For reasons that are not completely clear, the number of Americans who receive Social Security Disability Insurance (SSDI) benefits due to mental illness has increased significantly over the last quarter-century or so. In 1987, 1 in 184 people qualified for benefits; by 2007, that number had increased to 1 in 76, an increase of 284%.
Conventional wisdom would suggest that the increase is due mostly to advances in diagnostic technology, that we have simply become more skilled at identifying mental illnesses which used to go undiagnosed. Unquestionably, the advent of MRI, CAT and PET scanning have allowed us to witness the inner workings of the brain that previously could only be seen in a post-mortem examination, leaving us to draw conclusions based on evidence left behind after the brain’s functions had stopped.
Others, however, have different ideas regarding this meteoric increase. Some have suggested that the diagnostic upswing has been driven primarily by pharmaceutical companies. Many of the medications for mental health conditions are produced based on the premise that mental illnesses are caused by chemical imbalances in the brain. However, medical science has yet to convincingly prove that premise.
Because some medications which appeared to help with mental health symptoms also impacted the levels of certain neurotransmitters in the brain, the theory that arose was that the shortage of those neurotransmitters was the cause of the illness. One author compared this cause-and-effect confusion with the supposition that pain is the result of a shortage of opiates in the body, since pain medications act on the brain’s opiate receptors. In short, some suspect that the majority of the mental health pharmaceutical industry is based on loose assumptions, flawed science and aggressive marketing to the medical profession.
A similar theory is based on the notion that the testing methods used for these medications are flawed, leaving researchers with the false belief that the medications are having effects that they really aren’t. For example, when medications are tested, one group of people called the experimental group is given real anti-depressants while another group, the control group, is given a placebo, which is an inactive pill.
The theory is now that some of the experimental group reported positive results based upon the side effects of the medication; that is, since they experienced side effects, they assumed that they had been given real medication and reported benefits, whether they were real or not. In similar tests where a placebo which causes side effects only but has no active ingredients, there was little in the way of positive effects shown for the real medication in question.
Regardless of all this theoretical talk, the Social Security Administration (SSA)’s required diagnostic criteria for disability benefits related to mental illnesses have not changed. In order to demonstrate that you are disabled by a mental illness, you have to be able to prove that it has impacted your activities of daily living, your concentration, your social functioning, or has resulted in at least 3 episodes of decompensation (an increase in symptoms) in a 1 year period. Also, you have to be able to demonstrate that the impact of the illness is such that you are unable to work.