Thomas Insel: Why Are We Afraid To Discuss Mental Illness, If Many Struggle With It? Last year, about one in five were affected by a mental illness. Thomas Insel says we know how to give the right kind of care, but we're not doing it. He argues the first step is to talk about it.
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Thomas Insel: Why Are We Afraid To Discuss Mental Illness, If Many Struggle With It?

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Thomas Insel: Why Are We Afraid To Discuss Mental Illness, If Many Struggle With It?

Thomas Insel: Why Are We Afraid To Discuss Mental Illness, If Many Struggle With It?

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GUY RAZ, HOST:

It's the TED Radio Hour from NPR. I'm Guy Raz. And on the show today, ideas about Erasing The Stigma.

(SOUNDBITE OF MUSIC)

THOMAS INSEL: There are really two kinds of families in America - families who are struggling with a mental illness and families that are not struggling with a mental illness yet.

RAZ: This is Tom Insel. He's a psychiatrist and neuroscientist.

INSEL: Currently I'm serving as the mental health czar for the new governor of California.

RAZ: And Tom gives advice on statewide policies to help people who struggle with mental illness. And before that, he had a similar job, but for the whole country. He directed the National Institute of Mental Health for 13 years.

INSEL: I can tell you from my years in Washington that at the time when I was effectively the nation's psychiatrist, virtually every senior member of Congress had me on speed dial for someone in their family, someone in their office. This is something that keeps a lot of people up at night, but nobody wants to talk about during the day.

RAZ: Yeah. You know, as I've gotten older and I've had the chance to mentor younger people, particularly their 20s, I've realized that so many of them suffer through anxiety and depression in silence. You know, they don't talk about it. And I remember having that same experience in my 20s, you know, just being so filled with anxiety and depression and sadness and eventually seeking out help for it, but doing it in silence because I was embarrassed. You know, I felt like this wasn't a real illness.

INSEL: Yeah. You know, I - I sometimes say this is the biggest epidemic no one is talking about. Susan Sontag once talked about cancer as the visitor who entered without knocking. And that's very much the way I feel about mental illness. Nobody's - goes looking for it, but it finds you or finds someone in your family. And we all become involuntary experts. We have to.

RAZ: Yeah.

INSEL: The numbers bear that out. About 1 in 5 people are affected. And perhaps 1 in 20 are disabled by mental illness.

(SOUNDBITE OF MUSIC)

INSEL: What is difficult about it is that even though this is a common experience, it is incredibly hidden still. That's a really dangerous mistake.

RAZ: Tom Insel actually talked about this on the TED stage back in 2013, when he was still running the National Institute of Mental Health.

(SOUNDBITE OF TED TALK)

INSEL: My job is to make sure that we make progress on diseases of the mind - depression, bipolar disorder, schizophrenia, anorexia, on all of these disorders. I work for the federal government. Actually, I work for you. You pay my salary. And maybe at this point when you know what I do - or maybe what I've failed to do - you'll think that I probably ought to be fired because 90% of suicides are related to a mental illness. Now, when we talk about suicide, what you may not realize is just how prevalent it is. There are 38,000 suicides each year in the United States. That means one about every 15 minutes.

(SOUNDBITE OF MUSIC)

INSEL: Third most common cause of death amongst people between the ages of 15 and 25. It's kind of an extraordinary story when you realize that this is twice as common as homicide and actually more common as a source of death than traffic fatalities in this country. But it's not just the mortality from these disorders. Virtually 30% of all disability from all medical causes can be attributed to mental disorders, neuropsychiatric syndromes. What drives the disability for these disorders like schizophrenia and bipolar and depression is the fact that these start very early in life. Fifty percent will have onset by age 14, 75% by age 24. These are, indeed, the chronic disorders of young people.

RAZ: You know, you give this talk six years ago. And obviously public attitudes about mental health have changed and developed in leaps and bounds. And our understanding is growing. But even then, suicide is, I think, probably a bigger problem today than it was in in 2013, for example.

INSEL: That's right. The actual numbers are kind of mind-boggling. So it's 47,000 people who will die this year from suicide, 90% of them with a mental illness. That is more than the number of people who will die from breast cancer or from auto fatalities or from homicide, by far.

RAZ: Wow.

INSEL: For them, it's like they live in Somalia. They have the same life expectancy, 55 years.

RAZ: Wow.

INSEL: That's unthinkable, the fact that people with these brain disorders end up in prison 10 times more often than they would end up in a public hospital. We think 25% of the homeless population in the United States is homeless with a serious mental illness that's untreated. So this is a huge public health social crisis...

RAZ: It's enormous.

INSEL: ...That we're not talking about. And that is what, you know, in some ways, keeps us from making progress is that we can't address this as an issue that needs to be outed.

(SOUNDBITE OF TED TALK)

INSEL: As we think about this, maybe it's better to actually go a little deeper into one particular disorder, and that would be schizophrenia - that perhaps not at age 22 or 20, but even by age 15 or 16, you can begin to see the trajectory for development is quite different at the level of the brain, not at the level of behavior. Why does this matter? Well, first, because for brain disorders, behavior is the last thing to change. We know that for Alzheimer's, for Parkinson's, for Huntington's. There are changes in the brain a decade or more before you see the first signs of a behavioral change. The good news stories in medicine are early detection, early intervention. This tells us how we need to think about it and where we need to go.

RAZ: Do you imagine a future where we will understand the brain so well that we will understand every neural pathway, that mental illness will be fully treatable? Is that even a realistic future scenario?

INSEL: I think it is. I don't think it requires having to map every connection. And while the tools are better and our understanding is growing and neuroscience is becoming such a powerful agent for getting to know more about what happens with bipolar illness or schizophrenia or depression or PTSD, even without that stuff, we can do so much better than we're doing today in a world where we incarcerate and we keep homeless and we keep people with these very serious disorders from getting optimal care.

(SOUNDBITE OF MUSIC)

INSEL: I think one of the big changes in the way we think about serious mental illness is to realize that if we can arrive early and if we can intervene in a way that's comprehensive, which means not just medication, but a whole range of supports - safe housing, longer-term facilities that are not locked, that are compassionate, humanistic places where people can come and go, but get a range of care - people do pretty well.

But the critical piece is that we get there early and we treat with a comprehensive and continuous approach, which, quite honestly, we have not done in the United States. This is not a question of having to come up with, you know, the map of the brain at a cellular level to understand what is going to help someone with schizophrenia to be able to recover well enough to finish high school. We're not doing it. And the reason we don't do it is the fear. This is why you bring up stigma.

RAZ: Yes.

INSEL: We don't talk about it. We just don't have this kind of broad awareness, A, that this is a common problem, but, B, that it is a treatable problem.

RAZ: So what do you think we need to do as a culture to actually address this? Is the answer as simple as talking? Because I think it's pretty obvious that when other people know that other people are experiencing a similar thing, it kind of makes it a little bit easier.

INSEL: Yeah. By your talking about your own experiences, it allows other people to talk about theirs, some of which are, by the way, heartbreaking and others are incredibly inspiring. So that's always a huge step. And it's something that people find frightening to do. And if you can model that, it gives people the courage to do it and it also instills a huge amount of hope.

(SOUNDBITE OF MUSIC)

INSEL: You know, what people with these illnesses want isn't really that different from what you or I want. You know, they want to be connected. So I think that as we talk about what can we provide to help people really recover, part of that has to be giving people a reason to live, giving them something that they care about. And so often, that something is another person...

RAZ: Yeah.

INSEL: ...To help them to understand that this is not who they are. It's a piece of what they have to live with. That's what we're talking about. It's not that complicated.

RAZ: Tom Insel is a psychiatrist and neuroscientist. He's the co-founder and president of Mindstrong Health. You can see his full talk at TED.com.

(SOUNDBITE OF MUSIC)

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