Sunday, November 23, 2014

The Maddening of America

BOSTON – The relative global decline of the United States has become a frequent topic of debate in recent years. Proponents of the post-American view point to the 2008 financial crisis, the prolonged recession that followed, and China’s steady rise. Most are international-relations experts who, viewing geopolitics through the lens of economic competitiveness, imagine the global order as a seesaw, in which one player’s rise necessarily implies another’s fall.

But the exclusive focus on economic indicators has prevented consideration of the geopolitical implications of a US domestic trend that is also frequently discussed, but by a separate group of experts: America’s ever-increasing rates of severe mental disease (which have already been very high for a long time).

The claim that the spread of severe mental illness has reached “epidemic” proportions has been heard so often that, like any commonplace, it has lost its ability to shock. But the repercussions for international politics of the disabling conditions diagnosed as manic-depressive illnesses (including major unipolar depression) and schizophrenia could not be more serious.

It has proved to be impossible to distinguish, either biologically or symptomatically, between different varieties of these conditions, which thus constitute a continuum – most likely of complexity, rather than severity. Indeed, the most common of these illnesses, unipolar depression, is the least complex in terms of its symptoms, but also the most lethal: 20% of depressed patients are estimated to commit suicide.

Both manic-depressive illness and schizophrenia are psychotic conditions, characterized by the patient’s loss of control over his or her actions and thoughts, a recurrent state in which s/he cannot be considered an agent with free will. Obsessive suicidal thinking and paralyzing lack of motivation allow depressed patients to be classified as psychotic as well.

These conditions are often accompanied by elaborate delusions – images of reality that confuse information generated in the mind with that provided from outside. Often the distinction between symbols and their referents is lost, and patients begin seeing people solely as representations of some imagined force. The judgment of such people cannot be trusted, to put it mildly.

A massive statistical study, conducted from 2001 to 2003 by the US National Institute of Mental Health (NIMH), estimated the lifetime prevalence of major depression among American adults (ages 18-54) at more than 16%. Lifetime prevalence for schizophrenia was estimated at 1.7%. There is no known cure for these chronic diseases; after onset (often before the age of 18), they are likely to last until the end of the patient’s life.

Surveys among US college students estimated that 20% fit criteria for depression and anxiety in 2010, and that nearly 25% fit these criteria in 2012. Other studies have consistently shown rising rates of prevalence with each successive generation, and it is argued that, if older statistics were faulty, they erred on the side of underestimating the spread of mental illness.

All of this suggests that as many as 20% of American adults may be severely mentally ill. In view of disputes over the significance of available data, let’s assume that only 10% of American adults are severely mentally ill. As these conditions are presumed to be distributed uniformly within the population, they must afflict a significant share of policymakers, corporate executives, educators, and military personnel of all ranks, recurrently rendering them psychotic, delusional, and deprived of sound judgment.

If it is deemed sensationalist to characterize this situation as terrifying, one may add that a much larger share of the population (estimated at close to 50% in the NIMH study) is affected by less severe forms of mental disease that only occasionally disturb their functionality.

Comparative epidemiologists have repeatedly noticed something remarkable about these illnesses: only Western countries (or, more precisely, societies with monotheistic traditions) – particularly prosperous Western countries – are subject to prevalence rates of this magnitude. Southeast Asian countries appear to be especially immune to the bane of severe mental illness; in other regions, poverty, or lack of development, seems to offer a protective barrier.

As I argue in my recent book Mind, Modernity, Madness, the reason for high concentrations of severe mental illness in the developed West lies in the very nature of Western societies. The “virus” of depression and schizophrenia, including their milder forms, is cultural in origin: the embarrassment of choices that these societies offer in terms of self-definition and personal identity leaves many of their members disoriented and adrift.

The US offers the widest scope for personal self-definition; it also leads the world in judgment-impairing disease. Unless the growing prevalence of serious psychopathology is taken seriously and addressed effectively, it is likely to become the only indicator of American leadership. The rise of China is unrelated to this.

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    1. CommentedNathan Coppedge

      I wouldn't be surprised if policy-makers were more qualified than the average American believes. Certainly disease is not the 'whole person', nor does disease affect everyone.

      If it weren't for the negative aspects of emotion present in adopting irrational views, irrational views would long have changed into a form of rational genius. To some extent, the path of Zeno's paradoxes and the Romantic poets is untrod even today.

      If you consider these statements unoriginal or insane, consider that they may be some of the only positive options----like I said, simply a problem of emotional, rather than systemic or cognitivie, denial of the positive.

      In my book the Dimensional Philosopher's Toolkit I detail a profound system of objective knowledge---a form of rational mastery. In another book I wrote, called Creeping Cadence and Cadence Continues, I detail how I am schizophrenic and write poetry. In today's world, the complexity is not an 'ulterior' or 'spectre of history', but instead the question of our own minds, and involves a significant amount of potential reason, even amongst madness. Some of it is treatment, but there are people with good intentions, even amongst those who are mentally ill.

    2. CommentedOli Ver

      This is a very interesting overview, particularly this passage:

      As these conditions are presumed to be distributed uniformly within the population, they must afflict a significant share of policymakers, corporate executives, educators, and military personnel of all ranks, recurrently rendering them psychotic, delusional, and deprived of sound judgment.

      Perhaps we should address the elephant in the room - that a sizable proportion of US government, military and corporate leaders are psychopathic, rather than depressed. Depressives are treatable to some extent, psychopaths are not. The recent behavior in high places post-2001, including celebrating and rewarding the too-big-to-jail creators of the 2008 crash and the latest government paranoia over whistleblowers, tells me that the USA has far worse existential problems than 10% or 20% mentally ill citizens would indicate.

    3. CommentedMary Chapin

      Poverty, economic insecurity and especially the conditions under which American children are raised must surely contribute to this problem. In the US there is no guaranteed paid sick leave or maternity leave, no job security, mandatory overtime and many have no health insurance. Housing assistance for the poor is minimal at best, so many poor families are constantly on the move. Poor neighborhoods are plagued by violence. Add to this the increase in food insecurity and you have mothers who are under far too much stress to nurture their children. Fathers who are in jail or can't get a job often abandon their families and relatives are struggling with their own economic challenges. Americans who work full time work longer hours than contemporaries across the globe and the work pace has been accelerating. How can they find the energy to properly nurture the next generation? And now congress is debating further cuts to head start even though it has an amazing track record. In many states, clinics that provide poor women with birth control are being closed. We are a nation that seriously neglects our children and their caretakers.

    4. CommentedProcyon Mukherjee

      I do not know what role 'inconspicuous consumption' could play in furthering 'depression', but I have seen the potent role of 'conspicuous consumption', in societies like in the Gemeinde or local self-governed districts of Switzerland or in the extreme poverty-stricken areas in the interior of India, where the absence of greed or incentives that drive the 'seeking alpha' syndrome does not make a 'winner take all' denouement where the gains by one does not leave thousands return empty handed. However, egalitarian societies in advanced nations also have their bout of problems as in the Nordic States; perhaps only more research and data can prove conclusively what drives true happiness.

    5. CommentedMark Robertson

      How real is this data? Given that the DSM seems to exist to create patients for the pharmacological industry and its profits. Is it rational to assume that the USA is far more mentally ill per head of population than other countries? Seems unlikely unless the evidence is very good. What possible reasons could there be for Americans being far more mentally than any other country?

    6. CommentedRyan Edington

      I find the general point here sound-- that epidemic levels of mental illness is imperiling not only those afflicted but the entire country. But your manner of delivery reveals and attitude and purpose that is more than sensational-- it is demonizing. People with mental illness have faced such discrimination as far back as you care to look, but to characterize one fifth of the country; to characterize people with depression as ALL "psychotic, delusional, and deprived of sound judgment" is not only patently wrong-- it serves to warp public opinion against such people-- it treats them like a threat, a disease, something lesser than. Shame on you.

    7. CommentedDavid Harry

      A quite Larmarkian interpretation; at odds with the predominant view that genetics plays the predominant role...

    8. Commentedyancey simon

      Dr. Greenfeld is absolutely spot on here and in her book. Unfortunately, what she predicts concerning the dangers of those harboring mental illness guiding US policy decisions has all ready come to pass. The madness of those in power who initiated the Iraq War and the irrational justifications for it surely demonstrates Greenfeld's greatest fears. That the general population of the US is comfortable with the fact that its leadership initiated a senseless war based on lies and deception resulting in the deaths of multitudes of innocent people as well as producing over a million refugees reflects insensitivity and callous disregard that is off the charts of normalcy. The examples of the mass psychological malady that has developed in the US are considerable and dangerous to ourselves and others.