Beyond Blue

Awhile back Anthony Scioli, coauthor of "Hope in the Age of Anxiety" discussed nine forms of hopelessness and how you can overcome them. This week, I've invited Julie Neraas, author of "Apprenticed to Hope: A Sourcebook for Difficult Times," to tell us about the different kinds of hope. Julie is an ordained minister, spiritual director and associate professor at Hamline University, and speaks regularly about hope, where it can guide you, how it can sustain you, and what meaning it can bring to your life. For more information visit www.julieneraas.com. Here's Julie ...

In his post, "Why Does God Allow Suffering?" Beyond Blue reader Larry Parker sparkled a lively discussion. Among the opinions on the combox was this articulate response from Beyond Blue Mia. Thanks, Mia, for making me think!

Today I have the honor of interviewing Eugene (Gene) and Charles (Church) Zorumski, authors of "Demystifying Psychiatry: A Resource for Patients and Families." It is a fascinating and comprehensive resource to explain one of the most misunderstood sciences of our time.

Question: In your book, you chart the various trends of psychiatry. In your view what are the most substantial trends and why?

Answer: Thank you for asking us about our thoughts concerning the most substantial trends in psychiatry and about why we are optimistic about the future of psychiatry.

We believe that three of the most substantial trends in psychiatry today are:

• Increasing collaboration between primary care and mental health teams in the delivery of psychiatric care


• Increasing use of and greater availability of evidence-based treatments


• Increasing translation of neuroscience research into psychiatric diagnosis and treatment. By that, we mean these three things:

A) We believe that the delivery of psychiatric care will increasingly require close collaboration between primary care medical teams and mental health teams. In this model, the psychiatrist would act in a consultative role to the primary healthcare team. The primary care physician (PCP) and staff would learn to recognize and treat patients with less complicated psychiatric illnesses. A non-physician member of the primary care team could be specifically trained to serve in a case manager-type capacity and help coordinate the collaboration between the PCP and the psychiatrist.

In patients with more difficult-to-treat illnesses such as those involving psychosis, active manic symptoms, or refractory depression, the psychiatrist would take a more primary role in care delivery and lead the healthcare team with the help of collaboration from the PCP. The mental health team would utilize the skills of mental health professionals with various backgrounds in addition to the psychiatrist.

The impetus for this model of care is based on several trends discussed in the book. These include the likelihood that there will continue to be a significant shortage in the number of psychiatrists; increased use of evidence-based treatments, some of which can be effectively initiated by the PCP's team; increased recognition of the impact of psychiatric illnesses on the outcome of concurrent medical conditions (such as heart disease and diabetes) and on the health care economy; and continued decrease in the stigma associated with psychiatric illnesses as parity in insurance coverage is implemented.

Psychiatric disorders are major contributors to disability in western economies and are associated with substantial mortality, particularly when addictive disorders such as alcoholism and nicotine dependence are taken into account. We see psychiatry as playing a key role in helping to diminish these drivers of health care costs.

After reading the last chapter of "Demystifying Psychiatry," I felt so much better about where psychiatry might be when my kids are my age. Perhaps, if either is ever diagnosed with a mental illnesses, there will be more targeted treatments, and more optimism for a speedy recovery.

The following excerpts of "Demystifying Psychiatry: A Resource for Patients and Families" are reprinted with permission from "Demystifying Psychiatry: A Resource for Patients and Families" by Charles F. Zorumski and Eugene H. Rubin, published by Oxford University Press, Inc. © 2010, Oxford University Press.

Here are a few reasons we can be optimistic about the future of psychiatry:

1. Interdisciplinary Studies

Over the next 50 to 100 years, neuroscience research will lead scientists to understand in exquisite detail how humans process information, express and regulate emotions, and motivate themselves to achieve specific goals. This information will affect many clinical and scientific disciplines, including neurology, psychology, biomedical engineering, and computer sciences, but it will likely pay its greatest dividends in psychiatry. Interdisciplinary studies involving genetics, cognitive psychology, neuroimaging, and cellular and systems neuroscience offer great hope for understanding the mechanisms that contribute to psychiatric dysfunction and for finding new and innovative ways to treat mental illness.

2. Brain Plasticity

The ability of humans to learn, remember, and adapt is directly related to the changeableness (plasticity) of the human brain. Whenever we learn new information, the connections between nerve cells in the brain are modified. The activity of some connections (called synapses) increases, while the activity of other synapses decreases. The initial changes involve local chemical alterations in the way synapses transmit and receive information from other neurons. These initial chemical changes eventually lead to structural changes in the brain; that is, more connections and more complex connections form. The longer lasting of these changes require the turning on and turning off of specific genes; therefore, learning involves gene expression. Changes in synaptic connections represent a major way by which memories are formed. But as we all know, some memories fade, and it is likely that the newly formed connections must be reinforced by ongoing brain activity in order for these connections to survive. The important points to remember are that learning alters the actual structure of the brain and that genes are involved in learning.

3. Neurogenesis and Psychiatry

The story about neurogenesis (the formation of new nerve cells in the adult brain) is really part of the larger story about brain plasticity. Put another way, neurogenesis reflects the amazing resilience and plasticity of our brains. Expanding upon observations initially made years ago about birds, it has become clear that certain parts of the human brain are capable of generating new neurons throughout life, even during old age. Not all regions of the brain appear to have this ability to grow new nerve cells, but two regions, the dentate gyrus of the hippocampus and the areas near the lateral ventricles in the olfactory system (which is involved in the sense of smell), are really good at it. The dentate gyrus plays a key role in the function of the hippocampus, the region that is so critical for memory processing. It is likely that a thousand or more new neurons are born in this region each day and can be incorporated into the circuitry of the hippocampus where they help enhance certain types of learning. These new neurons may be particularly important for processing new information.

4. Biomedical Research

One of the strongest reasons we are optimistic about the future of psychiatry is the recent rate of progress in all of biomedical research. We have alluded to the major advances in genetics, molecular biology, neurobiology, and cognitive sciences that have taken place since the late 1980s. Psychiatry is especially well positioned to take advantage of these advances and to build on them. If we learned anything during the 20th century, it is that the capabilities of research involving both fundamental basic science and applied technologies have been amazing. Now, in the early 21st century, scientists have the ability to do things that were unimaginable even 30 years ago.

5. New Vistas in Diagnosis and Treatment

Today, it is easy to envision a future where psychiatric diagnosis is based on understanding fundamental defects in thinking, emotional processing, and motivational systems. In such a world, our traditional categories of psychotic disorders, mood disorders, anxiety disorders, cognitive disorders, and even personality disorders may need to be completely revised. In such a world, treatments might be much more based on underlying mechanisms, and there might be enhanced opportunities for early identification and even prevention of the disorders. In addition to the work on dementias, current research on the biology of syndromes associated with mental retardation is a great example of the potential opportunities.

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Awhile back I wrote about the four kinds of friends you need in your life to become more resilient. Now let's talk about the kind of friends you actually have! Or at least the 10 types of female friends described by author Susan Shapiro Barash in her new book, "Toxic Friends: The Antidote for Women Stuck in Complicated Friendships." (I promise to follow up with one for the guys, okay?).

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