Has Medicine Lost Its Mind?

Greek physician Hippocrates had it right in the fifth century B.C., says internist Robert C. Smith, M.D., a distinguished professor at Michigan State University and pioneer in patient-centered communication.

“Greek clinicians saw no reason to separate patients’ mental and physical elements, viewing them as a single unit. Practitioners incorporated mental disorders into medicine, recognizing melancholia [depression] and mania [bipolar disorder] for example, as part of everyday health care,” he writes in his new book, “Has Medicine Lost Its Mind? Why Our Mental Health System Is Failing Us and What Should Be Done to Cure It.”

In the 16th century, however, the Catholic Church influence separated the human mind – where the soul was believed to reside – from the body, he reports. This separation, says Smith, began scientific medicine’s path of treating the body’s physical symptoms, while virtually neglecting the mental condition and the patient’s way of life, including habits such as exercise or lack of exercise, work stress and diet.

This explains why the nation’s mental health system is in a “deplorable state,” he says, not because physicians don’t care, but because they are not trained to treat mental illness with the same rigor applied to physical illnesses such as heart disease or diabetes.

The Patient That Changed His Life

When Dr. Smith began practicing internal medicine decades ago, he believed he was doing everything right. He adjusted medications, monitored lab values and treated failing organs with precision, just like he was taught in medical school and his residency.

But the case of one patient haunted him: a man named Sven whom he met and treated early in his career. Once vibrant and engaging, Sven became withdrawn and despondent while hospitalized for kidney failure and high blood pressure.

“A month after being in the hospital, this ebullient and effervescent wonderful person was gone. He was curled up in the corner of his bed, almost in the fetal position. We did all the right things for his blood pressure and kidneys and heart, but when it came to his personal dimension, we didn’t do anything. Clearly, he must have been depressed and down, but nobody addressed any of this with him. We ignored his humanistic plight, and the poor guy just suffered in isolation.”

Sven died after two months in the hospital.

The Search for Compassion

Patients like Sven and others led Smith to leave his private practice to acquire more education, more skills to learn how to treat the mind. He arrived at the Los Angeles Center for the Healing Arts.

“It was the first time that I’d been exposed to people who valued the relationship [with the patient]. They modeled it and helped teach some of it to me. It was the first time it had been OK to relate to people.”

After a year, he joined the University of Rochester in upstate New York for a two-year fellowship as a faculty member. That would become the defining period of his professional life, he writes. The training he received there filled the gaps in his knowledge and skill base, including communicating effectively, establishing a doctor-patient relationship, learning about patients’ most meaningful psychological and social concerns and addressing mental disorders.

He then went to Michigan State University, where he continued his growth and understanding in psychiatry as an educator and researcher. His research established a unique model. “Patient-Centered Interviewing: An Evidence-Based Method,” is now widely used for teaching students, residents and practitioners of medicine, nursing and allied professions.

The High Cost of Untreated Mental Illness

“People assume their mental health care is as good as their physical care,” Smith said in an interview on Zonie Living. “It isn’t.”

He adds that no more than 25% of Americans with a diagnosable mental disorder receive any care at all. “And the problem gets worse even from that. Of that 25%, 75% or more of the care is provided by untrained medical care doctors. And yet, mental illness is much more common than heart disease and cancer combined.”

However, he maintains, it’s not the doctors’ fault. “They are good, hardworking people. But they’re not trained,” he says, noting that across four years of medical school and three to five years of residency, physicians spend no more than about 2% of their total training on mental health.

Psychiatrists, he writes, see only about 12% of mental health patients. The remaining majority are treated in primary care offices where depression, anxiety, substance abuse and suicidal thoughts often go unrecognized.

And the stakes are staggering. Smith points to the opioid epidemic, noting that since its onset in the 1970s, hundreds of thousands of Americans have died from prescription-related overdoses. Many prescriptions, he states, were written by physicians untrained in chronic pain management or addiction medicine.

In his book, “Has Medicine Lost Its Mind?” he notes that in 2013, 249 million opioid prescriptions were written by doctors – enough for every adult to have their own bottle. In addition, he writes, “The United States represents 5% of the world’s population, but we consume 75% of the world’s drugs.”

Suicide is another crisis. “There are 48,000 suicides a year. Half of those are seen by the primary care doctor in the two to four weeks before they commit suicide. This is an ideal opportunity to prevent the suicide from taking place. Doctors aren’t trained in suicide. They don’t recognize it and they don’t know what to do with it if they happen to recognize it. We’re talking here about tens of thousands of unnecessary deaths that are largely preventable.”

Beyond mortality, he says untreated mental illness contributes to job loss, divorce, school failure, addiction, homelessness and incarceration. Smith argues that early recognition and skilled intervention could lessen much of that human and economic toll.

He also emphasizes the hidden cost to patients with a chronic physical disease. “Some 30 million people in the U.S. who have a chronic physical disease have a co-occurring mental disorder. If you do not treat the mental disorder as well as the physical disorder, the physical disorder itself does not get better and that leads to inordinate cost.”

In the book, he writes: “Although the nation suffers financially from huge health care expenses, research done by [health care economics expert Stephen] Melek and his colleagues creates a ray of hope. In careful cost analyses, they found that the United States could save between $26 billion and $48 billion yearly by integrating care in patients with chronic diseases and associated mental illnesses.”

A Call to Action

Smith is calling for systemic reform, including expanded mental health training in medical education, supervised clinical experience with complex psychiatric cases and greater public involvement in shaping national health priorities.

“Organized medicine has known about this for 50 years,” he said. “Change has been minimal. The public needs to demand better.”

Despite the sobering statistics, his message is ultimately hopeful. The skills exist. The research exists. Training models have been developed and tested. What is missing, he says, is public involvement and federal guidance.

“If we can mobilize national campaigns to fight cancer and heart disease, we can address mental health with the same seriousness.”

He urges the public to become involved. “Our politicians need to hear about it. Politicians, inspired by an adamant public, could establish a rigorous, multiyear review to determine how well present medical-education practices adhere to modern science standards and how effectively they prepare graduates for mental health care. The review could be conducted by a presidential commission; a congressional commission; or the National Academies of Sciences, Engineering, and Medicine. Alternatively, a private foundation that wanted to make an impact on health care could do this.”

In addition, Smith offers an easy way for individuals to get involved by going to his website, www.RobertCSmithMD.com and clicking on the square that says, “Download Sample Letter,” which provides email addresses for the president, the surgeon general, the National Academies of Sciences, Engineering, and Medicine, members of Congress and U.S. Senators. Below the email addresses is a sample letter that requests a federal board to oversee and advise the nation’s medical system, which can be pasted into an email message to those individuals. FBN

By Bonnie Stevens, FBN

“Has Medicine Lost Its Mind? Why Our Mental Health System Is Failing Us and What Should Be Done to Cure It,” is available on Amazon. To hear more from Dr. Smith, visit Zonie Living at www.starworldwidenetworks.com.