Half of Us Are Mentally Ill (and the Other Half Are Undiagnosed)

Reason ^ | June 13, 2011 | Jacob Sullum

[TheDingoAteMyBaby]

In a New York Review of Books essay, Marcia Angell, former editor of The New England Journal of Medicine, considers three books that take skeptical looks at "the epidemic of mental illness" sweeping the country:

The tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007—from one in 184 Americans to one in seventy-six. For children, the rise is even more startling—a thirty-five-fold increase in the same two decades....

A large survey of randomly selected adults, sponsored by the National Institute of Mental Health (NIMH) and conducted between 2001 and 2003, found that an astonishing 46 percent met criteria established by the American Psychiatric Association (APA) for having had at least one mental illness within four broad categories at some time in their lives.

Angell poses some questions about this epidemic:

Is the prevalence of mental illness really that high and still climbing? Particularly if these disorders are biologically determined and not a result of environmental influences, is it plausible to suppose that such an increase is real? Or are we learning to recognize and diagnose mental disorders that were always there? On the other hand, are we simply expanding the criteria for mental illness so that nearly everyone has one? And what about the drugs that are now the mainstay of treatment? Do they work? If they do, shouldn't we expect the prevalence of mental illness to be declining, not rising?

As those questions suggest, Angell seems to share the skepticism of the authors whose books she reviews: University of Hull psychologist Irving Kirsch, who in The Emperor's New Drugs shows that antidepressants are only slightly more effective than placebos, so slightly that the difference may be attributable to stronger expectations of improvement primed by the drugs' side effects; the journalist Robert Whitaker, who in Anatomy of an Epidemic argues that the "astonishing rise of mental illness if America" can be understood largely as an outgrowth of the desire to sell psychiatric drugs; and Daniel Carlat, a Boston psychiatrist who confesses his profession's shortcomings in Unhinged: The Trouble With Psychiatry. Angell notes that "none of the three authors subscribes to the popular theory that mental illness is caused by a chemical imbalance in the brain." She adds that "the main problem with the theory is that after decades of trying to prove it, researchers have still come up empty-handed."

That may come as a surprise to uncritical viewers of pharmaceutical commercials or credulous readers of the APA's Diagnostic and Statistical Manual of Mental Disorders. But it is a truth acknowledged even by many psychiatrists, including the chief editor of the current DSM, who recently despaired that the attempt to define mental disorders is "bullshit." Despite psychiatry's medical pretensions, the equation of mental illnesses with brain diseases remains little more than an assumption. In fact, as Thomas Szasz observes in the preface to the 50th anniversary edition of The Myth of Mental Illness, once a particular pattern of behavior can be confidently ascribed to a physical defect, such as the brain damage caused by advanced syphilis or Alzheimer's disease, it is no longer considered a psychiatric issue. "Contemporary 'biological' psychiatrists tacitly recognized that mental illnesses are not, and cannot be, brain diseases," Szasz writes. "Once a putative disease becomes a proven disease, it ceases to be classified as a mental disorder and is reclassified as bodily disease."

Angell does not mention Szasz in the first installment of her essay, and I suspect he will be absent from the second part as well. It is OK to agree with Szasz about psychiatry's lack of scientific rigor as long as you do not acknowledge that you are agreeing with him. In an upcoming book review for Reason, I note that the renegade psychiatrist's ideas are is routinely dismissed as obsolete at a time when they seem more relevant than ever.

[Thrownatbirth]

Remember Catch-22: You can’t be crazy if you think you are.

[Talisker]

My father has a similar opinion. The brain can be ill, but the mind is not a physical organism subject to illness.

So a woman gets raped, or a guy comes back from combat, and their brain scans are normal but they have all the symptoms of PTSD, which proceeds to destroy their personal relationships with family and friends, cause loss of jobs, and perhaps alcohol and drug abuse and suicide.

What are they then, just losers?

How about a teenager held on the floor at gunpoint by screaming cops who threw grenades into their house and assaulted their parents, only to be told, as their smashed door swings on it's hinges, that they got the wrong house? When they then have perfect brain scans, but increasing trouble in school, then flunk out and spiral into depression, what are they - losers?

Or how about things that are seemingly less traumatic to most, but very traumatic to few - what are they, statistical rejects we don't have to listen to?

Oh but hey, a bunch of shrinks are corrupt, so let's throw out the whole field of psychology.

Yeah, that's the ticket.

:: spit ::

[Secret Agent Man]

The epidemic is the BIG MEDICAL making up new diseases we all have so that they can “treat” them forever.

What would all the shrinks and docs do if there weren’t ever more new diseases and mental issues to treat?

Hell many shrinks are themselves seeing shrinks.

And of course you don’t know anything about anything if you are not a doctor yourself. Condescending bastards.

[Secret Agent Man]

This is why you never go see a shrink. Liberal = gun hater = find anything to say you are unstable OR lie and say so ==> no more 2A rights for you

[Secret Agent Man]

Since psychology went off the tracks (ie pop society consensus) in 1973 caving into homosexuals, there is no frigging way you should trust any of them. Now if you have a problem with homosexuality and are disgusted by it, now they say YOU have a disorder.

Enough for me not to trust anything they’re telling you. Their foundations are not sound.

[Texas Fossil]

Mental Illness is hereditary, you get it from your children. hee hee hee

[TheDingoAteMyBaby]

I don’t consider any of those people to be losers. I just think there are other options besides a diagnosis of mental illness.

[Amberdawn]

I read it as situational. A veteran, or anyone who has experienced extreme duress will certainly have “issues” long after the fact, but that isn’t mental illness per say-It’s a natural response to a specific set of events. Mental “illness” is something like schizophrenia which is partly genetic, runs in families, and has no “event” onset.