Transcripts For CSPAN2 Sometimes Amazing Things Happen 20170702

My name is nancy widen, i am the owner of the strand along with my dad, fred bass, who usually can be found in the buying desk on the main floor. Ninety years ago my grandfather, benjamin bass, founded the strand on fourth avenue, right around the corner. It was an area that was known as book row. It ran from about the 1880s to about is about the 1970s, and at its height there were 48 bookstores. Today were till run by my family. Were the sole survivor of decades of big box stores, amazon, ebooks, and we hold our 18 miles of books of new, rare and old. And tonight i am delighted that were going to hear a truly inspiring story from the halls of the psychiatric ward that was born and bred right here in new york city. When a mentally ill inmate is too sick to handle, they are sent to Bellevue Hospital psychiatric prison ward. Dr. Elizabeth ford wrote about her experiences in this new memoir, sometimes Amazing Things happen. This is a place where problem our Society Faces with the incarcerated and mentally ill come together, and as dr. Ford pointed out last night on the daily show, amazing doesnt always mean good. This, im delighted that this important book is already number one on some biography bestseller lists. What . Oh. [laughter] [applause] so here to introduce can dr. Ford is dr. Howard owens who worked alongside dr. Ford in the department of psychiatric psychiatry at nyu school of medicine and sits on the board of directors at downton house. Hes going to tell us about downton house in a couple minutes. I want to say how much i deeply admire both of your work. You work in one of the most challenging careers possible, caring for those in our country that our country often abandons. So, please, join me in welcoming dr. O owens to the strand. [applause] all right. I want to thank you and the strand for our being here for this event. There are two reasons why im here. The first is because im a very old and dear friend of elizabeth ford, and the second is because im also an old friend of fountain house. Fountain house is an organization thats not quite as old as the strand. It was, it was first established in 1948 by a group of people who had been patients at the Rockland State hospital. And they came back to new york city and wanted to create a place for themselves where they wouldnt be shunned and stigmatized, where they would have their own place. One of the main problems for people who suffer from serious Mental Illness is that they often feel lost and that they have no place at all in everyday society. Fountain house on 47th street provides a place for people with serious Mental Illness. Its a place to form strong relationships, a place to pursue meaningful work, a place to pursue your education and a place where youre valued for what you can do and where the focus is on health and wellness and not on symptoms and illness. So the ultimate aim of fountain house is to help people be able to strive in society. If youre not familiar with this, we have a table over here that has literature or that can tell you more about fountain house, if youre interested. Now unfortunately, many people with serious Mental Illness dont thrive in society. As we all know, many of them end up being homeless on the street and, ultimately, many end up in jail as the only place that we have left to take careful take care of them. The book that were here to talk about tonight takes us into this place where Mental Health professionals struggle to help people with serious Mental Illness under very difficult and very stressful circumstances. Being in jail is an extraordinarily stressful experience for anyone, and to be mentally ill simply adds to the impossible conditions. So im going to be introducing you tonight to a person whos one of, who is as true a reformer as anyone youll ever meet. Someone whos devoting her career to working to improve the Mental Health care for people in our correctional system. Elizabeth ford is the chief of psychiatry for correctional Mental Health services for new york city, for the new York City Health and hospitals corporation. Shes also a clinical associate professor of psychiatry at nyu school of medicine. Now, since the after the events that are described in the book, at the very end of the book elizabeth describes how she went on to a new job which is her current position where shes the chief of psychiatry for the jails. And when she first told me that she was taking this job, i was worried. I thought of likers island reichers island as a place that grinds people down and burns them out, and i never had the ambition to actually go and work there. Be so, you know, i was concerned. As it turns out, perhaps i shouldnt have been to worried. I can say without exaggeration that i dont know anyone who could be better suited for the kind of job that she has at this point. Shes only been at rykers island for a relatively short time, but shes already published some quite amazing accomplished some Amazing Things there to improve the quality of care for the mentally ill people who are in jail. Now, the book tells the story that leads up to this point in her career. Its about the development of a young psychiatrist working first in the Bellevue Hospital emergency room and then in the psychiatric prison ward on the 9th floor of 19th floor of bellevue. And it takes you through all the trials and failures and hardwon battles for the early stages of her career as a psychiatrist. But i want to go back first to the first time i ever met elizabeth. I was at that time, as i am now, part of the faculty of the Forensic Division of bellevue and nyu. This is the point, this is the point in the book where she had finished her specialty training in psychiatry and was starting, and was starting her forensic psychiatry fellowship. The first time i met elizabeth i was impressed. And it wasnt just that she was a very smart and welltrained and very energetic young psychiatrist. There was another quality which struck me very early on, and that was she was fierce. What i mean by that is she was fiercely determined. Whenever she saw someone getting a raw deal or particularly when she saw mentally ill people who were not getting proper treatment, she had this fierce determination that something should be done about this to correct the situation. Think of the wonderful scene in the second alien movie [laughter] where the alien is about to grab the little girl, and Sigourney Weaver gets inside of this mechanical robot [laughter] a machine with the two arms, and shes going to take out alien. Thats elizabeth. [laughter] [applause] now, when you read the book, youll learn about many different battles that she fought along the way in order to improve patient care or for just simply basic human rights for people who were in jail in the hospital. But this brings us, you know, brings me to the second characteristic which is maybe even more important than the first, and that is the fact that when elizabeth decides to fight for something, she doesnt go into the mode of us against them the unfortunate usual approach that people have to fighting where you caricature the opponent so that you can beat them up. Instead, she looks at whats wrong with the system and comes up with ideas about how the system might be changed or how we might try to do something differently and then brings other people in who can be persuaded to give it a try and to collaborate and actually improve things. Now, youll see examples of this also in the book. Theres no doubt that there are some bad actors in this book. And not all of them are jail inmates. There are some people in the system who actually need to be removed. But the other thing that youll see in the book is the respect and appreciation that elizabeth shows toward people in the Corrections Department and individual correction officers who are good people and who are actually trying their best to do the right thing and people that you can collaborate with. Now, this, this brings me to the last characteristic which is really by far the most important and which i think is the main, the main heart of this book. And that is elizabeths tremendous empathy for people who, for many of us or for many people in society, people who are considered the lowest of the low or the dregs of society; that is, people with serious Mental Illness who are also criminals. Now, its very important that we not whitewash this and look at the patients as if, well, maybe theyre really nice people. In fact, many of the, many of the patients are people who have done quite horrific, awful things, whose behavior may be quite obnoxious, and thats the reality that were dealing with. So this is the problem for the psychiatrist. When you early in your career when youre being trained as a psychiatrist, one of the first things youre taught is that youre supposed to approach the patient with a, an attitude of neutrality. Which means among other things, what that means is your job is to help the potential the person with their problems, not to impose your moral views or your values on them. And, of course, in most of the practice of psychiatry, maintaining this kind of neutrality is not that difficult because, after all, most people dont do horrific things. However, when you come into the criminal justice system, you have to deal with that problem. Think, for example, of a person who drives a car up on the sidewalk up Seventh Avenue and runs over and kills a young woman and sends 20 other people to the hospital. What would it be like to have to be that persons doctor. Or if we went back to 19, went back to 1981 when Mark David Chapman killed john lennon and then was sent to Bellevue Hospital, this was before dr. Fords time, but he was sent to Bellevue Hospital to the prison ward as a patient. Think about the difficulty of being the eye chi tryst psychiatrist whos supposed to have this man as your patient. Now, its one thing to be able to say to yourself as a psychiatrist ill try to to maintain my equanimity here. I can do a careful evaluation, i can prescribe the appropriate medication if its necessary, and ill try to restrain my feelings and not show the contempt or rage or hatred that i might feel for this person. But heres the question. This is the question that is really the heart of this book. How to you manage to bring yourself how do you manage to bring yourself to actually care about that person . I think, again, if you read the book, youll see that dr. Ford has answered that question and made it clear how its possible, its possible to care in spite of some of the awful things that you have to teal to deal with. Now, there are stories in this book that are heroic, and there are other stories that are just mundane. The heroic stories are things like the time that the psychiatric staff in the prison ward had to manage and take care of the patients who were locked into the 19th floor during hurricane sandy. The hospital was flooded. The main electrical power went out. The elevators didnt work. The phone service went out. The toilets didnt work, and there was no regular food service. And the inmates who were psychiatric patients were locked into the 19th floor. The staff had to walk up 19 steps 19 floors just to get to where the patients were. There were a few days, they were really very harrowing and extremely difficult both for the patients and the staff. Dr. Ford at one point was bringing boxes of pizzas to the hospital that had to be carried up to the 19th floor so there would be something to eat. You probably all know the outcome of this story which is that the staff succeeded in getting all those patients out safely into other hospitals and didnt lose a single patient. The more mundane kind of stories, the one i really like the time that dr. Ford decided that the patients deserved to have decent clothing to wear when they had to go downtown to the criminal court to appear in front of a judge. This in other words and this, to me, represents a sort of basic Human Dignity issue. The concern was that the patient shouldnt have to shuffle down in front of a judge wearing hospital pajamas. And youll also read in the book about how that was accomplished. I want to close with a quotation. And since this is the strand, its a quotation from herman melville. And the reason im doing this is because i want to make the point that this is a true book. Melville said that the truest of all books was solomons book of ecclesiastes because it was made out of the fine hammered steel of woe. He went on to say that if a person dodges hospitals and jails and has to walk past, walk fast to get past graveyards, that man that person is not fit to sit down with unfathomably [inaudible] solomon. And then he says this there is a catskill ego in some souls that can alike dive down into the the blackest gorges and soar out of him again and become invisible in the sunny spaces. So i would submit to you that this book certainly does not hesitate to take you right into the the hospital and the jail, and the author is certainly a person whos gone down into the blackest gorges and, again, is still able to soar up into the sunny spaces. And, in fact, you can even see this depicted on the cover of the book. So for all these reasons, im suggesting to you, read this book. [laughter] [applause] thank you, howard. And, nancy, thank you very much. God, what a so im very humbled by this and very thankful to be here and was also told that reading from my book might be too boring, but im going to try it anyway just for a few minutes. So if it gets too much, just raise your hand x well continue. But i very much enjoyed the writing experience. It was very cathartic and therapeutic for me and a way to metabolize a lot of the stories that i heard from patients and things that i saw and personal experiences. And so i do want to just read a little bit about it and then, hopefully, field whatever questions you have. Any, any of them, fine. I may not answer them all to your satisfaction, but well try. And also to start just to let you know that the characters in this book with the exception of me are all deidentified. Not only the names have been changed, but many times ive changed the ethnicity, some of the criminal charge situations, some of the diagnoses. Its extraordinarily important to me to protect the confidentiality of my patients and, actually, was probably the biggest barrier in my ideas about whether to even publish Something Like this. But it became pretty clear to me after about a decade of this work that the pieces that were public published in academic journals and the policy discussions that were happening in the headlines and on the tv shows i dont think were getting really to the root of some of the challenges and were leaving behind the people. Not just the patients, but also the staff who really work in this environment. And i do fight, sometimes fiercely. And it seemed like if there was anything i could do to sort of further the humanity of the discussion, then i needed to do it. And this book is that result. It is also a book that is a narrative. I wanted to initially just write pieces about the patients, but then my very wise editor and publisher informed me that i really needed a narrator, and that was going to be me. And so it did turn into a memoir x the patients are very much a part of my high x. The staff and the staff, who ive worked with, are absolutely incredible and have also been very key to that. It does also mean that the stories its very hard to excerpt out them, because theyre all part of this one narrative. So ill try to introduce a little bit of what ive wrote and give you just a bit from the authors note to try to help to set the stage. For most doctors, working behind bars with patients whom others see as criminals, inmates, even bodies is not very appealing. The barriers to relieving suffering can be overwhelming, and the rewards can seep few and far can seem few and far between. Ive come to see my success as a doctor be e how well i respect and honor my patients humanity, no matter where they are or what they have done. The worlds described in this book, both the hospital and the jail it serves, are heartbreaking at times, infuriating at others and all compelling. These worlds can easily shape the lives of patients, staff or officers into hardened, angry and traumatized versions of themselves. The characters in this book, including me, have all been exposed and transformed in various ways. While some of the stories involve behavior by clinical staff and officers that may seem callous and even cruel, every action and word should be seen in the context of the whole system. A complicated tangle of courts, jail, laws, unions, bureaucracy and Public Opinion that struggles to support the men and women tasked with caring for and keeping safe a population that many would like to forget. The simpler and sometimes inevitable path for the staff is to absorb the chaos and culture and to decide that nothing can be done. The harder road is to fight every day to resist that transformation and find inspiration and hope in even the most dire situations. And so the book is a lot of stories about that. And then im going to read just part of a story that just to introduce. There are a couple of characters in here who track through the book, and im you wont hear their descriptions, but for reference, cynthia a composite of a number of medical students, and there are some officers in here and a few patients that have been introduced prior in the book. And this is leading up im just about to start a Group Therapy session on one of forensic units at bellevue. The room is on the Northeast Corner of the unit overlooking the east river. The expansive views make it seem larger than it is. A broken tv and a stillfunking stereo sit functioning stereo sit tucked in one corner. There are locked closets that hold the art, music and exercise equipment used in some of the other groups. The closet doors are decorating with patient art depicting scenes like family reunions, broken hearts and hopeful messages about getting out of jail. Some of the pieces are from a coloring book while others are original will originals that could be happening in a gallery. Cynthia, the medical student, and i quickly shove two oblong tables next to each other and arrange ten plastic chairs around the edges. I puck up a newspaper and a loose staple from the floor and then walk over to let the patients in. Most of them are strangers to me, but i recognize at least one. Its georgia mel, the patient who was literally trying to get out of his own skin, and who after he was released threatened one of the nursing techs when they ran into each other on the street. Seeing his face brings back his whole history in an instant. He looks at me with a big smile. Hey, docker how you doing . Ah, jamel, i say in response. He has put on weight and taken a shower, and his skin looks perfectly back. And just, sorry, as a side note, so this gentleman suffered from terrible schizophrenia. And early in my treatment with him and my introduction to him, hes this beautiful black man, and he was convinced he was white. And he would repeatedly peel off his skin in an attempt to prove that he was white. And so here i was seeing him years later, looking in a jail, is so not wonderful situation, but certainly looking healthier. Jamel laughs, oh, yeah, except im back in here again. But this is the last time, dr. Ford, i promise. I dont tell him how many times i have heard that one before. Everyone takes a chair, some close to the table, others as far away from the conversation as possible. A hefty black pa patient in a dorag pulls out one of the chairs for me and waits for cynthia to sit down before he takes a chair. Cynthia and i sit at opposite ends to that we can work off each of other and try to contain whatever emotions percolate up. She begins to speak first. Good morning, gentlemen. Welcome to the group. This is called dealing with jail, and we talk about anything that youd like to share or think useful to discuss about surviving in jail with Mental Illness. Lets go through the rules and some introductions, and then well get started. A couple of the patients recite the group rules, not very different from those in community meets, and then we begin introductions. Im dr. Jackson, a psychiatrist, says cynthia. Ann twain, mumbles the patient next to her. Jamel, manny, tyrone. Hey, i need to talk about my medicine, it antibiotic working. Okay, tyrone, well talk about that separately, says cynthia, motioning to the next patient. Arthur, campbell. Im dr. Ford, also a psychiatrist, i say. Sir, whats your name . I ask the last patient, one of wallflowers who has his head hung low. Im not sure he knows im talking to him. Arthur reaches out to the patient and taps him on the shoulder. Yo, man, whats your name . The patient looks up quickly briefly and then back down again. You dont have to to say your name, i add, but anytime you want to join us on the table, come on over. I sometimes see him looking around as if hes following the conversation. So, says cynthia, the floor is open. Anyone have anything youd like to share . The quiet feels strange in a unit that is always so noisy. It can be about anything, sixth ya prompts, hoping cynthia prompts, hoping someone will break the awkward silence. And still nothing. A minute slowly tick by before i open my mouth. I know its hard to talk about stuff in a group like this, especially when you in jail. When youre in jail. Did you know people with Mental Illness in likers island end up in the box, which is solitary confinement, more frequently and say in box longer . Or that they get beat up more often . How to you make it through a place like that . Youve got to man up, says arthur. No way to avoid fighting. Youve got to figure out whats worse, what you can do or what can be done to you. Its that simple. Yeah, thats true, campbell chimes in. Hes young compared to the others in the group. Theres other ways, says antoine quietly. I just stay out of everyones business, and no one bothers me. Ive been in and out of jail and prison so many times, and thats the only way to get through. I got to believe you, man, says jamel. He may still be psychotic, tense the add hence the admission to the hospital, but hes holding it well together for this group. I used to fight all the time about anything. Didnt no one disrespect me. But, man, im tired from all that fighting. It just keeps getting me back in the box. Manny sneezes. Oh, im to sorry, he fumbles softly. I didnt mean to interrupt. Im so sorry. Hey, man, that aint no big deal. Oh, thats to kind of you, says, manny. Please, please continue. Ill be quiet. Jamel and i are equally puzzled by mannys comments. I look at cynthia for help. Tyrone asks about his medication again, and cynthia deflects. The the conversation turns to drugs and alcohol when tyrone instead begins talking about getting arrested for smoking a blunt. Everybody except wallflower patient has manager to say about drugs something to say about drugs. May i Say Something minor, asks manny, during a pause. I dont mean to take up everyones valuable time in the group, i know i dont deserve it. Thank you so much for letting me speak. Jamel sighs in frustration. Youre fine, man, just talk. Thank you, thank you. Its just that i struggled with alcohol so long, almost 40 years now, and ive been sober since getting locked up. I hope so badly that i can stay clean when i get out. He seems more comfort basketball so continues talking. He tells us about being whipped against the wall as a 7yearold when he didnt do a good enough job cleaning up the mess from his fathers partying the night before. One morning he drank one of the glasses of orange juice not knowing it was filled with vodka. Manny said it didnt hurt as much to be whipped because he had drank alcohol. Thank you for letting me share, says manny. I know im not worth your time. I wrote these words and im still getting a little tearful. Manny, says jamel leaning forward in his chair, you are worth it, man. Youve got mad courage. You just hang on and keep going one day at a time. Thats all youve got to do. Jamel looks like hes about to cry as though no one has ever offered him kind words. Ann twain and tyrone look uncomfortable, but campbell nods in agreement. Yeah, manny, youve just got to take it one day at a time. Think about all those days youve survived already. I glance at cynthia to see if she is appreciating what is going on in front of us. Her eyes are wide and wet with amazement. We are witnessing a Pivotal Moment for manny, perhaps for the group itself, a collective responsibility to care for someone else. And no one wants it to end. So i chose that because, first of all, its short enough, and also i hope that it shows the potential and the, to my mind, sort of Amazing Things that can happen with this is a group of people all of whom have been incarcerated for which the exception of one drug crime, violet to offenses and all who had serious Mental Illness, and they collectively helped this 40yearold man who had really not dealt at all or talked about some very significant things in his history. And literally that moment, i dont want talk about the rest of mannys trajectory, but i can say he has not been back in the jail system that im aware of, and he was at least engaged in treatment when he was released from custody. And those, that may not seem like a huge deal, but in this world, like, any of those Little Things are really pretty phenomenal. So thank you very much. I would love to hear some questions and just have a discussion and just thanks. I mean, thank you for being interested in this topic. Okay. [laughter] questions . [applause] or just comments. Anything. Yes. If you have a question or anything or youd like to start a discussion, please raise your hand and i will bring you the microphone. Ill start off. If you had a wish list of anything that society can do to help psychiatric patients, what would be on the top three of your list . Ive thought of that question and come up with, like, 25 different kinds of top threes. [laughter] i mean, so i from my perspective as a psychiatrist, one of my first hopes, wishes would be really for the psychiatric and Mental Health Provider Community to really practice what were all taught, which is to listen nonjudgmentally to our patients and to approach them with as much empathy as we can drum up. I work with patients for whom sometimes it is very hard to feel that way, and i have worked in public systems outside of the jail as well where it really is not only sort of Public Perception that canning be problematic. It can also be a providers biases and misperceptions about a behavior or mote ill that can really motive that can really be destructive. So so i want us as a community to sort of reflect on that and to think about it. I would love to see decisions made about systems changes coming from the bottom up, so feedback from patients and consumers and staff rather than some of the topdown policy approaches that happen. And i think, in my mind, sometimes miss what can be very tiny but critical details in how a system and a plan or a program works. And then what would be my third . I mean, like, health care for everybody, i guess. Thats probably like one, two and ten. So, yes. Those would be my top three. Anyone else have a question . Hi. I have two questions. Thank you so much for coming here, both of you. That was really amazing, very interesting. So my first question is lo logistics about which patients ended up in the correctional unit at bellevue and how that worked. My second question is a psych resident, and even from my, like, two years in psych residency, i see how jaded a lot of my attendings can be and its something that really seeps into your care of all patients. Especially looking at the population. So how do you speak to other psychiatrists about that . Yeah. Good both, ones a relatively easy question, the other not so much. And also there are some people in the audience who actually still work on the bellevue unit, colleagues of mine. Im so grateful. So i have not been in bellevue for a couple of years, but ill tell you what i remember about how people get in there. I think its probably not so different now. So the forensic units at bellevue treat basically two different kinds of patients. Theyre all in the criminal justice system. The first group are those who are or arrested by the police and have not yet seen a judge. So theyve been picked up on the street, and theyre some point between the actual arrest and the time with the judge, and the police or sometimes its the defense lawyer, but usually the police will bring them in because they think theyre too sick to actually go in front of a judge. Those are police cases, and theyre prearraignment. That, at least at the time i was there, that made up about a quarter of the population. All men, by the way. Sorry, these are all men, and theyre 16 years and older. Although in several years itll be 18 and older, which is good. And the other 75 or so are male patients from the jail system who have already been charged with a crime, many of them not convicted, and they have serious Mental Illness for the most part or serious dangerous behavior. And usually you have to have both of those. So the Mental Illness, and you have to be significantly dangerous to yourself or other people. Because of those criteria, it is hard to get on that unit if you are safe and doing well, right in so it is and i think that is one thing to keep in mind in reading this book, that this is a very tiny representative sample of people with Mental Illness in the criminal justice system. Its very specific. And bellevue actually nationally is quite unique in terms of having this kind of hospital setting. Thats how people get in. Theyre evaluated in the emergency room just like in any other hospital, and the staff will assess whether the patients meet the criteria for getting in the hospital which can lead boo your second questions which is decisions about admission or not. Particularly in new york, the new york state laws are very doctorfriendly, i would say. Is so theres a lot of discretion in terms of how you can define Mental Illness and how you can define dangerousness. And so the decisions in the emergency room hope any are objective but sometimes can really be colored by how afraid the psychiatrist is, whether theyve had an experience with the patient in the past, whether theres some sort of threat or billion interaction that happens. I dont know of studies about this, but i am deeply curious about socioeconomic factors that may play into that and assumptions and biases. To your point about how hard it is to do this work and i think particularly in the Public Health system and public psychiatry system in new york city,s this is not unique to jails, it is extraordinarily noble work and very challenging. Taking care of patients who need, they need so much. They have not been for whatever reasons provided for or begin or taken what they need to be healthy. And when you i think it can be very hard for someone to be, it was very hard for me, it still sometimes is, to be sitting in front of someone who is asking you to, essentially, fix everything in their life in that moment and to do it quickly its an extraordinary task that no one can do. And i myself feel very helpless in that situation. And when i feel helpless, i start to get angry, and then i start to get angry at the person in front of me for being so nodety and why are they coming to me needy. Dont they know i cant fix everything. At least for me if i experience that enough over time and im not addressing it and working out through my own therapy which i continue to be in it can be very destructive. And i think also that if collectively the psychiatric, i mean, youre talking about being a resident. I think collectively if the psychiatric Training Staff are not in some way talking about this as a group and being mentored and nurtured about these very real phenomena that happen, then you run the risk of feeling ashamed about it, feeling deeply angry about it. And that, unfortunately, gets played out with poor patient care. So i appreciate the question. And, i mean, i dont have a i think everybody probably has an individual sort of thing that will work for them, but the first has got to be to talk about it. I dont know that theres a human being alive who thinks everybody is wonderful and, you know, doesnt have feelings about them when they meet them. We just have to acknowledge them. Any other questions . Be dont worry because you think im far away. Ill do my best to get to you. Ill go to the front and then wrap back around. Hi. Where am i . Oh, okay. [laughter] i have a question about how do you feel, like, being a woman in this career and in this specific job . How do you think that affects your work, and how to you think that affects the results . Yeah. So thats a good question, and i when i started in this work, there werent so many women in the field. There are, thankfully, more now. This is, you know, i a started this about 17 years ago. I think, so i think anybody regardless of their gender, orientation, anything, can be empathic and be a phenomenal be doctor. I dont think it matters if youre a man or woman, any of that. But i do think particularly in a jail setting there is a little bit of a code like you dont hit a woman, which i have felt sometimes makes me safer. I think sometimes im deluding myself, by the way, that im safer. But theres that, because i work with men. And theres sort of a respect for the mother figure, a respect for the girlfriend, for the baby mama, the women who have brought children into the world. Alternatively, however, times there are deepseeded angry feelings. So i am whether i seem like a mother or not, i am automatically almost a mother figure just by being a woman. I find that enormously helpful because it can bring up a lot of things to talk about with the patient, and many of them have conflicted, if not negative relationships with their mom. Some of them have wonderful relationships. That, unfortunately, is not as common as i would like. But so theres that piece. And then i do write about in the book the whole issue about being pregnant and dealing with that. I felt like i was pregnant or postpartum for 18 straight months when i was on the unit there. For the most part, the patients were very protective and kind and always were asking me what i needed even if they couldnt get me anything. And i there was one patient who would just escort me wherever i was going. I mean, he was lovely. And before i was showing, he was not very lovely to me. But all of a sudden i became this sort of woman who could, you know, give birth to life, and it became manager different for him. But there were also patients who were very, very scared of me leaving and abandoning them. I have now learned that once you deliver a child, you cant predict what youre going to want to do with your career or how things will shift. Now i actually see their worry as a little bit more realistic than what i had thought initially. But i and i also never thought, id get asked sometimes because it was such, and i think it continues to be such a maledominated field for forensic psychiatry whether ive felt like there are barriers for me. And i havent. I havent m im also the older child of a diplomat and a psychologist, and i feel like that sort of combination has just allowed me to feel like i can to whatever i want even though, frankly, i know that i cant. [laughter] thank you. We had a question. Hi. How do you feel about Mental Health care will be affected by the current Political Climate . Thats a good question. I also work for new york city now, so sort of weigh in about new york city political stuff. I probably wont do. I think anything that anything political regardless of whos running our country that pushes tolerance sort of more to the back burner, that leads to shifts in health care and that at least what appears to be is leading to criminal justice policies that are more stringent and strict like mandatory sentencing. Any leadership that heads in that direction is going to be highly problematic. And ill stop there. We had one other question back here. Hi. Im a child, adolescent and grownup psychiatrist for the last 35 years or so from oklahoma. And my, i had a comment, first of all, about being a woman in psychiatry, in the forensic field. Oklahoma locks up more women than any place in the world. We have the largest incarceration of women than anywhere in the world. Thats just a comment. I have right now what i do for work is i see people on federal probation, and ive done this for a number of years. So i see, what i see with people is, of course, trauma, family trauma. Drugs and alcohol in my case, particularly meth is a big problem. And a horrible problem to me is isolation. I see so many people, were talking about being out of a cell for 13 hours a day. I saw a man not too long ago whod been inslation for a year and a half in isolation for a year and a half which, to me, is torture. And i dont know the answer to because if youre loose in the community, if youre in the Prison Community or jail setting, its because youre either violent and youre always in fights or because youve been involved with gangs or in some situation where youre going to be killed. So what do you have any ideas about how we cannot isolate people and cause more trauma because i see people who are more traumatized yeah. And i think youre referring to solitary confinement. Yeah. So anything that restricts people to that degree is not healthy. Theres no question. I have, i do think there are ways to address that, and were actually in i currently work in the new york city jail system at Rikers Island, and despite some bumps in the road, the restrictions on solitary confinement sorry, the regulations have become so much more significant such that people cannot be in for more than 30 days which is very, which is important because two years ago people were serving 800day sentences in solitary. So it can be done. The trick is to make sure you are replacing that with something officers will buy into. Because this is a system that its not a health care system, it is a criminal justice system. And however we may whatever my personal feelings are about what jails and prisons should be, they exist right as they are at this moment. So no change will be effective or helpful without the buyin of the corrections staff. And at least in my experience, they have to feel safe. So to they have and for many of them, solitary confinement is much safe or. Not for the patients, but for the staff. And i think its i do think its naive to think that people are not considering their a own safe i in these kinds of safety in these kinds of decisions. So the critical piece to make sure theres something in place that they can understand and appreciate. And what we did at Rikers Island with one unit and took it and switched the dynamic of one from punishment to positive rewards. And so every time somebody did a good thing, they got a reward. And everybody was locked out. Theres no isolation. These were the patients who were serving very, very long sentences. And the violence was, like, cut in half. I mean, it was a much calmer unit. But it took about six months for the a officers to even believe that this kind of thing worked. And so the way we the things i think that may be helpful are trying small issues and then trying to grow that into the system. But it is very, its very complicated. And people feel very strongly about solitary con findment both that its confinement both that everybody should be in there versus nobody. And, unfortunately, i dont think were going to find the solution if we stay on either end of the spectrum with the issue. So thank you. We have time for one last question. Loved this evening. Is there an official partnership between town tape house and rikers fountain house and Rikers Island . That is an excellent question. I dont know. I love the idea of but thats a good idea. [inaudible] talking about integrating with everything youre talking about and really appreciate everything youve brought here this evening. A short one if theres maybe one last short one . Anyone else . No . Heres one. Could you Say Something about, first of all, it was a fabulous book. Thank you. Really fabulous, and i really enjoyed it. Thank you. I wonder if you could Say Something about what it was like working with some of the guards on the unit and how that impacts on the care youre trying to deliver. Yeah. So the first thing i learned is not to call them guards. So theyre correction officers. Okay. And actually, so im going to go a off on a tangent here, but language is extraordinarily important. Its important in anything, but particularly in the system. And the words you choose show how much respect you have for the people that that you are around. And so that was an early thing for me to learn. But the officers are the ones who are around the patients more than anybody else. Its different, its different in the hospital than in the formal jail system, because there are many more hospital staff and their nursing staff around also in the hospital. In the jail its much more just officers. But i went into the work thinking that, i mean, this is embarrassing to say, but whatever, its all about selfrevelation, i supposes. I thought that people became Correctional Officers because they wanted to beat people up. I really thought those that chose that kind of work sort of had it in for the inmates, and this was some way to act out aggression that had happened to them, something. I have, like, completely 180d on that. 100 x. That development happened in my time at bellevue, and its also been fostered at Rikers Island. Almost i actually havent talked to anybody for whom this is not true. Officers go into this work because they actually want to help. They want to help people. And there are different ways and approaches to helping people. And some of them feel like theyre helping the community at large because theyre sort of keeping these dangerous criminals out of the streets. Some of them are bornagain social workers and want to be, like, they really feel like if somebodys in their custody, theyll be able to have them, provide treatment, you know, someone cant walk away from you when youre in jail. Like those kinds of things. And there are some officers for whom this is a, its a source of great pride, to be part of this, like, Paramilitary Organization thats the boldest, right in they call themselves new york citys boldest. And i think some of them are very proud of that. What happens, and im its or very troubling to me, i feel like this has got to be the next step somewhere. What happens to the officers and i think what happens to the health staff also over time is that in this very broken system all that good stuff shifts. And i mentioned it a little bit in the beginning. But people change when they are chronically afraid and when they are chronically angry and when theyre mistreated and when they dont feel supported and when theyre not paid enough or they dont are are employee health. Like, all of these things dont have employee health. All of these things shift the way you behave. And if thats not tempered in some way, it can really run amok. But i really have found, howard alluded to this. I wasnt always a come promiers, by the way. And actually, my husband would disagree with you, i think, that im a compromiser. But what i have learned is that we actually share a lot of things, the officers and health staff. We basically want people to be safe. We want people to be safe. We may have different approaches to that, but if we can share that goal and Work Together in our different ways to get that, everyone is happier. When the officers are safe, theyre so sweet. Same with the health staff. When the health staff are safe, theyre great doctors. So weve got to find that kind of shared ground. Well, thank you all for your questions and, dr. Ford, thank you so much for spending the time. Youre welcome. I appreciate it. [applause] heres a look at some of the current best selling nonfiction books according to the Washington Post our look at the best selling nonfiction books according to the Washington Post continues. Of these many of these authors have or will be appearing on booktv. You can watch them on our web site, booktv. Org. They had the idea where they would, they did a marketing gimmick where they created fictitious brands of cereal because they wanted to pitch themselves as an air bed and breakfast, the name of the company then. And they did this whole thing where they made these two cereals, captain mccains and obama os for obama. And they were quirky, and they sold them for 40 a box at collectors editions, and they ceded them to the press, and they were right. They ended up making 30,000 from the cereal. Now, that didnt turn the company around. In fact, brians mother called him at one point and said, i dont get it, are you a Cereal Company now . [laughter] and he didnt know how to answer that question. And that was the most guesting thing, because depressing thing, because technically they were making a hot more money on cereals than the business. Ultimately, one of their advisers said you guys have to aplay for an Accelerator Program in silicon valley. Its very highly regarded. And the three founders said we launched, we dont need to to go. And he looked at them, and he said you guys are dying. You have to go to y come by nateer. So going gave them and it was the cereal that got them in, because paul grange who ran it at the time and who was a very tough critic, he didnt think it was a good idea either. He said, whats wrong with people . They stay in peoples homes . Thats crazy. But on the way out, they happened to mention they sold all this cereal, and he said, what . If you can convince people to buy cereal for 40 a box, you can convince people to sleep on other peoples air mattresses. It was the advice which was go to your users and shower them with love. They didnt have any users, but the ones they had were all here many new york, and they didnt even think about that. They literally sat with them for hours on end and watched them use their product. They realized that they didnt know how to post photos very well, they didnt know how to write listings in a way that made them appealing, is to they sat with them and helped them merchandise their listings and dress them up and gussi them up a little bit. And doing that they saw their numbers after a few weeks double. Doubled from a very low base, it was still a long journey, but thats what sort of thats when the kind of turning point hit. Youre watching booktv on cspan2, television for serious readers. Heres our prime time lineup that all happens tonight on cspan2s booktv. And now, heres henry olsen. [inaudible conversations] good afternoon, everyone