What is causing the mental health crisis?
52.9 million U.S. adults have a mental illness.
"1 in 5 Americans will experience a mental illness in a given year." — CDC
"More than 50% will be diagnosed with a mental illness or disorder at some point in their lifetime." — CDC
Suicide is the 12th leading cause of death for all ages in the U.S. and the second leading cause of death in people aged 10–34.
Things have gotten bad enough that the U.S. Senate held a hearing in February 2022 to address the nation's "growing crisis" of mental health and substance use disorders.
What's going on? Why are so many people mentally ill?
Answering these questions is the first step in solving the problem. If we know what's causing the mental health crisis, then we can dam the flood at its source. We can implement preventative mental health care practices that directly address the root causes of mental illness.
Is it possible that evidence of the mental health crisis is misleading?
Perhaps we just have more names for mental illnesses. In other words, we've always had high levels of mental illness, but now that more research has been focused on mental health and we've developed more names and classifications for mental health disorders, we are finally reporting and collecting data on mental illnesses that have always been prevalent. If this is the case, then the apparent increase in cases of mental illness really reflects our increased ability to detect and identify mental illnesses, rather than an increase in the mental illnesses themselves.
Or, maybe we're just more sensitive. As mental health becomes less stigmatized and more commonly discussed, health professionals are now more likely to diagnose and patients are more likely to self-report something as a mental illness, which before would have been not diagnosed/reported at all or diagnosed/reported as something else.
But neither of those theories explains why suicide rates increased by 36% between 2000-2018.
If the increase in cases of mental illness is not attributable to a statistical error, then what has actually happened in our everyday lives such that we are now more mentally ill than before?
Let's try to answer this question first on the individual level and then on the societal level.
What causes mental illness on an individual level?
There is an ongoing debate about this. These factors are all thought to be possible causes:
Genetic factors
Biological factors
Environmental factors
Behavioral factors
Social factors
This article published by the APA gives a great summary of the debate.
Biological factors
Some doctors think mental illness is all about biology, brain chemistry specifically.
"All mental processes are brain processes, and therefore all disorders of mental functioning are biological diseases."
"The brain is the organ of the mind. Where else could [mental illness] be if not in the brain?"
— Eric Kandel, MD, a Nobel Prize laureate and professor of brain science at Columbia University
Other factors
Others think that biology alone doesn't give us the full picture of what's causing a mental disorder.
"We've thrown tens of billions of dollars into trying to identify biomarkers and biological substrates for mental disorders ... The fact is we've gotten very little out of all of that."
"In the unusual case where normal traits come together in a certain configuration, you may be maladapted to society ... Call it a mental disorder if you want, but there's no smoking-gun malfunction in your brain."
"If we focus only at the brain level, we are likely to miss a lot of what's going on in mental disorders."
— Jerome Wakefield, PhD, DSW, a professor of social work and psychiatry at New York University
Different mental health disorders have different causes
Some mental health disorders are clearly caused by biological factors while others seem to be caused, at least in part, by environmental factors.
"Certain disorders such as schizophrenia, bipolar disorder and autism fit the biological model in a very clear-cut sense."
— Richard McNally, PhD, a clinical psychologist at Harvard University and author of the 2011 book "What is Mental Illness?"
"When it comes to mental illness, a one-size-fits-all approach does not apply. Some diseases may be more purely physiological in nature."
"In these diseases [that fit the biological model], [McNally] says, structural and functional abnormalities are evident in imaging scans or during postmortem dissection."
"Yet for other conditions, such as depression or anxiety, the biological foundation is more nebulous. Often, McNally notes, mental illnesses are likely to have multiple causes, including genetic, biological and environmental factors."
"To be sure, Wakefield says, some psychological disorders are likely due to brain dysfunction. Others, however, may stem from a chance combination of normal personality traits."
"The danger in placing too much attention on the biological is that important environmental, behavioral and social factors that contribute to mental illness may be overlooked."
— Kirsten Weir, APA
Depression and anxiety seem to be caused, at least in part, by environmental and social factors
My biggest takeaway from the APA article is that some disorders—e.g., schizophrenia, bipolar disorder, and autism—are more clearly caused by biological factors, and other disorders—e.g., depression and anxiety—are more influenced by environmental, behavioral, and social factors.
We know that our biology changes over time. This is evolution. But it's a very slow process.
On the other hand, changes in our environment, behavior, and social climate are rapid. Especially in modern times, due especially to technology, things are changing very fast.
Therefore, because our biologies change slowly, I would expect that rates of schizophrenia, bipolar disorder, autism, and other biologically-caused mental disorders have changed by a small amount in recent times.
On the other hand, rates of depression, anxiety, and other environmentally-caused mental disorders may have changed by a much greater amount in recent times, because our environment changes quickly in modern times and some of the changes seem to be having a negative effect on mental health.
COVID is a good case study for this.
In the first half of 2019, 11% of adults reported symptoms of anxiety disorder and/or depressive disorder. In January 2021, over 40% of adults reported the same symptoms, a 4x increase.
If a global pandemic can cause an increase in certain mental illnesses on a societal level, what other environmental and social factors might be causes?
What is causing the mental health crisis on a societal level?
There is no shortage of theories that blame various societal factors for mental health issues. The usual suspects are:
Technology
Economy
Politics
Climate change
Technology and social media
Studies have shown that use of social networking sites may be related to symptoms of depression.
Economic hardship
Psychological disorders increase during economic crises.
Political issues
Some argue that mental health is political, i.e., that political issues are causing increased anxiety and depression in Americans.
Climate change
"Eco-anxiety" refers to "a wide variety of emotional responses to climate change."
A few of my own theories
I have my own theories about what's causing the mental health crisis on a societal level:
Our economic success has created an existential void
The loneliness epidemic is intertwined with the mental health crisis
We're too smart for our own good
Our economic success has created an existential void
I formed this theory after I read about the "existential vacuum" in Man's Search for Meaning by Viktor Frankl and about how economic surplus can cause a general "nervous breakdown" in "Economic Possibilities for our Grandchildren" by John Maynard Keynes.
In his book Man's Search for Meaning, Viktor Frankl describes a phenomenon he calls the "existential vacuum."
"The existential vacuum is a widespread phenomenon of the twentieth century. This is understandable; it may be due to a twofold loss which man has had to undergo since he became a truly human being. At the beginning of human history, man lost some of the basic animal instincts in which an animal's behavior is imbedded and by which it is secured. Such security, like Paradise, is closed to man forever; man has to make choices. In addition to this, however, man has suffered another loss in his more recent development inasmuch as the traditions which buttressed his behavior are now rapidly diminishing. No instinct tells him what he has to do, and no tradition tells him what he ought to do; sometimes he does not even know what he wishes to do.
The existential vacuum manifests itself mainly in a state of boredom ... In actual fact, boredom is now causing, and certainly bringing to psychiatrists, more problems to solve than distress. And these problems are growing increasingly crucial, for progressive automation will probably lead to an enormous increase in the leisure hours available to the average worker. The pity of it is that many of these will not know what to do with all their newly acquired free time.
Let us consider, for instance, 'Sunday neurosis,' that kind of depression which afflicts people who become aware of the lack of content in their lives when the rush of the busy week is over and the void within themselves becomes manifest. Not a few cases of suicide can be traced back to this existential vacuum. Such widespread phenomena as depression, aggression and addiction are not understandable unless we recognize the existential vacuum underlying them."
Similar to the "Sunday neurosis" that Frankl describes, humanity as a whole is approaching—and, in some ways, is already in the midst of—an "end of work neurosis."
Frankl describes "Sunday neurosis" as "that kind of depression which afflicts people who become aware of the lack of content in their lives when the rush of the busy week is over and the void within themselves becomes manifest."
Now, it's not just the week. It's our whole lives. The economic game is over. We won. It's no longer the need to survive that motivates us to keep working. Now, it's antiquated social constructs that motivate us to work, but even these are starting to crumble, and the existential vacuum is becoming more and more apparent.
In his essay "Economic Possibilities for our Grandchildren," John Maynard Keynes explains how solving the economic problem can lead to a general nervous breakdown.
"Let us, for the sake of argument, suppose that a hundred years hence we are all of us, on the average, eight times better off in the economic sense than we are to-day.
I draw the conclusion that, assuming no important wars and no important increase in population, the economic problem may be solved, or be at least within sight of solution, within a hundred years. This means that the economic problem is not—if we look into the future—the permanent problem of the human race.
Why, you may ask, is this so startling? It is startling because—if, instead of looking into the future, we look into the past—we find that the economic problem, the struggle for subsistence, always has been hitherto the primary, most pressing problem of the human race—not only of the human race, but of the whole of the biological kingdom from the beginnings of life in its most primitive forms.
Thus we have been expressly evolved by nature—with all our impulses and deepest instincts—for the purpose of solving the economic problem. If the economic problem is solved, mankind will be deprived of its traditional purpose.
To use the language of to-day—must we not expect a general “nervous breakdown”? We already have a little experience of what I mean—a nervous breakdown of the sort which is already common enough in England and the United States amongst the wives of the well-to-do classes, unfortunate women, many of them, who have been deprived by their wealth of their traditional tasks and occupations—who cannot find it sufficiently amusing, when deprived of the spur of economic necessity, to cook and clean and mend, yet are quite unable to find anything more amusing.
Thus for the first time since his creation man will be faced with his real, his permanent problem—how to use his freedom from pressing economic cares, how to occupy the leisure, which science and compound interest will have won for him, to live wisely and agreeably and well."
Keynes approaches from an economic angle the same problem that Frankl approaches from a psychological angle. There is a void that opens up when we no longer have to work.
Technological automation and economic growth have brought us to this point. Luxuries and conveniences that weren't even imaginable a few generations ago are now available for less than a day's wages.
The average American is about seven times wealthier today than a hundred years ago.
You would think that economic abundance would be a good thing. right?
But Frankl and Keynes cite "Sunday neurosis" and "nervous breakdown[s]" as examples of why economic abundance might actually be to blame for mental disorders.
And there is evidence to support their theories.
A 2012 study found "a positive correlation between a country’s GDP per capita ... and lifetime risk of a mood disorder" and suggested that "an evolutionary mismatch between past human environments and modern-day living, may be central to rising rates of depression."
I've written more about this theory here:
The loneliness epidemic is intertwined with the mental health crisis
Cigna commissioned surveys on loneliness in February 2018, July 2019, and December 2021. The results show that:
"More than half of U.S. adults (58%) are considered lonely. This is fairly consistent with pre-pandemic research that showed 61% of adults experiencing loneliness in 2019, after a seven percentage point increase from 2018."
Some blame technology, especially social media and the internet, for the rising rates of loneliness.
Also, the old ways of community are dying. Less people are gathering at church, in the office, and at school.
Church membership is down
"Americans' membership in houses of worship continued to decline last year, dropping below 50% for the first time in Gallup's eight-decade trend. In 2020, 47% of Americans said they belonged to a church, synagogue or mosque, down from 50% in 2018 and 70% in 1999."
— Gallup, 2021
More employees are working from home
"Roughly six-in-ten U.S. workers who say their jobs can mainly be done from home (59%) are working from home all or most of the time."
— Pew, 2022
College enrollment is declining
"Undergraduate college enrollment is continuing its years-long decline, though at a much less drastic rate than during the pandemic ... U.S. colleges and universities saw a drop of just 1.1% of undergraduate students between the fall of 2021 and 2022. This follows a historic decline that began in the fall of 2020; over two years, more than 1 million fewer students enrolled in college."
— NPR, 2022
Lori Gottlieb is a psychotherapist and author of Maybe You Should Talk to Someone.
An interviewer asked her, "If you could wave a magic wand and change our society so people are less likely to need therapy, what would you change?"
Gottlieb said:
"Lack of connection. No matter what people come in with, there’s an underlying sense of loneliness, disconnection—even if they have friends and family or are surrounded by people. I think people are feeling a lot of depression and anxiety because they aren’t being nurtured by connection. We’ve lost that sense of community that used to be so inherent—at least in my parents’ generation—where you had neighborhoods, and you’d go outside and kids would play. I’m not idealizing the past, but I think the one thing the past did have was a greater sense of organic community.
Nowadays, because we move around so much, we don’t necessarily put down roots in the same way. And each family becomes its own little silo. We aren’t just in each other’s lives organically. Then add technology to that, and people are not having many “I/thou” interactions, where you make eye contact and you’re not distracted by your phone on the table pinging or dinging or vibrating or by the screen on the wall in the restaurant. We lose that unstructured downtime, where we might run into people and get in a conversation or go take a walk. I’m not anti-technology, but I think that people feeling disconnected contributes to a lot of the low-lying depression and anxiety I see."
The CDC and the Mayo Clinic also cite isolation and loneliness as causes of mental illness.
We're too smart for our own good
As much as we revere intelligence, smart people aren't always exemplars of mental health. There might even be something about being smart that causes certain mental disorders.
One study found that having a higher IQ correlates with a higher risk of mood disorder and anxiety disorder.
Anxiety, for example, is characterized by "intense, excessive and persistent worry and fear." If worries and fears are thoughts, and you have a super-powered brain, you might be at a greater risk of anxiety because you have a more powerful mind for processing more thoughts, thus accelerating your anxiety.
Just like certain individuals are smarter than the rest of the population, the whole human population today is, on average, smarter than we were thousands of years ago. We've gone from the bottom of the food chain to cooking our food in microwaves and teaching robots to do our work for us.
Is it possible that we're too smart for our own good?
We send our youth to school so that they can learn to become productive members of society, but are we setting them up for mentally unhealthy lives by teaching their brains to be so powerful? It's like we are giving them a tool and teaching them to use it but omitting the safety instructions.
And technology enhances our mental abilities. The human mind is already powerful on its own, then you introduce it to a computer with processing power and an internet connection—the possibilities are endless.
The problem is that our minds are also hooked up to our emotions. We can hurt ourselves with our thoughts.
Conclusion
On an individual level, mental illnesses may be caused by various genetic, biological, environmental, behavioral, and social factors.
On a societal level, mental illnesses may be caused by social media, economic hardship, political issues, and climate change.
If we know the causes of mental illness, we can start working on preventative solutions. For example:
If isolation causes feelings of loneliness which leads to mental illness, can we decrease isolation?
If social networking sites are related to symptoms of depression, can we decrease usage of these sites?
If an evolutionary mismatch between past human environments and modern-day living is causing depression, what can we do to bring back elements of past human environments?
Mitigating the impact of the root causes themselves is one way to go about it. Another way is to develop skills to alter how we perceive these events. Because what seems to lead to mental illness is our perception of the events, which we have some control over.
For example, if I get depressed after spending time on a social media site, it might be because of how my brain is processing the information on the site. If I can teach my brain to process the information differently, then maybe I'll experience fewer symptoms of depression.
Our current response to the mental health crisis seems to be focused on doing more—staffing more therapists and prescribing more drugs.
If this is our response to the mental health crisis, then we're building toward a future society that is dependent on talking to therapists and taking drugs in order to feel good, all while ignoring (and ignorantly furthering) what is causing us to feel bad in the first place.
If we can determine what the causes of the mental health crisis are and if they are avoidable, then the solution seems to be obvious: do less of the stuff that is making us mentally ill.
DISCLAIMER: THIS IS NOT MEDICAL ADVICE
The information on this website is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.
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