Tuesday, April 07, 2009

The Mystery of Mental Illness: Sent this to the Metro News responding to an editorial on mental illness.

I agree with Dr. Gordon's April 7, 2009 editorial "Don't Stigmatize the Mentally Ill." I believe, though, some critical comments about mental illness and its treatment are in order. It is true mental illness should not, of course, be stigmatized. We are advanced, at least SOME of us are advanced, enough to know that the brain is an organ just like any other in the body. Sometimes as one's pancreas, for example, it does not function effectively for a variety of reasons. However, the stigmatizing, I think, that is accorded mental illness is that it is behavioral and not simply systemic in nature. Unlike other illnesses mental illness CAN produce threatening behavioral manifestations. I submit, it is the nature of how mental illness presents itself that is often the reason people fear it, stigmatize it and isolate people who show symptoms of it. We can clearly, I think, state that the man from Binghamton who killed so many innocent people was mentally ill. That does not preclude the fact that he posed a very clear and present danger to the community and no one knew it. When people present with bizarre behavior or speech people often do not know and fear what they will do.

Dr. Gordon and others in the mental health field will say that there are treatments for people with mental illness as there are treatments for people with diabetes and that is true. I though, maintain, the treatment offered to the mentally ill is sporadic at best and ineffective at worst. The treatment for mental illness shown in the panoply of medications offered for it are delivered often by trial and error. Treatment is haphazard as medications for certain diagnoses are seemingly thrown into a hat and then selected. Even the diagnosis itself is subjective. There is, in my opinion, no effective scientific measurement yet to determine which mental illness one has and which treatments are proper for it. We can only guess. That is not the case with diseases such as diabetes. Much of mental health care is, I submit, guess work and it often does not achieve the effective result. Drugs seem to work for a time, then medications must be increased and finally stopped as they become ineffective or cause unacceptable side effects.

Further, to complicate matters, drugs to treat mental illness can get expensive. We know the record of insurance companies paying for the average disease is often less than desirable but it is worse than that when it comes to mental illness. It is NOT treated by insurance companies with the same procedural equality as other illnesses may be. Co-payments are often large and sustained treatment sometimes not available ESPECIALLY for people who fall into the middle of the socioeconomic strata who have a difficult time -- especially in a down economy -- of getting treatment for anything much less for mental illness.

In my opinion, mental health professionals must work most especially on developing scientifically precise measurements of the brain and blood chemistry of mental illness. Insurance companies, too, should be forced by law to pay for the necessary treatment as they should for any other disease. It is only then, by the successful treatment of mental illness and the patient's ability to pay for it that its behavioral ramifications will be ameliorated and the public stigma reduced.