The Invisible Pandemic

I guess you’ve all been reading about MERS, the Middle East Respiratory Syndrome. It’s hit South Korea and we don’t know where it will go next. It’s not an epidemic though. For the media that’s kind of a pity, they all love to talk about an impending epidemic, preferably a pandemic. Of course, there’s not too many of those. Or are there?

The Economist just ran an article on mental illness last week. Seems like, if you include things like depression and ADHD, it affects 20% or so of the population. That’s a lot.

Just to put that into perspective, the Centers for Disease Control estimated that in 2014, around 10% of the US population had diabetes. Diabetes is the gold standard for measuring the scale of an epidemic. On that scale, mental illness is twice the size. That sounds like a pandemic to me. So why aren’t the literati and the policy wonks cottoning on to that?

The amazing thing is that for all our modern technology and all the sophisticated medical research that is being done, we still have little or no idea as to how mental illness is caused. We’ve moved on from the idea that it’s self-inflicted or purely genetic. But other than that we are none the wiser.

There are some intriguing findings that the cause of some diseases like schizophrenia could be bacterial (as in chlamydia) or viral and that OCD could be caused by other bacteria. This has led to some speculation that mental disease could be infectious. The increasing evidence of the importance of the microbiome is leading some to think that gut bacteria are one cause. There is evidence as to links with parasites, especially those carried by cats which are responsible for toxoplasmosis and mental disease. Antibiotics have also been implicated, both as a direct cause and through their impact on the microbiome.

In other words, we don’t have a clue.

At present the state of the art is to treat the symptoms, mostly with drugs. They can certainly help but they rarely cure. One widely misunderstood treatment is ECT (electroconvulsive therapy) which is surprisingly effective, but we have no reason why, and it’s only useful sometimes. Behavioral cognitive therapy) BCT, aka talking, is also sometimes effective but it’s no use with most psychoses and we don’t even understand how it works either.

Mental illness has enormous social impacts. A huge proportion of all inmates in the “corrections” systems are estimated to be suffering from mental illness. A US Department of Justice report in 2005 estimated that 56% of State prisoners, 45% of Federal prisoners and 64% of jail inmates had a mental health problem.

A similarly high proportion of police arrests are for people with mental health problems. It’s now becoming tragically clear that a disproportionate number of mass shootings are committed by people with mental health problems. And we also know that a high proportion of the homeless, together with the (mostly but not always) petty crime that is associated with this, have mental illness of some kind.

And that doesn’t even include the many people amongst us who also suffer from mental illnesses that are not visible to others, except when they break out. These illnesses include attempted suicide, depression, and pathological behaviors such as OCD and bipolar disease.

Many of these are subclinical for much of the time but can suddenly become alarmingly clinical. There are many problems in families, which might appear to be caused by poverty, that are actually caused by mental disease of a family member.

And it’s not just at home. The invisible millions who suffer from mental illness mostly go to work. So many of the problems we see in organizations might not be due to sloth, incompetence (although some most assuredly are) but to mental health issues. How about the German pilot of the plane that crashed into the side of a mountain in the Alps not so long ago? How many other work “crashes” happen without us knowing the true cause? What about vehicular suicide?

Given the pandemic nature of mental illness, why isn’t it being given the attention it most assuredly deserves? Well by its very nature, it’s invisible. There aren’t any lesions, tumors, obvious physical manifestations, no visible scars.

And it’s still stigmatized, albeit things are improving. But most people still don’t want to talk about it, whether it’s concerning themselves or a relative or loved one. It can cause problems with employment and there are knotty legal issues.

But mostly it’s just not fashionable. HIV got its start because just at that time being homosexual had become part of the avant-garde counterculture. Ironically when homosexuality was considered a mental illness, mental health as a social cause might have received more attention. But now that LBGT lifestyles are becoming part of the mainstream, that aspect isn’t going to help either.

Obamacare requires parity in health insurance between physical and behavioral health needs. But that side of ObamaCare just isn’t working out as it was supposed to. So mental health is still an orphan in the health systems of the US.

Mental illness simply hasn’t become a cause celebre. It doesn’t have the raw public relations firepower of HIV, Ebola, Alzheimer’s or even MERS. So it isn’t getting the political support, and therefore the funding that comes from being one of the fashionable medical causes.

When will the world actually see the pandemic that is going on right in front of its face?