The Premise of the Question

The Confused Gaze I once heard what I thought was a very good question to a panel of mental health professionals. “Isn’t it true that mental illness causes myriad physical problems, and that we as a society, and insurance companies in particular, would do better to take that into account in how we treat mental illness?”

I thought to myself, Yes! It causes all sorts of physical problems. Take us seriously, Rest of the Medical Community!

But the panel politely took objection to the premise of the question. They said that mental illness does not need physical illness to make it important. By itself mental illness is an enemy to the productivity of the workforce. By itself mental illness is a cause of profound human suffering. It is not just the cause of other, more consequential public health problems, it is a public health problem, deserving of the same type of public concern as heart disease or diabetes. This is what we mean by mental health parity.

From a public health perspective, the problem with thinking that mental illness can cause other, real illnesses is that it perverts the structure of mental health research and treatment by confusing real recovery with the repression of symptoms and the mitigation of secondary outcomes. It’s bad science.

From a personal perspective, the problem with sticking to a physical interpretation of a mental illness is that it invalidates my suffering. It makes me feel as if I don’t matter.

Screw that.

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