How Sick Are We, Really?

Much can be learned about what makes a culture tick from its vocabulary. The classic example (however disputed) is the number of words Eskimos have for snow. One linguist counted only 15 words for snow and snow-related events in the Eskimo language Inuit; others count many more. But since snow figures so importantly in their lives, it makes sense that they would have a lot of different words to describe it.

A spiritually-oriented culture might have many words for G-d. There are 70 different names for Hashem in the Torah.

Once upon a time, we had a somewhat limited vocabulary for mental disorder: madness, craziness, insanity, lunacy. Modern psychology broadened that vocabulary with such words as schizophrenia, paranoia, catatonia, as well as the less incapacitating but nonetheless troublesome anxiety, neurosis, depression. More recent additions include caffeine intoxication and General Anxiety Disorder.

The soon-to-be-released fifth edition of the Diagnostic and Statistical Manual, the standard handbook of mental disorders, catalogues no less than 297 disorders or illnesses, up from 265 in 1980, 106 in 1952. It might be worth doing a study to determine whether there’s a correlation between the proliferation of mental disorders and the increase in the Gross National Product.

Americans have more words for these problems than Eskimos have for snow.

What are we to make of a society that is so seemingly obsessed with its mental state?

First, though, we have to ascertain if there really are more mental disorders about, or if it’s a figment of the psychotherapeutic community, which has managed to project its obsession onto the general consciousness, making its obsession America’s obsession.

While there is evidence that Americans do suffer more from mental disorders than they used to, there is also good reason to believe that much of the inflation in psychiatric nomenclature is artificial.

One study revealed that more adults displayed neurotic symptoms in 1993 than in 1963, and another showed that today’s children are more anxious than those in previous generations. (There could be reasons for the change; more on that later.)

But when confronted with the psychiatric profession’s estimate that over 50 percent of Americans are likely to have a mental disorder in their lifetime, one begins to wonder. Are we all, or most of us, losing our minds; or, rather, has the definition of mental disorder somehow gone awry?

A giveaway here is the promise made by the editors of DSM-5 that the total number of disorders will not exceed those in the fourth edition. Maybe it was a Freudian slip, but obviously, the explosion in mental problems is at least to some extent man-made.

Take, for instance, the “disorder” “caffeine intoxication,” characterized by at least five symptoms after consuming the equivalent of two to three cups of coffee: restlessness, gastrointestinal problems, difficulty sleeping, nervousness and rapid heartbeat. Some of us would object to calling this a mental disorder. After all, those “symptoms” will disappear in a short time without any treatment whatsoever. Just because we are coffee-crazed does not mean we’re crazy.

Trying to put a ceiling on new diagnoses is like putting a limit on government spending. There are constituencies and lobbies that make it hard to do. Insurance claims provide an incentive for labeling problems; without a professionally-recognized diagnosis, health insurance claims can’t be made.

And then there are the pharmaceutical companies, ever on the lookout for new disorders for which they can market their drugs. A notorious case in point was Generalized Anxiety Disorder (GAD), an illness of dubious definition for which GlaxoSmithKline produced Paxil, along with a massive media campaign to create as much anxiety and as many customers for Paxil as possible.

But we don’t want to cast all our burdens on the psychiatrists. As the abovementioned studies indicate, Americans really do seem to be more troubled than they used to be, more anxious and more depressed. The very fact that they are such eager consumers of anti-depressants and other mind-affecting drugs is in itself a proof of it.

What is the cause of all this angst?

No one knows for sure, but various possibilities have been offered. The stress of a high-tech, fast-paced life likely plays a role. In an age of blackberries and email, what were once 9-5 jobs are now 24-hour-a-day jobs that include weekends. The incessant bombardment of advertising and promotion of endless consumer products, along with the envy-generating media coverage of the rich and super-rich, may also play a role, as they cause people to crave what others have and to feel acutely deprived if they donhave the same.

The breakdown of the American family, the disintegration of moral and religious values, are not mere sociological cliches; they certainly contribute to the state of national dysfunction.

In our own communities, we are not immune to mental health problems. Indeed, the Talmud and poskim long recognized the problem of mental health. In a sense, it’s normal that a certain number of people (preferably a small number) in any society will have medical or mental problems.

When pondering the accuracy of mental health assessments on a national scale, great care must been taken that it not be misunderstood as belittling the pain of the many who suffer from real mental illness. Like those battling physical illness, they deserve our understanding, compassion and a firm commitment of assistance, including professional care as needed.

But over-diagnosing and over-stating the problems could well prove to be counter-productive, like crying “wolf” too many times. The more “disorders” are discovered, the less serious it all seems. If everybody is sick, maybe no one is sick.

And that does a disservice to those who really do need help.