01x01 - Evil or Illness?

[bunniefuu]

(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 k*ll 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

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 Salpêtrière 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 fiancée,

"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 q*eer.

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.


♪