Is Society or Psychiatry to Blame for the 'Seriously Mentally Ill' Dying 25 Years Prematurely?

“Adults in the U.S. living with serious mental illness die on average 25 years earlier than others, largely due to treatable medical conditions,” according to the National Alliance on Mental Illness. This is not controversial, as establishment psychiatry and its critics agree.

What is controversial is who is to blame—society, psychiatry, or the victims themselves? And what is too taboo for the mainstream media to even discuss is whether many of us, privately, don’t care—or may even want this population to disappear.

If we could admit that our society’s entire way of thinking about people diagnosed with “serious mental illness” has failed, we might become curious about other societies that view this population very differently—and have gotten very different results.

Who Is to Blame?

In 2011, the director of the National Institute of Mental Health (NIMH) reported that still another major study found, on average, Americans with major mental illness die 14 to 32 years earlier than the general population, and he then attempted to explain it: 

Disorders such as schizophrenia, major depression, and bipolar disorder are risk factors for suicide, but most people with SMI [serious mental illness] do not die by suicide. Rather, the 5 percent of Americans who have SMI die of the same things that the rest of the population experiences—cancer, heart disease, stroke, pulmonary disease, and diabetes. They are more likely to suffer chronic diseases associated with addiction (especially nicotine), obesity (sometimes associated with antipsychotic medication), and poverty (with its attendant poor nutrition and health care) and they may suffer the adverse health consequences earlier.

Antipsychotic medications’ association with obesity, as noted by the NIMH director, is part of the explanation for premature deaths; and according to the American Family Physician, antipsychotic drugs’ “life-shortening adverse effects” include diabetes, postural hypotension (especially deadly for patients with fall risk), cardiac arrhythmia, and sudden cardiac death. 

Psychiatrist Grace Jackson, critic of her profession and author of Rethinking Psychiatric Drugs, believes that establishment psychiatry minimizes the deadly effects of antipsychotic drugs. Jackson observes, “From the perspective of a physician, I agree that the causes of ill health are multifactorial and include poverty, poor diet, and homelessness, but even with proper diet, safe lodging, loving friends, and meaningful employment, psychiatric drugs end lives prematurely. It would be a tremendous disservice to patients to ignore the toxic effects of these drugs.”

The NIMH director also lists cigarette smoking as a major cause of premature death, noting, “People with a mental illness are more than twice as likely to smoke cigarettes.” However, blaming patients’ irresponsible cigarette smoking is an unfair “blaming the victim,” as antipsychotic drugs actually increase the desire for nicotine.

Specifically, a 2009 report, “Smoking and Schizophrenia,” states that, “Smoking may be an attempt by schizophrenic patients to alleviate cognitive deficits and to reduce extrapyramidal side-effects induced by antipsychotic medication.” Cigarette smoking enhances dopaminergic activity, which is especially craved by people using dopamine-diminishing antipsychotic drugs. According to the report, cigarette smoking can increase the clearance of antipsychotic drugs, and thus may be a way for antipsychotic drug users to lessen the adverse effects of these drugs. 

Antipsychotic drugs are the primary—and routinely the only—treatment by establishment psychiatry for people diagnosed with schizophrenia and other serious mental illnesses. However, in addition to these drugs’ direct deadly adverse effects as well as increasing the desire for cigarettes, psychiatry’s primary treatment also contributes to the premature death rate because of its general ineffectiveness resulting in financial poverty.

Investigative reporter Robert Whitaker in “The Case Against Antipsychotics: A Review of Their Long-Term Effects” offers extensive research to back up his conclusion that: “Antipsychotics, on the whole, worsen long-term outcomes.” While for some individuals, Whitaker notes, these drugs may provide a short-term benefit, there is a long line of research showing that antipsychotic drugs, as he states, “Impair functioning over the long-term.”

Impairing functioning over the long-term is obviously going to result in increased unemployment and poverty. And poverty, caused by any means, is well established as being associated with premature death.

The stigma of mental illness can result in unemployment, poverty, social isolation and also “diagnostic overshadowing”—a stigmatization in medical care in which the physical symptoms of people diagnosed with serious mental illness are falsely attributed to mental illness, resulting in not receiving treatment for very real medical conditions—another cause of premature death.

While establishment psychiatry rails against the stigma of mental illness, they have actually exacerbated it through their “brain disease” explanations. In “Myth: Reframing Mental Illness as a ‘Brain Disease’ Reduces Stigma, the Canadian Health Services Research Foundation (CHSRF),” reported in 2012:“Despite good intentions, evidence actually shows that anti-stigma campaigns emphasizing the biological nature of mental illness have not been effective, and have often made the problem worse.” A 2010 study in Psychiatry Research reported that for the general public, the acceptance of the brain disease or “biogenetic model” of mental illness was associated with a desire for a greater social distance from the mentally ill.

The CHSRF concludes, “Biological explanations can also instill an ‘us vs. them’ attitude, defining individuals with mental illness as fundamentally different.” Especially maddening, psychiatry’s highly promulgated biological explanation of the “biochemical brain imbalance theory of mental illness” has long been scientifically disproven—this recently announced even by establishment psychiatry.

Alternately, the CHSRF concludes, “Presenting mental illness in the context of . . . psychological and social stressors normalizes symptoms, creating a healthier public perception of mental illness.” Trauma is the psychological-social stressor that is likely the most critical variable (see articles: Trauma and Psychosis; Trauma, Psychosis, and Dissociation; and Childhood Trauma and Psychosis—What is the Evidence?).

Even more helpful in reducing the stigma of “serious mental illness” is eliminating this term “serious mental illness,” and instead using terms such as “altered state” or “extreme emotional state.” While these states can be frightening for society, family, and those experiencing them, depathologizing these states is one of the best ways to eliminate stigma. Depathologizing these altered and extreme emotional states, debunking brain-disease reductionism, and advocating for psychological-social approaches are among the goals of organizations such as the International Society for Ethical Psychology and Psychiatry; the National Empowerment Center; and MindFreedom.

So Why Do We Allow Psychiatry to Stay in Charge?

Given the horrific premature death rate and research such as a 2003 study in Psychiatry Research that reported: "On long-term prospective evaluation, risk for death in schizophrenia was doubled on a background of enduring engagement in psychiatric care,” the question is: Why do we allow psychiatry to stay in charge? 

It’s difficult to imagine society allowing an authority with such horrible results to stay in charge of a population that a society actually cared about. Would professional sports team owners allow orthopedic surgeons to remain in charge of treating their injured star players if these surgeons’ results consisted of, on average, increased impaired functioning and premature death? Team owners and fans care about these star athletes and would not accept the litany of excuses for failure that most of us accept from psychiatry.

So, why don’t enough of us care about the population diagnosed with serious mental illness?

One answer is that altered and extreme emotional states of people diagnosed with serious mental illness can create havoc for families and society within our economic system—an economic system that obliterates genuine community and creates extremely stressed families already struggling to find enough hours in the day to survive. And so families are vulnerable to resenting those in altered and extreme emotional states who need a great deal of attention, support, and time.

In many indigenous and tribal societies that have genuine community, people experiencing altered and extreme emotional states do not create havoc but are seen in a positive light. In Psychosis or Spiritual Awakening, filmmaker and photographer Phil Borges, who has been documenting indigenous and tribal cultures for over 25 years, investigated 40 shamans from all over the world. He observes that shamans in a community are routinely identified with “the call” going through a psychological crisis in their teens when they hear voices, have hallucinations, and exhibit other behaviors that are seen by psychiatrists in our society as “symptoms” of psychosis. In contrast to our society, in many indigenous and tribal societies, people who experience these altered states are viewed as “having a gift” and a “talent,” and so their behavior is seen positively. Instead of working with a psychiatrist and being viewed as mentally ill, they work with a mentor who has similarly experienced such a state and who is in the best positon to reduce anxiety and fine-tune their gift to be helpful to the community.

The late ethnobotanist Terence McKenna, who also studied indigenous and tribal societies, concluded similarly with Borges: 

In a traditional society, if you exhibited “schizophrenic” tendencies, you are immediately drawn out of the pack and put under the care and tutelage of master shamans. You are told: “You are special. Your abilities are very central to the health of our society. You will cure. You will prophesy. You will guide our society in its most fundamental decisions.” Contrast this with what a person exhibiting schizophrenic activity in our society is told. They’re told: “You don’t fit in. You are becoming a problem. You don’t pull your own weight. You are not of equal worth to the rest of us. You are sick. You have to go to the hospital. You have to be locked up.” You are on a par with prisoners and lost dogs in our society. So that treatment of schizophrenia makes it incurable.

Prior to modernity and not just in indigenous cultures and tribal society, when people experienced altered or extreme emotional states—such as being seriously suicidal—there was a very different reaction than the one of our current society. Abraham Lincoln biographer Joshua Wolf Shenk, in Lincoln’s Melancholy, recounts Lincoln’s friends’ “suicide watch” over him; and Shenk describes how Lincoln’s extreme dark emotional states “seemed not a matter of shame but an intriguing aspect of his character, and indeed an aspect of his grand nature,” which rather than stigmatizing Lincoln actually drew people toward him.

The key to a community truly helping people experiencing altered and extreme emotional states is for that community to believe that these states have meaning and value for the community. Once a society diseases and pathologizes these states as mere “illness” and “defect” without meaning or value, those people experiencing these states are seen as burdens on society. 

When people get treated as unwelcome burdens, they can become angry and agitated or, depending on their temperament, become passively dysfunctional. 

The more a society demands machine-like efficiency and productivity, the more people experiencing altered and extreme emotional states are seen as monkey-wrenches and burdens. When a society becomes so fanatical about machine-like efficiency and productivity that ethical injunctions against murder are thrown out the window, societies like Nazi Germany emerge.

In Nazi Germany’s T4 Program, involving virtually all of German psychiatry, Hitler created a mandate to kill anyone deemed to have a “life unworthy of living,” which certainly included people diagnosed with serious mental illness. Lack of economic productivity was the major criterion for inclusion in T4, and the Nazis referred to the program’s victims as having “burdensome lives.” 

To be clear, modern American society is not Nazi-German society, as it would be taboo in present American society to actually euthanize those diagnosed with serious mental illness. But in the United States in the earlier part of the twentieth century, there was widespread compulsory sterilization of those diagnosed with serious mental illness; and in current American society, apparently it is acceptable for this population to die, on average, 25 years prematurely without seriously challenging the authorities in charge of treating them.

Among societies that prioritize economic efficiency and productivity over life and all of life’s varieties, there are certainly differences in how they treat those who experience altered and extreme emotional states; but are these difference really a “difference of kind” or merely a “difference of degree”?

In any society that prioritizes economic efficiency and productivity over all else, people in altered and extreme emotional states will be seen as burdens, without meaning or value. And while such a society might have a taboo against euthanizing this population, most of that society’s members will not care enough to seriously challenge the authority in charge of treating this population despite that authority having a record of dismal failure.