When a psychiatrist meets people at a party and reveals what he or she does for a living, two responses are typical. People either say, 'I'd better be careful what I say around you,' and then clam up, or they say, 'I could talk to you for hours,' and then launch into a litany of complaints and diagnostic questions, usually about one or another family member, in-law, co-worker, or other acquaintance. It seems that people are quick to acknowledge the ubiquity of those who might benefit from a psychiatrist's attention, while expressing a deep reluctance ever to seek it out themselves.
That reluctance is understandable. Although most of us crave support, understanding, and human connection, we also worry that if we reveal our true selves, we'll be judged, criticised, or rejected in some way. And even worse – perhaps calling upon antiquated myths – some worry that, if we were to reveal our inner selves to a psychiatrist, we might be labelled crazy, locked up in an asylum, medicated into oblivion, or put into a straitjacket. Of course, such fears are the accompaniment of the very idiosyncrasies, foibles, and life struggles that keep us from unattainably perfect mental health.
As a psychiatrist, I see this as the biggest challenge facing psychiatry today. A large part of the population – perhaps even the majority – might benefit from some form of mental health care, but too many fear that modern psychiatry is on a mission to pathologise normal individuals with some dystopian plan fuelled by the greed of the pharmaceutical industry, all in order to put the populace on mind-numbing medications. Debates about psychiatric overdiagnosis have amplified in the wake of last year's release of the newest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the so-called 'bible of psychiatry', with some particularly vocal critics coming from within the profession.