To the hospital, we abandoned our symptom, and we behaved the way we usually behave. The question was, would anyone detect we were sane . The answer was, no. Your new book, the great pretender, centers around the story of this man. Who is he . Susannah he is a stanford professor named David Rosenhan. He was the architect of this amazing study. Footage youredible played. It is called on being sane in insane places. He and seven other people went undercover in Psychiatric Hospitals around the country. Their mission was to test the nature of diagnosis to see if their sanity would be detected. As he said, they were not. The study was done in the early 1970s. Why are you interested in it today . Susannah it came from a personal place. I emerged from my book, my memoir, brain on fire, which chronicled my experience with an autoimmune disease that can look that chronicled my brain. It was briefly misdiagnosed as a mental disorder. After that book came out, i was inundated by emails from the general public a lot of people who were looking for answers. Some of whom actually found answers because of my book. I also received many emails from people who felt lost within the Mental Health system, who felt they were not being seen, and they were not being heard. Really atrocious stories. I started to question a lot of these issues of diagnosis and misdiagnosis. The question of, what is Mental Illness . This led me to one story that i call my mirror image. That had any effect on me. We have a trailer from netflix. Your book was made into a movie. Lets watch. My head hurt. My stomach hurts. I have never felt this before. We have tested susannah for every infectious disease. All of the results are negative. We are going to get to the bottom of this together. Her eeg is normal. Her mri is normal. It is all normal. Her condition continues to regress. Manic behavior, paranoia. Everyone gives us a different diagnosis. We should look at hospitals that are better equipped. We will find the answer. When did this happen to you . Caller this was 2009. I was 24 at the time. A lot of that time, i do not remember actually. It is very bizarre to see it recreated in movie form. I wrote a book about a time that is very much lost to me. It was recreated in a movie. I have very strange feelings about that experience. As it was depicted, i experienced very serious signs of Mental Illness. Psychosis and hallucination, illusions. I was violent. I was paranoid. I was angry. There are various points that doctors had various diagnoses that ran the gamut from bipolar disorder to schizoaffective disorder. Various other theories in between. How did you get better . Susannah i am very lucky. That is something i very much understand to a greater degree, having done this new book. I came across i chanced upon this amazing forward thinking beautiful soul of a doctor who really listened to me and my parents and took an indepth patient history and was able to dig in and discover the cause that was a newly discovered autoimmune disease of the brain. And so, what was the treatment plan . Was it medication . Susannah it was not. The arsenal that you would use to treat any other autoimmune disease. That was steroids, plasma out of your blood in exchange for new blood. That is what cured me. Is there a chance you will get it again, or are you cured for life . Susannah since the disease itself was only named in 2007 i was treated in 2009. The Natural History of that on this is not well understood. There are a lot of question marks. There are relapse rates. It can come back. What i have on my side is i was treated very swiftly and aggressively. Hopefully, those rates are lower. I do live with the threat that it could return. You were out on the book tour and kept hearing from people, to be my diagnosis is also wrong. How did you get from there to this project . Susannah around that time, i encountered the story that would haunt me of this young woman. When i was doing proselytizing, i was talking about this illness to whomever would listen to me. I wanted to get the word out that this condition existed. I found myself in a Psychiatric Hospital presenting to doctors. After my presentation, one of the doctors came up to me and said, we have a woman here. She sounds a lot like you. We are going to test her for your honest. I remember walking through the halls they can, is that the person . I remember being moved by the thought that someone could have had it i had. Found out two weeks later that this person did have what i have. There was a stark difference between us. I was misdiagnosed for one month. She was misdiagnosed for two years. She had been misdiagnosed with schizophrenia. Her doctor told me she would never fully recover and that she would operate the rest of her life as a permanent child. This really not only angered me, but it galvanized me to continue asking these questions of, what is Mental Illness . I mentioned the story to two neuroscientists. One of them said to me, you and this woman are kind of like modernday pseudopatients. I had no idea what she meant at that night, she sent this study on being sane in insane places. That question percolated in my mind, what is Mental Illness . I remember reading the pages of that study and thinking, and feeling really seen and relating to it on a deep level. You write, the ability to answer this question, what is Mental Illness, shapes everything from how we medicate, hospitalized, how we police, and who we choose to imprison. Can you talk about how this about why this topic covers so many aspects of society . Susannah the broad general idea what is eccentricity . What is personality trait . What is pathological . These questions are about the self. That touches all of us. In a broader sense, the idea of, what is Mental Illness, if someone behaves in a way during a psychotic experience the labels and context of these diagnoses has an effect on the way we see people who have these illnesses. I think that it is a broad swath of an influence on our culture and society. You are a journalist. How did you use your journalism skills . Susannah i read the study. I wanted to know more. I wanted to know about David Rosenhan. He is a very charismatic man. I wanted to know about these other volunteers. He had seven other people. Who were these people . Whether they put their lives on the line for this assignment . I started to dig. I got access to his unpublished book. His diary entries. I started to dig. That turned into a sixyear investigation. How far did it take you geographically . Susannah all over the country. Into england as well. I hopscotch from the haverford area to stanford. I went everywhere in between on this wild goose chase for the seven other people and more information about David Rosenhan. What was the haverford connection . Susannah before he was recruited to stanford based on this study, there were rumors and he was recruited to become a tenured professor. He was previously at swarthmore. It was there that the idea for the study came to him. It was not actually his own idea. It was actually his students. They asked him, we want to see the idea of madness up close. He said to them, if you want to see it up close, become a mental patient. Go undercover in a Psychiatric Hospital. They all said, yes, we want to. When he actually posed this idea to their parents, none of them approved it. David rosenhan decided to go in himself. That is where the germs of this study started. Your readers will also get a brief history of how this country and western societies have treated Mental Illness over time. I would like to have you walk us through that. But say the early part of the 20th century, people who were diagnosed with Mental Illness, what were the options available . Susannah we have had some different stages in the way we treat and view Mental Illness. I start the book with the story of nelly bly. We could go back forever with ancient egyptians boring holes into peoples skulls. I started with nelly bly who was this amazing woman. An original sob sister. They wrote these sob stories, these amazing investigative reporters when women did not do such things. She went undercover in a hospital on roosevelt island. It was notorious. It was a hellhole. She went undercover as a psychiatric patient. She was one of the first to do so in this overthetop way. What she found was appalling. The idea of insanity was a one size fits all. If you were off or different, you would be put into an insane asylum. Care did not exist. There was neglect and outright abuse. Which he chronicled in the two part exposes shocked the country. Who paid for those institutions, which were all over the country. Susannah i believe we paid for them. Some of them are private. There were state institutions. Technology started coming along. There is something called electroshock therapy. Is that still in use . What does that do . Susannah it is electroconvulsive therapy now. It is still very controversial. It is interesting because in the time that David Rosenhan was going undercover, it was still kind of scary. We associate it with movies like one flow over the cuckoos nest. These are therapies that people describe as sledgehammers. We do not know how they work. They send electrical currents to the brain. In the past, they would induce seizures. This is no longer the case. These contributed to the general publics distrust of psychiatry at the time. There is another thing you can tell us when it became put into use. It is a procedure called a lobotomy. What is a lobotomy . Susannah that is one of the darkest chapters of the history of medicine. It was first created there was the first test on chimpanzees. It is basically a shutting off of the connections between the prefrontal lobe and the rest of the brain. It is supposed to produce higher functioning. It was intended to treat psychosis and a host this idea of onesizefitsall insanity. It was used to treat homosexuality and psychosis and depression. It was another one of the sledgehammers we should be ashamed of. In 1991, the bbc did a documentary on Mental Health called madness. They have interviews with two people who really popularized this procedure. We have a clip to show people. [indiscernible] i had no misgivings about lobotomy, until dr. Friedman begin to do the lobotomies in his office. One day, i walked in. As he was doing a lobotomy, he is a great man for recording things. Photographically. He had someone hold the ice pick while he took the photograph. He asked me, will you hold the ice pick while i take the photograph . I did not want to have a picture of me holding an ice pick at a patients head. I said no, i would rather not. That is hard to watch. How long was it practice . Susannah im not sure exactly the timeline. Many people in this country hundreds of thousands of people underwent it. The most shocking story for me ways, was theny story of Rosemary Kennedy who had a lobotomy done by walter friedman. I read a lot other biographers had done books about rosemary. The passages about her preand post a lobotomy were heartbreaking. Her mother, giving birth, had a difficult birth. There was oxygen deprived to her brain. She had always been a little bit different. But she was vivacious and very alive. Very strongwilled and beautiful. After the lobotomy, one of the writers described her as a painting that had been brutally slashed. She could hardly come up with any words. She walked pigeontoed. She would basically be an invalid the rest of her life. It was a travesty. So often, we see in this town of washington political figures who have personal stories in their lives use them to galvanize Public Policy efforts. How did the Kennedy Family incorporate this experience into a view of and work on Mental Health issues . Susannah this was an amazing story. Jfk was obviously very affected by his sister story. That 100 had an effect on his policy, which was the community Mental Health care act. He turned away from many of the institutions in bid to create a Community Care model, which would take people out of these warehouses where people were mistreated and neglected and have people treated in the community. Unfortunately, he died before any of this was actualized. The result was that these Community Care models were not enacted. Money did not follow the patients, even though the hospital did close. When Lyndon Johnson came into office with the signing of medicare and medicaid, what happened at that point that affected federal policy . There is something called the imd exclusion, which illuminated eliminated funding for any hospitals that had more than 16 beds. That facilitated the mass closure of a lot of these big state institutions that were very broken and needed fixing. They were outright closed without any safety net in place. State versus federal role in treating Mental Health changed as a result of that. What did states they were expecting something from the federal government that never materialized . Susannah they knew they were not going to get the funding. What was the outcome . They would close the institutions. If they were going to be losing money, the result was, if they closed the institution, they would save money. Some statistics the Community Care aspect of this never materialized. It is found in our archives that they celebrated the 50th anniversary of this act passing as though it had a big impact. Did it have a big impact . Susannah you walk the streets and see people i think it closed a lot of places that are terrible. It had a huge effect on closing very bad places. That is a great thing, but i think it did not it was not fully actualized. I think there is a lot that could have been done with these ideals. I relate to a lot of the idea of treating people in the community. The money was not there. You can see on your walk for me in new york city, i can see it on my walk to work every day bypassing Homeless People who are very sick. 90 of the Mental Health beds that were available when jfk signed the bill in 1963 have closed. Our population has doubled. Where are these people going, susannah . Of course, where these people going . Susannah of course, it is a broad and complex story. We have more drugs available to treat people. There are still very sick people who are not getting the help they need. At last count, there is wonderful work done by someone named dj jaffe who gets into the nittygritty of these statistics. At last count, we were 96,000 short. The word antipsychotic has been around since the 1950s. Around the time David Rosenhan and his people went undercover, that is when antipsychotic medicine is changing psychiatry. You add all of the synthetic drugs that would change the marketplace. That was all happening in the 1970s. We are going to spend a little more time with David Rosenhan. Heres another look. You write, David Rosenhan walked into the intake room in a hospital in pennsylvania and set off a metaphorical time bomb. Lets listen to him and we will come back and learn how. The term we use to describe the experience is dehumanized. Nobody talks to you. Nobody has any contact with you. The average contact of patients with staff was about six and a half minutes a day. Nobody comes to visit. The first time i was in a Psychiatric Hospital on an admissions board, my wife constituted four of the seven visitors on a weekend. Psychiatric hospitals are storehouses for people in society who you really do not want, who you really did not understand, and for people who you have lost sympathy for. Susannah that was probably the norm at that point in time. He is such a beautiful speaker. And a writer. It was one of the reasons i fell in love with the study. He went undercover in a Psychiatric Hospital at haverford state. He spent nine days as a patient. The descriptions he experienced they are gorgeous. I even in my brief period of being misdiagnosed, related to the feeling of otherness, the idea that doctors see you through a clinical gaze. Through a prism of your Mental Illness. These are all things he describes. I believe they were very common at the time. And continue to be, today. Describe how he put the rest of the study together with his students. Susannah after that First Experience the nine days at haverford hospital, he returned and said, students cannot go in. He had a very painful nine days. He was shaken. His colleagues described him as a shaken man. He put an end to the teaching exercise. The study would have ended there. What i only have the focus on was his unpublished book. It became a guiding star for me on how to put this narrative together. He said he was lecturing about his experience, and a husband and wife, a psychologist and psychiatrist, asked if they could go in, too. I cannot verify that happened. It started to be one of the many issues that started to emerge that started to indicate to me that things were not as he portrayed them. How many people participated . Susannah he said all eight participated. The problem was, i could not verify many of his claims and found many inconsistencies. How did the study become so important . Susannah the study itself was published in science, which is one of the most esteemed science publications in the world. In many ways, you think, eight people if you think of a data set in terms of number of subjects, it is not a very scientific or rigorous data set. The fact it was in science gave it this feeling of importance of scientific rigorousness that perhaps it did not deserve. That is why the study had this huge effect. Where it was published. So then what happened . Susannah after the study was published, there was a huge outcry. There were two differing reactions. On one side, the public read the study, and it was confirmation of what many suspected. It was confirmation of what they were seeing in mass media. At that time, you had movies like snake pit. You had one flew over the cuckoos nest. The fact that David Rosenhan and his patients came back misdiagnosed, grossly misdiagnosed, and never discovered as pseudopatients during long stays. One person stayed for 52 days according to the study and was never revealed to be faking her illness. These things confirmed what many people already believed. On the others, psychiatry was going through an identity crisis. They had issues with the diagnostic system. In the u. S. , people were being diagnosed with schizophrenia at higher rates. In the u. K. , people were being diagnosed with bipolar disorder. We did not seem to have a common language. We were moving away from psychoanalysis. Psychiatrys role in the place of medicine was coming under fire. This study looked into the sweet spot at the right time. One doctor who described as a sword plunged into the heart of psychiatry. How did those other patients get out of the institutions . Susannah the average stay was 19 days. They ranged from seven to 52 days. All of them according to the paper left against medical advice. At various points, they would petition to get out and would not be able to get out because they were not deemed well enough. A major part of the study was that each patient would only would try to commit themselves based on one symptom alone. I hear a voice that says thud. I hear a voice that says empty. Once they were admitted, they were to drop any other pretense. They did not hear any other voices. They were to act as normal as the situation allowed. One could simply check yourself out of a hospital if you wanted to . You could not. In some cases, you would have to get a court order. The patients Rights Movement changed that. We have this legislation two important pieces of legislation that are bringing people out of institutions. You mentioned the societal aspects. You referenced one flew over the cuckoos nest. It has become an iconic movie. Lets watch a little bit and talk about the impact it had on this. As a matter of fact, there are few men here who are committed. Cheswick, youre voluntary . Mmhmm. Scanlon . For christs sakes, you must be committed, right . You guys do nothing but complain about how you cant stand it in this place, and then you do not have the guts to just walk out. Do you think we are crazy, or something . We are not. Youre not. Host so, we still talk about this movie all these years later. What impact did it really have . Are you surprised that Something Like a movie can have such a Cultural Impact . Susannah at the time, it was the book that had a tremendous effect. What it did, both the movie and the book, it really shaped Public Opinion about psychiatry, about not only its limitations but the dangerousness of its power embodied in the nurse ratched character. And i think it had a huge effect on peoples kind of trust of psychiatry. And i think that, too, made psychiatry in a lot of ways in response to that general public distrust of its field. Host what happened . How did the field respond . Susannah this is really interesting because the study itself had a very key effect on psychiatrys response, which is embodied in the kind of bible of psychiatry which is called the dsm. The diagnostic statistical manual of mental disorders. During my unearthing of all of these correspondences in David Rosenhans history i found a treasure trove of letter between David Rosenhan and a man named Robert Spitzer who was the creator of the dsm iii, the third edition of the famous manual that affects our lives today. Robert spitzer was very much against this study. And he spoke out very widely about his distaste for the study and his kind of push back against it. In the letters between them i see this back and forth and i realized that Robert Spitzer saw the study as an opportunity. And i confirmed this with his wife. Basically at that time, 1973, he was starting to work on what would become the dsm iii, and which would become basically a medicalization of psychiatry. It would put together a manual that would make everything very prescribed and orderly. People described it, disparagingly as a chinese menu approach. It was a way of reclaiming psychiatrys role within medicine and really make it scientifically rigorous, make sure we are all speaking the same language, all using the same diagnoses. One person theyre in arizona would be diagnosed the same as another person in maine. That was a major push of the dsm. And what i found is during the writing and creating of the dsm Robert Spitzer often thought of David Rosenhan and his study. And he would say things, could David Rosenhan and the pseudopatients get past this if we had this criterion . It was amazing to see their interaction and also hear the incredible effect that the study hand on the kind of bible of psychiatry. Host as you started to put these pieces together, you are asking yourself the question, what is Mental Illness and how the society understand that . You find out about this, key study that David Rosenhan did that impacted the profession and really the country. So, when did you start asking yourself questions about its the validity . Susannah i would say, you know when i started to dig into those files and actually got access to David Rosenhans medical records, that is when question started to really emerge. In those medical records i found that David Rosenhan did not just exhibit a voice that says thud, as he often said he did. He actually exhibited way more severe signs of psychosis that that. I hear repeatedly that he said he put copper pots over his ears to drown out the noises. He had been hearing voices for many months. He had a long history of depression and he was often suicidal. And that, to me, created a far more nuanced and a far more severe portrait of psychotic ailments than i hear a voice that says hollow. Once i got access to that, other things started to not make sense. Maybe things i had been ignoring previously started to fall in line as major issues with the study. Host you set out to find the other people who participated. How did that effort go . Susannah it was a rabbit hole. Unfortunately, i was only able to find one of the original eight. I hired a private investigator and interviewed hundreds of people. And unfortunately could only find one. He was a graduate student at stanford. He was in David Rosenhans class on psychopathology. This is in 1970. He went undercover at agnew State Hospital. His name was bill underwood. I tracked him down at the Austin Hilton and interviewed him and his wife. His experience mirrored that of davids. He had a terrible time at agnew State Hospital whic is now in the process of closing. He describes the depersonalization. At one point, he was mistaken for another patient who had diabetes and almost given insulin therapy. At another point, he actually swallowed thorazine because he had been given a thorazine tablet that was a rapid melt tablet, and the idea of cheeking it, what they were trained to do with pills, would not have worked with the rapid melts. He was drugged and in a stupor when his wife visited. It was very traumatic for everybody involved. I found him and felt very positive about that. But through him, i found another person. He was not one of the eight. He was a ninth pseudopatient, a man i call the footnote. Host who was he . Susannah his name is harry landau. He is a professor of psychology at the university of minnesota and he studies smoking cessation. He started also as a graduate student at stanford and actually stuck with psychology. He went for 19 days undercover as a patient at the u. S. Public Health Service hospital. And was misdiagnosed, as david wrote everyone was, with schizophrenia. However, thats where his situation and his experience, the similarities ended. He had described to me that he had a positive experience during his 19 days. He was an unhappy graduate student at the time in an unhappy marriage. He felt lost and isolated. He was in a very competitive atmosphere at stanford. When he admitted himself to the hospital, he felt this tremendous relief. He walked on the wards. He described them as light and bright. The nurses were engaged. No one wore uniforms. They were men and women, they sang peter paul and mary in the hallways. He had a wonderful 19 days. He felt it was a healing environment. This did not match davids thesis at all. This is the opposite of davids thesis, in many ways. Host so therefore, he was not included in the final product. Unfortunately, David Rosenhan had passed away before the start of the study, but harry landau believes that his data does not support the thesis that David Rosenhan was writing, so he discarded the data. Host how did he feel about spending his life in a profession where he was part of such a pivotal study and yet had questions about its validity . Susannah it is interesting, because i think when i came to him with my questions and kind of digging this up, i think he went back and looked at it with a gimlet eye. When he was excluded from the study he felt disappointed and he felt angry. He did not know. He learned about it when he read the study in science. I dont think he knew enough to put in to context of there is something fishy here. As i started to present other issues ive found with the study, i think he refrained his experience and thought, ok, maybe i was excluded because he had had a bias. Host as a journalist and digging through all the stuff, what was the point when the scale got tipped for you, when you went from exploring to questioning . Susannah i would say probably harry. The medical records for me were damning. I also, in kind of a lead up to discovering those medical records, i also discovered some discrepancy with data, which, to me, in a scientific paper to have issues with the data was at that point, it tipped me over to really feeling there were some Serious Problems with the paper. And that was found through harry. One draft had nine pseudopatients. No footnote. The other draft had eight pseudopatients and one footnote, leading me to believe, very fairly, that in the earlier paper he did not remove harry and the later paper he did. And unfortunately, none of the numbers, not one changed. Still 2100 pills given. Still had down to the decimal number of minutes the psychiatrists on average outside, on the floor or nurses spent out of the cage. Very highly specific numbers. Not one changed. That, to me, was pretty damning. This is beyond sloppiness. There is some kind of willful massaging here. Host once you have an ahha moment that this is not all adding up, what did you do with that . Susannah well, you know, at first i thought the book is done. I really thought i wanted to find the pseudopatients, and the more i dug, i started to doubt if these patients existed at all. What do i do now . I really thought the book was over. Now, in retrospect, i realize it is actually a more interesting book, having to kind of search for this at the time, i thought, what am i going to do with this . I was also very much embedded in David Rosenhans world. Im very close with his Close Friends and close with his son jack. And it made me very uncomfortable because in many ways he was a hero and i loved that study. It was a lesson you do not want to meet your heroes. They might let you down. I felt very let down. Host what about his family . When you had to present the evidence at some point to them that their relative, their close relatives lifes work may have not been valid. How did they react . Susannah it was really difficult. One of the reasons this took six years is i wanted to be sure and i wanted to dig up every single lead i possibly could. I had a confidante who was who is davids very close friend, florence keller. She went through every major reveal with me and, at various points, came to the same conclusions i did. I felt supported by someone who knew him. Very well and some of the things i was finding the hardest person to talk to about this was his son. I took him out to lunch. I remember when i first had an inkling that things were awry, and i presented some of these issues to him. And his response of the time was my father was a storyteller. But i dont think he would do anything to mess with his research. That was his stance. Then as the book starting to come together and publication loomed i fact checked the book and made it clear this might not make for pleasant reading. And that the conclusion i came to may not put his father in the best light. Hes a lovely person. Jack rosenhan. He actually called me two days ago after he read the book in full. And he says he actually likes it. He said it was hard to read but in many ways the twinkle that was his father, this charismatic man, this amazing thinker, it still comes across even though there are now questions about the validity of the study. I am happy to hear that he had the response to it. Rosenhan died in 2012, a year before i started investigating the study. Host did his publisher answer the question of why his book never got published . Susannah the publisher actually sued him because he never delivered and that was another clue to me that kept haunting me. Why, why didnt he finish this book . Well over 100 pages written. This wouldve been a smash success, the study was huge. He was a media celebrity. Why not publish the book . And that really was an interesting thing. So, i tracked down a lawsuit in 1980 at doubleday, his publisher, and they actually sued him to recoup the advance they have given them, which was a sizable advance. That, to me, was a big question. I still dont know why he did not do the book. I have some ideas, some theories, but i still do not know why he did not finish that book. Host he did not share it with his family. Susannah not that i know. Host what is the implication if rosenhans study was not valid . Susannah because rosenhans study had such a wide influence on so much of what we contend with today, the crisis we see today was touched in some ways by this study and a lot of Public Opinion about psychiatry, about its institutions were in part shaped by this study. So, i think that in questioning it, we have to go back and question some of our assumptions. And i hope that this gives us an opportunity to kind of go back and reassess in a way that moves forward, because we cant move forward on a ruined foundation. If this study was not up to snuff, if it was not legitimate, we really have to rethink some of the conclusions that were presented. Host you told us about the connection between rosenhans study and dsm iii. Susannah im sorry. Diagnostic statistical manual of mental disorders. Host what version are we on now . Susannah five. Host there was a relationship between that and rosenhans study. Was it one where you questioned the dsm . Susannah i do. And i think that most psychiatrists, research psychiatrists who are on the cutting edge, are definitely questioning the dsm. Even the nimh now want their research to use a different criteria than the dsm. The dsm present illnesses and hard line senses. With schizophrenia, bipolar disorder, they are separated. What people are finding in the Research Side again, these are questions we do not have answers but what they are finding is that genetically there are overlaps. There are more gray areas between these diagnoses than hard lines. I think rosenhans pushed the field to kind of defend itself and say, we are legitimate. This is our criteria. And we are going to be very strident about the terms we use. But unfortunately, in response, it created a black and white system where a lot of it is there gray. Everything that deals with the brain is very gray. And i think that there is a reckoning with that today now too. Host here is another set of statistics that you record in the book that to me seems like a demonstration of having this roadmap of diagnoses. Since this period of time, childhood bipolar diagnosis, disorder diagnoses, increased 40 fold in 15 years. There has been a 57 fold increase in childrens autism spectrum diagnosis from the 1970s to today. Today, 8 of all children in the u. S. Are diagnosed with hyperactivity disorder. And 15 of all High Schoolers are diagnosed with adhd, attention deficit. What should we understand from those numbers . Susannah these are questions i do not have answers to. Hard lines do kind of protect us against over reach. Is it overreach or was it under reach before . These are questions we have to grapple with within the field, as a society. They are difficult ones and i do not have the answer to that. Host we talked earlier about pharmaceuticals. What impact has the growth of the pharmaceutical industry had on how we approach all of these questions in society . Susannah what has been amazing to me, my pursuit of these questions as i learned how much medicine, psychiatry in particular, medicine in general is manmade. We have these you know, guidelines that move and change and adapt and they are moved and changed in adapted by many things and some of them ours pharmaceutical industry interests. And some is changing standards. More understanding about technology and our understanding about the body. There is good and bad with these moving targets. But that was incredibly enlightening to me about how, how manmade, how artificial, how gray a lot of medicine is. And i think the pharmaceutical interest in psychiatry is something that i think the field is starting to come to terms with right now. Host you have been speaking about this before the book was published. To psychiatry groups and the like. What has been the reaction to your question the basic foundational tenants of their profession . Susannah i think the best psychiatrist embraces it because Robert Spitzer, who created the dsm iii, he created that document to be a living, breathing document your he said we do not have an a lot of knowledge yet. We are talking about the brain, and isolated organ. It is impossible to study in real time. We cannot look at it and touch it. The psychiatry deals with very complex issues. Our hope is what we are doing right now will seem primitive in 50 years. I think people are really thinking about these issues and really interrogating them welcome questions. We dont push against that. I hope in this book is that i raise these questions for reasons we can think more critically about some things we take for granted as being just the truth. Host circling back to your own experience with this, where will the questioning come of whether or not this has a biological organic base as opposed to Mental Health . Susannah in terms of . Host people getting diagnosed. Susannah if we have a blood test or objective measure. Host are people beginning to question, could this be something other than a Mental Health issue . Could it have biological origins that, as your experience did. The dsm does not prepare for that. Susannah the dichotomy is false. There is no difference between organic or inorganic or psychiatric versus neurological. There is so much overlap, and i think eventually down the line, im very optimistic, and i am not a doctor, but this is my hope is that those terms become outdated. That we discard them the more we learn about the brain and the body and interface between the two. Host we are getting close to our hour, but there is one aspect of what is happening in society that we have not referenced. You talked about the number of Homeless People. Some of it Mental Illness. We dont really know, do we, as a society how many Homeless People have Mental Illness. Susannah there estimates of 100,000 people with serious Mental Illness live on the streets. Host the other thing is pretty putting people in jail with Mental Illness. I have one other piece of video from chicago where a forward thinking cook county official has been trying to introduce these questions into how we put people in jail. Lets watch that. [video clip] an average 70,000 men and women pass through Cook County Jail each year, many more than once. What percent do you think he really should not be here . I would suggest conservatively that half of the people here in the jail should not be here. The county sheriff says the jail has become a dumping ground for the poor and mentally ill. Host so, another big societal question. Susannah he is amazing to the work he is the reason incredible. He put his psychologist as a head warden of the jail, coming to terms with the reality many of us do not want to face the fact that we are putting people who are very sick in prison and jails and in places that are not healing, they are punitive. They are opposite of a place they should be. I like that he is at least facing this headon, and he is saying this is the situation and we have to deal with it headon and we have to come to terms with the fact that we are putting sick people, we are imprisoning sick people. And i just really think it is a testament to his kind of, his way of seeing the world. Host so, is washington, right now we are of course very much involved in the impeachment issue, and a lot of policy issues are not being attended to, but are these questions being discussed in washington, d. C. , with federal policymaker or is it local or state legislatures . Thinking about homelessness and the connection to Mental Illness, and prison population and the connection to Mental Illness. Susannah i think youre seeing movement or lack thereof on the state side. I think across the board, from my perspective, we are losing this issue. If we have, you know, one of the more forward thinking jail saying half the people do not belong here. Clearly we are not going to correct, we are failing on the federal and state level. But i think that there are some bright spots in my experience. There are some interface between police and Mental Health experts that seem to be, Mental Health courts that talk to sears and mental ill people before they get into the prison system. There are some initiatives that seem to be doing something, but i think, in so many ways, we are so behind as a culture. And this is something that i think, it kind of is a wide swath across the political spectrum. We are not doing the right thing for very sick people. Host and your book you described our Mental Health system as harsh. If we look at other countries, are we different in that regard in the way we approach these questions, or is western society all in the same place . Susannah you know, i think we all grapple with similar issues. I think we probably, there are some places that seem to be doing this right. There is actually work thats interesting out of l. A. That is going on right now. They are studying a system in trieste, italy. It is not an institution model. It is interesting. Its tiers of care that is provided through the community. And they are trying to adapt that. It is interesting what this small town in italy seems to be doing it right. I visited a place that i thought was doing it correctly in south dakota, and this was a Hospital System there where not only do that have a mobile triage unit that goes to the actual sickest people, the interface with police officers, they have suicide hotlines for farmers manned by farmers. And they have acute care units and longerterm care units, and they have nurses and attendance who really care about their jobs and really care about the people there. In a similar way that harry landau described his experience, the wards were light and bright and airy and it fell healing. A lot of Psychiatric Hospitals, i would not use those words to describe pretty much any other ones that i saw at the state level. Host you end by saying you believe that psychiatry will one day be deserving of the faith you have in it to adapt. What will get our society there . Susannah as simplistic as this might sound, i think that psychiatry at its best is the art of medicine writ large. It is really relating to the patient, taking deep patient histories, using all five senses in terms of taking in the patient, because we do not have blood tests. We do not have these objective measures. So, you need to really focus on the art of medicine. So, i hope that as we learn more about the body and the brain, the art of medicine will not be discarded and that, as we kind of make these investments, those these advancements, those would be married and care would be improved. I am optimistic about that in the long term. Host the last seven or eight years of your life have been consumed with this question of what is Mental Illness and how do we treat it. You are so passionate about it. Do you think youll be spending more time on the subject . Are there more questions to be asked . Or is it time to put your skills to Something Else . Susannah wow, what a great question. I have to say i am obsessed. Maybe because it comes from a personal place, but i do not believe i am done talking about these issues. Because there is still so much. The minute you peel that onion, there is more layers. I think im going to be talking about this for a long time. Host thank you for talking with us about it for the past hour. Susannah thank you for having me. [captions Copyright National cable satellite corp. 2019] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] all q a programs are available on our website or as a podcast at cspan. Org. Next sunday on q a, Pamela Constable talks about her time is the Afghanistan Pakistan Bureau chief where she has been a reporter since the early 2000s. She talks about the people she has met, and the issues she has covered and conditions today. And her homecoming to the united states. Watch the cspan Networks Live this week as the House Intelligence Committee holds the first public impeachment committees. Starting wednesday at 10 00 a. M. Cspan3, willing willr and george kent testify. Then on friday at 11 00 came , former u. S. Span2 ambassador to the ukraine will appear before the committee. From awitness testimony deposition, find the transcripts at cspan. Org impeachment. Follow the response on cspan, tv,ltered coverage live on our radio app, and online. Or stream any time on demand at cspan. Org impeachment. Next, some of the highlights from last month in the austrian parliament, where the Prime Minister and members of his cabinet face questions about syria, climate change, agricultural change, and press freedom. Of skys courtesy freedom. Edition ofto another question time. Alarm across the globe, including here in australia. Australians in refugee camps in the north of syria. My question is to the minister of foreign affairs. Syria