Yale Department of Psychiatry Grand Rounds, June 12, 2020

June 12, 2020

Information

Andrew Solomon, PhD, writer, lecturer, Yale Department of Psychiatry's Special Advisor on LGBTQ Mental Health

ID5318

To CiteDCA Citation Guide

00:00It's my tremendous pleasure to introduce
00:02Andrew, Solid Doctor Andrew Solomon.
00:04Welcome back to Yale.
00:06When I thought of someone to be the
00:09first loudspeaker outside speaker as we
00:11passed the peak of the kovid pandemic,
00:14doctor Solomon was at the top of my list.
00:17Andrews professor of clinical
00:18Gayatri at Columbia and a former
00:21president of the pen American Center.
00:23In some ways,
00:24he needs no introduction because he's
00:26become such an important part of our
00:29Department community over the years.
00:31Is my special advisor on LG BDU
00:34issues and he's visited us many
00:36times speak to our Department?
00:39We meet with our trainees advisor
00:41LG LBGTQ Interest Group and to
00:44share the wonderful movie based
00:46on his book far from it.
00:48And of course to receive our mental
00:52health research advocacy Ward.
00:54Many under Zoom Conference to
00:55know him through his writings
00:57and through his public advocacy,
00:59which had been so important
01:00in their minds and hearts,
01:02to the experience of mental
01:04illness and the meaning.
01:05An impact of difference in the
01:07mental health field is probably
01:09best known for two books,
01:11in particular the Noonday Demon
01:13and far from far from the tree.
01:16The Noonday Demon,
01:17in which in which answer describes
01:19his personal experience with
01:20compression in a in place,
01:22is it in a broader consideration
01:24of depression, as one.
01:26Many honors,
01:27including the National Book
01:28Award for nonfiction in 2000,
01:30and one finalist for the Pulitzer
01:32Prize in 2002 and was designated
01:35by the London times as one of
01:38the 100 best books of the decade.
01:41An far from the tree which describes
01:43how families cope with difference,
01:46also won numerous awards,
01:48including the National Book Critics
01:50Award for nonfiction Welcome Book
01:52Award Prize and it would ignited
01:55by the New York Times as one
01:57of the top ten books of 2012.
01:59I thought he would be a particularly
02:02appropriate speaker to today
02:04because his books and articles
02:07address themes are really important
02:09to our community at this time.
02:12Is writing dress human vulnerability and
02:16resilience the challenge of knowing oneself?
02:20In the importance of knowing
02:21oneself in dealing with the even
02:23greater challenge of trying to
02:24get to know other people,
02:26particularly when they're different from you.
02:29In all of his writing,
02:31there is an honesty, a transparency,
02:34humility, and humanity.
02:35That's unique.
02:36Is writing weather about his
02:39struggle with depression?
02:41Death of his analyst or other
02:44experiences is both deeply personal and
02:46yet it touches on universal issues.
02:49So it's a special pleasure
02:53to invite back doctor Andrew
02:55Solomon random our Department.
02:58A River today's psychiatry grant.
03:03So Andrew,
03:04thank you very much.
03:06Well, thank you.
03:07It's a great pleasure to be here.
03:09I'm going to talk for a bit about my
03:12perceptions of mental illness during
03:14this time of Kovid and then I will invite
03:17any or all of you to ask questions.
03:19The easiest way to do that is
03:21probably through the chat function.
03:23I'm just trying to arrange my
03:25screen so that I will be able
03:27to see those when I get them and
03:30I am happy to answer question.
03:32You know, that relate specifically to what
03:34I've said or that are in this general.
03:37Area, so the question of Kovid
03:40an mental health has been a big
03:43topic at the moment where in the
03:46middle really of a double crisis.
03:48There's a crisis in physical health and
03:52which were obviously all very aware of,
03:54and there's a crisis in mental health
03:57and they've been an enormous amount
04:00of energy and resources devoted
04:02to the crisis in physical health.
04:05And there has been much less
04:07attention paid to.
04:09The crisis in mental health and I've
04:12been very concerned that mental health
04:14has been being neglected through this period.
04:18And while the crisis and physical
04:20health we hope is very temporary,
04:23the crisis in mental health has the
04:26potential to be much longer term
04:29and it's terribly important that we
04:32recognize the strains that people are
04:34under in that we attempt to address them.
04:39At the moment I'm at about 40% of
04:44Americans report experiencing symptoms,
04:46which would constitute a crisis
04:50of private health.
04:52Mental health,
04:53uh,
04:53and so we see these enormous skyrocketing
04:57rates of particularly depression,
04:59and most of all,
05:01anxiety and part of the trick is
05:04distinguishing between an appropriate
05:06response to very difficult times and.
05:10The mental health elements that
05:12escalate to the point at which they
05:14become clinical complaints that warrant
05:17a an intervention of some kind and
05:19trying to decide when to intervene
05:21and how to intervene and what the
05:24appropriate way is to look into that.
05:27So the prices of mental
05:28health has many elements.
05:30It's got the fear of being a becoming
05:33sick yourself and the sends all the
05:36time that the Angel of death is
05:39waiting at the door of your house.
05:41It has to do with the morning that
05:44people are going through for people
05:46they have lossed this illness or the
05:49fear they have about people who have
05:52the illness and whose outcomes physical
05:54health outcomes are uncertain or unsure.
05:57It has to do with the economic devastation
06:00that seems to be we consuming the country.
06:03The performance of the stock market in its
06:05bizarre irregularities notwithstanding,
06:07but an enormous enormous number of
06:09people obviously are out of work.
06:11Or,
06:12uh,
06:13unable to continue to pay bills that
06:17they have a broad range of industries.
06:21And finally it has to do with
06:24our response to the problem which
06:27has been social isolation.
06:29So even at a time when people in
06:32many states in the US are beginning
06:35to breakthrough social isolation and
06:37are ceasing to observe
06:39some of its strictures,
06:41the isolation continues for a very,
06:44very large number of people.
06:46Social distancing for an even
06:48larger number people people
06:50are wearing masks and don't.
06:52Have this stimulation of seeing one
06:54another space is all of those shifts comes
06:58to new significant losses forever for
07:00people and very significant stressors.
07:03So I'll look at all of them
07:06together and the concern of course,
07:09is that the mental health crisis is
07:12unaddressed in Wuhan when the crisis began.
07:15Their the Chinese government
07:17imported hundreds of mental health
07:20workers to help people in Wuhan.
07:22Through the psychological
07:23challenges of the crisis,
07:25uh, in the United States,
07:27there has been no such effort.
07:29There had been a patchwork of
07:31responses by individual governors.
07:32Some of those governor's have in
07:35fact brought in people to try to
07:37deal with at least some of the mental
07:39health ramifications of the problem.
07:42But many of them have not.
07:44And then,
07:45even when mental health services
07:47are available to people who
07:48recognize the need for them,
07:50there's the ongoing problem that.
07:52Uh,
07:53people don't have insurance that allows
07:55them to access those services we all know,
07:58or at least most of us know that
08:01there had been parody legislation
08:03that was designed to ensure that we
08:06have the same access to mental health
08:09services to physical health services.
08:11This is a Department of
08:13psychiatry grand rounds.
08:14Most of you will know that those
08:17services are available on a much
08:19more limited basis and then
08:21other medical services.
08:22And that indeed all medical services
08:25in the United States are available
08:27on quite a selective basis depending
08:29on who has insurance and what kind
08:32of insurance those people have.
08:34So, uhm, I think, uh,
08:37we're uh to be shocked appropriately by
08:40the absence of preparedness on this front.
08:44Um,
08:44there was a study following
08:46the H1N1 outbreak in 2013,
08:49and it was widely published that said,
08:52because pandemic disasters are unique
08:55and do not include congregate sites
08:58for prolonged support and recovery,
09:00they require specific response strategies
09:03to ensure the behavioral health needs.
09:06Children and families pandemic
09:07planning must address these needs,
09:10and another said well,
09:12information for the medical aspects of
09:14disaster surge is increasingly available.
09:17There is little guidance for health
09:20care facilities on how to manage
09:23the psychological aspects of Lord
09:25scale disasters that might involve
09:27a surge of psychological casualties,
09:30so these problems were identified,
09:33but nothing was done to ensure
09:36that we were in.
09:38A better place by the time of
09:41the next pandemic,
09:42and so we find ourselves very
09:45inadequately prepared at this point,
09:47uhm?
09:47So, uh,
09:48the responses to the Cove in situation,
09:52I think.
09:57People who are very robust who even.
10:00If they are saddened or frustrated
10:02by some aspects of what's going on,
10:04essentially sale on with their mood and
10:07their mental health more or less intact.
10:10There is a large group of people.
10:12I would say the largest of these four
10:14groups who are experiencing at troubling
10:17levels of anxiety and depression
10:19but don't rise to the threshold in
10:21clinical illness and those people need.
10:23But I felt psychiatric birthday.
10:25They need a recognition of the difficulties
10:28that they're going through and then they
10:30need to do a lot of self regulating.
10:33They need to regularize their sleep,
10:35they need to try to regularize their eating.
10:37They need to try to avoid
10:40excessive intake of.
10:41Caffeine, alcohol or substances of abuse.
10:43They need to make sure they're
10:45getting enough exercise.
10:46They need to avoid becoming complete
10:49junkies who do nothing but watch the news.
10:52All day news junkies,
10:53I mean that they need all of those
10:56sort of methods that are tried and
10:58true for helping people to remain in a
11:02reasonably balanced place psychologically.
11:03The third group are the people who
11:06have never before had a mental health
11:09diagnosis who are now at the point of
11:12meeting those clinical thresholds.
11:14Uhm.
11:14Depression and anxiety in particular
11:17result from the conjunction of a genetic
11:20vulnerability or a biological vulnerability,
11:22genetic and otherwise,
11:24that meets with triggering external
11:26circumstances and their level of
11:28triggering external circumstances is high,
11:30and particularly, I think,
11:32relevantly, it is sustained.
11:33So there are a lot of people who
11:37can deal with the crisis that takes
11:40place over a short period of time,
11:43and who can then deal with
11:46the aftermath of it.
11:47There are many people who can cope with
11:50something which takes longer if they have
11:52a sense of how long it's gonna take,
11:54and they can pace themselves who
11:56find the indefinite big shapeless
11:57have we gotten through the 1st wave?
11:59Is there going to be a second wave?
12:02What's actually happening to us?
12:03When are we going to be able to?
12:07Store without a mask?
12:08When are we gonna be able to
12:11socialize with friends?
12:12When are we going to be able to do
12:15block all of that chaos and confusion?
12:17Conservas triggers and there are
12:19people now escalating into clinical
12:21states who didn't before,
12:22and of course is always when there
12:24are very extreme external stressors.
12:26Many of those people are inexperienced
12:28with the idea of mental illness.
12:30They don't know what the approach to it is,
12:34but particularly they're often inclined
12:35to think that their situation.
12:37Is responding to existing difficulties
12:39outside of them rather than responding
12:41to an internal state,
12:42and they presume therefore,
12:44but it's not appropriate for them
12:47to try to treat the depression or
12:49the anxiety that what they have
12:51to do is simply wait for external
12:53circumstances to change.
12:55And I would say as I've said,
12:58under other circumstances,
13:00the Dickish Eology of depression
13:02and anxiety does not dictate the
13:05treatment for depression and anxiety if
13:07you escalated into clinical depression
13:09or anxiety, it's appropriate to pursue
13:12treatment whatever the origins maybe.
13:14And so we live in a time when those people
13:18should be getting good access to therapies
13:21that are appropriate medical therapies,
13:24biological therapies, medications, and.
13:26Or equally to various forms of talk
13:29therapy and forms of support that may help
13:32them to survive this moment in prices.
13:34And then the fourth group are the
13:37people who already had a mental health
13:40diagnosis of one kind or another and
13:42who may have been operating in a state
13:45of sustained Dis Timea and those
13:47people have been dealing with this
13:50timea now need to deal instead with.
13:53With Watt as some conditions
13:55called double depression,
13:56in which the dis timea is now
13:59overlaid with an acute episode and
14:01to find people in very extreme.
14:04Depression, or in paralyzing anxiety,
14:06and those people clearly need
14:08to have interventions made.
14:10Some of them require hospitalization,
14:13some of them admin require shifts
14:16in medical treatment.
14:17Whatever the form of that
14:19medical treatment is,
14:21all of them require
14:23expanded support services.
14:24Now the question of social isolation is,
14:28I think, a crucial one.
14:30We all recognize that social
14:32isolation has been effective.
14:34In flattening the curve and in bringing
14:38about some sort of change and how
14:41extreme peoples responses are too.
14:44Uh, uh, the physical effects of Kovid?
14:47Uhm, but isolation is also very dangerous.
14:51People find isolation very difficult.
14:54They have always found isolation
14:56very difficult.
14:57Solitary confinement in prison system
14:59and can result in panic attacks
15:02and hallucinations. Um, isolation.
15:04In fact, I met tends to make people,
15:08uh, experience?
15:09Uh, uh?
15:10Touch deprivation at often it reduces
15:12immune response.
15:13So when we talk about the issue
15:16of isolation when we talk about
15:19the idea that isolation maybe
15:21twice as dangerous as obesity,
15:23we're really talking not only
15:25about the fact that it's unpleasant
15:28to experience the mental health
15:30consequences of isolation,
15:32but also about the idea that
15:34one's immune responses.
15:36In a diminished and with the
15:38diminished immune response,
15:40people are ill prepared to deal with
15:43the physical assault of a virus,
15:46so it's very dangerous to have so many
15:50people who are in that state of depression,
15:54and you know the difficulty of
15:56course is determining what the
15:59borderline is between appropriate
16:01concern that exists when you're
16:04looking at something like Kovid and.
16:06The more extreme responses that
16:08many people have had to um at
16:11the crisis in in mental health,
16:13there is a very thin membrane
16:14between responding appropriately
16:15to something difficult.
16:17I mean,
16:17it would be troubling to see people who
16:20don't care at all about what's going on,
16:23but we've all seen some of
16:25those people on the news.
16:27And what is the membrane
16:29between that extreme?
16:31Between extreme anxiety that's within
16:33the realm of what I will loosely call,
16:37despite it being loaded word,
16:39the normal and the point at which it
16:42crosses over into being very deeply troubled,
16:46troubling.
16:46And isolation has,
16:48uh,
16:48you know there are two problems
16:50of isolation right now.
16:52Sartre famously said that
16:53hell is other people.
16:55And, um, hell, is it, turns out,
16:57is also the absence of other people.
17:00So, uh, that is to say that people
17:02are having a terribly difficult
17:04time when they are completely alone,
17:06and people are having a terribly
17:08difficult time when they are sheltering
17:10with a small group of other people,
17:13usually people to whom they are related
17:15and see no one else for a long time.
17:18But see those people.
17:20Constantly and all of the all of the time,
17:23so the intimacy is difficult and
17:25the lack of intimacy is difficult
17:27and Ivan cast back to thinking
17:29about research I did on depression
17:31among the Greenlandic Inuit.
17:32And when I went to Greenland,
17:34I thought that the reason there
17:36was a high rate of depression and
17:39suicide among the Inuit must be
17:41because it's so cold and so dark
17:43for a long period of the year,
17:45and they must suffer from a form
17:48of seasonal affective disorder.
17:50But it turned out that directly
17:52quite well suited to, um,
17:54the cold and the darkness,
17:56and that they aren't particularly
17:57troubled by them.
17:58The difficulty is that people in
18:01Greenland mostly live in relatively
18:03small houses because there are is no
18:05good source of fuel for electricity
18:07in their way to heat a larger house.
18:10They live with extended family,
18:12and it's too cold and too dark to leave
18:15the house for six months out of every year,
18:18and so There you are.
18:20In a small house with your children
18:23and your parents and your in
18:26laws and you're all together
18:27and you can't argue with anyone.
18:30Because if you argue with anyone,
18:33there's no place to go.
18:35You can't then leave and go away and
18:37so an enormous emotional repression
18:39has ensued and that emotional
18:42repression is extremely dangerous.
18:44So we then see in the current situation,
18:47people suffering from touch deprivation,
18:50which is a well documented
18:52phenomenon or touch starvation.
18:54And the lack of physical contact
18:56with other people becomes
18:57extremely difficult and troubling.
18:59Zoom cocktail are very well
19:02and very nice in their way.
19:04Meetings like this one and Cal.
19:07Some degree of connection among people,
19:09but they don't in fact fully
19:11answer the human need for physical
19:14contact with other people.
19:16And while I don't want to say
19:18anything that compromises people's
19:20engagement with social distancing,
19:22which is obviously absolutely crucial.
19:25The containing the further outbreak of a
19:27Cove in an problems associated with so good.
19:30I do want to say that you have to balance
19:33that against the costs of isolation.
19:36I had a letter last week from a someone
19:39in London who wrote to me to say,
19:42uh,
19:42that her best friend with previously
19:45suffered from depression had
19:47kept writing to her to say what
19:49a struggle she was having.
19:51We had I had the experience of
19:53isolation that you felt depressed
19:55and she felt very alone that you had
19:57no work, that she wasn't
19:59able to fill her days.
20:00She had been watching a lot of
20:02television and the person who wrote
20:04to me was extremely concerned
20:06and kept saying to her, you know,
20:08eventually will be able to break out of this.
20:11Eventually will be able to see one
20:13another she could hear in her friends,
20:16turn a voice that the depression
20:18was escalating. This woman said I
20:20can't stand being by myself anymore.
20:21I can't stand it and, uh,
20:23a few days later she hanged herself up.
20:26There are people who are dying
20:28of Kovid who don't even have it.
20:30They're dying of.
20:31It's psychological overtones and meanings,
20:33and we have to be attentive to how
20:36we deal with that crisis and how
20:39we deal with the possibility that
20:41it even people who don't commit
20:43suicide now may suffer a form of PTSD
20:47that goes on for years and years.
20:50So, uhm,
20:51now there's been a lot of looking at,
20:55uh, uh,
20:55there's been a lot of looking at what
20:58the meanings on the ramifications are of, uh?
21:02The Cove in situation,
21:05and particularly in looking
21:06at Florentine origin,
21:07is in fact the oldest or one of the
21:10oldest medical technologies in the world.
21:13The people who were diseased
21:15have been put in quarantine,
21:17and since the ancient world it was a
21:19very common means of dealing with Contagion.
21:22However,
21:23a quarantine has been for people
21:25who are sick,
21:26and while it has been awful for
21:29the people who are sick and many
21:32of them had severe or fatal as uh.
21:35Situations, in any case,
21:36um patients who are put into isolation
21:39to elevated rates of depression,
21:42anxiety,
21:42PTSD,
21:43their physical recovery is slower
21:45than the physical recovery of
21:47people who are not in isolation,
21:49and the prospect that people face
21:52and that many people with covert now
21:55face of dying alone is a terrible prospect.
21:58And it passed people into a
22:01very damaged state.
22:03Putting people in Quarantine
22:04who don't have an illness is a
22:07very modern technology.
22:08It's been done only a few times
22:11before and never on the scale
22:13on which is being done now.
22:15And so you have people sheltering
22:18inside with effectively have no
22:20symptoms who are nonetheless in a
22:23form of Florentine and the last time
22:25that that was tried on any scale was
22:28during the SARS outbreak in 2003
22:30in a mixed Canada where there was.
22:33Uh,
22:34a big movement to do that I want
22:37to read to you, Richard Chavez.
22:40The UM was Ontario Chief Medical
22:42Officer wrote about the effects
22:44of that foreign gene,
22:46which clearly helped to contain
22:48the SARS outbreak.
22:49He said in the unlikely event of
22:52another SARS outbreak in Canada,
22:54public health officials should
22:56quarantine no one.
22:57And his point was not to say that
23:00starts isn't contagious or the
23:02dealing with the contagion of SARS
23:04isn't a real an urgent problem,
23:06but that the after effects of that
23:09Florentine were so enormous that
23:10they may well not have been worth it.
23:13and I have seen as I've looked
23:16around many people whom I know or
23:18whom I have had some degree of
23:20contact with who have lost people,
23:22I lost one person to whom I'm
23:25extremely close and have now
23:27seen a number of friends losing.
23:29Parents losing relatives going
23:30through all forms of law and having
23:33to deal with the difficulty of not
23:35being able to go and help the people
23:37and being with their parents when
23:39their parents are dying of friend
23:41of mine described being on FaceTime
23:43with her dying father was in and
23:46out of consciousness and trying to
23:47sing to him over the Internet and
23:50she said they were the songs he
23:52had sung to her as a child and she
23:55felt that in singing them she had
23:57some degree of contact with him.
23:59But he said the fact.
24:01But I didn't know the last time
24:03I hug my father,
24:05but it would be the last time.
24:07The fact that I couldn't go there an
24:09provide the comfort of holding his
24:11hand while he passed into death was
24:13the worst agony that I've ever known.
24:15And I've heard similar things
24:17from other people.
24:18Now there's not only the loss of
24:20contact with the person who is died,
24:22there is also the aftermath
24:25of losing someone.
24:26People contact with the other people
24:28have survived people who were dying
24:31of Ovid don't have AM at funerals in
24:33any significant sense of the word.
24:35Even if there's a burial that
24:37somehow broadcast on zoom is there.
24:39Sometimes is we don't have the
24:41opportunity to gather with the
24:43rest of their families.
24:44There, someone I,
24:45the person I was very close to,
24:48was in fact my cycle analyst.
24:51Died, his wife lives in New York.
24:53His son a andamia grandchildren
24:55live in California.
24:57Under ordinary circumstances
24:58they would all have gathered in
25:00New York and been together.
25:02Instead, his widow is by herself.
25:05She's by herself in New York
25:07with her family someplace else.
25:09They talked on the phone.
25:11They use whatever other
25:13technologies there are.
25:14It is not the same as processing
25:17someones death in company with the
25:19people to whom you feel closest.
25:22So something doesn't have to be
25:24irrational to become a sickness.
25:26The fact that these people are
25:29struggling doesn't constitute,
25:30uh,
25:30something that is not a sickness
25:33simply because there's a reason for it.
25:35The suffering that people are going
25:37through Israel and real suffering
25:39escalates into mental illness and
25:42mental illness requires treatment.
25:43I'm in a truck just briefly
25:46about some animal models,
25:47and then I'm going to open
25:50the floor to questions and.
25:53The toxic effects of fear, um,
25:55at our uh for long fear sustained
25:57here are well documented.
25:59A mat part is all,
26:01of course,
26:01is intended to respond to a momentary crisis.
26:04And if you're an antelope and
26:06alliance suddenly materializes,
26:07the rush of cortisol can be helpful in
26:10allowing you to escape and get away.
26:13But the kind of sustained
26:14stress that we're looking at
26:16in the current situation is a
26:18very different matter, and, uh,
26:20I think it's important that we
26:22look at the fact that this is
26:25documented not only in humans.
26:27Being but as I say in animal models,
26:30if you take flies and you
26:32put them in South India,
26:33isolation for a period of two weeks and
26:37which is not such a terribly long time.
26:40It's a long time for fly.
26:43I suppose you discover that
26:45they develop behaviors that are
26:47aggressive and that are extreme,
26:50uh, extremely injurious.
26:51Scored other flies there clearly,
26:53profoundly distressed.
26:54UM, researchers at Caltech have isolated
26:57mice for a period of two weeks and
27:00noted increase in fear and aggression,
27:03and those researchers have located
27:05the problem at the techie kind.
27:08In Gene Chapter 2,
27:10which encodes.
27:11Euro kind and be and which is
27:13a neuropeptide active in the
27:15Amygdala and in the hypothalamus,
27:18and scientists believe, and that,
27:20um, a MKB Act throughout the brain,
27:22orchestrating the behavioral effects
27:24of isolation and humans have a
27:26comprable matatu signaling system,
27:28which means that there is good evidence
27:31and that we will be able to charge
27:34at the effects of social isolation,
27:37not only socially but also biologically.
27:39I don't know that.
27:41Anyone is working on that
27:43specifically during this crisis,
27:45but they should be so your role
27:47in the field of psychiatry.
27:49It's a thing to consider.
27:51Now.
27:52In conclusion,
27:52I want to talk about the
27:55intersection that we're now facing,
27:57which is the intersection between
27:59Kovid and all of that fear and anxiety
28:02that Tobin has brought up and met
28:04the protest movement that is taking
28:07place after the brutal and horrific
28:09murder of George Floyd, Anwer.
28:11All, I think,
28:12aware of how appalling it was,
28:15Ben Floyd went down in the way that
28:17he did and we all recognize that it
28:20is an indication of just how bad
28:23racism within law enforcement has
28:25become and how urgent it is that we
28:28address the problem of that brutality.
28:31But the protest movement,
28:32you know,
28:33has involved a huge number of people
28:36who have often gone out without
28:38masks and it stirred in many of the
28:41people who have not join the protest.
28:44Anxiety about an escalation
28:45in Contagion of Cobit.
28:47It starred in many people a sense that
28:50the social order is being disrupted
28:52not only by illness but also by
28:55these revelation and it's resulting
28:57again in a great deal of anxiety,
28:59and that anxiety is also rooted
29:02in the revelation that has come
29:04out of the coded work and that has
29:07been mentioned to some degree by
29:09the people of protesting is that
29:12the people who are dying of Kovid.
29:14Are unfairly people who have less
29:17economic opportunity and they are in
29:19many instances members of racial minorities.
29:22So the death rate among African
29:24American or black people,
29:26or black and Brown people who
29:28have kovid is much higher than
29:31the mortality rate is among white
29:33people who have the same infection
29:36and that points to the incredible
29:39injustice and unfairness not
29:40only if the society as a whole,
29:43but specifically of.
29:45This is already in a relationship to
29:47medical intervention and medical treatment.
29:50It's appalling that people who have
29:54less wealth are more likely to die
29:57if there's a point to the terribly.
30:00Hold in our health care system and it
30:03has been one of the many topics that
30:06have been brought up in the course of
30:09the protest movement and it's been
30:11very traumatic for people who are
30:13themselves in groups that tend to be
30:16stigmatized or who are sympathetically
30:18groups who tend to be stigmatized and
30:20to recognize how dangerous this current
30:22situation is for disadvantage people.
30:24So in the fight for justice,
30:26it's a fight not only for legal justice,
30:29not only for social justice.
30:31Not only for a reform police a
30:34core but also for medical justice.
30:36And if more people who are
30:38disadvantage are dying of Hell.
30:40But there are a lot more people,
30:43a lot more people who are socially
30:46disadvantage toward developing the
30:47psychiatric side effects of Co.
30:49But those are the people
30:51who are the least likely.
30:54And joins the least likely to know what's
30:57involved in accessing psychiatric care.
30:59The least likely to be able to turn
31:01around the psychological and psychiatric
31:03effects that they are suffering as
31:06side effects of the cobit prices and
31:09the most likely in many instances to
31:11be the people who are dying from those
31:14illnesses since the beginning of Co.
31:16Bid the number of calls to many suicide
31:19hotlines has gone up by as much as 400%.
31:22There are huge numbers of people
31:25who are contemplating suicide.
31:26There are huge numbers,
31:27though I'm not aware it's the
31:29statistics being fully assembled of
31:31people who are committing suicide.
31:33There are huge numbers of people who
31:35have received social directives to
31:37self isolate who are unable to do so,
31:39in part because they live in a
31:41single room with Seven other people,
31:43and in part because their economic
31:46duress means that they have to go
31:48out and try to do some kind of work
31:50and are constantly exposed on the
31:52streets and on public transportation,
31:54and quite possibly in their workplaces too.
31:56The virus in ways that other people with
31:59greater privilege don't have to be.
32:01So I think that is a terrible
32:03shame on the face of our nation.
32:06I would just say that when we
32:08look at the mortality of turbid,
32:10you know there's been an attempt
32:12to measure the mortality of Cobit,
32:14not only by responding to people
32:16who have been specifically diagnosed
32:17with the infection,
32:19but by looking at the increase
32:20in death rate overall over what
32:22it would ordinarily be.
32:24There has been a significant increase,
32:26and I don't have the numbers in front of me,
32:29but effectively at the number of people
32:31who died in the month of April and May
32:34was much higher than in any previous.
32:36April and May.
32:38We don't know whether all of those
32:40people had covet, but given that
32:42that's what's going around,
32:44it seems likely the Cove it
32:46was implicated in those guests.
32:48I would say that the people who
32:50died in April and May were not only
32:53people who had pre existing pulmonary
32:55conditions were not only people
32:57who are older and who are therefore
32:59more vulnerable to this situation,
33:01but also people who are psychologically home.
33:04We're both escalated into suicide.
33:06Whoever depressed immune response.
33:08For you for 1000 other reasons have ended
33:11up suffering an unfair an unjust death.
33:14Whether they have the virus or not.
33:18So I will wind up there.
33:20I'm very happy to take questions
33:22and I am never so clear unzoom
33:24of exactly how they work,
33:26but I think you can raise hands
33:28or you can type them into Jack.
33:30So please any questions at all.
33:32Very welcome.
33:39Oh, someone has a question, I feel certain.
33:50You have to. I would remind
33:52you have to unmute yourself
33:53if you're asking a question.
33:54I think everyone is stupid.
33:57So I'll get the I'll get the ball rolling
34:00one of the one of the challenges that
34:03we face in trying to provide support.
34:06Uh, uh, two of the health care community
34:09is the reluctance to seek help and a
34:13kind of martyr mentality where people
34:16feel like their the people who they
34:19have to take care of everybody else.
34:22They can't take time to take
34:25care of themselves.
34:26Uh, an uh, it's a huge challenge
34:29for us to reach the people who who
34:33seem to need the help the most and.
34:37Just curious if you have
34:40any thoughts about that,
34:42as as you think about groups of
34:46people that are struggling at a time like
34:50this, well the stigma persists around
34:53anything that appears to be psychiatric
34:56fragility or a a psychiatric diagnosis.
35:00If 40% of Americans are now
35:03experiencing a diagnosable depression,
35:05anxiety, or other mental illness.
35:08It seems to me hard to maintain the idea
35:11that this is a terrible embarrassment
35:13and the people will think less of you.
35:15I mean, that's nearly half the people in
35:18the country who are experiencing this,
35:20but I think the fear that is
35:22associated with stigma is enormous,
35:24and I think the sense that what you need to
35:27do is be tough and strong and get through.
35:30This is very powerful, you know.
35:31I've seen people have said I met,
35:34you know, it's like being in Auschwitz
35:36and you have to be a survivor.
35:38But in Auschwitz there were
35:40no mental health services,
35:41and in the United States at the
35:44moment at least met there are,
35:46and I think it's incredibly important
35:48that people recognize that this is
35:50a different situation from that.
35:51A lot of people don't know what
35:54services are available,
35:55and a lot of people don't recognize
35:57the problems that they have,
35:59and that's why I think we also need parent,
36:02if aggressive outreach,
36:03because many people will say,
36:04I mean and upsetting situation,
36:06an I feel really upset in terrible,
36:08and they will.
36:09Resume that whatever is going on with
36:12them is an appropriate response to the
36:15situation in which they find themselves
36:17in point of fact, what's going on?
36:20You know there is.
36:22As I said,
36:23some degree of appropriate response,
36:25and there is Additionally some enormous
36:27degree of response that goes in excess
36:30of that appropriate response and.
36:32So I think the,
36:34uh,
36:34the need is to have programs in which
36:37we scream people because they aren't
36:39going to self identify an we need
36:41to have public health campaigns.
36:43And we've seen how effective
36:45Republic of campaign can be.
36:46I mean, when the isolation started in Wuhan,
36:49I remember thinking wow,
36:51that Chinese government with their incredible
36:53control over their citizenry can do that.
36:55We could never do that here.
36:57It turns out, actually,
36:58we can do it here.
37:00We can set up a protocols for isolation.
37:03The city of New York.
37:05The most crowded,
37:06hectic,
37:06frantic place on the earth would be
37:09completely empty with everybody staying
37:11inside and not even a car driving down
37:14at 6th Ave that were driving up 6th Ave.
37:17I guess it should say that
37:19was an extraordinary change.
37:21If we really made an effort to
37:23inform people a of what the
37:25symptoms are of depression,
37:27clinical depression and anxiety
37:28and be of what the solutions are.
37:31Ansi of how to access those solutions.
37:34I think we would have been vast number
37:36of people who would respond and I
37:38think part of what has to happen is
37:40to give those numbers and say this is
37:42affecting this huge number of people.
37:43Don't feel ashamed of it and
37:45that that's part of
37:46the messaging that would have to take place.
37:49I see there's a question here.
37:51Do you have any advice to prevent
37:54the mental health side effects
37:55for future foreign to you,
37:57EG the predicted surge in the fall?
37:59Perhaps a public health message
38:01to take advantage of mental
38:03health challe health services?
38:04Yes, I think that's one of the other
38:06problems is that people don't recognize
38:09that there are Telehealth Services and
38:11they don't want to go into a hospital.
38:14I mean, there are many people who
38:16are dying of heart conditions or
38:18cancer or all kinds of other things.
38:20'cause they are so afraid of the
38:23risk of Contagion in hospitals,
38:25and while for extreme illness
38:27and you know the risk,
38:29even agent in hospitals now appears
38:32to be largely well controlled.
38:35You know,
38:35I wouldn't particularly want to
38:37go into a hospital right now if
38:39I could possibly avoid it myself,
38:42but I think people don't understand
38:44what the technologies are now.
38:45Telemedicine is very useful.
38:47It works best for people who have
38:49got a computer and an Internet
38:51connection and can engage with Challe
38:53Health as it's primarily practice,
38:55but it's possible even for people who
38:57have a telephone and you know most
39:00people in the United States have telephone.
39:02Certainly not all people have access
39:04to a phone, but most people do.
39:07I think it's important for people to
39:09know what treatment can look like
39:11when you can't actually go there,
39:13and I think it's very important
39:15to make it clear to people that
39:17there are and to create in fact
39:19situations in which there are central
39:22numbers they can call.
39:23They get widely advertised
39:25on the basis of calling them.
39:27There is some kind of
39:28telemedicine available to them,
39:30but people often don't have the
39:31capacity to do because they're
39:33depressed because they are anxious
39:35because they're overwhelmed because
39:37they don't know what's going on.
39:39Is the ability to do a lot
39:41of research and so did find,
39:43well, you know,
39:43I could maybe going to these people and
39:46they have a connection to those people.
39:48and I wonder whether this line is we
39:50need to have something centralized and clear.
39:52We need to have a National Health log.
39:55That would be my primary advice
39:57in terms of telemedicine in this
39:59crisis is that we need to have.
40:00A line we needed to be advertised.
40:02We need people to know and then we
40:04need to have people there who can
40:07pass treatment recommendations on
40:08or provide treatment themselves and
40:09you can set it up and make it easy.
40:12It's hard to do when it's hard to
40:14make up the phone all together
40:16when you're depressed.
40:17It's a lot harder if you don't
40:20know who to call.
40:21I have another question,
40:23if there's no other directly
40:24related question,
40:25perhaps you could talk about how
40:27this impacts kids and adults with
40:29special needs or disability and
40:31what we can do to advocate for
40:34them under these circumstances.
40:35Well, it's been,
40:36my other topic has been M disabilities,
40:39and particularly how families deal with
40:41children with differences or disabilities,
40:43and obviously all of this becomes
40:45more difficult for people who
40:47have a range of disabilities.
40:48You know, if you have someone who's got.
40:52Nonverbal autism then trying to explain
40:54to them how to use telemedicine is
40:56going to be sort of a losing operation,
40:59and there have to be systems in place
41:02to help those people, hopefully.
41:04There either in facilities where they can
41:07be treated or with families will freak them.
41:10But of course many such facilities have
41:12been emptied out during this crisis and
41:14people who were in careful years and
41:17years have suddenly been thrown out of
41:19the places that are familiar to them.
41:21Because Emma of the risk of Contagion
41:23in those contained environments,
41:25and they've often been put back
41:27with families,
41:27I mean it luckiest ones have
41:29been put back with families,
41:31and many of those families don't really
41:33know what the appropriate interventions.
41:35Are even to get their children
41:37through ordinary day-to-day life,
41:39and it's difficult to know how
41:42much those people are perceiving
41:44of the crisis in mental health.
41:47Physical health that's going on around
41:49them for people with physical disabilities,
41:52I think there it's possible to do
41:54mostly the same things that I've just
41:57talked about and Paula Sims will help
42:00line and try to help them get through.
42:03But for people with other disabilities
42:05and particularly with nonverbal disability
42:07or people who've got deafness and who
42:09need to access care through an interpreter,
42:12that can be a lot harder.
42:14and I think the best way that
42:17we prepare ourselves.
42:18Is my thinking through uh,
42:20what the ways are to gain access
42:23for those people to caretakers
42:25who can in turn access cab?
42:30Put my else has asked the question
42:32of the hour, which is how about
42:35the potential role of responsible,
42:37competent federal leadership during this war.
42:40Well, it would be nice if we had
42:42competent federal leadership.
42:43I mean, one of the things
42:45that has been most shocking.
42:47and I was kind of steering clear of politics,
42:50but I won't know is that in other countries,
42:53virtually every other country,
42:55including countries in the developing
42:57world where the resources are scanned
42:59there is at least a national policy
43:01and we instead of had a president
43:03who was trying to use the situation
43:05we find ourselves in as the basis
43:08for his own electioneering.
43:09And who is displayed.
43:10Little to no interest in what is involved
43:13in helping people who are suffering
43:15from Amoco bid to have a coherent response.
43:18The business of putting it all on
43:21the shoulders of the governance.
43:23and I mean the governor in one place.
43:25Who says you have to do one thing and
43:28a governor right across the border?
43:31Who's doing something else has
43:32created a kind of chaos of response,
43:35but I think it's been unbelievably
43:37toxic and that has escalated.
43:39People sense of psychological stress and.
43:41The feeling of not understanding how
43:44the treatment you're getting responds
43:46to the a response to the politics
43:48of the moment has been appalling,
43:50and the manipulation and the city of
43:53politicization and the politicization
43:54of masks in the stores,
43:56that won't let people in without mask
43:59all trickle down from a president,
44:01who,
44:02instead of putting on a mask
44:04like even Immanuel Makron dude,
44:06who instead had said I'm not
44:08going to wear a mask.
44:10You don't have to wear a mask out there.
44:14I want my election rallies to take
44:16place with large numbers of people not
44:18practicing social distancing because
44:20that plays better on television.
44:22That was a statement just from yesterday.
44:25It's it's appalling an it's making the
44:28situation much worse and that's why we
44:30have the highest rate of coded infection
44:33in the world and why there's no sign
44:36at that rate is being brought down.
44:38Other countries have managed
44:40Ahmed to largely eliminate,
44:41and the problem of this illness.
44:43We need world leadership, ideally.
44:45But certainly, federal leadership,
44:47in its absence, is really a gross deficit.
44:51Oh no.
44:53There is discussion.
44:54There's already discussion about
44:56illuminating the relaxed regulations
44:58related to have the teller health or
45:01decreasing reimbursement for virtual visits.
45:03What are your recommendations
45:05for Tele health advocacy?
45:08Well,
45:08I think that the first thing to be
45:11done is a lot of good studies on
45:14the efficacy of Keller held a gun.
45:16Think that we have at this point we have
45:19anecdotal experience and there's no
45:21question that ever helped helped many,
45:23many people under many circumstances.
45:25I'm not aware of,
45:27at least are having large,
45:28well funded studies in which we
45:30compare outcomes with Tele health
45:32outcomes with no response outcomes
45:34with in person visits.
45:36I think we need to put together.
45:38The research, in order to make those
45:40arguments, but those arguments would then
45:42have to be made to insurance industry
45:44that would like not to pay for all these
45:46telehealth visits and to a federal
45:48government that couldn't care less.
45:50So did studies are important
45:52and will be the first step.
45:53But there's still a long way to go.
45:57Um, here's one in your travels.
45:59If you experience other cultural rituals
46:02or techniques that enhance resilience
46:05into other situations of isolation or
46:08funeral rites, that could be helpful.
46:11Now, IE helpful practices in times of duress,
46:14suppression, or war. Well.
46:17The rituals that I've encountered have
46:20always involved people coming together.
46:22I mean, I reported from Afghanistan
46:24during the early days of the American
46:27invasion in February of 2002,
46:29and I recorded from Libya at
46:31the end of the Kadhafi period,
46:33and even in societies that were in
46:36total chaos when there was a death,
46:38there was a kind of pause in the
46:41chaos and people came together,
46:43maybe not as many people as we have
46:46come together in a peaceful time,
46:48but they were still human beings.
46:50In contact with other human beings,
46:52that is really the essence,
46:54I think of all of the cultural
46:56rituals that exist around death,
46:58and it's the thing of which
47:00we are currently deprived.
47:02Having said that,
47:03I think that you know it is better to have.
47:06I mean,
47:07if someone I know just had.
47:10A a telemedicine funeral in I mean up
47:13telling Medison Absolute zoom funeral,
47:15in which even though she was the only
47:17one at the graveside or I think machine,
47:20her daughters who are at the graveside
47:23that they had a camera setup and they
47:25knew that a huge number of people were
47:28watching and the people who were watching
47:30when it was over sent messages of concern.
47:33I think we need to figure out techniques
47:36in which people know how to do that,
47:39which it becomes a standard.
47:41Enterprise to uh to make that available,
47:44uh,
47:44in which people are responsive
47:46to the sense of absence.
47:48and I also think,
47:50and I know this is my possibly controversial.
47:54I also think that sometimes,
47:56especially if, uh,
47:57in this instance the window is uninfected,
48:00there are moments when you can then either.
48:04If you can't go to the funeral,
48:07you can actually go and see the person,
48:10possibly at 6 feet.
48:12Distance,
48:12I mean,
48:13if you can't have awake and you can
48:15have a Siva and you can't have any
48:18of these other rituals that usually
48:20bring people together in their morning,
48:23you can have individual visits
48:25outside with Mass under controlled
48:27circumstances and you can prioritize
48:29those and you can come up with
48:31parameters and that are dictated by
48:33religious leaders and by cultural
48:35leaders and of what is acceptable,
48:37what is unacceptable,
48:38what is available,
48:39what is unavailable and come
48:41together as a community of support.
48:44Even when you have to physically be there,
48:46holding your arm around someone
48:48shoulder at the great site.
48:51Um? I have one more here.
48:54Thank you for highlighting
48:56the nature of disease.
48:58Social isolation racism is pervasive,
49:00longstanding stressors,
49:01and in particular the elegant Aikikai
49:04Ninjew study by Zelikow ski at Al.
49:07How do you think appreciation of
49:10these pervasive stressors should
49:12change the nature of psychiatric
49:14treatment for stress related disorders?
49:17You know we live in stressful times.
49:20We're living in stressful times.
49:22Even before kovid came along we have
49:24lived in stressful times with the extreme
49:27polarization of American politics
49:29that it's been stressful for people
49:32at either end of the spectrum we're
49:34living in Ms stressful times because of,
49:37you know a million different things.
49:39The information revolution we now live in
49:42stressful times because we can't travel.
49:44We previously lived in
49:46stressful times because.
49:47You were on airplanes all the time,
49:50or if we were people who had fewer privileges
49:52and warrant on airplanes all the time.
49:54We lived in stressful times because
49:56the social safety net has been so
49:59profoundly eroded and the support.
50:00But we are struggling,
50:03have been adamant so profoundly undermined.
50:06So I think that we need to
50:10recognize that stress is a really
50:13basic problem in the 21st century,
50:16and that figuring out ways to figure out
50:20ways to deal with that stress is incredibly,
50:25is incredibly important.
50:27And obviously there are
50:29medications that help people too.
50:32Deal with short term stress,
50:33but we don't want to go to having an
50:36entire population that's on diazepam.
50:39A rope as a lab.
50:40What we want to do is to have a
50:43population with people learn better
50:45techniques for managing stress,
50:47and there's mindfulness.
50:48And there are all kinds of other things,
50:51but I would also say in relation
50:53to Ms dress that difficult.
50:55Though this time has been many
50:57people I've spoken to have said
51:00that while they are very frightened.
51:02The stripping back of their lives
51:04to relatively simple lives because
51:06they stay at home and they don't go
51:08out and they aren't involved in a
51:10great many social interaction for
51:12all of its deficits and challenges
51:14has also reduced in some ways.
51:16Their stress levels,
51:17and so I think if we stand to learn
51:20things from this experience and
51:22I very much hope we do.
51:23One of the things I hope will learn
51:26is that it's possible for all of us
51:28to slow down our lives with that.
51:31Our lives evaporating in disappearing.
51:33And I hope that on the far side of
51:36this we carry that sense of how we
51:38can limit the stress of our day-to-day
51:41lives and limit the range of our
51:44activity and remained fully productive
51:45and fully engaged in lots and lots going on.
51:48I also think we need to have better
51:51situations for emergency workers,
51:53the emergency workers in this crisis
51:55have done so much and it worked
51:57so hard and had been so in gay,
52:00and I think it's frightening to
52:02think have little.
52:03Uh,
52:04they have been given space
52:07for alleviation of their
52:10stress. Um? Ashley Clayton has raised
52:13her hand actually Flake and you want
52:16to speak? Yeah, I'm first.
52:18Thank you so much for this talk.
52:21This is fantastic and I had
52:23a question or concern that's
52:25actually related to with John
52:27was raised in his question, but
52:29I think one thing for me
52:31both personally and also a lot of people
52:34I've talked to is the threshold for
52:37seeking help for mental health related
52:39concerns is now raised right? I mean it.
52:42Or seeking medical attention in general,
52:44we've seen you know, admissions for
52:46heart attack and stroke go down in the D.
52:49Um, and you know, I know there's been
52:52this big prevention movement and
52:54kind of went the time to intervene
52:57as before stage for mental health,
52:59but where a lot of people,
53:01both for myself included.
53:03I have an incredible psychiatric team that
53:06I've been working with for a long time,
53:09but my threshold for reaching
53:11out to them is like,
53:12do I need to be in the emergency room or not?
53:17Because there's this message of right
53:19this overburdening of the medical system.
53:21Everyone is stretched so thin
53:23and I've heard that um,
53:25kind of in my peer communities as well.
53:28And so I'm just concerned.
53:30How long that will last,
53:32even as the health care system.
53:34You know, we flatten the curve.
53:37There's more.
53:38Availability of services,
53:40Telehealth Services and things.
53:41But how long that that kind of internal
53:45threshold for people will remain raised?
53:47and I think the larger
53:49implications of that of,
53:51you know,
53:52only seeking help help and only really
53:55intervening in acute crisis.
53:59Well, I mean to quote our old friend
54:02Benjamin Franklin an ounce of prevention
54:05is worth a pound of cure and I think
54:08at the moment there is so much stress
54:10and there is so much mental illness
54:12in circulation that people are really
54:15focusing on pure rather than on prevention.
54:17and I don't know that we have the
54:20resources to turn that around right now.
54:22I mean, I don't think we can start doing
54:26prevention and give up on cure, I just only.
54:28We have the the scope for that and I think we
54:32can't abandoned the people who are in prices,
54:34but it is to be hoped.
54:36I guess is that on the far side of
54:38the most acute phase of this crisis
54:41will recognize what can be done by
54:44way of prevention so that people are.
54:46More resilient when they come
54:48to situations like this one.
54:50But having said before,
54:52there should be a public health
54:54response in which, uh.
54:57Fine or whatever the technique is.
54:59Beltone gets used for the hotline
55:02or something along those lines
55:04is put into place.
55:05The UM.
55:07Perative right now I think is also
55:09to say to people if you are not
55:12yet really in an acute crisis,
55:14but feel like you're headed that way you
55:16two through the temp to access telemedicine.
55:19And if you have had severe
55:21depression or anxiety in the past,
55:23you know get everyone in order.
55:25I mean, I speak as someone who has suffered
55:27from severe depression and anxiety.
55:29I got in touch with my therapist.
55:32I said look,
55:33I'm feeling kind of fragile.
55:34These are the concerns I have.
55:36This is how well I'm dealing with them.
55:39I seem not so far not have escalated
55:42into a clinical depression,
55:43but I have people on tap or ready
55:46to help me when and as I do,
55:49and that's a very privileged position.
55:51I realized that you have people
55:53on the team who were already in
55:55place and to have the resources
55:57to be able to talk to them,
55:59but I think if the people you know I
56:02started off with those four categories,
56:04I think if the people who I said require
56:07what I thought psychiatric first aid.
56:10Are paying attention.
56:11There are ways that they can prevent
56:14themselves from escalating into the
56:16Group 3 in that analysis where the
56:18people who are having their first
56:21really serious here and I think back
56:23to what John said at the beginning,
56:26we need to destigmatize those efforts
56:28and we need to say to people you
56:31know if you're feeling really bad and
56:33if you're having terrible insomnia,
56:36and if you're waking up feeling
56:38incredibly anxious,
56:39or whatever the panoply of cyst symptoms.
56:41Maybe if you want to address that Patrick,
56:44leave something you need to,
56:45you need to find a way to do it and
56:47that needs to be a public health
56:49campaign and then the resources
56:51have to be there so the ones we've
56:53said that two people there are
56:55services that they can
56:56access.
56:59I will do this if you one more question and
57:03then I knew were running a little over.
57:06I'm find his Dave You are, but here we are.
57:10Therapist meeting with patients,
57:12isolation of calla health
57:13versus fear of Contagion.
57:15Much more equalization between both
57:17parties you to shared anxieties etc.
57:20Uh, well there's no question that
57:22people who are practitioners of mental
57:25health care are also having a rough
57:28time at the 40% of the population who
57:31have currently got clinical symptoms
57:33includes any number of people who are
57:36working in the field of mental health.
57:39There are some instances in which
57:41for a psychiatrist or psychologist
57:42or therapist to say I'm having a
57:45rough time too is immensely helpful
57:47and allows the patient to understand
57:49this is happening to everyone.
57:51There are some instances in which
57:53it's very unhelpful and makes the
57:55patient feel terribly insecure,
57:57but it's been work done on what degree
57:59of disclosure can be affected within
58:01relationship between a therapist
58:03and a patient.
58:04There is an allowed stuff on
58:06transference and on the ways in
58:08which you engage with friends friend.
58:10In terms of psychodynamic therapies,
58:12but even in terms of other forms of therapy,
58:14that's true.
58:15Mental health practitioners and there
58:17are many of you on this line right now.
58:19Need to attend to their own mental
58:21health as well as they can in order
58:24to be helpful to their feature,
58:26because the thing that is really most
58:28helpful if there's going to be disclosure,
58:30is to say I've been having a
58:32lot of similar symptoms,
58:33but I've been doing some things
58:35that seem to have really helped,
58:37and here's what they are.
58:38The equalizing if the relationship
58:40between psychiatrists and patience,
58:41I think, is frequently.
58:42Very helpful, so long as it's containing.
58:44I mean I think being a psychiatrist
58:46who breaks down in tears and
58:48says I can't stand this either.
58:50I don't know what I'm going to do I
58:53think about suicide every day is not
58:55reassuring to a patient who is in his office.
58:58Being able to say as a
59:01psychiatrist that you've had.
59:02No,
59:03you faced various difficulties of your own.
59:06And manage come through them in.
59:08Here are some things that might be helpful,
59:10and they really apply to everyone in this
59:13time of national prices can be very useful,
59:15so that's a complex balance and
59:17we could probably talk about it
59:19for the next three or four hours
59:21and still not fully resolved yet.
59:23But I do think that there is a sense
59:25in which the members of the psychiatric
59:28profession are vulnerable an I think
59:30the pressure to sustain the appearance
59:32of invulnerability can be enormous
59:34and can be very counterproductive
59:36both for the psychiatrist and for the.
59:38Agent,
59:38and I'm thinking of course of the
59:41woman who is running the emergency
59:43room in at the Allen Medical Center
59:45in the North of Manhattan,
59:47who killed herself about a month ago.
59:49Now I think it is.
59:51Another story was all over the papers and
59:53most of you probably saw, but I thought,
59:56OK, there was someone who felt she
59:58had to be strong and powerful in.
01:00:00Relation to everyone and what is
01:00:02it that we do with someone who is
01:00:06under those terrible pressures?
01:00:08Are we taking care of those people?
01:00:10And frankly, I mean she was
01:00:12seeing a lot of patients dying.
01:00:15But if you are in psychology or psychiatry
01:00:18and you're at the moment seeing a lot
01:00:21of patients who are in desperate shape,
01:00:24that's very taxing.
01:00:25Even if you yourself are quite resilient,
01:00:28that's very taxing.
01:00:29It's very taxing.
01:00:31If we mostly have dealt with the worried,
01:00:33well can suddenly be dealing with
01:00:35one person after another who's
01:00:37in a state of despair and we need
01:00:40for the profession to provide.
01:00:42Not a facility so that those people have
01:00:45not received in our sustained in there cat.
01:00:48I think that's it.
01:00:50That's it OK.
01:00:53Andrew, thanks so much
01:00:54wonderful presentation.
01:00:55Really thoughtful and and helpful
01:00:57discussion as always were in your dead.
01:01:00And thank you so much for
01:01:03for speaking with us today.