Affluenza is a pseudoscientific psychological malaise supposedly affecting wealthy people. It is a portmanteau of affluence and influenza, and is used most commonly by critics of consumerism. It is not a medically recognized disease. The word is thought to have been first used in 1954, but was popularised in 1997 with a PBS documentary of the same name and the subsequent book Affluenza: The All-Consuming Epidemic (2001, revised in 2005, 2014). These works define affluenza as "a painful, contagious, socially transmitted condition of overload, debt, anxiety, and waste resulting from the dogged pursuit of more". A more informal definition of the term would describe it as "a quasi-illness caused by guilt for one's own socio-economic superiority". The term "affluenza" has also been used to refer to an inability to understand the consequences of one's actions because of financial privilege. The term "affluenza" was re-popularized in 2013 with the arrest of Ethan Couch, a wealthy Texas teen, for driving while intoxicated and killing four pedestrians and injuring several others. Testimony from a psychologist in court referred to Couch as having a case of affluenza as his defense, sparking a media frenzy and victim family outrage. Theory In 2007, British psychologist Oliver James asserted that there was a correlation between the increasing occurrence of affluenza and the resulting increase in material inequality: the more unequal a society, the greater the unhappiness of its citizens. Referring to Vance Packard's thesis The Hidden Persuaders on the manipulative methods used by the advertising industry, James related the stimulation of artificial needs to the rise in affluenza. To highlight the spread of affluenza in societies with varied levels of inequality, James interviewed people in several cities including Sydney, Singapore, Auckland, Moscow, Shanghai, Copenhagen and New York. In 2008 James wrote that higher rates of mental disorders were the consequence of excessive wealth-seeking in consumerist nations. In a graph created from multiple data sources, James plotted "Prevalence of any emotional distress" and "Income inequality", attempting to show that English-speaking nations have nearly twice as much emotional distress as mainland Europe and Japan: 21.6 percent vs 11.5 percent. James defined affluenza as "placing a high value on money, possessions, appearances (physical and social) and fame", which was the rationale behind the increasing mental illness in English-speaking societies. He explained the greater incidence of affluenza as the result of 'selfish capitalism', the market liberal political governance found in English-speaking