Foretelling extinction?

Photo: Paint chipping on rail station.

Mental illness has reached epidemic proportions. The National Institute of Mental Health (NIMH) estimates eighteen percent of American adults suffer from a mental disorder each year. The World Health Organization (WHO) claims depression is the leading cause of disability in the world. These numbers, however, do not do justice to the burden of mental illness in our lives and in the lives of those we love and work with. Few of the one in four people the NIMH claims is mentally ill actually receive professional treatment. Rather, mental illness is often the unspoken source of strain on families, friendships, and the workplace that inevitably occurs when a person has difficulty ‘keeping it together.’ It is hardly surprising that self-help books generate over $8 billion in U.S. sales a year, as many of us find ourselves compelled to watch and improve our minds and relationships.

How did this epidemic come about? Why are so many people suffering from, and needing treatment for, mental illness—or at the very least, deep emotional suffering?

Whether the world has gone crazy, or just our little corner of it, may seem irrelevant if there is something that can be done—or taken—that will reduce suffering. For those who receive treatment, medication is increasingly seen as the cure. Worldwide, 54 million people have been prescribed Prozac. In response to a 2004 survey by the National Center for Health Statistics, 10 percent of women reported taking an antidepressant in the previous month compared with 4 percent of men—or approximately 42 million people. And antidepressants are just one of several classes of psychiatric medications.

How psychiatric medications work is more conjecture than fact, but this lack of knowledge rarely stops anyone from taking them. Many of us would rather leave the science to the psychiatrists and let them decide the “truth” about mental illness. But what if they don’t? What if they are asking erroneous questions, relying on incorrect suppositions, or using the wrong measurements, and in the meantime, the number of people suffering from mental disorders keeps escalating?

It would not be the first time psychiatry went astray. A quick look at the history of psychiatry reveals a few dead ends, including moral treatment, phrenology, lobotomies, and some might add, psychoanalysis. There have also been nefarious abuses of psychiatric power, such as the forced sterilization of the mentally ill and the murder of seventy thousand asylum patients in the first Nazi gas chambers. These two situations should raise a few flags about the specialty’s integrity, let alone its propensity for developing safe, efficacious treatments.

Science has been described as a noble pursuit and a cumulative process that builds on previous knowledge and good intentions. Yet it is also confounded by the political machinations, personal agendas, and pandering to wealth that can be found with almost any human endeavor. In the case of psychiatry, skepticism seems in order, particularly given the billions of dollars in profits the pharmaceutical industry makes each year from psychotropic medications—worldwide sales of antidepressants alone reached $19.5 billion in 2003.

Medications give psychiatry legitimacy as a medical field. This is something it has strived for since the specialty’s inception in the late eighteenth century when Philippe Pinel introduced moral treatment in France’s horrendous Bicêtre and Salpêtrière “hospitals,” where the mentally ill were often chained in cages. For the first time in its 200+ year history, psychiatry now has a treatment that looks and acts like the rest of medicine, and the field appears enamored by its own success. Developmental psychologist Jerome Kagan observes “psychiatrists are smug. Their attitude is “‘we have these drugs, so why should we change?’”

But change is just what psychiatry should be doing, particularly if the purpose of the specialty is not only to treat mental disorders, but also to reduce their occurrence. Presently, the treatment of mental disorders is filtered through an algorithm of sorts—the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)—which is used to decide an individual’s disorder, and thus which medication to try. Senior psychologist Arthur C. Houts weighed in on the success of this approach: “after 25 years of following changes in the various editions of the DSMs, I have concluded that there is far more pseudoscience than real science in the modern DSMs.” Many share his attitude. What should replace this ever-expanding tome of potentially misleading information? The solution is not likely a revised DSM-V.

As mental illness reaches the point of affecting one in four people in American society, it is time to recast mental disorders as a social problem and not a phenomenon of individual brains. The issue that needs addressing is how we could not go crazy in a world where, according to environmentalist Derek Jensen:

“In the last 24 hours, over 200,000 acres of rainforest were destroyed. Thirteen million tons of toxic chemicals were released. Forty-five thousand people died of starvation, thirty-eight thousand of them children. More than one hundred plant or animal species went extinct because of civilized humans.”

 But if this isn’t enough to feel the world has gone completely mad, social conditions uncovered by Kaiser Permanente and the Center for Disease Control and Prevention suggest at least two thirds of the American population have grown up in conditions that can lead to mental illness. These conditions include: physical, sexual, and emotional abuse; witnessing a mother being battered; a drug or alcohol abuser in the family; a family member with a mental illness; one or no parents; and the incarceration of a family member. Enduring such circumstances as children leaves many unable to trust relationships in adulthood as well as susceptible to developing a mental disorder.

We are foremost social creatures. As psychologist Louis Cozolino writes:

“The individual neuron or a single human brain does not exist in nature. Without mutually stimulating interactions, people and neurons wither and die. In neurons this process is called apoptosis; in humans it is called depression, grief, and suicide.”

 The ubiquity of mental disorders is analogous to the canary once used by miners to signal impending danger and possibly death. In the case of large numbers of people suffering from mental disorders, the community and social connections so vital for emotional survival may have become too tenuous. Yet we’re oblivious to this canary’s suffocation because we are often too busy medicating away the signs of life on the verge of extinction.

Rather than looking to other medical specialties to understand the epidemic of mental disorders, perhaps psychiatry should take a lesson or two from biologists dedicated to saving species from extinction. One of the first things psychiatry might learn is that to understand an endangered species’ needs, the environment that it was originally adapted to live in must be identified. I like to imagine a question would then quickly arise: How sane is this society we have created for ourselves? By addressing this question, we might begin to understand the nature and extent of human suffering and why there is so much mental illness today.

References

Cozolino, Louis. 2006. The neuroscience of human relationships: Attachment and the developing brain. New York: W. W. Norton & Company.

Jensen, Derrick. 2006. Endgame: The Problem of Civilization. II vols. Vol. I. New York: Seven Stories Press.

© 2009 Laura K Kerr, PhD. All rights reserved (applies to writing and photography).

  • Absolutely–in high school I was medicated to the gills with antidepressants and not one doctor inquired as to any personal or family issues; as it turned out, my depression was triggered and exacerbated by abuse and dysfunctional family dynamics. I feel like psychiatry is this impenetrable force fueled by Big Pharma, and seeing the amount of money flying around from the drugs I don’t know how we could change that. I do subscribe to the “Mad in America” blog, which has some helpful ideas, but it’s very strident and not interested in building bridges, which I think is the most productive approach. I hope you’re presenting on this to your colleagues!

    • Eve, I so wish you hadn’t been given those drugs, especially as a teen. I was talking with another trauma-focused therapist this past week about the problem of not asking the ‘right’ questions — the often loaded questions that point to a history of maltreatment and poor upbringing. Trauma-focused care really can work, but it’s hard work, and takes time; there are no quick and easy solutions to adverse childhood experiences. And vicarious traumatization is a very real work-related risk when you open to another’s victimization. Sometimes I think people don’t ask the right questions because it’s hard to, and sometimes I think there just hasn’t been enough trauma-focused emphasis and trainings until very recently. And I agree; it’s better to build bridges. The mental health system is broken in the U.S., and we need a collective effort to mend it. Thanks so much for your input.

  • Robert D. Stolorow