The Mental Health puzzle, part III: the cultural hypothesis.

In the two previous parts, I posed the puzzle of the measured increase in mental health problems (depression, anxiety, and obesity in particular) across the Western world since the 1950s and in Anglo-Saxon countries in particular. Here, I take it as given that this is real (and not just a measurement issue) and will discuss one of the leading cultural hypotheses as to what might be going on and what can be done about the mental health ‘crisis’.

As a pre-amble, it is perhaps handy to give a simple framework for how to think about these mental health problems. Whilst there are many different types of mental health problems, including many types of depression and anxiety, it will be useful to think of many of them as an inability to maintain self-esteem.

What do I mean by self-esteem? I mean by self-esteem an image of oneself as a useful person who is valued by her social group and abiding by its social standards. Someone whose self-esteem is high believes they are useful, valued, and successfully following the relevant social norms. Someone whose self-esteem is low feels useless, unvalued by others, and incapable of meeting perceived social norms.

Depression would then be understood as a breakdown in the ability to maintain the belief that one is useful, valued, and abiding. Anxiety would then be understood as an inability to discount fears that are not equally fears by others. Obesity would then be an inability to foster and maintain food and exercise habits that are valued by the social group and that enhance own functioning. Whilst clearly different, all these mental health problems then can be loosely grouped together as an inability to withstand pressures and temptations on self-esteem. And yes, this is a gross simplification for the specific purpose of creating a useful perspective.

Note how this set-up immediately gives you many predictions that are roughly true: the ‘winners’ (ie the rich) will want to win in every way and thus also keep closer to the group ideals in terms of beauty, mental resilience, and reasonable fears. Indeed, its the poor who suffer relatively more from all these mental health problems. Also, complaints that ‘society’ creates impossible demands on its members in terms of beauty and general mental ‘performance’ directly fits this kind of set-up.

Within this kind of general set-up, the leading candidate reason for the increase in mental health problems is then an increase in social standards such that abiding by them has become unattainable for many.
Whilst one hears complaints about impossible standards as it pertains to societal adoration of ‘anorexic supermodels’ or ‘super nerd billionaires’ one of course needs ‘deeper drivers’ to explain why social norms might have changed over time in particular countries and subgroups, yet not others.
A particularly popular story is that with high internal mobility, mass-media, and general standardisation of production processes have meant that people increasingly compare themselves to ideals belonging to very large groups. Areas with low mobility, low degrees of standardisation, strong local-focused media and strong economic roles for medium-sized groups (extended family and small communities) would then have ideals belonging to smaller groups.
The basic point is then that the ideals of smaller groups are easier to maintain because smaller groups have fewer superstars. Similarly, with smaller groups (but not groups of just 1 or 2) there is a more immediate feed-back on fears, expectations, and habits such that derailing of beliefs and habits is less likely.
In short, the individualisation of society in the US and, to a lesser extent, in particular Western countries would be held to blame for the increase in mental health problems.
One obvious policy solution is to resurrect medium-sized groups by means of mobility taxes and a general de-coupling of production chains. It should be clear that is not going to happen.
Another ‘market solution’ is for individuals to adopt, early in life, an iron degree of self-esteem as well as a habit of avoiding information that would be detrimental to that self-esteem, ie to become more selective about the information absorbed. This kind of thing, which to some degree fits the stories told about generation Y, would then mean that the ‘hit’ of a reality check comes much later in life where its effects are probably less devastating than earlier on.
Yet another solution is to equip a next generation with a whole system of ‘life-coaches’ that effectively take over the job previously done by medium-sized groups. Life-coaches would then constantly monitor and tell both youngsters and adults to exercise more, look after their diet, stop worrying about silly stuff, etc. If needed, this kind of ‘positive psychology’ is beefed up with medicines to prop up those for whom coaching fails.

I would say that this possibility is currently the leading contender in much of the psychologicalmedical literature as well as the thrust of the policy response to the mental health problems. Governments are gearing up to prevent kids from becoming depressed by means of school programs, to prevent obesity by means of more sports at school and bringing in taboos on fast-food and sugary drinks, etc. In effect, it is becoming an explicit role of the government to ‘correct’ social ideals and expectations such that they reflect neither the superstars nor the overly anxious and miserable in society but rather what people a bit below average might accomplish if prodded gently.

Note also that this ‘leading explanation’ has some problems, both in terms of its plausibility as an analysis and the feasibility of its policy prescripts.

In terms of plausibility, one essential problem is in providing a believable story for the cross-national data on this basis. Some cross-national data fits reasonably well. One can for instance make the story that Japan and Korea (which have lower levels of problems) medium-level communities are more intact and individuals are thus less individualistic, whilst the high-mobility Anglo-Saxon countries would have seen an increase in standardisation and aggregation of social norms. But why would France and India have such relatively high rates of depression, and how come Japan and South Korea have such high recorded rates of suicide?

One needs all kinds of sub-stories to rationalise the cross-national data, such as building in a temporal spacing of social pressure to adopt good habits (so that if you survive social pressure when young, you are fine as an adult), and some role for education habits (so that you can blame education idiosyncrasies for depression rates in France!). More ad hoc stories are needed for other cross-national anomalies. What the cross-national data forces you into is the ad-hoc recognition of many other factors that do not fit the basic framework above, begging the question whether that framework really is the most useful one to start out with: something that vaguely fits the Anglo-Saxon trends but needs tonnes of ad hoc stories for other places is unlikely to be the final word.

A second plausibility problem is that it is not all that clear that communities really have lost their economic role or have lost cohesion. Volunteerism in the local community is alive and well, and local churches in particular are thriving, so one is then really more in the business of explaining why local inclusive groups that cater for everyone have reduced in strength, as well as reasons for why individuals would start to compare themselves more with the winners in larger groups (which creates all the angst). Such issues are hot research topics at the moment.

The difficulty with the policy prescript is that it tries to keep a lid on the worshipping of the winners, whilst that worship is demanded by both winners and losers alike: keeping up ‘viable norms’ would need one to essentially trie to ‘undo’ at the national level the natural outcome of a more integrated economy wherein medium-level communities lose their economic role and thus their long-term social viability, leading to ideals that reflect the abilities of the top. One is then up against the ‘you too can be a star’ story that appeals to everyone.

I might also mention that the behavioural stories above do not yet exist in terms of economic models. One can pour them into a utility function mould, but they look very unfamiliar to mainstream economists, so the take-up of these stories amongst economists is, understandably, scant.

In the next installment I intend to talk about possible ‘economic’ explanations, but welcome your suggestions in the comment box as to whether you ‘buy’ the story above or favour some other cultural story.

Author: paulfrijters

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

3 thoughts on “The Mental Health puzzle, part III: the cultural hypothesis.”

  1. Over the same period we have seen the continual evolution of the US DSM. Sometimes Occam’s Razor applies. Just a thought.


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