Patrick Dylan's Blog

Our Broken System

Let’s do a thought experiment. Imagine that a person you love is driving on a mountain road. You’re watching from above, maybe from a helicopter. The road they’re driving on is unusual—it has tall walls on both sides, so your loved one can’t see the terrain. Suddenly, they begin driving faster and faster, which makes you nervous given how windy the road is. You glance ahead and see that around the next bend the road plunges off a cliff.

In other words, you are watching your loved one speed toward disaster, and you can’t do anything to help.

This terror captures what happens when a serious mental illness (SMI) strikes your family. In some cases, like ours, the attack is sudden and jarring. In others, the illness progresses over a longer period of time, with behavior becoming gradually more bizarre. But in each case, as your loved one moves closer toward the cliff, you feel more and more helpless.

“Leave us helpless, helpless, helpless." -- Crosby, Still, Nash & Young

Why feel helpless, you ask? First, you must understand that acute psychosis accompanies the worst psychiatric diseases. Psychosis means that your thoughts are not based in reality. You begin believing, hearing or seeing things that are not actually happening. However, given that your brain is processing all this information as real, you wholeheartedly believe it. Second, one of the most common symptoms of SMI is anosognosia. This is a just a medical term meaning that someone can’t recognize that he or she is sick. It makes perfect sense given that the brain is the organ that has been compromised. Combine these two factors, and it’s easy to see why very few people suffering SMI actually seek out treatment on their own.

Instead, their illness progresses, and their thoughts and actions become more disconnected. Watching someone experience this is incredibly distressing. You desperately want to do something, but when you reach out to help, trying to prevent the impending crisis, you realize how little power you have. You can’t force your loved one into treatment; you can’t force them to take medication; you can’t force them to see a psychiatrist. And, unless they meet one of three criteria, no one else can, either.

For someone to be committed for treatment against their will one of the following criteria must be met: (i) they are an imminent threat to themselves, (ii) they are an imminent threat to others, or (iii) they are unable to meet the basic needs of survival (food, lodging, hygiene, etc.). In reality, the last one is so problematic that it is almost never considered. But the first two are also difficult. How can you tell if someone is an “imminent threat?”

“Do you really want to hurt me?" -- Culture Club

In most cases, a psychiatrist or first responder makes the imminent threat determination. But here’s where things break down. First, many psychotic people can be amazingly coherent even when suffering delusions and hallucinations. They can sound and act fine when interacting with others, especially for short periods of time. Second, HIPPA laws, or the privacy rules that surround medical issues, scare people into keeping family members at a distance. So, those who really know what’s going on are often not consulted.

All of this plays out against a backdrop of laws and policies designed to protect civil liberties. This is understandable; if we’re giving the state the ability to confine people against their will, we need to set a high bar. That’s a slope no one wants the government slipping down, especially given the unfortunate long-term asylums of the past. For this reason, those making decisions regarding involuntary commitment usually err on the side of maintaining a person’s freedom. Or, in the case of many police officers, they aren’t trained to recognize or deal with SMI. And, frequently, they are responding after a law has already been broken.

The sad result is that in this country someone must essentially (i) commit a crime, (ii) hurt themselves or (iii) hurt someone else before they can be forced into treatment. And too often, instead of ending up in a place that can actually help, the sick person winds up in jail or prison or worse. Too many heartrending cases exist that underscore this reality. One of the most powerful advocates for change is Jerri Clark. Instead of receiving the treatment her son Calvin so desperately needed, he was repeatedly arrested, imprisoned, and then released without notice, alone and sick, until he succumbed to his illness.

“Now, I've been crying lately, thinking about the world as it is." -- Cat Stevens

Some middle ground has to be found. When sick people lack decision-making capacity, medical personnel have the ability to make decisions for them. When an unconscious victim of a car accident comes into the emergency room, doctors don’t wait to see if treatment is wanted; they operate. Likewise, if someone is suffering from SMI, they require psychiatric support immediately. They need a safe place, constant monitoring, and medication.

The bottom line is that family members must be brought into the process early, even after the age of 18, and given some power over the situation. Decisions should be made with as much information from trusted sources as possible, and no one is better informed than those close to the sufferer. As advocate Doris A. Fuller, whose daughter was a victim of the current system, stated in a testimony before the Federal Commission on School Safety:

"Family members possess unique insights into their loved ones facing mental health challenges, and they are uniquely positioned and supremely motivated to overcome those challenges."

And the Award Goes to...

Safe, Wanted, and Loved was named a finalist for an Audie Award, a competition people liken to the Oscars for audiobooks. What a wonderful honor!

It's up against memoirs by Molly Shannon, Billy Porter, and Delia Ephron, all of whom perform their own narration. Oh, and a memoir about Paul Newman narrated by people like Jeff Daniels and Newman's own family members. All of these titles are “Editor’s Picks” on Amazon with over 1500 ratings each! The odds of actually winning are pretty low, but just being nominated is a huge victory.

“To you, the next best thing to playing and winning is playing and losing." -- Alison Krauss & Union Station

For those who don’t know, awards such as these are more like marketing strategies than competitions. I mean, you still need to be selected above other entrants, but you have to pay an entrance fee. It makes sense, as these organizations must expend money to sponsor their events. They have judges and trophies and their own marketing costs. But it’s not like you receive a surprise notification out of the blue. And if no one pays the entrance fee, your audiobook won’t even be considered.

Most of the books submitted to the Audies are sponsored by the big publishing houses. These companies go through their titles and select those they believe have the highest chance of success. It works the same for other awards shows, too. Remember when “We Don’t Talk About Bruno” failed to win an Oscar? That’s because the deadline to submit came before the song became a hit, and Disney entered a different song from Encanto for consideration. Too bad; I think Lin Manuel-Miranda deserved EGOT status, and “Bruno” probably would have gotten him there.

Like so many things in life, winning an Audie is only possible if you have sufficient resources. It’s not a fortune to enter, but it does cost a couple of hundred bucks. For Indie authors who don’t have a large company footing the bill, the decision to participate isn’t easy. But very few paths exist for us to market our novels. Winning awards provides credibility and exposure, and it might even get your title mentioned in an article. Without these, convincing anyone to invest time with your story borders on the impossible.

“Nobody knows me at all." -- The Weepies

My wife and I published our story with the hope that it might contribute to ending the stigma that surrounds psychosis. Perhaps people who had never experienced serious mental illness could learn about it through us. If so, we might convince them that conditions of the brain should be treated with the same compassion as diseases elsewhere in the body. But if no one ever picked up the book, we’d be hard pressed to achieve that goal.

That’s why we decided to produce an audio version—to reach more people. When we persuaded the über-talented Raúl Esparza to become our narrator it was like winning the lottery. I’m proud of the book, but what caught the attention of the Audie judges was undoubtedly Raúl’s ability to bring the story to life. I’ve read the printed copy a million times, but it’s truly remarkable when I listen to the audiobook. Raúl has the amazing ability to transport me right back to those challenging times.

However, this makes the audiobook a heartbreaking rollercoaster of an experience. In a way, that was the intention—loving someone who is suffering from serious mental illness brings with it an incredible amount of emotional upheaval. But the heavy subject matter means it may not be first on someone’s download list. And that’s why paying the entrance fee for the Audies was an easy decision. We were hopeful that the judges would recognize the brilliance of Raúl’s narration, too, and help us reach people who otherwise might hesitate to give the audiobook a try. Listening to a difficult story is one thing; hearing a brilliant performance is something entirely different.

“The limits now were none." -- The Flaming Lips

And it worked! But then again, it shouldn't have been a surprise. As I stated when I announced the audiobook last fall, Raúl surpassed even our highest expectations. He captures the story perfectly--expressing the emotions, crafting the scenes, and giving voice to the many characters involved.

Sure, a big gala is planned where the winners will be named, and they’ll garner the most media attention. The big publishing houses will use their accolades to sell more copies and cover advances. But we’ve already won. Our self-published memoir is being ranked alongside celebrity books supported by huge companies with sizable marketing budgets. The fact that we’re even in the conversation is simply astounding.

Thank you, Raúl, for you time and talent. For those still unaware of this actor’s prodigious skill, here’s what New York Magazine had to say about him years ago:

"Raúl Esparza proves himself yet again one of our finest and most versatile actors."

Science not Satan

A few months ago, I wrote about exorcism and the fact that over 50% of Americans still believe in demon possession. It’s such a terrible contributor to the stigma surrounding mental illness that I haven’t stopped thinking about it.

When I’m stuck on a topic like this, I start reading everything I can find. I've spent months poring over articles about priests and devils.

“And I can't get it out of my head." -- Electric Light Orchestra

Recently, I stumbled across a fascinating article by Mike Mariani in The Atlantic titled “American Exorcism.” In it, Mariani writes about our country's growing interest in exorcism and the various steps that Catholic priests take during the ritual. But the focus of the story is Louisa, a woman whose chilling experiences certainly make her seem targeted by an evil spirit. When you read it, the hairs on the back of your neck will begin standing on end.

I found myself intrigued—not because I thought a demon was actually haunting Louisa—but because it all seemed so real to her. And her husband, who witnessed several “possessions” and captured one on video, seemed certain that a spirit had entered his wife’s body. Even one of her psychiatrists admitted that she had never seen anything like it. Clearly, it’s cases like these that drive a belief in the supernatural and, admittedly, are hard to explain.

But Mariani hints at a possible answer, referencing a specific mental illness called Dissociative Identify Disorder (DID). I referred to the official manual of the psychiatric world, the Diagnostic and Statistical Manual of Mental Disorders (or “DSM” for short), to learn more about DID. The DSM defines it as “a disruption of identity characterized by two or more distinct personality states.” These different personality states, or alters, are classified into sub-types. Several of these different alters can exist within the same person. For example, a common sub-type is the child alter, where an adult personality might live in the same body as its child alter. One might also have an opposite-sex, teen, protector or any number of other identities. As I kept reading, I discovered that one less common sub-type is the “demon, demonic, or evil” alter.

“She's just a devil woman." -- Cliff Richards

Most cases of DID are caused by suffering, usually childhood trauma. Before someone’s personality has had the opportunity to fully develop, they experience something so upsetting that the brain fractures, tucking that extreme pain into a section of the mind that can be kept apart. Indeed, many cases of DID include dissociative amnesia—one alter is not able to access the memories of another. Simply put, it’s a survival mechanism for extreme trauma. Our brains are so powerful that to protect us from past horrors, they’ve devised a way to eliminate the memories.

But the brain is even more amazing. Listen to this: Different alters can have altogether different biological markers. What that means is that someone’s heart rate, blood pressure, blood glucose levels, and similar measures—even responses to medication—can be dependent upon which alter is controlling their mental state. One alter can be diabetic while the other is not. In fact, a person can have different immunological responses depending on their identity. One alter could have different allergies than the other alters in the same biological body!

In this light, the spooky experiences of people like Louisa can be better explained and understood. Demonic alters are the result of children who have been abused or otherwise hurt and are then tricked into believing that they deserved their punishment. Forming the alter is the only way the poor child can cope with the guilt of what happened. Sadly, the “evil” side of their personality is given its own identity and remains with the individual as they grow. Given the brain's incredible power, it’s not surprising that these alters might remember Latin phrases they heard in prayer, other languages they overhead in conversation, or assume the personas and mannerisms that society and the Church typically associate with demons: low, guttural voices, a hatred of religious symbols, and names like Lucifer, Beelzebub, and Satan.

“Beelzebub has a devil put aside for me." -- Queen

All of this explains Louisa’s situation, especially given that she was molested by a family member as a child. One of the priests that Mariani interviews states that “as many as 80 percent of the people who come to him seeking an exorcism are sexual-abuse survivors.” The Catholic Church believes that childhood sexual abuse creates a “soul wound” that makes someone more vulnerable to demons. But what’s more likely, that an evil spirit infiltrated Louisa’s body or that a proven mental illness developed in response to her extreme PTSD?

The answer is clear, and as a society we need to accept it. We should show victims like Louisa compassion and support; they need trained clinicians with tools that can actually help, not priests with holy water and Middle Aged scriptures. Instead, we’d rather cling to outdated notions of supernatural spirits. It allows us to hide the fact that serious mental illness exists and justifies us ignoring those who suffer, exacerbating a stigma that already causes too much damage.

It’s a travesty, and we need to stop. When it comes to supernatural vs. science, as investigative journalist and podcaster Carrie Poppy says:

"The truth is--10 times out of 10, science wins."

No Apologies

Recently on Twitter, someone who has struggled with psychosis apologized to her family for past behaviors, hoping for forgiveness. Given what we have been through, that tweet stuck with me.

Why would she have to apologize?

Psychosis is a symptom of disease, let’s be clear about that. It is not in someone’s head; it is not caused by demon possession.

“What else should I be? All apologies." -- Nirvana

It’s triggered by a disruption in the chemicals that control thought. Psychosis can accompany many mental illnesses and some organic ones, or it can result from lack of sleep, extreme stress, or chronic pain. I’ve never experienced psychosis myself, but I supported my wife through several bouts of it. Aside from a terminal illness, I can’t imagine anything more challenging or harrowing.

If you want a better understanding of psychosis, read actress Sarah Wynter’s compelling narrative in Vanity Fair. Anyone who has witnessed it in a loved one immediately identifies with her retelling. Sarah’s paranoia begins with legitimate concerns about the health of her newborn twins in the NICU. She needs to keep them healthy; she needs to keep their environment pristine. But over time, the fears overpower rationale thought, leaving her unable to decipher fantasy from reality. Ultimately, she winds up in a psychiatric ward, blunted and tired from the antipsychotic medication. It takes years for her to achieve full recovery.

Reading her account, everything feels so familiar. Watching a loved one descend into psychosis is gut-wrenchingly sad and upsetting. At times, their behavior can become offensive—loud and aggressive. But I would never blame Ms. Wynter for her behavior, just like I would never blame my wife for hers. And I wouldn’t expect either of them to apologize. We wouldn’t expect a person suffering heart disease to apologize for their chest pains. We’d never ask a friend suffering asthma to excuse themselves for wheezing.

“I don't feel any shame; I won't apologize." -- Green Day

When someone experiences psychosis, they suffer thought disorder, misinterpreting what they hear and read. Usually, this is accompanied by delusions or hallucinations. A delusion is a thought or belief that isn’t grounded in reality, and a hallucination is hearing or seeing things that aren’t actually there. What makes these profoundly difficult is that the person can’t recognize that these are fabrications. As far as they know, their brain is working correctly, just like it always has. The devil really is hiding in the shadows of the room; that voice really is speaking to them.

Stop and think about how frightening this must be. We’ve all relied on our brains since before we can remember. But what if you couldn’t trust it? What if you had to question everything you thought or heard or saw, and you couldn’t tell what was real? Watching my wife—the most grounded person I know—suffer with delusions was terrifying. What’s more, you can’t explain to a psychotic what is transpiring; it’s nearly impossible to communicate with them in an effective way. They’re gone, and all you can do is try to keep them safe and protected.

But that’s not easy. Even though psychosis builds gradually, the final break with reality can be sudden and jarring. In these cases, the sick can quickly become unpredictable. We’ve all read articles about celebrities whose behavior becomes suddenly bizarre, unable to hide their illness with all the cameras around. Back in 2012, a relatively unknown film maker named Jason Russell found himself an overnight celebrity when his documentary went viral. Along with the fame came an incredible amount of criticism, and Jason became overwhelmed by stress and a lack of sleep. Ultimately, he broke from reality, with acute psychosis overtaking all rationale thought.

“This is a black out." -- Foo Fighters

Oprah interviewed Jason and his wife, Danica, after his recovery. His testimony is disturbing; he doesn’t remember much, only snippets and vague memories. He was found on a busy intersection in L.A., completely naked and pounding the cement so violently that he permanently damaged his wedding ring. But Danica’s answers hit just as hard. She was caught completely off guard, scared and in shock. Her first reaction was to protect their young kids, which left Jason free to rage publicly. And with smart phones everywhere, it wasn’t long before videos of his troubled behavior began spreading across the internet. The juxtaposition of the eloquent, personable father in the interview and the screaming, raving lunatic from the YouTube clip is startling.

But that doesn’t mean that Jason should have to say he’s sorry. A psychiatrist once told me that a psychotic break is alike a “heart attack of the brain.” No one that sick should have to apologize, especially when they have no control over their thoughts or behavior. On the contrary, anyone who has lived through psychosis should be shown support and compassion; we should applaud their strength and fortitude.

Journalist Carole Cadwalladr, who interviewed Jason for The Guardian a year after his psychotic break, captured it perfectly when she wrote:

"If Russell had had a heart attack, a coronary brought on by extreme stress, it might well be a different story. Heart-attack victims receive sympathy. People who rip their clothes off in the street don't, though attacking your own body is every bit as much of a symptom as chest pain."

Go Blu...Bucks?

Or, why I admire Ohio State even though I was raised by the Maize and Blue.

I didn’t attend the University of Michigan, but everyone else in my family did: brother, parents, grandparents, aunts, uncles, cousins. Even most of my friends are Wolverines. I grew up at the Big House; we loathed the Buckeyes.

“The Champions of the West." -- University of Michigan Fight Song

So please don’t tell the folks back home, but I have incredible admiration for Ohio State Head Coach Ryan Day and the entire community up in Columbus. You see, Coach Day and his wife Christina are leaders when it comes to mental health awareness, both in sports and across campus. They have given generously to building the university’s resources; their efforts have undoubtedly helped countless troubled souls find the support they so desperately needed.

Coach Day has saved one life in a very public way. If you haven’t heard the name Harry Miller, you should. He was a celebrated 5-star recruit, meaning that basically every major football program wanted him. He had a breakout freshman year; it wasn’t a question of if he would play in the NFL but when. From the outside, Harry had it all—starting lineman on a preeminent collegiate team, NFL scouts showing interest, straight A’s in his chosen field. For his part, Coach Day had plenty, too—a top recruit making an impact immediately and with several more years of eligibility.

But on the inside, Harry was suffering mightily. He had fought depression as a child, and the pressure of college football brought it screaming back. When he recounts his internal struggles, it’s difficult not to cry along with him. So as not to trigger anyone reading, suffice it to say that Harry was in a very, very dark place. At that point, he did something that took real courage: He told his coach.

“Sending out an S.O.S." -- The Police

Coach Day and his staff had recruited Harry for years. They had used up a limited scholarship spot on him. The coaches’ jobs were dependent on winning, and top recruits were an essential part of that. But not only did Coach Day take Harry seriously, listening sympathetically to his star lineman, he also called in doctors from the Ohio State community to provide immediate help. And when Harry decided to retire from football to concentrate fully on his well-being, Coach Day’s support never wavered. He prioritized “Harry the person” above “Harry the athlete,” showing the kind of steadfast care that someone suffering a mental health crisis requires.

How can you not admire someone like that, even when his team is facing yours across the gridiron? As a result of Coach Day’s actions, Harry Miller is not only alive today, but he has become a fellow advocate for fighting the stigma. The former lineman even has his own slogan, “Don’t Make It Weird.” It’s a great example of how the movement can build momentum when people have the courage to reach out for help and when those around answer the call.

It’s also a perfect argument for why we can’t put people and groups into boxes, believing that everything is up or down. Yes, I can root against Coach Day when the Wolverines take the field at the Shoe, but otherwise I will always be a huge fan of his. In our country today, too many have forgotten that people are not all one thing or the other. Republicans are not all Trump; Democrats are not all communists. And, of course, Buckeyes are not all bad.

“You'll find your first impression was mistook." -- Mary Poppins Returns Soundtrack

Sure, I’m glad Michigan won the game this past weekend, but let’s all keep a focus on what truly matters. The Game will come around again, and the Buckeyes will do their fair share of winning. But once you lose someone to mental illness, they’re gone forever. I'm grateful that we have leaders like those in Columbus helping to fight the stigma.

Christina Day captured my views on this perfectly when she said:

"I would like to tell people just like in physical health, we all kind of struggle with, you know, colds and Covid and broken ankles and all that. The brain is another organ in your body that can get sick. And not to feel shame if it does. And feel empowered to ask for help."

Devil Inside

Demon possession, as a cause of psychotic behavior, remains endorsed by the Catholic Church.

Halloween is a time for ghost stories and scaring people. All the old stereotypes are dragged out in the showing of horror films, and those suffering with mental illness are scapegoated for their symptoms. It’s frustrating for those of us trying to fight the stigma. The killer psychotics run rampant; terrifying demons possess little kids.

I’m referring to The Exorcist, one of the movies that started it all. Few remember that it was nominated for Best Picture in 1973 and remains one of the most profitable horror films ever produced. For those that missed it, the story revolves around a girl who becomes possessed by the devil himself.

“Devil inside, the devil inside, everything single one of us, the devil inside." -- INXS

Sounds ridiculous, right? Only in the movies? That’s what I thought, too, until I discovered this startling fact: 51% of Americans still believe in demon possession. You read that correctly. Over half of the people reading this believe that something like The Exorcist could happen in real life. Actually, it’s worse than that--they believe it does happen!

I’ve witnessed acute psychosis firsthand, and, trust me, it can be seriously upsetting. Trying to communicate with someone disconnected from reality is at once shocking and frightening. Shocking because they look and sound normal but are completely detached; frightening because you fear that madness might be lurking in your own mind, waiting to take hold. But to blame psychosis on supernatural beings is ridiculous. First, science has proven that psychosis is a symptom of an underlying illness, a result of unbalanced neurotransmitters. Drugs and time can modulate these imbalances and restore rational thought. Second, and probably more importantly, demons aren’t real.

Tying psychosis to the devil only perpetuates the tragic misconception that the mentally ill are violent and dangerous. They are not, as has been proven time and time again. Still, if someone honestly believes that demons are causing such bizarre behavior, they’re going to be petrified. How can we make any progress towards ending the stigma when so many are so ignorant about these diseases?

“Just call me Lucifer 'cause I'm in need of some restraint." -- The Rolling Stones

Religion has a lot to answer for here, especially the Catholic Church. Let me state upfront that my wife and I raised our kids Catholic. I’ve spent a lot of time around the Church, and for the most part its message is positive: love, forgiveness, patience, compassion. But in certain areas, it’s just plain wrong. And when it comes to these areas, the Church does real harm.

Did you know that every Catholic parish is required to name a priest who will carry out exorcisms in that area? Seriously, you can see examples here and here. So, if you’re a practicing Catholic, and a loved one begins to suffer psychosis, the Church would—apparently—recommend that you call a ghostbuster over a qualified psychiatrist. Maybe this was justified in the Middle Ages, when science was put on hold and superstition triumphed over reason. But today it is completely inexcusable.

Actually, the Church has stepped up its preaching of exorcisms over the past two decades. Whereas in 1983 it dropped the requirement that each parish have a named exorcist, it reinstated this condition in 2004. Apparently, the International Association of Exorcists had been lobbying the Vatican for years and finally won. In 2017, Pope Francis gave a speech where he encouraged priests to call upon exorcists if needed. The Church was prepared; in 1998, it had updated the ancient tome that provided guidelines for scaring off the demons—a book that was written in 1614!

“How can the devil take a brother if he's close to me?" -- Tupac

This must stop, not just with the Catholic Church but with all religions. People who suffer psychosis need help. They need medication, support, compassion and understanding. Treating them like monsters, or believing that horror-film creatures are controlling them, should not be tolerated. It’s demeaning and destructive. Honestly, it’s inhumane.

This is one battle in the fight to end the stigma that is concrete, actionable, and trackable. We should demand that the Catholic Church stop preaching exorcism and publicly recognize what science has proved: Mental illness is caused by disease not demon possession. We don’t need ghostbusters; although, of course, they approached the banishment of demons with the light-hearted ridicule the concept deserves:

"Good evening, as a duly designated representative of the city, county, and state of New York, I order you to cease any and all supernatural activity and return forthwith to your place of origin or to the nearest convenient parallel dimension."

The Importance of Community

Being part of something is empowering; being separate can be crippling.

Last month, I wrote about the launch of my audiobook, a story for which the brilliant Raúl Esparza provides narration. Raúl is a celebrated stage actor, well known on Broadway. He’s also an audience favorite on the long-running TV show Law and Order: Special Victims Unit, where he plays a tough, calculating district attorney.

When selecting him for the audiobook, I knew that he was a talented performer with Cuban American heritage. I failed to realize, however, the size of his fan base—and their loyalty.

“At least you're not alone, your friends are there, too." -- Tick Tick Boom

I was amazed by how quickly Raúl’s fans embraced the audiobook. A few influencers retweeted my message, and soon dozens of people were commenting. I had promised to give away free copies on a first-come, first-served basis; all were claimed within ten minutes. The positive support was incredible. Suddenly, I felt connected; I felt part of something.

Being part of a community is powerful; we’ve all felt it at some point in our lives. Early on, we recognize the importance of a group—learning, sharing, laughing—and it’s only reinforced as we mature. Many of us have happy memories of participating on teams or in other clubs in school. Typically, these experiences improve our self-esteem and build our confidence. As we mature, the groups might change, but the positive effects still accrue. I certainly felt appreciated when Raúl’s fans welcomed me so quickly and easily.

But then I thought about mental illness, and the way that society ostracizes those who suffer. It’s such a tragic result of the stigma—take someone who already feels alone, anxious, or afraid and convert those apprehensions into reality. We humans are social animals, something which the pandemic has proven so effectively. No one wants to be isolated.

“Stick to your own kind." -- West Side Story

Yet this is typically the punishment we dole out to those suffering from brain illness. We separate them, making sure they know through our words and behavior that they are not part of the group. Ashley L. Peterson summarizes this in her book A Brief History of Stigma, suggesting that we mark them as Other. If the sick people are over there, and I’m over here, that means I am not sick.

Hiding behind the Other label, we allow ourselves to treat them differently. It’s akin to so many of the stereotypes prevalent in our society today, be they racial, religious, or political. The Other become less than human, allowing prejudice and bias to follow. For example, one of the most damaging misconceptions is that mental illness leads to violence. Therefore, we justify our discrimination as an act of self-preservation. We can’t possibly allow someone who has a history of mental illness to practice medicine—what if instead of healing they end up hurting?

This only reinforces the stigma, making it all the more difficult to undo. If you believe you’ll be viewed differently for seeking help, you’ll go to great lengths to keep from doing so, even when you desperately need it. And that’s a huge problem, because the earlier mental illness can be addressed and treated the better the outcome. As a society, we need to flip the script—those dealing with a mental illness should expect to be pulled in and embraced rather than pushed out.

“I used to live alone before I knew ya." -- Leonard Cohen

Because the reality is that if you or a loved one suffer from mental illness, and you seek help, you will be amazed by the reception. I spoke about this with Congressman Patrick Kennedy—both of us were surprised by the outpouring of support that came after we shared our secrets. At an individual level, most people will show sincere support and compassion, I can promise you that.

Together, we can end the stigma. We can keep from separating those who suffer and make sure that everyone feels part of the community, regardless of illness or history of mental health symptoms. As Patrick so eloquently stated when being interviewed by Piers Morgan several years ago:

"We need to change the dialogue and open our arms and our hearts to all around us because, as I said, it's every single family in America."

Launching the Audiobook

Raúl Esparza captures the emotional turmoil of mental illness

About a year ago, a friend living with schizophrenia suggested making an audio version of my book, explaining that those with mental illness might find it easier to listen than to read. After much consideration, my wife and I ultimately agreed, but it wasn’t an easy decision.

“Keep it to yourself it's my life." -- Billy Joel

With such a personal account, the challenge was in finding the right narrator. A few friends argued that I should do it, but I knew better. I wasn’t an actor and, aside from reading to my kids when they were growing up, had no experience as a narrator. No, I needed someone who could accurately convey the myriad of emotions that surrounded our experience with dignity, while also respecting the many different accents included in our story.

This last part was the first obstacle. A few weeks into the project, the production company sent along snippets of dialogue from a half dozen potential candidates. They had selected white, Midwestern actors for the work, given that I am a white, Midwestern guy. But if you’ve read my book, you know that many of the primary characters are of Cuban heritage. Expecting non-native Spanish speakers to portray our relatives was not a viable approach.

“Dad, no way can you have these guys read your story,” my astute daughter commented after listening to the samples, “they all sound like caricatures of Latinos.” My wife and I quickly agreed, cringing as we finished the final submission. We realized that we required a narrator of Cuban heritage, someone who could sound like the average American but could also slip easily into Spanish that had been learned from parents and grandparents.

“You sound like a hillbilly; we want folks singers here." -- Bob Dylan

Taking matters into my own hands, I turned to the internet. I began searching for Hispanic actors who had experience with audiobook narration, thinking that any Spanish speaker would be an improvement. If I found someone, I’d go to audible and listen to samples of the books they had read. Finally, I stumbled across the name Raúl Esparza. It sounded familiar, and the article mentioned that he was Cuban American.

Raúl had only read for a few books, including Under the Dome by Stephen King, but I recognized his face from television. He starred on Law and Order: SVU and, although I wasn’t an avid fan, I’d seen the show a few times. I then began learning about his past performances, especially on Broadway. He had been nominated for several Tonys and a myriad of other awards. I quickly realized that Raúl was among the most talented actors in the country, and he happened to have grown up in Miami in a Cuban family.

I was excited to have identified such a great candidate, but I had no way to reach him. I knew that celebrities had agents and social media accounts, but I also knew that breaking through those channels was almost impossible. Upon reviewing Raúl’s biography, I saw that he had attended the same high school as my wife’s cousin, or “Alex” in my book. Reaching out, I learned that Alex and Raúl had known each other as teenagers. They still had mutual friends in common, and ultimately this helped me put the book in front of Raúl.

“Heard it from a friend who heard it from a friend who..." -- REO Speedwagon

Fortunately, Raúl was captivated by the story and supportive of the message. He carved out a few days this past spring to record the audiobook, and we received the files earlier this summer. Simply put, they surpassed even our highest expectations. He was the perfect person to narrate our story. His accents are authentic; his enactment is incredible.

We’re hopeful that the audiobook will help the story find its way into more hands—providing hope to others struggling and bringing understanding to those not familiar with mental illness. But more than that, we’re confident that others will appreciate the brilliance of Raúl’s performance as much as we do.

We are holding our official launch this month. Not many people read my blogs, so I’m going to reward the few that do. I’ll send along a free copy of the audiobook to the first five people who request it (you can use the contact form). And let me know what you think:

Chapter 1: The Start

“Life is Hard, Real Hard”

Ted Lasso depicts mental illness in a realistic light

Last month, I reviewed the frightening portrayal of psychosis in this summer’s most popular TV show, Stranger Things. Unfortunately, way too much of this unrealistic, stigma-reinforcing content has flooded our media over the years. But Ted Lasso proved that successful franchises can be built by treating mental illness for what it is—difficult and personal and affecting us all.

“Heaven knows I've tried." -- Marcus Mumford and Tom Howe

People watching the show immediately fall in love with Jason Sudeikis’ main character. Ted is cheerful, positive, and kind to everyone. Throughout the first season, we accompany him as he moves from Kansas to London to begin coaching soccer, a sport he doesn’t know anything about. Nothing seems to faze him—nasty fans, critical reporters, difficult players, even an owner secretly scheming for him to fail. However, we realize that something is wrong underneath the happy surface when Ted suffers a panic attack, seemingly provoked by his impending divorce.

But like most everyone, he hides his pain away, hoping that others won’t notice. And few do, so the audience is left with the mistaken belief that his dissolving marriage is to blame for Ted’s anxiety. However, the panic attacks continue into the second season where we meet new team therapist, Dr. Sharon Fieldstone. With her help, the audience slowly begins to appreciate the ghosts that haunt Ted. As it turns out, his father died of suicide when Ted was only 16, and he has never dealt with the poignant fallout from the ordeal.

And he doesn’t want to. From the outset, we witness the always affable Ted offend Dr. Fieldstone at every turn. He resists the idea of hiring her, and then, after she starts, he handles her with a level of disdain and disrespect out of place for his character. Unfortunately, many people treat “shrinks” in this same manner, questioning their worth and ridiculing their profession. Dr. Fieldstone weathers his jabs like an experienced fighter, waiting patiently for him to open up. When he finally does, the scene plays true to anyone who has gone through therapy. Ted starts down the difficult path of processing his past trauma.

“Well, I could have a nervous breakdown, but I don't believe in shrinks." -- John Mellencamp

Admirably, the show doesn’t end on the uplifting note, with patient and caregiver celebrating their emotional breakthrough. Instead, it ratchets up the reality, this time highlighting the stigma that accompanies any mental health condition. Someone leaks that the head coach is suffering recurring panic attacks, and suddenly Ted’s entire credibility is thrown into question. TV pundits call him “not fit to coach” and argue that the team needs a “captain whose brain works.” People had questioned his experience before, but now they come after his competence and character.

Meanwhile, Ted and everyone around him not only anticipate this behavior but accept it. This is especially accurate; we all recognize that society will see us differently if a mental health issue comes to light. So, we hide our troubles away, just like Ted, burying them deep until we can’t function anymore. We do this for a reason—the repercussions of the stigma can do genuine damage. Why risk certain discrimination?

Ironically, however, every single person faces challenges related to brain health. If Ted Lasso were real, each of those other characters would have some mental health issue of their own, and they’d be silently grateful that their secrets hadn’t been revealed. That’s what makes the stigma so frustrating and destructive. We all deal with this, and yet we don’t want to admit it. We’re afraid to talk about it and to ask for help. And the denial makes our challenges that much more difficult.

“And talk about it, talk about it, let's go home and talk about it." -- Dead or Alive

That’s why shows like Ted Lasso are so important. He enters so many homes, befriending all who watch. We like Ted; we root for Ted. We quietly hope that we can act more like him the next day—joyful, friendly, and energetic. So, when Ted admits to suffering inside, it might be okay for us to admit it, too.

Each character like this helps in changing the narrative. Each story that advocates for accepting mental illness with understanding and compassion rather than ridicule and fear moves us forward. We need more of them, so many more of them. When sharing memories of his father’s death, Ted sobs, “Life is hard, real hard.” And it is, but if we’re honest and ask for support, we can live many of our days in happiness. Just like Ted. So, always remember the profound wisdom he shares at the end of season one:

“There is something worse out there than being sad, and that is being alone and being sad."

Unfortunate Things

Netflix goes back in time to reinforce the stigma surrounding mental illness.

Prior to this season, I was a huge fan of Stranger Things. As a child of the ‘80s, I grew up playing Dungeons and Dragons, watching movies like E.T., and looking forward to visiting the local mall. Stranger Things felt familiar to me; I was the perfect audience.

“Still preoccupied with 19, 19, 1985." -- Bowling for Soup

Although never a fan of horror, I found much to love about the first three seasons. They could be scary at times, but they were never wake-with-nightmares terrifying. Sure, the monsters were gruesome, but Eleven was usually around to blast them into the other dimension. And the camaraderie of the cast was magnetic and entertaining. It was great television, and I loved it. But then along came season four, and instead of conjuring positive 1980s nostalgia, it summoned damaging biases that should have been left in the past.

Prior to our family’s struggle, I had a prejudiced view of mental illness. I’m certain this began in adolescence. My middle school showed Psycho in the cafeteria on movie night. Looking back, I can’t believe they actually did that. I vividly remember all the seats lined up like a theater, little kids shrieking in terror. It was hard for a 12-year old to sleep after that, wondering if people like Norman Bates really existed in the world.

Growing up, some of the most popular movies had essentially the same plot: psychotic killer sneaks up murdering people in the most graphic ways. Halloween was one of the first, with Michael Myers escaping the sanatorium and running around with his freaky white mask. Friday the 13th followed closely behind, the various Voorhees family members haunting Crystal Lake. And how about Nightmare on Elm Street? This was a franchise about how you could never be safe from a psychotic, even in your dreams.

“There stood Rita lookin' just like Tony Perkins." -- Bob Dylan

Like so many of my peers, I was brainwashed. Although I had never been with someone suffering psychosis, I was convinced of its deadliness. This could not have been more wrong. Recent research has shown that those with serious mental illness commit violent acts less than 3% of the time, which confirmed historical studies with comparative results. Psychotic individuals are more likely to hurt themselves than anyone else. They are mostly scared and confused, in desperate need of compassion and support.

Slasher flicks, and similar tropes from the world of entertainment, perpetuate a lie that does real damage. The stigma prevents people from asking for help, even if they begin to sense something off in their emotional state or thought process. It keeps us, as a society, from addressing mental illness in the same way that we do other diseases. Personally, when my loved one first became psychotic it scared the hell out of me—an unfortunate result of Hollywood’s exaggerated portrayals.

And that’s why I was so disappointed by this year’s Stranger Things. Almost immediately, it became clear that the theme that the Duffer brothers had chosen to resurrect was '80s horror, specifically movies cursed with tragically unrealistic psychotics. They even hired Robert Englund, the star of Nightmare on Elm Street, to play the institutionalized patient in the stereotypically spooky mental hospital. As much as I loved the prior seasons, I almost couldn’t watch anymore; I was too mad and frustrated.

“Well, it's too late tonight to drag the past out into the light." -- U2

Time warping back to 1985 was fun when it wasn’t detrimental, but old school scary movies did too much damage; we shouldn’t be revisiting and celebrating them. We’ve come too far to lose ground now. I’ve read articles arguing that season four encourages asking for help when faced with mental illness because the one kid who survives only does so after reaching out to her friends. But I’m not buying it.

Humans have been wired to react more powerfully to the negative than the positive. Max’s survival might have sent a positive message, but it became lost in the overwhelmingly destructive portrayal of the psychotic villain. Unfortunately, the primary take away from this season will be the misconception that mental illness is scary and dangerous. Make no mistake—Stranger Things has set us back in the battle to end the stigma. As social psychologist Roy Baumeister says of the negativity bias:

“It's one of the most basic principles and seems to be true everywhere. It's a key fact about how the mind works."