It's Time to Stop Permitting Abuse
Sylvia Caras, Ph D
The demand on the mental health system for treatment has also been increasing, even faster than population builds. More staff and more resources are allocated to repairing what psychiatry diagnoses. Somehow this mental health work load must be reduced.
There is a larger context for the work load. Today most attention is directed downstream at treatment and rehabilitation. But rescue medicine is not enough.
We can use primary prevention to reduce the number of people upstream, the number coming into the system and wanting services. Healthy lifestyles in healthy communities can reduce the impact of risk factors and create local peer support.
"Efforts to improve health, to change personal habits, and to work on unhealthy environmental and social determinants of injury and disease touch on some fundamental questions of morality and politics: the role of government, the place of health in individual and community life, the use of force or persuasion to change behavior, and the vision of society that lies behind a concern for health in the first place. These dimensions of the problem of promoting good health have not gone unremarked, but they have not been explored with the seriousness that they deserve." (1)
A serious gaze will help in not overlooking a risk factor for psychiatric diagnoses - abuse.
But in the executive summary of the US Surgeon General's Report on Mental Health, there is one mention of abuse and neglect, in the abstract fo the chapter on children. One mention, in 30 pages of summary. Yet the American Journal of Public Health reported this fall, "In any given year in the United States, more than 2 million wives are physically battered by husbands and nearly 3 million children are reported as victims of abuse." (5)
SAMHSA says that two-thirds in substance abuse treatment report physical, sexual or emotional abuse during childhood. (6)
Studies consistently confirm a 50-80% prevalence rate of sexual and physical abuse among persons who later acquire diagnoses of mental illness. (7)
So roughly 60 % of those diagnosed with mental illness or in substance abuse treatment report physical, sexual or emotional abuse.
Don't dismiss the evidence of the experiences behind these statistics. This essay would have more impact if I now told you stories, personal stories of the experiences of real people. I can't. I would disturb myself, and you too much. Think of little girls and big brothers, children and fathers, punishing mothers, think of rape, and incest, and beatings. Think of a lifetime with those memories. Try not to look away.
In 1990 there were an estimated 10 million adults in the US diagnosed with serious mental illness. (8) So then, statistically, some six million of those were abused. Try not to look away.
If abuse is causal and if in the next generation we reduce abuse enough to divert even 10%, we might save 600 000 people from a mental illness diagnosis. Even if we find out that abuse is not causal, merely correlative, we will have removed a variable, narrowed the research areas, and will be doing a social good. For is sexual abuse any less wrong if it does not lead to trauma and mental illness?
Research has indeed found ventricle enlargements before medication treatment. They've concluded this defect links to schizophrenia. (9) I haven't seen that social histories were taken. I would like to know if it is trauma that has caused the enlargements, trauma perhaps caused by sexual abuse.
Now, by de-emphasizing upstream risks like abuse we assure a steady downstream flow of problems and a concomitant increase in the size and costs of the behavioral health industry.
© Sylvia Caras, 2001
1. Daniel Callahan, Promoting health and preventing disease: ethical demands and social challenges, in Callahan, Daniel, Ed, Promoting healthy behavior: How much freedom? Whose responsibility? 2000. Washington, DC: Georgetown University Press. p 168
2. Ronald Labonte, Health promotion and the common good: toward a politics of practice in Daniel Callahan, Freedom, Healthism, and Health Promotion: Finding the Right Balance, in Callahan, Daniel, Ed, Promoting healthy behavior: How much freedom? Whose responsibility? 2000, p 112. Washington, DC: Georgetown University Press.
3. Kerry Healey et al, Batterer Intervention: Program Approaches and Criminal Justice Strategies, 1998. Washington, DC: U.S. Department of Justice, Office of Justice Programs, National Institute of Justice http//www.ncjrs.org/txtfiles/168638.txt
4. For one instance, Alison E. Gerencser, Family Mediationscreening for Domestic Abuse, 1995. Florida State University Law Review. http//www.law.fsu.edu/journals/lawreview/issues/231/gerencse.html
5. (AJPH Setp 2000 p 1473 book review)
8. Manderscheid, R W and Henderson M H, eds. Mental Health, United States, 1998, Washington, DC: Superintendent of Documents, U S Government Printing Office.
9. The search for causative factors, NARSAD Research Newsletter, 13:1, spring 2001, p 1
10. Warren S Brown, *Wisdom and Human Neurocognitive systems: perceiving and practicing the laws of life,* in Warren S Brown, ed, Understanding Wisdom, 2000, Philadelphia:Templeton Foundation Press, 2000. p 209
11. Richard Wilkinson, Unhealthy societies: the afflictions of inequality, quoted in the Newsletter of the Finnish Association for Mental Health, 2000
12. Janet Reno, The Nation's Health, APHA, August 2000, p 6