Translator: Angelica Teal Reviewer: Denise RQ
A few weeks ago, I was dining with some colleagues
in a fancy hotel restaurant in Buenos Aires.
While looking at the menu, I saw a well-known personality coming in
who, some time ago, had consulted me about a treatment.
This person walked very close to our table and then sat at her table,
but not only she ignored me,
she also asked to be sat somewhere else.
Had I been a doctor, a cardiologist, or even better, a neurologist,
this person would have come to say hello immediately.
My being a psychiatrist made it unacceptable for her to do so.
Because if you go to a psychiatrist, you are crazy.
Never mind that psychiatrists treat other conditions
such as depression and anxiety issues.
Psychiatry is no glamorous.
People have no problem
talking about heart problems, ulcers, even about the prostrate,
but no one will mention they go to the psychiatrist.
At most, you will know
someone goes to the psychoanalyst, or that someone has panic attacks.
Panic attacks are very cool.
When I was seven, I knew I would be a doctor.
By ten, that I was going to dedicate to something related to the brain.
I went into a neuropsychiatric hospital for the first time when I was 20,
when I went to the old neuroanatomy lab at the Borda Hospital
run by my professor, Diego Luis Outes.
A wise man who taught me
that the brain has life, and that we have to study it
to understand a healthy human mind as well as one that is not.
Nowadays, neurosciences are the rage,
but back then, to become a psychiatrist, to study the brain
went frankly counter to the norm.
Right now, I am fortunate to work
at the Institute of Neuroscience at the Favaloro Foundation
and at the Cognitive Neurology Institute - INECO.
They are our neuroscience headquarters.
But I am not coming here to talk about me.
I would like to talk to you about stigma,
about the rejection and misunderstanding
that even today, people with mental disorders suffer.
To admit that you see a psychiatrist is like saying you were in jail,
it is not something you tell just anyone.
It conveys a social stain, a stigma.
A stigma is how slaves were branded in order to know their condition.
If my being a psychiatrist
caused that behavior in this well-known personality,
what would be the rejection endured by those people
who suffer mental disorders?
Statistics tell us
one in four people here present
has some type of mental disorder:
a psychosis, bipolar disorder,
depression, OCD, or some anxiety disorder.
This is applicable to the workplace, clubs, Thursday's soccer team;
to each group.
However, it would be very difficult for us to find out.
Because people with mental disorders know that if their condition is known,
they are immediately subject to rejection and isolation.
The stigma is also transferred to the patients' families.
Relatives avoid speaking about the subject or use euphemisms.
We know that relatives of people with severe mental disorders
get sick and depressed
as a result of the suffering and rejection
produced by an environment that doesn't understand them.
The causes of the stigma are complex,
but they have to do with fear and ignorance.
It is as if insanity were dangerous and contagious.
Serious studies demonstrate that people with psychosis
are no more dangerous than the rest of the population.
Andreas Lubitz was not crazy
nor did he commit the mass murder of Germanwings flight because of depression.
He was a psychopath who knew exactly what he was doing.
Insanity is not contagious either.
Although we don't know all the theory,
we know that a psychosis is due to a complex interaction
between genetic and environmental factors
which affect the normal development of the nervous system from gestation,
and that certain environmental factors favor the development of a psychosis
but are not the cause.
We know that for people predisposed to psychosis,
situations like living in a big city,
being an immigrant or a child of one, and consuming toxics like marihuana
increase the chances this predisposition activates.
These socioenvironmental factors need to be seen
not as the cause of the psychosis
but as the ideal environment for the psychosis to occur.
When you think of immigrants, don't think of your brother-in-law in L.A.
who has a barbecue business or fixes computers.
Better yet, think of the Somalis, Jamaicans, and Asians
who live in the poor neighborhoods of London and Amsterdam
where this phenomenon was studied.
This situation produces something called the minority group position:
situations that help circumstances of domination, abuse, and social failure.
All of this favor a predisposed person to manifest his psychosis.
The way it would work
is stress acting over a vulnerable brain
due to a neurodevelopment disorder.
Let's think about bulling.
People who are going to develop severe mental problems
usually have a behavioral pattern different from others.
They are timid and withdrawn, have other interests,
and are not good at sports, which encourages abuse.
One of the most frequent forms of psychosis is schizophrenia.
As time goes by,
the diagnosis of schizophrenia, has become very stigmatized
because it is believed to be incurable
and with a profound decline in performing everyday tasks.
However, this is not always the case.
This stigma is so important,
that in some Asian countries, like Japan, they have changed its name.
We ask ourselves if we have to follow this path,
if this is going to provide some benefit to people with this disease.
To complete the picture,
people with schizophrenia and also those with bipolar disorder
have lower life expectancy, and get sick often,
especially of cardio pathologies.
Even more, the health system takes very little care of them,
and this happens all over the world.
During the 20th and 21st centuries,
society tried to solve the problem of psychosis
by locking patients up in institutions.
These people spent so much time locked up
that in some countries, they were given postcards like the ones you see
so they would write to their relatives as if they were on vacation.
Due to lack of specific treatments the only thing to do was to wait
until the crisis that caused the intervention ceased.
There is an additional problem:
some of these psychosis severely affect people's capacity to fend for themselves,
and this explains why they remained hospitalized for so long.
It was not due to the psychiatrists' malevolence.
Confinement does not cure psychosis
but generates prejudice against psychiatrists.
We are not someone who wants to help patients;
we are the ones who want to lock them up.
This prejudice is shown in movies a lot.
In movies, the psychiatrist is never logical and empathetic.
He is either mean, authoritarian, and cruel,
or is someone naive and somewhat silly.
Think of the psychiatrist in the trilogy "Millennium."
He was a sadistic abuser.
However, in the past few years,
we have seen this change dramatically.
We are better at diagnosing,
and to be a psychiatrist today means to articulate
complex medical, neuroscientific, neuropharmacological, psychologic,
and psychotherapeutic knowledge.
However,
diagnoses are still done by talking to patients;
we don't have an electrocardiogram.
The most expensive experiment in the history of humanity,
the Hadron Collider, or God's machine,
was done only to prove a physics hypothesis.
Similarly,
neuroscience carries out complex experiments everyday
that give us little bits of information that allow us to advance our knowledge
of how our brain functions and deteriorates.
By the end of the 50s, we had anti-psychotics.
For the first time, people with psychosis have their symptoms under control.
This way, they can return home, but not everything was easy.
As we can see, the great psychiatric revolution
came thanks to scientific research not to psychiatric prejudice.
Medicines like anti-psychotics, antidepressants, or lithium carbonate,
which were discovered soon after penicillin,
greatly changed the lives of hundreds of people who suffered mental disorders
and improved their lives.
The anti-psychiatry movement
hurts the lives of people with serious mental disorders
because it misinforms.
It started in the the late 60s,
it claims mental disorders don't exist,
that they are a way to deal with an ailing society.
Also, there are some who claim
that mental disorders were created by the pharmaceutical industry
in order to sell more drugs.
Ridiculous.
People no longer spend years locked up waiting to get better.
Treatments allow that patients recuperate while close to their families.
However, in spite of all the advances,
people with mental disorders continue to have difficulties
to get a job and to be taken seriously.
And their status continues to be misunderstood.
People with mental disorders sometimes behave strangely,
but not all the time.
We also behave strangely sometimes.
Think about yourselves at a soccer game.
Having a normally dignified nature, you become enraged
because an unfair foul was called on your favorite player;
you would not accept to be called a crazy person or a loony
because you fell under the spell of soccer.
For the most part, this person acts normally.
People with mental disorders do too.
However,
we have no qualms in calling them with all kinds of pejorative terms:
'nutcase,' 'deranged, ' 'few peas short of a casserole, '
'doesn't have all his dogs on one leash.'
Take your pick.
Every time you talk about someone with mental disorder this way,
you have one in four chances to unknowingly be causing pain
to someone who is listening to you.
This is why I will ask you to acquire a few habits
to become warriors against stigma.
First, do not label.
Don't say that he is psychotic, bipolar, depressed, or has OCD.
People are not their diseases.
That's why we tell them that they suffer them.
I prefer to say that they fight them.
Second, do not be afraid of them. Do not cut them off.
Third, do not judge nor blame people with a metal disorder
for having it.
No one tells someone with cancer,
"You need to pump yourself up, throw away the chemo,
and go for a walk in the sun, and you will you get better."
You would not do that.
Do not do it to people with mental disorders.
It is not as easy as you imagine; it is not easy at all, I can assure you.
To suffering you are adding incomprehension.
Fourth, do not offer advice. Try to listen to them.
Try saying, for example,
"I know you are not well. Do you want to talk? OK. Don't want to? OK, too."
Remember that a helping hand is worth more than a million words.
I leave you with this quote by Bill Clinton
- I consider it very telling -
"Mental illness is nothing to be ashamed of,
but stigma and bias shame us all."
Thank you very much.
(Applause)