Addressing the Mental Health Crisis: What Really Matters

Watch Dr. Schroeder’s presentation of “Addressing the Mental Health Crisis”

Evidence increasingly suggests that psychological difficulties are on the rise.  The Global Disease Burden Study, published in August of 2013, declared that “mental and substance use disorders are the leading cause of nonfatal illness worldwide, with a global disease burden that trumps that of HIV/Aids, tuberculosis, diabetes, or transport illnesses.”  Depression is the number one cause of illness and disability in 10-19 year-olds worldwide.  Suicide is the number three cause of death. (Health for the World’s Adolescents World Health Organization. Online May 14, 2014).  “A large survey of randomly selected adults, sponsored by the National Institute of Mental Health (NIMH) and conducted between 2001 and 2003, found that an astonishing 46% met criteria established by the American Psychiatric Association (APA) for having had at least one mental illness within four broad categories at some time in their lives.”(Angell, M., “The Illusions of Psychiatry,” New York Review of Books, July 14, 2011).  “The CDC, on May 3, 2013, reported that the suicide rate among Americans ages 35-64 years increased 28.4% between 1999 and 2010 (from 13.7 suicides per 100,000 people in 1999 to 17.6 per 100,000 in 2010).” (Bruce Levine, “Why the Rise of Mental Illness? Pathologizing Normal, Adverse Drug Effects, and a Peculiar Rebellion,” Mad in America, July 31st 2013).  In 1987, there were less than 20,000 severely mentally disabled children — now there are almost 600,000.  The number of children under the age of six receiving SSI have tripled over the last ten years, to more than 65,000 (AEA, Robert Whitaker).

For some, these findings raise questions about whether statistics are inflated, or are actually the result of another factor besides rising psychological difficulties.  These topics are beyond the scope of this article.  But it is reasonable to assert that greater openness regarding psychological concerns, increased classification of mental disorders, widening of diagnostic categories, or any other artificial inflating explanation falls short of accounting for the tremendous growth of psychological struggles today.  Studies are increasingly finding that even after accounting for all of these factors, psychological complications just continue to grow.

For those who actually believe that psychological problems are on the rise, serious inquiries must ensue.  Many have rightly raised concerns about iatrogenic culprits, including drug-induced effects, but this too seems to fall short of accounting for the meteoric rise. Except for those forced to take psychiatric drugs, I would suggest that most seek out drugs in the hope of relieving iniquities caused by factors such as those I discuss below;  unfortunately, this may not only lead to avoiding addressing the real issues, but may even lead to further complications of the drugs.  Given this, I present five areas for further discussion, which I believe are causal agents for the mental health crisis.  I will only provide a brief overview of each for brevity and readability sake.

Sleep:  As I noted in a recent article (Schroeder, J., “There’s More to Sleep than Shuts the Eye: Waking Up to All That Sleep Does for Our Health & Wellbeing,” Mad in America, December 20, 2014), research increasingly indicates that sleep is tied to almost every health marker imaginable, especially psychological well-being.  In the United States, evidence suggests that we are sleeping 20% less than a hundred years ago.  There is a 25-40% prevalence of sleep difficulties in childhood and evidence indicates that sleep problems have increased over the past three decades (Mindell JA, Owens J. A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems. Philadelphia: Lippincott Williams & Wilkins, 2003). Demands and distractions for many adults have only heightened during all hours, and with the 24/7 nature of our current culture, sleep has largely been denigrated as a second class citizen.  Chronic sleep deprivation and poor sleep quality are increasingly the norm, not the exception, and so likely follows our mental health.

Physical Health:  In the United States, the prevalence of pediatric obesity has more than tripled during the past 4 decades.  If current trends hold out, the generation represented by children born since 2000 is estimated to have a 35% chance of developing diabetes and represents the first generation in the United States since the Civil War to have a life expectancy shorter than that of their parents.  Type 2 diabetes accounts for roughly 90-95% of all diabetes cases in the United States (LINK 2010 estimates – Am. Family Physicians, 81, 7 863-870).  9-10% (29 million) of all people in US has diabetes (CDC, 2014 National Diabetes Statistical Report).  One-third of adults today [worldwide] have high blood pressure, when in 1900 only 5 percent had high blood pressure. (Cohen, R., “Sugar Love,” National Geographic, August 2013).  Meanwhile, studies have consistently linked mental health to fitness, including in young kids. (Zametkin, A.J., Zoon, C.K., Klein, H.W., & Munson, S. “Psychiatric aspects of child and adolescent obesity: A review of the past 10 years.” Journal of the American Academy of Child & Adolescent Psychiatry, February 2004, 43(2), 134-150).  Early soda and junk food consumption alone are linked with anxiety, inattention, and aggression (e.g., Jacka et al., (2013) JAACAP and Suglia (2013) Journal of Pediatrics).  The best predictor of cognitive health over the age of fifty is physical health.  As the physical health of our nation, and much of our world declines, it is no surprise that mental health would abide by the same trends.

Media & Technology Immersion:  The average 8-18 year-old in 2009 spent more than7 hours, 30 minutes exposed to technology a day, but close to 30% of this time was engaged in multi-tasking (e.g., watching television while texting).  The total exposure is close to 10 hours, 45 minutes, which was almost 44% more than in 1999, and exposure has only continued to grow.  The average adolescent female sends and receives almost 3,200 texts a month (research cited on both pages available through Media Clearinghouse) Screen time is consistently associated with poor outcomes in physical health, academics, traffic safety, aggression, compliance, depressed mood, attention, and creative play in youth (AAP, 2011).  Increased evidence indicates that popular media is strongly associated with more promiscuous sex (Garcia et. al, (2012) review featured in Feb. Psychology Monitor).  Sexually-active adolescents are at a higher risk for suicide, depression, and drug/alcohol abuse (AAP, 2005).  Violent media has consistently been linked to increased aggressive acts, thoughts, feelings, arousal, and decreased prosocial behaviors, albeit with small to moderate effects (Anderson, C.A. and Bushman, B.J. “Effects of Violent Video Games on Aggressive Behavior, Aggressive Cognition, Aggressive Affect, Physiological Arousal, and Prosocial Behavior.” Psychological Science, September 2001, 12(5)).  Media and technology used strategically can be an asset.  Serious questions abound whether most are using it in this way, and with these concerns come logical threats to psychological well-being.

Family Discord & Instability:  Divorce rates skyrocketed from the mid 60’s to the 1980’s before leveling off. Divorce and parent’s relational satisfaction has been consistently shown as a predictor of childhood distress (Bogels, S.M., & Brechman-Toussaint, M.L. (2006); Hoyt, L.A., Cowen, E.L., Pedro-Carroll, J.L., & Alpert-Gillis, L.J. (1990).   At the same time, divorce rates began to level out, unmarried couple households began to rise dramatically into the present. Kids born to cohabiting parents versus married ones have over five times the risk of experiencing their parents’ separation (e.g., P. Smock, 2010). In 2000, 41 percent of all unmarried-couple households included a child under the age of 18. In 1987, it was 21%.   (U.S. Census Bureau, March 2000).  Studies find that kids living in cohabitating households are more likely to suffer from psychological difficulties, including drug use, depression, and dropping out of school, than those in married homes (e.g., Wilcox, “Why Marriage Matters,” [2011], p. 1). Residing in a cohabitating household puts a child at 8 times greater risk for harm than when living with married biological parents (HHS Office of Planning, Research and Evaluation, “Abuse, Neglect,  Adoption and Foster Care Research, National Incidence Study of Child Abuse and Neglect, NIS-4, 2004-2009” [March 2010]).

In a 2005 Pediatrics study of inflicted-injury deaths over eight years, children living with unrelated adults were nearly 50 times as likely to die of inflicted injuries than children residing with two biological parents. Youth in homes with a single parent and no other adults in residence had no increased risk of inflicted-injury death. (P.G. Schnizter, “Child deaths resulting from inflicted injuries: household risk factors and perpetrator characteristicsPediatrics, 2005; 116:687-93).  Instability, trauma, and safety concerns have long been huge risk factors for psychological complications across the lifespan, which ties in directly to changing social, familial trends.

Faith:  Church attendance has steadily dropped over the past decades, and many Americans are not actually where they report to be.  As noted in a New York Times article (Angier, N., “The Bush Years: Confessions of a Lonely Atheist,” New York Times, January 14, 2001), best estimates are that the percentage of adults who actually attended religious services during the previous weekend dropped from 42% in 1965 to 26% in 1994.  Plunging religious membership has led to massive church closures in Europe.  Although religion gone badly is fraught with many negative outcomes, faith, spirituality, and religion have long been a source of coping and resiliency for many people. Large-scale studies have generally indicated that faith and a strong relationship with a higher power is associated with less anxiety, greater social support, increased relational stability, less substance use, and fewer negative behaviors.  Greater religiousness was found to be associated with fewer symptoms of depression in a meta-analysis of nearly 100,000 participants.  However, it appears the best predictor of whether faith is associated with less anxiety and better adjustment is when people have a strong relationship with a higher power.  If faith-based practices are truly declining in many areas, and this has long been a source of coping with psychological challenges, then psychological well-being may very well follow suit.

As we move from layers of substance to layers of motivation, there is another discussion worth having that deserves a book in itself.  In fact, one has been written entitled Generation Me:  Why Today’s Young People are More Confident, Assertive, Entitled—and More Miserable Than Ever Before.   When Twenge and colleagues analyzed the largest MMPI sample to date, which found increases in almost every area of psychological struggles over the past eighty years, something particularly noteworthy emerged.  Most attempts to test correlations with many other demographic, generational, and/or psychological factors yielded no significant findings, with two exceptions.  One was the rate of divorce, which was strongly correlated with every major scale on the MMPI.

The second clear association was that of intrinsic versus extrinsic goals endorsed by young people over the past eighty years.  For decades, polls have consistently showed that adolescent and young adults of later generations increasingly cite extrinsic factors, such as the pursuit of power, status, money, and image, as the primary reasons for what they did.  This contrasted with earlier generations, who more often reported that they were called to particular interests or careers because of intrinsic motivators, such as public good, civic-mindedness, affiliation, and deeper meaning.  Although difficult to demonstrate a causal relationship between psychological difficulties and self-centered endeavors, it raises serious questions about whether the me-focused culture may have a lot to do with our psychological crisis.

It was written, “For the love of money is a root of all sorts of evil, and some by longing for it have wandered away from the faith and pierced themselves with many griefs” (1 Timothy: 10).  This year, for the 9th straight time, Americans reported that financial issues are their leading cause of stress.  Although unfortunate circumstances account for a part of this strain, there is a case to make that greed and envy factor in mightily (see March 2015 article Auditing Our Financial Woes). Almost two thousand years later, C.S. Lewis wrote, “The essential vice, the utmost evil, is pride.”  Collectively, it is hard to not wonder whether the combination of the two may be heating the melting pot of our psychological woes of today.

And yet, there is more. A closer look at all of the major vices associated with human struggle find a strong connection to health and well-being, although not all are in control of the individual.  However, as noted earlier, gluttony and sloth have a direct link to both physical and mental health.  It has long been known that chronic wrath and hostility, often seen in the Type A Personality, puts a person at higher risk for hypertension, cardiac disease, social isolation, and emotional disorders. In a culture where pornography sales are greater than all the three major networks combined, lust seems to have manifested itself more than ever.  Research indicates that increased media exposure to sexually explicit material leads to greater sexual thoughts, feelings, and actions.  Meanwhile, teens who are sexually active are at greater risk for suicide, substance abuse, and depression, not to mention the burgeoning rates of multiple sexually-transmitted diseases.  And of course, pride, the root of all vices, denies us the ability to recognize and address our faults as they exist.

It is easy to become demoralized when we speak of all this. Still, if our vices are truly associated with our state of poor health and well-being, then it seems to reason that virtuous practices hold much promise for a fuller, healthier existence. These are the practices of fortitude, prudence, temperance, justice, faith, hope, and love. When we consider this, and look at the stories that exist around us, suddenly our misgivings seem full of opportunity.  Take for example, the story of KIPP Public Charter Schools, where children from some of the harshest beginnings learn just how developing virtuous practices are one huge key to successes rather astounding. Or the science of volunteering (see December 2012), where helping others can lead to improved well-being and social integration beyond the value of just doing good.  Or the story of a 92-year-old man, who survived the Holocaust despite losing most of his family to the horror, who died knowing that he had written one of the most influential, inspiring books of all-time as we all search for meaning.  Or what about the little boy born in Hall, Indiana, whose pyramid of virtue would later be a key to becoming who many argue was the greatest coach of all time.  And if that wasn’t enough, we must not forget this lean, inconspicuous, almost 85-year-old nun, who is the oldest woman to have finished an Ironman just a couple of years ago.  Who just this month, despite having already completed a half-ironman last year less than three months after breaking her hip, continues to pursue the full Ironman call two decades past the retirement age.

In the midst of our mental health woes, we draw hope from the astounding and the mundane. From changes in sleep, diet, and technology use patterns to a rise from anonymity to world renowned.  From daily steps to improve our families and our relationships, to championships founded on integrity and self-control.  From the bleakest of beginnings in a ramshackle, single-parent home plagued by violence and neglect, to a college graduate paying it forward many times over.  From faith that overcomes age and atrocity, to love that seeks to transcends it all.  It appears that when it comes to our mental health crisis, the scene of our mental health tragedy may well be the starting line of our psychological triumph after all.

Watch Dr. Schroeder’s presentation of “Addressing the Mental Health Crisis”

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