Mental Health Blog Party: Interview with Ellen Frank

May is Mental Health Awareness Month and today is the Mental Health Month Blog Party, an idea conceived by the American Psychological Association to spread the importance of good mental health and reduce its stigma.

To participate, we interviewed Ellen Frank, Ph.D., a distinguished professor of psychiatry and psychology at the University of Pittsburgh School of Medicine and director of the Depression and Manic Depression Prevention program at Western Psychiatric Institute and Clinic. Dr. Frank is also a member of the Dana Alliance for Brain Initiatives.

What are you working on now?

Currently, my biggest project is with David Kupfer, my husband. We’re looking at whether integrating medical care with psychiatric care for individuals who have bipolar disorder can reduce the medical morbidity and mortality associated with the disorder and improve psychiatric outcomes. We think there is probably a pretty strong link between medical problems, particularly those associated with the metabolic syndrome and bipolar disorder. Certainly individuals with bipolar disorder are at markedly increased risks for almost all of the components of the metabolic syndrome—obesity, high blood pressure, high cholesterol, diabetes—and seem to begin to have those problems at a much earlier age. We’re thinking if we can create an environment where the right hand knows what the left hand is doing then we might be able to improve both medical and psychiatric outcomes.

How is that study coming along?

We’re about halfway through the recruitment process. It would be premature to say anything definitive at this point. The plan is to follow people for 18 months to two years. We already have 30 patients who have been followed for that long. What I can say is that study participants seem to be enthusiastic about taking better care of themselves. There are two reasons it is hard for them to take care of themselves physically. First, I think they always see their psychiatric illness as their primary illness, and if they only have the energy to take care of one thing, it’s going to be that. Secondly, as soon as they get to a general medical specialist who sees they are on one of these marker medications (such as lithium), they often find they are treated badly. The few who have the energy and the will to get themselves medical care often find the stigma associated with the mental illness leads them to being treated in not the kindest way. By integrating medical care with psychiatric care, they wouldn’t have to face either of those problems. They can get their medical care at the same time they are getting their psychiatric care and don’t have to worry about the stigma associated with their mental illness.

Can you gauge the public perception regarding stigma?

I’m an empiricist, a researcher. I was looking for some data on this topic recently and couldn’t find anything that specifically compared, let’s say, bipolar disorder with unipolar depression as far as stigma. I wish there were more specific research on the nature of stigma but to be honest I haven’t really seen much in the way of new studies. In general, I found that the public doesn’t necessarily distinguish among different psychotic illnesses. It is the psychotic disorders that are the most stigmatized.

Have you noticed a change in public perception over the last 5-10 years?

There has been a huge change with the stigma associated with unipolar depression. I think that is largely due to the public information provided by the pharmaceutical industry. In the process of advertising the newer antidepressant medications there has been a really remarkable education to the public about depression and a destigmatization of depression. I don’t know if that has transferred to bipolar disorder.

Do you think that could change in the near future?

I can remember as a child when you couldn’t say the word cancer out in public. We’ve certainly been successful in destigmatizing cancer in that way. I think over time, as more knowledge is accumulated, attitudes will change. We are most afraid of what we can’t understand and can’t treat, so as we’ve come to understand cancer better and have developed highly effective treatments for many forms of cancer, I think that’s been an important part of its destigmatization. As we come to understand the major mental disorders and have increasingly effective treatments, I’m hopeful the stigmatization associated with these illnesses will decrease.

What do you see as your role as far as educating and interacting with the public?

I do a fair number of community talks. I’m always enthusiastic about the opportunity to meet with the general community. I recently did a public talk at the University of Louisville. I also recently talked to students at Pittsburgh—undergraduate psychologists. It was a couple of hundred 18-19 year olds majoring in psychology, but they are certainly not fully-formed psychologists yet; they are in a sense going to be the general community of the future. It was very exciting to talk to them about new ideas we have about the causes of bipolar disorder.

Thank you for your time. Anything else you’d like to share?

One other thing I have been focusing on of late is the fact that we do have a series of highly effective psychosocial treatments for bipolar disorder. The challenge has been to get these treatments from the ivory tower to the general community where the average person with bipolar disorder is being treated. I’m really pleased that a colleague of mine just got a grant from the National Institute of Mental Health to study how best to implement these treatments in a general community mental health setting. We’re trying to understand what it’s going to take. That is something I think is very, very important.