Under- or Overtreatment of Mental Distress? Practices, Consequences, and Resistance in the Field of Mental Health Care

Abstract

The economic, social, and health costs of mental distress are increasingly burdening individuals and societies in Europe. Yet, overmedicalization of mild symptoms is also well documented. This accumulates in more pressures and demands on health care systems. In this article, I explore how the process of help seeking in mental distress might be shaped by health system design and functioning in one of the South European societies—Spain. Employing Bourdieu’s theoretical lens, in-depth interviews with health care providers and users of services are analyzed. I reveal how the logic of the mental health care field, which is reinforced by the market, the state, and the media, may result in medicalization of mild distress while severe mental illness remains undertreated. I also show how mental help-seeking practices could gradually influence the functioning of the treatment system. Nevertheless, points of resistance to medicalization can also be identified.

Psychiatric Epidemiology

“…Further, there is evidence that there may also be substantial "met unneed": many individuals without a diagnosable mental disorder do receive treatment (Wang et al, 2005b;Bobevski et al, 2017). Moreover, among subjects with diagnosable disorders, there is undertreatment of severe cases and overtreatment of mild cases (Bijl et al, 2003;Olfson et al, 2016;Doblytė, 2020). These observations suggest that the observed treatment gap may partly be an allocation problem (Jorm, 2017).…”

Psicotrópicos e Atenção Primária à Saúde: a subordinação da produção de cuidado à medicalização no contexto da Saúde da Família

“…Essas práticas discursivas sobre o corpo e os sintomas correspondem ao processo da medicalização social e estão relacionadas a pesquisas anteriores que apontam a importância de fatores biológicos, psicológicos e sociais no diagnóstico e no tratamento do sofrimento psíquico, mas o que ocorre na prática é a prevalência e a dominação de fatores biológicos. Essa lógica contribui para a medicalização de situações e emoções cotidianas, e aumenta o número de prescrições de psicotrópicos com eficácia questionável 32,33 .…”

Have psychiatrists and general practitioners become traffickers of psychodrug?

“…With this model focused on psychoactive drugs, mental illness is neither understood nor is the patient helped quite the contrary. This implies a deep crisis in which psychiatry and general medicine find themselves, having embraced the pure pharmacological approach in their management of emotional and psychological disorders and having become, due to the weakness of the variables they manage, a scapegoat for the manipulation of scientific evidence by the research sponsored by the pharmaceutical industry (9)(10)(11). discrimination between anxiety and depression in real life is inconsequential (depression and anxiety are a continuum) (14,15), and on the other hand, it favors over-diagnosis.…”