The following is a conversation between Dr Jeffrey Borenstein, President and CEO of the Brain & Behavior Research Foundation, and Denver Frederick, Host of The Business of Giving on AM 970 The Answer WNYM in New York City.
Denver: An issue that has been ignored far too long – mental health – is becoming increasingly important to more and more Americans. This is a result of what we’ve seen on the news, but also issues in our own lives, those with our family, those with our friends. The Brain & Behavior Research Foundation is the largest non-governmental funder of mental research grants in the world, and it’s a pleasure to have with us tonight their President and CEO, Dr. Jeffrey Borenstein.
Good evening, Jeff, and welcome to The Business of Giving!
Jeff: Good evening. Thank you for having me.
Denver: The Brain & Behavior Research Foundation was founded in 1987. Tell us what the mission of the organization is.
Jeff: The mission is to support research in order to better understand how the brain works, better understand what happens when a psychiatric illness occurs, and most importantly, to develop new methods of treatment, methods of prevention and cures for these conditions.
Denver: In terms of those grants, how much have you given out over these 32 years?
Jeff: Over these 32 years, we have provided over $400 million in grants to scientists around the world. We select scientists, and we have a scientific council that consists of the top brain scientists in the world, and they’re the ones who make the selection as to what grants should be supported. The decision is based upon ideas that are innovative, that would not otherwise receive funding from the government. And in this way, the scientist could begin the process of getting the data that they need to go and receive further funding from the government.
Denver: What would the definition of mental illness be?
Jeff: Mental illness, similar to physical illness, is when a particular organ, namely the brain has something go wrong, and it can result in conditions such as depression, anxiety, post-traumatic stress, schizophrenia, bipolar disorder, chemical dependency, all of which are, unfortunately, a lot more common than we realize. As people are aware, 1 in 5 people experience one of those disorders, and basically, everybody knows someone.
Denver: That’s for sure.
Jeff: Everybody has someone important to them that is affected by one of these conditions.
Denver: Those 1 in 5 numbers…are those numbers going up due to the pressures, let’s say, of modern society, or are we just more aware of them?
Jeff: It’s a very good question. I don’t know that we have clear-cut information on whether or not it’s going up, but certainly people are more aware of it, and fortunately, more people are actually seeking help and receiving treatment. Unfortunately, many people don’t seek help and don’t get treatment, but people are more aware of these conditions.
Denver: I know you’ve spoken about the fact that when you have a mental illness/ disorder, in many ways, it’s like being sick. If I had strep throat, I wouldn’t be categorized as having strep throat for the rest of my life. But, as you say, when people get treatment, they can get better and then move on with their lives, but we sometimes as a society don’t treat it quite that way.
Jeff: We really continue to have what’s referred to as “stigma” towards these illnesses, and in many ways, I think stigma is too weak of a term. I think it’s more prejudice; that people are actually prejudiced about these illnesses, and that stands in the way of people getting the help that they may need in order to get better.
…if a parent is concerned about their child — perhaps the child seems increasingly anxious, maybe they’re not functioning at the level that they normally had functioned, maybe their schoolwork has decreased, maybe they’re not as social as they had been — they should seek help. Just as they would if they saw their child was limping or in pain, physical pain, they would seek help.
Denver: Speak about parental guilt, and I speak about this, I guess, from people that I know because parents sometimes – if they have a clinically depressed child, for instance – ask themselves:” Where did we go wrong? What could I have done?” They beat themselves up. That’s not the way to handle that, is it?
Jeff: Absolutely not. And you know what? I think that parents often feel guilt if anything goes awry for their child, including a mental health issue. The reality is that these conditions are very common and are treatable. So, if a parent is concerned about their child — perhaps the child seems increasingly anxious, maybe they’re not functioning at the level that they normally had functioned, maybe their schoolwork has decreased, maybe they’re not as social as they had been — they should seek help. Just as they would if they saw their child was limping or in pain, physical pain, they would seek help. Don’t be shy about looking for help.
Denver: Are there any other signs of mental illness that we should be aware of?
Jeff: There are a number of important signs that people should be aware of. First of all, a change in functioning. So, if somebody really isn’t functioning at the level that they normally would, that’s a cause of concern.
Denver: For a period of time.
Jeff: For a period of time.
If somebody seems particularly anxious, if somebody is very depressed, tearful, has difficulty concentrating, difficulty with sleep… either too much or too little, maybe some difficulty with self-care… not grooming themselves at the normal level. These are all potential signs that people should be aware of.
A very important sign is the issue of suicide. If somebody says something about wanting to end their life, or you’re concerned that someone may be thinking along those lines, don’t be shy about asking. People often have the misperception that if you ask, it’ll give the person the idea and therefore “don’t say anything, don’t ask.” But the reality is – and research has shown this – that asking about if somebody has thoughts of hurting themselves or killing themselves can actually save a life, and certainly doesn’t put the idea into the person’s mind. It could help them now get the help that they need.
Denver: Jeff, do we know the number of people who should be seeking help who actually go and get help?
Jeff: I don’t know that we have a specific statistic on that, but we do know that, for instance, half of the people who have a clinical depression do not receive treatment. So, if you think about that, if we said that sentence about diabetes or pneumonia, it would be the headline in every newspaper. But that half the people who have a clinical depression don’t receive treatment; nobody’s even speaking about it, and it’s because it often gets overlooked.
Denver: Is it just that, or are there an adequate number of mental health professionals to deal with the incidence of people who are being challenged at the moment?
Jeff: You’re bringing up a very good point, which is that we really do not have enough mental health professionals to do that. There is a shortage of psychiatrists and other mental health professionals. That being said, that fact shouldn’t block somebody from getting the help that they need because people can get help if they seek that help. And often, the first step is to speak to your primary care doctor and say “Hey doctor so-and-so. I’ve been feeling depressed, I’ve been feeling anxious,” and get some guidance from him or her.
Denver: What gets me mad is that very often, when you do go to your primary care doctor, they don’t ask questions about this the way they do about all your other physical conditions, and certainly not to the degree that they should. At least that’s my first-hand experience.
Jeff: I agree with you. This is an issue, and a part of what the field is trying to do is to get the primary care doctors to ask more about these things because it should be a routine type of area of questioning, just as you’re checking to see if the person has a cough or a headache or any other physical symptoms.
Denver: Do you smoke? Or whatever it may be.
Jeff: It should be: How’s your sleep? How is your mood? How are things going? So more and more primary care physicians realize this. But if they don’t ask you, you need to volunteer it and tell them so they could help you.
Denver: That’s good advice. Well, to get a better sense of what you do, you fund four kinds of research, and I’m going to ask you to say a word or two about each, starting with basic research.
Jeff: Basic research is crucial, and it relates to how we can better understand how the brain works. So what can we learn about the cells in the brain, the connection between cells in the brain? I’ll give you an example of what we’ve learned over time. When I went to medical school, I was taught that old brains do not grow new cells, and old was after the age of two.
Denver: Yes. I even learned that, and I didn’t go to medical school.
Jeff: Exactly. We now know that’s not true. Older brains do grow new cells, even brains at our age. We won’t say any specific age with that, but older brains do grow new cells—
Denver: The best news I’ve had in a long time.
Jeff: –through a process called neurogenesis, and that’s growing new cells and making new connections between cells. Exercise is an important impetus to that, so a part of brain health and having good mental health is exercise.
Denver: Yes. I mean, you even know that anecdotally.
Denver: With your workout, you just feel more alert, more alive. You think a little clearer as long as you don’t do too much.
Jeff: Too much of anything isn’t good, and it’s above and beyond the endorphins that we think of from the runner’s high. It is really the neurogenesis – the growth of new brain cells that is very healthy.
Denver: Another area you fund is new technology. Speak to that.
Jeff: So new technologies refers to developing new approaches to study the brain or treat psychiatric conditions. I’ll give you an example. This is something that’s now widely used, it’s called transcranial magnetic stimulation (TMS), and that was developed for the use of depression initially by Dr. Mark George at the University of South Carolina. Dr. George received initial funding from Brain & Behavior Research Foundation to develop this. This is the kind of thing you would think, “Wait a second. Magnets to the head is going to treat depression?”
But our Scientific Council was able to see what he had written and developed in terms of the basic science and why that may work, and then he received the initial funding to develop that. This is now being used by hundreds of thousands of people to treat depression. It’s been approved by the FDA for over 10 years for depression and recently has been approved for other indications as well.
Denver: We spoke a moment ago about the signs of mental illness, but probably nothing more important than early detection and intervening at a very early stage, and that’s a third area that you fund.
Jeff: It’s a very important issue. One of the areas that early intervention is crucial relates to schizophrenia. By making a diagnosis right away and getting the person into treatment, that can forestall a full-blown psychotic episode, and it can help the person function at the highest level possible and live a full, healthier life. That’s an example of early intervention.
Another relates to even younger people… that typically would occur in teenage years or early 20s… is anxiety. For many years, we as a field and certainly society has minimized youth anxiety. We now know that it’s important to do treatment. It may be talk therapy, it may be other interventions, but leaving anxiety to just sit there…it can get worse, and it could then expand into depression or other conditions.
I think that we need to do more research on the effects of social media, but certainly being connected 24/7 to social media, seeing what other people do, the issue of bullying. In the olden days if you would be bullied, it would be bad, it would happen in the schoolyard but then you’d go home and you’d be safe… Now, you go home, and maybe it’s even worse on social media. So I think that we need to step back as a society… There’s a lot of pluses to social media, but what are the downsides, and what can we do to help?
Denver: I’m certainly no expert on this, but it does seem like it’s getting worse as a result of social media and seeing how you fit on the continuum with all your friends on Facebook, and what they’re doing, and whether you’re in or out. Or the bullying. There’s a lot going on these days.
Jeff: I think that we need to do more research on the effects of social media, but certainly being connected 24/7 to social media, seeing what other people do, the issue of bullying. In the olden days, if you would be bullied, it would be bad. It would happen in the schoolyard, but then you’d go home, and you’d be safe.
Denver: Close your door.
Jeff: Now, you go home, and maybe it’s even worse on social media. So, I think that we need to step back as a society and see: There’s a lot of pluses to social media, but what are the downsides, and what can we do to help?
Denver: Now, that relentless nature…I just can’t even imagine. Like anything else, you need to rest, and if you’re being bullied, at least you used to be able to rest. There’s no rest now.
Jeff: There’s no rest.
Denver: Then finally the fourth area is Next-Generation Therapies. What do you have going on there?
Jeff: Well, this is extremely important. There was just recently an article in The New York Times about an article that recently came out in the New England Journal by Dr. Helen Mayberg, who’s currently at Mount Sinai, looking at deep brain stimulation to treat depression. This is still something that is in the experimental stage. Deep brain stimulation has been used to treat Parkinson’s disease for many years, and based on basic research, it looked at specific areas of the brain that may be related to depression.
Dr. Mayberg and colleagues have used deep brain stimulation in people who have what’s referred to as “refractory depression”– doesn’t get better from anything else. So, this is an intervention that is a major intervention because it requires surgery in the brain. But the study found that for people who respond to this intervention, the response continues for eight years, and they are continuing to follow people.
So this is something that is on the horizon, is a new approach to people who have very severe depression that doesn’t get better with anything else. It’s not usual that that’s the case, but for those people, this is a very important intervention.
Denver: Very exciting and very promising. Let me ask you about childhood trauma. How common or rare is it, or how long is its impact across a lifespan?
Jeff: The issue of childhood trauma is extremely important. We know that people who have experienced trauma, whether it be physical abuse, sexual abuse, and other types of trauma, are at an increased risk of developing a psychiatric illness right then and there during that timeframe and down the road.
Childhood trauma is very important. It’s important for people, if they’ve experienced that, to share that they’ve experienced that when they go to a doctor so the doctor is aware of it. That being said, there are many people who have had that kind of trauma and are fine, and they don’t need treatment; they don’t have depression, anxiety, post-traumatic stress. There are many people who never had any kind of trauma who do develop those types of illnesses. So it’s an important issue and one that shouldn’t be left under the rug. It should be spoken about.
Denver: The issue I think on the top of everyone’s mind these days is suicide. We see it among young people. It’s becoming more pronounced among professionals. I was surprised to see the number of nurses and veterinarians, certainly here in New York City, and our own police force, I think we’ve had nine officers who have taken their own lives this year, and certainly among veterans, which is about an average of 20 a day. Do we understand why this is happening? What measures can be taken to successfully and better address this issue?
Jeff: It’s such an important issue. It’s such a tragedy that more people die from suicide in our country than from homicide.
Denver: Yes, and car crashes.
Jeff: Yes, it’s a tragedy. A few things can be done. First of all, as we discussed earlier, if you’re concerned about a loved one, don’t be shy. Ask them, offer help, get them help. If somebody has thoughts of suicide, this is an emergency. Just as if they were clutching their chest with chest pain, you would take them to the emergency room, if they are clutching their mind with thoughts of suicide, they need help right away.
Denver: Don’t dismiss it.
Jeff. Don’t dismiss it. Don’t ever dismiss it. The next thing is: if somebody has depression, then it really does need to be treated because somebody with depression is at a greater risk of suicide. If somebody has chemical dependency, it needs to be treated. That increases the risk as well.
There are some very good things on the horizon with regards to it. So, there’s a newly approved medicine called S-ketamine. It’s a form of ketamine. This medicine has been shown to be a rapid-acting antidepressant. Unlike the typical medicines that can take a number of weeks to work, the S-ketamine has been shown to be rapidly acting; it could work in two to four hours. In people who have suicidal thoughts, it also lifts that suicide risk during that period of time. Those medicines while available, there’s still work that needs to be done. They’re not fully ready for primetime. They can be helpful for some people, but the mechanism of action of those medicines may lead us to even better medicines that can work quicker and help decrease this tragic suicide rate.
Denver: Has there been any research done on resilience, where people can train themselves to better face life’s challenges?
Jeff: There has been work done on resilience, and it’s an important issue. So, some of the work that has looked at resilience has spoken about: the importance of a social support system — making use of your family, making use of friends; the importance of religious beliefs — if a person is religious, to make use of that; the importance of purpose in life — that there’s a reason that a person is here, that they’re serving a purpose, whether it be for family, for friends, professionally.
So, there are things that can be helpful, and then along those lines, there are steps that people could take — proper exercise, proper eating, sleep habits. These are all things that people can do to build resilience and therefore be better able to deal with the stresses that we all go through.
Denver: Sometimes, it can really hit particularly young people right between the eyes, especially if they’ve been coddled, if you will, and they get out on their own, and they just aren’t equipped.
Jeff: It’s very challenging for young people. As a psychiatrist, one thing that I’ve noticed over the years is that every age really, really does have its challenges.
Denver: You’re right.
Jeff: It’s hard to be a child going to nursery school, leaving your mother for the first time, it’s hard to do that. It’s hard to be a teenager and all the challenges.
Denver: Or being a mother and having your child go.
Jeff: It’s hard to be the mother letting the child go. Exactly. It’s hard to be in middle age where you may have parents that have some illness and kids that need all of your help.
Denver: And the old sandwich generation, right?
Jeff: Exactly. And then it could be harder to be older where you may have medical problems, etc. There are challenges at every age, so therefore building resilience is useful across the lifespan.
Denver: No question. I was impressed that 100% of every dollar donated for research is invested in your research grants. How are you able to do that?
Jeff: We are very, very fortunate that we have two family foundations who from the get-go saw the importance of being able to support research, and they wanted to put funding in place for the administrative work of the foundation so that every dollar that somebody donates for research goes to the research.
In addition, the Scientific Council that I already mentioned that consists of 184– the top, top brain scientists led by Dr. Herb Pardes, who is extraordinary.
Denver: Yes, a legend is what he is.
Jeff: He is a legend, and having the opportunity to work closely with him is a privilege. Part of when Dr. Pardes put together the Scientific Council, they don’t get paid for the work that they do; they volunteer their time.
In many ways, that demonstrates how Brain & Behavior Research Foundation truly is a collaboration between the scientists who care so much about these issues and the donors who are so generous at all levels. We have some very wealthy donors who are very generous at that level, and we have people of more moderate means who are also very, very generous because they want to see better treatments and ultimately cures for these conditions.
Denver: And as you said earlier, you’re really the risk capital of this field. You can take a chance; you can roll the dice, and if something works… not that you’re not careful in rolling those dice, mind you, but then the federal government and others can pick it up and take it to a completely different stage, and that’s just a wonderful complementary relationship that you have.
Jeff: It really is both for the specific science that we support and also for the scientists. It’s very, very hard for a young scientist to begin a career in research, and part of what we’re able to do — because the bulk of our support goes to younger scientists — is give them that foot in the door so that they could get that early data to then go get federal funding. And so many of those young scientists have over the past 30 years gone on to become senior scientists and mentors to other young scientists.
Denver: I’ve noted that that $400 million you’ve given out in research grants, if you really follow that, it’s into the billions in terms of what it has led to.
Jeff: The statistics are extraordinary in terms of that multiplier effect, and in many ways, we really are very much like a venture capital fund for those new ideas.
Denver: And with any venture capital, if 9 out of 10 of them don’t work, so what? If you hit the big one, you know what I mean? You change everything!
Jeff: It makes a very big difference, and the track record over the years… because of the extraordinary judgment of the Scientific Council… has been wonderful.
Denver: You host an Emmy-nominated show that recently launched its sixth season. It’s called Healthy Minds with Dr. Jeffrey Borenstein. Tell us a little bit about it. Where can people find it?
Jeff: Well, people can find the link to the show on our website bbrfoundation.org. The show is now being broadcast on stations, public television stations around the country, and it’s also available online at pbs.org. And you could get to that location through the Brain & Behavior Research Foundation website.
I developed the show because I felt that we as a field really weren’t reaching people in a way that hit home, and I wanted to have a TV show so that people could watch it in the comfort of their home and learn about psychiatric illnesses, find out about cutting-edge treatment, hear about people who may be recovering from these conditions, and really open up conversations about depression, anxiety, bipolar disorder, chemical dependency — all of these conditions so that people wouldn’t suffer in silence… that they would seek help.
Denver: Doing this show, I can attest to the fact that it actually keeps you cutting-edge because to prepare for these shows, you have to really stay on top of things.
Jeff: I have had the privilege of interviewing top clinicians.
Denver: You’ve had some great guests.
Jeff: …top researchers, and also people recovering from conditions who share their experience; that helps other people then go seek treatment.
I think that the more that we have conversations like this, the better it gets. I think the younger generation is much better. I think younger people are more open to talking about it with each other than people from the older generation. I think we need to push that. I think that when celebrity, a well-known person speaks about their own depression, anxiety, any of the above — that adds to the conversation.
So the more that we can have people talk about it, share their experience, the less that it’s a stigma.
Denver: Let me close with this Jeff. There are some 44 million Americans who experience a mental health issue. How do you believe the national conversation surrounding this issue has to change in the coming years to better address this crisis and, as you said before, to eliminate the stigma?
Jeff: I think that the more that we have conversations like this, the better it gets. I think the younger generation is much better. I think younger people are more open to talking about it with each other than people from the older generation. I think we need to push that. I think that when a celebrity, a well-known person speaks about their own depression, anxiety, any of the above — that adds to the conversation.
So the more that we can have people talk about it, share their experience, the less that it’s a stigma. In many ways, cancer had been this way, and now people are much less shy, much less embarrassed, there’s much less stigma about cancer, and we need to do that for mental illness as well.
Denver: You’re absolutely right. In fact, I can remember when it was called the “Big C” because we didn’t even want to use the word cancer. It was that much in the closet; we’d whisper it.
Jeff: We would whisper that word.
Denver: That’s right. Well, Dr. Jeffrey Borenstein, the President & CEO of the Brain & Behavior Research Foundation, I want to thank you for being here this evening. Tell us what people will find on that website that you just talked about.
Jeff: There’s a lot of information, really cutting-edge information about all of the key psychiatric illnesses. So if you’re concerned about depression, go to the website and see the most cutting-edge information. We do webinars on a monthly basis on different topics. So, the recording of those webinars is available. Our Brain & Behavior Magazine is available online; it comes out quarterly. And as we already discussed, the link to the Healthy Minds TV show is available as well.
Denver: Well, great stuff. Thanks, Jeff. It was a pleasure to have you on the show.
Jeff: Thank you for having me.
Denver: I’ll be back with more of The Business of Giving right after this.
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