Satcher report is bad science

Criticism: The Surgeon General's report on mental health is inaccurate because its conclusions aren't based on valid research, a critic asserts.

January 23, 2000|By Richard E. Vatz

SURGEON GENERAL David Satcher's recently released position paper, "Mental Health: A Report of the Surgeon General," is inaccurate and misleading, because its conclusions are not the result of valid, scientific research.

Satcher's report maintains that about one in five Americans -or 53 million people - are mentally ill during any given year, and that about 50 percent of Americans suffer from mental illness during their lifetimes. These assertions are neither new nor scientific.

In the early 1990s, the National Institute of Mental Health (NIMH) made precisely the same claims. The statistics came from surveys by "lay interiewers." Along with the American Psychiatric Association, the NIMH recommended in the ill-fated 1993 Clinton health care plan that Americans should be insured for 30 out-patient psychiatric visits a year with unlimited psychotherapy sessions.

Let's do some math. If 53 million Americans had 30 outpatient visits, the insurance companies would have to pay for 1.6 billion psychiatric sessions a year. This would lead to the birth of what has been described by critics as "the Therapeutic Society."

If the recommendations and claims of the Surgeon General's report were taken seriously, it would also mean that mental illness would rank as the most common chronic disease in America. According to the latest "Statistical Abstract of the United States," it would surpass arthritis, which afflicts about 32.7 million, and hypertension, from which about 30 million suffer.

Psychiatrist Kay Redfield Jamison claimed in a Dec. 17 letter to the New York Times, "The science underlying the numbers and treatments in the surgeon's report ... is reliable and replicable." What she doesn't claim - what she cannot claim - is that the numbers are valid. Psychiatry uses reliability of psychiatric disorders (testing to see if diagnosticians agree on which psychiatric disease patients suffer from) in the place of a search for validity (ascertaining whether psychiatric diagnosis measures what it claims to measure). This has been pointed out most recently by Dr. Paul McHugh of Johns Hopkins University in an article in last month's Commentary magazine.

The Surgeon General's report maintains that mental health should not be viewed as "separate and unequal" to general health, and that there should be public support for the long-standing goal of "parity" for mental illness, which means insurers would have to treat mental illness on an equal basis with physical illness.

The costs of parity are widely disputed, but they are likely to be exorbitant.

In an article in the Washington Post, Carmella Bocchino, vice president for medical affairs of the American Association of Health Plans, said, "We've seen estimates that mental health parity would cost increases of 1 to 5 percent...Do we give up other parts of the benefits package, or are we looking to rising health care costs?"

The Employee Benefit Research Institute, a nonprofit think tank, has determined that, at a minimum, parity will lead to increases in employer costs and possible elimination of other benefits in some cases, including health insurance coverage altogether.

The report also promotes the mental health system's second major goal in addition to the ad-dressing of parity: the elimination of stigma, which produces public reluctance to pay for care and adds to the indignities of mental ill-nesses. In the words of the report, stigma "must be overcome."

There are three "severe mental illnesses" - schizophrenia, bipolar disorder and major depression-and they are arguably caused by brain disease. The stigma should be removed from them.

But stigma serves a useful purpose with the hundreds of other so-called mental disorders: It deters many who would frivilously claim to suffer from those "diseases."

One would think that the report's conclusions would be more tentative given its caveats, such as, "It is sometimes difficult to determine when a set of symptoms rises to a level of a mental disorder" and "No single gene has been found to be responsible for any specific mental disorder." Then there is this unqualified non sequitur: "For about one in five Americans, adulthood is interrupted by mental illness."

There is a reasonable alternative to the seemingly endless calls to expand the categories of mental illness and to exaggerate the incidence and prevalence of mental illness. Instead of allowing a large number of Americans to get cover-age for nebulous maladies such as "adjustment disorder" or "social anxiety disorder," the insurance companies should provide full coverage for everyone suffering from schizophrenia, bipolar disorder or major depression, all of which may result from authentic brain disease.

The American Psychiatric Association estimates that only about 3 percent to 4.5 percent of the public suffers from "severe mental illness." Focusing on the true brain disorders would save the nation millions of dollars and allow the money to be spent where it is really needed.

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