A new study published in JAMA Psychiatry finds that almost everyone will be treated for mental illness at some point in their lives and that their lives are worse in many ways after receiving diagnosis and treatment. About 80% of the population will be hospitalized or receive psychiatric drugs. After treatment, they are more likely to end up poor, unemployed, and receiving disability benefits, and they have worsening social connections.
The researchers conclude that their results “should add to changing our understanding of normalcy and mental illness by challenging the stigmatizing false dichotomy of individuals with vs without mental illness.”
Does this mean that the search for biological differences between the “mentally ill” and the “normal” can now be called off—since it appears that basically, everyone is “mentally ill”?
Their study also puts to rest the notion that mental illness is going undiagnosed and untreated. On the contrary:
“The present findings do document that citizens are getting attention and treatment for mental health disorders, at least in developed nations with universal access to health care, which can be viewed as encouraging,” the researchers write.
The study was conducted by Lars Vedel Kessing, Simon Christoffer Ziersen, and Per Kragh Andersen at the University of Copenhagen and Avshalom Caspi and Terrie E. Moffitt at Duke University and King’s College London.
The study data came from Denmark’s nationwide registry of healthcare contacts and included a random sample of 1.5 million Danes from 1995 to 2018. It included all diagnoses through hospital contacts and all drug prescriptions from hospitals, primary care, or private psychiatrists—meaning that this is still an underestimate, as anyone who received no treatment or psychotherapy rather than drugs was not counted.
It should be noted that these results, then, may not generalize to other countries, such as the United States, with its privatized, for-profit healthcare system.
According to the researchers, the likelihood of getting prescribed psychiatric drugs during your lifetime was 82.6% (87.5% for women and 76.7% for men). The likelihood of being hospitalized for mental illness was 29.0% (31.8% for women and 26.1% for men).
On average, the 80% who were treated for mental illness were already struggling before treatment: “At baseline, individuals with any mental health disorder were more likely to be unemployed or receiving a disability benefit, had lower earnings, were more likely to be living alone, and were less likely to be married, compared with control individuals from the general population,” the researchers write.
But after treatment, things only got worse.
After treatment, “individuals with any mental health disorder were more likely to experience new socioeconomic difficulties, compared with control individuals from the general population,” the researchers write. “During follow-up, they were more likely to become unemployed or receive a disability benefit, to earn lower income, to be living alone, and to be unmarried.”
The fact that those who received a diagnosis and treatment were worse off afterward was interpreted by the researchers as supporting the “validity of the diagnosis and treatment” since they concluded it must indicate the severity of the underlying mental illness.
They don’t address the notion that treatment might worsen things, especially if given for mild symptoms or normal human distress. Nonetheless, there is copious evidence that antidepressant use leads to worse outcomes in the long term, even after controlling for the severity of depression and other factors. The adverse effects of the drugs lead to worse health outcomes for those taking them, and withdrawal symptoms prevent people from being able to discontinue.
Likewise, long-term studies of antipsychotics show that, although those who discontinue the drugs are at a higher risk of relapse in the months after stopping, in the long-term, their outcomes are better than those who remain on the drugs, even after controlling for severity.
The researchers also don’t address the idea of overdiagnosis—that the reason almost everyone meets the criteria for mental illness is because the category of mental illness keeps expanding with each new edition of the DSM. Nonetheless, this remains a concern of many prominent researchers. For instance, Allen Frances, chair of the DSM-IV task force, has written extensively about the harms of overdiagnosis, as has Kamran Abbasi, the editor-in-chief of the medical journal BMJ.
The removal of the “bereavement exclusion” in the DSM-5 garnered controversy, with claims that psychiatry has “medicalized grief.” The DSM-5 text revision in 2022 went further, creating a new mental illness called “prolonged grief disorder,” with criteria indicating that someone is grieving for too long or too emotionally. Researchers argue that normal human emotions are now considered “illnesses” to be drugged away. Indeed, researchers have argued that the categories in the DSM are “scientifically meaningless.”
This isn’t the first study to show that the definition of “mental illness” is so broad that nearly the entire population meets the criteria. In a New Zealand study from 2020, researchers found that 86% of people will have met the criteria for a psychiatric diagnosis by the time they’re 45 years old, and 85% of those will have met the criteria for at least two diagnoses. Exactly half (50%) of the population will have met the criteria for a “disorder” by age 18.
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Kessing, L. V., Ziersen, S. C., Caspi, A., Moffitt, T. E., & Andersen, P. K. (2023). Lifetime incidence of treated mental health disorders and psychotropic drug prescriptions and associated socioeconomic functioning. JAMA Psychiatry, 80(10), 1000-1008. doi:10.1001/jamapsychiatry.2023.2206 (Link)
Editor’s note: this post was originally published on our sister site, Mad in America, and is reposted here with permission
Thank you Peter for your excellent work as always.
I am pleased to read of Kamran Abbasi and Allen Frances stating the harms of over-diagnosis of Mental Health disorders. I am particularly concerned that General Practitioners are actually loosing their clinical skills. With lots of appointments being undertaken over the phone. It is a big problem that patients are not being physically examined, having blood tests or investigations to exclude biological illnesses, diseases or conditions.
There has been major drives and incentives towards Mental Health that doctors are using shortcuts and biases within the Diagnostic Process. This can be a lengthy discussion over several appointments and can require referrals to other Medical Specialties such as Endocrinology or Gynaecology. Depression and Anxiety can be symptoms of Medical conditions but they are not the actual Disease or Illness.
Another problem that you have addressed is Outcome. If a patient has been given a MH label and the physical health problem ignored, then over time the person can indeed become extremely physical ill, become permanently physically disabled or can die. This is classed as Clinical Negligence. I totally agree with the Researchers and some DSM values being scientifically meaningless.
The perfect example is Medically Unexplained Symptoms. It is more often than not that the patient has received no testing nor investigations to find out why they may be Short of Breath or Dizzy ? Therefore, how can the Symptoms be Medically Unexplained ? It is NONSENSE. A simple blood test can indeed and does show that they can be suffering an illness such as Iron Deficiency Anaemia. So, disproving the initial Fallacy. The test result shows that the symptoms are Real, they can be Explained and they Need to be Treated either by an Iron Transfusion or Oral Supplementation.
In Medicine, once a plethora of investigations has been undertaken and Medical doctors have diagnosed. They can indeed write, of unknown Aetiology which means, of unknown origin. Medicine is a science and it is the skill of the Clinician who makes it an Art. You use Logic, go off on tangents to assist, care and treat each Person as an individual. I have found no Person Centred Care in Psychiatry. There is no holistic care, there are no discussions. It is a case of you do this, this and this, I am in charge and I know what is good for you.
This is when the Human Rights Act (1998) is breached. There is no Fairness, a patient does not have Autonomy. There is very little Respect towards patients. There is a huge power struggle with psychiatrists and Mental Health workers completely unaware that patients have Equality. Lastly, those with MH diagnoses are not treated with Dignity.
However, as you have commented on the validity of the diagnosis these also can be argued and disproved. Scientific tests can prove the person has indeed got a physical disease, illness or condition. Scientific research is robust, it can be replicated and it is reliable. A DSM value is NOT. The serious problem though is the DELAY to diagnosis. This means that the patient has suffered for a number of years unnecessarily which has a poorer outcome for their physical health. Usually, complications have occurred. The NHS does have a Duty of Candour which includes admission of the wrong doings and Transparency.
All the best.