What is Mental Illness?
Yesterday columnist Natalie Crofts reported that Utah has the highest rate of mental illness in the United States. Since she reported from Rockville, Maryland (a state that ranks near the bottom of the scale), we can safely trust that the survey represents a sane diagnosis of a national malady.
The study, conducted by an agency of the U.S. Department of Health and Human Services, ostensibly demonstrates that 22.4% of the adult population in Utah experienced a mental disorder in the past year, of which 5.14% suffered from a severe mental disorder. Crofts elaborated: “The study estimated 42.5 million people over the age of 18 in the U.S. have experienced a mental illness in the past year, at a rate of 18.2 percent. Severe mental illness affected 9.3 million people, at a rate of 4 percent.”
What Crofts conveniently failed to make clear in her report is that the organization that conducted the survey (The SAMHSA) defines mental illness based on diagnostic criteria in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). This same organization defines “Serious Mental Illness” or “SMI” as “a disorder that substantially interfered with or limited one or more major life activities” requiring “the most urgent need for treatment.” The study concludes that “The presence of SMI (Serious Mental Illness) and AMI (Any Mental Illness) in every state reinforces that mental illness is a major public health concern in the United States,” with the caveat that “Factors that potentially contribute to the variation are not well understood and need further study.”
In basic terms, the Center for Behavioral Health and Statistics has determined that “Mental illness is a major public health concern in the United States,” and Utah has the highest rate of mental illness in the nation.
But just what is mental illness? How does one determine whether another person is mentally ill? How would one know whether the person at the head of the agency, or the person who designed the survey, were mentally ill? How is mental illness measured? Can mental health be measured? What sort of thoughts does a 100% sane person think? What is the Diagnostic and Statistical Manual of Mental Disorders? How was it created? How were these surveys to determine mental illness conducted?
Setting aside the other questions for a moment, let us focus on the last question. To begin the survey, people were selected using the following process:
“A scientific random sample of households is selected across the United States, and a professional RTI interviewer makes a personal visit to each selected household. Once a household is chosen, no other household can be substituted for any reason. This practice is to ensure the NSDUH data represent the many different types of people in the United States.
After answering a few general questions during the in-person visit by the interviewer, one or two residents of the household may be asked to participate in the survey by completing an interview. It is possible no one will be selected for the interview. If an individual is selected for the interview, their participation is voluntary, but no other person can take their place. Since the survey is based on a random sample, each selected person represents more than 4,500 United States residents. At the end of the completed interview, the selected person will receive $30 in cash.”
Once the person was selected, how was the interview then conducted?
“Participants complete the interview in the privacy of their own home. A professional RTI interviewer personally visits each selected person to administer the interview using a laptop computer. No prior computer skills are necessary. Individuals answer most of the interview questions in private and enter their responses directly into the computer so even the interviewer does not know the answer entered. For some items, the interviewer reads the question aloud and enters the participant’s response into the computer. The interview takes about an hour to complete.”
And what sort of questions did the interviewer ask? Here are a few examples:
“During the last 30 days, how often did you feel nervous? / During the past 30 days, how often did you feel hopeless? / During the past 30 days, how often did you feel restless or fidgety? / During the past 30 days, how often did you feel so sad or depressed that nothing could cheer you up? / During the past 30 days, how often did you feel that everything was an effort? / During the past 30 days, how often did you feel down on yourself, no good or worthless?”
Those chosen to take the survey then entered one of the following answers for each question: “1 All of the time / 2 Most of the time / 3 Some of the time / 4 A little of the time / 5 None of the time / Don’t know/Refused”
If those questions weren’t enough to make a person feel nervous or hopeless, I don’t know what else could. Furthermore, if, after an hour of questioning, the interviewee didn’t start to feel restless or fidgety, that individual might just be superhuman. But a barrage of more specific questions were posed to determine whether or not the participant suffered from what the “experts” of the DSM have labelled “MDD,” or “Major Depressive Disorder”:
“1. Depressed mood most of the day: The following questions refer to the worst or most recent period of time when the respondent experienced any or all of the following: sadness, discouragement, or lack of interest in most things.
During that [worst/most recent] period of time…
- … did you feel sad, empty, or depressed most of the day nearly every day?
- … did you feel discouraged about how things were going in your life most of the day nearly every day?
- Markedly diminished interest or pleasure in all or almost all activities most of the day
- … did you lose interest in almost all things like work and hobbies and things you like to do for fun?
- … did you lose the ability to take pleasure in having good things happen to you, like winning something or being praised or complimented?
In answering the next questions, think about the [worst/most recent] period of time.
- Did you have a much smaller appetite than usual nearly every day during that time?
- Did you have a much larger appetite than usual nearly every day?
- Did you gain weight without trying to during that [worst/most recent] period of time?
- … because you were growing?
- … because you were pregnant?
- How many pounds did you gain?
- Did you lose weight without trying to?
- … because you were sick or on a diet?
- How many pounds did you lose?
- Insomnia or hypersomnia
- Did you have a lot more trouble than usual falling asleep, staying asleep, or waking too early nearly every night during that [worst/most recent] period of time?
- During that [worst/most recent] period of time, did you sleep a lot more than usual nearly every night?
- Psychomotor agitation or retardation
- Did you talk or move more slowly than is normal for you nearly every day?
- Were you so restless or jittery nearly every day that you paced up and down or couldn’t sit still?
- Fatigue or loss of energy
- During that [worst/most recent] period of time, did you feel tired or low in energy nearly every day even when you had not been working very hard?
- Feelings of worthlessness
- Did you feel that you were not as good as other people nearly every day?
- Did you feel totally worthless nearly every day?
- Diminished ability to think or concentrate or indecisiveness
- During that [worst/most recent] time period, did your thoughts come much more slowly than usual or seem confused nearly every day?
- Did you have a lot more trouble concentrating than usual nearly every day?
- Were you unable to make decisions about things you ordinarily have no trouble deciding about?
- Recurrent thoughts of death or recurrent suicidal ideation
- Did you often think about death, either your own, someone else’s, or death in general?
- During that period, did you ever think it would be better if you were dead?
- Did you think about committing suicide?”
Even if the participant made it through all of those questions, he or she might well be depressed just by reading them. By answering all of the questions, and then pocketing the $30 payment, the participant at least demonstrated that he or she was mentally healthy enough to endure an hour-long survey. But remember, all of these questions refer to “the worst or most recent period of time when the respondent experienced any or all of the following: sadness, discouragement, or lack of interest in most things.” It just so happens that if you are a human being, feelings of sadness, discouragement, or lack of interest just might be natural, particularly during difficult times. This survey could have been administered to someone who just lost a job. The participant might have recently lost a loved one, had a baby, or been injured in a hockey fight. In short, there is no real objective way to determine whether a person is mentally ill or not, in part because there is no real consensus about what it means to be mentally ill.
But this hasn’t stopped people from systematizing and spreading theories of illness. Nor has it stopped government agencies from conducting surveys to determine how ill America is. When asked what mental illness means, many would answer that it is a problem that results from a chemical imbalance in the brain, or a physiological problem with genetic links… but where is the medical proof that this is actually the case? I’ll let you in on a secret… there is none. In fact, the entire Diagnostic and Statistical Manual of Mental Disorders, the Bible of psychiatry, is a work of fiction, albeit a very clever work of fiction. This ever-expanding handbook of mental illnesses has yet to include a diagnosis for those who obsessively diagnose and over-medicate innocent people, and thereby brand them with a heavy psychiatric stigma. Perhaps it should include FDS (Fanatical Diagnosing Syndrome) in its more than 800 pages. Of course, in that case, too many doctors and psychiatrists would have to be medicated and hospitalized along with their patients.
In sum, Natalie’s article contributes to a burgeoning branch of media attention given to a nebulous idea that Americans in general, and particularly people from Utah, are becoming more and more mentally ill. This may or may not be true, but the results of the survey, and the statistics that follow, do little, if nothing, to explain what exactly mental illness means, or what exactly causes mental illness. The truth is that nobody knows. Those who claim to know often have something in a bottle to sell. Nevertheless, one thing is certain… if nobody were labelled mentally ill, an entire government agency would have to be dismantled, the profession of psychiatry would disintegrate, and pharmaceutical factories and offices would be razed to the ground. As it is, someone stands to profit from distributing labels, spreading rumors of mental illness and measuring each with statistics… and I’ll give you a hint: it’s not the people to whom the stigma is attached.
Think About It