The Mental Health puzzle, part III: the cultural hypothesis.

In the two previous parts, I posed the puzzle of the measured increase in mental health problems (depression, anxiety, and obesity in particular) across the Western world since the 1950s and in Anglo-Saxon countries in particular. Here, I take it as given that this is real (and not just a measurement issue) and will discuss one of the leading cultural hypotheses as to what might be going on and what can be done about the mental health ‘crisis’.

As a pre-amble, it is perhaps handy to give a simple framework for how to think about these mental health problems. Whilst there are many different types of mental health problems, including many types of depression and anxiety, it will be useful to think of many of them as an inability to maintain self-esteem.

What do I mean by self-esteem? I mean by self-esteem an image of oneself as a useful person who is valued by her social group and abiding by its social standards. Someone whose self-esteem is high believes they are useful, valued, and successfully following the relevant social norms. Someone whose self-esteem is low feels useless, unvalued by others, and incapable of meeting perceived social norms.

Depression would then be understood as a breakdown in the ability to maintain the belief that one is useful, valued, and abiding. Anxiety would then be understood as an inability to discount fears that are not equally fears by others. Obesity would then be an inability to foster and maintain food and exercise habits that are valued by the social group and that enhance own functioning. Whilst clearly different, all these mental health problems then can be loosely grouped together as an inability to withstand pressures and temptations on self-esteem. And yes, this is a gross simplification for the specific purpose of creating a useful perspective.

Note how this set-up immediately gives you many predictions that are roughly true: the ‘winners’ (ie the rich) will want to win in every way and thus also keep closer to the group ideals in terms of beauty, mental resilience, and reasonable fears. Indeed, its the poor who suffer relatively more from all these mental health problems. Also, complaints that ‘society’ creates impossible demands on its members in terms of beauty and general mental ‘performance’ directly fits this kind of set-up.

Within this kind of general set-up, the leading candidate reason for the increase in mental health problems is then an increase in social standards such that abiding by them has become unattainable for many. Whilst one hears complaints about impossible standards as it pertains to societal adoration of ‘anorexic supermodels’ or ‘super nerd billionaires’ one of course needs ‘deeper drivers’ to explain why social norms might have changed over time in particular countries and subgroups, yet not others.

A particularly popular story is that with high internal mobility, mass-media, and general standardisation of production processes have meant that people increasingly compare themselves to ideals belonging to very large groups. Areas with low mobility, low degrees of standardisation, strong local-focused media and strong economic roles for medium-sized groups (extended family and small communities) would then have ideals belonging to smaller groups.
The basic point is then that the ideals of smaller groups are easier to maintain because smaller groups have fewer superstars. Similarly, with smaller groups (but not groups of just 1 or 2) there is a more immediate feed-back on fears, expectations, and habits such that derailing of beliefs and habits is less likely.
In short, the individualisation of society in the US and, to a lesser extent, in particular Western countries would be held to blame for the increase in mental health problems.
One obvious policy solution is to resurrect medium-sized groups by means of mobility taxes and a general de-coupling of production chains. It should be clear that is not going to happen.
Another ‘market solution’ is for individuals to adopt, early in life, an iron degree of self-esteem as well as a habit of avoiding information that would be detrimental to that self-esteem, ie to become more selective about the information absorbed. This kind of thing, which to some degree fits the stories told about generation Y, would then mean that the ‘hit’ of a reality check comes much later in life where its effects are probably less devastating than earlier on.
Yet another solution is to equip a next generation with a whole system of ‘life-coaches’ that effectively take over the job previously done by medium-sized groups. Life-coaches would then constantly monitor and tell both youngsters and adults to exercise more, look after their diet, stop worrying about silly stuff, etc. If needed, this kind of ‘positive psychology’ is beefed up with medicines to prop up those for whom coaching fails.

I would say that this possibility is currently the leading contender in much of the psychological\medical literature as well as the thrust of the policy response to the mental health problems. Governments are gearing up to prevent kids from becoming depressed by means of school programs, to prevent obesity by means of more sports at school and bringing in taboos on fast-food and sugary drinks, etc. In effect, it is becoming an explicit role of the government to ‘correct’ social ideals and expectations such that they reflect neither the superstars nor the overly anxious and miserable in society but rather what people a bit below average might accomplish if prodded gently.

Note also that this ‘leading explanation’ has some problems, both in terms of its plausibility as an analysis and the feasibility of its policy prescripts.

In terms of plausibility, one essential problem is in providing a believable story for the cross-national data on this basis. Some cross-national data fits reasonably well. One can for instance make the story that Japan and Korea (which have lower levels of problems) medium-level communities are more intact and individuals are thus less individualistic, whilst the high-mobility Anglo-Saxon countries would have seen an increase in standardisation and aggregation of social norms. But why would France and India have such relatively high rates of depression, and how come Japan and South Korea have such high recorded rates of suicide?

One needs all kinds of sub-stories to rationalise the cross-national data, such as building in a temporal spacing of social pressure to adopt good habits (so that if you survive social pressure when young, you are fine as an adult), and some role for education habits (so that you can blame education idiosyncrasies for depression rates in France!). More ad hoc stories are needed for other cross-national anomalies. What the cross-national data forces you into is the ad-hoc recognition of many other factors that do not fit the basic framework above, begging the question whether that framework really is the most useful one to start out with: something that vaguely fits the Anglo-Saxon trends but needs tonnes of ad hoc stories for other places is unlikely to be the final word.

A second plausibility problem is that it is not all that clear that communities really have lost their economic role or have lost cohesion. Volunteerism in the local community is alive and well, and local churches in particular are thriving, so one is then really more in the business of explaining why local inclusive groups that cater for everyone have reduced in strength, as well as reasons for why individuals would start to compare themselves more with the winners in larger groups (which creates all the angst). Such issues are hot research topics at the moment.

The difficulty with the policy prescript is that it tries to keep a lid on the worshipping of the winners, whilst that worship is demanded by both winners and losers alike: keeping up ‘viable norms’ would need one to essentially trie to ‘undo’ at the national level the natural outcome of a more integrated economy wherein medium-level communities lose their economic role and thus their long-term social viability, leading to ideals that reflect the abilities of the top. One is then up against the ‘you too can be a star’ story that appeals to everyone.

I might also mention that the behavioural stories above do not yet exist in terms of economic models. One can pour them into a utility function mould, but they look very unfamiliar to mainstream economists, so the take-up of these stories amongst economists is, understandably, scant.

In the next installment I intend to talk about possible ‘economic’ explanations, but welcome your suggestions in the comment box as to whether you ‘buy’ the story above or favour some other cultural story.

This entry was posted in Uncategorized. Bookmark the permalink.
Subscribe
Notify of
guest
10 Comments
Oldest
Newest Most Voted
Inline Feedbacks
View all comments
murph the surf.
murph the surf.
8 years ago

Sorry I can’t accept the definitions of depression offered here.
By trying to tie the aetiology of depression in with low or poorly maintained self esteem
there is a misdiagnosis occurring.
Low self esteem is one problem , depression is a separate and probably unrelated problem.This doesn’t alter the conclusion you may draw from studying a group suffering low self esteem and their displaying of anxiety and eating disorders( not only overeating) but depression as I think many understand it is considered an organic brain malfunction.MRI studies reveal difference in brain activity between sufferers and healthy people and it must be stated that there is no direct link proven as yet to this theory of chemical( neurotransmitter) imbalance.The response to drug therapy can lead to support for it but it isn’t conclusive.
Trying to link the existence of depression to self control in any way is starting with an unproven assumption and so the subsequent argument falls over.
It is the disease which promotes the lack of control , it is the depression which leads to demotivation and it is the depression which renders the sufferer immobile or inert- not the reverse.
Drug control of this condition is also well known to dull the senses, make the taker hungry and while I don’t understand the link smoking rates are very high among the depressed.As such the external image is easy to interpret as one of lacking self esteem and control but you are looking at the outcomes not the causes.

Paul frijters
Paul frijters
8 years ago

I can’t see anything in the above that disagrees with what you say here, Murph. Have another go.

murph the surf.
murph the surf.
8 years ago

It is maybe just the use of the simple framework which jars with me.Stating that depression is a self image and self esteem issue sets the perspective up on a false footing.
Additionally the idea that these are a sort of continuum of derangement – related but different by degree seems odd. Better to try and visualise them as points apart radiating out from a central sphere of acceptable behaviours?

Paul Frijters
Paul Frijters
8 years ago

its an imperfect simplification, I agree, but trying out a few different simplifications is very useful for coming up with perspective. The way to approach such ‘models’ is to first suspend disbelief and go along with the story so as to give it a chance, and then apply the disbelief again to keep oneself honest.

Mind you, I am not particularly wedded to this perspective. Its a genuine puzzle to me as to what is driving the mental health decline and none of the perspectives I have come up with hit all the important stylised facts. Neither has anyone else, as far as I know, which makes it useful to bash a few ideas around.

conrad
conrad
8 years ago
Reply to  Paul Frijters

Paul, there are exceptionally complicated stories backed up by reams of data for different mental health disorders and why they exist (some good, some average, and some bad). They arn’t the same and nor is their bases, and it’s not clear to me why reducing it into what you have really does apart from make simplistic predictions. For example, I haven’t heard anyone claiming low self-esteem and not fitting in causes schizophrenia or autism. Good luck finding data that shows it does. You can also find groups within populations with fine self esteem, but still have mental health problems (and obesity, which you have lumped into this group), so even if self-esteem is involved, there must be lots of interactions going on.

For example, according to your story, we should find nice relationships between individualism and mental health, but then you even note that we don’t. If you want data to make real predictions for this, on this, you could do worse than look at some of the work by Yoshi Kashima over at Melbourne who has collected norms on different countries on individualism and collectivism (and relationional stuff which you have entirely ignored but is no doubt important in some disorders). It’s also the case many people don’t consider them two ends of a single factor, and that should give some underlying support to some of the things you’ve noticed here. I’m willing to bet that the data on many mental health disorders is exceptionally weak even after taking these things into account, however.

conrad
conrad
8 years ago
Reply to  Paul Frijters

This is where you really need to get your head on top of the data. Depression and anxiety are well correlated with many groups. If you look at the really simple and commonly used DASS scale, for example, you get correlations around the .7 mark for the three components, and it seems reasonable to suggest that there is probably some shared basis in many cases (some probably biological — some people are just susceptible or have had stress-shocks earlier in their lives). So in my books the story should be more or less the same for a big chunk of the data for those two (although I can’t tell you what it is for the increase, apart from greater acceptance and acknowledgement).

As for obesity, given that it’s just appeared in recentish times and often represents something that happens to people across a lifetime, I still don’t see why this isn’t just a cultural thing that represents a shift in the entire weight distribution (there are also long term correlates that I believe are not well understood — don’t be a fat kid!). It’s no surprise to me that the countries with the worst problem are all “eat everything on your plate cultures”, where the food chain is almost entirely hidden so actually why one eats what is almost lost (Mexico I think is an exception, but I could be wrong). Compare that to Asia where you can often just go and get, for example, a kill-your-own chicken for dinner and people actually prefer real ingredients and not the garbage people in Anglo countries often eat. These sorts of factors seem pretty orthogonal to those for other things like depression to me (aside from the fact their cultural changes).

There is a less-than-academic talk here by someone who realizes this problem that may be amusing: http://www.ted.com/talks/ron_finley_a_guerilla_gardener_in_south_central_la.html

john r walker
john r walker(@annesanders)
8 years ago
Reply to  conrad

Condrad
Would question the ‘right angle’ hypothesis. Evidence that changes to the gut biota can have impacts on brain behavior is no longer quack stuff.
http://www.scientificamerican.com/article.cfm?id=the-neuroscience-of-gut

Remember when it was thought that personality and stress, caused stomach ulcers?

john r walker
john r walker(@annesanders)
8 years ago

Paul re India , Southern India (especially Kerala ) has very high rates of university education, we were told on a number of occasions that this in itself had caused mental health problems- the supply of graduates in things like physics et al, was much greater than demand so a lot of graduates end up being, depressed taxi drivers and waiters… unable to move out of the family home or marry somebody of the appropriate class .

Anomie, alienation ,anxiety type issues and so on, have their origins in second half 19C French and Russian literature . For example Madame Bovary’s tragic tale centers on her new found access to ‘literature’ that educated her in dreams of a phantasy version of sophisticated modern life.

Mind I would still plump for a highly processed artificial diet, causing physiological changes that then result in depression type 2 diabetes and obesity.

john r walker
john r walker(@annesanders)
8 years ago

Should have said -Anomie, alienation ,anxiety type issues and so on as descriptive terms, have their origins in second half 19C French and Russian literature