Jewish World Review June 30, 2005/ 23 Sivan,
When society is the asylum
A survey for the National Institute of Mental Health (NIMH) says
that more than half of all Americans will develop mental illness in their
lifetimes, and that a quarter of us are already suffering from a mental
disorder. These extremely high numbers suggest inflation of rhetoric if not
reason, or at least an appetite for a larger budget appropriation.
The survey, published in the June issue of the Archives of
General Psychiatry, invites skepticism. Dr. Paul McHugh, professor of
psychiatry at Johns Hopkins University, is typical of the skeptics. "Fifty
percent of Americans mentally impaired?" he scoffs to the New York Times.
"Are you kidding me? Pretty soon we'll have a syndrome for short, fat Irish
guys with a Boston accent, and I'll be mentally ill."
You don't have to be Tom Cruise to be suspicious of psychiatry
(though you might have to be Tom Cruise to lapse into hysteria about your
skepticism on national television). The diagnoses of mental illness have
changed as often as the treatments and cures. Mental illness has been
medicalized, politicized and spiritualized. Patients have been put in cages,
dumped in "snake pits," drugged with chemicals and subjected to the removal
of parts of their brains, and shocked, literally, with electricity into
sanity, so called.
Distinctions between normal behavior and mental illness are not
always clear. Sometimes scientists and surveyors working the field suffer
from their own personal delusions. Thomas Szasz, a psychiatrist who has
written many books on the subject, says flatly that "mental illness is a
myth." On the other hand, Peter Kramer, a psychiatrist who writes best
sellers on contemporary treatments, tells of great strides in treating
depression with a combination of new drugs and talk therapy.
Schizophrenia, a major mental illness, is not counted in this
report. Instead, the diagnoses cover a wide range of disorders, anxieties
and mood changes, including "impulse control behavior," drug and alcohol
abuse, and severe depression. The diagnostic manual of the American
Psychiatric Association used for defining mental illness has grown from 60
to over 330 maladies in 50 years. More than 4 million homosexuals, for
example, went from sick to well in 1973, not from therapy but merely by
being dropped from the category.
The survey, conducted by the University of Michigan, cost $20
million in both government largesse and private money from health research
foundations and pharmaceutical companies. It was based on 10,000 interviews
of randomly selected Americans in 34 states. The findings, though
fascinating, should be taken with healthy skepticism and with a warning
label to follow the money. Psychiatry is big business. The federal
government pays about 66 percent of the costs of mental illness.
Medical miracles developed by drug companies have alleviated
great suffering. Such miracles require substantial scientific investments of
time and money, and return enormous profits. We can applaud devoted doctors
who work in a grueling and challenging field, often alleviating crushing
mental anguish. Their patients are by definition unstable, unreliable and
sometimes unresponsive. We should be outraged when stingy insurance
companies refuse to pay for legitimate disorders or when psychiatric
establishments offer diagnoses and treatments that apply only for the
duration of insurance payments.
Ignoring symptoms can be expensive, too. My father suffered from
depression for years that went undiagnosed by a general medical doctor. When
he finally saw a psychiatrist who prescribed anti-depressants, he called his
medicine "life saving." The National Institute of Mental Health reports that
only a third of those surveyed who sought help actually found effective
treatment. Many relied on those with no medical expertise at all.
Distinctions between mental illness and difficulty in dealing with everyday problems of living, between coping and growth, between traumas that destroy and traumas that make us stronger, have always been difficult to make. Psychiatry is not a science measured in a lab. It's vulnerable to misinterpretation. That makes it all the more important that a government survey be precise in its terms and clear in its definitions. This latest survey sounds as if its interviewers are eager to find a symptom to fit a label. When over half the population is labeled as suffering from mental illness, that's not believable. That's just nuts.
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