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The Facts

Mental Health

new internationalist
issue 209 - July 1990

Madness - The FACTS

[image, unknown]
Illustration: Steve Weston

The World Health Organization (WHO) is committed to a
policy of 'Mental Health for All by the Year 2000'. Here the NI
draws evidence from around the globe to show how far
short of that lofty goal we are likely to fall.

Health Warning: The 'facts' about madness can be misleading. Only the Western medical science
of 'epidemiology' pursues them with vigour, often to prove its own theories and with doubtful results.

USA: Lifestyles

A survey in Eastern Baltimore has shown how changing lifestyles are increasing the risk of mental disorder. This is because, in Western industrialized culture, those who live outside the nuclear family are vulnerable, and their numbers are increasing. For example, the number of female one-parent households has increased from 7% to 16% of the total number of households between 1950 and 1984; and the prevalence of distress is 27% for this group, compared with an average of 23.4% 1


UK: Disappearing Madness

Two of the most serious disorders recognised by Western psychiatry are schizophrenia and hysteria. First admissions to hospital for the former have fallen from 14 per 100,000 population in 1970 to 9 per 100,000 in 1978. The after has disappeared almost completely, falling from 2.12% of all admissions in 1960 to just 0.80% in 1978. This is not the result of patients being 'switched' into a different mental health category since the incidence of other types of illness has not increased over the same period. But no-one yet knows why this is happening.2


UGANDA: Irritating Tendencies

A survey of adults in two small Ugandan villages found 20% had some sort of disorder, mostly depressive. But the researchers also reported 'an irritating tendency for some Ugandan subjects not to answer questions directly. Thus ... in reply to being asked if they worried more than others, they would answer, "How can I know how much others worry?"3


LATIN AMERICA: Chilling Prospects

A recent survey for the WHO predicts that there will be an increase of 11.2% in deaths related to psychological factors. Violence accounts for a large proportion of this increase. By the year 2000 it is predicted that there will be 88.3 million people suffering from selected disorders in Latin America, an increase of 48.1%. Deteriorating social and economic conditions will play a major part in this trend.4


USSR: History of Abuse

Until 1988 the Ministry of the Interior, which runs the police and has close links with the KGB, supervised all top-security psychiatric hospitals. There are 25,000 a psychiatrists, more than anywhere else in the world except the US. In 1982 a book called 'The Pictorial Language of Schizophrenics' accused 'sick artists' of being interested only in the baser aspects of life.5


JAPAN: the Madness Business

Between 1955 and 1975 the number of private mental hospitals rose from 206 to 1,450 and the number of patients increased from 44,000 to 300,000. That number has now increased to some 340,000. 95% of patients are detained without their consent, at a rate of 250 per 100,000 population, compared with just 2.5 per 100,000 in Europe. Well over 800% of Japanese hospital beds are in private hospitals.6


SOUTH AFRICA: Cheap Black Patients

Apartheid is just as evident in mental health as elsewhere. Black psychiatric nurses and doctors are not permitted to care for white patients (according to a 1984 study) while there were no psychiatrists of 'African' descent in 1982. Institutional care is provided by a private company as well as by the state. In 1978 the Government paid this company 1.69 to 2.11 rand per day to care for black patients and 5.33 to 7.00 rand per day for white patients.7


AUSTRALIA: Tranquillized Community

According to its manufacturers (ER Squibb & Sons Pty), sales of the drug Modecate increased from 560 kg in 1975 to 1,552 kg in 1986. Of the sales in 1975, 10% were to dispensing chemists (primarily outpatients) and 90% to hospitals. By 1986, 40% of sales were to dispensing chemists. Modecate can be administered by means of 'depot', or long-acting injections, and is often prescribed for schizophrenia. The incidence of schizophrenia is also thought to be on the decline in Australia.8


AOTEAROA/NZ: Madness AND Racism

A recent survey showed that involuntary admission to mental hospital, especially under the Criminal Justice Act, is much more common among the Maori (36% of all Maori admissions) than the pakeha or non-Maori (24%). It is highest of all among Pacific Island Polynesians (45%).10


The prevalence rate of mental disorders - the proportion of the total population affected - is set to increase around the globe by the year 2000. There is a threat of a 'pandemic'. This is because, as population increases, so do the numbers of people in age groups at high risk of developing disorders. And successful treatment is prolonging the lives of affected people - affected in the first place. Here are the latest WHO figures.

1 Mental retardation
Approximately 3 to 4 per thousand children under 18 years of age have major disabilities in intellectual and social function. There are between 90 and 130 million in the world suffering such disabilities.

2 Brain damage
Caused by bacterial and parasitic infections, alcohol abuse, malnutrition, chemical pollutants etc. There are an estimated 400 million people suffering from iodine deficiency, which can damage the foetus.

3 Psychoses
The prevalence of severe mental disorders such as schizophrenia is estimated conservatively at not less than 1% of the world's population. More than 45 million people suffer social and occupational difficulties as a result. The prevalence of schizophrenia is approximately 2 to 4 per thousand.

4 Dementia
Diseases of the brain, particularly those associated with ageing, are increasing as people live longer. Senile dementia is estimated at 100 to 200 per thousand individuals aged 70 or older.

5 Epilepsy
Prevalence ranges from 3 to 5 per thousand in industrialized countries to 15 to 20 or even 30 per thousand in some areas in the developing world.

6 Neurosis
Estimated to occur at a frequency of 5% to 18% of the general population, and rising sharply in the industrialized countries.

7 Alcohol abuse
The number of countries in Europe with a per capita intake of more than 10 litres of pure alcohol per year increased from 3 in 1950 to 18 by 1979. There is a sharp global increase in alcohol consumption, particularly in some countries in Africa, Latin America and the Western Pacific.

8 Illicit drugs
There are an estimated 30 million cannabis users, 1.7 million opium-dependent and 0.7 million heroin-dependent people in the world. There are as yet no figures for cocaine.

9 Psychotropic ('mood altering') drugs
Drugs used in the treatment of mental disorders are often supplied over the counter without prescription, with insufficient or misleading information, or are prescribed inappropriately.

10 Somatic symptoms
Between 30% and 50% of all consultations with medical professionals in industrialized countries result from no detectable physical illness or when the complaint of discomfort is out or proportion to the physical problem. In developing countries such complaints, though a lower proportion of the total, are still the largest single complaint category in primary health care.

1 Changing living arrangements in the population and their potential effect on the prevalence of mental disorder', M Kramer et al in Psychiatric Epidemiology, ed Brian Cooper, (Croom Helm 1988).
2 'Is schizophrenia disappearing?', S Dev et al in The Lancet, 3 March 1990. and Psychiatry Around the Globe, J Leff, (Gaskell 1988).
3 'Psychiatric Disorders in two African Villages, J Orley and J Wing, in Arch Gen Psychiatry Vol 36, May 1979.
4 Mental Health for All? The Epidemiological Basis for Action', I Lever et al in Boletin de la Oficina Sanitaria Panamericana, Sept 1989.
5 Soviet Psychiatry, David Cohen (Paladin 1939).
6 Mental Health International, 1990.
7 'Aide-Memoir on South African Psychiatry', S Ferbabdi for TCPS UK. June 1988
8 Letter to The Lancet from P Graham. 7 April 1990.
9 'Psychiatric Illness in the New Zealand Maori', P S Sachder, in Australian and New Zealand Journal of Psychiatry 1989,
10 'The Rising Pandemic of Mental Disorders and Associated Chronic Diseases and Disabilities', M Kramer, in Acts Psychiatrica Scandinavica 62, Suppl 285, 1980
11 All information in this section taken from: Prevention of Mental, Neurological and Psychosocial Disorders, Report by the Director-General, WHO, Geneva 1986. Thanks to J Orley and W Gulbinat of the WHO, Geneva, for their assistance.

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