Thursday, June 06, 2013

The rise in mental health problems - and other measured diseases

Over on Club Troppo, The Mental Health puzzle, part III: the cultural hypothesis continues Paul Frijter's examination of the puzzle of the measured increase in in mental health problems (depression, anxiety, and obesity in particular) across the Western world since the 1950s and in Anglo-Saxon countries in particular. In looking at this, Paul explicitly took it as a given that that this was a real increase and not just a measurement issue.

Now I have only just come across the series (I missed the earlier posts), so have nor properly absorbed Paul's arguments. However, the discussions links to some things that I have been thinking about that I just wanted to jot down.

The rise in measured diseases is not limited to mental health. My impression is that we are looking at a pattern that is broader than that. I suppose that the two that have most puzzled me are the apparent rise in asthma and in allergies of all sorts. If we take asthma as an example, I was in my early twenties before I met anyone with serious asthma. It wasn't talked about in a day to day sense. Now I see puffers everywhere and I have met multiple people suffering from what appears to be relatively severe asthma.

No doubt part of the answer lies in the increase in population. Where serious conditions are rare, the visible numbers and hence the commentary rise as the population rises. However, it would appear to be more than that. Here, and just looking at social things, I want to list three interacting things.

The first is the combination of reporting and measurement. Our capacity to collect data has risen sharply, as has the desire to report on different things. There is, I think, plenty of evidence to show that better reporting and data management systems leads to a rise in the number of recorded incidents and responses to those incidents.

The second is the professionalisation and especially the medicalisation within our community. All professionals look for problems that they can solve with their respective tool kits. They classify things in terms of their own taxonomies. You can see this in the mental health field, for example, where there has been a very large expansion in the things classified as "mental Illness" and therefore addressable via medical means. This is not helped by our own desire for answers.

The third can be classified as feed-back loops. As we become more aware of things, we apply them to ourselves. We seek help and advice on more things. This is reported. We become more aware. Its kind of a reverse placebo effect.

These three interacting things to my mind play a significant role in some of the trends that we see. If we really want to measure something like the of serious allergies, asthma or mental illness we have to be able to net these other trends out, and this can be hard.      



Evan said...

Allergies are possibly a 'side effect' of our cleaner environment - and so less exposed immune systems. If anyone from the modern West was dropped into medieval Europe they'd probably be dead very soon.

Mental illness does seem to be on a mission to medicalise life. Though it is a quite young field in terms of drugs (post-ww2 really). So rapid development and hubris can be expected I think. (The drug cure for schizophrenia has been a decade away for the last 50 years.)

Jim Belshaw said...

On the cleaner surrounds, you could well be right, Evan. I know that many people including me have wondered about that. And your comment on medieval Europe would add a twist to time travel novels!

Not sure on the drugs timing issue, although I suspect that you are right.

Legal Eagle said...

Jim, my Mum has been doing a genealogy of our family. In the 1700s and 1800s, there are numerous descriptions of cause of death which clearly would indicate asthma or lung problems linked with it to modern eyes. So it's really not surprising that I'm severely asthmatic. But obviously they had no concept of this, and it is interesting to see how it is described in the death certificates when you don't have an obvious label.

I lived England as a toddler in the 1970s - I had this barking cough, and the doctor told my mother, "Oh that's just 'Cheshire Throat', everyone has it here." When we got back to Australia when I was 4, my paediatrician listened to the cough and said, "How long has she been asthmatic?" Later, when I lived in Manchester in the 1990s, the same barking cough was often diagnosed as "catarrh" by doctors in the area - but I suspect that a lot of what was diagnosed as "catarrh" was actually asthma. So it's about awareness (which even 20 years ago was not necessarily present in a developed country like the UK).

Legal Eagle said...

Oh yes, on mental illness - one of my great-grandmother's forebears (called John Bowie) apparently committed suicide after at least one other attempt (got himself tanked, threw himself in Sydney Harbour and drowned). It's no surprise that in that branch of the family there is a clear genetic tendency to depression, and both my great-grandmother and my grandpa suffered it badly. Again, I'd say that was always there, but I doubt that anyone at the time realised that John Bowie was "depressed" because there wasn't that concept.

Jim Belshaw said...

That's very interesting, LE. As you know, I read a lot of history, and the classification of the things that people died from does reflect the type of thing that you are talking about. So part of the story is simply more accurate recognition and diagnosis. I had to look catarrh up to refresh my memory. The description doesn't link it to asthma, but to other things like allergic reactions.