Thanks to Graham Davey and Richard Pemberton on Twitter for the link to an interesting article in the August 29, 2013 issue of the Lancet. It’s titled Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010, and was written by Harvey A. Whiteford, et al.
The Global Burden of Disease survey is a systematic, scientific attempt to quantify the comparative magnitude of disease, injuries, and risk factors by age, sex, and geography over time.
The work is coordinated by the Institute of Health Metrics and Evaluation at the University of Washington, and is funded largely by the Bill and Melinda Gates Foundation.
The work is carried out by various universities and by the World Health Organization (WHO).
The Lancet article focuses on the global burden of disease attributable to mental and substance use disorders in 2010.
The survey uses three basic measures to quantify disease burden:
-years of life lost to premature mortality (YLLs)
-years lived with disability (YLDs)
-disability-adjusted life years (DALYs’ equals YLL plus YLD)
FINDINGS
The 2010 survey findings are presented in the follow table:
| Proportion of Total DALYs 95% UI | Proportion of total YLDs 95% UI | Proportion of YLLs 95% UI | |
|---|---|---|---|
| Cardio, circulatory diseases | 11.9% (11.0-12.6) | 2.8% (2.4-3.4) | 15.9% (15.0-16.8) |
| Diarrhoea, lower respir. infections, meningitis, other infectious diseases | 11.4% (10-3-12.7) | 2.6% (2.0-3.2) | 15.4% (14.0-17.1) |
| Neonatal disorders | 8.1% (7.3-9.0) | 1.2% (1.0-1.5) | 11.2% (10.2-12.4) |
| Cancer | 7.6% (7.0-8.2) | 0.6% (0.5-0.7) | 10.7% (10.0-11.4) |
| Mental, substance use disorders | 7.4% (6.2-8.6) | 22.9% (18.6-27.2) | 0.5% (0.4-0.7) |
| Musculoskeletal | 6.8% (5.4-8.2) | 21.3% (17.7-24.9) | 0.2% (0.2-0.3) |
| HIV/AIDS, tuberculosis | 5.3% (4.8-5.7) | 1.4% (1.0-1.9) | 7.0% (6.4-7.5) |
| Other non-communicable diseases | 5.1% (4.1-6.6) | 11.1.% (8.2-15.2) | 2.4% (2.0-2.8) |
| Diabetes, urogenital, blood, endocrine diseases | 4.9% (4.4-5.5) | 7.3% (6.1-8.7) | 3.8% (3.4-4.3) |
| Unintential injuries other than transport injuries | 4.8% (4.4-5.3) | 3.4% (2.5-4.4) | 5.5% (4.9-5.9) |
As can be seen, mental and substance use disorders account for 7.4% of all DALYs worldwide, and 22.9% of total YLDs. They are in fact the leading cause of YLDs. The YLL for this category is only 0.5%. The authors attribute this to the fact that deaths in this population are usually coded to the specific physical cause of death.
DISCUSSION
This is an impressive paper, and it is obvious that the survey was comprehensive, and cost a great deal in terms of money and other resources. I would guess that the survey is as accurate and reliable as something of this magnitude can be.
There are two problems, however. Firstly, the mental and substance use disorders listed in the DSM are not illnesses in any meaningful sense of the term. They are indeed problems, and sometimes very serious problems, but the notion that they are illnesses is an assumption widely promoted by psychiatry and by their pharmaceutical allies. The fact that these problems are listed in the survey side by side with real illnesses like HIV/AIDS, tuberculosis, diabetes, etc., is a tribute to the efficiency of the psychiatry and pharmaceutical propaganda machine, but this doesn’t make the notion true. One can say that geese are swans for a hundred years, but geese will still be geese. As the spurious medicalization of all human problems expands, so the global burden of these “illnesses” will expand.
The second problem is more subtle. In the table shown earlier, it is clear that the problems labeled mental and substance disorders have relatively little impact in the category years of life lost, but a very high impact in the category of years lived with disability. In fact, in the latter category, it is the highest item.
On first sight, this might seem quite significant, and a casual reader might conclude that mental and substance disorders are very disabling. However, the DSM criteria for specific disorders routinely include the requirement: “The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.” “Social” and “other” areas of functioning are difficult to assess in a psychiatric interview, and so this requirement is usually met by noting that the person has been missing work. And, or course, years lost to disability is assessed by substantially the same metric – days missed from work.
So when the Global Burden of Disease survey “discovers” that people with “Mental and substance disorders” score high on years lost to disability, all they’ve really “discovered” is that people who are missing work a lot are missing work a lot.
Psychiatry is riddled with this kind of tautological nonsense.
IMPLICATIONS
The implications of the survey’s findings are grave. Firstly, the survey endorses the spurious notion that “mental illnesses” have the same kind of ontological reality as real illnesses. Secondly, they establish the “fact” that these illnesses have a high prevalence rate and a high disability impact. Thirdly – and most importantly – the survey will result in increasing levels of funding being channeled into the “treatment” of these fictitious illnesses. And “treatment” means drugs. So more validation and more profits for pharma, and more destructive side effects for the victims of this worldwide scam.
Psychiatry is like a virus – a virus that has truly gone global.