These days, we see more and more diagnoses, both of psychological ills and medical ones. Too many school children are taking one or more psychiatric drugs. Too many adults are, as well. But too many adults and children are also taking drugs for medical conditions. This would not be a such problem except for diagnosis creep. How many medical patients realize that what constitutes hypertension these days is not the same as what used to be hypertension? The criteria have gotten lower. The same goes for diabetes and high cholesterol. Results can also vary by doctor, as I discovered to my horror when a now-fired optometrist diagnosed me with macular degeneration and had me frantic that I was going blind. The specialist to whom I went running said I had no such, but a small particle of what my grandmother would have called "schmutz" on my retina, that was unlikely to affect my vision soon if ever. Diagnosis creep. Whether the reason is a surplus of caution on the part of a doc, a mistake, or a new set of rules from the AMA, more people have more diagnoses these days and it is NOT a good thing.
Perhaps you are thinking, "but if being diagnosed early makes you change your behavior, that is good." For some things you'd be right. It IS good for us to all wear sunglasses, and trust me, I have been scared into doing so. But did I need to endure half a year of sheer panic about my looming blindness to make such a change? Additionally, many such diagnoses come with prescriptions. Luckily the macular issue came with only a vitamin--expensive but harmless. But if it is diabetes or hypertension, you will be taking drugs for it. What's the harm of taking diabetes meds if you are showing some but not all the symptoms that used to be needed to make the diagnosis? One, you are less inclined to regulate your diet strictly (Ask anyone who keeps driving stats--people who wear seatbelts are a little less cautions than those without--the illusion of safety is dangerous.) And pre-diabetes can be stopped from leading to diabetes in many cases by diet and exercise. Cholesterol can be altered by--yep--diet and exercise. Same with low bone density and high blood pressure.
Clearly, many people prefer pills to making behavioral changes. I will not claim that it is foolish to prefer pills to diet and exercise. If it were that easy, why not? This preference, however, is not without consequences. First, when we take a pill for something, we tend to assume it is now under control and become less careful with our behavior., People diagnosed with diabetes still DO need to watch their sugar. People with low bone density still DO need exercise. Second, all medications have side effects,some of which can be quite dangerous. Statin drugs have been connected to neuropathies of the extremities. Is living with numb or painful feet and legs better than the slightly increased risk of heart disease (which, by the way, has NOT been unequivocally demonstrated--statins DO lower serum cholesterol, but a body of evidence shows that serum cholesterol is a symptom of arterial damage, not the cause.) Anticholinergic medications used to reduce bladder leakage (yes, there is an exercise for that) in older women carry a risk of decreased cognitive functioning!
SO diagnosis creep is serious in physical medicine. In psychiatry, it is the same. As more children are labeled depressed, oppositional-defiant, bipolar, they are put on medications that might improve their behavior, but surely provide a spate of side effects. I once treated a child for chronic pain who came to me on eleven (11) medications! The pain was a trauma-related pain, not a physically generated one, so the strong narcotic she had been on that caused severe constipation was no longer in her system (Pain meds are known not to work on this pain disorder known as CRPS), but various anti-constipation meds were. She also had a cocktail of psychiatric meds, each with its own set of effects, leading to other chemicals for THOSE side effects. Psychiatric meds are not known to help with CRPS, but MDs want to DO SOMETHING and desperate parents whose kid is in pain will agree to anything with a slim hope of helping the child. Similarly, children diagnosed with ADHD have trouble in school and may be difficult to handle at home as well. I won't deny the existence of this problem. In fact, my dissertation is on ADHD. What I do want to stress is that putting children on psycho-stimulant drugs is not without consequences for many. Some children fail to grow, some can't sleep, some get depressed, and some are fine. But, again, with diagnosis creep, how many more children are medicated than have a problem that "clinically affects functioning" versus an impatient teacher who demands more than the child can produce?
What about depression? Depression is a common symptom--we get depressed during the span of our lives for many reasons. The actual causes of depression are varied and inexact, but we know it when we see/feel it. For some, depressed moods are stable and debilitating, while for others, they are fleeting and situation-specific. It turns out that psychotherapy is pretty good at treating depression and that antidepressant medications are more placebo than cure and have serious side effects. Depression is being diagnosed in greater numbers than ever before and antidepressants are diagnosed for BOTH depressed mood and a variety of off-label uses, not to mention, being used widely in children, which, it turns out, is also off-label for the majority of such drugs. Some people swear by these drugs, but the people who find their ways to my office come because they are STILL depressed despite having tried a variety of meds in a variety of combinations.
Another cause of diagnosis creep, and therefore, treatment expansion, is testing. If we do enough tests on your body, something will look wrong and require more tests, and something will turn up that looks like it wants a treatment. And maybe it does, but maybe it just bears patient watching, as with the eye situation I described. Let's look at osteoporosis. The medications for it carry a serious list of weighty side-effects. But, despite belaboring the point, a diet rich in calcium plus weight-bearing exercise is preventative. AND, for a woman who might show low bone density despite adequate diet and exercise, is diagnosing the lower level of calcium in her bones as a disease going to improve her body's ability to hold calcium, and will the pretty serious medication actually improve her quality of life?
In conclusion, we must all remember that THERE. IS. NO. SUCH. THING. AS. A. FREE. LUNCH. There might be a pill for what ails you. But it is not free. You might have a diagnosable illness; you might simply have some symptoms or a pattern that approaches the pattern of the disease. Weigh your options carefully. Sometimes a medication really is the best and sometimes only, option. But many times, there are other, safer treatment options, and still other times, what you have is a pattern approaching a dangerous state, but not actually a disease, and a change in behavior would be the safer approach.
Remember that in medicine and psychiatry, YOU are the consumer and you are also the sole owner of the body being examined, diagnosed, and prescribed for. Shop wisely and do your homework. Your doctor does want what is best for you, but he or she also wants to do the most for you to avoid being sued. The first person in the medical treatment chain for your body needs to be YOU. Ask questions about both the diagnosis and the treatment. Seek other opinions. Take responsibility.
https://www.madinamerica.com/2020/02/around-web-diagnosis-debate-old-story-important-news/?fbclid=IwAR37mFUJ16SZpGD9uxPHpBiD9nkOdwSkbQpj_F4yV7N389VYxTQw--jlydU
https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/statin-side-effects/art-20046013
https://drhyman.com/blog/2010/05/19/why-cholesterol-may-not-be-the-cause-of-heart-disease/
https://www.psychologytoday.com/us/blog/charting-the-depths/201305/depression-over-diagnosed
https://www.diabetes.org/a1c/diagnosis
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