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LOS ANGELES TIMES INTERVIEW

David Satcher

Minding Madness: A Fresh Take on the Mystery of Mental Illness

May 07, 2000|David Davis

The numbers are chilling. According to the Centers for Disease Control and Prevention, suicide is the ninth leading cause of mortality in the United States, claiming nearly 31,000 a year. While the overall suicide rate has declined in the last 20 years, the rate for adolescents has soared: Suicide is the third leading cause of death among young people ages 15 to 24.

Since David Satcher took over the surgeon general's post in February 1998, he has made suicide, and the broader topic of mental health, his signature issue. In October 1998, he convened a blue-ribbon panel of mental-health professionals, researchers and suicide survivors to analyze the topic, resulting in the first-ever surgeon general's report on mental health. Last year, his office published the "Surgeon General's Call to Action to Prevent Suicide." Later this year, he will produce a national plan for suicide prevention.

Satcher was born and raised in rural Alabama, the son of farmer parents who never finished elementary school. He first decided to become a doctor when he was 6 years old, after recovering from a near-death experience battling whooping cough and pneumonia. Satcher graduated from Morehouse University, then earned his Md and PhD from Case Western Reserve University. In the 1970s, after residency and fellowship training at, among other schools, UCLA, he served on the faculty of the UCLA School of Medicine and Public Health and the King-Drew Medical Center, where he chaired the family medicine department and directed sickle-cell research.

From 1982 to 1993, he was the president of Meharry Medical College in Nashville, Tenn. Before becoming the nation's 16th surgeon general, he served as director of the Centers for Disease Control and Prevention.

Satcher and his wife, Nola, have four children, ages 23 to 31. They live in Bethesda, Md. In town to receive the leadership award from L.A.'s Didi Hirsch Community Mental Health Center, Satcher spoke to The Times at the Regent Beverly Wilshire Hotel.

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Question: Your background and training are in family medicine. Why did you decide to embrace mental illness and suicide as your issue?

Answer: What the surgeon general does is not a specialty. The surgeon general is supposed to listen to the American people and look at the issues affecting [them] and respond. . . . There had never been a surgeon general's report on mental health, and there have been 50 reports [since the first one was published in 1964].

Q: Why have mental illness and suicide been so stigmatized?

A: The stigma relates to a misunderstanding of the mystery that has surrounded what it means to be mentally ill. Some people think it's a character disorder. Some people think it's a spiritual disorder. Some people say, "Get yourself together and deal with this," because they can't see that people are struggling with something they don't necessarily control. . . . It's clear that not only are mental illnesses real--they have a basis in physical and chemical changes in the brain--[but] they [also] are treatable. Approximately 80% to 90% of people with mental illness can be effectively treated and returned to productive lives and positive relationships. . . . You end the stigma when you clearly point out that, just as things go wrong with the heart and the lungs and the kidneys and the liver, things go wrong with the brain. We can document that, and therefore we ought to be responding to that in the same way we respond to other illnesses.

Q: In your call to action, you note that the suicide rate for adolescents and young people has soared in the last 20 years and David Davis, a freelance writer, has contributed to Los Angeles Times Magazine and LA Weekly.

that the rate of suicide among African American males age 15-19 increased 105%. What's your explanation?

A: Clearly, depression is a major factor in suicide. Substance abuse is another major factor. Easy access to means of suicide--weapons--is another major factor in suicide. All these things come together to lead to many more suicides than before. . . . Some people even believe that some of the homicides that we were seeing in African American communities were expressions of depression and hopelessness. You join a gang, and you know that you're putting yourself in harm's way. . . . So the real question is whether we're not seeing different manifestations of the same problem.

Q: Another statistical anomaly concerns the elderly: The suicide rate is highest among white American males age 65 and older. With the baby-boom generation getting older, does this high rate worry you?

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