This article, Health Care’s Unfinished Bridge, was first published in California Healthcare News on April 5, 2016.
Every era relies on the intuition of a talented few in its search for scientific breakthroughs. Herodotus rejected the notion the Earth was flat, and in particular its description on the Shield of Achilles in Homer’s Iliad. Some 29 centuries later, science has reduced the labors of Homer to little more than myth, though philosophy still honors the epic, from its very first word (“μῆνῐν” or “wrath”) to its lesson addressing the value of balancing excessive pride with the fear of anonymity. Similarly, advances in technology have greatly benefited medicine in recent generations, as doctors increasingly approach diseases of the body from a tangible perspective. However, the treatment of diseases of the mind continues to be far more speculative in nature, serving to highlight the chasm between these two seemingly similar but ultimately disparate fields. This in turn presents a complex issue for both medical practitioner and mental health provider.
While modern medicine can envision scientific methods in its attempt to re-engineer poliomyelitis to treat glioblastoma multiforme, it struggles to cure, let alone truly understand, other attacks on the brain such as depression, posttraumatic stress disorder and addiction. Family members and friends of those fortunate enough to survive this deadly and most common form of brain cancer have little need to understand the importance of the fluorescent dye used during surgery or the necessity of anticonvulsants and corticosteroids. And yet, for the husband or wife watching a spouse suffer through depression or other mental illness, there is no standard prescription to assuage the inevitable feelings of helplessness, and no symptomatic treatment for the comorbidities known as blame, guilt and anger.
Conventional medicine’s struggle to connect matters of the body and mind often ignores matters of the psyche, hiding instead behind a façade of therapeutic and holistic approaches to treatment that references some type of somatic therapy. Even when science has linked certain conditions at least in part with past behavior, such as lung cancer or pancreatitis, the objectivity of the diagnosis renders any subjective reasoning nearly obsolete. Friends and family waiting for a patient to wake from a segmentectomy, lobectomy or pneumonectomy rarely cast aspersions in the direction of the operating room, placing fate squarely in the hands of the surgeon. And yet, someone suffering from depression or addiction is more likely to be called upon to produce positive results. Patients suffering from diseases of the mind that are equally physiological are often forced to endure platitudes such as “what’s wrong?” or “smile,” much like the recovering addict who must often shoulder insults or vilification from loved ones. Likewise, the moral code to honor the inextricable connection between sleep and healing for post-surgical patients often goes missing in homes afflicted by mental illness, as the disease is considered to be of the mind alone.
Medicine has yet to find the exact location where matters of the mind and body intersect, and for today’s health care practitioner this can create problems in terms of granting equal treatment and coverage. Unlike the traditional practice of medicine, which allows for specialization among its providers, the inclusion of mental health care professionals seeks to endow the totality of care with an umbrella suitable for covering all patients, regardless of type of illness. To be sure, an appendectomy is standard procedure for those suffering from appendicitis, and coronary artery bypass surgery does wonders to restore normal blood flow to the heart. However, the inability of the mental health care physician to diagnose based upon similar tangibles does not mean the disease is unconnected to the body, and as a result the diagnosis often calls upon a greater emphasis on instinct. Not everyone suffering from depression is suicidal, not everyone with mania is an artist, not every addict has lost his or her moral compass, and not every patient presenting with posttraumatic stress disorder has been a victim of war or sexual abuse.
To ensure that both factions receive equal coverage under the law, the Federal Government has been searching as well for a link between body and mind, although its efforts appear more like the construction of a bridge between New York and London than a direct plan to combine disciplines. Nevertheless, the 2008 Mental Health Parity and Addiction Act (MHPAEA), as amended by the Affordable Care Act, now enters its sixth year in its attempt to prohibit financial requirements and treatment limitations for mental health and substance abuse benefits in group health plans from being more restrictive than those placed on medical and surgical benefits, recognizing the equality of illness within the two differing factions. Even the Emergency Medical Treatment and Labor Act (EMTALA), the seminal law protecting all patients who present in an emergency department from disparate treatment due to insurance or financial status, extends the stabilization obligation to mental health as well.
More recently, in February 2016 the Federal Government updated the 1987 regulations that for the past 25 years had governed the confidentiality of substance use disorder patient records. The 38-page installment in the Federal Register bolsters the protection of substance abuse records to persuade such afflicted individuals to seek needed treatment rather than fear potential negative consequences such as loss of employment, housing or child custody, not to mention discrimination by medical professionals, insurers and law enforcement.
Parity and protection alone, however, are but bandages on the system’s infirmities, from the perspective of both the medical and health care provider. Some of the key components needed to find this elusive location where body and mind intertwine cannot as yet be measured tangibly, though modern technology laudably continues to forge ahead in its attempt to deconstruct and therefore further understand the brain. Only when such progressive tools are combined with intuition and wisdom can a great physician capable of such a breakthrough be born, and only then will body and mind find some semblance of balance, both under the knife and under the law.