I say "argues against", but he doesn't actually provide any arguments. He just links to the claims and says they're silly.Can it really be true that a quarter of Brits are bullied or beaten up at home or are mentally ill, or is this simply a case of social campaigners exaggerating how bad life is in order that they can continue to make headlines, make an impact, and get funding? I reckon it's the latter. Next time you see the "one in four" figure, be very sceptical – it's probably Dickensian-style doom-mongering disguised as social research, where the aim is to convince us, against the evidence of our own eyes and ears, that loads of the people we encounter everyday are basket cases in need of rescue.
As Neuroskeptic readers know, I am myself skeptical of the idea that one in four people are mentally ill, but I'm skeptical of it because I've looked at the evidence and it doesn't support that figure. Actually, if you take the available evidence at face value, it says that the true figure for the lifetime prevalence is much higher than one in four. I don't think those figures are very useful however because of various methodological issues.
So in my view we just don't know how many people are mentally ill, largely because we don't have any clear definition of what "mentally ill" means. But that doesn't mean we can just assume that it can't possibly be one in four just because "our own eyes and ears" tell us that most people are not "basket cases".
Much mental illness goes undiagnosed and unnoticed, and I'd imagine also that Brendan O'Neill and the kind of people who read him don't tend to "encounter everyday" people from groups such as the unemployed, the elderly and so forth, in whom the rates are higher.
But even beyond that, it's a silly argument because of selection bias. If you as a healthy person encounter someone everyday, chances are they're not severely ill - mentally or physically - because if they were, they'd be less likely to be around in places for you to encounter. Unless you're a doctor or whatever, you live your life in the world of healthy people.
It's like saying that you don't believe children or the elderly exist, because in your life as a working age adult, you never meet any of them.
21 comments:
Agreed. A lot of people, like myself, aren't obviously suffering from mental illness. Just because you don't see it doesn't mean it don't exist!
bipolar Project
I am glad that many mental illnesses sufferers are able to live and love and work without being considered mentally ill.
Provided they get the right social and professional support when needed and accepted by them.
Plus so many people are self overdiagnosed or suffered that abuse by clinicians...
I even ask aspies who are kind enough to seek my professional advice to think comprehensively about disclosure at work at least before they reach a stage of accomplishments in their carrer.
Idem on the social front.
Be it only because there are many naughty people out there who will take advantage of that knowledge.
Plus here are advantages -but no miracles from disclosure-
For schizophrenia, so many prejudices makes it advisable not to tell too many people -symptoms permitting of course-
Autism might be a life long condition but persons with asperger have lives and personality not limited to the autism.
For schizophrenia the prognosis is so much better than the public and many professionnal think and many people have a life free of symptoms and medication ahead of them.it will be very difficult to shake off the label of schizophrenia and the irrationnal fears of the public.
It would be very sad and detrimental for those concerned to accept the ludicrious idea that persons were to be limited to their mental illness or disability.
Even if it were to be selfinflicted for activism purposes -
I would respect that choice on the condition that it were really self-imposed and that you do not impose it on other sufferers.
Call me anyname you fancy but I know that in my heart of heart some people are asking not always kindly to receive a diagnostic of bipolar or asperger that I do not think right.
Some in good faith and some to take advantages on the job (I once met a mother of an autistic child who tried to convinced me that she deserved a bipolar diagnosis and invalidity status beacause she wanted special hours at work to take better care of her son without relinshing her high responsabilities at a time when her entreprise was making people redondant in addition and she wanted the protection).
it maybe more realistic to talk about how many people are taking psychiatric drugs and debate what it means and whether it is a good thing
Wall Street Journal
Psychiatric Drug Use Spreads
http://online.wsj.com/article/SB10001424052970203503204577040431792673066.html
The medicating of Americans for mental illnesses continued to grow over the past decade, with one in five adults now taking at least one psychiatric drug such as antidepressants, antipsychotics and anti-anxiety medications,
according to an analysis of pharmacy-claims data.
Brendan O'Neill - living proof that trolling can be an actual job.
Heh. He's also (as in this case) living proof of the adage that a stopped clock is right once per day.
In fairness, "1 in 4" is based on an assertion rather than evidence - why should we expect Brendan O'Neill to do anything more than assert against the "1 in 4" meme?
Hi,
Can I just say thank you for this post - why does scientific rationale evade statistics so often... no, wait, my bad: stats = spin. Duh.
The point you make about the chances of bumping into someone with a mental illness is very pertinent.
Only the other day, I remarked that the reason why so many people cannot reconcile my mental ill health with the person they know is simply because I totally withdraw from life when I'm ill. Ergo, no-one sees how profoundly different my face looks when I'm seriously depressed, nor how my voice flatlines, etc, etc...
I do wish though that people had more of a social conscience. I have a small handful of friends who are very good at checking up on me, but other than them and my family, no-one else could give a fig!
Clarissa
www.justdifficult.com
Clarissa
I sincerely wish every one -with a mental illness or not - could as you seem to be able to count on family member plus:
"a small handful of friends who are very good at checking up on me"
Because such things like cancer,rape, losing job,losin home and/or partner in life, having a child dying do exist
Besides:
What I also teach to any person kind enough for asking my psychiatrist advice is that we are not the center of the world and other people action never relate entirely to us and often not at all.
It makes life so easier and more pleasant when you are able to admit that.
Please go and read the Neuroskeptic post "confused" where he had the courage to tell us that he suffers bouts of depression when his bad mood overcome his nice personality.
So many bad things can happen in people life that you do not know necessarely about: ,cancer,rape, losing job, partner in life, having a child dealing with drugs, sexual difficulties..You name it.
Obviously borderline personality disorders and psychopaths do exist also sometimes with "white collars" (with apparent success in life at least professionnaly).
Jamzo
If I knew how many pairs of shoes are sold -say in Roumania and in the USA- would that help me to know how many feet part of a living human body are too be found in those country?
This said, my opinion -as a psychiatrist- is that Big Pharma and the psychiatrist academics are brainwashing the drugs prescribers and that so many psychiatrists are lazy or greedy, that the result is a ludicrious prescription of drugs.
Dear and kind NS:
"(...)Unless you're a doctor or whatever, you live your life in the world of healthy people.(...)"
You were obviously in excellent spirits when you wrote that!
But were on earth are the cunning psychiatrists and psychologists putting away their clients if you do no meet them at work or socially ?
Unless ou are an astronaut actually just entering with fellowastronauts a spaceship that is.
Beware: scientists have their share of mental illnesses and can do nasty things when delusional like a client of mine who put acid on the sensible parts of a very costly electronic microscope.
It seems One in Four is popping up everywhere these days:
http://www.slate.com/blogs/xx_factor/2011/11/17/if_1_out_of_4_women_is_really_using_mental_health_drugs_we_have_a_problem_that_drugs_won_t_fix_.html
Ivana: Of course we do meet mentally ill people, although often they are undiagnosed or don't go around advertising it. Lots of people meet me and don't know about my depression.
But still we know that rates of mental illness are higher in prisons, poor neighbourhoods, unemployment offices etc. Whether that's cause or effect is another question, probably both.
Willibrord: Many thanks for that link, I didn't see that one. Still, it's no surprise really - rates of psych drug have been rising for years.
And this one is super sad, because it seems based on good evidence ...
http://www.theglobeandmail.com/news/national/nearly-1-in-4-afghan-war-veterans-suffer-from-mental-illness-study-shows/article2238289/
I think you make an excellent point that it definitely depends on what population a person is dealing with on a regular basis as to whether or not one in four of the people they meet will be mentally ill. I go to a community mental health center and NAMI meetings regularly, so I know quite a few mentally ill people. If I didn't have a reason to be there, as in my own illness, I wouldn't have met these people. I also know a lot of people who have no idea I have Schizoaffective Disorder, and would be totally surprised if I told them (and have been in rare cases when I have told such people), which is interesting since it does make it obvious to me how much stigma still exists. People assume that you must be a freakish, dangerous psychopath if you've been psychotic or currently are experiencing psychosis. They don't realize that you might just be the woman sitting in the cubicle next to them at work or the desk next to them at the university. I tend to think that the figure is higher than one in four.
Jen Dasybee
Thank you so much for your testimony.
"(...)it does make it obvious to me how much stigma still exists.(...)"
You couldn't do better than selecting with care every person you confide into.
- knowing that that person will often tell a few others over time which means to be careful on your choice of confident(s) at work-
You also wrote:
"I tend to think that the figure is higher than one in four."
Please, dear Jan, do not confound prevalence (the number of case around) and incidence (the number of new cases in a given period of time like a year) because of the" mother nature" cures.
"mother nature" can very often cure even schizophrenia on the long term.
Some studies present a very high rate of recovery on the long term and the Big pharma guys are lying when they tell that it has been demonstrated scientifically that treatment helps long term outcomes!
NB: I do not think at all that Big Pharma treatments are never very useful in psychiatry.
NS 17 November 2011 19:23
I have no experience of prison so far - and I hope that the psychoanalyst French gangs will not succeed in putting me in for crimils insults-
But I did enough pro bono to elderly persons to be deeply ashamed of the psychiatric treatment of complains in the elderly: overmedication.
A scandal, the overuse of antipsychotics against angry old people or even insommiacs.
In our western societies elerly persons are very often badly treated by society at large and by family members and health professionals.
Unless they are rich or in a belgium residential care home.
In italy in my own family th change in mentality and behaviours has been quite dramatic in on generation.
For the prison a GP mother of three I knew tried to work in a prison because of the work schedule made easy to pick up her little children at school. She resigned telling me that she was expected to give only psychiatric drugs to young men complaining from rape to suffering from lack of personnal space, abandon from children or spouses etc...
For the elderly and the prison a more human treatment would not be bad per se and good clinical studies awith strong methodology and intelligent ideas to test are badly needed.
Political thinking and ideology even morally self satisfying ideologies just have limitations, haven'they?
NS 17 November 2011 19:23"Lots of people meet me and don't know about my depression."
Clarisa 17 November 2011 01:17
"I do wish though that people had more of a social conscience."
The point I attempted to make without success, sorry about that, was:
If Clarissa were to meet you when you are both depressed, she will think - very wrongly indeed of you- as a person "without any moral conscience" when your blog shows just the opposite.
You might think she is dumb or hostile and overcometitive.
I can write that because you told us in "confused" that depresion makes you feel suspicious of other people's motives.
I try to teach clients out of unreasonable and pain-inflicting social expectations.
I am a fervent faithful of the recovery movement and I subscribe unconditionally to the value of the knowledge by experience (what clients and families have to teach me to improve my practice.
But I remain firm with my clients on the fact that too high expectations of other people -and strangers' help with your difficulties are a recipe for disaster in many ways and a cause of unecessary suffering and even of some depressive moods in some people.
The biggest confounds, in my mind, are between (1) "obvious" and congential mental conditions (e.g. schizophrenia and bipolar) for which the proportions are quite low; (2) non-congenital and episodic mental conditions (e.g. many forms of unipolar depression triggered by environmental circumstances); and (3) congenital mental conditions that are arguably merely extremes in a normal human neurodiversity Bell Curve (e.g. milder cases of generalized anxiety disorder).
Co-morbidity, the inexactness of diagnosis (particularly complicated by the impairment requirement of DSM-IV that means that the same condition may count in some people but not others), and a failure to frame what evidence shows to have clear congenitial mental condition foundations (e.g. succeptibility to substance abuse difficulties) as matters of judgment without a mental health component don't help either.
Certainly, no one would find it odd to think that one in four people had experienced some manner of physical disorder at some point. Who hasn't broken a bone, gotten the strep or the flu, required glasses or hearing aids, developed an allergy to something, become obese, developed high blood pressure, or who knows what else?
Neuroskeptic's comment about encounter bias is on point as well. Is it any wonder we don't routinely run into agoraphobics in the mall?
Dear Andrews
On your last witty line:
That you do not find what you are not looking for should be taught in every med school.
Even in America when psychiatrists just want to make money and tell clients to discuss personnal matters with a psychologist.
Just in case you want to write in a blog about real peoples lifes.
At the RCP in London in 2008 I had the privilege to spend a small fortune in fees and London hotel to benefit from excellent teaching in Asperger in adults.
As the "knowledge by experience part" we had the contribution of a young man and his mother( not an aspie but an autist with high abilities who had severe retardation as a toddler and young child but my masters are already DSMV spectrum impregnated.
He was more than happy to help us.(Psychiatrists behave always wonderffully with clients when grouped with many other psychiatrists they do not know)
But he and his mother told me when I was chatting with them -Italian psychiatrist typic way -at meal time that the very bad part of the show he was happy and proud to deliver was that the time of his apperance made mandatory for him to travel at rush hour, a torture for him.
That young man did it and repetedealy to help fellow sufferers being diagnoses more rapidly than he was and he even was nice enough to tell that our kindness will be remenber by him at difficults times (like going back home in the tube presumably)!
I have also a few clients who suffer severe agoraphobia and take the tube to go to work just because they have the choice between very low paid job under their professionnal qualification and unemployement;
One of them drink alcohol "for the journey" another take a very small dose of an "old" tricyclic antidepressant - who works better sometimes -several are taking homeopathy tablets as much as needed and that my best treatment.
One of them choose to walk more than an hourfor months going to an internship to escape being "like a cattle going to be butchered as he put it" explaining to colleagues that this was a trick to make the boss understanhd he was underpaid.it Lodging is so expensive in Paris that it is exentric behavior but not crazy behavior for a graduate slave during an internship.
But he was assumed as a full time worker and I got into trouble helping him: He bikes to work with the excuse of the exercice although he is a danger for himself since he has very bad motor coordination.
Not that he is paid what he should be paid with his skills and diplomas but because the law in France makes mandatory to employeur to pay for the public transport of employees.
And I had another client who drove a metro train without telling anybody he suffered from terrible hallucination in a noisy environnement -and the train he drove was very noisy. I placed him on an haloperidol regimen at the lowest dose we could find efficient - an old very inexpensive and sometimes very efficient antipsychotic.
Dear Andrews
you wrote:
"The biggest confounds, in my mind, are between (1) "obvious" and congential mental conditions (...)(2) non-congenital and episodic mental conditions (...) (3) congenital mental conditions that are arguably merely extremes in a normal human neurodiversity Bell Curve (...).
A friend of mine told me that I guessed rightly that you were an American but missed the fact that you are an attorney and not a psychiatrist. I checked in a click by using the blogger technology.
You really could use a good psychiatrist to help you out of outdated thinking and put you up to date with the advances in sciences (recovery and and genetics studies).
I am considering to ask for political asylium in the USA since the medical board is persecuting me (my wallet and reputation and missing up with my divorce from an academic )in accusingh me of being incompetnt to treat Aspies and crazy with only English and German written in English papazer to state that I ma competent.
Do you have psychiatric medical litigation in your practice and do you need an MD loving ski and able to give you the help you obviously need for a modest salary?
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