Mental Illness, Rising Rates and What They Really Mean
Psychology can be defined as the science of behavior and mental processes. More specifically, psychology is the study of human perception, learning processes, memory, human development, intelligence, motivation, emotion, psychological disorders, the treatment of psychological disorders, and the social aspects of human behavior and mental processes. The American Psychological Association’s (APA) Diagnostic and Statistics Manual IV (DSM IV) lists almost 300 medical conditions that are labeled mental disorders, ranging from phobias to schizophrenia to depression (Bernstein and Nash 416). Mental disorders can be categorized into many main groups, including, but not limited to, anxiety disorders, mood disorders, and personality disorders. The World Health Organization (WHO) estimates that by the year 2020 mental illness will be the second leading cause of death and disability. The WHO also reports that today mental illnesses affect over 400 million people globally, 45 million of which suffer from schizophrenia (“Mental Illness” 1). Mental illness rates are on the rise in the United States; however, the increase is due not to a decline in collective American mental health but instead to rising numbers of recognized mental disorders, changes in the diagnostic criteria for mental disorders, Americans’ tendencies to blame social problems on medical causes, and the influence of various groups that stand to benefit from rising mental illness rates.
Epidemiology is the scientific study of all types of diseases and the ways in which they are distributed amongst the population. Epidemiologists study three aspects of a disease: prevalence (the ratio of those ill to those not ill during a particular moment in time), incidence (the number of patients newly diagnosed during a given period), and risk factors (elements that make a person more susceptible to a certain disorder) (Davison and Neale 111). The aspect of epidemiology that is most important to this essay is prevalence; a higher prevalence of mental disorders will naturally result in rising mental illness rates, and vice versa. Few dispute the fact that there is a higher prevalence of patients with documented mental disorders today than ever before. The reason for this is that the total number of mental disorders has risen from just one (insanity) in the mid-1800s to 106 in 1975 to 297 in 1994 (Brym and Lie 448). According to Brym and Lie, “As the number of mental disorders has grown, so has the proportion of Americans presumably affected by them” (448). The most logical conclusion one could draw from that statement is that the increase in the number of patients with mental disorders is due not to changes in American mental health but to the simple fact that the medical community now recognizes more mental conditions than ever before. This increase in the number of recognized mental disorders is due to powerful American organizations, Americans’ attitudes towards mental disorders, and American medical groups.
Some believe that the increase in mental illness rates is due in part to physiological changes in a number of Americans. Robert Brym and John Lie contend:
“Americans are now experiencing more stress and depression than ever before, due mainly to the increased demands of work and the growing time crunch. Mental health problems are thus more widespread than they used to be. At the same time, traditional institutions for dealing with mental health problems are less able to cope with them. The weakening authority of the church and the weakening grip of the family over the individual leave the treatment of mental health problems more open to the medical and psychiatric establishments.” (448)
Brym and Lie’s claim that today’s average American experiences more stress and depression than ever before just doesn’t make sense. Is it possible that even with an ever-increasing wealth of medical knowledge and technological breakthroughs life today is actually worse than in the past? The answer is no. Reporting on a study published in the February 1998 Archives of General Psychiatry, Bruce Bower writes, “The swelling [mental illness] rates stem far more from changes in diagnostic criteria than from a widening epidemic of mental illnessâÂ?¦Many folks meet the psychiatric definition of some disorder but may neither experience serious impairments in their daily lives nor need mental health treatment” (1). What this means is that while it appears that there are more people suffering from depression today, what is actually happening is that more people are seeking help for problems that were previously either untreated or not viewed as problems at all. This contradicts Brym and Lie’s claim that mental health problems are more common today than in the past. Their second claim that today’s patients with mental health problems are often forced to seek medical help because of the decreasing influence of churches, families, and peer groups is valid, but it backfires and proves Bower’s point. If more people are seeking medical help for mental problems, it does not necessarily follow that more people are mentally ill. What is more likely the case is that patients with mental illnesses who were not being treated before are more likely to seek medical help now from physicians who provided the statistics Brym and Lie rely on.
The cause for the increase in mental illness rates is the increase in the number of conditions that are considered “mental disorders” by the DSM IV. The number of conditions labeled “mental disorders” has risen because certain organizations have required it. For example, according to Brym and Lie, in 1908 the United States Census Bureau required the American Medico-Psychological Association (now known as the APA) to catalog and categorize the various mental disorders that were recognized at that time. Similarly, HMOs call for “precise diagnostic codes” before they will reimburse patients for psychotherapy. Brym and Lie state that “because public and private organizations find the classification of mental disorders useful, they have proliferated” (448). Again, the previous statement shows that the increase in the number of people with mental disorders is not due to changes in overall American mental health but instead to changes in the diagnostic criteria for mental illnesses. Another reason for the increase of patients with documented mental disorders has to do with Americans’ attitudes towards themselves.
Brym and Lie note that of all people in the world, Americans are the most likely to blame personal problems on medical or psychological conditions instead of searching within for answers or searching outside for social causes (448). Take, for example, the mental condition known as attention deficit disorder (ADD). A person with ADD may have trouble finishing the details of a project, find it hard to pay attention when spoken to, have trouble focusing on one task for an extended period of time, or misplace important things (“Symptoms” 1). People with ADD often squirm and move around when forced to sit still for a long time, are constantly wired, talk for long periods of time, or butt in and interrupt others’ conversations (“Symptoms” 1). In 1980, ADD became an officially recognized mental disorder; by the 1990s, psychiatrists were writing 6 million prescriptions a year for various ADD medications (Brym and Lie 448).. Why did the notion of ADD take off so quickly in America? It is because Americans are prone to turn family and social problems into medical and psychological conditions so that they can shift the blame from themselves and their surroundings. Once the symptoms off ADD were made public, many parents with energetic and troublesome children sought psychiatric help for the “quick fix” that medication promised, instead of searching for personal and social causes of their children’s behavior. Brym and Lie state, “Many children diagnosed with ADD may have no organic disorder at all.” They give other possible causes for the traditional symptoms of ADD, such as school curricula that do not challenge children and home environments where children feel neglected. However, Brym and Lie claim, once Americans learned of ADD and its symptoms, doctors habitually used medication to solve the problem instead of looking beneath the surface for other possible causes (449). This influx of patients into the medical system caused mental illness rates to rise; however, many of the diagnoses contained in mental illness rates are incorrect, proving that rising illness rates are not due to Americans’ deteriorating mental health.
The third reason for the increase in mental disorder rates is that certain medical groups and other organizations stand to benefit from it. Whether it is a doctor who earns more money by having more patients or a group of war veterans who receive disability because they have been diagnosed with post-traumatic stress disorder (PSTD), there are groups who benefit from a widespread acceptance of mental disorders. Using the example of PSTD, Brym and Lie claim:
“Once the disorder was officially recognized in the 1970s, some therapists trivialized the termâÂ?¦Some psychiatric social workers, psychologists, and psychiatrists may magnify the incidence of such mental disorders because doing so increases their stature and their patient load. Others may do so because the condition becomes ‘trendy.'” (449)
Again, this proves that it is not a decline in American mental health that causes an increase in mental illness rates. Mental illness rates have risen because the number of recognized mental disorders has risen, the diagnostic criteria for mental disorders has changed, Americans are likely to blame social problems on medical causes, and certain groups benefit from rising mental illness rates. The Surgeon General reports that, in a given year, at least one in five Americans meets the criteria for a mental disorder (Mental Health 1). This translates into 44.3 million Americans with a mental disorder (“Mental Disorders” 1). Given the forces behind the current increase in mental illness rates, that number is likely to soon go up.
References
Bernstein, Douglas A. and Nash, Peggy W. Essentials of Psychology. Boston: Houghton Mifflin, 2002.
Bower, Bruce. “Rethinking Mental Disorder Rates.” Science News March 7, 1998: On the Internet at http://web7.infotrac.galegroup.com/itw/infomark/84/
11/45796380w7/purl=rcl_ITOF_0_A20406304&dy (visited April 7, 2004)n.
Brym, Robert J. and Lie, John. Sociology: Your Compass For a New World. United States: Wadsworth/Thomson Learning, 2003.
Davison, Gerald C. and Neale, John M. Abnormal Psychology. New York: John Wiley and Sons, 2001.
“Mental Disorders in America.” On the Internet at http://www.nimh.nih.gov/publicat/numbers.cfm (visited April 8, 2004).
Mental Health: A Report of the Surgeon General. On the Internet at http://www.surgeongeneral.gov/Library/MentalHealth/chapter2/sec2_1.html (visited April 8, 2004).
“Mental Illness on the Increase.” On the Internet at http://www.irishhealth.com/?level=4&Id=1447&var=print (visited April 7, 2004).
“Symptoms of AD/HD.” On the Internet at http://www.additudemag.com/addabc.asp?DEPT_NO=201&article_NO=1
