On Being ‘Sane” in Insane Places: Science, Pseudoscience, and Psychiatry in the Modern Era with Susannah Cahalan in conversation with Dr. Nathan Ha and Dr. Randi Hutter Epstein

April 29, 2021

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April 28, 2021

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00:00I will go ahead and get started.
00:02So good afternoon everybody.
00:04I'm Anna Reesman, director of the
00:06Program for Humanities in Medicine,
00:08and I'm very glad to welcome you today too.
00:11The pointer lecture given by journalist.
00:14An author, Susannah Cahalan,
00:16which is entitled on being
00:18sane in insane places.
00:20Pseudoscience science, pseudoscience
00:21in psychiatry in the modern era.
00:25Susannah Cahalan will be in discussion
00:26with Nathan Ha and the session will
00:29be moderated by Randy Epstein.
00:30We have closed captioning available
00:32and the session will be recorded.
00:34This lecture is cosponsored by the Young
00:37College English Department and the
00:39program in the History of Science and
00:42Medicine here at Yale School of Medicine.
00:44Susannah Cahalan is a journalist
00:46based in Brooklyn, NY.
00:47She studied English at Washington
00:49University in Saint Louis.
00:51Her first book was published in 2012,
00:53and it was the best selling
00:55memoir Brain on Fire in which she
00:57chronicled her own struggles with
00:59a rare autoimmune disease called
01:01anti MDA receptor encephalitis.
01:03And she was misdiagnosed in that
01:05process with a serious mental illness.
01:07The book inspired a 2016 Netflix
01:09drama by the same name and her
01:12experience contending with the
01:14mental health care system has LED.
01:16Her to become a leading voice on
01:18the treatment of mental illness
01:19in the United States.
01:21Her second book, The Great Pretender,
01:23investigates the influential
01:24Pseudopatient experiment conducted by
01:26David Rosenhan in the 1970s and its
01:29place in the modern history of psychiatry.
01:31It was shortlisted for the 2020
01:34Royal Society Science Book Award.
01:36Kaylyn has also written for the New
01:39York Times, the New York Post L,
01:41The New Scientist,
01:42as well as academic journals including
01:44The Lancet and Biological Psychiatry.
01:46We're thrilled,
01:47be with us here today in Scala.
01:51Are discussing today is Doctor Nathan
01:52Ha who is currently a resident in
01:55the Yale Department of Psychiatry.
01:56Doctor Ha earned his MD from
01:58Hofstra Northwell in his PhD from
02:00Princeton in the history of Science
02:03and Gender and ********* Studies.
02:04His research focuses on the dynamic
02:07relationship between patients,
02:08clinicians and researchers
02:09in shaping understandings of
02:10human health and difference.
02:12He is developed and taught classes
02:13on the history of psychiatry,
02:15LGBTQ, health,
02:16race,
02:16gender and science is currently working on
02:19projects in the field of medical education,
02:21aiming to reach health care workers
02:24in multiple disciplines to improve
02:25care for racial and ****** minorities.
02:27Thank you for joining us today,
02:30Nathan.
02:31And finally,
02:32Doctor Randi Hutter Epstein is
02:34the writer in residence for the
02:36Yale School of Medicine and the
02:37Program for Humanities in Medicine,
02:39as well as a lecture in the
02:41Yale College English Department.
02:43Her most recent book is aroused
02:45the history of Hormones and how
02:47they control just about everything.
02:49Randy is a graduate of the Yale
02:51School of Medicine and has a degree
02:53from Columbia Journalism School,
02:55as well as an MPH.
02:56She's particularly interested in
02:58overlaps of science and society,
02:59and I'm hugely grateful that she
03:01suggested Susannah.
03:02Hey,
03:02Lynn is a speaker and I'm thrilled
03:04that Randy
03:05has agreed to moderate the discussion today.
03:08Please feel free to use the Q&A
03:10for any questions that you have.
03:12We will have about half an hour
03:14at the end from 6:00 to 6:30.
03:17For questions and discussions
03:18with our speakers.
03:20So I will turn it over to Randy.
03:24I'm grateful to hear to have both Susanna
03:27Nathan joining in the conversation and
03:29what I thought we do just so everyone
03:31sort of knows the lay of the land
03:33Susanna is going to speak a little,
03:36so those of you who haven't gotten
03:38a chance yet to read her book,
03:40but I do recommend it.
03:41I mean, it's a page Turner,
03:43and it's fascinating, so,
03:44but you might not have all
03:46gotten a chance to read it,
03:48so Suzanne is going to give a bit of an
03:51introduction for about 15 minutes or so.
03:53Nathan will then speak in in response.
03:55And then I have a few questions for
03:57them to get the conversation going,
03:59but Doctor Reese is going to be checking
04:02the Q&A so we're really hoping that this
04:04can break open into a bigger discussion,
04:06so please feel free to add to the Q&A.
04:09Will be checking it or
04:10doctor Ismali checking it,
04:12and now I want to turn it over
04:14to Susannah so you can give us
04:15some a bit of a background before
04:18we enter the conversation.
04:19Salute Lee and I just want to say to Anna
04:22and to Nathan. Thank you so much for.
04:25Rangers say man Randy especially
04:27thanks to you and I I was a big
04:29fan of rows before we actually met.
04:31I think I wrote about it and it's so it's
04:34so nice to have it come full circle and
04:36and thank you for suggesting me and for
04:39being such a real advocate of my work.
04:41I'm I'm deeply, deeply appreciative to you,
04:43so thank you so much so you
04:45know it's it feels really good.
04:47I'm going to put out to have a
04:49PowerPoint and play some things for you.
04:51All feels really good to be here.
04:53This is that my I can't believe I'm
04:56saying this is my second pointer.
04:58And my first pointer was eight years
05:00ago and that was when my first book,
05:03Brain on Fire, was published around
05:05the time it was published,
05:07and it was also right around the time that I
05:10first started to become interested in what
05:13would eventually become my second book,
05:15which is the Great Pretender.
05:17So there's a lot of connective
05:19tissue between my first book,
05:21which is a memoir,
05:22and between my second book,
05:24which was very much not a memoir.
05:28So I'm going to go through a little
05:30bit of brain on fire just too,
05:32and it's it's it's so funny I it's so
05:34outside of me now what happens to me
05:36and my experience with automated stuff?
05:38Latest that it almost is like my
05:40experience with brain on fire instead
05:42of my own personal experience.
05:43It feels so it feels so detached because
05:45you know there was a movie made about it.
05:48I kind of writing about it made
05:49me feel less connected to it,
05:51but it's neither here nor there.
05:53But this picture is of me at
05:55the time when I was sick.
05:56I was 24, the most pronounced.
05:58Symptoms initially were very
06:00very much psychiatric,
06:01so there was sorry with depression.
06:04Then it kind of morphed into paranoia,
06:07then full blown delusions and hallucinations
06:09and here's a bit from my medical records.
06:12A picture of me on the epilepsy unit,
06:16'cause I did also have seizures that
06:18were actually never captured Italy,
06:21so there was thoughts that maybe
06:23were this maybe was pseudo seizures,
06:26which again we're seeing this kind of.
06:29Merging between psychiatry and neurology,
06:30and his questions of what is
06:32real and what is not,
06:34which would become very important
06:35to me in the Great Pretender.
06:38But if you kind of read this you
06:40can see that there is a lot talked
06:42about in terms of my behavior
06:44because it was most robust.
06:46I was kicking and punching
06:48nurses trying to escape,
06:49you know,
06:50hearing and seeing things that were not
06:53there and so the rule out diagnosis at
06:55the kind of earliest stages of my month.
06:58Long hospitalization were skits,
06:59schizoaffective disorder and bipolar one.
07:01First I play one,
07:02then schizoaffective disorder and
07:04ultimately was diagnosed with
07:05anti MDA receptor autoimmune
07:07encephalitis which really had
07:09only gotten a name two
07:10years before my diagnosis.
07:12I was the 217th person in the
07:13world to be diagnosed with this
07:16newly discovered brain disease.
07:18I was an interesting patient.
07:20I had a lot of a lot of you know
07:22medical students come and kind
07:25of got me was kind of exciting.
07:28There's a lot of excitement
07:30around my diagnosis.
07:31And you know, I, my experience was very,
07:34very similar to many people
07:35with autoimmune encephalitis,
07:36and you can see it's 1018 study of 500 cases,
07:40so that psychiatric and behavioral
07:41symptoms are kind of the most pronounced,
07:44and this includes agitation psychotic
07:46systems, symptoms and catatonia,
07:47all of which I experienced.
07:49So it was in 2013.
07:50Again,
07:51when I first when I did my first pointer,
07:54and when I kind of first
07:56really dug into this study on
07:58being sane and insane places,
07:59and the way that happened was I was.
08:02Out to eat with two Harvard psychologists
08:04who study the MDA receptor.
08:06I was I was on book tour and I had mentioned,
08:10you know,
08:10you know my interest in psychiatry and
08:12the question about whether my illness,
08:14which is now been kind of branded
08:17and neurological illness and
08:18organic illness and how it fit
08:20into the history of psychiatry.
08:21I was really interested in that
08:23and one of the people who I
08:26was who was out to dinner with
08:28had suggested that said to me,
08:30you're kind of like a modern day
08:33pseudopatient and I had no idea
08:35what she was talking about and
08:37she suggested that I read a study
08:40on being sane in insane places,
08:43which was published in science in 1973,
08:45and it is a beautifully worded paper.
08:48I mean, it reads a little like fiction.
08:52The opening line is if sanity and
08:54insanity exists, how shall we know them?
08:57I mean, it's almost Talmudic,
08:59and it's in it's kind of intonation.
09:02There's a.
09:03A lot to take apart in that the
09:05question of using sanity and insanity
09:07in it in a paper about psychiatry,
09:10which are not terms that are typically used,
09:13but it really caught fire and a
09:14lot of it came from the design
09:17of the experiment which came from
09:198 pseudopatients three men,
09:21five women artists,
09:22a housewife psychiatrist for psychologist,
09:23and a pediatrician know why from
09:25a wide swath of humanity who went
09:27undercover across 12 hospitals across
09:29United States, I'm going to play you,
09:32David Rosenhan,
09:32describing the study a little bit.
09:34Just so that you can hear his voice,
09:36which is,
09:37I feel such a big part of his persona.
09:41The Rosenhan you did a study and in
09:43the study you got yourself committed to
09:46an institution and mental institution.
09:48How did you do this? How did you
09:52get them to believe that you were?
09:54You are mentally ill or that
09:56you had an emotional problem.
09:57I would rather hope that my
09:59friends would think at least
10:00that it wasn't easy.
10:02But that's that. May be a
10:04matter of dispute.
10:05What it really amounted to was
10:08faking the set of symptoms that
10:10had never before been heard of
10:12in a psychiatric hospital. And
10:14our expectation was that they
10:16would catch us right at the door.
10:19The symptoms went something like this.
10:21I'm hearing voices,
10:23which is a combination of symptom,
10:25but usually they ask you
10:27what so he heard voices that said
10:29thud empty and hollow. That was the.
10:32That word is how they all presented
10:35in the same set of symptoms he claimed
10:38and just based on those symptoms
10:40alone not changing any other really
10:43significant parts of 1's biography.
10:45Maybe just their job if they
10:47were worked in medicine.
10:49Also, the patients received
10:51serious mental health,
10:53illness, diagnosis,
10:54most mostly schizophrenia,
10:55and were hospitalised anywhere from
10:58seven days to 52 days.
11:02So many beautiful lines from from
11:04the the piece, but the ones that
11:07really called out to me personally
11:09go kind of what I went through and
11:11how differently I was treated when my
11:14diagnosis was seen as psychiatric versus
11:16when it was seen as as neurological.
11:18At various points,
11:19there was a kind of sometimes
11:21direct and sometimes underlying
11:23threat that if I didn't improve my
11:25behavior I would be sent somewhere
11:27else and that somewhere else was
11:30probably a psychiatric hospital or.
11:32That was the underlying kind of feeling,
11:34at least from kind of the nurses
11:36who said it specifically.
11:38But even in my medical records it
11:40kept there was they were actually
11:42overt references to moving me
11:44out of out of the epilepsy unit.
11:46So he talks about how many patients
11:48might be seen outside the psychiatric
11:50hospital would seem insane in it.
11:52This idea of context really changing
11:54the way people are seeing and you know,
11:57in my own personal experience,
11:58even what I was wearing was seen
12:00was kind of seen through the lens
12:03of my diagnosis at 1.1.
12:05The rule out diagnosis was bipolar.
12:07One my clothing which was you know,
12:09typical clothing a white T shirt and black
12:12leggings was described as revealing,
12:14which you know was shown as a sign
12:16of kind of hypersexuality that might
12:19support a bipolar one diagnosis, you know.
12:21He also wrote about this.
12:23These differences between things that
12:25are physical and psychological or
12:28psychiatric and how you know there
12:30is a tremendous stigma associated
12:31with that and and I felt that and
12:34so did my family when.
12:36The diagnosis became this
12:38exciting neurological one.
12:39People were far more interested in me,
12:42far more interactive, and so you know,
12:45he concludes quite damningly in
12:48the paper that psychiatrists,
12:49at least at the time in 1973,
12:53quote cannot distinguish insanity
12:55from sanity.
12:55Now, these kind of stunts had
12:58happened prior about many times,
13:01including most famously Nellie Bly,
13:03who in 1887 went undercover
13:05at Blackwell's Island.
13:07And what was different about David Rosenhan
13:10was that this was published in Science,
13:13one of the most Premier scientific journals.
13:16Generalist scientific journals in the world.
13:18I mean, this was.
13:20This was a beautiful,
13:22very evocative paper alongside earliest
13:24radiocarbon dates for domesticated animals,
13:26you know,
13:27very scientific seeming papers,
13:28so it gave it this level of kind of
13:32scientific expertise that many have argued,
13:35and many argue that time.
13:37That it did not deserve.
13:39You know, and this was an it's
13:41important to give some context.
13:43This was an extremely
13:44fraught time for psychiatry.
13:46They were moving away from Freud,
13:48for it was starting to kind of be
13:50relegated to you know either very
13:52much therapy coming out of kind of
13:55serious mental illness which we didn't
13:57intend it to be in the 1st place and
14:00into academia and out of psychiatry,
14:03which was starting to really insist that
14:05it was part of a medical paradigm and at.
14:08At the same time,
14:10there was a rise of the
14:11anti psychiatry movement,
14:13which is really typified by
14:15Artie Lange and Thomas Szasz,
14:17who are often lumped together who are
14:19extremely different ideologically.
14:20But the kind of Artie Lange approach
14:22was that you know the people who
14:25are so called schizophrenics as he
14:27called them were actually kind of had
14:30super sanity in a very insane world.
14:32And and Thomas has had a more hardline
14:34approach that the mentally ill are
14:36parasites so completely different views.
14:39But often lumped together,
14:40the thing that they very much shared
14:42was distrust and outright distrust
14:43of psychiatry as a medical specialty.
14:45And at the same time there was popular
14:48books and media that were to both.
14:50The Snake Pit was a huge movie at the time,
14:53and then this came out after this study.
14:55But the book was out.
14:57One flew over the cuckoos nest,
14:58which is probably most famously associated
15:00with psychiatric hospitalization.
15:01So there was a lot of distrust
15:03brewing and I don't have to play this.
15:05I'm going to go through it and then
15:08at the same time. Rise of medicine.
15:10So Thorazine hit the market in 1954.
15:13Lithium in 1970.
15:14All of a sudden there was a real
15:16importance on getting a diagnosis correct,
15:19and this was also important to
15:21insurance companies as well.
15:23And at the same time that David
15:25Rosenhan study hit,
15:26there was a very damning cross
15:28national study that was published
15:30that compared diagnosis in America
15:32and in the UK and showed that in
15:35the UK we were diagnosing the same.
15:38Patients were using the term.
15:40Bipolar disorder in the US.
15:41We are more likely to use the
15:43term schizophrenia.
15:44So what are these labels mean?
15:45There's no reliability.
15:47There's no validity that those
15:48were the takeaways at the time.
15:51When Rosenhan's study hit.
15:54The a PA was so disturbed by the
15:57fallout which I will show the the
16:00incredible response in the mass
16:02media at the time that they actually
16:05called an emergency meeting to
16:07address the bad publicity and out
16:09of that meeting emerged a task
16:12force headed by Robert Spitzer,
16:14who would eventually write the DSM
16:16three and I would actually later find
16:19that Robert Spitzer was very much very
16:22much influenced by David Rosenhan study when.
16:25Creating the DSM three criteria.
16:28So, and he actually was one of
16:29its most vociferous critics, too.
16:31He wrote a really,
16:32really biting commentary called pseudoscience
16:34and Science Logic in remission,
16:35and psychiatric diagnosis.
16:36And I anyone has questions about Spitzer,
16:38Spitzer has a lot more to do with this,
16:40and I was had time to show,
16:42and I would love to talk about him.
16:46So these are some of the some
16:48of the articles of times,
16:50like psychiatrists fooled by
16:51sham simple symptoms.
16:51Study finds doctors can't tell the same.
16:53You know, some of them played it straight,
16:56some of them played it a little bit.
16:58You know, a little bit more tongue in cheek.
17:00You may be normal,
17:01but not to a hospital.
17:03You know, the times kind of straightforward.
17:058 feign insanity and tests and
17:06are termed insane. Here's another.
17:08Here's a kind of mortality.
17:091 Stanford Brain says all shrinks are nuts.
17:12So at the time, I cannot overstate the
17:15kind of impact this this study had,
17:17not only on the field itself,
17:19but on the popular view
17:21of psychiatry at the time.
17:22I'm really interested in it personally,
17:24because it really called to me.
17:26It felt really true.
17:28It felt really real to me and I wanted
17:30to figure out more about the study
17:33and the person who wrote the study.
17:35The man, a man named David Rosen,
17:37whose voice you heard earlier.
17:39Luckily, his best friend, Florence Keller,
17:41rescued his unpublished book.
17:43And his diary entries from a trash
17:45pile and let me have access to them.
17:48So I had well over 100 almost 200
17:50pages of an unpublished book, a book.
17:53He actually had a book deal with,
17:55Doubleday to produce, but never did,
17:57and actually was sued by Doubleday.
17:59Which kind of created some
18:01early questions for me.
18:02But I, you know,
18:04I'm reading this, this work,
18:06and it's fascinating.
18:07It's particularly fascinating about his
18:08own experience because David Brosnan
18:10himself went undercover at Haverford
18:12State Hospital in Pennsylvania.
18:13And he spent 11 days hospitalised
18:15and he was misdiagnosed with
18:17schizophrenia and he described a host.
18:18This is a letter that he sent home
18:21to his son Jack and actually was.
18:23But what I found earlier he was really
18:25trying to hide the fact that he was.
18:28He was taking notes.
18:29So he was.
18:30This is actually a note about what was
18:32going on and it's written every third line.
18:34It was very hard to figure out.
18:36So it was like it started as
18:38an investigation very early.
18:40You know, just trying to even
18:41parse out what he was saying but.
18:44What he what he observed was
18:46really kind of abuse,
18:47you know,
18:48neglect and he described this
18:49world of this netherworld,
18:51of what it was like to live
18:53as a psychiatric patient.
18:55Here some diary entries at the time
18:57he he eventually found out that no one
19:00really cared much about his writing.
19:02In fact,
19:03he was ignored most of the time.
19:05The only time it showed up was actually
19:08in nursing notes that he would
19:10later get as signs of his pathology.
19:13His obsessive need to write.
19:16OK, so fascinating stuff.
19:18I'm really excited about this,
19:20but there are some early indication
19:22that things are not as they seem.
19:25He keeps changing the word, the,
19:28the kind of symptoms.
19:29You know, I said that empty hollow,
19:32but sometimes he would change it to thud.
19:36Dull, hollow,
19:37strange inconsistencies in his facts
19:39in his kind of data collection.
19:41And this real this real,
19:43opaque way of dealing with
19:45the pseudopatients.
19:46The other people involved,
19:48the number there were.
19:508 total so you know.
19:52Bit by bit I'm starting to kind of be a
19:55little bit sceptical of what I'm seeing,
19:57and the thing that really there were a lot
19:59of minor moments and this is a minor moment,
20:02but I share it with you because it's
20:04indicative of what I was dealing with,
20:06so I was interviewing his close
20:08friends and his colleagues and at
20:10one point a story of a wig came up.
20:12And David Rosenhan told this kind of
20:14really fun story about how he had
20:16to wear a wig when he was undercover
20:19at Haverford State Hospital.
20:21And everyone laughed and he went
20:23upstairs and showed the wig.
20:25It probably looked nothing like this.
20:27This is just a random wig and everyone
20:30just thought it was so great and he
20:32was talking about his hospitalization.
20:34And you know one of his major defining
20:38characteristics was that he was bald.
20:39So we laughed about this and.
20:42And afterwards I opened up his
20:45medical records and found that.
20:48The hospital had actually talked
20:50about his bald head and there was
20:53a picture of him with a bald head
20:56on the page and I thought.
20:58Why is he making up a story about a wig?
21:01It seems small,
21:02but all these little things start
21:03to raise serious questions.
21:05And then I started to really look at
21:07the medical records and the medical
21:09records started to reveal a portrait
21:11of symptoms that were far different
21:13than when he wrote in the paper.
21:16As you can see here.
21:19These points various doctors
21:20talk about how David Rosenhan,
21:23who went by a pseudonym, David Lurie,
21:26talked about.
21:27Thoughts of suicide and thoughts of
21:30insulating noise noises that he was
21:33hearing with copper pots over his ears.
21:36This is a far different and more.
21:41More involved portrait of psychosis
21:43than just I hear a voice that
21:46says thud empty or hollow and
21:49especially the threats of suicide.
21:51Anne, Anne Anne.
21:52Also what I started to notice 20
21:54someone's raised a hand I don't know.
21:56Is that OK to?
21:59To.
22:00Answer We can do it later,
22:02but if anyone wants to jump in I'm happy
22:04to answer any questions as I go to.
22:07But I also got access to the original
22:10medical records and he recreates
22:11the medical records in the published
22:14study and there's a huge discrepancy
22:16between what's written in the
22:17medical record and what he wrote
22:19was written in the medical record.
22:21I mean a vast difference,
22:23as you can see here in this,
22:26it's very Freudian.
22:27It's talking about relationship with Mother
22:29and his distant relationship to his father.
22:32In the above,
22:33it's very.
22:33It's all focused on the
22:35auditory hallucinations,
22:35mostly so it's just a different portrait of
22:38what kind of psychiatry he was dealing with.
22:40So again,
22:41all these questions are starting to emerge,
22:43and so I thought,
22:45OK,
22:45I have to figure out who
22:47these other participants were,
22:48and there are these clues that I
22:50had in these in these in these records,
22:53and another persons raised their hand out.
22:56I'm happy to take a question
22:57if you'd like to
22:59jump in. Nope. Just just jump in.
23:03If you'd like to talk.
23:08So I found these these kind of shorthand
23:12descriptions of each of the 8 pseudopatients.
23:16And what I started to find what
23:18they were so vague and so hard and
23:20in the description of the hospitals
23:22were they were all pseudonyms.
23:25Everything was really hard to parse out
23:27and I thought why was he protecting here?
23:30Why is he being in his own private notes so
23:33careful with names and names of hospitals?
23:36So eventually though,
23:37I was able to track down one of the
23:40participating pseudopatients and he this
23:42is Bill and he lives in Austin, TX.
23:44Now he isn't.
23:45That he was a graduate student at
23:48Stanford University and he was one
23:50of the graduate students involved
23:52and his experience very much matched
23:54that of the description that David
23:56Rosenhan included he did.
23:58He did present with just the symptom,
24:00thought, empty, hollow.
24:01He was misdiagnosed with schizophrenia.
24:03He only spent seven days Hospitalise
24:05at Agnews State Hospital,
24:06which was at the time preparing to
24:09close and it was a very chaotic
24:11environment and he witnessed some
24:13some pretty horrific things as well.
24:16What was troubling to me about
24:17his story was how little he was
24:20actually prepped for the study,
24:21and this would have been in the
24:23timeline one of the kind of last
24:26pseudopatients who would have gone in,
24:28and it was strange to me to see
24:30to talk to him and to realize
24:32he was not prepared at all.
24:34Instead, in fact,
24:35at one point he took Thorazine,
24:37he was administered Thorazine and David
24:39Rosenhan hands only prep was techique.
24:41The pill anthro and spit it in
24:43the toilet and unfortunately
24:44they had just come out with.
24:47Rapid melt Thorazine and he wasn't
24:49able to and he was dosed with the drug
24:52and pretty incapacitated and so there
24:54were other kind of strange lies too
24:56like David Rosenhan told Bill's wife
24:58that there were writs of habeas corpus
25:01to get him out of out of the institution.
25:04But I actually tracked down the
25:06lawyer who worked on it and he said
25:08there were never any writs filed.
25:10So again strange kind of discrepancies.
25:14That's him talking,
25:15which I can play later.
25:17And then there was someone
25:19else who I found through Bill.
25:22It was a man named Harry Lando.
25:24He is a professor of psychology in Minnesota,
25:27and he was not one of
25:30the participating eight.
25:31He was a knife pseudopatient of footnote
25:34who was removed from the study.
25:36In fact,
25:37as you can see on the right hand
25:40side of the screen,
25:41Rosenhan says that data were removed.
25:44From the study his that his data was
25:47removing study because he did not
25:49follow the same kind of rigorous
25:51set of standards that Rosenhan
25:53claimed that he did.
25:54And when I asked her what had happened,
25:57he had said that his parents
25:59had were deceased,
26:01that they were not alive when they
26:03actually were and that seemed so
26:05odd to me because David Rosenhan had
26:07presented an entirely different symptom set.
26:10Then he had described in the paper,
26:12and yet he kept almost.
26:14All of the paper is about
26:17his own hospitalization,
26:18so when I started to talk deeper
26:21with Harry about his experience,
26:23kind of another side of this came forward.
26:26Harry, who was hospitalised for
26:2821 days at a US public Health
26:31Service Hospital in San Francisco,
26:34actually had an incredible time.
26:36He described it as really, really comforting.
26:39He was very unhappy graduate student.
26:42He felt that he was.
26:44He's a graduate student, Stanford.
26:46He felt it was a very stifling,
26:49competitive place,
26:50and he was going through a very bad
26:53marriage and having the time to step away
26:56from what he felt was probably growing.
27:00Depression was really calming for him,
27:02and he described the the support
27:05of the nurses and the staff.
27:07And the support of the fellow patients.
27:10There were Peter, Paul and Mary sing alongs.
27:12I mean it was.
27:14It was idyllic.
27:15They went to the beach for trips
27:17and he he felt like he was part of
27:20a community and Harry really feels
27:22that his his bulk of his experience
27:25was dropped from the study because
27:27it didn't match David's thesis.
27:29However,
27:29there were still aspects of Harry study
27:32that were still used in this study.
27:34Harris data that were still
27:36used in this study.
27:38Even though David Rosenhan
27:39says that he dropped it.
27:41So again lots of discrepancies.
27:43After Harry.
27:44I went on a 6 year Odyssey to try
27:47to find the other pseudopatients.
27:49I hired a private investigator.
27:51I talked to everyone,
27:53whoever has talked to David Rosenhan
27:56and I kept hitting dead ends.
27:58And the book has come out now and has
28:00been out for over a year and I have
28:03not heard of anyone who's come forward.
28:06I thought maybe someone would come forward
28:08as one of the other six pseudopatients,
28:11but no one has and I have to admit
28:13to myself I I really do believe
28:15that he made a good deal of the
28:18study up and that there were not
28:218 total pseudopatients you know
28:22why does this matter now?
28:24Why is this important?
28:25I think you know there was
28:28a recent of fairly recent.
28:30Article in the New England Journal
28:31of Medicine that talks about the
28:33Psychiatry's identity crisis that you
28:35know started then and continues now.
28:37And I think that when we have bunk
28:40science and we have and that might
28:42be harsh to say, but you know,
28:45very problematic studies.
28:46We contribute to this identity crisis.
28:48We can contribute to a polarization
28:50the way we see things and in
28:52fact Nile boys who is editor in
28:54Chief of Lancet Psychiatry.
28:56His quotes here.
28:57I feel I feel really encapsulate.
29:00How I what I feel about the study
29:02and why it's important and I think
29:05is that the bottom quote and what
29:07he did was he produced a document
29:10of doubtful veracity that polarized
29:12debate in a very unhelpful way
29:14by removing nuance,
29:15driving us to extreme positions
29:16rather than considered action.
29:18The fact is, there were many
29:20institutions that were terrible,
29:21horrible, horrible places,
29:22but there were also ones that maybe
29:25we're doing some things that were good.
29:27Ann and Harry did experience that so.
29:30You know there could have been
29:32a more nuanced discussion of
29:34psychiatry of psychiatry's, you know,
29:36abilities and limitations and strengths,
29:37and also of the abilities for institutions
29:40to really take on the need of their
29:43patients in their best interest.
29:45And I think he really missed that
29:47opportunity, and I think you know, I,
29:50I really love this Karl Popper quote,
29:52which I'm going to end on the
29:55history of science,
29:56like the history of all human ideas,
29:59is a history of.
30:00Irresponsible dreams, obstinacy,
30:01and of error, but scientists,
30:03one of the very few human activities,
30:05perhaps the only one in which errors
30:08are systematically criticized,
30:09and fairly often in time corrected.
30:11This is why we can say that in science
30:13we often learn from our mistakes,
30:16and why we can speak clearly and
30:18sensibly about making progress there.
30:20So I'm hoping that in elucidating
30:22and really understanding this
30:24study in a more in a deeper,
30:26more honest way,
30:27we can talk about the past and the future.
30:30Mental health care and psychiatry
30:32in this country moving forward.
30:34So that's I'm going to stop here and
30:36and and ask Nathan and I apologize.
30:38I'm little bit long,
30:40but thank you so much for letting
30:42me let me talk about my book.
30:47Thank you, that was wonderful
30:49and I'm sure we're all gonna
30:50have questions and I will too.
30:51But I think we're gonna turn
30:52it over to Nathan for a few
30:54minutes and then I'm going to
30:55have questions for both of you,
30:57but we're going to.
30:57So we'll come back to you very soon.
31:05Hi everyone, so thank you.
31:10Anne Anne Randy for your kind introduction
31:13and for inviting me to come it today.
31:16I'm really excited to be here
31:18and to meet Susannah Cahalan.
31:19Actually first heard about Susanna
31:21and her earlier book, Brain on Fire.
31:24While I was a medical student in health
31:26care Northwell and I had a chance
31:28to meet Doctor Najar when I rotated
31:31through the neurology Department
31:33at Lenox Hill Hospital and everyone
31:35at the time was talking about how
31:37bringing fire had positively affected.
31:40Doctor John's career and change.
31:41The practice of neurology,
31:42so I'm really delighted to have
31:44this opportunity to meet and
31:46interact directly with Susanna,
31:48who by sharing her story,
31:49has influenced my training and
31:52inspired me to think about how
31:54patients and doctors can work
31:56together to make better medicine.
31:59So I just want to start by saying how much
32:02I really enjoyed the Great Pretender,
32:05an one into knowledge,
32:07how fun and compelling it was to read.
32:10It is truly an extraordinary piece
32:13of investigative journalism that's
32:15artfully rendered by a gifted writer.
32:17It is also more than this,
32:19and as a historian I want to express
32:23my appreciation for the original and
32:25novel contribution you have made
32:27to our understanding of the past.
32:30You dug up and discovered new archives,
32:33read them exhaustively,
32:34and offered us fresh insights
32:36into David Rosenhan's study.
32:38This was not only hard work,
32:40it has also changed historiography
32:42so that future historians of
32:45medicine will have to reckon with
32:47and build upon your contribution.
32:49And I think,
32:50like the intrepid inspiring
32:52journalist Nellie Bly not only have
32:54you succeeded in making history
32:55come alive in your writing,
32:57you have also contributed to
32:58the making of history itself.
33:00So I'm saying a big thank you for that.
33:04So I'd like to turn now to explore 3 themes
33:08that the Great Pretender brought up for me.
33:11They concern questions
33:12about scientific truth,
33:14power and privilege and the tension
33:16between medicine and psychiatry.
33:18One of the big turning points in your
33:21book is the realization that Rose in hand
33:24was less truthful in his famous paper,
33:27or less than truthful.
33:29I should say he omitted or exaggerated
33:31facts about his own hospitalization.
33:34And left out the account of Harry Lando.
33:38The Pseudopatient had a positive
33:40experience that raised serious
33:42questions about the validity of this
33:44work in as short as you suggest,
33:47he was a great pretender.
33:49Many of Rosenhan's can't.
33:50Contemporaries would have agreed an
33:53you show us that his critics that I'm
33:55faulted him for his methodological
33:57inadequacy's his pseudo data
33:59an having logic and remission.
34:01Even members of his tenure committee
34:04at Stanford were suspicious of him.
34:06And raised questions about his
34:08honesty and work ethic.
34:10Still,
34:10the question remains for us and
34:12it's a troubling one.
34:14Why did rosenhan's paper gain
34:16the stature that it did and why
34:18we still talking about it?
34:20Almost 50 years later?
34:23I think here that we would
34:25benefit from thinking about
34:27how certain claims gain their status
34:30as scientific facts and the specific
34:32context in which this occurs.
34:35So what factors made his study incredible,
34:38and if it lacked truth,
34:40then how did it gain truthiness?
34:43You highlight Rosenhan's rhetorical talents,
34:45his charisma and his
34:47audacious Hutzler an yeah.
34:49We should also add to this list the
34:51status he enjoyed as an upper middle
34:54class white man and a Stanford professor,
34:57because all of these privileges greatly
35:00facilitated his ability to make claims
35:02that others would deem as consequential.
35:04And indeed Rosenhan was well
35:06situated to get the eminent journal
35:09Science to publish his paper.
35:11We still don't know exactly
35:13why science approved.
35:14Publication,
35:15but we can certainly observe
35:17its effects with the journalist
35:19in premature rosenhan's claims
35:21gained tremendous legitimacy,
35:23invisibility,
35:24his reputation became intertwined with that
35:27of the journals producing for their fame,
35:30credit,
35:30and prestige for both.
35:33So even after a psychiatrist,
35:35Robert Spitzer published his
35:36searing critique of Rosenhan study
35:38as having logic in remission,
35:40it merely served to increase
35:42interest and discourse about it.
35:44And indeed, as you point out,
35:46Spitzer himself benefited from the
35:48disruptive force of Rosenhan's claims,
35:50and may even have used it to
35:53justify his own efforts to revise
35:55and reform with the Ascent 3.
35:58In other words,
35:59even if Rosenhan's claims
36:01were not totally incredible,
36:03they were legible to receptive
36:05audiences in multiple domains
36:06within psychiatry and beyond.
36:08Rosenhan's critique of psychiatry occur
36:10during a moment when the psychiatric
36:12establishment was challenged by
36:14numerous foes by antipsychiatry critics,
36:16by gay activists and patient rights
36:19activists by neuroscience researchers
36:21and by journalists so it fit,
36:23and it also fit in with other
36:26psychology studies at the time.
36:28That challenge blind faith in authority
36:31and institutions and resonated well
36:33with the cultural politics of the 1970s,
36:36as evidenced by the numerous TV and
36:38newspaper interviews that he was
36:41called the participating Rosenhan
36:42study was a consequential scientific
36:44object that became a media sensation
36:47because of its popular appeal and
36:49political salience and the media
36:51then also became a player and was
36:54in hand story because it became
36:56enrolled in the promulgation and
36:59reinforcement at this claims.
37:01In short,
37:01the paper proved useful to different
37:04actors who repeated its claims
37:06to fulfill their own arguments
37:08about Psychiatry's pitfalls,
37:10making his study a useful object sensation
37:14with truthiness and a fact in the world,
37:17if not scientifically speaking,
37:19not a fact about the world.
37:22Spencer,
37:22you know?
37:23Compare Rosenhan study too.
37:25And I love this part,
37:27a tasty morsel that left a bad after taste.
37:30So if so,
37:31then it is one that we cannot
37:33help but continue to consume
37:36and regurgitate ourselves,
37:38for better or worse,
37:39it has become part of psychiatry's Canon
37:41morality play with uncertain losses
37:43about the failings of individuals,
37:46systems and practices,
37:47and as such,
37:48it's worth remembering that influential
37:50science is not set in stone.
37:53But itself must be recited and remembered.
37:56Cannonical science is not made once,
37:59but is continually reproduced
38:00and thus is open to change
38:03and reinterpretation as you've just heard
38:06two in in your quote by Karl Popper.
38:09What, then, are the effects of
38:12our reproduction of rosenhan
38:14study in this forum today?
38:18I think one helpful effect.
38:21Would be a greater awareness of patient
38:24perspectives with regards to psychiatric
38:26care so that we can treat patients
38:29with humility instead of eragon's.
38:31Some of the worst abuses sterilizations
38:34lobotomys insulin shock have occurred in
38:36the history of psychiatry by physicians,
38:39believing that their good intentions
38:41inoculated them against that practices.
38:44Since history proves this untrue,
38:45we should ask what practices do
38:48we take for granted today that
38:50may be harmful to our patients?
38:53Susanna, you point out there are numerous
38:55problems ranging from diagnosis to treatment,
38:57including the misclassification
38:58of some psychotic illnesses is
39:00having at psychiatric origin,
39:02when in fact they may have a neurological
39:04ideology and you've become an advocate for
39:07patients seeking thorough medical workups,
39:09especially during the first
39:11presentations of psychosis.
39:12I think this is really crucial
39:15and totally agree with you.
39:17An in addition,
39:18my experience is a psychiatrist
39:20and training has made me ask.
39:23But who gets to have these thorough
39:25medical workups and what I've noticed is
39:28that more often than not in his people
39:31who are wealthy people who are white,
39:33were able to gain access to these
39:36workouts because they have the resources
39:38medical literacy and privilege that
39:41enables their demands to be respected.
39:43Just may partly explain why there
39:45are large disparities with black
39:47and Brown people been being given
39:49diagnosis of schizophrenia and
39:51then prescribed antipsychotics and
39:52higher rates than white people,
39:54and it is also an effect of the
39:57cultural and medical pathologization
39:58of black and Brown bodies that
40:01has a long and tragic history.
40:04So how then do we address issues
40:06of power and privilege that
40:08contribute to racial and class in
40:10equities in diagnosis and treatment?
40:13And finally,
40:14I think it is beneficial for us to
40:17discuss the elephant in the room,
40:20which is the uncomfortable
40:22relationship that psychiatry has
40:23with the rest of medicine.
40:25And since at least the 20th century
40:28psychiatry has been referred to as the
40:30Cinderella of Medicine sexist term
40:33keynoting psychiatry subservient.
40:35And lowly status among
40:36the medical specialties,
40:37one Tord which bad medical students
40:40with low USMLE scores or diverted when
40:42they can't hack it in real medicine
40:45and over the years I've been told that
40:48psychiatry is still in the dark Ages,
40:50that medical training is wasted
40:52on psychiatrists.
40:53That psychiatry is based on opinion,
40:55not facts,
40:56and that psychiatric medications don't
40:58work or cause more harm than good.
41:01And that talk therapy is useless.
41:04I should note here that many of
41:06these statements were made by others.
41:09Psychiatrists talk about internalized hatred.
41:13So to a certain extent,
41:15I think ROSENHAN'S study can be
41:17seen as reinforcing this hierarchal
41:20relationship between medicine and psychiatry.
41:23And I wonder if it's work hasn't
41:25contributed to the stigmatization of
41:27mental illnesses and has made people
41:30more reluctant to seek psychiatric care,
41:32even when it might be helpful.
41:34So.
41:35But maybe we shouldn't move past
41:38him too quickly.
41:40Since a closer look at his
41:41critiques in his paper
41:43reveals that one of the things that
41:45bothered wasn't handled most was a
41:47process by which hospitilization strip
41:49people their humanity and rendered
41:51them into compliant patients, not only
41:53four and marked by their the disease.
41:56He also criticized the technical
41:58aspects of diagnosis and the emphasis
42:00on medicating patients instead of
42:02spending time with them as healers.
42:04He urged for more Humane treatment,
42:06psychiatric patients,
42:06and this is a point I think you also
42:09illustrate beautifully, Susanna,
42:11when you share that the most
42:12important part of your hospitalization
42:14was when Doctor Najar sat down,
42:16looked you in the eye and told you that
42:20he would do everything to help you.
42:24So I wonder if this call for
42:26psychiatry to be more Humane can
42:28be extended to all of medicine.
42:31Those who have spent anytime as a
42:33patient or family in the hospital,
42:35which I suspect is most,
42:37if not all of us,
42:39would likely agree that the
42:40problems Rosenhan described are not
42:42unique to psychiatric hospitals.
42:44If anything,
42:45the emphasis on the technical aspects
42:47of medicine has only increased
42:49over the past 50 years and we
42:51now have a huge assortment of on
42:53spiring machines and technologies,
42:55medications and treatments.
42:56But we've also organized our health
42:59care in a way that exacts high costs
43:01in terms of both finances and labor.
43:04Anna's doctors we rely a great
43:06deal and lab values,
43:08tests and imaging on thinking
43:10about algorithms and rating
43:12skills on documentation,
43:14disposition plans and justifying
43:16here to insurance companies.
43:18And the result has been to prioritize
43:21doing things about patients
43:22instead of doing things with them,
43:25which reduces the time spent
43:27with patients and increases in
43:29emphasis on medicating them
43:31and ensuring their compliance.
43:33And I think this not only
43:36makes patients dissatisfied,
43:37dissatisfied with their care,
43:39it also makes doctors disillusioned
43:41with our work,
43:42contributing to burnout and attrition.
43:45And both my patients and my colleagues
43:48have complained that modern medicine
43:50has become more bureaucratic,
43:52technocratic and disconnected.
43:54In the word inhuman.
43:57How can we rectify this?
44:00I think your book is exemplary of
44:03the kind of work and scholarship
44:05that can be helpful and leading
44:07us out of this problem.
44:09We need more writers like you
44:11to remind us of the limits and
44:14failings of modern medicine,
44:16and insist on the humanity of our patients.
44:19We need doctors to listen to you and
44:22to others who are experts on their
44:25own illnesses and suffering as part
44:28of the tapestry of human experience.
44:30We need journalists and writers,
44:32humanists, and social scientists,
44:34artists, and advocates,
44:35people of all colors, and ways of life.
44:39In order to help medicine live
44:41up to its promise to leave it
44:44illness and suffering,
44:45and to amplify our potential
44:47to become more Humane.
44:50Thank you.
44:57Thank you so much Nathan.
44:59I feel like wow both talks
45:01that you gave were wonderful and exhausted.
45:04An exhaustive.
45:04I'm sorry of the subject and now I'm
45:07wondering what questions we still have,
45:10which I'm sure will have from the audience.
45:13But one of the things I'd want you both,
45:16and perhaps maybe Susana 1st and then Nathan.
45:20You do this wonderful investigation of
45:22an investigation and it's incredible,
45:24and I want to ask you a bit in in a bit
45:28about your personal journey through this,
45:31but one of the things that I was wondering
45:34this whole time about the Rosenhan study is,
45:38despite the flaws and
45:40despite removing people.
45:41The basis of his study was
45:44if I pretend to hear voices,
45:46an if I act this way and give a false
45:50story to a psychiatrist, can I fool them?
45:53And when you sit back and think,
45:56I mean to me and Nathan talks about
45:58we need to listen to patients.
45:59We need to hear what they have to
46:01say and we have to trust them.
46:03So I'm wondering.
46:06It just made me wonder about
46:08this whole study.
46:09Like how can we blame a psychiatrist
46:11for believing what the patient said
46:12and making a diagnosis when there
46:14isn't a blood test for schizophrenia
46:16and there aren't blood tests.
46:17So I'm wondering,
46:18maybe Susanna you can speak about it
46:20from the patients point of view of
46:22what you expect from the interaction.
46:24And then they think you can speak
46:26about it from a diagnostician.
46:28I've did this make you feel
46:29uncomfortable to think as one.
46:31That is one I'm going to lie about their
46:33symptoms and play gotcha with me and then.
46:36And how do we
46:37deal with that?
46:38I just before I even got to say to
46:41Nathans like I just I just really.
46:44I'm very moved by your like an emotional
46:47but you're taking my book and I,
46:49you know I think. There are so many
46:52interesting things that you do.
46:54He pulled from the book and so many
46:56things that I dreamed that physicians
46:58reading my book would pull from it.
47:00So I just want to thank you for the
47:02way that you engage with my book.
47:04And it means a lot to me.
47:06But to your point, Randy,
47:07about you know the question of oh,
47:09the gotcha.
47:10And what does it really mean?
47:11You know,
47:12I think the answer to that is that if you,
47:15if it was just like, oh,
47:16that I know I was able to fool
47:18psychiatrist into diagnosing me
47:19on the spot with schizophrenia,
47:21which would never happen now because there
47:23is a lot longer length of time that happened.
47:25Etc.
47:25It was the fact that it wasn't
47:28just the initial diagnosis.
47:29It was then, according to David Rosenhan,
47:32up to 52 days of supporting that diagnosis,
47:34even though the patient quote unquote behave
47:37as normally as they could within the context.
47:39So the really the question was,
47:41is there validity to psychiatry
47:43as a scientific specialty?
47:44You know, if we can so get this wrong,
47:47not just once.
47:48An initial assessment,
47:49but on repeated assessment of multiple
47:51doctors when someone has stopped kind of
47:53thinking any other following symptom,
47:55what does schizophrenia mean?
47:56And I I think that's what really kind
47:59of stuck in people's minds and what?
48:01Why it was more than just
48:03that individual doctor and I,
48:05I think that's why it rises above the
48:08initial OK, the initial diagnosis,
48:09if that makes sense.
48:15Yeah, I'm gonna echo that as well.
48:18And and also. Thank Susannah again just for.
48:25Sharing her story multiple
48:26times without seeing anything,
48:28making it possible for us to
48:32have this conversation together.
48:34It actually has been inspiring for me
48:37in multiple ways, so yeah, I. I think.
48:43To get your question Randy, I it is.
48:46It is a critique right that I think.
48:50Was stated by people who run Red Rose
48:53in his paper when it came out in
48:57in in the 70s that that one of the,
49:00I think most illustrative critiques was.
49:04Doctors said like if I drink blood
49:07right and then do someting yes and
49:10show up at the hospital and doctors
49:12diagnose me with an ulcer, right?
49:15That doesn't prove that there that that
49:18doctors don't know what they're doing,
49:20that they're misdiagnosing people.
49:22It just shows that it's possible to fool
49:25doctors and this is this is this is,
49:28I think, a very illustrative point.
49:30Because it's true, we we.
49:33We do have to take seriously what
49:35our patients tell us, right?
49:38And there is.
49:40Anne.
49:40And there is a certain amount of of
49:44faith and trust and credibility in
49:47the doctor and patient relationship,
49:50which is really,
49:52really crucial to how medicine
49:55good medicine should be practiced.
49:58You know with regards to rosenhan's
50:01other critiques of labeling and Suzanne,
50:03you talk about this as well.
50:06That part you know is something
50:09that we should all be.
50:12Mindful love and I think it's something
50:14as we have physicians talk about now,
50:17right?
50:17Like when we have somebody has
50:19a chart diagnosis of something.
50:21It sticks right?
50:22And it has really little profound effects
50:24on how that patient is treated in the future.
50:27And it is a good.
50:30It's a good lesson for us to keep
50:32in mind to be astute observers
50:34and to also always reassess what's
50:36happening with our patients.
50:39Make recently acquaint
50:40you know the at the time.
50:42The media really focused on
50:43psychiatrist fooled by sham symptoms.
50:45But I think the most enduring part of the
50:47people that appealed to me and what makes it?
50:50What is some of the reason why
50:52it continues to have this truth
50:54emails which I love that you use.
50:56That is because it did hit on something
50:59very detailed role of contexts and labeling.
51:01You know, in my experience,
51:02that happened to me,
51:04various points are,
51:04you know there was a mistake in my medical
51:06record that overestimated extraordinarily
51:08overestimate estimated my daily drinking.
51:10Of alcohol and that really shaped the way my
51:13neurologist saw me under initial assessment,
51:16so these early labels.
51:17These early words that get into
51:20people's hearts can really
51:22derail treatment and really,
51:23really affect outcomes too.
51:25So I think that that that part of the
51:29paper is what makes it really important,
51:31and I continue.
51:33And even though it's extremely
51:35flawed and someone even some
51:37would use the word fraudulent,
51:39I think there are some real.
51:41That is one of the primary takeaways
51:43beyond just the kind of kind of
51:46schooling psychiatrists I think.
51:48And Susanna, I wanna pull from you
51:50some things because we're we're so
51:52grateful to have you here today
51:54an I want to pull some things
51:56that might not be in the book or
51:59that you might not have shared.
52:01Another talks.
52:01One of the things that you began by
52:04saying which was so interesting that
52:05when you talk about your first book,
52:08you you sort of separate yourself.
52:10You don't say I went through this.
52:12You talk about brain on fire.
52:14But it seems to me having read this,
52:16I know I told you before I've
52:18read your book now three times,
52:19and each time it is such a page Turner.
52:22But
52:24you were going like
52:25it. You were going back into your history.
52:28You write about what you went through,
52:30your immersing yourself in psychiatry
52:31and diagnosis was that painful.
52:33I mean, you know I could.
52:34I could easily see your beautiful
52:36writer that you would want to go.
52:38Let's take on something that
52:39doesn't touch on my own personal
52:41history which you want to separate
52:43yourself as you had said before.
52:45So what was it like the process of writing?
52:48But did you ever say to yourself
52:50when you're in the thick of it?
52:52It's too late now, but I should have.
52:55Done something a lot lighter or not cycle. My
52:57husband keeps saying you do?
52:59What about wine country and valleys?
53:01But now it's it's funny that you
53:03say that because I came I don't
53:05at all feel this any anymore,
53:07but the kind of Edward R.
53:08Murrow school? You don't.
53:10You don't become part of the story
53:12if you're a real journalist, right?
53:13We try to have this objective.
53:15You know, I've given that up.
53:17I think that I think in a lot of ways,
53:20my story, my experience shaped
53:22the way I wrote this book,
53:23and I'm very upfront about that.
53:25And so I was,
53:26I initially when I when I actually
53:28sold this book on proposal,
53:30it was a far different book.
53:32I didn't know that I would
53:34face these questions.
53:35I thought it was just going to
53:37be an exploration of this study
53:38in a very straightforward way,
53:40not investigation,
53:41and I wrote it in third person.
53:43I I wasn't it wasn't it?
53:45You know it wasn't there
53:46wasn't really an eye there,
53:48and you know, I just started.
53:49I kept coming back to might
53:51not only my own experience,
53:53but this mirror image experience
53:54that I wrote about in the beginning
53:56of the Great Pretender which.
53:58It was around again the same time
54:00that I did the pointer talk.
54:02The first pointer talk I I did a
54:04grand rounds and it's psychiatric
54:06hospital in North Carolina and
54:07after my discussion about my
54:09experience with automated stuff,
54:11latest one of the doctors came up
54:13to me and said there was a woman
54:15here who has similar profile in
54:17terms of her symptoms were going to
54:19check her out and I found two weeks
54:21later that she had been properly
54:23diagnosed with automate encephalitis.
54:25But the difference was that she had
54:27been misdiagnosed with schizophrenia.
54:29You're not of institutions for two years
54:31before she received that diagnosis,
54:33and she had irreparable damage as a result,
54:36and so you know those experiences and that
54:39kind of how can we get this that wrong?
54:43We failing people and Nathan
54:45said so beautifully.
54:46You know who are we failing,
54:48you know,
54:49and I and that was a big part
54:52of my reason for writing.
54:54This book was the I was inundated by
54:56emails and people contacting me about
54:59interfacing with the medical system,
55:01either with psychiatry,
55:02neurology or other areas of medicine
55:04and feeling, neglected, abused, ignored.
55:06This was overwhelming, and so you know,
55:09it worked for me and I'm in a
55:12privileged position we had.
55:14The financial means I had parents
55:16who could advocate for me.
55:17You know, I was in New York City,
55:20but all I I know personally,
55:22you know,
55:23through my interactions with the public,
55:25very few people get as lucky as I did and so.
55:29You know that really?
55:30That question of I know who are we
55:33failing and how are we failing and really,
55:35really animated?
55:36This book and I thought if I don't
55:38put that perspective in first hand,
55:40if I don't share that.
55:42This book will suffer.
55:43I think you really need to be
55:46there with me and so I didn't.
55:47It felt inauthentic.
55:48It felt like a lie. Honestly,
55:50writing it without that I present.
55:52I don't think I could do it,
55:54but it almost felt stilted.
55:55I think. Was it a difficult journey for
55:57you or catharsis? Like in what way,
56:00or was it tough to go back to
56:02that interesting brain on fire?
56:04Was a catharsis.
56:06They pretend it was hard
56:08because brain brain on fire.
56:10It tells the story of medicine.
56:12We all want to hear.
56:13It tells the story of medical progress.
56:16It tells the story of interventions
56:18and lifesaving treatments.
56:19The great partner was an education
56:21for me that most people do not
56:24get that and we have a long long
56:27way to go an to really know how.
56:29How troubled the mental health care
56:31system and medical system is in this
56:33country was it was overwhelming.
56:35And so in some ways it wasn't
56:37hard to go back.
56:38It was.
56:39It was harder to go forward in
56:41some ways that that makes sense.
56:44And Nathan I I know that you said
56:47we need to hear more from patients
56:50and how much you love the book.
56:53But was there any point you know?
56:55There's one thing when a
56:57psychiatrist writes about here,
56:58doesn't exploration and say
57:00here's how one of our colleagues
57:02abused this study or had flaws?
57:04Was there any thought of you when you
57:07first open this book to sort of think,
57:10wait, who is this woman who can
57:12take a deep dive into psychiatry
57:14where you were you nervous about,
57:17but she's not the expert.
57:19She's not a historian, she had her own.
57:21You know, she's not trained historian.
57:24She's not change a psychiatrist.
57:25Or did you you know is there any
57:27feeling of what's your expertise
57:29going into it or you are more?
57:31This is great.
57:32This is great to have a patient.
57:34Do this
57:35deep dive. Yeah I so.
57:39I have to say that.
57:42One of the things I've I've spent
57:44a lot of time doing right when I
57:48did my own historical research was
57:51to actually try to recover patient
57:54perspectives and patient voices
57:56in in how doctors treated patients
57:59in the past and my research in
58:02the past was about bio medical
58:05understandings of ****** difference,
58:07gender and ********* and so for me,
58:11right, the.
58:12The the Authority right of patients and
58:15patient experiences is an invaluable one,
58:18and I think that it is one that
58:21has contributed to the making of a
58:24scientific and medical knowledge
58:26throughout history and one it's one
58:28that we should pay attention to.
58:32Think that like part of it is that.
58:38Patients are experts in their own
58:40experiences of illnesses, right?
58:42And that's something that we need
58:44to pay serious attention to.
58:47I also think that like we also should be
58:50honest about where wherever we come from.
58:54Our subjective roles in our
58:56situated places in life,
58:58whether they come from places of privilege,
59:01whether we have education or not,
59:03whether or patients or
59:05or doctors sometimes or.
59:07Looks like these are not mutually exclusive.
59:10Categories.
59:11Are racial backgrounds or ethnic backgrounds.
59:15Are genders in our *********?
59:17These are all crucial components
59:20of what makes us human.
59:22They inform,
59:22right our our experience as as patients,
59:25Anna's doctors and they also have a
59:29tremendous effect right on the kinds
59:31of access to security we get as well
59:34as the disease is an medications
59:37we may be labeled with or or have
59:40or have access to, and I think so.
59:44I think it's.
59:46Part and parcel of a larger picture of being.
59:50Honest,
59:50transparent about our experiences on our
59:54in our whole identity's as human beings.
01:00:01I'm gonna ask one more question to Suzanne,
01:00:03and then I think let's open it up.
01:00:06'cause I see questions coming in in
01:00:08the Q&A and I think Anna will control
01:00:11the Q&A from there. But Susanna.
01:00:13Just sort of taking the same question.
01:00:16I asked Nathan but flipping it a bit.
01:00:19Anyone that reads the book sees that you
01:00:22have done your homework more so than
01:00:24anyone has looked into this study before.
01:00:27Were you worried about what psychiatrist
01:00:29would think or did you say this is it?
01:00:31Sorry I've done it.
01:00:33Did you have anyone vet your?
01:00:34Did you show it?
01:00:36Was there a psychiatrist that use it?
01:00:38Here's what I'm going to write.
01:00:40What do you think?
01:00:41Or you just kind of put it out there
01:00:43and hoping that this would stir
01:00:45the kind of discussion that it has?
01:00:48Oh I, I was very, very lucky that I
01:00:50had a lot of people who I trusted who
01:00:52had a very deep knowledge either in
01:00:55their specific areas in psychiatry or.
01:00:57Historians of psychiatry,
01:00:58who I did trust enough to either,
01:01:00so the homeless, but fewer
01:01:02various parts and a lot of people,
01:01:04mostly people like folded I. I
01:01:06did show them aspects of of it before it.
01:01:08The thing I was really scared about nervous
01:01:11about wasn't necessary. The reaction of
01:01:13psychiatry in particular,
01:01:13which happened to embrace the book
01:01:15more than I necessarily anticipated.
01:01:17But I was worried I would get
01:01:19something wrong because it was a
01:01:21big undertaking and I, you know,
01:01:22I, I took various steps to hired a
01:01:25fact checker and I did really vet.
01:01:27It was really important to me.
01:01:29If I was going to raise questions about,
01:01:31you know the issues around around
01:01:33him and study and someone's legacy.
01:01:35I wanted to make sure it was airtight
01:01:38and I also wanted to make sure
01:01:40was fair and that's why this book
01:01:42took six years because I I really
01:01:45wanted to go down every possible Rd,
01:01:47not just about Rosenhan put about the
01:01:49history of psychiatry too and I I tried
01:01:51to walk a tightrope there because I I will.
01:01:54And I was honest in the book I started.
01:01:58This book is pretty. Pretty **** **
01:02:00psychiatry and I ended it very much.
01:02:03Really impressed by psychiatrists.
01:02:05I've met along the way.
01:02:07The difficulty in the job and in
01:02:09the role in the job of medicine in
01:02:12general and the art of clinical care.
01:02:14That was really a takeaway for me and so.
01:02:19Of course I was.
01:02:20I'm always concerned about criticism.
01:02:22Who wants to be criticized,
01:02:23or, you know, revile.
01:02:25There's something but I, I tried so,
01:02:27so hard to be fair and honest.
01:02:29And I tried.
01:02:30And, you know it.
01:02:31As Nathan says,
01:02:32your every aspect of your identity in
01:02:35history comes with you on the page.
01:02:37And that's again why I had to be
01:02:39that I why I had to be present,
01:02:42because I brought all of brain on
01:02:44fire with me in the way that I look
01:02:47at the history of psychiatry, Ann.
01:02:49You know my place in it and I
01:02:51want it to be straightforward
01:02:53about that and so so I you know,
01:02:56I, I hope that I I bridged that
01:02:58in a way that was, you know,
01:03:00it's a tightrope because there
01:03:02are you know Edward Shorter,
01:03:03who's a wonderful historian of psychiatry,
01:03:05talks about minefields,
01:03:06the history of psychiatry, or,
01:03:08you know, all these minefields,
01:03:09and he's right, you know,
01:03:11there are all these places,
01:03:13places where you can get it wrong,
01:03:15or you can be siloed.
01:03:16Or you can be extreme,
01:03:18and I really wanted to.
01:03:20To avoid that and I had,
01:03:21I had I had supportive of various
01:03:24factions that would nest,
01:03:25not necessarily support each other,
01:03:26and one of my favorite people I
01:03:29interacted with during the writing
01:03:31of this book was Ether Tori.
01:03:33And he wrote me a beautiful note
01:03:35in the beginning of my research
01:03:36about how he really was happy that
01:03:38someone outside psychiatry and
01:03:39medicine was doing this because I
01:03:41didn't come with all sorts of food.
01:03:43Conceived notions that maybe they helped,
01:03:45that I was seeing this with fresh new eyes.
01:03:48I actually printed that out and
01:03:49had it above my desk as a reminder
01:03:52that I can have a place
01:03:53and I can have a voice in this
01:03:56history. And I can do this.
01:03:59Well, you certainly have an.
01:04:00I think that that's probably what
01:04:02makes the book so compelling, is that.
01:04:04You it's not black and white
01:04:07and you finished the book.
01:04:09Thinking you know I when I teach writing,
01:04:12I would say the conclusion should sort
01:04:14of move people forward to keep thinking
01:04:16and not tie it up in a nice little bow.
01:04:19And you certainly don't do that.
01:04:20You finish the book and want
01:04:22to engage in a conversation.
01:04:23You know now what now, when we do?
01:04:26What does this mean?
01:04:27How can we make things better?
01:04:29So as as time is ticking forward,
01:04:31maybe I will pass this along to Anna Reisman,
01:04:33who will go through an some of the cute.
01:04:36There's some of the questions
01:04:37that are coming through.
01:04:40Thanks
01:04:40so much. This has been a wonderful
01:04:42discussion so far and there's
01:04:44some great questions here,
01:04:45so I'm going to start with this
01:04:48one that refers to the title of
01:04:50Rosenhan's study in this talk,
01:04:52which brings to the fore the
01:04:53dichotomy of sane and insane
01:04:55and organic versus psychiatric.
01:04:57That kind of plays off a lot of
01:04:59what you were talking about.
01:05:01Nathan as well,
01:05:02and I'm wondering if you could comment
01:05:04on the usefulness of these distinctions,
01:05:06particularly sane and insane if
01:05:08the symptoms present the same way
01:05:10aside from different treatments.
01:05:11With an anti inflammatory
01:05:12medication versus an antipsychotic,
01:05:14should we think of organic and
01:05:16psychiatric illness differently?
01:05:21I'm gonna let Nathan say about
01:05:23that is that is a big and I'd
01:05:26love to hear your thoughts.
01:05:30I guess the yeah that is a big big topic and.
01:05:37You know the terminology that we use in
01:05:41psychiatry keeps changing overtime and I.
01:05:44I don't certainly now is not a time
01:05:47when we still use the terms sane and
01:05:50insane to to refer to people anymore.
01:05:53That that has fallen out of Vogue for
01:05:56some time, but I think you also point
01:05:59out a really good point here about
01:06:02like and it certainly seemed enhancing.
01:06:04Does not map right onto the the
01:06:07other dichotomy here of between
01:06:09organic or inorganic, and even that
01:06:11there we've moved away from that.
01:06:14I think in the fields are catching,
01:06:17not talk about primary versus secondary
01:06:20causes of psychotic illnesses,
01:06:22and that which which seems to imply, right?
01:06:26That like.
01:06:28With the organic organic or secondary.
01:06:33First, the idea that somehow we
01:06:36can find a cause of their psychotic
01:06:39illness that Maps onto a lesion in the
01:06:42brain or the central nervous system.
01:06:45And that is what those terms
01:06:48are referring to.
01:06:49Whereas like if we can't write then some,
01:06:52somehow it's relegated to the
01:06:55field of psychiatry and becomes
01:06:57like a morphis in that way.
01:06:59And a good example of this is like.
01:07:03The way that.
01:07:06We used to have a medical
01:07:08diagnosis of general paresis of
01:07:11the inside of the insane right,
01:07:13which in modern terms, now we would.
01:07:16We would identify symptoms of
01:07:18somebody having tertiary syphilis.
01:07:19Once syphilis moves into the nervous
01:07:22system it can cause paresis it can
01:07:24cause something for Lucy nations,
01:07:26delusions and other behaviors that
01:07:28people deemed insane over a century ago.
01:07:31But once that happened,
01:07:33what's strange is that then it gets.
01:07:36Old as A is a neurological illness, right?
01:07:40And so this divide between these terms.
01:07:45Kind of recapitulates and reinforces
01:07:47like like the status of World Psychiatry
01:07:49explains all those things that are
01:07:52messy that are complicated but we don't
01:07:54actually have an answer to and that
01:07:57can be frustrating to some people.
01:07:59But it can also be exciting to
01:08:02others who who who you know who
01:08:05want to pay attention to.
01:08:06The fact that like you know psychiatrists,
01:08:09we spend a lot of time talking
01:08:12about peoples cognitions,
01:08:13their emotions, right?
01:08:15Their thought processes and this
01:08:17is something that's unique to
01:08:19psychiatry that that is not really
01:08:22paying attention so much in other
01:08:24medical specialties as well.
01:08:25It makes psychiatry unique,
01:08:27but it also makes psychiatry vulnerable
01:08:30to charges that were kind of loosey,
01:08:32Goosey,
01:08:32wishy washy and don't really
01:08:34know what we're doing.
01:08:38And then I guess your other question is,
01:08:41is is then what treatments
01:08:43then are available to this?
01:08:45And that's a good question, right?
01:08:47Because neurology has a specific set
01:08:49of of illnesses and diseases that they
01:08:52specialize in this divine happened
01:08:54where psychiatry has it has a different
01:08:56set of illnesses that we specialize.
01:08:58We have different treatments in that
01:09:01and that it really is more of a fact
01:09:04of a disciplinary boundary that's
01:09:05been drawn over time in history.
01:09:08Rather than, I would say necessarily
01:09:10something that might be unique to
01:09:12patient experiences themselves.
01:09:15That is so beautifully
01:09:17beautifully worded, and I think.
01:09:18To add to that idea of you know
01:09:22when psychiatry is practiced, well,
01:09:24I think it's really soulful and I
01:09:26think it deals with what makes us
01:09:29human and it's really sophisticated
01:09:31and really difficult and messy,
01:09:33but can be beautiful.
01:09:34And I think that is true of medicine
01:09:37when it's practiced well too,
01:09:39and I think that psychiatry has
01:09:41to rely on some more of that art
01:09:44because there are less of these more
01:09:47objective measures that are seen in.
01:09:50Cardiology so I think the potential in
01:09:52psychiatry to practice it in a soulful,
01:09:54beautiful way is just it's extraordinary
01:09:56and I think there is a lot of
01:09:59lessons for the rest of medicine
01:10:01that can be gleaned from psychiatry
01:10:03and from the messiness there.
01:10:05Because the fact is,
01:10:06many sort of quote unquote physical
01:10:08illnesses are very messy too,
01:10:10and we're only now learning,
01:10:11really, the complex interplay
01:10:13between the body and the mind,
01:10:15the body, brain, mind,
01:10:16and it's only going to be more
01:10:19and more apparent that you need to
01:10:21take a real whole body approach.
01:10:23To various illnesses.
01:10:24Not just things deemed psychiatric.
01:10:26So I think that there will be a
01:10:28turn around where people are going
01:10:30to be looking more to psychiatry.
01:10:32Hopefully the best practices of psychiatry.
01:10:34And as we move forward,
01:10:36the rest of medicine.
01:10:37At least I hope.
01:10:42So.
01:10:45Kind of flipping that to the complete
01:10:47other direction about best practices,
01:10:49so worst practices.
01:10:50There's a question that I would
01:10:53like to to bring up that reads even
01:10:56though Rosenhan study was flawed.
01:10:57Plenty of contemporaneous,
01:10:59even current lived experience accounts
01:11:01of psychiatric survivors would
01:11:03have shown similar abuses to those
01:11:05documented in the original study.
01:11:07Do you feel that Rosenhan's study
01:11:09legitimized or amplified longstanding
01:11:10psychiatric survivor accounts of abuse?
01:11:12That is
01:11:13a really beautiful question,
01:11:14and I think actually I think there there was,
01:11:18at least in the popular media.
01:11:20Eight more of a support of
01:11:23psychiatric survivors stories.
01:11:24I really do believe that it did
01:11:26actually give some legitimacy
01:11:28and that was hard to about.
01:11:30Uncovering the issues with this study
01:11:32because there is a residual effect
01:11:34of that that that I would not want
01:11:37to be intended in here that step
01:11:40people who have had bad experiences
01:11:42in the psychiatrist or in psychiatric
01:11:44institutions all of a sudden or discount.
01:11:46It would be a terrible response from this.
01:11:50So it it actually makes me matter about
01:11:53his at least augmenting the truth,
01:11:56because the fact the fact remains
01:11:59his experience.
01:12:00Rosen, hand singular experience
01:12:01did show abuse is did show neglect.
01:12:04You know that was true and
01:12:07confirmed through his diary.
01:12:08As much as I can confirm it and confirm
01:12:11that a lawsuit leveled at Haverford State
01:12:14Hospital at the time of a psychiatric
01:12:17survivor who had tales of horrific abuses.
01:12:21Ana Nurse, who also did win a
01:12:23lawsuit against the hospital,
01:12:24so these were real things happening.
01:12:26It wasn't as if he made up the fact
01:12:28that institutions could be uncaring,
01:12:30even harmful places.
01:12:31That was true,
01:12:32and I think you know at the
01:12:34time it did serve a purpose in
01:12:36legitimizing those stories.
01:12:38So I,
01:12:38you know,
01:12:39I really I hope that it doesn't serve
01:12:41now as we start to question it to
01:12:43kind of raise any questions about the
01:12:46legitimacy of those of those stories.
01:12:50And I also just want to chime in that,
01:12:52like. You know when we when
01:12:55you think about this right,
01:12:57it's important for us to think about that
01:13:00this is just not something in the past,
01:13:02right? That there are.
01:13:06That we should listen to the stories
01:13:08of people who are psychiatric
01:13:10patients right now and of the
01:13:12struggles with the mental health
01:13:14care system and healthcare at large.
01:13:16The experience today there
01:13:18are there are abuse is.
01:13:20There are things that we
01:13:22are doing wrong there,
01:13:23things we're doing,
01:13:25harm that we're doing harm to patients in in,
01:13:28in a multitude of ways,
01:13:30right that that didn't end with frozen hands
01:13:33paper and that continue to it to the present.
01:13:37And so.
01:13:39His study right is a resource right
01:13:42to some of these survival movements
01:13:44of these survivor movements have
01:13:47integrity in and of themselves.
01:13:49Whether or not right rosenhan
01:13:52study is legitimate or not.
01:13:54Survivor stories.
01:13:55Our expert also expert sources of
01:13:58knowledge on their own experiences
01:14:00that we should pay attention to
01:14:02as we're thinking even today.
01:14:04But how we can make the experience of.
01:14:08Getting mental health care better for people.
01:14:15Thank you.
01:14:18Speaking of power, the issue of.
01:14:21Caleb second book concerns in part
01:14:24the power imbalances between doctors
01:14:26and patients within psychiatric
01:14:27institutions that are not unlike the
01:14:30power imbalances between prison guards,
01:14:32prisoners part from banking on the
01:14:35generosity of individual psychiatrists.
01:14:37What can be done institutionally
01:14:39to mitigate these power imbalances?
01:14:42Oh my gosh, what?
01:14:45Figure that out. Yeah, I mean,
01:14:47I think that's what's really interesting,
01:14:49and I'm not saying this is the answer,
01:14:52but I did go to the Netherlands.
01:14:54I didn't put this in the book,
01:14:57but I did go to the Netherlands because
01:14:59they did pseudopatient experiments where
01:15:01nurses and doctors actually went undercover
01:15:03as patients in their own institution.
01:15:06This is not in prisons and jails,
01:15:08but this is in psychiatric
01:15:10institutions in the Netherlands.
01:15:11An it was profound.
01:15:13Especially for the nurses who had the
01:15:15most day-to-day contact with patients.
01:15:17And I doubt that there is any
01:15:19kind of way that we could have an
01:15:22IRB approve something like this,
01:15:24but I think anything that puts someone
01:15:27in the shoes of a patient and that could
01:15:30be reading patient survivor stories.
01:15:32Listening to people you know really having.
01:15:37Kind of a narrative sharing of narratives
01:15:41that's actually taken seriously and valued.
01:15:45You know, I know,
01:15:46there's a lot going on in narrative
01:15:47medicine with this and trying to bridge
01:15:49these these power imbalances in medicine,
01:15:51and I can only imagine the power
01:15:53imbalances that goes on in prison
01:15:55and jails and how to bridge that.
01:15:57But again, I'm not going to.
01:15:58I'm not going to to figure that out,
01:16:00and I would love to hear Nathan's
01:16:02take on that,
01:16:03but it was interesting to me to hear
01:16:05how profound it was to literally
01:16:07kind of stand in the shoes of a
01:16:09patient and and how different the
01:16:10care that in the level of care
01:16:13roses as a as a result of that.
01:16:16I don't know how to do that on a grand scale,
01:16:18but it was definitely
01:16:19fascinating to hear about that.
01:16:23It is a huge question and thank you
01:16:25so much for asking it because it's.
01:16:28Yeah, it it speaks to.
01:16:31Also the fact that that what's
01:16:33happened historically is that
01:16:35with the institutionalization,
01:16:36alot of psychiatric patients have been
01:16:40removed from institutions but then
01:16:42left without access right to mental
01:16:45health care and then either end up
01:16:48on the streets or in jails, right?
01:16:50So there's actually been a trans
01:16:53Institute institutionalization process.
01:16:55Sorry, and that in your question
01:16:57is actually literal, right?
01:16:59Like sometimes it actually.
01:17:01Like patients and prisoners are the same.
01:17:04Now in our current system and it is.
01:17:07It's it's a great tragedy.
01:17:10You ask questions though about
01:17:12like psychiatric practice itself,
01:17:13and this is.
01:17:14This is so hugely important
01:17:16and I just want to give a shout
01:17:19out to some of my friends.
01:17:22Who are envisioning new ways of
01:17:24imagining how we can provide care for
01:17:27people with serious mental illness in
01:17:30communities and in places that are
01:17:33not institutions and and do not have a
01:17:36strong relationship to the carceral state.
01:17:39So I shot some my friends on called
01:17:42Rojas Anne Jane Carter and and Allison,
01:17:45who are in there working on this project
01:17:49that now called seeds and Sprouts.
01:17:52And there in there,
01:17:54in dialogue with the community about
01:17:56like how can we can imagine care
01:17:59outside of traditional institutions
01:18:01that have had these problems, right?
01:18:05And yeah, I mean there's also so,
01:18:08so that's kind of really big
01:18:10picture and things,
01:18:11and I think Suzanne,
01:18:12you point out like there are precedents
01:18:15about maybe good role models for
01:18:17this like so Therea House which is
01:18:20a super healing group kind of home
01:18:22situation that had been there before.
01:18:26And so I I think with each generation right,
01:18:30there's always new ideas and we should
01:18:33encourage those ideas and give them
01:18:36a chance to to and support them with
01:18:39resources to be developed further.
01:18:41And I think there's also really,
01:18:44you know, more direct things we can do,
01:18:48which is that oftentimes some
01:18:50psychiatric institutions have like
01:18:52armed guards right at the front door,
01:18:55and that is actually incredibly stigmatising.
01:18:58And reinforces the idea that psychic
01:19:01psychiatric patients or dangerous that
01:19:03they and their potential criminals that
01:19:05they should be surveilled by the state,
01:19:07and that the the the the arm of the state
01:19:11and the law is always close right to?
01:19:14And unfortunately it's sometimes
01:19:17the only recourse.
01:19:18That that people have when someone
01:19:21needs help and and it's not seeking it.
01:19:24So how do we imagine different
01:19:26ways right of bringing?
01:19:30People with serious mental illness
01:19:32to care providers in a way that
01:19:35is healing that is non coercive
01:19:37that it is community oriented.
01:19:41I will add two. I thank you
01:19:43for that and I kind of Gerardo,
01:19:46a few Members I visited a few psychiatric
01:19:48hospitals, a lot of psychiatric
01:19:50hospitals around the country and.
01:19:52You know, a lot of these places,
01:19:55especially relics of the past, are not
01:19:57designed for that kind of interaction.
01:19:59And that kind of leveling,
01:20:01especially with physicians who
01:20:02are not on the Ward on the floors.
01:20:05Often. Usually it's kind of,
01:20:07you know, varies from place to place,
01:20:09but when David Rosenhan's
01:20:10assessment 15 minutes a day,
01:20:12if you're on that short amount
01:20:14of time that it in itself creates
01:20:16a power imbalance, right?
01:20:18You're trying to waiting for the
01:20:20doctor to come, and so there was.
01:20:23Interesting things that I saw
01:20:25specifically in South Dakota
01:20:26where doctors spent more time on
01:20:28the on the actual floors and the
01:20:31actual floors themselves were new
01:20:33and they had huge windows.
01:20:35You know there.
01:20:36Unfortunately there are suicide
01:20:38prevention issues that create kind
01:20:39of ice or situations that that don't.
01:20:42Again create that sense of imbalance
01:20:44that you're in an institution.
01:20:46An institutional setting,
01:20:47but there were some kind of
01:20:50beautiful touches of keeping the
01:20:51nurses where where the nurses are.
01:20:54Open not walled in.
01:20:55In glass staff you know little
01:20:57things like that.
01:20:59Lowering the bed to the floor to
01:21:01make it calming more peaceful.
01:21:03You know,
01:21:04eliminate ING kind of dark hallways and
01:21:07alleyways that might augment psychosis.
01:21:09Know using light and color on the walls.
01:21:12You know there are things that might
01:21:14sound unimportant but are extremely
01:21:16important in the experience of
01:21:18psychosis that I experienced firsthand.
01:21:21Keeping things serene and calm as possible.
01:21:24Really does affect the experience
01:21:26of psychosis and those little
01:21:28touches do mean a lot, so you know,
01:21:31I feel that there are potentials
01:21:33even in the architecture of the
01:21:35design of these institutions,
01:21:37when,
01:21:37when needed,
01:21:38that can create more egalitarian
01:21:40and healing places too.
01:21:46Thank you.
01:21:50I know, I know. We
01:21:52talked a little bit about the distinction
01:21:55between medical and psychiatric illnesses,
01:21:58but one person asked if there's utility of
01:22:01thinking about psychiatric diseases like
01:22:03chronic medical ones such as diabetes, which.
01:22:09And I guess that does.
01:22:11There are certain psych diagnosis
01:22:12where that that that is kind of
01:22:14part and parcel of how it's done,
01:22:16but I think others may be
01:22:19personality disorders and kind of.
01:22:21That kind of category,
01:22:22I think maybe is what this person is is
01:22:25thinking about and and and if there's
01:22:28some benefit to kind of thinking of
01:22:30changing the way that we in medicine
01:22:33think about those diagnosis would
01:22:35make them seem more legitimate and.
01:22:37Treated more like medical illnesses, IE.
01:22:40Kind of like what you were
01:22:43saying Nathan about.
01:22:44With more respect from the medical.
01:22:47Community as awful as that sounds.
01:22:54Yeah, thank you so much for it for that
01:22:57question and I think that like you know,
01:23:00one of the things is.
01:23:03Is that this distinction between
01:23:05things that are medical and that
01:23:07that things are psychiatric has been
01:23:10reinforced with with time, right?
01:23:12In the ways that I've talked
01:23:15about before that?
01:23:16More often than not is stigmatising
01:23:19to patients with mental illness
01:23:21and to psychiatry in general,
01:23:23and it's the way that we've thought about
01:23:27these things as intractable illnesses that.
01:23:31Chronic that once you have it,
01:23:33you have it forever and that there's
01:23:36not much you can do about it,
01:23:38and that the only recourse is to like
01:23:41put people or lock them up in in
01:23:44hospitals or institutions forever, right?
01:23:46And I think that like thinking of and
01:23:48I think Alan Sachs writes beautifully
01:23:50about this and in their book on the
01:23:54center cannot hold thinking about some
01:23:56psychiatric illness is more akin to.
01:23:59Chronic medical conditions that you
01:24:01you manage may be more helpful, right?
01:24:04So that like.
01:24:06It can be helpful right to take medications.
01:24:10Sometimes when you have
01:24:12psychosis it does help.
01:24:14A lot of people live better,
01:24:17more functional and you can very
01:24:20productive and successful lives and having
01:24:23a diagnosis of schizophrenia is not a
01:24:26sentence to go to institution and to
01:24:29be disabled or or impaired forever, right?
01:24:33And that.
01:24:34And that's it.
01:24:35Also,
01:24:36I think it thinking of it that way
01:24:39opens up sub to thinking about
01:24:41some of these diseases more,
01:24:44or illnesses more humanely and also well,
01:24:47maybe kind of brings into the
01:24:50question of like,
01:24:51well,
01:24:51what are the social right and
01:24:54cultural and political factors
01:24:56that go into enabling people to get
01:24:59access to the medications that care
01:25:02that they need that that sometimes.
01:25:04Are frustrated, right?
01:25:05So let's take the what I'm thinking
01:25:07about specifically here is like
01:25:09the frustration is we don't know
01:25:11what's happening with schizophrenia.
01:25:13We don't know the science.
01:25:15We don't know that diagnosis,
01:25:16but but,
01:25:17and so it's it's a problem that's
01:25:19that can't be solved.
01:25:21But if you look at something like diabetes,
01:25:24right?
01:25:24Like?
01:25:24The science flats known pretty
01:25:26well and we have medications that
01:25:29work for that pretty well, right?
01:25:31And but there's still problems
01:25:33with people having really poor
01:25:35outcomes with diabetes and then the
01:25:37traditional answer has been it's
01:25:38because people are non compliant.
01:25:40They're not taking their insulin,
01:25:42they're not taking their medications,
01:25:44they're just banned patients,
01:25:45and so that's why they have this illness,
01:25:48when in fact rotting the frame to
01:25:50looking at whether or not they have
01:25:53access right to insulin where they have.
01:25:56Where that they have resources,
01:25:58whether they know about it,
01:26:00whether they trust their doctors or or not.
01:26:03Right weather.
01:26:05They are able to get to due to the
01:26:08pharmacy to amended medication or
01:26:10maybe because they have children
01:26:12are and I would rather be able to
01:26:14put food on the table for their
01:26:16children rather than to get their
01:26:18medications. All these things.
01:26:21Take us into the realm of like the cultural,
01:26:24social, and political factors
01:26:26that are also really important
01:26:28to both psychiatry and medicine.
01:26:30When we think about some of the
01:26:33illnesses that are in our in our current
01:26:36day phenomenon that seem to be so
01:26:39frustrating and so difficult to treat.
01:26:44Thank you excellent answer.
01:26:48I see that it's 6:30,
01:26:49so I'm going to. Turn the mic
01:26:52back over to Randy to sum up and.
01:26:57Well, I feel I am so grateful
01:26:59to everyone here for those
01:27:01who've taken the time to attend,
01:27:04particularly to Nathan and Susanna,
01:27:06for I feel like for starting a conversation,
01:27:09Susanna, for doing the incredible
01:27:11work you did in the book.
01:27:14And also for joining us while we know
01:27:16you're in the process of moving,
01:27:18we made you push your box is off to the side,
01:27:22but that you're moving right now as we
01:27:24speak with toddler Twins and tons of boxes.
01:27:27So speaking about stress and you still
01:27:29found the time and you didn't back out.
01:27:31Thank you very very much.
01:27:34Nathan, you keep talking about how
01:27:36wonderful it is that Susanna did this
01:27:40to listen to our patients hearing.
01:27:42You communicate so beautifully and
01:27:45I'm sure everyone on the participants
01:27:48that are listening the attendees
01:27:50would would feel that.
01:27:52You have such a wonderful deep voice
01:27:55coming from the field of psychiatry that I
01:27:58hope that this conversation encourages you.
01:28:00As a historian,
01:28:01Anna psychiatrist to consider
01:28:03writing for a lay audience and
01:28:05putting something together.
01:28:07Because yes,
01:28:07we need to hear voices like Suzanne's.
01:28:10We also need to hear voices like yours,
01:28:13compassionate physicians grounded in history.
01:28:15So I want to end this by saying
01:28:18if either of you want to share a
01:28:22secret with us and we won't tell.
01:28:24Anyone we promise,
01:28:25except for anyone that listens to
01:28:27the recording of this and anyone that
01:28:30we tell after we click off and say.
01:28:32But don't tell anyone.
01:28:33If you want to share anything that
01:28:35projects that you may be working
01:28:37on and hope to publish one day an.
01:28:39If not, that's fine,
01:28:41but I am really grateful and I hope
01:28:43the two of you keep writing and
01:28:45I hope that we see your byline.
01:28:47Zannier authorship saw none more
01:28:49books to come.
01:28:50Randy, I was thinking the
01:28:52same thing about Nathan.
01:28:53I said he needs to write a book.
01:28:56There needs to be a book that
01:28:58comes out of you at some point
01:29:00and I'm sure there will be.
01:29:02I have no doubt about that.
01:29:04I would. I just feel that your
01:29:06perspective on these issues is so
01:29:08it's so deep it's it's so profound.
01:29:10And I, I'm so moved by hearing
01:29:12you speak on this and I just want
01:29:14to thank you so much for engaging
01:29:16so deeply with my own work.
01:29:18It's really been an honor and privilege.
01:29:21So thank you for giving me that gift.
01:29:24And to answer your question,
01:29:25I'm I'm working on a book,
01:29:27but it's funny I have this thing right here.
01:29:30This is a little clearer.
01:29:32You can see I'm working on a book
01:29:34about psychedelics actually right now,
01:29:36so I know everyone's talking
01:29:38about psychedelics,
01:29:38but that's kind of where I'm where.
01:29:40My kind of where my world has led me
01:29:43just in the same way that it led me
01:29:45to the right pretendre there's one
01:29:47person I'm focusing on in particular,
01:29:50but.
01:29:50Really does raise a lot of questions
01:29:53about the mind.
01:29:54The brain, the sold,
01:29:55the Selfon medicine in the
01:29:57history of psychiatry.
01:29:58So there is a path there somewhere,
01:30:00so that's what I'm doing.
01:30:05Thank you so much for this invitation.
01:30:09I came to see the tribute to an artist, Andy.
01:30:12I'm just this is Anna Ann for welcoming
01:30:15me into the world of writing and.
01:30:18I guess. Yeah I am.
01:30:20I will say since sometimes the universe
01:30:23works in mysterious like OK, I I have
01:30:26been thinking possibly about writing.
01:30:29Something about the experience I had
01:30:32going to medical school and then
01:30:35having a spouse who actually passed
01:30:37of cancer during the same time so.
01:30:40Still very embryonic and unclear, but.
01:30:44There you have it.
01:30:46Thank you for that invitation.
01:30:48It was so so kind and so validating.
01:30:50Appreciate it so very much.
01:30:52And so I'm grateful to have had this
01:30:54opportunity to view here the value today.
01:31:00Thank you so much everybody.
01:31:02Have a good night.