Maya Adam:
This episode discusses suicide. If you or someone needs help, please reach out to the National Suicide and Crisis Lifeline by calling or texting 9 8 8. Welcome to Health Compass. I'm your host, Maya Adam, director of Health Media Innovation at Stanford Medicine.
Leanne Williams:
I was remembering the day that it happened and the days after in the magazine story in Stanford Medicine Magazine, and I recalled just that memory of on the day feeling so obviously, so shocked, and just the cold and that kind of frozen feeling at the time when I found him.
Maya Adam:
The stigma surrounding mental illness prevents many people from getting the help they need. Even medical professionals will sometimes avoid admitting that they're struggling for fear of seeming weak or unfit to do their job, and that hesitation can be life-threatening. I'd like to start today's episode by reading an excerpt from the Stanford Medicine Magazine story featuring today's guest, Leanne Williams, who directs the Stanford Center for precision mental health and wellness. The coldness hanging in the air is what Leanne Williams remembers most about that morning. Nearly a decade ago, she was walking through the doorway of her seventh floor San Francisco condo when an abnormal chill immediately assaulted her senses. Something was very wrong. William's worst possible suspicions were confirmed. Moments later, her partner Jack had taken his life at age 49 after a decades long battle with depression. Leanne has the combined authority of both a medical expert and a person who deeply understands the perspectives of the patient. Leanne, I read the very moving story that you've shared with the writers of the Stanford Medicine magazine about your partner's struggle with mental illness, and I wonder if you feel like sharing that with us today.
Leanne Williams:
It took me several years to really think how to talk about it in a way that wasn't about myself, but was about how my personal story could hopefully create a connection point with others going through the struggle and how we could use it to think about motivating new approaches. So thinking about our chat today, Maya, I was remembering the day that it happened and the days after in the magazine story in Stanford Medicine magazine, we talk about my partner by the name Jack, and I recall there just that memory of on the day feeling so obviously, so shocked and just the cold and that kind of frozen feeling at the time when I found him, I was remembering making the calls. This was to his mom and to his friends and to his colleagues. And when I called his mom, she said something to the effect of, she'd been waiting for this call for a long time.
And I remember that because it highlights how long a struggle it was and just how much he'd been able to be so successful despite that struggle. And I can talk a bit more about that. I was remembering the days after and sitting around the table with his colleagues and family and his mom and we're all kind of processing this together. And we realized at that time that we all had in some ways different pieces of the puzzle. His colleagues were remembering, oh yeah, he was an emergency physician. And they're saying, yeah, he was slower than usual. He's normally very quick and really, really caring about patients wanting to spend time with them, but very effective. But they noticed he being slowed down and I noticed that he really was having trouble sleeping more than usual with the shift work. But all of us had these pieces of the puzzle.
And what that has brought to me with my research, which I've been doing for nearly two decades, which very confrontingly is on depression, is really how important it is to understand the root cause and the brain underlying the illness because we can't see everything from the outside. And so since that personal experience, I've interacted in our studies with other individuals going through this, coming to me, coming into our research saying, I'm at the breaking point. I don't think I can go on any longer. At the same time, they're very highly functioning people on the outside, so they're friends and colleagues may not see all the signs. You see it when you look inside the brain.
Maya Adam:
Leanne, there's one quote that I read in Stanford Medicine magazine that brought tears to my eyes when you said rationally he knew his depression was nothing to be ashamed of, but there was also a part of him that believed he should be able to cope. And that really moves me because I think so many people can probably relate to that and the concept of sort of fear of admitting your weakness or your struggle because you're afraid that there'll be a paper trail or that it'll somehow be on your record. And it makes me question when being sick became a crime and something that we should have on our record. I would love to hear your thoughts on that.
Leanne Williams:
Yeah, that really is at the essence of it. Going back to that personal experience, as I said, was emergency room physician and had that rational experience. We talked about it, understood that depression is a disease, nothing to be ashamed of, but thought that he could cope. And the resistance to getting treatment was exactly that. It's going to be on my record. How can I continue functioning as a physician if it's on my record? And I know this is more detail, but it really came out in talking with his colleagues because they all really so looked up to him. He really believed in the healing mission of being a physician. And they said to honor him, we shouldn't say that this was a suicide. So it was like a reflection of that challenge in how to deal with those two realities. And out of the conversations we had, they decided to make it public to help change the stigma and to donate to the research in this honor. So that was a very transformative experience, but as you say, it's really, it shouldn't be this way that it's effectively a crime.
I believe it's due to the lack of understanding of what it is and that it creates a fear and it creates a sense of, we can't talk about this is something that is about a character weakness or moral failing someone not trying hard enough because we don't actually understand what it is. So in the absence of an understanding, we have all these misattributions and we can't talk about an illness like depression or other mental illnesses as we would other illnesses when we're in the workplace or talking to our families, we have to hide it. And that makes it even harder to function when we're trying to hide it and we can't ask for help.
Maya Adam:
Yeah, I mean, Leanne, I so admire your strength. I'm so sorry you had to go through that. But as you said, it took you many years to really be able to talk about what happened. And I wonder what that time must have been like for you and also what changed when you started to, as you described, make a decision to start kind of pulling light from the darkness, I think you said, which is so beautiful.
Leanne Williams:
At the time, it was like I don't feel like I have the right words to link the personal experience to the motivation to how do we do something about it without it being about me, which in some ways was probably me overthinking it. It may have been a little about will this take away from the credibility of the research, which is a stigma in itself that I was experiencing. And then it got to the point where I felt so hypocritical because I am presenting so regularly on this is unacceptable. We have this suicide rate, depression is too often lethal, and I'm not sharing my own story. And so I'm feeding into that separation. And that just became not possible. So I chose the first time to talk about, it was actually in a Stanford presentation where I could share with the wider colleague, wider community of medicine colleagues, and then at a plenary I was invited to give in my field. And that was a way to share it and give a fuller context about the personal story and the research. At the same time. It felt in some ways liberating. And also I think the most rewarding thing from it was the number of colleagues who came up to me afterwards and expressed their appreciation and then shared their own story.
Maya Adam:
Leanne, I just want to go back for one second to something you said today where you said that Jack's mother said to you she'd been waiting for that call. And I wonder what parents or family members of people, when they see something and they know something's not right, but they don't have the words or the place to go to start that discussion, what advice would you give?
Leanne Williams:
I think it's first of all, just verbalizing it. And that I found all round for experience of mental illness. As soon as we speak about it, it's not as scary actually. I mean, it's still scary, but we can certainly speak it out loud and at least kind of diffuse it and maybe we can then do something about it.
Maya Adam:
What should we be looking for? I mean, I'm the mother of three adolescents. I am constantly sort of on the lookout as we all are trying to make sure we don't miss anything. What should we be looking for?
Leanne Williams:
So it's really a key question. And the tough side of this is there's not a single indicator. I mean, it's why it often happens with such a shock, even though you might know someone struggling, you might not even know they're struggling because of the fact that it's changes that are going on inside the brain that may not be expressing themselves on the outside. However, there are some indicators, for example, and it's not determinative by any means, but changes in sleep, like having those sleep disruptions, someone being slowed down, you may notice them disconnecting. And I say all this in relation to if someone is really in distress, likely that is more observable on the outside, and so you would know to talk to them.
Maya Adam:
So just keeping our eyes out for things that are different in the people we love. For people we
Leanne Williams:
Love, we know they're there. In my hindsight, I I'm like, I did know it was there, but I didn't speak about it. And that's the challenges. On the other side, I think it's how for the loved ones to not feel the blame as well, because it is inherently part of the illness that this could happen no matter what anyone does, which is very confronting,
Maya Adam:
Hard to accept, I imagine. Yeah. Leanne, what a story. I mean, I am sure that you are starting to change the way people in healthcare talk about these issues just because you've opened up the dialogue in sharing your own story. So thank you for that. And Leanne, now you lead the Stanford Center for precision mental health and wellness. Can you tell us a bit about what precision mental health means?
Leanne Williams:
Absolutely. So what precision mental health means to me, and I'm reflecting how many colleagues think about it as well, is we want to introduce measurement and tests, which is the precision part, to more specifically identify the underlying types of depression and other disorders so we can get at the root cause. So that's another form of precision. More precisely disentangle the heterogeneity of the disorder based in the underlying brain function that leads to so many different kinds of symptoms. And in doing so, we can then match those more precise types, which I call biotype to more personalized treatments. So it's the precise diagnostics matched to more personalized treatments using tests, and in my case, it's biotype tests, which are based on functional magnetic resonance imaging. And this is completely new for psychiatry. So this is something I'm very passionate about and very excited with the advances we've been able to make.
Maya Adam:
So by looking on an MRI, you're able to see clues about the type of depression that a person might have?
Leanne Williams:
Yes. So in this case, we are talking about the functioning of the brain, and we could draw a very broad analogy with cardiology, which I'll get to when I say functioning. In the last 10 to 15 years, there's been an explosion of information about how the human brain functions. There's a big project called the Human Brain Connectome Project. So it's a little like the Human Genome Project mapped out all the connections we have in the brain, and there are some major connections in how neurons in our brain communicate with each other. They form what are called circuits, they're kind of super highways. So we have these connections between regions of the brain that enable us to feel, to experience emotion, to regulate it. So obviously the emotions going on in our physiology, but our brain experiences, it experiences in cardiology, maybe chest pain, in depression, emotional pain.
It allows us to, these circuits allow us to think coherently most of the time to reflect on ourselves past future. Those circuits are the ones that get stuck like underactive or overactive or too connected in different types of depression. And so when we use the FMRI, we can look inside the brain and we can see where there is a disruption in these circuits. And I focus on six in particular, and the type of depression that in hindsight I think Jack May have experienced is one that's very tricky to see. On the outside you'll see some of this slowing, but inside the brain you can see that one circuit in the brain that helps us regulate our thoughts is underactive, and it gives us a kind of cognitive fog and difficulty making decisions. It's not normally thought about as part of depression, but it's one of the key features. And that type of depression can sometimes allow someone to be impulsive, so it can lead to higher risk of suicide and it can lead to long-term to really struggling. Having to compensate to perform well, doesn't respond to standard antidepressants very well. So that's one example and I'm happy to share others.
Maya Adam:
That's fascinating. Leanne, what if somebody doesn't have access to a psychiatrist with an MRI machine? Is there any other way to know what biotype
Leanne Williams:
In the future I believe there will be. What I am thinking in parallel one way is how do you create more access for people to be able to get a scan? If we agree that so much of depression, it's so much part of the crisis in mental health, it's the second frighteningly, the second leading cause of death in young people after accidents. So if we have this crisis, how can we make access to these scans more available? We've done it for migraine screening, we do it for other illnesses. We can get a scan if we have a broken leg, so the infrastructure is there. That's one path that I'm pushing. Of course not everyone can get one in parallel. In addition to looking at how we can make FMRI scans more available, I'm looking at how could you also develop other measures that correlate with the brain scans and that could be accessible remotely or on scale. And so for example, we developing these simple tests that you can do on a computer called cognitive tests that will correlate with the brain biotype information and then moving that into an app-based format.
Maya Adam:
Very interesting. And Leanne, in general, aside from digital interventions, are there sort of lifestyle changes that would benefit everybody or just sort of help prevent mental health problems from occurring in the first
Leanne Williams:
Place? I'm so glad you asked that question. I think clearly I've been focusing on the brain, and I believe that's important to establish the foundation like we have for cardiology. However, it's not everything at all. So yes, exercise really important for optimizing the way these circuits function. Main energy source for the brain circuits we measure is oxygen, so you need to breathe well. All of those things. Diet, what is it that helps you get a sense of joy in your life and you can boost those circuits that give you joy. All of those aspects I think of as linked to brain and biology, even though that may not be a natural connection for everybody. So you change your behavior environment, it'll also change your brain.
Maya Adam:
Leanne, do you have any words of hope or advice for people out there who might be struggling with a mental health issue or maybe struggling to talk to somebody they care about who they're worried about?
Leanne Williams:
It's always really important to have this be a message of hope, isn't it? I have great hope about the future, which doesn't help people immediately, but there are certainly really seismic changes happening in the field, which I think is important. What that tells us is I think the most important thing someone can do is talk, and that may feel like an impossible mission when you think about it may not feel like you have the right words, but certainly what I've observed talking about my own story, what I've seen for others, when they talk about it, they don't get blamed, they get support, and it's almost like we carry around all of us that big worry about it, which makes sense because of how it has been. But I think it's just finding any words that are comfortable to reach out if it's yourself experiencing it. We do get emails from many people just wanting to share, and we can often link them to studies or make suggestions. If you worried about one of your loved ones, I think it's in reverse. Start a conversation. It may not be about, I'm worried that you may be depressed. It could be just starting off a conversation and just sharing the things that you're noticing.
Maya Adam:
Excellent. Leanne, we're coming to the end of our discussion and we're so grateful to you, but I have one or two sort of closing questions. This podcast is called Health Compass, and I'm wondering if you have a personal or professional compass that guides you or keeps you moving in the right direction, either personally or professionally?
Leanne Williams:
Such a wonderful question, Maya. What's coming to my mind is what really was prompted by that personal story is to always, or not always, but certainly seek to always channel negative energy into positive. It's I guess my go-to mantra. It's like when something is just feeling too much or negatively visualize channeling it into the positive and kind of directed outwards. I don't mean that to sound a bit woo. I can think of how it actually is, literally can change the brain because our brain is connected to respond to negative more than positive.
Maya Adam:
Leanne, I want to thank you so much for making the time to share your incredible insights into your field and also for having the courage to share your story with us. It has been such a pleasure spending this time with you, and we're very grateful to you.
Leanne Williams:
Thank you so much, Maya. I really, really enjoyed talking with you.
Maya Adam:
So did I. In my discussion today with Leanne Williams, we talked about the damaging effects of stigma around mental health, how it can prevent people from getting help when they need it, and what can be done to start dismantling it. I was deeply moved by her personal story of losing a loved one to suicide, and I was inspired by her determination to speak up and catalyze change in our world. I hope you learned as much as I did. Thank you for listening to Stanford Medicine's Health Compass podcast. You can find more episodes on the Stanford Medicine YouTube channel, or wherever you like to listen. Stay well and see you next time.
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