Category: Psychology

Chronic loneliness is on the rise. But how can this be when we’re more connected now than ever? In today’s show, Dr. J.W. Freiberg, a social psychologist-turned-lawyer, explains that loneliness is not an emotion like happiness or anger. It’s a sensation like hunger or thirst. 

Join us for an in-depth discussion on the cost of feeling disconnected even when we’re surrounded by people.



Guest information for ‘Loneliness’ Podcast Episode

J.W. Freiberg studies chronic loneliness through the unique lens of a social psychologist (PhD, UCLA) turned lawyer (JD, Harvard). A former assistant professor of social psychology at Boston University, he served for decades as general counsel to more than a dozen Boston social service agencies, adoption agencies, and scores of private mental health practices. In his new book, Surrounded by Others and Yet So Alone: A Lawyer’s Case Stories of Love, Loneliness, and Litigation, Dr. Freiberg shares case studies mined from his law practice to illustrate dysfunctional bonds that can lead to chronic loneliness. In the book’s award-winning prequel, Four Seasons of Lonelinesshe explored chronic loneliness resulting from isolation and disconnection. For more information about all of his books, visit


About The Psych Central Podcast Host

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





Computer Generated Transcript for ‘Loneliness’ Episode

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

Announcer: You’re listening to the Psych Central Podcast, where guest experts in the field of psychology and mental health share thought-provoking information using plain, everyday language. Here’s your host, Gabe Howard.

Gabe Howard: Hey, everyone, and welcome to this week’s episode of The Psych Central Podcast, I’m your host Gabe Howard and calling into the show today, we have J.W. Freiberg. Dr. Freiberg studies chronic loneliness through the unique lens of a social psychologist turned lawyer. In his new book, Surrounded by Others and Yet So Alone: A Lawyer’s Case Stories of Love, Loneliness, and Litigation, Dr. Freiberg shares case studies mined from his law practice to illustrate dysfunctional bonds that can lead to chronic loneliness. Dr. Freiberg, welcome to the show. 

W. Freiberg: Thank you so very much.

Gabe Howard: You know, Dr. Freiberg, we are here to discuss loneliness and I promise we’re going to get to that. But I’d be remiss if I didn’t ask your thoughts on the differences between being a social psychologist and a lawyer. What’s that like?

W. Freiberg: Well, it proved interesting for me. I became a social psychologist first and I was a professor for a decade at Boston University, and then I had a chance to go across the river and go to Harvard Law School. So I wasn’t going to turn that down. I became a lawyer, and then it pretty quickly became clear that criss crossing the two expertises gave me a field of work that was unlike anybody else. No one else in Boston had both degrees. And that pretty quickly became what was sort of called around town, the psych lawyer, Boston’s psych lawyer. So institutions and agencies that had anything to do with psychiatry or psychology or clinical social work asked me to be their general counsel. And it was in the context of being general counsel that I heard about so many clinical cases, and that became the material for my research.

Gabe Howard: You define loneliness differently from others. Can you tell us about that?

W. Freiberg: Indeed, what I felt I discovered over thirty-five years of being counsel to a great percentage of Boston psychiatrists, psychologists and clinical social workers was that they kept reporting more and more loneliness. Sure, their clients had other issues as well, but the clients kept talking about being enormously disconnected from others, not having anybody to live with, anybody in their life, nobody to call. More and more as the years went by, loneliness became ever more present. So I started to think about this topic, and the more I researched it, it struck me that loneliness is not an emotion like anger or happiness. It’s a sensation like hunger or thirst. So just as our body tells us we’re hungry or thirsty, it also says, Oh, I feel really lonely and disconnected.

Gabe Howard: After hearing that definition, it makes a little more sense, this next statement, because you consider chronic loneliness a public health crisis of the first order.

W. Freiberg: The surgeon general of the United States, Vivek Murthy, the 19th surgeon general, about a decade ago, said, we are actually experiencing an epidemic of loneliness. About 35% percent of the American population in 2010 reported feeling chronically lonely. And what I mean by that, we all feel lonely from time to time. How could we not? But that’s not like being chronically lonely, just like being sad is not like being clinically depressed. There’s a huge difference. Chronic loneliness is in the land in the last 50 years ever more so, and it correlates with much worse health and much shorter lifespan. So it’s serious.

Gabe Howard: It sounds very serious, but one of the things that I keep thinking about is people are enmeshed around other people. I mean, we have social media. So even when you’re at home, you’re around other people. We work in offices now. I know COVID has changed that a little bit, but I just I’m trying to think of the last time that I was truly alone and I can’t come up with it. Even as I sit here interviewing you, my phone will ding. I’m never not surrounded by people. I guess my question is how can people still feel so lonely, given how connected our world is?

W. Freiberg: Well, that’s the key question, because there are two pathways to loneliness, one pathway is being all alone, being isolated, being disconnected, but a different pathway is being surrounded by people, just as you described, but not benefiting from those relationships, not feeling nourished, not feeling nurtured, not feeling soothed. Sometimes people are objectively lonely because they’re all divorced off from anybody. They don’t have anybody in their lives. But just as many people become chronically lonely, surrounded by others, but in an unfulfilling way.

Gabe Howard: There’s a quote that I use to describe living with bipolar disorder, which is alone in a crowded room, and, you know, I just say I’m surrounded by people, but I feel utterly alone. And for the purposes of my analogy, I’m talking about, like, you know, what it’s like to, you know, have this misunderstood illness. And, you know, it’s like all these people are in my life. But are they? And people have a hard time understanding that. And it handcuffs people a lot. They’re like, well, you can’t be alone in a crowded room. And I’m like, no, no, no. It actually makes sense. If you think about it. It’s just we need to do more on loneliness, because I, I do think that a high up reason for suicide is hopelessness. And one of the things that drive hopelessness is this idea that you’re all alone in the world and that nobody will miss you

W. Freiberg: Yeah exactly.

Gabe Howard: You want the pain to stop and nobody’s going to miss you. So I think loneliness is a huge issue that people just chalk up to personality. Well, go make some friends. That’s what I hear all the time. Go make some friends. Join a club.

W. Freiberg: No, you’re exactly right, because we have some powerful research on suicide attempts in the United States, I forget the percentage, but it was getting near two thirds of people who attempt suicide succeed in the sense that they were only attempting suicide, didn’t want to kill themselves. They wanted attention to their issues.

Gabe Howard: Right.

W. Freiberg: And when we asked people who attempted suicide, what’s up? When we try to learn from that subgroup of people, they have exactly what you described, one or several key relationships that they just couldn’t do that to. But what they were really doing is crying out for help. Their choice of language is a little drastic and dangerous. So what you said is absolutely correct. And by the way, when we study chronically lonely people, and we have some very powerful tests that we can use to test loneliness. If anyone listening is interested in how their own relationships are doing, I have these tests on my website, my website called or my name,, that’ll take you there. You can test to see how your relationships are, whether they help you feel safe and nurtured and soothed or not. You can really see about how the quality of your connectivity to others in general. And then you can work right through each of your major relationships and see how they’re doing and where you could improve them. But when you use those tests on people who are chronically lonely, what we learn is about, you know, magnitude, something like half of chronically lonely people are from objectively disconnected backgrounds. They really don’t have anybody in their lives. And the other half are people who are surrounded by others. But subjectively, they feel completely alone.

Gabe Howard: Speaking of research, you have five main modes of disconnection that you identify in your book. Can you tell us about those?

W. Freiberg: Sure, so when I looked at more cases, I literally took the files out of the cabinet, I had about fourteen hundred files from different relevant law cases and I started piling those that had to do with loneliness. And there were sort of five patterns that stood out. One was obstructed connections. Sometimes people are just too busy to relate to one another. The constant phone calls, late nights at the offices, doing a thousand things at once kind of society that we’ve become. Sometimes people are just too busy. And I have a case in the book about two parents who were so busy, each with their own career. One was a mayor and the other was a financial investor. And they were too busy to pay attention to their wonderful little 10-year-old son.

Gabe Howard: But it’s also kind of heartbreaking, right?

W. Freiberg: Yes, of course it is. So that’s one way of being lonely. Even though you’re surrounded by others. Another way is a one-way relationship. Sometimes people enter relationships with very different goals in mind, and that can lead to a relationship that doesn’t work. One person is thinking that they’re deeply in love with the other person, whether the other person is just a transactional relationship, trying to get some business or get advantage in some way or other. Sometimes people are in relationships for very different purposes. A third way are fraudulent relationships. So sometimes people enter relationships without being honest about who they really are, what they really want, what they really believe. A fourth one is sometimes relationships are uncertain. They’re tenuous. People are only conditionally involved. Depends on this. Depends on that. That’s the opposite of a successful, fulfilling relationship. Correct? We want to know that our friendships that matter, our love ships that sustain us are meant by everybody involved to go on indefinitely throughout our lives. That’s the point of old friends or successful marriage or marital relationship kind of thing where you can count on the other person being there and staying there through thick and thin. And the fifth and final kind of relationship are dangerous relationships of problematic relationships, dangerous relationships. The classic example is spousal abuse. Sometimes, in fact usually, spousal abuse involves people who love each other. But one of them is putting up with physical or psychological abuse. But it’s hard to leave because it’s still their relationship. So sometimes relationships are literally dangerous to be in even though they’re important to the person who’s at risk. So those are ways in which my actual law cases fell out and told us five different stories about how sometimes people are surrounded by others. They’re married, they have kids, they have neighbors, they have colleagues, but they experience life as if they were all alone.

Gabe Howard: How can we lower our risk of becoming chronically lonely, because in my mind, it just seems like gather up people, make more friends on Facebook and hey, you’ve achieved it. But I imagine that that’s not the answer you’re going to give.

W. Freiberg: Well, it’s not unrelated to the answer, so there’s no magic here, we learn our relational skills early on as children, as our parents do this. And for those listening who have been parents or can remember back into their own childhood, because we’re all ex-children, all that loving and nurturing care from our parents. When you raise a child, how many hugs, how many kisses, how many skinned knees and scraped elbows do you soothe and kiss and help the child work through? We’re training our children to relate and love others. We’re teaching our children to go make their relationships in the world just the way parental birds teach the little fledgling birds how to fly, how to find worms or fish for fish, whatever they do, we literally train our children in the skills of relationships and then they go out in the world and learn to make their own friends. We’ve all watched kids move from parallel play to real play with other children to friendships. And later in teenage years, as they learn to work out relationships. We’ve all been through that. And we’ve a lot of us have watched children or nieces, nephews learn to do that. So part of what we do in working with people who have relationship issues is teach them the bag of tricks about how to be good at forming relationships, how to be an active and interactive friend. There are people who are good at these things, just like any other sphere of life.

W. Freiberg: And there are others among us who are not so good. We can impart those skills. In direct response to your question, relational due diligence, just the way you look around your house and you say, oh, there’s a rotten piece of wood, I’m going to have to replace that or call a workman with that plumbing issue. So you have to look at your own relationships. Which ones haven’t you supported lately? Have you called your cousins, for example? Because we live farther from people now, we have busier lives between the work and the commuting and the geographical mobility and the social mobility of modern life. 

Gabe Howard: And we’ll be back in a minute after we hear from our sponsors.

Sponsor Message: Gabe here and I wanted to tell you about Psych Central’s other podcast that I host, Not Crazy. It’s straight talk about the world of mental illness and it is hosted by me and my ex-wife. You should check it out at or your favorite podcast player.

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Gabe Howard: We’re back discussing loneliness with Dr. J. W. Freiberg.

Gabe Howard: One of the things that you mentioned were children and you said that we learn as children how not to be lonely, I believe your exact phrase was we moved from playing next to our peers to playing with our peers. But doesn’t the research state that more and more children are chronically lonely?

W. Freiberg: Indeed, that’s the case, everybody’s much more chronically lonely and the loneliest among us is Generation Z and the Millennials. So that’s people from 18 to 38. They actually score the loneliest on the UCLA loneliness scale.

Gabe Howard: But how can we help children who are chronically lonely, because I don’t think that anybody likes the idea of kids just wandering around feeling so alone for reasons that we could probably discuss for hours, we’re OK with adults being lonely. But this idea that a five-year-old or a 10-year-old or even a 15-year-old would feel so disconnected and so alone, it kind of sticks with us in a way. How can we as adults help?

W. Freiberg: Each of us who’s involved with raising a child has issues to think through to help that child. Just depends on the child. Right. And if a child is unable to relate successfully to make friends successfully to get on in the schoolyard, it’s very important for the parent to take note of that and to listen to hints he or she may get from, say, the teacher or guidance counselor at school and to openly discuss, work with that child about friendship making skills where that child falls down in the process. And by the way, one of the negative consequences of trying to stay safe from COVID-19 is that many children are not able to have free play to the extent they always did. And it’s in the free play at recess on the play field during the weekends, during the summer, when adults aren’t telling kids how to interrelate, the kids are just learning to deal with one another. That’s when children work out these skills. Skills like how to approach someone about beginning a friendship, how to become part of a group, how to recognize and deal with the local bully. Those are all things that children learn by dealing with one another. And if somebody’s child is having a problem with those things, the trick is to pay attention to it, maybe even to seek some professional help about how to be a helpful parent in those circumstances.

Gabe Howard: Do you think that COVID and the global pandemic is increasing loneliness? Has it changed any of your thoughts or feelings about loneliness? How has COVID played into your overall thoughts about loneliness?

W. Freiberg: Needless to say, COVID is a very powerful stressor on the issue of connectivity or loneliness, no question about it, and it strikes different groups in different ways. Let’s take the age groups in terms of little children. I’ve sort of spoken about that they’re not able to have their free play time as much. It’s basically harder for children to play with one another and practice their inter-relationship and friendship making skills. Working people in that age group are farther from one another. Many are now working remotely or in an office with a reduced staff. So they don’t see people as much as they used to. They see their friends less. They go to restaurants and bars and fun events less. Of course, they’re more divided from one another. And let’s take a look at grandparents. Sure, we can see our kids on Zoom. I have a couple of grandchildren. I see them on Zoom. I wave at them, they wave at me. That’s certainly better than nothing. And it’s important to make use of it. But it isn’t the same thing as holding one’s grandchild. So COVID-19 is a tough variable. It’s a real stressor. It is critically hard on chronically lonely people, but it’s also hard on the rest of us who are fortunate to be involved in successful relationships that make us feel safe.

Gabe Howard: Thank you so much for that, I really appreciate it. I just, I just don’t see how we can talk about most things without mentioning COVID, but I really don’t see how we can talk about loneliness without mentioning COVID.

W. Freiberg: Yeah, I mean, the isolation, which is part of the public health response to COVID-19 acts directly on people who have issues with loneliness in a serious way, what I call chronically lonely people, but also on the rest of us who are just aren’t able to spend the time with the people we like and love who are so important in our lives.

Gabe Howard: I completely agree. Can you walk us through your theory that chronic loneliness is a sensation rather than an emotion?

W. Freiberg: Sure, I’m fascinated by the fact that we humans are also animals, we’re also mammals, and we’re mammals of a certain sort. We are small pod family herd animals, like, for example, the cetaceans, that’s the seagoing mammals, the whales, the porpoises and the dolphins. Also certain types of hooved animals and certain classes of the great apes. We are that kind of mammal. We are built, we are wired to be with others. And when we’re not with others, we feel unsafe, disconnected and at risk. And it alerts us. We have an alert system for hunger. We have an alert system for a thirst. We have an alert system for fear, and we have an alert system for connection. And that’s what loneliness is. Loneliness is the name of the sensation we feel when we are inadequately connected to others. Look, humans are slow runners. We don’t see that well, we don’t hear that well, we don’t smell that well compared to a lot of other mammals. But we’re really clever when we team up with one another because we have language and hands and we are able to coordinate, cooperate to be very viable. That has to do with connecting successfully with one another. And so we have a warning system that tells us when we’re unsafe by disconnection. And that’s the feeling of loneliness that wells up in this. And let me just say one thing. If you think I’m exaggerating about how powerful that signal of loneliness is that we feel, we don’t think, we feel, the way we feel hunger or feel thirsty. You tell me, which hurts more, a broken arm or a broken heart?

Gabe Howard: It’s a different kind of pain, though, right? It sort of reminds me of those questions that me and my teenage friends like, What’s your favorite movie? Well, my favorite comedy? My favorite action movie? Like, no, just your favorite movie. It’s I am thinking about this question sincerely. And you’re right. The problem with a broken heart is there’s no treatment and you never know when it’s going to end. It just kind of lingers forever. 

W. Freiberg: And let’s look at some of the consequences or the difference in consequences, if you have a broken arm, as you say, two hours later, you get a cast around it and two days later, your friends are signing your cast. Six weeks later, off it comes, you do some rehab. You’re back to who you were. People commit suicide over broken hearts. Not so much broken arms. People write poetry. People write opera about broken hearts, about failed love relationships. I’ve never seen any drama, opera or poetry about a broken arm. Have you?

Gabe Howard: This is very true, I can’t decide if that’s like a really good idea, if I’m going to be on Broadway next year with the broken arm, but you’re absolutely right. And it’s a broken heart is traumatic and it causes a trauma and Dr. Freiberg, there’s obviously so many questions surrounding loneliness, and it’s very evident to me in our discussion that it’s very misunderstood. People don’t understand it and often they blame themselves for it. I know there’s probably no way to wrap this up into a nice little bow, but if you could speak to people experiencing chronic loneliness, what would you want them to know?

W. Freiberg: I would want them to know that as painful as chronic loneliness is, whether it’s the objective sort where you’re you don’t have any friends or whether it’s a subjective sort of the people in your life aren’t fulfilling you, there are steps you can take and it doesn’t take a pile of money, doesn’t take the traveling around the globe. It takes being resourceful, looking honestly at your relationships, seeing where you could improve them and being active and clever about it. For example, learning to listen is one of the tricks we talk to people about. Some people are good listeners. They really are there while their friend is talking to them and they ask follow up questions. Other people are thinking what they’re going to say next and they don’t even really acknowledge receipt of the information they’ve been given. So learning to be a better listener, for example, as your friends tell you about how they feel about what’s going on in their lives, there’s a whole bag of tricks like that. And if you go to my website, or, I included some tests, the UCLA loneliness scale. If you take that little test at home, they’ll take about 45 minutes max. It’s just 20 little questions in everyday language. You don’t want to be any kind of psychologist to take the test. It’s made to be available. It’ll tell you how your relationships are doing. And if you take the relational assessment chart test, which is right next to it on that website, you’ll see how each individual relationship of yours scores. Is that a healthy sound one or just it has some areas to work on. So just as you could do a better job of policing, let’s say your diet or your exercise regime, you can do a better job of relating to others by being aware of what’s going on. 

Gabe Howard: I really do believe that loneliness is one of those things that everybody thinks that they understand, but that in actuality, nobody understands it at all.

W. Freiberg: I think you’re absolutely right, but it’s very possible to improve in this sphere, just as we’re supposed to watch that we eat a decent diet, that we get enough exercise, that we don’t smoke too much and so on, we need to take a look at our relationships and how we can strengthen them. And it’s very doable.

Gabe Howard: Dr. Freiberg’s latest book, Surrounded by Others and Yet So Alone: A Lawyer’s Case Stories of Love, Loneliness, and Litigation is out now. Dr. Freiberg, where can they find you and where can they find your book?

W. Freiberg: So it’s on Amazon, they just go under my initials J.W. Freiberg, F R E I B E R G, and it’ll lead you right there. And the website has all sorts of useful things. If you’re interested in being serious about the quality of your relationships, if you go to that little website and click around, you’ll find all sorts of useful hints and modes of approach that will help you get better with your existing relationship and go out and form some new ones as well.

Gabe Howard: Dr. Freiberg, thank you so much for being here. You’ve really illuminated a lot on loneliness.

W. Freiberg: It has been my pleasure.

Gabe Howard: Well, everyone, we’ve reached the end of the show. My name is Gabe Howard and I am the author of Mental Illness Is an Asshole and Other Observations, which is available on Or you can get signed copies for less money, and I’ll include The Psych Central Podcast swag. Just head over to If you like the show, and I certainly hope that you did, please rate, rank and review. Subscribe wherever you downloaded it and tell all your friends. And remember, you can get one week of free, convenient, affordable, private online counseling any time anywhere simply by visiting We’ll see everybody next week.

Announcer: You’ve been listening to The Psych Central Podcast. Want your audience to be wowed at your next event? Feature an appearance and LIVE RECORDING of the Psych Central Podcast right from your stage! For more details, or to book an event, please email us at Previous episodes can be found at or on your favorite podcast player. Psych Central is the internet’s oldest and largest independent mental health website run by mental health professionals. Overseen by Dr. John Grohol, Psych Central offers trusted resources and quizzes to help answer your questions about mental health, personality, psychotherapy, and more. Please visit us today at  To learn more about our host, Gabe Howard, please visit his website at Thank you for listening and please share with your friends, family, and followers.


The post Podcast: Loneliness and Litigation: A Lawyer’s Case Study first appeared on World of Psychology.

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Date: 10th December 2020 at 12:04
Author: Psychcentral – psychology – The Psych Central Podcast


Schizophrenia has been around since the dawn of time but actually treating it has only been around the past 100 years. In this episode host and schizophrenic Rachel Star Withers takes you through the dark and disturbing evolution of schizophrenia treatments. From systematic euthanasia to hydrotherapy, electroconvulsive therapy to the infamous lobotomy.

Were these doctors “mad scientists” torturing the mentally ill or were they the only ones trying to help a population of people seen as a burden?

About our Guest

Miriam Posner is an assistant professor at the UCLA School of Information. She holds a Ph.D. in Film Studies and American Studies from Yale University. She is a digital humanist with interests in labor, race, feminism, and the history and philosophy of data. As a digital humanist, she is particularly interested in the visualization of large bodies of data from cultural heritage institutions, and the application of digital methods to the analysis of images and video. A film, media, and American studies scholar by training, she frequently writes on the application of digital methods to the humanities. She is at work on two projects: the first on what “data” might mean for humanistic research; and the second on how multinational corporations are making use of data in their supply chains.


The Case of the Missing Faces

Frequently Asked Questions About the Lobotomy

Highlights from “Evolution of Schizophrenia Treatment”

[04:00] “Schizophrenia” as a term is first used

[05:00] Views of the top mind of the time

[07:00] Euthanasia of mental patients

[08:22] Nazi Germany’s plan to eradicate schizophrenia

[13:40] Mad Scientist or Helpful Doctor?

[14:00] Fever Therapy, Sleep Therapy, Insulin Coma Therapy, Hydro Therapy

[19:00] Seizure Therapies, Electroconvulsive Therapy

[23:00] The Lobotomy

[31:30] The First Antipsychotic

[36:00] Interview with Miriam Posner Ph.D.

[50:00] Walter Freeman’s Views on the Lobotomy

[1:03:00] Rachel’s Thoughts – it’s not the story of the patients

Computer Generated Transcript of “Evolution of Schizophrenia Treatment”

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

Announcer: Welcome to Inside Schizophrenia, a look in to better understanding and living well with schizophrenia. Hosted by renowned advocate and influencer Rachel Star Withers and featuring Gabe Howard.

Sponsor: Listeners, could a change in your schizophrenia treatment plan make a difference?  There are options out there you might not know about. Visit to find out more about once monthly injections for adults with schizophrenia.

Rachel Star Withers: Welcome to Inside Schizophrenia. I’m your host, Rachel Star Withers here with my wonderful co-host, Gabe Howard. How are you doing today, Gabe?

Gabe Howard: I am doing great. As always, thanks for having me.

Rachel Star Withers: I am excited about today’s episode; I feel like we’re going to talk about some really interesting stuff. I was about to say cool. But maybe, maybe interesting would be a better descriptor.

Gabe Howard: I don’t think that you can have a fully fledged conversation about mental illness without the history, and part of that history is the evolution of treatments. And these treatments were often used for the sickest of the sick psychosis, schizophrenia. And we’re going to talk a lot about lobotomies because it’s, I think everybody’s heard of it, but I don’t think people really understand it.

Rachel Star Withers: Correct. I mean, myself, look, we’ve been doing this podcast for two years, and before that I’ve made numerous videos and other types of media about schizophrenia. And yet I learned so much when I was doing the research for this episode, things that I was like, oh, what? I’m just surprised I’ve never heard that before. What blows my mind is everything that we’re talking about is in the past, you know, 100 years. This isn’t like, well, back in the 1500s, they thought, well,

Gabe Howard: Right.

Rachel Star Withers: It’s back in the 50s, you know,

Gabe Howard: Yeah, yeah,

Rachel Star Withers: Like people are still alive.

Gabe Howard: Our grandparents are still alive,

Rachel Star Withers: Right? Yeah. Like, it really isn’t that long ago. And that’s blown my mind learning about the evolution of the treatments to where we’re at now.

Gabe Howard: It’s blown my mind, too, because when we think of something like a lobotomy, we think of One Flew Over the Cuckoo’s Nest, and as anybody who’s listened to us long enough has heard us say, don’t get your understanding of schizophrenia from pop culture. Yet we fell right into the trap. We were like, well, we understand lobotomies. Why we saw it on TV. Even at our level, Rachel, we’re still realizing that there’s just so much to learn. It’s a lot more complicated than we thought.

Rachel Star Withers: Yes, even finding a guest for today’s show that turned into being quite the hunt.

Gabe Howard: So hard.

Rachel Star Withers: I didn’t think so. You know, the title and how I reached out to different professors and doctors was we’re talking about the evolution of schizophrenia treatments. And I’m looking at people who literally teach classes on the evolution of psychiatry over the past 100 years. I’m like, I feel it fits right in there. And so many didn’t feel comfortable talking about these treatments. And our wonderful guest who we’re going to hear from later, I’d say she’s not who you would expect. She’s a digital humanist, which I didn’t know what that was. But she’s actually like one of the best people to talk to about lobotomies. And she blew my mind. She was totally awesome. So she’s coming up a little bit later.

Gabe Howard: I feel like we should point out that Miriam Posner is also an assistant professor at the UCLA School of Information. She studied this like she’s got a degree in this. It was fascinating, both everything that she said and the number of people that just didn’t want to talk about this on record for some reason. Like you said, it’s don’t you study this? Yes. Do you teach classes on it? Yes. Do you have a Ph.D. in this? Yes. Do you want to talk about it? No. Why not? It shows you that the misinformation is allowed to continue because so many people are like, well, it’s kind of something that we don’t want people to understand. It was confusing. So we were very excited for Ms. Posner to come on.

Rachel Star Withers: Well, before we can get into all of the kind of crazy treatments that came out and have been shown in the media, we need to talk about how schizophrenia was seen. The first time schizophrenia comes up is 1910. A Swiss psychiatrist coined the term schizophrenia, which in Greek meant split mind. What he meant was like a loosening of the thoughts, your thoughts splitting away. But of course, that very quickly became misinterpreted as a split personality and that has stuck with schizophrenia since 1910, that confusion. Which is just crazy to me, it’s like, man like even in the beginning they knew that was a bad name, but we’ll stick with it. The following year, one of the top psychiatrists described schizophrenia as the senility of youth. And basically you were going to be retroverting with your brain deteriorating. During the same time, we have Sigmund Freud, who also quite famous. He revolutionized for better and worse psychology. And a lot of his theories and stuff are still very prominent today. And Freud had a lot of opinions about people’s schizophrenia. That they could not handle reality and their paranoid delusions are motivated by unconscious homosexual impulses.

Gabe Howard: Paranoid delusions are motivated by unconscious homosexual impulses? That Rachel.

Rachel Star Withers: I know he just he kind of hit multiple offenses, so, like, I’m just going to offend everybody in one sentence. He also described people with schizophrenia as they would eventually revert back to an infantile state of around six months to six years old. So you have to understand, as we are rolling into the beginning of the 1900ss, the top minds at this time are not hopeful. They saw schizophrenia as something that those people, they’re like adult babies. Their minds will just get worse. There is no oh, we can treat this. Oh, let’s find a way to help. It’s nah, no, these people are terrible. That’s a lot.

Gabe Howard: It is a lot, and they categorize them in a way as to make them others. They’re other, it’s OK to do whatever we want with them because they are the worst society has to offer. They stopped short of calling them evil because they said they’re the worst society has to offer because they’re sick. But let it be known everything was up for grabs because I think society didn’t really care about them very much.

Rachel Star Withers: Society painted people with schizophrenia and other serious mental disorders at that time as a huge burden, you know, most families were ill equipped to help their family members, so mental institutions were their only options. And then at the mental institutions, you have doctors who are following, obviously, what the leaders of the country are telling you. And many of them did see euthanasia as a mercy killing. Some thought that, well, like these different psychiatrists have said, these people can only get worse. So we should probably kill them now so that they can avoid suffering. And a lot of mental institutions had a death rate of 30-40% a year. That’s a big death rate. You know, if you’re going to a hospital, you might rethink that hospital.

Gabe Howard: Well, yeah.

Rachel Star Withers: And this isn’t advertised, like they’re not openly saying, hey, you could be one of them, but that’s like low key what was happening.

Gabe Howard: And there’s reports out there like a mental institution in Lincoln, Illinois fed its incoming patients milk infected with tuberculosis. They were just experimenting on people with schizophrenia. And once again, want to point out, this is 1950.

Rachel Star Withers: And at the same time, we also have sterilization was huge in the U.S. Many states had forced sterilization of any patients in mental institutions. Throughout today’s episode, Gabe, I keep getting thrown off by the fact that so much of this stuff was on women. I would think sterilization. I honestly, I think men. But the majority was they sterilized the women because they’re like, we have to stop the babies. If you think about it, though, guys can make a lot more babies like than a woman.

Gabe Howard: Yeah.

Rachel Star Withers: But yes, so a lot of times when women came into mental institutions, that was the first thing that happened. It was not the cleanest, nicest ways of doing things. It was done as cheap and quickly as possible. Unfortunately, this is all over America. And at the same time, Germany is beginning in the Nazi era. I have done a lot of research into the Holocaust. I’ve actually been through the Auschwitz camps. So the fact that I didn’t know this stuff coming up is bizarre. But Germany, Adolf Hitler specifically, they really liked our eugenics programs and they decided that schizophrenia was a hereditary trait. And Germany embarked on a plan to eradicate schizophrenia, which sounds great. You know, that’s like, hey, you guys, we’re going to do this. They formed an organization called the Charitable Foundation for Curative and Institutional Care. That sounds wonderful.

Gabe Howard: Right, on the surface, it sounds OK, we’re going to eradicate schizophrenia, the name of the organization is good. And remember at the time when this was going on, we didn’t understand that Nazis were bad yet.

Rachel Star Withers: And this program, depending on the different years, it was 70-100% effective at eliminating schizophrenia in the German population. So the way this would happen was if you are thought to have schizophrenia, you would have to be assessed by three different doctors. If two of them decided you had schizophrenia, then you were sent to be euthanized. And a lot of these people were children. They wanted to catch it as young as possible. So they’re trying to find, you know, schizophrenia in children, which is very hard nowadays, you know, and you have two doctors and knowingly like, yep, this one’s out. To handle this is that they started building extermination centers in the main six psychiatric hospitals and those would later become the concentration camps. That blew my mind. I didn’t realize that basically, concentration camps started at psychiatric hospitals. I’ve just never been told that before. They also did different programs to see how little you could feed the schizophrenics, slowly starving them to death, how much they could work. And they took all this data that they learned and then used it not many years later on the people in the concentration camps. It’s easy to be like, well, Rachel, of course, those are Nazis. They do crazy things. And it’s easy to just sweep this all under the rug as like Nazi bad stuff.

Rachel Star Withers: But it wasn’t just them. In 1934, the Journal of American Medical Association, they actually did a report on the German eugenics and pretty much went on and on about the expected benefits. One of America’s top psychiatrists praised Hitler’s program and also one of the most renowned neurologists in America at that time warned that American mothers might respond with guilt over killing their mentally ill children. And he suggested that there be public education to help them overcome the emotional resistance to euthanizing their children. That’s the top neurologist. He was also the president of the American Neurological Association. He was on the board of the American Psychiatry. Like, this is the top and they’re talking about killing children very openly. And these are the main journals that are going to all the doctors. So everybody, everybody thinks at this time, you know, the only way to deal with this is through extermination, euthanasia. I didn’t realize how intense, I’m going to say, the belief was. I kind of thought, you know, yes, a few back alleys, you got some mad doctors kind of playing around wanting to kill off people. But no, these are the leaders of the medical community at that time.

Gabe Howard: So here’s what we have, we have people utilizing science and data and listening to experts in the field saying that this is the best course of action and the correct response is to say no, the doctors, the researchers, the data, the science, it’s all wrong. This is not the way that we should be treating human life. We find ourselves in a situation here now in 2020 where we’re trying to get people to listen to data, science and doctors. But again, it was less than 100 years ago that stuff like this was going on. And you can see where this creates a ripple effect in the trust of the medical establishment. You can see where people who are diagnosed with these illnesses, when they think back to how they were treated in the 50s, the 30s, again, this is all in America less than a hundred years ago. And you, you ask why people don’t want to trust or rely on their diagnosis? Well, there’s better than average odds if you’re Rachel and I’s age, that our grandparents know somebody who was honest about their illness and was institutionalized for life, or worse. It’s made it very difficult to move forward. And as we’re listening to this and as Rachel continues explaining the evolution of the treatment of schizophrenia, maybe being worried about a schizophrenia diagnosis for fear of stigma and discrimination is not just about being called names or not getting a job. It’s not too far in our history that it was literally a matter of life and death.

Rachel Star Withers: And I think what society has grabbed on to is all of the crazy treatments, they make great horror movies that kind of criminalize all of it. But what I learned is that the doctors who are doing these treatments, many ill advised, they’re the only ones actually trying to help. Yes, some of it is kind of crazy. And why would you think that would help? They’re the only ones, because the major medical minds are saying don’t even treat them. It’s pointless. So me coming to, I guess, that realization, Gabe, that was kind of hard on me because you see these different people and you think, well, they were just torturing people with schizophrenia, doing these terrible things, but at the same time, they were the only ones doing any therapy, trying anything. They were the only ones giving these people relatively a chance. Some of the crazy ones, and this one just blows my mind, fever therapy. So they would actually like inject you with sulphur or different oils to make you have this horrible fever. Now, the reason they did that is that they noticed that people who have malaria don’t have psychotic symptoms. I mean, I feel that’s a stretch. But OK, something about a fever makes you less psychotic. Another one they did was deep sleep therapy. And that’s where they would, like, put you to sleep for days, sometimes weeks. Very close to that is insulin coma therapy. They would just repeatedly inject psychiatric patients with large doses of insulin and they would put you into a coma and the coma would only last for like an hour. But you would do about 50 to 60 of these comas in six weeks, up to two years, just repeatedly going in and out of a coma like that. That’s amazing to me. What kind of life is that?

Gabe Howard: I don’t think it’s much of a life at all, right? I think this is an excellent example of where the phrase the treatment is worse than the illness comes from. It sounds terrifying. It sounds traumatizing. It sounds painful. And it wasn’t particularly effective. Correct?

Rachel Star Withers: And as we’re going to see as we talk about some of these treatments, parts of it did. That’s where the issue is. Parts did work. Trying to separate those parts, you know, unfortunately, led to a lot of I would describe torture to a lot of people trying to get to those. And many of them were psychotic at the time and had no clue what was happening to them or could consent to it in any way or it was a family situation. You look at so many children actually were put through all of these treatments. You know, when we think back to horror movies and stuff, it’s always adults. When you have a child that you’re doing this to, you know, it stops being a horror movie. This just becomes something really just bad and gross. Why would you even do that? And to realize that was the truth in it is that it happened to the majority. Any children that were thought to have schizophrenia. Another one is hydrotherapy. So, Gabe, if anyone’s seen the new Netflix show, Ratched, they actually do hydrotherapy and I’ve never seen it before. I was like, what is this? But really interesting. And that’s where they would either put you in really, really hot water or really, really cold water. Sometimes you would literally be like strapped into a bathtub. You could be left in that bathtub for days. You know, when you think about a continuous bath at first that sounds nice. But when you’re like you’ve been in hot water for three days, I mean.

Gabe Howard: It’s terrifying. Each one is more terrifying than the next, and you’re not done.

Rachel Star Withers: Oh, no, I would say these are the softball ones. Oh, you have to understand, but there was logic to it. They found that warm water helped with insomnia. It helped with people who were suicidal and it helped calm people down. Cold water, freezing water was usually used on people who were psychotic. There was something about the cold water, slowed the blood flow down to the brain and decreased mental activity. You know, you see different bits of what was working, unfortunately, horrible ways to get to those little bits. One of the things with the hydrotherapy is that one of the mental institutions actually would chain the psychiatric patients to the wall and they used a fire hose on them.

Gabe Howard: Just wow.

Rachel Star Withers: It’s so easy for any of these treatments to turn into torture so quickly.

Gabe Howard: Rachel, I have to ask, though, you realize that if you would have been born 100 years ago, this is the treatment that would have been given to you. Rachel, as somebody who lives with schizophrenia, how are you feeling right now?

Rachel Star Withers: It makes me think back to around, I guess, sixth grade, you know, middle school age. But that was the first time around then that my parents took me to see a counselor for outbursts and issues. You know, I sat there. I didn’t like the woman. I don’t remember anything about it. I remember not liking her. We saw a couple of different ones, some religious, some normal. And I think had that been the situation, let’s say in the 40s, I could have been. All right, let’s just spray this, what, 12 year old down with the fire hose, that that would have been probably what could have happened.

Gabe Howard: Yeah, they would have sprayed you down with the firehose. How do you feel about the idea that your parents might have chosen to spray you down with a fire hose and then have been told by the top psychiatric doctor in America that they just needed to manage their emotions while watching you get sprayed down with the firehose? Actually, he said, manage your emotions for you to be euthanized, but let’s move it back a layer and just say manage your emotions to watching their 12 year old be sprayed down with a firehose.

Rachel Star Withers: It’s mind blowing.

Gabe Howard: It’s terrifying.

Rachel Star Withers: So the issue now is that we’re starting to find more of what works, but still how do we get to it is the issue. And that’s where seizure therapies came in. And the way they realized this was actually a Hungarian pathologist, he noticed that people with epilepsy almost never had schizophrenia and that after an epileptic seizure, those people tend to be very happy. So the idea was, well, if I give people with schizophrenia seizures, that should help them. There is numerous ways they went about this. It started with doing lots and lots of pretty much injections with drugs. They found they could go back to the insulin and inject you with tons of insulin. It would give you seizures. These are all horrible things and obviously lots of side effects from being injected with just tons of random chemicals. What happened was they found a much better way. I like the story of how this came to be because there’s just so much of this stuff is red flags, electroconvulsive therapy, where electricity is shot through the brain to induce a seizure. The first human trial was in 1938. So a while ago. But the idea was the doctor had learned that pigs before you like kill pigs to eat them, like at a big plant, you give them an electric shock and they pass out. And somehow that was like, you know what, I think that can help the schizophrenics. And I don’t know, just like you were at a pig plant, that, that’s where they

Gabe Howard: Wow,

Rachel Star Withers: What?

Gabe Howard: Wow.

Rachel Star Withers: So that’s where electroconvulsive therapy originated. Fortunately, in the 40s, they did it quite often. And at that time, they didn’t use any muscle relaxers or anesthesia. So a lot of people were fully aware as they’re being shocked, they broke bones. They had people holding them down. And it was a very intense procedure to go through. By the 50s, they had now learned to do a modified version where they would put you to sleep and give you muscle relaxers. So for about ten years is the real bad horror stories. And then in the 50s is where, OK, we’re going to keep doing this, but we got to find a better way. And I think really that was a good changing point in mental health of we need to find better ways to do this.

Gabe Howard: I guess it’s important to understand, ECT, electroconvulsive therapy is actually still a treatment that’s used today. It works very well. In fact, you’ve had ECT, so you’ve named off a lot of very scary things and things that they no longer do. But all of that scary list, one of them has stuck around.

Rachel Star Withers: Yes, it’s always a very touchy subject because I have people reach out to me who only see it as torture because of what happened to so many people. And I do agree it was used horribly. Another thing they like to do with children is shock them twice a day for 20 consecutive days. I was an adult when I had ECT and I can’t imagine someone doing it to a child. I had it for two weeks, three a week. There was so much bad stuff with ECT. But where it was in the 40s to where it is now is different. If you ever talk to my mom, she will always tell you how that was like a major change for me. For me it helped and I’ve looked into getting it again. So I understand it’s a very, you know, controversial thing. Does it work on some people? Yes. That segue leads us into, Gabe, one of the most notorious treatments, the lobotomy. What’s crazy is that when you hear lobotomy, you think of schizophrenia. But when they were actually doing them, you got a lobotomy for like everything. It was for ADHD. It was for manic episodes.

Rachel Star Withers: It was for depressive episodes. It was for people who didn’t fit in. The lobotomy was the go to. But looking back in history, you think, oh, man, that’s for that’s what they do to schizophrenics to get them under control. That’s been the enduring image. So lobotomy, it’s actually called psychosurgery. And that is any time that surgery is done on the brain in order to relieve a mental disorder. And a lobotomy is one of the psychosurgeries. Psychosurgery is still performed today. Versions of the lobotomy still take place today. Is any of it like it was in the 30s on to 60s? No, it is the completely different. The first form of a lobotomy was actually done they would drill holes in the skull and they would then inject ethanol into it. And the goal was to destroy some of the white matter in the frontal lobes. And for whatever reason, they learned that destroying white matter in the frontal lobes somehow makes people calmer. They notice that when, after the wars, the soldiers coming back who had had brain damage to the front of their heads, their personality had changed. So that’s where the whole thought process came of why we should, you know, start sticking holes in people’s brains.

Gabe Howard: I understand what you’re saying, but the exact words were used is that doing that psychosurgery made people calmer. You didn’t say made people better or allowed people to use their best lives. It very much seems like this was a mechanism of behavioral control, not necessarily what was best for the patient.

Rachel Star Withers: And that that’s where we get into so much interesting things, which Miriam Posner will help us understand some of that because, yeah, it’s a double edged sword. There are so many people who swear by it and it helped them. It’s the reason they were able to go have lives. And then you have other people who, for one, died. Quite a few people died from it, not just because they had pieces of their brain stabbed, but because of the conditions. Many got meningitis. Walter Freeman, one of the main neurologists who like to do the lobotomy, he didn’t use gloves or a mask and they were already using those back then.

Gabe Howard: Wow.

Rachel Star Withers: So you have people that are dying. And Walter Freeman, one of the things he’s known for is the ice pick lobotomy. And he figured out a way to avoid drilling holes in the brain. So at first, it sounds great. We don’t have to drill pieces in the skull. I found a way around that, that’s much quicker, much simpler. It involves an ice pick.

Gabe Howard: I, that’s, that’s not better.

Rachel Star Withers: No, it’s not, you know, the mental process of all of these always starts out good and then suddenly takes a wrong turn. And yes, he discovered that you could use an ice pick to go through the eye cavity. It is intense to watch. There’s lots of YouTube videos you can find of these surgeries. I would say after watching so many videos, it occurred to me that no movie has ever come close. There’s something about watching these black and white videos of them taking an ice pick to the person that is so unnerving. It’s not like any kind of crazy images from movies where they do it. It’s much more real and intense. And the majority of lobotomies were done on women and children. So you had a kid with ADHD or suspected with schizophrenia or didn’t fit in and was weird? Lobotomy. That was the go to

Gabe Howard: Wow.

Rachel Star Withers: It’s a very dark time in psychiatry in general. Did it help some people? Yes. Going into it, did it calm people down? So, Gabe, this actually it makes me think back because, yes, most of these treatments were to come and help people get control of their schizophrenic. That’s kind of what it was like. This is to help you get control of your loved one. It definitely wasn’t to make the loved one better. But I look back at my ECT. And what did it do for me? It took away my depression. It took away a lot of my OCD. My hallucinations were much harder to deal with. I would say I was not controllable. So did ECT do that to me? I think it did. It helped me, yes. But did it essentially make me calmer? Yes. So, I mean, this is a moral dilemma for me as I’m learning more and more about this, because I’m like I see both sides of it and I don’t even know where I stand when I think about that.

Gabe Howard: I certainly understand the idea of something can be two things, I mean, if you are calmer, if you are easier to talk to, if you are able to follow the rules, that’s definitely a benefit to friends, family, if you’re in the hospital, staff or society at large. But there’s also something to be said for that’s best for you as well. Right? Like, I guess that’s what I’m saying. It’s just you do go back and forth on whether ECT just made you better, made you better for your friends and family. But you’re making these choices on your own.

Rachel Star Withers: Right.

Gabe Howard: You like to have your home life be serene and calm and stable. Right. So just because your family benefits from your decisions doesn’t retroactively make them not your decisions. But in the case of some of these treatments, you don’t even know where you are. What was the one where they make you sleep for two years? They wake you up every four weeks to like what, rotate you? What kind of a treatment is that? It didn’t make you better. When you hear stuff like this, you can see why people are terrified of the treatments for schizophrenia, because, again, it wasn’t that far in the past before the outcome of treatment was just you obeyed and made life easier for the people around you, but your quality of life was nonexistent.

Rachel Star Withers: And especially there’s so much around the lobotomy, it was thought to be around 50% effective, which again, for the time period, your other option is death or pretty much just going on as you are and probably becoming homeless or other things and eventually dying of those reasons. So if someone offers you a 50% chance of being normal, that’s I mean, I’m like, well, that’s a pretty good deal. That’s a good deal. It had a death rate of around 14%, you know, so a lot of the people willingly had this done. They were desperate. They knew what could happen. It was very well known that your personality could change. You might have to relearn how to do everything. The neurologist, Walter Freeman, who did most of these, he called it a surgically induced childhood. They know what they’re doing. I don’t think they looked at anyone as this is going to make you better and take away this thing. It’s no, it’s going to make you more childlike. And you go from there. I don’t know. I worry because when I read his thoughts and a lot of the doctor’s thoughts, like, it’s like you kind of knew you weren’t doing a good thing. I just,

Gabe Howard: It’s what it sounds like, right?

Rachel Star Withers: Yeah. He described one of his patients who was a success story, he said following her lobotomy, she was a smiling, lazy, satisfactory patient with the personality of an oyster.

Gabe Howard: That’s not successful treatment.

Rachel Star Withers: It’s like, wait, what? You know, and later he had another patient he actually wrote notes about and said that the best that can be done for a family sometimes is to return the patient to them in an innocent state, much like a household pet.

Gabe Howard: Literally, it’s an incredible quote that the best that you can hope for your patient is to give them back to their family. He actually said as a veritable household pet. That’s the exact quote from his note. Like, that’s what the doctor thinks about the patient. Like, it is terrifying.

Rachel Star Withers: And that’s a success story,

Gabe Howard: Right.

Rachel Star Withers: That was a success story. That’s thing, it’s just like he’s like, this is good. He is promoting this.

Gabe Howard: Yeah, he’s proud of himself.

Rachel Star Withers: Yes.

Gabe Howard: Wow, wow. But luckily we moved past that, we get to medication therapy. The very first antipsychotic came out in the 1950s, and this is what I think people think of now when people think about the treatment for schizophrenia, now they think of antipsychotics. And those came onto the scene in the 1950s. Tell us about that, Rachel.

Rachel Star Withers: That was pretty much the revolution. Now, you don’t have to have that weighing on your conscience of having to stab your family member with an ice pick. It is they could take a medication and they can go they can get a bunch of pills and then come home and take them one a day, etc. So you also had people could come back and live with the family more. You didn’t have to worry that any of the procedures were going to leave them with brain damage, having to relearn how to read and write. Now, the way they came up with this for the first antipsychotic was it was used as a histamine. The point was that they noticed it had a calming effect. It all goes back to making people calmer. That was where antipsychotics started, was making people calmer and it went on from there. And at the same time, ironically, there is this crazy new form of psychotherapy that was gaining speed called cognitive behavioral therapy. And that was the first psychotherapy they had found that actually helped schizophrenics. They had tried different ones in the past. But there’s something about the cognitive behavioral, it really helped people with schizophrenia. So this was a big turning point.

Gabe Howard: And the medication is still the standard today, I mean, you know, medication therapy, peer support, but the big one, the one that everybody thinks of when managing schizophrenia is medication. And I think people are unaware of, you know, just how recent of a discovery that was. And it’s important to understand that the first one came out in the 1950s, that the first of anything, you know, the first cars were not so great.

Rachel Star Withers: Yes.

Gabe Howard: They took time to perfect cars from when they were invented. And I would argue that we still haven’t perfected medication treatments for schizophrenia. Would you agree with that? I mean, there’s side effects. There’s issues. There’s still a lot that we don’t understand. New medications are coming out all the time. Research is ongoing. And I only bring that up because I think so many people are like, well, just take your meds, Rachel, and you’ll be fine.

Rachel Star Withers: It’s kind of like looking back at all these old timey treatments, it’s like you’re trying to figure out what works and just do that without all the other horrible things. Ironically, that’s where we’re still at now. Luckily, the side effects are not death as many times as it was back then or sleep for two years. But that’s just yeah, that’s just the evolution of these treatments. To get to where we are now a lot of that stuff had to happen.

Gabe Howard: Obviously, we want to make sure that our listeners understand that there’s just a lot going on, it’s not as simple as good versus bad or right versus wrong or any of that. There’s just a lot going on and it’s difficult to understand. But I think that sometimes when people think about this, they’re really quick to say, oh, why are you so worried, patient with schizophrenia? The doctors had their best intentions in mind. So we give the benefit of the doubt to the doctors for the mistakes that the medical community has made. Well, why don’t we give the benefit of the doubt to the patients who are leery of the medical community, given the number of mistakes that they’ve made? And I think that’s one of the things that is missing. When we talk about people with schizophrenia who are afraid of medical treatment, there’s an actual factual basis to be concerned about what they’re being told. This isn’t made up of whole cloth.

Rachel Star Withers: And now a word from our sponsor.

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Gabe Howard: And we’re back discussing the evolution of schizophrenia treatments on Inside Schizophrenia.

Rachel Star Withers: Yes, I absolutely agree, and that’s why we reached out to our guests today, Miriam Posner, to help us understand this side of psychiatry.

Gabe Howard: Without further ado, here is that interview.

Rachel Star Withers: We’re here speaking with Dr. Miriam Posner, and she’s an assistant professor at UCLA School of Information and she’s a digital humanist. Miriam, tell us what is a digital humanist?

Miriam Posner: It’s a field of study where scholars use and experiment with digital tools to explore humanity’s questions, and so it can look like a lot of different things for different people. But if you think about like maps to show the spread of a historical event or a network diagram to show how people were corresponding during, say, the Renaissance or even there are some experts in computer assisted text analysis who try to find patterns in text. So, yeah, so I’ve been part of that community for about a decade now.

Rachel Star Withers: So the reason we asked you to be on our show today is that you have spent a considerable amount of time studying lobotomies and you wrote some different articles. The Case of the Missing Faces, frequently asked questions about the lobotomy. Tell us a little about that part of your research.

Miriam Posner: What got me interested in lobotomy was that I’ve always been interested in medical images and the kind of work that medical images do to persuade people or affect our understanding of disease and patients. And a professor in grad school just happened to show the class a clip from a film that was made of lobotomy patients after they had had surgery. And the footage was just so affecting to me. It was one thing to read about the effects of lobotomy and what it was like to have a lobotomy. And it was another thing to watch the patients struggle to find themselves afterward. Those images really stuck in my head and I started wondering how many other images are there of people who had lobotomies and what was the point of images in the history of lobotomy? I was looking at how physicians were using photographs and film to make arguments about lobotomy. But along the way, I learned a lot about that episode in our history and also about Walter Freeman, who was the foremost exponent of lobotomy in the United States.

Rachel Star Withers: And can you explain to us the pictures that you had studied, the before and after photos? Tell us about those.

Miriam Posner: Yeah, one thing that really took me by surprise is that Walter Freeman was obsessed with taking before and after photos of his patients, he would routinely take a before picture of a patient before performing a lobotomy. And then even years later, he would come back and follow up with a patient to take an after picture. He was very dedicated to seeking out patients and he would drive across country to stop at people’s houses and take after photos of his patients. And I just thought, what? Like why? Like, why would you do that? And it was really surprising to me. And I thought, what did he think he was showing with these images?

Rachel Star Withers: What is your interpretation since you’ve been studying them? What is yours of looking at all these different photos?

Miriam Posner: Well, to Walter Freeman, I think that those before and after photos constitute proof that lobotomy was effective in treating patients’ mental illnesses. The kind of strange thing is, that to us, it’s not always clear what about the after picture is proof because it’s really hard to tell what exactly he was seeing that meant that the person was visibly cured. In order to understand why he thought those after pictures were effective, I had to do research about what constituted mental health to Walter Freeman and to other psychiatrists in the period where he was active. The signs of improved mental health are often things like putting on makeup for women, wearing appropriately feminine clothes, being surrounded by family, for men wearing a suit and working what Freeman thought was an appropriate job and even putting on weight was for him like an example of mental health.

Rachel Star Withers: Interesting, but those also seem like that’s something that could be easily staged for as far as the clothing, the makeup.

Miriam Posner: For sure, for sure.

Rachel Star Withers: I’m not an emotional person, but I was looking at the before and after photos of this woman, and it made me cry because the before photo was very almost like a mug shot. She looked

Miriam Posner: Yeah.

Rachel Star Withers: Kind of annoyed that this was happening. And the second one, she was smiling and it wasn’t like a big smile or anything, but her eyes to me, what grabbed me was her eyes. And it just made me cry because just what I went through with depression. Now, I don’t know the story behind it. That could have been one of the ones, Oh, and she’s happy but had to relearn how to walk. But just the photo itself to me was incredibly powerful, if you would have just shown me that. And it was like this is proof that it works. I’d be like, wow.

Miriam Posner:  That’s something that hits me, too, is that these photos are actually emotionally pretty powerful to look at, but really probably not for the reasons that Walter Freeman thought that they would be powerful. He thought you could take a look at them and just be like, wow, that person got better. But just as you say, you feel like you can look in someone’s eyes and see that things are not OK, even though that’s not what Walter Freeman saw. But it kind of makes sense that the makeup and the dresses and markers of like appropriate gender presentation, that he thought that those were evidence of mental health just because of the way that psychiatrists like Freeman thought about mental health in the 30s and 40s. Mental health was not so much about a person’s insight or ability to articulate and identify their own feelings. It was much more about integrating the person into society in a quote unquote, useful way. Could the person hold a job? Could the person have a family and perform like a gender appropriate role in the family? Could the person show up to an event and not be disruptive? So that was mental health to him. It really wasn’t so much about a person’s feeling fulfilled as a human being.

Rachel Star Withers: I was very shocked to recently learn that majority of lobotomies were performed on women and even children. In your opinion, looking at the photos and now telling us this, that so much of it was the person playing the gender role correctly, why do you think more women had lobotomies? Was it that gender bias or is it just because women tend to seek help quicker than men do?

Miriam Posner: I don’t have an authoritative answer for you, but I can speculate a little bit about that. When the lobotomy first started being performed in the late 30s in the United States, it was reserved for patients for whom there was no or they believed there was no alternative. Patients with really intractable mental illness. But as the years went by, the indications for lobotomy expanded to include lots of other symptoms, things like depression, pain and inability to integrate into family and work. And it seems to me that it’s in that period of expanding diagnosis that women presented more often as candidates for lobotomy. And you’ll read case studies where it appears to a modern reader that the woman is unhappy with her lot in life. She’s not fulfilled by her role as a homemaker. She’s in an unhappy marriage. She perhaps doesn’t want to perform the activities appropriate to a woman during this period. And for some women, those signals became interpreted as depression that was severe enough to qualify her for a lobotomy. I don’t think that Walter Freeman or other lobotomists had an explicit policy of lobotomizing women more frequently. But I do think that they tended to interpret what they saw as maladjusted symptoms pretty loosely as making them good candidates for lobotomy.

Rachel Star Withers: As you spoke on, the lobotomy was used as a cure all for mental illnesses around that time, they didn’t have as much information on them. However, I think nowadays, when you look back on lobotomy, the disorder that’s most commonly associated with it is schizophrenia,

Miriam Posner: Mm hmm.

Rachel Star Withers: Why do you think that is? Why do you think that schizophrenia is, when they think of lobotomy, they think crazy person, screaming, schizophrenic? They don’t think depression. They don’t think ADHD. They don’t think, yeah, like you say, just not adjusting to the times, being oppressed.

Miriam Posner: Yeah, I do think that people sometimes have a mistaken understanding of the history of lobotomies, maybe because of the way it’s depicted in films. A lot of people assume that lobotomy was confined to the back halls of disreputable mental institutions, that it was disreputable physicians who performed lobotomies, that it was always a sketchy procedure. But what a lot of people don’t know is that during the heyday of lobotomy in the 30s and 40s, it was considered the top of the line, most modern and most effective treatment. Walter Freeman was on the cover of magazines. He was mentioned for a Nobel Prize. There was no sense that lobotomy was a weapon of cruelty. Lobotomy was understood to be the most current, up to date, scientifically precise treatment for mental illness. And I think people associate schizophrenia with being uncurable. So I think in people’s minds, because they believe schizophrenia is incurable, that lobotomy would be the most likely candidate for a disease. But while it was performed on people with schizophrenia, in fact, the indicators for lobotomy were actually a lot more broad than people suspect.

Rachel Star Withers: How has public perception changed as far as lobotomies and that type of treatment? Obviously 30s, 40s when Walter Freeman was at his height, yeah, that seemed like a go to. At what point did the public kind of start to pull away from this miracle cure?

Miriam Posner: One big rupture was the introduction of antipsychotic medication, chlorpromazine was introduced in 1954 and that really provoked a sea change in treatment of people with schizophrenia and related diseases. So suddenly there was another treatment that didn’t require biological surgical intervention and that could be fine tuned and didn’t seem quite as drastic as a surgical procedure. There was also increased interest in talk therapies around that time. Freeman’s brand of psychiatry, which was always most interested in biological organic causes for her mental illness, fell out of favor a little bit. And so as the years went by, it became more common for people to see lobotomy as a really brutal, inhumane treatment. But one thing that’s interesting about Walter Freeman is that he never really accepted that interpretation of lobotomy. He believed until the end of his life that lobotomy was the most appropriate treatment for people with intractable mental illness. And his interpretation of treatment with antipsychotic medication was that it was like a temporary solution to a problem that could be permanently solved by surgical intervention. Medication he thought was kind of a Band-Aid, but the real successful way to intervene would be to go in and separate the thalamus from the frontal lobe.

Rachel Star Withers: That’s interesting because we usually only see it from the side of the lototomy was a horrible, torturous thing, not the other

Miriam Posner: Mm-hmm

Rachel Star Withers: Way of him being like, yeah, the other option is like a Band-Aid. Very interesting. I think one of the most popular portrayals of a lobotomy was from the movie One Flew Over the Cuckoo’s Nest, and it’s known for its bad portrayals of mental hospitals, of people with mental illnesses, of showing electroconvulsive therapy in a very bad light. And, of course, in the movie, I’m sorry if you haven’t seen anyone listening. But, yes, a lobotomy takes place and he’s pretty much brain dead at the end. How do you think those massive media portrayals have affected research into psychosurgery and other types of mental surgeries?

Miriam Posner: I think that lobotomy often is interpreted as kind of a joke now, it feels like really distant in the past to a lot of people, and it is very closely associated with brutality and something that was performed in the like back wards of really brutal mental institutions. But it’s important if we really want to understand lobotomy to understand that a lot of people were on board with it. A lot of institutions and individuals thought that it was a good idea and there was a way in which it was part of a continuum of therapies that are called somatic therapies. So any kind of therapy that’s performed on the body. In many institutions, you’d start with a somatic therapy, like being tied to a bed and then continue on through this spectrum, through ECT or insulin shock therapy or being submerged in ice water. And when the patient failed to get better after this kind of chain of somatic therapies, they finally were seen as a good candidate for lobotomy. We tried everything and now it’s time for the real king of somatic procedures, which is lobotomy.

Rachel Star Withers: From all of your research, looking over Walter Freeman’s work and other aspects of lobotomy and portrayals with media, what is your overall take away?

Miriam Posner: What I like for people to understand about lobotomy is that the episode is not an aberration. It’s not the result of a couple kooky physicians who made miscalculations and somehow managed to sneakily lobotomize a lot of people. Instead, that’s science. That was mainstream science. That was considered the peak of good clinical practice at the time. And if we accept that’s true, then we have to accept that science can make some real drastic miscalculations and can inflict real damage on people just in the day to day course of doing business. So it’s not an aberration. It’s not a crime that people got away with. It was something that was endorsed at the highest level of the psychiatric profession.

Rachel Star Withers: Tell us what happened with Dr. Walter Freeman after the public and the medical community started to move away from lobotomies and it fell out of favor.

Miriam Posner: He never really accepted the rejection of lobotomy, and he was advocating for lobotomies until the end. He performed his last lobotomy in 1967 and shortly after that he was stripped of his operating privileges and was incredibly indignant about it. One episode that kind of sticks in my mind is that in order to make his case to the hospital board that he should be able to continue to perform lobotomies, in order to make this case, he brought a box full of Christmas cards from his former patients where they expressed thanks for what he’d done to them and concern for him as a human being. And so he emptied this box on the table and said, is this the result of a procedure that’s inhumane and brutal? Look at this. My patients are all grateful to me. And it’s in a way like for me, encapsulates just some of the weirdness of the whole episode and how confusing it is to try to understand what Walter Freeman thought he was doing. Because I really do think that he thought that he was fixing people and there were some people who did interpret what he had done to them or members of their family as a positive change. And he could never get his head around the idea that people didn’t see it that way anymore.

Rachel Star Withers: That’s a very powerful thought that, yeah, he saw it one way and all of the Christmas cards, the photos that he documented, and then, of course, I’m sure the actual people themselves. But then when you contrast it to the fact that his last lobotomy, the woman died and

Miriam Posner: Mm hmm.

Rachel Star Withers: So many people who became severely impaired, it’s very interesting when you think about

Miriam Posner: Yes.

Rachel Star Withers: The extremes of the lobotomies, how it worked out for everyone.

Miriam Posner: Yeah, nothing is ever black or white, and there are so many strange stories that still surprise me that pop up.

Rachel Star Withers: Given this kind of very dark area of schizophrenia treatment in the past, I know a lot of people could use this to not want to get psychiatric help today. Tell us your thoughts on that.

Miriam Posner: Well, I mean, they’re right that it’s a really sobering episode in the history of psychiatry and in thinking back about it and what it means to me today, one of the lessons that I hope that psychiatry has learned is that judging people’s mental health by their ability to integrate into mainstream society is actually really dangerous because there are a lot of reasons someone might not fit in. And to assume that they can’t fit in because something’s wrong with them is really damaging. And I think there has been a turn among psychiatrists to look at how patients themselves define health for themselves and to understand that mental health may not look the same for everybody and it may not look like psychiatrists want it to look for everybody. So the lesson is actually, I think, pretty simple, if difficult to actually realize. And that’s but you have to listen to patients, like you have to understand what their goals are, what their definition of health for themselves is. And you have to respect that for them, living a fulfilling life may look different than what we want them to think.

Rachel Star Withers: Is there any media that you suggest that you think really shows this treatment and is a good thing for laypeople like me to watch, to understand more?

Miriam Posner: There is a radio documentary called My Lobotomy, which is a long interview and a series of meditations by a guy named Howard Dully, who is still alive today and is one of the last people on whom lobotomy was performed. It was performed on him when he was a teenager. He talks about the experience of getting a lobotomy and how it still affects his life to this day. And it’s a really powerful documentary. And he also has a book that’s called My Lobotomy that is equally effective and moving. There’s a documentary, too, that’s called The Lobotomist that focuses more on Walter Freeman, the biggest cheerleader for lobotomy. What was going through his head? Why was he so convinced that lobotomy was the way to go? And talks a little bit about the context in which he was performing these procedures. Those are really good ways to get acquainted with how lobotomy was conceived of at the time.

Rachel Star Withers: Thank you so much for speaking with us today, Dr. Posner, about all this, so much good and bad when it comes to looking back over the different treatments for severe mental disorders just over the past hundred years alone. How can our listeners learn more about you and your work?

Miriam Posner: They can certainly check out my website, which is, and I have a lot of materials about lobotomies there and a blog where I sort of talk about what’s preoccupying me now. And they can always get in touch with me on Twitter, too. My handle is @MiriamKP, and I’m always really interested to hear from people particularly who have experience with the mental health system and can help me understand what their experiences are like.

Rachel Star Withers: Awesome, thank you so much for speaking with us today, Dr. Posner.

Miriam Posner: My pleasure.

Gabe Howard: Rachel, she was awesome and I’m super glad that she agreed to be on our show. What was your biggest takeaway after speaking to Ms. Posner?

Rachel Star Withers: I enjoyed this interview so much. I enjoyed her so much, I think because she wasn’t the doctor, she wasn’t one of the typical psychiatrists that I had originally reached out to. She definitely came at this with a different viewpoint. And that was kind of interesting to see, you know, someone who wasn’t directly in the psychiatric community as a patient or as a doctor, counselor or whatever, to be able to say, look, this is my views of what happened over this time. It was very refreshing and it was different the way she spoke about things than I would say any other guests we could have picked.

Gabe Howard: I would agree with that. Her understanding of history was very commanding. You think you understand because everybody’s talking about it. But as a researcher, she just had this other level that I thought was very, very interesting.

Rachel Star Withers: Yes. Should we look into becoming digital humanists or is it too late?

Gabe Howard: I did not know that that was a thing, but she explained it well and it’s understandable. I think this is another example of how modalities and research and life moves forward. I mean, digital humanist wasn’t a thing 50 years ago, but it is now and it’s understandable how we got here. And I think that’s very analogous to where we are with the treatment of schizophrenia. There is trauma in our past. There’s a lot of trauma. And I do think that we need to do more to address that trauma. The general attitude is, well, we were doing that for your own good. Well, we were trying to help. And I do think that we need to openly discuss mistakes that were made so that we can have more buy in that these mistakes won’t happen again. I do think that she did an excellent job of making sure that people understood the history of this particular schizophrenia treatment and where we’ve come from. And I think that’s overwhelmingly positive.

Rachel Star Withers: When I asked her final thoughts about advice for seeking treatment for schizophrenia. I kind of meant it as like, you know, a closing type kind of squishy question. And when she responded, it kind of threw me off because she spoke to psychiatrists in her response and about the definition of health. I was just like, oh, OK. I thought she would be like, oh, the medical community has come so far, blah, blah, blah. But no. And that was kind of it made me think because I’m like, well, that was weird that she spoke to them. You know, I clearly would have spoke to other people with schizophrenia, I think most doctors and whatnot when we have them on the show, that’s who they speak to and loved ones. But from delving into all of this research about how schizophrenia treatment has evolved, my main takeaway is that it is a story about the medical community. It’s a story about individuals who shaped how schizophrenia was perceived and how it was to be managed. It’s not a story at all about the patients. It’s not even a story about schizophrenia in general. So much of what I found when it comes to the coma therapy, ECT, lobotomies, it all related to the physical aspects of what was done, and so many cases of abuse and all of the doctors and researchers and neurologists who came up with these things.

Rachel Star Withers: I never found anything that was, oh, water therapy was found to calm the symptoms of psychosis and schizophrenia and helped the patients regain a physical feeling of reality or patients of schizophrenia found an easier treatment that insulin therapy because they didn’t have to be injected with harmful chemicals. That’s not what was worded. And I feel that that’s what’s missing. You know, I don’t care as a schizophrenic who came up with the idea of sticking an ice pick through the eye. Lobotomies were successful 50% of the time, and some patients with schizophrenia voluntarily got multiple lobotomies, up to four. My question is, what made these patients want to go through it again? And I think as people who have schizophrenia and loved ones and the medical community, I think that’s really the important part. It’s people seeking to get better and learning to focus more on what helps these people, not just what calms all the people down and makes them controllable. I think it’s going to be a question that hopefully we’ll always be answering as we continue to evolve our treatments. I’m Rachel Star. Thank you so much for listening to this episode of Inside Schizophrenia. Wherever you downloaded this podcast, please subscribe. Also, take a moment to rate, rank and leave a written review so other people know why they should listen too. We’ll see everyone on the next episode of Inside Schizophrenia.

Announcer: Inside Schizophrenia is presented by, America’s largest and longest operating independent mental health website. Your host, Rachel Star Withers, can be found online at Co-host Gabe Howard can be found online at For questions, or to provide feedback, please e-mail The official website for Inside Schizophrenia is Thank you for listening, and please, share widely.

The post Inside Schizophrenia: Evolution of Schizophrenia Treatments first appeared on World of Psychology.

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Date: 9th December 2020 at 15:04
Author: Psychcentral – psychology – Rachel Star Withers


A third of all people will be a caregiver at some point in their lives. Caregiving for people with schizophrenia presents challenges that many people are ill-prepared for.

Host Rachel Star breaks down the principles of caregiving and creative ways to navigate schizophrenia.

Dr. Sarah Kopelovich joins to share schizophrenia caregiver specific training.

About our Guest

Sarah Kopelovich, PhD is a forensically-trained licensed clinical psychologist in the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine. Dr. Kopelovich is an Assistant Professor in the department and holds the Professorship in Cognitive Behavioral Therapy for psychosis. Her current research is specifically oriented toward implementation and dissemination strategies for psychotherapeutic and psychosocial interventions for Schizophrenia Spectrum Disorders. She regularly conducts workshops, seminars, and professional consultation across the country for an array of mental health professionals and trainees in CBT for psychosis; Recovery-Oriented Cognitive Therapy; Individual Resiliency Training for First Episode Psychosis; Assertive Community Treatment; and diagnostic, suicide, and violence risk assessment.

Back to Life, Back to Normality: Volume 2 -outlines many of the cognitive-behavioral techniques used in the Psychosis REACH training.


Computer Generated Transcript of “Caregiving for Schizophrenia” Episode

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

Announcer: Welcome to Inside Schizophrenia, a look in to better understanding and living well with schizophrenia. Hosted by renowned advocate and influencer Rachel Star Withers and featuring Gabe Howard.

Sponsor: Listeners, could a change in your schizophrenia treatment plan make a difference?  There are options out there you might not know about. Visit to find out more about once monthly injections for adults with schizophrenia.

Rachel Star Withers: Welcome to Inside Schizophrenia. I’m your host, Rachel Star, here with my wonderful co-host, Gabe Howard. Gabe, now it sounds at first like we have a very squishy, lovey-dovey topic. Caregiving, right. I could feel like just the title of it. It sounds like a nice Hallmark movie kind of thing going on. But we’re going to get into some kind of, I don’t want to say deep, but intense stuff with it. We’ve talked before, Gabe, we feel strongly about that word being used towards people with mental health problems.

Gabe Howard: Caregiving is universally thought of only in the positive, but as folks are going to learn, even very positive things can have a flip side.

Rachel Star Withers: And right off the bat, I don’t like the term caregiver because it automatically puts that person kind of over the other one. So if my mom is my caregiver, then obviously she has to take care of me for whatever reason. I’m not able to. I’m sick. I’m inferior. You know, there’s a problem somewhere, which is true in it, but it does, it just kind of that mentally puts it out there. And, you know, Gabe, I gush all the time about my parents. They’re absolutely wonderful. And I cannot live on my own. It’s hard for me to have to accept that on some level that they are my caregivers, because that means I’m a burden to them. And I know they would never describe it that way. But it makes me feel bad as a 35 year old grown woman that I do have to depend on somebody else.

Gabe Howard: So here’s sort of the issue with caregiver, right? It becomes all encompassing. Let’s say that tomorrow you get in, we’re going to use car accident and for the purposes of this analogy, you’re going to recover. But in the car accident, you break both arms and both legs. Now, that’s like pretty high level caregiving. Nobody would argue that you need care and that the person doing it is your caregiver. But in that analogy, remember I said you’re going to make a full recovery. Eventually you start getting use of your body parts back. First your hands work and then your arms work and your family or your caregiver starts doing less and less and less and less and less. And in physical health, people acknowledge that. People acknowledge that you’re needing less assistance and less help. Over on mental health, it doesn’t matter if you are the worst of the worst, the sickest of the sick, or if you are Rachel Star and all you’re really doing is just living in your parents’ basement, hanging out. It’s talked about in exactly the same way, and I think therein lies the problem. Right? Because now when people say, oh, Rachel, your parents are your caregiver, they immediately assume that you are the worst of the worst and have no partnership, no control, no faculties. And you are not assisting in your own care.

Rachel Star Withers: And I also think whoever they’re talking to, like this third party, they automatically feel sympathy, like you poor thing, you have to deal with this, you poor thing. And I don’t want to say, like as the person who has the issue, like, I get jealous, but it’s also like, OK, well, they’re not the ones who are hallucinating.

Gabe Howard: We have more sympathy for the people next to the person with schizophrenia than we do for the actual person suffering from schizophrenia. And could you imagine if somebody said, oh, you know, Rachel has cancer, but the real people suffering are her family, like everybody would just be up in arms

Rachel Star Withers: Oh, yeah.

Gabe Howard: And not tolerate that. But if you say, well, you know, Rachel has schizophrenia, but the real people suffering are her family people immediately they’re like, well, but I mean, they’ve gone through a lot. It can’t be worse for them than it is for you, Rachel,

Rachel Star Withers: Yeah, to make it clear for everybody, when we were saying caregiver today, we’re not talking about the doctors, nurses, that kind of thing, we’re talking about the kind of normal day to day stuff. So a caregiver, they could be paid but most caregivers are unpaid members that are related or in the social circle of the person who is needing care. Usually our caregivers don’t have any professional training. We have a wonderful guest today who’s actually going to talk to us more about caregiver training. The majority of caregivers are women. I think with a lot of women, you already have that kind of motherly role and they’ll usually be the first to step up to be the caregivers. Typical duties, this is all little things, OK? Daily activity stuff is what caregivers do. They manage medications, making sure that you’re taking your medications, you’re taking them correctly. They may talk to the doctor or nurse or whoever on your behalf.

Rachel Star Withers: With schizophrenia, what we need might change. So caregivers, when it comes to schizophrenia, may or may not have to help with like cleanliness, that kind of thing, making meals, making sure that the person is eating healthy, not just eating Pop tarts nonstop. So right now, there’s around 50 million family caregivers nationwide in America. Fifty million people. That’s so many. And if you were to pay them, in theory, it would be around three hundred and six billion dollars. So these family care like you are worth a lot of money. To my people that are out there listening, it is a thankless, usually moneyless job. And a third of us, a third of all people will have to be a caregiver at some point in their lives. But you also have to take into account the person and you need to make sure that they are still feeling respect and dignity. No one wants someone telling them what they can eat, what they can’t eat. OK, this is what you’re going to do today. Like nobody wants their whole life controlled by somebody else.

Gabe Howard: And nobody wants to be seen as less than. Oftentimes, people experiencing schizophrenia don’t have that level of respect to balance out the burden. We just have the burden. That’s a lot to overcome, to be seen by society as hurting our families in addition to managing schizophrenia. That’s, that’s big. That’s, that’s mighty big. We don’t want to hurt our family. We love our families. And we are incredibly thankful for everything that they’re doing for us. We just want to make sure that we’re not lost in that discussion.

Rachel Star Withers: If you are a caregiver for someone who, like you said earlier, has a broken bone, if you’re a caregiver for someone who is elderly, you kind of know what to expect. But with schizophrenia, it’s not that predictable. The caregiver of someone who has schizophrenia, you have to be on the lookout for other things. One of the biggest is going to be medications and side effects. If the person that you are helping also has depression, you really need to kind of watch out for suicidal tendencies, kind of signs that this person might not need to be alone. This person might need to have their medication changed up. And the side effects I know, Gabe, and you’ve seen me do my little dance here, but I have tardive dyskinesia where I shake and there’s just a lot of side effects that can affect people with schizophrenia differently, it’s not predictable. With those medications, and we had a previous episode about this, it opens you up to being vulnerable for more diseases. So, for instance, diabetes is a huge risk if you have schizophrenia. If you’ve ever been on any antipsychotics, you do tend to put on weight very frustratingly quickly. So caregivers need to kind of watch that. And I’ll be honest, Gabe, I don’t like the idea of someone telling me what I can and can’t eat.

Gabe Howard: Well, right, because you’re an adult and you need to make your own decisions and let’s take this at a base level like a human dignity level, if you are not choosing your own meals, your own food, if somebody else is making that basic decision for you, how much wellness do you actually have if you don’t even have the autonomy to choose what you put in your own mouth, what you eat for sustenance and meals?

Rachel Star Withers: Another thing that changes with schizophrenia versus other types of disorders, diseases, et cetera, is the cognitive ability, disorganized thoughts. Sometimes, and it’s so hard to explain when people ask me about this, but sometimes, like, I’ll forget something very simple, like, how to zip up my jacket? It’s just like the piece is gone and you can have a full conversation with me, I’m fine. But then I’ll go to do something. And I’m like, oh, no, how do I do this random thing? And I’ll get confused. That’s what caregivers have to watch out for with schizophrenia. Like, I don’t need anyone to help me dress. I don’t need anyone to come over and pick my clothes out for me. But then some days I get confused and I can’t remember how to do something. And just throwing this out there, my way around that is that I lay out my clothing ahead of time and I always have a backup set with no fun things like zippers and things. Schizophrenia isn’t predictable. Gabe, a few weeks ago, I had a really bad psychotic episode and I haven’t had one this bad in way over a year, 99% of the time, I don’t need help.

Rachel Star Withers: I hallucinate and I have little delusions and things, but I’m able to manage it myself. I usually don’t even tell anyone. But this was different. And when it happened, I became very scared. I knew I did not have a grasp on reality. I couldn’t get my phone to work. I was trying to text my mom who was upstairs, and I couldn’t seem to text. I couldn’t remember how to text. I was like fighting my phone. I don’t know if I was texting the right person couldn’t put words together and somehow I got in the kitchen. Eventually, my mom, she did get some of the text messages. She came out, got me and stayed with me the rest of the night. That was very scary. And I’m very lucky that she was there to step in. Again, this is once a year that she had to do that. But we don’t know when that once is. She may have had to, like, be up early for work or something the next morning. So taking care with schizophrenia, it’s very unpredictable. And it’s kind of like you’re on call, like you’re ready to help if the person needs help in this way. But most of the time they might be OK.

Gabe Howard: And obviously, that can be frustrating for all involved, I mean, who wants to be on call? You’re going about your day, you’re doing what you’re supposed to do and then boom, right in the middle of it, this thing happens that you have to be 100% for your loved one and that you want to be 100% for your loved one. And hopefully your loved one realizes what you’re doing and they need help. And that’s why I think that it is extraordinarily important to make a plan when you’re well. You know, one of the things that that Rachel does well and that we’ve talked about in this whole podcast series is she doesn’t just talk about schizophrenia with her family when she’s in crisis or when she’s hallucinating, when she’s having a problem. This is a continuous conversation that they have even when she’s completely well. The analogy that I like to use is it’s like having a fire drill when the house is on fire. But the best time to install smoke detectors and the best time to have a fire drill is when your house is not on fire. It’s very much the same in schizophrenia. And I think a lot of caregivers miss this. And in fairness, a lot of people living with schizophrenia, they miss it, too. We want to believe when everything is fine that it’s going to stay fine. And we just want to focus on the here and now and not make a plan for what happens in the event that things go a different way.

Rachel Star Withers: So many of these caregiver relationships, like my own, is parent, adult child and mothers out there, a lot of you just kind of don’t step in to caregiving. You just step into mothering, just taking over like you did when they were five. And that’s where a lot of the tension comes from. ‘Cause I’ve talked to so many mothers who are just overwhelmed with trying to help their adult child and don’t know what to do. And part of it is you’re trying to do too much. You need to acknowledge what the person with schizophrenia can and can’t do. Like, I would much rather just bring someone food and be like, eat it, then say, OK, well, let’s work out the plan. You’re going to cook this, not, you know, I get it. That’s like more work. It’s totally easier to just dominate over someone and make all the decisions. But you can’t. Gabe, so I have a friend around in his 30s, but he has schizophrenia and he lives with his parents and he’s on disability and they’re constantly fighting because his parents take all of his disability money and he doesn’t like that. He’s like, that’s my money. And I was like, well, if you were out on your own, you would still have to pay for rent, groceries, utilities, etc. So I do believe that they are entitled to some of that because you’re using those things. I don’t think they should take all of it. But when they do give him money, he immediately spends it on alcohol, gets drunk. I don’t know, Gabe. What are your suggestions? Because I know so many people that get caught in like, what do we do? We’re stuck in this circle and don’t know how to get out of it.

Gabe Howard: In this scenario that you’re given, both sides are right, the family needs the money for the expenses that the person living with schizophrenia is generating. We can’t ignore that. But we also can’t ignore that the disability check is this person’s. It’s in their name and they feel like they’re not being given a choice. They feel like their money is being stolen. But then again, let’s go back to the other side. They feel like, well, when I give that person the money, they make dangerous choices. You know, buy alcohol, and especially in the case of, you know, the family dynamic, if this person uses alcohol, it interferes with the meds. They have a crisis. This crisis affects the whole family. So when taking a look at everything, these are very difficult things to resolve because the reality is, is both sides are right and both sides are wrong. This is where it’s really important to understand that. I call it negotiating in good faith. If you have this idea in your head that the other side is wrong and you’re right, you’re not negotiating in good faith. And I’m speaking both to the caregiver side and the side of people living with schizophrenia.

Gabe Howard: And that also points to a larger problem, which those two sides are often at odds. They’re often looking at each other as heroes versus villains when in actuality you’re neither of those things. That’s very important. These things get resolved in any number of ways, whether it be by compromise, whether it be by walking a mile in the other person’s shoes, whether it’s understanding. So often, caregivers don’t think that they’re the ones that need to seek mental health help. They don’t think that family therapy is needed because after all, they’re this big, strong caregiver. It’s only the person living with schizophrenia that needs help. It’s vital that you understand that if something is contributing to the mental health decline of the household, it means that the entire household needs mental health help. And so often people think, oh, well, I’m not as sick as my loved one with schizophrenia, therefore I don’t need any help. Don’t think of it that way at all.

Rachel Star Withers: And you have to know what you can and can’t do. Most people have to work full time. OK, so we get this. This is almost like a second job or maybe a third job for many on top of your life. And it becomes intense. Family members are awesome because they’re usually the main support system. Whenever you’re making that decision of should the person with schizophrenia live with you, there’s actually I like this. It’s a little chart, Gabe, I have here, but it says

Gabe Howard: I love charts as well.

Rachel Star Withers: I know, but it says, living with your family and you have schizophrenia works best if you are high functioning and you can still maintain friendships and activities outside of the home, meaning I’m still able to go to a part time job, volunteer work. I still have friends I talk to. It’s not just me and my parents and that’s it. Another is that the relationship around the family is relaxed. You know, if you always have a lot of tension with a certain family member, it’s going to be a lot worse when you add in schizophrenia and then living together. You want to make sure that there are other support systems. Again, you can’t do it all yourself. We’ve talked about NAMI and different things, support groups, at the doctor asking them. Make sure as the caregiver that you’re not all the person with schizophrenia has and make sure this last one here that the living situation is not negatively impacted, if there’s young children in the home, by the person with schizophrenia, children come first. Always make sure they’re protected and everything. I’d say for the most part, my family has, they fit all of those.

Gabe Howard: Ok, Rachel, but along that same vein, what things are immediate disqualifiers? Like living with the family is not advised if what happens?

Rachel Star Withers: Well, one, if the caregiver is single, ill or elderly, that’s going to be really hard. You know, someone in their 80s is going to have a very hard time helping out with someone with schizophrenia. That’s just the truth of it. If the schizophrenic is very low functioning, if they pretty much they need more help than you can give them. So when I say high functioning, low functioning, what I mean is I’m usually considered a high functioning schizophrenic, meaning that for the most part I’m good for, let’s say, two weeks I could live alone. But after that I get weird and I have, like, little spurts of times when I’m going to need a lot more help. But I’m high functioning. Low functioning would mean I need a lot more help, more supervision. I need someone kind of stepping in my life, helping me make important decisions, helping me with my money, etc.

Gabe Howard: Makes sense. Understood.

Rachel Star Withers: You shouldn’t be a caregiver for the person in your family if it’s causing stress on your marriage, if your life is in shambles, you can’t help anybody else. I can’t stress that enough. And you’re going to hate that person you’re trying to help because you’re like, oh, well, I’ve lost my marriage. I’ve lost my job because of this person. It’s going to impact you both negatively. You just have to accept that you cannot do everything.

Gabe Howard: And I think that’s really the key. What we want to point out is that doing something about it doesn’t necessarily mean that you personally do it. It could be a matter of getting the person to the right care. For example, we’ll go back to the car crash scenario that I gave. I am not an EMT. I am not a trauma surgeon. I don’t know how to set a bone. So if that happens to my friend Rachel, the best thing that I can do for her, of course, is call 911 and get her the help. In mental health, we have this tendency to do just the opposite, to say, oh, I’m going to pick you up, Rachel, and we move her from the car accident, we start doing all kinds of damage because we’re unaware. Sincerely, ask other family members to pitch in, call friends, call the local charity, schedule an appointment with a therapist, find out what you can do. And honestly, by listening to this podcast, you’re already starting that process. You’re looking for hints and tips of how you can be better. Again, I really feel the need to be clear. Me calling 911 one for Rachel in the car accident analogy is me doing a hundred percent of what I can do and ensuring that Rachel has the best possible outcome. We need to start thinking that way in mental health rather than thinking, OK, well, I have to fix 100% of this because after all, I love my child, friend, family member, etc.

Rachel Star Withers: So, Gabe, we’ve really been a downer up until this point,

Gabe Howard: And we don’t mean to be

Rachel Star Withers: We don’t mean to, but we have all these problems we discussed. How do we fix them? One of the best things you can do is set out rules or make it very clear as the caregiver what is expected of you and as the person receiving care, what is expected of them so that, you know, if you’re overstepping your bounds. Make sure that the person receiving care has to give something too. All right? It’s not just like take, take, take. Now, it could be little things. It could be. You know what, hey, if you’re able to vacuum, if you’re able to handle the groceries, but make it clear that this is a partnership, it’s not just one person completely depending on the other. You know, what you can and can’t do might change over time. For the most part in my family, I buy a lot of like the groceries and things like that. I like that I’m able to provide food, make food and things because it makes me feel that, hey, I am contributing to the household. It’s not just me living in the basement, creepily skulking around the house, taking everything and not giving back.

Gabe Howard: I really like what you said about little things really matter, you know, I have a, I have a pseudo kid in my life. I have a granddaughter and they’re a young family. They’re in their early 20s. They have a two year old. They don’t have a lot of money. They’re just starting out in life. They just bought a house. Long story short, whenever we go anywhere, I pay 100% of the time. I buy dinner, I buy the putt-putt tickets, I put gas in the car because I can afford to do so. The other day, my daughter in law bought me a Diet Coke. She showed up at the house. She was running errands. She had to drop something off. And when she pulled in, she handed me a Diet Coke from my favorite place. Straw and all, exactly how I like it with the light ice. It cost her a dollar. That meant a lot to me, an incredible amount, and it meant a lot to her because she got to give back in some small way. And, you know, there was hugging. You have to understand that those things are very, very powerful, breaking that analogy into the caregiver relationship with somebody living with schizophrenia.

Gabe Howard: Find out what that is. Because it empowers the person and it gives you that hope and positivity to move forward as the caregiver. So often we’d rather just sit and think, well, I pay for everything. Well, I do everything? Well, they don’t help at all. Find those, I’m going to call them little Diet Coke moments. If you have this idea that you’re always going to be the caregiver and that they’re always going to need help and that they’re never going to contribute, you create a self-fulfilling prophecy.

Rachel Star Withers: And so many times when someone does have to move back home or need care, they’re recovering. They’re recovering from a very bad psychotic episode, or maybe they’ve just fully been diagnosed as having schizophrenia and they’re going through that. So make sure that you have goals of where do I want to be in a year? If your goal is to live on your own, and right now you can’t. If the caregiver is too overprotective and just taking over my life, I will never get to that point because I won’t know how to stand up on my own. You did it all for me. So make sure as you find objectives to help with that, as a caregiver, you know when to step back. As the caregiver, you need to watch out for some things in your own life. There’s actually something called caregiver syndrome, and that is when you’ve just kind of you’re burnt out. And you can get burned out on a job, lots of things in life, but you’re burnt out of caring for a person. And that manifests in exhaustion, anger, rage, depression, anxiety and even physical things. High blood pressure, diabetes. This is all stuff we talked about earlier. Gabe, this is like, you’re trying to help someone else with these exact same problems and now you have the problems.

Gabe Howard: Yeah, you can’t pour from an empty cup. I know that it’s a cliche, but if you are not well, what support are you providing? Sincerely, Rachel, would you want help from a person who was sleepless, scattershot, angry, frustrated, confused, annoyed? Is that the person that you want to show up to provide you what, in some cases, could be life-saving care?

Rachel Star Withers: I do not, Gabe. The stress there. Can you imagine now if I’m living with that person and it just never ends? You’re going to have to learn as a caregiver to step back, take a vacation, even if it’s just like little mini vacations during the day. Really cool. I actually was talking with this family and they had a young teenage son. He was diagnosed with childhood schizophrenia. And so he had been on antipsychotics for quite a while. And they’d definitely affected his weight. And the parents were just pretty much, they were at their wits end. You know, they’re doing so much trying to help their child. And now on top of that, they’re worrying about his weight gain.

Rachel Star Withers: So what happened? The uncle stepped in. The uncle decided that he was going to start working out with the young man. And it was kind of cool. You know, you got the cool uncle. The pressure wasn’t there. They would go out, he’d pick them up, they’d go and they would do some physical activity every single week. For one, that gave the parents a chance to take a little break from having to worry about the son, but also gave the son a social outing. And it made him feel like this isn’t something I have to do. I’m getting to spend time with my fun, cool uncle. And I love that. And that’s something like if you’re able to incorporate that, look around. If there’s other family members, be like, listen, I’m already doing this, this and this. Is there any way that you could help with one of these things? If one of your family members likes to cook? Yo, like, maybe you could make a little more. Maybe you could come over and show, like, find ways to give yourself a break as a caregiver. You can also look into assisted living situations like that. You know, don’t think that you have to do everything. Get help when you need it.

Gabe Howard: I think a lot of people are experiencing stress in the time of corona, so it’s very important to understand that no matter how hard your family dynamic tries, external factors out of your control can change things. And the whole point of this is this is why it has to be an ongoing conversation and an ongoing partnership between all the parties. Otherwise, you’re not going to be nimble enough to survive when things happen. Now, obviously, I don’t think anybody saw a worldwide pandemic coming, but nevertheless, people with schizophrenia are also managing a worldwide pandemic, as are the people who love them.

Rachel Star Withers: And we’ll be right back after a message from our sponsor.

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Rachel Star Withers: And we’re back discussing schizophrenia and caregiving.

Gabe Howard: Rachel, you got to spend time with Dr. Sarah Kopelovich, who is an assistant professor, and has done a lot of research on caregivers. She taught us things like compassion fatigue, and it was very, very cool. I loved hearing your interview. So let’s go ahead and play that now.

Rachel Star Withers: We’re here speaking today with Dr. Sarah Kopelovich, who is a licensed clinical psychologist, and she’s also an assistant professor who has been doing a lot of very interesting research into schizophrenia spectrum disorders. And today we have been talking about caretakers and the role that they play in helping different people with schizophrenia. Doctor, tell us about your research and how it deals with caregiver training.

Sarah Kopelovich, Ph.D.: Sure. So my primary area of expertise is in psychotherapeutic interventions for people with schizophrenia spectrum disorders and other forms of serious mental illness. I do a lot of work trying to increase access to these evidence based psychotherapies. And the kind of frontline intervention in that realm is cognitive behavioral therapy. In trying to increase access to cognitive behavioral therapy for psychosis, how do we leverage other members of the treatment team and the natural support team so that we can really take an all hands on deck approach to helping people get access to good quality skills that can help them cope better with the symptoms of psychosis? There is a model called Psychosis REACH, which was developed by Dr. Douglas Turkington, who also happens to be one of the co developers of Cognitive Behavioral Therapy for Psychosis that teaches family members cognitive behavioral therapy concepts and skills so that they can have more therapeutic interactions with their loved ones. We have now piloted an eight hour training in May of 2019 and it was a huge success. So we found that just through a one day training, we were able to improve the well-being, so in other words, depression and anxiety, scores of the family members who attended that one day training and there was no other intervention involved. It was just that one day in person training, correcting myths and misconceptions about psychosis, providing background, and how can cognitive behavioral therapy help improve your life and well-being and depression and anxiety? And then how can you use these skills and concepts to improve relationships with your loved ones? So we’re really excited about these preliminary findings and we’re continuing to provide this training to family members in the coming years. Now, virtually, of course.

Rachel Star Withers: That’s really amazing. So it’s just a one day training as of right now?

Sarah Kopelovich, Ph.D.: This is a one day training and it is outside of any mental health clinic. We know that our national schizophrenia treatment guidelines recommend that the care team is providing family intervention for psychosis, but unfortunately, that’s just not playing out in practice. Only about two percent of families in the United States who have a loved one with serious mental illness are receiving any kind of family intervention for psychosis. So our goal was to take this out of the clinic. And I was able to do that because I was very, very fortunate to receive philanthropic support. So we offered this training to anyone. We provided financial support for travel and lodging. We brought them all together in a beautiful space, catered and just really communicated to families you’re valued. We care about you and we want you to learn. We know you’re doing as well as you can. We want to help you do even better.

Rachel Star Withers: So why is caregiver training important?

Sarah Kopelovich, Ph.D.: Well, we know that for a long time now, families have been in the shadow of the mental health system in our country. I talked about how 98% of the time families are not brought into their loved one’s mental health treatment, and this is contrary to the overwhelming evidence. Research shows that if we can support families appropriately, we can save money, we can save relationships and we can save lives. We spend three hundred billion dollars annually on costs associated with serious mental illness. And much of that comes from hospitalization costs. Which it just so happens that family interventions like caregiver training, one of the strongest outcomes that we see for this intervention is reduced hospitalization rates and reduced number of days in the hospital. In terms of saving relationships, there’s this really interesting study about 10 years ago out of Delaware. They just asked people living in the community with a schizophrenia spectrum disorder, do you feel alone? And 90% of the people that returned a survey said yes. And yet it’s also true that 90% of individuals with psychosis are in close contact with at least one family member. Psychosis can be a terribly isolating experience. So you can be surrounded by people, and by very well intentioned people, and feel so utterly alone. And we can change that. We can help get the relationship back on track. We can improve quality of life. And then, of course, that brings me to that last point, which is that family interventions like caregiver training can save lives. So one third of people with schizophrenia will attempt suicide and one in 10 will die from suicide. When you ask about why caregiver training is important, it’s about saving families and saving lives. It’s about giving family members a very different message than they’re likely receiving, which is that they should expect recovery. That’s what the data supports, is that most people who experience a psychotic episode will experience wellness, will experience recovery, and families need to hear that.

Rachel Star Withers: Very nice, I agree on that. When I know most people hear caregiver, we tend to think of someone taking care of like an older family member. When my grandfather and my grandmother both had Alzheimer’s, I remember we kind of had to do a little caregiver training, but it really had nothing to do with the mental. How is your type of caregiver training different than, let’s say, dealing with someone who’s in their 90s like we were?

Sarah Kopelovich, Ph.D.: Yeah, well, so first I want to clarify that I’m using the term caregiver quite broadly to refer to anyone who identifies as a support person. So that could be a biological family member, a significant other, a friend. And in terms of how it differs from other kinds of caregiver training, I think the domains in terms of what it’s trying to accomplish are actually more similar than they are different. If you are the loved one or the support person of somebody who’s experiencing an episodic or potentially episodic condition, then there are some basics that we need to help you to do. One is to have accurate information about the diagnosis and to be realistic and also hopeful. And with schizophrenia and other forms of psychosis, there’s a lot to be hopeful about. Despite all the doom and gloom you might confront on the Internet or in even peer reviewed journal articles, there’s a lot of progress that is being made in the realm of psychosis, recovery and treatment. Family members need to hear that. Otherwise, they’re going to go do a Google search or they’re going to talk to a family member that has their own anecdotal experience, and it might not be positive. Right? But there’s a lot to be positive or hopeful about. Family members want and need connection with their professional care team, but also that connection with other caregivers.

Sarah Kopelovich, Ph.D.: And that’s across conditions. And then finally, I think they want resources and skills training. How do I, how do I help? What helps? And what makes things worse? They want to know what can I manage at home and what will the professionals be doing to help my loved ones recover? And then on the flipside, what in the home environment might be counterproductive to my loved one’s recovery? And what kinds of treatments might be unhelpful? There are more similarities than there are differences. But when we get a little bit more granular, a little bit more detailed, that’s where we start to see differences within the Psychosis REACH training and other kinds of family interventions. We’re going to be giving psycho education, obviously, about psychosis. We’re going to be really defining some boundaries for a training so that when we teach you these skills, our goal is not for you to do psychotherapy with your loved one. Right? That is not indicated, nor is that within your skill set. It’s really about helping you to apply some of these skills to yourself in your own life so that you could be more effective with your loved one.

Rachel Star Withers: When you’re doing these different trainings or you’re speaking with loved ones, support givers and whatnot, what are some of the common problems that they bring up to you?

Sarah Kopelovich, Ph.D.: My colleague, Maria Monroe-DeVita, conducted focus groups before we started the Psychosis REACH training and these focus groups were across the state of Washington with families who had had a loved one hospitalized for a psychotic episode. And what these families disclosed can really be boiled down to two things. They wanted skills to manage their loved one’s illness. And they said that they wished that they had had someone, and they were referring to another family member, appear to tell them, this was my experience. This is what you can expect. Here’s what worked for us. There’s something incredibly powerful about connecting with other people who have walked that path before. And then they also wanted to know things like how do I respond when my loved one is experiencing a delusion? How do I help them when the voices get really intense or really degrading? They’re referring to things like coping skills, problem solving skills, communication skills. So that’s exactly what Psychosis REACH teaches them. How do you help? What do you do in those situations? And then also how do you know when to back up? Because we also need to make sure that we are meeting people where they’re at and kind of know when to tactfully withdraw from the situation.

Rachel Star Withers: How can your loved ones know when they need to tactfully withdraw or maybe kind of step back from a situation?

Sarah Kopelovich, Ph.D.: So it’s really important to know that we cannot progress from a place of conflict. Sometimes things can escalate quite quickly or unpredictably, and you find yourself in a situation where now people are yelling. And so that’s not a therapeutic interaction, right? That’s a situation where we need to actually withdraw. You know, this is a bad time. Let’s come back to this another time. Or shift topics, right? Hey, I’m wondering if you caught the game last night. I missed it. Can you fill me in? Falling back on the relationship, going to neutral topics, getting back on the same page with your loved one. Hey, I know it’s really important to both of us that you stay out of the hospital and I can see you’re feeling really unsafe right now. What can we do to help you feel safe in this moment?

Rachel Star Withers: So many times, including my own situation, you have a support person or caregiver that’s a parent, and the person that they’re supporting is their own child, an adult child with a serious mental disorder. Not only do you have the stress of the parent child, but with that added schizophrenia and psychosis. Can you speak on that?

Sarah Kopelovich, Ph.D.: Sure, it can be a really tricky balance, right? You have a parent who wants their child to be well and can feel quite helpless and might be concerned for their well-being, for their safety, for what’s happening with their school. Are they going to get so off track that they’re going to have implications for their future? And then you have a young adult who is appropriately going through this process of separating from the parent and individuating, really becoming their own person, independent of their parent’s aspirations, their parent’s thoughts and ideas. It can feel quite stifling for the young adult to now have a parent who is taking care of them, who’s asking them about their medications. Who’s asking them about whether they’ve gone to their therapy appointment. That’s part of what we try to do with the Psychosis REACH training is to create a different dynamic. How do we change that dynamic that has started to unfold with the diagnosis or with the onset of the disclosure of the symptoms so that we don’t have so much stress and tension in the home? And this is really coming from a key finding in the psychotherapy literature where we see that that therapeutic relationship is the key to positive outcomes in therapy. So we work with the family members to identify shared goals. What’s important to you and what’s important to your child? And the way to get to those goals might be different. And usually it is, right? Usually they can both be on the same page about the fact that they want to be healthy and to kind of get back to the things that matter to them.

Sarah Kopelovich, Ph.D.: But the parent thinks that the way to do that is to take this set of medications and to throw themselves back into life as usual. And the child thinks, well, when I smoke marijuana, that’s what helps me, right? It’s not these other medications. But the goal is the same. How do we take that goal and work from there? How do we help them activate positive emotions by thinking about positive memories, by having other things that they connect about outside of just the illness. And so when we can redevelop that healthy relationship, then we can progress to other kinds of skills, like inquiring curiously. So asking and not assuming, asking good quality, curious, open ended questions about your child’s experience, about their perspective, about what they want. We can teach parents to not fear their child’s experience. A lot of that concern and that tension that’s happening is coming from a place of fear. If we can tell parents actually voice hearing is a really common experience. And there are a lot of voice hearers all over the world. And here’s what we know about what leads to distress in some and not in others. Then they feel a little bit calmer. They feel a little bit less anxious about what their child is going through. And then we can help them work on the higher level skills as well, like trying out different skills together and getting feedback.

Rachel Star Withers: Very interesting. A large part of our audience is caregivers and the support people, family that are all around different people with schizophrenia. What do you have to say to all of those people?

Sarah Kopelovich, Ph.D.: What I want to say is it’s not your fault. That if you feel like you’re not doing enough or you feel like your child or your loved one isn’t getting enough, that it’s not your fault. And psychosis is nobody’s fault. That needs to be the first message right out of the gate. Psychosis is nobody’s fault. We have a lot of wishes for behavioral health system transformation, and we know that the system isn’t doing as well as it could be to help meet their needs. So I have training in dialectical behavior therapy as well. And one of the principles of dialectical behavior therapy is this assumption that we’re doing the best we can and at the same time we can do better. That’s the message I tell myself every day. That’s the message that as a policy advocate, as a mental health professional, I communicate to mental health providers and administrators. And that’s what I share with family members as well. You’re doing the best you can. And when we know better, we can do better.

Rachel Star Withers: It’s very interesting that you said that one of the main important things is that it’s not your fault. That was just kind of really struck me because in my own situation with my parents being my main support system, I do think it comes up a lot. And I would say that for other people with schizophrenia and their support system, that our family. Yeah, that’s a big thing is did I cause this? Did I give this to my child? Did something happen under my watch to my child to cause this? And I hear that a lot. As far as like, did something traumatic happen? This is very interesting. That’s one of your main points, you’ve got to accept right away that it’s not your fault. That just when you said that, it really struck me that was very powerful.

Sarah Kopelovich, Ph.D.: Absolutely, the more we know about psychosis, the more complicated that picture becomes, because it’s really not this simplistic model of how you’ve got this set of genes, then you’re going to develop schizophrenia. There are a lot of contributors to psychosis. We used to see psychosis as this really uncommon, abnormal state. Psychosis is far more common than we used to know. And across cultures. There are the schizophrenia spectrum disorders are one kind of set of causes for psychotic experiences. But there are a lot of people who have psychotic or psychotic like experiences who don’t have a mental health diagnosis. There is not a clear formula for this, but what we do know is that it’s not any one thing.

Rachel Star Withers: It’s a very powerful point that. Definitely helps a lot of different support people out there who are listening to hear that. So how can caregivers find training?

Sarah Kopelovich, Ph.D.: In my mind, the place to start is the National Alliance on Mental Illness, NAMI is the largest mental health organization for families, been around since 1979, and it’s really become a leading voice on mental health. What NAMI provides is both a way to connect with other families and also they provide their own set of education and resources to family and caregivers. And because they are such a large organization, there’s a good chance that you’re going to have a local NAMI chapter in your region. I find their trainings are a really nice base for families who are just beginning their journey supporting a loved one with psychosis. A lot of their educational programs will teach you about some of the common terminology. They’ll talk about different treatment options for different disorders. And then a lot of families will find that they’ll benefit from more specialized training. For loved ones who struggle with a family member who doesn’t agree with their diagnosis, which sometimes gets referred to as poor diagnostic insight or something called anosognosia, for those families they might find a specialized training program is helpful. And the LEAP Foundation, which is directed by Dr. Xavier Amador, can be really informative and helpful. They have a number of offerings, a number of different trainings that they’re now offering virtually.

Sarah Kopelovich, Ph.D.: It’s kind of the silver lining to the dark COVID cloud is that so many of these trainings are now being offered via distance learning. The LEAP program uses principles and techniques from motivational enhancement therapy or motivational interviewing to really target communication patterns and to improve relationships for family members who are looking to learn concrete coping and problem solving skills and to dive deeper into their understanding of psychosis. They can sign up for the Psychosis REACH training. We had our first training back in May 2019. We got a little off track because of COVID, but we are offering now our second training. It’ll be our first virtual Psychosis REACH training. We’re really excited because of the philanthropic support that we’ve received for this training, I’ve been able to get the leading expert on CBT for psychosis, a psychiatrist named Dr. Douglas Turkington, who co developed CBT for Psychosis and Psychosis REACH, and he’ll be leading the training. And then in May 2021, we have another training that will also be virtual that folks can pre register for. They can go to to learn more and to preregister.

Rachel Star Withers: Sarah, and I understand you have some different books that you can recommend.

Sarah Kopelovich, Ph.D.: Sure, Dr. Turkington and Dr. Spencer have written a book called Back to Life, Back to Normality: Volume 2, and this outlines many of the cognitive behavioral techniques that we’re teaching to families in the Psychosis REACH training. So I highly recommend that one. That’s been a big asset to the families who’ve gone through our Psychosis REACH training in Washington. And then I have a book chapter coming out next year in 2021. It’ll be in a book published by the American Psychiatric Association called Decoding Delusions Advanced Psychotherapy Practices for the Clinician. And I’ll have a chapter in there called Supporting Families Caring for Someone with a Delusion. I will also go through the Psychosis REACH training key points.

Rachel Star Withers: Well, thank you so much for sharing all of that with us today. I know that you have definitely helped a lot of our listeners who are support family and caregivers. I know my mom, I’m definitely going to have her listen to this and check out the books and the REACH program that you spoke about. Thank you so much for joining us today on our show, Sarah.

Sarah Kopelovich, Ph.D.: Thank you so much for having me. It was so nice to be here.

Gabe Howard: Rachel, a great interview, as always. What was your main takeaway?

Rachel Star Withers: It really kind of threw me during our interview when she said it’s not your fault. I don’t know, like why that struck a chord with me, but it just kind of maybe like, I guess, peacefulness almost. You know, caregivers, a lot of times it’s a family situation. You need to know that stuff going on, a lot of it’s out of your control. You didn’t cause it. And the same thing for people like me who have schizophrenia, you didn’t pick this. This is just something you got that you have to learn to deal with. But you didn’t do anything bad. You didn’t do anything wrong. And that’s not something that we tell ourselves very much, Gabe. I think it’s easier to blame yourself for everything, whether you’re on the caregiver or the receiver end of that.  It’s easy to be like, well, you know, this is all happening because I can’t work anymore. This is all happening because this person’s lazy. But you know what? A lot of this stuff, it’s no one’s fault. We just got to figure out how to deal with it. That gave me peace.

Gabe Howard: I can certainly understand why. When you start blaming people, you expect those people to fix it. If I say this is Rachel’s fault, well, then I can just sit back and do nothing except be angry that Rachel is not fixing it. And the reality is, is if it’s nobody’s fault, then that gives Gabe and Rachel an opportunity to work together to assess the situation, find the problem and fix it. And the fixing it is what we want. I’m angry because I’ve blamed Rachel and she’s not fixing it. That manifests itself as me being angry at Rachel, but in reality, I’m mad at the problem that’s not being fixed. And I’m placing the blame not on the problem, but on an individual. That spoke to me a lot.

Rachel Star Withers: Absolutely right, Gabe, and a lot of this keeps coming back to one thing, communication. Make sure that whatever the situation is between the caregiver, the care receiver, talk, make a plan, define the roles, what is expected of each person and reexamine them depending on if I’m doing better, if I’m doing worse. If I don’t need you to help me get dressed, don’t do that. All right. However, I could be sick one day and I haven’t showered in a few days, and you might have to help me. So be up front, reexamine the roles, know what’s required of each person. That way you don’t have to, like, step on toes. And to my fellow schizophrenics, check in, let people know how you’re doing. I’m really bad at this, OK? I won’t tell people I’m having a hard time until it’s really, really bad. And I don’t need to do that. I need to speak up. But it’s awkward sometimes. Just to be like, oh, hey, just so you know, I’ve been hallucinating a lot. I don’t know, I’m bad about that. But we need to step up, you know, let the other people know when you need help or especially if there’s signs that you notice that you’re going into a psychotic episode. Give them a heads up. Hey, by the way, this has been happening a lot. If you could just kind of watch me a little bit closer. We all need caregiving in some way during our lives, you know, we need to take care of each other, whether you are a family member or a close friend or even a neighbor or let’s say you signed up for a program and this is a stranger and you’re stepping up. That’s awesome. But know that you’re appreciated and make sure to treat each other with dignity and respect. I’m Rachel Star. Thank you so much for listening to today’s episode. Like, share, subscribe, pass it around to all of your friends and we will see you next time here on Inside Schizophrenia.

Announcer: Inside Schizophrenia is presented by, America’s largest and longest operating independent mental health website. Your host, Rachel Star Withers, can be found online at Co-host Gabe Howard can be found online at For questions, or to provide feedback, please e-mail The official website for Inside Schizophrenia is Thank you for listening, and please, share widely.

The post Caregiving for Schizophrenia first appeared on World of Psychology.

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Date: 28th October 2020 at 14:41
Author: Psychcentral – psychology – Rachel Star Withers


Do your feelings about a romantic relationship or your partner change significantly when it’s over? In today’s show, Gabe talks with researcher Aidan Smyth who conducted a study probing people’s feelings about their relationships — both during the relationship and after it was over.

What’s your experience? Do you recall your ex with fondness, indifference or negativity? And which of these emotions are best for moving on? Join us to hear the science behind feelings in romantic relationships.



Guest information for ‘Aidan Smyth- Relationships’ Podcast Episode

Aidan Smyth is a graduate student in the Psychology department at Carleton University who studies romantic relationships, mindfulness, and goal pursuit.





About The Psych Central Podcast Host

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

Computer Generated Transcript for ‘Aidan Smyth- Relationships’ Episode

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

Announcer: You’re listening to the Psych Central Podcast, where guest experts in the field of psychology and mental health share thought-provoking information using plain, everyday language. Here’s your host, Gabe Howard.

Gabe Howard: Hello, everyone, and welcome to this week’s episode of The Psych Central Podcast, I’m your host Gabe Howard and calling into the show today, we have Aidan Smyth. Aidan is currently a graduate student in the psychology department at Carleton University. His area of study focuses on romantic relationships, mindfulness and goal pursuit. Aidan, welcome to the show.

Aidan Smyth: Thank you very much, Gabe.

Gabe Howard: Aidan, you’re here today because you conducted a study that had some surprising results and garnered you some national attention. In a nutshell, you discovered that people’s feelings about their romantic relationships, both past and present, aren’t based on fact at all, but more how they feel in the moment. Can you tell us about your study and what specifically you were looking to discover?

Aidan Smyth: Sure. So this work was inspired by a fairly large body of research that suggests that for better or worse, we aren’t always as accurate as we might like to believe when it comes to the way that we think about our partners and relationships. For example, our perceptions of our relationships can be quite subjective and are often biased by our hopes and our goals. So assuming you want your relationship to work out, you might tend to see it through rose colored glasses, so to speak. For this particular study, my colleagues and I, Dr. Johanna Peetz and Adrienne Capaldi, we were interested in what happens to people’s perceptions of the relationships after a breakup when they may no longer be motivated to see it in the best possible light and in fact may even be motivated to see it in a negative light. Specifically, we were interested in whether or not people who had recently experienced a breakup would show a bias in the way they remember their former relationships. And we wanted to see if they would recall them as worse than they actually said that they were while they were still dating.

Gabe Howard: How did you find people who were in a relationship that they described as good, got them to break up and then asked them if they saw the, because that’s like right where my mind went, right. Like, it seems like in order to do this research, you had to find a happy couple and then follow them around until they broke up and then said, hey, what did you think of that relationship? Just to see. But I’m not a researcher, so I imagine that’s not how you did it.

Aidan Smyth: You know, that’s not a bad summary, actually. The study design was quite simple. We basically did recruit people who were in romantic relationships and we asked them how satisfied they were in those relationships. And then we waited a few months with evil grins on our faces, I suppose you could say, at which point we contacted them again. And a quarter of the sample had experienced a breakup at that point. And so at this point, we asked those individuals how satisfied they had been a few months earlier while they were still dating their now ex-partner.

Gabe Howard: And you found out that the information that they gave when you contacted them the second time was wildly different than the information they gave you the first time.

Aidan Smyth: Yes, after a recent breakup, people thought that they hadn’t been as happy as they actually had been, and they also recalled their former partners as less compatible than they actually had originally said that they were. So essentially, they recalled their past relationships as worse than they actually were, or at least worse than they said that they were while they were dating. Interestingly, it didn’t seem to matter how long they had been in those past relationships for

Gabe Howard: And just to clarify, when you first met these couples, they said we’re happy with each other. She’s great, he’s great, we’re happy, we’re dating. Everything is hunky-dory. They’re the one. And then after they broke up, it was, oh, I always knew that this wasn’t going to work out. I was miserable every day and I saw it coming. Is that sort of the answers that you were getting the second time around?

Aidan Smyth: There’s certainly a little bit of that going on, and I guess one thing to highlight would be that the people who ended up breaking up did in fact report less satisfaction in their relationships than the people who ended up staying together over the course of the study. So there was a difference even at baseline there at the start of the study in terms of how satisfied people were. But, yes, then after the fact, we did see some inaccuracies in terms of the way that they recalled their past relationship.

Gabe Howard: On one hand, it doesn’t surprise me that when you’re in a relationship, you would describe it as positive and I know putting a research modality on it or anonymity. I’m assuming that you didn’t interview them together. You interviewed each participant separately.

Aidan Smyth: Yes, so and it actually wasn’t even couples that were included in the study, it was individuals who were in romantic relationships. So,

Gabe Howard: Gotcha, gotcha.

Aidan Smyth: Yes.

Gabe Howard: So it doesn’t surprise me, again, not a researcher, that when you’re in a relationship, you would describe it positively. There’s a little bit of self-protection there, right? I mean, if somebody sat me down and said, Gabe, are you happy with your relationship? And I was like, no, I’m miserable and I hate it. That doesn’t make sense. There’s like a protective quality that’s like, no, of course not. I love her. We’re working hard. I can see using positive language like that, even if I had reservations. Did you notice sort of a read between the line language, even in the positivity, or was it just straight up happy?

Aidan Smyth: The way that we actually measured sort of their levels of satisfaction in the relationship was actually just with questionnaires. So we weren’t doing interviews with these individuals, which would be interesting to do as well, though. And I think you’d pick up on a lot more of the descriptors that you’re talking about there. But we looked at questionnaires and looked at the way their scores changed when they rated their relationship satisfaction and partner compatibility.

Gabe Howard: And what did you find out? What was the bottom line of all of this at the conclusion of the study?

Aidan Smyth: Basically, the bottom line was that people they were inaccurate in the way that they recalled their former relationships and essentially thought that they had been significantly less satisfied than they actually said they were while they were still in those relationships.

Gabe Howard: And if I understand correctly, you also found out that a lot of people realized that they didn’t hate their exes as much as they thought they did, and hate’s a strong word, maybe, maybe dislike? Weren’t as miserable did. Was that a flip side as well?

Aidan Smyth: So this is what we found, I’m not sure if the participants would acknowledge this or that they were aware of this,

Gabe Howard: Fair enough.

Aidan Smyth: We didn’t directly look into this in the study. But one possibility is that this finding could have to do with the fact that our memories of the past are often colored by the way that we feel in the present. Given that a breakup is often accompanied by a lot of emotional distress, these difficult feelings may sort of get in the way of people’s ability to recall their former relationships accurately and instead may lead them to remember them as worse than they actually were. Another possibility is that this type of bias might actually help people cope with the breakup and start to move on from that former partner. We know from past research that the way people think about their ex-partners is quite important when it comes to getting over a breakup. For example, thinking fondly of an ex has been associated with continued attachment to that partner, preoccupation with the former relationship and, ultimately, worse recovery from the breakup. And I guess it’s worth noting that this can also be problematic for the person’s subsequent relationships as well. Other research shows that recognizing the shortcomings of an ex-partner can help with adjustment and recovery after a breakup. And in fact, some researchers argue that people are unable to get over a breakup until they fundamentally change the way that they view their former partners and relationships. So to bring it back to this particular bias, if someone is no longer available to you as a romantic interest, then a bias towards viewing them in a slightly more critical light might actually provide some reassurance and comfort and reduce those feelings of regret.

Gabe Howard: Just to clarify, it sounds like your study has shown that people just are completely inaccurate in the way that they recall past relationships.

Aidan Smyth: It’s important to note they weren’t completely inaccurate when it came to the way that they recalled their past relationships. For example, it wasn’t as though they said they were absolutely head over heels in love with their former partner. And then after the breakup, they recalled that relationship as absolutely awful, although I suppose that is possible and could be the reality for some individuals. But yeah, they generally weren’t completely derogating their former relationships. It was more so that on average, they recalled them as slightly worse than they actually said they were while they were dating. And in that sense, it’s possible that after a breakup, people simply remove the rose-colored glasses and are no longer seeing that relationship in an idealized manner.

Gabe Howard: But isn’t that healthy, isn’t it good to really see somebody for who they are?

Aidan Smyth: Yes, I mean, these types of biases, it can be sort of a little unsettling almost to learn about them for the first time. And the idea that perhaps we’re not as accurate as we like to think in terms of the way we think about our partners and feel about them. But some researchers do speculate that these and similar types of biases are actually an important feature of a healthy and satisfying relationship. And often we see in past research that these types of biases are associated with greater relationship satisfaction.

Gabe Howard: Thank you so much for explaining that. I guess I need to understand, when are people in the best position to evaluate the quality of a relationship? Is it when they’re in the middle of it or only after they’ve broken up? Because obviously, if the best position to evaluate is after they’ve broken up, nobody in a healthy, happy relationship can ever get a true read on what’s going on.

Aidan Smyth: This is a really interesting question and one I’ll admit from the get go that I certainly don’t have the answer to, but it’s interesting to think about because there’s sort of this implicit assumption that we’re probably going to be more accurate in the way that we think about our relationships while we’re actually in them, as opposed to once they’re over and some time has passed. To give a poor analogy here, if you are eating a sandwich and I asked you how enjoyable that sandwich was, I would probably trust your answer now a lot more than I would if I were to ask you again a few months from now when this sandwich was over.

Gabe Howard: I like it.

Aidan Smyth: So, relationships are admittedly more complicated than sandwiches, but we know from a large body of research that when we’re in a relationship, we are prone to a number of biases that may lead us to view our relationships in that idealized manner rather than a more objective manner. Essentially, we’re motivated to see them as good, that we’ve got a great partner, we’ve got a great relationship, and therefore we’ll probably play up some of the positive aspects and downplay some of the more negative aspects. On the other hand, after a breakup, it’s possible that we’re motivated to do just the opposite. And we might want to believe that our former relationships were never really that great all along, because it probably isn’t exactly comforting to think that your past relationship, which ended for whatever reason, was absolutely fantastic and you’ll never find another one quite like it. So essentially, it seems as though we may be prone to biases on both sides of the breakup. And I think it remains an open question as to when we’re in the best position to evaluate them objectively.

Gabe Howard: What did you find in regards to people who stayed together? I mean, obviously you said 25% broke up,

Aidan Smyth: Mm-hmm.

Gabe Howard: Which means 75% were still going strong.

Aidan Smyth: Mm-hmm, an interesting finding, so our research showed that people who stayed in the same relationships over the course of the study also showed some biases or inaccuracies in the way that they thought about their relationships. These people thought that at the end of this study, their relationships had significantly improved over the past few months, even though no improvement had actually taken place. They said that they were significantly happier in their relationships at the end of the study than they recalled being at the beginning, even though they had been just as happy at the start.

Gabe Howard: Why do you think that was? Why do you think people thought that the relationships improved when in actuality they just stayed stagnant? I don’t mean, I don’t mean stagnant in any bad way.

Aidan Smyth: Mm-hmm.

Gabe Howard: Just as somebody who’s been married for almost a decade now, I’m fond of saying boring is healthy. There’s no drama. We know each other. It’s all fine. But I understand why young people are are like, man, I don’t, I don’t want to be that guy. I get it. But at the same time, that is what a healthy relationship looks like. There’s no gossip. It’s just there.

Aidan Smyth: Mm-hmm.

Gabe Howard: Why do you think they’re seeing this when in actuality they’re, I guess, boring? Is that, is that the word to use?

Aidan Smyth: Well, I think this type of a bias could also sort of reflect that idea of seeing the relationship through rose colored glasses and that it may be helpful to think of the relationship as continuing to improve or get better over time. And by downplaying or derogating the past, we’re able to do this. This bias might sort of reflect a mechanism that allows people to maintain a positive view of their relationships as time goes on. And it also probably sort of helps to fend off some of those ideas that you just mentioned about stagnation or the possibility that your relationship is getting worse over time. This type of a bias would sort of help protect against that and probably be a little more appealing. I guess I’ll also note that other research has found that we do this on a personal level as well. So, for example, there’s a study that showed that college students recalled their past selves more negatively on a number of characteristics like self-confidence or their social skills compared to how they had actually rated themselves a few months earlier. So essentially downplaying the past basically seems to be one strategy that we use to make ourselves feel better about ourselves and our relationships in the present.

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

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Gabe Howard: We’re back with Aidan Smyth discussing his study about relationships and our feelings. What are some other biases that you found existed in romantic relationships?

Aidan Smyth: Sure, so there’s a large body of research, and I think even some of your former guests have probably spoken about these types of things as well. One of the biases that I’ve alluded to a couple of times here is the idea of seeing our partners through rose colored glasses or in an idealized manner. What I mean by that is there was a study that essentially found that people tended to describe their partners in a manner that more closely resembled their ideal partner rather than their partners’ actual attributes. So there’s some nice empirical evidence for the phrase love is blind, I suppose.

Gabe Howard: I understand from a research standpoint why facts matter. I get it. But romance is, it’s I know why we research and it’s fascinating. But what you just said there kind of appeals to me, this idea that I accentuate my wife’s positives and I push down and ignore her negatives and that just lets me love her so much more. I’m, of course, fond of believing that in order to sustain a healthy marriage with me, you have to do that. Like that’s yeah, you got to. But sincerely, I think anybody listening to this would think to themselves, why is science messing with this? You think the best of your romantic partner and you, you know, kind of give them a pass on the worst. It sounds like a bias is almost helpful, but I imagine it can go too far.

Aidan Smyth: So there’s a lot there and a lot of great things to think about, I think.

Gabe Howard: Isn’t it good to accentuate the positive and diminish the negative, the very first thing that I thought when you said that is, I was like, yeah, that’s like any 20-year-old that said, hey, I’m getting married. What advice do you have? And I’d be like celebrate her positives, ignore her negatives. Like, that’s, you know, if she snores? Yeah. Downplay that. She, you know, is always a half an hour late getting ready? Yeah. Downplay that. But if she’s cheating on you, you need to have like real facts. So where, when is it good to have the rose-colored glasses on and when is it important to take them off?

Aidan Smyth: So that’s a good question, and I think there is some truth to that idea, and I think that’s even reflected in some of this other research that shows that these biases can be helpful and are often associated with greater satisfaction in our relationships. Now, with that being said, I do sort of wonder about a similar question that you seem to be alluding to here, which is, is knowing about these biases helpful? For example, is it helpful to know that your relationship may not have actually improved over time, even though you thought that it did? Or is it helpful to know that your relationship may not necessarily be better than your friends’ relationships or less likely to result in a breakup? On the one hand, I’m sort of reminded of the phrase that ignorance is bliss. And on the other hand, I’m reminded of a Nietzsche quote that I think goes something like, you can measure the strength of a person’s spirit by how much truth they can tolerate. I like to believe that knowing about these biases can be helpful in the sense that perhaps it’ll allow people to recognize that their relationships aren’t perfect. And that’s OK. It’s OK that their relationships aren’t perfect. And another possible benefit is for people that are in the early stages of a relationship. This sort of research might prompt them to potentially pay attention to red flags that come up rather than sweeping them under the rug. Perhaps this could save them a lot of stress and heartache in the long run.

Gabe Howard: Humans are biased. We have biases everywhere we look and the more research that’s being done and the more we learn about our culture and society, we realize that we have biases that we’re completely unaware of. I don’t want that to go unsaid. But this show is specifically about romantic relationships. And one of the things that I think about is the bias we have when relationships are new. I call it new relationship energy. Whenever I am in a new relationship, whether it’s a friendship, a business relationship or a romantic relationship, everything is amazing and exciting and new. And I have this bias to essentially chase this dragon of awesome because it’s so exciting and it’s not boring. It’s unique. And I don’t know that I coined the term new relationship energy, but I think it’s a well understood concept that all romantic relationships are great for a week. Aren’t we ruining that? Because that week is awesome. When should you make sure that the bias is understood? I guess the thing, Aidan, that I keep thinking about and maybe I’m a hopeless romantic, maybe I’m middle aged, maybe I’ve watched one too many rom-coms, but I think about the excitement of new relationships and frankly, how ridiculous they are. I would hate to think that relationships are going to come down to scientific questionnaires. And why can’t it just be fun for a while? But I’m also aware that people get involved in relationships that are destructive and codependent and dangerous and they carry those out for long terms. Where’s the balance?

Aidan Smyth: A great question, I think that’s going to sort of boil down to the personal level, and I think it really would depend on the individual and how much of these sorts of uncomfortable truths they feel that they can tolerate, I guess, and.

Gabe Howard: Maybe don’t let people move in on day one, but also don’t run their credit?

Aidan Smyth: Yeah, I think those are two great pieces of advice.

Gabe Howard: There’s sort of a quote that’s bumping around in my mind that says Trust in God, but lock your car. And if we apply that over to romance, I think it’s OK to love love. It’s OK to get carried away. It’s OK to be excited. But maybe don’t give the person the key to your house on day one. Don’t do the Dharma and Greg and get married and, you know, fact check. Remember that there is a bias and sort of apply that as you move forward. Enjoy the moment, but don’t make any long-term decisions, is maybe the advice that comes to mind. What was it like for you personally doing this study? Because whenever love comes up, people have generally very strongly held beliefs that have little to do with science and a lot to do with their grandmothers and then their parents’ marriage and their grandparents’ marriage. As your study proved, the history of our romantic relationships plays a large role into how we feel about romantic relationships moving forward. What were the conversations in your group launching this study?

Aidan Smyth: So I guess one thing I would say is that I certainly was very surprised when I first learned about all these types of biases, because it can be sort of quite uncomfortable or almost threatening to think that you didn’t see a former partner or a current partner as accurately as you might have. Over time, though, I think learning that this isn’t necessarily a bad thing and that people need to get up in arms about that provided me with a little bit of reassurance, I guess. But it certainly prompted me to reflect on past relationships and the way that I think about them now. And I try to sort of take the perspective of how I might have felt at the time, although these are difficult things to do.

Gabe Howard: Aidan, what’s the takeaway? What do you hope that society learns from your research?

Aidan Smyth: One thing I’ll point out right off the bat is I don’t think this is a green light for people to run out and get back together with their exes. That’s not what we’re trying to say with this research here. But I think it sort of gives us the chance to reflect on our past relationships and potentially see them in a new light as valuable experiences. And maybe over time, people can get to a place where they do actually recognize that they did enjoy their time with these people and that they probably did serve them in their lives moving forward.

Gabe Howard: Just for our listeners, please keep in mind that there was a final sample size of 184 participants. Roughly half of these participants were undergraduate students, the average age of the entire sample was about 27 years old, and 60% of the sample were female, 65% Caucasian. We just want to make sure that you have all the facts because research is limited and what conclusions can be applied to humanity as a whole. 

Aidan Smyth: Absolutely.

Gabe Howard: All right, thank you so much, Aidan, for being here. We really, really appreciate it.

Aidan Smyth: Thanks for having me, Gabe.

Gabe Howard: You’re very, very welcome. Hey, everybody, my name is Gabe Howard and I am the author of Mental Illness Is an Asshole and Other Observations. It’s available on Amazon. Or you can get signed copies for less money at my website, I’ll even throw in show stickers. We have a super secret Facebook page, Check it out. You can hang out with me. And if you really like the podcast, where ever you downloaded it, please subscribe, please rate, please rank and please review. Remember, you can get one week of free, convenient, affordable, private online counseling any time anywhere simply by visiting We’ll see everyone next week.

Announcer: You’ve been listening to The Psych Central Podcast. Want your audience to be wowed at your next event? Feature an appearance and LIVE RECORDING of the Psych Central Podcast right from your stage! For more details, or to book an event, please email us at Previous episodes can be found at or on your favorite podcast player. Psych Central is the internet’s oldest and largest independent mental health website run by mental health professionals. Overseen by Dr. John Grohol, Psych Central offers trusted resources and quizzes to help answer your questions about mental health, personality, psychotherapy, and more. Please visit us today at  To learn more about our host, Gabe Howard, please visit his website at Thank you for listening and please share with your friends, family, and followers.





The post Podcast: Relationships and Rose-Colored Glasses first appeared on World of Psychology.

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Date: 28th October 2020 at 14:40
Author: Psychcentral – psychology – The Psych Central Podcast


For too long, Western psychology has explored psychopathology without much inclusion of the positive aspects of being human, which may leave us with a bleak or stern view of psychology. Fortunately, being interested in wellness, personal growth, and positive psychology is a growing trend.

In an attempt to explain things simply, there is often a distinction made between positive and negative emotions. Positive emotions are considered to be pleasant feelings such as joy, pleasure, love, gratitude, or contentment. Negative emotions may include anxiety, anger, sadness, loneliness, fear, or other uncomfortable or undesirable feelings. 

While there is no consensus about how to define well-being, is often explained as the presence of positive emotions and the absence of negative ones. This is a simple way to differentiate between what uplifts us and what unsettles us. But there’s something about this simplistic view that unsettles me.

If we divide emotions into positive and negative ones, it creates a dualistic view of our human emotions. If we believe that some emotions are negative, it’s almost impossible for our human psyche to not want to eliminate these “negative” emotions and hold on to the “positive” ones. As a result, we’re likely to set up a tension in our psyche. We try to cling to what’s pleasant and develop an aversion what’s unpleasant. According to Buddhist Psychology, it is this very clinging that creates suffering in our lives. This is not a formula for finding joy and well-being.

There are no emotions that are bad or negative, but rather ones that are sometimes uncomfortable, unpleasant, or difficult to face and feel. If we want to enjoy more uplifting emotions, we don’t get there by pushing away, denying, or avoiding the unpleasant ones. We only get there by creating a friendly space for the full range of our human experience. The path toward inner peace and wholeness requires that we find peace with the full range of our emotions rather than trying to get rid of the ones we consider unsavory.

Befriending All of Our Feelings 

Since we are wired with the fight, flight, freeze response, it’s not surprising that our tendency would be to push away feelings that we experience as threatening to our well-being. Fortunately, there is also something in us that can relate to our experience in a more calm and measured way. We have the capacity to bring mindfulness to whatever we happen to be experiencing, whether pleasant or uncomfortable. 

One key to well-being is to honor and accept ourselves as we are. This means making room for our human experience just as it is without judging ourselves. In Eugene Gendlin’s Focusing approach, what helps us to create a shift in our inner landscape is move toward holding unpleasant experiences in a gentle, caring way. Gendlin called this approach the “Focusing attitude.” It is an attitude or orientation of kindness and friendliness toward whatever we’re experience inside.

The next time you notice feelings such as sadness, anxiety, shame, or hurt, notice how you relate to these feelings. Do you tend to push them away? Do they feel overwhelming? Before reacting or shutting down your feelings, try taking a moment to get grounded. Perhaps feel your feet on the ground or look at something pleasant in your environment. Take a few slow, deep breaths. 

When you feel grounded, see if you can bring some gentleness to what you’re noticing in your body. If it’s a feeling you don’t want to get close to, see if you can keep that feeling at some distance from yourself; maybe it’s ok to feel some part of the difficult feeling. If not, then just notice how scary or uncomfortable this feeling is. You don’t have to go into it. Perhaps you can come back to it later if you want, or work with a therapist who can help you explore it.

By viewing feelings as pleasant or uncomfortable rather than positive or negative, you might be more inclined to welcome them and explore them rather than cling to them or try to get rid of them. Unpleasant feelings tend to pass as we make room for them rather than seeing them as an enemy. Loving yourself means allowing your feelings to be just as they are. And we could all use a little more self-love.

The post The Fallacy of Positive and Negative Emotions  first appeared on World of Psychology.

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Date: 28th October 2020 at 14:40
Author: Psychcentral – psychology – John Amodeo, PhD

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