04:51 - Source: CNN
COVID-19's other toll: on mental health

Editor’s Note: Roy Richard Grinker, a professor of anthropology at George Washington University, is the author of “Nobody’s Normal: How Culture Created the Stigma of Mental Illness.” The views expressed in this commentary are his own. View more opinion articles on CNN.

CNN  — 

As one of the directors of psychiatric operations for the Air Force during World War II, my grandfather, Roy R. Grinker Sr., learned that no one is immune from mental illnesses in a global crisis. In fact, most of his patients were soldiers with no record of mental illness who developed emotional symptoms amid the stresses of war. He also met soldiers whose combat wounds, and sicknesses like dysentery and hepatitis, caused them great psychological distress. He said his patients were not abnormal; they were normal people in abnormal circumstances.

Richard Grinker

We now find ourselves in another global crisis affecting mental health – one many world leaders have likened to a world war. “This is a wartime undertaking,” President Joe Biden said of the Covid-19 pandemic on his first full day in office.

Decades ago, President Harry S. Truman leveraged World War II to jump-start mental health treatment and research, and to battle the persistent stigma so often associated with mental illnesses. In 1946, Truman established the National Institute of Mental Health (NIMH) in response to the high incidence of mental illnesses among soldiers and civilians. During the war, as many as 450,000 to 500,000 soldiers were discharged for psychiatric reasons, according to different estimates.

Truman then ordered the military to adapt its own manual of mental illness diagnosis (called Medical 203) for all Americans. It would be called the Diagnostic and Statistical Manual of Mental Disorders-I (DSM-I). Strongly influenced by William Menninger, who was chief of psychiatry for the US surgeon general during WWII, and who massively enlarged his own training programs in Topeka, Kansas, after the war, universities throughout the country soon expanded psychology departments and launched new psychiatric training programs in their medical schools.

The Covid-19 pandemic is an invitation to make similar progress. But throughout the country today, mental health professionals are scratching their heads trying to figure out why neither former President Donald Trump nor President Biden appointed senior mental health scientists to their Covid-19 task forces. To his credit, President Biden appointed Jane Hopkins, a nurse and union leader with experience in treating mental illnesses, to his transition force, now dissolved after the inauguration. At any rate, he appears to have done so to give representation to nurses and other essential health care workers, not to focus on mental health care.

Post-inauguration, Biden has not made any announcement that prominent mental health experts will be added to his pandemic advisory team. Yet there’s no doubt that the social isolation and economic hardships associated with efforts to stem the infection rate are having a profound impact on mental health. I don’t know anyone who isn’t suffering emotionally to some degree as a result of the pandemic.

Like the soldiers my grandfather treated, many people who now meet the criteria for a mental illness have no history of any significant psychological disturbances. One large study of 69 million US patient records found that survivors of Covid-19 with no psychiatric history had an increased incidence of a first mental illness diagnosis. Indeed, 18% of the patients who survived met the criteria for a psychiatric diagnosis within three months after testing positive. What’s more, the researchers found that people of all ages, sexes and socio-economic circumstances with a pre-existing mental illness were more likely to contract the virus.

With the help of a senior behavioral health scientist and clinician, Biden’s advisers could promote federal research on ways to reduce class, ethnic or geographic disparities in access to the computers and internet technologies needed for psychotherapy telehealth. It could spur software developers to adapt technologies, like smartphone applications and virtual workspaces, for mental health outreach and surveillance (for example, assessments of suicide risk and substance abuse), and propose methods that federal agencies could use to reduce the isolation and marginalization of the elderly, undocumented immigrants and people experiencing homelessness.

It could encourage hospitals to establish multidisciplinary teams that include mental health professionals both as a preventive strategy and to treat the emotional consequences of Covid-19 for patients, their families and caregivers. It could support scientific research on any number of pressing needs, such as the psychological consequences of school closings for children, especially those with developmental disabilities, and the short- and long-term effects of the virus itself on brain function.

Just as importantly, by acknowledging mental illnesses as a public health concern on par with “physical” illness at the highest level of government, the President would send an important and potentially lasting message: There is no shame in seeking mental health care.

Wars sometimes produce changes that are needed, and which reflect society’s values. We should remember that when the United States entered World War II, the American medical and military communities had little respect for mental health professionals. In both the United States and the United Kingdom, soldiers who sought mental health care were routinely discharged, bringing shame to themselves and their families for what the British called a “lack of moral fibre.” Gen. John Lucian Smith, a Medal of Honor recipient, angry at even the suggestion of sending psychiatrists overseas to the war itself, said, “We don’t want any damned psychiatrists making our boys sick.

But war altered those views. As early as 1944, The New York Times reported that my grandfather and his colleagues had “exploded as a myth” the idea that mental illnesses are a sign of weakness. Will the pandemic change our views, too?

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    If the pandemic is truly like a war, it provides us an opportunity to advance mental health research and treatment, and to reduce the stigma that makes people reluctant to seek care.

    “As a society,” President Biden wrote before the election, “we need to work together to eliminate the stigma felt by those who are suffering and struggling with their mental health.” Now is the time to make good on that campaign promise.