Speaker 1: I think it can benefit you to have your diagnosis
Speaker 1: because there are different treatments that may work for different things.
Speaker 1: But you are not your diagnosis.
Speaker 2: Welcome to the one you feed. Throughout time, great thinkers
Speaker 2: have recognized the importance of the thoughts we have. Quotes
Speaker 2: like garbage in, garbage out, or you are what you
Speaker 2: think ring true, and yet for many of us, our
Speaker 2: thoughts don't strengthen or empower us. We tend toward negativity,
Speaker 2: self pity, jealousy, or fear. We see what we don't
Speaker 2: have instead of what we do. We think things that
Speaker 2: hold us back and dampen our spirit. But it's not
Speaker 2: just about thinking. Our actions matter. It takes conscious, consistent,
Speaker 2: and creative effort to make a life worth living. This
Speaker 2: podcast is about how other people keep themselves moving in
Speaker 2: the right direction, how they feed their good wolf.
Speaker 3: Thanks for joining us. Our guest on this episode is
Speaker 3: doctor Ken Duckworth, the Chief Medical Officer of the National
Speaker 3: Alliance on Mental Illness, also known as NAMI. Ken has
Speaker 3: been the medical director since two thousand and three, and
Speaker 3: he also serves as Assistant Professor of Psychiatry at Harvard
Speaker 3: Medical School. He's received numerous awards for his work to
Speaker 3: advance our knowledge and treatment of mental illness. Today, Ken
Speaker 3: and Eric discuss his book, You Are Not Alone, The
Speaker 3: NAMI Guide to Navigating Mental Health with Advice from experts
Speaker 3: and wisdom from real people and families.
Speaker 4: Hi, Ken, welcome to the show.
Speaker 1: Thank you for having me here. I'm a big fan.
Speaker 4: I'm really excited to have you on and discuss your book,
Speaker 4: which is called You Are Not Alone The NAMI Guide
Speaker 4: to Navigating Mental Health with advice from experts and wisdom
Speaker 4: from real people and family. And we'll get into all
Speaker 4: that in a minute, but let's start like we always
Speaker 4: do at the parable. In the parable, there's a grandparent
Speaker 4: who's talking with their grandchild and they say, in life,
Speaker 4: there are two wolves inside of us that are always
Speaker 4: at battle. One is a good wolf, which represents things
Speaker 4: like kindness and bravery and love, and the other is
Speaker 4: a bad wolf, which represents things like greed and hatred
Speaker 4: and fear. And the grandchild stops think about it for
Speaker 4: a second and they look at their grandparent and they say, well,
Speaker 4: which one wins? And the grandparent says, the one you feed.
Speaker 4: So I'd like to start off by asking you what
Speaker 4: that parable means to you and your life and in
Speaker 4: the work that you do well, Eric.
Speaker 1: It's interesting, I just became a grandparent.
Speaker 4: Congratulations.
Speaker 1: And so this is very germane to my book, which
Speaker 1: democratizes the idea of expertise. Now, you might be a
Speaker 1: full professor at Harvard and conducted four hundred studies on
Speaker 1: bipolar disorder, you're in my book. But if you've lived
Speaker 1: with bipolar disorder for a decade, my working assumption is
Speaker 1: that you've also learned something about self management, communications, and relationships.
Speaker 1: And that's the joy of the book. So it's interesting.
Speaker 1: I always identified as the grandchild in my life. I
Speaker 1: was the youngest in my family system. Through a series
Speaker 1: of unfortunate losses, I'm now the oldest member of my
Speaker 1: family and I just became a grand parent. So this
Speaker 1: idea on paper, as a psychiatrist, you know, on the
Speaker 1: Harvard faculty, I look like your expert, But I actually
Speaker 1: think I learned as much from loving my dad with
Speaker 1: severe illness, even though we couldn't communicate and talk about it.
Speaker 1: So this idea of who is the expert who has
Speaker 1: the wisdom is very interesting to me. I guess I
Speaker 1: would say the corollary to that on the wolf side is.
Speaker 1: I think shame and isolation represent forces that I'm working
Speaker 1: against in my book, and giving people the option of
Speaker 1: seeing real people with real names from real places just
Speaker 1: like them is a more openness approach, and I view
Speaker 1: that as the good wolf.
Speaker 4: That's a beautiful way to sort of frame up this conversation.
Speaker 4: And actually, when you just said that, I was thinking
Speaker 4: about an experience I had a long time ago. This
Speaker 4: is probably nineteen ninety two, maybe, God, it's amazing it's
Speaker 4: that long ago. Anyway, I was a heroin addict and
Speaker 4: I'd been trying different things to get sober, but very
Speaker 4: half heartedly, and mainly moving different places and trying to
Speaker 4: detox myself. But one night I moved to this little
Speaker 4: town in Connecticut and I was in this little one
Speaker 4: room apartment I was living in, and I picked up
Speaker 4: the Narcotics Anonymous book, and as I read it, I
Speaker 4: just began to sob because I had never heard anyone
Speaker 4: describe what it was like to be in my head.
Speaker 4: I didn't know why I did what I did. I
Speaker 4: didn't know what was wrong with me. I didn't know
Speaker 4: any of it. And just to hear somebody else describe
Speaker 4: it was such a powerful experience. And I think that's
Speaker 4: what in this book does a really great job. Is
Speaker 4: like you said, there are voices from all different kinds
Speaker 4: of people in all different parts of mental illness, whether
Speaker 4: it be the helping side, the having it side, the
Speaker 4: parent side, right, and I just think it really frames
Speaker 4: all that up really well. I was wondering if we
Speaker 4: could start before we get into your story and the
Speaker 4: book with a little bit about used it in the
Speaker 4: title of your book, The NAMI Guide. What is NAMI?
Speaker 1: The National Alliance on Mental Illness is the largest grassroots
Speaker 1: organization of people who live with mental health conditions, parennes
Speaker 1: and addiction and those who love them. It was found
Speaker 1: that in nineteen seventy nine, I about two hundred and
Speaker 1: eighty people who met in Madison, Wisconsin who had been
Speaker 1: blamed by their psychiatrists for their children's mental illnesses, and
Speaker 1: as the hospitals were closing, one woman told me, you
Speaker 1: had to get paid to be blamed, ken you had
Speaker 1: to go to the psychiatrist to be told this was
Speaker 1: your fault. These women got together, almost all moms, but
Speaker 1: not entirely, and formed this group which is now seven
Speaker 1: hundred affiliates across America offering free services, support, education, advocacy.
Speaker 1: You may have heard of the recent nine eight eight number,
Speaker 1: which is the National Crisis Lifeline. I had nothing to
Speaker 1: do with that. I was working on the book, but
Speaker 1: the policy team at NAMI led a coalition of people
Speaker 1: to create a mental health response instead of a police
Speaker 1: response to mental health crisis.
Speaker 4: Share a little bit more about what that nine eight
Speaker 4: eight number is and what it does, because it is
Speaker 4: still pretty new, and I would say the vast majority
Speaker 4: of people probably have never heard of it.
Speaker 1: We're still under a year, so it came out in
Speaker 1: mid July last summer. Nine eight eight is the substitute
Speaker 1: number for a very long number for the National Suicide
Speaker 1: Prevention Lifeline. And if you have a crisis in mental health,
Speaker 1: or you have somebody you care about who has a crisis,
Speaker 1: you call that number. Someone who's trained will respond to you.
Speaker 1: It's quite unlikely they'll have a police involvement. So the
Speaker 1: old number calling nine to one one resulting in a
Speaker 1: lot of bad outcomes for a lot of people because
Speaker 1: it's not police's job to do mental health outreach. But
Speaker 1: of course, because of our fragmented, underfunded and chaotic system,
Speaker 1: police are often left holding the bag. So nine eight
Speaker 1: eight was an effort to create more of a thoughtful,
Speaker 1: compassionate crisis response. It's not enough. It's three digits. It's
Speaker 1: a start, and what you need to do is work
Speaker 1: with your local NAMI to help advocate for mobile crisis
Speaker 1: teams and culturally consonant services for people. But it's big improvement.
Speaker 1: It took a couple of years, and I think we
Speaker 1: all paid two cents on our Verizon bill for it,
Speaker 1: you know, our phone bill. It seems like a great investment.
Speaker 4: Yeah, I would say, what are some of the other
Speaker 4: things that NAMI offers? And if somebody is just hearing
Speaker 4: this right away and going okay, well, yeah, I or
Speaker 4: somebody I love is dealing with mental illness and I'd
Speaker 4: like a little bit more support maybe than I'm getting.
Speaker 4: What sort of things might we find it namy and
Speaker 4: how would we get to or access those things?
Speaker 1: Sure? Well, Nami's everywhere. We're in every major community in
Speaker 1: every major state. There are groups of fabulous people. So
Speaker 1: if you say, okay, I'm dealing with a mental health
Speaker 1: thing like borderline personal disorder, I'm hearing voices I have
Speaker 1: a problem with severe depression, and I feel alone, or
Speaker 1: I want to learn from other people. We have support
Speaker 1: groups for individuals. My son is developing an illness. I
Speaker 1: want to meet with other families so I don't feel
Speaker 1: so alone. I want to change the legislature to make
Speaker 1: sure that police are trained in being thoughtful and compassionate,
Speaker 1: as opposed to a leading with alternatives that I don't like.
Speaker 1: So does a group of people who will welcome you
Speaker 1: from all walks of life, all across America. All the
Speaker 1: services and support are free, and so it's a pretty
Speaker 1: cool group, and it's a beautiful little piece of my life. Eric,
Speaker 1: that I became their chief medical officer based on my
Speaker 1: little experience of feeling alone. So I feel very blessed.
Speaker 4: So somebody would just look for the NAMI chapter in
Speaker 4: their area.
Speaker 1: Nomi dot Org. Okay, but wherever you are, So where
Speaker 1: are you, Eric?
Speaker 4: I am in Columbus, Ohio.
Speaker 1: Today. There's a NAMI Ohio. There's a NOMI Columbus.
Speaker 4: Onwards from there. I would love to spend a few
Speaker 4: minutes on a little bit of your background, about what
Speaker 4: got you interested in a career in the mental health field.
Speaker 1: So I want to make it clear I had no
Speaker 1: interest in medicine or in mental health. I was actually
Speaker 1: interested in poetry, storytelling, and history. So it's no coincidence
Speaker 1: that I end up writing a mental health book that's
Speaker 1: based on people's stories. Yeah, so it's a kind of synthesis.
Speaker 1: At the end of the day, my father, who was
Speaker 1: very loving and charismatic. My cousins used to say, God,
Speaker 1: your dad's awesome. I'd say, I know. But then there's
Speaker 1: those whole months at the state hospital thing that we
Speaker 1: weren't talking about our families from Philadelphia for multiple generations.
Speaker 1: I was playing in the basement, you know, making one
Speaker 1: of those forts out of books with blankets that I
Speaker 1: think every seven year old kid does, and I heard
Speaker 1: these booming sounds upstairs. I went upstairs and I saw
Speaker 1: my father being carted away by the police. A few
Speaker 1: months later, we're driving in a U haul to the
Speaker 1: state of Michigan, where we knew no one, and I thought,
Speaker 1: seven year old me, does this have something to do
Speaker 1: with But nobody would talk about it. So the rest
Speaker 1: of my life became an understanding in so many different ways.
Speaker 1: What is the thing that is so powerful that it
Speaker 1: could move a family four hundred miles but you can't
Speaker 1: speak of it. The ANSWER's mental illness. So I'm not
Speaker 1: the kid who won the science prize. None of my
Speaker 1: volcanoes ever had game in fifth grade. Eric, I want
Speaker 1: to make it clear. I went to the career Counseling
Speaker 1: center at my University of Michigan center. And don't worry.
Speaker 1: We like Columbus. We're good. My dentist is from Ohio State.
Speaker 1: We're good. I said, I can't do math, by the way,
Speaker 1: I was kind of overwhelmed by some of my dad's symptoms,
Speaker 1: and I fell behind in math. And as some of
Speaker 1: you know, when you fall behind in math, you're behind.
Speaker 1: And so he said, I've got great news for you, Ken.
Speaker 1: There's eleven medical schools that require no calculus, and I
Speaker 1: got into nine of them. And I just wanted to
Speaker 1: help my dad. I majored in political science and history,
Speaker 1: and I was honest about my reasons for wanting to
Speaker 1: become a psychiatrist. But even that had violated an unwritten
Speaker 1: rule record I had learned that you weren't supposed to
Speaker 1: talk about your interest if it had to do with
Speaker 1: yourself or your family. I guess I was just kind
Speaker 1: of naive, or perhaps way before my time. Thirty five years. Yeah. Yeah,
Speaker 1: And so I wrote in my essay to become a psychiatrist.
Speaker 1: And my dad was loving and fabulous, and I was
Speaker 1: trying to understand both the secrecy, shame and isolation, but
Speaker 1: also understand what helped people and all across America. At
Speaker 1: the best psychiatry residency programs in America, people ignored my
Speaker 1: essay and they talked about everything else. One world famous facility,
Speaker 1: a man said this was a terrible reason to become
Speaker 1: a psychiatrist. And I said, what would be a good
Speaker 1: reason and he said, hm, after a long pause, well
Speaker 1: maybe if your father was a psychiatrist. So at that
Speaker 1: point I went into the parking lot, put my head
Speaker 1: on the rental car, and I thought, you know, I
Speaker 1: think this is actually not going to work. Cardiologists make
Speaker 1: a lot more money, they drawed nicer cars. I liked cardiology.
Speaker 1: I would be good at talking to people about their hearts.
Speaker 1: And then the next day I went to this place
Speaker 1: called the Massachusetts Mental Health Center, where a man named
Speaker 1: Ned Hallowell read my essay and said, kidn this is fantastic.
Speaker 1: You'll know so much more. You'll be able to help
Speaker 1: more people. I moved to Boston, and I'm still on
Speaker 1: the faculty of the exact same place that one person said,
Speaker 1: your reason for doing this.
Speaker 4: Is Okay, that's a great ending to that story. I
Speaker 4: was about to say, great story, but you know, you
Speaker 4: were talking about your father's mental illness to start, so
Speaker 4: that's not a great part. Do you know what your
Speaker 4: father had?
Speaker 1: Oh, my dad had straight up bipolar disorder. And so
Speaker 1: his first episode, I later learned as I pieced it
Speaker 1: all together, was at age seventeen and I was in
Speaker 1: the basement we were moving my parents to more of
Speaker 1: an assisted living and I noticed a pattern. Eric there
Speaker 1: would be a little teeny tiny plaque or statue nineteen
Speaker 1: sixty seven, nineteen sixty eight, there'd be a bigger one
Speaker 1: Salesman of the Year the Midwest nineteen sixty nine or
Speaker 1: sixty eight, be National Salesman of the Year nineteen seventy
Speaker 1: six months in a state hospital, so the pattern was unmistakable.
Speaker 1: He became more charming, more engaging, more fabulous, and he
Speaker 1: was quite a loving person. I was never mistreated. I
Speaker 1: was scared a fair amount of the time, but I
Speaker 1: was never mistreated, and so he had very recurrent what
Speaker 1: we call mixed episode bipolar disorder, classic bipolar one. So
Speaker 1: he would become psychotic, so communicating with the microwave, hearing voices,
Speaker 1: and then you know, after four months of treatment, he'd
Speaker 1: be like, Hey, Ken, you want to go to the ballgame.
Speaker 1: The Tigers are in town. Let's go. So it was
Speaker 1: a lot to integrate, and family that couldn't talk about it,
Speaker 1: you know, set me into motion. Neither of my siblings
Speaker 1: wanted anything to do with this path, but I guess
Speaker 1: as the youngest and again identifying with the grandchild and
Speaker 1: your parable, not the grandparent. I just became a grandparent
Speaker 1: two weeks ago. I'm still trying to figure out that
Speaker 1: whole shift. I was like, you know, I think I
Speaker 1: got to figure this out because somebody's got to help
Speaker 1: this guy, because he's so fabulous. So it was a long,
Speaker 1: unusual pathway into the mental health field, and I felt
Speaker 1: very fortunate because I was able to be of some
Speaker 1: help to him. And then I've helped a few people
Speaker 1: through my work at NAMI and as a doctor.
Speaker 4: So I'd like to move into the pieces of the book.
Speaker 4: And you know, I think the first place that the
Speaker 4: book really starts, or one of the early places, is
Speaker 4: talking about getting a diagnosis or getting an assessment, and
Speaker 4: I would love to talk about that. And I would
Speaker 4: also like to talk about the paradox of diagnosis, because
Speaker 4: at least in the waters I swim. And there's a
Speaker 4: lot more criticism these days of diagnoses and of the
Speaker 4: DSM five, which is the book that tells us what
Speaker 4: to diagnose for what conditions. But I'd love to hear
Speaker 4: you talk a little bit about the importance of diagnosis,
Speaker 4: how to feel confident or in that diagnosis, and the
Speaker 4: paradox of that.
Speaker 1: Yeah, so Eric, thank you the chapter that I wrote,
Speaker 1: the paradox of diagnosis. So I think it can benefit
Speaker 1: you to have your diagnosis, because there are different treatments
Speaker 1: that may work for different things, but you are not
Speaker 1: your diagnosis. And the humility which you have to approach diagnosis.
Speaker 1: We don't understand the underlying neurobiology of the brain. These
Speaker 1: are symptom descriptions. So when my brother I went through
Speaker 1: a pretty profound grief experience that at different times would
Speaker 1: have been called major depression, would have been called grief
Speaker 1: only would have been called super grief or extended grief reaction.
Speaker 1: That is to say, the diagnostic goalposts were moving. I
Speaker 1: was the same guy who couldn't get out of bed,
Speaker 1: and my wife said to me, is this what to
Speaker 1: be like if you had no sense of humor? I
Speaker 1: think this is what it would be like, And it
Speaker 1: was what it would like. It took months for me
Speaker 1: to pull through that experience. So you have to take
Speaker 1: diagnosis with a grain of salt. And there are different interventions.
Speaker 1: If you have borderline personal disorder, there's a psychotherapy that
Speaker 1: teaches you coping skills that can save your life. Bipolar
Speaker 1: disorder like my dad, Lithium could make a big difference
Speaker 1: in the course of your illness. Psychotherapy, community, giving to others.
Speaker 1: All these things are good things. But again, I'm not
Speaker 1: enamored with the diagnostic framework, or am I skeptical of it.
Speaker 1: It's a tool. It's only a tool. It's the best
Speaker 1: we have, and as long as you're humble about what
Speaker 1: we don't know, which is a lot. There's probably a
Speaker 1: dozen kinds of schizophrenia and we have one diagnosis called schizophrenia,
Speaker 1: And so there are people who have more symptoms, more
Speaker 1: motivational problems, more relationship challenges. We lump them all together
Speaker 1: because we don't understand the underlying biology well enough. The
Speaker 1: same problem with Alzheimer's disease. Eric I was a medical
Speaker 1: student way back in the day in nineteen eighty six,
Speaker 1: and the neurology professor announced right before my graduation that
Speaker 1: they had cracked the code of what causes Alzheimer's disease.
Speaker 1: I was like, Oh, my god, this is fantastic. It's
Speaker 1: so cool to be a doctor. And he said, it's amyloid.
Speaker 1: We understand the entire pathway it gets locked up in
Speaker 1: the brain. And he said, within five to ten years
Speaker 1: you'll be able to treat people and prevent this scourge
Speaker 1: of humanity. And I thought, God, it's so great that
Speaker 1: I became a doctor. And now thirty five years later,
Speaker 1: we have no material treatments for Alzheimer's disease. Same problem
Speaker 1: as mental illnesses. We don't understand enough about the brain.
Speaker 1: And if you can stay humble and stay engaged and
Speaker 1: promote research, keep asking questions. No psychedelics should be researched.
Speaker 1: They shouldn't just be given. We should try to understand things.
Speaker 1: What can you do to help people? It's a big question,
Speaker 1: and I think it's important to try to answer it.
Speaker 4: Yeah, one of the criticisms of the current diagnostic models
Speaker 4: is that you often end up with many of them,
Speaker 4: and you're like, well, wait a second, do I really
Speaker 4: have all four different things? That seems unfortunate? And then,
Speaker 4: like you said, the heterogeneity of the way they appear, right,
Speaker 4: Like you said that your depression may cause you sleep
Speaker 4: all the time, my depression may cause me to have
Speaker 4: trouble sleeping. Like they show up so differently. But I
Speaker 4: do agree with you, as somebody who has had a
Speaker 4: number of diagnosises for different things in my life, I
Speaker 4: find them a helpful starting point, you know. And then
Speaker 4: I think, to your point, we are not our diagnosis.
Speaker 4: We are more than that, and seeing the totality of
Speaker 4: who we are is always important, and also recognizing that
Speaker 4: diagnosis isn't a predictor of future reality necessarily, because two
Speaker 4: people could have a diagnosis of depression and have completely
Speaker 4: different looking levels of functioning based on how they're treating
Speaker 4: that depression. And so you know, sometimes the worry is
Speaker 4: that you live into your diagnosis, right, you limit yourself by, oh,
Speaker 4: I have this thing and so thus, but I do
Speaker 4: think diagnosis is a hugely important starting point. Let's talk
Speaker 4: a little bit about where to get a diagnosis. What's
Speaker 4: the best knowing that we're dealing with, As you said,
Speaker 4: a fractured, if not broken mental health system, well accept broken.
Speaker 1: It's a chaotic millange of services that are in continuous
Speaker 1: motion and different funding streams. There's private insurance and some
Speaker 1: people might decide, hey, I'm not taking that insurance anymore.
Speaker 1: As a Friday, and there's a commissioner of mental health.
Speaker 1: He says I'm going to do this fabulous program, and
Speaker 1: then there's a budget shortfallow the programs closed. So the
Speaker 1: system of mental health has to be in quotation marks.
Speaker 1: There's a complex mi lounge of services and what I
Speaker 1: encourage people to do if you think something's going on
Speaker 1: with you, and again, this could be your own observation
Speaker 1: or someone you love gently saying to you, I wonder
Speaker 1: if you're suffering with AB or C. I'm a psychiatrist,
Speaker 1: think about that. I couldn't really appreciate that I was
Speaker 1: having a grief depress reaction. I have a series of
Speaker 1: buddies who happen to also be psychiatrists. People hang out
Speaker 1: with people like them. They're not my only friends, but
Speaker 1: they're my buddies that I trained with them, they're wonderful.
Speaker 1: They took one look at me and they're like, Ken,
Speaker 1: you look like hell, you need to get evaluations stat
Speaker 1: And that really helped me because my wife had just
Speaker 1: told me that earlier the day, Ken, you look like hell,
Speaker 1: this isn't like you like this grief things really taking
Speaker 1: you over, so I couldn't see it. And I want
Speaker 1: to emphasize we all tend to normalize our own experience.
Speaker 1: If somebody loves you gives you feedback, ticket seriously, and
Speaker 1: if you've had a condition before, you may have learned
Speaker 1: what the symptoms are of a currents of your illness.
Speaker 1: So places to go. You can go to your primary
Speaker 1: care doctor. These are the unsung heroes of the mental
Speaker 1: health service system. They're underappreciated, but they're very comfortable. Probably
Speaker 1: half their work is anxiety, depression, and trauma and addiction,
Speaker 1: probably half their work. Sometimes they can be helpful. Sometimes
Speaker 1: they might know of a resource or a program or
Speaker 1: a therapist. That's one idea I would get in line.
Speaker 1: People might be critical of mental health, but the weights
Speaker 1: are months and months and months, so the demand is
Speaker 1: exploded and the supply is pretty limited. So whatever criticisms
Speaker 1: people level you know. I don't know a clinician who
Speaker 1: doesn't have five hundred people waiting for them to be seen.
Speaker 1: So there's something happening in terms of people's wanting to
Speaker 1: be seen. Mental Health America MHA dot org has a
Speaker 1: lot of screening tests. These are screening tests online that
Speaker 1: you might take if you were in a primary care office.
Speaker 1: The PHQ nine is nine questions zero to three twenty
Speaker 1: seven means you probably need to be in an impatient
Speaker 1: hospital because you're suicidal. If you have four, you're probably
Speaker 1: having what's called Tuesday. And if you have thirteen fourteen
Speaker 1: you need to attend to that. You probably have a
Speaker 1: condition that needs to be evaluated. So it's a ballpark.
Speaker 1: It's kind of like your blood pressure that you would
Speaker 1: take at CBS. It's not your real blood pressure, but
Speaker 1: it's a ballpark. It would tell you, you know, if
Speaker 1: CBS said your blood pressure was two twenty over one
Speaker 1: point fifty, you'd probably call your primary care doctor. It's
Speaker 1: not accurate, but it's probably directionally correct. So like the
Speaker 1: idea of primary care, contact your health plan. Health plans,
Speaker 1: it's their problem. If you can't find somebody to help you.
Speaker 1: I emphasize this because I had a job at a
Speaker 1: health plan and I want people to know you're paying insurance.
Speaker 1: There are no cardiologists who say I don't accept your insurance.
Speaker 1: That's not a thing, right. So if the therapist says
Speaker 1: I don't accept your insurance, you write a letter to
Speaker 1: the health plan or make a phone call and keep
Speaker 1: your documents, your paperwork, and say I've tried A, I've
Speaker 1: tried B, I've tried C, I've tried D. Need to
Speaker 1: help me find somebody out of network. And I feel
Speaker 1: like this is an important thing that people don't really recognize.
Speaker 1: You know, your health plan, your health insurance has an
Speaker 1: obligation to help you, Like, don't just take that on
Speaker 1: yourself battle with them, I know, maybe the last thing.
Speaker 4: You want to Yes, Yes, I've been working with my
Speaker 4: mother on some back issues and chronic pain issues, and
Speaker 4: it just feels like it's a constant Like for crying
Speaker 4: out loud, folks.
Speaker 1: For crying out loud. Well, Eric, you're a good son,
Speaker 1: because an advocate makes a difference.
Speaker 4: Yes, This is one.
Speaker 1: Of the beauties of NAMI is that people find how
Speaker 1: to support each other, to help the people they love
Speaker 1: and themselves.
Speaker 4: Let's talk a little bit about that because there is
Speaker 4: a I don't know if I would say it's burgeoning
Speaker 4: now or has been burgeoning, but there's been a big
Speaker 4: change in a lot of mental health care around the
Speaker 4: idea of peer support. Tell me what peer support is,
Speaker 4: what's good about it, maybe where its limitations are, and
Speaker 4: how to go about finding it.
Speaker 1: Yeah, it's interesting. Eric. I had put together a book proposal.
Speaker 1: I'm a rookie author. I'm probably a one hit wonder.
Speaker 1: Spotify has a one hit Wonder playlist. I'm probably going
Speaker 1: to be on it, right. I had put together book proposal,
Speaker 1: and I had a chapter called the Power of Community
Speaker 1: because in my work as a community psychiatrist, I had
Speaker 1: learned how much people support each other. After interviewing one
Speaker 1: hundred and thirty people, I had to change the chapter
Speaker 1: to the power of peers in community because so many
Speaker 1: people told me that what helped them was a person
Speaker 1: like them who had been through a similar journey, and
Speaker 1: a whole other set of people said, what really helped
Speaker 1: me was helping other people. That act of sharing what
Speaker 1: I had learned empowered me, gave my life meaning, gave
Speaker 1: my experience or suffering meaning.
Speaker 4: For years, I've been like, I know what the power
Speaker 4: of twelve step programs are, right, that's the fundamental insight.
Speaker 4: I talk to you and that helps you, and it
Speaker 4: helps me, and we are equals, we are peers. But
Speaker 4: I've looked around as I've gone on my own mental
Speaker 4: health journey over the years and been like, there doesn't
Speaker 4: seem to be at the same level this sort of
Speaker 4: thing for mental health. But I think we're seeing more
Speaker 4: of it.
Speaker 1: It's growing in the addiction community. It starts out as
Speaker 1: a peer movement. NAA right, it's non professional, right, the
Speaker 1: mental health community started out professional.
Speaker 4: Yes.
Speaker 1: And you could tell me whether you think the addiction
Speaker 1: community is integrating professionals. Well, I think the mental health
Speaker 1: community is much more welcoming to peers than ever before.
Speaker 1: I like that. I hope to think I'm part of
Speaker 1: that movement. Peers can't give you a diagnosis, and they should.
Speaker 1: Peers can't prescribe treatment. Peers can provide support, navigation, love
Speaker 1: and experience, and in a lot of states that's paid
Speaker 1: for by Medicaid. Georgia pioneered then, and so I interviewed
Speaker 1: a woman from Georgia who's a peer specialist in the book,
Speaker 1: and what Tera Carter's journey was about being on a
Speaker 1: mobile crisis team paid for as a peer specialist. She
Speaker 1: knows she's not the clinician, but when there's a moment
Speaker 1: the person says, I'm ready to give up on everything,
Speaker 1: Tara says, I think this is my turn to say
Speaker 1: A few years ago, I was in your shoes. I
Speaker 1: was ready to give up on everything too. I want
Speaker 1: you to know it won't be easy, and you're going
Speaker 1: to have to work. When I have a job, I
Speaker 1: have a life, you could be just like me. And
Speaker 1: I thought to myself, I'm so happy that Georgia led
Speaker 1: the way on this, and about half the states, maybe thirty,
Speaker 1: have covered peer support specialists, so it's happening, and there's
Speaker 1: not enough professionals. So while peers are not a replacement
Speaker 1: for professionals, the both end of it can be quite powerful.
Speaker 1: And while you're way on a professional anomic group is
Speaker 1: full of peers.
Speaker 4: Yeah. I like the way you made that observation about
Speaker 4: addiction and alcoholism started as a peer support program and
Speaker 4: how well they've brought professionalism into it. I don't think
Speaker 4: I'm even try and answer.
Speaker 1: That podcast on Yeah, the ambivalence about medication assistant treatment.
Speaker 4: Yes, yeah, But an interesting point and maybe we can
Speaker 4: transition here now, is you know you talk about in
Speaker 4: the book that recovery or treating mental illness, there's two
Speaker 4: sort of models, broadly speaking, that people use. One is
Speaker 4: a medical model, right, which you just described. It's going
Speaker 4: it's getting a diagnosis, it's perhaps getting a particular type
Speaker 4: of therapy, it may be getting medications, but it's sort
Speaker 4: of a professional medical model. And then there's a whole
Speaker 4: nother arm called the recovery model, which is support from
Speaker 4: peers and learning.
Speaker 1: To live with it, building a life, the.
Speaker 4: Things you do in your own life.
Speaker 5: Yeah, giving to other is faith, love, something to do
Speaker 5: on a Saturday night, all the beautiful things. But some
Speaker 5: people would say what helped me with the recovery was
Speaker 5: having my voices settled down or having my manic episodes
Speaker 5: under control.
Speaker 4: So it's not either or Yeah, I think you're right.
Speaker 4: I think ideally, depending on what you're dealing with, it's both.
Speaker 1: That's right, that's right. And so I really wanted to
Speaker 1: bring this idea to the four that there is another model.
Speaker 1: And I know I'm a psychiatrist and I went to
Speaker 1: medical school mostly I was trained in the medical model,
Speaker 1: but I observed with my dad, even though we couldn't
Speaker 1: talk about it, the things that brought him joy was
Speaker 1: not necessarily his treatment, and certainly he hated being in
Speaker 1: the hospital even as it helped him. So I was
Speaker 1: always interested in what could be more, what else could
Speaker 1: we think about?
Speaker 4: Yeah, I mean, I know in my case with depression,
Speaker 4: I have needed both. Yeah, the medical model and the
Speaker 4: recovery model. And we're going to spend more time on
Speaker 4: what the recovery model constitutes. But for me, either or
Speaker 4: wouldn't have gotten me where I am today. I think,
Speaker 4: like you said, going to your primary care physician is
Speaker 4: a great place to start.
Speaker 1: If you're lucky enough to have one. Yeah.
Speaker 4: Yeah. The challenge is often that your primary care physician goes, oh,
Speaker 4: you have depression. Here is this medicine. Good luck? And
Speaker 4: again I think it's good that we're getting medicine to
Speaker 4: people who need it, But it tends to leave out
Speaker 4: I think, and again, different primary care doctors are different.
Speaker 4: It tends to leave out that, like, in addition to
Speaker 4: taking this little pill, if you actually want to really
Speaker 4: deal with this, there's a whole bunch of other things
Speaker 4: you can be doing that, are really going to make
Speaker 4: this work better for you?
Speaker 1: You could join aa NA, you could touch base with Nami.
Speaker 1: Here's a psychotherapy that might be helpful for you, right.
Speaker 4: You could exercise. All this stuff contributes, for.
Speaker 1: Instance, Yeah, very strong evidence for anxiety and depression prevention. Yeah.
Speaker 1: But primary care people have seventeen minut and it's for patient,
Speaker 1: so I am sympathetic to them. And they are paid
Speaker 1: the same whether they give you a prescription or not.
Speaker 1: And a lot of people love to pile on the
Speaker 1: doctors that's making money. We're paid the same. I just
Speaker 1: want to emphasize.
Speaker 4: That, well, right, I don't mean any of that as
Speaker 4: a criticism of doctors, no, of course.
Speaker 1: But it is some people's experience.
Speaker 4: It's more to sort of say, like, it's good that
Speaker 4: we introduce both these models. And that's part of why
Speaker 4: I wanted to talk to you, so that people go, oh, okay,
Speaker 4: let me integrate it. I've often said, you know, when
Speaker 4: it comes to my depression, I have basically thrown the
Speaker 4: kitchen sink at it, right, that's right. I have put
Speaker 4: medicine on it. I have talked to people, I have
Speaker 4: had therapy, I work on exercise, I work on diet,
Speaker 4: I work on purpose. I work. I mean, I just
Speaker 4: throw everything at it and that works for me. That works, you.
Speaker 1: Know, it works for a lot of people too. Yep.
Speaker 4: So let's talk a little bit then about the recovery model,
Speaker 4: like what sort of things go into that. You went
Speaker 4: through a list pretty quickly, but let's lay out a
Speaker 4: few other things that in addition into If we're having
Speaker 4: a mental illness challenge, in addition to seeking professional help,
Speaker 4: what else can we be doing.
Speaker 1: So let's take symptom reduction the cinequin owne of the
Speaker 1: medical model, and let's let's call having a life worth
Speaker 1: living as the cinequin owne of the recovery model, love
Speaker 1: connection meaning purpose. These are things that are not easy
Speaker 1: to quantify, and they're certainly not FDA approved. The medical
Speaker 1: model would say your blood pressure is too high, let
Speaker 1: me give you a medicine that will lower your blood pressure.
Speaker 1: A recovery correlate to that would be, you know, if
Speaker 1: you walked four miles a day, you would also lower
Speaker 1: your blood pressure. So there could be symptom reduction without
Speaker 1: a pure treatment, and good doctors will say, let's give
Speaker 1: you this medicine, want you try exercising more, and let's
Speaker 1: see if we can get you on half a dose
Speaker 1: in six months and get you off of this in
Speaker 1: a year. And it happens all the time. So the
Speaker 1: recovery model is an alternative to the medical model, and
Speaker 1: I have heard people put it kind of in sharp distinction.
Speaker 1: I think of it as much more integrative process, just
Speaker 1: the way you do Eric, because what I've heard is
Speaker 1: so many people benefit from a both and approach. Medicines
Speaker 1: helped me reduce the intensity of my voices, but being
Speaker 1: a meals on wheels driver, this is a man I
Speaker 1: interviewed from Montana. I have all these people who love
Speaker 1: me and connect with me, and I'm part of my
Speaker 1: community and I'm very happy about that. And because the
Speaker 1: medicine has reduced the intensity of my voices, it has
Speaker 1: not eliminated them. I have to accept that I will
Speaker 1: never get rid of those voices. I've had them for
Speaker 1: thirty years. I could still have a life. And this
Speaker 1: is kind of the integration of the medical model and
Speaker 1: the recovery model. It's not either or it's both.
Speaker 4: Then there's a tool that came up as you were
Speaker 4: discussing the recovery model that I had never heard of,
Speaker 4: and after I don't know, nearly six hundred interviews of
Speaker 4: this style, I'm always sort of surprised when I'm like,
Speaker 4: WHOA never heard of that? Which is always fun. But
Speaker 4: it's called the Wellness Recovery Action Plan, and I love
Speaker 4: this idea. I cobbled one of my own together over
Speaker 4: the years, right, But this is a what you tell
Speaker 4: us what it is.
Speaker 1: So this is a cool recovery self management program that
Speaker 1: I happen to know about because of my travels and
Speaker 1: community mental health. So I went to the woman who
Speaker 1: originated it, Mary Allen Copeland, and I interviewed her for
Speaker 1: the book, and she basically described being in a hospital
Speaker 1: and when she was leaving the hospital asking the person
Speaker 1: who ran the hospital, what do you do for people
Speaker 1: that are trying to cope with stuff? And he's liked, yeah,
Speaker 1: we don't have that. We have treatment. We have medical
Speaker 1: model stuff. We have you know, medicine, shock trivia, whatever
Speaker 1: we have. That's not our thing. I don't know what
Speaker 1: to tell you about coping in the world. You should
Speaker 1: have Mary Allin Copeland on your show. She's fantastic. She's
Speaker 1: a friend of the family and we love her. And
Speaker 1: she basically said, I sat down with a bunch of people,
Speaker 1: like what would help us cope with depression or severe
Speaker 1: anxiety or profound law or mood swings that seemed out
Speaker 1: of our control. And she developed this idea that it's
Speaker 1: a self management tool that you're in charge of it.
Speaker 1: No one else can do this for you. When I
Speaker 1: talked to Mary Olwin Copeland about my panic about writing
Speaker 1: my first book on a deadline and writing Nami's first book,
Speaker 1: she said, oh, Ken, you should write a wellness recovery
Speaker 1: action plan for yourself. You should have all the triggers
Speaker 1: that get you really freaked out, you should have all
Speaker 1: the supports. You should put it all in place for yourself. Ken.
Speaker 1: Then she gave me her cell phone number, which was
Speaker 1: one of the kindest things anyone's ever done to me,
Speaker 1: and says, if you're having trouble with your rap, give
Speaker 1: me a call. And this is the beauty of like
Speaker 1: the recovery model. Mary only Copeland exemplifies that kind of
Speaker 1: generosity of spirit.
Speaker 4: Yeah, we'll have links in the show notes where people
Speaker 4: can find her work. And you know what actually goes
Speaker 4: into this wellness recovery action plan. I think the beauty
Speaker 4: of it. And you can follow that approach or you
Speaker 4: can follow other approaches, but it is to a certain
Speaker 4: degree to I really know what helps me, yes, and
Speaker 4: having that accessible and I find it really helpful to
Speaker 4: have it sort of written down because often when we're
Speaker 4: struggling mentally, it's very difficult to remember what did help us.
Speaker 1: Absolutely, I think everybody's experienced that under stress. We aren't
Speaker 1: the best thinkers. Yeah, we don't necessarily integrate our prior.
Speaker 4: Lesson Yeah, I mean the correl it I've made to
Speaker 4: having something like this, and it is part of my
Speaker 4: if we want to call it wellness recovery action plan
Speaker 4: is I know music helps me. Listening to music, loud
Speaker 4: music helps me.
Speaker 1: Yeah.
Speaker 4: But if I'm depressed this morning and I pick up
Speaker 4: Spotify and I start looking, I'm just like, no, no,
Speaker 4: that sucks, No, Like nothing sounds good. Right. So what
Speaker 4: I did years ago is I just made myself a
Speaker 4: playlist of music that I know, so all I have
Speaker 4: to do is go hit play, you know. And I
Speaker 4: had my own little like goal tracking thing where I
Speaker 4: had like fifteen things on it that I knew helped
Speaker 4: me with my mental health. And my goal is not
Speaker 4: to do all of them every day. My goal though,
Speaker 4: was to go in and check them off and I
Speaker 4: could just sort of see like, oh, you got eight
Speaker 4: points today, and knowing that.
Speaker 1: Yes, you're a natural Eric. Are you familiar with dialectical
Speaker 1: behavior therapy DBT? I am. I became friends with Marshall Lenihan,
Speaker 1: who invented it, and she basically says, you have coping
Speaker 1: skills that replace maladaptive self harming destructive coping things, and
Speaker 1: you rehearse them just as you said, and music is
Speaker 1: a great example. And you know what they are, and
Speaker 1: you rehearse them and you go to them, and then
Speaker 1: there are people that you remember that you can go to.
Speaker 1: It sounds really simple, but when you're overwhelmed with emotion
Speaker 1: or you're thinking of harming yourself, you may not have
Speaker 1: access to that, and so you're at work. Eric, Mary
Speaker 1: al and Copeland, Marshall Lenihan. All these things have in common,
Speaker 1: the idea of it's an inventory of coping skills that
Speaker 1: are recovery based. Yes, it's not, Oh my god, I've
Speaker 1: got to take my medicine now. Well, you might want
Speaker 1: to call your therapist. Yeah, you might want to figure
Speaker 1: out Oh maybe I stopped taking my meds six weeks ago.
Speaker 1: I wonder if that has something to do with it,
Speaker 1: you know, again, just self knowledge, self awareness, but the
Speaker 1: idea of rehearsal.
Speaker 4: I love that idea, Eric, Yeah, rehearsal. And the other
Speaker 4: thing that I found helpful was that keeping track of
Speaker 4: because if I was down, I could sort of look
Speaker 4: at it and go, well, yeah, the last week you've
Speaker 4: been getting instead of doing five things on your list
Speaker 4: of fifteen that are good, you've done like two, Eric.
Speaker 1: I would have given anything in my life to have
Speaker 1: pattern recognition with my own father. Yeah, my father got
Speaker 1: sick every other summer, and it was like a hurricane
Speaker 1: had just arrived in June, and there was no preparation
Speaker 1: in March. There was no discussion of closing the windows.
Speaker 1: There was no preparation for hey, maybe we should think
Speaker 1: about getting that some pump checked. I wonder if we
Speaker 1: could avoid that hurricane this one year. Every single time
Speaker 1: because we couldn't talk about it, because there was no communication,
Speaker 1: because we hadn't rehearsed anything. It was always a surprise.
Speaker 1: And it's hard to believe that a family that was
Speaker 1: loving and well meaning could be shocked by a recurrent
Speaker 1: chronic illness, and we were.
Speaker 4: Well, mental illness is a for the person who has it.
Speaker 4: The thing that can figure this stuff out is the
Speaker 4: thing that is malfunctioning to some degree. Right, I mean,
Speaker 4: that's a pernicious challenge, and it's.
Speaker 1: Well said, that's a pernicious challenge.
Speaker 4: And then of course all the stigma and shame around
Speaker 4: it makes it very hard for anybody else to talk
Speaker 4: about it, That's right, And so yeah, I mean I'm
Speaker 4: not surprised by what you're saying, you know, I think
Speaker 4: it's a pretty common thing, which is why seeking help
Speaker 4: is so important. And another thing you wrote in the
Speaker 4: book that I think is really important is you said
Speaker 4: that you know, one major theme that you notice or
Speaker 4: know from your work in this field is that the
Speaker 4: earlier we intervene, the better chance we have for recovery
Speaker 4: or for management.
Speaker 1: Right.
Speaker 4: And it just makes It's like, if I've got a
Speaker 4: little fire over here, I can dump my water on
Speaker 4: it and put it out.
Speaker 1: A brush fire, you can handle that.
Speaker 4: My son is now a wildland firefighter, and I think
Speaker 4: he's going to head to Canada in a few days
Speaker 4: where they've got you know, god knows how many acres
Speaker 4: already on fire. That's pretty hard to put out at
Speaker 4: that point, right, Yeah, al say so this earlier intervention
Speaker 4: say a little bit more about that.
Speaker 1: So one of the reasons I wanted to have real
Speaker 1: people use their names and share their stories, and everybody
Speaker 1: reviewed their quotes and approved them. So I want to
Speaker 1: make it clear this couldn't have been a more collaborative
Speaker 1: or respectful conversation. I think it's helpful. Like my family,
Speaker 1: had we found you were not alone, we might have said,
Speaker 1: wait a minute, there's all these other people with my
Speaker 1: polar disorder. They talk about it, They problem solved. The
Speaker 1: families deal with this, like what are you kidding me? Right,
Speaker 1: they don't go to the police station. Like that's not
Speaker 1: the first or second or third thing that other people do.
Speaker 1: So one of the things I was trying to do
Speaker 1: to promote early intervention was sees that there's real people
Speaker 1: just like you, sign of you, people from all across
Speaker 1: the country, from different ages, races, ethnicities, religions, professions. Because
Speaker 1: what I wanted to do is make it clear that
Speaker 1: you are not alone, which is of course the title
Speaker 1: of the book. There's someone like you, and so if
Speaker 1: you are cutting yourself in high school. Instead of hiding
Speaker 1: that behavior, consider reading the book and you'll find someone
Speaker 1: like you. Right if you are hearing voices, that's a
Speaker 1: terrifying experience. There are other people who are going through that,
Speaker 1: And there's actually now three hundred programs across the country
Speaker 1: that will treat you with love and strength approach, not medicine,
Speaker 1: and a clinic, not a medical model. You'll get a
Speaker 1: recovery model. That's in the book because I want people
Speaker 1: to recognize earlier is better than later. Yep. And I
Speaker 1: think my effort to reduce the shame and isolation that
Speaker 1: travels with these conditions was to do a book that
Speaker 1: didn't have the tone of every other book written by
Speaker 1: a psychiatrist. My patients are my greatest teachers. There's no
Speaker 1: resemblance to anyone in any aspect of this book. You know,
Speaker 1: privacy is everything. I like privacy. I want to make
Speaker 1: it clear I don't encourage people to go on Channel
Speaker 1: five and tell their mental health journey, but if you're ready, yeah,
Speaker 1: you can find a lot of meaning in helping other
Speaker 1: people as you have done. Eric. I've listened to a
Speaker 1: bunch of your podcasts. It's beautiful how you've metabolized your
Speaker 1: experience to be in service to this purpose. It's beautiful
Speaker 1: to watch.
Speaker 4: Thank you. We've given our Instagram account a new look,
Speaker 4: and we're sharing content there that we don't share anywhere else,
Speaker 4: encouraging positive posts with wisdom that support you in feeding
Speaker 4: your good wolf, as well as in behind the scenes
Speaker 4: video of the show and some of Jinny and Iz's
Speaker 4: day to day life, which I'm kind of still amazed
Speaker 4: that anybody would be interested in. It's also a great
Speaker 4: place for you to give us feedback on the episodes
Speaker 4: that you like, or concepts that you've learned that you
Speaker 4: think are helpful, or any other feedback you'd like to
Speaker 4: give us. If you're on Instagram, follow us it at
Speaker 4: one underscore you underscore feed and those words are all
Speaker 4: spelled out one underscore You underscore feed to add some
Speaker 4: nourishing content to your daily scrolling. See you there. So,
Speaker 4: if we know that intervening earlier is helpful, what that
Speaker 4: leads to is that for a lot of people who
Speaker 4: are parents, they may need to play a key role
Speaker 4: in seeking help. I mean, and we know that the
Speaker 4: symptoms show up far earlier than we used to think about.
Speaker 4: I mean, you talked about you found out from your dad.
Speaker 4: I mean, I read an essay with a interviewed a
Speaker 4: guy recently. Don't if you know Andrew Solomon.
Speaker 1: Of course, he endorsed the back of the book. He's
Speaker 1: one of the giants. He's on the Mount Rushmore of
Speaker 1: American mental health.
Speaker 4: Incredible guy. I interviewed him again recently, but in preparing
Speaker 4: for that, I read a very long essay that he wrote,
Speaker 4: a very devastating essay that he wrote about childhood suicide.
Speaker 4: So my point is that as parents, we aren't quite
Speaker 4: sure what to do. Is this normal teenage stuff? Do
Speaker 4: we have a problem here? My kid doesn't seem to
Speaker 4: really want to talk about it. Can you provide a
Speaker 4: little guidance for parents out there on how to start
Speaker 4: getting some help earlier if there is a problem.
Speaker 1: Sure. I just want to say, there's a second book coming,
Speaker 1: and I'm delighted to report I'm not writing it, which
Speaker 1: is very good for my relationships in life.
Speaker 4: Your own mental health has going way up.
Speaker 1: Can we talk about anything besides the people in your
Speaker 1: book tonight? Ken? I actually don't think so, but we
Speaker 1: could watch Netflix and be quiet. So the next book
Speaker 1: is going to be a parent guy, and my colleague
Speaker 1: Christine Crawford, who's a child psychiatrist like me, is writing
Speaker 1: a book interviewing parents and kids and teenagers for what
Speaker 1: they noticed and when they noticed it. And that book
Speaker 1: will be coming out in a year. Its tentative title
Speaker 1: as You Are Not Alone, a Parent's Guide. Okay, So
Speaker 1: that's just one piece, and like my book, all the
Speaker 1: royalties will go to Nami. Noami owns the copyright. That's
Speaker 1: kind of the model that I wanted to create for
Speaker 1: this kind of beautiful mission. So parents, you know your
Speaker 1: kids pretty well. In fact, you know them better than anyone.
Speaker 1: And so there's some basic developmental milestones that a pediatrician
Speaker 1: will help you with. Can they walk? Can they talk?
Speaker 1: How are they at? Basic socialization? But that's so early
Speaker 1: in life. You can pick up autistic specting best to
Speaker 1: risk very early on. And the earlier you intervene back
Speaker 1: to your earlier point eric, the better. So waiting till
Speaker 1: they're five is much more uphill than getting intervention at
Speaker 1: eighteen or twenty months. So that's one good example. And
Speaker 1: we don't understand why there's a rise and the rate
Speaker 1: of autistic spectrum disorder. The Center for disease control doesn't
Speaker 1: know why, so one emphasizes not just me who doesn't know,
Speaker 1: nobody knows. That's a great thing for parents to be
Speaker 1: on the lookout for. Shot on anxiety. Okay, all kids
Speaker 1: get anxious, but if the anxiety is in the way
Speaker 1: of their functioning, that's something that can be treated. Obsessive
Speaker 1: compulsive disorder happens in kids. Clinical depression happens in kids.
Speaker 1: So I was taught eric back in the day that
Speaker 1: kids could never become depressed because they didn't have their
Speaker 1: super ego developed, which was the critical part of your
Speaker 1: brain that would say, ken, you're a bad boy, you
Speaker 1: should feel bad about yourself. And instead what happened was
Speaker 1: researchers interviewed hundreds of kids and said, you know, these
Speaker 1: kids aren't sleeping well, they're thinking of self harm. They're
Speaker 1: incredibly sad, they're broken hearted about the death and their family.
Speaker 1: These kids meet all the criteria for depression. So the
Speaker 1: answer is always to talk to people and to listen
Speaker 1: to them. But parents just need to be mindful also
Speaker 1: of your own family history. And if you've many people
Speaker 1: who found out about their family history along their journey
Speaker 1: and it helped them make decisions. So, for example, go
Speaker 1: buy polar disorder in my family, and I'm mindful of that.
Speaker 1: One of my delightful daughters has ADHD and couldn't be
Speaker 1: more fantastic, creative, innovative. Remember, ADHD is not all deficits.
Speaker 1: None of these things are all deficits. And I was
Speaker 1: very cautious on considering a stimulant given the risk of
Speaker 1: bipolar disorder in my little genetic loading just as an example,
Speaker 1: So I knew my history. I thought i'd share that
Speaker 1: you know with them, because these things are relevant. Nothing
Speaker 1: is a straight line. It's not all genetics, it's not
Speaker 1: all anything you've heard you say that on this podcast.
Speaker 1: It's not all one thing. And so know your own history,
Speaker 1: so you might have an indication. So if your family
Speaker 1: history had multiple people die of addiction, you might want
Speaker 1: to be mindful of that and think about that with
Speaker 1: your child, particularly as they enter the independence that comes
Speaker 1: with the middle school. And ten years.
Speaker 4: Yeah, my son, Jordan, his mother and I met at
Speaker 4: a heroin dealer's house, which tells you that we were
Speaker 4: off to a fast start together. So we both addicts,
Speaker 4: and we were open with Jordan from very I mean
Speaker 4: not like when he was four, But I mean I
Speaker 4: would say by the time he was eleven, maybe I
Speaker 4: don't know exactly about Hey, FYI, you may respond differently
Speaker 4: than other people do not even if you experiment. Almost
Speaker 4: when you experiment, right like when it happens, you know,
Speaker 4: just know that you have a higher risk.
Speaker 1: That's right.
Speaker 4: Let's talk about what that looks like and what that means.
Speaker 4: And thankfully, at least so far, he doesn't seem to
Speaker 4: have that tendency.
Speaker 1: It's great integrating the family history, just as you would
Speaker 1: if you had cancer or herkase. It's just part of
Speaker 1: the conversation. It's just integrated into here's what we got biologically. Yep,
Speaker 1: there's what we're working with. It's not deterministic, but it's
Speaker 1: things to note.
Speaker 4: Yep. There's a lot of depression in my family that
Speaker 4: I don't think until I was in my thirties probably
Speaker 4: was I able to sort of name it and see
Speaker 4: it in them, and you know, and then my mom
Speaker 4: went on at one point to try and commit suicide.
Speaker 4: So it was there, it just was not known. It
Speaker 4: wasn't talked about, it wasn't out in the open until
Speaker 4: I started really dealing with it and started looking around
Speaker 4: and going, well, hang on a second. It's been helpful
Speaker 4: to me in a way just to kind of know, like, well,
Speaker 4: you know, I came by some of this honestly.
Speaker 1: Yeah, that's right, That's right. It's just a way of
Speaker 1: understanding it without all the shame and isolation. It's just
Speaker 1: another data point in life, this part of the portfolio
Speaker 1: that I have, And how do I act on that?
Speaker 1: How do I understand that?
Speaker 4: Yep, I want to find a line here that you
Speaker 4: wrote this is similar to what we were just saying,
Speaker 4: and you said a central theme is that no one medication, therapy,
Speaker 4: lifestyle change, or relationship is likely to be a magic
Speaker 4: wand and I think this is such an important idea,
Speaker 4: which is we've kind of hit it multiple times in
Speaker 4: this conversation about putting together sort of a package of
Speaker 4: these different things and also being willing to keep trying
Speaker 4: if something isn't working.
Speaker 1: So many of the people that I interviewed Eric struggled
Speaker 1: badly in their teens and twenties and built beautiful lives
Speaker 1: in their thirties and forties. Many of them was so
Speaker 1: interesting to me that the things looked hopeless or they
Speaker 1: had had suicide, attempts or overdoses, and they had learned
Speaker 1: things they had tried and learned things they hadn't just
Speaker 1: given up. They kept engaging. So some people found Nami,
Speaker 1: some people found ana. Some people found a medication that
Speaker 1: finally got their symptoms under control. Then they found a love,
Speaker 1: and love made all the difference for them. Some people
Speaker 1: found faith. It's very interesting to me. It's a pretty
Speaker 1: wide library of things that you might pick up to
Speaker 1: make a difference for you, and that's very hopeful to me. Yeah,
Speaker 1: there is no one script. And listening to all these people,
Speaker 1: I was so impressed that so many of them felt
Speaker 1: that if you could look farther ahead than what they
Speaker 1: were experiencing. So I'm helping some people in their twenties
Speaker 1: and teens who are struggling read this book and say,
Speaker 1: my gosh, there's all these guys in their thirties that
Speaker 1: have kind of figured some of this out.
Speaker 4: Yeah, what did they do?
Speaker 1: How did they do? And I try to break that
Speaker 1: down a little bit.
Speaker 4: It's funny in retrospect, I can see an old writing
Speaker 4: I would do when I was like eighteen or twenty,
Speaker 4: and I just thought, like the game is over now,
Speaker 4: being fifty two and looking back, I'm like, I clearly
Speaker 4: had zero perspective. Yeah, it's funny in retrospect to be
Speaker 4: like my favorite song at like nineteen is called Goddamn
Speaker 4: the Sun, Right, I mean, like it's just it's not
Speaker 4: a sign of you being on your way to the
Speaker 4: best place in the world.
Speaker 1: Well, we're back to the parable, because when you're young,
Speaker 1: you don't know everything. You know. Mark Twain said, my
Speaker 1: father was really an idiot when I was sixteen. Then
Speaker 1: I went away for a few years and he had
Speaker 1: become so much more mature in that period of time. Right,
Speaker 1: So we're all in a learning process.
Speaker 4: There were a number of different things that we might
Speaker 4: say would go into this recovery portfolio, and you listed
Speaker 4: a few of them, and I thought we could talk
Speaker 4: through what a few of these are. I'm just going
Speaker 4: to read what they all are, sure, so people have
Speaker 4: that whole picture, and then maybe we can hit you know,
Speaker 4: one or two of them. Acceptance, looking outward for community
Speaker 4: and purpose, looking inward to be present, belief in something bigger, developing,
Speaker 4: belief in oneself, self determination, and a journey orientation. So
Speaker 4: pick up any of those that you would like to
Speaker 4: start with so eric.
Speaker 1: These didn't come from me. These came from listening to
Speaker 1: about eighty people who said this is my primary experiences
Speaker 1: mental health slash addiction. About eighty people said, you know,
Speaker 1: I really consider myself a family member, so that means
Speaker 1: about forty people said, you know, I have an own
Speaker 1: and I love somebody with an illness, right, so they're
Speaker 1: both an individual and a family member. So you know,
Speaker 1: I like that list a lot. One of the things
Speaker 1: that I found compelling was the idea of becoming a
Speaker 1: peer in service to others. Many people picked up on that. Yeah,
Speaker 1: and of course you know, if you've ever seen a
Speaker 1: sponsor in AA or NA, it's a way to help
Speaker 1: your own recovery. Yes, you're helping other people becoming a
Speaker 1: peer support. And what I learned in this book is
Speaker 1: so many people. At the end of the interview, I
Speaker 1: checked in on them, what was this like to talk
Speaker 1: about for a book? We're going to use your name.
Speaker 1: Remember that when there's one hundred thousand of these out there,
Speaker 1: I can't take them back. What they said was my
Speaker 1: experience caused me so much hearty. If I could help
Speaker 1: another person by helping them get to where I am quicker,
Speaker 1: the meaning, the purpose finding that again, this idea of
Speaker 1: something bigger than yourself looking outward and saying, okay, I
Speaker 1: can't believe I get the opportunity to share what I've
Speaker 1: learned with other people. So it's pretty cool.
Speaker 4: Yeah. I mean, I think that thing right there is
Speaker 4: a really pivotal piece of recovery from whatever, where you
Speaker 4: sort of realize, like, oh, everything I've gone through here
Speaker 4: I can transmute into something that is helpful, that is
Speaker 4: a gift to the world. And that's when you get
Speaker 4: people saying crazy things like I'm grateful I was a
Speaker 4: heroin out You're like, well, hang on, like slow down
Speaker 4: with that for a second. But my experience was that's
Speaker 4: when I started to feel that sort of feeling, was
Speaker 4: when I was like, holy mackerel, like I have something
Speaker 4: to give that like I didn't have before. And I mean,
Speaker 4: AA sort of started the twelve step movement. I think
Speaker 4: at the end of the day, that's its foundational insight
Speaker 4: is one alcoholic talking to another and that both people
Speaker 4: are helped equally in that it is a truly reciprocal thing.
Speaker 4: I think that's so so important and if we can
Speaker 4: find that with whatever we're dealing with. I think it
Speaker 4: is a huge pivot point for me in seeing all
Speaker 4: these things differently.
Speaker 1: Well, not everybody has been down that road, and you have,
Speaker 1: and you've learned something, and that's why it's so valuable
Speaker 1: to learn from you and to me. Even though I
Speaker 1: didn't necessarily want to have a dad with a recurrent psychosis,
Speaker 1: it'd probably be a high school history teacher now. And
Speaker 1: I think of how rich and lovely. Yeah, my professional
Speaker 1: life has been the people that I have met that
Speaker 1: have just broken my heart with beauty on the service orientation,
Speaker 1: the giving to others, the work and the problem, going
Speaker 1: to the legislature, the testifying for more research, more service,
Speaker 1: and I think, Okay, this is not at all what
Speaker 1: I had in mind at all. I want to emphasize this,
Speaker 1: and I think I came out with a really nice
Speaker 1: life and I'm very grateful. I think the next life,
Speaker 1: I'd like to be a high school history teacher. I'd
Speaker 1: like to run that play and see how it compares.
Speaker 1: But you know, next life, sure, Yeah.
Speaker 4: I mean I think sometimes this idea gets trivialized and
Speaker 4: we sort of make it sound like, well, it's a
Speaker 4: worthwhile trade, you know, like you had this incredible, awful
Speaker 4: thing happen to you, and then you were able to
Speaker 4: help people with it, and what a good thing it
Speaker 4: turned out to be. And I think that can be
Speaker 4: overstating the case. There's a lot of situations where I
Speaker 4: think if people had a choice, you'd be like, no,
Speaker 4: thank you, no, thank you, No, Well, don't want it.
Speaker 4: And I have it. I have this thing, whatever it is,
Speaker 4: that's right. What am I going to do with it?
Speaker 4: And you know, one of the reliable ways of making
Speaker 4: that better, I think is to share what you've learned
Speaker 4: with others.
Speaker 1: Yeah, to go at it instead of away from it.
Speaker 1: And that's an instinct that both you and I have.
Speaker 4: Eric, Yeah, let's talk about a journey orientation. What does
Speaker 4: that mean?
Speaker 1: So you're say you're eighteen and you've decided it's never
Speaker 1: going to get better. I remember feeling that way with
Speaker 1: my dad and I thought this absolutely hopeless, he said,
Speaker 1: Northful State Hospital. Again, I am the most alone person
Speaker 1: on the planet, and I remember thinking that. And of
Speaker 1: course it seems trite to say it's a pathway, it's
Speaker 1: a long road, but if you can take a long view,
Speaker 1: it does look different. Many people do well with even
Speaker 1: serious mental health conditions over time. The research has demonstrated
Speaker 1: this over and over, but I find a lot of
Speaker 1: professionals don't necessarily have that exposure. They see people in
Speaker 1: the hospital they're really sick, the person goes home, they
Speaker 1: don't follow them up for the next decade or two.
Speaker 1: So this is both for professionals and for people and
Speaker 1: families and individuals. You can take the long view, and
Speaker 1: I know that's not the most natural thing to do, right,
Speaker 1: it has value. It is a journey. You've got to
Speaker 1: learn along the way. You've got to put tools in
Speaker 1: your bag as you travel down the path, and everybody's
Speaker 1: journey is different. But you can learn from each other.
Speaker 1: And I think that's part of the beauty of the
Speaker 1: work that I've been involved in. We can learn from
Speaker 1: each other.
Speaker 4: Yeah, yeah, I think that is a really useful thing,
Speaker 4: is to be able to at least have some part
Speaker 4: of you looking down the road that's right and seeing
Speaker 4: a bigger perspective. It's not to minimize the pain that
Speaker 4: we're in by saying like, oh, it's going to be fine,
Speaker 4: don't worry about it. I mean, the pain is real,
Speaker 4: and when you're in it, part of it is dealing
Speaker 4: with that and accepting that and working with it. But
Speaker 4: for me, it's always sort of like, can I have
Speaker 4: like part of one eye at least you know, down
Speaker 4: the road way is going, you know what, I don't
Speaker 4: know how this turns out. Even if I can't get
Speaker 4: to hopeful right like, well, I can at least get
Speaker 4: to my mind doesn't know the future.
Speaker 1: Stick around for a while and since what happens. This
Speaker 1: is the challenge for adolescents, particularly in today's world. You know,
Speaker 1: they get humiliated on social media, for example, and they
Speaker 1: haven't had the experience of getting through something difficult. Yeah,
Speaker 1: this is why being fifteen is so hard now, Yes,
Speaker 1: because you're a humiliat and you don't have the experience,
Speaker 1: and it's very difficult to have a longitudinal perspective. Then
Speaker 1: in fact, in ten years, you're not even going to
Speaker 1: remember who has given you a hard time on that
Speaker 1: social media platform if you could sustain that somehow, So
Speaker 1: it's very challenging.
Speaker 4: You're right, I mean, it is hard to have that
Speaker 4: perspective when you are younger. It's just more challenging to have.
Speaker 4: I mean, one of the things that is most helpful
Speaker 4: to me in my life is my ability to reflect
Speaker 4: back on and go. You've been through lots of hard things.
Speaker 1: That's right. Here, we are, Here, we are.
Speaker 4: You feel overwhelmed, but you've been overwhelmed somewhere around I
Speaker 4: don't know, twelve thousand times and you've gotten through it
Speaker 4: twelve thousand times. And that's really helpful. But you're right
Speaker 4: at fifteen, you don't have that experience. You just haven't
Speaker 4: done it enough yet, right.
Speaker 1: And that's you know, the rise of adolescent suicide is
Speaker 1: one of the public health crises we have, and part
Speaker 1: of that is it's very difficult to have a journey
Speaker 1: orientation when you're at the beginning of the journey. Yeah, right,
Speaker 1: you're taking their first few steps and you think that's
Speaker 1: the future.
Speaker 4: Yeah.
Speaker 1: I think it's a real challenge, and this is part
Speaker 1: of well, I think, you know, the adolescent mental health
Speaker 1: crisis is such an important thing for us to be
Speaker 1: working on as a community, as a society.
Speaker 4: Yeah, and I think it's difficult at any age, right.
Speaker 1: Yes.
Speaker 4: My depression has a few things that it is always
Speaker 4: certain to bring up every time it comes around. It's
Speaker 4: got a few key talking points on its platform, and
Speaker 4: one of them is you're always like this, and you're
Speaker 4: always going to be like this, right, And I'm like, well.
Speaker 1: The automatic critical thoughts, the automatic negative.
Speaker 4: That's just a signature one. You know, Yes, you're always
Speaker 4: like this, which I have to go like, well, hang on, like,
Speaker 4: was I.
Speaker 1: Like this last week?
Speaker 3: No?
Speaker 4: I wasn't. And what about now? I guess, you know,
Speaker 4: I guess I'm not always like this and you'll always
Speaker 4: be like this. It feels very very real, yes, and
Speaker 4: I know from experience it's not. But that journey orientation
Speaker 4: is really helpful. Let's talk a little bit about what
Speaker 4: self determination in this list means. Why was that one
Speaker 4: of the things that was a theme you pulled from
Speaker 4: all these people?
Speaker 1: Well, Mary All and culpland you know, and I had
Speaker 1: a beautiful interview and she says self determination is the
Speaker 1: idea that you're going to develop your plan and your life,
Speaker 1: that no one else can do it for you, that
Speaker 1: other people can support you, but you're actually the agent
Speaker 1: of your recovery, which actually is very close to the
Speaker 1: addiction model INNAA. You're the agent, yep, right, it's up
Speaker 1: to you. Nobody's going to cover for you or call
Speaker 1: in if you miss work. You're accountable, but the flip
Speaker 1: side of that is you have the authority to design
Speaker 1: what you want. And a lot of people in mental
Speaker 1: health have told me that they felt they lost agency
Speaker 1: when in the hospital, when their symptoms were out of control,
Speaker 1: when a relationship broke down, because they couldn't articulate what
Speaker 1: was struggling with them. They felt that they had lost
Speaker 1: their self determination in some way. And of course involuntary
Speaker 1: hospitalization is a great example of that. People feel like, hey,
Speaker 1: they take my shoes, my shoelace, what are you kidding me? Right,
Speaker 1: Like it's the ultimate injury in that regard. Hopefully in
Speaker 1: the servi of a short term emergency, right and hopefully
Speaker 1: you get some help and you get back into determining
Speaker 1: your life. But several people told me how harmful that
Speaker 1: was to them and how much that impacted them. That
Speaker 1: kind of experience and the idea that you can lose
Speaker 1: your agency because your moods can be get so severe
Speaker 1: that you can't control them. It doesn't feel like you
Speaker 1: So self determination seems like such a simple concept run
Speaker 1: your own life, but it turns out in the mental
Speaker 1: health and also in the addiction space, it actually becomes
Speaker 1: pretty central to what people say they need and what
Speaker 1: helps them. Now, other people can't help you, though that's critical.
Speaker 1: You don't have to do it alone.
Speaker 4: So we're kind of at the end of our time here.
Speaker 4: But if you wanted to sort of leave listeners who
Speaker 4: either have mental health challenges in their own life or
Speaker 4: in the lives of people around them, you know, what
Speaker 4: would you leave us with? As kind of a parting
Speaker 4: few words, I.
Speaker 1: Want to say, you know, it's the first book I
Speaker 1: ever wrote. Five publishers is bid on it. People actually
Speaker 1: wanted to learn from real people, and I got a
Speaker 1: very cool publisher named Molly Stern who edited Michelle Obama's
Speaker 1: becoming the best selling biography in American history. So there's
Speaker 1: no typos in the book because society has gotten to
Speaker 1: the place doesn't look like I printed in my basement.
Speaker 1: Society has gotten to the place where we are ready
Speaker 1: to learn from each other and consider your experience as
Speaker 1: a valid source of expertise. So the shame in isolation
Speaker 1: you might naturally be inclined towards is not the only
Speaker 1: choice that you have. And I feel like groups like NAMI,
Speaker 1: the Trevor Project, Mental Health America DBSAAA, and these are
Speaker 1: all communities of people that will welcome you. This journey
Speaker 1: is hard to do alone, and I think you will
Speaker 1: find there's a more welcoming set of communities than ever before,
Speaker 1: even as the service system is a mess. Those are
Speaker 1: both true, and they're both true at the same time.
Speaker 4: You are not alone, not alone. Thank you so much, Ken,
Speaker 4: This has been a real pleasure. Your book is a gift,
Speaker 4: and I think for people who are early in a
Speaker 4: mental health journey of any sort, it is an outstanding resource.
Speaker 4: So thank you so much for the book and for
Speaker 4: spending some time with us today.
Speaker 1: Eric. I think you're really doing beautiful work and I
Speaker 1: want to thank you for having me.
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