Copyright 2000 Times Mirror Company
Los Angeles
Times
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May 7, 2000, Sunday, Home Edition
SECTION: Opinion; Part M; Page 3; Opinion Desk
LENGTH: 2008 words
HEADLINE:
LOS ANGELES TIMES INTERVIEW;
DAVID SATCHER;
MINDING MADNESS:
A FRESH TAKE ON THE MYSTERY OF MENTAL ILLNESS
BYLINE:
David Davis
BODY:
The numbers are
chilling. According to the Centers for Disease Control and Prevention, suicide
is the ninth leading cause of mortality in the United States, claiming nearly
31,000 a year. While the overall suicide rate has declined in the last 20 years,
the rate for adolescents has soared: Suicide is the third leading cause of death
among young people ages 15 to 24.
Since David Satcher took over the
surgeon general's post in February 1998, he has made suicide, and the broader
topic of mental health, his signature issue. In October 1998, he convened a
blue-ribbon panel of mental-health professionals, researchers and suicide
survivors to analyze the topic, resulting in the first-ever surgeon general's
report on mental health. Last year, his office published the "Surgeon General's
Call to Action to Prevent Suicide." Later this year, he will produce a national
plan for suicide prevention. Satcher was born and raised in rural Alabama, the
son of farmer parents who never finished elementary school. He first decided to
become a doctor when he was 6 years old, after recovering from a near-death
experience battling whooping cough and pneumonia. Satcher graduated from
Morehouse University, then earned his Md and PhD from Case Western Reserve
University. In the 1970s, after residency and fellowship training at, among
other schools, UCLA, he served on the faculty of the UCLA School of Medicine and
Public Health and the King-Drew Medical Center, where he chaired the family
medicine department and directed sickle-cell research.
From 1982 to
1993, he was the president of Meharry Medical College in Nashville, Tenn. Before
becoming the nation's 16th surgeon general, he served as director of the Centers
for Disease Control and Prevention.
Satcher and his wife, Nola, have
four children, ages 23 to 31. They live in Bethesda, Md. In town to receive the
leadership award from L.A.'s Didi Hirsch Community Mental Health Center, Satcher
spoke to The Times at the Regent Beverly Wilshire Hotel.
*
Question: Your background and training are in family medicine. Why did
you decide to embrace mental illness and suicide as your issue?
Answer:
What the surgeon general does is not a specialty. The surgeon general is
supposed to listen to the American people and look at the issues affecting them
and respond. . . . There had never been a surgeon general's report on mental
health, and there have been 50 reports since the first one was published in 1964
.
Q: Why have mental illness and suicide been so stigmatized?
A:
The stigma relates to a misunderstanding of the mystery that has surrounded what
it means to be mentally ill. Some people think it's a character disorder. Some
people think it's a spiritual disorder. Some people say, "Get yourself together
and deal with this," because they can't see that people are struggling with
something they don't necessarily control. . . . It's clear that not only are
mental illnesses real--they have a basis in physical and chemical changes in the
brain-- but they also are treatable. Approximately 80% to 90% of people with
mental illness can be effectively treated and returned to productive lives and
positive relationships. . . . You end the stigma when you clearly point out
that, just as things go wrong with the heart and the lungs and the kidneys and
the liver, things go wrong with the brain. We can document that, and therefore
we ought to be responding to that in the same way we respond to other illnesses.
Q: In your call to action, you note that the suicide rate for
adolescents and young people has soared in the last 20 years and David Davis, a
freelance writer, has contributed to Los Angeles Times Magazine and LA Weekly.
that the rate of suicide among African American males age 15-19
increased 105%. What's your explanation?
A: Clearly, depression is a
major factor in suicide. Substance abuse is another major factor. Easy access to
means of suicide--weapons--is another major factor in suicide. All these things
come together to lead to many more suicides than before. . . . Some people even
believe that some of the homicides that we were seeing in African American
communities were expressions of depression and hopelessness. You join a gang,
and you know that you're putting yourself in harm's way. . . . So the real
question is whether we're not seeing different manifestations of the same
problem.
Q: Another statistical anomaly concerns the elderly: The
suicide rate is highest among white American males age 65 and older. With the
baby-boom generation getting older, does this high rate worry you?
A: We
view this as an impending public-health crisis. When you think of all of the
people who are going to be surviving beyond 80 years of age, not only do you
worry about suicide, because depression is so common among the elderly, but you
worry about Alzheimer's. Is the public-health system prepared to deal with that?
Not very well. . . . One of the things we point out in the report is that 70% of
the elderly who commit suicide have seen a primary-care provider within a month
before. What we're trying to do is to get family physicians and interns alert
and attuned to the fact that they can prevent many of these by making the
diagnosis and putting people on treatment who need it. We're also trying to make
families aware, so that people no longer say, "Well, he's 82, he should be
depressed." He should not be depressed: It's an illness.
Q: You
recommend three steps for reducing suicide: awareness, intervention and
methodology. Promoting public awareness seems like a logical first step, but
given that insurers are reluctant to pay for mental disorders, how will you
convince them to enhance services and programs?
A: What government can
do is set an example. When President Clinton announced that, beginning in 2001,
all health plans that cover federal employees must provide
parity of access for mental-health services,
that's a big step. At least 30 states have now passed parity laws, including
California. . . . If you look at the plans that have changed to provide parity
of access, they have not experienced dramatic increases in cost. We estimate it
at 2%. . . . In contrast, people who are not treated for mental illnesses
express their problems in other ways, including missing work. If you get on
treatment, you're going to save that company money. In the long run, it's a good
investment.
Q: Advances in pharmacology, including such drugs as Prozac,
have improved medical treatment for depression. But is there an overemphasis on
pharmacology as a cure?
A: We want quick fixes. . . . There have been
some dramatic breakthroughs in new drugs to treat depression, including drugs
that have far fewer side effects than the tricyclic anti-depressants of the
past. . . . It's important that we continue to improve the drugs and . . .
reduce their side effects, and we're doing that. The first thing we have to do,
though, is make those diagnoses, and that means we've got to get families and
primary-care providers and others attuned to what it takes to identify these
problems. . . . I also think we need to know that when it comes to treatment for
mental illness, we need drugs, we need behavior therapy, we need family therapy
and maybe even social therapy in terms of getting people together in groups and
working in school settings.
Q: Some critics maintain that the emphasis
on seeing all mental disorders in biological terms is misleading. Do they have a
point?
A: We believe that most mental illnesses have a biochemical
basis. I would not use the word "all" because that would close the door to
science. . . . Listen to what we say in this report: Not only do we know that
there are changes in the brain--the basic neurons and the chemical
secretions--that can explain mental illnesses, we also know that changes in
environment and experiences can affect the brain. What we need to do is to learn
more about how we can create the kind of environments that will optimize mental
health. We haven't done enough of that research. We know more about mental
illness today than we do about mental health. We know more about treating mental
illness than we do about preventing mental illnesses and promoting mental
health.
Q: How should the "mapping" of the human genome best be
utilized? Do you think we'll discover a genetic link to suicide?
A: I
agree with President Clinton and others who've said that, to the extent
possible, this material should be a public good. We have to be careful, because
we have to maintain the private incentive. . . . But we believe there's a very
close relationship between public health and genetics, that we're going to be
able to target public-health interventions based on what we know about genetics.
Look at what just happened in France. Apparently, there are three infants there
whose comprehensive immune-deficiency disorders may be corrected by genetic
intervention. . . . Now, are we going to find a gene for suicide ? Because of
the familial nature of suicide, it would lead you to believe that there is some
genetic relationship that we have not identified. I believe that, in time, we're
going to find some genetic relationship for the kinds of depression--manic,
schizo-affective disorders--that are associated with suicide. I also believe
that we might find some genetic relationship to addictive disorders, which
increase the risk of suicide.
Q: Last month, the TV show "Wonderland"
was canceled after just two airings, partly because many groups protested the
show's depiction of people suffering from mental illness as violent. Is it
possible to depict mental illness within the parameters of "entertainment"?
A: I'm glad "Wonderland" was canceled, because it was an extreme
depiction of mental illness. We need balance. I use this example--and it just
happens that all three movies involve Jack Nicholson--but in "One Flew Over the
Cuckoo's Nest," his character was depicted as harmless and humorous. In "The
Shining," he was very violent. In "As Good as It Gets," Nicholson played a
person who could be any of us struggling with a mental disorder who, if properly
treated, can continue to be productive. So I believe entertainment can make a
contribution to destigmatization, but it cannot be taken to the extreme and give
people the impression that people with mental illnesses are more likely to be
violent than others. People who have mental illnesses and are appropriately
treated . . . don't commit most of the violence in our society.
Q: You
mentioned that suicide in the African American community has risen dramatically.
So has AIDS. What are you doing about that?
A: HIV/AIDS is one of six
areas of disparity in health status that the Department of Health and Human
Services has targeted for elimination by the year 2010. Last year, working with
the Congressional Black Caucus, we secured $ 245 million to fund the president's
initiative to improve the nation's effectiveness in preventing and treating
HIV/AIDS in minority communities, and we announced an $ 11-million grant program
to provide innovative health care and support services for people with HIV/AIDS
living in the U.S.-Mexico border region. We also have launched a leadership
initiative on AIDS that is working to help leaders in minority communities
educate, motivate and mobilize their communities against the virus.
Q:
You're a presidential appointee in an election year. What will happen to the
mental-health and other initiatives that you've started if you're not
reappointed?
A: It's really important that the mental-health initiative
is not a federal initiative. It's a federal, state and local initiative, and
it's a public-private relationship. . . . It's not going to be dependent upon
David Satcher or this administration or this Congress. . . . You can't get rid
of that mental-health report. You can get rid of me, maybe, but you can't get
rid of the information that's now out there moving the people in this country.
GRAPHIC: PHOTO: (no caption), PHOTOGRAPHER: ANNE WELLS
/ Los Angeles Times
LOAD-DATE: May 7, 2000
