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Mental Illness in America

Aired December 19, 2012 - 21:00   ET


DR. DREW PINSKY, HOST: Welcome to the program this evening.

Now, listen, this slaughter has us all hurting. I am personally beside myself. And what I want to do on this program and continue to do on this program is look for solutions.

Do not let this opportunity pass us by. It`s kind of a complicated topic, but it`s something we`re going to get into.

Last night, we were picking up from last night`s heated discussion about how to prevent kids from turning into violent killers.

With us, child analyst and psychiatrist, Dr. Harold Koplewicz; attorney Lisa Bloom, author of "Swagger", and contributor to where she has an article posted about the Newtown massacre.

Lisa, I`m going to start with you. You actually have a very personal history with mental illness. Tell me about that and then how this Newtown disaster has affected you.

LISA BLOOM, ATTORNEY: Well, my father was severely bipolar all of his life. He always said to my brother and me that he was going to take a gun and kill himself one day. We grew up with that knowledge. We were young adults with that knowledge.

And about 10 years ago, that`s exactly what he did. And my brother and I always struggled with, should we take away the gun? We knew he had one. He`d shown it to us.

And the fact is, he owned it legally. And if we took it away from him, he`d just go out and get another one. So, there was nothing that we could do.

And that`s wrong. And that`s very similar to the situation that parents of mentally ill children face. When they know that they`re dangerous and they can hurt themselves or someone else and there`s very little they can do about it.

PINSKY: Well, that`s what we`re going to get into. One of the things I want to ask, Lisa, is why we can`t get conservatorship to be more easily obtained for parents? Can you tell me that?

BLOOM: Yes. That`s because we prize civil liberties in this country.

PINSKY: Hold on. Stop it. Do we prize civil liberties or are we mortified by violence? Which is it? We have to make a choice here, because it`s not working this way. It just isn`t working. Right?

BLOOM: Right. Well, that`s correct. But do we want to be able to take away people`s liberty because they don`t make good choices?

PINSKY: No -- Dr. Koplewicz, I want to bring you in at this point.

That`s the thinking that drives me insane. We are not talking about taking away people`s civil liberties because they make poor choices. We`re talking about restricting them because they have a brain disorder that makes them incapable of making good choices.

DR. HAROLD KOPELWICZ, PSYCHIATRIST, CHILDREN`S MENTAL HEALTH ADVOCATE: So I think the important part is to recognize when that happens. So the fact that someone has a brain disorder, has a psychiatric diagnosis doesn`t necessarily mean they have bad judgment. Certainly doesn`t mean they`re going to be violent or aggressive.

It`s when we have kids or young adults who, because of their psychiatric illness, is affecting their judgment, and makes them potentially at risk for hurting themselves or others, that`s when parents have to step in.

PINSKY: Let me step in here for you.


PINSKY: Please don`t use that language because attorneys use that language and that`ll prevent us from ever moving forward with this.

You as a physician know when that point arrives and yet you still can`t do anything. Can`t we make that easier?

KOPLEWICZ: Well, we certainly can do something. The trouble is that because we are protecting rights, someone can get out of a hospital very quickly. If they`re no longer acutely suicidal or acutely homicidal, we let them out.

I`m all in favor of letting them out if we`re letting them into something that was therapeutic, if we had a residential treatment program for them, if we had some kind of program with their parents.

The problem is we let them out and they`re back on the street and they can go get a gun or they can go get a knife, or they can go hurt themselves or hurt somebody else.

PINSKY: All right.


KOPLEWICZ: More often, by the way, that they`re going to hurt themselves --

BLOOM: And, Dr. Drew, most mentally ill people don`t commit crimes.

PINSKY: Of course.

BLOOM: Most mentally ill people don`t hurt anyone. So, we don`t want to lock them up.

PINSKY: Of course. But the problem is -- and this is what I encounter. I know Dr. Koplewicz is dealing with this as well, in our practice as physicians, we can`t do our jobs many times.

I guarantee you, I`ve been saying this, that the Aurora, Colorado, shooter had an excellent psychiatrist and she got undermined in her ability to intervene on that kid because somebody decided his personal liberties were more important than the safety of the community.

And I say that balance has got to change. It has got to.

And some of this has got to include -- Dr. Koplewicz, back me up on this -- maybe a program of residential treatment centers or state hospitals or something where we can hold people.

KOPLEWICZ: Drew, what if we went back one step? So let`s think about the time maybe 20-some-odd years ago, 25 years ago, when AIDS was a tremendous epidemic. And we were petrified that people, if they coughed on you, if they touched you, if they kissed you, you would get AIDS. And in fact, people were saying, shouldn`t we quarantine people who have AIDS because they could possibly hurt others?

We didn`t go down that slope. What we did is we changed the way we thought about this disease. We actually have schools where they never talked about sex education, teaching kids how to put condoms on bananas.

We actually got so much invested in research that we got drugs that actually work and keep people alive for decades who have AIDS.


KOPLEWICZ: And therefore, they`re no longer scary entity.


KOPLEWICZ: If we could do that for psychiatric disorders, I think we`d get back to a more medical model than worrying about whether or not we`re quarantining people and keeping them locked up or protecting them from themselves or others.

PINSKY: All right. Let`s take a quick call.

Linda in Massachusetts -- Linda, what have you got for us?


PINSKY: Linda.

LINDA: I have a son that`s mentally disabled. He has been threatening suicide. He`s been through all kinds of things. He`s gone to the hospital with a cut where they said it wasn`t deep enough and sent him home. He`s still having episodes of where he`s going nuts.

What am I going to do? He`s getting older. I can`t handle it.

PINSKY: How old is he now?

LINDA: He`s 19.

PINSKY: So, this brings up that question of conservatorship again, which I brought up, which is the ability of a loved one, a parent, or even a formal -- a professional who does the job of conservator taking over the -- conducting that person`s life for them.

Dr. Koplewicz, help me explain what that is and how that works.

KOPLEWICZ: The problem we have right know, and we`ve talked about this, is when people have psychiatric illness, very often severe psychiatric illness like schizophrenia or manic depressive illness, bipolar disorder, very often their judgment is clouded. And so, they`re not fighting with the doctor to kill the disease. They`re fighting with the disease on their side and the doctor and the family are on the other side.


KOPLEWICZ: So it becomes impossible to convince them that they need therapy, that they need medication, that they need help so they can think more clearly and behave in a more sensible way.


KOPLEWICZ: And so the way it works right now is that you can be committed to a hospital if you`re a threat to others or a threat to yourself.

PINSKY: Imminently. Immediately.

KOPLEWICZ: Right. But as soon as it`s no longer acute, you are allowed to go.

And what happens is frankly it`s not that -- most people do not commit suicide. Most people do not hurt others, but they lose their lives in other ways. They`re not able to function in school. They`re not able to maintain a job.


KOPLEWICZ: They can`t have a meaningful relationship.

So unless someone legally comes in, and it`s usually parents, and say, this person`s judgment is so impaired -- I mean, I think the way to think of it is usually when someone`s demented, when a parent has lost their ability to think --

PINSKY: Right. To help them.

KOPLEWICZ: Their children sometimes come in and say we don`t want them doing something foolish.

PINSKY: That`s right. We want to help them.

KOPLEWICZ: That`s when you think of that.

PINSKY: But you can`t do that easily. Now, it`s money, it`s cumbersome, it`s almost impossible to get.

Now, last night attorney Georgiana Kelman versus Steve Perry, educator, they were having it out a little bit. We`re going to bring them back into this conversation.

I`ll be right back.


PINSKY: I fervently hope -- in fact, I pray that this massacre will not have happened in vain. And as a result of that, I want some answers. I want action that we can all take.

So I`m expanding my panel. I`m asking you all to be very, very short in your answers because we`ve got a ton of calls and we have to get to as many calls as we can.

So joining us now about our broken system in the wake of this massacre, attorney Georgianna Kelman and school principal Steve Perry.

Steve, now, last night, I`ve said this is where I want to start the conversation tonight. You pointed out the problem of over-identification of minority children and the sense to which that community is distrustful of mental health because of having been ill-served in the past. Tell me your thoughts.

STEVE PERRY, SCHOOL PRINCIPAL: Eighty percent of the special education population in America is either African-American, Latino, and/or male. That`s a problem. We see that at the root of the system is an over- identification of a particular population which is a result of racism and sexism -- more sexism quite frankly than racism.

PINSKY: Dr. Koplewicz, let me go to you really quick. It seems to me that the reality is, is that the psychiatric community, the medical community has at times ill served certain populations. Don`t we need to cop to that and talk about how we can rebuild that trust?

KOPLEWICZ: I think that`s important. Let`s remember that anytime we have something that`s considered experimental or research, minority groups for very good reasons because of history avoid those things.

So, if you look at Prozac, when Prozac came out it was given out like candy, and amazingly, teenage suicide dropped by 30 percent among white males. It didn`t drop with black males. And when we found out it was that it was seen as an experimental drug and the African-American community avoided it.

When we put Prozac labels on warning people the suicide rate went back up for whites. It stayed stable for blacks.

So, we have to own up that not psychiatrically but medically, black Americans have been exposed to experiments and research that now make them very wary of anything that has even the slightest feel of experimental --

PINSKY: Yes, we`ve got to rebuild that trust because as a community they could really benefit from connection to help.

Georgianna, I`m going to go to you now. You put a lot of the responsibility for the problems we`re talking about tonight on the schools.


PINSKY: I don`t know where the schools get the money to do the things you`re talking about. But tell me what it is you think they should do.

KELMAN: First of all, let`s talk about where they get the money. Let`s talk about that the misappropriation of funds by our own government. What I`m talking about is states receive funds from the federal government for the special education system. However, the first cuts are seen in the special education system, and these funds never make it to the schools where they need to be used.

Having said that, you want to talk about where we get money? How about foreign aid to countries that want to obliterate us? Why don`t we focus our attention on our country, on our children?

We have a war within our borders, within our schools. Let`s focus our attention the way we did it when 9/11 occurred. We created programs. We created agencies, Homeland Security Department, and we focused our attention seriously on that. We have to do the same with our children.

All of those funds --

PINSKY: Georgianna, I`m going to interrupt. I`m sorry. We`ve got so many calls coming in I`ve got limited time.

Steve, I`m going to ask you to respond. What if we put more money and resources into schools? Is that sufficient?

PERRY: The issue is not money alone.

KELMAN: Absolutely it is.

PERRY: It`s the kids that are being identified and there`s an issue of training and other issues.

And what Georgianna fails to tell is that just because a school district is reimbursed, it doesn`t mean it`s fully reimbursed. I would hope as she`s someone who may be representing children in a PPT that she`d take a little more time to understand IDEA and how it actually works.

KELMAN: Understand IDEA? Do you sit in IEP meetings because I sit at three or four of them a week, and continually, I see assistant principals tell me you`re correct, you`re right, you`re citing the law. Our hands are tied. We`re being told from administration that we can`t give these services because we don`t have the money and if we advocate for these kids, we`re going to lose our jobs.

I am told this on a weekly basis. I am intimately familiar with IDEA. I spend three times a week defining it and identifying to administrators what it is. I show it to them in black and white.

PINSKY: Steve, what she talking about?

KELMAN: And they look at me and say, we`re sorry. You`re right.

PERRY: I think your question is a good one. I think both you and she are wondering what she`s talking about, because here`s what the facts are.

The facts are that we have children who have special needs, and when those children`s needs cannot be met within the school, it`s the expectation that we put together the least restrictive environment which means the school itself is not specifically responsible for providing mental health services any more than it is expected to do so for physical health services.

So, for instance, we`ve got a school nurse. They`re not going to do operations --

KELMAN: But the school is responsible for placing the kids in the --


PINSKY: OK, hang on. Let me get here. Lisa wants to ring in.

I believe, Lisa, you got something to say?

BLOOM: Yes, there`s no question that we`ve slashed mental health services across the board nationwide in schools, in prisons, in facilities, it`s happened everywhere. And there`s no question that more mental health services everywhere would be a good thing, right? I think that`s something we should all agree upon.

KELMAN: Absolutely.

BLOOM: Right and left, red and blue, we should all agree on more mental health services.

PINSKY: All right. Let me take a call on that point. Deborah in Mississippi -- Deborah.

DEBORAH, CALLER FROM MISSISSIPPI: Yes, sir. Thank you, Dr. Drew.

I was calling about my 24-year-old son. He has signs of -- hello?

PINSKY: We`re listening. We`re all ears. Go ahead.

DEBORAH: I was calling about my 24-year-old son. Four months ago, he had started showing signs of mental disorder and he threw all his electronics out the back door because he said they were talking to him and laughing at him.

PINSKY: Right.

DEBORAH: Three times we`ve put him in a behavioral health center. The longest stay he got to stay there was five days because they said he was no threat to others or himself.

PINSKY: Right. That`s the only reason you get in a hospital these days. But how`s he doing?

DEBORAH: And on November 10th, he went out and stole two cars and said that voices were telling him to steal these cars --

PINSKY: Let me ask you this, Deborah. Is he taking his medication? Or is he unwilling to do so?

DEBORAH: He wasn`t taking it all the time, no --


DEBORAH: He is now because he is in jail.

PINSKY: Dr. Koplewicz, here we go again. Hold on, Deborah.

So the disease is fighting the doctors. The disease, the patient is on the side of the disease because the disease consumes the patient`s thinking and then law enforcement becomes the mental health treatment of last resort.

KOPLEWICZ: But let`s remember, these diseases are hard to accept. So five days in a hospital is good when you`re in a crisis. Then you need follow-up care. You need to be taught, basically psycho education.

What is your disease? How do you take care of it? When you hear voices, how is that your brain playing tricks on you? How does medicine work? What are the side effects?

It`s not a quick fix. And very often, people stop taking the medicine and you have to convince them again.

So, you know, it goes back to services.


KOPLEWICZ: The inpatient unit or once a week treatment isn`t going to do it for people who are very ill.

PINSKY: It`s a team. It`s outpatient. It`s long-term proposition here.

More of the calls, straight ahead.


PINSKY: OK, Dr. Koplewicz, I`m going to go to you first. I`ve got a Twitter from @terrytI5. He says, "Wonderful solutions, doctors. Instead of getting to the root cause of child mental health, coat the problem with a drug."

To me, (a), he`s got a point, that we have sick families and systems, problems in our culture that are creating a lot of problems with behavior. But more, we have a cultural problem where he doesn`t appreciate that this is a medical problem with a medical solution. And people are unwilling to look at brain disorder that way.

Do you agree?

KOPELWICZ: Yes, absolutely. I mean, people have trouble recognizing that these are real common and treatable diseases, and that as evidenced today, you hear that the young man who was the shooter was not taking psychiatric medication.

I assure you that if they found out that he was they would blame the medication. Yet again, treating this differently than any other set of diseases. If someone dies of a heart attack and was taking heart medicine, they wouldn`t say it was the heart medicine. They would say it was a bad heart.

This is the same thing. We`re talking about brains that have real disease.

PINSKY: Let`s go to Rose in Alabama -- Rose.

ROSE, CALLER FROM ALABAMA: Thank you, Dr. Drew. And thank you very much, Dr. Perry.

Teachers all over this country are desperately seeking help for these children. And with all due respect, we are also desperately seeking help for every child in our class.

PINSKY: Rose, give me a specific. What is your situation?

ROSE: I have a student that has attacked me this year, has gotten help, his alternative school, because of his parents. And he`s coming back after six weeks there on the recommendation of the teacher that he has there.

PINSKY: Are you worried that he`s going to attack again?

ROSE: Yes. There`s no doubt he will.


KELMAN: No doubt.

ROSE: For children to succeed in America they have got to have a safe learning environment and they have to feel safe to come to school.

BLOOM: Dr. Drew?

PINSKY: I want to go to Steve first. What do you think?

PERRY: She`s telling the truth. She`s a teacher. She has 22 kids in the classroom.

You just need one who has a mental health issue to disrupt it for everyone. And therein lies the challenge. I -- you know, I`ve seen -- we have a school that`s pre-K to 12. I`ve seen children as young as 4 and 5 years old show some level of mental health issues.

And as much as we may try, we can assign an individual to them, a direct one to one who sits there and has the child in their lap, but that`s not what they need. They need a therapeutic setting.

KELMAN: And it`s your responsibility to make sure that they get it. You know very well that if you have a child in a specific placement that placement is not working, the one to one behavior aide is not enough. You call another IEP meeting and you ask for the next level of support.

PINSKY: Steve, so if Georgianna`s right, do you have a place you could send a kid to for residential treatment? Do you even have such a place?

KELMAN: Every state has them. Absolutely.

PINSKY: Hold on. Steve, do you have such a place?

PERRY: No one has that place. It`s called outplacement. That is --

KELMAN: That is not at all what that is called. You talk about IDEA --

PINSKY: Hold on. One at a time.

PERRY: (INAUDIBLE) is that a school that has teachers, some social workers and a nurse --

KELMAN: Absolutely not.

PINSKY: Let`s say, Steve, there was a residential place 60 miles away. Do you think a parent would allow you to send the kid there?

PERRY: Well, the problem is that because --

KELMAN: The parents are begging to send their kids there.

PERRY: What needs to be is something that you discussed earlier, Dr. Drew. There has to be something called intermediate care that`s accessible and safe so that parents don`t have to give a 4-year-old away to a system.

PINSKY: Got it.

KELMAN: I disagree --

PINSKY: Hang on, hang on. Patty in Connecticut -- Patty.

PATTY, CALLER FROM CONNECTICUT: Hi. I live in the neighboring town to Newtown.

PINSKY: Oh, my.

PATTY: And there is a facility that has been closed down that was an institution for these children and for these people who had problems, who could not live in our society. And there are people who thrive in the institution --


PATTY: -- in the institution.

PINSKY: Patty, let`s be clear. The institutions are not just for the protection of the community. They`re to help the person with the containment, of course. But it`s for both sides.

PATTY: It is for both sides. And we have a facility right in our town that they are waiting for these -- the patients that are left there to die before they shut it down.

PINSKY: OK, hold on, hold on, hold on. This sounds a little more complicated. I want to hear more. This is right by Newtown, is that correct?


PINSKY: So hold on. I want to hear --

PATTY: This facility is in Newtown.

PINSKY: OK. Hold on, I want to hear a little more about this. I`d be curious to know if Lanza was referred to something like that, if you know of anything. Obviously, we can`t substantiate that. And then, Lisa, I want you to address the issue of, again, restricting people`s rights to help them.

More calls also after the break.

And later on, a woman`s life spirals into madness because of repeated misdiagnosis and she, in an altered state, attempts to leave her treatment repeatedly because she`s so impaired. And were it not for her mother forming a power of attorney over her, she`d be dead.


PINSKY: Talking about changes we need to make in the wake of the Newtown, Connecticut, tragedy, And things perhaps parents can do to identify kids in trouble. I was talking to Patty.

Patty, are you still there?

PATTY: Yes, I am.

PINSKY: All right. Now, you say there are some facilities for adults of all ages who can`t function in the world who are potentially dangerous to themselves and others, so they don`t fall through the cracks. Is that what you were describing?

PATTY: That`s what I was describing. They also have a place, it`s for -- a jail for the criminally insane.

PINSKY: That`s a different thing. That`s a very different kind of a thing.

But do you think there`s any chance that this shooter was being referred to any of those centers, anything like that? I mean, this is obviously speculation, unconfirmed. But have you heard anything like that?

PATTY: No, I haven`t heard anything like that because the facility in Newtown is now closed.


PATTY: As a matter of fact, I had a very good friend whose brother was in that facility because he couldn`t live in society.

PINSKY: Why was it closed?

PATTY: They closed it, I think lack of funding.

PINSKY: There you go. Lisa, go. Lisa, you have at it.

BLOOM: I`m sure it was budget cuts. And this is happening all over the country.

Now, remember, Adam Lanza`s mother said he could never be left alone.


BLOOM: And she said the reason why she took him shooting, which was obviously a terrible choice in retrospect, was because she didn`t want to leave him alone. She brought him with to the shooting range.

I mean, there needed to be a better solution for Adam Lanza`s mother, a place where she could take her son where they knew he was potentially troubled, violent.

And, by the way, one more quick thing. We shouldn`t lump all the mentally ill together.

PINSKY: Of course. Of course not.

BLOOM: We could talk about the violent mentally ill.

PINSKY: Yes, yes.

BLOOM: Not just the mentally ill.

PINSKY: Yes. But Lisa, what I keep trying to put a fine point on is that physicians kind of know where the problems are, and we can`t do anything about it. As I mentioned, the Colorado shooter`s psychiatrist couldn`t do anything about him because we are not empowered properly --

BLOOM: Because of civil liberties. But here`s the thing, Dr. Drew. We have a terrible history in this country of confining people like Mary Todd Lincoln, Abraham Lincoln`s wife --

PINSKY: Yes, right.

BLOOM: -- who was committed for being --

PINSKY: Lisa. Maybe we`ve gone too far. Maybe we`ve gone too far is all I`m saying.


BLOOM: Just different from being confined.

PINSKY: Dr. Koplewicz, go ahead.

DR. HAROLD KOPLEWICZ, PSYCHIATRIST, CHILDREN`S MENTAL HEALTH ADVOCATE: How about going back just a little bit? We just heard from a lawyer and a school principal. I think the important part here is there are alternatives to having a teacher who needs a siat (ph) or a shadow holding on to one kid.

We really have to train teachers to learn how to do evidence-based treatment like teach your child interaction training, how they can manage kids who have behavioral problems in the classroom.


KOPLEWICZ: Just one second. In Minneapolis -- in fact, it`s statewide now in Minnesota. They`re instituting this so that every teacher has this new set of skills. Now, they can take care of remarkably different kids, but they can take care of kids who have behavioral problems so that they can be managed in the classroom to give the teacher more teachable time for the other kids.

PINSKY: Tere in Florida. Hang on. I have to go to calls. I need you guys to listen to me, please. Tere in Florida.

TERE, FLORIDA: Yes. I want to make a comment, Dr. Drew. I believe that Georgianna`s totally wrong with I.D.E.A. As teachers, we are not trained to provide therapeutic services. We are trained --


TERE: We are trained to provide a curriculum.

PINSKY: Well, Georgianna, we just heard Dr. Koplewicz saying that there`s evidence that it could work. So what are you saying?

KELMAN: What happens is, again, funding. These teachers are not properly trained. For example, in my specific situations that I fight for weekly, I have aides that we all agree the student needs a one-to-one behaviorist in the classroom, no question about it, and there has to be a certain level of training and a certain level of qualification and experience.

But these aides that are being assigned don`t have the training, don`t have the experience. They`ve gone on the internet and they`ve given six hours` worth of training and told go support this child. Of course, that child is not going to be properly supported because they don`t know what they`re doing.

So, the frustration then goes to the teacher who doesn`t know what to do with the kid and everyone just sits on it and complains and calls the parents to come pick up the kid.

PINSKY: OK, Georgianna, I`m going to ask you to slow down. Steve, go ahead. Steve.

STEVE PERRY, PH.D., SCHOOL PRINCIPAL: Listen, there are practical limitations to the theories that Georgianna`s throwing out. If there are 22 kids in the classroom, we`re not talking about a kid who has ADHD and just has trouble tapping and not paying attention. We`re talking about a child who goes over and hits another child in the --

KELMAN: Exactly. That`s what I`m talking about.

PERRY: We`re talking about children who cannot -- who have no impulse control. These children take up -- 10 percent of kids take up 90 percent of the time. And what I`m saying is that there is a limit. We`re not just talking about cognitive challenges. We`re talking about mental health --

KELMAN: But Steve, you as the principal --

PERRY: And therein lies the challenge. What needs to happen is there needs to be a second level of care because at the end of the day --

KELMAN: I disagree with you.

PERRY: -- my teachers need to teach math, science, social studies and --

KELMAN: What I`m hearing from you, what I`m hearing from you is you`re not advocating for kids with special needs. These kids are a problem for you. And I`m hearing that in your voice.


PINSKY: Slow down. Everybody slow down. Kelly in Florida -- Kelly.

KELMAN: Because I deal with this on a daily basis.

PINSKY: I understand you`re very charged up --

BLOOM: But teachers are the heroes of this --

KELMAN: I`m not talking about --

BLOOM: I mean, why are we attacking teachers? I`m just appalled by that.

KELMAN: I`m not attacking teachers at all.


KELMAN: Teachers come to me on a weekly basis and they ask me to --

PINSKY: The next move, guys, if you don`t listen to me, is I have to turn the mic off. I`m sorry about interrupting you, but I cannot conduct this conversation on television this way. Kelly in Florida.


PINSKY: Go ahead.

KELLY: My sister was murdered five months ago by her son. And we`re not talking about -- I mean, my heart broke. Friday, I cried all over again with the senseless violence, obviously. But, my nephew took my sister`s life. He stabbed her to death 25 times. I`m sorry. OK. He had just been released two weeks prior from a mental facility. And I want to know what is their responsibility?

PINSKY: OK. I want you to hang on --

KELLY: Understanding that --

PINSKY: Listen, you are the person who we want to talk to tonight. I`m going to have Dr. Koplewicz talk to you in just a second. Hang in there. I feel so bad for you. This is the kind of stuff that I want to prevent. This is why we`re having these conversations. It`s why we`re all charged up tonight. We all feel very passionately about this.

We`re going to get back to that call. And later on, I`ve got a woman that was difficult to diagnose, lands herself in a mental institution, tries to sign herself out repeatedly because she has rights, you know, and had she done so, she`d be dead now. She`s now fully recovered. We`ll talk to her after this.


PINSKY: OK. We`re going back to Kelly in Florida. And Kelly`s family tragedy is precisely an example of what leads to disasters today. So, your brother, was it, was let out of a psychiatric hospital after a few days --

KELLY: No. It was my nephew.

PINSKY: Your nephew.

KELLY: Yes. He killed my sister.

PINSKY: And he killed your sister.

KELLY: Which was his mom.

PINSKY: Dr. Koplewicz, let`s dig into this case a little bit. Can we learn something from this that other people can who are listening to this can learn and maybe are there opportunities to learn about where we can change things in this one tragic case?

KOPLEWICZ: Let`s try to remember that the reason why someone`s in a hospital is because they`re so ill that it`s more than just the risk to others and the risk to themselves. They`re so ill that their judgment, their thinking, their ability to function has completely decreased or diminished. What`s troubling about this story is why was this young man let out of the hospital when he was still symptomatic?

And was it the lack of insurance? Was it a lack of wisdom on the side of the doctors? But quite clearly, we do know we can treat psychosis. We know it takes time. It takes titrating medicine.

PINSKY: Of course.

KOPLEWICZ: And this is chilling to think that someone was let out and wasn`t sent somewhere -- to a step-down unit.

PINSKY: Well, the step-down is the part that we`re all advocating for that we don`t seem to have now. Kelly, what happened?

KELLY: Well, this is my understanding of the situation. And I saw my sister several years ago before she was killed. Unfortunately, it`s been several years, but my understanding is that he checked himself into the hospital because he was having issues, hearing voices, that sort of thing. And they, in my understanding, diagnosed him with paranoid schizophrenia while he was in there.

PINSKY: But the question is why did he get out before he was --

KELLY: Well -- and that was my question.

PINSKY: Do you know anything about it?

KELLY: My understanding was because he checked himself in, he was also allowed to check himself out. And that`s where --

PINSKY: OK. I have a feeling -- was your sister always afraid of him?

KELLY: Not to my knowledge. He was a big part of her life, a big part of my niece`s and my sister`s grandchildren`s lives.

PINSKY: Yes. So here - there --

KELLY: Every week having dinner with him once a week. I mean, they were very close.

PINSKY: Is he still around now, your nephew?

KELLY: He is in prison in Kentucky.

PINSKY: OK. Dr. Koplewicz, so he comes in voluntarily, he gets better, he leaves, probably makes plans for follow-up.

KOPLEWICZ: And it`s possible that he stopped taking his medicine. It`s also possible, Drew. We know that, over time, people sometimes can get sicker, particularly, if they`re not getting really good care. I mean, fortunately, this is a rare event.


KOPLEWICZ: But it`s terrible in the respect that schizophrenia is a terrible brain disease. It actually causes tremendous damage in some ways to the brain. I know you`re aware of the neurobiology. So, this is the most serious of the illnesses we deal with. And yet, if it`s not carefully -- if someone isn`t carefully cared for, they really can deteriorate.

PINSKY: Right. So, it is a progressive disease both in terms of its symptoms and in terms of its effect on the brain as Dr. Koplewicz was saying, even to the point of deteriorating the brain. Our thoughts and prayers are with you, my dear. Susan in California, I`m going to quickly go to you. Can we get to this very quickly? Susan?


PINSKY: Go right ahead.

SUSAN: Hi. I`m just calling because I totally agree with Georgianna. I really feel what she`s saying. She`s hitting everything right on the nose, because you know what, I worked with these kids for ten years. And I was a special ed aide. I worked very close with the principals and the teachers, and they were very, very frustrated because they don`t understand these kids --

PINSKY: OK. Would you agree -- Hang on. Would you agree, though, that an intermediate level of care, sort of a residential therapeutic model, is something that`s a good idea?

SUSAN: Honestly, no.


SUSAN: Because everything she`s saying -- she is hitting it on the nose.

KELMAN: We have something in place already. That`s my point. We have a beautiful piece of legislation from 1997, re-authorized in 2004, that gives the school principals, the assistant principals --

PINSKY: Georgianna, Georgianna, I`m going to ask you to do me a favor. Would you write a blog for so we can -- to really elucidate some of these resources --

KELMAN: I would love it.


KELMAN: People aren`t educated enough. Teachers aren`t educated or trained.

PINSKY: Got it.

KELMAN: That`s the problem.

PINSKY: This is so important. I hope that we shine a little light on the complexities of this. Thank you to Dr. Koplewicz, Lisa Bloom, Steve Perry, Georgianna Kelman.

Next up, I have a beautiful young woman who starts acting very strangely. She ends up in a psychiatric hospital. What happened to her was, in fact, a living nightmare. And she is now here to tell us what went down. Be right back.


PINSKY: We`ve been talking a lot about mental illness in the last few weeks with the recent tragedies and, oh, all these things we`ve been preoccupied with. But mental illness is a complex topic. My next guest lived in a true nightmare. She`s written a book called "Brain on Fire: My Month of Madness." And I want to expand our discussion about so-called mental illness to include the neurobiological and medical realm.

Welcome, Susannah Cahalan. Susannah, tell us the story. What happened? Give me the story, the 30,000-foot overview, and then, let`s get down into where it started.

SUSANNAH CAHALAN, AUTHOR, "BRAIN ON FIRE": All right. So, in 2009, I was a reporter for the "New York Post" and I had kind of strange behaviors. I started becoming psychotic and I started to hallucinate, and ultimately, I was is diagnosed with an autoimmune disorder where my immune system was attacking my brain.

PINSKY: All right. Now, when you say psychotic, I`m going to try to break this down for people at home. A psychosis means it`s a particular syndrome where people hear voices, where they have delusions, and they`re - - hallucinations and they`re disconnected from reality.

You -- I actually read a little bit of some of the hallucinations you were having. You had a hallucination, for instance, where you thought your dad was an impostor, he was trying --


PINSKY: -- somebody else dressed up as your dad.

CAHALAN: Yes. I actually -- I believed that he was turning into people to play tricks on me. You know, I also believed that I could age people with my mind, which sounds so bizarre saying it now. But I believed if I looked at someone, I can actually make them grow older.

PINSKY: I`m going to ask you please not to look at me. Anyway.


PINSKY: Did you have -- we`ve been talking a lot about violence in recent weeks. Did you have any violent tendencies?

CAHALAN: Yes. Actually, I was very violent, especially when I was in the hospital, especially towards the nursing staff. I actually kicked and punched them, and I tried to escape. I was very violent at that time as well.

PINSKY: Where did it start? Give us how this started unfolding.

CAHALAN: You know, it started so subtly. You know, it started kind of -- I just didn`t feel like myself. You know, I felt off one day. And I mean, everyone feels off one day. And you know, I thought my boyfriend was cheating on me. I was convinced of it. So, I actually ripped through his things in search of this kind of imaginary evidence. And I didn`t find it.

But you know, other kind of strange kind of paranoia, paranoid thoughts started to emerge, you know, and I kind of believed that, you know, I was bad at my job. I became lethargic. I became withdrawn. So kind of small things. But I just thought, you know, I`m having a bad month at that time.

PINSKY: And then, did you see doctors at that point?

CAHALAN: Yes. You know, the first doctor I saw thought I had mono because I had -- I was very tired and I had a little bit of numbness on the left side of my body. And so, he thought it was mono. And I thought, oh, okay, I have mono. I`m 24, I have mono. And then, you know, as this disease progressed, I became more and more psychotic and paranoid. And I became unable to do my job at work.

PINSKY: Didn`t you have a very vivid experience being, I think, driven to the hospital or something? Is there a story there?

CAHALAN: Yes. Yes, you know, on the way to the hospital, further along in the illness, I actually tried to jump out of a moving car to escape -- you know, I thought -- basically, I believed that my parents were kind of taking me against my will, and I wanted to get out. Any means possible, I wanted to get out of that car.

PINSKY: Let me ask you something because we`ve been talking a lot on my program recently about making people get treatment. Even though you didn`t want to go, and if you had gone and hired an attorney to protect your rights, think how ill served you would have been by that kind of intervention.

CAHALAN: Oh, yes. You know, actually my parents --

PINSKY: Go ahead.

CAHALAN: My parents actually got a power of attorney over me when I was in the hospital, because they knew -- you know, I was coming in and out of lucid moments. And, you know, even during my psychosis, sometimes, I could be very lucid in my psychosis. And I said to several doctors I can sign myself out, you can`t keep me against my will.

PINSKY: Right.

CAHALAN: And, so my mom, you know, was like I need to do something. So, she got a power of attorney and, you know, during one of my less lucid moments, she actually had me sign it.

PINSKY: Wow. When did things finally turn around? I want to tell you, I would have noticed something very, very early, which is this idea, a really classic psychosis of organic psychosis, meaning it`s not schizophrenic, it`s not a psychiatric disturbance, it`s a medical neurological syndrome, is feeling the people that are close to you are impostors.

That`s a classic organic psychosis symptom. So, when you started talking about your dad being an impostor, why didn`t they look harder for a medical explanation for this?

CAHALAN: You know, I don`t know. I mean, that`s called Capgras syndrome, right? I mean, I think that`s what it`s called. And you know, there were other signs, too. I had a seizure. I had several seizures. And, you know, I had a kind of increased heart rate. So, there were all these kind of -- you know, these signs, these physical signs that typically do not go with a psychiatric condition.

But in the hospital, one of the diagnoses I was given, was actually schizo-effective disorder, which is basically, you know, a combination of thought disorder like schizophrenia and mood disorder like bipolar disorder.

PINSKY: And it`s sort of more in the characterologic realm even. So, when did things turn around? You finally had a doctor who made the right call. How`d that go down?

CAHALAN: Well, he came in, and -- Dr. Souhel Najjar at NYU. I`d been in the hospital for about three weeks at that point, and I was getting worse and worse. So, I was sliding from psychosis and hallucination and kind of, you know, violence to catatonia. So, I became withdrawn. I mean, no emotional register. I could hardly speak.

I couldn`t read or write. And at that point, he asked me to draw a clock, which is a very bizarre thing to ask a 24-year-old because it`s typically a test given to Alzheimer`s and stroke patients.

PINSKY: Mm-hmm.

CAHALAN: So, he gave me a piece of paper, and he asked me to draw -- you know, draw a clock. And so, I drew a circle. And the numbers I drew in all on the right side.

PINSKY: So, all the --


PINSKY: -- there was a left-sided neglect and all the numbers were crunched into the left side. Yes, which is --

CAHALAN: Exactly.

PINSKY: -- the right side of your brain is not working. It`s shut off. That`s when they knew there was a problem.

CAHALAN: They knew at that point that it was a neurological problem and not a psychiatric one. That was kind of the clue. They didn`t know what was causing my brain to kind of malfunction in that way, but they knew, OK, this is not psychiatric at this point.

PINSKY: And then you started treatment for this autoimmune disorder. And how soon before you cleared?

CAHALAN: So after that, they did a brain biopsy and they did a spinal tap, and ultimately, they diagnosed me with what`s called anti-NMDA receptor autoimmune encephalitis, which is very hard to say. But, they started treating me almost immediately with very, very high doses of steroids, which kind of suppress the immune system.

And immune therapies such as IVIG and plasmaphoresis, which kind of flush out these bad, you know, immune cells.

PINSKY: And once you started clearing, what did you think about? What had happened to you? What`s your sort of insight looking back?

CAHALAN: Well, you know, a lot of that time, I don`t remember because part of the -- you know, one of the parts of my brain affected was the hippocampus.

PINSKY: So, no memory.

CAHALAN: And that means -- you know, it`s a waylay station for long- term memories, you know?


CAHALAN: So, I don`t have the ability to make memories then.

PINSKY: But you must have cleared and started hearing stories and looked back. I mean, how did you make sense of all this and when did you start feeling yourself again?

CAHALAN: Gosh, you know, I mean, I wanted to kind of turn my back on that time as much as possible. So, I`d say about -- it took about six, seven months, first of all, for me to feel any sort of normalcy again and to return to work. But then that six, seven months, I actually wanted to start learning about what had happened to me.

I became kind of open to hearing those stories, whereas before, I didn`t want to hear about it.

PINSKY: And are you completely normal now? Everything cleared completely?

CAHALAN: You know, it`s such a hard question to answer, because it`s so hard to be objective, you know, an objective judge of yourself. I think, well, six months from now, will I say, oh, wow, I still had some more to go, you know, some more recovery to make? But I feel great.

PINSKY: You`re not hallucinating?

CAHALAN: I don`t think so.


PINSKY: Do you think you`re on TV or something like that? Is that a possibility?



PINSKY: You`re connected to reality. Well, that`s good.


PINSKY: And do you have to take any psychotropic medication or is it all just the immune suppressions?

CAHALAN: No, I`m done with all the medication. I`m not on any medication right now.

PINSKY: Well, Susannah, thank you for sharing the story. I really do appreciate it. The book is called "Brain on Fire." It`s a fascinating story. And if you really -- the complexities of these problems of what goes on above our neck are just really nicely explored in that book. Thank you, Susannah Cahalan. Back after this.


PINSKY: The deaths of 27 children and educators in Newtown, Connecticut have motivated many of you to do something. We`re kind of calling it random acts of kindness or I`m calling it ritualized kindness. People have brought coffee for residents of Newtown. They have baked pies. They made pins, badges, and t-shirts.

Take a look at a few more small but really significant gestures. Here now is a message in the sand on Jones Beach in New York. An 11-year-old boy wrote, "pray for these angels." A college student in Maryland arranged Christmas lights in the number 27 to honor all those who died on Friday.

A little girl in Maryland wrote notes to, quote, "All of the kids in Connecticut that have lost their lives."

A Dallas boy opted out of candles on his annual birthday pie. He, instead, lit tea lights for each person who had died in the slaughter and disaster.

Now, if you`ve got an idea, act on it. Go to for help on ideas. A reminder that Georgianna will have put her -- I`m going to get her to put that blog in there for ideas on what you can do if you`re struggling with children with mental health issues, what schools can do. This is a complicated issue. But I hope you`ve stuck with us tonight. It`s -- I feel very passionately that there`s an opportunity here.

It has exposed something about us. This -- let`s call it what it is. This slaughter has exposed something about our country. Maybe we can get more rational about guns. I`m all for that. Loosen the privacy laws a little bit so we can ask questions like, have you killed somebody before? And hopefully, we can better serve the most vulnerable amongst us.

Thank you to Dr. Harold Koplewicz, Lisa Bloom, Georgianna Kelman, Steve Perry, Susannah Cahalan for amazing story. Thank you all for watching. And it`s "Nancy Grace" that starts up right now.