"It is far harder to kill a phantom than a reality." Virginia Woolf
In Within Our Reach: Ending the Mental Health Crisis, Rosalyn Carter's brief (156 pgs), well-researched (179 endnotes), interesting and readable book, the former first lady lays waste to many of the ghosts that haunt the field of mental health.
Mrs. Carter is no newcomer to the field, first becoming interested in the mental health issues while helping Jimmy Carter campaign for governor of Georgia in 1966. Under Jimmy Carter, the most significant mental health bill in modern times was passed in 1980, only to be defunded one month after Reagan was inaugurated.
Within Our Reach largely sticks to the facts, and is not a partisan polemic. One in four Americans suffer from mental health related symptoms. Mental health is the largest single cause of disability and loss of productivity in the work place. Yet the treatment for mental health related problems is plagued by lack of access, a diminishing work force of qualified mental health professionals, little to no coverage of costs for those without insurance, and very spotty coverage for those that do. In primary care (I'm a family practitioner) it is estimated that 40% of office visits are related directly or indirectly to mental health issues.
Within Our Reach is true to its introduction, which is titled "A Call to Action". In an easy to follow and logical sequence, Mrs. Carter lays out the phantoms that have inhibited reaching workable solutions to mental health illnesses in the U.S., and then provides the means to exorcise these demons. What are some of these specters? One is the stigma of mental illness, exacerbated by the frequent portrayal in the media of the mentally ill as being frightening and prone to violence. This ghost is laid to rest by pointing out that the mentally ill human has four times as many violent crimes committed against them as the average population does. Meanwhile, only 2% of violent crimes can be attributed to the mentally ill, suggesting that they are LESS likely to commit an act of violence than their sane counterparts in society. Another phantom, hard to kill, is that we can't afford to pay for adequate mental health treatment in the U.S. Carter's response to this is twofold: we can't afford NOT to treat the number one cause of loss of workplace productivity in the U.S., and there are many innovations in the field of mental health that drastically lower the price tag for treatment. The last difficult to slay phantom that I'll mention (there are many others in the book) is along the lines of "why should we bother, not much can be done for crazy people anyway". "Ah" Rosalynn Carter would say, "But there IS much that can be done." And much to the point, the earlier that intervention is done for conditions such as schizophrenia, persistent depression, PTSD, panic attacks, and bipolar affective disorder, the better both the short and long term results are, and the cheaper the short and long term costs are to both the sufferer and society. Watching for early signs of schizophrenia in schools for example, with subsequent prompt intervention, appears to result in dramatic improvements in long term outcomes.
Carter is a pragmatist, not a philosopher or neuroscientist; those looking for the underlying causes of mental illness or those who argue that mental illness is simply what those with neuro-typical behavior call behavior that is less common, will need to look elsewhere for edification.
It is refreshing that for every problem Carter raises, she also presents a workable and affordable solution. It is a rare book that can bring one up to speed on a complex subject in less than 160 pages; this gem is one of them. If the blueprint that Carter lays down were to have been implemented in Virginia Woolf's day, one of literature's most perceptive writers might not have filled her pockets with rocks and waded into a river to end her own life. If the scaffolding of Carter's suggested course of action can be erected, this book suggests (and I am now convinced) that our homes, our communities, and our nation would often move from mentally surviving to mentally thriving. Respect, compassion, and state of the art mental health concepts come together in an admirable and tantalizing blend in Carter's writings. Time to lay the phantoms that have prevented action in the past to rest, and Carter's potent remedies are the sort of bright sunlight that causes ghosts to vanish.
