I think this article gets closer to the truth of what is causing the upward trend in mental ill-health throughout societies.

“the market and its corresponding social upheaval. Industrialisation, urbanisation and growing labour mobility have resulted in looser ties between family and communities. This decline has meant many of the old functions performed by the extended family are now performed by the state or the private sector. The childcare operators on the rich list are a testament to this trend.”

“better described as affluenza than depression. It is a kind of dissatisfaction with the complexities of modern life that now gets medicalised as anxiety or neurosis.

Once the general causes of widespread mental ill-health are identified, then the next step would be to identify solutions.

Hopefully in future years, we will not become a “THX 1138” type society, where people can be convicted of the crime of not taking sufficient drugs http://en.wikipedia.org/wiki/THX_1138

Dr Tanveer

Many thanks for your article.

One of my colleagues often referred to many people [over] diagnosed with clinical depression as "the walking worried" and "the walking wounded". By this she meant that many people have their social problems medicalised which then means that they take psychotropic medication and thus their poor life coping skills are condoned. Then they do not have to take responsibility for their own behaviours and poor decision making - because "I have a mental health problem".

As a community mental health nurse I often saw this and agreed with my colleague above. I did not refer such people to a psychiatrist. I often said to these clients: "You are not depressed. Yes, you get down in the dumps as we all do. Rather, you have a living and loving problem". I referred them to living skills programs. They didn't bounce back into the system - so I guess I was on the right track.

The over diagnosis of "personaliity disorders" in my view, is alarming. I think this occurs as a result of inexperienced clinical diagnosis by tertiary educated nurses who have limited experience and understanding of major mental illnesses such as schizophrenia, bipolar disorder and major depression (true psychiatric nurses are a retiring and dying race). And by GPs who find it quicker and easier to give a quasi psychiatric diagnosis and a script, since they do not have the time to listen to the person's social and emotional needs (and the drug company kickbacks are also important).

And yes, people with drug (including alcohol) problems do clog up the system, taking valuable time away from those clients who have profound mental illness.

But having said that, a large group of drug addicted clients these days experience "drug induced psychosis" which clearly requires psychiatric expertise in the acute phase. That's a real catch 22.

I think there is a crisis. But my handle on it is somewhat different. I think that the crisis has a lot to do with people making psychiatric diagnoses who are not sufficiently qualified or experienced.

Cheers
Kay

Thanks Dr Ahmed. Really enjoyed the article. Please don't give up the fight. I wish the editors had titled the article "Mental health issues complicated by affluenza" or something besides "Blame Society."

- Eric Claus

very interesting article.

there are a number of chapters in Anthony Vidler's "warped spaces" that concern the particular phsycological developments and anxiety produced by modern conditions, mostly in relation to architecture and the modern urban space, if anyone is interested in another aspect of tanveer's argument.

appologies if it sounds like im approacing this from one aspect but i believe that the effect on the mind of idenifyibly modern spaces, the mall, airport, generic office space, the cinema multiplex, which architect rem koolhass refers to as 'junk spaces', being fluid, indefined, non directional, non specific in their program, everchanging and essentialy timeless, have an alienating effect on the mind which should be considerd along with economic and social aspects of modernism.

Excellent article and I tend to agree with what Tanveer said on the issue of the worried well types who present to doctors for treatment.

Whilst I have not read it, I assume that the essay in the recent "Quarterly Essay" entitled "The Worried Well" would be along similar lines.

It seems true that whilst our material 'wealth' might be increasing, our emotional and spiritual health seems to be deteriorating. My hope is that we reconsider the direction we are heading in and perhaps turn to the wisdom of those who fought in the two World Wars and ultimately to the wisdom of Christ Jesus.

Yes, an excellent article indeed from Dr Ahmed.

My only problem with it is that in glossing global industrial capitalism as "the market and its corresponding social upheaval", he unintentionally obscures much of the social etiology of the mental health conditions that he describes.

Although it's no longer fashionable, it seems to me that what he's describing is the working out in contemporary society of good old anomie and alienation, as theorised by early observers of industrial society like Marx and Durkheim.

I think that the atomisation of societies that global capitalism demands for its production and market purposes manifests in new kinds of mental health problems in individuals. Notably the decline in the salience of kinship ('extended families') and - dare I say it - religion, have diminished in the kind of mobile consumer/worker society that we are becoming. I agree that these structures that used to provide meaning, sustenance and certainty have declined in influence over individuals, and this manifests in the kinds of contemporary mental illnesses that Dr Ahmed talks about. I think this also extends to various other social pathologies like racism, crime, domestic violence etc, but that's another topic.

Depression is certainly a good example of this process, but the relationship between biological susceptibility and a pathogenic sociocultural environment remains controversial.

I'm arguing for neither the return to religion nor to failed totalitarian models of socialism. However, I think that most people would agree that there are increasing numbers of alienated individuals presenting at medical and mental health services with negative conditions that are increasingly diagnosed as mental illnesses.

Whether the mental health system can (or should have to) deal effectively with problems that have sociocultural and causes remains to be seen. I predict, that under the Howard regime's coming raft of alienating legislation (e.g. IR, 'anti-terrorism', Medicare/Health reviews etc) we're just going to see this apparent 'epidemic' of mental illness get worse.