0:05

As we all know, television and film

0:07

predominantly portray people with schizophrenia

0:10

as young white men. And

0:12

yet in real life, schizophrenia is not

0:15

as seen on television, especially

0:17

for women. Men typically show

0:19

symptoms of schizophrenia at a younger age

0:21

during their late teens or early twenties.

0:24

But some women with schizophrenia don't develop

0:26

the disease until later on in life, sometimes

0:29

not being diagnosed until their forties.

0:32

And while a lot more needs to be done around

0:34

women and serious mental illnesses, scientists

0:36

are still seeing how illnesses like

0:39

schizophrenia can impact men and

0:41

women differently. So what does this

0:43

mean? Does this affect women getting

0:45

an accurate diagnosis or accessing

0:47

care? And what about the additional stigma

0:50

or discrimination that women may

0:52

face? We are going to cover all

0:54

of these questions and much more with today's

0:57

guest, Dr. Araba

0:59

Chintoh. Dr. Chintoh

1:01

is an assistant professor at the University

1:03

of Toronto in the psychiatry department.

1:06

She's also a researcher and clinician

1:08

with a particular interest in treatment of

1:10

resistant schizophrenia. And

1:13

looking at the gender differences when

1:15

it comes to diagnosing and

1:17

treating mental illnesses. Dr.

1:20

Chintoh, thank you for joining us

1:22

today. Welcome to the podcast.

1:24

Thank you very much. I'm looking forward to it

1:26

as well.

1:27

Dr. Chintoh research has shown that psychosis

1:29

affects men and women equally and occurs

1:31

across all cultures and

1:34

all socioeconomic groups. But

1:37

as we just talked about, illnesses like schizophrenia

1:39

seems to affect women at a later

1:41

age than men. Why do you think

1:43

that is?

1:44

The general feeling is that

1:47

there's a protective effect of estrogen

1:49

that impacts women after puberty

1:52

differently to men. The peak

1:54

that we see in men for their

1:57

first episode of psychosis is in that kind of

1:59

18 to 24

2:01

year range. And for women, it's about 4

2:03

to 6 years later. So women will

2:06

become ill in their first episode,

2:08

22 to 28, 30 years

2:10

old. So it's meant to be

2:12

a protective effect of the estrogens.

2:14

And so with this protective

2:17

effect of estrogen, I'm

2:19

curious then, what are your thoughts

2:22

on taking estrogen replacement

2:25

and compensating for

2:27

that decreasing estrogen?

2:29

I'm glad you asked. My

2:31

thoughts are what

2:33

has been the answer? And

2:35

the reality is there is some

2:37

evidence that shows, okay, maybe we

2:39

can use these selective estrogen

2:42

receptor modulators, SERM, S-E-R-M

2:46

for short. There's some evidence to show

2:48

and some studies. There is a bit of a change

2:50

around symptoms and in others there aren't.

2:52

So if I summarize, we

2:54

don't have enough yet to say every

2:57

single woman who has schizophrenia. When you get older

2:59

and you're hitting menopause and you're losing

3:01

estrogen or some other hormones, let's give

3:03

you these. But is it a place to look where the

3:05

light is kind of bright? Yeah. Definitely.

3:07

And now, Dr. Chintoh, I'd like to take a moment to listen

3:09

to a clip. We are going to be hearing

3:12

from a woman talking about her evolving

3:14

mental health diagnosis since 1995.

3:23

When I first had depression in '95,

3:25

and my doctor just was like, 'You're just depressed.

3:27

You just need antidepressants.' Just saying

3:30

that 'You're in a mood' kind of thing. Not

3:32

being heard and not being really looked at

3:34

in a holistic type of let's look at all

3:36

the factors here, not just the depression. Then

3:39

you can't just treat it singularly. You

3:41

have to treat it and look at the whole

3:43

picture like, what's the past trauma, what's

3:45

the current trauma, what's the routine in

3:48

this person's life, what their support system like,

3:50

or what are they self-medicating with and all those

3:52

things? Because I don't think you can just

3:54

throw a pill to someone and say, 'Take this

3:56

and you'll be fine. Call me in a week.' That's

3:59

ridiculous. And that's what I felt

4:01

that the doctor that I saw in

4:03

Calgary, he missed the boat entirely.

4:06

And then my life unraveled.

4:11

So based on your experience

4:13

as a clinician and a researcher,

4:16

what are your thoughts on what we just heard?

4:18

Do you think gender does play a role

4:21

in getting a diagnosis for a mental illness?

4:23

100% it does

4:25

for a number of reasons are women

4:28

tend to present in atypical

4:30

ways early on. I don't mean fantastical,

4:33

but women will talk about emotions

4:36

or impacts in relationships

4:39

in a very different way than that kind of concrete.

4:41

'I just heard a voice', or 'I think it's a CIA

4:44

or that kind of thing.' And so it's almost

4:46

natural to lead towards

4:50

this kind of mood, picture or

4:52

mood, a diagnosis. And

4:54

part of the piece that we spoke about around

4:57

are women coming to the illness later

4:59

in life. And even if it's just four years

5:01

later, if you think about yourself at 18 and you think about

5:04

yourself at 22, for many people,

5:06

they've gone through some post-secondary education

5:08

or even have just worked in been out in the

5:10

world more. And there's a real key piece

5:13

around what you learn in those

5:15

transitional forming, self identifying

5:17

years that help in self preservation.

5:20

And so if a woman comes

5:23

and complains of things that sound

5:25

interpersonal, that sound kind

5:27

of mood related, and they're

5:29

functioning much better than

5:31

the average 18 year old who just drops off

5:33

and is hearing voices, then

5:36

I think those are some of the reasons why that kind

5:38

of missed diagnosis happens.

5:40

So, Dr. Chintoh, what

5:43

is the fallout from that kind of experience?

5:45

The negative pieces to that are those stigma

5:47

pieces? 'Oh, she 's just, she's being

5:50

melodramatic. Oh, she's hysterical. Oh.'

5:52

That kind of thing. I definitely think that

5:54

that happens. And I think it's really easy

5:57

to feel and think that we're in a hospital and

5:59

emergency department. And when we see people

6:01

returning with similar complaints

6:03

but not really great, function about like, you

6:05

know, what am I meant to do? Oh, it's very, very easy

6:07

to think, oh, they're just being melodramatic.

6:10

And so that really impacts women. And

6:13

the peace around that clip that hit

6:15

me was that this woman talked about her

6:17

life unraveling after that. Part of

6:19

the problem about not getting that diagnosis

6:22

right at the get go is

6:24

what we call duration of

6:26

untreated psychosis.

6:29

What does this mean and what's the impact

6:31

of having untreated psychosis.

6:35

The longer period of time

6:37

that you have this psychosis and it's

6:39

not being treated. It has a really

6:41

negative impact on your outcomes,

6:44

on what you can do, on how you can recover,

6:46

on what you can achieve later on

6:48

in your life. And there's all different kinds

6:50

of reasons that you may go

6:52

with a longer duration of untreated

6:54

psychosis, but we know that the impact

6:57

is negative. And my only other

6:59

caveat to that is that sometimes

7:01

the diagnosis isn't clear

7:04

upfront. And it's not I

7:07

mean, I love schizophrenia. This is my

7:09

jam and these are my people. But it's not a small

7:11

thing to make a diagnosis of schizophrenia.

7:13

And so in as much as I hear her almost

7:16

desperately needing to have know

7:18

what that was at the outset, sometimes

7:21

the picture isn't clear. And to move down

7:23

that route and to move down that medication

7:25

piece and some of those other things, and even the

7:27

stigma that is attached to schizophrenia, it's

7:30

not a small thing. And so I sense two families

7:32

all the time. So that was definitely wrong. And

7:34

I don't know what it is, and I'm going to stand by you

7:36

and you get to come through here for

7:39

as long as it takes to figure it out. So

7:41

right now, we don't know.

7:42

As we mentioned earlier, Dr. Chintoh ,

7:44

you have a particular interest

7:46

in treatment resistant schizophrenia.

7:49

So first off, what is that.

7:52

Here in particular in

7:54

Canada? This categorization

7:56

is for someone who has

7:59

tried and not responded

8:02

to at least two

8:04

antipsychotic medication. So say,

8:06

for instance, that you, Faydra, develop

8:09

the symptoms of this illness. We start you

8:11

on a medication, we get you up to a

8:13

good dose. You're on it for a

8:15

good enough chunk of time where we know that if

8:17

this medication we're going to work, it would be working

8:19

by now. We still have symptoms, you're

8:21

still in distress, you're still bothered by it, but

8:24

you switch to another medication. We

8:26

get you up to that good dose. We have you

8:28

on it for a good enough chunk of time where

8:30

we know that if your symptoms were going to respond, then

8:32

they would have responded by now and you're still in distress

8:34

and you're still not. Well, Then

8:37

we categorize you into what

8:39

we call treatment resistant schizophrenia. That

8:41

little explanation was important because there's

8:43

a next medication that we use,

8:46

and if they move straight to Clozapine , then

8:48

they will tell you the changes that that makes.

8:50

But many of them will tell you, well, no, I tried this and

8:52

this and then this. And then this. And then this and then this. And

8:55

so that's one of the research pieces

8:57

for me. But the other research

8:59

piece for me is around what

9:02

that recovery looks like

9:05

for people. I always say psychiatry

9:08

is the unwanted step. Child

9:10

of medicine and schizophrenia

9:12

is the unwanted stepchild of psychiatry.

9:16

This is just a marginalized group

9:18

of individuals and the ones

9:21

who don't respond to treatment,

9:23

who have ongoing challenges,

9:25

whose illness impacts all those

9:28

areas of their life. That's where I

9:30

found myself both advocating

9:32

for and trying to understand and

9:34

seeing if there are ways that

9:36

I can use my skill set to

9:38

change the trajectory of

9:41

their lives.

9:42

Thank you for that explanation. And

9:44

when it does come to

9:46

the differences between men and women,

9:48

what are the differences in the outcomes

9:51

of treatment resistant schizophrenia?

9:53

The short answer is we

9:55

don't know. That's the short and scientific

9:58

answer. And so I work with

10:00

a few gurus in this schizophrenia

10:02

area. And when

10:05

I started to develop this interest

10:07

and move my energies more

10:10

into the area of women with severe

10:12

and persistent mental illness. And then we would sit

10:14

down and talk about just our general questions

10:16

that we asked in treatment resistant schizophrenia.

10:19

The number of occasions where

10:21

my mentor said to me, I

10:23

actually don't know what that difference looks

10:25

like. And then between men, I don't know actually

10:28

what those outcomes are for cause

10:30

of pain between men and women. I'm not actually

10:32

sure what that dose range

10:35

looks like or what the side effect profile

10:37

looks like. So there was a lot of we

10:39

don't know which on the one hand

10:42

is quite disappointing. But

10:44

for someone like me who's a researcher at the launch

10:46

of her career, it's very exciting. And forming

10:48

a nice scaffold of questions to ask

10:50

and answers to help, to be able to provide

10:52

people.

10:53

So the women we heard earlier

10:55

talked about her life unraveling.

10:58

Based on your experience as a clinician?

11:01

What is the impact of

11:03

having untreated psychosis?

11:06

Traditionally, we feel like women

11:09

with schizophrenia do better. There's a number

11:11

of papers that women tend

11:13

to do better with all different types of treatment,

11:15

and at the outset they look a bit better.

11:17

They are a bit more functional for some of those reasons

11:20

that we spoke about. But what

11:22

we're starting to realize now is that when you look

11:24

later on the first 1

11:26

to 3 years, sure, women

11:28

look better at five, ten,

11:30

15 years, or women with

11:33

schizophrenia actually don't

11:35

do well.

11:38

I can't help but wonder, is it

11:40

the role of estrogen, why

11:42

there is a delayed

11:45

diagnosis for women and potential

11:47

outcomes? Or you think it's

11:50

some societal views of

11:53

females?

11:54

Oh, can I choose both? Because

11:56

I'd like to choose both. So in

11:58

terms of the illness unveiling

12:00

itself and the time that it does

12:03

right now, the richest place to look

12:05

for that answer and we're focusing on estrogen

12:07

here comes in a basket

12:10

of other hormones. But estrogen

12:12

is the key one. And I harp on that

12:14

for a reason, because we know the childhood

12:17

psychosis or very young psychosis

12:19

is a very small group, but we don't

12:21

see a difference in age difference there.

12:23

So that helps us realize that

12:25

maybe there is this effect of estrogen

12:28

when it starts to come. And it's not even just

12:30

sustained estrogen, because as we know, as women

12:32

are cycles and the way that the

12:34

hormones have it is pulsatile. And so

12:37

it's not just a blanket disfiguration in

12:39

your skin and cream forever and you'll be okay, because

12:41

what happens indigenously within our bodies

12:43

is pulsatile. So, yes, I think

12:46

there is something there around that

12:48

protective effect of estrogen before

12:50

the brains that are vulnerable to schizophrenia develop

12:53

it.

12:53

But what about the societal piece,

12:56

including the views towards women

12:58

overall.

12:59

This societal piece, it's both good

13:02

and bad. And so we spoke a

13:04

bit about the stigma of the ways in which this

13:06

is just you being melodramatic. And so you don't

13:08

get this diagnosis of schizophrenia. You're probably

13:10

just a drama queen. But

13:12

also and this is key

13:14

for women, and I feel it particularly

13:17

as a racialized woman as well. We

13:19

don't stop. We have families,

13:21

we have work, we have partners,

13:24

we have aging parents. We don't

13:26

stop. We point to the needs of other

13:28

people before us and we get it

13:30

done. We could be bleeding on

13:32

the streets and we still get it done.

13:34

We still make the dinner for the children. We're still there

13:36

for our aging parents. We're going to this and we're doing

13:39

that. And so some of

13:41

that delay in

13:43

developing the illness allows

13:45

women to get to a place where they

13:47

then have those commitments

13:50

and relationships. And I see this

13:52

all the time. I have older

13:54

women coming in to the clinic or

13:57

into the emergency department and saying,

13:59

oh, well, they're like this. They said, 'Well, they were always

14:01

a bit weird or bizarre', or they always had

14:03

some of those thoughts. Or the women will say, 'Yeah, I've always

14:05

had those voices or whatever. And somehow

14:08

now that the kids have left the house, now that I'm divorced,

14:10

now that my parents have passed, then it takes

14:12

over' and then they stop. And so

14:15

that stigma and that societal

14:17

pressure and expectation and that role

14:19

that women feel in society,

14:22

it is profound. And it all,

14:24

I think, impacts the timing of

14:26

when the illness maybe overcomes people.

14:30

You're listening to Look Again: Mental Illness

14:32

Re-examined. A podcast brought to

14:34

you by the B.C. Schizophrenia Society

14:36

and B.C. Partner organizations. I'm

14:39

your host, Faydra Aldridge . This

14:42

podcast would not be possible without

14:44

the support of the community. From

14:46

the bottom of our hearts, we want to thank

14:48

you for caring about serious mental

14:50

illness and everything that's around it.

14:53

Together, we truly can make a difference.

14:58

We'll come back to Look Again: Mental

15:00

Illness Re-examined. I'm Faydra Aldridge and

15:03

I've been speaking to Dr. Chintoh

15:05

about the differences, similarities

15:07

and the issues women face when

15:10

diagnosed with a serious mental

15:12

illness like schizophrenia. So,

15:14

Dr. Chintoh, I've read

15:16

in the 1970s and the 1980s,

15:19

women were left out or

15:21

underrepresented in many

15:24

clinical trials of psychiatric

15:26

drugs, and that a lack of inclusion

15:28

in these studies has made obviously prescribing

15:31

the correct doses for drugs just that

15:33

much more difficult and may

15:35

put many women at greater risk

15:37

for negative side effects. So

15:40

there was a lot to unpack there.

15:42

As I mentioned, I've done

15:44

a number of years of post-secondary

15:46

education. I wrapped up my Ph.D.

15:49

in 2008

15:51

before I went off to medical school. And

15:53

the entirety of

15:56

the work that I did in

15:58

my Ph.D. was based

16:01

only on male

16:03

breast, because specifically

16:06

we didn't want the complications

16:08

of the estrus cycle. So

16:10

the seventies and the eighties are not that

16:12

far in the past. But 2008

16:15

and my lifetime is also not

16:17

that far in the past. And I share that story

16:20

because I think for people who don't

16:22

know science, that is real.

16:24

We like to be simple. We like to get quick

16:27

and easy answers. We don't want to complicate things.

16:29

That's how we do things in science. The conversation

16:31

now is around systemic racism.

16:34

And for me, it goes a little bit further than

16:36

that. Like God, like the ways in which the system

16:38

was built for us to create science. And I

16:41

just believed it and bought it

16:43

and organized my research

16:45

so that I wouldn't say, look, I am a

16:47

woman, 50% of people.

16:50

You know what I mean? And I didn't even

16:52

question it at that time. So

16:55

what's my response to that? Oh,

16:58

yeah. And now

17:00

that I am growing, I am progressing.

17:02

I am seeing people. I

17:04

am in a position where

17:07

I can now question what

17:09

is it? Because that's really

17:12

it. We're 2022 now, nut this

17:14

past few years have really helped

17:17

me understand is that you

17:19

now get to question all

17:21

of what is.

17:23

And I just love your energy and I

17:25

can feel your enthusiasm

17:27

coming in the microphone. So

17:29

what is the answer, Dr. Chintoh? What

17:31

can we do to make a change?

17:34

So we no longer just have male

17:36

rats in our clinical trials so

17:39

we can view women differently

17:41

and realize that there are differences

17:44

between men and women when it comes to

17:46

negative side effects of drugs, when it comes

17:49

to prescribing the correct doses.

17:50

Well, I know what I'm doing. I

17:52

am building a research program

17:55

that looks at all of these life

17:58

stages of women, specifically

18:01

in severe and persistent mental illness, because

18:03

that's where my heart lies. So I

18:05

can understand exactly that. So when you come

18:07

to me, Faydra, and you say I am

18:09

a 30 something or a 50 something or

18:11

a 70 something woman, and this is my experience,

18:14

I can now say, 'Okay,

18:16

well, you know what? This is what we see are the patterns

18:19

in women of your age with

18:21

your experience.' Because right now what I say

18:23

is 'This is what I see in the patterns of

18:25

this illness broadly.' And I know

18:27

that that research is based largely

18:30

solely on men.

18:32

I want to be able to fine tune

18:35

the care that I can give to you

18:37

and others based on your personal

18:39

features. You know, we talk a lot

18:41

about personalized health care, and

18:44

this for me is the piece. The

18:46

other piece and this is

18:48

a piece that I don't know that I can fix, that I hold

18:50

so dearly is that I want to

18:52

say our system is broken because it just makes it seem like

18:54

I'm pooh poohing everything, but our system is broken.

18:57

We need to catch our women at

18:59

stage one. So when women

19:01

say, actually, I think I might be

19:03

a bit off. Let's get them in then,

19:05

and let's cut it off at the pass so we don't end

19:07

up with severe and persistent

19:10

mental illness if we don't have to. What are the things that we

19:12

can do early on in the same way to

19:14

screen early, that we don't end up with kind of stage

19:16

four cancers? What we do it, how

19:18

our system is set up is only

19:20

for the sickest of the sick.

19:23

And in some ways, sure, because I am a psychiatrist,

19:25

I am a specialist. My service should be

19:28

reserved for the sickest of

19:30

the sick. And still there is nothing

19:32

else to catch everyone else.

19:34

And so when you ask what can we do to change?

19:37

We need to change the system. And

19:39

if it takes the plight of

19:41

women for people to look

19:43

at the system differently and say it's not

19:45

just working because people can't get care, it's

19:47

not working because it's based on a model that isn't

19:50

fit for care. That's what we

19:52

can do.

19:52

Absolutely. So as

19:54

a clinician and a researcher, what?

19:57

Do you think we can do to

20:00

get people early on

20:02

in the beginning stages of their journey?

20:05

This is my question. This is what I'm trying

20:07

to build right now, is to understand what are the

20:09

pieces? And my history

20:12

is psychopharmacology. I

20:14

love drugs. I love the brain.

20:16

I love how it impacts behavior. And that,

20:18

for me, was my answer to that problem. I'll

20:20

have the medication for you. And as I work

20:22

more and more people, I realize this

20:24

is much, much broader than that. And our medications,

20:27

while they are the cornerstone of our treatment,

20:30

are also limited. And so that's exactly

20:32

what I'm trying to figure out right now, is what

20:35

are the pieces? So if you are

20:37

now, I don't know, 18, 12,

20:39

16 coming into me

20:42

and your parent or your caregiver

20:44

or your sibling says something's not quite

20:46

right. What are the pieces that I need to

20:48

glean out of your history that make me say,

20:50

Actually, you know what? She's probably going to be okay.

20:53

Let's just watch and see or let's

20:55

keep a close eye on this woman or hey, let's

20:57

intervene right now. And what are those

20:59

interventions? That's exactly what I'm trying to build.

21:01

So the short answer is, I don't know,

21:04

but I'm trying to find out.

21:06

So based on your experience as a clinician,

21:08

what role does trauma play for women

21:11

versus men when it comes to diagnosing

21:13

and treating a mental illness?

21:16

That's a big one and it's a big

21:18

part of what we spoke about earlier,

21:21

making it easy to dismiss a woman's

21:23

concerns as melodrama or whatever.

21:25

I don't know if your listeners will know that we kind

21:27

of speak about in psychiatry, kind of the big

21:30

key trauma is versus the little

21:32

things or the big things would be child

21:34

abuse, sexual abuse, overt neglect.

21:37

Even smaller things, bullying, that

21:39

kind of thing. But all of those

21:41

traumas have an impact on

21:44

women. And we know, at least

21:46

in terms of what they report. Women

21:49

with psychosis, of course, those

21:51

things more often. And yet,

21:54

how well do we target our services to

21:56

help explore and process

21:59

and move past that

22:02

trauma? I mean, I work in the

22:04

largest mental health and addictions research

22:07

and clinical setting in Canada,

22:09

and you come to me video

22:12

and you go somewhere else through drama. And

22:15

how am I not integrating that? I'm

22:17

aware of it now. And so I spend some time with my patients.

22:19

And yet our model isn't one

22:22

that's always holistic to

22:24

treat the person in front of us. And

22:26

so I guess it does answer your question

22:28

because I think that it is important to recovery.

22:31

I don't know that I can change the traumas

22:33

that people have had, but I can definitely

22:35

have a hand in helping them navigate

22:37

it and come through it, not to forget

22:39

about it, not to pretend like it never happened,

22:41

but to help them grow through it and understand

22:45

the role that played in their lives and

22:47

to help them move through it and

22:50

hopefully past.

22:51

Now, you talked about the important role

22:53

that medications play. Let's

22:55

talk about the difference between men

22:57

and women when it comes to responding

23:00

to those medications.

23:01

That's a great question. So

23:04

some of the research will show you that women

23:06

do better. And so

23:08

the assumption is that they

23:11

respond better to the medications.

23:13

And there's some of the work that looks

23:16

at that and ties it into that

23:18

piece around the estrogen or the hormones, and that says

23:20

maybe, actually women do respond

23:23

better. A piece of that has

23:25

to do with the way some of our medications

23:28

are in our body. And so

23:30

women have more fat cells than

23:32

men. The medications can accumulate in fat

23:35

cells in men. And so it may

23:37

look like women are responding better, but it

23:39

could be that there's more of the medication

23:41

hanging around in the women than

23:43

men. But then there's that other piece

23:46

around. Actually, maybe

23:48

women aren't responding

23:51

better, but are doing

23:54

better. And that has to do

23:56

again with all of those pieces,

23:58

those societal pieces, those roles

24:00

that women feel that force

24:03

them to function despite their

24:05

symptoms.

24:06

And I'm going to end with a pretty

24:08

big question, Dr.

24:10

Shinto. What policy changes

24:13

at a societal level do

24:16

you think could make both

24:18

diagnosing and treating

24:21

women more equitable?

24:24

Oh, so for me,

24:26

it's around that piece about

24:29

mental health being

24:32

health. And

24:34

it speaks a bit to those feelings that

24:36

I have around the system being

24:38

broken. Again, we didn't create our system

24:40

in a way to give people the care that

24:43

they need. And

24:46

I realize to find a psychiatrist

24:48

is very difficult. There are few of us

24:50

and we are overrun and

24:53

does all of mental health care

24:55

need to be through psychiatrists?

24:58

Are there ways that our policies

25:00

can change to support other

25:03

mental health practitioners? So it's not

25:05

just those who can afford to pay

25:07

for psychotherapy, social work

25:09

and dementia and that kind of thing, or

25:11

you have to be completely downtrodden

25:14

and on the streets before you get there. Is

25:16

there a way that we can bridge those

25:18

gaps? I would like to see policy

25:21

changes that open our

25:23

eyes to the types of care that

25:25

people need and have

25:27

the services and support the services

25:29

to meet that.

25:31

Dr. Chintoh, I could talk to you for hours.

25:33

You are obviously extremely passionate

25:35

about what you do and truly making

25:37

a difference. So thank you for everything

25:40

that you do and for walking the journey

25:43

with every single person that you see

25:45

in their families that has a severe and

25:47

persistent mental illness. Thank you.

25:49

Well, I thank you. And I thank them for helping

25:51

me along my learning path.

25:53

And a huge thank you to you, our audience,

25:55

for joining us for this episode. Together,

25:58

we can change the narrative around

26:00

mental illnesses like schizophrenia and

26:02

end the many myths and the stereotypes

26:05

that we spoke about today. If

26:08

you have any questions or any comments,

26:10

tweet us @ BC Schizophrenia

26:12

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26:48

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27:01

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