Saving Minds

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Myriam Anouk gazes nervously across a busy Montreal intersection. The streets are eerily familiar. In the aftermath of her mother’s death twenty years earlier, she had turned to walking four to eight hours a day as a means of coping. When these extreme walks failed to quiet the voices in her head, and her condition worsened, a friend called an ambulance. And so began her long and difficult relationship with the mental health system.

Alo, an up-and-coming comic who lives with several conditions, including bipolar disorder, finds freedom of sorts on the stage telling jokes and anecdotes that over time reveal a deeply troubled self. Although Alo’s and Myriam Anouk’s backgrounds are worlds apart in many ways, both share an unwavering determination to improve their health and long-term outcomes.

Saving Minds captures the intimate stories of Alo and Myriam Anouk as they navigate their way to recovery, and provides insights from experts in the field, presenting a clear picture of mental health care today. The film also features Joanne Greenberg, the internationally acclaimed author of I Never Promised You a Rose Garden (1964). Now in her eighties, she takes us back to a much earlier time when her own prognosis was very grim. Greenberg’s candid testimony offers hope to others facing similarly difficult challenges.

Filmed in English and French and shot in Montreal, Boston, Colorado, Chicago, Vermont and England, Saving Minds gives viewers a ringside seat as a new approach to mental health care emerges; one that moves beyond the biological-medical model entrenched in the 1980s towards a more therapeutic and empathetic approach that puts the patient first and uses medication cautiously. The film aims to spark a public debate on why a new vision of care is long overdue.

"This moving film helps viewers see the complex, human stories behind 'psychosis' and 'serious mental illness.' It does this by blending personal stories with interviews with a range of clinical and research experts to make the case for psychosocial approaches and greater caution in the use of psychotropic medications. College students learning about mental health conditions, clinicians in training, general community members, and people diagnosed with mental health conditions themselves would all benefit from viewing Saving Minds." Philip Yanos, Ph.D., Professor of Psychology, John Jay College of Criminal Justice - CUNY, Author, Written Off: Mental Health Stigma and the Loss of Human Potential

"[Saving Minds] stands out by emphasizing a therapeutic approach capable of looking suffering in the face. In doing so, Catherine Mullins recalls the primacy of the bonds that humans weave among themselves; benevolence and listening appeared here as cardinal virtues capable of alleviating suffering which cries out in distress even when we do everything to muzzle expression of their symptoms." Louise-Maude Rioux Soucy, Le Devoir

"Saving Minds is absolutely a must-see. It raises public awareness of mental health problems, and endeavors to eradicate prejudice and social stigma on the subject by engaging viewers deeply and taking them on the journey with the characters. The theme, the atmosphere, and the people will stay with you long after watching it." Somayeh Hezavehi, Film Today

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Main credits

Mullins, Catherine (film director)
Mullins, Catherine (film producer)
Mullins, Catherine (screenwriter)

Other credits

Editing, Vidal Béïque; music, Eric LeMoyne; cinematography, Michael Wees.

MARC Record See Worldcat record

Keywords

mental health,medication,mental health care,health care,healthcare,bipolar,joanne greenberg,bioligical-medical model,therapy,therapeutic,mental illness,psychiatric,psychiatry,pharmaceuticals,Catherine Mullins; "Saving Minds"; Bullfrog Films

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[soft instrumental music]

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[audience applauds]

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So what happens when you kill yourself?

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Where do you go?

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I think what happens when you kill yourself

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is you get charged with murder,

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but there's no one to place under arrest,

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so the case gets thrown out.
That's what I think.

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Now, if you wanna know what happens in the afterlife,

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that's another story.

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I don't know, I'm not planning to find out for a long time.

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[soft instrumental music]

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[soft instrumental music]
[footsteps thudding]

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[radio chattering]

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When I first met Myriam Anouk,

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she was coming to terms with her life.

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after 10 years in the mental health system.

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[train engine humming]

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[relaxed instrumental music]

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One evening we were filming Myriam Anouk

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at an open mic for mental health.

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That's when I met Alo.

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Ah, uh, uh, ah, ah.

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No "umms," no "buts."

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Some buts, no umms.

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So, hi.

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My name's Alo.

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Allô!

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Hello!

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And backwards, Ola.

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So a lot of "hellos" in my name.

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I'm a little nervous and I think it's showing.

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Did I mention bombing epically here last time?

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I think that's showing.

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When I was 18, I was diagnosed

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with having a manic episode.

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And it was really hard to accept

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because at the time I didn't wanna accept

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that I was bipolar disorder 1

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until I saw my therapist.

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There was, like, a policy on her door that said,

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"Only come in case of emergencies."

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And I was like, "I don't know if this is an emergency."

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Like, I was, like, sobbing, like, crying

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and, like, feeling terrible.

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But I still had self-doubt.

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I was like, "Is this an emergency?"

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So I took a breath, pushed the door, sat with her,

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and got an ambulance after speaking with her.

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When I got out of the psych ward,

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I decided to go to a party.

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My first party outta the psych ward.

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It was Halloween and I couldn't drink, you know.

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A lot of medications you can't drink on.

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And the first thing that happened

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was a young frat boy was like, "Hey, have a drink."

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And I was like, "No, thank you. I don't drink

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"'cause I'm bipolar. I take medication."

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And he said, "Oh, you don't look bipolar."

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[audience applauds]

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Now he just invented a new thing.

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What does bipolar look like, even at a costume party?

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I don't know.

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[audience applauds]

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This is what I wanna do with my life.

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I wanna perform comedy.

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I like producing comedy shows.

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I like producing storytelling shows.

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I love to perform.

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[traffic noise]
[soft instrumental music]

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I'm a 25-year-old student

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who still lives at home,

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trying to be a decent person.

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I got diagnosed with mental health issues,

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basically anxiety, manic episode,

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suicidal thoughts, bipolar disorder.

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And I deal with, like, hair-pulling or trichotillomania,

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it's like a self-soothing coping mechanism.

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But it's also a self-harm,

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and it's just hard to admit a lot of these things,

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let alone accept them.

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[soft instrumental music]

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So right now, the medication that I take

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stops me from having manic highs.

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These elevated high energy moods exhaust me,

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and I take Epival to cut it.

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[soft instrumental music]

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An award-winning American journalist

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plays an important role in this story.

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Robert Whitaker has challenged mainstream psychiatry.

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He's pointed out flaws in the research

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that underpins current practices.

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Whitaker's helping set a new course

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in our understanding of mental illness.

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The capacity for humans

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to struggle with their minds and their emotions

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and in fact to go mad, it's just part of being human.

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I mean, you can go mad, I can go mad

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if I don't sleep for four days.

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We can all start becoming psychotic.

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And so if we start with that humility,

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we don't know what's wrong,

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but we do know there's this capacity

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for humans to suffer in these extraordinary ways.

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But we also know history and science

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is telling us so many people can have a time of illness

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or time of an episode

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and then get their lives back

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if you build a different environment around them.

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[soft instrumental music]

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[traffic noise]

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[unseen voices whispering]

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[ominous ambient music]

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[traffic noise]

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[footsteps crunching]

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Myriam Anouk always believed

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she would benefit from psychotherapy.

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The problem was she couldn't afford to pay for it.

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Her luck changed the day she met Dr. Bordeleau.

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He specializes in psychosis

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and his services are covered by the healthcare system.

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[distant car horn honking]

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[soft instrumental music]

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I can remember riding in a car

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when it was raining,

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and the rain was tears down the front window.

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And a voice said to me,

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"This is going to be your life.

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"Tears and darkness."

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And in fact, that's what it was.

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[soft instrumental music]

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[water cascading]

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Six decades ago,

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Joanne Greenberg wrote the groundbreaking novel,

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"I Never Promised You a Rose Garden,"

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based on her experiences as a patient in a 1940s asylum.

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Her book took us inside her imaginary world,

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the world she escaped to

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when real life became unbearable.

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In 1953, I said, "I am leaving the psychiatric world

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"forever."

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I don't know how I dragged

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through 16 years.

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I say 16 because...

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...because getting told, getting put

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in a place where people knew what I had

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and were gonna help me fix it

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was the beginning of the end of the illness.

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When I was writing "Anatomy of an Epidemic,"

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when I met recovered people off medications,

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nearly all told a story of finding some person

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that believed in them

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and helped them through the crisis.

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No one just suddenly got better.

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There was some relationship

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that, like, gave them a new way forward.

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And I think that's what Frieda Fromm-Reichmann

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gave to Joanne Greenberg.

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She knew that we were minors.

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In what way?

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She had the light.

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I had the map.

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You were in it together?

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Yep. That's the whole thing.

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[soft instrumental music]

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The 16-year-old Joanne Greenberg

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was treated at Chestnut Lodge

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by one of the great psychotherapists of the day,

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Dr. Frieda Fromm-Reichmann.

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I was taken to her maybe a week

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after I came into the hospital.

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This was a lucky conjunction.

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She had an opening,

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and there I was.

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[soft instrumental music]

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"I never knew," she said.

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"I've never been mentally ill.

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"I don't know what it's like. Tell me what it's like."

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[rain pattering]
[thunder peeling]

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She understood my metaphor.

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Think about

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blood coming out of a faucet.

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Turn on the faucet and blood and gore

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come out of the faucet.

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Now you tell me, "We're on a city water system, honey."

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[Joanne laughs]

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"That can't be."

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I know that.

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I'm aware of that.

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But this is a metaphor for the uniqueness of my situation.

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I am alone in this.

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I'm the only one seeing this.

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This is my truth.

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[rain pattering]

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I went to camp every summer

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and boy did they let me know

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how different I was, kids.

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[soft instrumental music]

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There was a cloud where I was.

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[soft instrumental music]

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And I mean kids can tell who doesn't fit.

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Kids can tell who's sick.

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The life-changing moment was probably when I was about 10.

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"We're here,

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"and we're gonna

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"save you from all this."

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Where were you when you first heard them?

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I was in camp.

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And this is the key thing, I think,

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that what starts

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as a fort

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ends up as a prison.

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The fort that I went into at 10

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was a prison by the time I was 13.

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[ominous ambient music]

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It's a geography, there are plains,

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there are trees, there are places to be.

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You can walk there.

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You can meet godlings,

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you can meet different characters there.

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Ride horses.

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[horse galloping]

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Go away.

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[galloping continues]

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[soft ambient music]

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Did I have

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a persistent, long-term,

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debilitating

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illness? Yes.

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Called schizophrenia

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according to today's DSM?

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Called schizophrenia according to today's

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DSM whatever.

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It's a diagnostic and statistical manual.

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It's psychiatry's manual for categorizing mental disorders.

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The DSM that really has reshaped our lives is DSM-III.

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This is when they decided

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to reconceptualize mental disorders as diseases,

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diseases of the brain,
to get rid of Freudian ideas

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and basically say depression is like diabetes.

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Schizophrenia is like heart disease.

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And of course once you have illnesses of the brain,

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what is the natural thought

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is that you then need drug treatments

245
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that are specific to that illness.

246
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The problem was, that was not a story of science.

247
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That was a marketing story, or a branding story.

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[soft instrumental music]
[traffic noise]

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The DSM-III was published in 1980,

250
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and soon after most psychiatrists

251
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were explaining mental disorders

252
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as chemical imbalances in the brain.

253
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[soft ambient music]

254
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I was writing about that chemical imbalance story.

255
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I thought it to be true.

256
00:17:52.920 --> 00:17:54.937
And then at one point I asked a researcher,

257
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"Hey listen, could you just point me

258
00:17:56.767 --> 00:17:58.267
"to the research literature

259
00:17:58.267 --> 00:18:01.357
"where you actually found that people with schizophrenia

260
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"had a hyperactive dopamine system?"

261
00:18:05.727 --> 00:18:07.110
And I swear to God this is true.

262
00:18:07.110 --> 00:18:09.157
He said, "Well we didn't actually find that.

263
00:18:09.157 --> 00:18:13.027
"It's more of a metaphor, like insulin for diabetes.

264
00:18:13.027 --> 00:18:15.093
"We know these drugs are good for people,

265
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"and so we use this metaphor,

266
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"but we really don't know the causes of schizophrenia."

267
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We don't understand madness.

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00:18:23.430 --> 00:18:25.170 line:15%
There are various theories,

269
00:18:25.170 --> 00:18:28.110 line:15%
everyone has a theory of what schizophrenia is,

270
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but none of them really know.

271
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I mean, we don't really have a good theory about it,

272
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nor about bipolar disorders.

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[soft instrumental music]
[birds calling]

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Martin Harrow was the principal investigator

275
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of what became famously known as the Chicago Study.

276
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He followed patients for over 20 years,

277
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comparing outcomes of those who remained on antipsychotics

278
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with those who chose not to keep medicating.

279
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[soft instrumental music]

280
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I was very interested in outcomes in different disorders,

281
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especially schizophrenia patients.

282
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One of their symptoms

283
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is disordered thinking.

284
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We did follow-up work.

285
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We were able to get about 380 patients.

286
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We studied them at two years

287
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after they were discharged from the hospital,

288
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and then at four and a half years

289
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and then at seven and a half years

290
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and then at 10 years, 15 years and 20 years.

291
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So what happens to that person

292
00:19:28.710 --> 00:19:31.440
who does real well initially?

293
00:19:31.440 --> 00:19:33.810
How are they doing 5 years, 10 years down?

294
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Do they get a real, robust life back?

295
00:19:36.678 --> 00:19:39.495
And the evidence is pretty clear that,

296
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from study after study,

297
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that over the long term, the drugs exact a toll.

298
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Our data indicates that in the first two or three years

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those not on antipsychotics

300
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and those on antipsychotics,

301
00:19:54.099 --> 00:19:58.200
both of them have about the same degree of psychosis.

302
00:19:58.200 --> 00:20:03.150
But after a few years those,
at least in our data,

303
00:20:03.150 --> 00:20:07.268
those who were not on anti-psychotics,

304
00:20:07.268 --> 00:20:10.920
their psychotic ideas,

305
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not for all of them,

306
00:20:11.910 --> 00:20:14.313
but for many of them begin to diminish.

307
00:20:15.450 --> 00:20:18.510
And those who were still on the antipsychotics,

308
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they don't diminish.

309
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Most psychiatrists feel

310
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that they prevent people from relapsing.

311
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Our data doesn't show that.

312
00:20:27.539 --> 00:20:32.539
[soft instrumental music]
[traffic noise]

313
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Music - Shades Lawrence, "Falling Off Track"

314
00:20:41.655 --> 00:20:44.535
♪ And I was fallin' off track ♪

315
00:20:44.535 --> 00:20:46.963
♪ Came far, remember that ♪

316
00:20:46.963 --> 00:20:48.671
♪ And I was fallin' off track ♪

317
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♪ Falling off track ♪

318
00:20:52.794 --> 00:20:54.580
♪ And I was fallin' off track ♪

319
00:20:54.580 --> 00:20:55.782
♪ Falling off track ♪

320
00:20:55.782 --> 00:20:58.239
♪ Came far, remember that ♪

321
00:20:58.239 --> 00:21:00.279
♪ And I was fallin' off track ♪

322
00:21:00.279 --> 00:21:03.112
♪ Falling, falling ♪

323
00:21:05.310 --> 00:21:08.340
I had a manic episode.

324
00:21:08.340 --> 00:21:10.950
I had this boundless energy, but I had, like, no focus,

325
00:21:10.950 --> 00:21:14.430
my mind was racing, I couldn't stop or change the topic.

326
00:21:14.430 --> 00:21:16.620
It just was thought after thought

327
00:21:16.620 --> 00:21:17.730
after thought after thought.

328
00:21:17.730 --> 00:21:20.070
I already speak like a stream of consciousness,

329
00:21:20.070 --> 00:21:22.350
but this was, like, nonstop.

330
00:21:22.350 --> 00:21:25.770
I couldn't even sit in class

331
00:21:25.770 --> 00:21:27.720
without having, like, my hand up the whole time.

332
00:21:27.720 --> 00:21:30.660
I was in a math class answering every question,

333
00:21:30.660 --> 00:21:33.220
and it was just too much.

334
00:21:35.007 --> 00:21:37.290
So I had to go to a psych ward.

335
00:21:37.290 --> 00:21:39.030
I got lucky, I was only there for a month and a week.

336
00:21:39.030 --> 00:21:41.583
Some people spend months or a year.

337
00:21:42.540 --> 00:21:44.460
I felt very vulnerable.

338
00:21:44.460 --> 00:21:46.977
I'm just in, like, a, in a scrub, you know,

339
00:21:46.977 --> 00:21:51.640
and just walking around in the same square area.

340
00:21:54.280 --> 00:21:56.370
And you're basically, like, trapping people

341
00:21:56.370 --> 00:21:59.280
until they're okay enough in your mind,

342
00:21:59.280 --> 00:22:01.560
not theirs, to leave.

343
00:22:01.560 --> 00:22:05.471
Sorry, that's probably the hardest for me to talk about.

344
00:22:05.471 --> 00:22:07.888
[soft ambient music]

345
00:22:11.250 --> 00:22:13.350
What do you think would happen,

346
00:22:13.350 --> 00:22:15.270
let's say you were 16 today

347
00:22:15.270 --> 00:22:16.953
and had the same symptoms.

348
00:22:18.330 --> 00:22:21.178
Somebody would pick me up and dump me

349
00:22:21.178 --> 00:22:23.760
in a 72 hour hold-and-treat

350
00:22:23.760 --> 00:22:25.380
in a hospital.

351
00:22:25.380 --> 00:22:27.363
I'd be drugged to the eyes.

352
00:22:30.180 --> 00:22:33.580
Probably a diagnosis would be put on, hallucinations.

353
00:22:34.830 --> 00:22:36.390
"That goes there."

354
00:22:36.390 --> 00:22:38.913 line:15%
Not having the medication to rely on,

355
00:22:40.170 --> 00:22:43.320 line:15%
the psychologists have to have found other ways

356
00:22:43.320 --> 00:22:46.260 line:15%
to influence and improve the lives of people

357
00:22:46.260 --> 00:22:48.690
who are suffering with psychological difficulties.

358
00:22:48.690 --> 00:22:51.810
That's the premise that Frieda Fromm-Reichmann

359
00:22:51.810 --> 00:22:53.943
and that whole generation worked off of,

360
00:22:53.943 --> 00:22:57.150
that there was an unconscious mind

361
00:22:57.150 --> 00:23:00.750
and that it's there even if people don't talk about it,

362
00:23:00.750 --> 00:23:03.300
even if no one else knows about it.

363
00:23:03.300 --> 00:23:04.920
That it's real to the person,

364
00:23:04.920 --> 00:23:06.900
and that you have to be with them

365
00:23:06.900 --> 00:23:09.340
in what's real for them until they can

366
00:23:10.590 --> 00:23:13.560
decide to join you and what's real for you.

367
00:23:13.560 --> 00:23:18.560
[soft ambient music]
[horse galloping]

368
00:23:20.068 --> 00:23:24.196
[water lapping]

369
00:23:24.196 --> 00:23:26.312
[birds calling]

370
00:24:17.341 --> 00:24:19.664
[water lapping]

371
00:24:56.455 --> 00:24:59.464
[birds calling]
[soft ambient music]

372
00:25:25.980 --> 00:25:28.200
Contrary to what many believe,

373
00:25:28.200 --> 00:25:32.558
antipsychotics do not necessarily take away psychosis.

374
00:25:32.558 --> 00:25:34.526 line:15%
[keyboard clicking]

375
00:26:23.558 --> 00:26:24.391
[ominous ambient music]

376
00:26:24.391 --> 00:26:25.860
There's a huge price to pay

377
00:26:25.860 --> 00:26:27.510
with these drugs in particular.

378
00:26:27.510 --> 00:26:30.930 line:15%
They can cause heart disease, diabetes.

379
00:26:30.930 --> 00:26:32.370 line:15%
They make people put on weight.

380
00:26:32.370 --> 00:26:36.543 line:15%
They, you know, impair people's sex drive and sex lives.

381
00:26:38.220 --> 00:26:40.323
So there's a high price to pay.

382
00:26:41.430 --> 00:26:45.120
But some mental health problems are really serious

383
00:26:45.120 --> 00:26:47.010
and do go on for a very long time.

384
00:26:47.010 --> 00:26:50.668
So sometimes I do think they're the better of the two evils.

385
00:26:50.668 --> 00:26:52.380
[pills rattling]

386
00:26:52.380 --> 00:26:54.510
I do strongly feel that no one else should go

387
00:26:54.510 --> 00:26:56.768
anywhere near the drugs, absolutely.

388
00:26:56.768 --> 00:26:59.185
[ominous ambient music]

389
00:27:00.116 --> 00:27:03.491
[water cascading]
[footsteps tapping]

390
00:27:05.670 --> 00:27:08.433
Yom Kippur is a day of atonement.

391
00:27:09.300 --> 00:27:12.120
The last prayer on the holiday

392
00:27:12.120 --> 00:27:16.740
is an apology to yourself and also to others.

393
00:27:16.740 --> 00:27:19.616
A lot of Jews fast, I'm fasting right now.

394
00:27:19.616 --> 00:27:21.120
[soft instrumental music]
[water cascading]

395
00:27:21.120 --> 00:27:24.243
On days like this, I do think about my grandmother.

396
00:27:25.260 --> 00:27:27.300
She's a Holocaust survivor.

397
00:27:27.300 --> 00:27:31.740
Eventually she ended up in Auschwitz, the death camp,

398
00:27:31.740 --> 00:27:34.230
and she survived,

399
00:27:34.230 --> 00:27:36.400
but she never spoke

400
00:27:38.340 --> 00:27:40.030
about her entire

401
00:27:40.920 --> 00:27:43.080
story surviving the Holocaust.

402
00:27:43.080 --> 00:27:45.780
And it's still painful for her to talk about,

403
00:27:45.780 --> 00:27:47.800
even at 93.

404
00:27:47.800 --> 00:27:50.040
[soft instrumental music]

405
00:27:50.040 --> 00:27:51.570
It was really important for her

406
00:27:51.570 --> 00:27:54.900
to just feed the family

407
00:27:54.900 --> 00:27:56.790
and to not talk about death,

408
00:27:56.790 --> 00:27:57.810
and to move on.

409
00:27:57.810 --> 00:27:59.910
But what happens is it gets buried,

410
00:27:59.910 --> 00:28:04.152
and then no one seeks help when they have a problem.

411
00:28:05.340 --> 00:28:08.730
I grew up in the house that my dad grew up in

412
00:28:08.730 --> 00:28:13.730
and was raised by his mom, my grandmother, and his father.

413
00:28:13.770 --> 00:28:15.450
And it's a similar environment.

414
00:28:15.450 --> 00:28:18.720
It's just like there's thin walls,

415
00:28:18.720 --> 00:28:19.590
you can hear everything,

416
00:28:19.590 --> 00:28:22.080
but everyone kind of stays to their room

417
00:28:22.080 --> 00:28:24.510
and doesn't really talk.

418
00:28:24.510 --> 00:28:26.700
I feel like there's more suffering

419
00:28:26.700 --> 00:28:28.560
when there doesn't need to be,

420
00:28:28.560 --> 00:28:30.750
and that's just how I feel like.

421
00:28:30.750 --> 00:28:32.370
But that might be out of my control

422
00:28:32.370 --> 00:28:34.420
and I need to focus what's in my control,

423
00:28:35.315 --> 00:28:37.920
and that's to challenge

424
00:28:37.920 --> 00:28:39.780
even when I'm this discouraged

425
00:28:39.780 --> 00:28:41.580
and I feel shame and I feel judgment.

426
00:28:41.580 --> 00:28:44.614
Like, speaking openly is how I feel more free.

427
00:28:44.614 --> 00:28:49.614
[soft instrumental music]
[water cascading]

428
00:28:50.314 --> 00:28:52.897
[propulsive instrumental music]

429
00:28:56.400 --> 00:28:59.470
Hi, we're doing a comedy show from 8 to 10.

430
00:28:59.470 --> 00:29:02.147
It's pay-what-you-can.

431
00:29:02.147 --> 00:29:03.780
Yeah, it's monthly, in case now it's busy.

432
00:29:03.780 --> 00:29:04.951
Would you like a flyer?

433
00:29:04.951 --> 00:29:06.198
Yeah.

434
00:29:06.198 --> 00:29:07.710
Thank you.
Thank you.

435
00:29:07.710 --> 00:29:08.760
No problem.

436
00:29:08.760 --> 00:29:09.647
Bye!
Bye.

437
00:29:09.647 --> 00:29:10.590
[traffic noise]

438
00:29:10.590 --> 00:29:13.187
Ask how they wanna be introduced or anything, or?

439
00:29:13.187 --> 00:29:15.030
I mean, I have everyone who's already here.

440
00:29:15.030 --> 00:29:15.863
Perfect.

441
00:29:15.863 --> 00:29:17.040
So if you just wanna go do the mic.

442
00:29:17.040 --> 00:29:18.960
Well, I will, I trust you.

443
00:29:18.960 --> 00:29:21.000
Could we check the second mic for the panel?

444
00:29:21.000 --> 00:29:23.220
No, actually...

445
00:29:23.220 --> 00:29:24.483
Okay, sweet.

446
00:29:25.860 --> 00:29:27.573
Is it, like, a strict time?

447
00:29:29.730 --> 00:29:30.900
It depends when we start.

448
00:29:30.900 --> 00:29:31.740
Oh, okay.

449
00:29:31.740 --> 00:29:32.880
I'll try to go fast.

450
00:29:32.880 --> 00:29:36.000
Just enjoy your time and we're here to support you.

451
00:29:36.000 --> 00:29:36.833
Great.

452
00:29:36.833 --> 00:29:37.950
Don't worry about that.
Alright.

453
00:29:37.950 --> 00:29:39.270
People go into comedy

454
00:29:39.270 --> 00:29:40.590
'cause they like to make people laugh.

455
00:29:40.590 --> 00:29:42.450
They like to feel good when they make people laugh.

456
00:29:42.450 --> 00:29:44.190
They like to make themselves laugh.

457
00:29:44.190 --> 00:29:47.220
They like-- but they also like having validation

458
00:29:47.220 --> 00:29:49.116
and being seen and feeling needed.

459
00:29:49.116 --> 00:29:51.699
[rhythmic dance music]

460
00:29:53.076 --> 00:29:56.240
[audience applauds]

461
00:29:56.240 --> 00:29:59.837
Hi, my name's Alo. Allô!

462
00:29:59.837 --> 00:30:01.479
Ça va bien?

463
00:30:06.920 --> 00:30:08.670
[audience laughs]

464
00:30:08.670 --> 00:30:12.760
Around July, I fell into this deep depression.

465
00:30:15.254 --> 00:30:17.160
Yeah, so that's why I had to, like,

466
00:30:17.160 --> 00:30:19.680
take a step back from the show.

467
00:30:19.680 --> 00:30:21.730
Don't put those pity lights on, I'm fine.

468
00:30:22.631 --> 00:30:24.810
But you know, there was thoughts of suicide

469
00:30:24.810 --> 00:30:25.950
and urges and episodes.

470
00:30:25.950 --> 00:30:28.950
I like to say I'm kind of like a TV show of mental health.

471
00:30:28.950 --> 00:30:30.524
Bless you, bless you.

472
00:30:30.524 --> 00:30:31.770
Gesundheit, labriut.

473
00:30:31.770 --> 00:30:33.160
Let's get through all of them.

474
00:30:33.160 --> 00:30:34.952
À tes souhaits.

475
00:30:34.952 --> 00:30:36.930
I don't wanna blow you away with this story,

476
00:30:36.930 --> 00:30:38.370
but I'll tell you this.

477
00:30:38.370 --> 00:30:39.820
Steve Martin said this,

478
00:30:39.820 --> 00:30:41.610
"It's like the last stand of the ego."

479
00:30:41.610 --> 00:30:44.910
Like, how you see yourself and how you've survived,

480
00:30:44.910 --> 00:30:48.570
if that's gonna change, you're really challenging it there

481
00:30:48.570 --> 00:30:51.780
and, like, just putting yourself out there for five minutes,

482
00:30:51.780 --> 00:30:54.210
like, your best self.

483
00:30:54.210 --> 00:30:58.440
I was tired of being in the closet.

484
00:30:58.440 --> 00:31:01.080
I actually was outed to my family.

485
00:31:01.080 --> 00:31:02.460
Technically, it's partly my fault.

486
00:31:02.460 --> 00:31:04.500
I did a show called "Non-Binary Diary."

487
00:31:04.500 --> 00:31:07.320
It's a diary about being non-binary, it's my diaries.

488
00:31:07.320 --> 00:31:09.840
I came out, I wrote this post, like,

489
00:31:09.840 --> 00:31:12.090
literally on Saturday, Sunday,

490
00:31:12.090 --> 00:31:14.640
and, like, there was so much love and support.

491
00:31:14.640 --> 00:31:18.333
And a family member of mine told me to take it down,

492
00:31:19.200 --> 00:31:21.877
then asked me like a day ago,

493
00:31:21.877 --> 00:31:23.100
"So how do you feel?"

494
00:31:23.100 --> 00:31:25.050
Like, you know, just trying to hide.

495
00:31:25.050 --> 00:31:27.030
And I was, like, done hiding my anger.

496
00:31:27.030 --> 00:31:31.608
So what I told him was "I'm fasting and furious."

497
00:31:31.608 --> 00:31:33.676
[audience laughs]

498
00:31:33.676 --> 00:31:36.336
And on that, thank you so much

499
00:31:36.336 --> 00:31:37.488
for being here.

500
00:31:37.488 --> 00:31:39.657
[audience applauds]

501
00:31:39.657 --> 00:31:41.229
[soft instrumental music]

502
00:31:41.229 --> 00:31:43.305
[steeple bells ringing]

503
00:32:27.100 --> 00:32:31.283
[leaves rustling]
[soft instrumental music]

504
00:33:11.493 --> 00:33:14.243
[leaves rustling]

505
00:33:43.087 --> 00:33:44.773
[soft instrumental music]

506
00:33:44.773 --> 00:33:47.040
A child can shut down

507
00:33:47.040 --> 00:33:48.600
by age five or six

508
00:33:48.600 --> 00:33:50.460
and a parent may not even realize it

509
00:33:50.460 --> 00:33:52.920
until they're well into adolescence.

510
00:33:52.920 --> 00:33:54.877
You know, "Oh, they're just quiet. They like to be alone.

511
00:33:54.877 --> 00:33:55.920
"They're introverted."

512
00:33:55.920 --> 00:33:57.897
Yeah, people are like that, and many people are like that

513
00:33:57.897 --> 00:34:00.600
and just grow up to be introverted adults,

514
00:34:00.600 --> 00:34:03.633
not patients with serious difficulties, so.

515
00:34:04.498 --> 00:34:06.300
I think it's, you know,

516
00:34:06.300 --> 00:34:09.180
parenting is the hardest job in the world.

517
00:34:09.180 --> 00:34:10.320
I know from experience.

518
00:34:10.320 --> 00:34:13.620
And I think anyone who has been a parent knows that.

519
00:34:13.620 --> 00:34:15.150
And it's easy to miss things,

520
00:34:15.150 --> 00:34:16.473
even when you're trying.

521
00:34:16.473 --> 00:34:21.473
[leaves rustling]
[soft instrumental music]

522
00:34:25.260 --> 00:34:26.110
Hey, what's up?

523
00:34:30.045 --> 00:34:31.740
Just wondering,

524
00:34:31.740 --> 00:34:32.970
are you willing to come back

525
00:34:32.970 --> 00:34:34.795
to produce?

526
00:34:37.476 --> 00:34:40.028
Probably through December.

527
00:34:40.028 --> 00:34:41.724
[door creaking]

528
00:34:41.724 --> 00:34:42.940
Okay.

529
00:34:42.940 --> 00:34:44.550
Bye.

530
00:34:44.550 --> 00:34:48.090
I'm not afraid to seek support.

531
00:34:48.090 --> 00:34:50.730
And I get judged for seeking support.

532
00:34:50.730 --> 00:34:53.404
Mental health stigma is real.

533
00:34:54.437 --> 00:34:57.887
I don't like experiencing a manic episode.

534
00:34:57.887 --> 00:34:59.403
It is not fun.

535
00:34:59.403 --> 00:35:04.020
And internally, I'll be honest,

536
00:35:04.020 --> 00:35:06.510
maybe people enjoy the energy,

537
00:35:06.510 --> 00:35:08.340
you know, and the thoughts

538
00:35:08.340 --> 00:35:11.940
and the debate on the creativity.

539
00:35:11.940 --> 00:35:13.260
But at the end of the day,

540
00:35:13.260 --> 00:35:17.490
like, you could come up with thoughts by just working hard.

541
00:35:17.490 --> 00:35:19.320
You don't need it.

542
00:35:19.320 --> 00:35:23.191
And if it gets out of control, then what?

543
00:35:27.784 --> 00:35:32.220
I don't feel the same ever after a manic episode.

544
00:35:32.220 --> 00:35:35.535
It's very stressful on my body,

545
00:35:35.535 --> 00:35:37.143
on my mind,

546
00:35:38.160 --> 00:35:39.183
on my heart.

547
00:35:40.067 --> 00:35:43.586
♪ Bright sunny morning ♪

548
00:35:43.586 --> 00:35:46.940
♪ Head full of sand ♪

549
00:35:46.940 --> 00:35:50.392
♪ Wake up to a band playing ♪

550
00:35:50.392 --> 00:35:53.915
♪ Sweet and low ♪

551
00:35:53.915 --> 00:35:57.592
♪ I think you came to see me ♪

552
00:35:57.592 --> 00:36:01.122
♪ In a dream I had ♪

553
00:36:01.122 --> 00:36:02.485
♪ You reached out ♪

554
00:36:02.485 --> 00:36:03.960
♪ Your hand ♪

555
00:36:03.960 --> 00:36:06.224
♪ It was steady and warm ♪

556
00:36:06.224 --> 00:36:09.150
♪ And everything felt all right ♪

557
00:36:09.150 --> 00:36:10.828
I wanna talk about how hard it is

558
00:36:10.828 --> 00:36:13.140
to feel happy to be alive.

559
00:36:13.140 --> 00:36:14.790
And I don't always feel that way.

560
00:36:16.050 --> 00:36:17.910
I feel that way right now

561
00:36:17.910 --> 00:36:19.890
'cause I just got out of a depression,

562
00:36:19.890 --> 00:36:22.950
so I feel safe enough to talk about this.

563
00:36:22.950 --> 00:36:25.770
But I'm gonna talk about it slowly.

564
00:36:25.770 --> 00:36:30.770
So I could get manic and suicidal,

565
00:36:31.080 --> 00:36:34.590
and that's why I'm on medication now.

566
00:36:34.590 --> 00:36:36.720
I've visualized a plan.

567
00:36:36.720 --> 00:36:39.180
I've never acted on it,

568
00:36:39.180 --> 00:36:42.213
but I felt very close.

569
00:36:45.060 --> 00:36:47.610
Like, there's times where I've wanted to choke myself,

570
00:36:47.610 --> 00:36:49.941
there's times where I've wanted

571
00:36:49.941 --> 00:36:51.840
to jump in the Metro.

572
00:36:51.840 --> 00:36:54.690
But then I think about having family

573
00:36:54.690 --> 00:36:56.640
that cares about me, and friends.

574
00:36:57.898 --> 00:37:01.506
[soft instrumental music]
[footsteps tapping]

575
00:37:10.600 --> 00:37:13.470
You have these experiences that kind of just affect

576
00:37:13.470 --> 00:37:15.540
how you feel inside.

577
00:37:15.540 --> 00:37:19.665
So, like, traumas, first relationships.

578
00:37:22.170 --> 00:37:26.200
Okay, my first experience

579
00:37:28.080 --> 00:37:30.240
wasn't consensual.

580
00:37:30.240 --> 00:37:32.760
It's ruined how I view sex.

581
00:37:32.760 --> 00:37:36.600
It's just-- and I'm getting support for that.

582
00:37:36.600 --> 00:37:39.960
I went to the Sexual Assault Resource Centre at Concordia

583
00:37:39.960 --> 00:37:41.940
and I told them my story.

584
00:37:41.940 --> 00:37:44.190
And that was a good start,

585
00:37:44.190 --> 00:37:46.020
but it wasn't enough,

586
00:37:46.020 --> 00:37:46.853
if that makes sense.

587
00:37:46.853 --> 00:37:50.288
I just got the story out, and we didn't--

588
00:37:50.288 --> 00:37:52.170
It's kind of like when you unbox a trauma

589
00:37:52.170 --> 00:37:54.480
and you don't really cope with it.

590
00:37:54.480 --> 00:37:58.410
I'm right now working on forgiving myself

591
00:37:58.410 --> 00:38:02.010
for being so hard on myself after what had happened to me.

592
00:38:02.010 --> 00:38:05.793
'Cause I blamed myself for what this person did to me,

593
00:38:07.335 --> 00:38:09.943
which is why it's fucked up.

594
00:38:11.010 --> 00:38:13.427
[soft instrumental music]

595
00:38:16.620 --> 00:38:18.960
If one day, like, I stopped getting manic,

596
00:38:18.960 --> 00:38:21.060
and let's say my trauma was dealt with

597
00:38:21.060 --> 00:38:23.130
and I stopped becoming manic,

598
00:38:23.130 --> 00:38:26.280
I would just feel I wasn't bipolar anymore.

599
00:38:26.280 --> 00:38:29.738
But I would think right now I'm bipolar.

600
00:38:29.738 --> 00:38:32.155
[soft instrumental music]

601
00:38:34.830 --> 00:38:39.180
Let me say something about bipolar disorder.

602
00:38:39.180 --> 00:38:44.180
80 years ago they would talk about someone having a break,

603
00:38:44.700 --> 00:38:47.430
a bipolar break, a manic break

604
00:38:47.430 --> 00:38:50.520
at age 24, say,

605
00:38:50.520 --> 00:38:52.620
I'm making it up,

606
00:38:52.620 --> 00:38:54.150
at age 24

607
00:38:54.150 --> 00:38:56.310
and then getting over it

608
00:38:56.310 --> 00:39:00.360
and 8 years later, at 32, having another break.

609
00:39:00.360 --> 00:39:04.470
And then 15 years later having a third break,

610
00:39:04.470 --> 00:39:06.690
and maybe that was it for life.

611
00:39:06.690 --> 00:39:10.650
So I'm saying, years ago,
bipolar disorder

612
00:39:10.650 --> 00:39:13.680
used to look somewhat different.

613
00:39:13.680 --> 00:39:16.002
Why is there so much more

614
00:39:16.002 --> 00:39:18.873
bipolar disorder now than there used to be?

615
00:39:19.710 --> 00:39:22.650
I think it gets over-diagnosed.

616
00:39:22.650 --> 00:39:24.810
I think it's over-diagnosed.

617
00:39:24.810 --> 00:39:27.630
What I think's happened is that the term

618
00:39:27.630 --> 00:39:31.200
has been applied to many more situations

619
00:39:31.200 --> 00:39:33.660
than that core group,

620
00:39:33.660 --> 00:39:36.000
that sort of core group of situations.

621
00:39:36.000 --> 00:39:37.560
And now it appears to be more common,

622
00:39:37.560 --> 00:39:39.550
but I don't think the actual

623
00:39:40.500 --> 00:39:42.660
serious situation that we used to refer to

624
00:39:42.660 --> 00:39:44.973
as manic depression when people would become,

625
00:39:45.925 --> 00:39:49.260
you know, very disinhibited, very excited,

626
00:39:49.260 --> 00:39:52.320
not sleep for weeks on end,

627
00:39:52.320 --> 00:39:54.210
be running around all over the place,

628
00:39:54.210 --> 00:39:56.340
behaving in a very bizarre,

629
00:39:56.340 --> 00:39:58.230
very uncharacteristic fashion

630
00:39:58.230 --> 00:39:59.940
and almost always end up in hospital,

631
00:39:59.940 --> 00:40:02.190
often picked up by the police.

632
00:40:02.190 --> 00:40:05.010
That sort of situation hasn't become more common.

633
00:40:05.010 --> 00:40:08.070
It was rare a hundred years ago.

634
00:40:08.070 --> 00:40:09.690
It's still rare now.

635
00:40:09.690 --> 00:40:13.140
We know that various drug companies put a lot of effort

636
00:40:13.140 --> 00:40:15.870
into promoting the idea

637
00:40:15.870 --> 00:40:19.440
that bipolar disorder was a much wider condition.

638
00:40:19.440 --> 00:40:21.600
Most people would much rather have a diagnosis

639
00:40:21.600 --> 00:40:24.960
of bipolar than have another sort of diagnosis

640
00:40:24.960 --> 00:40:26.490
like personality disorder

641
00:40:26.490 --> 00:40:27.790
or addiction

642
00:40:28.650 --> 00:40:30.360
or schizophrenia.

643
00:40:30.360 --> 00:40:33.510
Kids are being diagnosed with bipolar disorder

644
00:40:33.510 --> 00:40:36.540
very frequently nowadays,

645
00:40:36.540 --> 00:40:39.930
or at least much more frequently than they used to.

646
00:40:39.930 --> 00:40:44.107
It really probably does exist in some kids,

647
00:40:44.107 --> 00:40:49.020
but it's probably vastly overused in kids.

648
00:40:49.020 --> 00:40:52.260
There are kids who are cranky and they're not cranky.

649
00:40:52.260 --> 00:40:54.155
That's not bipolar.

650
00:40:54.155 --> 00:40:57.270
Putting them on antipsychotics is crazy

651
00:40:57.270 --> 00:41:00.780
unless they're totally psychotic,

652
00:41:00.780 --> 00:41:02.430
which they usually aren't.

653
00:41:02.430 --> 00:41:03.600
That's crazy.

654
00:41:03.600 --> 00:41:06.870
I've spoken to psychiatrists,

655
00:41:06.870 --> 00:41:08.880
but I haven't come up

656
00:41:08.880 --> 00:41:13.320
with them saying intelligent things

657
00:41:13.320 --> 00:41:15.900
about why the kids are bipolar.

658
00:41:15.900 --> 00:41:18.780
So we're back at square one or--

659
00:41:18.780 --> 00:41:20.610
No, we're not at square one,

660
00:41:20.610 --> 00:41:22.290
we're at square seven.

661
00:41:22.290 --> 00:41:25.939
But it's square seven out of twenty squares.

662
00:41:26.864 --> 00:41:30.001
[soft instrumental music]

663
00:41:30.001 --> 00:41:33.084
[traffic noise]

664
00:41:36.051 --> 00:41:38.468 line:15%
[soft instrumental music]

665
00:42:30.107 --> 00:42:34.590
We are pleased to receive Dr. Steingard today

666
00:42:34.590 --> 00:42:39.240
to talk to us about slow psychiatry that focuses on patients

667
00:42:39.240 --> 00:42:41.520
rather than other needs like the needs

668
00:42:41.520 --> 00:42:44.160
of pharmaceutical industry.

669
00:42:44.160 --> 00:42:45.000
Thank you so much...

670
00:42:45.000 --> 00:42:47.550
This is young psychiatrists in training

671
00:42:47.550 --> 00:42:51.700
who became interested in the concept of critical psychiatry

672
00:42:52.708 --> 00:42:55.350
and organized a conference on that topic

673
00:42:55.350 --> 00:42:56.730
and invited me up there.

674
00:42:56.730 --> 00:42:58.740
And I've used the term slow psychiatry,

675
00:42:58.740 --> 00:43:01.950
which I've borrowed from David Healy.

676
00:43:01.950 --> 00:43:04.740
It accepts that drugs are a tool and not a cure,

677
00:43:04.740 --> 00:43:07.320
which I think is what the evidence supports,

678
00:43:07.320 --> 00:43:09.420
gives you a way of being that allows you

679
00:43:09.420 --> 00:43:11.790
to embody humility and uncertainty.

680
00:43:11.790 --> 00:43:14.610
You don't have to give up your psychiatric perspective,

681
00:43:14.610 --> 00:43:17.160
but you hold it in a way that acknowledges

682
00:43:17.160 --> 00:43:21.690
it's A perspective as opposed to THE perspective.

683
00:43:21.690 --> 00:43:23.340
I was asked to talk a little bit

684
00:43:23.340 --> 00:43:24.870
about what we're doing in Vermont,

685
00:43:24.870 --> 00:43:27.183
and I feel really proud of this one...

686
00:43:28.770 --> 00:43:30.450
What Dr. Steingard is doing

687
00:43:30.450 --> 00:43:33.003
in her Vermont practice is remarkable.

688
00:43:34.110 --> 00:43:36.210
She's a mainstream psychiatrist

689
00:43:36.210 --> 00:43:37.530
who is supporting patients

690
00:43:37.530 --> 00:43:39.723
who wish to reduce their medications.

691
00:43:40.650 --> 00:43:42.930
So I felt like I was shifting

692
00:43:42.930 --> 00:43:45.390
in my understanding of these drugs

693
00:43:45.390 --> 00:43:48.963
and I felt an obligation to bring it into the clinic.

694
00:43:50.490 --> 00:43:54.090 line:15%
I got assigned to Dr. Steingard about three years ago.

695
00:43:54.090 --> 00:43:56.400 line:15%
Temporarily is what it was supposed to be,

696
00:43:56.400 --> 00:43:57.963
because I lost my doctor.

697
00:43:59.130 --> 00:44:01.027
After about six months, she said,

698
00:44:01.027 --> 00:44:02.887
"You're on a lot of medication

699
00:44:02.887 --> 00:44:05.767
"and I'm not sure that it's all useful for you

700
00:44:05.767 --> 00:44:06.607
"at this point.

701
00:44:06.607 --> 00:44:10.110
"We could probably wean off of a lot of that."

702
00:44:10.110 --> 00:44:13.320
And over a period of three years, we did.

703
00:44:13.320 --> 00:44:15.790
What I do in my practice is just

704
00:44:17.082 --> 00:44:21.360
to talk with people, to talk about the risks and benefits

705
00:44:21.360 --> 00:44:22.620
for every decision,

706
00:44:22.620 --> 00:44:24.390
'cause there's, you know,

707
00:44:24.390 --> 00:44:25.830
there's risks of staying on a drug

708
00:44:25.830 --> 00:44:28.590
that you may not need at the current dose

709
00:44:28.590 --> 00:44:30.150
and then there's a risk of stopping

710
00:44:30.150 --> 00:44:32.313
if it turns out you do, and talk about that,

711
00:44:33.428 --> 00:44:37.590
and to try to build in as much support as possible

712
00:44:37.590 --> 00:44:40.738
so that we can intervene

713
00:44:40.738 --> 00:44:42.570
if something were to happen.

714
00:44:42.570 --> 00:44:46.739
And most of the time it's not a dramatic thing.

715
00:44:46.739 --> 00:44:48.330
And then there's a point

716
00:44:48.330 --> 00:44:51.300
where a person goes into an extreme state

717
00:44:51.300 --> 00:44:53.640
and all of that has gone out the window.

718
00:44:53.640 --> 00:44:55.620
It's like we don't even know each other.

719
00:44:55.620 --> 00:44:57.390
And that's really troubling,

720
00:44:57.390 --> 00:44:59.910
and that's why I think some people think

721
00:44:59.910 --> 00:45:02.460
we shouldn't ever taper these drugs,

722
00:45:02.460 --> 00:45:04.680
because you don't know when that's gonna happen.

723
00:45:04.680 --> 00:45:07.020
And I understand that argument,

724
00:45:07.020 --> 00:45:11.426
but again, to me, it's all a risk-benefit thing.

725
00:45:11.426 --> 00:45:14.772
[ducks quacking]

726
00:45:14.772 --> 00:45:16.440
[snow crunching]

727
00:45:16.440 --> 00:45:19.050
Three years ago I was taking

728
00:45:19.050 --> 00:45:24.050
approximately 22 and a half milligrams of Zyprexa a day.

729
00:45:24.150 --> 00:45:26.800
I was taking Klonopin,

730
00:45:27.720 --> 00:45:31.080
and I was taking antidepressant, Zoloft.

731
00:45:31.080 --> 00:45:34.440
Over three years, we'd reduced the antipsychotic

732
00:45:34.440 --> 00:45:37.535
by about two and a half milligrams

733
00:45:37.535 --> 00:45:38.973
every visit.

734
00:45:39.810 --> 00:45:43.110
And the antidepressant,

735
00:45:43.110 --> 00:45:44.950
I think we reduced it to half.

736
00:45:45.890 --> 00:45:47.790
And the Klonopins,

737
00:45:47.790 --> 00:45:50.250
reduced them to nothing.

738
00:45:50.250 --> 00:45:52.140
So what do you take now?

739
00:45:52.140 --> 00:45:54.870
10 milligrams of Zyprexa every night.

740
00:45:54.870 --> 00:45:55.980
Anything else?

741
00:45:55.980 --> 00:45:57.411
Nope.

742
00:45:59.839 --> 00:46:00.672
How you doing?

743
00:46:00.672 --> 00:46:01.922
Hi, Layne.
Hi.

744
00:46:02.820 --> 00:46:05.820
It's important for me to keep up my physical health

745
00:46:05.820 --> 00:46:09.320
to be able to do those type work that I do.

746
00:46:09.320 --> 00:46:12.213
It allows me to function financially.

747
00:46:12.213 --> 00:46:14.963
[shovel scraping]

748
00:46:16.027 --> 00:46:19.620
[ducks quacking]
[soft instrumental music]

749
00:46:19.620 --> 00:46:21.960
I'm a very pragmatic person.

750
00:46:21.960 --> 00:46:24.360
If it works, then I don't really wanna mess around

751
00:46:24.360 --> 00:46:25.650
too much with it.

752
00:46:25.650 --> 00:46:29.550 line:15%
We decided, because of that, to go down very slowly,

753
00:46:29.550 --> 00:46:32.130 line:15%
slower than other people had gone down

754
00:46:32.130 --> 00:46:33.693
in the tapering process.

755
00:46:34.770 --> 00:46:38.370
So that made me feel a little bit more comfortable,

756
00:46:38.370 --> 00:46:40.110
and then I started to notice

757
00:46:40.110 --> 00:46:43.380
that my symptoms were not reappearing.

758
00:46:43.380 --> 00:46:45.240
Sometimes your imagination,

759
00:46:45.240 --> 00:46:46.920
you might be able to imagine things,

760
00:46:46.920 --> 00:46:49.560
all of a sudden the imagination is real.

761
00:46:49.560 --> 00:46:51.570
It's happening to you.

762
00:46:51.570 --> 00:46:53.550
I've had conversations

763
00:46:53.550 --> 00:46:55.893
with my own imagination.

764
00:46:57.180 --> 00:47:01.380
That's a terribly difficult thing to see for people

765
00:47:01.380 --> 00:47:04.473
because it's so different from what most people do.

766
00:47:06.060 --> 00:47:08.160
I take clozapine.

767
00:47:08.160 --> 00:47:10.260
My original dose was probably somewhere

768
00:47:10.260 --> 00:47:12.213
around 350 milligrams,

769
00:47:13.320 --> 00:47:15.180
and at first we were going down

770
00:47:15.180 --> 00:47:17.790
by 25 milligrams every 6 months.

771
00:47:17.790 --> 00:47:20.310
And then I slowed it down again

772
00:47:20.310 --> 00:47:25.248
once we got below probably 200 milligrams, to 17.5.

773
00:47:25.248 --> 00:47:27.600
And we did that every 3 to 6 months

774
00:47:27.600 --> 00:47:29.550
for the remaining time

775
00:47:29.550 --> 00:47:32.550
that I was tapering down on this particular medication.

776
00:47:32.550 --> 00:47:35.760
And I actually had to increase the dosage last year

777
00:47:35.760 --> 00:47:38.760
during a difficult time that I was going through.

778
00:47:38.760 --> 00:47:42.120
And I've maintained that dosage for about a year,

779
00:47:42.120 --> 00:47:45.000
but I'm starting to get ready to go down again.

780
00:47:45.000 --> 00:47:47.250
And that's really empowering for me actually,

781
00:47:47.250 --> 00:47:50.583
is that I actually have a voice in this.

782
00:47:51.879 --> 00:47:53.940
If you have someone in their 40s

783
00:47:53.940 --> 00:47:56.400
and you're saying, "We're gonna take 10 years,"

784
00:47:56.400 --> 00:47:58.800
you're still maybe gonna have them off of the drug

785
00:47:58.800 --> 00:48:02.190
or down to a very low dose at 50.

786
00:48:02.190 --> 00:48:05.760
Well that's still 30, 40 years, you hope, of their life.

787
00:48:05.760 --> 00:48:06.903
That's a good thing.

788
00:48:08.280 --> 00:48:09.937
How did reading Whitaker's book

789
00:48:09.937 --> 00:48:13.110
"Anatomy of an Epidemic," affect you?

790
00:48:13.110 --> 00:48:16.170
Well, it was devastating,

791
00:48:16.170 --> 00:48:19.200
because my conceptualization

792
00:48:19.200 --> 00:48:22.740
of what I was doing was to convince people

793
00:48:22.740 --> 00:48:24.507
to take these drugs.

794
00:48:24.507 --> 00:48:26.911
And this idea that long-term exposure

795
00:48:26.911 --> 00:48:30.330
might result in a worse outcome

796
00:48:30.330 --> 00:48:32.430
was news to me,

797
00:48:32.430 --> 00:48:34.050
and very disheartening,

798
00:48:34.050 --> 00:48:37.500
and would be a fundamental shift

799
00:48:37.500 --> 00:48:38.610
in how I thought about work.

800
00:48:38.610 --> 00:48:40.620
But he's not an academic,

801
00:48:40.620 --> 00:48:42.300
he's not a psychiatrist.

802
00:48:42.300 --> 00:48:45.780
So what I started to do was to read

803
00:48:45.780 --> 00:48:47.610
all the primary literature

804
00:48:47.610 --> 00:48:51.150
and to try to talk with my colleagues about this

805
00:48:51.150 --> 00:48:53.100
and engage in conversation.

806
00:48:53.100 --> 00:48:55.623
And that's sort of-- that decision,

807
00:48:56.673 --> 00:48:59.816
you know, sort of leads me to be sitting with you today.

808
00:48:59.816 --> 00:49:03.030
[soft ambient music]

809
00:49:03.030 --> 00:49:06.960
You go on an antipsychotic, it blocks dopamine receptors,

810
00:49:06.960 --> 00:49:10.080
it blocks a particular receptor called the D2 receptor.

811
00:49:10.080 --> 00:49:12.990
So now what is your brain gonna do in response?

812
00:49:12.990 --> 00:49:15.540
It's gonna try to increase its dopamine activity

813
00:49:15.540 --> 00:49:18.660
to counterbalance that blockade,

814
00:49:18.660 --> 00:49:21.690
and researchers say the brain is trying to maintain

815
00:49:21.690 --> 00:49:23.670
a homeostatic equilibrium.

816
00:49:23.670 --> 00:49:25.670
This is well understood.

817
00:49:27.180 --> 00:49:28.373
The best way I know how to explain this

818
00:49:28.373 --> 00:49:29.880
is with a metaphor.

819
00:49:29.880 --> 00:49:33.000
Think of the drugs acting as a break

820
00:49:33.000 --> 00:49:35.280
on this transmission.

821
00:49:35.280 --> 00:49:38.310
Your brain in response puts down the accelerator,

822
00:49:38.310 --> 00:49:40.620
trying to maintain equilibrium.

823
00:49:40.620 --> 00:49:43.293
The drug acts as a blockade of dopamine, right?

824
00:49:44.250 --> 00:49:47.490
Your brain puts down extra receptors for dopamine.

825
00:49:47.490 --> 00:49:50.460
You might get 50% more D2 receptors.

826
00:49:50.460 --> 00:49:52.320
Now take away the drug.

827
00:49:52.320 --> 00:49:54.240
You have these extra receptors,

828
00:49:54.240 --> 00:49:56.820
and the idea is this is why you get such severe relapses

829
00:49:56.820 --> 00:49:58.570
when people come off.

830
00:50:00.570 --> 00:50:03.900
It's called dopamine withdrawal psychosis,

831
00:50:03.900 --> 00:50:07.200
and it occurs in people whose brains have become conditioned

832
00:50:07.200 --> 00:50:09.620
to taking antipsychotics.

833
00:50:11.640 --> 00:50:14.640
In response, a psychiatrist will typically

834
00:50:14.640 --> 00:50:16.860
put their patient back on the drug,

835
00:50:16.860 --> 00:50:18.810
usually at a higher dose,

836
00:50:18.810 --> 00:50:20.343
and the cycle continues.

837
00:50:22.320 --> 00:50:26.280
What is still unknown is whether the brain can stabilize

838
00:50:26.280 --> 00:50:29.283
after a certain amount of time off the antipsychotic.

839
00:50:31.230 --> 00:50:34.230
In the meantime, people for whom these drugs

840
00:50:34.230 --> 00:50:35.760
have been prescribed

841
00:50:35.760 --> 00:50:37.744
must live with uncertainty.

842
00:50:38.619 --> 00:50:41.619
[ominous ambient music]

843
00:50:46.950 --> 00:50:51.060
Psychiatry didn't always rely heavily on medications.

844
00:50:51.060 --> 00:50:54.450
There are other ideas and principles from psychiatry's past

845
00:50:54.450 --> 00:50:56.223
that have stood the test of time.

846
00:50:57.990 --> 00:51:00.660
Dr. Danielle Bordeleau works with his patients

847
00:51:00.660 --> 00:51:03.993
according to the teachings of Carl Jung.

848
00:51:43.478 --> 00:51:45.561
[soft instrumental music]

849
00:52:11.699 --> 00:52:14.116
[soft instrumental music]

850
00:53:23.700 --> 00:53:26.117
[soft instrumental music]

851
00:53:28.421 --> 00:53:30.630
[traffic noise]

852
00:53:30.630 --> 00:53:34.503
January was hard, as it is for so many people.

853
00:53:35.460 --> 00:53:38.583
My cat passed away.

854
00:53:39.883 --> 00:53:41.266
That was...

855
00:53:45.316 --> 00:53:48.330
That caused a lot of dismay.

856
00:53:48.330 --> 00:53:50.500
I couldn't really

857
00:53:52.350 --> 00:53:53.730
process that.

858
00:53:53.730 --> 00:53:56.190
School, I had to cut it down.

859
00:53:56.190 --> 00:53:58.980
I've worked so hard for school.

860
00:53:58.980 --> 00:54:00.960
Sometimes I forget how to take care of my mental health.

861
00:54:00.960 --> 00:54:03.630
I forget-- I forgot to take my medication yesterday

862
00:54:03.630 --> 00:54:04.687
and, like, I had to remember,

863
00:54:04.687 --> 00:54:07.800
"Go home, take your medication, sleep."

864
00:54:07.800 --> 00:54:11.109
So to get, like, a diagnosis of, like, something

865
00:54:11.109 --> 00:54:13.890
that sounds chronic

866
00:54:13.890 --> 00:54:18.685
can be really, like, damaging for hope.

867
00:54:18.685 --> 00:54:21.870
It's a real challenge to fight that.

868
00:54:21.870 --> 00:54:23.520
That's what the crisis line told me,

869
00:54:23.520 --> 00:54:25.350
that's what the therapist told me,

870
00:54:25.350 --> 00:54:26.940
and what I'm feeling is normal.

871
00:54:26.940 --> 00:54:30.431
And, like, just hearing that helped me get through January.

872
00:54:31.381 --> 00:54:34.131
[traffic noise]
[soft jazz music]

873
00:54:37.590 --> 00:54:42.360
There's a bad knot in the back, I'm really sorry.

874
00:54:42.360 --> 00:54:43.980
I wanna know what you think about the knots.

875
00:54:43.980 --> 00:54:45.660
Well, the best thing, conditioner.

876
00:54:45.660 --> 00:54:46.493
Yeah.

877
00:54:46.493 --> 00:54:48.120
Comb the hair every day.

878
00:54:48.120 --> 00:54:49.530
Yes.

879
00:54:49.530 --> 00:54:50.520
Like, even in the shower,

880
00:54:50.520 --> 00:54:52.740
just go in the shower and as you shampoo

881
00:54:52.740 --> 00:54:54.120
just comb through it.

882
00:54:54.120 --> 00:54:57.327
Oh really? Yeah, I don't comb.

883
00:54:57.327 --> 00:54:59.610
[soft jazz music]

884
00:54:59.610 --> 00:55:00.910
It's really well lit here.

885
00:55:02.040 --> 00:55:03.364
Yeah, it's pretty cool.

886
00:55:03.364 --> 00:55:04.314
It's a cool vibe.

887
00:55:06.450 --> 00:55:07.873
What's your show about today?

888
00:55:07.873 --> 00:55:10.170
It's about performing.

889
00:55:10.170 --> 00:55:12.330
We got some musicians singing

890
00:55:12.330 --> 00:55:17.310
and we got some poets, storytellers, comedians.

891
00:55:17.310 --> 00:55:19.140
My performance is kind of about, like,

892
00:55:19.140 --> 00:55:21.300
things I've been putting off for months,

893
00:55:21.300 --> 00:55:24.547
and one of those includes a haircut, so.

894
00:55:24.547 --> 00:55:27.798
The show starts at 8 right across the street.

895
00:55:27.798 --> 00:55:29.523
Okay, perfect.

896
00:55:32.598 --> 00:55:33.930
[audience applauds]

897
00:55:33.930 --> 00:55:36.730
I named myself after the plant, aloe vera,

898
00:55:39.089 --> 00:55:40.710
because it's a plant that heals itself

899
00:55:40.710 --> 00:55:42.150
and we all get cut sometimes,

900
00:55:42.150 --> 00:55:44.553
you know, by life and prickly situations.

901
00:55:45.630 --> 00:55:49.140
It's been just four weeks since I started therapy

902
00:55:49.140 --> 00:55:51.180
and I saw my therapist two days ago.

903
00:55:51.180 --> 00:55:52.740
We never get anything done.

904
00:55:52.740 --> 00:55:56.190
I look like Billy Crystal in therapy sometimes.

905
00:55:56.190 --> 00:56:00.540
So just try not to be that stereotypical comedian in therapy

906
00:56:00.540 --> 00:56:02.643
who's just pushing their emotions down.

907
00:56:03.510 --> 00:56:04.470
I learned something.

908
00:56:04.470 --> 00:56:07.150
I use comedy performance

909
00:56:08.586 --> 00:56:10.320
to dismiss my own pain.

910
00:56:10.320 --> 00:56:13.620
What I found there wasn't anger, it was just pain.

911
00:56:13.620 --> 00:56:15.480
I mean, I know this is, like, really obvious

912
00:56:15.480 --> 00:56:17.940
and maybe not the most entertaining.

913
00:56:17.940 --> 00:56:20.680
I'll stop judging myself, keep seeing that therapist.

914
00:56:21.582 --> 00:56:23.700
'cause I have as many exes as I do therapists

915
00:56:23.700 --> 00:56:25.202
I'd like to keep one around.

916
00:56:25.202 --> 00:56:29.348
[audience applauds]

917
00:56:29.348 --> 00:56:32.098
[leaves rustling]

918
00:56:34.777 --> 00:56:38.010
[soft instrumental music]

919
00:56:40.980 --> 00:56:43.560
To my surprise,
Myriam Anouk

920
00:56:43.560 --> 00:56:45.990
tells me she has a half brother

921
00:56:45.990 --> 00:56:48.710
and that he lives in Montreal.

922
00:56:48.710 --> 00:56:51.127
[soft instrumental music]

923
00:57:03.381 --> 00:57:05.798
[soft instrumental music]

924
00:57:07.929 --> 00:57:11.030
[doorbell ringing]

925
00:57:11.030 --> 00:57:13.863
[car horn blaring]
[sirens wailing]

926
00:57:27.455 --> 00:57:28.705
[door latching]

927
01:00:44.680 --> 01:00:46.500
[soft instrumental music]

928
01:00:46.500 --> 01:00:48.570
One of the ways in which Myriam Anouk

929
01:00:48.570 --> 01:00:52.170
reconnected with the world after her psychosis

930
01:00:52.170 --> 01:00:54.236
was through art.

931
01:00:54.236 --> 01:00:56.653
[soft instrumental music]

932
01:01:09.055 --> 01:01:11.138
[soft instrumental music]

933
01:01:43.584 --> 01:01:47.526
[traffic noise]
[soft instrumental music]

934
01:01:54.837 --> 01:01:56.760
[indistinct chatter]

935
01:01:56.760 --> 01:02:00.150
Organizations run by and for their members

936
01:02:00.150 --> 01:02:01.860
are on the rise.

937
01:02:01.860 --> 01:02:04.623
It's part of the changing landscape of psychiatry.

938
01:02:05.970 --> 01:02:08.580
People who have lived through these experiences

939
01:02:08.580 --> 01:02:09.997
want to be heard.

940
01:06:24.212 --> 01:06:27.604 line:15%
[traffic noise]
[soft instrumental music]

941
01:06:39.330 --> 01:06:41.640
The British are making great strides

942
01:06:41.640 --> 01:06:44.070
towards improving mental healthcare,

943
01:06:44.070 --> 01:06:46.950
beginning with the biggest study ever conducted

944
01:06:46.950 --> 01:06:48.243
on drug reduction.

945
01:06:49.530 --> 01:06:53.250
It is similar to what Dr. Steingard is doing in Vermont,

946
01:06:53.250 --> 01:06:55.740
but on a much larger scale.

947
01:06:55.740 --> 01:06:57.990
I'm involved in running a trial,

948
01:06:57.990 --> 01:06:59.770
a randomized control trial funded

949
01:07:02.232 --> 01:07:06.000 line:15%
by the research arm of the British National Health Service

950
01:07:06.000 --> 01:07:09.270
to look into whether we can help people

951
01:07:09.270 --> 01:07:13.710
to reduce and potentially come off antipsychotic medication

952
01:07:13.710 --> 01:07:16.020
in a gradual and supported manner.

953
01:07:16.020 --> 01:07:17.400
So that's going on at the moment.

954
01:07:17.400 --> 01:07:19.320
It's called the RADAR study,

955
01:07:19.320 --> 01:07:21.780
and we're hoping to be able to produce data

956
01:07:21.780 --> 01:07:25.230
to show what the rates of relapse are

957
01:07:25.230 --> 01:07:27.270
if you help people to come off gradually

958
01:07:27.270 --> 01:07:29.100
as opposed to just take them off suddenly,

959
01:07:29.100 --> 01:07:31.860
which most other trials have sort of done.

960
01:07:31.860 --> 01:07:35.340
So it's a study of people who've had more than one episode

961
01:07:35.340 --> 01:07:39.180
because there are a lot more people around like that

962
01:07:39.180 --> 01:07:41.040
who've had more than one episode.

963
01:07:41.040 --> 01:07:42.300
And there are a great deal of people

964
01:07:42.300 --> 01:07:45.450
who've been stuck on antipsychotics for many years

965
01:07:45.450 --> 01:07:47.220
who would desperately like a chance

966
01:07:47.220 --> 01:07:49.044
of trying to come off them.

967
01:07:49.044 --> 01:07:51.030
[ominous instrumental music]

968
01:07:51.030 --> 01:07:52.477 line:15%
Why did you call your book

969
01:07:52.477 --> 01:07:54.210 line:15%
"The Bitterest Pills"?

970
01:07:54.210 --> 01:07:56.970 line:15%
We know that they're profoundly altering

971
01:07:56.970 --> 01:07:58.443 line:15%
the body and the brain.

972
01:08:00.000 --> 01:08:03.630
There have been several different studies published

973
01:08:03.630 --> 01:08:07.380
which show a correlation between a gradual reduction

974
01:08:07.380 --> 01:08:12.030
in brain volume and exposure to antipsychotics in patients,

975
01:08:12.030 --> 01:08:14.100
patients who start on these drugs

976
01:08:14.100 --> 01:08:17.010
and then are followed up with progressive

977
01:08:17.010 --> 01:08:20.432
MRI imaging studies.

978
01:08:20.432 --> 01:08:23.400
[traffic and pedestrian noise]

979
01:08:23.400 --> 01:08:25.170
For me, what I think is really important

980
01:08:25.170 --> 01:08:29.010
is that we just do our very,
very best to minimize

981
01:08:29.010 --> 01:08:31.830
the amount that these drugs have to be used,

982
01:08:31.830 --> 01:08:34.440
that we start off by trying to help people

983
01:08:34.440 --> 01:08:38.220
get through psychotic episodes without them if possible.

984
01:08:38.220 --> 01:08:43.220
Now, that requires units with very highly trained staff,

985
01:08:43.560 --> 01:08:46.560
very committed, motivated people

986
01:08:46.560 --> 01:08:48.630
who are involving, you know,

987
01:08:48.630 --> 01:08:51.170
not just the patient but the whole family

988
01:08:51.170 --> 01:08:53.609
so the family feel supported.

989
01:08:53.609 --> 01:08:57.643 line:15%
[waves lapping]
[soft instrumental music]

990
01:09:01.290 --> 01:09:03.690
The British have also launched a pilot project

991
01:09:03.690 --> 01:09:06.180
to evaluate a new treatment program.

992
01:09:06.180 --> 01:09:08.430
It's called Open Dialogue.

993
01:09:08.430 --> 01:09:10.230
It originated in Finland

994
01:09:10.230 --> 01:09:12.560
and has achieved impressive results.

995
01:09:12.560 --> 01:09:14.520
[soft instrumental music]
[waves lapping]

996
01:09:14.520 --> 01:09:15.750
My name's Yasmin Ishaq,

997
01:09:15.750 --> 01:09:18.090
and I'm service lead for Open Dialogue.

998
01:09:18.090 --> 01:09:22.350
My professional background is social work and psychotherapy.

999
01:09:22.350 --> 01:09:24.120
Developing Open Dialogue in the UK,

1000
01:09:24.120 --> 01:09:25.570
it's come from the ground up.

1001
01:09:26.940 --> 01:09:28.574
Good morning.
Morning.

1002
01:09:28.574 --> 01:09:30.860
How are you?
Good, thank you. You?

1003
01:09:30.860 --> 01:09:31.693
Yes, good.

1004
01:09:32.670 --> 01:09:34.920
It's an adaptation of the Finnish model.

1005
01:09:34.920 --> 01:09:36.660
We have the main principles,

1006
01:09:36.660 --> 01:09:39.570
but we also have to develop from a UK perspective.

1007
01:09:39.570 --> 01:09:40.410
I figured it was urgent,

1008
01:09:40.410 --> 01:09:41.310
but when we spoke to her,

1009
01:09:41.310 --> 01:09:44.464
it wasn't urgent to see her that day.

1010
01:09:44.464 --> 01:09:46.464
It's not antipsychiatry,

1011
01:09:48.149 --> 01:09:49.860
but it endeavors to have a much more

1012
01:09:49.860 --> 01:09:53.610
non-hierarchical structure

1013
01:09:53.610 --> 01:09:56.670
so it's not the psychiatrist that dictates everything.

1014
01:09:56.670 --> 01:09:59.143
And then you decided not to take the medication

1015
01:09:59.143 --> 01:10:00.510
[water trickling]

1016
01:10:00.510 --> 01:10:02.190
and Charlotte had already warned you

1017
01:10:02.190 --> 01:10:04.110
that if you didn't take the medication

1018
01:10:04.110 --> 01:10:07.155
she would leave, and she left.

1019
01:10:07.155 --> 01:10:08.163
Yeah, sure.
You know what I mean?

1020
01:10:08.163 --> 01:10:09.600
Nick has been in crisis

1021
01:10:09.600 --> 01:10:11.670
since his marriage failed.

1022
01:10:11.670 --> 01:10:14.103
His parents have become his support system.

1023
01:10:15.607 --> 01:10:16.950
Well, I'll look at it--
And I remember

1024
01:10:16.950 --> 01:10:19.747
not so long ago, you asked Yasmin,

1025
01:10:19.747 --> 01:10:21.120
"Will you give up on me?"

1026
01:10:21.120 --> 01:10:22.867
And she said, "We won't give up on you.

1027
01:10:22.867 --> 01:10:25.740
"It's not a matter of time."

1028
01:10:25.740 --> 01:10:27.715
They're invested in me for a period of time.

1029
01:10:27.715 --> 01:10:29.613
You know, they're not gonna disappear.

1030
01:10:30.535 --> 01:10:32.467
[latch clicking]

1031
01:10:32.467 --> 01:10:34.620
Hi.
Hi, Yasmin.

1032
01:10:34.620 --> 01:10:36.177
Come in.

1033
01:10:36.177 --> 01:10:37.770
It's nice to see you again.

1034
01:10:37.770 --> 01:10:39.057
And you, and you.
Come in.

1035
01:10:39.057 --> 01:10:40.919
You know where to go.
Yep.

1036
01:10:40.919 --> 01:10:42.900
Straight through.
Straight through, yep.

1037
01:10:42.900 --> 01:10:44.220
What we are endeavoring to do

1038
01:10:44.220 --> 01:10:46.560
is see people through the crisis

1039
01:10:46.560 --> 01:10:49.230
and then continue seeing them afterwards.

1040
01:10:49.230 --> 01:10:51.060
So with the families we work with,

1041
01:10:51.060 --> 01:10:54.120
you might have seen them two or three times in a week

1042
01:10:54.120 --> 01:10:55.290
through the crisis.

1043
01:10:55.290 --> 01:10:57.450
And when the crisis starts to abate,

1044
01:10:57.450 --> 01:10:58.530
then we have discussions

1045
01:10:58.530 --> 01:11:00.690
about reducing the level of contact.

1046
01:11:00.690 --> 01:11:02.040
The last couple of days

1047
01:11:02.040 --> 01:11:03.540
I'm still getting up feeling sludgy

1048
01:11:03.540 --> 01:11:05.760
and sort of tired and a bit slow.

1049
01:11:05.760 --> 01:11:07.033
But actually, during the course of that

1050
01:11:07.033 --> 01:11:09.780
I can access those experiences which are like

1051
01:11:09.780 --> 01:11:12.806
"Old Nick" or "Good Nick" or "Healthy Nick."

1052
01:11:12.806 --> 01:11:15.690
And that's not to be underestimated, I think, really.

1053
01:11:15.690 --> 01:11:17.100
You've gotta feel positive.

1054
01:11:17.100 --> 01:11:17.933
Yeah.

1055
01:11:17.933 --> 01:11:19.110
You must feel positive.

1056
01:11:19.110 --> 01:11:20.551
I even got the point of thinking,

1057
01:11:20.551 --> 01:11:23.463
what would it be like if I didn't take the quetiapin?

1058
01:11:24.510 --> 01:11:27.211
So I've taken it, I'm taking the drugs.

1059
01:11:27.211 --> 01:11:29.130
I've got to the point where, actually,

1060
01:11:29.130 --> 01:11:30.540
maybe you know that-- anyway,

1061
01:11:30.540 --> 01:11:31.487
I've thought I put it out there,

1062
01:11:31.487 --> 01:11:33.000
'cause that's where it was, kind of--

1063
01:11:33.000 --> 01:11:36.150
It's just been simmering in the very back of my mind.

1064
01:11:36.150 --> 01:11:37.503
What might it be like?

1065
01:11:38.360 --> 01:11:41.460
I'm not going in looking for symptoms

1066
01:11:41.460 --> 01:11:45.420
of a particular diagnosis.

1067
01:11:45.420 --> 01:11:47.730
I'm going in wondering what's happened.

1068
01:11:47.730 --> 01:11:51.180
It's so easy to get angry with each other,

1069
01:11:51.180 --> 01:11:54.000
especially when you get the highs.

1070
01:11:54.000 --> 01:11:55.500
I was destined for a fall, really?

1071
01:11:55.500 --> 01:11:56.333
Yeah.

1072
01:11:56.333 --> 01:11:58.688
Maybe my body needed at that point to kind of,

1073
01:11:58.688 --> 01:12:02.176
to have that fall, that spiral,

1074
01:12:02.176 --> 01:12:03.930
that breakdown.

1075
01:12:03.930 --> 01:12:05.130 line:15%
You have to take control

1076
01:12:05.130 --> 01:12:06.690 line:15%
when somebody's out of control,

1077
01:12:06.690 --> 01:12:08.550 line:15%
is out of control and dangerous.

1078
01:12:08.550 --> 01:12:09.723 line:15%
You take control.

1079
01:12:10.830 --> 01:12:12.180
But if we took control

1080
01:12:12.180 --> 01:12:14.940
and we had to have somebody admitted to a ward,

1081
01:12:14.940 --> 01:12:18.576
then we would then very quickly have a meeting on the ward.

1082
01:12:18.576 --> 01:12:21.876
[traffic noise]
[soft instrumental music]

1083
01:12:24.300 --> 01:12:25.680
Yasmin's team is supporting

1084
01:12:25.680 --> 01:12:28.920
well over a hundred families in Kent County.

1085
01:12:28.920 --> 01:12:31.380
Open Dialogue recognizes that all families

1086
01:12:31.380 --> 01:12:33.690
operate differently and in their own time.

1087
01:12:33.690 --> 01:12:34.890
Some dark times...

1088
01:12:34.890 --> 01:12:36.420
The team worked with Brett's family

1089
01:12:36.420 --> 01:12:39.540
for 18 months when he was in difficulty.

1090
01:12:39.540 --> 01:12:41.460
While I was unwell,

1091
01:12:41.460 --> 01:12:43.417
my sister and dad have said,

1092
01:12:43.417 --> 01:12:48.417
"You was coming across very erratic, different.

1093
01:12:49.212 --> 01:12:51.090
"There was a difference in you."

1094
01:12:51.090 --> 01:12:53.160
It's a lot to process, you know, like the stress,

1095
01:12:53.160 --> 01:12:55.710
you know, the mortgage, the house, the business, the work.

1096
01:12:55.710 --> 01:12:58.297
Now I look back at that and they will say,

1097
01:12:58.297 --> 01:13:00.487
"You wanted to get in your car and drive away

1098
01:13:00.487 --> 01:13:03.307
"and, you know, drive up to Heathrow

1099
01:13:03.307 --> 01:13:05.167
"and get on the first plane.

1100
01:13:05.167 --> 01:13:06.570
"You couldn't be somewhere."

1101
01:13:06.570 --> 01:13:09.056
And that's not me.

1102
01:13:09.056 --> 01:13:12.330
It was just so scary because, how severe is this?

1103
01:13:12.330 --> 01:13:15.150
You're trying to constantly gauge that

1104
01:13:15.150 --> 01:13:17.340
knowing that he's already saying goodbye to people,

1105
01:13:17.340 --> 01:13:18.708
selling his car,

1106
01:13:18.708 --> 01:13:22.020
feeling like he's winding his life up.

1107
01:13:22.020 --> 01:13:24.077
So you want to try and keep him as safe as you can

1108
01:13:24.077 --> 01:13:26.160
'cause, you know, the last thing you want to do

1109
01:13:26.160 --> 01:13:27.930
is him to be in a vulnerable position,

1110
01:13:27.930 --> 01:13:31.440
in a scary place, and make the wrong decision.

1111
01:13:31.440 --> 01:13:32.790
And I met you on the Sunday.

1112
01:13:32.790 --> 01:13:34.944
I was visiting the ward on a Sunday.

1113
01:13:34.944 --> 01:13:35.777
Yeah.

1114
01:13:35.777 --> 01:13:39.000
And it's while we were talking that your mum visited,

1115
01:13:39.000 --> 01:13:40.927
and I asked the both of you then,

1116
01:13:40.927 --> 01:13:43.507
"I wonder if you would like to meet as a family

1117
01:13:43.507 --> 01:13:44.940
"to explore what's happened."

1118
01:13:44.940 --> 01:13:46.230
When we come outta that meeting,

1119
01:13:46.230 --> 01:13:48.780
we had some hope.
And he says about hope,

1120
01:13:48.780 --> 01:13:50.820
I keep saying hope,
but I felt we had some hope

1121
01:13:50.820 --> 01:13:52.350
and we had some direction,

1122
01:13:52.350 --> 01:13:55.320
and we sort of felt a little bit more where we were going.

1123
01:13:55.320 --> 01:13:57.330
Judgments will jump into our heads at times,

1124
01:13:57.330 --> 01:13:58.680
but you have to--

1125
01:13:58.680 --> 01:14:00.540
That's what's good about working with a colleague,

1126
01:14:00.540 --> 01:14:03.030
because if I say something and it feels judgmental,

1127
01:14:03.030 --> 01:14:05.227
he can say, "Oh, tell me a bit more

1128
01:14:05.227 --> 01:14:06.750
"about what you said there."

1129
01:14:06.750 --> 01:14:09.390
What I hope to see is a much

1130
01:14:09.390 --> 01:14:13.627
stronger psychosocial understanding of distress,

1131
01:14:13.627 --> 01:14:15.626
away from the dominant kind of

1132
01:14:15.626 --> 01:14:17.100
medical understanding of distress

1133
01:14:17.100 --> 01:14:19.245
that I think we still have.

1134
01:14:19.245 --> 01:14:22.040
[soft instrumental music]
[traffic and pedestrian noise]

1135
01:14:23.040 --> 01:14:25.530
The scope of the Open Dialogue pilot project

1136
01:14:25.530 --> 01:14:27.810
goes beyond Kent County.

1137
01:14:27.810 --> 01:14:30.573
There are teams working in various parts of England.

1138
01:14:31.560 --> 01:14:35.163
Dr. Russell Razzaque speaks from a countrywide perspective.

1139
01:14:36.306 --> 01:14:38.190 line:15%
So we wanna demonstrate, first of all,

1140
01:14:38.190 --> 01:14:39.480 line:15%
that after you've had some open dialogue

1141
01:14:39.480 --> 01:14:41.030 line:15%
compared to treatment as usual,

1142
01:14:42.675 --> 01:14:45.180
the time for you to-- until you come back to us

1143
01:14:45.180 --> 01:14:46.230
will be longer, okay?

1144
01:14:46.230 --> 01:14:48.600
So you're at least not gonna come back so often.

1145
01:14:48.600 --> 01:14:50.310
And in the longer term, we wanna demonstrate

1146
01:14:50.310 --> 01:14:52.860
that you're not using services as much

1147
01:14:52.860 --> 01:14:53.910
over a couple of years period

1148
01:14:53.910 --> 01:14:55.500
than if you had treatment as usual.

1149
01:14:55.500 --> 01:14:57.270
Because although there may be more costs involved

1150
01:14:57.270 --> 01:14:58.830
in the beginning when you're providing

1151
01:14:58.830 --> 01:15:00.330
this more intensive support,

1152
01:15:00.330 --> 01:15:01.789
over a period of at least two years

1153
01:15:01.789 --> 01:15:03.721
we're gonna demonstrate, hopefully,

1154
01:15:03.721 --> 01:15:04.827
that the costs will be less

1155
01:15:04.827 --> 01:15:06.169
'cause people are coming back less.

1156
01:15:06.169 --> 01:15:09.000
[indistinct chatter]

1157
01:15:09.000 --> 01:15:11.610
We have 644 patients recruited at trial.

1158
01:15:11.610 --> 01:15:13.830
You don't get studies that big in mental health, usually.

1159
01:15:13.830 --> 01:15:15.450
There's another whole bunch of countries

1160
01:15:15.450 --> 01:15:17.340
that are doing small replica trials,

1161
01:15:17.340 --> 01:15:19.173
and we're now linking up to form a big network

1162
01:15:19.173 --> 01:15:20.850
so that the evidence base

1163
01:15:20.850 --> 01:15:23.838
can all sort of add up with each other.

1164
01:15:23.838 --> 01:15:26.130
So they're using the same data set as us,

1165
01:15:26.130 --> 01:15:27.210
and we can hopefully demonstrate

1166
01:15:27.210 --> 01:15:29.280
that not only did this make a big impact

1167
01:15:29.280 --> 01:15:30.690
for patients in the UK,

1168
01:15:30.690 --> 01:15:32.790
but there's ways of replicating that in Italy

1169
01:15:32.790 --> 01:15:35.190
and, you know, in Germany and the States

1170
01:15:35.190 --> 01:15:37.200
and all these different countries, in the Netherlands,

1171
01:15:37.200 --> 01:15:39.120
that are gonna be part of this massive project.

1172
01:15:39.120 --> 01:15:40.195
And hopefully at that point

1173
01:15:40.195 --> 01:15:41.857
we'll be able to say something like,

1174
01:15:41.857 --> 01:15:43.500
"Why wouldn't we do this?"

1175
01:15:43.500 --> 01:15:46.770 line:15%
It opens up new possibilities, that's the point.

1176
01:15:46.770 --> 01:15:48.430 line:15%
We've had a failed narrative,

1177
01:15:50.197 --> 01:15:53.615
and it's failed by every possible,

1178
01:15:53.615 --> 01:15:54.960
you know, criteria.

1179
01:15:54.960 --> 01:15:57.000
The burden of mental illness has gone way up.

1180
01:15:57.000 --> 01:15:59.343
People are dying now 25 years earlier.

1181
01:16:00.570 --> 01:16:03.180
Children who are getting diagnosed,

1182
01:16:03.180 --> 01:16:05.021
they're hitting age 18, it's like,

1183
01:16:05.021 --> 01:16:06.240
so many of 'em are now just being prepped

1184
01:16:06.240 --> 01:16:08.801
for a life of being a "mental patient."

1185
01:16:08.801 --> 01:16:11.820
[traffic and pedestrian noise]

1186
01:16:11.820 --> 01:16:14.730
Imagine if you could have people going back to work,

1187
01:16:14.730 --> 01:16:15.843
paying taxes.

1188
01:16:16.680 --> 01:16:19.770
Invest in that person a lot upfront.

1189
01:16:19.770 --> 01:16:20.637
"We're gonna spend some money on you

1190
01:16:20.637 --> 01:16:22.470
and we're gonna do everything we can."

1191
01:16:22.470 --> 01:16:26.070
But then they go back into a real job and real life.

1192
01:16:26.070 --> 01:16:27.930
Don't we have an obligation as a society

1193
01:16:27.930 --> 01:16:30.870
to try to maximize that possibility for people?

1194
01:16:30.870 --> 01:16:32.550
Don't we need to set up

1195
01:16:32.550 --> 01:16:35.190
a form of care that maximizes that possibility?

1196
01:16:35.190 --> 01:16:38.108
Being with the family as well,

1197
01:16:38.108 --> 01:16:39.210
and everybody coming to...

1198
01:16:39.210 --> 01:16:40.830
Providing support to families

1199
01:16:40.830 --> 01:16:44.180
who have been on the frontline of care, often alone,

1200
01:16:44.180 --> 01:16:46.560
is long overdue.

1201
01:16:46.560 --> 01:16:50.058
And patients need a safe place to go in a crisis

1202
01:16:50.058 --> 01:16:52.323
other than simply back to the hospital.

1203
01:16:53.280 --> 01:16:55.980
What's needed are therapeutic environments

1204
01:16:55.980 --> 01:16:57.930
with specially trained staff

1205
01:16:57.930 --> 01:17:00.243
to help a person through a crisis.

1206
01:17:01.350 --> 01:17:04.110 line:15%
If smart people who understand more than medication,

1207
01:17:04.110 --> 01:17:06.840 line:15%
who understand psychosocial interventions,

1208
01:17:06.840 --> 01:17:08.430
understand milieu therapy,

1209
01:17:08.430 --> 01:17:13.430
understand the importance of a hopeful, caring attitude

1210
01:17:14.190 --> 01:17:15.940
despite whatever the symptoms are,

1211
01:17:18.125 --> 01:17:20.073
we'll get through it.

1212
01:17:43.773 --> 01:17:46.589
[soft instrumental music]

1213
01:17:46.589 --> 01:17:49.914 line:15%
[traffic noise]
[soft instrumental music]

1214
01:17:52.650 --> 01:17:56.200
July is, like, every festival in the city.

1215
01:17:57.570 --> 01:17:59.200
Just For Laughs is very cool,

1216
01:18:00.990 --> 01:18:02.220
but it's very stressful

1217
01:18:02.220 --> 01:18:05.460
because all these expectations come with it.

1218
01:18:05.460 --> 01:18:08.340
And expectations are exhausting.

1219
01:18:08.340 --> 01:18:10.710
We basically get compared

1220
01:18:10.710 --> 01:18:13.470
to, like, the top 10 comedians in the world,

1221
01:18:13.470 --> 01:18:14.640
the top a hundred comedians in the world,

1222
01:18:14.640 --> 01:18:17.190
they're all coming through Montreal

1223
01:18:17.190 --> 01:18:19.050
in less than two weeks.

1224
01:18:19.050 --> 01:18:20.160
Plus people that aren't comedians

1225
01:18:20.160 --> 01:18:21.960
are telling me to do things.

1226
01:18:21.960 --> 01:18:24.690
So, like, "Why aren't you in Just For Laughs?"

1227
01:18:24.690 --> 01:18:26.370
It's like when you're told, like,

1228
01:18:26.370 --> 01:18:28.860
"Why aren't you a doctor?"
by your parents.

1229
01:18:28.860 --> 01:18:31.097
It's like that times a thousand.

1230
01:18:32.089 --> 01:18:35.339
[birds chirping]
[music playing faintly]

1231
01:18:57.431 --> 01:19:00.448
[brisk classical music]

1232
01:19:01.603 --> 01:19:03.011
Bonjour.
Bonjour.

1233
01:19:06.615 --> 01:19:07.865
[door latching]

1234
01:19:25.252 --> 01:19:28.006
[soft instrumental music]

1235
01:20:53.449 --> 01:20:56.508
[boat horn blaring]
[soft instrumental music]

1236
01:21:24.990 --> 01:21:26.970
At the beginning of this documentary,

1237
01:21:26.970 --> 01:21:30.960
Myriam Anouk was taking three psychiatric drugs.

1238
01:21:30.960 --> 01:21:32.830
Now, she's down to one,

1239
01:21:34.200 --> 01:21:35.940
and she no longer identifies

1240
01:21:35.940 --> 01:21:37.620
with having schizophrenia

1241
01:21:37.620 --> 01:21:40.220
or bipolar disorder.

1242
01:21:40.220 --> 01:21:42.637
[soft instrumental music]

1243
01:21:44.190 --> 01:21:47.730
Everybody I've ever known who has come out of this

1244
01:21:47.730 --> 01:21:51.720
is so screaming, blinkin' grateful

1245
01:21:51.720 --> 01:21:55.553
that there's almost no room for anything else.

1246
01:21:58.320 --> 01:22:01.920
We are stunningly grateful.

1247
01:22:01.920 --> 01:22:06.076
Lives we never thought we could possibly imagine living.

1248
01:22:06.076 --> 01:22:07.680
[soft instrumental music]

1249
01:22:07.680 --> 01:22:09.690
Joanne Greenberg went on to write

1250
01:22:09.690 --> 01:22:11.280
another 18 books

1251
01:22:11.280 --> 01:22:14.340
after "I Never Promised You a Rose Garden."

1252
01:22:14.340 --> 01:22:18.060
She's been married to Albert for 63 years,

1253
01:22:18.060 --> 01:22:20.460
and they've raised two sons.

1254
01:22:20.460 --> 01:22:21.700
I think I fell in love.

1255
01:22:22.740 --> 01:22:25.140
As trite as that sounds,

1256
01:22:25.140 --> 01:22:26.940
I think that's what it was.

1257
01:22:26.940 --> 01:22:30.339
We were meant to be together.

1258
01:22:30.339 --> 01:22:34.281
[soft instrumental music]
[birds calling]

1259
01:22:38.745 --> 01:22:41.162
[gentle ukulele music]

1260
01:22:43.482 --> 01:22:45.327
Yes, yes, yes, I'm in Just for Laughs

1261
01:22:45.327 --> 01:22:48.000
for a show I created.

1262
01:22:48.000 --> 01:22:50.670
And at the same time, it's stressful.

1263
01:22:50.670 --> 01:22:53.820
[gentle ukulele music]
[traffic noise]

1264
01:22:53.820 --> 01:22:56.400
My mental health hasn't changed

1265
01:22:56.400 --> 01:22:58.680
as much as I've learned better how to deal with it

1266
01:22:58.680 --> 01:23:00.763
and understand it better.

1267
01:23:03.660 --> 01:23:06.120
You always hope the suicidal thoughts

1268
01:23:06.120 --> 01:23:08.550
won't come back, or the urges.

1269
01:23:08.550 --> 01:23:10.320
And you also hope that the medication

1270
01:23:10.320 --> 01:23:11.260
will finally, like,

1271
01:23:12.180 --> 01:23:14.075
work this time.

1272
01:23:14.075 --> 01:23:16.980
[gentle ukulele music]

1273
01:23:16.980 --> 01:23:19.140
If I knew how to process all of this,

1274
01:23:19.140 --> 01:23:21.060
I'd be much healthier.

1275
01:23:21.060 --> 01:23:22.727
Trust me. [chuckles]

1276
01:23:24.091 --> 01:23:26.508
[gentle ukulele music]

1277
01:23:28.320 --> 01:23:29.820
Alo continues to navigate

1278
01:23:29.820 --> 01:23:32.430
the mental health system cautiously,

1279
01:23:32.430 --> 01:23:35.070
setting boundaries as needed.

1280
01:23:35.070 --> 01:23:38.730
Therapy has been on again, off again, due to the cost.

1281
01:23:38.730 --> 01:23:40.020
But the good news is

1282
01:23:40.020 --> 01:23:43.020
that Alo has found a psychiatrist who listens

1283
01:23:43.020 --> 01:23:44.493
rather than dictates.

1284
01:23:45.990 --> 01:23:48.900
To keep debilitating symptoms at bay,

1285
01:23:48.900 --> 01:23:52.140
they are leaning more heavily on medications,

1286
01:23:52.140 --> 01:23:53.313
at least for now.

1287
01:23:55.291 --> 01:23:58.791
[rhythmic electronic music]
[traffic noise]

1288
01:24:07.200 --> 01:24:10.334
[rhythmic electronic music]

1289
01:24:12.009 --> 01:24:14.842
[audience cheers]

1290
01:24:22.560 --> 01:24:24.120
You know them, you love them.

1291
01:24:24.120 --> 01:24:27.037
Please give it up for the wonderful Alo Azimov.

1292
01:24:27.037 --> 01:24:29.870
[audience cheers]

1293
01:24:31.770 --> 01:24:34.500
I'm gonna tell you a story about escaping a hospital.

1294
01:24:34.500 --> 01:24:36.960
"Hmm, it's summer, is your summer depression acting up?

1295
01:24:36.960 --> 01:24:38.970
"Let's give you a mental health assessment."

1296
01:24:38.970 --> 01:24:41.520
This was at the Concordia nurse's office.

1297
01:24:41.520 --> 01:24:43.163
And I'm like, "Hmm, okay."

1298
01:24:43.163 --> 01:24:44.580
[audience laughs]

1299
01:24:44.580 --> 01:24:47.940
She told me to go to the Montreal General Emergency

1300
01:24:47.940 --> 01:24:49.560
and didn't give me much of a choice,

1301
01:24:49.560 --> 01:24:50.970
but she did give me a taxi voucher.

1302
01:24:50.970 --> 01:24:52.071
So I took it.

1303
01:24:52.071 --> 01:24:53.293
[audience laughs]

1304
01:24:53.293 --> 01:24:54.990
I get to the Montreal General Hospital,

1305
01:24:54.990 --> 01:24:57.496
I say the spiel the nurse told me to say.

1306
01:24:57.496 --> 01:25:00.630
I'm back in the psych ward.

1307
01:25:00.630 --> 01:25:03.840
I'm visited by the three psychiatrists

1308
01:25:03.840 --> 01:25:06.270
of the past, present and future disappointments

1309
01:25:06.270 --> 01:25:09.810
of my interactions with the medical system of Montreal.

1310
01:25:09.810 --> 01:25:11.580
And I have to convince all three of them

1311
01:25:11.580 --> 01:25:13.053
that I can leave.

1312
01:25:14.280 --> 01:25:16.920
I have to remember the name of every doctor I've ever met,

1313
01:25:16.920 --> 01:25:18.540
every medication they've given me

1314
01:25:18.540 --> 01:25:20.670
and what it was for specifically,

1315
01:25:20.670 --> 01:25:22.560
and why it wasn't working.

1316
01:25:22.560 --> 01:25:23.910
And I passed, people!

1317
01:25:23.910 --> 01:25:25.618
I passed!

1318
01:25:25.618 --> 01:25:27.051
Woo!

1319
01:25:27.051 --> 01:25:28.943
[audience cheers]

1320
01:25:28.943 --> 01:25:30.683
I've been Alo, thanks so much.

1321
01:25:30.683 --> 01:25:34.403
[audience applauds]

1322
01:25:34.403 --> 01:25:37.720
[soft instrumental music]
[Alo chats indistinctly]

1323
01:25:45.960 --> 01:25:48.383
What I would tell 18-year-old me:

1324
01:25:48.383 --> 01:25:51.360
"End the pain, don't end your life.

1325
01:25:51.360 --> 01:25:52.740
"They're not the same thing.

1326
01:25:52.740 --> 01:25:55.323
"I was there, I know what you're going through,

1327
01:25:58.671 --> 01:26:01.203
"but just ask yourself,

1328
01:26:02.167 --> 01:26:04.677
"is there a part of me that loves life?

1329
01:26:05.550 --> 01:26:09.775
"Because when everything else is destroyed and neglected,

1330
01:26:09.775 --> 01:26:12.270
"that's the part of you that's still gonna be there,

1331
01:26:12.270 --> 01:26:14.910
"that's ready to rebuild a new life.

1332
01:26:14.910 --> 01:26:17.370
"Who's been there for you?

1333
01:26:17.370 --> 01:26:19.680
"Who's really been there for you?

1334
01:26:19.680 --> 01:26:21.990
"Keep them close

1335
01:26:21.990 --> 01:26:24.840
"and learn from their example,

1336
01:26:24.840 --> 01:26:27.443
"and you'll have a strong foundation."

1337
01:26:28.418 --> 01:26:31.876
[soft instrumental music]
[footsteps receding]

1338
01:26:35.951 --> 01:26:39.051
[soft instrumental music]

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