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.

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The Whitehall Study

From Born to Love, page 245:

The pioneering research on social status and health was done in the United Kingdom, examining civil servants whose rank in the government bureaucracy is easy to track. Because Great Britain has national health insurance , the connection between social status and health there cannot be due primarily to lack of access to health care among the lower-ranking bureaucrats – all are cover by the same system, though the wealthy can add private insurance if they so desire. In this study, those on the bottom were not truly poor, simply working or lower middle class.

The “Whitehall Study” – and a second study that included female civil servants as well as males called “Whitehall II” – found a massive “social gradient” in health. This wasn’t just one correlation: it was a clear slope downward stepwise to worse health from top to bottom. The first Whitehall study – so called because this is the name of the headquarters of the British Civil Service – included eighteen thousand men. It found that at ages forty to sixty-four, the lowest ranking men were four times more likely to die from any cause than those who had reached the top of the greasy pole. The gradient directly tracked a man’s rank in the bureaucracy, so those of the second rank did better than those of the third, and the top rank was best of all.

Other studies – for example, those looking at a country’s population as a whole – have typically found a gradient where those at the bottom have twice to three times the mortality risk of those at the top. Studies that include women (like Whitehall II) tend to find interesting differences in status-related risk, where a woman’s health risks are more correlated with the overall income level in her household that with her own job status.

Stress-Related Disorders

From page 162 of Born to Love:

A ground-breaking study of more than seventeen thousand Californians enrolled in the Kaiser Permanente health plan has shown that childhood trauma is a critically overlooked factor in the obesity epidemic – and in virtually every other major cause of death studied. The risks for heart disease, stroke, depression, diabetes, asthma, and even many cancers are all effected by trauma-related changes in the stress response system.

I have never seen this stated so plainly – but I don’t doubt it.

Costa Rica no doubt saved my life.