Translator: AJ Jungbluth
Reviewer: Rhonda Jacobs I know we're only just meeting
for the first time, but I'd like to ask you a question, and it's a rather 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 classmates
in school, your colleagues at work. I'll bet that virtually everybody
knows someone with a mental illness. Now, maybe I should explain
what I mean by mental illness. Commonly thought of conditions
like depression, schizophrenia, bipolar, and anxiety disorders, and also
intellectual disturbances like autism and learning disabilities and ADHD, and addictions to alcohol and drugs. All of these conditions affect
the same areas of the brain and disturb, by varying degrees, the mental functions of cognition,
perception, and emotion regulation. So we're not talking about the worried
well here or problems in daily living. The World Health Organization has estimated that 20% of the world's population
suffers from mental disorder at some point in their lifetime. That's one in five people,
over 70 million Americans. A billion people worldwide. So if you do the math, everyone should know someone
who suffers from a mental disorder, and the fact that many of us
may think we don't reflects three inconvenient truths: that we lack an understanding
and awareness of what mental illness is, that we're reluctant
or ashamed to admit it, and that mental illness
is highly stigmatized. Now, stigma literally means
"dishonor" or "disgrace." It's the mark of Cain in the Bible. It's the "A" on the dress of Hester Prynne
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 illness
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 you were picked to give the toast. But on the day of the event, you got sick, and you had to cancel. When you called to cancel,
would you prefer to say that you couldn't come
because you had a kidney stone or that you were depressed and suicidal? Or would you rather say
you threw out your back or were having a panic attack? Or would you rather explain
that you were having a migraine headache or you were strung out
on prescription pain medication? If you would prefer the former
to the latter in each case, you, my friends, are affected by stigma. Now, I experience stigma every day
as a psychiatrist. The profession to which
I have dedicated my life is the most denigrated and distrusted
of all medical specialties. There's no anti-cardiology movement
that's trying to stamp out cardiology, (Laughter) and there's no anti-oncology movement
that's trying to ban cancer treatment. But there's a virulent
anti-psychiatry movement that claims there's no such thing
as mental illness and wants to eliminate psychiatry. Now, if we thought of mental illness
like we do heart disease, then symptoms like depression
would be like chest pain. Or anxiety would be
like shortness of breath. Or psychosis would be like an arrhythmia. In the former case,
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, for that matter. The heart is basically a pump
composed of four chambers, a dozen blood vessels, and comprised of two billion muscle cells. The brain, on the other hand,
is a three-pound corrugated mass of tissue composed of over 100 billion neurons, which make over 30 trillion connections and form an intricate array
of a myriad number of neural circuits, which simultaneously orchestrate functions
as basic and vital as breathing, temperature regulation, hunger,
coordinate movement. But also form what your personality is
and who you are as a person. The brain gives rise
to consciousness and creativity, and it also houses the human spirit. It's no wonder that it's taken us
so long to understand the brain and appreciate how it relates
to behavior and mental illness. Now, stigma is not unique
to mental illness. We've seen it associated with illnesses
throughout human history. Tuberculosis, leprosy, cancer. The most dramatic example
that 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 into the emergency room with terrible infections, and we couldn't figure out
what was wrong with them, and we had no treatments,
and they invariably died. Now, this by itself would have been enough
to stigmatize this illness, but the fact that it was occurring
predominantly in discriminated groups, including homosexuals
and intravenous drug users, made its victims virtual pariahs. But then an amazing thing happened. The AIDS Advocacy Group and community
aggressively spoke out. They expanded awareness, and they pressured the government
to fund research. And within five years, 1984, two scientists isolated
the human immunodeficiency virus, the cause of AIDS. By 1987, AZT was introduced, the first treatment for AIDS. And now AIDS is like diabetes. It's a chronic illness but you could live
a pretty normal life with treatment. Contrast the outcome of Rock Hudson,
who was diagnosed with AIDS in 1984, and he was dead within a year, to Magic Johnson, who was diagnosed
with AIDS in 1991, and he's still alive living a normal life,
I saw him on TV the other day, with treatment. That is the power of science
leading to knowledge and awareness and effective treatments. Treatments don't just eliminate
the symptoms of the illness. They also eliminate
the prejudice and the stigma. Now we're still learning
the causes of mental illnesses, but we already have effective treatments which 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 actually transform their lives. Earlier in my career, I treated
a young mother named Sarah, and she suffered from panic disorder, which had kept her
housebound for 10 years because she was afraid to go out,
a condition called agoraphobia. To start I had to make house calls
and visit her at home, and when she opened the door
to her home at our first meeting, I saw before me this woman
in a long, black, shapeless tunic with dark glasses and long dark hair. She looked like Morticia
from the Addams Family. I began with exposure therapy
and then gradually introduced medication. And within a couple of months, she was able to come
to see me in the clinic, but she insisted
on sitting next to an open door with her bike perched just outside so she could dash at a moment's notice. But within a year, she changed her attire. She was fashionably dressed, cut her hair. She was going out with her husband,
socializing with friends, and picking her kids up at school. When we ended treatment,
she came to our last session, and she came up to me
and thanked me, and she said, "I feel like I've been let out of prison,
like I've been given my life back." Now, not all disorders have good treatments. Witness Alzheimer's disease and autism, and not all patients respond
as well as Sarah does. A 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 noxious nature of the behavior
drives away family and friends, and even psychiatrists
are reluctant to treat patients. One such patient that I treated
was named Laurie. She was in her early 20s,
a waif-like girl with short hair, large glasses, a very fragile demeanor that could explode into volcanic rage and propel her into aggressive
or suicidal behavior. I worked really hard trying to help
Laurie control her mood volatility, stop her from these
self-destructive acts. But the treatments I used,
the medications I tried, had limited effects, and when she dropped out of treatment, I felt I really hadn't done very much, and I worried about
what would happen for her. So, we don't have treatments
for every disorder. And not all patients respond well. But make no mistake, there is indisputably
a world of difference between modern mental health care today and what existed for all human history prior to the latter part
of the 20th century. So I find it particularly ironic that while people suffered
from mental disorders throughout human history because of the fact we had no knowledge
and limited or no effective treatments, in the 21st century,
when we do have treatments, the biggest barriers
are 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,
like we've done before successfully such as with infectious diseases, with heart disease, with environmental toxins like asbestos, lead, and smoking, and we would begin
with two simple strategies. The first involves early
identification and intervention. And this involves having screening
mechanisms in place in primary care settings
like family medical clinics, pediatrics offices, obstetrical and gynecologic
clinics and offices, and also in schools and in universities, and also in the work place. And individuals who were screened
for being at risk for, or having symptoms of, a mental disorder,
would be referred promptly to a clinic that specialized in providing
the array of treatments that would be helpful to their condition. The goal of this
is to get people engaged early, before the illness has effects
on their brain, disrupts their lives, and risks them doing something
that'd be harmful to themselves or others. The second strategy would be an approach of providing community-based
comprehensive care for people who were already
at more advanced stages of the illness and had suffered some disability. This would include medical management,
rehabilitative services, and also residential facilities to support people
who can't care for themselves and prevent them
from falling through the cracks and ending up on the streets
homeless, or in prisons, or sequestered in state mental hospitals. So we have the means to do this, and this would provide
extraordinary changes in people's lives in many, many ways. People who are depressed, who studies have shown
suffer from symptoms of depression for up to seven years before
they get diagnosed and receive treatment, would not have to endure this. And also at the same time while they're
waiting to be diagnosed and treated, risk the possibility of hurting themselves
through suicide attempts or becoming addicted to something through misguided attempts
at self-medication. People who experience trauma from violent
crime or accidents or natural disasters would be treated promptly,
before they develop symptoms, as they're treated
for their physical injuries, instead of waiting for their
symptoms of PTSD to emerge and then having them
having to seek treatment. And for people like the first responders
and military personnel, who go into harm's way
routinely as part of their job, there would be preventative
and decompression treatments routinely administered, rather than waiting to see
who develops symptoms and has to overcome the embarrassment
of speaking up and seeking help. People who are abusing substances would be encouraged and supported,
rather than blamed and shamed, to seek detox, rehab,
and maintenance treatment before intractable addictions developed. And one in four women expecting babies would not have to risk experiencing
a pre- or post-partum mental condition, but would routinely be treated
as part of their pre- and post-natal care and so that they wouldn't have to
potentially endure symptoms, potentially harm themselves,
or even, God forbid, infanticide. And children who have learning
disabilities or attentional problems would be identified early
in their educational course. And they would not just
have remedial education, they would have cognitive training,
emotional support so they didn't become so frustrated
at their failure in school that they resorted to anti-social behavior
and potentially ended up in prison. Now, you might be thinking to yourself,
"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 kind
of proactive mental healthcare would actually reduce the cost
of delivering healthcare and result in enormous savings. In addition, the families
of people with mental illness would be relieved
of tremendous emotional stress and also financial burden. We would also have the benefit from the fact that many of the glaring
social problems that roil our society would be reduced or eliminated, and I'm speaking here particularly
about the mass violent incidents that have increasingly occurred. Too many of these incidents have been
perpetrated by young males, largely, who are mentally ill and manifest their symptoms
long before they committed their crime. They acted strangely. They were in emotional distress. They were socially isolated. But nobody reached out to them for help. Instead, they were shunned,
ridiculed, or feared. In some cases, families, friends do reach out to try and get
their family members or friends help. Take the case of Gus Deeds,
24-year-old man with bipolar disorder. His father, Virginia State Senator Creigh Deeds, desperately sought to have his son, who was in the throes
of a psychotic episode, hospitalized. But to no avail. Subsequently, Gus viciously attacked
his father and then killed himself. So Senator Deeds is now left
with scars on his face and pain in his heart, instead of his son. So how can we stop the suffering,
the violence, the stigma? We have to begin by recognizing
mental illness for what it is, a medical condition that can be treated,
like we do physical illness. If you look around you
and you saw somebody next to you who was grimacing in pain
or passing out or choking, you would rush up to them
or you would ask them, "Is there something wrong,
or can I help you?" But we don't do this when we see somebody
who's emotionally distressed or acting strangely, or too often intoxicated. But that's what we need to do. We need to be involved, show our concern,
don't be afraid to ask, make it your business. What's the worst that can happen? They say to you indignantly,
"Mind your own business"? Or "I'm fine, thank you"? But the best that can happen
is you may be able to get somebody help and alleviate unnecessary suffering and potentially harm
to themselves or others. Now, that will work for those around us,
that are close to us, or that we're with, but to have
an effect on the whole 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 and these must be
made available to people. I've been trying to do this
by speaking out publicly, including to audiences like you, and writing articles
for the lay public and the media. When Robin Williams died,
I wrote an article about suicide, and I received an email
in response that was titled, "Message from a patient
from very long ago," and I'd like to share this with you. Dear Dr. Lieberman, Last night I read your article
about the suicide of Robin Williams and recognized your name. You probably don't remember me,
but between the ages of 15 and 30, I was severely mentally ill with borderline personality
disorder and depression. I made many suicide attempts
and was frequently hospitalized. One of those times I took a large overdose and awoke in the intensive care unit
of St. Vincent's Hospital. You were assigned to be my doctor, and I clearly remember
how very much you helped me. You probably didn't see it that way,
as I know I gave you a really hard time with my acting out
and self-destructive behavior. However, eventually,
with a lot of treatment, I was able to get myself together. I got married, enrolled in nursing school,
and graduated as valedictorian. For the past 22 years
I've worked in psychiatric hospitals. When I look back at just
how mentally ill I was early in my life, I would never have thought
it could turn out so well, how very fortunate I feel
to have a pretty happy life. And so I just had to let you know. What I remember most
from when I was your patient is that you genuinely seemed
to care about me and didn't judge me. But I suppose the best doctors
are always the ones with the most heart. Signed, Laurie. So this was the same Laurie
that I treated and feared for so long ago. I was thrilled to know
that she had recovered and to think that maybe
I played some small part in this. But what really struck me most
about her email was the fact that it wasn't my medical knowledge
or my clinical skills that she keenly remembered. It was the fact that I showed
compassion for her, and compassion is something
that we all can show to people, including those with mental illness. So while science and medicine continues to pursue the causes
and the cures of mental illness, I ask that you join me to find the heart and muster the will to reach out to all people, particularly people who may show
signs of mental illness, to raise awareness of the public, of the government, and of the media
to end the stigma of mental illness. Thank you for listening. (Applause)
