Why Life in America Can Literally Drive You Insane (Hint: It's not just Big Pharma)

Interesting and important article, found at AlterNet.

Why Life in America Can Literally Drive You Insane

It's not just Big Pharma

By Bruce E. Levine
July 30, 2013

In “The Epidemic of Mental Illness: Why?” (New York Review of Books, 2011), Marcia Angell, former editor-in-chief of the New England Journal of Medicine, discusses over-diagnosis of psychiatric disorders, pathologizing of normal behaviors, Big Pharma corruption of psychiatry, and the adverse effects of psychiatric medications. While diagnostic expansionism and Big Pharma certainly deserve a large share of the blame for this epidemic, there is another reason.

A June 2013 Gallup poll revealed that 70% of Americans hate their jobs or have “checked out” of them. Life may or may not suck any more than it did a generation ago, but our belief in “progress” has increased expectations that life should be more satisfying, resulting in mass disappointment. For many of us, society has become increasingly alienating, isolating and insane, and earning a buck means more degrees, compliance, ass-kissing, shit-eating, and inauthenticity. So, we want to rebel. However, many of us feel hopeless about the possibility of either our own escape from societal oppression or that political activism can create societal change. So, many of us, especially young Americans, rebel by what is commonly called mental illness.

While historically some Americans have consciously faked mental illness to rebel from oppressive societal demands (e.g., a young Malcolm X acted crazy to successfully avoid military service), today, the vast majority of Americans who are diagnosed and treated for mental illness are in no way proud malingerers in the fashion of Malcolm X. Many of us, sadly, are ashamed of our inefficiency and nonproductivity and desperately try to fit in. However, try as we might to pay attention, adapt, adjust, and comply with our alienating jobs, boring schools, and sterile society, our humanity gets in the way, and we become anxious, depressed and dysfunctional.

The Mental Illness Epidemic

Severe, disabling mental illness has dramatically increased in the Untied States. Marcia Angell, in her 2011 New York Review of Books piece, summarizes: “The tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007—from 1 in 184 Americans to 1 in 76. For children, the rise is even more startling—a thirty-five-fold increase in the same two decades.”

Angell also reports that a large survey of adults conducted between 2001 and 2003 sponsored by the National Institute of Mental Health found that at some point in their lives, 46% of Americans met the criteria established by the American Psychiatric Association for at least one mental illness.

In 1998, Martin Seligman, then president of the American Psychological Association, spoke to the National Press Club about an American depression epidemic: “We discovered two astonishing things about the rate of depression across the century. The first was there is now between ten and twenty times as much of it as there was fifty years ago. And the second is that it has become a young person’s problem. When I first started working in depression thirty years ago. . . the average age of which the first onset of depression occurred was 29.5. . . .Now the average age is between 14 and 15.”

In 2011, the U.S. Centers for Disease Control and Prevention (CDC) reported that antidepressant use in the United States has increased nearly 400% in the last two decades, making antidepressants the most frequently used class of medications by Americans ages 18-44 years. By 2008, 23% of women ages 40–59 years were taking antidepressants.

The CDC, on May 3, 2013, reported that the suicide rate among Americans ages 35–64 years increased 28.4% between 1999 and 2010 (from 13.7 suicides per 100,000 population in 1999 to 17.6 per 100,000 in 2010).

The New York Times reported in 2007 that the number of American children and adolescents treated for bipolar disorder had increased 40-fold between 1994 and 2003. In May 2013, CDC reported in “Mental Health Surveillance Among Children—United States, 2005–2011,” the following: “A total of 13%–20% of children living in the United States experience a mental disorder in a given year, and surveillance during 1994–2011 has shown the prevalence of these conditions to be increasing.”

Over-Diagnosis, Pathologizing the Normal and Psychiatric Drug Adverse Effects

Even within mainstream psychiatry, few continue to argue that the increase in mental illness is due to previous under-diagnosis of mental disorders. The most common explanations for the mental illness epidemic include recent over-diagnosis of psychiatric disorders, diagnoses expansionism, and psychiatry’s pathologizing normal behavior.

The first DSM (Diagnostic and Statistical Manual of Mental Disorders), psychiatry’s diagnostic bible, was published by the American Psychiatric Association in 1952 and listed 106 disorders (initially called “reactions”). DSM-2 was published in 1968, and the number of disorders increased to 182. DSM-3 was published in 1980, and though homosexuality was dropped from it, diagnoses were expanded to 265, with several child disorders added that would soon become popular, including oppositional defiant disorder (ODD). DSM-4, published in 1994, contained 365 diagnoses.

DSM-5 was published in May, 2013. The journal PLOS Medicine reported in 2012, “69% of the DSM-5 task force members report having ties to the pharmaceutical industry.” DSM-5 did not add as many new diagnoses as had previous revisions. However, DSM-5 has been criticized even by some mainstream psychiatrists such as Allen Frances, the former chair of the DSM-4 taskforce, for creating more mental patients by making it easier to qualify for a mental illness, especially for depression. (See Frances’ “Last Plea To DSM-5: Save Grief From the Drug Companies.”)

In the last two decades, there have been a slew of books written by journalists and mental health professionals about the lack of science behind the DSM, the over-diagnosis of psychiatric disorders, and the pathologizing of normal behaviors. A sample of these books includes: Paula Caplan’s They Say You’re Crazy (1995), Herb Kutchins and Stuart Kirk’s Making Us Crazy (1997), Allan Horwitz and Jerome Wakefield’s The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder (2007), Christopher Lane’s Shyness: How Normal Behavior Became a Sickness (2008), Stuart Kirk, Tomi Gomory, and David Cohen’s Mad Science: Psychiatric Coercion, Diagnosis, and Drugs (2013), Gary Greenberg’s The Book of Woe: The DSM and the Unmaking of Psychiatry (2013), and Allen Frances’ Saving Normal (2013).

Even more remarkable than former chair of the DSM-4 taskforce, Allen Frances, jumping on the DSM-trashing bandwagon has been the harsh critique of DSM-5 by Thomas Insel, director of the National Institute of Mental Health (NIMH). Insel recently announced that the DSM’s diagnostic categories lack validity, and that “NIMH will be re-orienting its research away from DSM categories.” And psychiatrist Robert Spitzer, former chair of the DSM-3 task force, wrote the foreword to Horwitz and Wakefield’s The Loss of Sadness and is now critical of DSM’s inattention to context in which the symptoms occur which, he points out, can medicalize normal experiences.

So, in just two decades, pointing out the pseudoscience of the DSM has gone from being an “extremist slur of radical anti-psychiatrists” to a mainstream proposition from the former chairs of both the DSM-3 and DSM-4 taskforces and the director of NIMH.

Yet another explanation for the epidemic may also be evolving from radical to mainstream, thanks primarily to the efforts of investigative journalist Robert Whitaker and his book Anatomy of An Epidemic (2010). Whitaker argues that the adverse effects of psychiatric medications are the primary cause of the epidemic. He reports that these drugs, for many patients, cause episodic and moderate emotional and behavioral problems to become severe, chronic and disabling ones.

Examining the scientific literature that now extends over 50 years, Whitaker discovered that while some psychiatric medications for some people may be effective over the short term, these drugs increase the likelihood that a person will become chronically ill over the long term. Whitaker reports, “The scientific literature shows that many patients treated for a milder problem will worsen in response to a drug—say have a manic episode after taking an antidepressant—and that can lead to a new and more severe diagnosis like bipolar disorder.”

With respect to the dramatic increase of pediatric bipolar disorder, Whitaker points out that, “Once psychiatrists started putting ‘hyperactive’ children on Ritalin, they started to see prepubertal children with manic symptoms. Same thing happened when psychiatrists started prescribing antidepressants to children and teenagers. A significant percentage had manic or hypomanic reactions to the antidepressants.” And then these children and teenagers are put on heavier duty drugs, including drug cocktails, often do not respond favorably to treatment and deteriorate. And that, for Whitaker, is a major reason for the 35-fold increase between 1987 and 2007 of children classified as being disabled by mental disorders. (See my 2010 interview with him, “Are Prozac and Other Psychiatric Drugs Causing the Astonishing Rise of Mental Illness in America?”)

Whitaker’s explanation for the epidemic has now, even within mainstream psychiatric institutions, entered into the debate; for example, Whitaker was invited by the National Alliance for the Mentally Ill (NAMI) to speak at their 2013 annual convention that took place last June While Whitaker concludes that psychiatry’s drug-based paradigm of care is the primary cause of the epidemic, he does not rule out the possibility that various cultural factors may also be contributing to the increase in the number of mentally ill.

Mental Illness as Rebellion Against Society

"The most deadly criticism one could make of modern civilization is that apart from its man-made crises and catastrophes, is not humanly interesting. . . . In the end, such a civilization can produce only a mass man: incapable of spontaneous, self-directed activities: at best patient, docile, disciplined to monotonous work to an almost pathetic degree. . . . Ultimately such a society produces only two groups of men: the conditioners and the conditioned, the active and passive barbarians." — Lewis Mumford, 1951

Once it was routine for many respected social critics such as Lewis Mumford and Erich Fromm to express concern about the impact of modern civilization on our mental health. But today the idea that the mental illness epidemic is also being caused by a peculiar rebellion against a dehumanizing society has been, for the most part, removed from the mainstream map. When a societal problem grows to become all encompassing, we often no longer even notice it.

We are today disengaged from our jobs and our schooling. Young people are pressured to accrue increasingly large student-loan debt so as to acquire the credentials to get a job, often one which they will have little enthusiasm about. And increasing numbers of us are completely socially isolated, having nobody who cares about us.

Returning to that June 2013 Gallup survey, “The State of the American Workplace: Employee Engagement,” only 30% of workers “were engaged, or involved in, enthusiastic about, and committed to their workplace.” In contrast to this “actively engaged group,” 50% were “not engaged,” simply going through the motions to get a paycheck, while 20% were classified as “actively disengaged,” hating going to work and putting energy into undermining their workplace. Those with higher education levels reported more discontent with their workplace.

How engaged are we with our schooling? Another Gallup poll “The School Cliff: Student Engagement Drops With Each School Year” (released in January 2013), reported that the longer students stay in school, the less engaged they become. The poll surveyed nearly 500,000 students in 37 states in 2012, and found nearly 80% of elementary students reported being engaged with school, but by high school, only 40% reported being engaged. As the pollsters point out, “If we were doing right by our students and our future, these numbers would be the absolute opposite. For each year a student progresses in school, they should be more engaged, not less.”

Life clearly sucks more than it did a generation ago when it comes to student loan debt. According to American Student Assistance’s “Student Debt Loan Statistics,” approximately 37 million Americans have student loan debt. The majority of borrowers still paying back their loans are in their 30s or older. Approximately two-thirds of students graduate college with some education debt. Nearly 30% of college students who take out loans drop out of school, and students who drop out of college before earning a degree struggle most with student loans. As of October 2012, the average amount of student loan debt for the Class of 2011 was $26,600, a 5% increase from 2010. Only about 37% of federal student-loan borrowers between 2004 and 2009 managed to make timely payments without postponing payments or becoming delinquent.

In addition to the pain of jobs, school, and debt, there is increasingly more pain of social isolation. A major study reported in the American Sociological Review in 2006, “Social Isolation in America: Changes in Core Discussion Networks Over Two Decades,” examined Americans’ core network of confidants (those people in our lives we consider close enough to trust with personal information and whom we rely on as a sounding board). Authors reported that in 1985, 10% of Americans said that they had no confidants in their lives; but by 2004, 25% of Americans stated they had no confidants in their lives. This study confirmed the continuation of trends that came to public attention in sociologist Robert Putnam’s 2000 book Bowling Alone.

Underlying many of psychiatry's nearly 400 diagnoses is the experience of helplessness, hopelessness, passivity, boredom, fear, isolation, and dehumanization—culminating in a loss of autonomy and community-connectedness. Do our societal institutions promote:

Enthusiasm—or passivity?
Respectful personal relationships—or manipulative impersonal ones?
Community, trust, and confidence—or isolation, fear and paranoia?
Empowerment—or helplessness?
Autonomy (self-direction)—or heteronomy (institutional-direction)?
Participatory democracy—or authoritarian hierarchies?
Diversity and stimulation—or homogeneity and boredom?

Research (that I documented in Commonsense Rebellion) shows that those labeled with attention deficit hyperactivity disorder (ADHD) do worst in environments that are boring, repetitive, and externally controlled; and that ADHD-labeled children are indistinguishable from “normals” when they have chosen their learning activities and are interested in them. Thus, the standard classroom could not be more imperfectly designed to meet the learning needs of young people who are labeled with ADHD.

As I discussed last year in AlterNet in “Would We Have Drugged Up Einstein? How Anti-Authoritarianism Is Deemed a Mental Health Problem,” there is a fundamental bias in mental health professionals for interpreting inattention and noncompliance as a mental disorder. Those with extended schooling have lived for many years in a world where all pay attention to much that is unstimulating. In this world, one routinely complies with the demands of authorities. Thus for many M.D.s and Ph.D.s, people who rebel against this attentional and behavioral compliance appear to be from another world—a diagnosable one.

The reality is that with enough helplessness, hopelessness, passivity, boredom, fear, isolation, and dehumanization, we rebel and refuse to comply. Some of us rebel by becoming inattentive. Others become aggressive. In large numbers we eat, drink and gamble too much. Still others become addicted to drugs, illicit and prescription. Millions work slavishly at dissatisfying jobs, become depressed and passive aggressive, while no small number of us can’t cut it and become homeless and appear crazy. Feeling misunderstood and uncared about, millions of us ultimately rebel against societal demands, however, given our wherewithal, our rebellions are often passive and disorganized, and routinely futile and self-destructive.

When we have hope, energy and friends, we can choose to rebel against societal oppression with, for example, a wildcat strike or a back-to-the-land commune. But when we lack hope, energy and friends, we routinely rebel without consciousness of rebellion and in a manner in which we today commonly call mental illness.

For some Americans, no doubt, the conscious goal is to get classified as mentally disabled so as to receive disability payments (averaging $700 to 1,400 per month). But isn’t that too a withdrawal of cooperation with society and a rebellion of sorts, based on the judgment that this is the best paying and least miserable financial option?


~ Bruce E. Levine, a practicing clinical psychologist, writes and speaks about how society, culture, politics and psychology intersect. His latest book is Get Up, Stand Up: Uniting Populists, Energizing the Defeated, and Battling the Corporate Elite. His Web site is www.brucelevine.net

Robin S. Rosenberg - Abnormal Is the New Normal

As the DSM-5 begins to hit the shelves in the next week, people are already lining up to throw rotten vegetables at it. And with good reason. This version of the diagnostic bible for psychiatrists, psychologists, counselors, marriage and family therapists, and social workers has gone alarming deep into the realm of making basic human experience pathological.

Fortunate for me, I generally only use one diagnosis - PTSD. Occasionally, I need to look up the code for major depressive disorder, or a substance abuse disorder, or much more rarely, an Axis II personality disorder. If it were up to me, the DSM would cease to exist as anything other than an index for billing insurance.

In this article from Slate, Robin Rosenberg offers her criticisms of the DSM-5.

Abnormal Is the New Normal

Why will half of the U.S. population have a diagnosable mental disorder?

By Robin S. Rosenberg  |  Posted Friday, April 12, 2013

Illustration by Robert Neubecker.

Beware the DSM-5, the soon-to-be-released fifth edition of the “psychiatric bible,” the Diagnostic and Statistical Manual. The odds will probably be greater than 50 percent, according to the new manual, that you’ll have a mental disorder in your lifetime.

Although fewer than 6 percent of American adults will have a severe mental illness in a given year, according to a 2005 study, many more—more than a quarter each year—will have some diagnosable mental disorder. That’s a lot of people. Almost 50 percent of Americans (46.4 percent to be exact) will have a diagnosable mental illness in their lifetimes, based on the previous edition, the DSM-IV. And the new manual will likely make it even "easier" to get a diagnosis.

If we think of having a diagnosable mental illness as being under a tent, the tent seems pretty big. Huge, in fact. How did it happen that half of us will develop a mental illness? Has this always been true and we just didn’t realize how sick we were—we didn’t realize we were under the tent? Or are we mentally less healthy than we were a generation ago? What about a third explanation—that we are labeling as mental illness psychological states that were previously considered normal, albeit unusual, making the tent bigger. The answer appears to be all three.

Second, we really are getting “sicker.” The high prevalence of mental illness in the United States isn’t only because we’ve gotten better at detecting mental illness. More of us are mentally ill than in previous generations, and our mental illness is manifesting at earlier points in our lives. One study supporting this explanation took the scores on a measure of anxiety of children with psychological problems in 1957 and compared them with the scores of today’s average child. Today’s children—not specifically those identified as having psychological problems, as were the 1957 children—are more anxious than those in previous generations.First, we’ve gotten better at detecting mental illness and doing so earlier in the course of the illness. For decades, mental health clinicians, physicians, the U.S. surgeon general’s office, and various state and local agencies have been advocating for better detection of mental illness. If we are better at spotting it, we can treat it. And if we detect it earlier, we can, hopefully, intervene to reduce the intensity and/or frequency of symptoms. For instance, people who decades ago may have had undiagnosed attention deficit hyperactivity disorder, depression, or substance abuse are now more likely to have their problems recognized and diagnosed. But the increased awareness and detection translates into a higher rate of mental illness.

Another study compared cohorts of American adults on the personality trait of neuroticism, which indicates emotional reactivity and is associated with anxiety. Americans scored higher on neuroticism in 1993 than they did in 1963, suggesting that as a population we are becoming more anxious. Another study compared the level of narcissism among cohorts of American college students between 1982 and 2006 and found that more recent cohorts are more narcissistic.

An additional study supports the explanation that more people are diagnosed with mental illness because more of us have mental illness: The more recently an American is born, the more likely he or she is to develop a psychological disorder. Collectively, this line of research indicates that more is going on than simply better detection of mental illness.

Here’s a third explanation for the increased prevalence of mental illness, one that implies something important about our culture: What was once considered psychological healthy (or at least not unhealthy) is now considered to be mental illness. Some of the behaviors, thoughts, and feelings that were within the then-normal range of human experience are now deemed to be in the pathological part of the continuum. Thus, the actual definition of mental illness has broadened, creating a bigger tent with more people under it. This explanation implies that we, as a culture, are more willing to see mental illness in ourselves and in others.

The increasing prevalence is in part because each edition of the DSM has increased the overall number of disorders. The DSM-I, from 1952, listed 106; the DSM-III, from 1980, listed 265, and the current DSM-IV has 297. (Complaints about this ever-increasing total led the chair of the DSM-5 task force, David Kupfer, to announce that the total number of disorders in DSM-5 will not increase. One way to add new diagnoses—and DSM-5 will—but not increase the total is to make a disorder in a previous edition into a “subtype” of another disorder in the new edition, thereby keeping two diagnostic entities, but with one subsumed under another.)

The increasing number of disorders comes about because some “problems” that were not previously considered to be mental illness were reclassified as such by their inclusion in the DSM—and it is the DSM that functionally defines mental illness in the United States.

As an example, prior to the DSM-IV, there was no diagnosis of Asperger’s syndrome; rather, people with what is now called Asperger’s would have been diagnosed with autism (“high functioning” autism) or not diagnosed at all. This syndrome was added as a separate disorder to highlight the different forms that autism symptoms may take and to focus research on the most effective treatments for Asperger’s. Others, however, claimed that the diagnostic label pathologized quirkiness. (In DSM-5, Asperger’s is classified as a subtype of a newly consolidated single diagnosis “autism spectrum disorder.”)

Some of the disorders added to DSM editions are primarily—or wholly—medical in nature. One example is the diagnosis of “breathing-related sleep disorder,” which arises from medical problems that interfere with sleep. One such medical problem is obstructive sleep apnea, which occurs when the muscles of the throat relax so much during sleep that they narrow or block the airway. Throughout the night, people with obstructive sleep apnea have their deep sleep cut short as they relax because they stop breathing; once in a lighter phase of sleep, they breathe normally again. This disorder is not a mental disorder, but a medical one.

Another example is the “disorder” “caffeine intoxication,” characterized by at least five symptoms after consuming the equivalent of two to three cups of coffee: restlessness, gastrointestinal problems, difficulty sleeping, nervousness, and rapid heartbeat. To meet the diagnosis, the symptoms must impair functioning in some way. It’s hard to believe that an episode of too much coffee or Red Bull constitutes a mental disorder, but there you have it. DSM-5 has added “caffeine withdrawal” as a diagnosis—characterized by a withdrawal headache plus at least one other symptom, such as drowsiness, that interferes with some aspect of functioning. With disorders like this in the DSM, it’s no wonder that half of Americans will have a diagnosable disorder in their lifetimes. The wonder is why more Americans won’t!

Asperger's syndrome, which will be redefined into the broader category of autism spectrum disorders in the fifth edition of the Diagnostic and Statistical Manual, is one of several changes to the "psychiatry bible." Above, Matthew Kolen was diagnosed at age 8 with Asperger's. Photo by Shannon Stapleton/Reuters

In addition to classifying some medical disorders as mental disorders, the DSM also has been nibbling at the edges of “normal” by reclassifying as pathological the patterns of thoughts, feelings, or behaviors that were previously considered normal (albeit perhaps weird or odd). For instance, people who are extremely shy and concerned about how others might evaluate them, and who thus avoid certain types of activities, might be diagnosed with “avoidant personality disorder.” These same characteristics didn’t used to be considered pathological, and in some other cultures they are not considered to be so.

Another way that the increased prevalence of mental illness occurs is by lowering the threshold of what it takes to be diagnosed with a given disorder. For instance, DSM-5 will change in the criteria for “generalized anxiety disorder,” a disorder that involves excessive and persistent worrying. Whereas the criteria in DSM-IV required three out of six symptoms of worrying, only one symptom is needed in DSM-5. Similarly, whereas in DSM-IV the symptoms must have persisted for at least six months, in DSM-5 the duration has been reduced to three months. So if you are excessively worried for three months about your finances or your health or that of a family member (to the point where you can’t control the worries), you would be considered to have a disorder, whereas in the past you would not have.

One effect of a bigger mental illness tent is that there are fewer people standing outside the tent. Although the next edition of the DSM might not increase the overall number of disorders, if the criteria are loosened (that is, if it takes fewer symptoms or less severity to meet the criteria for diagnosis), then more people would qualify for a disorder. There are, and probably will continue to be, fewer and fewer people who will live their lives in relatively good mental health according to the DSM.

The normal trials and tribulations of life—the periods of sadness, or worry, of anxiety, or grief, of difficulty sleeping, of drinking too much caffeine or having caffeine withdrawal headaches—have been pathologized. They’ve been made into mental illnesses. More “normal” thoughts, feelings, and actions have come to merit a diagnosis. This way toward providing a bigger tent for mental illness leaves us with an increasingly restricted definition of mental health and can make us all more likely to see mental illness even when it isn’t there—where there is just normal human struggle. We can become so used to seeing psychopathology that we think—erroneously—that being odd or having difficulties must be an expression of mental illness.

What is going in our culture that allows for this expanding definition of mental illness? There are many explanations. The first is related to payment for treatment. Psychological treatments and medications can be useful for a variety of problems, but for those treatments to be even partially paid for by health insurance companies, the problems must have a diagnosis. It’s not enough that there’s a problem that’s being addressed. It has to be a problem. (Of course, if you treat a problem before it becomes a mental illness, the health insurance company will have ended up saving a significant amount of money, but they don’t pay for early mental health intervention—there has to be a problem. But that’s a story beyond the scope of this article.)

Second, pharmaceutical companies search for ever-wider markets for their products. When more people are diagnosed with a given disorder (perhaps because of less stringent criteria), or a new diagnosis is created, it widens the market for their drugs. They push for “off-label” uses of their medications that in some way reduce a problem, and then they push for that “problem” to be redefined as a problem. In fact, DSM-5 and the pharmaceutical industry have a significant number of connections: One study found that 70 percent of DSM-5 task-force members have financial ties to the pharmaceutical industry.

Third is increased work expectations. The pace and demands of many jobs have increased. Many companies maintain as few workers as possible to get the work done, and if an employee can’t reliably perform up to the (more intense) pace, he or she risks getting fired. If an employee has been feeling “down” or “anxious” enough that it’s not possible to work at near 100 percent or even 90 percent productivity, a pill that promises to counteract the symptoms of a newly identified psychological disorder seems like a better alternative than limping along, worried about being fired on top of other problems.

Fourth, in our era of instant gratification, ushered along by online shopping, downloaded entertainment, and the immediate access to the world available through the Internet, if we have problems, we want a quick fix. If a medication will help lessen uncomfortable thoughts or feelings or maladaptive behavior, we are receptive to medication. To quote Sami Tamimi, an adolescent psychiatrist in the United Kingdom, “Like fast food, recent medication-centered practice comes from the most aggressively consumerist society (USA), feeds on people’s desire for instant satisfaction and a ‘quick fix,’ fits into a busy life-style.” But if we’re going to take a medication, we need to have a problem that is being treated—at least to get those doctors’ visits reimbursed by the insurance company.

Fifth, certain diagnoses—along with other criteria—make the sufferer eligible for government services or programs or supplementary educational services, or allow them to claim legal rights of nondiscrimination. People who feel they or their loved ones could benefit from those services may advocate for a widening in criteria that enables more people to be diagnosed and thus eligible for those services. For instance, the diagnostic criteria for autism will change with DSM-5, and people diagnosed with the disorder—per DSM-IV—and their loved ones have vociferously expressed their concern that the new criteria will be more restrictive and thus will exclude some who currently have the diagnosis.

Finally, I think there is an additional reason: As our lives take on an even more frantic pace and our workload becomes ever greater, having a diagnosis gives a name to the suffering we feel and the hope that with a label can come relief. In dark or difficult times, hope is essential. But I’m not sure that ultimately labeling half of us with a mental disorder is the best way to give people realistic hope. Having a diagnosable mental illness has almost become the new “normal.” As a society, we have an opportunity to think about how we define mental health and illness. It shouldn’t only be up to the authors of the DSM.