answering cries for help 

by Ronnie S. Stangler, M.D.

Guest Columnist to the Seattle Times/Special to The Seattle Times

Carol M. Ostrom’s front-page story about Martha Silano, Langdon Cook and their baby boy, Riley, was deeply disturbing. The aftermath of Group Health Cooperative’s refusal to reimburse the majority of medical treatment for Silano’s devastating postpartum psychosis has produced a sad irony. This family demonstrates far more intelligence, generosity and courage than the system of care that refused to support their medical treatment. Silano and Cook have assumed the burden of attempting to educate all of us, not only about a terrible, yet treatable, psychiatric disorder, but also about the discrimination and ignorance that those who seek treatment so often confront.

The Surgeon General’s Mental Health Report of 1999 indicated that, in any given year, one in five Americans experiences significant psychiatric disturbance requiring medical attention.

This disturbance may take the form of a depressive episode in a young mother, such as Silano, following the birth of her first child; it may be observed in a series of terrifying panic attacks, which prevent our neighbor from leaving her home; it may appear in the obsessional thinking and ritualistic behavior of the little boy who compulsively washes his hands for hours despite pain and bleeding.

Psychiatric disorders do not just affect strangers and strange people. These illnesses alter the lives and destinies of our friends, family, neighbors, coworkers and, ultimately, the course of our entire society. Untreated psychiatric illness contributes to societal financial costs of underemployment, homelessness and imprisonment. The human cost of despair and broken lives is incalculable.

The U.S. Congress declared the 1990s the Decade of the Brain. Through research in basic neuroscience, behavioral science, molecular biology and genetics, we have learned much about the complex workings of the brain. The stunning progress of the decade was crowned in the fall of 2000 by the selection of Dr. Eric Kandel, an American psychiatrist, as Nobel Prize winner in medicine.

Kandel’s research helps fade false and dangerous distinctions between mind and body. A chief tenet of his work is that all mental processes, even the most complex psychological processes, derive from operations of the brain. We are increasingly able to pinpoint specific areas of brain dysfunction in many psychiatric conditions. Psychiatric medications, increasingly free of troublesome side effects, are dramatically effective in even the most serious illnesses.

While we have much to learn, especially in the areas of mental illness prevention and mental health promotion, current clinical research demonstrates effectiveness rates of combined psychotherapy and medication for many psychiatric conditions that significantly surpass those for the most commonplace medical interventions.

Yet, access to these treatments has been thwarted by stigma, prejudice and greed. Those most critically ill are poorly served in overcrowded and underfinanced public institutions and are least able to articulate their cause. Forty-four million Americans, a half million of whom are Washington residents, do not have any medical insurance at all.

And even those who do have insurance find it supports universally discriminatory care. Obstacles we too often suffer in silence are large co-payments, restriction of access to appropriate professionals, arbitrary limitations on the duration of treatment, and substitution of older medications when newer ones are better tolerated and sometimes even more effective.

Psychiatric treatment remains the beggar of health care.

Group Health CEO Cheryl Scott blames the Silano-Cook situation on failure of public policy. While it is true that enormous reform is necessary at both state and federal levels, this shift of responsibility is deeply destructive.

Group Health’s comments that this postpartum event was not a medical condition represent, at best, naïve, reductionistic word play and semantics; at worst, ignorance and/or compromised ethics. Meaningful solutions to protect the total health of all Americans require the exercise of our collective responsibility. Beyond the continued development of neuroscience in the laboratory, we must daily share a resolve. We must educate ourselves, as well as our policymakers, about these matters; we must demand rational behavior from insurers, as well as legislators; we must require both government and corporate responsibility.

And, ultimately, we must all join the Silano-Cook family to decry dangerous and foolish practice. Their most recent appeal for reconsideration of Group Health’s denial of complete coverage failed again, even after the recent tragedy in Texas, where Andrea Yates, in the throes of an inadequately treated postpartum psychosis, killed her five children.

The Seattle Times front page presents us with an alternative graphic: the photograph of healthy baby boy Riley, with his boundless potential and promise.

This is our choice.

Dr. Ronnie S. Stangler, a clinical professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington, chairs the Information Technology Committee of the American Psychiatric Association and is former president of the Washington State Psychiatric Association.

Published Seattle Times Monday, July 30, 2001