Every now and then you encounter a person who is really dedicated to changing the world for the better, and Dr Judy Kuriansky is one of them. Although “she is so famous” as somebody said about her, “in particular in the United States or even abroad”, she remains unassuming. She is always ready for a new adventure to help people –– whether by talking or listening to them, promoting mental health or disaster relief.
Q: Could you please tell us a little about yourself and why you are so committed?
I have a Ph.D. in clinical psychology from New York University. After graduate school I started to work with the New York State Psychiatric Institute on projects related to depression and schizophrenia, comparing the situation in England and the United States. I was the protégé of a team of very famous psychiatrists who were working on the evaluation of schizophrenia and depression. This was carried out by video-taping patients and comparing the outcomes. Our team became known for being great “value-adders”, so much so that Masters and Johnson from Saint Louis, who were the grandparents of sex therapy, visited my team at Columbia University in New York. They said that they wanted to do sex-therapy evaluation in the treatment of patients. This was in the early days and there was no actual field of study called sex therapy as yet. They asked the unit in which I was working to make some sort of evaluation protocol of the patients who were going through this new sex-therapy programme. That is how I got involved in the field of sex therapy even before it existed, beginning as a college graduate and as a protégé of the people who were carrying out this work for the first time. It was a kind of serendipity.
At that time, few people were talking and doing something about sex therapy. The first article I wrote was for Cosmopolitan magazine. It was about how women reach orgasm. I wrote about this subject because we were actually evaluating women who were going through group therapy in order to learn how to reach orgasm. It was quite unheard of! There was a ten-step programme where these women learned how to express their anger for what their mothers had taught them about sex, how to be assertive and how to ask their partners for what they wanted, etc. We evaluated the group therapy sessions and in this way I became involved in the whole field.
It was at this point that Cosmopolitan magazine asked me to write the article about the ways that women achieve orgasm. They actually asked me to write about five ways that women could reach orgasm. I wrote an article that started out with an academic approach and then moved into the public arena. They actually put the title of my article, which stated all the ways that women can have an orgasm, on the cover page. That was my first article about sexuality that progressed from the academic to the public sphere.
Some years passed during which I had other works published –– on toxic substance and drug abuse and many, many other things. I was then asked to testify before a committee in Washington about drug advertising on television. This is how academic issues can move into the public domain. Afterwards, I was asked to be on a TV show talking about TV advertising and the drugs. The producer told me: “You were so good on TV answering questions in a realistic way that people could understand”. He asked me about the subjects I was working on at Columbia University. I mentioned that we were doing research on sex. They then asked me to come on TV to talk about that subject! This is really how the transition happened. I did not set out to be a sex therapist or want to be on TV; it just turned out that way.
From those beginnings and from people I knew in the business, I became a feature reporter on TV news. I specialized in stories about anxiety, depression and some stories about sexuality. It was the time when Dr Ruth was broadcasting in the 1980s. She had a fifteen-minute radio show in New York on Sunday night. After I had appeared on WBTC-TV, the general manager of radio came up to me and said: “Would you like to do a nightly ring-in and call radio show?” I said OK … and that’s it! They hired me to be on the air from 9 p.m. to midnight every night from Monday to Friday. That was the beginning of my radio career that continued for the next twenty-two years!
I was on the air every week night, first at NBC and then on other radio stations. In the 1990s I went to Radio 100 on the FM network and the show was packed into a music context. It was called Lovefun because it was a show about love, sex and advice –– it was not just about depression, but more about how to solve your relationship problems. We used to have rock stars coming on the air to share their love advice. That show was phenomenally successful and is talked about to this day. Even last night somebody who now lives in Hong Kong came up to me saying: “I used to listen to you when I was 12 and it was the greatest experience. You taught me so much; it changed my life.” This is one experience among hundreds and it’s the same wherever I go! There are still lots of Lovefun listeners around.
The whole thing just blossomed and the show had huge audience ratings. At night you often get very low ratings on the radio; the radio station thought that it might reach 4% of the potential audience. Instead, we reached 12%! In some places we would achieve a 23% share! We were doing it out of the hottest radio station in New York. It was a music station, so kids would listen to it during the day and at night they would receive Lovefun. It was a very “cool” show because I had a co-host. While I was providing real advice, my very funny co-host was the disk-jockey. It was phenomenally successful.
At the same time, I was also working on TV stories during the day. I worked for many different TV stations. I did a show called “Money in Emotions” at the weekend. Many other things happened in the between. At the same time, I was still teaching at New York University and then I moved to Columbia teaching at the Graduate School –– where I am still located.
Then things evolved. When I was 8 years old I used to say that I wanted to do something for world peace. Through the American Psychological Association, I became involved with all sorts of organizations in my academic field. I was asked by the Representative for an organization accredited to the United Nations to become involved with the International Organization for Plaudit Psychology. In brief, for the last six years or so I have been doing many things in disaster risk reduction. It has been voluntary work because of my interest in the field. Disaster risk reduction means going to places where people are suffering from trauma and offering relief. For 9/11 I was working with the Red Cross, also during Hurricane Katrina, during the bombing in Israel, the earthquake in China, the Asian Tsunami –– so many of these events. This all became part of the body of work I was doing on international and global issues. Since then, at the UN every year I co-moderate or moderate forums and panels on global issues like “Human Rights” and “Climate Change”. This year it was about “Disarmament”. Alongside this, I am also involved in a continuing UN student journalist programme.
The second project I am working on is US Doctors for Africa (USDFA). It is similar to Médecins sans Frontières, but involves doctors from the United States. The founder, Ted Alemayhu who lives in Hawaii, asked me to be on the Board as the Social Director Sector. So I have developed a project to evaluate a programme for girl AIDS orphans in Lesotho, a very small country in the midst of Africa. This is a huge programme. We are working with the first lady in the country. It’s a multi-stakeholder project, which is very interesting and very rare because it involves the government, NGOs, civil society and a media group.
Q: Do you feel that mental health has not been taken into consideration in society as a whole, and especially during disasters?
Totally and absolutely! In fact, two years ago, when Dr Mary Weed was on the panel with me in Geneva for the disaster risk reduction management forum, the UN was working very diligently on inserting mental health into all of its statements being sent to all the UN agencies and to all the projects involving the UN.
Not enough attention is paid to mental health. Earlier, even health itself was not on the financial agenda. Fortunately, health was eventually included in many of these statements, but mental health was not. This situation was being debated in the meeting held two years ago.
There is now a huge a movement to do something about mental health. It has to do with funding and with awareness, compared to the present lack of funding and the lack of attention on the part of governments and people in power. That is an area where the organization I am working with –– the International Organization of Plaudit Psychology –– and other NGOs, as well as the committee on Mental Health at the UN, are really making an effort.
Q: Are there still a lot of stigmas around?
There is no question that this is the attitude that we still have towards these initiatives. First of all, we draw governments’ attention to all of the persons who might have some mental challenges, not even the extreme ones. We are talking about mild cases. This matters to governments because these are utilitarian losses. What happens because people have these disorders? Child care is neglected because mothers are disabled, which puts children’s health at risk. People stop working and therefore productivity goes down and the economy is affected. This is the argument we present to governments: anxiety and depression –– even on a small scale –– have an impact on the whole culture, the family structure and economics.
Q: Is it normal for a human being to suffer depression during his/her life?
Sadly, a huge number of people suffer from mild levels of depression. It is perfectly normal that people suffer acute states of anxiety or depression.
In the psychiatric nomenclature, there is a difference between an acute condition and a chronic condition. We really need to pay attention to these two types: acute and chronic. Chronic conditions last, as you would assume, for a long time. Acute conditions can be caused by some precipitating factor –– and may go away. When does this happen? It happens when people are faced with a crisis: they lose their job; their children leave home; they undergo hormonal changes, such as when women go through the menopause. All these kinds of things are cyclical. They can impact people for a period of time and then they go away. Chronic conditions require more attention, more health care.
Q: With the recent economic turmoil, has there been an increase in people falling into depression?
An economic crisis is a crisis that affects people personally and then filters downwards. They are not motivated, so they lose their jobs. That ends up affecting the family. The cycle goes downwards, downwards, downwards. When you think about it at the UN, there is the Economic and Social Council (ECOSOC) –– that is exactly what you are describing –– the economy affects the social situation and goes on to affect the personal situation. These days it is even worse because it’s global.
When the recession started, there was a lot of interest in what we call recession-proofing your relationships and recession-proofing your life –– just like affair-relation-proofing stops affairs from happening. The recession-proof relationships means not to be attached to their financial status affecting their personal self-worth, so that the portfolio and the money people make do not impact their self-esteem. What is the result? Domestic violence! An extreme outcome of the economic crisis has been an increase in domestic violence across the board, especially in developing countries. Even in developed countries people become aggressive. They become withdrawn from their relationships. Some of the people who live in very disadvantaged areas have been honest about observing that domestic violence is rising, especially affecting men in cultures where it has been traditionally the man’s role to support the family. Men have become unemployed, while women have been able to obtain jobs in various small ways and become the breadwinners of the family. The men become angry as their egos are impacted leading to a tremendous increase in domestic violence.
Q: What do you see as a solution?
The solution has to be on various levels, because all of these factors are interdependent and multi-faceted; the solution has to be multi-factorial too. You have the micro-cosmos in their personal environment; then you have the community environment; the wider the social circle; then the government; and then you have the global arena. It’s a set of inter-related circles and the solutions are found on all levels. You cannot simply impact on one level.
Q: People coming from different cultures sometimes have difficulties in accepting that they have a problem and therefore may be reluctant to seek help.
This is definitely a world-wide issue. In the United States the taboos about mental health have been broken. People are proud to say that they go to a therapist and to demonstrate that this is the way they work upon themselves. People like to talk about it.
I was in Sri Lanka just after the Tsunami. There was only one psychiatrist there. At that level, it is important that experts train the local people to intervene on a very simple level. You do not approach people in the way as in the United States. You conduct simple group therapies that help people to relax, to feel safe, to reduce stress and to increase resilience that boosts self-esteem and builds communities. By conducting these simple interventions, you are then able to identify the ones who may be more at risk. You can then talk to those people without labelling them. It’s a gentle process.
Q: Do you think that there should be more psychiatrists and mental health experts in emergencies and humanitarian assistance?
It is not well organized and it should be better organized on a larger scale. There was a group that came up with guidelines for mental health interventions within the UN system. What you are saying is again extremely relevant because, if you look at Maslow’s hierarchy of needs and the way he positions people’s lives, at the bottom is simple survival. Talking about making people happy or making them smile when they have lost their homes and their food supply is irrelevant. What concerns people in a crisis is shelter, food and mourning the people and the things they have lost. So, when you intervene, these are the things that you work on, rather than trying to make people happy.
Traditional kinds of interventions encourage people to talk about their feelings, and this helps them to recover. This is not necessarily the true outcome you are looking for, but rather group discussions to help people express themselves. Do they want to rebuild community connections among people? This is why group therapies, especially for children, are very helpful. From this, you will be able to determine the need for mental health. There is a broad need for mental health, community building and personal resilience. You can identify another group of people who need slightly more intervention, and then an even smaller number of people who are truly stressed and who were probably already suffering beforehand. They had simply not been identified.
Q: You say that the people were stressed beforehand. Does this always concern a certain percentage of the population?
You need to assess country by country, but there is no question that there are different kinds of psychiatric and psychological disorders that exist in all cultures. It may not necessarily be the same symptoms everywhere; at the same time, there are common symptomlogies. There is an international classification of diseases that is a global way of looking at disorders, and not only health disorders. People with diabetes have common symptons; people who have heart problems have common symptoms; people with psychiatric disorders have common symptoms. They sometimes show themselves in different places culturally, but –– yes –– there are a certain number of people in each culture who have disorders like schizophrenia and others who have mood disorders.
In certain countries they do not recognize these disorders and they label these people in different ways –– for instance, calling them witches or gurus. Why would they even think about the Western model and treat them differently? In some cultures, there is a tremendous diversity between the way mental disorders –– as we use this word –– are first perceived and secondly approached. I will give you an example. When I was in Nepal, I observed a “shaman” speaking in Nepalese. People would come into the room and she would perform certain divinations to them. That was a way of clearing the negative energy that would be impacting the spirit who might make her scream or do odd things. In the United States of America, we would call that behaviour “schizophrenic”.
Q: What about mental diseases linked to immigration and integration?
This is an extremely important issue for the entire mental health community because of globalization. There is no doubt that in the last ten years many people have been constantly uprooted. They have done it either as a family and that disconnects them, creating tensions within the microcosm of the family. The wife might feel disconnected from her immediate family or an individual may be completely uprooted from his/her whole culture. This has tremendous repercussions for the new culture and the old culture from which they were uprooted. There are different physiologists and related mental health workers from different areas who are specializing in this field.
Q: Diva’s readers are often diplomats spending a couple of years here and a couple of years there. What kind of advice would you give them?
I use what I call the “reassure model” for these situations. The reassure module refers to an intervention in a very simple non-invasive manner when people are suffering distress like that. The most important thing is to reassure these people that what they are going through is real. It sounds so simplistic, but it is true just to say: “Yes, you know what, you up-rooted yourself from your culture, your family and you are in a new environment. It’s normal that you are going to experience anxiety, depression and frustration, but you may also be very happy and excited to be involved in something new. This other side is also valid, real, acceptable … so expect it to happen.” That alone gives reassurance to people that everything is O.K. A major thing that people want to express is: “I have this feeling; I’m depressed and anxious; what am I doing here?” Etc. You are experiencing a million different things. When you say to them that this is exactly what you would expect in this situation, people realize that they are not crazy. There are different levels and you can dig deeper and deeper into this.
Leaving Dr Judy after having stayed much longer than initially intended, one realizes that although mental health might be overlooked, it is just as important as all the other factors …
