When I read about the recent government-sponsored study of mental illness, I wasn't surprised. It indicates that half of all Americans will, at some point in their lives, meet the criteria for mental illness (which includes substance abuse), and that those problems are starting at younger ages. I'm well aware of the argument that these rates must be exaggerated, but as a clinical psychologist, there is no doubt in my mind that there has been a real increase in the number of mood and anxiety disorders during the 20-plus years I have been in practice.
I believe I know one reason. As I listen to my patients and to the stories other therapists tell, it is clear that technological change -- the blessing and curse of our era -- has led many of us to tax the human body and psyche in ways that our species has not had time to accommodate. Not only do adults, adolescents and even little kids have so much activity crammed into the course of a day that it's tiring just to hear them talk, but each generation is experiencing the world quite differently from their parents and grandparents.
The scale of that change came home to me last week, when Jack Kilby, inventor of the microchip, died. Putting his achievements into perspective, the chairman of Texas Instruments said that "there are only a handful of people whose works have truly transformed the world and the way we live in it -- Henry Ford, Thomas Edison, the Wright brothers, and Jack Kilby."
Just think about that statement. Those men's innovations "transformed the world and the way we live in it." It's as if we have forgotten the lesson that Charles Darwin taught us: Evolution and biological adaptation take time, usually long periods of time. Yet people seem to assume that we can keep the pace the machine has set. (Remember Charlie Chaplin going round and round, caught in the gears of a giant machine, in his satire "Modern Times"?) Many of the patients I see reveal just how much we've overestimated our flexibility and underestimated the price we pay for how we live in these modern times.
Ever since the first electric bulb shed artificial light, we have been detaching ourselves from our natural rhythms. Business travelers cross time zones and go right back to work; adults extend their hours by bringing work home with them; teenagers contact their friends anywhere at any time of the day or night. Until, that is, they end up in therapists' offices having been stopped in their tracks by physical or psychological dysfunction. Many blame themselves when things go wrong. They minimize the impact of our super-charged environment on their psychological well-being.
It's hard to believe that not long ago, most people actually went to bed when the sun went down and got up when the sun came up. They were born, lived and died within short distances of their childhood homes. They communicated face to face most of the time, or else by letter or telegram. They gathered frequently at home, in places of worship and in civic organizations.
Even the movers and shakers kept to a saner schedule. In her book "No Ordinary Time," historian Doris Kearns Goodwin describes President Franklin D. Roosevelt's daily schedule. It included eight hours of sleep a night, and an evening cocktail hour when he gathered with friends to talk, laugh and relieve the pressures of the day. President Bush was the butt of his wife's jokes for keeping a similar schedule. Neither exemplified the lives described by many of my patients who work in government, law firms, medical practices and businesses in the D.C. area. With longer work weeks and commutes, they have fewer of the quiet restorative moments that nature requires to recharge and renew.
From depressed patients, therapists frequently hear about symptoms that psychiatrists term "vegetative." These concern the most basic biological functions, including sleep; appetite, for food as well as sex; and enjoyment. My children's babysitter, just back from a two-week vacation, once described her own restoration succinctly: "I feel good in my body." Too many people today do not know what it means to feel good in their bodies.
Part of the problem is simply lack of sleep. I sometimes fantasize that if I had a magic wand and could ensure that everyone would sleep eight hours a night, visits to therapists would drop by, perhaps, a quarter. Sleep -- particularly REM sleep and dreaming -- helps discharge tensions, restore energy and rebuild a foundation for stable functioning. I heard a lecture during my student days in which a psychiatrist said, "It is unclear whether depression is primarily a disorder of mood, or primarily a disorder of sleep." People who are sleep-deprived for any length of time are out of whack. Once sleep is seriously disordered, it can be difficult to restore the normal circadian rhythm essential to well-being.
I can think of a successful young couple with demanding jobs who found out the hard way. They fully expected to take the demands of children in stride, as well as a move to a new home. In time, the wife developed major depression with serious sleep disruption when child-care problems became for her the proverbial last straw. Only then did they wake up to the forced march their lives had become.
Another modern problem is when people sleep. Early to bed and early to rise really is a good idea, because it maximizes light exposure, which in turn boosts mood. Factories have largely stopped scheduling shifts with employees working days, then afternoons, and then nights at two-week or monthly intervals, because of the resulting physical and psychological strain.
Every summer, I talk with the mood-disordered teenagers who are heading off to college about trying to go to bed early and get up early as a hedge against depression. Students on so-called "college time" are without a doubt the most intransigent group when it comes to decent sleep habits. (My oldest child, newly home from college one summer, asked her father and me why we were going to bed so early -- at midnight.)
A healthy appetite is a sign of a healthy animal. For an increasing numbers of Americans, appetite disturbance takes the form of eating too much or too little. And how many people take time to eat lunch away from their desk, with another human being? Much less away from the office, at a restaurant or at home? My now 88-year-old father was busy during his middle years running a lumber business, but he always found time to go to the little deli nearby for lunch, and to play golf.
Another casualty of turbo-charged lifestyles is sex. There are surprising numbers of people, even in committed relationships, who report having sex infrequently. Lack of sexual desire is occurring at younger ages, sometimes in relationships that are otherwise sound, and it seems to be due to exhaustion. There is no cure except guarding time and energy. After all, sex is play. We all know how Jack became a dull boy!
Anxiety disorders, like depressive ones, are on the rise. (Interestingly, obsessive-compulsive disorder, considered by some psychiatrists to be heavily based in biology, is not increasing.) Noting the increase in the number of children being diagnosed with and treated for attention-deficit hyperactivity disorder, there are experts who believe that regular bombardment by electronic stimuli and the new habit of multi-tasking is fragmenting the attention spans of some kids who may already be at risk.
When teenagers say, "You don't understand," as teenagers have always said, they may be literally as well as figuratively accurate today. Those of us who grew up before instant messaging, for example, don't know what it's like to chat with friends or break up with a boyfriend online. This generation is also more deracinated than the last, having to devise a new set of cultural and social rules to fit new circumstances.
I don't mean to underestimate the benefits of technology: We can stay in touch with relatives and friends who live at a distance. We can get work done more efficiently. Huge amounts of information are at our fingertips. But the angst and dysfunction I've described are real. I can recall one family in need of time and togetherness who decided to take a hike in Great Falls Park, only to have the dad spend most of the time on his BlackBerry. The teenage son muttered under his breath, "Some togetherness."
It is the simple moments that bring our blood pressure down and our spirits up. I remember one workday when I had a killer headache, and a close friend called unexpectedly. We talked, we laughed, and in 10 minutes my headache was gone.
Are we destined to be the driven in our modern world, or can we become the drivers? What we often forget is that we can make deliberate decisions to improve the quality of our lives. The early-20th-century English writer G.K. Chesterton was probably right when he said, "New roads, new ruts." But we have more freedom than we realize to choose which ruts to avoid, given the changes that have already come and will keep coming in our high-tech world.
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Patricia Dalton is a clinical psychologist who practices in Washington.