01x02 - Who's Normal?

[bunniefuu]

♪

MIA YAMAMOTO: My story

starts off with understanding

that I was not

like everybody else,

so I thought

of course I was sick.

I was mentally ill.

And I believed it

for probably half my life.

Today, I feel quite different,

but when I first

went into therapy,

it was, like,

"Somebody, please

solve my problem."

And I spent a lot of years

in that state.

♪

(compact closing)

This one here,

I think that's me over

on the left-hand side here

pretending like I'm happy.

My identity was, at

a very early age, female.

I could see the world

through my sister's eyes,

through my mother's eyes,

far better than

I could understand

the world of my father

and my brothers.

I could hear my father saying,

"Well, he's just

going through a phase.

Mike's gonna grow out of it."

And my mom saying,

"Well, maybe we should

take him to a psychiatrist."

And when they realized

how much it cost,

that idea was

never discussed again.

(chuckles)

♪

I felt completely alone.

And that feeling persisted

until I read about

the first transgender

sex change operation,

which occurred in 1952.

The headline was sensational,

but for me, it was an epiphany.

And so I got the paper,

and I remember going in

to my mom,

where I show her the paper,

and I'm saying,

"Look, I'm not the only one

who feels this way."

And she looks at me,

looks back down at the paper,

and she just puts

her head on the ironing board

and starts crying.

And, um

Determined I would never

do that to her again.

I spent years after that

trying to figure out

what was wrong with me.

♪

♪

NARRATOR:

What is mental illness?

For centuries,

religion offered

spiritual answers,

while science looked to the body

and the mind.

Today, genetic breakthroughs

and neuroimaging

provide tantalizing clues

into the roots

of mental disorders.

But a simple answer

for who is

Or isn't mentally ill

remains elusive.

RONALD BAYER: It would seem

to be pretty straightforward.

Sick is sick,

healthy is healthy,

what's the big deal?

But it turns out

that in psychiatry,

the boundary between illness

and sickness is very fluid.

SUSANNAH CAHALAN: Where

do we draw that illness line?

What is abnormal,

what's normal behavior,

what's illness,

and what's the kind of,

you know,

broad swath of

what it is to be human?

NARRATOR:

There are no biological tests

to diagnose mental illness,

complicating the question

who's normal

and who's not.

KEITH WAILOO:

Societies decide

what constitutes

behavioral norms,

social norms,

and where

the lines of deviance exist.

♪

MICHAEL WALROND: God,

we bless Your name on today.

We bless Your name on today,

oh, God.

The hardest thing to do

is to feel like

you are walking through

the valley of

the shadow of death

and there's no one with you.

You've been constant, oh, God.

But most of all, oh, God,

You've been consistent

in our lives.

So, God, we bless

Your name right now.

In my 20s, I began to experience

bouts of depression.

I never sought help,

because that was not part of

the common conversations

that took place in my community

growing up

or in my house coming up.

In my 30s was the first time

I had any suicidal ideations.

There were numerous days

where I didn't want to preach,

I didn't want to teach,

I didn't want to talk to people,

but I felt like I never had

the option of not doing it

because of the weight

and responsibility of my call.

And so like so many people

who battle with

depression and other conditions,

you suffer in silence.

'Cause I didn't want

to be labeled.

"Nothing is wrong with me,

I'm a pastor."

To say that, "Oh,

I'm going to see a therapist,"

is tantamount to saying,

"I don't trust God can do it."

"I don't believe

that prayer can do it."

And no one wants to say,

"I don't trust God

and I don't believe in

the power of prayer."

♪

But it became torturous

that people saw me as

representing

some level of healing,

and yet I felt no resolution

within myself for that.

And it took a long time

for me to actually reach out.

And I remember going to

that first therapy appointment

with all sorts of walls up,

not wanting to admit that

something was really wrong.

Because as a Black man,

there's not a desire for

one more label.

Oftentimes, there's a,

a dangerous reductionism

that takes place.

The individual

becomes synonymous

with the thing they're

wrestling with.

So that when you

see me, potentially,

you don't see me,

you see my thing.

You see,

"Oh, he's depressed."

"Oh, he's Black."

♪

NARRATOR:

Labeling as "other"

has deep roots in

American history.

The 1840 national census

included a new category

to count the mentally ill.

At the time, many Black people

were escaping sl*very

and settling in the North,

and for some observers,

their new freedom didn't

seem "normal."

WAILOO: The census of 1840 is

a quintessential example

of how social judgment and

medical judgment

are intermarried

at a time when slaveholders

are arguing

that Black people are incapable

of managing themselves as

free people,

and at a time when others

in free societies

are asking whether

freedom itself

creates certain challenges for

African Americans.

NARRATOR:

With no clear standards,

white marshals decided

who to label mentally ill.

Free Blacks in the North

were identified as insane

ten times more frequently than

those enslaved in the South.

In many Northern towns,

all the Black residents

were counted as insane.

To critics,

the bias was obvious.

But to pro-sl*very advocates,

the census was evidence

that freedom made Black people

mentally ill.

The Medical Association

of Louisiana

endorsed this view with

a self-serving new diagnosis.

ANGELA COOMBS:

In the 1800s,

you see an illness

called drapetomania,

which was described

as an illness

that led enslaved people

to seek freedom.

So instead of people saying,

"Okay, these are human beings

who are trying to be free of

being enslaved,"

it's conceptualized

as an illness.

And of course,

the treatment for it

was to be whipped

and to be beaten.

♪

NARRATOR:

Drapetomania highlights

enduring questions in

psychiatry:

where is the line

between cultural judgment

and medical diagnosis?

Are psychiatric labels

helpful or harmful?

COOMBS: When we look at

who gets labeled

and what the service or

functioning of that label is,

that's what's really meaningful.

Are we saying

and diagnosing people

to get them a recovery-oriented

and humanizing kind of care

that, that, you know,

really affirms people's

humanity?

Or are we using it in a way to

treat people as less than human?

RYAN MAINS: I didn't

think mental illness was

something that happened

to normal people.

When I thought of

mental health issues,

I thought of the stereotypical,

straitjacket,

padded room-type things.

You know, somebody, uh,

like, in a vegetative state,

on meds, just laying in a bed.

NARRATOR: Ryan Mains is

a veteran and first responder.

Like many,

he has struggled to accept

his diagnosis of

post-traumatic stress disorder,

or PTSD,

and its associated stigma.

MAINS: There's a term in the

ultra-running community called

"brutiful," combination

of brutal and beautiful.

(chuckles):

And I so much love that term.

It's pain and it's glory

and it's, "How long

can you push yourself?"

My next run is going to be

130 kilometers.

That distance specifically,

because

over 130 firefighter-paramedics

died by suicide last year.

That's not something

that's known.

That's not something

that's talked about.

NARRATOR: Ryan served

in the Army for four years

and was a frontline medic during

the U.S. occupation of Iraq.

When he returned home,

he joined the fire department in

Woodstock, Illinois.

MAINS:

That's when it kinda hit me.

♪

I'd have intrusive

thoughts about my time in Iraq.

(faint expl*si*n)

You just, you see things

that are hard to forget.

(siren wailing)

And, um, they'd kind of

overlap with intrusive thoughts

from things

that happened at work.

I would lose my temper

and start yelling,

and that happened a lot,

and I didn't see it at the time.

I started avoiding work,

calling off sick for

a few shifts.

NARRATOR: When a fire department

counselor diagnosed PTSD,

Ryan rejected the label.

I said, "Go (bleep) yourself.

That's not for me."

I had a tremendous amount of

shame.

(sighs)

What I didn't realize was,

I was just setting myself up

for a bigger fall later.

NARRATOR:

More than a century ago,

millions of soldiers like Ryan

endured trauma,

and their struggles forced the

nation to confront the question:

who is normal and who is not?

(a*tillery and g*ns firing)

After the brutality of combat

in World w*r I,

many who escaped physical harm

still appeared damaged.

Doctors referred to

their mysterious condition

by many different names,

and wondered:

why were only some soldiers

exhibiting

a debilitating reaction?

ANNE HARRINGTON:

A lot of the young men

presented with

physical symptoms of paralysis,

or mutism, or blindness.

We would call it trauma,

we would call it PTSD.

NARRATOR:

Doctors searched for the source.

Perhaps explosions caused

tiny tears in the spinal cord.

Or cerebral hemorrhages.

But the brain was still

mostly a black box.

X-rays, surgery, and even

autopsies provided few clues.

As World w*r II dawned,

the military was determined

to weed out vulnerable recruits.

But how?

Without any reliable

physical tests,

they turned to the mind

and the work of Sigmund Freud.

ALLEN FRANCES: World w*r II

to a very strong degree

was a legitimization of Freud.

Freud's theory

was based on the fact that

the combination of

instinct and experience

dramatically influences

our lives.

But these are not always

available to consciousness.

And a lot of the things we do

we do for reasons

we don't begin to understand,

for motivations

that are not accessible

to our conscious thinking.

NARRATOR: Freud died just as

World w*r II began,

but his ideas had

revolutionized psychiatry.

He believed

there wasn't a clear line

between mental health and

mental illness.

Everyone lived on a spectrum

because the conscious mind

was always in conflict

with unconscious desires and

repressed memories.

If unresolved, this conflict

could cause neurosis,

which he claimed was often

the root of mental illness.

Practitioners of

Freud's theories

called themselves analysts

and used his

talk therapy techniques

to treat these neuroses.

MAN (in film): Psychoanalysis is

a long and difficult process

of reconstructing

from fragmentary recollections

a picture giving the patient

a correct insight

into the forces at work

within him.

JEFFREY LIEBERMAN:

Beginning in the 1930s,

every major department of

psychiatry in the country

was chaired by an analyst,

and every president

of the American Psychiatric

Association was an analyst.

NARRATOR:

Analysts developed a system

to help the Armed Forces

evaluate soldiers

in an effort to prevent

psychiatric casualties.

HARRINGTON: Not everybody

in World w*r I broke down,

but some did

What's the difference?

So if you could identify the

pre-existing vulnerabilities,

you could maybe then avoid a

repeat of the, of what happened

in the First World w*r.

Maybe the people that have

the combat neuroses

were fragile to begin with.

People really started to

talk about things like this.

MAN (in film): You will be

interviewed by a psychiatrist

along with all the rest.

They've got to know how you'll

adjust yourself to the Army

if you've got what it takes

to make a soldier.

FRANCES:

Freud's first theories were

that childhood trauma is

a precursor to mental illness.

Psychiatric problems

came from family trauma.

HARRINGTON:

They would ask questions like,

"Do you wet your bed?"

Ask about your relationship

with your mother.

"Do you find yourself getting

irrationally angry?"

Do you like

going around with girls?

HARRINGTON:

Being h*m* was believed

to both be a mental illness

and also be potentially

a disciplinary problem

in the military.

BAYER: In the

psychoanalytic worldview,

the normal course of development

was, you passed through

your bisexual phase

into your heterosexual phase.

So that becoming

h*m* meant there was

sort of an arrest in

the developmental process.

NARRATOR:

Using a list of potentially

"pathological" behaviors

and "neuroses,"

psychiatrists rejected

one out of eight draftees

nearly two million men.

But the screening strategy

didn't work.

(bombs roaring, g*ns firing)

ANDREW SCULL: During

the Second World w*r,

America's psychiatric casualties

were double and triple

what they'd been in World w*r I.

And in combat situations,

sometimes half of

all the casualties

were psychiatric casualties.

(mumbles): I just can't stand

seeing people k*lled, sir.

I can't hear you.

(louder): I can't stand

seeing people k*lled.

Did you see people k*lled?

(voice trembling):

Lots of them.

- What?

- (louder): Lots of them.

NARRATOR: The

battle-weary soldiers proved

it wasn't so easy to predict

who would or wouldn't

be vulnerable to trauma

on the front lines.

PSYCHIATRIST: What I'm

going to do is send you back

to another hospital,

where you can get more rest

and more treatment.

NARRATOR:

But the military once again

entrusted psychiatrists,

this time to rehabilitate

these psychologically

wounded soldiers,

and commissioned films to

convince the country

the right treatment would

help them return to "normal."

A display of emotion

is all right.

I'm not doing this

deliberately, sir,

- please believe me.

- Of course you're not,

I do believe you.

HARRINGTON:

All this is being filmed

to convey this message of,

"Psychiatry

knows what it's doing,

and there's nothing to fear

with these men."

MAN (in film): Under the

guidance of the psychiatrist,

he is able to regard his

experience

in its true perspective

as a thing of the past,

which no longer threatens

his safety.

♪

HARRINGTON:

And at the end,

they all go back to,

allegedly, a happy life.

What's not to like?

YEHUDA: People really

believed that soldiers

could start to sort of

take their place

back into a society

that they left.

What they didn't realize was

that the effects of combat

could last in perpetuity,

could last for

years and decades,

rather than for

weeks and months.

NARRATOR: The camera crews

didn't follow these vets home

to see how they adjusted

to civilian life.

But the message was clear:

they should be able

to overcome their trauma.

This message reverberates today,

and fuels stigma

for millions of PTSD patients.

(indistinct chatter)

MAINS: I have a lot of

self-stigma

about my diagnosis

and my struggles.

Irritability, poor sleep,

rash decision-making.

When I started

to have those feelings,

I just ignore it.

(siren blaring)

But the thought of being on

an ambulance was overwhelming.

I was unable to find the

motivation to do anything,

to bathe,

to take care of myself.

You know, I'm laying in bed

with suicidal ideations.

NARRATOR: Like many traumatized

veterans and first responders,

Ryan spent a few weeks at

a psychiatric facility

specializing in PTSD.

MAINS: At the time,

I thought that I was cured.

But it's pretty peaceful there,

and then you

come back to real life

with your kids and,

and work, and bills, and

It was a pretty rude awakening.

All those dark, empty feelings

started creeping back.

The therapist at work told me

that I was unfit for duty.

I couldn't go back.

Now it wasn't just,

"I need to take some time

to get myself right."

It was,

"I can't do the job anymore."

It reinforced

some of that stigma.

NARRATOR: Ryan is

one of many military vets

to feel responsible for

his inability

to overcome his

traumatic experiences.

World w*r II psychiatrists

contributed to

this misconception.

One of the ways

psychiatry persuaded

its military superiors

during the w*r

that it was doing

such a great job

was, it produced statistics

on how wonderfully it was doing.

Those statistics

were made up and bogus.

NARRATOR:

Military psychiatrists treated

more than a million soldiers

for psychiatric disorders.

Some doctors claimed

a cure rate of more than 80%,

but fewer than one in ten

actually returned to

active duty.

SCULL: And yet,

for the military,

psychiatry was seen as

one of the success stories.

And those early military

classification systems formed

the foundation for,

after the w*r,

the American

Psychiatric Association

beginning to create

a system of diagnoses.

NARRATOR: In 1952, the American

Psychiatric Association,

or A.P.A.,

published the first edition

of what was to become

the bible of the field:

the "Diagnostic and Statistical

Manual of Mental Disorders."

The DSM attempted to

standardize diagnostic labels,

but it became a repository

of how the profession,

and the culture of the day,

viewed mental illness.

The first DSM briefly described

nearly 100 disorders

and drew heavily on

Freudian concepts

of neurosis and psychoanalysis.

MAN (in film): the patient

freely associating ideas,

dreams, memories, under

the guidance of the therapist,

until underlying conflicts are

identified

NARRATOR:

This approach relied on

each practitioner's

interpretation

of each individual patient.

SCULL: Oddly enough,

psychoanalysts didn't

believe in putting people

into different boxes.

MAN (in film): Tell me more

about what you are thinking.

FRANCES: People could

see the same symptoms,

but diagnose them in

different ways.

So, diagnostic reliability

was close to zero

because everyone

had their own ideas.

NARRATOR: As always, these ideas

were shaped by culture.

In the face of

the perceived communist threat

during the Cold w*r,

the nation embraced patriotism

and conformity.

HARRINGTON:

This is a period when

people are obsessed with

being normal.

Freudian-inflected psychiatry

intermingles with a lot of

social conservativism

and sometimes gets called

into service

of that social conservativism.

MAN (in film):

Parents who are mentally healthy

bring up their children

to be mentally healthy, too.

Take Tommy Clark there.

NARRATOR: Psychiatrists

latched onto the notion that

early life experience

shaped personality

and could lead to neurosis.

And while Freud believed

most people lived on

a psychological spectrum,

the DSM tried to make clear

who was normal

and who was not.

The feeling of

being born in the wrong body

was so far outside "normal,"

the DSM and psychiatry

didn't even have a label

to describe what people like

Mia were experiencing.

YAMAMOTO:

You are a sexual deviate,

which nobody in society

likes very much.

There were a lot of years

where I was trying to figure out

some way to just kind of end it,

because every single person that

tells you you're crazy,

so you feel like you

don't belong in the world.

This is another picture

from my unit in August 1966.

Um, that's me.

NARRATOR: Mia enlisted in

the Army during the Vietnam w*r,

when she was 23

and her name was Mike.

YAMAMOTO: The military always

seemed like a beacon to me.

It was something that I could do

that would satisfy

the demands of the male gender.

If I had lost my life in w*r,

that it would be an

honorable exit from this life,

my family would

never learn my secret,

and people would honor

my memory.

This impersonation,

I took it a long ways,

and I got as far

as I could go with it.

NARRATOR: Society wasn't ready

to accept Mia's reality.

(protesters chanting)

But the Vietnam w*r sparked

a historic cultural shift

and a protest movement

that would alter

how psychiatrists understood

who was "normal"

and who was not.

MAN (in film):

One out of three of you

will turn q*eer.

If you don't get caught by us,

you will be caught by yourself,

and the rest of your life

will be a living hell.

LAWRENCE HARTMANN: Young people

now can hardly believe

that gayness was considered

a major illness and crime

to the extent that people

who were g*y

couldn't let you know

they were g*y.

BAYER: There were laws in

the United States,

across the United States,

they were called sodomy laws.

If two men were caught

having sex together,

they could go to jail.

So psychiatry took shape

under those conditions.

MAN (in film):

Your feelings do change

to some degree

from time to time.

There have been periods

when you've felt

- Mm-hmm.

- Quite strongly

- heterosexual in your interests.

- Mm-hmm.

HARTMANN:

Even though Freud had taken

a more agnostic point of view

about gayness

Freud had said,

"We don't know, really,

but we're learning something

about it"

psychiatrists and analysts

tended to consider g*y people

as deeply sick.

NARRATOR: In mid-20th-century

conservative America,

one renowned psychoanalyst

and psychiatrist

was Charles Socarides.

The aim of the h*m* act,

paradoxically enough,

is to seek masculinity.

He is attempting

to achieve the very thing

that he felt he was so lacking

in childhood.

BAYER: Socarides believed

that people became h*m*

because they had overbearing

mothers and distant fathers.

So he was the person who said,

"Our goal as psychoanalysts

"is to make them happy

and to make them fulfilled

"and to allow them to be the men

they were born to be,

"which is to be straight

and to have heterosexual

relationships."

SOCARIDES:

The whole idea of saying

"the happy h*m*"

is to, again,

to create a mythology

about the nature of

h*m*.

HARTMANN: Socarides said that

he had

treated and cured hundreds of

patients.

I think that he was a scoundrel

and a liar.

I saw several of the patients

that he thought he had cured

whom he had not cured.

♪

Those of us who wanted

to reform psychiatry

and gayness got some of our

courage

from Vietnam w*r protests,

women's rights,

and Black civil liberties

protests.

We said, "Is psychiatric

labeling and diagnosis

simply a way of society saying,

'We don't like it'?"

In psychoanalysis,

the goals are love and work.

They love, they work; why are

we defining them as sick?

NARRATOR: Was society once again

shifting the boundary

between the so-called ill

and the so-called healthy?

WOMAN (in film):

At first, I was very guilty.

And then I realized

that all the things

that are taught you not only

by society,

but by psychiatrists, are just

to fit you in a mold.

When I rejected the mold,

I was happier.

BAYER: The American Psychiatric

Association became targeted

as g*y people began to say,

"We're not sick,

we're normal,

and you are oppressing us."

NARRATOR: And then, at the 1972

A.P.A. conference in Dallas,

a panel called "Psychiatry:

Friend or Foe to h*m*?"

featured a man calling himself

Dr. Anonymous.

KENT ROBINSON: Our next speaker

is Henry Anonymous, MD.

Obviously a pseudonym.

He is a

(laughter)

He is an A.P.A. member,

board-certified psychiatrist.

Dr. Anonymous.

ANONYMOUS:

Thank you, Dr. Robinson.

I'm a h*m*.

I am a psychiatrist.

Cease attempting to figure out

who I am

and listen to what I say.

HARTMANN: Big mask, microphone

to disguise even his voice,

and he said, "I'm a psychiatrist

and I'm h*m*."

It was unheard of.

Nobody knew or acknowledged

that there was such a thing.

ANONYMOUS:

This is the greatest loss

our honest humanity.

And that loss leads all those

others around us

to lose that little bit of their

humanity, as well.

For if they were truly

comfortable

with their own h*m*,

then they could be comfortable

with ours.

HARTMANN: He was a psychiatrist

just about my age.

I was much more closeted

than he,

but I think it was 21 years

before he said,

"And my name is John Fryer."

NARRATOR: John Fryer had already

been fired

By two university psychiatry

departments

for his sexual preferences.

Though he didn't acknowledge his

role as Dr. Anonymous

until 1994, his actions laid the

groundwork for a revolution.

On December 15, 1973,

the A.P.A. voted unanimously

to remove h*m*

from the DSM.

Being g*y was now on the

spectrum of "normal."

HARTMANN: I was one of the ones

who wrote the wording

that said gayness should not be

considered an illness.

I was pleased that people would

reconsider,

what do we mean by diagnosis?

What do we mean by trying

to help people?

Good evening.

Tonight, "The Advocates" looks

at a question which raises

both civil rights

and moral issues.

Specifically, our question is:

should h*m*

be permitted to marry?

NARRATOR:

While stigma and prejudice

against gays didn't disappear,

the approach in the world of

psychiatry continued to evolve.

THOMAS ATKINS:

Dr. Charles Socarides

NARRATOR: And the once-revered

Socarides

was heckled for his positions

that a new generation saw

as outdated and discriminatory.

Dr. Socarides,

the American Psychiatric

Association,

when it was founded in the

vicinity of middle 1850s,

considered Blackness to be

a sign

of genetic illness

Is this not correct?

I'm not familiar with that,

but perhaps you're right.

I am.

(audience laughter and applause)

Now, of course, we don't believe

any of that today.

Judgments have changed.

Isn't it possible that in

50 years,

it will be considered just as

ludicrous when we hear

all the comments that you have

made

about h*m*, with

(applause)

BAYER: It's easy to look back at

that moment and say,

"How could people have been so

blind

"to how the

uses of diagnosis

was oppressing people

and punishing people?"

And I think when we do that,

sometimes,

we forget the fact that these

psychiatrists

very often really thought

of themselves as saviors.

They saw themselves as saving

someone from a tragic future.

(elevator chimes)

ELECTRONIC VOICE:

Going up.

NARRATOR: When the A.P.A.

removed h*m* from the

DSM in 1973,

Mia had finished her tour in

Vietnam

and was working as a lawyer.

Although the psychiatric

profession finally accepted

h*m* was not a disease,

what did it offer those

who questioned their gender?

YAMAMOTO:

Back in those days,

if you asked me if I was g*y,

I would say no.

I've always loved women,

I was enthusiastically straight.

But I go to bed at night,

I had the same feeling, like,

why am I in this body?

Why am I here, why am I still

living like this?

This has to be either 1973

or 1974.

The length of my hair actually

is an expression

of my gender identity

at that point.

I was in therapy for very many

years once I could afford it.

At first, I went to a guy who

worked with h*m* people.

A gender therapist didn't exist

in those days.

So I went to this fella

and I said,

"I feel like I'm a woman,

feel like I've got this body,

"and I feel like I don't belong

in this body.

"And, and I like to cross-dress.

"Actually, it helps me to feel

whole,

it makes me feel complete."

He had so few answers for what

was going on with me.

He says, "It's really odd

that you like women."

He said,

"That's, like, really q*eer."

He says, "I"

You know, "I'm a, I'm a

therapist

for h*m* people," he says,

"And they're q*eer people."

He says, "But you are

the queerest of the q*eer."

NARRATOR: The delisting

of h*m* had exposed

the fluid, even arbitrary nature

of diagnosis.

And Mia's therapist was

not alone in his confusion.

In the 1970s,

a young Michael Walrond

was struggling

with mysterious health issues.

A doctor labeled him with a

psychiatric disorder,

hypochondria.

WALROND: I heard that word often

growing up,

because no one could pinpoint

what was wrong with me.

I have a rare disease, common

variable immunodeficiency,

although I was misdiagnosed

for 36 years.

As I grew,

something was always wrong

hospitalized, emergency rooms.

I remember some people thought I

was trying to get out of school,

but I wasn't feeling well.

And then because no one

necessarily had answers,

but I knew what I was feeling,

it puts you in a space where

there were days

you don't really want to get out

of bed.

There are days you don't really,

you don't really want to engage

people.

I was experiencing these

what I would now call

depressive moments.

And at the heart of it was

my physical challenges.

And to seek out help

almost affirms that maybe I am

crazy.

NARRATOR:

The fear of being labeled

with a mental disorder was

well-founded.

♪

For decades, with subjective

diagnoses,

hundreds of thousands were

confined

to mental institutions,

often against their will.

By the early '70s,

many had had enough.

DAVID ROSENHAN: Psychiatric

hospitals are storehouses

for people in society

whom you really don't want,

whom you really don't

understand,

and for whom you've lost a great

deal of sympathy.

♪

NARRATOR: Americans wanted to

know after decades of trying,

could psychiatry even separate

the sane from the insane?

CAHALAN: You had a huge backlash

against psychiatry.

MAN (in film): I'm a therapist

in a day treatment program.

We have an anti-psychiatry

model.

We've gotten rid of the normal,

normalcy/abnormal dichotomy.

CAHALAN: All this groundswell

of fear, and loathing, really,

for the psychiatric

establishment

raises questions about

the daily indignities that

people face

when they are labeled

with a psychiatric condition.

FRANCES: People said, "You don't

know what you're doing

"when you diagnose people

"and you don't know what

you're doing

"when you treat people.

Why is this a medical

specialty?"

NARRATOR: The American

Psychiatric Association

diagnosed the problem: Freud.

LIEBERMAN: In the 1970s,

public opinion had shifted from,

"Freud's brilliant,

this theory is great,"

to, "The emperor has no clothes,

there's no evidence for this."

The leadership of the profession

got together

and said, "We've got to fix our

diagnostic system."

What we need

is a diagnostic system

that reliably produces

a predictable result.

NARRATOR:

To oversee this herculean task,

they appointed Robert Spitzer of

Columbia University.

CAHALAN: Robert Spitzer is a

very mathematically-minded,

very objective, fact-oriented

psychiatrist

who had always

had an interest in numbers.

So, Spitzer established

algorithms.

For each diagnosis, we're going

to establish certain items

that are required for the

diagnosis,

and how many of those items have

to be present

before making the diagnosis,

and then how many weeks

must we have this.

NARRATOR: But without any

biological tests,

Spitzer's team could only

describe symptoms,

so they still shaped diagnoses

in a highly subjective way.

FRANCES: I started working

on DSM

in 1978.

It was very arbitrary.

Wasn't as if these were meant

to be graven in stone.

But diagnostic reliability

went way up.

Well, you can't do diagnosis

without having an agreed-upon

system.

It's better to have

a consensus subjectivity,

than each person inventing

his own way of doing diagnosis.

NARRATOR: The A.P.A. published

DSM-III in 1980.

It split vague and broad types

of neuroses into new,

more specific disorders.

At the time,

the manual met society's demand

for a more scientific-seeming

approach.

But psychiatrists keep rewriting

it to describe

an ever wider range of

experiences

as they grapple with the same

questions raised by Freud:

is there such a thing as normal?

Or does everyone live on

a spectrum?

The current DSM

has 265 mental disorders,

nearly three times the original.

One describes the feeling

of having

the wrong gender assignment,

called "gender dysphoria."

But because of social judgment,

like all diagnoses,

it's a double-edged sword.

NEWS ANCHOR: Tonight, the FBI

is digging deeper

into the m*rder

of a transgender

NEWS ANCHOR: A transgender teen

has taken her own life.

YAMAMOTO:

Gender dysphoria, as a category,

it places people in a position

of, if not mental illness,

some sort of mental deviance.

But apart from the way

we view our gender identity,

we are in all other ways normal.

It just doesn't look that way

to a world

who is used to seeing things

in terms of a binary.

KIM: This was

the day we got married,

this was in Millie's chambers.

YAMAMOTO: On the other hand,

there is a whole movement

that is succeeding, actually, in

getting insurance companies

to cover therapy

and even gender surgery.

So to have no name for it at all

I don't believe would be

helpful.

MAINS:

You still doing your sunset?

NARRATOR: The authors of DSM-III

established the diagnosis

of post-traumatic stress

disorder to finally recognize

the enduring effects of trauma,

but it's not easy to overcome

the legacy of stigma.

MAINS: I'd always been an

advocate of,

you know, end the stigma,

everything, you know,

it's okay to not be okay,

et cetera, until it was

happening to me.

Are you done with that one?

NARRATOR: Like all

mental disorders in the DSM,

PTSD is defined by symptoms,

not biology.

♪

In the hopes of someday changing

that, scientists are searching

for trauma's biological

fingerprints.

YEHUDA: When I started

my post-doctoral fellowship,

I had never heard of

post-traumatic stress disorder.

Many people didn't believe

that this diagnosis was real,

and certainly very little

was known about it.

So I joined a lab

that was the first group

that began examining the biology

of PTSD

in hopes of understanding

what it was.

We've had to create

a whole language for this.

We've had to create a whole

science for this.

The tools that we needed

haven't even been available

for that long.

NARRATOR:

Over 30 years of research,

Rachel Yehuda has helped unravel

some of the biology of PTSD.

YEHUDA:

We really understand

from brain imaging studies

right now

that experience does produce

physical changes in us.

NARRATOR: Yehuda's work shows

that trauma

can damage crucial connections

between the memory

and emotional processing centers

of the brain.

These connections are made

of tissue called white matter.

YEHUDA: White matter refers to

a part of the brain

where the neurons can carry

information

from one neuron to the next.

So, in a sense, you can think

about

there being highways in between

structures in the brain,

and then the question is,

how good is the highway?

And what you see

in somebody with PTSD is,

you know what, it may not

be running that great.

Which really accounts for

things like over-responding

to triggers

or feeling that things are

dangerous in the environment

when they're not actually

dangerous in reality.

NARRATOR: But the strength,

or "integrity,"

of these neural highways

often improves

when patients confront problems

using a distant descendant

of Freud's psychoanalytic

approach

called cognitive behavioral

therapy.

YEHUDA: There is an idea that

the reason

you can't talk about the trauma

is because you're afraid that if

you talk about the trauma,

you'll become really distressed.

But if you do this in a safe

environment with a therapist,

the therapist can tell you that

your distress

doesn't mean that this

is happening all over again.

And continuing to tell the story

over and over again

may reduce the distress.

And this can make changes

in your brain circuitry.

In somebody who has successfully

responded to therapy,

we start to see that white

matter integrity building up.

We can see it improve.

So we're not exactly where we

need to be,

but we've come a long way from

where we started.

DAVID FERENCIAK:

We're going to be moving toward

the fear/trauma memories.

NARRATOR: Since his counselor at

the fire department

declared him unfit for duty,

Ryan turned to a type of

cognitive behavioral therapy

called exposure therapy.

But what would be maybe as close

to 100 in intensity?

One of the, one of the traumatic

calls that we went on at work.

NARRATOR: For him, this involves

the retelling of trauma

narratives

and revisiting the scarring

experiences

that ended his career.

So, I want you to close your

eyes, and when you're ready,

you can start

describing the narrative.

I don't remember exactly

what time it was.

It was dark, we had toned out

for a hit-and-run,

a child that was struck

by a vehicle.

We were the first ones

on the scene.

I see a child laying

on the ground.

Family says that, that the

vehicle that hit him

didn't stop.

I jumped in the ambulance.

As we pulled up to the E.R.,

the E.R. staff was waiting

for us outside.

♪

(voice trembles):

Uh

Give me a level.

Um

That was about the time

that the family started to

arrive.

I hear the screams

♪

From the family, um,

when, uh, the E.R. staff told

them that they,

they were, they were stopping,

that there was nothing,

nothing else that they could do.

I felt really angry.

I was, I was furious.

I think I even threw some

things, I was so angry.

We're just gonna

take a moment right now.

Before we go back into it,

I really want you to do

your best

to speak through the memory, as

if it was happening right now.

- Okay.

- Okay?

So what we're going to do is,

we're gonna rewind right back

to the beginning.

One of the misconceptions

I had about PTSD

was that I would go to treatment

and it would be cured,

and I never had to deal with

it again.

I hear the reaction from the

family, I hear the screams.

I have a better understanding

now in that

it's never going to go away.

It will always be there.

Give me a level.

- (crying): 85.

- (whispers softly)

And emotionally,

how did that feel?

Gut-wrenching.

My reaction to it has changed,

and I think that

has been the most powerful, uh,

thing for me.

Can you feel any physical

sensation right now

as you're recounting this?

Yeah, yeah, I've got that

uneasy feeling in my stomach.

My PTSD doesn't own me as much

if I can control my reaction

to it.

I don't know how it's going

to go over the next ten years.

I just try and handle each

moment as it comes.

You did a great job.

It's commendable the amount

of courage that you show

in being willing to open this

wound up again.

We're going to be revisiting

this event as many times as we

need to,

in order to clean out that

wound,

so that it can heal effectively.

♪

MAINS: Thanks for coming out,

guys.

NARRATOR: Ryan's last day

at the fire department

was nearly a year ago.

(indistinct chatter)

MAINS:

This is my pension beard.

So until I get the,

get that settled,

we're just gonna let it go.

(chuckling)

NARRATOR:

Today, he'll run one kilometer

for every firefighter-paramedic

who's died by suicide in the

past year.

He's raising money so others

living with PTSD can get

treatment.

It's gonna be brutiful.

When I initially told people

that 130 firefighter-paramedics

died by suicide last year,

they were shocked.

WOMAN: Here we go, guys!

(applause and cheers,

noisemakers clanging)

Love you!

♪

MAINS: There are so many

mental health issues

that we haven't done

a good job of, as a society to

this point, talking about.

(people cheering)

WOMAN: All right, Ryan!

Whoo-hoo!

♪

MAINS: So I'm hopeful that

the more I speak out,

the more okay

others will be with it

and the more normal it becomes.

(indistinct chatter)

(cheers, noisemakers clanging)

NARRATOR: It's possible that

future generations

will unravel the mysteries of

mental illness

and subjective diagnoses will

fade away.

In the meantime, many are

working to change society

and expand the fluid definition

of "normal."

WALROND:

The first Sunday of the year,

we talked about courage,

then we talked about anger,

then complacency, and then last

Sunday,

we talked about joy joy.

And today we're gonna talk

about

well, it's obvious healing.

When I first started talking

about depression openly,

you know, not too many pastors

were going to go on the pulpit

and talk about having

suicidal ideations.

No, because the first thing

is a thought that,

"Well, there's countless,

"countless people who wrestle

with this

"and may come to me looking

for some resolution.

How do I tell them I'm dealing

with the same thing?"

So, that stops so many of us

from being transparent.

There have been moments

in my life

where I've fought depression

and darkness

and that feeling of a shadow

hovering over me,

and I felt like I had no one

to turn to.

But for me,

as I was able to name issues

around anxiety and depression,

it helped other people see the,

the characteristics,

the traits, "Maybe this

is what's happening with me.

That made my transparency,

my vulnerability, necessary

Not just for me,

but for other people.

♪

As we often say in church,

"I'm not where I used to be,

"and I'm not fully where

I'm going to be,

but I thank God for progress."

♪

YAMAMOTO: Nice work

if you can get it ♪

And you can get it

if you try ♪

NARRATOR: Today,

Mia lives in L.A. with Kim,

her wife of five years.

YAMAMOTO: On my 60th birthday,

I started coming out to people.

They really thought I had just

absolutely gone crazy.

And I thought,

"Okay, you know, maybe I am."

Again, "going crazy,"

"gone crazy," "am crazy,"

I've, I've been imbued in that

for a lifetime.

♪

NARRATOR:

Over the course of her life,

the line between mental health

and mental illness

has shifted many times.

But society is still deciding

who's normal.

YAMAMOTO:

When I was going through

the actual last gender surgery,

I remember the night before

thinking, you know,

you know, "You're going to be

on the table

for seven hours tomorrow,"

you know.

"You're 60-something years old,

and you could die tomorrow."

And I remember saying to myself,

"Good."

What I meant was,

if I can survive this,

and survive all the haters

(chuckles)

and the bigots,

then I'm going to be living

the life

that I've always wanted to live.

The world is going to have to

adapt to my identity,

to my authenticity.

And that is my fate, that's our

fate, my world's fate, as well.

♪

(cheers and applause)

WOMAN: We're coming,

we're coming!

(cheers and applause)

(cheers and applause)

ANNOUNCER: Next, on "Mysteries

of Mental Illness"

MAN: The notion of asylum,

it was a place to be cured.

WOMAN: The reason he was

admitted was worry.

WOMAN: A lot of these people

were going to be there

for the rest of their lives.

MAN: The practices there

were unaccountable.

MAN: Experimental therapies.

MAN: Sterilization

without consent.

ANNOUNCER:

The first lobotomy.

MAN: The idea was

"interrupt the madness."

MAN (archival): There is

new hope for all, new drugs.

MAN: The mentally ill were not

really de-institutionalized.

ANNOUNCER: Today, there are

ten times more people

with mental illness

in jails and prisons

than in hospitals.

Who's been diagnosed

with schizophrenia?

WOMAN: There isn't any one place

to make sure

that they're cared about

once they leave the jail.


♪