Beyond Blue

Beyond Blue

Ken Duckworth, M.D. (PART 2): How Do You Move 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.

  • Wisdum

    All of these therapists, earn and learn from your dis-order…at your expense (that’s 17 years of your expense, according to Dr. Duck). And that is only true if you can afford it, those that can’t become the suicidal/homicidal victims/perpatrators we read about in the papers everyday. 12 Step Programs are basically free, or whatever you are willing to contribute (or is that pro-tribute, in more Ways than one)
    LUV 2 ALL

  • Nancy

    12 Step Programs are not for everyone, nor is it sufficient to treat all conditions. If you knew me, it would sound like the most off-beat statement, as I am 15 years sober through AA, have sponsored a number of women for 14 of those years, and I am extremely grateful for the life saving lessons taught along the way and the people who carried me along when I felt as though I could not take one more step. I have had to utilize a multi-disciplinary mode of “recovery”. I do not mean that it’s been an a la carte, pick from column 1,2 or 3, way of processing this journey. However, there are no absolutes. I have numerous factual examples to back this up in my own experience; but I am too weak, tired, and depressed today to be bothered in backing my writing. I believe that AA has definitely kept me from total self-destruction, but if not for the medication that I never go off (I don’t get the part about people starting to feel better and going off medication – that’s why they feel better in the first place – DUH!) – sorry to sound condescending – as I said, I’m at the end of my rope today and really don’t want to tie a knot in it and hang on. Having said what I began with, if I the medical community was my only option in care for all of my “issues” – too many I care to list right now – I probably would have killed myself, if not for my 2 sons. My physician sees me yesterday for 10 minutes yesterday, and because I can be humorous & make a decent presentation – it is determined that I am coping well and off I go with my prescriptions for the day. I was not “acting” through the office visit, he’s known me for years, but today I feel like absolute crap. Yes, I know all about gratitude and this too shall pass. I could probably outdo most with the cliches and implementing them constructively. I needed a therapist one-on-one in the early days, along with a competent physician and the 12 step program and sponsor. I was a huge work in progress. I’ve come a long; however I have another life altering illness that kicks my butt daily. So I don’t feel like a cheerleader today, and I do not have any encouraging words. Actually, I don’t want to do “try” anymore. I am so sick and tired of being sick and tired. I am the financial household provider. My husband’s not a slacker. It’s a result of a comedy of errors, which have been surreal these past few years. But I can’t “afford” to be sick. Not just in dollars and cents for the copays and insurance premiums. Today is one of those days that I am cooked, fried and crispy; mentally, emotionally & physically. I don’t want to kill myself, but I don’t want to do life right now. I have streamlined my life in coping with all of this as much as possible, and many days it still sucks. So I needed a place to just write this down and “say” it out loud.

  • Roy Moyer

    For what it’s worth: I now know, at the age of 70, that I have been depressed since I was a teenager. But the real thing hit me only a few years ago. Not just lethargy and lack of motivation, but sometimes waves of crushing, physically painful depression. Nobody knows the whys. The best description I’ve run across is the introduction to a book called “The Noonday Demon.” But descriptions aren’t much help; we already know what it’s like. My pschiatrist, who is strictly a medicine man, has tried me on just about everything, and nothing has worked. In fact, I stopped medication on my own partly because his last try — a combination of Prozac and Cymbalta — were only pulling me further down. “Feel Good” books, to a true depressive, are a joke. Extensive experience has convinved me that the mental health profession is a joke. There is no answer, because nobody knows what the real question is. One of the most baffling aspects is that deprssion seems to have no evolutionary survival value. It happens. We live with it. And we live alone with it, because “loved ones” cannot be expected to deal with it. As far as I can tell, there is no hope.

  • Larry Parker

    My DBSA support group (in my area, NAMI support groups are primarily for friends and relatives, not consumers) has been a G-dsend — and given my sometime religious skepticism, I absolutely mean that, which I hope says something.
    But the DBSA group (which I’m headed off to shortly, as tonight’s moderator) is not a 12-step group, and I’m not sure it would work on a 12-step model. Mind you, as a child of an alcoholic who binge-drank my way through college — though I’m now a teetotaler — I’ve been to tons of 12-step meetings, and they helped in those discrete situations.
    However, depression (IMHO) is not addiction or a dysfunctional relationship. It’s not an unholy (so to speak) combination of a genetic/medical tendency toward illness that can’t be helped — and a weakness (even if unintentional) that perhaps can be helped, that allowed/allows one to slide into the illness (or an dysfunctional role in relating to the ill person).
    Rather, depression is an illness where, even though the patient/consumer needs to be proactive in his/her own care and minimize (where possible) letting his/her moodiness affect loved ones, there was no moral “weakness” that allowed it to break through. To modify a rather ribald statement that is popular these days, DEPRESSION HAPPENS.
    Besides, anyone who survives with this disease is strong by definition.

  • Nancy

    Larry – Last line – all I can say is “AMEN” !! To survive is at times a miracle in and of itself and is no small task to accomplish or get through. As you said, nor moral weakness was what allowed it to break through. I’ve had years of “experience” in keeping the demons at bay, and when they’ve penetrated through the armour I thought so well protected me from more of the same, I am at times defeated in my soul when they get the best of me. After my last comment a few hours ago, I knew I was in need of leaving the office (I’ll work through the weekend to get in gear), have some meds, have dinner, cry a little, go to bed and say, that’s enough. My limitations were greated than I would have liked or anticipated for today, but that’s where One Day At A Time works for me. Otherwise I could easily exacerbate this lowly place in to being a new permanent home. Hopefully, tomorrow will prove me wrong. No miraculous parting in the sky, with the angels singing down from the heavens; just a peaceful day in the brain and body. My wants have been reduced to my needs for tonight and tomorrow. That we all have a reprieve from our individual pain (whatever that is at this moment), that we are granted a evening of a deep sleep and awaken to a morning of some semblence of well being (of course that will happen for me after my morning coffee and medication – if at all).

  • Nancy

    Ron – we do not have to deal with this alone, and there is always hope. I am not speaking of a “bright light” zap of a miraculous healing and total restoration. There are support groups out there (this blog included) where there is understanding & compassion. It’s having the willingness (and boy that’s a tough one when we can just about brush our teeth some days) to persue the avenues available. In spite of the stigmas that still exist, and because of them, there is an entire network at our disposal for connecting to someone who does truly get it and is willing to listen. On our end, it’s also being willing to looking at suggestions and not closing our minds to all that crosses our paths. I understand the frustration on medication mixes and trials/attempts. Four years ago, the medication that I was on successfully for 10 years stopped working. One of my worst nightmares coming to life. So along with living with the hell of a relapse into an extremely deep depression (I was no Mary Poppins prior – but I lived a good life), I too had to go through the ardous, tedious, mindbending journey of a new fit for my body/brain in living better through different chemistry. It was horrendous. As we all know, the answer of which medication (or combinations of medications) at what doses, with what tolerable versus intolerable side effects come in to play. I felt like I had set up camp (once again) and pitched my tent in Hell. It was almost unbearable. There were circumstances in my life that also coincided with this period of time. Yes, there were times when I wanted to throw the prescription samples at the Doctor and tell him – “Enough – I’m done – no more”, but I didn’t. Now, I’m not saying that I’m Rebecca of SunnyBrook Farm, but not persuing the trials and errors of regaining some footing in the pharmaceutical end of this for me would have eventually ended in either an suicide or a nice long stay (hmmmm – sounds like a vacation) – at a psych ward. I’m not saying that everyone should be on meds; however, there are those who give up on the miracle of some hope and help too soon. So, if someone who’s given up on the medication portion of assistance in their treatment regimen sees only more of the same in terms of deeper depression and hopelessness, I pray they give it another try, and another and another. Also, check oline for local support groups where you can meet people who have the common bond face to face. Some of my most precious relationships have formed that way – Including my husband, who/whom? (I’m too tired to express proper grammar) I met over 15 years ago in a room at a time where you don’t think things like that happen. That’s the nice chapter of the fairy tale pertaining to the the “good section” in my book of life.

  • Nancy

    p.s. – sorry Roy – I wrote Ron when I was typing – didn’t catch it.

  • Margaret Balyeat

    I took Prozac for several years in increasing dosages after it would seem to stop helping after a time, I had become a total advocate of the pharnacuetical element of treatment coupled with the therapy which I continued to also persue. My sisters could always tell me when my dosage needed changing or when, in one of my spates of self-diagnosis and trearnent, I had stopped taking my pills because my persona was that different (frustrating) I went through the all-too-common periods of feeling ‘guilty’ for relying on a chemical to solve my problems (And me a child of the sixties, no less!)until I finally was able to believe this was indeed an illnesfors which required chemical balance which my poor brain couldn’t restore on its own much in the same way the pancreas of a diabetic is unable to restore insulin production without help, dso that guilt would prompt ne to put the little pink and grey capsules away for awhile. Years later, after my stroke determined that I HAD(unknowingly) developed diabetes and I was sent to a neuropsychiatrist for evaluation of the damage incurred by the stroke and a suggestion for treatment of the accimpanying deficiencies, he informed me that often bi-polar depressives experience the merry-go-round of a medication needing to be frequently adjusted in order to work.(That, in fact, was one of the indicators he used in diagnosing me with bipolar rather than unipolar depression. According to this compassionate psychiatrist, who is reputed to be one of “the top” practitioners in the midwest, a bipolar patient placed on anti-depressants is actually at risk of exacerbating the condition and we frequently DO require continual increases in dosage in order for the meds to continue to help. In other words, those years of taking Prozac actually made my condition worse! regardless of how theyy seemed to provide relief for a while (SCARY) iNSTEAD, HE PUT ME ON A “cocktail” of a DIFFERENT antidepressent combined with a “mood stabalizer which seem to do the trick even though it also required several adjustments to find the correct combination for my wounded psyche. Apparently G.P.s who don’t deal with bipolar disorders frequently are slow to differentiate between the differences between unipolar and bipolar conditions and therefore actually exacerbate the condition by prescribing the incorrect medications (ALSO SCARY…sigh!) My therapistt at the time( a fully licensed psychologist) didn’t hold a medical degree, so she couldn’t prescribe, but (with my permission) had consulted with my primary care physician in terms of prescribing the Prozac. as it turns out, i believe the bipolar diagnosis is incorrect since I (THANKFILLY) don’t suffer bouts of mania per se,but the idea that there are so many inconsitencies even amongst the professionals to whom we look for help is truly frightening!
    Throughout this time I was a practicing christian with an abiding faith, and I believe with all m heart that this is part(if not most0 of the reason that I managed to come through this period of “mis-medicating” fairly intact. After all,dn’t we usually return misfiring automobiles (a much less complicated machine than the human mind)to the dealer or manufacturer to be fixed? Faith and prayer are two weapons in our arsenals which cannot be over-enphasized in my personal opinion. I do not, however, advocate throwing out all of the other weapons which help; an intelligent combination seems to work best for me!

  • Larry Parker

    I was misdiagnosed (almost willfully, I discovered in retrospect from the psychiatrist I thought I trusted — I really should have sued for malpractice) with unipolar rather than bipolar depression for more than two years.
    My medication finally pushed me over the edge into full mania and then a dark hole — a ride up and down the elevator in the Empire State Building — and then, of course, a mental ward for a stay.
    But my normal condition is bipolar disorder, type II — I get hypomania at most on the high end, but am still vulnerable to Acapulco cliff dives on the low end.
    Kay Redfield Jamison was right on Oprah when Oprah snapped irritatedly whether bipolar disorder was becoming too trendy (!!!!) a diagnosis. No, Jamison replied calmly, it’s still badly UNDER-diagnosed.

  • Wisdum

    Hi Therese and ALL,
    I have to thank you for this incredible site. It gives us ALL an open perspective (if we are open to it, and can venture outside the “Forest”) on Life from afar, and that is a very worthwhile and invaluable commodity, to say the least. I realized, that it is not so important of and for each of our individual testimony, but the overall testimony. There is no one cure for these maladies that persecute us like an anchor dragging us to the bottomless pit, or an albatross of guilt hanging around our necks, that seems to be bred, and hammered into our psyche, since birth. As unique as we all are, the things that plague us are the same, and vary slightly, and there is not one cure for ALL, but a multitude of cures (except of course the “One“ cure, which a lot of us have a resistance to) It looks like we ALL have to take a personal evaluation, as to what would work best for us, and that would be in terms of fulfilling our dreams and goals in our particular Life. This is all about fulfilling your dreams, and you cannot allow anybody to keep you from that (and it is never too late to start ~ “Today is the first day, of the rest of your Life”) There is their truth, and your truth…and there is The Truth . . . The Truth of it is, God (if you believe there is a God) has given you the freewill to accomplish that end. As your dis-order, you are not really angry, suicidal, homicidal or de-pressed by nature, but there is a problem ,turning that key, pushing that button, driving you to that state … town, country, or relationship. If you can search out that problem and its driver, you just may be able to fire and re-hire a better staff or path.
    “We are ALL sojourners along a Road Called Love”
    How we get, there are many different Ways (more of God’s sense of humor I suspect, that nobody thinks is one dam bit funny … but God … and me !) We can travel separately, or we can go holding hands, along this Road Called Love . . . I kinda like holding hands . . . right ! childish (I prefer to think of it as “childlike” and as in “Come to Me like a child”)
    LUV 2 ALL

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