♪ ♪ MATTHEW ROSENBERG: I have a diagnosis of OCD, obsessive-compulsive disorder, which I've been living with most of my life.
I hyperventilate throughout the entire day, because I'm afraid that I'm going to lose the ability to breathe.
When I speak, I, I speak for a certain length of time, and then I remember the need to breathe.
So I, all of my breaths-- inhale, exhale, inhale, exhale-- are, are driven by that process of voluntary artificial breaths.
I've been dealing with the breathing for close to eight years.
It's all I think about.
I'm afraid of performing these compulsions in public.
I spend my time in bed, or on the couch.
Or pacing around anxiously.
Sometimes I'll cocoon myself into blankets and sheets to make this experience as comfortable as I can, because it's incredibly painful.
I've tried psychotherapy, intensive exposure and response prevention, cognitive behavioral therapy, psychopharmacology, and I haven't seen results.
♪ ♪ So, right now, I'm just biding my time until surgery.
The neurosurgeon is going to implant two electrodes in my brain.
This is the final frontier in psychiatry.
It's my best and last hope.
♪ ♪ (indistinct chatter) ♪ ♪ KAY TYE: Why does someone have schizophrenia, depression, or anxiety?
What makes us different?
These subtle differences that we have in our mind, they, they are substantiated in cells and synapses in the brain.
But the reality of the current status of mental health treatment is essentially shooting in the dark.
ALLEN FRANCES: The brain has about 85 billion neurons.
Each of them has about 1,000 connections, and they're firing off hundreds of times a second.
It's no curiosity that sometimes people have troubles in brain functioning.
Mental illness is just so very complicated.
SIDNEY HANKERSON: I don't think there's ever going to be a silver bullet for everyone.
Mental health conditions are entirely too complex, based off of genetics, family history, environment, and each person's unique story.
NARRATOR: For centuries, as the quest to understand the mysteries of mental illness unfolded, patients endured a wide range of brutal, unproven therapies, often against their will.
But today, new tools yield remarkable insights into the brain, paving the way for more and better-targeted treatment options.
And some choose risky new procedures they hope will change their lives.
MATTHEW: It's a gamble.
Surgery does carry some risks.
But I believe the benefits outweigh the risks.
♪ ♪ MARTIJN FIGEE: I'm going to ask you some questions about your OCD.
I know you've been walking around with this diagnosis forever.
I do not respond to medications.
I've seen every sort of specialist you can think of.
I, I cannot live with this anymore, I just can't.
FIGEE: Obsessive-compulsive disorder, it's about patients who are stuck in compulsive behaviors, behaviors that are important for survival, like feeling clean, or making sure you don't have any illness.
Or making sure everything is sort of locked and safe, and usually you check those things-- we all do, and then it's fine, you go on with your life, and that doesn't really happen for most OCD patients.
MATTHEW: I literally feel that my breathing is not kicking in, so I... (stammering): I have to breathe, I have to breathe, I have to breathe.
SHANNON O'NEILL: Mm-hmm, mm-hmm.
FIGEE: You get in this sort of almost addiction loop.
Over time, it becomes harder to treat, and that's when patients come to us.
They've tried everything.
I remember him coming back, and telling me that he had met you.
That he was going to explore all options.
MATTHEW: I've asked for tracheostomies before.
FIGEE: And of course, they...
They look at me dumbfounded, of course.
FIGEE: Yeah.
So is that off the table, those kind of solutions?
- No, to me, I would...
I would have a tracheostomy, I would.
I don't mind having a hole in my throat.
Anything is better than this.
Yeah.
Okay.
Every minute of his life, he's feeling sort of captured by this compulsive control of his breathing.
There's nothing else he can think about.
From the outside, he may look pretty normal, but inside, it's one big agony.
And that's where deep brain stimulation becomes an option.
NARRATOR: In deep brain stimulation, or DBS, surgeons implant an electronic "pacemaker" into the brain to correct faulty signaling.
Doctors have treated fewer than 350 OCD patients with this form of psychosurgery-- all severe cases like Matthew's.
But DBS is widely used to treat Parkinson's disease, a neurological disorder that causes tremors often resembling the repetitive behaviors of OCD.
To treat these tremors, doctors often target a brain region called the basal ganglia, which helps control movements.
When somebody has a deep brain stimulator in for tremor, for instance, you can see their tremor wildly going about itself when it's off and then literally stop dead in its tracks by turning it on.
(indistinct talking on TV) NARRATOR: Matthew's doctors believe OCD also involves the basal ganglia.
But instead of causing tremors, for him, it drives his compulsive breathing.
FIGEE: This OCD originated, I think, at age 14, with scrupulosity, where he became obsessed with thinking bad things about God, and then I think around five or six years, he transitioned into his current OCD.
KOPELL: What's really great about something like deep brain stimulation, it's not only therapeutic, it's investigational.
Next step is that he will meet Brian, he will get an MR scan.
- Yep.
So, by treating these patients, we are also unlocking and revealing things that are going to help us maybe understand the brain a lot better than we do today.
♪ ♪ NARRATOR: The idea that specific regions of the brain control specific behaviors is not a new one.
During the Renaissance in the 16th century, autopsies led to detailed studies of the brain and the naming of its major structures.
Then, in the late 1700s, Viennese physician Franz Joseph Gall claimed these structures corresponded to specific behaviors, and mapped different traits onto dozens of different brain regions.
ANDREW SCULL: In phrenology, every one of these things had its location, and whether you were mean and avaricious or generous was the product of whether that bit of your brain was well-developed or underdeveloped.
Gall thought that this underlying shape of the brain was reflected in the shape of the skull.
So that by the lumps and bumps, by measuring the skull, you could detect what the underlying structure of the brain looked like, and by indirection, you could read somebody's character.
It provided the possibility of a treatment.
The idea was the regions of the brain were a bit like muscles.
If you were deficient in something, you could, by working on it, build that bit of your brain up and transform yourself.
GEORGE MAKARI: For people who wanted to have a scientific psychiatry, it was manna from heaven.
We're now empirical scientists.
It was genius.
But if you looked at it closely, it was clearly gaga.
He had no evidence for this stuff.
NARRATOR: Nevertheless, the concept that different brain regions correspond to different behaviors took hold, and some scientists sought clues from the amazing case of Phineas Gage.
In 1848, an explosion drove a railway spike through Gage's skull.
After his accident, the formerly mild-mannered foreman was prone to fits of rage.
The bulk of the damage occurred in an area of the brain known as the frontal lobe that seemed to act as a control panel for emotions and personality.
Many years later, doctors would attempt to alter patients' behavior with lobotomies, a psychosurgery that severed the frontal lobe from the rest of the brain.
But in the 1800s, some wondered: could this region be the source of mental illness?
Neurology was a pretty new discipline in medicine in this time.
The way that you try to understand the brain was by looking at large numbers of patients with the same disorder to discern, what were the common patterns?
NARRATOR: Early neurologists documented behaviors of patients with epilepsy, hoping to gain insights into the workings of the brain.
In the 1930s, a new device-- the electroencephalograph, or E.E.G.-- produced the first recordings of brain activity during an epileptic seizure.
There was no real scientific understanding of what caused mental disorders, but it had been observed that seizures, if they occur in individuals who are mentally disturbed, have this brief period of lucidity after the seizure.
NARRATOR: To reproduce the effect, some doctors tried chemically inducing seizures.
But they were unpredictable, and often dangerously violent.
So in 1937, two Italian physicians searched for an alternative.
SCULL: Somebody said to them, "You know, "you should go to the slaughterhouse in Rome, "because they use electricity there to stun the pigs before they slit their throats."
So, they go there, and the pigs are coming by, electrodes on the sides of the head, pig convulses, is now unconscious.
(makes sound effect) Throat gets cut.
NARRATOR: A vagrant picked up at the train station became their first subject.
SCULL: So this guy is put in a chair, he's mumbling incoherently.
They put electrodes on his head with some lubricant and they throw the switch, and nothing happens.
So they decide they'll up the current.
And the patient says, "No, not again, it's deadly."
And they proceed anyway.
And they throw the switch and this time, the patient convulses, and for a short while, he ceases breathing, and you can imagine the tension in the room, and then he starts breathing again.
His symptoms supposedly abate.
He's cured.
NARRATOR: They weren't sure how it worked, but it seemed to reduce psychosis, mania, and especially depression.
This electroconvulsive therapy, or E.C.T., quickly spread.
For decades, hundreds of thousands of Americans a year were treated with E.C.T., despite its downsides, which included memory loss and spasms so violent they could break bones.
FRANCES: My first experiences with E.C.T.
were absolutely dreadful.
We had to chase the patients down the hall because they were terrified of it.
There was no anesthesia and some of them used to get fractures.
It was just a painful, felt like torture doing it to the patients.
LIEBERMAN: There was an imbalance of authority within the doctor-patient relationship.
And the doctor was all-knowing and omniscient and the patient was the obedient victim.
NARRATOR: In crowded asylums, some used E.C.T.
not just to treat, but to control.
SCULL: That image of E.C.T.
being used as a disciplinary tool, not a therapy, stuck in people's minds.
This surfaces most clearly via the film "One Flew Over the Cuckoo's Nest."
LIEBERMAN: McMurphy, who's challenging authority, is systematically punished.
(muffled murmuring) MAN: Here we go.
LIEBERMAN: First with medication, then with E.C.T., and then finally with a lobotomy.
♪ ♪ CYNTHIA PILTCH: I was terrified of E.C.T.
and thought, "How barbaric can you be?"
Because my only image of it was "One Flew Over the Cuckoo's Nest."
My first depressive episode, 25 years ago, when I walked out of that hospital, I said, "I will never be in a psychiatric hospital again.
"I will beat this.
I will find a way to overcome this."
And saw it as an obstacle.
And it didn't matter how deep it ran in my family.
So when it happened again, that was devastating.
It's like some creature has inhabited my body.
And it's a creature that is very disdainful of me, and sees no good in the world, and no good in me.
So who wants to stay there?
Who wants to live with that?
NARRATOR: Cynthia has been hospitalized five times, and like about a third of those with depression, has tried many treatments with little success.
PILTCH: I have always been on an antidepressant and a mood stabilizer.
But I have also used talk therapy, reiki, acupuncture, and massage.
Over the years, I've tried all of it.
I may be the only person that I know for sure who begged for E.C.T.
I don't see this as a panacea.
That said, I think that it's critically important to give people a choice.
♪ ♪ WOMAN: All right, there we go.
MAN: Good luck, you'll be fine.
PILTCH: Thanks, I'll see you.
Bye-bye, thanks, honey.
NARRATOR: To treat her latest depressive episode, Cynthia received 14 sessions of E.C.T.
over the course of about a month.
This visit will hopefully be one of her last.
STEPHEN SEINER: If people start to relapse, you can jump in with a couple of treatments and right the ship and get them back on their way.
I think most of the stigma around the treatment comes from the fear and the misunderstanding of what we're doing.
NARRATOR: Today, patients receive targeted current, anesthesia, and muscle relaxants, so E.C.T.
is safer and has fewer side effects.
FRANCES: For people who have very severe depressions that haven't responded to anything else, it's a lifesaver.
SEINER (in hospital room): Maybe we should just go over what we're gonna do.
PILTCH: Okay.
SEINER (voiceover): E.C.T., from an efficacy standpoint, is unsurpassed, but, as with any medical treatment, there are some side effects.
And the one that we worry most about is that of memory loss.
You're not going to forget who your daughter is, but you might forget a piano recital you went to of hers a month or two ago.
(in hospital room): When you're really depressed, as you know, your, your brain kind of shuts down.
(voiceover): It is really a blunt way to kind of reboot the brain and start things over.
But we don't really understand that black box of how those changes in the brain result in a complex human emotion being corrected.
We will need research to indicate what types of mental illness it's most effective for.
FRANCES: No one knows how any psychiatric treatment works.
So the selection of a treatment has nothing to do with our understanding it.
It has to do with practical results.
NARRATOR: In the 1950s, after E.C.T.
took hold, breakthroughs in chemistry led to nearly all the psychiatric medications in use today.
But the brain was still mostly a black box.
So, like E.C.T., drug development relied on patient response, without understanding how these drugs actually worked.
LIEBERMAN: This was really the tipping point for psychiatric medicine.
And that was a huge breakthrough, equivalent, in my opinion, to the discovery of insulin for diabetes, antibiotics for infectious disease, and vaccines.
NARRATOR: New drugs promised to cure everything from severe psychosis to the anxiety of everyday life.
Good night, Mother.
Good night, Father.
(door slams) HARRINGTON: The 1950s is the age of anxiety.
The language that was used to describe these drugs were things like "the executive's Excedrin."
"An emotional aspirin."
It was like having a cup of coffee to wake yourself up in the morning, or, or having a martini.
And in fact, there was a particular martini where, instead of the traditional olive, they put a Miltown tranquilizer pill there floating in the alcohol.
NARRATOR: Drugs that produced socially acceptable behaviors entered mainstream culture, but another set of compounds had a radically different effect.
MAN: This is a glass of water.
It contains 100 gamma of LSD.
NARRATOR: While searching for new medications, a chemist accidentally created the infamous psychedelic LSD.
WOMAN: Can you see it?
It's right here in front of me.
Right now.
Watch.
No.
Oh, good heavens.
Everything is in color, and, and I can feel the air.
I can, I can see it, I can see all the molecules.
NARRATOR: LSD's molecular structure was surprisingly similar to a chemical only recently discovered in the brain: serotonin.
This similarity, along with LSD's dramatic effects on perception, helped lead scientists to the groundbreaking theory that neurotransmitters-- chemical messengers neurons use to communicate-- could be key to shaping mental experience.
What does it feel like?
It feels good.
NARRATOR: Soon, more than a thousand experiments suggested psychedelics helped alleviate addiction, anxiety, and depression.
But in the 1960s, these drugs left the lab and entered the growing counterculture.
Turn on, tune in, drop out.
RACHEL YEHUDA: This became very threatening to a conservative political society, particularly the part where, after taking a psychedelic, people didn't want to go to war.
People didn't want to go to Vietnam.
And so the establishment basically concluded that psychedelics was at the core of the problem of the counterculture rejecting their value system, and decided that psychedelics were more dangerous than they in fact are.
RONALD REAGAN: There is nothing smart, there is nothing grown up or sophisticated in taking an LSD trip at all.
They're just being complete fools.
NARRATOR: The government classified all psychedelics as Schedule I substances, with high potential for abuse and no accepted medical use, delaying research for decades.
♪ ♪ But today, with few new psychiatric drugs on the horizon, studies are once again underway, and some are taking matters into their own hands.
LAURA DUNN: So I remember the first time that I decided to do an MDMA therapy session, being someone who's very straitlaced and traditional and saying, "Oh, wow, you're about to commit a major felony, "take a substance that's banned, and put on an eye mask, "lay on a couch, and have therapy.
Like, this is a little insane."
NARRATOR: MDMA-- also known as the feel-good drug, ecstasy, or molly-- is still illegal.
But it's now in the final stages of FDA approval for use as a treatment for post-traumatic stress disorder.
YEHUDA: MDMA has a lot of qualities that reduce your self-judgment and self-blame.
It allows you to approach a fear memory in a way that you can tolerate it better.
DUNN: My freshman year at the University of Wisconsin, I was on the UW crew team, and one night I went to a party, was starting to meet some of the rowers, and two of them made a decision to sexually assault me that night.
I really didn't know how to comprehend it.
And I really just didn't speak about it.
Through a series of events, I eventually decided to report it to the police.
I went through every legal process, even hired a civil attorney.
And at the end of that experience, I didn't get justice.
I am a campus sexual assault survivor, and I've been a longtime activist... (voiceover): But I decided to go to law school and really use my story to make change for other survivors.
- My concern, actually, is, we only count by victimization, so you can have a gang rape that's one rape, even though there's ten perpetrators.
- So we're counting all the different crimes, but we're not counting all the different perpetrators.
DUNN: Yes.
(voiceover): I became a hyper-achiever, and I used that as my coping mechanism.
I finally did five years with a traditional therapist.
But I was so ashamed of the things that I was saying that I always looked down, because it's hard to be honest with yourself.
I think it's important to finally feel all of those things and try to let it go and not have it stay in me anymore.
- Yeah.
YEHUDA: The effect of the actual medication will last for seven or eight hours.
Within a day or a day and a half, all traces of the medicine will have left your body.
But the lingering effects of what you accomplished will last for a very long time, and it may be forever.
Because what will have happened during those seven hours isn't a pharmacologic effect, it's pharmacology helping you achieve an insight.
ANTHONY ADAMS: Laura and I will talk about what she wants to accomplish, what her intention is.
Then Laura will make a decision if she would like to take the medicine.
It's a small dose of MDMA, the idea being that once she's able to make contact with those parts of herself and process those experiences, that her perspective may shift and that there would be a sort of neurological or biological change to kind of to coincide with that inside of her.
♪ ♪ You've already done everything you need to do by being here.
So you can just relax and go where you need to go.
- (softly): Okay.
NARRATOR: Within the hour, Laura will experience MDMA's effects.
Her brain will flood with neurotransmitters, including serotonin, dopamine, and oxytocin.
These chemicals can create feelings of well-being and trust, and some speculate they make the brain more malleable, so it's easier to learn new ways of responding to traumatic memories.
But how chemical changes in the brain actually affect thoughts, feelings, and behaviors isn't well understood.
♪ ♪ The Harvard Brain Tissue Resource Center distributes specimens around the world to scientists working to unlock the mysteries of mental illness.
SABINA BERRETTA: It is a really humbling experience when we receive a brain donation.
We just found out that the donor passed, we know that person was experiencing feelings and thoughts and said goodbye to their loved ones.
And few hours later, we are holding the brain.
When I hold a brain of somebody that had a psychiatric disorder, or even dissect it, I wouldn't notice any difference between that brain and the brain of somebody that didn't have any brain disorders.
♪ ♪ Our work is to try to understand changes in specific parts of the brain, in specific cells, that may be responsible for certain symptoms.
NARRATOR: Brain specimens reveal that disorders like PTSD, depression, and schizophrenia share genetic vulnerabilities and patterns of molecular changes, so these diagnoses may not be as distinct as long believed.
BERRETTA: The more we dig, the more we understand, that the more we see that there is an added layer of complexity.
NARRATOR: New imaging techniques are revealing that brain regions themselves are also not as distinct as previously thought.
Instead, it might be the complex connections between regions, known as circuits, that are key to understanding mental illness.
TYE: When I started first studying neuroscience as a student, I was trained that, you know, different brain regions do certain things.
You know, "X brain region does Y."
And I think the evolution of the field is that brain circuits are really the functional unit of the brain.
KOPELL: Only recently have we begun to be able to see another layer of the anatomy of the brain, to see these connections.
NARRATOR: Doctors hope a better understanding of brain circuits will change lives like Matthew's and make treatment more targeted than ever before.
TYE: Right now, what we have is a sledgehammer, and that sledgehammer can look like electroconvulsive therapy to shake up the functioning of, of different circuits, and then see if it can kind of, like, settle back into a better state, but it's totally random.
If we understood specific circuits, we could apply current at the circuit-specific level.
♪ ♪ NARRATOR: A new type of MRI helps trade that sledgehammer for a more refined approach, showing these communication pathways in dramatic detail unattainable just a decade ago.
Today, we're trying to find the optimal surgical target for you, Brian.
NARRATOR: Can the precise placement of a brain implant help Matthew's compulsive breathing?
KOPELL: The best next step, I would think, would be for me to pick a trajectory.
FIGEE: Mm-hmm.
Our current investigative strategy is that we're looking for a confluence of two critical pathways passing through a big area of the brain.
That's like a giant highway coming from the frontal lobes down into the central structures of the brain, of the basal ganglia, which then distribute the information to the rest of the brain.
By electrically stimulating, we are able to very precisely intervene, fundamentally changing the underlying patterns of communication.
MAN: Sectioning the brain... NARRATOR: An early-- and infamous-- attempt to change patterns of communication was the lobotomy, which severed the frontal lobe's connection with the rest of the brain.
KOPELL: Lobotomies led us to the insight that frontal lobes were really, really important to psychiatric disease.
Today, it's already understood and known, and it doesn't seem like an earth-shattering notion, but the idea of demonstrating that was really earthshaking.
It really opened up psychiatry.
If we didn't understand the frontal lobe's inherent importance to mental illness, we wouldn't be sitting here today.
- So about how long does this typically take, like, before I'm on my feet again?
- Well, the very next day, you'll be on your feet.
You'll be on your feet that evening.
As long as there's no complications... NARRATOR: One out of three patients don't respond to the procedure.
And the risks are significant.
NAYLA: When you say complication, what is... KOPELL: The scariest risk is bleeding in the brain or stroke.
It's a little under one percent of it being clinically meaningful.
But it's something that you have to be mindful of.
With regards to this target region, the most common adverse stimulation effect is something called mania.
In my years of doing this, I had one patient go on a huge credit card spending spree.
That's part and parcel of stimulating these, these emotional circuitries.
Having these abnormal side effects in some ways is a good sign.
It means that we're getting close.
Does that make sense?
- Yeah, that, that we're seeing a response.
Right, we're in the right circuitry, now we just got to tune it in.
Mm-hmm.
(indistinct chatter) NARRATOR: Matthew will need three separate surgeries costing about $100,000.
But insurance coverage is a struggle.
O'NEILL: I know that you're fully aware of this insurance claim being denied and yet another time.
And now it's going all the way up to the New York State Executive, appeal.
- So I did a written review of the policy guidelines for the insurance company.
- Mm-hmm.
Mm-hmm.
- And it looks like deep brain stimulation is indicated for other disorders, not mental disorders.
- Right, right.
NARRATOR: DBS is approved by the FDA for treating some cases of very severe OCD, but as with many psychiatric treatments, insurance companies often don't provide coverage.
We are having huge problems getting the insurance cover the deep brain stimulation for psychiatric conditions, even though it's, it's, like, on the same spectrum as movement disorders.
The first thing we get back from the insurance, say, "No, we can't do it."
KOPELL: There has been this bright white line between mental illness and physical illness.
And I think it fundamentally speaks to a, a longstanding stigma against psychiatric disease.
O'NEILL: Bringing in that paperwork, focusing on that next week, and really prioritizing our session for it would be helpful.
Sounds like a plan.
- Okay, wonderful.
HANKERSON: Psychiatry has made tremendous scientific advancements, with new forms of treatment, like deep brain stimulation.
But these treatments are very, very expensive.
And so we really have to think about, how are we going to make access equitable for all people?
♪ ♪ LIEBERMAN: We don't have very good healthcare policy, and it affects disproportionately mental healthcare.
Mental Health Parity law passed in 2008, but it's not enforced, meaning that if insurers don't abide by it, who's going to know, unless somebody brings a suit, a lawsuit?
TYE: I think that really lies at the heart of the fundamental biggest problem of mental health treatment is that there's a stigma behind it, and there are many layers of that stigma.
MAN: Can you say your name and date of birth?
PILTCH: Cynthia Piltch... NARRATOR: Much of the controversy and fear about electroconvulsive therapy is tied to its history as a painful and sometimes punitive treatment.
WOMAN: Big deep breath all the way in, and all the way out.
NARRATOR: Efforts continue to reform its reputation and create a more comfortable and effective procedure.
SEINER: Most of the work over the last 20 years has been how to really minimize the side effects.
Under general anesthesia, with a muscle relaxant in place, using tiny pulses of electricity, people don't really convulse.
(in procedure room): We have to put a bite guard in is, because even though we have a muscle relaxant on board, she will bite down.
(voiceover): What we haven't been able to do with E.C.T.
is produce an effective treatment without the seizure.
(device beeping) (beep changes) You see the bite.
NARRATOR: Applied to only one side of Cynthia's head, the electric pulses are hundreds of times shorter than the original E.C.T.
Lasting about the length of time it takes a neuron to fire, they trigger more efficient seizures with fewer side effects.
SEINER: Now, if we didn't have a muscle relaxant, you'd see her really moving.
♪ ♪ This is the E.E.G.
tracing.
These sharp waves tell us whether there's an acute seizure going on.
Some people believe that part of the way E.C.T.
works is not so much in the seizure itself, but in the way the brain reacts to the seizure and shuts it down.
(indistinct chatter) (voiceover): It really is a very quick, somewhat boring procedure when it's done right.
♪ ♪ WOMAN: Cynthia, everything's all fine.
You did your treatment and you're in recovery, okay?
♪ ♪ PILTCH: I have some memory loss.
But I don't want to miss an opportunity to support my well-being.
The fact that I can still do credible work makes it harder for people to draw the conclusion that E.C.T.
strips you of any cognitive ability.
Not being able to be myself was much more frightening than whatever E.C.T.
brought.
♪ ♪ NARRATOR: For Cynthia, the benefits of E.C.T.
outweigh the risks.
(muffled wailing) And Laura is also taking risks to overcome the trauma of sexual assault.
DUNN: Right now, it is not legal for me to be taking MDMA or doing an MDMA therapy session.
(exhales deeply) But the idea of waiting any longer upon finding a possible solution to be fully well and healed meant that I had to take the action of taking an illegal substance outside of a clinical setting.
(in session): Everything in my head is screaming, but that was one of those moments where I was, like, I never get to be angry.
I never get to be angry!
(voiceover): Each session has its own theme.
I think the best way to explain it is your anxiety being a ball, and you can spin it around and see it from all angles.
You're, like, going into your own brain and almost like doing surgery.
(groaning in session) (crying): I was so desperate to be believed.
I thought about killing myself to be believed.
I just wanted to be believed.
(crying softly) That's so hard to believe.
- (quietly): You did not deserve that.
DUNN (voiceover): Now I cry more.
(laughing): But that's good.
Like, I'm not crushing all the pain in me.
These are real emotions that I used to never feel.
♪ ♪ So I think the substance does some work.
(breathes deeply) But, you know, the actual ability to shift perspectives that you learn from that stays.
(indistinct chatter) DUNN (voiceover): And the power of fixing yourself, I can't even begin to describe how important that is.
♪ ♪ NARRATOR: Many experts see MDMA-assisted therapy as a new frontier.
In some studies, 80% of patients show improvement, and FDA approval may be around the corner.
But the future of psychedelics remains uncertain.
LIEBERMAN: Maybe it'll work.
The data are still developing, but practice and use is leaping ahead of research.
And with the genie out of the bottle, we don't know what's going to happen.
KOPELL: Good.
Good.
Good.
Just kind of make sure...
Okay, that's great.
MATTHEW: So I guess they're gonna put me to sleep now, and I'll wake up when we do the, uh... KOPELL: Yeah, the testing, okay?
Looks good.
NARRATOR: After nearly a year and multiple appeals, with the hospital advocating on his behalf, the insurance company approved Matthew's deep brain stimulation surgery.
(drilling) ♪ ♪ It takes about two hours to place one electrode.
KOPELL: Good.
Let's have that.
Yup.
What's our blood pressure?
(indistinct chatter) ♪ ♪ KOPELL: Okay, great, let's get a scan.
♪ ♪ FIGEE: How are you feeling?
MATTHEW (weakly): Okay.
- Yeah?
- I mean, not okay, but... NARRATOR: To make sure the device is in the right place, Matthew's doctors wake him up.
FIGEE: Yeah, everything went fine so far.
The lead is in.
And it's positioned very well.
And we're going to run some tests in a moment.
NARRATOR: He's asked to rate his symptoms while they test the current.
FIGEE: You can actually use this to move.
So contact one.
This is just very intuitive.
Now you just click on it.
Anxiety, uh... Not so bad.
- Oh, that's good.
NARRATOR: In three weeks, Matthew will have another electrode implanted in the other side of his brain, and then a separate surgery to put batteries in his chest to power the device.
FIGEE: Contact three.
♪ ♪ MATTHEW: Compulsive breathing, I'm not doing it so much.
But I'm still, like, doing it occasionally.
FIGEE: Great.
- (murmurs) - Like, percentage-wise, what, what would you say, like... - A 70.
- 70.
- Okay, now I'm doing it.
- That's maybe because we just turned it off.
That's insane.
- (chuckles) Wow.
NARRATOR: The implant won't be activated until Matthew has healed from all his surgeries.
It will be more than a month before he knows if it works, but initial signs are promising.
This is much better than anything I've ever tried.
FIGEE: Does it feel natural or... - It feels not exactly natural, but it feels very close.
- He's feeling amazing.
KOPELL: All right, Matt, how about that?
So we're just going to do a little more recording, and then we're done.
I'm going to put you to sleep, okay?
MATTHEW: All right.
NARRATOR: Deep brain stimulation holds promise for people like Matthew, but the challenges in treating mental illness are as much about society as science.
One major hurdle involves overcoming psychiatry's controversial past.
HANKERSON: Many Americans do not see the formal psychiatric system as being for them.
They see psychiatry as being aligned with a punitive form of treatment that does not take into account family, does not take into account faith, and does not take into account community.
NARRATOR: For centuries, psychiatry has used labels to marginalize and subjected those considered mentally ill to experimentation and treatment, often without consent.
Today, in the United States, more than a million people living with mental illness are incarcerated or homeless.
And for many, access to treatment and insurance is limited.
Some are trying to combat this checkered legacy and make access to mental healthcare more equitable.
HANKERSON: The newest biological treatments are not the only new frontiers in psychiatry.
What I'm trying to do is to try to provide care where people naturally see it in culturally relevant settings.
DENNIS MITCHELL: With your son, what, what is the relationship like right now?
Like, you know, how does he, how does he respond to you?
- Um...
He's open, he's open to hear, okay, how you feel about it, kind of what are we gonna do about it now, kind of... HANKERSON: Barbershops, especially for Black men, have provided kind of informal mental health supports for centuries.
Guy, what up?
- Hey, man.
- Man.
- How you doing, brother?
- Wow, man, good seeing you, baby.
(voiceover): We're working to train these type of informal helpers with the latest evidence and techniques to be able to identify someone who may be experiencing a mental health crisis, how to support them in the moment, and then how to get them connected to health insurance, or how to get them connected to a mental health professional.
MITCHELL: I had a guy, you know, during the pandemic.
You know what I'm saying?
He was going through a lot.
A lot of his people was falling off, and... - Yeah.
- You know, this guy, I've been cutting for years, and I would never think that he would be sitting in my chair crying.
I gave him that platform to be able to do so.
- That really shows the trust that he has in you... - Absolutely.
- ...and, and his willingness and connection to you, that he felt safe.
(voiceover): When we talk about psychiatry, I think we traditionally have expected people to come to us, and we, when people don't come to our settings, we interpret that as resistance.
I think that the new way for psychiatry to move forward is to figure out how communities have dealt with issues around trauma and depression, substance use, and build upon and incorporate some of those traditions into the interventions that we develop and that we implement.
MICHAEL WALROND: God, we use our own pain and our own experience to bring a word of comfort and healing and relief to someone else.
(voiceover): Within the African American community, one of the things that often we know of is the normalization of trauma.
"This is what it's supposed to be, given the, the history of, of our people."
So, what happens in many of our communities, that embodied trauma, right, that has many tentacles, never gets addressed.
There's a big stigma in our communities around mental health issues, well, scratch it-- we've been traumatized.
HANKERSON: I actually met Pastor Mike.
One of his church members came up to me and said, "You know, my pastor talks about mental health from the pulpit."
I was just so excited, because I had never heard of a pastor talk about mental health.
One of the things I want to hear about is, how have we done with regard to cutting down the wait list?
I know we had a, a pretty large wait list.
WOMAN: We had a waiting list of 76 people.
NARRATOR: Hankerson and Walrond built a mental health support network that includes a crisis hotline and free clinic.
WALROND: You can't say, "Oh, it's..." We don't trust God.
No, it's a faith-based institution that created it.
You can't say, "Oh, it's too expensive."
No, it's for free.
Winter has crept in.
Have we seen an increase in people reaching out?
WOMAN: Yes.
HANKERSON: My dream, or one of my visions, in terms of transforming mental health, is really creating connection points and support.
We have to form partnerships, you know, with these trusted community settings so people can learn, so that trust can be created, so that it can be equitably accessed, you know, in, in society.
NARRATOR: Just a week ago, Matthew had his third and final deep brain stimulation surgery.
MATTHEW: What I remind myself is that I am my best advocate.
I found this clinic through my own research, through my own initiative.
I earned my way to this surgery by fighting for myself.
So, you know, I have that fighting spirit that is not going to go away no matter what the outcome is.
NARRATOR: Today, his doctor will test whether the electrical implants work.
FIGEE: Some people might say it's, it's a little creepy that we're going to actually manipulate someone's brain.
And I would say they're right, if it's, like, a healthy person with a healthy brain, but these are, like, very ill patients.
MATTHEW: So I know today, this appointment's not going to be, you know, a magic pill, but I'm hoping that, you know, we... - Maybe, maybe it will, maybe it won't.
This is actually your brain.
You can see the tracks that your leads are implanted to.
NARRATOR: The electrodes implanted in Matthew's brain have several contact points.
Dr. Figee will adjust the amount of electricity flowing through each of them.
FIGEE: Is that, is that still... - A little tender, but yeah.
NARRATOR: But first, he has to link the batteries implanted in Matthew's chest with a handheld controller.
FIGEE: You may not feel an immediate response... - Yeah, I feel it.
- Yeah?
Tell me if it's uncomfortable.
- I mean, it's okay.
I feel it kind of, like, in my heart, like, uh... Like, I don't know.
- Oh, yeah.
Like a little... - Yeah.
(chuckles) I'm, like, laughing now, um... (laughing quietly) Does the laughing, like, go away or... - Yeah, yeah, yeah, the first activation of the system is usually a little hypomania-causing, especially this contact.
But we're going to move to another contact soon.
- Like, I feel like I want to dance.
I feel like I want to run on the street, like... - Oh, yeah?
- Yeah.
I feel very energetic than, more than normal.
- But, but naturally, or like you're on drugs?
Like, a little like I'm on drugs, but, like, it's not bad.
- If you feel great, you might be better able to control your OCD, as well.
- Yeah.
- But it's not what we're strictly aiming for.
3A.
NARRATOR: As they try different contact points along the electrode, Matthew rates each of his symptoms.
FIGEE: This is gonna be left 3C, right 3B.
- I'm not even compulsively breathing.
It's almost gone, yeah.
Definitely less, so, like... Wow.
- Okay.
- But that was a good setting.
The compulsion is virtually gone.
Like, I'm not compulsively breathing, and... - Great.
- Yeah.
- Not too up, but definitely way more down.
- Better.
- In terms of your symptoms.
- Yeah, wow.
- It seems that, like, the contact is the best one, which is the third one... - Yeah.
Mm-hmm.
- Because it doesn't give you, this, this up, this sort of mania.
- Yeah.
This is, like, a whole new look on life, this is crazy.
- Mm-hmm.
- All right, so, here's the phone.
- Yes, turn it on.
NARRATOR: His doctors will control the programming of the device, but he can make slight adjustments to the amount of current through an app on his phone.
FIGEE: See?
You can go up and down.
And again, you can also turn it off.
- Okay.
FIGEE: It went perfectly as planned, and it was actually a copy of the responses that we also saw in the operation room.
Hopefully, he'll feel more normal, more like himself.
♪ ♪ MATTHEW: Right now, I'm at setting 4.5.
Now I'm at 4.6.
I felt a little pulse there.
It says I've been stimulated for 192 days.
The OCD is just a shell of what it was.
It's in the shadows.
The only time I've actually seen a drastic increase in OCD symptoms was when one of the electrodes was actually off by mistake.
It made me realize, you know, how dependent I am on this machine, how dependent I am on this device.
NARRATOR: After centuries of searching, are scientists finally close to solving some of the mysteries of mental illness?
♪ ♪ TYE: If we were able to think of the brain more as a tangled mess of wires that we need to carefully disentangle, I think it is totally, you know, within the realm of possibility in the future that there will be treatments-- cures, even-- for mental health disorders that are specific, that would have a completely different strategy than our current mental health treatments do.
MATTHEW: Before my surgery, I used to have trouble going outside, and I felt that it was almost futile.
Not going to feel better.
I was just sort of a prisoner of this illness.
So I'm here now.
I can appreciate these things I didn't, I didn't appreciate before.
I can listen to the birds.
I can really be myself here.
TYE: When I think about what a mental health revolution will look like, it will take time.
There's no shortcut.
SCULL: We've made a bit of progress, but it's a deeply disturbing part of the human condition and one we've wrestled with for millennia.
We cannot arrogantly assume that we have one single answer.
PILTCH: Come on, buddy.
MAKARI: This is a complex problem in a whole person, not a segment of a person that's a brain or a mind or a gene or an environment.
NARRATOR: Mental illness will likely endure as long as humanity itself.
But each new breakthrough brings greater understanding.
Will this help reduce stigma and lead to a healthier world?
(indistinct chatter, laughter) HANKERSON: When the health of people improves, the community's health improves.
So when we take care of everyone, then everyone in society benefits.
♪ ♪ ANNOUNCER: To order "Mysteries of Mental Illness" on DVD, visit ShopPBS or call 1-800-PLAY-PBS.
This series is also available on Amazon Prime Video.
For more about "Mysteries of Mental Illness," visit pbs.org/ mysteriesofmentalillness.
♪ ♪
