Enduring Mental Health: Prevalence and Prediction
ncbi.nlm.nih.gov
ncbi.nlm.nih.gov
> We review epidemiological evidence indicating that most people will develop a diagnosable mental disorder, suggesting that only a minority experience enduring mental health. This minority has received little empirical study, leaving the prevalence and predictors of enduring mental health unknown. We turn to the population-representative Dunedin cohort, followed from birth to midlife, to compare people never-diagnosed with mental disorder (N = 171; 17% prevalence) to those diagnosed at 1–2 study waves, the cohort mode (N = 409). Surprisingly, compared to this modal group, never-diagnosed Study members were not born into unusually well-to-do families, nor did their enduring mental health follow markedly sound physical health, or unusually high intelligence. Instead, they tended to have an advantageous temperament/personality style, and negligible family history of mental disorder. As adults, they report superior educational and occupational attainment, greater life satisfaction, and higher-quality relationships. Our findings draw attention to “enduring mental health” as a revealing psychological phenotype and suggest it deserves further study.
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I assume they adjusted for this, but this is funny at a surface level reading. People with superior educational attainment, greater life satisfaction, and higher quality relationships have fewer mental health issues. Who would’ve thought?!
Another take: we have medicalized the normal human range of human emotions to the point that 83% of the population will at some point be considered to have a mental disorder.
All men are mortal doesn’t mean all mortals are men.
Study was done with a largely Caucasian, New Zealand cohort born in the 1970s.
Factors which correlate with enduring mental health:
Childhood factors:
- little evidence of strong negative emotions
- social support and sociability
- self-control
Familiy environment factors:
- fewer first- and second-degree relatives with mental health issues
- less negative discipline
- reduced likelihood of parental loss
Not relevant:
- socioeconomic advantage
- perinatal complications
- physical health
- intelligence
That said it does seem that the extreme prevalence of something over a long period of time makes dubious the claim that it is a “mental illness”.
It feels like treating people as defective for falling over because they don’t have 3 legs ...
One uncomfortable part of mild depression is the questions around how correct it is. It is easy to logically deduce depression as a rational response to the world.
Quoting Wikipedia's summary (can't find my DSM-IV):
>According to DSM-IV, a mental disorder is a psychological syndrome or pattern which is associated with distress (e.g. via a painful symptom), disability (impairment in one or more important areas of functioning), increased risk of death, or causes a significant loss of autonomy; however it excludes normal responses such as grief from loss of a loved one, and also excludes deviant behavior for political, religious, or societal reasons not arising from a dysfunction in the individual.
https://en.wikipedia.org/wiki/Mental_disorder
We can argue about where to draw the line for distress or disability, but I just wanted to counter the myth that shrinks are totally subjective.
1) A refusal to distinguish between mental illness and permanent psychological disability (along with the idea that all mental illnesses are neurostructural in nature)
2) A refusal to acknowledge that "biologically normal" human emotions can nevertheless be a cause for medical concern, in the sense that a high fever is a "normal" and necessary response to infection that can nevertheless cause serious problems.
If someone is deeply depressed after their mother dies, they should be considered as having a mental injury that should heal on its own but needs to be monitored for "infection" or otherwise problematic healing. Saying ahead of time "this person isn't mentally ill so this is just normal bereavement" is bad medicine and bad science.
US society in particular (but also humans in general) really wants to draw a distinction between "the mentally ill" and "the mentally well." If you were to try to draw a similarly strong distinction between "people with stomach problems" and "people without stomach problems" the absurdity would be self-evident: there is no reason to lump people with norovirus in with people with IBD. But because mental illness is so much more mysterious (and, frankly, scary), and so entwined with social and societal expectations and norms, it is much harder to approach it from the same medical-first perspective.
I agree with everything you said except I'm having trouble with this bit. Neurostructural as opposed to what? All thoughts are physical things happening in the head.
The brain changes. Sometimes it changes to a state that creates problems for a person (perhaps long term depression spurred by grieving a loved one.) Sometimes talk or time can change it back. Or change it to another state that isn't impaired by ticks or grief or anger. But it is a physical process.
I understand that sometimes working at the granular level of neurons or chemistry isn't as productive as working at the psychological level. i.e. sometimes talking about emotions can get the brain to start to encourage different pathways that will eventually become the norm and take one away from the problematic ones. But this is still a neurostructural change in the brain. It is just mediated by the brain itself.
Perhaps I am missing some subtle point or misinterpreting you?
Scientifically there isn't a boundary, and I am speaking very loosely here and probably should have said something more specific.
But "all thoughts are physical things happening in the head" is perhaps too reductive, similar to saying "all physics is quantum mechanics" - just because it's true doesn't mean it's a useful way to think about a specific problem. There's a distinct medical difference between someone with chronic depression without a specific life event ("neurostructural"), and someone who started out being "legitimately" depressed after being laid off, but spiralled downwards. Both can be described as a "deficit in the structure of the brain" but in the former case that structural deficit likely cannot be fixed by the brain itself (even with the guidance of a therapist) and drugs are probably necessary. In the latter case, perhaps only CBT and general wellness habits are enough - the brain can fix its own "structural problem."
I lean heavily on the mechanisms of thought and mind because even now there is a tremendous amount of stigma and mysticism surrounding mental illness. I've encountered even mental health providers who still speak or act as if patients have a failure of character or personal weakness. I've encountered specialists who aren't really even familiar with CBT or who still think digging up trauma repeatedly a la Freud is useful. I encounter a kind of dualism all the time, as if the mind is some kind of sick spirit inhabiting the brain.
I agree though. Treatments can function at a more macro level. I think this is demonstrated by something as simple as venting about a problem or person. A resentment or regret that is stopping one up finally falls to the side when one talks to a friend about it.
These high level concepts we have about objects and people and concepts clearly have some power to drive the lower level. Attempting to resolve some issue a person might have with their spouse at the neuronal level would be a bit like building a house up from atoms rather than timber.