Parity for Mental Illness, Disparity for Mental Patients

By Szasz, Thomas | Ideas on Liberty, March 2002 | Go to article overview

Parity for Mental Illness, Disparity for Mental Patients


Szasz, Thomas, Ideas on Liberty


The Therapeutic State

By definition, diseases are afflictions of the body. Hence, afflictions of the mind, called "mental illnesses," are not real diseases. Organized psychiatry deals with that embarrassing fact by reasserting its age-old claim that "mental illnesses" are brain diseases and enlisting the power of the state to turn fiction into fact.

In October 2001 the Senate approved a bill, spearheaded by Senators Pete V. Domenici and Paul Wellstone, outlawing disparities between insurance coverage for mental and physical illnesses. Domenici, the papers reported, "has a daughter with schizophrenia, and Senator Paul Wellstone, Democrat of Minnesota, whose brother has severe mental illness, pleaded with House members to outlaw the widespread limits on treatment for psychiatric disorders." Virtually without dissent, the media endorsed the cry for "parity." Nevertheless, on December 18, House members of the conference committee rejected the Senate proposal by a party-line vote of 10 to 7, Republicans voting no, Democrats voting yes.

For all practical purposes, there was no public debate about the pros and cons of using the power of the state to compel insurance companies to sell, and the public to buy and pay for, insurance for psychiatric treatment. The Washington Times, however, published my critique of the then-pending legislation as an op-ed article (December 9, 2001). In part I said:

"All too often," complained Sen. Pete V. Domenici, New Mexico Republican, "insurance discriminates against illnesses of the brain." That statement-and the argument for socalled parity for mental illness it supports-is simply not true. Neurologists and neurosurgeons do not lobby for parity insurance for their patients because insurance companies have no special exclusions for patients with neurological diseases. Only psychiatrists lobby for such "parity."

Advocating "parity for mental illness" is a hoax. The supporters of "mental health parity" do not want parity for mental patients: They do not seek equal "legal treatment" by legislators and courts for mental patients and medical patients. What they want is parity for psychiatrists: They seek equal "monetary treatment" by health insurance companies for psychiatrists and other physicians.

The phenomena we label as mental illnesses are not brain diseases, and everyone knows it. That is why psychiatrists protest that mental illnesses are bodily diseases, and why politicians proclaim the disease status of mental illness. Politicians say that mental diseases are brain diseases, but don't mean it. Lawmakers regard mental diseases as quasi-crimes: They pass laws that authorize psychiatrists and judges to deprive innocent persons of liberty by confining them in mental hospitals. There are commitment laws for persons diagnosed with mental diseases; there are no such laws for persons diagnosed with brain, lung, or liver diseases. Mental patients are often treated against their will and they can plead mental illness (insanity) as an excuse for murder; medical patients cannot be treated against their will and cannot plead bodily illness (brain disease) as an excuse for murder. So much for parity for patients.

Sooner or later, we shall have to confront the nature of "mental illness" and the differences between the legal statuses of mental patients and medical patients. …

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Parity for Mental Illness, Disparity for Mental Patients
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