• How many disorders that are listed in the DSM-IV are curable?
  
   
• What documentable, confirmatory, diagnostic, physical abnormality is found in schizophrenia, ADHD and depression?
  
   
• What confirmatory, diagnostic tests are available and currently utilized to detect a chemical imbalance?

The APA would not respond to the questions and the NIMH, which claimed not to get involved in policy issues, deferred to a psychiatrist who refused to speak on the record. Both groups did, however, suggest reviewing the 1999 Surgeon General's Report on Mental Health, which Insight promptly read. The report contained the remarkable statement that, "in the United States, mental disorders collectively account for more than 15 percent of the overall burden of disease from all causes and slightly more than the burden associated with all forms of cancer."

But nowhere in the surgeon general's report was there any reference to a single confirmatory, diagnostic test that proves any physical abnormality in any psychiatric diagnosis. More importantly, several chapters into the report the surgeon general admits what Baughman and other neurologists have been saying for years: "The diagnosis of mental disorders is often believed to be more difficult than diagnosis of somatic or general medical disorders since there is no definitive lesion, laboratory test or abnormality in brain tissue that can identify the illness" [emphasis added].

Naturally, one might assume, it would be difficult to diagnose a mental illness if there were no confirming physical evidence that one exists. And one might even ask the surgeon general how he could make the statement that "mental disorders collectively account for more than 15 percent of the overall burden of disease" when he admits later in the report that there is no physical proof thus far of mental disease in any of the psychiatric diagnoses.

More important, critics say, is his honest admission that there is no proof of any physical abnormality that causes any psychiatric mental disorder. This begs the question: If there is no way to prove that a single psychiatric mental illness exists in life or death, how does one diagnose something that doesn't exist and then require insurance companies to pay for treatment?

While the observations of the nation's top medicine man seem crystal clear — and are, in fact, a carbon copy of what critics such as Baughman long have been saying about mental disorders — apparently the sponsors of the pending legislation missed the surgeon general's report. According to Allison Dobson, communications director for Sen. Paul Wellstone (D-Minn.), a cosponsor of the Senate bill, "We know that mental illness is valid based on the volumes of science that have been presented to the senator. The mental illness thing has pretty much been proved by science."

Sen. Pete Domenici (R-N.M.), the biggest cheerleader for requiring mental-health parity, didn't respond to Insight's calls. But Michael Zamora, the policy adviser for Rep. Patrick Kennedy (D-R.I.), a cosponsor of the House parity legislation, tells Insight: "We've had a number of specialists from NIMH who have talked about what they're doing. While they don't have any diagnostic criteria developed yet, they are making advances and starting to document the linkages between the physical and mental. But they haven't necessarily been able to establish yet exactly how these are working."

Indeed, says Kennedy's spokesman, "I'm pretty confident and trusting that the science base of the National Institute of Health, the surgeon general and Nobel laureates have researched this stuff when they say there is a science base behind mental illness. I know that the congressman is confident that the surgeon general and our premier medical-research facility, NIMH, is not full of quacks."

But that's not the issue, critics say. It's whether as-yet medically proved illness ought to be paid for by insurance companies, employers and patients at the same levels as diseases science physically has confirmed.

Neither former surgeon general David Satcher (author of the 1999 Surgeon General's Report on Mental Health) nor former NIMH director Steven Hyman would agree to an interview to discuss these matters. Given the official admission by former surgeon general Satcher it is tempting to speculate why the interviews were denied. What is unclear is why lawmakers continue to push for mental-health parity with medical disease when, to date, there is no physical proof that any of the psychiatric mental disorders can be confirmed as abnormalities of the brain.

As recently as late May sponsors of the House parity legislation, Marge Roukema (R-N.J.) and Kennedy, continued the push to "end discrimination against patients seeking treatment for mental illness." In a "Dear Colleague" letter to members of the House of Representatives entitled "The Truth About The Impact of Mental Health Parity," Roukema and Kennedy attempted to "eliminate any confusion about the DSM." The authors sought to give credence to the APA's diagnostic manual, explaining that, "for 50 years, DSM has been widely recognized as the 'international standard' system for classifying mental disorders," and the "DSM is the state of the art of the knowledge base."

The "Dear Colleague" advocacy letter closed by observing: "There will always be those who oppose ending insurance discrimination. … While we strongly disagree with them, we look forward to a debate on the facts." Perhaps so. But nowhere did the letter so much as mention that none of the psychiatric diagnoses in the DSM are based in physical science such as abnormalities of the brain found in life or death.

Meanwhile, independent groups representing businesses and other insurers say they are alarmed about the financial burden the proposed legislation is certain to produce. It is widely estimated that nearly 45 million Americans already are without health insurance and there is little doubt that mandating expanded coverage of undefined "mental disease" will run up costs and premiums still further. No one knows how much, but consider these guesstimates:

 

• In 2001 the Business Journal estimated the likely increase in costs would be as high as 40 percent; the National Association of Health Underwriters suggests insurance premiums likely would increase by 11.4 percent.
  
   
• The National Federation of Independent Businesses (NFIB) conducted a study among its 600,000 members that indicates even existing state benefit mandates could increase premiums by as much as 30 percent.
  
   
• An April 2002 PricewaterhouseCoopers report estimates that government mandates and regulations, which increased 25-fold from 1970 to1996, will add $10 billion to the overall increase in health premiums.
  
   
• Charles N. Kahn III, president of the Health Insurance Association of America (HIAA), testified before Congress in 1999 that coverage for psychiatric hospital stays alone already had increased premiums by 12 percent.
  
   
• In Maryland, a 1992 Blue Cross/Blue Shield Association study documented "the most expensive individual benefits were estimated to be substance-abuse and mental-health-care services." Outpatient mental-health-care visits increased more than 78 percent once mandates were expanded — from 448,000 in 1983 to 800,000 in 1986.