Welcome to the Reality Check podcast. Psychosis is Real, so is Recovery. On this episode, Ashley Weiss and Serena Chaudhry speak with Dr Ann Conn.

Dr Conn is a triple board-certified neurologist in Neurology, Interventional Pain, and Headache Medicine with 25 years of experience. She also co-founded Neuroglympse, a technology company that detects concussions by analyzing subtle changes in eye movement and supports recovery through remote therapeutic monitoring.

This is part 1 of 2 episodes with Dr Conn.

Subscribe for more episodes of Reality Check, where we uncover the truth behind mental health, one story at a time.

For more information about Clear Answers to Louisiana Mental Health (CALM) and their Early Intervention Psychosis Program (EPIC NOLA), visit the website: www.calmnola.org

🔴 Podcast produced by Red Rock Branding – www.redrockbranding.com

So welcome to reality check. it is July 29th, Wednesday. and I'm really glad to welcome Dr. Conn, Dr. Ann Conn. I first met her by doing her podcast, which we will shout out to at the end of this, at the end of this one. But to intro introduce Dr. Conn

She's has an incredible career as a triple board certified neurologist, also in interventional pain and headache medicine, which is amazing. and also has her own lived experience of of mental illness and family members. And so welcome and we're glad that you're here. And

Yeah, thank you.

Yeah, so I'd just wanna start out with opening it up to kind of getting really to the point of I would I would love for you to share share your story and what brought you to this place of being where you are right now, as a as a person and as a physician

Mm-hmm.

Right. So I'm I feel so fortunate to have be at this place right now in my life.

You're trying to bring everything into service for others. And most people that go into medicine, at least initially, they're interested in serving, and I certainly, you know, was and am. And so, you know, I got interested in brain science, didn't know anything about it, had no exposure to neurology, showed up in med school, and actually enjoyed it, which is interesting in itself because it's so challenging.

To teach. And I was very interested in pain. That evolved while I was evolving, and I was fortunate to be the first person to do the certified ACGME certified fellowship at charity before Hurricane Katrina had and you know my family had mental illness in it, and my first husband had significant issues. And even though I'm a doctor and I knew all this, it hadn't occurred to me.

that both my sons could actually experience mental illness. So, you know, we're so interesting as human beings, right? That it wouldn't have dawned on me until it actually began to unfold.

And both my sons had psychotic bipolar disorder. And that's why I fit with your you know your your work about psychosis. And you know, they had very terrible illness, they had the best treatment there is. one of them went to McLean at Harvard. They both spent months inpatient at Mineger Clinic, had major aggressive drug trials, and basically once they got psychotic, they had a psychotic

break nothing really helped. and they both died by suicide 10, it's 11 and 12 years ago. So they are so much missed by me and others that love them and remember them. And so of course that's a huge thing in life to try to integrate. It's a lifelong process.

so I understand that. And the grief changes, of course, and molts and melts and is different all the time. and

Amazing.

Feel so grateful because writing any book is just a monumental task. I've heard rumors, they're true. But especially writing something with this kind of emotional load. So I feel really grateful about that and where this version has ended up. And so yeah, that's part of the story.

Thank you for sharing that. I think you're you said several things that struck me. I think it is the reality that we are all human and we as much as we know mental el mental illness, excuse me, can take us by surprise, even when we're looking for it, right? And I think that it speaks to our need to be humble and to be able to when we see it not allow as we were talking before, stigma to get in the

Mm-hmm.

Mm-hmm.

And to take action and right, a huge part of the work we do at Epic and with Calm is to try and get pe young people into care early. So when we know there's that genetic risk, when we know there are other risk factors trying to bring them into care. And then the other thing that you said was just identifying the grief and that it's a lifelong process and it unfolds in ways. And I think there's the grief, the the loss of

Of your sons, like you said. And then there's the grief that accompanies diagnosis and illness, and the sort of impiguous loss of the life that people, parents envisioned for their kids, and the life that they weren't able to live, even if they remain alive and right amongst us physically.

Right. Yeah, that's really important because I experienced and they experienced a lot of grief because

their lives weren't what we had hoped and they had hoped, that's most important. I mean, of course for me too, but for them the loss of what they had wanted for themselves as they became so ill. And it's hard and it does you know that they felt stigmatized by others. They couldn't understand why they weren't

showing the promise that they had, you know, living the promise they had shown before they became ill. And that was really hard. And then the self-stigma too. That you know enduring that is just witnessing that was very difficult. And so it's you know brain illness. I mean as a neurologist before any of you know this happened it's so hard for people to understand because we can see a broken arm. We can all see that. We look on the x-ray everyone agrees. But the brain

Is a mystery in a lot of ways, and we can't. There's no genetic testing, there's no brain image, and so there leaves this unknown for a lot many people that they have trouble understanding and accepting what's happened. It looks like there's not a real reason. There's a real reason, but the real reason doesn't look like folks think it might look.

those are some of the factors that can be at play and they were certainly at play in our lives and maybe still are for people that don't really understand what happened. Yeah, in our lives.

Yeah, one of my one of my patients that died by suicide, that was the exact reason. I mean, he had told me, probably a year before it happened, that that this was not part of his plan. This that he was not gonna be a patient forever and it was just this not compatible with his

version of what he wanted life to look like. And there's it was the most helpless, like helpless position to be because I get it. You know, I I get it. And I what you know, I like empathize, you know, with him and I like saw where he'd be coming from, especially in a world that is so critical and so

comparable to you know, he had schizoaffective disorder, but just, you know, you're marginalized without even just by the word you know, by by a by a diagnosis.

by being different.

It's so tricky.

Right, because you know, in our system, the system of which I'm a part, we need to give people diagnoses so they can have money for treatment, right? That's how our system works, that's how they get funds. But people feel very stigmatized and angry about their diagnoses and I understand that too. And some diagnoses don't fit in a box. Okay, my sons have, you know, psychotic bipolar disorder. But where is the line between that and schizoaffective disorder or even schizophrenia?

You know, so because we can't at this time, we're not able to like subclassify these illnesses biologically, right? We're doing it by what we see. But I actually have a lot of hope. I think we're we're I feel more hope than I ever thought I would.

over the last year when I've seen the some of the research on brain omics and and some other factors I think we're on the precipice of a tremendous shift that is very exciting for every brain analyst and

'Cause they cross-pollinate. You know, we imagine or we, the public, imagines, you know, Alzheimer's disease, Parkinson's disease, schizophrenia, bipolar disorder, in these little silos, but it is so not like that.

And it all cross pollinates and I think that for the first time since my son died, had died sons died about a year ago, I I really think we're gonna at an inflection point where things are gonna change. And people don't aren't gonna have to live through what our family has lived through. I do believe that's coming. And we can dive into some summary level details if y'all want to, but I

I would love to. I'm so I'm so happy to hear that. Yes, I would love to.

Yes. You just like made me want to cry and scream at the same time.

Yeah. So yeah, so you know, I'm like been a reader my entire life. I was the elementary school kid that read all the time. You know, most of us are that end up going to med school. But anyway, so I read a lot of literature. And maybe a year ago, I discovered this study called BD Squared Integrated Network.

Mm.

BD stands for bipolar disorder, perhaps y'all are familiar with it. And so to meter just psychiatry is leading the way in brain science. It's really thrilling. Because in essence, just to give the big stroke summary,

They do what we call omics research. And so all these words end in omics, like metabolomics, genomics. Okay, but I'll switch them out of omics. You know, it's looking at the genes, you know, the way the genes are translated into RNA, the way they're modified after.

Immunology that affects the brain immunomics. Okay, so all these things that we had never been able to look at before are happening. But what's so exciting, just that alone, is combined with very advanced brain imaging and actually wearables, where for the first time we can track people at home when they're depressed and they're not getting out of bed. I mean, you can see there's no steps. When they're manic and they're pacing and they're not sleeping, that's how that's being captured too, along with the clinical.

Data, what medications are they taking? Are they working? Are they not working? Now we can see relapses by tracking things like heart rate variability, which is a measurement of biological stress. So I just went through a lot and what's beautiful about it is now we can use AI in a way, this is the positive application of AI. No human mind could hold that kind of data.

That big swath can now be analyzed, and we can we're going to find things and see patterns. And to me, the turning point is here. What I didn't mention that's important to me is also biological data from brain donation is is included in this. And I have pledged to donate my brain at the time of my death to Harvard Brain Tissue Resource Center, which is one of the most important

repositories for this kind of information in America. It's actually next to McLean Hospital where my son Colin was hospitalized the first time. The when he had a psychotic break at 20. so yes, I've been there and visited. And I mean there are European counterparts and because they have socialized medicine, their biobanks are a lot farther along than ours, particularly the British biobank, but it's going on in Europe too. But I do think we're just at pressing

of this where we're going to learn things and they're already cross-pollinating. Okay, like ALS is a brain disease. And I mean they're

They're cross-pollinating their data and it's I find it very exciting. I think we're gonna find new things, new treatments, be able to predict illness, be able to diagnose illness in ways we had only dreamed and predict, you know, like we all dream of as doctors. We want to know what medicines to give somebody. All of us do, whether you're an internal medicine doctor or a psychiatrist, and we have to do a lot of guessing, right? And that's hard for people. And that's the art of medicine, and I think we're gonna have better.

predictive abilities. It we're gonna go from you know this reaction, you know, recognize in a reaction to like prevent. I think that's possible. And so this is I feel so thankful that I've lived to see this day and hopefully I'll live long enough to see it come to fruition and for totally change things for people. Yes.

So that's where my hope comes from about the illness and treatment of illnesses like this.

Yeah, Serena can share with you we're affiliated or partnering with a group that is we're gonna be piloting their one of their wearables for bipolar disorder and relapse relapse prevention. And yeah we we were I can't remember in what wild conversation that

We had screening. But anyway, we had this like idea that, you know, if you could any person with a genetic risk for psychosis or bipolar, if like we could know in the very beginning, like at birth, because the predic especially with psychosis, like speech speech prediction and speech and as you know, as you become

Mm.

Paediatrics

a really skilled clinician, you start you can like hear subtleties, that stuff takes years to learn because you've seen patients over and over and over again. And like what if we could package that to where, yeah, these large language models are able to pick up on these subtle changes so that new clinicians could could get be like, that's that's what's happening. And we don't have to wait.

don't have to wait until you know, you have a doctor that's sixty and has been hearing it for you know, now can tell after thirty years. these like subtle signs. yeah, I think that that is so exciting.

Mm-hmm.

Yeah, so it's an important time and you know but although the excitement of what's coming we still need to work on stigma because pe nobody wants their child to have a mental illness. It's so painful, right? And so if we we need to help decrease stigma so we can improve early intervention because you know they go hand in hand.

That's why I want I want to speak about what's happening. I I just want to be one voice and you're joining into the many voices that are trying to help educate the people and open their minds and hearts to these things that have in the past been kept it secretive. And we don't need to be doing that because these are illnesses, they're brain illnesses. Yeah.

Yeah.

You know, your your voice is essential in this process of forward movement and destigmatizing mental illness. And I feel we're so lucky to, you know, be in conversation with you when we have parents at our clinic. I don't know if you've read or heard of the book The Tunnel by Tripp Friedler. he yeah, he I think was very courageous and vulnerable in writing his book and sharing his story, but right, these are the stories that the

Sad stories that need to be told and shared if we're going to make any progress. Cause when you know, in my conversations with Tripp and looking back on his son's Henry Henry's life, like it it is in this from this vantage point obvious where and when and how intervention should have happened. We have to learn from these sad stories to be able to prevent them in the future for others. But it brings me you said.

Mm.

pain you've studied pain and I can't help but ask about this intersection of pain and diagnosis pain like literal pain and the psychological pain right and how that ties into stigma and I just love to hear your thoughts if you have any about that.

Hit it right on the button because there's still so much stigma about pain. People that have pain are stigmatized so much. And they, it's the same thing, they self-stigmatize, they're stigmatized by society. and I mean, you mentioned I'm board certified in migraine and headache medicine. And

People are not believed by their family. They're minimized, like it's just a headache. My brain is so much more than a headache. It's an entire body experience. It is truly disabling. Fortunately, not all of them are. And so what one of the common threads is the brain is involved. And again, it's so hard, and people have to imagine, most people to conceptualize and imagine the brain. And what's happening? And we have no pictures to show.

people. We can't show a tumor or a broken bone. We can't show a stem lesion And so that that again makes it hard for people.

Maybe one day we will have some kind of imaging or at least have genetic testing so that people have something to hang on to. And I do think that's coming. So the common, well, that's one common denominator, the stigma. But actually, social injuries that we endure activate the same areas of the brain as physical pain. And this is very well studied. Like the anterior cingulate cortex, the middle of the brain that connects both sides is very involved.

And tylenol can actually help the pain of social rejection, which is fascinating. It decreases the activation. So sometimes I tell people if my patients are telling me about a significant social rejection they've experienced. I mean, I do talk to talk to enough tylanol of course, which is one tool among many that we need to use in those. But yes,

We're social creatures. We're made to be connected and it makes perfect sense because I mean in ancient times we needed to be connected to stay alive. If we got cut off from the tribe, we would literally die because we didn't have protection from, you know, the creatures and stuff. We have enough food. So it's connected to our very survival. Yeah.

Yeah, thank you for elaborating on that. That's fascinating. I'm caught on the Tylenol, which is something I didn't know. Could be used in those instances and it is a great tool, but it validates right that which we cannot, you know, see. But the injury can still be just as deep and harsh as physical pain.

It's

Terrible. I mean, we can see it on functional MRI. And but of course that's only done in research, that's not available.

Which is that's the part that really, really bugged me. You know, because there there is imaging that can help show disconnect and show disorganization and show this, but somehow it's only in research now. You know, and they it's it's been only in research for a long, long time. You know, so I'm like, why why is why is that?

Mm-hmm.

Ready.

Right. And why do we not right, like why can we not make these images accessible and when we're diagnosing someone, give them something tangible to help them better understand what's going on and reduce the self stigma and potentially reduce the stigma in sort of that, you know, nuclear family and circle of caregivers.

Well you asked important questions. I will say when my younger son Colin was at McLean, he was actually in an FMRI study about bipolar psychosis that was published. And he did that himself. I mean they asked him to do it and he did that. But yes, I wish it was more available because it would be more like all of us looking at a broken arm.

Right. It's the x ray it's the x ray now.

You know, it's tangible that everyone the x-ray that everyone could say, yes, I see they're pointing to this thing. And I agree with you and I don't understand why either. I would love somebody to enlighten me.

Yeah.

Well, I want to circle back to hope for a moment while Ashley's getting unfrozen here. I it really you moved me with your hope and I think you're standing in a place where you you verbalizing hope feels very powerful and

builds my own confidence and hope for the future. I'm curious for our listeners, what right, like because I think for many of our listeners and for families, right, sort of engaged in the beginning of this in diagnosis and oftentimes crisis and repeated crisis, there's a feeling of helplessness. So how can we take hope and helplessness and marry them in this moment?

Mm-hmm.

I mean the helplessness is real and the hope is real. They're both real. And they both deserve honoring because

Sons who are unstable and have multiple crises and hospitalizations, you know, the conveyor belt of hospitalizations. Somebody is chronically psychosis and it is helpless. It feels terrible because it's like, and maybe people can relate to it. I'm gonna give a few examples. It's like having chemotherapy and the person doesn't respond to the medicine.

Okay, that that feels not that doesn't feel good. But I think another way I like to talk about it is like addiction, because addiction is a brain disorder. And it's more relatable. More people have experienced that in their lives. You know, it's so common that most families have someone with a significant addiction or in their friend group. And so it's it is helpless having, you know, watching them, and it's hard to know how to skillfully respond.

to that. There are ways and I can talk about that. So I don't know, I mean if my sons were alive now I would be like, it's gonna come. You just need to hold on look right here. This is what's gonna happen.

It's it will come. I actually in my podcast I interviewed the executive committee of you know BD Squared Integrated Network and I really think we can see significant changes in five to ten years. And that may seem like a long time to some, but to me that seems short based on the you know the history of human suffering, probably since before people could write things down.

that close and maybe even closer in that they think that by the wearables and you know the clinicians and the patients that they're going to see earlier how to use medicines differently and different interventions. That's their thought. And so I'm convinced I think it's true. I think the first study is going to be published maybe next year. It's close and that'll be interesting.

So I think one way I like to talk about this, one thing I like to talk about is the difference between empathy and compassion from as, and this applies as a family member to oneself or as a doctor. so empathy and compassion, they're very they're different.

speaking with respect to brain states. Okay, so the definitions I'm going to give are they have neuroanatomical equivalents, meaning using that functional MRI we're talking about, we can see these these are two very different states. Okay so based on that there were studies done by in on Germany by Tania Singer on this monk, okay his name is Matthieu Ricard This like one of these Olympic level meditators that was in a lot of the studies.

initial studies showing how meditation changes the brain. So I'll try to give a summary of the of what they did and then what it meant. So then there's certain types of meditation to meditate on compassion. Okay. And then you know of course there's empathy. So empathy is to identify with the person. That's I it's identification.

Compassion is to it it's a an a motivational state to relieve suffering, right? So empathy is where burnout comes from. We can become over-identified and we're in emotional entrainment with the person instead and and it affects us deeply, like very biological, versus in this state of activity.

To be a benefit. Okay, and when we're in that state, that's a pro-social state. Empathy is actually a self-oriented state. And so compassion, you don't burn out in compassion. Okay, it's always renewable. Empathy is the state we burn out from. I mean, most clinicians have burnout, I certainly have.

Hmm.

I've been able to recover every time. But so what happened is Matthieu Ricard had seen a video, and maybe you guys are familiar with it, about the Romanian children that were neglected in orphanages. this is an old video, maybe in the 90s, whenever you know Romania fell after Ceaușescu this video, and I mean, of course, it was so sad, these children were neglected terribly, and they had they actually had neurological deficits and they

were unable to function in the world, right? Of course it was deeply upsetting. He goes to the lab the next morning, he gets in this functional MRI scanner and he got in there and he imagined the suffering of the children. And they imaged his brain and they did it for like 45 minutes. And he said when he got out he was just utterly exhausted. And Dr. Singer said, do you want to do the compassion part today or do you want to wait until tomorrow? He said, no, I need to do the compassion part. I totally want to do the compassion part.

And then he sent utter love and compassion to the children. And he he personally felt so much better. He a completely different part of the brain was activated, and he felt much more peaceful and biologically settled after that. So, how does that apply to us? This is how it applies. I'm gonna use the addiction model.

Okay, so when we have an addicted family member, it's so difficult. We have addiction in our family also. I mean I see it at work all the time. People will try to help, but it's not actually helpful. Okay, they'll ride around in their car and try to get the person at the bars they go to. And I mean they make their own life is becoming miserable and out of control, right?

And they give money that the person uses to do the addictive activity, right? But in compassion, we can give love and we can do it in a way where we're actually being of benefit, like setting boundaries and

Helping feed or enable the addiction. So, and all those things happened to me that I'm describing when I was dealing with my children being this ill. Being in over identification with them to the point where I was in such terrible distress, I could barely function. Okay. And so we can love somebody deeply and want the best for them and be helping them without being in this disabling state of over identification. And these are actually two different brain states. So I hope that made sense.

It made perfect sense and it made me want to invite you to do grand rounds for our people and to come speak to our family's mom's group. That makes total sense in terms of for family, and then for us as clinicians and I I, you know, do my own set of teaching on just

vicarious trauma. I forgot. And thinking about the work that one does and how burnout and right empathy and all of that integrate into there. And I love the idea of

flipping that script on to compassion and taking that more active and as you said, pro-social state and embracing that, I should say. So it made sense and I you definitely inspired me to do more reading. It's also interesting, you're talking about the Romanian orphanages, correct? One of our colleagues, Dr. Charlie Zina, has done a lot of work did a lot of work on orphans in that time period.

Mm-hmm.

And so I'm just curious if there is also a interconnection here between the monk study that you just shared and some of the work that he did. But I think to

Yes. This is so important because we all need to learn to state shift from empathy to compassion. I mean empathy is required to get to compassion in that we need to be able to identify with with the suffering, but then for us and everybody else, we need to switch to compassion. And this is a practice skill. There's actually compassion training institutes in different places around the male kind of world.

Because then we can thrive, we can offer ourselves more effectively, right, and more fully.

Just so important. Mm-hmm.

W yes, and I think you did the you perfectly married what I asked you to, right? Helplessness and hope. And I think that is a place to that's an action step. And I think so often all of us are looking for action steps to take in these moments of crisis and helplessness. So thank you for offering that to us, to our listeners, and I think it's something we can all read more on. We unfortunately lost Ashley.

to the universe. She's not quite sure what happened. but I wanna maybe just move towards closing in just thanking you for your time. We may need to do a part two because I know Ashley's gonna be very sad that she can't say goodbye.

Yeah.

Maybe she's here. but you connected so many dots for us today. and I I very much appreciate that and I feel like there is there's room for it's part two to like think more about these things, integrate them perhaps and reflect on how they've worked. Ashley, are you back?

Can you hear me at all?

Who's maybe?

Can hear us?

I can hear you.

Okay, so maybe for part two, something that I'm very interested in is you know what is psychosis? What is it? Okay. And the teaser for that is you know the predicted brain state, right? That is the new way to think about brain function, about interoceptive, you know. And that means what we feel inside, like how do we know we're hungry and we're tired? How do we know these things?

And what and there's thoughts, and I'm in this camp with Anil Seth and Karl Friston that when interpreting the environment in because the brain is having trouble interpreting the environment in a way that supports function, that's one of the building blocks to psychosis. And so yes, I

This is very important and I think there's new ways to understand this now that we have not been capable of before.

gonna take that teaser and stop there because that's perfect and we will get you scheduled to continue the conversation thank you so much thank you for your vulnerability thank you for your compassion and thank you for taking the time out of your day to be with us and ashley I know gives her thanks too I know technology works for us and against us simultaneously

So frustrating when the internet you know sometimes yes I go yeah.