On serious mental illness and Rev. Timothy Murphy

Part of the Holy Grail of Rev. Murphy has been his preaching of the gospel of serious mental illness.

The sermon is simple and some version of it is heard virtually every time he comes to the pulpit.

“The needs of the seriously mentally ill are not met in the mental health system because too much money is spent on services to other people.” He is not always quite clear about what this exactly means but if you try to translate the jargon and decipher the code he seems to be saying we need to spend more money putting people in psychiatric hospitals for longer periods of time and all this community stuff is making it impossible. Psychiatric hospitals will never be the flagship of the mental health system again. That ship sailed a long time ago. For a million different reasons those days are over and to try to bring them back would involve disenfranchising millions of people and telling them they really don’t need help. Murphy can try forever (and he might) to pass a law putting the genie back in the bottle but I don’t think this genie is going back in.

But Murphy is wrong on an even more fundamental level than that. The only living psychologist in Congress does not understand what the function of psychiatric diagnosis really is.

What Murphy says only makes sense if one thing is generally true.

For the seriously mentally ill to not be getting the services they need their must be services specifically for that diagnosis. In the mental health system there is largely no treatment specific to any diagnosis. If for example, you go into a psychiatric hospital you will be exposed to a generic cookie cutter kind of programming. Everyone regardless of what they are called is basically exposed to the same thing.

I know of one psych unit that was generally regarded as one of the better places in its area that had about 3 weeks of groups planned out. They just constantly recycled those groups. If you were readmitted enough times you eventually would know what the therapists were going to say before they said it.

Community mental health centers don’t treat diagnoses. They treat symptoms. Some are more disruptive than others. Everyone has different needs but the idea that there is a treatment for serious mental illness and another for just regular old mental illness simply isn’t true.

Murphy doesn’t know something the only living psychologist in Congress should know. The purpose of diagnosis is not to direct treatment. It is to justify it. It is to tell insurance companies why they need to pay. It is to put what you do in billable terms.

Diagnosis have little reliability. They are frequently a function of the training, experience and philosophy of the person doing the diagnosing rather than the person being diagnosed. Where I used to live we had one doctor who basically believed everyone was bipolar. We had another who basically believed no one was. The common joke was that if you were bipolar and wanted to be cured the best way was to change doctors.

The hymn to serious mental illness is a great sound bite and Murphy has gotten a lot of mileage and a lot of leverage out of it. To be called “soft on serious mental illness” has become something almost every politician fears.

It is a shame they are not nearly so scared about being called soft on the human rights, dignity and ultimate welfare of the people served in the mental health system.

A real shame….


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