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Opinion

By Kimberley Lee

 

The death of Peter Robbins resonated with me. He was tapped to be the first voice of Charlie Brown as a child actor in the early 1960s when Charles Schultz began to adapt his popular “Peanuts” cartoon strip for TV and movies.

I grew up with these shows, and so did my children, but it was not just nostalgia that made me take notice of Robbins’s death. His family announced on Jan. 25 that the 65-year-old Robbins had died the week before by suicide. He had long struggled with both mental-health and substance-use disorders.

MHA, the Mental Health Assoc., is the organization I work for, whose behavioral-health outreach clinic and residential programs have long offered support and treatment to individuals with such dual diagnoses. It was especially disheartening to read how the life of Robbins, associated through the 1970s with a character that brought much entertainment to the screen, ended.

The cartoon strip itself was sometimes subtitled “Good ol’ Charlie Brown,” and the world Schultz created was a self-contained one about childhood. Its ups, downs, and misplaced crushes were depicted by characters who were very animated, even in print. No adults are featured, but the characters struggle with plenty of personal issues that often follow into adulthood. Some, like Lucy, can be bossy; some are a bit vain, like curly-haired Freida; and some are self-absorbed, like Schroeder on his piano. Everyone is just trying to fit in or fit into who they are, including Snoopy, Charlie Brown’s beagle, who often retreats into his own world on top of his doghouse or into his imagination, where he fights the Red Baron as the Flying Ace. There is also Pig-Pen, who tells Sally, Charlie Brown’s younger sister, he doesn’t appreciate that name he has been tagged with because of his appearance, but neither does he like the rain to wash away that appearance from a day of playing in the dirt.

They are a complicated bunch, defying stereotypes in their own ways of being and thinking and friendships across neighborhoods and interests.

Schultz, who died in 2000, wondered if his characters would resonate through time, and they do, as Charlie Brown embodies a little bit of all of us emotionally as he navigates this world of personalities. And, of course, should he need advice, there is Lucy, who sets up a Psychiatric Help booth, where she gives her version of professional help for five cents. It is a world in which the timeless troubles and alienations of childhood are on display, but also one in which the characters cope and carry on with their pursuits and come together.

I grew up with all the animated specials, including A Charlie Brown Christmas, It’s the Great Pumpkin, Charlie Brown, and A Charlie Brown Thanksgiving, and, again, so did my children. Each time these classic movies aired, those 30 minutes provided an opportunity for us to be together as a family, to make a connection, to embrace each other emotionally.

In our house, emotional connectedness happens in other ways as well. For example, once a week, my husband and I pull our girls together (now that they are in college, this is done remotely), we all unplug, and we just simply and sincerely ask them, “how are you?” And not just physically, but emotionally. Their answers have been honest and transparent and emotional at times.

It gave them, at an early age, a green light to talk openly about how they feel from a mental-health perspective, and there was no stigma, no shame, no hesitancy in doing this.

We all know that challenges to mental health start young, and the sooner we address them, the better the outcome.

 

Kimberley Lee is vice president of Resource Development & Branding for the Mental Health Assoc.

 

Health Care

What’s Next in Behavioral Health

By Barry Sarvet, M.D.

As a science-fiction fan, I would love to be able to travel in time to see into the future of psychiatry. But, of course, the future isn’t really knowable and depends in large part on the choices we make. A more useful and realistic approach is for us to envision a possible future based on our awareness of the most urgent needs in the field, and to assume linear progress from the current state of our scientific knowledge and discovery.

Barry Sarvet

Barry Sarvet

In my opinion, the two most compelling needs within the field of psychiatry are the need for more effective, safe, and reliable treatments for the subset of psychiatric patients who don’t respond optimally to current treatments, and the need to make psychiatric care more accessible and equitable for everyone who suffers from mental-health conditions.

Depression is one of the most common psychiatric illnesses, affecting 7.1% of all adults and 13.3% of adolescents in the U.S. Severe depression is a potentially deadly illness, and suicide is a leading cause of death in this country. Although we already have a host of effective treatments for depression, between 10% and 30% of patients do not respond favorably to treatment. However, ongoing advances in our understanding of the neurobiology of mental illnesses in recent years have led to a number of novel biological treatments for treatment-resistant depression and other psychiatric conditions.

One recently developed treatment that has shown great promise with treatment-resistant depression is repetitive transcranial magnetic stimulation (rTMS). Available at Baystate, rTMS is a non-invasive procedure in which focused pulses of electromagnetic energy are applied to specific regions of the brain resulting in increases in blood flow and metabolic activity. rTMS belongs to a branch of psychiatric treatment referred to as psychiatric neuromodulation. We expect to see further development of this branch in coming years, particularly because of the encouraging observations of clinical effectiveness and safety of this type of treatment for patients whose conditions have not responded to conventional medications.

Other biological psychiatry advancements on the horizon include the development of medications targeting receptors for neurotransmitter systems (such as glutamate and NMDA) which have recently been implicated in the pathophysiology of depression and other psychiatric illnesses. We are also seeing a renaissance of research activity studying the use of so-called psychedelic drugs in combination with talk therapy to induce states of consciousness in which patients may find it easier to change well-worn patterns of thinking associated with psychiatric illnesses such as PTSD, anxiety, and depression.

Lastly, on the biological front, advances in the understanding of genetic variability in metabolism and responsiveness of the nervous system to psychiatric medications promise to usher in an era of personalized medicine in psychiatry, allowing psychiatric clinicians to select effective and tolerable medication treatments for patients without having to go through a trial-and-error process.

Even more important than advances in biological psychiatry is the need for progress in making psychiatric treatment more accessible to everyone who needs it. Currently, a majority of patients with mental illness do not receive any treatment at all, and for many more, treatment is delayed. In fact, many patients with untreated mental illness, disproportionately persons of color, end up in the criminal-justice system because of a lack of access to care.

In recent years, we have seen steady reduction in stigma surrounding mental illness and increased acknowledgment of the importance of mental health across society. Baystate’s recently announced plan for the development of a new, state-of-the-art psychiatric hospital facility for our region reflects the growing recognition of the importance of improving access to behavioral healthcare.

This new facility is just one component of a comprehensive strategy which needs to be executed in partnership with the whole community to improve access to all levels of mental healthcare and address persistent racial and socioeconomic disparities in access to care. Some of the components of this strategy includes work we have been doing at Baystate to embed mental-health services into our primary-care services. In addition, our development of new training programs for psychiatrists and child and adolescent psychiatrists have established a pipeline for enhancing the psychiatric workforce in our region.

We also will see continued use and improvement in telehealth models of psychiatric practice, which, of course, have dramatically grown in response to the pandemic, and have proven to be an important tool in reducing geographic barriers to access to care.

 

Dr. Barry Sarvet chairs the Department of Psychiatry at Baystate Health.

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