Latest / psychophobia* podcast / Episode 09: Part II - When Treatment Becomes the Problem - How modern psychiatry lost the human being

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Episode 09: Part II - When Treatment Becomes the Problem - How modern psychiatry lost the human being · 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_00: 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_00: perpetuate cycles of dependency.
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SPEAKER_00: Welcome to the Psychophobia Podcast.
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SPEAKER_02: So I'm probably going to jump up out here a little bit.
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SPEAKER_02: I'm going to quote the CEO of Eli Lilly.
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SPEAKER_02: He said in a podcast a few weeks ago,
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SPEAKER_02: he's talking about psychiatric medication,
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SPEAKER_02: if you pick the wrong one or dose too far,
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SPEAKER_02: the effects can be worse than the condition itself.
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SPEAKER_02: He said that.
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SPEAKER_02: Wow.
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SPEAKER_02: That's quite an admission.
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SPEAKER_02: Well, I don't know whether it was a slip or not.
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He was on the topic of GLP-1s and how they are having
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incredible results without
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SPEAKER_02: the side effects.
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SPEAKER_02: So I think Eli moved away a little bit.
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SPEAKER_02: They don't have too many antipsychotics, but it's a hell of an admission.
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SPEAKER_02: So something we haven't mentioned,
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which was the thing that made me really hone in on psychiatric
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medication was
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SPEAKER_02: polypharmacy.
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SPEAKER_02: Right, so where does the science come in there?
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SPEAKER_02: Because I see that as worse.
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I was working in a clinic for about three years that was an
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incredible clinic,
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SPEAKER_02: but the level of polypharmacy,
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SPEAKER_02: and what I mean by that is just multiple
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SPEAKER_02: I'll give an example,
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SPEAKER_02: you mentioned lithium,
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SPEAKER_02: so someone's on lithium,
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SPEAKER_02: antipsychotic,
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SPEAKER_02: a stimulant,
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SPEAKER_02: a benzo and an anticonvulsant.
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I made the argument that I could bring that prescribing to
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someone on the street
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SPEAKER_02: and they would go,
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SPEAKER_02: that's a lot of medication.
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SPEAKER_02: What do all those do?
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And do not some of those take someone in a different direction
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because you're
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SPEAKER_02: taking somebody up and you're taking somebody down?
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SPEAKER_02: And a lot of this to me is common sense, right?
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SPEAKER_02: Yes, it is common sense.
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But when you take polypharmacy and the statistics that indicate
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that the load
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SPEAKER_02: impacts life expectancy,
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SPEAKER_02: you know,
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SPEAKER_02: the statistics are still horrifying,
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SPEAKER_02: 10 to 15 years less life expectancy.
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SPEAKER_02: And worsening.
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SPEAKER_02: And worsening, right?
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SPEAKER_02: When you were researching,
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SPEAKER_02: where did the polypharmacy come into that,
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SPEAKER_02: or was there any science behind it?
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SPEAKER_02: There's none.
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SPEAKER_01: Zero, zip.
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SPEAKER_01: In fact,
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SPEAKER_01: you'll find that,
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SPEAKER_01: for example,
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SPEAKER_01: Ross Baldessarini,
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SPEAKER_01: Ross Baldessarini is sort of the father of modern psychopharmacology,
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SPEAKER_01: Harvard.
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SPEAKER_01: He was seen as a really thoughtful person.
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SPEAKER_01: And he looked and he showed that when you have polypharmacy, when you
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SPEAKER_01: start tapering away from polytharmacy, people got better.
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SPEAKER_01: But how does it develop?
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SPEAKER_01: Remember,
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SPEAKER_01: the story is that the drugs are specific to a certain condition,
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SPEAKER_01: like they're an antipsychotic or an antidepressant.
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SPEAKER_02: That is a misleading language.
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SPEAKER_02: I prefer when we use the term tranquilizers.
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SPEAKER_01: Of course, that's what we should be using.
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SPEAKER_02: Because antipsychotic shuts down the argument
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SPEAKER_02: Yes, exactly.
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SPEAKER_01: That's what I was done.
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SPEAKER_01: But the point is...
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SPEAKER_01: If the drugs were antipsychotics,
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SPEAKER_01: they really fixed the condition,
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SPEAKER_01: you wouldn't need two drugs,
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SPEAKER_01: three drugs,
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SPEAKER_01: four drugs,
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SPEAKER_01: right?
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SPEAKER_01: Because they would be more effective.
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SPEAKER_01: Why do you get into polypharmacy?
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SPEAKER_01: Because the one drug doesn't work.
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But rather than saying,
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like,
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maybe we should take it away,
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people say,
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well,
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let me add a drug.
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SPEAKER_01: And let me add another drug.
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SPEAKER_01: And it got to be so common.
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SPEAKER_01: Next thing you know,
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people would go in the first time and they'd come out with four
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drugs right away.
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SPEAKER_01: Not even over time.
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SPEAKER_02: I don't want to bash psychiatry,
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but I have to say with a degree of confidence that the easiest
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way to get on more
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SPEAKER_02: medication in America is to ask to come off the medication.
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SPEAKER_02: It's uncanny.
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SPEAKER_02: My experience working with a range of patients, it's uncanny.
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When they have got to the point where they want to come down or
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taper down,
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SPEAKER_02: it's usually a swap out.
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SPEAKER_02: Or,
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SPEAKER_02: if they haven't been informed,
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SPEAKER_02: they try to withdraw and they have a rebound,
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SPEAKER_02: either in reaction to the medication or withdrawal,
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SPEAKER_02: and then they go back,
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SPEAKER_02: they think it is them,
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SPEAKER_02: because they're not informed.
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SPEAKER_02: Yeah.
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SPEAKER_02: And they get put on a higher medication dose and it's a cycle.
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SPEAKER_02: The other issue is,
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SPEAKER_02: and again from experience,
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SPEAKER_02: it's so easy to go to a prescriber and say,
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SPEAKER_02: I've got attention problems or I'm feeling agitated or I can't say.
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SPEAKER_02: Once you're in that trajectory,
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the ability to get these medications seems to be far too easy
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and far too quick.
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SPEAKER_02: And that's a concern.
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SPEAKER_01: Yeah, I think, Michael, you've laid out the rabbit hole that exists.
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SPEAKER_01: People enter the system,
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SPEAKER_01: and next thing you know,
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SPEAKER_01: maybe the drug's not working well,
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SPEAKER_01: and now a second is added.
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SPEAKER_01: And of a different type.
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Next thing you know,
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as you say,
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one's on a stimulant,
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then they're on a tranquilizer.
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Yeah,
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you're on a stimulant during the day,
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and then you need something to go to sleep at night.
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SPEAKER_01: I mean, it's really crazy stuff.
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SPEAKER_01: And here's the thing, there's no evidence anywhere
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SPEAKER_01: Anywhere to support polypharmacy, any of these combinations.
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SPEAKER_01: I mean,
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SPEAKER_01: every once in a while they try to do two drugs,
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SPEAKER_01: but there really is not an evidence base for polypharmacy.
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SPEAKER_01: It's like which doctors just mixing things, right?
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SPEAKER_01: Like just throwing in this,
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SPEAKER_01: throwing in that,
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and that's the whole idea that somehow they are these experts
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in like mixing and
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SPEAKER_01: matching,
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SPEAKER_01: mixing up in sort of a cauldron of drugs.
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SPEAKER_01: But there's no evidence showing that that is beneficial.
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SPEAKER_01: None.
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SPEAKER_01: Zero.
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SPEAKER_01: And really you have to see the polypharmacy that exists
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SPEAKER_01: as a practice that tells of a failed paradigm of care.
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SPEAKER_01: If this works, you wouldn't need people to be on four, five, six drugs.
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Sometimes you hear people are on 10 drugs or they've cycled
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through 15 drugs.
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SPEAKER_02: It's crazy.
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So we mentioned the veterans a few times and you know,
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if anyone's listening,
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I would urge people to read the article in the Wall Street
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Journal that really
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SPEAKER_02: covers polypharmacy and veterans and their experience.
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SPEAKER_02: And unless you read that, you wouldn't believe it.
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SPEAKER_02: The list of medications and the number of medications,
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SPEAKER_02: these are either powerful drugs or they're not.
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SPEAKER_02: If they're powerful drugs and you've someone on six or seven of them,
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SPEAKER_02: I mean,
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SPEAKER_02: explain that to me.
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SPEAKER_02: It has no sense, but it has a consequence because they are very toxic.
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SPEAKER_01: Yeah.
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SPEAKER_01: Listen,
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I'm often amazed that people can function at all when they're
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on these six or seven
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SPEAKER_01: trucks.
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SPEAKER_01: I really am shocked that they can even get out of bed and do anything.
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SPEAKER_01: It's really quite remarkable.
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SPEAKER_02: I worked with a psychiatrist,
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SPEAKER_02: I was trying to get him on,
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SPEAKER_02: but I think he's retired,
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SPEAKER_02: called Mark Salter.
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SPEAKER_02: And he probably wouldn't mind me saying, he's a bit of a rebel.
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SPEAKER_02: He used to ask his interns to try the medication.
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SPEAKER_02: So he said if you're going to prescribe some of these meds,
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SPEAKER_02: you should at least have some sense of what they do.
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And he said some of these interns would take some of these
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pills and be on their
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SPEAKER_02: hands and knees by lunchtime,
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SPEAKER_02: which was a good experience.
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SPEAKER_02: The other story I would refer people to is Stevie Nicks.
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SPEAKER_02: Did you ever hear her interview?
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SPEAKER_02: Can you read this story?
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SPEAKER_02: Oh wait, go ahead.
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SPEAKER_02: I don't like- Stevie, if you're listening, I'd love you to come on.
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So Stevie Nicks got off cocaine,
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I believe,
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and alcohol,
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I think at the time.
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SPEAKER_02: And she, people were pushing her to go to AA or 12 steps.
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SPEAKER_02: And she says, I'm not, why would I go?
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SPEAKER_02: I'm not using.
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SPEAKER_02: I do feel some anxiety or whatever so she went to the psychiatrist,
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doctor feel good type psychiatrist and he put her on a cocktail
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of drugs including
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SPEAKER_02: benzos.
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SPEAKER_02: She became quite overweight,
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SPEAKER_02: she lost her creativity,
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she lost her zest for life and she had a friend and she asked
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him to come round
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SPEAKER_02: And follow her regime.
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So he basically took the same meds that she was prescribed and
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she said by the
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SPEAKER_02: evening he was on his back on the floor.
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SPEAKER_02: So the next day,
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SPEAKER_02: the both of them went down to the psychiatrist and said,
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SPEAKER_02: listen,
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SPEAKER_02: he's taking the same meds.
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SPEAKER_02: He was nearly on his back.
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SPEAKER_02: The psychiatrist said, what are you trying to do?
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SPEAKER_02: Kill him?
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SPEAKER_02: I think you have to fact check this,
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but I think she then went to the Betty Ford clinic and I think
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she was in for three
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months just to detox and come off the psychic medications that
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she was on.
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SPEAKER_02: She got off and I'm not suggesting that people come off their meds.
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SPEAKER_02: This was under medical supervision but she got her creativity back,
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she got it into a weight that was more healthy and she was
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happy with and her life
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SPEAKER_02: really changed and she tells it really really well but
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SPEAKER_02: It's a great example, and it was my experience in Malaysia.
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I used to say to people,
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just,
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well,
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bring in your medications,
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let me see what you have.
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SPEAKER_02: And they'd come in with a bag.
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SPEAKER_02: And to be fair,
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SPEAKER_02: if you went to the doctor for a runny nose in Malaysia,
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SPEAKER_02: they'd give you a pill for your eyes,
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SPEAKER_02: your ears.
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SPEAKER_02: You know, polypharmacy was just a thing.
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But they would come in with a bag of maybe generic meds,
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branded meds,
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like a cocktail of range.
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SPEAKER_02: And I'm not joking you.
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SPEAKER_02: When they came off the meds, their life came back, right?
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SPEAKER_02: But why were they medicated in the first place?
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SPEAKER_02: Gender issues, sexuality, underachievement, right?
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That's the whole other area of psychiatry where it is used to
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treat that which we
10:46
SPEAKER_02: are not content with or not happy with.
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And I think that the follow up on my story of being in London
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and seeing how people were treated
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SPEAKER_02: was really similar to your taxi story.
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SPEAKER_02: It was kind of like, how did these folks get here?
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They seem incredible and wonderful and more interesting than
11:08
many of my colleagues.
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SPEAKER_02: I like spending time with them, but what has happened?
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SPEAKER_02: It wasn't that I saw through the chemical imbalance through science.
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SPEAKER_02: I saw it through the more predominant obvious causes of these situations.
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SPEAKER_02: Trauma, social exclusion, racism.
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SPEAKER_02: It was, to me, self-evident.
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Now,
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it may have impacted in terms of a correlate in the brain in
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some sort of chemistry.
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SPEAKER_02: I'm not denying that, but certainly it was back to Artie Lang.
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SPEAKER_02: You know, how do you make
11:52
SPEAKER_02: sense of an unlivable situation.
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You know,
11:55
how do you deal with your father abusing you from childhood,
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for example?
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SPEAKER_02: And I'm not talking about linear causality either.
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I'm talking about a set of conditions,
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but the environment was huge and stress was huge.
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SPEAKER_02: Poverty was huge in terms of the data and I think at the time,
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I think the greatest set of data was indicating that being
12:25
Afro-Caribbean or Irish
12:26
in London was the biggest predictor of what they were labeling
12:31
schizophrenia.
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SPEAKER_02: That was kind of self-evident when you were working with the population.
12:41
SPEAKER_01: Yeah,
12:41
SPEAKER_01: you know,
12:41
SPEAKER_01: it seems so obvious,
12:45
SPEAKER_01: right,
12:46
SPEAKER_01: that if we can imagine a different life,
12:50
and we can imagine like some of the stories that are told by
12:54
people that you've
12:55
SPEAKER_01: met,
12:56
SPEAKER_01: you could see yourself going crazy,
12:58
SPEAKER_01: right?
12:58
SPEAKER_01: And not being able to cope.
13:00
I mean,
13:00
whether it be abuse,
13:01
I mean,
13:01
everybody,
13:02
talk about kids,
13:03
kids need to be safe,
13:04
right?
13:04
SPEAKER_01: So if they're sexually abused, you know,
13:08
SPEAKER_01: The world becomes quite a frightening place.
13:12
SPEAKER_01: You know,
13:13
one of the psychiatrists I met when I was writing Anatomy and
13:16
Empathetic was named
13:17
SPEAKER_01: Tony Stanton.
13:18
SPEAKER_01: And he was running a residential center in the Bay Area in California.
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SPEAKER_01: And this is where the worst of the worst kids came.
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SPEAKER_01: You know,
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SPEAKER_01: no hospital wanted them,
13:30
SPEAKER_01: no foster care wanted them,
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SPEAKER_01: no residential center wanted them.
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SPEAKER_01: This was their last stop.
13:35
SPEAKER_01: And
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SPEAKER_01: This is gonna go to your point.
13:39
SPEAKER_01: What he did,
13:40
SPEAKER_01: the very first thing he did when these kids came in,
13:43
SPEAKER_01: is he did,
13:43
SPEAKER_01: he spent like 12,
13:44
SPEAKER_01: 15 hours developing a life story about the kids.
13:48
SPEAKER_01: So now everybody with the staff,
13:50
SPEAKER_01: rather than seeing a kid who had schizophrenia or a kid who had bipolar,
13:54
SPEAKER_01: saw a kid had had a,
13:55
SPEAKER_01: you know,
13:55
SPEAKER_01: basically abused,
13:57
SPEAKER_01: what had happened to them.
13:59
SPEAKER_01: And that completely changed things.
14:01
SPEAKER_01: Now, the other thing he did, and this goes to your point,
14:03
SPEAKER_01: Is he took all these kids off the medication.
14:06
SPEAKER_01: Because clearly it wasn't working, right?
14:08
SPEAKER_01: They'd been diagnosed, medicated, they came in.
14:11
He said they would come in so drugged up they couldn't keep
14:15
their heads off their
14:18
SPEAKER_01: deaths and all.
14:19
SPEAKER_01: And he said this too, which was really important.
14:21
SPEAKER_01: They were so medicated, they couldn't form emotional ties to staff.
14:27
SPEAKER_01: And oddly enough,
14:28
SPEAKER_01: the staff really couldn't form emotional ties to the kids,
14:32
SPEAKER_01: because it's an exchange of emotion and empathy and warmth.
14:35
SPEAKER_01: So he would take every kid off,
14:37
SPEAKER_01: and initially the kids,
14:38
SPEAKER_01: having been told how awfully they were,
14:39
SPEAKER_01: would try to act up and stuff.
14:42
SPEAKER_01: But what happened when they got off?
14:45
SPEAKER_01: What did everybody there,
14:47
SPEAKER_01: I spent a few days there,
14:48
SPEAKER_01: what did every staff member say happened when the kids got off?
14:52
SPEAKER_01: They said they came alive again.
14:55
SPEAKER_01: That was the phrase over and over again.
14:58
SPEAKER_01: And they said, we can now care for these kids and they can care for us.
15:01
SPEAKER_01: They start wanting to model their behavior.
15:03
SPEAKER_01: So we love them.
15:04
SPEAKER_01: So.
15:11
SPEAKER_01: I think that the thing is when,
15:12
SPEAKER_01: go back to R.D.Lang and stuff,
15:13
SPEAKER_01: when we deny,
15:14
SPEAKER_01: so there's two different thoughts.
15:17
With the disease model,
15:18
the problem resides in the inside of the head of the
15:20
individual,
15:20
right?
15:20
SPEAKER_01: There's something wrong with the head of the individual.
15:22
When we talk about R.D.Lang and we talk about the social
15:25
determinants of health,
15:27
SPEAKER_01: we see that so much of this arises from the in-between spaces,
15:33
SPEAKER_01: the environment we're in.
15:36
SPEAKER_01: How we move through the world, racism, poverty, sexual assaults, etc.
15:41
And everybody alive knows that environments that are difficult
15:46
exact a toll on you.
15:48
That's because we're so geared by evolution to be responsive to
15:53
our environments.
15:54
SPEAKER_01: And to have lost that understanding that you're talking about,
15:56
SPEAKER_01: Michael,
15:58
SPEAKER_01: it's mind-boggling that we don't see
16:01
SPEAKER_01: that these stresses you want to call it,
16:04
SPEAKER_01: isolation,
16:05
SPEAKER_01: fear,
16:06
SPEAKER_01: sexual abuse,
16:07
SPEAKER_01: why wouldn't they cause psychiatric difficulties?
16:10
SPEAKER_02: Well,
16:11
SPEAKER_02: a great experiment,
16:13
a great randomized control experiment would be to put a
16:20
psychiatrist in a solitary
16:24
SPEAKER_02: confinement.
16:26
SPEAKER_02: Yeah.
16:27
SPEAKER_02: to see how they respond to that stress,
16:32
SPEAKER_02: that environment,
16:32
because the number of people who will have psychotic
16:36
experiences in an intense
16:39
SPEAKER_02: sensory deprivation setting is kind of
16:44
Pretty conclusive,
16:46
which sort of challenges a lot of these ideas,
16:51
you know,
16:51
very practically.
16:52
SPEAKER_02: But, you know, jumping back, that was one of my first realizations.
16:57
SPEAKER_02: Again, it speaks a little bit to psychophobia.
17:01
SPEAKER_02: I thought people were different to me, right?
17:04
So I'm entering the world and I want to help people and they're
17:07
different and they
17:08
SPEAKER_02: looked different and they moved differently and,
17:11
SPEAKER_02: oh yeah,
17:11
SPEAKER_02: no,
17:11
SPEAKER_02: that must be what mental illness is.
17:15
And then I realized that is not mental illness,
17:18
that is the effects of the medication.
17:21
SPEAKER_02: So I was in ward rounds,
17:24
SPEAKER_02: I think it's the same here,
17:25
SPEAKER_02: terrible,
17:25
terrible thing in London where the patients had to shuffle into
17:32
a room that maybe
17:33
SPEAKER_02: had 15 or 20 people
17:36
SPEAKER_02: Psychiatrists,
17:38
SPEAKER_02: trainee psychiatrists,
17:39
SPEAKER_02: trainee social workers,
17:40
SPEAKER_02: occupational therapists,
17:42
SPEAKER_02: nurses,
17:42
SPEAKER_02: right?
17:42
SPEAKER_02: Like just a bunch of people.
17:45
SPEAKER_02: If you were in a bed in a ward with say appendix,
17:49
SPEAKER_02: they might come around as a little group,
17:51
SPEAKER_02: right?
17:51
like for a five minute ward round but on the psychiatric ward
17:54
people had to shuffle
17:55
in and I watched often these upper class men make judgements
18:04
about women and people
18:06
SPEAKER_02: of colour that were wrong
18:08
And they were wrong because they were beginning from an idea of
18:15
who they thought
18:16
SPEAKER_02: they were,
18:16
SPEAKER_02: which was someone who was psychotic or bipolar.
18:21
SPEAKER_02: And to give you an example of the sort of things I was watching,
18:24
SPEAKER_02: you know,
18:24
SPEAKER_02: they were saying,
18:25
SPEAKER_02: oh,
18:25
SPEAKER_02: this woman's incoherent.
18:26
SPEAKER_02: You know, she's making no sense.
18:27
SPEAKER_02: This is after she leaves the room.
18:29
SPEAKER_02: And I'm going, what are you talking about?
18:31
SPEAKER_02: She was really hilariously funny.
18:34
SPEAKER_02: The issue was she was one question behind.
18:39
SPEAKER_02: But because they didn't know her, they were asking her a question.
18:43
SPEAKER_02: She was out of sequence.
18:45
SPEAKER_02: She sounded incoherent.
18:46
SPEAKER_02: But because I knew her and I was working with her,
18:49
SPEAKER_02: I knew she was really intelligent and funny and on point.
18:52
The reason she was a question behind was because she was so
18:56
heavily medicated.
18:58
SPEAKER_02: And I couldn't break this.
19:00
I couldn't get them to see her in a different,
19:03
because she did look,
19:05
you know,
19:05
very disheveled.
19:07
SPEAKER_02: So what I did was I knew she was a singer.
19:09
SPEAKER_02: She had a demo CD.
19:11
SPEAKER_02: So I said, listen, indulge me here.
19:13
SPEAKER_02: And I went in and I put one of those beat boxes and I put the CD.
19:16
SPEAKER_02: She was my age.
19:18
SPEAKER_02: I put the beat box on and I played the look of love, which bellowed out.
19:23
SPEAKER_02: And I said, that is who you're going to see next.
19:25
SPEAKER_02: Right.
19:26
SPEAKER_02: And they probably all thought it was great.
19:28
But I was trying to bring in the humanity because it's the
19:32
dehumanization.
19:33
SPEAKER_02: It's like, they are not like me.
19:35
SPEAKER_02: They are different.
19:37
And I think the most powerful intervention you can give a human
19:41
being who's in
19:41
SPEAKER_02: distress is not looking away is to be able to say,
19:46
SPEAKER_02: I
19:48
SPEAKER_02: Don't necessarily have the answer,
19:50
SPEAKER_02: but I'm gonna stay with you until we try and find out what it is for you.
19:54
SPEAKER_02: Not for me, right, but for you.
19:56
SPEAKER_02: And when I'm training candidates and analysts,
20:01
SPEAKER_02: I said,
20:02
SPEAKER_02: you might be the only person in their life
20:06
Who isn't judging them or labeling them or reducing them to a
20:11
bunch of symptoms.
20:13
SPEAKER_02: You're prepared to be with them to encounter them fully.
20:18
SPEAKER_02: And I think we are sadly moving away
20:20
SPEAKER_02: from that because of the pressure on the system,
20:23
SPEAKER_02: because of what I would call the McDonaldization,
20:27
SPEAKER_02: the tick box,
20:27
SPEAKER_02: the let's get somebody,
20:29
SPEAKER_02: you know,
20:29
SPEAKER_02: the average psychiatrist sees somebody for 20 minutes after their initial
20:33
SPEAKER_02: assessment.
20:34
SPEAKER_02: I might see somebody for a minimum of two hours a week.
20:40
I think I'm in a much better position to say where they're at
20:43
than somebody asking
20:45
SPEAKER_02: a few tick box questions,
20:47
SPEAKER_02: right?
20:50
SPEAKER_01: So, you know, it's interesting.
20:52
We,
20:53
of course,
20:53
in Latin America,
20:54
we have published a lot of personal stories over the years.
20:58
I also interviewed a lot of people when I was doing Anatomy of
21:01
the Epidemic.
21:03
SPEAKER_01: And what I heard over and over again for people who got their lives back,
21:07
SPEAKER_01: they all told stories of relationships.
21:10
SPEAKER_01: Someone believed in me.
21:11
SPEAKER_01: Someone listened to me.
21:13
Someone cared for me and I began to care for somebody,
21:15
that sort of thing.
21:16
SPEAKER_01: I never heard someone just say that, oh, the drug made me well.
21:21
SPEAKER_01: I never heard that.
21:22
Some people said the drug helped them sort of stabilize,
21:25
that sort of thing.
21:26
SPEAKER_01: But the key over and over again was a relationship,
21:30
SPEAKER_01: finding meaning in life if they could,
21:32
SPEAKER_01: you know,
21:33
SPEAKER_01: some sort of interaction with,
21:35
SPEAKER_01: like,
21:36
SPEAKER_01: whether it be a group they joined,
21:39
SPEAKER_01: that sort of thing.
21:40
SPEAKER_01: But over and over again,
21:42
SPEAKER_01: The story I heard,
21:43
it was some sort of human connection that enabled them to be
21:46
with others again and
21:49
see themselves in that light that reflects back not an image of
21:52
a crazy person,
21:53
SPEAKER_01: but someone that can be with others.
21:55
SPEAKER_01: So yeah,
21:57
this is part of I think what you're talking about that is so
21:59
sad is because when we
22:03
SPEAKER_01: talk about how psychiatry exists to 20 minute things,
22:08
SPEAKER_01: That ultimately is a reflection of a philosophy of being,
22:11
SPEAKER_01: so to speak,
22:12
SPEAKER_01: that these are sort of mechanical people,
22:14
SPEAKER_01: right?
22:15
SPEAKER_01: There's a mechanism in there, a chemistry.
22:18
SPEAKER_01: That's the most impoverished philosophy of being imaginable.
22:23
SPEAKER_01: Whereas what you're talking about,
22:25
SPEAKER_01: being with others,
22:26
SPEAKER_01: comes from an understanding of the richness of human beings.
22:30
SPEAKER_01: We're mysteries so often, but we also know certain things that keep us
22:35
SPEAKER_01: Well, what do we need?
22:37
SPEAKER_01: Well, it's good to have a place to sleep.
22:40
SPEAKER_01: It's good to have food.
22:42
SPEAKER_01: It's good to have people you love and people who love you, right?
22:46
And it's good to have something that you find meaningful,
22:49
whatever you do in life.
22:51
SPEAKER_01: So we know these are how human beings react to their environments,
22:58
SPEAKER_01: that we are shaped by our environments.
23:00
SPEAKER_01: And to remove the environment,
23:02
SPEAKER_01: and just sort of say it's all happening in your head.
23:04
It's just,
23:06
it's so out of sync with what we know,
23:09
you know,
23:11
what it is to be human.
23:12
SPEAKER_02: So I think you kind of nailed it there.
23:15
SPEAKER_02: So if I have a broken arm,
23:18
SPEAKER_02: I'm happy to see a doctor for 12 minutes, right?
23:22
SPEAKER_02: Yeah, yeah.
23:23
SPEAKER_02: Cast it up, baby.
23:24
SPEAKER_02: It's not subjective.
23:26
SPEAKER_02: You can see that broken arm under an x-ray, right?
23:29
SPEAKER_02: I don't really need that.
23:30
SPEAKER_02: I need a bit of a bedside manner from the doctor,
23:33
SPEAKER_02: but I don't need to really connect on the level of humanity.
23:39
SPEAKER_02: The presentations I see are nowhere near a broken arm.
23:43
To me it doesn't fit that model and therefore the paradigm of
23:48
care is wrong in the short term.
23:55
SPEAKER_02: Or at least it doesn't need to be the sole focus.
24:00
So we've already acknowledged that there are times when
24:04
medication can be an
24:06
SPEAKER_02: intervention that saves a life.
24:08
SPEAKER_02: Right and can help people stabilize and get through.
24:12
It's more this idea of that it's the bio model as opposed to
24:19
the bio psychosocial model.
24:22
SPEAKER_02: And I think that's what was exciting about working in London initially.
24:27
Any paperwork for an involuntary hospitalization had to be
24:32
signed by a psychiatrist
24:33
SPEAKER_02: and a social worker.
24:35
So the psychiatrist was always working with the psychosocial
24:39
component and happy to do so.
24:41
So for the record,
24:44
I refused to go along to an involuntary hospitalization.
24:51
I still won the prize for social work when I did my undergrad,
24:55
but I just struggled with it.
24:59
I struggled with being in meetings where they were talking
25:01
about people being
25:03
SPEAKER_02: forcibly admitted to hospital because they were lighting candles in their
25:06
SPEAKER_02: apartment.
25:08
SPEAKER_02: That's an example, that's an example, right?
25:11
SPEAKER_02: Yeah.
25:11
SPEAKER_02: That's crazy.
25:12
Um,
25:13
you know,
25:13
it,
25:14
it,
25:15
it was watching the creep of,
25:18
uh,
25:18
risk dominating decisions,
25:21
right?
25:22
SPEAKER_02: Uh, no one
25:23
SPEAKER_02: wants something to happen on their watch,
25:26
so they're gonna err on the side of caution and that meant
25:31
people's liberty being
25:33
SPEAKER_02: at stake,
25:34
SPEAKER_02: either the liberty of their mind,
25:36
SPEAKER_02: body,
25:36
SPEAKER_02: speech and mind,
25:37
SPEAKER_02: or actually their physical liberty.
25:41
These are big big big decisions and I think they need to be
25:45
taken really really
25:46
seriously but they can happen very very quickly and I'm talking
25:52
on Saturday at a
25:52
SPEAKER_02: conference and one of the things I'll be talking about is
25:54
SPEAKER_02: Stapistemic destabilization,
25:57
SPEAKER_02: which sounds very fancy,
25:58
SPEAKER_02: but,
25:59
SPEAKER_02: you know,
25:59
SPEAKER_02: Lang talked about ontological insecurity.
26:03
SPEAKER_02: He really gave a model of what it's like to break down, but I think what
26:09
SPEAKER_02: What he missed was, well, what leads up to that?
26:13
SPEAKER_02: We don't wake up in a breakdown.
26:15
SPEAKER_02: There's a set of conditions.
26:16
Even if you do argue it's a chemical imbalance,
26:22
you don't wake up one day,
26:23
right?
26:24
SPEAKER_02: There's a trajectory to it.
26:28
SPEAKER_02: And I think that is something that's kind of missed.
26:36
SPEAKER_02: I had a point there, but I missed it.
26:39
SPEAKER_02: No, no, no.
26:40
SPEAKER_02: I just missed the mark of where that was going to end up.
26:45
SPEAKER_01: No,
26:45
SPEAKER_01: no,
26:45
SPEAKER_01: but I think,
26:46
SPEAKER_01: Michael,
26:49
what you were saying really raises an important point about
26:53
liberty and that sort
26:54
SPEAKER_01: of thing.
26:55
SPEAKER_01: And the sole sense of,
26:57
do people have the right to be the author of their own lives if
27:00
they haven't
27:00
SPEAKER_01: committed a crime,
27:01
SPEAKER_01: right?
27:01
SPEAKER_02: Yeah.
27:03
SPEAKER_01: And forced treatment is the state
27:06
SPEAKER_01: taking over the authorship of that person's life, right?
27:10
SPEAKER_01: Even though they haven't done a crime.
27:12
SPEAKER_01: Now, if they want the drugs, fine, it's that sort of thing.
27:15
SPEAKER_01: But all of a sudden,
27:16
SPEAKER_01: when you enter the psychiatric system,
27:17
you can lose the right to be the author of your own mind and
27:20
the liberty to think
27:23
SPEAKER_01: in the way that maybe you want to think,
27:25
SPEAKER_01: or that maybe it provides you with some comfort.
27:29
And I just think we need to look at it in that way when we
27:33
think about forced treatment.
27:34
SPEAKER_01: Would you like this done to you?
27:38
And would you like your right to be the author of your own life
27:40
taken away from you?
27:42
Because once you're forced to be medicated,
27:43
your thoughts are going to be different.
27:44
SPEAKER_01: Your movement around the world is going to be different.
27:47
SPEAKER_01: Your possibilities are going to be different.
27:50
SPEAKER_01: Who has the right,
27:51
does the state have the right to do that in the absence of
27:54
someone committing a
27:55
SPEAKER_01: crime?
27:56
SPEAKER_01: And I think this is,
27:58
I think we really need to understand what a big deal it is to
28:03
take someone away
28:04
SPEAKER_01: that
28:06
SPEAKER_01: The chance to be the author of their own lives.
28:10
SPEAKER_02: Really important point.
28:11
SPEAKER_02: I remember what I was going to say now.
28:12
SPEAKER_02: So I was,
28:13
I was making the point of epistemic destabilization and it's
28:16
this idea of,
28:17
SPEAKER_02: you know,
28:18
over the decades observing how much people around someone
28:24
through psychophobia or
28:26
SPEAKER_02: whatever,
28:27
SPEAKER_02: exasperate
28:30
their experience so they're actually destabilized and it often
28:35
starts with they
28:36
have an experience and the experience isn't believed right so
28:41
they're discounted I
28:43
see it often with people who perhaps are also on the spectrum
28:48
and there is a double
28:50
empathy problem where the neurotypical person just can't
28:54
understand right so it's
28:56
SPEAKER_02: not one way it's two way
28:59
But only one person will be taken away in an ambulance for
29:03
being elevated.
29:05
SPEAKER_02: So this idea of epistemic destabilization is when people's experience is
29:10
SPEAKER_02: discounted,
29:11
SPEAKER_02: not believed,
29:13
SPEAKER_02: labeled in different ways.
29:15
SPEAKER_02: And people get very hung up in this idea of consensus reality.
29:19
And I realized that that's a red herring because I realized
29:24
there's a difference
29:25
SPEAKER_02: between what is real and what is true.
29:29
SPEAKER_02: So if I'm walking over a bridge and I have a fear of heights,
29:35
SPEAKER_02: that fear of falling is very,
29:37
SPEAKER_02: very real,
29:38
SPEAKER_02: right?
29:39
SPEAKER_02: It mightn't be true,
29:40
SPEAKER_02: the bridge could be structurally solid,
29:43
SPEAKER_02: but the feeling is real,
29:44
SPEAKER_02: the fear is real,
29:46
SPEAKER_02: and I think again over 20 years,
29:50
I think what we miss is how activated people are when they are
29:55
in a state elevated
29:58
SPEAKER_02: or extreme.
30:00
Artie Lang used to talk about,
30:01
you know,
30:02
you have to really look at and understand despair.
30:05
SPEAKER_02: Imagine being in a situation where you're in a state of despair,
30:08
you're sort of doubting yourself and then everyone else starts
30:11
doubting the very
30:12
experience that you're troubled by and then gives words to it
30:16
that just don't fit
30:17
your experience or give you a label that you perceive as very
30:23
stigmatizing.
30:25
SPEAKER_02: So not only have you got your lived experience
30:28
and trying to deal and cope with that but you've got all these
30:30
things that are
30:31
being put upon you often by people and you've mentioned it a
30:35
few times who are in a
30:36
position of more power or more authority and very very often
30:42
but not always there
30:43
SPEAKER_02: are people whose voice was quite weak to begin with
30:47
who perhaps didn't have the confidence or sometimes education
30:53
or understanding that
30:54
SPEAKER_02: the people that they're encountering have.
30:57
SPEAKER_02: So it's an unfair playing field to begin with.
31:03
SPEAKER_01: Yeah,
31:04
SPEAKER_01: listen,
31:04
SPEAKER_01: I mean,
31:05
SPEAKER_01: there's so much what you're talking about,
31:07
SPEAKER_01: power dynamics,
31:08
SPEAKER_01: who has the power.
31:10
But I just want to say one thing,
31:11
go through life and people start discounting your experiences.
31:16
SPEAKER_01: See how you deal with it.
31:19
SPEAKER_01: That is really crazy making.
31:22
So you have a certain reality you're moving through and people
31:24
say,
31:24
no,
31:24
that's not true.
31:25
SPEAKER_01: That's not true.
31:25
SPEAKER_01: Or they're just ignoring you.
31:27
SPEAKER_01: That'll make it crazy.
31:28
So going back to the ward,
31:29
you know,
31:32
15 white people in a room with one young black youth.
31:37
SPEAKER_02: Oh yeah, he's aggressive.
31:39
SPEAKER_02: He's aggressive.
31:40
SPEAKER_02: You've taken him away from his family and his friends.
31:44
SPEAKER_02: You're not telling him when he's going to get out.
31:46
SPEAKER_02: You're condescending to him.
31:48
SPEAKER_02: You're from a different class background.
31:50
SPEAKER_02: To me,
31:50
SPEAKER_02: he's acting completely appropriately,
31:53
SPEAKER_02: but you just get into the spiral of pathology and label and it's like,
32:01
SPEAKER_02: wow,
32:02
SPEAKER_02: that's a hard one to get out of.
32:06
SPEAKER_02: Once you're in
32:09
SPEAKER_01: Yeah,
32:09
I just think just in terms of even going how to move forward
32:13
with this whole thing
32:14
is how do we regain a system that actually sees people through
32:23
this light of
32:25
complex human beings and can be understanding that that black
32:29
person within a group
32:31
SPEAKER_01: of people with 15 whites,
32:33
SPEAKER_01: maybe they have reason to be paranoid.
32:36
SPEAKER_01: Maybe they have reason to be suspicious.
32:38
SPEAKER_01: Maybe they have reason to be silent.
32:41
SPEAKER_02: I can't think of anything worse than,
32:43
SPEAKER_02: you know,
32:45
SPEAKER_02: you're exposed,
32:46
SPEAKER_02: you're vulnerable,
32:48
SPEAKER_02: you don't fully know,
32:50
SPEAKER_02: you know,
32:50
the ground has sort of gone from under your feet and you've
32:52
been asked to come into
32:53
a room of 15 strangers who are going to ask you questions and
32:57
the answer may affect
33:01
SPEAKER_01: your liberty,
33:02
SPEAKER_02: right?
33:03
SPEAKER_01: Yeah, of course you'd be scared.
33:06
SPEAKER_01: You'd be like frightened beyond belief.
33:09
SPEAKER_02: So I want to try and bring it all back, bring focus.
33:13
SPEAKER_02: You've mentioned Mad in America.
33:14
SPEAKER_02: So this is like happy thoughts.
33:17
SPEAKER_02: This is the good stuff.
33:20
SPEAKER_02: So people aren't confused.
33:21
You know,
33:21
there's the incredible book Mad in America,
33:24
but there's also this wonderful
33:27
SPEAKER_02: Would you call it a platform?
33:30
SPEAKER_02: Media platform.
33:31
SPEAKER_02: Yeah, a media platform.
33:32
Media platform that is really fresh and contemporary and has a
33:39
mix of voices from
33:41
SPEAKER_02: some clinicians,
33:43
SPEAKER_02: but a lot of people with lived experience,
33:45
SPEAKER_02: a lot of scientists.
33:48
Where is that now and are you happy with where it's at and what
33:52
do you see the
33:52
SPEAKER_02: future of that and what is its contribution?
33:58
SPEAKER_01: So, you know, we set this up in 2012 is when we opened it.
34:04
SPEAKER_01: And one of the reasons was that I felt the media at large,
34:10
SPEAKER_01: the legacy media or whatever,
34:12
SPEAKER_01: was so beholden to the people in power,
34:15
SPEAKER_01: okay,
34:16
SPEAKER_01: that it really wasn't doing a good job about telling us what was,
34:20
SPEAKER_01: you know,
34:21
SPEAKER_01: about the science,
34:22
SPEAKER_01: that sort of thing.
34:22
SPEAKER_01: And it also excluded the voice of those with lived experience.
34:26
because they bought this idea they're not reliable witnesses to
34:29
their own life.
34:31
SPEAKER_01: So we set up Mad in America with this idea.
34:34
There's so much science that's being published that doesn't get
34:38
research findings,
34:39
that doesn't get publicized precisely because it doesn't fit
34:41
the conventional
34:42
SPEAKER_01: narrative.
34:43
So we're going to be a media that does go into the science and
34:46
tell about long term
34:47
SPEAKER_01: outcomes and tell about adverse events,
34:50
all the stuff that's appearing in peer reviewed journals that
34:52
doesn't get promoted
34:53
SPEAKER_01: to the public at large.
34:54
We've been doing that for 14 years and you can go on and we of
34:58
course archive it.
34:59
SPEAKER_01: It's an extraordinary database you can go through and you can search for
35:05
SPEAKER_01: antidepressants,
35:06
SPEAKER_01: antipsychotics and you'll find all sorts of long term studies,
35:09
SPEAKER_01: etc.
35:10
SPEAKER_01: So the first was to be a forum for
35:13
Science findings that aren't promoted to the public precisely
35:16
because they,
35:17
SPEAKER_01: in fact,
35:19
SPEAKER_01: counter-guild the interest.
35:20
SPEAKER_01: That's the first thing.
35:24
SPEAKER_01: The second thing was,
35:25
SPEAKER_01: there was an understanding when we started this,
35:27
SPEAKER_01: that this disease model of care is a failed paradigm of care.
35:33
SPEAKER_01: Once you understand that,
35:35
SPEAKER_01: and you were presenting evidence for that,
35:36
SPEAKER_01: you need to have a forum for society,
35:40
SPEAKER_01: in essence,
35:40
SPEAKER_01: to have a discussion about possibilities,
35:42
SPEAKER_01: about alternatives,
35:43
SPEAKER_01: about different things we could do.
35:45
SPEAKER_01: And that needs to be a societal discussion that includes professionals,
35:49
SPEAKER_01: family members,
35:50
SPEAKER_01: politicians,
35:51
SPEAKER_01: and people with lived experience.
35:53
SPEAKER_01: A big robust, in other words,
35:56
That thought about what might be possible should not be limited
35:59
to just the
35:59
SPEAKER_01: psychiatrists or professionals.
36:01
SPEAKER_01: It should be a societal discussion.
36:03
SPEAKER_01: So we try to promote that.
36:05
And then we certainly believe that the voice of those who are
36:09
treated needs to be
36:11
heard and needs to be honored and to be part of any rethinking
36:16
of psychiatry.
36:18
SPEAKER_01: So what you see here is a meant to be a media forum platform.
36:24
for rethinking psychiatry and it's composed of science we have
36:28
archives it's
36:29
composed of blogs from people who you know bring different
36:35
perspectives about what
36:36
might be different and also we can talk about alternatives and
36:39
different things
36:39
that are happening report on those we can do and also we can do
36:43
investigative
36:44
journalism looking at corruption that sort of thing and then we
36:47
need to have the
36:49
SPEAKER_01: voice of people with lived experience and you add all this together
36:52
SPEAKER_01: And it has been a, it's a robust forum for rethinking psychiatry.
36:58
SPEAKER_01: And we do it in a very sort of non-demonizing way.
37:05
SPEAKER_01: We don't call people evil.
37:07
SPEAKER_01: We just sort of say,
37:08
SPEAKER_01: here's,
37:08
SPEAKER_01: here's,
37:09
SPEAKER_01: now maybe if there's corruption,
37:11
SPEAKER_01: we'll say here is the corruption,
37:12
SPEAKER_01: but we never attack people as evil.
37:15
SPEAKER_01: Okay.
37:16
SPEAKER_01: And because that's not helpful.
37:18
SPEAKER_01: And often,
37:19
SPEAKER_01: so often people want to do well,
37:20
SPEAKER_01: but they get caught in sort of trapped into systems that are doing harm.
37:25
SPEAKER_01: So I think,
37:28
SPEAKER_01: and you know,
37:29
we started just as Mad in America and the idea of Mad in
37:31
America is would be to
37:32
SPEAKER_01: invite people to contribute from all over the world.
37:35
And I remember one year we had readers from virtually every
37:39
country in the world,
37:40
SPEAKER_01: if you,
37:40
SPEAKER_01: if you'd.
37:42
But then we found that there was this resistance bubbling up in
37:45
country after
37:45
SPEAKER_01: country and we developed the affiliate sites.
37:48
SPEAKER_01: So there's a man in Norway, there's a man in Sweden.
37:51
SPEAKER_01: And what's great about all these affiliate sites,
37:53
SPEAKER_01: I think there's about 18 now,
37:55
on the one hand they share this sense that the disease model
37:58
that was exported
37:59
SPEAKER_01: around the globe didn't work,
38:01
SPEAKER_01: but now there are different cultural contexts.
38:04
that shape what is done and also shape what is possible and we
38:08
can sort of learn
38:09
SPEAKER_01: about different initiatives in different countries.
38:12
So to finish up here is when Michelle Funk at the World Health
38:20
Organization was
38:21
getting ready to write a couple papers on the need for a
38:26
revolution care away from
38:28
SPEAKER_01: the disease model,
38:30
SPEAKER_01: she looked to Madden America for as a resource for information
38:34
as a resource for information about alternative programs and
38:38
actually worked with
38:40
some of the people who worked for Mad in America to help her
38:45
produce these
38:46
SPEAKER_01: documents.
38:47
So the same thing was with when Danius Purris at the Special
38:50
Rapporteur for Health,
38:51
SPEAKER_01: when he was issuing his claim,
38:53
SPEAKER_01: we need to have a revolution in thinking,
38:56
SPEAKER_01: a paradigm shift.
38:57
SPEAKER_01: He looked to Mad in America for evidence for that and actually
39:03
SPEAKER_01: Had one of our science writers be a consultant.
39:06
SPEAKER_01: So this was really confirming,
39:10
affirming that what we are doing is seen as of value to people
39:14
in positions of
39:15
SPEAKER_01: authority.
39:17
SPEAKER_02: Well, what would be the legacy?
39:20
SPEAKER_02: You know,
39:20
SPEAKER_02: if you've dedicated,
39:21
SPEAKER_02: I mean,
39:21
it's staggering the contribution that you made and I thank you
39:25
again for it.
39:27
SPEAKER_02: You know,
39:27
SPEAKER_02: if you could distill it down to one thing,
39:29
SPEAKER_02: uh,
39:30
SPEAKER_02: one difference that you could have made or have made in the world,
39:33
SPEAKER_02: what,
39:33
SPEAKER_02: what would that be?
39:34
SPEAKER_02: You know, when this is all done and dusted?
39:36
SPEAKER_01: So there's sort of two answers to that question.
39:45
SPEAKER_01: I do hear all the time from people who said,
39:47
I read your book or I've read Man in America and it changed my
39:50
understanding of
39:51
SPEAKER_01: myself.
39:52
Changed my understanding of what happened to me and now I built
39:56
a new narrative for myself.
39:57
SPEAKER_01: I built a new life for myself.
39:59
SPEAKER_01: And Laura Delano with her book,
40:02
SPEAKER_01: Unshrunk,
40:02
is an example of someone who encountered anatomy of an epidemic
40:05
and it shifted her
40:06
SPEAKER_01: narrative.
40:08
SPEAKER_01: So, you know, if you've been a journalist
40:13
And you have people writing you saying like,
40:15
wow,
40:15
my life changed because of your work.
40:18
SPEAKER_01: And I got my life back.
40:20
SPEAKER_01: And I hear this quite often.
40:23
It's hard to have anything more rewarding for you as an
40:26
individual to have had that
40:27
SPEAKER_01: impact,
40:28
SPEAKER_01: right?
40:29
That's sort of a evidence of a meaningful career that you can
40:36
be proud of,
40:37
right?
40:37
SPEAKER_01: That you've had this impact.
40:39
SPEAKER_01: And every time I hear this, I feel grateful.
40:41
SPEAKER_02: I was just gonna say, you know, just give an example of the impact.
40:45
SPEAKER_02: You know,
40:45
SPEAKER_02: in the clinic I was in,
40:48
someone had read Anatomy of an Epidemic and bought the senior
40:53
management copies and
40:55
SPEAKER_02: said,
40:56
SPEAKER_02: you know,
40:56
SPEAKER_02: you highlighted open dialogue and basically said,
40:58
SPEAKER_02: why are you not doing this here?
41:00
And they ended up,
41:01
they became the first clinic in America to introduce open
41:05
dialogue.
41:06
SPEAKER_02: So it had profound effect from the ground
41:09
SPEAKER_02: You know,
41:10
the service users themselves right up to senior management and
41:14
then transforming an
41:18
SPEAKER_02: area of an organization and then all the research that came out of it.
41:21
SPEAKER_02: So that's just like one example of the impact of your work.
41:26
SPEAKER_02: And think of that as a pyramid,
41:27
SPEAKER_02: write the book and then it's like,
41:30
SPEAKER_02: whoa,
41:30
SPEAKER_02: that's pretty staggering.
41:32
You know that is that is a nice way to think of it and I will
41:35
say that I have seen
41:37
so for example initiatives in other countries say like Norway's
41:42
medication free
41:43
initiative I was brought over multiple times to speak about how
41:47
this could be an
41:48
evidence-based thing to set up an award where you would treat
41:51
people with psychosis
41:52
without medications or allow that for that possibility and then
41:56
there was a whole
41:56
SPEAKER_01: hospital that started it
41:58
A medication-free hospital was really a place to help people
42:02
taper off in Norway,
42:03
SPEAKER_01: that the founder,
42:06
SPEAKER_01: Ulle Underland,
42:06
SPEAKER_01: said,
42:07
SPEAKER_01: this is because I read your book.
42:10
SPEAKER_01: And the Soteria Projects that's happened in Israel,
42:14
SPEAKER_01: that was very much,
42:15
there was people from Israel who brought me over there to speak
42:18
to the Ministry of
42:18
SPEAKER_01: Health and talking about how Soteria Projects could be a replacement for
42:23
SPEAKER_01: Uh, you know, hospitalization and now they have really taken off.
42:26
SPEAKER_01: There's something like 20, 30 of these houses in Israel.
42:30
So I have seen changes at a,
42:33
uh,
42:34
almost a country line level doing alternatives that did arise.
42:38
And I wouldn't say it's because the evidence itself is so
42:41
powerful,
42:42
right?
42:43
SPEAKER_01: It said, I'm just like open dialogue.
42:45
SPEAKER_01: I'm just making it known.
42:46
It's it's the people who did the research are the ones that
42:49
really provided the seed for change.
42:52
So I really want to emphasize this because I think it's a
42:55
really important quality.
42:59
SPEAKER_02: Sometimes people can get sort of nihilistic,
43:01
SPEAKER_02: you know,
43:01
SPEAKER_02: and activists can,
43:02
SPEAKER_02: I think,
43:03
SPEAKER_02: sometimes get nihilistic.
43:05
SPEAKER_02: You have not only sort of deconstructed,
43:08
SPEAKER_02: you've kind of reconstructed because you said,
43:10
SPEAKER_02: look,
43:12
SPEAKER_02: not only am I pinpointing things where it's not working,
43:15
but actually I'm highlighting things where it has and
43:18
potentially this is something
43:19
SPEAKER_02: that can be developed.
43:21
I think that's a really important quality and a really
43:23
important contribution of
43:25
SPEAKER_02: your overall work.
43:28
SPEAKER_01: Yeah, I think this is so important.
43:31
SPEAKER_01: If you go into the history and you go into the science,
43:34
it's really sort of an optimistic possibility for the very
43:37
reason we talked about
43:38
SPEAKER_01: before,
43:39
SPEAKER_01: what you see over and over again,
43:41
SPEAKER_01: that with the right social supports,
43:44
SPEAKER_01: so often these difficulties can be transformed into episodic problems,
43:49
SPEAKER_01: not chronic problems.
43:51
SPEAKER_01: And of course, if we talk about kids,
43:53
Kids grow out of who they are as little kids and they grow up
43:58
if they're given the
43:59
SPEAKER_01: chance to grow up.
44:01
SPEAKER_02: When did recovery and hope become conspiracy theories?
44:10
SPEAKER_01: Well, you know, this is part of the story with the disease model.
44:13
SPEAKER_01: It took away the hope.
44:15
SPEAKER_01: And I remember talking to people.
44:17
SPEAKER_01: I remember when I went in to the psychiatrist,
44:19
SPEAKER_01: he told me he had a chemical imbalance,
44:21
SPEAKER_01: I needed to take these drugs for life,
44:23
SPEAKER_01: and I left thinking,
44:24
SPEAKER_01: my life as I knew it is over.
44:27
So they delivered this pessimistic message rather than a
44:30
message of hope and possibility.
44:33
SPEAKER_01: It comes with the disease model.
44:35
SPEAKER_01: The disease model is so pessimistic, the problems are inside your head.
44:39
I'll probably get in a lot of trouble for saying this,
44:41
but I'm going to say it anyway.
44:43
SPEAKER_02: I draw a parallel to the 12 step groups.
44:47
SPEAKER_02: So they do incredible things.
44:49
SPEAKER_02: They save lives and all the rest.
44:51
SPEAKER_02: But the disease model, I would argue for some people takes away agency.
44:59
SPEAKER_02: I would make an argument, I'm sober for six months and I have a drink.
45:06
SPEAKER_02: In 12 step group, they might say it was because you're an alcoholic.
45:10
SPEAKER_02: I would say it's because you chose to have that drink, right?
45:13
SPEAKER_02: You're detoxed, you've had six months under your belt.
45:17
SPEAKER_02: Now,
45:18
SPEAKER_02: for some people,
45:19
using the disease model and an alcoholic is life-saving and
45:24
important and helpful.
45:26
SPEAKER_02: For other people,
45:27
SPEAKER_02: they never get the chance to experience full agency because,
45:31
SPEAKER_02: well,
45:32
SPEAKER_02: I had a drink,
45:33
SPEAKER_02: I'm an alcoholic.
45:36
There isn't the same focus on well there's actually choice and
45:40
I think my own
45:43
SPEAKER_02: breakthrough was seeing through my own psychophobia,
45:47
seeing that actually this person in this what seems like quite
45:51
an extreme elevated
45:52
SPEAKER_02: state is just like me.
45:54
SPEAKER_02: Right?
45:55
SPEAKER_02: But I have traditionally thought they're not like me.
45:59
SPEAKER_02: And when I think they are like me,
46:01
SPEAKER_02: I can connect on a level that breaks through stigma,
46:04
SPEAKER_02: label,
46:05
and opens up the possibility that things can get a lot better
46:10
if that's what the
46:11
SPEAKER_02: person wants.
46:13
SPEAKER_02: But it's a controversial view.
46:14
SPEAKER_01: No, but can I say something, Michael?
46:17
SPEAKER_01: What history tells you this.
46:19
SPEAKER_01: If you have a system that treats people with difficulties as the other,
46:24
SPEAKER_01: as different,
46:26
SPEAKER_01: that becomes a belief system that lends itself to harm,
46:31
SPEAKER_01: to doing cruel things,
46:33
SPEAKER_01: okay?
46:33
SPEAKER_01: Because they're the other.
46:35
SPEAKER_01: You'll do things to them you wouldn't do to yourselves.
46:38
SPEAKER_01: But if you see those people as like you,
46:41
SPEAKER_01: as the same as you,
46:42
SPEAKER_01: and therefore for the grace of God go I,
46:48
That recognizes a common humanity that can be so important for
46:52
going forward and
46:53
SPEAKER_01: people getting their lives back.
46:55
SPEAKER_01: So in big picture way,
46:59
SPEAKER_01: if we talk about rethinking a new paradigm of care,
47:02
the fee is not to have a belief system that treats people with
47:07
psychiatric
47:08
SPEAKER_01: difficulties as the other,
47:10
SPEAKER_01: kids as the other.
47:12
SPEAKER_01: The minute you do that, you abuse people.
47:15
SPEAKER_01: The system becomes abusive.
47:18
SPEAKER_01: But if they're like RV Lang and all this sort of thing,
47:20
SPEAKER_01: they're like us,
47:22
SPEAKER_01: they are us,
47:23
SPEAKER_01: well then that engenders improving the environment,
47:31
SPEAKER_01: helping people get a meaning in their life,
47:34
SPEAKER_01: good food,
47:35
SPEAKER_01: shelter,
47:36
SPEAKER_01: that sort of thing.
47:37
SPEAKER_01: That is to me the big message from history.
47:42
So I'm going to bring you back because you had two parts to
47:45
your legacy and I
47:46
interjected after you said the first one but you know the
47:50
reason I have an asterisk
47:52
SPEAKER_02: on my work is just to signify first of all psychophobia
47:57
is there's an irony in that because I'm using a
47:59
psychopathological term to calling
48:01
out how we psychopathologize people but also that the asterisk
48:06
represents nuance
48:07
and complexity and there are no easy answers to this so we've
48:10
covered a lot of
48:11
SPEAKER_02: ground
48:12
I think underneath that there's the implicit acknowledgement
48:16
that some of these
48:17
SPEAKER_02: situations are really complicated.
48:20
SPEAKER_02: What psychiatrists and first responders sometimes have to deal with
48:27
There are quite extreme situations and there is no quick easy
48:32
answer but I think
48:34
SPEAKER_02: there is more compassion,
48:38
SPEAKER_02: kindness,
48:39
SPEAKER_02: understanding and probably most important of all,
48:43
SPEAKER_02: uncertainty.
48:44
SPEAKER_02: You know,
48:45
to me so many mistakes come from people being certain and not
48:49
prepared to revise
48:50
SPEAKER_02: that certainty,
48:51
SPEAKER_02: remaining open and uncertain and it's interesting because
48:54
SPEAKER_02: To me,
48:55
SPEAKER_02: you know,
48:55
SPEAKER_02: working existentially and phenomenologically and psychoanalytically,
49:00
SPEAKER_02: uncertainty is at the heart and it's also at the heart of open dialogue.
49:05
So a lot of open dialogue approach I'd kind of a little bit
49:10
taken for granted as
49:10
SPEAKER_02: that's how I would practice.
49:12
SPEAKER_02: But what was the other pillar of legacy that you were going to mention?
49:18
SPEAKER_01: Oh, just I think the thing is in terms of legacy, there's this legacy of
49:23
Hearing from individuals who changed their narrative,
49:25
thanks to some of the work we've done.
49:28
SPEAKER_01: But there is, there's sort of almost three things.
49:31
SPEAKER_01: I think we have helped change the narrative that exists out there.
49:34
SPEAKER_01: We deconstruct that, the disease model narrative.
49:38
SPEAKER_01: And then we have helped prompt alternatives,
49:42
SPEAKER_01: satiria houses,
49:46
SPEAKER_01: an international institute for psychiatric drug withdrawal,
49:48
SPEAKER_01: making tapering
49:49
SPEAKER_01: Sort of acceptable support for tapering from drugs,
49:54
SPEAKER_01: medication-free efforts,
49:57
SPEAKER_01: that sort of thing.
49:57
SPEAKER_01: So,
49:59
SPEAKER_01: I mean,
50:02
SPEAKER_01: it's a little weird to be talking about your legacy,
50:05
SPEAKER_01: but if I speak to myself and say what has made this time worthwhile,
50:12
SPEAKER_01: I would say it's sort of those three points.
50:14
SPEAKER_01: It's that, one, individuals
50:17
Reshape their own narrative going forward and they talk about
50:20
getting their lives back.
50:22
SPEAKER_01: Second,
50:22
we have had a key role in showing that the conventional disease
50:27
model narrative is
50:29
SPEAKER_01: not a scientific narrative.
50:30
SPEAKER_01: It's really best understood to be a marketing narrative.
50:33
So it's good not to be organizing our thoughts around the false
50:36
narrative of science.
50:38
SPEAKER_01: And then finally,
50:39
it has helped spur some alternatives away from the drug model
50:43
and that sort of
50:43
SPEAKER_01: thing.
50:44
SPEAKER_01: So, you know, I'm proud of that.
50:47
SPEAKER_02: Yeah,
50:48
SPEAKER_02: I should have worded it,
50:49
SPEAKER_02: you know,
50:49
SPEAKER_02: legacy from all the work that you've done as opposed to
50:55
SPEAKER_00: This is your life, this is your legacy.
50:57
It's more just sort of the amount of effort that you've put in
51:01
and dedication.
51:02
SPEAKER_02: It's kind of like, what would be your dream outcome from that?
51:05
SPEAKER_02: And I think you've covered it.
51:07
SPEAKER_02: I think it's also fair to say,
51:09
because I'm sure we'll get a lot of people challenging some of
51:13
the things.
51:14
If someone believes in a disease model and it's helpful and the
51:21
diagnosis is
51:22
SPEAKER_02: helpful and the medication is helpful,
51:25
SPEAKER_02: Wonderful, right?
51:27
SPEAKER_01: Yeah, I wish that was the story.
51:29
SPEAKER_01: I wish it was helpful for everyone then.
51:31
SPEAKER_02: 100%.
51:31
SPEAKER_01: In that way.
51:32
SPEAKER_02: I think it's more the dominance.
51:35
SPEAKER_02: So it's the dominance of some of these ideas.
51:41
SPEAKER_02: They risk excluding opportunities for growth,
51:46
SPEAKER_02: for change,
51:47
SPEAKER_02: for recovery,
51:48
for hope or for seeing people in a different way and you made
51:53
that point and I
51:54
SPEAKER_02: think
51:55
I think when Leah was on she was talking about her own
51:58
experience of feeling that
52:00
well this is as good as my life's gonna get now having this
52:03
diagnosis and then she
52:06
realized through relationship with others that no no no no no
52:11
that is a really
52:12
SPEAKER_02: limited view of who I can be it's much much broader and
52:19
If people just understand that,
52:22
that the dominance of the medical model is quite limiting.
52:28
And I think my argument would be,
52:30
again back to informed choice,
52:32
the more you understand
52:35
SPEAKER_02: alternative approaches,
52:37
SPEAKER_02: wider approaches,
52:38
SPEAKER_02: the weakness and strength in some of these studies,
52:43
I think people will be in a much better position and be in a
52:47
much better position
52:48
SPEAKER_02: to seek the support that they actually need.
52:52
I remember being on a team once for early intervention and I
52:57
said to the lead
52:58
SPEAKER_02: psychiatrist,
52:59
SPEAKER_02: you know,
53:00
SPEAKER_02: what about the Hearing Voices group?
53:03
SPEAKER_02: And he said, the job of this team is to eradicate hearing voices.
53:10
SPEAKER_02: You know, again, it's about choice.
53:14
SPEAKER_02: Who is he to make that decision about someone's lived experience?
53:21
SPEAKER_02: That's extraordinary.
53:24
SPEAKER_01: Yeah.
53:24
I mean,
53:24
I think that's a fundamental value is that you're trying to
53:30
create a system
53:32
SPEAKER_01: A narrative where people can make choices.
53:35
They can retain sort of agency over their lives and you can
53:39
help them perhaps make
53:40
SPEAKER_01: better choices and see the possibilities.
53:43
SPEAKER_01: But at least from my own point of view,
53:48
SPEAKER_01: you don't want to force things on individuals,
53:52
SPEAKER_01: including ideas.
53:54
SPEAKER_01: Including conclusions, that sort of thing.
53:58
Get people information and let them work their way through that
54:02
information.
54:03
SPEAKER_01: See how it fits with their individual lives.
54:08
SPEAKER_01: But I think there's a value,
54:09
SPEAKER_01: and this goes back to against forced treatment,
54:11
SPEAKER_01: is you want a system that
54:16
ultimately honors the individual's chance to be the author of
54:21
their own lives and
54:23
SPEAKER_01: do so in an informed manner regarding possibilities.
54:29
SPEAKER_02: Do you think, because it gets complicated, the more sort of extreme
54:38
SPEAKER_02: End of certain presentations.
54:41
Do you think there's ever a case for forced medication or
54:45
forced treatment?
54:48
SPEAKER_01: Well, I was hoping you wouldn't ask that question.
54:51
SPEAKER_02: Well, because somebody's going to ask us, aren't they?
54:54
SPEAKER_02: That's what they'll come back with.
54:56
SPEAKER_02: It's always the extreme end of the argument that you're hit with.
55:00
SPEAKER_02: And I can answer it because I spent a lot of time at that end,
55:05
SPEAKER_02: but I was just wondering what you thought.
55:09
The problem,
55:10
in my opinion,
55:12
I know of cases of sort of forced treatment that ended well.
55:18
SPEAKER_01: Okay.
55:19
But they ended well because the forced treatment did not
55:23
translate into continual treatment.
55:27
Someone was clearly out of their mind and in bad shape and they
55:30
were forcibly medicated.
55:32
SPEAKER_01: But then in this, for an example of this case, the person still saw
55:38
SPEAKER_01: An example,
55:39
SPEAKER_01: my friend,
55:40
SPEAKER_01: as someone who was just having a difficult time,
55:42
SPEAKER_01: so they didn't really put him in that box.
55:45
SPEAKER_01: And they got him off the meds pretty fast.
55:48
SPEAKER_01: And,
55:49
SPEAKER_01: you know,
55:49
SPEAKER_01: that person,
55:50
SPEAKER_01: I think if you spoke to him,
55:51
would feel grateful that they sort of calmed him down with a
55:54
tranquilizer,
55:55
SPEAKER_01: okay,
55:56
SPEAKER_01: for a while.
55:58
SPEAKER_01: The problem is forced treatment, the fact that it exists,
56:06
SPEAKER_01: It can,
56:07
it's so easily abused and it's so easily turned into like sort
56:10
of control over
56:11
SPEAKER_01: others and harm done for others.
56:15
SPEAKER_01: And it becomes sort of the go-to thing.
56:19
SPEAKER_01: And it is a thing of,
56:22
SPEAKER_01: once it becomes really sinking into what you do as a society,
56:26
SPEAKER_01: it becomes a way of taking away people's liberty.
56:31
SPEAKER_01: It does.
56:32
SPEAKER_01: And their chance to be there, you know, make their own decisions.
56:36
SPEAKER_01: And so you,
56:37
SPEAKER_01: when you forcefully treat people,
56:39
SPEAKER_01: especially in any sort of lengthy way,
56:41
SPEAKER_01: it's one thing to give them a tranquilizer,
56:43
SPEAKER_01: okay?
56:44
SPEAKER_01: Okay, we need to tranquilize.
56:45
SPEAKER_01: We need to sedate this person.
56:46
SPEAKER_01: We need to like chill them out.
56:48
SPEAKER_01: Okay, fine in a way, I think.
56:50
But the minute you think you're giving them medication they
56:53
need and you're going
56:53
SPEAKER_01: to start insisting on that,
56:55
SPEAKER_01: right?
56:55
SPEAKER_01: For a long term.
56:58
SPEAKER_01: And we know these medications do change how you interact with the world,
57:02
SPEAKER_01: your sexual function,
57:03
SPEAKER_01: how you think,
57:04
SPEAKER_01: why you feel.
57:07
That just becomes a system that is doing harm and it's not
57:10
honoring the liberty of
57:12
SPEAKER_01: people,
57:12
SPEAKER_01: the freedom of people.
57:13
SPEAKER_01: So I actually think unless we're talking about tranquilizers,
57:20
SPEAKER_01: unless we talk about changing the language,
57:24
SPEAKER_01: then I'm against worse treatment.
57:28
I'm against forced treatment with antipsychotics when they're
57:30
not antipsychotics.
57:32
Could I see the thing where you would give a person a
57:34
tranquilizer who was,
57:36
SPEAKER_01: you know,
57:36
SPEAKER_01: really thin?
57:37
SPEAKER_01: Yeah.
57:38
SPEAKER_01: That's okay with me.
57:39
SPEAKER_02: If that makes sense.
57:40
SPEAKER_02: It does.
57:41
SPEAKER_02: And, you know, I concur.
57:43
You know,
57:43
I was,
57:44
you know,
57:44
your thing is,
57:44
well,
57:44
how would you like yourself to be treated?
57:47
SPEAKER_02: Right.
57:47
SPEAKER_02: If it was short term, help me calm down.
57:50
SPEAKER_02: I'm more than happy.
57:52
SPEAKER_02: I think you described two very, very different
57:54
SPEAKER_02: And I think it's important to make the distinction.
57:59
So I'm going to ask you a really difficult question and this is
58:02
a personal question
58:03
SPEAKER_02: that I really struggle with.
58:05
SPEAKER_02: I was in
58:10
I left the hotel about half five in the morning and I drove I
58:15
ended up in a taxi
58:16
and I went through this area we talked about this before the
58:21
opioid fold where you
58:23
SPEAKER_02: see human beings they're standing on their feet it was the most
58:27
SPEAKER_02: It was a disturbing thing I've seen because it seemed not human.
58:33
You know,
58:34
you couldn't stand like that without the aid of the medication,
58:39
right?
58:39
SPEAKER_02: Because it was just, it kind of really defied gravity.
58:43
SPEAKER_02: And then I realised that I forgot my passport.
58:45
I had to go back to the hotel in the car and then come through
58:48
that area again.
58:51
SPEAKER_02: In some of these areas,
58:53
people are given safe places to use drugs and fresh needles and
59:00
all the rest.
59:01
SPEAKER_02: And when I see some of the images in real life and on the news,
59:06
SPEAKER_02: I think,
59:07
SPEAKER_02: is that the best we can do?
59:09
SPEAKER_02: Do we just leave people in that state to make the choices that they are,
59:15
SPEAKER_02: or do we do some sort of intervention?
59:17
SPEAKER_02: But I know
59:19
SPEAKER_02: That moves towards a forced intervention.
59:22
And I know that people are very against that,
59:23
but what is the,
59:25
again,
59:25
it's the asterisk.
59:27
SPEAKER_02: To me, true compassion is a response to what you see, right?
59:34
SPEAKER_02: I'm responding to a need.
59:37
SPEAKER_02: To me, there is a need there.
59:40
SPEAKER_02: Clearly.
59:41
SPEAKER_02: Well, is there any sort of answer or have you ever thought about that?
59:45
SPEAKER_02: I mean,
59:45
SPEAKER_02: is that just seeing people,
59:47
SPEAKER_02: you know,
59:48
SPEAKER_02: with open sores and ulcers and...
59:50
SPEAKER_01: Yeah,
59:50
SPEAKER_01: yeah,
59:50
SPEAKER_01: yeah.
59:51
You know,
59:52
there's areas in Boston,
59:53
you can see it,
59:53
but certainly in San Francisco.
59:55
You know,
59:58
sometimes it's good to not have an opinion because you don't
1:00:01
know enough.
1:00:03
SPEAKER_01: I love that, yeah.
1:00:05
SPEAKER_01: And I haven't worked with such people, okay?
1:00:10
SPEAKER_01: So,
1:00:11
I would be loath to really offer an opinion because I don't
1:00:16
know enough about what
1:00:18
SPEAKER_01: is possible and what is happening to these people,
1:00:22
SPEAKER_01: that sort of thing.
1:00:25
My gut check is you should have a society that is trying to
1:00:30
help them out of that condition.
1:00:34
SPEAKER_01: Question is, how do you do it?
1:00:37
SPEAKER_01: Just giving a place to have drugs, I don't know if that's the answer.
1:00:40
SPEAKER_01: I mean, are we talking about housing problems?
1:00:45
SPEAKER_01: Are we talking about access to food?
1:00:48
SPEAKER_01: You know, what led people to this place?
1:00:50
SPEAKER_01: All of it, I think.
1:00:51
SPEAKER_02: You know, you see the tents on the streets.
1:00:56
SPEAKER_01: Yeah, so the tents, why do they have tents?
1:00:58
SPEAKER_01: Because they can't afford places, right?
1:01:00
SPEAKER_01: I mean, so often there's not subsidized housing and that sort of thing.
1:01:04
SPEAKER_02: Yeah.
1:01:05
SPEAKER_01: So,
1:01:06
SPEAKER_01: my answer is,
1:01:09
it's a societal failure to see that on the streets of San
1:01:12
Francisco or other
1:01:13
SPEAKER_01: streets,
1:01:14
SPEAKER_01: okay?
1:01:14
SPEAKER_01: The homelessness.
1:01:15
SPEAKER_01: That speaks of a societal failure.
1:01:20
And you know,
1:01:21
we have drugs running across our country like crazy too,
1:01:25
right?
1:01:26
SPEAKER_01: The availability of drugs of different types.
1:01:34
SPEAKER_01: I think if I had a magic wand,
1:01:38
SPEAKER_01: I would try to say,
1:01:39
SPEAKER_01: first of all,
1:01:40
to recognize it as a societal failure and then think about how
1:01:44
do we change things
1:01:45
SPEAKER_01: so we start diminishing this problem,
1:01:48
SPEAKER_01: people living in tents and doing drugs and that sort of thing.
1:01:52
SPEAKER_01: And then, again, this is not my, you know, I'm not a social worker.
1:01:59
SPEAKER_01: You really would need a social worker to talk.
1:02:00
SPEAKER_01: But it seems to me that programs that help people get housing,
1:02:06
SPEAKER_01: help people get food,
1:02:10
SPEAKER_01: that sort of thing,
1:02:11
that's probably a better response than just helping them find a
1:02:16
place to shoot up.
1:02:18
SPEAKER_02: I think...
1:02:19
SPEAKER_01: But that's... Yeah, go ahead.
1:02:21
SPEAKER_02: The opioid thing is crazy.
1:02:23
You know I've never met anyone here with a serious opioid issue
1:02:30
that didn't start
1:02:31
SPEAKER_02: with some sort of accident.
1:02:33
SPEAKER_02: You know where they've been medically
1:02:36
I was working with a veteran who's injured their leg and they
1:02:44
were given it in a tub.
1:02:47
SPEAKER_02: Again, no informed consent or someone's injured their back.
1:02:51
At the point of presentation to services,
1:02:56
they're maybe buying heroin on the street or
1:03:02
SPEAKER_02: Fentanyl on the street, right?
1:03:03
SPEAKER_02: But, you know, prior to that, there had no history of drug use.
1:03:08
SPEAKER_02: So I'm thinking,
1:03:09
SPEAKER_02: you know,
1:03:10
SPEAKER_02: if you think in terms of agency,
1:03:14
SPEAKER_02: I think in terms of,
1:03:16
SPEAKER_02: you know,
1:03:16
SPEAKER_02: also facticity,
1:03:18
SPEAKER_02: right?
1:03:19
SPEAKER_02: I might say I want to give up an opioid,
1:03:22
but my chemical structure has been rewired by the use of my
1:03:28
relationship to pain.
1:03:31
SPEAKER_02: I could be on the street,
1:03:32
which is actually a traumatic experience in and of itself for
1:03:35
many people,
1:03:36
SPEAKER_02: just having the grind of being unhoused.
1:03:43
So it's a bit like someone who's in the throes of alcoholism
1:03:47
and then four weeks
1:03:49
SPEAKER_02: later they're sober.
1:03:50
To try and imagine what that sobriety would be like when you're
1:03:54
in the middle of
1:03:54
SPEAKER_02: the alcoholism is really impossible.
1:03:57
SPEAKER_02: So if you give someone an opportunity to experience that,
1:04:00
SPEAKER_02: you know,
1:04:01
SPEAKER_02: in some sort of way to detox,
1:04:05
SPEAKER_02: et cetera,
1:04:05
SPEAKER_02: et cetera,
1:04:06
SPEAKER_02: I guess the alternative might be to offer those pathways.
1:04:09
SPEAKER_02: And I think you said something beautiful.
1:04:12
SPEAKER_02: I mean, I don't know enough about it.
1:04:14
SPEAKER_02: I don't know what opportunities there are for people.
1:04:17
It just seemed to be such a hard thing to witness and to know
1:04:22
in a city of such
1:04:23
SPEAKER_02: wealth,
1:04:24
SPEAKER_02: with all the billionaires and all the tech people,
1:04:27
SPEAKER_02: with human beings who are in a physical state of duress.
1:04:36
SPEAKER_02: Shocking.
1:04:36
SPEAKER_01: Listen, it's clearly a societal failure to tolerate that.
1:04:42
SPEAKER_01: To accept it as a sort of a regular norm, right?
1:04:46
SPEAKER_01: And it does talk about housing,
1:04:52
SPEAKER_01: shelter,
1:04:53
SPEAKER_01: access to food,
1:04:54
SPEAKER_01: social supports,
1:04:56
the incredible unequal distribution of wealth in this country
1:05:01
is just unbelievable.
1:05:02
SPEAKER_01: It's crazy.
1:05:03
SPEAKER_01: Billion, yeah.
1:05:05
SPEAKER_02: So, I'm very conscious of time and you've been really extremely generous.
1:05:10
SPEAKER_02: I love, I could talk to you forever, I have to be honest.
1:05:14
SPEAKER_02: I've really enjoyed it.
1:05:16
SPEAKER_02: What's the summary, because I know that we
1:05:18
SPEAKER_02: I would love jumping all over the place,
1:05:20
SPEAKER_02: but how do we summarize what we're saying in all of this?
1:05:24
SPEAKER_02: Because I think you've got real clarity.
1:05:29
SPEAKER_02: So let's give an example of someone who is in a state of distress,
1:05:36
SPEAKER_02: who may be in an emotional,
1:05:39
SPEAKER_02: destabilized,
1:05:40
SPEAKER_02: maybe their sense of consensual reality has shifted.
1:05:46
SPEAKER_02: How would,
1:05:47
SPEAKER_02: with all the experience that you've had and all the research,
1:05:50
SPEAKER_02: what would you say would be the best intervention?
1:05:53
SPEAKER_02: And I know we're talking very generally,
1:05:55
SPEAKER_02: given all the science and all the data,
1:05:57
SPEAKER_02: what would be the optimum?
1:06:02
SPEAKER_02: How that person would be met and encountered in an ideal world?
1:06:07
SPEAKER_01: Well,
1:06:07
SPEAKER_01: I think actually the open dialogue program in Northern Finland,
1:06:10
SPEAKER_01: as it existed starting in 1990,
1:06:14
SPEAKER_01: really did a good job at this.
1:06:17
SPEAKER_01: Because what did they do?
1:06:17
SPEAKER_01: They immediately, first of all, they reconceived it.
1:06:21
They didn't say the problem's in the individual,
1:06:23
it's in the in-between spaces,
1:06:24
okay?
1:06:24
SPEAKER_01: So right away they're going to try to treat the person's community.
1:06:29
SPEAKER_01: And then the second of all,
1:06:31
SPEAKER_01: so they would,
1:06:32
SPEAKER_01: once they heard of this problem,
1:06:34
SPEAKER_01: once they encountered the problem,
1:06:35
they would immediately try to set up a setting where people
1:06:38
could talk about this,
1:06:39
SPEAKER_01: including the person that
1:06:41
SPEAKER_01: You know, in extreme distress.
1:06:44
SPEAKER_01: But they weren't treating just the individual.
1:06:45
SPEAKER_01: They were treating the environment that that individual existed with.
1:06:50
SPEAKER_01: And they gave the message, we're going to be here for you.
1:06:53
SPEAKER_01: We'll meet today.
1:06:54
SPEAKER_01: We'll meet tomorrow.
1:06:55
SPEAKER_01: We're going to try to keep you out of the hospital.
1:06:57
And we're going to try to build a chance for you to be with
1:07:01
others again and not be
1:07:03
SPEAKER_01: afraid with others.
1:07:05
SPEAKER_01: So the ideal way, and it kept people safe, okay?
1:07:09
SPEAKER_01: When they set up these containers at these group meetings,
1:07:13
SPEAKER_01: right,
1:07:14
SPEAKER_01: in the open dialogue model with two people and listening to each other,
1:07:18
SPEAKER_01: they had a long record of doing this in a safe manner.
1:07:21
SPEAKER_01: That became a safe space for everyone involved,
1:07:24
SPEAKER_01: basically,
1:07:25
SPEAKER_01: because there was a de-escalation of,
1:07:28
SPEAKER_01: they weren't trying to do things to the person who was in distress,
1:07:31
SPEAKER_01: but they were trying to meet that person,
1:07:33
SPEAKER_01: offer a safe space.
1:07:36
SPEAKER_01: What I think we need to do is learn from systems of care,
1:07:42
approaches that have shown they can be successful in the way
1:07:45
we're talking about.
1:07:47
And open dialogue was a very good model for this because also
1:07:53
their use of drugs.
1:07:54
SPEAKER_01: They initially tried not to use antipsychotics, right?
1:07:57
Because they thought without antipsychotics people could bring
1:07:59
more emotions to
1:08:00
SPEAKER_01: this dialogue that was seen as so helpful.
1:08:04
SPEAKER_01: But if people weren't getting better after a while,
1:08:06
they would use a tranquilizer for a time to help people
1:08:09
stabilize and then they
1:08:10
SPEAKER_01: would see who could come off.
1:08:11
SPEAKER_01: So it was a selective use model.
1:08:14
SPEAKER_02: So the challenge or the difficulty I have,
1:08:18
SPEAKER_02: I guess,
1:08:18
SPEAKER_02: with open dialogue is incredible principles,
1:08:20
SPEAKER_02: right?
1:08:22
But having done some training and facilitation in it,
1:08:26
there were two issues I had.
1:08:28
SPEAKER_02: One was the Finland model felt much more comprehensive,
1:08:33
SPEAKER_02: where everyone was on board,
1:08:35
SPEAKER_02: including the community.
1:08:37
SPEAKER_02: And the other issue I have in America,
1:08:40
SPEAKER_02: it's as good as the prescribers involved in the network,
1:08:43
so what you described there is not my experience of open
1:08:48
dialogue and prescribers
1:08:50
SPEAKER_02: in America.
1:08:52
Maybe it was certain personnel,
1:08:54
but they didn't have that attitude and those core principles.
1:08:59
SPEAKER_02: It was like,
1:09:01
SPEAKER_02: oh,
1:09:01
SPEAKER_02: here's another cool thing psychiatry is doing,
1:09:05
SPEAKER_02: but actually if the psychiatrist doesn't have,
1:09:07
SPEAKER_02: or the prescriber doesn't have the right attitude,
1:09:09
SPEAKER_02: it's just more of the same.
1:09:13
SPEAKER_01: So this is a whole nother story.
1:09:15
SPEAKER_01: It didn't get exported from McKinland in its real form.
1:09:20
SPEAKER_02: Yeah.
1:09:21
SPEAKER_01: They got exported in this way,
1:09:23
it was like an add-on to the disease model and were still going
1:09:26
to use the drugs.
1:09:28
And if you talk to Jaco Sekul and the people that said,
1:09:30
no,
1:09:30
that's a problem.
1:09:32
But the other thing,
1:09:33
yeah,
1:09:33
that's a problem trying to marry it to the disease model.
1:09:38
SPEAKER_02: For me,
1:09:38
the big problem was families were coming along with this
1:09:41
statistic of 79% of people
1:09:43
SPEAKER_02: didn't need to be on medication and we got back to employment.
1:09:48
You know,
1:09:48
there was a managing of expectation and the expectations were
1:09:52
really,
1:09:52
really high.
1:09:53
SPEAKER_02: And I thought that was, there was an ethics issue in that for me.
1:09:57
SPEAKER_02: Sorry to interrupt you there, but I just want to get that in.
1:10:00
SPEAKER_01: No, that's a good question.
1:10:01
SPEAKER_01: I mean,
1:10:02
SPEAKER_01: that's what it was in Finland after five years,
1:10:05
SPEAKER_01: but we're,
1:10:05
SPEAKER_01: we live in a different culture.
1:10:07
SPEAKER_01: Sure, sure.
1:10:08
And the other thing was in Finland,
1:10:09
that was the only form of care in Northern Finland.
1:10:12
SPEAKER_02: Yeah.
1:10:13
SPEAKER_01: It wasn't an alternative.
1:10:14
SPEAKER_01: This is what you got.
1:10:16
SPEAKER_01: Okay.
1:10:17
And so the society that's limited society there built in,
1:10:21
they bought into that system.
1:10:22
SPEAKER_01: Okay.
1:10:23
SPEAKER_01: It wasn't an alternative.
1:10:25
SPEAKER_01: It wasn't an add on.
1:10:26
SPEAKER_01: It wasn't like sort of being adjusted to this other model.
1:10:29
SPEAKER_01: And obviously the other thing is in where they did it,
1:10:34
SPEAKER_01: it was a small community where people knew each other,
1:10:38
SPEAKER_01: right?
1:10:39
SPEAKER_01: People often were still living close to their families.
1:10:41
SPEAKER_01: It was a different situation.
1:10:44
SPEAKER_01: I agree.
1:10:45
SPEAKER_01: I don't think the exporting of open dialogue has gone well.
1:10:48
SPEAKER_01: I just don't think it has.
1:10:50
SPEAKER_01: I guess the only question to,
1:10:52
SPEAKER_01: not the only question is,
1:10:55
what are the possibilities that are visible with open dialogue
1:11:01
as it was practiced
1:11:02
SPEAKER_01: in Finland for 20 some years?
1:11:07
SPEAKER_01: How might that inform care in other places today?
1:11:11
SPEAKER_01: What does that tell you about the possibilities?
1:11:13
SPEAKER_01: It's not about exporting exactly that,
1:11:16
SPEAKER_01: but it's exporting,
1:11:17
it's adopting a different conception and then a way to sort of
1:11:24
maximize the
1:11:24
possibility within our different cultures that this can be a
1:11:28
time of difficulty.
1:11:30
SPEAKER_01: So I don't know if I'm going away from this, but
1:11:34
For me,
1:11:36
the sensibilities in open dialogue could benefit nearly all
1:11:43
aspects of care.
1:11:44
SPEAKER_02: Multiple voices are very
1:11:49
SPEAKER_02: Very, very important.
1:11:51
SPEAKER_02: Not putting the emphasis just solely on the individual,
1:11:56
SPEAKER_02: being able to sit with uncertainty,
1:11:59
SPEAKER_02: not rushing in to the medical model immediately.
1:12:02
SPEAKER_02: So I think the principles are really important.
1:12:06
I was a bit shocked seeing people think a lot of it is fresh
1:12:14
when I would have an
1:12:15
SPEAKER_02: expectation that
1:12:17
SPEAKER_02: That's how people need to be treated to begin with.
1:12:20
SPEAKER_02: You know what I mean?
1:12:21
SPEAKER_02: It's like the whole principle of uncertainty.
1:12:23
It's like,
1:12:23
who do you think you are to be so certain about someone else's
1:12:28
subjectivity?
1:12:29
SPEAKER_02: It's nearly like, I know your subjectivity.
1:12:32
SPEAKER_02: Whereas being open to the fact that I don't,
1:12:35
I can interact with it and I can have an experience of what
1:12:38
that feels like for me,
1:12:40
SPEAKER_02: but I can never know you fully.
1:12:44
SPEAKER_02: And I think there's a humility in that.
1:12:46
And many times the person knows what they need more than the
1:12:52
professionals if
1:12:53
SPEAKER_02: they're only given the space and the voice to be heard.
1:13:00
SPEAKER_01: So this one psychiatrist I knew that I really admired,
1:13:05
SPEAKER_01: and he had this conception,
1:13:07
SPEAKER_01: this can be,
1:13:08
SPEAKER_01: you know,
1:13:10
SPEAKER_01: we are human beings that react to our environment.
1:13:12
SPEAKER_01: There's things that happen to us that throw us off.
1:13:15
SPEAKER_01: We also know that environment can be healing.
1:13:18
But when the person came to me,
1:13:19
he had one thought,
1:13:20
how can I be of help to you?
1:13:24
SPEAKER_01: What can I do to be of help you?
1:13:25
SPEAKER_01: That's the humility and just being responsive to that person.
1:13:29
SPEAKER_01: And if you,
1:13:30
SPEAKER_01: I think,
1:13:31
if you meet a person that way and you're actually giving that
1:13:34
person the power,
1:13:35
SPEAKER_01: you tell me what you need,
1:13:37
SPEAKER_01: that sets up a whole different dialogue.
1:13:39
SPEAKER_01: But I think as a systemic,
1:13:42
SPEAKER_01: as a philosophy,
1:13:44
SPEAKER_01: if you ask me what we need to have,
1:13:46
SPEAKER_01: we need to have is that like environment matters.
1:13:49
SPEAKER_01: This is trauma, etc.
1:13:50
SPEAKER_01: We are creatures who are responsive to our environment.
1:13:53
SPEAKER_01: That's number one.
1:13:54
SPEAKER_01: Two, we are not fixed human beings.
1:13:57
Who I am today is not going to be the same person I am going to
1:13:59
be in five years.
1:14:00
SPEAKER_01: So we can have good times and we can have bad times.
1:14:03
SPEAKER_01: And that environment can really help us regain our footing.
1:14:08
SPEAKER_01: And we start thinking about what humans need,
1:14:10
SPEAKER_01: shelter,
1:14:11
SPEAKER_01: food,
1:14:11
SPEAKER_01: someone to love,
1:14:12
SPEAKER_01: be loved,
1:14:12
SPEAKER_01: meaning in life,
1:14:13
SPEAKER_01: and that sort of thing.
1:14:15
SPEAKER_01: And then what you talk about, a humility, just like
1:14:19
SPEAKER_01: There's no certainty with these things, right?
1:14:22
And just to try to maximize the possibility that people can get
1:14:26
their life back.
1:14:30
SPEAKER_01: Anyway, I think humility is important.
1:14:33
A philosophy of being that sees us as responsive to our
1:14:36
environment is important.
1:14:39
And rather than doing things to others,
1:14:42
if you have a system that says,
1:14:43
how can we help?
1:14:46
SPEAKER_01: If that's the starting point, that's a much better place to start.
1:14:51
SPEAKER_02: Lovely.
1:14:53
SPEAKER_02: What haven't I asked you that I should have?
1:14:57
SPEAKER_01: No, you don't.
1:14:59
SPEAKER_01: You've done more than ask it what you should have.
1:15:02
SPEAKER_01: I've gone on at great length, but it's been fun.
1:15:04
SPEAKER_01: It's been wonderful.
1:15:05
SPEAKER_01: But, uh, yeah, I mean, you've asked everything.
1:15:09
SPEAKER_02: I think, uh, what we get, when we
1:15:12
SPEAKER_02: When we edit this, we'll probably get two episodes.
1:15:18
SPEAKER_02: We've spent a good chunk of time.
1:15:21
SPEAKER_02: Thank you so much, Bob, for everything that you do and continue to do.
1:15:26
And I hope that people feel that there's optimism in what we're
1:15:31
talking about here
1:15:32
SPEAKER_02: and that the future can only get better.
1:15:38
SPEAKER_01: And that's the opportunity to be grass for sure.
1:15:41
SPEAKER_01: So anyway, Michael, thanks a lot.
1:15:42
SPEAKER_01: It's really been a pleasure, fun.
1:15:43
SPEAKER_01: And what I really love is an exploration of ideas.