good afternoon ladies and gentlemen my name is pat lawrence and welcome to the panel or intro as you know the show is dedicated to get rid rid of stigma of the mentally ill it so that they can go on with their lives and to become functioning citizens of massachusetts and wherever they move so i wanted to let you know that most of my guests are people who are very well versed in mental illness and the doctor that i have on today is dr dos is the chief of psychotic division at mclean's hospital and welcomed us thanks very much it's very good to have you here today we're going to educate these people and we're going to tell them everything they wanted to know about mental illness but we're afraid to ask the first thing i really want to get into is the  know the the people's view on recovery and mental illness but as far as the psychiatry view do these people recover can they recover and what does it take to help them so first of all thank you for having me on the show it's really great to be here and absolutely this is really a big issue among psychiatry ists who work with individuals who've been diagnosed with severe mental illnesses things like schizophrenia bipolar disorder you know major depression o c d which is obsessive compulsive disorder and recovery is in fact a fact of life for many of our patients but we a second i interest have not paid enough attention to recovery i would say as we should have and i think the field is changing and there is a much greater awareness of this fact a psychiatrist were often focused on diagnosing and treating the problems the disorders the symptoms and you know our our treatments especially our medications are not what they should be they're not always effective and they can have side effects but at least they are decent at treating the symptoms so we can for people who hear voices for example we can make the voices go away or people who are suffering with delusional thinking we can make that somewhat better but because we've been focused on treating symptoms we haven't paid enough attention to asking the question of what is this person's life like what are they going to do in the community once the symptoms are better and how can you go through the rehabilitation process and that's exactly where recovery actually comes in so we haven't been paying a lot of attention to this there are some patients out there who recover despite the psychiatrist's ignorance and you know it comes to them they're lucky enough that their brain heals in a certain way and they become functional again and by functioning in the community are referring to things like going back to school holding jobs having meaningful relationships and being a member of commune of the community where they're integrated into the community and they're being appreciated and they make a contribution and so there are many people who are able to do this even though the psychiatrist isn't paying a lot of attention but there are other people who suffer with symptoms and even though the symptoms are treated they cannot make a full recovery  as a field psychiatry has not focused on this enough and if we do that i actually believe that we can make outcomes better for our patients in future generations so a psychiatrist focus on these questions as to the sions as doctors and scientist trying to understand what are the interventions that are going to make an individual's life better going forward that's not going to be only medications or only psychotherapy but other kinds of interventions things like support around employment support around going back to school skills training for learning to be to integrate back into society in an effective way if we focus on those things more a psychiatrist i think the outcomes are also going to be better for our patients so absolutely recovery is real it happens to people but we can actually make it happen more than it has been by focusing on this as an issue well it's great to know how you feel it's great to know that recovery is real and i can honestly say from a personal aspect  my daughter was diagnosed with schizophrenia my daughter was diagnosed with bipolar my daughter was diagnosed with clinical depression there wasn't anything left out of her diagnoses and  my daughter has her associate's degree my daughter has a job my goal would be six hours a week but it's still a job and  car she has a boyfriend she has a life and that's what they need they need people not only the psychiatry are suspect haters as one big chunk of their existence but it's the other people it's the support system that they have high in them and if they don't have that support system they're not going to get their life and  i do know that the so much has been cut from the budget so want to get out of the hospital you know they maybe they have nowhere to stay maybe they don't have  housing which is very sad because that's the way it was supposed to be when all the state hospitals were close there was posed to be housing for them when they got out of the street hospital how do you feel if you don't know where you're going to live if you don't know where your next paycheck is going to come from if you don't have friends and a community and a job and other things to look forward to recovery would be harder so recovery from any kind of illness depends very much on what's going on in people's lives and i think you can't you know to make a general statement you can't recover very well if you don't know where you're going to be living we're going to be sleeping tomorrow night is absolutely true and we you know when people are healing from these illnesses and the next order of business is recovery we need to prepare the conditions so that people can succeed and again as a society and also as a field we haven't done a very good job with this the budget cuts are hurting things have slipped somewhat back from where they used to be and from where they should be not forward so there is a lot more work to do to create the conditions so that people with hooves who've experienced symptoms of mental illness can actually now recover and reintegrate into society and if you think about it it's actually an investment that should have good returns because if you can help people heal so they can come back to society so they can work so they can have relationships and so on and be part of society that's actually good for all of us and so even economically it's a good case to be made but of course that takes a long term thinking and we're not very good at looking into the future like that not only that but these people that are recovering people  and voting is extremely important because these people need to vote for the legislators and who will help them and if a person has it on his campaign you know i will provide this for the mentally ill well you can grab it and there is one gentleman out there named from who row and his main campaign was i will help the mentally ill and he's been doing it yeah you know that i think every family's touched by mental illness think about it and if you think about sort of the wider extended family so i don't have anybody very close to me in my nuclear family but i grew up knowing about people in my family who had mental illness as well and i think the point you're making is an important one also about families people with mental illness are recovering they vote they want to be part of society it's their agenda but al family the people whose lives are also being affected by the illness of the individual who suffering of course the core of the suffering is the individual who has to struggle to put their lives back together but parents siblings children or all directly affected and also extended family are all directly affect affected and this is where advocacy comes in and i know you're a dedicated longtime advocate for improving the lot of people with mental illness and their families and we need a lot more of that because  i think there isn't a mechanism where even though everybody is affected every family is affected by mental illness and everybody knows somebody who has struggled with psychiatric problems but the mechanism of stigma  sweeping it under the rug and ignoring the problems because these are uncomfortable facts these are difficult things to talk about it creates an environment where you can imagine this isn't real and it's not happening whereas it's very real it's very common  and the more advocacy that brings it into the light the more we can affect public policy so finally we can break the silence right well i'm all for taking that rug and throwing it in the trash and it's we've been all those  child and it is a beloved child and they don't know their beloved child any war and some families can't handle it and with money taken away from the department of mental health a lot has gone back on to the families and like take your child in support your child which is a good thing if the child is not psychotic if the child a psychotic then that's a different thing but there are so many kids out there and i'm saying kids because mental illness usually so you know affects kids starting around sixteen i defected my daughter when she was eighteen and there are a lot of kids out there that are on the streets there are a lot of kids sleeping under bridges i know very wealthy man whose nephew who's nephew has schizophrenia and the last time he saw his nephew he was walking in boston common and that is very sad because this man is very wealthy this man could could put his nephew in some place that would take care of him but they don't want to because they're so afraid they're so as i said traumatized so what we're going to do is get rid of this fear of people with a mental illness are people with a mental illness ladies and gentleman i care of you'll find a good percentage of them sitting in a corner and wondering what is happening with their brain wondering what they're seeing and wondering why these voices are saying so many bad things about them when they really very good people so i think that's a key point that the person who's suffering the most is the person who has the illness and the sims very of these are scary things confusing things very intimate very personal things that you know sometimes people can't even i've had patients say to me i can't describe it but something about my body is going to fall apart or my you know i'm disintegrating but i can't really tell you exactly what that means there's no words for what i'm experiencing and it's really think of we difficult to deal with these things so the person who's suffering the most is the patient and then the dignity of fighting those things and then recovering from the illness is actually something that most people in the general public don't understand very well people with mental illness work hard to control their symptoms and then to come back into life as a productive member of society and that is harder to do than somebody who's broken their leg and is healing from it oh yeah you know most other conditions these are huge struggles and you really have to appreciate all the struggles that people with mental illness come through they also come out on the other end and there is a great dignity to fighting these problems well i find that people with a mental illness are the most courageous people i've ever met and i love every single one of them you know i really don't care what they say to me because i used to go into the lock you know took my daughter she was in lock units twelve times and i used to be there every single every single visiting hour and the the kids they were the kids the kids would sit on my lap in oh because their mothers were and they'd call me mom and and i would write my name in the guest book and there wasn't any of the name and it was so sad you know this is it but to do better for our patients you know these are our people we really need to have a consistent message to society that this is an illness like any other there is nothing to be afraid of there's nothing to be spooked by the point is to help people recover and heal and then you will see the person that emerges is the person you want to have in your in your family in your community in your life because i think they're going you know coming from a psychiatrist perspective i can also talk a little bit about the field psychiatrists themselves tend to one and not talk about these issues or not to emphasize the positive outcomes not their for size the good that comes out of people with mental illness because we see of course when you come to work in the morning and all you see is the sickness we see the symptoms we see the people who are suffering  it can create this illusion that there's only suffering and there's only negative things in life of somebody with mental illness but i think a psychiatrist we actually need to do a better job of sending out this consistent message that what we're striving for here is something positive and to do that we need society's understanding and support that what we're we're in the healing business and these people can heal and they can go back to their lives and that's good for everybody of course you know what ever they want to classify as is the angel of my life and i couldn't love her more and it didn't make a difference when she when she was in a hospital that was like forty miles away and i would have to go there every day because i wanted to and she would look at me and say go home i just  home because that was illness being that wasn't hurt yes but anyway she doesn't do that anymore she's gone with me and and we laugh and we talk and we saying and we have a good time and we go out to dinner and she's a regular person she is my wonderful laurie and i'm not i'm not afraid of saying her name and she's not she said that  she would tell anybody what her diagnosis is and fact of the place that she's working if she's going to be getting up in front of everyone that you work with and talk about schizophrenia and probably talk about t who get their care at our hospital of course it's a very personal decision that this closure but for those who are willing to do it they are clearly serving society because it was something i need to see is people who can say this is what i have this is what happened to me and this is what i'm doing now because i'm strong and all recovering from it right it's always hard to talk about any of this and for people with you know physical illnesses other not mental illnesses but the more people with mental illnesses can educate the rest of the public i think the more progress we can make again i don't want to you know i appreciate that it can be a burden for people and some people don't want to come across come forward with with what they have lived through and that's going to that's a very personal decision but you've got to appreciate that some people are doing it and really give them give them a recognition i mean cancer had a stigma once but people started coming forward and say i have this cancer i have that cancer and and it happened so frequently one in every four families have a person with mental illness and i actually had three three people on s s at the same  time and that was hard you know it was either sink or swim and i was the best swimmer of the it was but anyways let's talk a little bit on involuntary commitment  because i know that is a big thing now and i think it's very scary for a lot of the mentally very complicated topic of course it's come up because of all the high profile cases recently of people with alleges mental illnesses yeah being violent in the community based on very little actual information they don't talk about the people who quote unquote chronically normal that are often the same that's right so there are so many things to talk about you know this isn't my field i'm not an expert in violence and mental illness but i can cite some of the basic statistics for you that the vast majority of crimes in our country and really anywhere in the world are committed by people who don't have mental illness crime by people with mental illness is a small problem it's not a big problem and also people with mental illness are much more likely to be victims of violence than to perpetrate violence themselves and that's clear that's that's that's well known that this is not some kind of epidemic  some kind of major problem in our society is there a do some people with mental illness commit crimes absolutely like as you said many many people with no mental illness so that's sort of the big backdrop but unfortunately because of the media attention and basically a lot of rumor and innuendo we are now dealing with this environment where the question is well are people with mental illness dangerous and should we do something about that  so that isn't really the right debate to be having and of course there are other issues that we haven't mentioned like access to guns that create an environment where anybody can pick up a gun and do something with it and that wasn't the case one hundred years ago or two hundred years ago in the sense that it's about civil liberties and it's about an individual's right to choose and it's about decision making a medical conditions about somebody's life so i don't want to tell you you know i have one opinion and my opinion is x i've also certainly met people who respond the beautifully to treatment but always chose not to take the treatment so that they suffered in their own lives because of their decisions not to be on treatment and would they have had a better life if maybe if they'd stayed on treatment maybe so it really depends on each person these are very personal very complicated decisions but i do worry about if we had an outpatient commitment law whether that would also be abused because if we if go in that direction we must have very strong checks and balances on that system because if you create a situation where it's easy for an individual to be under an outpatient commitment most likely  people are going to look for that and the system is going to start doing that in large scale and that's probably not what we need even if there are cases where that would help an individual's life that should be under great scrutiny that should not be something that you can do easily so i have my great concerns i can see some of the arguments pro and con so i'm not going to say i'm for it or i'm against it but what i want people to understand is that in any given case if you're talking about a family member or a neighbor or somebody you know where this is come up there has to be a very careful look at this it can't be an easy oh yeah they should all be under the commitment or no that should never be possible it's got to be something that you have clear checks and balances for and it's got to scare them absolutely news the good news is our understanding of brain function has gotten a lot better than it was twenty thirty years ago and through that and we're also learning a lot about what may be happening in the rate of somebody with mental illness so our knowledge has improved the bad news is we haven't turned that knowledge into treatments and the parallel just as you said psychiatrists often talk about diabetes and they often talk about cancer because in those two cases once you started to unravel the biology you know started to understand what was going on and it was obvious what you could do in the lives of people with cancer and diabetes have improved immeasurably things are much much better now that gives us motivation that we should be just like that we must go in this direction  but the barriers have been great i think that we're not close right now to a major breakthrough of treatments so in the next few years five years you're not going to see a major breakthrough i think that's a sad reality and we have to be realists about this i wish i could say there is something in the pipeline just in a few more years you know it's going to be in the pharmacies but we don't have those kinds of treatments but a decade from now in the next decade to two decades i do believe we're going to have meaningful breakthroughs the way closer people was when it first came out we're going to have more of those breakthroughs but we're talking about probably ten plus years from now and that's going to come from our improved understanding of brain function from the neuroscience research and  close of being was a miracle drug sure was cause a ping was like a drug of last resort only because number one they had to have blood tests in the beginning like every week overseas in china japan australia and europe before it came to the us right now a lot of people were dying and nobody knew why until it came here to the united states and everybody was put on a national register that went on to cause pain and  so now my daughter will take a blood test once a month and some of which is great for her you know she used to hate it every you know every week it has brought her back own let alone the rest of the family the rest so i said earlier you know that our treatments are not where they should be and then this is just you know the personal story that you tell is just such a example of the tradeoffs we're having to live with that a lot of our effective treatments can be effective and the symptoms symptoms start to go away and people finally get some peace of mind when they finally start to come back to who they really are their personalities and  their their recovery starts unfortunately that comes with many side effects in some cases unacceptable side effects the bone marrow suppression that causes the white count to drop the white blood cell count in your blood stream to drop closing can cause that and this is why people have to get the blood draw us weekly at first and then every other week and then eventually monthly we have to do that to make sure that people are not having that side effect fortunately it creates a big burden so people who are taking these medications are most effective medications three are having to pay the price in a way with these side effects and the goal is when we have the next breakthroughs in the in the coming decades the goal is to have effective treatments that don't have side effects or at least they have more tolerable side effects of better profile so that finally we can say to our patients take this medicine it will be good for you and it's not going to hurt you about me because right now you can say that with a straight face as a psychiatrist we're always having to struggle with how much better somebody's going to get and what kind of side effects are they going to have from the well right now we're at a time ok is there anything you want to say that before we stop well i just want to thank you for having me on the show and  going thank you very much and thank you very much for feeble for watching and we'll be back again with more interesting informative things in regard to mental illness thank you for watching very much