Tooting from San Francisco - II: I Love Smart People

Monday, 9 PM: I’m in my hotel room, chilling out after a very stimulating day. To recap:

Morning, 9 AM. I have a front row seat for a lecture by the legendary psychiatric geneticist Kenneth Kendler, who executes a stunning fly-over. Brief sample:

The environment may neutralize genes. Say, for instance, it is difficult for a kid to obtain alcohol. Then certain alcoholism vulnerability genes have less chance to kick in. Conversely, “our brains have feet.” We’re not just passive recipients of our environment. Rather, our genes cause us to create the environment around us.

Genes and environment, in other words, dance a very intricate two-step.

10:15 AM: I step out into the sunlight. I’m headed from Muscone North to Muscone South. As I negotiate my way past the median strip separating two traffic lanes, someone with a bullhorn and a clown nose hands me an antipsychiatry flier.

I hurl it back at him. “F___ing idiot,” I inform him, as I keep walking. I’m across to the other side when I hear the idiot through the bullhorn: "Ooh, f___ing idiots, the best kind.”

No more Mr Nice Guy. “F___ you,” I shout in a voice that carries much louder than his puny bullhorn. “I’m a patient, and I’m going inside where the SMART people are.”

Damn! That felt good.

11:00 AM: I’m listening to an extremely smart individual, Elyn Saks, author of the highly-acclaimed “The Center Cannot Hold: My Journey Through Madness.” Despite psychotic episodes, Elyn graduated valedictorian from Vanderbilt with a major in philosophy (she learned ancient Greek so she could read Aristotle), then went to Oxford where her deteriorating condition resulted in a lengthy hospitalization. An enlightened psychiatrist urged her to go back to doing what she loved and got her hooked up with an equally-enlightened psychoanalyst.

After graduating Oxford, she earned a law degree from Yale, but not before another hospitalization that involved her being placed in restraints 20 hours a day. The “benign neglect” of English care, she said, is “much preferable to the over-intervention in US hospitals.”

Elyn graduated from Yale and procured a teaching position at USC (where she is now a professor specializing in legal-psychiatric issues). Her attempts there to get off her meds simply resulted in the return of florid psychosis. After 20 years she finally got smart and accepted the fact she was mentally ill, which meant her illness had less power over her.

She eventually got married in her 40s and joked with her husband that they’d both skipped their first marriage.

12:30 PM: My first poster session of the day. “Cingulate gyrus” I read on the heading of one poster I walk past. I freeze in my tracks, and address the researcher standing in front. “I’m going to ask a stupid question,” I warn holding up my name badge which shows I’m a journalist. “Can you explain to me the difference between the cingulate gyrus and the anterior cingulate?”

Next thing, I’m being treated to an individualized masters class in brain science. I love listening to smart people.

2:05 PM: I arrive a few minutes late for a session on the DSM-V (due out in 2012). Darryl Regier, vice-chair of the DSM-V task force is raising the topic of “categorical” vs “dimensional.”

This really gets my attention. As opposed to our current categorical system of assigning illnesses to separate pigeon holes, a dimensional approach would recognize the overlap.

The second speaker is Ellen Frank of the University of Pittsburgh, who five years ago opened my eyes to the “spectrum” way of looking at mental illness. Thus symptoms that do not necessarily cluster together over a specific period of time are regarded as clinically significant.

Think of bipolar, for instance, plus a little bit of anxiety. That small dose of anxiety, Dr Frank said, is likely to result in greater illness severity and make treatment more difficult, and she has the studies to prove it.

Dr Frank is pushing for a “simultaneous approach” to the next DSM.

3:15 PM: In the hallway, I say a warm hello to Eduard Vieta from the University of Barcelona. Two years ago, Dr Vieta and I shared the same stage at the Seventh International Conference on Bipolar Disorders, as recipients of the Mogens Schou Award (in recognition of his research and my public service, respectively).

Then it’s over to my second poster session of the day to ask my dumb questions (which is how you get smart answers). Two separate posters concern themselves with the topic of the relationship between impulsivity and suicide. Immediately, I think of my good friend Kevin, who last September threw himself in front of a train. My voice catches. I need to pause.

Kevin is my reminder why I’m here. I may be enjoying myself, but this is no game. We’re playing against our will with a rigged deck, our lives on the line. I’m here to gather in all the information I can, try to make sense out of it, connect the dots, and put it out there in a way that somehow allows us a slightly better advantage.

5:30 PM: Dinner on Fisherman’s Wharf with a “neuro-immunologist.” This is a new field that you will be hearing a lot more from, along with other fields of enquiry that are bound to lead to improvements in our lives - assuming funding is available.

8:00 PM: Chilling in my room. Another long day tomorrow ...