Legally Speaking: Elyn Saks

this program is a presentation of uctv for educational and non-commercial use only check out our YouTube original channel you see TV Prime at youtube.com slash you see TV prime subscribe today to get new programs every week Ellen Sachs is both a tenured law professor at the University of Southern California and the recipient of a MacArthur Genius award she is also the graduate of the Yale Law School she studied philosophy as a Marshall scholar at Oxford University and back in 1977 when she got her BA degree from Vanderbilt she graduated number one in her class Ellen sacks is an expert in mental health law and has written at length about the legal rights of the mentally ill but she is not simply an expert she is also someone who has struggled herself with serious mental illness she knows firsthand what it's like to live with terrifying delusions to be hospitalized against your will and to be strapped down to a hospital bed and immobilized for hours on end she described all of this in her 2007 memoir which Time magazine recognized as one of the 10 best non-fiction books of that year her book was called the center cannot hold my journey through madness Ellen sacks welcome to our legally speaking series wonderful to be here Marc exactly when you were diagnosed with chronic paranoid schizophrenia you were what in your late 20s early 30s you know I had broken down in my early 20s but I got that diagnosis sort of mid-twenties and your prognosis was described as grim which meant I think well I had two different ones one was very poor and one was great and what that means is that okay groom is a little bit grim yeah then I would not be able to live independently let alone to work that's right sort of let us hope to have a career as an eminent scholar and good friends and a husband and our great wife's so how do you explain how you were able to in such a spectacular fashion defy the conventional wisdom well I don't think I was sort of a lone woman who through sheer strength of will overcame odds I had a lot of resources invested in my care so I had five-day-a-week psychoanalytic psychotherapy for decades and anyway and I had excellent psychopharmacology in the beginning I resisted the meds now I accept them and my life is much better wonderful family and friends very supportive very kind very helpful a wonderful work environment I just love going to work every day in fact I go in seven days a week because reading and writing is one of my most favorite things and that helps stabilize note so all those things together you know let me have a better life than I was expected to have in fact my little brother used to say even when I was a teenager I was the most stubborn person he ever met and maybe I was just an example of my stubbornness you say I can't work I'll show you so is it fair to describe your you as an outlier when it comes to the illness that you have probably I don't really know what the stats are on how many people are high-functioning with my diagnosis a lot of people say I'm unique I'm not I'm engaged in two studies one at USC and UCLA I'm one at USC and UCSD involving other quote high functioning people with schizophrenia NAR la project has two MDS PhD clinical psychologists and JD teachers full time students full time parents there are other people out there it's just a stigma so great that they don't come at I have a great platform because I have a tenured position at a law school so my job's not endangered and for some people it may be more of a risk to come out when you before you publish your memoir knew that you suffered from a mental illness and it's understandable that you would not tell a lot of people because there is this huge stigma attached to mental illness right so how do you what convinced you after so long not to tell anybody yeah to in essence tell the world you know I just thought about it over many many years and my best friend Steve would talk about it with me and encouraged me to do it and I just at some point I thought you know this could help people this could make a difference in some people's lives I could give people hope I really should do this one of my friends an emeritus professor of psychiatry at UCLA said I should do it under a pseudonym and I said you know that would send the wrong idea that this is just too awful to say out loud part of the point is to a fate a human face on schizophrenia on Metro illness and to do it as myself and to own it and not hide from it or be ashamed is it fair to say that you wouldn't have done it well haven't gotten tenure first probably yeah I mean I think probably if there were no such institution as tenure and I were in my what was it my 17th year here at USC it's a great place it's very nurturing it's very stimulating and caring you know so I probably would have done it anyway I think here but it would have been a big arrest you wrote a book a few years before your memoir in which you observed that there was this huge stigma attached to mental illness and you said in that book that one of the reasons there's a huge stigma is because people who are highly functional who have these illnesses do not come forward so when you wrote that were you feeling that all guilty that you had probably I mean the stigma is really horrific I mean as an example one of my colleagues said after the Jared Lochner case if he had been bleeding copiously from the nose his parents would have taken him to the ER whether he wanted to go or not there were a lot of red flags either they didn't see it didn't know how to understand it or were afraid of the stigma but the consequence was disastrous I mean people quite even quite a part of from people actually harming other people people who don't get care suffer and they don't need to suffer it's an illness there's there is treatment available it's a stigma is a real bad thing you were what seven eight years old when you got your first hint that you may have you may have a mental illness or that something was different about you well I don't I don't think I would have been diagnosed as a childhood person with schizophrenia but I you know I had phobias I had obsessions I had night terrors yeah I had as you said when I was seven or eight I had my first period of disorganization it sounds like like you have kind of like an existential meltdown you wrote in your memoir most people know what it's like to be seriously afraid and this this was after you I guess your father snapped at you for some reason they've had this reaction right and you say but explaining what I've come to call this organization is a different challenge altogether consciousness gradually loses its coherence one Center gives way the me becomes a haze and the solid center from which one experiences reality breaks up like a bad radio signal now as you got older and your delusions became more elaborate did this lack of centeredness that you described remain a constant oh sure I mean it's a I call it and it's called this organization there's a form of schizophrenia there's paranoid schizophrenia which I also have a touch of and disorganized schizophrenia is and that's what I described as what disorganization feels like it feels like your minds is a sand castle with all the sand sliding away in the receding surf and nothing no sensor to take things in and make sense of them and that's why I call following Yeats my book the center cannot hold to kind of convey that experience you studied philosophy at Oxford so I think it's fair to ask you one grand philosophical occasion and that is you know having experienced mental illness do you think that that gives you any unique insights into the nature of free will is it real is it a biochemical illusion or something in between it's a really really hard question I think there's a lot of evidence and a lot of what we do is psychically determined but we also feel like we have free will in a sense am i coming to accept that there were certain things that were wrong with me that were added my control was a hard battle to win and in a way that's saying I'm not responsible for it and something that befell me or happened at the same time you know I also feel like I've made a lot of effort to have a good life and that you know surely that those choices were mine and good choices to make kind of thing so it's a real yeah your memoir kind of conveys a mixed message on this I want it you just alluded a little while ago to your stubbornness that suggests for you know a free will kind of you know take on how you were able to get through it you got through but on the other hand you also talked about your struggles with trying to do without anti-psychotic medication right and in the end you realize you couldn't do without those drugs right suggest right that you know you were kind of enslaved by your biochemistry to the point where you needed it's sort of interesting a drug because it's sort of interesting because I used here's an example of I used to think that I'm I'm not mentally ill for a variety of reasons but one of the reasons was that I was choosing to believe what I believed and so on and then I realized there was a time when I was on a drug called NA vein and a friend was on NA vein in the support group and she was complaining about how she was tapping her toes all the time and I knew I was tapping my toes all but she was on naã¯ve and I knew I was tapping my toes all the time but I was just doing it I wanted to do it I did it I could stop whenever I wanted to I'd start again very quickly but it was my choice and then I switched drugs and my toe-tapping stopped so you can kind of claim responsibility for something that's not really in your control well you you do explicitly taught you raised the question in your memoir whether the brain is the same thing as the mind right and you write I had been taught all my life that intelligence combined with discipline could overcome any challenge and mostly that belief had served me well the problem was it assumed that the intelligence at hand was fully functional fully capable but I'd been told by experts that my brain had serious problems could I hang on to one while conceding that there was a big flaw in the other so how do you exactly sort that how do you retain a sense of self that's distinct from an illness that is in a profound way affecting not only how you view the world but also it seems your personality how do you keep those things it's it's difficult it's difficult you know sort of interesting because I struggled against having the diagnosis for such a long time and the ironic thing is once that I accepted that I had the illness and I needed medication and therapy it really came to define me much less so it became sort of accident rather than essence so I now think of myself as a person yes I have schizophrenia yes it affects my life but I'm much more than the diagnosis it took me a long time to get there and so talk a little bit more about that how do you how are you able to get to that point I think you know one thing was that when I I struggled about medication for a long time and when I finally got on a stable dose it occurred to me that I had always thought that people had the same chaotic and violent and scary thoughts that I did they were just better at hiding it yeah I was like socially mallet or a rather yeah and when I got on the new medication and stayed on and then it cleared my mind a lot I realized that wasn't true how do you know it's not true how do I know it's not oh yeah you don't know you don't really know why are diagnosed at one point by a psychologist named Anthony stool Walker story yeah and very eminent psychologist written a number of books I think it's like I etre stannis I think so okay but anyway he wrote at one point in one of his books he said the dividing lines between sanity and mental illness have been drawn in the wrong place the sane are madder than we think the math that's a great way yeah yeah I do I do but you also buy into the idea now that it's not just that you were lacking diplomatic skills right well it's sort of not uncommon for people to think other people think the same way that they do right you know like I I think people who say they like to exercise or just telling lies that's the point we assume that people feel and and a lot of times they don't yeah yeah you know as you describe the the sorts of delusions that you had in your memoir it does seem to me that there's a paradoxical quality to them and what I mean by that is on the one hand there is the sense that you had of appearance right that you could you actually imagine in the throes of your delusions that you could kill people with your mind right and in fact in the throes of some of your delusions you actually thought that you had killed people hundreds of thousands of people yeah but then on the other hand you also had a sense of profound vulnerability yeah that people were trying to kill you right is this a typical pattern pretty common law experiencing these sorts of episodes I think that's pretty common people are both afraid of their own violence and fraid of other people's violence it's pretty common it was during your trip for one second speaking about feeling kind of grandiose my husband read a little bit when I showed him my memoir there was a passage where I talked for I was having delusions and I said I'm God or I used to be and he wrote a marginal note did you quit or were he fired yeah he said who would had the authority to fire God that was kind of fun there's another quote that I had read an eminent psychiatrist or psychologist that I remember which who quoted one of his patients who said you know in my world I'm nipa and in your world I have to practice diplomacy that's great and you kind of felt that way didn't you I did I did actually I mean one of the things that served me well having a very serious illness is I even if I didn't have insight that it was an illness completely I always knew what other people would think was crazy I didn't want to appear crazy so either I wouldn't say it or if I couldn't not say it I just stayed home so that kind of social judgment served me well in terms of making myself away from the world in the throes of a delusion to do what what's called double bookkeeping you know what I mean by that yeah I think not all the time but some all the time I mean that my worst I would just be kind of sitting in bed listening to music and holding my head afraid that it was going to explode but I could be pretty symptomatic and still work I mean work has been an important part of my you know the package that keeps me sane and stable it was during your first year at Yale Law School I Drive that you experienced the breakdown that led to the forced hospitalization in which you were forcibly restrained right that's what if you could talk about that experience it sounded like it was a terrifying experience it was devastating being in restraints over ten hours as extremely painful for one thing you're just not moving makes your muscles a there's a terrible feeling of degradation and helplessness and pain and you don't know when it's gonna end and you don't know what to do to get out and it goes on and on and it's just very traumatic so explain how you were having a breakdown and a professor driving to the hospital right yeah and and and so good talk about how so you got there and this was not my first time in a hospital I've been hospitalized in England but England is very much more humane in a lot of ways than we are and they haven't used full mechanical restraints for over 200 years anyway I my professor brought me to the ER I had made a belt out of television wire that I found on the roof and I was doing like that and the very nice kind of guard type guy said can I have that I need to have that and I said mmm he said please I need it I said okay here it is but I'm not gonna give you my six inch nail in my pocket and then the psychiatrist came and he said I'd like the nail and I said no and he called security over and then motioned to the bed and several people surrounded me lifted me up slammed me down on the bed and tied my wrists and my ankles to the bed and then put a net over me so I couldn't move my body either and it was devastating it was terrifying I didn't know that this kind of thing existed because I hadn't seen in England I never read about it I never saw it and again it's very painful very degrade and people actually die I feel there was a there was a series of articles in The Hartford Courant where they reported on some deaths and the Harvard statistician estimated that every week in this country one to three people died in restraints so the question is are we saving more people or losing more people by how do they actually die sometimes they aspirate their vomit or they have a heart attack or they strangle themselves struggling there are all sorts of different ways but it's it's a terrible thing and there's efforts underway to reduce the use of restraints if done in Pennsylvania they've done it in Massachusetts in fact I have a new institute called the Sachs Institute for mental health law policy and ethics here at USC and last year our subject was mechanical restraints so we had a distinguished lecturer event and we had a symposium and I have students and we're trying to get everything published and it's was very interesting to read kind of the current state of the art which is efforts to reduce but not everywhere and you were restrained for it for the better part of three weeks right well no no I was the most I was restrained was twenty hours at a shot but over three-week period every day from two to 18 hours for three weeks then I went to another hospital my behavior didn't change and I stopped being restricted and how are you behaving I you know I might pace anxiously or agitatedly I might say some a veiled threat like just now I thought about hurting you I wouldn't say I'm gonna hurt you or plan to hurt you but I thought about it in psychoanalysis you say those kinds of things out loud but in hospitals you shouldn't yeah yeah so you were in the hospital for how long and well in England the first year was a month the second year was four months and then in America was five months and it's been since 82 83 which is in a way my most proud accomplishment to have stayed out of the hospital all those years so after you got out of the hospital in New Haven you were able after I guess a year to continue your studies that you know there's actually a very funny story about that so Yale had a policy that the director of university psychiatry should examine you evaluate you tilt see if you were ready to go back yeah and like any good student I looked him up this is before the internet so I like was pulling books from the shelves and there was an article that he had written patients who were students who are withdrawn from school for psychiatric reasons questions you want to ask an answer she went into the interview I knew all the question like any good student right so what kinds of questions were they asking I don't remember to tell you the truth I do remember that the doctor suggested that I take a year and work as a cashier somewhere I said I would think about it and of course what I really thought was you know I've been a student all my life I like it I'm good at it your time is flexible that would be so much less stressful for me than a line of people demanding change right so it's not like one size fits all one of the interesting lis enough after you came back to Yale you published a paper in the Yale Law Journal on restraint on on the use of mechanical restraints effect that was the name of the paper was the use of mechanical restraints in psychiatric hospitals right no you and that paper gave no hint right of what you had gone through I see the little thing yet at the beginning is about me so okay in fact there's another story about that that's really telling so I went to one of my professors who had training in psychiatry and told them I was working on mechanical restraints and must be so painful and degrading and he said Ellen you don't understand these people are psychotic they don't respond to this as you or I would they're different yeah yeah I didn't have the courage at that moment to say well no they're not that different for me talk to him since he's passed away absolutely okay I would have well you proposed a model statute in that paper cuz that's and and that was back in 1986 right so I'm wondering you know so many years later our our mental institutions more judicious now I think they are immobilizing strapping people down a lot of places are and as I say a number of jurisdictions have made really concerted efforts to reduce restraints and it turns out that they can it doesn't cost much more and it doesn't raise the rate of injuries and it's just so much the right thing to do in fact you're the recommendations that you proposed and that paper have many of them been adopted some of them have you know I mentioned that I think if choices are equal patients should be given a choice and some of the new statutes incorporate that I also suggest that the liability regime change and as far as I know that hasn't happened you know reading about how you were restrained reminded me of something that happened to my own father Wow he went into the hospital he was I think around 55 years old you know around my dad all my h2 with chest pains and they you know they hooked him up and they told him he was having a heart attack and his first reaction was a curious one I believe that he said and then he started to get up and leave or tried to leave and he didn't get it very far because they physically restrained him did they then tie him to the bed well I don't know if they tied him to the bed but they made sure he wasn't going anywhere and so of course that's nothing like what you went through but I think it kind of underscores the point that there are those situations when it makes moral if not legal sense to ignore what a patient wants and you don't disagree with that do you know I don't I I'm not I think there are limited occasions where coercion makes sense either if someone's imminently dangerous or if they don't understand what's going on if they want capacity I mean the deeper question here it seems to me is that do the mentally ill have a right to choose what kind of people they want to be right even if their families and friends and doctors feel that that choice is being heavily influenced by the disease that their stuff the illness that they're suffering from so you can almost think of it as different selves there's a healthy self yeah also yeah and why why what gives us the authority to respect the healthy self and not recent right y'all self right y'all self has its own people with schizophrenia for example they do often exhibit an attachment to their delusional selves right right so and as you point out in your book doctors and lawyers and to approach that question very differently Tyler yeah yeah psychiatrists think of it as an illness that requires medication and therapy and then you'll be restored to the real you whereas yours are more libertarian more libertarian more wanting to leave it up to the person him or herself what what they value on what they want and if it's unwise and their point of view and the lawyers point of view well that's too bad because they have their own perspective you note that as a group the mentally ill are no more dangerous than people in the general population was there ever a point in your illness that you felt that you were danger I would say one thing first which is that people think mentally ill people are dangerous and some some are but the people who are really dangerous or substance abusers they're the ones who commit most of the crimes but I think people are more frightened of mental illness they sort of understand drinking too much or whatever so that it's less exotic I guess yes yeah yeah so did you feel at any point that you were dangerous yeah I think I think I was I think you know when I was in Oxford and not on medication I was had very violent thoughts and fantasies and even carried a box cutter in a serrated kitchen knife in my purse to my sessions with my analyst yeah and she's an analyst that you refer to as mrs. Jones mrs. Jones yeah and in your memoir you describe how you would stop you am at first of all you're very attached to this very attached but at the same time at one point you felt that she was intended to hurt you right and so you found yourself walking by kitchen stores staring at knives and at one you um you went into a hardware store looking for an axe right so let's just suppose god forbid that you bought an axe right and ended up doing something really bad with it you know if you were in the United States under our laws is it more than likely that you would have been found not guilty by reason of insanity yeah cuz I had a lot of delusions about mrs. Jones and about my safety and her safety and I think there's a good chance that I would have benefited criminally insane even I mean the insanity defense in this country is rarely used and it really well and it's also it's even more rarely used successfully right and and more rarely you successfully in a contested case some of the cases are by agreement with the prosecution ya know the stats are very different from what the public imagines it's very little used and even successful I was once told by a psychiatrist that the actual wording of the delusion can have an impact on whether or not someone has judged not guilty by reason of insanity yeah so as an example the question is if the delusion that you had were true would it justify what you did so imagine someone has a delusion that his next-door neighbor's spreading rumors about him and kills him versus his next-door neighbor just pulled the gun on him was about to shoot him so the second would be a delusion that would qualify for the insanity defense but the first wouldn't and you can kind of understand why because even if it were true it wouldn't excuse what the person did that said when someone's mentally ill they're confused and they're thinking quite a bit and it's sort of hard to pin down exactly what they're thinking and fear but to the extent you can the question is you know what the delusion excuse you if one delusion says you know this guy is trying to kill me right and that would be you know a good delusion to have if you want to get a not quickly by reason of insanity of finding but fire let's say your delusion of saying your voice inner voices are saying to this person as evil and deserves to die right how would that would with that sort of delusion work that's part of it's difficult to say it could go either way that kind of those oh yeah yeah well it's funny that the word the actual worrying of a delusion all the difference in the world where you wind up there's also you know command hallucinations if you think that you're being commanded by God to kill someone that's usually a defense as well because you're not doing anything wrong in your own eyes just as you're not doing anything wrong if you think someone's trying to kill you when you defend yourself so to speak most states in this country have a McNaughton type rule right on the insanity defense it's a cognitive test whether you know that there's between right and wrong right I I think it's a very few states that have a volitional component right to their and today I don't remember what the breakdown is between those that haven't and don't have it but yeah there's the cognitive there's a defense I think here in California for example there's no resistible impulse there's lawmen there's not do you think there should be yeah I do I think I mean I think it's troublesome because it's hard to tell what an impulse was irresistible versus well resisted yeah yeah yeah but I think there are times when people feel impelled to do stuff and can't control themselves and that should be to the extent we believe it the basis for a defense mm-hmm you mentioned the the Jared Lee Loughner case that laughing of course was the very disturbed young man who went on a shooting spree in Arizona last January killed six people and wounded 13 including congresswoman gabrielle Giffords after Lautner's arrest the lawyers started fighting over whether or not to allow prison officials right to forcibly medicate lautner in the end the judge ruled that he could be forcibly medicated do you think the judge made the right decision you know I don't know enough about the facts if I mean typically you would allow medication if the summons dangerous or gravely disabled in the prison system that's Washington vs. Harper allows that for prisoners it's a more controversial question when and whether you should be able to medicate someone to render him competent to stand trial yeah or competent to be severely punished right or executed right you there is a competence requirement for executions so right you don't appreciate that you're about to be killed for something that you did you can be spared execution until you're restored to your understanding right some people think that's kind of crazy because what are you gonna make someone better and really appreciate how horrible it is to die and then give them isn't it more humane to love I don't think so actually I think you know I think that being put to death while you're insane is kind of crawl more cruel than being made I think the fourth to be forcibly treated right to be competent up to appreciate right what's happening yeah I you know I really don't have an opinion on whether on that medication issue I really I mean leave and tell health aside you know there are people who become seriously ill on death row right and then the doctors come in and you know take heroic measures to knock these people well again so that they can execute them later well there it's even there are even worse things than that like someone attempt suicide the day before their and their execution and they're revived and that's not a lot you can they reach out you and then kill you the next day right well I guess that underscores how ritualistic right all is right but the idea of treating people enforcing treatment on someone for the sole purpose of making that person comput enough to be seriously punished you don't have a problem with that I it's again it's an issue that I need to think about or I think it's a difficult question I mean I think in the execution context I mean first of all they're terrible dilemmas for the psychiatrist's you know trying to give someone drugs to make them well so they can be killed I mean that just really seems to stress kind of professional psychiatric ethics I basically think it's you know I basically think that people with serious mental illness shouldn't be executed anyway they should shouldn't be death penalty eligible you know we've never said that you can't execute people with mental retardation and people under the age of 18 when they commit their crime I think people with serious mental illness even if they don't meet the insanity defense can be so confused and and deranged and unclear thinking that they should you know not be a death penalty eligible either let's talk a little bit about multiple personality right you wrote a book about that called Jekyll on trial back and I guess was published in 1997 right with my friend Steve banking right yeah and first of all just to be clear schizophrenia is not the same now as multiple personality sort of people think it is schizophrenia is what personality more multiple personality but it's actually a totally different category of illness multiple personality disorder which is an alcohol dissociative identity disorder is a dissociative disorder and schizophrenia is a psychotic disorder they're just two completely different kettles and fish right schizophrenia involves being out of touch with reality multiple personality involves having splits in your mind you know there has been and I guess there continues to be rather heated debate over whether multiple personality disorder is a real medical condition right but but whether or not it is real I have the the sense that the app the MPD multiple personality disorder epidemic right that we saw in the 80s and 90s when tens of thousands of people were told by their therapists that they were suffering from that illness that that is now viewed as something of an embarrassment if not you know just a full-blown scandal by the mental health establishment that in part staked its credibility on the authenticity of that epidemic do you agree with oh I think that probably in some ways for a time MPD or di T was over diagnosed or actually even created in patients quote iatrogenic Li yeah I mean created by the toyota's right yeah so I think that happened at the same time I think there are some real cases and it's a mistake to say because it was over diagnosis it doesn't exist and I was pretty much persuaded you know I watched about a hundred hours of videotapes of people being interviewed on the on a diagnostic instrument and I was very persuaded by some of the reality like one guy was saying you know my boyfriend says that I get up in the middle of the night and I say I caught myself by a different name and I act really scary and he said and my boyfriend taped me doing that the other night but he must have drugged me because I would never have acted that way or there was a woman who said you know I'm a therapist you know and you know I have an active practice and I'm fairly happy and she said and some people say I have multiple personality disorder which is just totally insane and then she flips that jerk doesn't even know that I exist you know so seeing things that were pretty persuasive to me you know again a you know acknowledging that there has been some over diagnosis some funny story go ahead so i one of the things I did when I wrote my book is I wanted to get familiar with what the disorder looked like so how did you get into how did you know I was walking to lunch one day my first year here at USC and one of my colleagues saw a newspaper article about ross carlson who had killed his parents and I just thought this is Ennis intersex kind of psychology's philosophy law so I just heard guy had multiple personality disorder yeah he killed his school teacher parents and and the auntie ended up dying of leukemia okay it's kind of a sad story yeah but so as I was saying I watched the videotapes of the patients and I oh there was a ward in LA that I forget the name of the hospital but they had a ward for people with dissociation so I went once a week for six months and spent a few hours with with the patients the first patient I interviewed individual a lovely person very sweet very committed to treatment she's not someone who was getting a lot of secondary gain about being in the hospital and she reported that she had you know in the last couple of months got married and she's a number 20 that's terrific congratulations she said yes my anniversary our engagement lasted for two years because my husband insisted on getting consent of all the alters before I thought that was a touching and a lovely story I'll show you how my mind works does that mean you know when he when this gentleman must have sex with his daddy's gotta exactly yeah there was actually a criminal case there was a criminal case where our guy meets a woman at a party and she reveals that she has multiple personality disorder and that her mischievous fun-loving personalities named Jennifer and he calls on her house the next night calls on her has the next night and she's in the car with them and he parked and he says you know can I make love to Jennifer oh is Jennifer there can I make love to Jennifer so they had sex under the watchful eye of a little child named Sarah who reported it to the police I know this concept yeah Pete Peterson was a defendants and I don't remember the name yeah and and and so and this woman had like 47 personalities okay at least it was claimed that yeah she did and yeah so what do you make of that case you know it's a difficult case because as you say what is it for someone with multiple personality to have capacity or consent to sex right right do you have to have everybody agree right this is enough that one competent person agrees if that competent person is sort of the fun-loving one well people you know play you know trade on people's vulnerabilities all the time yeah or whatever so but I out but I do think that taking advantage of someone you know to be unwell is kind of unfortunate at the best so then as a general rule can people with you know this disorder of consent to something like marriage or sex or yeah or sign a contract so in my book I talk about the simple context a little bit and I think it's you know complicated part of me feels like in the context of say accepting medication if one competent author says yes that's enough part of me feels like what if that competent altar is Jehovah's Witnesses and saying no to blood transfusion and everybody else wants to live so just having a competent author maybe not not enough in some context so maybe you want to have an unconscionability well I mean it's a difficult issue I don't really know what the answer is right Paul McHugh the directors like hire to Johns Hopkins I guess more or less a critic of total of MPD said when we all look back on the MPD epidemic in this country we will be dumbfounded by the gullibility of the public in the late 20th century and by the power of psychiatric assertions to dissolve common sense you know you don't agree I agree uh-huh but aren't there those situations where an illness can kind of become an epidemic through I don't know it's kind of like almost becomes a so it's like a social contagion and an example of that like then the 19th century there was something called the mad travelers disease I never heard of that is where you know one guy walked off and a few right and ended up somewhere else and simply didn't have any memory of his former life and it triggered this epidemic where everyone started walking from their lives you know certainly I mean there's their contagion effects I mean things like self-mutilation you know uncommon more common now probably because there's a lot of publicity or eating disorders or whatever there are kind waves of you know you know and sort of raises interesting questions about the nature of mental illness if it can be created on that way you know that kind of I mean there has it's been observed that every culture has its idiom of distress so it's stereo yeah Freud today but yeah very uncommon today but right borderline personality disorder is very common today but that's you know relatively new diagnosis in the last 150 years or something like that there are diagnostic trends and kids with bipolar illness you know some people think it doesn't exist I am actually working on a book with a manic bipolar lawyer who wrote a book about her childhood bipolar and she made her first suicide attempt when she was five or six you know I think there are some who are genuinely but maybe it's being overdiagnosed now or whatever so in your book about multiple personality disorder you allude to cases in which accused murderers or rapists with MPD claim that only one or two of their many personalities have any knowledge of or any involvement in the crimes that they've been accused of and your position as I understand it is that if the MPD is real then these defendants should never be made to go to prison unless all or virtually all of their alters knew about and acquiesced in the crime and for me that would be either they participated or they could have stopped it and they didn't which is different for different people and the funny thing is when I first proposed this I thought you know most people with MPD would be exonerated but then I realized that many many many of the cases all the personalities took part so most people with multiple personality who commit crimes are men just as most people who commit crimes are men men with MPD have many fewer alters than on average that women with MPD and a lot of times they they participate so an example is a case gosh I forget her forget her name but she had her name was Marine more she had a Marine more personality and a Billy Joel personality I don't know where that came from but and she and Billy Joel held hostage and ended up participating in the beating death of a kid and they held hostage of several several kids and then killed one of them and but you know both Murray Moore and Billy Joel knew about the crime Murray more would pretend to be getting phone calls from Billy Joel saying what their daily discipline would be and when the police were suspicious mizmor deflected their enquiries so she participated in the crime she was an accomplice so you've got two personalities both participating I think that person should be found guilty she probably you know has some mitigation available but it shouldn't be an insanity defense based on her multiple personality disorder and a lot of times the criminal defendants all the authors do participate mm-hmm okay so saying if all the personalities are participating in a crime right the person is convicted right and say after the conviction another personality pops yeah that's a good question what do you do then I mean I think if this is one of those line-drawing things again I think you just say you know sorry you're in you were you were responsible because you make you analogize this to conjoined twins right you know if one of your twins shoots somebody right see the thing that I'm concerned about is just too much the possibility of malingering just generating fabricating this problem which is also true at the front end that's right right yeah so how do you draw the how do you draw the line yeah you got me up against the wall well what about the other issue is if they're not if it's not fair to put them all in prison if not all of them are guilty is it fair to put them all in a hospital if not all of them have mental illness right and not all of them are dangerous that's you know that's a good question well I guess the answer would have something to do with the hospital being a price for treatment a prison being a place for punishment so it's I think it's fairer the innocent personality is a treatment facility than to put them in a punitive environment exactly so okay so what happens when that innocent Bersani pops up after the crime has been committed and we believe it's January yeah let's say we believe it's genuine I think we still have to multiple personalities need multiple lawyers yeah what is it for them to be competent and as each one had you know and if one lawyers more expensive than the other there was actually when I was working on multiple personality disorder there was an article in a local Beverly Hills newspaper that I ran across in which a French lawyer was suing his other personalities for using his money using up his own network I never heard what the outcome is do you have any idea how many criminal defendants have invoked MPD as a defense or pretty small number I don't know the exact number but it's a hard case to win because most people are skeptical right so I mean would it surprise you if like more than a dozen that mouth the defense and it was successful with it uh oh yeah sure yeah I would be surprised if more than two or three were successful really but in terms of invoking it you know I you know ten twenty something like that yeah not a lot yeah yeah I mean I think when you reading your book about multiple personality disorder a couple things occurred to me number one you know it's hard not to be overwhelmed by a sense of the bizarreness of it yeah and the second thing that occurred to me was that you know yeah when you look at our criminal justice system you know it subscribes to very conventional notions of responsibility and freewill right this is that system get its arms around yeah what you're talking about well I'm reason the insanity defense is so often invoked and because it's so often unsuccessful and sometimes can backfire so I think the disorder itself is more understandable I mean it sort of got this exotic you know kind of Florida kind of quality to it but the basic mechanism is you know a little kid is being hurt by someone she loves and she makes it happen to her and not to me she splits away it's happening to her and not to me and it's very common response to trauma dissociation so like a lot of rape victims report that they went up to the ceiling and was we're looking down on themselves being raped that's another form of dissociation it's a very common response to trauma with a little kid when it happens when you're really young and haven't had time to consolidate a personality you can have this splintering that looks like multiple personality disorder you know it seems to me whether or not MPD is real your discussion of it I think does raise broader questions for example let's say someone commits a very serious crime and ends up getting a life sentence and then say five or six years into the sentence this person has a dramatic shows a dramatic transformation say born again kind of conversion it seems to me under your logic that you apply to MPD cases when we have to discontinue the punishment of this person yes because they're more than trivial sense the person that committed the crime right no longer exists right no I think that's a very good point and I think you know I guess I think in the same way that if someone develops MPD once they've been convicted they should stay in prison that if someone gets better two things the difference between the born-again person and and his past person is probably less significant than the difference between alters they have memories of each other and you know they couldn't consider each other the same person and that kind of thing there where's mpg there are these like amnesia barriers cordoning off some of the personalities and they don't feel like one person and that kind of thing so they identify as different selves and not just parts of a different self or a person who's been transformed so I think the way we would talk about the person who's been transformed as a person who's been transformed not a new person whereas with MPD there's a stronger case for saying they really are different personalities or people that doesn't there isn't there with many of these people a host their lives all the personalities well there's a host all that really means is there's a personality that's in charge whatever personality is in charge most of the time it's called the host and it can vary from time to time and they can last longer or shorter periods of time and that kind of thing so I mean what when I first started working on this I thought one of the things I thought was you know maybe the rule should be only if the host commits the crime is the person guilty because the host is the person and in fact there's a case like that called ne versus denne denne Schaffer right where the court says if the host unless the host commits the crime the person's not guilty I really thought that was a meaningless distinction I think but the host concept is not that robust of a concept it's kind of just a practical way of thinking about the person so whatever is whatever personalities in control most of the time it can vary from time to time they can be in existence for shorter or longer lengths of time and so on but basically the thing that moved me was that all person like alters there are transient personalities and there are fragments but all person like alters have as much claimed to be the person as the host personality they're really the same concept I asked you before whether you know the person that you know undergoes that born-again conversion right you're saying that there's there's enough integration there that it's still one person right and so you would make but actually I'm fairly tempted if someone really undergoes a radical personality transformation and so on that maybe there should have some you know lenience or mercy or what about like a juvenile that gets a life sentence I mean there's I think an argument to be made that you know people who are locked up as teenagers right as much older people are different people yeah it's all I don't know if I would call them different people but it's certainly the case that people who are young have less capacity and less ability to control themselves and less ability to understand the implications of their behavior than people who are older and I think that's why we have the juvenile justice system and and don't penalize juveniles as much and as I said again we don't execute people who commit their crime before the age of 18 but you're right you someone commits it yeah I know I know someone commits a crime you know when they're 17 that's really horrific you know you again we have the opportunity of treating them as it's all time keeping them in but it's it's a harder choice and someone who's older and does the same thing yeah yeah well you know reading that book on MPD that you wrote it just reminded me how you know squishy these notions like personal identity and personality can become the more and more you you look at it yeah I mean you very spontaneously had a existential meltdown at the age of seven right then there are these sophisticated philosophers who you know think about like like Derek Parfit or I think about personality and an identity and they kind of it seems to me arrive at that same sense of coherence so it's sort of when I think I've actually had a colleague who was visiting here or who's both a philosopher and and a lawyer as a law professor and we were kind of noting that a lot of the things philosophers believe or play with are things that mentally yo people really believe yeah so philosophers you know say you can't prove the existence of the external world but no philosopher lives as if there is no external world well some mental patients do they have a psychotic belief that the world's and it has come to an end and they don't interact with the world so on the one hand it's kind of an interesting and you know challenging kind of philosophical problem on the other hand actually lived it's a severe problem I didn't bitching steen see a very close connection mental illness and philosophy did he I'm not we're of his work on that but doesn't surprise me there's well there's and then I you know I wrote a paper about the Schreiber case Schreiber was a German judge who had a breakdown and right he wrote his memoir and the Florida case study yeah and I Daniel Paul Schreiber yeah Wow and and I wrote a paper about Schreiber as well what were we talking about well oh yeah yes doesn't matter the thing is that he you know he wrote this really wacky memoir yes he was being transformed right I've read the map yeah transformed by the Rays of God to come a woman and bring forth a new race of man and woman which by the way when I was on the teaching market and speaking to to Notre Dame and they asked me about this paper I said that and one of the persons a nun said what's wrong with that but he so his memoirs totally wacky it's way off the wall even though it's sort of like a lot of the old philosophers cosmologies except it was very self referential but it was in the same kind of vein and then at the end he appended a legal brief to get himself out of the hospital which was completely lucid yeah completely coherent and I was just so interesting to when you read that memoir did you identify because a lot of the delusions I mean you didn't imagine yourself being transferred transferring to a man but the paradoxical quality of the delusions you know of vacillating between omnipotence and profound vulnerability so that yeah is in your memoir absolutely yeah really resonated with me let's change the subject entirely you have talked about the connection between genius and mental illness it's long been suspected that there is a connection and indeed you know when you read the biographies of artists and novelists and scientists I don't know if most of them but a healthy percentage of them you know have struggled with a mental illness of one sort of another well actually Kay Jamison who whom I've met and really think highly I've wrote a great memoir called unquiet mind but her first book was called touch with fire and it was about all the famous bipolar people in history you know in creative genius as an artist's less so as schizophrenic much less so a schizophrenic so I mean typically with schizophrenia your first year or two with the disorder your IQ points go down there's no correlation between high IQ and schizophrenia high correlation with low socio-economic class could be downward risk could be just more stressful to be poor but people with schizophrenia typically aren't the ones you know you've got your exceptions like John Nash right although Nash actually made his discoveries before he became ill so I'm not really sure that his illness facilitated his discoveries maybe he was getting ill or whatever there is you know the kind of out-of-the-box thinking that you might get with a mental illness and sometimes that's productive and sometimes it's damaging do you think they feel that your illness has in any way facilitated your creativity ah you know I think I might have been a little bit more flexible like with this idea that multiple personality personalities could be people by the best criteria of personal identity I mean that's sort of a very you know kind of avant-garde or quirky or eccentric way to think and I think it makes some sense and so maybe thinking out of the box made me think of that and I wouldn't have for the most part I think you know I my illness fights against my creativity and my productive and my productivity and creativity fight against my illness because when I'm working I can usually keep the bad stuff to the periphery it's very therapeutic for me to to use my mind so to speak but when you were fighting the idea of being dependent on these antipsychotic drugs your concern was that they undermined your authentic self yeah and so was that tied into any sense of creativity that no I I know people think if I take medication it's gonna take away my creativity I never really thought that for me I think the main thing was the quote as we say in the field narcissistic injury of having a mental illness and needing medication and so I used to say you know I don't want medication because I don't want to use a crutch and now I say you know if my foot were broken I gladly use it to cry sharp my neurotransmitters miners' entitled to his gentle treatment so I've sort of gotten over the shame of having a mental illness and needing treatment and that was a big thing in my therapy can you describe to me you know what it's like to live with your brain now pretty much like what it's like to live with most people's brains who do kind of creative or intellectual work and have important people in their lives and you know I think I think in many ways I'm fairly normal now except I have these transient thoughts and I have periods of two or three days you know several times a year when I kind of fall off the cliff but for the most part I think I'm pretty healthy I think I'm probably healthier than many of my neurotic colleagues even though I have a psychosis back to the same yeah yeah Oh professor sex it was really just a treat talking to you today I really appreciate it thank you Marty I enjoyed talking to you as well thanks you

Channel: University of California Television (UCTV)

Views: 18,598

Rating: 4.9103141 out of 5

Keywords: Elyn Saks, mental illness, MacArthur award, Martin Lasden, multiple personality disorder, Schizophrenia, insanity defense

Id: tTVoximfT2E

Length: 59min 12sec (3552 seconds)

Published: Thu Mar 08 2012

Reddit Comments

[u/arex1337]

MacArthur genius award recipient Elyn Saks has written extensively about the rights of the mentally ill. She has also written at length about her own bouts with serious mental illness. In this very candid interview Saks, who is a tenured law professor at the University of Southern California, speaks with California Lawyer editor Martin Lasden. Series: "Legally Speaking" [4/2012] [Public Affairs] [Show ID: 23630]

[u/zpmorgan]

Much appreciated, as usual.

x	arex1337	AristotleJr
total score	11	7

[u/specialkake]

Very good, thanks.