Are There More Mental Health Problems Nowadays?

“Are people getting crazier?” A client bluntly asked me not long ago. One of the most common types of questions I get asked is about whether the prevalence of mental health problems is increasing. People usually frame it in terms of their current diagnosis or problem: “Are more of us depressed?”; “Is there an anxiety epidemic?”; “Why are so many people addicted?”. Once we have a particular problem, we tend to see evidence of the same in other people much more readily. But, these clients are not just projecting their own problems onto society as a whole. More people are depressed, and more are attending psychological treatment than ever before. It seems like we might just be getting crazier.

There are two main theories to account for the increase in the use of mental health treatment. One theory is that disorders like depression and anxiety were always with us, it’s just that we’re better at recognising and labelling them these days. Only a few hundred years ago mental health issues were regularly explained in religious or supernatural terms. The profession of psychiatry is only 160 years old, clinical psychology 120 years old. Perhaps there was less depression and anxiety in the past, but more curses and evil-eyes.

These days, almost everywhere, we view mental health from a biosocial perspective. Bio means that disorders can be a result of a biological dysfunction of the nervous system. Biological explanations for mental health disorders include terms like “chemical imbalance” or “genetic disorder”. Social (sometimes psycho-social) refers to dysfunctional ways of thinking and relating to others. Mental health diagnosis and treatment may be increasing because we now interpret these symptoms as biosocial mental health problems. They were always there, it’s just that the label changed.

A second theory holds that disorders like anxiety and depression have increased due to the relative decline of other, non-mental health, problems. The human organism (like most complex organisms) is oriented toward avoiding negative consequences before seeking opportunities. Our current time and place (assuming that you are not currently living in a war zone) is far safer than most times and places in evolutionary history. “Why on earth are we here? Surely not to live in pain and fear” asked John Lennon. But maybe we can’t help but live in fear.

Historian Yuval Harari makes a similar claim about anxiety. In his recent best-seller Sapiens: A Brief History of Humankind, Harari states that many of the problems facing humans result of our poor adjustment from the middle of the food chain to the top. Hariri explains that most predators are “majestic creatures”, brimming with “self-confidence”. Humans, in contrast, “having recently been the underdogs of the savannah… are full of fears and anxiety over our position”. When our Nervous Nelly ancestors were stalked by lions and cheetahs it was absolutely appropriate to feel anxious much of the time. These days, with few external threats to grapple with, we are left to jump at our shadows due to our trigger-happy anxiety response.

So, probably we are experiencing more anxiety disorders and other mental health problems these days than the distant past. Partially, this is because we have theories and systems to explain symptoms like elevated heart rate, low mood and avoidant behaviours, in terms of mental health, rather than due to evil spirits and the like. Partially, this is because we’ve vanquished most of our external enemies, without having changed our biological fear alarm system. Our own prosperity and safety have become a back-handed gift.

Psychological treatments for mental health work by helping us to understand and respond to our emotional states in a manner than is helpful rather than harmful. Nobody chooses to experience a mental illness, but once one strikes, we can choose to cope with it in better ways than others.