Today I happened to capture and episode of the CBC show Ideas. The topic for discussion was Depression. The show was fairly critical of the DSM and of psychiatry as a field. The host interviewed a psychiatrist who explained how the diagnoses maintained in the great Diagnostic and Statistical Manual of Mental Disorders is largely the result of lobbying and is not based on any scientific process.
I had heard this argument before. And I believe it. I may not be a psychiatrist myself but I do feel that I am at least somewhat qualified to proclaim an opinion on the matter. I come from a family of physicians. My father, my uncle, my cousin, my grandfather, my sister are all trained physicians. Two of these are trained psychiatrists: my father and my sister.
Aside from my pedigree, I have personally struggled with mental illness since childhood. I can trace the beginnings of darkness back to the tender age of 11. Five years later, my father would prescribe me anti-depressants. In my early twenties I attempted suicide. I was briefly (and voluntarily) hospitalized. At age 26, I experienced a nervous breakdown that left me incapable of working and barely able to do basic activities such as bathe, eat or leave my basement suite.
My road to recovery has been gradual and often painful. I no longer suffer from depression, at least not to the same degree, but I take my mental health very seriously. Every two weeks I see a therapist. Every month, my partner and I consult with a couple’s therapist. I’m doing everything in my power to ensure that the black dog doesn’t bite me again. And by choice, I am doing it medication free.
I am not here to claim that no one needs medication. For those with severe mental disorders such as schizophrenia or bipolar disorder, medication may mean the difference between life and death. Even in my own case, when I was severely depressed, I cannot prove that the pills I took did not, in some way, prevent me from successfully killing myself. But I also acknowledge that I regularly overdosed on those self-same pills, sometimes to feel better and other times to wipe myself off the face of the earth. For me, they were not the solution. They were just another complication.
Especially as a long term strategy, I think we are wrong to rely on psychopharmaceuticals to heal us. They do not.
It shocked me to discover how quickly doctors reached for their prescription pads when they found out my diagnosis. This primary focus on medication as the solution to mental illness must stop. We are teaching people to become dependent rather than take ownership of their own healing. Other solutions do exist. Meditation, for example, was much more successful in my own life than any pill I ever took. But practicing it wasn’t easy. Part of my illness involved a severe case of anxiety. As I sat on the floor, trying to focus on my breath, my mouth would salivate as I struggled to keep calm. Sometimes the emotions would simply overwhelm me and I would burst into tears.
I credit meditation with helping me regain my composure and my sanity after my father passed away when I was 26 years old. Meditation, rather than medication, made all the difference to me, because it returned the power to me. By simply observing my own reactions, impulses and truly experiencing my emotions, however uncomfortable, I slowly learned to steer myself, like a sailor learns to sail along the ocean.
But back to the DSM. My own experience has been that psychiatric labels too easily become pitfalls and life sentences. At various points in my life I have been labeled with: major depression, agoraphobia, generalized anxiety, borderline personality tendencies, obsessive compulsive tendencies, and gender identity disorder. The latter is currently a topic of heated debate and is set to be re-labeled in the DSM-5 as gender dysphoria. But how much do these labels become a kind of self-fulfilling prophecy? As we seek to name what we struggle with, we take on diagnoses as the thing that defines us. How dangerous is this, especially when those diagnoses are more the result of internal politics within in the field of psychiatry than scientific reality?
In my early twenties I was told that I would need to take medication for the rest of my life. I am happy to state that I have been drug free for over 10 years now. And I have never been better.
It makes me wonder: has the field of psychiatry outgrown its usefulness? Where can it go from here?