Mental illness: is there a global epidemic? | Hacker News Reader

Mental illness: is there a global epidemic?

theguardian.com

89 pointspseudolus55 comments

Since mental illness is largely defined as any sort of behavior or thoughts that make it difficult for one to be a productive member of society, however that society defines ‘productive’, if the structure of society changes such that previously normal and healthy behaviors and beliefs become destructive and difficult for people, that will lead to an increase in so-called mental illness even if people as individuals haven’t changed at all.

This is definitely worth recognizing. Some conditions like ADHD are understood to be the extreme of "normal" variation rather than a specific change in functionality, and many conditions are explicitly defined as being diagnosable only when they interfere with everyday life. We should absolutely expect the rates of such illnesses to vary as the meaning of 'everyday life' changes - I mention ADHD because changes to education and job structure have made focus and executive function increasingly important. And of course, there's the entire debate around increased access to diagnosis and broadened diagnostic standards over the last few decades.

That said, it's also worth talking about which things aren't derived from changing standards, or at least recent ones. The perception of something like schizophrenia or suicide may differ between cultures, but both have been pathologized in the US and Europe since pre-industrial times. Less dramatically, any psychological condition which leaves a person largely housebound (e.g. extreme depression or some presentations of OCD) has been pathological since at least the end of the Victorian Era.

To the extent that we see a rise in suicide rates, debilitating depression and anxiety, and patterns like hikikomori and its international analogues, it really does seem like something has changed about behavior as well as society.

ADHD exists on a continuum, much like many other behavioral/mental disorders. The near side is probably what you describe--something that would be normal in the right circumstances, but is maladaptive in the real ones. That phenomenon probably partially explains people whose ADHD "disappears" in adulthood. As an adult you can choose your environment better. However, that's by no means the whole of it, and the farther sides are potentially quite disabling. Executive function covers an awful lot of your everyday behavior, and it's all potentially affected.

The diagnosis for ADHD specifies multiple areas impaired. Just flunking class or getting fired won't do it. Unless we think maintaining basic friendships or relationships, suppressing destructive impulses, defeating procrastination, avoiding chronic disorganization (extreme clutter), staying away from addictive substances, etc., has also become significantly more sophisticated, I'd think the aspects that affect those types of activities would stand alone as an indicator.

There have been epithets/cliches for many, many years that come down to pathologically spaced out, lazy, foolish to the point of not being "normal"; and we've had "minimal brain damage" and other pre-ADHD executive function impairment diagnoses for a long time as well. It's not just a modern thing.

Social impacts can be associated with mental illness, but they do not define it.

From the American Psychiatric Association:

"Mental illnesses are health conditions involving changes in emotion, thinking or behavior (or a combination of these). Mental illnesses are associated with distress and/or problems functioning in social, work or family activities."

https://www.psychiatry.org/patients-families/what-is-mental-...

> distress and/or problems functioning in social, work or family activities

For some mental illnesses, this pretty much does amount to society defining the condition. That doesn't mean they aren't real, just that diagnostic standards including "interferes with functioning" will necessarily shift as the meaning of everyday functioning varies.

The classic example is someone with poor cognitive control meeting the ADHD standard of "difficulty in at least two settings". Trouble maintaining a home, but not socially or professionally, doesn't suffice, but trouble in home and education does. So the same person could be mentally ill in a place with compulsory education through 18, but not mentally ill in a place where they drop out of school earlier and find a job that works for them.

> Since mental illness is largely defined as any sort of behavior or thoughts that make it difficult for one to be a productive member of society

I have seen enough of this up close to know that it isn't society's construct, that many sufferers are objectively having problems.

Maybe not all cases and conditions are like this. But it doesn't do anyone favors to handwave some of those serious conditions away.

The more society becomes increasingly oriented around thought-work the more these problems will manifest. Humans evolved to cooperate, but we didn't evolve to spend all day thinking about long-term work-related stressors that are only indirectly related to our own well-being. Once it became trivially easy to obtain food, water, and shelter, a good portion of our biological imperative was left without anything to be concerned with.

For an interesting tangentially-related thought, try asking people what the definition of "healthy" is for a human. Mental health is the hardest part to define out of all health.

> Once it became trivially easy to obtain food, water, and shelter

I would argue that the average human being doesn't consider these things easy to acquire. For society it COULD be easy to distribute these things if we decided that was a goal of ours, but we haven't gotten there yet. I would be very interested in seeing the ideas (or problems?) invented by children born into a world where this was true, but unless things get very interesting very quickly, I doubt we'll get the chance.

Most mental illness is definitely society's product.

Without the immense pressure to conform to insane, abusive and destructive standards in combination with living in a harmful environment with poisonous "food" and "medicine" in competition with others who are likewise fighting to keep their head above water; I suspect most mental illness would disappear by itself.

Treating mental illness like some kind of natural law which can't be avoided, only stops us from finding the real causes and progressing towards a more humane society.

I think you're right that there are social, societal, and stress-related causes of many of these conditions that are under-explored. And certainly the cultural attitudes need to be adjusted more towards compassionate acceptance and helping others than they are today.

However, when it comes to an individual person being stuck in one of those states... What you are saying winds up feeling a tad ridiculous. For example, if presented with someone who has a delusional belief in something objectively, demonstrably false on a factual basis, to the point where acting on their belief makes them a danger to themselves or others ... It is not the case that a different society will make those delusions into true facts. What they need in that moment is probably medication. I have seen people for whom that has definitely been the case, and they show improvement with treatment.

You are missing the point.

I'm not saying a more humane society would cure existing mental illness, though I'm sure it would help.

The point is that most mental illness is a product of the society we live in, and the long term solution is fixing that rather than medicating the symptoms.

There are a lot of factors. Stress and trauma. Genetics and heredity. Some degree of randomness. I think you are onto something but over-simplify.

Trust me, there's nothing simple about taking this stance and pointing out the big elephant in the room.

Blaming chaos or genetics, that's how you over-simplify.

Genetics is not the only factor, but it is a huge one, not to be ignored. I suppose you think people talk about terms like "family history of mental illness" just for fun?

What do you mean "most"? What kinds of mental illnesses are you referring to here?

I mean most, that's about as specific as it makes sense to be since the definition keeps morphing to hook an ever growing part of the population into the profit-machine.

When I said that the sufferers of mental illness objectively do suffer, you did not seem to have a problem and you said that society is the primary cause. (And explicitly not a hereditary disposition, as is generally believed to be a factor.)

Now you seem to be suggesting the conditions are expanding, as if invented, to serve a profit machine.

This all suggests to me that your real opinion is that the illnesses don't exist.

All I ever said was that most mental illness is a product of society. Anything beyond that is a product of your imagination. If you're going to actively avoid truth by taking every chance to derail the discussion, why even bother?

But you seem to be morphing the definition in order to sculpt your narrative, which is why I'm asking you to nail it down.

Right. A mass delusion by society (which is culture, the shared beliefs of a group that are not true) can create the appearance of sickness in ones not deluded by defining sickness as being what is different from the norm.

I think that since industry has boomed, we exposed ourselves to hazardous chemistry.

While testing for toxicity, cancers and other illnesses, I think science is not able to foresee the effect of all the new chemicals we created, especially cocktail effects, endocrine disruptors, and every bit of thing which is a product of industry. If we investigate product per product when something goes wrong, there will be a lot of things that won't be detected.

I'm sure there are many effects of all those products, but we cannot remove those components, because of cost/benefits and all the great things they bring. As long as public health agencies can be happy, things are okay. When we are not able to really make quality studies on how the brain is affected because we cannot measure a brain, things become foggy.

Add this the norm of 9 to 5, lack of sleep, bad diet, sedentary life style, political frustration, it's expected to have mental illness or imbalance.

Without some sources, I remain a bit skeptical that any old cocktail of chemicals will interact in a way to cause the whole spectrum of mental or mood disorders we are seeing. It is hard to refute with authority as this is just such a sweeping statement that encompasses most everything around us.

I believe there are some indications that it is not that accurate: firstly, depression and anxiety disorders as well as schizophrenia have probably been described in ancient times (of course with a very different wording) and in different regions of the world.

Second: if you look at this chart (https://ec.europa.eu/eurostat/statistics-explained/index.php...), and squint a bit, you can see depression tends to be more frequent in rich, northern European countries like Ireland, Germany, Finland, Sweden than poor, southern countries like Greece or Cyprus. Public awareness is a probable confounding factor, but it could still be that the amount of daylight and outdoor activity is helping in the South, even though living conditions are objectively worse as are environmental standards.

It could also be related to social media use (correlation with this: https://www.internetworldstats.com/stats4.htm) but this is a very recent phenomenon, so I doubt it is the causal reason.

In God We Trust. After a fashion that is, because if you told your doctor you just met god, they'd lock you up for being delusional or at the minimum prescribe anti-psychotic medication. Yet Billions of people claim to believe in a "magic man in the sky", think of it; some parents are Actually Proud that their children blew themselves up to kill other who disbelieved.

Perhaps the crisis is far, far worse than even the pill pushers proclaim. Just a thought.

It's different. Nobody will prescribe anti-psychotic medication to a religious person. It's just not the same thing. Speaking as someone who has a family member with mental illness, you know it when you see it, it's just a different thing. When someone who's never in his life had religious inclinations, suddenly starts doing weird rituals, not sleeping, and claiming to be the messiah and behaving differently then before,... well, it's just, has nothing to do with being a religious person.

> It's different. Nobody will prescribe anti-psychotic medication to a religious person

I feel you are missing the point(s) I made. I am not referring to someone with a Messiah complex; and I dated someone who was suicidal (for almost a year) and interacted with some people in her therapy group--schizophrenics, people with mania and so on. So I'm not a "virgin".

I just wanted to point out the blatant hipocrosy that some, not all, of the experts in this arena. I think my points do stand on their own merit--despite the fact that I'm low on sleep due to a 16 hour work related grind yesterday, and I could have been a bit more precise with my original post.

I didn't just mean the messiah complex, it's someone experiencing a distorted reality and no amount of evidence will sway their delusional ideas. It's very noticeable. I don't really understand where the hypocrisy is and what your actual point was. I don't think anyone considers religious extremists completely sane.

Worth pointing out Robert Whitaker's book Anatomy of an Epidemic. https://en.wikipedia.org/wiki/Anatomy_of_an_Epidemic. It goes in depth into the conflicting paradox of a dramatic increase in amount of mental health care and the paradoxical increase in the burden of mental health on society. It concludes that the latest generation of psychiatric drugs are hurting long term outcomes of psychiatric diseases.

Pretty bad conclusion on insufficient data.

What we see is medicalization of mental illness, which also includes sharp diagnostic tools and accurate data.

In past someone like that could be called Bohemian or eccentric or moody or slow, work at physical tasks to which they were still suited; with exception made for truly insane (mostly schizophrenics, murderers and catatonics) got committed, and even the it was layperson or law's idea, not of medical profession.

Remember how new even psychoanalysis is...

Read Lost Connections by Johann Hari recently. It’s a touch repetitive but a quick and easy read. And I think it hits some important notes on why we might be seeing this. A lot has changed about how we live and that deserves more attention.

I wouldn't recommend it - Hari is a notorious bullshitter.

https://en.wikipedia.org/wiki/Johann_Hari#Plagiarism

https://www.theguardian.com/science/brain-flapping/2018/jan/...

I read it and would give it a mild recommendation for the layperson that holds onto old misconceptions about mental illness and psychiatry (eg that depression is a deficit of serotonin).

That guardian article doesn’t really refute anything Hari says, it mostly complains that what Hari says is well understood by modern mental health practitioners, which is true but he’s not writing for mental health practitioners.

Exactly. I read it and enjoyed it because it opened my eyes to a new way of looking at things, and it also kinda made me realize that is where some of the problem with my depression does lie. Enough that I know if I'm feeling down, simply doing something with people is a great way to help lift myself up before it gets into full blown can't leave my room depression.

"It is no measure of health to be well adjusted to a profoundly sick society." - Jiddu Krishnamurti

> The fact that millions of people share the same vices does not make these vices virtues, the fact that they share so many errors does not make the errors to be truths, and the fact that millions of people share the same form of mental pathology does not make these people sane.

-- Erich Fromm

> Of course it's extremely easy to say, the heck with it. I'm just going to adapt myself to the structures of power and authority and do the best I can within them. Sure, you can do that. But that's not acting like a decent person. You can walk down the street and be hungry. You see a kid eating an ice cream cone and you notice there's no cop around and you can take the ice cream cone from him because you're bigger and walk away. You can do that. Probably there are people who do. We call them "pathological". On the other hand, if they do it within existing social structures we call them "normal". But it's just as pathological. It's just the pathology of the general society.

-- Noam Chomsky

Isn't part of the rise due to the fact that, in 1990, DSM-5 classified a substantial number of additional symptom sets as mental illnesses?

Redeclaring what for aeons was wanted and usefull behaviour as sickness? Yes, your ancestors wanted that hobo under the bridge.

He made a excellent scout, he was fearless and his pattern search skills where superior to yours. He kept you fed, he kept you save, until he was no longer useful. If it has no skin colour, and the difference is all in the head- one could obviously not term this a race. It has to be visual, to be a acceptable concept.

Look at him, going the way, you will go, once your usefullness has ended.

I like to think of mental illness like myopia. Many people used to be blind, but then we figured out the technology, it got cheap, and now 60% of adults wear glasses.

As there is an incentive to classify mental illness for insurance, occupation, and drug development reasons, there is going to be 60% of people on ‘mental illness’ treatment, because we have an ‘ideal human’ (20/20 analogy) that we are trying to reproduce.

As the ideal changes (e.g. homosexuality was thought of in the past as non-ideal, so it was a mental illness, now these things have changed in many parts of the world, so those parts of the world do not classify it as such anymore.), the treatment options/norms change.

tl;dr, it is entirely possible due to biology that eventually ~60% of us will have some classification of mental illness that we will be treated for.

Pretty sure myopia rates increased quite a bit in the 20th and 21st centuries. Scientists now think myopia is heavily related to sunlight exposure in youth: don't get enough bright hours, get myopia. 3 is the recommended minimum for outdoors time.

I've spent a few hours looking into myopia. You're correct that it's been increasing and is still increasing, it's increased so quickly genetics can't explain it, and the sunlight hypothesis is new to me.

Some areas in Asia have >80% myopia rates.

(As an ally myself, I also think it's worth pointing out that Gen-Z having a 7% LGBTQ rate theoretically could also have an environmental cause. There is evidence of a biological basis for transexualism.)

[1] https://en.wikipedia.org/wiki/Near-sightedness#Asia

Personally I think the increase in LGBTQ people would most likely be caused by increasing public acceptance and/or awareness - if you're going to be ostracized by everyone you know it's a lot harder to come out, and if you think feeling however you do is bizarre/unprecedented/obscene you similarly won't tell people. Plenty of anecdotes out there of people who didn't think they were gay/bi/trans/etc because they didn't think of it as a thing-you-could-be; you see things like "oh, I thought everyone thought girls were hot" (or equivalent).

As acceptance and awareness grow, the bar gets lower -- fifty years ago it'd take a lot of dysphoria to justify trying to transition; now it's still not simple but it's a lot easier, and so more people who are comparatively less dysphoric are willing to take that particular plunge, and more of them know it's a doable thing.

One of my eyes has myopia. The other one is fine.

Did I play out too much as a pirate with an eyepatch?

Joke aside, the disease has many causes, and there is some genetic predisposition. It is too easy to blame it on the modern environment.

It clearly existed before the 20th century. I said it increased markedly, and researchers think this is linked to sun exposure.

This seems a little... sketchy.

Who gets to define what the "ideal human" is?

If the ideal can change, doesn't that make classifying mental illness completely subjective?

If so, doesn't that mean you can essentially declassify your own mental illness if you can normalize it via political and social vectors?

>Who gets to define what the "ideal human" is?

Psychiatrists/the authors of the DSM.

>If the ideal can change, doesn't that make classifying mental illness completely subjective?

Yes, it is completely subjective:

"psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests" -Allen Frances, Chairman of DSM-IV

https://en.m.wikipedia.org/wiki/Allen_Frances

I don't think myopia is a good analogy. When it comes to vision, the target is well-defined. Better vision is, well, better. Myopia is unambiguously a defect and (AFAIK) has no advantages. Curing someone of myopia wouldn't change the person. Neither do glasses, they're an external tool -- not part of the organism.

Mental illness is different. A person isn't their eyes but arguably, they are their mind. Treating a personality disorder, in particular, obviously has to change the patient's personality.

It is also not necessarily just a defect. Sometimes it's a pattern of behaviors that is perfectly appropriate for certain situations -- but very bad in the current ones. Whereas bad vision is never good.

This is quite an interesting perspective, and as someone that has been struggling with depression lately I found this kind of comforting in a weird way. Thank you for sharing this!

>>First, to bust some myths: there is no global epidemic. It is not growing exponentially. It is not a disease of western capitalism.

>>Second, a warning. Data is remarkably patchy.

Well, if the data is remarkably patchy then don't boldly claim something is or isn't happening. Admit the uncertainty, so we can proceed with due caution.

Confidence is inextricably linked to effect size - we can be very certain that nothing major is happening, even if we're completely unsure if something is happening. Put more crudely, it takes a very large sample size to ascertain if bacon might increase your risk of colorectal cancer, but a very small sample size to ascertain if a bullet to the head causes brain damage.

Headline: "Is there a global epidemic???????"

Article: "No."

This is where I closed the tab. GTFO with your clickbait, Guardian.

>It is not a disease of western capitalism.

I'm curious as to how this conclusion was arrived at.

no... there are just more people and we are more connected than ever.

Reply on news.ycombinator.com