Translator: Nataliia Pysemska Reviewer: Tanya Cushman
I have mental illness.
It's taken me hours of talk therapy,
months of trying to find the right medication,
and years to learn how to live successfully with it.
I've redefined how I think and feel
and have learned what kinds of experience and people to allow or limit in my life.
Now at age 55, I've come to appreciate the textures of my own mental illness
and the wisdom that comes from living within those margins.
But there was a time that I wasn't so wise.
A time when my mental illness overwhelmed me.
A time when, at age 19, I reached for a handgun,
ready to end my life.
As a young girl, I didn't know I was depressed.
I was just tired and tearful a great deal of the time.
And I just thought that everybody felt that way as a kid.
And teachers, friends, family -
nobody really noticed that I was depressed.
Partly because clinical depression wasn't thought to exist in young children.
And partly because I was a good kid who didn't need a lot of looking after
and I knew how to put a smile on my face to hide the pain.
But as I got older, my depression worsened.
The tiredness and tearfulness
morphed into an unshakable fatigue and a looming despair.
In college, I started skipping classes because I was having trouble focusing.
As things worsened, I stopped going to school altogether,
and stayed in my room, and slept for hours at a time.
Sometimes I didn't know if it was afternoon or morning,
or if it was a Tuesday or a Thursday.
And the fatigue was just the tip of the iceberg.
What bubbled beneath the surface
were negative, corrosive and menacing thoughts and feelings
that completely overwhelmed me.
"Dad's gun is in the left-hand side of his dresser drawer,"
I told myself one morning.
"When everybody leaves, go in and get it.
Then go into the bathtub, release the safety,
make sure you closed the shower curtains all the way."
It's hard sometimes to hear myself say those words out loud
because I'm very lucky that my suicide attempt was interrupted.
I got immediate help and began working with a psychologist
who taught me about mental illness and mood disorders,
specifically the one that I was struggling with,
which was called "unipolar depression."
I learned how my own life story and my own family's genetics
created this perfect storm for my mental illness to hit.
And not only did mental illness stay in my family,
it became something that I learned to recognize and needed to maintain
not only for myself but for my loved ones as well.
Psychotherapy not only saved my life,
it changed my life,
so much so that I decided to become a psychologist myself
and treat people who had the very same mental illness that I did.
My unique experiences as being both a doctor and a patient
offers me a perspective that most people don't have.
I know what it's like to live with a mental illness.
I know the shame that comes from feeling betrayed by your own mind and body.
I know what it feels like to have to take medication
and the awful side effects that come with it,
like weight gain, loss of libido,
night sweats and hand tremors, just to name a few.
But a psychologist doesn't need to know firsthand
what an experience is like or what a disorder is like
to help people heal.
But my perspective, personally living with depression,
taught me things that clinical training and education never could.
So what if you knew depression as both a doctor and a patient?
Well, you would know these six things.
As a doctor, I tell you that stigma is alive and well
no matter what you see, read or hear.
Technology and science have advanced the understanding of mental illness,
but unfortunately,
the general public still fears those who live with mental illness.
I know what it's like to feel the shame and the cold, hard stare.
I've had a pharmacist tell me one time when I went to fill my prescription,
"Yes you mustn't forget your Prozac; there's a full moon out tonight."
And mental illness stigma is not just seen in the general public.
There's something called "diagnostic overshadowing."
This is where healthcare professionals
discriminate against people - children and adults - who have mental illness.
And as a result, these individuals have undiagnosed physical disorders
and are more likely to prematurely die than the general population.
So as a doctor, stigma still represents one of the biggest wedges
in getting well-being for those who have mental illness.
And we need to do more.
As a doctor, I tell you,
we're not accessing the field of personal medicine the way we need to.
In fact, it may be a phrase that many of you are not even aware of,
particularly genetic metabolism testing.
Research tells us that it takes up to 10 years
for a person with depression to get adequate treatment for their depression.
Mostly it's finding the right medications.
But a test like this can shave years and months
and can turn into a week turnaround
to find out the genetically designed medications that will work best for you.
Now, personalized medicine is a field that offers enormous hope.
But a lot of professionals are unaware that it's out there,
and it's called "genetic illiteracy."
And it's something that a lot of health professionals can't really keep up with
because there are so many new breakthroughs
when it comes to genetic sciences.
But I'm here to tell you as a doctor
that personalized medicine and genetic metabolism testing
should be done for every single person who lives with a mental illness.
As a doctor,
I would tell you that the single most important thing you can do
if you live with someone who has a mental illness
or if you have mental illness yourself
is to adhere to your treatment plan.
Research says up to 80% of individuals who have depression
never reach recovery.
That means they never feel better,
let alone reach remission, which means that depressive symptoms are gone.
Now, consistency in dealing with your treatment plan
is not just showing up for your therapy sessions
or taking your medication.
In my practice, it's the biggest issue that prevents people from feeling better.
Consistency means taking your medication every day -
the same dose every day, at the same time every day -
and making sure that you get your refills done on time
so there's no gaps in treatment.
And consistency means
not just going for psychotherapy sessions because you're not feeling good.
You have to go when it's a nice beach day
or even if you don't want to or feel like talking.
The idea of consistency for any chronic illness
is the key to well-being.
In the field of real estate, they have the mantra,
"Location, location, location."
Well, in the field of mental illness we need to talk about
"Consistency, consistency, consistency."
Now as a patient - turn my perspective towards that end -
I would love for everybody to just watch your words.
Please don't tell me to "buck up" or "just try harder,"
"be strong"
or, you know, "Maybe you're just being a little lazy today."
You would never say those things to somebody who has cancer
or diabetes or muscular dystrophy.
Depression is a real illness with a neurobiological basis.
And just like chemotherapy won't help somebody's cancer be cured in one dose
or insulin won't regulate somebody's blood sugar forever,
recovery from depression is not going to get better
from a dosage of medication or a trial of psychotherapy sessions.
Depression needs to be accepted as a real illness.
As a patient, I tell you I need to know my triggers,
and I ask that you respect them.
So if you ask me to come out with you for a drink,
celebrate your latest promotion,
or we're going to go out to the city, stay out late,
and I say "no,"
or I pass on watching the latest tearjerker movie -
it's not that I don't want to have fun.
There's a reason behind my noes.
Drinking alcohol reduces the effects of my medication.
Staying out late will interfere with my sleep architecture,
and I need nine to ten hours a day.
It just might be too overwhelming emotionally for me
to watch a really sad movie.
So as a patient,
I'm hopeful that you can understand how invested I need to be in my self-care.
And as a patient, I need to let you know
that there's a likelihood that I may have a serious relapse.
70% of individuals who have a depressive episode
will have another one.
And that statistic doubles to almost 90% if you've had two episodes.
So I need to know that you'll know what to do, who to call, where to go
if I become suicidal or dangerously depressed.
This is called an emergency plan,
and in it will contain the names of my doctors,
the names of the pharmacy, the names of the local hospital.
And if I go willingly, that's terrific.
But if I can't go willingly, you may have to call the police, dial 911,
and you'll have to deal with me maybe being angry,
telling you "I'm never going to speak to you again."
But that really won't matter, because that's the depression talking.
Once I feel better, I'll be so grateful that you cared to look out for me.
I'd be so grateful to be alive.
Depression is a serious but treatable illness.
As a doctor, I'm here to tell you there is hope.
And as a patient, I'm here to tell you there is healing.
Thank you.
(Applause)