MENTAL ILLNESS AND BRAIN 

DISEASE: DISPELLING MYTHS AND 

PROMOTING RECOVERY THROUGH 

AWARENESS AND TREATMENT 

HEARING 

BEFORE THE 

SUBCOMMITTEE ON HEALTH 

OF THE 

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED NINTH CONGRESS 

SECOND SESSION 

JUNE 28, 2006 

Serial No. 109-120 

Printed for the use of the Committee on Energy and Commerce 

Available via the World Wide Web: http://www.access.gpo.gov/congress/house 

U.S. GOVERNMENT PRINTING OFFICE 

WASHINGTON : 2006 

For sale by the Superintendent of Documents, U.S. Government Printing Office 

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30-414PDF 
COMMITTEE ON ENERGY AND COMMERCE 

JOE BARTON, Texas, Chairman 

RALPH M. HALL, Texas 

MICHAEL BILIRAKIS, Florida 

 Vice Chairman 

FRED UPTON, Michigan 

CLIFF STEARNS, Florida 

PAUL E. GILLMOR, Ohio 

NATHAN DEAL, Georgia 

ED WHITFIELD, Kentucky 

CHARLIE NORWOOD, Georgia 

BARBARA CUBIN, Wyoming 

JOHN SHIMKUS, Illinois 

HEATHER WILSON, New Mexico 

JOHN B. SHADEGG, Arizona 

CHARLES W. “CHIP” PICKERING, Mississippi 

 Vice Chairman

VITO FOSSELLA, New York 

ROY BLUNT, Missouri

STEVE BUYER, Indiana 

GEORGE RADANOVICH, California 

CHARLES F. BASS, New Hampshire 

JOSEPH R. PITTS, Pennsylvania 

MARY BONO, California 

GREG WALDEN, Oregon 

LEE TERRY, Nebraska 

MIKE FERGUSON, New Jersey 

MIKE ROGERS, Michigan 

C.L. “BUTCH” OTTER, Idaho 

SUE MYRICK, North Carolina 

JOHN SULLIVAN, Oklahoma 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

JOHN D. DINGELL, Michigan 

 Ranking Member 

HENRY A. WAXMAN, California 

EDWARD J. MARKEY, Massachusetts 

RICK BOUCHER, Virginia 

EDOLPHUS TOWNS, New York 

FRANK PALLONE, JR., New Jersey 

SHERROD BROWN, Ohio 

BART GORDON, Tennessee 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

BART STUPAK, Michigan 

ELIOT L. ENGEL, New York 

ALBERT R. WYNN, Maryland 

GENE GREEN, Texas 

TED STRICKLAND, Ohio 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

MIKE DOYLE, Pennsylvania 

TOM ALLEN, Maine 

JIM DAVIS, Florida 

JAN SCHAKOWSKY, Illinois 

HILDA L. SOLIS, California 

CHARLES A. GONZALEZ, Texas 

JAY INSLEE, Washington 

TAMMY BALDWIN, Wisconsin 

MIKE ROSS, Arkansas 

BUD ALBRIGHT, Staff Director 

DAVID CAVICKE, General Counsel

REID P. F. STUNTZ, Minority Staff Director and Chief Counsel

SUBCOMMITTEE ON HEALTH 

NATHAN DEAL, Georgia, Chairman 

RALPH M. HALL, Texas 

MICHAEL BILIRAKIS, Florida 

FRED UPTON, Michigan 

PAUL E. GILLMOR, Ohio 

CHARLIE NORWOOD, Georgia 

BARBARA CUBIN, Wyoming 

JOHN SHIMKUS, Illinois 

JOHN B. SHADEGG, Arizona 

CHARLES W. “CHIP” PICKERING, Mississippi 

STEVE BUYER, Indiana 

JOSEPH R. PITTS, Pennsylvania 

MARY BONO, California 

MIKE FERGUSON, New Jersey 

MIKE ROGERS, Michigan 

SUE MYRICK, North Carolina 

MICHAEL C. BURGESS, Texas 

JOE BARTON, Texas 

 (EX OFFICIO)

SHERROD BROWN, Ohio 

 Ranking Member 

HENRY A. WAXMAN, California 

EDOLPHUS TOWNS, New York 

FRANK PALLONE, JR., New Jersey 

BART GORDON, Tennessee 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

GENE GREEN, Texas 

TED STRICKLAND, Ohio 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

TOM ALLEN, Maine 

JIM DAVIS, Florida 

TAMMY BALDWIN, Wisconsin 

JOHN D. DINGELL, Michigan 

 (EX OFFICIO)

(II)
CONTENTS 

Page 

Testimony of: 

Insel, Dr. Thomas, Director, National Institute of Mental Health, National Institutes of 

Health, U.S. Department of Health and Human Services ............................................ 21 

DePaulo, Dr. Raymond, Director, Department of Psychiatry and Behavioral Sciences, 

Johns Hopkins University School of Medicine ............................................................. 26 

Jamison, Dr. Kay, Author and Founder, UCLA Affective Disorders Clinic ..................... 32 

Gooding, Dr. Diane C., Associate Professor of Psychology and Psychiatry, University 

of Wisconsin................................................................................................................... 37 

Martin, Jennifer L., Attorney, Law Offices of Jennifer L. Martin ..................................... 64 

Lamphere, Gilbert H., Managing Director, Lamphere Capital Management .................... 67 

Earley, Pete, Writer ............................................................................................................. 71 

(III) 

(1) 

MENTAL ILLNESS AND BRAIN DISEASE: 

DISPELLING MYTHS AND 

PROMOTING RECOVERY THROUGH 

AWARENESS AND TREATMENT 

WEDNESDAY, JUNE 28, 2006 

HOUSE OF REPRESENTATIVES, 

COMMITTEE ON ENERGY AND COMMERCE, 

SUBCOMMITTEE ON HEALTH, 

Washington, DC. 

The subcommittee met, pursuant to notice, at 10:00 a.m., in Room 

2123 if the Rayburn House Office Building, Hon. Nathan Deal 

[Chairman] presiding. 

Members present: Representatives Deal, Gillmor, Shimkus, 

Shadegg, Pickering, Pitts, Ferguson, Myrick, Burgess, Barton (ex 

officio), Pallone, Rush, Eshoo, Capps, Allen, and Baldwin. 

Also Present: Representative Murphy. 

Staff Present: David Rosenfeld, Chief Counsel; Randy Pate, 

Counsel; Ryan Long, Counsel; Brandon Clark, Policy Coordinator; Chad 

Grant, Legislative Clerk; John Ford, Minority Counsel; and Alex 

Gerlach, Minority Staff Assistant. 

MR. DEAL. The subcommittee will come to order and the Chair 

recognizes himself for an opening statement. We had delayed for just a 

few minutes because we were having technical difficulty with the server 

that is our Web cast to the offices. I am going to take the prerogative of 

proceeding with the opening statements because my colleagues I am sure 

will forgive me for not having their statements broadcast into 

everybody’s office, but I hope they will have it finished by the time we 

get to our first panel. 

I am proud to say that today we have two expert panels of witnesses 

appearing on the subject of “Mental Health and Brain Disease: 

Dispelling Myths and Promoting Recovery Through Awareness and 

Treatment.” I think that after we hear these two panels we will have a 

greater understanding of the issues related to the treatment for and 

recovery from severe mental illness. 

According to the National Institute of Mental Health, an estimated 

10.4 percent of American adults suffer from bipolar disorder, major 

depressive disorder, or schizophrenia in any given year. These three 

diseases are included in the list of eight mental disorders that are clarified 
2

as serious mental illness, or SMIs. The precise cause of these diseases is 

not clear. Scientists know that SMIs affect the physical nature of the 

brain, the structure of the brain, and have made progress in linking 

genetic markers to specific mental illnesses. Like many other serious 

diseases, however, the particular factors that cause SMIs are difficult to 

determine. It is now accepted that bipolar disorder, major depression, 

and schizophrenia are biologically based diseases like diabetes, autism, 

and a host of other physical ailments. The biological nature of these 

diseases, however, cannot be separated from environmental factors that 

may trigger symptoms or enhance their severity. For example, a recent 

study showed that if mothers with major depression were treated 

successfully, their children were 11 percent less likely to be diagnosed 

with depression themselves. Clearly both genetic and environmental 

factors play a role in these disease processes. 

But many high profile citizens have spoken publicly about being 

diagnosed with these diseases in recent years. Stigma surrounding 

mental illness diagnosis and treatment persist. Stigma can be more or 

less severe depending on race, sex, ethnicity, socioeconomic background, 

and age. Moreover, the social and economic ramifications of being 

labeled mentally ill can be considerable and sometimes devastating. 

While SMIs are serious and complex, people who obtain effective 

treatment can be productive and successful in spite of their disease. 

Treatments available for bipolar disorder, depression, and schizophrenia 

are not perfect or foolproof however. Some have considerable side 

effects, and it is often difficult for patients to take recommended 

medications consistently. A combination of medication and counseling 

tends to be most effective. 

According to a 2002 Department of Health and Human Services 

report, diagnosable mental illness costs the United States about 

$170 billion per year in healthcare expenditures and lost productivity. 

The costs of untreated mental illness are staggering, including 

homelessness, substance abuse, criminal behavior, incarceration, 

unemployment, and suicide. Research conducted at NIMH indicates that 

over 90 percent of people who commit suicide have depression or other 

diagnosable mental or substance abuse disorder. 

The first panel today will provide an overview of severe mental 

illnesses. Dr. Raymond DePaulo will address the burden of mental 

illness in the United States. Dr. Thomas Insel will discuss current 

research initiatives that demonstrate the biological nature of these 

diseases and the effectiveness of current treatments. He will also provide 

an outline of the NIMH’s mission for future research. 

Dr. Kay Redfield Jamison will testify as both a person with bipolar 

disorder and as one of the disease’s leading experts. Dr. Jamison will 
3

discuss current trends and treatment of bipolar disorder and major 

depression as well as the risk associated with untreated illness. 

Dr. Diane Gooding will testify about the biological basis of 

schizophrenia and highlight effective treatment strategies. 

The second panel will discuss their experiences with seeking help, 

diagnosis and treatment. Jennifer Martin is an attorney who was 

diagnosed with major depression. Gil Lamphere, Managing Director for 

Lamphere Capital Management, also suffers from depression. Mr. Pete 

Earley, a local author and former Washington Post reporter, has a son 

who has struggled with bipolar disorder for several years. 

Again, I would like to thank all our witnesses for participating today. 

I would also like to give a special thanks to Ms. Myrick from North 

Carolina, a member of our committee, and her staff, whose hard work 

and dedication to helping those suffering from brain disease has made 

today’s hearing possible. 

At this time I would like to ask unanimous consent that all members 

are allowed to submit statements and questions for the record. 

Without objection, it is so ordered. I am now pleased to recognize in 

the place of our normal Ranking Member a very able substitute, Ms. 

Baldwin, for her opening statement. 

[The prepared statement of Hon. Nathan Deal follows:] 

PREPARED STATEMENT OF THE HON. NATHAN DEAL, CHAIRMAN, SUBCOMMITTEE ON 

HEALTH

3⁄4 The Committee will come to order, and the Chair recognizes himself for an opening 

statement. 

3⁄4 I am proud to say that we have two expert panels of witnesses appearing before us 

this morning that will help us examine issues related to the treatment for and 

recovery from severe mental illness. 

3⁄4 According to the National Institute of Mental Health, an estimated 10.4 percent of 

American adults suffer from bipolar disorder, major depressive disorder, or 

schizophrenia in any given year. These three diseases are included in a list of eight 

mental disorders that are classified as serious mental illnesses, or SMI’s. 

3⁄4 The precise cause of these diseases is not clear. Scientists know that SMI’s affect 

the physical structure of the brain and have made progress in linking genetic 

markers to specific mental illnesses. 

3⁄4 Like many other serious diseases, however, the particular factors that cause SMI’s 

are difficult to determine. 

3⁄4 It is now accepted that bipolar disorder, major depression, and schizophrenia are 

biologically based diseases like diabetes, autism, and a host of other physical 

ailments. 

3⁄4 The biological nature of these diseases, however, cannot be separated from 

environmental factors that may trigger symptoms or enhance their severity. For 

example, a recent study showed that if mothers with major depression were treated 

successfully, their children were 11% less likely to be diagnosed with depression 

themselves. Clearly, both genetic and environmental factors play a role in these 

disease processes. 
4

3⁄4 Though many high profile citizens have spoken publicly about being diagnosed 

with these diseases in recent years, stigma surrounding mental illness diagnosis and 

treatment persists. Stigma can be more or less severe depending on race, sex, 

ethnicity, socioeconomic background, and age. Moreover, the social and economic 

ramifications of being labeled “mentally ill” can be considerable and sometimes 

devastating. 

3⁄4 While SMI’s are serious and complex, people who obtain effective treatment can be 

productive and successful in spite of their disease. Treatments available for bipolar 

disorder, depression, and schizophrenia are not perfect or foolproof, however. 

Some have considerable side effects and it is often difficult for patients to take 

recommended medications consistently. A combination of medication and 

counseling tends to be most effective. 

3⁄4 According to a 2002 Department of Health and Human Services report, diagnosable 

mental illness costs the United States about $170 billion per year in health care 

expenditures and lost productivity. The costs of untreated mental illness are 

staggering, including homelessness, substance abuse, criminal behavior, 

incarceration, unemployment, and suicide. Research conducted by NIMH indicates 

that over 90 percent of people who commit suicide have depression or another 

diagnosable mental or substance abuse disorder. 

3⁄4 The first panel will provide an overview of severe mental illnesses. Dr. J. Raymond 

DePaulo will address the burden of serious mental illnesses in the U.S. 

3⁄4 Dr. Thomas Insel will discuss current research initiatives that demonstrate the 

biological nature of these diseases and the effectiveness of current treatments. He 

will also provide an outline of the NIMH’s mission for future research. 

3⁄4 Dr. Kay Redfield Jamison will testify as both a person with bipolar disorder and as 

one of the disease’s leading experts. Dr. Jamison will discuss current trends in 

diagnosis and treatment of bipolar disorder and major depression as well as the risks 

associated with untreated illness. 

3⁄4 Dr. Diane Gooding will testify about the biological basis of schizophrenia and 

highlight effective treatment strategies. 

3⁄4 The second panel will discuss their experiences with seeking help, diagnosis, and 

treatment. Jennifer Martin is an attorney who was diagnosed with major 

depression. 

3⁄4 Gil Lamphere, managing director of the Lamphere Capital Management, also 

suffers from depression. Mr. Pete Earley, a local author and former Washington 

Post reporter, has a son who has struggled with bipolar disorder for several years. 

3⁄4 Again, I would like to thank all of our witnesses for participating today, and I would 

also like to give a special thanks to Ms. Myrick from North Carolina and her staff 

whose hard work and dedication to helping those suffering from brain disease has 

made today’s hearing possible. 

3⁄4 At this time, I would also like to ask for Unanimous Consent that all Members be 

allowed to submit statements and questions for the record. 

3⁄4 I now recognize the Ranking Member of the Subcommittee, Mr. Brown from Ohio, 

for five minutes for his opening statement. 

MS. BALDWIN. Thank you, Mr. Chairman, and thank you so much 

for holding this very important hearing today. 

Part of the purpose of this hearing is to raise awareness about mental 

illness and reduce the stigma associated with it, and these are certainly 

worthy goals and I know many of my colleagues join me in sharing 

them. 
5

It is amazing to me to think that one of the biggest challenges that 

continues to face mental health researchers, advocates, parents, and 

patients is the belief that mental illness is not a real illness, and frankly it 

is sad that this continues to be a commonly held misconception in the 

year 2006. 

I consider myself lucky because courageous family members, dear 

friends and constituents have told me their stories and shared with me 

their struggles so that I might understand. 

The Alliance for the Mentally Ill, or AMI, which in French means 

“friend,” was founded in the Congressional district that I have the honor 

of representing. This advocacy group has made amazing strides with 

regard to public policy change, meanwhile providing important public 

education on mental illness as well as support for families dealing with a 

new diagnosis. 

I am happy that our first panel of witnesses is here to inform and 

update us on the exciting and groundbreaking work that is being done in 

the arena of mental health research. Mental illnesses are tangible, 

treatable health problems just like hypertension or cancer or heart 

disease, and I know that the research being done confirms this every day. 

Just as heart disease is a disease of the heart, mental illness is a 

disease of the brain, and the more that we can learn about the origins, 

symptoms and treatment of mental illness, the more ammunition we have 

to fight the myths and stigma that surrounds mental illness. 

While holding this hearing is a promising step, I think that there are 

several other steps that we as Members of Congress can take to promote 

awareness and reduce stigma. 

One is to support adequate funding for the NIH. It is unacceptable 

that after a significant commitment that this Congress has made to 

doubling the NIH budget, we have allowed that momentum to disappear 

by flat funding the NIH in recent years. In the world of medical 

research, where the costs of doing research are continually rising, this 

flat funding translates into a cut. 

In the past few years, funding for qualified grant applications has 

fallen to about 20 percent from a high of about 33 percent at the peak of 

the doubling in 2001, and I wonder sometimes what this says to young 

aspiring researchers. 

Similarly unacceptable is this Congress’ inability to pass mental 

health parity legislation. Mental illness is no different from physical 

illnesses. It should be covered by insurance in a nondiscriminatory 

manner. And we see this inequity in private insurance and even in 

Medicare. It is time to pass mental health parity. 

Lastly, I would like to extend a very warm welcome to my 

constituent, Dr. Diane Gooding, Associate Professor of Psychology and 
6

Psychiatry at the University of Wisconsin, Madison. Dr. Gooding, I am 

honored you were able to join us and I am very proud of the 

groundbreaking research that is conducted at the University of Wisconsin 

Madison, and this holds true for the research that you are doing regarding 

schizophrenia. Thank you for joining us and thank you to the rest of our 

witnesses as well, especially those who are courageously sharing their 

personal stories so that we may learn. 

Thank you, Mr. Chairman. 

MR. DEAL. Thank you. I am pleased to recognize the Chairman of 

the full committee, Mr. Barton from Texas, for an opening statement. 

CHAIRMAN BARTON. Mr. Chairman, I will submit my statement for 

the record. I appreciate you doing the hearing and I look forward to 

hearing from our witnesses. 

[The prepared statement of Hon. Joe Barton follows:] 

PREPARED STATEMENT OF THE HON. JOE BARTON, CHAIRMAN, COMMITTEE ON ENERGY 

AND COMMERCE

 Thank you Chairman Deal for holding this hearing on the important topic of mental 

health, also increasingly referred to as brain disease. 

 As science advances and as our understanding of the human body increases, we are 

coming to a greater awareness of the infinite intricacies of the human brain. A brain is 

faster than the fastest super computer ever built, performing millions of calculations per 

second and storing enormous quantities of information. Our brains are marvelous tools 

we rely on every second to navigate through a dangerous world. The brain also allows us 

to ponder and ask questions about the universe and our place in it. 

 With all the activities the brain coordinates and makes possible for us, we encounter 

remarkably few problems. The artificial intelligence we now use each day may be 

wizardry, but it’s no match for the brain. Generally speaking, the mind does not require 

rebooting, does not freeze up or shut down just as you get ready to save something. 

Memories may fade, but they’re not usually deleted. 

 Sometimes, however, our brains do encounter problems that interfere with our 

functioning as human beings. When that happens, it can be disastrous for the patient, but 

also for family, friends, and colleagues. 

 We are learning more every day about how the brain works and how to fix it when it 

breaks, and I want to say a special word of thanks to Sue Myrick at this point. Sue was 

the driving force behind today’s hearing. Her family knows what it is to encounter the 

problems and the stigma of a disease that is just as destructive as cancer and disabetes, 

and I want to applaud her courage and her determination to bring these issues into the 

light. 

 Today we will hear from a distinguished panel of experts about the biological and 

environmental causes of common mental illnesses and learn about the exciting research 

and treatments that are becoming available to us. 

 We are also fortunate to have with us today on our second panel three people who 

have experienced mental illness either as a patient or as a family member. They are here 

to shed light on their battles with mental illness as well as on their struggles with its 

unfortunate and unfair stigma; more often the result of ignorance than malice. I look 

forward to hearing each of their stories today and thank them for being here. 

 Thank you again Chairman Deal for holding today’s hearing and welcome to our 

witnesses. 
7

MR. DEAL. I thank the gentleman. I would then recognize Ms. 

Myrick, who is really the leader of this cause and brought this issue 

before the subcommittee. Ms. Myrick. 

MS. MYRICK. Mr. Chairman, thank you and I really appreciate this 

opportunity that you are holding the hearing today and I want to thank all 

of you that are here to share with us because you are what makes it 

happen as well. 

The real goal that I have in mind is, personally today with this 

hearing, is to bring mental illness out of the shadows and emphasize it 

conceptually, these are really brain diseases, conditions that are 

biological, they are diagnosable and they are treatable. And though the 

title says mental illness and brain disease, they are really one and the 

same. 

Monday, after an article appeared in my local paper that we were 

going to have this hearing, I was really encouraged because I was going 

through the airport and after I got on the plane a lot of people came up to 

me and just said, thank you, thank you for doing this. And what that said 

to me was this is a bigger problem than anybody is willing to admit. It 

really affects a lot of us, and again those of you who are sharing your 

personal stories, thank you, thank you, thank you because the more of 

that that happens, the more progress we are going to make. 

Today we are going to focus on three diagnoses that fall under the 

severe mental illness category: major depression, bipolar disease, and 

schizophrenia. These are some of the most serious mental illnesses, and 

acknowledging that these diseases exist is good for our whole society, 

not just for parents and patients and the people who deal with it. 

Awareness provides a clearer path to treatment and lessens the personal 

and societal costs of the disease. 

You know, all of us on this subcommittee support various awareness 

hearings and programs for diabetes, breast cancer, arthritis, chronic pain, 

Alzheimer’s, everything else. This is just another one that we need to 

consider in the same way. 

You know, I think about what it was like 20 to 30 years ago when 

nobody wanted to say I have cancer. You know it was a stigma that you 

just never told anybody. You were afraid to go forward because you 

might lose your job or women would say to me, you know, I might--my 

husband will leave me. Whatever the reason, nobody would talk about 

it. 

And when I went public with my breast cancer in 2000, a lot of close 

friends and colleagues came up to me and said, I have had breast cancer. 

I had known them 20 years and they never told me. They kept it a secret. 

And it is really I believe the same thing that we are dealing with today 

with brain disease. We are in the same position. People don’t want to 
8

talk about it because they are afraid. Sometimes they think there is no 

solution to the problem. But there are ways to live with it, and I hope 

that will be clear today. 

We have a granddaughter who is bipolar, and she first started 

suffering with this when she was about 13 years old. It has been a long 

road. She is now an adult and, very frankly, the whole family has lived 

this story the whole time. And it doesn’t affect just the person. It affects 

the family. And that is I think the thing that we forget about. Everybody 

gets involved. It is not just the patient. And so, we as a family have 

spent countless hours, counseling and trying to get her to accept 

treatment that you know she will accept, worrying about her. Those of 

you who have been through it know what it is like. But they are life 

threatening diseases and we don’t realize that. 

In 2001, by the way, more Americans killed themselves through 

suicide, which is directly related to these diseases in many, many ways, 

than died of HIV and AIDS. And when I saw that, that really hit me hard 

because we don’t consider that the same thing. 

So we need to get to the root of the problem, why are people 

committing suicide? It is because there is another problem there that 

they are dealing with that hasn’t been dealt with themselves. And so the 

progress in research to me is so great. I mean there is no reason for 

hopelessness with this issue because those of you in front of us have 

been doing wonderful work. Other people are doing wonderful work. 

And we are finding out more and more that there are solutions to the 

problem, that we really can be hopeful about what can happen. 

So I really welcome all of you again. Thank you from the bottom of 

my heart for what you do every day, and for those of who you who are 

sharing with us, thanks again for being here. 

MR. DEAL. I thank the gentlelady. Mr. Pallone is recognized for an 

opening statement. 

MR. PALLONE. Thank you, Mr. Chairman. I am glad we are holding 

today’s hearing. Now more than ever we need to be talking about mental 

health. Nearly 30 million Americans suffer from mental health disorders 

and more than one in five persons will experience a mental health 

disorder in their lifetime. Millions of people suffer from serious, 

debilitating and life altering mental illnesses, such as bipolar disorder 

and schizophrenia, and nearly every American has a friend or relative 

that has to cope with such diseases. 

Mr. Chairman, I have to be honest, while I appreciate your calling 

today’s hearing, the truth of the matter is that for far too long the 

Republican led Congress has shirked its responsibility when it comes to 

mental health in America. One hearing on mental health cannot make up 

for the many years this important topic has been largely ignored or for 
9

the harmful policies that my Republican friends have enacted over the 

past few years by cutting Federal programs that could provide some help. 

And I recognize the importance of raising public awareness, but I don’t 

know how you can talk about treatment and recovery without talking 

about access, which I think increasingly is a problem. 

Many of the witnesses testifying today will talk about new research 

and breakthrough discoveries, yet what good is it if the research never 

reaches the patient? Millions of Americans are unable to access lifesaving treatment and therapy because this committee, and I think the 

Republican leadership, have not taken action on the Paul Wellstone 

Mental Health Parity Act, which my colleague from Wisconsin 

mentioned has strong support from both sides of the aisle, including 

many members of this committee. So we should simply move it. 

And I think the Republican record on mental health issues or the 

problem with the lack of record doesn’t stop there. It is one thing to 

block important legislation such as the Parity Act that would 

undoubtedly improve access to mental health services, but it is another 

thing to pass legislation that would further restrict treatment options, 

which is exactly what Republicans did when they gutted Medicaid this 

year. 

Medicaid, as we know, is the single largest source of funding for 

mental health care in this country, comprising over half the State and 

local spending on mental health services. But that didn’t stop this 

Congress, again the Republican leadership, from taking their red pen 

during last year’s reconciliation and slashing billions from the Medicaid 

program. As a result millions of low-income people who suffer from 

debilitating mental disorders, some of our most vulnerable citizens, will 

have to overcome new barriers to care such as prohibitive cost sharing 

requirements for medications, and I have no doubt that their mental 

health is now in jeopardy. 

Again I want to thank the Chairman for holding today’s hearing. 

Certainly, raising awareness about mental health and treatment is an 

important topic, but so is access. And if my Republican friends are truly 

interested in improving the current state of mental health in this country 

then a good first step would be addressing the lack of access that most 

Americans face or many Americans face when they seek treatment. 

Thank you, Mr. Chairman. 

MR. DEAL. I now recognize Mr. Ferguson for an opening statement. 

MR. FERGUSON. Thank you, Mr. Chairman. I don’t have a prepared 

opening statement, but I want to thank you for holding this hearing. I 

want to thank Sue Myrick for her leadership on this issue, and I am 

pleased to be able to be here to listen to our witnesses today and to read 

their testimony because this is a very difficult and very important issue. 
10

There are so many misunderstandings and a lack of awareness that 

Ms. Myrick touched on before that surround mental illness and brain 

disease. People don’t talk about it very much and Ms. Myrick was 

referring to that earlier. And even though people don’t talk about it a lot, 

and there is this still unfortunately this stigma that surrounds mental 

illness, many, many, many families are touched by mental illness and 

brain disease and frankly my family is one of them. 

Mental illness and brain disease are particularly difficult to deal with 

because they are not immediately physically apparent to others, and it is 

only through real process of diagnosis and investigation do they become 

better known or more apparent. And because of that, it makes it 

extremely difficult on a family, on the loved ones of the person who is 

affected, and it makes it even more difficult, frankly, to translate that into 

more public awareness and frankly good public policy. 

I have been a supporter of the mental health parity efforts here in the 

Congress. I have a very, very close friend at home who is a young 

person who is struggling with brain cancer right now, that the brain is so 

difficult and so complex and it is my hope that through Sue Myrick’s 

efforts, this committee’s efforts, this Congress’ efforts that we will begin 

to know more and more about the brain and about how we can conquer 

the difficulties and the challenges that we face in treating brain disease 

and mental illness. 

You know, 20 and 30 years ago, people in the healthcare field talked 

about the heart and they talked about cancer, and we have made such 

incredible progress when it comes to the heart and to cancers and other 

previously really vexing diseases and difficulties and afflictions that 

human beings deal with. It is really my hope and belief that this next 

frontier, the next huge breakthroughs in human health are going to come 

with the brain and it is my hope that through hearings like this, Mr. 

Chairman, and the efforts of this Congress that we can continue to 

further those efforts. 

So thank you very much again for holding this hearing, Mr. 

Chairman. I appreciate your leadership on this issue and I yield back. 

MR. DEAL. I thank the gentleman. Ms. Eshoo is recognized for an 

opening statement. 

MS. ESHOO. Thank you, Mr. Chairman, for holding this hearing and 

I want to salute our colleague, Congresswoman Myrick, for being the 

agitator as it were to make sure that we have this examination. It is an 

important hearing for all the reasons that my colleagues have stated. 

All we have to do, as many of my colleagues have said, is just look 

within our own circle, our families and our close friends, to know that 

this is something that is really relatively common, and that much 
11

progress has been made in terms of research and the examination of the 

human brain. 

I think that in one of the individual’s testimony they used the 

following phrase, that this is the treatment of cancer in the 21st Century--I 

am just paraphrasing. It wasn’t all that many years ago when the word 

“cancer” was like an atomic bomb when the word was stated. There was 

hopelessness that accompanied the word, and now the progress that has 

been made--well we could go on and on, we could have hearings 

celebrating the progress. There is a reason for that, and I think that our 

committee needs to reappreciate it. And that is that we made it a top 

priority in the country. And when we did, we said that we would invest 

in the necessary research in order to advance cures for the disease. 

Now there are some cancers we haven’t conquered yet. There are 

others that are really stoppable and curable. As we did that, we also 

recognized that if anyone that was afflicted with cancer did not have 

access to what the researchers had brought forward, then they were 

condemned to essentially the past. In other words, they might as well be 

living without the benefit of the research. And so today is one of the 

steps, in my view, along the way because there is much to do. 

We know that there are several of our colleagues battling this illness, 

and one of our colleagues talked about this today. Patrick Kennedy has 

been very courageous in coming out and talking about his illness. We 

know that a President of the United States--at least one, maybe there 

were many--Abraham Lincoln suffered from what I think was what we 

would now call depression for different bouts in his life and spent time I 

think with family or friends because he needed them not only to help 

him, but also probably so that he wouldn’t harm himself. 

So the history is very rich in terms of experience. 

We need to not only hear from the researchers today and those that 

have firsthand experience, but I hope what the subcommittee will do is to 

take the next step, and that is to see that we have robust funding for the 

research, because the breakthroughs will not be made and we will really 

all be condemned to the discrimination and the lack of awareness of the 

past unless we make the proper investments. And then the step that 

comes with that is that there not be a discriminatory system in terms of 

access to what the researchers put out there for all Americans. And when 

we do that, we will give hope to humankind because the United States of 

America is always first. Always first. We have a great pride in that and 

it is justifiable. But it won’t happen unless the political will is really 

exhibited. 

It wasn’t that many years ago when Richard Burr was on this 

committee, we had legislation that established the National Institute of 

Bioimaging and Bioengineering. That was all it was. We did that 
12

because we understood that through the bioimaging and through the 

bioengineering that breakthroughs could indeed be made, but only unless 

and until we made that investment, which we did. We were very proud 

of the work that we did. President Bush signed that bill into law. 

These are all steps in the right direction. The President has said, I 

believe it was in 2002, that he favored ending discriminatory insurance 

coverage. And so we should not only be comforted by that, but match 

his forward thinking on this. It will take some boldness because there 

seems to be an attitude around the Congress that we could take some 

baby steps, but we can’t take the last full step that will need to be taken. 

And this is a bipartisan issue. It is a nonpartisan issue. And there are 

many, many Americans, too many Americans that are still waiting in the 

wings to have this addressed. 

So thank you, Mr. Chairman, thank you to our colleague, 

Congresswoman Myrick, and to the researchers, the leaders that are here 

as well as those that are going to give testimony, which I think is very 

courageous, from their own experience. I look forward to hearing from 

you. 

MR. DEAL. Thank you. Mr. Shimkus is recognized for an opening 

statement. 

MR. SHIMKUS. I will yield, Mr. Chairman. 

MR. DEAL. Mr. Shadegg is recognized for an opening statement. 

MR. SHADEGG. Thank you, Mr. Chairman. I will make a few brief 

remarks. I want to commend you for holding this hearing. I want to 

commend my colleague, Ms. Myrick, for drawing our attention to this 

topic. It is a topic that affects all of us. 

I remember as a young child in Phoenix, Arizona, growing up both 

seeing homeless people on the streets and at times going past the Arizona 

State asylum for mentally ill and thinking about this issue. 

Obviously it is an issue that concerns us as a society. We as a Nation 

I think long ago made a decision that no American should go without 

basic healthcare, and for that reason we passed various laws that ensured 

that Americans can go, for example, to an emergency room, and get 

health care. Many of us, as you know, Mr. Chairman, are working on 

legislation that will even improve upon that system and would provide 

better coverage for the 44 million or more uninsured Americans who for 

one reason or another, largely for many of them it is cost, can’t today get 

health insurance or afford health insurance. A part of that big puzzle is 

the mentally ill. 

I worry today with the deinstitutionalization of many mentally ill 

which occurred in decades gone by, there are too many homeless that are 

affected by mental illness and we are not caring for them enough. I 
13

know it is an issue about which we need to be concerned and I commend 

you for holding the hearing. 

The specific topic of this discussion today is treatment for and 

recovery from severe mental illness. That is very important. Obviously, 

a family member can affect the entire family when they have these kinds 

of diseases and we need to touch upon them. 

In the discussion, however, I would hope that we would look at the 

issue of balance. One of my concerns is that mandated health care 

coverage runs up the cost of health insurance for everyone, and I am 

deeply worried about America’s overall competitiveness in the world, in 

the business realm because of the cost of health insurance today. 

The President of Intel visited me just toward the end of last week in 

my office and his major concern for their competitiveness worldwide is 

that the cost of health insurance is going to make America uncompetitive 

in the market which means that the market for building those products 

will move overseas and America will lose jobs to countries where the 

cost of health insurance isn’t so great. 

It could well be that rather than directing additional resources to 

come out of the insured population maybe these are insurance where the 

taxpayers themselves through the National Institutes of Health or other 

government organizations should be looking at funding these costs 

because of the incredible burden that cost of healthcare can impose on 

America’s economy in a worldwide, very competitive economy, where 

we have to compete with all the countries around the world. That is an 

aspect we need to look at. 

With that, Mr. Chairman, I yield back. 

MR. DEAL. I thank the gentleman. Ms. Capps is recognized for an 

opening statement. 

MS. CAPPS. Thank you, Mr. Chairman, and I too thank you for 

holding this hearing. I salute our colleague, Sue Myrick, for pulling 

together an expert panel of witnesses and making this day happen in the 

life of our subcommittee and I would be one who would be in favor of 

this not being an occasional time to raise awareness for us. We need 

that, but we surely could use the community’s NAMI, National Alliance 

of Mental Illness, and mental health associations, that we have those 

groups in our communities to help us along with our expert witnesses to 

set some benchmarks for ourselves in terms of achievable standards and 

goals that we really have a responsibility to meet and make this day 

worth something. 

It is important in itself because it gives us a chance to discuss issues 

that are significant, that are life saving, that will have a positive effect on 

our economy, that we just need to be doing as a civilized nation in this 

world today. 
14

I came to Washington as a spouse in the late 1990s, and because of 

that position I was able to avail myself of the last couple of years of the 

decade of the brain and to learn about the breakthroughs and the radical 

transformations in understanding the brain and the illnesses and disease 

conditions that can be affected by imaging technology, and the National 

Institute of Mental Health has really pushed us and opened so many 

doors for our society that are now just poised to becoming standards of 

practice. Again it is all about who has access to care, in my opinion. 

But I was privileged also to be here in the beginning of my term in 

Congress when the White House had its first ever, I believe, conference 

on mental illness and, Dr. Jamison, that is when I first heard you and I 

was struck by many of you--all of you may have there. I don’t know--

but the power of people telling their stories. 

And what a long way that goes and some of the outgrowth from that 

conference and other effects on destigmatizing and the multimedia 

campaign to raise awareness among our young people in language they 

could understand and can understand. We have to keep that momentum 

going because we have a dual purpose, I believe, to keep the awareness 

level but also to make sure that we see mental health and diseases of the 

brain as parity, as a part of health every bit as much as a broken arm or a 

leg or a situation requiring insulin if you have diabetes. 

We have come a long way with cancer. We need to do the same 

thing in this situation, and yet today in 2006 I know because my brother 

who lives with bipolar disorder has taught me so much throughout his 

adult life on what this means. We still carry stigmas and we still leave so 

many people without access to treatment that could make such a 

difference in their lives. 

So we have our work cut out for us, and one of the areas that is so 

significant to me is the determination by many of our insurance carriers 

that therapy and comprehensive treatments are not worth the bottom line 

and that we can only do short term, we can only do capped treatments, 

we can only do quick fixes. And that means we haven’t learned what we 

need to know about the short-sightedness of some of this. 

Now we need to know that. We do know that mental illness needs to 

be treated like other illnesses. Many of you know I was a school nurse 

for 20 years. And if a student were to come to my office with a broken 

arm, what if I just gave that person a Band-Aid and sent them back to 

class? I mean, it is appalling to think of that, and that is what we are 

doing with people who present themselves to those who are professionals 

and, you know, X-rays and treatment, but denying patient coverage to 

psychotherapy by telling them that their mental health professionals’ 

recommended course of treatment is unnecessary and forcing those 
15

individuals to cope alone is exactly like putting a child with a broken 

limb back into the classroom with a pat on the back and a Band-Aid. 

So we cannot afford to let this go on. We have the ability to set 

standards. We have shirked our responsibilities, and that is why this day 

and this opportunity that we have with these witnesses here is important. 

We need to be listening to what you are going to be telling us that we 

need now in this society and this century to take mental illness more 

seriously and to bring the issue of parity to the floor. 

I yield back. 

MR. DEAL. Mr. Pitts is recognized for an opening statement. 

Dr. Burgess is recognized for an opening statement. 

MR. BURGESS. Thank you, Mr. Chairman. Actually in the interest 

of time I submit for the record and look forward to hearing from our 

witnesses. 

[The prepared statement of Hon. Michael C. Burgess follows:] 

PREPARED STATEMENT OF THE HON. MICHAEL C. BURGESS, A REPRESENTATIVE IN 

CONGRESS FROM THE STATE OF TEXAS

I would like to thank Chairman Deal for holding this hearing on mental health and 

brain disease. 

According to the National Institute of Mental Health (NIMH), 6 percent of 

Americans ages 18 and older or 1 in 17 adults suffer from a serious mental illness. 

Individuals can also be diagnosed with several disorders at one time. 

During this hearing, we will focus on the following illnesses - major depressive 

disorder, bipolar disorder, and schizophrenia. Major depressive disorder and bipolar 

disorder are mood disorders. In addition, major depressive disorder is the leading cause 

of disability in the United States for people between the ages of 15 to 44. Next, 

schizophrenia affects about 2.4 million American adults. Both men and women have an 

equal chance of developing schizophrenia. In consequence, the lives of millions of 

Americans are touched by these diseases. 

Mental illnesses can be devastating to the affected person as well as his family. As 

with every disease, people can become affected by a mental illness at any time in their 

lives. These can be difficult to diagnose and much research is still needed to bring us a 

better understanding of the biological basis for these brain diseases. The brain can now 

be studied in greater depth, as our technology improves, such as with functional MRI that 

can tract the blood flow associated with different brain activities. Furthermore, studies 

on the signaling molecules, such as neurotransmitters, are leading to discoveries about 

where they are located and what they are involved with. Many of these mental disorders 

have already been associated with disruptions in normal brain processes. This knowledge 

about pathways is crucial to develop more targeted drugs. 

Making a proper diagnosis can be difficult, but it is just the initial step. The 

treatment that works best for an individual can sometimes remain elusive. However, 

once it is found, these individuals have a chance to lead fulfilling lives if they continue 

their treatments throughout their lifetimes. Two issues that physicians consider are 

compliance and the medication side effects, which are both important factors in the 

successfulness of treatments. 

I look forward to the testimony from the first panel on the ongoing research and the 

direction it is headed. Our discussion would also not be complete without getting the 
16

perspective of patients and their daily lives with these mental illnesses. The second panel 

will bring us some of these insights. Thank you for being here with us today. 

MR. DEAL. Mr. Allen is recognized for an opening statement. 

MR. ALLEN. Thank you, Mr. Chairman, for convening this hearing 

to examine the progress our Nation has made in identifying and treating 

mental illness and brain disease. Mental illness can have a devastating 

impact on Americans from all walks of life. One in five Americans is 

affected by mental illness. 

This hearing can help raise awareness, ease the stigma of mental 

illness, and let patients and their families know there is hope. Since 

1996, Congress has been working to pass bipartisan legislation to ensure 

that Americans have access to affordable mental health care. 

Though it is not the focus of this hearing, I want to point out that 

H.R. 1402, the Paul Wellstone Mental Health Equitable Treatment Act of 

2005, has 227 cosponsors. I hope that our committee will hold a hearing 

on that bill later this year. 

Lack of access to mental health treatment as a result of insurance 

discrimination costs our economy more than $100 billion each year 

through absenteeism, turnover and retraining expenses, lower 

productivity, and increased medical costs. 

There is no scientific or medical basis that justifies insurance 

coverage of mental health disorders on different terms and conditions 

than other coverage for other illnesses or disorders. The State of Maine 

has been a leader in this area by requiring that insurers provide the same 

level of coverage for mental health care as for other illnesses. 

We also need to invest more funding in medical research to 

diagnose, treat, and find cures. Of great concern to me is the lack of 

mental health professionals, particularly in rural areas, and especially 

those who treat children with mental illnesses, a major problem in my 

home State of Maine. 

I look forward to hearing our distinguished panel share their 

experience and expertise. Together we need to find ways to build a 

comprehensive, efficient system to identify, evaluate, diagnose, and treat 

mental illnesses at every stage of life and ensure that all Americans have 

access to mental health services. 

With that, Mr. Chairman, I yield back. 

MR. DEAL. I thank the gentleman. The bell, as you heard, we have a 

motion to adjourn on the floor which we will need to go vote on. But 

before that, I am going to ask unanimous consent of the subcommittee 

that one of the members of our full committee be allowed to make an 

opening statement. He is a licensed clinical child psychologist and that 

is Mr. Murphy. 
17

Without objection, Mr. Murphy will be recognized for 3 minutes to 

make an opening statement, and then we will go vote and return. 

MR. MURPHY. I thank the Chairman for this opportunity. We heard 

over and over again mental illness is a real and not imagined problem, as 

real and devastating to a family as any other medical illness. It can lead 

you to lose a job. It can lead you to lose your family and cost business 

productivity. In fact it can cost employees billions and it does cost lives. 

And yet, it is more treatable than many other medical diagnoses. If 

we ignore it, mental illness can both increase the risk of heart disease and 

if mental illness is untreated it can double the cost of healthcare. 

Without integrating the care of the body with the care of the brain, our 

current system is wasting billions of dollars. 

But the private sector has time and time again demonstrated that 

direct healthcare cost savings can save money as well as productivity. 

One study reported that when depression management was included in 

their health plans productivity increased over 6 percent and absenteeism 

declined 28 percent with a savings of over $2,000 per employee. 

When workers with depression receive treatment, medical costs 

declined by over $800 per employee. But untreated mental illness costs 

about $300 billion, according to the National Institute of Mental Health. 

It is $150 billion from lost workdays and premature death, $70 billion in 

emergency care and $80 billion from societal costs such as the justice 

system. The success in treatment requires proper and timely treatment 

and treatment is not just a matter of medication. 

For example, there was a past concern with use of one antidepressant 

medication associated with increased adolescent suicide risk, and it 

shows you how partial treatment and misunderstanding of mental illness 

actually cause harm. Antidepressant medications change mood but they 

don’t change your mind. Psychotherapy performed by a qualified 

practitioner is also needed to properly treat patients. But when only 

25 percent of antidepressive medications are prescribed by a psychiatrist 

and 75 percent of the time by a nonpsychiatrist and many cases people 

do not receive the additional psychotherapy treatment, then the prognosis 

remains low. So when health plans do not cover mental health 

treatments, including Medicare, the diseases of mental illness cannot be 

treated properly. 

Now I urge us to also look at those businesses who have found great 

success in providing this care. AT&T, American Airlines, IBM, and 

PepsiCo are among those companies who have found that good mental 

health care is good for employees and good economics for the business. 

The time has come for us to improve mental health care by integrating 

and coordinating medical and mental health services for more effective 

diagnosis and treatment rather than just shifting the burden to pay for 
18

healthcare or just calling for more money. Congress can lead the way to 

save lives and money through integrated care. 

I look forward to working with my colleagues to transform our 

health care system, to spend dollars wisely, rather than just spend dollars. 

And I yield back, and I thank the Chairman. 

MR. DEAL. Thank the gentleman. Mr. Gillmor, I believe you 

indicated you would waive your opening statement. I believe all 

members who are here have given their opening statements. So we will 

stand in recess pending the completion of the vote. At that time we will 

resume with our first panel. Committee will stand in recess. 

[Recess.] 

STATEMENTS OF THOMAS INSEL, DIRECTOR, NATIONAL 

INSTITUTES OF MENTAL HEALTH, NATIONAL 

INSTITUTES OF HEALTH, U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES; RAYMOND DEPAULO, 

DIRECTOR, DEPARTMENT OF PSYCHIATRY AND 

BEHAVIORAL SCIENCES, JOHNS HOPKINS UNIVERSITY 

SCHOOL OF MEDICINE; KAY JAMISON, AUTHOR AND 

FOUNDER, UCLA AFFECTIVE DISORDERS CLINIC; AND 

DIANE GOODING, ASSOCIATE PROFESSOR, 

UNIVERSITY OF WISCONSIN 

 

MR. DEAL. I am pleased to introduce the members of our first panel. 

Dr. Thomas Insel, he is the Director of the National Institute of 

Mental Health where he has served in that capacity since 2002; Dr. J. 

Raymond DePaulo, recognized as one of the world’s foremost 

investigators into the genetic basis of affective disorders such as manic 

depression, depression, and panic disorder; Dr. Kay Redfield Jamison, 

author and founder of the UCLA Affective Disorders Clinic. 

Dr. Jamison struggled with bipolar disorder during her teenage years, 

successfully completed her Ph.D., and is now a professor of psychiatry at 

Johns Hopkins School of Medicine and Co-Director of the Johns 

Hopkins Mood Disorders Center; Dr. Diane Gooding, Associate 

Professor at the University of Wisconsin at Madison, and her research 

focuses on schizophrenia and schizophrenia spectrum disorders as well 

as early detection and prevention measures for mental illness. 

We are pleased to have all of you here, and we will start with 

Dr. Insel. 

Your written testimony is made a part of the record. It will be 

available for Members to read. We would ask if you would summarize 

during your 5 minutes allotted for your testimony. 
19

DR. INSEL. Thank you, Chairman Deal and Ranking Member 

Baldwin, and thanks especially to Congresswoman Myrick for pulling us 

all together. I think your leadership here is very important to everybody. 

I will keep my remarks relatively brief given the time. I am Dr. Tom 

Insel, Director of the National Institute of Mental Health, a component of 

the NIH of the Department of Health and Human Services that is tasked 

with the responsibility of developing improved methods of diagnosing, 

treating, and preventing mental disorders, including schizophrenia, 

autism, and mood and anxiety disorders. 

I am delighted to have an opportunity to be here today. As you 

mentioned, my testimony has been submitted for the record, so let me 

share with you a few thoughts. 

I spent yesterday afternoon at a memorial service for a 23-year-old 

young man with schizophrenia who killed himself in our hospital. This 

was a truly tragic event for a young man with a tremendous amount of 

promise. He was from Tucson, Arizona, and as many other people have 

done who come from all over the United States, he came to the NIH 

Clinical Center to get what is arguably the best care available in the 

United States. 

This was a fellow who was a creative, tremendously compassionate 

young man who had struggled with schizophrenia since about the age of 

19 and had been in and out of various treatment programs. When he 

finally came to us, it was with the hope that he would be able to reach a 

satisfactory stage of recovery--everybody was hoping for that. 

He spent 6 months in our hospital with intensive treatment, including 

a whole range of experimental and available medications. And 2 days 

before his discharge, he jumped to his death. This was, as Ms. Myrick 

mentioned before, an event that is sort of like dropping a pebble into a 

pond because it affects so many people, not just his family. Whenever 

there is a suicide, there are many, many victims. And in this case, it has 

been a huge event for the NIH community, particularly for those who 

worked with this fellow and the people who cared for him. 

At the memorial service yesterday, what I began to think about was 

how important it was for us to recognize that, at a time like this, when we 

have had such a focus on the need for providing better access and 

providing better services and making sure that young people have the 

best treatments that are available, we also need to recognize that for this 

young man getting the best treatment at the best place, we still had the 

worst outcome. 

What that says to me is, we are really not where we need to be yet. 

We need to do much more to be able to make sure that we have better 

treatments for the people who suffer with these very, very serious 

diseases. 
20

So I come here really with a very heavy heart as someone who is 

responsible for being able to deliver those treatments in order to make 

life much better and ensure recovery for those with serious mental 

illness. 

In all fairness, however, I need to tell you that I also come here with 

a lot of hope because I believe in the same heart that we have now the 

opportunities that we have never had before. 

You heard from your colleagues this morning that there is an 

increasing recognition in the decade following the Decade of the Brain 

that these are brain disorders, that mental disorders are brain disorders, a 

simple and profound truth that has completely altered the way that we 

approach diagnosis and ultimately will alter the way we treat them. 

We recognize that these are chronic disorders. But unlike many 

other chronic disorders in medicine, these are the chronic disorders of 

young people: 50 percent start by age 14; 75 percent by age 24. This is 

very different from Alzheimer’s disease, Parkinson’s disease and other 

neurological brain disorders that we think about. The other difference is 

that these are brain disorders, but they are not brain disorders where a 

focal lesion can be identified. These are disorders of brain systems. 

The good news is that we now have the tools to be able to understand 

how brain systems go from being normal to abnormal. We have the tools 

of genomics which give us some of the molecular candidates that we 

need, and we have the tools of brain imaging that allow us to look inside 

the brain. It is no longer a black box, and we can begin to understand 

where something has gone wrong in those that suffer with these 

disorders. Finally, the last thing that I would like to say to you, besides 

the fact that these are chronic diseases and clearly brain disorders, is that 

we now have the ability to study them. 

I have submitted for the record a lot more information to back up 

those statements, including a set of pictures that I hope you will take a 

look at that show where some of those abnormal circuits appear to be. I 

will leave those with you. I will not go through the slides. 

But I do want to suggest that we also have a real need to change the 

way we think about these illnesses. If you can go to the second to last 

slide, what I would like to suggest is where we want to go as we think 

about this and the future and why I have such great hopefulness. We 

need to go from the point where we are now, where we diagnose by 

symptoms and treat by episode, the way we were with heart disease and 

cancer 30 years ago, to the point of understanding the underlying 

pathophysiology, that is, the biological mechanisms, of these illnesses, 

the way we do now for cancer. That will give us, as indicated on the 

next slide, both the biodiagnostics, biomarkers, and the treatments that 

really do go after the core pathology. 
21

The goal here is personalized care, just as it is for cancer. And what 

I would like to suggest is that we can actually for the first time envision 

what prevention would be like if it is strategic and what we call cure 

therapeutics. 

The bottom line is that the hopefulness comes from having the tools 

to be able to do that. We have those tools, and we have been using them 

in a very effective way for other brain disorders. We have been using 

them for cancer and heart disease. We can do this. That will be 

happening over the next 5 years. 

Finally, we need to find ways to translate those discoveries to 

practice, and that is going to be one of the great challenges we will face, 

even when we get the new tools that we currently use. We will have new 

discoveries, and that will make a major difference. 

I want to thank you again for having us to this subcommittee hearing. 

I think that your leadership in this area will be extraordinarily important 

for those millions of people who suffer with these brain disorders. For 

me, the bottom line is that through research we do have the opportunity 

to envision this moment of hope and we have opportunities that we have 

never had before in thinking about how to approach these illnesses. 

Thank you. 

[The prepared statement of Dr. Thomas Insel follows:] 

PREPARED STATEMENT OF DR. THOMAS INSEL, DIRECTOR, NATIONAL INSTITUTE OF 

MENTAL HEALTH, NATIONAL INSTITUTES OF HEALTH, U.S. DEPARTMENT OF HEALTH AND 

HUMAN SERVICES

 Chairman Deal, Ranking Member Brown, Mrs. Myrick and members of the 

Subcommittee: I am Thomas R. Insel, M.D., Director of the National Institute of Mental 

Health (NIMH), the component of the National Institutes of Health (NIH) of the 

Department of Health and Human Service (HHS) tasked with responsibility for 

developing improved methods of diagnosing, treating, and preventing mental disorders, 

including schizophrenia, autism, and mood and anxiety disorders. Thank you for giving 

us this opportunity to share our excitement about progress in understanding mental 

illnesses. 

 Mental illnesses are brain disorders, with specific symptoms rooted in abnormal 

patterns of brain activity; like other medical disorders, they are diagnosable, and they are 

treatable. This is critical, given the tremendous burden mental illnesses exert personally, 

socially and economically. Unlike most chronic medical disorders, mental disorders 

most often begin in adolescence and young adulthood. Without proper treatment they can 

devastate individuals and their families. Despite this dour background, there has been 

significant advancement in the science of mental illness. We have reliable diagnostic 

tools and effective medications and psychological therapies for depression and anxiety 

disorders; we have treatments that can predictably reduce the hallucinations and 

delusions of schizophrenia, as well as psychosocial interventions that enable people with 

disorder to remain in their communities, to work and lead productive lives. 

 We referred to the 1990s as the “Decade of the Brain,” based on a Congressional 

Resolution signed by President George H.W. Bush on July 17, 1990. It was a period of 

major growth in neuroscience, revolutionizing the way we think about the brain. We 
22

were able to demonstrate that mind and body cannot be separated, that mental activity 

can be represented as brain activity, and that a clear distinction cannot be made between 

mental events and neural events. One implication of this revolution is the recognition of 

mental disorders as brain disorders. 

 For example, studies of children who have the onset of a rare form of schizophrenia 

before age 14 show a marked change in brain structure. When they were initially seen in 

the clinic in the NIMH intramural program at about age eight or nine, they had already 

shown some thinning of the part of the brain called the cerebral cortex, compared to the 

cortical thickness of other eight- and nine-year-olds. Scans of their brains over the next 

five years demonstrated a profound loss of cerebral cortex relative to the brain scans of 

normal children of the same age. This provided strong evidence that childhood-onset 

schizophrenia involves loss of brain matter in a manner similar to other neurological or 

neurodegenerative disorders. The difference is that in most neurological disorders, such 

as Parkinson’s disease, there is a specific site of damage. But, schizophrenia, bipolar 

disorder, depression and autism seem to be disorders of networks, or circuits, rather than 

of specific cells identifiable by brain scan. 

NEW FINDINGS 

Genes and Neuroscience 

 Since mental disorders are brain disorders, we have been exploiting the power of 

genomics and neuroscience to solve the mysteries of the mind. The Human Genome 

Project in 2003 provided a full map of the 23,000 genes common to all humans. The 

next vital map, which has just become available in the past few months, comes from the 

International HapMap Project, whose goal is to chart all of the common points of 

variation in the human genome. This new map of variation should give us the clues for 

understanding how one person is susceptible to a mental disorder and another is resilient. 

Genetics and neuroscience together give us the tools for predicting risk, validating 

diagnosis, and identifying targets for new, more effective treatments. 

Gene-Environment Interactions

 We have learned that genes confer susceptibility; but environmental factors, such as 

the loss of a loved one, traumatic events, or physical attributes of the fetal environment, 

also exert a powerful influence on the development of mental illness. The complexity of 

this interaction is apparent in a serotonin gene that has been associated with depression. 

A particular segment of the gene comes in two forms; people with the “short” form are 

about two to three times more likely to get depressed when also faced with severe life 

stressors, such as death of a family member or loss of a job. Conversely, if a person has 

the other “long” form, they appear to be protected, even when faced with four or more 

severe life stressors. With the protective form, a person is actually no more likely to 

develop depression than if he had experienced none of those events. 

 Researchers are now asking how environmental factors during critical phases of 

development exert long-term effects on how and when genes are activated. Exploring 

how genes interact with the environment to result in a mental disorder such as depression 

is not much different from understanding how environmental toxins contribute to illness. 

However for mental disorders, the trigger may be stressful experiences, the exposure may 

only have an impact at specific stages of development and the effects may be limited to a 

narrow range of cells in the brain. 

Brain Systems 

 With the advent of neuroimaging, we can, for the first time, look at the activity of 

brain circuits during illness and map how activity changes during recovery. Advances in 

neuroimaging in the past 5 years have provided more detailed pictures and the ability to 

see events almost in real time. For instance, imaging has recently revealed that a brain 
23

region called Area 25 is important in depression. In depressed people, both volume and 

metabolic activity in this region are abnormal. As people recover from depression, 

activity in Area 25 undergoes significant changes. Whether the treatment is an 

antidepressant medication, behavioral therapy, or deep brain stimulation, recovery is 

associated with a reduction in the activity of this brain circuit. 

Clinical trials

 In addition to searching for new targets for treatments to help people in the future, 

we have been working to use current treatments more effectively, identifying those who 

will respond best to the treatments available now. Over the past seven years, NIMH has 

completed several practical clinical trials that are the largest and longest of their kind, 

involving more than 10,000 patients at more than 200 sites. These studies were designed 

to examine not only changes in symptoms but changes in functioning, to determine 

whether a treatment improves quality of life, care giving burden, or use of health 

services. 

 These studies have already demonstrated the effectiveness of antidepressant 

medication for adolescents with depression and the value of an off-patent, inexpensive 

antipsychotic medication for adults with chronic schizophrenia. These clinical trials are 

part of a rigorous effort to discover what therapies work best, and for whom. Current 

research is discovering how individual differences in biology could determine how that 

person reacts to a certain medication. Discovering these individual differences will help 

improve and personalize both diagnosis and treatment. For a person with mental illness, 

one can imagine that in the future a physician would perhaps use a memory task together 

with brain imaging and a genetics test to diagnose and select a specific treatment -- just as 

a contemporary cardiologist uses a stress test and echocardiogram to diagnose heart 

disease and select the proper treatment. 

THE FUTURE 

 It is critical to realize that this vision of personalized care does not mean designing 

exotic therapies for a few privileged patients. The ultimate goal is personalized care for 

the full spectrum of people with mental disorders. As researchers learn more about the 

brain mechanisms of mental disorders and related behavioral and environmental factors, 

treatments will become more specific. 

 These are some of the issues that will be addressed by the newest generation of 

NIMH researchers. In the 60 years of NIMH’s history, there has not been a more exciting 

time. We are on the verge of significant advances that will move us closer to predictive, 

preventive, and personalized mental health care grounded in research. 

 We are also striving to assure that evidence-based practices can be disseminated 

and delivered, so that people have access to treatment and services that are coordinated 

and effective. We are working within NIH to better integrate psychiatry with the rest of 

medicine, for they are inextricably linked: stress and depression are major risk factors for 

heart disease and other serious medical conditions. The mechanisms underlying these 

relationships are not yet clear, but integration will be a significant step toward improved 

care of the whole person by an effective treatment team. 

 I firmly believe we have made a great start in understanding mental illnesses and 

that in our lifetimes we will be able to treat and even prevent mental illnesses with much 

greater certainty and speed. This will restore productivity, make families whole, and 

eliminate many of the 30,000 suicide deaths each year. 

 Thank you for providing me the opportunity to discuss these issues with you. I will 

be happy to answer any questions you may have. 

MR. DEAL. Thank you. 
24

Dr. DePaulo. 

DR. DEPAULO. Chairman Deal, Representative Baldwin, 

Representative Myrick, thank you very much for holding these hearings 

and thank you for inviting all of us to speak this morning. 

I am Ray DePaulo, Professor and Chairman of the Department of 

Psychiatry at Johns Hopkins, and I have been lucky enough to focus my 

own clinical and research career on bipolar disorder and depression. And 

that is what I will focus my remarks on today. 

Because of this focus and the ability to do these sorts of things at a 

place like Johns Hopkins, I have now had the chance to see about 10,000 

patients with depression and bipolar disorder. 

I know from seeing them, but also from the research we have done 

on the brain and the genetics research I have participated in, that these 

are certainly brain diseases, as certainly as pneumonia and asthma are 

lung diseases. 

I am also confident that, as Dr. Insel has laid out for you, that 

research can illuminate the molecular pathways to these diseases and that 

those molecular pathways will provide for us a way to design better 

diagnoses, better treatments and attempt prevention. 

If I can show my first slide, I want to make a little bit of the case that 

depression, if you will, bipolar disorder and we can certainly say 

schizophrenia are the cancer of the 21st Century. Going back to the 

1960s when I was a medical student at Johns Hopkins, I can tell you, 

cancer was prevalent then, and it is certainly prevalent today. Both have 

a rate of somewhere in the range of 5 to 10 percent. Both of these 

diseases, as has been said several times, have great impact on families, 

not just the patients. 

Cancer was stigmatized, and depression still is. In 1960, there was 

very little support for research on cancer. It was a mysterious disorder, 

and people thought it was hopeless. Today, research on depression and 

other psychiatric disorders is still under-supported. Are they mysterious? 

Yes. Are they hopeless? Absolutely not. 

The cancer treatments in 1960 were not very effective, and they were 

very poorly understood. Our treatments for depression and bipolar 

disorder and schizophrenia today are fairly effective, not as effective as 

we would like and not as good as they should be, but they are very 

poorly understood. We don’t know why they work when they work and 

why they fail when they fail. 

Next slide. The World Health Organization has now included mental 

illnesses on its list of diseases to study around the world. They have 

shown that of the top ten causes of disability worldwide, five of them are 

mental disorders. Unipolar or major depression, that is, major depression 

is number one on their list. Alcoholism is number four. Bipolar disorder 
25

by itself is number six. Schizophrenia is number nine, and 

obsessive-compulsive disorder is ten. That is a very telling feature. 

They wouldn’t have seen that if they didn’t include these. 

The next slide. Another part from their study is to look at the ten 

leading causes of social burden in the developed countries, and again, I 

apologize that these are not easy to see, but four or five of these are 

clearly related to mental health. Unipolar depression again is number 

two. Road traffic accidents, which are highly involved with alcohol and 

alcoholism, are four and five on that list. Dementias due to Alzheimer’s 

and other diseases are number eight, and self-inflicted injuries are 

number nine on the causes of total social burden on society. 

You have also heard that depression by itself is an independent risk 

factor, an important one for heart attacks and for strokes. So these are 

medical diseases, and they lead to other medical diseases. 

The next slide, some numbers and again hard to read on your 

monitor, is that the ultimate cost of these disorders is, as Tom Insel has 

said, is suicide. 

Actually, what I think is the best population study of suicide ever 

done was done in a little town in Sweden where everybody was 

interviewed by psychiatrists three times 25 years apart. Over those 25 

years, they kept track of lots of things that happened to these people, 

including suicide. 

The good news is that 75 percent of the interviews had no psychiatric 

diagnosis, but the revealing thing is that suicide rates in people with any 

psychiatric disorder were ten times greater than the population rate. For 

those with bipolar disorder and depression, they were 80 times greater. 

So this is a dose response curve to show you the impact of these 

diseases. 

Let me conclude with my last slide and again talk about depression 

which I believe is the cancer of the 21st Century. It was cancer biology, 

the molecular biology of cancer, and epidemiology, that is population or 

public health studies, that illuminated the genetic and environmental 

pathways to cancer and have created logical treatment and prevention 

strategies for cancer. 

The cancer centers, very important, clinical cancer centers have 

conducted the largest and best done clinical trials of treatments that have 

ever been done in the world anywhere, and I am saying this because I 

think this is what our future should be in mental disorders as well. 

Depression biology is human brain biology, and as Dr. Insel has 

noted, that is now possible, and it is occurring, and we are in the early 

days, but it is occurring. What we need is to take those tools and turn 

them into what is called translational research. Translational research, a 

term that comes from cancer research by the way and the war on cancer, 
26

means developing new interventions, new diagnoses, markers, and 

treatments based on what we discover in the biology of the disorder. 

This is really required. 

So what do we need to do that? What we need to do is, certainly, 

yes, more research. That will require more funds, but it requires more 

than that. We also need more careers devoted to these disorders, and we 

need more public education. 

I really appreciate both the turnout here but also the statements that 

the Members have made that said that public education is a priority for 

all of us. 

As well, we do depend, because these are diseases, on the general 

progress of medical research, both at the level of molecules and at the 

level of public health. I want to thank you for the opportunity to testify 

today. 

[The prepared statement of Dr. Raymond DePaulo follows:] 

PREPARED STATEMENT OF DR. RAYMOND DEPAULO, DIRECTOR, DEPARTMENT OF 

PSYCHIATRY AND BEHAVIORAL SCIENCES, JOHNS HOPKINS UNIVERSITY SCHOOL OF 

MEDICINE

Representative Deal, Ranking Member Brown, Mrs. Myrick and the Members of the 

Health Subcommittee: I am Ray DePaulo, Henry Phipps Professor and Chairman of the 

Department of Psychiatry at The Johns Hopkins University School of Medicine. I’m 

pleased to be invited here to speak about mental illness and brain disease. I have spent 

the last 30 years as a clinician, research, and teacher at Johns Hopkins focused on 

Depression and Bipolar Disorder, which are two of the serious brain diseases referred to 

as “mental illnesses”. I will describe the prevalence and costs of these 2 conditions. I will 

explain why we are convinced that these are diseases of the brain (as surely as pneumonia 

and asthma are diseases of the lungs) and why I am confident that research will 

illuminate the molecular and structural pathways to these brain diseases and lead to much 

better ways to diagnose, treat and, in some cases, prevent these disabling diseases. 

Major depression and bipolar disorder make up what are called mood disorders. The 

most recent estimate is that about 10% of Americans (and about 5% of adolescents) have 

had at least one episode of depression in their lifetime (Kessler et al, 2005). Most will 

have multiple episodes of depression and one in 10 of them will have one or more severe 

manic episodes. When depressed, patients experience a low, anxious, or apathetic 

change in their mood, inability to enjoy things that normally give them satisfaction or 

pleasure, a loss of energy, reduced ability to sustain attention & concentration, as well as 

a very negative change in their view of themselves and of the future. These symptoms, if 

untreated, last for several weeks up to a few years and like asthma or epilepsy once 

begun, they tend to recur. Most worrisome, patients with severe depressions often 

contemplate or attempt suicide. Of those who complete suicide most have depression and 

90% have one or more diagnosable mental disorders based on information gathered about 

them prior to the suicide. Before he served in Congress, Abraham Lincoln had 2 welldocumented periods of depression (or melancholia as it was called then). During these 2 

periods, each lasting several months, he was taken in by relatives on a farm in Kentucky 

where someone was always with him to keep him from throwing himself into the river. 

But everyone has moods and some must be worse than others. Why do we say that 

clinical forms of depression, namely major depression and bipolar disorder are brain 

diseases? As defined in Webster’s dictionary, a disease is a set of clinical symptoms that 
27

are directly attributable to an abnormal body part (called pathology). The part of the 

brain that is malfunctioning in depression is not a single spot but a set of circuits in the 

brain in the frontal areas that are known because of both modern brain imaging methods 

show this (Mayberg et al , 2005; Drevets et al, 1997; House et al, 2000) but also from the 

known brain lesions of Parkinson’s Disease and of stroke. Over half of patients with 

Parkinson’s disease (which injures the basal ganglia in the subcortical regions of the 

frontal lobes) experience episodes of depression after their Parkinson’s disease onsets and 

in stroke patients; the likelihood of clinical depression in the immediate aftermath is 

related to which area of the brain is injured by the stroke. Most cases of depression 

though are not caused by direct injuries to the brain, but by a combination of genetic and 

environmental factors that affect the structure and function of key circuits in the frontal 

areas of the brain. In this sense, depression is like asthma, it’s largely genetic in origins 

but its exacerbations are usually caused by changes in the environment. For asthma 

patients this is often dust or pollen while for depressed patients psychological stressors 

are the most frequent environmental triggers. For asthma patients, when a severe attack 

occurs, removal of the dust or pollen is not sufficient therapy; medical treatment is 

needed to bring the patient back to normal breathing. Severe depression it is the same, 

the patient will need counseling and medications usually to achieve a remission sufficient 

to return to functioning. And longer term treatment between episodes is needed for many 

patients with asthma and with depression. Because we cannot as physicians control the 

flow of pollen or psychological stresses (which by themselves are not bad things for most 

people) it is important that we find the genes whose malfunction is ground zero on the 

pathway to these diseases. In depression because we don’t understand why our 

medications help when they do help and why they fail in other cases, we need the 

molecular clues that genes can provide to make our treatments more effective. Genes 

which are molecules of DNA direct cells to make particular proteins. The proteins make 

up the structure of brain cells, brain pathways and circuits, and when they malfunction 

they make the brain vulnerable to stresses which can set off episodes of psychiatric 

illnesses such as depression. Understanding how this works can’t help but make us 

better at making diagnoses and giving the right treatments to the right patients. The 

molecular formulas should tell us much about which patients will respond to which of 

today’s treatments and which will not. They should also guide us to create new 

treatments which would be “engineered” rationally based on knowledge of what is wrong 

in the brain, not just in the emotions or behavior of the patient. 

Depression and bipolar disorders are common diseases like cancer and like cancer 

they have many different forms caused by several different genes and several distinct 

environmental toxins acting in combination. Like cancer, therefore, the big 

breakthroughs will not be cheap or easy and we can expect challenges at many steps. 

The War on Cancer was the right decision by Congress at the right time (1971) and it has 

led to a great deal of progress so that cancer deaths are finally falling and many forms of 

cancer are now detected early and cured and even severe cancers can be managed much 

better than they were 35 years ago. The key breakthrough that made the war on cancer 

possible was the discovery of the genetic code (called codons) which allowed 

pathologists who looked at tumors under the microscope see where the cellular 

mechanisms went astray, in the DNA, the RNA, or at the protein level itself. Thus 

pathologists and cancer experts could “interrogate” the tumors. However this technology 

was not sufficient to allow us to interrogate the living brain. Now with the genome 

project largely completed and the brain imaging methods progressing (and incorporating 

the imaging of proteins in the brain) we can now see how we might look into the 

mechanisms of depression like we have illuminated so much of the pathway to various 

forms of cancer. And as we have done with cancer patients, we now are much better at 

predicting which patients will respond to old treatments (radiation and hormonal 

manipulations) and we have also devised many new treatment strategies (immune 
28

therapies and new less toxic chemotherapies) that we never imagined before the 

molecular war on cancer was begun. 

 This description of depression (and Bipolar disorder) as today’s “cancer” is very 

appropriate. When I started medical school at Johns Hopkins in 1968, there were only 4 

cancer doctors on the staff. Cancer was a word that many doctors would not utter to their 

patients with cancer for fear of the stigma. Patients who were admitted with late 

“metastatic” cancers were often put in the room farthest from the doctors and nurses, not 

because the doctors or nurses didn’t like them, but because they didn’t know what to say 

and they thought there was nothing useful that they could do. Today, we understand 

cancer and although it is still a serious and often fatal condition there is no sense of 

cancer as a death sentence or as a stigma on the family whose relative suffers from it. At 

Johns Hopkins now there are over 200 cancer doctors and now 3 cancer buildings, 

reflecting the progress and the optimism we have about further progress in cancer. It has 

not been cheap or easy going. Cancer has not been eradicated and may never be fully 

eradicated but no one can deny the progress and the difference it has made to patients, 

families, and to society. We understand it so much better and, therefore, we are 

continuing to find new ways to prevent it, to detect it early, to cure it, and to make life 

meaningful and substantial as we manage some forms of it now as a chronic disease 

rather than as a death sentence. 

The World Health Organization global burden of disease study has demonstrated 

that depression is the leading cause of disability world wide and that 5 of the top ten 

causes of disability are psychiatric disorders (depression, alcoholism, bipolar disorder, 

obsessive compulsive disorder, and schizophrenia). It has predicted that by 2020 

depression will be “the second most debilitating disease worldwide, after ischemic heart 

disease, and one of the leading causes of death, as suicide takes more lives than traffic 

accidents, lung disease, or AIDS.” Cardiovascular disease receives the largest amount of 

government funding, 25 percent; diabetes gets about 8 percent and cancer a little over 6 

percent, while all mental illnesses (which includes all of the conditions noted by the 

W.H.O. and many more) receives only 4 percent. 

 Of those who suffer from depression year, approximately 74% (or 7.8 million) of 

them are in the workforce. This has numerous implications as far as the potential 

strength of our economy, should this group of individuals have access to the mental 

health care they require. Furthermore, workers with depression have a much higher rate 

of missed days than their healthy counterparts. On average, depression accounts for a 2.5 

fold increase in the probability of missing work as a result of their illness (Langlieb and 

Kahn 2005). In 2000, depression alone was estimated to cost the US economy $83.1 

billion each year , most of it due to absenteeism and decreased productivity at work 

(Greenberg et al 2003). 

The issue of mental health care is particularly timely as our nation is in the midst of 

the War on Terrorism. The primary goal of terrorism is not simply kill Americans, which 

can be done only on a small scale by our adversaries. The goal is to wage psychological 

war that will sap our citizen’s morale and confidence in our civilization. Although 

depression and many forms of anxiety disorders have strong genetic components they 

also have strong environmental triggers. The events of September 11, 2001 created an 

enormous amount of mental anguish for those working in and living around the World 

Trade Center and the Pentagon. Numerous studies were published soon after these events 

describing both civilian and military response to these unspeakable attacks. Among of 

the 1008 adults randomly telephoned who reside near the World Trade Center, “9.7 

percent reported symptoms consistent with current depression” (Galea et al 2002: 982). 

In a study on civilian and military employees of the Pentagon, 17.7 percent of 

respondents reported depressive symptoms following the attack events of 9/11 (Jordan et 

al 2004). This rate is higher when you examine the experiences of military personnel 

returning from the war in Iraq. When examined for mental health following deployment 
29

to Iraq, 19.1 percent of those questioned screened positive for depression (Hoge et al 

2006). These numbers indicate a strong need for mental health care among those 

indirectly and directly affected by the events on and following September 11, 2001. It 

should be noted, as well, that a recent article in the New York Times reported an 

epidemic of depression and post-traumatic stress disorders in New Orleans following 

Hurricane Katrina. This mental health epidemic has lead to a three-fold increase in the 

suicide rate from that before the hurricane (Saulny 2006). Lack of resources in this area 

is compounding the problem and greatly taxing local mental health experts. 

 The need for research on disorders of mood disorders (and the other mental 

disorders as outlined by Dr Insel) is vital for our troops and to all American citizens. 

About 15 million people (10 million women and 5 million men) in the United States at 

any given time have major depression or some form of manic depression. The 

prevalence for depression runs very high, as do the costs to the individual and the country 

as a whole. It is imperative that we invest more time and money towards this “Cancer of 

the 21st Century,” so that treatments can lead to cures and hopes into reality. 

References 

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can do about it. New York: John Wiley & Sons, Inc, 2002. 

Dinos, S., Stevens, S., Serfaty, M., Weich, S., King, M. Stigma: The feelings and 

experiences of 46 people with mental illness. British Journal of Psychiatry 184:176-181, 

2004. 

Fenton, W.S., Stover, E.S. Mood Disorders: Cardiovascular and diabetes comorbidity. 

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Psychological Sequele of the September 11 Terrorist Attacks in New York City. The New 

England Journal of Medicine 346: 932-987, 2002. 

Greenberg, P.E., Kessler, R.C., Birnbaum, H.G., Leong, S.A., Lowe, S.W., Berglund, 

P.A., Corey-Lisle, P.K. The economic burden of depression in the United States: how did 

it change between 1990 and 2000? Journal of Clinical Psychiatry 64:1465-75, 2003. 

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MR. DEAL. Thank you. 

Dr. Jamison. 

DR. JAMISON. Yes, I am delighted to be here. Thank you, 

Mr. Chairman. Thank you, Ms. Myrick. Someone called her a great 

agitator. She is a great agitator and a wonderful human being who has 

been very supportive of mental health causes. 

My name is Kay Redfield Jamison, and I am a Professor of 

Psychiatry at the Johns Hopkins School of Medicine. My clinical and 

research interests lie in the study of mood disorders, especially bipolar 

disorder, and in the study and prevention of suicide. 

My written testimony includes some basic information about bipolar 

disorder, but I am here really to talk about my own experiences with 

manic depressive illness and to strongly advocate for increased research 

funding. 

Although we know much more about this illness than even 5 years 

ago, thanks in significant measure to the excellent research efforts of 

NIMH, there is far too much we do not know. Only an aggressive and 

concerted effort to study the underlying causes of bipolar illness, 

particularly genetics, will result in earlier and more accurate diagnosis 

and better treatment. 

But I would like to speak now at a more personal level. Like most 

people, I had absolutely no reason to expect that I would become so 

seriously, so terribly mentally ill. I certainly had no preparation for 

insanity. No one does. I came from a military and very traditional 
31

family, and although I have a very extensive family history of bipolar 

illness, nobody in my family talked about it. 

I had a healthy, active, and very happy childhood and adolescence. I 

loved school and did well at it. I loved sports, was a school leader and 

captain of all my teams. Then in my senior year of high school, after a 

period of much, much, much enthusiasm and not much sleep, I became 

deeply depressed, suicidal, and psychotic. I had never thought of suicide 

or death before, and now I thought of little else. For much of each day, 

during several months of my senior year in high school, I thought about 

when, whether, and how to kill myself. 

Over the years, my manic-depressive illness became much, much 

worse, and the reality of dying young from suicide became a dangerous 

undertow in my dealings with life. Then when I was 28 years old, after a 

particularly damaging and psychotic mania followed in turn by a 

particularly prolonged and violent siege of depression, I took a massive 

and, because I was a lithium researcher, what I knew to be a lethal 

overdose of lithium. I unambivalently wanted to die. I nearly did die. I 

was in a coma for many days. 

Yet I have been fortunate. My illness responds very well to lithium, 

and I have been well for more than 20 years. I have had the best medical 

care available. I have had access to that care, and I have been able to 

afford to pay for that care. Most people cannot. 

My family, friends, and colleagues have been surpassingly 

supportive. Most people are not so lucky. I would like to end with a few 

beliefs and a few concerns. 

As a clinician, I believe there are treatments that can and do save 

lives. As one surrounded by scientists whose explorations of the brain 

are eloquent and profound, I believe that our basic understanding of the 

brain’s biology is radically changing how we think about both mental 

illness and suicide. As a teacher of young doctors and graduate students, 

I feel the future holds great promise for the intelligent and compassionate 

care of the seriously mentally ill. 

Still, the effort to develop new treatments for severe mental illness 

and to prevent suicide seem to me to be remarkably unhurried. Every 17 

minutes in America, someone commits suicide. Where is the public 

outrage? Where is the public concern? I have become more impatient in 

recent years, and I didn’t start off particularly patient, and I am more 

acutely aware of the problems that stand in the way of denting the death 

count. I cannot rid my mind of the desolation, confusion, and guilt I 

have seen in the parents, children, friends, and colleagues of those who 

kill themselves. Nor can I shut out the images of the autopsy photos I 

have seen of 12-year-old children or the prom photographs of teenagers 
32

who will within a year’s time put a pistol in their mouths or jump from 

the top floor of a university dormitory building. 

Looking at suicide, the sheer numbers, the pain leading up to it, and 

the suffering left behind, is harrowing. For every moment of education 

and exhilaration in the science or in the success of governments, there is 

the matching and terrible reality of the deaths themselves: the young 

deaths, the violent deaths, the terribly unnecessary deaths. 

Like many of my colleagues who study mental illness and suicide, I 

have seen time and again the limitations of our science. I have been 

privileged to see how good some doctors are and dismayed by the 

incompetence of others. Mostly, I have been impressed by how little 

value our society puts upon saving the lives of those who are in such 

despair as to want to end them. 

It is a societal illusion that suicide is rare. It is not rare. Certainly 

the mental illnesses most closely tied to suicide are not rare. They are 

common conditions. And unlike cancer and heart disease, they 

disproportionately affect and kill the young. The tens of millions of 

Americans who suffer from mental illness deserve compassion and good 

science. The diseases from which they suffer deserve to be given the 

kind of research funding commensurate with the pain and death they 

cause. In short, they deserve action. 

Thank you. 

[The prepared statement of Dr. Kay Jamison follows:] 

PREPARED STATEMENT OF DR. KAY JAMISON, AUTHOR AND FOUNDER, UCLA AFFECTIVE 

DISORDERS CLINIC

Good morning. My name is Kay Redfield Jamison and I am a professor of 

psychiatry at the Johns Hopkins School of Medicine and co–director of the Johns 

Hopkins Mood Disorders Center. I received my Ph.D. from the University of California, 

Los Angeles in clinical psychology, with a specialization in psychopharmacology. My 

clinical research interests lie in the study and treatment of mood disorders ─ depression 

and bipolar disorder─and in the study and prevention of suicide. I have also studied 

creativity and literature and have an appointment as Honorary Professor of English at the 

University of St. Andrews in Scotland. I am here today to speak about my own 

experiences with manic–depressive illness, also called bipolar disorder, and to strongly 

advocate for increased research funding for psychiatric illnesses. Before turning to my 

own experiences, I would like to give a very brief overview of what we know about 

bipolar disorder. 

 Manic–depression, or bipolar disorder, is a painful, common, and potentially lethal 

disorder of mood, thinking, energy, and sleep. It ranges tremendously in severity, from 

relatively mild expressions to extremely severe, life–threatening and psychotic forms of 

the illness. The depressive phase — like depression itself — is characterized by a 

profound lack of energy, apathy, hopelessness, sleeping far too much or far too little, 

difficulties in thinking, and a loss of pleasure in life. Suicidal and morbid thoughts, as 

well as undue guilt, are common. 

 The manic phase is characterized by symptoms in many ways the opposite of those 

seen in depression. Mood is elevated and expansive, or paranoid and irritable; activity 
33

and energy levels are greatly increased; the need for sleep is decreased; speech is fast and 

excitable, and thinking is very rapid. Other common features of mania are spending large 

amounts of money, impulsive involvement in questionable endeavors, impatience, and 

volatility. In its extreme forms mania is characterized by violent agitation, bizarre 

behavior, delusional thinking, and hallucinations. 

 What, briefly, do we know about the causes, correlates, and treatment of bipolar 

illness? First, we know it is genetic. It runs in families. The scientific evidence that 

bipolar disorder is biological is indisputable. We also know also that the illness is 

potentially lethal. The mortality rate is very high. The suicide rate in untreated, severe 

bipolar illness is 10–15%; 25–50% of people with the disorder will attempt suicide at 

least once. It has been estimated that at least 70% of the adolescents who commit suicide 

suffered from a potentially treatable, major mood disorder. 

 Bipolar illness, like virtually all of the major psychiatric disorders, is an illness of 

youth; that is, the illness most frequently first occurs in late adolescence or the early 

twenties. The average age of onset is about 18 years. Men and women are equally liable 

to bipolar disorder, and alcohol and drug abuse are common. The illness is recurrent and, 

if not treated, is often progressive; that is, it will tend to worsen over time. About one 

percent of the population will develop the more severe form of bipolar illness; perhaps 

two to three percent will have milder forms. 

 Finally, and most important, bipolar illness is treatable. Most patients will respond 

to lithium, anticonvulsants, or a combination of anticonvulsants, lithium, and 

antipsychotic medications. Unfortunately, and unfairly, many people do not have access 

to good medical care, nor can they afford to pay for the medications that have been 

prescribed for them. 

 Although we know much more about this illness than we did even five years ago — 

thanks in significant measure to the excellent research efforts of the National Institute of 

Mental Health—there is far too much we do not know. Only an aggressive and concerted 

effort to study the underlying causes of bipolar illness will result in earlier and more 

accurate diagnosis and better, less problematic treatments. 

 I would like to speak now at a more personal level. Like most people, I had no 

reason to expect that I would become so seriously, so terribly mentally ill. I certainly had 

no preparation for insanity. I came from a military and traditional family and, although I 

had a very extensive family history of bipolar illness, no one talked about it. I had a 

healthy, active, and very happy childhood and adolescence. I loved school and did well 

at it, loved sports, was a school leader, and captain of all of my teams. 

 Then, in my senior year of high school, after a period of much enthusiasm and not 

much sleep, I became deeply depressed, suicidal, and psychotic. I had never thought of 

suicide before; now I thought of little else. For much of each day during several months 

of my senior year in high school, I thought about when, whether, where, and how to kill 

myself. I learned to present to others a face at variance with my mind; ferreted out the 

location of two or three nearby tall buildings with unprotected stairwells; discovered the 

fastest flows of morning traffic; and learned how to load my father’s gun. 

 The rest of my life at the time — sports, classes, writing, friends, planning for 

college — fell fast into a black night. Everything seemed a ridiculous charade to endure; 

a hollow existence to fake one’s way through as best one could. But, gradually, layer by 

layer, the depression lifted, and, by the time my senior prom and graduation came around, 

I had been well for months. Suicide had withdrawn to the back squares of the board and 

become, once again, simply unthinkable. 

 Over the years, my manic–depressive illness became much, much worse, and the 

reality of dying young from suicide became a dangerous undertow in my dealings with 

life. Then, when I was twenty–eight years old, after a particularly damaging and 

psychotic mania, followed, in turn, by a particularly prolonged and violent siege of 

depression, I took a massive, and what I knew to be a lethal overdose of lithium. I 
34

unambivalently wanted to die, and nearly did. Death from suicide had become a 

possibility, if not probability, in my life. 

 Yet I have been fortunate. My illness responds very well to lithium and I have been 

well for more than twenty years. I have had the best medical care available and I have 

been able to afford to pay for it. My family, friends and colleagues have been 

surpassingly supportive; most people are not so lucky. 

 I would like to end with a few beliefs and concerns. As a clinician, I believe there 

are treatments that can save lives; as one surrounded by scientists whose explorations of 

the brain are elegant and profound, I believe that our basic understanding of the brain’s 

biology is radically changing how we think about both mental illness and suicide; and, as 

a teacher of young doctors and graduate students, I feel the future holds out great promise 

for the intelligent and compassionate care of the seriously mentally ill. 

 Still, the effort to develop new treatments for severe mental illness and to prevent 

suicide seems remarkably unhurried. Every seventeen minutes in America, someone 

commits suicide. Where is the public concern and outrage? I have become more 

impatient in recent years, and am more acutely aware of the problems that stand in the 

way of denting the death count. I cannot rid my mind of the desolation, confusion, and 

guilt I have seen in the parents, children, friends, and colleagues of those who kill 

themselves. Nor can I shut out the images of the autopsy photographs of twelve–year–

old children, or the prom photographs of adolescents who within a year’s time will put a 

pistol in their mouths or jump from the top floor of a university dormitory building. 

Looking at suicide — the sheer numbers, the pain leading up to it, and the suffering left 

behind — is harrowing. For every moment of celebration for the science, or in the 

success of governments, there is a matching and terrible reality of the deaths themselves: 

the young deaths, the violent deaths, the unnecessary deaths. 

 Like many of my colleagues who study mental illness and suicide, I have seen time 

and again the limitations of our science, been privileged to see how good some doctors 

are, and dismayed by the incompetence of others. Mostly, I have been impressed by how 

little value our society puts upon saving the lives of those who are in such despair as to 

want to end them. It is a societal illusion that suicide is rare. It is not. Certainly the 

mental illnesses most closely tied to suicide are not rare. They are common conditions, 

and, unlike cancer and heart disease, they disproportionately affect and kill the young. 

The tens of millions of Americans who suffer from mental illness deserve compassion 

and good science. The diseases from which they suffer deserve to be given the kind of 

research funding commensurate with the pain and death they cause. In short, they deserve 

action. 

Attachment: Biographical sketch 

Kay Redfield Jamison

 Kay Redfield Jamison is Professor of Psychiatry at the Johns Hopkins University 

School of Medicine and co-director of the Johns Hopkins Mood Disorders Center. She is 

also Honorary Professor of English at the University of St. Andrews in Scotland. She is 

the coauthor of the standard medical text on manic-depressive illness, which was chosen 

in 1990 as the Most Outstanding Book in Biomedical Sciences by the American 

Association of Publishers, and author of Touched with Fire, An Unquiet Mind, Night 

Falls Fast, and Exuberance. Her memoir about her experiences with manic-depressive 

illness, An Unquiet Mind, was cited by several major publications as one of the best 

books of 1995. An Unquiet Mind was on The New York Times Bestseller List for more 

than five months and translated into twenty languages. Night Falls Fast: Understanding 

Suicide was a national bestseller, translated into fifteen languages, and selected by The 

New York Times as a Notable Book of 1999. Her most recent book, Exuberance: The 
35

Passion for Life, was selected by The Washington Post, The Seattle Times, and The San 

Francisco Chronicle as one of the best books of 2004 and by Discover magazine as one 

of the best science books of the year. 

 Dr. Jamison did her undergraduate and doctoral studies at the University of 

California, Los Angeles where she was a National Science Foundation Research Fellow, 

University of California Cook Scholar, John F. Kennedy Scholar, United States Public 

Health Service Pre-doctoral Research Fellow, and UCLA Graduate Woman of the Year. 

She also studied zoology and neurophysiology at the University of St. Andrews in 

Scotland. 

 Dr. Jamison, formerly the director of the UCLA Affective Disorders Clinic, was 

selected as UCLA Woman of Science and has been cited as one of the “Best Doctors in 

the United States”. She is recipient of the American Suicide Foundation Research 

Award, the UCLA Distinguished Alumnus Award, the UCLA Award for Creative 

Excellence, the Siena Medal, the Endowment Award from the Massachusetts General 

Hospital/Harvard Medical School, the Fawcett Humanitarian Award from the National 

Depressive and Manic-Depressive Association, the Steven V. Logan Award for Research 

into Brain Disorders from the National Alliance for the Mentally Ill, the William Styron 

Award from the National Mental Health Association, the Falcone Prize for Research in 

Affective Illness from the National Alliance for Research on Schizophrenia and 

Depression, and the Yale University McGovern Award for excellence in medical 

communication. She has been awarded numerous honorary degrees, selected as one of 

five individuals for the public television series “Great Minds of Medicine”, and chosen 

by Time magazine as a “Hero of Medicine”. She was Distinguished Lecturer at Harvard 

University in 2002 and the Litchfield Lecturer at the University of Oxford in 2003. She is 

the recipient of a MacArthur Award. 

 Dr. Jamison was a member of the first National Advisory Council for Human 

Genome Research. She is Senior Scientific Consultant to the Dana Foundation and Chair 

of the Genome Action Coalition, an alliance of more than 140 patient groups, 

pharmaceutical corporations, and biotechnology companies. She also serves on the 

National Committee for Basic Sciences at UCLA and is the executive producer and 

writer for a series of award-winning public television specials about manic-depressive 

illness and the arts. 

MR. DEAL. Unfortunately, those bells mean we have another vote on 

the floor. People are playing games this morning. We have a motion 

that the committee rise that we have to go vote on. 

Dr. Gooding, rather than try to hurry your testimony, we will go vote 

and come back and resume with your testimony after we return. 

[Recess.] 

MR. DEAL. The hearing will reconvene. 

Dr. Gooding.

DR. GOODING. Thank you. Good morning, Chairman Deal and 

members of the subcommittee. 

My name is Diane Gooding, Associate Professor of Psychology and 

Psychiatry at the University of Wisconsin, Madison. 

My primary areas of research are identifying and validating 

indicators of heightened risk for schizophrenia and then identifying and 

studying at-risk individuals. While summarizing current schizophrenia 

research, I would like to illustrate the ways in which focusing on genetic 
36

markers at risk for schizophrenia can help us to better understand and 

combat this devastating mental disorder. 

Although there are currently some palliative treatments for 

schizophrenia, the specific biological mechanisms underlying the 

disorder are currently unknown, and the goals of schizophrenia research 

are focused on identifying the pathophysiology and etiology of the 

disorder and eventually preventing the disorder. 

Contrary to earlier notions about schizophrenia, it is not due to bad 

parenting or personal failure. Schizophrenia is an equal opportunity 

disorder. It affects people of all socioeconomic groups, ethnicities, and 

races. 

The typical age of risk is between late adolescence and early 

adulthood, and the consensus right now is that schizophrenia is a 

genetically mediated neurodevelopmental disease. We know that genes 

are necessary but not sufficient for the development of schizophrenia. 

As a group, people with schizophrenia differ from healthy people in 

terms of their neurocognitive performance. People with schizophrenia 

show impairments in terms of executive functioning. For example, 

attention, inhibition, response planning, different types of memory, eye 

movements, information processing, and sensory gating. 

We know that some of these neurocognitive impairments have the 

following characteristics: The ones that we see in schizophrenia in 

disproportionate numbers are relatively rare in the general population. 

They are heritable, and they are stable over time. 

In the schizophrenia patients, these abnormalities are present during 

acute episodes as well as during symptom remission, and they are 

independent of medication status and chronicity. Also, these same 

abnormalities are present in higher proportions of the clinically 

unaffected biological relatives of the patients. 

When neurocognitive impairments have all of these characteristics, 

we consider them to be markers of a genetic liability for schizophrenia, 

and we call markers of genetic liability endophenotypes. 

It is really exciting right now in research because we are making a lot 

of progress in terms of identifying such endophenotypes. Examples 

would be eye-tracking abnormalities, working memory impairments, and 

sensory gating deficits. 

Why would we want to study these? What are the advantages? 

Because these endophenotypes, these markers of genetic risk, are closer 

in the etiologic chain than symptoms, these markers can be an invaluable 

aid in the genetic dissection of the disorder. Currently, we know that 

genes are involved, but we don’t know which genes are involved, how 

many genes need to be present, and how they affect brain development. 
37

We also know that not everyone at heightened risk for schizophrenia 

goes on to manifest the disorder, so we can study endophenotypes to 

identify those individuals of heightened risk and study them over time, 

follow them to try to figure out why among the vulnerable individuals 

some of them succumb to the disorder and others are spared. 

Moreover, we can use the study of endophenotypes to investigate 

whether certain indicators that have predictive validity at the population 

level also have predictive validity at the individual level. 

We know that palliative treatment of schizophrenia can lead to 

considerable improvements in terms of quality of life, ability to live and 

work in the community, and studies indicate that the shorter the duration 

of untreated psychosis, the better the chances for more positive outcome. 

Currently, there are research projects that attempt to intervene with 

individuals who show schizophrenia-like functional deficits early on but 

have not yet experienced psychotic symptoms. The goals of these early 

intervention programs are to detect early on emerging psychosis, to 

intervene to prevent further development of disfunction, psychological 

disfunction, to delay the onset of disorder if you can’t prevent the further 

development of it and to reduce treatment delay at the first episode. 

How do they get people into these studies? Well, it is based on an 

accumulation of risk factors, and they use a statistical risk-oriented 

approach, but we still don’t know who our target population should be 

for these prodromal studies, and this is where markers can come in. 

Also, through the use of risk factors and endophenotypes, we would 

know which ones are the best screening tools for inclusion into these 

early trials and how soon we should be including people. So at this 

point, we know that schizophrenia is a genetic disorder, and we are 

investigating the different neurocognitive impairments to identify the 

biological underpinnings of the disorder. 

It is gratifying to participate in dispelling myths about schizophrenia 

and then educating the public about the disorder. 

Chairman Deal, thank you for the opportunity to provide testimony 

to the committee on this important health topic. 

And thank you, Representative Sue Myrick and Representative 

Tammy Baldwin, for your ongoing support of research and education in 

improving the lives of people with mental illness. 

[The prepared statement of Dr. Diane C. Gooding follows:] 

PREPARED STATEMENT OF DR. DIANE C. GOODING, ASSOCIATE PROFESSOR OF 

PSYCHOLOGY AND PSYCHIATRY, UNIVERSITY OF WISCONSIN

Introduction 

Good morning, Chairman Deal, Chairman Barton, and members of the 

Subcommittee. Thank you for inviting me here today to provide testimony on the 

biological basis of schizophrenia. My name is Diane Gooding, Associate Professor of 
38

Psychology and Psychiatry at the University of Wisconsin-Madison. My primary areas 

of research are: identifying and validating indicators of heightened risk for schizophrenia 

and related conditions and identifying and studying individuals putatively at heightened 

risk for the disorder. 

Defining schizophrenia

Schizophrenia is one of the most severe forms of psychopathology. It is a disorder 

that affects one’s thoughts, feelings, goal-directed behaviors, social functioning, and even 

one’s self-care. Since the early observations of Kraepelin [1896] and Bleuler [1911], 

schizophrenia has been regarded as a primarily cognitive disorder of neurobiological 

origin. It is an equal opportunity disorder, affecting individuals of all races, ethnicities, 

and socioeconomic strata. Although its prevalence is relatively low (1.1% of population 

aged 18 and older; APA, 2000), clinicians and researchers often regard schizophrenia as 

the “cancer of the mental illnesses” due to its severity, chronicity, societal costs, and 

personal costs to affected individuals and their loved ones. Clearly, schizophrenia is an 

important public health concern. Although there are some palliative treatments for 

schizophrenia, the mechanisms underlying the disorder remain unknown. If the long term 

goal is to prevent schizophrenia, then an intermediate goal would be to identify the 

pathophysiology and etiology of the disorder. 

Diagnosing schizophrenia

There is no direct measure of the neuropathology of schizophrenia at present. 

Currently, the diagnosis of schizophrenia is made on the basis of symptoms, which are 

inferred based on the individuals’ language and behaviors. There are symptoms which 

represent an exaggeration of normal functions, such as hallucinations, the false 

perception of sensory experiences (such as hearing voices, or seeing things that aren’t 

there) and delusions, which are false beliefs that are persistent, unusual, and unshakable. 

Although most of the general public is aware of the florid symptoms of delusions and 

hallucinations, they have less aware of the symptoms of schizophrenia which represent 

the absence of normal functions and behaviors. These symptoms include 

amotivation/avolition (loss of motivation), anhedonia (loss of pleasure), alogia (reduced 

speech), affective impairments (such as loss or restriction of emotional display) and 

attentional impairment. The clinical picture of schizophrenia varies from patient to 

patient. Not all individuals with schizophrenia have the same constellation of symptoms 

and not all have the same severity of impairment. Despite the apparent heterogeneity of 

schizophrenia, there is a core underlying deficit; the core deficit in schizophrenia is a 

cognitive one. 

The genetic basis of schizophrenia

Schizophrenia is not the result of the way in which a person is raised, nor is it the 

result of a personal weakness or failure on behalf of the affected person. Contrary to 

earlier notions about the causes of schizophrenia (e.g., the schizophrenogenic, 

ambivalent mother) schizophrenia is a genetically-based brain disorder. Family studies 

indicate that individuals who are biologically related to a person with schizophrenia are at 

much higher risk for developing schizophrenia. The risk of developing schizophrenia for 

a person who is related to someone with schizophrenia increases as a function of how 

many genes they share in common. 

The role of genes in schizophrenia has been demonstrated by twin and adoption 

studies. In order to estimate the extent of the genetic component of any trait or 

disease,twin studies compare the concordance rate, or the likelihood of both twins having 

the same illness, between monozygotic (identical) and dizygotic (fraternal) twins. The 

greater the monozygotic twin concordance compared to the dizygotic concordance, the 

greater the inherited component. The risk for schizophrenia for a co-twin of a 
39

schizophrenia patient is significantly higher (46 - 58%) for an identical (monozygotic) 

twin than for fraternal (dizygotic) twins (15%). Adoption studies demonstrate that a 

shared genetic component, rather than shared familial environment, contributes to 

susceptibility for schizophrenia. Adoption studies indicate that adopted-away biological 

offspring of schizophrenia patients are also at heightened risk for schizophrenia. These 

studies indicate that it’s shared genes, not shared environments, that underlie the 

increased risk of schizophrenia in relatives of individuals with schizophrenia. 

Genes account for approximately 68 to 85% of the underlying risk for schizophrenia 

(McGuffin et al., l995). The consensus is that genetic factors that cause schizophrenia 

are necessary but not sufficient for the development of schizophrenia. One doesn’t 

inherit schizophrenia; one inherits susceptibility to schizophrenia. Environmental risk 

factors are also important, and the genetic and environmental factors may interact. 

Nearly all of the theories of the genetic basis of schizophrenia are based on what we call 

a diathesis-stress model. In a diathesis-stress model there’s a diathesis (or susceptibility) 

which is biological in nature. The manifestation of that diathesis is triggered by a 

stressor, which may be environmental (pregnancy and birth complications, early 

childhood brain damage such as ischemic attacks/hypoxia, early exposure to viral agents, 

use of psychoactive substances such as cannabis or amphetamines, or psychosocial 

stress). 

In a complex disorder such as schizophrenia, there are likely to be many genes that 

are involved in predisposing people to the disorder. The genes may affect brain 

development, they may affect neurotransmitter systems, or they may affect individuals at 

both these levels. Investigators and theorists differ in terms of the number of genes that 

they believe are likely to be implicated in the underlying diathesis for schizophrenia. 

While we can conclude that there’s a strong genetic basis for schizophrenia, we have 

not yet identified the genes that are implicated. We are hopeful that new molecular 

techniques and modern statistical analyses can allow us to focus in on particular genes 

that confer risk to schizophrenia. The more genes that are associated with the disorder, 

the harder it will be to replicate associations between the disease and a given gene. 

However the search for “schizophrenia risk genes” has been made more difficult by the 

fact that at present most researchers rely upon the presence of symptoms (disease 

phenotype) to identify individuals who are most likely to possess the genetic diathesis 

(genotype). Indeed, progress in this area is stymied by the phenotypic heterogeneity of 

the disorder, i.e., the diversity in clinical presentation of the disorder, as well as the likely 

existence of etiological heterogeneity. It remains very possible that there are different 

causes for schizophrenia, all of which can lead to the same outcome (Gooding & Iacono, 

l995). 

Endophenotypes

The identification and use of heritable neurocognitive markers (known as 

endophenotypes; Gottesman & Gould, 2003) can be an invaluable aid in the genetic 

dissection of schizophrenia. Here are characteristics of these biobehavioral markers of 

liability: low prevalence among the normal population; genetic transmission; 

significantly higher proportion among affected individuals; stability over time; 

independence from clinical status (i.e., symptom remission vs. acute symptoms), and 

presence in unaffected relatives of affected individuals. 

There are several advantages to the application of endophenotypes to the search for 

the biological basis of schizophrenia. First, endophenotypes may assist genetic studies of 

schizophrenia because they can provide a way to identify individuals carrying the genetic 

risk. Endophenotypes are believed to be closer in the etiological chain to underlying 

genetic factors than the symptoms of the disorder. Moreover, endophenotypes have 

associated brain regions and circuits that may provide further clues about the areas that 

are dysfunctional in the schizophrenic brain. 
40

Examples of some promising markers of genetic liability for schizophrenia include: 

oculomotor deficits such as smooth pursuit eye tracking dysfunction and saccadic 

inhibition deficits; working memory impairments; and sensory gating abnormalities such 

as P50 nonsuppression. The occurrence of oculomotor impairments, such as smooth 

pursuit eye tracking abnormalities has been a consistent research finding since the l970s. 

Individuals with schizophrenia have marked difficulty matching their eye velocity to the 

velocity of a slowly moving target, which results in abnormal smooth pursuit eye 

tracking. Indeed during smooth pursuit eye tracking, individuals with schizophrenia 

show insufficient inhibition of small fast eye movements, which tends to take their eyes 

further away from the target they’re trying to visually follow. These deficits are observed 

in a disproportionate number of schizophrenic individuals even during their first episode 

of illness.. Some of my early work indicated that this abnormality is stable over time, 

regardless of chronicity, medication status, or clinical status. Another potential marker of 

a schizophrenia liability is a deficit in antisaccade task performance, in which individuals 

are instructed to look immediately to the opposite side of a laterally displaced visual 

target. The neural basis of eye movements is well understood, so this remarkably 

consistent finding in individuals with schizophrenia and their first degree relatives 

(siblings, parents, and offspring) supports the notion that schizophrenia is a brain 

disorder. 

Working memory is defined as the ability to hold information in temporary storage, 

manipulate that information, and use it to guide subsequent behavior. Spatial working 

memory impairments in schizophrenia were first demonstrated in the early l990s (Park & 

Holzman, l992). Since then, several investigators have shown the following: spatial 

working memory impairments in schizophrenia are common, they’re seen in unaffected 

first-degree relatives such as parents and siblings, and they’re stable over time. 

Schizophrenia patients have these deficits whether they’re acutely psychotic or in 

remission, whether they’re medicated or not, whether they’re hospitalized or fully 

functioning in the community. 

In the P50 paradigm, two auditory stimuli are presented in quick succession. 

Normally, a person’s neuronal response to the second stimulus will be smaller (lower 

amplitude) than the response to the first stimulus. P50 suppression is an indicator of 

information processing, or sensory gating. Individuals with schizophrenia fail to show 

this P50 suppression. Decreased P50 inhibition is found in approx. 50% of patients and 

in 10% of healthy subjects. P50 nonsuppression is also frequently observed in the firstdegree relatives of schizophrenia patients. 

Who is at risk for schizophrenia?

There’s increasing evidence that suggests that we may be able to identify the 

underlying diathesis, or viability to schizophrenia, before the risk condition progresses to 

full-blown schizophrenia. There are several ways of identifying individuals at heightened 

risk for the later manifestation of schiozphrenia: they can be identified on the basis of 

genetic, psychometric (questionnaire/inventory), biobehavioral, or clinical risk factors. 

Much of the knowledge gleaned about the study of individuals at genetic risk for 

schizophrenia has been based on studies of the offspring of schizophrenia patient 

(Erlenmeyer-Kimling, 2000). The presence of clinical risk factors can also be used to 

identify individuals at heightened risk for the development of schizophrenia. One 

example of the clinical high-risk strategy would be to study individuals who have clinical 

disorders that are genetically related to, but less severe than schizophrenia, such as 

schizotypal personality disorder. 

In the psychometric high-risk method, at-risk individuals are identified on the basis 

of their psychometric profiles using questionnaires or instruments such as the MMPI. 

Much of my research at the University of Wisconsin-Madison focuses on elucidating the 

developmental trajectory from risk status to clinical disorder, whether schizophrenia, or a 
41

related, but less severe condition such as schizotypal personality disorder. This is done 

by following at-risk individuals over time, and comparing them with typicallydeveloping, age-matched individuals. Using a set of well-validated instruments known as 

the Chapman psychosis-proneness scales, investigators (Chapman et al., l994) observed 

that individuals who report the experience of strange perceptual experiences are at 

heightened risk for schizophrenia and other psychotic disorders such as psychotic mood 

disorders. Individuals who report social anhedonia, or the reduced ability to experience 

pleasure and/or a deficit in the ability to seek and experience pleasurable activities, are at 

heightened risk for the specific development of schizophrenia and schizophrenia-related 

conditions (Gooding et al., 2005). These findings are consistent with data from the 

genetic high-risk studies that indicate that attentional deviance in early childhood (a risk 

factor for the later development of schizophrenia) was associated with poor social skills, 

anhedonia in adolescence and social deficits in early adulthood (cf. Erlenmeyer-Kimling 

et al., 2000). 

Predicting the development of schizophrenia in at-risk individuals

Studies indicate that offspring of schizophrenia patients who later develop 

schizophrenia and schizophrenia-related disorders displayed attentional deficits, verbal 

memory deficits and gross motor impairments even as children. However, among the 

offspring of schizophrenic patients, only a subset of the at-risk individuals were later 

diagnosed with a schizophrenia-related illness. A composite index of risk was a better 

predictor of a schizophrenia-related outcome than reliance upon a single indication of 

deviance. Because not all good predictors of schizophrenia outcome, such as lower IQ or 

motor impairments, are indicators of a genetic liability towards schizophrenia, searching 

for the presence of the endophenotypes in the genetically at-risk population is especially 

beneficial. At present, we cannot predict who, among the individuals at risk for 

schizophrenia, will later manifest the disorder or one of its spectrum disorders, such as 

schizotypal personality disorder, or schizoaffective disorder. 

Can we intervene in the case of at-risk individuals before they develop psychotic 

symptoms?

A newer research strategy concerns the study of individuals at the prodromal stages 

of schizophrenia, before they have an outbreak of manifest psychosis. So clinical 

researchers attempt to treat individuals who are showing functional deficits like those 

seen in schizophrenia, but who are not yet experiencing the psychotic symptoms of 

delusions and hallucinations. This research strategy is based on the premise that the 

premorbid and prodromal phases of schizophrenia are windows of opportunity to 

intervene, in order to maximize the likelihood of a better disease outcome. These early 

intervention programs are preventive in the sense that part of the goal is to prevent further 

psychosocial decline, and/or to delay the onset of severe psychosis. The risks and benefits 

of these early intervention programs are currently investigated and debated. The 

preventive treatment of individuals who show an accumulation of risk factors is based 

upon a statistical risk-oriented approach to treatment. The study of biologically-based 

markers, in conjunction with other screens, e.g. clinical signs and behavioral symptoms, 

can be useful in terms of further identifying who the target population should be, which 

risk factors are most valid as screening tools for the entry into the study, and what 

prodromal deficits should be targets for intervention. Endophenotypes are increasingly 

being integrated into some of these prodromal studies. 

Current status of schizophrenia research

The consensus is that schizophrenia is a genetically-mediated neurodevelopmental 

disease that is typically developed during late adolescence and early adulthood. We don’t 
42

know which genes are involved, how many need to be present, and how they affect brain 

development. 

Schizophrenia is associated with neurobehavioral impairments. We know that as a 

group, people with schizophrenia differ from healthy people in terms of neurocognitive 

and psychophysiological performance. A disproportionate number of biological relatives 

of schizophrenia patients also display these deficits, albeit to a lesser degree. Research 

indicates that these biobehavioral deficits are stable over time. We can conclude that 

several of these neurocognitive impairments are potential markers of increased 

susceptibility of risk for schizophrenia. The study of these putative markers can be useful 

in terms of refining the diagnosis and classification of schizophrenia and schizophreniarelated disorders. These markers also have the potential to enhance our current research 

strategies for identifying individuals at heightened risk for schizophrenia. We know that 

not everyone at heightened risk for schizophrenia goes on to develop the disorder. 

However, it appears that even prior to the onset of the disorder, individuals who later 

develop schizophrenia deviate on a range of functions, including attention and 

information processing, motor development, language difficulties, and social behavior. 

We don’t know how schizophrenia develops from risk to manifest disorder. We are at 

the very beginning of discerning the ways in which the at-risk individuals who later 

develop schizophrenia differ from those at-risk individuals who remain clinically 

compensated. We are still investigating whether indicators and predictors which have 

validity at the population level have predictive validity at the individual level as well. 

Prodromal studies of schizophrenia are underway. 

Summary

My hope is that the scientific community will have adequate resources to continue 

the research, so that can we further the progress of unlocking this epigenetic puzzle that 

we call schizophrenia. I’m proud of the work that we are doing in Wisconsin to help 

demonstrate the ways in which schizophrenia is a genetically-mediated 

neurodevelopmental disorder. At the University of Wisconsin, many of the researchers 

like myself have partnered with mental health professionals, mental health consumer 

organizations and community advocates such as NAMI (which originated in Madison, 

WI) to educate the local community as well as the community at large about 

schizophrenia. It is especially gratifying to participate in dispelling myths and correcting 

misconceptions about schizophrenia and schizophrenia-related disorders through 

education, research, and advocacy. 

Thank you for the opportunity to offer testimony on this important health issue. At 

this time, I would be happy to answer any questions. 

REFERENCES 

American Psychiatric Association (2000): Diagnostic and Statistical Manual of Mental 

Disorders: DSM-IV. 4th ed., text revision. Washington, DC: American Psychiatric 

Press. 

Chapman, L. J., Chapman, J. S., Kwapil, T. R., Eckblad, M. & Zinser, M. C. (1994). 

Putatively psychosis-prone subjects 10 years later. Journal of Abnormal 

Psychology, 103, 171-183. 

Erlenmeyer-Kimling, L. (2000). Neurobehavioral deficits in offspring of schizophrenic 

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MR. DEAL. Thank you very much. 

I will begin questions. 

You have talked about these markers of genetic liability. Did you 

call them endophenotypes? 

DR. GOODING. Endophenotypes, and they are closer in the chain, the 

causal chain, than phenotypes which are the clinical manifestations, the 

symptoms of a disorder. 

MR. DEAL. Would the same general statements about these markers 

apply to other disorders other than schizophrenia? 

Dr. DePaulo, you are indicating yes? 

DR. DEPAULO. Absolutely. But they are better known in 

schizophrenia than they are in depression or bipolar disorder. So they 

are very helpful. 

MR. DEAL. Dr. Insel, are we further along in any of these three 

general areas we are talking about in terms of research? Since we have 

talked about schizophrenia, are we further along in the research for that 

disease than we are for the bipolar or just simple depression? 

DR. INSEL. Yes, I think we are. It is surprising. If one had looked at 

this 20 years ago, one would expect that all of the big breakthroughs in 

genetics and in the biology would have involved bipolar disorder, and 

Dr. DePaulo has been at the cutting edge of that science. But much to 

our surprise, it is in the area of schizophrenia where we have found the 

greatest association between genetic variation and having the disease or 

being, as Dr. Gooding mentioned, at risk for the disease. So, right now, 

schizophrenia is the place where I would say there is the most traction 

and the most excitement. 

MR. DEAL. We have made the analogies to cancer in several 

different comments that have been made. When we think of cancer and 

the treatment for it, we normally think of surgically removing it or 

treating it chemically to shrink the cancer, or perhaps eliminate it 

altogether. I gather we are not able to make that same analogy in terms 

of the treatment of these mental diseases. Can you surgically remove 
44

something that would eliminate any of them? Can you chemically treat 

them to make it disappear or simply try to overcome what is there? 

DR. INSEL. The question really comes down to, can we go from 

response to cure? And that is true in the case of cancer and heart disease; 

we have set the goal at cure. And that is particularly true of diabetes, 

where one looks for what is going to be the cure. 

Increasingly in medicine generally, we are having to settle for being 

able to help people with the chronic illness to be able to live better lives, 

what we call more recovery than cure. The cure is not yet in sight for 

most of these disorders, but there are opportunities to reach for recovery, 

and more than we have had in the past. Some are medical, and some are 

actually psychosocial treatments. 

In the case of schizophrenia, we know that some of the treatments, 

some of the interventions that make the greatest difference are not 

necessarily medications, although those are necessary. It is helping 

people with this chronic illness to be able to live with it, to be able to live 

in a community where people are supportive. Getting families involved 

and getting them back to work, is really essential. 

MR. DEAL. Anyone else? 

DR. GOODING. I would like to add that there used to be the myth that 

if you got the diagnosis of schizophrenia, it was tantamount to a death 

sentence or the prognosis was very poor. We do have better treatments, 

and as Dr. Insel said, right now, we are concentrating on helping people 

really further integrate into the community. 

We have a program that started actually in Madison, Wisconsin, the 

PACT program, Program for Assertive Community Treatment, that 

really worked towards bringing the focus of treatment outside of the 

hospital into the community. It is a community-based multidisciplinary 

treatment strategy. 

They leave patients where they are, and they help them get into the 

workforce, live independently, and really move toward recovery and 

self-actualization so it is really gratifying to see the improvements and be 

able to tell people, you have been diagnosed with this chronic disorder, 

but here are the things you can still do and here are the ways we are 

going to help you get there. Including psychosocial interventions, social 

skills training, and so forth. 

DR. DEPAULO. One last point, in the analogy of cancer, it was the 

appearance at the macroscopic level, at the eyeball level, of tumors that 

led to the recognition that surgery might be helpful. But from the 

research in the molecular biology of cancer have come treatment 

strategies that we never imagined, such as treatment strategies designed 

through hormones, through the immune system, and through the blood 

supply to cancers. 
45

Those are the kinds of treatments that you can’t imagine yet that we 

hope to come up with to aid all of these other treatments in 

schizophrenia, bipolar disorder, and depression. 

MR. DEAL. Thank you. 

Ms. Baldwin. 

MS. BALDWIN. Thank you, Mr. Chairman. 

I would like to hear a little bit more about the impact of recent cuts 

or flat funding of NIH with regard to the research. As you heard me 

proudly say in my opening statement, I represent the University of 

Wisconsin, Madison, which receives a great deal of support for 

biomedical research through NIH funding, and I have been hearing 

anecdotally from researchers on campus about the impact of recent flat 

funding in terms of grants cut short or experiencing their colleagues with 

very high-quality grant applications which are being denied at a much 

higher rate. No doubt these are because of Congressional action in 

funding the NIH in recent years. I know in the past 4 years, we have not 

kept pace with medical inflation, which is around 3.5 percent, meaning 

the cost of doing research is increasing, but the funding available for the 

research is either flat funded or cut. 

I am wondering if any of our researchers here today have felt the 

effects of these policies, and has it affected your own research or the 

research of your colleagues? And additionally, how is it affecting 

recruitment of new talent, new investigators into the area? 

DR. DEPAULO. As a chairman of a department that has 180 faculty 

members, I would be happy to tell you, because the results are palpable 

and very visible. 

To the point, my faculty has been extraordinarily stable across the 

years. When people come onto the faculty at Hopkins, they tend to die 

on the faculty, much later, thankfully, and after very successful careers. 

But recently, in the last year and a half, we have been losing young very 

talented investigators, actually several of them funded by the NIH, 

because they can see the handwriting on the wall, as they put it, and they 

are going to places that don’t offer them the same kind of scientific 

opportunities, but where they are sure of being funded. I am very 

concerned about the loss of a generation of young, very talented 

investigators. 

DR. JAMISON. I couldn’t agree more, and I think it is such an 

exciting time in neuroscience. All of us have lived with so much hype 

and promise for so long, and now in the last 10 years, it really has begun 

to take off. It seems the oddest, most strange, and devastating time to cut 

back. It really will affect tens of thousands of lives. There is no question 

about it. 
46

DR. GOODING. I can say that personally I have been the beneficiary 

of NIH grant funding, and it was invaluable in terms of being able to 

investigate the risk factors and to follow longitudinally people at 

hypothetical risk for schizophrenia. We found some really exciting 

things, and we would not have been able to do it otherwise with the cuts 

in funding or at least the flat funding. 

We have more ideas from some of my colleagues in my research lab, 

and it is really difficult because they are saying, yes, this is a great idea 

and it would be very helpful in terms of furthering the field. But you 

know what, in order to get NIH funding right now, you are going to need 

a lot of pilot data. How do you get the pilot data if you don’t have the 

funding? So it is very frustrating. 

DR. INSEL. I feel the pain from our side. As you mentioned, the 

biomedical inflation rate is somewhere between 3.5 and 4 percent. That 

is part of our challenge. Although we have a doubling since 1998, we 

are funding more grants, and the grants are larger than they were. We 

still are able to do quite a bit of great science, but this has been a time 

where we have had to set priorities. 

The reality is that the Nation, this Nation, invests about $4.76 per 

American for research on mental illness each year. And we have to ask 

not whether this is a cost center, but whether this investment is the right 

investment for the level of concern that you have heard this morning. 

MS. BALDWIN. Thank you. 

Thank you, Mr. Chairman. 

MR. DEAL. Thank you. 

Ms. Myrick. 

MS. MYRICK. Thank you, Mr. Chairman. 

Dr. Jamison, I know you have done so much research and are an 

expert on suicide, and I want to ask you a question and also make a 

comment because we have talked about the people who have the illness 

committing suicide themselves. 

Recently, in our community, we have had two fathers, living in great 

neighborhoods, great careers, everything about them very normal, one of 

them who actually was successful in killing two of his own children. He 

did not take his own life. The other one tried to kill both of his young 

children. One is still living, but he took his own life. 

I share that because that is another aspect of this that we don’t talk 

about, not just taking their own life but taking someone else’s life as 

well. 

Do you know what percentage of bipolar people actually do end up 

committing suicide, because I know a lot attempt it? Our granddaughter 

attempted it several times, thankfully unsuccessfully. But any 

percentages on that? 
47

DR. JAMISON. There are percentages depending on how serious the 

form of bipolar illness is. If you take people who have been hospitalized 

for bipolar illness, the rate of suicide goes up somewhere between 15 and 

20 percent, which is a higher mortality rate than most forms of cancer or 

heart disease. I think one of the unfortunate things about psychology and 

psychiatry is that, as a profession, we have not used the words “mortality 

rate” when it comes to our own illnesses. So there is this notion that 

suicide is off in the ether and it is caused by stress or things that go on in 

the environment as opposed to 90 to 95 percent of the time being 

associated with a major psychiatric disorder. 

We have done ourselves a big disservice by not focusing on how 

very strongly associated, and of the illnesses, major psychiatric illnesses, 

certainly bipolar disorder has the highest suicide rate. It is a very real 

concern. 

MS. MYRICK. Dr. Insel, I was glad to hear you talk about 

personalized care for these diseases just like we have done for cancer. 

That is really exciting. And yes, I know funding is a problem for that, 

but that is something that is good on the horizon where we haven’t been 

before. 

Either you or Dr. DePaulo, you introduced me to the term of 

presenteeism some time ago, people who are actually present at work but 

don’t do anything. Would you both elaborate on that, because I think 

that is something that we totally overlook in society? We talk about 

people who are absent from work because they have problems. What 

about the people who actually show up for work but don’t do it? 

DR. DEPAULO. Since depression is probably one of the most 

common sources of that kind of lost productivity, what you find from 

your patients is that, one is, first off, when they are depressed, depression 

is not simply feeling sad when your dog dies, people have multiple 

inabilities to function. Concentration and attention is certainly one of the 

things hit quickly and hard by depression. 

The second thing that happens is the idea that even having an 

interaction with somebody, going to see a client, going to interact with 

other workers to get something done, becomes a big stress for people, 

and so they tend to avoid doing that, and they tend to be more irritable. 

So people, when they are depressed, although most are in the workforce 

and about 80 percent are working. They are unable to concentrate, they 

tend to withdraw a bit because they are irritable, and they don’t have the 

energy to sustain the interaction to get the job done. 

DR. JAMISON. And they are also more likely to use alcohol and 

drugs which then compounds all of the problems. 

MS. MYRICK. There is an article in the Wall Street Journal today 

that says, a study that says heart troubles often lead to depression, and it 
48

is talking about people who are depressed who have heart attacks, and I 

thought it was very interesting. 

On the schizophrenia side, Dr. Gooding, this is an area that I don’t 

understand very well. I read through your testimony, and so much of it is 

over my head, and forgive me. When you talked about the multiple 

personality disorder and schizophrenia and how that is confused, can you 

address that a little bit? 

DR. GOODING. That is a common misconception. Multiple 

personality disorder, which now is called dissociative identify disorder, 

has to do with different personality states, different memories and one 

aspect of the personality not knowing or having awareness of other 

aspects of personality. That is very different from schizophrenia. 

Schizophrenia is really a cognitive disorder in which there is some 

exaggeration of some functions, such as delusions, false beliefs, 

hallucinations on the one hand, and that is what most people think about 

when they think about schizophrenia. But more devastating for people 

with schizophrenia are the negative symptoms, the symptoms that 

represent loss or diminution of functioning and those are things like loss 

or lack of motivation; anhedonia, loss of pleasure; reduced speech; 

reduced expressiveness, facially, and emotionally. As you can see, it is 

very different. One is clearly a psychotic disorder. Where there is lots of 

evidence for genetic basis in dissociative identify disorder, there is still a 

bit of controversy regarding the rates of diagnosis and the validity of it. 

MS. MYRICK. Mr. Chairman, if I may, our colleague, Patrick 

Kennedy, was here for a while and had to leave, but I just wanted to take 

this opportunity to thank him about being open about his challenges 

because that is a big help to everybody. 

Thank you. 

MR. DEAL. Thank you. 

Mr. Rush is recognized for questions. 

MR. RUSH. Dr. Insel, can you tell me, can you tell what the NIMH is 

doing with regard to research on postpartum depression and psychosis? 

DR. INSEL. There is a broad range of studies that are looking at both 

the mechanisms and the best treatment for women during this period. 

It is a complicated area because there are many different syndromes 

that fall under the umbrella of postpartum depression, and postpartum 

psychosis sometimes overlaps with that, and sometimes is quite different. 

There is no question that in some way it relates to the endocrine 

changes that accompany the end of pregnancy. But we still don’t 

understand the mechanism by which that group, that profile of endocrine 

changes, puts women at risk. We do know that the risk is huge, and 

women at that point in life, especially if they have a history of 

depression, are many, many times more likely to develop a severe 
49

depression at a moment when their energy and attention is more vital 

than at any other time to their infant. 

So it is an area of high priority for our institute where we hope to be 

able to have some real discoveries very soon. 

MR. RUSH. Do you have any opinion about the way in which it is 

being viewed or the way that it is being portrayed or not portrayed as far 

as our legal system is concerned? 

DR. INSEL. I am not sure what your concern is? 

MR. RUSH. There seems to be a strong reluctance by the judicial 

system to even entertain the possibility that postpartum psychosis is a 

mental illness, and therefore, those unfortunate victims find themselves 

in positions where they are denied really the full weight, I would say 

denied a fair trial. 

DR. INSEL. Science would certainly support the idea that this form of 

depression, or psychosis, either one of them, are brain disorders, just as 

other forms of major depressive disorder and other psychotic illnesses. 

We have that kind of evidence, and we also know they are treatable. 

But as we have been saying all morning, one of the gaps we are 

facing here is that we have the science on the one side, which often 

doesn’t match up perfectly with public policy. Part of the challenge is 

making sure that science informs service at some point. 

MR. RUSH. Any other comments? 

DR. JAMISON. I think, in general, there is a huge gap between what 

many judges know about mental illness, and I was actually talking to a 

friend of mine who is an attorney and asking him what kinds of courses 

were taught in law school. Given so much of the law relates to human 

behavior and abnormal human behavior, what kinds of courses are 

actually taught about psychopathology and the science of 

psychopathology? Next to none, which to me was staggering because we 

all know the cases that have come before the courts with postpartum 

psychosis where a mother has killed one or more children and how 

dreadful that is and how preventable often it is. 

What strikes me is that highly educated lawyers know very little 

about psychopathology despite the fact that the ones in the criminal 

system deal with it all the time. 

MR. RUSH. I have given you an example. I have a bill that is 

pending in the Congress that is called the Melanie Blocker-Stokes 

Postpartum Depression Act. Melanie Blocker-Stokes she was a young 

African-American woman, professional, came from an upper middle 

class family, was a sales manager for a leading pharmaceutical company. 

She married a physician. She had a disease. Nobody knew what it was, 

and she committed suicide. She jumped out of a tenth floor hotel 

window on a bright Saturday afternoon and left one child. Her husband 
50

was a physician, and he had no understanding. He had never heard of a 

postpartum depression, and so the medical profession is also ignorant 

about this. I think it probably has a lot to do with the fact that it affects 

women, and there is a disparity in terms of concern about women’s 

health. 

I am just astounded that even Members of Congress, when I went to 

get cosponsors on the bill invariably, out of all of the people I talked to, 

probably a third of them had some experience with somebody who had 

postpartum psychosis, but we still have not been forward in our solutions 

or our attempts to deal with this particular issue. 

Mr. Chairman, I yield back the balance of my time and will have 

some additional questions if we do a second round. 

MR. DEAL. I thank the gentleman. 

Dr. Burgess. 

MR. BURGESS. Thank you, Mr. Chairman. I apologize for being out 

of the room for most of the testimony. 

Dr. Insel, it comes to mind, hearing your response to questions from 

others on the committee, just as an outsider looking in, and I have only 

been here a short period of time, but as an outsider looking in, I can’t 

help but feel there is a lot of duplication, for want of a better word, when 

you look at the various institutes, National Institutes of Health, National 

Institute of Mental Health, National Institute on Alcohol Abuse and 

Alcoholism, and run through the list. 

MR. BURGESS. Has that been at all an encumbrance upon the correct 

application of research dollars as you see it? 

DR. INSEL. Well, as I think you have heard from NIH Director 

Zerhouni when he has testified here, there has been a huge, new thrust to 

try to coordinate all of the Institutes around projects like the NIH 

RoadMap which are across Institutes and involve an integrated and 

shared approach to the biggest impediments of medical science. I might 

add that, because of the Institutes that you’ve mentioned, in the last 

2 years the groups that are interested particularly in the brain and mental 

disorders and drug abuse have also developed their own integrated effort 

which is called the Neuroscience Blueprint. That is actually very much 

like the roadmap in which, rather than having redundancy and 

duplication, we are actually bringing the best from all of those Institutes 

together to try to address common problems. And there are many 

common problems, because we are all ultimately dealing with the central 

nervous system. But we come at it either through the eye or the ear or, in 

our case, through abnormal behavior, but we have this opportunity now 

to do this in a very integrated way, and I think it is working very well. 

MR. BURGESS. Is that in a form where it can be shared with 

Members of Congress at this point, the Neuroscience Blueprint? 
51

DR. INSEL. Absolutely, I would be happy to submit that for the 

record. We are in our second year. We have a very active Web site. We 

have 15 or so projects already funded and maybe more than that, and we 

can get you up to date on all those issues. 

MR. BURGESS. I will leave it up to the Chairman whether or not he 

wants it in the record, but I know my office would very much appreciate 

being informed of that because you are correct, Dr. Zerhouni, in his own 

inimitable way, implied that perhaps Congress shouldn’t be interfering 

with the make-up, but he also acknowledged that there was, at least to 

the uninitiated outsider, he could understand how the appearance of 

duplication of services might lead one to believe that perhaps it is not the 

best or most efficient application of research dollars. 

In your written testimony, talking about the new things that are going 

on between understanding of the human genome and neuroscience, it 

actually sounds pretty exciting. Can you give us any specifics to things 

that you are working on in particular there? 

DR. INSEL. Very quickly, as we were mentioning before, I think the 

greatest traction happens to be right now in schizophrenia where we have 

a whole range; I think there are eight or ten candidate genes where there 

seems to be an association between variation in a particular gene 

sequence and risk for the disorder. 

But hands down, the most exciting opportunity now is what is called 

whole genome association, and that has been made possible by 

something called the haplotype map. This is a map of human variation at 

the genetic level, so it is a map of where all the most common variants 

are in the human genome. It offers the opportunity to scan those very, 

very quickly in a way that we never imagined possible 5 years ago, 

quickly and cheaply. All of this has really come about in the last 

6 months, the whole human genome hap map will be available later this 

year, but we have a very good working draft that has already had a 

tremendous impact on a whole range of disorders. We expect that will 

affect the way we look at variation and the molecular basis of risk in 

mental disorders as well. 

MR. BURGESS. And do you see a date on the horizon where that will 

be generally available to the clinician? 

DR. INSEL. Well, the big challenge, Dr. Burgess, is how you go from 

having an exegetic research finding that explains, say, 5 percent or 

3 percent of the risk, to being able to take that and make a difference for 

clinicians. Where I think it will come first is not actually in the diagnosis 

of any of these disorders but in the selection of treatments. 

So we already have evidence that has just come out in the last 

6 weeks that we can predict who is more or less likely to respond to a 

serotonin reuptake inhibitor treatment for depression, and I think we will 
52

have a number of those genetic variants that tell us about medication 

response. As you know, we call that pharmacogenomics, and I think that 

is going to be the first deliverable to happen very quickly. 

MR. BURGESS. It is no secret that in my mind at least managed care 

is not the thing for the practice of psychiatry in this country. 

But one of the unintended consequences was for someone like 

myself who is in more of a primary care field, OB/GYN, by default, I 

became the prescribing physician for antidepressants, and I can’t tell you 

how excited I am to hear you talk about that because, so often, I was left 

with my best clinical judgment as to which of this wide panoply of 

antidepressant medications might be the best one for this particular 

patient. And probably about 80 percent of the time, I was satisfied with 

the result. But about 20 percent of the time, I was not only unsatisfied 

with the result, I was struck by how wrong I could have been on the 

selection of a particular agent for a particular patient. So that just, from 

the perspective of a practicing physician who had the practice of 

psychiatry forced upon him by external forces in the insurance world, I 

am very glad to hear you talk about that because I think it is going to 

make us much more effective in our ability to deliver care for patients. 

Now, Mr. Rush, who has I guess already left, talked a little bit about 

postpartum psychosis and unfortunately probably using depression and 

psychosis interchangeably there where it is not actually well suited for 

that interchangeability. But you talk about, in the imaging part of your 

discussion on area 25, sounds like where they took the alien from 

Roswell, but nevertheless, area 25 in the brain that has some specifics to 

it, have you looked into the management of postpartum psychosis with 

these imaging techniques? 

DR. INSEL. That is a great question and the answer is, no, that study 

hasn’t been done, recognizing that much of this research has really just 

emerged in the last 9 to 12 months. Much of it is still underway, so there 

is a lot of interest in moving forward with those kinds of studies for 

postpartum depression, but it has not yet been done as far as I know. 

MR. BURGESS. Again, he alluded to the difficulty with the disease 

being much more common than people think, and yet, at the same time, 

even the unfortunate individual who was a physician and married to a 

patient didn’t recognize the signs, and I will tell you, as a physician who 

is also a husband, it is sometimes difficult to recognize signs, not just 

postpartum depression but from other more common illnesses. I think I 

missed the diagnosis of chicken pox with all three children. We don’t 

need to put that in the record, Mr. Chairman. 

MR. DEAL. It is there forever. 

MR. BURGESS. But a tool like this would be so helpful, and you 

know, during the course of the day, the average OB/GYN who sees what 
53

30 to 45 patients in order to pay overhead and liability insurance and has 

to make a decision based on a 10- or a 15-minute interview with a patient 

who is struggling after delivery, to know which ones are truly at risk. 

And, unfortunately, as we have seen in Texas, some very famous and 

very dramatic cases of postpartum psychosis that resulted in the injury to 

in some cases multiple children within a family, the ability to be able to 

provide that practitioner with a reliable test that would be 

community-based or nearby in a community to be able to say, I need to 

send you down to the Medical School to get this scan done because I am 

concerned about your symptoms, that would be tremendous to be able to 

put that in the hands of practicing physicians across the country. 

With that, Mr. Chairman, you have been very indulgent, and I will 

yield back. 

MR. DEAL. I think Dr. Insel wanted to respond. 

DR. INSEL. The NIH mantra now is what we call the three Ps, that is: 

predictive, personalized, and preventive. And I think all of those 

together, if we can deliver that to individual practitioners, is where we 

want to be. 

MR. BURGESS. Mr. Chairman, just a point of personal privileges, 

coming to Congress, I did not realize what a national treasure the NIH 

was. 

I have taken now a series of field trips out to a variety of the 

institutes out there. Every time I do that, I come back so impressed with 

what is going on and so optimistic about the future of our country and 

what we are going to be leaving for our children, because you guys are 

doing work out there that is nothing short of fantastic. I will yield back. 

MR. DEAL. Thank you. 

Mr. Pickering you are recognized for questions. 

MR. PICKERING. Thank you, Mr. Chairman, I want to thank the 

panel, and I want to thank the Congresswoman from North Carolina for 

her leadership. It was great to hear a physician on the committee, 

Dr. Burgess, as he engages. And it is truly remarkable the progress that 

we have made in understanding mental illnesses. And as 

Congresswoman Myrick has appropriately defined various brain 

diseases. 

I would like to ask Dr. Insel what we have seen over the last 

10 years, what would you say you see over the next 5 to 10 years in our 

understanding, our ability to do the three Ps, to be able to predict whether 

a child born next year could be susceptible to autism-related disorders or 

to mental illnesses, bipolar, mental depression, and to what degree will 

we be able to give those therapeutic predictors or plans and help to our 

physicians and our psychiatrists and psychologists, and to our families? 

And to what degree will the pharmacological prescriptions be enhanced 
54

to really make a difference in the lives of a lot of individuals and 

families? So what do you see over the next 5 to 10 years? 

DR. INSEL. Well, it is a tall order. Let me just give you the 

10-second overview which is that the three Ps will come about largely 

with the two best tools we have now which are genomics and imaging. 

And you can probably add to that some better kinds of neurocognitive 

batteries, as Dr. Gooding was talking about for schizophrenia. We have 

already seen this with autism, although we don’t have the genetics yet, 

and imaging hasn’t been particularly informative. With some of the 

neurocognitive tools, we have taken the diagnosis of autism from a point 

much earlier from 5 years ago, when most children were being diagnosed 

at age 4, 5, or 6, depending on their level of access; we are now able to 

reliably diagnose autism well before age 3 and, in some cases, before age 

2. And that is critical, because we know that if we can intervene early, 

that we can, in some cases, preempt many of the worst aspects of this 

very devastating illness. 

I wish I could say we could now do the same thing for schizophrenia. 

We are not quite there. But there is no question that through the use of 

genetics, through imaging and through all of these other kinds of tools 

like neurocognitive batteries, the vision for mental disorders is very 

much the vision that we have had for cardiology and cancer. For 

example, for schizophrenia, we want to be able to intervene well before 

the first break, just as with heart disease, we now intervene generally 

before the first heart attack. And so much of what cardiology is about 

now is preemption; it is treating people with lifestyle changes, with diet 

and sometimes with statins to keep them from having a heart attack. 

We need to be taking just that pathway forward for schizophrenia, 

for bipolar disorder, and for autism. 

MR. PICKERING. Anybody else on the panel like to--and what 

policies can we adopt to help accelerate, if Dr. Burgess was talking about 

getting the scanning and the imaging capabilities out to the physicians 

and to the community, what are the things that this committee can do, 

both in research, and in practical resources to the communities, hospitals, 

physicians, that would accelerate that? 

DR. DEPAULO. Well, if I might and I will say that we all have the 

dream that we are going to be able to, quote, “translate a basic science 

finding into a deliverable treatment,” and so far, those things still take 

years to do. 

So that is why I think that the war on cancer and the serious work 

that is being done on heart disease is, I consider, about half done. 

But I think one of the things you can do is to obviously not only 

increase funding for research but to make it predictable, so that it won’t 

be varying up and down so much. That would be very helpful I believe, 
55

and I think Dr. Insel would possibly be very much happier if he could 

plan ahead beyond the life of a particular grant. I think that is also 

extremely important, as we were saying earlier, for the careers, because 

we don’t just need money. We need young careers of people who are 

going to devote their lives and their careers to this. You don’t want to 

cut off a generation of those people, so certainly those are two ideas. 

I think in terms of translating, I think we need a number of things to 

happen on the clinical side, but certainly I don’t want to neglect the idea 

of public education. I still think that is fundamentally important, and 

when people know what they have, they become much better in some 

ways. Coming from Dr. Burgess, is that we find that it is easier to 

educate patients sometimes than it is to educate physicians who weren’t 

trained at a time in which a certain development took place. 

So those are certainly points I would make. 

DR. JAMISON. One of the things that is always striking to me is, 

parents learn about mondo bizzaro diseases that kids never get that are 

very rare diseases, and they learn next to nothing about depression and 

bipolar illness, which are very common illnesses. It seems to me that 

pediatricians and doctors who are primary care physicians have an 

obligation to not only learn themselves but also to transmit that education 

through the school systems. One of the things that is great, Johns 

Hopkins for example has a very aggressive program in the Baltimore 

public and private schools to educate kids, teachers, and parents about 

depression. I just think this should be much more common than it is. 

There is one thing that you can do in terms of research that is going to 

affect people 10 years from now; what can you do to keep people alive 

now with what we do know? 

DR. GOODING. I would like to echo that and say that education is so 

critical, increasing public awareness, not just about mental illness in 

general but about specific warning signs or specific help-seeking or 

specific behaviors that would lend one’s self to realize that maybe they 

should start seeking help. 

We also need to educate people. They need to know that there are 

more advances now in terms of mental health treatment and mental 

health research. So that they don’t feel that there is no hope and that they 

do go and follow up on the treatment recommendations. 

Furthermore, we need to educate people so that we can reduce 

stigma because people are not going to go and admit to having problems 

and they are not going to seek treatment if there is stigma associated with 

doing so. 

MR. PICKERING. Mr. Chairman, thank you. 
56

And I would be interested to follow up just on how much we are 

spending on the educational side of educating and informing the public, 

but I know my time is up. 

MR. DEAL. Thank the gentleman and to the panel, very excellent 

testimony, and any documents that you wish to submit for the record, 

Dr. Insel, one of the references to the question from Dr. Burgess about 

that study would be certainly appreciated, and we will, without objection, 

allow that to be included in the record. 

[The information follows:] 
57
58
59
60
61

MR. DEAL. I want to thank the panel very much for your 

distinguished testimony. 

Now I call the second panel to the table. 

MR. RUSH. Mr. Chairman, I would like to ask unanimous consent--

there were questions I had of the first panel. I am sorry I was out on the 

phone, but I would like to submit the questions in writing so I might be 

able to get-- 
62

MR. DEAL. Yes, I have already done a unanimous consent that 

would allow any member to do that, and certainly, I think they would be 

willing to respond to your questions. 

MR. RUSH. Thank you Mr. Chairman. 

MR. DEAL. Likewise, we have a second distinguished panel. We 

want to thank all of you for being here. It is my pleasure to introduce 

them at this time. 

 

STATEMENTS OF JENNIFER MARTIN, ATTORNEY, LAW 

OFFICES OF JENNIFER L. MARTIN; GILBERT 

LAMPHERE, MANAGING DIRECTOR, LAMPHERE 

CAPITAL MANAGEMENT; AND PETE EARLEY, WRITER;

 

MR. DEAL. Jennifer Martin is an attorney who is in private practice 

in Topeka, Kansas. She is here today to talk about her struggle with 

severe depression and her efforts to treat her condition. 

Mr. Gil Lamphere is a capital fund manager. Mr. Lamphere has a 

very distinguished business record, having worked at Morgan and 

Stanley as a Vice President and many other areas of the business world, 

and, in 1998, founded Lamphere Capital Management where he is the 

Managing Director. 

And Peter Earley, who is a journalist and author, a New York Times 

best-selling author and a former reporter at the Washington Post. We are 

pleased to have him here today, and he is going to talk about his son’s 

mental illness and the family’s experience in dealing with bipolar 

disorder. 

We are pleased to have all of you, and I will say to you as I did the 

first panel, your written testimony is in the record, and we would ask you 

if you would to use your minutes please to summarize that and talk about 

issues that are of concern with you. Thank you. 

We will begin with Ms. Martin.

MS. MARTIN. Thank you, Mr. Chairman Deal. I want to thank the 

Chair and the members of the committee and especially Congresswoman 

Myrick for holding this hearing today and allowing me to testify on this 

vitally important issue. 

If anyone had told me 5 years ago that I would be sitting here 

testifying in front of the House of Representatives about my own mental 

illness, I would have told you that you were crazy and that, certainly, I 

wasn’t crazy, and I was never going to be crazy. 

I grew up in the Midwest, outside of St. Louis in a normal every day 

average household. I have the same parents I started with. We had a dog 

and a picket fence. 
63

Life was perfect. But inside, inside the family, I knew of depression. 

My Mom had suffered from depression, from postpartum depression and 

generalized major depressive disorder her whole life, it was always 

untreated and only once diagnosed. Her sister, my aunt, committed 

suicide in 1987 from diagnosed but untreated bipolar disorder. So it was 

always the specter in my family. I had bouts of depression, the blues, 

things like that, but I thought that was normal because, in my family, 

everybody suffered from depression that was undiagnosed, so that was 

my normal life. 

I sort of thought, once I grew up and got out on my own and had my 

job and had my life, I would be happy, and things would be fine. 

So I kind of pushed aside those empty feelings or the bad feelings I 

had. I graduated from the University of Missouri Kansas City School of 

Law in the top of my class. 

I was recruited by the two largest most prestigious firms in Kansas 

City, went to one of them and had what everyone thought was the perfect 

life. I made great money. I had good friends. I had the perfect job. I 

had a perfect life, but I was absolutely miserable. The fact that everyone 

kept telling me, oh my gosh, you must be so happy with yourself, and 

life is great, made it worse. I would go home and sit by myself and be 

miserable on a daily basis. 

We talked over and over today about stigma and the stigma of 

mental illness. When I first started working at the law firm, I was told, 

don’t let them see you sweat. Don’t let them know that you are stressed 

because they will think you can’t handle the work. So I was able to push 

those feelings down, but then I had to be there. I had to make billable 

hours. I had to work 7 days a week, and I didn’t have any recovery time. 

Partners kept asking me, what is going on, you are not meeting your 

billable hour requirements? It was like I had a secret life. During the 

day, I was a hot shot young associate, and then, at night, I was binge 

drinking and using drugs in an effort to mask the pain and mask the 

depression that I felt. 

I can’t even explain what it is like to live that secret life, for people 

to say, oh, you have a perfect life and everything is rosy, and then to be 

doing cocaine on the weekends and waking up from a bender and not 

knowing what had happened the weekend before. 

I was really sick, but I couldn’t tell anybody because of the stigma 

that was associated with depression. I mean, after all, smart people don’t 

suffer from mental illness. 

I learned eventually that I did suffer from major chronic recurrent 

depression. I finally sought treatment with the insistence and the help of 

a friend in November 2003. I started receiving counseling and 

antidepressant medications, and at that time, it was covered by the law 
64

firm, and I had a great insurance program, but it was too little too late. 

Not a month and a half after I started my treatment, I was called in by the 

partners and they said, we think you need to find opportunities outside 

the law firm. Apparently, my lack of a team player attitude combined 

with my constant hangovers and runny noses were being noticed even 

though I thought I was doing a good job of hiding it. 

Once I left the big firm and went out on my own, somehow I was no 

longer able to get health insurance coverage because I had a mental 

illness, and I couldn’t even get basic coverage in the State of Kansas 

where I lived because of that diagnosis. 

But I was lucky, my parents had been able to foot the bill for me. 

For the last few years, I have been out on my own, but I pay over $400 a 

month just for my mental health coverage. Not everybody has the 

resources I have. 

Today I am recovering from depression. I have been in recovery 

about 2.5 years. I just got married 3 weeks ago. Life is going really 

great for me, but I do relapse. When I do, I know I am not lazy or overly 

emotional or just feeling sorry for myself. That is why I am so grateful 

and honored to be here today in the U.S. House of Representatives. 

Since I began speaking out about my depression just recently in an 

effort to reduce the stigma, I have been amazed by the millions of people 

who suffer from depression and the many people that I meet. Just on the 

plane here this morning, someone saw me working on my testimony and 

preparing, and they leaned over and started to tell me their story of a 

friend who had suffered from bipolar disorder and committed suicide. 

In February of this year, I made my first trip to Washington, D.C., 

with the Depression and Bipolar Support Alliance to introduce their 

groundbreaking research paper, The State of Depression in America. I 

had the honor of sharing a podium with Mr. Mike Wallace and 

Representative Patrick Kennedy, and we, all three, got to talk about the 

effect that serious mental illness has had on our lives. 

By removing the stigma of depression and helping people recognize 

that depression is a real illness, we bring the shadowed illness into the 

light of day and gave millions of people who are now quietly suffering 

from this excruciatingly painful illness the opportunity to seek treatment, 

treatment that we know can and really does help. Thank you. 

[The prepared statement of Jennifer L. Martin follows:] 

PREPARED STATEMENT OF JENNIFER L. MARTIN, ATTORNEY, LAW OFFICES OF JENNIFER L.

MARTIN

 I have always been aware of depression. My mother has suffered from depression 

for as long as I can remember. Her sister, my aunt, committed suicide in 1987 while 

suffering from diagnosed, but untreated, bipolar disorder. I had even had small bouts of 

depression growing up, but never believed I could suffer from “mental illness.” 
65

 I am an attorney in Kansas City, Missouri. I graduated at the top of my class from 

the University of Missouri – Kansas City School of Law. 

 Not long after graduating and beginning my dream job with a prestigious Kansas 

City law firm, I realized something was wrong. I didn’t smile or laugh. Feelings of 

sadness and despair inexplicably began to cascade over me. I had the perfect life (great 

job, good friends, money), but the world seemed dark and hopeless. The fact that I 

should have been happy made my misery even worse. 

 As an associate at a big law firm, I was expected to work long hours and weekends 

in order to meet the billable hour requirement, but I was frequently chastised by the 

partners in my firm because I was not hitting the bottom line and my attitude seemed 

poor. I was told I didn’t seem like “part of the team.” Instead of billing hours and being 

part of the team, though, I was living a secret life: a life where I was abusing drugs and 

alcohol heavily and regularly in order to ease the pain of my depression. Those drug and 

alcohol binges were always followed by even darker days where I could not even get out 

of bed. 

 I was really sick. But all I could think was that my employers would assume I was 

weak or lazy. That I couldn’t cut it in the corporate world and surely wasn’t smart 

enough to work for their presitigous law firm. After all, smart people don’t suffer from 

mental illness. 

 I have learned, though, that depression is a real disease brought on by a number of 

factors, including physical and chemical changes in the brain. I have also learned that 

depression is a very treatable illness. In November 2003, I began to receive counseling 

and anti-depressant medication, which was covered by the group health insurance plan at 

the firm. By then, though, it was too late for my job. My lack of billable hours, 

combined with my constantly runny nose and regular hangovers led the partners to 

suggest that I look for “other opportunities outside the firm.” 

 And, once I left the big firm and opened my own law practice, I could no longer get 

mental health insurance coverage. I am fortunate that I can afford to continue my 

treatment even without insurance coverage. But what about the many people who cannot 

afford the $400 a month I pay? 

 Today, I am recovering from depression. I have a successful and growing law 

practice. I just got married 3 weeks ago. When I relapse, which I do, I know that I am 

not “lazy” or “overly emotional” or simply feeling sorry for myself. I have depression – 

a real and serious illness that affects millions of Americans. 

 That is why I am so grateful and honored to be here today in the U.S. House of 

Representatives. Since I began speaking out about my depression in an effort to reduce 

the stigma of depression for others, I have had been amazed by the millions of people I 

have met who are living with and suffering from depression and other mental disorders. 

In February of this year, I attended and spoke at a press briefing for the Depression and 

Bipolar Support Alliance’s presentation of the groundbreaking paper: The State of 

Depression in America. I even shared a podium with Mike Wallace and Representative 

Patrick Kennedy. 

By removing the stigma of depression a and helping people recognize that 

depression is a real illness, we bring this shadowed illness into the light of day and give 

millions of people who are now quietly suffering from this excruciatingly painful illness 

the opportunity to seek treatment – treatment that we know can and does help.

MR. DEAL. Thank you. 

Mr. Lamphere. 

MR. LAMPHERE. Good morning, Mr. Chairman. 

Congressman Stuckey from the great State of Georgia, who I had the 

privilege of working for some 30 years ago, always told me, if 
66

everything has been already said, when your time comes, you better tell 

some good stories. 

And that I will try to do within 5 minutes. 

A couple years ago, I was suffering in the third year of what would 

be characterized as the 99th percentile of severity of depression, a serious 

case. 

I had taken some 27, 28 medicines, none had worked, that 27, 28, did 

not include any cocktails or combinations of medicines which would 

have boosted that number considerably. I have had 41 electric shock 

treatments which were effective until the last 10 or 12. 

During all this, I had had a very supportive family and wife, but 

things proved a little too much, and I lost my wife to divorce, lost the 

family, lost the apartment, lost a good deal of my liquid assets, lost my 

job. And finally, I was poured into a seat on the Acela and taken down 

to Baltimore to Johns Hopkins. Dr. DePaulo was there, and his 

predecessor, Paul McHugh, was there, and I said, gentlemen, you got to 

pull out all the stops; I don’t care what the side effects are, pull them out. 

And so they went back and got a class of drug that was over 35 years 

old called Parnate. It is an MAOI, rarely used, very hard to find in the 

drug stores, even in New York. They combined it with a drug that was 

less than 2 years old called Geodon that had been invented not for 

depression but for hallucinations for schizophrenics and for bipolar with 

hallucinations but had been found by Johns Hopkins to be very, very 

effective in lower dosages with depression. Thirty years old, and year 

and a half old. 

The magic bullet was lithium and then Lamictal, which are mood 

stabilizers with antidepressant qualities. 

They handed over that lobster roll, and they said, enjoy, because we 

think this is it. One day later, I felt better. I said let’s put some more 

lobster in that one, and we added a little bit more. I felt that much better. 

I said, just keep going. 

Sure enough, by the fourth or fifth day, I was back to my old self. 

The story I want to leave you with is that I don’t know if I could have 

made it if I didn’t have the support of my family, at least until the end, or 

had the great wealth, and the perseverance, but the money to have taken 

advantage of the finest doctors in this country and finally find a teaching 

hospital that had the ingenuity to find the combination that would bring 

my particular predicament to a resolution. 

My first point I want to make, Mr. Chairman, is, I honestly believe 

this is a physical illness. It is not a mental illness. The sooner we get 

that fact out in the educational system, in the elementary grades, the high 

school grades, the more people will understand. 
67

Let me tell you why I think it is a physical illness and what 

convinced me. I was having a great debate with one of the great 

psychopharmacologists in New York, one of the finest, and I was telling 

him, psychologically, that these people who went to work in the morning 

looked like ants with briefcases on a treadmill. I said, I don’t know what 

they are laughing about. I don’t know why they take pleasure in sitting 

under a tree waiting in the shade. He said, “Gil, this is not psychological. 

This is all physical.” I said, “What do you mean?” He said, “Well, you 

pay, I can’t pay, and healthcare is not going to pay, but why don’t you go 

down to NYU on 16th Street, and we will take some brain scans.” 

So I went down there, and they hooked up 25 electrodes to my head, 

and it looked like a Christmas tree. It was bright red here. It was 

beautiful blinking green here. It was blue and white here. We got here, 

and I said, well, that is the overview, but where is the detail? Because 

they said, that is the detail. It is black. 

It is black. It is not working. 

It is gone. I realized this is like charging a battery. You have to 

have in the charging battery the right chemicals. You have to have the 

right jumper cables. You have to have the right ignition, and you have 

got to permeate that brain, which is in reference today. I mean, the brain 

is designed to keep all this stuff out with good reason, but you’ve got to 

get it through there. 

So it takes a long time to cure this illness oftentimes. 

We talk about some of the illnesses, high blood pressure and diabetes 

and broken arms and Band-Aids. That is exactly what this is. 

It is a physical illness. Our panel before us can talk about a lot of the 

environmental things that happen that we think are causative that people 

are prone to. There is no question about that. 

But what happens is, there is a snap. The brain goes black. I think 

that is what we have got to get across today is it is a physical illness. I 

will stop there, Mr. Chairman. 

[The prepared statement of Gilbert H. Lamphere follows:] 

PREPARED STATEMENT OF GILBERT H. LAMPHERE, MANAGING DIRECTOR, LAMPHERE 

CAPITAL MANAGEMENT

 Good Morning. 

 What is not on my resume is that I was severely depressed for 3 years. In fact, I was 

in the 99th percentile of severity. Life was not worth living. I had the finest psychiatric 

and psychopharmacological attention my fortunate wealth could access. I had tried 27 

medicines, not including combinations or “cocktails” of them. I had 42 electric shock 

treatments to give me some respite. I spent 75 weeks in and out of hospitals. I had a 

loving wife that I lost to divorce 6 months prior to the end of my successful treatment. I 

lost my family, I lost a good deal of my assets, I lost my apartment, my job and 

profession, and my father had a stroke. 
68

 Finally, when the last electric shock treatment had surprisingly failed, I was gifted 

by a friend who said “get down to Johns Hopkins”. There I was told I would be lucky, 

given the severity and duration of my illness, to regain 80% of normalcy, 80% of the 

time. Since normal for me is more like 120% and a blessed hypo-manic state, not manic, 

just happy and positive and energetic most of the time, I remember telling Dr. Raymond 

DePaulo and Dr. Paul McHugh, two of the outstanding psychiatrists in the world, that 

80% wasn’t good enough and to pull out the stops and we’d worry about side effects 

later. And so we did, because that’s their philosophy anyway—pull out the stops, think 

outside of the box, in fact, collapse the box entirely. 

 So here I am today. Hopkins gave me a 30 year old, off patented, class of 

depressant called Parnate (an MAOI), invented in the early 70’s, together with a 2 year 

old drug designed for calming hallucinations in bipolar and schizophrenics, but which 

Hopkins had discovered had powerful anti-depressant behavioral effects at low dosages. 

Add to this mix, Lithium and Lamictal as mood stabilizers with anti-depressant qualities 

and we had the perfect cocktail. 

 I spent 12 weeks off and on at the hospital. My wife and children never visited me 

for reason I still don’t fully understand. But it’s very possible they had been advised not 

to get further swept up in the vortex of an illness that eats marriages alive, until we got 

the fine tuning right. And here we are two and a half years later, and I feel better today 

than I ever remember in my life. 

 Against this backdrop, I have just 2 points to make today. 

 First, depression, bipolar and its related cousins are not mental illnesses. They are 

physical illnesses, in both cause and treatment. Allow me to explain. In the middle of 

my illness, Dr. Francis Maas, one of New York’s premier psycho-pharmacologists, told 

me that part of my brain affecting emotion and cognitive behavior was shut down, non 

functioning. I didn’t believe him, since I thought I was right in all my thinking, e.g., that 

nothing was humorous, nothing gave pleasure, people going to work in the morning was 

a repetitive tragedy like ants with no brains, etc. To prove my point that my 

psychological insights were correct, I went down to New York University Hospital were 

they hooked up my head to 25 electrodes and for a half hour recoded my brain functions. 

Then I looked at the printouts. It looked prettier than a Christmas tree. My brain’s right 

front was blinking red, my back right was blinking green, my left back was blinking 

yellow and blue and my front left was—holy smokes—it was black with nothing going 

on. 

 Mental illness may have gotten its name by being lodged in the brain, but at its core, 

it is not psychological (although counseling can help after the brain is lit up enough) 

illness. It is a physical illness like diabetes, high blood pressure or a broken arm, which 

things like extreme stress triggers. There can be a predisposition, or there can be not 

trigger at all. But suddenly, the physical components of the brain, the electrons, the 

chemicals, the neurons, the reuptakers, electrical charges don’t work. And my point is, if 

these disorders are thought of correctly, as physically caused and physically cured, 

mental illness will be called a brain problem, seen entirely differently and the stigma will 

melt away. Incidentally, I find this insight to be most easily accepted by people under the 

age of 60 and not so easily accepted by people over 60 (mostly men) who feel if you are 

depressed you should “pull yourself up by the bootstraps and regain the respect of your 

wife, family and friends.” 

 My second and last point today, is that finding the right medicine or combination of 

medicines can often be a long drawn out process. We seem to understand what we are 

trying to stimulate in the brain, and medicines today are targeted, with variations, to do 

that. But it is still hit and miss. We need to manage patients expectations while, at the 

same time, give them hope. But medicines sometime take a long time to fully work, and 

sometime the patients grow discouraged that he/she is not getting better and the doctor 

has moved the goal post another 100 yards down the field. 
69

 In summary, we have a physical ailment, not psychological, that is treated 

physically, and that is difficult to treat and takes time. Thank God I have had my family 

for much of the time, and my wealth to get me through. How other people without those 

two ingredients struggle through the months and years of being without human support, a 

job, money and the finest care in the United States, is beyond me. 

MR. DEAL. Thank you. 

Mr. Earley. 

MR. EARLEY. Thank you. 

My name is Pete Earley. I am the author of, “Crazy: A Father’s 

Search Through America’s Mental Health Madness.” I am also the 

proud father of a 27-year old son, Mike, who happens to have a brain 

disorder. 

His illness surfaced while he was in college in New York. His 

brother called me one day in a panic and said, Mike has gone crazy. I 

drove immediately to New York to get him from my home in Virginia. 

It is difficult for me to tell you how painful it was to ride home with him 

on that day. 

During the 4-hour drive, his moods would shift within seconds, 

crying at one moment, laughing at the next. 

He said to me, “Father, how would you feel if someone you loved 

killed himself?” I did what any parent would do. I drove him to an 

emergency room. 

I will never forget the intake nurse rolling her eyes as Mike 

described how he was getting secret messages from God. We waited for 

4 hours. A doctor came in. He came in with his hands up as if he were 

surrendering, and he said, “I can’t help your son.” I said, “You haven’t 

even looked at him.” He said, “It doesn’t matter. Your son has told the 

nurse that he believes pills are poison, and under Virginia law, I cannot 

treat anyone against their will unless they are in an imminent danger to 

themselves or someone else. Take him home and bring him back when 

he tries to kill himself or kill you.” 

The next 48 hours, I watched my son sink into a mental abyss. At 

one point, he had tinfoil wrapped around his head because he was 

convinced the CIA was reading his thoughts. He slipped out of my 

house. He broke into a stranger’s house to take a bubble bath. Five 

officers had to go in and wrestle him out. 

They took him to a community treatment program. I arrived, and the 

policeman outside said, unless you go in there and you tell his 

psychiatrist that your son tried to kill you or kill himself, he will not be 

admitted. I said, he hasn’t done that. He said, it doesn’t matter, under 

the law, he has to be in imminent danger to himself or others. So I went 

in, and I lied. My son was put in the hospital. A few days later the 
70

police called me. My son had been charged with two felonies, breaking 

and entering, and destruction of property. 

I was so frustrated. Our laws had stopped me from getting him help. 

Now the laws wanted to punish him for a brain disorder. 

As a father, there was little I could do. As a journalist, I could 

investigate our system. 

I quickly discovered that my Mike was not alone, because of 

deinstitutionalization and our flawed system, there are 300,000 persons 

with severe mental disorders in our jails and prisons; 500,000 on 

probation; 700,000 go through our justice system every year. The largest 

public mental facility in the United States is not a hospital; it is the Los 

Angeles County jail. 

Mike ended up being sentenced to 2 years of probation. He 

completed treatment. He took his medication. Everyone told him mental 

illnesses are chemical imbalances. They are biologically based. The 

heart gets sick. The mind gets sick. There was nothing for him to feel 

ashamed about, but when Mike told potential employers he had a mental 

illness, his application was rejected. My son has a college degree. He 

was refused a job bagging groceries. 

Six months after Mike’s probation ended, he stopped taking his 

medication. Because of my research, you would think I would be smart 

enough to protect him. But I found myself again being stymied. When I 

called the Fairfax County Mobile Crisis Unit for help, the dispatcher 

asked if Mike were dangerous. Not yet, I said. Then there is little we 

can do to help him. 

I begged. I pleaded. I badgered my son to take his medicine. But he 

refused, and he got worse. 

A month ago, 4 weeks ago, his mother and I called the Fairfax 

County Mobile Crisis Team. Mike had become violent. The dispatcher 

told us, call the police. We don’t answer calls if the person is violent. I 

was afraid of the police. I was afraid they would arrest him. I was afraid 

they would harm Mike or he would harm them. So I called a social 

worker who is a close friend who works with the police department. He 

got out of his bed at midnight and came over. He insisted that the police 

call a sergeant who is equipped with an electric stun gun, a taser. He was 

sent to our house. Mike ended up being shot twice with the taser. He 

was hog-tied, and once again, he was taken to a community center 

instead of to the jail. 

It took us 3 hours before we could see a doctor on duty. Luckily, he 

agreed to hospitalize Mike. It took 3 more hours to find a hospital with a 

vacant psychiatric bed, and they only agreed to take my son after they 

learned he had insurance. 
71

I live in one of the wealthiest counties in America. It can take a 

person with a severe mental illness 6 months to get into a treatment 

program, 2.7 years to get a case manager, 17.5 years to get into 

subsidized housing. You have asked me what it is like to be a parent 

with a person with a mental disorder. Each time my son laughs, I 

wonder if he is taking his medication. Each time he becomes sad, I 

wonder if he is heading for another relapse. Each time the phone rings, I 

shudder. I live on an emotional cliff waiting for the next breakdown. 

But I also cling to the hope that Mike will find a way to control his 

illness, that science and therapy will curb his disorder. 

I try to focus on persons such as my panel members for inspiration. I 

look to you for leadership, leadership that will bring an end to the 

criminalization of persons with mental illnesses, leadership that will 

bring about sensible reforms, leadership that will enable Mike and other 

sons and daughters to get help and not be turned away by a doctor when 

he says, bring him back when he tries to kill himself or kill you. Thank 

you. 

[The prepared statement of Pete Earley follows:] 

PREPARED STATEMENT OF PETE EARLEY, WRITER

Summary: When journalist Pete Earley’s adult son, Mike, developed a major mental 

illness, his father rushed him to an emergency room, but a doctor there refused to treat 

him, citing civil rights laws that said Mike had to be an “imminent danger” either to 

himself or others before he could be helped against his will. Mike thought pills were 

poison. Earley was told to bring his son back if he tried to kill himself or someone else. 

Forty-eight hours later, Mike broke into an unoccupied house to take a bubble bath 

during a psychotic episode. He was arrested and charged with two felonies: breaking and 

entering, and destruction of property. Earley was so outraged by a legal system that had 

stopped his son from getting help and now wanted to punish him, that he launched his 

own investigation into today’s mental health system. He eventually spent a year inside the 

Miami Dade County jail in Florida where he followed several mentally ill prisoners 

through the court system and into the community. He interviewed correctional officers, 

judges, attorneys, mental health workers, psychiatrists, the police, parents of persons 

with mental illnesses, and consumers to learn why jails and prisons have become our new 

mental asylums. He has published his findings in a nonfiction book, CRAZY: A Father’s 

Search Through America’s Mental Health Madness, which tells two stories. The first is 

his son’s. The second is an expose that explains how persons with mental illnesses are 

being treated today. Earley concludes that we need to take immediate steps to stop the 

criminalization of persons with mental illnesses by: re-examining our nation’s 

commitment laws, establishing Crisis Intervention Training for the police, stopping the 

closing of psychiatric hospital beds, and by improving community based treatment 

services. 

Thank you for inviting me to testify this morning about my son, Mike, and what it 

feels like to be a parent or a loved one of a person with a serious mental disorder. The 

quick answer is: frustrating and heartbreaking. It is difficult enough to battle a biological 

brain disorder. It is even more frustrating and more heartbreaking when you encounter a 
72

mental health care system that is callous and so deeply flawed that it throws up 

roadblocks to recovery rather than offering a helping hand. 

I have included an excerpt of my book, CRAZY: A Father’s Search Through 

America’s Mental Health Madness, in this written testimony. It will explain how we are 

turning persons with mental disorders into criminals, how jails and prisons have become 

our new mental asylums, and how we have gotten ourselves into this tragic yet 

preventible mess. 

Please read it. I live in one of the most affluent and sophisticated suburbs in 

America in a Virginia county that prides itself on having a model mental health care 

system, yet my son ended-up being punished – rather than treated -- because of his 

illness. Sadly, what happened to him is not an aberration. 

There are 300,000 persons with severe mental illnesses currently in our jails and 

prisons. Another 500,000 are on probation. 700,000 go through the court system each 

year. Those who aren’t in jail, oftentimes are hidden away in repugnant assisted living 

facilities. In Miami, 4500 persons with severe illnesses are housed in 647 rooming 

houses. 397 of these slum operations can’t pass the state’s minimum standards for 

boarding homes, yet Florida continues to use them. We have closed down the giant 

warehouses that were state mental asylums. But sadly, we have not helped thousands of 

persons with severe disorders. Instead, we have simply hidden them better. 

As we have heard today, we have made significant advances in developing 

medications and treatment. But none of these promising scientific discoveries will matter 

if we cannot find a reasonable and sensible way to deliver services to persons who need 

help. As you read my son’s story, you will discover that getting help is often nearly 

impossible even when medical solutions are available. Please remember two additional 

facts. Mental disorders can strike anyone regardless of their race, creed, political clout, or 

wealth. Bipolar disorder, severe depression and schizophrenia are equal opportunity 

afflictions. If it happened to my son and me, it can happen to your son, daughter, mother, 

father, or sibling. Also understand that I am not alone in asking for reform. Consider this 

note that was written by a mother who posted it on my author’s webpage 

(www.peteearley.com). 

“Only a parent with a seriously mentally ill child, like yourself, can understand the 

terror and desperation that we suffer. I live constantly with the threat of my adult 

son’s arrest or death (or worse) and I have even harbored the horrible thought of 

taking my own life and his on occasion to just end this never-ending nightmare.” 

This mother is suffering, not only because of her son’s mental illness, but by her 

inability to get him meaningful help. Science can give us the tools to unlock the brain’s 

mysteries. But these discoveries are useless if we can’t develop a mental health care 

system that can provide services and treatment. My son’s story is a testament that such a 

system does not exist today. What I found during my year long investigation at the Miami 

Dade County jail is a testament that such a system does not exist today. We need 

Congress to fix these problems. 

I applaud your committee for taking an important step today by holding this hearing 

and calling attention to the need to end stigma. But please don’t stop here. I beg you. My 

son, Mike, has a mental disorder that is trying to destroy him. He and I have no choice 

but to put our trust in medical research. But whether or not Mike ends up living on the 

street, eating out of a garbage can and being attacked by teenage thugs wielding baseball 

bats – or living in a rat infested assisted living facility -- or spending the rest of his life 

locked in a jail cell for a crime that could have been prevented – these are scenarios that 

are within our control. 

Here is our story. I wrote it because I wanted mental illness to take on a human face. 

It is my son’s, but it is a face that can be worn by thousands. 

***** ***** ***** 
73

“How would you feel, Dad,” Mike asked me, “if someone you loved killed 

himself?” 

My son’s voice sounded weary. We were speeding south on Interstate 95, just north 

of Baltimore, racing toward a Fairfax County hospital. I had rushed to Manhattan earlier 

that morning to get Mike after his older brother telephoned me in a panic. They both 

lived in New York City. Mike had not slept in five days, had been walking aimlessly 

throughout the city, and was about to lose his job as a waiter. He was convinced God was 

sending him encrypted messages. 

Without warning, Mike burst into laughter. “Dog God!” Ha, ha, ha. “God Dog! Get 

it?” 

Just as quickly, he began to sob. Tears flowed down his cheeks. I hadn’t seen him in 

such pain since he was a boy and got smacked in the scalp with a stick by a playmate. I 

had driven him to the hospital and held his hand while they sewed stitches. He had been 

five years old back then. Now he was twenty-three. 

“Why are you crying?” 

“I can’t tell you because you will hate me forever.” 

 My wife, Patti, already had alerted the emergency room at Inova Fairfax Hospital. 

It’s where we had taken him before when he’d suffered a mental breakdown a year 

earlier. There had been no warning signs, no known family history of mental illness. 

Mike had recently graduated from a Brooklyn art school when one of his friend’s had 

showed up with him at my front door. He was babbling about a girl named Jen, telling me 

that she was in danger, that people were going to hurt her and that he needed to save her. 

None of it made sense. I put him to bed, but he became paranoid and when I finally was 

able to persuade him to go to the hospital, security guards had to wrestle him down. That 

was when I had first heard the term: bipolar disorder. 

With anti-psychotic medication, time, and therapy, Mike had become his old self 

again and returned to New York. I called every Sunday but our recent conversations had 

been shorter than ususal. Still, I’d not suspected that anything was wrong. The truth was 

that both of us wanted desperately to believe the doctors had made a mistake, that he had 

been misdiagnosed and his first episode had been a fluke brought on by too much stress 

and too little sleep. 

But then his brother called. Mike had not been taking his pills and now he was 

acting crazy. 

“Please take your medicine,” I begged. I’d been trying to get Mike to take Zyprexa, 

an anti-psychotic, since he’d first gotten into my car. 

“Pills are poison.” 

But moments later, he said: “Okay, I’ll take your damn pill.” He reached for the 

water bottle that I’d given him, but he paused before he slipped the tablet into his mouth 

and then dropped his hand next to the car seat out of my view. Was that the pill? 

I pressed harder on the gas pedal. I had to get him to the hospital. He would be safe 

there. Its doctors would know what to do. 

***** ***** ***** 

I had no idea. 

 I had been a journalist for more than thirty years, a Washington Post reporter, and 

the author of several nonfiction books about crime and punishment and society, some 

award-winning, even best-selling. I’d interviewed murderers and spies, judges and 

prosecutors, defense attorneys and defendants. But I was always on the outside looking 

in. I had no idea what it was like to be on the inside looking out – until Mike was 

declared mentally ill. 

 Our manic trip from New York City to Fairfax in late August 2002 was the start of 

a harrowing journey. We were about to plunge headlong into the maze of contradictions, 

disparities, and catch-22s that is America’s mental health system. But even that was 

nothing compared with what happened when Mike, suffering delusions, committed a 
74

crime and was arrested, thrusting us into a judiciary that proved ill-equipped to handle 

madness. 

 Few of us worry that we’ll wake up mentally ill. But what if the phone rings, and it’s 

someone telling you about your sister, your daughter, your mother or your son? It 

happens more than you think. Fifty-one million Americans have mental disorders. Nearly 

all Americans have at least one relative who is mentally ill. Six-and-a-half million 

Americans are so debilitated by mental illness they are considered disabled. 

Because of what happened to Mike, I have spent the last four years examining our 

nation’s mental health system from an unusual perspective -- as a father struggling to 

help his son and as a journalist investigating a larger story. What I have discovered 

should outrage us. It should also scare you. Because the way we treat the mentally ill 

today in America is a national disgrace and mental illness is indiscriminate. Your 

education, your income, your political clout, your zip code – none of it matters. 

 If it could happen to my family, it could happen to yours. 

***** ***** ***** 

 By the time we reached the hospital it was eight p.m. The intake nurse rolled her 

eyes as Mike blabbed about God. She put us in an examination room to wait. For the next 

two hours, no one came to help us. Another hour passed and then, incredibly, another. It 

was now midnight. 

“I’m leaving,” Mike declared. 

I stepped out and flagged a nurse. An emergency room doctor came in moments 

later. As he stepped toward Mike, the doctor raised his arms as if surrendering to enemy 

troops. “There’s not going to be much I can do for you,” he announced. 

 I thought: You haven’t even examined him! 

 The doctor asked Mike: “Do you know who I am?” 

 “You’re the witch doctor. Owe-ee-ow-ah-ah.” 

 The doctor grinned. This isn’t funny, I thought. I blurted out: “He’s been 

hospitalized before for bipolar disorder. He hasn’t been taking his medication.” 

 But the doctor cut me short. “What’s happened before this moment really doesn’t 

matter.” He asked Mike to name the president. Then had him count backwards from a 

hundred. “What does the phrase ‘Don’t cry over spilled milk’ mean?” Mike answered 

each question and then added that God had made him indestructible. 

 “Virginia law is very specific,” the doctor explained. “Unless a patient is in 

‘imminent danger to himself or to others,’ I cannot treat him unless he voluntarily agrees 

to be treated.” Before I could reply, he asked Mike, “Will you take medication?” 

 “I don’t believe in your poisons. Can I leave now?” 

 “Yes,” the doctor said. Mike leaped from the exam table and hurried toward the exit. 

 “But he’s not thinking clearly,” I stammered. 

 The doctor shrugged. If Mike tired to kill himself or hurt someone, he said, I could 

bring him back. 

***** ***** ***** 

 During the next twelve hours, I listened to Mike as he slipped deeper and deeper 

into a mental abyss. Nothing can prepare a parent for this horror – watching your child 

being tormented by his own thoughts. In the morning, I decided to spike his breakfast 

cereal with an antipsychotic medication. But Mike spied flecks of the pill’s pink shell 

floating in the milk and erupted. “Take me to mom’s house!” he yelled. 

 His mom is my ex-wife, who lives nearby. During the drive, he became so furious at 

my badgering about his pills that he jumped out before I could bring the car to a full stop. 

He ran the rest of the way there. 

 Forty-eight hours later, the Fairfax County Police called. Mike had been arrested. 

He’d gotten up before sunrise and gone outside. Suddenly, he’d felt filthy, so dirty that he 

had to take a bath – immediately. He shattered a glass patio door at a stranger’s house and 

darted in. Fortunately, the homeowners were away for the weekend. After rummaging 
75

through the kitchen, Mike went upstairs to take a bubble bath. Alerted by the home’s 

clanging burglar alarm, the Fairfax County Police sent a dog inside. It bit into Mike’s arm 

and dragged him down. But it still took six officers to subdue him. 

 The police drove Mike to the Woodburn Center for Community Mental Health, less 

than one mile from the Inova emergency room where I’d first taken Mike for help and 

been turned away. None of this would have happened if that damn doctor had treated 

Mike, I thought as I turned into the Woodburn parking lot. 

***** ***** ***** 

 Police Officer Vern Albert was standing at the entrance. “Even though your son has 

broken into a house, unless you tell the medical personnel inside that he’s threatened to 

kill you, they aren’t going to treat him. We’ll end up taking him to jail and you don’t 

want that. Not in his mental condition.” 

 “But he hasn’t threatened to kill me.” 

 Albert shot me an exasperated look. 

 I went inside, and I lied. The police drove Mike to the psychiatric ward at Inova 

Mount Vernon Hospital in Alexandria. I followed. “How long does it take anti-psychotic 

medicines to work?” I asked a nurse there. 

 She seemed surprised. “Just because your son is being admitted doesn’t mean he’s 

going to be treated,” she said. It was against the law for doctors to force Mike to take 

anti-psychotic medication, she explained, even though he was clearly psychotic. 

 An attorney called a few hours later and explained she had been appointed to 

represent Mike. I was excited because I naively thought she was going to help me get 

Mike treatment. But she explained it was her job to get him released as quickly as 

possible if that is what he wanted. 

 “But he’s not thinking clearly!” I snapped. “He’s sick.” 

 “I’m just doing my job,” she replied. 

***** ***** ***** 

 At a commitment hearing the next morning in the hospital, Mike agreed to sign 

himself into treatment voluntarily. 

 “Why are you doing this?” the hearing officer asked. 

 “Because I’m having a relapse and my parents want me somewhere safe.” 

 I felt relieved. Now he could finally get help. That night, I brought Mike a box of 

fast food chicken. I knew he wouldn’t like hospital food. It happened to be my fifty-first 

birthday and despite his confused mental state, Mike remembered and handed me a 

hand-drawn card. From nowhere, he mentioned a fishing trip to South Dakota we’d 

taken. He’d been five and had wandered off from the lake. The ground had given way at 

the edge of a ravine, causing him to fall half-way down it before he’d grabbed a shrub 

and stopped the fall. I’d climbed down and rescued him. Over time, the story had grown. 

The gully had become a hundred-foot-cliff. That was when he was little, and I was still 

his hero. We laughed about the story and then I said: “Get well, son, that will be the best 

birthday gift ever.” 

 The next morning, the hospital psychiatrist called. A pill had been found on the floor 

in Mike’s room. He’d pretended to take it and then spit it out. I confronted him that night. 

“I keep thinking this is all a dream,” he said. “I’ll just wake up and it didn’t happen.” 

 I touched his hand. “This is real. You’ve got to take your medication.” 

 Dr. James F. Dee called the next morning. Mike was taking his pills, but there was a 

new problem. Our insurance company wanted Dr. Dee to discharge Mike later that day. 

Dr. Dee didn’t believe Mike was ready, but because Mike hadn’t tried to kill himself and 

was now taking his pills, the insurance company wanted him out. 

 I called the insurance company, but the woman there had no sympathy. “Your son 

can recover at home.” 

 “But he’s not stable!” I said, and then I lost it and I did something that I had never 

done before as a journalist. I warned her that I was a former Post reporter and was friends 
76

with Mike Wallace of 60 Minutes. If her company forced Mike out, I’d notify the Post. 

I’d call Wallace. As I put down the receiver, I realized that since Mike’s breakdown, I 

had lied to get him hospitalized and now I was violating my professional ethics to keep 

him there. 

 Dr. Dee telephoned that afternoon and said the insurance company had backed off. 

Mike could stay in the hospital as long as necessary. I learned later that a girl, who had 

stabbed herself in the neck with a pencil, had been released that day. Within two hours, 

she had disappeared, leaving her parents to drive the streets. 

 Mike slowly got better and we arranged for him to enter a community mental health 

day treatment program in Reston. I began to feel optimistic. And then the phone rang. 

 “I’m Detective V.O. Armel,” the caller said. “Two felony warrants have been issued 

for your son’s arrest.” Mike had been charged with “intentionally destroying, defacing, 

and damaging property in excess of $100” and “breaking and entering...with the intent to 

commit larceny.” Both carried up to $10,000 in fines and five year prison terms. 

 “But my son’s mentally ill,” I protested. “He didn’t know what he was doing. And I 

tried to get him help in a hospital before this happened.” 

 “Just because your son is mentally ill doesn’t mean he can’t be charged with 

breaking the law.” 

***** ***** ***** 

 What happened to Mike was not uncommon. A major shift has occurred in America. 

 In 1955, some 560,000 Americans were patients in state mental hospitals. Between 

1955 and 2000, our nation’s population increased from 166 million to 276 million. If you 

took the patient-per-capita ratio that existed in 1955 and extrapolated it out based on the 

new population, you’d expect to find 930,000 patients in mental hospitals today. But 

there are fewer than 55,000. Where are the others? More than 300,000 are in jails and 

prisons. Another half million are on court-ordered probation. The largest public facilities 

for the mentally ill are not hospitals. They are jails and prisons. They have become our 

new asylums. 

Why? I decided to go to Miami, Florida to find out. I chose it for two reasons. I 

didn’t want to risk irritating local officials in Fairfax by writing about the jail system here 

since they would be in charge of deciding Mike’s fate. I also had been told that Miami 

has a higher percentage of mentally ill residents than any other major city. Three percent 

of the population in most American cities are mentally ill. In Miami, it’s nine percent. 

Besides the normal three percent, another three percent come for the warm weather and 

another three because of Fidel Castro. In 1980, he released patients in Cuba’s mental 

hospitals into the stream of refugees fleeing to Florida from the port of Mariel. 

 Miami has been struggling with mixed success to deal with its mentally ill. It proved 

representative. I could just as easily have chosen Chicago, Los Angeles, Philadelphia or 

Washington D.C. Miami’s jail system is the fourth largest in the nation. Sixteen percent 

of its inmates have severe mental disorders. The craziest are housed on the ninth floor in 

the downtown jail in “suicide watch” cells with plexiglass front walls so officers can keep 

an eye on them. 

 Dr. Joseph Poitier, the jail’s psychiatrist, took me on his morning rounds. As we 

entered C wing, I gagged. The air stunk. It was a putrefied scent, a blending of urine, 

expectorant, perspiration, excrement, blood, flatulence, and dried and discarded jailhouse 

food. I listened to the sounds. Toilets flushed. Prisoners hacked, coughed, groaned. 

Correctional officers laughed and yelled commands. Leg chains click-clacked against the 

hard surface as prisoners arrived. These were typical jail noises. When I listened closer, I 

heard the asylum sounds. A prisoner sobbing uncontrollably, another moaning, a third 

screaming. 

 Thud, thud, thud.. Then faster. Thudthudthud. Then louder. THUD. THUD. THUD. 

An inmate was banging his forehead against a glass cell front. 
77

 The inmates peering out at me in the first cells were naked. There was nothing in 

their cells except a combination sink and toilet. Nothing. No television, no radio, no 

magazine, no place to sleep, no chair. Nothing. Because of a design flaw, the temperature 

in each cell hovered in the 60s. The inmates were trembling in the frigid air. A few 

rocked back in forth on their heels, mumbling. Some had urinated and defecated on the 

floor. Most stood at their cell fronts looking out at the officers. They had blank 

expressions, hollow eyes. I had never seen such bleak conditions and I have been in 

hundreds of jails and prisons as a reporter. 

 “What I do here is triage,” Dr. Poitier explained. There is no meaningful treatment. 

As we shifted from cell to cell, he spent his rounds trying to persuade prisoners to take 

medication. They had arrived on C wing with no medical records. Many were homeless. 

Most of their families have given up on them. Psychotic inmates could spend months 

here. Others would be released only to be arrested within hours on different charges 

related to their illnesses, such as trespassing or being a public nuisance. If they were 

charged with a felony, they would eventually be sent to one of Florida’s three forensic 

hospitals. But there was a long waiting list and even then, they were not treated there. 

Instead, they would be given medicine until they were judged “competent” for trial and 

returned to Miami. Sometimes it could take five or six trips between the jail and hospital 

before they were stable enough to appear in court. 

We paused outside a cell designed for two men, but holding six. A prisoner was 

lying on the floor next to a toilet that another was urinating in. Because the splash was 

hitting the inmate’s face, Dr. Poitier was concerned. He asked a prisoner to roust the man 

to make certain he was sleeping and not dead. The inmate raised his head, grunted, and 

rolled over. As we were about to move on, I notice movement underneath a steel bunk. 

Dropping to my knee, I peered through the smudged glass wall. A man was curled up 

there. He had schizophrenia, which can cause hallucinations and confused thinking, and 

was chewing on day-old orange peels. He smiled and waved. 

 I checked my watch after we finished the morning rounds. Dr. Poitier had spoken 

with or visibly observed ninety-two inmates. His rounds had taken 19 1⁄2 minutes. That 

was an average of 12.7 seconds per prisoner. 

 “A lot of people think someone who is mentally ill is going to get help if they are 

put in jail,” Dr. Poitier said. “But the truth is we don’t help many people here... we can’t.” 

 A man with bipolar disorder, which causes rapid mood swings, had been put in jail. 

For twenty-five years, he’d taken his medication and lived an ordinary life. But then he’d 

lost his job and couldn’t afford his pills. He’d attacked his father and been arrested. In 

jail, he jumped from a top bunk headfirst into the floor, snapping his neck. Now, he was a 

paraplegic. 

 “Jails are not hospitals,” Dr. Poitier said. “Mentally ill people belong in hospitals, 

not here.” 

 That night I woke up sweating. I had dreamed I was with Dr. Poitier making rounds 

and had spied an inmate under a bunk. When I bent down to see, the inmate eating the old 

orange peel was Mike. 

***** ***** ***** 

In a well-schooled Virginia drawl, Fairfax defense attorney Andrew Kersey assured 

us that he’d be able to cut a plea bargain for Mike. Because my son had no previous 

criminal record, was clearly psychotic when he broke into the house, and was now in a 

treatment program, Kersey felt confident the Fairfax County prosecutor assigned the case 

would reduce the two felony charges to misdemeanors. Mike would be given a year of 

probation. It would be an open-and-shut matter. 

 On the morning of his court appearance, I asked Mike if he understood what was 

happening. He didn’t. He was still groggy from medication, but he was eager to go to 

court. When I asked why, he replied: “I get to wear my new suit!” Before he’d become 
78

manic, he’d bought a suit because he was going to interview for a new job. This would be 

the first time he had worn it. 

 “There’s a problem,” Kersey announced moments before the hearing. “Our plea 

deal is off.” He explained that the assistant prosecutor had never cleared the deal with the 

homeowners and when they heard about it this morning, the wife had gotten angry. 

 “She wants your son put in jail or an institution,” Kersey explained. “The victims are 

demanding he plead guilty to at least one felony charge.” 

 “But a felony will ruin Mike’s future.” His college degree was in a profession that 

required a Virginia state license. Felons were ineligible. 

Kersey gave us a sympathetic look and said: “What’s odd is the judge will still give 

Mike the exact same sentence.” If Mike pleaded guilty to two misdemeanors, he’d get a 

year of probation. If he were forced to plead guilty to a felony, he would still get a year of 

probation. 

 Kersey wasn’t certain if the wife understood this, so he ducked back into the 

courtroom to talk to her, leaving us to wait in the hallway. I checked my watch. Six 

minutes to go before court started. A few moments later, Kersey reappeared. The husband 

didn’t care but the wife wanted Mike punished. Before Mike took his bubble bath, he 

broke a family heirloom dish, turned photos of her children face down on the mantel, 

drank some booze and left the bathwater running in the house causing extensive damage. 

Most of all, Kersey said, the wife felt violated. Mike had taken a bath in her teenager 

daughter’s bathroom. That’s creepy. Why had he chose their house? What if he came 

back? She was so unnerved that she was pressuring her husband to sell their house and 

move away. 

 “What she really wants is for your son to be put in prison,” Kersey said. 

 “But he’s mentally ill. Bipolar disorder is a chemical brain disorder. It’s like cancer. 

You get it. You don’t do anything to get it. It just happens to you,” I said. 

Kersey nodded at his watch. Four minutes. He explained our options. If Mike 

pleaded guilty to a felony, the case would be over. If he pleaded not guilty, the judge 

would set a trial date. But a jury would probably find Mike guilty because he’d been 

arrested inside the house. It might send him to prison. There was a third choice. Mike 

could plead “not guilty by reason of insanity” but if we won, he would not be turned 

loose. He would be taken directly from the courtroom to the jail to wait for a bed in a 

Virginia forensic hospital. Mike could spend weeks waiting and there would be no way to 

know when he might be released after he was sent to the hospital. He’d also be identified 

in court records forever as being innocent, but insane. 

 “We’d win in court,” Kersey said, “but your son would lose.” 

 Three minutes and ticking. Three minutes to decide which was the lesser of three 

punishments that, as Mike’s father, I believed were all unfair. 

 “Offer them money,” I said. Kersey said no. The wife was legitimately afraid. She 

felt twice victimized. Mike had broken into her house. The prosecutor had not consulted 

her about the plea deal. She was the victim, not Mike, and in today’s get-tough-on-crime 

environment, no elected prosecutor wanted to appear soft on crime. 

 Two minutes. 

 “What do you want to do?” Kersey asked. 

 I didn’t know. How could this be happening? Kersey suddenly had another idea. 

He’d ask Detective Armel for help. The police often bond with victims. He rushed back 

into the courtroom. 

Mike and I waited. He didn’t have any idea what was happening. When Kersey 

rejoined us, he shook his head. Nothing had changed. Detective Armel had explained that 

Mike’s punishment would be the same, but it hadn’t mattered to the wife. 

 We were out of time. Mike and I followed Kersey into the courtroom. I noticed 

Detective Armel was still speaking to the victims. I didn’t know what to tell Kersey. 

Which was better? Pleading guilty to a felony and having Mike marked for life? Risking 
79

a trial and having him found guilty? Or fighting the charges by pleading that Mike was 

insane? I’d been given less than ten minutes to make a decision that was going to forever 

alter my son’s future. 

 The judge entered. The clerk began reading the calendar of cases. Mike’s name was 

third on the list. For the first time in my life, I was literally frozen with indecision. I 

looked at Mike. I looked at Kersey. He needed an answer. 

 At that moment, I saw Detective Armel walk down the aisle to talk to the 

prosecutor. I glanced at the husband and wife. She was sobbing. But I felt no sympathy. 

 Kersey hurried up to Armel. The clerk called Mike’s name. The prosecutor said, 

“Judge, we’d like to continue this case.” 

 The judge agreed to put it aside for three months. 

 Kersey hustled us out into the hall. Detective Armel had won us more time by telling 

the wife that Kersey might be able to come up with an offer that would be better for them 

than one year of probation. 

 The homeowners and Armel exited the courtroom. None looked at us. 

 “Mike,” I said, “do you see those people walking there?” 

He looked and had no idea who they were. 

***** ***** ***** 

 Dorothea L. Dix visited a Boston jail to teach a Bible class in the 1800s and 

discovered mentally ill prisoners had no heat despite freezing temperatures. The jailer 

said: “The insane don’t need heat.” Dix spent the next two decades exposing how 

“lunatics” were being abused in jails and prisons. She would be credited with persuading 

thirty states to build asylums for treating the mentally ill, rather than punishing them 

because they were sick. 

By 1900, every state had a mental institution, but conditions in them were wretched. 

Patients were often committed by relatives. The system was abused and the hospitals 

became a catch-all for society’s disposables – the elderly, the deaf, the blind, and the 

poor. On May 6, 1946, Life magazine published a story entitled: Bedlam: Most U.S. 

Mental Hospitals Are a Shame and a Disgrace. It began by describing a mental patient 

being tortured to death by the staff. Other investigative stories compared conditions in 

state mental hospitals to Nazi concentration camps. 

 In 1963, President John F. Kennedy asked Congress to spend three billion dollars to 

replace the nation’s cruel state hospital system with a network of Community Mental 

Health Centers. The discovery of promising new antipsychotic drugs made it possible for 

severely mentally ill patients to return to their hometowns and live outside locked wards. 

It was a grand plan, but Kennedy was assassinated, the Vietnam war escalated, 

Congress got ensnared in Watergate, and the mentally ill were forgotten. In the 1980s, 

civil rights attorneys began filing class actions lawsuits to close down horrific state 

hospitals. They won a slew of precedent setting cases. The police could no longer arrest 

someone just because they were mentally ill; a psychotic person could not be locked 

indefinitely against their will in a hospital; they couldn’t be forced to take medication or 

undergo forced treatments, such as electric shock or lobotomies. The U.S. Supreme Court 

ruled that the mentally ill were entitled to the same due process protections as suspects in 

criminal trials. Under pressure, Congress agreed to make the mentally ill eligible for 

Medicaid and Medicare, but only if they were not living in a state hospital. It was 

Congress then, that gave state legislators a way out. Afraid of class action lawsuits and 

mounting public pressure to do something about the asylums, state legislators began 

boarding up mental hospitals and discharging patients. This massive exodus was called 

“deinstitutionalization.” 

 And what happened to the mentally ill? 

In most states, patients were released without any effort being made to link them to 

community services – if, in fact, there were any. President Kennedy’s promise of three 

billion dollars was a cruel lie. There were no network of community treatment centers 
80

and those that had been built were never intended to help deeply disturbed patients. 

Chronically mentally ill patients began appearing on street corners. By the 1990s, there 

were so many being locked up on minor charges that a word emerged: transinstitutionalization, bureaucratize for the “transfer” of the mentally ill from hospitals into 

jails. 

 Like most states, Florida made no preparations before it began dumping patients. 

But eventually, it found homes for most in “assisted living facilities” – cheap hotels and 

boarding houses. Today, there are 4,500 mentally ill patients living in 650 “ALFs” in 

Miami. Almost 400 of these ALFs fail the state’s minimum standards for boarding 

homes. They are unsanitary, unsafe, and, in most cases, wretched places. “I wouldn’t put 

my dog in this house,” a Miami police officer told me when we toured an ALF. But 

Florida allows these substandard homes to operate because there is no where else to 

house the mentally ill. 

 Florida’s dreadful state mental hospitals had been closed by deinstitutionalization, 

but the lives of the mentally ill hadn’t really gotten better. The state had simply scattered 

them and hidden them better in ALFs. 

 I decided to check the Washington D.C. metro area. Since 1955, the District has lost 

92 percent of its public mental hospital beds; Maryland has lost 86 percent, and Virginia: 

84 percent. Although private hospitals have opened some wards, there are only 98 beds 

for every 100,000 mentally ill people in the metro area, creating a staggering backlog. As 

in Florida, the number of mentally ill in local jails has mushroomed. Today, 2,551 

inmates in Virginia state facilities are considered severely mentally ill. Another 3,330 

prisoners in Maryland – fourteen percent of the state’s inmate population – are mentally 

ill. And an whopping 33% of the District’s inmate population require mental health 

services. 

***** ***** ***** 

 In a letter to the homeowners, our attorney said Mike would meet a much tougher 

set of restrictions if they would allow him to plead guilty to misdemeanors. Instead of 

serving a year of probation, he’d serve two. He’d stay in the day treatment program, 

continue seeing a psychiatrist after he was discharged, submit to blood tests to prove he 

was taking his bipolar medicine. Kersey would obtain a restraining order against Mike 

that would forbid him from coming near their home. He reminded them that Mike had a 

clean record, was truly remorseful, and that he’d chosen their house at random. “This 

should do it,” he said confidently. 

 But a few weeks later, he received the couple’s harshly-worded response. They 

wanted Mike in jail. They insisted he plead guilty to a felony. If anyone deserved 

sympathy, they added, it was them. 

 “You need to prepare Mike,” Kersey warned. “He’s going to become a felon.” 

 Mike was wearing his new suit again when we returned to court. Just before it was 

about to start, Kersey came rushing up. 

 The victims had telephoned the prosecutor’s office the night before and asked for a 

continuance. The husband was out-of-town on a business trip and the wife didn’t want to 

come to court alone. But the prosecutor had turned them down. “If the wife isn’t here, 

there’s a chance the prosecutor will let your son plead to the two misdemeanors,” Kersey 

said. He’d shown the prosecutor the list of additional restrictions that Mike was willing to 

accept. 

 We stepped inside. Every time I heard the courtroom doors open behind me, I turned 

to see if it were the wife. The judge entered. The wife still hadn’t. The clerk began to call 

the docket. When he reached Mike’s case, I heard the door swing open and felt betrayed. 

I assumed she had been hiding, mustering her courage, but when I glanced around, it was 

a stranger. Still, none of us knew what if the prosecutor would accept our offer. 

 “Your honor,” he said, “we have reached an agreement in this matter.” 
81

 In fewer than three minutes, it was over. Mike had pleaded guilty to two 

misdemeanors and had been placed on two years of probation. 

As we left the courtroom, I thought about the wife. I had honestly come to despise 

her. But now, I wondered how I would have felt if I had come home and discovered a 

madman had broken through my plate glass patio door. How would I have reacted if he’d 

taken a bubble bath in my teenage daughter’s tub? What if I had become so distraught 

that I had felt compelled to put my house on the market? Would I have acted like she 

had? Or, would I have showed compassion? Because it was Mike, the answer had seemed 

so obvious. But, sadly, when I stripped away his face and replaced it with the menacing 

look of a deranged stranger, I realized I might have reacted much as she had. I felt 

conflicted. The victims had not had the knowledge that I now had about mental illness. 

But I would not have had that information either had it not been for Mike’s unexpected 

plight. I began to see the wife differently. I began to see her as the reader whom I most 

wanted to reach with my book, the audience that I most needed to persuade. I was also 

forced to realize that she truly was a victim. And it was Mike who had victimized her. I 

only hoped that someday she would come to see that Mike had been a victim too. 

***** ***** ***** 

 Mike kept the plea deal. He completed the day treatment program, stayed on his 

medication, and began looking for a job. He’d been told being mentally ill was nothing to 

be ashamed about because it was a chemical imbalance. But when he mentioned that he 

had bipolar disorder, his job applications were rejected. Mike had a college degree, but 

our neighborhood Giant food store turned him down for a job bagging groceries. A 

sympathetic human relations director told him not to be so forthcoming. “If I knowingly 

hire someone who is mentally ill and you end up hurting someone on the job, that person 

can sue me and the company. No one is going to hire you if you tell them the truth.” 

Mental illness, we’d discovered, carried its own life sentence. 

A temp service finally found Mike menial work and he eventually became a fulltime employee. Proud of his new independence, Mike invited me to lunch. We met at a 

steak house and sat outside because it was a warm afternoon. He had come a long way 

from that panicky day when we had raced to the hospital. Our food came and he recalled 

how I’d brought him fried chicken in the hospital. We talked again about the fishing story 

-- the one about him falling down a South Dakota cliff and me climbing down to rescue 

him. 

 I watched him eat his steak. He was a handsome man. Tests showed his IQ was 

higher than mine. I realized how fortunate we both had been. He had recovered. He 

hadn’t spent time in jail or been marked for life as a felon. He was doing well on his 

medication. His bipolar disorder was in check. 

I thought about people whom I’d met in Miami while I was doing research inside 

and outside the jail. Judy Robinson’s mentally ill son had been in-and-out of jail forty 

times. Another mother’s son had lived homeless on the streets for nine years - despite her 

attempts to get him help. She had driven by him rooting through garbage cans every 

morning on her way to work and had been helpless under the law to intervene. How 

ironic, that the civil rights laws that had been passed to prevent the mentally ill from 

being abused in state hospitals were now being cited to keep them from getting help until 

they hurt themselves or someone else and ended up in jail. I’d met a woman in Miami the 

same age as Mike. Her mother had gone to court several times to force her into a hospital, 

but doctors had repeatedly discharged her because her life wasn’t in imminent danger. 

She had been twice gang raped while psychotic on Miami’s mean streets. Another 

woman, Alice Ann Collyer, had shoved an elderly bystander at a bus stop during a 

delusional moment. Because she was considered dangerous, prosecutors had transferred 

her back-and-forth between the Miami jail and a state forensic hospital for three years 

just to keep her off the streets. Three years in jail without ever being convicted of a 

crime. Miami’s treatment centers were overwhelmed and inadequate. Its system badly 
82

broken. As Dr. Poitier had warned, we had gone backward. We now treat the mentally ill 

in America just as we did in the 1830s when they sat in freezing jail cells put there 

because there is no where else for them to go. 

I had begun my research because I wanted to save my son. But I now realized that I 

had actually been searching for a way to save both of us. I had been trying to learn how a 

parent comes to accept his child’s mental illness. So what had I learned, not as Pete 

Earley the reporter, but Pete Earley, the father? Several quiet truths. Life is often unfair 

and nothing in life is ever guaranteed. There was a slim chance Mike would never have a 

relapse. But there was a better chance that he would stop taking his medicine because he 

would become convinced that he no longer needed it. His illness was not over because I 

was writing the final chapter of my book. 

“You know what your problem is dad?” Mike said, as if he were reading my 

thoughts. “You worry too much. Just eat your steak and enjoy this lovely day.” 

 Everything is going to work out fine for me, you’ll see.” 

It was the blind optimism of youth talking. And yet, Mike was right. At that 

moment, everything was fine. My son was thinking clearly. He had a job, was making 

plans for his future, and seemed happy. 

 Which led me to another lesson. 

 Mental illness is a cruel disease. No one knows who it might strike or why. There is 

no known cure. It lasts forever. My son Mike has it. And because he is sick, he will 

always be dancing on the edge of a cliff. I cannot keep him from falling. I cannot protect 

him from its viciousness. All I can do is stand next to him on that ravine, always ready to 

extend my hand. All I can do is to promise that I will never abandon him. 

 I took a bite of my steak and it tasted better than any I had ever eaten. I understood 

why. The sun was warm on my face and I was a most fortunate man. I was a proud father. 

Mike was laughing. He was safe. 

I had my son back. At least for now. 

MR. DEAL. I want to thank all of you for the very courageous 

testimony we have heard, very heart-wrenching, quite frankly. 

Mr. Earley, as someone who has been a former juvenile court judge 

myself, I can empathize with the situation that a parent is in. 

Unfortunately, these diseases as we have heard from your testimony and 

as we have heard from the expert panel earlier, the onset many times is at 

the age beyond which the law says that they are independent and 

therefore not subject to the control of parents. Yet parents are the ones 

who feel the impact of these situations as you have so graphically 

described. 

I guess I would ask some general questions of the three of you, and 

you come at this issue, quite frankly, from sort of different directions, 

one being the parent and the other two being the victims themselves or 

the individuals suffering from the problem. 

Looking back on your situations, I suppose, Ms. Martin and 

Mr. Lamphere, what could have been done earlier in your personal 

situations that would have made a difference in the direction that your 

lives took? Who and what would have been the resources that could 

have been that difference? 

Very general question. Ms. Martin, I will start with you. 
83

MS. MARTIN. I think the way I could have been most helped is, my 

family knew I was suffering from depression, but my Mom especially, 

having suffered from it herself, was of the attitude, you don’t talk about 

it, you don’t tell people about it, you keep it in the family, and you don’t 

get help because therapy is for other people, therapy is for people who 

are weak, therapy is for people who are whiny. If I had been aware of 

the benefits of treatment and had someone talk to me about how there 

shouldn’t be a stigma with mental illness, it would have prompted me to 

get help a lot sooner instead of taking it to the point where I lost a job 

and I lost income and I lost a lot of self respect. So I think just an initial 

almost an intervention of someone in my family who knew what was 

going on to say, you need to get help and you need to get it now and it is 

okay to get that help, it is okay to admit that you have a mental illness. 

MR. DEAL. Mr. Lamphere, you appear to be the rugged individual 

here who tried to do it on your own. Is that pretty much the course that 

you took of trying to do it yourself, and if not, what resources did you 

utilize? 

MR. LAMPHERE. My wife was right there until almost the very end. 

I would say this, there are general practitioners who can dispense 

antidepressants, and then there are psychiatrists who can dispense them. 

Then there are psychiatrists, who have depressive experience, and then 

there are psychopharmacologists, and then you begin to get into teaching 

level hospitals, and then you can get into real cutting-edge teaching. 

This is so complicated, to find the right medicine. You cannot just 

take Wellbutrin, I am not picking on Wellbutrin, off the shelf and think 

that that is going to work. You can’t just take Paxil next and think that 

this is going to work. 

You are looking for a witch doctor is what you are looking for. You 

have got to get far down the line to someone who truly understands the 

combination of drugs that are apt to bring you up. 

I think that is where I would have done it differently. I don’t think I 

would have started here and said, oh, these people are experts, or that the 

drugs are experts in and of themselves. 

It is the utilization of the cocktail. You are creating the cocktail, and 

you need to have the cutting-edge people. 

On top of that, I would only add one other point. The treatment of 

adolescents is a whole other area of specialization. So what I am talking 

about is adult. But don’t forget, these age groups over here are real 

specialties. If you are dealing with a son or a daughter in that age group, 

you have got to find the expert there, too. 

MR. DEAL. Mr. Earley. 

MR. EARLEY. Well, Mr. Chairman, when my son starts to become 

psychotic, he thinks he is fantastic. Expecting someone with bipolar 
84

disorder or schizophrenia to treat themselves is like asking someone who 

has 2 broken legs to run a marathon. The National Institute of Mental 

Health has done a number of studies that show that one of the first parts 

of the brain that starts to go bad, if you want to use that terminology, is 

the part that makes you aware that you need help, which is why it is so 

frustrating for parents and others who love mentally ill persons to try to 

get them help when they don’t recognize they need it. 

MR. DEAL. I want to thank all of you. 

Ms. Baldwin, you are recognized for questions. 

MS. BALDWIN. Thank you, Mr. Chairman. 

And thank you all for very powerful testimony. You all point out so 

powerfully how important it is to educate. 

Mr. Earley, I wanted to explore further one of the main issues that 

you had testified about, I remember when I was a State legislator, having 

our State legislature tackle the issue of what in Wisconsin we call the 

fifth standard, dealing with the issue of when you have a patient who 

does not want treatment, as you just described, under what circumstances 

treatment can be administered against that patient’s will and direction. 

And I remember that the debate was fascinating, and it is one that is 

usually governed at the State level, but I would be interested in hearing 

more about your thoughts of where you would like to see the State of 

Virginia go. In Wisconsin, we ultimately created a fifth standard that 

you could get around the imminent risk of harming oneself or another 

person. But I remember the very powerful testimony of a man whose 

wife was mentally ill, and it never manifested itself in any type of 

dangerous activity in terms of life-threatening to herself or to others. But 

she wandered and was homeless, and it was just devastating for him to 

see her in that condition. So dangerousness wasn’t an element that 

would have necessarily gotten care to her. I wonder if you have 

thoughts, through both Mike’s experience and also your reporting on 

this, of where you believe the State ought to go in terms of getting 

greater access to treatment for people in your son’s condition? 

MR. EARLEY. Thank you. You know, I love my son. I want to 

protect his civil rights. But I don’t think it does any of us any good to 

send someone out in his kind of condition when it is obvious he is not 

thinking clearly. I think you have to take a look at why these stringent 

commitment laws were passed. In the 1960s through the 1980s, we had 

these horrific institutions. They were absolutely horrible. They were 

compared to Nazi concentration camps, and civil rights lawyers came in 

and basically said, we are going to make it impossible to commit 

someone to those horrible places. They have done that. 

I don’t believe we should trample civil rights, but I think we need to 

take another look at those laws and try to bring parents and doctors in 
85

and try to remove this imminent danger clause. Treatment today is 

different than it was. We know more. No one volunteers to be 

schizophrenic. 

My son has been forced into a hospital twice. Each time, it has been 

less than 2 weeks. He got his medication. He thanked me for taking him 

in. You know, we have protections in place with advocacy funded by 

Congress to make sure people don’t get abused and put away. Does it 

happen? Absolutely, look at the D.C. situation. It is horrific. People are 

being abused. But, right now, people are being abused in jails and 

prisons. Right now, in Miami, 4,500 people are being housed in assisted 

living slums by the State that don’t even pass minimum standards. So 

we have closed down these institutions, but we have just hidden the 

people better. 

So I think we need to look at the commitment. I think we need to be 

more humane about that. I will be real brief here. What you just 

mentioned is what I found in Miami: 455 people with serious mental 

illnesses, homeless on the street, most of them committed misdemeanors. 

What happens? Because they are not dangerous, they go into jail and are 

held, and they are released, 40, 50 times a year. That is ridiculous. 

MS. BALDWIN. Let me ask your opinion on another innovation that I 

had heard discussed, I don’t know of any location where this might 

actually be law, but there was at one point during our debate in 

Wisconsin the proposal of allowing somebody with a mental illness to 

essentially, when treated, issue an advanced directive and basically be 

able to say that, if at some point in the future I have a reoccurrence and I 

am not able to make my own decisions, at that point, use the advanced 

directive as permission to treat me. 

Is that something that you think would be worthy of exploration? 

Would that have served--would your son, for example, at a point in time 

when he is under treatment and feeling better, be willing to sign 

something like that? 

MR. EARLEY. You know, I have looked at that, and you have a 

mixed result. In some States, they are not accepted, and in some States, 

what you will run into is a doctor like I ran into at a hospital that 

basically will turn to someone and say, you signed this, but how do you 

feel now? They will say I am fine. They won’t abide by it. So I looked 

into that in Virginia, and I found mixed results. 

MS. BALDWIN. Thank you. 

Madam Chairman, I yield back. 

MS. MYRICK. [Presiding.] I want to thank all of you again for 

coming and taking your time. 
86

Mrs. Earley’s birthday is today, and I want to thank you, say thank 

you, because she took time from her birthday to be here with us. Thank 

you. 

MR. RUSH. I do have a question. 

MS. MYRICK. I am sorry, Mr. Rush, forgive me. 

MR. RUSH. That is quite all right. 

Ms. Martin, you indicated in your testimony that one of your 

remedies or one of the things that you attempted to do, you found 

yourself falling into I guess you implied there was a use of narcotics or 

drugs, different type of drugs. 

And I really feel as though that is a part of the drug problem across 

this Nation that doesn’t get addressed. Again, we are quick to 

criminalize those who have addictive behaviors rather than really try to 

understand what are the causes of it. And in your testimony, you 

indicated that your mental condition, your illness, was the basis of your 

drug abuse; is that correct? Could you elaborate somewhat on that, 

please, that particular aspect of it? 

MS. MARTIN. Certainly, certainly, Mr. Rush. It was the basis of my 

drug problem. I had never touched any kind of illegal drug until I was 22 

years old. I had just finished my first year in law school, and my 

depression that I kind of dealt with off and on and had issues with was 

getting stronger and was pushing more and more forward. Suddenly, I 

had friends and I knew people who were using drugs. I tried them for the 

first time and was happy for the first time ever. I remember thinking, 

wow, this is amazing. Now I know why people do drugs. 

For me, it wasn’t that physical addiction that people talk about. 

When I stopped using drugs, I never went through a withdrawal or 

anything like that. I did it completely as self-medication to feel better. 

MR. RUSH. I kind of think that that is--you know, I have a son who 

is a recovering alcoholic, and his diagnosis, manic, manic depressive. 

And he invariably at certain points in time I think has been clean now for 

a couple, about 2, 2.5 years. But, he was self-medicating through alcohol 

abuse. And it seems to me that, particularly in poor communities, that it 

is much more prevalent when we, because they don’t have access to 

preventative or diagnostic or clinical services and professional help, that 

that is a part of the problem in terms of drug abuse and also alcohol or 

alcohol abuse and using illegal drugs. 

And it seems as though our Nation just doesn’t want to look at that 

particular aspect. Does anybody else have any comments you would like 

to share on that? That is a hidden part. Madam Chairman, that is a 

hidden part of what is missing here. 

MS. MARTIN. I think it is a hidden part, and to some extent, what 

you say about it being prevalent in the poor community because they 
87

don’t have access is completely true, and therefore, they self-medicate 

that way. Then if you get into a more affluent area of society, you see 

people like myself, I have several friends who did the same thing. We 

didn’t want to admit we were suffering, and we didn’t want to go to a 

doctor and get help. We didn’t want to seek any kind of outside 

assistance, so we used drugs. SSRIs work on the brain by stimulating 

serotonin and causing the brain to release serotonin. That is exactly what 

ecstasy does. Ecstasy floods your brain with serotonin, so taking an 

ecstasy pill, for me, was like overdosing on my antidepressant. It was 

amazing. People just say, you are just spoiled kids having a good time, 

or you are poor, you don’t have adequate resources. Well, people really 

are missing that hidden side of drug abuse and alcohol abuse that is 

self-medication. It makes us feel better. 

MS. MYRICK. Yield back? 

MR. RUSH. Yes. 

MS. MYRICK. Thank you. You are right. This is an issue we don’t 

talk about. Our granddaughter did the same thing. I have a question 

about you, and I am glad you are talking about that issue, by the way. I 

hope you will keep on doing that. 

MS. MARTIN. I will try. 

MS. MYRICK. My question was, what was the final straw? I know 

you lost your job, but what was the final straw that made you say, I need 

to get help? 

MS. MARTIN. It actually wasn’t losing my job. I knew I was about 

to lose my job. I had people in my office saying, what is the matter with 

you, you don’t seem like you are enjoying yourself? I was regularly 

asked if I was suffering from some sort of nasal condition because my 

nose ran a lot. It finally kind of came to a head in the fall. My 

grandmother had passed away, and what was pretty much just a weekend 

binge became an all-week obsession. I had a very close friend who had 

suffered from depression and mental illness and was one of my drinking 

buddies for the longest time, and he finally came to me and said, you 

have to stop or something bad is going to happen, and you need to get 

help. So that was the final straw. When the person you drink with most 

of the time says you are drinking too much, then you kind of know you 

are in trouble. 

MS. MYRICK. It was an intervention by a friend. 

MS. MARTIN. It was, yes. 

MS. MYRICK. Thank goodness. 

Mr. Lamphere, again, thank you for being here. I was glad to heard 

you talk about this being a physical illness because, my point in this 

hearing has been this awareness issue of brain disease, and it is no 
88

different than heart disease and diabetes and all the other things that we 

deal with. 

We seem to take our brain and put it over here on a shelf, and then 

here is our body over here, so please keep doing that. 

But was there anything in your life, going through this, that you 

would have done differently? If you look back on it, is there any point 

where you would have realized, can you see anything now that would be 

helpful to other people possibly? 

MR. LAMPHERE. There is some interesting work being done in New 

York. I think people have felt that depression always was the causative 

item of divorce, because of the extraordinary black vortex that sucks the 

spouse right in, and work being done on what is the middle ground that a 

spouse can take in that. What is interesting, though, to answer your 

question is the research that is being done which is, did the marriage 

cause the depression to begin with, and the drinking or anything else 

behaviorally that started? I think people might need to start thinking 

about that. That they have been depressed for prolonged periods of time 

and maybe self-medicating, and it has to do with the relationship rather 

than anything else that needs to be addressed that could be the causative 

item of the depression. 

MS. MYRICK. I appreciate that. 

Mr. Earley, you have done a lot of research on the prison systems 

and the jails and the problem that government is paying for. And I hope 

you will continue along those lines. I have a son who works in that field, 

and he tells me continually, the percentage of people that are in prison 

who have a problem with their brain and drugs or alcohol, et cetera, has, 

gotten them here. And I think we have got to face those tie-ins that we 

haven’t looked at before as a society, because they are very real, and as 

Mr. Rush was saying, those are areas that sometimes we don’t look at. 

The frustration that you have experienced, I know is very difficult. 

And the system is a mess from the standpoint of what you can do. We 

have gone through that with our granddaughter. That is why it took us 

6 years to get her diagnosed, because she wouldn’t stay anywhere long 

enough, because the laws would say she could get out and up. You could 

never get her diagnosed. Recommendations that you have, and I know 

we don’t have time today, but anything that you can share with the 

committee and anything that we could do, as Ms. Baldwin was saying, 

that would help would be very beneficial because some of what we have 

done has caused the problem, and then you get all these jurisdictional 

problems in addition, and of course, we can’t do a lot about that, but 

nevertheless, there are some things that maybe we could work on and 

you could be very helpful if you would be willing to work on that as 

well. 
89

MR. EARLEY. I appreciate that. I think if you look at 

deinstitutionalization, the population that was in State mental hospitals, 

as it goes down, jails and prisons went up. 

You know one of the quick answers, one of the quick fixes, every 

police department in this Nation should have a crisis intervention training 

program, CIT. Fairfax should have one. None were available. These 

are officers who are trained to deal with people with mental illness. In 

Miami, the year I was there, the Miami police department, I saw them 

disarm a man with two knives without him getting hurt. He later thanked 

them. That same time period, the Miami-Dade Police Department killed 

five people with mental illnesses because they didn’t know how to take 

care of them. CIT, just like bomb squad, hostage rescue, every police 

department should have one of those. 

MS. MYRICK. Very good advice, again, thank you all very much for 

being here. Are there further questions? Chairman Deal? 

Then that concludes our hearing for today. Thank you. We are 

adjourned. 

[Whereupon, at 1:20 p.m., the subcommittee was adjourned.]

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