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Friday, Dec 19, 2014
Letter of the Day

The heart of the matter in behavioral health

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People the world over are grieving the loss of Robin Williams — his gifts to us warrant that — and much has been written about his death. The Tribune ran Simon Jenkins’ “The sadness of a clown who could not be fixed” (Other Views, Aug. 14), where he states, “Yet it seems inexplicable that their addiction should be immune to personal success, the care of a loving family and all the therapies money could buy.” Unfortunately, having the resources generally means receiving the most expensive care, not the best care. The current state-of-the-art treatment generally means treatment by a psychiatrist with medication in the medical/psychiatric model, and that is not necessarily the best care.

Jenkins asks the right question: “Mental Illness, if illness is the right word. …” This is the heart of the matter. Psychiatrists, nurse practitioners and therapists treat what are now called behavioral health (previously mental health) symptoms. It’s important to note the symptoms are real; the conditions are not. Depressive symptoms are very real, but depressive disorders only exist because a panel of psychiatrists voted to include a certain cluster of symptoms into the Diagnostic and Statistical Manual of Mental Disorders as a certain disorder.

There is no empirical, biological evidence that a person with major depressive disorder has any medical or physical difference from someone who does not. All behavioral health diagnosis is made by the report of the person regarding their thoughts, feelings and behavior and the reports of others. So why do we treat people as if it is a biological condition which should be treated medically with medication?

As a licensed mental health professional for over 20 years, I take issue with Jenkins’ statement: “Therapists wander the scene like surgeons on a medieval battlefield, at a loss for what to do.” Therapists are doing what we have always done — which is use psychotherapy to help relieve the symptoms of the people who come to us, and for many of us without the use of psychotropic medication. The problem is the majority of people see a psychiatrist first, and by the time they get to my office they have started on a medication, which complicates my work.

I have no idea what treatment Robin Williams received. This is not a comment on his case, but it will continue to appear as if behavioral health is not effective as long as we treat behavioral conditions as medical ones.

Daniel Kane

Tampa

The writer is a licensed mental health counselor.

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