We hear a lot about depression these days and we are told that depression is experienced by increasing numbers of people. We read about it in the press and its increasing prevalence is widely reported on radio and on social media.
So what is happening? More and more people, especially the young complain that depression has become a feature in their emotional lives. Yet those of us who live in economically advanced countries have never had it so good in terms of our standard of living and general material benefits. To quote: western society has never been so prosperous, yet western society has never been so depressed!
So what is going on? Do we have an explanation for this paradox? Are we really becoming more susceptible to depression or as some experts have suggested, depression has become modern society’s label for unhappiness.
Perhaps it is an indication of an emerging perspective that bad things are not supposed to happen to us, and when bad things do occur, they are perceived as an abnormal intrusion into our lives and are relegated to the domain of pathology or disease. So rather than acquiring the skills to deal with an adverse experience ourselves, we seek help from the expert whom we expect to problem solve our difficulties and often with the assistance of pills.
This issue is especially relevant today with reports of rising rates of mental illness in our communities and particularly in young people.
A 2018 study published by Higher Education Research at the University of California, Los Angelas reported a consistent rise in anxiety in first year university students over a period of thirty years. For example in 1985, 18% reported overwhelming anxiety, this figure rose to 29% in 2010 and to 41% in 2017.
Another example; in 2019 the Ontario University and College Health Association reported the results of a survey completed in 2016. It revealed that 65% of students described experiencing overwhelming anxiety in the previous year while 46% stated that they experienced depression sufficiently severe that “they found it difficult to function“.
While closer to home here in Oakville, the emergency department of Halton Healthcare Services saw an increase in patients (of all ages) presenting with a major psychiatric diagnosis rising from 3,392 in 2009 to 12,333 in 2019. This trend was also seen in other hospitals in Ontario.
What does this mean? Is mental illness really on the rise? Are we as a society more susceptible to mental illness? Are we becoming more sychologically fragile, especially our youth?
The emerging influence of social media in society has been noted by many as one of the most significant social changes over the past twenty years. It has been further noted that the impact of these changes may have had a detrimental affect on the lives of young people.
For example, smart phones became available in 2007 and it is reported that by 2015 almost ninety percent of teenagers owned a smart phone. This increase in their availability coincided with a sharp spike in the number of young people seeking help for psychological issues. Problems identified included, low self esteem, sleep deprivation, social isolation with loss of social skills, and multitasking, resulting in ADHD type behaviour. Body image issues were a concern in younger women when they compare themselves to the idealized images they often saw on social media.
A paper published in the Canadian Medical Association Journal in 2020 raised the interesting point that what we are seeing are rising rates of psychological distress rather than strictly diagnosed psychiatric disorder. Other experts have noted, for example that prevalence rates for schizophrenia have not increased in recent decades.
Yet psychiatric illnesses that we consider culturally sensitive are making increasing demands on the health services and these include eating disorders, ADHD, addictions, autism spectrum disorder and post traumatic stress disorder.
Are we observing a true rise in mental illness or does this reflect a trend that we are becoming more expansive in our diagnostic habits? This trend has been described by social psychologist Professor Alex Haslam as “creeping clinicalism” or “concept creep” where concept boundaries are progressively stretched, and we run the risk of pathologizing behaviour that may be more a manifestation of temporary distress rather than an indication of the presence of a serious mental illness.
And more about this issue later!
Karl O’Sullivan MD