Was the number of unreported cases of mental health conditions among young people higher in the past?

Dear Lena

Thank you for your interesting question. It is complex and contains several sub-questions, which I will address briefly one by one.

Firstly: what does ‘in the past’ mean in this context?

‘In the past’ is, of course, a relative term in history. Your question relates to the history of psychiatry. And since modern psychiatry developed in the second half of the 19th century and modern psychiatric hospitals also emerged during this period, by ‘in the past’ I mean roughly the period between 1870 and 1970. From the 1970s onwards, psychiatry then underwent a significant shift towards the way it is practised ‘today’.

Different times, different diagnoses

When comparing the past with the present, we must first ask: what was considered a mental illness at which time? So what could actually be perceived and described as a ‘mental health problem’ in a given era?

A diagnosis is, in effect, a description of a mental health problem. Psychiatric diagnoses are constantly changing. This means that the definition of what constitutes a mental illness or a mental health problem has evolved continuously over time. Some diagnoses that were previously made even in young people no longer exist today, whilst others have emerged.

One example of this is ‘oligophrenia’. People with a congenital intellectual disability were referred to as oligophrenics. These people were cared for or institutionalised in psychiatric hospitals, often whilst still children or adolescents. Today, reduced intelligence or a cognitive impairment is no longer regarded as a psychiatric diagnosis or a ‘mental health problem’. And since around the 1970s, other institutions have been in place to care for people with cognitive impairments.

A second example is ‘pubertal hysteria’, a diagnosis made of young women who exhibited severe conflicts or problems during their development, behaved in a conspicuous manner, defied the prevailing rules and norms of their time – in other words, when they had so-called ‘hysterical fits’. The diagnosis of ‘hysteria’ has not been made for around 50 years. Mental health issues that may arise during personality development in adolescence are now described, interpreted and treated in a more nuanced way.

On the other hand, the diagnosis of ADHD first appeared in psychiatric diagnostic manuals in 1980. This means that, although children and adolescents may well have been hyperactive or had difficulty concentrating even before 1980, they could not be diagnosed with ADHD.

But clearly, even in the past, people who did not conform to the norms and rules of the time – or who even actively defied them – in other words, those who were not ‘normal’ – were diagnosed, treated and ‘corrected’ in one way or another. Diagnoses were made in the past too, though they were often different from those made today. And the nature of the treatment is also different today.

The change in diagnoses is therefore of great and fundamental importance in answering this question!

Mental health issues among young people today

Current statistics and media reports clearly suggest that young people today are worse off than in the past. And this raises precisely the question you’re asking: do they actually have more mental health problems? Or are these problems simply being recognised, expressed, treated, recorded and reported on in the media to a greater extent? Both are true.

To explain the answer, I’d like to draw on the views of experts in the field of psychiatry. Whilst preparing the exhibition ‘Crazy Normal – A History of Psychiatry in Basel’ at the Basel Historical Museum (September 2024 to June 2025), we put a very similar question to 13 experts and those affected. The responses, including those from Alain di Gallo, Director of the Clinic for Children and Adolescents at the University Hospitals of Basel, can be summarised as follows:

Mental health issues and various stressors have always existed. However, several factors are currently converging that did not exist in the past and which pose a major challenge, particularly for young people. One example is the media, which demands constant availability and a perpetual online presence. The constant act of comparing oneself to others and being compared on social media places young people under enormous pressure. Global crises, environmental issues and wars are also omnipresent through the media – a daily and constant reality – which is stressful for many people and can trigger fears about the future.

In an interview, Alain di Gallo states clearly: children and young people are experiencing more mental health problems today than in recent years. And they are seeking help more often than was previously the case, particularly because of mental health issues.

He therefore also answers the second sub-question. The reason for this is essentially positive: mental health issues have been destigmatised and the taboo surrounding them has been broken in recent years. This means that we can now talk more openly about mental health conditions. There are more ways to say that we’re not feeling well. There are more places to turn to and support services available. People – including young people – are more willing to accept help – and that’s a good thing.

I hope this answer has been helpful to you.

Kind regards

Gudrun Piller