The mental health puzzle, part II: happiness?

Last week, I posed the puzzle of the decline in mental health from around 1950 till now in most Western countries (with some countries showing a plateau since the 90s). I was talking in particular about the increase in depression, anxiety, and obesity.

One of the reactions (by Andrew Norton in particular) was on the important clue that we cannot see the mental health decline in happiness data. Indeed, we can hardly see any trend in longitudinal happiness within rich countries: some small ups and downs around recession times, but a basic flat line since the 1950s.

It gets worse: we dont really see any change in the distribution of happiness either. This is not what one would expect from the data on mental health decline: with perhaps 30% of the population in some form of serious mental health problem in any given year, one would expect 30% of the population to be unhappy, perhaps counter-balanced by a deliriously happy 70%. This is not true either: happiness in rich countries looks pretty much like a Bell-Curve whenever it was measured. No elongating ‘left-tail’ as far as I know.

Yet, at the individual level, those with mental problems are a lot less happy than others. Indeed, health in general is the most important of all demographic variables one normally sees in a happiness regression.

Let us first discuss the possible ‘data’ explanations which make sense of this all, many of which are yet to be empirically tested:

There is something wrong with the happiness data because of selection. We can for instance suspect that the mentally unhealthy are under-represented in happiness data and that, over time, the number of people not in the data has increasingly been made up of people too depressed to answer surveys. The problem with the suspicion is that it is probably the other way round: as far as we know, misery loves company in that people who stay in a panel for a long time tend to answer more miserably. Indeed, the prevalence of mental health problems in general surveys is large.
There is something wrong with the happiness data because people lie about their happiness. For this, we can appeal to the same ‘time in panel’ finding as above: people who answer years in a row tend to answer more miserly as time goes by, perchance because they get comfortable with the surveyor and are thus becoming more honest about their unhappiness. This possibility would of course be quite devastating for the happiness literature as it would cast doubt on the many cross-sectional surveys. One would then still need to find a reason though for why this ‘keeping up happiness appearances’ has gone up over time rather than stay constant.
There is something wrong with the health data because of exaggeration. The clear front-runner along these lines is the hypothesis that everyone with a bit of a problem nowadays gets given a label. That would rationalise why the mentally unhealthy are indeed less happy and why we get a measured increase in mental health problems. The problem with this one is both the clinical literature which purports a true increase in the number of people with serious anxiety and depression (of which there are many variants, of course), as well as the undoubted increase in obesity rates which indicate an increased inability to withstand temptations and keep up healthy food and exercise habits (aka willpower), which in turn might be caused by all kinds of factors (including increased temptation and social norms that have lessened the taboo on particular behaviour).
There is something wrong the health data because of changed expression. Here, one can think of a change in the manifestation of unhappiness and mental health problems: it would not be the case that in previous eras people were mentally healthier, but rather they were more actively hiding their mental health problems and these got channelled in different ways, perhaps more destructive ways. The person who would have been a paranoid bully in previous decades would now simply be at home on prozac, equally mentally unhealthy and unhappy but displaying that unhealthiness differently. This one is very hard to refute or verify because it relies on the possibility of any particular mental health problem being a mere ‘expression’ of underlying factors. It is not clear that is mechanically possible or plausible.
There is nothing wrong with the health and happiness data, but something else is causing both the increased mental health problems as well as some compensating factor that keeps the level of happiness constant. Stories in this direction include the notion that Western societies have seen an explosion in ‘entitlements’ and ‘optimism’. At one level both entitlements and optimism bring happiness because they reduce uncertainty and give people a warm glow in terms of happy beliefs about themselves. On the other hand, there is a sleight of hand involved in both of them in that cashing in on entitlement comes with a knock to self-esteem (sometimes it even comes with the duty to be unhealthy), and optimism comes with the mental cost of having to self-delude constantly. Both can be psychologically draining and thus lead to the bottom of the distribution succumbing to serious mental health problems more often than before. Variations on this theme include the literature on reduce ‘resilience’, the literature on increased ‘temptation’ (thank you Andreas Ortmann), the literature on reduced ‘connectedness’ (which is, after all, for many people a choice), etc. From an economic point of view, one could term all of these in the form of the availability of more psychological choices early in life, with expected value close to zero but a higher probability of derailing. With more psychological risk-taking comes a larger number of people in problems. The mental health industry then keeps the bottom of the distribution up by means of medication and therapy.

My own inclination is to think in terms of option 5: the cross-country data does appear convincing to me, particular the fact that Japan and Korea have fairly low levels of happiness but also low levels of mental health problems compared to the West. Having visited Japan, I basically believe the data on this: the Japanese are neither unhappy nor mentally unhappy. Their happiness levels are just medium but levels of real problems are low. In the West the distribution in that sense is more extreme, but the bottom is kept up by means of the health industry. This of course does still beg the question where changes in these cultural traits of ‘optimism’, ‘temptation’, ‘resilience’, ‘connectedness’, etc. come from and why you get the distribution over countries in these traits.

Author: paulfrijters

Professor of Wellbeing and Economics at the London School of Economics, Centre for Economic Performance

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