Only a few weeks ago, it would have been safe to assume that Jewel held a veritable lock on the Holiday Feelgood Prize for her latest collection of Christmas poems and profundities. But no one considered the dark-horse late entry from Washington—Mental Health: A Report of the Surgeon General—which comes as a soothing tonic to those who feared that, come Y2K, all the computers would be fine but all six billion world-wide humans would have a simultaneous nervous breakdown. Apparently the future is much more promising than that.
Dec. 13’s report marks the first time the Surgeon General has ever addressed the matter of mental health, in a 458-page document available online at www.surgeongeneral.gov or by calling, toll-free, 1-877-9-MHEALTH. Its calm, understanding tone makes it easy to picture its catalyst, U.S. Surgeon General David Satcher, wearing a cardigan sweater and smoking a pipe as he dictates it from a soft leather den chair, occasionally pausing to smile knowingly, pondering the wild world we live in. The reality may be that the report required two years, a massive staff, and an obsessive bibliography to complete—but after reading it, you feel like you’re going to get a clap on the shoulder, the keys to the sedan, and a warm “Everything’s going to be all right.”
The report’s eight chapters cover mental health’s scientific foundations and a history of how it has been handled. Children’s, adults’, and older adults’ differing requirements are addressed. There are sections on the increasing roles of HMOs in providing help and treatment, as well as a chapter devoted to the legal and ethical issue of confidentiality. It closes with “A Vision for the Future”—a formula requiring the elimination of stigma, continuing medical research, more universal coverage, and more specialized treatments.
A lot of it is stuff most of us secular humanists already knew: That mental illness isn’t just major psychosis, but a wide range of conditions that affect us all, directly and indirectly. The report lists Alzheimer’s disease, depression, and attention-deficit/hyperactivity disorder as some common examples that weren’t considered treatable mental illness until relatively recently. The common ground is that whatever the cause, the result is “distress and/or impaired functioning”; the bottom line is that, in the vast majority of cases, treatment exists, just like with physical ailments.
The problem has always been that there’s always been a lot more stigma going to a psychiatrist than there is going to the orthopedist after you turned your ankle stepping on a tennis ball. For this, the report says, we can blame Descartes and his philosophical separation of mind and body. (It’s always the French’s fault.) Mental processes are, in fact, physical: Actual transfers of chemicals and electrical impulses can just as easily swing a leg as a mood. So now, after centuries of alienation and asylums, the government’s clearing the air by saying that “almost everyone has experienced mental health problems in which the distress one feels matches some of the signs and symptoms of mental disorders”; that at least one in five Americans is affected by mental illness; that major depression has as much of a Disease Burden (calculated by lost years of healthy life to disability or premature death) as blindness and paraplegia; and that “nearly two-thirds of all people with diagnosable mental disorders do not seek treatment.”
If those who haven’t sought treatment in the past were to do so now, it might result in a national medical revolution. By braving a few potentially askance looks from the folks in the next pew, those looking to bring about positive change in their mental health would spur new research and treatment. Effective treatment is the proven remedy to the social stigma connected with mental illness; people most fear what they deem irrational and incurable. At the turn of the last century, for instance, tertiary syphilis and pellagra were considered mental illnesses—until antibiotics and niacin supplements, respectively, were found to cure them. Then the diseases were moved to the “physical” end of the medical encyclopedias and suddenly were no longer perceived as raving madness. As time passed, however, the stubborn few illnesses whose causes and remedies remained nebulous came to be viewed with greater suspicion and fear. Now that most mental disorders “are responsive to specific treatments,” the report says, “much of the negative stereotyping may dissipate.
“With rare exceptions, few persons are destined to a life marked by unremitting, acute mental illness,” it goes on to say. “The most severe, persistent forms of mental illness tend to be amenable to treatment, even when recurrent and episodic.”
Needless to say, if all of us feel symptoms akin to mental illness at some point, and if we all shake the fear of seeing a professional about it, the current health management system may not be perfectly poised to handle the roughly 280-million-patient influx. But even in the past year, both public and private health coverage have made decisive moves into the mental health arena, recognizing that both physical health and work productivity depend on solid mental health.
“Parity calls for equality between mental health and other health coverage,” our Surgeon General says with a chuckle, taking a long pull from his pipe. “Now get out of here, Tiger, and paint the town red.”