PREVALENCE INFLATION

 

YEE, GADs!
   On the long list of acronymic afflictions of which we are all aware, a new one for me is "GAD" - "Generalized Anxiety Disorder." I ran across it in an article that mentions, "prevalence inflation", which I found interesting and was going to relate to you. As I was about to roll up my sleeves, I slowly realized that both anxiety and inflation were topics already tackled - twice. That I was slow to remember that I had written about these subjects twice, is additional proof that my memory is quickly fading and that recording things in MM does not guarantee their retention in me.
  I will concede and admit straight away that there is a lot to be anxious about these days. It is the case, however, that some people have more reason to be anxious than others and that not everyone feeling anxious is deserving of the diagnosis of the acronym, "GAD". 
  I now know that my first post about this subject was, "Stress - A Contrarian View" and in it there was this subtitle: "The Anxiety Industry." My second one was, "The PTSD Pandemic" and a subtitle in it was, "Trauma Inflation." Although I did not re-read much of either post, the first sentence in the first one is: "In an article on the “Anxiety Industry” it is noted that this vaguely defined ‘malady’ appears to have reached epidemic proportions and that it seems to be particularly infectious among those working in the public sector." I am sure there are many other cleverly contrived sentences and you should have a look, since I will now take a different approach and not construct many going forward.

Antithetical Bibliographies
  Instead, I will offer an antithetically bibliographic approach, which means you will be presented with sources you will likely not have seen, or may have deliberately avoided because they appeared to be contrary to what you wish to believe.
  In short, if you do not wish to read on, I will condense here, the points I think I am trying to make: there seems to be a really large number of people now infected with acronyms of the the mental kind; that promoting awareness of these maladies, while reducing the stigma attached, may increase the incidence in people claiming to have them; and, that many of the treatments may not help.

Prevalence Inflation:

   I came across, both GAD and prevalence inflation in this article, the title of which reveals the message: "How Anxiety Became Content: The Way We Commonly Discuss Mental-Health Issues, Especially on the Internet, Isn't Helping Us," by Derek Thompson in his "Work in Progress" newsletter in The Atlantic, Dec. 13, 2023.

[read all of the pieces referred to in this antithetical bibliography in case my clips do not include qualifiers the original may have had.]

"Anxiety has become its own genre of popular content. Social-media feeds are crowded with therapy influencers who tell us to be more aware of our anxiety, our trauma, our distress. Instagram is full of anxious confessions and therapy-speak....

   As anxiety has become content, it’s also become a part of more daily conversations. I’ve spoken with many parents about my work on America’s mental-health crisis in the past few years, and several have noted that their kids share their symptoms and diagnoses in group chats, rattling off the acronyms OCD, GAD, and PTSD with a casualness once reserved for high-school gossip....

Watching and listening to so much anxiety content, which transforms a medical diagnosis into a kind of popular media category, might be contributing to our national anxiety crisis.

The Prevalence Inflation Part:

   The way we talk about the world shapes our experience of the world. In 2022, the researchers Lucy Foulkes and Jack L. Andrews coined the term prevalence inflation to describe the way that some people, especially young people, consume so much information about anxiety disorders that they begin to process normal problems of living as signs of a decline in mental health. “If people are repeatedly told that mental health problems are common and that they might experience them … they might start to interpret any negative thoughts and feelings through this lens,” Foulkes and Andrews write. This can trigger a self-fulfilling spiral: Some individuals who become hyperaware of the prevalence of anxiety disorders may start to process low levels of anxiety as signs of their own disorder, which leads them to recoil from social activities and practice other forms of behavioral avoidance, which exacerbates their anxiety.

   Prevalence inflation might explain why some policy makers and schools have struggled to reduce anxiety with behavioral interventions. As The Atlantic’s Olga Khazan has reported, studies have found that several mental-health programs for young people actually made many of their mental-health problems worse…

If you are really interested see: "Are Mental Health Awareness Efforts Contributing to the Rise in Reported Mental Health Problems? A Call to Test the Prevalence Inflation Hypothesis," Foulkes & Andrews, New Ideas in Psychology, Vol. 69, April 2023.

The Great Mental Health Crisis Pandemic of Our Time

  If one is just investigating the segment of the population in universities (admittedly a vulnerable group), this one Canadian reference will do:
"Inside the Mental Health Crisis at Canadian Universities" Students Are At Increasing RIsk of Mental Health Problems, and Universities Are Struggling in Their Efforts to Respond," Sarah Treleaven, Maclean's, Nov. 14, 2022.
  For the U.S., here are some recent titles from the Chronicle of Higher Education, from which there were many to choose:

"Colleges Can’t Keep Up With Students’ Mental-Health Needs. Teletherapy Companies Are Filling the Gaps."

By Charlotte Matherly January 12, 2024

BURNOUT WARNING

"Professors Struggle With Demands to Tend to Students’ Mental Health."

By Kelly Field October 24, 2023

'A HUGE SUPPORT'

"A University’s New Approach to Student Mental Health: Put Therapists in the Dorms."

By Kate Hidalgo Bellows April 21, 2023

ADVICE

"Will Mandated Mental-Health Breaks Do More Harm Than Good?"

By Sarah Rose Cavanagh February 28, 2023

"New Policies Presume it’s Beneficial for Anxious Students to Take Days Off From Class." That assumption has several critical flaws."

'EMOTIONAL WORKLOAD'

"As Students’ Mental-Health Concerns Grow, One University’s Professors Say They Should Get a Raise." [Woo Hoo!!]

By Julian Roberts-Grmela January 17, 2023

University of Illinois at Chicago faculty members went on strike Tuesday, in part because they say students’ mental-health needs have become so severe, while administrators have failed to adequately respond.

WELLNESS ON CAMPUS

"Colleges Are Investing in Student Mental Health. But ‘There’s Still a Long Way to Go,’ Survey Finds."

By Eva Surovell January 18, 2023.

Should We Be Screened For Anxiety? -- NO
"Canadian Doctors, Psychiatrists Don't Recommend Routine Adult Anxiety Screening," Megan DeLaire, CTV News, Sept. 22, 2022.

  Contrary to new recommendations(opens in a new tab) by the U.S. Preventive Services Task Force, health-care professionals in Canada are warning against routine anxiety testing for adults.

 The American health guidelines panel released a draft recommendation earlier this week that said U.S. primary care doctors should regularly screen all adults under 65 for anxiety using standardized questionnaires like the generalized anxiety disorder (GAD) scale.

…However, doctors and psychiatrists with three major mental health research institutions in Canada warn the risks of implementing a routine anxiety screening program here would likely outweigh the benefits.

"Screening for Anxiety Will Just Make Us More Anxious," David Rosmarin, Wall Street Journal, July 29, 2023.

   In response to the country's anxiety epidemic, an influential panel of doctors appointed by the U.S. Department of Health and Human Services recently published a new set of guidelines. All adults, they recommended, should now be screened for anxiety by their primary care physicians. As the founder of a large clinical practice focused on anxiety, I stand to benefit from increased referrals. And yet, I've been lying in bed at night with growing worries that this policy will compound our anxiety epidemic.

  All of us experience anxiety, and it's awful -- but it is not a disease. Anxiety can become a disorder when persistently elevated levels cause significant distress and encumber life activities. Such anxiety disorders are common, with nearly one in five U.S. adults experiencing them each year.

  But there is a great difference between anxiety and anxiety disorders. The latter depend on how much distress and dysfunction anxiety causes. The mere occurrence of anxiety is nothing to be medically worried about.

Are Drugs Involved -- Of Course

"Quebec Doctors to Face Increased Scrutiny For Overprescription of Anti-Anxiety Medication," Matthew Lapierre, CBC, Feb. 16, 2024.

More Proof: "Anti-Anxiety Drug Market Size Report, Industry Analysis, Share, Growth, 2030", (For $4,000 US, you can buy the report if you are in the business of anxiety reducing.)
"The global anti-anxiety drug Market size was worth around USD 15.23 billion in 2022 and is predicted to grow to around USD 21.22 billion by 2030 with a compound annual growth rate (CAGR) of roughly 4.23% between 2023 and 2030."

Post Script: PRE-INTERNET VIRALITY

   Generally the Internet can be blamed for most things and certainly social-media increases the contagion of bad political ideas and mental maladies. As I am typing all of this stuff, my inbox is surely filling with messages offering Valium, Xanax and Ativan. But, I have learned that the promotion of mental diagnoses was occurring even before this century, so the inflation cannot just be blamed on the Internet. 
Since it is highly likely you will think I made this up, the citations are included and can be checked. 

"National Anxiety Screening Day Exceeds Expectation; Coalition of Volunteers Help," PR Newswire, 1997:

STATEN ISLAND, N.Y., May 20 /PRNewswire/ -- The effort of nearly 10,000 volunteers make the 1997 National Anxiety Disorders Screening Day (NADSD) the largest single event to promote the awareness treatment of anxiety disorders. Nearly 2,000 health facilities provided free screenings on May 7 to an estimated 50,000 Americans.

Now in its fourth year, NADSD is organized by a non-profit consumer advocacy group called Freedom From Fear with assistance from numerous other organizations and supported, in part, by an unrestricted educational grant from Bristol-Myers Squibb, the makers of BuSpar(R) (uspirone HCl, USP), an anxiolytic, and Serzone(R) (nefazodone HCl), an antidepressant.

There Was Celebrity Involvement As Well:

"Anxiety Disorders Association Bestows Jack Nicholson with First Annual R.E.A.L. Achievement Award"

17 March 1998

PR Newswire

PRN

English

(c) 1998 PR Newswire

Nicholson's Portrayal of Obsessive Compulsive Disorder in 'As Good As It Gets' Performs Major Public Service by Raising Awareness of Anxiety Disorders

ROCKVILLE, Md., March 17 /PRNewswire/ -- The Anxiety Disorders Association of America (ADAA) has bestowed upon Jack Nicholson the first annual R.E.A.L. Award ("Realistic Enactment of Anxiety and Living") for Achievement in the Arts for the Accurate Depiction of an Anxiety Disorder, for his portrayal of a person with obsessive compulsive disorder (OCD) in the movie "As Good As It Gets." The ADAA is the foremost national non-profit organization dedicated to promoting the welfare of people with anxiety disorders.

"Anxiety Disorders Association Bestows Jim Carrey With the Second Annual R.E.A.L. Achievement Award"

17 March 1999

PR Newswire

PRN

English

(c) 1999 PR Newswire

Carrey's Portrayal of a Person Suffering With Post-Traumatic Stress Disorder Performs a Major Public Service by Raising Awareness of Anxiety Disorders

ROCKVILLE, Md., March 17 /PRNewswire/ -- The Anxiety Disorders Association of America (ADAA) has announced that Jim Carrey is the recipient of the second annual R.E.A.L. Award ("Realistic Enactment of Anxiety and Living") for Achievement in the Arts for the Accurate Depiction of an Anxiety Disorder, for his portrayal of a person with post-traumatic stress disorder (PTSD) in the movie "The Truman Show." The ADAA is the foremost national non-profit organization dedicated to promoting the welfare of people with anxiety disorders.

"Anxiety Disorders Association Taps Robert DeNiro For the Third Annual R.E.A.L. Achievement Award"

22 March 2000

PR Newswire

PRN

English

(Copyright (c) 2000, PR Newswire)

       DeNiro's Portrayal of a Person Suffering with Panic Disorder

   Performs a Public Service By Raising Awareness of Anxiety Disorders

ROCKVILLE, Md., March 22 /PRNewswire/ -- The Anxiety Disorders Association of America (ADAA) has announced that Robert DeNiro is the recipient of the third annual R.E.A.L. Award ("Realistic Enactment of Anxiety and Living") for Achievement in the Arts for the Accurate Depiction of an Anxiety Disorder, for his portrayal of a person with Panic Disorder in the movie "Analyze This." The ADAA is the foremost national non-profit organization dedicated to promoting the welfare of people with anxiety disorders.

Women Were Considered And Were Also Anxious:

"National Survey Shows That Half of All U.S. Women Suffer From Anxiety Symptoms and Worry."

29 February 2000

PR Newswire

   'Take Control of Your Anxiety' Campaign Helps to Educate Women About

                       Generalized Anxiety Disorder

PRINCETON, N.J., Feb. 29 /PRNewswire/ -- Fifty percent of the 1,044 women polled in a recent telephone survey reported that they experience anxiety symptoms and worry for a period of more than six months. In addition, one out of 10 women describes herself as having "unrealistic" or "excessive worry." Furthermore, the majority of women polled (70 percent) are not aware that these continuing anxiety symptoms and worry may be caused by a common disorder called Generalized Anxiety Disorder (GAD).  GAD affects approximately 10 million Americans each year. Women are more likely to develop this condition than men.

The Bonus:

   I admit that as I approached this point I was getting quite anxious because I did not yet have a "bonus." I have just thought of one, however, and you are welcome to use it since I have completed my trifecta about terrible things: stress, trauma and anxiety. Perhaps in addition to "prevalence inflation" one could also consider in relation to the anxiety pandemic, the  "Munchausen syndrome", "a psychological condition where someone pretends to be ill or deliberately produces symptoms of illness in themselves. Their main intention is to assume the "sick role" so that people care for them and they are the centre of attention."

THE PTSD PANDEMIC

Trauma Inflation

The Present Intrudes Again

If you look at the portion of this blog that offers the rather flimsy rationale for its existence you will find that I said I would likely be writing about benignly boring events and uncontroversial subjects which occurred in the remote past. Now here I am again pontificating, this time about PTSD, a topic about which I know little, but which cannot these days be avoided. And again I will be taking a contrarian position which is unfortunate since the holder of such an unpopular view will seem to be devoid of any sympathy for the suffering. (At least, I am consistent; see my earlier post about Stress and the “Anxiety Industry).

One does not have to scan a wide variety of national or international sources to find evidence of trauma inflation. Local stories about the apparent rise in the incidence of PTSD among EMS workers, first responders and the police are increasing.  Even those less directly associated with a critical trauma incident can become a victim. A recent article focussed on the PTSD experienced by a juror who had to sit through a trial involving the kidnapping, rape and murder of a young child. “Symptoms have been debilitating, she says, including memory loss, bouts of extreme anger and a shopping addiction that drained her retirement savings and children’s education plans.” Perhaps it is a good thing that in Ontario, members of juries are not allowed to discuss the deliberations with others, thus possibly preventing the infectious spread of PTSD.

I am pleased to live in a compassionate society and in such a place one expects compensation as well as commiseration. As a result, a local hospital is doubling the size of its “operational stress injuries clinic” and the province is “dedicating money and resources to preventing and mitigating post-traumatic stress disorder (PTSD) in first responders.” Earlier this year (2016) the Ontario Government introduced Bill 163, Supporting Ontario’s First Responder’s Act (Post-traumatic Stress Disorder), 2016.  The Bill sets out proposed changes to the Workplace Safety and Insurance Act, 1997 (“WSIA”) and the Ministry of Labour Act.

“The amendments to the WSIA cover a variety of first responder’s, including among others, firefighters, including volunteer firefighters and part time firefighters, fire investigators, paramedics, and police officers.  The amendments would create a presumption that a first responder who is diagnosed with post-traumatic stress disorder is eligible for WSIA benefits as if the PTSD was a personal injury.  For purposes of entitlement, the Bill removes the need to prove causation or a link to the workplace, and creates the presumption that the PTSD arose out of and in the course of the worker’s employment unless the contrary is shown by the employer.  Workers will not be entitled to benefits for PTSD arising out of an employer’s decisions or actions relating to the worker’s employment including a decision to change the work, the working conditions or to discipline or terminate the worker’s employment.” For now, at least, the last sentence seems to indicate that PTSD cannot be claimed if one is simply shouted at by a supervisor.

In the case of the traumatized juror, the jury is still out. Victims of violent crime are entitled to compensation from the Criminal Injuries Compensation Board and in this instance the juror argues that she also is a victim of the crime. Her case will be considered soon by the Ontario Court of Appeal. Some fear that “compensating a juror would open the floodgates so anyone who sits through a extremely violent trial — judges, court staff, prosecutors, defence lawyers, police and journalists — will want compensation.”

There is some evidence from abroad that the floodgates already have been opened. A veteran BBC war reporter with some experience with circumstances we will simply describe here as ‘difficult’, reported on the expansion of PTSD claims among civilians who generally operated in more peaceful and serene environments. According to his report on the “Trauma Industry”, it is now worth 7 billion (pounds sterling). One person interviewed for the program indicated that he thought that PTSD was being over-diagnosed: “ Dr.James Thompson, a trauma psychologist, made the comments on BBC's Panorama programme investigating the growing army of sufferers. The programme claims that the NHS now treats an estimated 220,000 people a year suffering with post-traumatic stress disorder, a diagnosis once reserved for those coming back from war zones. The disorder is adding enormously to the burgeoning multibillion personal accident industry business, it said. Those being diagnosed include people who have had a minor traffic accident, bullying in the workplace, even in the schoolyard. In the programme, titled “The Trauma Industry,” Dr Thompson suggested it was part of the growing "victim culture"."And that is always attractive to all of us. Now you can teach yourself PTSD on the internet within five minutes." “Post Traumatic Stress Disorder Has Become a "Fashionable Diagnosis" That is Far Too Liberally Diagnosed…”,  Richard Alleyne, The Telegraph, July 27, 2009.

Trivializing Trauma

There has been an increase in both the types of things classified as ‘traumatic’ and in the number of those individuals likely to experience them. A term originally applied to physical injuries is now applied to psychic ones and those affected include not only those who experienced the incident, or witnessed it, but even to those who have learned or heard about it. Perhaps it is the case that not every unfortunate episode is traumatic nor is everything that is horrible horrific. The merely distressing does not have to be totally debilitating. If one uses the term ‘traumatic’ to describe a bad day at the arcade, how does one describe a day in Aleppo?

Stoicism

Since you probably remain unconvinced by my argument, here is a piece by someone better credentialed than I and I encourage you to look at the full article:

“How we Became a Country Where Bad Hair Days and Campaign Signs Cause ‘Trauma’”, by Nick Haslam, Washington Post, August, 12, 2016. ( Haslam is a professor of psychology and head of the Melbourne School of Psychological Sciences at the University of Melbourne.)

“Trauma is being used to describe an increasingly wide array of events. By today’s standards, it can be caused by a micro-aggression, reading something offensive without a trigger warning or even watching upsetting news unfold on television. As one blogger wrote, “Trauma now seems to be pretty much anything that bothers anyone, in any way, ever.”

This is not a mere terminological fad. It reflects a steady expansion of the word’s meaning by psychiatrists and the culture at large. And its promiscuous use has worrying implications. When we describe misfortune, sadness or even pain as trauma, we redefine our experience. Using the word “trauma” turns every event into a catastrophe, leaving us helpless, broken and unable to move on.

All of this is problematic. The way we interpret an experience affects how we respond to it. Interpreting adversity as trauma makes it seem calamitous and likely to have lasting effects. When an affliction is seen as traumatic, it becomes something overwhelming — something that breaks us, that is likely to produce post-traumatic symptoms and that requires professional intervention. Research shows that people who tend to interpret negative events as catastrophic and long-lasting are more susceptible to post-traumatic reactions. Perceiving challenging life experiences as traumas may therefore increase our vulnerability to them.

Another fine invention of the ancient Greeks was stoicism. Contrary to popular opinion, the stoics did not think we should simply endure or brush off adversity. Rather, they believed that we should confront suffering with composure and rational judgment. We should all cultivate stoic wisdom to judge the difference between traumas that can break us apart and normal adversities that we can overcome.

Some Sources:
“Juror at Trial of Michael Rafferty, Found Guilty of Killing Tori Stafford, Suffering PTSD, Looking for Compensation,” Jane Sims, The London Free Press

Tuesday, October 18, 2016.
“London's Parkwood PTSD Clinic for Veterans, Soldiers, and RCMP Officers Expanding,” John Miner, The London Free Press, Friday, October 21, 2016.

When I poked around a little bit, I was surprised to learn that the founder of a major PTSD Association has London connections and she would certainly offer a rebuttal to this piece. For more see:“Struggling for a Way to Just Get Over It: After Witnessing a Horrific Car Crash, Ute Lawrence Couldn’t Find a Group to Help Her Recover from PTSD, So She Started Her Own,” Gerald Hannon, The Globe and Mail, Aug. 4, 2008. [The accident was indeed horrific - the fog crash on the 401 Sept. 3, 1999, 87 cars, 45 injured and 8 dead- and Ms Lawrence was in it.]

Ute Lawrence is the CEO and founder of the Post Traumatic Stress Disorder Association and has published The Power of Trauma.
(Since I have not ‘gone public’ with this blog she is unlikely to read this, nor is my son who is a first responder - nor for that matter is his mother, who is in the ‘industry’ and would surely be opposed to these opinions.)

See also this interesting article which shows how the definition of trauma has evolved: “The Man in the Gray Flannel Suit Put the War Behind Him. Why Can’t We?” Annals of Psychology and, "Getting Over It,” Malcolm Gladwell, The New Yorker, Nov. 8, 2004.

“Somehow in the intervening decades our understanding of what it means to experience a traumatic event has changed.”