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Thursday, March 20, 2014

Medieval times in mental health

Three years ago a study asserted that 38% of Europeans have some form of mental or neurological illness and that they are woefully under-treated despite the generally acclaimed European health system. I doubt the number afflicted in the USA is much different, and treatment levels here are probably even lower. See this factsheet from the National Alliance on Mental Illness.

Steve Martin created a memorable character for Saturday Night Live in the 1970s: Theodoric of York, Medieval Barber. It satirized the practice of medicine, but it also serves as a warning that what we believe to be accurate, efficacious, compassionate, and safe today may turn out to be all wrong in the future. The history of psychiatry is replete with mistakes in hindsight such as the diagnosis of hysteria or the classification of same-sex orientation as a disease – an attitude that remains prevalent in some places. Some caregivers behaved outrageously.

There has been progress. We know more about mental illness now. We have better treatments, both pharmaceutical and non-pharmaceutical. Today's professionals in mental healthcare are conscientious caregivers, not motivated by their incomes. I am reminded of Ordinary People from 1980 and Good Will Hunting from 1997. Nevertheless I can't help thinking that we are still in medieval times when it comes to mental health overall. We still don't talk about mental illness much. We shun people who are afflicted and blame them for their own affliction. We closed many of our centralized institutions that provided mental healthcare, relying instead on community institutions, the private sector, and (especially) pharmaceuticals – changes that haven't worked out well. (The mentally ill comprise a large percentage of those who frequent homeless shelters, soup kitchens, etc.) Insurance companies and employers who self-fund their healthcare coverage turn the screws on therapists and their patients by limiting access and capping payouts.

This is so sad. Somehow, someway our society must do better. Meanwhile, beware that the rising costs of treating dementia are threatening our ability to finance healthcare for the elderly. Military suicides are an emergent problem, too.