Peter Moore: Are you mentally unwell or just a bit different?

Some years ago a child was taken to the GP with a cough.

He was examined, the GP diagnosed asthma and entered it on his notes. Fortunately the cough went away and, throughout his active childhood he played sport and never suffered from a chest problem.

He was keen to join the RAF and train as a pilot. He passed all the academic tests but was then rejected. When he asked why he was told that they had checked his medical records and found the diagnosis of asthma. 

As he had never had a problem since his childhood cough, asthma was unlikely but there was a clear rule. No one can train as a pilot who has asthma recorded in the notes. I can see the logic. No one wants a member of the Red Arrows wheezing as they loop the loop but making a tentative diagnosis in a child can have serious effects. Given a label can lead to unforeseen consequences. 

Has the fashion for labelling strong emotions or abnormal behaviour also led to problems? Does giving young people a psychiatric label lead to an increase in recorded mental illness? 

I am not thinking about what we used to call the “psychoses”, serious mental illness such as schizophrenia when people lose touch with reality. These people can hear voices or believe they are being attacked by aliens. 

The recent increase is in conditions such as anxiety. At what level does anxiety become an illness? A certain level of anxiety is healthy. When a hunter gatherer heard a rustle in the bushes it was the one that did not get anxious and run away who was eaten by the sabre-toothed tiger. Today I would be worried about a driver who never got anxious. He (and it is likely to be he) would be quite happy to overtake at high speed on a blind bend. 

It is when anxiety is at such a level that the person cannot lead a normal life, too anxious to leave the front door, that it becomes a problem.

And when does normal unhappiness become pathological depression. When Queen Victoria’s husband, Albert, died it was understandable for her to be low but it became pathological ten years later she was still wearing black and refusing to attend Parliament.  

There was a problem in the past when any mental illness was seen as a weakness, a stain on the family. But does simply talking about mental illness lead to more people giving themselves a label? Between 2019 and 2021 there has been a 3,200 per cent increase in the number of British women taking the test for ADHD. The NHS website says that there is no single test for ADHD. 

Diagnosis requires a detailed assessment by a specialist with interviews, forms and a computer-based test. Immediately under the online NHS guidelines were three adverts from private companies, the first one saying “Do you have ADHD? Take our free quiz”. 

I am not decrying the many people who suffer from these disorders but autism and ADHD require a detailed assessment from a professional not a short online questionnaire. The difficulty is that there is a long waiting list for a professional assessment on the NHS. 

Between 1998 and 2018 there was a 787 per cent increase in autism. The problem is that anyone can relate to several of the symptoms on a list for autism or ADHD published online. ADHD lists disorganisation, problems planning and poor time management, yes that’s me. 

It has become fashionable to talk about neurodivergence but does this simply reflect the reality that we are all different? Some people are brilliant at maths and computer geeks, some great musicians and some gifted writers. 

Are people who function well in society with mild autism or ADHD just a bit different rather than mentally unwell?  

Even after a diagnosis people need to learn how to live with the problem rather than suffer from it. Anxiety is made worse by sitting at home. Many people with anxiety and depression need a supportive integration into the workforce. Labels are vital on clothes and food but not always helpful when applied to people.