Gary Greenberg,  April 19, 2016

The Happy Mill

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Workers of the world, cheer up! Researchers from the World Health Organization, aided by an international team of scientists, have crunched the numbers, and the results are in: relieving anxiety and depression is good for the bottom line. A $147 billion investment over the next fifteen years—a mere dollar and a half per inhabitant of the earth per year—will increase productivity to the tune of $399 billion. Factor in the $310 billion dollars that economists estimate “being alive and healthy” are worth to the laborer, and you’ve got an aggregate increase in GDP of over $700 billion, a benefit-cost ratio of nearly 5.7:1. Sure, that’s nothing like the return on treating malaria (up to 40:1). But it may be enough that help will soon be on the way.

The study, published in The Lancet, is an attempt to meet the “enormous economic challenge [mental] disorders pose to communities and society at large as a result of foregone production and consumption opportunities as well as health and social care expenditures.” In 2010 alone, those foregone opportunities to work and spend cost economies at least $2.5 trillion. Depression and anxiety, with their “12 billion days of lost productivity,” account for just under one trillion of those lost dollars. Think of the waste! And there’s little chance of recovering it: Depending on the income level of a given country, only between 7 and 28 percent of the depressed, and between 5 and 20 percent of the anxious are currently receiving treatment. 

So what do we get for that $1.50? Prozac, of course (the cost estimate is based on a six-month course of the generic version) and “psychosocial treatment” of varying intensity and duration, depending on the severity of your affliction. There’s no mention in the study of first-line medications for anxiety disorders, like Valium, Xanax, and the other minor tranquilizers. Perhaps that’s because, unlike Prozac, those drugs are addictive. Nor does the study acknowledge the dismal failure of antidepressants to actually treat depression. (In more than half of the clinical trials submitted to the FDA for approval of the six leading antidepressants, placebos outperformed the drugs, and the advantage in the successful trials was only barely significant. Subsequent research indicates that drugs are more effective with more severe depression, but even these studies rarely show effectiveness in more than half the patients.)

Suffering is reduced to excess productivity loss.

Neither does the study explain what those “psychosocial” treatments are. The current industry standard is cognitive-behavioral therapy, a set of techniques designed to use rationality in service of emotional resilience. In an earlier, less scientistic age, this was called the power of positive thinking, which posits that nothing is good or bad but thinking makes it so.

Those who feel imprisoned in their private Denmarks, or in any of the thirty six real-life countries assayed in the study, aren’t really in a position to protest that reducing their suffering to disability-adjusted life years might be part of the problem. These supplicants are meant to be grateful that the WHO, with the assistance of the American Psychiatric Association, has managed to convince the public that depression and anxiety are diseases to be tallied by epidemiologists, studied by biologists, and treated by doctors. By this reasoning, however, a Bostonian executive depressed about her divorce is suffering the same malady as the man in Flint despairing over ever getting another job (or lead-free drinking water), and the Thai sex worker tired of servicing businessmen in Dubai, and the Nigerian mother pining for her kidnapped daughters, and the Afghan farmer grieving his drone-murdered son. There are an awful lot of worried, unhappy people in the world. If their suffering is to be reduced to excess productivity loss, well, then that’s just what you have to do when having a disease is your best ticket to social resources that might relieve your suffering. You have to hit the people who actually run the world where they hurt.

Of course, you also have to reassure them that they can do something about it without actually giving up any power. Which the Lancet study does very nicely, if obliquely. An increase in treatment, the authors declare, requires “not only (…) a new level of political commitment and resource mobilization (…) but also a significant reorientation of public health systems toward chronic disease identification and management.”

Millions of private individuals managing their chronic diseases are far less worrisome than a public nursing its rage.

The researchers note that “socioeconomic status, and particularly poverty, can have an adverse effect on the risk of depression and anxiety disorders,” but, they acknowledge, the question isn’t well enough studied to know whether the adversity lies in the inaccessibility of treatment to poor people or in the stress of poverty. And while it’s true that “the workplace itself can be a souce of stress for many people,” that fact entails a “need to integrate mental health and wellbeing into (…) employee support programmes.”

Translation: if your worries or depression focused on the possibility that your wealth was responsible for our suffering, there is a treatment, or at least a new way of looking it: anxiety and depression, like diabetes and high blood pressure, are merely the bad luck of the body, best left to the experts to handle. Hey, millions of private individuals managing their chronic diseases are far less worrisome than a public nursing its rage. Now that’s a return on investment.

Gary Greenberg is the author of four books, most recently The Book of Woe: The DSM and the Unmaking of Psychiatry. He is a contributing editor at Harper's. He lives in Connecticut. 

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