Copyright 2000 The Baltimore Sun Company
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The Baltimore Sun
January 23, 2000 Sunday FINAL EDITION
SECTION: PERSPECTIVE, Pg. 4C
LENGTH: 1053 words
HEADLINE:
Satcher report is bad science;
Criticism: The Surgeon General's report on
mental health is inaccurate because its conclusions aren't based on valid
research, a critic asserts.
BYLINE: Richard E. Vatz
BODY:
SURGEON GENERAL David Satcher's recently
released position paper, "Mental Health: A Report of the Surgeon General," is
inaccurate and misleading, because its conclusions are not the result of valid,
scientific research.
Satcher's report maintains that about one in five
Americans -or 53 million people - are mentally ill during any given year, and
that about 50 percent of Americans suffer from mental illness during their
lifetimes. These assertions are neither new nor scientific.
In the early
1990s, the National Institute of Mental Health (NIMH) made precisely the same
claims. The statistics came from surveys by "lay interiewers." Along with the
American Psychiatric Association, the NIMH recommended in the ill-fated 1993
Clinton health care plan that Americans should be insured for 30 out-patient
psychiatric visits a year with unlimited psychotherapy sessions. Let's do some
math. If 53 million Americans had 30 outpatient visits, the insurance companies
would have to pay for 1.6 billion psychiatric sessions a year. This would lead
to the birth of what has been described by critics as "the Therapeutic Society."
If the recommendations and claims of the Surgeon General's report were
taken seriously, it would also mean that mental illness would rank as the most
common chronic disease in America. According to the latest "Statistical Abstract
of the United States," it would surpass arthritis, which afflicts about 32.7
million, and hypertension, from which about 30 million suffer.
Psychiatrist Kay Redfield Jamison claimed in a Dec. 17 letter to the New
York Times, "The science underlying the numbers and treatments in the surgeon's
report ... is reliable and replicable." What she doesn't claim - what she cannot
claim - is that the numbers are valid. Psychiatry uses reliability of
psychiatric disorders (testing to see if diagnosticians agree on which
psychiatric disease patients suffer from) in the place of a search for validity
(ascertaining whether psychiatric diagnosis measures what it claims to measure).
This has been pointed out most recently by Dr. Paul McHugh of Johns Hopkins
University in an article in last month's Commentary magazine.
The
Surgeon General's report maintains that mental health should not be viewed as
"separate and unequal" to general health, and that there should be public
support for the long-standing goal of "parity" for mental illness, which means
insurers would have to treat mental illness on an equal basis with physical
illness.
The costs of parity are widely disputed, but they are likely to
be exorbitant.
In an article in the Washington Post, Carmella Bocchino,
vice president for medical affairs of the American Association of Health Plans,
said, "We've seen estimates that mental health parity would cost increases of 1
to 5 percent...Do we give up other parts of the benefits package, or are we
looking to rising health care costs?"
The Employee Benefit Research
Institute, a nonprofit think tank, has determined that, at a minimum, parity
will lead to increases in employer costs and possible elimination of other
benefits in some cases, including health insurance
coverage altogether.
The report also promotes the
mental health system's second major goal in addition to the
ad-dressing of parity: the elimination of stigma, which produces public
reluctance to pay for care and adds to the indignities of mental ill-nesses. In
the words of the report, stigma "must be overcome."
There are three
"severe mental illnesses" - schizophrenia, bipolar disorder and major
depression-and they are arguably caused by brain disease. The stigma should be
removed from them.
But stigma serves a useful purpose with the hundreds
of other so-called mental disorders: It deters many who would frivilously claim
to suffer from those "diseases."
One would think that the report's
conclusions would be more tentative given its caveats, such as, "It is sometimes
difficult to determine when a set of symptoms rises to a level of a mental
disorder" and "No single gene has been found to be responsible for any specific
mental disorder." Then there is this unqualified non sequitur: "For about one in
five Americans, adulthood is interrupted by mental illness."
There is a
reasonable alternative to the seemingly endless calls to expand the categories
of mental illness and to exaggerate the incidence and prevalence of mental
illness. Instead of allowing a large number of Americans to get cover-age for
nebulous maladies such as "adjustment disorder" or "social anxiety disorder,"
the insurance companies should provide full coverage for everyone suffering from
schizophrenia, bipolar disorder or major depression, all of which may result
from authentic brain disease.
The American Psychiatric Association
estimates that only about 3 percent to 4.5 percent of the public suffers from
"severe mental illness." Focusing on the true brain disorders would save the
nation millions of dollars and allow the money to be spent where it is really
needed.
Richard E. Vatz is a professor of communication at Towson
University. He holds a Ph.D. in communication from the University of Pittsburgh
and has written extensively on mental health issues.
About the issue
Last month, United States Surgeon General David Satcher issued a report
that determined one in five Americans suffers from a mental disorder and
millions of them fail to get treatment.
The report cited the stigma
associated with mental illness and the costs of treatment as reasons why people
fail to get help.
Money is a big factor. About 44 million Americans lack
health insurance. Many others are covered by insurance that restricts access to
mental health professionals and pays lower benefits for mental health care than
it does for physical illness.
The report renewed the call for "parity,"
equal coverage for physical and mental illnesses for all Americans.
Richard E. Vatz, a communications professor at Towson University,
maintains that the report is based on "bad science" motivated by a push to
expand the categories of mental illness.
Dr. Howard H. Goldman, a
psychiatry professor at the University of Maryland School of Medicine and the
report's senior editor, maintains that mental illness is widespread in our
society and that the report was based on sound research.
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