Rebels with a jihadist cause

The authors of the pop economics bestseller Freakonomics argue that there is a socio-economic drift of baby names from middle class suburbs that takes approximately a decade. As a result, names like Aidan and Siena are becoming more popular in outer metropolitan areas and the regions. In another decade, names increasingly favoured in the leafier parts of town, like Arabella and Harry, may become commonplace elsewhere too.

But there is another socio-economic drift of great significance occurring in the opposite direction. There is a nexus of mental illness, insurance and disability that began among the poor and blue-collar workers that is spreading to white-collar professionals. I assess them for income protection protection claims.

Between 2001 and 2014, there was a 51 per cent increase in the proportion of people receiving the disability pension for psychiatric reasons. The government is tightening the requirements slowing the increase, but the dramatic shift of disability from bad backs a few decades ago, to troubled minds now, is well established. Groups from lower socio-economic areas are over-represented.

Meanwhile data compiled by KPMG in association with the Financial Services Council assessed 30,000 claims filed between 2007 and 2011, which showed a tremendous increase in the proportion of claims associated with mental health. Income protection premiums in particular are set to rise.

In 2016 figures compiled by the Actuaries Institute of Australia show mental illness is now associated with almost half of all claims.

In a Sydney presentation to the industry, reinsurance client manager Nicole Gamerov titles her talk as “Mental Illness – Heading for the Perfect Storm”.

The opening slide has pictures of nuclear mushroom clouds implying apocalypse for the sector with the quote: “A large and complex low pressure cell is heading towards the insurance industry …combined with increasing levels of politicisation, media coverage and court challenges could lead to widespread devastation and destruction.”

Gamerov correctly identifies the great challenges of pricing risk for psychiatric claims. The intellectual foundations of mental health are significantly weaker than other branches of medicine, making future predictions difficult. Descriptions are largely subjective and there are no physiological tests to confirm diagnoses.

Legal claims do tend to favour claimants. The fact that concepts like temporary and permanent disablement arose almost 40 years ago and were designed for physical ailments complicates the situation further.

Societal shifts

The cultural rise of mental health occurs in parallel with the transformative social currents of the past half-century. Life’s project has shifted to one of individual self-fulfilment. Collective structures such as family, community or the church are diluted. Union membership, for example, is now only 17 per cent, less than half of what it was in the 1970s.

As a result, we are more likely to process emotional distress as individuals and make sense of our lives through the language of psychology.

Previously we might have spoken about people having characters with the associated connotations of good or bad, whereas now we are are more likely to describe their personalities, which have a different emphasis of self-presentation.

For white-collar groups in particular, work is often the pre-eminent marker of status and identity. The outer markers of our lives have shifted to one of achievement, and less with affiliation.

But the greater emphasis on meritocracy has, for many, led to melancholy.

The decline in traditional religion means we look to alternative narratives to handle adversity and suffering. When things go wrong, more people conceptualise and interpret their experience through the categories of mental illness, making sense of their lives in ways that weren’t available previously. The decline in stigma makes it more acceptable to do so.

I see professionals with some psychological vulnerabilities, who go into decline when things haven’t quite gone to plan. Dentists whose practices failed, executives who didn’t get the promotion they dreamt of, or lawyers whose partners left them over their drinking.

The strains are beginning to show in the life insurance industry, with more public pressure to minimise the practice of mental health exclusions.

In public statements, the chief executive of the Financial Services Council, Sally Loane, said the sector plans to “increase obligations on insurers when interacting with consumers suffering mental health issues”.

But the financial weight on both disability pensions and income protection are a broader symptom of the modern condition in a largely post-religious, de-ritualised society. Mental health continues to be poorly understood. With predictions that one in four of us will now suffer mental illness, then collectively bearing the risk will become an extraordinary challenge.

Tanveer Ahmed is a psychiatrist and author of Fragile Nation

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