The Body and Psychosis

00:00:00 foreign director of The Centers today's program on the body on psychosis was suggested by Professor Vittorio galese

00:00:34 can you hear me now no get a little closer yeah to put it in my mouth now my check one two yeah absolutely my check oh finally sorry about that I'm heading

00:01:07 accession director of the center today's program the body and psychosis was proposed by Professor vittoriogalese who's sitting right there uh Dr Jerry Horowitz will be introducing the participants and watch over the discussion with a light touch on I'm just going to give you a update about the programs we are planning for

00:01:39 the rest of the year on March 18 professor John Williams has organized one on memory on April 8 Professor Chris MP from Arizona is doing life beyond Earth when and how will it be found on April 22nd Ellen Gilbert is organizing Shakespeare forever on May 13 professor John June crisis in the University

00:02:09 on September 23rd Professor Catherine Elkins organizing one on emotions on October the date is not yet clear there will be a round table and the title will either be uh generational dividing mathematics or shift in Paradigm in mathematics paradigm shift in mathematics and then on November 1st we have Professor David

00:02:42 greenspoon doing on planetary intelligence so that's the program for 2023. thank you hi I'm Jerry hurwitz Ed forgot to mention if the aliens actually do arrive ahead of that talk we'll we'll schedule something else I'm here to announce our participants today and it's a wonderful group first and uh if you

00:03:12 could raise your hand when you mentioned and as a board-certified addiction and general psychiatrist he has been he has been researching novel treatments for addictions for over a decade Port of several grants from the National Institutes of Health period a special focus of his research has been evaluating sub anesthetic ketamine infusions for cocaine use disorders in both laboratory and clinical settings as well as investigating ketamine infusions as an

00:03:44 adjunct to mindfulness-based treatment Mind Body practices motivational interviewing and other behavioral Frameworks for alcohol cannabis and opioid use disorders George Helton denfield is a leon Levy fellow in neuroscience and Psychiatry resident physician at Columbia University and the New York State psychiatric Institute he completed his BS at Tufts University concentrating in biopsychology and cognitive science

00:04:15 Dr Daniel Dennett served as an advisor to his thesis exploring whether and how Notions of cognitive modularity might be reflected and instantiated in neuroanatomical structures okay then you're the originator of this talk Vittorio galesse is a trained neurologist and professor of psychobiology at the University of Parma in Italy where he is director of the lab of social cognitive neuroscience fellow at the International Academy of

00:04:46 advanced studies in America of of Columbia University he's an honorary fellow of The Institute of philosophy at the school of advanced study of the University of London and honorary member of the American College of psychiatrists cognitive neuroscientists his research focuses on the relation between that sensory motor system and social cognition by investigating the neurobiological grounding of inter-subjectivity Psychopathology language and Aesthetics

00:05:16 he's the author of more than 300 scientific Publications in three books Siri has that is an author of a book of poetry reading to you is the name of the books and several novels the blindfold the Enchantment of Lily doll what I loved the Sorrows of an American this summer without men the Blazing world and memories of the future as well as five essay collections a woman looking

00:05:47 um I'm sorry I'm sorry yeah that's what I was trying to jump ahead right so no but thank you no there's a lot and it's Wonder there's a lot and it's wonderful and it should be read but we're yeah okay um I want to jump ahead she um has a PhD from Columbia University in English literature and is a lecturer in Psychiatry at Wild Cornell Medical College in New York City her scholarly interests are interdisciplinary she has given numerous lectures at scientific and academic conferences on

00:06:17 philosophy Neuroscience neurology Psychiatry and literature and published papers in scientific and scholarly journals Gale Weiss is Professor of philosophy at George Washington University she recently served as executive co-director of the society for phenomenology and existentialism and as general secretary for the international Merlot Ponte Circle her previous monographs include refiguring the ordinary and body images and bodymen as intercorporeality and she

00:06:50 is currently completing a monograph entitled existential ambiguities Beauvoir and Marlo Ponte in 2020 she credited she credited 50 concepts for a critical phenomenology with Anne Murphy and Gail Salomon thank you very much [Music] so we agreed in advance that Victoria might open with a few comments about what made you think of this round table and we'll go from there yeah first of

00:07:22 all thank you for for having us here for hosting this uh debate I'm very looking forward to uh its outcome since we we will be in a position to hear um different points of view from different backgrounds I myself are not a psychiatrist I was trained as a neurologist I'm basically a neuroscientist a mechanic of the brain body so to speak but I developed an interest in schizophrenia and psychosis a long time ago uh and I think my first

00:07:56 encounter with schizophrenia was during my undergraduate years when a teacher of a Psychiatry uh brought patients to the class had them interview read the part of their Diaries and so maybe this sort of existential imprinting uh with schizophrenia was able to play a role in steering part of my research somehow 20 years ago in this direction Neuroscience should be

00:08:27 spelled in the plural because there are a variety of approaches we all look at the brain but with different scales we go from the tiny very little micro level of receptors neurotransmitters to a more integrative view which somehow try to find a correlation between the functioning of large chunks of the brain brain circuits and behavior

00:08:57 I belong to that part of neural science and why is schizophrenia well because schizophrenia has an old psychiatrist a long time ago would have defined it before being a disease is uh one of the many possible way uh to understand human existence and this brings me to the second Point uh Today We Live in the age of

00:09:28 categorical psychiatry which is very useful because we can exchange data from different countries whenever we say schizophrenic Spectrum or OCD everybody understands what we're talking about so I'm not questioning the the relevance and usefulness of this approach unfortunately in my opinion nature though is not categorical but but dimensional so there was a time when some psychiatrists

00:10:00 um approach mental diseases from a more dimensional point of view and for example uh Binswanger was one of them and he was defining schizophrenia as a variation a van lung of the many possible ways of declining a human existence I think there are also very important ethical implications from this dimensional psychiatric approach but to make a long

00:10:30 story short my interest in schizophrenia started from the realization that more than a hundred years of psychopathological thought mostly Continental German French Italian Danish never made it to Neuroscience I mean the the great bulk of research very useful very interesting we need that desperately was focused on the micro level genetic level of description

00:11:00 neurotransmitters level of description but the phenomenal experience of living your life being in this condition was totally left out from the laboratory with the very few exceptions so we decided to tackle the the topic of schizophrenia from a bottom up point of view and by bottom map I refer to the the level of description of experience

00:11:31 which is another big neglect the topic in Neuroscience as we speak experience and the body and before shutting up I would like to read a few lines from a schizophrenic patients published by a friend of mine Professor Thomas Cooks who's in Heidelberg University who speaks is a 20 year old woman beginning quote for some time I had a feeling as if my clothes did not seem

00:12:01 appropriate anymore my gate had changed I walked stiffly and did not know how to hold my hand then I often looked into the mirror and founded my facial expression a change and I began to think that I might be regarded as a product man looked so strange at me I took passport pictures of myself in order to examine whether I only imagined that then I began to feel the kind of charging or tension in my body when

00:12:33 others came near to me as if it were passing over from them finally I thought I should be made a prostitute by brain manipulation I think this very concise report from this patient in remission when when she said that um tell us something very interesting about the progression of the disease and the relationship between negative and positive symptoms which is a very old intuition by psychopathologists like Jim

00:13:05 minkowski for example who who's bukus schizophrenia I'm afraid was never translated in English and this I think is something that should be done so the idea is that the basic if safety to use the term employed by Luis assassin Joseph parnas and from that the the positive aspects the delusional aspects can be viewed as a sort of compensatory defensive mechanism

00:13:38 to give sense uh to an existence that has totally lost any clear meaning when the patient relates to the world and this is something that can be addressed by Neuroscience and this is something that we are currently being addressing in the last 15 years or so well this is the anecdotal I had a job as a volunteer writing teacher for patients at Payne Whitney not far away

00:14:11 and um one thing uh Victoria was just mentioning if you're at all burst in diagnostic categories it gets in fact rather easy to identify especially psychotic patients in in your in your class even when they're medicated and one of the observations I made was that the patients were generally more

00:14:41 linguistically creative than the staff members who sometimes sat in that we should remember and also that especially people who had disorders that included psychosis had a lot of problems with narrative right so telling a story which if you think about Paul Ricker and his beautiful way of thinking about

00:15:11 narrative as making meaning through causes the fragmentation and interruptions in psychotic disorders make telling a story really difficult it didn't make poetic bursts of language difficult but I think that sense of linkage which

00:15:42 um is disrupted and there are many testimonies from people have suffered I will save it for later but Antonin the great uh playwright and um theater person in France wrote letters to his doctor about really prodromal schizophrenia when it's beginning to happen to him and it is a hugely physical description

00:16:16 um something uh to keep in mind I think that's what's really striking when you look at the diagnostic criteria that we use in the DSM is how little the body factors into the criteria we actually use to diagnose schizophrenia or other psychotic conditions but when you interact with people who are undergoing psychotic experiences the body features very prominently in in what they describe and that's a pretty striking disconnect between how we've

00:16:49 characterized it and how people feel the experience themselves don't you think it's the neocartesian legacy of uh of you know first generation cognitive science that's been hanging on for a long time despite Paradigm changes yes okay yeah I am inclined to agree with that and and to think you know about I mean I'm very interested in uh so other part of my background is also as a neuroscientist a

00:17:20 systems neuroscientist and very interested in thinking about how we can kind of work in these alternate uh paradigms into neuroscience and framing Neuroscience research from these different perspectives that are more embodied and uh ultimately more biologically rooted than a lot of the sort of cognitivist approaches that have dominated historically a matter of um not that it's something

00:17:51 Sarah Ahmed talks about called straightening devices you don't have their disciplinary methodologies and straightening devices even thinking about serious example about Narrative of these patients having trouble that having creative poetic creativity isn't a problem right coming up with a coherent what's regarded within as an acceptable coherent narrative that's the kind of thing that Sarah almonds talking about it's a straining device so then it's seen as maybe not making sense or not eligible from within that Paradigm and so the need to kind of break out

00:18:25 framework and saying and often linear framework and this is the Cartesian aspect too that you know needing it to be a kind of coherent means there's got to be a beginning a middle and end a kind of progressive narrative and I think that then you miss a lot um and the body isn't linear and the body is messy and and doesn't doesn't um comply with those kinds of disciplinary or methodological restrictions and so I think that's where things can escape there's a psychosis that

00:18:57 can involve the Deep disintegration of experience the relation to the body the the world being deeply anomalous but there's also a kind of psychosis that is characterized by the linearity we're talking about where the the story is imposing the same structure on on experience in a

00:19:29 manner that can um abandon intersubjectivity just as just as deeply so can you give an example do you have uh well then the the paranoid um variation of schizophrenia for example is a very high functioning mode of schizophrenia can characterized primarily by um delusions that that are fairly coherent and and well delineated and the

00:20:01 person has no trouble um narrating them often ad nauseum and also there's that logic there's always a logic yeah logic has been somehow uh leveraged in in reapplying that that was like reading license plates I mean I actually had a friend of mine who went through a period of of psychotic experience like this where he

00:20:31 found um completely coherent patterns in license plates that related to his own existence and there was nothing to use that word it was coherent there were aspects of contextual reality that were missing but the patterns had a logic that was perfect you say it was a super coherent some of

00:21:02 these stories because of the fixity of the thoughts of the narrative I think what's most interesting about this topic is the intimacy involved which um as as we've said isn't often inquired into when diagnosing we treat the the person as as a as an object in the world in a way um and and forget that they're also um

00:21:33 uh being in in the world in in in their own Manner and and I've described for the purposes of diagnosis what we see and and that invariably misses a lot very little being done in terms of a comparative differential approach to to schizophrenia for example so we we put a lot of effort in

00:22:04 [Music] framing uh the so to speak the pattern of the genetic profile of neurotransmitter profile with respect to affective diseases or other form of uh mental diseases but uh not so much at this level of description of the body and that there's a debate indeed um I was recently having a longer walk

00:22:35 in Brooklyn with Luis SATs and we were we were chatting on on the relationship between some aspects of schizophrenia which seems to affect these core nucleus of the cell that Joseph Barnes that cause whether this is really a specific characterization of schizophrenia or if rather some aspects of an effective if safety can be found also Elsewhere for

00:23:06 example in the personalization yeah so in our lab we are as we speak investigating both schizophrenia and depersonalization disease in a variety of domain uh the way a patient mapped the space around their body that we compare personal space the way they deal with time travel and there are differences and I can't say much because this is still an ongoing process but what we found for example is that

00:23:37 uh in depersonalization disorder the mapping of very personal space is not affected at all while it is it's schizophrenia its shrinked is much more limited this is not the case in the personalization on our disease which seems to be in terms of the dimensionality we were discussing before similar but with the less degree of

00:24:09 intensity schizophrenia seems to um affect the the true pillars upon which we build a coherent way of relating to the world which we are not able to find in in the personalization yeah well I mean I think Seth and purnas talk about that about anchoring um this very primary sense of being

00:24:40 dislocated from both agency and ownership when it comes to the body another anecdote that a psychiatrist friend told me many years ago a psychoanalis psychiatrist she um had an appointment with the schizophrenic patient a patient rather who had been diagnosed with schizophrenia and right before she went to the session she had had her hair cut short and when he entered the room of her

00:25:11 office he looked at her and he said oh no you cut my hair and that's when she was you know alerted you know this is not a just a prenomenal problem right this is not just about what's happening at the level of language but that you know the possibility of that kind of reversal which

00:25:42 um I think in this case he didn't seem to be suffering but some people can suffer that very deeply yeah we take very much for granted the the way in which we typically differentiate boundaries between self and other and that does seem to be a a core feature of at least certain varieties of psychotic experience that that breaks down and it's very interesting sort of what uh what is the cause of that one

00:26:14 biologically or otherwise well the etiology of schizophrenia is just a mystery yeah like many other issues many other things we're talking about narrative and causality and the body and you know psychosis uh is the title so what do you

00:26:44 think the connection is or can you start to outline what the connection is between the buy and some disturbance and a sense of causality for a sense of narrative what was interesting kind of when we were talking about different varieties of psychosis and one that seemed to have a more intact narrative structure or at least one that uh people who are not currently having a psychotic experience feel like they

00:27:15 could understand and relate to versus other varieties that seem more disorganized um and you know it's interesting I was I've recently been reading some work from Matthew Ratcliffe and his book feelings of being which is very interesting I would definitely recommend um people uh look at that because he's talking about how the the the way that the body shapes uh our sense of reality and our sense of belonging in the world

00:27:47 uh and how changes in bodily feelings are actually something that happen a lot in day-to-day sort of typical experience but we don't pay a lot of attention to it or we aren't fully oriented to it but that more persistent or more intense different varieties of changes in those bodily feelings can really alter our sense of belonging in the world and our sense of reality how the world appears to us whether it's a welcoming familiar uh environment that feels easy to

00:28:17 interact with or whether it's unfamiliar frightening threatening in some way and it's interesting because the orients US specifically to how those are sort of two sides of the same coin of our feeling of being in the world is at the same time a feeling of the body and so that really implicates the body very deeply and centrally in just our general sense of reality and therefore in uh alterations to that sense of freelance I think if

00:28:53 will create a relationship's narrative that our you know rhythmic bodily reality as part of movement in time via the repetitions the simplest ones right breathing heartbeat so become walking walking that is also experienced by uh the fetal being they know this right very early on so

00:29:23 rhythm is part of our reality it's timing that felt an experience it's not time that abstraction right that that physicists talk about but the real bodily time I think that is where the roots of narrative are thinking about um the way a body can be both um inhabited and

00:29:55 um existing as a mode of being in the world but also as something other people interact with as a thing in the world that um we have no claim to [Music] and and I I suspect that depending on which is that

00:30:27 I think I'm lost I don't know you a bit okay um I imagine depending on on the mode of derangement whether someone is inhabiting the body and inhabiting being in a very idiosyncratic way or um on the other hand feeling more of an object than than one should feel um different narratives emerge um

00:31:02 which is the body as thing you know the body scene um you know like in an anatomical uh drawing and the lived or experienced body and these are parts of all human experience and I think you're right in some um schizophrenic or psychotic experiences the objects part of the self takes so you lose the intense

00:31:32 location of your lips and how it outstrips the intentions of the individual and so even if somebody is feeling where there are ways in which your relationship to your own body you may not even get aware of that are being other evident to other people and that start to form a narrative that they're creating about you and your comportment or how you relate to your own body so I think the expressivity I think about that when you were talking about you

00:32:03 know the body of something we inhabit but also it's out there in the world and the way in which and in a way that outstrips our intentions and also connects us always to to other people and and the relationships that we sustain and I think one of the dangers is viewing the body too you know atomistically the body and it reminds me um I'm a male punty person but at the end of the phenomenology perception malapunti concludes with a quote from Sonic superee that talks about each person is a knot of relations a knot of relations

00:32:35 and I love that expression and I think about how that captures a whole gamut of even psychotic different ways in which those relations get disrupted get maybe but there's always there's different kinds of things going on there that can't again non-linear but that I think that's such a helpful concept to think about um to think about each person as a knot of relations and how those that knot can kind of get loosened I'm doing work on Aging right now and thinking about um you know I've got a paper I'm writing called unraveling the ties That Bind the

00:33:07 social fragility of old age and how if someone gets older and their their their their peers die there maybe their partner dies and Friends die and and then yet they may have caretakers or people coming into their home who are strangers but now have an intimate relationship and caring for them and for for their body and so that that's a way in which is not of relations gets reformed and that there's ways in which we don't give enough credit we focus so much on the physical fragility of old age and not enough about those kinds of Social Challenges which people have negotiate

00:33:40 that's just something I was thinking I mean for one time I would like to sound optimistic there are many signals telling us that Neuroscience is finally moving in the right direction for a variety of reasons first because more and more people are realizing that it's time perhaps to close the drawer of the most cut Asian solipsistic approach to the mind what what we

00:34:12 this ill-defined notion uh that always comes up um for example this tradition taught us uh for decades that what you were talking about body behavior is intentionally opaque there's no way to get any meaning about what the other is up to unless from that ostensive behavior we reach a sort of hidden set of propositional amplitudes by

00:34:43 theorizing which is certainly something we can do we are pretty good at that but that's definitely not the whole story so now we we speak of social Neuroscience second person approach people like Shield back for example develop Paradigm to study uh at the very least niatic interactions in uh we start using hyperscanning which means to study two brain or three or more possibly brain bodies at once yeah

00:35:16 in in a more ecological interaction and the third element of of optimism is that even in our Western tradition we are Marching towards a far more holistic notion of um of an organism so we we study more and more the relationship between the brain and the Heart uh the brain the heart and the guts there are colleagues and friends of ours studying

00:35:49 the relationship between political discourse and God's feelings yeah so this this new term interception extra reception deals with our perception of what happens outside of our body interception refers to what's going on inside our body uh you were mentioning Merle Ponte he was acquainted with cool Goldstein Goldstein was one of the few who had this intuition about a more holistic

00:36:20 view of um of of humans and of our organism and I think we are uh starting moving in that direction and I think we are about to learn a lot more by integrating the immune system the cardiovascular system the digestive system the brain the heart and inflammation inflammation is a very Hot Topic in all branches of medicine and so

00:36:52 perhaps we need a new synthesis but but um you can see it happens as we speak direction in which Neuroscience is expanding too which holds a lot of Promise is in terms of uh movement getting back to kind of what we were talking to about the rhythms that kind of Define our existence in many ways most of the experiments that we do in Neuroscience whether it's in

00:37:22 humans or animals are in sort of a confined situation where people aren't moving where the animals aren't moving and yet in our lives we're moving all the time and the brain so much of the brain is oriented towards uh facilitating that and controlling that and you know it's there's a study that came out not too long ago um Carson stringer's lab uh where they did some uh very sort of wide scale Imaging of neuronal activity in the

00:37:53 brain and what they found were all of these sort of ways in which neural activity related to the movement of the mice even in primary visual areas where we just think of you know taking in signals from the outside world we don't think of it as a movement area and yet there's so much neuronal activity even in visual cortex that's related to movement set ourselves up to be able to study that currently these do bring up philosophical questions about you know biology right

00:38:24 System Theory which you mentioned earlier holism that goes way back to the Montpellier School of you know doctors holism versus mechanism um the problem comes for me when Dogma becomes part of the issue right when I mean it was mentioned earlier modules in the brain they're very various kinds of

00:38:55 modular thinking um I think the evolutionary psychology modules have died I hope um after too long but but again this is all part of how we have to think I have a very flexible way of thinking about epistemology but not everybody does etymological pluralism is

00:39:25 interesting to invoke in a conversation on psychosis yeah I'm I think the the Big Challenge I see with um more fruitfully engaging psychosis is that we do invariably hit up against this opacity and there's a an inherently relational Dimension to the diagnosis we we pronounce someone psychotic because

00:39:58 they violated some some set of rules or some verification scheme absolutely and they may not be suffering they often do as you've mentioned but um they may feel that we're I'm trying to pigeonhole them in some category they don't belong to so it is interesting to consider that opacity that yeah that we invariably hit up against where it's Baron they're in the

00:40:28 world in in their way and and the body being um so so deeply involved in the meaning making and epistemological process right um becomes extremely important right don't you think I mean the context because obviously psychotic experiences have been there's a lot of work on this have been understood in very different ways

00:40:58 in different cultures so there's a cultural relativity so someone who's hearing voices um you know in in one culture doesn't necessarily suffer from Exile from the community in the way that psychiatric patients who have been diagnosed with schizophrenia and end up in a hospital suffer you know here in in in the United States for example I think this is what brings up the issue of thinking about the world

00:41:29 taking seriously the fact that well we all may exist in a who's really incense and one in the same life world people inhabit different worlds and I think the world of the psychotic is a very different kind of world than the world of the quote-unquote normal subject and I think that finding the bridges you know across those worlds and under and trying to really understand their world from their perspective rather than that imposed perspective of their hearing voices there's something wrong you know majorly wrong here or

00:42:01 um you know incredibly dysfunctional I think that's a that's I think that's really promising in a lot of recent work that's been done in phenomenology and thinking critically about different worlds in Mariano Ortega Latina feminist phenomenologist has written a book called Between Worlds and thinking about how sometimes people don't fit within a world of not being at ease in a certain world which is an experience we can all have on occasion Rosemary Garland Thompson who's a bioethicist and disability theorist has

00:42:33 talked about misfitting and and I think that's been really useful for disability studies because also it creates a bridge because we've all had the experience of misfitting on some occasion or other but socially misfitting uh you know even physically misfitting in some ways but thinking about misfitting of this way in which the body in the world aren't aligned in certain kinds of ways and how to get a better fit and to avoid a kind of normative there's only one size fits all but it's this body in this world and how to get those to fit together so I

00:43:03 think there's some really promising work that's being done thinking seriously about worlds and I but one of the issues I think is isn't it is is a major issue especially in our country with our health insurances the specialization of medicine and you're getting specialist treating different Solutions if you've got different practitioners or different Specialists treating the individual but not with any kind of overall no one sort of their coordinate working on that coordinating

00:43:33 well there is the tendency in medicine but in you know since the beginning of modern science right since the 17th century to create these isolated Parts they're machine parts and when you think of how recently uh the you know Placebo studies you know revealed that the nervous system and the immune system are highly related

00:44:03 it was assumed that they were separate because the assumption is always about separation oh is it about boundaries and it was Robert eater who did work on Placebo from a very simple behaviorist point of view and he made the leap that these rats were getting sick even when they weren't giving getting a poison because the nervous system and the

00:44:33 immune system had to be related but he was a psychologist so he hadn't bought the truism this is very interesting we still teach undergraduate students about the existence of the uh Altona was never a system which is not autonomous at all is fully integrated and speaks with a prefront of cards with the amygdala

00:45:04 so it's all tightly integrated and but our pedagogic model in medicine as we speak apparently it doesn't know what's going on around the corner in the lab and so we still keep teaching the body severed in pieces each of those uh making a distinct discipline it happened to some relatives of mine addressing an orthopedic about

00:45:34 a relative kidney problem and the orthopedic center the kidney what do I know I'm an orthopedic in a hospital an empty so this is the way it works many times unfortunately we should challenge that we should because I mean it's all out there I mean it's clear that we should move towards a much bigger integration of our knowledges and we need to think a new scene well you can

00:46:06 imagine that if um if people are um in these silos if these practitioners are in silos it incentivizes the sort of categorizational the category Centric approach because it's sort of like a lingua Franca see look there's just this small set of objective you know symptoms and signs that's all I need for the diagnosis it would be um more conducive to having a sort of a

00:46:38 dimensional approach if those silos did not exist I think right well and I think we are talking about what are now classified as psychiatric disorders psychosis and Psychiatry has always for a long time right move back and forth between more phenomenological approaches and you know sort of biomedicine model and and has had severe case of of physics

00:47:10 Envy throughout because other Physicians don't always regard psychiatrists as real doctors right because uh being a psychotic patient is not the same as having the measles there's no pathogen that you can identify and after let's face it billions of dollars spent there isn't a single gene or a single biomarker worth its salt in a clinical

00:47:42 situation that helps diagnose psychiatric illness that's a big deal I was speaking with a friend about this who is a psychiatrist and he's involved in The Liberation Psychiatry movement um so when he heard the name he said oh finally you know we're going to be talking about the the carceral aspect of of Psychiatry

00:48:15 the the ways that Psychiatry has been involved in the um demonization incarceration subjugation of people who are other um and including women who are just half the population right and psychosis remains the the motive being that is most often

00:48:46 associated with involuntary hospitalization with um oh yeah there's no there's no question they don't need help the the I think the the point is that that um element of the social um involvement where there's a

00:49:18 putting in place quite literally of of the person who's who's being challenged by certain modes of Psychopathology it's most most Salient in this realm um and I think the question when we're talking about how we might Embrace more epistemological pluralism or fluidity or or be able to acknowledge the the very unique mode of being that psychotic individuals

00:49:49 um might have how do how do we reconcile those things how do we how do we continue to see them as as both um in the world for us and also in the world for themselves for for their own their own modes of being some of the way they are create anxiety in the other person so there is a protective element based on the anxiety

00:50:19 that we because it doesn't follow the logic that you have in your head the expectations that you have in your head so they create social disease in others you know I think that's and so there's that removal and then there's the world of the institution which often is very sterile and is you know things are there's nothing personalized about that space it's removing them from all of that and sort of taking them out of the world and putting them in this

00:50:50 institutionalized World which is probably not the most conducive to having them be able to function back in the world but you're right that it but not always so there were always patients in my experience again this is just my little volunteer class but there were always patients who wanted to stay and there were patients who wanted to leave so you know you have different experiences there were patients who were

00:51:20 in my class that I got to know over you know a couple weeks who felt safer in the hospital who liked especially the you know artsy activities um and so again I think it varies the old idea of the Asylum is something that can be rethought I think

00:51:51 in different ways yeah but the point is that if one would want to take dimensionality seriously the immediate implication which uh partly relates with individual matters everybody speaks about nowadays the individual methods which is a an optimal goal uh the point is that it costs a lot of money so how much our society is willing to invest

00:52:23 from a public sphere mostly in still as we speak in in Europe in Continental Europe or uh in a mixed system like in this country um in the early 70s there was a very strong movement in Italy whose main goal was to close asylums Franco bazaria was one of the most feminologically a trained by the way he was heavily acquainted with pharmacologically

00:52:55 inspired Psychopathology and I think it was not coincidental that that brought him to to say we should close up this horrible places then it was the first promulgator of the law that not only shut down all the asylums but the plan to have protected homes for these patients with operators only part of that was realized and mainly in Northern Italy in the vast

00:53:28 how many people uh with with the problems mental problems you see around and I read an interview in the times about the guy working on an ambulance and he was telling uh well we when they come into crime or they they hurt people or they they disturb people we put them on a bed in a hospital for a few days and then they are released but there's

00:53:58 no program uh taking care but because it costs a lot of money we spend a lot of money differently and our societies our Western societies that speak the world that I know uh they are well behind in aggressive problems the problem is always currently in diversity of which uh psychosis is just a case but also like the idea this is I think

00:54:29 relates to what we've been talking about about a social context and then voice hearing which is a classic um supposed symptom of psychosis well okay I am a voice hearer not all the time but especially before I go to sleep nabakov had it there are lots of people who function perfectly well who Hear Voices a lot more than than I do

00:55:00 the interesting difference between some of my patients who heard voices and I who have heard voices is that I knew I was hearing voices no once we had a friend from Sarajevo who was in the middle of the war and he had was staying with us at our house and he left the house I heard the door closed and a minute later I heard him say help me and I thought he had fallen and I ran

00:55:31 downstairs that was a true hallucination because I it wasn't like oh I'm going to sleep and now you know they're talking to me it was a real he wasn't there I had summoned his voice saying Help Me No Doubt for Meaningful reasons he was coming from a war that was and telling terrifying stories and that had become part of that whatever my voice hearing

00:56:02 tendency I I'm curious as to your use of the word I know or no um I the difference is I know I was hearing voices because the person with psychosis would say the same thing I know I'm hearing voices yeah but the but usually they're often cosmological explanations I mean in my classes for example people had very elaborate explanations that I for example just to give myself um never had I thought when I was 12 and

00:56:34 I heard voices rather often I thought I was going crazy and if I told anybody they would put me in a hospital so it's a somewhat different your reality testing my yeah exactly I didn't think I had a you know chip in my head or you know or the Martians were coming uh Alien Invasion uh I thought that if I said anything about this weird business they would ship me away took Fair Mall I wish

00:57:05 the mental institution so um I didn't tell anyone and they went away mostly but it seems to me the questions about how much what sort of evidence did you Marshal in response to you're hearing this voice that you thought about it he said oh it sounds like he's downstairs let me go see right yeah um I was interested in this case I want to go back to this idea about causality and psychosis because I you know I wake up in the morning and some days I know I need to do something and pretty much the first thought of my head is like you

00:57:35 know get up because you got to do this right so there are times because I'm really a lazy person in the morning where I I wait a long time before I get out of bed just relaxing whatever and I have to tell you I don't know why I get up when I do like I just sort of find myself I'm oh I've moved out of bed right so there are a lot of different I mean that doesn't surprise me it's like it seems pretty uh quotidian I'm just do that right but there are a lot of different ways I might relate to that delay and the sort of the my unconscious movement towards

00:58:06 getting out of bed I could say I'm depersonalized like I did it but I feel somehow alien from the person who got out of bed right I don't do that I'm happy to say but I could I could say someone controlled my body right some someone outside my body controlled me and that's why I got up when I did because this is really a question right and the question I have is why do sometimes the patients with psychosis have such productive elaborate explanations yeah right it

00:58:39 almost seems uh over Storyteller yeah like over abundant like you know right and really elaborate like cosmology that I found were often borrowed from religious Traditions various religious Traditions depending on the education and upbringing of the person in the class um but they were never in my experience singular it wasn't adopting a tradition there were many aspects that were linked

00:59:12 and there were personal uh parts of this huge cosmological elaborate and they wrote you know this was part of it and so I got to read some of this material which um was fascinated complex um and uh borrowed from as far as I could tell from many different uh traditions I'm thinking about some of the patients that I saw when I was a resident who

00:59:44 seemed to exemplify certain philosophical systems yeah like uh really see what dualism is like you know or um animism or and and yeah there's the no back to that idea of a super coherence of an over identification with with a with a scheme that most of us might be able to contemplate

01:00:14 I'm in a bracketed way and and and not um become stuck in but somehow for at least some some people with psychosis there's a real stuckness in that yeah yeah it seems more uh that it originates in a in a feeling rather than in some sort of rational process that you use to construct elaborate explanations of of you know well why must I be hearing voices it doesn't seem like when you pay

01:00:45 attention to the subjective experience it doesn't seem like they're going through a deliberate rational and parental sort of process to try and explain and just sort of their expressing their sort of deeper sort of more background feelings I wonder if there's like a noetic feeling you know this I I work with psychedelics and and often there's a there's the sense of I know the truth I and we tend to get a little wary when

01:01:16 people are knowing but but there's this this this this real sense of conviction and and knowingness um what is that yeah and perhaps that's part of the feeling and it's a bodily feeling to John Nash would say right about his delusional thoughts that they were like mathematical truths yeah he experienced them in the same way yeah it's a matter of of uh we are back to dimensionality I mean

01:01:47 the problem you you you were telling us about how comes that I get out of bed and coincidentally it was last night I was reading in a novel the author was treating uh exact point what would make people getting out of bed this can be the topic for a philosophical paper or a psychological dissertation or something to be discussed with colleagues and friends around the table as we are doing

01:02:19 here but when it becomes the the center of gravity of your whole life system then reference when hyperactivity is really the Cornerstone of the way you deal with your presence in the world then we we speak of psychosis but again and your voice is example is is beautiful because it says that there's

01:02:49 nothing totally alien in hearing voice no I mean you can hear voices and be a marvelous novel writer or you can hear voices and being a psychotic patients in war we are dealing with the same bricks with which you can build different once we understand that I think it would be a major step we are dealing with the same bricks but those bricks are doing different things yeah yes yes you have a psychotic

01:03:20 patient who's in a state of chronic hallucinatory psychosis that person's life is dominated by those voices it's not like series example she goes down the stairs and says well the guy isn't there but but completely dominated as a result of which no other functioning is possible that's all just some amount of functioning connected to survival but nothing else oh well and and I again

01:03:50 degrees of terrible torment for some people not everyone right but some people are in states of horrifying suffering and torment and then one wants to Marshal every possible Aid now there is a further social Dimension that we've experienced I think with the pandemic and with with politics which is that pattern seeking can have this larger uh political aspect

01:04:25 um with things like Q Anon which have very powerful resemblances to certain psychotic states where again there's a logic that propels the discourse uh and it's often centered on the importance of being part of the the team and it feels powerful yeah and it feels deeply meaningful

01:04:56 and has the moral aspect too one of the ways we um one of the ways we um assess a false idea let's say or an idea that we're not sure whether it's false or not is we go and investigate right that's what and that's what you did in fact you went down and you said yeah oh that's not what I thought right um if you talk about Q Anon there's there's not any obvious way except if you go down to the pizza restaurant and try to apply the basement it wasn't

01:05:28 there well that was it right that look at the extent to which that one individual had to go to realize that his belief was false right he had to go that far because otherwise most people don't have those opportunities they're swimming in a lot of false narrative and they can't enact that's where I think the body comes in again because the body does the investigating typically it's true but there's a lot of marshaling on evidence of evidence in these um groups as well and I I did once it

01:05:58 did scare me a bit I have to say but I did look into some of these chat rooms and there's a lot of numbers a lot of statistical uh uh proof that's offered uh so it it's not that the patterns are nonsensical which brings us back to your earlier comments um they're they they make a kind of sense often their Rag and holes in within

01:06:31 those patterns that you know if you have a different point of view you could point that out but they then are self-creating in a way I think we're kind of dealing you know with the question of uh how do we as uh society as people decide what counts as acceptable realities uh to hold I mean we're exploring what are all the ways in which someone's reality and world can differ and then

01:07:03 how do we decide which ones are acceptable or not I'm still ahead with not clear but oh I think Victoria you're talking about the role of the body in psychosis so what is the role of the body in psychosis in other words in one way or

01:07:33 is it that you are saying understanding the body better and its reactions better it would help us get a better understanding of psychosis it's both I mean the body is highly relevant for our cognition I mean our cognition is the intrinsically bodily based and we are rediscovering this truth after a century many people had the same intuition emotions not only emotion but also

01:08:04 language language a bodily Dimension that God completely washed out by by the classic cognitive Paradigm and to stay on the body for example uh the way we relate to others uh means that to a various degree we try to accuse yeah uh and this Attunement to the other uh I think investigation is for example

01:08:34 that the very same part of your brain that map your tactile Sensations on your own body become active also when you witness those Factor experiences on the body of others and in for example one of our studies showed that in the first step is a schizophrenic patients this mechanism is not functioning properly first because those areas are less active when they witnessed the

01:09:05 experience of someone else but simultaneously in other parts of the brain that normally gives a sort of effective quality to the experience of being patched which is the posterior insula in LT controls shuts off when you witness the tax the present or unpleasant tactical experience of someone else this didn't happen and with the colleague who is in Quebec Gerald North yeah who is a psychiatrist

01:09:37 Aquarius a philosopher he's a Renaissance kind of psychiatrist if you allow me this expression we started to bring connectivity of this very straight first episode the uh patience and it turns that they have a deficient connectivity between the posterior insula and the anterior part of the insula and the posterior cingulate cord while they have an abnormal connectivity with respect to

01:10:09 control uh between the ventral premature cortex which fits on the lateral surface of the hemisphere and the very same posterior singular cortex which according to Norco is part of brain circuit that is mapping the ego from a self-referential point of view while the lateral surface of the hemisphere would be more focused on what happened to me in relation to the extent see so

01:10:39 these are all another element I was mentioning before which is also interesting because it it it opens uh um interesting perspective for uh Rehabilitation intervention schizophrenic and tend to have a mapping of the very personal space which is uh tighter more string with respect to healthy controls however this personal space can be expanded through motor exercise

01:11:11 this was first shown in in single neurons the macaques and then demonstrated in humans by a variety of studies if you have someone retrieving objects using a rake which extend the reachability out there in space of your forearm then the very same neural the map your very personal space so so to speak embody this tool which become part of your body skip okay so this very

01:11:41 personal space is plastic can be expanded through motor axis this dynamicity is found also in schizophrenic patients so they start from a shrinker smaller very personal space but this can expand as that of non-sizophrenic individual through motor exercise and we don't know why the dynamic processes of the brain that are developmental have ended up shrinking

01:12:13 that very personal space in schizophrenic fish yeah another interesting aspect that relates the body uh with schizophrenia is that um if you look very carefully you can see highly significant correlation between the phenomenality of the patient that you can study with a variety of scale and we we tend to use the the bond scale of basic symptoms the SPI uh schizophrenia pronouns instrument for

01:12:46 adults and basic symptoms are very interesting because they can be found even in the prodromic phases of the of the of the disease and are rather stable even during The Chronic phase we found significant correlation between the phenomenality of being schizophrenic as evaluated by the scale which are more significantly correlating with the neurobiological is a negative symptoms like the plant

01:13:18 scale Okay so the most severe your symptoms are the more deficient is the activation of this bodily related circuit that connects your body to the other uh most likely enabling you to appreciate the similarity of the other but granting to the other status of altered which is what I'm fulung is all about okay it's not my thing it's your feeling that I

01:13:50 understand so it's very clear in saying that you must and that's why they they crucify the poor lit lips is considered to project it when it comes to high school but anyway that's a different story so the point is that you can uh you can study the first person experience of a patient and Link it to uh the way of functioning of his brain body and this is something that very few

01:14:22 lab are doing uh in the world as we speak and I hope that more people will maybe uh beside the the genetics and the uh serotonin or dopamine or whatever a take on the issue will start developing also this form of correlation which are highly important I think we might have time to take a few questions from the audience so if you're interested you want to come up to the microphone and please keep your

01:14:54 questions it's on yes hi Laura price I'm a psychiatric social worker I work with uh patients with severe mental illness at a City Hospital I just wanted to say one thing about regarding like being an asylum is an institutionalization I I work with this every day I you know I wasn't there for the history because I'm you know I'm 42 but I know it was very horrific how people with severe mental illness were treated um you know there are really some good

01:15:24 initiatives out there we work a lot with Supportive Housing there really is a huge push to get um you know SMI patients you know living on their own there was like a lawsuit against New York State I don't know if you guys are aware of that so we have an adult initiative we have some patients that it's amazing like they they're very institutionalized you know they really some of them were abused when they were young and they were just like thrown into adult homes in Far Rockaway and they're trying to live on their own in support of housing in Jackson Heights Queens so it's really this is it's kind

01:15:55 of an emotional um topic for me anyway so my question is about I'm gonna mispronounce this so I need the experts in the room the ad hedonia yeah right lack of insight right yeah what no lack of pleasure sorry what lack of insect is one of the checklists right so the lack of insight I know there's a medical term is there anything in the pipeline to address that like with rehab or pharmacological treatment because we have some patients that are really suffering like who really just

01:16:26 they don't know that they're sick and it's really hard to yeah take care of them yeah thank you I thought Ed Smile as uh at me when that question was asked because uh you know I do work with these these substances called psychedelics that are now being um touted as um you know enhancers of insight and might might provide opportunity for New

01:16:57 Perspective one one Frontier that this area hasn't reached is giving these substances to people with psychosis um because of concerns about exacerbating the the problem but if we were to think more fundamentally about what these substances are doing and and how they might be helpful for for people with issues of insight or or even I like the time yeah

01:17:35 yeah I was thinking about um maybe even more behavioral strategies of of uh I thinking about the board you know the gutari's clinic that involved um most famously people would have these um it's a non-hierarchical clinic in France that was um oriented around rethinking

01:18:08 um one's relation to others especially within power structures and the patients and staff would stage place together they would take on roles the the thinking being that this is a way of practicing being in the world together but also a way of um paying attention paying deeper attention to one so you know when when occupying a role one one has this this distance between what one is and

01:18:38 what one is presenting as and there's opportunity for for thinking deeply about things now that that German saying um person who only knows his family doesn't even know his family so similarly I think with with that especially that that very very personal space being so constricted being able to broaden it in a more intersubjective social way the distance is a fascinating and important thing to say especially with Arts therapy which is what you've mentioned here uh theater is one

01:19:10 um writing I realize that for patients writing putting the word I on a piece of paper and writing a text that does not move then everyone around the table can look at that text I call it the alien familiar right so it's an I but the distance can also have a cooling effect on uh you know the patient on the group

01:19:43 and I I really believe that this can have therapeutic effects you could see it in the room I had no scientific ability to follow any of this up I you know could have evaporated after five minutes but during that time that alien familiar played I think an important role in is what Virginia will called cooling when she was writing her Diaries right

01:20:13 and she suffered from um uh what was then called manic depression now you know bipolar disorder but uh she felt that the diary had that effect essentially an antipsychotic effect for her yeah that process of reconciling with the alien system yeah turning it into something familiar with which yeah in language is already an alien familiar right it's it's not the

01:20:46 embodied self it is the self on the page away from this and that away quality can have therapeutic benefits that's why a lot of people write but you know there's a component also on ad which is the empathy that you exhibit when you deal with these patients because you're interested also in what they're writing right yeah and you want to understand your experience I I mean I find that that sort of like even to go

01:21:18 so far as to be transparent about your your own personal struggles with the patient's poor Insight even to say that in a way that's not judgmental you know this just puts me in a difficult position is a v you because we're having this problem you don't you don't you're rejecting what can we do about that and over time it's not an easy thing and it doesn't always work but I think over time these patients and it could be quite a long time they could develop more insight yeah I think that

01:21:52 you can't really do anything and then you they hang themselves they try and hang themselves no yeah yeah no exactly yeah yeah I wanted to ask the panel uh where is psycho pharmacology that's a big question but we're psychopharmacology going with all of this anyway

01:22:23 I mean there's a revolution in psychopharmacology right in the last decades is it good is it bad is it yeah except for what I'm a Layman so uh who had a schizophrenic sister for many many years and dealt with things as a Layman with institutions so I don't know but um and and you know the medication became a large part of her you know managing her life and so on but I'm just wondering in a more broad area as you're discussing where is that all going well you're the

01:22:54 you're the closest to the yeah right yeah I mean yeah yeah exactly that's that is something that we discussed is really how we're kind of um at in impasse in terms of developing new uh psychopharmacologic treatments I mean that the newest psychopharmacologic treatments are also old and they're the psychedelics um as making a Resurgence to treat certain conditions but in terms of you know new treatments for schizophrenia it's it's it's pretty

01:23:26 limited and I think that just reflects you know the the state of the Neuroscience that underlies uh our understanding of these conditions so particularly for negatives and and money has been withdrawn if you look at the you know there was enormous sums of money poured into both genetics and Neuroscience research um let's face that the ongoing fantasy was pretty reductive you were going to find a part of the brain

01:23:57 remember uh you know schizophrenia is a brain disease which is like saying nothing right I mean it's like zero meaning to that right but the idea was that you could show um diminished gray matter and schizophrenics right you can show this it it's not really a biomarker because you can also show it in pregnant women and poor children um so that kind of biomarker turns out to be useless from a clinical point of

01:24:29 view um not an interesting to ask ourselves what that means but if it also relates to say malnourished children and pregnant women how do we um how do we put all that together well there's one benefit Sylvania is the brand is which has its importance because it's saying it's not your mother's bad behavior who caused it which was a thinking not so long ago and also that medication brain-based

01:25:00 medications are the way to address it as opposed to other interventions well be they relational but actually even in psychosis there are psychotherapeutic uh approaches that have had very good effects I think they are not funded the research isn't funded because people don't stand to companies don't stand to make huge sums of money on those treatments but there's quite a bit of research that shows that psychodynamic Psychotherapy has had

01:25:32 positive effects on people with all kinds of uh different diagnoses so um it's a it's a mixed bag here I'm also a psychopharmacologist I would say that it's it would be false to go so far to say the meds don't do any good oh yeah and there are a few new drugs that are different the problem with most of the pharmacological research pharmaceutical

01:26:03 research is that there's a lot of you know they call me two drugs and drugs that work the same way the last successful you know big project drug works so they do something just like it but there are a few a few examples of drugs that are not like this is a new one called xenoma line xenomylene which works through acetylcholine and that's a new approach to treating these patients uh pimivantrin is a little bit of a novel antipsychotic so they're they're there's moving but what I find so interesting is that everything we talked about today so

01:26:35 all this phenomenological level of discourse we medicines are not getting at those particular things you know it you think about it most of what we said today had to do with well relating to the patient and understanding the patient holistically and whatever it is about the disconnect between the body if there's a neuro biological explanation whatever that disconnect is the medicines aren't touching that yet I don't think there's enough I mean that doesn't mean being less scientific than speaking about receptor of

01:27:06 neurotransmitter exactly the other way yeah I mean it's clear that the the brain functions in a certain way because neurotransmitters and receptors function in the very same way but nobody would dare to believe that we can find a solution of mental diseases and say schizophrenia by dealing with protons okay to compare neurotransmitters and receptors to proteins but in a way you

01:27:39 need more than that okay you need to put in in place in the picture other variables which are the fact mainly that we are never dealing with the brain in a bath we are dealing with a brain which is wired to a body which lives in a physical world dealing with other Brave bodies that's the point yeah so what might bring the way my brain Maps my being in the world

01:28:09 is the outcome of a variety of a multiplicity of causal factors you are dealing with cause of factors my life In Utero the kind of pregnancy that my mother entertained the quantity forget that there is a strong genetic Dimension to schizophrenia like in autism or in other conditions so it's all this puzzle that

01:28:40 we need to put in Focus if we are looking for the magical peel that once taken will dissolve all of my problems and turning myself in a successful high-functioning Western World guy forget about it to me one of the biggest problems is that we're actually from a neuroscience standpoint we're not working with adequate descriptions and characterizations of the phenomena that we're trying to treat that's right and

01:29:10 that's where I think phenomenology has a really important role to play and why we need to really seriously integrate that in our neuroscientific life is experience well and also to not be terrified by a subjective report right that you can have collections of patient uh testimony and that should be part of the science and it so rarely is in medicine you have

01:29:41 case studies not as many as there used to be but case studies and you never have quotations anymore okay it's great because it's the body hair this is beautiful um he is talking about his suffering um he says this is sensory the body think about it he said if it is cold I can still say that it is cold

01:30:13 but there are also times when I am incapable of saying it this is a fact for there is in me something damaged from the emotional point of view and if someone asked me why I could not say it I would answer that my inner feeling on this slight and neutral point did not correspond to the three simple little words I would have to pronounce and this lack of Correspondence therefore between

01:30:44 a physiological sensation and its emotional response in the first place and next is intellectual response insofar as it is possible to summarize and synthesize in general terms the series of Swift almost instantaneous operations which give rise to the truism it is coal this lack of Correspondence since it does not select its subjects on

01:31:17 on May or or spare me in any way culminate as it spreads in the Colossal troubles which correspond perfectly alert to the loss of personality I mean this is profound this is a description of such Nuance by a person of such high intelligence who's working so hard to describe what has happened

01:31:47 is this not valuable to Medicine you bet it is sometimes that level of Lucidity like I was thinking you invoked um binsmonger earlier and thinking about the case of Ellen West and how Lucid she was she knew exactly say um and the whole I'm thinking about the the Foucault binsmonger and dream in existence volume um too that has I mean they talk about that but the case of Ellen West which is

01:32:18 followed by the the diagnoses were they none of them are as Lucid or or clear as she is about what she's she's laying it out she's stating it and nobody can help her so it's there's a level of insight there sort of the opposite of what she was asking you were asking earlier about your patients lack of insight so having insight doesn't necessarily get you the kind of treatment that you might think you could get and that just that that failed case I thought was I just was so struck I've always you know come back to

01:32:49 that it's just anger got it wrong also would that be about yes yes it's her testimony it's just what you're saying sir the power of the testimony and it's and and also I think you know to keep thinking that human beings are people who make meaning we make meaning in multiple ways um through patterns so you want to hear Virginia Woolf I love Virginia okay about her her psychosis

01:33:21 she gave this um it's called Old Bloomsbury is this is just a little part of it and she gave it at the Memoir Club she was doing fine when she gave this when I look back on that house it seemed so crowded with scenes of family life grotesque comic and tragic with the violent emotions of Youth Revolt despair intoxicating happiness immense boredom with parties of the famous and the dull

01:33:52 with rages again George and Gerald with love scene with Jack Hills with passionate affection from my father alternating with passionate hatred of him all tingling and vibrating in an atmosphere of youthful bewilderment and curiosity that I feel suffocated by the recollection when I recovered from the illness that

01:34:22 was not unnaturally the result of all these emotions and complications 22 Hyde Park no longer existed while I had laying in bed thinking that birds were singing Greek choruses and that King Edward was using the foulest language possible among Ozzie Dickinson's azaleas Vanessa had wound up Hyde Park once and for all

01:34:57 that's great I think um we might have time for one last question does anyone interested you want to come up please so quickly first of all thank you this has been a very interesting uh conversation I was struck by the fact that hearing voices is the shorthand that we're using to describe auditory hallucinations because of course it's uh something that we all do it's a means that your mind is

01:35:27 functioning properly we're all hearing we just heard voices just now hopefully we're hearing voices we're feeling textures yes you know we're doing all these things but um it reminded me that uh what we're really talking about is the not being in the world there's a there's a sort of a I think a consensus that something of the insights of phenomenological uh experience um help us understand psychosis in an

01:35:58 important Way Beyond the Pharma Pharmaceutical um but that world is really what's interesting about the question right and I was I was just as I was sitting I was imagining um a patient perhaps who says you know I'm crippled by this sense that when I eat that the food becomes human flesh inside of me and it's terrifying Oh you mean the Eucharist like so that led me to wonder what about the religious how do you approach psychosis from the perspective of religiosity and for

01:36:29 people for whom for that the world is occupied by presences and experiences that in a in a sort of a clinical condition you might describe as as hallucinatory foreign well yeah that's something that we're uh working to better contend with as a field I would say because you know that I mean that really touches on one of you know that broader issue that

01:37:00 we referenced a few times of where do you draw these lines that we're trying to draw and when when does someone's reality differ so much in such in such a way that uh we as a society decide there's something wrong with that um and often it ends up being a a matter of degree which is not necessarily the best way to do it but um you know we certainly are trying to do a better job of taking in cultural

01:37:31 context as I think this discussion reflects we need to do an even better job that's that's I guess the main thing that I would say is that that's you know it's a very challenging issue that gets that a lot kind of the heart of a lot of what we were discussing that we really need to continue to work on I just wanted to mentioned to our two Arctic films that deal with this problem in

01:38:03 terms of the community relationship and attitude toward it one was an old Italian film by the taviani brothers called cows and in it one man would as a lunatic would Howl at the Moon every time it was a full moon so the village just tied them to a tree and he howled like a wolf of the at the moon and then the next day they untied him and he lived the other 27 days until the next moon and there's a wonderful

01:38:35 film out right now called Empire of light a Sam Mendes film where Olivia Coleman plays the schizophrenic woman in a small English Village and everyone on the staff of the movie theater that she's in just knows she's going to have schizophrenic episodes and they deal with it and they cover for her when she's hospitalized and it's so they're both so moving in terms of what our attitude is toward people who go through these experiences I just wanted to

01:39:07 mention them she's up for an Academy Award for that right of light one I just want to add one more thing about the religiosity question you know a lot of times just the simple what do the people in the person's family thing or anyway in their in their universities

01:39:38 a little bit of a litmus test that you can apply yeah um but also the question is does it is it divisive or does it move the patient into more conflicts with people in their Community or is it allowing them to really form a wonderful bond with people because that's the whole idea of the religion yeah have a sense of humanity and Brotherhood or Sisterhood and such so I think that's an important thing like it goes back to the question so does the illness create conflict and tension either for the patient they're suffering or for the

01:40:08 loved ones and people around them who are trying to but religion isn't very interesting if it's if it doesn't involve conflict um that's not true of all people I think I think about Jesus I came not to bring peace with the sword so uh yeah that there's invariably going to be some disruption in in religious expression even even when the person is expressing the religion according to the the tenets

01:40:40 right that it's it's um you know anchored in something ineffable and well the cannibalism is interesting that he brought up right because it turned out um that the early yeah the youth is sorry that the um that the early the turn against the Jews right who during the medieval period were blamed for play for eating the flesh right until it was

01:41:13 like an it's an inversion of the Eucharist in in that case so the other scapegoating is something that can enter into this discussion too well not very large note I want to thank everyone the panel for really stimulating talk today the rest of the week thank you thank you

01:41:44 [Applause] thinking the religious example moves you from hearing voices to speaking in tongues oh that was great okay