- 6 months ago
A look the science and societal struggles behind schizophrenia, a disease that affects millions of Americans.
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00:00I am probably or possibly under surveillance by the Drug Enforcement Administration, private investigative officials, and various units of the NYPD.
00:13The FBI once told me that they weren't interested in me, which was kind of refreshing, who knows.
00:18See, when determining whether something is real or something is not real, it's real simple, get the facts.
00:26Keep up with me or it's over.
00:29Tonight on Frontline, the enigma of schizophrenia.
00:33The whole capacity of the individual to relate to the world has been shaken and devastated by this illness.
00:39We don't understand why.
00:41The system's frustration with schizophrenia has often led to neglect of the most basic human needs.
00:46What we did is we emptied out the hospitals and then did not provide the care for these people.
00:51And we are now paying the consequences of really the severe mistakes we made back there.
00:56Tonight, Broken Minds.
01:03With funding provided by the financial support of viewers like you.
01:07And by the Corporation for Public Broadcasting.
01:15This is Frontline.
01:18The Frontline.
01:20The Frontline.
01:29The Frontline.
01:30The Frontline.
01:30Oh, look, Paddy, look there.
01:33Uh-huh.
01:34We have a camp.
01:35One or two people.
01:36Look like one.
01:38I can't tell from here.
01:39Might be two.
01:40Let's go closer.
01:41Okay.
01:42I don't know, there's somebody there. Is that a person or just clothing?
01:47No, it's clothing.
01:51Wow, look at that in there.
01:53What, what, what?
01:54For some reason, I have evil eyes.
01:57Way over what you're talking.
01:59Okay.
02:00Or is that the other guy?
02:01No, this is Jerry.
02:02That's the other guy who's very, very, very paranoid.
02:06God, how are we going to approach him again?
02:09Yeah.
02:09This is what we're going to do.
02:10Okay, I'm going to stop a little in the front, and then we get out and try to put the sandwich a few feet before he get there to see if he pick it up.
02:19Okay, well, let's, we got to do it before he gets over here.
02:23We'll see.
02:24We're going there.
02:26Jesus, he looks bad.
02:31He's looking worse and worse.
02:33I know, he looks terrible.
02:34It is so difficult to find him.
02:36He's going this direction?
02:37Yeah, he's going this direction.
02:38I want him to see us through the front.
02:41Yeah, but we don't want to, we're going to make it clear to him.
02:44Okay, he's on my side.
02:45All right, I see.
02:46You want to do it from the van?
02:47No.
02:48Yeah.
02:53Jerry?
02:54Want a sandwich?
02:55No.
02:55I want to, I want to do it from the van?
03:13I want to do it from the van.
03:17maybe he come back and take it
03:26when a client that i approach in the park doesn't allow me to approach them for years
03:36i understand i don't take it personal you tell me if i if i encounter you in a park
03:45and i get out of the van and i go to you and offer you a sandwich
03:48you tell me if you're going to take the sandwich from me
03:51and you are normal supposedly you don't have any problems in your brain
03:55that doesn't make you perceive reality different than when a schizophrenic perceive it
04:00then you tell me how a schizophrenic who is paranoid is going to react when i offer a sandwich
04:06they may think it's poison they may think i'm coming to kill them
04:11you never know what can what can go through the mind of these people
04:15oh jerry's coming back jerry's coming back for the sandwich
04:21all right guy god maybe he's gonna sit
04:24there are at least 150 000 severely mentally ill men and women living in the parks and on
04:41the streets of this country project reach out is a private new york agency
04:45that tries to draw some of them in for shelter and treatment
04:49keep the distance okay
04:51want a sandwich
04:55see you later
05:00last year patty moon and margarita lopez one of three reach out teams
05:05made contact with more than 2,500
05:07okay he took the sandwich
05:10live
05:19you're some damn good instincts
05:22god
05:23how did you know to approach him again
05:25i don't know he was too he was too to settle that too so
05:28okay he's gonna eat it even
05:31either that or he'll throw it
05:33first sandwich
05:34i know i can't believe this
05:36margarita lopez calls new york central park
05:43the largest open psychiatric ward in the world
05:46thirty percent of the nation's homeless suffer severe mental illness
05:51and the most psychotic try to isolate themselves in places like this
05:56the primary diagnosis is schizophrenia
05:59schizophrenia is a major problem for us to understand
06:05and it's been a tough nut to crack and for a number of reasons first of all we can't sense a central problem in schizophrenia we can only say look all of mental life is devastated by schizophrenia and we can't point to a central mental function that is at the heart of the problem that's not true of conditions like mental retardation or dementia or manic depressive disorder with each one of them we can say
06:35the whole mind and the whole mind and the whole mind and the whole mind and the whole capacity of the individual to relate to the world has been shaken and devastated by this illness and we don't understand why
06:50this was when the twins were a year old
06:57sharon sharon is on the left and marge is on the right
07:00and look back and they were awfully cute then
07:02and
07:03why
07:04so much attention was drawn to them when i would take them out in public
07:08it's the kind of thing
07:10it's the kind of thing where i
07:11had all the dreams and everything that a typical parent has for their children
07:17and then to see
07:18see them cut down
07:19in
07:20in
07:21such a dramatic
07:22way
07:23um
07:24i guess
07:27i guess i'm glad i didn't know then what i know today
07:30what amy murphy didn't know then
07:33was that one of her daughters marge would become acutely ill with schizophrenia in 1982
07:39when she was a junior at college
07:45in 1989
07:47the murphy twins and their mother came to the national institutes of mental health in washington
07:52to be part of a major study into the enigmatic causes of schizophrenia
07:56okay this is for the procedure that dr tory talked to me about
08:07marge
08:07marge
08:08marge
08:09but you're not you're not listening a minute
08:11okay
08:12okay
08:12okay i'll listen
08:13okay
08:13remember we said you were going to have a needle in both arms and they're going to take the white blood cells out
08:20okay that's what i
08:21you told me
08:22that's the machine that is doing it
08:24yeah
08:25see you didn't see the machine before
08:27it's marge's illness
08:28her whole personality has changed
08:32so
08:32do you want to go
08:33it's like there's a shell
08:34that her body is standing there and it talks
08:39and says things
08:40but the girl i knew
08:43the daughter i raised isn't there
08:45she
08:47she's gone
08:49or not quite gone
08:51but almost
08:52marge
08:54the only thing that's going to be a little bit different about yours is that we have to do a finger stick first
09:00which we don't have to do with sharon
09:02because we were able to get her blood sample the other day
09:06and we couldn't so we just have to do a finger stick first
09:10when marge got sick
09:12sharon lost
09:13lost her best friend
09:15it's hard to describe how twins twins are but they've always had each other and they've always shared each other
09:22there's a bond that's that's so close that it's it's real hard to break
09:27and when that bond is broken
09:30it's hard to it's hard to replace
09:33yeah can you make a statement
09:41what kind of a statement am i supposed to make
09:43i don't know
09:44in the case of the murphy twins
09:49marge has a more severe form of the disease
09:53than the average person with schizophrenia
09:56marge is kind of in the same class as my sister
10:00who was hospitalized for many years also
10:02schizophrenia is a brain disease we know that now
10:05when my sister got sick in the 1950s we didn't know that
10:09and there was a lot of confusion about what schizophrenia was
10:11we know now that schizophrenia is a disease like
10:14parkinson's disease or alzheimer's disease or multiple sclerosis
10:17we know that something gets in the brain and changes the chemistry in the brain
10:21and causes symptoms
10:22so that the kind of symptoms that people have
10:25and my sister had
10:26are hearing voices
10:28delusional thinking so that you misinterpret what's going on
10:32and think that things refer you to you
10:34don't refer to you
10:35and the inability to think logically from a to b to c
10:38can you take this off the needle off
10:42i put the nose you know
10:44no
10:44no
10:44okay
10:45we have to leave it in now
10:46for a while
10:46we'll have to leave it in for a few minutes
10:48well for being a bad little girl
10:50no
10:50you've been an excellent girl
10:52marjorie
10:52you're a marjorie
10:53this is the 40 minutes now
10:56that we were telling you about
10:57when we take blood from the twins
10:59and we hook them up to this special machine
11:01that will take a small amount of blood
11:03but will take selectively the lymphocytes that we want to study
11:06they are the best means for studying the immune system
11:09and we know that many people with schizophrenia
11:11have abnormalities in the immune system
11:14in all there are 17 pairs of identical twins in the study
11:23identical in every way
11:25except that one twin has schizophrenia
11:27guess again
11:29i'm trying to
11:30i don't want to be wrong
11:31it's okay if you are
11:34this is sharon
11:35yeah
11:35yeah that's sharon
11:37it's hard
11:38really hard
11:39you can actually see down the side
11:41very hard to get
11:43identical twins are extremely useful for all kinds of medical research
11:50including research on schizophrenia
11:51because they start with the same genes
11:55they start as basically clones of each other if you like
11:57and in any disease including schizophrenia
12:01schizophrenia where genetics are thought to play a role
12:04this is the best way to separate the genetic from the non-genetic aspects of the disease
12:09if it were a purely genetic disease
12:12then whenever one set of identical twins
12:15whenever one person got the disease
12:17the other one would always get it
12:19because they have the same genes
12:20in studies of twins
12:21that have been done for about five decades now
12:24the likelihood
12:27that if one twin has the illness
12:29the other twin will have the illness
12:31is only about 50 or 60 percent
12:33in other words
12:34half the time
12:35the twins are concordant
12:36meaning they both have the illness
12:38and half the time
12:39if one has the illness
12:40the other one does not have the illness
12:41now this means by definition
12:43that genetics cannot be the entire story
12:46we don't understand what the factors are
12:50that make it possible for someone to have the gene
12:53but not have the illness
12:54but there are many human illnesses like this
12:57this is not unique to schizophrenia
12:58I'd like to ask you a couple of proverbs
13:04can you tell me what the same means
13:06a rolling stone gathers no moss
13:08I don't know
13:11what do you mean?
13:13well
13:13this is a saying
13:15this is something people sometimes say
13:17a rolling stone
13:18is it a cliche?
13:19sort of
13:19yeah
13:20a rolling stone gathers no moss
13:23what does that mean to you?
13:26what is moss like grass on the ground?
13:30I think it's one of those things
13:31it's whatever you think it is
13:32you think you throw it?
13:34I don't know
13:35I don't know
13:36a rolling stone gathers no moss
13:39okay
13:40what that means to me?
13:42what does it mean to you?
13:43that something is moving so fast
13:46that it gathers no extraneous material
13:50okay
13:55how about
13:56people who live in glass houses
13:59shouldn't throw stones
14:00or stow thrones
14:02you've heard that one
14:05yes
14:05okay
14:07people in glass houses
14:08the relief I got from the twin study
14:12was
14:12you know
14:13just
14:13incredible
14:14Dr. Tori said
14:15out of the
14:16first 35 things
14:18to worry about
14:19in life
14:20getting sick like her
14:21ought to be
14:2137 on my list
14:23people looked at me
14:27and said
14:27you've lost weight
14:29and
14:31I hadn't lost
14:32any physical weight
14:33at all
14:34I'm just kind of
14:36the same
14:36but
14:38I knew what they were
14:39talking about
14:40because
14:40it was emotional weight
14:42that
14:43that was gone
14:44and
14:45and people saw it
14:46and
14:47and people I hadn't seen
14:48in years
14:49said that
14:50well
14:50since
14:51since the twin study
14:52she looks lighter
14:53and brighter
14:54and
14:54so much more relaxed
14:56I
14:59I wish my life
15:00were different
15:01and
15:01and I wish this illness
15:03never existed
15:04but
15:05it
15:05it's a part of my life
15:07and it is a part of who I am
15:09and that's not going to change
15:11schizophrenia strikes one in 100
15:19there are different degrees of severity
15:21but to see the disease at its most severe
15:24is to see it untreated
15:25we first met David
15:28when he had just come in
15:29from the cold
15:29to Project Reach Out
15:30although he agreed
15:32to talk to our producer
15:33DeWitt Sage
15:34he was also
15:36deeply suspicious
15:37David is a paranoid schizophrenic
15:39the
15:41I
15:41the
15:42my stomach
15:44kind of gives me trouble
15:44when I don't have enough sleep
15:45the stomach and the legs
15:46are the two things
15:47that tend to most prominently
15:48go
15:49when I
15:49when I don't sleep
15:50Reach Out's Mike Mastrogiovanni
15:53is David's case worker
15:54oops
15:58happens often
15:59yeah
16:00what happened to the
16:01to the lens there
16:02they fell off my face
16:04one day
16:05in their glass
16:05and they was
16:06they were cold
16:06and it was cold
16:07so they were probably
16:08a little extra brittle
16:09and mango
16:10because this happened
16:11since the last time
16:11I saw you
16:12right
16:12which was just
16:13which was a couple days ago
16:14yeah
16:14it fell and hit the sidewalk
16:16and that's
16:17it's glass lens
16:17have you
16:18confirmed your
16:20your prescription
16:21is it the right prescription
16:23I
16:23you were going to check that
16:25I haven't
16:26I
16:27I
16:27I
16:27I can't answer that at the moment
16:30but
16:31the reason that I'm going to
16:32that I'm confirming
16:33I'm going to
16:33I'm going to
16:33I'm setting up
16:34so that I can confirm
16:35the prescription
16:36is having had lenses stolen
16:37so on tape
16:39having had lenses
16:40had glasses disappear
16:41and then reappear
16:42when I squawked
16:43so I
16:44definitely
16:45must
16:46must
16:47must
16:48must
16:49so that I can be safe
16:50crossing streets
16:51make sure that I get the correct prescription
16:53and
16:54and that means
16:56all the way
16:56from
16:57all the way
16:59from the stage
17:01of
17:01getting a prescription
17:03to
17:04actually having the glasses made
17:06and one other thing
17:07I really appreciate
17:08in light of what else is on the tape
17:10this is going to make sense
17:11I really appreciate
17:12if there's no transmitter
17:13embedded in the frame
17:14okay
17:15and
17:16I
17:16I
17:16you know
17:17I would hope that that's not the case
17:18like the one
17:19like the one that's probably here
17:21anyway
17:21that's fact folks
17:22this will get lost on a cutting room floor for sure
17:28uh
17:29I am
17:29probably
17:30or possibly
17:31under surveillance
17:32by the drug enforcement administration
17:35um
17:36private investigative officials
17:38um
17:39and various units of the NYPD
17:41the FBI once told me
17:43that they weren't interested in me
17:44which was kind of refreshing
17:46who knows
17:46David let me ask
17:51the FBI
17:52all of this intense surveillance
17:55could this be part of an illness that you have
17:57nice try
17:59if
18:03when you uh
18:05when you say
18:06well maybe it's
18:09it was
18:10it's just something I'm thinking of
18:12and
18:12product of my situation
18:13when it happens
18:14a hundred and
18:15hundred and fifty times
18:16I mean
18:18let's take an example
18:19uh
18:20someone might be reading a book
18:23and leave it
18:24on the telephone booth
18:26as he's making a call
18:27someone might be doing
18:29someone might do that
18:30and
18:30sometimes
18:31that book might be
18:32a really attractive book
18:33or an expensive book
18:34or
18:34or somebody else
18:35might have liked that book
18:36and that book might not be there
18:37when you turn back
18:38say thirty seconds later
18:39okay
18:41when that happens
18:42thirty or forty times
18:43when sometimes
18:44those books
18:45are obviously
18:45of no conceivable
18:46cash value to anybody
18:47when sometimes
18:48the books
18:49contain your right
18:49to contain
18:50your identification documents
18:51and your money
18:52which nobody but someone
18:53maintaining close surveillance on
18:54you could have discovered
18:55just see
18:59see when determining
19:00whether something is real
19:01or something is not real
19:03it's real simple
19:04get the facts
19:05schizophrenia has to be viewed
19:18as the cancer
19:19of mental illnesses
19:20it is certainly
19:22the most profound
19:23illness
19:24treated by psychiatrists
19:26part of the desperation
19:29that people felt
19:31in treating
19:33this profoundly
19:34disabling
19:34and dramatic illness
19:35was reflected
19:37in the
19:38in the
19:39amazing treatments
19:40that were brought to bear
19:41on schizophrenia
19:42I mean there are treatments
19:42from
19:43surgical treatments
19:44where people would
19:45you know
19:46lobotomies
19:46people would do surgery
19:48on the brain
19:48but there were
19:49surgical treatments
19:50on other organs
19:50people used to take out
19:51the adrenal glands
19:52castration at one time
19:54was considered to be
19:55an effective treatment
19:56for schizophrenia
19:56there have been
19:58all kinds of medical treatments
20:00there have been
20:00all kinds of
20:01psychological treatments
20:02lobotomies to me
20:09just seeing them
20:10devastated me
20:13I was a part of it
20:15you have to remember
20:18you have to remember
20:18that in the early 50s
20:20there were no
20:20tranquilizers
20:21lobotomies were done
20:23for those patients
20:24that we completely
20:25had no control of
20:26they were assaulting
20:28other patients
20:29employees
20:30we had over
20:3315,000
20:3416,000 patients here
20:35if you looked
20:38at a patient
20:39two weeks after admission
20:40they have already
20:41started to regress
20:42if you picture yourself
20:44in one room
20:44nothing to think about
20:47just meals
20:49you were told
20:50it's meal time
20:51you were told
20:52when it was time
20:53to go to the bathroom
20:54that's how they existed
20:57well lobotomies
20:59were the last resorts
21:01I'm sure many of these
21:02patients had been
21:03patients that were
21:04in camisoles
21:05sheet restraints
21:07they may or may not
21:09have gone through
21:10insulin
21:11shock
21:11there were the
21:13cold wraps
21:14you can remove
21:16a camisole
21:17you can remove
21:18a restraint
21:19this is a mechanical
21:20device
21:21lobotomy was not
21:23mechanical
21:24lobotomies are
21:26permanent
21:27justin can we talk
21:35for a minute
21:36sure
21:37you want to sit up
21:38or do you want
21:39to lie down
21:40really
21:41yeah
21:43i remember
21:56on lobotomies
21:58they'd bring the
21:59patient in
22:00doctor would be here
22:04complete head shaved
22:06they would take
22:08gentian violet
22:09and score the
22:12the head
22:13novocaine would be
22:14injected
22:15and
22:19the surgery would
22:20begin
22:20the patient was
22:22fully awake
22:22i remember as a
22:25young student for
22:26that matter
22:27i would be standing
22:28here
22:29and they would
22:32on the side
22:34the scapel
22:36and they would use
22:38a little drill
22:40and i remember
22:42oh
22:43it
22:43to me
22:45especially as a
22:46young girl
22:47i mean this
22:47to me was
22:48absolutely terrible
22:50they would take a
22:53probe
22:53and insert
22:55they did not know
22:57where they were
22:58going but they
22:58were hoping
22:59that
23:00something
23:02would
23:02slow down the
23:03process of this
23:04patient
23:04justin
23:06what kind of
23:07treatments have
23:08you been given
23:08over the years
23:09ambulatory insulin
23:11insulin
23:13coma
23:13electric shock
23:16neurosurgery
23:18and finally drug
23:19therapy
23:19and finally
23:21drug therapy
23:22and when you say
23:24neurosurgery
23:25what do you mean
23:26brain surgery
23:27i prefer
23:31a laboratory
23:31152
23:34in new york state
23:35sanjee institute
23:36and hospital
23:36722 west
23:38168th street
23:39new york 22
23:40new york
23:41vulnerable
23:42rain age
23:42for basal
23:43and as slowly
23:45as you can
23:46and as clearly
23:46what happened
23:47that day
23:48the operation
23:51we were on a stretcher
23:52and i thought
23:54something moved
23:55to a light room
23:56with four surgeons
23:57there
23:58with the aronson
24:00with the sapman
24:02with the pierce
24:05and at the rancinor
24:07and they started
24:09the operation
24:10and i passed out
24:11in 1949
24:17when stanley
24:18gross was
24:18lobotomized
24:19at pilgrim state
24:20the treatment
24:21was seen
24:21as a cure
24:22for the most
24:22extreme
24:23schizophrenia
24:24although the
24:25operation
24:26did subdue
24:27violence
24:27it soon
24:28became clear
24:29that the
24:29underlying
24:29illness
24:30was not
24:30affected
24:31at all
24:31stanley
24:33we had
24:33been warned
24:34never discussed
24:34his operation
24:35follow him
24:37kill
24:37no
24:38he died
24:38i told you
24:40about
24:40the time
24:41i had a bomb
24:42dropping
24:42and boom
24:43the blue
24:44picture
24:44which was
24:45a great big
24:47hole
24:47about
24:47what was
24:48trying
24:48to the ground
24:49so it was a
24:51baby bomb
24:51a major bomb
24:52stanley
24:56which planet
24:57should have come
24:58down to attack
24:58the earth
24:59the planet
25:01of headbreakers
25:02the planet
25:03of headbreakers
25:04yeah
25:04one million miles
25:05up
25:06so you know
25:07it takes about
25:07two and a half
25:08days before
25:09they can land
25:10probably a million
25:11miles an hour
25:12planet of headbreakers
25:13and stanley's
25:14supposed to be
25:15the head of that
25:15planet
25:16what
25:16tomorrow
25:17how many heads
25:19has stanley
25:20broken
25:20what do you think
25:22do you remember
25:23anything else you
25:34want to tell me
25:34oh sorry
25:35you see them break
25:36any heads around
25:36here
25:37did i see them
25:38break any heads
25:39around
25:39did stanley ever
25:40break any heads
25:41in pilgrim
25:42in pilgrim state
25:43did stanley ever
25:44break any heads
25:45no
25:45okay
25:46but let me ask
25:50you a funny
25:51question
25:51did pilgrim state
25:53ever break
25:53any heads
25:54i don't know
25:55i know
25:57this isn't a joke
25:58to wear
25:59two holding heads
26:00and i'll tell you
26:01something
26:01i read on a
26:03on a bulletin
26:04that was put up
26:05that if a doctor
26:06did that
26:07anymore
26:07he could find
26:09fifteen thousand
26:10dollars
26:10and spend
26:11ten years
26:12in jail
26:12against the law
26:14to do it
26:15what do you think
26:19a doctor
26:19wants to go
26:20to prison
26:20for ten years
26:21and pay
26:21fifteen thousand
26:22dollars
26:22by the time
26:32lobotomies
26:33were stopped
26:34at pilgrim state
26:35in the mid
26:35nineteen fifties
26:36over thirty
26:37thousand
26:38had been
26:38performed
26:39throughout the
26:39united states
26:40at that time
26:42this now
26:43abandoned
26:43building
26:44was filled
26:44beyond capacity
26:46a monument
26:47to the
26:47ineffectiveness
26:48of any known
26:49treatment for
26:49schizophrenia
26:50the desperate
26:52search for cause
26:53and treatment
26:53continued
26:54it further
26:55polarized
26:56psychiatrists
26:57already divided
26:58between those
26:59who embraced
26:59the principles
27:00of modern
27:01medicine
27:01and the promise
27:02of antipsychotic
27:03drugs
27:03and those
27:04who held
27:05to the more
27:05dominant
27:05tradition
27:06of american
27:07psychiatry
27:07sigmund
27:11freud's couch
27:12was never
27:13used as a
27:14window into
27:14the souls
27:15of madmen
27:15while his
27:17theories
27:17revolutionized
27:18the way we
27:19think about
27:19ourselves
27:20he never
27:21treated any
27:22schizophrenic
27:22patient
27:23freud
27:24considered
27:25psychoanalysis
27:26his theory
27:27of unconscious
27:28drives
27:28and conflicts
27:29inappropriate
27:30impossible
27:31for the
27:32treatment
27:32of
27:32schizophrenia
27:33but after
27:37freud came
27:38to america
27:39to deliver
27:40a series
27:40of lectures
27:41in 1909
27:42the practice
27:44of american
27:44psychiatry
27:45would eventually
27:46come to be
27:46dominated
27:47as nowhere
27:48else
27:49by the
27:50theories
27:50and techniques
27:51of psychoanalysis
27:52not infrequently
27:54freud's followers
27:55in treating
27:56schizophrenia
27:57would practice
27:58what the
27:59founding father
27:59never preached
28:00an important
28:02thing to know
28:03about the
28:04freudian idea
28:05is that it's
28:06fundamentally
28:06a salvationist
28:08idea
28:09it says
28:10that it knows
28:11the cause
28:12and the trouble
28:12built into
28:13human nature
28:14and human life
28:15experience
28:16and it has
28:17the cure for it
28:18and we americans
28:20at least have been
28:21again and again
28:22ready to take up
28:24at least temporarily
28:25with a new
28:26philosophy
28:26a new doctrine
28:27if we think
28:28it's going to
28:29make this world
28:30and this life
28:31in it better
28:32that's what
28:33psychoanalysis
28:34offered to us
28:35it's a shame
28:36that it didn't
28:36work out really
28:37i think psychoanalytic
28:40treatment for
28:40schizophrenia
28:41is not only
28:42not helpful
28:43i think it's
28:43quite harmful
28:44and the reason
28:45is because
28:46it implies
28:47very clearly
28:47that the reason
28:48the person
28:49is sick
28:49is because
28:50of the way
28:50they were treated
28:51in childhood
28:51because of what
28:52happened with
28:53their mother
28:53because of
28:54what happened
28:54with their father
28:54or their baby
28:55sister
28:55or whatever
28:56it is
28:56we know
28:57that has
28:58nothing to do
28:58with it
28:58i mean
28:59would you talk
28:59about someone
29:00with polio
29:01would you ask
29:02them gee
29:02how did you feel
29:03when your little
29:03sister was born
29:04if someone
29:05comes in
29:05with alzheimer's
29:06disease
29:06or multiple
29:07sclerosis
29:08you don't say
29:08how did your
29:09mother treat you
29:10when you were
29:10little
29:10it's that silly
29:11and yet we still
29:12do that
29:13in some cases
29:13today the struggle
29:16between opposing
29:17factions in psychiatry
29:18is largely resolved
29:20there is wide
29:20agreement that
29:21schizophrenia is a
29:22disease and that
29:23psychoanalysis is an
29:24inappropriate treatment
29:26although no one
29:27disputes the
29:27important role
29:28of supportive
29:29talking therapy
29:30but old ideas
29:32die hard
29:33some training
29:34institutes
29:34still teach
29:35that schizophrenia
29:36sometimes springs
29:37from the traumas
29:37of childhood
29:38we asked dr phyllis
29:40meadow for an
29:41example
29:41we absolutely
29:43know what causes
29:44schizophrenia
29:44and i wish more
29:45people would just
29:46study schizophrenia
29:47in depth and learn
29:49about it
29:49for example
29:50the child comes
29:51into the world
29:52already frustrated
29:53he's just been
29:54born which is a
29:55terrible experience
29:56and the only thing
29:58that woos him
29:59towards the life
30:00drives
30:00is the
30:02relationship
30:04with the breast
30:05he doesn't have
30:05a relationship
30:06with the mother
30:06but he has a
30:07relationship with
30:08the breast
30:08it's never there
30:09every time you
30:10want it
30:11but it's there
30:11enough of the
30:12time
30:12i think some
30:14some analysts
30:15refer to that
30:15as good enough
30:16mothering
30:17that is
30:18the child
30:19can feel
30:20magical
30:21omnipotent
30:22he can call
30:24up the breast
30:24and within a
30:25few minutes
30:26he'll hear the
30:26noise of the
30:27breast approaching
30:28something to
30:29indicate that
30:30the breast is
30:30forthcoming
30:31he'll have a
30:32fantasy in his
30:32mind of a
30:33breast
30:33and it will
30:34usually trickle
30:35milk
30:35if he's
30:36healthy
30:36if he's
30:37very unhealthy
30:38he'll roll
30:39over
30:39feel apathetic
30:41and feel
30:42there's no
30:42breast
30:42there's no
30:43fantasy
30:43and there's
30:44no way to
30:45get anything
30:45he needs
30:45and that
30:47is what
30:47leads to
30:48pathology
30:48sometimes it
30:49leads to
30:49death
30:50but that
30:51would certainly
30:52lead to
30:52schizophrenia
30:53this is
31:04david's
31:04second
31:05meeting
31:05with dr
31:05jim
31:06neininger
31:06a reach
31:07out
31:07volunteer
31:07psychiatrist
31:08who tries
31:09to treat
31:09schizophrenia
31:10with a
31:10combination
31:11of
31:11supportive
31:12talking
31:12therapy
31:13and
31:13medications
31:14he believes
31:15both are
31:15necessary
31:16so
31:18i need
31:19to say
31:20i need
31:20to say
31:20the first
31:21of this
31:21don't
31:21mind
31:22me
31:22call
31:22up my
31:22paranoia
31:23or my
31:23carefulness
31:24anyway
31:25that anything
31:26which has been
31:26taped prior to
31:27this on this
31:28data
31:28what was
31:29yesterday's
31:29date so i
31:30know today's
31:31tuesday october
31:3224th was
31:33taped when
31:34to my knowledge
31:35the camera
31:35was not
31:36running
31:37therefore i
31:38have not
31:38consented
31:39to its
31:40taping
31:40okay that
31:41being said
31:42the camera's
31:42now running
31:43and this
31:43stuff's all
31:43good
31:44okay anyway
31:45i don't mind
31:46me i was a
31:47political science
31:47major
31:48so it's been a
31:49couple weeks
31:50since we met
31:51uh can you
31:52bring me up
31:52to date
31:52on how
31:53you've
31:53how you've
31:53been since
31:54then
31:54i've been
31:55uh my
31:56weekends
31:56have been
31:57fine my
31:57weeknights
31:58have been
31:58hellish
31:59and the
32:00weekends you
32:00have a place
32:01to stay
32:01and during
32:02the week
32:02you don't
32:03right
32:03that's
32:03correct
32:04and i uh
32:06during the
32:06week i
32:07lately have
32:08been inhabiting
32:09subway stations
32:10and parks
32:10does that get
32:13you depressed
32:13sure it does
32:15and i wonder
32:16you know i
32:16sort of think
32:17wow i'm depressed
32:18maybe i need an
32:19antidepressant but
32:20who wouldn't be
32:20let me ask you
32:22this how have
32:22you been sleeping
32:23uh last night i
32:25slept great if i
32:26had any decent
32:27place to stay
32:27whereas a rule
32:28a pair of glasses
32:29once went poof
32:30there but but
32:31as it were as a
32:32rule my uh my
32:34possessions in my
32:35body aren't being
32:36searched and i
32:37have something
32:38resembling a
32:38security perimeter
32:39between me and
32:41the other guy i
32:42mean i trust my
32:42friend and blissfully
32:43you know then i
32:44sleep much better
32:45these glasses have
32:46almost gone poof
32:47these aren't mine
32:48these aren't even
32:49my prescription and
32:50the glass and
32:50they're glass glasses
32:51so and you'll
32:52notice that i have
32:53yet to have a
32:54complete pair of
32:55glasses in months
32:56anyway and that
32:57the uh are there
32:58people here or
32:59recently that you've
33:00worked with that you
33:00do trust
33:01nobody implicitly i
33:02trust absolutely
33:03nobody implicitly
33:04that i have that
33:05i have met within
33:05the last two years
33:06with since i came
33:08under surveillance at
33:08least nobody i
33:10can't uh you know
33:11it's like unless i
33:13have i mean i take
33:15everything else on a
33:16situation by situation
33:17basis on uh you
33:18know if you when it
33:20comes to the level of
33:21trust but when it
33:22comes to uh nobody
33:23that i haven't that
33:24i've met since i
33:25since i undertook that
33:26surveillance could i
33:26ever trust implicitly
33:28there might be let me
33:29just tell you what my
33:31thoughts are at this
33:31point in terms of uh
33:33as you said i think
33:34you know you are at
33:35this point on an
33:36ongoing basis uh
33:37uh getting treatment
33:39with your peer
33:39counseling and coming
33:40here and that's good so
33:41that if things started
33:42to emerge uh hopefully
33:45that could be contained
33:46you know um my own
33:48feeling though just so
33:49you know it is that i
33:51think uh probably low
33:53doses of medicine would
33:55help you in terms of
33:56minimizing the chance
33:58that under stress that
33:59you'd uh feel too
34:00aggressive or that
34:01you'd hear voices and
34:02also i think it might
34:03help you organize your
34:04your thinking a little
34:05you and i last time
34:07said and i think we
34:08agree on that that
34:09medicine would only
34:10make sense if it
34:12offered you something
34:13and that that outweighed
34:14any side effects and
34:16that's why i'm not
34:16pushing it but i want
34:17you to know it's
34:18available
34:18let's say one other
34:18thing on you
34:19mentioned something i
34:20mentioned it too sort
34:21of but in the
34:22treatment of
34:22schizophrenia today
34:23it is very clear that
34:26the absolute mainstay
34:28of treatment is the
34:29use of medications
34:31that reduce psychotic
34:32symptoms but
34:33medications are not
34:34the whole story and
34:36just like when a
34:37patient leaves a
34:38hospital with a heart
34:38attack and they go
34:40out to an environment
34:41that's extremely
34:41stressful they're not
34:43going to do well the
34:44patient with
34:45schizophrenia goes to
34:46an environment that's
34:47extremely stressful where
34:48there may be a great
34:49deal of difficult
34:50relationships and
34:52anxiety and hostility
34:53in their environment
34:54they're not going to
34:55do well
34:55hello
34:58hello sir
35:03would you like a
35:05sandwich you would
35:07like a poncho
35:07and a sandwich
35:10look this is an
35:12invitation if you
35:14would like to come to
35:15our work and give
35:16him dinner you will be
35:17welcome to come
35:18it was clear in
35:21schizophrenia that the
35:22brain were involved
35:23it was a subtle
35:24problem because you
35:25didn't see it just by
35:26casually looking at the
35:27brain so what we've
35:31needed to do is be
35:32able to say well what
35:33would this person's
35:34brain have looked like
35:36if they maybe never had
35:37schizophrenia and in our
35:41view the best solution
35:43to this is to look at
35:44twins twins where the
35:46where you have one twin
35:47that has the illness and
35:49one twin that does not
35:50have the illness now if
35:52you look at the brains of
35:53these twins and you find a
35:56consistent anatomical
35:57difference that goes along
35:59with that illness you can
36:01pretty much conclude that
36:04this deviation is related to
36:06this illness with twins we've
36:10been able to say that these
36:12subtle anatomical deviations
36:13appear to be characteristic of
36:16almost every patient with the
36:18illness because when we
36:19compare them to what their
36:20brain should have looked
36:21like genetically environmentally
36:24etc physically if they didn't
36:27have the illness it looks as
36:29though there's a consistent
36:30change that we see that is
36:32associated with the ill twin but
36:34not associated with the well
36:36twin most of these areas
36:39involve what's called the limbic
36:40system which is a part of the
36:42brain that we think is very
36:43important for emotion memory
36:46and higher order kinds of human
36:48behaviors we think that somehow
36:51when this part of the brain was
36:53being formed its connections
36:55its wiring the way cells early in
36:57development have to sort of
36:58travel they travel from one part
37:00of the very primitive embryo brain
37:02to what becomes the fetal brain
37:04there's good reason to think at
37:07this time it's something goes
37:08wrong during that process that's
37:10affected development of these
37:11areas what the insult is whether
37:14it's a virus or a toxin or a
37:18little less blood supply through
37:19the placenta or some hormonal
37:22thing we just have no information
37:24on that
37:24do you need help no no no you
37:29can get down okay well when i
37:32first heard schizophrenia as a
37:34diagnosis my reaction was one of
37:37bewilderment and shocked the most
37:45terrifying thing was when it was
37:49around four years ago i had injured
37:53my foot so i was on crutches and in a
37:58blind psychotic rage she came after me
38:02and tried to kill me it was clear then
38:08that there was violence intent it takes
38:16all all the courage i have to deal with this
38:20illness because that the one thing is is the
38:27most intimate relationship i i've ever had in my
38:32life is is gone and and then on top of that march has been hit harder than a lot of people i know she's she's
38:45she's far sicker than any of the other twins that
38:49that that that i have talked to
38:52well they told me i was sick as a dog and i had bubonic
38:56bubonic who told you that oh one of the doctors and when you went down to
39:08washington why did you go down there why did i go down there is because there was a
39:16problem that wasn't going to get straight
39:23problem with with whom or what well i don't
39:27there was a problem of being on a on a ten most wanted list and no one had turned me in
39:37in the united states
39:48when when i think who who is that client
39:52there a client that i know for for three years
39:55in three years today was the first day that he has
39:59received a sandwich for me and took it directly from my hands
40:06you know
40:08that's enormous progress some people may think
40:11that is not progress but it is a lot of progress
40:14because i bet that this man is being hospitalized a thousand times
40:18i bet to you that he's been medicated a thousand times
40:21and i bet to you that he's been discharged from the hospital to the street a thousand times
40:26time and i bet to you that he and here in central park every time that he gets discharged
40:33eighty percent of the hospital beds for the mentally ill in the state system have been closed since 1955
40:45hundreds of thousands of people have been displaced from these hospitals
40:50what we did is we emptied out the hospitals and then did not provide the care for these people
40:55and we are now paying the consequences of really the severe mistakes we made back there
41:00and to have literally at least two hundred thousand seriously mentally ill people
41:06on the streets in the united states with serious mental illnesses among the homeless population
41:11is probably a disgrace of a magnitude that we haven't seen in this century
41:16before its introduction of anti-psychotic medications in the mid-sixties
41:23bangor state hospital in eastern maine had twelve hundred patients
41:27today only three hundred including marge murphy are left
41:31now there is the suggestion that marge too should prepare to leave the hospital
41:42i was just wondering if you wanted to if you had thought about after the hospital or what you wanted to do
41:50i don't know
41:51i don't know
41:52okay
41:53it depends
41:54it's your concern about this is that
41:58the concern about it isn't real
42:01you know
42:02okay
42:03you know i really can't go to an elementary school
42:07and walk in and sit in a chair and just do it
42:10you know
42:11you know the the real the reality of this i can't do it
42:15you know i can legally do some things and i can legally do others
42:20and then i cannot legally do anything
42:22yeah
42:23i don't know
42:25i've been
42:26right now what's happening with marge is
42:29they want to move her from the hospital into what they call a less restrictive setting
42:35the problem is marge isn't really ready to go
42:40yeah
42:41i thought it was your decision
42:43it's it's hard when she has been violent to know what to do
42:47i think the most difficult thing for me to work through and deal with
42:52was having to call the police to to come in and pick her up and take her back to the hospital
43:00to know that i had to do that for her benefit as well as for ours
43:10because she was out of control at that point in time
43:13and she was a danger both to herself and to possibly anybody else
43:18and i didn't want anything to happen to any of us
43:21if you had a choice of your living situation what would you like
43:27what would i what you know you're asking me something and i don't know what you're talking about
43:33okay
43:34well we're talking about dreams
43:36of it
43:37i'm not talking about a dream i'm talking about a place to jump in a car drive to and get out into it
43:44and sit and you know watch the football game
43:47oh is that what you want to do is watch the football game
43:50football game
43:51yes
43:52what are those doing real well
43:54about leaving you know uh
43:57i'm not a committed a totally insane patient i have a problem and
44:03it has to be you know fixed where it can be and then let out you know it's material
44:12what will fix it
44:13i don't know
44:15i don't know like like they said i might have to do uh
44:19chemotherapy uh with instruments uh electronic instruments high voltage on it
44:27although marge's thinking often seems bizarre
44:34her severe psychosis has been successfully checked by medications
44:38and a safe hospital environment
44:40mrs murphy fears that if marge leaves too soon
44:44she will go off her medications
44:46become violent again and have to be forcibly returned to the hospital
44:50the ward psychiatrist sees things differently
44:53the most difficult problem that marjorie faces at this time would be separation and individuation from her family
45:07what i mean by that is she is an individual in her twenties who has never really been independent
45:14has been able to live and function on her own
45:17and i feel her greatest task is to pull away and to be able to develop a character and a personality for herself
45:28i think it's very important for marjorie to move away at this time and to be independent
45:34she voices that desire quite regularly
45:38she and i were talking earlier
45:41and the hospital is a safe place for her
45:46it's one of the few places that she knows she's not going to get kicked out on
45:50she she said they've got to take me here
45:53other places group homes
45:56uh boarding homes apartments and everything else
46:00if mental patients get a little rowdy
46:03they can be evicted from these from these living situations
46:07and then they have nowhere but the streets to go
46:10where's the wit
46:14where's the wit
46:16where's the wit
46:18where's the wit
46:19the wit
46:20you keep up with me
46:21or it's over
46:22maybe you've got all the videotape you need today
46:26you keep up with me and continue to talk
46:28this is not a photo op dave's habits
46:30you've got guys with long lenses and parabolic mics for that
46:32okay
46:33no comment
46:35now
46:36keep up with me
46:37if you want to talk with me
46:43otherwise i really mean it's over this morning
46:46not to mention forever
46:47where are we headed right now
46:49where are we and where are we going
46:51i'm
46:54attempting to secure newspapers
46:57my income doesn't permit me to buy them
47:00by now david was convinced that frontline was part of the government's surveillance network
47:12which was sabotaging his life
47:14but he had come to trust producer dewitt sage
47:17and so he made one last exception
47:19it would allow the crew to follow him on his morning rounds at penn station
47:23given the severity of his paranoia
47:26it was an especially brave decision
47:29today's wednesday right
47:32and how are things going with reach out david
47:35no comment
47:38but tell me more about the quid pro quo
47:41because i'm this is important and
47:43we hope
47:45the program is saying in a defecto manner that i have to
47:49that i have to uh
47:51be on medication to get housing
47:53i repeat there's no real justification for that
47:56that's all i'll say about it right now
47:58i'm sorry you repeat what david i didn't hear
48:00i repeat there's no
48:01there's no
48:02the hope is you're gonna find it
48:04i am not gonna answer any more details than what i have just said
48:07remember when i say no comment no follow up
48:10when i say no comment no follow up
48:12the discussion on that subject is ended
48:39the idea of calming
48:42it's something that that just evolved
48:46what marge's illness made me do
48:49is just you know stand up for myself more
48:53and say the heck with this
48:56i mean i have all this pain to deal with
48:58i'm gonna do what i want to do
49:00how do i cope
49:05well i think under the circumstances i'm doing remarkably well
49:11so
49:18in
49:24per
49:27per
49:30per
49:34per
49:36In performing, the hardest thing I ever had to do was a birthday party for twins where the little boy, he was developmentally disabled in some way.
49:55I don't know what the diagnosis was, but he was disabled and the little girl was well.
50:06And I was almost in tears in the back.
50:10And that's the only thing that has ever touched me that deeply, that I really had to pull myself together.
50:18That was the hardest thing I ever did.
50:26I think for any family that's faced with schizophrenia, the pain that is involved in it is really extraordinary.
50:34When you have identical twins, especially identical twins that have been very close in which one gets sick, it's almost like part of them has died because they're interchangeable in a way.
50:46In terms of Marge, I think Marge is likely to benefit from some of the improvements in medication that are going to come along in the next decade.
50:52And I think she is going to really benefit from the research that we're doing on the disease right now.
50:58She is someone that I can say is likely to see some real effects of the research we're doing on identical twins.
51:07In my thinking, one of the most fascinating things about the brain evidence in schizophrenia is that it suggests that somebody's walking around for 20 years with something wrong with their brains, approximately 20 years, until the time that they manifest the illness.
51:23And that they're walking around with a brain abnormality, but for some reason they're able to compensate for it.
51:28For some reason, it doesn't show itself as a clear illness, disease, schizophrenia. It doesn't show that.
51:36In the case of twins, we have two twins who are both relatively well, doing very well for most of their lives, even though one twin, it seems, was probably born with some difference in their brain from the other twin.
51:50Now, what happens that all of a sudden, this brain difference, which can seemingly be compensated for for 20 years, all of a sudden is no longer compensatable?
52:01Is that environmental stress? We don't have an answer to that question.
52:06Strange things happen. No, it's all. It's all.
52:18I found it in trash in my buddy's building. Somebody threw it out.
52:22It's a fine make. The zipper is a little bit broken, but the snaps work, and, you know, when you're sleeping in the subway or somewhere, warmth throughout a reframion.
52:38It turned out that the morning filming at Penn Station was the last time we ever saw David.
52:43Having steadfastly refused medications for his paranoia, he parted company with Reach Out the next day.
52:50David is back where he was first found.
52:57What's your name? Jim. Jim? Okay. I like your beer. It's very nice.
53:03Then, this is the one that I'm talking about for Wednesday. Okay? You're very much welcome to come. Now, on Thursday, we also have an-
53:16I wonder why, why? Why we cannot deal with mental illness? What is so bad about it?
53:23What is so bad that people refuse to look at it, you know, and take care of the problem instead of ignore it, put it in a psychiatric ward where nobody can see it?
53:37Or completely, you know, abandon them.
53:42But what keeps me going day by day is that after working with a client for three years and seeing that person coming into a van for the first time,
53:59it's so fulfilling that it's bigger than a candy in the hands of a child.
54:05You know, it's bigger than, I don't know, than, than, you know that the miracle that is when, when the spring comes, it's bigger than that. It's bigger than that.
54:24There are some moments of hope in the search for the cause and treatment of this terrible illness.
54:29But in the past, we have often, with the best of intentions, done more harm than good.
54:35There are now twice as many severely mentally ill people living on our streets as in all of our state mental hospitals.
54:42We're being tested to find solutions, not just in our science, but in ourselves.
54:48We're being tested to find solutions.
54:52Santa Claus. Where?
54:53Santa Claus, over there.
54:54Where?
54:55Over, across the street.
54:56Across the street!
54:58I haven't seen him in so long.
55:01He's in so much shape.
55:03I can't believe he's still here.
55:06Okay, you have to put down now the, the, the videotape, please.
55:09The videotape, please.
56:10Funding for Frontline is provided by the financial support of viewers like you.
56:16And by the Corporation for Public Broadcasting.
56:20Frontline is produced for the Documentary Consortium by WGBH Boston, which is solely responsible for its content.
56:39For videocassette information about this program, please write to this address.
56:56This is PBS.
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