Is America driving you crazy and then killing you?

Real Change (Seattle WA homeless newspaper) Sept 10, 2008

Is America driving you crazy and then killing you?


It’s a paradox: Our nation has the most mental illness of all countries as well as the most treatment. Our Surgeon General estimates that in any given year, one in five Americans suffer from mental illness. More than 2.5 million U.S. children are on antipsychotic drugs in contrast to fewer than 2,800 children in the United Kingdom being prescribed them from 1992 to 2005. One in 10 U.S. adults are on antidepressants. Are we heading to pharmageddon?

In 2004 the World Health Organization published a study of mental illness in a selection of countries that demonstrated the U.S. having not only the most mental illness but also the most serious forms. What produces mental health in a nation? Studies demonstrate that the amount of mental illness in a rich nation is associated with the income gap, the difference in earnings between the rich and the rest of us.

In a big-gap nation, life is much more stressful for most people. Those lower down the economic ladder (the bulk of the population) struggle to get by on two or three low-paying jobs and have little time to devote to raising children or nurturing relationships. Those in the ever smaller so-called middle class (in fact most of us are in the working class) struggle to keep up with the Gateses.

Our overall health is also related to the income gap. We die much younger than we should for living in the richest and most powerful country in history that houses close to half of the world’s billionaires. In some 30 countries, life is longer and better. And to accomplish this feat we spend half of the world’s health care bill, over $2.2 trillion in 2006, representing about one-sixth of our total economy.

How does a bigger income gap lead to poorer health? The key period for producing good mental and physical health outcomes is in the first year or two of life. Studies demonstrate that the infants securely attached to a single caregiver in early life have better mental health, fewer behavioral problems later, and better health outcomes. Structuring the circumstances that allow that to happen requires societal policies to permit parents time to spend with their young, something that comes naturally for non-human animals. The U.S., Swaziland, Papua New Guinea, and Liberia are the only countries in the world without a paid maternity/paternity leave policy. We get what we pay for, namely, worse mental and physical health.

In big-gap societies, those on top do not want to spend public funds to benefit the less fortunate. The U.S. spends the least for social welfare of all rich countries, the reason for our worse outcomes. In the mid 1970s, the richest 1 percent of us had less than a quarter of all wealth and now they have regained almost half, which is what they enjoyed in the 1920s and considered their rightful share. All of us are unaware of living in the midst of this odorless, invisible, highly toxic and ultimately lethal gas of inequality. If we eradicated our leading killer, heart disease, we still wouldn’t be the healthiest country in the world. Such is the effect of the inequality vapors.

What could we do to rid ourselves of this scourge? Narrowing the income and wealth gaps is the obvious answer. But how? We could go back to policies espoused by Democratic and Republican presidents not too long ago. In 1942 President Roosevelt proposed a 100 percent tax on incomes above $25,000, an amount that is equivalent to about $400,000 today. In 1969 President Nixon sponsored legislation promising a guaranteed income for all families with children.

Such social welfare policies enjoyed tremendous public support only 40 years ago, while today even many with low incomes say that such measures would be un-American. Instead we only have welfare for the rich, with tax breaks and subsidies, while the rest of us have to fend for ourselves.

Everyone, including the rich, suffers from worse health. The solution in theory is simple. Go back to policies we considered when we were one of the healthiest countries in the world. A win-win situation, not today’s lose-lose with all of us suffering from too much stress, depending on ourselves instead of each other.

We should begin with a universal paid maternity/paternity leave policy, as all the other rich countries enjoy. This would support the importance of creating more secure attachment in early life, the bellwether for good health in later life. Let’s create a health Olympics, or a mental health Olympics and monitor our progress toward a medal, something that might be achievable in a generation or two, once we recognize that economic justice is the medicine we need.

Martin Luther King, Jr. understood that when he said, “True compassion is more than flinging a coin at a beggar… it comes to see that an edifice which produces beggars needs restructuring.”

Stephen Bezruchka teaches in the School of Public Health and Community Medicine at the University of Washington and is an emergency room physician.

1 Response to “Is America driving you crazy and then killing you?”

  1. 1 mlyon01 September 13, 2008 at 11:17 am

    With regards to the figures of prevalent mental illness in the US, a great deal of skepticism is required. There is no doubt that there is a great deal of suffering, due to poverty, racism, war and the many inequities and social ills in our country, but suffering is not the same as illness. Many groups, like Narsad, the biggest mental illness “charity”, largely supported by drug cos. have published national ads this week saying one in four adults is mentally ill in any given year. And the diagnosis of bipolar illness in children has increased 40 fold in the last few years. But who is behind this? It is psychiatrists such as Biederman at Harvard, recently exposed as hiding the millions he makes from drug companies. The pharmaceutical industry is madly promoting new indications for their medications by labeling childhood problems, shyness, sadness, frustration, anger, dementia of aging all as illnesses requiring their new antipsychotics and anti-depressants. Unfortunately, many academic psychiatry departments and associations are dependent on pharma support and have given heft to these ideas. There are some truly psychotic people who have difficulty getting treatment, but for most of us, the best medicine is joining with others in fighting back against whatever is causing our distress.
    Ellen Isaacs, MD

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