Is Psychiatry Overdiagnosing Normal Life? | Dr. Patricia Casey

Patricia Casey (0:00)

In a specialty that has no biological markers that we can use for the most part, except for dementia, we need to be really, really judicious in how we label people, because labels stick with people, and they tell people something about who they are and the kind of people they are, so we mustn't mislabel them.

SPEAKER_2 (0:41)

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Richard Taite (1:02)

Before we start the conversation today, I want to deliver a personal message. Every day, families across America lose someone they love to an overdose. That's why I've partnered with the CDC Foundation through their COPE, Community Overdose Prevention Efforts Campaign, and committed to matching every donation, dollar for dollar, up to $25,000. I've spent my life helping people recover from addiction. But if we can get to the place of prevention first, this would help save so many more lives. I hope you'll join me in supporting the CDC Foundation's overdose prevention work at cdcfoundation.org/cope.

Thank you from the bottom of my heart.

Today on We're Out of Time, I'm joined by Dr. Patricia Casey, Professor Emeritus of Psychiatry at University College Dublin. Consultant, psychiatrist and author of 14 books and more than 120 peer-reviewed papers. She also serves as editor of BJ Psych Advances and is a leading voice questioning how modern psychiatry defines and treats mental health. Her work takes a closer look at adjustment disorder, overdiagnosis and whether we've begun to medicalize normal human emotions and life experiences. Professor, are we over diagnosing people and turning normal life struggles into mental disorders? In other words, are we helping people or are we teaching them to see themselves as broken?

Patricia Casey (2:42)

I absolutely agree with the latter part of what you said. I think we are teaching people to believe that they have illnesses and that they're vulnerable and that they're not resilient when it should be the other way around.

And now that doesn't mean, and I don't want your listeners or you to get the impression that I don't believe there are vulnerable people that exist because there are lots of them. It's your bread and butter. It's my bread and butter. There are people with mental illnesses and with addiction and all of that. But I think there are a cohort now that are being overdiagnosed, overmedicalized and are given very serious diagnosis. I mean, being diagnosed as being on the autistic spectrum, I think is quite a serious diagnosis. Being diagnosed as having a major depression, as DSM-5 calls it, is a big deal and I think we need to be terribly careful about how we make the diagnosis, the process we go through and the terminology we use. For example, a lot of people say, I suffer with depression. But of course, depression isn't in itself a diagnosis, it's a symptom that may reflect a depressive illness, or it may reflect sadness and being fed up, or it may be secondary to delusions or secondary to anxiety. But yet, language is used very loosely in psychiatry. I wouldn't want to comment about psychology in this regard because it's not my bailiwick, but certainly in psychiatry. And I suspect that maybe psychology is just as loose with this language, but I leave that to you for you to comment on.

But so I think we need to be careful about the whole process. And I am very concerned about the use of screening tools and schedules, you know, tick boxes, the Beck Depression Infantry, or any of the other, there's a range of them, and they're very useful for research, and that's what they were designed for. But now they're being misused greatly, I think. And at the moment now, I'm frequently discontinuing medication on people, because they will have been prescribed for the wrong reasons. Like people who are bereaved get prescribed, antidepressants, you know, pretty quickly. Now, grief can turn to an illness, there's no doubt about that. But for most people, it's a normal, it's a healthy response to a major loss.

Richard Taite (5:34)

That's exactly right. If somebody who you love dies, you can expect to feel sad.

Patricia Casey (5:41)

Yes, indeed. Or indeed, lesser than human beings, animals of people are lonely and isolated, they have an animal that they lose, they could be very devastated and very distressed by it. But it's not the thing that makes an illness whereby you would say somebody has a psychiatric illness and they need an intervention, be it medication or indeed psychology as well, psychotherapy. Because I believe that there's an overuse of both medication and psychotherapy.