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Kay Redfield Jamison is a Professor of Psychiatry at Johns Hopkins School of Medicine, where she also do-directs the Mood Center. Once a manic depressive herself, she is now a prominent expert on mental health, suicide, and creativity.
Her books include Touched With Fire: Manic Depressive Illness and the Artistic Temperament; An Unquiet Mind; Exuberance: A Passion For Life; and Nothing Was The Same.
Question: Why did you finally turn to medication?
Kay Redfield Jamison: I, quite literally, woke up from a coma, from having tried to kill myself and it was very clear to me what my psychiatrist had been saying for years. The choice is not between a drug that has side effects or not, life is not ideal. Yes, your drug has side effects and yes if you don't take it you're going to die. And I—that had been clear to me, but there is something really crystal clear about actually nearly dying. I have not, since I emerged from my suicide attempt, there has not been a day that I have not taken my medication.
Question: Could you have coped with manic depression if you hadn’t been a doctor?
Kay Redfield Jamison: It's hard to say. I mean, I had the advantage, as I said, of having been treated by someone I knew was a superb clinician. Most people don't have the advantage of being able to evaluate their doctor in advance. So, that I think was a huge advantage and particularly since, in my particular illness, one of the worst things that can happen for a certain kind of severe bipolar illness is be given antidepressants, is that my psychiatrist knew better and didn't do that or only for a very short term and very controlled periods; very, very short and only once or maybe twice. So I am very fortunate in that respect. I would never say how fortunate I was. On the other hand, there were real difficulties because I was constantly concerned about losing my license, somebody finding out, so I didn't go into a hospital and the California Commitment laws were such that I could keep out of a hospital and I should have been in a hospital. I should have had ECT and I now have Advanced Directives written out for my doctor and my family that say, "This is what I want done. If I get severely depressed again, if I get manic again, I want ECT, I want to be treated at John's Hopkins, I want to be treated by the following doctors. I do not want the following medications. I do want the following medications." All the things that you know we encourage people to do in advance, I do. But at that time, it wasn't really possible.
Question: How do you identify manic depression?
Kay Redfield Jamison: Again, it's hard. One of the things that has been great over the last ten years or so are people a lot more educated about it, particularly young people. I spent a lot of time on college campuses because it is an illness that hits young. I am just staggered by the amount of information, not all of it accurate, but a lot of information that people have, much more than their professors and their administrators do about these illnesses, particularly about depression. I think that one of things, you know—for example, at Hopkins we have a very active program that goes out into the public and private schools in Baltimore and Washington and now across the country and just teach people the symptoms of depression. Just in a very straightforward way say, "These are the symptoms, really treatable illness, important that you are treated early." Matter of fact and so forth. Teach the teachers. Teach the parents; parents learn all about these mondo bizarro diseases that nobody gets and they don't learn about depression, which is what is actually most likely to hit one of their kids.
So I think there is more education out there. With bipolar illness it is more complicated because it often gets tied up with alcohol and drug abuse, agitation, problems with behavior that people don't necessarily associate with psychiatric problems.
Question: Are anti-depressants over-prescribed?
Kay Redfield Jamison: Well I think that—a couple of things. First of all, I am a huge advocate of prescription drugs given wisely and for the right reasons and the right diagnosis and also psychotherapy. I think psychotherapy saves lives and is hugely meaningful and I think that one of the unfortunate aspects of prescription drugs working well is that people tend to think that's enough. Usually it's not enough; sometimes it is. There is no question in this day and age that I think there is a lot of over-prescription. From a public health point of view, still the overwhelming problem is that people are not treated enough for depression; depression remains under treated. But are there certain zip codes, education levels, areas of the country where people are medicated if they are just a little volatile, little moody-broody, series of bad days, break up with a relationship? Yeah. There are and it's outrageous. I don't think anybody would defend bad practice and it's against gets along your earlier question about medicating grief or medicalizing grief. It's the same thing. It's the last thing you want to do is be medicating people because, a, there—these drugs do affect the brain. Now, they affect the brain in a lot of good ways as we're finding out in terms of regenerating parts of the brain that are damaged and it's important to put it in the perspective of both mania and depression are very toxic conditions to the brain. They are really bad for the brain and most of the medications are really pretty good for the brain, but for sure they're definite pockets of society where people are just over-prescribed.
Recorded On: September 30, 2009
After waking up from a coma after a suicide attempt, Kay Redfield Jamison realized that medication was her only remaining choice.
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A new coronavirus vaccine on display at the Nikolai Gamaleya National Center of Epidemiology and Microbiology in Moscow, Russia.
Credit: Alexander Zemlianichenko Jr/ Russian Direct Investment Fund via AP
Medical workers draw blood from volunteers participating in a trial of a coronavirus vaccine at the Budenko Main Military Hospital outside Moscow, Russia.
Credit: Russian Defense Ministry Press Service via AP
A report from the New York Times raises questions over how the teletherapy startup Talkspace handles user data.
- In the report, several former employees said that "individual users' anonymized conversations were routinely reviewed and mined for insights."
- Talkspace denied using user data for marketing purposes, though it acknowledged that it looks at client transcripts to improve its services.
- It's still unclear whether teletherapy is as effective as traditional therapy.
Talkspace.com<p>Former employees also questioned the legitimacy of certain interventions by the company into client-therapist interactions. For example, after one therapist sent a client a link to an online anxiety worksheet, a company representative instructed her to try to keep clients inside the app.</p><p style="margin-left: 20px;">"I was like, 'How do you know I did that?'" Karissa Brennan, a therapist who worked with Talkspace from 2015 to 2017, told the Times. "They said it was private, but it wasn't."</p><p>Other former employees said the company would pay special attention to its "enterprise partner" clients, who worked at companies like Google. One therapist said Talkspace contacted her for taking too long to respond to Google clients.</p><p>Talkspace responded to the Times with a Medium <a href="https://medium.com/@founders_22883/talkspace-founders-respond-to-a-new-york-times-article-78d6f5c45c59" target="_blank">post</a>, which claimed the Times report contained false and "uninformed assertions."</p><p style="margin-left: 20px;">"Talkspace is a HIPAA/HITECH and SOC2 approved platform, audited annually by external vendors, and has deployed additional technologies to keep its data safe, exceeding all existing regulatory requirements," the post states.</p>
HIPAA concerns<p>However, if the claims in the Times report are true, Talkspace may have violated the <a href="https://www.hhs.gov/sites/default/files//hipaa-privacy-rule-and-sharing-info-related-to-mental-health.pdf" target="_blank">Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule</a>, which prohibits providers from disclosing patients' medical data for marketing purposes, unless the patient gives <a href="https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html" target="_blank">authorization</a>.</p><p style="margin-left: 20px;">"If it is true that Talkspace used information from private therapy sessions for marketing purposes, that is a clear violation of trust with their customers," Hayley Tsukayama, Legislative Activist from the Electronic Frontier Foundation, told <a href="https://www.salon.com/2020/08/10/therapy-app-talkspace-allegedly-data-mined-patients-conversations-with-therapists/" target="_blank">Salon</a>. "All companies should be very clear with their customers about how they use personal information, make sure that they don't use information in ways that consumers don't expect, and give them the opportunity to withdraw consent for those purposes on an ongoing basis. Talkspace trades on its trustworthiness and mentions privacy frequently in its ad campaigns. Its actions should be in line with its promises."</p><p>(It's also worth noting that Talkspace recently threatened legal action against a security researcher who wrote a blog post outlining the potential discovery of a bug that allowed him to get a year's subscription for free. A report from <a href="https://techcrunch.com/2020/03/09/talkspace-cease-desist/" target="_blank" rel="dofollow">TechCrunch</a> notes that Talkspace rejected the findings, and that the company does not offer a way for researchers to submit potential security bugs.) </p><p>Beyond privacy concerns, the report also raises questions about the efficacy of teletherapy, especially within a corporate model.</p><p style="margin-left: 20px;">"The app-ification of mental health care has real problems," Hannah Zeavin, a lecturer at the University of California and author of an upcoming book on teletherapy, told the <a href="https://www.nytimes.com/2020/08/07/technology/talkspace.html" target="_blank" rel="noopener noreferrer dofollow">Times</a>. "These are corporate platforms first. And they offer therapy second."</p><p>The main problem with judging the efficacy of teletherapy is the lack of solid research — it's too new to comprehensively compare it with in-person therapy. Still, some <a href="https://www.theraplatform.com/blog/284/is-telemental-health-effective-how-does-it-measure-up" target="_blank" rel="noopener noreferrer dofollow">studies</a> suggest it could be useful for at-risk populations, or for people in the wake of a disaster.</p>
'It's just not therapy'<p>But others remain skeptical.</p><p style="margin-left: 20px;">"Maybe [teletherapy] products and services are helpful to certain people," <a href="https://www.nytimes.com/2020/08/07/technology/talkspace.html" target="_blank">said</a> Linda Michaels, a founder of the Psychotherapy Action Network, a therapists advocacy group. "But it's just not therapy."</p><p>Proper therapy or not, it's worth considering how platforms like Talkspace use — and possibly even depend on — user data. In a 2019 <a href="https://www.nytimes.com/2019/10/02/opinion/health-care-data-privacy.html" target="_blank" rel="dofollow">opinion piece published in the Times</a>, Talkspace co-founder Oren Frank wrote:</p><p style="margin-left: 20px;">"The vast amount of information each of us possesses is far too important to be left under the control of just a few entities — private or public. We can think of our health care data as a contribution to the public good and equalize its availability to scientists and researchers across disciplines, like open source code. From there, imagine better predictive models that will in turn allow better and earlier diagnoses, and eventually better treatments.</p><p style="margin-left: 20px;">Your health care data could help people who are, at least in some medical aspects, very similar to you. It might even save their lives. The right thing to do with your data is not to guard it, but to share it."</p><p>Would you?</p>
A new Harvard study finds that the language you use affects patient outcome.
- A study at Harvard's McLean Hospital claims that using the language of chemical imbalances worsens patient outcomes.
- Though psychiatry has largely abandoned DSM categories, professor Joseph E Davis writes that the field continues to strive for a "brain-based diagnostic system."
- Chemical explanations of mental health appear to benefit pharmaceutical companies far more than patients.
Challenging the Chemical Imbalance Theory of Mental Disorders: Robert Whitaker, Journalist<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="41699c8c2cb2aee9271a36646e0bee7d"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/-8BDC7i8Yyw?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>This is a far cry from Howard Rusk's 1947 NY Times editorial calling for mental healt</p><p>h disorders to be treated similarly to physical disease (such as diabetes and cancer). This mindset—not attributable to Rusk alone; he was merely relaying the psychiatric currency of the time—has dominated the field for decades: mental anguish is a genetic and/or chemical-deficiency disorder that must be treated pharmacologically.</p><p>Even as psychiatry untethered from DSM categories, the field still used chemistry to validate its existence. Psychotherapy, arguably the most efficient means for managing much of our anxiety and depression, is time- and labor-intensive. Counseling requires an empathetic and wizened ear to guide the patient to do the work. Ingesting a pill to do that work for you is more seductive, and easier. As Davis writes, even though the industry abandoned the DSM, it continues to strive for a "brain-based diagnostic system." </p><p>That language has infiltrated public consciousness. The team at McLean surveyed 279 patients seeking acute treatment for depression. As they note, the causes of psychological distress have constantly shifted over the millennia: humoral imbalance in the ancient world; spiritual possession in medieval times; early childhood experiences around the time of Freud; maladaptive thought patterns dominant in the latter half of last century. While the team found that psychosocial explanations remain popular, biogenetic explanations (such as the chemical imbalance theory) are becoming more prominent. </p><p>Interestingly, the 80 people Davis interviewed for his book predominantly relied on biogenetic explanations. Instead of doctors diagnosing patients, as you might expect, they increasingly serve to confirm what patients come in suspecting. Patients arrive at medical offices confident in their self-diagnoses. They believe a pill is the best course of treatment, largely because they saw an advertisement or listened to a friend. Doctors too often oblige without further curiosity as to the reasons for their distress. </p>
Image: Illustration Forest / Shutterstock<p>While medicalizing mental health softens the stigma of depression—if a disorder is inheritable, it was never really your fault—it also disempowers the patient. The team at McLean writes,</p><p style="margin-left: 20px;">"More recent studies indicate that participants who are told that their depression is caused by a chemical imbalance or genetic abnormality expect to have depression for a longer period, report more depressive symptoms, and feel they have less control over their negative emotions."</p><p>Davis points out the language used by direct-to-consumer advertising prevalent in America. Doctors, media, and advertising agencies converge around common messages, such as everyday blues is a "real medical condition," everyone is susceptible to clinical depression, and drugs correct underlying somatic conditions that you never consciously control. He continues,</p><p style="margin-left: 20px;">"Your inner life and evaluative stance are of marginal, if any, relevance; counseling or psychotherapy aimed at self-insight would serve little purpose." </p><p>The McLean team discovered a similar phenomenon: patients expect little from psychotherapy and a lot from pills. When depression is treated as the result of an internal and immutable essence instead of environmental conditions, behavioral changes are not expected to make much difference. Chemistry rules the popular imagination.</p>
Why Depression Isn't Just a Chemical Imbalance<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="fbc027c9358dad4a6d9e2704fc9ddb04"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/GAC9ODvSxh0?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>Many years ago, my best friend tried to quit smoking. He asked for help. While I'm no addiction expert, I offered what I knew from my fitness toolkit: breathing exercises and cardiovascular training, methods for strengthening his body and mind that could, I hoped, inspire him to take better care of himself in general. He replied, "No, I meant something like a pill."</p><p>A few years later, he quit for good. After failing the cold turkey method a number of times, it finally stuck. Maybe it was watching his children grow up—the reason my parents quit when I was young. This method is not easy, however. It challenges you; it forces you to confront your demons; it drastically affects your brain chemistry. Yet, in the long run, it sometimes works. </p><p>Sometimes pills work, too. But often they do not. The journalist Robert Whitaker, author of "Anatomy of an Epidemic," discussed the clinical trial process <a href="https://bigthink.com/mind-brain/antidepressants-dangers" target="_self">during our recent conversation</a>. While the FDA process appears thorough from the outside, pharmaceutical companies only need to prove that a drug works better than placebo, not that it works for the most amount of people. He continues, </p><p style="margin-left: 20px;">"Let's say you have a drug that provides a relief of symptoms in 20 percent of people. In placebo, it's 10 percent. How many people in that study do not benefit from the drug? Nine out of 10. How many people are exposed to the adverse effects of the drug? 100 percent."</p><p>Even though some pharmacological interventions show little efficacy, and even though Xanax, an addictive and destructive benzodiazepine that only showed <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846112/" target="_blank">short-term (four weeks) efficacy</a> in clinical trials, is being prescribed for many months and years, doctors continue to use the language of clinical neuroscience to describe mental health issues. If chemistry is the problem, people will turn to chemistry for the solution. </p><p>Perhaps we should, as psychiatrist Dean Schuyler <a href="https://bigthink.com/surprising-science/antidepressant-effects" target="_self">writes</a> in a 1974 book, recognize that most depressive episodes "will run their course and terminate with virtually complete recovery without specific intervention." The problem is that idea isn't profitable. As long as the gatekeepers continue to use the language of chemical imbalances to describe what for many is just an episodic case of the "blahs," we'll continue creating more problems than we solve.</p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a>, <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a> and <a href="https://derekberes.substack.com/" target="_blank">Substack</a>. His next book is</em> "<em>Hero's Dose: The Case For Psychedelics in Ritual and Therapy."</em></p>
Viewing art that doesn't look like anything makes your brain take extra steps to try and get it.
- A new study finds that viewing modern art causes real cognitive changes in the viewer.
- Abstract art causes the viewer to place more psychological distance between themselves and the art than with more typical works.
- Exactly how this works is not yet known.