Charles Darwin, Expression, and the Harmful Legacy of Eugenics

In 1872, with the publication of “The Expression of the Emotions in Man and Animals,” Charles Darwin went rogue. Only a decade after the anatomist Duchenne de Boulogne’s produced the first neurology text illustrated by photographs, Darwin claimed to be the first to use photographs in a scientific publication to actually document the expressive spectrum of the face.

Combining speculation about raised eyebrows and flushed skin with vile commentary about mental illness, he famously logged diagrams of facial musculature, along with drawings of sulky chimpanzees and photographs of weeping infants, to create a study that spanned species, temperament, age, and gender. But what really interested him was not so much the specificity of the individual as the universality of the tribe: If expressions could, as de Boulogne had suggested, be physically localized, could they also be culturally generalized?

As a man of science, he set out to analyze the visual difference between types, which is to say races. While Darwin’s scientific contributions remain ever significant, it’s worth remembering he was also a man of his era — privileged, white, affluent, commanding — who generalized as much as, if not more than, he analyzed, especially when it came to objectifying people’s looks. In spite of his influence on evolutionary biology and his role in the scientific study of emotion, Darwin’s prognostications read today as remarkably prejudicial. (“No determined man,” he writes in “The Expression of the Emotions in Man and Animals,” “probably ever had an habitually gaping mouth.”) This urge to label “types” — a loaded and unfortunate term — would essentially go viral in the early years of the coming century, with such assumptions reasserting themselves as dogmatic, even axiomatic, fact.

This article is adapted from Jessica Helfand’s book “Face,” an elaborately illustrated A to Z of the face, from historical mugshots to Instagram posts.

Hardly the first to postulate on the graphic evidence of the grimace, Darwin hoped to introduce a system by which facial expressions might be properly evaluated. He shared with many of his generation a predisposition toward history: simply put, the idea that certain facial traits might have a basis in evolution. Empirically, the idea itself is not unreasonable. We are, after all, genetically predisposed to share traits with those in our familial line, occasionally by virtue of our geographic vicinity. At the same time, certain specimens, when classified by visual genre, become the easy targets of discrimination. In so doing, comparisons can — and do — glide effortlessly from hypothesis to hyperbole, particularly when images are in play.

Almost exactly a century after the arrival of Darwin’s volume, Paul Ekman, a psychologist at the University of California, published a study in which he determined that there were seven principal facial expressions deemed universal across all cultures: anger, contempt, fear, happiness, interest, sadness, and surprise. His Facial Action Coding System (FACS) supported many of Darwin’s earlier findings and remains, to date, the gold standard for identifying any movement the face can make. As a methodology for parsing facial expression, Ekman’s work provides a practical rubric for understanding these distinctions: It’s logical, codified, and clear. But what happens to such comparative practices when supposition trumps proposition, when the science of scrutiny is eclipsed by the lure of a bigger, messier, more global extrapolation? When does the quest for the universal backfire — and become a discriminatory practice?

The real seduction, in Darwin’s era and in our own, lies in the notion that pictures — and especially pictures of our faces — are remarkably powerful tools of persuasion and do, in so many instances, speak louder than words.

The idea that photography allowed for the demonstration and distribution of objective visual evidence was a striking development for clinicians. Unlike the interpretive transference of a drawing, or the abstract data of a diagram, the camera was clear and direct, a vehicle for proof. The process itself allowed for a kind of massive stockpiling — pictures compared to one another, minutiae contrasted, hypotheses often mistakenly corroborated — which, while arguably rooted in scientific inquiry, led to a stunning degree of generalization in the name of fact. If evolution is seen as the study of unseen development — biological, generational, temporal, and by definition intangible — the camera provided the illusion of quantifiable benchmarks, an irresistible proposition for the proponents of theoretical ideas.

Wellcome CollectionIn his study of boys from the Jews’ Free School in Bell Lane, Galton laid the foundation for his Jewish type. “What struck me,” Galton would later write, after driving through the Jewish neighborhood in Stepney, East London, was their “cold, scanning gaze.” Image: Wellcome Collection. Sir Francis Galton – The Jewish Type (1885)

Darwin’s cousin, the noted statistician Francis Galton, saw such generalizations as precisely the point. Long before computer software would make such computational practice commonplace, he introduced not a lateral but a synthetic system for facial comparison: what he termed “composite portraiture” was, in fact, a neologism for pictorial averaging. Galton’s objective was to identify deviation and, in so doing, to reverse-engineer an ideal “type,” which he did by repeat printing — upon a single photographic plate and within the same vicinity to one another — thereby creating a force-amalgamated portrait of multiple faces. At once besotted with mechanical certainty and mesmerized by the scope of visual wonder before him, Galton thrilled to the notion of mathematical precision — the lockup on the photographic plate, the reckoning of the binomial curve — but appeared uninterested in actual details unless they could help reaffirm his suppositions about averages, about types, even about the photomechanical process itself.

That Galton drew upon the language of statistical fact — and benefited from the presumed sovereignty of his own exalted social position — to become an evangelist for the camera is questionable in itself, but the fact that he viewed his composite photographs as plausible evidence for an unforgiving sociocultural rationale shifts the legacy of his scholarship into far more pernicious territory.

At once driven by claims of biological determinism and supported by the authoritarian heft of British empiricism, Francis Galton pioneered an insidious form of human scrutiny that would come to be known as eugenics. The word itself comes from the Greek word eugenes (noble, well-born, and “good in stock”), though Galton’s own definition is a bit more sinister: For him, it was a science addressing “all influences that improve the inborn qualities of a race, also with those that develop them to the utmost advantage.” The idea of social betterment through better breeding (indeed, the notion of better anything through breeding) led to a horrifying era of social supremacism in which “deviation” would come to be classified across a broad spectrum of race, religion, health, wealth, and every imaginable kind of human infirmity. Grossly and idiosyncratically defined — even a “propensity” for carpentry or dress-making was considered a genetically inherited trait — Galton’s remarkably flawed (and deeply racist) ideology soon found favor with a public eager to assert, if nothing else, its own vile claims to vanity.

George Rinhart—Corbis via Getty ImagesDr L. Sherman examining some of the 983 children between 2 months and 5 years who have been entered into the Better Babies contest near Washington D.C. in 1931.

The social climate into which eugenic doctrine inserted itself appealed to precisely this fantasy, beginning with “Better Baby” and “Fitter Family” contests, an unfortunate staple of recreational entertainment that emerged across the regional United States during the early years of the 20th century. Widely promoted as a wholesome public health initiative, the idea of parading good-looking children for prizes (a practice that essentially likened kids to livestock) was one of a number of practices predicated on the notion that better breeding outcomes were in everyone’s best interest. The resulting photos conferred bragging rights on the winning (read “white”) contestants, but the broader message — framing beauty, but especially facial beauty, as a scientifically sanctioned community aspiration — implicitly suggests that the inverse was also true: that to be found “unfit” was to be doomed to social exile and thus restricted, among other things, by fierce reproductive protocols.

In 29 states — beginning in 1907 and until the laws were repealed in the 1940s — those deemed socially inferior (an inexcusable euphemism for what was then defined as physically “inadequate”) were, in fact, subject to compulsory sterilization. From asthma to scoliosis, mental disability to moral delinquency, eugenicists denounced difference in light of a presumed cultural superiority, a skewed imperialism that found its most nefarious expression during the Third Reich. To measure difference was to eradicate it, exterminate it, excise it from evolutionary fact. Though ultimately discredited following the atrocities endured during multiple years of Nazi reign, eugenic theory was steeped in this sinister view of genetic governance, manifest destiny run amok.

Later, once detached from Galton’s maniacal gaze, the composite portrait would inspire others to play with the optics of the amalgamated image. The 19th-century French photographer Arthur Batut, known for being one of the first aerial photographers (he shot from a kite), may have been drawn to the hints of movement generated by a portrait’s animated edges. American photographer Nancy Burson has experimented with composite photography to merge black, Asian, and Caucasian faces against population statistics: Introduced in 2000, her Human Race Machine lets you see how you would look as another race. The artist Richard Prince flattened every one of Jerry Seinfeld’s fifty-seven TV love interests into a 2013 composite he called “Jerry’s Girls,” while in 2017, data scientist Giuseppe Sollazzo created a blended face for the BBC that used a carefully plotted algorithm to combine every face in the U.S. Senate.

Galton would have appreciated the speed of the software and the advantages of the algorithm — but what of the ethics of the very act of image capture and comparison, of the ethics of pictorial appropriation itself? There’s an implicit generalization to this kind of image production and indeed, seen over time, composite portraiture would become a way to amalgamate and assess an entire culture, even an era. In a 1931 radio interview, the German portraitist August Sander claimed he wanted to “capture and communicate in photography the physiognomic time exposure of a whole generation,” an observation that reframes the composite as a kind of collected census, or population survey.

The camera, after all, bears witness over time, its outcome an extension of the eye, the mind, the soul of the photographer. Sander was right. (So was Susan Sontag: “Humanity,” she once wrote, “is not one.”) With the advent of better, cheaper, faster, and more mobile technologies for capturing our faces, the time exposure of a whole generation was about to become a great deal more achievable.

School, camp, daycare, and sports physicals: What to do in the time of COVID-19

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As some youth sports teams get started again, some summer camps and daycares are opening up, and we begin to think about school (or some form of it) in the fall, many parents are wondering: what do I do about getting that physical form I need for my child?

Understandably, many families do not want to go to the doctor right now. They are worried about going anywhere, and especially worried about going to a medical office, where they are concerned they may end up around sick people.

I want to say up front that most medical facilities are very aware of the risk, and take measures to make sure that patients can safely get the medical care they need. But when it comes to forms for physicals, in some cases families may not need to leave their homes at all — or if they do, they may be able to do it in a limited way.

What questions should parents ask about forms for sports, daycare, or school?

Do I even need a form?

• In many school districts, forms are not required every year but rather at certain times, such as kindergarten or middle school entry. Parents should check and find out; it may not be an issue at all.
• Some activities and facilities that the child has attended in the past may be willing to use a previously submitted form. It’s worth asking.
• Because of the pandemic, there may be some wiggle room or a grace period allowed for forms. Again, parents should check.

Would my child’s last appointment suffice for the form?

• Very often, what is required is documentation of a check-up within the past one to two years. If your child had a check-up within that time frame, you may be able to just get a form sent to you, no visit needed.

Would a telehealth visit be possible — and accepted?

• Many practices, mine included, are providing well-child care via telehealth for children who do not need to be seen in person — and providing forms based on those visits. (It’s helpful if you can get your child’s height and weight before the visit.). Parents should call their doctor to find out if this is an option, and also check to be sure a form based on a telehealth visit would be accepted.

Does my child need immunizations or something else that requires an in-person visit?

• It’s very important that children stay up to date on immunizations. Because of the pandemic, many children are falling behind. This may lead to outbreaks of measles and other vaccine-preventable diseases, many of which could be more dangerous to children than COVID-19.
• There are some conditions that require in-person monitoring, like anemia or high blood pressure. While many practices are finding remote ways to manage these and other chronic health problems, not everything can be done remotely. Parents should check with their doctor.

If my child needs to go in person, what can be done to keep us safe?

I strongly encourage families to call their doctor’s office to find out what they are doing to minimize risk; they will likely be pleasantly surprised. For instance:

• In my practice, we have cut down on the number of patients we are seeing, and spread out the appointments so that patients go directly into rooms and don’t wait in a waiting room. We also do lots of screening before and at the visit, everyone wears a mask, and we have made physical changes to our office as well as changes in our routines that make spread of the virus less likely.
• Sometimes, the visit can be streamlined by having a phone call or virtual visit ahead of time to collect information. Then when the child comes in, it’s for a quick exam and any shots or other in-person care they need, minimizing the time in the office. Parents should see if this is an option.

As a pediatrician, the most important thing to me is that children get the medical care they need. I worry that many children won’t because their families are afraid of COVID-19. Please, call your doctor and talk about what your child needs — and how they can get it safely. Trust me, we are just as invested in your child’s health and safety as you are.

Follow me on Twitter @drClaire

The post School, camp, daycare, and sports physicals: What to do in the time of COVID-19 appeared first on Harvard Health Blog.

Local governments ‘overwhelmed’ in race to trace U.S. COVID contacts; "With the pandemic claiming hundreds of American lives daily, many city and county health departments say they lack the money and staff to warn people who have been exposed, a Reuters survey finds."

submitted by /u/progress18 [link] [comments]

Local governments ‘overwhelmed’ in race to trace U.S. COVID contacts; "With the pandemic claiming hundreds of American lives daily, many city and county health departments say they lack the money and staff to warn people who have been exposed, a Reuters survey finds."

submitted by /u/progress18 [link] [comments]

source https://www.reddit.com/r/Health/comments/i3kepe/local_governments_overwhelmed_in_race_to_trace_us/

‘The biggest monster’ is spreading. And it’s not the coronavirus

‘The biggest monster’ is spreading. And it’s not the coronavirus The coronavirus pandemic has hindered the availability of drugs for HIV, TB and malaria worldwide. According to one estimate, a three-month lockdown across different parts of the world and a gradual return to normal over 10 months could result in an additional 6.3 million cases of tuberculosis and 1.4 million deaths from it. https://ift.tt/eA8V8J

With RIL eyeing Netmeds deal, ePharmacy in for consolidation

With RIL eyeing Netmeds deal, ePharmacy in for consolidation Reliance's yet-to-be announced acquisition of Netmeds for an estimated $120 million is a catalyst for other players such as PharmEasy and Medlife to explore merger and acquisition negotiations. https://ift.tt/eA8V8J

Podcast: My Husband Has Psychosis

 

What does psychosis feel like? What’s the difference between a delusion that demons exist and a religious belief of the same? In today’s show, Gabe and Lisa recall Gabe’s real-life psychotic episodes and discuss all the pain and stress surrounding psychosis.

Join us as Gabe shares how it felt when there were demons under his bed and when the window washers were watching his every move.

(Transcript Available Below)

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And We Love Written Reviews! 

About The Not Crazy podcast Hosts

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from Gabe Howard. To learn more, please visit his website, gabehoward.com.

 

 

 

 

Lisa is the producer of the Psych Central podcast, Not Crazy. She is the recipient of The National Alliance on Mental Illness’s “Above and Beyond” award, has worked extensively with the Ohio Peer Supporter Certification program, and is a workplace suicide prevention trainer. Lisa has battled depression her entire life and has worked alongside Gabe in mental health advocacy for over a decade. She lives in Columbus, Ohio, with her husband; enjoys international travel; and orders 12 pairs of shoes online, picks the best one, and sends the other 11 back.

 

 

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Computer Generated Transcript for “Husband Psychosis” Episode

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Lisa: You’re listening to Not Crazy, a psych central podcast hosted by my ex-husband, who has bipolar disorder. Together, we created the mental health podcast for people who hate mental health podcasts.

Gabe: Hello, everyone, and welcome to the Not Crazy podcast, I’m your host Gabe Howard, and with me, as always, is Lisa.

Lisa: Hey, everyone, and today’s quote is the scariest thing of all is never knowing what you’re suddenly going to believe. And that is by Neal Shusterman.

Gabe: It’s a fascinating quote, because I don’t think that you have to have a mental illness in order to be caught in this. For example, on Facebook, you’re just minding your own business. You’re scrolling through. You’re seeing adorable pictures of your niece who lives 700 miles away. And suddenly there’s this meme, and you’re like this meme must be true. Whether it’s political or religious or something that’s going on in the world or you see a video and you’re like, I believe this now. And I think anybody on social media is going to understand at least the base level of our topic today. Today, we’re going to be talking about psychosis.

Lisa: That is funny, but in general, psychosis, not funny. Actually, very, very, very depressing.

Gabe: Now, psychosis, of course, it’s one of those symptoms that can mean a lot of different things to different people. For example, the psychosis that I experienced was almost entirely delusional. I believed and felt and knew things were happening that, of course, were false. I knew that somebody was following me around. I didn’t hear that person and I didn’t see that person, but I was positive of it in my own brain, even though I didn’t see them. But of course, there’s auditory hallucinations, which is hearing things. There’s visual hallucinations which is seeing things. And there’s all kinds of other hallucinations that are. I was going to say less popular.

Lisa: Well, maybe now’s a good time to say that psychosis is usually divided into the two categories of hallucinations and delusions. And hallucinations have the sensory aspect of where you’re actually seeing, hearing, tasting, touching something that is not, in fact, there. Whereas delusions are just about beliefs. You don’t see the demons. You don’t hear the demons. But you know they’re there, for sure.

Gabe: And we should point out that delusions are one of those things that gets thrown around a lot. Like when people say that they’re depressed, when they’re actually sad. We say that, ugh, mom’s delusional if she thinks that her boss is going to give her a raise. No, she’s not delusional, she’s wrong.

Lisa: Right.

Gabe: Delusions are much, much different. It’s not just an unpopular opinion or even an incorrect assumption. It’s well, it’s a medical issue. It’s there’s something wrong. That’s the difference between being delusional and just being incorrect.

Lisa: Psychiatry actually divides delusions into two types, which are either bizarre and non bizarre. Bizarre being something beyond the realm of possibility and non bizarre is things that are within the realm of possibility. So a bizarre delusion would be things like being abducted by aliens or having the implant in your brain. And the non bizarre delusions are things like, oh, someone is following me or poisoning me or someone is out to get me. And interestingly, psychiatrists believe that if you have the non bizarre delusions, the ones that are within the realm of possibility, it’s actually less serious and easier to recover from.

Gabe: On one hand, I can kind of understand that a little bit, because you’re not so far gone that you believe in, you know, aliens and demons and,

Lisa: Something unreasonable.

Gabe: Yeah, something unreasonable. But? But really? Your brain is telling you

Lisa: Yeah. Yeah.

Gabe: That something is happening that does not exist, is not supported by fact. You are positive that it is happening. You refuse to listen to the people around you. You refuse to accept any sort of visual confirmation, or you’re just you know that it is happening. But because what’s following you is a person versus, say, a dragon, you’re less sick?

Lisa: There is an element of judgment to it, yeah. And subjectivity. Once again, everything is on a spectrum and it’s all culturally constructed. So what kind of views are reasonable and which ones aren’t?

Gabe: We do have examples of where it gets really tricky, right? When I believed that demons were following me, it was a delusion and I was delusional. 

Lisa: And everyone was very clear on that. There was no doubt.

Gabe: But we have a country that has flat earthers, and they believe unequivocally that the earth is flat. So now it gets tough. We have plenty of science, data, evidence to prove that the earth is not flat and they are ignoring that evidence in the same way that I was ignoring that when I turned around, nobody was behind me. But I’m delusional and flat earthers are just wrong. So it gets. 

Lisa: Yeah.

Gabe: It gets tricky, right? Now, listen, for my money, I would bet that some of the flat earthers are in fact delusional, that there’s probably something going on in their brains that’s making them believe this. This is an extreme view.

Lisa: Well, this is part of the subjectivity of mental illness. At what point do you tip over into mental illness and at what point were you just weird?

Gabe: Yes. And Lisa, to answer your question, the way that you know is if it’s interfering with the activities of daily living. If you’re a flat earther and you’re working and your wife loves you and your kids are fine and you go to work and you pay your taxes and you just have this one weird belief that you refuse to get rid of. Yeah, you’re probably not mentally ill.

Lisa: Well, but again, where does that begin and end?

Gabe: Exactly.

Lisa: The unending struggle of psychiatry and of us, of what is symptom and what is personality?

Gabe: We could do this forever. But, Lisa, the reason that we wanted to do this show is because we have sort of a unique opportunity. You witnessed my psychosis. You had a front row seat for most of my downfall, for lack of a better word.

Lisa: I wouldn’t call it downfall. This was most of this particular symptom that was a manifestation of your illness.

Gabe: But you had a front row seat for it, and

Lisa: It was very upsetting.

Gabe: I feel that the unique opportunity is not that you witnessed it, but that I remember these things from my perspective and you remember these things from your perspective, and we can discuss them. You know, often the parts are very separate. We’ll listen to, you know, parents or loved ones who describe it, but their loved one is nowhere to be found or we’ll listen to people like me describe this, and the people who witnessed it or suffered because of it are nowhere to be found. So for the rest of this conversation, everything that we talk about, you’re going to hear essentially Gabe’s opinion and Lisa’s opinion of the identical symptom.

Lisa: Well, it’s not an opinion, it’s an observation or an experience. But yes.

Gabe: But it’s your opinion of the experience.

Lisa: I suppose that’s true.

Gabe: For example, we both went to a hockey game and my opinion was that it was amazing and your opinion was that it was boring. But it’s the same hockey game

Lisa: Right. Right. I was actually a little bit hesitant to do this topic, although I did think it was a good one, that we’d have a lot to talk about because, you know, what I was about to say is, well, your psychosis wasn’t that bad. Well, how do you classify that? Or, you didn’t have it that often.

Gabe: I love it when people say that to me, like when they

Lisa: Right.

Gabe: Tell me that I’m high functioning.

Lisa: Right. right.

Gabe: Thanks. I don’t know what that means.

Lisa: Yeah.

Gabe: I’m positive that if I went to the cancer ward and I found whoever was doing best. And I’d be like, well, you’re a high functioning cancer patient. They’d be like, What? What are you doing? Get out of here. You’re a jerk. You’re an asshole. But people throw this around like it’s meaningful.

Lisa: Right. You did not have. See, what is often? I don’t actually know. In my mind, you did not have delusions very often you did not have long periods where you were delusional. But it was by far the symptom that bothered me the most. It was by far the thing that upset me the most. And in part because there is such a social stigma against it. Because that was the thing that made you crazy. That was the thing that meant that you were mentally ill.

Gabe: In preparation for this episode, Lisa, you said, and I quote, psychosis was the symptom that terrified me and made me consider leaving you the most.

Lisa: Yes.

Gabe: You’ve backed it down here. And I appreciate that. You’re trying to sounds like a good friend, but why did it scare you?

Lisa: Because it’s scary.

Gabe: Were you scared for your safety? Were you scared for the safety of your stuff? Did you think I was going to eat your cats? I mean, when you say

Lisa: Well, yes.

Gabe: Scared. Like, we watch horror movies and were scared.

Lisa: Notice that the horror movie villain is almost always psychotic. Not a coincidence.

Gabe: Yes. Yeah, good point.

Lisa: So, some.

Gabe: But no, seriously. Did you ever feel that you were in danger

Lisa: No,

Gabe: For your life?

Lisa: Absolutely not. No.

Gabe: Why?

Lisa: Never once.

Gabe: Why?

Lisa: That was another thing I learned in research today. You hear psychosis and you think it means the person must be dangerous, if not necessarily to you, especially to themselves. But no, it turns out that more often than not, psychosis is more troubling than dangerous. Which I didn’t know. That was an interesting fact.

Gabe: And that’s my point. I’m not. I swear I’m going to hold you down for you to answer this question. Listen to the actual question.

Lisa: I was getting there.

Gabe: All right. But let me ask it again, because took you a long time to get there.

Lisa: Wow. Wow.

Gabe: Why?

Lisa: Glass houses, Gabe, glass houses.

Gabe: But seriously, you did not have any of this research. You were not a mental health advocate. You were just a woman that for some reason decided to date a dude with untreated bipolar disorder who was experiencing psychosis. So you

Lisa: Well, I didn’t know that.

Gabe: You had to believe the stereotype. What do you mean? I called you up and I said, there’s demons under my bed. You did not know there was something wrong?

Lisa: But that wasn’t, you didn’t say that on the first day.

Gabe: No, no, no, I’m not.

Lisa: That didn’t happen immediately.

Gabe: Follow along. I need you to focus. When I called you and you were in the safety of your apartment and I was screaming and yelling that you needed to come to my apartment. 

Lisa: Right.

Gabe: And help me get the demons from under my bed. You knew I was sick. You knew I was experiencing psychosis. And the stereotype is that I am no doubt dangerous.

Lisa: Right. And I did worry about that.

Gabe: Why did you come over?

Lisa: That is an excellent question

Gabe: That is the question.

Lisa: Because I was worried for you.

Gabe: The specific thing that I’m trying to get you to answer is, I called you up, I said, Lisa, I need you to come over and help me get the demons that are under my bed. You knew that I was mentally ill. You knew that I was experiencing psychosis. And I know you want to help me. You had options. Why didn’t you call the police? Why didn’t you call nine one one? Why didn’t you call the E.R.? Why didn’t, why didn’t you call a man? You, just anything, I’m. Why did you, a single woman that at that time believed all the stereotypes that existed, that people experiencing psychosis were violent, agree to get in your car and enter my apartment where you would be alone with a psychotic man?

Lisa: You know, I’ve actually never thought about that until just now. Why did I do that? I wouldn’t say that I believed all of the stereotypes. But yeah, I believed a lot of them. I found it extremely scary and extremely disturbing. And the idea that people with psychosis were inherently violent, yeah, that was certainly at the top of my mind. I guess the reason why was I was so concerned about you. I was worried about you and what was going to happen to you. I was worried that if I called someone else, it would turn out poorly. I knew that I could control my actions, I couldn’t control what someone else would do. You hear such horror stories about people who are psychotic and something bad happens to them. And then finally, because I probably didn’t really believe it. This was the first time that you’d ever shown any signs of being delusional or believing in things that were manifestly not real. That if I had had time to think about it, I probably wouldn’t have done it. Or if somebody else had been telling me about this story, I would have said, oh, my God, no, don’t go there. What’s wrong with you? But it came up so suddenly and I just reacted. I didn’t really think it all the way through.

Gabe: Just to clarify, did anything bad happened, was I violent? 

Lisa: No.

Gabe: Was it just?

Lisa: No. Not even a little. No. That would be the answer to why it is I never worried about it again. Because after that happened, you no. I didn’t think I needed to clarify this, but I guess I should clarify this. I absolutely never felt that you were a danger to me, or anyone else, for that matter. Absolutely never.

Gabe: I know that you didn’t feel this way after the first time, but this was the first time, the first time my delusions, my psychosis interfered with Lisa’s life was that middle of the night phone call.

Lisa: Yes, it was. It was the first time I was aware that you had delusions.

Gabe: Well, yeah, it’s not like I could tell you, I didn’t know that I had them.

Lisa: Well, that’s true, that’s true. But in retrospect, you’d had these beliefs for a long time. You had been believing in the demons for a long time, but you never said anything about it or told me about it.

Gabe: I didn’t think that I needed to. One of the things I think about is

Lisa: Well, because you thought it was real?

Gabe: I did. I did think it was real. It goes back to that. You know, I tell people that I thought about suicide from birth and it never really

Lisa: Yeah, me too.

Gabe: Got questioned until I was like 25 years old. And then suddenly I was like, how could I believe this for 25 years? And the answer is, why wouldn’t I? It’s what I believed as far back as I can remember.

Lisa: That’s what a delusion is. The idea that you think it’s real, that you don’t have. And I think that TV and movies have let us down on this one, because when people on TV or in the movies are delusional or psychotic, they always show something that indicates to us, the viewer, that it’s not real. The delusion or the hallucinations is encased in a white light or something so that we, the viewer, know for sure. And you think, well, how come they can’t differentiate it then? It’s so obvious that this is set apart from reality. It’s so obvious that this isn’t part of the normal world. Why are they not able to tell? And in real life, it’s not like that. This was perfectly enmeshed with the normal world. You thought it was real. There was no sign to you that it was not. That is the definition of a delusion.

Gabe: Now, what you’re, of course, describing is a visual hallucination. Now, I did not see the person, so I was much more likely to have felt that I just hung up the phone and talked to somebody that did not call or I had orders to do something.

Lisa: Did that happen?

Gabe: Well, yeah. I mean, yes. And that’s where it gets kind of confusing. Right? And the reality is, is if you think about it too much, it all falls apart.

Lisa: For people who have never been psychotic, and I have never been psychotic, the idea that demons are following you is completely unreasonable. Why were you not able to rationally think it through and say to yourself, OK, that’s ridiculous. Demons don’t exist. Clearly, there aren’t any under the bed. That’s ridiculous. Because that’s what mental illness is. You lose that ability. You did not have the ability to rationalize or think it through or apply logic to the situation. That’s why you thought they were real. And why wouldn’t you?

Gabe: Yeah, logic would be really helpful.

Lisa: Well, yeah.

Gabe: But then you get into the who am I going to believe, you or my lying eyes?

Lisa: Exactly.

Gabe: Who am I going to believe? I know this to be true. An excellent analogy of this is like trying to convince a four year old that there’s no Santa Claus. They know it. They know that Santa is real. Their whole lives have been set up for this. It doesn’t matter what you show them. You can take them to the mall right now, rip off Santa’s fake beard, show them that it’s their uncle and they’re like, well, yeah, I mean, he’s not Santa. But the other ones are real.

Lisa: That’s not the real one.

Gabe: Again, in a four year old mind, there’s all of these mental gymnastics to keep that belief because it’s part of their makeup.

Lisa: This is an excellent analogy because getting older, getting wiser, having better cognitive skills can be an excellent analogy for getting well and now having the mental ability to think it through and think to themselves, OK, that doesn’t make sense. There weren’t any demons there. There aren’t any demons there. It’s an excellent analogy. Good job. Good job.

Gabe: Thank you. I love it when you praise me. It’s very rare. So I’m sure this will be cut out. If it makes it to the final cut, I will be shocked. Lisa, let’s go back to that night.

Lisa: Mm hmm. It was scary.

Gabe: Twenty five years old, just recently been diagnosed with bipolar disorder. It’s the middle of the night, I call you up, demons under my bed. You race over. We’re standing in my apartment, in my bedroom. I am pointing under the bed screaming that there are demons under there.

Lisa: You weren’t screaming, you were crying.

Gabe: I like my version better because I sound manlier.

Lisa: I think that is an important distinction. You weren’t agitated or angry or worked up. You were scared. You were scared, and you were crying, and you were upset. And so when someone comes to you and they’re afraid, you don’t see them as a threat. You don’t think, oh, no, this guy’s going to hurt me. No, he’s afraid. He needs hugs. I’m sure that that was a key reason why I handled it the way I did.

Gabe: What did you do? What happened next?

Lisa: You know, sadly, I don’t know that I remember. Well, I realize you were delusional, but do you remember?

Gabe: Here is what I remember. I remember that you came over.

Lisa: Yeah, I remember driving in the night and thinking, oh, my God. Because we didn’t live that far apart. So I was driving up the road and there wasn’t any traffic. It was like 2:00 a.m.. And I remember thinking, oh, my God, what am I walking into? Where am I going? What’s happening?

Gabe: I remember you coming in. You used your key because I was still upstairs. You came in and you asked what was wrong. I told you again, repeated the same thing. You told me that you would take care of it. You looked under the bed and then we left.

Lisa: Did we go to my apartment?

Gabe: Yeah. We went to your apartment where it was safe

Lisa: Oh, OK.

Gabe: And it was the middle of the night. So we went to bed.

Lisa: Right.

Gabe: It was sleepy time. And when I woke up, I recall you telling me that you took care of it. Maybe it’s because I had slept. Maybe it’s because I had taken my medication. Maybe any number of things. I cycled out. But I believed you. It sounded perfectly logical that my girlfriend defeated demons. Awesome.

Lisa: It wouldn’t be very long after that until because obviously we called your doctor pretty much right away on that and you started taking antipsychotics for the first time and the drugs were very difficult. They had a lot of side effects. There were a lot of problems with them, but they worked like magic. It was a miracle. You believed something that was so incredibly crazy. You believed something that was so nutty and so obviously not real as there were demons under the bed and within less than two weeks of taking these magic pills, you were like, oh, no, absolutely not. It was incredible. You wouldn’t think that something that was so profound and so scary and such an upsetting symptom could go away so fast. It seemed like it should take longer or there should be more difficulty to it. Do you remember? And this is actually heartbreaking. They had started working. So now you no longer believed the demons were there, but you weren’t quite over it all the way. Do you remember what you said to me?

Gabe: I don’t. 

Lisa: You said that the demons were gone. Because they had been following you. They weren’t just like living in your apartment. They were following you around. And that the demons were gone, they weren’t following you anymore. They had left you alone. And you were worried that they might come after me now. And you were telling me all the things that we needed to do to keep me safe. Because after all, I was the one who had gotten them to go away. So clearly, they would be angry about that and they would now target me. And it was just heartbreaking because you were. You were. You were very sincere. Obviously, you were so worried. You were terrified that something horrible was going to happen to me because I had vanquished the demons and they would be out for revenge.

Gabe: What did we do to protect you?

Lisa: Over the course of a couple more weeks. That belief went away as you got better and the antipsychotics really took hold. So we’d actually didn’t need to do anything to protect me because by the time it became a super serious problem, you had cycled out of it. But just how emotionally wrenching is that? That the psychotic guy is worried for my safety from his delusions. God, I feel almost teary just thinking about it.

Gabe: I think about stuff like this a lot, because I have such little memory of it, right. Obviously, I remember the demons, I remember calling you, I remember lots of things to do with the demons. I remember them just being a constant presence in my life. But then people tell these stories like you know, you tell the story of being in my bedroom with the demons under the bed. I don’t remember crying. That sounds much more reasonable than the version that I remembered, which was I pictured myself is as strong, as tough. I was screaming. I was yelling. I was fighting. And you were going to help. When in actuality.

Lisa: No, you were crying and cowering in the corner. In retrospect, why? Well, this is a stupid question. Why did you not leave the house? If there were demons under the bed, why didn’t you just go wait in the driveway or something? But of course, that’s a stupid question because, yeah, if you had that ability, you wouldn’t have believed they were there in the first place. So dumb question.

Gabe: I think it’s really interesting to think about stuff like this, especially from this vantage point all of these years later. As you know, part of my job as a podcast and a writer and trying to help people understand is I get to reflect back a lot on when I was the sickest and some of the.

Lisa: It’s been very odd because some of the things that I remember you have a completely different perception of. And it’s been really strange because there’s a lot of stuff where I would have thought that you and I were in complete lockstep. If you had asked me at the time, does Gabe perceive this the same way as you? Yes. Yes, he does. We are in 100% agreement. I thought for sure that I understood what you were thinking and feeling during that time. And, yeah, I was way off. Now, to be fair, maybe you’re not remembering it like you’re retconning it in your head to go backwards. But, yeah, there’s a lot of things that I’ve been way off and that has been very disturbing to me, and fascinating.

Gabe: I want to talk about something psychosis adjacent for a minute. People listening to the show, they’re probably well versed with the side effects of medication. But.

Lisa: Obviously, all medications have side effects, but the other ones were always very manageable. The side effects from your mood stabilizers or your antidepressants? I mean, yeah, it sucked. But whatever, what are you gonna do? But the side effects from the antipsychotics were bad enough. You would think, OK, if this was for high blood pressure, I’d stop taking this immediately. But it was so important, specifically to me, that you not stop taking them.

Gabe: So I remember the first one that I was on, and that’s the one that you said worked like magic. And within two weeks, they were gone.

Lisa: It was amazing.

Gabe: At around the two month mark, the side effects were so extreme that I couldn’t take them anymore.

Lisa: Right. Yeah.

Gabe: There was just so many of them. And they were noticeable, Lisa. You could see the side effects.

Lisa: Yes. Yes.

Gabe: And so you knew that I wasn’t lying.

Lisa: Yes, the side effects were very extreme and very evident.

Gabe: And I told you, I’m going off these meds.

Lisa: Yeah, you said you couldn’t take it.

Gabe: What did you say?

Lisa: I said, absolutely not. Are you insane? Are you crazy? Absolutely not.

Gabe: Ok, but the cure was worse than disease. How did we resolve this issue?

Lisa: To my thinking, there was no such thing as worse than the disease. The idea that you believed in demons was so horrifying and so bad that I didn’t see where there was any side effect. Ever. Pretty much nothing could have happened that I would have thought it was worth it for you to stop taking those drugs. And I insisted that you can continue. And you kept saying, look, the following terrible things are happening. You’ve got to be nuts, lady. I can’t do this. No, absolutely not. You’re swallowing these pills.

Gabe: It’s interesting to compare and contrast our beliefs, because in your mind the cure could never be worse than the disease, because the worst thing was the demons. The psychosis was worse than any possible side effect. In my mind, the side effects were way worse because I was used to the demons. I knew how to manage the demons. The demons only reared their ugly head, you know, a couple of times a month. And yeah, I had to call my girlfriend to save me and I was crying in a corner. But then it was all over and I’d have a few weeks of fineness, whereas these side effects were day in and day out. So in my mind, the cure was 100% worse than the disease. In your mind, hey, this is a great trade. How did we resolve that?

Lisa: I saw it as evidence of how incredibly irrational you were, and how incredibly sick you still were that you thought there was any side effect that would not be worth it. That you would even consider not swallowing that pill every day was obvious sign that you were crazy. The way that we resolved this was we told your doctor. You told your doctor all about the side effects. I insisted that you could not stop taking the drug. We went together. And many, many visits over the course of many, many weeks ensued. And they changed up your meds. You know, a different antipsychotic. A lower dosage. Just lots and lots of experimenting back and forth, seeing what would work. And it was this really intensive process. Normally you’d see a psychiatrist, what, once a month, maybe once every couple of months? For five, 10 minutes max? You were going in there every couple of days, largely at my insistence. And I would not let that poor man out of the room. It was this very intense, multiple appointments, multiple times a week, day to day tracking of your symptoms, a day to day measuring of what was going on, some of which was probably unreasonable. Because drugs need more time than that to work. You need more time to get your blood levels up and all that. But no, I insisted on it and would not hear of anything else. And everybody accommodated me. And.

Gabe: Can I talk now or?

Lisa: No, I have something else to say. And when it comes to stigma, I was kind of embarrassed or maybe even ashamed of this symptom in you. It was the thing that I hid. People would be like, oh, how’s Gabe? How are his symptoms? Or even my friends who also struggled with mental illness, I did not want to tell them about this in particular. And when I did, I would minimize it big time. Well, I mean, he believes in, I mean, he doesn’t see the demons. He doesn’t talk to the demons. He just thinks they’re there. They’re really more of just a hovering cloud. I went out of my way to minimize this as much as possible, even though it was not minimal in my mind. It was huge.

Gabe: It’s interesting because my official diagnosis was bipolar disorder with psychotic features, but of course, I just tell everybody that I have bipolar disorder. So even I am minimizing it. And I, I don’t mean to. I talk about the psychosis all the time. It comes up a lot. And it was scary for me. And the delusions were big. And I don’t. Feeling suicidal or the mixed episodes or the mania, but psychosis. Not only did I believe things that weren’t true, but I would essentially blackout. I don’t remember a lot of this stuff. I have no recollection of calling you. 

Lisa: Really?

Gabe: I know that you called me because you told me you called and you showed up in my room.

Lisa: Really?

Gabe: I don’t have a recollection of this.

Lisa: You never told me that.

Gabe: I don’t have a recollection of a lot of stuff. I honestly felt that I was, you know, tough. I thought I was a tough guy in the room helping you vanquish the demons. And you’re like, no, you’re were in a corner crying. I don’t remember it that way. I believe you, because why would you lie?  This losing time is scary.

Lisa: It was extremely scary.

Gabe: We’ll be right back after these messages.

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Gabe: And we’re back discussing Gabe and Lisa versus psychosis.

Lisa: Do you remember? It was about two or three months later. And you were no longer having the delusions, they were gone. And we were arguing over whether or not you should keep taking the pills. And you were saying, look, the side effects are just too much, I want to stop. And I said, absolutely not. And you actually said, you know, nothing will happen if I stop taking these. It won’t matter because it was never real anyway.

Gabe: I remember having this conversation. I remember saying that I never had the delusions, I had just been up for a few days and I was, I was clearly confused. You misunderstood. It got blown out of proportion.

Lisa: You went with all of that first. This was just blown out of proportion, it wasn’t really that big of a deal, I was just really tired. I hadn’t slept since in a couple of days. I overreacted. And when that wasn’t working, and I kept insisting, no, no, no, you are going to keep taking these pills. You said, well, you know, actually, well, I made it up. I was exaggerating. I wanted your attention. I wanted you to take me seriously and see how sick I was. They were never really real. They were never really there. I didn’t actually believe that. At first, I thought, wow, you know, screw you, buddy. How could you possibly do something so evil and cruel? I’m breaking up with you. This is unacceptable. Why would I ever be willing to stay with this guy? And I don’t remember how, but I actually talked about it with your doctor. And he told me that that was actually quite common, that people after the fact would claim, even though it was not true, that they had actually been in complete control the whole time, that it had never really been like that, that it had never really actually happened, that they had made it up. It was better, in your mind to be amended, to be a manipulative jerk, than it was to have had such an extreme symptom. Which I decided was 100%t true and absolutely what had happened to you. Because if you had actually been faking for whatever reason, you’re an amazing actor. I didn’t think that you could have faked that level of distress. 

Gabe: Well, and if you needed further proof that I wasn’t faking a few months later, it came back.

Lisa: You realize that wasn’t a few months later. That was a few years later.

Gabe: Wow. I thought it was a few months.

Lisa: That was years later, we were married by then.

Gabe: Yeah, and I tell this story a lot because it was

Lisa: It was extreme.

Gabe: I mean, it was huge. Lisa, the story is basically you came home and your husband was wearing his robe walking around the house.

Lisa: Literally around the house, outside around the house. 

Gabe: In the winter, no coat, cold 

Lisa: Yeah. No shoes.

Gabe: No shoes. You pull in and you pick up the story from here.

Lisa: It was wintertime, it was dark. When I pulled in, you were doing like a square pattern in the driveway, like this really rigid pattern. You weren’t just like wandering around. You were almost like following a line or a track. And I said, what are you doing? And you said, I’m guarding the house. A few days earlier, there’d been some teenagers in the neighborhood doing some vandalism. Just kids stuff, though, nothing serious. And you said, they’re going to come back. They’re going to come back and they’re going to hurt us. So I’m standing guard out here so I can make sure that they won’t come back. And I thought, what? What are you even talking? Are you talking about those kids who were messing around a few days ago? Is that? What? Are you serious? That’s what you’re worried about? To be fair, you had been. You were still going to work, but I could tell you’d been kind of depressed for a couple of weeks. So I, of course, was worried that something was coming. But this seemed to me to come pretty much out of nowhere. I did not think you were that sick when this happened. This was the first time that something like this had happened in years and it had been so long that I’d almost forgotten. The depression, the mania that was still part of it for me. But the psychosis wasn’t really part of it for me anymore.

Gabe: But what did you do?

Lisa: I told you to go inside.

Gabe: And did I?

Lisa: Yeah, yeah.

Gabe: And then it was over.

Lisa: Umm, no.

Gabe: I feel like you’re kind of burying the lead here. I mean, it just sincerely, I was outside in winter barefoot. I said that there was cameras in the trees. Demons were gonna get you. I was standing sentry.

Lisa: There were no demons that time.

Gabe: You’re like, well, I pulled in and I thought that was weird. And I told him to go in the house and then it was all over. That’s it? That’s all?

Lisa: I told you that that was ridiculous, that you certainly did not need to be walking through the driveway and that you needed to go in the house. And that didn’t work. And then stupidly, well, or brilliantly, I actually remembered something that I had heard someone else say at one of the local mental health charities. She was talking about her daughter, who was schizophrenic and had psychosis, and she felt bad about it because she thought it wasn’t a good thing to do, but that sometimes, just for expediency because she just couldn’t take it anymore, she would go along with the delusion until she got the desired result. The specific example she gave is my daughter said, oh, there’s people outside wanting to hurt me. And I said, OK, why don’t you go to your room and I’ll let you know when they leave. And I thought of that. And I thought, OK, desperate times, I guess. And I said, don’t worry about it. I’m home now. You’ve been doing this the whole day. I’m going to start watch, it’s my turn. It’s my turn to take up watch.

Gabe: This is the advice that psychiatrists, psychologists give. You’re not supposed to tell somebody they’re wrong because why would they believe you?

Lisa: Well, it’s mixed, though.

Gabe: If you are seeing a dragon and your friend says, hey, there’s no dragon there and you’re seeing it, you’re not going to believe them. Why would you? You’re looking at it. Who am I going to believe? You or my lying eyes?

Lisa: Well, but there’s a lot of debate on that. And it’s not really clear because on the one hand, you don’t want to reinforce the delusion and be like, oh, yeah, I see that dragon. Look at that. Look at that giant dragon over there. That’s not good.

Gabe: No, no, no, no. Nobody said reinforce the delusion. Nobody said agree that you see it. They just said to go along with it.

Lisa: Right. So where’s the line?

Gabe: Well, but you recognize that what you chose to do is reinforce the delusion.

Lisa: I know. I did not necessarily feel good about it, but it was late, it was dark. I just got home from work. I was confused. I wasn’t sure what was happening. And I went with the path of least resistance.

Gabe: Hey, you know, you were new. We were all new. The perfect way you could have handled this was not to say I’ll take up watch, but to say it’ll be okay. I’m home now. See that part, you’re not agreeing or disagreeing with me. You’re not confirming or denying. Basically start thinking like a politician where your answers are accurate but yet meaningless. That’s the correct way. Because obviously, if you say there’s no dragon there and I see a dragon, then I’m not going to trust you and I can’t get help. But to your point, if you say, oh, yes, I see the dragon, too. Well, that is going to make it much harder to talk me down. 

Lisa: Right. Right. And it’s the reflective listening, etc. You should try to respond to the feeling behind what they’re saying rather than the actual words, which, by the way, works really great. You should all do that. I was just so thrown by it. I thought, what? What is going on? So I started out with rational. That’s ridiculous, honey, of course not. We don’t need to worry about that. Why are you worried about that? That’s not real. That’s not reasonable. And then when that didn’t work. Yeah. Like I said, I don’t necessarily feel good about it, but that is what I did.

Gabe: What did we do the next morning? Because I.

Lisa: We called your doctor.

Gabe: And what did the doctor say about this, because as you pointed out, this was the first time that I had had a psychosis episode in a couple of years. Which, again, to me seems like two months. But, yeah, you have a much better grasp of the timeline than I do.

Lisa: We’ll think about it. You were in that apartment and I came over. And now this was when we were in the house. Well, that was years later.

Gabe: That’s a good, yeah.

Lisa: So it couldn’t have been months.

Gabe: Wow,

Lisa: Yeah.

Gabe: Wow.

Lisa: You really remember it as being just a few?

Gabe: I did,

Lisa: You see how it can’t be?

Gabe: Yeah. No, I agree with you completely. I saw it as a couple of months.

Lisa: It would be years before we moved into that place.

Gabe: Wow.

Lisa: So we called your doctor and you and I, what we would always do back then is I would go with you to the doctor and we would talk beforehand about, you know, what are your top three symptoms? What are the things you want to make sure to say? We would plan out the doctor’s visit together.

Gabe: Right. Right. I remember. Top three.

Lisa: Yeah, top three. And so we would be ready when we got in the door. I think you couldn’t get an appointment until, like the next day or something. So we talked about it pretty extensively. And that’s when you told me these other things. That it wasn’t just outside, you know, our house. That this had happened to you at work as well. I don’t know if you remember, the window washers were watching you?

Gabe: They were.

Lisa: You worked in a skyscraper downtown. I think you were on like the 14th floor.

Gabe: Yup.

Lisa: They weren’t just there doing their job of washing the windows. They had some nefarious purpose that surrounded you, that the whole reason they were there at all was because of you. And you had this long and involved reasoning behind it. And I asked you, well, are they there every day? And you said, well, no, on the days they weren’t there, they were leaving behind cameras. So it turned out that you’d been thinking this fairly involved delusion with lots of details for weeks. And this was the first I’d seen or noticed of it. When we went to see your doctor, she adjusted your meds.

Gabe: And then it all went away?

Lisa: Yes. And once again, within an extremely short time period, just a couple of weeks, it was gone completely. It was amazing. And this time you got a med that had a lot less side effects.

Gabe: Yeah, it was newer.

Lisa: Yeah, it was incredibly expensive, but I thought it was worth every dime. The pharmacy was doing that thing where you got the for every.

Gabe: Fifty dollars you spent, yeah.

Lisa: Yeah, $50, you get 10 cents off a gallon of gas. We got free gas that entire year because of that prescription.

Gabe: I remember,

Lisa: Which did not cancel the price, but was still nice.

Gabe: I do remember. Lisa, after that, was there any more bouts of psychosis that involved you?

Lisa: A couple of years later, there was something that was much more mild. When you were leaving that job and you were going back and forth on disability payments, you told me that people were following you, that you were being watched.

Gabe: So when I was fired from that job.

Lisa: Yes. When you were fired from that job for being bipolar.

Gabe: For having bipolar disorder.

Lisa: Yeah. Once again, you said that people had put up cameras in the neighborhood to watch you.

Gabe: I don’t remember anything about cameras. I

Lisa: There were cameras.

Gabe: I remember telling you that I’m worried because I feel that they’re watching me. One of the things that they said is, as we were, you know, arguing back and forth about, you know, FMLA and time off work and me getting treatment and insurance payments, which was a nightmare and can be another whole episode, is that well, you’re well enough to go on vacation because you flew to the the state that

Lisa: You went to visit your parents.

Gabe: I was at my parents’ house, who live in a different state

Lisa: I needed rest.

Gabe: Yeah. Lisa needed respite. And we also saw that you went to a hockey game while you were off work, which is not untrue. Lisa had taken me to a hockey game to try to do something at the request of, you know, I live with bipolar disorder. They didn’t. They didn’t.

Lisa: That’s another whole episode.

Gabe: I know it’s another whole episode, but I said they’re watching me because they know this stuff. 

Lisa: Right.

Gabe: And that, of course, made it more difficult because I was maintaining this was absolutely, unequivocally not a delusion, because I have facts.

Lisa: Well.

Gabe: And we brought this up to my doctor and she said.

Lisa: Well, because, again, you had the thing with the cameras, which was absolutely ridiculous. People were not.

Gabe: But what did, what did the doctor say?

Lisa: Let me get there.

Gabe: I already told that story, Lisa.

Lisa: No, you didn’t. You left that out. You said they were watching me or following me. You didn’t say. You made it sound like they were watching me or following me. The cameras was the part that pushed it into, OK, that’s absolutely not happening, Gabe.

Gabe: All right, I’ll give you that.

Lisa: Right.

Gabe: I’ll give you that. So and the doctor said, remember the top of the show when we said that there was two types of delusions and one’s more serious than the other? Well, it’s about to play out in real life. Lisa?

Lisa: The doctor said that that was not the same as your other bouts of psychosis. Basically what she said is, look, this idea, because you hear about that on the news or you see it on 20/20 or whatever. So there could be a little bit of truth to this. There might be some reality behind that. So it is not the same as his other periods of psychosis. And I said, but this is clearly not true. These people may be watching him or something like that, but they are clearly not putting cameras in our trees so that they can spy on him in the house. And she said that there was a difference there, that there was a meaningful distinction there. And as such, it needed to be treated differently.

Gabe: I feel that in our marriage, in our life and you helping with mental illness, that if we wait long enough, for example, you said that they weren’t placing cameras, that that was clearly delusional. But, of course, now you hear about putting cameras up all the time. They’ll go to the neighbor across the street and give them a free Ring bell if they

Lisa: This is basically what your doctor said. Yes. That you did, in fact, hear about stuff like that that wasn’t completely outside the realm of possibility.

Gabe: They hire private investigators and on and on and on.

Lisa: Right. They hire private investigators for disability claims and and that therefore, this needed to be responded to differently than your previous things who were just out of nothing. It didn’t feel that way to me.

Gabe: I want to be clear here that Lisa’s not wrong. The reason it didn’t feel that way is because Lisa had experience. You knew what to see, she could see the look in my eyes. I mean, my body language. This wasn’t a difference of opinion. I was fearful of it. And that’s what Lisa was responding to. I understand why a doctor can’t react to that. And it was small and light and all the things that Lisa is saying. But I don’t want anybody hearing this and be like, a-ha, she should have listened to Gabe because he knew.

Lisa: You didn’t know, that was not.

Gabe: First off, you should always listen to Gabe. But I was still wrong. Lisa had this one right. So as much as I want to smirk and say, ha ha, the doctor agreed with me, the doctor really didn’t agree with me. She just.

Lisa: Well, if we had come into this cold, if you had not had those previous episodes of psychosis, I would have just thought, OK, he’s worried about this. This is paranoia. You would have tried to use, OK, but think about it, honey, would they really put up that kind of money to? That doesn’t really make sense. That wouldn’t be cost effective. How would they get the camera in the? You would do all of those things. But since I knew, in my mind, I just went straight to OK, nuts, crazy, delusional. If you had not had those previous episodes of psychosis, you would have treated it as someone who was just worried about something.

Gabe: It’s fascinating, this entire episode, which we’re nearing the end of, all of the delusions that I have shared, are all the scary ones. The delusions of grandeur, which you experienced as well, that.

Lisa: Yeah, but I didn’t know that back then.

Gabe: You’ve said, oh, my God, he was the life of the party. He was so much fun. You thought all of those delusions were somehow reasonable.

Lisa: Yeah, I didn’t see them as delusions. Ok, there’s a question. Looking back on it, that was pre-diagnosis.

Gabe: Mm-hmm.

Lisa: Was that just bipolar disorder? Was that just mania? Or was that delusional?

Gabe: This is very tough for me because, like you said, it’s all subjective, right?

Lisa: Right. Where’s the line?

Gabe: On the one hand, mania is about feeling that you’re bigger and better and badder than you are. You’re the greatest ever. Was I so manic that I believed that I had unlimited money and could afford to buy everybody in the bar a drink? Or was I delusional to believe that I was so rich that I could just throw around several thousand dollars in an evening? And I kind of think that that’s just mania. Mania convinced me that because I had three thousand dollars, I could afford to spend three thousand dollars. But other people would argue that thinking that you are so wealthy that you can drop that kind of money in an evening, that’s delusional. They’re both right. The phrase is delusions of grandeur. I did think that I was the world’s greatest fill in the blank. My confidence is what attracted you to me. I was clearly overconfident. It was delusional of me to think that I was so great at so many things. Or I was manic.

Lisa: Well, that’s the ongoing theme. Where’s the line? What is personality? What is mental illness? What is one symptom? What is another? Where does it cross? When does it become a vague annoyance? When does it become something that needs medical treatment? On and on and on.

Gabe: I don’t know. This is the trouble with bipolar disorder. It shows how hard this is to tease out.

Lisa: Yeah, and to treat.

Gabe: I remember being very reasonable and you remember it being a delusion. And some of these things, we can find hard core, objective facts. For example, the presence of demons. But imagine if my delusions were about, I don’t know, Lisa, your faithfulness

Lisa: Right. Yeah, that’s a whole thing.

Gabe: Or whether or not you were hiding money from me. As scary as it was that I believed in demons, I think it would have been worse if my delusion was that you were hurting somebody I loved.

Lisa: Because it would have been harder to talk yourself out of it.

Gabe: It would’ve been harder to talk myself out of it and people might have believed me. Let’s say that I said that you’re abusing my mother. Well, obviously, I can’t tell you because you’re the one that’s abusing my mother. I’m not going to bring it up with my mom because I’m afraid that you’re going to hurt my mom more. So obviously, I have to tell somebody because I’m very concerned that you are abusing my mother. And I know that in this scenario, you’re my girlfriend, wife or friend. But let’s pretend that you’re the nurse at the nursing home. So now I report this. I report this to elder abuse. I love how my mom just became elderly. When she’s listening to the show, whe’ll be like, how did I get in a nursing home? I’m 60. Suck it up, Mom. It’s for the greater good. But I’d start making phone calls. Hello, nurse such and such is abusing my elderly mother. And I’d start putting things together, you know, bedsores, which are very common. Or maybe my mother has dementia. And wow, mom has just really taken a beating on this one, I think those could just be extraordinarily damaging to other people. And of course, I believe it. Perception becomes reality.

Lisa: Well, but you also have to consider there’s an even scarier level. What if some of it’s true? That guy says that his mother is being abused, but he has a history of delusions. He has a history of psychosis. So we can ignore it. And lo and behold, he was actually warning us about this terrible thing and no one believed him.

Gabe: This is one of the many adjacent problems with living with mental illness. It’s even more insidious than that because the example that you gave is talking about how other people behave around you. Yeah, we’re already used to discrimination and stigma and being ignored. But now I start to wonder, maybe they’re right. I do, in fact, have this history. Maybe my mom is OK. And then when it all comes out six months later, I think, why didn’t I fight harder? Or maybe it doesn’t come out ever.

Lisa: It makes you doubt yourself.

Gabe: Yeah, it makes you doubt yourself constantly and chronically, and you never know when you want to stand up and say, no, you are moving past my boundaries and you are wrong. Or maybe I’m being oversensitive. Maybe I’m wrong. Maybe it’s a delusion. Maybe it’s depression. Maybe it’s mania. There’s so many reasons that we can ignore ourselves. Forget about the symptoms, just the doubt that the symptoms sew in us are almost worse than psychosis itself. You know, Lisa, I’m thinking about another time with a medical provider where I told you that the medical provider was doing all of these things that were, well, frankly, illegal and unethical and abusive toward me. And you did not believe me and you would not help me.

Lisa: I did not. Yeah, I feel very badly about that. You did come to me, the only person you felt you could trust during that time because you were so sick and so paranoid, and said, hey, this guy is doing the following things and it’s not right. And I said you are wrong. That is not happening. You are paranoid. This is a symptom of your illness. And then many months later, yeah, I discovered that they were.

Gabe: He overplayed his hands.

Lisa: Yes, he did. He finally got caught.

Gabe: I am fortunate in this story. Believe it or not.

Lisa: Yeah, actually.

Gabe: Lisa, I consider myself one of the lucky people because he overplayed his hands. He involved a third party. And that third party sounded the alarm. And it got an objective investigation which proved unequivocally that I was right and he was wrong.

Lisa: Yes, you were right.

Gabe: And I’m only pointing that out because that gave me validation. That let me know that I wasn’t wrong. Because I kind of believed you. You’d been right up until now. If that wouldn’t have happened, to this day, I would wonder if I was right. You would be positive that it was another episode of psychosis.

Lisa: I was positive you were wrong. I feel terrible about it.

Gabe: You don’t need to feel terrible. You’ve apologized a million times. I bring this up because look how good Lisa is. Look how smart Lisa is. Look how involved Lisa was in my care early on, in the middle. When this was going on, she was my wife and frankly, still a gold star caregiver. And even she got fooled.

Lisa: Yeah, I did not believe you and I actively told you you were wrong, and when you said, I’m telling you this guy’s doing this, I don’t want to go back there. And I made you go back.

Gabe: You did.

Lisa: I told you you had to. You did not want to see that guy again. You wanted to take yourself out of this horrible situation, and I said no. And I made you go back and you did it because of me. If we hadn’t been together, you would’ve stopped. So, yeah, I feel very badly about that. It was very, very damaging. And again, it’s because of your history of psychosis. When you came to me and said, hey, I think the following things are happening, I dismissed you outright. I didn’t even investigate it.

Gabe: The bottom line is that psychosis is a common symptom. Yet it’s so misunderstood and it carries such baggage in terms of stigma and discrimination. And it even in our life, Lisa, just.

Lisa: It has really struck me, like you said, how much baggage psychosis has and how uncomfortable I am with the idea that you were psychotic. I’m not uncomfortable in the same way with the idea that you were suicidal or that you were manic or that you spent too much money or ate too much food or did too many drugs. I’m not uncomfortable with any of those things in the same way that I am with you believed there were demons under the bed. It makes me uncomfortable. It makes me sad. It, I have a lot of feelings.

Gabe: Lisa, I appreciate everything that you did for me and even in your missteps, I feel that there’s a lot to learn and frankly, the score is still like Lisa one misstep, Gabe, like nine hundred and fifty. So it’s not a shut out anymore.

Lisa: Thank you for that.

Gabe: But I still think that you are comfortably the winner of whatever twisted game we are playing.

Lisa: I win. I win. I always knew I was a winner. So, Gabe, looking back what was the worst part of psychosis for you?

Gabe: I think for me, the worst part of psychosis was the after. That’s when I realized what happened, right? That’s when I saw the damage I caused. And it’s also, not for nothing, when all of the stigmatizing jokes about crazy people and all the news stories cavalierly saying psychotic people, because I realized that they only meant violent. They weren’t saying people with psychosis, they were saying violent, but they were using the word psychotic. I had to come to terms with the fact that I understand what psychosis is. It’s a psychological disorder. It’s not just some pop culture, news media buzz word. And it’s painful because everybody else sees psychosis as dangerous. And I know I’m not dangerous. But it’s said so much and so often, frankly, the common usage starts to make me question myself. It’s an incredible burden on top of already being sick. I have to wonder when it’s coming back. Is it coming back? And then I have to wonder what part of my memories are even real. Did that actually happen or have I just deluded myself into believing that it’s true? It’s, it’s a lot.

Lisa: Yeah. This is something we’ve never really talked about. And it’s always been very upsetting.

Gabe: I’m so glad. I’m so glad that we could do it on a podcast where everybody else can hear it. If you love that kind of thing, please, please subscribe to our show on your favorite podcast player. Rate us, rank us, review us, share us on social media. Use your words and tell people why they should listen. Don’t hesitate to email your friends and family the link to the show. It’s over there at PsychCentral.com/NotCrazy or literally every podcast player imaginable.

Lisa: Don’t forget the outtake. And we’ll see you next Tuesday.

Announcer: You’ve been listening to the Not Crazy Podcast from Psych Central. For free mental health resources and online support groups, visit PsychCentral.com. Not Crazy’s official website is PsychCentral.com/NotCrazy. To work with Gabe, go to gabehoward.com. Want to see Gabe and me in person?  Not Crazy travels well. Have us record an episode live at your next event. E-mail show@psychcentral.com for details.