First Lady Rosalynn Carter came to the issue of mental health in 1966, when her husband was running for governor of Georgia. As she was greeting workers outside a cotton mill at 4:30 in the morning, one of the employees – small, worn and covered in lint – confided that although she’d just completed the night shift, she doubted she’d sleep once she got home: She had a mentally ill daughter living with her. The encounter left such an impression on Mrs. Carter that she made a surprise visit to one of her husband’s rallies later that day to tell him about it.
Jimmy Carter lost his gubernatorial campaign that year. But in 1970 he won, and shortly thereafter he created the Governor’s Commission to Improve Services for Mentally and Emotionally Handicapped Georgians. Rosalynn became an integral part of the organization; she was an advocate on mental-health issues throughout her husband’s term as president, and has been ever since. Given the recent surge in neuroscience research and the successful passage in 2008 of the Mental Health Parityand Addiction Equity Act, a law that attempts to ensure equal mental- and medical-health coverage, one would think that Mrs. Carter would be feeling pleased with the nation’s progress. Instead, she told Jon Stewart this spring that things were more or less as bad today as they were when she first started in the field: jails have supplanted crumbling institutions as warehouses for the mentally ill. Partly in response, she wrote Within Our Reach: Ending the Mental Health Crisis, which was published earlier this year.
You discuss in your book how under-diagnosed mental illness often is. But there’s also the argument – in the case of depression, at least – that it’s overtreated, not undertreated, and that doctors are too quick to prescribe medication. Where do you stand?
I think we’ve learned that it takes more than medication to help people. In writing my book, I talked to Tom Insel, director of the National Institute of Mental Health; he was very distressed, because what they’ve focused on is medications, and that’s just not the total answer.
What would a more complete answer look like?
Well, what we know from the consumer movement – people with mental illness helping each other – is that when consumers have a say in their treatment, wonderful things happen. People who have been incapacitated for years by major mental illness are recovering – sometimes without medication, probably most often with medication.But you have to work with a professional to figure out what kind. So many people with a mental illness go to a primary care doctor, and so many primary care doctors don’t get the training they need to recognize mental illnesses. Many of them just prescribe a pill.
Assuming our government has a responsibility to the mentally ill, what can it do, and how can it do it most effectively?
We’re going to have to work across different categories. Look at the different departments that are responsible for children: it’s a maze, there’s no way that one department knows what the other is doing. When Jimmy was president, he created the Federal Emergency Management Agency; all the organizations responsible for responding to disasters reported directly to the president. And it worked, until the agency was put under Homeland Security. So it can work; you can design programs that work.
In Within Our Reach, you note that former Florida governor Lawton Chiles publicly discussed his depression, and Colin Powell openly talked about his wife’s. Tipper Gore and George Stephanopoulos have also discussed their own battles with the illness. Why do you suppose so much productive discussion about depression has come from politicians? Do you think they feel a greater moral obligation to disclose it?
I don’t know whether they have to disclose it; sometimes somebody else discloses it, and they have to respond. Tipper was working on the issue because everyone already knew that her son was very badly injured in a car accident, and they went through a lot of trauma with that; she wanted to work on the issue. More people are beginning to speak out about it today than in the past, which is good. But not enough. Stigma still curtails funding for mental health programs. Look how long we worked on parity – and still, people don’t want the law to be enacted the way it reads. People still think that if you fund mental health programs the money’s going down a sinkhole.
Jennifer Senior writes about politics and social science for New York Magazine.