When Does Fear Become a Disorder?

In his review of All We Have to Fear: Psychiatry's Transformation of Natural Anxieties Into Mental Disorders, Jonathan Abramowitz describes sensations and experiences that most of us can identify with. What parent has not experienced a sense of almost terror at the sight of a child's dash toward the street; a curfew violation; or a child's failure to respond to telephone calls, text messages, or an e-mail in what a parent considers a reasonable or expected time frame? Who cannot recall the rapid breathing and sweaty palms that accompany the emotions before a big speech or performance, first date, or first day on a new job?

As Abramowitz notes, most of us get through these events without therapy or medication, and may actually congratulate ourselves for the ability to do so and ultimately respond positively. Abramowitz states, "Horwitz and Wakefield's overarching contention is that the DSM's symptom-based diagnostic system needlessly pathologizes normal everyday anxieties." However, in our personal and professional lives we encounter many people who find it difficult to cope with these expected, seemingly ordinary challenges of life. The challenge for mental health professionals is to determine when these individuals require intervention. Do we know exactly when to offer psychotherapy, offer a medication referral, or reconceptualize the anxiety? Does psychology, as a profession, have a responsibility to educate the public about its potential to pathologize normal responses? Are these research, clinical, or ethical questions?

Read the Review

DSM, Organized Psychiatry, and the Pharmaceutical Industry: That’s What We Have to Fear
      By Jonathan Abramowitz
      PsycCRITIQUES, 2013 Vol 58(7)

Comments

[Dr. Judith Schlesinger]

It's more critical than ever for psychologists to uphold the distinction between true pathology and what was once quaintly called "problems in living."

As the DSM-5 slouches toward Washington to be born, the challenge of defending the integrity of "normal" has never been greater. But the question is: who will do it?

Not those colleagues who have surrendered to the medical model in an attempt to make a decent living - all the psychologists, social workers, and others who have quietly bought the LPN credential so they can prescribe medication for every blip, slip, bump and gasp of daily life.

Not those parents and educators who want real physiological "diseases" that get them off the hook and qualify their problem children for extra services.

And, most certainly, not those responsible for the exponential increase in disorders that can be "fixed" with pills, since they are also those who accrue the most benefit from them. Psychiatry and Big Pharm can thereby afford the massive advertising campaigns and academics-for-hire to assure the gullible and blame-phobic public that everything is safe, effective, and right as rain.

So, what's next?