Mysteries of Mental Illness

(grunting) VIRGINIA FUCHS: My dad taught me how to water-ski when I was four.

I've done team sports.

I got involved in running in high school.

(grunting) While I was in college, that's where I actually found boxing.

(crowd cheering, applause) I dedicated everything to boxing.

(crowd cheering) I won the Olympic trials for the 2021 Olympics.

And now I'm in the top three in the world, so getting the gold is definitely doable.

WOMAN: What are you doing, Ginny?

FUCHS: I just felt like my feet got very, very contaminated and it made my anxiety go to a ten.

It makes, it makes the world feel like everything's falling down.

I feel like I'm gonna throw up, my heart's racing, I can't...

I'm foggy, I can't think straight.

(grunting) Boxing is the only thing that takes me away from my obsessive thoughts and my OCD world.

Like, I know I'm a strong-willed person.

And I have good self-control when it comes to boxing.

But when it comes to my OCD, it's, like, no self-control.

I use, like, eight to 12 toothbrushes in one session.

Because I might brush it for ten seconds, be, like, "Oh, the brush feels contaminated."

I don't know why I get this thought.

It feels contaminated, throw it away, grab a new one.

(repeatedly punching speed bag) I'm, like, "Wow, Ginny.

"You can spar eight rounds, "go hit the bag six rounds, and go do a 30-minute run."

That's easy to me.

But I can't clean a countertop and wash my hands in ten minutes.

There's no way I would be able to do that in ten minutes.

That would take me, like, two hours.

There's always a constant battle in my head.

Like, "Ginny, let's stop," but I can't stop.

Even though I want to so bad.

Blows my mind, almost.

(grunting) I don't understand why I can't.

And that's what I'm still trying to figure out.

(sniffs) JEREMIAH ROBINSON: Well, I was diagnosed with bipolar, PTSD, schizophrenia, and depression.

MATTHEW ROSENBERG: I've been diagnosed with co-morbid depression, but it is secondary to the OCD.

LAURA DUNN: Generalized anxiety.

I'm pretty confident that that is my formal diagnosis.

NARRATOR: Half of all Americans are diagnosed with a mental illness during their lifetime.

I don't want to be viewed as someone who has a psychological problem.

MIA YAMAMOTO: I felt completely alone.

Every single person that you communicate with tells you you're crazy.

Here I am saying, "You know, my family would probably be better off without me."

NARRATOR: For many, the diagnosis of a mental illness is made worse by the stigma that accompanies it.

We have a natural inclination as human beings to be afraid of the things that we don't understand.

RYAN MAINS: I didn't think mental illness was something that happened to normal people.

NARRATOR: And in the era of the COVID pandemic, even more Americans grapple with mental illness.

RACHEL YEHUDA: One out of every five people that were treated for COVID have developed a mental health illness.

We know that there are a lot of people that have been traumatized.

SIDNEY HANKERSON: Coronavirus has highlighted health inequities in general, and the rates of depression and anxiety are through the roof.

NARRATOR: Now, more than ever, the cracks in America's mental health care system are exposed.

JEFFREY LIEBERMAN: At this point in time in the 21st century, we know more than we ever have in history, but at the same time, far less is being done than could be done.

Because treatment of people with mental illness has always been sort of separate and unequal.

There's so much stigma and fear as it relates to mental illness.

People might do whatever they can to say it's anything but that.

NARRATOR: Why?

Why does mental illness carry such stigma?

KEITH WAILOO: Lowering levels of stigma has proven to be very difficult.

You see this intermingling of social judgment and medical judgment always in the history of psychiatry.

NARRATOR: The past holds clues to why the puzzle of mental illness is so hard to solve.

Since the beginning of recorded history, people searched the body, the soul, and the brain for clues into mysterious behaviors, asking, "Are they evil or illness?"

In fifth century BCE Greece, Hippocrates, known as the father of Western medicine, wrote these words.

ANDREW SCULL: "It is the brain which is the seat of madness "and delirium of the fears and frights "which assail us.

"Insomnia and sleepwalking of thoughts that will not come, "forgotten duties and eccentricities-- "all such things result from an unhealthy condition of the brain."

NARRATOR: This was a radical notion at a time when most saw madness as a curse from the gods.

SCULL: This idea that so much of what is essentially human about us runs through this thing that sits inside our head is a remarkable insight.

NARRATOR: Hippocrates believed the health of the brain depended on the health of the whole body.

His ideas were inspired by the culture of his time.

For the Greeks, the four elements-- air, earth, water, and fire-- were essential to their understanding of the world.

And Hippocrates claimed they corresponded to four fluids in the body called humors.

ANNE HARRINGTON: Humoral theory saw a variant of each of the four elements operating in the human body.

They were either dry or they were wet.

And they were either hot or they were cold.

The way to stay healthy is to have everything in balance, not too hot, not too cold-- sort of the Goldilocks kind of principle of good health.

NARRATOR: This theory would shape the treatment of the mentally ill for more than 2,000 years.

AHMED RAGAB: Most physicians believed these humors affected the brain and therefore affected how people actually behaved.

For example, like, a person with more black bile in their body would be more depressed.

So it can lead to insomnia, forms of hallucinations.

It can lead to a number of other issues that we would identify as mental illness.

NARRATOR: Doctors believed blood carried the humors throughout the body.

So they treated these imbalances by bleeding patients with leeches or knives.

But who was considered mentally ill was shaped by the culture of the time.

COOMBS: Historically, medicine in general and also psychiatry have looked at themselves as immune to the impact of society and culture, as if, that it would be unbiased, right?

And totally just trying to be scientific.

But you see from the very beginning ways that people try to make sense of what they're seeing that are completely shaped and informed by the ways in which the world is biased.

NARRATOR: One enduring bias embodied by an ancient Greek diagnosis targeted women who behaved too emotionally.

SCULL: Hysteria is a diagnosis that doesn't exist anymore.

It derives from the Greek word for a womb.

There was a sense that the womb wasn't fixed in place, it could move about, and part of the mischief it created was upset in the body and in the brain and in the behavior of women.

NARRATOR: Even late into the 20th century, when the female anatomy was better understood, doctors continued to diagnose women with hysteria.

RAGAB: The term hysteria has expanded and shrank depending on society and depending on where women are.

In many cases, women simply voicing their opinion, participating in society, or offending a prominent male in their household would be branded as mentally ill. NARRATOR: The beliefs of the day often shape the understanding of mental illness.

WAILOO: In societies where authority was organized around religion, it was common sense that mental illness was either divinely inspired or the product of devilish intent.

NARRATOR: In the fourth century, the rapid rise of Christianity forged an enduring framework that would shape how society sees the mentally ill to this day.

Early proselytizers quoted the Old Testament, warning non-believers, "The Lord shall smite thee with madness."

ALLEN FRANCES: One of the problems for the mentally ill that came with Christianity was that mental illness was related to the morality and the worthwhileness and the sinfulness of the person who was suffering.

So if life was a battle between God and the devil, the mentally ill were seen as pawns of the devil.

NARRATOR: When it came to treatment, humoral techniques competed with religious ritual.

GEORGE MAKARI: You would vet these people, triage them, like in an E.R., and try to figure out whether, let's say, a delusion was due to a supernatural spirit that had invaded their soul or a disruption of their body.

It was a critical fork in the road, because if it was a disruption of their body, you were going to send them to the humoral doctors, who would bleed, who would do their thing.

If it was a possession of the soul, you needed to really be careful with this person, 'cause the power of a witch and of being possessed, they can possess others.

FRANCES: And so they were shunned, and even worse, they were often punished.

Sometimes with the best of intentions-- exorcisms, but exorcisms that might result in death.

SUSANNAH CAHALAN: Anyone that doesn't fit into the kind of archetype of what a woman is supposed to be is obviously ill or sick/a witch.

That is a direct reflection of the culture that it came from.

So psychiatry is a science that grapples constantly with cultural norms, because it's really deciding what's outside the kind of spectrum of normal behavior and what is inside it.

The question of what these behavioral problems mean has persisted, right?

The, "Why this person?"

"Why me?"

"There must be some meaning associated with this affliction."

So even though our religious and social and scientific authority has shifted over time, there is still this notion, this quest for meaning.

(indistinct chatter) CECILIA McGOUGH: If I lived in a different time, I could have very easily have been labeled possessed.

It could have cost my life.

When I was very young, maybe five, I remember seeing shadowy figures.

I got very confused and scared about what it was.

I grew up in a very religious community, so I was embarrassed about these hallucinations, because I started thinking that maybe this is a punishment, maybe I did something wrong.

NARRATOR: Cecilia McGough turned away from religion and towards science for answers to the unknown.

McGOUGH: I loved school.

It was an escape for me.

And I became quite the nerd.

NARRATOR: When she was 17, Cecilia fell in love with astrophysics and helped discover a type of collapsed star called a pulsar.

McGOUGH: That was an amazing opportunity, but this was the same time that my hallucinations were becoming much more prevalent.

(static hissing) I started hearing staticky whispers and struggling with scattered thoughts.

Up to, like, the moment, I was, like, "Cecilia, "it just might come up on the screen as, like, you know, "like, nothing's there, you know, or, oh, there's a lot of "RFI there, you know, it must have been some wacky radio signal," you know?

These symptoms progressed.

And then, I watched the older adaptation of Stephen King's "IT."

It really resonated with me, because the kids were seeing something that the adults weren't.

And I started seeing, like, these shadowy figures very similar to the clown.

I think, like, something with my consciousness sort of, like, latched on to that figure, and it's still a hallucination that I struggle with 24/7, even to this day.

I kept these hallucinations very much a secret.

I was hoping that maybe if I moved away, things will change.

But it was quite the opposite.

In college, I tried to go to different mental health clubs, but no one was really talking about hallucinations.

So it in a way even stigmatized it more, because I felt like if I can't even open up about this in a mental health space, then, like, is there something that wrong with me?

It was just a very dark time in my life.

I wasn't just losing my future, but I was also losing my mind, and I didn't know if I wanted to live like that.

I thought it would be better to just sort of end things.

And I tried to take my own life.

NARRATOR: A combination of the Greek words "split" and "mind," schizophrenia is used today to describe Cecilia's hallucinations and scattered thoughts.

While this diagnosis only dates to the early 20th century, individuals have experienced Cecilia's constellation of symptoms across time and culture.

This is the case for other mysterious disorders, as well.

In the 16th century, St. Ignatius Loyola, founder of the Jesuit order, blamed himself for his obsessive behaviors he called "scruples" or "doubts" about his faith in God.

Today, psychiatrists still use the word "scrupulous" to describe certain types of obsessive behaviors.

And for many, the legacy of self-blame persists.

FUCHS: I was diagnosed with OCD when I was in sixth grade.

My family, they support me all the way.

But I hid my OCD, 'cause I was scared of getting judged.

I didn't accept it, and I was, like, "That's not who I am.

I don't want people to know, that that's who I am."

I came out to the public in 2015 at the Olympic trials, because I knew that I was going to be around, like, my team members 24/7 and rooming with them.

So, I knew I wasn't going to be able to hide it from them.

(groans) Okay, you know what?

That's not going to work.

I forgot I was out of plastic bags, but I got an idea.

See, you wanna...

When I'm out of something and I need to do something, I can figure out a way to get around it.

(sniffs) This thing in the middle, the top of it is contaminated to me, because it doesn't really get washed, so I always have to cover that, 'cause it'd be impossible to take that out without my clothes touching it.

NARRATOR: Obsessive-compulsive disorder is characterized by anxiety, repetitive unwanted thoughts, and compulsive behaviors.

ANGELA SMITH: What we look at to determine if something meets the threshold of OCD is the frequency and intensity and level of distress that it causes.

(Fuchs sighs) So this happens with this, um, washing machine.

My arm touched the side, so now I gotta go wash it off.

SMITH: With Ginny, her symptoms right now are at a severe level, in that the compulsions take up several hours a day.

FUCHS: I'm so focused on getting that clean feeling of what it is at the moment, I'm not realizing the mess I'm creating around me.

The tip of this just actually touched that, which is contaminated to me, so...

I can't use, like, the squirter thing.

I just have to take this off.

I could spend almost $500 a week on just supplies.

And I go through soap a lot.

When I moved to the Olympic Training Center, so these past four years, I've relapsed really bad.

It has hit me very hard, to the point to where I feel no control over it.

Coronavirus has not helped.

It's kind of made it worse.

I've... my anxiety level is... (sighs) From a scale from one to ten, it's just, I wake up with an eight and I can't get it down to a one.

(sighs): Okay.

It's the only thing in my life that is really, like...

Almost, like, a good way to describe it, like, possesses me-- it's kind of scary.

(humorless chuckle, inhaling deeply) Don't...

Hold on, I gotta concentrate.

Okay.

(shudders) Hate these washing machines.

So I bring myself down a lot, like, "I'm never going to be able "to have a normal life, "I'm never gonna be able to own a house, and I'm never gonna be able to have kids."

And it's so distressful.

It takes so much energy.

I do that every day, three to four times a day.

These items right here, I have to rewash them because it touched the in, the rim of the washing machine that I feel is contaminated.

But my therapist tries to get me out of that negative loop, so I don't go down that hole.

So, we're kind of manipulating my mind, in a way.

NARRATOR: Today, therapy is a common intervention used to "manipulate" the mind.

But the modern concept of the mind is only a few hundred years old.

In the 18th century-- known as "the Age of Reason"-- people looked beyond religion for clues into the mysteries of mental illness.

England's King George III ruled a global empire.

But when he was 50 years old, he was racked with convulsions and delusions, and began speaking incessantly until he foamed at the mouth.

MAKARI: When King George III became ill and started to spout nonsense, it was exceedingly distressing because he was supposed to be close to God.

Initially, the doctors around him tried the usual humoral remedies.

They bled him, they blistered him, and it didn't work.

MAKARI: Everyone by this point knows, you call in the humoral doctors, you probably should get ready for the funeral.

'Cause they're gonna kill you.

If you're not going to die on your own, they'll bleed you to death.

But King George's wife took a chance.

She called in a doctor named Francis Willis, who was, you know, rather obscure country doctor, but he had adopted the methods that had started with John Locke.

John Locke is the first person who says, "There's a thing called a mind."

NARRATOR: Locke, a philosopher and physician, defined the mind as the source of consciousness and identity, and claimed it was part of the natural-- not supernatural-- world.

MAKARI: And because it's a natural thing, it can be ill. And this, he says, is a kind of illness that only the mind can have, mental illness-- has nothing to do with a soul.

We need to treat it.

You gotta attack these incorrect ideas.

You've got to refute them.

And Francis Willis has the gall to do this to the king.

NARRATOR: Willis took Locke's ideas and attempted to manipulate the mind of King George with physical force.

But a letter from the queen's attendant reveals this new therapy was not so different from the spiritual exorcisms of the past.

SCULL: "The unhappy patient was no longer treated "as a human being.

"He was sometimes chained to a stake.

"He was frequently beaten and starved, and at best, was kept in subjection by menacing and violent language."

You know, as we've seen, exorcism involved, through some metaphysical means, driving out the devil.

This is a more physical attempt to force the patient back into the world as it is, not into the phantasmagorical world that he is trapped in.

MAKARI: Francis Willis printed a coin that said, "The king is restored."

And on the back, he might as well have put, like, "Francis Willis-- call me," because the coin said, "This is the guy who did it."

Now, all throughout Europe, there was this almost panic.

The English know how to treat mental illness.

They can cure it.

This was, in a way, the biggest moment for the emergence of a mental kind of medicine.

NARRATOR: King George relapsed 12 years later, but Europe embraced this new kind of "mental medicine" and its physical interventions.

(machine ratcheting) The Industrial Revolution was in full swing, and every facet of society turned to mechanization.

Following the trend, physicians even invented machines to cure madness.

SCULL: One is the swinging chair.

The patient was strapped into the chair, and started to spin faster and faster and faster.

People vomited, they voided their bowels and their bladders.

Their hair stood on end.

They lost consciousness in the end.

There were all kinds of devices like this.

(water splashing) CAHALAN: It's this approach to trying to make something in the mind a physical force.

Because if it's just kind of metaphysical, if it's just in the mind, how do you fix that?

So by making it a part of the body, it kind of galvanized medicine to try to treat it in many misdirected ways.

(Lorina Gutierrez speaking indistinctly, dog barking) LIEBERMAN: Right now, there is no objective biologic test that can be used for mental disorders.

We'd like to have them.

We desperately seek them.

It's the Holy Grail.

(Lorina speaking indistinctly) NARRATOR: Even today, many cases confound both doctors and patients, and people still search the mind, the body, and even the soul for answers.

LORINA: You know what I mean.

(Stephen Gutierrez murmurs) LORINA: I'm talking about you, I'm talking about you-- you.

STEPHEN: I don't know what you're talking about.

I was working nights.

Lorina called me and said she wanted me to come home because she didn't feel good.

(Lorina speaking indistinctly, dog barking) STEPHEN: By the time I got home, she was not making any sense at all.

Making up her own words.

(Lorina panicking) STEPHEN: She kept saying the word "fire" a lot.

(Lorina panicking, speaking indistinctly) STEPHEN: Religion is a big part of our life.

So even though it might sound crazy to a lot of people, I thought, "Could my wife be possessed?"

It did cross my mind.

We have holy water in our house.

I splashed her, it got her pretty good in the face, but nothing happened.

So I called up her doctor.

MARCUS HIGI: In Lorina's case, you're left with, "Okay, this has got to be psychiatric and psychological."

That was the conclusion that I came to.

A lot of the things that started to come up appeared to coincide with an anniversary of her mother's death and an extremely difficult childhood with a long history of multiple episodes of abuse.

So it seemed like the perfect storm of a lot of psychological issues.

NARRATOR: Lorina was admitted to a psychiatric hospital.

But after nearly a week on medications, she showed no response.

STEPHEN: They did tell me one day, "We don't think this is something psychiatric."

They said, "We think it's something medical.

We need to send her back to the hospital."

So they start over.

They were just trying everything they can.

They came back and said, "Look, we see something, like a mass, on one of her ovaries."

And they said, "We found antibodies.

"In our lifetime, we would never think we would ever see any of this."

NARRATOR: A team of specialists uncovered evidence of a rare autoimmune disease attacking her brain called anti-NMDA receptor encephalitis.

For her, triggered by an immune response to an ovarian tumor.

HIGI: What appeared to be a psychotic break was really just a symptom of a storm of hormones and chemicals that just essentially made her brain on fire.

NARRATOR: The disease was virtually unknown until journalist Susannah Cahalan brought it to the world's attention.

CAHALAN: I was the 217th person to be diagnosed with this ever in the history of the world-- 217.

But I remember feeling so ashamed about the psychosis, about the hallucinations.

First was misdiagnosed as bipolar disorder, and then was misdiagnosed as schizoaffective disorder.

And as I became more and more psychotic, I became-- a difficult patient is what I was called.

There was a hopelessness.

But when I was diagnosed with autoimmune encephalitis, there was a shift.

You could recover from this illness.

Whereas the implication with a serious mental illness is that it's something that you have for the rest of your life.

LORINA: Please tell me I'm not on fire.

STEPHEN: No, you're not.

- Please tell me I'm not on fire.

STEPHEN: You don't remember that one?

LORINA: This disease just took over my mind, heart, body, soul-- everything.

It took probably about five months of me being home for me to even really know I was here in my house.

It's just very scary.

But who knows how many individuals have ended up in the psychiatric ward being labeled with schizophrenia or anxiety or bipolar or what have you, when there could be more of a underlining medical issue?

You just never know.

NARRATOR: Lorina's case sheds light on how biology and mental illness are intertwined.

Was she suffering from a physical or mental disorder?

Is there even a difference?

This question has long puzzled science.

In the late 1800s, a biological breakthrough raised hopes researchers were close to finding the root of all mental illness.

Advances in dissection revealed the brain contained cells called neurons.

And scientists discovered different regions controlled different behaviors, like speech, movement, and sight.

Would they find the source of madness next?

This was the era of the asylum.

Hundreds were built to treat and house the insane.

When patients died, their bodies were often sold to researchers.

They probed these corpses and zeroed in on a mental illness afflicting about one in four asylum patients: general paralysis of the insane.

SCULL: This came with both neurological symptoms and psychiatric symptoms, which were often quite subtle at first: difficulty articulating words, shuffling gait.

You at the same time developed these extraordinary psychiatric symptoms.

You often believed you were Jesus or Napoleon or Mary, Mother of God.

And as this progressed, you became increasingly paralyzed and eventually you usually choked to death.

Some psychiatrists thought that general paralysis of the insane was the end state of all forms of madness.

NARRATOR: But then doctors noticed a surprising connection.

Dissections revealed that in many patients previously treated for syphilis, a common sexually transmitted disease, the infection had migrated to their brains.

SCULL: It creates a sense that biology may be a way forward.

If a quarter of all madmen were really the result of infectious illness, what about the rest of them?

NARRATOR: Soon, advances in imaging techniques unlocked the details of single neurons, and for the first time, scientists found physical evidence of diseases like Alzheimer's and Parkinson's.

CAHALAN: But this idea that we were going to make this major breakthrough in understanding all of madness through biology, through pathology, um, that didn't come to fruition.

NARRATOR: Today, ever more sophisticated tools provide new clues.

Gene sequencing may one day reveal the genetic origins of these diseases.

MRIs and PET scans offer insight into how disorders like schizophrenia impact different regions of the brain.

But there are still many unknowns.

COOMBS: With schizophrenia, not unlike any other diagnosis, we know that there are multiple factors, but we don't know exactly, you know, which factors are playing out more in which person.

How much of it is, you know, a biological component, how much of it is social, how much is psychological, how much of it relates to trauma and all different kinds of aspects, is the question.

FRANCES: So many genes are involved.

For schizophrenia, 150, interacting in permutations that are probably in the billions.

There's never any specific genetic pattern that explains a particular clinical presentation.

We know more than we ever have, but there's still a lot that's not known.

And so that's a big reason why the stigma persists.

McGOUGH: I didn't talk about my hallucinations at all.

After my first suicide attempt, I didn't feel comfortable.

It took me eight months after that to finally get treatment.

I've had three near-attempts since then.

NARRATOR: Even after her diagnosis, Cecilia tried to hide her symptoms, but events intervened.

(sirens) McGOUGH: My second psych ward stay, I had to open up afterwards because the police were involved.

They patted me down in front of my roommates and I had to convince them not to put handcuffs on me.

I wasn't at all refusing to go.

I have no history of violence.

(sirens) I believe I was gone for ten days, and when I came back, people knew something was up, and I had to set the story straight.

So I opened up through a social media post.

And that's when I started realizing that, you know, this is something that needs to be talked about more.

So I'm Cecilia McGough, I'm the blogger for the "I Am Not a Monster Schizophrenia Project."

I have a real problem of getting trapped, trapped in my bedroom, because my hallucinations are the worst when I wake up.

I'm doing this live stream right now because it's important that I do these live streams, even when I'm, when I'm struggling.

LIEBERMAN: There's extensive data which shows that if you're treated for an acute episode of schizophrenia, particularly early or at the beginning of your course of illness, your response to treatment is very good.

NARRATOR: But if left untreated, studies suggest schizophrenia gets worse over time.

Cecilia didn't start therapy or medication until 15 years after her first hallucinations.

McGOUGH: This is my first video since coming back from my sixth psych ward stay.

NARRATOR: And like many living with schizophrenia, she's tried a variety of drugs and therapeutic approaches.

Sometimes I feel like it's a choice for me to take my medicine, go to sleep, be a good patient, or stay up and do work, because my medicine makes me go to sleep.

LIEBERMAN: 80%-plus people will have a very significant response to anti-psychotic drug treatment.

The thing is, is sustaining that.

I tried different medications.

Some of them would make the hallucinations worse.

COOMBS: With schizophrenia, we believe that there's a certain biological component, but it's not the full story.

When I see those giant spiders, that usually happens during the medicine changes.

COOMBS: So what that means is that, when we look at treatment, we have to combine different interventions that target different types of challenges.

NARRATOR: More than a century ago, one doctor recognized this complexity and realized biology might not have all the answers.

In the late 1800s, Sigmund Freud was a frustrated neurologist hoping to discover the biological mechanisms of thought and feeling.

MAKARI: The motor neuron had been found, the sensory neuron had been found.

He thought for sure there's gonna be a will neuron and a memory neuron and a thought neuron.

And he scribbled out this thing called "The Project for a Scientific Psychology."

And then he looked at it and he said, "This is a, this kind of a madness, this is all BS-- I'm making this up."

So Sigmund Freud is at the end of his academic tether when he gets this grant to go to Paris and study with Charcot.

NARRATOR: When Freud met him in 1885, Jean-Martin Charcot was the world's most prominent neurologist.

At the Salptrire Hospital in Paris, he was trying to unravel one of psychiatry's oldest and most vexing diagnoses.

HARRINGTON: This was a hospital for a lot of indigent, sick women.

A group of those women had been diagnosed with hysteria.

They suffered from motor problems, paralyses, and most dramatically, fall into states of convulsion, like someone with epilepsy.

MAKARI: Charcot, he thought "You know, there's something to this illness.

"I bet you it's a neurologic illness and it has discrete neurologic stages."

He then tried to sort out what those stages were.

NARRATOR: Charcot decided to use a technique popular at the time: hypnosis.

A trance-like state was induced in patients to control their minds and bodies.

HARRINGTON: Hypnosis drew from the exorcism rituals.

Exorcists often required the demon to obey commands.

"Make this person go rigid!"

And the person would go rigid.

"Okay, now, demon, now that you know that I control you, begone!"

So hypnotists kind of do a little bit of that, too.

Charcot uses hypnosis to create on command the various symptoms of hysteria that he believes occur naturally.

He can call them out on command, and then he can photograph them, or then he can demonstrate them.

MAKARI: Everyone wants to come and see this.

And Freud goes there and he's utterly blown away by this stuff.

He writes to his fiance, "My brain is sated as after an evening of theater.

No other human being has ever affected me in the same way."

But that theater was not all real.

The patients were figuring out what the doctors wanted them to do.

These apparently spontaneous pictures took two, three, four, five minutes to produce, and so these figures had to somehow learn to hold these poses.

It was suggestion, a bath of suggestion, where what the doctors wanted, the patients gave them.

And soon it seemed like that was just the truth.

NARRATOR: The medical establishment dismissed Charcot's work as unscientific.

MAKARI: And Freud goes back to Vienna just as Charcot's reputation starts to really plunge.

And he comes out of it with a new synthesis.

NARRATOR: The notion that doctors can tap into hidden parts of a patient's mind sparked an insight in Freud.

At the time, society was starting to embrace the concept that humans and animals alike possess innate instincts.

Charles Darwin had recently introduced the revolutionary idea that evolution shapes not just humans' physical characteristics, but their behavior.

FRANCES: Darwin said that we have inborn tendencies that developed during the evolution of our species, that our behavior is just as much a function of evolution as is our body.

That was the home run.

Freud applied this Darwinian thinking to clinical situations by saying we had inborn instincts that were not always available to consciousness.

The treatment is really basically getting the person to understand what was previously unconscious and to try to change those patterns through that understanding.

MAKARI: He said, "Whatever the brain has to do with that, "someday we'll find out.

"I'm just going to say that's a black box and I'm gonna track these things psychologically."

And that's psychoanalysis.

NARRATOR: Psychoanalysis relies on dream interpretation and stream-of-consciousness exploration to resolve what Freud calls neurosis, the distressing conflict between the conscious and unconscious mind.

Finally, after centuries wrestling with the question, "Is mental illness an evil infestation or a biological disorder?

", Freud argues it's part of the human condition.

But how society applies his ideas changes as culture changes.

COOMBS: We know for a fact that when we're walking and living our lives, that there are all kinds of behaviors and actions that we do that are not within our conscious awareness, we just do them.

So why wouldn't that be the case when it comes to unconscious feelings, motivations?

So for me, sort of the lessons and teaching of Freud as it relates to some of that is helpful.

Other things, not so much.

MAN (in film): Tommy wouldn't be behaving as he is if he weren't seriously upset by something that we don't understand at the moment and that he's not aware of himself.

NARRATOR: In the mid 20th century, American psychiatrists took Freud's ideas about the importance of early life experience to the extreme.

After centuries of searching, they claimed to have finally found the source of mental illness: bad mothers.

WOMAN (in film): You know it's the mother who is responsible for the child's character.

HARRINGTON: This does lead to a kind of project to identify the range of ways that mothers can harm their kids' emotional development.

MAN (in film): She inflicts on both her husband and son the kind of punishment she had.

- Poor child.

- And poor man.

HARRINGTON: It has a kind of quasi-medical sort of spirit to it, because certain kinds of bad mothering lead directly to certain kinds of messed-up kids.

MAN (in film): There's an angry, frustrated woman.

HARRINGTON: There was a mother that was blamed for driving her children into states of schizophrenia, the "schizophrenogenic" mother.

There was a lot of controversy over what was exactly wrong with her.

But there was clarity that there must be something wrong with her, because her children were so sick.

MAN (in film): He is placed on a couch and urged to let his mind roam freely.

NARRATOR: Through the lens of this conservative era, Freud's ideas were widely adopted, but distorted.

PSYCHIATRIST: Now, tell me about your mother.

NARRATOR: Psychiatrists saw the need for new approaches and built off Freud's use of talk therapy.

FRANCES: Starting in the '50s and '60s, there became the addition of different therapies that focused less on unconscious motivation and more on the current behaviors, thoughts, and feelings, with the idea that you might have a quicker and more efficient way of promoting change.

SMITH: You are going to be doing a cleaning, and we want to try to achieve not clean enough.

- Okay.

- Go.

NARRATOR: To manage her OCD symptoms, Ginny relies on one of these different approaches, known as cognitive behavioral therapy, or CBT.

SMITH: Not clean enough... NARRATOR: CBT combines talk therapy with a theory pre-dating Freud: John Locke's notion that it's possible to identify problems and manipulate the mind.

COOMBS: Cognitive behavioral therapy is shown to be really helpful in how people build up and bolster tools for themselves to be able to, you know, ask themselves and challenge some of their automatic thoughts.

NARRATOR: Ginny uses a form of CBT called exposure therapy.

SMITH: Very different than lying on a couch talking about your mother.

That is just fine, and it's relevant, but the focus of exposure therapy is to be in contact with the thing that you've been avoiding.

It's a very active kind of treatment.

NARRATOR: Ginny's exposures include using a single toothbrush for two minutes... ...and touching dirty surfaces she'd usually avoid.

SMITH: She's been in treatment now with me somewhat on and off over a year and a half.

And she, she is still in need of treatment.

- I just feel weird.

- Mm-hmm.

NARRATOR: Like many, Ginny continues to search for effective treatments.

SMITH: Sometimes it's a matter of, is medication being taken consistently?

Sometimes the answer has been no.

But I always hold on to hope that things can be different and we'll keep on working for that.

- It's a feeling, I don't know how to handle this feeling.

Like, I feel like it's never gonna go away...

When I'm having a bad time, I will go and do therapy with my therapist every day.

Therapy for mental health disorders, it's out of network, so my insurance doesn't pay much of it.

So that adds up.

If I resist those thoughts sometimes, it's, like, sometimes I get all these other thoughts that overwhelm my brain that I, um... that I can't, like... that I feel stuck, like...

I feel like I would just call my coach and say, like, "I can't go to the gym."

Well, I think society doesn't help people with mental health as much as, like, physical problems, because a lot of people still don't understand it.

The United States Olympic Committee, they're willing to help me, because they want to see me succeed and win a gold medal.

So I'm lucky with that, but most people don't get that.

Most of my therapists that I've had have been when I've been in a psych ward.

I went to a therapist once.

But unfortunately, and this is the case for a lot of people, I couldn't afford to have a therapist and a psychiatrist and support myself.

It is frustrating that sometimes you have to make that choice on what, what can you afford for your mental health.

NARRATOR: After centuries, mental illness is still shrouded in stigma and mystery.

Like millions, Cecilia and Ginny live with disorders that are challenging to treat, and managing difficult symptoms dominates daily life.

I sometimes actually take pictures of little spiders with my phone, because I've realized that if I take a picture, I don't hallucinate it on the... NARRATOR: Cecilia's social media presence took off...

I think that says "hello from Spain."

NARRATOR: ...attracting thousands around the world living with schizophrenia.

WOMAN: Hey, Mr. Honey, don't you drive too fast for me Turn the radio down So you can hear me NARRATOR: Cecilia left her studies in astrophysics and started the organization Students With Psychosis.

It's a supportive community that pushes back against centuries of stigma.

MAN: We're starting a big movement here tonight, and, you know, what we really want to do is change policies in the future.

(song continues) McGOUGH: I think there can be some parallels between the discovery of pulsars and also people realizing that schizophrenia is a medical condition.

When pulsars were first discovered, people were initially scared.

It was thought that they were aliens.

But they realized that pulsars can be used as, like, these lighthouses in space, a way to triangulate location.

It just shows how something can be less scary when we know more about it.

And I think the same can be said about schizophrenia.

A lot of times, people will look at me in fear after I tell them what I hallucinate, but really, we all see, hear, and feel things that aren't there when we're dreaming.

As much as I loved the research I did with pulsars-- I freaking love pulsars-- I shifted gears because I feel like I can make more of an impact or making this world better.

It helped make me feel less alone.

When I look up at the sky, there's still that hope.

WOMAN: So I can fly high NARRATOR: Only a few days after Cecilia's event, the COVID pandemic shut down New York City and the world, raising urgent new questions about mental illness and how society will respond.

WAILOO: COVID-19 is a great revealer.

There is a sad and tragic opportunity we have to take stock of what kind of vulnerabilities exist in our society and try to remedy them.

At the same time, looking back at history, you wonder whether, you know, Americans have the steel to address the kinds of problems that are being revealed in our time.

ANNOUNCER: Next, on "Mysteries of Mental Illness"... CAHALAN: What is abnormal, what's normal behavior?

What's illness?

RONALD BAYER: The boundary is very fluid.

COOMBS: In the 1800s, drapetomania was described as an illness that led enslaved people to seek freedom.

WAILOO: Societies decide the lines of deviance.

YAMAMOTO: I was not like everybody else, so I thought of course I was sick.

WALROND: In my 20s, I began to experience depression.

You suffer in silence, because, as a Black man, there's not a desire for one more label.

MAN (in film): One out of three of you will turn queer.

MAN (in film): Judgments have changed!

BAYER: People began to say, "We're not sick and you are oppressing us."

YAMAMOTO: If I can survive this, I'm going to be living the life that I've always wanted to live.

ANNOUNCER: To order "Mysteries of Mental Illness" on DVD, visit ShopPBS or call 1-800-PLAY-PBS.

This series is also available on Amazon Prime Video.

For more about "Mysteries of Mental Illness," visit pbs.org/ mysteriesofmentalillness.