Introduction: WHY I HATE THE TERM MENTAL ILLNESS AND YOU SHOULD TOO

In times of profound change, the learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists.

ERIC HOFFER

Stuck at a traffic light midday at the corner of Hollywood and Vine in Hollywood, California, on my way to record a podcast with storyteller and social media phenom Jay Shetty, I saw a thirtysomething man, about 5′10″, with dirty blond hair, ripped clothes, and blood on his face, talking to himself while gesturing wildly in the air. He seemed oblivious to everyone around him, and those walking on the street paid him no mind. After all, this was Hollywood and Vine. Most of my colleagues would have diagnosed him with schizophrenia or unstable bipolar disorder and wondered why he wasn’t taking his medication to help the voices and visions stay away. When I saw him, I wondered when he’d had his last brain injury, if he had been exposed to mold or environmental toxins, if he suffered with severe gut-health issues, or whether he had an infectious disease like Lyme or toxoplasmosis ravaging his brain.

We are on the cusp of a new revolution that will change mental health care forever. The End of Mental Illness discards an outdated, stigmatizing paradigm that taints people with disparaging labels, preventing them from getting the help they need, and replaces it with a modern brain-based, whole-person program rooted in neuroscience and hope. No one is shamed for cancer, diabetes, or heart disease, even though they have significant lifestyle contributions. Likewise, no one should be shamed for depression, panic disorders, bipolar disorder, addictions, schizophrenia, and other brain health issues.

Over the last 30 years, my colleagues and I have built the world’s largest database of brain scans related to behavior. We have performed more than 160,000 brain SPECT (single photon emission computed tomography) scans, which measure blood flow and activity patterns, and over 10,000 QEEGs (quantitative electroencephalograms), which measure electrical activity, on patients from 9 months old to 105 years from 121 countries. Our brain imaging work has completely disrupted how we help our patients get well, and this information can help you, even if no one ever looks at your brain. The human brain is an organ just like your heart and all your other organs, and you can only be as mentally healthy as your brain is functionally healthy.

It has become crystal clear to us that, as psychiatrists, we are not dealing with mental health issues, but we are dealing with brain health issues; and this one idea has changed everything we do to help our patients.

We are not dealing with mental health issues, but we are dealing with brain health issues; and this one idea has changed everything.

I have come to hate the terms mental illness and psychiatric disorders, and you should too. They place emphasis in the wrong domain (the mind or the psyche), when our imaging work teaches us that we must first focus on the brain. “Mental illness” and “psychiatric disorders” conjure up stigmatizing images of lunacy in people who are mad, disturbed, unbalanced, or unstable, even though these adjectives apply to an extremely small percentage of people who struggle with brain health/mental health issues.

Being diagnosed with a mental illness or a psychiatric disorder insidiously taints or stains everyone who struggles with perceived issues of the mind, making them less likely to ever want to seek help for fear they’ll be diminished in the eyes of others. Just look at what happened to 1972 vice-presidential nominee Thomas Eagleton. The up-and-coming senator from Missouri, who had been the Show-Me State’s youngest-ever attorney general, a devout Catholic, and a fiery opponent to the Vietnam War, was tapped to be presidential candidate George McGovern’s running mate and was considered a perfect choice.[3] But when it was discovered that he had been treated for depression, he was asked to step down from McGovern’s political ticket only 18 days after his nomination. Ever since this dark national memory, mental health issues have been considered lethal in political circles.

Yet, according to biographer Joshua Wolf Shenk, Abraham Lincoln “fought clinical depression all his life, and if he were alive today, his condition would be treated as a ‘character issue’ —that is, as a political liability. His condition was indeed a character issue: It gave him the tools to save the nation.”[4] Shenk argues that because of depression, Lincoln knew how to suffer and how to rise above his bad feelings in difficult times. Of note, Lincoln had a serious head injury at age ten, when he was kicked in the head by a horse and left unconscious.[5] You will see that head injuries are a common and often overlooked cause of emotional and behavioral problems.

[Lincoln’s depression] was indeed a character issue: It gave him the tools to save the nation.

By labeling these issues as mental health or psychiatric instead of brain health, people suffer in silence because of the shame they feel. Consider the rash of celebrity suicides and deaths by overdose of people who were too embarrassed or ashamed to ask for help (from Ernest Hemingway, Judy Garland, and Junior Seau to Robin Williams, Mindy McCready, Philip Seymour Hoffman, Anthony Bourdain, and Kate Spade). On the outside, they seemed as if they had everything; on the inside, they were suffering.

If we do not erase —or at least lower —the stigma for these brain health issues, many more people will unnecessarily suffer and die without getting the help they need. We must do better because:

• About every 14 minutes, someone dies by suicide in the United States. Suicide is the 10th leading cause of death overall and the second leading cause of death for those 10 to 34 years of age.[6] Since 1999, suicide has increased 33 percent, decreasing overall life expectancy, while during the same period of time cancer has decreased 27 percent.[7] The last time America experienced a decrease in life expectancy was in the early 20th century, when the Spanish influenza and World War I killed nearly one million people. I’ve been surrounded by suicide, with an aunt who killed herself, as did my adopted son’s biological father, and my son-in-law’s father. The pain of suicide is unlike any other loss because people see it as a choice, rather than as a consequence of an illness.
• Every eight minutes, someone dies of a drug overdose,[8] and the recent opiate crisis in America is only getting worse year after year. In 2017, there were more than 70,000 drug overdoses, with 67 percent of them from opiates (an increase of 45 percent from 2016).[9]
• In 2017, teens and young adults in the United States were more prone to depression, distress, and suicide compared with millennials when they were the same age.[10]
• Thirty-six percent of girls will experience clinical depression during their teenage years, compared to 13 percent of teenage boys.[11] Both numbers are unacceptable.
• Twenty-three percent of women between the ages of 40 and 59 are taking antidepressant medication.[12]
• According to a large epidemiological study, 50 percent of the US population will struggle with a mental health issue at some point in their lives.[13] Anxiety disorders (28 percent), depression (21 percent), impulse control disorders (25 percent), and substance use disorders (15 percent) are the most common. Half of all cases start by age 14, and 75 percent start by age 24.
• According to the World Health Organization, 25 percent of all health-related disability is due to mental health and substance use conditions —eight times more than disability caused by heart disease and 40 times more than cancer.[14]

Shame holds people back from getting the help they need. No one is shamed for cancer, diabetes, or heart disease; likewise, no one should be shamed for depression, panic disorders, bipolar disorder, and other brain health issues.

Even though I have loved being a psychiatrist for the past 40 years, I am not a fan of my professional label because psychiatrists are often dismissed as unscientific and scorned by other medical professionals and the general public. In 1980, when I told my father, a highly intelligent and successful entrepreneur, that I wanted to be a psychiatrist, he asked me, “Why don’t you want to be a ‘real’ doctor? Why do you want to be a nut doctor and hang out with nuts all day long?” At the time, his words upset me, but 40 years later, I have a deeper understanding of why he was concerned. In a similar vein, I’ve heard countless patients say, “I’m not going to see a psychiatrist because I’m not crazy.” Stigma reigns. I prefer the term clinical neuroscientist to psychiatrist.

REIMAGINING MENTAL HEALTH AS BRAIN HEALTH CHANGES EVERYTHING

Early in my career, I learned that very few people want to see a psychiatrist. No one wants to be labeled as defective or abnormal, but once people learn about the importance of their brain, everyone wants a better one. What if mental health was brain health? That is what the brain imaging work we are doing at Amen Clinics teaches us daily. Think of it this way. Your brain can have problems just as your heart can have problems. Most people who see cardiologists, however, have never had a heart attack. They are there because they have risk factors —a family history of heart disease, high blood pressure, or too much abdominal fat —and they want to prevent a heart attack. To end mental illness, we must develop a similar way of thinking.

Reframing the discussion from mental health to brain health changes everything. People begin to see their problems as medical, not moral. It decreases shame and guilt and increases forgiveness and compassion from their families. Reframing the discussion to brain health is also more accurate and elevates hope, increases the desire to get help, and increases compliance to make the necessary lifestyle changes. Once people understand that the brain controls everything they do and everything they are, they want a better brain so they can have a better life.

Reframing the Discussion from Mental Health to Brain Health Changes Everything

• People see their problems as medical, not moral.
• It decreases stigma, shame, and guilt.
• It increases compassion and forgiveness from families.
• It is a more accurate description of the biology involved.
• It elevates hope.
• It increases compliance with treatment plans.

The End of Mental Illness will give you a completely new way to think about and treat brain health/mental health issues, such as anxiety, depression, bipolar disorders, attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD), addictions, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), schizophrenia, and even personality disorders. It is based on a very simple premise: Get your brain right, and your mind will follow. In study after study, improving the physical functioning of the brain improves the mind.[15]

YOUR BRAIN’S HISTORY IS NOT YOUR DESTINY

The reason I dedicated this book to my two nieces, Alizé (15) and Amelie (10), is that they were born into a family plagued by mental illness —multiple suicides, major depression, schizophrenia, drug abuse, manic depressive behavior, OCD, anxiety and panic disorders, ADD/ADHD, body dysmorphia, and criminal behavior. Their genetic vulnerability for mental illness was incredibly high from before birth. In addition, they were born into chaos, with parents who struggled with addictions, depression, and behavioral issues. In 2016, Child Protective Services, who deemed they were living in a dangerous situation, took them from their parents. The two girls still vividly remember the panic and horror of police taking them from their mother.

At the time, my wife, Tana, was estranged from her half-sister, Tamara, the girls’ mother, but when we found out that the children were taken into foster care, we knew we must act. We wrapped brain health/mental health services around Tamara (at the time, the father refused to get help), and she was able to gain control over her addiction, depression, ADHD, and past head trauma (19 car accidents). Thanks to this progress, she was reunited with her children on Mother’s Day 2017. Since that time, using the principles in this book, Tamara, Alizé, and Amelie have thrived. Like all people who experience this type of chaos, they have had ups and downs, but Tamara is gainfully employed at a job she loves, and the girls are both A students, happy, social, and purposeful. At the time of this writing, Alizé is an honor society student and participates in cross country and track and field. In the last year, she has been awarded Language Arts, Life Science, and Automation and Robotics Student of the Year.

Tana, Tamara, and I are committed to ending the cycle of mental illness in the girls as well as in their future children and grandchildren. This book is our blueprint. It is your blueprint too. The end of mental illness starts with you and the people close to you.

Alizé (right) and Amelie

ALIZÉ (RIGHT) AND AMELIE

THIS BOOK IS YOUR BLUEPRINT

Part 1 will briefly introduce you to the history of psychiatry and mental health treatment. To illustrate this, I will reveal some of the surprising and downright shocking ways one of my patients, Jarrett, would have been treated throughout the ages. I’ll help you reframe mental illness. We’ll discard an outdated diagnostic paradigm based solely on symptom clusters and replace it with a brain-centered paradigm based on symptoms plus neuroimaging, genetics, and a personalized medicine approach to brain/body health. Then I’ll share the 12 major lessons we’ve learned from our brain imaging work that completely changed the way we think about and help our patients. You will be introduced to the Amen Clinics Four Circles BRIGHT MINDS Program to end mental illness, which reveals the simple yet very powerful concept that, in order to have a healthy mind, you must first have a healthy brain. To do that, you must optimize the four circles of a whole life (biological, psychological, social, and spiritual), as well as prevent or treat the 11 major risk factors that damage the brain and steal your mind.

In part 2, you will learn how to create or eliminate mental illnesses. If you know how they’re created, you will have the prescriptions to avoid and treat them. Here you’ll discover the enormous impact that modern society has had on the exploding brain health/mental health crisis in America. This section will also explore the 11 BRIGHT MINDS risk factors that steal your mind and show you how to avoid them. I wrote about these risk factors extensively in my book Memory Rescue but only as they relate to memory; these same factors greatly influence other brain health/mental health problems. BRIGHT MINDS stands for:

Blood Flow

Retirement/Aging

Inflammation

Genetics

Head Trauma

Toxins

Mind Storms (abnormal brain electrical activity)

Immunity/Infections

Neurohormone Issues

Diabesity

Sleep

As you will see, once you reduce your risk factors, your brain —and mind —will be healthier.

In part 3, I’ll share many practical strategies on how to boost your brain and optimize your mind, including how to think about psychiatric medicines versus nutritional supplements (nutraceuticals), the important health numbers to check every year, and the critical importance of your food. In addition, the final chapter summarizes the strategies on how to create and end mental illness.

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Get your brain right, and your mind will follow. It’s time to get the help you need by discarding an outdated, stigmatizing, unscientific paradigm.

 

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Here’s an example of why we need to discard the current outdated paradigm in favor of our new model.

HOW CHASE ELIMINATED HIS “MENTAL ILLNESS” BY HEALING HIS BRAIN

Chase was a smart, successful young man fresh out of college with a great job. But inside, he was suffering. Chase struggled with severe anxiety, uncontrollable mood swings, negative thought patterns, crippling panic attacks, a bad temper, and disrupted sleep. He had difficulty with work relationships and making friends. He couldn’t talk to people and always seemed to be in a bad mood. He also lacked a clear sense of any purpose.

As a teenager, he saw a psychiatrist, who after asking him to fill out a questionnaire, diagnosed Chase with bipolar disorder (a severe mood disorder in which people cycle between depression and mania) as well as ADHD and intermittent explosive disorder (IED). Chase also had a family history of depression and addictions.

Over the years, he jumped from one medication to the next, trying to find something that worked. The side effects only made things worse, and he gained more than 80 pounds. This young man, who already had social anxiety, now had even more reasons to isolate himself. Chase’s brain and body finally gave up; he had a nervous breakdown and was unable to work.

Chase’s stepmother, Terry, suggested he come to our clinic in New York City for an evaluation. Terry’s daughter had struggled with learning and anxiety attacks but had a dramatic turnaround after coming to our clinic. That inspired Terry to visit one of our clinics, which helped her improve her own troubled brain to become a better businesswoman. Subsequently, Terry sent many other members of her family to our clinics for help.

As we do with all our patients, we did a comprehensive evaluation of Chase. As part of our diagnostic process, we took a detailed history, performed neuropsychological tests, ran a lab workup (Chase had low levels of vitamin D and testosterone), and scanned his brain to assess blood flow and activity patterns in the brain. SPECT looks at how the brain works. It is different than CAT scans and MRIs, which are anatomy studies that look at the structure of the brain. SPECT looks at brain function and, in my opinion, is much more helpful for people with complex brain health/mental health problems, like ADD/ADHD and bipolar disorder. You will learn much more about our work with SPECT in chapters 2 and 3.

Chase’s SPECT scan (see images on the following pages comparing his scan to a healthy scan) showed significantly low overall blood flow to his brain, especially to his prefrontal cortex (a brain region associated with focus, forethought, judgment, planning, empathy, and impulse control) and his temporal lobes (a brain region associated with mood stability, learning, memory, and temper control). His scan was consistent with past head trauma and toxicity, which caused us to ask Chase more pointed questions to try to understand why his brain looked so troubled.

It turned out that his family owned a NASCAR speedway, and Chase had been racing cars since he was a child, spending a lot of time around and breathing in toxic gasoline fumes. He’d had a number of significant concussions, including one from racing. Many people are misdiagnosed with bipolar disorder (mental illness) after they have had a significant concussion (brain illness) that affects their prefrontal cortex and temporal lobes.

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Many people are misdiagnosed with bipolar disorder after they have had a significant concussion. The right diagnosis is critical to effective treatment.

 

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Healthy SPECT

HEALTHY SPECT

Full, even, symmetrical activity

Chase’s SPECT

CHASE’S SPECT

Low activity (areas that look like indentations), especially in prefrontal cortex and temporal lobes

Chase Plows into a Wall

CHASE PLOWS INTO A WALL

After seeing his scans and understanding the story of Chase’s life, it was clear he did not have bipolar disorder, ADHD, and IED but, rather, the long-term effects of concussions and toxic exposure to the gasoline fumes, giving him these symptom clusters. We stopped his medications, gave him brain supportive supplements, and went to work rehabilitating his brain using the Amen Clinics Four Circles BRIGHT MINDS Program, which will be laid out in detail in upcoming chapters. As part of the program, we completely changed Chase’s diet, encouraging him to only eat foods that served his brain health rather than ones that hurt it. Plus, he started exercising daily. Chase did everything we asked him.

Chase’s Before SPECT

CHASE’S BEFORE SPECT

Low activity, especially in prefrontal cortex and temporal lobes

AFTER SPECT

Overall improvement

Before

After

In just a few months, his confidence soared. Several months later, his brain showed significant improvement. (His skin also cleared up, and he had lost 80 pounds —other signs that his brain was healthier.) Now he has an even better job where he says he has great working relationships, lots of friends outside the office, loves trying new things, and is in a committed relationship.

After learning about his brain, Chase still loves watching car racing but says he’ll personally never race again. And not just because of the concussions but also because of the toxins he was inhaling: gas, oil, burned rubber, and all the other chemicals he does not want inside his body.

Chase desperately needed a radical new approach; both his physical and mental health were going the wrong way.

Chase had been given three major psychiatric diagnoses —bipolar disorder, ADHD, and IED —from his psychiatrist, who used checklists and groups of related symptoms, known as symptom clusters, from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), and his treatment was doing him more harm than good. Yes, on the surface, it is much easier to try different medications, hoping for a quick fix, and not have to bother with changing your life. But the medications we use in psychiatry are often insidious, meaning once you start them, they are very hard to stop. They change your brain to need them in order for you to feel normal. In the long run, it is generally easier to do a bit of work to change your habits, so you need fewer medications or, in some cases, none at all.

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On the surface, it’s easier to try different medications, hoping for a quick fix, and not have to bother with lifestyle changes. But psychiatric medications are often insidious, meaning once you start them they are very hard to stop. They change your brain to need them in order for you to feel normal.

 

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The way we evaluated and helped Chase is very different from the typical way most people are diagnosed and treated for “mental illnesses.” In 2020, if you suspect you have a mental health issue, you are likely to visit a psychiatrist or primary care physician (who prescribe 85 percent of psychiatric medications), who will ask you to describe your symptoms. In most cases, your doctor will listen, do an examination, then look for symptom clusters. Based on this, they will give you a diagnosis and treatment plan, usually involving one or more psychiatric medications.

For example, if you are anxious, you usually get an “anxiety disorder” diagnosis and end up with a prescription for an anti-anxiety medication, which has been found in some studies to be associated with an increased incidence of dementia.[16] If you have attention problems, you may end up with a diagnosis of ADHD and a prescription for stimulant medication, such as Ritalin or Adderall. These medications can help many people, but it’s important to be aware that they can also make some people worse.

Or you may say, “I’m depressed.” Your doctor will then label you with a diagnosis that has the same name as your symptoms —depression, in this example —without taking any biological information into consideration. Treatment is typically an antidepressant medication.

According to psychiatrist Thomas Insel, the former director of the National Institutes of Mental Health (NIMH), “For the antidepressants . . . the rate of response continues to be slow and low. In the largest effectiveness study to date, with more than 4,000 patients with major depressive disorder in primary care and community settings, only 31 percent were in remission after 14 weeks of optimal treatment. . . . In most double-blind trials of antidepressants, the placebo response rate hovers around 30 percent . . . The unfortunate reality is that current medications help too few people to get better and very few people to get well.”[17] This is consistent with what Insel’s predecessor, Steve Hyman, former director of the NIMH, wrote in 2018, that in the last half century we have failed to progress significantly in medications to treat psychiatric illnesses.[18]

A typical example of this outdated diagnostic method is for people who have temper problems, like Chase, and who explode intermittently. They often get diagnosed with IED, which is an ironic acronym. These people are often prescribed anger management classes or any number of medications.

From our experience with tens of thousands of patients at Amen Clinics and after 40 years in the field, I’m convinced that making diagnoses solely based on DSM symptom clusters, such as anxiety, depression, temper outbursts, or a short attention span, is inadequate and disrespectful to patients. Symptoms don’t tell us anything about the underlying biology of the problems our patients have. All other medical professionals look directly at the organs they treat, but psychiatrists are taught to assume what the underlying biological mechanisms are for illnesses —such as depression, ADD/ADHD, bipolar disorder, and addiction —without ever looking at the brain, even though our patients are every bit as sick as those with heart disease, diabetes, or cancer.

Making diagnoses solely based on DSM symptom clusters, such as anxiety, depression, temper outbursts, or a short attention span, is inadequate.

An explosive 2019 study in Psychiatry Research confirms what I’ve been saying for decades: Making psychiatric diagnoses based solely on symptom clusters is scientifically meaningless and disingenuous. The study, led by University of Liverpool researchers, focused on a meticulous analysis of five chapters in DSM-5: anxiety disorders, depressive disorders, trauma-related disorders, bipolar disorder, and schizophrenia. Their main findings highlight many of the shortcomings of the current diagnostic paradigm:[19]

• There is a major overlap of symptoms among diagnoses.
• Many diagnoses overlook the role of psychological trauma and head trauma.
• The current approach rarely takes the individual into account.

This study’s deep dive into the numbers shows just how murky and inconsistent the diagnostic model is. For example, “there are almost 24,000 possible symptom combinations for panic disorder in DSM-5, compared with just one possible combination for social phobia.” Equally concerning is their finding that “two people could receive the same diagnosis without sharing any common symptoms.” And the sheer number of combinations of symptoms makes the ability to arrive at an accurate diagnosis nearly impossible. Take this stunning fact, for instance: “In the DSM-5 there are 270 million combinations of symptoms that would meet the criteria for both PTSD and major depressive disorder, and when five other commonly made diagnoses are seen alongside these two, this figure rises to one quintillion symptom combinations —more than the number of stars in the Milky Way.” The researchers conclude that following a different approach may be more effective than remaining committed to what they called a “disingenuous categorical system.”[20]

Rest assured, it doesn’t have to be this way. Reframing the way we think about “mental illnesses” by looking at them as brain health issues is more accurate. It is this discovery that completely changed the way we approach diagnosing and treating our patients at Amen Clinics. It is also the underlying reason why Amen Clinics has one of the highest published success rates for complex patients, who have failed an average of 3.3 providers and five medications.[21] In fact, 84 percent of the complex, treatment-resistant patients we treat at Amen Clinics report feeling better after six months.

This book will share some of those stories and provide the steps to end mental illness now, not just in the lives of Alizé and Amelie, but also in your own life and in the lives of your children and grandchildren.

1. 1. Eliminate the term mental illness and replace it with the term brain health/mental health issues.
2. 2. Discard an outdated diagnostic paradigm based solely on symptom clusters and replace it with a brain-centered paradigm based on symptoms plus neuroimaging, genetics, and a personalized medicine approach to brain/body health (chapters 1–3).
3. 3. Assess and treat whole people in four circles —biological, psychological, social, and spiritual (chapter 4).
4. 4. Prevent or treat the 11 major BRIGHT MINDS risk factors that damage the brain and steal the mind (chapters 5–15).
5. 5. First, do no harm. Know the science comparing “mind meds” versus nutraceuticals. Nutraceuticals have more scientific support than most people know and are often an evidence-based option (chapter 16).
6. 6. Know your important health numbers and re-check them on a yearly basis to help prevent brain health/mental health issues before they start (chapter 17).
7. 7. Eat foods that enhance brain health rather than those that accelerate brain/mind illnesses (chapter 18).
8. 8. Provide brain health/mental health education in schools, businesses, churches, and anywhere people congregate (chapter 19).

[3] NPR Staff, “The Thomas Eagleton Affair Haunts Candidates Today,” NPR, August 4, 2012, www.npr.org/2012/08/04/157670201/the-thomas-eagleton-affair-haunts-candidates-today.

[4] Joshua Wolf Shenk, “Lincoln’s Great Depression,” Atlantic, October 2005, www.theatlantic.com/magazine/archive/2005/10/lincolns-great-depression/304247/.

[5] Edward J. Kempf, “Abraham Lincoln’s Organic and Emotional Neurosis,” A.M.A. Archives of Neurology and Psychiatry 67, no. 4 (April 1952): 419–33; accessed at www.lincolnportrait.com/emotional_neurosis.html.

Timothy P. Townsend, “Life of Lincoln, 1809–1865,” National Park Service, US Department of the Interior, https://www.nps.gov/liho/learn/historyculture/life.htm.

[6] National Institute of Mental Health, “Suicide,” updated April 2019, www.nimh.nih.gov/health/statistics/suicide.shtml.

[7] Holly Hedegaard, Sally C. Curtin, and Margaret Warner, “Suicide Mortality in the United States, 1999–2017,” National Center for Health Statistics Data Brief No. 330, November 2018, www.cdc.gov/nchs/products/databriefs/db330.htm.

[8] Jürgen Unützer, “What If We Treated Mental Health Like Cancer?” NEJM Catalyst event, “Expanding the Bounds of Care Delivery: Integrating Mental, Social, and Physical Health,” January 25, 2018, Vanderbilt University Medical Center, catalyst.nejm.org/videos/treat-mental-health-like-cancer/.

[9] Lawrence Scholl et al., “Drug and Opioid-Involved Overdose Deaths —United States, 2013–2017,” Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention, January 4, 2019, www.cdc.gov/mmwr/volumes/67/wr/mm675152e1.htm?s_cid=mm675152e1_w.

[10] J. M. Twenge et al., “Age, Period, and Cohort Trends in Mood Disorder Indicators and Suicide-Related Outcomes in a Nationally Representative Dataset, 2005–2017,” Journal of Abnormal Psychology 128, no. 3 (April 2019): 185–99.

[11] J. Breslau J et al., “Sex Differences in Recent First-Onset Depression in an Epidemiological Sample of Adolescents,” Translational Psychiatry 7 (2017): 1139.

[12] Janice Wood, “Antidepressant Use Up 400 Percent in US,” Psych Central, January 8, 2018, psychcentral.com/news/2011/10/25/antidepressant-use-up-400-percent-in-us/30677.html.

[13] R. C. Kessler, M. Angermeyer, J. C. Anthony et al. “Lifetime Prevalence and Age-of-Onset Distributions of Mental Disorders in the World Health Organization’s World Mental Health Survey Initiative,” World Psychiatry 6 no. 3 (October 2007):168–76, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2174588/.

“Learn about Mental Health,” Centers for Disease Control and Prevention, January 26, 2018, https://www.cdc.gov/mentalhealth/learn/.

[14] Jürgen Unützer, “What If We Treated Mental Health Like Cancer?” NEJM Catalyst, January 25, 2018, https://catalyst.nejm.org/videos/treat-mental-health-like-cancer/.

K. Kroenke and J. Unützer, “Closing the False Divide: Sustainable Approaches to Integrating Mental Health Services into Primary Care,” Journal of General Internal Medicine 32, no. 4 (2017): 404–10.

[15] Julia Velten et al., “Lifestyle Choices and Mental Health: A Representative Population Survey,” BMC Psychology 2, no. 58 (2014): 58.

[16] Mitsutaka Takada, Mai Fujimoto, Kouichi Hosomi, “Association between Benzodiazepine Use and Dementia: Data Mining of Different Medical Databases,” International Journal of Medical Sciences 13, no. 11 (October 18, 2016): 825–34.

[17] Thomas R. Insel, “Disruptive Insights in Psychiatry: Transforming a Clinical Discipline,” Journal of Clinical Investigation 119, no. 4 (April 1, 2009): 700–705.

I. Kirsch, “Antidepressants and the Placebo Response,” Epidemiologia e Psichiatria Sociale 18, no. 4 (October–December 2009): 318–22.

[18] Steven E. Hyman, “The Daunting Polygenicity of Mental Illness: Making a New Map,” Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences 373, no. 1742 (March 19, 2018): 20170031.

[19] Kate Allsopp et al., “Heterogeneity in Psychiatric Diagnostic Classification,” Psychiatry Research 279 (September 2019): 15–22.

[20] Ibid.

[21] Daniel G. Amen et al., “Multi-Site, Six Month Outcome Study of Complex Psychiatric Patients Evaluated with Addition of Brain SPECT Imaging,” Advances in Mind-Body Medicine 27, no. 2 (January 1996): 6–16.