67: A New Approach to Women's Mental Health with Prof Jayashri Kulkarni

Welcome to Dear Menopause podcast, where we discuss the menopause transition to help make everyday life a little easier for women. My name is Sonya Lovell and I am the host Dear Menopause the podcast. Today, i am delighted to have a return visitor Dear Menopause Jayashri Kulkarni. If you have been listening for a while, you may remember Professor from episode 22,. Way back in September of 2022, when she was my guest on what has proven to be the most downloaded episode to date. is a professor of psychiatry. She founded and directed one of Australia's largest psychiatric research groups. Women's mental health is a major area of Jayashree's research. We caught up with today to hear about the developments in women's mental health since we last talked. Enjoy listening in to Professor Kulkarni. , welcome back Dear Menopause. It's so wonderful to have you back on the show today.

Thanks for having me, sonya. I really appreciate the interest that you have.

You have been very busy since we last chatted. It is why I've got you back on the show now For anyone that is interested. We have recorded a previous episode with Professor Kulkarni which is very, very juicy. To this day is actually my most downloaded and, i truly believe, probably the most important episode that we've recorded. We'll link through to that in the show notes for anyone that's interested. Today specifically, we're here to talk about all the new work that you have been doing on this amazing new her mental health campaign. , why don't you actually give us a little bit of an intro for those that haven't listened to you before, and then tell us what you've been up to?

Thank you so much. The problem for you, sonja, will be to get me to stop talking, because I have so much that I want to get across to your listeners. Women's mental health has not received the individual attention that this big field deserves, if I could dare say. One of the positive things that came out of COVID was suddenly mental health became something that people were happy to talk about. But the bad thing that happened was that, in fact, covid and the lockdowns and all the bits and pieces adversely affected women's mental health much more than any other group. As a result of that, we've got huge numbers of women now experiencing depression, anxiety, post-traumatic stress disorder, eating disorders and alcohol and other addictions. It just underlines the fact that there really needs to be a rethink on how are we going to provide services and new treatment approaches that will help women. It's not good enough to keep on with a one size fits all and have no particular regard for the fact that there are several, several issues that women experience quite differently to men. Now, i'm not trying to have a who's suffering the most, that's not it But it actually is really critical, in this era of individualized and personalized medicine, that psychiatry needs to step up. One of the things that psychiatry can do is to look at women as a separate group, in fact experiencing even more than 50% of mental ill health in the whole mental health arena. So that's why we first of all launched Her Center Australia. Her Center is HER stands for Health, education and Research in Women's Mental Health. This is a Monash University Centre with collaborative partnerships with Alfred Health and Cabrini Health. We launched that in 2022, even though we've been doing the work for decades, this is a new flag to fly to consolidate the women's mental health research, education and services Now, because this is, well you know, it's not new to us in the field. It's not new to any woman who has experienced mental ill health, but we are noting that there's a lot of people who said, oh, i didn't know there was any difference between men experiencing depression or anxiety disorders and so on. So, in fact, we want this vehicle of Her Center Australia to be a bit of a beacon, to make that bold statement that women experience mental ill health differently and need special attention. And what the campaign is all about. Her mental health campaign is about actually trying to raise the issues to our politicians, to our bureaucrats, to our philanthropists and to anyone actually and to the general public, because many times I've seen women in my clinic and in the women's mental health hospital that we set up at Cabrini Health, and they've expressed surprise when I say well, you know, there are different things that impact on women's mental health. So that's the vehicle And, if I may, i'd like to talk about the differences and why women experience mental ill health differently.

Yes, please do please.

So I think the best thing to think about here is to take a holistic view. And women, more than anybody else, are really impacted by their environment and what's going on in their social world. And this is really evident in that when we look in early life of women, when they're girls and many women will tell us this retrospectively, looking back as a girl many, many people experienced as a girl terrible early life traumas And they include emotional traumas. That can be actual emotional abuse, or it can be emotional invalidation, where any of her feelings or thoughts are discounted, or actual sort of neglect and she's kind of raising herself. That's the emotional trauma, this physical trauma which is as it sounds, where there's corporal punishments and all sorts of humiliation attached to that And there's also horrendous sexual abuse, often hidden, and that causes enormous amounts of distress and shame and all sorts of things as the girl grows up. Girls' brains are much more sensitive to environmental traumas. Now we can rand and rave about why is that the case, but unfortunately, teleologically you can go back and think about the ancient sort of role of nurturing and having young, and so maybe it did help that women were much more inclined to be wary of what's going on in their environment because they were protecting their young and had to be aware of threats in their world. But whatever it is, girls' brains are much more sensitive to environmental stuff. So the girl who has emotional, physical, sexual traumas growing up is much more likely to have brain changes that then continue to perpetuate or precipitate mental ill health conditions. Now this is where I say a holistic approach for women is really important and necessary, because you've got to take into account what has happened longer term in this person's environment, what is happening right now and more recent traumas. So often we find that the girls with early life traumas have got brain changes that then lead them into difficulties with substance addictions or self-harm or choosing people who will then punish them further because they don't feel that they are worthy. That's a really important thing that we need self-worth. So for all these reasons and you can see the psychological term self-worth comes into it here but the bit that's missing usually in psychiatry, modern-day psychiatry, which drives me nuts is the lack of understanding of brain biology, the connections in the brain with what is going on in the external environmental world. So people say, oh, but you're a neurobiologist. So yeah, i am, and I'm a clinician and I'm actually very interested in anthropology, sociology, politics, the whole damn lot, because it all has an effect. So here's an example. Take the example I've seen many, many women in my clinic who have presented with this ridiculously named condition. I'm going to give you my frank opinion What we're here for? A ridiculous term, borderline personality disorder. Now, this is a term that is applied mainly to women and it's applied for the woman as a diagnostic term who presents with deliberate self-harm, often the adolescent who has deliberate self-harm, who has fluctuations, rapid fluctuations in her mood, kind of up then down, then up, and might have a whole range of other issues, like a bit of an eating disorder today and it's gone tomorrow, a bit of an addiction problem today and it's gone the next week, those sorts of things, chaotic lifestyle, and usually we'll get, you know, involved with emergency departments and so on, because of the deliberate self-harm. This is called borderline personality disorder and I really think this is a term that is appalling. Why? Because inherent in there is a blame of the person, blame of the victim. Why do I say victim? Because when we go back and we spend hours with these now women and talk about their girlhood, we discover to our horror that this is a woman who is actually a survivor of awful, awful stuff that happened way back in her early life. But the problem is that it has altered her brain chemistry, altered her brain circuitry, so that she has poor impulse control And there are fluctuations in mood that are biochemically created. And there's coping mechanisms that she's adopted that are not great. You know, deliberate self-harm is a coping mechanism. It's not great, but that's what she had to fall back on. Sometimes women will be very obsessional and keep everything terribly, terribly clean because it's a control. It's like she's got no control over this horrible environment that she was in, but she can keep things clean or she'll control her eating because she's got no other thing to control. So you can see that these are all coping mechanisms And I think we should stand back and applaud the women who, despite this awful, awful early beginning, had managed to get on with their lives, and many of them have, you know, against all odds, gone on to education, to jobs, to have families, to be successful but unhappy in themselves and have no or have poor self-esteem, and then, when stress comes along, we'll resort to the maladaptive coping styles. Their brain chemistry is altered because, as if you stress anybody continuously, and especially in youth, in young age, their brain hormones get screwed up in the sense of gee, that's a technical term, isn't it? What I'm talking about here is the stress hormone. Cortisol, which we know about, is a big mama of hormones in the brain, you know. It really does have a whole range of effects in a whole lot of different ways. It affects the gonadal hormones. It affects the other hormones downstream. So this is the young girl growing up who's going to have a whole range of different brain chemistry changes in different brain circuits because of what's happened to her. So this is what I mean by holistic. What happened to her back there, affects her brain now, affects her coping styles now, affects her quality of life now, and yet traditional psychiatry calls this a personality disorder. Well, you know, i just want to raise my hands and throw my hands up in horror when I hear stuff like that. So this is again where I think, if we focus on women's mental health, what we could do is actually say, hang on, wait a minute. This is actually a trauma disorder, because you know it's a longstanding trauma disorder And we can, then we can help this, this woman, using a trauma approach, and that means biologically, it means in psychotherapy, and it also means in making sure she's safe in her environment And politically. You know, that's what all the campaigns in a big, nationwide sense is about. So here's that's one of my, one of my soap boxes. I've got many soap boxes, but you know that's one, and that's why women's mental health needs its own agenda, its own recognition and its own resourcing. So that's one of the areas that we're working in And we've got some really interesting stuff coming out which is about a new, both, you know psychotherapeutic approach as well as a medication approach which combined, really do help a number of women who had been struggling with this dreadful label And if you listen they'll tell you. You know I really want help And I've done the positive things of X, y and Z, but I got treated really badly And I feel really stigmatized by this label. That's one thing. The second area that I've touched on is eating disorders, and we have just launched, as a part of her Centre, australia, there's a hub, the Lee Family Transformative Hub, for research into eating disorders, and this isn't yet. Let me climb up on my next soap box, which is basically that anorexia nervosa is one of the most severe forms, or is the most severe form, of eating disorder and affects about 65% women, thank you, wow. And there is a high morbidity. It can take years and years and years, decades of someone's life in terms of quality of life, and it also, soberingly, has a mortality. Young girls and women can die from this condition. And when I looked at my team and I looked at what is going on in the treatment of this condition, it has not shifted for the past 60 years. Oh gosh, i don't know myself when I was a registrar, when I was a first year registrar in psychiatry this is going back into ancient history now I'm pretty old But I noted that the sorts of treatments were very behavioral treatments which really were not hitting the mark at all. And now I look at the treatments and there's still psychotherapeutic treatments which might be good in some conditions and are also good as an adjunct. Everybody can do some good psychotherapeutic work And I'm not having a go at the people who are really laboring long and hard out there, who are doing good work, but they haven't been provided the treatment tools to understand. How is it? What is going on in the brain of this person? You can override a fundamental human drive or an animal drive which is to wait, to stay on the ground, do it Yeah. Do it. I mean the appetite is a hypothalamus which is a major part of the brain, or a controller in the brain, a central center effect. So how is it that this condition can And overdrive that Yeah. Overdrive that. I mean I tear my hair out sometimes when I look around at what advances have been made in the other fields. If we only look back at COVID again, remember when it first broke, the most people say, oh no, we can never have a vaccine because it has to be an mRNA vaccine. Well, guess what? Yeah, it happened. If you really want to move the field forward, you have to resource it, and you've got to resource. I think the bit that's missing in psychiatry is resource, the brain biology, part of it. Marry that with good psychotherapy, with humane services and treatments that offer these things in a very respectful and empowering way. But the X factor that's missing often is understanding the neuro or brain biology. And then women, surprise, surprise is different to men and we cannot just go well, okay, drug X worked beautifully in a 85 kilogram Caucasian male, so of course it's going to work beautifully in a 45 kilogram Asian female. No, it won't.

And of course, I would imagine then we've also got to factor in the different hormonal stages and phases that a woman will experience throughout her life as well.

Absolutely, and this is the work of the big amount of work. But why do something simple when you can take on a big challenge? But I am driven by what I see in the suffering in my clinic, in our hospital, which is a 30 bed women's mental health hospital in Cabrini Health, we're doing good work because we take a different approach. It's a holistic approach And it's a sit back and spend time, because I find so many times that the woman has the answers. Especially when I'm dealing with women who are in their midlife or older. You learn a thing or two and never be discounted. Or the person who's been through various hardships and the questions that are asked about well, how did you triumph over that? Not what the hell is wrong with you that you keep to do with self harm. It's a tipping over of the traditional model And this is why I think terms like borderline personality disorder should be relegated to the rubbish bin because they really don't help. And I've never in my clinic, where I see many, many, many women, i really haven't met somebody who's absolutely, you know, like oh, i love that label, what they want. What they'll often say is, if they don't absolutely just like the label, is I like the help that I can get, you know, but the help usually is not of a biological nature. So if you put that extra factor in, then I think you'd be getting somewhere, and if you redo the trauma work in terms of looking at that, that will be helpful as well.

But anyway, lots to do, lots and lots to do, but the great news is you are doing it, which is fantastic. So you've launched the her mental health campaign. You have some brilliant advocates that have come on board to support the campaign. Can you talk us through a little more around what that's going to look like in the future, what your hopes for that are?

So the campaign, as I said, is multi-pronged. It is about raising awareness at different levels. Look bluntly, we're also looking for funding for research, because we can't do any of this without funding, And funding of research in Australia is not anywhere like in the US, for example. So you know, we really are trying to boost the funding to get some projects happening in all the different areas as well. And also a big part of the awareness is to see if we can shift the dial in politicians' minds and legislators' minds and in our service designers so that the next round of new services that come up will be much more sensitive to women's needs. And we need to break that kind of old thinking that one size fits all. It's not just one size fits all, it's one masculine size fits all, And that's really sad for a number of women. And I would also like to put the plug in for bring back the brain in psychiatry alongside the very needed humanitarian ways of delivering services and also the empowering therapies. It's not one or the other. We never should get into a nature versus nurture argument here. The answer is it's all of the above. Just ask any woman who's experienced depression or something else. It is all of the above, And that's why our treatments should be all of the above.

Yeah, yeah, so, so true, And I love that you always come back to just ask the woman. You know one of the stories that you told in that, when I very first sat down and chatted with you in the episode that I'll link through to in the show notes, was you talked about your first experience of being, you know, in the early days of your career, being on the psych wards with. You know those awful, awful psych wards that we used to have. You know when the women that were in there and you know saying to the women, you know why do you think you're here? and they always said to you it's my hormones, doc, it's my hormones, and you know. You said they knew, they knew why they were there, the doctors weren't listening, but that they always knew.

Absolutely So. I think the way forward is with this kind of well, not kind of this holistic approach and empowerment and listening, and also neurobiology I do. I do the last point. I do stress that because I look at where we are in managing cancers breast cancer and other cancers. You know that is a great leap forward. From when I was a student. You know the sorts of thing going on there. Neurologists can cure strokes I've seen. You know that people come in with a dreadful stroke and they get the clot busted or extracted and they're out the next day. I mean, how amazing is that? Yeah, and the vaccine that we've just talked about. I mean there's all just movements that are forward. That didn't just happen because people sat around and tried to sort of support each other with with um, you know, talking therapies only, and then you know when you're in a family, they're always adjunctive and always helpful, but they can't, in some conditions, be the mainstay of treatment, and that's where I think we need to really, you know, get going with some of these things. But I think a woman-focused approach is only common sense when you look at how many people are struggling and suffering. Women are struggling and suffering And it COVID did take a toll in many of the domains. A lot of women lost their jobs if they're in casual workforce, and that's awful. A lot of women got lumbered with the homeschooling and also having to try and work from home, and you know. Then there was the sort of loss of networking. Many women really deal with their own issues by networking with their friends, their family and so on And all that came to a stop And that's, you know, had quite an adverse effect.

And, as a personal trainer, you know the fact that you know our ability to exercise was taken away from us as well. You know everybody knows that exercise, you know not just getting out for a walk, but you know exercise beyond that is so important for mental health, and you know that was taken away from us as well for periods of time. So, yeah, absolutely women really. You know everybody's mental health took a, took a knock, but women in particular. Yeah, jess, the last topic that I really wanted to cover off, because I think this is so exciting and and I'm so looking forward to this and I can't wait to be in Melbourne for this amazing event that you are putting on. So in October of this year, you are hosting the inaugural Asia Pacific Conference on women's mental health. Congratulations.

Yeah, well, we have to have together. There was a whole lot of work involved, but you know my team just look at me and go what we're doing this as well. But look, it's going to be. It's going to be, i think, really exciting And I'm so thrilled with the response that we're getting. But this is the other interesting thing. You know I've run women's mental health conference back in 2008. And it was trying to get blood out of a stone in terms of getting trying to get people interested in it. This time there's a different feel. So I think you out and really in the ether, out there, the message is getting across that women's mental health is different, deserves attention. So I'm getting interest from a lot of different communities of women who would like to come to the conference. It's going to be held in Melbourne. October 11, which is a Wednesday evening, will be the opening stuff. Then Thursday, friday, as the actual scientific and clinical, we're taking a different approach. It's going to be much more practical, hands on clinical, with consumer well, with the person who's got the lived experience of conditions, informing different panels and so on and so on, and being part of it all. But not so much. That's not so much the sterile kind of. Here's the latest on a rat brain study, which you know doesn't really it's. Of course it's important, but that doesn't translate into something that people can take away and go. Oh, i can do that.

Yeah, and I'm very excited because you have Dr Louise Newsom coming out from the UK, leading UK based GP in women's health, particularly menopause, so that's going to be fantastic to have her out in Australia for it, absolutely.

She's a powerhouse and she established, i think, 57 clinics in the UK.

Yeah, the balance app for the women that are familiar with the balance app, which has been an absolute game changer for so many women globally using that to track and manage their perimenopausal or menopausal symptoms.

Absolutely, and so Louise is going to be one of our keynote speakers. We have also Professor Prabha Chandra from Bangalore, or Bengaluru as it's called now, and she's a perinatal psychiatrist And we have all of our you know very interesting local work. So what this is? again, the reason for her center, australia, is because there are pockets of people beavering away doing good stuff and yet nobody else really hears about it. So this is another opportunity to bring people together. But we are trying a different model, a very much more informative but also practical approach to what am I going to do when I or a client of mine has depression? What can I do for her that is going to help her, or be different and actually tackle her issues? So it is a different model. We're going to just have one session in rather than breaking people up into groups, because, again, it's a holistic approach And so we thought that way. The camaraderie between women attending is also a significant part of it, and you can see it's a slightly different approach that we have, focusing on holistic approach for the conference delegates as well as for the actual topics and the content that we're presenting.

Fantastic. Well, you do. You've got a lot of work ahead of you, but it is very exciting And, as a huge advocate and campaign of women's health and particularly mental health as well, i am really excited and I'm absolutely delighted that you are putting this on And, as I said, i can't wait to be there in October in Melbourne.

Yeah, i'm looking forward to seeing you in person And again, thank you so much for your work because, as I said, it's so critical that the general community of everybody gets to know about women's mental health, and we can't do it without podcasts like yours, without other social media aspects being involved. It's not about just being just doing stuff in a lab somewhere. that's not going to get there.

No, that's right. We have to spread the word and make it as accessible as possible to as many people as possible. So that's amazing. Jessery, thank you so much for your time. It has been wonderful chatting to you. Was there anything that you wanted to leave us with before you go?

No, i think I've probably talked, and talked, and talked at you.

No, it's fabulous. That's what I get you on for it. It's me with. I just sit here and listen and spoke it all in and I know that you always bring so much goodness And, yeah, i appreciate everything that you're doing in the world of mental health. Thank you, thank you. Thank you for listening today. I am so grateful to have these conversations with incredible women and experts And I'm grateful that you chose to hit play on this episode of dare menopause. If you have a minute of time today, please leave a rating or a review. I would love to hear from you because you are my biggest driver for doing this work. If this chat went way too fast for you and you want more, head over to stellarwomencomau For the show notes and, while you're there, take my midlife quiz to see why it feels like midlife is messing with your head.