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21 December 2011: Have the boundaries of mental illness been overextended?

Professor Joan Busfield from the Department of Sociology has written a new book, Mental Illness, in which she argues that the boundaries of mental illness have been overextended. Personal troubles – feelings and behaviour arising from difficult events and circumstances – are too often regarded as matters of individual pathology to be treated mainly by drugs – drugs that are frequently irrelevant to the individual’s needs.

This expansion in the boundaries of mental illness is reflected in the enormous increase in the number of mental disorders listed in the American Psychiatric Association’s official Diagnostic and Statistical Manual (DSM) from 109 in the first, 1952 edition to the 297 in the last revision in 2000 – a list that will become even longer with the current revision due in 2013. The additions include disorders such as social phobia – a label now applied to those who might formerly have been considered shy – as well as hyperactivity, now termed attention deficit hyperactivity disorder, initially only applied to children but now also to adults.
Boundary expansion has been exacerbated by the fact that since the 1980 edition of the DSM, in an effort to standardise diagnostic practice, diagnosis has formally to be based on symptoms, frequently abstracted from their social context, so that for instance unhappiness becomes a symptom of depression almost regardless of what has given rise to it.

A number of factors underpin this expansion, including professional interests and the activities of the pharmaceutical industry, as well as the political attractions of individualising personal troubles so that their social origins are not visible.

Mental Illness is published by Polity Press, price £15.99