On a rainy June afternoon, RDSF Board Secretary, Rachel Cruz, sat down with one of Sutherland Center’s most dedicated psychiatrists, Dr. Gregg Olsen, who has been doing pro bono work as a Board Member and with the Center’s clients for over a decade.
Rachel: How did you get involved with the Sutherland Center?
Gregg: I got involved through Will Van Derveer. Will is a longstanding friend and colleague of mine, and he knew Bob Sutherland. He told me of the Sutherland Center and the work that they were doing. I’m fully supportive of any organization that’s promoting mental health. What I loved about it is the fact that all the funding goes directly towards clinical care. That’s what was most appealing to me. And Bob, once you meet Bob… he’s such a kind man. It’s easy to want to support him and partner with him with his mission.
R: Yes, I feel very fortunate in that, working with him; he’s great to work with. So how long ago was that?
G: That was 2004. When I got involved, I got on the Board fairly quickly. I was on the Board from 2004 to 2008.
R: Were you working tangentially to service patients, as well?
G: No, that was just work-work. There was a big bottleneck for psychiatrists. There were a lot of psychological evaluations coming through the Sutherland Center. Essentially there was a bottleneck of being able to get consistent psychiatrists to take on those patients. There were a few psychiatrists that were getting paid by the Sutherland Center to provide consultation and services. But then, they left and there was really nobody to fill their roles. And then there was concern among the people at the Sutherland Center about having physician psychiatrists who were good at treating bipolar disorder. They didn’t want to refer patients to just anybody in the community. So I recommended trying to get people to do pro bono evaluations for the Sutherland Center, even if it was just consultation and then referring them to someone in the community. But then again, there was a lot of protection because the Sutherland Center had seen a lot of people, I think, who were mismanaged by particular psychiatrists in the community. That was one of the things they really wanted to make sure, and David Miklowitz was in this as well, they really wanted to be assured that there were people who would be familiar with and adept at working with bipolar disorder.
R: Was it David Miklowitz who chose the doctors?
G: I don’t know who actually chose and how we ended up getting chosen over time. Sutherland Center staff said, if you’re willing to see a pro bono person we would love that. And Will Van Derveer was the same thing. Then Gila Steinbock came on; I don’t know how they became familiar with her work, but they decided to invite her as well. And I’m not even sure who are pro bono providers for psychiatric services now.
R: But you’re doing pro bono work, right? It’s all pro bono, what you do for the Center?
G: Yes, I’ve never gotten paid by anybody. But I only usually take one person at a time. That’s usually all because I do pro bono work for other organizations, too. I have to make a living! I’m really big at giving back to the community, being a part of the community.
And I love treating bipolar. It’s really become an area of my biggest interest. When I started out, it was mostly mood disorders in general anyway, certain psychotic disorders, but not in a private practice kind of setting. They usually ended up in a mental health center setting if they have a more severe illness, and they need to have a system around them. So I’d been seeing mostly mood and anxiety disorders, and the majority of mood disorders we were seeing were bipolar-type mood disorders because primary care doctors are not at all treating bipolar disorder. Primary care doctors were very comfortable treating major depression or anxiety. But once patients become unresponsive to medication or aren’t responding in typical ways, they refer to us, and a lot of times there’s a suspicion of a bipolar disorder. So we kind of just end up with those.
Anyway, I find them the most challenging. I think there are so many aspects of working with bipolar clients. They tend to be very articulate, have a wider range of emotion, which makes them very interesting. I see a lot of high intellect in people with bipolar disorder, interestingly enough. People have been very successful before they’re ever diagnosed. Many people have been running companies, starting companies, chains of restaurants, all sorts of things before they were even adequately treated.
And we’ve fortunately had more medications come out over time, but we’ve been sort of limited in the amount of medications we have to treat bipolar disorder to some respect. But for me, it comes to challenge, and I like a good challenge and handling medication management. There’s nothing better than seeing somebody get stabilized, and how appreciative they can be once they had a period of mood stability (for a year!) that they can start trusting that they’re not going to have another mood episode.
They also tend to be a really creative population of people, musicians and artists, with their creative powers, and they’ve created meaningful work for themselves, successful work.
R: How do you think the family unit contributes to their lives? Do they help in healing them, managing them? Is family a really big part of the treatment?
G: Yeah, well, David Miklowitz and his book speak volumes about that, and it can go either way. It can be a family who is incredibly supportive, and is making sure the person is getting the right services they need and is trying to provide the right support that the person needs just on a day to day basis. On the other hand, when you have an identified patient in the family, then sometimes if there’s any sort of discord or problem he gets blamed, that the person is unstable in some way. At the same time, I think families are crucial because what they always say is, people come in complaining of depression, but nobody comes in complaining of mania. Patients like the euphoric feeling, they like the creativity, and they think nobody gets it, that only they get it, the grandiose quality that can come along with it. So it’s often times not until I get a call from a family member saying they’re manic do we really know that they’re in that phase of an illness, so family and collateral information is really helpful.
I also treat adolescents as well, so there’s that tricky dynamic between adolescents and their parents, and the parents are trying to control and dispense the medication. And I’m trying to get the adolescent to take responsibility for the illness, manage their own medication, and then learn how to manage their illness as they turn into young adults.
R: Are you finding that patients are being diagnosed even earlier on with bipolar disorder?
G: I think so. There’s been a lot of controversy around that. There’s the question, are we just getting better at screening for it at this point? Are there environmental factors that are contributing that are increasing the incidents of that, many other factors that can play a role environmentally as well? But we’re definitely better at screening. There was also a lot of controversy about there being a spectrum of bipolar disorder that there was just a Type 1 and just a Type 2, and that they were classic types. And if they didn’t meet the criteria for 1 or 2 they didn’t have bipolar disorder. And yet they responded best to mood stabilizers and got worse on anti-depressants.
R: What do you see are the challenges that patients face today?
G: I think the biggest challenge is getting an accurate diagnosis because the earliest identification and the earliest treatment have been shown to improve the overall course of the illness. So the sooner somebody can be identified and treated, I think the better their outcome over time. The average is 7 years until a bipolar disorder diagnosis from their first presenting symptom. There might be a number of different medication trials, and that’s a lot of exposure to a lot of medications that have a lot of side effects. Getting an accurate diagnosis as early as possible is challenging.
R: Why does it take so long?
G: Because people don’t always present with classic criteria. And many people present with depression as being their first mood episode. If they present with mania it’s very easy and very clear. But if they present with depression, it’s hard to know what direction they take, especially with adolescence and late adolescence; it’s almost always a depressive episode. And the hypomania doesn’t really develop until a bit later in a number of people, so it makes diagnosis a bit more difficult. Their challenge is also finding medications that are tolerable and coming to terms with having an illness that’s likely a lifelong illness, and they may need medications for the rest of their life. And there’s also the label that’s almost become slang in modern society about “oh, they’re acting so biploar…” It’s hard for people to feel comfortable coming out saying, “I have bipolar disorder.” Like many other psychiatric illnesses, the stigma is not just confined to bipolar disorder.
R: … especially if they’re so young…
G: Yes. And while they’re taking medications that have side effects, I think one of the other challenges is that they get dulled to a certain degree. It’s finding that line between are they going to have the richness of experience of emotions but not tip over the end one direction or the other? They want a little creativity, but we have to keep them out of the manic creativity. They want to be able to cry at a sad movie, but they don’t want to end up in a major depression. So it’s really the finessing of the physician/patient relationship– let’s work to find that sweet spot for you.
And there’s the challenge in finding psychiatrists in general. I get calls from people in Boulder, certainly, but I also get calls all the time from all over the country looking for psychiatrists. There’s a shortage of psychiatrists, and many are relegated to medication management only. When I trained, I trained to do medications and therapy, and I find that useful because then you’re relying on a psychologist or a master’s level therapist who has the most contact with the person to identify symptoms early. We’re just seeing them once in a while; we’re going through our little checklist and we don’t really get a bigger sense of what’s happening.
R: Does meditation play a role in some treatments? Self-awareness…?
G: Absolutely. It’s very popular now, mindfulness-based stress reduction therapies and programs. There are physician trainings dedicated to mindfulness-based stress reduction, and it’s even made it into our APA (American Psychiatric Association) Guidelines as a recommendation for anxiety disorders. I think over time we’re discovering more and more that anything we can do to help self-regulate and cultivate an internal skill is more helpful versus rely on an outside resource, whether it be a therapist or a medication or turning to alcohol or other substances. I think that’s one of the other challenges that people face with bipolar disorder. There’s such a high co-morbidity with substance abuse and with anxiety disorder. So trying to tease that all out and help somebody get off substances to help clarify their diagnosis can be very tricky if you’ve been self-medicating for a long time.
R: But the more that they can learn that skill of self-soothing, self-regulating, self-awareness it empowers them.
G: Exactly. It gives them a tool, a very useful tool. So, I’m a meditation practitioner, and a yoga practitioner. I’ve always encouraged that for clients as a way to quiet a busy mind, which is one of the things, one of the biggest complaints I hear from people.
And exercise as well. That’s another thing that somebody can do to help them regulate their illness by getting enough exercise. Because sleeping well, I think, is one of the key components of maintaining stability in bipolar disorder. If someone’s getting adequate sleep, then I think they do much better than someone who has an irregular sleep schedule, works a night shift, is waking frequently throughout the night, or has an altered sleep cycle where they’re up until 3am then sleeping until 10 or 11am. Those are the college kids and adolescents I see; they do that. So just regulating somebody’s sleep cycle is very helpful.
And that’s one of the things I also talk to people about as a warning sign, that they’re moving into a mood episode when their sleep starts changing and they need less sleep or more sleep. If they’re not feeling consistently rested, or they’re waking up with racing thoughts, or they can’t get to sleep because of those racing thoughts, those are early warning signs, and things can topple very quickly with poor or very little sleep.
R: And how about diet? Does diet play a role?
G: I know less about diet and the role that it might play. There is a lot of study going on now about nutrition and the potential factors. What we do know is that we have serotonin receptors all throughout our gastrointestinal system, so we have receptors throughout the body. And there is a lot now on the concept of psycho-neuro immunology where all of this is tied together. I’ll see people with IBS (irritable bowel syndrome) who have bipolar disorder, and when their mood is stabilized their irritable bowel will stabilize. It’s the same thing with migraines. I think there can be an interplay in both directions. We can’t separate the mind from the body. That would be ridiculous for us to try and do so.
And sugar. I think we’re going to find that sugar is one of the biggest problems in our culture at this point and the role it can play in people’s rising moods and energy levels and other aspects that get confused with psychiatric symptoms.
Will Van Derveer is very big on the nutritional aspects, so he would be a great resource for you to talk to if you wanted to know more about that. Dr. David Perlmutter has a new book. He’s doing a lot of work to look at the nutritional aspect, and it’s just broadened from there.
But not a lot of people can afford a good doctor, a good therapist, mindfulness-based training because it’s very hard to ask somebody to do that on their own. People give up meditation very quickly because they don’t see an immediate benefit, so being able to work with someone on a consistent basis like that is good. Also, not everyone can afford to eat well. They either don’t have access or they just can’t afford good quality food, so there are a lot of things that make it difficult. And there are various reasons why people can’t or aren’t getting enough exercise; it might be a medical issue, so I think these things become a barrier of somebody being able to cultivate a tool.
And access to medications, that’s another big issue for some people. It depends on one’s level of healthcare coverage, and what the insurance is willing to authorize and what they’re not willing to authorize. If it’s a newer, better medication, oftentimes insurance still won’t cover it unless they failed a number of the other ones. They’re working harder and harder to create medications with less and less side effects and improve compliance, but if people are still experiencing side effects that’s one of the most common reasons for people to discontinue their medications, and understandably so.
R: What are the hopeful scenarios that patients can look for when they receive treatment through the Sutherland Center?
G: I think what the Sutherland Center does so well is education, such comprehensive education. Psychiatrists can do education during the course of an appointment, but a six week Seminar Series, it’s invaluable for many clients to help them understand their illness and understand how to treat it, to help them come to terms that they have the illness. When they look at the criteria and compare themselves to other people in the room, they begin to recognize that this is something that they have and that treatment can be very successful. What I always encourage people is that I’ve never seen anybody that we’ve not been able to successfully treat. The more difficult thing is to successfully maintain somebody. But even then, once they’re on a good treatment regimen, they stick with that consistently. The Sutherland Center, its big strength is on education, and I think psycho-education is so important.
R: So whether it’s education for the patient, or their family, or their friends…?
G: Absolutely. And that’s a lot of calls that I’ll get are from family members, “how do we best support them? What is it that we can do?”
R: And you end up telling them, “Go to the Seminar!”
G: Yeah. Or whatever education there is. But we don’t have the time. If I could spend six to eight weeks, two hours a week, so 16 hours…? I barely get 15 minutes to educate a patient in one appointment. And again that’s based on their financial resources. And I think that another nice thing about the Sutherland Center is that it makes it more accessible to more people. And probably people who need the most education, again because they have the limited resources.
R: So one of the ideas that I’ve had is to record those seminars and make them available online.
G: Yeah, that would be fantastic.
R: We would make them available and then the Foundation could get a little bit of a kickback from people who want to download the Seminars so we can raise some money for patient care.
G: Yeah, I think that’d be fantastic. And physicians! I think there’s a way to provide continuing medical education credits for physicians that would encourage physicians. Because I see bipolar stuff coming up all the time in continuing medical education, but oftentimes it’s on the pharmacological aspect of it. Many physicians aren’t comfortable treating it, because they don’t know enough about it. They don’t have enough expertise in treating it.
R: Well, thank you so much for meeting with me today, Gregg. And thank you for all the work you’ve done for the Foundation and for all the clients you’ve helped at the Center. We greatly appreciate you!
G: Thank you. I hope this was helpful.
R: Yes, I’m sure everyone who reads this article will glean a lot of information. Thank you so much!