This episode features a conversation with psychiatrist, author, and Peabody Award-winning producer and director, Dr. Kenneth Paul Rosenberg. He’s the author of “Bedlam: An Intimate Journey Into America’s Mental Health Crisis” and director of the documentary “Bedlam.” (Read more about his work and virtual visit to the University of Iowa.)

Anya, Alexis, and Dr. Rosenberg talk about the challenges of creating work that could be seen as controversial in the eyes of fellow clinicians, the state of mental illness in the U.S., and individual/systemic level change that could improve the quality of care.

Anya Morozov:

Hello, everyone. Welcome back to From the Front Row, brought to you by the University of Iowa College of Public Health. My name is Anya Morozov, and I am joined today by Alexis Clark. If this is your first time with us, welcome. We’re a student run podcast that talks about major issues in public health and how they are relevant to anyone, both in and out of the field of public health.

Anya Morozov:

Today, we are talking with Dr. Kenneth Paul Rosenberg, who works as a psychiatrist in a private practice in Manhattan and as a clinical associate professor at Weill Cornell Medicine. He’s a distinguished fellow of the American Psychiatric Association, and he is also a Peabody award-winning producer and director of multiple films about mental health issues.

Anya Morozov:

Finally, he is also the filmmaker and author of Bedlam, an intimate journey into America’s mental health crisis, which is this year’s book for the University of Iowa College of Public Health’s Book Club. Today, he is on the show to talk with us about his career, his book and film, and serious mental illness in the United States. Welcome to the show, Dr. Rosenberg.

Kenneth Rosenberg:

I pleasure to be here.

Alexis Clark:

So Anya just gave a great introduction to what you’re currently endeavoring in. What was your journey like to psychiatry, and why did you decide to venture into other forms of work such as filmmaking and writing?

Kenneth Rosenberg:

Right. So I went to medical school to become a psychiatrist. I wanted to become a psychiatrist because it fascinated me. I loved learning about the human mind. I became very interested in the 1970s and 1980s in humanistic psychology, transactional analysis, Fritz Perls, all these great authors and great thinkers.

Kenneth Rosenberg:

But I had another reason as well. My sister had schizophrenia and developed a very severe case of schizophrenia, and unfortunately ultimately died from schizophrenia. That happened later on, but her illness and my experience with my family, on top of my interests, led me to want to become a psychiatrist.

Kenneth Rosenberg:

And by the way, I went to medical school for no other reason except to become a psychiatrist. I was not interested in… You could keep the bodies, you could keep the microscopes, all the things that you have to do as a medical student were kind of interesting, but really not something I wanted to really delve into.

Kenneth Rosenberg:

Now, the first year of medical school in New York City at the Albert Einstein College of Medicine was really tough in a way. There was no psychiatry, or very little psychiatry in that year. And I was going to cut up a rat brain that summer and do the research I had done from since I was an undergraduate, but I decided, “Nah, this summer I’m going to do something really different. I’m going to take a film course.”

Kenneth Rosenberg:

And for me, making films and interviewing people and delving into the issues of mental illness and mental health vis-a-vis film, was much closer to what I was interested in than what I was doing in medical school. So it wasn’t that I was interested in doing something else, it was that I was interested in really being involved with people’s lives, telling their stories, getting to know them. And film provided me such a vehicle.

Kenneth Rosenberg:

And I loved it. I really loved the visual part of it. I loved the storytelling part of it. And my medical school, as it turned out, was very, very supportive of me. And they enabled me to study film at NYU while I was getting my medical degree.

Kenneth Rosenberg:

And throughout my career I found that level of support. My residency at Cornell was supportive. My fellowship at Cornell was very supportive. They created a fellowship that would allow me to study addiction psychiatry, which I was interested in, but also allow me to make films and study films and talk about films. So I was really blessed with mentors who could support this interest and not think it’s some wacky thing.

Kenneth Rosenberg:

And I can’t emphasize it enough, for me, making films, writing books is just like my same job as a psychotherapist. I’m in with someone’s life. I’m trying to understand what they’re about and I’m trying to make some sense out of it, and put it to some good use.

Kenneth Rosenberg:

So there is a lesson in there for all of us. You don’t have to be someone with schizophrenia or bipolar disorder to know what it’s like to have that and to learn something about your own life and your own world.

Alexis Clark:

Do you think had your mentors or your medical school not have played that level of support that your career path or your life would look a lot differently?

Kenneth Rosenberg:

Yes, absolutely. My mentor in medical school, his name’s David Previn, became really one of my best friends in what I’ll call adult life as a doctor and a professor and all that. And we’re still close as friends to this day. And oh, it was so important because David Previn, he was the person who led us in psychiatry at the medical school.

Kenneth Rosenberg:

He really believed in what I was going to do and really supported. And he helped raise money. If you make a film… If you write a book you need some way to support yourself. But if you make a film, you need some way to support yourself and tens, if not hundreds of thousands of dollars to support your endeavor. So David was really helpful in doing all of that.

Kenneth Rosenberg:

And throughout my career, there were many psychiatrists, [inaudible 00:05:34], Allan [inaudible 00:05:36]. These names mean nothing to you, but to me they were the people who really steered me in a direction and said we’ll help you do this.

Kenneth Rosenberg:

Absolutely. Mentorship meant everything to me, including the mentorship from my medical school. I thought about going to Penn for medical school, and I’m not sure that they would’ve been as supportive, but Einstein surely was.

Alexis Clark:

So when writing Bedlam, did you have in mind always that there was going to be a film to follow, or what was the chronological order there?

Kenneth Rosenberg:

Well, actually, films take a long time. So writing the book and making the film took about seven years, maybe really longer if I’m going to be honest. I think it was 2010 that I thought about this project and started looking in earnest at where I was going to do it. And it was 2019 we premiered at the Sundance Film Festival, and 2020 that we were on TV on PBS.

Kenneth Rosenberg:

So, a long time went through it. And so the book and the film developed simultaneously. I always have to say whenever I make a film now I always think of a book. And whenever I write a book I always think of a film. So they worked hand-in-hand.

Kenneth Rosenberg:

The book really offered me an opportunity to do what the film couldn’t. In a film you can’t go much longer than 90 minutes in a documentary. Some people do, but it’s really super hard. And you have to have a narrative that really is cohesive and makes sense. That has a beginning, middle, end.

Kenneth Rosenberg:

In a book you don’t have to worry about that so much. You could start with one character, go to another character, go to another chapter. It’s divided up very neatly in chapters, which enable you to do different topics.

Kenneth Rosenberg:

So the book really enabled me to go into the history. We went into the history… If you’ve seen the film, we go into the history in the film, and the film’s available on Amazon and all those places. But if you see the film, we go into history, but just the history of psychiatry is collapsed into three minutes. In the book it’s 40 pages at least of where we came from, and then 40 more pages about where we need to go.

Anya Morozov:

So when you released the film how did stakeholders like the National Alliance on Mental Illness, the American Psychiatric Association, and the LA Mental Health Department react to the film?

Kenneth Rosenberg:

Great question. So, the National Alliance on Mental Illness, NAMI, they were always really supportive. We actually worked a lot with NAMI before the film came out and worked with them about how we would bring the film out and what kind of thoughts we should put into, not only the film, but into the marketing, if you will, and trying to get our messaging across. So they were very enthusiastic, as enthusiastic as anyone could be. And we expected that.

Kenneth Rosenberg:

I was a little more scared about organized psychiatry, frankly, because in the book and in the film I take a lot of shots at psychiatry. And I say that we, in psychiatry, have abandoned our sickest patients. Now that’s not a popular thing to say to your colleagues. But they took it really well. In fact, the American Psychiatric Association embraced the film.

Kenneth Rosenberg:

I was also afraid about how the folks in Los Angeles would react because we show they’re really good doctors, actually great doctors, great healthcare providers. Everyone’s trying to do their best but the system is really broken. It’s really messed up. And I was afraid that they would not like showing how messed up their system is.

Kenneth Rosenberg:

It turned out they loved it. They couldn’t have supported it more. They actually took over the Paramount Theater and Paramount lots in Los Angeles because they wanted to usher the film into LA. And we had big screenings there sponsored and supported by the Department of Mental Health. So they became in some ways our biggest fans.

Kenneth Rosenberg:

And I think I’m really moved by that, frankly. I’m really touched by the fact that we had this diverse group of folks, from Black Lives Matter to the National Sheriff’s Association. You can’t get these people in a room otherwise. And the American Psychiatric Association and groups that were not so in favor of psychiatry, and pretty much they all rallied behind the film.

Kenneth Rosenberg:

And I think they did because the film was very honest. It wasn’t finding villains because I don’t think there are villains in this. But it was saying we have to do a better job. And we’re doing a terrible job, in fact. And our society has ignored these people, but we, professionals, have also ignored these folks who are really sick. So the fact that we had such an incredible response was very, very… It just felt great.

Alexis Clark:

I think that’s really important that you did go in with such an open mind because I think you’re right, it could have gone one, one way or the other. And the fact that they did rally behind this film and this book really says a lot that people are trying to improve the system.

Kenneth Rosenberg:

Yes.

Alexis Clark:

So moving on to the topic of mental illness, can you define exactly what constitutes as a serious mental illness?

Kenneth Rosenberg:

Well look, any mental illness that you or I have or our family members have is serious. But in the psychiatric understanding, what we call serious mental illness, are those illnesses that are really debilitating. Those illnesses that stop you from working, that stop you from having relationships.

Kenneth Rosenberg:

It’s not like you’re anxious, you’re depressed, and it’s a little hard to have a relationship or you’re, “God I’m going out with the same person over and over again.” All the kind of problems that we usually have, but that you find it impossible because, for instance, you’re hearing voices and the voices are telling you that everyone is out to get you. Or you’re having delusions and you think you’re seeing things, and you have misunderstandings or misperceptions.

Kenneth Rosenberg:

So serious mental illness, which affects some small percentage of the population, anywhere from 1 to 4%, really are those illnesses which make it impossible to function. You can’t work. You can’t have a relationship. You can’t really live outside some protective place.

Kenneth Rosenberg:

And those illnesses are things like schizophrenia and bipolar disorder, both of which, by the way, are very treatable if people get illness. But in their acute foment state, when you get really sick with those illnesses, man, you can’t do anything. You’re really sick. So that’s what we call severe mental illness.

Anya Morozov:

Kind of related to that, are there any groups that are disproportionately affected by serious mental illness?

Kenneth Rosenberg:

Great question. So, what are the things that cause serious mental illness? Well, certainly it’s partly your genes. It’s partly your DNA. But at most your DNA accounts for 50% of it. At most.

Kenneth Rosenberg:

So why do I say 50% of it? If you have schizophrenia, let’s say, and you have an identical twin with your same exact DNA, more or less, and they have what chance of having schizophrenia if you have schizophrenia?

Kenneth Rosenberg:

Well, they have a 50% chance. The same DNA. Well, what else? And that’s a very severe illness, which is very treatable, by the way, but still a severe illness. And probably the most biologically based illness.

Kenneth Rosenberg:

So what accounts for the other 50%? Poverty, trauma, structural racism surely doesn’t help. If you are mistreated and you don’t have a family structure, that doesn’t help. If you are doing substances, if your life revolves around recreational substance abuse. And you’re not just getting high once in a while, but you’re addicted to alcohol, or any other kind of recreational drug, well that puts you at much, much greater risk.

Kenneth Rosenberg:

So the people who are more vulnerable are people who are subject to all those sorts of things. Of poverty, of, structural racism, of trauma, repeated trauma.

Kenneth Rosenberg:

So in our film, we have a guy, Monty, for instance. And in our book, we have a guy, Monty. Monty is a black man who was diagnosed in jail, and then in prison. He had a very severe mental illness. He had schizoaffective disorder, which is some combination of bipolar disorder and schizophrenia. And Monty was not diagnosed until he was in jail for a number of years.

Kenneth Rosenberg:

And that was very traumatic for him. So he didn’t get the proper treatments. He was traumatized. He was certainly the recipient of a lot of bad stuff in life. And that makes someone certainly more vulnerable to a mental illness. And we see that in Monty.

Kenneth Rosenberg:

Now, Monty also has something great going for him, which is a wonderful, wonderful family. And if you’ve read the book or seen the film, his sister Patrisse, was so involved in his care and she was actually quite involved in other people’s care. She co-founded Black Lives Matter. And she did that in the course of our following her for the book and film. But a good family’s good, but all the other things that Monty had against him, that puts him at great risk.

Alexis Clark:

So a question relating back to your comment about substance abuse being a factor. A lot of times substance abuse and schizophrenia, for example, are related. Is it actually the substance that can trigger the on-bringing of mental illnesses? Or is it more so their lifestyle and them revolving their lifestyle around these substances?

Kenneth Rosenberg:

That’s a great question, Alexis. And I think that if you could answer that you’ll win the Nobel prize. It’s very, very, hard. But I think your question implies what is probably happening, which is, once you have a brain disorder or a mind disorder, if you prefer, you’re then more vulnerable to all the other bad things that can happen to you. Bad relationships, bad situations because of poverty because of the downward spiral of life, if you’re seriously ill.

Kenneth Rosenberg:

And one of the bad things that could happen, especially if you’re, God forbid, living on the streets, is that you’re now using lots of recreational drugs because that’s your world. And frankly, it’s a way to escape or even self-medicate the horrible things that you’re experiencing, both because of your situation and also because of your illness. Now, so that’s the idea.

Kenneth Rosenberg:

The second idea that you mentioned, Alexis, which is that mental illness makes you more vulnerable to substance use. But it could work the other way around. And in the book I write about that quite a bit. This might be a rather unpopular thing to say, but I do believe that for a certain population that substance use will open a window onto mental illness that might otherwise have remained closed.

Kenneth Rosenberg:

And I think that, although I’m a fan of not criminalizing marijuana, I believe that for some people, some small population, smoking day and night, as I’ve had patients do, will open a window on a psychotic experience. A psychotic experience like schizophrenia, bipolar disorder, that might have otherwise remained closed or partially open.

Kenneth Rosenberg:

So I think that it’s hard to figure out what is what here, but I think it’s fairly safe to say that if you have a mental illness you’re vulnerable to all these things and they’re going to make you worse. And if you do something, for some subpopulation that’s vulnerable, that may bring out a foment mental illness that would’ve otherwise remained dormant.

Anya Morozov:

Yeah. That makes a lot of sense. You talk a lot in your book about the role of early intervention in improving outcomes for people with serious mental illness, and how that can be very difficult when there’s stigma surrounding these illnesses. So what would you say are some of the early warnings signs of serious mental illness that can prompt people to seek care?

Kenneth Rosenberg:

This is a very important question, Anya. Thank you for bringing it up. The early warning signs are hard to say because these illnesses become apparent over time. You can’t really say that because someone’s doing X or Y or Z, that they’re going to develop schizophrenia or bipolar disorder. But there are some things that we know are associated with those people who develop it.

Kenneth Rosenberg:

So, what we would call bizarre thinking. Thinking where people are really just, it’s not that they’re out the box or original thinkers, but they have thoughts which just don’t make sense. Or they have ideas, magical ideas, which are not just their connection to spirituality, but it’s over the top. It’s not what you or any of your friends are thinking.

Kenneth Rosenberg:

They have mood disorders. And again, we all have bad days and good days. We all have depressed days. And we all have days where like, this is the greatest day ever. But people with bipolar disorder, in particular, are subject to really deep depressions and really high highs. Really this irrational exuberance, mania, euphoria.

Kenneth Rosenberg:

So you could see some of these things in people who are vulnerable. You also see that they’re cutting themselves off from other people. Their school work is declining. Their friend base is shrinking. They’re not showing up and everyone’s wondering why. So that could be any number of things from a mental illness to a substance abuse problem, but it really suggests there might be a problem.

Kenneth Rosenberg:

And it’s important… You mentioned the stigma. It’s really important that we not let that hold us back because we know that any illness, any illness, if you treat it early on, if you address it early on, it’s much easier to treat than down the road. It’s much easier to treat stage one cancer or stage zero cancer, and that’s why we all want early detection for these kinds of things, than it is to treat stage four metastatic cancer.

Kenneth Rosenberg:

Well, the same is true with mental illness. It’s much easier to help someone when they’re having some problems and they’re on the cusp of some bigger problems than when they’re homeless or ill for years and years and years. It’s an art to figure that out, Anya, because you don’t want to be overly aggressive with medications because of the side effects. You don’t want to take someone out of school, for instance, and send them to hospital unless you absolutely have to. That could really have a profound impact.

Kenneth Rosenberg:

But still, it’s really super important to figure out what is going on and at least get therapy, at least talk to a professional. At least talk to someone so you get some help early on. That’s critically important. And we all know people like that. I’m sure you know people in school where you’re like, “I think they should really talk to someone because things aren’t going so well for them. They were doing okay in the first semester, but by their sophomore year it’s not looking good.” And it’s really super important to get help with that.

Anya Morozov:

So as a family member or a friend, or just being a concerned individual in general, what are some ways you can support someone with a serious mental illness?

Kenneth Rosenberg:

Yeah, it could be really hard because when people get a serious mental illness they have something called anosognosia, which I wrote about the book. And that means that you’re hearing voices and you have a sense that the FBI is out to get you, and that your roommate wants to stab you in your sleep. And you don’t have a sense that that’s wrong. You have a sense that all that’s right and anyone who argues with you, you immediately think they’re part of the conspiracy. There is a plot against me.

Kenneth Rosenberg:

So it’s not so easy. But you really want to approach people, it’s so corny to say, but with love and understanding. You want to let them know, “Look, I’m not trying to judge you, but I think you have a problem.” It’s very, very helpful to contact family members. It’s very, very helpful to contact other people in the network. Maybe a teacher, certainly someone in the health office who could really help you think this through.

Kenneth Rosenberg:

And I think that’s true whether they have a substance abuse problem, or a mental health, or a mental illness problem. And I would encourage people to think you’re not ratting them out, you’re just trying to find some way to help them because you know that this gets worse, and a fair number of people commit suicide. And a fair number of people get sick and get in trouble and have to drop out of school. And you want to really endeavor to prevent that.

Kenneth Rosenberg:

So, I would say support them the best you can. Not abandon them, and not get angry at them, and not try to rescue them. We try to rescue people and we’re like, “I’ve got to help you. You have to listen to me.” Then we end up fighting with them, they fight with us, and we feel persecuted, and then we feel victimized and they feel victimized. So just hanging in there with them and trying to be just a loving family member, a loving friend. But I hasten to add, sometimes that’s not so easy to do because you will be seen as part of the enemy camp.

Anya Morozov:

When somebody first seeks out treatment, can you talk a little bit more about what that looks like? And if somebody, like a family member is seeking to help with that process, how much can they, and how much does somebody need to refer themselves for care?

Kenneth Rosenberg:

I want to answer… Anya, I think it’s a very important question, but when you say how much does someone need to refer themselves for care, I’m not sure exactly what you’re asking.

Anya Morozov:

Yeah. I guess in your experience, does it tend to be people are self-referring or are they being referred by family members?

Kenneth Rosenberg:

Family members. Yeah. Yeah. It really depends on where people are at. I think, thank God, millennials and younger are much more aware of mental illness problems than people, that previous generations and baby boomers who are just so ashamed to get help. I think people who are in university settings are much more educated and aware of these issues. They’re much more willing to get help.

Kenneth Rosenberg:

But by and large, when people get really sick and really get reclusive, then it’s often the family members or friends, or roommates, or whomever, who have to say, “Hey, we need to get you help.” And sometimes that help could take a very aggressive stance. Sometimes you have to hospitalize people against their will, or unfortunately, the police might have to take them out of their room and put them into a hospital.

Kenneth Rosenberg:

So I don’t think there’s any formula. I think that for people who are very, very ill, it’s often the family members, friends, and loved ones who have to get involved and bring them to someone’s attention. But it really, really varies.

Kenneth Rosenberg:

Increasingly, because there’s awareness and because there’s a lot of initiatives for what’s called first episode intervention, where you intervene with someone who has a serious illness, a serious mental illness early on, and there’s lots of talk about it, people are self-referring more and more. And again, I think younger people, people who are more educated, are willing to do that because they realize it’s very good help than not.

Kenneth Rosenberg:

I think everyone should be in psychotherapy. That’s what I do for a living. So I think that we all should avail ourselves of mental health. And I think that younger people really realize that, whereas older people are stuck with the idea that, there’s your medical health, and then there’s going to an asylum, and there’s nothing in between.

Kenneth Rosenberg:

But if you had, just like we see doctors, medical doctors all the time, why should you get a yearly physical or go to a specialist for some issue you might have, but not get your mental health checked or be talking to someone? That’s just part of the, I really think ignorance and stigma that we have lived with for a long time.

Anya Morozov:

So in your book Bedlam, you give a really good summary of the history surrounding the treatment of serious mental illness in our country. Would you be able to summarize some of the main events in mental health care policy that has led to some of the present day gaps that we’re seeing in care now?

Kenneth Rosenberg:

Absolutely, Alexis. So, look, the history of mental illness treatment is as old as the history of medicine. But let’s start in, let’s say, the 1800s, when in the Enlightenment period people wanted to build asylums or places where people could go and get help.

Kenneth Rosenberg:

And the Quakers, in particular, in this country and in Europe, created what’s called the moral treatment, which doesn’t sound good. It’s not a great name. But what the moral treatment was is just rest and meditate and give yourself to God or something, give yourself to good work and just take it easy, just chill for a little bit. And that became the treatment till pretty much until the 1900s.

Kenneth Rosenberg:

Now, those asylums were built with the best of intentions. They were monuments to enlightenment and improvement. They were replacing the jails. They were replacing the terrible places that people had been. But by the mid 1900s they really became disgraces. They became terrible places and they were a national disgrace and scandalous, frankly.

Kenneth Rosenberg:

Now, in between that, before you get to the 1950s when there’s this movement to get rid of those, abolish those terrible asylums, before that, in the 1900s, early 1900s, there are all these biological psychiatry treatments that people tried. And not with much success.

Kenneth Rosenberg:

And they were, what many people call desperate attempts, huge attempts to do things like take people’s intestines out or take their teeth out because it was this cockamamie idea in the 1920s that infections were the source of mental illness. Which had some credence because syphilis had become a major problem for mental illness. And that was cured by penicillin. And it was an infection. And that was discovered in the 1900s.

Kenneth Rosenberg:

But for schizophrenia and bipolar disorder there was no infection that was causing this. But that idea was there. People would take out people’s body parts with the idea that that would cure them. They would put them in a coma, an insulin coma, to cure them.

Kenneth Rosenberg:

They would do frontal lobotomies in which they would literally take an ice pick and drive it through the crevice between your eyeball and your nose and knock it into your brain to try to knock out some frontal lobe tissue. And that, of course, was a disaster. That also was what people were doing. It was so important, as I talk about in the book, that it won the Nobel prize for advances in medicine. But it was not an advance. It really wasn’t.

Kenneth Rosenberg:

Then in the 1950s they developed these drugs, which were no panacea, but they enabled people to finally leave the asylums. Finally get out the door and finally not have to be harassed by these delusions and hallucinations.

Kenneth Rosenberg:

Now at the same time, as I was saying earlier, asylums became scandalous places. So President Kennedy, in 1960 said, “Hey, let’s get rid of these asylums. Let’s replace them with community mental health care. And now that we have these drugs, let’s get people in the community and treat them there.” It was a good idea, but poorly executed.

Kenneth Rosenberg:

And jump to the 1980s when President Reagan is in office, he says, “Look, these community mental health center centers aren’t doing anything. Let’s get rid of them. Let’s give the money back to the states. The federal government should no longer be in this business.” And as a result you had at that point in the 1980s few asylums, I won’t say no, but few asylums. Roughly 80% or more of the asylum beds had been gone by the 1980s, 1990s.

Kenneth Rosenberg:

And then you had no community mental healthcare service, which wasn’t so great, but it was something. And then you had these drugs, which were good, but they weren’t a panacea. So we really developed a real gap in the system. And that’s when you see a homeless population develop. There really wasn’t… There were hobos in the Great Depression, but there wasn’t this big homeless population. And it’s developed for a lot of reasons. Housing crisis, poverty, drug abuse, a lot of reasons. But the lack of infrastructure for people with serious mental illness certainly contributed to at least 25% of homelessness.

Kenneth Rosenberg:

And then in the 1990s, where are we going to put these people? Well, they end up in the jails. We’re going to have the same number of people who had been in the asylums per capita now are in the jails. So the jails and the prisons become the largest providers of mental health care in America. Our three major providers of mental health care are our three largest jails.

Kenneth Rosenberg:

And that’s a situation we have now. We have emergency rooms, we have psychiatric care, we have new medications, but still, we’re stuck with this legacy of how to treat people and where to treat them. And that’s something that developed about 200 years ago, but it’s a disaster that now we really have to remedy.

Anya Morozov:

Yeah. I think it’s really interesting how it is the story of people trying to do an intervention with good intentions that just doesn’t pan out the way they planned, that’s led us to today. I find that interesting.

Kenneth Rosenberg:

The road to hell is paved with good intentions, right?

Anya Morozov:

So looking forward and thinking carefully about any next steps that we planned, what do you think would be some policy or organizational level changes that could improve care for people with serious mental illness [crosstalk 00:34:13]?

Kenneth Rosenberg:

That’s a great and important question, Anya. Well, for starters, we have to realize these are medical illnesses, and we need medical research. We need better medications. The medications, as I point out throughout that, some are very problematic. They help people, but they also cause lots of problems for folks, diabetes among them. And that’s a significant problem, weight gain, movement disorders.

Kenneth Rosenberg:

And there are some people who say the medications have made things worse. Well, I understand and respect that perspective. I don’t think that’s correct. But the medications need to be improved, and the way they’ll be improved is by research. So, we’ve made in this country, cancer a priority. I think we certainly should do that for serious mental illness, and those illnesses like schizophrenia and bipolar disorder.

Kenneth Rosenberg:

So because it’s a medical illness, we need medical research and we need new medications. Look, we also need good places to put folks. You can’t solve any illness with a brick and mortar solution. You could build a hospital, you could build a jail, whatever you build is not going to cure the illness. But we could have better places to put people. So I think we should build community mental health centers. I think we should build compassionate psychiatric centers, which humanely take care of people.

Kenneth Rosenberg:

And I think we need to see that shift as well. I think we also need to have [inaudible 00:35:44]. This is not a Bernie Sanders’ platform here, but I think that at least when it comes to serious mental illness, these folks do much better when they have universal healthcare. When they have wraparound services. When they have healthcare that comes to help them to prevent them from getting sicker. Not just comes to help them when they need to go to an emergency room and rack up a big bill, because we have an economically incentivized medical system, which provides incredibly good acute care, but not very good preventative or long-term care.

Kenneth Rosenberg:

So I think those are the three things we need. And we also need to educate law enforcement and that sort of thing. There’s a whole list of things I talk about in the book, like mental health courts and something called assisted outpatient treatment.

Kenneth Rosenberg:

And I think we also need treatments that don’t rely on medication but rely on psychosocial interventions. And there’s a very good record of people in places who do that in Norway, in Israel, in parts of the United States. Places where they hardly use any medication, but they really treat people effectively by treating them humanely and compassionately.

Alexis Clark:

Do you think when looking ahead as the millennial and the Gen Zers are taking on professional roles, do you see access in mental health services expanding in a positive light as this generation is growing up?

Kenneth Rosenberg:

Absolutely. Because I think this generation is really more interested in it and they also grew up in a time when a kid goes to the nurse for their afternoon medications in elementary school. And when it’s not such a big deal to see a psychotherapist. In fact, it’s probably, the smart kids in class are [inaudible 00:37:35]. And also they grew up in a time when there’s a lot of information about mental illness and severe mental illness out there.

Kenneth Rosenberg:

So it’s not just like the 1950s or 60s where all you’d see are images of One Flew Over the Cuckoo’s Nest or, there was a movie called the Snake Pit, that sort of thing. So yeah, I think Gen Z and millennials are really benefiting from a shift, a paradigm shift, that they’re, frankly, a part of.

Anya Morozov:

Well, I think that’s a good hopeful note to end on. Our last question that we ask to everybody on the show, is what was one thing you thought you knew but were later wrong about?

Kenneth Rosenberg:

Oh God, the list is so long. But let me say with regards to the book and film, that I told you about this guy, Monty. I met his sister. And I met his sister because she was trying to help him. And she also told me that she was an activist. And I thought when I met her, I thought, “This is great because I really believe in activism.” I believe that activism could change things.

Kenneth Rosenberg:

But I thought to myself, it’s like, “You want to be a rock star. You’ll never be a rock star. You’re not going to change things that much. It’s good that you want to do it, and I’ll chronicle your efforts to do it, but I’m not going to bet on it.” It turns out she becomes the foremost mental health activist in the world and she co-founds Black Lives Matter, Patrisse Cullors, who’s now my friend. That’s one thing I was completely wrong about.

Kenneth Rosenberg:

The other thing is when I saw Bruce Springsteen when I was a kid. I said, “He’s a great guy, but I don’t think he’s ever going to become a singer.” He also became a star as well, but that’s for another podcast.

Anya Morozov:

Well, those are all great points, and I really hope that this podcast can contribute to the conversations about mental illness in this country and hopefully spark more conversations among our listeners.

Anya Morozov:

So just to conclude, thank you, Dr. Rosenberg, for joining us today.

Kenneth Rosenberg:

My pleasure.

Anya Morozov:

And I really highly recommend reading Bedlam. We’ve touched on a lot of it on the show today, but there’s a lot more to the book that I think we could all benefit from learning from or from watching the associated documentary, which is available on Amazon, iTunes, and Google Play to learn more about serious mental illness in the United States.

Speaker 4:

That’s it for our episode this week. Big thanks to Dr. Rosenberg for coming on with us today. This episode was co-hosted and written by Anya Morozov and Alexis Clark, edited and produced by Alexis Clark.

Speaker 4:

You can learn more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple Podcasts, and SoundCloud. If you enjoyed this episode and you’d like to help support the podcast, please share it with your colleagues. Our team can be reached at cphgrandambassador@uiowa.edu. This episode was brought to you by the University of Iowa College of Public Health. Stay happy, stay healthy and keep learning.