Schaler, J.A. (1994, March 29) Health coverage for the mentally ill.
The Washington Post, Health Section, Letters, p. Z4.

Health Coverage for the Mentally Ill

Your Second Opinion asserts that mental illness exists and is a brain disease. I submit there is no such thing as mental illness, thus there can be no treatment for it.

Real disease is diagnosed and treated on the basis of symptoms (complaints) and signs (objective tests) or signs alone. Fake disease, or mental illness, is "diagnosed" and "treated" on the basis of symptoms alone. Thus "schizophrenia," "depression" and "addiction" are fake diseases for which fake medicine is given.

This is not to deny the fact that people labeled "mentally ill" often display abnormal behavior, or that drugs used to "treat" them have certain effects, e.g., anti-psychotic medication causes irreversible tardive dyskinesia. Does the fact that people feel good after drinking a glass of wine mean they are suffering from "wine deficiency"?

Since the factual difference between real diseases and the fake ones called "mental illness" actually exists, inequity in health coverage is appropriate. The diagnosis and treatment of mental illness have no place in health care reform because neither have anything to do with the legitimate practice of medicine.

Jeffrey A. Schaler, PhD
Adjunct professor, School of Public Affairs American University
Washington



The following responses to Schaler's letter above were published in The Washington Post (note these were all published in the newspaper on the same day):



Copyright 1994 The Washington Post
The Washington Post
May 3, 1994, Tuesday, Final Edition

SECTION: HEALTH; PAGE Z4; LETTERS

Readers React to Idea of 'Fake Disease'

I was appalled to read the March 29 letter from Jeffrey A. Schaler in which he refers to mental illness as a "fake disease" that deserves no health benefits.

As the sibling of a schizophrenic who has witnessed firsthand the suffering and devastation mental illness can cause, I can assure Mr. Schaler it is indeed a legitimate medical condition. Contrary to what he says, schizophrenia is diagnosed not only from numerous symptoms (i.e., hallucinations, paranoia, hearing voices) but from extensive blood tests, brain scans and a battery of psychological tests.

The antipsychotic drugs used to treat schizophrenia can cause numerous side effects, among them tardive dyskinesia (an often irreversible brain damage). Clozaril, the newest antipsychotic medication, does not cause tardive dyskinesia, but there is a danger of a fatal blood disease, so weekly blood tests are required. The cost of this can run up to $ 10,000 a year.

These people deserve something better than the choice between toxic drugs and the life of a zombie. Local, state and federal governments must provide adequate services in addition to other health coverage.

Individuals suffering from schizophrenia or any other mental illness deserve the same empathy, respect and health benefits as an individual suffering from cancer. To have Mr. Schaler infer otherwise after I have witnessed the pain and suffering my sister has endured for the past 10 years is an insult to her and the other millions of Americans suffering from a debilitating mental illness.

Mary Koger
Herndon



I would never deny Jeffrey Schaler his right to believe and say what he wants. I am sure that his students at American University are intelligent enough to realize that everything their professor says is not necessarily so. America is great because we grant the fringe the right to speak and because we have the right and duty to disagree.

Daniel H. Byars
Washington



I am a recovering alcoholic and drug abuser who is taking Prozac for depression. Over the past two months, I have learned about the quantifiable physiological causes (or as Dr. Schaler might say, "objective tests") of my disease through attendance at my treatment program, as well as Alcoholics Anonymous, that resulted in abnormal behavior on my part -- mental illness, if you please.

I brought the Schaler letter to my treatment program and read it aloud to the group. The counselor that evening simply shook her head. She pointed out that as I had been in denial of my addictive behavior, and required loving friends to intervene to get me to the hospital, so was Dr. Schaler denying the very essence of mental illness.

J. Mike Ferrara
Alexandria



Just take a walk around D.C., Jeffrey (i.e., get out of your pompous ivory tower) so you can get a little glimpse of homeless people with "fake" diseases. Go to American University's library and read a book or two on depression, schizophrenia and addiction.

Were you so isolated studying public affairs as to never have had contact with or knowledge of someone with a mental illness?

C.I. Dutzman, MBA
Arlington



If Dr. Jeffrey Schaler were right, then the past several years of emotional and financial strain in my life never happened. I have a family member with a chemical imbalance in the brain, a physical condition that is easily controlled and treated with medication, periodic doctor visits and occasional hospitalizations.

I have seen the reality of a person hallucinating and not functioning properly when the medication has needed adjustment. For the past several years, I have lived with the reality of a physical disease that Dr. Schaler states does not exist.

These brain diseases are as real as a physical disease in any other organ of the body. Unfortunately, the insurance companies have singled out this one organ for limited coverage. This is in the form of very high co-payments and very low lifetime maximums.

This health insurance discrimination against brain diseases (commonly called "mental illness") means that we families of people with physical diseases of the brain are continuously at risk of bankruptcy and losing our homes. We desperately need health care reform to correct this injustice.

Joseph F. Lipari
Alexandria



Jeffrey A. Schaler, PhD, has avowed that "there is no such thing as mental illness." I submit that there is no such thing as Dr. Schaler. He does not exist.

The alleged Dr. Schaler might have taken leave of his ivory tower and spent some time, as I have, with individuals who have suffered from severe clinical depression; he could have witnessed their extreme pain and suicidal despair. Then he could have observed their remarkable recoveries after treatment with antidepressants.

However, he has chosen not to do so, preferring to smugly dismiss mental illness via his version of pure rhetorical logic, and perish the thought of discovering reality through scientific observation.

Since Dr. Schaler does not exist, I take exception with The Washington Post printing a letter from a fictitious person, thereby wasting valuable natural resources such as ink and forest products.

David L. Charney, MD
Medical director
Roundhouse Square Psychiatric Center
Alexandria



My biggest concern about Dr. Schaler's letter is that I can fearfully imagine sufferers from mental illness reading it, concluding that they are morally weak, bad or otherwise deficient and making a decision to live silently with the unaddressed pain of a treatable disease. If this happens to only one reader, the cost is truly immeasurable.

Tish Bachelder, MEd
Director of behavioral medicine
Prince William Hospital
Manassas



I have struggled throughout my 43 years with major recurrent depression and post-traumatic stress disorder. My anguish and pain are just as severe and often debilitating as pain caused by cancer or heart disease, just in different ways.

Because a doctor cannot diagnose mental illness from a CAT scan, biopsy or X-ray does not mean it is not real. Just as there are a wide variety of physical illnesses, so too are there a variety of mental illnesses. Mental health benefits need to be included in any health care reform. This inequity cannot continue.

Diane P. Derow
Alexandria



In response to Jeffrey A. Schaler, professor at American University, who wrote that "there is no such thing as mental illness" and its treatment therefore has "no place in health care," I just want to say:

Thank you General Patton! Do you intend to slap me now? Or have you mellowed since World War II?

Norman Burnett
Alexandria



The brain, the most complex of human organs, is the locus of conscious thought and unconscious control of much of the rest of the body. It is the means to express the will of the individual and is the seat of the senses, emotion and reason.

Like any other organ in the body, its function can be altered by physical changes due to disease, injury or other factors. It is generally agreed that changes to the brain directly affect the behavior and health of the individual.

Neither Dr. Schaler nor I know the complex causal relationships affecting behavior, but it is clear that behavior can affect health. By this criterion, there is such a thing as mental illness.

Bill Lyda
McLean



As graduates of The American University, we are shocked by Dr. Schaler's attitude toward the existence of mental illness. Moreover, we are appalled that he associated his antiquated ideas with the university.

We implore him to seek out the educational resources available at his own institution; then perhaps he will realize that the diagnosis and treatment of mental illness have a place in the legitimate practice of medicine.

Carolyn Levine
Ariadne Goerke Green
Allyson Suski
Stephanie Voyda
Washington



We should not continue to argue over whether mental health and substance abuse should be included in health care reform. Mental health benefits are not a luxury that we may or may not be able to afford.

Mental health disorders are major health problems for which afflicted individuals should receive treatment as they would for any other health problem. It is spurious to argue over whether we should pay for mental health coverage. We already pay. The real issue with which the country should be grappling is the best way in which to cover these disorders.

Beth A. Stroul
McLean

Sheila A. Pires
Washington

Former members
Mental Health and Substance Abuse Working Group President's Task Force on Health Care Reform