Restigmatizing Mental Illness

  1. Negative Spirals: It isn’t true that cultural acceptance is higher than ever before. If anything, cultural acceptance is lower, the stigma is higher and the costs of depression are more severe, negatively reinforcing people handicapped by this illness, which handicaps them even more, which causes more negative reinforcement etc etc, a horrible trap they can’t escape from. It’s true that awareness of depression/anxiety is higher than before, but does that automatically translate to lower stigma? Would I have been able to come out as depressed as a 16yr old in the 2000s? Not likely, society is more ready to talk about this, and it’s going to be an uphill task to square this readiness to talk with a simultaneous increase of stigma. Or even if we tortuously maintain this cognitively dissonant claim, we’d expect the increased stigma to disincentivize further self-reporting of depression and cases should drop off a cliff and go into hiding. Still, it’s not a 0% claim, if nothing else we could segment stigma according to different cultures, socioeconomic bands, countries, ages, institutions etc and find that in some of them at least the stigma has increased. Confidence: 5%
  2. Incidence vs Reporting: The same proportion of young people are depressed, we hear about their stories more now because they come forward. Either more of them are coming out and acknowledging their illness, or the same number of them are coming out but much louder. Either way, this reframes the issue slightly from one of increasing depression instead to increasing importance of depression. This is joint best case scenario for destigmatizing depression, and bears out at least a little in how many middle-aged people are now coming out with stories of how they’ve been depressed all their lives but have only now been able to talk about it. Unfortunately, this is anecdotal and by definition never going to be statistically significant to a level that bridges the gap between today’s numbers and those from decades ago. Especially when you have even more old people grumbling about snowflake youth being too fragile these days, which shows that the stigma is lowered but doesn’t say too much about whether that’s responsible for better uncovering of concealed cases. Still, I’m partial to this claim, and in general we’d be better off if it were the null hypothesis to be assumed until proven wrong, as opposed to the other way round. Confidence: 40%
  3. Reporting vs Incidence: The same proportion of young people are depressed, but non-depressed people are now self-diagnosing and artificially inflating the numbers. This is the joint worst case scenario for destigmatizing depression, where society actively loses out on human potential. If this were true, some data we might see: no increase in serious depression cases (hospitalization, chronic medication), no increase in suicide rate despite increased depression rate (or maybe we’re just better at treating, mitigating its consequences). Ultimately, this claim is weakened by its counterfactual nature of causality, which is what differentiates it from claim 2 and makes the arrow of causality run in the oppose direction. Ultimately it’s a trade-off game where we accept this loss if it means a higher number of real-cases being uncovered in claim 2. Confidence: 10%
  4. Apples to Oranges: More young people are depressed. The environment is more depressing now, if the Boomers were growing up today, they’d be depressed too. The other part of the joint best case scenario, the first part was prevention (catch it early, get more people to report quickly and get treatment), and this is the cure part, where conditions are terrible but thankfully we have treatment and cultural support otherwise the situation could have been much worse. Most macroeconomic indicators support this claim, from housing prices to student debt to air pollution to quality and cost of living indices, life is more competitive and harder in many ways today. Plus, this is the first generation that grew up with social media, that favorite whipping boy for all social maladies we don’t want to take responsibility for. Unfortunately life is also easier in many more ways, prosperity is at an all-time high, access to goods and services is incomparable, and political stability is unprecedented, so it’s difficult to be certain about this claim. Confidence: 40%
  5. Snowflakes: More young people are depressed. They shouldn’t be. This is the mollycoddle argument, the favorite argument of the ideological Right, which, wholly unintentional I’m sure, is actually somehow more charitable than claim no.3 where we’re simply calling depressed people frauds. At least here the claim is they are actually suffering from physical symptoms, but given the strongly psychosomatic nature of this illness, they did it to themselves, or had it done to them through weak incompetent parents and adult role models during developmental stages. The other half of the joint worst case scenario for destigmatizing, in fact this one is even worse because if there is an element of causality involved it actually decreases physical well-being and experience, as opposed to just causing erroneous self-reporting and some minor negative externalities like claim 3. If we accept that a larger proportion of young people are depressed, then any uncertainty we have about claim 4 (it is environmental) spills over to more certainty about this claim 5. On the flip side, it’s also really hard to pull apart this claim from claim 4, where does environmental effect end and personal responsibility begin? If rich people are more depressed than poor people, does that automatically make them snowflakes because the environment is objectively better? I’m not at all certain, yet this claim needs to be its own, because personal responsibility does start somewhere, though that dividing line is nebulous. Confidence: 5%




A novel insightful exercise to determine the pragmatic difference in intellectual payoff between a novel insight and an obvious fact mistaken for novel insight.

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