Monday, March 25, 2013
Screening - A "Fault-line" in the Mental Health Literature
Screening often seems like an obvious solution to health problems. In mental health there is a strong view that much morbidity is undetected - providing an even more compelling intuitive appeal to screening. However, intuitive appeal is a two edged sword because it allows people to overlook some of the actual challenges and problems that accompany screening. This has resulted in some highly polarized debates with entrenched positions and even a degree of hostility. In keeping with Haedt's concept of a righteous mind one suspects that people tend to adopt one side of this debate instinctively, or according to some unarticulated moral compass. I heard Jonathan Haedt interviewed on CBC on March 22nd, 2013 and I've read his book as well, various of the "morality modules" that he describes seems to factor into this debate. Screening proponents often describe screening opponents as uncaring and disloyal to the cause of mental health whereas screening opponents often accuse screening proponents of having a malfeasant agenda - medicalization specifically. Fortunately, there are a set of scientific rules and principles that help to determine the real impact of screening, and as such the debate can be informed by evidence and methodology, all in the (hopefully) wide open sphere of scientific discourse. James Coyne, a prominent psychologist has engaged fully in this debate in a series of articles and a book - and he now contributes to a blog associated with PLoS Medicine called "Mind the Brain". The blog includes some very detailed critiques of screening studies. This makes for interesting reading for those interested in these issues.