The Courier Mail (Madonna King) - March 5, 2010 - Time to redefine what is mental illness

Monday, March 08, 2010

LABELLED: Alex Walsh (front), who has Asperger's, with Tyson Keene, Alysse Keene and Sophie Walsh. Source: The Courier-Mail

And you'll think twice before reprimanding your three-year-old in a shopping centre: a temper tantrum in a toddler is set to be re-termed a "temper dysregulation disorder with dysphoria".

This is not fiction, but the picture painted by proposed changes to the gospel medical specialists use in the diagnosis of patients and to guide research.

Yet although the recommendations – 10 years in the making – have massive ramifications which threaten to ricochet through our community on implementation, public debate about them remains muted.

But now is the time to consider the consequences of this overhaul of diagnoses by the American Psychiatric Association for use across the world, including Australia.

It will not only broaden the definition of mental illness but affect people's insurance, their ability to get specific types of jobs, the type of medicines on offer, and where the big research dollars will go. It also risks labelling our children in a way that might mark them for life.

The Diagnostic and Statistical Manual of Mental Disorders, or DSM, determines how mental orders are diagnosed worldwide.

Its draft release this week shows several changes are in the wind, including lumping Asperger's and a host of developmental disorders into one – "autism spectrum disorders". Asperger's would be considered a mild form of autism.

Now just take that one change as an example. Its affect on families with children diagnosed with Asperger's would be huge.

Most families dealing with Asperger's do not consider it mild. And it is valid for those same families to fear research dollars and support programs aimed specifically at Asperger's could be redirected into the broader autism disorder.

That's just one example. Binge eating will become a specific disorder. So will hoarding.

Gambling, too, will be diagnosed as a disorder – a "behavioural addiction" – but internet addiction has been dismissed.

The disorder suffered by Tiger Woods, in his inability to keep his private parts private, will be termed "hypersexuality", falling just short of the "addictive" label.

The tome, which will become operational in three years, is aimed at keeping up to date with changes as more research becomes available and science becomes more specific.

But it also poses a big problem. When do you know a child's temper tantrum is a disorder, and when is it simply bad behaviour? Could "intermittent explosive disorder" just be an excuse for uncontrollable anger?

Do we risk over-diagnosing what might amount to bad behaviour as a new syndrome, to the point where everyday living presents a new round of diagnoses?

Perhaps this is best exemplified by another change reported as part of the new document.

At the moment, someone who rapes is a criminal: a violent person who is held up as the reason our judges need to get tougher on crime.

But that same person might soon be diagnosed with "paraphilic coercive disorder" instead, a move that has enormous consequences for our court system and whole our community.

Of course, as science becomes more accurate, and research leads to greater understanding, the umbrella of mental illness will change. And it has been doing that for years.

Melancholia is now depression, shyness no longer considered a pathological disorder, and a bad case of nerves can now be considered one of many disorders.

But the concern being voiced in the US is that, with pharmaceutical companies quick to jump on the bandwagon, more and more people will turn to medicine to curb a disorder which might not require intervention at all.

That's an important issue. Diagnosis, particularly of a mental illness, significantly affects people's lives. And for every wrong – or changed – diagnosis, there is immeasurable heartache.

That's one issue. The other is an underlying fear that a mental illness diagnosis can act as an excuse – an excuse to avoid personal responsibility, or pass off bad behavior, or to use the system fraudulently.

The number of people now suffering from disorders has grown exponentially. That is largely because of better diagnosis, but it's also about putting labels on people and ticking boxes.

Few issues should attract the same priority as mental illness. But just as high a priority needs to be assigned to getting it right, both in medical terms and in terms considered acceptable in the community.

And that's why the latest proposed changes need a full public debate, not just in the US where the diagnostic guide is drawn up, but in Australia, where many thousands of families will be affected.

madonnak@bigpond.net.au

Madonna King presents Mornings each weekday from 8.30am on 612 ABC Brisbane.

Stefanie Evans

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