An excerpt from Has Medicine Lost Its Mind?: Why Our Mental Health System Is Failing Us and What Should Be Done to Cure It.
One of society’s great issues is who decides what science does—the public or science. For example, the populace has taken control and been clear that it does not want science to create human beings in a laboratory or construct computers that run the world. Once Americans became informed of these potential harms, they were alarmed and insisted, through their political representatives, that science align with their demands.
The situation with medicine, however, is just the opposite. The public does not understand how abysmal its mental health care is, that medicine refuses to improve it, or that it can direct its politicians to require change. What details do Americans need to know that might activate them to seek control?
First, even though mental illness is the most common health condition in the U.S., most do not know that only 25 percent of patients receive any care; compare this to 70 percent of physical disease patients receiving care. Second, their compromised mental health care results from medicine failing to train enough mental health professionals (psychiatrists conduct only 12 percent of care) and providing almost no training for the primary care clinicians who, by default, conduct over 75 percent of mental health care. U.S. citizens will be shocked to learn that only 2 percent of physicians’ training is devoted to mental health care. This points to the surprisingly unidentified solution to the mental health crisis: Train the doctors who provide the care and train more mental health professionals.
Third, few understand why medicine would resist such obvious solutions. From the 16th- and 17th-century Scientific Revolution, the theory of the “mind-body split” has guided medicine—the mind, soul, and spirit the church’s domain, the physical body and its diseases from the neck down belonging to medicine. That made mental disorders and other mind issues, such as emotions, off base. Even though mental health care has long since been medicine’s responsibility, medicine has never shown interest in mental health and patients’ other psychological and social issues. Imbued with the mind-body duality, it sees no need to train physicians; as an afterthought, it trains a few psychiatrists. While guidance by the mind-body split led to massive physical health care advances in the last 75 years (life survival doubled), its exclusion of patients’ psychological and social lives now renders it obsolete for the country’s most common problem—mental illnesses.
Finally, the public does not realize that medicine flouts modern scientific principles. Only medicine, among all sciences, fails to follow modern scientific theory, a systems view of life. It requires that all parts of a problem and their interactions be considered rather than addressing just one aspect, as medicine does with its narrow disease focus. Worse yet, medicine repeatedly ignores the systems model proposed for it in the 1970s, the biopsychosocial model. This demonstrably superior, research-based model links the patient’s physical disease (biological) features with their psychological and social parts, fully integrating mental health care with medical care. Implementing the model would guarantee that patients’ access to, and quality of, mental health care matched that for physical disease care.
Medicine’s dereliction in mental health care supports Hannah Arendt’s argument that the public must control science, lest the latter’s direction fail to meet citizens’ needs. An incensed citizenry has productively dealt with refractory institutions in the past. People knew little, for example, about the risks of automobiles until Unsafe at Any Speed (by Ralph Nader) made millions upon millions of Americans aware that seat belts saved lives, but that the auto industry refused to install them for financial reasons. Similarly, Rachel Carson’s Silent Spring exposed the chemical industry’s egregious pollution of our drinking water with DDT and its refusal to clean up the mess it created. In both instances, the laggard industry was forced to change—that’s why we have seat belts and clean water today. An irate population insisted its politicians enforce change. That’s what Has Medicine Lost Its Mind? intends: to create an angry populace that directs its politicians to require that medicine change and thus better meet the needs of the public it serves and that supports it.
Robert C. Smith is an internal medicine physician and author of Has Medicine Lost Its Mind?: Why Our Mental Health System Is Failing Us and What Should Be Done to Cure It.
