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November 27, 2007

Are Mental Disorders Really Increasing?

Between the years of 1952 and 1968, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders stayed pretty much as is, but in the 1980s, ideas about mental health and our ability to cure everything took a turn for the worse. Suddenly, there were hundreds of new disorders which needed medication.

With the advent of slick marketing and new drugs, there has been an artificial creation of disorders in need of treatment. Take the classic case of human growth hormone—initially it was created to treat a form of pituitary dwarfism, but companies soon found other ways to market the drug: they simply created a new disorder called shortness.       

In the December issue of The New York Review of Books, cultural critic Frederick Crews reviews three books dealing with this issue.

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Mark Triplett

There are probably more illnesses diagnosed just due to better technique, but not to the extent that is reported. As they said during the 70's, "follow the money."

Money is what runs most of these lobbying organizations and there is lots coming from all directions.

Also, why work hard in finding out what is wrong with your patient when you can read the sheet for the RX and see that it treats problem "a". Why bother. It's also nice to get that check every month for each and every RX for the special drug.

Doctors, treat the disease and not the symptom!


When I was in medical school, I was told that 10% of the population was mentally ill. I recall thinking that was awfully high; I didn't know anyone with a mental illness.

Thirty years and almost half a lifetime later, I look back with a chuckle at the naivete of youth...as I have come to believe that 10% is way too low. I've personally known dozens with one diagnosis or another that I could personally confirm (and mental health isn't even my specialty). Sure some things get overdiagnosed (ADHD) and it can always be argued what constitutes a real mental illness versus common personality dysfunction. But with all the depression, narcissism, alcoholism and other addictions, eating disorders, bipolar personalities, and undiagnosed personality disorders - most of which have no pharmaceutical remedy and no corporate constituency, mind you - there is an epidemic to be sure. When the numbers are already epidemic in proportion, how important is it really whether they are increasing?

Kim Moreland

Why are you classifying narcissism as a mental illness?


Good question; it was probably redundant since I also mentioned personality disorders, and narcissism is only considered a mental illness when five of nine criteria for narcissistic personal disorder (NPD) are present. Everyone's a little narcissistic, but some to such a severe degree that they can't sustain relationships and make a train wreck of their lives. I know; I was once married to one. What is sobering to me is that had I not been a physician having some familiarity with mental illness, and had I sought out clinical psychologists for our marital counseling, she would never have been diagnosed.

For a Christian perspective on the subject, Paul Maier discusses NPD in his book "Crazy Makers - Getting Along with the Difficult People in Your Life." The discouraging thing is that they are very difficult to help, because as their lives come crashing down around them, it's always because of bad luck or bad people, never because of something they think, do, or say.

Kim Moreland

I'm very sorry to hear of your personal experience with extreme narcissism. I'm sure that it was painful to walk through.

Where are we to draw a line between sin and an organic mental health problem sickness?


I'm not the expert, but I would think that, generally speaking, sin is sin whenever it is committed. The only exception, and where one might draw that line you mention, is when the individual is truly not in control of his faculties. Where there may be some genetic predisposition towards sinful behavior, as in alcoholism, that only affirms the Biblical concept of our innate fallenness. Why would it not show up in our genes? (Which is why I think the whole argument over whether homosexuality is genetic is such a red herring)

Knowing where to draw the line between the normal dysfunctions we all have and bona fide mental illness is a continuing challenge. Professions in the mental health field argue among themselves over where to draw those lines. Is shyness a personality trait or an illness ("social anxiety disorder"). In cases like that, the tendency has been to identify the outliers, define some criteria, and give it a name. The fact that some things, like panic disorders or social anxiety disorders, improve with medications used to treat other mental illnesses, also makes it easier to believe these are real illnesses.

When is depression a disease, and is it organic or behavioral? The common belief today that it is caused by abnormal "brain chemistry", and is therefore organic, is confounded by research showing the superiority of cognitive therapy over antidepressants in the long term treatment of depression (hearkening back to the original comment about pharmaceuticals).

Depression is really an interesting one to look at. Some of it is transitory and related to traumatic life events, but most of the chronic depression results from habits of negative thinking, and especially the chronic disappointment resulting from the collision between expectations and reality. Various books have examined the rise of narcissism in our country ("Generation Me" by Jean Twenge comes to mind). A key element of narcissism is the presence of unrealistic expections for oneself. Thus more narcissism should lead to more depression. Dr. Twenge connects those very same dots in her book, by the way.

Anyway, I've gone on way too long on a field I'm no expert in. Maybe a psychiatrist would like to chime in.

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