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Back in July, I had the privilege to interview Dr. Ken Duckworth, the medical director for the National Alliance of Mental Illness (NAMI), through a blogger conference call hosted by Revolution Health.
Below I have excerpted part of the interview, but I encourage you to go the podcast of the interview (you can get to it by clicking here), because we covered so many topics in such little time (and I couldn’t include the entire interview because it took me three hours to transcribe the first twenty minutes). Dr. Duckworth is among the most knowledgeable, wise, and truly compassionate physicians I have ever met. I only wish one of him existed in every city to treat persons with mental disorders.
Triple board certified by the American Board of Psychiatry and Neurology in Adult, Child and Adolescent, and Forensic Psychiatry, Dr. Duckworth has extensive experience in the public health arena. He first served as the Acting Commissioner of Mental Health and the Medical Director for the Department of Mental Health of Massachusetts, then as a psychiatrist on a Program Assertive Community Treatment team. He was also the Medical Director of the Massachusetts Mental Health Center for eight years.
Dr. Duckworth won the award for Clinical Excellence from the Massachusetts Psychiatric Society as well as teaching awards from Boston University, for his work at Harvard Medical School, and from the American Psychiatric Association. He was also a recipient of the Ken and Rona Purdy Award for his work to combat stigma.
Currently an Assistant Professor at Harvard University Medical School, Dr. Duckworth is also a board member of the American Association of Community Psychiatrists. He has served as a school consultant for a decade, has had an active private practice, and currently does community mental health work with Vinfen Corporation in Boston as their Medical Director.
But what was TRULY amazing about the guy is this: I could understand him!!!!
Here he is … Dr. Ken Duckworth.
What do think the biggest misconceptions are about mental illness?
Well, there are many mental illnesses. We’re in a big barnyard there. But I think there is more pessimism regarding treatment than is warranted. If you look at many aspects of treatment outcomes of persons with most psychiatric illnesses, a synonym for mental illnesses—anxiety disorders, OCD, bipolar disorder, even schizophrenia—a lot of people do well over time. And I think one of the misconceptions of the field is that these illnesses are invariably chronic and therefore untreatable.
Another misconception is association of violence and mental illness. While it is true that a subset of persons with psychiatric illnesses are violent, the percentage is very small. And most of them are associated with substance abuse problems, which are not being treated.
Also, we do not know how our treatments work. This unsettles people. We have all these theoretical models. This is the way medicine was shortly after penicillin was delivered. People knew that it worked, but they couldn’t say know how. I think it will be very elegant once we have neuroscience mapped out, and we can say exactly how medicines work. That’s an Achilles heel of the field. Because people want to know exactly how medication works.
You say that the treatment outcomes of persons with mental disorders are favorable, in general. I’ve read statistics that say 80 percent of people respond to treatment. And about 20 percent don’t. Those people are treatment-resistant. Is that correct?
We are lumping together a lot of different conditions here, so I think we need to be thoughtful. But it is true that not everyone responds to even our best interventions.
Many of my readers, I believe, are treatment resistance. They’ve been on tons of medications and nothing seems to work. There is a real desperation in some of their messages. What, as a blogger, can I tell them?
If you look at the STAR*D study, I think the message there is to keep on trying new medicines, and you are likely to hit one over time that works. Is it arduous? Of course. Is it unpleasant? You bet. Is it unfortunate that we don’t have the kind genetic mapping that can say how you are going to respond to a certain medication? Yes.
The other thing I recommend people to do is to get an independent consult with an expert. For example, in Boston, I can tell you who the treatment-resistant depression guru is. He will get more creative with medications and try some that other doctors didn’t consider.
I would advise people generally to go to the local academic medical center. Go to the depression center. Most academic medical centers do have such capacity.
The other thing I encourage people to do is to re-double up on their non-pharmacological efforts. So Tom Cruise and I have almost nothing in common on how we see mental health conditions. However, he does encourage people to exercise. Aerobically exercise: that’s his answer to everything. And if you look at it, there is some data that shows it does help persons with mild to moderate depression. Now can aerobic exercise help people with treatment-resistance, severe depression? Never alone. And I mean NEVER alone.
But what I have found that someone who has been severely depressed for years is that they can become despairing, which is a human, natural response, and they forget about the comprehensive nature of the approaches that probably helped them in the past to combat the illness.
For example, I’ll sit down with a patient and go over not just the medicines, but the other strategies that can help. None of this is a magic bullet phenomenon. Very few interventions in mental health are solely medication driven. It’s almost always psychotherapy plus meds, vocational rehab plus meds, a thoughtful, creative, strength-based approach plus a med.
Could you address the connection between alcoholism, bipolar, and suicidal tendencies?
I cannot say that we’ve identified a neurochemical smoking gun. That would be an exaggeration of our capacitiy on the biological side, but I will say that these things travel together quite commonly. This is a relatively classic association of bipolar disorder, substance abuse, and suicide. In fact these conditions run in my own personal family. But not always in the same person.
I will just say that in my experience there is a common association between mood disorders and alcoholism.
The piece on suicide is an interesting problem. Suicide does run in families. Is this a biochemical phenomenon? There are some theories that there are biochemical changes in people’s serotonin levels before they commit suicide. There is some reason to believe that serotonin is the biochemical contributor to suicide.
However, I’ll also say that just as divorce runs in families or another phenomenon runs in families, when suicide runs in a family, another way to think about it is psychologically—that people now have that in their lexicon, in their repertoire, of choices they can make when they’re desperate. So for the socially taboo act, if someone in the family has done it, it can give the person a little bit more permission to do it when they feel desperate.
So when people say that suicide is the most selfish act, what would you say to that?
My experience with people who are suicidal in the context of a mood disorder is that they’ve actually lost sight of the other people in their lives. They are so self-troubled that they haven’t been able to connect to the other people in their lives. The other people in their lives are, of course, very hurt by their act. Very hurt.
That goes along with the concept of being connected to alcoholism, because isolation is so much part of alcoholism.
That’s right, and there is no question that mental illnesses and alcoholism put together is a very bad combination, a very high risk combination.
One of the things that I’ve observed in working with this dual-diagnosis population—usually substance abuse and some form of mental illness, in this case bipolar disorder—is that it’s difficult because the cultures of treatment are so different.
In the substance abuse culture, the person is generally viewed as the agent of the problem, and they are held accountable and have consequences for their relapses. In the mental illness culture, the person is often viewed not as the agent of the problem, but as the victim of their illness. We tend to hold people a little less accountable for bio-chemical processes.
So if a person has schizophrenia and is hearing voices, people tend to be a little more paternalistic, they tend to be leaning forward a little more in their interventions.
Now what I have experienced, when the person has both substance abuse and a mental illness, people don’t know how much to do for the person, and how much to have them be accountable, and to have them learn from their mistakes because in this case, when you have both together, the mistakes could easily be lethal.
You can see this dichotomy. And when I work with families dealing with both conditions, my heart really goes out to them because in the AA world, and in the substance abuse culture, they are encouraged to have the person hit bottom and be accountable, but that’s not the case in the mental health world.
A question for my Beyond Blue readers: Do you want me to type out the rest of the interview? If you’d benefit from it, I don’t mind.
posted September 21, 2007 at 12:24 pm
Excellent podcast, and well worth the listen. (Although the audio quality is poor — which perversely made your transcription so difficult and simultaneously makes a further transcription helpful to BB readers … sigh.)
A couple of thoughts:
1. I don’t think the idea that mental illness is “chronic” automatically makes it “untreatable.” But there’s no objective question that it is chronic (note Dr. Duckworth’s chilling remark about how 1 in 10 lives of the seriously mentally ill ends …) and, as Dr. Duckworth would note, just because mental illness is treatable, and that some or even many patients do well, doesn’t mean the treatments are perfect or even particularly well-targeted, to say the least.
2. There is another side to the question of faith and depression. Just as for many people, their faith is the only consolation that keeps them going, for others (yours truly), their depression causes them to question the religious and theological teachings of a lifetime. I would agree with Dr. Duckworth that a therapist/psychiatrist not addressing these questions on EITHER end is a form of malpractice, morally if not legally.
posted September 21, 2007 at 6:32 pm
I am one of those people that rely on my faith and spirituality to help me through tough times.
“just because mental illness is treatable, and that some or even many patients do well, doesn’t mean the treatments are perfect or even particularly well-targeted, to say the least.”
I agree- the medication that I take is targeted for people with epilepsy. It really does help me, but at first I was worried that it wouldn’t work since it wasn’t specifically for my issues.
Love this blog, and I will definitely be back! Thank you for sharing!
Aimee
http://anxiousnomore.blogspot.com
posted September 22, 2007 at 11:19 am
Most medications besides lithium used as mood stabilizers for people with bipolar disorder, of course, were originally developed for epilepsy.
We know they “calm” the brain. As Dr. Duckworth basically said, we have no idea WHY
posted September 22, 2007 at 12:05 pm
I find the comment regarding lithium being originally used for epilepsy,fascinating as I had a grand mal seizure at age 2 and was on meds for 12 years. So the connection with my familyies mental health issues makes alot of sense…so then
my sister who was dx bipolar at age 20 went on to try lithium for a short while but was unsuccessful due to not being cooperative in getting her blood tested on a regular basis. I have clincal depression,
at age 45 I’ve been stable on wellbutrin for 4 years now and due to
sexual abuse traumas that were never really dealt with until I turned
35. I was hospitalized for two weeks during the summer of 1997, it sucks to be suicidal…I hope I never have to go there again…its
like being in a freefall within a black hole or abyss!
Iam now getting certified here in WI to be a Peer Support Specialist. I so appreciate this website and all the wonderful information that is being offered here to help me help others on their
journey to wellness. Thank YOU Dr. Duckworth and Therese Borchard
posted September 22, 2007 at 1:45 pm
Actually, I don’t think lithium was ever used for epilepsy — only the class of anti-seizure drugs like Depakote, Tegretol, Lamictal, Neurontin, Topamax, etc.
Lithium is chemically different — a natural salt. There are towns in the South called “Lithia Springs” where people once soaked in spas with lithium-filled water to get “healing” — and probably, from what we know now about lithium, some no doubt did!
(In fact, just as Coca-Cola once had cocaine in trace amounts, 7-Up once had lithium in trace amounts from such lithium-filled water!)
There were thoughts in the late ’40s and early ’50s of making lithium a low-calorie substitute for table salt to prevent heart disease. Unfortunately, as we know now, if you sprinkle a bunch of lithium on your french fries, the dose can be extremely dangerous. (As I recall, I think some of the “food testers” may even have died … ugh.)
The difference between lithium’s “therapeutic range” (where it helps treat manic depression) and its toxic range where it poisons the body is very small — thus the need for periodic blood tests. As a result, lithium was banned in the U.S. for many years — despite some simultaneous research showing incredibly promising results in Australia …
… which ultimately resulted in lithium coming to be used to treat bipolar disorder. This is just the simplified version of a truly fascinating story:
http://en.wikipedia.org/wiki/John_Cade
Amazing that such an interesting and mostly positive story (despite its ups and downs) has resulted in such a stigmatized drug. (Sigh.)
posted September 22, 2007 at 6:42 pm
Yes, please post the rest of the interview. It’s interesting and helpful.
posted September 22, 2007 at 7:07 pm
I would definitely classify myself as the faith sustained depressive. When I am at my darkest is when I have moved the furthest from God. He never leaves…I do. Luckily He’s always waiting patiently when I return from “The Dark Side” I remember when my favorite uncle died. The whole family was there at his passing by his bedside. His son Michael said “It’s okay to go, you can let go now” It was the most unexpectedly peaceful thing I have ever witnessed. I could see the Christ figure in him at that moment. He was a faithful christian. I felt the sorriest for my aunt. It’s always the hardest on those left behind. When I was alone for a moment in the cemetery I heard a voice. It was the most beautiful sound, of a young man and he said “Let your soul be at peace, for I am with you…always” If you are a believer, no explanation is neccesary. If you are not…no explanation is possible. (that doesn’t make me sound like a lunatic) I BELIEVE!
posted September 22, 2007 at 8:38 pm
Please post the rest of the interview with Dr. Duckworth!!! He seems to be one in a million who absolutely understands,especially when it comes to substance abuse and mental disorders. What I learn on this blog is sooo helping me to educate my current “doctor” to the point he no longer treats me as if I’m nothing more than a junkie looking for ‘legal’drugs and by presenting him with information as to why I self-medicated is slowly but surely (very slowly!!) leading to the correct combo of meds for me. I once told him I don’t have a problem getting drugs(illegal)but that’s not what I want to do and I’m aware that a diagnosis of adhd (maybe bipolar also) at age 50 may not be the norm but I used meth for the past 16 years and functioned highly and since being clean (103 days!!)I am now having major problems functioning. Of the many,many challenges that I have faced head-on and beaten,being,staying and learning how to live clean is without doubt the most difficult!! But I am sure that because of underlying mental issues without treatment with medications,along with groups and therapy,I am setting myself up for a relapse. And without this site,Therese,and others who share their lives,because this has become my self-medication,my homework so to say. It feels great to go to my ‘doctor’with information he is not aware of to back my ideas,suggestions and requests. Thank you from the bottom of my heart!! And by the way,you are doing super with your video blogs,keep up the great stuff!!!What you are doing has been a lifesaver for me and I’m sure many others!Peace and Love from a faithful reader!!!
posted September 22, 2007 at 8:57 pm
Patricia:
Even though (if you read BB) you know I’m not the most faithful of believers, believe me when I say I pray you stay in your recovery. You are doing an amazing and incredibly difficult thing. I understand meth is, chemically, one of the most addictive substances on the planet. As you’re probably already being told, one day at a time.
There is an incredibly high rate of “dual diagnosis” (substance abuse occurring simultaneously with mental illness such as bipolar disorder and/or ADHD). Precisely because, as you said, it’s a way people who know they have something “wrong” but don’t have a diagnosis can “self-medicate.”
And, as the difficulties you are going through probably have already silently “told” you, people with dual diagnosis are more likely to slip back into substance abuse than those who have a substance abuse problem but not a mental health diagnosis. You have a hard row to hoe — again, as I know you know.
I am just plain lucky (or should I say, blessed?). Yes, I have bipolar disorder, but I could easily have had a dual diagnosis like you. My father is an alcoholic and I was headed down that road (binge-drinking my way through college) when a friend of mine did an intervention on me at age 23. I’ve been a teetotaler now for more than 15 years (without AA, although I did attend Al-Anon for several years).
Speaking of which … mental illness support groups may be extremely helpful for you, both to get some perspective from other people in your “boat,” and perhaps to get resources to find another doctor who is more familiar with treating dual diagnosis patients.
In addition to the many resources Therese puts on her site (including of course, nami.org, the Web page for Dr. Duckworth’s organization), might I suggest the organization that sponsors my support group:
http://www.dbsalliance.org
Again, we are all thinking about and praying for your continued recovery and mental health.
PS — Some substance abuse support groups will encourage you to give up psychiatric medications since they too are “drugs” in their opinion. Personally speaking, I strongly oppose that view; and if anyone in a support group encourages you in that direction, I’d suggest at least that you speak to a doctor (even your current doctor you don’t really like) first. Just IMHO.
posted September 23, 2007 at 1:30 am
yes please type it out this sounds great !! more more
posted September 23, 2007 at 2:50 pm
Let me begin by telling you all that I am a high school teacher and live in a rural, conservative, suicide-stigmatizing culture. A little over two years ago, my beloved youngest brother, who was a high school guidance couselor, completed suicide. I have always struggled with low grade chronic depression, but this trauma sent me over the edge into what my psychiatrist has dg as chronic severe depression, panic disorder and PTSD. All of those were latent in me until my brother took his life and suddenly the whole world stopped, except my intense depression and constant grief. This, combined with an exacerbation of my rheumatoid arthritis, kept me out of the classroom for the first semester after his death. Since then, my grief and therapy journey has been active, not always straightforward, but cyclical and I have begun to speak out. I wrote an article for our local paper in which I wrote about his suicide and invited the public to attend a suicide survivors’ group I was starting with my therapist and another clinical social worker. The group attendance was low, I now believe, because we chose to hold it in the conservative stronghold community of the area and feel that if we try to move it to a local university town, our attendance would improve. In addition, I have spoken to university classes about my loss and the warning signs, the grief, etc. and have been very open with my 12th grade classes. No one in the school community has complained, perhaps because I’m a vet, and well-respected as a teacher. I agree so much with the advice here. Meds need to be tweaked until the right combo is found. It’s frustrating by I’m now on celexa supplemented by cytomel and use clonezapam for threatening anxiety attacks. My startle reflex comes and goes now, and I am still seeing my therapist with regularity. The loss I experienced blew the top off of the volcano of my unconscious and since then I’ve been processing my life and growing spiritually into a new person. Reconstruction is like reincarnation and it hurts! But so worth the effort to be honest, to struggle, to weep and to laugh, to meditate and be thankful. All spiritual paths lead us to one unity and there are many “good red roads” in this world we live in.
Blessings!
posted September 28, 2007 at 12:03 pm
PLEASE print the rest! There are people reading this, suffering with depression, who need to read it. Some may have computers that do not support podcasts very well, and others who have auditory issues, whether it be physical or the learning type. I realize it is a lot of work, but you will be helping a lot of people!! Thank you so much for all you do!
posted September 29, 2007 at 2:39 pm
yes, please post the rest i am very depressed and would enjoy reading more of it
posted September 29, 2007 at 8:25 pm
I do not know what my problem is, but have suffered from much sadness. This seems to be helping me so that I do not feel alone in this. Too much bad luck, a very hard head lol, or depression. I just really do not know. I do feel that I think in a rationale manner, but life is just so very sad. Thanks so much for trying to help.
posted October 4, 2007 at 6:33 pm
please type out the rest of the interview so that I am able to read it when I have more time to go over it again and again. (while on the bus to work, during lunch break ect)
As a Family Member and conservator of a dual diagnosis patient I am always looking for anyone with compassion towards Mentaly Ill people.
Let a lone a doctor like Dr, Duckworth with education and experience as well as compassion.
posted October 5, 2007 at 6:13 pm
Yes, please do so if it won’t be too stressful or burdensome.
posted October 8, 2007 at 3:57 am
Please post the rest,Iám really researching depression and bi polar now, as Í have been on meds for 15 years and still have lots of problems, I also have fibromyalgia and that’s what they thought the depression was from due to so much chronic pain. The more I read the more I feel like I have bi polar tendencies and others in my family have mood disorders also. My 8 yr old grandson was just diagnosed as bi polar and put on meds. This is such a confusing illness, and it’s hard to find good docs to help that really care. Let’s all keep plugging along to understand mental health and hope that more people become caring docs in the near future. Bless you all and don’t lose faith! My grandkids call me gra “moo”instead of grandma.If any one else suffers from fibromyalgia and has serious depression from it I would like to hear from you. I have horrible SAD in the Summer, where I live it is so hot and the heat makes my Fibro really bad. I also have SAD really bad around the holiday months when the weather is really changing where I’m from.
posted October 13, 2007 at 7:45 am
I’m so glad that you did this interview and have shared it with so many. I suffer from severe major depression with suicidal tendencies and borderline personality disorder. I found it interesting that depression and suicide runs in families. I have yet to find anyone else in my family (or family history) that has had these problems. I also don’t have the combination of alcohol or drug abuse, so I am very interested in reading more. I have suffered of depression since I was very young. I spent 30 years in a deep and secret silence before I got a little help. Then there is the stigma of being labled with a mental illness and the way people react when they learn about “our” conditions. I’ve heard things like “just get over it”, “you are going to burn in hell”, and these are comments I’ve heard from so called friends and siblings. I just recently got out of the hospital from another failed suicide attempt. At this time I am sitting here crying and feeling totally void and empty of all positive emotions and feelings. Thank you and Dr. Duckworth for not only informing those of us who suffer, the people who do love and care about us, but now I can share the information with the people around me who are ignorant of the facts.
posted October 14, 2007 at 3:14 am
I would like to read more. I am severly depressed right now and seriously thinking about not taking my medicine so I can die. I have diabetes, congestive heart failure, and end stage renal failure. I am going to have to go on dialysis in the very near future and I’m scared. I have a daughter who hates me and claims my husband (her step-father) molested and raped her repeatedly all of her life and that I knew it and let it happen. Everywhere I move to, she comes along and tells her story. I moved here to be close to my parents and sisters after my husband died and now my parents have passed on and my daughter came up and told my sisters her story and now they have turned against me.I thought my older sister was on my side but tonight she told me exactly what she thought of me and called me a b—- and other things and said what a horrible mother I had been and on and on and on. I have been crying for hours and I just want to die. I have nothing left to live for.
posted September 27, 2008 at 9:15 am
I would love to read more about this please post the rest of the interview I have a son that has rapid cycle bipolar and odd adhd he has high blood pressure and he is on tons of meds . and I need as much information I can get I had just found out about nami just a couple of days ago and I am really excited to meet with the president there I have talked to her on the phone I have taken my son to many of drs and got him treatment and seen people he can talk to and evrytime I talk to the dr and ask him for advice on where can I go for more help or what can I do he just tells me to call and have him locked up or puts his head down and doesnt give me a straight answer. I feel locking a child up with this mental illness is not going to help him its going to make it worse please if anyone can help me please email me at mchace112971@aol.com thank you god bless
posted April 29, 2010 at 3:22 am
WE changed psychiatric care in this country but I can’t contact Dr.Duckworth. ! Will someone pass on that the Nurse who was on “60 minutes II:Unsafe Haven”with Ed Bradley would enjoy an audience with Ken Duckworth?! It seems he is unavailable to the common MAN.
The topic(s) VINFEN/SYNERGY HHC & a fair question about conflict of interest..client? abuse ? neglect.
Charles Belanger RN (781)582-2364
posted August 12, 2010 at 3:17 am
Would love to read the rest of the interview
posted August 29, 2010 at 6:57 pm
company scenarios growing last
posted February 29, 2012 at 6:43 am
Please type out the rest of the interview; I am extremely interested in your questions and what the Doctor has to say. Thank you so much!