Latest / psychophobia* podcast / Episode 01: Self-Stigma - When the Diagnosis Becomes the Prison

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Episode 01: Self-Stigma - When the Diagnosis Becomes the Prison · psychophobia* podcast

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What if the institutions designed to help us understand the
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human psyche are
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SPEAKER_01: actually afraid of them?
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Hosted by Dr.
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Michael Montgomery,
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this podcast explores the uncomfortable questions.
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Together we'll examine how the mental health systems meant to
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heal us instead
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SPEAKER_01: perpetuate cycles of dependency.
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SPEAKER_01: Welcome to the Psychophobia Podcast.
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SPEAKER_02: I'm really,
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really excited and very grateful that you decided to come on
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the Psychophobia
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SPEAKER_02: Podcast.
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SPEAKER_00: Of course, any excuse for a good chat.
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SPEAKER_02: Yeah, the format is basically, we just jump straight in.
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So I don't really introduce you yet because I like just to get
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stuck right into it.
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SPEAKER_02: Okay.
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SPEAKER_02: Sounds good.
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SPEAKER_02: So with that said, what is this and what does it mean to you?
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SPEAKER_00: The DSM-5.
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SPEAKER_00: Yeah.
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That's a complicated,
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interesting thing to spring up on me right at the beginning.
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SPEAKER_02: I know.
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SPEAKER_00: When I see the DSL vibe, I do have a visceral reaction to it.
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SPEAKER_00: Of course, working in the field.
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SPEAKER_00: It is a manual that is treated like the Bible.
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SPEAKER_00: When in my perspective, it's really only one of many theories.
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And it's not as scientifically backed and as research backed as
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it should be.
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I take great offense to it being used as the beyond end all to
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describe human
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SPEAKER_00: distress and people's experiences.
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SPEAKER_00: However,
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I also don't want to negate for those people for whom they've
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found use or
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SPEAKER_00: helpfulness in a diagnosis they may have received using the DSM.
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SPEAKER_00: Because there are lots of people, maybe not necessarily psychosis.
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I haven't met anybody who's really embraced a diagnosis of
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psychosis yet in my time so far.
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SPEAKER_00: But I do know of others who maybe have embraced a diagnosis of bipolar,
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SPEAKER_00: for instance,
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SPEAKER_00: and see it in a positive light.
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So there are some people for whom it helps them to make sense
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of their experiences.
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SPEAKER_00: But I think the DSM,
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SPEAKER_00: especially in the American context,
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SPEAKER_00: becomes something much more problematic.
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Wow,
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you covered so much in such a short space of time and I put you
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right on the spot.
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SPEAKER_02: Yes, I did.
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SPEAKER_02: Yeah, where do you start with that?
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SPEAKER_02: I'm going to jump right in and say you used the word psychosis.
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SPEAKER_02: What does that mean?
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SPEAKER_00: Well, of course, I have to bring up psychosis.
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SPEAKER_00: So as the executive director of ISPSUS,
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the International Society for Psychological and Social
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Approaches to Psychosis,
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SPEAKER_00: US chapter,
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SPEAKER_00: of course,
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SPEAKER_00: a lot of my thinking centers around what is known as psychosis.
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So as somebody myself who's experienced psychosis,
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and I name it as psychosis,
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it is a state of mind where you have lost contact with
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so-called consensual reality
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and you may hear things or see things that are not there or
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have unusual or
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SPEAKER_00: problematic beliefs that others may not share.
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SPEAKER_00: So,
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SPEAKER_02: I would say,
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SPEAKER_02: in the spirit of psychophobia,
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some people might fall off their chair hearing you reveal that
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you experienced
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SPEAKER_02: psychosis.
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SPEAKER_00: Well, maybe.
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SPEAKER_00: I am quite open about it.
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So it would actually surprise me if people have been following
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my work or have
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SPEAKER_00: watched any of our webinars and they haven't mentioned it yet.
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SPEAKER_00: But yeah,
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SPEAKER_00: as a teenager,
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I experienced a whole lot of different mental health problems
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and symptoms.
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SPEAKER_00: And there was a period of my life where I was diagnosed with psychosis.
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SPEAKER_00: And that was probably the worst period of my life, to be frank.
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SPEAKER_02: So firstly, thank you for being so open.
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What I meant was people's prejudice around how someone with
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psychosis or having had
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SPEAKER_02: psychosis may look.
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Ah,
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now that's very interesting because now we're getting into the
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topic of stigma.
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SPEAKER_02: Yeah.
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SPEAKER_00: And that is something that I'm very interested in.
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In fact,
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my master's thesis was on the topic of stigma,
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specifically self-stigma.
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SPEAKER_00: So yeah, there are definitely misconceptions.
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I don't think so much so amongst maybe the groups that we're
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involved with,
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SPEAKER_00: but certainly the general public,
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they have a very fixed viewpoint on what somebody with
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psychosis might look like.
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SPEAKER_00: And I probably am not one of them.
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SPEAKER_02: So I'm so glad we're getting into this so quickly.
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SPEAKER_02: I see whatever those labels point to, I see them all on a spectrum.
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So I would see no difference in terms of admitting I'm
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struggling with what I might
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SPEAKER_02: label depression or psychosis,
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SPEAKER_02: right?
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SPEAKER_02: But society seems to have graded them.
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SPEAKER_02: in terms of potential levels of stigma.
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SPEAKER_02: I think a huge door that you opened towards recovery is being open,
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especially with people who understand and won't judge and won't
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label and will not
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SPEAKER_02: negate,
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which is unfortunately perhaps many of the things that people
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do experience when
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SPEAKER_02: they reach out for help.
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SPEAKER_00: Yeah, absolutely.
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So I'm going to guess that you chose to research stigma because
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perhaps you experienced some?
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SPEAKER_00: Well, there's two reasons to why I wanted to look at stigma.
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SPEAKER_00: One is that I was working in mental health services in the UK.
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SPEAKER_00: I was working in early intervention in psychosis teams.
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SPEAKER_00: And I have to admit,
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SPEAKER_00: I worked in an amazing team,
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SPEAKER_00: doing amazing work,
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and everybody had a very shared set of values that was very
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recovery focused,
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SPEAKER_00: very open-minded.
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SPEAKER_00: We ran hearing voices groups.
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We did so many different,
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wonderful,
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holistic approaches and treatments as part of that team.
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SPEAKER_00: However, stigma came to me, one, in what I saw my
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SPEAKER_00: patients,
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SPEAKER_00: the people I was working with,
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dealing with as they were trying to integrate their experiences
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into their life,
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trying to get work or dealing with what their family's
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perceptions was of what
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SPEAKER_00: helped them,
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SPEAKER_00: what happened to them,
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SPEAKER_00: sorry.
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SPEAKER_00: But on another side was the concept of self-stigma.
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SPEAKER_00: So I very much saw,
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SPEAKER_00: very clearly saw in those folks,
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SPEAKER_00: and in myself too,
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SPEAKER_00: when I was going through this,
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SPEAKER_00: the idea that when you're diagnosed with psychosis,
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there's a picture in your mind too of what your life is now
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going to look like.
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SPEAKER_00: So I think I'll use myself as an example, right?
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SPEAKER_00: So I'm half Asian.
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SPEAKER_00: My mom was Indonesian.
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SPEAKER_00: And Asian parents are very hard on their children.
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SPEAKER_00: They want their children to succeed, especially immigrant parents.
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SPEAKER_00: They want you to be a doctor, a nurse, or a lawyer.
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SPEAKER_00: And so at an early age,
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SPEAKER_00: it was on the cards that I was going to excel academically and get some
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SPEAKER_00: high-powered job.
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SPEAKER_00: When I started to struggle...
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SPEAKER_00: after a childhood full of different traumas,
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SPEAKER_00: and I was diagnosed with psychosis,
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SPEAKER_00: all of a sudden it seemed like,
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SPEAKER_00: well,
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SPEAKER_00: that future doesn't exist for me anymore.
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SPEAKER_00: So what am I going to do now?
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SPEAKER_00: And I recall very strongly,
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SPEAKER_00: this is a very strong memory for me,
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thinking I'm just going to work in a convenience store for the
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rest of my life.
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SPEAKER_00: And that's not something that I, it wasn't like giving up on myself.
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SPEAKER_00: I still believed in my own abilities,
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but I didn't think somebody diagnosed without somebody like me
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was capable of
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SPEAKER_00: achieving it.
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SPEAKER_00: And I was afraid that going down that path would cause me to relapse.
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SPEAKER_00: So I saw this in the people that I was working with,
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SPEAKER_00: that they'd come to this like existential crisis of,
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SPEAKER_00: even after maybe the initial acute symptoms had faded,
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either because maybe some people were a medication for other
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people that wasn't
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SPEAKER_00: part of their treatment plan,
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SPEAKER_00: they managed to break through and those symptoms died down.
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SPEAKER_00: But there was still this existential crisis of, well, what now?
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Because the life I thought I was going to have cannot exist now
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because now I'm a
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SPEAKER_00: psychotic,
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SPEAKER_00: now I'm a mental patient.
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SPEAKER_00: So that was why I wanted to approach stigma.
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SPEAKER_00: Because stigma, of course, is...
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Deeply problematic when it can stop you getting jobs or
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relationships and people
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SPEAKER_00: are actively rejecting you.
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SPEAKER_00: But I think that is the very obvious side of it.
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The other side of it is how it impacts us as people when we
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internalize it.
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SPEAKER_02: So nearly like self-stigma?
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SPEAKER_00: Yeah, self-stigma or internalized stigma.
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SPEAKER_00: Yeah.
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SPEAKER_02: Yeah, that's really, really powerful.
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So are you saying that your actual experience didn't make your
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capacity and your
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SPEAKER_02: future,
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it was the internalization of the label and everything that
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came with that created
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SPEAKER_02: the doubt?
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To make it as slow cut as that,
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because I think very rarely are these things black and white.
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There was certainly a time in my life where my quote-unquote
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psychotic experiences
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SPEAKER_00: were making my life difficult.
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SPEAKER_00: I was very paranoid,
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particularly about my family and doing some quite bizarre
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things like running into
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SPEAKER_00: the street at night because I was afraid of being in the house.
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SPEAKER_00: That isn't conducive to study,
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SPEAKER_00: to work,
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SPEAKER_00: to,
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SPEAKER_00: you know,
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SPEAKER_00: steady relationships because I was,
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SPEAKER_00: you know,
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frantic and not able to connect with people or to stay on the
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path of the things in
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SPEAKER_00: my life that brought meaning and self-actualization,
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SPEAKER_00: like work and education for me.
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SPEAKER_00: However,
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SPEAKER_00: once that passed,
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absolutely the self-stigma that I was experiencing was a major
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factor in giving
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myself permission to continue down the same path I was on or
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correcting course.
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SPEAKER_00: Because the things that,
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the kind of expectations that people had of me before and after
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diagnosis were
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SPEAKER_00: very,
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SPEAKER_00: very different.
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What was expected of me is that I would turn up at the
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community mental health team
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SPEAKER_00: once a week.
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SPEAKER_00: The expectation was that I would meet my psychiatrist once a month.
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SPEAKER_00: The expectation was that I would take my medication every day.
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And nobody expected that person that was shuffling in and out
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of the psychiatric clinic.
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SPEAKER_00: you know, to succeed.
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I'm not saying success needs to be this capitalized notion of
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becoming an executive
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SPEAKER_00: director or getting a master's degree or,
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SPEAKER_00: you know,
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SPEAKER_00: those things that I have managed to achieve.
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SPEAKER_00: But even like getting married or having a relationship or having kids,
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SPEAKER_00: there's definitely a stigma,
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SPEAKER_00: a self-stigma you actualize,
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SPEAKER_00: you internalize where you think those things won't be possible.
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SPEAKER_02: You describe it so clearly and so vividly.
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I think it speaks to the journey that you've been on and
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perhaps the work that you've done.
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SPEAKER_02: Because if there's one thing,
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SPEAKER_02: you know,
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I would like people to get out of these conversations is it's
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not black and white,
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SPEAKER_02: right?
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So I use the word pharmakon,
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you know,
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this Greek word,
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which means it's a poison and a cure.
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SPEAKER_02: So, I think we share a lot of views.
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If you take psychiatric medication,
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for some people it can save their lives.
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SPEAKER_02: For other people, applied wrongly, it can ruin their lives.
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SPEAKER_02: You have to reconcile those two pieces of information.
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SPEAKER_02: Hospital, for some people, can turn their life around.
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SPEAKER_02: For other people, it can make their life a lot worse.
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SPEAKER_02: Those are uncomfortable truths,
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but I think they're truths that we're kind of avoiding because
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you tend to get
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SPEAKER_02: often too extreme camps.
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SPEAKER_02: One of the things I really respect,
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SPEAKER_02: value and love about you,
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SPEAKER_02: your work,
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your leadership is you very much appreciate that there are
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different views and
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SPEAKER_02: different experiences and it isn't black and white.
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SPEAKER_02: We also have so much in common.
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SPEAKER_02: I lived in Asia,
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I lived in Malaysia for four years and I've been in community
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settings where
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perhaps I'm talking to one of the adults in a family and the
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mother and father come
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SPEAKER_02: in and they literally,
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SPEAKER_02: this is a true story,
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SPEAKER_02: have photographs of all the other siblings.
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SPEAKER_02: who have all got degrees and, you know, successful.
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And they're basically saying,
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you know,
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there's a shame,
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there's a stigma.
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So they're saying,
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you know,
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we've done a great job on the other children.
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SPEAKER_02: It's just this one.
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SPEAKER_02: And this one is probably one of the most beautiful,
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SPEAKER_02: incredible people you've ever met in your life.
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SPEAKER_02: But they're not like the other three.
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So I saw people get psychiatrised for gender challenges,
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sexuality challenges,
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unusual view.
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SPEAKER_02: It was used in a very, unfortunately, draconian way.
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SPEAKER_02: It was nearly an abuse,
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which kind of reminded me of the sort of literature that I
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would have read from the
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SPEAKER_02: anti-psychiatry movement 50 years ago or whatever.
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SPEAKER_02: I'd like to be talking to you today to say I think we've come a long way,
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SPEAKER_02: but one of the reasons for doing the podcast is I don't think we have.
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SPEAKER_00: No, I don't think we have.
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SPEAKER_00: I think you mentioned some interesting things there yourself, like...
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SPEAKER_00: in the anti-psychiatry movement,
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there can be a romanticization of non-Western cultures and how
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they treat or
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SPEAKER_00: understand mental distress,
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SPEAKER_00: emotional distress.
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SPEAKER_00: And that isn't necessarily the case.
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I mean,
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there are some great examples of extreme states being seen as
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spiritual gifts,
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but it
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SPEAKER_00: isn't actually the case amongst all non-Western societies.
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SPEAKER_00: So I just want to uphold that.
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SPEAKER_00: You know,
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SPEAKER_00: being a person myself of,
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SPEAKER_00: you know,
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SPEAKER_00: half Asian backgrounds,
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SPEAKER_00: there's always this fetishization of non-Western cultures.
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SPEAKER_00: And sometimes it's actually a lot worse.
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SPEAKER_00: I do think there has been progress.
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SPEAKER_00: Yeah.
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In the UK,
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where I'm originally from and in the US,
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but definitely there was a long way to go.
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And it feels like a lot of the progress we had made is rapidly
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going backwards.
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In the last year or two,
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I feel like things are rapidly going backwards with the rise
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of...
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carceral treatments and involuntary treatments and an influx of
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policies that seek to do that.
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This is the same thing because you're viewing somebody's
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distress or someone's hardships as
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through this lens of illness and this maternalization of the
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mental health system
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that somehow just being put in a hospital and fed drugs is not
15:53
going to fix that.
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SPEAKER_00: When you have a more black and white viewpoint and you can see that,
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SPEAKER_00: yes,
15:59
SPEAKER_00: medication is helpful for some,
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SPEAKER_00: for some it can completely destroy their lives or kill them,
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SPEAKER_00: kill them,
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SPEAKER_00: literally kill them decades earlier than it should have happened.
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SPEAKER_00: Or with hospital,
16:11
then we can actually start making change because this black and
16:15
white thinking
16:16
isn't helping anybody and it's causing more division and it's
16:18
pushing this extreme
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SPEAKER_00: end of promoting forced treatment.
16:24
SPEAKER_00: It's making it more powerful.
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SPEAKER_02: So I've been reflecting on this a little bit,
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SPEAKER_02: and as I've prepared more for the podcast,
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SPEAKER_02: I realized there is quite a divide.
16:37
SPEAKER_02: So I was teaching recently,
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SPEAKER_02: I was teaching a bunch of existential psychoanalysts in training,
16:42
SPEAKER_02: and I noticed that their interests,
16:45
SPEAKER_02: I think,
16:45
SPEAKER_02: veered more towards what I would call the worried well.
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So talking of a hospital and involuntary,
16:54
this and that,
16:55
wasn't of interest.
16:57
And I thought it drew a parallel to this sort of push to talk
17:01
about profound autism
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SPEAKER_02: versus sort of on-spectrum autism.
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SPEAKER_02: It can be quite an extreme spectrum.
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SPEAKER_02: The thought of someone who seeks help,
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SPEAKER_02: and when they seek help,
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actually they end up being incarcerated or taken away by
17:27
security and forcibly
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SPEAKER_02: injected.
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SPEAKER_02: These are not rare occurrences, unfortunately.
17:34
I work very much at the harder end and I'm dealing principally
17:43
often with the
17:45
trauma that has been experienced in the mental health system
17:49
before I even get to
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SPEAKER_02: talking about what was the presenting issue in the first place.
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SPEAKER_02: It's harrowing.
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SPEAKER_02: And it's also very,
17:59
SPEAKER_02: very complicated because there are times,
18:03
SPEAKER_02: and I've witnessed it,
18:04
when there are people who are in such a state who don't
18:11
arguably deserve to go to
18:14
SPEAKER_02: jail,
18:15
SPEAKER_02: but are in such a state they need some form of containment.
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And society is structured that that containment seems to be
18:24
then potentially a hospitalization.
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SPEAKER_02: Were those two worlds converge,
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SPEAKER_02: I think,
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SPEAKER_02: in America,
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SPEAKER_02: and what I've witnessed is if you're in distress in America,
18:36
SPEAKER_02: certainly in the areas I live,
18:38
SPEAKER_02: and you phone for services,
18:40
SPEAKER_02: you'll have an ambulance.
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SPEAKER_02: a fire truck, which I never understood, and a police car.
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SPEAKER_02: The optic is not one of safety.
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If I came out of the house and saw that in America,
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I would be really nervous.
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SPEAKER_02: No offense to those hardworking folks in those services,
18:58
SPEAKER_02: but just in terms of the language that you're using,
19:02
SPEAKER_02: which is one of people are in a state of distress.
19:06
SPEAKER_02: They are looking for safety, but they'll have the same level of
19:12
response that someone who is maybe presenting is needing some
19:17
sort of containment
19:19
SPEAKER_02: because maybe the situation has just got really volatile.
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SPEAKER_02: How different would that be to the UK, do you think?
19:30
SPEAKER_00: Well, you know, I see the British system through two different lenses.
19:35
One is having experienced it as a patient myself and being
19:40
taken to hospital without my consent.
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SPEAKER_00: And also as a person working in the mental health system.
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SPEAKER_00: So yes, I can see both sides.
19:49
I do acknowledge that there are times when somebody is very,
19:51
very distressed and
19:54
is in imminent danger of ending their life or hurting other
19:59
people where a form of
20:01
SPEAKER_00: containment is needed.
20:02
SPEAKER_00: I would argue,
20:04
SPEAKER_00: before I say it anymore,
20:05
SPEAKER_00: that once somebody has got to that stage,
20:07
SPEAKER_00: I believe very strongly that something has failed them prior to that.
20:13
Things can be done prior to that happening to ensure that that
20:16
doesn't happen.
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SPEAKER_02: Can you speak to that a little bit?
20:20
SPEAKER_00: Yeah, sure, sure.
20:21
SPEAKER_00: So...
20:23
By the time somebody has reached a point of intense distress
20:29
where they feel so
20:31
threatened by other people that they are planning and they need
20:37
to hurt somebody or
20:39
SPEAKER_00: that they plan to end their own lives,
20:41
I believe there are many missed opportunities that either
20:45
mental health systems or
20:48
SPEAKER_00: society at large has missed for an extent.
20:53
SPEAKER_00: the role of trauma.
20:54
SPEAKER_00: So if that person,
20:55
I'm not saying every person who's experiencing things has been
20:58
through trauma.
20:59
SPEAKER_00: I think that can be a bit of a trope too.
21:01
But it is obviously a huge correlation between trauma and
21:05
extreme mental states.
21:06
SPEAKER_00: That if that trauma had never existed in the first place,
21:10
SPEAKER_00: if that person had never been abused,
21:13
SPEAKER_00: maybe it wouldn't have led to that.
21:15
SPEAKER_00: That's like the furthest back that could happen.
21:18
SPEAKER_00: If there was a way of primary intervention to stop
21:22
SPEAKER_00: child abuse, for instance.
21:24
We would probably see a lot less instances of people entering
21:27
the mental health
21:27
SPEAKER_00: system in a great state of distress forcefully.
21:32
SPEAKER_00: However,
21:32
SPEAKER_00: there's lots more proximal things,
21:34
SPEAKER_00: like what treatment has that person received at this point?
21:38
SPEAKER_00: What has their local community done to support them?
21:41
SPEAKER_00: What has their family done to support them?
21:43
And it's not placing blame with other people,
21:46
but it's like looking back and thinking,
21:49
SPEAKER_00: What could have happened at this point?
21:50
SPEAKER_00: And also at the point of crisis, what has been tried?
21:54
SPEAKER_00: Are we immediately going in there?
21:57
SPEAKER_00: And again,
21:57
SPEAKER_00: I speak from experience also in the United States of the police,
22:01
SPEAKER_00: the ambulance,
22:02
SPEAKER_00: the fire truck coming and taking me away,
22:04
SPEAKER_00: pinning me down.
22:06
SPEAKER_02: What is that fire truck for?
22:07
SPEAKER_00: Michael, what is the fire truck for?
22:12
SPEAKER_00: I have no idea.
22:14
SPEAKER_00: I had no idea then.
22:15
SPEAKER_00: I have no idea now, but it is frightening.
22:17
SPEAKER_00: It's scary.
22:18
SPEAKER_00: But they come in there with such force and they're shouting and they're,
22:23
SPEAKER_00: they have no interest in finding out why are you feeling this way?
22:26
SPEAKER_00: I mean,
22:28
SPEAKER_00: you could argue that,
22:29
SPEAKER_00: you know,
22:29
SPEAKER_00: a police person is not a therapist,
22:31
SPEAKER_00: so they're not equipped to deal with that.
22:33
SPEAKER_00: And why are they showing up?
22:34
SPEAKER_00: Why are they, why are they the first line of crisis response?
22:38
SPEAKER_00: Yeah.
22:39
Because my experience was that if someone I think is someone
22:43
who had just sat and
22:43
SPEAKER_00: talked to me,
22:44
SPEAKER_00: it might have taken two hours.
22:45
SPEAKER_00: I'm not going to say it would be quick.
22:48
SPEAKER_00: For me to feel heard and safe in that moment,
22:51
SPEAKER_00: probably they would have needed to have dragged me away.
22:54
SPEAKER_00: There's as many examples that I've seen of other folks,
22:58
SPEAKER_00: but it's easier to talk about myself because I can tell you how I felt.
23:02
SPEAKER_00: I'm in a position now of being able to articulate how I felt.
23:06
SPEAKER_00: And I'm also in this position of privilege,
23:07
SPEAKER_00: of people going,
23:08
SPEAKER_00: well,
23:08
SPEAKER_00: somebody who's articulate and who's accomplished stuff like her,
23:12
SPEAKER_00: they shouldn't be treated that way.
23:13
SPEAKER_00: But it's not just me, though.
23:16
We also need to think about the people who are homeless and
23:18
being dragged away.
23:19
SPEAKER_00: Something has failed them.
23:22
SPEAKER_00: Many things have failed those folks.
23:26
SPEAKER_00: prior to that point of crisis.
23:28
SPEAKER_00: And it's a lot easier to blame them at that point of crisis.
23:31
SPEAKER_00: They need to be taken away.
23:32
SPEAKER_00: They're sick.
23:33
SPEAKER_00: They're defective in some way.
23:35
SPEAKER_00: We need to treat them.
23:36
SPEAKER_00: We are the experts.
23:38
SPEAKER_00: And acknowledging we have failed collectively somewhere along the line.
23:45
SPEAKER_02: My goodness, you cover so much and such important points.
23:48
SPEAKER_02: I mean, you mentioned trauma.
23:51
I set myself a goal when I first got into this area to try and
23:57
find somebody who was mad.
24:00
SPEAKER_02: I haven't found them yet.
24:01
SPEAKER_02: Mad people make the most sense.
24:06
SPEAKER_02: Well,
24:07
what I mean by that is when I have met someone who has been
24:11
labeled a particular
24:12
SPEAKER_02: way and I've sat down and listened to their story,
24:16
SPEAKER_02: their presentation made complete sense.
24:20
SPEAKER_02: It was a way to cope, right?
24:23
SPEAKER_02: And again,
24:23
SPEAKER_02: I'm not trying to romanticize it,
24:24
SPEAKER_02: but I'm saying that there was a hell of a lot more meaning there
24:29
in their story and how it related to their presentation than
24:34
perhaps a medical
24:35
SPEAKER_02: model would let you believe.
24:37
SPEAKER_02: I think you mentioned the ISPS.
24:43
SPEAKER_02: When I was in Malaysia,
24:45
I came across that as a resource and there's a book by John
24:50
Reid and it just
24:52
SPEAKER_02: reframed a lot of the ideas,
24:54
SPEAKER_02: you know,
24:56
SPEAKER_02: a much more psychosocial approach and trauma really came into focus.
25:03
And I think I moved from,
25:05
you know,
25:08
what's wrong with you to what happened to you.
25:12
SPEAKER_02: And now to what you're saying is, what was that like for you, right?
25:17
SPEAKER_02: So I don't,
25:18
SPEAKER_02: I think the term psychosis is useful as a very,
25:22
SPEAKER_02: very broad umbrella,
25:24
SPEAKER_02: but I would argue it's psychosease,
25:29
SPEAKER_02: right?
25:29
SPEAKER_02: There isn't autism, there's autisms, there's psychosease.
25:33
SPEAKER_02: And from here to Malaysia and back, there is form, right?
25:38
SPEAKER_02: So from a phenomenological point of view,
25:40
SPEAKER_02: I could say there is a form to whatever that word points to,
25:44
SPEAKER_02: be it,
25:46
SPEAKER_02: you know,
25:47
SPEAKER_02: a paranoia,
25:47
SPEAKER_02: for example,
25:48
SPEAKER_02: for some people,
25:51
SPEAKER_02: for some people,
25:52
SPEAKER_02: a form of hearing voices,
25:54
SPEAKER_02: right?
25:57
But the content in that forum is so personalized and so
26:01
individual and so different.
26:05
SPEAKER_02: You mentioned,
26:05
SPEAKER_02: and I agree,
26:07
SPEAKER_02: the number of people that I have met,
26:10
SPEAKER_02: first episode,
26:11
SPEAKER_02: they call it psychosis,
26:13
SPEAKER_02: who I have had immediate intervention and the psychosis has gone.
26:19
SPEAKER_02: Right.
26:20
SPEAKER_02: But you mentioned sitting down for two hours.
26:23
SPEAKER_02: And we are in a McDonaldized society that's looking for quick results.
26:30
You know,
26:31
average psychiatrist apparently is between 15 and 22 minutes
26:35
for a session,
26:36
right?
26:36
SPEAKER_02: And you're asking to have an encounter.
26:41
SPEAKER_02: I think it's the only way.
26:44
But how do we make that case in a society that's looking for
26:48
quick results?
26:50
SPEAKER_02: It's very, very challenging.
26:52
SPEAKER_00: Well, I think there's a systemic issue at play.
26:55
SPEAKER_00: So you asked me earlier, the difference between the UK and the US.
26:58
SPEAKER_00: And I don't want to romanticise the UK either,
27:01
SPEAKER_00: because many people are also harmed in that system.
27:04
And I feel myself,
27:05
especially as an adolescent,
27:07
that system also led to harm.
27:11
SPEAKER_00: Some healing, but probably mostly harm at that point.
27:14
SPEAKER_00: But I will say this.
27:15
SPEAKER_00: So...
27:16
SPEAKER_00: The early intervention team I worked for,
27:19
at no point do we have to diagnose somebody to give them a code
27:22
to build an
27:23
SPEAKER_00: insurance company.
27:25
SPEAKER_00: It is completely up to the clinician or it wasn't just clinicians.
27:31
SPEAKER_00: They were also like myself when I was working early intervention,
27:33
SPEAKER_00: I was what was called a support time recovery worker,
27:36
SPEAKER_00: an STR worker.
27:38
SPEAKER_00: So I'm not like a clinician.
27:39
It was more like a peer worker and an occupational therapy
27:44
assistant maybe because
27:45
SPEAKER_00: there's a lot of
27:47
SPEAKER_00: like group work and therapeutic activity involved in what I used to do.
27:53
SPEAKER_00: But,
27:54
SPEAKER_00: you know,
27:54
you didn't have to bill for an intervention that could only
27:58
last a certain amount
27:58
SPEAKER_00: of time,
27:59
SPEAKER_00: right?
28:00
SPEAKER_00: Like it was completely down to you.
28:01
SPEAKER_00: Like I could literally spend a whole day with a person
28:06
SPEAKER_00: getting to know them,
28:07
SPEAKER_00: building rapport,
28:09
SPEAKER_00: going out and doing an activity of interest of theirs,
28:13
SPEAKER_00: trying to re-engage them in things that were important to them.
28:16
SPEAKER_00: But also in times of crisis,
28:19
SPEAKER_00: when somebody was in crisis,
28:20
SPEAKER_00: I could easily spend two hours with somebody talking with them,
28:25
SPEAKER_00: trying to explain what was happening,
28:27
SPEAKER_00: seeing if we could keep them in their home,
28:29
SPEAKER_00: seeing what support they needed,
28:31
SPEAKER_00: even if it was just
28:32
SPEAKER_00: You know, basic needs, like they actually, they need some food.
28:36
SPEAKER_00: And if they had some food and they could turn electricity back on,
28:40
then they would feel less distressed because they weren't
28:42
hungry and cold.
28:43
SPEAKER_00: You know,
28:44
SPEAKER_00: there was these,
28:44
sometimes there are very easy fixes you can have that aren't
28:47
actually a mental
28:48
SPEAKER_00: health treatment.
28:49
SPEAKER_00: But the point is that because we didn't have this billing system,
28:53
SPEAKER_00: it was completely down to you as not just a service provider,
28:57
SPEAKER_00: but also a human provider.
28:59
SPEAKER_00: on what you were willing and wanted to do to support that other human.
29:03
SPEAKER_00: And I think when we come to this system of private healthcare,
29:07
SPEAKER_00: again,
29:08
SPEAKER_00: as you mentioned,
29:08
SPEAKER_00: there are great people as are working in emergency services,
29:11
SPEAKER_00: as there are working in mental health services in the United States.
29:15
SPEAKER_00: But the system itself lends you to not being able to be human to human.
29:20
SPEAKER_00: It's a consumer model.
29:22
It's a consumer and a provider model where you're having to
29:25
bill and money is the bottom line.
29:29
SPEAKER_00: And that is a huge barrier we need to overcome.
29:33
SPEAKER_02: Yeah, I think you make great points.
29:34
SPEAKER_02: I experienced that myself,
29:36
SPEAKER_02: the sense of in the UK,
29:38
SPEAKER_02: because there wasn't the push to code for insurance,
29:44
SPEAKER_02: it wasn't even necessary to give a diagnosis actually,
29:47
SPEAKER_02: unless the psychiatrist was prescribing,
29:53
SPEAKER_02: which was often.
29:55
SPEAKER_02: But the other thing that just,
29:56
SPEAKER_02: and I'm free associating here,
29:58
SPEAKER_02: came to mind,
29:59
SPEAKER_02: when I was on a community mental health team,
30:01
SPEAKER_02: it was an open plan office.
30:03
SPEAKER_02: So the psychiatrist was actually on the other side of the desk.
30:07
SPEAKER_02: So there was a much more sense of parity of esteem.
30:11
SPEAKER_02: And at the time,
30:13
SPEAKER_02: for someone to be involuntarily hospitalized,
30:16
SPEAKER_02: the social worker had to sign the paperwork with the psychiatrist.
30:20
SPEAKER_02: So there was always the counter of the psychosocial.
30:25
SPEAKER_02: Now, I think that's changed and that's shifted.
30:28
SPEAKER_02: But
30:29
SPEAKER_02: I think it was very much a different mindset.
30:33
In 20 years,
30:33
I've never had to work towards someone being involuntary
30:40
admitted.
30:41
When I did my first training in social work,
30:48
I refused to go to involuntary hospitalisation.
30:53
SPEAKER_02: I still won the prize for social work, right?
30:56
SPEAKER_02: Because to me,
30:59
Social work was about activism and protest and trying to make
31:04
change in the most positive way.
31:06
SPEAKER_02: It wasn't to collude with a practice that perhaps you saw was wrong.
31:13
SPEAKER_02: You mentioned again the DSM, which is kind of what we started with.
31:18
SPEAKER_02: It was fascinating because in the UK, I was trained to deconstruct.
31:22
SPEAKER_02: So when I came here, I had to sort of reconstruct how to use it.
31:26
And as a broad thing,
31:31
it has its advantages when you're talking to colleagues.
31:34
SPEAKER_02: But in its own words, it was never meant to be a formulation.
31:38
SPEAKER_02: It talks about it in the introduction.
31:41
SPEAKER_02: It was meant to be one of many things.
31:45
SPEAKER_02: So I think how I see it being used is it uses formulation.
31:49
SPEAKER_02: So you tick the boxes and then that's what they are.
31:56
SPEAKER_02: They have psychosis, what?
31:58
SPEAKER_02: So immediately it dehumanizes and labels and puts somebody in a box.
32:05
SPEAKER_02: As a starting point,
32:06
SPEAKER_02: as I say,
32:07
if I was differentiating between someone who presents in a very
32:11
manic state,
32:12
SPEAKER_02: compared to what I would describe as a more psychotic I think that's good
32:16
information as a top broad line so some of the broad categories
32:22
are useful but when
32:23
it's confused as a method it's confused in the truth then I
32:30
think that is where it
32:31
gets into great difficulty and also the push to bill billable
32:38
hours and all that so
32:40
SPEAKER_02: Jumping back, you talked about your experience.
32:43
SPEAKER_02: What would it have been like?
32:44
What would you have wanted that conversation to be like rather
32:48
than phone services?
32:49
SPEAKER_00: You mean like in the United States when they get the fire truck?
32:56
Yeah,
32:56
or any of the times when you were in a state of distress and
32:59
you just needed someone.
33:02
SPEAKER_02: Tell me what you would have needed in those two hours.
33:05
SPEAKER_02: That might be helpful.
33:06
SPEAKER_02: Yeah.
33:08
SPEAKER_00: It's hard to say exactly.
33:10
SPEAKER_00: I think so much it depends on who you're speaking to.
33:13
SPEAKER_00: But broadly speaking,
33:14
SPEAKER_00: I would say in times of distress,
33:16
SPEAKER_00: I've needed someone to sit down with me,
33:19
SPEAKER_00: to ask me what was going on,
33:21
SPEAKER_00: what I was upset about,
33:23
SPEAKER_00: what was distressing me,
33:24
SPEAKER_00: to validate those feelings.
33:28
SPEAKER_00: to feel understood and heard,
33:33
SPEAKER_00: for somebody to have interpreted what I was saying as a form of truth.
33:39
Not every time that I've been in a state of distress has it
33:43
been psychotic in nature.
33:44
SPEAKER_00: Sometimes it's been much more depressive in nature.
33:47
But even during times where I wasn't making sense and I was
33:51
talking about paranoid things,
33:53
Somebody needed to see that as a form of truth,
33:55
as my truth,
33:57
that it wasn't just delusions.
34:00
SPEAKER_00: It was rooted in something.
34:01
SPEAKER_00: And what I was experiencing was real.
34:04
SPEAKER_00: Even if it was just that, that sounds really scary.
34:07
SPEAKER_00: I can see why I'm feeling this way, Leah.
34:09
SPEAKER_00: I would be terrified if that was happening to me.
34:12
If what we're saying is happening to you will happen to me,
34:15
I'd be terrified.
34:18
SPEAKER_00: I think you've done really well to survive up to this point.
34:22
If maybe they were able to talk about the things I have done to
34:27
support myself and
34:29
SPEAKER_00: to explore more about that,
34:31
SPEAKER_00: what was helpful,
34:33
SPEAKER_00: what was harmful,
34:34
then we could have come up with a pathway together that was
34:37
collaborative.
34:37
SPEAKER_00: Mm-hmm.
34:38
SPEAKER_00: Um,
34:39
SPEAKER_00: you know,
34:39
SPEAKER_00: before we spoke,
34:41
SPEAKER_00: he talked about,
34:41
SPEAKER_00: oh,
34:42
SPEAKER_00: I think maybe we should talk a bit about agency.
34:44
SPEAKER_00: And I was thinking a bit about agency,
34:46
SPEAKER_00: um,
34:46
SPEAKER_00: before I spoke to you today,
34:48
SPEAKER_00: when I was walking my dogs through the park for their,
34:51
SPEAKER_00: their afternoon sabbatical.
34:53
SPEAKER_00: Um,
34:54
SPEAKER_00: And I was thinking that in situations like that,
34:58
agency is so easily lost because the person is coming from this
35:03
very paternalistic
35:04
SPEAKER_00: point of view of,
35:05
SPEAKER_00: if we're talking about psychosis,
35:07
SPEAKER_00: my reality is the true reality.
35:09
SPEAKER_00: What this person is experiencing is not the truth.
35:13
But working with someone collaboratively is giving them agency
35:17
and acknowledging
35:18
SPEAKER_00: that even if they're not making sense,
35:20
SPEAKER_00: um,
35:22
SPEAKER_00: it doesn't mean they completely lack capacity because it might be that,
35:26
SPEAKER_00: you know,
35:26
SPEAKER_00: they're not making sense,
35:27
SPEAKER_00: but they know,
35:28
SPEAKER_00: they know that being pinned down and drugged is not helpful for them.
35:32
SPEAKER_00: In fact, it will greatly traumatize them in the future.
35:35
SPEAKER_00: Or they might know that going to a hospital, um,
35:40
SPEAKER_00: Maybe it's mixed gender, maybe it's very busy.
35:44
SPEAKER_00: In a city hospital,
35:45
SPEAKER_00: you know,
35:45
SPEAKER_00: ones that I've worked in also being a patient in,
35:48
that doesn't feel safe to them because of whatever's happened
35:50
in the past.
35:51
SPEAKER_00: So the collaboratively can come together of,
35:53
SPEAKER_00: okay,
35:54
SPEAKER_00: this isn't,
35:54
SPEAKER_00: the situation isn't manageable as it is.
35:57
SPEAKER_00: We need to change something.
35:59
There might be something we can change that will actually help
36:02
the person rather
36:03
SPEAKER_00: than just contain them and further harm them.
36:06
pushing them further away from mental health services and
36:10
becoming less trusting.
36:12
SPEAKER_00: And maybe even,
36:12
I know from my experiences and experiences that I've seen from
36:17
other people when
36:17
SPEAKER_00: I've been through this,
36:19
they might even stop believing that they can get better because
36:21
every time that
36:22
SPEAKER_00: they reach out for help or provide them with help,
36:24
SPEAKER_00: it makes it worse.
36:25
SPEAKER_00: And eventually you might think, nothing can help me.
36:30
And that's a very sad place to be in because there always is
36:33
something that can help you.
36:34
SPEAKER_02: Well, it speaks to the
36:38
SPEAKER_02: The iotrogenic nature of care is not necessarily intentional,
36:46
but it certainly can be the consequence where the systems think
36:51
this is...
36:53
SPEAKER_02: what we are doing to actually help someone,
36:56
SPEAKER_02: but actually that very help is what's exasperating and making it much,
37:01
SPEAKER_02: much,
37:02
SPEAKER_02: much worse.
37:03
SPEAKER_02: So it sounded like what you're describing as an experience,
37:07
SPEAKER_02: and this is how I talk to people,
37:09
SPEAKER_02: but it's very,
37:10
SPEAKER_02: very,
37:11
SPEAKER_02: very real,
37:12
SPEAKER_02: but it may not be true.
37:15
So it's like someone crossing a bridge that's very high up and
37:22
it's absolutely
37:23
solid and safe and engineeringly perfect and hundreds of people
37:30
cross it a day and
37:32
SPEAKER_02: they try and cross it and they're absolutely petrified with fear.
37:37
SPEAKER_02: That fear is absolutely real.
37:40
It's pure and it's real,
37:42
but it may not be true in the sense of the bridge.
37:46
SPEAKER_02: At what point did you realize that,
37:50
SPEAKER_02: or what shifted it from,
37:51
SPEAKER_02: and I'm assuming that it shifted from,
37:54
SPEAKER_02: yeah,
37:54
SPEAKER_02: it was real,
37:55
SPEAKER_02: but I could see maybe something that wasn't as true as I thought it was.
37:59
SPEAKER_02: What changed that, or did that ever change?
38:02
Well,
38:03
in my case,
38:03
it was distance from the triggering people and circumstances.
38:07
So I had to remove myself from the environmental and personal
38:11
triggers that were
38:12
SPEAKER_00: making me feel unsafe.
38:15
SPEAKER_00: That was very important.
38:17
SPEAKER_00: That would not happen,
38:18
SPEAKER_00: like I say,
38:18
SPEAKER_00: like I have trauma in my past where being in a busy,
38:22
SPEAKER_00: impatient world just exasperates it.
38:24
But then there's also things at home that were causing me
38:26
stress that I needed to
38:27
SPEAKER_00: kind of figure out with my family and the people close to me.
38:31
SPEAKER_00: But equally, it was finding I had a very good therapist.
38:35
SPEAKER_00: I really credit the therapist I had in my late teens as saving my life.
38:42
And it was because she saw me,
38:46
she validated me,
38:47
and I felt nurtured by her.
38:49
SPEAKER_00: And that was quite a different experience of what I had received,
38:52
SPEAKER_00: at least through crisis services,
38:54
SPEAKER_00: or even in...
38:56
SPEAKER_00: very busy community mental health teams that,
39:00
SPEAKER_00: you know,
39:00
SPEAKER_00: wanted you in and out and just,
39:01
SPEAKER_00: you know,
39:02
SPEAKER_00: tick boxes.
39:03
SPEAKER_00: Are you hearing voices?
39:04
SPEAKER_00: Are people broadcasting thoughts into your head?
39:07
SPEAKER_00: Like, even like phrases in very clinical ways that,
39:11
A person experiencing these things,
39:12
they think people are broadcasting something into my head.
39:14
SPEAKER_00: You don't think of it that way.
39:15
SPEAKER_00: You think of it much more organically, right?
39:17
SPEAKER_00: But UK services aren't all universally great either.
39:24
But yeah,
39:25
having a therapist that I could sit with and I saw weekly for
39:30
two years.
39:32
SPEAKER_00: Her influence,
39:33
the care that she gave me and that feeling loved and supported
39:38
made a huge
39:38
SPEAKER_00: difference to me.
39:39
SPEAKER_00: And that to me, that can be a friend, that could be a family member.
39:42
SPEAKER_00: I believe that.
39:43
SPEAKER_00: But for me, it needs to be someone separate from me.
39:46
It needs to be someone that didn't tell me they cared for me
39:49
because they were my family member.
39:51
SPEAKER_00: It needs to be someone else because then I could believe them more.
39:55
SPEAKER_00: They didn't have a duty or role to care for me.
39:58
SPEAKER_00: They were somebody else.
40:01
SPEAKER_02: So you mentioned the tick box.
40:03
There is no form or tick box or module on a training course
40:10
that I've ever seen
40:11
SPEAKER_02: that says love and support.
40:15
SPEAKER_02: And you also mentioned the word care.
40:18
SPEAKER_02: When I did a significant piece of research with 20 senior therapists,
40:24
SPEAKER_02: What I learned from them over their decades of experience,
40:28
SPEAKER_02: it was like something like 600 years of experience.
40:31
What I learned from them inadvertently that seemed to work was
40:36
explicit care.
40:37
So when the patient knew that the therapist truly actually
40:43
cared and could communicate that,
40:45
not hide behind a desk or a title that that was where the
40:50
healing and the the if
40:52
you like the trick was once they knew this person occurred then
40:56
they could access
40:57
SPEAKER_02: care for themselves they could access their their own value
41:02
SPEAKER_02: There isn't a tick box for that because actually it's a numbers game.
41:07
SPEAKER_02: You mentioned going to the community mental health team and again,
41:11
SPEAKER_02: no offence to anyone in that environment.
41:14
SPEAKER_02: I've been in that environment.
41:16
SPEAKER_02: It literally is a tick box form.
41:19
SPEAKER_02: Now,
41:20
SPEAKER_02: some people can memorize it,
41:23
so they can ask the questions that are going to go on the form
41:28
in a way that
41:29
SPEAKER_02: doesn't look like it's a tick box,
41:30
but it is absolutely a tick box because it has to be fed back
41:33
into the computer.
41:36
SPEAKER_02: And we put people in boxes we think we understand, right?
41:40
There is no form long enough to try and capture the beauty of
41:47
the difference of the
41:48
SPEAKER_02: individual that is presenting.
41:52
SPEAKER_02: I'm going to jump back and say, you know, you were very, very lucky.
41:55
SPEAKER_02: You had good experiences on an early intervention team.
41:59
SPEAKER_02: My heart was about early intervention.
42:01
SPEAKER_02: I thought that is where it was going back 20 years.
42:05
SPEAKER_02: And I should say, I came from the corporate sector.
42:07
SPEAKER_02: This was a second career.
42:09
But I was on this early intervention team,
42:11
and I remember being in the clinic.
42:12
SPEAKER_02: I was horrified,
42:14
SPEAKER_02: first of all,
42:14
by what I was seeing and the use of medication to medicate what
42:18
I would say needed
42:20
SPEAKER_02: a conversation.
42:20
SPEAKER_01: Very well.
42:22
So I was in the team meeting and I said,
42:26
where is the hearing voices group in this network?
42:29
And the lead psychiatrist said,
42:31
our job in this team is to eradicate voices.
42:36
SPEAKER_02: And I thought, oh.
42:38
SPEAKER_02: And I ended up, I've had to do this several times in my journey.
42:44
SPEAKER_02: I just had to leave because there was no...
42:47
SPEAKER_02: there was nowhere to go with it because he quoted NICE,
42:50
SPEAKER_02: I was challenged in his prescribing,
42:52
SPEAKER_02: always a bit of a troublemaker,
42:54
SPEAKER_02: and he pointed me to the NICE guidelines,
42:57
SPEAKER_02: which for listeners is sort of the Bible of best clinical practice or
43:02
SPEAKER_02: evidence-based practice in the UK.
43:05
SPEAKER_02: But that was kind of
43:08
shocking and it showed me the power dynamics because if you got
43:11
a couple of
43:12
individuals who saw things in a particular way they could hold
43:18
that whole system
43:19
hostage whereas if you had a more open person who was into the
43:23
ideas of more
43:24
psychosocial and whatnot then you could bring it in but it's a
43:30
challenging and
43:31
you've mentioned a few times you know you are potentially up
43:34
against the system
43:37
SPEAKER_02: Um, but just by structure and by order.
43:39
SPEAKER_02: So when I talk about McDonaldization,
43:42
SPEAKER_02: you know,
43:42
SPEAKER_02: it's,
43:42
SPEAKER_02: it's not that McDonaldization is wrong in and of itself,
43:45
SPEAKER_02: you know,
43:46
SPEAKER_02: efficiency,
43:47
SPEAKER_02: accountability,
43:48
SPEAKER_02: these sort of things are,
43:49
SPEAKER_02: are,
43:50
SPEAKER_02: are,
43:50
SPEAKER_02: can be positive and helpful,
43:52
SPEAKER_02: but not at the expense of,
43:54
SPEAKER_02: of the human and not at the expense of the individual needs of people.
44:01
SPEAKER_02: Um,
44:03
SPEAKER_02: I unfortunately see it getting worse rather than better.
44:07
I was in a community clinic for three years and I saw
44:10
McDonaldization come in more
44:14
SPEAKER_02: and more powerfully every day at the expense of great clinicians,
44:19
at the expense of people who would see the individual and be
44:23
able to encounter them
44:24
SPEAKER_02: as an individual.
44:25
SPEAKER_02: They're under such pressure to do the numbers.
44:28
SPEAKER_02: to turn it around, to keep the session exactly to the time.
44:34
What has your experience been in contrast between the UK and
44:38
America in terms of
44:39
SPEAKER_02: McDonaldisation and healthcare generally?
44:42
SPEAKER_00: Well,
44:42
I think you pointing out your negative experience working at an
44:45
early intervention
44:46
SPEAKER_00: team just shows that the British system itself is very varied.
44:50
SPEAKER_00: And it can depend on what NHS trust you're in.
44:54
SPEAKER_00: And it can just depend on literally the people that are hired.
44:58
SPEAKER_00: So the team I was on had various psychiatrists across the years.
45:04
um sometimes we had a lot amount of time from the psychiatrist
45:10
who headed like the
45:12
the south of the city and cmht or the north of the city so we
45:16
like half a day a
45:17
week then see our patients around and so some of those people
45:20
were exactly like
45:21
that like my goal is to eradicate the symptoms even it means
45:25
completely destroying
45:26
SPEAKER_00: somebody um
45:28
SPEAKER_00: who has quote-unquote treatment-resistant schizophrenia with clozapine,
45:33
SPEAKER_00: even though clozapine wasn't doing an ounce of difference.
45:36
SPEAKER_00: It wasn't helping in any way.
45:38
SPEAKER_00: It was just causing all those physical health problems.
45:41
SPEAKER_00: But my God, they were going to stick with it to the bitter end.
45:44
SPEAKER_00: And the bitter end,
45:45
SPEAKER_00: sadly would mean,
45:46
SPEAKER_00: I wasn't there for decades,
45:47
but the bitter end would mean somebody passing away earlier
45:51
from all the metabolic
45:53
SPEAKER_00: and cognitive and all these other issues that we know are happening.
45:56
It's a part of antipsychotic medication,
45:58
particularly at higher doses for long times.
46:03
SPEAKER_00: So in terms of this McDonaldization that you're talking about,
46:06
people who are operating in that framework are very much going
46:09
to see it as a tick
46:09
SPEAKER_00: box exercise,
46:11
SPEAKER_00: because that's the only thing they're interested in.
46:16
In the US,
46:18
I think,
46:19
again,
46:19
it's the billing system that leads people to be that way.
46:22
SPEAKER_00: And there's also this, I'm not sure the same in every state.
46:27
SPEAKER_00: I was in Indiana,
46:29
SPEAKER_00: but having therapist friends,
46:30
SPEAKER_00: the person didn't show up to their appointment,
46:32
SPEAKER_00: they couldn't bill.
46:34
And therefore you have to kick them off your books after three
46:36
no-shows because the
46:39
SPEAKER_00: system needs to keep chugging along and getting money.
46:42
SPEAKER_00: If a person doesn't show up for sessions,
46:45
SPEAKER_00: it's probably the person that needs the sessions the most.
46:49
SPEAKER_00: They need somebody to reach out for them and be there for them.
46:51
And it's indicative that what they're being offered there isn't
46:55
working for them.
46:56
SPEAKER_00: Maybe it's a therapist they're not connecting with or a therapist that's
47:01
SPEAKER_00: legitimately bad because they don't care or they're burnt out or...
47:06
I do think the majority of people working in this field are
47:08
wanting to help in some way.
47:10
SPEAKER_00: But over time,
47:11
SPEAKER_00: that can become very difficult and a drain,
47:14
SPEAKER_00: particularly if we're feeling we're not actually supporting people.
47:17
SPEAKER_00: But the system isn't set up for this longer term of engagement.
47:21
SPEAKER_00: Like, for instance, I talk about McDonald's.
47:24
SPEAKER_00: I could think of two of my...
47:27
people I worked with,
47:28
patients of mine,
47:29
that I felt I had the best possible relationship with.
47:32
SPEAKER_00: But it started from literally taking them to McDonald's,
47:36
SPEAKER_00: buying them a burger,
47:37
SPEAKER_00: sitting and chatting about the football mat last night.
47:41
And that being our engagement for periods of time before we
47:44
could start doing therapeutic work.
47:46
SPEAKER_00: Um,
47:48
And I think this whole concept of...
47:51
Was that not therapeutic work in itself?
47:55
SPEAKER_00: Well, I don't know.
47:57
SPEAKER_00: I'm not the biggest fan of...
47:59
But in terms of the encounter,
48:00
in terms of just being with...
48:02
No,
48:02
exactly.
48:03
SPEAKER_00: And then feeling like,
48:06
SPEAKER_00: you know,
48:06
SPEAKER_00: I was...
48:07
SPEAKER_00: They knew I wasn't a friend,
48:09
SPEAKER_00: but I was a friend because I did actually care for them.
48:12
SPEAKER_00: I was very interested in them as a human being.
48:14
SPEAKER_00: They were interested in me and I would share the things that I...
48:18
SPEAKER_00: I felt able to share about my own recovery journey,
48:20
SPEAKER_00: if that was appropriate about my own life,
48:22
SPEAKER_00: if that felt safe and appropriate for me.
48:24
SPEAKER_00: But we were connected.
48:26
SPEAKER_00: You can call it friendship.
48:28
SPEAKER_00: You can call it therapeutic engagement.
48:29
SPEAKER_00: You can call it what you like.
48:31
But having that opportunity to build that in a natural or a
48:34
more natural setting
48:35
SPEAKER_00: I mean,
48:35
SPEAKER_00: the fluorescent lights and ingredients,
48:38
SPEAKER_00: McDonald's are not saying that they're most like,
48:39
SPEAKER_00: yeah,
48:40
SPEAKER_00: nutritious to the body,
48:41
SPEAKER_00: but in terms of nutrition for the soul,
48:43
SPEAKER_00: connecting with somebody at least.
48:47
SPEAKER_02: I'm going to get sued.
48:48
SPEAKER_00: Maybe you will.
48:49
SPEAKER_00: I'm sorry.
48:49
SPEAKER_00: But you can't imagine that existing in the American system.
48:55
SPEAKER_00: Maybe you could,
48:55
SPEAKER_00: when it comes to services working outside the system,
49:00
SPEAKER_00: more like peer support services or mutual aid programs.
49:06
SPEAKER_00: I don't necessarily think it's what background you come from.
49:08
SPEAKER_00: You can come from a clinical background.
49:10
SPEAKER_00: You come from a peer background.
49:12
SPEAKER_00: You can just be a good friend.
49:14
SPEAKER_00: What makes good therapy is that connection,
49:19
SPEAKER_00: that relationship and that love that you can give somebody.
49:23
SPEAKER_02: No tick box for love.
49:26
SPEAKER_00: No tick box for love.
49:27
SPEAKER_00: But this is also why I went into occupational therapy is because,
49:31
SPEAKER_00: you know,
49:32
this idea of eliminating symptoms of all costs to me was
49:36
nonsensical because
49:37
SPEAKER_00: somebody can have symptoms,
49:39
find a way around them or integrate them or learn to appreciate
49:43
them in some level
49:45
SPEAKER_00: and live extremely fulfilling lives.
49:47
SPEAKER_00: Yeah.
49:48
And so occupational therapy gave me that perspective and that
49:51
way forward,
49:52
SPEAKER_00: as in it doesn't really matter if someone's diagnosis,
49:55
SPEAKER_00: it doesn't matter necessarily what symptoms they're experiencing,
49:58
is the impact they have on their life and the things that they
50:01
want to do that
50:02
SPEAKER_00: matters.
50:03
SPEAKER_02: Very powerful.
50:05
SPEAKER_02: You know, a sidebar, you know, I do love Freud.
50:09
SPEAKER_02: Freud the thinker,
50:10
SPEAKER_02: not necessarily Freud the psychoanalyst,
50:12
SPEAKER_02: but,
50:12
SPEAKER_02: you know,
50:13
SPEAKER_02: I'm paraphrasing here,
50:14
SPEAKER_02: you know,
50:15
SPEAKER_02: he talked about psychoanalysis being a cure through love.
50:20
SPEAKER_02: Which a lot of people are surprised to hear.
50:23
SPEAKER_02: I remember a patient recently said, he basically said, I love you.
50:30
And I said,
50:31
well,
50:32
I kind of love you or I wouldn't be able to do this work.
50:35
SPEAKER_02: And that's not how I would have been trained.
50:40
SPEAKER_02: That would be like a no-no.
50:42
SPEAKER_02: Absolutely.
50:44
SPEAKER_02: Because it was authentic and it was also true.
50:47
And I think that truth and that authenticity is more powerful
50:51
than a technique.
50:55
You said something very important there about someone being on
51:00
a high dose of
51:01
SPEAKER_02: medication and it not working at all.
51:04
SPEAKER_02: Why are they on it then?
51:06
SPEAKER_00: Because all treatment-resistant patients... Please, I'm using that term.
51:10
I find it an offensive term because I think that's a lot more
51:14
complicated than it sounds.
51:16
SPEAKER_00: Because all treatment-resistant patients should be on clozapine.
51:19
SPEAKER_00: That's the last line of treatment.
51:23
SPEAKER_00: I agree with you.
51:23
SPEAKER_00: Why?
51:24
SPEAKER_00: Why should anybody be on medication that isn't helping them?
51:28
SPEAKER_02: So...
51:29
SPEAKER_00: Just because they're diagnosed with psychosis,
51:31
SPEAKER_00: I think that really is a psychosis-specific phenomenon.
51:35
I don't think we see it as much with depression,
51:39
anxiety,
51:39
or other diagnoses.
51:41
But when it comes to psychosis,
51:44
the only legitimate form of treatment is medication.
51:48
SPEAKER_00: To me, that's false.
51:51
SPEAKER_02: In my experience,
51:52
it's false because I've worked with many people who haven't
51:54
been on medication and
51:56
SPEAKER_02: experienced a recovery.
51:59
I'm going to say stay for the record because I think we've
52:02
talked about this.
52:03
SPEAKER_02: We are very much in the camp of three pillars.
52:06
SPEAKER_02: So we're not against medication.
52:10
SPEAKER_02: But belief doesn't necessarily have to be the first place you need to go.
52:15
SPEAKER_02: We're against higher doses of medication than people need to be on.
52:21
And we're against people being on medication long term when
52:26
they don't need to be.
52:28
SPEAKER_02: Not anti-psychiatry, right?
52:31
SPEAKER_02: But anti-bad psychiatry.
52:32
SPEAKER_02: Huge difference.
52:33
SPEAKER_00: Yes.
52:35
SPEAKER_02: Collaboration.
52:37
SPEAKER_02: informed choice.
52:39
SPEAKER_02: So if this podcast is about anything, it is about informed choice.
52:45
I should say I came from the corporate sector into the mental
52:50
health sphere and I
52:52
SPEAKER_02: just couldn't believe what I was saying.
52:54
SPEAKER_02: Right.
52:54
SPEAKER_02: So I had no agenda, no informed background and
53:00
SPEAKER_02: But watching how people were treated in London,
53:04
SPEAKER_02: particularly people from socially disadvantaged backgrounds,
53:10
SPEAKER_02: people of colour predominantly,
53:13
SPEAKER_02: how they were treated within this sort of forced medication system,
53:19
SPEAKER_02: the really poor results were
53:23
SPEAKER_02: that I was witnessing again,
53:25
SPEAKER_02: I use this term virgin eyes,
53:27
I didn't know just what I was seeing and then most
53:33
frighteningly the side effects
53:36
SPEAKER_02: of the medication which already lying
53:39
Thankfully I picked up what we've already taught me are not the
53:42
side effects,
53:43
SPEAKER_02: they're the effects of the medication.
53:44
SPEAKER_02: And I don't mean to be sexist anyway,
53:47
but I saw people who looked as beautifully as presented as
53:51
yourself one month and
53:54
SPEAKER_02: then seeing them literally at an unhealthy weight.
53:58
and unrecognisable physically three months later after a period
54:04
in the hospital and
54:04
SPEAKER_02: heavy,
54:05
SPEAKER_02: heavy doses of these very,
54:07
SPEAKER_02: very potent medications.
54:09
SPEAKER_02: I just couldn't understand it.
54:11
SPEAKER_02: And then
54:13
SPEAKER_02: When I saw people under community treatment orders who basically,
54:18
SPEAKER_02: if they didn't accept the medication,
54:22
SPEAKER_02: they would have to go back in the hospital.
54:24
SPEAKER_02: I felt that was kind of torture.
54:28
SPEAKER_02: And again,
54:28
SPEAKER_02: not being dramatic,
54:29
the World Health Organization has recently described
54:32
involuntary treatment and
54:34
SPEAKER_02: restraints as a form of torture.
54:41
SPEAKER_02: what do we do to try and change this?
54:43
SPEAKER_02: Because to me, it's self-evident that we could be doing a lot better.
54:47
SPEAKER_02: How do we change?
54:51
SPEAKER_02: I'm sure a psychiatrist is going,
54:53
SPEAKER_02: oh yeah,
54:53
SPEAKER_02: it's very well said for you two people sitting in your comfy chairs,
54:58
SPEAKER_02: but we're at the front end.
55:01
SPEAKER_02: People are brought to hospital by the police in these elevated states.
55:06
SPEAKER_02: What do you suggest?
55:07
SPEAKER_02: You mentioned homeless people.
55:11
SPEAKER_02: Right?
55:11
SPEAKER_02: Yeah.
55:12
SPEAKER_02: Do we just let them,
55:14
SPEAKER_02: you know,
55:14
you see the images of San Francisco in these safe spaces where
55:19
people can inject
55:19
SPEAKER_02: fentanyl.
55:20
Do we just let them inject themselves to death or do we as a
55:23
society make any intervention?
55:26
It's at the extreme end,
55:27
but these are real questions that people might come by.
55:30
SPEAKER_02: What are your thoughts on that?
55:33
SPEAKER_00: Well,
55:35
SPEAKER_00: going back to what I said earlier,
55:37
I think once somebody has reached this point of being homeless
55:41
and injecting
55:42
SPEAKER_00: fentanyl and talking to themselves in the street and,
55:45
SPEAKER_00: you know,
55:46
SPEAKER_00: thinking of absolute worst case scenario,
55:49
we have to acknowledge that something very wrong has happened
55:53
in the past for them
55:54
SPEAKER_00: to reach this stage.
55:55
SPEAKER_00: There are many opportunities we've had in the past to intervene.
56:00
SPEAKER_00: I would say
56:02
The most horrifying difference to me between the US and the UK,
56:08
the US isn't all terrible.
56:11
SPEAKER_00: I don't mean to spin it that way.
56:12
SPEAKER_00: I've also seen some incredible work going on.
56:15
But what was hardest to me as a helper and a helping profession
56:20
was to go from a
56:21
system where people's basic needs could be met through
56:24
comprehensive welfare
56:25
SPEAKER_00: systems.
56:26
SPEAKER_00: Again,
56:27
not saying that the UK has got it perfect and it's definitely
56:29
not perfect now and
56:30
SPEAKER_00: it's ever eroding.
56:33
SPEAKER_00: Let's look at this scenario.
56:34
SPEAKER_00: So before working at ISPS,
56:36
SPEAKER_00: I was working at my local YWCA leading domestic violence programs,
56:41
SPEAKER_00: which included the domestic violence shelter,
56:43
SPEAKER_00: which is essentially a homelessness shelter.
56:45
I saw many people who were chronically homeless and who were
56:49
experiencing very complex problems.
56:52
SPEAKER_00: emotional problems.
56:55
SPEAKER_00: Often people who were experiencing what seemed to be paranoia,
56:59
sometimes it'd be hard to pick out because you know that person
57:01
has legitimately
57:02
SPEAKER_00: been under threat,
57:04
SPEAKER_00: but it seemed to spiral into something much more broad,
57:08
SPEAKER_00: conspiracy-based perhaps.
57:11
SPEAKER_00: And the hardest thing for me going between these two systems was,
57:14
SPEAKER_00: at least in the UK,
57:16
SPEAKER_00: I could think of Maslow's hierarchy.
57:19
SPEAKER_00: This person right now is homeless.
57:21
SPEAKER_00: They need a home.
57:22
SPEAKER_00: I will get them housing benefit.
57:24
SPEAKER_00: Therefore, they could be housed.
57:26
um now it's a universal income so that an universal income
57:30
would be housing but
57:31
also not just food stamps where you go in and you can only buy
57:35
food but an amount
57:36
of money that they could get whatever their needs are the
57:38
things that help them
57:40
feel better it could be food it could be whatever it's like a
57:42
leisure activity they
57:43
SPEAKER_00: could use their benefits for um and so using that meager that's
57:50
SPEAKER_00: Still,
57:51
SPEAKER_00: friendly,
57:52
comprehensive welfare system meant I could get these folks who
57:56
are in really
57:58
SPEAKER_00: tricky,
57:58
SPEAKER_00: complicated situations into a place where they could feel safe,
58:02
SPEAKER_00: where they are fed,
58:03
and they may even have a little bit of additional money to do
58:08
things that they
58:09
SPEAKER_00: enjoy that bring them a sense of identity and purpose.
58:14
SPEAKER_00: That wasn't possible in the US.
58:18
So these people that have very complex problems,
58:20
they could never get out of the shelter system.
58:24
SPEAKER_00: And in fact, the shelter system in itself is extremely stressful.
58:28
So the person who's experiencing paranoia living in a communal
58:32
shelter environment
58:33
may often get into disagreements with other people around them
58:36
or feel threatened
58:37
SPEAKER_00: by other people because of what they're experiencing,
58:39
SPEAKER_00: particularly if they have trauma.
58:41
SPEAKER_00: and therefore become excluded, kicked out of shelter systems.
58:47
SPEAKER_00: It's because a shelter system was never the answer in the first place.
58:51
SPEAKER_00: So I know that's not mental health specific,
58:52
SPEAKER_00: but I'm saying once they're able to get into a safe space,
58:57
SPEAKER_00: this is very much a housing first model,
59:00
SPEAKER_00: then you can begin to work on the deeper mental health problems.
59:04
SPEAKER_00: And in fact,
59:05
a lot of those things that they're experiencing may eat a huge
59:09
amount because
59:10
SPEAKER_00: they're not in a dangerous environment anymore.
59:13
SPEAKER_00: So it seems, honestly, I can't find no sense in it.
59:17
SPEAKER_00: I'm completely baffled.
59:19
SPEAKER_00: Why am I thinking that the answer to homelessness,
59:22
SPEAKER_00: particularly chronically,
59:24
SPEAKER_00: mentally ill,
59:25
SPEAKER_00: homeless,
59:26
SPEAKER_00: again,
59:26
SPEAKER_00: I'm using the phrasing that they use,
59:28
SPEAKER_00: not because that's phrasing that I believe in,
59:33
It's the ridiculous thing that we think the answer to that is
59:36
throwing them into
59:37
SPEAKER_00: hospital,
59:38
SPEAKER_00: injection them with drugs that may or may not help.
59:41
SPEAKER_00: Some people it may help, but some people it does not work.
59:45
Throwing out the system and thinking that they're going to want
59:47
to keep engaging.
59:48
SPEAKER_00: It's never going to happen and they're not getting housed.
59:52
So we need to think broader than what's happening in the desk
59:57
in a psychiatrist's
59:58
SPEAKER_00: office to think about the person's whole life context.
1:00:03
SPEAKER_02: So I agree with a lot.
1:00:06
I had an epiphany along the journey where I remember seeing
1:00:14
someone who had been
1:00:15
SPEAKER_02: labelled depressed.
1:00:16
They were middle-aged and they'd just been made redundant and
1:00:19
there's financial
1:00:19
SPEAKER_02: issues and da-da-da-da.
1:00:23
The term depression was meaningless without looking at those
1:00:26
things first.
1:00:28
SPEAKER_02: It's like,
1:00:30
SPEAKER_02: perhaps you're not psychotic,
1:00:32
perhaps you were brutally abused and this is creating some sort
1:00:37
of meaning to help
1:00:39
SPEAKER_02: you cope with the unlivable.
1:00:44
But there is a tension here because the question,
1:00:47
and this has come up for me recently,
1:00:49
right?
1:00:49
And it's back to kind of,
1:00:51
it took me to the brink of my experience and beliefs,
1:00:56
right?
1:00:57
SPEAKER_02: So you have somebody who is not engaging with services, who is,
1:01:06
SPEAKER_02: presents with what you would say episodic psychosis,
1:01:10
SPEAKER_02: is also extremely neurodiverse,
1:01:14
SPEAKER_02: which is another thing we could touch upon.
1:01:17
And potentially they're putting themselves in kind of life
1:01:20
threatening situations.
1:01:22
SPEAKER_02: So if you go back to the fentanyl user,
1:01:26
Are you saying that agency is primary and that if that person
1:01:32
is choosing to use
1:01:35
SPEAKER_02: fentanyl,
1:01:35
SPEAKER_02: the best we can do is give them clean needles and a safe space.
1:01:39
SPEAKER_02: I know it's an extreme example, right?
1:01:41
SPEAKER_02: But it's a true example.
1:01:44
SPEAKER_02: So is the person who's refusing treatment.
1:01:47
SPEAKER_02: Do we just let them, what do we do as a society is the answer.
1:01:54
SPEAKER_00: Well,
1:01:55
SPEAKER_00: I know this isn't,
1:01:56
I don't think fentanyl use in and of itself is a reason to
1:02:00
involuntary hospitalise
1:02:01
SPEAKER_00: somebody.
1:02:01
SPEAKER_00: But if we're talking about that,
1:02:02
SPEAKER_00: maybe this person also has very clear mental health difficulties as well.
1:02:09
SPEAKER_00: My personal belief is not completely against all forms of,
1:02:12
SPEAKER_00: I want to say involuntary treatment,
1:02:16
SPEAKER_00: but
1:02:19
SPEAKER_00: treatment,
1:02:19
like a hospital or environment where somebody may not be
1:02:23
choosing it as their first
1:02:24
SPEAKER_00: line,
1:02:25
SPEAKER_00: but it's,
1:02:26
SPEAKER_00: but the environment that we put people into,
1:02:29
SPEAKER_00: this is what I'm trying to say,
1:02:30
if they are like actively trying to hurt somebody else or
1:02:35
actively hurting
1:02:35
SPEAKER_00: themselves,
1:02:36
SPEAKER_00: I don't necessarily mean drug use.
1:02:38
SPEAKER_00: I mean, they've got a gun to their head.
1:02:41
I am not so far down the agency primary that I don't believe we
1:02:45
should take the gun
1:02:45
SPEAKER_00: from their hand.
1:02:47
SPEAKER_00: and put them in an environment where they don't have a gun.
1:02:49
I do know folks who are like that and people should have agency
1:02:56
to take their own
1:02:57
SPEAKER_00: life if they want to.
1:02:59
SPEAKER_00: I find that a little bit,
1:03:00
I think it comes from my own experiences of having suicide
1:03:03
attempts and being glad
1:03:05
SPEAKER_00: that I didn't succeed,
1:03:06
SPEAKER_00: that I come from this point of view.
1:03:08
I'm not saying that there is a possible situation,
1:03:10
a very extreme situation,
1:03:14
SPEAKER_00: where somebody needs to be put somewhere to receive some support.
1:03:19
However,
1:03:19
the environments that we put people into are not conducive to
1:03:21
providing that support.
1:03:24
SPEAKER_00: Like I say, hospitals are very often scary and dangerous places.
1:03:29
What's being offered is maybe seeing a psychiatrist and being
1:03:32
prescribed something.
1:03:34
My own experience of being in a psychiatric hospital was seeing
1:03:38
the psychiatrist
1:03:40
SPEAKER_00: when I came in and then once a week.
1:03:42
And then the only other thing to do within that time is
1:03:43
watching data on television
1:03:45
SPEAKER_00: in the smoking room.
1:03:47
SPEAKER_00: wasn't a therapeutic environment.
1:03:48
SPEAKER_00: So if we,
1:03:49
SPEAKER_00: if there are very rare,
1:03:51
much rarer than is currently happening situations where
1:03:54
somebody needs to be in a
1:03:56
SPEAKER_00: hospital,
1:03:58
SPEAKER_00: Those places need to be much better,
1:04:00
SPEAKER_00: much safer and be providing actual,
1:04:03
SPEAKER_00: actual approaches that support people.
1:04:07
And then there are pipelines afterwards where this isn't the be
1:04:10
all and end all.
1:04:10
SPEAKER_00: The goal isn't to get someone on medication.
1:04:13
SPEAKER_00: The goal is to get someone stable.
1:04:15
So more crucially than metaphorically taking the gun out of
1:04:19
somebody's hand is set
1:04:21
them up for success in their lives and figuring out what that
1:04:24
looks like for that
1:04:25
SPEAKER_00: individual.
1:04:25
SPEAKER_00: Okay.
1:04:28
SPEAKER_02: You know,
1:04:28
SPEAKER_02: you describe situations,
1:04:31
SPEAKER_02: you know,
1:04:32
SPEAKER_02: the idea is,
1:04:33
SPEAKER_02: you know,
1:04:36
in some wards you reduce all stimulation and that's meant to be
1:04:40
kind of helpful.
1:04:41
My experience was often people in wards didn't get any
1:04:45
engagement because the idea
1:04:47
SPEAKER_02: was if they were engaged with it would make things worse.
1:04:50
which comes back to the sort of the history of psychiatry and
1:04:56
how psychosis was
1:04:57
SPEAKER_02: actually viewed.
1:05:00
SPEAKER_02: But I'd mentioned, you know, neurodiverse.
1:05:03
SPEAKER_02: I mean, you had mentioned
1:05:06
SPEAKER_02: a trauma background and being in a busy ward and environment.
1:05:10
SPEAKER_02: For some people,
1:05:13
some of those experiences are so triggering that the triggering
1:05:19
response can look
1:05:20
like either they look like a mental health issue when actually
1:05:24
it's how they
1:05:25
SPEAKER_02: organize the world and how they feel safe in the world.
1:05:29
And I'm seeing those two really intersect in a really,
1:05:32
really bad way within the system.
1:05:35
SPEAKER_02: But again, I'm tortured by this idea of agency because
1:05:43
I really believe that there is more agency in psychosis than we
1:05:51
as a society
1:05:53
SPEAKER_02: realize and as the individual perhaps realizes.
1:05:56
And it's leading people to the point where they can see they
1:06:03
have more agency,
1:06:04
SPEAKER_02: I think is so central.
1:06:08
SPEAKER_02: I should clarify,
1:06:09
SPEAKER_02: when I talk about...
1:06:10
SPEAKER_02: I think of radical agency,
1:06:11
SPEAKER_02: and what I mean by that is avoiding what I would call a sorterian bypass.
1:06:17
SPEAKER_02: So it's not like agency is...
1:06:20
SPEAKER_02: You're choosing to use fentanyl or you're not choosing to use fentanyl.
1:06:25
SPEAKER_02: No...
1:06:26
SPEAKER_02: Radical agency is about embodiment,
1:06:28
SPEAKER_02: it's about context,
1:06:30
SPEAKER_02: it's about structure,
1:06:31
SPEAKER_02: it's about neurobiology.
1:06:33
SPEAKER_02: I might decide that I want to stop using fentanyl,
1:06:37
but my body might not allow it because it's now wired in a
1:06:42
dependency point of
1:06:43
SPEAKER_02: view.
1:06:45
SPEAKER_02: But if you go back to your own experience,
1:06:47
SPEAKER_02: how would you describe your agency when you were at your worst?
1:06:51
SPEAKER_02: By your own words, you said you were very paranoid.
1:06:54
SPEAKER_02: How much agency would you say you had in that moment?
1:06:59
I don't think I saw myself as having agency at that time
1:07:03
because I was already in
1:07:04
SPEAKER_00: the mental health system.
1:07:06
SPEAKER_00: I didn't enter into the mental health system at the culmination of this.
1:07:10
I was already in the mental health system and things weren't
1:07:12
getting better and
1:07:13
SPEAKER_00: then culminated further.
1:07:15
SPEAKER_00: So I think by that stage, I already felt I didn't have a lot of agency.
1:07:20
That at times I felt like an annoyance to my care coordinator
1:07:26
and my mental health
1:07:27
team or like the therapist I'd tried before I found a really
1:07:32
great therapist.
1:07:33
Didn't really have time to listen or weren't getting what I was
1:07:36
saying to them.
1:07:37
um and psychiatrists I felt were reducing my my experiences to
1:07:42
a diagnosis rather
1:07:43
than like understanding the context of what I was talking about
1:07:47
so all of that
1:07:49
SPEAKER_00: eventually strips away your agency and I do think that some of the
1:07:54
Some of the more bizarre things that I was doing was an
1:07:56
expression of agency.
1:07:58
SPEAKER_00: Running out into night was like, I want to be free.
1:08:01
SPEAKER_00: It doesn't make sense to me now.
1:08:03
SPEAKER_00: It didn't make sense to me then.
1:08:04
SPEAKER_00: I don't know why I was doing those bizarre things.
1:08:06
SPEAKER_00: But if I'm trying to think about almost like the primal reason,
1:08:10
SPEAKER_00: deep in my brain,
1:08:12
SPEAKER_00: why was I doing these bizarre things?
1:08:13
SPEAKER_00: It was like, I want to be free.
1:08:16
SPEAKER_00: I'm scared and I'm trying to find somewhere safe.
1:08:20
SPEAKER_00: Which is also like a form of agency because I'm leaving my home,
1:08:25
SPEAKER_00: which was where I was supposed to be and going away from the home,
1:08:28
SPEAKER_00: which I wasn't supposed to.
1:08:29
SPEAKER_00: So that was an expression of agency.
1:08:31
SPEAKER_00: I would think that for me and for many other folks that I've accounted,
1:08:36
SPEAKER_00: that rediscovering your own agency is the key to recovery.
1:08:43
SPEAKER_00: Because
1:08:45
SPEAKER_00: you're not expecting someone to heal you.
1:08:49
SPEAKER_00: You're realizing that you have a life worth living,
1:08:54
SPEAKER_00: that you have a future,
1:08:56
SPEAKER_00: that you are capable,
1:08:58
SPEAKER_00: that you are resilient,
1:08:59
SPEAKER_00: that you have skills.
1:09:01
SPEAKER_00: All of these realizations is a rediscovery of your agency.
1:09:06
SPEAKER_00: Because when we rely on psychiatrists to make us better,
1:09:10
SPEAKER_00: we're going to be sadly disappointed because that is not really what
1:09:14
SPEAKER_00: moving forward from distress is.
1:09:16
Maybe it does reduce symptoms for some folks,
1:09:19
but it's not going to put your life back on track.
1:09:21
What puts your life back on track is you and also the
1:09:24
connections and relationships
1:09:25
SPEAKER_00: we have with others,
1:09:26
SPEAKER_00: this interdependence that we have with others.
1:09:29
SPEAKER_00: I'm not talking about,
1:09:30
SPEAKER_00: it's only an individualistic thing,
1:09:32
but we can find that agency also exists in the relationships we
1:09:36
have with others.
1:09:37
SPEAKER_00: In the relationships and contact we allow others to have with us.
1:09:41
SPEAKER_00: And if you come from a trauma background,
1:09:43
that's all the more important because maybe the interactions
1:09:46
you've had with others
1:09:47
have not been consensual or have hurt you in some way and they
1:09:50
weren't the
1:09:51
SPEAKER_00: interactions you wanted to have.
1:09:53
So being able to find a healthier relationships or to connect
1:09:56
with others where you
1:09:57
SPEAKER_00: can express that agency is also key.
1:10:02
I'm feeling kind of emotional because you kind of described
1:10:06
what I feel is my life's work.
1:10:08
So everything you just said is everything that I believe and
1:10:14
the work that I'm trying to do.
1:10:16
People get very upset with me initially because perhaps in
1:10:20
groups or individually I
1:10:21
SPEAKER_02: will say no one is coming.
1:10:25
and people have said to me it made them really angry when they
1:10:30
first heard it but
1:10:32
SPEAKER_02: then when they found their own agency they were liberated because
1:10:38
SPEAKER_02: What I realized,
1:10:39
SPEAKER_02: Leah,
1:10:40
SPEAKER_02: was when I first saw people,
1:10:42
SPEAKER_02: I would say,
1:10:43
SPEAKER_02: my job is to make myself redundant.
1:10:45
SPEAKER_02: I don't want to be a therapist.
1:10:47
SPEAKER_02: I want to live in a world where people don't suffer.
1:10:49
SPEAKER_02: But I learned so much about the mind with a small M and a big M.
1:10:57
I felt that I could help people come back to a place where they
1:11:03
find confidence
1:11:04
SPEAKER_02: within themselves to kind of in a way self-heal.
1:11:08
SPEAKER_02: But that's not the way the system was geared up.
1:11:12
SPEAKER_02: It was geared up that actually I'm not helping somebody find themselves.
1:11:18
SPEAKER_02: I'm helping somebody become dependent on my help,
1:11:21
SPEAKER_02: on my dispensing of a pill or my weekly therapy.
1:11:26
SPEAKER_02: And through the research,
1:11:27
SPEAKER_02: what I discovered was by their own admission,
1:11:30
SPEAKER_02: people were saying,
1:11:31
SPEAKER_02: actually,
1:11:32
SPEAKER_02: what we do is we make people feel comfortable.
1:11:36
SPEAKER_02: So you're in distress,
1:11:37
SPEAKER_02: you pay me,
1:11:38
SPEAKER_02: you come along for an hour a week,
1:11:40
SPEAKER_02: I make you feel better,
1:11:42
SPEAKER_02: you go away.
1:11:44
What I was saying was people were talking about being afraid of
1:11:46
their depression or
1:11:48
SPEAKER_02: their psychosis.
1:11:50
SPEAKER_02: Why would you be afraid of your mind?
1:11:53
SPEAKER_02: it's your own mind.
1:11:55
SPEAKER_02: What have you been doing in,
1:11:57
SPEAKER_02: use the word treatment,
1:11:59
SPEAKER_02: where you haven't discovered this,
1:12:01
SPEAKER_02: where you haven't discovered empowerment and self-efficacy?
1:12:04
SPEAKER_02: And then I realized that, and not everyone, right?
1:12:08
But by many clinicians' own admission,
1:12:12
they need people to come back,
1:12:15
right?
1:12:16
SPEAKER_02: If everyone has self-efficacy, they wouldn't be needed.
1:12:19
SPEAKER_02: Now,
1:12:21
There's great value going to spend time with anyone who will
1:12:26
witness you and listen and talk.
1:12:28
SPEAKER_02: But I want people to be free, and I think agency is absolutely central.
1:12:35
SPEAKER_02: What I felt was the other reason for psychophobia,
1:12:40
SPEAKER_02: underneath what I call fear of the mind,
1:12:42
SPEAKER_02: is fear of suffering,
1:12:44
SPEAKER_02: fear of grieving,
1:12:47
SPEAKER_02: fear of mourning.
1:12:48
SPEAKER_02: So to take somebody...
1:12:52
through a journey and to support them often it gets worse
1:12:55
before it gets better
1:12:57
that's not the way modern therapists are trained they're
1:13:00
trained to fix and to do
1:13:03
right the thought of being with someone in McDonald's as having
1:13:07
value in terms of
1:13:09
connection and encounter and all the great things that you said
1:13:13
about your
1:13:13
SPEAKER_02: therapist that were very very real right that
1:13:19
SPEAKER_02: you don't describe a dependency,
1:13:21
you describe someone who saw you enough for you to regain your
1:13:25
confidence in
1:13:26
SPEAKER_02: yourself.
1:13:29
SPEAKER_02: That self-efficacy is everything, but I am seeing a system that
1:13:35
pushes out the idea of recovery and hope and self-healing and
1:13:41
connection.
1:13:42
And as you say,
1:13:44
connectedness and community,
1:13:46
all those things are very,
1:13:47
very important.
1:13:49
SPEAKER_02: But I think the self-belief that someone is okay
1:13:53
SPEAKER_02: And it's going to be okay.
1:13:55
And they can learn the triggers and the things that make things
1:14:00
not okay without
1:14:02
SPEAKER_02: becoming dependent on someone else for that for the rest of their life.
1:14:07
SPEAKER_00: All of that.
1:14:08
SPEAKER_00: All of the above.
1:14:09
SPEAKER_00: I subscribe to that.
1:14:11
SPEAKER_00: But I do want to say something.
1:14:13
SPEAKER_00: So I know very much this is your life work.
1:14:16
SPEAKER_00: We've had many great conversations that haven't been recorded.
1:14:20
SPEAKER_00: I do think there is legitimacy to a level of psychophobia.
1:14:24
SPEAKER_00: I do think there's legitimacy to being afraid of your mind.
1:14:29
SPEAKER_00: My mind has led me to states of mind that have put me into very dangerous
1:14:33
SPEAKER_00: situations and have completely derailed my life.
1:14:37
Even now,
1:14:38
I would be afraid if I was thinking that I was relapsing in
1:14:43
some major way.
1:14:45
SPEAKER_00: However, as you say, that having self-efficacy
1:14:51
SPEAKER_00: has been key to me taking control of my life.
1:14:54
What I think needs to happen that what we need to make happen
1:14:57
as a society is
1:14:59
um is this acknowledgement but also understanding that doing
1:15:02
this work um as you
1:15:05
say good therapy is not comfortable good therapy to me is like
1:15:10
um you've got a
1:15:11
wound that's healed badly that's all like gnarled and scarred
1:15:15
good therapy you have
1:15:16
to like cut cut that sucker off and like set it back up again
1:15:20
it's very painful to
1:15:21
SPEAKER_00: go back to the things that have have been done to you or hurt you
1:15:26
SPEAKER_00: or if you don't have a trauma history,
1:15:27
SPEAKER_00: like what's happening in the present that's causing you harm,
1:15:31
SPEAKER_00: making you feel stressed.
1:15:32
SPEAKER_00: And to be able to do that work, you need to be in a place of safety.
1:15:36
You need to be in a place of physical safety,
1:15:39
which means your basic needs have to be met.
1:15:42
SPEAKER_00: And you also have to be in emotional safety with somebody.
1:15:46
SPEAKER_00: So it doesn't mean that every,
1:15:47
SPEAKER_00: you know,
1:15:49
SPEAKER_00: every mental health professional is capable of providing that.
1:15:53
SPEAKER_00: You know,
1:15:54
SPEAKER_00: if they're in this for the wrong reasons,
1:15:56
or they're not in a position to be able to really witness and
1:15:58
see somebody and care
1:15:59
SPEAKER_00: for somebody.
1:16:01
SPEAKER_00: Because if you're just treating people,
1:16:03
SPEAKER_00: as a conveyor belt of consumers,
1:16:08
you're never going to prevail to provide them the emotional
1:16:10
safety where that work
1:16:11
SPEAKER_00: can take place.
1:16:12
SPEAKER_00: Somebody isn't going to gift you that.
1:16:14
SPEAKER_00: I really feel like somebody who's...
1:16:18
SPEAKER_00: It's received therapy.
1:16:19
SPEAKER_00: Not only am I receiving like a service and a gift from the therapist,
1:16:23
I also feel like by revealing myself as a full human is also me
1:16:27
giving somebody
1:16:28
SPEAKER_00: something of me.
1:16:29
SPEAKER_00: And I'm not going to give that to somebody unless I feel safe with them.
1:16:35
very powerful you said something really profound and well many
1:16:40
you've said many
1:16:41
things but one of the reasons other reasons I wanted to do the
1:16:45
podcasts and talk to
1:16:47
SPEAKER_02: incredible people like yourself was to refine my own thinking and
1:16:51
SPEAKER_02: So you made me stop and pause there.
1:16:53
SPEAKER_02: I think you make a really good point about fear.
1:16:56
SPEAKER_02: There's times to fear the mind.
1:16:58
SPEAKER_02: But I think it's more of you have to know your mind.
1:17:01
You have to be brought into an experience of your own mind to
1:17:05
know at times when
1:17:08
SPEAKER_02: there's difficulty.
1:17:09
SPEAKER_02: You know,
1:17:10
it's a bit like I meet incredible people who you might describe
1:17:14
as quite mystical,
1:17:16
SPEAKER_02: right?
1:17:16
SPEAKER_02: And they're able to tell you, they might get...
1:17:20
They might get signs from water,
1:17:22
right,
1:17:24
that are very positive and wholesome for their life.
1:17:26
SPEAKER_02: And there are times when the signs from water take a malevolent turn,
1:17:33
take a darker turn or a turn that's more persecutory and they
1:17:37
know something has
1:17:39
SPEAKER_02: shifted.
1:17:39
SPEAKER_02: I think if someone is able to...
1:17:47
SPEAKER_02: be supported to come into relationship with their own mind,
1:17:50
then they have agency and can know the steps that they have to
1:17:55
take rather than
1:17:59
SPEAKER_02: things are out of kilter.
1:18:00
SPEAKER_02: I need someone to come in and help me, right?
1:18:06
SPEAKER_02: Which they may do.
1:18:07
SPEAKER_02: But the move,
1:18:08
SPEAKER_02: I think,
1:18:09
is towards a point where someone is more confident to
1:18:14
understand what is going on
1:18:16
SPEAKER_02: for them and that they can actually get through to the other side.
1:18:19
SPEAKER_02: But I'm going to think about that a lot more.
1:18:21
SPEAKER_02: I think it's a really, really important point.
1:18:24
SPEAKER_02: I'm going to have to factor it in.
1:18:27
SPEAKER_02: I'm really conscious of time.
1:18:29
SPEAKER_02: I could just keep talking to you forever.
1:18:31
SPEAKER_02: I'm such a huge fan.
1:18:33
SPEAKER_02: I think you are such an incredible leader,
1:18:37
SPEAKER_02: such an important voice in this space,
1:18:41
SPEAKER_02: not least of which,
1:18:43
SPEAKER_02: because you aren't black and white,
1:18:45
SPEAKER_02: you understand the complexity and the nuance.
1:18:49
SPEAKER_02: Let's speak quickly before we finish about the ISPS US.
1:18:53
I want to give you space to talk about that because I think
1:18:55
it's an incredible
1:18:58
SPEAKER_02: organization,
1:18:58
SPEAKER_02: which I am a member of and support.
1:19:02
SPEAKER_02: Such a colorful bunch of folks I've
1:19:06
SPEAKER_02: never met in my life,
1:19:07
especially at the conference and people I have learned so much
1:19:11
from and I'm
1:19:11
SPEAKER_02: absolutely indebted to,
1:19:12
SPEAKER_02: especially people who self-identify as survivors.
1:19:17
They've taught me so much as a person and as a clinician and
1:19:22
I'm endlessly grateful
1:19:24
SPEAKER_02: to them for that.
1:19:26
SPEAKER_02: Tell me about your role and the organisation for those who don't know.
1:19:32
SPEAKER_00: Sure.
1:19:33
SPEAKER_00: Well,
1:19:33
SPEAKER_00: first of all,
1:19:33
I should say that anything I've expressed in this podcast are
1:19:36
my own opinion and
1:19:37
SPEAKER_00: not that of my organization.
1:19:38
SPEAKER_02: Fair enough.
1:19:39
SPEAKER_00: Because this is,
1:19:40
SPEAKER_00: I know that's a cheesy disclaimer,
1:19:42
but it comes to a more interesting point is that ISPS is a
1:19:48
membership organization
1:19:49
SPEAKER_00: that also provides education,
1:19:51
SPEAKER_00: but that is what we deem a big tent.
1:19:54
SPEAKER_00: So within that organization, there's a full gamut of belief systems that
1:19:59
SPEAKER_00: And types of experience.
1:20:01
So some people may be completely abolitionist when it comes to
1:20:06
the mental health system.
1:20:08
SPEAKER_00: Some may have more mainstream beliefs.
1:20:12
I think the thing that links us all is this belief in dialogue
1:20:19
and wanting to learn
1:20:20
SPEAKER_00: and understand all different perspectives and approaches to dialogue.
1:20:25
quote unquote,
1:20:26
psychosis and understanding that it all has value and purpose.
1:20:30
SPEAKER_00: So I enter the organization.
1:20:32
SPEAKER_00: I'm an occupational therapist.
1:20:34
SPEAKER_00: I'm a person of lived experience.
1:20:35
I've worked on the mental health system and also in the
1:20:38
homelessness systems.
1:20:40
SPEAKER_00: But there are also people who are like leading peer support networks.
1:20:45
SPEAKER_00: There are people who are psychiatrists,
1:20:47
SPEAKER_00: there are professors,
1:20:48
SPEAKER_00: there are researchers,
1:20:49
SPEAKER_00: there are family members who are desperate for a
1:20:52
SPEAKER_00: different types of support for their loved one.
1:20:55
SPEAKER_00: And I think we all acknowledge that what we have in the US,
1:21:00
SPEAKER_00: the system that we have,
1:21:01
SPEAKER_00: the approaches that we have are not enough.
1:21:04
SPEAKER_00: So we're coming together to exchange ideas,
1:21:06
SPEAKER_00: experiences,
1:21:07
SPEAKER_00: to debate,
1:21:08
SPEAKER_00: to dialogue,
1:21:10
SPEAKER_00: to bring in best practices,
1:21:13
SPEAKER_00: to bring in novel thinking,
1:21:17
SPEAKER_00: in order to revision what the mental health system could look like.
1:21:22
SPEAKER_00: And I've met so many people through my work.
1:21:24
I've now been with the organization for four years that have
1:21:27
completely changed my
1:21:28
SPEAKER_00: mind about things.
1:21:30
that have opened my eyes to new ways of thinking that have
1:21:35
challenged me in the
1:21:36
SPEAKER_00: best possible ways.
1:21:37
SPEAKER_00: And I feel like every day that I'm working at my job,
1:21:42
SPEAKER_00: I'm forced to re-examine the things that I believe in.
1:21:45
SPEAKER_00: And I think that makes me a better person,
1:21:48
SPEAKER_00: not just a better clinician,
1:21:49
SPEAKER_00: not just a better professional,
1:21:50
SPEAKER_00: not just,
1:21:51
SPEAKER_00: you know,
1:21:53
SPEAKER_00: a better person going through my own experiences,
1:21:56
SPEAKER_00: but it's making me a better human.
1:21:58
Because we're having to tolerate uncertainty to understand
1:22:02
there are multiple
1:22:02
SPEAKER_00: truths and to understand the significance of all of it.
1:22:05
SPEAKER_00: And that's one thing that I love about ISPS.
1:22:09
SPEAKER_02: I love that.
1:22:10
SPEAKER_02: That's such a great description.
1:22:12
SPEAKER_02: And I would say I wholeheartedly agree, just being as a member.
1:22:17
SPEAKER_02: I left out families.
1:22:19
SPEAKER_02: I have learned so much and I'm indebted to families.
1:22:23
SPEAKER_02: Completely challenged what I thought I knew about mental health,
1:22:29
SPEAKER_02: the mental health system,
1:22:30
SPEAKER_02: just from witnessing
1:22:34
the impact on families and working with families and people
1:22:38
desperate for some sort of support.
1:22:41
I get quite a few people who reach out to me in desperation,
1:22:46
but they've come through ISPS.
1:22:49
Their loved ones have kind of been through the system and
1:22:53
they're kind of stuck.
1:22:55
um what are your goals and aims for the organization in the the
1:22:59
the next 12 months
1:23:01
what what's what should we be excited about we'll have our
1:23:05
annual conference as
1:23:06
always in the fall and that's always a really exciting time for
1:23:09
us to come together
1:23:10
and to be with one another and to share our ideas and learn
1:23:13
from one another so
1:23:14
we're currently looking at different venues across the country
1:23:17
so i'll be able to
1:23:17
SPEAKER_00: release that
1:23:19
SPEAKER_00: that soon.
1:23:20
We're about to launch a series that's going to be looking at
1:23:25
quote-unquote negative
1:23:26
SPEAKER_00: symptoms and what that means.
1:23:29
SPEAKER_00: Just from preparing for this series and meeting different speakers,
1:23:32
SPEAKER_00: I've already,
1:23:33
SPEAKER_00: like I say,
1:23:33
SPEAKER_00: challenged my own perspectives.
1:23:36
on what is traditionally seen as a deficit model into more
1:23:39
adaptive ways of thinking about it.
1:23:42
SPEAKER_00: And it will also look at different clinical approaches,
1:23:46
SPEAKER_00: different types of assessments that someone could use.
1:23:50
SPEAKER_00: But again, with this quite critical mindset of looking to expand
1:23:55
SPEAKER_00: what has been a very neglected area,
1:23:57
SPEAKER_00: I think,
1:23:57
SPEAKER_00: of thought,
1:23:58
SPEAKER_00: even within our own communities,
1:23:59
which is focused very much on the meaning behind positive
1:24:03
symptoms and neglecting
1:24:04
SPEAKER_00: to focus also on what are called negative symptoms.
1:24:09
SPEAKER_00: And we are also looking at advocacy work.
1:24:13
SPEAKER_00: So we've recently been involved in supporting the Informed Consent Act,
1:24:17
which is specifically looking at making sure that veterans
1:24:21
involved in the VA
1:24:22
system have to give informed consent before being given
1:24:27
potentially dangerous
1:24:28
SPEAKER_00: medications,
1:24:29
SPEAKER_00: including antipsychotics,
1:24:30
SPEAKER_00: which is why we have become involved in that.
1:24:33
Because I hope that what I've expressed over the course of this
1:24:37
conversation that
1:24:38
SPEAKER_00: we've had is that informed consent is key.
1:24:42
SPEAKER_00: Yes,
1:24:42
SPEAKER_00: there's those three pillars where not anti-medication,
1:24:45
but medication should be the least amount possible for the
1:24:49
least amount of time
1:24:49
SPEAKER_00: possible.
1:24:50
Fundamental to that is informed consent where that person can
1:24:53
give consent to be given it.
1:24:55
SPEAKER_00: So we look forward to being engaged in more advocacy projects like that,
1:24:59
SPEAKER_00: that underscore our values.
1:25:02
SPEAKER_02: It's very exciting.
1:25:04
SPEAKER_02: It doesn't sound like it's a lot to ask for informed consent,
1:25:09
but I believe that the most recent attempt at getting a bill
1:25:12
through was denied.
1:25:15
SPEAKER_00: It's in the balance right now.
1:25:16
SPEAKER_00: So I believe it's still being worked on.
1:25:21
SPEAKER_02: If people are interested, I'll put it in the show notes.
1:25:23
There's a great article in the Wall Street Journal about
1:25:27
polypharmacy and veterans.
1:25:30
SPEAKER_02: I do a lot of work with veterans and I've met a lot of these key players.
1:25:35
SPEAKER_02: The stories are extraordinary.
1:25:38
It's a great case study just to show how far in the wrong
1:25:43
direction we've come in
1:25:45
SPEAKER_02: some of these areas.
1:25:47
SPEAKER_02: Okay, listen, I'm really conscious.
1:25:49
SPEAKER_02: I've kept you so long.
1:25:51
SPEAKER_02: As I say, I could probably do another four hours.
1:25:54
I am indebted to you as an individual and the contribution you
1:25:58
make in the space,
1:25:58
but also as a friend and all the guidance and keeping me on the
1:26:03
straight and
1:26:03
SPEAKER_02: narrow.
1:26:06
Is there anything you can ask you that I haven't or anything
1:26:09
that you wanted to say
1:26:10
SPEAKER_02: that you wanted to get in that we missed?
1:26:14
SPEAKER_00: No, I don't think so.
1:26:15
SPEAKER_00: I appreciate the opportunity to chat with you as always.
1:26:18
SPEAKER_00: And I also consider you a friend and a thought partner.
1:26:21
So I'm so grateful to you and to all the other amazing people
1:26:26
I've met in this
1:26:27
SPEAKER_00: space who continue to help me grow.
1:26:31
I always feel I've grown and most of all,
1:26:34
I feel really inspired after talking to you.
1:26:36
SPEAKER_02: So it encourages me to keep going.
1:26:39
SPEAKER_02: So thank you.
1:26:41
SPEAKER_00: We all have to keep going.
1:26:44
SPEAKER_00: Yes,
1:26:44
we have to keep going together because I feel like we're at a
1:26:46
critical momentum and
1:26:49
more people's eyes are being open to the fact that our current
1:26:51
system isn't
1:26:52
SPEAKER_00: working.
1:26:53
SPEAKER_00: So we have to keep supporting each other in this world.
1:26:57
SPEAKER_02: Yeah, I think we are at a point in time.
1:27:00
SPEAKER_02: Definitely a raising of consciousness in the most positive of ways.
1:27:06
SPEAKER_00: All right, pleasure.
1:27:08
SPEAKER_02: Thank you.
1:27:09
SPEAKER_02: We will speak soon.
1:27:10
SPEAKER_00: All right, bye.
1:27:12
SPEAKER_02: Bye-bye.