Online exclusive
Opinion: We are at an inflexion point in our approach to mental health.
We’ve swiftly gone from never talking about it and viewing it as a binary proposition – “you’re fine, mate, but he’s crazy” – to marinating in mental health in mainstream and social media.
Around the world, the middle and upper class are eager for a diagnosis to put a name to the noise in their heads – whether it’s the cacophony of living in the mid-2020s or something more serious.
Two Oxford University research psychologists, Lucy Foulkes and Jack Andrews, coined the term “prevalence inflation” in a paper published last year. They argued that greater awareness of mental health was leading to more reporting of under-recognised symptoms, which they saw as beneficial. But they also found that “awareness efforts are leading some individuals to interpret and report milder forms of distress as mental health problems”. That led people to “experience a genuine increase in symptoms, because labelling distress as a mental health problem can affect an individual’s self-concept and behaviour in a way that is ultimately self-fulfilling”.
Dr Foulkes also worked on a British study that followed 28,000 teenagers over eight years, hoping to show that mindfulness training would improve their mental health. But the results, released in 2022, showed mindfulness lessons led to an increase in depressive symptoms in the students most at risk for mental health problems.
Turning to neurodiversity, cases of ADHD are now exploding in the rich world. Between 2006 and 2022, prescriptions for ADHD medications increased tenfold in New Zealand, from 55 per 100,000 people to 556 per 100,000. Pharmac says demand for ADHD medicines has increased 140% in New Zealand in just the past two years (there is now a global shortage). Many New Zealanders not prepared to wait in the public health system are paying $2000 for a private diagnosis.
In Australia, prescriptions have doubled in the past five years. Interviewed by The Age newspaper, psychiatrist Professor Ian Hickie said he asked his colleagues: once people have paid $2000 to get to a clinic, how often do you say, no, you don’t have ADHD? “And the answer is, ‘not often’. "
Britain’s rise in ADHD medications has skewed towards the rich. Prescriptions for ADHD meds for the wealthiest 20% of the population grew twice as fast as for the poorest 20% between 2020 and 2023, according to reporting by the Financial Times in February.
Many health experts – and I couldn’t be further from that description – believe we are still under-diagnosing ADHD. I defer to their expertise, but I am sceptical. I am grateful to now live in a time where we can be more open about our mental health. But I suspect there may be a social-contagion effect as citizens and celebrities share their experiences on Instagram and TikTok (The Age estimated #ADHD had 36 billion views as of March 2024).
Foulkes and Andrews say that “describing one’s difficulties as a mental health problem might now have social value” leading to mental health issues being “glamorised or romanticised” on social media.
I am also conscious that naming things changes things. Philosopher Ian Hacking calls this “dynamic nominalism”, although he concedes Nietzsche may have beaten him to it in writing that “unspeakably more depends on what things are called than on what they are”.
ADHD diagnosis largely relies on criteria set out in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition). I went on the ADHD New Zealand website and found myself ticking box after box. How often do you have problems remembering appointments or obligations? How often do you misplace or have difficulty finding things at home or at work? How often do you feel restless or fidgety?
The DSM is published by the American Psychiatric Association, which is not immune from the ebbs and flows of societal change. Between the DSM-4 and DSM-5, “pervasive developmental disorders” were collapsed into “autism spectrum disorder”, meaning Asperger’s disappeared. About 37 million people who felt they were part of the “Aspie community” no longer had a distinct diagnosis. Names matter.
The definition of autism has broadened to the extent that “evidence of the psychological and neurological traits associated with the condition” declined by 80% between 2000 and 2015, according to reporting by the New York Times.
None of this is to say that any of these conditions are not very real and very serious for people suffering from them.
I’m not a mental health professional. I’m a professional sceptic.
Are we being sceptical enough? What is the cost of telling a young person they have ADHD or an anxiety disorder if that then defines them in a way it may not have needed to?
It’s complex. But we know some of the risk factors for poor mental health, such as poverty, isolation, addiction and social media. Perhaps we need more focus on improving those and less focus on names and medication.
Guyon Espiner is an investigative journalist and presenter at RNZ, who hosts TV and radio interview show 30 With Guyon Espiner. He writes a fortnightly column for listener.co.nz
