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BRAINSICK

With a career like his, Dr. Leon Rosenberg never had to worry much about how people perceived him until he battled a near-fatal episode of mental illness five years ago. A physician and genetics professor at Princeton University, Rosenberg previously served as dean of the Yale University School of Medicine and as vice president for scientific affairs of the Bristol-Myers Squibb Co. He is also a member of the National Academy of Sciences, an elite group of scientists that advises the federal government.

He had reached stellar heights in his field. But while he had suffered from a mood disorder for more than 30 years, he had declined treatment for fear that his career could be adversely affected. Now, having overcome that fear and gotten help for his manic depression, Rosenberg believes he has a story to tell that might prod his profession into recognizing that its members were just as likely to suffer a mental illness as anyone else.

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"Fundamentally, you have to be trusted, you have to be credible, you have to be stable," Rosenberg said of the predicament in which physicians and scientists with mental illness find themselves. To help remove the stigma, Rosenberg decided to write this article, which recently appeared in its entirety in Cerebrum, the Dana Forum of Brain Science, and to speak to journalists about his experiences. Rosenberg said he hopes to reach other scientists who may be suffering in silence, as well as families of people who have attempted suicide.--Jonathan Bor

More than four years ago - on May 26, 1998, to be exact - I awakened during another restless, dreadful night. The clock read 4:15 a.m., so I closed my eyes and tried to be calm. It didn't work. I got out of bed. "This must end, today," I thought. "I can't sleep. I can't eat. I can't teach. I can't even read or write."

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After taking a walk around our farm, I brewed coffee for my wife, Diane, and me, and then helped get our 16-year-old daughter, Alexa, off to high school. Diane asked if she should cancel her appointment to go horseback riding. "No," I said. "I'm a little less depressed, and you can't just sit around here day after day and take care of me like I'm a baby. By the time I get a haircut, you'll be back."

As soon as she had driven away, I put all the antidepressants and sleeping pills I had into a small satchel, added a full quart bottle of vodka, and headed my car toward Highway 95. I didn't know where I was going, but it certainly was not to the barber.

As I crossed the bridge into Pennsylvania, I vaguely remember seeing the sign for Highway 32, and I exited. The sun was shimmering on the Delaware River, which only made keeping my eyes on the road more difficult. I saw a sign for New Hope (or was it No Hope?) and drove into town. I wandered up one street and down another until I saw a sign for the Wedgewood Inn. I had never been there before, but I was too agitated to look further.

The proprietress looked askance at the luggage I carried but showed me to a small room anyway. "This will be fine," I think I said and closed the door. I sat down on the double bed with its chenille spread and put the pills and the vodka on the bedside table.

Slowly, almost ritually, I took one or two pills at a time, washed down with a generous swig of vodka. By the time all the pills and more than half the vodka were gone, I started to feel less wired - even quiet. As I lay down and sank toward what I believed would be death, I found myself thinking of a relative who had committed suicide this way some years earlier. Perhaps I connected with him because my jumbled brain thought he, and only he, might comprehend what I was doing.

I woke up 12 hours later with a headache, dizziness, nausea, and hiccups.

I stumbled out to my car in the darkness, and called my wife from the cell phone.

I remember being so relieved to hear her voice. "We've been looking all over for you," she said, "where are you?" I told her what I had done, where I was, and that I wanted to come home. "Stay right where you are," she said.

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Once home, I proclaimed to Diane and Alexa that I loved them very much, that they needed to do a better job of looking after each other, and that each of us must figure out how to take better care of ourselves. They laughed at the incongruity of this advice. "That's it!" they said in unison, and whisked me to the emergency room of the Princeton Medical Center.

I was taken to the psychiatric service, called Princeton House, and admitted to the highest security wing. I exchanged my clothes and toilet kit for a robe and flimsy flip-flops. The shame I felt on surrendering my belt, shoelaces, and razor is still palpable.

After breakfast I had an awkward encounter with my primary care internist, Dr. Andrew Costin, who had been one of my students at the Yale University School of Medicine. As he was examining me in his usual thorough and thoughtful way, he blurted out, "No one will believe that you, of all people, would try to take your own life." Then he asked if I understood that my family had made frantic efforts to find me after I disappeared, and that he had as well. I apologized. He shook my hand and left, looking as bewildered as I felt.

Next came a visit from a psychiatrist I had already been seeing, Dr. Philippe Khouri, who, it seemed to me, always spoke softly and unemotionally lest he disturb me. He was accompanied by a third-year student from Robert Wood Johnson Medical School.

Dr. Khouri asked me to tell the student what had brought me to the hospital and how I was feeling at that moment. For someone who had spent much of his career teaching medical students at the bedside of sick people - young and old - being both patient and teacher under these circumstances was more than I could bear, and I wept.

I now understand that I was brainsick ("diseased of the brain or mind") when I tried to kill myself. I view my suicide attempt as the end result of mental illness in the same way I view a heart attack as the end result of coronary artery disease. Both are potentially lethal, both have known risk factors, both are major public health problems, both are treatable and preventable, and both generate fear and grief. But the shame associated with them differs greatly. Heart attack victims are consoled ("Isn't that a pity?"); suicide victims are cursed ("How could he?")

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I have the typical risk profile for a suicide victim, if one can use such a banal expression for so terrible an action. By "typical," I mean that I'm white, male, over age 65, and I suffer from a mood disorder. Yet as I write this memoir, I can barely believe that, not very long ago, I was so filled with psychic pain that I temporarily "crossed over" from sanity to insanity, and nearly took my life in the process.

Life-changing treatment

After giving me time to regain whatever was substituting for composure at that moment, Dr. Khouri said that the depression that had nearly taken my life must be treated at once. "Prozac hasn't worked," he said, "and there isn't time to start other antidepressant medications."

"What do you recommend?" I asked. "Electroconvulsive treatment," he replied. "It acts quickly and there is about an 85 percent chance that it will lift your depression in less than one month."

However groggy I still was, I registered surprise. Dr. Khouri knew what I was thinking. "ECT isn't anything like it used to be. I have spent the last fifteen years learning how to do it correctly," he said. He went on to tell me that he was treating more than 50 patients with ECT each year, that treatments were given under general anesthesia, that use of muscle relaxants eliminated muscle contraction everywhere but in one foot, that the seizure would be monitored by EEG and would last between 30 and 60 seconds, and that treatment would be on only one side of the brain.

I shuffled back to the pay phone, waited my turn, and asked Diane to come soon. We sat in the cold, cavernous, patients' lounge, equipped with a Ping-Pong table and numerous groupings of upholstered chairs, couches, and tables. I expressed my fear that ECT would incapacitate me permanently, yet both of us allowed that my situation was perilous. Diane reminded me that she had recently read an article about ECT that corroborated Dr. Khouri's description. So it didn't take us long to decide to go along with it.

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Friday morning finally came, and with it my first ECT. A motley group of us, all dressed in our loose-fitting pajamas and robes, was driven to the Princeton Medical Center in a van. I felt like a character in a prison movie. After being ushered into a waiting room with lockers for our clothes, we waited our turn, then entered a large ambulatory surgical suite with eight gurneys, each surrounded by assorted electronic paraphernalia and stainless steel poles.

Electrodes were attached to my head, an EKG to my chest, a blood pressure cuff to my arm, and a blood-oxygen-measuring device to my finger. The anesthesiologist injected Brevital, a very short-acting barbiturate, into a vein, and I promptly lost consciousness. Five minutes later, I woke up to find that the treatment was over, and was told I could sit up whenever I felt ready. Shortly thereafter, I walked back to the waiting room and sat there until all of us were ready to be transported back to Princeton House. I asked Diane to check my recent and not-so-recent memory with particular questions - all of which I answered correctly, to our shared relief.

The weekend passed slowly. We lobbied Dr. Khouri to discharge me. I remember him shaking his head and saying, "Please allow me to treat you like I would anyone else." After the second ECT treatment on Monday morning, which went as well as the first, he agreed to let me go home provided I continue ECT three times weekly for up to twelve treatments.

From then on, my improvement was dramatic. After the fourth ECT, I was noticeably less depressed. My appetite returned, as did my ability to sleep. After eight treatments, my mood was fully restored. I experienced no confusion, memory loss, headache, or any other symptom sometimes attributed to ECT.

ECT was the first treatment that was lifesaving for me. The second was lithium. Based on my history of recurrent depressions and on a compelling family history (an older brother with confirmed manic-depression responsive to lithium, several of my children, a niece, and a nephew with clinical depression, paternal aunts and cousins with mental illness of undefined type), Dr. Khouri made a presumptive diagnosis of manic-depression (also known as bipolar disorder) and put me on a low dose of lithium, the drug of choice for this condition. For the past four and a half years I have taken lithium carbonate daily and have not experienced a single instance of depression - the first time in more than 30 years that I have been free of this curse for that length of time.

Time to speak out

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There are some things I have come to know and need to tell. The condition I have, manic-depression, is a remarkably common illness, probably affecting nearly five million Americans, yet most people with manic-depression go undiagnosed and untreated, and 20 percent of the latter group commits suicide. It makes no sense to allow stigma, whose underlying premise is that people with mental illness are weak, to cow affected people into being unwilling to be diagnosed. It is time that I and other physicians say so.

Manic-depression is among the leading causes of morbidity and mortality in our country and the world, with huge economic and human costs, and it is time that I and my colleagues in the world of health policy say so.

Manic-depression runs in families, but we remain woefully ignorant about the genes that underlie it or the relative importance of them compared to environmental factors. It is time that I and my colleagues in genetics say so.

Manic-depression responds well to treatment with lithium and anticonvulsants, but SSRIs [a class of antidepressants] must be used with caution, and it is time that psychiatrists say so.

Manic-depression is compatible with a fulfilling career in medicine and science (as well as other occupations), and it is time that I and my many affected colleagues say so.

Finally, manic-depression and other mental illnesses - regardless of their biological basis and their chemical nature - are not like disorders of the heart or lung or kidney, because the brain is unlike any other organ. The human brain is the organ that validates our being at the top of the hierarchy of species. It enables us to create, to contemplate, and to communicate. It helps us make sense out of life. When any other organ gets sick, it is the brain, and its Janus-like other half, the mind, that manifests our fear, concern, dread, or relief. But when we become brainsick, the brain's ability to be a mind is diminished, and we become mindsick as well.

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Attempting suicide is a "brainquake," in that it signifies that this remarkably complicated organ, with its 10 billion neurons, has failed in a profound way. Although I feel intense remorse for my suicide attempt, I feel no guilt because I know I was temporarily mad. But that doesn't absolve me from culpability for the anguish my dark morning and its long antecedents heaped on those closest to me. Nor does insanity absolve me from the awful responsibility of being a suicide survivor, a responsibility I must face for the rest of my life - my natural life. And it is time - past time - that I say so.

This is reprinted with permission of Dana Press.


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