The human brain is a wonder. Through folds of tissue and pulses of electricity, it lets us perceive, attempt to understand, and shape the world around us. As science rapidly charts the brain’s complex structures, new discoveries are revealing the biology of how the mind functions and fails. Given the centrality of the brain to human health, its malfunctions should be a priority, separated from stigma and treated on par with the diseases of the body. We aren’t there yet, but the transformation is underway.
Mental disorders affect nearly 20 percent of American adults; nearly 4 percent are severely impaired and classified as having serious mental illness. These disorders are often associated with chronic physical illnesses such as heart disease and diabetes. They also increase the risk of physical injury and death through accidents, violence, and suicide.
Suicide alone was responsible for 42,773 deaths in the United States in 2014 (the last year for which final data are available), making it the 10th leading cause of death. Among adolescents and young adults, suicide is responsible for more deaths than the combination of cancer, heart disease, congenital anomalies, respiratory disease, influenza, pneumonia, stroke, meningitis, septicemia, HIV, diabetes, anemia, and kidney and liver disease.
The treatment of mental illness has long been held back by the sense that disorders of emotion, thinking, and behavior somehow lack legitimacy and instead reflect individual weakness or poor life choices. Not surprisingly, there has been a mismatch between the enormous impact of mental illness and addiction on the public’s health and our society’s limited commitment to addressing these problems. Here are three examples of how that plays out:
- Most emergency departments are ill-equipped to meet the needs of patients in the midst of mental health crises.
- Most insurance plans view mental illness and addiction as exceptions to standard care, not part of it.
- Despite an overall cultural shift towards compassion, our society still tends to view the mentally ill and those with addiction as morally broken rather than as ill.
Too often, individuals suffering from serious mental illnesses — those in greatest need of care — have been isolated and cared for outside of traditional health care, as in the asylums of the past. There, mental health care was separate from, and far from equal to, traditional health care.
Why the disconnect? Psychiatry has been hampered by an inability to observe and record the physical workings of the brain. Because of that, psychiatric assessments and treatments have been viewed as somewhat mysterious. Even today, the underlying mechanisms behind some of the most powerful and effective psychiatric treatments are still poorly understood. All of that translates into the difficulty that many people have finding help for real, disabling symptoms attributed to a mental illness or addiction.
However, just as other fields of medicine have evolved as knowledge advanced during the past century, psychiatry has also made profound gains. Advances emerging from unlocking the brain’s physiology and biochemistry are coming at a time when mental health care is being integrated into traditional health care. The potential has never been greater to finally bring psychiatry quite literally under the same roof as the rest of medicine.
The Ohio State University Wexner Medical Center, where I work, offers an example of this kind of transformation. Now celebrating its centenary, the Ohio State Harding Hospital was founded as the Indianola Rest Home by Dr. George Harding II, younger brother of President Warren G. Harding. It was created as an asylum that provided quiet, nutrition, and a focus on spirituality.
Today, the hospital can address mental health issues as effectively as it treats trauma or cardiac arrest. This shift is occurring nationally, with community-involved, comprehensive mental health integration into hospitals in cities and rural communities alike.
Proven regimens for treating common mental disorders and addictions are aiding the “cure” rate and boosting public acceptance that such care works. Modern practices have the potential to improve public health and, perhaps equally important, engage families more actively in the care of individuals suffering from mental disorders and addictions.
I find it fascinating to see the commonsense approaches to treating mental illness once employed by the Indianola Rest Home increasingly being accepted within mainstream medicine. Bringing together the sensibilities and experience of the past with state-of-the-art modern medicine often makes good sense.
Will the stigma of mental illness finally fade? Better understanding of the human brain and the biological nature of the mind will help, but it won’t be enough. How we think about mental health matters. When mental health is ultimately recognized as essential to physical health, not an extraneous element of it, then we will have access to true, complete, modern medicine.
John V. Campo, MD, is professor and chair of the Department of Psychiatry and Behavioral Health at The Ohio State University Wexner Medical Center in Columbus, Ohio.