One in five adults – approximately 46.6 million people – experience mental illness in a given year. One fifth of those are serious illnesses that interferes or limits major life activities. With proper diagnosis and treatment, patients can escape the darkness and live productive, successful lives.
Brad Means: Doctor Joseph McEnvoy is a psychiatrist and professor with the Medical College of Georgia, appearing for The National Alliance on Mental Health. He’s an expert in his field, to say the very least, especially when it comes to severe cases of mental illness. Doctor McEvoy, thanks for what you do for people and for being with me today.
Dr. Joseph McEnvoy: Thanks for the opportunity.
Brad Means: I’ll ask you the same question I asked the bladder cancer experts, and that’s how do you know when you have mental illness, when there’s a problem versus just the typical stresses and anxieties we feel?
Dr. Joseph McEnvoy: Many mental illnesses, feelings of depression, feelings of anxiety or distressing, you don’t feel right, you go seek out help for that. Some of the more severe ones like schizophrenia, people don’t seek treatment. They do not understand. They do not perceive the experiences they have as though they’re unusual. Their brain is ill. It’s not a normal brain worrying about blood in the urine, or a broken foot, for which they go seek help from a doctor. The experiences they have seem real. For that reason, the treatment of people with particularly schizophrenia, or in the manic phases of bipolar disorder, it’s very difficult, ’cause they think they’re doing fine.
Brad Means: Through their eyes, is it as if they’re living in another dimension? Do they have a whole different reality than others?
Dr. Joseph McEnvoy: They have perceptual experiences, they have beliefs that suddenly appear in their mind, but they hold as firmly as any of ours because they came to them in the same way. These perceptions, these beliefs came to them the same way as beliefs and perceptions come to us.
Brad Means: What’s a primary cause or what are some primary causes of mental illness?
Dr. Joseph McEnvoy: The vast majority of these diseases are genetically, familially passed on. They’re inherited liabilities. On top of which, various events, problems during pregnancy, head injuries, and certainly, psychoactive drugs that people go out and take can tip you over, just the same way eating a high-salt diet can tip you into hypertension or becoming overweight can you tip you into diabetes mellitus. It’s a mixture of your liability, your risk, and these offensive things that happen to the organ during your life.
Brad Means: When it comes to mental illness, even when it comes to the types that are more in your wheelhouse like bipolar, like schizophrenia, can it hit people of all ages or is it just grown-ups?
Dr. Joseph McEnvoy: Well, the most common ages for these to come to us is late teens into early 20s, but these diseases do appear in younger individuals, in kids. The sad thing is that usually signifies genetic loading, genetic risk from both sides, heavy liability, and it ends up being a tougher-to-treat, more difficult illness. It’s very important in any of these illnesses that we get people into treatment as early as possible. Think about high blood pressure. If you’ve got high blood pressure today and I started you on treatment tomorrow, it would be very easy to treat and you wouldn’t have much damage done. If I waited for a year, big trouble. Same thing with these mental illnesses. If you’re concerned that a loved one, a family member, you may have to be the push to get them into treatment, but the earlier you do that, you’re doing them some good. Even if they’re saying oh, it’s all right. There’s nothing wrong with me.
Brad Means: Right.
Dr. Joseph McEnvoy: It’s very tough for the family members, people who love the person with mental illness, but it’s important that you do it.
Brad Means: Can a family doctor pick up on this during your annual visit?
Dr. Joseph McEnvoy: Especially if another family member comes in with them and says we’re worried. This bright, young fellow, or this bright, young woman at school is not going out with her friends. Her grades are falling off. That’s the time the family has to say we love you. We want you to do well, so please come with us to the doctor.
Brad Means: Mental health is so much in the spotlight. Our president mentions it in a wake of a school shooting, perhaps, calling for the need for more mental health awareness and treatment. With that much attention, is there still the stigma attached to it?
Dr. Joseph McEnvoy: Yes. There sadly is. The intensity of stigma that the public assigns to mental illness is related to how severe the manifestations are, how impressive the treatments have to be, does somebody need hospitalization, versus talking with, and the degree of disability associated. So there’s some sense to the assignment of stigma. Stigma need not have a core of meanness, though. If the public understands, I’m worried about this ’cause this is very strange behavior, but can approach it with some beneficence instead of meanness, this would be great, ’cause we could get the person in, get ’em the treatment, and take away the mark, the sign, the attribute that is frightening the public by treating them successfully.
Brad Means: Can you make it go away? Especially in the less severe cases, can you make mental illness go away?
Dr. Joseph McEnvoy: We can. Even as far as bipolar disorder. We can make it that a lot of these people have completely normal lives. Not everyone, ’cause some are really tough, just like some diabetes cases are really tough. With depression, we can do this. With anxiety, we can usually get these to where no life’s easy and perfect, and without trouble, but we can handle them where people lead really good, productive lives, have good relationships, contribute to the wellbeing of society. Schizophrenia’s our toughest one. If we catch people really early, if they have strengths of their own, if they have a family who will assist them in making it to the appointments, taking their meds, many of these folks can work, can go back to school, can have jobs, and don’t end up with persistent psychopathology that gets etched in if people aren’t getting the treatment they need.
Brad Means: Do you see a lot of veterans coming back with severe mental illness or developing it?
Dr. Joseph McEnvoy: Well, the traumatic experiences these people have, the brain-rattling experiences of combat, of injuring others, being injured themselves, such as that, that’s not good. The head injuries can bring out mental illnesses that might not have made their way if their brain hadn’t been assaulted. And there’s drug use, at times, when people go to these foreign countries.
Brad Means: You’re talking about marijuana, something worse?
Dr. Joseph McEnvoy: There’s a clear, straight-line correlation between severity of marijuana use and risk for a psychotic break.
Brad Means: Really?
Dr. Joseph McEnvoy: Yes, yes.
Brad Means: So to the casual pot smoker out there, be careful.
Dr. Joseph McEnvoy: Yes. Beautifully stated.
Brad Means: Yeah, really! I mean, seriously, it’s an eyeopener for a lot of people out there, I’m sure. Treatment scares people, Doctor McEvoy. They don’t wanna be under a doctor’s care forever. Is this a lifelong deal once we come to you?
Dr. Joseph McEnvoy: In most cases, it is. But I stress to people, I wouldn’t take medicine that made me feel awful, and I’m not expecting that from you. You and I need to work together. I will get you on the fewest medicines and the lowest doses that I possibly can. I give all my patients and their family members my cellphone number, ’cause if somebody gets a side effect, I don’t want them to have to wait three weeks to the appointment when I’m gonna see them, I want them to call. I tell them I’m old, they have to remind me who they are, et cetera.
Brad Means: Sure, sure.
Dr. Joseph McEnvoy: But, let’s talk about it now. I can usually handle it in two minutes.
Brad Means: For the more severe cases, for the people with bipolar and for schizophrenia, can behavioral therapy help as well, or just conversations with you?
Dr. Joseph McEnvoy: These more severe cases in particular are best served by a team.
Brad Means: Okay.
Dr. Joseph McEnvoy: I’m the non-empathic, technocrat, the pill guy. I try to manage getting their brain back to functioning normal at a biological level. Then we have wonderful psychologists, social workers, case managers who talk with patients about the experiences they’ve had, the stuff they’ve had to suffer, and folks who help them get back to school, help them get back to work. Because what’s life about? Something to do, and good people to do it with. And I need help to get these folks back to that.
Brad Means: That was gonna be my last question, and it’s just a personal one. How does it make you feel to see someone in their darkest hour, or a family in its darkest hour and then watch them turn a corner?
Dr. Joseph McEnvoy: One of the most heartbreaking things is seeing the parents when a child is sick. When everybody works together and you have a good outcome, it really feels good.
Brad Means: Well, you’re doing incredible work at MCG, you and your team. I know it’s a multi-disciplinary approach and I appreciate you helping me understand mental illness better. I know our viewers do as well.
Dr. Joseph McEnvoy: Thank you so much for having me.
Brad Means: Absolutely. Doctor Joseph McEnvoy at the Medical College of Georgia doing incredible work, as are all of our friends at MCG. When we come back, we’re gonna let you know how you can shape future editions of the show. But know this, there’s a mental health clinic free for uninsured and underinsured folks. It’s the last Thursday of every month. Six ’til eight, walk-ins are welcome. No need to call, no need to blow up Doctor McEvoy’s cell, just show up on St. Sebastian Way and start to open that door and get the help that you or a loved one may need. There’s the website for more information, as well as the phone number. End the stigma of mental illness and take that first step.