On the Mic with Mike #10: Dr. Erin Michalak addresses the stigma of mental illness

Dr. Mike Strong: Well welcome to this edition of On the Mic with Mike. Today we're here on the beautiful campus of University of British Columbia. We'll be talking with Erin Michalak, a professor here who was actually one of the Gold Leaf Award winners at the CIHR awards this past spring. Erin does some fascinating research, which we are going to give an opportunity to hear about very shortly.

Now, as you remember, these episodes are really designed for us to have a little bit of a conversation with investigators across this country, get a bit of a sense for what makes them tick, why they're doing this in the first place, how they got here, and maybe where they see where things are going. So come on and join me. We're about to have a great conversation.

On this episode of On the Mic with Mike, Erin, thank you very much for joining us.

Dr. Erin Michalak: My pleasure.

Dr. Strong: As I said, we're here at the University of British Columbia today where you’re a professor.

Dr. Michalak: Isn’t it beautiful? What a lovely campus on a day like this.

Dr. Strong: It's gorgeous. I don't know how much people can see the scenery we've got behind us, but it's amazing. How do you do this? How do you work here?

Dr. Michalak: I think it helps actually with a view like this. And also we can walk during the daytime and we do some walking in the scenery as well.

Dr. Strong: So listen - this is all about exploring your history and your career and such. Can you tell us a little bit about what you do?

Dr. Michalak: Yeah. So I was thinking about it today. I think we're at 15 years since we set up our team, which is called the Collaborative RESearch Team, to study psychosocial issues and bipolar disorder. It was set up provincially here in Vancouver quite some time ago now. I was looking back thinking that a lot has changed since that time. We were a small, provincially focused team designed really to do two things.

First of all, it was to help improve health and quality of life for people who are living with a condition called bipolar disorder. And, just as important, we wanted to create a new way of doing research hand in hand with people with bipolar disorder specifically.

Dr. Strong: So there's a lot of discussion right now about working with people. It seems like this is new concept of patient centred research. But somebody got that wrong before.

Dr. Michalak: Well, actually, a lot of people have been at that for a long time, I think. Language changes the way that we describe different orientations to research changes. Actually if you look back historically, people in research has been done for a long time in participatory medicine, participatory action research, and what we would call community-based work. So there's a long legacy and history of working with communities and working with people with life experiences to shape research. So patient orientated research isn't new per se, but I think we're doing it more thoroughly and more thoughtfully now than we have in the past.

Dr. Strong: How so?

Dr. Michalak: Well, we have a lot more funding that acknowledges the importance of doing research and knowledge translation hand in hand with the people who live with health conditions – which seems like a bit of a no-brainer, doesn’t it?

But of course, as you know, there's a huge impact of funding agencies, of people who support the process of research that prioritizes that piece and creates systems and structures so that that research happens. So that's prioritized with funding. So it's increasingly hard to get research funded now without explicitly explaining how people who are impacted by health conditions and health research will be involved in either thinking about the research that should be done, doing it, or at least moving the results of it into action.

Dr. Strong: So we can't be Canadian and not be aware of a lot of what's happening on mental health here in Vancouver, right, and your research and what's been driving it. In the time of your career that you've been working on it, what's changed recently?

Dr. Michalak: Certainly we're talking about mental health more. That's clear to everybody. That's not Vancouver-centric - that's international. We're having conversations more, and really trying to address stigma and reduce negative public attitudes towards mental illness. This means to live with mental illness and how these conversations can be happening and be driven by major international initiatives.

But, you know, I think that we won't get there until there is really good data on some more discrete outcomes like: Are discrimination levels reducing for people with mental illness? Are the structures that we’re creating for society shaped to be as inclusive as possible? So, you know, I feel like it's important that we're talking more about mental health conditions and innovative treatments and those pieces are happening in research. But I also feel like we have a long, long way to go still.

Dr. Strong: You're the recipient of Gold Leaf award from CIHR. So congratulations on that.

Dr. Michalak: Thank you.

Dr. Strong: You made a really clear point about your team – and that this research is not just by you but by your whole team. Can you talk a little bit about that?

Dr. Michalak: The team is the essence of what we do. You know, I think I'm an okay researcher. I think I'm a decent researcher. I'm certainly kind of a jack of all trades that can use a lot of these lots of different methods, and have a fairly big picture orientation. But I think that, and I always downplay this, one of my skills as a researcher is to create environments and ways for people to work together so that they can do things differently and perhaps do more than they would be able to do individually.

That's really what we've been able to specialize at CREST-BD is to create a team of people that’s cross-disciplinary and not just made up of psychiatry or psychology or occupational therapy or social work or lived experience. It's the nexus – or sweet spot - between those types of expertise where we can really catalyze change and impact. And so it's a huge honour to get the Gold Leaf prize for patient engagement. It's just massive for us as a team.

But there are some points of awkwardness in that for me as an individual receiving it, because I really feel like I create I've helped create the space for that team to flourish. But I never view that work as my own or take ownership of that piece.

Dr. Strong: There is this concept of team researching and how that works. I was giving a talk a couple of years ago, and people were asking me about this sort of interdisciplinary team based research. I said at the time that I don't remember ever waking up one day and thinking that wish that I was on a team doing research. As scientists coming forward, we're often trained as individual entities. Then if we work in a team, it's kind of nice that it happened. But was there a time in your life when you realized that to achieve the goals that you wanted to in this, you would have to be working in a team, or was it natural for you?

Dr. Michalak: Yeah, you're absolutely right - because I think it's actually changing for more junior scientists and researchers. But when I grew up as a researcher, we got a very clear message which was around carving your individual piece of space by showing that you could do something in a way that was different from everybody else. It's highly competitive and we weren't culturing and supporting or promoting teams in the same way.

It’s different now in terms of funding. For a start, we fund teams. We recognize the value of teams and health research in a way that we didn't before. So that makes a huge difference. But I very clearly remember the point where I realized I needed a group of people to do this. I was interviewing a woman who I've worked with now for 15 years, and lives with bipolar disorder. We did a long interview about the factors that affected her quality of life. It was right at the beginning of my career. I remember being kind of terrified at the end of the interview. It was very, very clear to me that I could not do this well by myself. It would be ridiculous to try and do that, and it wouldn't be as effective or impactful as it needed to be.

So the team piece, or the interdisciplinary piece where we could use different scientific methods, was important. But it was absolutely crystal clear to me at that point that lived experience of health conditions had to be at the centre of that. Believe me, there have been so many times where we've started to get on track as researchers in the group. We’ve worked with community, and they're just really kind of learned what we're doing out of the water and said: “no, that's not going to work on the ground.” So we've saved so much time and effort and really pinpointed what we did so much better because that collaborative approach.

Dr. Strong: So getting into this field - how did it come about?

Dr. Michalak: It came about through a small piece of funding for the development of the team from the Michael Smith Foundation here in B.C. That started us off in 2005. Then shortly after that, CIHR was providing funding for knowledge translation teams. We secured three years of funding to grow from a provincial network into a national network, learn a lot as part of that process, and then really kind of embed that teamwork approach into more traditional kinds of operating grants.

Dr. Strong: So let’s go back even earlier than that. A lot of people that I talk to say that there's one day when they woke up as a teenager – and said: “yes – I want to be a researcher.”

Dr. Michalak: Oh – you mean me as a researcher?

Dr. Strong: This is a bug, right? So when did you get it?

Dr. Michalak: Oh - it is a bug, isn’t it?

I was headstrong as a teenager. I think that looking back now one of the reasons that research suits me so well is that it gives you a huge amount of latitude of control and space for creativity.

I don't know that I fell out of bed one morning and realized I was going to be a researcher.

I published my first paper as an undergraduate in Manchester, UK. I was about 20 or 22 at that point. So maybe it was always in the cards for me.

But, you know, I came to UBC for my first postdoc. Research for me just made sense for my personality style. I still at this point feel so privileged and lucky to have a career like this, because it gives me such latitude and ability to work with smart, creative, fun people. There is a huge amount of fun in this job.

Dr. Strong: There are so many people that I talk to - particularly young people - and they’re thinking about this career. They ask me what's in my career? I say: “I have the best career. I love it.” And they’re just like: “Right. Come on - nobody has that.” But it's true. So like if you had to give up this job tomorrow, you would absolutely regret losing some part of it. What would that be?

Dr. Michalak: The people - you know - the interactions with people. Yeah, I would miss that element.

At this stage of my career - sort of mid-career or late mid-career at this point depending on your measuring stick - it's getting to work with the trainees.

You know at one point I would have said that I was one of the people in the world specializing in studying quality of life with this condition - bipolar disorder.

Then a PhD student who was based in Australia at the time, Emma Morton, focused her entire PhD on that. She runs rings around me theoretically at this point. She's actually moved from Australia now to join us here at UBC and that is experience. That's the way it should be, right? You’re actually outflanked appropriately by your trainees coming through. And that ability at this stage of my career to work with those smart, younger scientists coming up is wonderful.

Dr. Strong: What's the future of that look like - the research program that you've got right now? You must have somewhat down the road goals.

Dr. Michalak: We did this years ago in that we had a consultation session with community called, “What if Erin’s hit by a bus?”.

It’s an important thing when you think about sustainability. We could all be hit by a bus any day. We need to think about different ways and methods for keeping the science going so that it's not dependent on one person or one voice. So at that point we changed the leadership out of the network so that there's another scientist or two other scientists, one of whom lives with bipolar disorder. I want to culture the trainees and the younger researchers in the group to take that baby on - take it to the next generation. I’m not precious about this - it's something that needs to be carried forward.

Dr. Strong: What do you think are the questions that they’ll be asking? What are the tools that you think they’ll have?

Dr. Michalak: Well a lot of what we're doing is in digital work now. I don't want to focus so much on digital health innovations. We don’t do it to disservice this or the importance of face-to-face, human-to-human interactions in mental health, which is incredibly powerful. But having said that, in a country like Canada, for example, where we can't get good services in real time to people across this huge swath of geography we have, it's really important for us to think about digital health, health interventions, and online interventions.

So a lot of our work has been in that area, and will continue and grow at pace. If we look at the innovations around machine learning and AI and our ability to provide good, safe, evidence-informed research, and treatments for people wherever they are at any time, the big part of what we always do will be in that space.

Dr. Strong: So there's a lot of discussion right now about first onset of psychosis versus bipolar and the differentiation of the two. Does your research touch on that?

Dr. Michalak: We do a lot of research on how to help people who are newly diagnosed absorb that diagnosis and access good treatments. You know, about a third of people with some types of bipolar disorder will have psychosis. A lot of people are misdiagnosed - and that's not the fault of clinicians or the fault of the people who are trying to describe their experiences. It's just that these are really tricky diagnoses to make.

So a lot of our work is actually around, regardless of whether your condition is going to end up being bipolar disorder or some other type of kind of psychosis-flavoured condition, much of what you are going to do to stay well is going to be similar. You are going to look at having good treatment interventions. You are going to address stigma. You are going to try and not internalize what society tells you about what it means to live with a mental health condition. You are going to look at your self-care strategies. Those ingredients are pretty similar.

Dr. Strong: I have to ask you – you have an interesting life outside of this science. It's something that's pretty fascinating when I do these interviews and talk to people. It’s this concept of figuring out a work-life balance so that this is a different kind of a life that we lead as researchers - but it's balanced off by other parts of our life. So tell us a little bit about that. What are your hobbies?

Dr. Michalak: It needs to be balanced off and - believe me - it isn't balanced all of the time.

We all go through periods I think as academics when it doesn't feel like you have balance. It’s when you can take a step back and you can come to the point where you can kind of catch your breath from whatever deadline you've been meeting, and reprioritizing your self-care activities at that point is vital. For me, it's funny. I used to try and drag myself to exercise classes, and mostly hated it. I would feel better afterwards. Any kind of organized exercise wasn't my thing. For me, it's about nature.

It's mushroom hunting season here in British Columbia right now. We breed dogs, and we're avid mushroom foragers. And so for me, my biggest self-care strategy at this time of the year is being out in the forest, looking for mushrooms, which has to be very slow and mindful, and walking the dogs at the same time. Getting some exercise is kind of a secondary gain.

Dr. Strong: So looking for mushrooms is one of those things in my life I've never done – or really understood. I know about truffles. Is that what we're talking about here or are we talking about other kinds of mushrooms?

Dr. Michalak: They have truffles in Washington. I don’t think we have them in British Columbia.

Dr. Strong: I have no idea.

Dr. Michalak: You know what a chanterelle looks like. That's a type of mushroom.

Dr. Strong: It's a big one, right?

Dr. Michalak: It's a golden one. You have probably eaten chanterelles. You have probably even been to restaurants where you have been eating foraged mushrooms.

Through the fall, we are only picking about 15 different types right now. There are some dangerous ones. So you have to do it quite slowly and learn what the dangerous ones look like. But yeah, foraging is a great way to sort of sustain yourself naturally as well – for free.

Dr. Strong: So when you're talking about hanging out with your dogs, we're not talking about some little Chihuahua wandering around behind you. We're talking about a dog like – well I shouldn't say that because people are not to be happy if I say Chihuahua… But this is a big dog!

Dr. Michalak: Chihuahuas are good dogs, too. They are diminutive dogs.

These are giant Schnauzers though. They are about 100 pounds each. They are a larger breed of dog. They are bred as guard dogs - but they are great with kids.

Dr. Strong: If I understand correctly, it may have been in our conversations earlier, these dogs are not bred regularly. So this is unique for you to be bringing them - or something along those lines.

Dr. Michalak: Well, you know, I met my first giant Schnauzer when I was a baby and grew up with one, I came here on my first postdoc to UBC on a plane with a Bengal cat and two giant Schnauzers in the whole of the plane. I've had them since I was a teenager. It was part of my choice of Canada. It’s a wonderful country to live in with animals.

Dr. Strong: OK - do you breed them competitively?

Dr. Michalak: No, we don’t. We breed every couple of years. It’s a huge endeavour. You're really tied to being around the house for three or four months to do it properly. So it can't be that frequent for us. And, you know, we breed for health, and we breed for great, great family dogs. It’s sheer pleasure.

Dr. Strong: So if you were watching this and you were thinking about a career in this science…

Dr. Michalak: … not dog breeding.

Dr. Strong: No - but it's the balance that goes along with all of this, right? If you had an opportunity where you were talking to a young person who was thinking about this - perhaps particularly a woman thinking about a career in science, and knowing that it can be challenging. You know that it's a tough career, but it has all of those rewards. What advice would you give to her - or to them?

Dr. Michalak: When I look back on my career, the things that have really made a difference during those tough times, which are going to happen were mentors - the people who were supporting me through those processes.

I have been blessed to have incredible mentors over the years who were different types of mentors for different things. Those were people that you could lean on during those times, and sound out for a piece of advice. I think that when we think about mentors, we often think about people who are much more senior than us. But actually it hasn't always been like that for me. Some of my best mentors have been very similar to me in terms of where they are in terms of their career trajectories. But having them as people to go to for support, advice, or you know, sessions where I just needed to talk, it was really just so critical and so helpful.

Dr. Strong: Excellent.

There is a question that I ask everybody at the end of these interviews. If you could go back and talk to anybody - I don't care what era or what time and what conversation - who would it be and why?

Dr. Michalak: Could I have a dinner party and invite a whole bunch of people to that – or do you want me to choose one person?

Dr. Strong: You could choose one person and then bring them to the dinner itself.

Dr. Michalak: I'm going to have dinner with two people. OK - one of them is going to be Stephen Fry. Have you heard of him? Writer-actor?

Dr. Strong: Yes.

Dr. Michalak: He lives with bipolar disorder, and he’s done a lot around mental health stigma. He is funny as anything – and would be fun to have at dinner.

Dr. Strong: I saw him at Niagara-on-the-Lake this summer.

Dr. Michalak: Oh – what was he doing?

Dr. Strong: It was a one-man play - and it was about Greek mythology.

Dr. Michalak: That sounds about right. Stephen Fry. Yeah, I would love to have him over. And who else I would invite to dinner? It would be my Polish grandfather. I think I am the last person carrying my name at this point - and sometimes I think he would be proud. I would love to know how he and Stephen Fry would get along. With grandpa being Polish, it would be an interesting dinner to have the two of them together. That is what I would do.

Dr. Strong: That's awesome. Erin, thank you so much for joining us. It’s been a great conversation, and I wish you the best of luck as you continue on. Hopefully we'll see you more of you at CIHR than just at the award ceremonies.

Dr. Michalak: Thank you.

Dr. Strong: Thank you for that - thank you.