A recent article published in the International Review of Psychiatry explores the “concepts, practices, and discourses” around mental health that have emerged since the mid-20th century, following from French philosopher Michel Foucault’s work. The authors, philosopher Derek Bolton and social psychiatrist Dinesh Bhugra, argue that there has been a shift in the relationship between “us” and them” – or the “sane” versus the “insane.” They also discuss possible causal factors related to the continuing rise of mental health problems in western countries, such as distress around climate change and income inequality.
“Our aim in this paper is to consider some of the profound socio-cultural changes around mental health from the mid-twentieth century, implications for the cultural imaginary of merging the places of what used to be called ‘madness,’ on the one hand, and ‘our mentally normal life’ on the other,” Bolton and Bhugra write.
As rates of suicide and “mental health problems” rise in western democracies and as new social and mental health-related “epidemics” are announced seemingly every year, researchers are scrambling to discover the causes.
The current article picks up where the French philosopher Michel Foucault left off in the mid-20th century, in his critical historical analysis of how western societies understand, section off, and treat those deemed “mentally ill.” The authors trace social shifts in understanding who is considered “mad” or changes in the “representations of mental health problems.” They also discuss some of the likely causal factors affecting younger generations regarding rising rates of mental distress.
Pointing to the difficulties of measuring something like increasing rates of “mental illness,” the authors suggest that it can be tricky to distinguish between increased reporting (or diagnosis) and “real rises in disorder rates.”
This is especially the case since the mid-20th century because of what is sometimes referred to as diagnostic creep. Historically, the “mentally insane” were sectioned off as a small and potentially dangerous minority. In contemporary times, mental health problems are often considered to be common—affecting many of “us,” rather than only “them.”
The increasing rates get more complicated when factoring in increased help-seeking, better “self- or services detection,” and “better access to service provision.”
The authors believe it is likely that both changes in the culture around mental health and “real disorders” are to blame. Representations of mental health and mental health services have expanded, leading to debates around stigmatizing terminology and how we should conceive of “mental illness.” On top of that, they discuss several sociopolitical and economic factors that may explain increased rates of anxiety, depression, and other conditions.
They include potentially distressing external factors, including breakdowns in social cohesion due to cultural conflict (such as between conservatism and liberalism), increasing intergenerational wealth inequalities, and anxiety over climate change. The authors believe that these factors may be especially distressing for young people, such as those belonging to Generation Z.
The authors state that although cultural conflict is certainly nothing new, it is likely more “in-your-public-face” because of social media and the increasing “public profile of populism.”
“We intend to do no more than raise the question: what is it like to grow up in such a world, as a child or young teenager, and what is it like in such a world, for older adolescents and young adults, to try to imagine and work towards your future goals.
Hypotheses worth considering are that they may struggle with the questions: Who and what are they to believe? How are they to know what is going to happen and how to plan their future, ends, and means accordingly? To the extent that there are disagreements over fundamental matters between vocal and active groups, both influencing events, both ‘sides’ are likely to find what is going on hard to understand, unpredictable and therefore stressful.”
They also discuss the evidence for a relationship between economic insecurity, wealth inequality, and anxiety. The 2008 economic crash, for example, has been linked to poorer health. Downward economic trends can negatively impact young peoples’ expectations for future stability and motivation related to career and life planning.
Young people are less likely to own property than their parents or have stable housing, less likely to have well-paid work, and are more likely to have insecure work positions such as zero-hour-contracts. Parents can add to these anxieties by stressing over their children’s academic and professional success.
Additionally, stress around climate change is shown to be a major concern for members of Generation Z (age 18-25). Climate change was the most cited global issue in a poll of 11,000 members of Gen Z across 22 countries, at 41%, while pollution was the second most cited global issue, at 36%.
The authors conclude:
“Since the mid-twentieth century, practically and symbolically marked by the closing of the asylums, concepts, discourse, and practices around mental health have been adjusting to ‘mental health problems’ becoming in and among ‘us.’ This has involved uncertainty and controversy in terminology, prevalence, case definition, and distribution of expertise.
[…] In addition, over recent decades, there have been increasingly evident fractures in social solidarity, interacting with and exacerbating specific socio-political-economic-environmental stressors on younger generations, including increasing intergenerational wealth inequalities, and accelerating worries about climate change.”
Bolton, D., & Bhugra, D. (April 29, 2020). Changes in society and young people’s mental health. International Review of Psychiatry, 1-8. (Link)