Since the 1990s, there has been talk of a mental health epidemic in the US, particularly among young people. Last month’s mass shootings in Uvalde, Texas and Buffalo, NY, carried out by 18-year-old gunmen, have heightened fears that something has gone terribly wrong. But the problem is not new. American psychiatrists have been studying the rates of functional mental illnesses such as major depressive disorder and schizophrenia since the 1840s. These studies show that the ratio of those suffering from such diseases to the mentally healthy population is steadily increasing.
Ten years ago, one in five college students had a mental illness, according to the annual Healthy Minds study of college students. Between 2013 and 2021, the proportion of US college students affected by depression increased by 135%, according to Healthy Minds. In the same period, the proportion of students affected by psychiatric disorders doubled to over 40%. “America’s youth,” wrote journalist Neal Freyman in April, “are in the midst of a deepening mental health crisis, and public health experts are scrambling to get to the root causes before it gets worse.”
You are right to race. Functional mental illness threatens the existence of a society and stands behind its social, economic and political ills.
Functional mental illnesses are not curable. It can be managed with just Lithium or Prozac, for example. The effectiveness of such management depends on a patient’s rationality, but a symptom of the disease is irrationality. The epidemic rates of mental illness, even assuming 20% when measuring the 2007 incidence among adults ages 18 to 54, mean that one in five American adults is likely to be irrational at any point in time. That is, their judgments would be incorrect and subjective, reflecting their psychological state rather than objective reality. If we consider current rates among college students or tomorrow’s elite, we might expect that judgments on economic, military, political, or social matters by 2 in 5 American decision-makers would soon become unreliable.
By definition, a functional mental illness is a disease of unknown biological origin. The constant, systematic increase in its incidence rates since the 1840s is evidence that its origins are not biological. Contrary to all logic, however, mental health research focuses exclusively on biology and casts no broader net of explanations. The evidence points to a historical and cultural explanation for the rise in incidence rates. In particular, it suggests that functional mental illness is a hallmark disease of prosperous and secure liberal democracies.
The more committed a society is to the value of equality and the more choices it offers for individual self-determination, the higher the rates of functional mental illness. These rates increase in tandem with the increase in available occupational, geographic, religious, gender, and lifestyle choices. This explains why, since the 1970s, the US has been the country most affected by functional mental illness in the world, although other wealthy liberal democracies are not far behind. Prior to the 1970s, the top spot was held by Great Britain, which lost that rank along with its empire and the dramatic reduction in choices the nation offered its members as a result. In contrast, rates of functional mental illness are remarkably low in societies that are insecure, poor, unequal, or authoritarian. For decades, the World Psychiatric Association has pondered the “perennial conundrum” of relative immunity to such diseases in Southeast Asian countries.
Equality inevitably makes self-definition a matter of choice, and the formation of personal identity—necessary for mental health—becomes a personal responsibility, a burden some people cannot bear. In democracies, one must therefore expect a relatively high rate of functional mental illnesses, which are expressed primarily in dissatisfaction with oneself and thus in social maladjustment. But while high rates of mental illness are an old problem, the rising rates of recent decades cannot be explained by equality alone. They are also related to what has happened to western values, especially in the United States, since the dissolution of the Soviet Union.
The disappearance of the West’s common adversary made individual identities in the West more confusing and unsatisfying. Lost in sight of what they were opposed to as a society, millions of people in the West lost sense of what they represented and rejected common reference points, such as personal responsibility, which used to be the core of self in the West. Soviet-style virtues and vices were seen as characteristics of groups, significant social groupings were genetically defined, all personal inconveniences were attributed to society, and the burden of responsibility was shifted off the shoulders of the individual.
This shift shifted the understanding of justice from one based on individual actions to one based on collective, biologically determined dispositions. It encouraged social maladjustment because people who thought they were decent naturally felt uncomfortable in a society that wasn’t decent. And at the same time, it has trapped huge crowds in vicious but inescapable genetic identities. While solving the problem for some, this shift in values accelerated the rise in rates of mental illness.
The tragedies in Uvalde and Buffalo underscore the urgency of addressing the mental health crisis. Understanding its causes will help us in this.
Ms. Greenfeld is Associate Professor and Professor of Sociology, Political Science, and Anthropology at Boston University and the author of Mind, Modernity, Madness: The Impact of Culture on Human Experience.
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https://www.wsj.com/articles/the-wests-struggle-for-mental-health-illness-uvalde-shooting-depression-anxiety-religion-meaning-authoritarian-11654034338 The West’s Struggle for Mental Health