Child mental health

Recently, The Sun Herald had as its front page headline "Tantrum or mental illness?" (10 June 2012). The article went on to state that three-year-olds will be screened for mental illnesses.

The term 'mental illness', is a term that is used often, but typically never defined. Regardless of its definition (or lack of), most would agree that the term is used to describe challenging behaviours that are considered problematic, either for the person with the 'mental illness' or those around him or her. Nobody denies that the behaviours in question actually exist, or that they can be problematic.

However, what myself and others are concerned about is that the term 'mental illness' can be used to convey the idea that the behaviours in question are not normal or are due to an underlying medical condition, such as a chemical imbalance in the brain. When cast as something medical, then doctors are automatically assumed to be the experts on the behaviours in question.

Further, there is the concern that the application of labels do not help explain why certain behaviours occur in the first place. To suggest that a child or adult is severely depressed because they have depression is circular reasoning, and not helpful.

Now before I am criticised as being uncaring, dangerous, etc., I agree that many of the behaviours attributable to a mental illness (whatever that term may mean) are serious. What I question, and encourage others to question, is at what point does behaviour become a mental illness?

For example, at what point does a person who is depressed, go from simply being depressed, to having 'depression'? Is it a question of extremity? And for those who think that 'depression' is a mental illness that afflicts only adults, consider that some researchers in a 2009 article in the Archives of General Psychiatry (volume 66 no 8) state that "The validity of major depressive disorder (MDD) in childhood has been well established."

Use of the word 'validity' here could be interpreted as meaning that science has been used to establish a medical or biological basis to depression. However, it does not. In psychiatry, 'validity' can simply mean that enough health professions recognise a consistent pattern of depressive-type behaviours and agree that a label should be applied.

The article in the Sunday paper mentioned that some mental health experts fear children will be misdiagnosed and given psychiatric drugs unnecessarily. I share the same concern. But I am also concerned about what it means exactly to say that a child has been correctly diagnosed. There are no clear answers here. Until the term 'mental disorder' is clearly defined, then I think we should be cautious about labelling behaviours as mental disorders, and even more cautious about choosing treatments.

Far too often medication is offered to control behaviours which science has yet to establish as resulting from a neurological abnormality, or for which there is a genetic link. On this matter, American psychiatrist (and outspoken critic of psychiatry), Dr Peter Breggin has stated "There are no known biological and physical bases for the range of commonly diagnosed psychiatric problems". Dan Carlat (another American psychiatrist) has stated "… the shocking truth is that psychiatry has yet to develop a convincing explanation for the pathophysiology of any illness at all". And this claim is echoed by many other psychiatrists.

Interestingly, if mental illnesses were due to abnormal brain chemistry, then surely they would simply be called brain illnesses or physical illnesses, as this comes under the topic of neurology.

Some believe that because an official document called the Diagnostic and Statistical Manual (4^th edition), simply referred to as the DSM IV, is used by psychiatrists to diagnose people with a mental illness, that this establishes the certainty and objectivity of mental illnesses. It does not. Entries of the DSM IV are not illnesses discovered by scientific research, but are simply clusters of behaviours that are voted on for inclusion. DSM entries are voted in, and can be voted out, as was the case for homosexuality – something that was once considered a mental illness. Physical illnesses are discovered, whereas mental illnesses are voted upon.

The DSM 5 will soon replace the DSM-IV. Dr Allen Frances, who was chair of the DSM-IV Task Force, has stated that the DSM 5 would "radically and recklessly expand the boundaries of psychiatry". This is quite a statement as the boundaries given in the DSM IV are already very well stretched. For the DSM 5, what this means is that more and more normal (albeit problematic) behaviour could be classed as symptoms of a mental illness. For example, look at what is being proposed for the DSM 5 - Paraphilic Coercive Disorder. On their webpage it is mentioned "The individual has acted on these sexual urges with a nonconsenting individual". I thought that was called rape.

As a society, let's not be quick to medicalise behaviour, especially for children, unless science shows that there is good reason to do so. Let's provide support and acceptance to those who are in need. At one time, parents were seen as the experts on parenting. These days, 'mental health professionals' have emerged and given rules about what parenting should and should not be. Are we better off than what we were say twenty or thirty years ago? You be the judge.