Week of December 28, 1998 (Originally aired September 21, 1998)The tragic death of Tim Hogan, publisher of the Taunton, Massachusetts Daily Gazette, is a reminder that today's health care system is often unable to help people with mental illness. Hogan, a 36-year-old executive, had kept his severe depression hidden from close friends and family. His repeated efforts to get a psychiatric referral from his HMO and referral hotlines were fruitless. Doctors from his HMO couldn't provide him with immediate treatment. At one point he was referred to a mental health clinic but they told him they wouldn't take his insurance. When he offered to pay with cash, he was again turned away, told they didn't take cash "because it was too expensive."
On May 14, 1998, just three months after finding his dream job, running a daily newspaper, Hogan killed himself. His family has made no public comment until now. Tim Hogan's sister, Althea Davis, speaking for the family, broke that silence with The Infinite Mind's June Peoples. They hope that the story of his death will awaken the health care community, so that other lives will be saved.
She recalls that only rarely did she ever see him sad or depressed, and while she knew he was dealing with some personal issues, never imagined how serious his condition was. Ms. Davis read the suicide note in which Hogan described his efforts to find help, and blasted the nation's health care system. She tells us that "I was angry that our country, our society has gotten to the point of not having empathy or feelings for our fellow man and that insurance companies and even doctors have become so tuned-out to the needs of individuals, that my brother had to end up taking his life to ease his pain." You may also wish to visit the Timothy Hogan Memorial Web site.
How could such a competent executive like Timothy Hogan be unable to find medical help, or manage to conceal the anguish of his hidden illness? Dr. Joseph Goldberg says that men often hide the pain of emotional disturbances. He explains that the underlying cause of suicide is not usually a traumatic setback, but a psychiatric problem such as depression, alcoholism, or psychosis. "Depression and suicide are not simply feelings and responses to life events. Everyone gets depressed, everyone gets lonely, everyone has periods of sadness. Depression is a syndrome. We need a better name than depression to describe a syndrome that includes, not just sadness, but a loss of ability to experience pleasure, changes in one's sleep, and one's appetites, thought processes, and levels of energy?" At least 15% of people with depression complete the act of suicide, but a higher proportion will attempt it. While depression is one of the most treatable psychiatric conditions, Dr. Goldberg tells us, it is also one of the most underdiagnosed and underrecognized, and it costs us $44 billion annually in lost days of work, productivity, and quality of life. Dr. Goldberg's forthcoming book, Bipolar Disorders, will be published by the American Psychiatric Press. For information about Dr. Goldberg's research program in New York, you can call the Payne-Whitney Clinic at 212-821-0778.
Even with good insurance, it's sometimes harder than one may expect to find help. Shelly Stewart is Deputy Director for Federal Relations at the American Psychiatric Association, and heads the Coalition for Fairness in Mental Illness Coverage. Mental health care and substance abuse providers are often not covered by health insurance plans, and are absent from the directories of HMO health care providers. For more information about the Coalition, call 202-682-6000.
Chris Koyanagi, Director of Legislative Policy with the Bazelon Center for Mental Health Law, tells us that access to mental health services has suffered from the influx of managed care programs. Financial barriers of higher co-payments have kept people from seeking early treatment, forcing them to wait until severe crisis hits. Advocates say that insurers try to cut costs by unfairly limiting what mental health treatment they will pay for. They call for parity, or access to the same level of care those with heart disease or diabetes commonly receive. You can reach the Bazelon Center at 202-467-5730, or visit their Web site.
Dr. Gary Brooks knows that even when men are troubled, it can be difficult for them to ask for help. And even when they do visit a therapist, it's often hard for them to open up. He has developed a type of therapy specifically for men. Since many men have a deeply learned fear of feelings and intimacy, and an unspoken expectation that they must be stoic and self-reliant, psychotherapy is not something they're comfortable seeking out. Some common issues confronting men, Brooks thinks, are intimacy, lack of close male friends, change in gender roles, and those arising within sexual relationships.
Dr. Brooks is Chief of the Psychology Service at the Central Texas Veteran's Healthcare System, an Associate Professor of Psychology at Texas A&M, an adjunct faculty member at Baylor University and instructor of Men's Studies at Texas Women's University. He is the author of the books A New Psychotherapy for Traditional Men, published by Jossey-Bass Publishers in San Francisco, and The Centerfold Syndrome.
Weekly commentator John Hockenberry has some things to say about the Tim Hogan case.
For more information on depression and suicide prevention, you can call the American Foundation for Suicide Prevention at 888-333-2377 or the Suicide Prevention Advocacy Network, at 888-649-1366. Additional online suicide resources are listed below:
Suicide and Depression links:
Parents of Suicide support:
www.onelist.com/subscribe/parentsofsuicide
www.parentsofsuicide.com
1000 Deaths Suicide Survivor Support:
www.1000deaths.com
