Let's look specifically at Schizophrenia because it is among the most studied mental health disorders and many mental health issues share comorbidities. That is, if you are diagnosed with one "disorder" then there is a pretty good chance that at some point you will also be diagnosed with another disorder as symptoms evolve and manifest. So it is reasonable to assume that the "triggers" or environmental risk factors for Schizophrenia are likely to be risk factors for other mental illnesses.
Schizophrenia is also of interest because Nick Reiner was (reportedly) diagnosed with it. Schizophrenia is one of the "lifetime" diagnosis unlike Anxiety Disorder or Depression which can come-and-go.
It is currently believed that Schizophrenia is highly heritable and that the external "risk factors" that trigger it represent between 15%-and-40% of the aggregate risk. Some of those external risk factors* include (Link):
- In-Utero Trauma (bleeding, diabetes, rhesus incompatibility, preeclampsia, low birth-weight, oxygen deprivation, malnutrition, drug-use, other) Link
- Infections
- Migration
- Urban environments
- Childhood Trauma
- Cannabis use
Let's look at them one-at-a-time
In-Utero Trauma: I would rate this as slightly elevated compared to 20 and 40 years ago. From anecdotal evidence, recent immigrants are less likely to seek prenatal care and might not even be paying attention to their pg/non-pg status...risk factor slightly increased.
Infections: Specifically Toxoplasma gondii and Chlamydia. T. gondii is spread via untreated fecal material, primarily from cats. Chlamydia rates increased by 50% between 2000 and 2015...so this risk-factor increased.
Migration: Migration to the United States showed a very large increase in the 2021-to-2024 (inclusive) time-frame. Literature specifies 1st and 2nd generations being at increased risk....so this risk-factor increased.
Urban environments: My perceptions is that there is a small, net outward migration from highly urban environments. I will call this....risk factor slightly decreased.
Childhood Trauma: It has been observed that the most dangerous person in a young child's life is his mother's new boyfriend. Traditional families continue to shred....risk factor increased.
Cannabis Use: It has been decriminalized at the state level and legalized in many "Blue" states. Furthermore the level of THC in samples obtained "on the street" have increased by a factor of three between 2000 and 2019....risk factor increased.
Tallying up the count, five of the six environmental risk factors increased with three of them increasing substantially. One of the six risk factors shows a weak improvement.
Conclusion: Perceived increases in rates of severe mental illness is factual and not a figment of reporting or in increasingly aggressive diagnosis or more expansive definition of diagnostic criteria.
Note to readers: I will be busy today and expect to be back-in-the-saddle tomorrow. Responses to comments will be slow.
Bonus video
Hat-tip to Lucas Machias.
* Poor sleep-hygiene was mentioned as a risk-factor for Bipolar Disorder (aka, Manic-Depressive or Jekkyl-and-Hyde Disorder) but not in the paper referenced. Forty years ago broadcast TV shut-down after midnight and people didn't stay awake round-the-clock "gaming". Except for some convenience stores, nearly all businesses shut-down for maintenance or cleaning every night. That has been a major change during my lifetime.
Its funny to hear/see people extoll certain changes as virtues, while others decry them as problematic. Its not even a question of degree, but literal opposites.
ReplyDeleteI've worked nights, it screws with you. That our entire society should be this way ignores obvious issues, and yet, we continue marching along the path regardless.
I worked a "swing shift" for a while and that REALLY screws with you. Two, 12 hour shifts on days and then two, 12 hour shifts on nights then three days to reset your body-clock.
DeleteThank God Mrs ERJ was very supportive. I was not a very good father during that period.
Back in the Dark Ages (1976) Nuclear power Prototype training in Idaho ran on the following schedule for students: 5 days of Nights (8 PM to 8 AM), 2 days off, 5 days of Mids (Noon to Midnight), 1 day off, 5 Days of Days (8 AM to 8 PM), then 5 days off. Add in 2 hours of bus travel each shift. Staff and qualified students worked a more normal 8 hour shift (8-4, 4-mid, mid-8) but students still had to ride the bus. The only way we survived is the students were 20-somethings and staff mostly under 40.
DeleteFor a look at mental illness in the pharma context, I highly recommend "Anatomy of an Epidemic ... the Astonishing Rise of Mental Illness in America" by Robert Whitaker. Super-long title and super-discouraging read in the sense that what we are seeing today, not just in schizo but in all mental disorders, has been a very long time in development. Whitaker has an hypothesis to flog. In my extended family, I've seen one stark real-life example of the syndrome he covers in which a depressed person is giving antidepressants, subsequently "turns" bipolar, and an entire family of people's lives are ruined. I found it convincing; YMMV. BTW this book was first published in 2011, so it is not connected to the details of recent / current events.
ReplyDeleteWhen I was an academic I twice had to deal with twenty-one year old undergraduates suddenly exhibiting schizophrenia. It was horrible enough to see the state of the poor wretches: to meet their devastated parents was, if anything, worse. Their golden boy destroyed. His life and theirs turned upside down. And nothing that could be done about it. The pain, the grief - inconsolable.
ReplyDeleteWhile these are true and undoubtedly have an impact, the biggest reason for more diagnoses are changes in the medical system.
ReplyDeleteThe DSM has changed the criteria for diagnosing mental illness, substantially expanding what qualifies. In addition, in some circles it is celebrated so people look for and encourage diagnoses that may not be medically accurate.
Jonathan