Mysteries of Mental Illness (2021) s01e02 Episode Script

1
♪
MIA YAMAMOTO: My story
starts off with understanding
that I was not
like everybody else,
so I thought
of course I was sick.
I was mentally ill.
And I believed it
for probably half my life.
Today, I feel quite different,
but when I first
went into therapy,
it was, like,
"Somebody, please
solve my problem."
And I spent a lot of years
in that state.
♪
(compact closing)
This one here,
I think that's me over
on the left-hand side here
pretending like I'm happy.
My identity was, at
a very early age, female.
I could see the world
through my sister's eyes,
through my mother's eyes,
far better than
I could understand
the world of my father
and my brothers.
I could hear my father saying,
"Well, he's just
going through a phase.
Mike's gonna grow out of it."
And my mom saying,
"Well, maybe we should
take him to a psychiatrist."
And when they realized
how much it cost,
that idea was
never discussed again.
(chuckles)
♪
I felt completely alone.
And that feeling persisted
until I read about
the first transgender
sex change operation,
which occurred in 1952.
The headline was sensational,
but for me, it was an epiphany.
And so I got the paper,
and I remember going in
to my mom,
where I show her the paper,
and I'm saying,
"Look, I'm not the only one
who feels this way."
And she looks at me,
looks back down at the paper,
and she just puts
her head on the ironing board
and starts crying.
And, um
Determined I would never
do that to her again.
I spent years after that
trying to figure out
what was wrong with me.
♪
♪
NARRATOR:
What is mental illness?
For centuries,
religion offered
spiritual answers,
while science looked to the body
and the mind.
Today, genetic breakthroughs
and neuroimaging
provide tantalizing clues
into the roots
of mental disorders.
But a simple answer
for who is
Or isn't mentally ill
remains elusive.
RONALD BAYER: It would seem
to be pretty straightforward.
Sick is sick,
healthy is healthy,
what's the big deal?
But it turns out
that in psychiatry,
the boundary between illness
and sickness is very fluid.
SUSANNAH CAHALAN: Where
do we draw that illness line?
What is abnormal,
what's normal behavior,
what's illness,
and what's the kind of,
you know,
broad swath of
what it is to be human?
NARRATOR:
There are no biological tests
to diagnose mental illness,
complicating the question
who's normal
and who's not.
KEITH WAILOO:
Societies decide
what constitutes
behavioral norms,
social norms,
and where
the lines of deviance exist.
♪
MICHAEL WALROND: God,
we bless Your name on today.
We bless Your name on today,
oh, God.
The hardest thing to do
is to feel like
you are walking through
the valley of
the shadow of death
and there's no one with you.
You've been constant, oh, God.
But most of all, oh, God,
You've been consistent
in our lives.
So, God, we bless
Your name right now.
In my 20s, I began to experience
bouts of depression.
I never sought help,
because that was not part of
the common conversations
that took place in my community
growing up
or in my house coming up.
In my 30s was the first time
I had any suicidal ideations.
There were numerous days
where I didn't want to preach,
I didn't want to teach,
I didn't want to talk to people,
but I felt like I never had
the option of not doing it
because of the weight
and responsibility of my call.
And so like so many people
who battle with
depression and other conditions,
you suffer in silence.
'Cause I didn't want
to be labeled.
"Nothing is wrong with me,
I'm a pastor."
To say that, "Oh,
I'm going to see a therapist,"
is tantamount to saying,
"I don't trust God can do it."
"I don't believe
that prayer can do it."
And no one wants to say,
"I don't trust God
and I don't believe in
the power of prayer."
♪
But it became torturous
that people saw me as
representing
some level of healing,
and yet I felt no resolution
within myself for that.
And it took a long time
for me to actually reach out.
And I remember going to
that first therapy appointment
with all sorts of walls up,
not wanting to admit that
something was really wrong.
Because as a Black man,
there's not a desire for
one more label.
Oftentimes, there's a,
a dangerous reductionism
that takes place.
The individual
becomes synonymous
with the thing they're
wrestling with.
So that when you
see me, potentially,
you don't see me,
you see my thing.
You see,
"Oh, he's depressed."
"Oh, he's Black."
♪
NARRATOR:
Labeling as "other"
has deep roots in
American history.
The 1840 national census
included a new category
to count the mentally ill.
At the time, many Black people
were escaping slavery
and settling in the North,
and for some observers,
their new freedom didn't
seem "normal."
WAILOO: The census of 1840 is
a quintessential example
of how social judgment and
medical judgment
are intermarried
at a time when slaveholders
are arguing
that Black people are incapable
of managing themselves as
free people,
and at a time when others
in free societies
are asking whether
freedom itself
creates certain challenges for
African Americans.
NARRATOR:
With no clear standards,
white marshals decided
who to label mentally ill.
Free Blacks in the North
were identified as insane
ten times more frequently than
those enslaved in the South.
In many Northern towns,
all the Black residents
were counted as insane.
To critics,
the bias was obvious.
But to pro-slavery advocates,
the census was evidence
that freedom made Black people
mentally ill.
The Medical Association
of Louisiana
endorsed this view with
a self-serving new diagnosis.
ANGELA COOMBS:
In the 1800s,
you see an illness
called drapetomania,
which was described
as an illness
that led enslaved people
to seek freedom.
So instead of people saying,
"Okay, these are human beings
who are trying to be free of
being enslaved,"
it's conceptualized
as an illness.
And of course,
the treatment for it
was to be whipped
and to be beaten.
♪
NARRATOR:
Drapetomania highlights
enduring questions in
psychiatry:
where is the line
between cultural judgment
and medical diagnosis?
Are psychiatric labels
helpful or harmful?
COOMBS: When we look at
who gets labeled
and what the service or
functioning of that label is,
that's what's really meaningful.
Are we saying
and diagnosing people
to get them a recovery-oriented
and humanizing kind of care
that, that, you know,
really affirms people's
humanity?
Or are we using it in a way to
treat people as less than human?
RYAN MAINS: I didn't
think mental illness was
something that happened
to normal people.
When I thought of
mental health issues,
I thought of the stereotypical,
straitjacket,
padded room-type things.
You know, somebody, uh,
like, in a vegetative state,
on meds, just laying in a bed.
NARRATOR: Ryan Mains is
a veteran and first responder.
Like many,
he has struggled to accept
his diagnosis of
post-traumatic stress disorder,
or PTSD,
and its associated stigma.
MAINS: There's a term in the
ultra-running community called
"brutiful," combination
of brutal and beautiful.
(chuckles):
And I so much love that term.
It's pain and it's glory
and it's, "How long
can you push yourself?"
My next run is going to be
130 kilometers.
That distance specifically,
because
over 130 firefighter-paramedics
died by suicide last year.
That's not something
that's known.
That's not something
that's talked about.
NARRATOR: Ryan served
in the Army for four years
and was a frontline medic during
the U.S. occupation of Iraq.
When he returned home,
he joined the fire department in
Woodstock, Illinois.
MAINS:
That's when it kinda hit me.
♪
I'd have intrusive
thoughts about my time in Iraq.
(faint explosion)
You just, you see things
that are hard to forget.
(siren wailing)
And, um, they'd kind of
overlap with intrusive thoughts
from things
that happened at work.
I would lose my temper
and start yelling,
and that happened a lot,
and I didn't see it at the time.
I started avoiding work,
calling off sick for
a few shifts.
NARRATOR: When a fire department
counselor diagnosed PTSD,
Ryan rejected the label.
I said, "Go (bleep) yourself.
That's not for me."
I had a tremendous amount of
shame.
(sighs)
What I didn't realize was,
I was just setting myself up
for a bigger fall later.
NARRATOR:
More than a century ago,
millions of soldiers like Ryan
endured trauma,
and their struggles forced the
nation to confront the question:
who is normal and who is not?
(artillery and guns firing)
After the brutality of combat
in World War I,
many who escaped physical harm
still appeared damaged.
Doctors referred to
their mysterious condition
by many different names,
and wondered:
why were only some soldiers
exhibiting
a debilitating reaction?
ANNE HARRINGTON:
A lot of the young men
presented with
physical symptoms of paralysis,
or mutism, or blindness.
We would call it trauma,
we would call it PTSD.
NARRATOR:
Doctors searched for the source.
Perhaps explosions caused
tiny tears in the spinal cord.
Or cerebral hemorrhages.
But the brain was still
mostly a black box.
X-rays, surgery, and even
autopsies provided few clues.
As World War II dawned,
the military was determined
to weed out vulnerable recruits.
But how?
Without any reliable
physical tests,
they turned to the mind
and the work of Sigmund Freud.
ALLEN FRANCES: World War II
to a very strong degree
was a legitimization of Freud.
Freud's theory
was based on the fact that
the combination of
instinct and experience
dramatically influences
our lives.
But these are not always
available to consciousness.
And a lot of the things we do
we do for reasons
we don't begin to understand,
for motivations
that are not accessible
to our conscious thinking.
NARRATOR: Freud died just as
World War II began,
but his ideas had
revolutionized psychiatry.
He believed
there wasn't a clear line
between mental health and
mental illness.
Everyone lived on a spectrum
because the conscious mind
was always in conflict
with unconscious desires and
repressed memories.
If unresolved, this conflict
could cause neurosis,
which he claimed was often
the root of mental illness.
Practitioners of
Freud's theories
called themselves analysts
and used his
talk therapy techniques
to treat these neuroses.
MAN (in film): Psychoanalysis is
a long and difficult process
of reconstructing
from fragmentary recollections
a picture giving the patient
a correct insight
into the forces at work
within him.
JEFFREY LIEBERMAN:
Beginning in the 1930s,
every major department of
psychiatry in the country
was chaired by an analyst,
and every president
of the American Psychiatric
Association was an analyst.
NARRATOR:
Analysts developed a system
to help the Armed Forces
evaluate soldiers
in an effort to prevent
psychiatric casualties.
HARRINGTON: Not everybody
in World War I broke down,
but some did
What's the difference?
So if you could identify the
pre-existing vulnerabilities,
you could maybe then avoid a
repeat of the, of what happened
in the First World War.
Maybe the people that have
the combat neuroses
were fragile to begin with.
People really started to
talk about things like this.
MAN (in film): You will be
interviewed by a psychiatrist
along with all the rest.
They've got to know how you'll
adjust yourself to the Army
if you've got what it takes
to make a soldier.
FRANCES:
Freud's first theories were
that childhood trauma is
a precursor to mental illness.
Psychiatric problems
came from family trauma.
HARRINGTON:
They would ask questions like,
"Do you wet your bed?"
Ask about your relationship
with your mother.
"Do you find yourself getting
irrationally angry?"
Do you like
going around with girls?
HARRINGTON:
Being homosexual was believed
to both be a mental illness
and also be potentially
a disciplinary problem
in the military.
BAYER: In the
psychoanalytic worldview,
the normal course of development
was, you passed through
your bisexual phase
into your heterosexual phase.
So that becoming
homosexual meant there was
sort of an arrest in
the developmental process.
NARRATOR:
Using a list of potentially
"pathological" behaviors
and "neuroses,"
psychiatrists rejected
one out of eight draftees
nearly two million men.
But the screening strategy
didn't work.
(bombs roaring, guns firing)
ANDREW SCULL: During
the Second World War,
America's psychiatric casualties
were double and triple
what they'd been in World War I.
And in combat situations,
sometimes half of
all the casualties
were psychiatric casualties.
(mumbles): I just can't stand
seeing people killed, sir.
I can't hear you.
(louder): I can't stand
seeing people killed.
Did you see people killed?
(voice trembling):
Lots of them.
- What?
- (louder): Lots of them.
NARRATOR: The
battle-weary soldiers proved
it wasn't so easy to predict
who would or wouldn't
be vulnerable to trauma
on the front lines.
PSYCHIATRIST: What I'm
going to do is send you back
to another hospital,
where you can get more rest
and more treatment.
NARRATOR:
But the military once again
entrusted psychiatrists,
this time to rehabilitate
these psychologically
wounded soldiers,
and commissioned films to
convince the country
the right treatment would
help them return to "normal."
A display of emotion
is all right.
I'm not doing this
deliberately, sir,
- please believe me.
- Of course you're not,
I do believe you.
HARRINGTON:
All this is being filmed
to convey this message of,
"Psychiatry
knows what it's doing,
and there's nothing to fear
with these men."
MAN (in film): Under the
guidance of the psychiatrist,
he is able to regard his
experience
in its true perspective
as a thing of the past,
which no longer threatens
his safety.
♪
HARRINGTON:
And at the end,
they all go back to,
allegedly, a happy life.
What's not to like?
YEHUDA: People really
believed that soldiers
could start to sort of
take their place
back into a society
that they left.
What they didn't realize was
that the effects of combat
could last in perpetuity,
could last for
years and decades,
rather than for
weeks and months.
NARRATOR: The camera crews
didn't follow these vets home
to see how they adjusted
to civilian life.
But the message was clear:
they should be able
to overcome their trauma.
This message reverberates today,
and fuels stigma
for millions of PTSD patients.
(indistinct chatter)
MAINS: I have a lot of
self-stigma
about my diagnosis
and my struggles.
Irritability, poor sleep,
rash decision-making.
When I started
to have those feelings,
I just ignore it.
(siren blaring)
But the thought of being on
an ambulance was overwhelming.
I was unable to find the
motivation to do anything,
to bathe,
to take care of myself.
You know, I'm laying in bed
with suicidal ideations.
NARRATOR: Like many traumatized
veterans and first responders,
Ryan spent a few weeks at
a psychiatric facility
specializing in PTSD.
MAINS: At the time,
I thought that I was cured.
But it's pretty peaceful there,
and then you
come back to real life
with your kids and,
and work, and bills, and
It was a pretty rude awakening.
All those dark, empty feelings
started creeping back.
The therapist at work told me
that I was unfit for duty.
I couldn't go back.
Now it wasn't just,
"I need to take some time
to get myself right."
It was,
"I can't do the job anymore."
It reinforced
some of that stigma.
NARRATOR: Ryan is
one of many military vets
to feel responsible for
his inability
to overcome his
traumatic experiences.
World War II psychiatrists
contributed to
this misconception.
One of the ways
psychiatry persuaded
its military superiors
during the war
that it was doing
such a great job
was, it produced statistics
on how wonderfully it was doing.
Those statistics
were made up and bogus.
NARRATOR:
Military psychiatrists treated
more than a million soldiers
for psychiatric disorders.
Some doctors claimed
a cure rate of more than 80%,
but fewer than one in ten
actually returned to
active duty.
SCULL: And yet,
for the military,
psychiatry was seen as
one of the success stories.
And those early military
classification systems formed
the foundation for,
after the war,
the American
Psychiatric Association
beginning to create
a system of diagnoses.
NARRATOR: In 1952, the American
Psychiatric Association,
or A.P.A.,
published the first edition
of what was to become
the bible of the field:
the "Diagnostic and Statistical
Manual of Mental Disorders."
The DSM attempted to
standardize diagnostic labels,
but it became a repository
of how the profession,
and the culture of the day,
viewed mental illness.
The first DSM briefly described
nearly 100 disorders
and drew heavily on
Freudian concepts
of neurosis and psychoanalysis.
MAN (in film): the patient
freely associating ideas,
dreams, memories, under
the guidance of the therapist,
until underlying conflicts are
identified
NARRATOR:
This approach relied on
each practitioner's
interpretation
of each individual patient.
SCULL: Oddly enough,
psychoanalysts didn't
believe in putting people
into different boxes.
MAN (in film): Tell me more
about what you are thinking.
FRANCES: People could
see the same symptoms,
but diagnose them in
different ways.
So, diagnostic reliability
was close to zero
because everyone
had their own ideas.
NARRATOR: As always, these ideas
were shaped by culture.
In the face of
the perceived communist threat
during the Cold War,
the nation embraced patriotism
and conformity.
HARRINGTON:
This is a period when
people are obsessed with
being normal.
Freudian-inflected psychiatry
intermingles with a lot of
social conservativism
and sometimes gets called
into service
of that social conservativism.
MAN (in film):
Parents who are mentally healthy
bring up their children
to be mentally healthy, too.
Take Tommy Clark there.
NARRATOR: Psychiatrists
latched onto the notion that
early life experience
shaped personality
and could lead to neurosis.
And while Freud believed
most people lived on
a psychological spectrum,
the DSM tried to make clear
who was normal
and who was not.
The feeling of
being born in the wrong body
was so far outside "normal,"
the DSM and psychiatry
didn't even have a label
to describe what people like
Mia were experiencing.
YAMAMOTO:
You are a sexual deviate,
which nobody in society
likes very much.
There were a lot of years
where I was trying to figure out
some way to just kind of end it,
because every single person that
tells you you're crazy,
so you feel like you
don't belong in the world.
This is another picture
from my unit in August 1966.
Um, that's me.
NARRATOR: Mia enlisted in
the Army during the Vietnam War,
when she was 23
and her name was Mike.
YAMAMOTO: The military always
seemed like a beacon to me.
It was something that I could do
that would satisfy
the demands of the male gender.
If I had lost my life in war,
that it would be an
honorable exit from this life,
my family would
never learn my secret,
and people would honor
my memory.
This impersonation,
I took it a long ways,
and I got as far
as I could go with it.
NARRATOR: Society wasn't ready
to accept Mia's reality.
(protesters chanting)
But the Vietnam War sparked
a historic cultural shift
and a protest movement
that would alter
how psychiatrists understood
who was "normal"
and who was not.
MAN (in film):
One out of three of you
will turn queer.
If you don't get caught by us,
you will be caught by yourself,
and the rest of your life
will be a living hell.
LAWRENCE HARTMANN: Young people
now can hardly believe
that gayness was considered
a major illness and crime
to the extent that people
who were gay
couldn't let you know
they were gay.
BAYER: There were laws in
the United States,
across the United States,
they were called sodomy laws.
If two men were caught
having sex together,
they could go to jail.
So psychiatry took shape
under those conditions.
MAN (in film):
Your feelings do change
to some degree
from time to time.
There have been periods
when you've felt
- Mm-hmm.
- Quite strongly
- heterosexual in your interests.
- Mm-hmm.
HARTMANN:
Even though Freud had taken
a more agnostic point of view
about gayness
Freud had said,
"We don't know, really,
but we're learning something
about it"
psychiatrists and analysts
tended to consider gay people
as deeply sick.
NARRATOR: In mid-20th-century
conservative America,
one renowned psychoanalyst
and psychiatrist
was Charles Socarides.
The aim of the homosexual act,
paradoxically enough,
is to seek masculinity.
He is attempting
to achieve the very thing
that he felt he was so lacking
in childhood.
BAYER: Socarides believed
that people became homosexual
because they had overbearing
mothers and distant fathers.
So he was the person who said,
"Our goal as psychoanalysts
"is to make them happy
and to make them fulfilled
"and to allow them to be the men
they were born to be,
"which is to be straight
and to have heterosexual
relationships."
SOCARIDES:
The whole idea of saying
"the happy homosexual"
is to, again,
to create a mythology
about the nature of
homosexuality.
HARTMANN: Socarides said that
he had
treated and cured hundreds of
patients.
I think that he was a scoundrel
and a liar.
I saw several of the patients
that he thought he had cured
whom he had not cured.
♪
Those of us who wanted
to reform psychiatry
and gayness got some of our
courage
from Vietnam War protests,
women's rights,
and Black civil liberties
protests.
We said, "Is psychiatric
labeling and diagnosis
simply a way of society saying,
'We don't like it'?"
In psychoanalysis,
the goals are love and work.
They love, they work; why are
we defining them as sick?
NARRATOR: Was society once again
shifting the boundary
between the so-called ill
and the so-called healthy?
WOMAN (in film):
At first, I was very guilty.
And then I realized
that all the things
that are taught you not only
by society,
but by psychiatrists, are just
to fit you in a mold.
When I rejected the mold,
I was happier.
BAYER: The American Psychiatric
Association became targeted
as gay people began to say,
"We're not sick,
we're normal,
and you are oppressing us."
NARRATOR: And then, at the 1972
A.P.A. conference in Dallas,
a panel called "Psychiatry:
Friend or Foe to Homosexuals?"
featured a man calling himself
Dr. Anonymous.
KENT ROBINSON: Our next speaker
is Henry Anonymous, MD.
Obviously a pseudonym.
He is a
(laughter)
He is an A.P.A. member,
board-certified psychiatrist.
Dr. Anonymous.
ANONYMOUS:
Thank you, Dr. Robinson.
I'm a homosexual.
I am a psychiatrist.
Cease attempting to figure out
who I am
and listen to what I say.
HARTMANN: Big mask, microphone
to disguise even his voice,
and he said, "I'm a psychiatrist
and I'm homosexual."
It was unheard of.
Nobody knew or acknowledged
that there was such a thing.
ANONYMOUS:
This is the greatest loss
our honest humanity.
And that loss leads all those
others around us
to lose that little bit of their
humanity, as well.
For if they were truly
comfortable
with their own homosexuality,
then they could be comfortable
with ours.
HARTMANN: He was a psychiatrist
just about my age.
I was much more closeted
than he,
but I think it was 21 years
before he said,
"And my name is John Fryer."
NARRATOR: John Fryer had already
been fired
By two university psychiatry
departments
for his sexual preferences.
Though he didn't acknowledge his
role as Dr. Anonymous
until 1994, his actions laid the
groundwork for a revolution.
On December 15, 1973,
the A.P.A. voted unanimously
to remove homosexuality
from the DSM.
Being gay was now on the
spectrum of "normal."
HARTMANN: I was one of the ones
who wrote the wording
that said gayness should not be
considered an illness.
I was pleased that people would
reconsider,
what do we mean by diagnosis?
What do we mean by trying
to help people?
Good evening.
Tonight, "The Advocates" looks
at a question which raises
both civil rights
and moral issues.
Specifically, our question is:
should homosexuals
be permitted to marry?
NARRATOR:
While stigma and prejudice
against gays didn't disappear,
the approach in the world of
psychiatry continued to evolve.
THOMAS ATKINS:
Dr. Charles Socarides
NARRATOR: And the once-revered
Socarides
was heckled for his positions
that a new generation saw
as outdated and discriminatory.
Dr. Socarides,
the American Psychiatric
Association,
when it was founded in the
vicinity of middle 1850s,
considered Blackness to be
a sign
of genetic illness
Is this not correct?
I'm not familiar with that,
but perhaps you're right.
I am.
(audience laughter and applause)
Now, of course, we don't believe
any of that today.
Judgments have changed.
Isn't it possible that in
50 years,
it will be considered just as
ludicrous when we hear
all the comments that you have
made
about homosexuality, with
(applause)
BAYER: It's easy to look back at
that moment and say,
"How could people have been so
blind
"to how the
uses of diagnosis
was oppressing people
and punishing people?"
And I think when we do that,
sometimes,
we forget the fact that these
psychiatrists
very often really thought
of themselves as saviors.
They saw themselves as saving
someone from a tragic future.
(elevator chimes)
ELECTRONIC VOICE:
Going up.
NARRATOR: When the A.P.A.
removed homosexuality from the
DSM in 1973,
Mia had finished her tour in
Vietnam
and was working as a lawyer.
Although the psychiatric
profession finally accepted
homosexuality was not a disease,
what did it offer those
who questioned their gender?
YAMAMOTO:
Back in those days,
if you asked me if I was gay,
I would say no.
I've always loved women,
I was enthusiastically straight.
But I go to bed at night,
I had the same feeling, like,
why am I in this body?
Why am I here, why am I still
living like this?
This has to be either 1973
or 1974.
The length of my hair actually
is an expression
of my gender identity
at that point.
I was in therapy for very many
years once I could afford it.
At first, I went to a guy who
worked with homosexual people.
A gender therapist didn't exist
in those days.
So I went to this fella
and I said,
"I feel like I'm a woman,
feel like I've got this body,
"and I feel like I don't belong
in this body.
"And, and I like to cross-dress.
"Actually, it helps me to feel
whole,
it makes me feel complete."
He had so few answers for what
was going on with me.
He says, "It's really odd
that you like women."
He said,
"That's, like, really queer."
He says, "I"
You know, "I'm a, I'm a
therapist
for homosexual people," he says,
"And they're queer people."
He says, "But you are
the queerest of the queer."
NARRATOR: The delisting
of homosexuality had exposed
the fluid, even arbitrary nature
of diagnosis.
And Mia's therapist was
not alone in his confusion.
In the 1970s,
a young Michael Walrond
was struggling
with mysterious health issues.
A doctor labeled him with a
psychiatric disorder,
hypochondria.
WALROND: I heard that word often
growing up,
because no one could pinpoint
what was wrong with me.
I have a rare disease, common
variable immunodeficiency,
although I was misdiagnosed
for 36 years.
As I grew,
something was always wrong
hospitalized, emergency rooms.
I remember some people thought I
was trying to get out of school,
but I wasn't feeling well.
And then because no one
necessarily had answers,
but I knew what I was feeling,
it puts you in a space where
there were days
you don't really want to get out
of bed.
There are days you don't really,
you don't really want to engage
people.
I was experiencing these
what I would now call
depressive moments.
And at the heart of it was
my physical challenges.
And to seek out help
almost affirms that maybe I am
crazy.
NARRATOR:
The fear of being labeled
with a mental disorder was
well-founded.
♪
For decades, with subjective
diagnoses,
hundreds of thousands were
confined
to mental institutions,
often against their will.
By the early '70s,
many had had enough.
DAVID ROSENHAN: Psychiatric
hospitals are storehouses
for people in society
whom you really don't want,
whom you really don't
understand,
and for whom you've lost a great
deal of sympathy.
♪
NARRATOR: Americans wanted to
know after decades of trying,
could psychiatry even separate
the sane from the insane?
CAHALAN: You had a huge backlash
against psychiatry.
MAN (in film): I'm a therapist
in a day treatment program.
We have an anti-psychiatry
model.
We've gotten rid of the normal,
normalcy/abnormal dichotomy.
CAHALAN: All this groundswell
of fear, and loathing, really,
for the psychiatric
establishment
raises questions about
the daily indignities that
people face
when they are labeled
with a psychiatric condition.
FRANCES: People said, "You don't
know what you're doing
"when you diagnose people
"and you don't know what
you're doing
"when you treat people.
Why is this a medical
specialty?"
NARRATOR: The American
Psychiatric Association
diagnosed the problem: Freud.
LIEBERMAN: In the 1970s,
public opinion had shifted from,
"Freud's brilliant,
this theory is great,"
to, "The emperor has no clothes,
there's no evidence for this."
The leadership of the profession
got together
and said, "We've got to fix our
diagnostic system."
What we need
is a diagnostic system
that reliably produces
a predictable result.
NARRATOR:
To oversee this herculean task,
they appointed Robert Spitzer of
Columbia University.
CAHALAN: Robert Spitzer is a
very mathematically-minded,
very objective, fact-oriented
psychiatrist
who had always
had an interest in numbers.
So, Spitzer established
algorithms.
For each diagnosis, we're going
to establish certain items
that are required for the
diagnosis,
and how many of those items have
to be present
before making the diagnosis,
and then how many weeks
must we have this.
NARRATOR: But without any
biological tests,
Spitzer's team could only
describe symptoms,
so they still shaped diagnoses
in a highly subjective way.
FRANCES: I started working
on DSM
in 1978.
It was very arbitrary.
Wasn't as if these were meant
to be graven in stone.
But diagnostic reliability
went way up.
Well, you can't do diagnosis
without having an agreed-upon
system.
It's better to have
a consensus subjectivity,
than each person inventing
his own way of doing diagnosis.
NARRATOR: The A.P.A. published
DSM-III in 1980.
It split vague and broad types
of neuroses into new,
more specific disorders.
At the time,
the manual met society's demand
for a more scientific-seeming
approach.
But psychiatrists keep rewriting
it to describe
an ever wider range of
experiences
as they grapple with the same
questions raised by Freud:
is there such a thing as normal?
Or does everyone live on
a spectrum?
The current DSM
has 265 mental disorders,
nearly three times the original.
One describes the feeling
of having
the wrong gender assignment,
called "gender dysphoria."
But because of social judgment,
like all diagnoses,
it's a double-edged sword.
NEWS ANCHOR: Tonight, the FBI
is digging deeper
into the murder
of a transgender
NEWS ANCHOR: A transgender teen
has taken her own life.
YAMAMOTO:
Gender dysphoria, as a category,
it places people in a position
of, if not mental illness,
some sort of mental deviance.
But apart from the way
we view our gender identity,
we are in all other ways normal.
It just doesn't look that way
to a world
who is used to seeing things
in terms of a binary.
KIM: This was
the day we got married,
this was in Millie's chambers.
YAMAMOTO: On the other hand,
there is a whole movement
that is succeeding, actually, in
getting insurance companies
to cover therapy
and even gender surgery.
So to have no name for it at all
I don't believe would be
helpful.
MAINS:
You still doing your sunset?
NARRATOR: The authors of DSM-III
established the diagnosis
of post-traumatic stress
disorder to finally recognize
the enduring effects of trauma,
but it's not easy to overcome
the legacy of stigma.
MAINS: I'd always been an
advocate of,
you know, end the stigma,
everything, you know,
it's okay to not be okay,
et cetera, until it was
happening to me.
Are you done with that one?
NARRATOR: Like all
mental disorders in the DSM,
PTSD is defined by symptoms,
not biology.
♪
In the hopes of someday changing
that, scientists are searching
for trauma's biological
fingerprints.
YEHUDA: When I started
my post-doctoral fellowship,
I had never heard of
post-traumatic stress disorder.
Many people didn't believe
that this diagnosis was real,
and certainly very little
was known about it.
So I joined a lab
that was the first group
that began examining the biology
of PTSD
in hopes of understanding
what it was.
We've had to create
a whole language for this.
We've had to create a whole
science for this.
The tools that we needed
haven't even been available
for that long.
NARRATOR:
Over 30 years of research,
Rachel Yehuda has helped unravel
some of the biology of PTSD.
YEHUDA:
We really understand
from brain imaging studies
right now
that experience does produce
physical changes in us.
NARRATOR: Yehuda's work shows
that trauma
can damage crucial connections
between the memory
and emotional processing centers
of the brain.
These connections are made
of tissue called white matter.
YEHUDA: White matter refers to
a part of the brain
where the neurons can carry
information
from one neuron to the next.
So, in a sense, you can think
about
there being highways in between
structures in the brain,
and then the question is,
how good is the highway?
And what you see
in somebody with PTSD is,
you know what, it may not
be running that great.
Which really accounts for
things like over-responding
to triggers
or feeling that things are
dangerous in the environment
when they're not actually
dangerous in reality.
NARRATOR: But the strength,
or "integrity,"
of these neural highways
often improves
when patients confront problems
using a distant descendant
of Freud's psychoanalytic
approach
called cognitive behavioral
therapy.
YEHUDA: There is an idea that
the reason
you can't talk about the trauma
is because you're afraid that if
you talk about the trauma,
you'll become really distressed.
But if you do this in a safe
environment with a therapist,
the therapist can tell you that
your distress
doesn't mean that this
is happening all over again.
And continuing to tell the story
over and over again
may reduce the distress.
And this can make changes
in your brain circuitry.
In somebody who has successfully
responded to therapy,
we start to see that white
matter integrity building up.
We can see it improve.
So we're not exactly where we
need to be,
but we've come a long way from
where we started.
DAVID FERENCIAK:
We're going to be moving toward
the fear/trauma memories.
NARRATOR: Since his counselor at
the fire department
declared him unfit for duty,
Ryan turned to a type of
cognitive behavioral therapy
called exposure therapy.
But what would be maybe as close
to 100 in intensity?
One of the, one of the traumatic
calls that we went on at work.
NARRATOR: For him, this involves
the retelling of trauma
narratives
and revisiting the scarring
experiences
that ended his career.
So, I want you to close your
eyes, and when you're ready,
you can start
describing the narrative.
I don't remember exactly
what time it was.
It was dark, we had toned out
for a hit-and-run,
a child that was struck
by a vehicle.
We were the first ones
on the scene.
I see a child laying
on the ground.
Family says that, that the
vehicle that hit him
didn't stop.
I jumped in the ambulance.
As we pulled up to the E.R.,
the E.R. staff was waiting
for us outside.
♪
(voice trembles):
Uh
Give me a level.
Um
That was about the time
that the family started to
arrive.
I hear the screams
♪
From the family, um,
when, uh, the E.R. staff told
them that they,
they were, they were stopping,
that there was nothing,
nothing else that they could do.
I felt really angry.
I was, I was furious.
I think I even threw some
things, I was so angry.
We're just gonna
take a moment right now.
Before we go back into it,
I really want you to do
your best
to speak through the memory, as
if it was happening right now.
- Okay.
- Okay?
So what we're going to do is,
we're gonna rewind right back
to the beginning.
One of the misconceptions
I had about PTSD
was that I would go to treatment
and it would be cured,
and I never had to deal with
it again.
I hear the reaction from the
family, I hear the screams.
I have a better understanding
now in that
it's never going to go away.
It will always be there.
Give me a level.
- (crying): 85.
- (whispers softly)
And emotionally,
how did that feel?
Gut-wrenching.
My reaction to it has changed,
and I think that
has been the most powerful, uh,
thing for me.
Can you feel any physical
sensation right now
as you're recounting this?
Yeah, yeah, I've got that
uneasy feeling in my stomach.
My PTSD doesn't own me as much
if I can control my reaction
to it.
I don't know how it's going
to go over the next ten years.
I just try and handle each
moment as it comes.
You did a great job.
It's commendable the amount
of courage that you show
in being willing to open this
wound up again.
We're going to be revisiting
this event as many times as we
need to,
in order to clean out that
wound,
so that it can heal effectively.
♪
MAINS: Thanks for coming out,
guys.
NARRATOR: Ryan's last day
at the fire department
was nearly a year ago.
(indistinct chatter)
MAINS:
This is my pension beard.
So until I get the,
get that settled,
we're just gonna let it go.
(chuckling)
NARRATOR:
Today, he'll run one kilometer
for every firefighter-paramedic
who's died by suicide in the
past year.
He's raising money so others
living with PTSD can get
treatment.
It's gonna be brutiful.
When I initially told people
that 130 firefighter-paramedics
died by suicide last year,
they were shocked.
WOMAN: Here we go, guys!
(applause and cheers,
noisemakers clanging)
Love you!
♪
MAINS: There are so many
mental health issues
that we haven't done
a good job of, as a society to
this point, talking about.
(people cheering)
WOMAN: All right, Ryan!
Whoo-hoo!
♪
MAINS: So I'm hopeful that
the more I speak out,
the more okay
others will be with it
and the more normal it becomes.
(indistinct chatter)
(cheers, noisemakers clanging)
NARRATOR: It's possible that
future generations
will unravel the mysteries of
mental illness
and subjective diagnoses will
fade away.
In the meantime, many are
working to change society
and expand the fluid definition
of "normal."
WALROND:
The first Sunday of the year,
we talked about courage,
then we talked about anger,
then complacency, and then last
Sunday,
we talked about joy joy.
And today we're gonna talk
about
well, it's obvious healing.
When I first started talking
about depression openly,
you know, not too many pastors
were going to go on the pulpit
and talk about having
suicidal ideations.
No, because the first thing
is a thought that,
"Well, there's countless,
"countless people who wrestle
with this
"and may come to me looking
for some resolution.
How do I tell them I'm dealing
with the same thing?"
So, that stops so many of us
from being transparent.
There have been moments
in my life
where I've fought depression
and darkness
and that feeling of a shadow
hovering over me,
and I felt like I had no one
to turn to.
But for me,
as I was able to name issues
around anxiety and depression,
it helped other people see the,
the characteristics,
the traits, "Maybe this
is what's happening with me.
That made my transparency,
my vulnerability, necessary
Not just for me,
but for other people.
♪
As we often say in church,
"I'm not where I used to be,
"and I'm not fully where
I'm going to be,
but I thank God for progress."
♪
YAMAMOTO: Nice work
if you can get it ♪
And you can get it
if you try ♪
NARRATOR: Today,
Mia lives in L.A. with Kim,
her wife of five years.
YAMAMOTO: On my 60th birthday,
I started coming out to people.
They really thought I had just
absolutely gone crazy.
And I thought,
"Okay, you know, maybe I am."
Again, "going crazy,"
"gone crazy," "am crazy,"
I've, I've been imbued in that
for a lifetime.
♪
NARRATOR:
Over the course of her life,
the line between mental health
and mental illness
has shifted many times.
But society is still deciding
who's normal.
YAMAMOTO:
When I was going through
the actual last gender surgery,
I remember the night before
thinking, you know,
you know, "You're going to be
on the table
for seven hours tomorrow,"
you know.
"You're 60-something years old,
and you could die tomorrow."
And I remember saying to myself,
"Good."
What I meant was,
if I can survive this,
and survive all the haters
(chuckles)
and the bigots,
then I'm going to be living
the life
that I've always wanted to live.
The world is going to have to
adapt to my identity,
to my authenticity.
And that is my fate, that's our
fate, my world's fate, as well.
♪
(cheers and applause)
WOMAN: We're coming,
we're coming!
(cheers and applause)
(cheers and applause)
ANNOUNCER: Next, on "Mysteries
of Mental Illness"
MAN: The notion of asylum,
it was a place to be cured.
WOMAN: The reason he was
admitted was worry.
WOMAN: A lot of these people
were going to be there
for the rest of their lives.
MAN: The practices there
were unaccountable.
MAN: Experimental therapies.
MAN: Sterilization
without consent.
ANNOUNCER:
The first lobotomy.
MAN: The idea was
"interrupt the madness."
MAN (archival): There is
new hope for all, new drugs.
MAN: The mentally ill were not
really de-institutionalized.
ANNOUNCER: Today, there are
ten times more people
with mental illness
in jails and prisons
than in hospitals.
Who's been diagnosed
with schizophrenia?
WOMAN: There isn't any one place
to make sure
that they're cared about
once they leave the jail.
ANNOUNCER: To order "Mysteries
of Mental Illness" on DVD,
visit ShopPBS
or call 1-800-PLAY-PBS.
This series is also available
on Amazon Prime Video.
♪
For more about "Mysteries of
Mental Illness,"
visit pbs.org/
mysteriesofmentalillness.
♪
♪