Addressing the Mental Health Crisis:  What Really Matters

James Schroeder, PhD
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Evidence increasingly suggests that psychological difficulties are on the rise.  The Global Disease Burden Study, published in August of 2013, declared that “mental and substance use disorders are the leading cause of nonfatal illness worldwide, with a global disease burden that trumps that of HIV/Aids, tuberculosis, diabetes, or transport illnesses.”  Depression is the number one cause of illness and disability in 10-19 year-olds worldwide.  Suicide is the number three cause of death. (Health for the World’s Adolescents World Health Organization. Online May 14, 2014).  “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% 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, M., “The Illusions of Psychiatry,” New York Review of Books, July 14, 2011).  “The CDC, on May 3, 2013, reported that the suicide rate among Americans ages 35-64 years increased 28.4% between 1999 and 2010 (from 13.7 suicides per 100,000 people in 1999 to 17.6 per 100,000 in 2010).” (Bruce Levine, “Why the Rise of Mental Illness? Pathologizing Normal, Adverse Drug Effects, and a Peculiar Rebellion,” Mad in America, July 31st 2013).  In 1987, there were less than 20,000 severely mentally disabled children — now there are almost 600,000.  The number of children under the age of six receiving SSI have tripled over the last ten years, to more than 65,000 (AEA, Robert Whitaker).

For some, these findings raise questions about whether statistics are inflated, or are actually the result of another factor besides rising psychological difficulties.  These topics are beyond the scope of this article.  But it is reasonable to assert that greater openness regarding psychological concerns, increased classification of mental disorders, widening of diagnostic categories, or any other artificial inflating explanation falls short of accounting for the tremendous growth of psychological struggles today.  Studies are increasingly finding that even accounting for all these factors, psychological complications just continue to grow.

For those who actually believe that psychological problems are on the rise, serious inquiries must ensue.  Many have rightly raised concerns about iatrogenic culprits, including drug-induced effects, but this too seems to fall short of accounting for the meteoric rise. Except for those forced to take psychiatric drugs, I would suggest that most seek out drugs in the hope of relieving iniquities caused by factors such as those I discuss below;  unfortunately, this may not only lead to avoiding addressing the real issues, but may even lead to further complications of the drugs.  Given this, I present five areas for further discussion, which I believe are causal agents for the mental health crisis.  I will only provide a brief overview of each for brevity and readability sake.

Sleep:  As I noted in a recent article (Schroeder, J., “There’s More to Sleep than Shuts the Eye: Waking Up to All That Sleep Does for Our Health & Wellbeing,” Mad in America, December 20, 2014), research increasingly indicates that sleep is tied to almost every health marker imaginable, especially psychological well-being.  In the United States, evidence suggests that we are sleeping 20% less than a hundred years ago.  There is a 25-40% prevalence of sleep difficulties in childhood and evidence indicates that sleep problems have increased over the past three decades (Mindell JA, Owens J. A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems. Philadelphia: Lippincott Williams & Wilkins, 2003). Demands and distractions for many adults have only heightened during all hours, and with the 24/7 nature of our current culture, sleep has largely been denigrated as a second class citizen.  Chronic sleep deprivation and poor sleep quality are increasingly the norm, not the exception, and so likely follows our mental health.

Physical Health:  In the United States, the prevalence of pediatric obesity has more than tripled during the past 4 decades.  If current trends hold out, the generation represented by children born since 2000 is estimated to have a 35% chance of developing diabetes and represents the first generation in the United States since the Civil War to have a life expectancy shorter than that of their parents.  Type 2 diabetes accounts for roughly 90-95% of all diabetes cases in the United States (LINK 2010 estimates – Am. Family Physicians, 81, 7 863-870).  9-10% (29 million) of all people in US has diabetes (CDC, 2014 National Diabetes Statistical Report).  One-third of adults today [worldwide] have high blood pressure, when in 1900 only 5 percent had high blood pressure. (Cohen, R., “Sugar Love,” National Geographic, August 2013).  Meanwhile, studies have consistently linked mental health to fitness, including in young kids. (Zametkin, A.J., Zoon, C.K., Klein, H.W., & Munson, S. “Psychiatric aspects of child and adolescent obesity: A review of the past 10 years.” Journal of the American Academy of Child & Adolescent Psychiatry, February 2004, 43(2), 134-150).  Early soda and junk food consumption alone are linked with anxiety, inattention, and aggression (e.g., Jacka et al., (2013) JAACAP and Suglia (2013) Journal of Pediatrics).  The best predictor of cognitive health over the age of fifty is physical health.  As the physical health of our nation, and much of our world declines, it is no surprise that mental health would abide by the same trends.

Media & Technology Immersion:  The average 8-18 year-old in 2009 spent more than7 hours, 30 minutes exposed to technology a day, but close to 30% of this time was engaged in multi-tasking (e.g., watching television while texting).  The total exposure is close to 10 hours, 45 minutes, which was almost 44% more than in 1999, and exposure has only continued to grow.  The average adolescent female sends and receives almost 3,200 texts a month (research cited on both pages available through Media Clearinghouse) Screen time is consistently associated with poor outcomes in physical health, academics, traffic safety, aggression, compliance, depressed mood, attention, and creative play in youth (AAP, 2011).  Increased evidence indicates that popular media is strongly associated with more promiscuous sex (Garcia et. al, (2012) review featured in Feb. Psychology Monitor).  Sexually-active adolescents are at a higher risk for suicide, depression, and drug/alcohol abuse (AAP, 2005).  Violent media has consistently been linked to increased aggressive acts, thoughts, feelings, arousal, and decreased prosocial behaviors, albeit with small to moderate effects (Anderson, C.A. and Bushman, B.J. “Effects of Violent Video Games on Aggressive Behavior, Aggressive Cognition, Aggressive Affect, Physiological Arousal, and Prosocial Behavior.” Psychological Science, September 2001, 12(5)).  Media and technology used strategically can be an asset.  Serious questions abound whether most are using it in this way, and with these concerns come logical threats to psychological well-being.

Family Discord & Instability:  Divorce rates skyrocketed from the mid 60’s to the 1980’s before leveling off. Divorce and parent’s relational satisfaction has been consistently shown as a predictor of childhood distress (Bogels, S.M., & Brechman-Toussaint, M.L. (2006); Hoyt, L.A., Cowen, E.L., Pedro-Carroll, J.L., & Alpert-Gillis, L.J. (1990).   At the same time, divorce rates began to level out, unmarried couple households began to rise dramatically into the present. Kids born to cohabiting parents versus married ones have over five times the risk of experiencing their parents’ separation (e.g., P. Smock, 2010). In 2000, 41 percent of all unmarried-couple households included a child under the age of 18. In 1987, it was 21%.   (U.S. Census Bureau, March 2000).  Studies find that kids living in cohabitating households are more likely to suffer from psychological difficulties, including drug use, depression, and dropping out of school, than those in married homes (e.g., Wilcox, “Why Marriage Matters,” [2011], p. 1). Residing in a cohabitating household puts a child at 8 times greater risk for harm than when living with married biological parents (HHS Office of Planning, Research and Evaluation, “Abuse, Neglect,  Adoption and Foster Care Research, National Incidence Study of Child Abuse and Neglect, NIS-4, 2004-2009” [March 2010]).

In a 2005 Pediatrics study of inflicted-injury deaths over eight years, children living with unrelated adults were nearly 50 times as likely to die of inflicted injuries than children residing with two biological parents. Youth in homes with a single parent and no other adults in residence had no increased risk of inflicted-injury death. (P.G. Schnizter, “Child deaths resulting from inflicted injuries: household risk factors and perpetrator characteristicsPediatrics, 2005; 116:687-93).  Instability, trauma, and safety concerns have long been huge risk factors for psychological complications across the lifespan, which ties in directly to changing social, familial trends.

Faith:  Church attendance has steadily dropped over the past decades, and many Americans are not actually where they report to be.  As noted in a New York Times article (Angier, N., “The Bush Years: Confessions of a Lonely Atheist,” New York Times, January 14, 2001), best estimates are that the percentage of adults who actually attended religious services during the previous weekend dropped from 42% in 1965 to 26% in 1994.  Plunging religious membership has led to massive church closures in Europe.  Although religion gone badly is fraught with many negative outcomes, faith, spirituality, and religion have long been a source of coping and resiliency for many people. Large-scale studies have generally indicated that faith and a strong relationship with a higher power is associated with less anxiety, greater social support, increased relational stability, less substance use, and fewer negative behaviors.  Greater religiousness was found to be associated with fewer symptoms of depression in a meta-analysis of nearly 100,000 participants.  However, it appears the best predictor of whether faith is associated with less anxiety and better adjustment is when people have a strong relationship with a higher power.  If faith-based practices are truly declining in many areas, and this has long been a source of coping with psychological challenges, then psychological well-being may very well follow suit.

As we move from layers of substance to layers of motivation, there is another discussion worth having that deserves a book in itself.  In fact, one has been written entitled Generation Me:  Why Today’s Young People are More Confident, Assertive, Entitled—and More Miserable Than Ever Before.   When Twenge and colleagues analyzed the largest MMPI sample to date, which found increases in almost every area of psychological struggles over the past eighty years, something particularly noteworthy emerged.  Most attempts to test correlations with many other demographic, generational, and/or psychological factors yielded no significant findings, with two exceptions.  One was the rate of divorce, which was strongly correlated with every major scale on the MMPI.

The second clear association was that of intrinsic versus extrinsic goals endorsed by young people over the past eighty years.  For decades, polls have consistently showed that adolescent and young adults of later generations increasingly cite extrinsic factors, such as the pursuit of power, status, money, and image, as the primary reasons for what they did.  This contrasted with earlier generations, who more often reported that they were called to particular interests or careers because of intrinsic motivators, such as public good, civic-mindedness, affiliation, and deeper meaning.  Although difficult to demonstrate a causal relationship between psychological difficulties and self-centered endeavors, it raises serious questions about whether the me-focused culture may have a lot to do with our psychological crisis.

It was written, “For the love of money is a root of all sorts of evil, and some by longing for it have wandered away from the faith and pierced themselves with many griefs” (1 Timothy: 10).  Almost two thousand years later, C.S. Lewis wrote, “The essential vice, the utmost evil, is pride.”  Collectively, it is hard to not wonder whether the combination of the two may be heating the melting pot of our psychological woes of today.

30 COMMENTS

  1. NIMH, psychiatry and Big Pharma would all have us believe that there is a “mental health crisis” in America, and throughout the world. Why? Because that is what sustains the whole enterprise. Mental health is just as much a myth as mental illness, but it is a powerful myth that sucks ludicrous amounts of money from innocent, suffering people. Sleep, physical health, media and technology use, family relationships and faith are all crucial elements in the overall well-being of individuals, but anyone who falls into the clutches of psychiatry and psychotropic drugging will have all of those things and more stripped away from him. If anything, the self-fulfilling prophecy of psychiatry is growing larger because those who should oppose it remain silent, and those who would oppose it are silenced.

    There is no doubt that selfishness, pride, and the love of money are at the root of all evil, and that such evil causes waves of suffering to crash through society. There is no doubt that people should take better care of their health and their families. But the propaganda of a “mental health crisis” serves the purposes of those who are most invested in the selfishness, pride and love of money that threatens to destroy the world, namely proponents of psychiatry, Big Pharma and the therapeutic state.

    C.S. Lewis wrote clearly on this topic as well: “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.”

  2. I do agree with you. The “crisis” is one that is largely fabricated for primarily economic gains. The removal of the mental health industry would devastate the economy of the US as it holds a substantial portion of the gross domestic products.

    I love your quote: “If anything, the self-fulfilling prophecy of psychiatry is growing larger because those who should oppose it remain silent, and those who would oppose it are silenced.” This in itself is the sad history of psychiatry and remains to be.

  3. The only mental health crisis in this country is the mental health industry. It’s ALL about so called mental illness. You put more money into the mental health system, and you are going to get more mental patients. That’s the way it works.

    At this time it’s gotten even more ridiculous. All this mental health industry propaganda talks about people who need treatment, but who aren’t receiving that treatment. Nobody is talking about who determines that “need”. I never wanted any mental health treatment, but that didn’t prevent the mental health authorities from “treating” me. I still say I never needed mental health treatment and, in fact, that treatment I received was actually mistreatment. If people could refuse mental health treatment, there would be a lot fewer mental patients. If mental health treatment weren’t a matter of torturing or brain washing people into confessing (“admitting”?) a “sickness”, there would be a lot fewer mental patients. We’ve got so many mental patients because money is going into having so many mental patients. Turn off the spending stream, and you will find much fewer mental patients.

    If you look at the problem historically the numbers have done little since early on but rise. Manufacturing a crisis in mental health adds fuel to the mental health industry and, thus, it means a mental patient manufacturing boom, but “cure”. Like I was saying, “mental health” is all about “mental illness”. We have a large mental patient population because we’re paying for it. Stop paying for it, and that population is bound to shrink.

    I feel like Ronald Reagan taught me a lesson when it came to the big institutions. The problem then becomes the community mental health system, you know, that thing that voted in around the time of the Kennedy administration.In other words, who needs a big prison out in the sticks when you can have many mini-prisons close to home. Stop funding the prisons, psychiatric prisons, altogether, and then maybe we’d be getting somewhere with, what did you call them, “psychological difficulties”?

    • I find a different thing interesting: they do talk about people who need treatment but they rarely if ever talk about the people who have received it. Maybe it’s because this side of the story is a little bit less favourable to them?

      • When you are not thinking, I think it helps to be indiscriminate. You see the people who are talking about this need people have for treatment are usually not the people who would be undergoing treatment themselves. This being the case, need is equated with receiving. If they must impose that treatment on another person, in their minds, it must be because the other person “needed” it. I don’t think, given such fuzzy reasoning, it matters much that this figure ends up, in that it is always an estimation, being an abstraction. Don’t get me wrong, given some fancy editing, there are success stories. I’m not even sure the success stories are that important really. It’s the failure stories that we should be paying more attention to that we tend to brush over. Where would these people be who had received treatment if they could refuse treatment? Probably not stuck in some kind of lop sided relationship of dependency on power, and that sounds like a better place if you ask me.

      • Very true. The point I was trying to make above is that I don’t think people receive treatment so much because it is thought that they are in ill health as it is because it is thought that somehow their irregular behaviors could become a threat to public safety. In other words, it is policing that gets people receiving treatment. A sort of policing that perhaps we’d be better off scraping altogether.

  4. Hi,

    I like your article, but take exception to some of your comments about declines in faith based organizations as one cause of the increase in mental health difficulties….I think it’s important to separate the benefits of connection and community from the problems of organized religion and many of the harms it can cause. I have always felt alienated from the idea that a group of people must all share the same religious beliefs, the same beliefs as their parents and their religious community…this feels oppressive and leaves little or no room for free thought. In addition, religious dogma often leads to conflicted and guilt ridden people who struggle to accept aspects of themselves forbidden by their religion’s “God.” Most religions are very judgmental and separate the good from the bad, the holy from the sinners. This type of thinking prevents the type of honest, reflective soul searching that humanity needs to understand our impulses for love, for hate, for peace or for war…Writing someone off as ‘evil’ or a ‘terrorist’ asks little of us and sets us up for continuing cycles of pain as a world community.

    However, the benefits of feeling connected to a community and something beyond oneself is powerful and the part of organized religion that may explain the positives you refer to as associated with religious communities…I think it is very important to distinguish between the oppressive and “us vs them” elements of religion and the benefits of community and connection to the mystery and wonder of our existence.

    Signed,

    A spiritual person and “non-believer”

  5. Thank you once again for taking the time to write back. I appreciate your well written and kind response. I read the article that you attached as well.

    For me, I cannot accept any doctrine that denies women access to birth control and formal power equal to men. I also cannot accept gay people being denied equal rights…(regarding the spread of HIV/AIDS mentioned in the article as associated with gay behavior, I would note that lesbians actually have the lowest rate of HIV/AIDS of any group of sexually active adults). Just because something has been practiced one way for a long time does not provide reason enough to continue the practice if it hurts people. For me, secular humanism is a good fit.

    Best Wishes to you and your family. I too deeply value our community and opportunity to dialogue at MIA.

    Thanks again

  6. Truth in Psychiatry and James

    First off I want to thank Truth in Psychiatry for raising the important challenges to James regarding the major forms of discriminations against women and gay people that reside within Catholic doctrine and practice.

    James, while it is true that these are important conversations to have in a civil manner here at MIA it does not eliminate the fact that the doctrines that you have defended here literally affect millions of people in this world. And there are powerful arguments (and I believe facts to them back up) that these doctrines and practices harm millions of people.

    I have read almost all of your blogs and have respected and learned from those viewpoints on several subjects. This blog on “Addressing the Mental Health Crisis: What Really Matters” I believes misses the mark and promote a somewhat covert and wrong political agenda.

    Your blog misses the most essential factor that matters in all of these issues confronting us in the movement against psychiatric abuse – POVERTY and the profit system that creates and sustains these forms of inequalities. It is that system and the traumas it produces on a daily basis that creates the level of stress and psychological harm to push people over the critical edge of human tolerance. To not address this issue lets the system off the hook and directs people towards secondary issues.

    As to the secondary issues, your position on sleep and physical health are clearly very important. However, your statistics about faith and the family are promoting a clear agenda that what the world needs now is more religion and traditional family values. Should we be waiting for the hereafter, as the slaves were preached to, to seek true liberation and freedom.

    You cannot escape the fact that the traditional family and the institution of marriage has not been very kind (an understatement) to half of the human race over many centuries. To promote an implied agenda that cohabitation and divorce is bad simply ignores how these particular values oppress millions of women who are often culturally forced to stay in very unequal and outright abusive marriages. The freedom to divorce (without legal, economic, psychological, religious or cultural restraints) allows people the freedom to actually love at a higher level if they choose to continue. Women who remain in abusive marriages are oppressed and the children who both witness this abuse and most often are themselves the victims of patriarchy abuse will suffer in the long term. What does living within these abusive marriages teach children about love and how people should treat other human beings, especially women.

    On the issue of contraception, it is also easy for you given your education and economic status to promote the agenda opposed to contraception, and promote the joys of having 6 children. Your children are blessed to have such devoted, economically stable, and competent parents. BUT to deny half of humanity the right to have complete control over contraception, reproduction, and their bodies, is to end up supporting laws and policies that harm millions of women. One pregnancy at the wrong time and place in a woman’s life could end up subjecting that woman to years, or even a life time of economic and psychological degradation.

    In under developed countries the position of powerful churches and religions (negatively influencing government leaders) has denied funding for birth control where there ware very high levels of HIV/AIDS. It is a fact that this exposed millions of women and men to a life threatening disease. How many people have died as a result of this?

    One cannot pretend to be in favor of equality for women, or support feminism, and deny half of humanity the right to control their reproductive rights.

    Their is moral inconsistency in the moral high ground you claim to stake out at MIA. When it comes to the issues confronting women and gay people in this world you have resorted to the highest level of verbal and psychological gymnastics to defend those positions. These are not just intellectual debates, your position on these issues (and how your words might potentially influence people) affect the daily lives millions in the world.

    Gay people suffer enormous harm from those institutions that seek to deny them the right to experience sexual love and marriage with those of the same sex. Their is simply no way that you can defend this discrimination without resorting to quotations from the Bible. Does that mean you will defend a literal interpretation of scripture which also says that defiant children should be killed and adulterous women should be stoned.

    As you know there are many churches and religions that now (in the past they did not) fully accept gay people, divorce, contraception. and the full equality of women in society.

    I am currently away but I could not rest without responding on these crucial questions.

    Richard

    • Thank you for your thoughtful comments. I have also known many people who have felt harmed by religious dogma and its impact on cultures and legal systems. As a non-religious, but spiritual and kind (I try anyway) person, I have felt unfairly judged by people who claim that they are following God’s laws when I am just operating on the human level. I find it very difficult to have a rational discussion that keeps us all on the same playing field. This is why I feel we need to keep a separation between religion and a secular state (Church and State). I know that we are all sincere people here, but we are speaking from different paradigms. I feel as spiritual as the next person but I do not claim to know what God would believe, because I do not see things in this way…my hope is that we create a safe space to disagree, but laws that protect everyone’s civil rights and equality…and that brings us back to MIA and our shared quest for human rights and dignity for all..

      Wishing us a peaceful meeting place,
      Thanks again for the discussion.

  7. Me-focused culture or, more broadly, modern culture? The theory that explains the “causal relationship between psychological difficulties and self-centered endeavors” is proposed in Liah Greenfeld’s Mind, Modernity, Madness: the Impact of Culture on Human Experience. From the description of the book: Citizens of the twenty-first century enjoy unprecedented freedom to become the authors of their personal destinies. Empowering as this is, it also places them under enormous psychic strain. They must constantly appraise their identities, manage their desires, and calibrate their place within society. For vulnerable individuals, this pressure is too much. Training her analytic eye on extensive case histories in manic depression and schizophrenia, Greenfeld contends that these illnesses are dysfunctions of selfhood caused by society’s overburdening demands for self-realization. In her rigorous diagnosis, madness is a culturally constituted malady.