Translator: Nataliia Pysemska
Reviewer: Tanya Cushman I have mental illness. It's taken me hours of talk therapy, months of trying to find
the right medication, and years to learn
how to live successfully with it. I've redefined how I think and feel and have learned what kinds of experience
and people to allow or limit in my life. Now at age 55, I've come to appreciate
the textures of my own mental illness and the wisdom that comes
from living within those margins. But there was a time
that I wasn't so wise. A time when my mental illness
overwhelmed me. A time when, at age 19,
I reached for a handgun, ready to end my life. As a young girl, I didn't know
I was depressed. I was just tired and tearful
a great deal of the time. And I just thought that everybody
felt that way as a kid. And teachers, friends, family - nobody really noticed
that I was depressed. Partly because clinical depression
wasn't thought to exist in young children. And partly because I was a good kid
who didn't need a lot of looking after and I knew how to put a smile
on my face to hide the pain. But as I got older,
my depression worsened. The tiredness and tearfulness morphed into an unshakable fatigue
and a looming despair. In college, I started skipping classes
because I was having trouble focusing. As things worsened, I stopped
going to school altogether, and stayed in my room,
and slept for hours at a time. Sometimes I didn't know
if it was afternoon or morning, or if it was a Tuesday or a Thursday. And the fatigue was
just the tip of the iceberg. What bubbled beneath the surface were negative, corrosive
and menacing thoughts and feelings that completely overwhelmed me. "Dad's gun is in the left-hand side
of his dresser drawer," I told myself one morning. "When everybody leaves, go in and get it. Then go into the bathtub,
release the safety, make sure you closed
the shower curtains all the way." It's hard sometimes to hear myself
say those words out loud because I'm very lucky
that my suicide attempt was interrupted. I got immediate help
and began working with a psychologist who taught me about mental illness
and mood disorders, specifically the one
that I was struggling with, which was called "unipolar depression." I learned how my own life story
and my own family's genetics created this perfect storm
for my mental illness to hit. And not only did mental illness
stay in my family, it became something that I learned
to recognize and needed to maintain not only for myself
but for my loved ones as well. Psychotherapy not only saved my life, it changed my life, so much so that I decided
to become a psychologist myself and treat people who had
the very same mental illness that I did. My unique experiences
as being both a doctor and a patient offers me a perspective
that most people don't have. I know what it's like
to live with a mental illness. I know the shame that comes from feeling
betrayed by your own mind and body. I know what it feels like
to have to take medication and the awful side effects
that come with it, like weight gain, loss of libido, night sweats and hand tremors,
just to name a few. But a psychologist
doesn't need to know firsthand what an experience is like
or what a disorder is like to help people heal. But my perspective,
personally living with depression, taught me things that clinical training
and education never could. So what if you knew depression
as both a doctor and a patient? Well, you would know these six things. As a doctor, I tell you
that stigma is alive and well no matter what you see, read or hear. Technology and science have advanced
the understanding of mental illness, but unfortunately, the general public still fears
those who live with mental illness. I know what it's like to feel
the shame and the cold, hard stare. I've had a pharmacist tell me one time
when I went to fill my prescription, "Yes you mustn't forget your Prozac;
there's a full moon out tonight." And mental illness stigma
is not just seen in the general public. There's something called
"diagnostic overshadowing." This is where healthcare professionals discriminate against people - children
and adults - who have mental illness. And as a result, these individuals
have undiagnosed physical disorders and are more likely to prematurely die
than the general population. So as a doctor, stigma still represents
one of the biggest wedges in getting well-being
for those who have mental illness. And we need to do more. As a doctor, I tell you, we're not accessing the field
of personal medicine the way we need to. In fact, it may be a phrase
that many of you are not even aware of, particularly genetic metabolism testing. Research tells us
that it takes up to 10 years for a person with depression to get
adequate treatment for their depression. Mostly it's finding the right medications. But a test like this
can shave years and months and can turn into a week turnaround to find out the genetically designed
medications that will work best for you. Now, personalized medicine
is a field that offers enormous hope. But a lot of professionals
are unaware that it's out there, and it's called "genetic illiteracy." And it's something that a lot of health
professionals can't really keep up with because there are
so many new breakthroughs when it comes to genetic sciences. But I'm here to tell you as a doctor that personalized medicine
and genetic metabolism testing should be done for every single person
who lives with a mental illness. As a doctor, I would tell you that the single
most important thing you can do if you live with someone
who has a mental illness or if you have mental illness yourself is to adhere to your treatment plan. Research says up to 80%
of individuals who have depression never reach recovery. That means they never feel better, let alone reach remission, which means
that depressive symptoms are gone. Now, consistency in dealing
with your treatment plan is not just showing up
for your therapy sessions or taking your medication. In my practice, it's the biggest issue
that prevents people from feeling better. Consistency means taking
your medication every day - the same dose every day,
at the same time every day - and making sure that you get
your refills done on time so there's no gaps in treatment. And consistency means not just going for psychotherapy sessions
because you're not feeling good. You have to go when it's a nice beach day or even if you don't want
to or feel like talking. The idea of consistency
for any chronic illness is the key to well-being. In the field of real estate,
they have the mantra, "Location, location, location." Well, in the field of mental illness
we need to talk about "Consistency, consistency, consistency." Now as a patient - turn
my perspective towards that end - I would love for everybody
to just watch your words. Please don't tell me to "buck up"
or "just try harder," "be strong" or, you know, "Maybe
you're just being a little lazy today." You would never say those things
to somebody who has cancer or diabetes or muscular dystrophy. Depression is a real illness
with a neurobiological basis. And just like chemotherapy won't help
somebody's cancer be cured in one dose or insulin won't regulate
somebody's blood sugar forever, recovery from depression
is not going to get better from a dosage of medication
or a trial of psychotherapy sessions. Depression needs to be accepted
as a real illness. As a patient, I tell you
I need to know my triggers, and I ask that you respect them. So if you ask me to come out
with you for a drink, celebrate your latest promotion, or we're going to go
out to the city, stay out late, and I say "no," or I pass on watching
the latest tearjerker movie - it's not that I don't want to have fun. There's a reason behind my noes. Drinking alcohol reduces
the effects of my medication. Staying out late will interfere
with my sleep architecture, and I need nine to ten hours a day. It just might be too overwhelming
emotionally for me to watch a really sad movie. So as a patient, I'm hopeful that you can understand
how invested I need to be in my self-care. And as a patient, I need to let you know that there's a likelihood
that I may have a serious relapse. 70% of individuals
who have a depressive episode will have another one. And that statistic doubles to almost 90%
if you've had two episodes. So I need to know that you'll know
what to do, who to call, where to go if I become suicidal
or dangerously depressed. This is called an emergency plan, and in it will contain
the names of my doctors, the names of the pharmacy,
the names of the local hospital. And if I go willingly, that's terrific. But if I can't go willingly,
you may have to call the police, dial 911, and you'll have to deal
with me maybe being angry, telling you "I'm never
going to speak to you again." But that really won't matter,
because that's the depression talking. Once I feel better, I'll be so grateful
that you cared to look out for me. I'd be so grateful to be alive. Depression is a serious
but treatable illness. As a doctor, I'm here
to tell you there is hope. And as a patient, I'm here
to tell you there is healing. Thank you. (Applause)
