Friday, May 15, 2015

Parity, Like Charity, Begins at Home

On May 14 my wife, Margot Head and I spoke at a Congressional briefing, "Parity 101 - Understanding the Mental Health Parity and Addiction Equity Act and the Current State of Implementation.  My remarks follow below

Were I to have a one on one conversation about substance use disorder with any individual in this room, I’d ask, “What is your personal experience?  How has substance abuse affected you and your family?” Unfortunately, our family is closer to the norm than the anomaly.
There are lots of family stories out there. More than a few have come our way since we shared ours.  More than 2/3 of American families have been touched by addiction.  It is not inconceivable that 10% of us, the people in this room, as in the population at large, will have, do have, or have had a personal battle with this substance abuse.  20% of Americans live with mental illness.
A recent New Yorker cartoon portrayed a politician being interviewed outside the Capitol Building.  He’s saying, “I like to think we’re not so much anti-science as pro-myth.”  That needn’t be a politician.  It could be almost any American citizen.    
Before we can talk today about parity in terms of mental illness and substance use disorder we need to talk about judgment, fear, shame  - the stigma surrounding these diseases.  We need to confront the myth.   
For centuries, indeed most of human history, we have attempted to  name the unknown, the other, that which terrifies us.  An old prayer from the British Isles goes:   
From ghoulies and ghosties
And long-leggedy beasties
And things that go bump in the night,
Good Lord, deliver us!
The myth of the changeling is about the offspring of a fairy, troll, elf – or even a gypsy, being secretly exchanged in the middle of the night for a human child. The changeling would often grow sick or die.  This was a convenient, though not especially scientific explanation, for infants who die young from unexplained diseases, or suffer disabling disorders, including mental disorders, over a longer period of time.
Of course we don’t believe in such mythology in our time, unless you or someone in your family happens to believe in the Tooth Fairy.  A spirit who comes in the night and makes an exchange for at least part of a child.  We don’t pay much attention to such mythology, unless you happened to see a production of Peter Pan – Peter luring children from the nursery and taking them to Never Never Land. Old myths change shape and die hard.
In 1584 an English gentleman, Reginald Scot, attempted to describe witchcraft as irrational and un-Christian.  He wrote, in part:
“…But in our childhood our mothers maids have so… fraid us with:  spirits, witches, pans, dwarfes, imps, changelings, Incubus, and other such bugs, that we are afraid of our owne shadows…
“…right grave writer’s report, that spirits most often…take the shape of women… and of beasts… of fowles, as crowes, night owles, and shreeke owles.”
Mr. Scot changed the minds of few.  All copies of his book were purportedly burned. The fright remains.  As Andrew Solomon wrote in his brilliant 2012 book Far From The Tree, “We live in xenophobic times, when legislation with majority support abrogates the rights of women, LBGT people, illegal immigrants, and the poor.”  At the end of the parade, behind even those disenfranchised groups, are the mentally ill…and bringing up the very rear, people with substance use disorder.

A recent Johns Hopkins research study indicates only 22 percent of respondents said they would be willing to work closely on a job with a person with drug addiction compared to 62 percent who said they would be willing to work with someone with mental illness. Sixty-four percent said that employers should be able to deny employment to people with a drug addiction compared to 25 percent with a mental illness. Forty-three percent were opposed to giving individuals addicted to drugs equivalent health insurance benefits to those afforded the public at-large, while only 21 percent were opposed to giving the same benefits to those with mental illness.  Respondents agreed on one question: Roughly three in 10 believe that recovery from either mental illness or drug addiction is impossible.

 We perpetuate the mythology in the way we speak of the afflicted.  Prejudice, hatred and stigma marinate in our language.  We freely call the sufferers:  lushes, alkies, disturbed, acid freaks, wastoids, boozers, juicers, scary, tweakers, coke whores, crack heads, winos, tipplers, nuts, loonies, pill poppers, speed freaks, people with a screw loose, mental  inebriates, drunkards, dope fiends, druggies, junkies, dipsomaniacs, psychonauts, dopers, freaks and retards.  We persist in trying to make what we fear disappear by naming it and shaming it. We prefer the myth of weak morality to the fact of disease.    
Only when we accept that mental illness and substance use disorder are brain diseases, treatable brain diseases, best engaged at their earliest manifestation.  Only when we realize that 23.5 million people, 10% of adults, are already “living life in recovery”.  Only when we truly believe that the value of addiction recovery far outweighs the $500 Billion spent each year on lost productivity, absenteeism, health care, social services and incarceration. Only then can we truly begin our conversation about parity.  Otherwise we continue to live in a dark past.
When we abandon the ancient, vestigial mythology; when we confront the myth; when we confront the stigma by confronting our language;  when we adopt a language of hope and possibility;  when we use the best science has to offer us to treat long stigmatized conditions, then we can talk of parity.  Parity in our nation, parity in our states, parity in our communities, parity in the voting booth, parity in our homes. 
Parity, like charity, begins at home.        


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