From Blame to Absolution?

It used to be that society diagnosed medical disorders to stigmatize people.

When men became uncomfortable with the changing role of women over the course of the 18th and 19th centuries, for example, they pointed to a medical condition known as hysteria. In fact, by the early 1900s many believed that they were living in an "age of hysteria" – an era of "feminine nervousness." While the presumed cause was the weakness of women, in reality, the perceived anxiety was probably a manifestation of stresses resulting from societal change: industrialization and urbanization, the liberalization of society, and the drive for gender equality. But society got over it, and hysteria is no longer recognized as a classification of psychiatric disorders.

Similarly, not too long ago, homosexuality was suspect in the eyes of society, and also considered to be a mental illness. In fact, homosexuality was thought to be curable, despite a lack of consensus on the cause. But that too changed, when in the 1970s, the American Psychiatric Association removed homosexuality from its revised Diagnostic and Statistical Manual of Mental Disorders.

Whatever their actual origins – a lack of understanding, fear, an oppressive social order, examples of inadequate scientific knowledge, etc. – hysteria and homosexuality were instances of using a label to stigmatize a segment of society: in the one case, to stigmatize women as weak, and in the other, to stigmatize homosexuals as mentally ill.

Today, with the progress of medical science, we've created a host of new labels. But, unlike in the past, labels are no longer intended to stigmatize; we use them to de-stigmatize. And despite our seemingly good intentions, the result is the same: It diverts attention from the real problem.

De-stigmatization is good, but …

Take, for instance, the concept of addictions. Previously, those who indulged themselves too much and too often, were looked down upon as being unable to control themselves. But today, addictions are referred to as "diseases" and "disorders." People who drink too much suffer from the "chronic disease" (The National Institute on Alcohol Abuse and Alcoholism) or "psychological and nutritional disorder" (Merriam-Webster Online) of alcoholism. People who gamble too much have an "illness" (The Council on Compulsive Gambling of New Jersey, Inc.), a "pathological" or "compulsive condition" (The National Council on Problem Gambling), or an "impulse control disorder" (DSM-IV). People who are excessively overweight suffer from obesity, which is increasingly being referred to as a "disease" (American Obesity Association and the Centers for Disease Control and Prevention). And now, internet users need to beware of developing an "internet addiction disorder" (Addiction News) or, at the very least, a "behaviors and impulse-control problem" (Center for Online Addiction).

Where does it end?

The reality is that while some people are obese due to medical conditions, others are obese because they eat to excess. In such a case, it's not a disease. Rather, it's a behavior (e.g., overeating and lack of exercise), that causes a situation (e.g., obesity), that results in disease (e.g., diabetes, cardiovascular problems). In effect, the de-stigmatization has shifted responsibility for doing anything about it away from the individual.

Consider attention deficit hyperactivity disorder (ADHD). I believe that this is a valid disorder, but its diagnosis – particularly by those who are not in a position to diagnose – has become an almost knee-jerk reaction to any behavior deemed unacceptable. But don't most children, especially in certain age groups, conduct themselves inappropriately and exhibit defiance? (As a former teacher, I'd say the child that never does is more likely to be suffering from a disorder!) Why is ADHD being over-diagnosed? Again, it seems to be about shifting responsibility. The ADHD label absolves parents who have poor parenting skills, and governments whose cutbacks have resulted in overcrowded public schools and overworked teachers. Administering medications to control behavior is much easier than providing proper parenting and squeezing more money out of taxpayers.

Depression seems to be epidemic, but perhaps the only epidemic is the prescription of antidepressants. Working in overseas healthcare recruitment, I have had many candidates say to me how, in the course of a quick check-up, they told their GP that they were a little down, so were given a prescription for antidepressants. Quick fix for an overworked doctor? Getting rid of a demanding patient?

Of course, as the book Prozac Nation suggests, many of us spend more time numbing our senses (some people's drug of choice is food, others' alcohol, others' illegal drugs, others' prescription drugs…) than we do dealing with our problems.

Beyond De-Stigmatization to Abuse

Western society has become increasingly self-indulgent – we drink too much, eat more than we need, gamble ourselves into debt, and ignore our families and jobs to surf the internet. For most, moderation is a foreign concept, and when our bodies – or families – break down as a result of our excesses, rather than change our behavior, we cry that we're sick. Moreover, whenever possible, we depend on or demand pharmaceutical cure-alls to save us.

So have we now taken de-stigmatization to point where, like in the past, we are creating phantom diseases and disorders? Are we just over-diagnosing? Or are we simply absolving everyone of their responsibility to take care of themselves?

In the end, things aren't all that different from when hysteria and homosexuality were considered medical disorders.

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