Jewish World Review

Dec. 22, 1999/ 13 Teves, 5760

You are NUTS!

Cathy Young
Jewish World Review

"GET THEE to a therapist!" is the Surgeon General's mandate in a just-released 500-page report on mental health. The report claims that more than one in five Americans (22%) suffers from a "diagnosable mental disorder" at any time, and laments that two-thirds don't seek treatment. This is blamed on stigma and cost; the report endorses equal insurance coverage for mental disorders and physical illness, a goal the Clinton Administration has championed for some time.

As one might have guessed, pushing the number of sufferers to one in five required defining mental illness down. To most of us, "mental illness" means an extreme condition that makes a person incapable of functioning in daily life: psychosis (loss of contact with reality) or major depression, especially unrelated to depressing life events. But the "official" definition includes mild depression and plenty more. The latest, 1994 edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV) lists more than 300 "diagnosable mental disorders," compared to just 60 in the 1952 edition.

Has the psychiatric profession's knowledge of mental illness improved so dramatically, or has its notion of what constitutes mental illness expanded so dramatically? A look at some diagnostic criteria suggests the latter. Narcissism, self-doubt, excessive devotion to work, obnoxiousness -- everything is a "disorder."

The latest rage is "social phobia." One survey determined the prevalence of this disease by asking respondents if they thought they were more nervous than other people when speaking in public or attending large social gatherings, and if this bothered them a lot.

While the Surgeon General's report frets about "the public's reluctance to pay for mental health services," its summary of poll data does not seem to support this complaint: people show "greater willingness to pay for insurance coverage for .... severe mental disorders, such as schizophrenia and depression, rather than for less severe conditions such as worry and unhappiness." Seems like -- pardon the pun -- a pretty sane approach.

The ballooning definition of mental illness should cause us worry and unhappiness for at least two reasons.

First, medicalizing such a wide range of problems essentially reduces the human condition to a clinical condition, undermining such old-fashioned notions as character, self-reliance, and the human spirit. It's ironic: at one extreme, there's an effort to "mainstream" people with truly severe mental disturbances; at the other, any deviation from some white-bread norm of stability is pathologized.

(Including, says the Surgeon General's report, bereavement lasting more than two months!)

This evokes shades of Aldous Huxley's Brave New World, where any unpleasant emotions were quickly medicated away. The potential for coercive therapeutic intervention in private lives is clear and disturbing.

The other danger is that vast sums of money may be spent on treatments of dubious value. As John Horgan convincingly argues in his recent book The Undiscovered Mind, science still knows very little about treating mental distress. The field of psychotherapy is full of modern-day witch doctors whose techniques (such as recovered memory therapy) may do more harm than good. As for highly touted miracle drugs, studies show that while 50% to 60% of patients on anti-depressants such as Prozac show an improvement, so do 30-40% of patients given a placebo pill. The effects for people with mild depression may be especially negligible. What's more, the improvement is often temporary.

In one fascinating study of depression treatments, reported in a 1995 article by University of Washington psychologist Neil Jacobson, some patients took drugs, some had conventional therapy, and others met with therapists but talked about subjects like sports or gardening rather than personal problems.

All three groups had fairly similar (and not very encouraging) outcomes: 20 to 30% recovered from depression and stayed well for the next year and half.

Unquestionably and tragically, many people with severe mental illness that makes them dangerous to themselves and others are not getting treatment that could help them. But let's not lump them together with those whose problems could be addressed just as well by joining a gardening club.

JWR contributor Cathy Young is co-founder and vice-president of the Women’s Freedom Network and author of Ceasefire! Why Women and Men Must Join Forces to Achieve True Equality. Send your comments to her by clicking here.

©1999, Cathy Young