My background is behavioral science research by training. Behavioral science informs psychology/psychiatry. Since nobody knows what another is thinking, patient behavior informs the therapist of condition. But, some patients learn from therapy sessions about how to temporarily hide some symptoms of greater severity. But, humans are unable to maintain lies downstream and become exposed.
Outside the hospital, I would think that a designated therapist (or psychiatric social worker) would have observed Michael’s progression into the “danger zone.” Even if pretending “Everything is fine”, body language reveals tell-tale signs of increased pre-occupation or mental fixation about imagined danger. I also would think that therapist would train immediate family and significant other to recognize warning signs. Police and other professionals train people on how to recognize the approach of violence.
On Yale- sounds like well-intended interference. The key to managing patient mental illness is to interview patient often and to observe task performance. Mental illness interferes with task performance- daily activities, hygiene and grooming, home chores and meals, job performance and relationships. Loving another human is a task that can be observed. It sounds like Yale deprived Michael of normal student tasks. If Michael had been in an environment where task expectation were normal- then a decline would have been noticed by other professors or job supervisor.
I have the DSM-5 Manual on my bookshelf. Next to it is “Handbook Of Psychological Assessment” by Wiley, Sixth Edition (2016). Handbook is a roadmap to assessing and diagnosing patients. It is basically a decision-tree based on rules. The key to success is therapist’s adherence to rules. (Jordan Peterson is correct.)
An example of a therapist rule would be to weigh expected mental harm of “Zero privacy + zero security of homeless during nighttime sleep hours” against benefit of patient autonomy. Or threat of harm resulting from automobile collision vs. freedom of mental patient to move randomly among traffic. Once a month in SF, I scream in horror and look away as I watch someone walk towards moving traffic.
My public health/therapist colleagues create a pathway to Hell, when they replace rules with “reasons”. I have a question for the author Jonathan Rosen; “If you could step into a time-machine, what would you change at different time points so as to avoid the tragic outcomes of your friend Michael and his girlfriend?
Thirty feet from my Tenderloin apartment are the homeless with severe mental illness on the street. In 2004, a homeless man slammed an aluminum coffee cup against my face because- “I owed him a million dollars”, half a block from my apartment. Six months ago, half a block in opposite direction- a stranger out of nowhere punched the air three inches in front of my nose. Business owners are terrified. Mayors and governors are not transparent about the homeless and mentally ill, putting everyone at risk.
In 2023, it is not possible to have an honest discussion with mental health directors or NIMH or public health establishment about homeless or mental patients who fall through the cracks; because everyone lies so as to protect a politicized agenda.
In closing; I wasn’t aware that activists are trying to redefine mental illness as “not ill.”
A good friend of mine lost her stepson to paranoid schizophrenia. He was utterly incapable of self care, and eventually was brutally murdered after years of living on the streets. Every judge before whom he appeared, always after some series of crimes, deemed him “competent” and refused mandatory state care. He should have been in a state hospital. He needed help, and that help had to be compelled upon him. Utterly tragic.
This was a wonderful episode. Not a “happy” one, but so poignant. Much of what Mr. Rosen said helped give me words for how I feel about the mental health approach in our current culture. I watched my father lose his mind, and eventually succumb to Lewy Body Dementia, and it was so disheartening and frustrating as we worked to get a diagnosis and help.
This was a great episode - you could tell how much he cares and loves his friend. I’m a big fan of the Jungian view that reality is the best medicine. It’s clear the institutions have gone so far in the opposite direction and suffering is getting much worse for individuals and society
Immensely validating to me as a psychiatrist at the end of my career. I trained in NYC. I have spanned the generations of brutal evolution in psychiatry, which has been hijacked by political ideologues even from within professional organizations. The term “evidence based” needs to be reclaimed by the mathematicians and scientists who are adherents to the power of good math. I lament the closing of state hospitals. Instead of reform, we have outsourced the care and management of the chronically mentally ill to the mercy of the streets and carpetbagging for profit psychiatric hospitals as general hospitals jettison their psychiatric units. We have also seen the expansion in the definition of psychiatric illness with the DSM5 as a continuation of science by committee. There is an explosion in the diagnosis of autism, ADHD, bipolar disorder, and transgenderism, and yet those diagnoses which demand accountability for behaviors have become much rarer: borderline, narcissistic, or antisocial personality disorders. Anything construed as pejorative is bad; anything that might fit into a protected class is good. These days anyone who calls an emperor naked may be professionally tarred and feathered. I know.
This was a super interesting episode. I had never heard of this individual or incident, but its very tragic. Mr. Rosen was a great speaker and I plan to look more into this.
Sobering. But I lean to making mental health services to the ill available but without coercion and insisting on full consequences for their actions. We can debate until the end of time whether they can freely make choices but what is glaringly evident from this interview is that no one can do it for them. It’s an unresolvable paradox of human freedom. If the mentally ill are not free or they are not accountable we are all at risk of having our freedoms taken.
This interview demonstrates that virtue signaling solves no problems.
Bari - this is an incredible episode, perhaps one of my favorites. It delves into so many topics of great import. Many of which I have thought deeply about, but have no answer to. Thank you, I cannot wait to read Mr. Rosen's book.
For a long time we have been concerning ourselves with rights. And with those among us who seem not to be enjoying them. Out of the Declaration and the Preamble and the Constitution's first ten amendments we have lighted upon the word and elevated it above all else preceding from the most remarkable set of documents thus far to illuminate the course of mankind on this orb. To be sure, we have not just elevated it but enshrined it and attached it to any number of concepts, undertakings, past times and habits imaginable. So that now it must certainly be our right to play Parcheesi. This even though the rights mentioned in those founding documents are limited to just three: Life; Liberty; and our Pursuit of Happiness.
Beyond those very basic God-given rights are only individual freedom and responsibility -- two things which go hand in hand -- and a guarantee the tyranny that is a central government shall not interfere with anyone's freedom to exercise his thought or his word or his action within the law. I take that to mean when I am unable or unwilling to be responsible for myself in what I think or say or in how I behave, I can expect I shall forfeit the opportunity to do those things freely.
This seems a legitimate assumption and one, when applied in any instance, gives clarity to society's reaction to problems that arise ... including homelessness, mental illness, and all of man's inhumanities to his fellow men.
Thanks for recommending the book and doing this podcast with the author.
I'm pretty busy right now so I've only gotten into the first chapter. 2 young children and writing a course on AI have me tied up at the moment, but I hope to scrape together a little time to read more. I'm always interested in a book that goes into depth on mental illness - "A Mother's Reckoning" by Sue Klebold would be one.
Wanted to let you know that I come at this book from a different background and it has already taught me some very important lessons. Thought my observations might be of some interest to you.
First, that 1 in 3 Jews were murdered in the Holocaust. Second, that communities like the one in Mr. Rosen's childhood had members who survived it. Third, that children were named after murdered relatives. Perhaps you think these are small things, they are not. I thought I had some concept of the Holocaust - obviously I was naive at best. I'm looking forward to the rest of the book, Mr. Rosen is an exceptional author.
Listening this episode right now. Thank you so much for these episodes discussing severe mental illness. Thank you for not just discussing the illness, but discussing the more difficult questions of what do we as a society/community do (or not do) about severe mental illness. These are questions and conversations we need to have now and take action on now. Families that want to help their loved ones with mental illness have few real options. It is a heartbreaking, frightening and lonely world.
My background is behavioral science research by training. Behavioral science informs psychology/psychiatry. Since nobody knows what another is thinking, patient behavior informs the therapist of condition. But, some patients learn from therapy sessions about how to temporarily hide some symptoms of greater severity. But, humans are unable to maintain lies downstream and become exposed.
Outside the hospital, I would think that a designated therapist (or psychiatric social worker) would have observed Michael’s progression into the “danger zone.” Even if pretending “Everything is fine”, body language reveals tell-tale signs of increased pre-occupation or mental fixation about imagined danger. I also would think that therapist would train immediate family and significant other to recognize warning signs. Police and other professionals train people on how to recognize the approach of violence.
On Yale- sounds like well-intended interference. The key to managing patient mental illness is to interview patient often and to observe task performance. Mental illness interferes with task performance- daily activities, hygiene and grooming, home chores and meals, job performance and relationships. Loving another human is a task that can be observed. It sounds like Yale deprived Michael of normal student tasks. If Michael had been in an environment where task expectation were normal- then a decline would have been noticed by other professors or job supervisor.
I have the DSM-5 Manual on my bookshelf. Next to it is “Handbook Of Psychological Assessment” by Wiley, Sixth Edition (2016). Handbook is a roadmap to assessing and diagnosing patients. It is basically a decision-tree based on rules. The key to success is therapist’s adherence to rules. (Jordan Peterson is correct.)
An example of a therapist rule would be to weigh expected mental harm of “Zero privacy + zero security of homeless during nighttime sleep hours” against benefit of patient autonomy. Or threat of harm resulting from automobile collision vs. freedom of mental patient to move randomly among traffic. Once a month in SF, I scream in horror and look away as I watch someone walk towards moving traffic.
My public health/therapist colleagues create a pathway to Hell, when they replace rules with “reasons”. I have a question for the author Jonathan Rosen; “If you could step into a time-machine, what would you change at different time points so as to avoid the tragic outcomes of your friend Michael and his girlfriend?
Thirty feet from my Tenderloin apartment are the homeless with severe mental illness on the street. In 2004, a homeless man slammed an aluminum coffee cup against my face because- “I owed him a million dollars”, half a block from my apartment. Six months ago, half a block in opposite direction- a stranger out of nowhere punched the air three inches in front of my nose. Business owners are terrified. Mayors and governors are not transparent about the homeless and mentally ill, putting everyone at risk.
In 2023, it is not possible to have an honest discussion with mental health directors or NIMH or public health establishment about homeless or mental patients who fall through the cracks; because everyone lies so as to protect a politicized agenda.
In closing; I wasn’t aware that activists are trying to redefine mental illness as “not ill.”
A good friend of mine lost her stepson to paranoid schizophrenia. He was utterly incapable of self care, and eventually was brutally murdered after years of living on the streets. Every judge before whom he appeared, always after some series of crimes, deemed him “competent” and refused mandatory state care. He should have been in a state hospital. He needed help, and that help had to be compelled upon him. Utterly tragic.
This was a wonderful episode. Not a “happy” one, but so poignant. Much of what Mr. Rosen said helped give me words for how I feel about the mental health approach in our current culture. I watched my father lose his mind, and eventually succumb to Lewy Body Dementia, and it was so disheartening and frustrating as we worked to get a diagnosis and help.
This was a great episode - you could tell how much he cares and loves his friend. I’m a big fan of the Jungian view that reality is the best medicine. It’s clear the institutions have gone so far in the opposite direction and suffering is getting much worse for individuals and society
What percentage of prisoners incarcerated for a crime, were probably mentally ill to begin with?
Immensely validating to me as a psychiatrist at the end of my career. I trained in NYC. I have spanned the generations of brutal evolution in psychiatry, which has been hijacked by political ideologues even from within professional organizations. The term “evidence based” needs to be reclaimed by the mathematicians and scientists who are adherents to the power of good math. I lament the closing of state hospitals. Instead of reform, we have outsourced the care and management of the chronically mentally ill to the mercy of the streets and carpetbagging for profit psychiatric hospitals as general hospitals jettison their psychiatric units. We have also seen the expansion in the definition of psychiatric illness with the DSM5 as a continuation of science by committee. There is an explosion in the diagnosis of autism, ADHD, bipolar disorder, and transgenderism, and yet those diagnoses which demand accountability for behaviors have become much rarer: borderline, narcissistic, or antisocial personality disorders. Anything construed as pejorative is bad; anything that might fit into a protected class is good. These days anyone who calls an emperor naked may be professionally tarred and feathered. I know.
This was a super interesting episode. I had never heard of this individual or incident, but its very tragic. Mr. Rosen was a great speaker and I plan to look more into this.
Sobering. But I lean to making mental health services to the ill available but without coercion and insisting on full consequences for their actions. We can debate until the end of time whether they can freely make choices but what is glaringly evident from this interview is that no one can do it for them. It’s an unresolvable paradox of human freedom. If the mentally ill are not free or they are not accountable we are all at risk of having our freedoms taken.
This interview demonstrates that virtue signaling solves no problems.
Bari - this is an incredible episode, perhaps one of my favorites. It delves into so many topics of great import. Many of which I have thought deeply about, but have no answer to. Thank you, I cannot wait to read Mr. Rosen's book.
For a long time we have been concerning ourselves with rights. And with those among us who seem not to be enjoying them. Out of the Declaration and the Preamble and the Constitution's first ten amendments we have lighted upon the word and elevated it above all else preceding from the most remarkable set of documents thus far to illuminate the course of mankind on this orb. To be sure, we have not just elevated it but enshrined it and attached it to any number of concepts, undertakings, past times and habits imaginable. So that now it must certainly be our right to play Parcheesi. This even though the rights mentioned in those founding documents are limited to just three: Life; Liberty; and our Pursuit of Happiness.
Beyond those very basic God-given rights are only individual freedom and responsibility -- two things which go hand in hand -- and a guarantee the tyranny that is a central government shall not interfere with anyone's freedom to exercise his thought or his word or his action within the law. I take that to mean when I am unable or unwilling to be responsible for myself in what I think or say or in how I behave, I can expect I shall forfeit the opportunity to do those things freely.
This seems a legitimate assumption and one, when applied in any instance, gives clarity to society's reaction to problems that arise ... including homelessness, mental illness, and all of man's inhumanities to his fellow men.
Thanks for recommending the book and doing this podcast with the author.
I'm pretty busy right now so I've only gotten into the first chapter. 2 young children and writing a course on AI have me tied up at the moment, but I hope to scrape together a little time to read more. I'm always interested in a book that goes into depth on mental illness - "A Mother's Reckoning" by Sue Klebold would be one.
Wanted to let you know that I come at this book from a different background and it has already taught me some very important lessons. Thought my observations might be of some interest to you.
First, that 1 in 3 Jews were murdered in the Holocaust. Second, that communities like the one in Mr. Rosen's childhood had members who survived it. Third, that children were named after murdered relatives. Perhaps you think these are small things, they are not. I thought I had some concept of the Holocaust - obviously I was naive at best. I'm looking forward to the rest of the book, Mr. Rosen is an exceptional author.
Thank you.
Listening this episode right now. Thank you so much for these episodes discussing severe mental illness. Thank you for not just discussing the illness, but discussing the more difficult questions of what do we as a society/community do (or not do) about severe mental illness. These are questions and conversations we need to have now and take action on now. Families that want to help their loved ones with mental illness have few real options. It is a heartbreaking, frightening and lonely world.
Great one.