by Dr.Harald Wiesendanger– Klartext – Oct. 2022 Updated: 5.1.2024
What the mainstream media is hiding
Public mental health has never been worse than it is today.
Why shouldn’t talented lay helpers be allowed to help alleviate the emergency? In contrast, the constitutional state has erected irrational barriers that place class interests above the common good. It is time for more pragmatism instead of lobbying.
Nowhere does the earthly valley of tears seem deeper than between Flensburg and Passau. 69% of all adult Germans are “restless and agitated,” 69% “can no longer switch off properly,” and 67% “feel depressed,” as the insurer AXA found for its Mental Health Report 2023 using a representative survey of 2,000 people between 18 and 74 found out years ago. (1) Furthermore, 58% state that they “cannot be happy about anything anymore.” 49% “no longer have positive feelings.” 44% feel “anxiety for no apparent reason.” On a scale from 0 to 10, they rate their personal stress level at an average of 5.5; young adults even place it at 6.7.
“In the middle of a mental health pandemic.”
The more depressed the mind, the more likely it is to develop what experts call a “mental disorder.” At least in this respect, as statistics consistently show, Germany continues to be one of the world leaders. With rapidly increasing growth rates, it constantly strives towards new all-time highs. Around a third of the adult population is now said to be affected by a mental illness every year – the figures vary between 28 and 32% – especially anxiety, depression, adjustment disorders, and addictions. (2)
In addition to cardiovascular diseases, malignant tumors, and musculoskeletal diseases, they are among the four leading causes of the loss of years of healthy life. “People with mental illnesses,” states the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN), “also have a life expectancy that is ten years shorter than the general population.” (3) “We are in the middle of a mental health pandemic, the effects of which are only gradually becoming visible,” explains Prof. Dr. med. Christoph Correll, Director of the Clinic for Psychiatry, Psychosomatics and Psychotherapy for Children and Adolescents at the Berlin Charité.
This pandemic is already affecting young people to a shocking extent. Mental illnesses are now the most common reason for inpatient hospital treatment among 10 to 17-year-olds. One in five people aged 15 to 24 are diagnosed with it.
The psychological epidemic is becoming increasingly noticeable in the world of work. Two out of three employees in Germany now feel restricted in their job due to psychological stress – 29 percent constantly or often, and another 34 percent at least sometimes. (4) One in five working people has been diagnosed with depression; A further 19% suspect that they have already been affected by it. (5)
Around 16% of all days absent are due to mental illness. Within a decade, between 2012 and 2022, they rose by 48%. (6) The absences from work among those affected totaled 60 million days in 2012 – an increase of over 60 percent within a decade. In the past 20 years, the number of sick days due to emotional distress has tripled. It has increased fivefold since the beginning of the 1960s, and its share of all cases of incapacity to work has since then been seven times higher. In the first half of 2023 alone, absenteeism due to mental illnesses increased by 85% compared to the same period last year, and the number of mental illness cases increased by 32%.
While mental illnesses had little statistical significance three decades ago, today, they are the most common diagnosis group for sickness and incapacity for work among women and the second most common among men, behind musculoskeletal disorders. (7)
This development is all the more worrying because psychologically-related illnesses last three times longer than others (13 days), with an average of 39 days. For anxiety disorders, it is more than 43 days; for depression, it is over 25. (8)
In addition, mental disorders are now the most common reason for early retirement due to illness: Since the beginning of the 1990s, the proportion of people who leave working life early due to mental illness has increased from 14.5 to 41.9 percent. (9). On average, they are only 49 years old. (10)
Hair-raising cost trap
The federal government now assumes that mental illnesses burden our economy with a total of 99.6 billion euros per year. (11) On the one hand, it includes the direct costs for treatment, prevention, reintegration, and care, as well as the administrative costs of the health insurance companies (28.6 billion euros) – and these are expected to at least double by 2030. (12) In addition, there are indirect costs due to incapacity to work and the resulting loss of production (26 billion euros) as well as lost gross value added amounting to a further 45 billion euros. (13)
According to EU estimates, three to four percent of the gross national product is lost across Europe. Psychoses such as schizophrenia alone place an annual burden of 207 billion euros on Europe’s health systems. (14) Globally, scientists predict that the total cost of mental illness will rise from $2.5 trillion in 2010 to $6 trillion in 2030. (15)
It is laypeople who prevent the system from collapsing.
These alarming figures from the health-economic horror cabinet would undoubtedly be many times higher if psychotherapy were not being practiced illegally in every nook and cranny of the republic by unqualified, titleless citizens without practice rooms, medical licenses, psychology diplomas or alternative practitioners’ licenses, who provide mentally distressed fellow human beings with advice and assist with action. And it’s free of charge.
The therapy locations, which are also training facilities for lay psychologists, are bars and hairdressing salons, park benches and walking paths, kitchens and living rooms, beds and confessionals, cafeterias and canteens, buses and train compartments, cafés and pubs. They exist everywhere where people occasionally talk about what is bothering them. If they are physically separated, distance healing sessions often occur via telephone, smartphones, the Internet, email, and old-fashioned letters.
Even in the USA, 80 percent of all people in life crises continue to seek help first from partners, friends, neighbors, the family doctor, or the priest (16) – and this in a country that is considered a stronghold of professional spiritual helpers, where one can at least find help in large cities A therapist is almost as commonplace as getting a pet, a weapon or a pay-TV subscription. According to a study in the mid-1970s, more than 95 percent of all psychological problems are treated without specialists. (17)
According to an estimate in the early 1980s, it is laypeople who take care of 75 percent of all mental illnesses. Only one in five of those affected prefers to go to the doctor, and only one in 20 prefers to go to a clinic. (18) Psychotherapy has always been an everyday social activity, and it still is today.
Shouldn’t health politicians, additionally motivated by austerity-minded finance ministers and chronically cash-strapped health insurers, greet this free, comprehensive medical practice with euphoria? Shouldn’t they immediately use research results that unanimously demonstrate the approximate equivalence of lay and professional assistance in the case of mental disorders as an opportunity to involve amateurs as intensively as possible in the care of mentally distressed people? Wouldn’t this dramatically reduce the ridiculous costs associated with professional fees?
Henchman services for professional interests
Nothing like that happens. Instead, government representatives continually and impressively apply for the honorary chairmanship of the interest groups that lobby them to get behind them. How else can we understand the unspeakable educational brochure entitled “Soul out of Balance,” which the Federal Ministry of Education and Research distributed to hundreds of thousands of people in two editions in 2010 and 2011? “When the soul is sick,” its owners empathize, “many people find it difficult to decide to whom it is best to turn.” Thank God the federal government shows them the right path, into which it graciously “provides insight”: of course, to “recognized and legally protected (…) professionals for the soul: psychotherapists, psychiatrists, psychologists, psychoanalysts”. (19) No advertising agency could have found more appropriate words.
And no one could have ensured fairer legal conditions. The Psychotherapists Act (PTG) has been in force in Germany since 1999. With it, the legislator prescribes certain essential professions and training courses for psychotherapy – without any scientific basis, as was the case with the previously applicable “delegation procedure,” according to which only doctors were allowed to carry out psychotherapy, psychologists only based on a doctor’s referral and only if they were licensed to do so in accordance with the had obtained the alternative practitioner law. (20) Why did parliamentarians create such a legal situation even though the latest research could hardly have remained hidden from them?
They did it with the feeling that psychotherapy couldn’t just be practiced at random. No, it must be based on science. Consequently, the PTG defines “psychotherapy” as psychological “activity to identify, cure or alleviate disorders with illness significance” using “scientifically recognized procedures.” (21)
But in this sense, psychotherapy is non-existent. What their qualified users complacently do to those seeking help lacks both empirical foundation and the promised added value. The facts described speak for themselves.
The cult of the professional
If “professional mental health” is actually a fairy tale, and the expert status derived from it represents a bold presumption, How can politics and society be blind to it?
The view that sick souls are in good hands with professionals arises from the proven belief that you can do something better if you do it professionally after you have been extensively taught and tested. For good reasons, we only allow trained engineers, architects, pilots, and pharmacologists to design a bridge, erect a building, pilot an aircraft, or develop a vaccine. Professionalization, it seems to us, guarantees greater efficiency, more security, and better quality.
The modern trend in this area covered more and more areas of activity; it gradually included not only crafts, research, and technology but also spread to all kinds of services. In the meantime, no one is allowed to bake or cook for their fellow citizens, do their hair, teach their children, or build a house for them without a license. And laypeople, in particular, are now completely excluded from the healthcare system. From the masseur to the nurse and the geriatric nurse to the doctor, there are no longer any unauthorized actors in Western medicine; any healing-related activity has now gone through all five stages of professionalization (22):
1. Tasks that were previously carried out privately or on a voluntary basis are removed from everyday social life and become the core of permanent employment.
2. Special teaching centers impart the knowledge and skills required for this in a longer, fixed training course. Only those who successfully complete this can carry out the activity in question.
3. Those trained join together in professional associations to represent and protect their interests effectively, especially from unqualified competitors.
4. Rules arise for the practice of the profession, compliance with which is monitored by professional courts and chambers.
5. The activity is regulated by law. Exercising it without permission and using the job title without authorization becomes a criminal offense.
As soon as only licensed health professionals are allowed to heal, a widespread fear of a suspected epidemic will only benefit them. The worse the plague, the more welcome it is. Because the perceived threat alone gives them plenty to do, only they are entitled to take care of it. The worse the perceived danger, the more urgent professional defense is. So professionals can introduce practical constraints, complain about alleged understaffing, and demand a rapid increase in supply density and more government funding.
And the legislature is taking notice. Instead of making decisions in the name and for the benefit of his people, who are supposedly threatened by a psycho-pandemic, he is becoming a stooge of interest groups. Without questioning their scientific claim and their actual performance, he leaves them the authority to interpret our mental health – and the responsibility for it.
This is exemplified by the decision-making process that the legislature established in September 2014 for a planned new version of the Psychotherapists Act. (23) Who should be heard? Who was allowed to have their say, explain the state of research, point out problems, raise or refute concerns, make suggestions, have a say, and have a say? At least not patients, indeed not psychiatric patients and other therapy victims, nor any fundamental critics of the prevailing conditions.
The only people involved were the Federal Chamber of Psychotherapists because it offers “the guarantee of sufficient knowledge of the professional requirements in theory and practice” and the “Working Group of the State Chambers of Psychological Psychotherapists and Child and Adolescent Psychotherapists.” They are “authorized to make recommendations.” It was considered “necessary to consider the expertise of the Scientific Advisory Board for Psychotherapy (WBP) and the German Society for Psychology. (24) What those mentioned were concocting should then be approved by the two federal ministries of health and education and research and made binding by issuing a legal ordinance.
Who is then responsible for “checking both regularly and on an ad hoc basis (…)” whether the recommendations should continue to apply or “necessary adjustments should be made”? The Federal Chamber of Psychotherapists, who else? Here comes another lesson in expertocracy: a form of government that the social psychologist Harald Welzer aptly characterizes as “a combination of administration and experts in which strategy papers are constantly being written with bite-sized information about what politicians should know from an expert perspective.
The political community, i.e., the citizens, is completely excluded from this process. The disastrous thing about it is that all parliamentary forms of traffic are adhered to at the technical level – but at the same time, the planning processes are inherently undemocratic. (…) Ultimately, it says: There was no alternative to what we decided.” (25)
Expert-believing united front
Critics are powerless against the united front of science-believing representatives of the people, defensive associations, clever lobbyists, representatives of the academic establishment, and thousands upon thousands of professional beneficiaries of the exclusion strategy, supported by a public that listens to experts. No matter how compelling, well-founded arguments are, they do not prevent the healthcare market from being sealed off in favor of its primary financial beneficiaries, whose profits are secured under the pretext of ensuring quality, protecting consumers, and ensuring compliance with scientific standards. Germany and a large proportion of the 26 other EU states have now regulated the practice of psychotherapy by law, and the rest are likely to follow suit shortly. Everywhere there, laypeople no longer have the slightest chance of working as psychological counselors or psychotherapists – even if they achieve demonstrable success.
Because of the increasing number of home break-ins that an overwhelmed police force can neither prevent nor solve, Federal Interior Minister Thomas de Maizière (CDU) proposed an unusual countermeasure in June 2016: He suggested that problem-aware, committed citizens – namely police candidates who had failed the entrance exam – to send uniformed police officers on patrol in residential areas as low-paid police officers. This was preceded by promising model experiments in two federal states.
They employed over 500 such guards after they had undergone three months of intensive training. The experiences with it were great. Shouldn’t law enforcement officers be delighted to be forgiven in this way? Not at all. Rather, there was immediately strong opposition, most loudly from the professional representative of the “real” security forces, the German Police Union. But North Rhine-Westphalia’s Interior Minister also criticized that it was “backward” to invest in “amateurs” instead of “professionally trained” additional police officers.
What the state of Saxony offered to experienced career changers in order to compensate for the teacher shortage also came under fire: teaching in schools without a teaching qualification. (26) I bet: no less vehemently, and with comparable justifications, would any initiative to employ laypeople in psychotherapeutic care be strangled. I can think of only one valid reason that would speak against it: those affected do not perceive lay helpers as “genuine.” They take the lack of a university diploma and state recognition as proof that “real” therapy cannot occur. The legislature succumbs to the same reasoning error.
Instead of cementing professional boundaries, responsible health policy should aim to tear down walls, open doors, and bring together experts from all backgrounds. Many laypeople, but also non-medical professionals such as social workers, teachers and educators, occupational therapists, nursing staff, life coaches, pastors, and other professional groups, are no less knowledgeable about helping and healing than those who are authorized to do so by law. Therefore, forms of advice, treatment, and care should be promoted as quickly as possible in which everyone involved pulls in the same direction without the arrogance of experts.
To do this, each person must be able and willing to contribute the general impact factors that have proven to be far more important than titles, diplomas, and social prestige. There is too much at stake in our health system for millions upon millions of patients for representatives of the people to willingly allow a few powerful actors to hijack it like a landlord in a penetrating display of the fine art of dealing with lower forms of life in the most condescending manner possible. The effortless coexistence that quickly welds helpers and those seeking help of all kinds together into a healing community in the therapy camps of my Auswege Foundation/Ways Out Charity shows how easy it would be to take long-overdue steps in a different direction.
See also > Nine days in the future – from the “Auswege” camp to the clinic of the future.
This text is a revised excerpt from H. Wiesendanger: Psycholügen, Volume 3:Seelentief: Ein Fall für Profis?, Schönbrunn 1st edition 2017.
The consequences of this series:
1 Extensively researched: Many laypeople can do more
3 Dodo bird in the Psychotechnics race
4 How much does psychotherapy really help?
5 Why is psychotherapy beneficial?
6 Why some Laypeople are better Therapists
7 Embarrassing, telling: successful imposters
8 Psychotherapy as a source of danger
9 What some professionals can do better – and why
10. Pragmatism instead of lobbying – For wise psycho-politics
Remarks
1 https://www.axa.de/presse/axa-mental-health-report-2023; https://www.axa.de/presse/mediathek/studien-und-forschung/mental-health-report-2023
2 DGPPN: Basisdaten – Psychische Erkrankungen, Stand: Januar 2023; DPtV: Report Psychotherapie 2021 und 2023; https://www.dgppn.de/_Resources/Persistent/f80fb3f112b4eda48f6c5f3c68d23632a03ba599/DGPPN_Dossier%20web.pdf
3 DGPPN: Basisdaten – Psychische Erkrankungen, Stand: Januar 2023.
4 Ärzteblatt, 23.10.2012: „Psychische Probleme schränken jeden Vierten im Job ein“.
5 Stiftung Deutsche Depressionshilfe: Deutschland-Barometer Depression https://www.deutsche-depressionshilfe.de/pressematerial-barometer-depression, November 2021.
6 DAK_Psychreport 2022 und 2023, https://www.rehadat-statistik.de/statistiken/behinderung/behinderungsarten/psychische-erkrankung/
7 DAK Gesundheit, 27.1.2017: „Psychische Erkrankungen: Höchststand bei Ausfalltagen“; BKK Gesundheitsreport 2014 – Zahlen, Daten, Fakten der Betriebskrankenkassen BKK, online bei www.bkk-dachverband.de/publikationen/bkk-gesundheitsreport; M. Meyer/H. Weirauch/F. Weber: „Krankheitsbedingte Fehlzeiten in der deutschen Wirtschaft im Jahr 2011“, in B. Badura u.a. (Hrsg.): Fehlzeiten-Report 2012, Heidelberg/Berlin 2012, S. 291-467.
8 DAK Gesundheit, 27.1.2017: „Psychische Erkrankungen: Höchststand bei Ausfalltagen“; sowie nach Berechnungen des Gesundheitsökonomen Wolfgang Bödeker und des Mathematikers Michael Friedrichs: „Kosten der psychischen Erkrankungen und Belastungen in Deutschland“, in: Lothar Kamp/Klaus Pickshaus (Hrsg.): Regelungslücke psychische Belastungen schließen, Düsseldorf 2011. DAK_Psychreport 2022 und 2023, https://www.rehadat-statistik.de/statistiken/behinderung/behinderungsarten/psychische-erkrankung/
9 Deutsche Rentenversicherung Bund (Hrsg.): Rentenversicherung in Zeitreihen, Berlin 2012; C. Hagen u.a.: Zugang in Erwerbsminderungsrente wegen psychischer Erkrankungen: Entwicklungen, Gemeinsamkeiten und Unterschiede, Berlin 2012.
10 DAK_Psychreport 2022 und 2023, https://www.rehadat-statistik.de/statistiken/behinderung/behinderungsarten/psychische-erkrankung/
11 In ihrer Antwort vom 30. April 2012 auf eine Anfrage mehrerer Abgeordneten der Fraktion Die Linke, veröffentlicht als Drucksache 17/9478 des Deutschen Bundestags, dort S. 12.
12 Nach http://psyga.info/psychische-gesundheit/daten-und-fakten/
13 Unter Bruttowertschöpfung (BWS) verstehen Ökonomen den Gesamtwert aller erzeugten Waren und Dienstleistungen, abzüglich des Werts der Vorleistungen.
14 Nach Deutsches Ärzteblatt, PP Heft 1, Januar 2006, S. 25: „Psychische Erkrankungen in Europa – Lebenszeitrisiko mehr als 50 Prozent“, sowie www.pronia.eu.
15 World Economic Forum/Harvard School of Public Health: The Global Economic Burden of Noncommunicable Diseases. A Report, Genf, September 2011.
16 Nach Surin u.a. 1960, zit. bei Michael Dietrich: „Laien und/oder Profis in Psychotherapie und Seelsorge?“, Seelsorge 2/1999, S. 41-49; J. Veroff/R, Kulka/E. Douvan: Mental health in America: Patterns of help seeking from 1957 to 1976, New York 1981, S. 60.
17 M. L. Moeller: „Selbsthilfegruppen in der Psychotherapie“, Praxis der Psychotherapie 20/ 1975, S. 181.
18 F. Scheuch: Dienstleistungsmarketing, München 1982, S. 67.
19 Bundesministerium für Bildung und Forschung: Seele aus der Balance – Erforschung psychischer Störungen, 2. Aufl. Berlin 2011, S. 9, 11.
20 In der Schweiz hingegen dürfen Psychotherapeuten weiterhin nur tätig werden, wenn sie vom Psychiater „delegiert“ sind. Noch rigider verfährt Österreich: Ausschließlich Ärzte dürfen dort Psychotherapie ausüben.
21 Psychotherapeutengesetz der Bundesrepublik Deutschland, § 1, Abs. 3, Sätze 1,2.
22 s. H. L. Wilensky: “The Professionalization of Everyone? “, American Journal of Sociology 70 (2) 1964, S. 137 ff.; vgl. E. Stooß: „Die Systematik der Berufe und der beruflichen Tätigkeiten“, in Heinz Seifert u.a. (Hrsg.): Handbuch der Berufspsychologie, Göttingen 1977.
23 Im „Entwurf eines Gesetzes über die Berufe des Psychologischen Psychotherapeuten und des Kinder- und Jugendlichenpsychotherapeuten“, http://dgpt.de/fileadmin/download/Aus-_Weiterbildung/2014-09-22_Bericht_ zur_aktuellen_Ausbildungsdiskussion/2014-10-15_Begruendung_Forschergruppe_fuer_Gesetzesentwurf-PsychThG.pdf
24 Auch die „Deutsche Gesellschaft für Erziehungswissenschaften“ und der „Fachbereichstag Soziale Arbeit“ sollten „eingebunden“ werden, siehe S. 3 des Gesetzesentwurfs.
25 In einem Interview mit der Tageszeitung taz vom 22. Oktober 2010.
26 Zit. nach Süddeutsche Zeitung Nr. 138, 17.6.2016: „Hilfspolizisten gegen Einbrecher“; welt.de, 20.12.2014: „Wenn der Quereinsteiger den Lehrermangel ausgleicht“, abgerufen am 8.11.2016.