Different explanations have been given for the increased number of people suffering from mental illness. Some have claimed the increase is the result of ever-expanding diagnostic criteria and syndromes that risk medicalizing normal emotional reactions. Others argue the increase is the result of the pharmaceutical industry financially courting the medical establishment as well as using advertisements to attract potential users of their medications. While both these arguments seem correct, they nevertheless fail to address that an increasing number of people regularly experience despair and anguish and are struggling to make a meaningful life, if not keep themselves psychologically, socially, and financially afloat.
I would like to suggest an additional explanation for the increase in mental illness: The upsurge is the result of the collective failure to alleviate conditions that contribute to trauma-related stress. I also believe the mental health field has stood in the way of people overcoming mental illness and returning to growth-centered lives. In particular, models of mental illness as chronic, genetic-based disorders gives us the sense that we are reaching the origins of our suffering — that is to say, the genes we inherited — when in actuality, we risk denying the traumatizing conditions in which many of us grew up or continue to live. Although a diagnosis and medications may provide temporary relief, they may also cause Americans to evade making the challenging changes that are necessary for moving into an emotionally sustainable future.
Childhood abuse and other emotional damaging experiences are so prevalent today that trauma-focused psychiatrist Bessel van der Kolk claimed the single most important health problem facing Americans is our exposure to what are increasingly referred to as “adverse childhood experiences,” which have been rigorously associated with chronic psychological and physical illnesses.
Adverse childhood experiences include recurrent physical abuse; recurrent emotional abuse; sexual abuse; an alcohol and/or drug abuser in the household; an incarcerated household member; living with someone who is chronically depressed, mentally ill, institutionalized, or suicidal; domestic violence; one or no parents in the household; and emotional and physical neglect. (I would also add to this already long list living in a violent community; the conditions of poverty; and the effects of racism, sexism, homophobia, and other forms of oppression.) Based on self-reports of over 17,000 adults in America, a study conducted by Kaiser Permanente and the Center for Disease Control (CDC) concluded that more than two-thirds of the participants in the study had at least one adverse childhood experience when growing up; over two-fifths have a history of at least two of these experiences.
A study conducted at the University of Minnesota, Twin Cities, obtained results similar to the Kaiser/CDC study. Psychologist Patricia A. Frazier and colleagues administered the Traumatic Life Events questionnaire to 1528 college students. The results showed 85% had at least one trauma in their relatively short lives, and on average students reported a history of three traumas. The most common traumatic events included sudden bereavement (47%); life-threatening illness of a family member or friend (30%); witnessed family violence (23%); received unwanted sexual attention (21%); and involvement in an accident in which either self or someone else was hurt (19%).
If “normal” correlates with the greatest number of people, then coming from a normal household in America means growing up in conditions that contribute to poor emotional and physical health in adulthood.
The denial of trauma’s impact — or complete silence about its occurrence, such as the silence that often surrounds childhood abuse — has been the main approach to dealing with trauma’s aftereffects. There are benefits, of course, to denying trauma. For example, trauma-focused psychiatrists Alexader McFarlane and Bessel van der Kolk point out:
“Powerful social institutions such as insurance companies and the armed forces … benefit from downplaying the impact of trauma on people’s lives.”
Medicine’s reliance on clinical- and laboratory-based studies also allows its practitioners to ignore, or downplay, the role trauma plays in the development of mental disorders and diseases. McFarlane and van der Kolk remarked:
“Hitherto, science has generally categorized people’s problems as discrete psychological or biological disorders — diseases without context, largely independent of the personal histories of the patients, their temperaments, or their environments.”
The outcome is an anesthetic presentation of disease in which objectivity is prized over emotionally taxing “social work” and the more ambivalent outcomes that come with taking into account the actual lives of its subjects.
But the denial of trauma is more expensive than its benefits, and likely distorts the basic social fabric of our society. Again, quoting McFarlane and van der Kolk:
“How are the memories of brutualization and cruelty stored at a societal level? How does this affect people’s capacity for loyalty, personal and social commitments, beliefs in individual sacrifices for the common good, belief in justice, willingness to delegate decision making to elected representatives, and belief in the meaning of laws and rules?”
As I discussed in a previous post, America is a country born from trauma, and Modernity — especially its latest configuration as Neoliberal Capitalism — is a costly distraction from our deep, unhealed wounds. Modernity’s ethos of progress, and its continual need for expansion and growth, is not only a diversion from our emotional wounds, but also acts like an addiction, numbing the traumatic remembrances of our individual and collective pasts.
Medicine has gained prominence in our society as a method of denial likely because it successfully identifies in individuals’ bodies the effects of social ills for which we seem to have no solution — except going cold turkey off Modernity, which at this point we are ill prepared to do. Instead, we often look to mental healthcare to ‘fix’ individuals enough so they can function ‘responsibly’ (often defined in terms of holding a job and paying the bills) in a society that habitually denies its responsibility to its members.
When we fail to grapple with the conditions that lead to suffering, and thus fail to address the root causes of mental disorders, we are resigning ourselves not only to repetition of the problem, but also to a prevalent sense of “stuckness” that has us collectively doubting the possibility of meaningful social change.
We seem to have forgotten how to grow after trauma, both as a society and as individuals. I say “forgotten,” because traumatic experiences — those events that activate defense responses such as fight or flight and overwhelm us with fear — have gone on throughout human history, and most early forms of social organization seem in part to have developed in response to the need for a cohesive and supportive community to heal trauma-related stress and defend against threats.
It’s time to rethink the nature of mental disorder and how, as a society, Americans need to respond to the conditions that contribute to early life trauma. During the past several decades we have witnessed a shift from unprecedented — and largely unquestioned — growth in science and technology, to the need to increasingly devote energies to managing the fallout and risks of the imprudent choices previous generations made in the name of scientific advancement. As we rethink our relationship with Earth and the other life forms that inhabit our planet, we also need to reconsider our relationship with ourselves. How can we save the world if we can’t even save ourselves?
Kolk, Bessel A. van der, Alexander C. McFarlane, and Lars Weisaeth. 1996. Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society. New York: The Guilford Press.
© 2014 Laura K Kerr, PhD. All rights reserved (applies to writing and photography).