Everything that we do as humans, in a sense, needs to be in moderation. Anything done to the extreme might be described by a layman an unhealthy obsession, or by a psychiatrist as a manifestation of some type of mental health disorder. Dieting, or being careful about how one eats to remain fit and healthy, is encouraged by health professionals. Living in a hygienic way and bathing regularly is also encouraged and recommended by health professionals. Worrying about a child who is sleeping away at a friend’s house for the first time is a reasonable feeling that no one, health professional or not, would think abnormal. However, these behaviors exist on a spectrum, with the normal behavior on one end, and the pathologic on the other. For example, having an abnormal body image that causes one to diet to the point of near-starvation, putting one’s health at risk, is clearly pathologic, an eating disorder. Obsessively washing one’s hands to the point at which it disrupts one’s life is also pathologic, an obsessive-compulsive disorder; the key distinction here between the normal and the pathologic may well be the “disrupting one’s life” part. Overanxiously worrying about a child who is safe at home, sleeping comfortably in bed one room over, might also be perceived by laymen and health care professionals alike as pathologic, an anxiety disorder, especially if the excessive worrying disrupts the person’s ability to function.
I use these examples because we have spent a lot of time discussing the difference between cosmetic medications and those that are medically necessary. We have also discussed not trying medicines like propranolol for memory dampening because it would be too hard to draw the line, but when we look at examples like these, we realize we are already drawing lines in the mental health world. The three types of behavior described above all lie on a spectrum, the behavior on one end clearly normal and not necessitating the administration of a medication, and that on the other end perhaps requiring one (or if “requiring” is too strong a word, it might be better to say the person might “benefit greatly” from a medication). This concept of behavior lying on a spectrum raises questions worthy of debate and discussion in the public health field. Exactly where on the spectrum does “normal” end and “pathologic” begin? Who should decide if an individual’s troubles are sufficiently “disrupting of life” to require medical or pharmaceutical aid? Should the individual himself be able to request medication, because he knows himself best and whether the behaviors he’s exhibiting or the anxieties he feels are wreaking havoc on his life? Should medical doctors alone decide, because they have the training? Or is the training of general medical doctors not sufficient — should only specialists be allowed to decide? What should the government’s role in this be?