When society is the asylum

Suzanne Fields
Posted: Jun 30, 2005 12:00 AM

Is something driving us all mad? The government seems to think so.
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.

 But there's a lot of room for inflation, distortion and misrepresentation in the diagnosis of human conduct as "sick." At one time, Washington was a mecca for psychiatrists because the government health insurance policies offered liberal benefits for therapy with scant evaluation of "success."

 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.