Reality of mental health

Edition 28 December 2017, by Johannes Visser

One in four people in the Netherlands suffers from a brain disorder. To combat this ‘epidemic’, about 25 billion euro a year is spent on mental health, more than a quarter of all healthcare spending. Of all deaths in the Netherlands, one in five results from the patient having a brain disorder. These are the conclusions of a large scientific study done by the National Institute for Public Health (RIVM), commissioned by the Dutch Brain Foundation. According to the study, in 2016 about 3.8 million Dutch citizens were registered at their general practitioner (GP) as having a brain disorder.

These are the conclusions of a large scientific study done by the National Institute for Public Health (RIVM), commissioned by the Dutch Brain Foundation. According to the study, in 2016 about 3.8 million Dutch citizens were registered at their general practitioner (GP) as having a brain disorder. Its researchers concede that the real number of cases is probably much higher, because not everybody suffering from mental challenges seeks out medical assistance, and those who do may go to specialized care directly, skipping their GP altogether and so remain unregistered. Another reason for the likely underrepresentation of mental health cases is that not all GPs recognize and diagnose the symptoms of brain disorders, like feelings of depression, but instead remain focused on the physical symptoms.

According to the study, basically every single person in The Netherlands will know somebody suffering from a brain defect, apparent or not. Of the 3.8 million registered cases last year 2.1 million are women and 1.7 million men. This large cap is explained by the fact that women generally live longer lives. Of those dying because of a brain disorder, women die more often than men from a chronic disorder whereas men often suffer from a psychological disorder or sleep deprivation as the main causes. Disorders of various kinds With a total of 1.9 million patients in 2016, psychological and psychiatric disorders make up the largest number of cases in The Netherlands, consisting of personality disorders like anxiety, panic disorders and depression. The second most occurring category, with a total of 1.3 million cases, are the so-called chronic brain disorders that formed gradually in life, such as dementia, Parkinson’s disease or epilepsy. Acquired brain injuries such as a stroke or traumatic brain injury resulting from an accident or assault account for 644,000 people. About half a million people suffer from sleep disorders like insomnia and sleep apnea and lastly, there are about a hundred thousand cases of brain disorders that are expressed in the first year of life, such as an intellectual disability or abnormalities in the central nervous system. Explaining the high prevalence of psychological disorders, the national study says most are accounted for by mood disorders like depression or bipolar disorders, anxiety, alcohol and drug dependency, ADHD and the very controversial (and not universally accepted) ‘behavioral disorders’. Women usually outnumber men in anxiety disorders and men are overrepresented in alcohol abuse. Other prevalent diseases included in the study -either inborn or acquired throughout life- are Down syndrome, Parkinson’s disease, chronic migraine, emotional exhaustion and burn-out, posttraumatic stress disorder (PTSD) and schizophrenia.

Big business

Government expenditure as well as insurance payments for treating brain disorders mostly go into the Dutch Association of Mental Health and Addiction Care (ggz) or revalidation after brain trauma. Of the 25 billion euro that is spent on mental health care every year, the biggest portion consisting of more than eight billion goes to the smallest group (100.000) of those suffering from brain disorders expressed in the first year of life, mostly boys and men. Another almost eight billion euro goes to the largest group consisting of psychological and psychiatric cases, where young people are overrepresented. The elderly and women account for the highest mental care spending with regard to chronic brain disorders, mainly because of dementia. For sleep disorders there is no cost data available due to a lack of research in this area.

The main issue arising from the study is whether the claim of one in four suffering from a brain disorder is either overblown or is actually only the tip of the iceberg. For a lack of scientific consensus on mental health definitions, the question remains: What really is a brain disorder? According to the study, pretty much everything. Whether it’s about having trouble falling asleep, stuttering, headaches or one’s tendency to reach for a beer during breakfast, these are all considered problems of the mind and thus of the brain. No official and/or internationally accepted definitions or guidelines clarify what could be considered a brain defect and what not. A number of Dutch mental health experts have balked at the outcomes of the RIVM study. Said André Aleman of the Rijksuniversiteit Groningen to newspaper Trouw: “if someone becomes depressed for a few weeks after losing a loved one or having a burnout at work, to me that is not a brain disorder. Perhaps we should focus only on the chronic disorders, where we see a clear cause and correlation with the brain.” By contrast, brain research pioneer and writer of the book ‘We are our brain’ Dick Swaab, does heartily agree with the study’s broad definitions, stating that: “the real cause of every single psychological disorder is a vulnerability in the brain, which has been inherited or develops early on in life. And that is a disease of the mind.”

The future

And so, the controversies remain. If it happens to be that there is something wrong with one in every four Dutch persons, if not more, then what is the real cause behind all of this? If one applies the all-encompassing definition of what a brain defect is, including psychological ‘deviations from the norm’, and so many people seem to fall into this category, then perhaps there is something wrong with what is considered normal. Stated differently: maybe it’s not the patient who’s insane, but the doctor and the system he represents. Setting aside all mental problems resulting from chemical imbalances in the brain or other inherent defects in the body, it seems that most of the other two million Dutch ‘patients’ suffer from causes that reside outside of themselves and beyond their influence. Unrealistic expectations from parents, co-workers and the significant other; painful life events; a dominant culture that promotes all kinds of unhealthy tendencies and a general undercurrent of unease about one’s life and future can all result in a brain overloaded and unable to cope.