Imagine There Was No Stigma to Mental Illness | Dr. Jeffrey Lieberman | TEDxCharlottesville

Translator: AJ Jungbluth Reviewer: Rhonda Jacobs I know we're just meeting for the first time, but I'd like to ask you a question, and it's a pretty personal question. How many of you suffer from or know someone who suffers from a

mental

illness

? Well, think about it. Your family, your friends, your schoolmates, your coworkers. I bet practically everyone knows someone with a

mental

illness

. Now, maybe I should explain what I mean by mental illness. It is commonly thought of in conditions such as depression, schizophrenia, bipolar and anxiety disorders, and also intellectual disorders such as autism and learning disabilities, ADHD, and alcohol and drug addictions.

All of these conditions affect the same areas of the brain and disturb, to varying degrees, the mental functions of cognition, perception, and regulation of emotions. So we are not talking here about worried people or problems in daily life. The World Health Organization has estimated that 20% of the world's population suffers from a mental disorder at some point in their lives. That's one in five people, more than 70 million Americans. One billion people around the world. So if we do the math, everyone should know someone who suffers from a mental disorder, and the fact that many of us think we don't reflect three uncomfortable truths: that we lack understanding and awareness of what an illness is. mental illness, that we are reluctant or ashamed to admit it, and that mental illnesses are highly

stigma

tized.

Now,

stigma

literally means "dishonor" or "disgrace." It is the mark of Cain in the Bible. It's the "A" on Hester Prynne's dress in "The Scarlet Letter," and it's the yellow stars that were emblazoned on the clothing of Jews in Nazi Germany. So why should mental illnesses be similarly stigmatized? Well, to show you how insidious stigma can be, let's do a little thought exercise. Imagine that you were invited to celebrate your boss's 50th birthday party and they chose you to toast. But on the day of the event you got sick and had to cancel. When you called to cancel, did you rather say you couldn't come because you had a kidney stone or that you were depressed and suicidal?

Or would you rather say that you pulled your back or had a panic attack? Or would you rather explain that you had a migraine or were off prescription pain medications? If in each case you prefer the former to the latter, you, my friends, are affected by the stigma. Now, as a psychiatrist, I experience stigma every day. The profession to which I have dedicated my life is the most denigrated and mistrusted of all medical specialties. There is no anti-cardiology movement that is trying to end cardiology (Laughter) and there is no anti-oncology movement that is trying to ban cancer treatment.

But there is a virulent anti-psychiatry movement that claims that mental illness does not exist and wants to eliminate psychiatry. Now, if we thought about mental illness like we think about heart disease, then symptoms like depression would be like chest pain. Or anxiety would be like difficulty breathing. Or psychosis would be like an arrhythmia. In the first case, the symptoms emanate from the brain. In the latter case, they emanate from the heart. But the brain is infinitely more complicated than the heart, or any other organ in the human body. The heart is basically a pump made up of four chambers, a dozen blood vessels and two billion muscle cells.

The brain, on the other hand, is a three-pound corrugated mass of tissue composed of more than 100 billion neurons, which make more than 30 trillion connections and form an intricate series of countless neural circuits, simultaneously orchestrating basic and functional functions. basic. vitals such as breathing, temperature regulation, hunger, coordinating movement. But it also shapes what your personality is and who you are as a person. The brain gives rise to consciousness and creativity, and also houses the human spirit. It's no wonder it has taken us so long to understand the brain and appreciate how it relates to behavior and mental illness.

Now, stigma is not exclusive to mental illnesses. We have seen it associated with diseases throughout human history. Tuberculosis, leprosy, cancer. The most dramatic example I know of is AIDS. In the late 1970s, I was an intern at St. Vincent's Hospital in the Greenwich Village section of New York City when the first cases of AIDS began to appear. I remember seeing patients come to the emergency room with terrible infections, and we couldn't figure out what was wrong with them, we had no treatments, and they invariably died. Now, this alone would have been enough to stigmatize this disease, but the fact that it occurred predominantly in discriminated groups, including homosexuals and intravenous drug users, made its victims virtual pariahs.

But then something surprising happened. The AIDS Advocacy Group and the community spoke out aggressively. They raised awareness and pressured the government to fund research. And within five years, in 1984, two scientists isolated the human immunodeficiency virus, which causes AIDS. In 1987, AZT, the first treatment for AIDS, was introduced. And now AIDS is like diabetes. It is a chronic disease but you could live a fairly normal life with treatment. Let's compare the outcome of Rock Hudson, who was diagnosed with AIDS in 1984, and died within a year, with Magic Johnson, who was diagnosed with AIDS in 1991, and is still alive and leading a normal life.

I saw him on television the other day, with treatment. That is the power of science that leads to knowledge, awareness and effective treatments. Treatments not only eliminate the symptoms of the disease. They also eliminate prejudice and stigma. Now we are still learning the causes of mental illness, but we already have effective treatments that have helped millions of people around the world. In many cases, these eliminate the symptoms of the person's illness, but in some cases, they truly transform the person's life. Early in my career, I treated a young mother named Sarah, who suffered from a panic disorder that had kept her housebound for 10 years because she was afraid to leave it, a condition called agoraphobia.

To begin with, I had to make house calls and visit her at home, and when she opened the door of her house on our first meeting, I saw before me this woman in a long, black, shapeless robe, with dark glasses and long hair and dark. She looked like Morticia from the Addams Family. I started with exposure therapy and then gradually introduced medication. And after a couple of months, she was able to come see me at the clinic, but she insisted on sitting next to an open door with her bike placed right outside it so she could run out at any moment.

But after a year, she changed her clothes. She was dressed fashionably and had her hair cut. She went out with her husband, socialized with friends and picked up her children from school. When we finished treatment, she came to our last session, she came up to me, thanked me and said, "I feel like they let me out of prison, like they gave me my life back." However, not all disorders have good treatments. If you look at Alzheimer's disease and autism, not all patients respond as well as Sarah does. One particularly difficult condition that psychiatrists treat is called borderline personality disorder.

This affects young people and produces extreme mood volatility, self-mutilating behavior, and stormy relationships with people. The harmful nature of the behavior drives away family and friends, and even psychiatrists are reluctant to treat patients. One of those patients I treated was named Laurie. She was in her early 20s, a girl with a waif-like appearance, short hair, large glasses, and a very fragile demeanor that could explode into volcanic rage and drive her into aggressive or suicidal behavior. I worked very hard trying to help Laurie control the volatility of her moods and stop her from these self-destructive acts. But the treatments I used, the medications I tried, had limited effects, and when she stopped treatment, I felt like I hadn't really done much and I was worried about what would happen to her.

Therefore, we do not have treatments for all disorders. And not all patients respond well. But make no mistake: it is indisputable that there is a huge difference between modern mental health care today and that which existed throughout human history before the latter part of the 20th century. So I find it particularly ironic that while people suffered from mental disorders throughout human history due to the fact that we had no knowledge and limited or no effective treatments, in the 21st century, when we have treatments, the barriers The greater the lack of awareness. lack of access to care and stigma.

So if there were no stigma, we could launch a public health initiative against mental illness, as we have done successfully before, such as with infectious diseases, heart disease, environmental toxins like asbestos, lead and smoking, and we would do it. Start with two simple strategies. The first involves early identification and intervention. And this means having screening mechanisms in place in primary care settings such as family medicine clinics, pediatric offices, obstetrics and gynecology clinics and offices, and also in schools and universities, and also in the workplace. And people who were screened for being at risk or having symptoms of a mental disorder would be immediately referred to a clinic specialized in providing a variety of treatments that would be helpful for their condition.

The aim of this is to get people involved early, before the disease has an effect on their brain, disrupts their lives and puts them at risk of doing something that would be harmful to themselves or others. The second strategy would be an approach of providing comprehensive community care to people who are already in more advanced stages of the disease and have suffered some disability. This would include medical management, rehabilitation services and also residential facilities to support people who cannot care for themselves and prevent them from falling into oblivion and ending up homeless on the streets, in prisons or sequestered in state psychiatric hospitals.

So we have the means to do it, and this would provide extraordinary changes in people's lives in many, many ways. Depressed people, who studies show suffer symptoms of depression for up to seven years before being diagnosed and receiving treatment, would not have to endure this. And also, at the same time, while waiting to be diagnosed and treated, they run the risk of harming themselves through suicide attempts or becoming addicted to something through misguided attempts at self-medication. People who suffer trauma from violent crimes, accidents, or natural disasters would receive treatment promptly, before they develop symptoms, just as they receive treatment for their physical injuries, rather than waiting for symptoms of post-traumatic stress disorder to emerge and then having to seek treatment. .

And for people like first responders and military personnel, who routinely expose themselves to dangerous situations as part of their jobs, preventive and decompression treatments would be routinely administered, rather than waiting to see who develops symptoms and has to overcome the embarrassment. to speak and looking for help. People who abuse substances would be encouraged and supported, rather than blamed and shamed, to seek detoxification, rehabilitation, and maintenance treatments before untreatable addictions developed. And one in four women expecting babies would not have to risk mental illness before or after giving birth, but would instead be treated routinely as part of their pre- and postnatal care and so they would not potentially have to endure symptoms. , potentially harming themselves or even, God forbid, infanticide.

And children who have learning or attention problems would be identified early in their educational course. And not only would they have remedial education, they would have cognitive training and emotional support so that they would not become so frustrated by their failure in school that they would resort to antisocial behavior and potentially end up in prison. Now, you might be thinking, "Okay, that sounds good. How much is this going to cost? Can we afford to do all this?" Well, the reality is that health economists have found that providing this type of proactive mental health care would actually reduce the cost of providing health care and generate huge savings.

Furthermore, families of people with mental illness would be relieved of tremendous emotional stress as well as financial burden. We would also benefit from the fact that many of the glaring social problems affecting our society would be reduced orwould eliminate, and I am referring here particularly to the mass violent incidents that have increasingly occurred. Many of these incidents have been perpetrated by mostly young men who suffer from mental illness and manifest their symptoms long before committing the crime. They acted strangely. They were in emotional distress. They were socially isolated. But no one asked them for help. Instead, they were rejected, ridiculed, or feared.

In some cases, families and friends reach out to try to get help from their family or friends. Take the case of Gus Deeds, a 24-year-old man with bipolar disorder. His father, Virginia state senator Creigh Deeds, was desperately seeking to hospitalize his son, who was in the throes of a psychotic episode. But he was in vain. Later, Gus brutally attacked his father and then committed suicide. So Senator Deeds now has scars on his face and pain in his heart, instead of his son. So how can we stop suffering, violence and stigma? We have to start by recognizing mental illness for what it is, a medical condition that can be treated, just as we do with physical illnesses.

If you looked around and saw someone next to you wincing, fainting, or choking, you would run to them or ask them, "Is there a problem or can I help you?" But we don't do this when we see someone emotionally distressed or acting strangely, or too often intoxicated. But that's what we have to do. We need to get involved, show our concern, not be afraid to ask, make it yours. What's the worst that can happen? Do they tell you indignantly: "Mind your own business"? Or "I'm fine, thank you"? But the best thing that can happen is that you can get help from someone and relieve unnecessary suffering and potentially harm to yourself or others.

Now, that will work for those around us, who are close to us or with whom we are, but to have an effect on the entire population, we need to influence the government and the media, either individually or through advocacy groups. We have to make them understand that mental illnesses are real medical conditions and that we have effective treatments that should be made available to people. I have tried to achieve this by speaking publicly, including to audiences like you, and by writing articles for the lay public and the media. When Robin Williams died, I wrote an article about suicide and received an email in response titled "Message from a long-ago patient" and I would like to share it with you.

Dear Dr. Lieberman: Last night I read your article about the suicide of Robin Williams and I recognized his name. You probably don't remember me, but between the ages of 15 and 30 I suffered from severe mental illness with borderline personality disorder and depression. I made many suicide attempts and was frequently hospitalized. One of those times I took a huge overdose and woke up in the intensive care unit at St. Vincent's Hospital. He was assigned to be my doctor and I clearly remember how much he helped me. You probably didn't see it that way, since I know I gave you a very difficult time with my self-destructive behavior and my self-destructive behavior.

However, eventually, with a lot of treatment, I was able to recover. I got married, enrolled in nursing school, and graduated with top grades. For the last 22 years I have worked in psychiatric hospitals. When I remember how mentally ill I was at the beginning of my life, I would never have thought it could end up so well, how lucky I feel to have a pretty happy life. And so I had to let you know. What I remember most from when I was your patient was that you seemed to genuinely care about me and didn't judge me. But I guess the best doctors are always the ones with the most heart.

Signed, Laurie. So this was the same Laurie I treated and feared for so long. I was excited to hear that she had recovered and to think that maybe I had a small role in this. But what really caught my attention about her email was the fact that it wasn't my medical knowledge or clinical skills that she deeply remembered. It was the fact that I showed compassion for her, and her compassion is something we can all show to people, including those with mental illness. So, as science and medicine continue to investigate the causes and cures of mental illness, I ask you to join me in finding the heart and mustering the will to reach all people, particularly those who may show signs of mental illness, to raise public, government and media awareness to end the stigma of mental illness.

Thanks for listening. (Applause)