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[ Silence ]

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[ Music ]

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>> Good morning all.

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Hi, my name is Damian Rose.

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Welcome to the pen ultimate grand rounds of the 2324 grand round season.

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This will be the final what we call Bay Area grand rounds.

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Just to remind everybody the goal of this series is to sort of celebrate our sort of local collaborations.

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And so with that in mind, I want to just sort of give you a little bit of a background

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about how I met our speaker.

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So about a year and a half ago, I became very interested in other models of care,

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in particular for first episode psychosis.

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And so I've talked to some folks in Norway.

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I had a lot of sort of, it really sort of triggered me to do a lot of reading.

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And I had a couple of really great conversations with with Will Hall.

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And one of the things I actually made a grand round about this because it struck me so much was

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just how pernicious this word insight is.

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And to me it was a great example of how I think as a field we really need to start listening

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to people who experience us and listen to what they have to say.

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And I mean listen with very open mind and really just take it in.

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And I really feel like we've been moving the series more and more towards a frame of social justice,

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a social justice frame.

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And I feel like involving peers and former patients and advocates is going to be a really important part

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of thinking about a social justice frame in psychiatry.

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With that in mind, I would like to introduce Will Hall, who is a PhD candidate

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at Maastricht University in the Netherlands.

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He is a schizophrenia diagnosis survivor, a long time organizer in the psychiatric survivor movement.

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He's a host of madness radio, which I would recommend folks.

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He's a co-founder of Portland hearing voices, a co-founder of the hearing voices network USA,

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and a past co-coordinator of the Icarus project.

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He's authored the Harm Reduction Guide to coming off of psychiatric drugs,

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and outside mental health, voices and visions of madness. These are free downloads.

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He also co-organizes Mad Camp.

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He is formerly trained in Jungian psychology and open dialogue.

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Let's please give Will Hall a warm welcome.

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Thank you.

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Thank you. Wonderful. Yeah, great to see you again.

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Damien, thank you for your work. Thanks to Gina and also to Jonas for all your working making this happen.

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Really, it's quite a dreamlike experience doing a presentation for UCSF

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because the last time there was so much interest in me, it was when I was a patient here.

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I was a patient or inmate at the Langley-Portrace psychiatric institute,

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did not have a good experience and had no idea that I would ever be invited back in this context.

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I'm really grateful. It seems like things may be changing, so that's great to hear.

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Damien, that's a great intro for my talk. I really appreciate that.

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I also want to thank to my colleague, Dean Attila, who's also has presented at ground rounds at UCSF.

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You can listen to her talk, wonderful talk on the madness radio website.

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I want to welcome everybody who's involved listening, participating, being part of this.

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I know that students, professionals, clinicians, also people who you yourself have psychiatric diagnosis of one kind

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or another people who are taking medication, people who maybe have been offered medication, not taking medication, people coming off their medication.

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Even family members, I'm also a family member.

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So I want to welcome all the different roles.

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And one of the key things about listening is recognizing that you're listening to an individual and individuals are different.

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And this is one of the core problems that I think are approached to psychosis,

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suffers from, is that we don't allow for the diversity and unique individual perspectives and experience of each person.

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So I'm going to be speaking about my own experience in the system.

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And my own experience with what I call altered or extreme states or different realities, experiences that would be called psychosis clinically, depending on who you get interviewing you and where you are when you're being interviewed experiences that I continue to have.

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And so one of the things that I do as part of the psychiatric survivor movement is really kind of break up the stereotype of what does someone who's diagnosed with schizophrenia or in my case a kind of schizophrenia called schizoaffective disorder.

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What do those people look like?

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So I am someone who goes against maybe certainly the media representations, but also a lot of the professional and clinical understandings that we have.

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And also breaking up the stereotype of what it is this thing that we call psychosis and the idea that it's not something that you can live with, or is actually I do live with experiences that would be called psychotic.

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I do hear voices including very aggressive, persecutory, painful, distressing voices.

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And I'm also someone who goes through altered states where I perceive a reality to have a meaning that's directed at me sometimes very beneficial, positive, beneficent, meaning, but also sometimes very malevolent and frightening meaning.

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And I'm also someone who lives with suicidal feelings and I'm not going to ask for a show of hands, but suicidal feelings are a lot more common than we tend to think of them.

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We tend to think of suicidal feelings as an occasion for emergency and obviously they are an occasion for great concern, but they're actually part of life.

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There's something that I think a lot of people struggle with. And so I'm really happy to be invited here and to be kind of breaking up those stereotypes.

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And in the spirit of the diversity, which I think is a really important thread, I also want to say that I had a negative experience, a very traumatizing experience in the psychiatric system, including at UCSF, also at the Mao Zai and Crisis Center,

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the West Side Lodge, this was all when I was in my 20s, San Francisco General Psychiatric Emergency Services, I had very, very, very traumatizing painful experiences.

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And at the same time, I know people that had positive experiences that had experiences that they felt were a sanctuary and respite for them.

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So I also, I don't take medication. I found that medications not only did not help me, I tried a number of different antipsychotics, I tried different bipolar drugs, I was on benzos, I was on different SSRIs.

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Not only did they not help me, but I felt that they were life-threatening.

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And if I had continued to stay on antipsychotics, I certainly would not be with you today in any kind of capacity the way that I am now.

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I attribute my ability to get off of disability, because I was on a disability check for 15 years.

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I'm one of the very, very, very small number of people with a schizophrenia diagnosis who are able to come off of a disability check once you're on that disability.

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I'm not able to do that if I, this is my belief, I can't predict, but I would not have been able to do that if I remained on antipsychotic medications.

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So I know people that are helped and feel benefited by different kinds of medication, but I'm really here to help us have a more accurate, a more evidence-based, a more grounded understanding of the experience of psychosis,

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which includes welcoming in the voices of people who have been traumatized and who are survivors and who identify as people who have been harmed by the psychiatric system.

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When I left the system, because I had not been helped, and I really believed in it, and I really wanted to get help.

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I tried all the different things that were offered me.

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I had the kind of classic experience of relief when I finally had that diagnosis, "Ah, now there's an understanding. Now I can connect dots. Now I can have a reason for the difficulties that I have gone through in my life."

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When I left psychiatry because it hadn't helped me, I had no idea that my experience wasn't just shared by some people, was actually shared by a lot of people.

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In fact, there's a whole global movement of psychiatric survivors that have been extremely impactful in the way that care is delivered.

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We actually had incredible successes in the services, in the way that the standard of care operates.

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The basic legal protection, the consent protections, the precautions that are part of, or at least are supposed to be part of the standard of care, getting consent from medication, the judicial review, when your court review, when you're being held involuntary.

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All of that came in as a push on the psychiatric survivor movement.

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I think it's really important that we recognize that this movement does exist, that it's been crucial for the evolution of psychiatry.

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I believe that the psychiatric survivor movement joined with our allies in what can be called the critical psychiatry movement, that we show the way forward.

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There are innovations that are happening that I'm going to get into today, a lot of changes, including the call for abolition.

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I use that word carefully and purposefully because it is a strong indicator that we face a moral emergency that psychiatric care with the caveats that I've said that some people do feel benefited and are helped by psychiatry.

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It's widespread violence that is happening. There's a system of normalized violence in psychiatric practice today.

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It's happening at UCSF, it's happening throughout the United States, it's happening worldwide.

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That is one of the reasons that we are, a lot of us in the movement are pushing for an end to the legally sanctioned denial of equal rights,

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the use of force psychiatric interventions, drugging, incarceration, confinement, restraints, seclusion.

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I was put in restraints, I was in seclusion, I was in a locked ward for about two months.

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In fact, when I was moved, the voluntary ward at Langley Porter, I was told that if I tried to leave, I would be locked up.

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Also when I was at West Side Lodge, which was kind of a residential hospital treatment program in the community in downtown San Francisco, I was also told that if I tried to leave, I would be locked up.

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The movement for the abolition of psychiatric incarceration is really part of the global disability justice movement.

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When you start to think about it carefully, which I hope you will, it becomes a pretty clear cut moral imperative that people with psychiatric disabilities, psychosocial disabilities deserve equal rights.

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There should be no removal of any of those rights based on disability itself.

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The problems that we encounter with people who are in altered states or who are difficult, who are troublesome, who we worry about, who may be doing things that are for us feel that they are self-destructive or harmful.

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There are difficultities that I believe in the psychiatric survivor movement believes there is a demonstrated research evidence base that whatever we're encountering with people, we can resolve without the resort to psychiatric forced intervention.

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As Damien said, I'm a researcher at Master's at University. I'm a therapist, studied young and open dialogue, rights advocate and community development worker.

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My training or my experience, yes, I have a counseling degree, yes, I've done clinical training, but I kind of come from an old school tradition in science, which is that you get close to whatever the phenomenon is.

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I'm very influenced by the work of William James, who felt that there needed to be a very introspective approach to psychology, who couldn't rely on the measurement of the laboratory model that psychology is a very different kind of science is needed.

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I'm very close to my own experience of psychosis and also I've spent countless hours in support groups. I helped start a support and advocacy community called the Freedom Center, Portland Hearing Voices.

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I stay very close to the experience and I'm also very close to the latest research and I'm going to be providing you with a number of links and research leads for your further interest in learning on a webpage on my website at the end of this talk.

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Remind me if I overlook that, so you'll have a bunch of leads for you and also I encourage you to get in touch with me.

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I want to tell my story in three different chapters.

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The first chapter was I was facing poverty. I had lost my job. I was cut off from my professional community. I was isolated and my days and nights were turned around.

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I was nutritionally very, very in a really bad place with my food and my daily habits. I was spiraling down. I spiraled down.

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At that time in life where I think the first episode is kind of described as often happening 26, 27 mid 20s. I don't believe it's because there's some dormant disease that sort of comes to incubation.

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But it's really because it's a developmental moment. It's a time of independence, transition from adolescence to adulthood.

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I, under a lot of these pressures, many different ingredients. I spiraled down into a very dark, altered state of consciousness. I was living in San Francisco. I was so terrified of my roommates that I would leave out the window of our apartment.

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I believed that the devil was speaking to me through a postcard and phone calls that I would get. I would wander the streets of San Francisco and I would see and feel other people communicating with me. I have to run away from them because they were trying to hurt me.

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I heard very aggressive voices telling me that I was a failure and I should end my life. I went up to the Golden Gate Bridge. You know how the story turns out. I didn't kill myself, but that's where this voice was telling me to go. At one point I was holding a scrap of plastic up to the oncoming cars.

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When I came down from the bridge, I talked to my therapist at the time who said, "Go to the clinic, get a medication adjustment." I went to the clinic and I had no idea what was coming next, but you don't just walk into the clinic. They buzzed you in. The door locks behind you.

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I was there for about five hours. Being observed, I was told that the doctor was going to see me. The doctor was going to see me. I never saw a doctor. When it came time for the clinic to be closed, I was ready to go home because I wanted to go to work. I was no longer feeling like I wanted to end my life.

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They said, "No, we're locking you up. This was shocking to me. I was put in the back of a van in restraints." You have to understand, I was very much withdrawn. I was in the negative symptom space. I was very quiet. I wasn't making eye contact. No way was I aggressive threatening or violent anyway.

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They put me in restraints in the back of this van because they said that's how they transport people to psych emergency at San Francisco General. I was given how vulnerable and sensitive and open and raw emotionally I was and how terrified I was.

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I cannot imagine a worse place to be brought than the psychiatric emergency room at San Francisco General was extremely chaotic. The police were coming and going. This started a year long ordeal in the psychiatric public psychiatric system, including two months of force treatment at Langley Porter.

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The experience was considered top of the line psychiatric treatment UCSF but it wasn't something that helped me. Like I said, I first went in really all in. I really wanted help.

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When the two residents and the senior testing clinician, Dr. Kamin, told me, "We've done these steps with you. Mr. Hall, we've determined that you have a kind of schizophrenia called schizoaffective disorder. There's no cure. It's caused by genetics. You will need to be on medications and manage your symptoms for the rest of your life."

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There was an element of relief. Finally things have been figured out for me but that was an extremely dangerous moment because that was a moment not where something was being revealed about me but where a spell was really being cast on me.

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The relief system was being imposed on me and had I continued to stay within that relief system, it can very much become a self-fulfilling prophecy. We talked about open dialogue, we talked about the hearing voices network.

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We can also talk about this. So, Tyria House, Experience in San Jose, we can also talk about areas of the world like Zanzibar, Muslim culture where there's a belief in Jin, there's a belief in possessing spirits and angry ancestors.

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These different contexts have better recovery rates for people like me who are diagnosed with schizophrenia because there's that expectation whether it's in an indigenous context or a clinical innovation like open dialogue or the peer support of the hearing voices movement.

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There's an expectation that you'll go through it that we can help you that you're in the right place. So that moment when I was diagnosed was really a bone pointing and anthropology talks about the magical induction through the power of belief of illness.

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So this is one of the key things that we need to stop doing. We need to stop telling people that they're other, that they're not normal, that they're different.

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Fortunately, I was able to get out of that belief system, the system that I believed in exhausted itself. I went on years later to try and go back to school and failed going back to school. I was at California Institute of Integral Studies because I had not connected with other people who shared my experience.

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My turning point was getting involved with the psychiatric survivor movement and being involved with mutual support peer groups, mutual support groups.

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I was able to find people that I wasn't other, I wasn't strange, I wasn't one of those monsters and I could start to see myself in a more humane, ordinary way.

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And so for a lot of people connecting with community, because let's think about it, psychiatric crisis is about fear and it's about overwhelm and it's about isolation.

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So if you can connect with other people, maybe you can come out of that isolation out of that fear if you can find some trust.

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That's chapter one, chapter two was when I went back to school before I had found the movement. I went through some very difficult stressful times at school with how school was going. I started to not sleep.

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And I remember I started to, this was a time when the Columbine School Killings happened. People may remember the school shootings. I started to believe that I was responsible for those shootings.

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And I went to see the film The Matrix, this was 1999. I went to see the film The Matrix and I was convinced that this was my story, but I was the dark Messiah. I was the Neo that had failed.

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And so that's why the world was ending with the school shooting and I became really, really terrified and I spiraled down and I didn't want to go back into a hospital.

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So I found a residence to go to and I lost my school training. I never finished that degree. So that's chapter two.

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Chapter three is years later after I've come off of disability and I was also under a lot of stress and I was also not sleeping. And I started to have very strange altered experiences. I remember I had a dream and then I saw an image from the dream on the side of a bus, like an advertising on the side of the bus that was on.

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It was from the dream and I called my friends and I talked about how scary this was and how overwhelming it was. And there was another shooting at Aurora, I think, in Colorado.

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It was around the dark night, a returns of Batman movie. I felt very connected. I felt very involved with that. Like it was somehow my fault or something was part.

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I played a role in that and I remember I was rushing to the plane because I was going to do a training and I rushed to the plane. I got the plane and I sat down and right next to me was someone wearing a Batman t-shirt.

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And so all these connections started happening. I got off the plane and I was looking for a taxi to go to the venue where I was going to be doing my work.

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And it was this commotion over my head and it was bats flying around at twilight. So this third experience, I was in what could clinically be called a relapse of my schizophrenia.

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But I didn't have that belief system. I had shed that disempowering meaning system and I had a new meaning system.

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I had an understanding of where as I believe now that these are spiritual experiences that I'm actually accessing a different reality. I'm not sick or having a relapse. I don't have deficits. I'm just in an altered state. I'm having this weird experience that yes, it's fearful, but it's also interesting.

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And the situation was very different because I wasn't isolated. I was able to call a friend of mine, two friends of mine around the image on the bus.

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And so that, because of a different response to the altered state, I didn't go into a crisis. I didn't crash out of my career. I didn't have to go into mental health treatment.

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So the lesson that I believe I learned that I see over and over again in my work as a therapist and support groups and the communities that I work with is that it's not the experience. It's the response to the experience that actually psychotic experiences are normal or normal.

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Anybody listening to this presentation, you too can hear voices and have a psychotic episode. Just don't sleep for five, six, ten. However long it takes you, eventually you will reach that point.

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Laboratory animals, I don't endorse animal testing, but laboratory animals are used in modeling psychosis by introducing stress to normal animals.

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There aren't schizophrenic lab mice that they find genetically schizophrenic that they do the studies on for modeling psychosis.

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They create stress. The stress is environmental stress. It can also be sleep deprivation. It can also be neglect, maternal neglect in rearing of the animal as a baby.

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So the experiences that we call psychosis are normal. In fact, there is no experience whether you want to call it ideas of reference, whether you want to call it being suicidal, whether you paranoid, paranoid, whatever.

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That isn't in some other culture historically considered normal. In fact, historically around the globe, the initiation into becoming a healer is not something that you say, "Well, I think I want to be a healer, I want to be a doctor for the tribe."

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No, you have a calling and your initiation comes through an initiatory illness that is often a psychosis. The person goes through a breakdown and then the elders, the people around who carry those traditions, they recognize.

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And again, they create the expectation that there will be a positive outcome of becoming a shaman or becoming a spirit healer.

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So the experiences that we call psychotic are mixed up with the responses. In fact, as soon as we call it psychotic, we're creating a fear response.

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We're creating a fear response. There's a big movement now, including among professionals, to drop the words schizophrenia.

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Because not only is it just clinically amassed, it comes out of a crepolin and the asylum era where there were just throwing different labels on everybody that was grouped together for all kinds of organics, psychoses, insephylitis, Alzheimer's, they're throwing all kinds of things on people.

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So not only is it an antiquated diagnosis, but it's a catch-all. There's so much diversity. Five people with schizophrenia diagnosis or a schizophrenia diagnosis could have a very, very different set of symptoms that they describe.

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So there's a movement to get rid of the words schizophrenia because it just induces fear. In fact, that's one of the things that they found in Japan is that a lot of patients tragically would go through a psychotic experience,

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get the diagnosis of schizophrenia, just go right out and kill themselves because the shame, the humiliation.

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So we have to disentangle the experience from the response and the experience. Hearing voices is a really powerful example because the majority of people who hear voices don't have any kind of clinical involvement.

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They're outside of the system because the voices aren't distressing. Why is it that some people's voices are distressing and some aren't? Why is it that some people are able to respond and cope well with distressing voices and some people aren't?

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That's what we should be researching, their response. Depression, another example, there's many people who work with their depressive experiences as part of a creative process.

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A lot of artists, a lot of writers will talk about this. They have to go through almost like an incubation stage of depression and suddenly this inspiration comes.

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So that is a big part of the message that if we look at something as a deficit, as a symptom of a disease, we lead out of the equation, the way in which we're responding to it.

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I mentioned suicidal feelings before I'm someone who lives with suicidal feelings. I'm committed to being here. I'm not going to end my life.

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But I take my suicidal feelings as messengers that a change needs to happen. Then I go on the hunt for finding out what a change needs that I need to do to address that there's some kind of information in the feeling which you think about it.

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But feelings are for to give us information to help us navigate the world. In fact, if psychosis were not normal, a lot of evolutionary biologists are asking why wasn't it selected out of the species?

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Why is it that the species of humans has persisted with this experience of psychosis around the world if it's not advantageous for us as a species? Well, clearly it has some kind of purpose or strategy or some kind of meaning for it.

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And if we miss that meaning in the response, that's when we have a problem. And I don't want to exaggerate the possibility of making dramatic change because in the system in our response, because there are people, even with the most innovative programs, I'm thinking of the open dialogue program, there are people that seem to be like, well, we can't really figure out even over a long period how to reach this person.

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But there seems to be some core of mystery and anthropologically, if you look at the way that madness is responded to historically, there do seem to be some people that just go out into these far out states and then they, but very, very small percentage compared to the people that the response is the problem.

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And of course, because we can't predict which are going to be the people that will come back or find some kind of recovery or reconnect with themselves in the community, we can't predict, predict those people in contrast to people who may be more difficult to reach or may take longer, may not be able to be reached because we can't predict it, then we have to offer the expectation of recovery to everyone.

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So my experience is not unusual, it's happened over and over again, it's happening right now in San Francisco, it's happening UCSF.

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And so you might ask me like, well, Will, this is really, you're saying this is a moral emergency, you're saying this is normalized violence, it's pretty hard to believe given the investment that so many clinicians and the psychiatric industry really has the insurance system.

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The hospital system, how could that be possible? Well, actually medical science is always advanced by finally coming to terms with harm that it had done previously and we have a very strong example with homophobia in psychiatry because prior to 1980, we go back to the '50s, the '40s earlier, we're talking about the widespread abduction, assault, torture and murder.

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And murder of LGBT people in the asylum system, in the psychiatric system. And that was normalized, that was considered, well, this is what we need to do to help people.

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We have the example of insulin coma treatment, there's a myth that insulin coma treatment was a result of the best research at the time.

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And then the research improved and then insulin coma was dropped, which insulin shock coma you induce a coma into a patient, the idea is that you're so shaking up their system that they could somehow improve.

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It's very parallel to electro shock therapy. But actually at the time when insulin coma was a widespread accepted treatment, there was a huge diversity of, there was a debate about the research and there were people that were criticizing it and said that it didn't work.

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And so also with the SSRIs, we're finally waking up to the fact that the SSRIs do not have the efficacy that was claimed when they were promoted as huge profit blockbusters by Eli Lilly introducing the Pharma blockbuster era that the SSRIs are marginally or not effective at all compared to placebo.

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And that the side effect profile is horrific, the cognitive problems that can come, people are finding that the sexual dysfunction that they have on the SSRIs, they were promised like, well, okay, you know, if you come off the SSRIs, you will get your sexual libido and orgasm back.

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Actually, a lot of people are finding that they are not getting it back. So we're doing this widespread harm to people with the SSRIs and that was considered and is still considered normative accepted practice to provide SSRIs to people, although now the National Health Service in the UK is now saying, well, actually maybe we should try exercise first for depression.

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And so the reality is that historically there has been normalized violence in psychiatry. I see it very clear that the way that we're responding to psychosis is another chapter in the cycle of normalized violence.

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And then you could go back to 1950 and you could say, well, you know, there are these gay patients that come in and they have higher rates of anxiety, they have higher rates of suicide, they have higher rates of alcoholism and addiction, they have higher rates of depression.

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Clearly, being gay is a problem. Well, actually, it's the response to being gay. It's the homophobia that was causing these distress to be associated with being gay and that's self-evident.

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Now, and that's how we need to start understanding altered states of consciousness. That's how we need to start understanding what we call psychosis and scrutinizing the response that we give to people.

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Hearing voices is absolutely normal. I can't tell you how many times I've worked with families where they just need to go to someone who's in the clinician expert role who just says, hey, your 16 year old daughter who's taking shrooms and she's staying out late and she doesn't want to listen to mom and dad and she's talking about hearing voices.

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The voices are normal that don't freak out, don't have a fear reaction. You have a parenting problem. You've got a parenting problem. Rebellious teenagers is part of what families go through.

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A lot of what I work with and my work with families is really developmental transitions between adolescence and adulthood. That because there's some kind of behavior or experience going on that fits a symptom, boom, here comes the mental health system, here comes drugging.

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The picture gets completely confused that there are a parenting steps that need to take place, like giving the young person a chance to learn from their mistakes and to connect the dots and take accountability.

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So a lot of my work is just stepping back from that mental health frame, understanding that what the young person is going through is normal in the context of the stresses of moving from adolescence to adulthood, which I think is a big part of what I went through.

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The claim that psychosis is normal is completely backed up by the reality of how the antipsychotics work. It's a misnomer. There is no antipsychotic, these are tranquilizers.

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In fact, the neuroleptics, the antipsychotics are used in veterinary medicine to tranquilize animals and to manage and control wildlife and to control animals.

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In zoos, these are tranquilizers. Anybody on this call that we give antipsychotics to is going to have that sedating effect.

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And we know with any tranquilizer, maybe there's a kind of a functioning sweet spot that can kind of bring down the stress and the distress and the excitement of certain states and allow the person to cope and manage.

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So the reality of how medications work supports the conception of psychotic experiences as normal and as stress responses.

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And also points to the fact that the approach that I take, a hearing voices movement, the psychiatric survivor movement, is not an anti-medication approach.

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It's a pro-harmoned action approach and it's a pro-honesty approach. There are circumstances I can imagine where if I'm on a really extreme sleep deprivation vendor, yeah, I want to tranquilizer.

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I want to interrupt and I've seen many people who I work with to come off of medications. I've seen them use intermittent short-term doses of antipsychotics or benzodiazepine, especially a drug like seroquel, which can be very effective for going to the drug.

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It's effective for going to sleep. In fact, it's used, it's the only anti-psychotic that there's a market on the street as a recreational drug context because it's so reliable to get to sleep.

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So I've seen that these drugs be very useful, but with specific intention based on an accurate understanding of their usefulness, not as a disease treatment or that there's some psychosis disease process that you're treating like an infection of antibiotics, interrupting sleep deprivation.

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It's one of the most useful. But then sometimes people start to really disconnect from reality. They maybe are not in a position where they've learned to manage overwhelming emotions. Some people don't even know what an emotion is.

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When I was in my 20s, I had a family upbringing from two parents. I love both my mom and my dad very much, but they're very, very traumatized people. There was no emotional literacy. There was no helping me to understand my emotions.

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I'm part of my recovery process. You could say, although I'm recovering from the diagnosis, not from the experience, but part of my process of learning to live with these experiences has been to learn how to deal with my emotions.

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What is an emotion? How do you respond? Again, there's that idea of response. Sometimes when people are in a learning process with coming off meds, they may get overwhelmed. They don't know how to deal with their emotions.

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They connect the fact that they're not sleeping well. They're not eating well. They're not talking with other people. They're not using the different coping things that we all, they're not going to the gym. They're not going into nature. They're not talking with their friends. They've lost track of all that. They may be never learned it.

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Maybe they use an anti-psychotic to bring the temperature down, to get everything a little bit more under control, but we understand it as a tranquilizer. The long-term use of anti-psychotics, I'm talking just a few months. There's tarted dyskinesia that can emerge in just a few months.

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The long-term and even shorter-term use is very dangerous for the anti-psychotics. People can have a really severe life-threatening adverse effects.

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We have to get away from this idea of medications for life because really the shift in the prior to the emergence of the kind of pharma dominance in the early 80s with the deregulation under Reagan, prior to that, a lot of people did and were expected to recover from a schizophrenia diagnosis.

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The therapy was considered a very effective way of responding to schizophrenia diagnosis. Mantic depressive, very rare disorder, these kinds of experiences were expected to resolve.

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Only after we get into the 80s and then today that we start to have this idea of chronic disease management, and it's very interesting because the whole society is going to chronic disease management.

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We understand that there are lots of social determinants for obesity, but we move into this chronic disease management model rather than going to a prevention model.

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The piece of the puzzle once we start to understand psychosis as normal and locate the conversation about medications where it should be is that medications are drugs, psych drugs are drugs, and they create an adaptation in the brain and the body.

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One of the symptoms of that adaptation is greater susceptibility to psychosis also with lithium administration. There's a greater susceptibility to mania.

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So when you're coming off, if you come off too quickly or you come off cold turkey, which often happens because of the frustration of not having support in the adverse effects, you can actually trigger a rebound psychosis or rebound mania that's very specific to the chemistry of having taken the drug.

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So we have to understand this and there is starting to be more awareness. There's the new modestly in the UK, there's the new modestly deep prescribing guidelines for SSRI because there's also apparently more and more research around rebound depression and rebound anxiety coming off of the SSRIs.

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There's also deep prescribing guidelines coming out around the anti-saccomic. So that's a big part of the story here with helping people to come off medications is understanding that slow withdrawal, even hyperbolic withdrawal where the reduction at the end is very, very small reduction.

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That that can actually lead to success, not just because of the pharmacological adjustment, but because it's a learning process. It's a learning process. If psychosis is a normal adaptation to a response, a stress response, then if you don't want to be in a psychosis, you're going to have to learn different ways to respond.

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So we fail to see people in a learning experience when someone is homeless. I hope that we tend to see them. This is a snapshot of a larger story. It's a moment in time.

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There's a story before and there's a story after being homeless is not an attribute of a trait of the person. You don't have domicile deficiency disorder. The same with domestic violence, mostly women, domestic violence survivors, we send to see that as a snapshot in a larger story.

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We don't diagnose someone who comes to a shelter domestic violence services as having a massacistic personality disorder. Although there was an effort to do that, that was actually a political struggle that happened. Thankfully that was not brought into the DSM.

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But the way we respond to domestic violence is that we see it as a learning process. We see it as a question of resources. We see it as a question of the social context. This is how we need to respond to psychosis.

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This is a snapshot in a moment in time, not a trait in the individual. This leads to two directions. First of all, the social determinants of the harmful response to psychotic experience and the social determinants of the psychotic experience itself, the stresses that lead to the psychotic experience.

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Let's be really clear. This is not going to happen in a for-profit medical system. The institutional factors that pile on just the housing situation. I can't tell you how many people in the Bay Area would be helped through their psychotic experience if they just had a safe place to go.

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It's also true of domestic violence as well. The housing situation directly drives domestic violence because there's no options for people to leave their partners.

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We have an enormous amount of research that looks at poverty, that looks at trauma, that looks at social isolation, that looks at bullying, that looks at the immigration experience if you're dealing with racism, for example, as driving psychotic experience.

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And then also the people who have some kind of transformative process, that they, for whatever reason, are going through a psychosis because there's something on the other end that they're becoming a healer.

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They're connecting with spiritual belief. They're connecting with a spiritual identity. I was just learning about William James was very severely depressed.

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You could really definitely diagnose him with clinical depression, but he forced him to discover the kernel of his entire philosophy around pragmatism and free will and the importance of the subjective experience of choice around free will and the power of that choice.

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And it came out of that dark night of the soul. So if we have a new conception, a new framework, and we have a set of needs to deal with the prevention and the social response, we see clearly that there needs to be social transformation, that this is a social justice movement.

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That's exactly the right note. Thank you, Damien, for starting the talk with that. And it's actually the conversations is already there. The conversation is already happening.

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The right-spaced approach to mental health is established in international law. We have the convention on the rights for people with disabilities.

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The disability justice movement has been working for many years to establish the really the common sense need for equal rights.

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There are alternatives. You don't have to put people into a context of confinement around psychosis and mental health, just like you don't need to put them into a context of confinement around other disabilities, being deaf, being blind.

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People are just forced into institutions and assailant and still are around the world. We have a society where we have an imperative of elevators and public buildings. We have an imperative to provide ASL translation.

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We have an imperative to build these bridges to different abilities. That's what we can do if we're committed around the experiences that get called psychosis and altered states.

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We have a different response and we create supported decision making. We create different kinds of needs, adapted responses that are focused on the specificity of the person's needs and what they are trying to accomplish in the world, rather than seeing them as a disease and a disorder, and then putting them into this other category.

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The open dialogue approach is extremely instructive and extremely useful in this because what they've created in Western Finland, they've created a social response that sees the individual in the context of their relationship.

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When you build a bridge from that isolated withdrawn or strange or disruptive experience, they build a bridge to the family experience and the family talking about its problems.

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Sometimes the individual who's diagnosed is really the canary in the coal mine and the coal mine is family difficulties. Gregory Bateson, of course, someone else very closely associated with UCSF Langley Porter.

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He did a lot of work on the context of psychotic experiences and the double bind. I don't think that that's so useful in terms of the etiology of psychotic experiences because once you start locating this is the specific cause, I think you've gone too far.

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There's a danger in blaming the family and RD Lang was very clear that he didn't blame families because he located families in the context of larger systems. Families are always in heriters of their families and then the larger social system.

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But what we can do is we can see the context as the potential for building bridges out. We can think pragmatically.

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One person is going to find medications a useful bridge. Another person is going to need a focus on family. They're going to need a trauma response.

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Another person is going to need the space to just be in their state, just be given tolerance. However long that it takes to accept that person.

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Until we move to a more factory and fast paced model in society under capitalism where urban spaces were very controlled, which is when the asylum started.

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Before that happened, there was much more space to not be working and to be taken care of by the community.

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I have a colleague in India who's teaching me a lot about how people in altered states are often seen as having been touched by some kind of spiritual experience.

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And the temples, the work of the temples is just to take care of. Look after people, make sure they're safe. But in a non-intrusive, non-coversive, non-violent way, provide some food, some tolerance.

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And what I've seen again and again, and a lot of my colleagues in the peer movement, is that often the professionals, they don't really know how to build those bridges.

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When you've been through it, if I sit down with somebody and I say, "Hey, you know, I hate these medications too. I don't want to take them."

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You know, I was locked up. I was in restraints. I hear you. Let's talk about the matrix. Let's talk about something that's a bridge that's being built.

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That maybe the professionals can't quite build. And that's why I think the peer movement, the survivor movement, the movement of ex-patients, is so central because we've been there.

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And we know what works, we know what directions the system needs to go. And abolition is a strong word. It's a word that I use because I believe that the moral emergency is there.

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And unless we start to focus on equal rights for people with psychosocial, psychiatric disabilities, differences, diversibilities, until we focus on that, it's not going to force us to start dealing with these other bridges, these other supports that we need to build.

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And again, the World Health Organization, the United Nations, have come out very strongly that we need to end coercive practices. We need to have a voluntary mental health system.

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If we recognize that psychosis and mental health are connected to poverty, we need to put ending poverty on the agenda.

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We have to not see that as separate from the mental health discussion. We certainly, in the richest country in the world, in the richest empire in human history, 800 military bases worldwide, the richest state, in the richest, the idea that we cannot eradicate poverty is ridiculous.

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And of course we can eradicate poverty. If we have the political power, if we have the political will, the psychiatric survivor movement, the changes that we were able to achieve, the reforms of the psychiatric system, the legal protections, as limited as they are, but the legal protections came out of a movement that was deeply, deeply influenced by the women's movement, the gay liberation movement, which were very much driving protests against psychiatry.

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Of course, the gay liberation movement and the women's movement, deeply rooted in the black power, the civil rights movement, the peace movements.

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So this is a systemic problem. If we keep seeing it as individual, we are only doing the work of reproducing the status quo of the system by locating the problem within the individual, which is something that contemporary capitalism does all the time.

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Instead of saying, let's look at the job market and why there aren't better jobs, we say, oh, you need to learn how to do a better resume. So let's get you with a resume writing workshop, or let's help you with your job search skills.

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This is done to individualize social problems is a systematic ideological move by the contemporary system that we live in. But fortunately, especially younger people, a lot of the younger psychiatric professionals that I work with and students, they're open and they're looking and they're having quite got the career investment in a certain paradigm.

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So, changes happening, I want it to happen faster. I think the time is now. I think we need to raise our voices for abolition. I think we need to raise our voices for a new conception of psychotic experiences.

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We need to identify the kinds of treatments that work and are effective. The research has been done. The research base is there. I'm familiar with the research base. It's there.

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So, we need to really join our voices to make these changes happen. The three things that I recommend to professionals who get interested in these changes.

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First of all, don't be isolated. Find other professionals, other students, other people in your field who share your concerns and are asking the same questions. You may not have the answers, but they're asking the same questions.

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The second thing that I encourage people to think about is that when you're in a situation that's imperfect. For example, when you have a mandated reporting context around suicidal feelings.

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Someone discloses suicidal feelings to you. You've got to tell that to your supervisor. Be transparent about it. Give a dilemma. Look, I would like to be able to work with you in a 100% confidentiality.

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But I can't under these circumstances if you say these kinds of things. I would like to be able to provide a satiria house for you or a peer respite, which is a hospital alternative. We don't have one in our community.

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Therefore, it's difficult for me to be transparent. Name the dilemma that you're in. I don't believe that people should have different rights based on their disability.

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But we don't have the systems in place yet to respond in a way that is going to help your family. I understand the dilemma that you're in. It's not about perfection or purity.

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It's about naming the truth of what's happening and pointing in a direction that we need to go. Finally, I want to say that fundamentally, psychiatry and mental health, it's a healing profession. It's about how you help people.

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It's about how you alleviate suffering. So we have to take that seriously and we have to think about what is our role in society and what kinds of changes are we going to make in society?

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How do we use the power and the privilege that we have in our training and our position in the industry to fulfill that responsibility of providing a society that's a caring society.

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Rather than so much of a competition industry, a profiteering, so much money that's being made off of the psychosis industry, people discarded because they aren't reductive.

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Are we going to be a caring society or not? And that's something I think that we all have to be actively involved in creating. So thank you very much. And I'm happy to take a little bit of time for questions.

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Thank you, Will. I will pass the microphone around if people have questions just because I've been monitoring the chat. Well, I think we would really appreciate a lot of the research studies that you referenced if you could send us those things.

280
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Also, the way data gets to me is I hear about every augmentation study that reduced a scale by one point over four weeks.

281
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But I find it much harder to find the studies that you're citing, although they are out there very well done.

282
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Yeah, so this is a link to a page on my website. Can you see this? It's a QR code. Can you see that? Yeah. Okay. So there's a lot of links on my website.

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The main places that you want to go are a wonderful site that was started by Robert Whitaker, a journalist. He won the George Polk Magazine Award, Matt in America.

284
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There's also a professional association, the ISPS, the institutional, the International Society for the Psychological Study of Psychosis. And then there are a number of different studies specifically.

285
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And if you have questions, for example, the research showing that forced interventions, forced treatment in voluntary commitment don't work. There's a bunch of studies about that.

286
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Also, one of the research that I like to point people to is the research, actually, there was an overview of the research done by the US Army showing that suicide assessments don't work.

287
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We can't know that we are protecting people from killing themselves by doing a suicide assessment. That was the justification for my forced incarceration at San Francisco General Hospital, was we're protecting you from suicide.

288
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Well, actually, that's not what the research says. We can't do those kinds of predictions. The research can't do that. So yeah, so check out the website, a bunch of links there.

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Yeah, that's great. Thank you very much. I'm going to hand the microphone to somebody with a question. Okay.

290
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Hi, well, thank you so much. My name's Andrew. I'm one of the third year residents. I really appreciate you sharing your story with us. And I also really appreciate that you talked about building because I think that's a core of abolitionist theory. And I love that you brought that up.

291
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You also spoke about how the psychiatric survivors movement is rooted in the women's rights movement, the LGBTQ rights movement as well as the black power movement.

292
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And I'm curious what opportunities you see for the psychiatric survivors movement is actually liaison as well with the prison abolition movement given that prisons and jails are the largest psychiatric provider in the US.

293
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And abolition is a core part of what Mary and Cabo Rufus and Gilmore as well as Angela Davis have all spoken about.

294
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Wow, it's thank you. It's very rare that the first question is so wonderfully informed and right on. Thank you so much. That's exactly the question we need to be asking is how do we bridge these movements.

295
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Unfortunately, the psychiatric survivor movement a lot of it moved into a kind of a co-optation phase. A lot of people were given jobs. There's a lot of opportunities to work as peers.

296
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Being in peer is wonderful. Not everybody is co-opted, but a lot of the energy and the fire of the psychiatric survivor movement kind of went down. And then here it gets picked up again by the black lives matter movement, the prison abolition movement, the decarcerating care.

297
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A lot of people are asking these questions. Why are police doing wellness checks? Why did this person get killed because they were suicidal?

298
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This person was high on shrooms and they were ended up being locked up for months and months. So the questions and the activism is really coming from the younger generation.

299
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I'm actually working a lot. It's one of the reasons that we use the abolition language is that we're trying to weave these connections.

300
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Britney Spears is on people's mind, Kanye is on people's mind because they're thinking, wow, psychiatry really has this power, but the psychiatric survivor movement hasn't really been there in terms of visibility.

301
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So that's something that I'm working on and a lot of people are working on. You're absolutely right that some of the people who are doing some of the best work around psychiatric abolition are really from those prison abolition, prison transformation movements.

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Because we can't, what I hear sometimes is people say, well, we'd be better that someone go to the hospital, then go to the prison, which go to the jail. Well, sometimes, I mean, at least when you're in jail, maybe you have an expiration date in the hospital, they can keep you as long as they want.

303
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But that's a terrible dilemma. That's like a like, like, we're doing harm reduction between the violence of mental health care and the violence of the prison system clearly some transformation needs to take place in in both aspects.

304
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So that's a great, great thought. You're and there's a lot of discussion that happens at on Madden America, exactly that that question. So thank you so much.

305
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So we are at time. I want to thank Will Hall again, really appreciate this will I'm not sure if you can stick around if folks have a place to be please, please feel free to step away.

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I don't know. We there may be some communications still continuing on the chat. Well, I have to go, but I will leave it up to you if you want to jump on to the chat. Okay.

307
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Sure. Okay. I'll get on the chat. Thank you, everybody. Thank you, everybody. Great. Can people hear me? I guess I'm not a Damien had to go, but are we still on for conversation?

308
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There's still a lot of people still here. You will. Okay. Great. Great. Okay. Yeah. So let's see. Should I should I look on the I should look on the chat to for the questions.

309
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Is there any is there any reason to not share this presentation with a patient? I don't I don't see why not.

310
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What kind of someone who's an aspiring medical professional, what kinds of organizations and literature. Great. Check the website. I have a lot of links there. I think mad in America. There's also the wildflower wildflower alliance.

311
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And that's a great resource and the ISPS is also a great resource. I think that a couple of the questions here. This is great. Thank you, everybody, for this wonderful feedback.

312
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One of the questions here are addressing like what do I do as a professional. I think it's important to recognize that you know we put too much responsibility on the professionals that decision to lock somebody up because you know they're their suicidal.

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And then if they do end up killing themselves, which people do it does the vast majority of suicidal feelings don't lead to people ending their lives, but a small number of them do. Why do we why does that land on the professional.

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I don't think that that the mental health professionals really honestly there's any evidence that you can blame an individual or choice that a professional made there are so many different factors that come into someone's life to that point, that breaking point where they end they do they do end up killing themselves.

315
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So the idea that you're going to blame I mean it really is about the standard of care. It's about the professionals being afraid of being sued and we have a very litigious society. So that's one of the reasons that we kind of use we sort of use the mental health system kind of as the last resort for a lot of social problems.

316
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It's just like kind of we use the police as a last resort and this is this is never going to work. We're never going to deal with the problem downstream. We need to go upstream. So I hope that the professionals would welcome the idea of not being the kind of like the final deciding factor about locking someone up or not because it's too much pressure. It's too much responsibility.

317
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Yeah, someone points out about the evidence based or relapse. Yeah, if relapse, although the definition of relapse is itself a question.

318
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If relapse happens if there's a return of difficult experiences right after a medication reduction or discontinuation. It's often a good working assumption that that's the reason the medication reduction led to the return of that experience.

319
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The reason that's important is then if the person goes through it and then comes out the other side and then want to try it again, they can try something different. But I've also seen situations where the they could go slower, for example, but I've also seen situations where an increase of say psychotic symptoms after a medication reduction.

320
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The person gets more excitable, they get more, they're more talkative, they're more, they're complaining more, they're maybe staying up at night. Now the family that lives with the person gets scared and the work isn't necessarily to reduce the rate of the medication withdrawal because they're it's within a tolerable range. The distress that the person is going through.

321
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The work is now with the family and to teach the family like, hey, okay, this person is their personality has changed. You know, it's probably they're going through some withdrawal, but they're also probably maybe waking up to some of the emotions that have been suppressed by the medication.

322
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So the work may be with the social context, with the family to tolerate maybe this transition and then typically the withdrawal effects will ease over time, not always, but that is something that is I'm often thinking about right in any kind of difficult withdrawal moment. It's just give a time, be patient, hang in there.

323
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I'm involved in the most strict world survey on anti-psychotic withdrawal as the principal investigator and we've discovered a lot of things we've surveyed several thousand people around the world.

324
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One of them is that having better withdrawal coping tools, it seems to be a predictor of whether the person can withdraw effectively.

325
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So as someone is maybe coming down like a 10% 20% reduction, things start to get rough. They start to have some emotions and experiences.

326
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What can we do instead of going back up on the med? What can we do to provide some coping tools? Sometimes it's just having someone to talk to, which again, then there's the social context, there's not a respite, there's not a sanctuary, there's not maybe even a warm line or a hotline that the person can call where they will be familiar and simple.

327
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Familiar and sympathetic and supportive about medication withdrawal. Maybe they'll get someone on the call that is going to just tell them to go back up on the meds or is going to give them a fear response.

328
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So making it through that period of withdrawal is, it can be complicated. It takes a certain amount of experience to look at the different options.

329
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Okay, here's a question. What are the studies? Yes, so the question about SSRIs. This is starting. There was actually a couple of news media pieces.

330
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I'm thinking of one in the Guardian, just a couple of weeks ago about, I think it's called post SSRI sexual dysfunction.

331
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And there's not a lot of research on this, but it's starting to get acknowledged, it's starting to be advocacy.

332
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Again, put it in the historical context. Now there are black box warnings on the SSRIs that they can cause suicidal feelings, and they can cause agitated or aggressive behavior.

333
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When the drugs first came out, those warnings were not on the boxes. There was advocacy work. There was patient advocacy.

334
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There were hearings. There was pressure that was done. And so that's what we're facing with the SSRIs. The communities of people who've taken SSRIs, and we have these persistent residual side effects after withdrawal, they haven't been listened to.

335
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Now they're starting to get listened to. So there are a number of links. If you go one of the links on my website is for surviving antidepressants, which is a great website of people who are with drugs.

336
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And so there are a number of people who are withdrawing from all kinds of different medications to run by my friend and colleague Adele Framer.

337
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And that's a great place to ask questions about research into the sexual side effects of SSRIs. It's called surviving antidepressants, but they do a lot of work around other meds as well.

338
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So I'm going to talk about the hearing voices movement. These are great. I love these. Thank you so much for all these questions in the chat. Let's see really wonderful comments, intersectionality.

339
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What are your concerns, hopes, fears about the push towards AI therapists and providers?

340
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That's a great question. I mean, I'm kind of in a niche. My kind of my work in as a therapist is very specialized. So I'm probably okay.

341
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But most of the people on this call, you're going to lose your jobs. It's going to be replaced by algorithms and AI's. And that's happening already.

342
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So the larger question about AI, I think has to do with how do we introduce technological change in society? Because these are technologies. SSRI is a technology. Antisexotics is a technology.

343
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AI is a technology. Psychedelics are a technology. How do we introduce technology into society? Do we do it because of profits? Do we do it because it's a great market and it's out there and you hate someone can make a fast buck?

344
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That's a fast-track to disaster. AI is just one example. Biotechnology is all kinds of different, more and more potentially dangerous technologies that we have left to the marketplace to determine when they get unleashed.

345
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So the reality is that a lot of the fears that we have around AI aren't just about AI, but they're about the larger question of how do we make decisions of what kind of a mental health system that we want?

346
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We don't have a society where we're able to vote for politicians meaningfully who then say, "Let's create this kind of mental health system." Because I don't think that most people want to replace humans with robots when it comes to caring. They want to have time. They want to have a human connection.

347
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But we don't live in the society where the politicians have that power. The power really is in the marketplace. It's really in industry. It's really in the profit motive.

348
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So again, we have these larger systemic problems that we're facing. Someone recommending Lang his essay on schizophrenia in the politics of experience is quite extraordinary. It's quite eye-opening.

349
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He's really mischaracterized as extremist and as romanticizing madness and as blaming families. But his understanding is actually a lot more sophisticated and sympathetic and nuanced.

350
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Someone saying they are frustrated with the pushback from leadership. Well, we need new leadership. This is where organizing and not being alone and dealing with dividing conquer is so important.

351
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And also, I think that you have to recognize that I do think that at heart it's a caring system and that people, everybody in the mental health system wants to care.

352
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And so if we can unite around how to care better, we can move forward around what can we actually provide people.

353
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And also, I think that it's a mistake to see the solution just in mental health system reform and change. A very simple example is a time. There's so little time in society just to care for each other, to just listen to each other, to take the time that's needed to pay attention when your friend has a family that's in distress or that there's someone in your workplace.

354
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So if we had more time as a society, we could create spaces for more support groups and more connections and just more hanging out and getting to know each other.

355
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I'm interested in universal basic income as a potential direction that we could go in. Now, there's a lot of problems with it.

356
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If you give people universal basic poverty income, that's not a solution. And then there's the question of what's the rest of the society doing when people are getting universal basic income? Are those decisions still not being made democratically?

357
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But I think the idea of freeing up time, a lot of the research on when you provide people universal basic income, they meet their basic needs and then they start to open up creativity and generosity, which defies a lot of our kind of free market assumptions about competition being morbidive.

358
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So let's see what kinds of organizations and literature. Yeah. Okay, let's see if we've got. Let's see.

359
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Okay, yes. Thank you so much for the Latino community. I imagine you're thinking about Spanish speaking monolingual services. It's limited. There is work happening in the hearing voices movement.

360
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And there are some services that are happening. But again, it's political because services for Latinos, for people of color in general, tend to be the last to be thought about and the last to be resource. So again, it's a political question.

361
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And there are some Spanish language resources on my website. And if you have, if you get stuck connecting with Spanish language, email me and I'll do my best to get you connected with some resources.

362
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Okay. Yeah, I like someone says it's helpful to direct patients towards the movement. Yeah, I think that people can decide for themselves. And I think it's important because I'm not an advocate that says one size fits all.

363
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But I do think we need a menu of options. Believe me, I've been to support groups that were terrible. Okay, I don't think support groups fight for everybody and some people don't want to go to support groups. So it's about having a menu of options. This is why the hearing voices movement is so, I think it's so instructive and so innovative.

364
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Because when you go to a hearing voices group, you don't get lectured. Here's the pathway to deal with your voices or here's the solution or here's what causes voices that's not the model at all. The model is we're going to create a support group where people are going to be free to share equally different perspectives.

365
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So you may hear different points of view, sometimes even diametrically opposed points of your medications, people who love their doctors, people who don't like their doctors, spiritual people, people who are more atheist or existential.

366
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And then the person going to the group is able to kind of take from that environment, that resourced environment, what might be useful for them or hook up something new that works for them because they're kind of hearing things that don't work for them.

367
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So I feel really strongly that we don't want to reverse the equation that psychiatry says meds for life and then we say we also give an instruction of the solution.

368
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But we want to open up into dialogue and conversation and the opportunity in space for people and families to figure out for themselves.

369
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So this is someone who says I'm going to read this. My mother has Cisco's affective disorder and I went to a family constellations workshop on intergenerational trauma, which is something that I work with quite a bit.

370
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And the facilitator asked me what the trauma was in the generation before her.

371
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And it was the US Navy bombed by the Japanese and World War II and how deeply traumatizing that was and how she grew up and majored in Japanese before her symptoms began.

372
01:17:58,300 --> 01:18:09,300
Really important. Thank you for this comment. So there's so much story that we lose when we focus so much on diagnosis and symptoms and treatments and medications.

373
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This story and often the presenting problem directly maps on to some kind of intergenerational historical experience person, the person's something that happened in the person's past.

374
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It can even happen in their ancestry. It's really powerful and it's not about moving that that was the cause. It's more about finding pathways if someone connects to their ancestors and it's meaningful to them to understand like wow there's always been these kind of like outsiders in my family tree going back and they've always been kind of pathologized.

375
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And now I'm playing that same role. I wonder what family secrets are going on here. I wonder how this line goes all the way back through trauma.

376
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If that's useful to the person, I'm very much a pragmatist in the way that I work. If it's useful to you, then it's useful to you.

377
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Let's see, I'll go to some of the more recent ones. Can you share examples of bridge building language that providers can use with individuals hearing voices and or seeing things that may be meaningful to those individuals seeking clinical services.

378
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I think that one of the most useful kinds of languages that we can use is the language of personal disclosure. So in the services, there are many people that work as professionals who have different altered states experiences, but don't talk about it.

379
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Maybe they had a psychedelic experience, maybe they had a sleep deprivation experience, or maybe they've lived with all sorts of states, maybe they've been in the psychiatric system.

380
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So if you meet a patient, a client comes in, wouldn't it be wonderful? And there are some agencies where this works this way. If you can say, hey, there's somebody on the staff here who hears voices and they live with it. It's actually part of how they make music.

381
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Would you like to talk with them about that? Or if it's okay, I'd like to share some of my experience. When my father died, I went through very stressful time and I heard a voice.

382
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So being able to build that language of personal connection, I think, is the most important way to create a shared language with people.

383
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But again, the key is to allow the person to discover for themselves what will work for themselves, not to create a model or a template. Here's how I did it. So this is how you do it. This is how you need to do it.

384
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Okay, here's somebody asking, we learned about RD Lang in grad school and the house he set up in London, yes, Kingsley Hall.

385
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Everyone lived together and were offered therapeutic support, but the residents also provided one another support to, yes. Very interesting moment. Historically, Kingsley Hall was kind of a place for people to go if they didn't want to go to the hospital.

386
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And it was also a place for just people in the society and also professionals to go if they wanted to explore their mad side. They wanted to open up.

387
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Because Lang was not someone who romanticized madness, he saw madness and normalcy as both problematic responses to a mad society.

388
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And he saw that these were both strategies that were denying our authenticity. So Kingsley Hall was a place that people could live together communally.

389
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It was kind of like a commune, an urban commune, and support each other and explore their experiences and high tolerance for unusual disruptive behavior and acceptance.

390
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It was very kind of chaotic and there were definitely people that were really helped. But there was also kind of too much chaos at that end of the spectrum.

391
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And so what's interesting is that Lang's colleague was Lauren Mosher, who set up Sotiria House. And Sotiria House is a really important research study that I think people need to look into.

392
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It was a house that was set up in San Jose, California.

393
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Lauren Mosher, who directed, he was also the head of the National Institute of Health Schizophrenia program.

394
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So he was very high up, but it was the beginning of the pharmaceutical sort of takeover of psychiatry, if you will.

395
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There were still a lot of social psychiatry, there were still a lot of humanistic, nemensic, and psychoanalytic psychiatry.

396
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So Lauren Mosher set up this house that was actually modeled on Kingsley Hall that Lang had done. But he sort of like made it more structured.

397
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And interestingly, they just had a model of being with people that you are going through a psychotic state. You haven't been medicated. We're just going to bring you to this home-like environment.

398
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And we're just going to hang out with you. And for a lot of people, not everyone, but a lot of people, things resolve themselves just with caring, listening, attention just being with.

399
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And what they found was that when they were hiring staff, it wasn't trained counselors that they felt had the best ability to just be with people.

400
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But it was actually people who had experience helping people through bad psychedelic drug trips, who were able to help someone go through an LSD freak out.

401
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Just being calm, being centered, being relaxed, not being afraid, being gentle, being a presence with a person being open.

402
01:23:31,300 --> 01:23:40,300
But these were the kind of people that they hired at Sotiria House. And actually there was a bunch of research that was done showing that it was actually quite effective.

403
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Unfortunately for political reasons, so Terry was kind of shut out. Again, that pushed towards the biomedical pharmaceutical era.

404
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Okay, well we've gone quite a lot over and I guess we'll wrap it up unless somebody has a last question that they want to put in the chat.

405
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I want to thank everybody for being part of this and I really appreciate this invitation. So thank you very much.

406
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[Music]