You’re reading a transcript of the Mental Health Download from the nonprofit Mental Health Association Oklahoma.

On today’s episode, we’re going to give you highlights from day 1 of the Zarrow Mental Health Symposium keynote sessions. 

First up, let’s hear from Esmé Weijun Wang. She is an author and advocate for ambitious people living with limitations. Her essay collection, “The Collected Schizophrenias” is a New York Times bestseller. Her keynote challenged the audience to expand their view of what recovery and resilience really means.

We’ll start with Esmé giving a wonderful overview of not only her speech, but, really, her mission as a mental health advocate dedicated to breaking down the stigma of mentall illness...

So we're going to be opening the Symposium with some stories and we're going to talk about some big ideas and you're going to hear me tell bad jokes and hopefully open our minds to learning about one another's minds. And so I'm going to talk about three main things. I'm going to talk about stigma, different forms of stigma and how toxic it can be as well as how embedded it is, not only in our culture, Western culture, American culture, but also in other cultures. And then No. Two, I'm going to talk about the fight against stigma, which I believe we're all engaged in, as well as how that relates to resilience and self-advocacy and how that can fight other difficulties that go with a mental health diagnosis. And, finally, I'm going to talk about hopes and dreams and how your jobs are a way to carry other people's hopes and dreams for them when they can't do it themselves. And how that's such an important thing to be able to do. And such a special job and gift.

In this next short section of Esmé’s speech, she talks about what life was like before people knew she had a serious mental illness and how she tried to hide it from her friends and co-workers...

I've been living and working in the worlds of mental health and illness for a while now and I'm often asked, "So what is it like to disclose to people that you have this diagnosis of schizoaffective disorder?" I gotta say it is different now that I have a book out that is all about my life with schizoaffective disorder. But before the information used to come months or even years into new friendships. I would often have jobs that would last for years without my coworkers ever learning that I had a psychotic disorder. That time in my life was really stressful. It was stressful because I didn't know when, if ever, would be the appropriate time to come out about having a serious mental health diagnosis in my personal life, in my work life and my school life.

This next section of her speech focused on the power of words to change the way regular ordinary people view mental health.

We live in a society though that frequently throws around words like skitzo and psycho and crazy. And that's one small thing we can do, right? We can say "ridiculous" instead of "crazy" because that's often what we mean when we say that was totally crazy. We can try to catch our verbal habits in order to prevent ourselves from reinforcing the fact that pop culture portrays mental illness as something to fear rather than something that our loved ones might be dealing with or that we might be dealing, something that pop culture portrays as something coming from our worst nightmares and certainly not something that we can thrive with. We can catch when other people do the same thing. It's hard to speak up when other people are doing the talking, but in our communities, we can speak up and say, "Oh, do you mean that something, that thing, is ridiculous or, you know, "wild," not "crazy?" I thank you in advance for doing this.

In this next section, we find Esmé in 2013, when she had been experiencing a psychotic episode for for 10 months and she was about to quit her full-time job because she couldn't hold down that job anymore.

I went to see my psychiatrist and she told me that because I tried every atypical anti-psychotic on the market, I had what was known as medication-resistant schizoaffective disorder.

She told me that I had a very low likelihood of ever reaching 95% or 90% again in my life. I left her office sobbing, really sobbing and hopeless. There are times in life when we are terrified because the forecast for the future is just really, really bleak. If it were meteorological, it would say natural disaster. I'd say they are because I think these times in all of our lives are unavoidable, as much as we would like to think that they are. These times when we wonder how we are going to get through and how we're going to survive. So I was crying and crying and I left her office and I'm heading toward the elevators. And the security guard in the psychiatry department stopped me and I feel like as the security guard for the psychiatry department at a big HMO, seeing a crying woman running to the elevators is not that weird. But he stopped me and he said, "Are you okay? Okay. What happened?" And I told him a short version of what it just happens. Well, he said, and he was a very big guy, "The doctors don't know everything. Are you a writer?"

I was really surprised by that because how could he know that I was a writer? And I said yes. And he said, "Go home and write about this. Six years later, "The Collected Schizophrenias" debuted at No. 3 on the New York times Bestseller List. But I couldn't have imagined that on that day. All I could do was keep going, which is its own kind of resilience. I'm so grateful to my psychiatrist. I am so grateful to my therapist and I am so grateful to everyone who has helped me just survive, including the security guard who I gave a thank you card to the next time I saw him. And I never saw him again. So, finally, I will say this, No. 3, one of your biggest jobs when you work with people who have mental health issues is to help them keep going. If at all possible, on top of that, to keep dreaming, too. And when they can't do that, to keep dreaming and hoping for them.

This next story is such a powerful message for mental health professionals.

I went to give a couple of talks at the Chinatown mental health clinic in San Francisco a few years ago. And the first talk was fine.

It was very easy. It was in front of a bunch of Chinese and Chinese-American people who had been diagnosed with schizophrenia and they'd been meeting in this group for years and years. And I gave them a talk about stigma and it went very well. I was very comfortable. I felt like, you know, they were my people so to speak. But the second meeting was in front of clinicians, kind of like this, but much smaller. I'm downstairs in a different room and this room was bright and it was clean and the clinicians started to wander in, men and women in business casual, and they found their seats and they stared. There was one man in the back, he was kind of glaring at me and I really focused in on him. But it was true that everyone made me nervous, not just the guy in the back who was glaring at me because there something about being in front of all of those clinicians.

It took me back to my first inpatient hospitalization when a group of psychiatrists and social workers and psychologists would make their daily rounds through the ward and check in to see how we were doing. It's been hard for me ever since to shake the anxiety I have in front of clinicians because there's kind of an imbalance of power when you're in an inpatient ward. During my first hospitalization, I learned that clinicians control when inpatients get privileges, like going downstairs for a meal, getting a 10-minute smoke break, et cetera. And it was my team of clinicians who decided when I would get to go home, you know, so I would get to do the whole like I'm fine, I'm okay things. So when it was time to give a talk to the clinicians of the Chinatown mental health clinic, it was very determined to make sure that they thought that I was a well-functioning member of society.

I tried and just sound confident. I didn't want to be the crazy person giving a talk, even though I was definitely the crazy person giving a talk. I worried that they were bored. I'm pretty sure that the guy in the back was actually bored. I made sure to mention what schools I'd been to and what jobs I'd had. When it was over, I was so relieved and I was so glad that I could go home. But this one woman stopped me before I could leave. She thanked me for coming to the clinic and for giving my talk and she said, "You know what? It's hard working with these people. At first you have so many hopes for them and then they get sick and relapse and then they get better and then they get sick again and happens over and over until a lot of the time you lose that hope. Having you come today reminded me that it's important to keep hoping for them."

OK, we’re going to close out our Esmé highlights with my favorite portion of her speech, where she explains why she inspires her Twitter followers with the most beautiful messages of hope.

And I've mentioned that there's a thing that people associate with me. The um, "keep going, you're doing great." But there's another one that people probably associate with me even more than that one. I didn't even realize it was happening until I went on tour. So the standard outline for a book tour event is you read from the book and then you have a moderated conversation and then you get to Q&A and then you do the book signing.

And then as I traveled around the country, and even when abroad doing events, I learned that as much as people appreciate the new book, weirdly, they also appreciate something else -- my good morning tweets on Twitter, by which I mean these little blessing type things that I write a lot of mornings. But first of all, I need to explain why I'm on Twitter in the first place.

I never meant to be on Twitter. It's kind of a cesspool even more than most social media. The trolls are awful. People are constantly saying mean things. The news is pouring in all the time and overwhelming. It causes a lot of anxiety. But I started my account in 2009 and then I became very ill in 2013 and there were long periods of time when I was unable to leave the house. And so I began to go on Twitter as a way to be social and as a way to connect with people. And so I started making these good morning tweets, which always start and end in the same way. And, so I just wanted to share a few of them, especially since it's morning and, um, we could, we could use some good morning mojo, I think. "Good morning. May we let ourselves soften with the pleasure of some things small. May we find a granule of joy or better yet maybe we grow into our best selves and love and be loved. Eyes up. Let's go."

Here's another one. "Good morning. May we be loved. May our minds thrive. May our hearts not skitter in fear, but be proudly with courage. May we help others more than we harm. Eyes up. Let's go." Last one. "Good morning. May we be safe, may we not hurt others and work for justice not only in the wider world but in our smaller circles as well. May we love and be loved. May we be kind. Eyes up. Let's go." And so those are a few examples of these tweets that grew to mean something to people. These good morning tweets that I didn't think too much about, but that people, all over the world told me we're encouraging in a world that can be really frightening sometimes and desolate, especially when you're struggling with mental illness. And I'm often asked that if I could have one thing to say to a person who has been newly diagnosed with a mental health disorder, what would that be?

And I usually say, "Remember that you are still you. You are still that person who hates peas in their fried rice, who has a freckle on their right hand and who can sing like a bird. Holds onto that. And for those of you who work within systems that often reinforce the strangeness of mental illness rather than the humanity of those who live with mental illness, remember that too, but also help your clients and patients to remember that about themselves because you, as the people around them, their support system, their healing team have a job to do among other things. You are to hold on to their dreams and their hopes such as your challenge as people who work with and for those who might leave an office crying and hopeless or feel as though the next five minutes are impossible to get through. How wonderful is that and how wonderful are you to carry that dream until they can carry it themselves. Fight the stigma that exists toward mental illness. Cultivate resilience and self advocacy. Carry the hopes and dreams. Eyes up. Let's go. Have a wonderful Symposium.

Wow. Esmé was so amazing. People have been raving about her talk. She is such an inspiration and I’m so glad you could hear a bit of why we love her so much.

Next up in our day 1 highlights is Dr. Stephanie Covington. She is acclaimed for her pioneering work in women's issues. Dr. Covington is co-director of both the Institute for Relational Development and the Center for Gender and Justice in La Jolla, California. Her keynote focused on trauma and justice-involved women.

For the most part, you’re going to hear an uninterrupted 15 minutes of Dr. Covington, but I’ll be back to talk about the final section of her incredible speech. Enjoy.

A good friend of mine, who is a professor emeritus criminologist, for 10 or 15 years, she will not call it the criminal justice system anymore. She said it's the wrong name. She calls it the criminal injustice system and I think it's a better name actually. It's a much more accurate name.

Now, I know Oklahoma has the highest incarceration rate for women in the country. You need to know the United States incarcerates more women than any other country in the world. We incarcerate the most. And we've had a huge increase, not a decrease. It's actually slightly beginning to decrease for men. It hasn't decreased for women. The women in the United States represent 5% of the world population of women, but we represent 30% of the incarcerated women. Nobody around the world looks to us as to what to do with justice-involved women. Everybody in the world is a teacher for us. People teach us what to do and they also teach us what not to do. We're teaching the world what not to do and we should feel ashamed. There are always two themes in the lives of women in the justice system -- adversity and abuse. And we know that trauma is linked to substance use disorders, mental health problems, sex work, self-harming behavior and relationship issues. And so we put women with these high rates of abuse into our jails and prisons, which actually are retraumatizing. Just the standard practices and policies. Think about a woman who's been abused. How about a woman who was held down and raped? Now let's put her in a jail or prison or let's restrain her. What's going to happen?

What about the woman as a child who was locked in a closet for 24 hours? What happens when we put her in isolation? What happens when we search women, pat searches and cavity searches? In 1976, an international agreement was signed by many countries in the world saying you couldn't do what's called a cross-gender pat search, meaning a man could not search a woman. The U.S. never signed that. We changed the rule in California three years ago. Up until that time, a male correctional officer could pat search a female. Need I say more. When we talk about abuse, we also have to talk about gender differences. We see that if we look over the lifespan. Boys and girls are at risk for harm from the people they know, families and people they know, physical and sexual abuse. But when you get into adolescence, the risk changes.

The young man is at risk if he's a gay young man, if he's a young man of color, if he's a gang member, if he's a boy who's transitioning. And his greatest risk comes from people who dislike him, peers and police. For a woman, a young girl, young woman in her adolescence, her greatest risk of harm comes from the person to whom she's saying, "I love you." If a man serves in the military, his greatest risk for harm comes from the enemy. If he's living in the free world in our communities, his greatest risk for harm is being victim of crime committed by a stranger. For a woman in the United States who serves in the military, her greatest risk for harm comes from the people she's serving with. And if she's living in our communities, her greatest risk for harm comes from her relationships, again, from the person to whom she says, "I love you." So when we work with men who are trauma survivors, it's very unusual to work with a man who is harmed in his childhood by someone he was in a relationship with in his adolescence and in his adult life. But it's a very common scenario for women. And that's why the services we provide when we work with trauma are different for women than they are for men. Of course, our transgender, gay, lesbian, transgender population is at the greatest risk for harm.

So when we begin to think about trauma, we can go back and actually start with stress. Normal stress. Everybody in this room knows about stress, right? I mean, positive stress comes from getting a promotion, deciding to get married, having a child -- stressful events. You want them, you're looking forward to them, but they're stressful. So that's our positive stress. Tolerable stress is probably what you experience every day, but tolerable stress; you go to work, it's a stressful day, you come home and you hopefully relax. Tolerable stress you can get away from, you can take a vacation from. But then we have destructive stress. Relentless stress are the things that are stressful in people's lives they cannot escape: poverty, racism, sexism, hunger, child growing up in a family where there's drug use. Relentless stress. No escape. Think about what percentage of the women in our jails and prisons do you think grew up in families with relentless stress in communities of violence?

A very high percentage. And what that does is that creates toxic stress for children. And toxic stress actually impacts the development of the brain and the brain architecture. And there are three primary times where this is most impactful: in utero, the first five years of life, and in adolescence. The parts of the brain that are impacted are the part of the brain having to do with emotions and the ability to regulate emotions. It's the part of the brain that helps you control your behavior and the part of the brain that helps us be in connection with others and relationships and trust. So when we're working with children who've experienced toxic stressors, there's actually an impact on the brain. So a lot of what women are struggling with in our jails and prisons, the seeds for those problems actually were planted in childhood. Now the ACE study, adverse childhood experiences study, has told us a lot about what happens with kids. ACE study: 10 questions originally done in San Diego, where I live. So over 17,000 adults answered the questions according to their life experiences before the age of 18. The first 10 years of the study, nobody paid any attention to it. Zero. The last 10 years has gotten a lot of play because in fact what they have found, what they found initially in the study, that if people had a score of four more yeses on 10 basic questions, these were the people at higher risk to be smoking, alcoholism, the injection of illegal drugs and obesity. That study was then replicated in five different states here in the U.S. because the population was so skewed in San Diego, predominantly white, college educated, blah, blah, blah.

Now we have over 2,000 studies around the world who have used these 10 ACE questions. So we have an incredible amount of data. And they've used it every which way to show connections of things. What they found in the original study, that 50% of the women were more likely than men to have a score of five or more. So the women had higher ACE scores. What they also found is if they gave one hour with a mental health professional to the people with the high ACE scores, the one hour made a difference. It decreased their use of health care by 38% over the next year. Huge difference.

17,000 people, the staff at Kaiser, did not want the program. They said, you can't ask people these questions. Everybody will have an emotional breakdown. It's what every social service agency says when you try to introduce trauma work. Oh no. Oh no, we're not well trained. We don't have enough staff. So a pager was carried 24 hours a day, seven days a week for three years. How many phone calls did they get? Zero. The only people that melted down were the staff, just saying. People had already survived the worst. People said things like, "You know, I've never told anybody this. Do you really think that maybe it's affected my life now that I'm adult?" One man said, "The only person I ever tried to tell was my mother when I was five, and she said, 'that doesn't happen in our family.' " One 78-year-old woman said, "You know, I thought I'd just take the secret to my grave." People were grateful being asked. Now my original training around trauma was this, that as a psychologist, if I worked with a trauma survivor, I would probably work with them three times a week for three to five years. Guess who was going to get that service? Right? I now know we can make a difference in 15 minutes.

We all can make a difference. In fact, we all are making a difference, but the question we have to ask ourselves is, and what kind of a difference am I making? We have people in criminal justice settings who are making positive differences, but we also have people in criminal justice system who are making really horrible differences, horrible differences. They took the ACE study into California prisons, found out, of course, the women with a higher ACE scores of the women had had all the same health problems, everything. Greatest risk of what was happening to mental health. They're on more medication, needed, more mental health treatment, more attempted suicide. But look at this statistic. If a woman had a score of seven or more yeses on those 10 questions, her risk of having a mental health problem increased by 980%. And yet the mental health services in prisons often do nothing around trauma.

They diagnose and medicate. And that, in fact, it's how we're training most of our master's-level clinicians now: to diagnose and medicate, or to do cognitive interventions, which is not what you do with trauma. So let me show you this slide quickly about what happens to people. You have the event. It overwhelms someone's capacity to cope. That's why resilience is so important. You have the initial response to trauma. That's where we hear about fight, flight, freeze. But the person ends up with a sensitized nervous system. There are changes in the brain, the brain chemistry, how the brain operates. Then there's physical or some kind of psychological distress. It can come from a current stressor in life. Could be the experience of being arrested, could be admitted into a prison, it could be coming into a residential treatment program. It can come from lots of things. It can be a trigger. A reminder of the trauma, which could be a sight, sound, smell, a feeling. And when a trauma survivor is triggered, they're pushed back in time and they're flood ed by the feelings that were attached to the traumatic event. So you can imagine how disorienting that is if you have a 35-year-old woman who's triggered, and all of a sudden she's flooded by the feelings that are connected to something that happened when she was five or six, right? So what we see as how people emotionally respond. We have retreat responses. These are our mental health responses: isolation, dissociation, mind & body split, depression, anxiety, mental health, harmful behavior to self, substance use disorders, eating disorders, deliberate self-harm, suicide attempts, harmful behavior to others, aggression, violence, rages, and the physical health issues, the lung disease, heart disease, pulmonary disease, autoimmune disorders. The things that the ACE study looked at originally. What we've done in our communities is that we've provided services for mental health services, for substance abuse treatment. You have anger management programs, and we have hospitals, and then no one's talking about trauma.

So how effective is it going to be if you're not going back up and looking at what might be underneath all this, right? What, what might be underneath all this? And so if we want to be effective, I think we have to go back.

OK, I’m actually going to let Dr. Covington not only close out her Zarrow Mental Health Symposium speech, but also this podcast transcript with this short quote from Desmond Tutu. So, thanks for reading, and we’ll be back next week to give you highlights from day 2 of the Symposium. Now here’s Dr. Covington...

I leave you with one last thought. When Archbishop Desmond Tutu was going to give a mass in South Africa to celebrate his, at that time, 25 years of service, he tried to think about where he wanted to perform the ceremony and he chose a women's prison. And people said to him, "Why did you choose to do this in a women's prison?" He said, "Because there's no other place on earth that holds as much pain as a women's prison." Thank you.