Wednesday, March 18, 2009

If the U.S. were my students, they'd flunk

The National Alliance on Mental Illness recently released a report card on America's health care system for adults with mental illness. Our grade: D.

At the Newhouse School of Public Communications, where I teach, this is a failing grade. We flunk when it comes to creating a support system for people with mental illness. We have no network of consistent services, no consistent access to mental health care, and no standardized system of licensing or treatment criteria.

We fail in other ways, too. We as a society fail to take seriously the ravages of mental illness. We step over those with mental illness both literally and figuratively. We turn our faces away. We perpetuate the shame and stigma of diseases like schizophrenia, bipolar disorder, and, yes, eating disorders.*

My students always want to know how they can raise their grades. I put the same question to all of you: How can we as a society raise our grades when it comes to mental illness?

Here's my two cents on the subject:
1. Offer incentives to those studying to be doctors and therapists. One reason we have such a staggering lack of good mental health providers is that in our current health-care system (or shall we say lack of health-care system) they can't earn as much as other docs. This is partly a function of how our disgraceful so-called health insurance system works. See 2.
2. Mental health parity is a good first step, but it's full of loopholes. Enact legislation that prevents health insurers from weaseling out of covering mental health issues. The track record is dismal, especially for eating disorders.
3. The first two items on the list would start us on the road toward lessing stigma around mental health issues. Shame on the health insurers for heaping more shame, and financial burden, on families struggling with these issues.
4. Talk, talk, and more talk. The more we talk about a subject, the less shameful it becomes. Social change takes time. Let's get started.

What are your ideas?

* I'm not a believer in classifying eating disorders as mental illnesses, but for now that's where they reside and so that's where we've got to live with them.


Anonymous said...

Canada has free allopathic and surgical treatment, but our mental health system is horrible, as well. It is basically a warehousing of people who need *real* help (i.e., long-term therapy, economic security, curative natural health treatments, etc.) Adding more 'doctors' (i.e., allopathic psychiatrists) to this appalling system definitely wouldn't improve it much.
My heart aches to know that so many people with mental illnesses (as I once was myself) just need a supportive environment, a large daily dose of a particular nutrient, and/or a few drops of a homeopathic remedy -- and yet, they will never, ever get it, because of the crazy, prejudiced system which is designed to make money selling drugs, not to actually cure people.

Anonymous said...

New York's grade is a B - isn't that where you are?

Anonymous said...

What is the problem with labeling eating disorders as mental illness? In the couple of blog posts I've found that address this issue I see a lot of 'well, mental illness is so stigmatized'. Well, yeah it is and it sucks. But no amount of concern about stigma is going to take away the fact that I am a person who deals with depression. Its almost as if people living with eating disordered are trying to distinguish themselves from 'those other people who really are crazy'.
In my own issues with bulimia/EDNOS as well as people I've known who battle anorexia and bulimia, mental illness was definitely an accurate description.
So I guess I'd like some more clarification and maybe even resources.

Harriet said...

NY may be a grade B, but the country as a whole gets a D. For the last 17 years I lived in Wisconsin, which gets a C. I have friends and family in California (C), Florida (D), Utah (D), Vermont (D), etc.

As for eating disorders and mental illnesses, my issue isn't that I think EDs are somehow "better" than things like depression and panic disorder. It's that I don't think EDs are psychological illnesses at all. Of course I don't think that depression, anxiety, schizophrenia, etc. are psychological illnesses either. So maybe my problem is with the associations around the phrase "mental illness," which many people read as "illnesses you could think your way out of if you really tried."

Anonymous said...

So maybe my problem is with the associations around the phrase "mental illness," which many people read as "illnesses you could think your way out of if you really tried."

When actually, the opposite is true. If you could think your way out of it, you wouldn't seek treatment. (Of course, there are people with serious depression for whom standard treatment modalities don't work at all, or cause life-threatening side effects, and they have no choice but to try to "think their way out of it." Which usually involves being on some sort of disability payments for years, since it's pretty much impossible to do it and hold down a job simultaneously.)

Of course, if they want a lot more people on psych meds, they're going to have to deal with that many more fatasses in the world. Just sayin'.

Harriet said...

Yes, well, fatasses of the world, uniter!

Anonymous said...

I live in Florida. I belong to a managed care practice. Humana to be exact. To obtain help for mental health issues one can call a number; get the name of available practitioners to choose from, psychiatry or psychology and have unlimited visits for $5.00 per visit. If you go to one and do not feel it is a fit, you call and get another name until you get a fit. I disagree with your assessment of Florida.

Harriet said...

It's not my assessment--it's NAMI's. You might want to take a closer look at their report and see why they gave Florida a D.

Anonymous said...

"My heart aches to know that so many people with mental illnesses (as I once was myself) just need a supportive environment, a large daily dose of a particular nutrient, and/or a few drops of a homeopathic remedy -- and yet, they will never, ever get it, because of the crazy, prejudiced system which is designed to make money selling drugs, not to actually cure people."

I really get angry when I see people make irresponsible comments like this. Its these kinds of comments that just add to the stigma of mental illness because you make it sound as if we're being duped by some giant conspiracy by 'they' who's just trying to make profit.

That's fine if a large dose of a nutrient works for YOU but the vast majority of us dealing with mental health issues have to rely on this 'crazy prejudiced system' to get better. And your patronizing sympathy for those of who do resort to man made chemicals that helps us get out of bed in the morning, take a shower, eat, go to work- all those things average people take for granted- is nauseating.

Anonymous said...

Harriet, I disagree with your assessment that eating disorders aren't mental illnesses. As a recovering binge and compulsive eater, I most certainly view my issues with food/body image/eating as mental illness. The distorted views of my body and the compulsion to eat were combined with anxiety and depression. The eating behavior was a mechanism and coping strategy to deal with the depression and anxiety. I don't feel at all comfortable separating the two (eating disorder/depression). I'm proud to be on my path to recovery and not ashamed to have suffered from a mental illness.

Ari J. Brattkus said...


Just the other night I watched a show called 'Strugggling in Silence' on our local PBS station. It discusses the stigma of depression within the medical community. Every year 300-400 doctors commit suicide, quite a staggering figure. The group that produced the film has a web site at and they are trying to find ways to destigmatize depression and educate physicians about mood disorders. It was really interesting.

Harriet said...

We'll have to agree to disagree on this. But I'm very glad you don't feel ashamed--you shouldn't. Whatever you call these disorders they are not anyone's fault. They're heritable, biological disorders. I have no doubt you've worked hard at recovering, but that doesn't to my mind change the basic fact that all of these disorders are rooted in physiology. If you were not in recovery now, I hope you wouldn't feel ashamed or culpable. I just don't think this stuff is anyone's fault.

I've had panic disorder for most of my life. I've come to understand that my neuro wiring is just a little screwy. Living with anxiety for so many years, I developed coping mechanisms that were not so hot. I think that's how "mental illnesses" become a blend of physiology and psychology. I can certainly do things to help myself (cognitive adjustments, meditation, diaphragmatic breathing, medication), but bottom line: it's not my fault, either.

Like Anonymous. I've had times in my life when better living through chemistry saved my life. Literally. I feel lucky to live in a time when we have access to medications as well as a range of other treatments.

Erica, thanks for the link. I'll check it out.

I'm glad this is such a lively discussion.

Anonymous said...

"a few drops of a homeopathic remedy"

um, what? so a few drops of a solution that is ten thousand parts water to one part medicinal substance is supposed to cure all mental illness? if my province ever decides that my tax dollars would be better spent subsidizing water placebos instead of legitimate research, that will increase, not decrease, people's suffering.

Anonymous said...

Harriet I'm almost wondering if there's some sort of misunderstanding about the definition of mental illness. It's almost as if its being conflated with psychosomatic disorders. I'm not trying to argue with you. I'm just trying to understand your perspective.

Most psychiatrists and therapists that I've dealt with are keen on saying this isn't your fault- its partly about environment but its mostly biology. There's no 'this is all in your head' One of the first things they ask about besides feeling down is physical manifestations of depression like lethary, chronic pain, headaches etc

Anonymous said...

Harriet; It strikes me that it's a false dichotomy that gets played out when people debate whether emotional, cognitive and personality disorders are biological vs psychological. The brain is an organ just like every other, and we must simply treat diseases of the brain as the medical problem that we do diseases of the kidney, or diseases of the endocrine system or diseases of the heart.

In doing this, we have to be realistic about dealing with the fact that the brain's FUNCTIONS include our personality, behavior, feelings and perceptions. A brain disease is going to impact these human functions. Those impacts will then need treatment by the appropriate clinicians. Just like you need to have knee surgery and then PT in order to recover.

The reverse applies as well, when we behave in such a way that our brain's physiology and function is affected - addiction, disordered eating, etc, those physiological effects have to be treated, as well as the psychosocial aspects of the behavior.

We really can't separate the brain's physical state, from our psychology or behavior, because they are in fact, different aspects of the the same miraculous organ.

Harriet said...

IrishUp, I think that's exactly right, and I look forward to a time when more people see it that way. Especially psychologists. Maybe I've been burned by ED "specialists" and their antiquated notions of causality. I think it's bigger than that, though. The fields of psychology and psychiatry are changing to a more biological framework, but we're in the middle of that change and not everyone is on the same page yet.

Anon, sounds like you've had some good therapists. Better than me. :)

Anonymous said...

There is a bill, recently proposed in Congress, HR 1193, that proposes money, etc, to fund research, treatment and education about eating disorders. Here is the letter that the Maudsley Newsletter recommends one can copy &/or edit and send to your congressperson in support of this bill. You can also google the bill and read the whole thing if you like:
and you can find your congressperson via

Your Name

Street Address



The Honorable First Name Last Name

United States House of Representatives

Washington, DC 20515

Dear Congressman(woman) XX,

As a member of the Eating Disorders Coalition and someone who has personally suffered the impact of

living with an eating disorder, I am writing you today to ask your support for the Federal Response to

Eliminate Eating Disorders Act (H.R. 1193). This is the first comprehensive eating disorders bill in the

history of Congress. By focusing on research, education, prevention and treatment this bill is a beacon

of hope for the millions of people currently suffering from an eating disorder.

It is estimated that 9 million Americans suffer from anorexia, bulimia, binge eating and other eating

disorders. Eating disorders are associated with a host of medical complications including cardiac

arrhythmia, cognitive impairment, osteoporosis, infertility, heart failure and most seriously death. In

fact, anorexia nervosa has the highest death rate of all mental disorders, upwards of 20%.

Research shows that eating disorders can be successfully overcome with early detection and adequate

and appropriate treatment. Unfortunately eating disorders are often undiagnosed by health

professionals and/or access to treatment is limited. Less than half of all people with eating disorders

receive the treatment needed.

The Federal Response to Eliminate Eating Disorders (the FREED Act) can change these state of

affairs. H.R. 1193 will save lives by providing more funds for research so that we can better

understand, prevent and treat eating disorders, grant programs that provide training for health

professionals, and steps toward better access to treatment coverage.

We urge you to sign on as a cosponsor of the FREED Act. I look forward to hearing from you. Thank

you again for your consideration.

Warm regards,

First and Last Name

Anonymous said...

Interesting posts on this blog. Thank you for taking the time to share. Blessings.

Dreaming again said...

I live in Oklahoma. I find it very scary that OK got a B, if this is a B, I'd hate to see lower grades!