Beyond Blue

Last week I introduced you to Dr. Ken Duckworth, the medical director for the National Alliance of Mental Illness (NAMI), whom I interviewed as part of a blogger conference call hosted by Revolution Health.
Since I couldn’t cover the entire interview in one “How Do You Move Beyond Blue?” post, I have stretched it out over two weeks (because many of you told me you wanted to read the rest).
You can go to the podcast of the interview and listen to it yourself.
But I’ve transcribed the second part for all of you who like to read it better. For a longer bio on Dr. Duckworth, go to the first “How Do You Move Beyond Blue?” segment (by clicking here).
Here’s Part 2 of the interview (especially interesting for Beyond Blue readers, I think, is our discussion of spirituality and faith, and the integration of them with mental health … the last question):

I’ve been really lucky in that my psychiatrist is from Johns Hopkins Mood Disorders Clinic, and holds a Ph.D. and an M.D. Therefore, while writing prescriptions for me, she also helped me with some cognitive-behavioral techniques I could use, especially the methods that Dr. David Burns outlines in “The Feeling Good Handbook” and “10 Days to Self-Esteem.” Now, that was after trying six other doctors, most of whom never addressed the cognitive-behavioral strategies. Why do you think doctors are reluctant to introduce cognitive-behavioral resources?
The NIMH has stated, and I think this is true, that new treatments take about 17 years to disseminate into the field. On average. I think cognitive-behavioral therapy is something that most of the people who are the trainers in America weren’t taught to do. You have a generation of practitioners in the 40s and 50s who were taught to use inside-oriented supportive psychoanalytic techniques. That was the bread and butter of psychotherapy intervention in most training programs across the country. And cognitive-behavioral work has often been off-camera, not high status, and there’s not that many practitioners of that work.
And what you’re basically seeing is that the advocates and the consumers who have these conditions are essentially demanding this, and they’re creating a market for it. But what’s funny about the mental-health market is that it’s all distorted by third-party payment. And so basically, you need professional societies to get organized and to add this to the repertoire. And you also need the advocates to push for this. Because the professionals left to their own devices aren’t especially motivated to change the way that they’ve been trained.
This leads me to another question. While my doctor used cognitive-behavioral therapy to help me get better, she knew when such techniques would be a liability … when you are so severely depressed that any effort you put forth to try to turn around your thoughts essentially compounds your depression, because you feel like a failure yet again in this capacity.
Yes. That’s why this work is EXTREMELY individualized. Every one person is one person. And that’s why this work is so challenging as well. Because we can talk in general principles, but each individual needs their own thoughtful and creative intervention, which is shaped around the person’s strengths and vulnerabilities, and where they’re at in their process of recovery.
I know you’re probably familiar with the positive psychology movement of Martin Seligman and Dan Baker.
Yes. In fact, Angela Duckworth, my niece, is one of Seligman’s protégés.
I just wrote a blog recently about it. I took Dan Baker’s six tools for happiness. I wrote them out, but then I had in brackets my thoughts about them. In some places I think it’s oversimplified. You know, if you’re grateful, if you’re doing altruistic acts, if you have a grateful heart … kind of an Oprah mentality, then depression goes away. But at the same time I know that you do have to work on your positive thoughts, and you need to get out there and see that other people are hurting. I’m not discounting that. But some people were writing me and telling me that sometimes this self-help isn’t helpful. What is your take?
Yeah, that’s the thing. Everyone is unique. Really, my message to you is that no size fits all in the treatment of people with mental-health conditions. For some people, they might find inspiration with that, and it might motivate them to pursue more treatment. Some people might believe that that is a substitute for treatment. And given that a lot of major mental illnesses do end in suicide–about ten percent of people with bipolar disorder and schizophrenia commit suicide–these are not breezy problems. These are very serious conditions that require our best kind of attention and intervention.
And I would say not only professional, clinical intervention. I think that people can use churches, community, work, love—all sorts of things can be added to the mix of what can help a person get better.
But I do get anxious sometimes when I see people advocating for the substitution of thoughtful, professional intervention with these alternative pop-psychology ideas. I practice many of these principles—an attitude of gratitude, and I try to be altruistic in helping out the homeless people in the city of Boston—but if I were to develop a psychiatric illness, I think they might be necessary but not sufficient.
I want to follow up on that and ask you about the role of faith in mental illness and where it fits into things?
I think this is a really interesting and relatively under-explored area. You know, Sigmund Freud was not a very big fan of religion. And that’s part of the mental-health tradition. I always ask people what their religious and spiritual history is because I frequently find that a big support in their lives comes from their faith or from their community of people who believe the same things they do, particularly in the African-American and Latino communities.
I would say that if you don’t pursue a person’s religious an spiritual history of a person, you’re walking the line of malpractice. To not ask someone about something that is a core value in that culture, is missing something really large.
I think there is a body of evidence that suggests that people who believe in God, who attend church, are more resilient to the development of mental illnesses. And I think there is literature suggesting that it will help with the recovery of mental illnesses. That is, to some extent. However, it might be another great thing that alone isn’t sufficient.
Fortunately, we don’t live in a world where we have to choose between an antipsychotic and faith. So you can have them both. And I think most of the better practitioners who are out there are very open to this. But I will tell you: they’ve come to it more or less on their own. There’s still not a very active spiritual teaching within the mental health profession. It’s just not a big component of our training.
I think if you look at the work of John Peteet: he’s had a number of grants to pursue the promotion of looking at people’s spiritual lives within the mental health field. He’s one of the national leaders—he’s received a few Templeton grants—to pursue the questions of spirituality and the integration with mental health.
But again, this is a very individualized thing. There are people who are true believers, people who go there for a sense of community. It’s not clear to me what are the active ingredients in faith that help people with their mental health. But I’m all for it. And I encourage people to pursue it, and I think most good practitioners do. But I will tell you, we come to this on our own. This isn’t something aggressively pursued in our training. This is an area where I think we could do some nice work on. Because this is an area where I thought mental health practitioners are slightly out of touch or more than slightly out of touch with mainstream America.

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