If you are waiting for a book bearing the title of this article, don’t hold your breath. No publisher or author would make more than a few nickels from sales. It’s much more exciting to write about the terrible “epidemic” of mental illness that has swept across our nation—and to expose the nefarious treatments and practices of Psychiatry (capital “P”) as the cause of this scourge.1
All this vituperation makes for good online chatter, and it certainly sells books. But from the standpoint of epidemiological science, the “epidemic of mental illness” narrative is—with a few qualifications—mostly fear-mongering drivel. When we carefully define an “epidemic” as “. . . an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area . . .”—the definition used by the CDC—the so-called epidemic of mental illness among adults in the US proves largely illusory.2 And once we pull out the bottom card—the epidemic narrative—from the critics’ claim, the entire house of cards collapses. In addressing this issue, I am not taking aim at the “psychiatry is medicalizing normality” argument, which is itself dubious, but is at least worthy of serious discussion.3
Note that the CDC definition of “epidemic” applies to actual cases of disease—not to changing rates of diagnosis, which are subject to many socio-cultural variables. For example, a desperate parent’s attempt to secure special services for an autistic child may influence the clinician’s willingness to diagnose an autistic spectrum disorder. This is a critical point, since psychiatry’s critics do not claim merely that there is more diagnosis of schizophrenia or major depression; rather, they claim there are actually more people sick with these illnesses, owing to misguided or harmful psychiatric treatment. Ironically, their claim presupposes the “reality” of mental illness, thereby putting the epidemic-mongers at odds with mental-illness deniers—an intriguing schism within the anti-psychiatry movement.
The “epidemic” claim has been supported mainly on the basis of increasing US rates of psychiatric disability determinations over the past 50 years.4 But Social Security Administration disability determinations are notoriously susceptible to claimant preparation and administrative pressures, and they cannot be used as a legitimate index of disease incidence or prevalence.5
Let me hasten to add that there is indeed a growing population of persons with serious psychiatric illness who are not receiving adequate treatment. Most of them wind up either in prison or on the streets—a shameful deficiency in our mental health care that has been highlighted by Dr. Allen Frances,6 Dr. Fuller Torrey,7 and many others. As Dr. Torrey has observed, “. . . on any given day in the United States, half of all individuals with schizophrenia, or about one million people, are not being treated.”7 If there is an “epidemic” to be addressed in this country, it is this unconscionable neglect of our most severely impaired citizens.
Acknowledgments: I wish to thank Peter Kramer, MD, for his helpful comments on an early draft; and Ronald C. Kessler, PhD, for pointing out some sources of epidemiological data. The views expressed here, however, are my own.
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2. http://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/section11.html. Accessed September 22, 2016.
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5. Ultimate Social Security Disability Guide: SSDI, SSI, How to Win, Information Social Security Disability Hearing and How to Prepare for Disability Hearing. http://www.ultimatedisabilityguide.com/disability_hearing.html. Accessed September 22, 2016.
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7. http://www.treatmentadvocacycenter.org/component/content/article/2085-anatomy-of-a-non-epidemic-a-review-by-dr-torrey. Accessed September 22, 2016.
8. http://www.psychiatrictimes.com/blogs/couch-crisis/there-really-%E2%80%9Cepidemic%E2%80%9D-psychiatric-illness-us. Accessed September 22, 2016.
9. http://www.psychiatrictimes.com/blogs/bogus-epidemic-mental-illness-us. Accessed September 22, 2016.
10. http://archive.samhsa.gov/data/2k12/MHUS2010/MHUS-2010.pdf. Accessed September 22, 2016.
11. http://www.nimh.nih.gov/health/statistics/prevalence/serious-mental-illness-smi-among-us-adults.shtml. Accessed September 22, 2016.
12. https://www.cdc.gov/nchs/data/nhis/earlyrelease/er_spd_access_2015_f_auer.pdf. Accessed September 22, 2016.
13. Center for Behavioral Health Statistics and Quality. Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50. September 2015. http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.htm. Accessed September 22, 2016.
14. Bentall R. Psychiatry’s failed paradigm. Washington Post. January 4, 2010. http://voices.washingtonpost.com/shortstack/2010/01/rcent_decades_have_seen_dramat.html. Accessed September 22, 2016.
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16. Leucht S, Hierl S, Kissling W, Dold M, Davis JM. Putting the efficacy of psychiatric and general medicine medication into perspective: review of meta-analyses. Br J Psychiatry. 2012;200:97-106. http://bjp.rcpsych.org/content/200/2/97.long. Accessed September 22, 2016.
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