Why Are So Many Americans Suffering from Mental Health Disorders?

May is National Mental Health Awareness month, and slightly more than half of American adults are estimated to be suffering from some form of mental health issues.

EDITOR’S NOTE: ICD10monitor publisher and program host for Talk Ten Tuesdays Chuck Buck recently interviewed Dr. H. Steven Moffic, a world-renowned psychiatrist and award-winning author, to probe why so many adult Americans are mentally unwell. Here is his interview, edited for clarity and brevity.

BUCK: If Americans as a whole were given grades, as in a high-school report card for mental health, what grade would you assign our country today?

MOFFIC: For sure, Chuck, we can’t give our mental health a grade of “A,” can we? After all, the main criteria usually used for mental health is how much ill mental health there is. We must not forget that there is also “good” mental health to consider, sort of two sides to the same coin.

Good mental health is often ignored, but it is best conceptualized by psychologist Abraham Maslow in his hierarchy of fulfilling psychological needs, first proposed in 1943. So, he starts on the bottom of the pyramid or triangle with “physiological needs,” which include food, water, shelter, and the like – that we all need to survive. Next up is “safety needs,” such as personal security resources, general health, and even psychological safety. Then comes “love and belonging,” including friendship, intimacy, and a sense of connection. Second to the top is “esteem,” as in self-esteem, status, and respect. The top in his original hierarchy is “self-actualization,” which is the desire to become the most one can be and feel fulfilled by a purpose in life. In 1970, he added “transcendence” at the top, a person who is motivated by values that transcend the personal self.

Although his pyramid is geared to individuals, as the United States tends to be, it can also be applied to communities and even countries.

Let’s take a quick look at each step up the hierarchy. Where are we falling short in the United States? With “physiological needs,” we see growing and distressing homelessness in all our major cities, especially in the warmer Western ones. Now, we can unfortunately add in the border communities to that deficit. “Safety needs” have been compromised by our escalating gun violence and record-setting mass shootings, all of which produce traumatic ripples that spread out in the country, as if a psychological bomb dropped into a body of water. “Love and belonging” has been challenged by racism, antisemitism, sexism, ageism, cultish cliques, political conflict, divorces, and the like, all contributing to the loneliness epidemic that our Surgeon General just called out. “Esteem” is harder to measure, because it is mainly an internal feeling of self-esteem, but divisiveness challenges those criticized. That the pandemic seemed to allow people to leave unsatisfying jobs where they were burning out is a plus, though, as far as reaching “self-actualization.” Similarly, the pandemic has fostered personal reassessments of what gives one’s life meaning, so “self-actualization” may go on the plus side, too. As to “transcendence,” our country surely needs more leaders at various levels who put the needs of all people first.

So, putting all these levels together, although there are some advances toward the top in the higher levels, the bottom levels are likely holding more people back, especially those in the lower socioeconomic groups, so that would pull our mental health grade down. As the country as a whole had the worse COVID-19 morbidity and mortality data of any developed country during the pandemic, our collective health has also been pulled down.

I’d give our mental health a generous grade of C+!

As to ill mental health, which covers the spectrum of diagnosable ICD-10 disorders, as well as sub-threshold undue symptoms, all surveys indicate a worsening. That includes the richer as well as the poorer, especially when sociopathy and undue narcissism is included. Research indicates that there are more sociopaths at the top of corporations than there are in prisons.

As in your introduction to our topic, over half of Americans are suffering from some form of mental issues (whatever “issues” actually means), and add in that the data on teenagers, especially Black female teenagers, is worst of all and includes suicidality, and our ill mental health grade is also of concern.

To start to address this, resources for help are inadequate, especially affordable and quality residential facilities for adolescents. Most of mental healthcare is now controlled by businesses that often put profit before quality of patient care (see my book The Ethical Way: Challenges & Solutions for Managed Behavioral Healthcare, Jossey Bass, 1997).

I’d give our mental illness grade a C-!

This is not to say that people with compromised mental health or mental illness can’t still be satisfied with life and contribute to the country. That would be a stereotyping stigma. Sometimes, in fact, they can make crucial contributions to the world. Take President Abraham Lincoln, who suffered from significant periodic depression much of his adult life. Those who have hypomania may have increased energy and creativity. Those with Attention-Deficit/Hyperactivity Disorder (ADHD) can be more creative and innovative. Then, in general, those with enough support and renewed vision can develop increased resilience and growth.

BUCK: Last Thursday marked the end of the national three-year COVID-19 public health emergency (PHE), although some states may continue to enforce the PHE through November. Nonetheless, how, in your judgment, has the PHE impacted America’s mental health?

MOFFIC: Although all the mental concerns that I mentioned were in place and escalating before the pandemic, the pandemic in general produced more mental harm than benefit. Losses of life, jobs, freedom to socialize, and other constraints inevitably caused much grieving and mourning, some to the extent of the new classification of Prolonged Grief Disorder. Then add the increase in fear and trauma and you have an escalation of different degrees of posttraumatic stress disorder (PTSD), and knowing that the emergence of PTSD after trauma can be delayed by months and even years, some is still going to emerge even in this time of recovery (and what some view, erroneously I think, as a return to normality).

BUCK: In your judgment, what is contributing to what might be characterized as a collective national angst?

MOFFIC: The pandemic has made us feel more vulnerable. We humans don’t like that feeling. Our lives can be at risk from a tiny virus we can’t see, but we can infect each other. When will another pandemic emerge? Then,  the constraints on our lives for an unexpected three years (exceeding the Spanish flu pandemic of over a century ago) has made so many of us more irritable. Then there are increasing risks to our future well-being. Those include climate instability, the renewed threat of nuclear war from the Russian invasion of Ukraine, and a variety of environmental toxins, including more plastic in our bodies. As to the United States particularly, all great and dominant civilizations in the past have dissipated. Are we in a death spiral now?

However, I wouldn’t end on such a negative note. Just look at some of the positives that happened during the pandemic years:

• Whether one thinks a vaccine was needed or not, it was produced in record time;

• Zoom enabled social contact during social distancing, including providing health and mental healthcare, and apps are proving useful;

• Greater intimacy in couples and families brought some closer together, as if the pandemic was a blessing;

• The harms of social media are finally being recognized and hopefully addressed; and

• We understand that gender can be fluid and on a spectrum as a normal development.

The development of functioning artificial intelligence (AI), though creating risk for causing harm in the wrong hands, can also provide great benefits in knowledge and decision-making – as long as humans remain in control.

Perhaps, then, like a bright high-school student who has just been fooling around until midterms, bad grades might wake us up so we reach our competence, potential, and actual greatness. Our final grade can be better, markable up by a full grade to B+ or B- in my lifetime.

Final Mental Health Overall Grade: To Be Determined!

Programming note: Listen to Dr. H. Steven Moffic today, 10 a.m. EST, during Talk Ten Tuesdays, when he is the broadcast’s special guest.