GAD7 - The Anxiety Test That Turns Experiences Into Problems

It's only fair to warn you.  This entire post following the image is a Facebook post and comment that grew out of control and which I haven't edited in the slightest since typing there.  It's a little disconnected in places as my head exploded its way through the topic.

I wanted an anxiety image to go with this post and settled on this one.  It's the front cover of a book being published later this year.  I want a copy when it's released.  The blurb on Amazon says this:

"An in-depth guide for engaging with anxiety--not as an affliction, but as an essential source of foresight, intuition, and energy for completing your tasks and projects.

If you're facing anxiety, you've probably got one thing on your mind--how to make it go away. But what if this challenging emotion were actually trying to help?"

That's almost diametrically opposed to anything ever said to me by anyone from the psychiatric professions in decades as a "service user".  Some psychologists, especially recently, have said to embrace anxiety.  But for most I've experienced in "services" and in most internet memes anxiety has been seen as the great enemy.  A negative emotion.  Something to be conquered, fought.  Something to be anxious about!  I'm firmly convinced though that to fight or suppress our anxiety is to fight or suppress part of ourselves.  Seeing our anxiety as an enemy is ultimately to see ourself as the enemy.  To embrace our anxiety is a part of learning to better love and accept ourselves.

Just for fun I looked yesterday at the GAD-7 questionnaire, the one that's handed out to impose a diagnosis of Generalised Anxiety Disorder.

It asks you to consider a range of symptoms each time with the same question:

"Over the last 2 weeks, how often have you been bothered by any of the following problems?"

I was looking at the symptoms. On how many days have you felt nervous or on edge? Had trouble relaxing? Become irritable? and so on.

And I realised this:

I could answer that questionnaire even now and gain top marks because every day I feel anxious at some point.

I could get middle or low marks by interpreting the intent of the questions differently, because I haven't been anxious all day. I did that. I'm only mildly disordered now, which is less disordered than at any point since I first encountered the questionnaire.

Or I could score zero. Because while I may experience anxiety, that's a normal part of human experience. I was very anxious before my exams. So what. Am I "bothered by" these things? No, not really. Do I choose to interpret them as "problems?" No.

That's just one way the questionnaire makes assumptions and applies a major bias to the diagnostic procedure.

It's a way I haven't thought much about before. I could talk at length about other ways in which the questionnaire is flawed. But that one's new to me.

I'm now imagining people visiting a doctor and finding themselves quizzed about things they interpreted merely as "experiences" but which the expert is immediately telling them are "problems" to be "bothered about".

That could serve to create an anxiety disorder where none previously existed. Congratulations psychiatry! You can make people ill. To be fair, physical illness diagnosis can do that on occasion too - there was a recent article in MiA that mentioned the effects on people of greatly widening the criteria for hypertension and it's well known that believing you're in a high risk group for heart disease increases your chances of getting it just as much as actually being in a high risk group.

That's without all the other problems of the testing. I can tell you that two weeks after the election many of my friends would have been diagnosed with an illness. The people on this estate who can't really afford to eat pass it too, with flying colours. Drug them! That'll sort out their medical illness as defined by psychiatric symptom books. They won't suffer with their GAD anymore. They'll be too drugged to care. It's a crock of shit.

I was thinking about poverty last night in relation to the cost of psychiatry. Yes, I was awake in the night so that's an extra GAD7 point to me. Drug me now! The cost of seeing the consultant. Or a night in a psych unit. Or of everything else involved in the medical model.

A full nine month course of the new antidepressant nasal spray - which has a bad scientific evidence base but we won't mention that! - set for approval in the UK soon costs nearly £30,000. And yes, I'm sure that if someone takes ketamine they might feel different. Same with alcohol, cocaine, and heroin. Heroin can be incredibly calming I'm told but nobody says the calming effect is because it's tackling a mythical physical illness of neurochemistry. I bet that if it wasn't so addictive Bayer would have marketed it for mental illness.

It's interesting that withdrawal symptoms from heroin are known as withdrawal symptoms while withdrawal symptoms from prescribed drugs are known as "psychiatric drug withdrawal syndrome." I was talking with someone yesterday for whom the withdrawal brain zaps didn't stop. I can only hope they do and that they haven't been permanently harmed in that difficult way by the drugs. Talking with someone else yesterday who is a wheelchair user only because their physical symptoms were put down to mental illness for years.

You could raise someone out of poverty for the money it costs to "properly" medically treat them, and do so much more. I think that would be far healthier than leaving them in poverty hell and drugging them.  To be less anxious and depressed because you have no food insecurity, you can get clothes for your child and aren't one step away from homelessness seems infinitely better than to be less anxious because you're taking Xanax or Sertraline or, coming soon to a pharmacy near you, Ketamine. We're brainwashed into thinking that lack of services causes the mental health crisis - a friend wrote yesterday that that's the cause. It doesn't. It only harms people already in crisis because of what's happened. The medical model harms people too because it's so disempowering and dehumanising and stigmatising to our complexity. And sometimes the medical system creates a bigger crisis once you enter into it.

Wow, I don't like psychiatry very much! As one of my lecturers says, it's primary function was and often still is control of people and the othering of people who don't quite fit in to societally sanctioned ways of being or can't quite mask their differences or who don't have the privilege to get away with it. Actually looking after people was secondary, no matter how many good people were scattered in the profession or how many good and caring people have psychiatric functions in community mental health teams.

I guess creating an illness that didn't ever exist would serve the motives of the copyright holder who allow the quiz to be used for free - as long as the question is not altered in the slightest because that actually goes against the free use agreement and breaks copyright law. Perhaps I'm too cynical, except it's Pfizer which makes Sertraline, although the patent is now expired so they're not making as much cash off it anymore. Similarly they introduced Xanax, and Effexor. Sertraline itself is a drug which doesn't really work much at all for depression (none of them have clinically meaningful test results so that's not a surprise) beyond placebo in (very flawed) double blind testing - even according to recent Lancet Psychiatry studies - but has a little effect for anxiety "disorders" (i.e. it numbs people to it) and which there is now pressure to prescribe to people who don't even merit a diagnosis of anything at all.

PHQ9 is also owned by Pfizer and they're written by Robert Spitzer, one of the key names in DSM3 and the resurrection of Kraepelin leading to vastly increased and systemic medicalisation of human experience to the exclusion of social factors and that simple fact that we're human beings. Just like GAD and PHQ do every single day in the NHS and lots of other places.

That may be too cynical but I would feel better if the questionnaires in such common use weren't owned by a pharmaceutical company and written by a man who did so much to codify the medical model of mental illness.  What patients are presented with isn't a fair test but the opinion of someone with a particular view of people that excludes taking into account those people's thoughts and experiences.

Patients won't know the background to the tests or the history of mental health care.  They won't know about Kraepelian nosology or the history of diagnostic systems.  They won't have read up on how nobody worth listening to actually believes that thing the papers keep saying about serotonin causing depression.  They won't, unless they're like me, have a genius level IQ - even with that strangely high IQ it still took me years to fully usurp the authority I'd granted the system of psychiatry in my life.

The expert will show them the expert's questions and tell them their life is full of more problems to bother them than they thought.  The expert has the power in that situation.  The patient is disempowered, removed from the meaning their lives have, and it's done with a simple piece of paper.  In Talking Therapies in Newcastle I have to answer the questionnaires every single visit even though I said, giving reasons, why I didn't want to and even though the person I was seeing didn't like them either.  Rules are rules.  You have to follow the rules.  Even when the rules don't make much sense.  Even when the rules are harmful.  Because the rules are imposed by the powerful and rejecting the rules means you can be turned away from receiving care of any kind.  The UK punitive benefits system is very similar to psychiatry at times!

Guess who has some strong feelings and views about such things and about the biases inherent in a diagnostic procedure that is, yes, a load of rubbish anyway.

Guess who's sometimes the controversial one even in a Mad Studies group! It annoys the small number there who are strong disciples of the medical model. I do stay quiet sometimes. And sometimes others can be more controversial than me.