How American Psychiatry Misled the World and Ruined Mental Health Worldwide
For a half century, at least, American psychiatry and its fellow travelers have been cheerleading a descent into madness.
We stand on the threshold of advances in the biological sciences so relevant to psychopathology that one can look forward in the decades ahead to an ultimate resolution of the major psychotic disorders that have plagued mankind for centuries.
—Norman Garmezy, American Psychological Association Master Lecture Series, 1975 (cited in Peele, 1981, “Reductionism in the Psychology of the Eighties”).
I proposed, alternatively:
Yet not only has biochemical and neurological research not explained basic aspects of human behavior and mental disorder—it has fundamental problems in attempting such explanations. A psychology that accepts and accounts for subjective human experience in a cultural setting is presented as a counterpoise to the reductionist thrust.
The Current Crisis
The World Health Organization mental health newsletter for June, 2022 has some bad news about our mental health:
As we enter the third year of the pandemic and live with its far-reaching effects we must accelerate our efforts to address the significant impact that COVID-19 has had on people’s mental health. A WHO scientific brief indicated that rates of already-common conditions like depression and anxiety went up by more than 25% in the first year of the pandemic, adding to the nearly one billion people who were already living with a mental disorder.
In addition to the pandemic, the war in Ukraine and protracted conflicts in Afghanistan, Ethiopia and Syria have increased the need for mental health services and psychosocial support in these regions. WHO estimates that one in five people living in settings affected by conflict in the preceding ten years will have depression, anxiety, PTSD, bipolar disorder or schizophrenia.— Dévora Kestel, Director, Department of Mental Health and Substance Use
But, not to fear, Kestel continues:
I’m also very pleased to share that we will shortly release the WHO ‘World Mental Health Report’ that argues for a worldwide transformation towards better mental health for all. Drawing on the latest evidence available, showcasing examples of good practice from around the world, and voicing people’s lived experience, this comprehensive report highlights why and where change is most needed and how it can best be achieved. The report launch event scheduled for June 17th, at 12. (The incorrect sentence structure is in the WHO newsletter.)
How America Bet on the Wrong Horse
And why do we need this sudden announcement of new best practices? Because of the complete, utter, abject failure of a half century of biological psychiatry, led by the US.
The US is at the bottom of the heap among 196 nations measured by WHO in drug and mental health death and disability. In its Global Burden of Disease study, the US loses second most life years due to disability and death (DALYs) from drugs:
The US lost 1,703 DALYs per 100K population from all forms of drug use, the second-highest rate of drug-use disease burden in the world. The US rate compares with 340.5 DALYs per 100K in Europe, one-fifth of the US rate.
Among all 196 countries, the US ranks 2nd overall in DALYs lost to all drug use disorders; 1st in DALYs from cocaine use; 3rd in DALYs from opioid addiction; and 2nd in DALYs from amphetamine use.
As for mental health:
These very heavy burdens of substance disorders are matched by the high US rankings on other mental disorders. The US ranks 5th in the world in DALYs from anxiety disorders and 11th in the world from depressive disorders. Across all mental disorders, the US ranks 4th in the world.
American mental health has been declining since 1990 (which former National Institute of Mental Health director Thomas Insel labeled an “inconvenient truth”).
The most discouraging assessment came in 2013 from an in-depth analysis by the U.S. Burden of Disease Collaborators. Hundreds of investigators gathered data on 291 diseases and injuries between 1990 and 2010. Combining premature death and disability to calculate the burden of each disease, they found that the toll of mental disorders had grown in the past two decades, even as other serious conditions became more manageable. (emphasis added)
And this drop off occurred during years when “life-changing medications were regularly brought to market.”
The NY Times reflects on the current mental health crisis in America for young people: “’It’s Life or Death’: The Mental Health Crisis Among U.S. Teens. Depression, self-harm and suicide are rising among American adolescents.”
American adolescence is undergoing a drastic change. Three decades ago, the gravest public health threats to teenagers in the United States came from binge drinking, drunken driving, teenage pregnancy and smoking. These have since fallen sharply, replaced by a new public health concern: soaring rates of mental health disorders.
In 2019, 13 percent of adolescents reported having a major depressive episode, a 60 percent increase from 2007. Emergency room visits by children and adolescents in that period also rose sharply for anxiety, mood disorders and self-harm. And for people ages 10 to 24, suicide rates, stable from 2000 to 2007, leaped nearly 60 percent by 2018, according to the Centers for Disease Control and Prevention.
Emergency room visits for self-harm by children and adolescents rose sharply over the last decade, particularly for young women.
In case you haven’t gotten the idea, here is the Surgeon General (Vivek Murthy) weighing in: “Surgeon General Warns of Youth Mental Health Crisis. The coronavirus pandemic intensified a rise in adolescent depression, anxiety and mental health distress that was underway before the spring of 2020.” (emphasis added)
The Failure of Reductive Psychiatry
That the world of mental health and psychiatry is in a tailspin as indicated by a spate of current books. These are led by Thomas Insel’s own confessional professional memoir. Insel, who headed the National Institute of Mental Health from 2002 to 2015, was biological psychiatry’s biggest booster.
He has changed his mind, to wit, “The ‘Nation’s Psychiatrist’ Takes Stock, With Frustration. In a new book, Thomas Insel, who led research into psychiatric disease for 13 years, says that advances in neuroscience have yet to benefit patients.”
His book “calls out a paradox”:
The United States, a country that leads the world in spending on medical research, also stands out for its dismal outcomes in people with mental illnesses. Indeed, over the last three decades, even as the government invested billions of dollars in better understanding the brain, by some measures, those outcomes have deteriorated.
Others, like Andrew Scull, have noticed. In his “Desperate Remedies: Psychiatry’s Turbulent Quest to Cure Mental Illness,”
Scull is especially critical of the last 20 years when research narrowed its focus onto possible biological factors for mental illness. The lack of concern with the social and psychological dimensions of mental disturbance, he argues, has precipitated inequities in treatment and led to the consignment of the mentally ill to the streets and jails of this country.
Then there is Daniel Bergner’s “The Mind and the Moon,” based on the decades of failures of psychiatry to help his brother. Reviewing Bergner’s book (“The Limits of Biological Psychiatry”), Christine Kenneally describes how she learned that mental illness was due to a brain imbalance:
I still recall when an undergraduate friend confidently told me that her recent bout with depression had resulted from a chemical imbalance in her brain. I was dazzled by the explanation. It made her sadness cleaner, more easily resolved, less unglamorous.
It turns out that we had both signed on to the “chemical imbalance theory,” which proposed, in the 1960s, that depression could result from a deficiency of neurotransmitters. This ultimately evolved into the idea that too many or too few neurochemicals could cause different kinds of mental illness, such as psychosis. Biology became ascendant in our understanding of psychiatric conditions, which led to a vision of medicalized mental health that one of Bergner’s scientists calls “a house of cards.”
In fact, the US is such an outlier in its dedication to this view, and its simultaneously sacrificing common sense social awareness (let alone humanity), that it is the negative case study worldwide cited in JAMA Psychiatry. Our utter failure is embodied by our epidemic of “deaths of despair”:
The US National Academy of Sciences reports rising mortality for US adults, most steeply for White adults with a secondary education or less. The rise is largely attributable to deaths of despair (suicide and poisoning by alcohol and drugs) with strong contributions from the cardiovascular effects of rising obesity. . . . The US National Academy of Sciences report notes that mortality is decreasing in a control group of 16 wealthy nations (including countries in Western Europe, Canada, Australia, and Japan), but it does not ask what protects those nations from despair. . . .The 16 wealthy nations provide communal assistance at every stage, thus facilitating diverse paths forward and protecting individuals and families from despair. The US could solve its health crisis by adopting the best practices of the 16-nation control group.
Which is the opposite of biological psychiatry.
And which the US does not know how to do.
Instead, we are still convincing the rest of the world that they are suffering from diseases we have created and for which we have medical remedies, as Ethan Watters describes in “Crazy Like Us: The Globalization of the American Psyche.”
Too bad about the deaths, disability and despair!