An Epidemic of Mental Disorders?Every month, I run across a newspaper or online article about how such-and-such mental disorder is an “epidemic.” I can rattle off the disorders that have been paired with this word so far this year — bipolar disorder in children, ADHD, depression and anxiety, a lesser form of schizophrenia… and the list goes on.

In fact, it makes me wonder whether there’s really any journalism done any more, or if it’s just, “Let’s pair one expert’s opinion with the word ‘epidemic,’ and there’s our story!”

The problem with a word like “epidemic” is that, sans a legitimate base comparison, you can always throw this claim around with little regard for actual scientific data. Because if you actually look at the scientific data, you’d be hard pressed to use the word “epidemic” for virtually any mental disorder.

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An Epidemic of Mental Disorders?

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  1. I thank Dr. Grohol for his citation of my article, and I would urge Psychcentral readers to take a close look at the excellent posting by Dr. E. Fuller Torrey, at:

    http://www.treatmentadvocacycenter.org/index.php?option=com_content&task=view&id=2085

    Dr. Torrey convincingly debunks many false claims about the prevalence, course, and treatment of schizophrenia.

    Best regards,
    Ron Pies MD

  2. It’s true that we should be careful of “opinions of people who have their own agendas”, as Dr. Grohol wrote above. So perhaps we should keep in mind that Dr. Ronald Pies is editor-in-chief emeritus of Psychiatric Times, a journal that accepts advertising from pharmaceutical companies. That fact does not invalidate his opinion, of course, but since Dr. Grohol himself raised the issue of conflicts of interest, I don’t think I’m being unfair here.

    I mention pharmaceutical advertising because there is evidence that drug companies are involved in creating the epidemic of mental illness that is engulfing this country (and other countries). Now, Dr. Grohol and Dr. Pies deny that the epidemic exists, but that claim is certainly debatable.

    Investigative reporter Robert Whitaker has written a book in which he outlines the evidence for an epidemic of mental illness that stems from the widespread use of psychiatric drugs. The book is called, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. And, unlike many critics of psychiatry, Robert Whitaker does not have any apparent ax to grind, and he’s got solid credentials as a journalist and author. He recently presented at Grand Rounds as Mass General, so even the establishment listens to him (to some small extent, anyway).

    • I’ve read Whitaker’s book and there are issues with it, but I’ll save that for a blog post or book review.

      I don’t think we can lay blame for any rise in mental disorder prevalence — real or imagined — primarily at the alter of any single cause, because the systems in place are far too complex. (I liken it to people who try and pin the blame of the American healthcare system on any single factor, like doctors charging too much.)

      Certainly pharmaceutical companies were a part of the problem, but they were not the whole problem in and of themselves. For instance, an argument could be made that had the system not been designed for family doctors and general practitioners to be able to diagnose and treat so many mental disorders — that they have no particular specialized training to do so — we’d be in a very different place than we are today.

      Like I said, there’s a lot of blame to go around, and no single cause. But the answer isn’t to throw around emotionally-laden words like “epidemic” and over-simplify the problem.

  3. John,

    Bob’s rebuttal which is on the Mad in America site. Why hasn’t that been published on this site?

    If any other non psych drug was appearing to cause a huge spike in disability rolls, there would be a huge outcry and an investigation. But when it involves psych meds, it easy to blow it off and blame everything on the label.

    By the way, Bob never suggested that causation equals correlation but he is asking a very legitimate question regarding why the mental health disability rolls are exploding if the meds are successful treating mental illness as psychiatry claims they are.

    And of course, if the mental health disability rolls were going down, I doubt that you and people like Dr. Pies would be using the same arguments such as you can’t attribute success to one factor. You would be highlighting this success as often as possible.

  4. I get the sense that Whitaker may have used the word “epidemic” in a more colloquial sense to describe the large increase in the chronicity of mental health problems, not necessary the strict definition of a large increase in new diagnoses. Whitaker mostly argues that (following diagnosis) the chronicity of mental health problems is much worse than before medications were so prevalent. (And for children, there was indeed a false epidemic of new childhood bipolar diagnoses.) The editorial by Dr. Pies seems to briefly acknowledge this legitimate concern over increased chronicity, but then goes back to basically arguing that the use of the word “epidemic” is incorrect or imprecise.

    I don’t know if Whitaker would grant that he mostly used the word “epidemic” in a more colloquial sense, as opposed to the stricter definition. But let’s not have the argument over word definitions get in the way of exploring his main assertion, that long-term use of medications possibly contributes to worsening chronicity of problems.

  5. Arguments regarding the “chronicity” of psychiatric disorders should not be based on “colloquial” notions and definitions–particularly when the public health is at stake, and an entire medical specialty is being taken to task. We would never accept a “colloquial” use of a term like “epidemic” if cancer or heart disease were under discussion.

    In brief: “incidence” is the number of new cases per unit time. “Prevalence” is, to oversimplify, the number of new cases plus existing cases. If incidence of a disorder declines or remains the same, but prevalence increases, we interpret that to mean that
    “the sick are staying sick” and “accumulating” over the years; i.e., there is increased “chronicity.” (You can also get a bump in prevalence if people who were surveyed earlier and did not report an illness now “remember” that they had it, say, five years ago). Prevalence rates may rise, if, for example,
    more people are willing to acknowledge that–five or ten years ago–they had a bout of depression.

    To understand how all this works, I recommend that readers get hold of a copy of the study of depression prevalence, by Eaton et al [Acta Psychiatr Scand. 2007 Sep;116(3):182-8. Prevalence and incidence of depressive disorder: the Baltimore ECA follow-up, 1981-2004.] The conclusion of the study was, “These results to not suggest an epidemic of depression…”
    and this was based on a stable or declining incidence
    of depression overall, with significantly rising prevalence mostly in one subgroup: late middle-age females. This was interpreted as evidence of “chronicity” in that group; however,there was no change in depression chronicity among males–a finding that contradicts the far-fetched claim that depression treatment (e.g., antidepressant use) is somehow making people worse or increasing chronic depression generally. (One caveat: inappropriate prescribing of antidepressants for patients with bipolar disorder can indeed make some people worse!)

    Neither, so far as I am aware, is there evidence of
    greatly increased prevalence of schizophrenia or bipolar disorder, worldwide, or in the U.S., based on
    carefully-done epidemiological studies.

    Fluctuations in frequency of chart diagnoses and prescription rates are subject to all manner of artifactual variables (such as insurance company reimbursement rates, direct-to-consumer advertising, increased awareness of the illness, etc.) and cannot be used to reach conclusions regarding the actual rate of change in a particular disease.

    Of course, as I stated in my commentary, we should take seriously the issue of potential over-diagnosis and over-prescribing, in the realm of bipolar and other psychiatric disorders. So, too, we should consider that there are also instances of
    under-treatment (both with respect to psychotherapy and medication) and under-diagnosis of psychiatric disorders.

    Indeed, as Mojtabai & Olfson point out, there is a growing “mismatch” in the U.S. between serious need of mental health treatment and actual provision of treatment [Health Affairs. 2011;30:1434–1442.] That is, in many cases, the sickest individuals are not getting the care and treatment they need, while those with milder illness (who may have better insurance coverage) are getting what may be unnecessary treatment–for example, antidepressant treatment for very mild cases of situational depression that would be well-managed with a course of brief psychotherapy.

    Sincerely,
    Ronald Pies MD

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