My intention with this blog, among others, is to push myself to do better research on topics of interest to me. Writing things down in my own words proves a deeper level of understanding, and it helps me sit with the ideas for a couple of days to solidify my view. My previous post on georgism was my first real attempt at that, and, while I now have a good grasp on all the important concepts, I found my explanations to be lacking and too convoluted when compared with others.
In this entry I would like to explore a simple question: Does the increase of awareness of mental health issues increase mental health cases? My knowledge in psychology is quite basic, but I am personally very interested in the way motivation works, why we make the decisions we make and how can we determine our own weights and biases. I have read a bit on those topics, but in this post, I will be entering into the much scarier world of psychiatry intersecting with one of the most prestigious pseudosciences, sociology.
The inspiration for this post comes from this book review by Scott Alexander. The book in question is Crazy Like Us, The Globalization of the American Psyche. I have not read the book, but some of the points raised in this review are important to my question. To start off, it’s sufficiently proven that exposure to suicide cases increases the amount of suicide attempts. This known as suicide contagion or the Werther effect. In most countries, there are journalistic codes in place to try to minimize this effect. There is also the The Papageno effect which describes the opposite case, where responsible media coverage leads to fewer completed attempts, such as in Kurt Kobain´s case. A clear example of these phenomenons is the series 13 Reasons Why, which provoked an increase not only in the search for suicide information but also in hospital admissions and suicides in the age bracket that it targeted. Unsurprisingly, it also led to a lot more openness about this traditionally taboo theme.
Media is just one part of the situation, and the most “dangerous” kind of contagion happens from peers and persons you know in real life. There is a myriad of examples of these so-called “suicide clusters”, especially when it involves a public figure. This to me makes sense since it involves both the media attention and the peer aspects, as many people experience parasocial relationships with famous people. Notable cases include that of the South Korean actress Choi Jin-Si or Marilyn Monroe. This disproportionately affects young people (<25) as they are much more impressionable and tend to act more impulsively.
Most explanations involve the fact that copycat suicides are committed by people of the same gender, race, or cultural background as the detonating one, and also tend to use the same execution methods. But it’s not the coverage that worries me, as I believe that is a solvable problem that we can turn to have a positive effect. What worries me is the romanticization and suggestion that there is an epidemic, glorifying the deceased and simplifying the reasons that will lead to it. Many people can see suicide as a glamorous ending, with the deceased getting attention, sympathy, and concern that they never got in life. This is mostly a social media problem, but institutions are not doing a good job of managing this epidemic
One can also observe this contagion in other areas, such as how coverage on mass shootings (and school shootings in particular) increases risk or how much violent videogames (and music and books for that matter) increase aggressive conducts in people. Obesity is another interesting case. These questions are mostly true since human beings are easy to influence (especially when young or in difficult situations), and once you widen your scope you can start seeing this kind of effect everywhere, starting with stock markets and politics.
Before moving from the topic of suicide, labeling it as a “selfish” or “cowardly” choice does a disservice to the real complexity of the situation. For one to surpass its self-preservation instincts many environmental factors have to have gone incredibly wrong, and those are society´s responsibilities. While it’s universally agreed upon that social media is bad for our mental health, there has been practically little response to it. Social media has been key in the increased cultural globalization, and there is not enough attention given to how it’s changing our way of living and thinking, especially on those with a developing brain.
I can be convinced of the benefits of having an open discussion on traditionally taboo topics like depression or suicide, but I maintain that these are delicate conversations and should be subject to a set of standards. One of the reasons for me to write this was a (now deleted) post by a well-known meme account in Spain, which shared the case of a young woman who took her life while most people who knew her thought that she was happy. He even posted her personal information (name, account…) and the method used. This angered me, as this is the most effective way to incite people to commit the same acts (easily seend in the comments). As in most things in life, I don’t think there were bad intentions behind this, maybe some monetary incentive but mostly a “good” person trying to help a society where everyone can see that there is a growing problem with mental health issues. There are many examples of this kind of behavior all around the world and I wanted to really understand why they are counterproductive.
The explanation that convinced me the most comes from a concept coined by Ian Hacking, The Looping Effect. It outlines how a classification may interact with the people classified. For example, around the 1970s a few sensationalistic cases of multiple personality disorder (a mostly forgotten illness) arose into the public eye, showing persons having 2 or 3 different personalities. Within the decade there were cases of people showing up to 17. This fed back into the diagnosis entered the standard of symptoms and worsened the situation. Ian presents really interesting frameworks to understand this effect. Both these essays provide a lot of data and ideas that cleared up most of my doubts about this problem.
So part of it comes from the classification itself, but dividing into classes is kind of necessary, if only for bureaucratic purposes. There are some alternatives around, like Transdiagnostic approaches. To me, they make a lot of sense but they are difficult to implement and require a radical change in the dogma. As anecdotal evidence, I asked a couple of friends that have almost finished their psychology degree and this problem was never mentioned once. That is extremely worrying to me as it is the biggest problem that mental health is facing by far.
Both the pandemic and social media haven’t helped at all, and neither has individualism under globalized capitalism. Under this looping effect paradigm, they appear as both causes and consequences and also contribute to a wider problem of victimization in the newer generations. I don’t feel entirely comfortable writing about this from my position, but the reason why I feel like it’s problematic is that it prevents you from taking concrete action. In “Capitalism Realim Mark” Fisher blames neolliberalism, more specifically post-fordism for the increase in psychiatric and affective disorders. And the numbers back it up, with the rates of mental distress being much higher in countries with that pratice more “selfish capitalism”.
Classifications do have some amount of value when it comes to de-stigmatizing and encouraging to look for help, but after reading on this I believe that in the way they are used right now, the bad outweighs the good. Cross-cultural studies are considered to be the best way to measure this kind of stuff, and while they point to my conclusion, I don’t think they are completely reliable (The Null Hypotheys).
Some other interesting reads I would like to include are this and this news reports that illustrate decently well the situation that people my age are facing. Also this post where Scott Alexander poses the idea of illnesses like depression and anxiety working like feedback loops, which as a model makes a lot of sense to me. There are a bunch more studies around this topic and all reach similar conclusions and causes.
The looping effect is everywhere, and its interesting its effect on LGTBQ+ identities as well. The amount of people identifiying as queer is exponentialy bigger in the newer generations, and while there is no moral dilemma in that, it does aggravate the demographics problem that we are facing in western cultures. Also related is the concept of hyperstition and The Social Multiplier
If there is one thing that I would like a reader to take away it’s that this problem is not negligible and we should spend more effort on studiying it and preventing it. And that most of the time sharing posts about mental health on your social media (like depression awareness month) is probably having the opposite effect to what you intended.
As always all discussion is welcomed.
https://michaelstrong.substack.com/p/evolutionary-mismatch-as-a-causal Considering Evolutionary Mismatch as a Causal Factor in Adolescent Mental Illness