The Wrong Diagnosis

I applaud the New York Review of Books for publishing Dr. Marcia Angell’s articles on “The Illusions of Psychiatry.” Three years ago, I responded to my step-brother’s suicide by giving up my practice as a corporate attorney to become the Executive Director of the National Alliance on Mental Illness for Montana (NAMI Montana). Shortly after that, another one of my loved ones was struck by serious mental illness. I have been personally and professionally immersed in the stark realities of serious mental illnesses and the haphazard treatment system that has evolved to treat those conditions.

While I disagree with many of Dr. Angell’s conclusions, I could not agree more that the method of diagnosing mental illnesses needs serious improvement. This ineffective diagnostic methodology has led to too many people taking medications that they do not need and too many people that do need medications taking the wrong types or dosages. As Dr. Angell described, some of the most heart-breaking examples of this systemic failure involve the improper medication of children. The financial impacts of these misdiagnoses on the public and private healthcare system are staggering. The pharmaceutical industry’s marketing efforts deserve some of the blame for this state of affairs, but it is not the main culprit.

The real problem is that medical providers are trying to diagnose biologically-based conditions without biologically-based screening tests. Doctors do not have effective brain scans, blood tests, or other tangible biological screening tool to identify which patients are affected by biologically-based mental illnesses. Instead, they try to use patients’ perceptions and behaviors to discern the presence or absence of a biological condition. It is the equivalent of trying to determine whether a patient has a broken leg by asking them if they can walk or if they are in pain. If we were forced to apply that method of diagnosing broken legs, one would expect to find a number of books decrying the number of casts on people that did not need them and the number of people in need of casts that are forced to go without.

We must find a way to foster the development of biologically-based mental illness diagnostic tools. There are many ways of going about this task and many of them would likely succeed. Personally, I recommend establishing a Mental Illness Screening X Prize, similar to the multi-million dollar prizes that have been used to stimulate innovation in commercial space flight and fuel efficient vehicles. The winner of the Mental Illness Screening X Prize would be able to use a biological test to determine whether a person has either schizophrenia or bipolar disorder.

That biological test would be a major step toward revamping our broken mental illness treatment system to address many of the legitimate issues that Dr. Angell described in her article. With the billions of dollars that our nation spends on treating these conditions each year, it is time to make the development of that screening tool a priority.

Matt Kuntz, JD
Executive Director
NAMI Montana