The Silent Struggle

By Olivia Heersink

A woman holding her face in her hands.

Mental illness remains shrouded in stigma. Despite the occasional celebrity going public about their battle with depression, anxiety, or substance abuse, it’s an issue that most of us (most of the time) would prefer not to mention. Sometimes, however, it’s impossible to ignore when symptoms of mental illness, and the devastating effects, are visible to us.

Mental illness may be taboo, but we can all expect to experience it—either personally or in someone close to us. The most reliable national epidemiological survey—the U.S. National Comorbidity Survey Replication—found that around one in four Americans had experienced a clinical psychological disorder in the previous 12 months. That equates to around 75 million adults. Around half of Americans are likely to develop a clinical disorder at some point in their life (a statistic that puts the U.S. the top of international rankings for mental illness).

It has been found that psychological disorders (particularly depression and anxiety) are more common in women than men. Women seem to seldom make public displays of their unhappiness; a sort of “externalizing” behavior is seen far more often in men. Women tend to be especially vulnerable to depression, anxiety, eating disorders, and sleep problems: conditions that typically cause us to turn inward, retreating psychologically from the world and the people who surround us. Plenty of men also suffer from these disorders, of course, but the proportion is markedly smaller than for women. On the other hand, men are more susceptible to alcohol and drug problems and anti-social personality disorder, which are more likely to produce a kind of conspicuously erratic behavior.

Why are overall rates of mental illness higher in women than in men? Given that many experts seem unaware of this troubling fact, it’s hardly surprising that the sort of research that could provide a definitive answer hasn’t yet been done.

Compared to physical ailments, psychological problems are very much ignored in healthcare, receiving far less attention, resources, and cash. The US spends at least $2.5 trillion on health each year, but only five percent of that goes towards mental health. This is despite the fact that mental illness accounts for almost half of all ill-health in people aged under 65. Indeed, because mental and physical health are often so closely intertwined, with each influencing the other, some scientists have campaigned under the slogan “no health without mental health.”

Besides the distress such conditions cause individuals and their families, there is a financial penalty: people diagnosed with a clinical disorder earn an average of $16,000 a year less than other folk. The annual cost to the nation as a whole runs into hundreds of billions of dollars.

Most people in the U.S. with a psychological disorder receive no treatment at all; too often individuals and families have to shoulder the burden. The situation is no better when adolescents are involved: research shows that more than half of 13-18 year-olds with severe problems have never been treated. There are more than half a million mental health professionals in the US. That may seem like a substantial number until one recalls that around 75 million people are in need of help.

Where services are available, stigma means that it may not be sought: no one wants to be thought of as ‘crazy’. Moreover, treatment tends increasingly to equal medication. Eleven percent of Americans over the age of 11, for instance, now take antidepressants—a 400 percent increase from the 1990s. Almost a quarter of women aged 40–59 are on these drugs; indeed, women are much more likely than men to be prescribed antidepressants even when their symptoms are equally severe. In certain cases, drugs can certainly help. But psychological therapies (especially cognitive behavior therapy—CBT) are more effective in the long-term for many common issues such as depression and anxiety.

As a society, we need to radically change the way we think about mental illness; we must recognize its prevalence, and the particular problems facing women; and we must make treatment, and CBT in particular, readily available to all who need it. If we don’t, and with rates of mental illness likely to increase with current economic instability, this will cause harm not just to the individual, but to our nation as a whole.


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