But
the exclusive focus on economic indicators has prevented consideration
of the geopolitical implications of a US domestic trend that is also
frequently discussed, but by a separate group of experts: America’s
ever-increasing rates of severe mental disease (which have already been
very high for a long time).
The
claim that the spread of severe mental illness has reached “epidemic”
proportions has been heard so often that, like any commonplace, it has
lost its ability to shock. But the repercussions for international
politics of the disabling conditions diagnosed as manic-depressive
illnesses (including major unipolar depression) and schizophrenia could
not be more serious.
It
has proved to be impossible to distinguish, either biologically or
symptomatically, between different varieties of these conditions, which
thus constitute a continuum – most likely of complexity, rather than
severity. Indeed, the most common of these illnesses, unipolar
depression, is the least complex in terms of its symptoms, but also the
most lethal: 20% of depressed patients are estimated to commit suicide.
Both
manic-depressive illness and schizophrenia are psychotic conditions,
characterized by the patient’s loss of control over his or her actions
and thoughts, a recurrent state in which s/he cannot be considered an
agent with free will. Obsessive suicidal thinking and paralyzing lack of
motivation allow depressed patients to be classified as psychotic as
well.
These
conditions are often accompanied by elaborate delusions – images of
reality that confuse information generated in the mind with that
provided from outside. Often the distinction between symbols and their
referents is lost, and patients begin seeing people solely as
representations of some imagined force. The judgment of such people
cannot be trusted, to put it mildly.
A massive statistical study,
conducted from 2001 to 2003 by the US National Institute of Mental
Health (NIMH), estimated the lifetime prevalence of major depression
among American adults (ages 18-54) at more than 16%. Lifetime prevalence
for schizophrenia was estimated at 1.7%. There is no known cure for
these chronic diseases; after onset (often before the age of 18), they
are likely to last until the end of the patient’s life.
Surveys among US college students estimated that 20% fit criteria for depression and anxiety in 2010, and that nearly 25% fit these criteria in 2012. Other studies have consistently shown
rising rates of prevalence with each successive generation, and it is
argued that, if older statistics were faulty, they erred on the side of underestimating the spread of mental illness.
All
of this suggests that as many as 20% of American adults may be severely
mentally ill. In view of disputes over the significance of available
data, let’s assume that only 10% of American adults are severely
mentally ill. As these conditions are presumed to be distributed
uniformly within the population, they must afflict a significant share
of policymakers, corporate executives, educators, and military personnel
of all ranks, recurrently rendering them psychotic, delusional, and
deprived of sound judgment.
If
it is deemed sensationalist to characterize this situation as
terrifying, one may add that a much larger share of the population
(estimated at close to 50% in the NIMH study) is affected by less severe
forms of mental disease that only occasionally disturb their
functionality.
Comparative
epidemiologists have repeatedly noticed something remarkable about
these illnesses: only Western countries (or, more precisely, societies
with monotheistic traditions) – particularly prosperous Western
countries – are subject to prevalence rates of this magnitude. Southeast
Asian countries appear to be especially immune to the bane of severe
mental illness; in other regions, poverty, or lack of development, seems
to offer a protective barrier.
As I argue in my recent book Mind, Modernity, Madness,
the reason for high concentrations of severe mental illness in the
developed West lies in the very nature of Western societies. The “virus”
of depression and schizophrenia, including their milder forms, is
cultural in origin: the embarrassment of choices that these societies
offer in terms of self-definition and personal identity leaves many of
their members disoriented and adrift.
The
US offers the widest scope for personal self-definition; it also leads
the world in judgment-impairing disease. Unless the growing prevalence
of serious psychopathology is taken seriously and addressed effectively,
it is likely to become the only indicator of American leadership. The
rise of China is unrelated to this.
Liah Greenfeld is Professor of Sociology, Political Science, and
Anthropology at Boston University, and Distinguished Adjunct Professor
at Lingnan University, Hong Kong. She is the author of Mind, Modernity, Madness: The Impact of Culture on Human Experience (Harvard University Press, 2013), Nationalism: Five Roads to Modernity (Harvard University Press, 1992) and The Spirit of Capitalism: Nationalism and Economic Growth (Harvard University Press, 2001).