How Modern Society Has
Failed Mental Health: An Assessment of Mental Health
through History
Written 2020
Understanding mental illness has become of increasing importance to
modern society. In modern societies, we are far less likely to experience
adversary through war and famine than any other time, however the effects of mental
health issues have been shown to be taking an increasing toll on our lives. The
Mental Commission Canada estimates a 31% increase in Canadians living with
mental health issues in concordance with a population increase of 26% in 2040
(Mental Health Commission of Canada, 2016). It may be easy to say that this
issue is largely due to changes in the diagnosis of mental illnesses with new
disorders being proposed every year and the increasing amount of diagnoses,
however, the increase in the prevalence of mental health also has a crippling
more concrete effect as shown the increase in suicide rates (Weir, Kristen,
2019) and work truancy for mental health issues (WHO, 2000). Oddly enough, even
with increased access to healthcare and a better perceived quality of life, the
statistics indicate that mental health and substance abuse disorders seem more
prevalent in developed countries (Demyttenaere et al., 2004). Suicide rates are
also 133% more likely in developing countries (World Health Organization,
2014). Even with increased spending for healthcare, mental health disorders are
still on the rise. It appears that our current approach towards mental health
may be faulty and severely blind sighted. To properly assess mental illness, we
must not just look at the present to predict the future, but rather understand
the past through a historical analysis of various thinkers and movements, as to
why our societies, most notably first world metropolises have facilitated a
deterioration in mental health.
The issues regarding mental health are incredibly broad and convoluted.
In this paper I will attempt to touch on three of many issues that society
poses in the promotion of positive strides in mental health. Firstly, being the
issue of over diagnosis and how our testing methods have facilitated a crisis
in mental health assessment. Secondly how many of our societal perceptions of
mental illness have undergone a dramatic shift while still stigmatizing
individuals. And finally, how our evolutionary needs have gone unsatisfied in
modern industrial societies.
Over Diagnosis
It is no secret that our modern techniques result in a greater
diagnostic range for mental health disorders. Due to innovations in technology,
there has also been an increase in the usage of computers for psychological
testing and assessments (Butcher, Perry & Hahn, 2004) and we can only
expect these methods to increase. Though it may seem a positive to have more
widespread assessments of mental health, the way we assess mental health is
still largely flawed and has led to issues of overdiagnosis.
Allen Frances, a leading
psychologist in advocacy for better diagnostic procedures notes the problem of
overdiagnosis. In his 2013 paper The New
Crisis of Confidence in Psychiatric
Diagnosis he explains how changes of the DSM have led to “unpredictable
overdiagnosis” due to constant changes and additions of diagnostic criteria.
For example, the DSM IV, included a disorder called the somatic symptom
disorder, which is defined as “any mental disorder that manifests as physical symptoms that
suggest illness or injury, but
cannot be explained fully by a general medical condition or by the direct
effect of a substance, and are not attributable to another mental disorder”
(American Psychiatric Association, 2000, p. 485). Frances and many other mental
health practitioners fear that this diagnosis should not relate to mental
illness and
“risks
mislabeling a sizeable proportion of the population as mentally ill”.
Occurrences like these highlight the issue of subjectivity. On subjectivity, a
1971 study found that American and English psychiatrists differed broadly in
their conceptualizations of schizophrenia. After being shown an identical videotaped
interview American psychiatrists diagnosed more patients seen in the videotapes
as schizophrenic than their British counterparts (Kendell, 1971). The issue of
subjectivity remains today, and it is not just influenced by the assessor but
also continuous changes in diagnostic procedures.
A profound issue that has arisen through the industrialization of mental
health lies in the conflict of interest between the pharmaceutical industry and
its patients. Largely an aspect of the scrutiny is in its relation to the over
prescription of drugs. The pharmacological revolution of the 1950s saw an
increase in prescription drugs which subsequently resulted in an increasing
trend of deinstitutionalization. Though the advances in pharmacological
treatments have greatly benefited many people suffering with mental disorders,
it also results in a conflict of interest. One of the pioneers of understanding
ADHD and the development of ritalin, Keith Conners, later became critical of
pharmaceutical industry. He echoes a belief held by many mental health
practitioners, that the over prescription of drugs is largely due to weak
regulations which allow for “ruthless advertising by Big Pharma” (Francis,
2016). This belief is not unique to ADHD with disorders such as bipolar among
others also believed to be over diagnosed (Day, 2008). This conflict of
interest has also led to prevalent academic ghost writing, a practice in which
pharmaceutical companies fund and promote their interests through academic
journals written to favor them (Healy, 2003). This issue of overdiagnoses may
be more easily permissible if it did not appear to have repercussions, however,
that is not the case. With the increase in diagnoses, rates of drug
prescriptions have risen (Preidt, 2017) which in turn has been found to be
associated with elevated rates of drug dependency and abuse (Mccabe et al.,
2007). Though to many the value of these drugs is immense, the conflict of
interest between the pharmaceutical industry and its patients may have
ironically hindered the promotion of mental health through over prescription.
Many proponents to the anti-psychiatry movement have also noted that the
psychological ramifications surrounding a mental health diagnosis can be
detrimental (Spitzer, Lilienfeld & Miller, 2005). Paula Chapan, a figure in
this movement reiterates the argument that they are unscientific but also
believes them to impede on positive therapeutic change as labelling can lead to
a self-defeating prophecy (Chaplan, 1995). This is largely because of the
stigma of mental illness, which will be discussed in the subsequent section.
Stigma and
societal perceptions of mental illness
The stigma behind a mental health diagnosis has become a sensitive issue
in modern society. This is because a mental health diagnosis seems to label
patients as abnormal or ill fit to society. However, to better understand the
true problems that stigma poses to mental health we need to assess not only the
psychological impacts on a patient but also how changes in perceptions of
mental illness have created structures that impede on positive strides to
mental health and subtly promote stigma.
How
societal structures have affected mental illness can be examined historically.
To best understand the effects of societal structures and their effects we must
look to the philosophical movement of Structuralism. Structuralism (Not to be
confused with Structuralist Psychology) as defined by philosopher Simon
Blackburn is “the belief that phenomena of human life are not intelligible
except through their interrelations. These relations constitute a structure,
and behind local variations in the surface phenomena there are constant laws of
abstract structure” (Blackburn, 2008, p. 353). To many structuralist thinkers,
institutions and systems are used as a means of control. An example of this
hypothesis can be seen in the deinstutionalization of psychiatric asylums
during the 1960s. This movement was largely successful, however failed to
properly integrate the “mentally ill” into society. This is for many reasons,
many who needed their prescriptions may have remitted or not been able to
access therapy or lacked the social services or connections to properly
integrate. This failure to integrate led to a large transfer of mental illness
into the prison system where the issue of mental illness was swept under the
rug (Harcourt, 2007). Many proponents to the anti-psychiatry movement have
noted this occurrence and see it as proof that societal structures themselves
are put in place to control and ultimately impede the proper integration of the
“mentally ill” into society (Antonucci, 1986). It is important to note that
this transportation of mental illness to various institutions has continuously
occurred throughout history and with an examination of its earlier occurrences
we can truly see the issue that it poses to mental health.
In Madness and Civilization structuralist
philosopher Michel Foucault explains how in the medieval times the “mad” were
relatively free in the community and thought to have a unique form of wisdom
while the lepers were subjugated away and treated with moral condemnation. When
writing about the Renaissance, Foucault notes that “the beast is set free; it
escapes the world of legend and moral illustration to acquire a fantastic
nature of its own” the beast being the incarnation of the madness in humans.
However, as society became more industrialized and leprosy declined, Foucault
explains that leprosy was replaced by mental illness during what he terms “The
Great Confinement”. During this period many were confined to asylums which “had
nothing to do with any medical concept” but were rather “an instance of order,
of the monarchical and bourgeois”, these asylums were largely composed of
criminals, vagrants and political dissidents among the “mad” and many were put
to labour. This led to the ill definition of mental illness as all those in
asylums were deemed “mad” as well as the transfer of the stigma and societal
moral judgements which the lepers once had onto the “mad”.
As the Enlightenment era began, the occurrence of doctors to treat
“madness” began. Many changes in the Enlightenment era were positive as a shift
toward a more humane psychological approach eventually become more commonplace.
This movement spearheaded by psychiatrists such as Phillipe Pinel sought not
only to permit more freedoms to patients but also to understand them better
(Weiner, 2010). This movement allowed for psychiatry to become a distinguished
practice but also allowed for an emphasis of patient rights, a movement which
has never ceased. However, this movement Foucault argues in Birth of the Clinic allowed for a new
hindrance towards mental health which Foucault describes as the “medical gaze”.
This “medical gaze” is the phenomenon that occurs in which the patient is
looked at from an objectively scientific angle with little regard for their
humanity or personal interpretations of the world.
Essentially
the true danger that this “medical gaze” poses is in how it separates the
patient from the psychiatrist or “normality” while subtly judging their
morality (Foucault, 1963). Foucault and many other anti-psychiatry thinkers
believe this “medical gaze” continues to promote stigma to this day (Hancock,
2018). Structuralism can be supplemented by the views of 18th
century philosopher Jean-Jacques Rousseau who claimed that the constraints of
society corrupt individual human nature and impeded on their individuality. To
quote Rousseau “People in their natural state are basically good. But this
natural innocence, however, is corrupted by the evils of society” (Rousseau,
1992, p.26).
Evolutionary
Needs
In
previous paragraphs, I argued that the methods in which we assess mental health
and how society defines it are largely detrimental to the promotion of mental
health. However, this is independent of the actual occurrence of mental health.
Though there are concerning worries of overdiagnosis and abusive social
systems, there are equally concerning developments of mental illness through
our lifestyles. In the following paragraphs I will further examine Rousseau’s
belief that society corrupts humans and explain reasons the industrialization
of society has led to increased rates of mental illness.
Recent understandings into our
evolutionary history have given us profound insights to how we as homo sapiens
existed years ago. It would be incorrect to assume that our living conditions
have changed contingent to our biology. Evolutionary psychologist pioneer,
Donald Symons, explains that the human brain has not adapted much since the
Pleistocene era (12,000 years ago) (Symons, 1992), however many lifestyle
changes have dramatically changed in our modern society. To better compare our
differences in mental health to our ancestors, we can examine our lifestyle to
that of more primitive populations.
The Kaluli people of Papua New Guinea are one of the most well
documented aboriginal groups in the world. Though they live a largely primitive
lifestyle, with high rates of infant mortality and lack the luxury of the
health care services and technology that industrialized societies offer, after
being assessed, the Kaluli were shown to have a rate of depression of .05%
(Kenedy, 1987). Evolutionary psychologists have given insight into why these
people are less depressed than other industrialized societies. Among the
Kaluli, it becomes apparent that a large reason for their resiliency is their
social structures. The Kaluli have egalitarian social structures with
consistent social contact and relationships that are based on kinship and
marriage (PetersGolden, 2012). This can be contrasted with modern day
statistics that show that almost half of Americans have no close friends
(Mcpherson, Smith-Lovin & Brashears,2006), which has been shown to be a
detriment to mental health (Tran, 2017)
Another profound difference between the Kaluli and our modern society is
exercise. The lifestyle of hunter gatherers requires movement and caloric
expenditure, while most industrial societies are largely sedentary. A recent
survey from Statistic Canada indicate that only 16% of Canadians are getting
their required amount of exercise (Stats Canada, 2019). The positive effects of
exercise on mental health have been well documented in particular to depression
(Blumenthal, 2007). Recent studies indicate that exercise has been associated
with a decreased risk of depression and other mental illnesses (Teychenne,
2010).
Why is it then that we are choosing to live these sedentary, socially
isolated lives? Though there are likely many contributing factors to this
issue, much of the answer to this question is because we can. This is mainly due to the profound influence of
technology on our lives. In our modern lives we don’t need to expend much of
our physical energy or maintain crucial relationships as much as we needed to
when we were hunter-gatherers. However, the effects that technology leaves on
mental health are profound. Among many of the purported negative effects of
technology, it has been shown to weaken social relationships and empathy
(Konrath, 2011). The industrialization of our lives has also led to largely
indoor sedentary lifestyles for many. The ancient philosophy of Epicureanism is
one that might be used to combat this issue in mental health. The teachings of
Epicurious remain very relevant today and to this topic, as they espouse the
pursuit of happiness in its most simple unindulgent ways. To Epicureans the optimal
state (ataraxia) was one in which we were free and unconstrained by superfluous
pleasures, allowing our selves to live in a tranquil harmony with our own
nature (O'Keefe, 2010). Perhaps it is best that we recognize our ancient
history and act as best we can on it, with as minimal extraneous influence as
possible.
How we can move forward
The
goal of this paper was to examine mental illness in modern industrial societies
and how many of the methods being used are detrimental to society. Though the
criticisms surrounding modern mental health practices and how society promotes
it are extensive, this paper was meant as a brief overview. In a positive
light, the knowledge and insight we have gained from evolutionary studies and
continued positive criticism of our healthcare and social systems are greatly
beneficial. The issue of mental illness is only one that will continue to grow
in our modern society, but never were we able to understand the past and our
potential faults as well as we could today. Society can use this knowledge and
understanding and continue to build on it in advocating for the importance of
stricter, more transparent diagnostic procedures, properly assess and criticize
our social structures and advocate for lifestyles that are more complementary
with our evolutionary past.
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