0:00

I'm Joe Graydon. And I'm Terry

0:02

Graydon. Welcome to this podcast of

0:04

The People's Pharmacy. You can

0:07

find previous podcasts and more

0:09

information on a range of

0:11

health topics at peoplespharmacy.com. Severe

0:15

mental illness remains mysterious and hard

0:18

to treat. A leading

0:20

psychiatrist offers new insights on

0:22

prevention. This is

0:25

The People's Pharmacy with Terry and Joe

0:27

Graydon. Whenever

0:34

there's a mass shooting, politicians blame

0:37

the tragedy on mental illness. Providing

0:40

resources for treatment and support,

0:42

much less prevention, is rarely

0:44

a priority. What

0:46

can be done to help people with

0:48

schizophrenia? Our guest today is

0:51

one of the country's foremost experts in this

0:53

field. Closing state mental

0:55

facilities was supposed to improve conditions

0:57

for people with severe mental illness.

1:00

Too often, it left them homeless.

1:03

Coming up on The People's Pharmacy, learning

1:06

about the malady of the

1:08

mind. In

1:14

The People's Pharmacy health headlines, the

1:17

flu is back. Actually, it never

1:19

quite went away, but it did have a bit

1:21

of a dip over the last few weeks. The

1:24

CDC is now alert to an uptick

1:27

in positive flu tests, with

1:29

influenza A dominating. People

1:32

with flu have been showing up

1:34

in doctors' offices since November, and

1:36

currently, school-age kids are suffering more

1:38

than other age groups. On

1:40

the other hand, COVID cases appear to be

1:42

letting up slightly. Wastewater tracking

1:45

shows that virus levels are high,

1:47

but that's slightly better than it

1:49

was previously. The JN.1

1:51

variant now completely dominates, accounting

1:54

for 93% of sequenced

1:56

samples. When it comes to influenza,

1:58

H3N too is

2:01

increasing. This strain is often

2:03

more challenging than the H1N1 that was

2:05

predominant earlier

2:07

in the season. The CDC

2:09

anticipates that oral antiviral medicine

2:12

will continue to work against

2:14

common strains of blue virus.

2:17

A hard-to-treat fungal infection called

2:19

Candida auris is spreading around

2:21

the country. This fungus

2:24

has developed resistance to most

2:26

antifungal medicine. Once it

2:28

gets a foothold in a health

2:31

care facility, it's very difficult to

2:33

eradicate. The fungus can infect a

2:35

range of tissues including the ear,

2:37

the urinary tract, the skin and

2:39

the blood. People with

2:41

weakened immune systems are especially

2:43

vulnerable. Symptoms include fever, chills,

2:46

shortness of breath, cough, muscle

2:48

aches, fatigue and headache.

2:50

If that sounds a lot like

2:52

influenza, you're not wrong. Getting

2:54

an accurate diagnosis can be

2:56

challenging. There's good news

2:58

when it comes to a mysterious illness

3:00

that's been affecting children for about a

3:02

decade. Acute flexid myelitis

3:04

has polio-like symptoms, but it's

3:07

not caused by the polio

3:09

virus. Many children experience

3:11

a respiratory tract infection caused

3:14

by a specific enterovirus. Most

3:17

recover, but some are left with

3:19

paralyzed limbs. Epidemiologists have

3:21

noted that cases seem to increase

3:23

during the winter every other year.

3:26

It was expected to surge in

3:29

2022, but cases remained low. As

3:32

of this week, the CDC reports

3:34

15 confirmed cases in 2023.

3:36

That's far below the peaks that were seen

3:38

in 2014, 2016 and 2018. Terzepatide

3:47

has garnered a lot of

3:49

attention under its brand names,

3:51

Monjaro for diabetes and Zepbown

3:54

for weight loss. A

3:56

new clinical trial shows that the drug

3:58

also lowers blood pressure. In

4:01

this study, 600 heavy people took

4:03

the drug for nine months. They did

4:05

not have diabetes. The

4:07

study was originally designed by Eli Lilly

4:09

to investigate the ability of the medication

4:12

to help people lose weight. Researchers

4:15

already knew that people taking terzepatide have

4:17

lower blood pressure in the doctor's office.

4:20

This trial took it even further

4:22

and looked at continuous 24-hour blood

4:24

pressure measurement. People on

4:26

the drug had average systolic blood pressure

4:29

measurements. People on the drug

4:31

had average systolic blood pressures 7 to 10 points

4:33

lower than those on

4:36

placebo. Several

4:38

studies suggest that older people who want

4:40

to ward off cognitive decline in their

4:42

later years need to keep moving. A

4:45

new analysis of 104 controlled

4:47

trials confirms that continued

4:49

physical activity can help

4:51

prevent cognitive impairment, but

4:53

the effect is modest. More

4:56

than 300,000 people participated in

4:58

these studies, which showed that

5:00

global cognition, episodic memory, and

5:02

verbal fluency were better in

5:05

active individuals. Most of

5:07

these studies were of moderate or low quality.

5:10

Higher quality physical activity measurements and

5:12

higher follow-up rates were linked to

5:15

better results on cognitive tests. For

5:17

this outcome, more is better, at least up

5:19

to about 16 hours of

5:22

exercise a week. Humans

5:24

focused on football because of the

5:26

Super Bowl, but there is growing

5:28

concern that tackle football may affect

5:30

the structure and function of adolescent

5:32

brains. A study tracked over 200

5:35

young football players and 70 young

5:37

men who served as controls. The average

5:39

age? The

5:42

authors employed advanced neuroimaging techniques

5:44

that revealed critical thinning in

5:46

the frontal and occipital regions

5:48

in the football players, but

5:50

not the controls. The

5:52

brain areas affected are important for

5:54

mental health. And that's the

5:56

health news from the People's Fantasy this

5:59

week. Welcome

6:15

to the People's Pharmacy. I'm Joe

6:17

Graydon. And I'm Terry Graydon. Mental

6:20

illness is one of the great mysteries of

6:22

medicine. Although names and

6:24

theories have changed, schizophrenia has been

6:27

part of the human condition for

6:29

all of history. Because

6:31

this condition remains so mysterious, people

6:34

with schizophrenia have been met

6:37

with fear, stigma, isolation, and

6:39

mistreatment for centuries. That's

6:42

as true today as it was in

6:44

Joan of Arc's time. There

6:46

are a lot of myths and misconceptions about

6:48

mental illness. Many people

6:50

believe that psychosis is untreatable

6:53

and that the prognosis is bleak. But

6:56

does it have to be that way? Are

6:58

there effective therapies that can

7:00

help people with schizophrenia lead

7:03

satisfying lives? Could

7:05

our mental health resources be

7:07

utilized more effectively? To learn

7:09

more about this malady of

7:11

the mind, we are talking

7:13

with Dr. Jeffrey Lieberman. He's

7:15

professor of psychiatry and holds

7:17

the Constance and Steven Lieber

7:19

Chair at Columbia University in

7:21

the Vagelos College of Physicians

7:23

and Surgeons. His research

7:26

has advanced the treatment of mental

7:28

illness and led to the therapeutic

7:30

strategy of early detection and intervention

7:33

for schizophrenia. While

7:35

on the faculty of the University

7:37

of North Carolina at Chapel Hill,

7:39

he led the Cady study, the

7:41

largest study ever funded by the

7:44

National Institute of Mental Health comparing

7:46

the effectiveness of drug treatments for

7:48

schizophrenia. His research has been published

7:50

in over 800 scientific articles

7:52

and 20 books, including

7:55

Shrinks, The Untold Story

7:57

of Psychiatry, and His

7:59

Most recent, Malady of

8:01

the Mind, Schizophrenia and

8:03

the Path to Prevention.

8:07

Welcome back to The People's Pharmacy, Dr.

8:10

Jeffrey Lieberman. Hello.

8:12

It's good to be back

8:14

with you, Terry and Joe, and

8:17

to really our acquaintance, even though I'm now

8:19

in New York as opposed to in

8:21

the southern part of heaven, the UNC with you all.

8:24

Well, thank you. We're so happy to have you

8:26

with us today. Dr. Lieberman, schizophrenia,

8:31

it's been part of the human

8:33

condition from the very beginning of

8:35

recorded history. It's

8:38

been associated with fear

8:40

and stigma, isolation, mistreatment,

8:43

myths and misunderstandings.

8:46

I guess the best place to

8:48

start is what is

8:51

schizophrenia? Or perhaps I should

8:53

say, what are the schizophrenia,

8:55

as my old mentor, Dr.

8:58

Carl Pfeiffer, would say. Give

9:01

us a sense of what we're talking about today. Well,

9:04

schizophrenia, if you want to know

9:07

the truth, is kind

9:09

of demystifying the popular notions

9:12

that have been promulgated over throughout history

9:14

and by the media and the entertainment

9:18

industry. It's a brain disorder. It

9:21

tends to occur equally in

9:24

men and women. It has

9:26

its onset in adolescence

9:28

to young adulthood, 15 to 25 years.

9:33

It is pretty much consistent in

9:35

its population frequency around the world

9:37

and in different ethnicities and cultures,

9:41

and is characterized by a set

9:43

of symptoms which reflect

9:45

disturbances and thinking, delusions, false

9:48

beliefs, disorganization, false

9:51

perceptions, feeling paranoid,

9:55

having hallucinations, meaning hearing voices or

9:57

saying things that aren't there. and

10:01

having a lack of logic and

10:03

normal train of thought. My

10:06

conditioning is treatable, but if

10:08

it's not maintained in some

10:11

controlled maintenance, treatment, fashion, it

10:13

will recur. And over

10:16

time, if it recurs too many times or

10:18

it goes on too long, it

10:21

produces a deterioration of a person's

10:23

intellectual capacity, hence the original name

10:25

that was given to it in

10:27

the 19th century by M. L.

10:29

Preplin of

10:31

dementia precox. We know senile dementia, we

10:33

know Alzheimer's dementia. This means dementia

10:36

precox, meaning occurring not late in life,

10:38

but early in life. Now,

10:41

Dr. Lieberman, you mentioned that happens

10:44

around the world, that the rate

10:48

of schizophrenia, should we say, is

10:52

similar in many different

10:54

societies. How many people are

10:56

affected here in the U.S.? Well,

10:59

the population frequency, our

11:02

lifetime prevalence is 1%. So

11:05

if we have 300 million people and

11:09

300 plus million people, it's three million people. However,

11:13

the rate of schizophrenia,

11:15

which over time, at least

11:18

as best we can tell, has been fairly stable, is

11:21

actually rising. And one

11:23

of the reasons why that's the case, or

11:25

a prime reason that that's the case, is

11:29

the ubiquity,

11:32

courtesy of decriminalization,

11:34

legalization, commercialization of

11:37

recreational substances, particularly

11:39

cannabis, ketamine, and

11:42

possibly soon to be psychedelics as well.

11:44

So what this does, since

11:47

schizophrenia is caused by

11:50

a group of genes

11:52

that confer susceptibility to an

11:54

individual to develop it under

11:58

certain environmental conditions. or

12:00

stressful or in

12:02

other ways, the onset of the illness.

12:06

Pharmacologic substances can

12:08

trigger it also and among

12:11

those that are the most likely

12:14

to are EHC and these

12:16

more potent strains of commercialized cannabis,

12:19

stimulants like Adderall,

12:22

enchenamine and

12:24

also ketamine. You

12:28

know, it fascinates me as a

12:30

pharmacologist that there are medications that

12:32

can induce hallucinations

12:35

and you know, we think about

12:37

magic mushrooms for example, so the

12:39

siben or LSD and

12:42

even some antibiotics like

12:44

the fluoroquinolones, cipro and

12:47

levoquine and there was

12:49

a time in fact in the laboratory

12:51

that I worked at at the New

12:53

Jersey Neuropsychiatric Institute, they thought, oh well,

12:56

if LSD and these

12:59

hallucinogens can induce some

13:01

kind of hallucination, maybe

13:04

there's a similarity. We

13:06

no longer believe that, do we? Well,

13:09

yes, we don't believe it anymore but

13:12

we learned it the hard way. We

13:14

had to just prove it because it

13:16

was a perfectly valid hypothesis in theory.

13:19

The idea of an endogenous

13:22

psychotogen in fact

13:24

and you're showing

13:27

your prior

13:29

lived experience in neuropsychopharmacology

13:32

and laboratory experience, I'm

13:35

going to disclose about

13:37

my experience, lived experience

13:39

with being a child

13:41

of the 60s with psychedelics. So

13:43

being a good Jewish boy, I guess I was

13:45

always destined to be a doctor but I'm

13:48

necessarily a psychiatrist but

13:50

when I was in college in

13:52

the late 60s, counterculture

13:55

and use recreational substances and

13:58

when I experimented

14:01

with hallucinogens or micrograms

14:07

of a tiny concentration

14:10

of a substance could so profoundly

14:12

change your state of mind. And

14:15

that gave rise to the idea

14:17

of there may be an inward

14:19

error of metabolism that was producing

14:21

a psychontogen that was causing it. But

14:24

the experiment that disproved it, and some

14:26

of your mentors were among the proponents

14:29

of this theory, but what

14:31

disproved this finally was a study that

14:34

was done at the NIH

14:37

where they reasoned that if

14:39

there is a endogenous psychontogen that's

14:41

being produced, apparently, let's

14:44

subject the people, the

14:46

patients, to hemodialysis and

14:49

try and filter it out. And

14:52

they did so in a double-blind study,

14:54

the Sham Heimberdialysis and Reolimiter, and did

14:56

an endel effect. So

14:59

that was disproven. But

15:01

it's given way to essentially an understanding

15:03

of the illness, having

15:06

a pathophysiology, meaning

15:08

pathology that causes the expression of

15:10

the symptoms, to be a neurochemical

15:12

basis. That's not the etiology

15:15

cause, but that's the pathology

15:17

that causes the illness to

15:19

express itself synchronically. So it

15:22

wasn't as simple as we originally thought, but it

15:25

pointed in the right direction than something

15:27

neurochemical. Dr. Lieberman,

15:29

in your new book, Malady of

15:31

the Mind, you describe

15:34

a number of myths

15:36

and misconceptions that people

15:38

have about schizophrenia. And

15:40

maybe in the next couple of minutes, we

15:42

could just mention a few and shoot them

15:44

down. Gladly.

15:47

Gladly, because, you know,

15:50

schizophrenia is really the nape-loose

15:53

ultra or flagship or poster

15:55

child for mental illness. If

15:58

you talk to the layperson... and you

16:01

ask them what is insanity that

16:06

they described as somebody who

16:08

has schizophrenia or you see a person on

16:11

the street shouting at no one

16:13

in particular, standing barefoot in the freezing

16:15

cold past schizophrenia or

16:18

you see a movie like Shutter Island or

16:23

something that they depict some serial killer

16:27

or some individual that's scary

16:30

so it's really what the public has in

16:32

mind and fears most about

16:34

it but at the

16:36

same time it gets trivialized how if

16:38

somebody has

16:41

what they call a split

16:43

personality they're act differently they're erratic in

16:45

their behavior you say oh that's schizophrenic

16:48

or if somebody holds two ideas

16:50

that are contradictory in mind

16:53

simultaneously that's the weather

16:55

is schizophrenic because it's changing from one

16:57

day to the next or my favorite

16:59

illusion is a flat

17:02

earth society we have chapters around about how we

17:04

have chapters of it around the world all around

17:06

the globe so and

17:09

then the worst one I think is that

17:11

schizophrenia is not at NILSS

17:14

it's an exalted state of

17:16

creativity where individuals just think

17:19

differently than the rest of us they

17:21

don't adhere to convention

17:23

and the proprusting ways of

17:26

viewing the world and societal

17:28

reality these are

17:30

all wrong it's a brain disease

17:33

which disrupts the highest

17:35

mentative functions of

17:38

Homo sapiens that's

17:41

why partly why it's been hard so hard to figure

17:43

out because it's basically affecting the

17:45

parts of the brain and of the

17:47

most highly evolved and they're uniquely human

17:50

you're listening to dr. Jeffrey Lieberman

17:52

professor and Constance and Stephen Lieber

17:55

chair in psychiatry at

17:57

Columbia University's Vagellus College

18:00

of physicians and surgeons. Dr.

18:02

Lieberman's most recent book is

18:05

Malady of the Mind, Schizophrenia and

18:07

the Path to Prevention. After

18:09

the break, learn how schizophrenia is

18:12

treated today. Is the

18:14

prognosis still as bleak as before? What

18:16

are the barriers to getting a diagnosis in

18:19

a timely fashion? Why

18:21

is early diagnosis and treatment

18:23

so important? You'll hear how

18:25

innovative, coordinated treatment can make

18:28

it worse. You're

18:39

listening to The People's Pharmacy with Joe

18:42

and Terry Graden. This

18:44

podcast is made possible in part by Coco

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20:24

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20:51

was a time when people with

20:53

severe mental illness were placed in

20:56

facilities designed to keep them safe

20:58

and separated from society. Deinstitutionalization

21:01

from state mental hospitals

21:04

began in the 1950s

21:07

with good motives, but too

21:09

often resulted in homelessness and

21:11

lack of services. To

21:13

find out what went wrong,

21:16

we're talking with Dr. Jeffrey

21:18

Lieberman, professor and Constance and

21:20

Stephen Lieber Chair in Psychiatry

21:22

at Columbia University's Vajulos College

21:24

of Physicians and Surgeons. Dr.

21:27

Lieberman's latest book is Malady

21:29

of the Mind, Schizophrenia

21:32

and the Path to Prevention. Dr.

21:36

Lieberman, I'd like to share

21:38

a somewhat personal story. It

21:41

actually involved my mother. My

21:44

mother was abandoned by

21:47

her biological mother, and

21:51

her father remarried, and

21:53

her stepmother was

21:56

pretty clearly schizophrenic. She tied a little...

22:00

bows of ribbon all around the

22:02

house to protect

22:05

her and the family from some

22:09

strange force, some alien force, maybe

22:11

even from outer space. This would

22:14

have been in the very early

22:16

20th century. She locked

22:18

my mother occasionally in the attic, she

22:20

cut up her clothes, she made my

22:22

mother's life a living hell.

22:25

She would play the piano for

22:27

sometimes days on end without stopping,

22:29

without making food for the family,

22:32

and she

22:34

ended up in a mental institution in

22:36

Pennsylvania. I think

22:38

a lot of people believe that

22:41

schizophrenia, psychosis, mental illness,

22:44

whatever we want to call it, can't

22:47

be treated successfully, that

22:49

it has a very

22:51

bleak prognosis. That

22:53

certainly was true of her stepmother.

22:56

But what about today? If we

22:59

fast forward to now the 21st

23:01

century, is it still a bleak

23:03

prognosis? It

23:06

is absolutely not, and that is

23:09

reading the central points of my

23:11

book that you've been alluding

23:13

to, which is that there

23:16

are treatments, they do work, and

23:18

they can enable people who are affected

23:21

to lean reasonably, if

23:23

not completely, normal lives if they're

23:25

administered in a timely, appropriate

23:28

fashion. The problem was that,

23:30

let me put it

23:32

in a historical context, Joe, up

23:36

until the middle of the 20th

23:38

century, even though we'd

23:40

identified it as a disease, well, I

23:42

mean, the history was, and this alludes

23:45

really to Susan Sontag's great book

23:47

on illnesses metaphor, where she

23:49

talks about how a society, which

23:51

lacks knowledge about something, in this

23:53

case, a disease, refracts it through

23:56

its own culture. And in

23:59

the ancient times, the culture was,

24:01

it must be supernatural affliction of

24:03

either sainthood or demonizing. In

24:06

the Middle Ages, there was

24:08

religious deviance, heresy, moral deviance.

24:11

Post-Enlightenment, these were considered

24:13

natural conditions, but nobody

24:15

had any idea what the basis

24:17

of it was, much less having treated. It

24:20

was only in the middle part of the 20th

24:22

century, 1950s onward,

24:25

that we had any type of scientific

24:27

inkling as to what caused

24:31

schizophrenia. And

24:33

unfortunately, the thinking

24:37

up until then had to do

24:39

with preposterous notions like the

24:43

psychoanalytic view of the schizophrenogenic

24:45

mother, who was the cause

24:48

of somebody becoming schizophrenic, or

24:50

the Orgo theory of schizophrenia.

24:55

So these were preposterous theories,

24:58

and it was replaced initially

25:01

by genetic evidence,

25:04

which was apogemiologic genetic

25:06

evidence, which was

25:08

very consistent and conclusive that if

25:11

you had a person with schizophrenia

25:13

in your family, then

25:16

the other members in your family had

25:18

a higher rate of schizophrenia than

25:20

in the general population, if there's no

25:22

one. So this led to

25:24

the notion of doomed from the womb,

25:28

and that there was an inexorable decline

25:30

that would occur and nothing could be

25:32

done to really halt it. But

25:36

over time, and particularly in the 1980s

25:39

and 1990s, studies

25:41

were done which disproved that,

25:43

that if you identified people

25:46

who were developing the symptoms of the

25:48

illness, again, in adolescence or

25:50

young adulthood, you treated them

25:53

promptly and properly,

25:55

they recovered. They had a

25:58

symptomatic remission. However, If

26:01

you then discontinue the medication

26:03

as many people of those

26:05

ages want to do, because they think it's a

26:07

one and done problem, they

26:09

had recurrence. And as

26:12

they had multiple recurrences, like

26:14

little mini brain insults, at

26:17

some point they didn't recover as well as

26:19

they did initially. So the

26:21

answer to your question is that there

26:23

are treatments, they're just not administered and

26:25

made available to people. Well,

26:28

Dr. Lieberman, it sounds as though the very first

26:31

step is a timely diagnosis.

26:33

And can you tell us how that

26:36

diagnosis is made and what

26:38

are the barriers to people getting an

26:40

appropriate diagnosis at the right time?

26:44

Yeah, that's an excellent question. And that

26:46

gets back to Joe's experience

26:48

with Carl Pfeiffer and

26:50

schizophrenia. I sort

26:55

of take umbrage at the notion of

26:57

the schizophrenia because to say

26:59

that it's heterogeneous, there's different forms of

27:01

it. It's a little bit of

27:04

a cop-out when your data don't match up

27:06

what you expect to happen. I

27:09

call it really a process

27:11

of peeling the onion. What

27:14

I mean by that is every illness

27:17

that's in the ICD and

27:20

known to medicine was

27:23

identified and began to be reigned and

27:25

characterized in the same way. In

27:28

ancient times, epilepsy was

27:30

falling sickness. Congestive

27:32

heart failure was dropsy because the

27:35

fluid wasn't

27:37

being pumped through your veins was

27:39

accumulating in your ankles. Diabetes

27:42

was determined as to mellitus

27:44

or insipidus if it was

27:46

water-retasted watery. The irritated watery

27:48

was sweet. But

27:51

then we got an EKG. We

27:53

got laboratory tests to measure hemoglobin A1C.

27:56

We got an EKG to manage the seizures. illnesses

28:00

in schizophrenia in particular, we're

28:02

still at that descriptive phenylologic

28:04

level. And

28:07

as a result of that, there is over-inclusion

28:10

of what I call genocopies,

28:13

phenocopies, or facsimiles. So

28:16

diagnosis, particularly at the beginning

28:18

of the illness, first episode,

28:21

is a critical thing in order

28:23

to rule out these form fruits, these

28:26

things that look like it, but

28:28

aren't being it. So

28:30

I can go through an algorithm for you,

28:32

but I don't want to do that. It's

28:35

just prolonging the answer to this question. Well,

28:39

I think one of

28:41

the important elements in your book discusses

28:45

how essential it is

28:47

to get an early diagnosis and

28:50

early treatment because it can

28:52

reduce the damage to the

28:54

brain and speed recovery. I

28:56

wonder if you could reinforce

28:59

why that's so important. Well,

29:02

that's really a key element, and actually

29:04

it means that the

29:06

fact that there's a window in time when

29:09

the illness occurs should

29:12

make it a prime

29:14

target for preventive intervention

29:16

that we're not adequately taking advantage

29:19

of. So

29:21

pre-pupital, so schizophrenia

29:23

in its

29:28

original form is a polygenic

29:32

brain disorder, meaning that

29:34

single gene is multiple

29:36

genes conferring susceptibility for

29:38

certain neural circuits to go off and

29:42

malfunction, malfunction, and

29:44

certain points in life under

29:46

certain environmental pressures. So

29:49

you're born with a liability, but it doesn't mean you're

29:51

definitely going to have it, and

29:54

it rarely occurs before puberty. Childhood

29:57

on schizophrenia is rare. after

30:00

puberty for various maturational

30:02

reasons. And

30:05

when it does, it

30:07

begins in an iterative or

30:09

gradual fashion. Now, what

30:12

complicates the identification of this

30:14

is pathologic and

30:16

would warrant or justify treatment

30:18

is that it's occurring when

30:20

very adolescents, when young

30:24

people are going through

30:26

changes, not just secondary sex correctness,

30:28

but seeking identity who they

30:30

are, trying to establish independence,

30:33

going out into a world where they have

30:36

to assume greater responsibility, going to college where

30:38

they're separated from home at the first time.

30:41

And so the initial

30:43

prodrolal or early warning

30:45

signs are often nonspecific,

30:48

heritability, change in interest,

30:52

change in their sleep habits. So

30:54

those are difficult to

30:56

pin diagnosis on. But

30:59

when there is an index of

31:01

suspicion that warrants the

31:04

introduction of treatment, it's

31:06

important to introduce that as soon as

31:08

possible because what we've learned is that

31:11

the brain cannot withstand a persistent

31:14

state of neurochemical

31:16

dysregulation that's causing

31:18

psychosis or repeated episodes of

31:20

it without incurring some

31:23

damage. Tell us

31:25

a bit about treatment, if you would, please. And

31:28

especially about your mantra about

31:30

innovative and, and I want

31:32

to emphasize this word, coordinated,

31:36

coordinated treatment. Well,

31:38

the first effective treatment in

31:41

the history of humankind for

31:43

schizophrenia was when we're antipsychotic

31:46

medications, medications that acted

31:48

on the dopamine system to block

31:51

overstimulation of these receptors.

31:54

And that led in the

31:56

1950s to a policy of

31:59

deinstitutionalization which opened the

32:01

doors to state mental hospitals, which would

32:03

become unfortunately snake pits. It

32:06

may have been well-intended, but it

32:08

overestimated the therapeutic effects

32:10

of medication. And

32:13

what was learned painfully through

32:16

understanding the limitations of

32:18

the institutionalization was that what

32:21

was required is an approach

32:23

that can be called disease

32:25

management or in the

32:27

way it's applied to schizophrenia-coordinated specialty

32:30

care, meaning that when

32:32

you have a stroke or you break a

32:34

leg, you need

32:36

not just to have the angioplasm, I

32:38

mean the lysing of the blunt clot

32:40

or the repairing of the broken

32:43

boat, but then you need to see a physical

32:45

therapist and you need to gradually work your way

32:47

back. There

32:49

needs to be a coordinated approach with

32:51

people with schizophrenia because having a psychotic

32:53

episode, which is all marked with

32:55

the onset of the illness, is like having a brain

32:57

attack. And medication will

32:59

suppress the psychotic symptoms,

33:02

the disturbances in your thinking and your

33:04

perception, but your brain

33:06

still cognitively is not back in shape

33:08

to getting the game, to go back

33:11

to college, to resume a job, to

33:13

resume your social life. And

33:16

so there needs to be coordinated services

33:18

such as having somebody

33:20

who's like a case manager that helps you sort

33:22

of navigate when you make an appointment to see

33:25

a doctor, when can you sort

33:27

of resume going back to school. There's

33:30

services called supported education

33:32

and supported employment, meaning

33:34

somebody who's your advocate in

33:36

being able to help your

33:39

educational program or your

33:42

vocational activity understand

33:44

you're coming back after having had

33:46

some infirmity and giving you

33:48

this type of understanding so that you're able

33:51

to, until

33:53

you regain all of your cognitive capacities, you

33:55

may be missing a couple

33:57

days or performing sort of sub-optimally. There's

34:00

a tendency for people to use

34:03

recreational substances to self-medicate. So

34:05

there needs to be that monitoring. Now

34:08

Dr. Liebron, I want to

34:11

interrupt you if I

34:13

may because you referred

34:15

briefly to deinstitutionalization. And

34:19

I really would like to go back and

34:21

touch on that for a minute because you've

34:23

just talked about all the support that

34:26

someone who is experiencing

34:28

mental illness needs in

34:30

order to be able to function. Well

34:34

literally thousands, tens of thousands, hundreds

34:36

of thousands of people were let

34:38

out of mental

34:41

institutions and many

34:43

of them ended up on the street. And

34:45

they're still not those very people from the

34:47

70s and 80s. But

34:50

there are literally hundreds of thousands

34:52

of people on the street today

34:55

with mental illness or

34:57

in prisons. So that

34:59

whole experiment of deinstitutionalization

35:02

was a massive failure.

35:05

Absolutely. And the great

35:08

late Senator Daniel Patrick Moynihan called

35:10

it out in a series of hearings

35:12

that he held on this, on

35:15

how it was really a misguided

35:17

policy that you know, dressed itself

35:20

up as well-intentioned but

35:23

there's no question about it. The

35:26

zenith of inpatients in

35:28

state mental hospitals in 1955 was 550,000 people.

35:34

It's now less than 30,000 people

35:36

nationwide. And it

35:39

was a displacement from there to largely

35:42

as you point out the streets, the

35:44

prisons and nursing homes. And

35:47

the idea is you can let these people out, they

35:49

should be fine, their families should come to support them.

35:52

It never happened and we're paying the

35:54

price of it still. It

35:56

seems as though the plan was

35:58

that... that there would

36:00

be something

36:03

in place, community centers or something

36:05

else that would provide the support

36:07

that people need. And of course,

36:09

that would have required spending.

36:11

It would have required

36:13

planning. And none of that happened

36:16

at all. Well, you

36:18

just, Terry, you had on the

36:21

slight of hand that occurred at state

36:23

legislative levels, which is that

36:26

originally there was a estimation

36:29

of the number of community mental health

36:31

centers that needed to be established to

36:33

sort of pick up the slack and

36:35

support people after they were discharged

36:38

from the hospital. And as Senator

36:40

Moynihan points out, it was a

36:44

little more than a third of

36:46

those that were intended to be

36:48

established that were actually established

36:51

and resourced. So this was

36:53

grossly underfunded, under-established,

36:56

and God knows where their money that

36:59

was supposed to be used for that

37:01

went. And it still hasn't

37:03

shown up for that matter. And this

37:05

is really probably the unkindest

37:07

and most fool realization of all

37:12

if one really drills down to this. And

37:16

one hand you could say that there was a

37:18

scientific, I would say,

37:21

delay in coming to

37:24

reckon with what schizophrenia was

37:26

ever developing in treatments,

37:29

like pharmacologic treatments.

37:31

On the other hand, the policy and

37:34

the legislative side of things

37:36

made things much

37:39

worse and continues to be the laggard

37:41

here. Because treatments

37:44

do exist. They don't exist. They

37:46

could be applied. They would be game-changing.

37:49

But they simply don't exist. You

37:52

can be the wealthiest, the best connected, the

37:54

smartest family. And if you have a kid

37:56

that's struck with this, you

37:59

have to go find it yourself. yourself

38:01

and piece it together because it doesn't

38:03

exist and is fully formed. It's

38:05

like if you have breast cancer and

38:07

you go to your doctor and they say you

38:09

need a lumpectomy and you need

38:11

radiation and chemotherapy, but we can

38:13

only do the lumpectomy. That's

38:16

the situation resembling schizophrenia. You're

38:19

listening to Dr. Jeffrey Lieberman,

38:21

professor and Constance and Steven

38:23

Lieber Chair in Psychiatry at

38:26

Columbia University's Vagelos College of

38:28

Physicians and Surgeons. His

38:31

most recent book is Malady of

38:33

the Mind, Schizophrenia and the Path

38:35

to Prevention. After the

38:37

break, we'll talk about the

38:39

intersection of mental illness and

38:42

violence. Although politicians may think

38:44

otherwise, the mentally ill are more

38:46

likely to be victims than perpetrators

38:49

of violence. Dr. Lieberman will

38:51

share his five-pronged approach to

38:53

treatment. We'll also talk about

38:55

the tricky task of prevention. How

38:57

can we create safe places

39:00

for those with mental illness?

39:09

You're listening to The People's Pharmacy with

39:11

Joe and Terry Graydon. This

39:14

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41:17

Welcome back to the People's Pharmacy

41:19

I'm Joe Graydon and I'm

41:21

Terry Graydon the People's Pharmacy

41:23

is made possible in part

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41:47

If people with schizophrenia don't get

41:49

adequate treatment or support they find

41:52

it difficult to cope. Have

41:54

we abandoned the mentally ill?

41:57

What should a caring society? do

42:00

for those who can't take care of

42:02

themselves. Our guest is Dr.

42:04

Jeffrey Lieberman, professor and Constance

42:07

and Steven Lieber Chair in

42:09

Psychiatry at Columbia University's Vagelos

42:12

College of Physicians and Surgeons.

42:15

His most recent book is

42:17

Malady of the Mind, Schizophrenia

42:19

and the Path to Prevention.

42:23

Dr. Lieberman, continuing that conversation

42:25

about how we have failed

42:29

families and people

42:31

with mental illness, it seems like

42:33

whenever there is a tragedy, whenever

42:35

there is a violent

42:39

act, we

42:41

hear from the politicians, oh,

42:43

it's a mental health problem.

42:45

It's mental illness, and

42:47

that's how we should solve it, but then

42:49

they never do. They never put the money

42:51

into it. And I just want to get

42:54

one thing clear that a

42:56

lot of the violence that has occurred

42:58

over the last several decades is

43:01

directed at patients with

43:04

schizophrenia rather than from

43:06

patients with schizophrenia. Yes,

43:08

there are sometimes

43:10

terrible acts, but they are most often

43:13

the victims. Well, you're

43:15

touching on a nerve of the mental

43:17

health advocacy community because they really are

43:23

offended when

43:25

there's some mass violent

43:27

incident and politicians

43:29

and pundits say it's a mental

43:31

health problem. And they

43:33

will say, which is true, that if

43:35

you take all violent crime in the United States, only

43:38

4% of it involves people, I

43:40

mean, as perpetrators, that

43:43

a little supposed to be assumed, gang

43:45

violence, mobs, greed, robbery, things of that

43:47

sort. But if

43:49

you look at mass violence, and people

43:51

who are mentally ill are,

43:53

as you point out, very

43:55

susceptible victims of

43:58

this kind of crime. However,

44:00

if you look at mass violence,

44:02

which is defined as three or

44:04

more people, generally strangers, no discernible

44:07

motivation necessary, there's

44:10

an over-representation of people

44:12

with mental illness, almost

44:15

predominantly schizophrenia,

44:18

and almost always

44:20

untreated. And the

44:22

rate of perpetrators is 30 to

44:25

40 percent, the mass violence

44:28

incidents that occur, and they have

44:30

three categories and perpetrators. They

44:32

have ideological zealots. They

44:36

have disaffected loners. And

44:38

they have untreated people with mental illness who

44:40

are being impelled by their symptoms to

44:43

do these things. And the

44:46

reality is that this

44:48

could be stopped if people would

44:51

be treated. But the

44:53

problem is we run into another

44:55

policy or legislative issue that got

44:57

it wrong, which is

44:59

that if somebody is

45:02

ill, they don't think they're ill,

45:04

which is often the case because the organ

45:06

that makes these decisions about whether you're sick

45:08

or not is the brain. And in this

45:10

case, the brain is the organ that's affected.

45:13

They don't think they're ill. They don't think they need treatment.

45:16

And treatment can't be imposed over

45:18

objection unless there's

45:21

signs that they're imminently dangerous to self

45:23

or others. And that

45:25

can be hard to pick up. Well,

45:28

it's basically waiting until

45:30

after something happens. I

45:32

mean, people are not coming in saying, I'm going to

45:34

kill somebody. You have to make

45:36

inferences. But a law

45:38

was changed in 1970, from what it used to be. There

45:44

was a principle called parents' patriere, which

45:46

meant that as citizens of the country

45:49

were not able to care for themselves

45:51

or exercise best judgments that the

45:53

government, the state, could act as their

45:56

parent. However, the

45:58

problem was that there was a lot of gang. translating

46:00

what was going on where people

46:03

would try and Prolocate

46:05

stories to get their relative

46:08

Institutions this was changed

46:11

in 1970 to imminent

46:13

danger and as a result People

46:16

who are above the age of 18

46:19

even if they're wholly dependent on their families

46:21

financially and every other way But

46:23

won't accept treatment It

46:25

can't be a post of them and a

46:27

very small percentage of them can turn violent

46:31

Dr. Lieberman, let's talk about

46:33

treatment if we can please You

46:35

you describe a five-pronged

46:38

approach to treatment

46:40

in malady of the mind And

46:43

I'm hoping that you'll be able to

46:45

tell us what those five prongs

46:47

are and why each of them is

46:49

important Well, I

46:52

can even boil it down to the

46:54

three essential treatments So

46:57

one is medication medication

46:59

is like

47:01

insulin for diabetes and It

47:05

has to be administered in a

47:07

judicious way meaning the

47:09

right medication at the right dose

47:12

in a tolerable fashion the

47:15

second is social services

47:18

as disease management there needs to be

47:20

more than just a prescription and It

47:23

needs to be attentive to how to put the

47:25

person's life back together, which means

47:28

positive remediation Enabling

47:31

person to relearn social skills

47:33

if necessary to help

47:35

them get back into their educational as well

47:38

or back into a job prospect and

47:40

someone to act as a case manager They

47:45

don't have a family member one of the

47:47

things that's happened in our country is that

47:50

families dissociate themselves from a person

47:52

who develops schizophrenia For

47:54

a variety of reasons and they

47:57

do become wards in the state. So these

47:59

treatments they do incorporate that. But

48:01

the third thing is, and this is

48:04

really interesting, and this

48:06

is depicted in a number of ways

48:08

including in Sylvain Astell's great book, A

48:10

Beautiful Mind, nothing

48:12

is more important than an

48:14

individual who is impaired with

48:16

this illness having a consistent,

48:20

supported, significant

48:22

other that they can

48:24

rely on and develop trust in. And

48:27

there's numerous examples of

48:30

this. John Nash is one of

48:32

them. Ellen Sachs in

48:34

her book, Shutter Can't Hold, describes

48:37

her husband Will. And in

48:40

an afterward that's just being added to

48:42

the paperback edition to my book, I

48:45

have a nice segment about Fred

48:47

and Penny Fries, a remarkable

48:51

individual who,

48:53

if not for her, would

48:56

have probably languished either on

48:58

the streets or in the back wards in some

49:00

mental hospital. So, medication,

49:03

psychosocial services and

49:06

a significant other that

49:09

can be consistently relied upon. Dr.

49:12

Lieberman, you talk about medications

49:15

and I certainly remember watching

49:20

patients on phenothiazines, the

49:22

earliest class of antipsychotic

49:25

drugs, Thorazine,

49:27

chloropromazine, Haldol,

49:29

Haloperidol. And

49:31

they had a lot of side effects

49:33

and a lot of patients were jerking

49:35

and had something called Tardive Dyskinesia. And

49:38

then along came the atypicals, Abilify

49:41

being just one example, Cyprexa being

49:43

another. And I think a lot

49:45

of your colleagues thought, oh, they

49:48

don't have any side effects. Well,

49:50

they too have side effects. And

49:53

I am fascinated with what you

49:55

wrote about a drug called Clozapine

49:58

because early in the development of the drug, development

50:00

of Clozapine, we got messages

50:02

from people who said that

50:04

drug changed our

50:08

relative, our child's life. People

50:12

contacted us and said, Clozapine,

50:14

it's amazing. Yet

50:16

Clozapine has sort of disappeared. Yes,

50:19

it has some potential problems,

50:21

some blood problems that can be

50:24

monitored. Why do you think

50:27

Clozapine hasn't gotten the respect that

50:29

I think it deserves? The

50:33

answer is embarrassing and shameful. Clozapine

50:37

is a unique... So

50:39

the antipsychotic drugs overall

50:42

have more in common

50:44

and they do differences. Most

50:46

of the differences have to do with side effects, not

50:48

efficacy. Clozapine is exceptional.

50:51

It's been proven categorically that

50:54

it has superior antipsychotic

50:57

efficacy in

50:59

individuals who have

51:01

proven not to be sufficiently responsive

51:04

to other medicines. But

51:06

as you point out, it also has

51:09

some side effects that are

51:11

truly problematic, a

51:13

blood dysprazia and

51:15

ground cytosis, potential for

51:18

myocarditis. As

51:21

a result, people have to have blood tests

51:23

done on their patients to monitor their white

51:25

blood count. That's no excuse

51:27

though. It's used vastly

51:30

less than it should be. And

51:33

the only thing that reason

51:36

that it isn't used more is

51:39

either patients aren't sufficiently

51:41

informed as to what

51:43

the benefits of it are or

51:45

doctors just find it to be too much of

51:48

a hassle or too much of a risk. And

51:51

that simply is unacceptable

51:53

because far less people are getting it

51:56

and really should be receiving it. Lieberman,

52:00

I'd also like to ask you about

52:02

prevention because you do suggest in Malady

52:05

of the Mind that prevention

52:07

is possible and certainly would

52:09

be desirable. Can

52:11

you describe for us please how

52:14

we would go about preventing

52:17

schizophrenia? Do we have a

52:19

good enough idea of who

52:21

requires intervention? Yes, yes,

52:24

Terry. I'd love to answer that but I'm gonna

52:26

go back to the point that Joe was making

52:28

just quickly because I wanted to make

52:31

this clear also. Every medication

52:33

for every disease goes

52:35

through a process and refinement. When

52:38

you look at cancer, the early

52:40

treatments for cancer, the chemotherapies,

52:43

literally were true, gave

52:47

truth to the notion that treatment

52:49

was worse than the illness. And when

52:51

you look at some of the early surgical procedures

52:54

that were done for cancer,

52:57

breast cancer, mastectomies, Johns Hopkins

53:00

that were deforming of people. So there's

53:03

an overshoot that often occurs when prototypes

53:05

and treatments occur and then they get

53:07

refined back to ones

53:09

that are more tolerable, possibly

53:12

more effective. And that's what's happened

53:14

with anti-psychotic drugs. And with anti-psychotic

53:16

drugs, there are

53:19

so many of them now, there's like 30

53:21

that are commercially available. It's a

53:23

matter of finding one that is

53:25

effective and is tolerable

53:27

and working with adjusting the dosage

53:30

of the minimally tolerated, the effective

53:32

dose. So it

53:34

requires some work but I don't buy it

53:36

when people say I can't take it, I'm

53:39

allergic to it. That's absolutely unwarranted. Now

53:42

in terms of prevention, there's

53:45

three categories by which prevention

53:47

can be defined. The

53:49

best is primary prevention, meaning, oh,

53:52

somebody has a gene for

53:54

cystic fibrosis or

53:56

for Huntington's disease. Let's

53:58

do some gene. editing and

54:00

remove that will prevent the onset.

54:04

Then there's secondary prevention. Secondary

54:06

prevention is when somebody begins to show

54:09

symptoms of the illness but

54:11

a treatment is introduced which

54:13

prevents its onset

54:16

or its progression. And

54:19

in the world of Alzheimer's disease

54:21

or neurodegenerative diseases, we

54:24

call those treatments disease modifying

54:26

treatments. So for

54:28

Alzheimer's disease, we have treatments like

54:30

a If

54:58

there's sufficient manifestations in their

55:00

behavior, their history, perhaps

55:02

their family history, that

55:05

this could be the early

55:07

warning signs, the beginning of the onset

55:09

of schizophrenia that intervention

55:12

then can

55:14

interdict the illness, prevent

55:18

possibly the full-blown onset in terms

55:20

of this endurable diagnosis. And

55:23

then if it's sustained,

55:26

meaning the suppression of symptoms,

55:28

the remission of the

55:31

onset of the illness, they can

55:33

prevent any recurrence over the course of their

55:36

lifetime and lead a life as if they

55:38

never would have had it. That's

55:41

an experiment that hasn't been

55:43

definitively conducted

55:45

and proven. It

55:47

is my, based on my experience with

55:50

treating patients at the early stage of

55:52

the illness, and is

55:54

not just a plausible hypothesis, but

55:57

it's a likely

55:59

outcome. outcome of this

56:01

kind of hands-on right from the

56:03

start, providing disease

56:06

management that

56:08

will halt the illness before it even begins.

56:12

Dr. Lieberman, you've been consulted

56:14

on several high-profile cases involving

56:16

mental illness and violence. Could

56:20

you share one such story with us

56:22

and tell us what lessons can be

56:24

learned from these examples? Over

56:27

the course of my career, I've been

56:29

asked periodically to consult in some terrible

56:31

mass violence cases, James

56:33

Holmes in the Batman case in

56:36

Colorado, Wendell

56:38

Williamson, a law student at UNC.

56:43

But the one that I wanted to

56:45

mention is Jared Lofner, who

56:47

was a young man

56:50

who shot the

56:52

Congresswoman and Gabrielle Giffords, unfortunately Jim

56:54

Killer, but who impaired it for

56:57

life. So Jared Lofner

56:59

was 18 years old and

57:01

he was in high school and then he started getting

57:03

weird. He was using recreational drugs

57:06

and he then attends

57:08

a community college for

57:10

several months where he's

57:13

acting strange and

57:15

the students and the classmates there

57:17

are making jokes about him or

57:19

shunning him and they complain to

57:22

the administration and they suspend him from

57:24

school. And he

57:26

is throughout having

57:29

intensifying symptoms of schizophrenia,

57:32

delusions, hallucinations, disarmamentous thought,

57:34

bizarre behavior. Then

57:37

he at some point, from

57:40

Arizona, it's relatively easy to

57:42

acquire firearms, purchase guns, ammunition

57:45

and then he attends a rally

57:47

that Congresswoman Giffords is holding in

57:50

the shopping center for her constituents

57:53

and he goes to the front of

57:55

the assemblage and he

57:57

starts firing, hits her in the

57:59

head. and killed six people, injuring 15

58:01

others. He

58:04

is arrested, goes

58:06

to jail. I'm asked to consult on the

58:08

case. Why? Because

58:11

the prosecution, who the

58:14

Justice Department contacted me, they

58:17

wanted to be to testify

58:20

that he should be forcibly medicated

58:23

while he was in custody. And

58:25

when I heard this, I said, well, that makes

58:27

sense to me, because you don't want to leave

58:29

somebody symptomatic if they can be treated.

58:32

And then I realized that the reason they wanted

58:34

him to be treated was so

58:37

that he would be capable of standing

58:39

trial, and they could get to

58:41

death penalty. But

58:44

the point that I want to make, not

58:46

that, is that he had

58:48

been a mentally

58:52

disturbed person, and potentially taking

58:54

time, bomb, hiding in

58:56

plain sight for years. And

58:59

he was in his classroom with

59:02

other students and teachers, and

59:04

nothing was done to help him, other than

59:06

to suspend him. If

59:09

somebody had a

59:11

seizure, or if somebody started

59:13

choking, or if somebody

59:15

fainted, or screaming in pain, everyone

59:18

would rally around them. It would

59:20

call 911, try and get him help. But

59:22

for this kind of bizarre behavior, he

59:25

was stunned and

59:27

didn't understand. So the

59:30

idea of see something, say something,

59:33

do something, applies,

59:35

even if it's awkward. And

59:38

this is kind of a

59:41

dramatic example of the fact that

59:45

we have to be attentive to changes

59:48

in people's mental functioning, their

59:50

behavior, particularly at periods

59:53

in life that are the periods that

59:55

are at greatest risk, and

59:59

not being helicopters. parents or

1:00:01

nosy friends or individuals say

1:00:04

something or

1:00:06

try and encourage a person to seek

1:00:09

help or get help if there is

1:00:11

something going wrong before it goes too

1:00:13

far. All

1:00:15

of this is feasible to do and it's

1:00:18

not high tech, it's not rocket science, it's

1:00:20

not usually expensive. It really revolves in social

1:00:22

and political will to do it. And

1:00:25

the last thing I'll say is that to

1:00:29

not accept the more

1:00:32

proactive and optimistic premise

1:00:35

that I'm advancing to

1:00:38

my mind of thinking is discriminatory

1:00:41

and perpetuates what's a civil

1:00:43

rights violation by denying a

1:00:46

large constituency of

1:00:49

the population the

1:00:51

right to treatment that does exist but

1:00:54

isn't being provided. Dr.

1:00:56

Lieberman, how do we begin

1:00:59

to create safe places for

1:01:01

those people with mental illness

1:01:03

or schizophrenia in particular so

1:01:05

they don't end up homeless and

1:01:07

in prisons and can follow the

1:01:09

positive path that you have described?

1:01:13

The infrastructure for treating people

1:01:15

with serious mental illness like

1:01:17

schizophrenia just doesn't

1:01:20

exist and

1:01:22

the workforce that would

1:01:24

be required to

1:01:27

provide the services within

1:01:29

this workforce doesn't

1:01:31

exist even in the best

1:01:34

institutions in the country, one

1:01:37

of which is mine. So there

1:01:39

needs to be a reckoning at either the state

1:01:41

or the federal level that they're going

1:01:43

to take mental illness seriously. And

1:01:46

if they do, then you have

1:01:48

to approach it in two ways. One is

1:01:51

put in place the necessary preventative

1:01:54

measures that will interdict the illness

1:01:57

at the early stages so it

1:01:59

never progresses. to

1:02:01

a state of chronic disability and

1:02:04

requiring very intensive

1:02:06

support. And then secondly,

1:02:08

for the people who have already progressed

1:02:10

in the advanced stages of the illness,

1:02:13

we will need residential facilities.

1:02:16

We'll need services, both

1:02:19

medication management but also support

1:02:21

services, to enable

1:02:24

them to lead at least

1:02:26

reasonable lives and recover to the extent that they

1:02:28

can. And they can't – they'll never be the

1:02:30

same as they would have been if they didn't

1:02:32

have it. But we

1:02:35

can provide support for them. And

1:02:37

I have it. I have patients who I've been

1:02:39

treating for 30 years who are the

1:02:42

back words of hospitals, got out

1:02:44

because of close opinion, and their

1:02:46

families have taken an act of cobbling

1:02:48

together, these coordinated

1:02:50

specialty care services. So

1:02:53

this is not a matter of a

1:02:55

scientific breakthrough being required to

1:02:57

discover the cure for ALS

1:03:00

or pancreatic cancer. This is

1:03:02

something of understanding what needs

1:03:04

to be done and providing the resources

1:03:07

to do it. Dr.

1:03:09

Jeffrey Lieberman, thank you so much

1:03:11

for talking with us on The

1:03:14

People's Pharmacy today. Thank

1:03:16

you, Joan Cherry, a great program and just

1:03:18

great to be back in our discussion. Such

1:03:21

a good topic with you. You've

1:03:24

been listening to Dr. Jeffrey Lieberman. He's

1:03:27

professor of psychiatry and holds

1:03:29

the Constance and Steven Lieber

1:03:31

Chair at Columbia University in

1:03:33

the Vangelos College of

1:03:35

Physicians and Surgeons. His

1:03:38

research has advanced the treatment of

1:03:40

mental illness and led to the

1:03:42

therapeutic strategy of early detection and

1:03:44

intervention for schizophrenia. His

1:03:47

most recent book is Malady

1:03:49

of the Mind, Schizophrenia and

1:03:51

the Path to Prevention. B.J.

1:04:00

Lederman composed our theme music. This

1:04:03

show is a co-production of

1:04:05

North Carolina Public Radio WUNC

1:04:07

with The People's Pharmacy. Today's show

1:04:09

is number 1,373. You

1:04:13

can find it online at

1:04:15

peoplespharmacy.com. That's where you

1:04:17

can share your comments about today's

1:04:19

interview. You can also reach us

1:04:21

through email, radio at peoplespharmacy.com. Our

1:04:24

interviews are available through your favorite

1:04:26

podcast provider. This week's podcast

1:04:29

has some additional information on the

1:04:31

issue of violence and the mentally

1:04:33

ill. Dr. Lederman has

1:04:35

consulted on some high profile cases,

1:04:38

including the man who shot Gabby Giffords

1:04:40

and several other people. This

1:04:43

story is powerful. You'll

1:04:45

find the show on our website

1:04:47

on Monday morning. At peoplespharmacy.com,

1:04:49

you can sign up for our free

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online newsletter to get the latest news

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about important health stories. When

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you subscribe, you can also have regular

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1:05:00

so you can find out ahead of

1:05:02

time what topics we'll be covering. In

1:05:05

Durham, North Carolina, I'm Joe Graydon. And

1:05:07

I'm Terri Graydon. Thank you for

1:05:09

listening. Please join us again next week.

1:05:23

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1:05:25

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