Study in JAMA Psychiatry shows that most people experience treatment for “mental illness” and their lives worsen after diagnosis and treatment
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 hospitalised 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 stigmatising 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 generalise to other countries, such as the United States, with its privatised, 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 hospitalised 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 “medicalised 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.
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)