Consider one oft-cited study, which implausibly claimed that every cohort from the GI Generation through the Baby Boomers was more depressed than the one before.63 The investigators reached that conclusion by asking people of different ages to recall times when they had been depressed. But that made the study a hostage to memory: the longer ago an episode took place, the less likely it is that a person will recall it, especially (as we saw in chapter 4) if the episode was unpleasant. That creates an illusion that recent periods and younger cohorts are more vulnerable to depression. Such a study is also hostage to mortality. As the decades pass, depressed people are more likely to die of suicide and other causes, so the old people who remain in a sample are the mentally healthier ones, making it seem as if everyone who was born long ago is mentally healthier.
Another distorter of history is a change in attitudes. Recent decades have seen outreach programs and media campaigns designed to increase awareness and decrease the stigma of depression. Drug companies have advertised a pharmacopoeia of antidepressants directly to consumers. Bureaucracies demand that people be diagnosed with some disorder before they can receive entitlements such as therapy, government services, and a right against discrimination. All these inducements could make people more likely to report that they are depressed.
At the same time, the mental health professions, and perhaps the culture at large, has been lowering the bar for what counts as a mental illness. The list of disorders in the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association tripled between 1952 and 1994, when it included almost three hundred disorders, including Avoidant Personality Disorder (which applies to many people who formerly were called shy), Caffeine Intoxication, and Female Sexual Dysfunction. The number of symptoms needed to justify a diagnosis has fallen, and the number of stressors that may be credited with triggering one has increased. As the psychologist Richard McNally has noted, “Civilians who underwent the terror of World War II, especially Nazi death factories . . . , would surely be puzzled to learn that having a wisdom tooth extracted, encountering obnoxious jokes at work, or giving birth to a healthy baby after an uncomplicated delivery can cause Post-Traumatic Stress Disorder.”64 By the same shift, the label “depression” today may be applied to conditions that in the past were called grief, sorrow, or sadness.
Psychologists and psychiatrists have begun to sound the alarm against this “disease mongering,” “concept creep,” “selling sickness,” and “expanding empire of psychopathology.”65 In her 2013 article “Abnormal Is the New Normal,” the psychologist Robin Rosenberg noted that the latest version of the DSM could diagnose half the American population with a mental disorder over the course of their lives.66
The expanding empire of psychopathology is a first-world problem, and in many ways is a sign of moral progress.67 Recognizing a person’s suffering, even with a diagnostic label, is a form of compassion, particularly when the suffering can be alleviated. One of psychology’s best-kept secrets is that cognitive behavior therapy is demonstrably effective (often more effective than drugs) in treating many forms of distress, including depression, anxiety, panic attacks, PTSD, insomnia, and the symptoms of schizophrenia.68 With mental disorders making up more than 7 percent of the global burden of disability (major depression alone making up 2.5 percent), that’s a lot of reducible suffering.69 The editors of the journal Public Library of Science: Medicine recently called attention to “the paradox of mental health”: over-medicalization and over-treatment in the wealthy West, and under-recognition and under-treatment in the rest of the world.70
With the widening net of diagnosis, the only way to tell whether more people are depressed these days is to administer a standardized test of depressive symptoms to nationally representative samples of people of different ages over many decades. No study has met this gold standard, but several have applied a constant yardstick to more circumscribed populations.71 Two intensive, long-term studies in rural counties (one in Sweden, one in Canada) signed up people born between the 1870s and the 1990s and tracked them from the middle to the late 20th century, embracing staggered lives that spanned more than a century. Neither found signs of a long-term rise in depression.72
There have also been several meta-analyses (studies of studies). Twenge found that from 1938 to 2007, college students scored increasingly higher on the Depression scale of the MMPI, a common personality test.73 That doesn’t necessarily mean that more of the students suffered from major depression, though, and the increase may have been inflated by the broader range of people who went to college over those decades. Moreover, other studies (some by Twenge herself) have found no change or even a decline in depression, especially for younger ages and cohorts and in later decades.74 A recent one entitled “Is There an Epidemic of Child or Adolescent Depression?” vindicated Betteridge’s Law of Headlines: Any headline that ends in a question mark can be answered with the word no. The authors explain, “Public perception of an ‘epidemic’ may arise from heightened awareness of a disorder that was long under-diagnosed by clinicians.”75 And the title of the biggest meta-analysis to date, which looked at the prevalence of anxiety and depression between 1990 and 2010 in the entire world, did not leave readers in suspense: “Challenging the Myth of an ‘Epidemic’ of Common Mental Disorders.” The authors concluded, “When clear diagnostic criteria are applied, there is no evidence that the prevalence of common mental disorders is increasing.”76
Depression is “comorbid” with anxiety, as epidemiologists morbidly call the correlation, which raises the question of whether the world has become more anxious. One answer was contained in the title of a long narrative poem published in 1947 by W. H. Auden, The Age of Anxiety. In the introduction to a recent reprint, the English scholar Alan Jacobs observed that “many cultural critics over the decades . . . have lauded Auden for his acuity in naming the era in which we live. But given the poem’s difficulty few of them have managed to figure out precisely why he thinks our age is characterized primarily by anxiety—or even whether he is really saying that at all.”77 Whether he was saying that or not, Auden’s name for our era has stuck, and it provided the obvious title for a meta-analysis by Twenge which showed that scores on a standard anxiety test administered to children and college students between 1952 and 1993 rose by a full standard deviation.78 Things that can’t go on forever don’t, and as best we can tell, the increase among college students leveled off after 1993.79 Nor have other demographic sectors become more anxious. Longitudinal studies of high school students and of adults conducted from the 1970s through the first decades of the 21st century find no rise across the cohorts.80 Though in some surveys people have reported more symptoms of distress, anxiety that crosses the line into pathology is not at epidemic levels, and has shown no global increase since 1990.81
* * *
Everything is amazing. Are we really so unhappy? Mostly we are not. Developed countries are actually pretty happy, a majority of all countries have gotten happier, and as long as countries get richer they should get happier still. The dire warnings about plagues of loneliness, suicide, depression, and anxiety don’t survive fact-checking. And though every generation has worried that the next one is in trouble, as younger generations go the Millennials seem to be in pretty good shape, happier and mentally healthier than their helicoptering parents.
Still, when it comes to happiness, many people are underachievers. Americans are laggards among their first-world peers, and their happiness has stagnated in the era sometimes called the American Century. The Baby Boomers, despite growing up in peace and prosperity, have proved to be a troubled generation, to the mystification of their parents, who lived through the Great Depression, World War II, and (for many of my peers) the Holocaust. American women have become unhappier just as they have been making unprecedented gains in income, education, accomplishment, and autonomy, and in other developed countries where everyone has gotten happier, the women have been outpaced by the men.
Anxiety and some depressive symptoms may have increased in the postwar decades, at least in some people. And none of us are as happy as we ought to be, given how amazing our world has become.
Let me end this chapter with a reflection on these happiness shortfalls. For many commentators they are an occasion to second-guess modernity.82 Our unhappiness, they say, is payback for our worship of the individual and material wealth and for our acquiescence in the corrosion of family, tradition, religion, and community.
But there is a different way to understand the legacy of modernity. Those who are nostalgic for traditional folkways have forgotten how hard our forebears fought to escape them. Though no one gave happiness questionnaires to the people who lived in the close-knit communities that were loosened by modernity, much of the great art composed during the transition brought to life their dark side: the provincialism, conformity, tribalism, and Taliban-like restrictions on women’s autonomy. Many novels from the mid-18th to the early 20th century played out the struggles of individuals to overcome the suffocating norms of aristocratic, bourgeois, or rural regimes, including works by Richardson, Thackeray, Charlotte Brontë, Eliot, Fontane, Flaubert, Tolstoy, Ibsen, Alcott, Hardy, Chekhov, and Sinclair Lewis. After urbanized Western society had become more tolerant and cosmopolitan, the tensions were played out again in popular culture’s treatment of small-town American life, such as in songs by Paul Simon (“In my little town I never meant nothin’ / I was just my father’s son”), Lou Reed (“When you’re growing up in a small town / You know you’ll grow down in a small town”), and Bruce Springsteen (“Baby, this town rips the bones from your back / It’s a death trap, a suicide rap”). It was played out yet again in the literature of immigrants, including works by Isaac Bashevis Singer, Philip Roth, and Bernard Malamud and then by Amy Tan, Maxine Hong Kingston, Jhumpa Lahiri, Bharati Mukherjee, and Chitra Banerjee Divakaruni.
Today we enjoy a world of personal freedom these characters could only fantasize about, a world in which people can marry, work, and live as they please. One can imagine a social critic of today warning Anna Karenina or Nora Helmer that a tolerant cosmopolitan society isn’t all it’s cracked up to be, that without the bonds of family and village they’ll have moments of anxiety and unhappiness. I can’t speak for them, but my guess is they’d think it was a pretty good deal.
A modicum of anxiety may be the price we pay for the uncertainty of freedom. It is another word for the vigilance, deliberation, and heart-searching that freedom demands. It’s not entirely surprising that as women gained in autonomy relative to men they also slipped in happiness. In earlier times, women’s list of responsibilities rarely extended beyond the domestic sphere. Today young women increasingly say that their life goals include career, family, marriage, money, recreation, friendship, experience, correcting social inequities, being a leader in their community, and making a contribution to society.83 That’s a lot of things to worry about, and a lot of ways to be frustrated: Woman plans and God laughs.
It’s not just the options opened up by personal autonomy that place a weight on the modern mind; it’s also the great questions of existence. As people become better educated and increasingly skeptical of received authority, they may become unsatisfied with traditional religious verities and feel unmoored in a morally indifferent cosmos. Here is our modern avatar of anxiety, Woody Allen, playing out the 20th-century generational divide in a conversation with his parents in Hannah and Her Sisters (1986):
MICKEY: Look, you’re getting on in years, right? Aren’t you afraid of dying?
FATHER: Why should I be afraid?
MICKEY: Oh! ’Cause you won’t exist!
FATHER: So?
MICKEY: That thought doesn’t terrify you?
FATHER: Who thinks about such nonsense? Now I’m alive. When I’m dead, I’ll be dead.
MICKEY: I don’t understand. Aren’t you frightened?
FATHER: Of what? I’ll be unconscious.
MICKEY: Yeah, I know. But never to exist again!
FATHER: How do you know?
MICKEY: Well, it certainly doesn’t look promising.
FATHER: Who knows what’ll be? I’ll either be unconscious or I won’t. If not, I’ll deal with it then. I’m not gonna worry now about what’s gonna be when I’m unconscious.
MOTHER [OFFSCREEN]: Of course there’s a God, you idiot! You don’t believe in God?
MICKEY: But if there’s a God, then wh-why is there so much evil in the world? Just on a simplistic level. Why-why were there Nazis?
MOTHER: Tell him, Max.
FATHER: How the hell do I know why there were Nazis? I don’t know how the can opener works.84
People have also lost their comforting faith in the goodness of their institutions. The historian William O’Neill entitled his history of the Baby Boomers’ childhood years American High: The Years of Confidence, 1945–1960. In that era, everything seemed great. Belching smokestacks were a sign of prosperity. America had a mission to spread democracy around the world. The atom bomb was proof of Yankee ingenuity. Women enjoyed domestic bliss, and Negroes knew their place. Though much about America was indeed good during those years (the economic growth rate was high; rates of crime and other social pathologies were low), today we see it as a fool’s paradise. It may not be a coincidence that two of the sectors that underperform in happiness—Americans and Baby Boomers—were the sectors that were most set up for disillusionment in the 1960s. In retrospect we can see that a concern with the environment, nuclear war, American foreign-policy blunders, and racial and gender equality could not be put off forever. Even if they make us more anxious, we are better for being aware of them.
As we become aware of our collective responsibilities, each of us may add a portion of the world’s burdens to our own worry list. Another icon of late 20th-century anxiety, the movie Sex, Lies, and Videotape (1989), opens with the baby-boomer protagonist sharing her angst with a psychotherapist:
Garbage. All I’ve been thinking about all week is garbage. I can’t stop thinking about it. I just . . . I’ve gotten real concerned over what’s gonna happen with all the garbage. I mean, we’ve got so much of it. You know? I mean, we have to run out of places to put this stuff eventually. The last time I started feeling this way is when that barge was stranded and, you know, it was going around the island and nobody would claim it.
“That barge” refers to a 1987 media frenzy over a barge filled with three thousand tons of New York garbage that was turned away by landfills up and down the Atlantic coast. The therapy scene is by no means fanciful: an experiment in which people watched news stories that had been doctored to have a positive or negative spin found that “participants who watched the negatively valenced bulletin showed increases in both anxious and sad mood, and also showed a significant increase in the tendency to catastrophize a personal worry.”85 Three decades later I suspect that many therapists are listening to patients sharing their fears about terrorism, income inequality, and climate change.
A bit of anxiety is not a bad thing if it motivates people to support policies that would help solve major problems. In earlier decades people might have offloaded their worries to a higher authority, and some still do. In 2000, sixty religious leaders endorsed the Cornwall Declaration on Environmental Stewardship, which addressed the “so-called climate crisis” and other environmental problems by affirming that “God in His mercy has not abandoned sinful people or the created order but has acted throughout history to restore men and women to fellowship with Him and through their stewardship to enhance the beauty and fertility of the earth.”86 I imagine that they and the other 1,500 signatories do not visit therapists to air anxieties about the future of the planet. But as George Bernard Shaw observed, “The fact that a believer is happier than a skeptic is no more to the point than the fact that a drunken man is happier than a sober one.”
Though some amount of anxiety will inevitably attend th
e contemplation of our political and existential conundrums, it need not drive us to pathology or despair. One of the challenges of modernity is how to grapple with a growing portfolio of responsibilities without worrying ourselves to death. As with all new challenges, we are groping toward the right mixture of old-fashioned and novel stratagems, including human contact, art, meditation, cognitive behavioral therapy, mindfulness, small pleasures, judicious use of pharmaceuticals, reinvigorated service and social organizations, and advice from wise people on how to lead a balanced life.
The media and commentariat, for their part, could reflect on their own role in keeping the country’s anxiety at a boil. The trash barge story is emblematic of the media’s anxiogenic practices. Lost in the coverage at the time was the fact that the barge was forced on its peregrination not by a shortage of landfill space but by paperwork errors and the media frenzy itself.87 In the decades since, there have been few follow-ups that debunk misconceptions about a solid-waste crisis (the country actually has plenty of landfills, and they are environmentally sound).88 Not every problem is a crisis, a plague, or an epidemic, and among the things that happen in the world is that people solve the problems confronting them.
And speaking of panics, what do you think are the greatest threats to the human species? In the 1960s several thinkers advised that they were overpopulation, nuclear war, and boredom.89 One scientist warned that although the first two might be survivable, the third definitely was not. Boredom, really? You see, as people no longer have to work all day and think about where their next meal is coming from, they will be at a loss as to how to fill their waking hours, and will be vulnerable to debauchery, insanity, suicide, and the sway of religious and political fanatics. Fifty years later it seems to me that we have solved the boredom crisis (or was it an epidemic?) and are instead experiencing the (apocryphal) Chinese curse of living in interesting times. But don’t take my word for it. Since 1973 the General Social Survey has asked Americans whether they find life “exciting,” “routine,” or “dull.” Figure 18-4 shows that over the decades in which fewer Americans said they were “very happy,” more of them said that “life is exciting.”