The Epidemic of Mental Illness: Why?

New York Review

This is the first of a two-part review of three books on the subject.

It seems that Americans are in the midst of a raging epidemic of mental illness, at least as judged by the increase in the numbers treated for it. 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. Mental illness is now the leading cause of disability in children, well ahead of physical disabilities like cerebral palsy or Down syndrome, for which the federal programs were created.

Strangely enough, a friend of mine here in Orosi is going to be working for a psychiatrist from the States who will be bringing groups of Americans down with a variety of psychosomatic disorders – some of which will also be hospitalized at times. My friend is just supposed to keep an eye on them, make sure they don’t hurt themselves, take them for walks – or perhaps even play cards with them. She is ecstatic: the perfect job right in her back yard (they will be staying in a resort close to Orosi).

But to get back to the NY Review article – much of which is about the effects of all the new medicines now being heavily used for emotional disorders. The pharmaceutical industry is making a fortune with them – but their effects are dubious, or even harmful.

I have been this route myself – with Prozac. After all the sound and fury about it – and with me being on ever-increasing doses – it was discovered to be no better than a placebo. I dropped it with no serious withdrawal problems.

I was diagnosed with depression – but what I was really suffering from was Silicon Valley (a madhouse if there ever was one) – and then the culture shock of living in Latin America.

I also had experience here with Beth’s emotional problems. At one point, she cracked up completely and ended up on the psych ward at the county hospital. They shot her full of drugs and she recovered – or seemed to. We were told schizophrenia was just an chemical unbalance in the brain – and a cure for it was just around the corner. In reality, nothing changed – her condition worsened, and she ended up killing herself.

I ended up having a dim view of that part of the medical profession.

To me, what is wrong is simple: America has become so crazy it is driving Americans crazy.


Dying by Degrees

This is the way to go, people will tell you: not from a sudden trauma, but gradually, over a long period of time. Don’t believe them, there is no good way to die – and I ought to know.

Being run over by a truck has its advantages: no complicated explanations are necessary, and the whole thing is over quickly. Everybody assumes it was not your fault – even if it was.

When you get progressively feebler, mentally and physically – people can’t help feeling you are not trying hard enough. Maybe you haven’t been eating enough Wheaties. Maybe old age is some kind of disease the really clever could avoid – or at least put off for awhile longer, with no serious consequences.

You even begin to feel that way about yourself: “What can’t I be as sharp as I used to be?” Loving your decrepit self gets harder and harder – not that it was ever that easy.

Fasting is no Longer a Religious Practice

Fasting was an important practice in early and medieval Christianity, but it has fallen out of fashion. In our instant-gratification, get-rich-quick culture we cannot deny ourselves anything, especially food.

Like anything else, fasting can be misunderstood – as those suffering from Anorexia nervosa have, but its basic purpose is simple: by denying ourselves this gratification, we can concentrate our mental energy elsewhere – hopefully, someplace better.

The medical benefits of a low-calorie diet are well-known, but almost never followed – because this also requires a mental discipline few possess – here again, one of the benefits of a fasting practice.

In researching this I noted that the Mormons still have this practice – as does Islam.

Fungus in the Blood

Latin American is home to some virulent species of fungus – and some of them like people. I have been fighting a fungus infection of the large toenails for nearly a year. I even have a therapist, Wendy, who specializes in this. I enjoy having her work on my feet (I love being pampered in any way), but progress has been slow – even though she constantly assures me that “everything is getting better”.

This week I had an appointment with my doctor, and I showed him my toenails. At one time he had me on the latest fungus medicine, taking a pill a day for three months, each of which cost $2. I have spent hundreds of dollars on the things. He agreed that my regime of carefully applying a liquid every other day, accompanied with a careful work-over of the surface of the nail, was the right thing to do. But fungus was still coming from underneath.

I was surprised, “What do you mean?” I asked. He explained that most Ticos have fungus infections residing in their blood, and this can result in fungal infections in all  kinds of places, such as the ear or the tongue – or even the stomach. He prescribed a pill for me to take once a week.

This reminded me that a friend of our family, who was a missionary living in the high desert of Mexico (Bob Fishburn) had died of a fungal infection of the lungs. The doctors could do nothing to save him. This was an entirely different climate from damp, warm, Costa Rica – but fungus were active there too.

Tropical diseases are a specially all of their own – and often they aren’t much help.

No Kayaking for this Old Dog

I just got back from a trip to Turrialba, a town on the east edge of the central mesa, down which a number of rivers cascade on their way to the Caribbean. I wanted to learn kayaking and go on trips down some of them. Everybody was doing rafting, but I wanted to be different.

You know the saying “You can’t teach an old dog new tricks.” Painful as it is for me to admit, it is sometimes true. I grew up on the Mississippi River, and spent a lot of time there in our little rowboat. I considered myself a river rat. Beth and I had a Klepper folding kayak, and once did a trip down the Sacramento River. But white water rafting is something else – as I found out in a hurry.

These white water kayaks are little things, not much bigger than you are, and you don’t sit in them, you wear them. They are naturally unstable, this is what makes them so maneuverable, but this also means you can easily end up going down a river upside down.

I signed up for two hours of classes, but for logistical reasons they decided to through in a half-day raft trip too, for the same price: $75, all on the Pejibaye River. By the end of the day I was dead.

Rafting is a lot of FUN, I found that out, and that is why it is so popular. It doesn’t take much skill, only 10 minutes of safety instruction – and then you are getting soaking wet, and loving every minute of it.

Kayaking, by contrast is more expensive. Everyone has to have his own kayak. But six people can easily be accommodated on one raft. I spent $100 on a one day trip, including a hotel room for two days. This was relatively inexpensive, but far more than my budget can afford.

Bicycle Accident

Me and my bicycle almost disappeared down a drainage culvert today.

There is a one-way suspension bridge for vehicles just south of Orosi. This is a little tricky to navigate for an old-timer on a bicycle like me. A small bus was patiently waiting for me to cross on the other side, and that made me nervous. As I swung around the bus to the right, I didn’t notice a large hole disguised by weeds directly on the side of the road. This was the opening to a drainage culvert going under the road to the river.

Plop! Down we went, head first. The top of my head hit the the edge of the concrete and that stopped our fall. Two men jumped out of their cars and pulled both of us (me and my bike) out of the hole. They carefully walked me to the restaurant nearby, made me sit down, and got me a glass of water.

Fortunately, I was wearing a bicycle helmet, and only got a mild headache out of the episode – but it cut short the much longer ride I was planning today.