Last weekend I was fortunate enough to speak at the International Psychology Conference Dubai, and also at the 8th National General Assembly of the Emirates Medical Students’ Society, held in Sharjah. Both conferences had strong mental health themes, which I think reflects the growing appreciation that psychological problems are real. These issues are not just “in our heads” and should never be trivialised.
In general, there has been a tendency to view the psychological as somehow not real, or inferior to the physical. We might say: “It’s just psychological; it’s all in your mind.” This slightly dismissive and ill-informed attitude vanishes in the bright light of epidemiological evidence. We know that about 350 million people experience depression, making it, according to the World Health Organisation, the leading cause of disability worldwide.
A study from the Centers for Disease Control and Prevention in Atlanta suggests that depression is the leading cause of lost workdays in the United States – 200 million days annually at an estimated cost of $44 billion (Dh161bn). When you tag on treatment costs, the bill rises to about $87bn. This is just depression that we are talking about. Anxiety disorders, eating disorders, substance abuse and so on all have their own associated costs.
The largest cost, of course, is in human suffering. Suicide, an occasional tragic consequence of mental health problems, has also been on the rise. In the US, it is the second most comon cause of death for people under the age of 25. In the United Kingdom, it is the leading cause of death for males under 40. The leading cause of death for US military personnel is not enemy combatants, but suicide.
Burying our heads in the sand and thinking that this is only a problem in other countries is not an option, nor is this position supported by the data. A community psychiatric survey conducted more than a decade ago put the rate of mental health problems in Al Ain to be about 8 per cent. More recent work in Qatar estimates the depressive prevalence to be around 13 per cent for Qataris, with the younger, better-educated citizens being at higher risk. This has important implications for workforce nationalisation and health-service planning.
What can be done? The answer is not that simple. Progress in psychiatry has been slow. Some even argue that psychiatry has worsened the plight of many people with severe mental health problems. Robert Whitaker, an author and investigative journalist, examined historical psychiatric records going back to 1955. He estimates that, since then, the US has had a six-fold increase in mental health problems, in spite of new drugs and advances in medical technology.
An international study of schizophrenia spanning 10 countries lends some support to Whitaker’s controversial contention. The study, undertaken by the World Health Organisation, found that the outcomes (full recovery or better functioning) for schizophrenia were better in developing nations than they were in developed nations, despite the former having fewer psychiatrists and less access to the latest treatments.
Simply mimicking or buying in the dominant biomedical mental health care model from a developed nation might not be that wise. There is a need to look at a society and examine what we are losing as we transition from developing to developed status. When “we” becomes “I”, does “we”llness become “I”llness?
After more than a century of searching for biomedical cures for psychological complaints, we have none. We shouldn’t give up looking just yet, but it seems sensible that we also begin to invest more heavily in prevention – by the time we find a cure, let’s hope we don’t need it. This, for me, is one of the main goals of the happiness agenda. What can we do to ensure people feel connected, supported and purposeful? How can we help people deal positively with disappointment and unmet expectations? The disciplines of psychology and education have huge roles to play.
Dr Justin Thomas is an associate professor at Zayed University
On Twitter: @DrJustinThomas
