Angell
also reports that a large survey of adults conducted between 2001 and
2003 sponsored by the National Institute of Mental Health found that at
some point in their lives, 46 percent of Americans met the criteria
established by the American Psychiatric Association for at least one
mental illness.
In 1998, Martin Seligman, then president of the American Psychological Association,
to
the National Press Club about an American depression epidemic: “We
discovered two astonishing things about the rate of depression across
the century. The first was there is now between 10 and 20 times as much
of it as there was 50 years ago. And the second is that it has become a
young person’s problem. When I first started working in depression 30
years ago … the average age of which the first onset of depression
occurred was 29.5 … Now the average age is between 14 and 15.”
reported
that antidepressant use in the United States has increased nearly 400
percent in the last two decades, making antidepressants the most
frequently used class of medications by Americans ages 18-44 years. By
2008, 23 percent of women ages 40–59 years were taking antidepressants.
that
the suicide rate among Americans ages 35–64 years increased 28.4
percent between 1999 and 2010 (from 13.7 suicides per 100,000 population
in 1999 to 17.6 per 100,000 in 2010).
The
New York Times reported
in 2007 that the number of American children and adolescents treated
for bipolar disorder had increased 40-fold between 1994 and 2003. In May
2013, CDC reported in “
Mental Health Surveillance Among Children—United States, 2005–2011,”
the following: “A total of 13%–20% of children living in the United
States experience a mental disorder in a given year, and surveillance
during 1994–2011 has shown the prevalence of these conditions to be
increasing.”
Over-Diagnosis, Pathologizing the Normal, and Psychiatric Drug Adverse Effects
Even
within mainstream psychiatry, few continue to argue that the increase
in mental illness is due to previous under-diagnosis of mental
disorders. The most common explanations for the mental illness epidemic
include recent over-diagnosis of psychiatric disorders, diagnoses
expansionism and psychiatry’s pathologizing normal behavior.
The
first DSM (short for Diagnostic and Statistical Manual of Mental
Disorders), psychiatry’s diagnostic bible, was published by the American
Psychiatric Association in 1952 and listed 106 disorders (initially
called “reactions”). DSM-2 was published in 1968, and the number of
disorders increased to 182. DSM-3 was published in 1980, and though
homosexuality was dropped from it, diagnoses were expanded to 265, with
several child disorders added that would soon become popular, including
oppositional defiant disorder (ODD). DSM-4, published in 1994, contained
365 diagnoses.
DSM-5 was published in May 2013. The journal PLOS Medicine
reported in 2012, “69% of the DSM-5 task force members report having ties to the pharmaceutical industry.” DSM-5 did not add as many
new diagnoses as had previous revisions.
However, DSM-5 has
been criticized even by some mainstream psychiatrists such as Allen
Frances, the former chairman of the DSM-4 task force, for creating more
mental patients by making it easier to qualify for a mental illness,
especially for depression. (See Frances’ “
Last Plea To DSM-5: Save Grief From the Drug Companies.”)
In the last two decades, there have been a slew of books written by
journalists and mental health professionals about the lack of science
behind the DSM, the over-diagnosis of psychiatric disorders, and the
pathologizing of normal behaviors. Even more remarkable than Allen
Frances jumping on the DSM-trashing bandwagon has been the
harsh critique of DSM-5 by
Thomas Insel, director of the National Institute of Mental Health.
Insel recently announced that the DSM’s diagnostic categories lack
validity, and that “NIMH will be re-orienting its research away
from DSM categories.”
Yet another explanation for the epidemic may
also be evolving from radical to mainstream, thanks primarily to the
efforts of investigative journalist Robert Whitaker and his book
“Anatomy of an Epidemic.”
Whitaker argues that the adverse effects of psychiatric medications are
the primary cause of the epidemic. He reports that these drugs, for
many patients, cause episodic and moderate emotional and behavioral
problems to become severe, chronic and disabling ones.
Examining
the scientific literature that now extends over 50 years, Whitaker
discovered that while some psychiatric medications for some people may
be effective over the short term, these drugs increase the likelihood
that a person will become chronically ill over the long term. Whitaker
reports, “The scientific literature shows that many patients treated for
a milder problem will worsen in response to a drug — say, have a manic
episode after taking an antidepressant — and that can lead to a new and
more severe diagnosis like bipolar disorder.”
With respect to the
dramatic increase of pediatric bipolar disorder, Whitaker points out
that, “Once psychiatrists started putting ‘hyperactive’ children on
Ritalin, they started to see prepubertal children with manic symptoms.
Same thing happened when psychiatrists started prescribing
antidepressants to children and teenagers. A significant percentage had
manic or hypomanic reactions to the antidepressants.” These children and
teenagers are then put on heavier-duty drugs, including drug cocktails,
often do not respond favorably to treatment, and deteriorate. That, for
Whitaker, is a major reason for the 35-fold increase between 1987 and
2007 of children classified as being
disabled by mental disorders.
Whitaker’s
explanation for the epidemic has now, even within mainstream
psychiatric institutions, entered into the debate; for example, Whitaker
was invited by the National Alliance for the Mentally Ill (NAMI) to
speak at its
2013 annual convention that
took place last June. While Whitaker concludes that psychiatry’s
drug-based paradigm of care is the primary cause of the epidemic, he
does not rule out the possibility that various cultural factors may also
be contributing to the increase in the number of mentally ill.
Mental Illness as Rebellion Against Society
The
most deadly criticism one could make of modern civilization is that
apart from its man-made crises and catastrophes, is not humanly
interesting. . . . In the end, such a civilization can produce only a
mass man: incapable of spontaneous, self-directed activities: at best
patient, docile, disciplined to monotonous work to an almost pathetic
degree. . . . Ultimately such a society produces only two groups of men:
the conditioners and the conditioned, the active and passive
barbarians. —Lewis Mumford, 1951
Once it was
routine for many respected social critics such as Lewis Mumford and
Erich Fromm to express concern about the impact of modern civilization
on our mental health. But today the idea that the mental illness
epidemic is also being caused by a peculiar rebellion against a
dehumanizing society has been, for the most part, removed from the
mainstream map. When a societal problem grows to become
all-encompassing, we often no longer even notice it.
We are
disengaged from our jobs and our schooling. Young people are pressured
to accrue increasingly large student-loan debt so as to acquire the
credentials to get a job, in a profession they often have little
enthusiasm for. And increasing numbers of people are completely socially
isolated.
Returning to that June 2013 Gallup survey, “
The State of the American Workplace: Employee Engagement,”
only 30 percent of workers “were engaged, or involved in, enthusiastic
about, and committed to their workplace.” In contrast to this “actively
engaged group,” 50 percent were “not engaged,” simply going through the
motions to get a paycheck, while 20 percent were classified as “actively
disengaged,” hating going to work and putting energy into undermining
their workplace. Those with higher education levels reported more
discontent with their workplace.
How engaged are we with our schooling? Another Gallup poll, “
The School Cliff: Student Engagement Drops With Each School Year”
(released in January 2013), reported that the longer students stay in
school, the less engaged they become. The poll surveyed nearly 500,000
students in 37 states, and found nearly 80 percent of elementary
students reported being engaged with school, but by high school, only 40
percent reported being engaged. As the pollsters point out, “If we were
doing right by our students and our future, these numbers would be the
absolute opposite. For each year a student progresses in school, they
should be more engaged, not less.”
Life clearly sucks more than it
did a generation ago when it comes to student-loan debt. According to
American Student Assistance’s
Student Debt Loan Statistics,
approximately 37 million Americans have student-loan debt. The majority
of borrowers still paying back their loans are in their 30s or older.
Approximately two-thirds of students graduate college with some
education debt. Nearly 30 percent of college students who take out loans
drop out of school, and students who drop out of college before earning
a degree struggle most with student loans. As of October 2012, the
average amount of student loan debt for the class of 2011 was $26,600, a
5 percent increase from 2010. Only about 37 percent of federal
student-loan borrowers between 2004 and 2009 managed to make timely
payments without postponing payments or becoming delinquent.
In
addition to the pain of jobs, school and debt, there is increasingly
more pain of social isolation. A major study in the American
Sociological Review in 2006, “
Social Isolation in America,”
examined Americans’ core network of confidants. The study authors
reported that in 1985, 10 percent of Americans said that they had no
confidants in their lives, but by 2004, 25 percent of Americans stated
they had no confidants in their lives.
Underlying many of
psychiatry’s nearly 400 diagnoses is the experience of helplessness,
hopelessness, passivity, boredom, fear, isolation and dehumanization —
culminating in a loss of autonomy and community-connectedness.
Do our societal institutions promote:
- Enthusiasm—or passivity?
- Respectful personal relationships—or manipulative impersonal ones?
- Community, trust, and confidence—or isolation, fear and paranoia?
- Empowerment—or helplessness?
- Autonomy (self-direction)—or heteronomy (institutional-direction)?
- Participatory democracy—or authoritarian hierarchies?
- Diversity and stimulation—or homogeneity and boredom?
Research
shows that those labeled with attention-deficit hyperactivity disorder
do worst in environments that are boring, repetitive and externally
controlled; and that ADHD-labeled children are indistinguishable from
“normals” when they have chosen their learning activities and are
interested in them. Thus, the standard classroom could not be
more imperfectly designed to meet the learning needs of young people who
are labeled with ADHD.
As I discussed last year
on AlterNet,
there is a fundamental bias in mental health professionals for
interpreting inattention and noncompliance as a mental disorder. Those
with extended schooling have lived for many years in a world where they
all pay attention to much that is unstimulating. In this world, one
routinely complies with the demands of authorities. Thus for many M.D.s
and Ph.D.s, people who rebel against this attentional and behavioral
compliance appear to be from another world — a diagnosable one.
The
reality is that with enough helplessness, hopelessness, passivity,
boredom, fear, isolation and dehumanization, we rebel and refuse to
comply. Some of us rebel by becoming inattentive. Others become
aggressive. In large numbers we eat, drink and gamble too much. Still
others become addicted to drugs, illicit and prescription. Millions work
slavishly at dissatisfying jobs, become depressed and passive
aggressive, while no small number of us can’t cut it and become homeless
and appear crazy.
Feeling misunderstood and uncared about,
millions of us ultimately rebel against societal demands; however, given
our wherewithal, our rebellions are often passive and disorganized, and
routinely futile and self-destructive.
When we have hope, energy
and friends, we can choose to rebel against societal oppression with,
for example, a wildcat strike or a back-to-the-land commune. But when we
lack hope, energy and friends, we routinely rebel without consciousness
of rebellion and in a manner which today is commonly called mental
illness.
