Mysteries of Mental Illness (2021) s01e04 Episode Script
The New Frontiers
I have a diagnosis of OCD,
obsessive-compulsive disorder,
which I've been living with
most of my life.
I hyperventilate
throughout the entire day,
because I'm afraid
that I'm going to lose
the ability to breathe.
When I speak, I, I speak
for a certain length of time,
and then I remember
the need to breathe.
So I, all of my breaths
Inhale, exhale, inhale, exhale
are, are driven by that process
of voluntary artificial breaths.
I've been dealing with
the breathing
for close to eight years.
It's all I think about.
I'm afraid of performing
these compulsions in public.
I spend my time in bed,
or on the couch.
Or pacing around anxiously.
Sometimes I'll cocoon myself
into blankets and sheets
to make this experience
as comfortable as I can,
because it's incredibly painful.
I've tried psychotherapy,
intensive exposure
and response prevention,
cognitive behavioral therapy,
psychopharmacology,
and I haven't seen results.
So, right now,
I'm just biding my time
until surgery.
The neurosurgeon
is going to implant
two electrodes in my brain.
This is the final frontier
in psychiatry.
It's my best and last hope.
Why does
someone have schizophrenia,
depression, or anxiety?
What makes us different?
These subtle differences
that we have in our mind,
they, they are substantiated in
cells and synapses in the brain.
But the reality
of the current status
of mental health treatment
is essentially
shooting in the dark.
The brain has about
85 billion neurons.
Each of them has about
1,000 connections,
and they're firing off
hundreds of times a second.
It's no curiosity that
sometimes people
have troubles
in brain functioning.
Mental illness is just
so very complicated.
I don't think there's ever
going to be a silver bullet
for everyone.
Mental health conditions
are entirely too complex,
based off of genetics,
family history, environment,
and each person's unique story.
For centuries, as
the quest to understand
the mysteries of
mental illness unfolded,
patients endured a wide range
of brutal, unproven therapies,
often against their will.
But today, new tools
yield remarkable insights
into the brain,
paving the way for more and
better-targeted
treatment options.
And some choose
risky new procedures
they hope will change
their lives.
It's a gamble.
Surgery does carry some risks.
But I believe the benefits
outweigh the risks.
I'm
going to ask you some questions
about your OCD.
I know you've been
walking around
with this diagnosis forever.
I do not respond to medications.
I've seen
every sort of specialist
you can think of.
I, I cannot
live with this anymore,
I just can't.
Obsessive-compulsive disorder,
it's about patients who are
stuck in compulsive behaviors,
behaviors that are
important for survival,
like feeling clean,
or making sure
you don't have any illness.
Or making sure everything
is sort of locked and safe,
and usually you check
those things we all do,
and then it's fine,
you go on with your life,
and that doesn't really happen
for most OCD patients.
I literally feel
that my breathing
is not kicking in, so I
I have to breathe,
I have to breathe,
- I have to breathe.
- Mm-hmm, mm-hmm.
You get in this
sort of almost
addiction loop.
Over time, it becomes
harder to treat,
and that's when patients
come to us.
They've tried everything.
I remember him coming back,
and telling me
that he had met you.
That he was going to
explore all options.
I've asked
for tracheostomies before.
And of course, they
They look at me dumbfounded,
of course.
Yeah.
So is that off the table,
those kind of solutions?
No, to me, I would
I would have a tracheostomy,
I would.
I don't mind having
a hole in my throat.
Anything is better than this.
Yeah. Okay.
Every minute of his life,
he's feeling sort of captured
by this compulsive control
of his breathing.
There's nothing else
he can think about.
From the outside,
he may look pretty normal,
but inside, it's one big agony.
And that's where deep brain
stimulation becomes an option.
In deep brain
stimulation, or DBS,
surgeons implant
an electronic "pacemaker"
into the brain to
correct faulty signaling.
Doctors have treated
fewer than 350 OCD patients
with this form
of psychosurgery
all severe cases like Matthew's.
But DBS is widely used
to treat Parkinson's disease,
a neurological disorder
that causes tremors
often resembling the
repetitive behaviors of OCD.
To treat these tremors,
doctors often target
a brain region
called the basal ganglia,
which helps control movements.
When somebody
has a deep brain stimulator
in for tremor, for instance,
you can see their tremor
wildly going about itself
when it's off
and then literally stop dead
in its tracks by turning it on.
Matthew's doctors believe OCD
also involves the basal ganglia.
But instead of
causing tremors, for him,
it drives his
compulsive breathing.
This OCD originated,
I think, at age 14,
with scrupulosity,
where he became obsessed
with thinking bad things
about God,
and then I think
around five or six years,
he transitioned
into his current OCD.
What's really great
about something like
deep brain stimulation,
it's not only therapeutic,
it's investigational.
Next step is
that he will meet Brian,
- he will get an MR scan.
- Yep.
So, by treating these patients,
we are also unlocking and
revealing things
that are going to help us
maybe understand the brain
a lot better than we do today.
The idea that
specific regions of the brain
control specific behaviors
is not a new one.
During the Renaissance
in the 16th century,
autopsies led to
detailed studies of the brain
and the naming of
its major structures.
Then, in the late 1700s,
Viennese physician
Franz Joseph Gall
claimed these
structures corresponded
to specific behaviors,
and mapped different traits
onto dozens of
different brain regions.
In phrenology,
every one of these things
had its location,
and whether you were
mean and avaricious or generous
was the product of
whether that bit of your brain
was well-developed
or underdeveloped.
Gall thought that this
underlying shape of the brain
was reflected in
the shape of the skull.
So that by the lumps and bumps,
by measuring the skull,
you could detect what
the underlying structure
of the brain looked like,
and by indirection,
you could read
somebody's character.
It provided the possibility
of a treatment.
The idea was
the regions of the brain
were a bit like muscles.
If you were deficient
in something,
you could, by working on it,
build that bit of your brain up
and transform yourself.
For people who wanted to have
a scientific psychiatry,
it was manna from heaven.
We're now empirical scientists.
It was genius.
But if you looked at it closely,
it was clearly gaga.
He had no evidence
for this stuff.
Nevertheless, the concept
that different brain regions
correspond
to different behaviors
took hold,
and some scientists
sought clues from
the amazing case of
Phineas Gage.
In 1848, an explosion
drove a railway spike
through Gage's skull.
After his accident, the formerly
mild-mannered foreman
was prone to fits of rage.
The bulk of the damage occurred
in an area of the brain
known as the frontal lobe
that seemed to act as a
control panel
for emotions and personality.
Many years later,
doctors would attempt
to alter patients' behavior
with lobotomies,
a psychosurgery
that severed the frontal lobe
from the rest of the brain.
could this region be
the source of mental illness?
Neurology
was a pretty new discipline
in medicine in this time.
The way that you
try to understand the brain
was by looking
at large numbers of patients
with the same disorder
to discern,
what were the common patterns?
Early neurologists documented
behaviors of patients with
epilepsy,
hoping to gain insights into
the workings of the brain.
In the 1930s, a new device
the electroencephalograph,
or E.E.G
produced the first recordings
of brain activity
during an epileptic seizure.
There was no real
scientific understanding
of what caused mental disorders,
but it had been observed
that seizures,
if they occur in individuals
who are mentally disturbed,
have this
brief period of lucidity
after the seizure.
To reproduce
the effect, some doctors tried
chemically inducing seizures.
But they were unpredictable,
and often dangerously violent.
So in 1937,
two Italian physicians
searched for an alternative.
Somebody
said to them, "You know,
"you should go to the
slaughterhouse in Rome,
"because they use electricity
there to stun the pigs
before they slit their throats."
So, they go there,
and the pigs are coming by,
electrodes on
the sides of the head,
pig convulses,
is now unconscious.
Throat gets cut.
A vagrant picked up
at the train station
became their first subject.
So this guy is put in a chair,
he's mumbling incoherently.
They put electrodes
on his head with some lubricant
and they throw the switch,
and nothing happens.
So they decide
they'll up the current.
And the patient says,
"No, not again, it's deadly."
And they proceed anyway.
And they throw
the switch and this time,
the patient convulses,
and for a short while,
he ceases breathing,
and you can imagine
the tension in the room,
and then he starts
breathing again.
His symptoms supposedly abate.
He's cured.
They weren't sure
how it worked,
but it seemed
to reduce psychosis,
mania,
and especially depression.
This electroconvulsive therapy,
or E.C.T.,
quickly spread.
For decades, hundreds of
thousands of Americans a year
were treated with E.C.T.,
despite its downsides,
which included memory loss
and spasms so violent
they could break bones.
My first experiences with E.C.T.
were absolutely dreadful.
We had to chase
the patients down the hall
because they
were terrified of it.
There was no anesthesia and some
of them used to get fractures.
It was just a painful,
felt like torture
doing it to the patients.
There was
an imbalance of authority
within the
doctor-patient relationship.
And the doctor
was all-knowing and omniscient
and the patient
was the obedient victim.
In crowded asylums,
some used E.C.T.
not just to treat,
but to control.
That image of E.C.T.
being used as
a disciplinary tool,
not a therapy,
stuck in people's minds.
This surfaces most clearly
via the film
"One Flew Over
the Cuckoo's Nest."
McMurphy,
who's challenging authority,
is systematically punished.
Here we go.
First with
medication, then with E.C.T.,
and then finally with
a lobotomy.
I was
terrified of E.C.T. and thought,
"How barbaric can you be?"
Because my only image of it was
"One Flew Over
the Cuckoo's Nest."
My first depressive episode,
25 years ago,
when I walked out of that
hospital, I said,
"I will never be in a
psychiatric hospital again.
"I will beat this.
I will find a way to
overcome this."
And saw it as an obstacle.
And it didn't matter
how deep it ran in my family.
So when it happened again,
that was devastating.
It's like some creature
has inhabited my body.
And it's a creature that is
very disdainful of me,
and sees no good in the world,
and no good in me.
So who wants to stay there?
Who wants to live with that?
Cynthia has been
hospitalized five times,
and like about a third of
those with depression,
has tried many treatments
with little success.
I have always
been on an antidepressant
and a mood stabilizer.
But I have also used
talk therapy, reiki,
acupuncture, and massage.
Over the years,
I've tried all of it.
I may be the only person
that I know for sure
who begged for E.C.T.
I don't see this as a panacea.
That said, I think that
it's critically important
to give people a choice.
All right, there we go.
- Good luck, you'll be fine.
- Thanks, I'll see you.
Bye-bye, thanks, honey.
To treat
her latest depressive episode,
Cynthia
received 14 sessions of E.C.T.
over the course of
about a month.
This visit will hopefully be
one of her last.
If people start to relapse,
you can jump in with
a couple of treatments
and right the ship
and get them back on their way.
I think most of the
stigma around the treatment
comes from the fear
and the misunderstanding
of what we're doing.
Today, patients receive
targeted current, anesthesia,
and muscle relaxants,
so E.C.T. is safer
and has fewer side effects.
For people who have
very severe depressions
that haven't responded to
anything else, it's a lifesaver.
Maybe
we should just go over
- what we're gonna do.
- Okay.
E.C.T.,
from an efficacy standpoint,
is unsurpassed,
but, as with any
medical treatment,
there are some side effects.
And the one that we worry most
about is that of memory loss.
You're not going to forget
who your daughter is,
but you might forget
a piano recital
you went to of hers
a month or two ago.
When you're really depressed,
as you know, your, your brain
kind of shuts down.
It is really a blunt way
to kind of reboot the brain
and start things over.
But we don't really understand
that black box of
how those changes in the brain
result in a complex
human emotion being corrected.
We will need
research to indicate
what types of mental illness
it's most effective for.
No one knows how
any psychiatric treatment works.
So the selection of a treatment
has nothing to do with our
understanding it.
It has to do with
practical results.
In the 1950s,
after E.C.T. took hold,
breakthroughs in chemistry
led to nearly all
the psychiatric medications
in use today.
But the brain was
still mostly a black box.
So, like E.C.T.,
drug development
relied on patient response,
without understanding
how these drugs actually worked.
This was
really the tipping point
for psychiatric medicine.
And that was
a huge breakthrough,
equivalent, in my opinion,
to the discovery of insulin
for diabetes,
antibiotics for infectious
disease, and vaccines.
New drugs
promised to cure
everything from severe psychosis
to the anxiety of everyday life.
Good night, Mother.
Good night, Father.
The 1950s is the age of anxiety.
The language that was used
to describe these drugs
were things like
"the executive's Excedrin."
"An emotional aspirin."
It was like having
a cup of coffee
to wake yourself up
in the morning,
or, or having a martini.
And in fact, there
was a particular martini
where, instead of
the traditional olive,
they put a Miltown tranquilizer
pill
there floating in the alcohol.
Drugs that produced
socially acceptable behaviors
entered mainstream culture,
but another set of compounds
had a radically
different effect.
This is a glass of water.
It contains 100 gamma of LSD.
While searching
for new medications,
a chemist accidentally created
the infamous psychedelic LSD.
Can you see it? It's
right here in front of me.
Right now.
Watch.
No.
Oh, good heavens.
Everything is in color, and,
and I can feel the air.
I can, I can see it,
I can see all the molecules.
LSD's molecular structure
was surprisingly similar to a
chemical only recently
serotonin.
This similarity, along with
LSD's dramatic effects
on perception,
helped lead scientists
to the groundbreaking theory
that neurotransmitters
chemical messengers
neurons use to communicate
could be key to shaping
mental experience.
What does it feel like?
It feels good.
Soon, more than a
thousand experiments
suggested psychedelics
helped alleviate addiction,
anxiety, and depression.
But in the 1960s,
these drugs left the lab
and entered
the growing counterculture.
Turn on, tune in, drop out.
This became very threatening
to a conservative
political society,
particularly the part where,
after taking a psychedelic,
people didn't want to go to war.
People didn't want to go to
Vietnam.
And so the establishment
basically concluded
that psychedelics was
at the core of the problem
of the counterculture
rejecting their value system,
and decided that psychedelics
were more dangerous
than they in fact are.
There is nothing smart,
there is nothing grown up
or sophisticated
in taking an LSD trip at all.
They're just being
complete fools.
The government
classified all psychedelics
as Schedule I substances,
with high potential for abuse
and no accepted medical use,
delaying research for decades.
But today, with few new
psychiatric drugs
on the horizon,
studies are once again underway,
and some are taking matters into
their own hands.
So I remember
the first time that I decided
to do an MDMA therapy session,
being someone
who's very straitlaced
and traditional and saying,
"Oh, wow, you're about
to commit a major felony,
"take a substance that's banned,
and put on an eye mask,
"lay on a couch,
and have therapy.
Like, this is a little insane."
MDMA
Also known as
the feel-good drug,
ecstasy, or molly
Is still illegal.
But it's now in the final stages
of FDA approval for use
as a treatment for
post-traumatic stress disorder.
MDMA has a lot of qualities
that reduce your self-judgment
and self-blame.
It allows you to
approach a fear memory
in a way that you can
tolerate it better.
My freshman year
at the University of Wisconsin,
I was on the UW crew team,
and one night I went to a party,
was starting to
meet some of the rowers,
and two of them
made a decision to
sexually assault me that night.
I really didn't know how
to comprehend it.
And I really just
didn't speak about it.
Through a series of events,
I eventually decided
to report it to the police.
I went through
every legal process,
even hired a civil attorney.
And at the
end of that experience,
I didn't get justice.
I am a campus
sexual assault survivor,
and I've been
a longtime activist
But I decided
to go to law school
and really use my story
to make change
for other survivors.
My concern, actually, is, we
only count by victimization,
so you can have a gang rape
that's one rape,
even though
there's ten perpetrators.
So we're counting
all the different crimes,
but we're not counting
all the different perpetrators.
Yes.
I became a hyper-achiever,
and I used that
as my coping mechanism.
I finally did five years
with a traditional therapist.
But I was so ashamed of
the things that I was saying
that I always looked down,
because it's hard
to be honest with yourself.
I think it's important
to finally feel
all of those things
and try to let it go and
not have it stay in me anymore.
Yeah.
The effect
of the actual medication
will last for
seven or eight hours.
Within a day
or a day and a half,
all traces of the medicine
will have left your body.
But the lingering effects of
what you accomplished
will last for a very long time,
and it may be forever.
Because what will have happened
during those seven hours
isn't a pharmacologic effect,
it's pharmacology helping you
achieve an insight.
Laura and I will talk about
what she wants to accomplish,
what her intention is.
Then Laura will make a decision
if she would like
to take the medicine.
It's a small dose of MDMA,
the idea being that once
she's able to make contact
with those parts of herself
and process those experiences,
that her perspective may shift
and that there would be
a sort of neurological or
biological change
to kind of to coincide
with that inside of her.
You've already done
everything you need to do
by being here.
So you can just relax
and go where you need to go.
Okay.
Within the hour,
Laura will experience
MDMA's effects.
Her brain will flood
with neurotransmitters,
including serotonin,
dopamine, and oxytocin.
These chemicals can create
feelings
of well-being and trust,
and some speculate
they make the brain
more malleable,
so it's easier to learn new ways
of responding to
traumatic memories.
But how chemical changes
in the brain
actually affect thoughts,
feelings,
and behaviors
isn't well understood.
The Harvard Brain Tissue
Resource Center
distributes specimens
around the world
to scientists working to unlock
the mysteries of mental illness.
It is a really
humbling experience
when we receive a brain
donation.
We just found out that the donor
passed,
we know that person was
experiencing feelings
and thoughts and said goodbye
to their loved ones.
And few hours later,
we are holding the brain.
When I hold a brain of somebody
that had a psychiatric disorder,
or even dissect it, I wouldn't
notice any difference
between that brain and the brain
of somebody
that didn't have
any brain disorders.
Our work is to try to understand
changes in specific parts
of the brain, in specific cells,
that may be responsible
for certain symptoms.
Brain specimens reveal
that disorders like PTSD,
depression, and schizophrenia
share genetic vulnerabilities
and patterns of molecular
changes,
so these diagnoses may not be as
distinct as long believed.
The more we dig,
the more we understand,
that the more we see that there
is
an added layer of complexity.
New imaging techniques
are revealing that brain regions
themselves are also not as
distinct as previously thought.
Instead, it might be the complex
connections between regions,
known as circuits, that are key
to understanding mental illness.
When I started first studying
neuroscience as a student,
I was trained that, you know,
different brain regions do
certain things.
You know,
"X brain region does Y."
And I think the evolution of the
field is that brain circuits
are really the functional unit
of the brain.
Only recently
have we begun to be able to see
another layer
of the anatomy of the brain,
to see these connections.
Doctors hope a better
understanding of brain circuits
will change lives like Matthew's
and make treatment more targeted
than ever before.
Right now, what we have
is a sledgehammer,
and that sledgehammer can look
like electroconvulsive therapy
to shake up the functioning
of, of different circuits,
and then see if it can kind of,
like,
settle back into a better state,
but it's totally random.
If we understood specific
circuits, we could apply current
at the circuit-specific level.
A new type of MRI
helps trade that sledgehammer
for a more refined approach,
showing these communication
pathways in dramatic detail
unattainable just a decade ago.
Today, we're trying to find
the optimal surgical target
for you, Brian.
Can the precise
placement of a brain implant
help Matthew's compulsive
breathing?
The best next step,
I would think,
would be for me to pick
a trajectory.
Mm-hmm.
Our current investigative
strategy is that we're looking
for a confluence of two
critical pathways
passing through a big area
of the brain.
That's like a giant highway
coming from the frontal lobes
down into the central structures
of the brain,
of the basal ganglia, which then
distribute the information
to the rest of the brain.
By electrically stimulating,
we are able to very precisely
intervene,
fundamentally changing
the underlying patterns
of communication.
Sectioning the brain
An early and infamous
attempt to change patterns of
communication was the lobotomy,
which severed the frontal lobe's
connection
with the rest of the brain.
Lobotomies led us to
the insight that frontal lobes
were really, really important
to psychiatric disease.
Today, it's already understood
and known,
and it doesn't seem like
an earth-shattering notion,
but the idea of demonstrating
that was really earthshaking.
It really opened up psychiatry.
If we didn't understand
the frontal lobe's
inherent importance
to mental illness,
we wouldn't be sitting here
today.
So about how long does this
typically take,
like, before I'm on
my feet again?
Well, the very next day,
you'll be on your feet.
You'll be on your feet
that evening.
As long as there's no
complications
One out of three
patients don't respond
to the procedure.
And the risks are significant.
When you say
complication, what is
The scariest risk
is bleeding in the brain
or stroke.
It's a little under one percent
of it
being clinically meaningful.
But it's something that you
have to be mindful of.
With regards to this
target region,
the most common adverse
stimulation effect
is something called mania.
In my years of doing this,
I had one patient
go on a huge credit card
spending spree.
That's part and parcel of
stimulating these, these
emotional circuitries.
Having these abnormal
side effects in some ways
is a good sign.
It means that we're
getting close.
Does that make sense?
Yeah, that, that we're seeing
a response.
Right, we're in the right
circuitry,
now we just got to tune it in.
Mm-hmm.
Matthew will need
three separate surgeries
costing about $100,000.
But insurance coverage
is a struggle.
I know that you're fully aware
of this insurance claim being
denied and yet another time.
And now it's going
all the way up to
the New York State Executive,
appeal.
So I did a written review of
the policy guidelines
for the insurance company.
Mm-hmm. Mm-hmm.
And it looks like
deep brain stimulation is
indicated for other disorders,
not mental disorders.
Right, right.
DBS is approved
by the FDA for treating
some cases of very severe OCD,
but as with many
psychiatric treatments,
insurance companies often
don't provide coverage.
We are having huge problems
getting the insurance cover
the deep brain stimulation
for psychiatric conditions,
even though it's, it's, like,
on the same spectrum
as movement disorders.
The first thing we get back
from the insurance, say,
"No, we can't do it."
There has been this
bright white line
between mental illness
and physical illness.
And I think it
fundamentally speaks
to a, a longstanding stigma
against psychiatric disease.
Bringing in that paperwork,
focusing on that next week,
and really prioritizing our
session for it would be helpful.
Sounds like a plan.
Okay, wonderful.
Psychiatry has made tremendous
scientific advancements,
with new forms of treatment,
like deep brain stimulation.
But these treatments are
very, very expensive.
And so we really have to
think about,
how are we going to make access
equitable for all people?
We don't have
very good healthcare policy,
and it affects
disproportionately
mental healthcare.
Mental Health Parity law
passed in 2008,
but it's not enforced,
meaning that if insurers
don't abide by it,
who's going to know,
unless somebody brings a suit,
a lawsuit?
I think that
really lies at the heart of the
fundamental biggest problem
of mental health treatment
is that there's a stigma
behind it, and there are
many layers of that stigma.
Can you say your name
and date of birth?
Cynthia Piltch
Much of the
controversy and fear
about electroconvulsive therapy
is tied to its history
as a painful and sometimes
punitive treatment.
Big deep breath all the
way in, and all the way out.
Efforts continue
to reform its reputation
and create a more comfortable
and effective procedure.
Most of the work
over the last 20 years
has been how to really minimize
the side effects.
Under general anesthesia,
with a muscle relaxant in place,
using tiny pulses of
electricity,
people don't really convulse.
We have to
put a bite guard in is,
because even though we have
a muscle relaxant on board,
she will bite down.
What we haven't
been able to do with E.C.T.
is produce an effective
treatment without the seizure.
You see the bite.
Applied to only
one side of Cynthia's head,
the electric pulses
are hundreds of times shorter
than the original E.C.T.
Lasting about the length of time
it takes a neuron to fire,
they trigger more efficient
seizures
with fewer side effects.
Now, if we didn't have
a muscle relaxant,
you'd see her really moving.
This is the E.E.G. tracing.
These sharp waves tell us
whether there's
an acute seizure going on.
Some people believe that
part of the way E.C.T. works
is not so much in the
seizure itself,
but in the way the brain
reacts to the seizure and shuts
it down.
It really is a very
quick,
somewhat boring procedure
when it's done right.
Cynthia, everything's all fine.
You did your treatment
and you're in recovery, okay?
I have some memory loss.
But I don't want to miss
an opportunity
to support my well-being.
The fact that I can still
do credible work
makes it harder for people
to draw the conclusion
that E.C.T. strips you
of any cognitive ability.
Not being able to be myself
was much more frightening
than whatever E.C.T. brought.
For Cynthia,
the benefits of E.C.T.
outweigh the risks.
And Laura is also taking risks
to overcome the trauma
of sexual assault.
Right now, it is not legal
for me to be taking MDMA
or doing an MDMA therapy
session.
But the idea of waiting
any longer upon finding
a possible solution to be
fully well and healed
meant that I had to take
the action of taking
an illegal substance
outside of a clinical setting.
Everything in my
head is screaming,
but that was one of those
moments where I was, like,
I never get to be angry.
I never get to be angry!
Each session has its own theme.
I think the best way
to explain it
is your anxiety being a ball,
and you can spin it around
and see it from all angles.
You're, like, going into
your own brain
and almost like doing surgery.
I was so desperate
to be believed.
I thought about killing myself
to be believed.
I just wanted to be believed.
That's so hard to believe.
You did not deserve that.
Now I cry more.
But that's good.
Like, I'm not crushing
all the pain in me.
These are real emotions
that I used to never feel.
So I think the substance
does some work.
But, you know, the actual
ability to shift perspectives
that you learn from that stays.
And the power
of fixing yourself,
I can't even begin to describe
how important that is.
Many experts see
MDMA-assisted therapy
as a new frontier.
In some studies, 80% of patients
show improvement,
and FDA approval may be
around the corner.
But the future of psychedelics
remains uncertain.
Maybe it'll work.
The data are still developing,
but practice and use
is leaping ahead of research.
And with the genie
out of the bottle,
we don't know what's going
to happen.
Good.
Good.
Good.
Just kind of make sure
Okay, that's great.
So I guess they're
gonna put me to sleep now,
and I'll wake up when we do
the, uh
Yeah, the testing, okay?
Looks good.
After nearly a year
and multiple appeals,
with the hospital
advocating on his behalf,
the insurance company approved
Matthew's deep brain
stimulation surgery.
It takes about two hours
to place one electrode.
Good.
Let's have that.
Yup.
What's our blood pressure?
Okay, great, let's get a scan.
How are you feeling?
- Okay.
- Yeah?
I mean, not okay, but
To make sure the
device is in the right place,
Matthew's doctors wake him up.
Yeah, everything
went fine so far.
The lead is in.
And it's positioned very well.
And we're going to run
some tests in a moment.
He's asked to rate
his symptoms
while they test the current.
You can actually use this
to move.
So contact one.
This is just very intuitive.
Now you just click on it.
Anxiety, uh
Not so bad.
Oh, that's good.
In three weeks,
Matthew will have
another electrode implanted
in the other side of his brain,
and then a separate surgery
to put batteries in his chest
- to power the device.
- Contact three.
Compulsive breathing,
I'm not doing it so much.
But I'm still, like,
doing it occasionally.
Great.
Like, percentage-wise, what,
what would you say, like
- A 70.
- 70.
Okay, now I'm doing it.
That's maybe because we
just turned it off.
That's insane.
Wow.
The implant won't be activated
until Matthew has healed
from all his surgeries.
It will be more than a month
before he knows if it works,
but initial signs are promising.
This is much better than
anything I've ever tried.
Does it feel natural
or
It feels not exactly natural,
but it feels very close.
He's feeling amazing.
All right, Matt,
how about that?
So we're just going to do
a little more recording,
and then we're done.
I'm going to put you to sleep,
okay?
All right.
Deep brain
stimulation holds promise
for people like Matthew,
but the challenges in
treating mental illness
are as much
about society as science.
One major hurdle
involves overcoming
psychiatry's controversial past.
Many Americans do not see
the formal psychiatric system
as being for them.
They see psychiatry
as being aligned with
a punitive form of treatment
that does not take into account
family,
does not take into account
faith,
and does not take into account
community.
For centuries,
psychiatry has
used labels to marginalize
and subjected those considered
mentally ill to experimentation
and treatment,
often without consent.
Today, in the United States,
more than a million people
living with mental illness
are incarcerated or homeless.
And for many,
access to treatment
and insurance is limited.
Some are trying to combat
this checkered legacy and
make access to mental healthcare
more equitable.
The newest biological treatments
are not the only
new frontiers in psychiatry.
What I'm trying to do
is to try to provide care
where people naturally see it
in culturally relevant settings.
With your son,
what, what is the relationship
like right now?
Like, you know, how does he,
how does he respond to you?
Um
He's open, he's open to hear,
okay, how you feel about it,
kind of what are we gonna
do about it now, kind of
Barbershops,
especially for Black men,
have provided kind of informal
mental health supports
for centuries.
- Guy, what up?
- Hey, man.
- Man.
- How you doing, brother?
Wow, man, good seeing you,
baby.
We're working to train
these type of informal helpers
with the latest evidence
and techniques to be able
to identify someone
who may be experiencing
a mental health crisis,
how to support them
in the moment,
and then how to get them
connected to health insurance,
or how to get them connected
to a mental health professional.
I had a guy, you know,
during the pandemic.
You know what I'm saying?
He was going through a lot.
A lot of his people
was falling off, and
- Yeah.
- You know,
this guy,
I've been cutting for years,
and I would never think
that he would be
sitting in my chair crying.
I gave him that platform
to be able to do so.
That really shows
the trust that he has in you
- Absolutely.
- And, and his willingness
and connection to you,
that he felt safe.
When we talk about psychiatry,
I think we traditionally have
expected people to come to us,
and we, when people don't
come to our settings,
we interpret that as resistance.
I think that the new way
for psychiatry to move forward
is to figure out how
communities have dealt with
issues around trauma and
depression, substance use,
and build upon and incorporate
some of those traditions
into the interventions
that we develop
and that we implement.
God, we use our
own pain and our own experience
to bring a word
of comfort and healing
and relief to someone else.
Within the
African American community,
one of the things
that often we know of
is the normalization of trauma.
"This is what
it's supposed to be,
given the, the history of, of
our people."
So, what happens
in many of our communities,
that embodied trauma, right,
that has many tentacles,
never gets addressed.
There's a big stigma
in our communities
around mental health issues,
well, scratch it
we've been traumatized.
I actually met Pastor Mike.
One of his church members
came up to me and said,
"You know, my pastor talks
about mental health
from the pulpit."
I was just so excited,
because I had never heard of
a pastor
talk about mental health.
One of the things
I want to hear about
is, how have we done with regard
to cutting down the wait list?
I know we had a,
a pretty large wait list.
We had a waiting list
of 76 people.
Hankerson and Walrond built
a mental health support network
that includes
a crisis hotline and
free clinic.
You can't say,
"Oh, it's"
We don't trust God.
No, it's a faith-based
institution that created it.
You can't say,
"Oh, it's too expensive."
No, it's for free.
Winter has crept in.
Have we seen an increase
in people reaching out?
Yes.
My dream,
or one of my visions,
in terms of
transforming mental health,
is really creating connection
points and support.
We have to form partnerships,
you know, with these
trusted community settings
so people can learn,
so that trust can be created,
so that it can be
equitably accessed,
you know, in, in society.
Just a week ago,
Matthew had his third and final
deep brain stimulation surgery.
What I remind myself
is that I am my best advocate.
I found this clinic
through my own research,
through my own initiative.
I earned my way to this surgery
by fighting for myself.
So, you know,
I have that fighting spirit
that is not going to go away
no matter what the outcome is.
Today, his doctor will test
whether the
electrical implants work.
Some people might say
it's, it's a little creepy
that we're going to actually
manipulate someone's brain.
And I would say they're right,
if it's, like, a healthy person
with a healthy brain,
but these are,
like, very ill patients.
So I know today,
this appointment's
not going to be, you know,
a magic pill,
but I'm hoping that,
you know, we
Maybe, maybe it will, maybe it
won't.
This is actually your brain.
You can see the tracks that
your leads are implanted to.
The electrodes
implanted in Matthew's brain
have several contact points.
Dr. Figee will adjust
the amount of electricity
- flowing through each of them.
- Is that,
- is that still
- A little tender,
- but yeah.
- But first,
he has to link the batteries
implanted in Matthew's chest
with a handheld controller.
You may not feel
an immediate response
- Yeah, I feel it.
- Yeah? Tell me if
it's uncomfortable.
I mean, it's okay.
I feel it kind of, like,
in my heart, like, uh
- Like, I don't know.
- Oh, yeah.
- Like a little
- Yeah.
I'm, like, laughing now, um
Does the laughing, like,
go away or
Yeah, yeah, yeah,
the first activation
of the system
is usually a little
hypomania-causing,
especially this contact.
But we're going to
move to another contact soon.
Like, I feel like I want to dance.
I feel like I want to
run on the street, like
- Oh, yeah?
- Yeah.
I feel very energetic than,
more than normal.
But, but naturally,
or like you're on drugs?
Like, a little
like I'm on drugs,
but, like, it's not bad.
If you feel great,
you might be better able
- to control your OCD, as well.
- Yeah.
But it's not what
we're strictly aiming for.
3A.
As they try
different contact points
along the electrode,
Matthew rates
each of his symptoms.
This
is gonna be left 3C,
right 3B.
I'm not even
compulsively breathing.
It's almost gone, yeah.
Definitely less, so, like
- Wow.
- Okay.
But that was a good setting.
The compulsion
is virtually gone.
Like, I'm not
compulsively breathing,
- and
- Great.
- Yeah.
- Not too up,
but definitely way more down.
- Better.
- In terms of your symptoms.
Yeah, wow.
It seems that,
like, the contact
is the best one,
- which is the third one
- Yeah. Mm-hmm.
Because it doesn't
give you, this, this up,
- this sort of mania.
- Yeah.
This is, like, a whole new look
on life, this is crazy.
Mm-hmm.
All right, so, here's the phone.
Yes, turn it on.
His doctors will control
the programming of the device,
but he can make
slight adjustments to
the amount of current
through an app on his phone.
See? You can go up and down.
And again,
- you can also turn it off.
- Okay.
It went perfectly as planned,
and it was actually
a copy of the responses
that we also saw
in the operation room.
Hopefully, he'll feel more
normal, more like himself.
Right now, I'm at setting 4.5.
Now I'm at 4.6.
I felt a little pulse there.
It says I've been stimulated
for 192 days.
The OCD
is just a shell of what it was.
It's in the shadows.
The only time I've actually seen
a drastic increase in
OCD symptoms
was when one of the electrodes
was actually off by mistake.
It made me realize, you know,
how dependent I am on this
machine,
how dependent I am on
this device.
After centuries of searching,
are scientists
finally close to solving
some of the mysteries of
mental illness?
If we were able to
think of the brain
more as a tangled mess of wires
that we need to
carefully disentangle,
I think it is totally,
you know, within
the realm of possibility
in the future that
there will be treatments
cures, even for mental health
disorders that are specific,
that would have a
completely different strategy
than our current mental health
treatments do.
Before my surgery,
I used to have trouble
going outside,
and I felt that it was
almost futile.
Not going to feel better.
I was just sort of
a prisoner of this illness.
So I'm here now.
I can appreciate these things
I didn't,
I didn't appreciate before.
I can listen to the birds.
I can really be myself here.
When I think about
what a mental health revolution
will look like,
it will take time.
There's no shortcut.
We've made a bit of progress,
but it's a deeply disturbing
part of the human condition
and one we've wrestled with
for millennia.
We cannot arrogantly assume
that we have one single answer.
Come on, buddy.
This is a complex
problem in a whole person,
not a segment of a person
that's a brain
or a mind or a gene
or an environment.
Mental illness
will likely endure
as long as humanity itself.
But each new breakthrough
brings greater understanding.
Will this help reduce stigma and
lead to a healthier world?
When the
health of people improves,
the community's health improves.
So when we
take care of everyone,
then everyone
in society benefits.
To order "Mysteries
of Mental Illness" on DVD,
visit ShopPBS
or call 1-800-PLAY-PBS.
This series is also available
on Amazon Prime Video.
For more about "Mysteries of
Mental Illness,"
visit pbs.org/
mysteriesofmentalillness.
obsessive-compulsive disorder,
which I've been living with
most of my life.
I hyperventilate
throughout the entire day,
because I'm afraid
that I'm going to lose
the ability to breathe.
When I speak, I, I speak
for a certain length of time,
and then I remember
the need to breathe.
So I, all of my breaths
Inhale, exhale, inhale, exhale
are, are driven by that process
of voluntary artificial breaths.
I've been dealing with
the breathing
for close to eight years.
It's all I think about.
I'm afraid of performing
these compulsions in public.
I spend my time in bed,
or on the couch.
Or pacing around anxiously.
Sometimes I'll cocoon myself
into blankets and sheets
to make this experience
as comfortable as I can,
because it's incredibly painful.
I've tried psychotherapy,
intensive exposure
and response prevention,
cognitive behavioral therapy,
psychopharmacology,
and I haven't seen results.
So, right now,
I'm just biding my time
until surgery.
The neurosurgeon
is going to implant
two electrodes in my brain.
This is the final frontier
in psychiatry.
It's my best and last hope.
Why does
someone have schizophrenia,
depression, or anxiety?
What makes us different?
These subtle differences
that we have in our mind,
they, they are substantiated in
cells and synapses in the brain.
But the reality
of the current status
of mental health treatment
is essentially
shooting in the dark.
The brain has about
85 billion neurons.
Each of them has about
1,000 connections,
and they're firing off
hundreds of times a second.
It's no curiosity that
sometimes people
have troubles
in brain functioning.
Mental illness is just
so very complicated.
I don't think there's ever
going to be a silver bullet
for everyone.
Mental health conditions
are entirely too complex,
based off of genetics,
family history, environment,
and each person's unique story.
For centuries, as
the quest to understand
the mysteries of
mental illness unfolded,
patients endured a wide range
of brutal, unproven therapies,
often against their will.
But today, new tools
yield remarkable insights
into the brain,
paving the way for more and
better-targeted
treatment options.
And some choose
risky new procedures
they hope will change
their lives.
It's a gamble.
Surgery does carry some risks.
But I believe the benefits
outweigh the risks.
I'm
going to ask you some questions
about your OCD.
I know you've been
walking around
with this diagnosis forever.
I do not respond to medications.
I've seen
every sort of specialist
you can think of.
I, I cannot
live with this anymore,
I just can't.
Obsessive-compulsive disorder,
it's about patients who are
stuck in compulsive behaviors,
behaviors that are
important for survival,
like feeling clean,
or making sure
you don't have any illness.
Or making sure everything
is sort of locked and safe,
and usually you check
those things we all do,
and then it's fine,
you go on with your life,
and that doesn't really happen
for most OCD patients.
I literally feel
that my breathing
is not kicking in, so I
I have to breathe,
I have to breathe,
- I have to breathe.
- Mm-hmm, mm-hmm.
You get in this
sort of almost
addiction loop.
Over time, it becomes
harder to treat,
and that's when patients
come to us.
They've tried everything.
I remember him coming back,
and telling me
that he had met you.
That he was going to
explore all options.
I've asked
for tracheostomies before.
And of course, they
They look at me dumbfounded,
of course.
Yeah.
So is that off the table,
those kind of solutions?
No, to me, I would
I would have a tracheostomy,
I would.
I don't mind having
a hole in my throat.
Anything is better than this.
Yeah. Okay.
Every minute of his life,
he's feeling sort of captured
by this compulsive control
of his breathing.
There's nothing else
he can think about.
From the outside,
he may look pretty normal,
but inside, it's one big agony.
And that's where deep brain
stimulation becomes an option.
In deep brain
stimulation, or DBS,
surgeons implant
an electronic "pacemaker"
into the brain to
correct faulty signaling.
Doctors have treated
fewer than 350 OCD patients
with this form
of psychosurgery
all severe cases like Matthew's.
But DBS is widely used
to treat Parkinson's disease,
a neurological disorder
that causes tremors
often resembling the
repetitive behaviors of OCD.
To treat these tremors,
doctors often target
a brain region
called the basal ganglia,
which helps control movements.
When somebody
has a deep brain stimulator
in for tremor, for instance,
you can see their tremor
wildly going about itself
when it's off
and then literally stop dead
in its tracks by turning it on.
Matthew's doctors believe OCD
also involves the basal ganglia.
But instead of
causing tremors, for him,
it drives his
compulsive breathing.
This OCD originated,
I think, at age 14,
with scrupulosity,
where he became obsessed
with thinking bad things
about God,
and then I think
around five or six years,
he transitioned
into his current OCD.
What's really great
about something like
deep brain stimulation,
it's not only therapeutic,
it's investigational.
Next step is
that he will meet Brian,
- he will get an MR scan.
- Yep.
So, by treating these patients,
we are also unlocking and
revealing things
that are going to help us
maybe understand the brain
a lot better than we do today.
The idea that
specific regions of the brain
control specific behaviors
is not a new one.
During the Renaissance
in the 16th century,
autopsies led to
detailed studies of the brain
and the naming of
its major structures.
Then, in the late 1700s,
Viennese physician
Franz Joseph Gall
claimed these
structures corresponded
to specific behaviors,
and mapped different traits
onto dozens of
different brain regions.
In phrenology,
every one of these things
had its location,
and whether you were
mean and avaricious or generous
was the product of
whether that bit of your brain
was well-developed
or underdeveloped.
Gall thought that this
underlying shape of the brain
was reflected in
the shape of the skull.
So that by the lumps and bumps,
by measuring the skull,
you could detect what
the underlying structure
of the brain looked like,
and by indirection,
you could read
somebody's character.
It provided the possibility
of a treatment.
The idea was
the regions of the brain
were a bit like muscles.
If you were deficient
in something,
you could, by working on it,
build that bit of your brain up
and transform yourself.
For people who wanted to have
a scientific psychiatry,
it was manna from heaven.
We're now empirical scientists.
It was genius.
But if you looked at it closely,
it was clearly gaga.
He had no evidence
for this stuff.
Nevertheless, the concept
that different brain regions
correspond
to different behaviors
took hold,
and some scientists
sought clues from
the amazing case of
Phineas Gage.
In 1848, an explosion
drove a railway spike
through Gage's skull.
After his accident, the formerly
mild-mannered foreman
was prone to fits of rage.
The bulk of the damage occurred
in an area of the brain
known as the frontal lobe
that seemed to act as a
control panel
for emotions and personality.
Many years later,
doctors would attempt
to alter patients' behavior
with lobotomies,
a psychosurgery
that severed the frontal lobe
from the rest of the brain.
could this region be
the source of mental illness?
Neurology
was a pretty new discipline
in medicine in this time.
The way that you
try to understand the brain
was by looking
at large numbers of patients
with the same disorder
to discern,
what were the common patterns?
Early neurologists documented
behaviors of patients with
epilepsy,
hoping to gain insights into
the workings of the brain.
In the 1930s, a new device
the electroencephalograph,
or E.E.G
produced the first recordings
of brain activity
during an epileptic seizure.
There was no real
scientific understanding
of what caused mental disorders,
but it had been observed
that seizures,
if they occur in individuals
who are mentally disturbed,
have this
brief period of lucidity
after the seizure.
To reproduce
the effect, some doctors tried
chemically inducing seizures.
But they were unpredictable,
and often dangerously violent.
So in 1937,
two Italian physicians
searched for an alternative.
Somebody
said to them, "You know,
"you should go to the
slaughterhouse in Rome,
"because they use electricity
there to stun the pigs
before they slit their throats."
So, they go there,
and the pigs are coming by,
electrodes on
the sides of the head,
pig convulses,
is now unconscious.
Throat gets cut.
A vagrant picked up
at the train station
became their first subject.
So this guy is put in a chair,
he's mumbling incoherently.
They put electrodes
on his head with some lubricant
and they throw the switch,
and nothing happens.
So they decide
they'll up the current.
And the patient says,
"No, not again, it's deadly."
And they proceed anyway.
And they throw
the switch and this time,
the patient convulses,
and for a short while,
he ceases breathing,
and you can imagine
the tension in the room,
and then he starts
breathing again.
His symptoms supposedly abate.
He's cured.
They weren't sure
how it worked,
but it seemed
to reduce psychosis,
mania,
and especially depression.
This electroconvulsive therapy,
or E.C.T.,
quickly spread.
For decades, hundreds of
thousands of Americans a year
were treated with E.C.T.,
despite its downsides,
which included memory loss
and spasms so violent
they could break bones.
My first experiences with E.C.T.
were absolutely dreadful.
We had to chase
the patients down the hall
because they
were terrified of it.
There was no anesthesia and some
of them used to get fractures.
It was just a painful,
felt like torture
doing it to the patients.
There was
an imbalance of authority
within the
doctor-patient relationship.
And the doctor
was all-knowing and omniscient
and the patient
was the obedient victim.
In crowded asylums,
some used E.C.T.
not just to treat,
but to control.
That image of E.C.T.
being used as
a disciplinary tool,
not a therapy,
stuck in people's minds.
This surfaces most clearly
via the film
"One Flew Over
the Cuckoo's Nest."
McMurphy,
who's challenging authority,
is systematically punished.
Here we go.
First with
medication, then with E.C.T.,
and then finally with
a lobotomy.
I was
terrified of E.C.T. and thought,
"How barbaric can you be?"
Because my only image of it was
"One Flew Over
the Cuckoo's Nest."
My first depressive episode,
25 years ago,
when I walked out of that
hospital, I said,
"I will never be in a
psychiatric hospital again.
"I will beat this.
I will find a way to
overcome this."
And saw it as an obstacle.
And it didn't matter
how deep it ran in my family.
So when it happened again,
that was devastating.
It's like some creature
has inhabited my body.
And it's a creature that is
very disdainful of me,
and sees no good in the world,
and no good in me.
So who wants to stay there?
Who wants to live with that?
Cynthia has been
hospitalized five times,
and like about a third of
those with depression,
has tried many treatments
with little success.
I have always
been on an antidepressant
and a mood stabilizer.
But I have also used
talk therapy, reiki,
acupuncture, and massage.
Over the years,
I've tried all of it.
I may be the only person
that I know for sure
who begged for E.C.T.
I don't see this as a panacea.
That said, I think that
it's critically important
to give people a choice.
All right, there we go.
- Good luck, you'll be fine.
- Thanks, I'll see you.
Bye-bye, thanks, honey.
To treat
her latest depressive episode,
Cynthia
received 14 sessions of E.C.T.
over the course of
about a month.
This visit will hopefully be
one of her last.
If people start to relapse,
you can jump in with
a couple of treatments
and right the ship
and get them back on their way.
I think most of the
stigma around the treatment
comes from the fear
and the misunderstanding
of what we're doing.
Today, patients receive
targeted current, anesthesia,
and muscle relaxants,
so E.C.T. is safer
and has fewer side effects.
For people who have
very severe depressions
that haven't responded to
anything else, it's a lifesaver.
Maybe
we should just go over
- what we're gonna do.
- Okay.
E.C.T.,
from an efficacy standpoint,
is unsurpassed,
but, as with any
medical treatment,
there are some side effects.
And the one that we worry most
about is that of memory loss.
You're not going to forget
who your daughter is,
but you might forget
a piano recital
you went to of hers
a month or two ago.
When you're really depressed,
as you know, your, your brain
kind of shuts down.
It is really a blunt way
to kind of reboot the brain
and start things over.
But we don't really understand
that black box of
how those changes in the brain
result in a complex
human emotion being corrected.
We will need
research to indicate
what types of mental illness
it's most effective for.
No one knows how
any psychiatric treatment works.
So the selection of a treatment
has nothing to do with our
understanding it.
It has to do with
practical results.
In the 1950s,
after E.C.T. took hold,
breakthroughs in chemistry
led to nearly all
the psychiatric medications
in use today.
But the brain was
still mostly a black box.
So, like E.C.T.,
drug development
relied on patient response,
without understanding
how these drugs actually worked.
This was
really the tipping point
for psychiatric medicine.
And that was
a huge breakthrough,
equivalent, in my opinion,
to the discovery of insulin
for diabetes,
antibiotics for infectious
disease, and vaccines.
New drugs
promised to cure
everything from severe psychosis
to the anxiety of everyday life.
Good night, Mother.
Good night, Father.
The 1950s is the age of anxiety.
The language that was used
to describe these drugs
were things like
"the executive's Excedrin."
"An emotional aspirin."
It was like having
a cup of coffee
to wake yourself up
in the morning,
or, or having a martini.
And in fact, there
was a particular martini
where, instead of
the traditional olive,
they put a Miltown tranquilizer
pill
there floating in the alcohol.
Drugs that produced
socially acceptable behaviors
entered mainstream culture,
but another set of compounds
had a radically
different effect.
This is a glass of water.
It contains 100 gamma of LSD.
While searching
for new medications,
a chemist accidentally created
the infamous psychedelic LSD.
Can you see it? It's
right here in front of me.
Right now.
Watch.
No.
Oh, good heavens.
Everything is in color, and,
and I can feel the air.
I can, I can see it,
I can see all the molecules.
LSD's molecular structure
was surprisingly similar to a
chemical only recently
serotonin.
This similarity, along with
LSD's dramatic effects
on perception,
helped lead scientists
to the groundbreaking theory
that neurotransmitters
chemical messengers
neurons use to communicate
could be key to shaping
mental experience.
What does it feel like?
It feels good.
Soon, more than a
thousand experiments
suggested psychedelics
helped alleviate addiction,
anxiety, and depression.
But in the 1960s,
these drugs left the lab
and entered
the growing counterculture.
Turn on, tune in, drop out.
This became very threatening
to a conservative
political society,
particularly the part where,
after taking a psychedelic,
people didn't want to go to war.
People didn't want to go to
Vietnam.
And so the establishment
basically concluded
that psychedelics was
at the core of the problem
of the counterculture
rejecting their value system,
and decided that psychedelics
were more dangerous
than they in fact are.
There is nothing smart,
there is nothing grown up
or sophisticated
in taking an LSD trip at all.
They're just being
complete fools.
The government
classified all psychedelics
as Schedule I substances,
with high potential for abuse
and no accepted medical use,
delaying research for decades.
But today, with few new
psychiatric drugs
on the horizon,
studies are once again underway,
and some are taking matters into
their own hands.
So I remember
the first time that I decided
to do an MDMA therapy session,
being someone
who's very straitlaced
and traditional and saying,
"Oh, wow, you're about
to commit a major felony,
"take a substance that's banned,
and put on an eye mask,
"lay on a couch,
and have therapy.
Like, this is a little insane."
MDMA
Also known as
the feel-good drug,
ecstasy, or molly
Is still illegal.
But it's now in the final stages
of FDA approval for use
as a treatment for
post-traumatic stress disorder.
MDMA has a lot of qualities
that reduce your self-judgment
and self-blame.
It allows you to
approach a fear memory
in a way that you can
tolerate it better.
My freshman year
at the University of Wisconsin,
I was on the UW crew team,
and one night I went to a party,
was starting to
meet some of the rowers,
and two of them
made a decision to
sexually assault me that night.
I really didn't know how
to comprehend it.
And I really just
didn't speak about it.
Through a series of events,
I eventually decided
to report it to the police.
I went through
every legal process,
even hired a civil attorney.
And at the
end of that experience,
I didn't get justice.
I am a campus
sexual assault survivor,
and I've been
a longtime activist
But I decided
to go to law school
and really use my story
to make change
for other survivors.
My concern, actually, is, we
only count by victimization,
so you can have a gang rape
that's one rape,
even though
there's ten perpetrators.
So we're counting
all the different crimes,
but we're not counting
all the different perpetrators.
Yes.
I became a hyper-achiever,
and I used that
as my coping mechanism.
I finally did five years
with a traditional therapist.
But I was so ashamed of
the things that I was saying
that I always looked down,
because it's hard
to be honest with yourself.
I think it's important
to finally feel
all of those things
and try to let it go and
not have it stay in me anymore.
Yeah.
The effect
of the actual medication
will last for
seven or eight hours.
Within a day
or a day and a half,
all traces of the medicine
will have left your body.
But the lingering effects of
what you accomplished
will last for a very long time,
and it may be forever.
Because what will have happened
during those seven hours
isn't a pharmacologic effect,
it's pharmacology helping you
achieve an insight.
Laura and I will talk about
what she wants to accomplish,
what her intention is.
Then Laura will make a decision
if she would like
to take the medicine.
It's a small dose of MDMA,
the idea being that once
she's able to make contact
with those parts of herself
and process those experiences,
that her perspective may shift
and that there would be
a sort of neurological or
biological change
to kind of to coincide
with that inside of her.
You've already done
everything you need to do
by being here.
So you can just relax
and go where you need to go.
Okay.
Within the hour,
Laura will experience
MDMA's effects.
Her brain will flood
with neurotransmitters,
including serotonin,
dopamine, and oxytocin.
These chemicals can create
feelings
of well-being and trust,
and some speculate
they make the brain
more malleable,
so it's easier to learn new ways
of responding to
traumatic memories.
But how chemical changes
in the brain
actually affect thoughts,
feelings,
and behaviors
isn't well understood.
The Harvard Brain Tissue
Resource Center
distributes specimens
around the world
to scientists working to unlock
the mysteries of mental illness.
It is a really
humbling experience
when we receive a brain
donation.
We just found out that the donor
passed,
we know that person was
experiencing feelings
and thoughts and said goodbye
to their loved ones.
And few hours later,
we are holding the brain.
When I hold a brain of somebody
that had a psychiatric disorder,
or even dissect it, I wouldn't
notice any difference
between that brain and the brain
of somebody
that didn't have
any brain disorders.
Our work is to try to understand
changes in specific parts
of the brain, in specific cells,
that may be responsible
for certain symptoms.
Brain specimens reveal
that disorders like PTSD,
depression, and schizophrenia
share genetic vulnerabilities
and patterns of molecular
changes,
so these diagnoses may not be as
distinct as long believed.
The more we dig,
the more we understand,
that the more we see that there
is
an added layer of complexity.
New imaging techniques
are revealing that brain regions
themselves are also not as
distinct as previously thought.
Instead, it might be the complex
connections between regions,
known as circuits, that are key
to understanding mental illness.
When I started first studying
neuroscience as a student,
I was trained that, you know,
different brain regions do
certain things.
You know,
"X brain region does Y."
And I think the evolution of the
field is that brain circuits
are really the functional unit
of the brain.
Only recently
have we begun to be able to see
another layer
of the anatomy of the brain,
to see these connections.
Doctors hope a better
understanding of brain circuits
will change lives like Matthew's
and make treatment more targeted
than ever before.
Right now, what we have
is a sledgehammer,
and that sledgehammer can look
like electroconvulsive therapy
to shake up the functioning
of, of different circuits,
and then see if it can kind of,
like,
settle back into a better state,
but it's totally random.
If we understood specific
circuits, we could apply current
at the circuit-specific level.
A new type of MRI
helps trade that sledgehammer
for a more refined approach,
showing these communication
pathways in dramatic detail
unattainable just a decade ago.
Today, we're trying to find
the optimal surgical target
for you, Brian.
Can the precise
placement of a brain implant
help Matthew's compulsive
breathing?
The best next step,
I would think,
would be for me to pick
a trajectory.
Mm-hmm.
Our current investigative
strategy is that we're looking
for a confluence of two
critical pathways
passing through a big area
of the brain.
That's like a giant highway
coming from the frontal lobes
down into the central structures
of the brain,
of the basal ganglia, which then
distribute the information
to the rest of the brain.
By electrically stimulating,
we are able to very precisely
intervene,
fundamentally changing
the underlying patterns
of communication.
Sectioning the brain
An early and infamous
attempt to change patterns of
communication was the lobotomy,
which severed the frontal lobe's
connection
with the rest of the brain.
Lobotomies led us to
the insight that frontal lobes
were really, really important
to psychiatric disease.
Today, it's already understood
and known,
and it doesn't seem like
an earth-shattering notion,
but the idea of demonstrating
that was really earthshaking.
It really opened up psychiatry.
If we didn't understand
the frontal lobe's
inherent importance
to mental illness,
we wouldn't be sitting here
today.
So about how long does this
typically take,
like, before I'm on
my feet again?
Well, the very next day,
you'll be on your feet.
You'll be on your feet
that evening.
As long as there's no
complications
One out of three
patients don't respond
to the procedure.
And the risks are significant.
When you say
complication, what is
The scariest risk
is bleeding in the brain
or stroke.
It's a little under one percent
of it
being clinically meaningful.
But it's something that you
have to be mindful of.
With regards to this
target region,
the most common adverse
stimulation effect
is something called mania.
In my years of doing this,
I had one patient
go on a huge credit card
spending spree.
That's part and parcel of
stimulating these, these
emotional circuitries.
Having these abnormal
side effects in some ways
is a good sign.
It means that we're
getting close.
Does that make sense?
Yeah, that, that we're seeing
a response.
Right, we're in the right
circuitry,
now we just got to tune it in.
Mm-hmm.
Matthew will need
three separate surgeries
costing about $100,000.
But insurance coverage
is a struggle.
I know that you're fully aware
of this insurance claim being
denied and yet another time.
And now it's going
all the way up to
the New York State Executive,
appeal.
So I did a written review of
the policy guidelines
for the insurance company.
Mm-hmm. Mm-hmm.
And it looks like
deep brain stimulation is
indicated for other disorders,
not mental disorders.
Right, right.
DBS is approved
by the FDA for treating
some cases of very severe OCD,
but as with many
psychiatric treatments,
insurance companies often
don't provide coverage.
We are having huge problems
getting the insurance cover
the deep brain stimulation
for psychiatric conditions,
even though it's, it's, like,
on the same spectrum
as movement disorders.
The first thing we get back
from the insurance, say,
"No, we can't do it."
There has been this
bright white line
between mental illness
and physical illness.
And I think it
fundamentally speaks
to a, a longstanding stigma
against psychiatric disease.
Bringing in that paperwork,
focusing on that next week,
and really prioritizing our
session for it would be helpful.
Sounds like a plan.
Okay, wonderful.
Psychiatry has made tremendous
scientific advancements,
with new forms of treatment,
like deep brain stimulation.
But these treatments are
very, very expensive.
And so we really have to
think about,
how are we going to make access
equitable for all people?
We don't have
very good healthcare policy,
and it affects
disproportionately
mental healthcare.
Mental Health Parity law
passed in 2008,
but it's not enforced,
meaning that if insurers
don't abide by it,
who's going to know,
unless somebody brings a suit,
a lawsuit?
I think that
really lies at the heart of the
fundamental biggest problem
of mental health treatment
is that there's a stigma
behind it, and there are
many layers of that stigma.
Can you say your name
and date of birth?
Cynthia Piltch
Much of the
controversy and fear
about electroconvulsive therapy
is tied to its history
as a painful and sometimes
punitive treatment.
Big deep breath all the
way in, and all the way out.
Efforts continue
to reform its reputation
and create a more comfortable
and effective procedure.
Most of the work
over the last 20 years
has been how to really minimize
the side effects.
Under general anesthesia,
with a muscle relaxant in place,
using tiny pulses of
electricity,
people don't really convulse.
We have to
put a bite guard in is,
because even though we have
a muscle relaxant on board,
she will bite down.
What we haven't
been able to do with E.C.T.
is produce an effective
treatment without the seizure.
You see the bite.
Applied to only
one side of Cynthia's head,
the electric pulses
are hundreds of times shorter
than the original E.C.T.
Lasting about the length of time
it takes a neuron to fire,
they trigger more efficient
seizures
with fewer side effects.
Now, if we didn't have
a muscle relaxant,
you'd see her really moving.
This is the E.E.G. tracing.
These sharp waves tell us
whether there's
an acute seizure going on.
Some people believe that
part of the way E.C.T. works
is not so much in the
seizure itself,
but in the way the brain
reacts to the seizure and shuts
it down.
It really is a very
quick,
somewhat boring procedure
when it's done right.
Cynthia, everything's all fine.
You did your treatment
and you're in recovery, okay?
I have some memory loss.
But I don't want to miss
an opportunity
to support my well-being.
The fact that I can still
do credible work
makes it harder for people
to draw the conclusion
that E.C.T. strips you
of any cognitive ability.
Not being able to be myself
was much more frightening
than whatever E.C.T. brought.
For Cynthia,
the benefits of E.C.T.
outweigh the risks.
And Laura is also taking risks
to overcome the trauma
of sexual assault.
Right now, it is not legal
for me to be taking MDMA
or doing an MDMA therapy
session.
But the idea of waiting
any longer upon finding
a possible solution to be
fully well and healed
meant that I had to take
the action of taking
an illegal substance
outside of a clinical setting.
Everything in my
head is screaming,
but that was one of those
moments where I was, like,
I never get to be angry.
I never get to be angry!
Each session has its own theme.
I think the best way
to explain it
is your anxiety being a ball,
and you can spin it around
and see it from all angles.
You're, like, going into
your own brain
and almost like doing surgery.
I was so desperate
to be believed.
I thought about killing myself
to be believed.
I just wanted to be believed.
That's so hard to believe.
You did not deserve that.
Now I cry more.
But that's good.
Like, I'm not crushing
all the pain in me.
These are real emotions
that I used to never feel.
So I think the substance
does some work.
But, you know, the actual
ability to shift perspectives
that you learn from that stays.
And the power
of fixing yourself,
I can't even begin to describe
how important that is.
Many experts see
MDMA-assisted therapy
as a new frontier.
In some studies, 80% of patients
show improvement,
and FDA approval may be
around the corner.
But the future of psychedelics
remains uncertain.
Maybe it'll work.
The data are still developing,
but practice and use
is leaping ahead of research.
And with the genie
out of the bottle,
we don't know what's going
to happen.
Good.
Good.
Good.
Just kind of make sure
Okay, that's great.
So I guess they're
gonna put me to sleep now,
and I'll wake up when we do
the, uh
Yeah, the testing, okay?
Looks good.
After nearly a year
and multiple appeals,
with the hospital
advocating on his behalf,
the insurance company approved
Matthew's deep brain
stimulation surgery.
It takes about two hours
to place one electrode.
Good.
Let's have that.
Yup.
What's our blood pressure?
Okay, great, let's get a scan.
How are you feeling?
- Okay.
- Yeah?
I mean, not okay, but
To make sure the
device is in the right place,
Matthew's doctors wake him up.
Yeah, everything
went fine so far.
The lead is in.
And it's positioned very well.
And we're going to run
some tests in a moment.
He's asked to rate
his symptoms
while they test the current.
You can actually use this
to move.
So contact one.
This is just very intuitive.
Now you just click on it.
Anxiety, uh
Not so bad.
Oh, that's good.
In three weeks,
Matthew will have
another electrode implanted
in the other side of his brain,
and then a separate surgery
to put batteries in his chest
- to power the device.
- Contact three.
Compulsive breathing,
I'm not doing it so much.
But I'm still, like,
doing it occasionally.
Great.
Like, percentage-wise, what,
what would you say, like
- A 70.
- 70.
Okay, now I'm doing it.
That's maybe because we
just turned it off.
That's insane.
Wow.
The implant won't be activated
until Matthew has healed
from all his surgeries.
It will be more than a month
before he knows if it works,
but initial signs are promising.
This is much better than
anything I've ever tried.
Does it feel natural
or
It feels not exactly natural,
but it feels very close.
He's feeling amazing.
All right, Matt,
how about that?
So we're just going to do
a little more recording,
and then we're done.
I'm going to put you to sleep,
okay?
All right.
Deep brain
stimulation holds promise
for people like Matthew,
but the challenges in
treating mental illness
are as much
about society as science.
One major hurdle
involves overcoming
psychiatry's controversial past.
Many Americans do not see
the formal psychiatric system
as being for them.
They see psychiatry
as being aligned with
a punitive form of treatment
that does not take into account
family,
does not take into account
faith,
and does not take into account
community.
For centuries,
psychiatry has
used labels to marginalize
and subjected those considered
mentally ill to experimentation
and treatment,
often without consent.
Today, in the United States,
more than a million people
living with mental illness
are incarcerated or homeless.
And for many,
access to treatment
and insurance is limited.
Some are trying to combat
this checkered legacy and
make access to mental healthcare
more equitable.
The newest biological treatments
are not the only
new frontiers in psychiatry.
What I'm trying to do
is to try to provide care
where people naturally see it
in culturally relevant settings.
With your son,
what, what is the relationship
like right now?
Like, you know, how does he,
how does he respond to you?
Um
He's open, he's open to hear,
okay, how you feel about it,
kind of what are we gonna
do about it now, kind of
Barbershops,
especially for Black men,
have provided kind of informal
mental health supports
for centuries.
- Guy, what up?
- Hey, man.
- Man.
- How you doing, brother?
Wow, man, good seeing you,
baby.
We're working to train
these type of informal helpers
with the latest evidence
and techniques to be able
to identify someone
who may be experiencing
a mental health crisis,
how to support them
in the moment,
and then how to get them
connected to health insurance,
or how to get them connected
to a mental health professional.
I had a guy, you know,
during the pandemic.
You know what I'm saying?
He was going through a lot.
A lot of his people
was falling off, and
- Yeah.
- You know,
this guy,
I've been cutting for years,
and I would never think
that he would be
sitting in my chair crying.
I gave him that platform
to be able to do so.
That really shows
the trust that he has in you
- Absolutely.
- And, and his willingness
and connection to you,
that he felt safe.
When we talk about psychiatry,
I think we traditionally have
expected people to come to us,
and we, when people don't
come to our settings,
we interpret that as resistance.
I think that the new way
for psychiatry to move forward
is to figure out how
communities have dealt with
issues around trauma and
depression, substance use,
and build upon and incorporate
some of those traditions
into the interventions
that we develop
and that we implement.
God, we use our
own pain and our own experience
to bring a word
of comfort and healing
and relief to someone else.
Within the
African American community,
one of the things
that often we know of
is the normalization of trauma.
"This is what
it's supposed to be,
given the, the history of, of
our people."
So, what happens
in many of our communities,
that embodied trauma, right,
that has many tentacles,
never gets addressed.
There's a big stigma
in our communities
around mental health issues,
well, scratch it
we've been traumatized.
I actually met Pastor Mike.
One of his church members
came up to me and said,
"You know, my pastor talks
about mental health
from the pulpit."
I was just so excited,
because I had never heard of
a pastor
talk about mental health.
One of the things
I want to hear about
is, how have we done with regard
to cutting down the wait list?
I know we had a,
a pretty large wait list.
We had a waiting list
of 76 people.
Hankerson and Walrond built
a mental health support network
that includes
a crisis hotline and
free clinic.
You can't say,
"Oh, it's"
We don't trust God.
No, it's a faith-based
institution that created it.
You can't say,
"Oh, it's too expensive."
No, it's for free.
Winter has crept in.
Have we seen an increase
in people reaching out?
Yes.
My dream,
or one of my visions,
in terms of
transforming mental health,
is really creating connection
points and support.
We have to form partnerships,
you know, with these
trusted community settings
so people can learn,
so that trust can be created,
so that it can be
equitably accessed,
you know, in, in society.
Just a week ago,
Matthew had his third and final
deep brain stimulation surgery.
What I remind myself
is that I am my best advocate.
I found this clinic
through my own research,
through my own initiative.
I earned my way to this surgery
by fighting for myself.
So, you know,
I have that fighting spirit
that is not going to go away
no matter what the outcome is.
Today, his doctor will test
whether the
electrical implants work.
Some people might say
it's, it's a little creepy
that we're going to actually
manipulate someone's brain.
And I would say they're right,
if it's, like, a healthy person
with a healthy brain,
but these are,
like, very ill patients.
So I know today,
this appointment's
not going to be, you know,
a magic pill,
but I'm hoping that,
you know, we
Maybe, maybe it will, maybe it
won't.
This is actually your brain.
You can see the tracks that
your leads are implanted to.
The electrodes
implanted in Matthew's brain
have several contact points.
Dr. Figee will adjust
the amount of electricity
- flowing through each of them.
- Is that,
- is that still
- A little tender,
- but yeah.
- But first,
he has to link the batteries
implanted in Matthew's chest
with a handheld controller.
You may not feel
an immediate response
- Yeah, I feel it.
- Yeah? Tell me if
it's uncomfortable.
I mean, it's okay.
I feel it kind of, like,
in my heart, like, uh
- Like, I don't know.
- Oh, yeah.
- Like a little
- Yeah.
I'm, like, laughing now, um
Does the laughing, like,
go away or
Yeah, yeah, yeah,
the first activation
of the system
is usually a little
hypomania-causing,
especially this contact.
But we're going to
move to another contact soon.
Like, I feel like I want to dance.
I feel like I want to
run on the street, like
- Oh, yeah?
- Yeah.
I feel very energetic than,
more than normal.
But, but naturally,
or like you're on drugs?
Like, a little
like I'm on drugs,
but, like, it's not bad.
If you feel great,
you might be better able
- to control your OCD, as well.
- Yeah.
But it's not what
we're strictly aiming for.
3A.
As they try
different contact points
along the electrode,
Matthew rates
each of his symptoms.
This
is gonna be left 3C,
right 3B.
I'm not even
compulsively breathing.
It's almost gone, yeah.
Definitely less, so, like
- Wow.
- Okay.
But that was a good setting.
The compulsion
is virtually gone.
Like, I'm not
compulsively breathing,
- and
- Great.
- Yeah.
- Not too up,
but definitely way more down.
- Better.
- In terms of your symptoms.
Yeah, wow.
It seems that,
like, the contact
is the best one,
- which is the third one
- Yeah. Mm-hmm.
Because it doesn't
give you, this, this up,
- this sort of mania.
- Yeah.
This is, like, a whole new look
on life, this is crazy.
Mm-hmm.
All right, so, here's the phone.
Yes, turn it on.
His doctors will control
the programming of the device,
but he can make
slight adjustments to
the amount of current
through an app on his phone.
See? You can go up and down.
And again,
- you can also turn it off.
- Okay.
It went perfectly as planned,
and it was actually
a copy of the responses
that we also saw
in the operation room.
Hopefully, he'll feel more
normal, more like himself.
Right now, I'm at setting 4.5.
Now I'm at 4.6.
I felt a little pulse there.
It says I've been stimulated
for 192 days.
The OCD
is just a shell of what it was.
It's in the shadows.
The only time I've actually seen
a drastic increase in
OCD symptoms
was when one of the electrodes
was actually off by mistake.
It made me realize, you know,
how dependent I am on this
machine,
how dependent I am on
this device.
After centuries of searching,
are scientists
finally close to solving
some of the mysteries of
mental illness?
If we were able to
think of the brain
more as a tangled mess of wires
that we need to
carefully disentangle,
I think it is totally,
you know, within
the realm of possibility
in the future that
there will be treatments
cures, even for mental health
disorders that are specific,
that would have a
completely different strategy
than our current mental health
treatments do.
Before my surgery,
I used to have trouble
going outside,
and I felt that it was
almost futile.
Not going to feel better.
I was just sort of
a prisoner of this illness.
So I'm here now.
I can appreciate these things
I didn't,
I didn't appreciate before.
I can listen to the birds.
I can really be myself here.
When I think about
what a mental health revolution
will look like,
it will take time.
There's no shortcut.
We've made a bit of progress,
but it's a deeply disturbing
part of the human condition
and one we've wrestled with
for millennia.
We cannot arrogantly assume
that we have one single answer.
Come on, buddy.
This is a complex
problem in a whole person,
not a segment of a person
that's a brain
or a mind or a gene
or an environment.
Mental illness
will likely endure
as long as humanity itself.
But each new breakthrough
brings greater understanding.
Will this help reduce stigma and
lead to a healthier world?
When the
health of people improves,
the community's health improves.
So when we
take care of everyone,
then everyone
in society benefits.
To order "Mysteries
of Mental Illness" on DVD,
visit ShopPBS
or call 1-800-PLAY-PBS.
This series is also available
on Amazon Prime Video.
For more about "Mysteries of
Mental Illness,"
visit pbs.org/
mysteriesofmentalillness.