Three Leaders Discuss Science, Advocacy, and Language of Mental Health

Science, advocacy, and perspectives on language and mental health—those were topics of a special “Conversation” event at APA’s 2015 annual meeting in Toronto featuring APA President Paul Summergrad, M.D.; groundbreaking researcher and neurologist Helen S. Mayberg, M.D.; and former Rep. Patrick Kennedy.

The three met for what turned out to be a lively and engaging exchange led by Summergrad immediately after the Opening Session.

The conversation circled around the question of how to evolve a language that conveys the excitement and complexity of neuropsychiatric research and tells the story of mental illnesses as brain disorders while not losing sight of the unique humanity and individuality of patients—a language that spans the artificial gap between mind and body, brain circuits and human soul, psychopharmacology and other somatic treatments versus psychotherapy. It is an effort that will be crucial to achieving the goals and vision of the mental health parity law, the three agreed.

As Summergrad said as he introduced his guests, “There is a certainly a thirst for knowledge and understanding, but are we satisfying that thirst?”

Kennedy, who was instrumental in the passage of the Mental Health Parity and Addiction Equity Act and has been a tireless advocate for its enforcement, characterized the quest for parity as a long-term process in which there have been and will continue to be incremental achievements as well as obstacles.

The coming few years will be crucial. “I don’t think we have had a better opportunity than we do now in the next few years to fundamentally transform” the nation’s mental health system, Kennedy said. “The work all of you have done to get us this far has put us at the doorstep” of a transformation. “We are really at a blank slate in terms of defining what we want. And I can guarantee that mental health will be crucial because it will be central to what patients desire out of their health care system. … They are going to want mental health because it is the piece [of health care] that will have the greatest impact on their quality of life.”

He emphasized the need for enforcement of the law—an effort in which Kennedy praised APA for its leadership—particularly in the area of nonquantifiable treatment limits, or NQTLs. Insurance companies have seized upon NQTLs as a way to skirt the requirements of the law.

Mayberg, too, hailed the immense opportunities now being made available by genetic and neurobiological research. Her studies on the role of the subcallosal cingulate region of the brain—known as “area 25”—in depression and other mental illnesses have been groundbreaking, as have her advances in testing deep brain stimulation to treat depression.

She said the language for talking about mental illness and genetic and neurobiological research will have to continue to evolve as the science emerges. It will be especially important to link what basic scientists, geneticists, and neurobiologists are learning in their laboratories to the real needs of patients with mental illness, as they present in the office of a clinician, she said.

Mayberg noted that brain research has come a long way from the concept that certain defined brain regions performed certain defined tasks to the idea that different parts of the brain are involved in many functions.

This has important implications for understanding that the mind, brain, and body are one. “We argue about whether we are going to cover what’s above the neck as well as what is below the neck—as if that were negotiable,” she said.

Asked by Summergrad to discuss what she thinks will be a particularly important development in future years, Mayberg said she looks forward to the day when real-time brain scans of patients will be able to help physicians personalize treatment by matching them to the best evidence-based treatment.

Kennedy reminded his fellow discussants and the audience that although the civil rights legislation of the 1960s ended legally sanctioned discrimination, it didn’t end racism or the problem of race in American society—as evidenced by recent news events. So, too, he said, the passage of the parity law has not ended the need to be vigilant in its enforcement and the need to speak clearly to the public about the neurobiological basis of mental illness—while also telling the individual stories of human patients.

“So it’s a civil rights process,” he said, “as well as a process of medical discovery.” ■