Imagine There Was No Stigma to Mental Illness: Dr. Jeffrey Lieberman (Transcript)

Dr. Jeffrey Lieberman – TEDx Talk TRANSCRIPT

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, 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.