HYPERLINK : http://dx.doi.org/10.1136/bmj.f7037
Labelled for life
BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f7037 (Published 27 November 2013)
Des Spence, general practitioner, Glasgow
Teenagers get a hormonal mainline rush of adult insight that sends them into a spiral of mental agony. They fight against parents to try to define themselves; they don’t want to be us. Childhood is not about defining what you want to be but what you don’t want to be. Yet we all remain captive to our childhood: try as we might, we can’t change who we are or where we come from, or free ourselves from the emotions we develop as children.
Therefore, I am deeply concerned by the modern medical fad of labelling children who are often yet to reach school age, as dyslexic, dyspraxic, autistic, or having attention-deficit/ hyperactivity disorder. These are not labels but tattoos. How do these indelible marks affect children’s lives? Will they undermine self belief, damage relationships, and make these children question becoming parents themselves, for fear of passing it on?1
But there is a much bigger problem. Risk factors that have morphed into full blown diseases—such as hypertension, high cholesterol, and osteoporosis—now ensnare entire populations. The overdiagnosis of, for example, breast cancer, thyroid cancer, and melanoma, has turned millions of the unsuspecting well into “cancer survivors.” And mental illness is now the norm rather than the exception, with only 17% of adults in the United States reporting “optimal mental health.”2
There is constant news chatter about breakthroughs in cancer genetics. The biological model of mental health has won the war for psychiatric causation and is the pretext for widespread psychotropic polypharmacy. It is assumed to follow, therefore, that mental illness must be genetically inherited, and popular culture says that these “illnesses” are passed down from our parents. So I often see young adults worried that they will develop mental illness or requesting blood pressure, cholesterol, and cancer checks and the rest. If we have been careless about the effect of label-gun medicine on patients, we are utterly thoughtless as to the consequences for their children: widespread unnecessary health anxiety.
And there is little research (and most is unintelligible) on intergenerational effects of a diagnosis of illness. But every thoughtless diagnosis and label cascades through generations of families. This is medical myopia at its worst and abdication of our duty to protect the well. This iatrogenic harm wrecks our children’s sense of wellbeing forever.