The report effectively plants the government's top medical dog firmly on one side on the thorny question of what constitutes mental disease. The recent proliferation of diagnosable mental disorders has been coupled with a national divide over the difference between personality ticks and legitimate disorders. People who 20 years ago would be called lazy, annoying or unruly, for example, can now be diagnosed with chronic fatigue syndrome, neuroticism or attention deficit disorder. Satcher's report states that such "mental disorders are not character flaws, but are legitimate illnesses that respond to specific treatments." But, notes TIME science writer Christine Gorman, "while people have much more of an idea that these problems are biologically based, there's still the sense that it's somehow a moral failing."
So the big question becomes whether everyone else — specifically health care plans — will buy it. Surgeon general reports are only advisory, but have in the past sparked the government into declaring war on cigarettes and teen drug use. "Sometimes these reports have a tremendous amount of weight," says Gorman. "And sometimes they're completely ignored." The technical term is chronic governmental indecisiveness syndrome.