Although, among New York Times commentators, Paul Krugman claims the title, "The Conscience of a Liberal," in many ways this label best fits fellow Times columnist Nicholas Kristof. Kristof has selected as his beat human rights broadly construed around the world. This includes the sex trade, gun control, ethnic strife and cleansing, childhood poverty and education, third-world health problems, and so on. But guess Kristof's nominee for the most "systematically neglected issue." He thinks it's "mental health," and specifically that we are ignoring mental disorders.
"One-quarter of American adults suffer from a diagnosable mental disorder, including depression, anorexia, post-traumatic stress disorder and more, according to the National Institutes of Health. Such disorders are the leading cause of disability in the United States and Canada, the N.I.H. says.
A parent with depression. A lover who is bipolar. A child with an eating disorder. A brother who returned from war with P.T.S.D. A sister who is suicidal.
All across America and the world, families struggle with these issues, but people are more likely to cry quietly in bed than speak out. These mental health issues pose a greater risk to our well-being than, say, the Afghan Taliban or Al Qaeda terrorists, yet in polite society there is still something of a code of silence around these topics." (emphases added)
Finally, among the many problems with which Kristof is concerned that have been with us for some time, and that might invite the idea that they are intractable, Kristof has an issue on which he has a powerful, well-financed ally with a tremendous track record of success in imposing its point of view on others -- the international psychiatric/pharmaceutical industry.
The awareness that one in four of us suffers from a diagnosable mental disorder -- a percentage that never stops growing, especially among the young with whom Kristof is primarily concerned -- is in good part due to this industry. The conditions it has amplified our awareness of since DSM-III's publication in 1980 have been identified in part by PT blogger Edward Shorter. Whereas Shorter restricts his attention to depression, there has also been monumental growth in the diagnoses of bipolar, ADHD, schizophrenia and other psychoses, a development that has coincided with a dramatic rise in the use of psychiatric drugs over the last 35 years. Dr. Allen Frances has been concerned to alert PT Blog readers to this ever-expanding diagnosis and medication of Americans.
As a result, it is hard for me to second Kristof's view of mental health as suffering a "code of silence." Rather, treatment for mental disorders is marketed around the media and around the clock, and especially for children. The Times has focused on "The Selling of Attention Deficit Disorder" and the promotion of drug treatments for ADHD. The hypermarketing of anti-depressant and anti-psychotic drugs (both also used to treat bipolar disorder) has pushed these products to the top of the drug sales charts. According to Dr. Marcia Angell, we now have an "Epidemic of Mental Illness." The Times tell us that "one in five Americans takes at least one psychiatric medication." How much more growth in this figure would Mr. Kristof like to see -- is one of two Americans the right ratio?
These conditions are being actively spread around the globe. Ethan Watters, author of Crazy Like Us, published "The Americanization of Mental Illness" in the New York Times Magazine exactly four years ago. (Kristof probably doesn't read that rag!) As I quoted Mr. Watters in PT:
For more than a generation now, we in the West have aggressively spread our modern knowledge of mental illness around the world. We have done this in the name of science, believing that our approaches reveal the biological basis of psychic suffering and dispel prescientific myths and harmful stigma. There is now good evidence to suggest that in the process of teaching the rest of the world to think like us, we've been exporting our Western "symptom repertoire" as well. That is, we've been changing not only the treatments but also the expression of mental illness in other cultures. Indeed, a handful of mental-health disorders -- depression, post-traumatic stress disorder and anorexia among them now appear to be spreading across cultures with the speed of contagious diseases. (emphases added)
Watters seems to be speaking about Kristof's worldview and catalogue of concerns:
Americans, particularly if they are of a certain leftward-leaning, college-educated type, worry about our country’s blunders into other cultures. In some circles, it is easy to make friends with a rousing rant about the McDonald’s near Tiananmen Square, the Nike factory in Malaysia or the latest blowback from our political or military interventions abroad. For all our self-recrimination, however, we may have yet to face one of the most remarkable effects of American-led globalization. We have for many years been busily engaged in a grand project of Americanizing the world’s understanding of mental health and illness. (emphasis added)
So, Nicholas Kristof, in his own particular brand of American exceptionalism, can take pride in how much America has already forced our psychiatric categories and logic on the world -- but, yet, push us even harder in this direction. Then, maybe, the whole world will enjoy the mental health represented by America's current rate of 20 percent (and rising) use of psych meds!
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