Are doctors ‘over-diagnosing’ mental health problems?

In 2018, back pain ceased to be the main reason people were taking days off work. The number one spot is now occupied by the stress-anxiety-depression family of mental health problems.

Some used to say that people with back pain were malingering; now, we reserve that accusation for people with mental health issues.

MP Wes Streeting, the health secretary, recently added fuel to this fire by suggesting that doctors were ‘over-diagnosing’ mental health problems. The cynics are having a field day.

A godly perspective

As a Christian, what do I make of this? It is an important question because the answer has a bearing on pastoral care for those who suffer from mental health challenges.

I think that three things are important to consider.

1. Scripture recognises mental health
   
   Here’s the first: Scripture recognises mental health struggles and sometimes in surprising places. Just think of three ‘difficult’ Psalms. Psalm 6, where David’s feelings look very much like what we might call depression. Psalm 88, where the song writer feels immersed in inescapable darkness. And in Psalm 137, where, traumatised by the destruction of his people, the writer asks God to bless those who kill little Babylonian children.
   
   These Psalms show us that depression exists, that anxiety is real, that trauma makes godly people ask for ungodly things. Even Paul, in the months before he wrote his second letter to the Corinthians, experienced stresses so great that he says that he "despaired of life" (2 Corinthians 1:9). Sometimes the Bible is more real than we would like it to be!
   
   The great Victorian preacher, Charles Spurgeon, knew about this. Expounding Psalm 88 he says, “It is all very well for those who are in robust health and full of spirits to blame those whose lives are sicklied o’er with the pale cast of melancholy, but the evil is as real as a gaping wound… Reader, never ridicule the nervous and hypocondriacal, their pain is real; though much of the evil lies in the imagination, it is not imaginary."
   
   Christians who brush aside the reality of mental ill health really need to think again.
   
2. Doctors know how to diagnose
   
   Secondly, we should not be too sceptical about diagnosis itself.
   
   Even though mental illness is all about feelings such as low mood, anxiety, or feeling disconnected from reality, psychiatrists are trained to assess people’s feelings objectively. If a doctor has made a reasonably objective assessment, I need compelling reasons, and some expertise, to question it. A diagnosis can be helpful in itself for someone who is confused about their feelings, convinced that they are alone and that there is no hope.
   
3. Doctors know how to support us
   
   Thirdly, medical professionals are our partners when we support people who are experiencing mental health challenges. I encourage the Christians I support to see a doctor because it opens the door to a variety of therapies within the NHS. Alongside the church’s ministry, these interventions can be effective in the journey to wellness.
   
   The hair-raising experience Paul records in 2 Corinthians 1:9 had a purpose; Paul tells us that it both sensitised him to the struggles others face (equipping him to be pastorally effective) and it helped him to trust God more than he did before (read the whole chapter).
   
   The gospel changes the meaning of suffering. While others see it as random hardship, a Christian sees it as a means to growing resilience, character and hope (Romans 5:1-5). Preaching the gospel should offer this to those who suffer, but it should not exclude God’s goodness to us through medicine and other helpful therapies. Cynicism is not a Christian virtue.