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?
By Jonathan Abramowitz
PsycCRITIQUES, 2013 Vol 58(7)