Dee Higley is initially skeptical when he hears that Kennedy is managing without medication. "We really don't have good data for bipolars doing very well with just therapy, but we have a lot of data showing that medications work quite well," Higley said.
But he takes a step back when he learns of Kennedy's rigorous regimen. Therapy often works for some patients and not for others, Higley said, because some go home and internalize what they learn, hard wiring it into the brain, while others set it aside until the next session.
"Attending a group daily is like practicing the same things he was learning in therapy," Higley said. "If you go to someplace where you are reminded every day of what you have learned, its like therapy every day and you are much more successful." In short, Kennedy may be defying the odds through strong social support and his own hard work and determination.
If so, we have come full circle. "It's chemistry, not character," Kennedy had said in our conversation.
But it's not just chemistry. There is no pharmaceutical silver bullet. And experts are clear that environment will always play a potent role — harmful triggers for failure and social support for recovery. And Kennedy's own experience suggests that personal factors also carry weight.
With so many crosscutting variables, it's no surprise that this "last frontier" of medicine and policy remains maddeningly elusive.
"If Kennedy and Insel are right," Higley said, "this last frontier may be like President Kennedy's visionary race to the moon, but in this case repairing the brain is not a race or a dream, but combined effort of many disciplines and perhaps much harder work than any moonshot."
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