Who's looking after our brains?
On the importance of treating our brains at least as seriously as our teeth
If vaccines merely reduced the amount of total human suffering in the world, that would be enough to commend them to widespread use. But they don't do just that: For communicable diseases, they can be exceptionally cost-effective measures. If a Covid-19 vaccine costing less than $50 a dose cuts just one $42,200 hospitalization in a hundred, that's still a huge net return of more than 8:1.
■ But vaccines aren't the only preventative medicines. While we're paying acute attention to one particular public-health event, it's worthwhile to examine whether we ought to be looking to other circumstances where small investments in prevention could have highly-leveraged returns. The fluoridation of public water, for instance, pays off 20:1 in dental-treatment savings.
■ We ought to give serious consideration to the possibility that society could end up with an attractive return on investment if we were to institute a prevention-first approach to mental wellness.
■ The consequences of the pandemic have been far more than just physical. The social and emotional consequences have been such that the American Academy of Pediatrics and other professional organizations published a statement to "declare a National State of Emergency in Children's Mental Health".
■ Because we are social beings, we have a greater interest in one another's mental well-being than in almost any other aspect of health. Another person's broken ankle, root canal, or kidney disease represents a misfortune, but it rarely has broader consequences for other people. The health of our brains, by contrast, can affect others quite a lot.
■ As Americans, we have an utterly terrible track record of approaching mental health with the seriousness and objectivity it deserves. The terrible and nearly universal consequences of the pandemic are such that, at long last, perhaps we are gaining some ground on realizing that mental wellness isn't an on/off switch, in which everything is fine unless diagnosed otherwise. Everyone lives on multiple continua of mental wellness, from conditions that emerge from the chemical structure of the brain through environmental factors, from the permanent to the temporary. And all of them are worthy of respectful attention rather than stigma.
■ The brain is a powerful organ, responsible for 20% to 25% of a normal adult's metabolism and 100% of their consciousness. The proportional physiological demand is even greater in children. And since the overall state of the brain cannot be as easily measured as blood pressure, we ought to be prepared to invest accordingly in seeking out thoughtful ways to ask that most basic of human questions: How are you doing?
■ A stethoscope can't really answer that question, so it's well worth considering what kinds of specialists we ought to be cultivating -- and perhaps even funding -- so that we don't accept as "normal" a serious shortage of necessary professional care. If it's sensible for people to go in for a physical checkup at the doctor's office once a year or to visit the dentist for semiannual cleanings, then wouldn't it also be sensible for everyone to have a therapeutic check of their mental wellness at least once a year, too? Just as we consider the "physical" a routine part of life, so we ought to consider how a "mental" should be just as commonplace, too -- long before we reach a state of "national emergency".
