Sunday, July 11, 2010

Charlie Rose: The Brain Series: Mental Health


In case you missed it, Charlie Rose had quite the guest list this week in Episode 9 of his Brain Series:

Helen Mayberg
, Jeffrey Lieberman, Kay Redfield Jamison, Eric Kandel, Stephen Warren and Elyn Saks in Science & Health on Thursday, July 8, 2010

Here is a link with the transcript of the interviews: http://www.charlierose.com/view/interview/11113#frame_top

Nobel Prize winner Dr. Eric R. Kandel co-hosts the show with Charlie Rose, and to quote Dr. Kandel from the transcript:

The whole history of psychiatry, which is a culmination of Emile
Kraepelin, is interesting.  We’ve known about these illnesses since
Hippocrates, the great Greek physician in the 5th century, who not
only spoke about depression and manic-depressive psychosis but
specifically indicated that these are medical illnesses.

But this basic idea was lost on European medicine for the
longest period of time.  During the middle ages, even later in
the Renaissance period, these were thought as demonic disorders,
people possessed by the devil or moral degeneracy.

And people with mental disorders were put away in insane
asylums usually far removed from the center of town and often
they were kept in chains so they don’t move around.

Fortunately, this situation was reversed in about 1800.  The
Paris school of medicine began to really express a very modern
view of medical science.  And Philippe Pinel, a great French
psychiatrist, realized psychiatric disorders, as Hippocrates had
said, are medical illnesses, and he began to institute humane
treatment, the beginning of psychotherapy with mental patients.

But from 1800 to about 1900, no progress was made in
understanding psychiatric disorders.  One couldn’t localize
them specifically so one didn’t know is there one mental illness
or are there many?

And that’s when our mutual hero, Emile Kraepelin, came on the
scene. And his textbooks which began to emerge around 1902 and
continued until he died in 1926, he outlines, for example, in this
book in his first three chapters he defines the fact that mental
illnesses are not unitary.  They affect two different processes,
they affect mood, emotion on the one hand, and affect thinking on
the other.

And he defined the disorders that affect mood -- depression and
manic-depressive disorder, and he defined the disorders of thinking
as schizophrenia.  He called it dementia praecox.  He thought it
was a deterioration of cognitive process in the brain early in life,
praecox.

And as you outlined, we have some insight into the nature of
these diseases.  We know that depression is an illness that involves
mood, which is associated with the feeling of worthlessness, an
inability to enjoy life.  Nothing, it’s all pervasive -- nothing
gives one pleasure.

And there’s a feeling of helplessness, of worthlessness, often
leading to thoughts of suicide and, tragically, to suicide attempts
themselves.

And 25 percent of people that have depression also have manic-
depressive illness.  They have the opposite end of the spectrum.
They feel fantastic at the beginning of the disease.  They feel
better than they’ve ever felt in their life.  But ultimately this
leads to grandiosity and frank psychotic episodes.

Schizophrenia is a thought disorder that has three types of
symptoms-- positive, negative, and cognitive.  The positive symptoms
are characteristic I can of schizophrenia.  It’s the thought disorder,
hallucinations, delusions, the acting crazy.  The negative symptoms
are the social withdrawal, the lack of motivation.  And the cognitive
disorders are the difficulty with organizing one’s life and a
difficulty with a certain kind of memory, called working memory,
short-term memory.

Fortunately, as you indicated, we can now see people who have had
effective treatment who have very productive lives.  And Kay Jamison
and Elyn Saks, despite the fact they suffered the this disorder much
of their life, have rich personal lives, both of them involved in
meaningful interpersonal relationships, marriage, that is very
satisfying to them and having spectacular academic careers.

So there’s tremendous hope for the treatment of the disease.