Amanpour and Company

>> WE TURN TO A WOMAN WHO DEDICATED HER CAREER TO HOW PEOPLE WITH MENTAL ILLNESSES ARE CARED FOR. PROFESSOR ELLEN SACKS FOCUSES ON THE IMPORTANT ETHICAL ISSUES SURROUNDING TREATMENT AND HERE HE IS SPEAKING TO MICHELLE MARTIN ABOUT HER OWN STRUGGLES WITH SCHIZOPHRENIA AND HOW BEST TO HELP OTHERS. PROFESSOR, THANKS FOR JOINING US. >> I'M DELIGHTED TO BE HERE. THANKS FOR INVITING ME. SUCH AN IMPORTANT ISSUE. >> IT IS. I'M SO GLAD WE HAD A CHANCE TO TALK WITH YOU BECAUSE YOU OCCUPY AN IMPORTANT PLACE. YOU'RE A DISTINGUISHED SCHOLAR. YOU'VE DONE VERY IMPORTANT WORK AND LIVED FOR MANY YEARS WITH A DIAGNOSIS OF A SERIOUS ILLNESS. DO YOU MIND IF I START WITH YOUR STORY? HOW DID THE SIGNS OF MENTAL ILLNESS FIRST MANIFEST IN YOUR LIFE? >> WHEN I WAS A SENIOR IN HIGH SCHOOL, IT SPOKE TO ME AND ONE DAYS I GOT UP IN THE MIDDLE OF SCHOOL AND STARTED WALKING HOME ABOUT THREE MILES AWAY AND SOMETHING STRANGE HAPPENED, THE SIGHTS AND SOUNDS AROUND ME WERE DIFFERENT AND SCARY AND I WAS HEARING YOU ARE SPECIAL, YOU ARE ESPECIALLY BAD, YOU KNOW, DO THIS AND THAT AND I -- I WAS EXTREMELY FRIGHTENED. >> YOU'VE BEEN DIAGNOSED WITH LIVING WITH SCHIZOPHRENIA. JUST AS BRIEFLY AS YOU CAN BECAUSE THERE ARE SO MANY MYTHOLOGIES. >> MANY PEOPLE THINK IT'S HULL -- MULTIPLE PERSONALITY DISORDER. IT'S A DIFFERENT CATEGORY, MPD IS A DISASSOCIATED DISORDER AND SCHIZOPHRENIA IS A PSYCHOTIC DISORDER SO MANY DIFFERENT THINGS PEOPLE MIGHT HAVE. A LOT OF CONFUSION ABOUT HOW DANGEROUS PEOPLE ARE AND HOW ABLE TO TAKE CARE OF THEMSELVES, STATS ON DANGEROUSNESS ARE VERY MUCH DON'T SHOW THAT PEOPLE WITH MENTAL HEALTH DISORDERS ARE DANGEROUS. THEY'RE RATHER VICTIMS MORE LIKELY THAN VICTIMIZERS. >> HOW DOES IT GENERALLY MANIFEST IN PEOPLE? >> BASICALLY PEOPLE HAVE WHAT ARE CALLED POSITIVE SYMPTOMS, WHICH MEANS THINGS LIKE HALLUCINATIONS, DELUSIONS, DISORGANIZED SPEECH. NEGATIVE SYMPTOMS ARE APATHY AND WITHDRAWAL AND INABILITY TO WORK OR CONNECT WITH PEOPLE SO I OFTEN HAVE THE SYMPTOM THAT I TOLD HUNDREDS OF THOUSANDS OF PEOPLE WITH MY THOUGHTS -- >> THAT SOUNDS HARD. >> IT'S VERY HARD. IT'S VERY HARD. I'VE HAD HALLUCINATIONS RARELY WHERE I SEE A MAN WITH A RAISED KNIFE STANDING IN FRONT OF ME OR A WOMAN AT THE FOOT OF MY BED AT NIGHT SO DELUSIONS, HALLUCINATIONS AND DISORGANIZED SPEECH. PEOPLE HAVE WORD SALAD, THEY SEEM LIKE THEY HAVE A CONNECTION BY THEY DON'T REALLY. >> CAN YOU CURE THESE ILLNESSES OR IS IT AT THE CURRENT MOMENT, IS IT ONLY THEY CAN BE GENERALLY CONTROLLED? >> SO WE HAVE MEDICATIONS AND THERAPIES THAT CAN HELP PEOPLE PUT A GOOD LIFE FOR THEMSELVES TOGETHER. BUT, YOU KNOW, IT'S VERY UNLIKELY ANYONE WOULD EVER BE ABLE TO GET OFF MEDICATION AND DO OKAY. >> IF YOU ARE IN THE THROWS OF SAY A PSYCHOTIC EPISODE, DO YOU KNOW SOMETHING IS WRONG YOURSELF? >> YEAH, IT'S NOT UNIFORM. ABOUT 50% OF PEOPLE UNDERSTAND WHAT IS GOING ON AND MAKE DECISIONS ABOUT TREATMENT AND SO ON AND ANOTHER 50% SAY NOTHING WRONG WITH ME. IT'S JUST WHO I AM. >> YOU'VE BEEN HOSPITALIZED MANY TIMES. WHAT HAPPENS WHEN YOU'RE HOSPITALIZED? >> YOU KNOW, I HAVE BEEN HOSPITALIZED MANY TIMES BUT THE LAST TIME WAS LIKE 1986 -- '83 AND WHEN I BROKE DOWN AT YALE LAW SCHOOL, I WAS PUT IN A YALE NEW HAVEN HIGH SCHOOL PSYCHIATRIC DEPARTMENT. >> YOU WERE THERE INVOLUNTARY. >> IT WAS PAINFUL AND TOXIC. I THINK THEY WERE AFRAID I WAS A FLIGHT RISK SO THEY WOULDN'T LET ME GO BEYOND A CERTAIN POINT ON THE WARD IN CASE I WOULD RUN SO THAT WAS KIND OF HARD. RESTRAINED ME A LOT THE FIRST TWO DAYS 20 HOURS A DAY AND THE NEXT THREE WEEKS FIVE TO 15 HOURS A DAY AND MY CHART HAD THIS NOTATION USED RESTRAINTS LIBERALLY WHICH I THOUGHT WAS PRETTY AWFUL. THEY RESTRAINED ME LONG PERIODS OF TIME AND THEY EVEN WOULDN'T LET ME GO TO GROUP THERAPY PATIENTS AND I WAS REALLY BADLY MISTREATED. I REMEMBER WHEN I WAS IN THE ER, THEY MISTREATED ME AND THERE WAS A WOMAN LOOKING IN THE ER THROUGH THE GLASS OF THE DOOR AND I WAS LIKE WHY IS SHE LOOKING AT ME? AM I A SPECIMEN? IT WAS REALLY AWFUL. THEN ALSO, ONE OF MY PROFESSORS OF THE LAW SCHOOL I SAID I'D DO MY STUDY ON RESTRAINTS AND HE SAID YOU DON'T UNDERSTAND, THESE PEOPLE ARE PSYCHOTIC, THEY'RE DIFFERENT FROM YOU AND ME. THEY EXPERIENCE RESTRAINTS DIFFERENTLY THAN WE WOULD SO DON'T WORRY ABOUT THAT. I DIDN'T HAVE THE COURAGE IN THAT MOMENT TO TELL HIM NO, WE'RE NOT THAT DIFFERENT AND THE EFFECT OF FORCED MECHANICAL RESTRAINTS IS VERY PAINFUL FOR PEOPLE. I USED TO HAVE NIGHTMARES EVERY NIGHT ABOUT IT. >> THANK YOU FOR SHARING THAT. I APPRECIATE IT. ONE OF THE REASONS WE CALLED YOU -- WELL, THE IMMEDIATE REASON WE CALLED YOU IS THERE IS A NEW DIRECTIVE IN NEW YORK TO ALLOW PEOPLE IN PROTECTIVE SERVICES, POLICE, FIRE, EMERGENCY, ET CETERA TO FORCE HOSPITALIZATION IN CERTAIN CASES. NEW YORK IS A BIG CITY AND EXPENSIVE CITY TO LIVE IN AND A LOT OF PEOPLE UNHOUSED SO PEOPLE PAY ATTENTION TO THE THINGS THAT PEOPLE IN NEW YORK DO IN A LOT OF INSTANCES SO I WANTED TO DOES WHAT IS YOUR KIND OF TOP LINE RESPONSE TO THAT GIVEN YOUR OWN EXPERIENCE AND GIVEN YOUR WORK WHERE YOU'VE EXTENSIVELY STUDIED AND WRITTEN ABOUT THESE ISSUES? >> THE NEW MAYOR OF L.A. NOTICED THE NEW YORK SITUATION AND WANTS TO DO THE SAME THING HERE WHICH I THINK IS A GOOD IDEA. THE BEST IDEA IS TO GET PEOPLE TO WANT CARE AND NOT USE FORCE AND MUCH MORE SUSTAINABLE SOLUTION OF SOMEONE BUYING IN THEMSELVES THAN IF THEY'RE FORCED BECAUSE ONCE THE FORCE STARTS YOU HAVE NO INCENTIVE TO GO BACK TO THE WAY THINGS WERE SO I THINK THAT'S KIND OF IMPORTANTLE. >> YOU'VE SAID YOU'RE PROPSYCHIATRY BUT ANTI FORCE. WHAT DOES IT MEAN TO BE PROPSYCHIATRY BUT ANTI FORCE? >> WE SHOULD FIND WAYS TO STUDY HOW WE CAN GET PEOPLE TO WANT CARE VERSUS USING FORCE TO GET CARE AND THAT'S IMPORTANT AND GOOD AND AGAIN, IF YOU BUY INTO THE TREATMENT, YOU'RE MUCH LIKELIER TO STAY ON IT SO THAT'S ANOTHER REASON. >> THE NEW YORK MAYOR ERIC ADAMS ANNOUNCE THING POLICY THINKS THAT PEOPLE MISUNDERSTAND OR OVER THE YEARS TOOK THE WRONG APPROACH. HE SAYS THERE IS A COMMON MISUNDERSTANDING WE CANNOT PROVIDE INVOLUNTARY ASSISTANCE UNLESS THE PERSON IS VIOLENT OR PRESENTING A RISK OF IMMINENT HARM. HIS ARGUMENT IS THAT THE STANDARD IS JUST TOO STRICT THAT PEOPLE WHO ARE NOT NECESSARY IN IMMINENT DANGER OF HURTING THEMSELVES, IF THEY CAN'T MEET BASIC HUMAN NEEDS THAT COULD BE THEIR STANDARD. WHAT'S YOUR THINKING ABOUT THAT? >> MY IMPRESSION IS THAT IS ALREADY THE STANDARD IF YOU'RE DANGEROUS TO YOURSELF OR OTHERS OR GRAVELY DISABLED MEANING YOU CAN'T MEET ESSENTIAL NEEDS FOR FOOD, CLOTHING OR SHELTER SOME JURISDICTIONS SAY CAN'T MEET REQUIREMENTS FOR MEDICAL CARE, YOU ARE COMMITTABLE. ONE QUESTION IS WHY CAN WE ROUND UP PEOPLE WITH MENTAL HEALTH CHALLENGES WHO ARE HOMELESS AND NOT JUST HOMELESS PEOPLE WHO DON'T HAVE MENTAL HEALTH. I THINK THE ANSWER IS IF YOU'RE HOMELESS MENTALLY ILL, YOU MAY NOT BE ABLE TO LIVE AS WELL AS A HOMELESS PERSON WHO IS NOT MENTALLY ILL. IT'S ALSO THE CASE THAT WE SHOULD BE THINKING ABOUT POLICE IN THIS CONTEXT. BECAUSE A LOT OF TIMES IF POLICE GET INVOLVED, YOU KNOW, IT'S EASY TO BRING SOMEONE TO A HOSPITAL OR A JAIL AND DON'T HAVE TO REALLY WAIT AROUND OR ANYTHING LIKE THAT. I THINK ACTUALLY THE POLICE ARE DOING BETTER THAN PEOPLE SAID THEY ARE SO I HAVE MY EVENTS ON MENTAL HEALTH AND LAW WE HAVE A TABLE WITH POLICE AND SHERIFF. THE POLICE ASK ME TO COME DOWN TO SEE THEM AND THEN SEPARATELY TO SEE SHERIFFS TO TALK ABOUT WHAT I THINK IS THE MOS EFFECTIVE HUMANE WAY TO DEAL WITH SOMEONE WITH MENTAL ILLNESS. POLICE USE A SHOW OF FORCE AND THAT GETS PEOPLE TO STAND DOWN AND FOR PEOPLE WITH MENTAL HEALTH DISORDERS A SHOW OF FORCE WILL RATCHET UP THE ANXIETY AND MAKE THEM MORE DANGEROUS OR WHATEVER. WE HAVE TO BE THOUGHTFUL HOW WE APPROACH PEOPLE WITH MENTAL HEALTH DISORDERS BUT I DON'T THINK THAT IT'S A GOOD IDEA TO HOSPITALIZE EVERYONE. >> THE IMPRESSION I GET FROM YOU IS YOU DON'T OBJECT ON ITS FACE TO REQUIRING SOME PEOPLE TO INVOLUNTARILY GET PSYCHIATRIC CARE AND BEING HOSPITALIZED? >> I'M NOT AN ABSOLUTEST THAT SAYS IT NEVER PERMISSIBLE AND A BAD THING TO DO. I THINK THERE ARE CASES WHERE IT'S THE RIGHT THING TO DO. >> I DO THINK THERE IS A CONCERN THAT HOSPITALIZATION WILL BE ABUSED. THE FACT IS AROUND THE WORLD PSYCHIATRIC CARE HAS BEEN USED TO PUNISH DISSIDENTS AND GET PEOPLE OUT OF SIGHT AND NOTHING HAPPENS WHEN THEY'RE OUT OF SIGHT, RIGHT? >> YEAH. >> AND THIS BECOMES THIS VICIOUS CIRCLE BUT WHAT ARE SOME CIRCUMSTANCES IN WHICH YOU THINK IT COULD BE BENEFICIAL? >> I THINK IF SOMEONE IS SERIOUSLY MENTALLY ILL AND UNAWARE OF THAT OR DOESN'T BELIEVE IT AND NOT WILLING TO TRY TREATMENT EVEN THOUGH TRYING TREATMENT IS THE MOST SENSIBLE THING TO DO, WE JUST HAVE TO MAKE A DECISION AS A SOCIETY OF WHEN DO WE MAKE THEM GET TREATMENT. THAT'S A DIFFICULT AND HARD DECISION AND IT'S NOT JUST LET'S JUST SAY EVERYBODY WHO IS HOMELESS SHOULD BE ROUNDED UP. THAT'S KIND OF AWFUL. IF YOU LOOK AT THE STATISTICS, THERE'S A LOT OF DISCRIMINATION SO MOST PEOPLE WHO ARE INVOLUNTARILY COMMITTED TO PSYCHIATRIC HOSPITALS AT LEAST IN L.A. ARE AFRICAN AMERICANS. AND MOST PEOPLE WHO ARE PUT IN JAIL OR PRISON ARE AFRICAN AMERICANS. WE'RE NOT DOING THIS IN THE RIGHT WAY. I THINK SOME FORCED TREATMENT IS NECESSARY AND IMPORTANT AND IT SHOULD BE THE MINIMAL AMOUNT OF FORCE YOU CAN DO SO YOU SHOULD WORK REALLY HARD TO GET THE PERSON TO UNDERSTAND WHAT IS GOING ON AND WHAT THEIR OPTIONS ARE AND ASSETS ARE AND STUFF LIKE THAT. >> TALK MORE ABOUT SOMETHING YOU RAISED EARLIER WHICH IS VIOLENCE. I MEAN, YOU INDICATED THAT THE NUMBER OF INCIDENTS ACTUALLY OF VIOLENCE ACTUALLY COMMITTED BY PEOPLE WITH SEVERE MENTAL ILLNESS IS RELATIVELY LOW BUT THE ONES THAT DO OCCUR ARE DEEPLY FRIGHTENING. THEY ARE. I MEAN, IT'S THE IDEA THAT YOU'RE ON A SUBWAY GOING TO YOUR JOB AND SOMEONE SHOVES YOU IN FRONT OF A MOVING TRAIN BECAUSE VOICES TELLING YOU TO DO IT. HOW SHOULD WE THINK ABOUT THIS? >> I THINK AS A SOCIETY, WE'VE DONE A DISSERVICE TO PEOPLE WHO HAVE SERIOUS MENTAL ILLNESS SUGGESTING PUSHING PEOPLE IN FRONT OF A SUBWAY IS THE NORM AND WE REALLY HAVE TO WORRY AND THAT'S NOT TRUE. I MEAN, IN TERMS OF INSANITY ONLY 1% OF PEOPLE HAVE MENTAL ILLNESS AND THREE QUARTERS OF THAT 1% ARE BY AGREEMENT OF THE PROSECUTION. MANY PEOPLE THINK THAT PSYCHIATRIC PATIENTS, SCHIZOPHRENIC PEOPLE ARE EXTREMELY DANGEROUS AND COMMIT VIOLENCE AND THEY WILL BE PUT IN A HOSPITAL FOR THE REST OF THEIR LIVES SO THAT'S A MISCONCEPTION. >> SOME PEOPLE SAY THIS PERSON HAS THE RIGHT TO NOT ACCEPT CARE AND OTHER PEOPLE SAY I HAVE THE RIGHT TO BE IN A PEACEFUL ENVIRONMENT. MAYBE THIS RIGHTS CONVERSATION IS NOT AS PRODUCTIVE AS IT COULD BE. IS THIS ANOTHER WAY TO THINK ABOUT THIS? >> THE QUESTION IS WHAT DO WE DO ABOUT PEOPLE REFUSING CARE BUT COULD HAVE A BETTER LIFE IF THEY ACCEPTED CARE. RIGHTS MAY NOT BE THE RIGHT LANGUAGE. MAYBE THE LANGUAGE SHOULD BE ABILITY TO MAKE REASONABLE DECISIONS AND IF THEY MAKE DECISIONS WE DISAGREE WITH, THAT'S NOT A SUFFICIENT REASON TO HOSPITALIZE THEM. IF THEY MAKE DECISIONS THAT INDICATE THAT THEY DON'T REALLY KNOW WHAT IS GOING ON, THAT'S A DIFFERENT SITUATION. I GUESS THERE IS SOMETHING CALL CALLED PEOPLE THAT DON'T HAVE INSIGHT THAT THEY HAVE THAT AND IN SCHIZOPHRENIA 50% HAVE THAT AND THAT'S ONE THING WE NEED TO TALK ABOUT IS THAT ENOUGH TO FORCE YOU TO GET CARE IF YOU DON'T KNOW YOU NEED IT. >> IF YOU COULD WAVE A WAND AND CHANGE ONE THING, WHAT WOULD IT BE ABOUT THE WAY WE TALK ABOUT THIS ISSUE OR ADDRESS THIS ISSUE FROM A MATTER OF POLICY? WHAT DO YOU THINK THAT WOULD BE? >> WAVE A WAND TO HELP PEOPLE UNDERSTAND THE STIGMA IS A REAL SCAR. PEOPLE WHO HAVE MENTAL CHALLENGES DON'T GET HELP. OUR COMMITTEE MANY YEARS AGO SOME STUDENTS WOULD SELF-DISCLOSE IN THEIR APPLICATION AND WHEN I WAS IN THE ADMISSIONS COMMITTEE, HALF OF THE PROFESSORS WERE LIKE AND DEANS AND SO ON THIS PERSON HAS GONE THROUGH A LOT OF STUFF IN LIFE AND COME OUT THE OTHER END. HOW COOL. WE SHOULD GIVE THEM A CHANCE AND AT THE OTHER END PEOPLE SAY DO WE REALLY WANT TO BORROW TROUBLE? IF SOMEONE WAS MENTAL ILLNESS DECOMPENSATES, IT WILL AFFECT OTHER STUDENTS AND THE MORAL OF THE SCHOOL AND WHEN STUDENTS WHO ARE APPLYING FOR LAW SCHOOL OR MEDICAL SCHOOL ASK HE SHOULD THEY SELF-DISCLOSE? I GIVE THE PROS AND CONS AND LET THEM DECIDE. MY REAL ANSWER IS IF YOU DON'T HAVE TO EXPLAIN GAPS IN THE RESUME, YOU SHOULDN'T. I WON'T SAY THAT BECAUSE IT SENDS THE WRONG MESSAGE IF IT'S REALLY TRUE. >> DO YOU THINK THESE CONVERSATIONS ARE GETTING BETTER? >> I I THINK IT'S GETTING BETTER BECAUSE PEOPLE ARE MORE WILLING TO COME FORWARD AND TELL THEIR STORIES. EVEN IF IT COULD BE RISKY. I HAD A FRIEND, A SIGH COAL SQUIS AT UCLA. I TOLD HER I'D WRITE A MEMOIR. SHE SAID DO IT UNDER A STUDENT. DO YOU WANT TO BE KNOWN AS A SCHIZOPHRENIC WITH A JOB? THAT'S NOT HOW I WANT TO BE KNOWN. IT SENDS THE WRONG MESSAGE THIS IS TOO AWFUL TO SAY OUT LOUD TO DO IT UNDER A PSEUDONYM AND SHE SAID I WAS RIGHT AND SHE WAS WRONG SO THAT WAS INTERESTING. THINGS MAY BE CHANGING. >> PROFESSOR ELLEN SACKS, THANK YOU FOR TALKING WITH US TODAY. >> THANK YOU FOR INVITING ME TO TALK.