Single Payer Health Coverage Needed to Treat Epidemic of Affluenza

Michael C. Moynihan | January 3, 2008

At the Guardian's Comment is Free blog, Affluenza author Oliver James bemoans the rise of "Selfish Capitalism" (James's capitalization) which, he argues, is making us flat-screen television-obsessed Westerners "mentally ill." James claims, without offering any convincing data, that those living in the generous welfare states of Western Europe—whom he ridiculously calls practitioners of "Unselfish Capitalism"—are much less likely to suffer from depression than their counterparts in England and the United States. James doesn't provide a definition of "mental illness" or sources for his data, though it is, of course, likely that the "nationally representative studies in the United States, Britain and Australia" he vaguely references employ very different definitions and standards of what it means to be "mentally ill." And one could obviously argue that the American data set represents not an epidemic of illness but an epidemic of overdiagnosis. Regardless, James says that his case is rather more nuanced than a simple correlation between income inequality and depression:

In itself, this economic inequality does not cause mental illness. WHO studies show that some very inequitable developing nations, like Nigeria and China, also have the lowest prevalence of mental illness. Furthermore, inequity may be much greater in the English-speaking world today, but it is far less than it was at the end of the 19th century. While we have no way of knowing for sure, it is very possible that mental illness was nowhere near as widespread in, for instance, the US or Britain of that time.

This is absurd. James argues that the supposed "commercialization" of society, creating an insatiable appetite for consumption, is driving those who, say, can't afford an iPhone into fits of debilitating illness. But he speculates, without a shred of evidence, that in the 19th century the English-speaking world—a world of enormous hardship and disease—was a happier epoch. If you couldn't bank on extending life past a 50th birthday, I suppose it wouldn't be too depressing when your parents die at 40. But health and longevity don't feature in his argument; he simply wants the government to be the arbiter of "when you already have enough income to meet your fundamental psychological needs."

It's worth reading (or rereading) Will Wilkinson in reason's December issue, in which he convincingly demonstrates that the "alleged epidemic of depression [in the United States] simply doesn't exist":

According to [The Loss of Sadness authors] Horwitz and Wakefield, "There are no obvious circumstances that would explain a recent upsurge in depressive disorder." The ranks of the depressed are bulging, they argue, because the clinical category fails to make the elementary distinction between normal, functional sadness and true mental disorder. The depression data are littered with false positives-jilted lovers, white-collar workers who missed out on a promotion, and kids nobody asked to the prom. People who are suffering but aren't sick.

Full review here.

Comments

Rapid -cycling Bipolar|1.3.08 @ 5:46PM|#

Cue the Szaszian idiots to DENY the science of mental health.bb

R C Dean|1.3.08 @ 6:04PM|#

Speaking of mental illness . . .

he simply wants the government to be the arbiter of "when you already have enough income to meet your fundamental psychological needs."

Juan|1.3.08 @ 6:08PM|#

You gotta be kidding me....

|1.3.08 @ 6:10PM|#

I read the article in the Guardian. The countries identified as having this problem are USA, UK, New Zealand, Australia, and Canada. What do they have in common?
They are primarily anglophonic.
I order to stay happy, Ich werde niemals Englisch sprechen..Wunderbar, Ich bin bereits besser.

|1.3.08 @ 6:11PM|#

This is absurd. James argues that the supposed "commercialization" of society, creating an insatiable appetite for consumption, is driving those who, say, can't afford an iPhone into fits of debilitating illness.

I can afford an iPhone. I just don't want one.

The annoying ring tones, however, may drive me into fits of homicical rage...

Fluffy|1.3.08 @ 6:11PM|#

James argues that the supposed "commercialization" of society, creating an insatiable appetite for consumption, is driving those who, say, can't afford an iPhone into fits of debilitating illness. But he speculates, without a shred of evidence, that in the 19th century the English-speaking world-a world of enormous hardship and disease-was a happier epoch.

This isn't that confusing at all. Poverty is voiceless. We imagine the poor were happy because no one bothered to ask them how they felt, nor to record it afterward. The poor who trot by in the record of the wealthy are engaged in making a pretense of amiability because they are in a servile position. [I say all these things as a very pro-19th-century person, too.]

Affluence doesn't make people unhappy. People are always unhappy. Affluence just makes it possible for more people to bitch and complain in a way that we are forced to hear.

|1.3.08 @ 6:14PM|#

this is rediculous, comparing levels of mental illness between different cultures is impossible, because the definitions vary tremendously.

Whereas someone in the US may be bipolar with ADHD, that same person is a great warlord leader in Nigeria or an brilliant artist in France.

We just want one more way to pigeonhole every single person on Earth so we can make everybody the same. Bah, *kicks pebble*

|1.3.08 @ 6:14PM|#

I remember watching a PBS documentary at church a couple years ago about "Affluenza" and agreeing with the thing completely. Lately, I've done a 180 flip, going ape-shit to the ad-buster clutching busts who try to tell me that ladies living in Trinidad who, all they have to do all day is cook for their husbands, are happier. Or people living in mud huts are happier, or dying of dystintary are happier.

fyodor|1.3.08 @ 6:16PM|#

It's occurred to me that Socialists can always claim that the Revolution can only be judged once it's been completed over the entire globe and there's no more rich capitalist pigs to make the socialist workers envious, which is the rationalization they give for why those behind the Iron Curtain were so desparate for it to come down.

|1.3.08 @ 6:16PM|#

If I put the name "Michael Moynihan" through an anagram machine, does it spell Katherine Mangu-War?

There couldn't have been less mental illness in the 19th century, because there were other problems that were more severe then than now. That's some terriffic analysis right there.

The author specifies that it is not the effects of poverty or inequality bringing about severe harm that causes the problem, but the culture of competition. So to refute this point, Moynihan points out that people in the 19th century experiences more severe hardships.

I have no idea if there is anything to this guy's theory, but I know I'm not going answer that question here.

|1.3.08 @ 6:17PM|#

Fluffy,

While affluence may not make me happier than a person of the 18th century, knowing what I have at my disposal now, I would be most unhappy being thrown into 18th century poverty and forced to live out my life in that manner. We are grateful for what we've done to improve our society (well, many of us), but there is no way we will achieve a greater amount fo euphoria for it.

|1.3.08 @ 6:20PM|#

joe,

I'd argue that the culture of competition is impossible to correct, unless you remove all natural mating instincts.

but that's just the annoying anthropologist in me trying to make a break for it (don't worry, I've got him pinned)

|1.3.08 @ 6:20PM|#

Hmm, the Soviet Union had--along with the present day poster-child "social democratic" states of Norway, Sweden, and Finland--extremely high rates of suicide and alcoholism.

|1.3.08 @ 6:22PM|#

I guess also the author thinks the riots in France among (surprise!) immigrants and the poor are caused by SelfishCapitalism as well. Oh, wait...

|1.3.08 @ 6:24PM|#

Cesar,

That's Russia throughout history. I'd wager if you compared the rates under yeltzin (also an alchoholic) to those under the soviet union or the czarship before, it'd come out in a wash. That's not to say that communism was the most uplifting social organization, but I think that many people see that as a Russian, not necessarily a communist trait.

|1.3.08 @ 6:26PM|#

That's Russia throughout history. I'd wager if you compared the rates under yeltzin (also an alchoholic) to those under the soviet union or the czarship before, it'd come out in a wash. That's not to say that communism was the most uplifting social organization, but I think that many people see that as a Russian, not necessarily a communist trait.

Well, I'd say being slightly insane is also American throughout history, and an all-American trait.

But actually, as bad as alcoholism was in pre-Communist Russia, it went off the charts in the 70s and 80s near the end of the Soviet era. Mostly because it was the only consumer good that was actually availible for purchase with their artificially inflated wages. That, and a whole lot of time on their hands from such short work days.

Paul|1.3.08 @ 6:26PM|#

which, he argues, is making us flat-screen television-obsessed Westerners

Man I wish I had one of those...

|1.3.08 @ 6:27PM|#

I think the mistake is frequently made that, as affluent people, we sometimes romanticize simple lifestyles with little material need. We imagine how nice it would be to live in a hut/cabin/what-have-you and subsist for ourselves, and then project that feeling of happiness on to people who HAVE to lead lives where they struggle to survive.

Paul|1.3.08 @ 6:30PM|#

studies show that some very inequitable developing nations, like Nigeria and China, also have the lowest prevalence of mental illness

If 99% of the people are dirt poor, is that inequitable distribution?

If 15% are dirt poor, 70% are varying levels of lower to upper middle class, 10% are rich, and 5% are super rich, how equitable is that?

I say the commies had it right, make everyone poor, and call it done.

|1.3.08 @ 6:30PM|#

Well, I'd say being slightly insane is also American throughout history, and an all-American trait.

I agree, we're not no Switzerland.

JMR|1.3.08 @ 6:32PM|#

If I put the name "Michael Moynihan" through an anagram machine, does it spell Katherine Mangu-War?

No, but you do get "Manic Manly Hoe, Hi"

Paul|1.3.08 @ 6:45PM|#

I think the mistake is frequently made that, as affluent people, we sometimes romanticize simple lifestyles with little material need.

I want to live like a poor man, but with a lot of money. -- Pablo Picasso.

|1.3.08 @ 6:50PM|#

I would imagine that Mr. James, with very little trouble, could arrange to spend the rest of his life in a consumer-product-free mud hut somewhere.

Would that eliminate his mental illness?

God\'s Own Drunk|1.3.08 @ 6:51PM|#

Hmmm, short work days and easy access to booze... Maybe those commies were on to something

|1.3.08 @ 6:54PM|#

"Once, a man sent me a pre-publication copy of his book, called Everyday Neurosis. I sent it right back with a note saying, 'Dear Sir, the people I live with have money trouble, not neurosis, and if they have a neurosis it's a neurosis that money will cure.' "
-Eric Hoffer-

|1.3.08 @ 6:54PM|#

LIT,

If I understand the author's argument correctly, it is not the natural competition that is the problem, but the amplification of competition in "Selfish Capitalist" countries.

I have no idea if he's onto something or not. I'm not going to let my political insticts decide for me.

Paul|1.3.08 @ 6:55PM|#

Joe, I see nothing wrong with MM's refutation. Oliver James asserts higher rates of mental illness because of (Selfish?!) Capitalism, titling his own article "Selfish capitalism is bad for our mental health".

He starts his article with:

By far the most significant consequence of "selfish capitalism" (Thatch/Blatcherism) has been a startling increase in the incidence of mental illness in both children and adults since the 1970s.

It's not Moynihan that's doing the analysis, it's James' analysis that's found wanting. Moynihan is merely throwing the most obvious wrenches into the works.

James has made so many bogus assertions, that one doesn't even know where to start, especially with... excuse me... retarded statements like this:

Selfish Capitalism, much more than genes, is extremely bad for your mental health. But why is it so toxic?

To sniff at comments Moynihan makes as poor analysis is an almost willful disregard of the retarded cousin sitting the living room whose name is Oliver James.

|1.3.08 @ 7:00PM|#

"Add to this the astonishing fact that citizens of Selfish Capitalist, English-speaking nations (which tend to be one and the same)..."

Please. When did Britons start speaking English?

|1.3.08 @ 7:00PM|#

Just another lefty pinhead with no interest in the facts, here are some:
http://www.who.int/mental_health/prevention/suicide/suiciderates/en/

Paul|1.3.08 @ 7:03PM|#

Compare and contrast, term papers to be on my desk first thing:

Margaret Thatcher reinstated the rich's capital wealth after three postwar decades in which they had steadily become poorer.

with

In fact, there is an alternative. We desperately need - and before long, I predict we will get - a passionate, charismatic, probably female leader who advocates the Unselfish Capitalism of our neighbours.

|1.3.08 @ 7:08PM|#

Over-educated nitwits have always romanticised the 'simpler' past - that's where the whole 'noble savage' thing a couple of centuries back came from, I believe. Being over-educated about the past usually cures that particular form of idiocy, so I wonder what the Social Anthropology curriculum at Cambridge covered...

|1.3.08 @ 7:11PM|#

joe-
I agree that Moynihan and KMW are the two Reason regulars that fail to impress me the most. I think most of it has to do with the fact that they, unlike Sullum (public health), Balko (crj issues), etc. who have an area they specialize in and have become experts, MM and KMW just shoot the breeze about whatever silly liberal practice fits their fancy.

"comparing levels of mental illness between different cultures is impossible, because the definitions vary tremendously"
I'm not so sure, at least not so sure this is "necessarily" so. Doctors have a set of phenomena they use as indicators of depression (sleeplessness, weight loss/gain, etc) that are not necessarily culture specific I should think. One can then imagine surveys measuring the self-reported or diagnosed amounts of these indicators.

"Affluence doesn't make people unhappy. People are always unhappy. Affluence just makes it possible for more people to bitch and complain in a way that we are forced to hear."

I agree fluffy. In Stardust Memories Woody Allen talks about how poor people, like in the BiCycle Theif, have to worry that they will be unable to feed themselves and family if they lose their bicycle, but that more affluent people, safe from such dangers, just make up other neurotic things to worry about (am I really happy? Is my marriage all that it can be? etc). However, depression properly understood is more than just being unhappy and bitchy.

"But actually, as bad as alcoholism was in pre-Communist Russia, it went off the charts in the 70s and 80s near the end of the Soviet era." Cesar, do you have any reference for such a claim? I can swear my old Russians Studies prof told me a few years ago that alcoholism rates were as high under Free Market Yeltsin as under the USSR...I'd also point out that the USSR was hardly egalatarian, that was just its rhetoric, so if the authors point is that inequality=mental illness pointing to the USSR does not refute it (of course if his argument is "commercialization" or what Marx would have called "commodification" then the USSR would be appropriate).

|1.3.08 @ 7:14PM|#

Paul-I think you miss the point that James stress is on this part of the sentence:

"who advocates the Unselfish Capitalism of our neighbours."

It's THIS that he contrasts with Thatcher.

Let's try to be fair when we critique an essay class (though I realize MM is a poor example of this).

|1.3.08 @ 7:18PM|#

Cesar, do you have any reference for such a claim? I can swear my old Russians Studies prof told me a few years ago that alcoholism rates were as high under Free Market Yeltsin as under the USSR

No reference, just what was told to me by my Russian history professor in college. I didn't hear anything about Yelstin, just that alcoholism was much higher in the 70s and 80s than previous times in Russian/Soviet history for the reasons stated (no consumer goods to spend money on combined with over-inflated salaries, short work days due to shortages).

|1.3.08 @ 7:23PM|#

BTW-Cesar, glad to see you back. I've only been visiting the site sporadically for the past week or two and had not seen you on any threads when I did.

Paul|1.3.08 @ 7:27PM|#

Mr. Nice Guy

You're whistling past the graveyard. James made a rather base, dim-witted hat-tip to old-school feminism in his statement. You know it, I know it, James knows it.

He's making an off-the-cuff commentary about how women are naturally more compassionate than men are, and are best equipped to advocate this "Unselfish Capitalism".

The only other possibility is that he's making a direct reference to the liklihood of a HRC presidency. But if he is, you'd have to admit that's a very, very odd way of putting it.

|1.3.08 @ 7:29PM|#

The USSR couldn't subjugate the world and make it into a workers' paradise, so the the CFR, Bilderburgers, the Illuminati, the trans national corporations and the Trilateralists will give us the new world order.

Hoping for Corporations or the State to care about the individual is pissing into the wind. Either way, the average guy is screwed.

|1.3.08 @ 7:29PM|#

If you look at the countries with high suicide rates, they tend to be clustered in high northern countries, with long cold winters with little daylight. I used to live in Seattle, and by January or so I'd have a mild case of Seasonal Affective Disorder. Moved to Hawaii, cleared that right up.

Another factor that may be at play is that countries settled by prisoners and other dregs of their host society (U.S., Australia), may have a slightly higher incidence of craziness or quirkiness or the inability to fit in because that's what landed their ancestors here in the first place. Be interesting to see what percentage of libertarians there are in such places than in the home country, since you have to be a bit of a rebel to be such a prominent minority holding views completely at odds with the rest of society.

|1.3.08 @ 7:33PM|#

Prediction:

If single payer health care is insituted in the US, wealthy people will be able to opt out, creating a 'separate but unequal' system of health care.

Neu Mejican|1.3.08 @ 7:34PM|#

Mr. Nice Guy,

unlike Sullum (public health)... who have an area they specialize in and have become experts,

Sullum....expert...specialize....

Damn, I spit my milk all over the screen.

Sullum.

Expert.

Funny stuff.

"comparing levels of mental illness between different cultures is impossible, because the definitions vary tremendously"

http://www.who.int/topics/mental_health/en/
http://www.who.int/classifications/icd/en/GRNBOOK.pdf

Not as much of a problem as in the past.
Also see the ICF
http://www.who.int/classifications/icf/site/icftemplate.cfm

If ever there was an argument for a government funded safety net, it is mental illness.

|1.3.08 @ 7:34PM|#

"He's making an off-the-cuff commentary about how women are naturally more compassionate than men are, and are best equipped to advocate this "Unselfish Capitalism"."

He very well may have just meant that women are more likely than men to have such an orientation. I'm not sure he's wrong about that (i.e. the "gender gap" in our politics). Just because you find it to be the case that women more than men have such a view does not mean you are asserting they are "better equipped" to do so.

Though I can think of many ways that women are better equipped than men, but that just might be me ;).

|1.3.08 @ 7:35PM|#

NM-Was their somebody posting under your name here a few days ago?

Well, what I mean is that Sullum at least concentrates on an area. I think he's pretty well informed in that area even if I don't think he is right on everything.

|1.3.08 @ 7:44PM|#

"Unselfish Capitalism"

Congress will use this term like a doorknob, into our wallets.

MattXIV|1.3.08 @ 8:03PM|#

Sigh. Anybody who handwaves away differences in mental health incidence reporting doesn't really deserve a serious response, but...

In terms of suicide, a pretty good indicator since it isn't sensitive to differences in diagnositic criteria, should have more reliable reporting, and it or its attempt is a clear indicator for depression, the US is at 45, beating out almost all of Western and Northern Europe (interestingly, the UK is one of the countries that beats out the US).

So unless the US and the UK are excellent at treating clinical depression relative to France, Finland, and Belgium, we may infer that depression is either substantially less frequent or substantially less traumatic in the US and UK than in many of the continental European countries he cites. And to the extent that policy impacts suicide rates outside of incidence of mental illness, the US would expect to be higher (limited public mental health services, easy access to firearms, limited financial "safety net").

It's also worth noting that susceptibilities to many mental illnesses are highly heritable, including depression and anxiety disorders, which are the most prevalent conditions, and schizophrenia.

Affluent American|1.3.08 @ 8:14PM|#

Yeah, I was soooooo much happier when I was making $30,000 a year.

What a steaming pile of horseshit.

Neu Mejican|1.3.08 @ 8:39PM|#

Mr. Nice Guy,

Yes, there was someone posting anti-semitic and racist comments under my name while I was away on holiday.

Odd.

Sullum at least concentrates on an area. I think he's pretty well informed in that area

It is true that Sullum concentrates on a single area, but I am always amazed at how uninformed and misguided his posts are.

I would be comfortable calling him a political pundit with an area of interest...but expert? I don't think so.

|1.3.08 @ 10:17PM|#

which, he argues, is making us flat-screen television-obsessed Westerners

Man I wish I had one of those...

I have one but I'm bored with everything offered on the 300 odd channels.

Gilbert Martin|1.3.08 @ 10:51PM|#

Jame's labeling of european style socialist, watered down capitalism as "unselfish" is absurd to begin with.

The is nothing unselfish about people thinking they are "entitled" to all sorts of material goods and services whether they can pay for them or not. There is also nothing unselfish about volunteering other people's money to pay for these things.

|1.4.08 @ 12:08PM|#

Why is inequality within a nation supposed to be so damaging while inequality between nations not so much?


If I'm supposedly unhappy because of constant efforts to keep up with the Joneses, then why aren't the poorest Mexicans absolutely suicidal?

R C Dean|1.4.08 @ 12:27PM|#

If I understand the author's argument correctly, it is not the natural competition that is the problem, but the amplification of competition in "Selfish Capitalist" countries.

Naturally, none of this is quantifiable, but . . .

I tend to think that the most savage competition occurs, not around economics, but around social status. The most consuming, cut-throat conflict cultures I have seen are in non-profit settings - government, academia, and the church. I think this has something to do with the way economics is not a zero-sum game, but status is.

I would also say that the general level of anomie and unhappiness tends to be higher in these non-profit settings, even though they generally have good job (and therefor economic) security.

All very impressionistic, but when thinking about competition, I wouldn't assume that it is all, or even predominantly, about money and things.

|1.4.08 @ 2:36PM|#

It is slightly encouraging that even most of the Inner Party Guardianistas commenting on this article also seem to feel that he is full of beans. They also point out that he plugs his book on "Selfish Capitalism" in the first paragraph, thus adding to our burden of madness.