Yale Department of Psychiatry Grand Rounds, June 12, 2020
June 12, 2020Yale Department of Psychiatry Grand Rounds, June 12, 2020
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Andrew Solomon, PhD, writer, lecturer, Yale Department of Psychiatry's Special Advisor on LGBTQ Mental Health
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- 00:00It's my tremendous pleasure to introduce
- 00:02Andrew, Solid Doctor Andrew Solomon.
- 00:04Welcome back to Yale.
- 00:06When I thought of someone to be the
- 00:09first loudspeaker outside speaker as we
- 00:11passed the peak of the kovid pandemic,
- 00:14doctor Solomon was at the top of my list.
- 00:17Andrews professor of clinical
- 00:18Gayatri at Columbia and a former
- 00:21president of the pen American Center.
- 00:23In some ways,
- 00:24he needs no introduction because he's
- 00:26become such an important part of our
- 00:29Department community over the years.
- 00:31Is my special advisor on LG BDU
- 00:34issues and he's visited us many
- 00:36times speak to our Department?
- 00:39We meet with our trainees advisor
- 00:41LG LBGTQ Interest Group and to
- 00:44share the wonderful movie based
- 00:46on his book far from it.
- 00:48And of course to receive our mental
- 00:52health research advocacy Ward.
- 00:54Many under Zoom Conference to
- 00:55know him through his writings
- 00:57and through his public advocacy,
- 00:59which had been so important
- 01:00in their minds and hearts,
- 01:02to the experience of mental
- 01:04illness and the meaning.
- 01:05An impact of difference in the
- 01:07mental health field is probably
- 01:09best known for two books,
- 01:11in particular the Noonday Demon
- 01:13and far from far from the tree.
- 01:16The Noonday Demon,
- 01:17in which in which answer describes
- 01:19his personal experience with
- 01:20compression in a in place,
- 01:22is it in a broader consideration
- 01:24of depression, as one.
- 01:26Many honors,
- 01:27including the National Book
- 01:28Award for nonfiction in 2000,
- 01:30and one finalist for the Pulitzer
- 01:32Prize in 2002 and was designated
- 01:35by the London times as one of
- 01:38the 100 best books of the decade.
- 01:41An far from the tree which describes
- 01:43how families cope with difference,
- 01:46also won numerous awards,
- 01:48including the National Book Critics
- 01:50Award for nonfiction Welcome Book
- 01:52Award Prize and it would ignited
- 01:55by the New York Times as one
- 01:57of the top ten books of 2012.
- 01:59I thought he would be a particularly
- 02:02appropriate speaker to today
- 02:04because his books and articles
- 02:07address themes are really important
- 02:09to our community at this time.
- 02:12Is writing dress human vulnerability and
- 02:16resilience the challenge of knowing oneself?
- 02:20In the importance of knowing
- 02:21oneself in dealing with the even
- 02:23greater challenge of trying to
- 02:24get to know other people,
- 02:26particularly when they're different from you.
- 02:29In all of his writing,
- 02:31there is an honesty, a transparency,
- 02:34humility, and humanity.
- 02:35That's unique.
- 02:36Is writing weather about his
- 02:39struggle with depression?
- 02:41Death of his analyst or other
- 02:44experiences is both deeply personal and
- 02:46yet it touches on universal issues.
- 02:49So it's a special pleasure
- 02:53to invite back doctor Andrew
- 02:55Solomon random our Department.
- 02:58A River today's psychiatry grant.
- 03:03So Andrew,
- 03:04thank you very much.
- 03:06Well, thank you.
- 03:07It's a great pleasure to be here.
- 03:09I'm going to talk for a bit about my
- 03:12perceptions of mental illness during
- 03:14this time of Kovid and then I will invite
- 03:17any or all of you to ask questions.
- 03:19The easiest way to do that is
- 03:21probably through the chat function.
- 03:23I'm just trying to arrange my
- 03:25screen so that I will be able
- 03:27to see those when I get them and
- 03:30I am happy to answer question.
- 03:32You know, that relate specifically to what
- 03:34I've said or that are in this general.
- 03:37Area, so the question of Kovid
- 03:40an mental health has been a big
- 03:43topic at the moment where in the
- 03:46middle really of a double crisis.
- 03:48There's a crisis in physical health and
- 03:52which were obviously all very aware of,
- 03:54and there's a crisis in mental health
- 03:57and they've been an enormous amount
- 04:00of energy and resources devoted
- 04:02to the crisis in physical health.
- 04:05And there has been much less
- 04:07attention paid to.
- 04:09The crisis in mental health and I've
- 04:12been very concerned that mental health
- 04:14has been being neglected through this period.
- 04:18And while the crisis and physical
- 04:20health we hope is very temporary,
- 04:23the crisis in mental health has the
- 04:26potential to be much longer term
- 04:29and it's terribly important that we
- 04:32recognize the strains that people are
- 04:34under in that we attempt to address them.
- 04:39At the moment I'm at about 40% of
- 04:44Americans report experiencing symptoms,
- 04:46which would constitute a crisis
- 04:50of private health.
- 04:52Mental health,
- 04:53uh,
- 04:53and so we see these enormous skyrocketing
- 04:57rates of particularly depression,
- 04:59and most of all,
- 05:01anxiety and part of the trick is
- 05:04distinguishing between an appropriate
- 05:06response to very difficult times and.
- 05:10The mental health elements that
- 05:12escalate to the point at which they
- 05:14become clinical complaints that warrant
- 05:17a an intervention of some kind and
- 05:19trying to decide when to intervene
- 05:21and how to intervene and what the
- 05:24appropriate way is to look into that.
- 05:27So the prices of mental
- 05:28health has many elements.
- 05:30It's got the fear of being a becoming
- 05:33sick yourself and the sends all the
- 05:36time that the Angel of death is
- 05:39waiting at the door of your house.
- 05:41It has to do with the morning that
- 05:44people are going through for people
- 05:46they have lossed this illness or the
- 05:49fear they have about people who have
- 05:52the illness and whose outcomes physical
- 05:54health outcomes are uncertain or unsure.
- 05:57It has to do with the economic devastation
- 06:00that seems to be we consuming the country.
- 06:03The performance of the stock market in its
- 06:05bizarre irregularities notwithstanding,
- 06:07but an enormous enormous number of
- 06:09people obviously are out of work.
- 06:11Or,
- 06:12uh,
- 06:13unable to continue to pay bills that
- 06:17they have a broad range of industries.
- 06:21And finally it has to do with
- 06:24our response to the problem which
- 06:27has been social isolation.
- 06:29So even at a time when people in
- 06:32many states in the US are beginning
- 06:35to breakthrough social isolation and
- 06:37are ceasing to observe
- 06:39some of its strictures,
- 06:41the isolation continues for a very,
- 06:44very large number of people.
- 06:46Social distancing for an even
- 06:48larger number people people
- 06:50are wearing masks and don't.
- 06:52Have this stimulation of seeing one
- 06:54another space is all of those shifts comes
- 06:58to new significant losses forever for
- 07:00people and very significant stressors.
- 07:03So I'll look at all of them
- 07:06together and the concern of course,
- 07:09is that the mental health crisis is
- 07:12unaddressed in Wuhan when the crisis began.
- 07:15Their the Chinese government
- 07:17imported hundreds of mental health
- 07:20workers to help people in Wuhan.
- 07:22Through the psychological
- 07:23challenges of the crisis,
- 07:25uh, in the United States,
- 07:27there has been no such effort.
- 07:29There had been a patchwork of
- 07:31responses by individual governors.
- 07:32Some of those governor's have in
- 07:35fact brought in people to try to
- 07:37deal with at least some of the mental
- 07:39health ramifications of the problem.
- 07:42But many of them have not.
- 07:44And then,
- 07:45even when mental health services
- 07:47are available to people who
- 07:48recognize the need for them,
- 07:50there's the ongoing problem that.
- 07:52Uh,
- 07:53people don't have insurance that allows
- 07:55them to access those services we all know,
- 07:58or at least most of us know that
- 08:01there had been parody legislation
- 08:03that was designed to ensure that we
- 08:06have the same access to mental health
- 08:09services to physical health services.
- 08:11This is a Department of
- 08:13psychiatry grand rounds.
- 08:14Most of you will know that those
- 08:17services are available on a much
- 08:19more limited basis and then
- 08:21other medical services.
- 08:22And that indeed all medical services
- 08:25in the United States are available
- 08:27on quite a selective basis depending
- 08:29on who has insurance and what kind
- 08:32of insurance those people have.
- 08:34So, uhm, I think, uh,
- 08:37we're uh to be shocked appropriately by
- 08:40the absence of preparedness on this front.
- 08:44Um,
- 08:44there was a study following
- 08:46the H1N1 outbreak in 2013,
- 08:49and it was widely published that said,
- 08:52because pandemic disasters are unique
- 08:55and do not include congregate sites
- 08:58for prolonged support and recovery,
- 09:00they require specific response strategies
- 09:03to ensure the behavioral health needs.
- 09:06Children and families pandemic
- 09:07planning must address these needs,
- 09:10and another said well,
- 09:12information for the medical aspects of
- 09:14disaster surge is increasingly available.
- 09:17There is little guidance for health
- 09:20care facilities on how to manage
- 09:23the psychological aspects of Lord
- 09:25scale disasters that might involve
- 09:27a surge of psychological casualties,
- 09:30so these problems were identified,
- 09:33but nothing was done to ensure
- 09:36that we were in.
- 09:38A better place by the time of
- 09:41the next pandemic,
- 09:42and so we find ourselves very
- 09:45inadequately prepared at this point,
- 09:47uhm?
- 09:47So, uh,
- 09:48the responses to the Cove in situation,
- 09:52I think.
- 09:57People who are very robust who even.
- 10:00If they are saddened or frustrated
- 10:02by some aspects of what's going on,
- 10:04essentially sale on with their mood and
- 10:07their mental health more or less intact.
- 10:10There is a large group of people.
- 10:12I would say the largest of these four
- 10:14groups who are experiencing at troubling
- 10:17levels of anxiety and depression
- 10:19but don't rise to the threshold in
- 10:21clinical illness and those people need.
- 10:23But I felt psychiatric birthday.
- 10:25They need a recognition of the difficulties
- 10:28that they're going through and then they
- 10:30need to do a lot of self regulating.
- 10:33They need to regularize their sleep,
- 10:35they need to try to regularize their eating.
- 10:37They need to try to avoid
- 10:40excessive intake of.
- 10:41Caffeine, alcohol or substances of abuse.
- 10:43They need to make sure they're
- 10:45getting enough exercise.
- 10:46They need to avoid becoming complete
- 10:49junkies who do nothing but watch the news.
- 10:52All day news junkies,
- 10:53I mean that they need all of those
- 10:56sort of methods that are tried and
- 10:58true for helping people to remain in a
- 11:02reasonably balanced place psychologically.
- 11:03The third group are the people who
- 11:06have never before had a mental health
- 11:09diagnosis who are now at the point of
- 11:12meeting those clinical thresholds.
- 11:14Uhm.
- 11:14Depression and anxiety in particular
- 11:17result from the conjunction of a genetic
- 11:20vulnerability or a biological vulnerability,
- 11:22genetic and otherwise,
- 11:24that meets with triggering external
- 11:26circumstances and their level of
- 11:28triggering external circumstances is high,
- 11:30and particularly, I think,
- 11:32relevantly, it is sustained.
- 11:33So there are a lot of people who
- 11:37can deal with the crisis that takes
- 11:40place over a short period of time,
- 11:43and who can then deal with
- 11:46the aftermath of it.
- 11:47There are many people who can cope with
- 11:50something which takes longer if they have
- 11:52a sense of how long it's gonna take,
- 11:54and they can pace themselves who
- 11:56find the indefinite big shapeless
- 11:57have we gotten through the 1st wave?
- 11:59Is there going to be a second wave?
- 12:02What's actually happening to us?
- 12:03When are we going to be able to?
- 12:07Store without a mask?
- 12:08When are we gonna be able to
- 12:11socialize with friends?
- 12:12When are we going to be able to do
- 12:15block all of that chaos and confusion?
- 12:17Conservas triggers and there are
- 12:19people now escalating into clinical
- 12:21states who didn't before,
- 12:22and of course is always when there
- 12:24are very extreme external stressors.
- 12:26Many of those people are inexperienced
- 12:28with the idea of mental illness.
- 12:30They don't know what the approach to it is,
- 12:34but particularly they're often inclined
- 12:35to think that their situation.
- 12:37Is responding to existing difficulties
- 12:39outside of them rather than responding
- 12:41to an internal state,
- 12:42and they presume therefore,
- 12:44but it's not appropriate for them
- 12:47to try to treat the depression or
- 12:49the anxiety that what they have
- 12:51to do is simply wait for external
- 12:53circumstances to change.
- 12:55And I would say as I've said,
- 12:58under other circumstances,
- 13:00the Dickish Eology of depression
- 13:02and anxiety does not dictate the
- 13:05treatment for depression and anxiety if
- 13:07you escalated into clinical depression
- 13:09or anxiety, it's appropriate to pursue
- 13:12treatment whatever the origins maybe.
- 13:14And so we live in a time when those people
- 13:18should be getting good access to therapies
- 13:21that are appropriate medical therapies,
- 13:24biological therapies, medications, and.
- 13:26Or equally to various forms of talk
- 13:29therapy and forms of support that may help
- 13:32them to survive this moment in prices.
- 13:34And then the fourth group are the
- 13:37people who already had a mental health
- 13:40diagnosis of one kind or another and
- 13:42who may have been operating in a state
- 13:45of sustained Dis Timea and those
- 13:47people have been dealing with this
- 13:50timea now need to deal instead with.
- 13:53With Watt as some conditions
- 13:55called double depression,
- 13:56in which the dis timea is now
- 13:59overlaid with an acute episode and
- 14:01to find people in very extreme.
- 14:04Depression, or in paralyzing anxiety,
- 14:06and those people clearly need
- 14:08to have interventions made.
- 14:10Some of them require hospitalization,
- 14:13some of them admin require shifts
- 14:16in medical treatment.
- 14:17Whatever the form of that
- 14:19medical treatment is,
- 14:21all of them require
- 14:23expanded support services.
- 14:24Now the question of social isolation is,
- 14:28I think, a crucial one.
- 14:30We all recognize that social
- 14:32isolation has been effective.
- 14:34In flattening the curve and in bringing
- 14:38about some sort of change and how
- 14:41extreme peoples responses are too.
- 14:44Uh, uh, the physical effects of Kovid?
- 14:47Uhm, but isolation is also very dangerous.
- 14:51People find isolation very difficult.
- 14:54They have always found isolation
- 14:56very difficult.
- 14:57Solitary confinement in prison system
- 14:59and can result in panic attacks
- 15:02and hallucinations. Um, isolation.
- 15:04In fact, I met tends to make people,
- 15:08uh, experience?
- 15:09Uh, uh?
- 15:10Touch deprivation at often it reduces
- 15:12immune response.
- 15:13So when we talk about the issue
- 15:16of isolation when we talk about
- 15:19the idea that isolation maybe
- 15:21twice as dangerous as obesity,
- 15:23we're really talking not only
- 15:25about the fact that it's unpleasant
- 15:28to experience the mental health
- 15:30consequences of isolation,
- 15:32but also about the idea that
- 15:34one's immune responses.
- 15:36In a diminished and with the
- 15:38diminished immune response,
- 15:40people are ill prepared to deal with
- 15:43the physical assault of a virus,
- 15:46so it's very dangerous to have so many
- 15:50people who are in that state of depression,
- 15:54and you know the difficulty of
- 15:56course is determining what the
- 15:59borderline is between appropriate
- 16:01concern that exists when you're
- 16:04looking at something like Kovid and.
- 16:06The more extreme responses that
- 16:08many people have had to um at
- 16:11the crisis in in mental health,
- 16:13there is a very thin membrane
- 16:14between responding appropriately
- 16:15to something difficult.
- 16:17I mean,
- 16:17it would be troubling to see people who
- 16:20don't care at all about what's going on,
- 16:23but we've all seen some of
- 16:25those people on the news.
- 16:27And what is the membrane
- 16:29between that extreme?
- 16:31Between extreme anxiety that's within
- 16:33the realm of what I will loosely call,
- 16:37despite it being loaded word,
- 16:39the normal and the point at which it
- 16:42crosses over into being very deeply troubled,
- 16:46troubling.
- 16:46And isolation has,
- 16:48uh,
- 16:48you know there are two problems
- 16:50of isolation right now.
- 16:52Sartre famously said that
- 16:53hell is other people.
- 16:55And, um, hell, is it, turns out,
- 16:57is also the absence of other people.
- 17:00So, uh, that is to say that people
- 17:02are having a terribly difficult
- 17:04time when they are completely alone,
- 17:06and people are having a terribly
- 17:08difficult time when they are sheltering
- 17:10with a small group of other people,
- 17:13usually people to whom they are related
- 17:15and see no one else for a long time.
- 17:18But see those people.
- 17:20Constantly and all of the all of the time,
- 17:23so the intimacy is difficult and
- 17:25the lack of intimacy is difficult
- 17:27and Ivan cast back to thinking
- 17:29about research I did on depression
- 17:31among the Greenlandic Inuit.
- 17:32And when I went to Greenland,
- 17:34I thought that the reason there
- 17:36was a high rate of depression and
- 17:39suicide among the Inuit must be
- 17:41because it's so cold and so dark
- 17:43for a long period of the year,
- 17:45and they must suffer from a form
- 17:48of seasonal affective disorder.
- 17:50But it turned out that directly
- 17:52quite well suited to, um,
- 17:54the cold and the darkness,
- 17:56and that they aren't particularly
- 17:57troubled by them.
- 17:58The difficulty is that people in
- 18:01Greenland mostly live in relatively
- 18:03small houses because there are is no
- 18:05good source of fuel for electricity
- 18:07in their way to heat a larger house.
- 18:10They live with extended family,
- 18:12and it's too cold and too dark to leave
- 18:15the house for six months out of every year,
- 18:18and so There you are.
- 18:20In a small house with your children
- 18:23and your parents and your in
- 18:26laws and you're all together
- 18:27and you can't argue with anyone.
- 18:30Because if you argue with anyone,
- 18:33there's no place to go.
- 18:35You can't then leave and go away and
- 18:37so an enormous emotional repression
- 18:39has ensued and that emotional
- 18:42repression is extremely dangerous.
- 18:44So we then see in the current situation,
- 18:47people suffering from touch deprivation,
- 18:50which is a well documented
- 18:52phenomenon or touch starvation.
- 18:54And the lack of physical contact
- 18:56with other people becomes
- 18:57extremely difficult and troubling.
- 18:59Zoom cocktail are very well
- 19:02and very nice in their way.
- 19:04Meetings like this one and Cal.
- 19:07Some degree of connection among people,
- 19:09but they don't in fact fully
- 19:11answer the human need for physical
- 19:14contact with other people.
- 19:16And while I don't want to say
- 19:18anything that compromises people's
- 19:20engagement with social distancing,
- 19:22which is obviously absolutely crucial.
- 19:25The containing the further outbreak of a
- 19:27Cove in an problems associated with so good.
- 19:30I do want to say that you have to balance
- 19:33that against the costs of isolation.
- 19:36I had a letter last week from a someone
- 19:39in London who wrote to me to say,
- 19:42uh,
- 19:42that her best friend with previously
- 19:45suffered from depression had
- 19:47kept writing to her to say what
- 19:49a struggle she was having.
- 19:51We had I had the experience of
- 19:53isolation that you felt depressed
- 19:55and she felt very alone that you had
- 19:57no work, that she wasn't
- 19:59able to fill her days.
- 20:00She had been watching a lot of
- 20:02television and the person who wrote
- 20:04to me was extremely concerned
- 20:06and kept saying to her, you know,
- 20:08eventually will be able to break out of this.
- 20:11Eventually will be able to see one
- 20:13another she could hear in her friends,
- 20:16turn a voice that the depression
- 20:18was escalating. This woman said I
- 20:20can't stand being by myself anymore.
- 20:21I can't stand it and, uh,
- 20:23a few days later she hanged herself up.
- 20:26There are people who are dying
- 20:28of Kovid who don't even have it.
- 20:30They're dying of.
- 20:31It's psychological overtones and meanings,
- 20:33and we have to be attentive to how
- 20:36we deal with that crisis and how
- 20:39we deal with the possibility that
- 20:41it even people who don't commit
- 20:43suicide now may suffer a form of PTSD
- 20:47that goes on for years and years.
- 20:50So, uhm,
- 20:51now there's been a lot of looking at,
- 20:55uh, uh,
- 20:55there's been a lot of looking at what
- 20:58the meanings on the ramifications are of, uh?
- 21:02The Cove in situation,
- 21:05and particularly in looking
- 21:06at Florentine origin,
- 21:07is in fact the oldest or one of the
- 21:10oldest medical technologies in the world.
- 21:13The people who were diseased
- 21:15have been put in quarantine,
- 21:17and since the ancient world it was a
- 21:19very common means of dealing with Contagion.
- 21:22However,
- 21:23a quarantine has been for people
- 21:25who are sick,
- 21:26and while it has been awful for
- 21:29the people who are sick and many
- 21:32of them had severe or fatal as uh.
- 21:35Situations, in any case,
- 21:36um patients who are put into isolation
- 21:39to elevated rates of depression,
- 21:42anxiety,
- 21:42PTSD,
- 21:43their physical recovery is slower
- 21:45than the physical recovery of
- 21:47people who are not in isolation,
- 21:49and the prospect that people face
- 21:52and that many people with covert now
- 21:55face of dying alone is a terrible prospect.
- 21:58And it passed people into a
- 22:01very damaged state.
- 22:03Putting people in Quarantine
- 22:04who don't have an illness is a
- 22:07very modern technology.
- 22:08It's been done only a few times
- 22:11before and never on the scale
- 22:13on which is being done now.
- 22:15And so you have people sheltering
- 22:18inside with effectively have no
- 22:20symptoms who are nonetheless in a
- 22:23form of Florentine and the last time
- 22:25that that was tried on any scale was
- 22:28during the SARS outbreak in 2003
- 22:30in a mixed Canada where there was.
- 22:33Uh,
- 22:34a big movement to do that I want
- 22:37to read to you, Richard Chavez.
- 22:40The UM was Ontario Chief Medical
- 22:42Officer wrote about the effects
- 22:44of that foreign gene,
- 22:46which clearly helped to contain
- 22:48the SARS outbreak.
- 22:49He said in the unlikely event of
- 22:52another SARS outbreak in Canada,
- 22:54public health officials should
- 22:56quarantine no one.
- 22:57And his point was not to say that
- 23:00starts isn't contagious or the
- 23:02dealing with the contagion of SARS
- 23:04isn't a real an urgent problem,
- 23:06but that the after effects of that
- 23:09Florentine were so enormous that
- 23:10they may well not have been worth it.
- 23:13and I have seen as I've looked
- 23:16around many people whom I know or
- 23:18whom I have had some degree of
- 23:20contact with who have lost people,
- 23:22I lost one person to whom I'm
- 23:25extremely close and have now
- 23:27seen a number of friends losing.
- 23:29Parents losing relatives going
- 23:30through all forms of law and having
- 23:33to deal with the difficulty of not
- 23:35being able to go and help the people
- 23:37and being with their parents when
- 23:39their parents are dying of friend
- 23:41of mine described being on FaceTime
- 23:43with her dying father was in and
- 23:46out of consciousness and trying to
- 23:47sing to him over the Internet and
- 23:50she said they were the songs he
- 23:52had sung to her as a child and she
- 23:55felt that in singing them she had
- 23:57some degree of contact with him.
- 23:59But he said the fact.
- 24:01But I didn't know the last time
- 24:03I hug my father,
- 24:05but it would be the last time.
- 24:07The fact that I couldn't go there an
- 24:09provide the comfort of holding his
- 24:11hand while he passed into death was
- 24:13the worst agony that I've ever known.
- 24:15And I've heard similar things
- 24:17from other people.
- 24:18Now there's not only the loss of
- 24:20contact with the person who is died,
- 24:22there is also the aftermath
- 24:25of losing someone.
- 24:26People contact with the other people
- 24:28have survived people who were dying
- 24:31of Ovid don't have AM at funerals in
- 24:33any significant sense of the word.
- 24:35Even if there's a burial that
- 24:37somehow broadcast on zoom is there.
- 24:39Sometimes is we don't have the
- 24:41opportunity to gather with the
- 24:43rest of their families.
- 24:44There, someone I,
- 24:45the person I was very close to,
- 24:48was in fact my cycle analyst.
- 24:51Died, his wife lives in New York.
- 24:53His son a andamia grandchildren
- 24:55live in California.
- 24:57Under ordinary circumstances
- 24:58they would all have gathered in
- 25:00New York and been together.
- 25:02Instead, his widow is by herself.
- 25:05She's by herself in New York
- 25:07with her family someplace else.
- 25:09They talked on the phone.
- 25:11They use whatever other
- 25:13technologies there are.
- 25:14It is not the same as processing
- 25:17someones death in company with the
- 25:19people to whom you feel closest.
- 25:22So something doesn't have to be
- 25:24irrational to become a sickness.
- 25:26The fact that these people are
- 25:29struggling doesn't constitute,
- 25:30uh,
- 25:30something that is not a sickness
- 25:33simply because there's a reason for it.
- 25:35The suffering that people are going
- 25:37through Israel and real suffering
- 25:39escalates into mental illness and
- 25:42mental illness requires treatment.
- 25:43I'm in a truck just briefly
- 25:46about some animal models,
- 25:47and then I'm going to open
- 25:50the floor to questions and.
- 25:53The toxic effects of fear, um,
- 25:55at our uh for long fear sustained
- 25:57here are well documented.
- 25:59A mat part is all,
- 26:01of course,
- 26:01is intended to respond to a momentary crisis.
- 26:04And if you're an antelope and
- 26:06alliance suddenly materializes,
- 26:07the rush of cortisol can be helpful in
- 26:10allowing you to escape and get away.
- 26:13But the kind of sustained
- 26:14stress that we're looking at
- 26:16in the current situation is a
- 26:18very different matter, and, uh,
- 26:20I think it's important that we
- 26:22look at the fact that this is
- 26:25documented not only in humans.
- 26:27Being but as I say in animal models,
- 26:30if you take flies and you
- 26:32put them in South India,
- 26:33isolation for a period of two weeks and
- 26:37which is not such a terribly long time.
- 26:40It's a long time for fly.
- 26:43I suppose you discover that
- 26:45they develop behaviors that are
- 26:47aggressive and that are extreme,
- 26:50uh, extremely injurious.
- 26:51Scored other flies there clearly,
- 26:53profoundly distressed.
- 26:54UM, researchers at Caltech have isolated
- 26:57mice for a period of two weeks and
- 27:00noted increase in fear and aggression,
- 27:03and those researchers have located
- 27:05the problem at the techie kind.
- 27:08In Gene Chapter 2,
- 27:10which encodes.
- 27:11Euro kind and be and which is
- 27:13a neuropeptide active in the
- 27:15Amygdala and in the hypothalamus,
- 27:18and scientists believe, and that,
- 27:20um, a MKB Act throughout the brain,
- 27:22orchestrating the behavioral effects
- 27:24of isolation and humans have a
- 27:26comprable matatu signaling system,
- 27:28which means that there is good evidence
- 27:31and that we will be able to charge
- 27:34at the effects of social isolation,
- 27:37not only socially but also biologically.
- 27:39I don't know that.
- 27:41Anyone is working on that
- 27:43specifically during this crisis,
- 27:45but they should be so your role
- 27:47in the field of psychiatry.
- 27:49It's a thing to consider.
- 27:51Now.
- 27:52In conclusion,
- 27:52I want to talk about the
- 27:55intersection that we're now facing,
- 27:57which is the intersection between
- 27:59Kovid and all of that fear and anxiety
- 28:02that Tobin has brought up and met
- 28:04the protest movement that is taking
- 28:07place after the brutal and horrific
- 28:09murder of George Floyd, Anwer.
- 28:11All, I think,
- 28:12aware of how appalling it was,
- 28:15Ben Floyd went down in the way that
- 28:17he did and we all recognize that it
- 28:20is an indication of just how bad
- 28:23racism within law enforcement has
- 28:25become and how urgent it is that we
- 28:28address the problem of that brutality.
- 28:31But the protest movement,
- 28:32you know,
- 28:33has involved a huge number of people
- 28:36who have often gone out without
- 28:38masks and it stirred in many of the
- 28:41people who have not join the protest.
- 28:44Anxiety about an escalation
- 28:45in Contagion of Cobit.
- 28:47It starred in many people a sense that
- 28:50the social order is being disrupted
- 28:52not only by illness but also by
- 28:55these revelation and it's resulting
- 28:57again in a great deal of anxiety,
- 28:59and that anxiety is also rooted
- 29:02in the revelation that has come
- 29:04out of the coded work and that has
- 29:07been mentioned to some degree by
- 29:09the people of protesting is that
- 29:12the people who are dying of Kovid.
- 29:14Are unfairly people who have less
- 29:17economic opportunity and they are in
- 29:19many instances members of racial minorities.
- 29:22So the death rate among African
- 29:24American or black people,
- 29:26or black and Brown people who
- 29:28have kovid is much higher than
- 29:31the mortality rate is among white
- 29:33people who have the same infection
- 29:36and that points to the incredible
- 29:39injustice and unfairness not
- 29:40only if the society as a whole,
- 29:43but specifically of.
- 29:45This is already in a relationship to
- 29:47medical intervention and medical treatment.
- 29:50It's appalling that people who have
- 29:54less wealth are more likely to die
- 29:57if there's a point to the terribly.
- 30:00Hold in our health care system and it
- 30:03has been one of the many topics that
- 30:06have been brought up in the course of
- 30:09the protest movement and it's been
- 30:11very traumatic for people who are
- 30:13themselves in groups that tend to be
- 30:16stigmatized or who are sympathetically
- 30:18groups who tend to be stigmatized and
- 30:20to recognize how dangerous this current
- 30:22situation is for disadvantage people.
- 30:24So in the fight for justice,
- 30:26it's a fight not only for legal justice,
- 30:29not only for social justice.
- 30:31Not only for a reform police a
- 30:34core but also for medical justice.
- 30:36And if more people who are
- 30:38disadvantage are dying of Hell.
- 30:40But there are a lot more people,
- 30:43a lot more people who are socially
- 30:46disadvantage toward developing the
- 30:47psychiatric side effects of Co.
- 30:49But those are the people
- 30:51who are the least likely.
- 30:54And joins the least likely to know what's
- 30:57involved in accessing psychiatric care.
- 30:59The least likely to be able to turn
- 31:01around the psychological and psychiatric
- 31:03effects that they are suffering as
- 31:06side effects of the cobit prices and
- 31:09the most likely in many instances to
- 31:11be the people who are dying from those
- 31:14illnesses since the beginning of Co.
- 31:16Bid the number of calls to many suicide
- 31:19hotlines has gone up by as much as 400%.
- 31:22There are huge numbers of people
- 31:25who are contemplating suicide.
- 31:26There are huge numbers,
- 31:27though I'm not aware it's the
- 31:29statistics being fully assembled of
- 31:31people who are committing suicide.
- 31:33There are huge numbers of people who
- 31:35have received social directives to
- 31:37self isolate who are unable to do so,
- 31:39in part because they live in a
- 31:41single room with Seven other people,
- 31:43and in part because their economic
- 31:46duress means that they have to go
- 31:48out and try to do some kind of work
- 31:50and are constantly exposed on the
- 31:52streets and on public transportation,
- 31:54and quite possibly in their workplaces too.
- 31:56The virus in ways that other people with
- 31:59greater privilege don't have to be.
- 32:01So I think that is a terrible
- 32:03shame on the face of our nation.
- 32:06I would just say that when we
- 32:08look at the mortality of turbid,
- 32:10you know there's been an attempt
- 32:12to measure the mortality of Cobit,
- 32:14not only by responding to people
- 32:16who have been specifically diagnosed
- 32:17with the infection,
- 32:19but by looking at the increase
- 32:20in death rate overall over what
- 32:22it would ordinarily be.
- 32:24There has been a significant increase,
- 32:26and I don't have the numbers in front of me,
- 32:29but effectively at the number of people
- 32:31who died in the month of April and May
- 32:34was much higher than in any previous.
- 32:36April and May.
- 32:38We don't know whether all of those
- 32:40people had covet, but given that
- 32:42that's what's going around,
- 32:44it seems likely the Cove it
- 32:46was implicated in those guests.
- 32:48I would say that the people who
- 32:50died in April and May were not only
- 32:53people who had pre existing pulmonary
- 32:55conditions were not only people
- 32:57who are older and who are therefore
- 32:59more vulnerable to this situation,
- 33:01but also people who are psychologically home.
- 33:04We're both escalated into suicide.
- 33:06Whoever depressed immune response.
- 33:08For you for 1000 other reasons have ended
- 33:11up suffering an unfair an unjust death.
- 33:14Whether they have the virus or not.
- 33:18So I will wind up there.
- 33:20I'm very happy to take questions
- 33:22and I am never so clear unzoom
- 33:24of exactly how they work,
- 33:26but I think you can raise hands
- 33:28or you can type them into Jack.
- 33:30So please any questions at all.
- 33:32Very welcome.
- 33:39Oh, someone has a question, I feel certain.
- 33:50You have to. I would remind
- 33:52you have to unmute yourself
- 33:53if you're asking a question.
- 33:54I think everyone is stupid.
- 33:57So I'll get the I'll get the ball rolling
- 34:00one of the one of the challenges that
- 34:03we face in trying to provide support.
- 34:06Uh, uh, two of the health care community
- 34:09is the reluctance to seek help and a
- 34:13kind of martyr mentality where people
- 34:16feel like their the people who they
- 34:19have to take care of everybody else.
- 34:22They can't take time to take
- 34:25care of themselves.
- 34:26Uh, an uh, it's a huge challenge
- 34:29for us to reach the people who who
- 34:33seem to need the help the most and.
- 34:37Just curious if you have
- 34:40any thoughts about that,
- 34:42as as you think about groups of
- 34:46people that are struggling at a time like
- 34:50this, well the stigma persists around
- 34:53anything that appears to be psychiatric
- 34:56fragility or a a psychiatric diagnosis.
- 35:00If 40% of Americans are now
- 35:03experiencing a diagnosable depression,
- 35:05anxiety, or other mental illness.
- 35:08It seems to me hard to maintain the idea
- 35:11that this is a terrible embarrassment
- 35:13and the people will think less of you.
- 35:15I mean, that's nearly half the people in
- 35:18the country who are experiencing this,
- 35:20but I think the fear that is
- 35:22associated with stigma is enormous,
- 35:24and I think the sense that what you need to
- 35:27do is be tough and strong and get through.
- 35:30This is very powerful, you know.
- 35:31I've seen people have said I met,
- 35:34you know, it's like being in Auschwitz
- 35:36and you have to be a survivor.
- 35:38But in Auschwitz there were
- 35:40no mental health services,
- 35:41and in the United States at the
- 35:44moment at least met there are,
- 35:46and I think it's incredibly important
- 35:48that people recognize that this is
- 35:50a different situation from that.
- 35:51A lot of people don't know what
- 35:54services are available,
- 35:55and a lot of people don't recognize
- 35:57the problems that they have,
- 35:59and that's why I think we also need parent,
- 36:02if aggressive outreach,
- 36:03because many people will say,
- 36:04I mean and upsetting situation,
- 36:06an I feel really upset in terrible,
- 36:08and they will.
- 36:09Resume that whatever is going on with
- 36:12them is an appropriate response to the
- 36:15situation in which they find themselves
- 36:17in point of fact, what's going on?
- 36:20You know there is.
- 36:22As I said,
- 36:23some degree of appropriate response,
- 36:25and there is Additionally some enormous
- 36:27degree of response that goes in excess
- 36:30of that appropriate response and.
- 36:32So I think the,
- 36:34uh,
- 36:34the need is to have programs in which
- 36:37we scream people because they aren't
- 36:39going to self identify an we need
- 36:41to have public health campaigns.
- 36:43And we've seen how effective
- 36:45Republic of campaign can be.
- 36:46I mean, when the isolation started in Wuhan,
- 36:49I remember thinking wow,
- 36:51that Chinese government with their incredible
- 36:53control over their citizenry can do that.
- 36:55We could never do that here.
- 36:57It turns out, actually,
- 36:58we can do it here.
- 37:00We can set up a protocols for isolation.
- 37:03The city of New York.
- 37:05The most crowded,
- 37:06hectic,
- 37:06frantic place on the earth would be
- 37:09completely empty with everybody staying
- 37:11inside and not even a car driving down
- 37:14at 6th Ave that were driving up 6th Ave.
- 37:17I guess it should say that
- 37:19was an extraordinary change.
- 37:21If we really made an effort to
- 37:23inform people a of what the
- 37:25symptoms are of depression,
- 37:27clinical depression and anxiety
- 37:28and be of what the solutions are.
- 37:31Ansi of how to access those solutions.
- 37:34I think we would have been vast number
- 37:36of people who would respond and I
- 37:38think part of what has to happen is
- 37:40to give those numbers and say this is
- 37:42affecting this huge number of people.
- 37:43Don't feel ashamed of it and
- 37:45that that's part of
- 37:46the messaging that would have to take place.
- 37:49I see there's a question here.
- 37:51Do you have any advice to prevent
- 37:54the mental health side effects
- 37:55for future foreign to you,
- 37:57EG the predicted surge in the fall?
- 37:59Perhaps a public health message
- 38:01to take advantage of mental
- 38:03health challe health services?
- 38:04Yes, I think that's one of the other
- 38:06problems is that people don't recognize
- 38:09that there are Telehealth Services and
- 38:11they don't want to go into a hospital.
- 38:14I mean, there are many people who
- 38:16are dying of heart conditions or
- 38:18cancer or all kinds of other things.
- 38:20'cause they are so afraid of the
- 38:23risk of Contagion in hospitals,
- 38:25and while for extreme illness
- 38:27and you know the risk,
- 38:29even agent in hospitals now appears
- 38:32to be largely well controlled.
- 38:35You know,
- 38:35I wouldn't particularly want to
- 38:37go into a hospital right now if
- 38:39I could possibly avoid it myself,
- 38:42but I think people don't understand
- 38:44what the technologies are now.
- 38:45Telemedicine is very useful.
- 38:47It works best for people who have
- 38:49got a computer and an Internet
- 38:51connection and can engage with Challe
- 38:53Health as it's primarily practice,
- 38:55but it's possible even for people who
- 38:57have a telephone and you know most
- 39:00people in the United States have telephone.
- 39:02Certainly not all people have access
- 39:04to a phone, but most people do.
- 39:07I think it's important for people to
- 39:09know what treatment can look like
- 39:11when you can't actually go there,
- 39:13and I think it's very important
- 39:15to make it clear to people that
- 39:17there are and to create in fact
- 39:19situations in which there are central
- 39:22numbers they can call.
- 39:23They get widely advertised
- 39:25on the basis of calling them.
- 39:27There is some kind of
- 39:28telemedicine available to them,
- 39:30but people often don't have the
- 39:31capacity to do because they're
- 39:33depressed because they are anxious
- 39:35because they're overwhelmed because
- 39:37they don't know what's going on.
- 39:39Is the ability to do a lot
- 39:41of research and so did find,
- 39:43well, you know,
- 39:43I could maybe going to these people and
- 39:46they have a connection to those people.
- 39:48and I wonder whether this line is we
- 39:50need to have something centralized and clear.
- 39:52We need to have a National Health log.
- 39:55That would be my primary advice
- 39:57in terms of telemedicine in this
- 39:59crisis is that we need to have.
- 40:00A line we needed to be advertised.
- 40:02We need people to know and then we
- 40:04need to have people there who can
- 40:07pass treatment recommendations on
- 40:08or provide treatment themselves and
- 40:09you can set it up and make it easy.
- 40:12It's hard to do when it's hard to
- 40:14make up the phone all together
- 40:16when you're depressed.
- 40:17It's a lot harder if you don't
- 40:20know who to call.
- 40:21I have another question,
- 40:23if there's no other directly
- 40:24related question,
- 40:25perhaps you could talk about how
- 40:27this impacts kids and adults with
- 40:29special needs or disability and
- 40:31what we can do to advocate for
- 40:34them under these circumstances.
- 40:35Well, it's been,
- 40:36my other topic has been M disabilities,
- 40:39and particularly how families deal with
- 40:41children with differences or disabilities,
- 40:43and obviously all of this becomes
- 40:45more difficult for people who
- 40:47have a range of disabilities.
- 40:48You know, if you have someone who's got.
- 40:52Nonverbal autism then trying to explain
- 40:54to them how to use telemedicine is
- 40:56going to be sort of a losing operation,
- 40:59and there have to be systems in place
- 41:02to help those people, hopefully.
- 41:04There either in facilities where they can
- 41:07be treated or with families will freak them.
- 41:10But of course many such facilities have
- 41:12been emptied out during this crisis and
- 41:14people who were in careful years and
- 41:17years have suddenly been thrown out of
- 41:19the places that are familiar to them.
- 41:21Because Emma of the risk of Contagion
- 41:23in those contained environments,
- 41:25and they've often been put back
- 41:27with families,
- 41:27I mean it luckiest ones have
- 41:29been put back with families,
- 41:31and many of those families don't really
- 41:33know what the appropriate interventions.
- 41:35Are even to get their children
- 41:37through ordinary day-to-day life,
- 41:39and it's difficult to know how
- 41:42much those people are perceiving
- 41:44of the crisis in mental health.
- 41:47Physical health that's going on around
- 41:49them for people with physical disabilities,
- 41:52I think there it's possible to do
- 41:54mostly the same things that I've just
- 41:57talked about and Paula Sims will help
- 42:00line and try to help them get through.
- 42:03But for people with other disabilities
- 42:05and particularly with nonverbal disability
- 42:07or people who've got deafness and who
- 42:09need to access care through an interpreter,
- 42:12that can be a lot harder.
- 42:14and I think the best way that
- 42:17we prepare ourselves.
- 42:18Is my thinking through uh,
- 42:20what the ways are to gain access
- 42:23for those people to caretakers
- 42:25who can in turn access cab?
- 42:30Put my else has asked the question
- 42:32of the hour, which is how about
- 42:35the potential role of responsible,
- 42:37competent federal leadership during this war.
- 42:40Well, it would be nice if we had
- 42:42competent federal leadership.
- 42:43I mean, one of the things
- 42:45that has been most shocking.
- 42:47and I was kind of steering clear of politics,
- 42:50but I won't know is that in other countries,
- 42:53virtually every other country,
- 42:55including countries in the developing
- 42:57world where the resources are scanned
- 42:59there is at least a national policy
- 43:01and we instead of had a president
- 43:03who was trying to use the situation
- 43:05we find ourselves in as the basis
- 43:08for his own electioneering.
- 43:09And who is displayed.
- 43:10Little to no interest in what is involved
- 43:13in helping people who are suffering
- 43:15from Amoco bid to have a coherent response.
- 43:18The business of putting it all on
- 43:21the shoulders of the governance.
- 43:23and I mean the governor in one place.
- 43:25Who says you have to do one thing and
- 43:28a governor right across the border?
- 43:31Who's doing something else has
- 43:32created a kind of chaos of response,
- 43:35but I think it's been unbelievably
- 43:37toxic and that has escalated.
- 43:39People sense of psychological stress and.
- 43:41The feeling of not understanding how
- 43:44the treatment you're getting responds
- 43:46to the a response to the politics
- 43:48of the moment has been appalling,
- 43:50and the manipulation and the city of
- 43:53politicization and the politicization
- 43:54of masks in the stores,
- 43:56that won't let people in without mask
- 43:59all trickle down from a president,
- 44:01who,
- 44:02instead of putting on a mask
- 44:04like even Immanuel Makron dude,
- 44:06who instead had said I'm not
- 44:08going to wear a mask.
- 44:10You don't have to wear a mask out there.
- 44:14I want my election rallies to take
- 44:16place with large numbers of people not
- 44:18practicing social distancing because
- 44:20that plays better on television.
- 44:22That was a statement just from yesterday.
- 44:25It's it's appalling an it's making the
- 44:28situation much worse and that's why we
- 44:30have the highest rate of coded infection
- 44:33in the world and why there's no sign
- 44:36at that rate is being brought down.
- 44:38Other countries have managed
- 44:40Ahmed to largely eliminate,
- 44:41and the problem of this illness.
- 44:43We need world leadership, ideally.
- 44:45But certainly, federal leadership,
- 44:47in its absence, is really a gross deficit.
- 44:51Oh no.
- 44:53There is discussion.
- 44:54There's already discussion about
- 44:56illuminating the relaxed regulations
- 44:58related to have the teller health or
- 45:01decreasing reimbursement for virtual visits.
- 45:03What are your recommendations
- 45:05for Tele health advocacy?
- 45:08Well,
- 45:08I think that the first thing to be
- 45:11done is a lot of good studies on
- 45:14the efficacy of Keller held a gun.
- 45:16Think that we have at this point we have
- 45:19anecdotal experience and there's no
- 45:21question that ever helped helped many,
- 45:23many people under many circumstances.
- 45:25I'm not aware of,
- 45:27at least are having large,
- 45:28well funded studies in which we
- 45:30compare outcomes with Tele health
- 45:32outcomes with no response outcomes
- 45:34with in person visits.
- 45:36I think we need to put together.
- 45:38The research, in order to make those
- 45:40arguments, but those arguments would then
- 45:42have to be made to insurance industry
- 45:44that would like not to pay for all these
- 45:46telehealth visits and to a federal
- 45:48government that couldn't care less.
- 45:50So did studies are important
- 45:52and will be the first step.
- 45:53But there's still a long way to go.
- 45:57Um, here's one in your travels.
- 45:59If you experience other cultural rituals
- 46:02or techniques that enhance resilience
- 46:05into other situations of isolation or
- 46:08funeral rites, that could be helpful.
- 46:11Now, IE helpful practices in times of duress,
- 46:14suppression, or war. Well.
- 46:17The rituals that I've encountered have
- 46:20always involved people coming together.
- 46:22I mean, I reported from Afghanistan
- 46:24during the early days of the American
- 46:27invasion in February of 2002,
- 46:29and I recorded from Libya at
- 46:31the end of the Kadhafi period,
- 46:33and even in societies that were in
- 46:36total chaos when there was a death,
- 46:38there was a kind of pause in the
- 46:41chaos and people came together,
- 46:43maybe not as many people as we have
- 46:46come together in a peaceful time,
- 46:48but they were still human beings.
- 46:50In contact with other human beings,
- 46:52that is really the essence,
- 46:54I think of all of the cultural
- 46:56rituals that exist around death,
- 46:58and it's the thing of which
- 47:00we are currently deprived.
- 47:02Having said that,
- 47:03I think that you know it is better to have.
- 47:06I mean,
- 47:07if someone I know just had.
- 47:10A a telemedicine funeral in I mean up
- 47:13telling Medison Absolute zoom funeral,
- 47:15in which even though she was the only
- 47:17one at the graveside or I think machine,
- 47:20her daughters who are at the graveside
- 47:23that they had a camera setup and they
- 47:25knew that a huge number of people were
- 47:28watching and the people who were watching
- 47:30when it was over sent messages of concern.
- 47:33I think we need to figure out techniques
- 47:36in which people know how to do that,
- 47:39which it becomes a standard.
- 47:41Enterprise to uh to make that available,
- 47:44uh,
- 47:44in which people are responsive
- 47:46to the sense of absence.
- 47:48and I also think,
- 47:50and I know this is my possibly controversial.
- 47:54I also think that sometimes,
- 47:56especially if, uh,
- 47:57in this instance the window is uninfected,
- 48:00there are moments when you can then either.
- 48:04If you can't go to the funeral,
- 48:07you can actually go and see the person,
- 48:10possibly at 6 feet.
- 48:12Distance,
- 48:12I mean,
- 48:13if you can't have awake and you can
- 48:15have a Siva and you can't have any
- 48:18of these other rituals that usually
- 48:20bring people together in their morning,
- 48:23you can have individual visits
- 48:25outside with Mass under controlled
- 48:27circumstances and you can prioritize
- 48:29those and you can come up with
- 48:31parameters and that are dictated by
- 48:33religious leaders and by cultural
- 48:35leaders and of what is acceptable,
- 48:37what is unacceptable,
- 48:38what is available,
- 48:39what is unavailable and come
- 48:41together as a community of support.
- 48:44Even when you have to physically be there,
- 48:46holding your arm around someone
- 48:48shoulder at the great site.
- 48:51Um? I have one more here.
- 48:54Thank you for highlighting
- 48:56the nature of disease.
- 48:58Social isolation racism is pervasive,
- 49:00longstanding stressors,
- 49:01and in particular the elegant Aikikai
- 49:04Ninjew study by Zelikow ski at Al.
- 49:07How do you think appreciation of
- 49:10these pervasive stressors should
- 49:12change the nature of psychiatric
- 49:14treatment for stress related disorders?
- 49:17You know we live in stressful times.
- 49:20We're living in stressful times.
- 49:22Even before kovid came along we have
- 49:24lived in stressful times with the extreme
- 49:27polarization of American politics
- 49:29that it's been stressful for people
- 49:32at either end of the spectrum we're
- 49:34living in Ms stressful times because of,
- 49:37you know a million different things.
- 49:39The information revolution we now live in
- 49:42stressful times because we can't travel.
- 49:44We previously lived in
- 49:46stressful times because.
- 49:47You were on airplanes all the time,
- 49:50or if we were people who had fewer privileges
- 49:52and warrant on airplanes all the time.
- 49:54We lived in stressful times because
- 49:56the social safety net has been so
- 49:59profoundly eroded and the support.
- 50:00But we are struggling,
- 50:03have been adamant so profoundly undermined.
- 50:06So I think that we need to
- 50:10recognize that stress is a really
- 50:13basic problem in the 21st century,
- 50:16and that figuring out ways to figure out
- 50:20ways to deal with that stress is incredibly,
- 50:25is incredibly important.
- 50:27And obviously there are
- 50:29medications that help people too.
- 50:32Deal with short term stress,
- 50:33but we don't want to go to having an
- 50:36entire population that's on diazepam.
- 50:39A rope as a lab.
- 50:40What we want to do is to have a
- 50:43population with people learn better
- 50:45techniques for managing stress,
- 50:47and there's mindfulness.
- 50:48And there are all kinds of other things,
- 50:51but I would also say in relation
- 50:53to Ms dress that difficult.
- 50:55Though this time has been many
- 50:57people I've spoken to have said
- 51:00that while they are very frightened.
- 51:02The stripping back of their lives
- 51:04to relatively simple lives because
- 51:06they stay at home and they don't go
- 51:08out and they aren't involved in a
- 51:10great many social interaction for
- 51:12all of its deficits and challenges
- 51:14has also reduced in some ways.
- 51:16Their stress levels,
- 51:17and so I think if we stand to learn
- 51:20things from this experience and
- 51:22I very much hope we do.
- 51:23One of the things I hope will learn
- 51:26is that it's possible for all of us
- 51:28to slow down our lives with that.
- 51:31Our lives evaporating in disappearing.
- 51:33And I hope that on the far side of
- 51:36this we carry that sense of how we
- 51:38can limit the stress of our day-to-day
- 51:41lives and limit the range of our
- 51:44activity and remained fully productive
- 51:45and fully engaged in lots and lots going on.
- 51:48I also think we need to have better
- 51:51situations for emergency workers,
- 51:53the emergency workers in this crisis
- 51:55have done so much and it worked
- 51:57so hard and had been so in gay,
- 52:00and I think it's frightening to
- 52:02think have little.
- 52:03Uh,
- 52:04they have been given space
- 52:07for alleviation of their
- 52:10stress. Um? Ashley Clayton has raised
- 52:13her hand actually Flake and you want
- 52:16to speak? Yeah, I'm first.
- 52:18Thank you so much for this talk.
- 52:21This is fantastic and I had
- 52:23a question or concern that's
- 52:25actually related to with John
- 52:27was raised in his question, but
- 52:29I think one thing for me
- 52:31both personally and also a lot of people
- 52:34I've talked to is the threshold for
- 52:37seeking help for mental health related
- 52:39concerns is now raised right? I mean it.
- 52:42Or seeking medical attention in general,
- 52:44we've seen you know, admissions for
- 52:46heart attack and stroke go down in the D.
- 52:49Um, and you know, I know there's been
- 52:52this big prevention movement and
- 52:54kind of went the time to intervene
- 52:57as before stage for mental health,
- 52:59but where a lot of people,
- 53:01both for myself included.
- 53:03I have an incredible psychiatric team that
- 53:06I've been working with for a long time,
- 53:09but my threshold for reaching
- 53:11out to them is like,
- 53:12do I need to be in the emergency room or not?
- 53:17Because there's this message of right
- 53:19this overburdening of the medical system.
- 53:21Everyone is stretched so thin
- 53:23and I've heard that um,
- 53:25kind of in my peer communities as well.
- 53:28And so I'm just concerned.
- 53:30How long that will last,
- 53:32even as the health care system.
- 53:34You know, we flatten the curve.
- 53:37There's more.
- 53:38Availability of services,
- 53:40Telehealth Services and things.
- 53:41But how long that that kind of internal
- 53:45threshold for people will remain raised?
- 53:47and I think the larger
- 53:49implications of that of,
- 53:51you know,
- 53:52only seeking help help and only really
- 53:55intervening in acute crisis.
- 53:59Well, I mean to quote our old friend
- 54:02Benjamin Franklin an ounce of prevention
- 54:05is worth a pound of cure and I think
- 54:08at the moment there is so much stress
- 54:10and there is so much mental illness
- 54:12in circulation that people are really
- 54:15focusing on pure rather than on prevention.
- 54:17and I don't know that we have the
- 54:20resources to turn that around right now.
- 54:22I mean, I don't think we can start doing
- 54:26prevention and give up on cure, I just only.
- 54:28We have the the scope for that and I think we
- 54:32can't abandoned the people who are in prices,
- 54:34but it is to be hoped.
- 54:36I guess is that on the far side of
- 54:38the most acute phase of this crisis
- 54:41will recognize what can be done by
- 54:44way of prevention so that people are.
- 54:46More resilient when they come
- 54:48to situations like this one.
- 54:50But having said before,
- 54:52there should be a public health
- 54:54response in which, uh.
- 54:57Fine or whatever the technique is.
- 54:59Beltone gets used for the hotline
- 55:02or something along those lines
- 55:04is put into place.
- 55:05The UM.
- 55:07Perative right now I think is also
- 55:09to say to people if you are not
- 55:12yet really in an acute crisis,
- 55:14but feel like you're headed that way you
- 55:16two through the temp to access telemedicine.
- 55:19And if you have had severe
- 55:21depression or anxiety in the past,
- 55:23you know get everyone in order.
- 55:25I mean, I speak as someone who has suffered
- 55:27from severe depression and anxiety.
- 55:29I got in touch with my therapist.
- 55:32I said look,
- 55:33I'm feeling kind of fragile.
- 55:34These are the concerns I have.
- 55:36This is how well I'm dealing with them.
- 55:39I seem not so far not have escalated
- 55:42into a clinical depression,
- 55:43but I have people on tap or ready
- 55:46to help me when and as I do,
- 55:49and that's a very privileged position.
- 55:51I realized that you have people
- 55:53on the team who were already in
- 55:55place and to have the resources
- 55:57to be able to talk to them,
- 55:59but I think if the people you know I
- 56:02started off with those four categories,
- 56:04I think if the people who I said require
- 56:07what I thought psychiatric first aid.
- 56:10Are paying attention.
- 56:11There are ways that they can prevent
- 56:14themselves from escalating into the
- 56:16Group 3 in that analysis where the
- 56:18people who are having their first
- 56:21really serious here and I think back
- 56:23to what John said at the beginning,
- 56:26we need to destigmatize those efforts
- 56:28and we need to say to people you
- 56:31know if you're feeling really bad and
- 56:33if you're having terrible insomnia,
- 56:36and if you're waking up feeling
- 56:38incredibly anxious,
- 56:39or whatever the panoply of cyst symptoms.
- 56:41Maybe if you want to address that Patrick,
- 56:44leave something you need to,
- 56:45you need to find a way to do it and
- 56:47that needs to be a public health
- 56:49campaign and then the resources
- 56:51have to be there so the ones we've
- 56:53said that two people there are
- 56:55services that they can
- 56:56access.
- 56:59I will do this if you one more question and
- 57:03then I knew were running a little over.
- 57:06I'm find his Dave You are, but here we are.
- 57:10Therapist meeting with patients,
- 57:12isolation of calla health
- 57:13versus fear of Contagion.
- 57:15Much more equalization between both
- 57:17parties you to shared anxieties etc.
- 57:20Uh, well there's no question that
- 57:22people who are practitioners of mental
- 57:25health care are also having a rough
- 57:28time at the 40% of the population who
- 57:31have currently got clinical symptoms
- 57:33includes any number of people who are
- 57:36working in the field of mental health.
- 57:39There are some instances in which
- 57:41for a psychiatrist or psychologist
- 57:42or therapist to say I'm having a
- 57:45rough time too is immensely helpful
- 57:47and allows the patient to understand
- 57:49this is happening to everyone.
- 57:51There are some instances in which
- 57:53it's very unhelpful and makes the
- 57:55patient feel terribly insecure,
- 57:57but it's been work done on what degree
- 57:59of disclosure can be affected within
- 58:01relationship between a therapist
- 58:03and a patient.
- 58:04There is an allowed stuff on
- 58:06transference and on the ways in
- 58:08which you engage with friends friend.
- 58:10In terms of psychodynamic therapies,
- 58:12but even in terms of other forms of therapy,
- 58:14that's true.
- 58:15Mental health practitioners and there
- 58:17are many of you on this line right now.
- 58:19Need to attend to their own mental
- 58:21health as well as they can in order
- 58:24to be helpful to their feature,
- 58:26because the thing that is really most
- 58:28helpful if there's going to be disclosure,
- 58:30is to say I've been having a
- 58:32lot of similar symptoms,
- 58:33but I've been doing some things
- 58:35that seem to have really helped,
- 58:37and here's what they are.
- 58:38The equalizing if the relationship
- 58:40between psychiatrists and patience,
- 58:41I think, is frequently.
- 58:42Very helpful, so long as it's containing.
- 58:44I mean I think being a psychiatrist
- 58:46who breaks down in tears and
- 58:48says I can't stand this either.
- 58:50I don't know what I'm going to do I
- 58:53think about suicide every day is not
- 58:55reassuring to a patient who is in his office.
- 58:58Being able to say as a
- 59:01psychiatrist that you've had.
- 59:02No,
- 59:03you faced various difficulties of your own.
- 59:06And manage come through them in.
- 59:08Here are some things that might be helpful,
- 59:10and they really apply to everyone in this
- 59:13time of national prices can be very useful,
- 59:15so that's a complex balance and
- 59:17we could probably talk about it
- 59:19for the next three or four hours
- 59:21and still not fully resolved yet.
- 59:23But I do think that there is a sense
- 59:25in which the members of the psychiatric
- 59:28profession are vulnerable an I think
- 59:30the pressure to sustain the appearance
- 59:32of invulnerability can be enormous
- 59:34and can be very counterproductive
- 59:36both for the psychiatrist and for the.
- 59:38Agent,
- 59:38and I'm thinking of course of the
- 59:41woman who is running the emergency
- 59:43room in at the Allen Medical Center
- 59:45in the North of Manhattan,
- 59:47who killed herself about a month ago.
- 59:49Now I think it is.
- 59:51Another story was all over the papers and
- 59:53most of you probably saw, but I thought,
- 59:56OK, there was someone who felt she
- 59:58had to be strong and powerful in.
- 01:00:00Relation to everyone and what is
- 01:00:02it that we do with someone who is
- 01:00:06under those terrible pressures?
- 01:00:08Are we taking care of those people?
- 01:00:10And frankly, I mean she was
- 01:00:12seeing a lot of patients dying.
- 01:00:15But if you are in psychology or psychiatry
- 01:00:18and you're at the moment seeing a lot
- 01:00:21of patients who are in desperate shape,
- 01:00:24that's very taxing.
- 01:00:25Even if you yourself are quite resilient,
- 01:00:28that's very taxing.
- 01:00:29It's very taxing.
- 01:00:31If we mostly have dealt with the worried,
- 01:00:33well can suddenly be dealing with
- 01:00:35one person after another who's
- 01:00:37in a state of despair and we need
- 01:00:40for the profession to provide.
- 01:00:42Not a facility so that those people have
- 01:00:45not received in our sustained in there cat.
- 01:00:48I think that's it.
- 01:00:50That's it OK.
- 01:00:53Andrew, thanks so much
- 01:00:54wonderful presentation.
- 01:00:55Really thoughtful and and helpful
- 01:00:57discussion as always were in your dead.
- 01:01:00And thank you so much for
- 01:01:03for speaking with us today.