A Conversation With Dr. Michelle Furuta

“Mental illness is the number one cause of disability worldwide”. You will find this lesser-known fact on the website of Dr. Michelle Furuta, a practicing psychiatrist located in Torrance, CA. Changing Tides was first introduced to Dr. Furuta when she spoke in May of this year at the inaugural Changing Tides event. With shocking statistics such as these, she brought awareness to the harsh gravity of the current state of mental illness/mental health. 

Growing up in a household where multiple family members struggled with undiagnosed mental illnesses, Dr. Furuta had a personal connection to mental illness/mental health from an early age. Coming from a family of artists, she began to study art in college. Her path turned to psychology when she transferred to UC Berkeley, where she would earn her first degree. Influenced by the positive impact of modern medicine on her own family’s mental health, she continued on to medical school at UCLA in order to become a psychiatrist.

Now with children of her own, Dr. Furuta has become a strong advocate for the voices of youth in mental health. “I feel like young people don’t have a voice and information is often passed one directionally like, ‘This is what you need to do’ or ‘You just need to change your attitude’. With mental health, as you’re trying to learn how to navigate your unique life, it really doesn’t work like that” says Dr. Furuta. In line with her vision of creating bidirectional conversations on mental illness/mental health between youth and adults. Changing Tides sat down for an interview with Dr. Furuta to learn more about what she had to say.

What are the differences between psychiatrists, psychologists, and therapists?

That’s a great question. Mental health treatment at different levels of providers is so confusing. A psychiatrist is a medical doctor (MD or DO degree), meaning that you have to go to medical school for 4 years and then do 4-years of residency training in psychiatry. This includes a one year internship in an academic hospital where part of your training is in multiple other medical fields such as Internal Medicine, Pediatrics, Neurology, and Emergency Medicine. As a medical student, prior to residency you also do rotations in all the major medical specialties including things like Obstetrics and Surgery. So psychiatrists have been exposed to all of it. During a psychiatry residency you’re honing in more and more on the complex biological and psychosocial aspects surrounding psychopathology and learning a variety of treatment interventions including psychotherapy, neuromodulation, and medications.

Psychologists have a doctorate - a Ph.D or a Psy.D in psychology - meaning they go to graduate school with a focus on emotional and behavioral health and they do a dissertation as a major component of their education. The length of the process can vary but is typically 4-6 years. They are not medically trained and cannot prescribe medications. 

There are also social workers and marriage and family therapists. They commonly have master’s degrees (MSW, MFT) which are 2 year programs after completing an undergraduate degree. 

Psychiatrists, psychologists, social workers, and marriage and family therapists all provide psychotherapy and are commonly and interchangably referred to as “therapists”. It should be noted, however that there are many types of psychotherapy, and experience with different modalities can vary greatly between providers.

Out of curiosity, is it more common for a primary care doctor to recommend a patient first see a psychiatrist, or to first see a psychologist or therapist?

I’m not sure; this would be a better question for a primary care doctor, but my guess is that it would be psychiatry as medical specialists tend to refer to other medical specialists. For example, I would refer someone with a musculoskeletal issue to an orthopedist for an evaluation before I referred them to physical therapy. What I can tell you is that I have had cases where primary care doctors were the first point of contact for a patient with a psychiatric problem, and they accurately diagnosed the problem and initiated treatment. This can be a huge help for many people to get started with mental health treatment, especially in areas where there are shortages of psychiatrists. However, sometimes patients won’t be referred on to psychiatry after treatment is initiated and they can end up on a poorly optimized or indefinite regimen if there is a partial response and this is misperceived by both patient and doctor as being as good as it gets. Primary care doctors have some training in psychiatry, but it’s about as much training as psychiatrists have in primary care.  Most people would not feel comfortable with their psychiatrist managing their hypertension, so it is a bit odd that many people feel comfortable with their primary care doctor managing their depression. I suspect that the stigma of going to see a psychiatrist is still an obstacle for many people – or the feeling that if you need to go see a psychiatrist your illness is more severe, which is not necessarily true. Seeing a specialist tends to optimize your diagnosis, treatment, and recovery regardless of severity.

It seems to me like a mental illness can really be a controlling factor over your life if you don’t address it early on.

Yes it can be.  OCD or anxiety disorders are good examples of that. Sometimes people will dysfunctionally adapt to their anxiety. They will modify their lifestyle, change their sleeping habits, change what they do, how they work, the relationships that they have, etc. Their entire life starts to warp around the anxiety in a desperate attempt to accommodate it, and then you treat the anxiety and it’s like Oh my gosh. Now what? Your whole life can change.

For someone who either doesn’t realize that they’ve had experiences with mental health or mental illness, or who don’t feel educated on the topics, how do they remain a supporter and an advocate for a friend or for someone who is dealing with a mental illness?

It’s so tricky. The art of being able to listen to somebody is something that professional therapists work on for years to be able to do. As a lay person, sometimes just showing up for somebody and being present - not even talking about it - is a huge deal. If you don’t know what else to do, just be there and try not to dismiss the problem, make it go away, or belittle it.  You don’t have to be a cheerleader -  “Let’s just be happy! I’m going to cheer you up!” - is not always what people need, and can sometimes make people feel worse. Meeting someone where they’re at and being willing to be present for them is huge. It’s uncomfortable sometimes because you’re going to be sharing a little bit in their experience and that’s hard. Being able to do that, but also knowing your own limits and not getting too enmeshed or overly involved (like making their problems your problems) is a finely honed skill. I think getting familiar with resources and what’s available to patients and families, and being willing to decrease the stigma of mental illness in your own mind in whatever way you can, is also helpful.

I think you definitely hit it when you said that a lot people’s initial response is to try to respond by cheering somebody up and trying to make them happy again right away.

That can be helpful when it is kind of a minor thing. Say you failed a test, you got rejected by someone you were interested in, or you didn’t get the job that you wanted. Those are kinds of bummer life things that you want to forget about and get on with your life.  Having your friends show that they care about you and remind you that it’s going to be okay can be really nice and helpful in those times. But, when it comes to depression or anxiety - things that aren’t going to go away quickly no matter what happens - that kind of response can come across as really invalidating.

I think it’s such a multifaceted issue. Even while trying to help someone with their mental issues, you have to always keep your own mental health in mind.

There’s this psychiatrist named Dan Siegel who is amazing and he said it perfectly. He said, “Serve--don’t save.” So you’re not there to save somebody, you’re there to serve them and serving requires knowing how to be helpful, which is totally an art. The other interesting thing which kind of touches on what we’re talking about is the length of time it takes on average from the onset of symptoms to the engagement of treatment. It takes about 9 years. So when you’re talking about how most mental illnesses will have onsets before age 24, you’re talking about a lot of kids who are going for years without any support or any treatment. It makes me realize how relevant this conversation is about supporting your peers because so many young people go for so long with only their peers to support them.

So how do you know when you should go see somebody?

Generally speaking, most people have kind of a range of what feels normal emotionally. So any persistent change from your baseline state that is causing significant distress, suffering, or functional impairments, should alert you to seek help. For kids, this can be tough though because when you’ve been living with a chronic anxiety disorder or chronic depression since you were like five or six, that is always going to feel like your normal. So if you don’t know what your baseline is, and you’re having frank symptoms such as persistent, uncontrollable worry, racing thoughts, feelings of low self worth, not wanting to live, urges to harm yourself, lack of enjoyment in pleasurable activities, or even physical symptoms such as chronic stomach upset, headaches, or muscle pain, then it’s time to check in with somebody. If your symptoms start impacting your schoolwork, your friendships, or your home life, then it’s definitely time to go.

What do you imagine a healthy conversation about mental health would look like?

Oh gosh. I don’t know. I have dreams about this. Being able to have groups where kids can have bidirectional conversations with older generations, where people can validate where other people are coming from. It goes both ways. It’s about youth being able to talk about what their experiences are like and parents being able to talk about their worries and fears and problems too. A lot of parents feel like they have to keep it invisible. They feel they can’t ever tell their child about their mental health issues because they might actually cause them to have a mental health problem! It doesn’t work like that. They share your genes! So if they also develop a mental health issue, that’s probably why. It’s not because its contagious; it’s already there. Openly discussing mental health issues in a safe environment with accurate information typically leads to a deeper understanding of the problem, an opportunity to work through it together, and a more intimate, compassionate relationship. So even if you are living with a chronic mental illness, having a healthy conversation about it with important people in your life can improve your well being. Organizations such as NAMI and DBSA can be really helpful for this.

Is there anything you know now that you wish you knew when you were younger?

That’s such a good question and so hard to answer. One of the biggest things I’ve learned is that there are always options, even though you might not be able to see what they are in that moment. Often times when I was younger I would come to these points where I was desperate, like there was no hope and there was no way it was going to get better. There are always options, it’s just sometimes you can’t see them. So learning to be patient, asking for help, and not giving too much credit to one source for a solution but rather taking ownership of life’s problems myself and working them through over time is something that I wish I had known how to do better. But I think in some ways that’s just a product of growing up. There can be worries about failure or just giving up at a time when your life is just getting going. So you can feel like your life is failing but it’s going to keep going regardless and it gets better if you hang in there, be kind to yourself, and keep working at it.

If you or anyone you know are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting TALK to 741-741.