When it comes to mental health, Docs Tracey and Paul Discuss it All! This episode centers on the intricate and multifaceted nature of mental illness, as discussed by esteemed psychiatrists, Dr. Tracy Scale and Dr. Paul Keck. In this inaugural installment of a series dedicated to mental health, we endeavor to elucidate the definition of mental illness and explore its prevalence and impact on individuals and society at large.

Our collective experience of over 70 years in the psychiatric field equips us with unique experience and insights, which we hope to share with both the general public and our professional peers. Throughout the series, we will examine various mental health conditions, including depression, bipolar disorder, schizophrenia, and anxiety disorders –while fostering a deeper understanding of these critical issues. Through our new podcast – Docs Tracey and Paul Discuss it All – we aspire to provide a platform for open dialogue, reducing stigma and enhancing awareness regarding the complexities of mental health.

**DISCLAIMER: This podcast discusses mental health topics that may be sensitive or triggering for some listeners. The information shared is for educational and general discussion purposes only, and is not a substitute for personalized medical advice, diagnosis or treatment. Please consult your own qualified healthcare professional for guidance tailored to your unique needs and circumstances.

If you are in crisis, reach out to a local mental health provider or call the National Suicide Prevention Lifeline at 988.

Welcome to the Two Minds Better Than One podcast.

Docs Tracy and Paul Discuss it All.

Welcome to Docs Tracy and Paul Discuss It All.

This is the first of a series of podcasts about mental health and mental illness.

I'm joined today by my wife, a renowned psychiatrist, Dr. Tracy Scale.

Hi, honey.

Hi, everyone.

And I am Paul Keck, also a psychiatrist.

And today's topic is what is mental illness?

Right.

Thanks for leading us off, honey.

And so welcome, everyone.

We are talking about what is mental illness, but we also want to introduce ourselves because this is the first podcast and there'll be many.

And in this series, we will be talking about all aspects of mental illness.

So hence, docs Tracy and Paul Discuss It All.

As the name of our podcast, our company is called Timbo Enterprises, Two Minds Better Than One.

Because we feel like the two of us together have a synergistic effect.

Right.

And we're work pretty well together.

So we'll be talking about all aspects of mental illness.

We'll talk about depression and bipolar disorder, schizophrenia, some other topics.

Paul, what else?

Talk about obsessive compulsive disorder.

We'll talk about anxiety disorders, eating disorders,.

Post traumatic stress disorder.

Yes.

Anything that you could think of related to psychiatry, we will be talking about.

This is meant for the general population, but our psychiatric colleagues are obviously welcome to be part of this as well.

A lot of the times will be just us discussing things like it is every day of our lives.

This is our lives.

We have these discussions over dinner all the time.

Right.

But we'll also have guests in, and we're looking forward to introducing them to you a little bit about ourselves.

I'll talk about you, Paul.

So I've.

Paul and I have been married for several years now, but we've known each other a long, long time.

35 Years, I think, now.

So.

Paul came into my life when I was a resident at the University of Cincinnati College of Medicine, and you came over from Harvard and brought psychopharmacology to our program.

And I'll never forget that you changed the psychiatric program from more of a psychodynamic program to psychopharm.

I learned a lot from you.

I took feverish notes.

And here we are all these years later.

And what do you want to say about me?

I guess.

How would you like to say that?

Well, I remember you as a resident.

I remember the chairman trying to desperately recruit you to stay in the department.

And I remember your courage and commitment in wanting to be a psychiatrist in the community mental health system.

And you quickly ascended to be chief Medical officer.

Well, medical director and then chief medical officer at the largest community mental health system or center in Cincinnati.

And you devoted your life to treating the most serious people with the most serious mental illnesses.

And that took a lot of courage and commitment.

Thank you.

It was the greatest honor of my life serving in that role in treating thousands of patients over the years with chronic, severe, persistent mental illness.

My specialty is working with people with schizophrenia.

As you know, schizophrenia, schizoaffective, severe bipolar disorder.

Paul, you're an internationally known bipolar expert, but you treat lots of people with depression, bipolar disorder, anxiety.

And you founded the Lindner center of Hope in Cincinnati, which is what?

Describe that to people.

Lindner center of Hope was the first freestanding comprehensive mental health center to be built in about 25 years.

Yes.

And you were president and CEO and treated patients for many, many years.

I've always been a doctor.

I've been an administrator, a researcher.

But the most rewarding part of my career has always been working with people with psychiatric problems.

Same.

So we both think of ourselves in the trenches as doctors.

We see people every single day of our lives.

So why did we start this podcast?

People have been asking us for a long time to do something like this.

I know you and I have both been on many radio shows and local TV programs talking about different aspects of mental illness.

So this podcast was long overdue.

We started it, as, you know, a few years ago.

We started doing this, and then life happened, and good, exciting things happened, and including a move across the country.

We're now relocated in beautiful, sunny Arizona and a grandchild, and all these different things happened to us, which were all wonderful.

But then we had a serious conversation, said, this is time.

It's beyond time.

We should be doing our podcast.

Between us, 70 years of psychiatric experience, and you always say we have bookends.

Talk more about that.

Yeah, I think our work has.

Well, first of all, we, I think, together probably treated thousands and thousands of people, one on one, usually in our offices.

And that was extremely rewarding.

But what we also figured out was that our careers were complementary.

You worked with, in the community, the public health system, with, as we said, very, very seriously mentally ill people.

And I worked more in the private sector system.

And together, I think our knowledge, hopefully, will help the general public, not just individual by individual, but amplify what we learn and help people identify when there's a problem and go get help.

Right.

I love that idea.

We have very Much cherished our time seeing patients.

And you'll hear us say patients.

So we're both MDs, we both went to medical school.

We both did residencies.

We both did internal medicine and neurology before we did our psychiatric residencies.

So you'll hear us say patients, because doctors see patients.

If you had a cardiac condition, you would be a patient of the cardiologist.

If you had cancer, you would be a patient of the oncologist.

Same thing.

If you have schizophrenia, bipolar disorder, you're a patient of ours.

Now, our colleagues, who we love, our esteemed colleagues in all aspects, then our nurse practitioner colleagues, our PAs, our therapists and social workers, you will hear them say clients or various other names.

But for us, you'll hear us say patients.

I think the word patient is important to use because it stems from the Greek to suffer.

And I think people come for help to a mental health practitioner, provider, whatever, because they're suffering.

So why did you go into psychiatry?

So I know that your background.

You were a jock.

I mean, you played rugby, you ran marathons, you played football.

I thought you were going to orthopedic surgery.

How did you choose psychiatry?

As you know.

But maybe some people don't.

When you're in medical school, you have some choice in the order of your rotations, your experience in the clinics.

And I had no history whatsoever with psychiatry.

And in fact, where I went to medical school, the lectures in psychiatry in the second year were just boring and uninspiring, really.

Psychiatry is so interesting all the time to me, I think.

So what's your undergraduate degree in?

Anthropology and biology.

So I planned my psychiatry rotation, dead last in my third year, because I didn't think I had any interest in it.

I was going to go into internal medicine.

Actually had a stack of applications on my desk in my apartment.

And then I was assigned to work at the Bronx va, which was a Mount Sinai affiliate at the time.

And it was.

It was an epiphany.

I was assigned to work with a young man who was almost exactly my age, who had schizophrenia.

Very bad case of schizophrenia.

He could barely speak, nothing coherent.

And it struck me that there, for the grace of God go I.

So I had a career ahead of me.

I had my health.

And he had nothing to look forward to because the medicines we had available then were simply ineffective.

And so I thought, well, we know a lot about how the heart works, kidneys work, the lungs work, but we didn't know much about how the brain works.

And I thought if I could make just a tiny Little contribution to this field.

That would be a career worth living.

Well, you've had a career worth living then because you've made more than a tiny contribution, I'm very proud to say.

And how about you?

So I had nobody in my life that was a doctor.

Nobody was in medicine.

I'm from a small town in western Massachusetts.

I always look back at this because people ask me this, especially with my special interest in working with people with psychosis or severe mental illness of other sorts.

I must have somewhere seen some show about somebody that was hearing voices.

I read the book.

I never promised you a rose garden early on.

I remember that being instrumental to me too.

But I was always fascinated by the brain.

Now I did not.

You had.

You said anthropology.

I was a neuroscience major.

I went to Amherst.

I was a neuroscience major.

I love science, I love the brain.

And so neuroscience is the perfect major for me.

But I also had a major in psychology, so I had a double major.

And at the time I loved my advisors at Amherst.

And the psychology advisor said, please, whatever you do, don't be a psychologist.

Taking nothing away from our psychology colleagues.

We love psychology.

But he said, there's so many more opportunities for you if you go to medical school and you love science so much.

I really recommend you go to medical school.

My neuroscience advisor is the big reason I went to University of Cincinnati, because he said, cincinnati is a school for nice kids.

You need to go there.

Which was very kind of him to say that.

My pre med advisor said, why are you going to medical school?

I think you should be a writer.

You like to write.

I said, I really want to go to medical school.

So went to medical school knowing that I would do something with the brain.

I loved all my rotations and the rotation people liked me because I was so interested.

I remember my surgical rotation was great.

I was very honest.

A lot of medical students, by the way, aren't.

They'll say they're going into whatever rotation if they're on surgery, ob, gyn, whatever, that's what they're going into.

I was always, I'm going to be a psychiatrist or a neurologist.

And they would, they appreciated that I gave effort, you know, and let Tracy see the surgery.

So I was leaning toward neurology.

But then the neurology residents, you were talking about the classes and not being interesting in psychiatry or psychology.

The neurology residents weren't particularly happy.

And in those days they were doing a lot of post stroke care and a lot of chronic pain.

And that didn't seem Particularly interesting to me.

That's not what I wanted.

Had I gone into neurology, I would have been interested more in Parkinson's disease, seizures, Huntington's or some more obscure things.

So psychiatry made sense to me.

And then I did my psychiatry rotation.

Absolutely loved it, Loved every second of it.

Especially inpatient, where people are very, very ill. And if you like that, you like psychiatry, you know, but in terms of other things in my life that were pivotal to me.

You said you talked about that patient that you met.

I've been thinking a lot about that.

So when I was 18 or so, I'm in early college years, my boyfriend at the time had a brother with severe mental illness.

So I think that also played a big part.

And I remember he was really handsome and really smart.

And my boyfriend at the time said, we need to go visit my brother in the hospital.

And I didn't know anybody that had psychiatrically hospitalized.

And we're.

My little small town.

There wasn't anywhere.

There wasn't even a psychiatric hospital, you know, where I was.

But this was closer to the Boston area.

And we went to see him in a psychiatric hospital.

And it was a bad experience.

So don't Forget, I was 18.

I'm in my 60s now.

This was a long time ago.

And much like you said, there weren't many good treatments then.

And I remember this handsome, smart man, shuffling gait, drooling, flat facial expression, still mumbling in a nonsensical manner, but with all these side effects.

And I remember thinking, this is really horrible.

And if I ever go into psychiatry, I'm going to try to make someone's life a lot better than this guy's life is right now.

Unfortunately, he went on to die by suicide.

Very, very tragic.

And you will hear us say, die by suicide.

We don't ever say, commit suicide.

That's passe.

No one says that anymore.

You'll hear that on TV every once in a while.

And we cringe when we hear that, because just if you would die from your cancer or your heart disease, you can die from your refractory illness.

Mental illness, right?

Yeah.

I had a friend from college who died by suicide, and it was a shock to everyone.

He was married, had two young sons, and for about six months, I would talk to his wife about once a month to help each of us try to understand what happened.

And she was a doctor.

She was a neurologist, actually.

And finally she said, you know what?

I realized he died from depression.

Just like you die, you can die.

The heart attack is the End result, but usually of atherosclerotic heart disease.

And I thought that was a great way to frame it.

It is a good way to frame it.

And you'll see more in obituaries now talking about that.

People are more forthcoming about that, which is good because it really helps destigmatize when people are more open about talking about their mental illness.

Another pivotal thing for me, I was in medical school already and I got paged.

That's in the old days, we had these pagers and they said somebody was there to see me.

And it was this teacher I had in high school.

And here, you know, I went to high school in Massachusetts and now I'm in Cincinnati.

And here's this teacher from high school found me and wanted to talk to me.

I went down and this was one of the most important teachers of my life.

Very important person in my life in high school and my memory.

He was my math teacher.

I was a math lead.

I love math, you know.

And he was very buttoned up, serious guy.

And he showed up there and the reason is he was on his way to some pilgrimage in Indiana and it was a religious retreat of some sort.

And he, this very short haired, tie, buttoned up man, had long hair and kind of wild clothes and he was talking really rapidly and he was completely different than I remembered.

And don't forget, I'm a medical student and now I'm not in psychiatry.

But I knew, oh my goodness, he is in mania.

And then I did something, probably not smart, but I ended up okay.

He said, you want to go have coffee?

And I said, sure.

And I got in a car with him and now hadn't seen him in years.

But this is an important person in my life.

And his car had all kinds of religious figures, Virgin Mary statues everywhere and bumper stickers and things.

And we started talking and he, he said, what are your plans?

And I said, well, I am going to go into psychiatry.

He said, really?

I don't believe in psychiatry.

And again, this was said with very rapid speech and some disorganization.

But this came out and I said, why is that?

He said, well, I have an identical twin brother.

And when we get into our bipolar discussion, another, you'll see the strong genetics associated with certain mental illnesses.

I have an identical twin brother who was diagnosed with bipolar disorder.

And my mother was diagnosed with manic depression, which is what we used to call bipolar disorder.

And people tried to say I have that, but I don't have that.

I just don't believe in that.

And I thought, oh, wow.

And we sat and it was just really touching to be with him, and he was able to come out of his psychosis here and there, and we had some meaningful conversation, and he went on his way, and I never really heard about him ever again.

But that was also really an important piece of my life.

And he also exhibited.

And I think we'll probably do a podcast about this, something called anosognosia, which is one of the most insidious symptoms of a severe mental illness, is that you don't recognize that you have a mental illness.

So, you know, anosognosia is one of my favorite things to talk about.

We are doing a whole podcast on that, and there's books written about it.

We might actually have one of our guests be someone that specializes in anosognosia.

So it's the lack of insight, but it's truly, you do not believe you have mental illness.

So it's not unique to the psychiatric world, people within the neurology world.

For example, some people had a stroke.

They can't move their right arm, yet they think they can.

Some people have lost vision in one eye.

They think they can see.

With us, especially with my patient population, we had several ACT teams, assertive community treatment teams.

Many people are in and out of the hospital all the time, and they could be hospitalized 40 times, and they would say, there's nothing wrong with me.

My mother must have paid off the police.

This is a conspiracy.

And there's just not any insight about that.

And then that becomes particularly challenging.

How do you get someone to take a medication that they might need when you really don't think there's anything wrong with you?

So that's also very fascinating.

Yeah.

Should we talk a little bit about how common mental illness is?

Sure, go ahead.

And some facts.

I've.

You do facts and figures because you like facts and figures more than I do.

We might say when we were preparing and we did a little synopsis of who are we?

I said, paul, we should probably figure out, you know, who are we?

How are we approaching this?

And it was really interesting.

I wish we should have brought that.

We might bring it another time.

But mine was all, hi, I'm Tracy, and my husband's Paul, and rah, rah, rah, you know, we.

We love treating patients, and we love, you know, and Paul's was very.

Tracy went to this school, I went to this school, we, blah, blah, blah, and all that.

And it's funny, but together it works really well.

So you do do some statistics for us.

Well, it's been estimated that anywhere from one out of four to one out of five people have a mental illness in their lifetime at some point.

So when, you know, there's a lot of focus on cancer, heart disease, diabetes, appropriately, but mental illness in aggregate is more common than all of those illnesses combined.

So it's the number one public health problem in our country and actually globally.

So it's not just a product of industrialized society, Western lifestyle, things like that.

The organ is the brain.

85 Billion nerve cells plus or minus in the brain, and over a trillion connections among those nerve cells, which makes it obviously the most complicated organ.

Most fascinating.

That's why I've always been interested in the brain.

And again, taking nothing away from the heart, very important organ.

The kidney, also important organ.

They're all important.

But the brain, that's the final frontier.

And as you were saying with your patient years ago, we didn't have much to offer.

We still have a long, long way to go, but we've come a very, very long way and we'll be having discussions about psychopharmacology and other therapeutic techniques that we use.

Yes.

So I think there are some myths about mental illness.

One is that these are character defects that, come on, just pull yourself up,.

Pull yourself up by the bootstraps, right?

Oh, I'm sure anybody out there that has psychiatric illness or knows someone, that's a really rough one to take.

I, I, we hate hearing that.

Well, that's why I, honestly, my, my agency was something Behavioral health.

Sir, I don't like to, I personally don't like behavioral health because to me it connotes that you have some control, misbehavior.

I don't like that.

You don't say again, oncology, behavioral.

I don't know.

Nobody else says that.

So I don't like that.

No, I got voted on that one, I guess.

But you hear it a lot, right?

Behavioral.

You hear it a lot and it' syou know, we talked about stigma a little bit ago, but I actually prefer the term discrimination because I think people with mental illness, again, not to make comparative statements about other people who are discriminated against, but they are among the most discriminated against people in our society.

And they're among the most vulnerable among us as well.

Yes.

Another myth is that diagnoses are imprecise, they're psychobabble.

But I think in the 40 years that I've been in this field, our diagnostic precision accuracy is about as good as most fields of medicine.

Now, we still lack blood tests, still Lack X rays.

But we rely on the old school way of diagnosing which is basically history, physical lab tests and course of illness.

And using those, they're called validating criteria.

Using those criteria, our accuracy for diagnosis is actually quite good and very important.

Well in the book.

So we use a book and it's called the DSM Diagnostic Statistical Manual 5 Text Revised.

So they update it and we do rely on that.

But you bring up an important point is that the patient is of a.

As a whole, you cannot get accurate diagnosis in psychiatry by five minute appointments.

So I'm going to preach that till the end of time.

So again I was chief medical director but I saw patients every single day and I saw some of the most ill people because I chose to and I wanted them to get the best possible care.

And it, and I'm good at this.

It takes time.

You're good at this.

It takes time.

We, I insisted on an hour intake or more.

We had what we called a first break team, which is very important team.

We had, we took, I'm an adult psychiatrist but I took people as young as 14 in that program, 14 to 40 within the first 18 months of any signs of psychosis.

And we wrapped services around them, try to keep them on a trajectory of wellness.

The longer you stay in an ill state, the harder it is to get out of it.

And if you start losing things like dropping out of school and relationships fall apart and lose work and it's hard to get back in that world.

So we wrap services around them with those patients.

You're telling a family that their 15 year old scholar athlete son is hearing voices and they have schizophrenia.

Now that's a hard diagnosis to tell.

And, and we need, and we're trying to rule out all kinds of things.

Please tell us if you're using substances.

We're not judging you.

We need to know.

And again our medical expertise comes into play.

Is there something medical going on that could potentially be causing this?

You know and initial workups with head CTs.

Right.

I know you sometimes, sometimes at Lindner center and it depends on how they are presenting, but definitely taking a thorough evaluation and spending time.

Our follow up appointments were always half an hour.

It depends if someone, if there was a person that said I just need a refill on my Prozac, that was rare in my life.

That's not my typical patient.

That's a different story.

But most people, you need time.

So you and I give lots of presentations to our colleagues.

And after this happened, I swear I told this story 400 more times because it was so disturbing.

I was giving a talk to a large group of nurse practitioners.

Again, it could have been.

We have great nurse practitioner colleagues and I'm still consulting and collaborating with many of them.

Just spoke to two of them this morning.

But this one woman, she was a new nurse practitioner in family practice.

And much to the chagrin of her supervisor, she spoke in front of the whole group and I said the importance of spending time with patients.

And she said, excuse me, that's very old school.

And I said, oh, tell me more, I want to hear more.

And she said, oh, I only spend five minutes with every patient.

And she was really proud of this.

I spent five minutes with every patient.

And she said, yeah, like I have one pill for every disease state.

So if they have high blood pressure, they get Norvasc.

If they have diabetes, they get Metformin, if they have depression, they get Prozac.

And I, I was mortified.

But I've told again, I've told the story so many times and here I am telling it on our inaugural podcast.

So if you are a person that's seeking psychiatric treatment and you go to your insurance company and they say, here's a provider, here's a psychiatric provider for you and they spend five minutes for you with you, please try to, if you can get a different provider, that's not good care.

Especially in early on, they need to be spending time.

I don't like it when people make a diagnosis.

When a couple minutes.

I remember even as early as residency, because you talked about bipolar disorder a lot.

When I was a resident, I remember there was a resident in my class, someone would start presenting and they would be two sentences in, you know, Ms. Smith is a 43 year old Caucasian female with blah, blah, blah.

And the person would say, bipolar disorder.

Like, I don't like that.

Like, you shouldn't be making snap decisions like that.

If there's a lot of things to consider making a diagnosis.

Yeah, so I've always said psychiatry is a pretty low tech field, but what we have is our mind and our experience and time.

The other point I think it's worth emphasizing is diagnosis is important, but people are not their diagnoses.

Right, Right.

And I think one of the most important aspects of finding a mental health provider is not just time, but are they authentic?

Do they care about you?

They care about you as a human being.

So when I left my practice of 31 years.

And how many years were you in practice?

40, 40, 71 Year.

Well, that was very emotional.

We should write Books about that, Just the whole saying goodbye.

I had some patients at my agency, so I had some patients I had when they were 20 and they were 51 when I left.

Can you imagine what life we experienced together?

So very emotional, saying goodbye.

And I gave lots and lots of notice, nine months notice and lots of, you know, we have five more sessions, we have four more sessions.

And I had all kinds of inspirational quotes in my office.

Never, never, never give up.

And the journey starts here.

And.

But the one that people love the most besides never, never, never give up was I don't care how much you know until I know how much you care.

And that was right behind my head.

And I also had all kinds of brain charts and brain models because these are neurobiological illnesses.

Right, but you're an excellent psychopharmacologist.

I'm a very good psychopharmacologist.

But I think the thing that we are best at, Paul, is that you just talked about authenticity.

We truly care.

Our patients knew that.

When I got so many cards and letters from my patients at the end, that was the theme that kept recurring is I know you really cared about me.

And we would show that and we did.

We actually genuinely cared about them.

So I know, same with you.

When someone was in the room with me, they were the center of my universe.

Nothing else mattered.

I wasn't distracted.

They are my higher levels.

We were 100% present.

And most people don't get that in their lives and certainly many people with serious mental illness really don't get that in their lives that someone is paying attention to them and listening.

So when my patient with schizophrenia would come in, for example, but I remembered that last time they were in, they were really concerned about Uncle Bob was having gallbladder surgery.

And that was important to that person.

And I said, before we start, whatever happened to Uncle Bob in that gallbladder surgery?

Taking that few seconds to ask that meant so much because she remembered that she cares that I care about that.

And those were these connections.

So people would often say to me, how do you get people to take long acting injectables?

So some of our patients on with long acting medication, we weren't forcing people to do it, but some people was highly recommended that they be on it.

But people would say, how do you get people to do that?

Why?

How?

Why?

They took these medications because they trusted me.

It wasn't, I was spending five seconds with them and I was saying, by the way, you need to be injected with this heavy duty medication.

We had a relationship.

They Trusted me.

And over time they thought, wait, she cares about me.

She knows me.

And if she's suggesting this, I might consider this.

And I think that was really powerful.

Our title of this podcast is Docs Tracy and Paul.

That's pretty informal.

We're not going by our last names.

Dr.

Skill, Dr. Keck.

And so many of my patients called me Tracy.

I don't care.

So many called me Paul.

And much to my mother, may she rest in peace, is rolling over in her grave because she, my mother was, was so proud that I was a doctor, first doctor in the family.

And she really wanted everybody to call me doctor.

And she was appalled that.

That I always introduced myself.

But I would say to everybody, I would say, hi, you know, welcome.

I'm Tracy Scale.

I'm the lead psychiatrist here and I'm looking forward to working with you.

And then we would go from there.

It was just two people having a discussion.

Well, so I have a close friend from college who also became a doctor and he retired before.

Well, a couple years ago.

And he and I still write long hand letters to each other.

So I wrote him.

I found myself sitting down writing a letter congratulating him.

And as part of that letter, it occurred to me that while we were all pre med and studying and trying to get good grades and all that, we didn't realize that we were being given a gift.

And the gift is a sacred one.

We know things about people, our patients, that they probably never told anyone.

It's as sacred as the confessional.

I love the word sacred.

And I feel like this is.

We have a very sacred profession.

You know, as a callow youth, I didn't really appreciate that until later in my career.

But towards the end, I started telling patients that I was working with some like you for decades.

I said, thank you for giving me the gift of giving you my gift.

And the gift was caring.

And I meant it.

Right?

No, they knew you cared about them.

So I think that's one of the beauties of being a doctor in general, but especially being a psychiatrist.

I love being a psychiatrist and you do too.

We really chose the right professions.

Absolutely.

Again, love all aspects of medicine, but psychiatry is.

It's so special to have someone telling you their deepest, darkest things and their fears and their shame and their.

All these things and being able to bear witness to that and being able to provide some solace is unbelievably powerful.

So I was always aware of that and always very grateful for that.

And I just, I've also loved people's stories So I think that's another thing.

I watched the Biography channel.

I always read biographies and autobiography.

I love people's stories and everyone has a story.

So I worked with many people that literally lived under a bridge or in the woods.

I worked with what we called the Homeless act team as people who are unhoused with serious mental illness.

And I learned some of the most important things in my life from those people that allowed me to share their lives.

I remember telling you this story and I am will write a book about this and this will be in the.

But this man who I was working with, very sweet, had psychosis, was living under a bridge.

The team kept trying to get him in.

Housing we did have in Cincinnati was called Housing first model, which is based on Maslow's hierarchy of needs.

At the base of the triangle is security and safety.

We all, everybody deserves that dignity.

And then you keep working your way up to self actualization.

Right?

But everybody deserves a safe place to be.

So it was a very good program.

New York City, I believe, has multiple places have it.

But you don't have to jump through hoops.

You don't have to not be on substances.

You don't have to take medications.

We just want you to be safe.

So we kept trying to offer this man and he wasn't ready to do it.

He was relatively content living under the bridge.

And he had a series of people on there.

And he came into the office one day and was very disheveled and malodorous.

And many of my patients were.

I always say we worked with a lot of people that the general public often would walk on the other side of the street if they saw many of my patients.

And we were the opposite.

We welcome you with open arms, you know.

And he came in and he.

I had a care manager, love my care managers.

They're the backbone of the organization.

Was sitting in the room and the patient came running to behind my desk to me with a little flip top, little grainy phone that he had.

And it was like, I think they called them Obama phones then.

That was the, you know, little phones that he got for free.

But it had a little grainy picture in it.

And the care manager was afraid that he was gonna hurt me or something.

I wasn't afraid at all.

And he was.

I said, no, no, it's okay.

And he said, I.

Can I show you something?

I just wanna show you something.

I said, sure.

And he held up this picture.

And it was this little picture.

It was a.

It was a goose.

And there were, if you remember In Cincinnati.

There were lots of parts of Cincinnati that had a lot of geese.

That was actually a problem.

It's a problem.

Caus messy.

They were kind of messy.

So most people would have seen these geese as a nuisance.

But he held up this thing, this picture of a goose, and he said, look at this goose.

Isn't it majestic?

And he was so happy to share this with me.

And it's just.

I don't know, I felt emotional.

I remember feeling emotional when he told me that, because I thought, wow.

And it was just this beautiful moment.

And then I remember one day I wear.

We lived in an affluent part of Cincinnati, and I went to get Starbucks or something, and I.

There was a woman in line, wealthy, who was yelling at the barista because something with her order was being really difficult.

And here's a woman that all the financial things she could ever want.

And I go to work, and I'm working.

Homeless clinic, right?

And here's this guy, really, not a penny to his name.

This is a different person.

Comes in all bedraggled.

And I said, Mr. Smith, how are you today?

Well, I am blessed because the sun is shining and I get to see you.

Right.

It just puts everything in perspective, you know?

Yeah.

So we have so many stories.

Docs Tracy and Paul discuss it all.

This is us.

We like to discuss.

We like to discuss.

We never shut up.

We talk constantly.

But this is our dinner conversations.

Right.

We talk about all these things, but we.

I think the bottom line is we feel so blessed to have had these incredible careers and have touched so many lives and so many people.

Touched our lives and very, very lucky.

We're so lucky.

Yeah.

We have incredible gratitude, which, by the way, gratitude is a key to mental health.

Mental health.

And we're going to talk about that a lot.

You know, keeping a gratitude journal.

And, you know, we both.

No matter how ill our patients have been, we've talked about gratitude to all of our patients, you know.

Yeah.

Mental illness, you were talking about statistics and touching so many people's lives.

So we've now moved to Arizona, and we have a whole new group of people in our lives.

And it is fascinating to me, and it just corroborates everything we've been saying.

Mental illness touches everyone's lives.

We know many, many very wealthy people, and mental illness does not discriminate.

It's not just for people who are poor living under the bridge.

You know, that's partly why the Lindners, you know, made the Lindner Center.

Right.

They wanted help for people, for their own Family as well, right?

Yeah.

So there's not a week, I would say, every couple of days that goes by that someone doesn't say to us, my brother, my uncle, my sister, and you know, somebody has mental illness.

Can you help us?

Which is one of the reasons we emphasize that this podcast is we want to make people aware of what to look for.

How do you seek mental health?

How do you navigate the system?

Right, yeah.

When I was CEO at Lindner Center, I would get at least a call a day from a family, a family member, sometimes from the person themselves.

And Craig Lindner, who was chairman of the board, he once asked me, how often do I get these calls?

And I said, and then how much time do I spend on.

I did a quick time in motion study.

It was about five hours a week or about an hour a day.

And people were scared, as they should have been, but also didn't know, like, when.

When should I be worried about my teenager who's saying he wants to kill himself?

When should I worry about such and such family member?

Is this just acting out or is this for real?

What happens if.

Do we call the police?

Well, what happens if we hospitalize my son?

Will he hate me forever?

I mean, these kinds of things.

All the.

You still get calls like this, right?

And I think the gist of our podcast isn't that we expect people to be able to diagnose, but be able to at least be appropriately concerned or recognize some behaviors, signs and symptoms that are worth crossing the threshold to go see a mental health provider.

That's so scary for so many people.

I mean, I'm a doctor and I hate going to the doctor.

Yeah, that's for sure.

That's why I'm going with you to your next appointment, because I don't trust that you're going to give all the information you're supposed to give.

Thank you for sharing that.

I'm sharing that.

That's true.

No, I think.

No, I think that's true.

The point is, it's scary for all of us to go to a doctor for any reason.

I think it's even scarier for people who have never seen a mental health provider to go see a mental health provider.

Don't understand psych.

We still see this.

People think we'll.

We'll be at dinner.

People think, are you analyzing me?

Are you?

And it's kind of tongue in cheek, but truth and all humor.

They kind of think that, don't they?

That just happened at dinner the other night when we went out with.

And everybody was Laughing.

Everybody was laughing.

But truth and all humor.

Then you get a psychiatry couple.

Holy cow.

They're really thinking.

We're analyzing every move they make, but we're off.

We're off the clock.

We always say when we're at dinner.

But they also think people, psychiatry, psychic powers or something, that we can kind of read their minds and all that.

No, it's not that.

We're just.

We are really good listeners.

And then I think people are afraid that they're going to be thrown into the hospital against their will, which occasionally happens, but not very commonly.

I'm glad you brought that up, too, because as chief medical officer, I would really impress upon my staff.

You know, we were.

We were all able to write psychiatric holds called Different Things in Different States.

I took that very, very seriously.

And I would always tell my staff, you do not write a psychiatric hold unless the first of all.

Most people needed to discuss it with me before they would do that.

But I rarely wrote a psychiatric hold.

But if I wrote one, they really needed to be in the hospital.

And we had a psychiatric emergency room we were very fortunate to have in Cincinnati.

And they knew that if I wrote a psychiatric hold, that person needed to be in.

So really, the person needs to be at imminent risk.

And imminent is the key of harm to themselves, harm to someone else, or they're so psychotic they can't put a spoon to the mouth, can't take care.

Of their basic needs.

Right.

So we took that very seriously.

So no one should be loosey goosey just writing a psychiatric hold on someone.

Right.

Another myth you.

I know we're bouncing around, but another myth is that if you're really intelligent, you can't have psychiatric illness.

I've had this happen so many times, people saying, I can't have schizophrenia, or my son can't have schizophrenia because he went to Harvard, or he was the top of his class.

That has nothing to do with it.

Again, it doesn't discriminate against intelligence.

And if you've seen A Beautiful Mind, highly recommend that.

Also the book, beautifully written.

Also another book, the Center Cannot hold by Ellen Sachs, is beautiful.

Ellen Sachs.

I've been on many panels with her.

I mean, she's a lawyer.

She won the MacArthur Genius Award, and she talks very openly about her psychiatric illness in that book.

The Center Cannot hold, so it doesn't discriminate against intelligence.

Another story I always like to tell is I had medical students in residence rotating with me, and we saw a young man who was beautifully dressed, very articulate, But I had given the heads up ahead of time to this student that this person has a history of schizophrenia.

I probably shouldn't even have said that, but I gave a.

Said we're going to be seeing someone with schizophrenia.

And we did the interview and again, the importance of spending time because had I spent six minutes with him, he would have kept it together.

But the 14th minute everything kind of falls apart and the delusion started coming out and all of these things.

And he was very delusional and a delusion.

We'll get into it in that podcast.

But it's a fixed belief that's not reality based.

And he had lots of delusions about this woman being attracted to him.

And it was a rotomanic delusion and led to stalking behaviors and it was bad.

It led to legal issues and things like that.

And he left.

And I had discussion with the student afterwards and she said I'm confused why you said he has schizophrenia.

And.

And I said, well, tell me more because I'm confused that you're confused by this.

Why do you not think.

Why, why don't you think he has schizophrenia?

And she said he was wearing a polo shirt, Paul.

She really said that.

And those are the days.

Polo shirts were popular, but he was.

Because he was clean and neat and he didn't have aluminum foil on his head or some stereotype of what someone with schizophrenia would look like.

And that was concerning to me.

Luckily she did not go into psychiatry, but that was concerning.

Oh, I have another story.

Could I tell you another story about.

That was hugely impactful to me.

Please.

This is seriously so important.

I'm so glad that this just came up now.

So fourth year of medical school.

This is another reason I went into psychiatry.

So fourth year of medical school we had this rotation and I want to say it was called a hac.

And I don't even know what that stands for, but it was you.

It was either family medicine, pediatrics or psychiatry you could do.

And it was an additional one month rotation and it was public health.

Was public health thing.

That's what it was.

And I remember I would walk down to the clinic in downtown Cincinnati and it was a primary care.

I thought I'm going to do this family practice clinic.

So I go down and there was this.

The primary care physician who'd been there forever and he was late 70s and he was a pretty serious guy and kind of scary.

And.

And I was.

Went in to see this patient.

So the patient, if you're watching the pit, highly recommend by the way.

We're watching it right Now, Absolutely.

People present.

Talk about authentic.

Yeah.

So medical students and residents have to present.

So I'm, you know, fourth year medical student, I go in and I do the exam and it said, you know, man complaining of abdominal pain.

So I go in to do this exam and the man, yes, he was disheveled, he was malodorous, he was talking in a nonsensical way, but he was holding his belly and complaining of abdominal pain.

He's on, he's laying down on the gurney.

I start palpating again.

We're real doctors.

I know how to do it.

You know, palpating the abdomen.

Start pressing.

He has an acute abdomen.

He jump, he almost jumps off the table.

You learn that right away in medical school.

That's potential medical emergency.

It could be appendicitis, it could be pancreatitis, could be some.

It's an acute abdomen.

Some acute abdomen, right?

Yeah.

And I go then, and I said, sir, we're going to help you.

I'm so sorry, we're going to help you.

And I'm trying to reassure this man.

I go out and present to the family practice older man that's been there forever.

And I say, Mr.

So and so is a so, you know, 42 year old man with.

Presenting with an acute abdomen.

He dismisses me.

I barely get the words out of my mouth.

And he's like, ah, he's crazy.

He.

Did you see that guy?

He smells.

We want to get him out of here.

He's stinking up at the, the whole place.

And he's just, he's crazy.

He's like a, he's a vagrant.

Yeah, I said.

And I remember it was shocking to me.

And again, how many years later is this?

50.

I mean, I'm still thinking about how stressful this was, how horrible this was.

And I had no power as a student.

Yeah.

By the way, it's not 50.

I would make me my 70s.

I was, I had no power as a student.

But I tried to again, I said, but he really.

But, but Dr.

So and so, he really does have an acute abdomen.

I think he might have appendicitis.

And he would not admit, do anything to help him.

He, they call him street him or something.

Right.

He just sent him out to the street.

And that bothered me.

It was so horrifying.

And just because someone has severe mental illness doesn't mean they can't have an acute abdomen or a heart attack or something.

And that still haunts me.

And that doctor's long gone.

But I remember thinking when I'm a doctor, whatever kind of doctor I am, I'm going to make sure I treat the whole patient and I listen to people and I show that I care and get to the bottom of things.

So there's.

Many times, haven't we, as psychiatrists, diagnosed lupus, diagnosed Huntington's disease?

There's many other things we're trying to figure out as physicians, what's going on with that person.

And we'll probably have a podcast about this, too.

But unfortunately, people with severe serious mental illness are at higher risk for having other serious medical problems.

Comorbid.

We call it comorbidity.

Comorbidity.

And so you really have to look for those comorbid medical conditions because one, they could be caused by the psychiatric illness, but two, left untreated, they're exacerbated.

By the one exacerbates the other.

It's a vicious cycle.

Yeah, right.

See, there's so much to talk about.

You were also.

We're talking about authenticity and the patient being the center of the universe and all that.

And so another story.

So part of our intro to our podcast, we want to tell you a little bit about us.

And so one of the other key things for me is when I was a teenager, I worked at a place that doesn't exist anymore, but it was an institution for people who had developmental delays.

But it also, it was actually a terrible place that's now been torn down, and there's stories written about it.

But we.

My father worked there, and we all got summer jobs there.

And there was a.

Every day I would see a man that was picking dandelions and things like that, and I would say hello to him, and he would say hello back, and we would smile and say hello to each other.

And one day my father was.

We were going to lunch, and he said, why are you saying hello to that guy?

And I said, I don't know.

I just, like, see him and I say hello to him.

And he said, that guy doesn't talk.

He's been here his whole life.

And he's muted.

He doesn't say any words.

And I said, well, yes, he does.

And no one told me that.

And I just treated him with dignity.

With dignity.

And that's how we treat every single person, with dignity and respect.

We could go on and on forever.

We will.

We're going to have many, many podcasts, but we want to just.

We just wanted to introduce ourselves.

We're going to be talking about depression, bipolar in the next couple podcasts, and we're looking forward to that.

I think, Paul, the biggest thing that we offer is not our psychopharmacology skills, not our therapy, psychotherapy skills, is that we are keepers of hope.

Never, never give up hope.

We never, never give up hope with each other, with our friends and family, with our patients.

And we just never give up.

And we can't wait to share more of these stories with you.

Thank you so much.

And until next time, Sam.