There are methodological issues to consider, but assuming that this figure is correct, how do we make sense of this?

At a descriptive level, it shows that the psychological difficulties that meet criteria for various diagnosable conditions are quite common... /1 https://twitter.com/Mental_Elf/status/1387060244648497152

Vast majority of us have or will experience one diagnosable difficulty or another at some point over the course of our lives; furthermore, the vast majority of these difficulties are not persistent or chronic (14% of the cohort had enduring psychiatric problems in this study). /2

This suggests that our diagnostic criteria cast a wide net. If our goal is to identify those who experience substantial degree & duration of distress/impairment, this suggests that the criteria are doing what they are supposed to do. That's not necessarily a bad thing. /3

Some feel that such high lifetime prevalence is logically absurd bcz mental illness has to be defined in opposition to some majority norm, but that is fallacious reasoning... as evident by the fact that all of us will experience one or another physical illness in our lives. /4

Many reactions to this report on twitter illustrate how deeply stigmatized mental health conditions still are; many individuals, including many mental health professionals, are visibly *horrified* at the prospect. It is as if the asylum walls are still erect in our minds. /5

"Surely individuals with mental illness are not *amongst us*! Surely it can't be you and me! How can so many of *us* be so many of *them*?"

Perhaps you can see why this is problematic. /6

Some of us will say: yes, psychological distress/impairment meeting XYZ thresholds is v common, but there is no reason for us to call it an "illness" or "disorder". Maybe so. Tackling this argument requires tackling the functions these terms serve, something I won't do here... /7

...The pertinent point is that for proponents of this view, prevalence is irrelevant. For these folks, psychiatric conditions are never illnesses or disorders, regardless of whether their lifetime prevalence is high or low. High prevalence does not by itself make this true. /8

Are there other, perhaps more sensible, reasons to be concerned? I think there are. We have to guard against certain possibilities:

The reason we want to identify those who experience substantial degree & duration of distress/impairment is so that we can *help* them. /9

It is not obvious that by using current diagnostic thresholds that lead to such high prevalence we help more people than we hurt. Our interventions are generally of low efficacy & have serious side effects or substantial costs, which means restricting their use... /10

... to those who really need them, i.e. for whom the benefits are likely to outweigh costs/harms, is the more prudent strategy.

It's also not obvious how many of those diagnosed improve on their own with time & ordinary social support without any professional intervention. /11

If professional intervention is unnecessary for a substantial portion, that would also suggest the need to make current thresholds more stringent.

Another factor to consider is the understanding we impose on those diagnosed. What explanations do we offer them? /12

Do we deprive these individuals of meaningful narratives and offer them reductive stories of broken brains, genetic etiologies, and chemical imbalances? If so, and there is no shortage of instances where we have done so, then many people would be better off on their own. /13

I would end thiswith a quote by Derek Bolton: "Madness never could be among us - not among *us* - bcz it was behind asylum walls. Whatever we may have cannot be the old madness, not something isolated, different, pure deficit, meaningless, with nothing to say--but rather... /14

"...it would have to be something new, more familiar, something we come across in friends & family, on TV & in ourselves, something more understandable, having a voice - something better called something like mental health problems,..." /15

"... fading into ordinary or extraordinary problems of living. Madness transforms into something else when it is in the community..."

[Derek Bolton, What is Mental Disorder? 2008]

16/16