UCSF Psychiatry Grand Rounds: My Journey Through Madness

[Music] honored today to introduce the 12th annual dr. Evelyn Lee visiting scholar lecture and cultural competence and diversity for those of you don't know me I'm dr. Kristina member and the vice chair for diversity in our department and I guess I was wondering did anybody in this room know dr. Lee could see a show of hands okay so I've seen social hands yeah she was just really a remarkable human being and why we're having this special lectureship today she was unpacking our department she was a professor she came to UCSF back in 1982 and she came to San Francisco General Hospital at that time she was a program director of the Asian Asian focused inpatient team and she worked there for many years and then she left at the San Francisco General and became the executive director at Ram's which is in the Richmond District it's a nonprofit community-based mental health clinic focused on serving the predominantly Asian American and actually Russian American population during the Richmond and she was just extremely productive and innovative she started many programs that are still available today like higher ability which is a supported employment program the she also started bridge to wellness which is a private transportation or partial hospitalization and I think particularly relevant to today some things that I thought were interesting about her work is she initiated training programs for immigrant parents about parenting skills and for school personnel about working with immigrant refuge and refugee children and their families she published widely and her best recognized book is actually working with Asian Americans a guide for clinicians and then unfortunately in March of 2003 she died suddenly and the department said her loss and for that reason we started this lectureship series in 2005 to kind of recognize and carry on her memory and her work in the department and because she's been so dedicated to cultural psychiatry and diversity we and the Diversity Committee that the owner of getting to select our annual speaker every year and that normally we have had people who haven't had expertise in working with Latino communities or african-american communities or LGBT communities and this is the first time that we've actually been able to focus on people with lived experience and so I'm just really delighted that dr. SPECT is here today and with that I'm going to turn onto CP Shanta give an introduction dr. sex welcome everyone is my distinct pleasure to introduce dr. Ellen sacks I'm going to read and do from memory a few facts about her academic career as quickly as possible so we can hear from her for the full time for this long awaited lecture so Ellen Sachs is the Orang B Evans professor of law psychology psychiatry and behavioral sciences at USC s golden School of Law adjunct professor of psychiatry at UC San Diego School of Medicine and a faculty member at the new Center for psychoanalysis she received her bachelor's degree from Vanderbilt or she not only received honors but was the class valedictorian on a Marshall scholarship she then went overseas to Oxford where she received her Inlet in philosophy came back to the States received her JD from Yale Law School where she was on the Yale Law Journal and then subsequently a doctorate in psychoanalytic science from the new center for psychoanalysis where she was awarded the jocks and prized she's also an honorary Doctor of Laws from Pepperdine she works extensively in the interface between law and mental health just published several books and numerous scholarly articles it was her publication ten years ago of the center cannot hold that brought her work in her life to national and international attention if you haven't read this book it's a must read I'll be doing a little bit later this morning over the car auditorium and inside the Actor's Studio interview with Ellen about her life and the writing of this book and the juxtaposition of what I just read off of these incredible honor she's received throughout her career with the utter struggles with psychosis medication stigma and silence about her life until much later in her career it is a striking contrast subsequent to the publication of the center cannot hold couple years later she received a MacArthur Fellowship otherwise known as the genius grant which solidified her infamy as a cultural icon representing her life and her work and her struggles with schizophrenia among many other recent doing she's founder of the Stax Institute for mental health law policy policy and ethics at USC studying issues at the intersection of these vital fields so again after this lecture come over to Carr auditorium at 10:30 she'll be at the VA this afternoon with a number of trainees and faculty there and without further ado please welcome professor Ellen sacks thank you all for coming out on this rainy day and thank you dr. ken Justi for that lovely introduction so I'm honored and delighted to be delivering the dr. Evelyn Lee visiting lectureship and cultural competence and diversity dr. Lee as you've heard was clinical professor of psychiatry here at UCSD I was a remarkable woman who did great good in the world so for example she worked on issues around cultural competence and diversity bringing the message to mental health organizations schools hospitals and government agencies as one of her admirers said quote she was widely respected and loved in the mental health field and the asian-american community as a clinician administrator teacher author community advocate and humanitarian in the quote again I'm honored to be delivering this lecture than Evelyn was at Norma's name I'm also honored to be talking here today at UCSF Medical School which as I understand it is like the best Medical School in the country good for you I hope my colleagues at UIC are listening and I'm also delighted to be presenting to trainees and psychiatrists and psychologists and social workers you guys are the face of the profession that helps people like me and I want to give you a kind of window into the mind of someone who suffers with psychosis sort of to convey what this objective experience is like in the hopes that that will be useful too so I'm going to be speaking this afternoon about people with schizophrenia not about schizophrenic the difference is more than semantics words Malheur good psychiatric treatment has kept me alive sensitive and wise psychiatric treatment that has recognized the centrality of my own - my healing has allowed me to flourish this afternoon I'm going to speak about the relational aspects of my brain disease do you here today know that people with who struggle with mental health disorders are not just walking symptoms that can be cured by a pill even though many forces within our health system would have described me as precisely that mental health and mental illness involve whole people and relational social and political context all illnesses are experienced in these contexts which can have a powerful role and how an illness is experienced we need to understand people in the richness and fullness of their lives so I've been formally titled my talk today schizophrenia and I'm making peace with mental illness my title is an attempt to convey that schizophrenia which is a brain disease is a relational illness but relational I mean it involves personal identity that a profoundly impacts one social world and then it has political meanings as well that's what I want to address today the identity the social and the political aspects of schizophrenia so my title schizophrenia and I'm making peace with mental illness is therefore intended to convey that I have a relationship with my illness that to make sure this relationship respects my social world and that how I conceptualize the role of this illness and how I respond to that conceptual relation are among other things a political issue so I'm going to be addressing these three aspects of mental illness and I'll be doing that by using excerpts from my memoir the center cannot hold my journey through madness as it wouldn't go into these issues I have left time at the end for discussion I first became seriously ill as a mugful scholars studying ancient philosophy at Oxford at first it looked like depression with mild paranoid features which is often has schizophrenia as I understand it begins but my illness evolved into a more pure thought disorder rather than a mood disorder despite much resistance I eventually found my way to a psych hospital with strong and card for my doctors at the University who might had seen at the urging of her friends who was a neurologist I had graduated a class valedictorian at Vanderbilt and had been accepted as a Marshall scholar at Oxford but I was in terrible shape shortly after I arrived in England I spent much of my time wandering the streets of Oxford talking to myself just stick elated and contemplating various ways commit suicide to rid the world of my evil I had absolutely no insight into the severity of my condition I had no idea that there might be a gap between how I saw myself and how others saw me I entered the hospital voluntarily after about a week or two there everything changed it wasn't something what that a doctor or a friend or a fellow patient said it was a simple look into a mirror I saw myself reading from the text of my blog it was the first time I actually see myself in lys and it felt as if someone had punched me in the stomach who'd God I thought who is that I was emaciated and hunched over like seven three or four times my age my face was gone my eyes will simultaneously vacant and full of terror my hair was wild and filthy my clothes wrinkled and stained it was a vision of a crazy person on the long forgotten backward of a hostel of four lunatics and in the passage the gap between who I imagined myself to be and whom I saw in that mirror that day was profound and unavoidable far from making peace with my mental illness until that moment I did not truly understand that I had a mental illness to make peace with that moment that looking to the nerve was the beginning of a journey that would last a quarter of a century in retrospect it's no accident that the song I chose to listen to most often in the music world what room on the psych ward was the Beatles once there was a way to get back home work once there was a way to get back home I needed to find my way home finding my way home and finding my way back to a relational life now I think Freud was a brilliant figure and he got many things right but I don't think forgot right is his view that intense talk therapy is not appropriate for people who psychotic as you know Freud believed that analysis was not appropriate for psychotic patients because an individual who was actively psychotic could not form a transference to the analyst Freud she was absolutely not consistent with my experience in my experience the need to be in a relationship to be part of a social world maybe most percent for fans precisely when someone the psychotic finding my way home and finding my way back to a relational life I began my first work with a psychoanalyst at Oxford and it was difficult and paying for work but I noticed for my first experience with intense talk that intensive talk therapy was two things first my animals was hugely helpful in diffusing a sense of shame that went along with the thoughts I was having my thoughts were violent and deeply disturbing about myself and other people my analyst mrs. Jones was able to tolerate everything it's difficult for me adequately to convey how awful it was to have someone to listen not judge and not threatened to put me in the hospital or call the police as might have happened in the u.s. shame is a powerful component in a psychotic illness we understand the shame when an aging person soils for himself we see it we smell it we feel the shame often for individuals of the psychotic illness the shame is every bit as real and every bit as intense but it's invisible to other people second I noticed it as I felt more related to my analyst mrs. Jones I began to make friends and found it easier to work together now I realized someone could request object by question with the direction of the causal hours here fair enough my point is that as I became able to share my internal experience as I've been able to relate to someone without shame my ability to interact with all around me got that oh I want to note and emphasize is the most helpful consultant I had in England the famous psychiatrist and psychologist psychoanalyzing dr. anthony store said two things first i needed to be in an intensive psychotherapy and second i should be back in school as a way to exercise my mind i will be ever forever grateful to that consultants I finished my degree at Oxford and came back to the states to study law at Yale my transition was rocky and maybe difficult to appreciate that at this point I still didn't believe really I had a mental illness I thought that I was that I was somehow different from other people and not in a good way but that's through the exercise of willpower I could tame what was wrong but literally like one has a wild horse in a corral that you must take the challenge as I framed it in my life at that point was to take that woman who I had seen in that mirror and tame her and groom her or maybe just make sure she always stayed at home when I went out which is if there were two needs and helping me in the sick made I'm not speaking here about a dissociative experience but I really saw that woman in the mirror as not being the real name so I began yet law school I was not in treatment nor was I on meditation as a parenthetical note my analyst at Oxford mrs. Jones never suggested I consider meds even out of a psychotic at Oxford most of the time within several weeks after law school began I became overwhelmed one night in the library at the Yale Law School I became quite psychotic and the following day I ended up being taken to the hospital I'm one of my professors whose assignment has sent me over the edge at the hospital I found myself in a small room waiting for a doctor the attendant was a really huge guy was kind and I readily gave him my telephone wire bail which I proudly made the evening before when I've been floridly psychotic on the roof of the Yale Law School and not satisfied with my planes you blue jeans and t-shirts have decided to accessorize I'd also picked up a nail that I kept in my pocket which resulted in my first experience of being with straightens many people who are psychotic carry things which can be used as weapons that because they want to hurt someone but because they're afraid that someone might want to hurt them shame and fear are fused to the relational aspect of the illness shame again is a pervasive experience of people with psychosis often we are ashamed of what we are thinking and so we hide our thoughts from other people the shame may play itself out in many ways after my experience of being restrained in the emergency room five months of hospitalization ensued hospitalization involved in long-term restraints and seclusion the first three weeks I was probably restrained anywhere from five to twenty hours of area I've been switched wards my behavior didn't change but I stopped being restrained and it's kind of a robust finding in the literature that whether your restraint has more to do kind of with the ethos of the ward and patient characteristics so I'm involved watering strength and seclusion I was forcibly medicated at times and had no privacy in the beginning I was even watch as I showered I went to the bathroom and was not a lot of privacy while talking to other people including my parents I believe that the hands-off approach at the British Hospital I might even be termed benign neglect was much preferable to the over interventionist approach of the American Hospital as I have come to say I'm very Pro psychiatry by very anti force generally my in my experience people do not like it when forced is exercised in their relationships and my experience is exactly the same in treatment relationships after two weeks under emergency commitment I was faced with a question of whether I would try to get out of the hospital parenthetically the doctors put me on an emergency 15-day emergency commitment Connecticut was fifteen days versus three here and the papers said they said I was dangerous to myself and others and they said I was gravely disabled and the reason they gave that I was greatly disabled was I Clinton by Yale Law School homework which made me wonder how much of the New Haven's wish I could contact your motion to civilly commit me to me actually seem clear I would demand a hearing to fight the commitment I brought this up to my father who's an attorney my father was equally clear do nots in Texas because if he lose you have now been simply permitted and you're going to have to report your commitment every time you apply for a license to practice law which was true he said to me you certainly don't want anything in the record where a judge orders you to stay in the hospital I'll be forever grateful to my father that I do not have the burden of a civil commitment in my background that to this day I might be forced to disclose when I speak about the political dimensions of schizophrenia I seek not only about the social stigma which is real and pervasive I also speak about these lights events that can follow an individual with schizophrenia for decades there are profound political aspects to this illness it can be some huge burdens that people with schizophrenia and other brain diseases carry it's important to health professionals we're aware of these ways they can affect a person's subsequent life choices so we expect personal identity aspects of the illness we've discussed some about the social aspects and we've touched upon the political aspects I want to push these ideas further by talking more about the centrality of relationship to healer Gillan does not occur in isolation it's painful to me when I speak with psychiatrists working in community mental health centers who measure their caseloads in the hundreds I have a good friend named dr. Lisa fine who works at the Edelman clinic in LA and she has like 500 patients how does she remember them she only begins a relationship and in all kinds of ways a patient's relationship with the health professional is an integral part of the healing I worry tremendously that this point has been lost on our policymakers and some administrators of course other relationships are healing as well after I was hospitalized upon returning to the States I took read the rest of that year off what would have been my first year in law school and then I returned the following fall to begin again it was when I began me at law school a second time I mean my closest friend a man named Steve Venky Steve is an attorney and a clinical psychologist with an important appointment in clinical ethics at apartments Department of Psychiatry reading from the text one of the worst aspects of schizophrenia is a profound isolation the constant awareness that you're different some sort of alien not really human other people have flesh and bones and insides made of organs and healthy living tissue you are only a machine with insides made of metal medication and talk therapy away this terrible feeling but friendship can become as powerful as either Steve thinking in our contracts clause together and a couple of times he'd asked me for an assignment other than that we've never really spoken one evening we sat down at the same table on the Yale Law School dining hall the dinner conversation that night was casual and pleasant Kristin from one subject to another classes at Law Journal and summer jobs I noticed that Steve seemed engaged enough not as he smiled but after a while I began to look like simple for like this as our classmates got to leave the table I realized I wasn't ready to go just yet and there began one of those conversations that lost for a lifetime one of which there's immediate comfort and acceptance the equivalent of someone strong hands offered to you when you need to repose need to grasp them that first talk flew far and wide how we got to Yale who our families were then philosophy and religion and what mattered to us in live secret natures and classics at Princeton where it was name class a libertarian and spoke a lot never a rotten at graduation the summer after graduation he worked as a janitor or a small-town airport then got to know where he lived with the group of Benedictine monks and their Latin after that again with a monk who serves as a Pope's lightness he considered entering the monastery in studying the evil philosophy but decided against it because medieval philosophy had ceased to hold his interest at least as a lifelong endeavor instead of becoming a monk Steve came to Yale Law School and so John and neither of us was quite sure why sometime later the carts are meeting that at the very moment I was being tied to a bed in a psych ward screaming bloody murder and afraid for my life ceaseless singing Gregorian chants in a monastery overlooking the ancient city of Rome either a why I decided to tell Steve the truth about myself I don't know why I thought I could trust him but I did I believe from our very first conversation that this man would be a significant friend and a force for good in my life what's the possibility came to my mind I realized how much I wanted it to be so but I didn't believe that could happen unless I reveal the truth about myself I let him see me in full so much of what I did a daily basis was about faking it I knew I would never fake it with him and so on a rainy afternoon at a pizzeria in New Haven I shared my history apart from doctors and therapists it was the first time I'd ever done this with anyone anywhere and in the passage after Steve graduated from law school and left New Haven my den analyst dr. white announced that he was in a close his practice in three months fully two years before I had intended to leave the news of whites leaving shattered gray again I returned to what I see a short mistaken view that psychotic patients don't form transferences with their analyst in fact my preferences with my first two analysts were quite powerful and at the end of these relationships I could have easily ended up back in the hospital fortunately neither did one learn me there when white gave me the news of his plan retired early retirement he was traveling around the country interviewing for PhD programs and clinical psychology he said something was terribly wrong and he came to New Haven to see me reading from the text I opened the door of my studio apartment Steve would later tell me that for all the times he had seen me psychotic what he saw that day shocked him for a week or more I had barely eaten I was gone and moved as if my legs were wooden my face looked and felt like a mask since I pulled out all the shades the apartment in the middle of the afternoon was in near total darkness the air was fed at the place of sham Siva's worked with many patients who suffer from severe mental illness and to this day he'll tell me that on that afternoon I look as bad as any Eve ever seen hi I said then return to the character I was silent for about five minutes thank you for coming to leave I finally said crumbling world Lord voice tell the clock to stop time his time has Contin what did you leave in Steve said Sutherland I'm being pushed into a braid the situation is grave I'm Oh gravity is pulling again tell them to get away I'm scared and in the passage dr. right in the end did not leave for another few years healing takes place in many forms and in many venues I could not have survived this illness without close friends family and colleagues who know me over the course of my illness and who have been there to help me healing takes place in relationship as wonderful as Steve wasn't as he was a friend like a brother around the time I received tenure shortly after I ran into a man named well a man I thought was cute friendly and smart a man with whom I tried to flirt a few times when I was working for tenure and he was working in the law library USC I mustered my cards Nats if you'd like to have lunch sometime it had been 18 years since I've been at on a date I had been just too tormented by internal demons quoting from the test when it came to my personal life after my almost acquire to dance and what I started nurturing a fragile but broad relationship for a relationship with the man names will a librarian at USC and an artist I tried forwarding with him to no avail who knew how to do that but after you left USC he invited me to lunch and then he invited me to see the California Poppy reserve and Lancaster not far from Los Angeles so I kept it was really beautiful field of poppies and I kept saying how cold I was hoping he would put his arm around it but he never did but at the end of the day he kissed me a long lingering kiss goodnight and the thought I have and this is literally the thought that went through my mind was this is even better than getting an article accepted actually between lunch and generations of poppies we'll brought me a feather from his parents when we lovingly decide to just Roger at lunch and paste it on my computer and that night I asked my closest friend Kenny from Vanderbilt and I'm not sure why I put it this way but I said can you get the Diamond Club stiff feather from this parrot and paste it on your computer likes you I don't know Ellen but one thing for sure he likes you better than he likes his parents actually at that moment he liked his character at the right back to the text at the right moment I told them about my illness and he responded assembly and a crime we as a person could if skeeves friendship could make me feel human will was making me feel like a woman ending the passage when I say my relationship with Steve made me feel human don't take that metaphorically I did not feel like a human I felt my insides are made of metal and that things have happened to other people the feelings that other people had more important of my life I believed I was something else it was those two relationships with seas and with will which brought me not simply to think but to feel that I am human and that I am capable of loving relationships Merkel could have healed the relational aspect of myself I'm using other people for that purpose today Seaver will are my closest friends and I think of them as my two pillars but there was a point where I thought I may have lost Steve I suffered from an episode of cactus in German which as you know one believes that a person has been taken over by someone or something else that person is no longer really that person this episode happened to me in the mid-90s when I was in a struggle with my analyst Dr Kaplan but I how much medication I should be on we had reached a compromise which I was not entirely happy with but which I agreed to I was scheduled to give two talks the first Senate Sunday and the second on Wednesday at a conference in San Francisco once I arrived in San Francisco and checks into my hotel room I started to fall apart I called Kaplan and he suggested that I get my first talk and then returned to Los Angeles between the first and the second table for me having to come home between talks who represented failure if I had to choose between feelin terrible and being a failure I chose this clear I feel terrible it wasn't a close call for you from the text my sickness took a new horrific turn for some reason I decided the Kaplan and Steve are Impostors they look the same they sound the same they were identical in every way the originals but they had been replaced by someone or some sin was it the work of alien beings I had no way of knowing I was terrified it was a struggle but I delivered by Wednesday paper and flight back to Los Angeles shaking a completely paranoid in nearly ten years of experience I had never missed an appointment with Kaplan now he didn't go to my next two scheduled sessions and didn't call them to tell them why so he called me Ellen you're not at your appointments what's going on I did not respond it's not him don't say a word it's not him don't know what's happening nothing I think it's important for you to come to your sessions he said I expect you to be here tomorrow is there something I can do I know what's going on and who you are and are not I said fine life doesn't get us anywhere he said talk to me straight nothing no answer because you are not you okay then I'll see you tomorrow and he hung up I did not attend our next session Steve sensing that something is very wrong was calling frequently I did not return any of his calls will of course recognize that I was very agitated but he didn't know why what's going on he has the children call themselves Kaplan and Steve are Impostors I said the real ones are gone and they've been replaced the ones who are leaving messages on the answering machine our faith to his everlasting credit will stay calm and do the passes eventually i exceeded Kaplan's suggested that i go on more meds and the delusion test this will was world's first experience of me delusional and he passed with flying colors he didn't get too scared he didn't get angry he didn't flee and he treated me with kindness and care my god the only way to understand why the Capra's episode was so disturbing to me is to understand that these relationships were tethered to my own humanity if I want these ties to my humanity I might really no longer be human I've been talking here about myself a relationship I would like to return to say a few more words about my relationship with my mental illness and how I conceptualize that relationship when I moved to Los Angeles from New Haven my analyst and I developed a way of talking a sort of heuristic about my illness and my relationship to my illness there were in a way of speaking three moves that one professor Sachs I Malaya the medical charts the citation and could not integrate these three aspects of myself how could I be a thinker of big thoughts a professor but my mind was so damaged how could I be both professor Sachs and the lady of the medical charts a Morgan Alan said in all this what took a huge amount of effort and was ultimately self-defeating was to keep these three cells separate which I work to do for the previous 15 years but I wasn't sure who was the real maid this confusion expressed itself in an attention equivalence for taking my medication for meeting my water was the less medicine the less effective she was a virtual Saint as he spent literally years of our relationship going through time and time again when I tried to get off my meds with disastrous results it wasn't simply that I didn't like the side-effects of my psychiatric medication the need to take medication reach to the core of my identity if I can get by without medication I wasn't really mentally hell on the way here the charts would disappear only Ellen and the professor would be left as a real maid this cycle culminated in one final effort to get off my medication several years after I have been on the faculty at USC reading from the text while white had supported me many times in my efforts to get off medication which I undertook with great bass though and failed miserably at each time one battle between Kaplan and me concerned the use of meds early on we were really locked horns over this Kaplan thought I should just stay under that to get in my life as I said for me the motto was the less mental less effective part of the way I could prove I wasn't really mentally ill which I resisted mightily for many years was to get off medication and so I kept trying and trying trying I decided to make one last effort to dental if I thought I never really tried hard enough until I started the reduction I think what I was feeling when I started feeling bad the days and nights were farther now the sheer physical effort of containing by God in my thoughts felt like trying to hold back a team of wild horses sleep with spotty and filled with dreams that left me awake and sweating in terror nevertheless I dropped down again months before I'd accepted an invitation to attend a workshop in Oxford by the time I boarded the plane for home I was a complete wreck when I walked into chaplains office my first day back I headed straight for the corner crouched down on the floor and began to all around we were thoughts of evil beings course with daggers they slice me up and thin slices or make me swallow hot coals captain would later describe his quote writhing in agony even in this state where he accurately described as a cute way in for the psychotic I refused to take more meds the mission was not yet completed immediately has to be appointment with Kaplan I went to see dr. mortar as hits assuming the expert who was following me for Court of dyskinesia he'd never seen me ill before and acted under the impression which I hadn't disabuse him up that I had a mild psychotic illness and my primary concern is avoided he do have I repeated this because I okay once in his office i sat in his cab folded over and began muttering I was a Scheffel I couldn't remember when I'd slept or what I do when I gave an officer before a surd didn't matter if we were all going to die anyway and they loved me walked into that room would have thought martyr was treating a schizophrenic strange person weeks later people told me that's exactly what I look like ten explosions and people trying to kill is it okay if I totally trashed your office in each of these if you think you're going to do that said martyr okay small fire on ice tell them not to tell me tell them not to tell me what have I done wrong all the explosions hundreds of thousands of thoughts interdiction Allen do you feel like you're dangerous to other people too or to yourself yes that's a trick question is it I think you asked a mental health law professor she meets the statutory criteria for commitment in the language of the statute that's or how you do it but not that way so it's not as for questioning I'm serious I think you need to be in the hospital I can get you into UCLA right now and the whole thing could be very discreet ha ha ha you're offering to put me in the hospital hospitals are bad they're mad they're sad I must stay away I'm God or I used to be well that hasn't made a marshal notice I'm not or I used to be he says as you quit are you fired I give life and I take it away forgive me for I know not what I do I really think a hot stove David idea Marta said no thank you oh so very much I said all right then but if I were you I'd stay away from work for a while we don't want your colleagues to see this thanks.thanks bang bye see you soon oblivious to the look on his face I love the next morning I didn't drag myself to my office because it was my hideout of refuge I ran it to my colleague ed in the hall and he quickly figured out what was going on Ellen what the hell is going on I thought you were kidding at first but you're not are you does anyone else know about this is it ok for anyone else to know I wouldn't mind telling Michael I said not the Archangel one or Halloween suffice to say that it eventually brought me home showing a good judgment to follow the advice of my psychiatrist rather than tackles me to the ground and taking me to the ER as others including it internist wife or recommended eventually I acceded to everyone's demand that I take more meds I can no longer deny the truth and I could not change it revolve attack me Ellen professor Sachs chapter from the insane woman I had once seen in that mirror long ago by smashing and wounds and in the passage and then another event push me past the point of no return accepting that I was indeed had a mentor although I got in a new drug because of erisa - Kaplan suggested one of the new classes of psychotic Sutro and called olanzapine benefit I ended up on like 40 or 50 milligrams a day with a lot of breakthrough symptoms so I switch to clozapine in 2004 and you know it's not perfect but it's an amazing drug it's kind of a miracle drug going back to the texture change with the zyprexa was fast in Germanic first the side effects were much less than by affixing more important the clinical result was not to overstate at like daylight dawning after a long night I could see the world in a way I had never seen it before the illness was still there but it wasn't pushing me around as much as what once did finally I could focus on the task at hand unencumbered by the threat of working demons the most profound effects of the new drug was to convince me once and for all but I actually had a real illness for 20 years I've struggled with that acceptance managing to hold on to the belief that basically there was nothing unusual about my thoughts everyone's lines contained the chaos that mine did it's just they were all much better at managing it that I my problem I thought had less to do with my mind and I had to do with my lack of social graces I wasn't mentally ill I was socially Malinois course that wasn't true there's no way to overstate what a thunderclap this revelation was to me and with it my final and most profound resistance to the idea that I had a mental illness began to give way ironically the more accept that I had a mental illness Alessio Alyssa finally I became accident as it were and not essence at which point the riptides that kept sucking me and set me free so I was finally able to integrate the three parts of myself I wasn't heat Ellen the professor Sachs and Bolivia the medical charts also was made for me and I was all three it was making peace with the lady of the charts my mental health disorder that allowed Ellen and the professor to flourish and enjoy the many wonderful relationships that have blessed my life I have been enormously Gregg Furth had my memoir the senator nunn Falls has been receiving with monies from the MacArthur crackers actually a funny story about the MacArthur bread so that that was no so my my boss will behave me a lovely reception and gave me a t-shirt with a picture of Einstein in a picture of me and it said only one of us is a certified genius and I said I've been certified many times in the past but never heard this way so with money from the MacArthur grant I founded the Sachs Institute for mental health law policy and ethics the Law School the goal of the facts institute is to translate ideas into action to better the lives of people with mental illness remember sisters your brother's your sons your daughters your colleagues and your friends we want in the words of Sigmund Freud whatever one wants to work into love [Applause] do we have time for questions yes I appreciate it yeah in fact we collaborate now on some research so really I don't think he did anything wrong I don't think he did anything wrong I just needed to you know come to terms with it I think there are lots of reasons people who sit snags there just to go through some you know they don't like to find the facts obviously is one to me if the choice is between gaining 10 10 20 pounds of being psychotic I'm gonna gain 20 pounds which I did if I gained 200 pounds I might feel differently second they feel better on the medicines and they don't need it anymore the way people don't finish antibiotic prescriptions third they feel like they don't have an illness so why should they take medication I think one way you can finesse that is to say you know well you know you're complaining a lot about sleeplessness and being jittery and that can help with that and then finally the quote as we call narcissistic injury of needing to be having a mental illness and eating regs and for me that was the big thing and I just needed to work to work through that in mostly an analysis and you know Steve Steve was prescribing and when I finally did decide to give it a go he had prescribed good beds for me that made me feel better and once I started feeling better I was like well I'm not going to stop this you know because it you know so that's my analyst and it wasn't you know encouraging me and Steve Marta was encouraging me and I decided to give it a go and block the effects basically how the time not happened yeah Oh I'm sort of interesting because I had one of the few insurances maybe 15 years ago that would pay for psychoanalysis and he believed it so a paid-for analysis for me for three years for my doctor who was Kaplan at the time how to write up a report about me and you know say that this is really helpful and the gatekeeper basically said you know she's really made a strong case that Narellan really benefits from this treatment and I'm inclined so okay and then out okay but I really think the diagnosis is wrong I think psychosocial if she's so much more like a polar patient with psychotic symptoms to which my analyst said to me that'd be a great diagnosis if you are ever in either of the poles so cuz I you know I had some mild depression at Oxford I also had a couple of miles oppressions and I had my supper afterwards hemorrhage you know after that I was a bit depressed but mostly my symptoms had been thought symptoms and not mood symptoms at all so I actually think it is it's the right diagnosis should it be you know schizoaffective should it be a typical psychosis it's something in the psychotic well is what I think it would all my treat her so yeah excellent about this writing preferably okay okay that was what what history archaeology political tactics with look at structures and talk to people to work from so I you know people say how do you remember and I said I remember the way anyone who writes a memoir remember sometimes you who remember the exact words and thoughts and sometimes you just said the kinds of things you were thinking and I I did go back and leave my records and I talk to people and I showed people what I wrote who were there at the time and I feel like I you know did an adequate job conveying it was a traumatic to do that to relive you know I make an analogy and this is not it you know Holocaust survivors obviously had it much worse than I ever did but you know some survivors like want to go back to the camps and I review them and think about it and process and some want to say as far away as possible so people navigate or negotiate trauma in different ways because there was a traumatic experience and for me it turned out to be a good thing I'm sort of like helping understand things more you know put it in perspective and not kind of them so but it may be different for other people you know it's sort of interesting because I affiliate like six or seven law students of my Institute every year and then a psychiatrist a psychologist a social worker student social workers philosophy or our science and the lot students write something saying why they want to gain the Institute and I would say 85% of them talk about self disclose their own illness or illness in their family and their friends and then the six years I've learned the Institute the first day of class I ask people to say why they were interested in the Institute Here I am as someone who's out with mental illness one person in six years of self disclose which I found really kind of stunning so there's still so much stigma on the other hand I often get undergraduates who come and say now I'm thinking about a blunt saying in my law school or my medical school application that I have it psychiatric illness is that a good idea or a bad idea and I'm usually get Brenda pros and cons and the real answer is it's about again you know what you have to a lot of them are like you know thinking about it this is part of me this is who I am I'm not ashamed I'm going to talk about I think that's kind of cool soon so the younger generation may be coming more to terms with you know this diversity no I actually did all of my therapist I have then will reasonless I mean to my analyst a new a and Oxford I used to carry in my purse serrated kitchen knife in a box cutter I never took it out and I told her I had it and I think a lot of people would have hospitalized me and I I think I am very grateful that my therapist we're willing to sit with a certain amount of anxiety for the sake of respecting my strong wish not to be in the hospital obviously it's easier to do that with someone you're in long-term treatment with and with someone who shows up in your er that's the kind of different kettle of fish what they were willing to do that I was really really grateful that they were so I have been hospitalized in 82 83 and I sometimes say that's my pride as accomplishment which is kind of a weird thing to say you wouldn't say if you didn't relapse with cancer that you were proud you would say you're lucky so all right you know I you know I mean the a geographies are important and a lot of people don't observe it you know what my school is really generous to me I find classroom teaching stressful here let me do one-on-one teaching and practitioner teachers my mental health law class and one of my colleagues was asking about that and I said you know they really like me I want me to be happier accommodating than with the Americans with Disabilities Act she said I hope it's the latter because they don't seem to want me to be very happy and I don't really care what it is it just makes my life better but you know really the only thing you can do is you know go get the HR department and say you know I have this disability and entitled to accommodations and if you you know if two days a week I can have a two-hour lunch break so I can see my therapist I will be able to do my job and I would like you to accommodate me and let me do that and if they say no I mean you go to a lawyer I guess or a mental health Lodge and see we have something called mental health advocacy services in LA that has a provision that does that kind of work absolutely right right all right all right she need to help your patients understand that if you can absolutely idea of providing to send that signal this is shameful removed from the rest of Medicine right we get into this kind of building integrates medical care I have a Stephan private place and learning from your experience do you have any advice about how to write I mean I actually think it integrated care is really good at having your own shop in stop where people can go and there's not a special door that you're going to prove it psychiatric birth it's medical the one reason is you know stigma another reason is is there a statistic that people with mental health disorders die what is it 15 to 20 years earlier than other people to actually have a meet you easy access to actually physical medical care could be very beneficial to patients in terms of survival so I think that's that's an important important then some people probably would want the psych thing to be way far away that nobody knows where it is and you know maybe maybe you can sort of have some focus groups with patients and see what they what they said okay so I was actually taught there or some small essay written about me in the New York Times and the title was schizophrenic not stupid I said you can't use that title you just can't use that title so they change it was skip the Friday and successful which is still still pretty bad it's sort of interesting because well-meaning people who would never use a racial or an ethnic slur talk about crazies and wackos and Looney Tunes and nut cases without even thinking about that these words might be painful or harmful for people who struggle to hear so I think we need to kind of educate people educate the public educate the press that outline which is language is important that as an effect it has an effect that we live a friend with schizophrenia he's a PhD psychologist at Ohio named Fred Frese he does a lot of work around stigma and the line he uses is please stop using the n-word nuts which I think really makes the point very very well and I think the media is getting better there are more TV shows with people with mental health disorders who aren't portrayed in them either a ridiculous or a scary way eric mccormack who flip who is in little Gracie also played doctor Daniel what was his name Dennis something in their TV show called perception I need played a neuroscience professor risk it's a friend and it was a pretty cool and accurate and you know careful portrayal I've never seen the show but the is there something called homeland the woman has bipolar illness is that done well or yeah some of it of penicillin like monks OCD is kind of a caricature but I think we're having more TV shows and more movies and our culture as a TV and movie culture so that say that's how people think about about mental health disorders and what they say that Sigmund is coming to see that mental illness as a brain disease doesn't much reduce it by putting a human face on does such an extent that people can come forward and discuss their illness you know you're going to change your minds and you know if you just tell them it's it's difficult okay did I talk about the reasons I think analysis works yeah okay I really do have a bad memory I don't know if it's my subarachnoid hemorrhage or my mental illness or my meds but it's pretty awful I'll be talking to something they'll be saying something out in the middle of the conversation I'll forget she was sick anyway so I think the analysis helps in a number of different ways and these aren't all specific to analysis but I think they all are at work here and first stress is bad for any illness and particular mental illness and analysis can help you identify your stresses and either cope with them or avoid them second it sort of fortified a quote observing ego where you can kind of stand back and review what's going on in your mind and assess there that makes sense it and process it third it's a safe place where you can bring your tonic and scary and violent thoughts and if you talk about them in therapy you may be able to not talk about them out of therapy I think it interpretations can be helpful and people have different views about psychotic symptoms some people think that they're sort of random firings of neurons with no meaning some people think that they kind of tell the truth about your psychic reality and some people but that tell them that talking about that with the patient doesn't work with the patient psychotic and some people think it may work with the patient psychotic and my experience alas has been true most analysts wouldn't take the first view but many would take the take the second video so interpretations could be helpful so I was saying violence and scaring things and my doctor said Ellen I think they're saying violent things because you're really scared the violence is your defense against fear or to make sense and made it go away and also we you know nowadays we don't think of so much reduction in remission of symptoms but recovery and quality of life and it's for the patient him or herself the stable quality of life is for him or her but therapy can help with that for sure I mean if you needed to think about it this way the patients with schizophrenia also had the same kind of work and relationship issues that chronically healthy people and that therapy can help them with those as it helps other people so for me it's just it's just been a lifesaver right yeah you know it's a hard thing to say that you can't just sort of reason with people you can't reason someone out of their lack of insight but you can try and say you know some of the things you're talking about you know these kind of beliefs are not things that people who don't have mental illness thing and you know it's not a crime to be mentally oh you know it's a medical condition there are things you can do for it you know so let's try to work with it instead of fighting it because if you fight it it's just gonna get stronger and more of a power so that you know it's a really hard nut to crack you know it's get people seeing seeing that it's real again for me what really clinched the deal was when Ned started working and I realized that other people's thoughts were like my medicated thoughts and not like the thoughts I had before so that's one way you can make some inroads if you can get the person to take the meds and also way to work through the north of Cystic injury in a big way you might about any narcissistic injury you've got a bad grade you got a bad report card this term you know somebody on your family's sick and that's more in you and you know you're thinking not properly and that's all I can really suggest I wish I had more do you think that if we were young and first started taking meds you've had the benefit for some of the second-generation antipsychotics Tucker thank you recently a lot of that struggle worked in created or would have taken decades to come to Trent of awaken I actually think meditation earlier would have been a good thing it whatever felt right and also what has helped when it come to terms order for the reason that I said you get a really good feel for you know the medication versus the unmedicated state I still think you know some people say well if you had taken meds in 1977 maybe he wouldn't have needed to go to therapy at all but I don't think that I don't think that that would would have been the case right yeah I you know I'm I'm glad that I was allowed to make the choice sort of in my own time in my own way to take the meds but I wish I have been smarter sooner you know if I can put it that way right well actually you know Matt you have a research assistant look at this right now for certain projects with the top policy so let's say first of all I think mostly the civil commitment standards the same as dangerous of self or others and gravely disabled or rightly disabled different jurisdictions have very different procedural regimes so like an L in California you know it's originally a three-day commitment and then it's you know you get a week and then another week and if you're dangerous other people's expected there's a very lockstep you know process you have to go with hold someone in Connecticut at least when I was there I'm not sure it's still the same the emergency commit was for 15 days and if you were committed you were there for a year even have a right through here enough for another year and then every year thereafter it was a totally different procedural regime as I said England at least what I was there was very different from America so I think at that time they created for the percent of their patients and that includes your emergency commitments and we committed 50 percent and that did include emergency commitments it's a very different kind of culture there for unclear reasons you know maybe British people are just more deferential right if the doctor says I should go I go yeah whatever but so but restraints are and medication is different so right refuse medication if you're confident is true in 50% of the cases face and the other 50% have a different standard most of them have some kind of standard of life you know you need the medication and if you don't take the medication that's going to lead to a substantially long period or longer period of time ill and you're at risk of being similar you know standards like that I've been in a few places just you know you're mentally ill and you need medication that's rare sir states are different different in that regard but not so much in civil commitment probably with restraints there are some difference in some jurisdictions we'll say getting imminent danger to self or others symbol also say the last time I looked for treatment purposes as well but two people observe that my friend Steve and I had applied to Connecticut Valley Hospital who what type report after type report of his chart said patient refuses to get out of man so they get out of bed so we're estranged it doesn't look like danger it looks like uncooperative siga so I wasn't a law professor at that time I was just student yeah I was I was a law student when I was ill here ah I don't think people think lost in fact much knowledge or power but as a lawyer now probably it would make people more anxious I sometimes like go to my dentist I say I've just developed a new specialty in dental malpractice and reflection it's not just kidding just kidding you some more respect that's interesting that's interesting I did not feel treated like a pure actually yeah see you so yeah you might you might actually be more likely to say that to someone who's got high professional stature so at that time I was a professor yeah I think I think that's right and I kind of think it's a shame because I think everybody should contribute dignity and respect yeah now I think that's a really good point sometimes people will say you know I can afford to see my patients 15 minutes every three months and you see your doctor five days a week how on earth are my patients supposed to do as well as you I say you're absolutely right and I feel some survivor guilt there are other people wise leads on doing the high functioning study with speed water we've got two MDS at JD PhD candidate at cetera et cetera I asked someone's what percentage of patients with schizophrenia did the teasing or high functioning in our sense professional managerial technical said I don't know alone the real question is how many could be if we dilute a proper resources which i think is exactly exactly the right answer sort of my conviction is that many people can live up to their promise potential if we give them the resources to help them and that we have a you know we should have a commitment and we have an obligation to try to do that because the difference between a life like that in a life you know in a clubhouse watching TV all day is a big difference yeah I'm not aware of any literature if there might be but I'm not so you're saying how we're kind of we get those people to psychoanalysis yeah no I don't know it's a hard it's a hard thing I do believe it's important I have a friend with severe bipolar illness we did great in psychoanalysis I do well on it you know going back to the transference point avoid Meg you know you can have a psychotic or an erotic transference so I get around that my transference went from thinking my analyst was a devil and a monster who was going to kill me thinking that just didn't like me so look for a really psychotic to a real erotic transference I hope you know I guess you know the developer reputation or you have sons and colleagues who are aware that you're willing to try that and refer people to you so I don't you know I don't really know that's one of the things I admire kind of private practice psychiatrists and psychologists for which is in a way you know you're doing really good works but you're also running a business and you know that part of it can be challenging and hard too so I don't really know what for Afghan next year at the timing money and volunteered yes like you were crazy enough to make we've been impatient right so you never called back right well and then I called the volunteer person back as you know turns out we just really don't have anything but I went to the other Hospital in Canada and volunteer there so that was 20 and maybe that was only the first their experiences big yes olden yeah you know I just you know didn't think that I shouldn't say I should have said and when I did she said well I call the baths you know we don't actually have places but there's this new club has opening up for people with psychiatric illnesses who are in recovery I took her to say that I was going to be like a staff member I was really gonna be a patient there but it was really you know it's really sad it was really really going to talk to go a little bit off point to talk about going back to school or going back to being a volunteer so Gayle had a policy that if you were removed from school for psychiatric reasons you had to be evaluated by the head of the Department of Psychiatry to see if you were ready for return and like any good student like look this guy up and isn't before the age of the Internet so I'm selling books and looking at periodical and just season I find them article by the guy seems withdrawn from squall for psychiatric reasons evaluating them for readmission questions you want to ask and answers you want to hear as the interview I'm told it exactly like the article said I don't knew all the right answers outside of a funny funny experience effective ad 890 seniors like the law and over time under 5% of all ABA comes really from taking a terawatt for distance buildings of a builder you rabbits much more expensive and view is your summer spending a BA in the consumerism so it's not one of our studies of areas of studying yet but certainly will be something we do in future years it's really it's really important no she definitely was tours there so it's really interesting because I would say well I would the 20 people I directly interviewed 19 of them said that they've got an enormous amount of gratification and fulfilment and well-being from work and one of the people said he fans work stressful and horrible but he had to do it's a supportive family yeah but only one only only one out of 20 which i thought was really interesting fellow question soon would you take a pill that would instantly cure you if you could so Rilke said you know it's like if I take the pill my Devils I sleep among them by angels may as well so I wouldn't take the pill only one person said they wouldn't take to tell everybody else that I would take the co on a second get rid of my illness so with this population at least there's not a lot of secondary game there people who wanna do Alan and not be though you know when I was in the hospital there were kind of therapy room since I wasn't real crazy about I was like you know it's hard enough to trust one person let alone trust a whole room with people but when I got cancer I started going to what was then called the wellness computing at the cancer support community once agree for a 2-hour kind of support group and I find it extremely helpful I mean I feel like nobody understands as well as a fellow sufferer which is one reason PR people are a good thing to do with mental health disorders so nobody understands as well and for me also I saw many people with much more serious cancer some nine you know living life with dignity hope and well-being and that was kind of that's been kind of inspirational today so I'm a really big fan of support groups now but again it's an individual thing some people don't take to it at all and that's like totally fine sort of interesting I try to start a support group at USC for faculty that were just general general support group advertising the daily Trojan and the Chronicle faculty newsletter and I met with the Counseling Center guy who's been moderate was going to be the facilitator three times one and adjunct Ain nobody else came so either faculty are like afraid of confidentiality or professors sort of temperamental would like to fly solo or whatever it is nobody came which I thought was pretty pretty shocking yeah so that's an interesting question a good question not really so I'm very close to my family I speak to my parents pretty much every day and my brother's two or three times a week or four times a week and had done for a long time but I kept my family very distant from my illness life they knew I go down at Yale Hospital called them and they were there for that but they assumed that I had in my last episode although the reality was I hadn't any kind of more minor episodes over the years that they didn't know about and they were hurt that they didn't know about them but for me when I first became ill I was already living independently for four or five years I did not want to go back to being the kid in my family of origin and also my family's more ease a lot and I didn't want them to worry and they don't do supported that well I mean they do other things really well but they don't do supportive that well so for me it wasn't you know a difficult choice and I still think I made the right decision but as I said you know we talk all the time you know maybe if if I didn't have my data weeks therapy I would have more need to reject them and ask them for help than I actually leave thank you so much thank you [Applause] [Music] you [Music]

Channel: UCSF Dept. of Psychiatry and Behavioral Sciences

Views: 2,803

Rating: 5 out of 5

Keywords: psychiatry, medicine, schizophrenia, Elyn Saks, UCSF, Evelyn Lee Lecture, diversity

Id: uBJU-PFdHJ4

Length: 76min 56sec (4616 seconds)

Published: Sat Apr 29 2017