Full transcript
0:16we Americans like to say we're
0:18pragmatists we stick with the things
0:21that
0:22work that may be true in many parts of
0:24our life but as far as I'm concerned
0:26it's not true right now in our health
0:27care System
0:31approach to mental ill illness as well
0:33as mental um physical illness tends to
0:36be the following we wait for people to
0:38break down and we park ambulances at the
0:40bottom of the
0:42cliff and we have to question that in
0:45this day and
0:47age where does that come from well I
0:50believe it comes from two mistaken
0:52assumptions one is if it's not
0:55broken there's no need to fix
0:58it that's the idea we don't need need to
1:00prevent it but the second one is built
1:04is is where that comes from if it does
1:07break down we'll find a cure we'll fix
1:15it I believe
1:22this and I should tell you in in the
1:25interest of um not being politically
1:27indelicate or inapo appropriate I suffer
1:31from mental illness I had
1:32PTSD I have bouts of
1:37depression and so I know the system
1:40pretty
1:42intimately so it goes something like
1:45this 1996 was a very important year for
1:49people like me it was our Declaration of
1:51Independence a study was published
1:53called the global burden of disease
1:56study that study
2:00was the
2:01first to put mental illness on the top
2:0510 list of conditions that are causing
2:08significant economic and social problems
2:12to All Nations on this
2:14planet was the
2:16first every study done before 1996
2:19focused only on
2:21death and the top 10 list were the
2:25health conditions that cut our lives
2:27short the most the big change was the
2:30following it may not sound like a big
2:32change to you but it is to folks Like Us
2:36in addition to including the number of
2:38years shortened by health conditions the
2:41global burden of disease study included
2:44the amount of disability that was
2:46created by those conditions so if it
2:49didn't cut your life short how much did
2:51it prevent you from living a full
2:53life Depression was in the top five list
2:57along with cancer and heart disease
3:01disease I can't begin to tell you how
3:04much this shocked governments around the
3:05world and it's
3:08still shocking
3:12them so that would that put mental
3:14illness in the in the top five list and
3:16here's what it meant to folks like us
3:18for the first time ever it meant that
3:21our governments need to put money
3:24towards it through their Public Health
3:25Systems to really take it seriously and
3:29if we don't the wh the World Health
3:32Organization predicts by the year
3:342030 depression will be second only to
3:37heart disease and causing significant
3:40problems to many countries on this
3:42planet not just developed Nations
3:44developing nations the places where we
3:47think it's all infectious disease no
3:55depression 2006 was another important
3:57year for me I opened up a journal called
4:00Psychiatry and a person I know dearly
4:03and respect very very much who runs the
4:07National Institute of Mental Health
4:08wrote an article and part of the title
4:11said cure
4:13Therapeutics it was the first time I'd
4:15ever heard anyone who directs the
4:17National Institute of Health say the
4:19following and especially for mental
4:21illness all known treatments talk and
4:25medication for mental illness are
4:28pallative none are even proposed as
4:33cures that is to say all they do is
4:35treat our symptoms now that isn't to say
4:38they're not effective in getting us back
4:40in the game they work they alleviate
4:44symptoms like wanting to end your life
4:47wanting to sleep the entire day eating
4:49too little eating too
4:54much and the problem was
4:58this they are aru that up to 2006 all
5:02research in mental illness sought only
5:06to improve on existing
5:10therapies I won't go into this but
5:12almost all the medical Miracles that we
5:14can think of that today when when it
5:16comes to Med medications for mental
5:18illness were
5:20accidents somebody trying a drug that
5:22was built for something else and say hey
5:25let's try this on somebody who's sad
5:27what does it do and if it uplifts their
5:30mood guess what they spend the
5:32next several decades improving upon that
5:36drug well he said stop that you know
5:39what we need to do shoot for a
5:45cure that sounds like a great thing
5:48doesn't
5:49it it's pretty hard to argue with
5:52that it made me
5:55livid I thought it was promising way too
5:58much
6:00there over 350 mental disorders in the
6:03diagnostic and statistical
6:06manual there's no one cure for any one
6:10mental illness and even if they find a
6:13cure my research suggests they may not
6:15even promote your mental health they may
6:18alleviate mental illness symptoms but
6:21they may only leave you
6:23empty so what was he doing his job is to
6:27bring more money taxpayers money in to
6:29his
6:31Institute to do the same thing again and
6:34again study mental illness look inside
6:38the hood the brain and our genes to find
6:41a
6:42cure that's where that comes from you
6:44know Benjamin Franklin's
6:47definition what we're doing now for
6:48mental illness is what we're doing for
6:50many illnesses in our country let's do
6:52more of the same thing over and over and
6:54now let's expect a different
6:56result well I'm tired of that I we live
7:00in a country that encourages us to give
7:02away our health whether it's the
7:05intentional or not because they promise
7:07US One medical cure after
7:10another and here's the problem if you
7:12give away your health our healthc care
7:15system is going to require that you buy
7:17it
7:18back and not many people can afford that
7:21and certainly not a nation that's going
7:24to be competitive in this Century can be
7:27spending as much as we do
7:30on parking ambulances at the bottom of
7:32the
7:34cliff I'm tired of it and I think
7:37there's an
7:39alternative let's take Health
7:42seriously where do mental health come
7:44from I study happiness I know TED Talks
7:48have have there's a lot of Happiness
7:50talks on Ted this might be the most
7:52depressing happiness
7:56talk but bear with me there's hope
8:01I want to talk about the signs and
8:02symptoms of good mental health one one
8:05group comes from psychological
8:08well-being psychological well-being is
8:12about accepting who you are liking most
8:14parts of your personality having warm
8:17trusting relationships with other human
8:19beings being challenged to become a
8:22better human being
8:25growing having purpose in life have a
8:27direction and meaning to your life
8:31being able to manage your daily
8:33responsibilities and autonomy confident
8:36to think and express your own ideas and
8:38opinions anyone here against any of
8:40those
8:42things I hope
8:44not it's not just psychological we don't
8:48it's we don't get to live our lives
8:50entirely in the pronoun pronoun I and me
8:55we also live as we and
8:57us and there's a thing thing called
8:59social well-being and functioning well
9:02it consists of things like do you accept
9:04and Trust other human beings do you
9:07belong to a community where you derrive
9:09sense Comfort and Joy are you
9:11contributing anything of value to the
9:14world around
9:15you can you make sense of what's going
9:17on in the world around you and why
9:19things are happening the way they are
9:22and are you being challenged to become a
9:24better kind of people a better unit a
9:27better workplace a better City dare I
9:30say a better kind of
9:33American are we being challenged to
9:35become a better kind of
9:38people last but certainly not least
9:40there's a tradition of happiness that
9:42goes back to emotional
9:44well-being do you feel
9:46happy do you feel
9:49satisfied and are you interested in
9:52life where did these come
9:54from well the first tradition is about
9:57functioning well and it goes all the way
9:58back to a fellon Aristotle who
10:00championed a kind of happiness in doing
10:03well in life or doing life well as an
10:06individual and as a citizen the other
10:09tradition goes back to epicurus it's
10:11about feeling good he championed a form
10:13of Happiness called Hedonism it didn't
10:16have excess it wasn't the excessive
10:18connotation back then wasn't the way
10:21what he was talking about he was talking
10:22about Simple
10:23Pleasures now here's how I put happiness
10:26together I call mental health
10:28flourishing because you can't use the
10:30word mental health it's been taken over
10:32and obscured and Confused some people
10:34think well we're talking about mental
10:35illness and other people say we're
10:36talking about the absence of mental
10:37illness no I'm talking about the
10:40presence of those signs and symptoms of
10:43Happiness what does it mean to flourish
10:46every day or almost every day in the
10:48last month you felt one of those three
10:50emotional well-being combined with six
10:54or more of the positive functioning now
10:56if anyone here knows how to diagnose
10:58depression you will see a resemblance
11:01here to diagnose depression you have to
11:03have one of two symptoms of
11:05anhedonia combined with five or more
11:08signs and symptoms of
11:11malfunctioning I built the diagnosis of
11:13positive mental health on the platform
11:16that psychiatrist built for the most
11:18canonical mental disorder depression
11:22turned it on his head parked in their
11:25garage and said you're not going to get
11:26rid of me until you start taking mental
11:28health serious
11:30languishing well that's
11:32emptiness we'll get to that but I want
11:35to move on to talk about something very
11:37important these are
11:40twins and they helped me investigate a
11:44very important hypothesis something that
11:46was near and dear to me it's been around
11:49since 1941 in a book called medicine and
11:51human welfare on page 100 Henry curas
11:55says the following health is more than
11:57the ABS absence of illness it is
12:01something
12:02positive now if your child brought that
12:05home in an essay and on and they said
12:07what is kindness and that was their
12:08essay the task would you give him an a
12:12for saying it's something
12:14positive no we've put up with that
12:18for decades why because we think illness
12:21is more serious than
12:23health well that hypothesis is
12:27testable and here here's what we found
12:30flourishing is just as heritable as
12:32things like
12:36depression and it only partially
12:39overlaps with the genes that we inherit
12:41for things like depression and panic
12:45disorder over half of the genes that we
12:48inherit that give us potential for
12:49flourishing operate independent of the
12:52risks we inherit for things like
12:56depression we're born of two potentials
12:59it's in our
13:02DNA and what it means is the following
13:04just because you inherit a risk for
13:06depression does not mean you you will
13:08not flourish because you could also
13:10inherit a very high genetic potential
13:12for
13:12flourishing and conversely just because
13:14you don't have any genetic risk for
13:16depression doesn't mean you're out of
13:17the woods you may not have inherited a
13:19very high genetic potential for
13:20flourishing the
13:23absence of illness does not mean the
13:26presence of Health it's not just in the
13:28way we think and answer questionnaires
13:30it's in our
13:33DNA so what does that mean well this is
13:36what it looks like this two Continuum
13:38model I put up flourishing because
13:41that's where we say we want to be in
13:43every Public Health document I want to
13:45be in a healthier
13:49country that's where we do want to be
13:52people and here's
13:54why one the absence does not mean the
13:58presence of mental this is the typical
14:00way we look at the world in black and
14:01white this is a study of us adolescence
14:04aged 12 and 18 we could diagnose whether
14:07they fit the criteria for depression 14%
14:09did we would assume in a usual world
14:13that 86% are mentally healthy right
14:17wrong less than four and 10 of our
14:20teenagers are flourishing and free of
14:23something as common as
14:25depression we're not anywhere close to
14:28having having an adolescent population
14:31that's starting out with a tank
14:35full of wonder and
14:39joy second anything less than
14:43flourishing creates problems for society
14:46it's not just depression and mental
14:48illness people so here is a study of
14:51college students huge study we've been
14:53doing and here's what we're
14:55finding risk for suicidal attempts and
15:01plans
15:03increase as a level of good mental
15:05health decrease now these are college
15:07students who would screen free of mental
15:09disorders in the past two weeks things
15:11like depression are they out of the
15:13woods
15:16no most college students are free of
15:19mental illness
15:2175% are they out of the woods
15:24no and if they have mental illness does
15:28level of mental health matter does it
15:31ever yes 6% of us college students are
15:34flourishing with a mental disorder and
15:37they have easily half the rate of
15:39suicide as those with moderate mental
15:41health but also mental disorder and look
15:43at if kids are languishing no
15:47well-being and mentally
15:49ill so here's what this looks like we
15:53tend now to say that mental illness
15:54depression is a serious problem right it
15:57is but so is anything less than
16:00flourishing just because you're free of
16:02mental disorder does not
16:06mean you're not missing days of
16:10work you're not showing up to the doctor
16:13asking what's
16:15wrong healthc care utilization goes up
16:17for those who are not flourishing M days
16:19of work go up for those who are not
16:21flourishing and it gets worse the
16:24absence of mental illness is often as
16:26bad as the presence of mental illness a
16:28study looked at these six
16:31activities whether you were performing
16:33more of these and the hypothesis was if
16:36you did more of these in a typical day
16:38you would end the day feeling happier
16:40and more satisfied with your life that's
16:42true for five out of six exercise didn't
16:45do it sorry to say that for the prior
16:49speaker but here is what happens look at
16:53everyone starts with very low enjoyment
16:56of life if they do nothing
16:59here's what happens if you're depressed
17:00if you do more the end of the day you
17:03end up with more good feelings and
17:05enjoyment but look at not flourishing
17:09it's almost
17:10indistinguishable from those who are
17:13depressed now these are people not
17:14flourishing H are not
17:17depressed but look what happens if
17:19you're
17:23flourishing the absence of mental health
17:27is often as bad as the Pres of mental
17:30illness most of the American adult
17:32population is not
17:36flourishing we have a lot of big
17:38problems on our agenda it's not just
17:41mental illness so here's where I want to
17:47end the medical system will say Corey
17:51well we can measure all kinds of mental
17:54illnesses physical and mental it's
17:55really specific that stuff you're
17:57talking about it's something positive
17:59well guess what we can measure mental
18:01health the same way we measure mental
18:03illness then they will come back and say
18:05well
18:06Corey isn't health and illness belong to
18:08a single
18:10Continuum I say
18:12no even if you could cure menalon
18:15tomorrow doesn't mean we are anywhere
18:17closer to flourishing well then they
18:19will say oh Corey here bless your
18:23heart mental illness is a burden and I
18:26will say yes guess what but so is the
18:29absence of good mental health and then
18:31they're going to get harped and say well
18:33wait a minute there's too much mental
18:36illness in this world and I'll say
18:37you're right there's also not enough
18:40flourishing they're both problems and
18:44last but certainly not least they will
18:45say wait a minute I'll give you money to
18:48do this now I'm not pitching from the
18:50stage I'm simply saying we'll support
18:53your research when we fix all the
18:55problems and guess what we have studies
18:56showing that it's the loss of good
18:59mental health that precipitates the
19:02falling off the
19:04cliff so you tell me what's more serious
19:09people what are we waiting
19:12for more of us to
19:17break I'm not doing it
19:21anymore everything looks like a nail
19:23when all you hold is a
19:26hammer all of us are patients in a heal
19:29in a country like this where the only
19:32tools for promoting Health are
19:35hospitals
19:37clinics diagnostic tests and
19:40doctors I've grown tired of being
19:43considered a patient in waiting another
19:45disease waiting to happen I have dreams
19:47I have hopes I have a
19:49purpose I want to live in a country that
19:51takes flourishing and health as serious
19:55no more serious than it does our
19:57floundering in our illness
19:59now think about that thank you