Stanton comments on the recent Surgeon General's report that more treatment for our emotional problems will make us more content.
Published on The Stanton Peele Addiction Website, 6 January 2000
Treating the Blues Away
Stanton Peele
The U.S. Surgeon General says we can — and should — treat more Americans for mental disorders. But, as in the case of my brother, more treatment may not translate into more happiness.
The U.S. Surgeon General has issued a new report on mental disorders — such illnesses are rampant (diagnosable in more than 1 in 5 Americans), they often go untreated, and yet there are available effective medical treatments for "nearly all mental disorders."
I have both a professional and a personal slant on this report. I was part of one of the advisory groups to DSM-IV (the Diagnostic and Statistcal Manual of Mental Disorders, the treatment bible of the American Psychiatric Association). However, as a psychologist, I question the prevailing approach to mental illness in this country.
On the personal side, my brother committed suicide at age 58 in November. He and I disagreed about mental illness issues. My brother was an active member of his local chapter of NAMI (the National Alliance for the Mentally Ill), because he had a stepson who was mentally ill. My brother had had psychiatric treatment and periodically resorted to antidepressant drugs before he killed himself.
The current Surgeon General's report does not actually present a new picture. Since at least the mid-1950s, American psychiatry and public health officials have argued that emotional problems are treatable medical illnesses. Repeated campaigns over the years since then have endeavored to convince Americans that this is the case. And these campaigns have succeeded. Educated opinion accepts that serious emotional problems require treatment.
At the same time, many new emotional disorders have been uncovered over the years. The DSM's first edition, which appeared in 1952, identified 60 categories of disorders. By the time DSM-IV was published more than forty years later, the volume had grown to include 410 conditions. Among these are Obsessive Compulsive Disorder (OCD), Multiple Personality (Dissociative Identity) Disorder, Post-Traumatic Stress Disorder (PTSD), Attention Deficit/Hyperactivity Disorder (ADHD), Social Phobia, Oppositional Disorder, and so on.
Not only have more emotional disorders been identified, but many more Americans are being treated for them. In 1988, 130 million prescriptions were written in the U.S. for psychotherapeutics, or drugs to improve emotional disorders (antidepressant, antipsychotic, and antianxiety drugs). By 1998, this figure had increased by 100 million prescriptions — adding up to about a prescription each year for each teenage and adult American. Antidepressants account for the most drug sales.
The Surgeon General's report identifies children as special targets for concern — how could they not be, with repeated incidents of school shootings by teenagers. But children are already being diagnosed and treated in record numbers. There are 2.5 million prescriptions for emotional disorders written each year for children in the U.S.
In fact, a number of professionals have expressed serious concern about the overdiagnosis and overtreatment of American youth. The Colorado Board of Education recently voted to oppose the widespread use of Ritalin (a drug prescribed for Attention Deficit/Hyperactivity) and antidepressants by school children. Part of their motivation was that one of the teenage shooters at Columbine, Eric Harris, had been taking Luvox, an antidepressant.
When I was a child, antidepressants hadn't been formulated, and few children were treated for emotional problems. Yet, mass school shootings were not a part of the national consciousness. This is one sign that growth in the concern about and treatment of emotional disorders doesn't seem to have curbed the disorders themselves. Actually, quite the reverse appears to have occurred.
Although it is notoriously hard to compare the prevalence of emotional problems between historical eras, several studies have found that depression and schizophrenia have increased markedly in this century, and continue to do so. Dr. Myrna Weissman, of the New York Psychiatric Institute, found that of Americans born before 1945, only 1 percent had suffered a major depression by age 75; of those born since 1955, 6 percent had become depressed by age 24.
No one wants mentally ill people either to suffer or to be penalized for their problems. Yet, it is hard to avoid the conclusion that we may not be on the trail of the sources and cures for these ailments. While urging treatment of emotional disorders, the Surgeon General's report notes that, "for the most part, their causes remain unknown." Even today, emotional problems are rarely identified by laboratory tests or abnormalities of the brain.
One cannot help feeling that Americans are lost in a sea of emotional problems. Most of us don't have the sense that we are happier than were our parents, or that our children are happier than we are. We want to do something about the suffering around us. But even if we followed every recommendation to increase the funding for and treatment of mental disorders, this would not improve the emotional health of the nation.
