Traumatized America:
I recently posted a note about America’s dwindling work force.  One of the elements in the decline is increasing disability.  The increase is mostly because of increasing numbers with back pain – a terribly difficult thing to diagnose.  The obvious scenario is a patient that complains bitterly to his doctor about his pain.  The doctor ultimately refers the patient to a specialist who is able to do back surgery.  There is now a conflict of interest between the urge to be nice and the urge to perform a lucrative procedure.  So the surgeon refers the patient to a radiologist.  The radiologist, assuming that there is some evidence of abnormality in the back, which seems to me to be invariably true of anybody over forty or fifty, has the conflict between chronic skepticism about the utility of back surgery and his urge to continue to get referrals from that surgeon.  Eventually a determined patient can shop around until the right trio turns up, whereupon there is an operation; the patient gets serious pain medication for a time, and there is now a pretty good chance that the pain will eventually be worse than ever.

I am not saying that humans are evil.  (We are, of course, but the real evil is our willingness to ignore the big issue I keep bringing up.)  The problem is that the diagnosis is difficult and motivations are mixed.

But that’s nothing compared with the difficulty of diagnosing mental illness.  At least with back pain it’s possible to put your finger on an imaging study and say, “There it is.  There is the disc pressing on the nerve and causing the pain.”  You may be wrong, but you can say it.  Mental illness cannot be so clearly shown.  Yet I think there is no doubt it exists.  I was once working in an institution when I heard a woman walking slowly down the hall screaming, “Why are they shrinking my head like a peanut?”  over and over again.  Clearly something was amiss. 

And America’s system for dealing with mental illness is flawed.  (Andrea Tone America the Traumatized NATURE vol. 502 no. 7472 October 24, 2013 page 446 reviewing E. Fuller Torrey American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System Oxford University Press 2013) What’s worse, there is a lack of unanimity of opinion of just what has been going on historically.  If they can’t get “who did what, where, when?” right, I really don’t expect them to get the “why?” bit straight. 

The article from the ECONOMIST I cited two years ago suggested the people are feigning mental illness to find some sort of support when their unemployment benefits dry up?  Are people feigning back pain for the same reason and/or to get access to drugs they crave?  I think it is beyond doubt that some do; how many I do not know.  In fact I wonder whether there is a syndrome of mental illness that manifests itself as perceived back pain.  I imagine there is. 

And do these issues complicate a situation whereby lack of babies and/or regrettable marriage choices are driving our society mad?  I shall not venture a guess.  I’m not the crazy … yet … most days … I think.

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