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0 P O V RANT

WHAT THE ELITE


WONTTALK ABOUT
THE STIGMA ABOUT MENTAL-HEALTH CONDITIONS REMAINS RAMPANT, EVEN AMONG THOSE WHO HAVE
ACCESS TO WORLD-CLASS CARE.JEFFREY LIEBERMAN, M.D., ARGUES THAT IF WE UNDERSTAND THE BREAK
THROUGHS OF 21ST-CENTURY PSYCHIATRY, THE BARRIER TO SEEKING TREATMENT WILL FALL.

FO U R DECADES AGO, when Shortly after I became chair of psy angry gestures. W hen I remained silent
my cousin needed treatm ent for chiatry at C olum bia University, I was and observed her, she talked to h er
her asked to consult on a 66-year-old woman selfm ore accurately, she talked to
away from the m ost promi named Dr. Kim* She had been admitted nonexistent people. Because I could not
and well-estaffished psyo to our hospital with a severe skin infec engage her in conversation, I decided
facililies o ft :ime, fearinpihey tion that seemed to have gone untreated to speak w ith her family. The next day,
migM: only ifjH :e things worse for for a long time. This was puzzling: Dr. her husband and adult son and daugh
her. Today, I M>uldnt h e itate to Kim was both educated and affluent. She ter reluctantly came to my office. After
send her to the psychiatric depart had graduated from medical school and, much cajoling, they revealed that shortly
m ent o f any major medical cen- as the wife of a prom inent industrialist, after Dr. Kim graduated from medical
; someofil who haHvorked she had access to the best health care. school, she had developed symptoms of
: front lines o f clinical care, I quickly discovered why a psychia schizophrenia.
en firsthand the sweepin trist had been called to see a patient with Her family was ashamed of her con
ISTOCKPHOTO

*ress th a t as transform ed a skin infection. W hen I tried to ask Dr. dition. Despite their wealth and resources,
liatry; s not everyone Kim how she was feeling, she began to neither Dr. Kims parents nor her hus
^ e f i t from it. shout incoherently and make bizarre, band sought any kind of treatm ent for
* Name has been changed.

Adapted from the book Shrinks by Jeffrey A. Lieberman. MD with Ogi Ogas. Copyright (cl 2015 by Jeffrey Lieberman Reprinted with permission of Little. Brown and Company. All rights reserved. M ay/Ju ne 2015 P sych olog y Today 39
NEW RANT
WORKBOOK
N e w York Times
her illness; instead, they decided to do
Bestselling A uthors o f whatever they could to prevent anyone DESPITE HER
The W hole-B rain C h ild & from discovering her diagnosis. They sec
tioned off her living quarters in a wing
WEALTH,
N o -D ra m a D iscipline of their spacious home and kept her iso RESOURCES,
lated whenever they had guests. Despite
her having received a medical degree,
ANDMEDICAL
practicing medicine was completely out DEGREE,THE
of the question. Until she developed the
skin rash, Dr. Kim rarely left the prop
PATIENTS
erty. Her family tried over-the-counter CONDITION WAS
r the^ ^
remedies, hoping for relief. But when
the rash becam e infected and rapidly
HIDDEN FOR
WHOLE-BRAIN ^ began to spread, they were frightened 3 0 YEARS
CHILD and called in the family doctor. W hen
L WORKBOOK he saw her torso dotted with abscesses,
he implored the family to take her to the
hospital, where she was diagnosed with
a severe staph infection.
I repeated back to them what they A few short generations ago, the
DANIEL 3 SIEGEL. M had told methat for the past 30-some greatest obstacles to the treatm ent of
TINA PAYNE BRYSON. years, they had conspired to keep their mental illness were the lack of effective
wife and mother shut off from the world therapies, unreliable diagnostic criteria,
to avoid public em barrassm ent. They and an ossified theory of the basic nature
unabashedly nodded their heads in uni of the conditions. Today, the single great
son. I told them that their decision to est hindrance to treatm ent is not any
withhold treatm ent was both cruel and gap in scientific knowledge or short
im m oralthough, tragically, not ille coming in medical capability, but social
gal and I urged them to let us transfer stigma. This stigma, unfortunately, has
her to the psychiatric unit when she had been sustained by the legacy of psychia
A u n iq u e , in te ra c tiv e a p p ro a c h been medically cleared so that she could try s historic failures and its enduring
th a t allow s readers n o t o n ly to be treated. They refused. reputationno longer justifiedas the
th in k m o re d e e p ly a b o u t h o w stepchild of medicine.
They informed me that even if Dr.
th e ideas fit th e ir o w n p are n tin g
Kim could be successfully treated, at Though we live in a time of unprec
a p p ro a c h , b u t also d e v e lo p
this point the resulting changes would edented tolerance of different races, reli
cu s to m iz e d a n d p ractical w ays
to im p le m e n t.
be too disruptive to their lives and their gions, and sexual orientations, mental ill
position in the community. They would nessesinvoluntary medical conditions
have to explain the reason why she sud that affect one out of four people are
20% OFF & denly began to appear in public after such still regarded as a mark of shame, a scarlet

Free Shipping a long absence and who knows what


she herself might say or how she would
letter C for crazy.
I encounter this shame and sensitiv
behave in such circumstances? The Kims ity nearly every day. Many of the patients
perceived the stigma of mental illness as seen by o u r faculty opt to pay out o f
so oppressive that they would have this pocket rather than use health insurance,
once intelligent, otherw ise physically for fear o f th eir treatm ent becom ing
healthy woman remain untreated and known. Other patients choose not to visit
8 0 0 8 4 4 -8 2 6 0
-
incapacitated, her brain irreversibly our doctors at the Columbia Psychiatry
deteriorating, rather than face the social Clinic, preferring a private medical office
Use C ode: child consequences o f acknow ledging her without any signs indicating the specialty
mental illness. practiced inside.

*sr mbs*
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Starts Today

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Actress Glenn Close, who has a sister and nephew who both suffer mental illness, helped found
the nonprofit Bring Change to Mind. Here, she speaks about the organization Fountain House. ( 8 0 0 ) 845-2211
RosewoodRanch.com
A FEW YEARS AGO, I gave a talk about we can. One key reason for this psychiat
mental illness at a luncheon in Manhat ric renaissance is my professions adop
tan to raise funds for psychiatric research. tion of a pluralistic view of mental illness.
Afterward, I circulated among the attend C o n tem p o rary psychiatry em braces
eessmart, successful, and outgoing peo neuroscience, psychopharm acology, is ra A new
ple who had all been personally invited
to the event by a w om an Ill call her
and genetics but also wields psycho
therapy to understand a patients unique IOURNEY
J E ating D isorder C e n te r.
Sarahwho was a prom inent socialite problems and history.
whose schizophrenic son had committed But the hardest part for so many
suicide. They chatted over poached salm peoplelike the Kimsis simply believ D is c o v e r S a n ta M o n ic a s first
on and Chablis, openly praising Sarahs ing that a psychiatrist can actually help. e atin g d is o rd e rs c e n te r to o ffe r a
selfless efforts to raise awarenessthough In the media, psychiatrists are still por u nique array o f treatm ent program s
none of them adm itted any direct expe trayed as shrinks spouting psychobabble. fo r a d u lts a n d a d o le s c e n ts :
rience w ith m ental illness themselves. And although in the past, psychiatry
E xte n d e d Intensive
Instead, m ental illness was treated like som etim es served as a safety net for
Partial Transitional Teen
the genocide in Sudan: an issue deserv med students seeking to solve their own
ing public attention, but one distant and problems or feeling unable to compete in
removed from the patrons own lives. other disciplines, it now vies with other
Several days later, I received a call. specialties for top trainees. (8 0 0 ) 6 3 4 -1 7 3 3
One of the attendees, an editor at a pub In 2010, we were trying to recruit a anewjourney.net
lishing company, asked if I could help talented young doctor named Mohsin
her. It seemed that she had lost interest A hm ed, who was considering apply
in her job, had trouble sleeping, and fre ing to our psychiatry program. He had ENROLL YOUR CHILD
quently become emotional, even tearful. com pleted his doctorate in neurobiol TODAY FOR A TRULY
Was she having a midlife crisis? I agreed ogy under a celebrated neuroscientist LIFE CHANGING, LIFE
to see her and eventually diagnosed her who proclaim ed him one o f the most SAVING EXPERIENCE
as suffering from depression. But before talented graduate students he had ever
she made the appointm ent w ith me, she
insisted I keep it completely confiden
tialadding, Please dont tell Sarah!
had. Ahmed was a prized recruit and had
his pick of any program. Although he had
signaled his interest in psychiatry, it was
Wellspring
In the next few weeks, I received
more calls from Sarahs invitees seeking
clear he harbored some reservations.
When the results of matching gradu
Camps
help. Over time, fully half o f the people ating medical students with training pro
who attended this event reached out to grams came out, I was thrilled to see that
me, and none w anted Sarah to know he had selected psychiatry after all and
about their problems. was com ing to Columbia. But midway
Its finally tim e to end this stigma. through his first year, he started having
And, now, theres good reason to think second thoughts and told our training
director he wanted to switch to neurology. sies and Calens DNA revealed that they
1 promptly arranged to meet with share a rare genetic variant, resulting in
him. He told me he was fascinated by extra copies of the gene that produces
the daunting complexities of mental an enzyme that metabolizes the amino
illnesses but disappointed by the clini acid glycine, which has been implicated
cal practice of psychiatry. We still base in psychotic disorders. This meant that
diagnoses on symptoms and assess the Jessie and Calen were deficient in gly
effectiveness of treatments by observing cine because their bodies overproduced
the patient rather than relying on labora the enzyme that metabolizes it. When
tory measures, he lamented. I want to Levy gave them supplemental glycine,
feel that I have some real sense ofwhy my their symptoms markedly improved.
- ,
patients are sick and what our treatments It was like watching a patients fever
"
are doing in their brains to help them. decline after giving him aspirin. When
How could I argue? Ahmeds con they stopped taking the supplemental
The Sovereign cerns were common and valid. But I glycine, their symptoms worsened.
explained that even though we were still Using a genetic test on this mother
Way for Teens bridging the gap between psychological and son pair to identify a specific drug
Evidence-based Treatment Programs
Substance Abuse / Co-occurring / Mental Health
constructs and neurobiological mecha that could ameliorate their mental ill
nisms, it was entirely possible to embrace ness was one of the first applications
Why We Are Different both, as many world-class researchers of personalized medicine in psychiatry.
have done. The most exciting psychiatric This technology holds the promise of
Individualized Treatment Plans research in the 21st century is linked to revolutionizing the diagnosis and treat
Gender Separate Programming neuroscience, and all the leaders in our ment of mental illness.
& Housing field now have some kind of biological or In light of these advances, Ahmeds
neurological training. At the same time, generation would be the one to finally
Individual Cognitive Behavioral there is still steady progress in psycho close the gap between psychodynamic
Therapy
therapy. Cognitive-behavioral therapy, constructs and biological mechanisms
Process Groups one of the most effective forms of psy and given his own abilities and passions,
chotherapy for depression, has recently he could lead the way. Ahmed is now
On-site Teacher & Academics
been adapted by psychodynamic pioneer conducting an innovative project on
Equine & Art Therapy Aaron Beck to treat the negative symp the pathophysiology of psychotic disor
toms of patients with schizophrenia. ders. Ironically, despite maintaining his
Extracurricular Activities & Another promising area of research focus on neuroscience research, he has
Outings
is genetics. It is virtually certain that no shown himself to be a most empathic
Family Support single gene alone is responsible for any and skilled psychotherapist. To my mind,
particular mental illness, but through he personifies the 21st-century psychia
The Sovereign Health Adolescent
genetic techniques we are starting to trist. No longer an alienist, shrink, pill-
program was designed to treat and
support the adolescent and the Family understand how certain patterns or pusher, or reductionist neuroscientist, he
system for a more successful recovery. networks of genes confer levels of risk. has become a compassionate and plural
Intensive Family Therapy These genetic signatures will lead to istic psychiatric physician.
more precise diagnosis of patients, as
Parenting Classes well as earlier identification of those JEFFREY LIEBERMAN,
Shrinks
vulnerable to severe mental illness. The
M.D., former president of
Support Groups
Actress Glenn Closes family pro U ntold theAmerican Psychiatric
vided one of the first examples of the Story Association, is the Law
Most Insurance Accepted of
application of genetics in psychiatry. In Psychiatry rence C. Kolb professor
Call Today to Learn More. 2011, her sister Jessie and nephew Calen, and the chair of psychia
Get the Help for YourTeen Today! both havinga mental illness, volunteered try atColumbia. Heisthe
Jeffrey
24/7 Admissions Hotline for a study led by Deborah Levy, a psy Lieberman, MO author of Shrinks: The
with O gj Ogas
chologist at Harvard. An analysis ofjes-
866 656-7220 -
Untold Story of Psychiatry.

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