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Dr Siddhartha Mukherjee discusses how mental health can go the cancer way

Dr Siddhartha Mukherjee, tousled hair, sneakers on feet, takes his jacket off, exposing his ikat shirt that he untucks. “I’m a very informal person. I forgot my socks today,” he says, breaking the ice (in a very cold hotel hall). On stage, he’s ready for the first lecture series by The Live Love Laugh Foundation. The author of The Emperor of All Maladies: A Biography of Cancer and The Gene: An Intimate History, he’s well-known as a scientist, oncologist and writer.

Last week, he was in the country to speak about how the progression in our understanding of cancer may help with how we destigmatise mental illness. His own family’s encounter with schizophrenia has made him acutely aware of his own and his two daughters’ predisposition to it, and also empathetic towards families that grapple with it. In this interview, he talks of how the discourse around it can be changed.

When TLLLF reached out to you, what was your reaction?

I did say why me, although I understood there were broad parallels between what happened in the world of cancer and what is going on in the world of mental health, in terms of how to take an illness that was previously unknown, stigmatised and hidden and bring it out in a very public conversation, and remove the nihilism, shame, and stigma.

How did the discourse around cancer change from one of misinformation of being a communicable disease to green-juice cures?

It went through multiple phases, but really a ground-swell of social and political forces, led very much by women, around diseases such as breast cancer, changed the focus of the conversation. One really can’t talk about the history of cancer without mentioning people like Mary Lasker or Rose Kushner, among others. And so that conversation began to change in the 1970s and 80s, leading to the so-called war on cancer. To some extent, this has tipped over in directions that I think can create problems — this whole idea that positivism is the way you cure cancer. It makes the idea that the reason you acquired the cancer was because of negativism, which is complete nonsense. Cancer is a genetic disease. It’s acquired by mutations in genes. So one has to be careful of the positivism and the green-juice culture, but the change in the conversation away from cancer as a locus of shame was in fact very important for the history of the disease.

Dr Siddhartha Mukherjee discusses how mental health can go the cancer way

Even today though, when a woman gets breast cancer, there is a sense of shame involved.

Absolutely, but I think all across the world, as we’ve understood cancer biologically...as a disease of genetic mutations caused by chemical substances or viruses or you can inherit these mutations. We’ve come a long way in changing the dialogue – not all the way.

Like cancer, do you think women have led the mental-health advocacy movement?

Particularly around depression — I do think there is a role that women have played. For instance, post-partum depression was never recognised as a disease. In fact, we still don’t understand its biology. The hormonal or neuro-hormonal effects that surround psychiatric diseases are often misunderstood. And there have been crucial roles in patient-advocates and physician-scientists trying to understand the effects and consequences of gender in mental health.

Is the stigma around a disease because we don’t know enough?

Certainly, the mystery deepens the stigma and the stigma deepens the mystery — it’s a vicious cycle. So understanding, unlocking the molecular mechanism is crucial. One of the jobs of science is to break that cycle and insert reason into it. Now, for instance, with diseases such as schizophrenia and depression, we’re increasingly finding out that there are strong genetic components and these interact with the environment. The analogy is that you require both: the gun and the trigger. These gene-environment interactions are one of the most poorly understood phenomena in health in general, and they’re extraordinarily poorly understood in mental health. But even thinking of gene-environment mechanisms as a framework is an advancement, and that also comes from cancer.

War is a metaphor used for cancer and in mental health. Why is it used so much?

There’s a historic and cultural use of the metaphor. Some people, me included, don’t find it particularly useful; others find themselves empowered by it. I usually let patients make the decision for themselves. One patient told me, ‘As a doctor, you’re the soldier; you go fight the war.’

Do you see mental-health experts holed up in their offices, or lending their voices to the movement?

I’m not an expert in mental health, although I’ve written about my own struggles with mental health and the struggles in my family. I think finding the right voices is crucial. Around the globe, mental health is in a major crisis. We’re setting up our children to have mental health problems, with the new world we’re creating. New forms or perhaps incipient or latent forms of mental illness are emerging rapidly. Social media has in fact amplified this by creating a kind of Greek chorus of normalisation against which you always see yourself. I think we need mental health professionals now more than anytime before. The arena that I’ve seen them most is around cancer care. We’ve certainly had the birth of psychiatric oncology and the melding of oncology and psychiatric practice. That’s been extremely helpful. It’s allowed patients to alleviate a lot of suffering.

How Dr Mukherjee marries art and science
  • As a collector of art and the husband of Sarah Sze, sculptor and installation artist, Dr Mukherjee is in a unique space. He also has an interest in scientific drawings. “I have been very interested in the history of diagrams. In fact, I collect them, and was recently in Rome looking at 14th and 15th Century diagrams,” he says. Diagrams, he feels, are ways to abstract the world, the cosmos. “I don’t know of a scientist who doesn’t bring pen to paper to make a diagram. Is that art? I don’t know,” he says. In fact, his new immuno-oncology company, Vor Biopharma, was indirectly born out of a drawing that he was making with his daughter, in Mexico.

Does a scientist need to be a survivor in order to write with empathy?

When you talk about survivorship and empathy, given the natural history of human illness, it’s impossible to think of a scientist who hasn’t gone through some form of suffering. The death of a parent, the death of a child, the loss of a loved one. I don’t think survivorship is the issue. The issue is finding one’s own history and centre — the empathy that emerges out of that experience. Not everyone writes about loss. Scientists write equally about wonder. I sit somewhere in the middle. Half my books are about loss and half about wonder. Some scientists choose one or the other.

You flit between the personal and the professional in your writing. Is that the key to successful science writing?

It is the key to my successful science writing. I don’t think there’s a key to any successful science writing. The range of books that have changed history, particularly for books that are about science, range from extremely personal like The Double Helix, to about the cosmos. There’s no particular formula. What’s interesting is if you take someone like Oliver Sacks. Oliver was full of wonder. His wonder usually surrounded other patients. He reinvented the Victorian form of the case history. To some extent I’ve taken quite an opposite approach. I don’t make as many case histories, except use myself as a case history. And ironically, all the empathy that came into Oliver’s work came from patients. The empathy from my work comes from me, from my experiences.

What do you feel about the way science is reported in the media?

In general science journalists do a very responsible job. it’s extremely tough to communicate science to an audience which wants to read about celebrity. They have a hard job to do. I still teach one class about writing about science in Columbia, and I’m always impressed by the efforts of the students to take really complex ideas, and focus on big ideas. Think about the things that are confronting the world as major problems: climate change, the spread of new diseases. They’re carrying a large burden and they’re as best a job as they can. We don’t have enough of them.


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Printable version | Jan 21, 2022 12:25:44 AM | https://www.thehindu.com/authors/parallels-between-mental-health-and-cancer-says-dr-siddhartha-mukherjee/article29489384.ece

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