemical coshes" by their critics, who thought they were administered by a coercive state apparatus in the name of conformity, are they now used as "chemical crutches" grasped at by individuals themselves, assisted by their doctors and a consumer oriented pharmaceutical industry, in the name of a shallow or engineered contentment? But if so, how can we account for the evidence that a significant proportion of thoseprescribed such drugs do not, in fact, take them? In this talk I will review these issues - focussing on depression, ADHD and personality disorder - and examine the claims that these are over-diagnosed and over-medicated. I will suggest that we need a more complex approach to understand the growth of these diagnoses, not only addressing marketing of drugs by pharmaceutical industry, and the role of doctors, but also examining the pressures and incentives that lead to the ascription of such diagnoses and their treatment with drugs.