Civilization and its Discontents
SMHS faculty explore the causes of—and antidotes to—anxiety, which is on the rise nationally.
From Sigmund Freud (Civilization and its Discontents) and Michel Foucault (Madness and Civilization) to Gilles Deleuze and Félix Guattari (Capitalism and Schizophrenia), scores of philosophers and physicians have for more than a century explored the degree to which mental illness is not necessarily internal to the sufferer, but “caused” by the increasingly complex society in which she or he lives.
The question is especially poignant in the United States, which today is in the midst of what some observers have characterized as an unprecedented eruption of mental illness—anxiety in particular—unique to the Western world.
One recent study in the New England Journal of Medicine, for example, found that the number of American youth receiving any outpatient mental health service shot up 30 percent between 1996 and 2012. And as JAMA Psychiatry put it in 2017, generalized anxiety disorder “is more prevalent and impairing in higher-income countries,” like the United States, “than in low- or middle-income countries.”
Sleepless in North Dakota
Although the comparative data suggest that North Dakotans are typically less anxious than others in the U.S., the creeping rise in anxiety nationally has reached the northern plains as well.
According to the Fifth Biennial Report on Health Issues for the State of North Dakota, a 2019 survey by the UND Center for Rural Health found that access to behavioral and mental health services was the top concern of hospital CEOs—and their workforce—in the state.
Such figures have providers, politicians and parents from Williston to Wahpeton asking: What’s going on? Why is anxiety, in particular, so prevalent now, and what role does environment play in the cause of such conditions?
Such questions have been buzzing in Dr. Andrew McLean’s ear for years.
“[The rise in anxiety] is accurate, particularly with youth,” said McLean, chair of the Department of Psychiatry & Behavioral Science at the UND School of Medicine & Health Sciences (SMHS). “It’s interesting because a few years ago I’d ask my child and adolescent [psychiatry] colleagues about this and they’d say, ‘Yes, it has definitely increased, but we don’t know why.’ But today we have some ideas.”
Those ideas include both biological factors such as genetics, lack of exercise, and poor nutrition, as well as environmental factors like social media, social isolation, and worry over issues like climate change (especially among youth) and income inequality.
“Some have called this increase in angst, resulting in higher rates of suicide and overdose, ‘diseases of despair,’” noted McLean from his office on the SMHS Southeast Campus in Fargo. “There have been a number of papers recently alluding to the fact that the increase in anxiety and depression at least seems to correlate with the emergence of smartphones and the rise of social media. Plus there has been a gradual decrease in the amount of sleep Americans and even people in other Western countries are getting.”
As McLean explained, devices like smartphones and tablets not only disrupt more conventional ways of interacting with friends and family but can also disrupt sleep in a variety of ways. And both of these scenarios have an impact on physical activity, inflammatory processes in human tissue, and hormone changes generally.
More than this, McLean added that such devices contribute to the idea that each of us now must be “on-call” for our jobs or friends and families all the time, which can be stressful.
“So we’re seeing more clinicians and teachers saying ‘give it a break,’” he added. “Put it down for 15 minutes—or much longer—in order to combat this idea of being on-call all the time. There are some businesses that are trying to help staff minimize their on-call time, not expecting them to answer email after hours.”
Still, said McLean, it’s perhaps too easy to blame the environment alone for any so-called anxiety pandemic.
"There are systemic issues involved, but there are also individual solutions,” he said. “There are things individuals can do to avoid falling into these traps like putting the phone down, working on our sleep hygiene, and interacting with people face-to-face.”
A better understanding of human physiology also helps, of course.
To that end, a host of researchers at the SMHS are studying the pharmacology of mental illness, hoping both to learn better the chemistry of anxiety and explore new treatments for this and other complex conditions.
“Unfortunately, the current drugs for anxiety are less than satisfactory,” noted Department of Biomedical Sciences Professor Saobo Lei, Ph.D., from his office in the UND Neuroscience Research Facility. He is part of a research team at the School studying the basic science of human neurotransmitters (e.g., glutamate, serotonin, and dopamine) and how they impact mental health. “Many [drugs] have serious side effects, and the effect of treatment is unsatisfying. We need to try a different approach to anxiety.”
This is why Lei and crew are hoping to discover new ways of treating or preventing anxiety by focusing more on the physiological mechanisms at the core of the body’s anxiety response.
Having already explored the connection between neurotransmitters and anxiety, Lei was awarded a five-year, $1.5 million R01 grant late last year from the National Institutes of Health to explore the connection between anxiety and vasopressin, an anti-diuretic hormone that plays a role in regulating blood pressure.
According to Lei, vasopressin can interact with many receptors in the brain, including the V1a, V1b and V2 receptors. If too much vasopressin lingers in the nervous system, blood vessels will tighten up and the kidneys will produce less urine, which can increase blood pressure generally and heighten anxiety.
“But if you knock out the V1a receptor in mice, they showed a decrease in anxiety,” Lei explained. “Our hypothesis is that in the brain vasopressin is involved in the mechanism that leads to increased anxiety. How? We don’t know—maybe through the activation of glutamate—that’s what we’re trying to figure out.”
The hope, said Lei, is to find a novel target for pharmaceuticals that will better control patients’ anxiety with fewer side effects.
“If we figure out these mechanisms, we can perhaps develop treatments for anxiety and have a clinical trial and increase drug options for people.”
Madness and civilization
All of that said, Lei, who earned a medical degree in China and a doctoral degree in pharmacology from the University of Alberta in Canada, also recognized that cultural differences—even from one city to another—have an impact on our society’s collective level of anxiety.
Admitting that he has yet to read any peer-reviewed studies on the subject, Lei nonetheless feels that the speed and rhythm of work-life in the U.S. is faster, often in problematic ways.
“In Canada it’s slower—we would get to work at 9 a.m.,” he said. “Here it’s eight. Things are busier, and there can be more pressure [in the United States].”
The research suggests that Lei is correct, and that an increase in anxiety among Americans, relative to a generation ago, might be the consequence.
But research is also helping us understand why—and what we can do to reduce our experience of anxiety and, hopefully learn how to keep calm and carry on.