WEBVTT - The Science of Connection 0:00:14.916 --> 0:00:22.756 Pushkin. Just a heads up, we talk about suicide in 0:00:22.796 --> 0:00:37.476 this episode. Please take care while listening. In Zimbabwe, let 0:00:37.516 --> 0:00:40.436 alone the whole of Africa, you're looking at a ratio 0:00:40.556 --> 0:00:44.396 of one psychiatrist to about one and a half million people. 0:00:45.356 --> 0:00:49.876 That's doctor Dixon Chabanda, a psychiatrist in Zimbabwe. He knew 0:00:49.916 --> 0:00:53.196 people in his country desperately needed access to mental healthcare 0:00:53.356 --> 0:00:56.596 but weren't getting it, and even though Dixon felt daunted 0:00:56.596 --> 0:00:59.276 by the magnitude of the problem, he was determined to 0:00:59.276 --> 0:01:03.116 try and find a solution. My initial thoughts were to 0:01:03.196 --> 0:01:06.916 work with trained nurses and doctors at the hospital, but 0:01:07.116 --> 0:01:09.796 I was immediately told no, the nurses and the doctors 0:01:10.316 --> 0:01:13.036 are extremely busy. They have to deal with people who 0:01:13.116 --> 0:01:15.716 are living with HIV, they have to deal with people 0:01:15.716 --> 0:01:18.076 who are coming in with malaria, and all sorts of 0:01:18.116 --> 0:01:20.156 other things. They just don't have the time to do 0:01:20.196 --> 0:01:24.236 this mental health stuff. Since health professionals were fully tied 0:01:24.316 --> 0:01:27.316 up with other work, Dixon was forced to look elsewhere, 0:01:27.876 --> 0:01:29.796 and so in two thousand and five, he turned to 0:01:29.836 --> 0:01:35.796 a rather unorthodox group for help. On today's episode, how 0:01:35.796 --> 0:01:38.716 you can vastly improve access to mental healthcare when you 0:01:38.716 --> 0:01:45.276 put grandmothers on the case, I'm Maya Shunker, and this 0:01:45.356 --> 0:01:47.836 is a slight change of plans, a show about who 0:01:47.876 --> 0:01:50.076 we are and who we become in the face of 0:01:50.116 --> 0:02:07.356 a big change. Dixon and I started our conversation by 0:02:07.356 --> 0:02:10.316 talking about what drew him to the field of psychiatry. 0:02:10.436 --> 0:02:13.756 He had initially wanted to become a pediatrician, but then 0:02:13.956 --> 0:02:17.796 something happened in medical school that deeply affected him. A 0:02:17.876 --> 0:02:21.516 classmate of his, who outwardly seemed stable and cheerful, took 0:02:21.556 --> 0:02:25.036 his own life. This came as a total shock to Dixon, 0:02:25.476 --> 0:02:27.956 and it motivated him to reassess how he wanted to 0:02:27.956 --> 0:02:30.796 spend his time as a doctor. And then there were 0:02:30.796 --> 0:02:34.876 a couple of other things. You know, I grew up 0:02:34.916 --> 0:02:39.436 in a family where my parents they didn't really have 0:02:39.516 --> 0:02:43.196 a wonderful marriage, you know, if I could put it 0:02:43.236 --> 0:02:47.956 that way, And when my parents divorced, that really affected 0:02:47.956 --> 0:02:51.676 me psychologically emotionally. I think I must have had childhood 0:02:51.676 --> 0:02:54.556 depression for a very long time, and no one really knew, 0:02:54.596 --> 0:02:58.636 and I didn't know either, you know, So that all 0:02:58.636 --> 0:03:01.796 of these kind of things, and then going to high 0:03:01.836 --> 0:03:07.876 school and being bullied and then you know, feeling completely 0:03:07.956 --> 0:03:12.236 out of place, So quite a number of events which 0:03:12.276 --> 0:03:18.996 had an emotional or traumatic effect on me. I believe 0:03:19.116 --> 0:03:23.076 contributed to that final decision for me to get into 0:03:23.116 --> 0:03:26.636 mental health and psychiatry. The thinking was, you know, if 0:03:26.676 --> 0:03:30.276 I can understand more about mental health and mental illness, 0:03:30.596 --> 0:03:35.036 I'll be able to heal myself, you know, and and 0:03:35.036 --> 0:03:38.116 and that's actually what it's all about, you know, It's 0:03:38.156 --> 0:03:42.956 really about finding a way of making myself a better person. 0:03:44.876 --> 0:03:48.636 So you end up deciding to become a psychiatrist, and 0:03:49.636 --> 0:03:52.956 you end up having a patient named Erica whose experience 0:03:53.596 --> 0:03:57.316 inspires you to specifically work in the area of increasing 0:03:57.356 --> 0:04:04.476 access to mental healthcare. Do you mind sharing her story? Yeah, Erica. 0:04:06.156 --> 0:04:10.716 Erica was a twenty six year old patient of mine 0:04:10.756 --> 0:04:14.916 who I had been saying for a good close to 0:04:14.956 --> 0:04:20.236 three years. She was initially brought to the hospital where 0:04:20.276 --> 0:04:25.196 I worked as a psychiatrist with a history of major depression. 0:04:26.676 --> 0:04:29.836 And I spent quite a lot of time with Erica, 0:04:29.876 --> 0:04:31.716 and I've really got to know her, And I think 0:04:31.716 --> 0:04:34.756 that's one of the things with psychiatry, when you really 0:04:35.436 --> 0:04:39.476 connect with your clients, you get to know them on 0:04:39.636 --> 0:04:43.716 a very personal level, and you know everything about their lives, 0:04:43.756 --> 0:04:45.636 because I mean, that's what mental health is all about. 0:04:45.676 --> 0:04:48.396 You know, you talk to people, you listen to people's stories, 0:04:49.036 --> 0:04:52.796 and so, you know, over the years, Erica and I 0:04:52.796 --> 0:04:57.356 had built this very strong rapport. But Erica actually lived 0:04:57.596 --> 0:05:02.516 some three hundred kilometers from where I am, and she 0:05:02.596 --> 0:05:06.396 would come and see me once every month together with 0:05:06.396 --> 0:05:09.276 her mum, you know, for review. And she may had 0:05:09.316 --> 0:05:13.596 a lot of progress over the years. And you know, 0:05:13.996 --> 0:05:17.596 one evening, I get a call in the middle of 0:05:17.636 --> 0:05:20.956 the night from the hospital where I worked, and the 0:05:21.276 --> 0:05:25.516 er doctor, you know, informs me that Erica, you know, 0:05:25.556 --> 0:05:29.476 my patient, Erica has taken an overdose, but she will 0:05:29.516 --> 0:05:32.636 be fine. But you know they kind of think that 0:05:32.716 --> 0:05:36.556 after that she should really come over and probably get 0:05:37.356 --> 0:05:41.476 more psychiatric evaluation and attention. And you know, we agreed 0:05:41.556 --> 0:05:44.076 that that was what was going to happen, you know, 0:05:44.116 --> 0:05:48.036 as soon as she's released. But you know, Erica didn't come. 0:05:48.436 --> 0:05:51.156 When she was released from the ear they went back 0:05:51.396 --> 0:05:54.396 to the village where she lived with her mother and father, 0:05:55.116 --> 0:05:57.716 and I only got a call three weeks later from 0:05:57.836 --> 0:06:02.036 Erica's mother to tell me that Erica had had hanged herself. 0:06:05.276 --> 0:06:08.276 You know, when Erica's mother phoned me to tell me 0:06:08.396 --> 0:06:12.156 what had happened, and you know, my sort of instinctive 0:06:12.476 --> 0:06:17.556 knee jerk response was to say, to Erica's mother, why 0:06:17.596 --> 0:06:21.836 didn't you bring Erica to the hospital for the review 0:06:21.956 --> 0:06:25.196 that we had talked about, you know, after after she 0:06:25.316 --> 0:06:29.516 had taken that initial overdose. And it was her response 0:06:29.596 --> 0:06:32.036 really that that struck me, you know, because she said, 0:06:32.836 --> 0:06:35.436 you know, we wanted to come, but we couldn't because 0:06:35.476 --> 0:06:39.716 we didn't have a bus there to come to your hospital, 0:06:39.956 --> 0:06:43.516 and that was like ten dollars, and as a result, 0:06:44.156 --> 0:06:49.596 Erica couldn't really get the help that she needed. Yeah, 0:06:49.596 --> 0:06:52.916 and from what I understand, I mean, the fact Erica 0:06:52.996 --> 0:06:56.596 even had access to you already put her in a 0:06:56.636 --> 0:07:01.156 minority of people, right, just given the sheer number of 0:07:01.196 --> 0:07:06.516 psychiatrists in the area. Yeah, the ratio is actually quite 0:07:06.756 --> 0:07:10.196 appalling when you think about this statists, in terms of 0:07:10.876 --> 0:07:15.436 psychiatrists in Zimbabwe, let alone the whole of Africa, you're 0:07:15.476 --> 0:07:18.996 looking at a ratio of one psychiatrist to about one 0:07:18.996 --> 0:07:23.036 and a half million people. And I think, you know 0:07:23.196 --> 0:07:29.356 that that whole story about Erica got me really thinking 0:07:29.396 --> 0:07:32.876 about my role as a psychiatrist. You know, when you're 0:07:32.916 --> 0:07:37.916 trained as a psychiatrist. You you kind of see yourself 0:07:37.996 --> 0:07:40.676 working in a hospital. I mean, that's what psychiatrists do. 0:07:40.876 --> 0:07:44.076 You know, they work in hospitals. You know, we work 0:07:44.076 --> 0:07:46.916 in clinics. We deal with people. People come to us. 0:07:47.436 --> 0:07:51.156 And I started asking myself if this was really the 0:07:51.276 --> 0:07:54.436 right way of looking at my role as a psychiatrist 0:07:54.516 --> 0:07:58.516 in Africa, expecting people to come to me, And you know, 0:07:58.516 --> 0:08:01.196 I just realized that that just wasn't going to work. 0:08:02.316 --> 0:08:05.316 Erica's inability to access help and it mattered most had 0:08:05.356 --> 0:08:09.076 a profound impact on Dixon. He felt inspired to bridge 0:08:09.196 --> 0:08:12.316 this gap and access to mental healthcare, but wasn't sure 0:08:12.356 --> 0:08:16.516 how to do it. Then a moment of insight. Dixon 0:08:16.596 --> 0:08:19.396 was in West Africa at an academic conference being run 0:08:19.436 --> 0:08:22.316 by the World Health Organization when he caught wind of 0:08:22.316 --> 0:08:26.076 a local ceremony nearby. It was a spiritual gathering where 0:08:26.076 --> 0:08:28.316 a number of people had come together to try and 0:08:28.396 --> 0:08:31.676 heal those in the community who were suffering, and Dixon 0:08:31.716 --> 0:08:35.076 immediately took note of one particular aspect of this ceremony, 0:08:35.436 --> 0:08:39.676 the prominent role elderly women played in leading it. They 0:08:39.716 --> 0:08:45.676 were really powerful, but above all, they had this amazingly 0:08:45.836 --> 0:08:51.516 profound way of conveying empathy and connecting with their subjects. 0:08:52.716 --> 0:08:55.756 That was really what struck me, and that was when 0:08:55.796 --> 0:09:00.276 I kind of realized that there was something in having 0:09:01.556 --> 0:09:08.876 an older woman who has wisdom and experience reaching out 0:09:09.196 --> 0:09:14.956 to help a young mother who is struggling with postnatal depression, 0:09:15.716 --> 0:09:20.636 a young mother who is struggling with anxiety disorder, and 0:09:20.756 --> 0:09:25.516 just reaching out and establishing that connection that makes that 0:09:25.636 --> 0:09:29.916 person feel comfortable to share their story, to make them 0:09:30.036 --> 0:09:33.316 feel that sense of belonging that I am in a 0:09:33.396 --> 0:09:36.436 place where I'm being taken care of. That was really powerful. 0:09:37.476 --> 0:09:40.636 Dixon drew a lot of inspiration from observing the elderly 0:09:40.676 --> 0:09:43.676 women in that ceremony. The influence they had in the 0:09:43.716 --> 0:09:46.956 community because of their age, their wisdom, and their empathetic 0:09:46.996 --> 0:09:50.596 nature gave him an idea. Since there weren't enough mental 0:09:50.596 --> 0:09:53.676 health professionals in Zimbabwe to meet the needs of his community, 0:09:54.236 --> 0:09:56.156 Dixon thought one way to help could be to bring 0:09:56.196 --> 0:09:59.756 elderly women or grandmothers into the fold. If they could 0:09:59.836 --> 0:10:02.876 lend a compassionate ear to people who were struggling, that 0:10:02.956 --> 0:10:06.516 could give more people the support they needed. But when 0:10:06.556 --> 0:10:09.716 Dixon told his friends in the medical community about his idea. 0:10:09.836 --> 0:10:13.956 They did not share his enthusiasm. Well, the initial reaction 0:10:14.196 --> 0:10:20.476 was obviously negative. Everyone thought it just wouldn't work because 0:10:20.596 --> 0:10:27.796 therapy is designed to be delivered by trained therapists such 0:10:27.836 --> 0:10:33.036 as psychiatrists or clinical psychologists, and grandmothers with minimal education 0:10:33.676 --> 0:10:36.636 just did not have the capacity to do this kind 0:10:36.636 --> 0:10:41.836 of work. So friends in the field, colleagues and other 0:10:42.156 --> 0:10:45.596 senior colleagues as well who I looked up to, all 0:10:45.716 --> 0:10:49.196 kind of thought this wouldn't work, you know. But I 0:10:49.236 --> 0:10:51.796 guess at the back of my mind, I always had 0:10:51.836 --> 0:10:56.796 that vision of these elderly women, and also just looking 0:10:56.796 --> 0:10:59.476 at my own childhood as well. You know, I grew 0:10:59.556 --> 0:11:03.676 up in a family where the women were very strong, 0:11:03.956 --> 0:11:09.756 very powerful. Both my grandmothers, you know, were literate, were educated, 0:11:10.556 --> 0:11:15.436 and had a very strong contribution to the family and 0:11:16.196 --> 0:11:19.316 making decisions. So I guess that's another part of my 0:11:20.236 --> 0:11:25.356 history or my childhood that has influenced this work. Dixon 0:11:25.396 --> 0:11:27.756 did not have to wait long to test out his theory. 0:11:28.396 --> 0:11:32.276 Zimbabwe was reeling from a recent government crackdown which traumatized 0:11:32.356 --> 0:11:36.476 millions and left hundreds of thousands of people homeless. Against 0:11:36.476 --> 0:11:40.476 this backdrop, Dixon's medical supervisor implored him to double down 0:11:40.556 --> 0:11:43.396 on his existing efforts and try to find a solution 0:11:43.476 --> 0:11:46.836 to the growing mental health crisis. And at the time, 0:11:46.956 --> 0:11:50.956 I was the only psychiatrist actually working within the public 0:11:50.996 --> 0:11:56.476 health sector, you know. So my supervisor said, you need 0:11:56.556 --> 0:11:59.836 to go out there and you need to come up 0:11:59.876 --> 0:12:04.636 with something. You know, but there's no money. You know, 0:12:04.716 --> 0:12:08.556 you have to try and think of some innovative way 0:12:08.636 --> 0:12:13.396 of addressing the psychological trauma that this community is going through. 0:12:13.836 --> 0:12:17.156 And my initial thoughts were, you know, to work with 0:12:18.516 --> 0:12:22.676 the trained nurses and doctors at the hospital. But I 0:12:22.716 --> 0:12:25.356 was immediately told no, the nurses and the doctors are 0:12:25.876 --> 0:12:28.636 extremely busy. They have to deal with people who are 0:12:28.676 --> 0:12:31.276 living with HIV, they have to deal with people who 0:12:31.316 --> 0:12:33.996 are coming in with malaria and all sorts of other things. 0:12:33.996 --> 0:12:36.116 They just don't have the time to do this mental 0:12:36.156 --> 0:12:40.396 health stuff. But you could consider working with other, you know, 0:12:40.476 --> 0:12:43.356 non professionals, you know, And I thought, my goodness, this 0:12:43.476 --> 0:12:46.756 can't be done by non professionals, but just the thought then, 0:12:46.876 --> 0:12:50.716 you know, there are lots of community grandmothers here who 0:12:51.236 --> 0:12:56.076 have been involved in sort of outreach programs. How about 0:12:56.116 --> 0:12:59.996 I start with just fourteen grandmothers from this community and 0:13:00.716 --> 0:13:04.156 see what we can do. A part of me was 0:13:04.356 --> 0:13:07.996 also quite skeptical, but you know, when you think you 0:13:08.276 --> 0:13:13.116 onto some thing, you kind of keep going, you know. Yeah. 0:13:13.156 --> 0:13:15.356 I mean I can also imagine therapist and doctors reacting 0:13:15.356 --> 0:13:19.436 negatively because they're thinking, I have a real degree in this, 0:13:19.836 --> 0:13:21.836 you know, I'm actually trained, and now you're telling me 0:13:21.956 --> 0:13:25.276 that grandma's can do my job for me? Like, did 0:13:25.316 --> 0:13:28.276 you hear any of that kind of response? Yes, I 0:13:28.356 --> 0:13:31.356 had a lot of that kind of response. But you see, 0:13:31.396 --> 0:13:35.196 that's where I think, you know, the problem we have 0:13:35.396 --> 0:13:41.356 with today's education, where we see everything through the lengths 0:13:41.676 --> 0:13:47.356 of academia and academics, you know, particularly from the northern hemisphere, 0:13:47.916 --> 0:13:54.476 and we don't take time to look at the local 0:13:55.636 --> 0:14:02.036 indigenous knowledge and the wisdom that is inherent in every culture. 0:14:02.156 --> 0:14:04.996 I mean, one of the things that I really learned 0:14:04.996 --> 0:14:13.036 from the grandmothers is that every culture has the amazing 0:14:13.116 --> 0:14:19.756 ability to teach you a piece of profound wisdom. And 0:14:19.836 --> 0:14:24.396 this is something that I have really taken to heart 0:14:25.316 --> 0:14:29.876 from my interactions with a grandmother's, just appreciating more the 0:14:30.036 --> 0:14:33.516 local culture and the role that it can play in 0:14:33.716 --> 0:14:37.476 addressing not only mental health issues, but a wide range 0:14:37.476 --> 0:14:41.596 of issues that people are struggling with in communities or 0:14:41.636 --> 0:14:48.716 in society. Will be right back with a slight change 0:14:48.756 --> 0:15:04.316 of plans. Doctor Dixon Chibanda, a psychiatrist in Zimbabwe, had 0:15:04.356 --> 0:15:06.356 an idea for how to help more people in this 0:15:06.476 --> 0:15:09.836 country access mental health services, and it would come to 0:15:09.876 --> 0:15:13.356 be known as the Friendship Bench. Here's how it would work. 0:15:13.956 --> 0:15:16.396 Members of the community with mental health needs would be 0:15:16.396 --> 0:15:19.396 paired with a local grandmother. They then plan to meet 0:15:19.476 --> 0:15:21.956 up at a bench outdoors and work through problems the 0:15:22.036 --> 0:15:25.876 person was facing. Dixon took his idea to some grandmothers 0:15:25.876 --> 0:15:29.356 in his community in order to get their feedback. I 0:15:29.396 --> 0:15:34.876 was given fourteen grandmothers who were not very excited about 0:15:34.996 --> 0:15:39.756 working with me initially because you tell me more about that. Well, 0:15:39.756 --> 0:15:42.876 you know, when I approached them, I had my psychiatrist's hat, 0:15:43.356 --> 0:15:46.156 and over time, over the years, I've realized that when 0:15:46.156 --> 0:15:49.076 you really want to engage with communities, you need to 0:15:49.116 --> 0:15:52.636 take off your professional hat. If you really want to 0:15:52.676 --> 0:15:56.756 heal people who are traumatized in this part of the world, 0:15:57.196 --> 0:16:01.676 you need to rely on the local language, the local 0:16:01.836 --> 0:16:07.276 idioms of distress, and just use the language that resonates 0:16:07.356 --> 0:16:10.636 with communities because when you use your own language, you 0:16:10.836 --> 0:16:14.676 instantly remove stigma, because stigma is one of the biggest 0:16:14.676 --> 0:16:17.636 problems that we face in mental health. And in this 0:16:17.716 --> 0:16:21.916 part of the world, stigma is brought about because we're 0:16:21.956 --> 0:16:25.556 trying to adopt terms that I used in the Western world. 0:16:25.836 --> 0:16:28.156 You know, if you talk about depression in my country, 0:16:28.316 --> 0:16:31.436 people think you've lost it yourself. That people don't believe 0:16:31.436 --> 0:16:36.556 there's depression. People think that depression is something that just 0:16:36.676 --> 0:16:38.916 doesn't happen to people in this part of the world. 0:16:38.956 --> 0:16:43.396 But if you use the terms which which resonates with 0:16:43.436 --> 0:16:46.556 the local folks, like in our culture, for instance, the 0:16:46.676 --> 0:16:51.676 equivalent for depression is a word called kofungi sisa, which 0:16:51.796 --> 0:16:57.356 literally means thinking too much. When you break down the 0:16:57.516 --> 0:17:01.596 symptoms of thinking too much in the local language, it's 0:17:01.676 --> 0:17:06.236 exactly the same as depression. So, you know, I learned 0:17:06.236 --> 0:17:11.436 from the grandmothers that the words that we use and 0:17:11.516 --> 0:17:16.876 the terms that we use to describe people's emotional experiences 0:17:17.236 --> 0:17:23.556 can make or break people. Fascinating So, so you said, 0:17:23.556 --> 0:17:26.756 the grandmothers were not excited initially about the prospect of 0:17:26.796 --> 0:17:31.076 working with you, but you learn to adopt the language 0:17:31.116 --> 0:17:33.716 of the locals, right, and to make sure that you're 0:17:34.116 --> 0:17:38.356 speaking in their terms. Was that effective in getting them 0:17:38.436 --> 0:17:42.276 onto your side and motivating those fourteen initial grandmothers to 0:17:42.596 --> 0:17:46.796 want to partner with you. I remember Grandmother Jack, the 0:17:46.956 --> 0:17:51.396 very first grandmother who I interacted with and spoke to 0:17:51.516 --> 0:17:54.636 about the Friendship Bench and the idea that I had. 0:17:55.556 --> 0:18:03.716 She was very apprehensive initially and dismissive when I first 0:18:03.756 --> 0:18:11.276 approached her because I was I was using lingo from 0:18:11.356 --> 0:18:15.916 the DSAM five, you know, the Diagnostic Statistical Manual, which 0:18:15.996 --> 0:18:20.316 is kind of the psychiatrist's handbook or bible, you know, 0:18:20.756 --> 0:18:23.316 and I was using terms from that book. And she's 0:18:23.396 --> 0:18:26.356 looking at me like, and you think that kind of 0:18:26.356 --> 0:18:29.036 stuff is going to fly in this community, you know, 0:18:30.396 --> 0:18:35.156 totally interesting, you know, And I remember distinctly, you know, 0:18:35.236 --> 0:18:38.516 she said, if you really want to make a difference 0:18:38.556 --> 0:18:42.116 in this community, you have to put down your book 0:18:43.076 --> 0:18:47.756 and don't come here acting like a doctor. She knows 0:18:47.836 --> 0:18:53.916 the community inside out. And I persisted, you know, every week, 0:18:53.996 --> 0:18:55.916 you know, I'll go to the to the clinic, you know, 0:18:56.036 --> 0:18:59.156 meet the grandmother's and you know, Grandmother Jack would be 0:18:59.196 --> 0:19:02.396 looking at me, you know, very skeptical, and and and 0:19:02.396 --> 0:19:05.916 and gradually, you know, she warmed up to me, you know, 0:19:06.036 --> 0:19:08.836 and gradually, you know, they're bought into the whole idea 0:19:08.956 --> 0:19:13.036 or therapy on a bench. Yeah. You know, you said 0:19:13.036 --> 0:19:15.276 that the grandmothers eventually warmed up to you. But it 0:19:15.316 --> 0:19:18.556 seems like a key feature of that is the fact 0:19:18.636 --> 0:19:22.156 that you maintained an open mind throughout right you were 0:19:22.996 --> 0:19:25.516 you were viewing this as a dialogue between you and 0:19:25.596 --> 0:19:28.436 grandmothers right at the two way street, in which both 0:19:28.476 --> 0:19:32.196 sides were contributing to the conversation. And I think that's 0:19:32.236 --> 0:19:35.596 so that's such an important lesson for people who are 0:19:35.636 --> 0:19:40.316 trying to bring new and innovative approaches to their communities. 0:19:40.436 --> 0:19:43.396 You know. An example of this is that initially you 0:19:43.436 --> 0:19:46.076 would plan to call the bench the mental health bench, 0:19:46.356 --> 0:19:49.196 right yeah, and no one was coming when it was 0:19:49.236 --> 0:19:51.996 called the mental health bench. And then the grandma's you know, 0:19:52.076 --> 0:19:54.236 came to you. I imagine Grandma Jack was among them 0:19:54.236 --> 0:19:57.196 and said, look, Dixon, you need to change the name 0:19:57.236 --> 0:19:59.036 to friendship bench. No one is going to come to 0:19:59.036 --> 0:20:01.316 the mental health bench. Yeah. Yeah, And that's a good 0:20:01.356 --> 0:20:06.196 example of me having my psychiatrists hat on, you know, like, hey, 0:20:06.276 --> 0:20:09.716 this is we're providing mental health services. Yes, so this 0:20:09.756 --> 0:20:12.316 is the Mental Health Bench. And it just didn't occur 0:20:12.396 --> 0:20:16.476 to me that a name could make or break a program, 0:20:16.516 --> 0:20:19.236 But I've learned now. You know, the language is very important, 0:20:19.276 --> 0:20:21.956 the language that you used to navigate through the therapy, 0:20:22.036 --> 0:20:25.716 through the session, that's critical because that's what people identify with. 0:20:26.316 --> 0:20:29.436 So yeah, indeed, everything is in a name. I guess 0:20:30.876 --> 0:20:33.556 I'd love to dive a bit deeper into the features 0:20:33.556 --> 0:20:37.876 of Friendship Bench, and there's this very strong storytelling component involved. 0:20:38.476 --> 0:20:41.476 But what's trucking me about the program is that both 0:20:41.556 --> 0:20:45.476 sides are encouraged to share their stories. And I find 0:20:45.476 --> 0:20:49.956 this fascinating because in the clinical world, providers are often 0:20:50.436 --> 0:20:55.556 discouraged from sharing personal stories. Right. Yeah, but you've identified 0:20:55.596 --> 0:21:00.196 that there are huge therapeutic benefits to having people bond 0:21:00.396 --> 0:21:03.156 in this way. So can you share a bit more 0:21:03.156 --> 0:21:06.676 about that? Sure? I think before I share one of 0:21:06.716 --> 0:21:09.596 the things, I'd like to also just mention that through 0:21:09.756 --> 0:21:14.796 my interaction with the grandmothers over the years, my own 0:21:14.796 --> 0:21:19.196 approach as a psychiatrist has changed significantly. I am more 0:21:19.276 --> 0:21:24.396 comfortable sharing my own story with clients who come to 0:21:24.436 --> 0:21:29.116 me for help and I find that extremely powerful because 0:21:29.116 --> 0:21:33.196 you really connect at a human level. You know, when 0:21:33.196 --> 0:21:36.636 we're trained as psychiatrists, we're trained to keep this distance, 0:21:36.876 --> 0:21:40.836 don't really open up, don't show your vulnerabilities, because as 0:21:40.836 --> 0:21:44.676 a therapist you're supposed to be strong. But actually there's 0:21:44.676 --> 0:21:48.676 a lot more strength in showing your vulnerabilities. There's a 0:21:48.676 --> 0:21:52.796 lot more strength that comes from telling your own story, 0:21:52.956 --> 0:21:56.836 including the negative things, because then you really connect. Because 0:21:56.876 --> 0:21:59.196 one of the things I've learned from Friendship Bench is 0:21:59.236 --> 0:22:03.356 the therapy actually starts when you connect with a person. 0:22:04.556 --> 0:22:08.116 The different steps that you take in the process of 0:22:08.276 --> 0:22:12.196 reaching out to people are important, but if you do 0:22:12.236 --> 0:22:16.996 not have that connection that ra poor you may lose 0:22:17.036 --> 0:22:21.396 everything else. So if you ask me what I consider 0:22:21.436 --> 0:22:24.116 to be the most critical feature of the work we do, 0:22:24.716 --> 0:22:28.836 it's that connection. Being able to get two people to 0:22:28.956 --> 0:22:33.636 connect in a way that is empathic. And that's the 0:22:33.676 --> 0:22:37.836 first part, you know, which the Grandmother's called or opening 0:22:37.916 --> 0:22:41.636 up the mind, because without opening up the mind, you 0:22:41.676 --> 0:22:44.996 don't get to the root of the problem. The other 0:22:45.116 --> 0:22:52.476 key component that we emphasize is the Grandmother's ability to summarize. 0:22:53.796 --> 0:22:58.116 So if you're listening to a story, you know this 0:22:58.196 --> 0:23:00.396 is what I normally would say to the grandmothers if 0:23:00.596 --> 0:23:04.716 if you're listening to a story, how does the person 0:23:05.756 --> 0:23:09.676 that is telling the story know that you really were listening? 0:23:10.836 --> 0:23:14.996 And the simplest way is a summary. You know, a 0:23:15.076 --> 0:23:20.156 good summary of what you've heard shows how well you 0:23:20.236 --> 0:23:24.036 were immersed in this story. And you can see from 0:23:24.036 --> 0:23:28.676 the grandmothers who are brilliant at summarizing, they are also 0:23:28.756 --> 0:23:32.756 the best grandmothers when it comes to immersing themselves into 0:23:32.756 --> 0:23:38.156 a story and also showing that empathy and that ability 0:23:38.196 --> 0:23:43.836 to make people feel respected and understood you. So those 0:23:43.876 --> 0:23:47.836 are the two key components. Another component of the friendship 0:23:47.836 --> 0:23:51.796 bench is a diagnostic screening tool. The grandmothers have everyone 0:23:51.836 --> 0:23:54.476 who comes to the bench fill out a questionnaire so 0:23:54.516 --> 0:23:56.356 they can get a better sense of what kinds of 0:23:56.396 --> 0:23:59.796 symptoms the person is experiencing and their degree of severity. 0:24:00.596 --> 0:24:03.956 If someone presents with severe symptoms, the grandmother refers them 0:24:04.036 --> 0:24:07.476 right away to a trained medical professional, but if someone 0:24:07.556 --> 0:24:10.796 presents with more mild to modern symptoms, the friendship bench 0:24:10.916 --> 0:24:13.836 is for them. Grandmothers are trained in a form of 0:24:13.876 --> 0:24:18.316 cognitive behavioral therapy called problem solving therapy, which focuses on 0:24:18.436 --> 0:24:23.116 identifying concrete problems like unemployment rather than the symptoms of 0:24:23.156 --> 0:24:26.876 that problem, like anxiety. Grandmothers then work with a person 0:24:26.916 --> 0:24:30.836 to brainstorm specific steps they can take to solve the problem, 0:24:30.836 --> 0:24:34.596 and according to research, this focus on resolving specific problems 0:24:34.956 --> 0:24:38.156 can give people a greater sense of agency over their lives. 0:24:39.116 --> 0:24:45.916 A classical sort of presentation on the bench is, you know, 0:24:47.556 --> 0:24:56.636 a young client presenting with numerous problems. I'm HIV positive, 0:24:57.236 --> 0:25:01.836 I'm unemployed, I mean an abusive relationship, I have a 0:25:01.956 --> 0:25:05.236 child who is not able to go to school because 0:25:05.276 --> 0:25:07.956 I don't have money to pay for school fees. I'm 0:25:07.996 --> 0:25:12.276 struggling to feed my family. So they present with numerous problems, 0:25:13.316 --> 0:25:16.956 you know. And one of the things that has really 0:25:17.076 --> 0:25:24.756 characterized the therapy component is the ability to help these 0:25:25.196 --> 0:25:28.596 clients who come to the bench after sharing these stories, 0:25:29.076 --> 0:25:33.156 the ability of the grandmothers to help them select one 0:25:33.276 --> 0:25:36.876 problem to focus on. And that seems that sounds very simple, 0:25:36.956 --> 0:25:40.516 but actually, when you're immersed in all these problems, every 0:25:40.556 --> 0:25:43.716 single one of those problems is a big problem for you. 0:25:44.276 --> 0:25:47.796 So because the grandmothers live in these communities, the actual 0:25:47.876 --> 0:25:51.876 treatment is often not only on the bench, but it 0:25:52.076 --> 0:25:54.476 also occurs in the community. So you can get a 0:25:54.516 --> 0:25:58.636 grandmother meeting a client, for instance, at church. So I'll 0:25:58.636 --> 0:26:01.316 see you this Sunday at church and you and I 0:26:01.356 --> 0:26:04.756 can pray together. I will see you at the market 0:26:05.116 --> 0:26:07.996 and we can do this together. So you're slowly introducing 0:26:07.996 --> 0:26:12.436 a very practice called kind of behavior activation to help 0:26:12.516 --> 0:26:18.956 someone who is depressed and unmotivated and isolating themselves at 0:26:19.036 --> 0:26:23.116 home because they feel they are in this miserable situation. 0:26:23.236 --> 0:26:26.076 But because the grandmother has come up with this set 0:26:26.156 --> 0:26:30.396 of activities that they then carry out together, you slowly 0:26:30.436 --> 0:26:33.836 begin to see this person transforming, you know. So that's 0:26:33.876 --> 0:26:37.116 one sort of example of how the grandmothers will deal 0:26:37.156 --> 0:26:40.796 with situations of depression. Often people think the work we 0:26:40.916 --> 0:26:45.596 do is just on the bench. The bench, the friendship bench, 0:26:45.756 --> 0:26:48.916 or the bench. The physical bench is just an entry point. 0:26:50.076 --> 0:26:53.076 There's a lot more that happens outside of the bench. 0:26:53.516 --> 0:26:56.436 We encourage everyone who sat on the bench with the 0:26:56.556 --> 0:27:00.076 grandmother is to join a support group in the community. 0:27:00.436 --> 0:27:05.276 And through the support groups that you get peer support 0:27:05.556 --> 0:27:12.116 with individuals who've all gone through the friendship bench, share 0:27:12.156 --> 0:27:16.556 their own experiences and collectively problems solved around challenges that 0:27:16.556 --> 0:27:19.836 they are facing within the community. I'd love if you 0:27:19.876 --> 0:27:23.116 could talk about the efficacy of the program, because you 0:27:23.196 --> 0:27:26.756 actually ran a randomized control trial, which is considered the 0:27:26.796 --> 0:27:34.796 gold standard of evaluation, and found some extremely exciting results. Yeah. 0:27:35.476 --> 0:27:40.796 So we have over fifty peer reviewed publications, you know, 0:27:40.836 --> 0:27:43.836 scientific publications about the Friendship Bench, But I guess the 0:27:43.876 --> 0:27:49.356 most seminal publication would be our cluster randomized controlled trial, 0:27:49.476 --> 0:27:53.396 which is published in the Journal of the American Medical Association, 0:27:53.956 --> 0:27:58.836 which in a nutshell, shows that six months after receiving 0:27:58.956 --> 0:28:05.076 therapy from a trained community grandmother on a bench in Zimbabwe, 0:28:05.876 --> 0:28:11.276 people were steal symptom free. The grandmother where in essentially 0:28:11.396 --> 0:28:16.876