5 Ways We Are Absolutely Lost When It Comes To Mental Health
Mental health is a complicated issue, and anyone who promises to have all the answers is probably about to hand you a pamphlet with Xenu on the cover. But just because we don't know everything, that doesn't mean we're totally clueless, right? Medically speaking, we've made some huge strides in recent history. Huge, huge strides. In the wrong direction. For example ...
The Official Psychiatry Manual Is Ridiculously Inaccurate
In the United States, The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the recognized authority on diagnosing mental illness. It's so influential, in fact, that most folks in the field just call it "the Bible."
Unfortunately, much like that other Bible, some parts are so outdated that they may be doing more harm than good. The existing research strongly suggests that mental illnesses lay on a spectrum, like so:
We assume "fear of bright colors" has its own chart.
However, textbooks love nothing more than clean spaces and nice, orderly tables, so the DSM still stubbornly splits mental illnesses into neatly defined ailments. Science offers little support for this: When tasked with finding genetic or neuroscientific evidence to back the DSM cataloguing, biology slowly backs away and spends the rest of the night sobbing in a bottle. But because hard science has also yet to produce any conclusive information on the nature of mental disorders, and since the DSM has been the go-to guide of the industry since the 1950s, that's what psychiatry opts to roll with.
Sure, maybe they'll come around and revise the DSM for the better in its next iteration. It's just that, so far, the bastard has been revised every 15 years or so, and its latest version -- the one that still includes all that stuff described above -- just came out in 2013. Right now, the manual's arbitrary criteria are a giant problem for medical research. Treating actual patients with it is like attempting to fine-tune a race car using an old, filthy shop manual ... for a combine harvester.
"The language is kind of vague, but it looks like the first treatment step is to check your spark plugs."
But why, then, does the industry so stubbornly cling to a manual that is, if not fundamentally flawed, at least in clear need of a massive update? Why, Big Pharma, of course! It's estimated that over 70 percent of the people who serve on the DSM "task force" -- the group that decides what goes into the manual -- have ties to the drug industry, which is understandably a fan of the "One Ailment, One Pill" approach.
There is hope: In 2013, the director of the National Institute of Mental Health said they would be redirecting their research away from DSM categories. Now, let's all sit back and wait to see how "one earnest doctor" fares against "massive multinational trillion-dollar corporations with tentacles that stretch all the way into the highest levels of government."
We assume well!
Children's Mental Health Is A Minefield
You've probably heard some alarming numbers, like that 7.5 percent of U.S. children between the ages of 6 and 17 are taking ADHD medication. That's a pretty worrying figure. But do you know what's equally worrying? Eleven percent of all U.S. children have been diagnosed with ADHD.
There's 49,600,000 U.S. kids in that age range, meaning that little 3.5 percent discrepancy is about the population of Idaho.
We're not great with math, but we're pretty sure there's a bit of a gap there. A gap filled with sick children -- the worst gap this side of the one at the outlet mall, which only sells jeans with one leg.
While an estimated 10 percent of children have some serious form of mental health problem, only about half of them are receiving treatment from an appropriately trained therapist. Another 10 percent of children have less serious issues, and their neglect can be even greater. For example, an estimated 60 percent of children with diagnosable depression and 80 percent of kids with anxiety disorders aren't receiving any treatment. Roughly half of all lifetime mental health issues begin by age 14. To further depress you, studies have found that treatment works super well for young people, but becomes increasingly less effective the longer you wait to receive it.
"My recommendation? At this point, I'm leaning toward 'time travel?'"
Technically, we have the tools to fix this. We know how to recognize the major behavioral signs of children who might need professional help. So, let's just start screening kids and sending them to child therapists, right? It's just that there are only around 8,500 of them in the U.S., and about 15 million children who should have one. That would leave therapists' offices more crowded than a Bangladeshi train. Or an inner city classroom in America.
Psychiatry Has A Deep Racial Bias
Black patients are diagnosed with schizophrenia up to 2.5 times as often as white ones. So what's going on here? Do black people, as a racist '90s stand-up comic would say, "just be crazy"?
Of course not. It even works the other way around: Studies have found that black people are less likely to be diagnosed with milder mood disorders, basically getting involuntary upgrades to full-on psychotic diagnoses instead.
"Hmm ... mild social anxiety. Better start out with involuntary commitment just to be sure."
Here's the thing: The medical field was pretty complicit in the whole "Let's justify black inferiority so we can continue slavery" thing, back in the 19th century. Bits and pieces of that old brick wall survive even today. In psychology, this manifests in both physicians' tendency to misdiagnose and black patients' relative unwillingness to seek treatment unless the condition is extremely serious. One feeds the other, in a never-ending, twisted, psychological daisy chain of injustice.
And even if they decide to spin the roulette wheel of mental health, hoping the ball lands on "reasonable treatment for my depression" instead of "dragged away screaming by men in white," black folks are still out of luck. One study had voice actors leave messages with over 300 therapists -- one group of actors portrayed black people, and another portrayed white people. Middle-class black women were 30 percent less likely to get called back than white women. With men, it was 60 percent. With working-class women and men, the likelihood to receive a callback was 70 percent and 80 percent lower, respectively, for the black test subjects.
But don't mention that if you do get an appointment, black people: Your shrink might take it a sign of paranoia ...
Prenatal Depression Is Largely Ignored
We have a deeply ingrained societal belief that pregnancy is a blissful time. Unfortunately, the idea doesn't quite hold up to reality. Research suggests that between 10 and 16 percent of pregnant women suffer symptoms of depression and receive no treatment, likely because most of them are unaware of how common depression during pregnancy is.
Why would they think that? Well, even though we're pretty well versed on depression after childbirth, until very recently doctors believed that the elevated levels of estrogen during pregnancy protected women against pretty much all psychological distress. Wow, estrogen is magical! Where can we get some? We'll shoot it directly into our eyeballs. What can go wrong?
Oh, right -- breasts. Well, live and learn.
Unfortunately, estrogen is not actually Huxley's soma -- this is all just willful ignorance. Studies conducted with medical students reinforce this idea, citing that med students often have a bias against treating pregnant women for depression, simply because they are pregnant. Because we, as a society, think pregnancy is a happy time, we just stick our fingers in our ears and yell until we can't hear the sobbing anymore.
America Is Exporting Its Mental Illnesses
We don't mean to pick on the DSM, but ... yes, actually we do: Turns out the DSM also largely ignores cultural differences. This is especially harmful when the manual is employed abroad, since culture very much influences the way mental illness manifests.
At least Arctic hysteria has had the courtesy to not expand to other cultures ... yet.
After the 2004 tsunami that devastated parts of Sri Lanka, American trauma counselors visited the country to help disaster victims. Chiefly, they wanted to address a problematic psychological behavior that many Sri Lankans were displaying: the uncontrollable urge to help those around them.
The poor, deluded bastards!
These counselors weren't from the Ayn Rand School of Mental Deviancy -- they just thought that the victims might be deferring, rather than dealing with their own trauma. That might have been true in America, but in many Asian countries, helping others before yourself is an integral part of their culture. This was just how their society functioned. But because American culture is more concerned with self-sufficiency, the U.S. trauma counselors unnecessarily diagnosed many of the victims with PTSD.
"You made us 'thank you' cookies?! We need to get you on some very aggressive medication!"
Of course, that was just a case of the American worldview misunderstanding a foreign scenario. That's not nearly as harmful as the U.S. straight up giving another country a disorder. Like the time America inadvertently gave Hong Kong a much worse version of anorexia.
Prior to 1994, anorexia was a rare and very different thing in Hong Kong. Patients didn't experience conventional American symptoms, such as starving or body dysmorphia, but mainly had issues with food, like complaints of bloated stomachs. In short, the Hong Kong version was milder than the American version, and much less common.
It wasn't without its more serious cases, of course: In 1994, a girl with anorexia collapsed and died on a busy street. But when local papers reported what happened, they unwisely used the American DSM to explain anorexia to the public. The message was promptly taken: The number of anorexia cases exploded, and these days, 90 percent of anorexic patients in Hong Kong experience American symptoms.
But then, we also gave them McDonald's, so maybe this is all moot and the heart attacks will get them first.
For more reasons we don't know a lot about our brains, check out 5 Things Everyone Gets Wrong About Mental Illness and Jokes You Didn't Know Were Indicators Of Mental Illness.
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