EVERYONE WANTS TO BE SPECIAL:

A more realistic way we could imagine demedicalization happening is not by completely eliminating a category but by making its diagnostic criteria more stringent. Medicalization refers not just to the growing number of new categories of disease, disorder, and risk but also to their expansion to an ever wider scope of human characteristics, states, and experiences. Conrad, for example, who has long studied ADHD, suggests that

it is certainly possible that a small proportion of children with a diagnosis of attention deficit hyperactivity disorder may have a discernable neurological problem, but the identification and diagnosis of ADHD goes far beyond these few children and includes a huge number of children with no identifiable neurological disorder.

The problem, on this understanding, is not so much the category itself as the set-points for the diagnostic criteria -- a view echoed by David Kupfer, who chaired the task force overseeing the writing of the DSM-5 and said that the previous edition's thresholds for an ADHD diagnosis were "too low," causing an "unreal" epidemic.

Demedicalization, then, might be thought of as the process of raising the diagnostic thresholds for a condition so that it captures only serious and debilitating clinical cases. By this process, what the psychiatrist Peter Kramer once called "diagnostic bracket creep" would be reversed; cases sometimes referred to as "mild disorders" and "subthreshold syndromes" would be eliminated. The domain of pathology would shrink, and far fewer individuals would be subject to medical management.

But this reversal too appears to hardly ever happen. The solution to the "unreal" ADHD epidemic that Kupfer noted would have been to change the criteria for the diagnosis so that kids with mild "symptoms" are not diagnosed or treated. But instead the DSM-5 lowered the thresholds even further. The unreal epidemic got worse. More youth qualify for the diagnosis, which is now also skyrocketing among adults.

According to a 2016 paper by psychologist Nick Haslam, over the past sixty years

the concept of mental disorder has undergone significant expansion.... An increasingly wide assortment of psychological phenomena fall within the psychiatric domain and diagnostic criteria have tended to loosen over time, so that clinical presentations that would once have failed to reach the threshold of diagnosis now do so.

A similar relentless expansion, in diagnoses and risk factors, can be seen in other areas of medicine.

So, we're back to our original question. Why does change seem to move relentlessly in the same pathologizing direction?

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