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Ten Minutes with Austen Riggs Center’s Medical Director/CEO – Talking about Mental Health

Dr. Eric Plakun came to the Berkshires to train in psychoanalysis, and it has turned into “a 41-year residency,” as he puts it. Today, he heads the world-class mental health treatment facility on Main Street in the village of Stockbridge. Every morning before work, he bike rides or cross-country skis. “You can’t have a bad day if you have watched the morning sun turn the snow fields pink on Monument Mountain,” he says. This year marks the 100th anniversary of Austen Riggs.

The Austen Riggs website has an intriguing quote: “We have gained a better understanding of mental disorders, but haven’t moved the needle on treatment.” Is that a fair assessment?
It’s true. If you follow the news, there is an opioid problem that is exploding. There has been a 30 percent increase in suicides in the past 25 years. Tom Insel, the mental health czar in California, has figured out the kind of back-to-the-future quality of what we need to do, which is go back to relationships and community. We need each other and a society that supports mental health.

Drugs were over-prescribed in the treatment of mental illness?
It happened because of false advertising about the wonderful benefits of putting everyone on opioids for any kind of pain and overselling it and underrepresenting the risks. I worry about where we’ll be in ten years in Massachusetts, where now you can’t say the word “cannabis” without adding wellness to it. I don’t think marijuana is bad or good; I just think that we are, as a society, leaping into it in a way that’s way ahead of the science.

What signs of progress are you seeing?
We’re actually making some headway and fighting stigma, and so people are more willing to be forthcoming about their troubles. We’re seeing more and more trouble, more evidence of the way that people struggle with mental disorders. What we’ve learned in the cutting-edge science is that it’s gene by environment interaction equals disease and health, and that perspective is completely consistent with the foundations of Riggs. There’s a biology, but there’s also a psychology and a social context that causes and is part of treating mental conditions.

In cases where mental health issues lead to tragedies, families say, “We knew, but we didn’t know who to turn to.” Where should they turn?
Is this the kind of thing you can deal with individually, with medication and therapy? Is it a family issue? A school issue? A work issue? Is there access to care through insurance? Insurance companies have largely focused on making the goal of treatment crisis stabilization for mental disorders. And then they’re done. Coverage issues are tremendously important.

Do we have the resources to go beyond crisis stabilization?
Managed care expanded tremendously in the ’90s, making decisions up to the insurance company about what care will be authorized. It was kind of the Wild West. I want to be clear: Managed care operates with the exact same kind of moral imperative that the environmental movement operates. Healthcare costs were escalating 15-20 percent a year. It’s the same thing as global warming. You know, my God, we have to not burn down the Amazon, and we have to not burn down the economy spending 75 cents of every dollar on healthcare. Once the crisis is done, you’re done. We are in the Main Street of Stockbridge, this fully open setting where we ask patients to balance their freedom against their responsibilities. It made no sense to suddenly become a short-term, two-week locked in-patient unit. We said, look, either the world is going to figure out that treatment is about more than crisis stabilization, or I guess we’ll go out of business. Within two years, we went from being half full, to full, with a waiting list of 30 people.

The Austen Riggs approach of respecting and helping patients find their own solutions sounds great. Can we deal with every patient that way?
No. Austen Riggs is appropriate for a small group of people who have complex psychiatric problems. We need to think about relationships and communities for all. There is a study where patients who had a good relationship with their doctor did better on a placebo than those who had drugs and a bad relationship. These relationships are powerful.

With gender variability, how equipped are professionals in the field?
Not as well as they need to be or will be. Younger clinicians are more comfortable with it than older ones like me, but the perspectives of the older ones still matter. We have learned that it’s not our job to be the gender police. We need to help people claim their lives and their voices.

Tell us about the Excellence in Mental Health Media presentation on November 1, at Austen Riggs.
We’ll have our first public opportunity to see the awards presented. Kiese Laymon, an African-American literature professor from Mississippi, is recognized for his book Heavy: An American Memoir. I was blown away by this compelling, honest, but gritty, painful story. The other award, for a video called Mine 21, shows how a Tennessee mine disaster traumatized future generations and how a catastrophe can shape an entire community. These are powerful works.




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