In December the surgeon general's office released a new report to the nation, focusing on mental health. Those who have been involved in preparation of the document hope that its impact will be of the same order of magnitude as previous surgeon general's reports on smoking or on violence - to change the behavior of the nation.

Though the report is a long scholarly document that is half footnotes, there are really only two very simple messages: mental illnesses are real, and treatment works.

There are a lot of forces that get in the way of us realizing just how real mental illnesses are. We place a high cultural value on the belief that hard work and right thinking pay off, in terms of material and emotional success. The idea of an illness in the mind stirs our most irrational fears about losing control. The mental health professions have in some ways played into our grand denial, sometimes by promising too much and sometimes by promoting pseudoscience. These all contribute to the stigma that still overshadows mental illness. 

Right now, our attitude about mental illness is like our attitude about cancer in the '50s and '60s. Remember when you couldn't say the "C" word in public? Remember when it was an automatic death sentence? Now most of us know someone who's beaten cancer; we don't smoke and we don't go in the sun without sunscreen; and the beauty salon in my little town carries a full line of "dignity" wigs. 

Our wish to deny the reality of mental illness hurts us in the same way as denying the facts of cancer hurt us. According to the World Bank, of the ten diseases that cause the most disability worldwide, five are mental illnesses. In the U.S., depression is the second most costly disease of all, just behind heart disease, worse than AIDS, cancer, arthritis, MS. 

The news in the Surgeon General's report is that we know enough about mental illness now to be sure that these are diseases of the brain, with characteristic changes in the neuroanatomy. And, we know that treatment can reverse these changes. Medication and psychotherapy can change the neural pathways that mediate mental illness; this is now an accepted fact. Mental illness is not incurable. 

All is not rosy, of course. Though treatment can be effective, finding effective treatment and paying for it can still be very difficult. The surgeon general's report doesn't ignore these basic facts. But by making it clear that mental illness is real, and that it's treatable, the surgeon general takes away the legitimacy of all discrimination, whether it's in our health insurance plans or in our hearts.