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Do you have to prove you have a headache?

Monday, April 23 at 12:01 AM

This Speakout has not been edited

By Tony Robucci, M.D.,President, Colorado Psychiatric Society

Have you ever had a headache? Perhaps you've had a simple tension one, or worse, a migraine headache. My guess is that you have. Now if that headache persisted for days, despite your trying your favorite over-the-counter remedy, you'd likely seek medical help. It's also my guess, however, that you've never considered not having that doctor's visit covered by your insurance. You see, there is no test to prove you have a headache, and there are no objective signs that necessarily substantiate its presence.

Headaches, just like psychiatric illnesses, are a subjective experience. It's only by a matter of convention that most people consider them neurologic rather than psychiatric.

There's actually no dividing line between mental and physical illnesses. They simply exist on a spectrum.

That basic principle of diagnostic philosophy, however, seems to have been lost in all the debate I've been hearing over Senate Bill-36, the mental health parity bill. I realize that cost is a realistic concern, and the biological basis of these conditions and evidence-based practices are the sensibility of the day. There's a major problem, however, when those factors override fairness.

You see, headache sufferers are not required to prove that their condition is legitimate. They aren't expected to quote research studies or provide evidence that it's an illness. But when it comes to headaches, the biological-basis substantiated in the literature is essentially at the same point in development as that for psychiatric disorders. It's funny then that the mentally ill are asked to do something that people suffering from other neuropsychiatric disorders are never asked, specifically, to somehow substantiate their worthiness for coverage.

When you treat the mentally ill as a separate class and according to different criteria, then you've created a disparity. And indeed, this bill is about the stigmatization of people with mental illnesses for centuries. All the discussion about the biological basis and cost is nothing but a ruse to cover discrimination. I won't repeat the counterarguments already given to your April 5th article "Smitten by mandates" (see Dr. Hagman's response on April 13th and Dyana Furmansky's from April 12th), but it's time for the mentally ill to be treated equally.

As for me, I'm saddened to see the bill reduced to its amended state. A less than 1% increase for even full parity would have been a small cost to end discrimination. All this debate, however, has given me a headache. So I think the night before the bill is debated in the Senate, I'll take two aspirin.

Hopefully, the next day I won't have a reason for a headache.

READER COMMENTS

The problem is not whether the headache exists. One problem is whether the doctor can do anything to cure it. Another problem is what constitutes a cure. A third problem is who is a doctor.

Related problems include defining malpractice, the problem that the treatment records are kept only by the doctor, and what actions by the docotr are real treatments.

One statement you made was false. Medical doctors frequently have to send insurance companies test results showing that the patient was indeed sick.

Posted by Yaakov Watkins on April 25, 2007 06:19 AM

The problem with the premise here is that mental health professionals have a hard case because many of their solutions as well as their diagnoses are on problems that may exist but have been so confused and downright muddled that they are the equivalent of declaring a headache to be a certain color. Imaginary illnesses are all well and good and the mental health community is guilty of many such illnesses being "identified" with no treatment plan or even a reliable assumption of actual existence, but the compromise of limiting coverage to those where an actual chance of improvement has been demonstrated is wise.

Perhaps if there had not been such a piggy rush to feed at the public trough in so many areas there would be more respect for the profession. Now to complain that only the great majority of mental illnesses will be covered is foolish.

Posted by momma y on April 24, 2007 05:21 AM