In December 1999, David Satcher, MD, then Surgeon General of the United States, reported that almost one fifth of the American population will experience a mental disorder in any given year, and that fully half of the population will have such a disorder at some time in their lives. [Mental Health: A Report of the Surgeon General.]
Most Americans have understandably become somewhat skeptical with regards to government press releases and statistics, and it is unlikely that the report received total acceptance by the general population. On the other hand, the report received no major challenge. Indeed, it was endorsed wholeheartedly by several leading healthcare organizations and lobbying groups. The American Academy of Family Physicians, for instance, described mental illness as “one of the most pressing concerns we are facing” and made it their annual clinical focus for the year 2000. The National Institute of Mental Health estimates that 22% of American adults have a diagnosable mental disorder in any given year, and that four of the ten leading causes of disability in the US are mental disorders.
When repeated often enough, claims of this sort become accepted as facts, particularly when they are undisputed. Although the man in the street might not be able to cite the official government figures, there has been an increasing acceptance in our society that mental disorders are on the rise, and are much more prevalent than was once thought to be the case.
The intriguing question, however, is where are all these mentally disordered people. At any given time they supposedly constitute one in five of the population. There should be one or two of them in an average line at the store or the Post Office; two or three on the school football team; twenty or thirty in a small church congregation; and literally thousands at a large concert or sporting event. Every organization and work place in the country should be staffed by large numbers of mentally disordered people, and if we are to believe the government statistics, these disorders will infect fully half of our population at some time in our lives. This amounts to more than one person per household!
In the face of claims of this sort, the astonishing fact is that life seems so normal. People get up in the morning, eat breakfast, ride busses, go to work, go out on dates, etc., and for the most part our communities and societies continue to function in a reasonably collaborative and harmonious fashion. The reportedly vast numbers of mentally disordered individuals are not instantly conspicuous or disruptive, and the question arises as to how people carrying such stigmatizing and potentially unmanageable diagnoses can remain so anonymous and concealed.
To older people in particular, the matter is all the more puzzling. In 1950 if you had asked an intelligent, socially active adult to identify the “mentally disordered” individuals in his town or community, he would probably have been able to name a few individuals who were considered “crazy” or “out of their minds.” These would have been very few in number, however, and by no stretch of the imagination would ever have reached the proportions claimed in the government statistics cited above for the present day. In fact, an attempt to persuade our 1950 citizen that half of the population would develop a mental disorder in their lives would probably have generated within the listener a firm conviction that the speaker himself was crazy.
So what has happened? How has our open, democratic society deteriorated to the point where mental disorders are among the most prevalent conditions, almost as common as coughs and colds? Have we as individuals been making terrible mistakes in our daily lives, or has our leadership let us down in areas of social policy and community direction? Why is it that in a fifty-year period, during which enormous strides have been made in physical medicine, general technology, and civil rights, our mental health has declined to such appalling standards? And why has this decline gone largely unnoticed and unrecognized by the man in the street?
The answers to these questions are astonishingly simple. The increase in mental disorders implicit in the government statistics is fictitious. No deterioration of this magnitude in the nation’s mental health has occurred. All that has happened between 1950 and the present time is that a wide range of human problems that formerly had been considered normal challenges of the human condition, have been relabeled as mental disorders. This relabeling process has been subtle, progressive, insidious, and persistent. It has received “official” approval from governmental and other agencies at national, state, and local level, and is beginning to be accepted by the general public.
In 1950, for instance, a child who was routinely disobedient to his parents was considered to be simply a misbehaved child, – a brat – and by and large the problem was attributed to lax or indifferent discipline on the part of the parents. Remedial action was conceptualized as a need for the parents to regain an appropriate level of control and to train their child in socially accepted ways using the normal time-honored methods of dialogue, reward, punishment, etc.. Today a misbehaved child is routinely diagnosed by psychiatrists and other mental health professionals as having a mental disorder called oppositional defiance, and this putative mental disorder is presented as the underlying cause of the problem behavior. Remedial action is conceptualized in terms of intervention by paid professionals, and in particular the administration of psychotropic prescription drugs.
This extraordinary shift in conceptual framework is not confined to childhood problems. Virtually every problem that confronts individuals and families has been relabeled in this way. Fears and depressions, bad habits, poor coping skills, painful memories, and just plain old-fashioned irresponsibility have all been painstakingly and systematically relabeled as mental disorders, and the new philosophy is being promoted actively by government and by an increasingly wide range of establishment-affiliated groups and organizations. As a society, not only are we being encouraged to accept the new ideas, but to “seek help” for these alleged disorders. The Surgeon General’s report cited earlier laments the fact that most people with mental disorders “do not seek treatment” and actively encourages them to do so.
The issues at stake here are very fundamental, and it is important to ask how such a profound paradigm shift can have occurred in just the comparatively short space of two generations. Who, it needs to be asked, has managed to orchestrate this extraordinary shift in focus? Who are these people that have persuaded us that most of the normal challenges of life with which our ancestors coped adequately for thousands of years, are, in fact, mental disorders requiring professional help and drugs?
This question will be addressed in the next post.