The Advocate Gala: Taking Off the Mask, Featuring Keynote Speaker Dr. Abdul El-Sayed

A Conversation With Dr. Abdul El Sayed

Advocacy for the concerns of ordinary people is a theme that runs throughout the college and professional career of Dr. Abdul El Sayed. Physician, epidemiologist, public health expert and activist, Dr. El Sayed is now a resident fellow at the University of Chicago’s Institute of Politics and will be the keynote speaker at NAMI Washtenaw’s Advocacy Gala on Feb. 21, 2020. He was recently interviewed by NAMI volunteer Lois Maharg.

LM: Recently you served as executive director of the Detroit Health Department but you left that position to run for Governor of the State of Michigan. Why?

AES: I never intended to run for office. One doesn’t go to med school and get a PhD in public health to run for office. But I realized that if we weren’t able to advocate for the best interests of people in the political arena to shape the values and ideals that government institutions like the one I was running work through and engage with, then we’d never be able to really take on the biggest issues that keep people sick. That’s why I decided to run.

LM: What are some of those big issues you’re talking about that keep people sick?

AES: One of the themes I hope to talk about in my talk on the 21st is that we live in a society that atomizes us and that tells us . . . that the things that happen to us and the things we do are just a function of our own choices. And that does a couple of disservices. No. 1, [it hides the fact that] truly, fundamentally, we are social creatures. We need each other to experience the full joy and meaning of life. Second, when bad things do happen to us, we assume that they’re of our own making rather than that they’re simply consequences and circumstances of living a life. Then we’re cut away from the people who can help us make sense of those things and the relationships that matter most. We need to invest in social infrastructure. . . . Social infrastructure is about creating spaces where people naturally come together, public places that allow you to share interactions that you might have missed if you didn’t have them. 

LM: You’re a strong advocate for universal health care. How do you see care for mental health conditions fitting into that picture?

AES: As far as I’m concerned, the most important organ in the body is the brain. Insofar as we’re suffering illness in the brain, the rest of the person cannot be healthy. I think we’ve seen this systematic undercutting of mental health and mental illnesses as being as important [as physical health and illness] simply because we don’t understand them as well. . . . We haven’t invested in the research to understand them. One of the things that’s so critical about universal healthcare . . . is that it truly does make the bottom line our well-being, which implicitly raises the value of mental illness in the eyes of the system.

LM: How did you become aware of the problem of mental illness and the inadequacy of our current health system to fully address it?

AES: My wife’s a psychiatrist, and we talk about the fact that a lot of folks don’t do psychiatry because it’s not as well recompensed as other practices simply because it’s undervalued in the system. But we also know that 15% of Americans in their lifetime will suffer a serious mental illness, which makes it the leading cause of disability in the country. Our country has [recently] suffered declines in life expectancy, and those were largely attributable to death by suicide and to overdose on either opioids or alcohol. That tells us that the dominant feature of illness in America is mental illness. We need a system that recognizes that.

LM: Mental health conditions are often stigmatized and people experiencing symptoms may try to hide them and not reach out for help. How can we address the problem of stigma?

AES: First, everybody is somebody’s loved one. In our atomized society, we create an artificial barrier between my loved one and somebody else’s loved one. We’ve got to extend that love for the people we care most about outward, because everybody is somebody’s loved one. It takes a level of empathy to appreciate that you can’t shut out somebody else’s experience just because it’s different from yours.

Second, we don’t stigmatize people for having cancer or for falling and breaking a leg. We recognize that these things happen to humans, and in the same way, mental illness happens to humans. It is out of respect for the human condition that . . . we’ve got to create a society where there are no barriers to care for people with mental illness.

Lastly, frankly, we have made the experience of mental illness worse because we have not built an adequate mental health infrastructure to make sure people get their treatment. We have criminalized mental illness in a lot of ways: 20% of people in our jail system are people with diagnosed mental illness because we don’t have a system to treat them. We don’t have a housing system in our country that makes sure that people can be housed and have a stable base from which to operate. All of those things exacerbate the experience of mental illness. We’ve got a real responsibility to build a system that empowers people suffering in this way, which would go a long way toward destigmatizing serious mental illness in our society.

LM: You’ve made a series of podcasts called “America Dissected.” In them, you have people sharing their personal stories of health problems and experts speaking objectively. Along the way you offer commentary and advocate for change. Why did you choose this particular format?

AES: We’re so focused on empiric arguments that sometimes we forget the story is the most powerful thing. I think it’s critical to share stories and then to leverage those stories to make a broader, scientific, evidence-based argument. That’s the tool we try to employ in the podcasts. Also, what I try to do in my own advocacy is to share a story that captures a broader trend that is empirically rigorous and true. 

LM: What changes would you like to see in the way our society addresses mental health concerns?

AES: We need to invest in mental health infrastructure. We are woefully behind as a society. . . . We need to eliminate any barriers to care that exist in our current system. We leave people without access to mental health care even when they have access to physical health care. We need to have broader conversations about substance use and about the consequences of opioids and also things that are legal, like alcohol. But we need to take a much more harm reduction-based approach and realize that addiction is not a moral failure — it’s a disease and needs to be treated as such.

LM: What should we expect of our leaders by way of helping improve the country’s overall mental health?

AES: We need our public officials to lead from the front on destigmatizing mental illness and having open, honest conversations about suffering and the suffering it causes in our society. I think that elected officials in a democratic society are more than just policy makers. They’re also people who symbolize who we are and who we want to be. In a society where 15% of the people are going to suffer a diagnosable mental illness, it’s really critical for our elected officials to be leaders on this issue rather than just follow.

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