In any given year, an astounding 26.2% of Americans, ages 18 and older, suffer from a diagnosable mental disorder. That is astounding because we’re talking about things like major depression, PTSD, schizophrenia, and bipolar disorder— significant mental illnesses that cause people to lose their ability to function in a normal capacity.
Studies show that depression is the leading cause of disability worldwide. In fact, the second leading cause of disability is only half as common as is depression. No other disease is even close with regard to causing disability. An estimated 90 billion dollars are spent on treating this disability and on lost productivity in the US each year. Added up over a lifetime, the costs come to 2.1 trillion dollars, which does not include the increased cost of medical care that all of us must assume for these individuals.
The national alliance on mental illness (NAMI) did an exhaustive study on mental illness in America. What do you think the United States got as a whole as far as its grades on mental health care?
The national grade was a “D.” No wonder the director of NAMI said: “The tragic reality is that no state in the nation is able to pass this true test of a mental health system’s performance.”
As you can see, the problem is real. Now I want to talk about fixing it. First, we need to focus more on the prevention of mental illness than we presently do. The key to prevention is a new approach to education. If I were the mental health czar in this country, I would require every high school student not just to take a psychology class, but to study things like the frontal lobe, emotional intelligence, and cognitive behavioral therapy.
Second, with 26.2% of people having mental disorders, there are nowhere near enough psychiatrists and psychologists in the nation. We don’t have enough to handle even 5% of the population, much less 25%. So, if we are really going to tackle this, we have to tackle it where people will be on a regular basis. This is why school counselors, principals and educators need to understand the principles we are talking about. This is why family practice doctors, internists, etc. need to understand this as well.
The pharmaceutical industry has learned this, at least to some extent. I remember a few years ago when the drug, Remeron, came out. It is an antidepressant that helps out particularly with anorexia-associated depression. What happened, however, was that instead of just giving it to psychiatrists, the pharmaceutical representatives started going to family practice doctors, internists, and OBGYNs. Their sales went way up. Why? Because those people actually see more people with depression and anxiety than the psychiatrists do.
If most of the pharmaceuticals for mental health issues are being handed out by primary care physicians, and not by psychiatrists, then it stands to reason that those very people need to learn the other therapies that can also greatly benefit people with anxiety and depression.
One of the biggest concerns regarding the inefficient treatment of mental illness in this country has to do with the causes of mental illness. Major depression and/ or anxiety disorders are, really, just a constellation of symptoms. If we want to increase the likelihood of a long-term solution, we’ll identify the causes of these symptoms and, then, systematically treat them.
Unfortunately, this is not as simple as prescribing a drug (in some cases, the drug may get in the way!). Like most chronic diseases, depression and anxiety, are multi-factorial diseases. To treat them, we need an “all fronts attack” on as many operative causes as can be identified. I believe that four areas are crucial: the frontal lobe; lifestyle; nutrition; and genetics.
Take, for instance, the frontal lobe. Studies show that the lack of frontal lobe circulation is often the cause of depression, while the depression symptoms are only the effects. Despite all the research that has been done in the last 15 years, frontal lobe issues continue to be largely ignored. Some of the reasons are clear. Secular neurology textbooks tell us that the frontal lobe is the seat of spirituality, morality, and the will. Because it’s the center of spirituality and morality, many psychologists and psychiatrists state, basically: “Hey, this area is off limits. I’m not going to touch it.” But, in reality, if this is the lobe that is primarily involved in mental illness, they need to touch it. They have to address the actual problem if they are going to present a comprehensive way of restoring wellness there.
The Drug Factor
Then there’s the whole question of drugs. We now know that antidepressants have their limitations. In fact, 80% of people on antidepressants are still depressed. One third of them don’t respond to any antidepressant. Those that do respond, have a high chance of relapse, even while on the drug. If taken off, they have a very high chance of relapse.
Medications do have an effect. Medications often change the form of the disease. They can have strong side effects, such as lethargy. I don’t like the side effect of increasing impulsivity before improving depression. That’s why the most commonly used antidepressants have black box warnings. If, for instance, the patient is suicidal and starts using an antidepressant, the worsening of impulsivity can lead to a big problem.
One study showed that 75% of patients in a cognitive therapy group remained free of relapse (and this was a short 12- week course that met only once a week). In contrast, among those taking an antidepressant, 60% who remained on the medication were relapse free. This means that 40% of those taking the drugs started to relapse. And so you can see that even though the cognitive behavioral therapy is said to be equal to the drugs in its efficacy, it is actually superior.
People sometimes ask why our Nedley Depression Recovery Program has a relatively high positive response rate. The reason is simple. We are not just using cognitive behavioral therapy alone. In fact, we don’t even use it as the first line. We use nutrition, lifestyle, sunlight, and hydrotherapy as well. We also use omega 3 fatty acids. We use these things first in order to get the frontal lobe circulation up. Additionally, changes are made in exposure to various forms of entertainment. We start to include the types of entertainment that are going to improve frontal lobe function, and not detract from it.
We work on all these before we start into the CBT. The CBT is far more effective once you have an intact frontal lobe. You have to analyze thoughts. You have to look for distortions in those thoughts. You have to try to correct those distortions and reconstruct the thoughts into an accurate thought process. You can’t do that without a functioning frontal lobe.
Because cognitive behavioral therapy has been shown to be far superior to placebo, and because it is based on thinking truthful and accurate thoughts, I think it is very clear today that truth matters. One of the setups for failure in mental health treatment in our country is this false idea that there is no such thing as truth, and that what is truth for you may not be what is truth for me, and so forth. When you get into that line of thinking, CBT is out the door.
Thinking about Thoughts
Another principle learned is that people can change the way they feel by changing their thoughts. What most Americans do to change the way they feel is to reach for alcohol, drugs, or some instant-but-false way to make themselves feel better. It can transiently change your dopamine/serotonin levels, but discovering truth and correcting errors will also improve dopamine levels and serotonin levels. Both groups get their feelings improved. It’s just that the truth-based method maintains the improvement; the other ways have these peaks and valleys that keep getting worse, and pretty soon people are utilizing these techniques just to get numb.
You can never get enough of what you don’t need, because what you don’t need will never satisfy you. On the other hand, self-sacrificing love – altruism – improves mental and physical health. That’s where you can see that spiritual component in the frontal lobe. Truth is, indeed, a spiritual component; self-sacrificing love is as well. We also know now, from the psychiatric literature, that the primary change agent, which will help you change someone else’s life for the better, is for you to exhibit altruism and self-sacrificing empathy in dealing with that individual.
How We Do It
In our program, we start like this. When a patient comes to us, and when a mental health problem is found, a comprehensive workup is initiated. It begins with a hit-list test. Of course, along with the hit-list test, I get a score of what the patient’s anxiety level is, what their depression level is, whether they do have major depression or not, what their emotional intelligence is, etc.
After the workup is complete, then a comprehensive treatment plan is initiated. That treatment plan is based on the hits that are active, so it is individualized. And then we look at general treatment measures.
After I research the cause of depression, I research treatments. I’ve found over 100 treatments that have been identified as being superior to taking a placebo. Many of those are pretty simple.
Also, group-coaching sessions are used instead of group-exposing sessions. In certain tough cases, there may be a need for an excellent therapist to listen long enough to help the individual. But as far as group expositions in regards to what’s happened in the past, I’m opposed to it for multiple reasons. Often there is regret afterwards and it can produce additional complex issues later on.
We compiled data from the last seven programs that we did. In these programs we measured all of the DSM-IV criteria. A score of 20 or higher is in the severely depressed range. Of course, most of these people are on medications when they come to the program, and have been depressed for years. Not all patients are going to have major depression, some will have isolated anxiety.
After only ten days in a comprehensive, intense treatment program we could see that many with severe depression were walking away depression free. Many of those with anxiety will also walk away anxiety free. If they stay on this program, their scores are going to improve much more than that when they return home.
So the average individual – either severely depressed or right at the border of severe and moderate – is able to leave the ten-day program with no depression. This is average. This is according to both the Beck inventory and the DSM-IV criteria. About 10 percent of patients entering the program were classified as extreme according to the Beck inventory, where they were almost catatonic. Just looking at them, you know that this isn’t someone who can communicate on a meaningful basis. That’s how severe it is. Yet, even in these severe cases, we have seen significant, dramatic improvement.
We used to run a 19-day program. One of the reasons why we shortened it is that it’s more economical for the patient. And though we were seeing results that were better at 19 days than at 10 days, it starts to taper off. It continues to improve, but the most dramatic changes usually happen within 10 days. Usually by day 7 they start feeling something. By day 8 it’s pretty dramatic. By day 10 it’s amazing what can happen, both with depression and anxiety (interestingly enough, anxiety is often more difficult to treat than is depression).
And then there are gratifying results that we didn’t anticipate. These results relate to emotional intelligence. Some people with depression/anxiety have pretty good EQs (Emotional Quotients, a measure of emotional intelligence). You might think everyone has poor emotional intelligence with anxiety and depression, but this is not true. The emotional intelligence rates improve significantly in the program. The EQ average of those entering the program is at 95. At the end it is 115. Because the average EQ is 100, these patients leave not only depression and anxiety free– they are leaving right there in the top 20 percentile in the nation as far as EQ. That means the sky is the limit to their possibilities for future success.
That’s what we call wellness and restoration.
In short, I like to close with a quote from Dr. Leihe, of the cognitive institute: “Depression is a lifelong vulnerability for increasing millions of people. It’s a world economic crisis. Depression is an ongoing war that is difficult.”
I agree. Leihe continues: “Simply from a practical point of view, effective treatment for depression makes economic sense. It’s a good investment. If you effectively treat depression, people are more likely to work, require less disability coverage, and as cynical as it may sound, more likely to pay taxes. Treating depression pays. It’s smart policy, and it’s the right thing to do.”
A comprehensive mental health education program works. It can restore wellness. It is cost effective. It can raise our nation’s mental health services grade significantly. I think we ought to go for an A grade, not a D. these types of changes will positively affect the future of mental health care. And so I look forward to better days as word gets out. As a nation, we can’t afford to do anything else.