“We have little time left to right the ship .The number of resentful and angry people who feel lied to and cheated is rising. …explanations for why they feel so hurt have so far blamed the victim. This is no longer tolerable, even if it is the only paradigm left standing from the ‘old system’ of psychology.”…………TomThumb, Wind Shear...

The Prevalence of Mental Illness in America.

This study reported in 2004 shows the frequency of reported mental illnesses in a World Health Organization, World Mental Health Survey. The U.S. tops the chart with 18.2% reporting Anxiety Disorders, 9.6% reporting Mood Disorders, 6.8% reporting Impulse-Control Disorders, 3.8% reporting Substance Abuse Disorder. and 26.4 % reporting Any disorders. The numbers do not mean much until they are compared to other countries. They are the highest on the chart. Except for the the Ukraine, who kicked our butts on substance abuse, with reporting 6.4% (The second chart shows Australia above the U.S. too, on an Index of Drug Abuse created by Wilkinson & Pickett.)

Income Inequality and Mental Illness.

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Wilkinson and Pickett authors of The Spirit Level, plotted the data from the W.H.O. survey, and found that there is a strong relationship between income inequality in the countries on the above graph and the proportion of adults who had experienced mental illness in the twelve months prior to the survey. The U.S.A. is up in the far top right hand corner, on the ultimate ‘income inequality’ High end of the X axis, and at the High end of the ‘% with any mental illness’ on the Y axis. Approximately 26 % of Americans, or 1 in 4, reported mental illness within the prior 12 months of the survey.  Following the same gradient of income inequality and loss of trust discussed here, the same pattern is displayed when differences in proportion of people reporting mental illness between countries are compared. About 8% reported mental illness in the more equal countries on the left hand side of the X axis, and about 26% in the more unequal country. That is a ratio of 3.25 times greater frequency of mental illness in the more unequal society.

Types of illness reported included subtypes of mental illness and their relative frequencies. Anxiety disorders, impulse control disorders and severe illness all were strongly related to inequality. In all countries, anxiety disorders represented the largest group. The authors of The Spirit Level noted that this subgroup of anxiety disorders had increased its frequency in all countries over recent decades and had theorized that this was due to an increase in status competition in the presence of widening inequalities. The recent WHO data confirmed that this subgroup of anxiety disorders is reported more highly in countries which are more unequal. Given the emphasis on status competition in extremely unequal societies, it is surprising that subjects reported mental illness to the extent shown in the survey.  In discriminating, unequal societies, mental illness is stigmatizing and is used as a reason to exclude individuals from educational, employment, and recreation opportunities.

Wikinson & Pickett found that in and among  American States individually, that men’s mental illness did not show an increase related to relative inequality in the society, but that there was a stronger relationship for women, and a very strong relationship between frequency of mental health of children and living in unequal states within context of the U.S.A..  Although the authors were hard pressed to find an explanation for the low reported association between men’s mental illness and income inequality, my theory is that popular U.S. culture promotes male dominance. In a culture suffused with the denial of any male personal weakness, mental health difficulties would be perceived as a ‘male social death’ sentence.

Overall, however, the U.S.A. showed the very high levels of mental illness which would be expected in a highly income unequal country. Wilkinson & Pickett attribute the high level of mental illness to the exponential levels of stress in income unequal countries. They attribute the stress to the relentless, insatiable quest for money and possessions as symbols of social status. And the importance of social status is to buttress the forever vulnerable and fragile narcissistic self, in its quest for individual recognition. These kind of values promote mental illness and place everyone at risk for status anxiety. The greater the inequality, the greater the need for everyone at all levels, to compete to ‘keep up’ and to keep striving for more. Conversely, the bottom fifty per cent of society gets to feel shamed for not having these same status symbols.

Dr. Friedli wrote about the isolation and loneliness of the mentally ill, and about how social connection and social resources act like a hidden reservoir of social wealth; of friendships and family relationships which we can draw on when we are in need. With the loss of trust and loss of social cohesion in communities which Wilkinson & Pickett found were associated with unequal countries, it is plausible that these same unequal societies with their high rates of mental illness, are also very isolating, very lonely places too.

Inequality and Illegal Drugs.

The Spirit Level authors created an Index of Drug Use and graphed it along a measure of Income Inequality. They found that the use of illegal drugs was more common in more unequal countries. The U.S.A is at the top right hand corner of the graph.

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The World Drug Report included separate data on drug use which the authors combined to form a single index. Drug use included in the report was for use of opiates, cocaine, cannabis, ecstasy and amphetamines. In the United States, the authors also found a correspondence with higher addiction to illegal drugs, deaths from drug overdose, to higher income inequality in individual States. So not only was the U.S. a ‘winner’ for higher drug use as a nation among nations but it is also one of the most unequal income inequality countries among rich democracies. The authors attribute the severity of drug use to the pain of low status in a highly unequal society. This appears to be self-medication. There is no judgement here against this, because I will not deny humans relief from pain. It is just too much to bear to have your face rubbed in the fact day after day that you are low-ranking; to have  your nose rubbed in what you do not have, over and over.

Disembodied Problems.

It is a basic human right to be able to walk about in public without feeling shame. Poverty is living in shame and is forcing people to either hide in shame or to experience its humiliations in public. Six ways to Sunday, our society is saying to the dislocated, disconnected and the impoverished, you are not worth Society’s time. The Libertarian imperative to solve all of one’s problems on one’s own is painful vinegar in the wounds of the impoverished, the rejected and the excluded. Positive psychology’s imperative to pepper one’s mind with false reassurances, is empty, calorie-less saccharine. Conventional mental health’s emphasis on the individual’s mental health as his/her own creation has lost its legitimacy and its panache. And, like conventional thinking, individualistic psychology substantiates and supports the unequal divisions in society, the myth of meritocracy, and supports keeping society just as it is. Mental health and mental illness are made to appear to float in vapor, disconnected from their social contexts, and reappearing as disembodied problems.

The Social Stress>Biological Responses Pathway.

Hope for a new theoretical model comes from work on the biology of social stress. Depression in humans is associated with reduced levels of dopamine and serotonin. Animal studies show brain chemistry changes associated with low status and high social status. These studies also show that the changes suggest plasticity:

Among animal communities which form hierarchical social structures with dominant and subordinate members, research into the effects of social stress has been possible. Monkeys were assessed when they were in individual cages and then again when they were in social interactions in a group. Researchers found that there were observable differences in brain chemistry and in behavior towards self-administration of cocaine.  Monkeys which became dominant when they entered the group had more dopamine activity in their brain than they did before. Monkeys that became subordinate in the group condition, showed no changes. Subordinate monkeys took more cocaine and dominant monkeys took less cocaine. Researchers interpreted this as  ’losers’ who were self-medicating against the pain of low social status.

The monkeys’ social-status-experiences and changes in brain chemistry, and need for cocaine, show plasticity in response to social stress. (Surprise. Surprise.) If this applies to humans as it does to these monkeys, it suggests human brain chemistry and behavior may be altered by social status. Instead of tolerating the Darwinian perspective of a dog-eat-dog world and a belief that only the strong survive, we can challenge D.’s theory with this evidence of plasticity. Perhaps in the next post about Income Inequality and Physical Health this evidence of the biological impact of social stress will become central to the argument for a more equal society.  New theories of what makes us sick are possible.

Solutions.

The solutions to our mental health difficulties are not as obvious as we might think and involve broader more comprehensive interventions in all areas of our society.  The solutions to mental health problems look very similar to the solutions to all of our social and health problems. (From the report by Dr. Friedli, W.H.O.):

Support family and community life. Provide education that enables children to flourish. Create employment, pay, workplace conditions that are good for mental health. Partner with health and other sectors to address social and economic problems that lead to psychological distress. Reduce barriers to social contact.

The core principle Dr. Friedli adheres to in her recommendations, is to consider the impact of every social policy decision on mental health and mental illness.

All of the cited works are available as resources at the www.EqualityTrust.org.uk/ site.  The Spirit Level:Why Greater Equality Makes Societies Stronger is available as a book and contains all of the charts and an extensive bibliography.