This month, a bill was introduced in the Minnesota House that would require the development of a mental-health curriculum for middle and high schools. The bill, authored by Rep. Andy Welti, D-Plainview, and four others, surely has its heart in the right place. But the bill’s length — it is two sentences long — betrays a troubling presumption that mental-health prevention is without controversy, and that all parties speak with one voice, and that effective legislation is merely a matter of decreeing that the state put the word out.
Many would like to believe nothing but good can come in telling students about the symptoms of an illness. Our era is filled with campaigns to “raise awareness” of one illness or another, despite the fact that these campaigns are often funded by private companies that stand to profit from ever more treatments, then drummed into the public consciousness by media organizations that seem to know no other approach to reporting on health besides that of The Grave Warning. This week, in fact, is Eating Disorders Awareness Week, one of the very illnesses that spurred Welti to put forward this bill.
But research shows that prevention campaigns can sometimes backfire. Ten years ago, for instance, Susan Nolen-Hoeksema, PhD, discovered that done wrongly, eating-disorder prevention programs for high-school students actually caused an uptick in symptoms. The toxic combination of simply notifying high-school students about the symptoms of eating disorders (“primary prevention,” for a general audience) while also attempting to reduce its stigma (“secondary intervention,” for subjects likely to have the illness) was not only ineffective, Nolen-Hoeksema found, but counterproductive. (The abstract is here.)
That’s because eating disorders are surely less understood than we like to believe. Take the issue of “control.” Conventional wisdom has long treated the illness as an attempt by helpless parties to achieve some sense of control in their life — and perhaps take refuge from the influence of their families in the process — by controlling their intake of food.
But an emerging family-based approach to treating the illness, a method with empirical support and manualized by NIH funded Daniel LeGrange at the University of Chicago, utilizes the family to a great extent. Other successful in-patient treatment approaches employ behavioral contingencies to mandate patients meet strict daily caloric intake levels, which is essentially the removal of all control.
Treatment issues aside, a second problem with legislation mandating the availability of a mental-health awareness intervention, and doing so in only 62 words, is the doors that it opens for the influence of outside parties.
According to Welti’s bill, the state mental health commissioner would compile a new curriculum on mental health every three years, and do so “in consultation with mental health organizations.” Who those organizations may be, however, the bill does not specify.
But just to take one example, the National Alliance on Mental Illness, or NAMI, is one organization such a bill might utilize. Yet as Sen. Charles Grassley recently learned, NAMI receives two-thirds of its funding from the drug industry.
There’s no need to single out NAMI, of course. Drug- and device-industry sponsorship is widely distributed throughout the community of mental-health-advocacy organizations, and is generally considered to have influenced the remarkable rise in a host of diagnosed illnesses, not least of which has been the 4,000 percent rise in the last decade in the diagnosis of pediatric bipolar disorder. It’s hard to turn around a societal movement like that envisioning the bipolar child, but should new DSM V guidelines to be followed, in coming years that diagnosis will likely be curtailed.
It may not be clear that every illness benefits from greater “awareness,” but were Welti’s bill to assemble unbiased information on mental illness prevalence and best practices for schools, one positive would surely be its ability to stand in contrast to the overwhelming influence within mental-health research and advocacy communities of sponsoring industries.
Freelancer Paul Scott of Rochester writes frequently about health and fitness for various media. Susan Perry will return March 8.