The elephant in the room: Mental disorder or mental health problem?

Let’s be honest about it.  Sometimes it is difficult to determine where the boundary between a mental health problem and a mental disorder can be.  A mental health problem is a signal that a person is having substantial difficulties coping and is suffering a number of difficulties in their feelings, their thinking and even in their behavior.  Usually the person is also having some problems functioning in their daily lives – at work or at school for instance.  A person with a mental health problem will often sort things out with help from friends or confidants or when the stressors that are overwhelming them pass.  Sometimes, help from a counselor or another health provider is helpful.  A disorder is more substantive and usually signals that the person needs professional help – treatment to recover.

In the absence of independent biological markers (such as blood sugar levels for diabetes or the electrocardiogram tracings for heart attacks), psychiatric medicine has to rely on signs and symptoms and statistical methods to define disorders.  This can leave some grey areas – perhaps more than we would like. 

How to deal with these grey areas?  One school of thought – exemplified perhaps by Dr. John Oldham, President of the American Psychiatric Association (APA) chooses to extend the boundaries of the diagnosis of disease, to include people with mental health problems – the so called false positives.  In order to ensure that those people who need treatment can receive it.  Others, me included, think that a more narrow definition of disease is warranted, so that we do not make normal life equal pathology.  And, we argue that people with mental health problems are deserving of intervention but perhaps they don’t need treatment from doctors.

One area in which this debate is very heated is in the upcoming plans of the APA to consider normal bereavement as a mental disorder.  To me this is just plain nonsense.  Any idiot can understand that the loss of a close and intimate relationship leads to depressive like symptoms and that this is not the same thing as depression.  There is no need to make usual life a psychiatric diagnosis.  There is no need for medical doctors to “treat” normal bereavement.  Unless of course there is insurance money involved!  I wonder, is that the elephant in the room?

-Stan