Making Maryland 'the Therapeutic State'

February 13, 1994|By RICHARD E. VATZ and LEE S. WEINBERG

Enactment of the Mental Health Insurance Parity Act makes Maryland the first state to require insurers to make available mental illness benefits "under the same terms and conditions [as those] provided for any other type of health care."

This "landmark legislation" (the Washington Post) was passed without significant news coverage (none in The Sun) and without public debate.

Sen. Howard A. Denis, R-Montgomery, a long-time supporter of legislatively imposed parity coverage for mental illness, "Mental illness should be viewed as it is: a form of illness. It should be treated in insurance policies the same as other types of illnesses."

This is the oldest myth of the mental health field: "Mental illness is just like any other illness."

Also a myth is the current claim that expansive (and expensive) ** insurance coverage of mental illness has wide public support.

Even with proposed changes, the new law will cost Marylanders millions, but more damaging, it will purport to resolve by legislative fiat a raging scientific dispute over whether the hundreds of so-called "psychiatric disorders" as well as the abuse of drugs are in reality "just like other illnesses."

The Maryland law has been under attack in the courts, but it appears now that a compromise has been reached among all interested parties that will avoid the court challenge.

The compromise, reached this month by legislators, insurers, organizations of health workers and the Mental Health Association of Maryland, would drop a provision in the law that would have allowed policyholders to waive mental health coverage. It provides coverage parity for inpatient treatment beginning July 1, 1995, and eventually expands outpatient coverage, but with co-payments.

Both the original statute and the compromise represent a major step toward bringing about what psychiatrist Thomas Szasz has termed the "Therapeutic State," one that medicalizes all problems in living. This comes despite a general movement across the country in commercial and private insurance to restrict mental health coverage. Further, it represents the first test of the concept of "parity" for mental illness, a clear goal of the Clinton National Health Care Plan.

Mental health professionals use the same term, "mental illness," to refer to all categories of mental illness, whether or not there is a scientifically established link to a biological condition. Thus, while less than 5 percent of the American people have mental illnesses that even psychiatrists claim are proven medical conditions, the term "mental illness" is regularly applied to a population large enough to justify the word "pandemic."

The view that all mental illnesses are genuine physical illnesses has been promoted by psychiatry in recent years. In the Journal of Abnormal Psychology, members of the American Psychiatric Association's task force on the revision of their diagnostic manual admit that "there are those who want some or all mental disorders designated as diseases in order to protect reimbursement and research funding."

Mental health expansionists have successfully managed to create an association in people's minds between "mental illness" and pictures of pathetic, deranged people who speak incomprehensibly or are incapacitated. Even the American Psychiatric Association argues that only about 4.5 percent of the public is in that category.

The rest of the "mentally ill" are either the "worried well," with problems in living that are manageable without further taxing the overly taxed health care dollar, or others experiencing a wide range of distress, some of whom might deserve coverage.

More and more middle-class people, however, are using psychoactive drugs for the casual pursuit of "enhancing" their lives. Such prescriptions are reimbursable through what psychiatrist Peter Kramer concedes in his well-publicized work "Listening to Prozac" is a "diagnostic bracket creep -- the expansion of categories [of mental illnesses] to match the scope of relevant medications."

As David Rothman, professor of social medicine at Columbia University, points out in a recent issue of the New Republic, in large part because of the Prozac craze, between 1980 and 1989 there has been a 50 percent increase in the number of patients who are prescribed anti-depressants.

In support of treating "mental illnesses" at parity with physical illnesses, the mental health industry has of late been trumpeting a Parade magazine poll from October of last year. A front-page story in the American Psychiatric Association's newsletter reported that the Parade poll had found that "ninety-eight percent of the respondents say that insurance [plans] should cover medication and/or therapy for the mentally ill."

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