The grim paradox engulfing psychiatry today

Peter Kay, who was a counsellor in Hampshire, England, believes parallel paradoxical problems have arisen in the field of psychiatry in the 21st century: those with serious mental pathologies are not being diagnosed, while those experiencing regular, day-to-day negative emotions are being over-diagnosed and over-medicated for depression.

In fact, over-diagnosis and inappropriate prescriptions are now becoming more common than under-diagnosis, with patients presenting with general sadness or distress being given antidepressant medication that can have serious side-effects. Consequently, psychiatry today is focusing less on attending to ill patients, but rather, on medicalising normal human emotions. As part of “being human”, it is normal for individuals to experience emotions such as distress, sadness and emptiness – however, presence of these emotions cannot be equated to a biological pathology. Vague definitions of psychiatric disorders, ulterior motives of authors formulating diagnostic manuals and financial drive of pharmaceutical companies are considered major factors influencing and motivating over-diagnosis.

On the other hand, athletes suffering from significant mental disorders are not seeking help, in fear of tarnishing their reputation and becoming targets for their opposition’s fans. As a result, many sportsmen and women suffer in silence, unable to receive the help they need, further worsening their mental health and condition.

In a field such as psychiatry, there is a fine line between a physiological and pathological state. As qualified physicians, it is important that psychiatrists are able to make the distinction between patients suffering from severe mental distress from those experiencing regular human emotions. As Peter Kay describes it, “there is a difference between depression and sadness”.

Tushar Goyal

Read more about mental health in sport or check out a 2007 BMJ paper about the over-diagnosis of depression.

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