Briefly and speculatively this morning, at a friend's behest I've been reading Robert Whitaker's Anatomy of an Epidemic, another entry in the thriving anti-psychiatry industry. I am still early in the book, but so far it is, for its genre, a sober attempt to answer the question of why, after decades of intensive research, the problem of mental illness and its attendant disability appear to be, if anything, worse than ever. A hypothetical answer came to me when I read Robert J. Samuelson's suggestion about educational reform in Newsweek.
Samuelson observes that the United States has been in educational "crisis" for decades now, yet despite the application of massive resources and large numbers of teachers (and immeasurable pedagogical ingenuity), average academic performance has not significantly budged. He makes the not very politically correct claim that the problem is no longer the educational system, it is the students, or at least the kinds of students that the culture at large now produces. He adduces two factors: the increasingly anti-intellectual and autonomous culture of adolescence, and the huge increase in educational access in an increasingly technological and sophisticated society. In a nutshell, the educational system increasingly aspires to wring blood from a stone.
Human beings naturally vary in cognitive skills, concentration, etc. and for most of human history only a minority of the population endured extended formal schooling. The past generation or so has been the first experiment in population-wide education, and it could be that the system is coming up against natural human variability. In the past those who, whether due to lack of opportunity or aptitude, could not obtain extensive education were able to find niches in agricultural or other basic functions that are now increasingly occupied by machines. In an economy increasingly requiring advanced and specialized skills, niches are more competitive and harder to come by. Thus the uneducated are, relatively speaking, more disabled than in times past.
It could be that mental disorders, except perhaps for the most severe forms (the exact boundaries of which are still not determined), are not so much discrete entities as they are one end of the bell curve in terms of parameters such as mood, anxiety, attention, and reality testing. They may be analogous to learning disabilities inasmuch as deficits in stress tolerance, mood stability, and sustained attention increasingly place persons at greater disadvantage. Contemporary society is not so much provoking these problems as it is making them more apparent, that is, revealing natural human variability in the same way that, say, a basketball camp highlights differences in jumping ability. Because these capacities are complex and developmental, they are not easily modified.
Just as in centuries past, the academically challenged found niches, so those with anxiety and mood disorders may have been able to gravitate to settings that accomodated their symptoms. They found rural occupations permitting distance from people; they found solace in church; they were able to obtain support from family. But in our more mobile and dispersed society, the only jobs available are often intensely stressful, requiring constant contact with people even if only on a telemarketer's line. Individuals who used to rely on family increasingly have to resort to official disability status. It is not the case that psychological disability is new or unprecedented--it is just that there is nowhere for it to hide.
ADHD is obviously the place at which educational and psychiatric challenges intersect, and to my mind it is the perfect example of a hypercompetitive, ambitious post-industrial society illuminating natural and evolutionary variation in a human cognitive capacity, in this case attention and impulse control. The fact that distractibility, like the ability to metabolize (then scarce) calories parsimoniously, was adaptive for much of human evolution, does not unfortunately mean that it is adaptive now. The effort to suppress obesity, like much of psychiatry, may be an instance of cultural evolution, one that appears to have a lot of bumps in the road.