Managing Editor's Memo

Mental Health Integration Easier Thought Than Done

Frank Diamond

Start with the psychiatrist: a medical doctor by training who specializes in treating mentally ill patients. That’s integration of mental and physical health right there, but it may also be the highlight of that cooperation, as our cover story makes clear. Contributing editor Joseph Burns lays out the benefits of mental health integration, which includes the possibility of lowering the medical costs of treating people with chronic diseases who also have behavioral health problems. That’s a combination that drives up medical costs, so if behavioral problems were dealt with as part of medical care, the cost of managing chronic disease might be a lot less.

Figuring out mental health care’s place in medicine was never easy, as practitioners for too long adhered to Sigmund Freud’s methods, most of which have been debunked. That’s tough to recover from. The effort to clearly diagnose conditions, as primary care physicians might do before treating, say, the flu, doesn’t satisfy skeptics either.

Theodore Dalrymple, MD, worked as a physician and prison psychiatrist in Birmingham, England, for years before turning to the craft that would make him famous: writing. In his book Admirable Evasions: How Psychology Undermines Morality, Dalrymple argues that the over 300 categories in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, leads to overtreatment and undertreatment. Schizophrenics “are left to molder in doorways, streets, and stations of large cities, while untold millions have their fluctuating preoccupations attended to with the kind of attention that an overconcerned mother gives her spoiled child with more or less the same results.”

That mental conditions seem to spread “in proportion as they are known about” undermines not only the specialty, but also culture, Dalrymple argues. Even the many who disagree with him would have to admit that it’s difficult to imagine an oncologist disparaging cancer treatment in a similar manner.

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