Excluding Mental Illness: That's Messed Up

My long term health insurance, the insurance I paid for and which is required of all employees by my university, has an exclusionary condition:  after two years, benefits can be stopped if it is found that mental illness, including depression, is either the sole cause of or a contributing factor to, the beneficiary's disability.  Otherwise, as long as a person continues to prove to be disabled, benefits continue until the standard age of retirement. 

This condition means that even if you develop depression as a secondary condition related to or brought about by your primary condition(s), and your primary condition remains significant enough to keep you from working, your benefits can be stopped.  

That sucks for a lot of people.  Many chronic conditions have depression as a presenting symptom.  In multiple sclerosis, for example,

Depression may be a result of the MS disease process itself, since MS damages the myelin and nerve fibers deep within the brain. If MS damages areas of the brain that are involved in emotional expression and control, a variety of behavioral changes can result, including depression (The National Multiple Sclerosis Society, http://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/symptoms/depression/index.aspx). 

With respect to fibromyalgia:

Many studies link fibromyalgia and depression. In fact, about three out of every 10 people with fibromyalgia also have major depression at the time of their diagnosis (http://www.webmd.com/fibromyalgia/guide/fibromyalgia-and-depression).  

Additionally, depression can be a side effect of drugs used to treat chronic conditions:

Depression can also be a side effect of some drugs, such as corticosteroids, which may be prescribed for the treatment of MS attacks. There is also some evidence that the interferon medications may trigger or worsen depression in susceptible individuals, although the research on this issue has yielded conflicting results (The National Multiple Sclerosis Society, http://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/symptoms/depression/index.aspx). 

And not at all surprisingly, many people with chronic pain become depressed.  According to the Harvard Mental Health Newsletter, "Pain is depressing, and depression causes and intensifies pain. People with chronic pain have three times the average risk of developing psychiatric symptoms — usually mood or anxiety disorders (http://www.health.harvard.edu/newsweek/Depression_and_pain.htm)."  Chronic pain disrupts sleep, creates stress, and can be socially isolating, all risk factors for depression. 

And, duh, people who are determined eligible for disability benefits have just gone through some major life changes--they've lost their careers and professional identities, their incomes, their ability to be self-supporting adults.  A common element of the definition of disability is an inability to perform one or more major life functions such as bathing, walking, shopping, cleaning, etc.  When you can't take care of yourself the way most of us automatically expect we'll be able to as adults in the prime years of our lives, there's some major psychological stress that results, and some serious psychological work that has to be done with respect to emotions, identity, and purpose. 

The writer William Stryon, in his autobiography Darkness Visible, provides a vivid description of his experience of the connection between pain and depression.  Note that his description of the depressed as "the walking wounded" applies equally well to those with invisible disabilities: 

In depression this faith in deliverance, in ultimate restoration, is absent. The pain is unrelenting, and what makes the condition intolerable is the foreknowledge that no remedy will come- not in a day, an hour, a month, or a minute. If there is mild relief, one knows that it is only temporary; more pain will follow. It is hopelessness even more than pain that crushes the soul. So the decision-making of daily life involves not, as in normal affairs, shifting from one annoying situation to another less annoying- or from discomfort to relative comfort, or from boredom to activity- but moving from pain to pain. One does not abandon, even briefly, one’s bed of nails, but is attached to it wherever one goes. And this results in a striking experience- one which I have called, borrowing military terminology, the situation of the walking wounded. For in virtually any other serious sickness, a patient who felt similar devastation would by lying flat in bed, possibly sedated and hooked up to the tubes and wires of life-support systems, but at the very least in a posture of repose and in an isolated setting. His invalidism would be necessary, unquestioned and honorably attained. However, the sufferer from depression has no such option and therefore finds himself, like a walking casualty of war, thrust into the most intolerable social and family situations. There he must, despite the anguish devouring his brain, present a face approximating the one that is associated with ordinary events and companionship. He must try to utter small talk, and be responsive to questions, and knowingly nod and frown and, God help him, even smile. But it is a fierce trial attempting to speak a few simple words.    --William Stryon, Darkness Visible

 
Because of the exclusion written into insurance policies such as mine, I and many others with chronic, disabling illnesses will hesitate to seek out professional care if we experience the symptoms of depression.  We'll be left to cope with a major symptom of our illnesses, a side effect of our medications, and the life- and mood altering-effects of becoming disabled without being able to access medical care.  That seems messed up to me.