Gayle lost her father recently after a prolonged period of treatment for prostate cancer. She made an appointment to see me, requesting antidepressants and sleeping tablets, as she was not coping and described herself as depressed. Her father had been an incredibly important figure in her life, supporting her financially and emotionally through a marital breakdown. Gayle’s daughter suggested she needed medication. While I sometimes prescribe something to aid sleep for a few days after a bereavement, the death of an elderly relative is a very sad but normal part of life.
There is now a much broader acceptance of mental health disorders, which has rightly reduced stigma and encouraged robust discussion about conditions previously considered shameful. But a recent study undertaken by the University of Melbourne suggests there is an increasing tendency to pathologise normal emotions and experiences.
Words matter. As health literacy expands and social media becomes a central source of information for many, terms like anxiety and depression are increasingly used to describe grief, sadness and worry, which are all part of a healthy range of emotions. Even the term trauma has entered everyday conversation, sometimes applied to minor adversity, such as an argument with a boss at work.
The grief process is well described. It is painful and difficult, but not necessarily a disorder requiring medication. Gayle’s loss is very sad, but what she needs most is acknowledgement that what she is experiencing is normal. Kindness and ongoing support from loved ones will serve her better than medication. I encourage Gayle to put together an album of photographs and memories of her father, as a tribute to the important role he played in her life. We talk about anniversaries in the upcoming year—birthdays, Christmas, the date of diagnosis—and she puts plans in place for managing these important dates. I suggest some time off work, prescribe a sleeper for a few nights, and arrange to see her again in a fortnight, reinforcing that grief is not only normal but a necessary emotion.
In the Health of the Nation report published by the Royal Australian College of General Practitioners in 2022, forty-nine percent of GPs reported mental health conditions as their primary concern for the future, with chronic illness, pain, and multimorbidity lagging behind at twenty-two percent. For six consecutive years, the most reported reason for patient presentations to GPs has been psychological issues, with seventy-eight percent of presentations for female GPs and sixty-three percent for male GPs.
The reality is that emotional ups and downs are a normal part of life and cause discomfort. There are unintended consequences when we diagnose every experience as a mental health disorder. It impacts access to timely mental health care and diminishes the traumatising experiences of those who have psychiatric disorders that impair their ability to function normally in daily life.
'Many people derive great benefit from this class of antidepressants, and they can be life-changing when appropriately prescribed. However, I am concerned that more and more patients are presenting, requesting prescriptions to blunt the experience of being human.'
The medical model for physical illness has long been one where you present to your doctor with a list of symptoms, receive a diagnosis, and are treated with medication with the expectation that you will soon feel better. Our healthcare system is set up around this model, with the average GP consultation lasting only fifteen minutes. When applied to mental health, it is impossible to explore the complexity of an individual’s experience in such a short time frame. It becomes easier to diagnose their grief, recent divorce, or job loss as depression or anxiety, and to prescribe medication. Whenever possible, I put interim strategies in place and bring a patient back for a longer consultation so I can assess them more thoroughly and determine whether they require psychological and/or pharmaceutical intervention or whether their situation can be normalised. It is an opportunity to implement preventative strategies that stop normal worry or sadness from becoming pathological. Some are resistant, preferring a prescription to a conversation and information.
With a health system ill-equipped to deal with complex mental health concerns, patients turn to other sources for information, including the internet and digital mental health platforms. These offer tools for self-diagnosis and apps for management, often run by entrepreneurs who exploit our anxieties and fluctuations in mood—blurring the spectrum between normal psychological variation and pathology. This is further complicated by the availability of subsidised services for some diagnoses, incentivising both patients and GPs to label every experience as pathological.
Another patient, Dale, was worried about an upcoming conference where work had asked him to give a presentation and arrange a merchandise stall. He had self-diagnosed with anxiety and wanted a prescription to help him manage. I reassured him that it is normal to feel anxious about doing a public presentation — it’s outside his comfort zone and unfamiliar. It is not a disorder requiring medication. He agreed to complete an online course on a platform called This Way Up to learn strategies for managing anxiety. This platform, designed by psychiatrists and psychologists, provides useful support for patients like Dale, helping them understand how the brain works and how this knowledge can be harnessed to navigate challenging situations. There is the added benefit that GPs can opt to receive feedback on the patient’s progress and initiate further intervention if needed.
Learning strategies for responding appropriately to emotions like anxiety builds resilience. It is important to recognise the integral role that negative emotions like sadness, grief, worry, and anger play in our lives — to understand that they are necessary and healthy. The antidepressants sertraline and escitalopram have entered Australia’s top ten most commonly taken medications and are frequently prescribed for depression and anxiety, as noted by the Australian Prescriber. Many people derive great benefit from this class of antidepressants, and they can be life-changing when appropriately prescribed. However, I am concerned that more and more patients are presenting, requesting prescriptions to blunt the experience of being human.
Gayle now books in to see me whenever an anniversary date comes up. She usually has a cry, tells me an anecdote about her father, takes a sleeper for a couple of nights, and catches up with a close friend for coffee. She functions normally at other times. Dale’s presentation went well, and he has since applied the strategies he learned to other areas of his life. He found the courage to leave his job and apply for a more stimulating role that includes public speaking. He still gets anxious beforehand, but now understands this is normal.
We have become so busy that we rush through life seeking quick solutions to every glitch, discomfort, or inconvenience. Life can sometimes be distressing, overwhelming, or even debilitating. Some experiences test endurance and resilience, but this does not always constitute a diagnosis requiring medical intervention and medication. Challenges offer an opportunity to grow and learn adaptive strategies for coping with life. Measures for dealing with human distress and psychological difficulty include access to social support — especially kindness from friends and family — and tools that require time and patience, which are sadly in short supply and underutilised in our approach to matters of the mind.
Jo Skinner is a Brisbane-based GP, women’s fiction author, freelance health writer and distance runner.