Parity or Prevarication?

Mental Illnesses Are Not the Same as Physical Illnesses

In my March 2002 column I showed that the advocates of parity for mental illness are engaged in a campaign of calculated falsehoods. Their claim that mental diseases are brain diseases is a lie. The last thing the mental-health zealots want is parity in the legal treatment of mental patients and medical patients. Despite being characterized by a scorched-earth policy toward the truth, this campaign enjoys the unanimous support of both psychiatrists and journalists. The parity warriors seem very near to “victory,” as the following developments show.

Thanks to momentous advances in the science of psychiatry, the problems of diagnosing and treating these dreaded maladies have, according to the experts, been solved. Thus the battle lines have shifted from health and illness to money and where it should come from. Who should pay for mental-health treatment?

Formerly, the person who had a bodily disease, say diabetes, either paid for the treatment he needed, or his family paid for it, or he received care as a charity patient in a public institution, often the “teaching hospital” of a medical center. Today, private insurance, Medicare, and Medicaid are additional sources of payment for the treatment of such diseases.

The economics of treating mental diseases was never like this. Prior to the 1960s, the person who had a serious mental disease, say, schizophrenia, typically maintained that he was not ill, did not seek treatment, and was confined in a state mental hospital; the taxpayers of his state paid for the “treatment.” The person who had a nonserious mental disease, say anxiety neurosis, paid for the treatment himself or employed nonmedical means of coping with it or managed to live without what we call “medication.”

During the past several decades, psychiatrists, politicians, and the media convinced themselves and the public that “mental illnesses are like other diseases.” One result was that private health insurance, Medicare, and Medicaid have “recognized” some mental illnesses as diseases and have reimbursed patients for some psychiatric treatments. However, for reasons most people are familiar with, third-party payers have limited coverage for mental-health treatment to certain “conditions” and to defined periods of time. As a result, the war against mental illness has become a war against the enemies of “mental health,” waged with the slogan, “parity for mental illness.” Leading the war most recently were Marge Roukema and Patrick Kennedy in the House and Pete V. Domenici and the late Paul Wellstone in the Senate; they sponsored the new sets of mental-health parity bills.

As I shall now show, when our politicians talk about mental-health parity, they really mean parity between crazies and criminals, not between mental illness and bodily illness.

Our Lady of Peace Act of 2002

In the spring of 2002, Rep. Carolyn McCarthy of New York announced new legislation to “require states to notify the federal government when anyone who has been committed to a mental institution attempts to purchase a gun.” McCarthy was joined by Senator Chuck Schumer of New York, Father Bill Singleton from Our Lady of Peace in Lynbrook, New York, and Lynbrook Mayor Eugene Scarpato.

What prompted the introduction of still another law demonstrating parity between the mental hospital and prison, and hence, derivatively, between the “patient” in the “hospital” and the criminal in the prison? The shooting of two people in a church in Lynbrook allegedly by a “a disturbed gunman with a history of mental health problems.”

Actually, since 1968, federal law has required state and local government agencies to report the names of persons “adjudicated as mentally defective” to the FBI, which is responsible for conducting the National Instant Criminal Background Check System for people seeking to purchase firearms.

Not surprisingly, this law has not protected Americans from crazies with guns. But that has not persuaded the supporters of mental-health parity that the provision treating mental patients as felons ought to be abolished. On the contrary, it has inspired our policymakers to strengthen the law by defining mental illness more carefully.

How does the bill define mental illness? By criminal, not medical, criteria: “The term ‘adjudication as a mentally defective’ as defined in S. 2826, encompasses a variety of categories, including all individuals who have ever been involuntarily committed to a psychiatric facility, without regard to the seriousness of their disability, when the commitment occurred or the reason for the commitment. Additionally, any determination (formal or otherwise) by a governmental agency that a person is a danger to themselves as a result of a mental disorder or illness would serve as a basis for reporting their name to the FBI.”

The cost of implementing this bill? A total of $375 million for fiscal years 2004, 2005, 2006.

Hypocrisy Anyone?

None of this fazes the mental-health-parity fanatics. In May 2002 an editorial in the New York Times lauded President Bush for saying “some encouraging words this week about the need for a health care system that will treat mental illness with the same urgency as physical illness,” and urged him “to lean on recalcitrant House Republicans . . . to pass a bill elevating mental health coverage to a par with medical and surgical coverage.”

An editorial in the Los Angeles Times echoed the same view: ” . . . President Bush decried how the mental health system lets ‘too many Americans fall through the cracks,’ leaving people whose brains have somehow betrayed them stuck on the street or in prison before help is given.” This editorial also encouraged the President to embrace the so-called mental-health parity bill sponsored by Senators Domenici and Wellstone, compelling “health plans to offer equal payment for the treatment of certain mental illnesses and other physical ailments.”

In my March 2002 column I called attention to the fact that, by definition, diseases are afflictions of the body; hence, afflictions of the mind, called “mental illnesses,” are not real diseases; and if, as many people now claim and seemingly believe, mental illnesses are brain diseases then they ought to be treated by neurologists.

Here I add that if we are serious when we say that “mental illnesses are like other diseases,” then hospitalization for mental illness should, for purposes of qualification for gun ownership, be treated as hospitalization for trigeminal neuralgia, not as imprisonment for crime.

In the meantime, I stick to my view that there are no mental illnesses, and lament that we attribute the violence of so many people to these fictitious diseases and, in the process, undermine personal responsibility, individual liberty, and public safety.