What Kind of Future?

What are the future needs of mental health in this country?  Many mental health workers worry daily about their jobs.   Will they be replaced by smart cognitive behavioral programs delivered over the net?

Will insurance companies pay for what’s coming? Below are a series of factors that will potentially produce a booming national need for mental health services:

1. The 24-7 Society.  As people work endless hours, abetted by machines, they begin to act like machines.  From low skilled workers performing three part time jobs to Silicon Valley digerati yearning but unable to use the nap rooms on their campus, people now work night and day.

But disregard biological clocks and people experience more insomnia, leading to more depression; greater weight gain with its problems for cognition and overall health (see below); and increased irritability and family stress. Humans are built to sleep and night – and to rest.

2. Cellphones and the internet of things – cellphones are now “always on.”  Teenagers who require  9 hours of sleep to learn get 6 or 7; workers become used to constant interruptions, which recent studies argue decrease overall attention and productivity.  With innumerable devices interconnected all the time – from watches to refrigerators to running shoes – constant interruptions may strongly affect personal relationships, sleep time, and general capacities to attend, think and create.  And that’s before people realize how insecure the security systems are for most devices – something that may provoke anxiety everywhere.

3.Social Media – The “sharing and caring” economy may not create the increased social connectedness promised; more people are complaining of loneliness than before.  And with everyone in social media potentially  an actor in their own drama – which they can easily and continually place online – the effects on personality may prove profound.  A recent study described in the Economist noted over half of high school seniors feel they would merit a biographer.  Christopher Lasch’s “Culture of Narcissism” appeared in 1979.  What will the future bring?

4. Obesity – Now it’s clear large waistlines mean earlier and more profound cognitive impairment; not a good prospect with society facing an epidemic of Alzheimer’s and vascular dementia.  Effects of obesity on overall inflammation also do note bode well for future health, and certainly not mental health.  About 2/3 of American adults are now considered overweight.

5. Diabetes – Glucose intolerance is a scourge, its effects on mental health very negative.  Greater rates of depression, dementia and sleep disorders among diabetics will produce many psychological effects – without considering the large impacts on families and the workplace.

6. Video Games and Virtual Reality –  Like artificial intelligence, the advance of VR (virtual reality) is often announced prematurely. But the software/hardware is improving. Already many adolescents and adults find themselves addicted to Internet porn. So what happens when virtual reality experiences are not just more entertaining – but more engaging –  than everyday reality?  Robotic sex dolls are already in the works.  What will happen when the virtual “feels” better than the real – and people don’t want to go back?

7. Designer Drugs – the effect of legalized marijuana remains to be seen on accident rates, mood and anxiety disorder incidence.  However, the rise of automated laboratories, 3-D printing, and easily available “recipes” for drug cocktails argues that for a long time the human nervous system will be bombarded by drugs it has never seen before – and which will appear well before researchers and pharmacists know what they are and do.  What might happen if new, cheap euphorigens are found more varied and powerful than amphetamines?  How many synthetic cannabinoids are possible?

8. Economic dislocation – not much of the world is doing well economically right now.  Recessions increase depression rates.  What happens when more manufacturing and service jobs are replaced by robots, and the social dislocations of rapidly changing work environments find governments fiscally and managerially unable to respond?  Major Depression already has a strong relationship with poverty and unemployment.

The Waves of the Sea

Things always change, and will.  That’s how biology works – continually creating work arounds to deal with changing environments.  Humans generally adapt, and adapt well.

But new problems will arise.  Mental health disorder rates may rise with them.  In preventing – and combating them – two principles should be considered:  how important health and well-being are to the political, social, and economic life of societies; and what the human body is actually built to do.

Hopefully the debates will not be about only how much money will be spent on psychiatric and psychological services, but on how the health of all its people is necessary to societal survival.  That’s what the public health is ultimately about – and mental health is a big part of it.