The books and commentaries that claim we are pathologizing normal life experience continue to appear. My experience of 23 years in office practice of psychiatry did nothing to convince me that the worried well are being labeled and pushed into therapy offices. Of course being a psychiatrist perhaps I see only the worst cases. But conversations with my therapist colleagues lead me to the same conclusion.
I have also reviewed the data and spoken to researchers. It is undeniable that the frequency of common mental disorders has been rising in industrialized countries for decades. These disorders include depression, anxiety, and addiction disorders among others. Severe mental illness, such as schizophrenia and bipolar disorder, is not more common but does occur earlier in life, which predicts a more malignant course of illness.
If this data was about cancer, infections, nutrition, or metabolic disorders we'd be up in arms. When will we realize that mental illness is real and is more common in modern societies?
Good commentary but I think we need to be careful to not make therapy binary "good or bad". There is enormous financial incentive for therapists to not completely see through healing. If a therapist or we as a community see improvement from therapy short of complete healing / full restoration I would caution celebrating this represents therapy "works". If we help someone go from a level 9 of depression to a level 6 requiring perpetual ongoing therapy and medication, when we / they have the capacity to get to a level 1 (requiring no further therapy or medication), we are enslaving patients not truly healing them.
You're absolutely right we have to keep researching therapy & medications to find more effective ones. Not everyone responds, and even those who do so may not get fully well. But there are benefits for going from (as you describe) level 9 of depression to level 6: The risk of suicide goes down, and the person should be able to function better. That's not ideal, but it's still improvement. And yes, we have to be cautious about the financial incentive piece and about how long therapy goes on. The field has already moved on from the psychoanalytic idea that people should be in perpetual therapy for years; more modern techniques like CBT are intended to work fairly quickly. A good therapist's goal is to get someone well and then not see them again. So when hiring a therapist it's a good idea to ask about the timescale for the treatment plan. [And just for context: I don't give therapy and never have -- my training is in personality and social psychology so I am not trained in the administration of therapy. What I relate in the post is based on the research literature on the effectiveness of therapy.]
Interesting take. I will note however that Gen X (and Boomers too) were probably the most lead-poisoned generation (in infancy and early childhood) in modern history (only the ancient Romans were notoriously more so), more than any recent generation before or since. That was thanks to leaded gasoline, which was then phased out. According to Rick Nevin, whose life's work was to research the lead-crime hypothesis, that easily explains the elevated youth homicide, suicide, and teen pregnancy for Gen X. Throw in the late 1980s and early 1990s crack epidemic, and one can easily explain the trends better than the specious idea that Gen X had too much freedom and independence too soon.
Good point about lead. Any papers/links you'd recommend in particular on this work? I can see the argument tying lead to homicide and suicide, but I'm not as sure about how it could cause alcohol use or teen pregnancy. But looking forward to learning more.
Since lead exposure during early childhood causes impaired impulse control later in life, among other neuropsychological deficits, that could plausibly result in more unplanned teen (and adult) pregnancies, or, more accurately, the act leading to such pregnancies. The part about alcohol may be a bit of stretch though, and so many other factors are also involved.
The books and commentaries that claim we are pathologizing normal life experience continue to appear. My experience of 23 years in office practice of psychiatry did nothing to convince me that the worried well are being labeled and pushed into therapy offices. Of course being a psychiatrist perhaps I see only the worst cases. But conversations with my therapist colleagues lead me to the same conclusion.
I have also reviewed the data and spoken to researchers. It is undeniable that the frequency of common mental disorders has been rising in industrialized countries for decades. These disorders include depression, anxiety, and addiction disorders among others. Severe mental illness, such as schizophrenia and bipolar disorder, is not more common but does occur earlier in life, which predicts a more malignant course of illness.
If this data was about cancer, infections, nutrition, or metabolic disorders we'd be up in arms. When will we realize that mental illness is real and is more common in modern societies?
Good commentary but I think we need to be careful to not make therapy binary "good or bad". There is enormous financial incentive for therapists to not completely see through healing. If a therapist or we as a community see improvement from therapy short of complete healing / full restoration I would caution celebrating this represents therapy "works". If we help someone go from a level 9 of depression to a level 6 requiring perpetual ongoing therapy and medication, when we / they have the capacity to get to a level 1 (requiring no further therapy or medication), we are enslaving patients not truly healing them.
You're absolutely right we have to keep researching therapy & medications to find more effective ones. Not everyone responds, and even those who do so may not get fully well. But there are benefits for going from (as you describe) level 9 of depression to level 6: The risk of suicide goes down, and the person should be able to function better. That's not ideal, but it's still improvement. And yes, we have to be cautious about the financial incentive piece and about how long therapy goes on. The field has already moved on from the psychoanalytic idea that people should be in perpetual therapy for years; more modern techniques like CBT are intended to work fairly quickly. A good therapist's goal is to get someone well and then not see them again. So when hiring a therapist it's a good idea to ask about the timescale for the treatment plan. [And just for context: I don't give therapy and never have -- my training is in personality and social psychology so I am not trained in the administration of therapy. What I relate in the post is based on the research literature on the effectiveness of therapy.]
Interesting take. I will note however that Gen X (and Boomers too) were probably the most lead-poisoned generation (in infancy and early childhood) in modern history (only the ancient Romans were notoriously more so), more than any recent generation before or since. That was thanks to leaded gasoline, which was then phased out. According to Rick Nevin, whose life's work was to research the lead-crime hypothesis, that easily explains the elevated youth homicide, suicide, and teen pregnancy for Gen X. Throw in the late 1980s and early 1990s crack epidemic, and one can easily explain the trends better than the specious idea that Gen X had too much freedom and independence too soon.
Good point about lead. Any papers/links you'd recommend in particular on this work? I can see the argument tying lead to homicide and suicide, but I'm not as sure about how it could cause alcohol use or teen pregnancy. But looking forward to learning more.
Thanks. Best link can be found here, Rick Nevin:
https://ricknevin.com/
Since lead exposure during early childhood causes impaired impulse control later in life, among other neuropsychological deficits, that could plausibly result in more unplanned teen (and adult) pregnancies, or, more accurately, the act leading to such pregnancies. The part about alcohol may be a bit of stretch though, and so many other factors are also involved.