The Jamieson family did not think of itself as lucky when Patrick’s bipolar disorder emerged. But for the sizeable swath of American adolescents and families struggling with mental illness, the fact that this happened to a son of Kathleen Hall Jamieson was a stroke of remarkably good fortune. Though she’s not a medical doctor or scientist, it’s hard to imagine anyone better equipped—by temperament, connections, and stature in the academy—to lead an initiative like the AMHI.

“This is the area in which I have the least expertise as a scholar and the most expertise as a mother, and it makes it a different project,” says Jamieson, who was famously protective of her family during her two sons’ adolescent years. “Ordinarily, you’re ill-advised as a scholar or policy-center director to take on anything that you don’t have a fair amount of scholarly expertise in, because you won’t find a niche and you can’t make a contribution,” she says. “What is exciting about this project is that Penn was able to identify the scholars, to find the niche, and to make the contribution.”

As she speaks, she is sitting at the large table in her office in the Annenberg Public Policy Center, where a photo of her first grandchild adorns a glass door. Her jeans suggest a more casual workday environment than she was accustomed to during her years as dean of the Annenberg School, but her speaking style—fast, precise, content-rich—hasn’t changed one bit.

“Am I personally invested in it?” she asks rhetorically. “Yeah. When you see that your child has benefited from access to a body of professionals and a body of knowledge, and then you realize that other parents would not have had the same benefit because they weren’t tied to a research university and might as well have lost their child, you’ve got to be very grateful to the Annenberg Foundation Trust at Sunnylands saying: ‘Yes, you can do this project.’ It’s the story of what happens when the Annenbergs enter your life.

“I am invested in it because I think it is incredibly important,” she adds, “but the real investment, in terms of time and expertise, was the Penn scholarly community.”

“There are five or six places this could have been done, and Penn was one of those places,” says Dr. Martin E. P. Seligman Gr’67, the highly influential professor of psychology who headed the AMHI’s commission on positive psychology. (Seligman founded the positive-psychology movement, and is director of the Positive Psychology Network.) He and Evans were the initiative’s “co-chairs and conceptualizers,” in Jamieson’s words (they also edited their commissions’ chapters and wrote the introduction to Treating and Preventing), but they both point to Jamieson as the AMHI’s catalyst and linchpin.

“This never would have remotely happened without Kathleen and Patrick,” says Seligman. “This is a product of Kathleen’s emotional life and the financial weight that she could throw around. She said she was going to do this adolescent mental-health thing, and whatever she would say, I would do, and trust her taste. Kathleen’s got a real nose for who’s important, and I think she just picks up the phone and people say Yes.”

“It was very interesting—nobody said No,” says Raquel Gur. “All these people who are so busy, from all around the country and even Europe—nobody said No. I thought it reflected the perception of all the participants that this was a really important initiative.”

Two underlying principles are worth mentioning. One is that the initiative’s leaders didn’t want any funding from pharmaceutical companies.

“There’s no drug money,” says Jamieson. “So when the book says, ‘This medicine category works,’ they’re not saying this with any hint that some influence in that decision might have been drug money.”

“This was funded by the Annenberg family, who care about mental illness and want to get the best information out to the public at large, both professionals and a lay audience,” says Joan Bossert, the Oxford University Press editor of Treating and Preventing. “That it was not funded by the pharmaceuticals is very powerful.”

The other principle had to do with “crossing the psychological/psychiatric divide,” in the words of Jamieson. Essentially, that divide lies between psychologists who stress psychotherapy and psychiatrists who emphasize medication. While there are obviously members of both camps who don’t follow that pattern and cross the great divide in their own ways, “in a whole lot of places those areas fight each other, which makes no sense,” Jamieson notes. “Marty [Seligman] and Dwight [Evans] don’t do that. They started out with a broader list.”

“I’ve never had a psychiatric/psychological divide,” says Seligman. “The divides are really more biological vs. psychological, and Dwight and I are both serious about both. I’m closer in mind to Dwight than 90 percent of my colleagues in the psychology department, so I’m an easy fit for a lot of different departments.”

“Our understanding of brain development is rendering the old debates between nature and nurture or biology vs. behavior increasingly irrelevant,” note Evans and Seligman in their introduction to Treating and Preventing. The recent advances in the field “make this a most exciting time for advancing our knowledge and ultimately for preventing the onset and development of mental disorders at the earliest signs of presentation.”

Certainly, those afflicted with mental illness now have a better chance at living a productive life than ever before, especially if they are diagnosed and treated early. Five or six years ago, Raquel Gur recalls, Penn’s Student Health Service called her and asked her to see a student whose behavior suggested psychosis. After evaluating him, she met with his parents, who had flown to Philadelphia. “I asked the mother, ‘Are you familiar with schizophrenia?’ She said, ‘Yes, my husband’s brother is schizophrenic’—that’s why they flew in,” says Gur. “She was crying and saying, ‘Dr. Gur, I wish you were telling me it was cancer! There’s more progress and more potential for curing young people with cancer! I saw what schizophrenia did to his uncle.’”

As it turned out, the woman’s son was successfully treated. “He came back to Penn, and he was able to graduate, and he’s OK,” says Gur. “But their reaction—‘It would be easier for me if it was cancer’—really captures the fear, the feeling of being totally alone and scared. And because the implications can be so significant, it’s important to identify it early, because there’s much more that can be done if it’s identified early rather than late.”

Sept|Oct 07 Contents
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Youth, Interrupted By Samuel Hughes
Illustration by Josh Cochran

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What Is To Be Done?

The final chapter of Treating and Preventing Adolescent Mental Health Disorders is titled “A Call to Action on Adolescent Mental Health.” After laying out the mostly good news about the success rate for mental disorders when treated effectively, and discussing the current debate about the safety and efficacy of antidepressants, the authors—Kathleen Hall Jamieson and Daniel Romer—make a number of recommendations, including:

Increase the number of psychotherapists trained in cognitive behavioral therapy and interpersonal therapy.

Improve access to results of clinical trials evaluating effects of all therapeutic interventions.

Treat substance-abuse issues and mental-health issues within the same service system, since drug dependence is often “co-morbid with other mental conditions” and would benefit from “treatment as a medical problem rather than as criminal behavior.”

Increase and improve early detection and treatment, especially in the area of substance abuse.

Achieve “full parity” in mental-health insurance coverage.

Reduce the stigma of mental illness by educating the public about the effectiveness of treatment “and the reality that persons with mental disorders can lead productive lives.”

Increase research, both about “appropriate protocols and systems for treatment” and to “increase our understanding of the multiple pathways to both healthy and unhealthy development.” While a study that follows a “large and representative sample of children and twins” into adulthood would be quite costly even for the National Institute of Mental Health, it would “greatly advance our understanding of the emergence of mental disorder and resilience in youth,” and pave the way for more tests of intervention strategies. —S.H.

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