Live from the APA: Final Thoughts

John McManamy Health Guide
  • It’s morning of the last day of the APA annual meeting in San Diego. I have been here all six days of the conference. Today, the Convention Center is pretty well deserted. Most of the more than 20,000 attendees have packed their bags and are headed for home. The exhibits in the exhibit hall are being dismantled and carted away.


    This is the graveyard shift of the convention. Nothing in particular in the program booklet is jumping out at me and hitting me in the face. I’m pretty well APA’d out, and will probably spend the rest of my day checking out the pandas in the zoo or something until my ride “back up the hill” to San Diego’s mountainous back country shows up.

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    Some parting thoughts:


    Believe it or not, I attended only one session on bipolar. The session was well worth it for a singular “knock me over with a feather” moment. That was when Holly Swartz MD of the University of Pittsburgh polled her audience after giving a talk on interpersonal therapy, a form of talking therapy. She provided a case example of a young women not responding well to her meds and worried about her father and her graduate school status. Fifty-two percent of the audience responded that they would go with one of three meds options. Only forty-eight percent said they would suggest adding psychotherapy to the meds.


    Are psychiatrists really that dumb?


    What I was really interested in at the APA was the brain science underlying our illness. This meant attending sessions that had seemingly nothing to do with bipolar, such as sleep disorders, schizophrenia, the unconscious mind, the DSM classification system, creativity, and, of course, pure brain science.


    Think of bipolar occupying a small spot in this vast universe of the mind. To understand Planet Bipolar, we need to appreciate the entire mind universe it occupies. My academic credentials are a C in high school biology, but our illness is way too important to concede the field to the MDs and PhDs. If we want to intelligently take part in any conversation that influences our fates, we need to bootstrap ourselves up and learn what these guys are learning.


    That’s why I attend these conferences and read the same stuff our docs do. My job is to listen and learn and to attempt to explain this to you in an accessible fashion, free of jargon but not dumbed down. Hopefully, we all benefit.


    Which leads me to my next observation: From the sessions at the convention, it is clear that psychiatrists are finally getting the message that second-generation antipsychotics are not the wonder pills that their trusted drug reps have beenmaking them out to be. The news has nothing to do with the recent bad press antipsychotics have been getting. In fact, that’s yesterday’s news. Rather, the news is that for years psychiatrists have displayed clear lack of judgment in either not keeping abreast of numerous studies, in not reading the labels on the drugs they prescribe, in not heeding treatment guidelines issued by their own profession, or in not listening to the concerns of their patients. I’ve been reporting on these issues for years. Finally, the profession is getting the message.


    Mind you, antipsychotics have been life-savers for many patients, including kids, but they need to be prescribed wisely.


    Here’s where the brain science connection comes in. As we learn to get away from diagnostic labels and start figuring out what is really going on in our brains, we can work with our docs on more effective meds and talking therapy and lifestyle strategies. We don’t need to be brain scientists, only astute observers of our own mental processes and the conditions around us and how we react. Maybe that means an antipsychotic in the mix, maybe it doesn’t. But at least, based on our knowledge, we are more in control of our own destiny.

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    Part of the fun of these conferences is bumping into leading psychiatrists and psychologists, many who are featured in my recent book, “Living Well with Depression and Bipolar Disorder” (HarperCollins). These included Kay Jamison PhD of Johns Hopkins (who needs no introduction), Trisha Suppes MD, PhD of the University of Texas, one of the lead authors of the TMAP/TIMA algorithms, Gary Sachs MD of Harvard, who headed up the STEP-BD bipolar treatment studies, Raymond DePaulo MD who chairs the department of psychiatry at Johns Hopkins, Holly Swartz MD (who loved hearing about my “knock me over with a feather” moment), Joseph Biederman MD of Harvard, who treats early-onset bipolar (and who is as incensed as I am over the irresponsible journalism appearing in the NY Times and other sources), Michael Thase MD of the University of Pennslyvania (very prominent in our understanding of meds and psychotherapies), Robert Post MD of the NIMH (from whom I first heard back in 2001 that we are depressed way more than we are manic), and Sarah Lisanby MD of Columbia, who is applying ECT in an innovative new fashion called MST.


    All but one of these individuals I have met before, most of them several times. Dr Lisanby was the exception. I spotted her name tag, and piped up. “Hi, I attended your session at the APA in New York. You spoke on MST.”


    At this stage, she was either flattered by this groupie of hers, or alarmed by this stalker who somehow got through security. Then the clincher: “You’re in my book.”


    It turns out that Dr Lisanby was extremely gracious. Just about all the docs I talk to are, and are very happy to spend time with me. I may be critical of the psychiatric profession at times, but these people are part of an enlightened group intent on raising the awareness of their professional colleagues. They have dedicated their lives to improving ours. I will be seeing a lot of these people again in Pittsburgh in two weeks, where I will have the chance to publicly express my appreciation for their efforts. More on this in two weeks …


    Finally, my most inspirational moment of the APA: This was listening to John Nash address a special convocation. John Nash is a Nobel Laureate with schizophrenia, which is not as unusual as it may appear when you consider that Isaac Newton had a psychotic break when he was age 40, and that both Albert Einstein and James Watson were eccentrics who had kids with schizophrenia. You may recognize the name from “A Beautiful Mind.” His actual talk was about as fun to listen to as your high school science teacher reading the technical manual to the latest gadget you can't get to work, but that didn’t matter. It was time to turn off the frontal lobes and simply experience the presence in the room. It was an emotional experience bordering on spiritual.

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    Now you know why I love my job.


    This is John McManamy, “live” from the APA.     

Published On: May 24, 2007