Excessive Medication, Mental Health, Evolutionary Psychology, and The Creation of New Cultures

John Horgan, in The Chronicle of Higher Education, on “Are Psychiatric Medicines Making Us Sicker?

“As recently as the 1950s, Whitaker contends, the four major mental disorders—depression, anxiety disorder, bipolar disorder, and schizophrenia—often manifested as episodic and “self limiting”; that is, most people simply got better over time. Severe, chronic mental illness was viewed as relatively rare. But over the past few decades the proportion of Americans diagnosed with mental illness has skyrocketed. Since 1987, the percentage of the population receiving federal disability payments for mental illness has more than doubled; among children under the age of 18, the percentage has grown by a factor of 35.

This epidemic has coincided, paradoxically, with a surge in prescriptions for psychiatric drugs. Between 1985 and 2008, sales of antidepressants and antipsychotics multiplied almost fiftyfold, to $24.2-billion. Prescriptions for bipolar disorder and anxiety have also swelled. One in eight Americans, including children and even toddlers, is now taking a psychotropic medication. Whitaker acknowledges that antidepressants and other psychiatric medications often provide short-term relief, which explains why so many physicians and patients believe so fervently in the drugs’ benefits. But over time, Whitaker argues, drugs make many patients sicker than they would have been if they had never been medicated.”

Meanwhile, in “So Young and So Many Pills” by Anna Wilde Mathews we hear that 25% of children and teens are on medication, and 7% are on two or more drugs.

Meanwhile, a comprehensive review article on “Religiousness and Mental Health” covering  850 studies concludes:

The majority of well-conducted studies found that higher levels of religious involvement are positively associated with indicators of psychological well-being (life satisfaction, happiness, positive affect, and higher morale) and with less depression, suicidal thoughts and behavior, drug/alcohol use/abuse. Usually the positive impact of religious involvement on mental health is more robust among people under stressful circumstances (the elderly, and those with disability and medical illness).

In addition, there are several studies showing that religious homogeneity correlates with less suicide and less juvenile delinquency (see also my article on “School Choice and Adolescence in America”).

We evolved in small tribes with a degree of homogeneity with respect to religious belief and cultural norms that is unimaginable today.  Most human beings would never have known of another human being with significantly different beliefs or norms from themselves.  Their ancestors would have believed in the same gods and the same origin stories, regarded the same rituals as sacred, and the same patterns of behaviors as virtuous or violations of tribal norms.  Individuals would be married into or captured by neighboring tribes, but in general the beliefs and norms of nearby tribes were not radically different from those of one’s own tribe.  It is unlikely that evolution prepared us to live in a world in which we are constantly exposed to different beliefs and norms constantly, or in which we had no clear guidance as to what to believe or how to behave (Jaynes is once again relevant here).

As a Socratic intellectual who has introduced open-ended questioning into hundreds of public school classrooms, I’ve long been acutely aware of what damage I might be doing to religious students.  While academic intellectuals ridicule those who believe in God as primitive and stupid, when face to face with children who are struggling with life’s questions I regard the conceptual and behavioral software that allows people to live healthy, happy, good lives as a very serious problem.  Certainly many secular intellectuals live such lives, as do many religious people, as to many believers in recently created systems of belief and behavior.  But we should not take lightly the challenges of living outside our evolved zone of mental, emotional, and spiritual comfort, which was indubitably one of homogeneity of belief and behavior.

Finally, consider “The Americanization of Mental Illness,”

We have for many years been busily engaged in a grand project of Americanizing the world’s understanding of mental health and illness. We may indeed be far along in homogenizing the way the world goes mad.

. . . In any given era, those who minister to the mentally ill — doctors or shamans or priests — inadvertently help to select which symptoms will be recognized as legitimate. Because the troubled mind has been influenced by healers of diverse religious and scientific persuasions, the forms of madness from one place and time often look remarkably different from the forms of madness in another.

That is until recently.

For more than a generation now, we in the West have aggressively spread our modern knowledge of mental illness around the world.  . . . Indeed, a handful of mental-health disorders — depression, post-traumatic stress disorder and anorexia among them — now appear to be spreading across cultures with the speed of contagious diseases. These symptom clusters are becoming the lingua franca of human suffering, replacing indigenous forms of mental illness.

DR. SING LEE, a psychiatrist and researcher at the Chinese University of Hong Kong, watched the Westernization of a mental illness firsthand. In the late 1980s and early 1990s, he was busy documenting a rare and culturally specific form of anorexia nervosa in Hong Kong. Unlike American anorexics, most of his patients did not intentionally diet nor did they express a fear of becoming fat. The complaints of Lee’s patients were typically somatic — they complained most frequently of having bloated stomachs. Lee was trying to understand this indigenous form of anorexia and, at the same time, figure out why the disease remained so rare.

As he was in the midst of publishing his finding that food refusal had a particular expression and meaning in Hong Kong, the public’s understanding of anorexia suddenly shifted. On Nov. 24, 1994, a teenage anorexic girl named Charlene Hsu Chi-Ying collapsed and died on a busy downtown street in Hong Kong. The death caught the attention of the media and was featured prominently in local papers. “Anorexia Made Her All Skin and Bones: Schoolgirl Falls on Ground Dead,” read one headline in a Chinese-language newspaper.

 . . . As the general public and the region’s mental-health professionals came to understand the American diagnosis of anorexia, the presentation of the illness in Lee’s patient population appeared to transform into the more virulent American standard. Lee once saw two or three anorexic patients a year; by the end of the 1990s he was seeing that many new cases each month. . . .  By 2007 about 90 percent of the anorexics Lee treated reported fat phobia. New patients appeared to be increasingly conforming their experience of anorexia to the Western version of the disease.

What is being missed, Lee and others have suggested, is a deep understanding of how the expectations and beliefs of the sufferer shape their suffering. “Culture shapes the way general psychopathology is going to be translated partially or completely into specific psychopathology,” Lee says. “When there is a cultural atmosphere in which professionals, the media, schools, doctors, psychologists all recognize and endorse and talk about and publicize eating disorders, then people can be triggered to consciously or unconsciously pick eating-disorder pathology as a way to express that conflict.”

The problem becomes especially worrisome in a time of globalization, when symptom repertoires can cross borders with ease. Having been trained in England and the United States, Lee knows better than most the locomotive force behind Western ideas about mental health andillness. Mental-health professionals in the West, and in the United States in particular, create official categories of mental diseases and promote them in a diagnostic manual that has become the worldwide standard. American researchers and institutions run most of the premier scholarly journals and host top conferences in the fields of psychology and psychiatry. Western drug companies dole out large sums for research and spend billions marketing medications for mental illnesses. In addition, Western-trained traumatologists often rush in where war or natural disasters strike to deliver “psychological first aid,” bringing with them their assumptions about how the mind becomes broken by horrible events and how it is best healed. Taken together this is a juggernaut that Lee sees little chance of stopping.

“As Western categories for diseases have gained dominance, micro-cultures that shape the illness experiences of individual patients are being discarded,” Lee says. “The current has become too strong.”

The implications of The Creation of Conscious Culture through Educational Innovation are very, very deep.

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About Michael Strong

Co-founder, Ko School + Incubator, Conscious Capitalism, Radical Social Entrepreneurs, lead author of Be the Solution: How Entrepreneurs and Conscious Capitalists Can Solve All the World's Problems, author of The Habit of Thought: From Socratic Seminars to Socratic Practice.
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