President bush invited us down and told us we had to be there at 7 in the morning every tuesday. That inclusion created a chemistry among us that allowed us to deal with a crisis and made a huge difference in a ships that came from it really made a difference in terms of what we were able to get done. Joint caucuses, opportunities for republicans and democrats to sit together and break bread together and listen to the leadership together rather than separately so these joint, maybe separate caucuses dont become pep rallies for your side. Bringing spouses together, and opportunities to get to know one another on an informal bases is the way we used to do things. It made a difference. We dont have that happening today. Several times we face the crisis of acting in the senate we would have a joint conference meeting. Tell him about the Graham Kennedy agreement. We came to terms with the house voting to impeach the president and we would have to have the trial. But we were not sure how to proceed. We had not had one in a hundred years. We came up with the idea of meeting in the Old Senate Chamber and we would have a discussion about the result. But i called on dana kaka from hawaii to open with prayer and ask for guidance on how to tell us the history about our constitutional duties and he did a good job. He opened the session and kennedy made comments, ted kennedy, and phil graham from texas. There are the polls of the parties. Conservativeconservative and liberal line of the democrats. What it sounded like was they were saying the same thing. I looked down at mac, my buddy, and i said we have the kennedygraham solution. Everybody was so excited. We broke up the session, had an agreement on how to proceed and tom said i think we should tell the press the agreement. We are going down the hall and i dont know which one said it but exactly what did we agree to . And i said i dont know either. Lets put kennedy, graham and others in a room to write up what we agreed to. We got the agreement, proceeded and did our constitutional responsibility. We did it in a way we felt was fair to all and we came out on the other side with the ability to then go back to doing legislation for the people. You can watch this and other programs online at booktv. Org. Every day books are reviewed by publications throughout the country. Here is a look at titles premiering this weekend. Jane mayors book dark money about the hidden intersection of money and politics was reviewed in the Washington Post by reporter tom hamburger. He writes, mayor takes readers through decades long efforts by charles and coch and other families to fluence politics. She makes the case antigovernment campaigns have helped wealthy elites block changes on things like climate change. She will be live next sunday at noon. In the usa today we looked at the invisibles and the lives of the africanamerican slaves that lived in the white house. Commenting on the book, it is noted holland had to dig deeply to learn about the people that cooked the president s food and tended to their family needs. There were interviews in newspapers and magazines. Mike bowdon, considered playing to the edge in the york times. It is written he does a good job of making his case. He is particularly strong on nsa data collection. He continues there are practical difficulties created by new technology and data was not being swepted without discretion. Here is a preview with the former cia director iran was the second most discussed topic in the oval office. We didnt talk about other stuff for it to be number three. It was terrorism and then it was iran. President bush and the other question he gave he was how do these guys ask these questions . This is an opec society and hard to penetrate. Watch for that and more this weekend on booktv. Thank you so much. I would like to welcome you to the alexanderia center for life science. It is new yorks first and only life science campus providing the fapharmaceutical, bio tech, and other institutes with state of the art laboratories. Our urban campus is a part of the citys life science eco system that is defined to foster innovative collaborations among new yorks world renowned academics and medical institutions and preimminent talents and top tier investment capital. And it proceeds the translation of new lifetime discovery from bench to bedside. We are the largest and leading developer uniquely focused on collaborative science and Technology Campuses and innovates in cluster locations. We have campuses all over the country and the largest life science hub, cambridge mass, San Francisco and san diego. Ten years ago there was little commercial life science in new york city. Now we are proud to be part of the citys vibrant system. In the past few months over a half dozen new Life Science Companies have been started out of new york institutions. Tr truly amazing how far we have come. Alexandria build Laboratory Buildings that are important but we build collaborative leadership through thought prarm programming events like this. Aimed at bringing the Life Science Community together around issues that have the potential to accelerate developments for lifechanging treatment in patients that need them the most. The chairman and founder of the Real Estate Equity found the summit to bring together Key Stakeholders across the life science continuum to address the most Critical Issues in drug discovery, research, development, and global health. We have had eight alexandria summits including one last january dedicated to neuroscience in which both of our speakers tonight participated. And economic consequences. According to the world health organization, worldwide depression or bipolar disease affects more than 400 million people. The social and economic costs are staggering. Severe mental disorders have been estimated to cost society 2. 5 trillion worldwide. Without an understanding of the brain they continue to destroy patients and their families, undermine Health Systems and oppose a great burden to our global economy. It is imperative we Work Together to create new fiscal and regulatory Government Policies to increase public and private funding and develop incentives for innovation and research and Drug Development and to continue to increase emphasis on Public Awareness about these diseases. We bear responsibility for convening conversations and actions that can lead to the solutions. We are honored to host this event tonight and grateful for our Ongoing Partnership with jeff and bob command as we all work to decrease stigma and improve health care for those that have brain disorders. Tonight i would like to introduce bob and jeff. I will start with bob sitting on the far left. The Senior Vice President of the Albright Stonebridge group, a leading diplomacy and Global Strategy Firm based in washington dc. Bob is more than 25 years of experience in private government and nonprofit sectors. He worked at google and public policy,policy, when the National Security program for the center for american progress, the dc think tank, advised and continues to advise fortune 500 executives, serves on the National Security council, treasury, and state departments during the clinton administration. Since 1987, when he was diagnosed with bipolar disease, bob has been an outspoken advocate for people with Mental Illness and has worked closely with leading advocacy groups. In the Clinton White house he helped advance policy to guarantee parity, coverage for Mental Illnesses. I would like to introduce doctor jeff lieberman, chair of the Psychiatry Department at Columbia University in the past president of the American Psychiatric association. Advance the understanding of the geology and treatment of schizophrenia and related psychotic disorders and has authored and coauthored over 600 papers, written or edited 11 books and Mental Illness, psychopharmacology and psychiatry and is the recipient of Many National awards. In 2000 he was elected to the National Academy of Sciences Institute of medicine, and during his term as president of the American Psychiatric association he actively contributed to government policy and legislation including the Mental Health parity and addiction equity act, the Patient Protection and Affordable Care act, the families and Mental Health crises act and was a visible a visible spokesperson for the media on Mental Illness and psychiatry. Recently in this last year he published shrinks, which we will discuss here tonight. One quick word, everyone has a copy of the book in their chair. When we finish the dialogue in here we will move to outside for a book signing and cocktails. I will turn it over to you, i guess, bob and jeff. Okay. Thank you very much. Much. Welcome, ladies and gentlemen. Thank you for coming this evening. It is an honor to host this dialogue tonight. Especially with my colleague, bob boorstin. After a long career in academic psychiatry, someone who treats patients and looking at how the field of Mental Health care is evolving and being perceived in our country, it seems to be incomprehensible that the capacity to help people would mask getting through. And when you think about it, Mental Illness barriers to treatment or lack of knowledge and lack of any affects treatment. 21st century now, the barriers or lack of awareness, shame and lack of access. And so something much more poetic. Pariahs in the palace of medicine. Shrinks is better. [laughter] that is what my editor said. And that may now turn it over to my friend, bob boorstin. One of the most interesting and admirable people that i know. Thank you very much. I am here for two reasons. The 1st is because ii am a big admirer, and you should be, too. Survived a year plus. Those ofthose of you who have any relation to the field of psychiatry should know that is one of the most difficult jobs in the country. To survive the battles on system press. Second thank him 2nd reason i am here as ii could not pass up the opportunity for role reversal. For almost 30 years now i sat and psychiatrists office and asked questions. Now. Now i get to ask the questions, if only for an hour. I promise to not incessantly then say, and how do you feel about that, jeff . We are going to talk about jeffs book, shrinks, and a few of the issues involved in Mental Health right now in american society. But before we cracked the cover of your book, jeff, let me start with the big question. And that is, people talk a lot about the term health and illness. How do you define Mental Illness . What does it really include . It is a set of disorders that are akin to how we think about respiratory disorders, cardiovascular disorders, gastrointestinal disorders. The long, hard, and stomach. Yes. Just translating for the crowd. Any organ of the body. So complex that it requires three special groups to cover it. Surgery, neurology, psychiatry. Psychiatry got the space in the brain that was the most highly evolved. Mediate the mental functions of cognition, perception, and emotion. Based on Mental Illness and the purview of psychiatry or neural psychiatry, it accomplishes what is traditionally thought of as Mental Illness, depression, bipolar disorder, schizophrenia, anxiety, eating disorder, dementia in the intellectual and mental disorders. In the addictions, alcohol and drugs. These are all effectiveness same real estate in the brain and are disturbing by varying degrees these method functions. Very expansive definition. Keeping your definition in mind, i picked up the newspaper this morning, for the young people here, this here, this is a newspaper. You might not have seen one before. Panel urges screening for maternal depression. Very interesting to me. For several several reasons, but the reason i want to ask you about it is, this is the kind of headline where people say, zero, maternal depression is now Mental Illness. And what i want to ask you, are we perhaps experiencing a little definition creep when it comes to Mental Illness . Everyone being diagnosed. In washington we talk about Mission Creep in the military. And it can be a real problem. A real problem. Do you think that it is a problem right now . It is not Mission Creep and that are apologizing for normal behavior. Dsm five came out with a book that my former friend and colleague once called saving normal. Greedy psychiatrists were coming up with a diagnosis for everything. Hangnail disease. And so that is actually untrue. The reality is the notion that everyone is so crazy and needs to shrink which is popular in the heyday of psychoanalysis from the 1950s, being analyzed with Plastic Surgery today, you know, trending. Is this dispelled . There is a bright line between the list. Everyone has problems in living in socalled issues. To find the service. Going talk about screening for depression my answer is, what took us along. Depression is the most common mental disorder in terms of population frequency. The World Bank Says that by 2020 depression will be the 2nd most expensive illness in terms of global illness. By 2030 will be the 1st. So why wouldnt we . Particularly when one in four women, pre or postpartum well have a psychiatric condition, most commonly depression. Why would we try normal prenatal care . The other group that is recommended for routine screening is the elderly. The reason for that is that geriatric depression is common in the highest suicide rate of every Demographic Group is elderly males. Tb screening, diabetes screening. This is a book that i like a lot. Not only because it is about something close to my mind and heart but also because that is one of the few non memoirs and psychiatry that is approachable and is approachable he written. Absolutely. Stalin was not too young when he wrote his command there have been others that i just terrific. But this book has both, i think, the medical and the personal. One of the reasons that it appeals. The other thing i like about it is that you do not pull your punches. You tell it like it is. End lets start with that talking about the biggest name in Mental Illness, sigmund freud. In the book you say that reading the interpretation of dreams got you thinking about having a career in psychology. But at the same time you by no means go easy on freud. In fact, at certain points in the book he seems like a villain. You write, freud ended up stranded in psychiatrys in an intellectual desert for more than half a century before eventually pushing a profession and one of the most dramatic in public crises endured by any medical specialty. So i guess my question is, what did forget right . Freud got a lot right. You know, a lot of inventors or discovers a great ideas produce works that in some ways are going to produce problems. To darwin by evolution create problems . Well, for the creationist, he did. Freud was a neurologist, by the way. He studied disorders that were ostensibly related to the grain. And at the time there was virtually no Scientific Understanding of the brain and the conditions that were associated with it ranging from stroke to brain tumors to anorexia, to psychosis, to depression. And the Research Methodology that was available to people at the time was basically digging up cadavers and dissecting them and looking for the the organs corresponded to the Homeless People have before they died. And just by his own powers of observation people coming into his office say i feel this or that and his imagination, he invented the theory of the mind. Psychology had not been invented then. And his theory of the mind was that the mind was involved at various components, not like some phenomenon. Components of the mind and that there was a process and some disturbances in the process because you feel like you are paralyzed, nothing physically wrong with you. A lot of the things that we find they still used today, the idea of the conscious and unconscious. The conscious minds. The themind. The idea of Defense Mechanisms to be rationalized, denying things. The idea of being able to have conflicts with conflicting sort of impulses or desires with moral or legal constraints. So these were seminal, not just on the order of einstein and on. Situated to problems. You never allowed his theory to be submitted to testing. He was controlling and insisted on his acolytes loyalty and obedience. And the 2nd thing that he did is that he began to applies theory to psychoanalytic and talking to severe Mental Illness. Although there are many aspects very useful and effective. It has virtually nothing to do with depression, bipolar disorder, schizophrenia compact disorder, eating disorder, dementia, autism. Transgenic mother, refrigerator mother, homosexuality, the result of a castrating overbearing mother and these things we handle the untrue but pure. Applications the other day. Someone who went through analysis for two years before having a delusional breakdown in theending up in the hospital and then having the psychoanalyst say maybe new medications, i kind of relate to that. Your for to it in your book as the stepchild of medicine. Isolated, sometimes seen as an illegitimate science. And yet your book is full of descriptions of cures and procedures and ideas that could legitimately be called illegitimate. Ego as far as to entitle one section of the book nothing an ice pick to the eye cant fix. Fairly harsh there. Two questions to answer or avoid as you choose. How much of psychiatrys current poor image and the stigma problem that is attached can be laid at the foot of psychiatrists and people who claim to be doctors of the mind do you think the stigma was inevitable given the crazy complexity of the brain . I think its about 6040. 40 percent gets us through to psychiatry. 60 percent is due to the social and cultural environment through which it evolved and functions. Psychiatrist started out like every other doctor bone doctors, cardiologists, dermatologists, pulmonologist and everything , psychiatry and neurology one of the 1st specialtys of science. Actually the oldest professional, the summer of 1834. What happened was that has medicine became not just a trade but a science, discipline, and research providing evidentiary basis for how he understood the illness and feeding it technique, searchable instruments, Infectious Disease and mythology, you can see tumors and strokes, the tangles of dementias. There was no basis to it. That there was so compelling that it became enthralled. When i was in medical School Training with my supervisor, they would joke about how they have forgotten. Everything was focused on the psychology of the mind and psychotherapy and so forth. So psychiatry really went overboard. Then you have the people who , the 1st nobel prize given in 1929 doing austrian psychiatrist to developed malaria therapy. He would take the blood of soldiers that came back from being in tours of duty, take their blood and injected in the patience of men and women in order to induce a fever. The symptoms are temporarily improved, just like with autism. Sounds barbaric, doesnt it . That actually did not approve. What was happening was at the time as these were individuals read tertiary syphilis. Itsyphilis. It was the syphilis of the brain that produce the psychosis. Susceptible to hypothermia. Nothing happened except to got in the way. The infamous lobotomies. These guys were not sadistic. Three people who are completely out of control, but nevertheless the legacy legacy concept. The cultural concept is a little more complicated. Explain and alleviate symptoms and anything that is stigmatized or you can do that. Smallpox, tuberculosis, polio, cancer, aids. Develop a treatment and then the people look to psychiatry to do that and they did not. But there is one other thing that i think is important and distinctive about Mental Illness and psychiatry. The illnesses that affect parts of the brain that govern behavior and mental function are so intimate, who we are as an individual, as a person so that you are not you, if what you think isnt like an active reflection of your circumstances and reality and relationships than that just shakes the foundations of your confidence and your ability to sort of understand. It was and is difficult for people to suspend belief. It is an incorrigibly. Something that is completely inaccurate, unreal, that no one can talk about. So whether you say to somebody, your anxiety is due to unwarranted exaggeration of fear depressed not because of what your life is like but it is harder to accept that. How does someone in the military said have ptsd. A century after was 1st observed. Now, you know, we have advanced in this age of the difficult and unworkable cures to a period of a dangerous type of pharmacology, and agent which theyre is a general consensus when people think about psychiatry that a combination of drugs and therapy in the case of most people with serious Mental Illness can actually make a difference. Not cure by any means but can help maintaining control. Do you think that the medication, however, remains as much as an art as a science today . An equation between art and science. Maybe that wont be forever, but it continues to be. There wont be medicines will not be completely formulaic. Even the decisions are genomic they driven. Psychiatry more than any other discipline requires or has meant as an integral part of it as a human relationship. But with healthcare, financing the way that it is fortunately the human aspect of it gets tripped but there always will be, in terms of psychiatry, that is misleading. Modalities that are part and parcel to psychiatric treatment, talk therapy, pharmacology, medications, and then socalled neural modulatory therapy are brain stimulation therapy. And you cant stop. So the question is how do you stop it. We see serving electro and magically alleviate and these kinds of approaches and how do you do it without having to drill, usable and, i think, it was important that the psychiatrist or personal aspect of it is probably more integral than any other. All right, lets stay on interpersonal. In your book youve given a number of case studies of people youve treated. Why dont you share with our audience here a case someone whom you succeeded and with whom you think you might benefit . Well, theyre numerous. I could go on forever. A good friend of ours who who is aban elegant, sophisticated women who suffers from current depression. She didnt want to take medication because it made her gain weight. Ive been good for years and i dont need the medication, she stopped and subsequently relapsed and she could not get better. She didnt live here, she lived in the city where they had one of the best hospitals and went there and didnt get better and she was suicidal and her success ful husband didnt want to trade on friendship before but they did then and transferred her, he treated her and took a fair amount of adjustment of treatment that was a long period of time but shes now leading extraordinarily exciting and glamorous life with children and grandchildren and happy as a clamp. And probably wouldnt have happen if there hadnt been sophistication of modern 21st century psychiatry. These are all real stories but names are fictional. Elena who is the daughter of a famous celebrity, 20 years old, became psychotic and had to drop out of school, wouldnt accept the idea of a Mental Illness and ended up with schizophrenia and the family went their own way and she relapsed and thats the end of it, but if you see it tells the happy ending of the story, this didnt exist 50 years ago. It exists now. On the other hand, an operational hazard is you dont succeed with everybody. We dont have treatments for everything. We dont have a treatment for alzheimers disease, we dont have treatment and people with other conditions that is the minority of people. Any doctor has cases about mistakes they made and things didnt worked out like they hoped and one that has trouble, one that probably resinates the most was a surgeon that i treated, a very prominent surgeon, big guy, surgeons get pressed with pretty big eagle blow but he couldnt work and thoughts of killing himself. Finally his mother and wife to drag him in and treated him with standard antidepressant treatment. Theres a period of at no timuation treatment at least in the First Episode because increase of relapse over complete remission. And i relented and usually when people have a current of systems and they call you or tell you, never did, one night i remember i came home, and i got a phone call in the hospital saying that your patient and what happened is he took an overdoes, well, how bad it is . Very bad. He ended up dying, so relapse that couldnt do it without his own. His wife didnt notice or either didnt force him to come in. The other case that i would like to tell you is one of the most cig mytize and really devastating conditions on psychiatry. Affects young people. Every psychiatrist knows the difficulty in treating people that has severe forms of this. Earlier in my career there was a patient in the icu that was there of an overdoes that i took on and treated, early 20s, resuscitator and recovered and worked with him about a year and multiple medications and didnt feel like we made progress and she just quick, oh, boy, this didnt work out too well and sort of feared the worse. So 20 years later, after the book came out, actually i had written an article about suicide and your permission, bob, i get this email, dear dr. Liebermani read the article, you probably dont remember between the ages of 1530 i was mentally ill with depression and many suicides attempts and was frequently hospitalized. One of the times i took large overdoes. You were assigned to be my doctor and i clearly remember how much you helped me, you probably didnt see it that way but i gave you a hard time with my acting out and selfdestructive behavior. Eventually with a lot of freedom i was able to get myself together. I got married enrolled in Nursing School and graduated va valedictorian and i would have never thought it could have turned out so well. I have a Pretty Healthy life and i just want today let you know. Candidates need more psych pharmacology ever before. [laughter] i guess we should be positive and constructive unlike the candidates and ill just ask you if you had time with the next president , what would you suggest aside from increasing funding radically, which is what a lot of people would say, make it harder for you, what would you suggest that he or she does to improve the lives of those with Mental Illness . Actually i had an opportunity to do it recently, meet with Health Policy adviser to one of the candidates and the upshot was as i said, none of political strategist will tell you, but you should make Mental Health care a signature issue of the campaign and then final election would call a panel the Blue Ribbon Committee to develop a comprehensive plan to reform Mental Health system and financing in the country and deliver report, even though its not something that is identified like the economy or terrorism or gun control or global warming. Its a key issue. It resinates because everybody experiences it but nobody wants to talk about it. The good news is, you know, with a lot of things if you have als, alzheimers, if you have panceatic cancer, its not much that can be done. We need to wait for the next discovery but for the vast majority of mental disorders as ive defined them, we already have enough to make a huge difference. We just dont provide it in accurate accessible way, i think this is the only way that this kind of gets the attention, the media, public government is when theres Mass Violence incidents and some individual who is mentally ill and the untreated kills people. These are like the tips to have iceberg, glaring social pathtologies that occur as a result of a failed Mental Health policy. Whether its homelessness, mentalill people in prison, rising rates of Domestic Violence or Mass Violence thats occurring, suicide, the rate of suicide in this country has not gone down in over centuries. We dont take them seriously. Suicide is not a random event. Many of the people, the majority have seen a Health Professional in the month prior to committing suicide. The story in the news recently about depression, the story about this navy sale who committed suicide after pcsb and have been been duty and lost colleagues. This guy was at highrisk. So its really its a lack of social and political will more than a lack of knowledge and capacity. So you know, what is the motivation for a political candidate to take this on as a signature issue. Its not what will you do but how much harm will it do. Its interesting to me because you are seeing people in congress and some candidates, actually, because they want to of course, i have no opinion about this, not restrain access to firearms because they want to stay there, theyre now turn to go Mental Illness and Mental Health as the solution and theyre proposing to pour lots and lots money into Mental Health treatment, lots and lots and relative terms compared to the past. And i find myself conflicted, for a long time ive been on the side for those fighting for more money for Mental Health care, so even though some of us feel that the reason behind this, you know, its not guns, its its Mental Health, a false pretense, should we nonetheless just shut up and accept the fact that we may get more money out of it. Well, you spent a lot more time in washington than i have. Yeah, lucky me. My two years there has made me very cynical. You know, its hard to overstate the cynicism that drives behavior from the government. So the president has executive actions that he issued a couple of years ago, what is it that the government is interested visavis Mass Violence, these are the politically things, other than that, nobody cares. Four different bills in Congress Addressing Mental Illness. Theyre all the motivation for them all was new town, connecticut and violence. Some of them have good stuff in them and others less good stuff. In the mist of it for something to be done in response to addressing the violence thats perpetrated by some of the people with Mental Illness, the government issues executive actions. Restrict access to guns, im not against that, stricter background checks, put money into the rapid background check system but then he says we are going to focus on mentallyill people, two ways, one is we are going to put money into the Mental Health system, its good. Ly come back to that. We are going to have background checks if youre ever hospitalized for Mental Illness or if youre on Social Security disability for Mental Illness, those identities will be moved into the National Crime immediate background check system, so thats solely, you know, targeting people with Mental Illness, now any person thats criminology, i meant mean people thats been to aa. A lot of Government People have probably been to aa. You should shut up and accept that discrimination but since theres money attached to that, whats that money going to do. Its inadequate to interpret the amount. You know who its going to . Sanford. Explain that to me. Samsa is a washington term. The va doesnt provide health care, you know, hospitals, cities, counties, private hospitals too. Theres no theres no Health Care System but they do Mental Health care because Mental Health has deny disenfranchise, we have state Mental Health system and theres a federal that provides, samsa, its an acronym and they Fund Services in some states, provide certain kinds of services that they give money to. Treatment of the mentally ill. The money thats been put in which is this to ken token, mental disorder, 1. 2 billion annually an annual budget of 2. 6 billion which is wasted. If you go to the wasted at samsa and you look under the section that says evidencebased treatment, 265 different types of treatment. How can that be . How does the government allow that . This is like antipsychtry, antigovernment. They dont put the money there. Right. Okay. This is like donald trump is getting popular because hes expressing this frustration. Ill remind you some day about that about president trump. Theres a question from pat, he or she, i think its a she from clear handwriting, helping remove the stigma to bring about more treatment, a diagnosis fancy terms, addiction is clearly growing in this country. Right, and medical phenomenon. It was not recognized as a disease and thats to our shame and discredit. Like a moral failing and medical profession did nothing and all these selfhelp groups developed to their credit, to try and help people and they have, but finally, you know, medicine became engaged and we have a very good scientific basis for understanding how addictions develop and what we know is that probably 50 of addictions start as people who have some disorder, anxiety, depression, whatever who are selfmedicating and in the course of doing so become addicted. Thats the dual diagnosis, some people have simply constitutional genetic, vulnerability to addiction, in other words, if you takes 00 people and expose them to addicted substance, not everybody is going to have the same motivations to repeat use and repeat use so they can become dependent on. But what happens that after you use it, it changes your brain. So if you brake a bulb or ankle, it doesnt heal. The brain changes as a result of the alteration of the adductive substance and its how to identify people who may be at highrisk but also reverse those effects in individuals who have been addicted as really the scientific challenge and so i think, now that we have the problem in focus in a way in which to conceptualize the problem, and unfortunately the access of treatment is the problem. You have addiction and Substance Abuse clinics that are out here but you dont any necessarily in the standard epidemic Medical Center and you dont in the finance system dont allow that. If you go for treatment for your alcohol or Prescription Drug opioids or anything, at the same time youre going for treatment and depression and anxiety, you cant build two different types of treatment. So theres sort of these bureaucratic issues that have access to it. Through theres no question. Why is it growing . I think theres a lot about questions about that. One is we have a lot of Discretionary Income and we have culture which is encouraging feelgood but then you have other things which are more mysterious like the statistics that came out a few months ago by two economists that although survival and longevity is Getting Better and better, one group which is declining is middleaged males, white males and whats that all about . It must be a cultural factor thats impacting or encouraging them to be engaging in these selfharmful behaviors like drug addiction. Thinking that bacon is one of the basic four groups. [laughter] that too. Some people think eating. This is raw noncontroversial question, in your catalog of brain functions, you did not list gender, transsexual regarding Mental Illness, end quotes, do you have a physician in this controversy . Sexual identity and sexual orientation, again, talk about sort of fundamental issues that are neglected, the whole biology of Sexual Identity and orientation has been virtually unstudied and its something that we are now coming to appreciate because tolerance has progressed to the point that we recognize and also are coming more accepting of this, but the area of well, lgbt issues whether its related to social tolerance, insurance benefits, samesex marriage, child rearing, this has changed enormously like health care, how to address these issues is not progressed that far because there hasnt been an effort by a good scientist and clinicians to really focus on but this is beginning. We add colombia have established a division that focuses on sexual gender, scope of Healthcare Services specifically for the constituencies within the Lgbt Community which may be other constituencies of population are now tempting to be developed and taught. Its a huge progress, but we are at a very what i would call rutementary state. Its deny discriminated against, neglected against for so long, on the other hand u, its progress and moving in the right direction. Wehave another question, are Mental Illnesses being discovered or clustered . This person obviously went to business school, ie, depression, bipolar, et cetera . Thats an interesting question. I would say theres probably not new ones like zika virus. Who heard of zika virus before this year . No one. So ebola, aids, hiv, new illnesses do develop when it comes to disorders, i dont think we are going to be discovering many new disorders unless videogame disorder. Peeling the onion and diagnoses into more specific conditions and how we name them is another matter. I think theyll be greater day hes notically and also with the ability to use and effectiveness of treatment. We will end with a personal question directed at me that both of us will answer. John asks, what advice would you give to a young professional with bipolar who also wants to be, and this is in quotes, as successful as you, question mark . John, theres all sorts of ugliness. The advice that i would give to anybody that has an illness like bipolar and is trying to advance in the professional world is pretty simple, be as open as you can. The law does not permit employers to ask people about their Mental Illnesses during job interviews, but i made it a practice of always telling someone afterwards, after ive been hired who hasnt had the sense to google