Perspectives - Vol. 5, No. 4 - Mental Illness, A Powerful And Dangerous Idea - Page 2 of 2Marilyn La Court Updated: Sep 1st 2000Continued from Page 1 Traditionally, health insurance protected us from having to pay for the treatment of a major illness at a cost that could wipe out a lifes savings, and we paid for our routine health care ourselves. Today, insurance pays the cost of treating both catastrophic and routine illness. The cost of health care has been rising over the years, and theres a lot of talk about how to cut it down. Many think covering the cost of services for people who are not even sick yet would be just plain crazy. Others however, think it would be just good business. During the years when Health Maintenance Organizations (HMOs) managed themselves, providing services for people who were not sick yet was considered cost effective, just good business. Studies show early detection and treatment for emotional problems reduces the potential for physical health problems. HMOs covered the cost of marital therapy, family therapy, and therapy for individuals with normal problems of living. They chose to pay up front to reduce the stress of their healthy members, before that stress could make them sick. HMO administrators realized, healthy people who are experiencing stress from unsolved problems of living are more likely to get a major physical illness like cancer, for example. Cancer can be very expensive to treat. Even on a routine basis, people with untreated emotional problems are heavy users of costly medical services. And, the services of mental health care providers are cheaper than those of medical health care providers. Apparently managed care thinks covering the cost of services for people who aren't even sick yet is just plain crazy. When the HMO was taken over by managed care everything changed. While the HMO sought to cut costs by cutting illness, managed care cuts costs by cutting benefits. Healthy people, with unsolved stress producing problems, must wait until they are sick before the cost of their treatment will be covered. By then, the cost of their care could be very expensive. Managed cares strategy of cutting benefits to cut costs could be a shortsighted solution that would increase the price of health care for the consumer and for the insurance company in the long run. Is covering the cost for treating people who are not sick yet just plain crazy or, is it just good business? Psychiatry seems to be saying, if treatment for mental illness is covered by insurance, lets just decide to call every problem of living a mental illness, and you and I can go see a therapist for help with a marital problem. Your therapist will simply find some code number in the DSM for you or your spouse to pacify the Managed Care Company and your treatment will be paid for. The only thing thats really changed is the requirement of a diagnosis of mental illness from DSM IV and the inclusion of intimate supporting information in peoples medical records. In the insurance world, Managed Care Companies (MCCs) rely on the DSM to determine what is considered medical necessity. They dont just rely on it, they insist on it. You cannot bill for treatment without using it. Insisting on a DSM diagnosis however is like no gate keeping at all. Just about every human behavior you can think of will qualify for a diagnosis of mental illness in the DSM, and therefore treatment will be covered by insurance. See, La Court, Marilyn. The Stigma of Mental Illness . Perspectives: A Mental Health Magazine. : April - July 1998. Who gains the most from our acceptance of the idea of mental illness? That should be no surprise. Drug Companies! Now that weve got a diagnosis, how will our illness be cured? Why with drugs called medicines of course. The drug companies know a good thing when they see it. They could teach us a lot about promoting an idea for financial gain. A screening test funded by a drug company doubled the number of people with psychiatric difficulties, many of whom will therefore be needing regular pills. Pfizer Inc. funded the creation of Prime-MD, a simple one-page questionnaire meant to be used by primary care doctors to screen for psychiatric problems. (John Leo (8) Drug companies advertise magical cures for mental illness as though they were offering Tylenol to reduce the pain of a headache. Now John and Jane Doe can request a happy pill from their doctor because everybody is taking it, or so it seems. The diagnosis of mental illness required to get the prescription will not be hard to come by. Their insurance will cover the cost for the doctor to diagnose and it will also, in many cases, pay for the drug as well. Incidentally when are Managed Care Companies going to catch on that the APA and the drug companies are one step ahead of them? While MCCs attempt to cut costs for the insurance companies, the APA markets mental illness to the American Public, and drug companies hawk their wares in the media. See Depression Update: atypical depression by Jeffrey Paul Kahn, M.D. in Newsweek, November 30, 1997. (10) This full-page ad looks and sounds like a public information announcement, however its an ad. This is an example of only one of many APA advertisements masquerading as news. TIMEMagazine, April 24,2000 carries a thirteen page ad, called a Special Advertising Feature supporting the idea of mental illness and magical cures offered by drug companies. The ad includes a particularly offensive ad by Lilly featuring Hope in a bottle. No doubt the Alcoholics Anonymous people will be justifiably outraged by this ad. Consumer Reports calls drug advertising to task in Your Health: Drug Advertising, Is this good medicine? June 1996. (12) Research findings clearly indicate that psychotherapy alone is equally as effective as drugs for treating the emotional pain of depression and anxiety. And psychotherapy has a better track record than drugs when it comes to long term results. Psychotherapy goes the extra step of solving the problems of living that cause the emotional distress. And, heres an interesting fact. Psychotherapy actually costs less to provide than drugs. But dont take my word for it. Im too lazy to do the research myself. See Institute for the Study of Therapeutic Change for research findings. wwwtalkingcure.com (2) check it out. Were a drug culture alright, but its not just street drugs that are the problem.
Who has the most to lose from acceptance of the idea of mental illness and its consequences? Unfortunately, its our kids. A recent report in Family Therapy Networker, Running on Ritalin states that there has been a 700 percent increase in the amount of Ritalin produced in the United States since 1990. And, that doesnt include other stimulants prescribed for ADD. (Dexadrine and Adderal) Ritalin like Dexadrine and Adderal is an amphetamine, speed. Diller (11) A psychiatrist friend of mine once told me that psychotropic drugs could be considered safe because they were not peddled as street drugs. Speed has been a drug of choice on the streets for many years. Now we are forcing our kids to take it. See, La Court, Kids Cant Just Say No to Drugs Prescribed By Their Doctors. Through My Eyes Family Page, CNI Newspapers, September 30, 1999. (13) Peter Breggin, a psychiatrist in Bethesda MD states, We are the first adults to handle the generation gap through the wholesale drugging of our children. We may be guaranteeing that future generations will be relatively devoid of people who think critically, raise painful questions, generate productive conflicts, or lead us to new spiritual and political insights. Growing up on psychiatric drugs, millions of children are developing little sense of personal responsibility. Instead of discovering their own capacity to improve their lives and to transform the world for the better, they are being taught they are brain-defective - and require lifetime treatment with psychiatric drugs. Peter Breggin, (14) Those who are concerned about the stigma of mental illness ought to be concerned about the harm done by the diagnosis itself, the ease with which it is possible to get a diagnosis, and the pushing of psychotropic drugs as a necessary treatment. A diagnosis of mental illness is not necessary for the treatment of stress producing problems of living, marriage problems, and family problems, and there are many effective alternatives to drugs for the treatment of these problems. But, there is still another problem with these diagnoses, they are not confidential. Medical information is not only easily accessible; it is used against people. See: Robert Davis, Private Medical Records Make Public Rounds in USA Today, Monday April 27, 1998. (15) According to Davis, some big employers have admitted in recent surveys that they use medical information to screen candidates There are many that support the practice of keeping medical records for continuity of treatment and for research purposes. Certainly a point could be made for the value of keeping detailed records on peoples physical illnesses, and having this information accessible for legitimate use. Its really terrible when information about breast cancer gets into the wrong hands, and the person with the disease is punished for having it. But maybe there is no way around the practice of having that information in a medical record; closer controls about who has access to it and how it is used may be the only answer. There is a big difference however between information about a persons physical health and information about a persons mental health. Its one thing when you and I casually use the terms anxious or depressed to describe an emotional state of being, but when a therapist attaches a code number from the DSM to these words, anxiety and depression become mental illnesses, and its not just the diagnosis that goes into the record. (And incidentally stays there practically forever) Detailed personal information about the persons behaviors, thoughts, beliefs, emotions, and values to justify the diagnosis are most often required by the Managed Care Company. These details are meant to be used as a gate keeping strategy. MCCs want to be sure therapists use the correct diagnosis so that the correct number of sessions can be approved. It used to be common practice for therapists to give clients the least harmful diagnosis possible, to protect their privacy. Now, they give bigger more serious diagnosis, to get more sessions paid for by insurance. When more serious diagnoses are used however, more serious and detailed information about people must accompany them. The very soul of the patient is exposed and that person is not only punished but is also stigmatized and blamed for her/his problems. A diagnosis of physical illness says something about a persons misfortune, but like it or not, to many a diagnosis of mental illness says something about a persons moral fiber. Consider this: What Fortune 500 company is going to hire a talented 30 year old who was diagnosed depressed with suicidal tendencies at age 25 if there is another talented 30 year old who only has medical information describing a bout with cancer, now in remission in her/his record? What is the justification for having mental illness diagnoses and intimate details about a persons soul in an insurance record? To whom is this information useful? Apparently a diagnosis of mental illness in a record is useful to insurance companies when determining rates to be charged, and the denial of coverage; to prospective employers who want to be sure the people they hire have the moral fiber to do their jobs; to the legal system when determining which parent will have custody of the children in a divorce action; to the military to determine who should be kept out of its ranks; to current employers when it comes to deciding who gets a promotion; to school personnel when deciding how to treat our children, and even to family members who want to have more leverage in a power struggle. Confidentiality can not be adequately protected no matter how many laws make unauthorized access illegal. Information about people in their insurance records is often used in harmful ways. Information about a persons mental health is not the same as information about a persons physical health. The only conceivable reason for having intimate details about a persons life in a medical record is for social control. But we cant have it both ways. We cant depend on a paternalistic system that attempts to protect us from the bad drugs of our choice, while at the same time it pushes and doles out the good drugs of its choice. We cant use mental illness as an excuse to act immorally, maliciously, and irresponsibly and protect our privacy our dignity, and our liberty. Mental illness: thats one mighty powerful and dangerous idea. References: American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. (DSM IV (reference # 3) Breggin, Peter Kids Are Suffering Legal Drug Abuse Boston Globe, 9/26/99 p.Eo7. (Reference #14) Consumer Reports, Your Health: Drug Advertising, Is this good medicine? June 1996. (12) Davis, Robert Private Medical Records Make Public Rounds in USA Today, Monday April 27, 1998. (Reference # 15) Davis, L. J. The Encyclopedia of Insanity. Psychological hand book lists a madness for everyone. Harpers Magazine. February, 1997. (Reference # 5) Diller, Lawrence, Running on Ritalin, Family Therapy Networker May/June 1999, p41. (Reference # 11} Kahn, Jeffrey Paul, M.D. Depression Update: atypical depression in Newsweek, November 20, 1997 (Reference # 10) Kutchins, Herb and Stuart A. Kirk, Making Us Crazy: DSM: The Psychiatric Bible and the Creation of Mental Disorders. Free Press, 1997. (Reference # 7) La Court, Marilyn. The Stigma of Mental Illness in the 1990s. Perspectives: A Mental Health Magazine. : April - July 1998. http://mentalhelp.net. (Reference # 9) La Court, Marilyn, Kids Cant Just Say No To Drugs Prescribed by Their Doctors Through My Eyes CNI Newspaper Family Page September 30, 1999. (Reference # 13) La Court, Marilyn, Mental Illness is a Bad Name Through My Eyes. CNI Newspaper Family Page, August 19, 1999. (General reference) Miller, Scott and Barry Duncan, Institute for the Study of Therapeutic Change. http://wwwtalkingcure.com (Reference #2) Leo, John The DSM Doing the Disorder Rag, U.S. News and World Report. October 17, 1997. (Reference # 8) Sharkey, Joe Youre Not Bad, Youre Sick. Its in the Book The New York Times, September 28, 1997 (reference # 4) Szasz, Dr. Thomas, A Lexicon of Lunacy: Metaphoric Malady, Moral Responsibility, and Psychiatry, Transaction Publishers, New Brunswick, New Jersey, 1993. (Reference # 6) Szasz, Dr. Thomas, The Myth of Mental Illness: Foundations of a Theory of Personal Conduct, rev. ed. (New York: Harper and Row, 1974. First published in 1961 (General reference) Szasz, Dr. Thomas, The Untamed Tongue; A Dissenting Dictionary. Open Court Publishing Company La Salle, IL, 1990. (Reference #1) TIME Magazine Special Advertising Feature April 24,2000 Marilyn La Court, M. A. of Confidential Counseling Services is a State Certified Marriage and Family Therapist and a State Certified Independent Clinical Social worker with over twenty years of professional experience. For information or to make an appointment: 262-797-9857. Reference
La Court, Marilyn (2000). Mental Illness, A Powerful And Dangerous Idea. [Online]. Perspectives. [2000, July 1]. | 
