When a Washington-area construction worker was laid off from his job recently, he began spending his days moping around the house, depressed and anxious about the loss of income. What little money he had managed to save over the years was going fast -- and not very far.
Finally, in a drunken rage, he smashed up the family car. Then he turned on his wife.
Inflation, mental health experts say, is pushing that man and thousands of people like him over the brink.
"The economy is the most profound stress in our society today," said M. Harvey Brenner, a Johns Hopkins University sociologist and expert in the field of money problems and mental illness. "Can inflation drive you crazy? When you add it to existing pressures, yes."
Double-digit inflation, Brenner said, has led to "an unusual upsurge in the use of psychotherapy" across the country. "And 25 to 60 percent of that therapy time is spent talking about economic issues," he said.
The economic discomfort manifests itself most often in depression, an overwhelming sense of frustration and anger, mental health experts said. In extreme cases, it can lead to domestic violence, alcohol abuse and suicide.
Although inflation does not cause mental illness, the experts said, it can exacerbate emotional problems that might normally be alleviated by a spending spree, a new car or a Caribbean vacation.
"It's the straw that broke the camel's back," said Dr. Alan Gruber, a psychologist from South Shore Counseling Associates in Hanover, Mass. 'The economy is only exaggerating other difficulties.'
A year ago, Gruber said, people tended to focus on the Organization of Petroleum Exporting Countries (OPEC) as the enemy. A sense of strength was gained by reducing gasoline consumption and saving energy. "As the villain becomes diffused," he said, "there's less to focus on."
In the Washington area, which has more psychiatrists per capita than any major city in the United States, the money crunch is forcing more people who need help to seek affordable alternatives such as psychologists, psychiatric social workers, community mental health clinics and self-help groups.
There is no hard data on how many people in the United States are under psychiatric care, although the National Institute of Mental Health estimates that 15 percent of the population suffers from some form of psychiatric disorder.
During one week this year, the Washington Psychiatric Society determined that more than 30,000 people in the Washington area were seeing private psychiatrists. Although it is widely believed that liberal insurance benefits enjoyed by federal employes contributes to a high proportion of people here who are in therapy, fewer than half that number were government workers.
"Washington isn't just the government any more," said Dr. Louis Kopolow, a NIMH staff member who is a practicing psychiatrist.
A recent study by the Washington Psychiatric Society, which has 1,032 members, concluded that a larger share of mental health patients in Washington are treated by private psychiatrists than anywhere else in the country. However, that may soon change.
The Woodburn Center for Community Mental Health in Annandale, for example, reports a 25 percent increase in patients since January. The Prince William County Mental Health Center has experienced a 20 percent increase. Both clinics, which charge patients on a sliding scale, say economic pressures are causing the increase.
The D.C. Institute for Mental Hygiene, which treats 1,000 patients a month and provides 50 percent of all outpatient clinical work in the city, reports a greater increase in patients who -- a year ago -- would have gone to a private psychiatrist.
"We hear it from patients all the time," said administrator Carol Purcell.
"They say there were in private therapy but they can't afford it anymore."
Dr. Marc Hertzman, director of George Washington University Medical Center's psychiatric inpatient service, said yesterday that Washington sustained high admission rates for inpatient psychiatric care.
"I suspect that it's related to economics," Hertzman said.
Many years ago, the NIMH's Kopolow said, the American outlook was "things will get better. Now, there are serious doubts about that."
For example, he said, two of his clients are moving out of the Washington area because they are afraid their children won't be able to afford to live here as adults. "You can't buy a house unless you already own one," Kopolow said. "Couples are beginning to argue more. I hear it all the time. 'How are we going to cope?'"
For those still willing and able to pay $60 an hour for therapy, inflation has meant cutting out other expenses."A few of my clients have started brown-bagging their lunches to work to pay for their therapy," one psychiatrist said.
"People in a recession seek comfort first," said Los Angeles psychologist James W. Gottfurcht, who received three times the normal number of patient referrals in March. Gottfurcht said he is frequently called upon to act as a financial counselor, something he did not see as a legitimate aspect of psychotherapy a year ago.
With insurance companies willing to cover a substantial portion of the cost, psychiatric care for a large segment of the public no longer is a luxury.
"Shrink bills fall into the catecory of telephone bills," said Dr. Donald Kaplan, a New York City psychologist.
Federal employes are luckier than most when it comes to mental health benefits. According to Blue Cross and Blue Shield, 80 percent of a federal employe's psychiatric care is covered by insurance.
Most nongovernment employe benefits cover 30 to 50 percent of a patient's psychiatric treatment.
"I've heard patients say that, without insurance, they couldn't continue their therapy," one psychiatrist said.
Besides forcing more people into therapy, inflation has also caused an increase in psychiatric fees, which vary widely depending on the locality and degree of professional help. In Washington, the average psychiatrist's fee is $50 to $60 an hour. In New York, it's slightly higher.
"It used to be that the money mattered," Kaplan said. "It doesn't any more. Sixty-five dollars a session is like going out to dinner for two people."
But the doctors have also felt the money pinch. Several psychiatrists said they are revamping their bill-collecting policies, demanding the fee at the end of each session. "I've had more bounced checks, and more bankruptcies than usual," one West Coast psychologist said.
"We are also human beings" Dr. Alan Grubers said. "We feel the discomfort just as much as anyone else."
In Washington, Deana Goldstein, director of the Psychiatric Institute's Crisis Intervention Center, said she has noticed more and more psychiatrists talking about belt-tightening measures.
"I've heard them say they won't be taking as long a vacation, or can't afford to buy something new," Goldstein said with a laugh. "When the psychiatrists start talking about inflation, then you know we're in trouble.