E-BOOK DESCRIPTIONNearly 50 percent of Americans have been mentally ill at some point in their lives, and more than a quarter have suffered from mental illness in the past twelve months.1 Madness, it seems, is rampant in America. These startling conclusions emerged from the National Comorbidity Survey Replication (NCSR), a study involving psychiatric interviews with a sample of more than nine thousand adults. Studies in other countries, for their part, seem to confirm the high level of mental illness in America. Consider two recent psychiatric surveys done in China and Nigeria. Both indicated that about 4–5 percent of the population had a mental disorder during the previous year, compared with 26 percent of people in the United States.2 Remarkably, Americans seem more vulnerable to breakdown than people in impoverished, often chaotic regions of the globe. Does affluence somehow breed mental disorder? The NCSR surveyors interviewed adults, not children. But they did ask subjects when their problems began. They found that half of those who had suffered from mental illness developed their disorder before the age of fourteen, and three-quarters of them had fallen ill by the age of twenty-four.3 Mental disorders, then, strike much earlier in people’s lives than many would have guessed. The NCSR also found that most people do not receive treatment in a timely fashion, if at all.4 For example, for those with mood disorders, the delay from illness onset to first professional contact ranged from six to eight years. For those with anxiety disorders, it ranged from nine to twenty-three years. The reasons for delay are unclear.
Some people may fail to recognize their problems as symptoms of treatable mental disorders, whereas others may worry about the stigma of being labeled “crazy.” Furthermore, among people who had a mental disorder during the previous year, 59 percent went untreated. The NCSR researchers interpreted these findings as indicating a “profound unmet need for mental health services.” 5 Yet strangely enough, despite the vast number of untreated individuals, nearly one-third of all mental health visits involve problems too mild to meet criteria for any psychiatric disorder.6 So in addition to the many cases of unmet need, we seem to have many cases of “met un-need,” as the psychiatric epidemiologist William Narrow called it.7 This would seem to imply that distressed people experiencing ordinary problems of living are consuming scarce resources needed by those with serious problems such as schizophrenia and depression. If so, then we have the worst possible situation: those most in need of treatment do not receive it, whereas those least in need do.