Have you ever heard it said that 1 in 4 -or sometimes it is said to be 1 in 5- people have suffered mental illness? This is a good statistic for making people feel that mental illness is normal and thus reducing stigma, hence it is quoted extensively by charities and other services which deal with mental health. The problem is that it appears to be pretty much a made up number.

There is no single study that produced this statistic. One person who is sometimes credited for doing such a study actually says, if asked, that he didn’t come up with anything remotely corresponding to the 1/4 or 1/5 figure.

A person spoke on the radio some time ago saying that the figure was valid but it was impossible to site proof because it was the result of a meta-analysis. I’m sorry, but that’s bullshit. Here’s how I would attempt to validate my own claims if I had done a meta-analysis:

  • I would present a list of the different studies I analysed (for a radio program, a long list wouldn’t be read out, but I could invite listeners to view the list on a website etc. if interested.)
  • I would note whether, if things like “mental illness” were assessed using different criteria in different studies, I re-interpreted the results of the various studies according to a single criteria -stating what that criteria was, of course- or if I took the stated results at face value.
  • I would note whether I had excluded any studies from my final conclusions because I felt any aspect of the methodology to be inaccurate, or conversely if I chose to include any studies which came up with very different conclusions to the others; if I’d done this, I would speculate, if possible, on the reasons for the difference in result and I would say why I felt both this study and the rest to be equally worth inclusion in my study
  • I would confirm whether my final result was simply a mean average of the various results or if it was arrived at some other way.

This may not be a perfect way to do it; I am not a sociologist or any sort of scientist. The point is that even a complete amateur such as myself can easily reason that a properly documented meta-analysis is far from impossible to understand or (in)validate after the event.

Throwing spurious statistics around undermines an organisation’s credibility, so I hate to see it from organisations that I basically support. In addition, I wonder how useful it is to be telling the public we have a 25% or 20% chance of experiencing mental illness, regardless of the accuracy of this information in relation to current diagnostic criteria. Such criteria are subject to revision, and as such I think it would be useful to ask, assuming that a very large percentage of the population fulfil them, if it is useful for anyone other than psych-drug manufacturers to be pathologising so many people’s minds. I don’t suggest anyone stop striving for, and getting any useful help they can in reaching, optimum mental health. I think that if anything even more of us should be doing this. However, I wonder if a lot of what we call mental illness these days is a level of misery, confusion, stress, or set of unusual beliefs that constitute a relatively normal sort of reaction for human beings to have in whatever the circumstances. Reducing the suffering that comes from these things could , I think, be better likened to giving the body good nutrition or regular exercise to make it more healthy rather than giving it medicine or physiotherapy to recover from an illness.

This brings me in a roundabout way to the subject of defining mind and body normality in general, and the train of thought I actually started with today: I believe that in general we define normality far too tightly. I don’t say this lightly, because I am aware that for “normal” to have any useful meaning, some people will always be excluded from the definition. Reducing the number of “abnormal” people makes these people more vulnerable to being oppressed and disempowered.

On the other hand, defining even the nearly-normal by their variations from average could be seen as making the truly unusual seem even more so. For example, if I’m called short, as a guy who can’t reach the top self in an average kitchen without standing on a chair, then what do we call men who couldn’t even reach the worktop? The answer, of course, is that we call them (in a more or less polite and subtle way) freaks. Not merely abnormal, but medically abnormal. Precisely where doctors draw the line that takes the noteworthy mind or body into their jurisdiction can seem relatively arbitrary.

The act of drawing a line between illness and wellness can be problematic. One problem is that many people near to that line are likely to develop an investment, emotional, social, financial or otherwise, in being placed on one side of it or the other. One of countless examples is the person recovering from a really difficult period, either physical or mental, who is approaching but not fully reaching an ability to return to work. If they are judged well too soon they may lose sick pay and/or be put under pressure to work too much or too soon for their abilities. Failure to cope, or coping at the expense of their own wellbeing, is likely to be the outcome. Other people – in fact, some of the same people in different contexts!- may have an investment in being judged well. They may be aware of stigma surrounding some conditions and want to avoid it for themselves, or perhaps their ability to cope with parenthood is being challenged in the courts and they want to prove that, perhaps with a little support, they are capable and should not have their child(ren) taken away. Being sick enough to qualify for financial or practical aid in an ongoing way one day and being well enough to work, raise children, etc. to a satisfactory standard and in an ongoing way the next day is in fact a relatively rare state of affairs when it comes to human health. Yet medical and governmental agencies apply this binary model of wellness to millions of people in the world every day.

Nationwide systems for distributing resources and for granting the rights/privileges and responsibilities associated with mental and physical normality will probably always fall short of perfection. The question I hope to leave you with is this: Do we as a society, as citizens, and as individuals benefit ourselves and others from thinking within similar same binary models of illness/wellness and normality/abnormality to the extent we do?



~*~ Ash