Limiting Aid for Mental Illnesses

In response to “Sort Out Mentally Ill From ‘Worried Well” by Richard Vatz and Lee Weinberg, Commentary, Dec. 13:

Vatz and Weinberg’s position is a clear example of the anti-psychotherapy rhetoric that seems to be approaching fever pitch since the rollout of the Clinton health plan.

The authors, neither a psychotherapist, make several distortions. One is that psychological suffering falls into only two categories: “severe,” by which they mean psychotic, and the “worried well.” In a given week I might see an unemployed aerospace executive, impotent for a year, a single mother stressed to exploding point who wants help before she hits her kids, a teen who has shredded his surfboard while listening to his divorcing parents shred each other, a woman experiencing flashbacks from a rape at gunpoint seven years ago. None of these is “severely mentally ill”; all are in debilitating pain, underfunctioning at work, in school and in their lives. “Worried well”? Come on.

They also suggest that because we cannot afford to help all of the 52 million Americans with some form of diagnosable condition without bankrupting the system, we solve this problem by de-legitimizing psychologists, social workers and counselors. That’s the equivalent of putting a bag over your head and believing you’ve disappeared.

Unacknowledged mental pain does not disappear. Neither do odd behavioral problems, spousal abuse, victimization and job stress. “Problems of living” are real problems with significant psychological dimensions that if untreated, lead adults and the children in their lives to the severe and chronic conditions the professors do seem willing to have treated.

Withholding treatment until people hit bottom is the most expensive and least effective (not to mention least compassionate) way to structure mental health services. If early intervention is recommended for heart disease, why not for psychological illness?

MAUREEN O’HARA Ph.D.

Solana Beach

Congratulations to Vatz and Weinberg for defying the “politically correct” dogma that mental and physical disease are equivalent. There are not objective tests for most mental disease and there are strong disagreements among mental health practitioners over questions of diagnosis and therapy. Indeed, they often form opposing camps that champion one particular form of therapy above all others. Can you imagine a group of internists with serious disagreements over the diagnosis and therapy of diabetes or congestive heart failure?

JOHN J. MICHON MD

Los Angeles

On behalf of the National Alliance for the Mentally Ill, with its 140,000 families who have a relative suffering from a severe mental illness, I respond to the column by Vatz and Weinberg. We agree with the headline, provided that “mentally ill” refers only to persons suffering from a neurobiological disease of the brain, known as schizophrenia, manic depression, clinical depression, obsessive compulsive and panic disorder. These diseases are as diagnosable as Alzheimer’s and Parkinson’s, and as treatable and controllable as diabetes, hypertension and other physical diseases.

When the number of people with mental health problems are added to those with diagnosable, treatable neurobiological brain diseases, the total is so large that many argue mental health coverage is not affordable. We strongly disagree. The National Institute of Mental Health estimates that in any given year, 5 million people require acute medical care for their mental illness. The real diseases must be covered in parity with all other physical diseases.

Outcomes indicate that with proper medication combined with psychiatric (psychosocial) rehabilitation and case management, recovery for these persons to their potential--returning to school, to vocational training, to working at a part-time paid job or a volunteer job--is possible. Not treating or under-treating persons with neurobiological diseases would be far more costly. They would be returning to hospital care, to jails without care, to the streets--or to their grave.

STELLA MARCH, First Vice President

National Alliance for the Mentally Ill

Los Angeles