Reports show a dramatic rise in reported depression and anxiety symptoms in adults, from 10% in 1990 to 28% in 2023. This surge raises questions: is human biology changing, or has the definition of mental illness expanded to mask structural causes of distress?
The pharmaceutical and psychiatric industries appear to benefit from framing societal dysfunction as individual pathology. Updates to the Diagnostic and Statistical Manual (DSM) have broadened definitions, turning shyness into Social Anxiety Disorder, grief into Major Depressive Disorder, and normal stress into Adjustment Disorder. This diagnostic creep significantly expands the market for interventions.
For example, ADHD diagnoses in school-aged children have risen from under 1% in 1990 to 11% today. International comparisons reveal wide variations in diagnosis, suggesting criteria expansion rather than biological differences drives these numbers.
The core issue is the systematic redefinition of structural problems as individual ones. Worker depression due to job insecurity or low wages is treated with antidepressants rather than workplace reform. Student anxiety about economic futures is addressed with medication instead of systemic change.
This medicalization converts systemic critique into a treatable medical problem. A worker identifying exploitation as the cause of depression can demand change; one believing it's a serotonin imbalance can only take medication. Institutions profit from treating symptoms, not addressing root societal causes.
Mental health measurement often obscures systemic factors, quantifying individual symptoms rather than material conditions. Reasonable anxiety about economic precarity is pathologized, while the objective structural disorder is ignored.
While SSRIs help some severe cases, meta-analyses show marginal benefits for mild-to-moderate depression compared to placebo. Their widespread prescription is driven by profitability and the fact that psychiatric institutions are designed to treat individuals, not societies.
Therapists and psychiatrists, operating within systems designed to treat individuals for profit, have little incentive to address systemic issues like poor working conditions or economic insecurity, as these would reduce demand for their services.
An alternative approach would focus on job quality, economic security, social connection, and material stability. Addressing anxiety would require confronting its root causes. Such a system would resemble labor unions and community organizations, not profit-driven institutions.
The medicalization of suffering is an inevitable outcome of systems designed to profit from symptoms, leaving causes unaddressed. Recognizing this structural feature is key to understanding the persistent mental health crisis.