MIKE VILLERS: From WHYY in Philadelphia, this is Commonspace, a collaboration between First Person Arts and WHYY.

DR. FREDERICK FRESE: If a guy with a delusion knows it’s a delusion then it’s not a delusion.

JAMIE J: Yes, yes, this is not an episode about diets or politics. From WHYY in Philadelphia, this is Commonspace, a collaboration between First Person Arts and WHYY, to bring you true personal stories that speak to the pressing issues of our time. I’m your host Jamie Brunson – please, call me Jamie J - and I’m here in the studio with—

ELISABETH PEREZ-LUNA: Elisabeth Perez-Luna of WHYY.

JAMIE J: So today we’re talking about mental health with stories, interviews and media. I think we get most of our enduring images about people with mental health issues from TV and film. And it can be pretty confusing.

ELISABETH PEREZ-LUNA: Here are a few examples…

[Audio Montage]

JAMIE J: We also hear about behavioral health issues in the headlines, when it may be too late, and something tragic has happened.

ELISABETH PEREZ-LUNA: But the truth is much simpler, and at the same time, even more complicated. Studies say that one out of four people suffer from some sort of behavioral health issue. And most are more likely to be victims of crimes, than the perpetrators. Of course, that doesn’t make tragedy, when it happens, any easier to bear.

JAIME J: So we thought we’d hear from real people, living with behavioral health issues, to understand them a little better. We have stories from brave folks today, who are willing to share their experiences with us. But first, let me introduce the third person in the studio. He’s Dr. Lawrence Real, the Chief Medical Officer for the City of Philadelphia Department of Behavioral Health and Intellectual Disabilities Services. Welcome Dr. Real.

DR. LAWRENCE REAL: Thank you, Jamie. I’m happy to be here.

JAMIE J: So, we have some stories and some of them are funny. And, you know, is it ok to laugh about these behavioral health issues? Is that all right?

DR. LAWRENCE REAL: Well, that’s interesting you ask that 'cuz one of the things that struck me listening to several of those stories was the importance of humor, and how these people were able to reflect their lived experience with a certain amount of humor, which, again, is a way to join with the rest of us. And I think humor is amongst the best medicine that we have and the ability to laugh at oneself is important and I, so I think no, we don’t want to laugh at people, we certainly can laugh with them.

JAMIE J: Why don’t we start with Justine?

JUSTINE: So, this is a story about my interview at Google. So, I was living in Austin, Texas at the time. I was working for a mutual fund company and at the time I had a lot of free time. And so in my free time I started developing this social network, just, you know, I was just designing it and was working on it in my free time. So anyway, I decided after about six weeks of working on this and staying up late and working on it, and working on it, working on it, that I would go pitch this idea to Google Ventures. And so I flew out to Seattle. And they had a Google Ventures Company right across the street from this really awesome coffee shop. It wasn’t like Starbucks, right. It was like, you know, Seattle-awesomeness, perfect hipster coffee shop and I decided to finish working on my presentation there. Oh, by the way, sidebar. I brought my whole family out, I had my husband and my nine-month-old son at the time, and they were there and they were just kind of like in the hotel room, “Ooh, what’s going on?” I’m like, “Well ok, I’m just working on my presentation just hang out, go to the zoo.” Ok, so they were at the zoo. And so I was there, and I was just typing away. And I knew I was across the street from this company. And, you know, did you know that like Google has these really non-traditional recruiting techniques? Like, for example, they had these billboards that they would put on the side of the road that just had an equation on it. And it would be like this massive math equation that, you know, normally most people would just drive by it. But the only people it would actually pique their interest would be these computer geeks or math nerds or whatever that would just look up and be like, “Hmm. I feel like solving that equation.” And they would solve it and then they would go to this website and enter in the answer and it would take them to another website where they would go to another equation that they had to solve. And it would take them to another website with another equation they had to solve and then eventually it would take them to another website that said, “Welcome to Google. You’re hired.” Right? That’s what they do. So I knew this about them. So anyway I’m sitting in the coffee shop, right, across the street from Google Ventures. And all of a sudden I’m typing on my presentation and it just starts like, moving around on my page. And I’m just like, “I get it. They can kind of, like, see what’s going on, on my computer right now.” And I get a little nervous, I felt like I kind of had to pee and I got up and I went to the restroom and I was gonna come back and I came back I realized that my zip drive was missing. I’m like, “Ok. Game on.” I slapped my laptop closed, ran across the street and banged on the door and was like “Somebody stole my zip drive! I need to give my presentation. I’m ready to go now!” And the tiny little Japanese woman in a kimono, who opened the door, was like “This is a doctor’s office?” And I was like “I can’t believe that they hired actors! This is crazy!” So, I’m like “Alright,” and I shoved her out of the way, walked all the way to the back of the room. I’m looking, I’m looking around, there were all these people and these patients and I’m just like, “Whoa. This is crazy.” And I get to the back and I’m looking for the boardroom because I want to give my presentation and I get to the back and there’s just this tiny little office with a woman standing there on the phone talking to the police. And um, I’m like “Ok, cool.” And she was saying, “There’s somebody trespassing here,” and I’m like “Oh, this is getting cool.” And then the cop walked in and he was super cute and I totally had recognized him from SNL. I knew he was an actor too. He had this glint in his eye as he was coming to cuff me. He grabbed me as he was walking me out and I was just flirting with him on the way out because I knew this guy. I had seen him somewhere but I couldn’t remember what the actor— something with Justin Timberlake. I had seen him before. Anyway, so then he tried to take my computer and I had my laptop with me and I was holding on for dear life and I knew this was part of Google, to protect your intellectual property and I was like, “I’m not going to fail this test.” And so I held onto it as he tried to pull the laptop away from me I actually slammed myself down on the ground. And he tried to pull it away again and so I bit him. And I knew, I was like, “Man, I probably scored some massive points for that one.” They took me to the police station and I’m standing there, and you know my husband arrived with my son and he’s standing there as well and he’s like, I was like, “Wow, I can’t believe they got him in on this too! Did they tell him while he was at the zoo or did they call him while we were in Austin?” And yeah, I just couldn’t figure it out. But then they took me to the hospital to get evaluated because I knew they do that with all high-level executives. Just a psychological evaluation prior to the— part of the part, part of the interview, but it’s standard. And then I think I did really well because they released me within a day and they were like, “Massive manic episode, something like that.” And I was released and I went back to Austin and then, I don’t know, like two and a half years passed and um, kind of still waiting for that second interview. So…

JAMIE J: So, what was Justine experiencing? What was happening in this story?

DR. LAWRENCE REAL: Well, you know, we’re not allowed to diagnose people who we haven’t evaluated but I think she may have intimated that she had bipolar disorder, was in the midst of a manic episode, hadn’t slept for days at a time and it’s fascinating when people go through such episodes where their thinking strays as far as it does from reality. What she exhibited, in my way of thinking on hearing it, was what we call referential thinking. Referential thinking sort of means that you have suddenly become the center of the universe and everything that happens is explainable in terms of you and what you’re about to do. So if she recognized everyone whom she encountered and everyone was somehow part of this unique interviewing strategy that Google had cooked up. When in fact she was psychotic at the time that she put herself through and her family through this. And I think the other important thing that that story illustrated to me, as did a couple of the others, is the importance that we recognize that people are not islands, that people live often in families or in circles of friends and networks, and when someone in your family becomes ill, it affects everyone in the family.

JAMIE J: Does one just wake up one day and have a manic episode? Is there anything that you might see as precursors or hints that somebody’s in trouble?

DR. LAWRENCE REAL: Yeah, I hate to say this Jamie, but unfortunately there’s great variability in that. However, generally speaking, most family members are able to recognize early warning signs that something’s going on. As are many people who have the conditions. And yes, if you intervene early and you address it sometimes with medication, sometimes in other ways like reducing a person’s stress or deciding to postpone a particular trip then you may be able to head the episode off at the pass. So, quite often, seemingly innocent behaviors - I can recall one patient whose mother said, “Whenever she starts eating Fruit Loops, I know within a week or two there’s going to be a problem ‘cause she doesn’t normally eat Fruit Loops.” That’s certainly not in any of our diagnostic manuals. So, yes, there are early warning signs. And I think the other thing that this leads to a discussion of is what we call Psychiatric Advanced Directives. I mean, everyone knows about advanced directives for general health care, people don’t realize that Advanced Directives for mental health conditions are available and can be very, very helpful.

JAMIE J: Dr. Real, what is an Advanced Directive?

DR. LAWRENCE REAL: An Advanced Directive, in so many words, is a crisis plan you make ahead of time, that enables you to kind of chart the course of how your crisis is going to be handled. It also, in particular, empowers some individual, could be a spouse; could be a parent; could be an adult child, to whom you trust to help you make decisions if you’re in a position where you may not be making the best choices. So it’s a legal document, preparing a crisis plan, things that you know will work, things that you know will help you to remain calm and cooperative and do what’s in your best interest when you have an episode of illness.

ELISABETH PEREZ-LUNA: What does it mean when this person can process all this and make a story out of it and tell people about her experience? I mean, I would say it’s a healthy thing, to be able to say, “Well, you know, hey! Look at me.”

DR. LAWRENCE REAL: I think it is very healthy, and particularly that she’s able to look back on it and see the humor as well as the pain in the situation. You know, it’s interesting, a psychotic episode can be a very painful, very life-altering event and some people, perhaps protectively, their minds kind of push them way into the recesses. They don’t remember much of the detail because it’s kind of too painful. So that was an unusual kind of story for someone to be able to tell.

ELISABETH PEREZ-LUNA: Dr. Real, it occurred to that you see an increasing number of television shows, jokes, films, that use some of mental health symptoms as plots, and influences the way that we look at these illnesses or the circumstances of the symptoms.

JAIME J: Most of what I learned early on about behavioral health disorders I learned from TV and movies. Elisabeth, do you remember the movie “Psycho”?

ELISABETH PEREZ-LUNA: Oh, absolutely.

(“Psycho” shower scene)

Jamie J: That sound still scares me!!

ELISABETH PEREZ-LUNA: Sure, in the movie Psycho, for those who haven’t seen it, real estate secretary Marion Crane skips town with her boss’s money instead of going to the bank to deposit it, when a sudden rainstorm forces her to stop for the night at the Bates Motel.

JAIME J: Heh, heh, spoiler alert…

ELISABETH PEREZ-LUNA: Unbeknownst to Marion, the hotel proprietor, Norman Bates, has an alternate personality, and he kills Marion in the shower with a chef’s knife. The murder scene is underscored by the iconic…

(“Psycho” shower scene sound)

DR. LAWRENCE REAL: One of the greatest barriers to people with mental health challenges, getting their lives back, having better quality lives and suffering less, is the stigma that has been around for centuries about people with mental illness. And I think though we have come a long way in the past 30 or 40 years, in particular, to de-stigmatizing these illnesses, we still have a way to go. But 30 years ago there were not stars and athletes coming out in public talking about their illness. I know I’m very sensitive to the way that mental illnesses are portrayed in the media, in television shows and in movies and there are still some very disturbing portrayals, particularly those that portray people with mental illness as, by definition, dangerous. You know, the classic psychotic killer. But I think, even with that, the portrayals are much more empathic than they used to be. And the psychiatrists you’ll see on TV are much more user friendly, like the psychiatrist on ‘Code Black’.

JAMIE J: So, Dr. Real, what are the major disorders?

DR. LAWRENCE REAL: Well, the major disorders, I would say, would be first the mood disorders are the most common. And the most common of the mood disorders is what we call Major Depression or what sometimes is called Clinical Depression. Within the subset of mood disorders there is also what we now call Bipolar Disorder, what used to be called Manic-Depressive illness. Which though the frequency in the society is maybe one or two percent, much less than Major Depression, which could be as much as 15 or 20 percent, it’s a significant and disabling illness. Another major category of severity of illness is the Psychotic Disorders, or the Schizophrenia spectrum, which is characterized by disorders of people’s thinking or their ability to test reality. Beyond that, there’s a wide spectrum of anxiety disorders, which includes Obsessive Compulsive Disorder, it includes phobias, it includes Generalized Anxiety Disorder, Panic Disorder, and until recently included Post Traumatic Stress Disorder.

ELISABETH PEREZ-LUNA: Like Justine, some people who are suffering are not immediately aware of it. But sometimes we know something is not quite right. We’ll talk a little bit more about this in our podcast about mechanisms to recognize symptoms in the workplace.

JAMIE J: You’ve been listening to Commonspace, a collaboration between First Person Arts and WHYY. It’s been supported by a grant from the Pew Center for Arts and Heritage. I’m Jamie J.

JAMIE J: So, let’s go to another story, told by a storyteller named Steve, who got what I consider, to be a really unique treatment for OCD. Now, Dr. Real, tell us what OCD stands for?

DR. LAWRENCE REAL: It stands for Obsessive Compulsive Disorder.

JAMIE J: Ok. Let’s listen to Steve and then I’m gonna come back and ask you to tell us about that.

STEVE: Do you guys believe in destiny? Yeah, I don’t, I don’t know if I do, but David Foster Wallace, who is an author who people want to appear intelligent reference often. He once said that, “Nothing ever important happens because we try to engineer it.” He says that “destiny is always kind of in a trench coat, leaning out of an alley, whispering ‘psst!’ but we’re usually too busy to hear it because we’re on our way to or from something that we tried to engineer.” So, let’s keep that in mind as the story goes on. I want to tell you a joke, an old joke that also might be a metaphor. So, there’s this executive who works in a skyscraper downtown on the top floor. And he’s highly successful but he has this really weird habit of every time someone walks into his office, he snaps several times. And one day a curious employee asks him, he says, “Why do you do that every time someone walks in?” And he says, “To keep the lions and tigers and bears away!” And his employee says, “We’re in the middle of Center City Philadelphia; we’re on the top floor of a skyscraper; there’s no lions and tigers and bears!” And he says, “See! It’s working.” I don’t know when I began obsessively washing my hands but I do know that every time I did it I would count to 15. And just about after every time I got done, I would think to myself, “Well there was at least a couple of seconds that I skimped on. So do it again.” I’d go back and do it again and I’d think the same thing and I’d walk away. And this time I’d start to think, “Well if you don’t go back, you’re going to get everyone sick.” So I’d go back and I’d do it again. And I’d walk away and this time I’d think, “Well, now you want to get everyone sick because you’re skimping on purpose.” And somewhere along the way I also started to get this thing in my head that I had to end on the number seven. So it’d be like, “One, two, three, four, five,” I’d get to 15 and then I’d say, “seven.” But it had to be a good seven. So, more often than not, I would wash my hands and it wouldn’t be a good seven, or I’d feel like I hadn’t done it enough times. So I’d usually try to end on the number seven, the seventh time washing my hands. Does this make any sense? Yeah, A little bit? Ok, so. That’s not the only kind of thing I thought obsessively about and sort of superstitiously tried to fight off but it’s probably the most stereotypical. So it got to the point my sophomore year in college where I couldn’t take it anymore. And I started to kind of give up control of this idea and I went to the counselor at the counseling center at my college and he gave me a book. And as soon as I gave up control, I started to kind of hear destiny’s whisper. And the book that he gave me was by the number one expert in the world on the treatment of OCD. And this seems to me like destiny. The number one expert in the world for the treatment of OCD resided at the University of Pennsylvania. I emailed her and she emailed me back. I was a little bit star-struck at first. She told me to come in so I went in. And I quickly found out, as often happens with insurance, that my insurance didn’t cover it, and being the number one center in the world for the treatment of this condition, the cost was prohibitive. However, it just so happened that I was able to enter into a research study and get complete treatment because at this particular point in time they were doing a study and I got free treatment. So I entered this study with a score of 24 out of 40 on the Yale-Brown Obsessive Compulsive Scale, which meant I was somewhere in between moderate to moderately severe. The first thing my therapist told me that I couldn’t do, for the next three months, outside of daily showers, was wash my hands. At all. Now, there’s lots of moments where a regular person feels the needs to wash their hands. And after going to the bathroom, it was really, really hard for me not to do that. It was really hard for me not to count. But eventually it got easier. And I was able to do it. When I left the study, and I took the Yale-Brown Obsessive Compulsive scale score again— test again— I scored an 11. Which means that, had I gone into the study then, I wouldn’t have even been accepted because the symptoms were so unrecognizable. So now, metaphorically speaking, when someone walks into my office I can greet them...and not snap. Thank you.

JAMIE J: So, Dr. Real. OCD. You said is Obsessive—

DR. LAWRENCE REAL: — Compulsive Disorder

JAMIE J: What does that mean?

DR. LAWRENCE REAL: Well, this is a condition in which people suffer greatly and their functioning is often really challenged from either reoccurring thoughts that they can’t shake, which are known as obsessions, or from compulsions, which are behaviors they feel just driven to repeat over and over, and often the two are linked together; hence in Steve’s story, the need to wash his hands a certain number of times and in a certain way and end on a certain number so that terrible things would not happen. That’s the obsessive thought; the washing of his hands was the behavior. I think Steve’s story illustrates another thing: sometimes the kind of thinking associated with Obsessive Compulsive Disorder could be called “Magical Thinking.” Meaning, like he says if he did not snap his fingers when somebody—you know, keeps away the lions, tigers and bears. We all do things like that. Athletes do this all the time. They don’t change their socks because the team is on a winning streak. I can remember trying to help the 76-ers win games by if I shot a bull’s-eye— ten bull’s-eyes in a row they would win a game. [Jamie laughs] So we’re all prone to that kind of thinking that we can influence destiny, influence the world by something that we do.

JAMIE J: But what I think I’m hearing from you is the difference between, you know, normal superstition and OCD is where OCD begins to have a negative impact on your life.

DR. LAWRENCE REAL: Yes, it’s the severity of the symptoms and particularly the impact on your functioning in your various roles in your family, at work and school.

ELISABETH PEREZ-LUNA: I’ve seen more than one film in which the clue to somebody’s crime is that they have OCD. And somebody says, “You know, that’s where the problem is.” You know, its a little bit— pop psychology. Is it legitimate?

JAMIE J: Let’s have that conversation, Dr. Real. Let’s talk about — what’s the likelihood of someone suffering from a mental illness becoming a criminal?

DR. LAWRENCE REAL: I think the likelihood of a person with mental illness becoming a criminal is similar to those who don’t. I think the issue that society wrestles with is the question of violence. And we do know, one, for a fact, that people with severe mental illness are much more likely to be victims of violence than perpetrators of violence. We also do know, and have to be realistic, that there’s a very small percentage of people who are both mentally ill and have violent tendencies and there’s endless debate about how to best manage those people and protect their rights as well as protecting the public safety. But it’s interesting also, you know the National Alliance on Mental Illness has, for many years, been touting the fact that people with mental illness have abilities as well as disabilities and, of course, our department has a small ‘d’ and a big ‘A’ in the part that talks about disability services. And it’s intriguing if you look on TV, there’s a fair number of protagonists where the people are extremely intelligent and very useful at deductive reasoning and helping to solve crime. So I like the way that people who are a little different that whatever average is are portrayed as having skills and great value.

JAMIE J: So, let’s go to a different story now, by Aaron. And, Aaron had his own way of getting help. Let’s listen to Aaron.

AARON: I am an erratic...um…how do we say this…an erratic daydreamer. Or, as my therapist likes to call it, a bipolar person with Dissociative Identity Disorder. I know, I didn’t get it either. How did we come to this conclusion? Right? You like that? How did we come to this conclusion? A long time ago, let’s say about four months ago, four months ago I’m standing in my kitchen looking at my wife—ex-wife now. Looking at her and we’re having an argument, really extreme argument. I’m looking at her, I’m like, “No I didn’t! I did not do this, I was not doing that, I was not sleeping with this person, I was not out here, I was not driving around here—” got heavy, right? “I was not driving around here, I was not looking at this, I was not doing that,” and then she’s looking at me and she’s like, “Aaron, yeah, you were doing this. You were doing this. I don’t know what you’re talking about. I don’t know, you were doing this, really. Really.” I’m like, “No. No, really, I wasn’t. I was not doing this at all. I don’t know what you’re talking about. I don’t know what’s going on.” And in my mind I’m thinking, “What are you doing, man? You know what she’s saying. You know what she’s doing. She’s telling the truth. You can feel it! You can feel it here.” I don’t know if you know anything about mental disorders, but for this mental disorder, right, when we’re talking about it we’re looking at this person and I’m standing there and I’m like “Yes, yes, yes this is what my behavior is saying, right?” He’s saying, “Do this! Do this! Do this!” But inside, in your heart, in your soul, you’re like, “No. What are you doing, man? This is not right. You know what the truth is. Why are you saying this? Why are you doing that?” And he’s standing there and I’m standing there, it’s me. I’m standing there and I’m looking at myself and I’m saying, “Why? Why are you standing here doing this? Why are you saying this? Why are you lying to this person that apparently pledged her love to you, standing there in this garden saying, “I love you. I love you and this is where I want to be for the rest of my life.” And yet I am standing in this kitchen, I can see the kitchen if you’ll close your eyes and imagine with me, in this kitchen, looking at this lime green wall—yes, we had lime green walls— on my picture that was posted on the wall, you can look down the hallway, if you look back you can see this bright kind of beige color, which is the living room. And I’m standing there at the glass table looking at her saying, “No. You cannot go do this. I will not allow you to do this.” And inside I’m saying, “No, no, you need to let her go. What are you thinking about? You need to let her go.” And at that moment? Snap. It clicks. I forget. I black out. I’m thinking, “What the heck is going on?” The next thing I know I’m sitting on the stairwell. You walk up to the steps there’s a landing, you walk up to the next of the step there’s a landing and that’s the top of the steps. Well I was down on that first landing and I’m sitting there—I’m sitting there with a bottle of Jack in my hand and I’m sittin’ there, “What in the world is going on? Why did I do this?” And I’m crying—I’m sitting there crying with this bottle of Jack in my hand and I’m looking at it thinking, “This is what it’s gotta be. This is what I have to do.” The whole time not realizing what was happening in the past. I’m like, “What just happened? Why am I here? Why am I sitting here? Where did they go?” And by they I mean my daughter. My daughter was sitting in the living room at the time. Got heavy, right? She was sitting there in the living room and I’m standing there and I’m standing in the kitchen as this argument goes on; snaps; now I’m sitting on this dining – this uh - landing that’s the next row up and I’m sitting there and I’m thinking to myself, “What in the hell happened?” And I text my wife—ex-wife, I text her and I say, “Where are you? What’s going on?” and she’s like, “Well, I’m upstairs in the bed.” And I’m like “Why are you upstairs in the bed?” And she’s like, “Because you took my phone from me, and I had to grab it back from you.” And in my head I’m thinking, “Wait a minute. No, no, no, no, no. I didn’t do that. I didn’t do these things. What are you talking about?” But then in my heart I’m like, wait, something happened. Something really, really serious happened. So I’m sitting there, I’m sitting there with the Jack, and the bottle of Jack in my hand - I’m looking at it like, “I can’t do this, what are you doing? What are you doing?” So I take another swig. Of course, that’s the reasonable answer to do, right? You just take another drink. So I take another swig and I’m like, “I can’t do this. I can’t do this.” So I get up. I drive. I drive to the hospital. I check in. The lady is very cordial as I’m sitting there at the hospital. “What are you here for?” “I’m in a state of crisis.” “Ok, can you fill out this paper?” “Yes, I can do that.” Police officer is standing behind me and I’m like “Umm…” Why is he standing back there? Didn’t realize that he was afraid that I was going to burst out into a psychotic rage and start running around the room. And she’s like, “Ok, will you step over here to the waiting room?” I’m like, “Ok, yes, I’ll stand over there.” The police officer takes me back after what seems to be hours but was probably only ten minutes because they were probably afraid of everyone’s safety. I’m sitting there in the back hallway - I strip down naked—naked to my underwear. Of course, I’m there and I‘m like, “This is freezing!” I don’t know if you know this, they keep hospitals very, very cold. And I’m like “I’m not taking this shit off, I need my underwear because I need that extra layer. So I’m sitting there, and I’m sitting in the hospital bed, and I’m coming out of this fog and I’m like “what happened…” and that’s the moment that I realize in that time at that moment I disconnected. And my rage and my body language and my mind got lost in its entirety. That’s it.

JAMIE J: So, Dr. Real. Is it common for someone to have enough presence of mind to know that they need help and drive themselves to the hospital?

DR. LAWRENCE REAL: I think it is fairly common. Not so much for people in the midst of a psychotic episode, which I don’t think that he was. It was hard to tell from his story exactly what was going on. But it was interesting, as with Justine’s story that despite the very distressed state he was in, and where he was not thinking as clearly as he could and was really wrestling within his own mind that he was able to sot of step back from the situation, or presumably step back as he told the story now about what happened in the past and see what was going on and sort of come to an understanding that the reason the policeman was hovering around was they saw him as a potential time bomb.

JAMIE J: You’ve been listening to Commonspace, a collaboration between First Person Arts and WHYY. Commonspace has been supported by a grant from the Pew Center for Arts and Heritage. I’m Jamie J.

So this is a story from a student named Craig, and he’s talking about a very different phenomenon. And quite frankly, I’d like to know if this is a behavioral health issue. Let’s hear from Craig.

DR. REAL: OK.

CRAIG: There’s a room full of fists, some red, some clean. The red fists hurt just as much as the thing they connected with. A face, the primary target of those fists. The nurse’s office school is crowded with the same person every other week— it hurts. Parents lay silent, oblivious to their child’s whereabouts— it hurts. Sleep some nights to take away the pain— it hurts. Not knowing what to do about it— it hurts. Eventually, the fists start to grow dull and reality becomes more beautiful— it doesn’t hurt. Eventually, the fists begin to recede back and forth, further and further— it doesn’t hurt. And while the fists were there eventually, they’re gone now— it hurts. Oh wait, it doesn’t hurt. My name is Craig Terry and this is my story. Being verbally and physically abused is something no child should have to go after. No matter the circumstance, no matter the school. No child should have to pray for a bully to spare a him a punch or should have to sleep some nights to take away the pain. It’s a saddening but proven fact that 160,000 kids get bullied each year in schools across the country. That means there is a kid out there right now being bullied by another one. I should know because for five years, my childhood adolescence was dominated by this. Bullying. From first grade in 2006 to third grade in 2008, I was bullied. The main kid, he took the mantle of class bully in first grade. He hit on kids for no reason. I never really found out why. But he wasn’t a bully to step up to. Now, some may have heard the cliché stories about the kid who gets tired of his bullies and then steps up to them. But I was the reality: the kid who knew better than to risk his education or the pain for a fight. He started to influence other people to start bullying too, and while sometimes I was the main victim, I never really fought back because I was scared. Fourth grade, nothing changed the bullying just continued every day from Monday through Friday. Fifth grade hit, it got even worse. There was this new bully named Keyshawn, he was quicker with the hits and taller and stronger. And while I look back on it and realize I shouldn’t have let them bully me, it doesn’t really matter. Because little did I know, five years later my life would change. Because in 10th grade I was with an internship named Power. Power was a Temple University program that focused on social injustices while getting the youth perspectives on it. And then my internship had offered me a job with a group called Poppin’. Poppin’ focused on that, while also focusing on video production. I was with people that understood me and had the same interests as me: film and acting. And I know for a fact that I’ve changed since elementary school because when I came to this program, I was very quiet. I didn’t let anyone talk to me and I didn’t talk to anyone else, because I figured, I thought they would hurt me, and I didn’t know any better. But then I met one of my leading coordinators, and she forced me to talk – and even though I didn’t understand then, I understand why now. I was recovering from the insecurities of a neglected child. And I didn’t know any better. But I know for a fact that I’ve changed. They turned me into a more confident person; every time I talk to them I get reminded of the memories that we’ve made. While…thank you. While being bullied had changed me into a quiet person, this summer of 2015 changed me for the better. Instead of me turning into the bully that caused me pain, I instead protect those others who suffer from bullying. Thank you.

JAMIE J: So, Craig’s story starts out by talking about bullying. Is bullying a behavioral health issue?

DR. LAWRENCE REAL: Well, yes it is. Certainly bullying has been shown to be a causal factor in the development of Post Traumatic Stress Disorder and to be a risk factor for young people as regards to suicide. Bullying is a way of being traumatized and certainly this individual could have developed some severe mental health challenges as a result of what he experienced at such a vulnerable age. However, I think even more importantly what Craig’s story illustrates is the resilience of human beings, particularly kids. That, five years’ worth— or more—of bullying were kind of undone by a couple of empathic souls who met him where he was, made him feel respected, made him feel self-value and he bounced back in a tremendous way.

JAMIE J: Is the bully challenged with a behavioral health issue?

DR. LAWRENCE REAL: The bully may well be. I thought it was very interesting also how Craig towards the end of his story said, “I could have gone that route. I could have—once I pulled myself together or if I got bigger or if I chose to be in the stereotypical story of the kid who stands up to the bully”, that he could have turned into a bully himself. And as we know, people who have been abused often end up being abusers themselves.

JAMIE J: You’re listening to Commonspace, at WHYY. I’m your host Jaime J. We’ve already noted how behavioral health issues can happen to anyone, and often seemingly out of the blue. But what is so amazing is how many people have managed to thrive in their lives despite them. A Beautiful Mind is a 2001 American film, based on the life of John Nash, a Nobel Laureate in economics. The film was inspired by a book of the same name, by Sylvia Nasar. Now, early in the film, Nash begins to develop paranoid schizophrenia, and endures delusional episodes while painfully watching the loss and burden his condition brings on his family and friends.

(Audio clip from “A Beautiful Mind”)

ELISABETH PEREZ-LUNA: Hey Jamie, this reminds me of a conversation I had about three years ago, at a conference on behavioral health, when I spoke with Dr. Frederick Frese. He’s one of the most respected authorities on schizophrenia in the country, and he told me his story.

DR. FREDERICK FRESE: At one point I was actually declared to be insane— an insane person and committed, and told I’d spend the rest of my life in the hospital. But I got out. There were no overt symptoms until I came down with a disorder. I mean, I’d been selected for a national scholarship by the Navy and then selected again to go into the Marine Corps, had served four years, just been promoted to captain, when I developed this delusional system concerning the Vietnam War. And here I was working 24-7 during the Vietnam War, guarding these atomic weapons, and then they locked me away and called me crazy. I was absolutely sure they were making a mistake. In my mind—and this is the way it works with Schizophrenia, delusions— as I often say: if a guy with a delusion knows it’s a delusion then it’s not a delusion! So when you have this you can’t tell yourself that there’s really something wrong with you. So I spent quite some time thinking that really, there’s nothing wrong with me. But after a number of hospitalizations— particularly when I was put away as insane I thought, well maybe there’s something, something wrong here. Not with me but something wrong somewhere. 50 years ago, the answer to somebody being seriously mentally ill was to put them away, forever, essentially. Now, 95 of those of us who were, or would have been, in those old state hospitals are out. Now, not all of us are doing as well as myself or some others, I mean, there are too many homeless in the streets or in jail, there are 400,000 seriously mentally ill in jails, which we really need to do something about. But the big thing that I feel is, it’s important for me to interact with the professional communities, the psychiatrists, the psychologists, the research communities, the veterans administration, and advocacy groups such as NAMI and The Mental Health Associate et cetera and be a living example, I can function even though I have this disorder. And there are an awful lot of people like me. Most of them will not be open about having had these psychotic breaks. Now, in the old days, I didn’t want to be lobotomized. I didn’t want forced electroshock therapy and the terrible things that were done in the early 20th century. But, for the most part, that’s behind us. I’m not over it. I still have episodes and the mind works funny ways but I’m able to catch it with the medication and that sort of thing.

ELISABETH PEREZ-LUNA: Dr. Frederick Frese is a psychologist with over 40 years of experience in public mental health. He’s a professor of psychiatry at Northern Ohio Medical University.

JAMIE J: So, Dr. Real…our last storyteller, Geoff, talked about being a young person, a child, who has been transplanted into an environment very different than anything else he’s ever experienced, where he is very different, he looks different from everyone around him, and he talks about this traumatic experience he had in school. Let’s listen to Geoff.

GEOFF: I’m very fortunate in that I have excellent parents. I have a wonderful mother, a wonderful father. And my father’s parenting philosophy can be distilled into one fact, one approach, which is: my children will not go to public school. He grew up on the south side of Chicago; he went to terrible public schools. He made the tough decision to move my family from that environment to very isolated Illinois, farm country—very insular community. I would call it a rural community, but the word rural is grotesque and disgusting. Even I, with my perfect diction, struggle with the world “rural.” So we move to this isolated farm community, Marengo, is the name of it, and my father wanted us to go to, functionally a parochial school— it’s a church school. He wanted us to be able to play outside. So we lived in this very isolated area, we were able to play outside and we were able to go to this school. It was dreadful. Dreadful place. Dreadful place. Very insular community, meaning that a group of farmer families had founded it a little over a century prior and no one else had moved in or out until we arrived. They had been, largely, Scandinavian farmers, so, we stuck out. Immediately. We did not fit in and they made it very clear to me that I did not fit in very immediately. I also had a terrible stutter and a lisp. I had yet to perfect my impeccable diction; my head was about the same size that it is now on a much smaller body. School was tough. Kindergarten was tough. Very, very tough. I felt threatened all the time. And like many people who feel threatened I decided to fortify my position. Since I was a small child I didn’t have a lot available to me but I used what was available and that was my desk. I got under it. And you couldn’t get me out. Anytime there was a problem, which was often, I would get under that desk.
“Geoffrey.”
“Yes?”
“Can you draw a circle?”
“Yes.”
Long pause. They didn’t ask me if I would draw a circle, they asked me if I could draw a circle. I understood language and it infuriated them. They started yelling and screaming; under the desk I went. They tried to pull me out, they tried to intimidate me out, they couldn’t do it. Made a big scene. Called my parents, call on the administrators. Everybody in the school is talking about this crazy kid with the huge head and the lisp that won’t come out from under his desk. Thankfully, there were two Kindergarten teachers. I was in Miss Coreo’s class and there was another Kindergarten teacher, his name was John Fleener. He heard about this commotion about this child under the desk and he came to find out more. And he came over and he said, “Geoffrey, what are you doing under this desk?” And I explained my position to him and he said “Do you wanna come over be in my class across the hall?” I said, “No, I wanna go home.” And he said, “Well, we can’t send you home but you’re welcome to stay under your desk all day in my class if you want.” And I said ok. So I transferred! He moved me to his class. He had no problem with me staying underneath the desk. He would put the assignments to be completed on top of my desk and I would reach up, I would complete them—- they were simple things like using one’s hand as a stencil to make a turkey. It’s Kindergarten, it’s not complicated stuff, but it’s important stuff. So I would reach up and I would complete the assignment, I would put it back on top of my desk, he never made a big deal out of it. Yeah, he’s a little weird, he’s got a lisp, let him stay under the desk all day. I don’t care. I care about the results. And I was usually right, I was very good at spelling, I was very good at hand turkeys. I was excelling in Kindergarten and this man saved my education. Cause everyone else in that school was prepared to just leave me under there and write me off as some sort of degenerate or weirdo or someone that had deep seated emotional problems as opposed to a small child in an aggressive community of people who don’t want him there, who’s just trying to feel safe far from home. John Fleener ended up being my godfather. John Fleener ended up saving my life. In ways that I don’t think he still—he probably still doesn’t even appreciate how much he’s done for me. And if any of you find yourselves in a comparable situation: - who’s this weirdo? Take a little time, be a little patient with them. You never know what might happen. Could end up like this guy; I turned out alright. Thank you.

JAMIE J: What is happening in that story? What’s happening to Geoff?

DR. LAWRENCE REAL: I think Geoff was doing the best that he could as a small child under the circumstances of being scared to death and afraid that if he showed his head it might be cut off. I’ll tell you what I thought this story in particular illustrated, as well as resilience, and the capacity for resilience…that sometimes it only takes one person, the teacher who invited him into his classroom and said you can stay under your desk as long as you want, it only takes one person to make a difference and turn things around. So, again, this theme of treating people - kids, homeless people, psychotic people, people with substance use disorders - with dignity and respect often makes all the difference in helping them recover.

JAMIE J: I know that there’s a confidentiality that you have to deal with as a physician. But can you tell us a profound experience that you had that made this work really meaningful to you?

DR. LAWRENCE REAL: I think I could. I will try to tell you a short version of this. We haven’t talked about it on this show, you might talk about it on another show which is the whole concept of recovery, meaning that people with these challenges can improve and or can have very meaningful, productive quality lives despite the presence of a mental illness or a substance use disorder. And that people have great potential and you have to be careful because in the old days somebody developed an illness like schizophrenia some doctors would say to families, “Forget about it. His life is over.” Years ago I met a young man who to all intents and purposes that could have been what I concluded. He could not keep a job because of the severity of his psychosis, he was living at home with his family and it did not seem like his future held much for him. And then over time what I discovered was he wanted to get a job. So first he got a part time job, helping out a guy, the old fashioned TV repairman, lugging TVs in and out. And then before long that turned into, he got a fulltime job working in a quarry somewhere, and he told me he was going to get a fulltime job and I’m thinking, “yeah right!” ‘til he gets a full time job. He had the full time job he started talking about he was going to get a house until I’m thinking right he’s going to get a house until he came in and told me he had bought a house and had moved out of his parents - on and on to getting a car. And once he walks into my office and tells me he’s got a girlfriend, 20 years after we met, I’m gonna say our work is done. But I never would have believed that possible. And what has impressed me profoundly over time is the resilience of people and the depth of the human spirit and how people can overcome all sorts of odds and achieve all sorts of things that you didn’t think imaginable.

JAMIE J: What can we do if we suspect that someone we love is undiagnosed but struggling with something?

DR. LAWRENCE REAL: You can talk to them. And listen empathically and be there for them and try to help them find a way to accept help.

JAMIE J: What if they don’t want to accept help, but they are clearly struggling?

DR. LAWRENCE REAL: Well you might want to seek some counseling of your own. Nowadays there are people who do what’s known as family consultation and they will help you to strategize differently. You also don’t need to give up because some people accept these things at different paces. But people do recognize that you’re there and that you care though they may never seem to listen to what you’re suggesting.

ELISABETH PEREZ-LUNA: You’ve heard the stories. Is there something we haven’t asked you simply because we don’t know to ask?

DR. LAWRENCE REAL: Perhaps, and I think it’s probably on the tip of all of our brains. What you have presented me and your audience with is these wonderful stories from First Person Arts and what essentially this is is people telling about their lived experience. And we have learned in our field that one of the greatest assets that we have are the people we have who have lived experience, who have recovered sufficiently to where they can use their lived experience and their own experience of recovery to help others along the way. And I think if there’s anything that’s revolutionary, or about time in what we do in the behavioral health field, it has been the recognition of the importance of certified peer specialists and people with lived experience in helping their brothers and sisters.

ELISABETH PEREZ-LUNA: So, we are – our storytellers are heroes.

DR. LAWRENCE REAL: Your storytellers are heroes to me.

JAMIE J: You’ve been listening to Commonspace. This is Jamie J, your host. And we’ve been talking today to:

DR. LAWRENCE REAL: Dr. Larry Real.

JAMIE J: Chief Medical Officer of the City of Philadelphia Department of Behavioral Health and Intellectual Disabilities Services, and the Executive Sponsor for Mental Health First Aid. Dr. Real, thank you so much for your time, we so appreciate you here at Commonspace.

DR. LAWRENCE REAL: My pleasure.

JAMIE J: You’ve been listening to Commonspace, a collaboration between First Person Arts and WHYY. It’s been supported by the Pew Center for Arts and Heritage. Commonspace includes this broadcast, live events, and two additional podcasts available online. Commonspace airs on WHYY the last Sunday of each month. Remember to tune in. It’s also available any time online at A-Commonspace-Dot-Org, where you’ll also find two monthly podcasts that dive deeper into the topics presented here, show transcripts, live event schedules, and ways to share your stories with us.

ELISABETH PEREZ-LUNA: Commonspace is produced by Mike Villers. The Commonspace team includes Sreedevi Sripathy, Dan Gasiewski, Becca Jennings, Jen Cleary, and Neil Bardhan. Our studio engineers were Al Banks and Adam Staniszewski. Jamie Brunson is the host and co-writer and I’m Elisabeth Perez-Luna, Executive Producer and lead writer.

JAMIE J: One more thing, on a personal note. Todd Marone was a storyteller for First Person Arts for a long time. During the 2011 Christmas season, Todd took his own life. It was a blow to the First Person Arts family. We asked ourselves, “Did we miss the signs? Could we have done something to help?” Todd’s death was a wake up call for us. This show is dedicated to him. Rest in peace, Todd.