DON EDGAR. Looking for the cuckoo in the mental health nest.

Nov 27, 2018

As a researcher, I have always been suspicious of statistics touted as incontrovertible truths; and of propagandists for a cause who claim to be the holders of effective remedies for complex social problems.  The current ‘truths’ being touted (and winning huge increases in government funding) are that one in every five Australians has a mental disorder, that mental health problems are on the increase, costing the economy billions of dollars, and that a few chosen mental health experts have the solutions, if only their services were better funded. 

It’s time to call them out, and I trust Victorian Labor’s proposed Royal Commission into Mental Health will provide a more careful assessment of the evidence on both prevalence and the efficacy of proposed ‘treatments’. Its chief supporter, the ever-ubiquitous Professor Patrick McGorry, claims the system is broken down; his sceptical NSW counterpart Professor Ian Hickie is not sure we need such an inquiry and a critical eye needs to be applied to what is actually being done.

The one-in-five figure comes from the ABS National Survey of Mental Health & Wellbeing of 2007. A careful look at that study is worthwhile but few journalists bother, and the mental health advocates whose incomes depend on a moral panic about rising mental problems never bother to correct them. Trigger warnings on TV shows urge us repeatedly to call Beyond Blue or Lifeline if you get upset, reminding us how widespread mental illness may be. It is not, but it seems to be the flavor of the day.

The ABS survey was not about paranoid schizophrenia or manic depression. Instead, what it found was that, at some point over a lifetime, 47% of the Australians surveyed had had something labelled a ‘mental disorder’ and one in five had a ‘12 month disorder’ of some kind. That 1 in 5 category included a substance abuse problem (5.1% drugs and alcohol), an ‘anxiety disorder’ (14.4% overall, including post-traumatic stress, agoraphobia, ‘generalised anxiety’, ‘social phobia’ and obsessive-compulsive disorder). Another 6.2% had an ‘affective disorder’, including ‘a depressive episode’ and ‘bipolar disorder’.

That’s a very mixed bag, with all sorts of definitional problems. Few members of the public would consider alcohol as a mental rather than a physical health problem. ‘Depressive episodes’ can arise from losing a job, being divorced, diagnosed with cancer, failing an exam or being bullied at work. The category ‘affective disorder’ is defined as ‘recurrent or stressful events/situations’ and is more prevalent with women, disadvantaged/low socio-economic groups and single parents. Anxiety is highest in the 35-44 year-old age group, those most under pressure from work-family conflicts, the threat of losing a job from automation and mid-life angst.

The survey also found (using the Kessler Distress Scale) that lifestyle factors such as obesity, lack of exercise, disability and lack of contact with friends to rely on are linked to so-called mental health problems. The unemployed are particularly vulnerable (29%) and substance abuse is four times higher for those not married. Surprise, surprise.

In other words, much of the stress, anxiety and depression arises from social causes and situations, not from some underlying ‘mental health’ defect. Yet the ‘solutions’ being proposed are not social, they are more ‘services’ such as counselling, giving drugs or some form of psychotherapy. And evidential proof that such psychological interventions ‘work’ is lacking.

A 2016 study of the much-vaunted ‘Headspace’ program for youth mental health services found it provided only a ‘small’ benefit, with less than a quarter of clients significantly improved, and the wellbeing of one in every ten patients actually went ‘backwards’. The International Mental Health Watchdog CCHR calls Headspace “a $37.5 million gigantic experimental lab”. McGorry’s claim that pre-drugging adolescents with anti-psychotics could ‘prevent’ mental illness was thoroughly debunked, and some of the drugs actually used exacerbated suicidal tendencies. Also debunked was his ‘Psychosis Risk Syndrome’ (which included symptoms such as ‘odd beliefs’, ‘suspiciousness’ and ‘going off track while speaking’). Who would define such things? The psychiatrist or psychologist in charge, of course. And why wouldn’t a teenager be suspicious of questions designed to elicit such ‘evidence’ of mental illness? On that basis nine out of every ten teenagers would be misdiagnosed!

As an early critic of psychiatry, Thomas Szasz, put it: “In the past, men created witches: now they create mental patients”.  His argument focused on the power of definition, from a ‘profession’ with no code of ethics and no body of evidence to prove what interventions work. “If you talk to God, you are praying. If God talks to you, you have schizophrenia.” In his view, psychiatric expert testimony is “mendacity masquerading as medicine”, perhaps somewhat extreme but still a warning against throwing millions at ‘solutions to the mental health problem’ when evidence is lacking on all fronts.

There is not even evidence that common mental health disorders have increased. A 2017 study found no change in the rates between 2001-2014. Yet there was a 50% increase in those receiving disability support pensions on grounds of mental illness, with ‘depression’ becoming the fourth highest ‘cause’ of disability in Australia. The 2014-15 ABS National Health Survey reported some 15% had co-existing long-term mental or behavioural conditions, with the same links to unemployment, disadvantage, lower educational attainment and lone-person status – all social conditions hardly likely to be affected by counselling or drug treatments; and co-existing with conditions such as obesity and lack of physical exercise. Yet prescribing anti-depressant drugs doubled and the cost of ‘depression’ was estimated to be an alarming $12.6 billion. The parallel rise in rates of ‘ADHD’ and ‘autism’ is a similar example of definitional, diagnostic over-reach. The aged are next in line, with doctors over-prescribing anti-depression pills as a way of blocking out the misery of declining physical health.

Say something often enough – “one in five have a mental illness” or “suffer from anxiety and depression” – and the troops fall in behind the mantra, government money flows to those making the most noise and the real underlying causes of distress and anxiety in society go begging. We should not easily dismiss the problem;  social stress does seem to be on the rise. But its causes go well beyond the new witch-doctoring and we should demand better evidence of effectiveness, not simply call for more ‘trained psychiatrists’ (trained where? and how well?).

The links between advocates of the mental health industry and major drug companies should be exposed, their methods called into question. There is no consensus anywhere on ‘valid’ forms of psychotherapy and new diagnostic categories are added to the manual every year. The numbers of those with a ‘mental illness’ have not grown, but those in need of ‘treatment’ are, according to the experts, exploding into a national crisis. It’s a nonsense crying out for full disclosure.

Dr Don Edgar is a sociologist, foundation Director of the Australian Institute of Family Studies and a Patron of the National Ageing Research Institute (NARI). He is co-author (with his wife Patricia) of PEAK: Reinventing middle age.

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