The Corpus Callosum

A while back, Gred Laden and Dr. Shock independently linked to a remarkable video.  In it, a famous author-surgeon-professor reveals that he had had an episode of severe depression.  Moreover, he underwent treatment with electroconvulsive therapy.  It worked, he got back to work, and went on to have a distinguished career.  The video can be seen here -- Sherwin Nuland: My history of electroshock therapy.

His point, I suspect, was really to help destigmatize mental illness.  
As an aside, the thing I found most interesting in his talk, was something that was apart from his main message.  When he sank into a severe depression, he was hospitalized.  His most troubling symptoms were obsessions.  Here, I mean obsessions in the technical sense: intrusive, repetitive, horrific thoughts (and/or images) that are accompanied by great anxiety.

His experience highlights an important point about psychiatric diagnosis.  

If his treatment providers had looked only at the most prominent symptoms at the time that the treatment was considered, ECT would not have been considered very highly.  If the clinicians just looked at symptoms, and ignored the history, they might have given him a diagnosis of obsessive-compulsive disorder, not major depression.  At that point in time, there was little or no evidence that ECT could be effective for OCD.  But by considering both the history and the symptoms, they arrived at the correct diagnosis and the correct treatment.  

Treatment guidelines for OCD are here.  Note that ECT is not the first line, or the second-line treatment.  It is mentioned, only in passing, in the section on treatment-refractory OCD with comorbid depression.  Of course, such guidelines are not always correct or comprehensive; there is a least some evidence that ECT can help OCD independent of its effect on mood.  

Anyway, back to the main point.  I thought of the video when I read the NYT article in the Sunday paper, about a burgeoning movement to destigmatize mental illness by discussing it, openly and personally.  

'Mad Pride' Fights a Stigma
By GABRIELLE GLASER
Published: May 11, 2008

...Like many Americans who have severe forms of mental illness such as schizophrenia and bipolar disorder, Ms. Saks and Ms. Spikol are speaking candidly and publicly about their demons. Their frank talk is part of a conversation about mental illness (or as some prefer to put it, "extreme mental states") that stretches from college campuses to community health centers, from YouTube to online forums...

This is not entirely new.  Nuland's lecture occurred in 2001.  Even before that, Kay Redfield Jamison, a clinical psychologist, published her autobiography (An Unquiet Mind) in 1995.  In it, she discusses her experience with bipolar disorder.  William Styron published Darkness Visible: A Memoir of Madness, in 1989.  There are many others; these are just the ones that came to mind first.  

I can't say, now, whether there really is a trend toward more openness and acceptance, but that has been my impression over the past couple of decades.  

One of the impediments to an effective advocacy movement had been the absence of a way for advocates to find each other.  I suspect that socially-oriented electronic media are making it easier for people to connect, and speak out.  While that is not the same as connecting in person, it may be that the electronic connections can facilitate personal connections.  It also may be the case, that some people can make better use of electronic connections as opposed to face-to-face interaction.

However it is done, the more this information is out in public, the more readily it will be accepted as part of the mainstream culture.