Mental Health Toll
Human suffering, economic costs are staggering.
The ‘bible” of mental health diagnoses is DSM-5, formally known as the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. I know it’s a cliché to call anything “the bible” of this or that discipline or following, but it really is valid here. For decades, this book, produced by the American Psychiatric Association, has been the standard reference work for almost everyone in the mental health field, including psychiatrists, psychologists and assorted therapists.
Here's an excerpt from Psychiatry.org (which is the American Psychiatric Association) explaining the book’s utility and some of its updates (hence the 5th edition):
[It] features the most current text updates based on scientific literature with contributions from more than 200 subject matter experts. The revised version includes a new diagnosis (prolonged grief disorder), clarifying modifications to the criteria sets for more than 70 disorders … symptom codes for suicidal behavior and nonsuicidal self-injury, and updates to descriptive text for most disorders based on extensive review of the literature. In addition … [it] includes a comprehensive review of the impact of racism and discrimination on the diagnosis and manifestations of mental disorders. The manual will help clinicians and researchers define and classify mental disorders, which can improve diagnoses, treatment, and research.
Most interesting to me is that work on the 5th edition began in 1999; it was published in 2013. Others will find comfort in the topline reference to “the impact of discrimination and racism on the diagnosis and manifestations of mental disorders,” while other will allege political correctness.
There are hundreds, if not a thousand or more, mental illnesses and disorders listed, including subdivisions or sub-categories of an illness or disorder. Traditionally, one might only think of the major psychiatric illnesses such as schizophrenia, bipolar (1 or 2), clinical depression (now more commonly referred to as Major Depressive Disorder) and a few others. It’s easy to ask how can there be hundreds more disorders worthy of inclusion in a book like DSM-5, with a code for insurance purposes and diagnostic criteria. But maybe it’s true!
Then there is the case of Asperger’s Syndrome, which was listed in DSM-IV (they formerly used Roman numerals) but has been dropped in favor of a reference to “Autism spectrum disorder” in the latest edition. This move has proven controversial because, according to one qualified source, “those suffering from Asperger's syndrome have no general delay or retardation in language or in cognitive development.” Does the change encourage treatment, or discourage it?
There is always controversy surround this manual, in every edition, either because it lists too many disorders, or not enough, or there is not a real consensus on the nature of the disorder or its diagnosis. Nonetheless, the manual is an effort to refine definitions and descriptions in much the same way, for example, cardiologists would identify heart problems. Physicians can physically examine organs, tissue and cells (under a microscope or other lab equipment), and can use tests that give positive or negative results, while psychiatrists and clinical psychologists mostly rely on observation, self-reported data, and scores on various written tests. Clearly, it is more difficult to come up with a reliable diagnosis and treatment plan, but that is the goal. As for traditional psychoanalysts … well, there aren’t many left, and they largely relied on “theory.” I’ll have more to say on Freud, Adler and maybe some others in a later post.
Estimates for receiving a diagnosis of a mental health disorder or illness during one’s lifetime vary, but are always high, even as high as 50 percent. What does it mean for so many people to be walking around with a mental illness or disorder at any given time? Are so many of us the walking wounded?
Well, maybe yes. I think of the human suffering, but there also are the economic costs. According to a White House report, we spent $280 billion annually on mental health treatments and services as of 2020, and a quarter of that sum came from Medicaid, which is taxpayer supported. That figure does not include the cost in lost productivity at work, whether from days off or just poor performance on the job. Also apparently not included in that estimate is the cost to homeless people – those “living rough” on the streets or shuttling between different shelters. I’ll later be writing about “deinstitutionalization” from state mental hospitals that began at least in the 1960s and its direct relationship to the homeless problem of today.
There was a time when insurance plans covered little or nothing in terms of mental health treatments, and the cost of hospitalization for major mental health illnesses was prohibitive for most families (also more on this in a later post). The situation is better today, but there are still substantial limitations. In another later post I’m going to look more closely at the new, online ads for therapy, which work very much like Thumbtack (for home repair services) or Upwork (for more computer-related work such as establishing a website or help writing a resume). These sites have you register and log in, after which you’ll see a picture of a smiling, caring therapist, and then you click here or there to make a contact. The websites absolutely take a cut of your fees, and the screening can be sketchy.
What’s the solution? I don’t know. Right now, all I want to do is raise awareness of the trends in diagnosis, the pervasiveness of the problem, and the extent of the economic costs involved.
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