Why Is Everyone "For" Or "Against" Treating Mental Disorders?


Everywhere I turn, people are debating mental illness. Not only in the media, but also in my community, the subjects of rising autism rates, ADHD versus bad parenting, mental health funding versus gun control are all being discussed passionately. I scan social media to see that my friends, “friends,” family, and colleagues are sharing posts, updates, and tweets taking a firm stance on some aspect of mental healthcare. I see updates shared by professionals: psychiatrists, psychologists, social workers or others who diagnose and treat people with mental illnesses or addictions. But lay people share content and take positions on mental illness as well, many of them my family and friends. I have observed hundreds (maybe thousands) of social media postings and community discussions about mental health, and regardless of the sharer, opinions seem to only come in two flavors: For and Against. Either the opinion-holder takes a position that mental healthcare is underfunded, stigma must be battled, and awareness must grow so we can expand services (For), or by contrast the opinionated will say mental disorders are overdiagnosed, bad parents let doctors push pills on themselves and their innocent children, and we’ve all been duped by big pharma (Against).

Each time I read a plug for one side of the debate or the other, I hear myself respond the same way: I know which perspective is the truth: Both.

As a practicing clinical psychiatrist, I am giving care for a range of mental health problems. My patients span from the “worried well” to the seriously mentally ill. Anyone on the entirety of the spectrum may walk though my front door. On the one hand, I treat many truly mentally ill people who battle stigma and cannot afford care. They fight shame, worrying about discriminatory treatment in the workplace as well as in social contexts. They struggle to pay for unethically expensive medications. (One example: bipolar patients take an average of three to four medications for the bipolar diagnosis- and some bipolar medications can cost more than five hundred dollars for a month supply of a single med.)

But I also have patients who are not seriously ill. They come seeking answers, and I find that some tend to rely unnecessarily on medical doctors for solutions to life’s problems for themselves and their children. Some are in situational distress due to failing marriages or careers or school failure; others chalk up problem behaviors to biologic disease rather than gaining or teaching self-control. They seek a “magic pill” to solve problems pills cannot solve.

Both extremes exist. Mental illnesses go undertreated, while clinics are overrun with healthier patients over-utilizing mental health care resources. The most severely mentally ill suffer from lifelong psychiatric sicknesses. Some of those sicknesses rob people of their independence and ability to work for income. Chronic diseases burden patients due to high cost and limited access.

Meanwhile, clinics are overflowing with less serious patients. The healthier patients may not need care, or may need only short term treatment. Those with transient, stressor-induced symptoms may continue to receive care far too long. Most episodes of mental distress are destined to come, and then go, as stressors abate. Unfortunately, patients with short term, symptom-inducing mental distress may mistakenly believe they suffer from chronic psychiatric illness. As our profession tries to expand access to care and raise awareness, we seem to be catching too many healthy people in our nets.

The origins of these problems are complex. For one, mental health criteria are vague, leaving far too much room for subjective interpretation. Doctors, trained to diagnose disease and prescribe treatment, stretch these vague criteria to explain patients’ symptoms and rarely turn away anyone asking for care. Doctors diagnose and prescribe even when reassurance or support might have been more appropriate. Patients want answers- easy ones if possible. Payers want diagnoses and scientifically validated medical treatments, labeling with “normal stressors” and treating with “reassurance” can be expensive for patients when payers refuse to cover them.

One of the biggest burdens on our current medical care system is the treatment of mental illnesses. Presently, the approach is messy and inefficient. Both over-diagnosis and under-diagnosis run rampant. Educate yourself. Take charge of your healthcare. Advocate for change. Do something. But please don’t take a simple stand For or Against.


Dr. Deuter is a psychiatrist who specializes in the care of emerging adults.

Posted on April 13, 2014 .