A child who doesn't like doing math homework may be diagnosed with the mental illness developmental-arithmetic disorder (No.315.4). A child who argues with her parents may be diagnosed as having a mental illness called oppositional-defiant disorder (No.313.8). And people critical of the legislation now snaking through Congress that purports to "end discrimination against patients seeking treatment for mental illness" may find themselves labeled as being in denial and diagnosed with the mental illness called noncompliance-with-treatment disorder (No.15.81).
The psychiatric diagnoses suggested above are no joke. They represent a few of the more than 350 "mental disorders" listed in the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the billing bible for mental disorders which commingles neurological diseases with psychiatric diagnoses. Whether the described diagnoses are real diseases or subjective speculation, science is at the heart of the debate about whether lawmakers will require employers and insurers to cover mental illness on the same level as physical disease.
Advocates of the Mental Health Equitable Treatment Act of 2002 (S 543), and its sister proposal in the House (HR 4066), are seeking to expand the 1996 "mental-health parity" legislation. It mandates employers with more than 50 employees and that offer mental-health coverage to provide insurance benefits equal to those of standard health care, such as surgery and physician visits.
The pending proposals would expand the 1996 legislation to require that caps, or limitations on coverage, be the same for mental illnesses as those provided for medical illnesses, in the name of so-called mental-health parity. When it comes to "mental illness" and "medical illness" however, there is no scientific parity between the two schools of thought. That is, only one is based in physical science.
Proponents of mental-health parity believe, and have for the most part successfully convinced lawmakers, that the mental illnesses described in the DSM-IV are medical diseases. For example, obsessive-compulsive disorder (OCD) is considered medically equivalent to, say, measles or anemia.
But critics patiently explain that the psychiatric "mental illness" as described in the DSM-IV is a subjective diagnosis that lies in the eye of the beholder rather than in proved medical science. How this issue is decided, these critics say, likely will determine whether millions of American families will be priced out of health insurance.
Fred Baughman, a San Diego neurologist and leading critic of the alleged mental illness called attention-deficit/ hyperactivity disorder (ADHD) (see picture profile, Feb. 18), tells INSIGHT the question that must be answered before a mental illness can qualify as a disease is this: "Where is the macroscopic, microscopic or chemical abnormality in any living patient or at death/autopsy?"
Baughman explains: "No one is justified in saying anyone is medically abnormal/diseased until such time as they can adduce some such abnormality. This, by the way, would apply to a person suspected of having diabetes or cancer."
The fact is, Baughman adds, "There is no psychiatric diagnosis for which any part of this question can be answered in the affirmative. In other words: no abnormality; no disease. There is no confirmation of abnormality in the brain in life or at autopsy for any of the psychiatric diagnoses. And they [in the psychiatric community] don't say this because it's part of the propaganda campaign to make patients out of normal people. The findings at autopsy would be very specific and would reveal whether it is a diseased brain and, if so, which disease it is. There is no proof in life or at autopsy of any of the alleged psychiatric mental illnesses, including schizophrenia, psychosis, depression, OCD or ADHD. …