Here is a paper proposal that I recently wrote. I gotta say there’s definitely room for improvement, there’s a lot more to learn about every aspect of this topic but it’s a bit of a rushed start since I had a deadline.

“Capitalist realism insists on treating mental health as if it were a natural fact, like weather (but, then again, weather is no longer a natural fact so much as a political-economic effect). In the 1960s and 1970s, radical theory and politics (Laing, Foucault, Deleuze and Guattari, etc.) coalesced around extreme mental conditions such as schizophrenia, arguing, for instance, that madness was not a natural, but a political, category. But what is needed now is a politicization of much more common disorders. Indeed, it is their very commonness which is the issue… I want to argue that it is necessary to reframe the growing problem of stress (and distress) in capitalist societies. Instead of treating it as incumbent on individuals to resolve their own psychological distress, instead, that is, of accepting the vast privatization of stress that has taken place over the last thirty years, we need to ask: how has it become acceptable that so many people, and especially so many young people, are ill?”

*― Mark Fisher, *Capitalist Realism: Is There No Alternative?

INTRODUCTION

Are we in the midst of a global mental health crisis? An imperative question with a very elusive nature. Global measures of the prevalence of mental health are not very reliable for several reasons. One major problem is the vague definition of what constitutes mental health. Another is under-coverage. However, based on the accepted definition it is safe to say that the inclination is towards underestimation rather than overestimation because not every case of mental illness is reported or diagnosed. In 2017, 10.7% percent of the global population has been estimated to suffer from at least one kind of mental disorder, with depression and anxiety taking the lead (Ritchie & Roser, 2018). This can be regarded as a minimum estimate, especially in lower-income countries. So we can infer that more than 1 in every 10 people worldwide suffer from mental illness and we do not know how much more. The available data also indicate that there has not been a significant increase in mental illness from 1990 to 2017, but considering the confessed unreliability of this data this inference does not really mean anything. Another interesting health statistic used to measure the burden of disease is the Disability Adjusted Life Year (DALY) which reflects the number of years lost due to premature death and years lived with a disability. The global burden of mental disease and substance abuse (these two concepts are often grouped together) is estimated to have increased from 90.65 million DALYs in 1990 to 142.01 million DALYs in 2017 (IHME, 2017). Another approach we could take to understand the cost of mental illness would be to consider suicide statistics, as approximately 90% of suicides in high-income countries are claimed to be caused by underlying mental illness. This differs by country and can be lower because suicide caused by dysphoric effect or impulsivity is not regarded as connected to mental illness. Although the arbitrary nature of these definitions must be considered given that mood dysphoria has a very similar definition with depression. Globally, we lose 800,000 people to suicide every year. That means that one person every 40 seconds takes their own life. Suicide is one of the leading causes of death worldwide, especially for young people. Any given person is more likely to die at their own hands than someone else’s (Ritchie et al., 2015). That’s something to think about. And keep in mind that these measures are also underestimates.

What can we actually infer from this information? Are we in the midst of a global mental health crisis? Many sources think not. But our information mostly proves that we do not, in fact, have enough information and that the information we do have is quite unreliable. However, we can’t ignore the fact that there does seem to be a problem that actually costs a significant share of the population many of their healthy years or even their lives. Let us now dive deeper into what mental illness means, as this is one of the major issues surrounding the subject.

What Does Mental Illness Mean?

Mental illness is a tricky concept as it is not absolutely clear what the term means. Mental illness has only recently begun to be diagnosed using biological indicators through brain imaging techniques and these techniques are less effective in diagnosing more mild disorders such as depression and anxiety. Therefore, the definition of mental illness is to some extent still open to interpretation. Although not the first, the most renowned study that exposes the arbitrariness of psychiatric diagnosis is Rosenhan’s study that effectively proved that psychiatrists are not able to actually distinguish between real patients and “pseudo-patients” in psychiatric facilities (1973). The same idea was also portrayed in an even more famous movie and the book it was based on, Ken Kesey’s “One Flew Over the Cuckoo’s Nest (1962).” These critiques of the psychiatric industry are intriguing but do they have an actual basis? The Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association is considered “the Bible” of psychiatry. The earlier editions of the DSM were highly criticized for not having an empirical basis and for reflecting social norms to a degree that resulted in the classification of any kind of deviant behavior as mental illness. The latest edition, DSM-V which was published in 2013, improves upon these criticisms (Stein et al., 2010). It defines mental illness as:

“A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above (Thyer, 2015).”

Despite being an improvement on previous definitions, this definition has also been criticized to be a tautology — -or scientifically meaningless (Thyer, 2015). The Substance Abuse and Mental Health Services Association (SAMHSA) distinguishes between two types of mental illness based on the severity of the condition. Any mental illness (AMI) is defined as exhibiting any disorder that meets the DSM definition and serious mental illness (SMI) is when an AMI interferes with the regular functioning of a person (NIMH, 2021). As is evident from these definitions, and as these sources themselves confess, “no definition perfectly specifies precise boundaries for the concept of either ‘medical disorder’ or ‘mental/psychiatric disorder (Stein et al., 2010).’” Even Allen Frances, lead editor of the DSM-IV claims that “there is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it (Greenberg, 2010).” Let’s turn to a critical discussion of mental illness and address why a lack of a concrete definition is problematic.

Deconstructing Mental Illness

In essence, the definition of mental illness is derived from the definition of normality, and this relies extensively on social and cultural context and norms. Even with brain imaging, I still don’t understand how we decide whether or not we consider a certain state of the brain ill or not ill. I mean this is obviously easier to do with more severe mental illnesses like schizophrenia, but what about ADHD for example? Why are we pathologizing neurodivergence?

The not-so-obvious nature of the concept puts the definition of mental illness into the hands of certain people that form the authority when it comes to mental health. This category of people are referred to as the “psy-professions” by Sociologist Bruce M. Z. Cohen in his book “Psychiatric Hegemony: A Marxist Theory of Mental Illness,” which constitutes the inspiration for this paper. Cohen defines these people as those that have the required training and credentials to make claims about what constitutes “normal” when it comes to the functioning of the human mind, and hence, what is “abnormal” and requires intervention (Cohen, 2016). That is, obviously, a lot of power. What happens if these professionals make a mistake? Well, let’s take a look at the dark past of the psy-professions and some of the mistakes that have been made before and their consequences.

Perhaps the most criticized embarrassment of the mental health industry was the DSM classification of homosexuality as a mental disease that ought to be treated, and the treatments were quite horrifying: aversion shock therapy, conversion therapy with hired prostitutes, lobotomies and even castration (Blakemore, 2019). The earlier legitimization of differences in sexual orientation as a mental disorder still has its effects on the everlasting stigma associated with the queer community today. Another cultural bias we see reflected in the psy-professions is against women. In his book, Cohen elaborates extensively on how psychiatric discourse legitimizes and reproduces the age-old oppression of women and the patriarchal order in neoliberal society (2016). Not only are women more likely to suffer from mental illness, they’re more likely to be misdiagnosed and they are more likely to attempt suicide (Ritchie, 2018; Tasca et al., 2012, Ritchie et al., 2015). Another disparity involves children. Child and adolescent mental illness prevalence is increasing and was globally at 15% in 2018 (Bruha et al.). Critique emphasizes that this is the sedation of children who merely exhibit completely normal childhood attributes. It is an issue that has gained popularity in recent years, especially regarding the diagnosis of ADHD, an “illness” so many children seem to be experiencing (Erlandsson & Punsy, 2016). While the psychiatric community regard their previous biases as steps towards a better understanding of the human mind and claim improvement, in my personal opinion these mistakes are way too colossal to be just be forgiven and forgotten. Also, there is no guarantee that mistakes aren’t being made today. The above examples of bias in the mental health industry make it evident that the concept of mental illness and the power associated with authority in the industry make this concept a very effective tool for social control. A dangerous tool that is vulnerable to exploitation by the powerful, exercised on the powerless.

What Does it Mean to be Mentally Ill?

The legitimate form of practicing medicine in the “developed” world is Western medicine. Western medicine is characterized by diagnosis rather than prevention, a specialized division of labor rather than a holistic approach, and treatment by pharmaceutical drugs and surgery (Saks, 2018). This means that our system for dealing with mental health waits for one to become noticeably ill, diagnoses the illness and then prescribes a treatment based on the severity of the condition. It’s a solution-oriented approach applied after the problem occurs rather than an approach that might address the causes of the problem to prevent it. So what are the solutions for mental illness? The less severe cases of mental illness are often treated with various methods of therapy which are often quite expensive especially considering that it takes several sessions to actually get any result. Increase the degree of severity and you’ll get prescription drugs, especially if the condition interferes with the daily “functioning” of the individual which is another way of saying if it reduces an individual’s work-related productivity. SSRIs like Prozac are often prescribed, the effectiveness of which is controversial. Not only that, but the associated side-effects are a legitimate point of consideration as they can be addictive, or even lethal. In even more severe cases where you might be deemed a threat to society, individuals are basically imprisoned in mental asylums, deprived of many of their basic human rights. It’s basically incarceration.

From this brief overview of current solutions for mental disorders, it seems as if the solutions are either expensive and inaccessible, involves sedation and a risk of addiction or death, or dehumanization on grounds that have a controversial scientific basis. (How wonderful!) This situation makes one wonder who our mental health industry actually benefits, given that it does not seem to be very beneficial for the “mentally ill.” I obviously believe that states of mental unwellness exist, but are there no better solutions? It is not within the scope of this paper to fully discuss the topic of alternative solutions, but the recently re-emerging research on psychedelic medicine holds promising potential in the curative treatment of several psychological conditions: especially depression, anxiety, PTSD and substance addiction (Tupper et al., 2015). That makes one wonder why they were deemed extremely dangerous and illegal in the first place when they are at least just as effective as, and less addictive and toxic than the palliative prescription drugs that are currently used (Hendricks et al., 2015; Haden & Woods, 2020). (This is all I could say in a term paper but I have so many more ideas about this, maybe in another post). So what function does the mental health industry serve in capitalist/neoliberal society?

What is the Function of the Mental Health Industry in Society?

One popular point of criticism is the mental health industry’s connections with pharmaceutical companies. The more people diagnosed with a mental health condition, the more prescription drugs sold. The longer these people suffer from their condition, the more prescription drugs sold. The more addicted people are to their prescription drugs, the more prescription drugs sold. The more drugs prescribed, the more the psy-professions gain legitimacy in the medical community (Cohen, 2016). What kind of subjects does this solution create? Sedated, passive, obedient subjects that can “function properly” in society, or more specifically in a capitalist labor market. A neoliberal ethos that defines the main objective of society as economic growth, holds the danger of reproducing and legitimizing anything that contributes to this objective. Including mental illness. Our well-being is only profitable in the sense that we’re well enough to go to work and maintain our state of constant productivity. Cohen argues in his book that the mental health industry and the discourse produced by it are social constructions that have risen with capitalism “to police dissent and reinforce conformity, not to emancipate people (Cohen, 2016).”

What Kind of Relationship Exists Between Capitalism and Mental Illness?

Why do so many people feel mentally ill? We’re generally taught that this has to do with our own individual experiences and traumas and that we must learn to cope with them in various ways. What about our environment? Is it possible that these symptoms of mental illness could disappear given that we changed our environment? What about our socio-economic systems? Could they possibly have an effect on our well-being? Capitalism itself may be a cause for the prevalence of mental illness, considering that it is not an economic system designed with the well-being of humankind in consideration. Not only this, but our current perception of mental illness and the industry built around it distract us from the systemic nature of the problem. This approach to mental illness makes it seem like an individual issue, a natural phenomenon that just happens to people. However, mental illness does not just appear in a void, it is the reaction of the body & mind to stimuli. Along with the individual factors, and maybe even to a greater extent, external social factors out of our control can also trigger mental illness. This more comprehensive approach is called the psychosocial model of mental illness (Cohen, 2016). So perhaps it is our modern way of life and modern neoliberal society that produces so much suffering? Perhaps it is the immense inequalities inherent to capitalism and their consequences that are the problem? Perhaps it is the constant push for productivity and the idealization of it that deems you as worthy as how much you contribute to economic progress? Perhaps it is the unnatural expectation of spending most of our lives in institutions that prepare you for the labor force and the work organizations that are allowed to exploit you for your labor? Or the inherently traumatizing experience of living in a patriarchal society? Or perhaps it’s the several forms of poverty and social exclusion you are exposed to if you don’t agree with this lifestyle? While all of this may seem very difficult to discuss objectively (no surprise there), in the case that we do find a positive correlation, in our discussion we will try to explain the micro-level mechanisms that could produce such a macro-level phenomenon, relying on psychological papers regarding status anxiety, work and subordination.

These are not novel ideas, the idea that capitalism is the fundamental cause of mental illness has been explored before (Rosenthal & Campbell, 2016). However, it must be acknowledged that establishing a causal relationship between capitalism and the prevalence of mental health is quite the empirical challenge, if it is possible at all. First of all, as we discussed in the beginning of this paper the data on mental health prevalence is very problematic due to issues of under reporting, under diagnosing, the problems associated with self-reporting, the confidentiality of health data and just the mere fact that the definitions of mental health terms are vague and open to interpretation. Perhaps the people best equipped to study this idea, the psy-professionals, wouldn’t even want to because of conflicts of interest. So there is a lack of empirical evidence for these claims. Perhaps the closest attempt was when Wilkinson & Picket, using WHO data, took on the intriguing challenge of demonstrating that more equal societies had fewer problems, including mental illness, in their book “The Spirit Level: Why Equality is Better for Everyone (2010).” However, the book was met with criticism regarding their empirical approach, the lack of actual statistical analyses, and non-replicability (Snowdon, 2010; Saunders, 2010; Sanandaji et al., 2010).

This study aims to use an innovative approach to studying the correlation between capitalism and mental illness prevalence by utilizing big data methods. It is only a tiny step towards a colossal goal and it is far from perfection but we need to start somewhere and can only hope this study will inspire improvements. Perhaps similar to the industrial revolution, we are at a point in history where we have the revolutionary opportunity to redesign our socio-economic systems while they are being digitalized. We could also just end up transferring the existing inequalities and biases to these systems if we don’t intentionally try to fix them. In order to fix them, we must acknowledge these problems first, and acknowledge their relationship with our socio-economic systems. As an indicator of the general absence of well-being in society, I believe mental illness is a good starting point to study this idea.

DATA & METHODS

To overcome, to some extent, the problem of underreporting in mental health statistics, this study uses Google Trends data that signals potential mental illness to derive country-based estimates for the prevalence of mental illness. The assumption made here is that someone who experiences feelings that they think are a symptom of mental illness, would at least try to obtain information about this personally even if they do not end up seeing a professional about the issue. There are obviously several other reasons why someone would search for information on mental illness and it is also obvious that not everyone who experiences mental illness would do a Google search on it. The study acknowledges but operates on these assumptions. Also, not everyone who suspects mental illness is actually mentally ill but we already established that we don’t really have an objective definition for mental illness so this study accepts individuals’ feelings as sufficient evidence that something is wrong.

First, we will try to establish whether or not using Google Trends data provides useful estimates for mental health prevalence by comparing our results to official sources. Since Google Trends data does not offer a specific number of cases but rather how popular a search term is compared to everything else that has been searched for in a specific place and time, we expect that the comparison amongst countries will be approximately the same.

In the second part of our analysis, we will try to understand the relationship between mental health prevalence and the welfare state regime of countries. In other words, we want to see if more capitalist societies have a higher tendency for mental illness. We operationalize this using Esping-Andersen’s classification of welfare state regimes: liberal, conservative and social democratic (Esping-Andersen, 1990). Of these categories, countries classified as liberal would represent what we deem to be a capitalist/neoliberal society. It is expected that these countries would have higher estimates of mental illness prevalence compared to the other two categories. Google Trends data provides you with a number from 0 to 100 that represents how popular the search term is in comparison with all other search terms in a given time and place. Our sample will consist of all countries that we can fit into this classification, although we believe it would be beneficial to have a separate analysis of just postindustrial Western countries (European and North American countries) because this sample might constitute a relatively better research setting due to our assumption that the differences between these countries (confounding factors) would be less compared to the differences between all the countries of the world. Also, we assume that most people would have access to such a search possibility in these countries although there may be systematic under-coverage due to a lack of a computer or a smartphone that may be linked to low income which is itself a factor for mental disorder.

Google searches containing keywords regarding mental disorders, more specifically “depression,” “anxiety,” and “stress” are considered a single case of mental illness. We specifically exclude more severe forms of mental illness as they may have a higher risk of being genetic, and aren’t what we are interested in, in this study. Google Trends data doesn’t count the same search term for the same person over short periods of time (the information offered by the tool is not more specific than this unfortunately) and it includes searches that contain this keyword and its relevant translations. The data will be collected from the years between 2010 and 2020, the Covid-19 Pandemic will not be included as this is an obvious reason for the increase of such searches. Despite the limitations, we believe the study is worth executing, even if only to spark a discussion that might pave the way for better research.

Resources:

Blakemore, Erin. n.d. “Gay Conversion Therapy’s Disturbing 19th-Century Origins.” HISTORY. Retrieved April 18, 2021 (https://www.history.com/news/gay-conversion-therapy-origins-19th-century).

Bruha, Lauren, Valentini Spyridou, Georgia Forth, and Dennis Ougrin. 2018. “Global Child and Adolescent Mental Health: Challenges and Advances.” London Journal of Primary Care 10(4):108–9. doi: 10.1080/17571472.2018.1484332.

Cohen, Bruce M. Z. 2017. Psychiatric Hegemony: A Marxist Theory of Mental Illness. Place of publication not identified: PALGRAVE MACMILLAN.

“DALYs from Mental Health and Substance Use Disorders.” Our World in Data. Retrieved April 18, 2021a (https://ourworldindata.org/grapher/dalys-from-mental-health-and-substance-use-disorders).

Dickinson, Tommy, Matt Cook, John Playle, and Christine Hallett. 2014. “Nurses and Subordination: A Historical Study of Mental Nurses’ Perceptions on Administering Aversion Therapy for ‘Sexual Deviations.’” Nursing Inquiry 21(4):283–93. doi: 10.1111/nin.12044.

Erlandsson, Soly, and Elisabeth Punzi. 2016. “Challenging the ADHD Consensus.” International Journal of Qualitative Studies on Health and Well-Being 11(1):31124. doi: 10.3402/qhw.v11.31124.

Esping-Andersen, G. 1990. The Three Political Economies of the Welfare State. International Journal of Sociology, 20(3), 92–123. Retrieved April 19, 2021, from http://www.jstor.org/stable/20630041

Fisher, Mark. 2009. Capitalist Realism: Is There No Alternative? Winchester: O Books.

Greenberg, Gary. n.d. “Inside the Battle to Define Mental Illness.” Wired.

Haden, Mark, and Birgitta Woods. 2020. “LSD Overdoses: Three Case Reports.” Journal of Studies on Alcohol and Drugs 81(1):115–18. doi: 10.15288/jsad.2020.81.115.

Hendricks, Peter S., Christopher B. Thorne, C. Brendan Clark, David W. Coombs, and Matthew W. Johnson. 2015. “Classic Psychedelic Use Is Associated with Reduced Psychological Distress and Suicidality in the United States Adult Population.” Journal of Psychopharmacology 29(3):280–88. doi: 10.1177/0269881114565653.

“Is the DSM the Bible of Psychiatry?” Psychiatric Times. Retrieved April 18, 2021c (https://www.psychiatrictimes.com/view/dsm-bible-psychiatry).

Kesey, Ken, and Robert Faggen. 1962. One Flew over the Cuckoo’s Nest. Nachdr. Harmondsworth: Penguin Books.

Lim, Austin. n.d. “Psychedelics as Antidepressants.” Scientific American. Retrieved April 18, 2021 (https://www.scientificamerican.com/article/psychedelics-as-antidepressants/).

“NIMH » Mental Illness.” Retrieved April 18, 2021d (https://www.nimh.nih.gov/health/statistics/mental-illness.shtml).

Ritchie, Hannah, and Max Roser. 2018. “Mental Health.” Our World in Data.

Ritchie, Hannah, Max Roser, and Esteban Ortiz-Ospina. 2015. “Suicide.” Our World in Data.

Rosenhan, D. L. 1973. “On Being Sane in Insane Places.” Science 179(4070):250–58. doi: 10.1126/science.179.4070.250.

Saks, Mike. 3 Jan. 2018. “Complementary and alternative medicine”. Encyclopedia Britannica, https://www.britannica.com/science/complementary-and-alternative-medicine. Accessed 18 April 2021.

Saunders, Peter. 2010. Beware False Prophets: Equality, the Good Society and The Spirit Level. Policy Exchange.

Snowdon, Christopher, and Patrick Basham. 2010. The Spirit Level Delusion: Fact-Checking the Left’s New Theory of Everything. Ripon, North Yorkshire: Little Dice [u.a.].

Snowdon, Nima Sanandaji, Tino Sanandaji ,. Arvid Malm and Christopher. 2010. “Un-Level Ground.” Wall Street Journal, July 9.

Stein, D. J., K. A. Phillips, D. Bolton, K. W. M. Fulford, J. Z. Sadler, and K. S. Kendler. 2010. “What Is a Mental/Psychiatric Disorder? From DSM-IV to DSM-V.” Psychological Medicine 40(11):1759–65. doi: 10.1017/S0033291709992261.

Stein, Dan J., Katharine A. Phillips, Derek Bolton, K. W. M. Fulford, John Z. Sadler, and Kenneth S. Kendler. 2010. “What Is a Mental/Psychiatric Disorder? From DSM-IV to DSM-V.” Psychological Medicine 40(11):1759–65. doi: 10.1017/S0033291709992261.

Tasca, Cecilia, Mariangela Rapetti, Mauro Giovanni Carta, and Bianca Fadda. 2012. “Women And Hysteria In The History Of Mental Health.” Clinical Practice & Epidemiology in Mental Health 8(1):110–19. doi: 10.2174/1745017901208010110.

Thyer, Bruce A. 2015. “The DSM-5 Definition of Mental Disorder: Critique and Alternatives.” Pp. 45–68 in Critical Thinking in Clinical Assessment and Diagnosis, edited by B. Probst. Cham: Springer International Publishing.

Tupper, Kenneth W., Evan Wood, Richard Yensen, and Matthew W. Johnson. 2015. “Psychedelic Medicine: A Re-Emerging Therapeutic Paradigm.” Canadian Medical Association Journal 187(14):1054–59. doi: 10.1503/cmaj.141124.

Here is a paper proposal that I recently wrote. I gotta say there’s definitely room for improvement, there’s a lot more to learn about every aspect of this topic but it’s a bit of a rushed start since I had a deadline.

“Capitalist realism insists on treating mental health as if it were a natural fact, like weather (but, then again, weather is no longer a natural fact so much as a political-economic effect). In the 1960s and 1970s, radical theory and politics (Laing, Foucault, Deleuze and Guattari, etc.) coalesced around extreme mental conditions such as schizophrenia, arguing, for instance, that madness was not a natural, but a political, category. But what is needed now is a politicization of much more common disorders. Indeed, it is their very commonness which is the issue… I want to argue that it is necessary to reframe the growing problem of stress (and distress) in capitalist societies. Instead of treating it as incumbent on individuals to resolve their own psychological distress, instead, that is, of accepting the vast privatization of stress that has taken place over the last thirty years, we need to ask: how has it become acceptable that so many people, and especially so many young people, are ill?”

*― Mark Fisher, *Capitalist Realism: Is There No Alternative?

INTRODUCTION

Are we in the midst of a global mental health crisis? An imperative question with a very elusive nature. Global measures of the prevalence of mental health are not very reliable for several reasons. One major problem is the vague definition of what constitutes mental health. Another is under-coverage. However, based on the accepted definition it is safe to say that the inclination is towards underestimation rather than overestimation because not every case of mental illness is reported or diagnosed. In 2017, 10.7% percent of the global population has been estimated to suffer from at least one kind of mental disorder, with depression and anxiety taking the lead (Ritchie & Roser, 2018). This can be regarded as a minimum estimate, especially in lower-income countries. So we can infer that more than 1 in every 10 people worldwide suffer from mental illness and we do not know how much more. The available data also indicate that there has not been a significant increase in mental illness from 1990 to 2017, but considering the confessed unreliability of this data this inference does not really mean anything. Another interesting health statistic used to measure the burden of disease is the Disability Adjusted Life Year (DALY) which reflects the number of years lost due to premature death and years lived with a disability. The global burden of mental disease and substance abuse (these two concepts are often grouped together) is estimated to have increased from 90.65 million DALYs in 1990 to 142.01 million DALYs in 2017 (IHME, 2017). Another approach we could take to understand the cost of mental illness would be to consider suicide statistics, as approximately 90% of suicides in high-income countries are claimed to be caused by underlying mental illness. This differs by country and can be lower because suicide caused by dysphoric effect or impulsivity is not regarded as connected to mental illness. Although the arbitrary nature of these definitions must be considered given that mood dysphoria has a very similar definition with depression. Globally, we lose 800,000 people to suicide every year. That means that one person every 40 seconds takes their own life. Suicide is one of the leading causes of death worldwide, especially for young people. Any given person is more likely to die at their own hands than someone else’s (Ritchie et al., 2015). That’s something to think about. And keep in mind that these measures are also underestimates.

What can we actually infer from this information? Are we in the midst of a global mental health crisis? Many sources think not. But our information mostly proves that we do not, in fact, have enough information and that the information we do have is quite unreliable. However, we can’t ignore the fact that there does seem to be a problem that actually costs a significant share of the population many of their healthy years or even their lives. Let us now dive deeper into what mental illness means, as this is one of the major issues surrounding the subject.

What Does Mental Illness Mean?

Mental illness is a tricky concept as it is not absolutely clear what the term means. Mental illness has only recently begun to be diagnosed using biological indicators through brain imaging techniques and these techniques are less effective in diagnosing more mild disorders such as depression and anxiety. Therefore, the definition of mental illness is to some extent still open to interpretation. Although not the first, the most renowned study that exposes the arbitrariness of psychiatric diagnosis is Rosenhan’s study that effectively proved that psychiatrists are not able to actually distinguish between real patients and “pseudo-patients” in psychiatric facilities (1973). The same idea was also portrayed in an even more famous movie and the book it was based on, Ken Kesey’s “One Flew Over the Cuckoo’s Nest (1962).” These critiques of the psychiatric industry are intriguing but do they have an actual basis? The Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association is considered “the Bible” of psychiatry. The earlier editions of the DSM were highly criticized for not having an empirical basis and for reflecting social norms to a degree that resulted in the classification of any kind of deviant behavior as mental illness. The latest edition, DSM-V which was published in 2013, improves upon these criticisms (Stein et al., 2010). It defines mental illness as:

“A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above (Thyer, 2015).”

Despite being an improvement on previous definitions, this definition has also been criticized to be a tautology — -or scientifically meaningless (Thyer, 2015). The Substance Abuse and Mental Health Services Association (SAMHSA) distinguishes between two types of mental illness based on the severity of the condition. Any mental illness (AMI) is defined as exhibiting any disorder that meets the DSM definition and serious mental illness (SMI) is when an AMI interferes with the regular functioning of a person (NIMH, 2021). As is evident from these definitions, and as these sources themselves confess, “no definition perfectly specifies precise boundaries for the concept of either ‘medical disorder’ or ‘mental/psychiatric disorder (Stein et al., 2010).’” Even Allen Frances, lead editor of the DSM-IV claims that “there is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it (Greenberg, 2010).” Let’s turn to a critical discussion of mental illness and address why a lack of a concrete definition is problematic.

Deconstructing Mental Illness

In essence, the definition of mental illness is derived from the definition of normality, and this relies extensively on social and cultural context and norms. Even with brain imaging, I still don’t understand how we decide whether or not we consider a certain state of the brain ill or not ill. I mean this is obviously easier to do with more severe mental illnesses like schizophrenia, but what about ADHD for example? Why are we pathologizing neurodivergence?

The not-so-obvious nature of the concept puts the definition of mental illness into the hands of certain people that form the authority when it comes to mental health. This category of people are referred to as the “psy-professions” by Sociologist Bruce M. Z. Cohen in his book “Psychiatric Hegemony: A Marxist Theory of Mental Illness,” which constitutes the inspiration for this paper. Cohen defines these people as those that have the required training and credentials to make claims about what constitutes “normal” when it comes to the functioning of the human mind, and hence, what is “abnormal” and requires intervention (Cohen, 2016). That is, obviously, a lot of power. What happens if these professionals make a mistake? Well, let’s take a look at the dark past of the psy-professions and some of the mistakes that have been made before and their consequences.

Perhaps the most criticized embarrassment of the mental health industry was the DSM classification of homosexuality as a mental disease that ought to be treated, and the treatments were quite horrifying: aversion shock therapy, conversion therapy with hired prostitutes, lobotomies and even castration (Blakemore, 2019). The earlier legitimization of differences in sexual orientation as a mental disorder still has its effects on the everlasting stigma associated with the queer community today. Another cultural bias we see reflected in the psy-professions is against women. In his book, Cohen elaborates extensively on how psychiatric discourse legitimizes and reproduces the age-old oppression of women and the patriarchal order in neoliberal society (2016). Not only are women more likely to suffer from mental illness, they’re more likely to be misdiagnosed and they are more likely to attempt suicide (Ritchie, 2018; Tasca et al., 2012, Ritchie et al., 2015). Another disparity involves children. Child and adolescent mental illness prevalence is increasing and was globally at 15% in 2018 (Bruha et al.). Critique emphasizes that this is the sedation of children who merely exhibit completely normal childhood attributes. It is an issue that has gained popularity in recent years, especially regarding the diagnosis of ADHD, an “illness” so many children seem to be experiencing (Erlandsson & Punsy, 2016). While the psychiatric community regard their previous biases as steps towards a better understanding of the human mind and claim improvement, in my personal opinion these mistakes are way too colossal to be just be forgiven and forgotten. Also, there is no guarantee that mistakes aren’t being made today. The above examples of bias in the mental health industry make it evident that the concept of mental illness and the power associated with authority in the industry make this concept a very effective tool for social control. A dangerous tool that is vulnerable to exploitation by the powerful, exercised on the powerless.

What Does it Mean to be Mentally Ill?

The legitimate form of practicing medicine in the “developed” world is Western medicine. Western medicine is characterized by diagnosis rather than prevention, a specialized division of labor rather than a holistic approach, and treatment by pharmaceutical drugs and surgery (Saks, 2018). This means that our system for dealing with mental health waits for one to become noticeably ill, diagnoses the illness and then prescribes a treatment based on the severity of the condition. It’s a solution-oriented approach applied after the problem occurs rather than an approach that might address the causes of the problem to prevent it. So what are the solutions for mental illness? The less severe cases of mental illness are often treated with various methods of therapy which are often quite expensive especially considering that it takes several sessions to actually get any result. Increase the degree of severity and you’ll get prescription drugs, especially if the condition interferes with the daily “functioning” of the individual which is another way of saying if it reduces an individual’s work-related productivity. SSRIs like Prozac are often prescribed, the effectiveness of which is controversial. Not only that, but the associated side-effects are a legitimate point of consideration as they can be addictive, or even lethal. In even more severe cases where you might be deemed a threat to society, individuals are basically imprisoned in mental asylums, deprived of many of their basic human rights. It’s basically incarceration.

From this brief overview of current solutions for mental disorders, it seems as if the solutions are either expensive and inaccessible, involves sedation and a risk of addiction or death, or dehumanization on grounds that have a controversial scientific basis. (How wonderful!) This situation makes one wonder who our mental health industry actually benefits, given that it does not seem to be very beneficial for the “mentally ill.” I obviously believe that states of mental unwellness exist, but are there no better solutions? It is not within the scope of this paper to fully discuss the topic of alternative solutions, but the recently re-emerging research on psychedelic medicine holds promising potential in the curative treatment of several psychological conditions: especially depression, anxiety, PTSD and substance addiction (Tupper et al., 2015). That makes one wonder why they were deemed extremely dangerous and illegal in the first place when they are at least just as effective as, and less addictive and toxic than the palliative prescription drugs that are currently used (Hendricks et al., 2015; Haden & Woods, 2020). (This is all I could say in a term paper but I have so many more ideas about this, maybe in another post). So what function does the mental health industry serve in capitalist/neoliberal society?

What is the Function of the Mental Health Industry in Society?

One popular point of criticism is the mental health industry’s connections with pharmaceutical companies. The more people diagnosed with a mental health condition, the more prescription drugs sold. The longer these people suffer from their condition, the more prescription drugs sold. The more addicted people are to their prescription drugs, the more prescription drugs sold. The more drugs prescribed, the more the psy-professions gain legitimacy in the medical community (Cohen, 2016). What kind of subjects does this solution create? Sedated, passive, obedient subjects that can “function properly” in society, or more specifically in a capitalist labor market. A neoliberal ethos that defines the main objective of society as economic growth, holds the danger of reproducing and legitimizing anything that contributes to this objective. Including mental illness. Our well-being is only profitable in the sense that we’re well enough to go to work and maintain our state of constant productivity. Cohen argues in his book that the mental health industry and the discourse produced by it are social constructions that have risen with capitalism “to police dissent and reinforce conformity, not to emancipate people (Cohen, 2016).”

What Kind of Relationship Exists Between Capitalism and Mental Illness?

Why do so many people feel mentally ill? We’re generally taught that this has to do with our own individual experiences and traumas and that we must learn to cope with them in various ways. What about our environment? Is it possible that these symptoms of mental illness could disappear given that we changed our environment? What about our socio-economic systems? Could they possibly have an effect on our well-being? Capitalism itself may be a cause for the prevalence of mental illness, considering that it is not an economic system designed with the well-being of humankind in consideration. Not only this, but our current perception of mental illness and the industry built around it distract us from the systemic nature of the problem. This approach to mental illness makes it seem like an individual issue, a natural phenomenon that just happens to people. However, mental illness does not just appear in a void, it is the reaction of the body & mind to stimuli. Along with the individual factors, and maybe even to a greater extent, external social factors out of our control can also trigger mental illness. This more comprehensive approach is called the psychosocial model of mental illness (Cohen, 2016). So perhaps it is our modern way of life and modern neoliberal society that produces so much suffering? Perhaps it is the immense inequalities inherent to capitalism and their consequences that are the problem? Perhaps it is the constant push for productivity and the idealization of it that deems you as worthy as how much you contribute to economic progress? Perhaps it is the unnatural expectation of spending most of our lives in institutions that prepare you for the labor force and the work organizations that are allowed to exploit you for your labor? Or the inherently traumatizing experience of living in a patriarchal society? Or perhaps it’s the several forms of poverty and social exclusion you are exposed to if you don’t agree with this lifestyle? While all of this may seem very difficult to discuss objectively (no surprise there), in the case that we do find a positive correlation, in our discussion we will try to explain the micro-level mechanisms that could produce such a macro-level phenomenon, relying on psychological papers regarding status anxiety, work and subordination.

These are not novel ideas, the idea that capitalism is the fundamental cause of mental illness has been explored before (Rosenthal & Campbell, 2016). However, it must be acknowledged that establishing a causal relationship between capitalism and the prevalence of mental health is quite the empirical challenge, if it is possible at all. First of all, as we discussed in the beginning of this paper the data on mental health prevalence is very problematic due to issues of under reporting, under diagnosing, the problems associated with self-reporting, the confidentiality of health data and just the mere fact that the definitions of mental health terms are vague and open to interpretation. Perhaps the people best equipped to study this idea, the psy-professionals, wouldn’t even want to because of conflicts of interest. So there is a lack of empirical evidence for these claims. Perhaps the closest attempt was when Wilkinson & Picket, using WHO data, took on the intriguing challenge of demonstrating that more equal societies had fewer problems, including mental illness, in their book “The Spirit Level: Why Equality is Better for Everyone (2010).” However, the book was met with criticism regarding their empirical approach, the lack of actual statistical analyses, and non-replicability (Snowdon, 2010; Saunders, 2010; Sanandaji et al., 2010).

This study aims to use an innovative approach to studying the correlation between capitalism and mental illness prevalence by utilizing big data methods. It is only a tiny step towards a colossal goal and it is far from perfection but we need to start somewhere and can only hope this study will inspire improvements. Perhaps similar to the industrial revolution, we are at a point in history where we have the revolutionary opportunity to redesign our socio-economic systems while they are being digitalized. We could also just end up transferring the existing inequalities and biases to these systems if we don’t intentionally try to fix them. In order to fix them, we must acknowledge these problems first, and acknowledge their relationship with our socio-economic systems. As an indicator of the general absence of well-being in society, I believe mental illness is a good starting point to study this idea.

DATA & METHODS

To overcome, to some extent, the problem of underreporting in mental health statistics, this study uses Google Trends data that signals potential mental illness to derive country-based estimates for the prevalence of mental illness. The assumption made here is that someone who experiences feelings that they think are a symptom of mental illness, would at least try to obtain information about this personally even if they do not end up seeing a professional about the issue. There are obviously several other reasons why someone would search for information on mental illness and it is also obvious that not everyone who experiences mental illness would do a Google search on it. The study acknowledges but operates on these assumptions. Also, not everyone who suspects mental illness is actually mentally ill but we already established that we don’t really have an objective definition for mental illness so this study accepts individuals’ feelings as sufficient evidence that something is wrong.

First, we will try to establish whether or not using Google Trends data provides useful estimates for mental health prevalence by comparing our results to official sources. Since Google Trends data does not offer a specific number of cases but rather how popular a search term is compared to everything else that has been searched for in a specific place and time, we expect that the comparison amongst countries will be approximately the same.

In the second part of our analysis, we will try to understand the relationship between mental health prevalence and the welfare state regime of countries. In other words, we want to see if more capitalist societies have a higher tendency for mental illness. We operationalize this using Esping-Andersen’s classification of welfare state regimes: liberal, conservative and social democratic (Esping-Andersen, 1990). Of these categories, countries classified as liberal would represent what we deem to be a capitalist/neoliberal society. It is expected that these countries would have higher estimates of mental illness prevalence compared to the other two categories. Google Trends data provides you with a number from 0 to 100 that represents how popular the search term is in comparison with all other search terms in a given time and place. Our sample will consist of all countries that we can fit into this classification, although we believe it would be beneficial to have a separate analysis of just postindustrial Western countries (European and North American countries) because this sample might constitute a relatively better research setting due to our assumption that the differences between these countries (confounding factors) would be less compared to the differences between all the countries of the world. Also, we assume that most people would have access to such a search possibility in these countries although there may be systematic under-coverage due to a lack of a computer or a smartphone that may be linked to low income which is itself a factor for mental disorder.

Google searches containing keywords regarding mental disorders, more specifically “depression,” “anxiety,” and “stress” are considered a single case of mental illness. We specifically exclude more severe forms of mental illness as they may have a higher risk of being genetic, and aren’t what we are interested in, in this study. Google Trends data doesn’t count the same search term for the same person over short periods of time (the information offered by the tool is not more specific than this unfortunately) and it includes searches that contain this keyword and its relevant translations. The data will be collected from the years between 2010 and 2020, the Covid-19 Pandemic will not be included as this is an obvious reason for the increase of such searches. Despite the limitations, we believe the study is worth executing, even if only to spark a discussion that might pave the way for better research.

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