March 18, 2026 • 28 mins
Embracing Autism and Mental Health: Psychiatrist David Hager's Journey
In this episode of 'Why Not Me, Embracing Autism and Mental Health Worldwide,' host Tony Mantor speaks with psychiatrist David Hager about his unplanned journey into psychiatry, his work in correctional facilities, and his unique perspectives on mental health and serious mental illnesses like schizophrenia.
Hager shares his experiences from various jobs, discusses the challenges and strategies of treating incarcerated populations, and underscores the importance of viewing severe mental illnesses as neurological disorders.
The conversation also touches on the issue of anosognosia and the need for better systemic support. Tune in for an insightful and heartfelt discussion aimed at fostering awareness and understanding of autism and mental health.
Meet David Hager: From Vet School to Psychiatry
David's Journey into Psychiatry
Challenges and Rewards in Psychiatry
Correctional Psychiatry: A Unique Perspective
Forensic Psychiatry and Systemic Issues
Reframing Mental Illness: A Neurological Perspective
Personal Reflections and Closing Thoughts
INTRO/OUTRO Music: T. Wild
Mantor Music BMI
The content on Why Not Me: Embracing Autism amd Mental Health Worldwide, including discussions on mental health, autism, and related topics, is provided for informational and entertainment purposes only.
The views and opinions expressed by guests are their own and do not reflect those of the podcast, its hosts, or affiliates.
Why Not Me is not a medical or mental health professional and does not endorse or verify the accuracy, efficacy, safety of any treatments, programs, or advice discussed.
Listeners should consult qualified healthcare professionals, such as licensed therapists, psychologists, or physicians, before making decisions about mental health or autism- related care.
Reliance on this podcast's contents is at the listener's own risk.
Why Not Me is not liable for any outcomes, financial or otherwise, resulting from actions taken based on the information provided.
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intro/outro music bed written by T. Wild
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Episode Transcript
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SPEAKER_00 (00:05):
Welcome to Why Not Me, Embracing Autism and Mental
Health Worldwide.
Hosted by Tony Mirator.
Broadcasting from the heart ofMusic City, USA, Nashville,
Tennessee.
Join us as our guests sharetheir raw, powerful stories.
Some will spark laughter, otherswill move you to tears.
(00:30):
These real life journeysinspire, connect, and remind you
that you're never alone.
We're igniting a global movementto empower everyone to make a
lasting difference by fosteringdeep awareness, unwavering
acceptance, and profoundunderstanding of autism and
(00:52):
mental health.
Tune in, be inspired, and joinus in transforming the world one
story at a time.
Hi, I'm Tony Mantor.
Welcome to Why Not Me, embracingautism and mental health
worldwide.
Joining us today is David Hager,who interestingly never planned
(01:14):
on becoming a psychiatrist.
He started college at Texas AM,dreaming of a white coat for
four-legged patients set onveterinary medicine.
But somewhere between anatomylabs and late-night soul
searching, the human mind pulledharder than any animal heart
ever could.
He pivoted, earned his MD atUTMB Galveston, completed his
(01:35):
psychiatry residency, and movedforward from there.
He then walked into stateprisons in Florida and Illinois
where the patients were humanbut often treated as less.
His journey is outstanding andhe has so much information to
give us today.
So before we dive into ourepisode, we'll be back with an
uninterrupted show right after aword from our sponsors.
(01:57):
Thanks for coming on.
SPEAKER_01 (01:59):
Yeah, this is interesting.
It's a first uh first-timeexperience for me.
SPEAKER_00 (02:04):
Well, that's good.
I do not think there'll be anyproblems.
I think the most important thingis getting it started.
So let's do that.
If you would introduce yourselfand tell us what you do.
SPEAKER_01 (02:14):
Oh, I'm David Hager and I am a psychiatrist.
SPEAKER_00 (02:18):
Okay.
Now, the big question (02:19):
what led you to go into psychiatry?
SPEAKER_01 (02:24):
Well, I didn't uh I didn't plan on psychiatry.
I went to Texas AM to be aveterinarian.
SPEAKER_00 (02:30):
Okay, I safely can say I didn't expect that.
SPEAKER_01 (02:34):
Yeah, it's actually more difficult to get into vet
school than medical school.
SPEAKER_00 (02:39):
That's interesting.
SPEAKER_01 (02:40):
Yeah, it is.
It's just a it's a numbersthing.
So I applied in my sophomore,junior, and senior years of
college to vet school.
And then that that last time Ialso applied to med school
because I realized uh there's acouple of things.
One is the veterinarians I wasworking with all of a sudden
they wish they had gone tomedical school.
And then I realized the mainreason I wasn't going to medical
(03:03):
school or considering it isbecause my father wanted me to
go to medical school.
Anyway, wound up in medicalschool, was accepted to three
med schools, and I got a thirdalternate spot that time to the
vet school.
Yeah, so uh went to UTMB andGalveston.
After going through the thirdyear, which is the usual round
of clinicals, I had it boileddown to surgery or psychiatry.
SPEAKER_00 (03:27):
Okay.
SPEAKER_01 (03:28):
Psychiatry was unexpected.
What I liked about psychiatrywas listening to people's
stories.
SPEAKER_00 (03:34):
Yeah, I get that completely.
And those stories can get prettyintense.
They can, yeah.
I guess my question is, how doyou deal with that?
From a standpoint of someonethat wants to help someone, I've
been told all my life that I'm afixer because I like to help
people.
In your scope of work, fixingmeans helping people.
And sometimes when you're tryingto help these people, you can't
(03:57):
fix them.
Right.
That can be very frustrating.
So how do you deal with that?
SPEAKER_01 (04:02):
Well, not always gracefully.
I'm a human.
You know, sometimes with uhstiff professional formality,
and sometimes I think more so asthe as my career has progressed
and I've become more human as apsychiatrist, that um I'm able
to listen to people's storieswithout having to be necessarily
(04:23):
strictly a psychiatrist whiledoing so.
SPEAKER_00 (04:26):
Okay.
That makes sense.
Now I'm guessing by doing itthis way, you're able to
hopefully break down somebarriers, which will allow them
to get into a comfort zone withyou, which allows them to tell
you more things that you need tohear in order to be able to help
them.
SPEAKER_01 (04:45):
Yeah, a lot depends on the setting.
How clinical interviews go in acorrectional setting, for
instance, is very different fromhow interviews go in, let's say,
a substance abuse rehab.
Now I had worked for severalyears at a rehab and lots of
stories there.
I can only imagine.
It worked better to be a littlebit more myself in those
(05:07):
settings.
You don't really let people knowmuch about yourself personally
when you're working with uhfolks in a prison or a jail.
SPEAKER_00 (05:16):
Yeah, that makes sense.
SPEAKER_01 (05:18):
Yeah, but one of the ways I I tried to deal with that
to um reduce some of theformality of the interviews was
I actually I wrote a program todo a computer psychiatric
interview before I saw thepatients.
So get through a lot of thestructured stuff beforehand that
(05:39):
I could follow up on during theactual face-to-face interview
and then focus more on the humanelements instead of going
through a whole bunch of rigiddiagnostic stuff that can chew
up a lot of time.
SPEAKER_00 (05:50):
That computer program is such a great idea,
saves a lot of time, I'm sure.
I'm sure you're like everyoneelse that you have a limited
amount of time to give to thesepeople.
SPEAKER_01 (06:00):
Right.
SPEAKER_00 (06:01):
What happens when a patient starts opening up and
digging into some of thesethings that you really need to
know?
And then all of a sudden, thetime's up.
Yeah.
So do you go into overtime?
Do you punch the clock?
What do you do?
SPEAKER_01 (06:17):
Again, that depends on the setting.
You know, in that substanceabuse rehab setting, I had a
schedule.
And you know, patients are kindof notorious for bringing up the
most difficult thing right atthe end of a session.
And there's a tab dancing thatthen occurs.
Um, yeah, hopefully acompassionate tab dancing that
says our time is limited, andand I hope we'll continue to
(06:39):
talk about this the next time wesit down.
Yeah, it's uh that's a toughone.
On the other hand, ininstitutional settings, there's
not so much of a hard timelimit.
It can be a lot more flexible inhow long a particular session
lasts.
SPEAKER_00 (06:54):
That makes total sense.
Are you working with people thatare incarcerated, or are you
still working with people thatneed help with substance abuse?
Or is it a little bit ofeverything?
What's your schedule look likenow?
SPEAKER_01 (07:08):
Well, I'm partially retired now.
SPEAKER_00 (07:10):
Okay.
SPEAKER_01 (07:11):
Yeah.
But you know what I'm doingright now is contract work.
And I'm doing contract workdoing correctional psychiatry
because over the years I havefound that to be the most
interesting work.
SPEAKER_00 (07:23):
Okay.
SPEAKER_01 (07:24):
And the contract work is uh there's other factors
that play into why it works outwell for us at this point, so
that I can work half the yearand still get by.
Tell you a little bit about howI got into correctional work and
what that experience has beenlike.
SPEAKER_00 (07:40):
Yeah, that sounds great.
When did that start?
SPEAKER_01 (07:42):
It's 2001.
I'll tell you that I'm I'm notgreat at running a business, and
I had a practice in SouthwestFlorida, a private practice with
a number of clinicians, and thatfinancially didn't go well.
Yeah, I wound up in a lot ofdebt out of that.
I learned some hard lessons, andthe uh the job that was
available nearby was at aprison.
And I had an interest inforensics already.
(08:04):
I was doing court evaluationsand such, and so I figured it
was a good way to round out orflesh out some of my forensic
experience.
So I started working at thisprison, Charlotte Correctional
in Southwest Florida.
Turns out that's a place thathas a bit of a reputation.
It's it's a tough place.
It's a close management camp onsite, which is a prison within a
prison.
And it also happens to have thecrisis unit, one of the crisis
(08:25):
units and a transitional careunit for people with severe
mental illness or well, peoplewith mental health concerns.
Because it kind of parses outinto a few basic categories in a
correctional setting.
SPEAKER_00 (08:38):
Okay.
Can you expand on that some?
SPEAKER_01 (08:41):
You've got people who are real deal severely
mentally ill.
You've got people who are tryingto make you believe that they're
real deal mentally ill becauseof various reasons.
Either they want specialconsiderations or they want the
medications, or either they wantto take the medications or sell
the medications.
And then there's uh populationthat it's important to manage uh
(09:02):
from a safety perspective, thefolks who are at risk for
suicide.
There are some people who areactually at true risk for
suicide, but you know, ourexperience is that most of the
people who say they're at riskfor suicide are using that
particular process to try tomake a change happen.
So at Charlotte Correctional, Ibegin to appreciate what happens
(09:23):
to people who have severe mentalillness, real deal severe mental
illness.
SPEAKER_00 (09:28):
With that said, does anyone or any particular
situation stand out to you?
SPEAKER_01 (09:33):
I remember this one guy in particular.
You know, I'd go look at theclassification file for people
where I wasn't really sure whatwas going on.
And this one guy I wasn't quitesure.
And I looked through hisclassification file and I saw
his history of arrests, and itwas a whole bunch, it was like
30 trespassing arrests.
Wow.
Yeah.
And then he became, you know, inthe course of me trying to take
(09:55):
care of him, he became floridlypsychotic.
He became, you know, it wasthere was no ambiguity at all.
You know, there was theprogression of people uh for
this person anyway, of um allthese misdemeanors, misdemeanor
arrests, and eventually hefinally got popped with a felony
and he wound up off the streetsfor a longer period of time.
And why he didn't wind up in aforensic psych hospital, it's
(10:18):
just, you know, it's luck of thedraw, it seems.
Probably depends on who hispublic defender was or how well
put together he was at the timeof the hearing.
Real deal people, because ofanasygnosia, they uh they don't
declare themselves.
There was actually there's asemi-appocryphal story out of
one of the big urban jails inHouston.
(10:39):
Remember a colleague telling me,and I'm it fits perfectly.
A Harried, busy psychiatrist wasshowing up for what was
essentially a mental health sickcall, and she saw that there
were there was an impossiblenumber of people to see.
So she had to make a decisionabout who she was going to try
to see and who she wasn't.
So she calls out to them.
She says, Okay, all of y'allhere who have a mental illness,
(11:02):
raise your hand.
So a whole bunch of hands go up.
And she says, Okay, y'all can goback to your cells.
I'll see the rest of you.
SPEAKER_00 (11:07):
Wow, that's um pretty unbelievable, actually.
SPEAKER_01 (11:13):
That's the world of corrections.
I worked at that facility for 15months.
I worked subsequently at thePalm Beach County Jail.
Jail work is very different,it's uh a whole different vibe.
SPEAKER_00 (11:25):
Yeah, I can just imagine.
Now, what happened after that?
Where did you go?
SPEAKER_01 (11:30):
I went up to Indiana.
I was the uh director of themental health services for the
Indiana Department of Correctionfor a while.
We lost that at Rebid.
Working for one of thefor-profit companies, contracts
come and go.
And I subsequently worked at theMarion County Jail and Valuesia
County Corrections in CentralFlorida.
After that, I went on in 2008 toshift from corrections, which
(11:54):
especially in jail work, it canbe difficult.
There's stories around that, butthere are difficult political
stories around that.
And I came back to Texas andworked at Kerrville State
Hospital, which is a primarilyforensic hospital.
It's it's 100% forensic at thispoint.
I used to have a crisis unit,but uh that went away while I
was there.
And it has specialized even morein uh people who are not guilty
(12:18):
by reason of insanity.
So that's pretty much the entirepopulation at Kerrville State
Hospital.
So I worked there for four yearsat one point and then two years
again during the pandemic.
SPEAKER_00 (12:29):
That's quite a path of different scenarios that
you've worked with in.
SPEAKER_01 (12:32):
Working with the forensic population in that
setting, different experience, adifferent system, feel to how
that system works.
But there's the length of stay.
If you look at prisons and youlook at forensic psych
hospitals, there's one commontheme, and that is the length of
stay is much, much longer.
You can debate whether that's agood thing or a bad thing.
(12:54):
For some of the people asdebilitated as they were,
especially at the forensic psychhospital at Kerrville State
Hospital.
Oh my God, some of these peoplewere so low functioning.
There was no other option forthem, really.
Another thing while working atKerrville State Hospital, it was
a sad comment that familieswould make.
A repeated question fromfamilies was, why did my loved
(13:17):
one have to kill somebody to getservices like this?
SPEAKER_00 (13:20):
Yeah, that's a tough question.
And unfortunately, I've heardthat so many times with people
that have been on my podcast.
This podcast has been reallygood to get a lot of information
out there.
Unfortunately, a lot of thisinformation is things that
people just don't want to hearand shouldn't have to hear.
unknown (13:40):
Yeah.
SPEAKER_00 (13:40):
A lot of people will see something that's on TV, they
don't understand it, they don'tknow what it is.
Because of the sensationalism ofthe TV, they will get their
perception of what it is.
Usually it's the wrongperception.
Unfortunately, it's a situationof where the system failed the
(14:00):
person that had the problem.
Before I started addressingserious mental illness and
anesthynosia on this podcast, Ihate to say it, but I had a lot
of the same thoughts.
It truly is sad that you had tocomment on how many people will
say, Why did my loved one haveto do something so bad to get
the help that they need?
(14:22):
What's even sadder is it doesn'tseem to matter which state I'm
talking with, they all have thesame issues.
So I'm interested because youworked in so many different
facilities, you've seen theissues that they face firsthand.
So everyone has a differentapproach.
(14:42):
I'm interested in what yourapproach would be.
What are your thoughts?
How do you think we can makethings better to help people
that really need the help?
SPEAKER_01 (14:53):
Yeah, it's a sad irony that at this point the
criminal justice system does abetter job with accountability.
I hate to use the wordcontainment, but a containment
within a process, whether it'soutpatient or whether it's uh
somebody who's in incarceratedactually, or in a forensic
system, because if they're in aforensic system, forensic
psychiatry hospital, they'restill under the umbrella of the
(15:15):
criminal justice system in someway or another.
So um the civil sector, the wayit works, if somebody with a
severe mental illness doesn'tshow up for an appointment,
well, that person will bereplaced by somebody who does
show up for appointments.
And that tends to be a less sickpopulation.
SPEAKER_00 (15:32):
So what do we do to change that outcome?
SPEAKER_01 (15:36):
My personal take on this is when that person with a
true severe mental illnessdoesn't show up for an
appointment, you go get them.
You go track them down.
And AOT is supposed to be a wayto do that.
And certainly uh programs likeuh sort of community treatment,
those are good programs.
They're not used enough.
And then AOT, I don't think it'sused enough.
(15:57):
And and when I've seen it used,because I did some outpatient
forensic work as well, it's notnecessarily backed up with as
much oomph as it should be.
Like if the person doesn't showup for the psychiatrist
appointment and then doesn'tshow up for the psychiatrist
appointment, and then doesn'tshow up for the psychiatrist
appointment, there'sinconsistency about whether
anybody actually goes to say,hey, how come we're not showing
(16:20):
up for the appointment?
So there's some inconsistency inimplementation of that.
What's the next step then?
So I think beefing up AOT,assisted outpatient treatment.
Um, you know, the original ideawas outpatient commitment, but
the the phraseology was changedto AOT, making assertive
community treatment moreavailable for the real deal
(16:40):
people so that people aren'tlost to follow-up.
And then I have something that'sa little off script.
Okay.
There are other psychiatristswho think along these lines and
neurologists.
You know, historically,schizophrenia spectrum illnesses
have been, they've fallen underpsychiatry.
They just have.
You know what the original termor name for schizophrenia was?
SPEAKER_00 (17:02):
That's something that I do not know.
SPEAKER_01 (17:04):
Yeah, the original name for schizophrenia in the
early 1900s was dementiaprecocks, a premature dementia.
SPEAKER_00 (17:12):
Now that's very interesting on how that's
changed over the years as well.
SPEAKER_01 (17:17):
Yeah, and and that that way of looking at the
illness holds.
The more we learn about it, themore we realize, or I mean it's
accepted, it's a brain-leveldisorder, it's a
neuropsychiatric disorder, it'sa neurological disorder.
In fact, what I tell familiesand patients, I don't say that
they have a mental illness.
You know, people withschizophrenia, I don't say they
(17:38):
have a mental illness anymore.
Because that gets conflated witha lot of other stuff that, you
know, panic disorder is a mentalillness.
Um, drinking too much coffee isa mental illness, apparently,
because it's in DSM, right?
Look at the list of thingsthat's in DSM.
You know, it's a book ofpsychiatric disorders, and
schizophrenia is kind of inthere as well, but schizophrenia
(17:59):
is pretty serious.
SPEAKER_00 (18:00):
Yeah, it is.
And I think that you have agreat way of looking at it and
wish other people would look atit the same way as well.
SPEAKER_01 (18:07):
So I tell families and I talk with patients about
schizophrenia being aneurological disorder with
neurological symptoms.
Helps families to accept itbetter and understand it better,
especially when I point out thatthere is neuropsychological
decline, you know, cognitivedecline, that hallucinations and
delusions are neurologicalsymptoms.
(18:29):
They're not unique toschizophrenia.
There's an enormous, a multitudeof pathways.
Anybody can become psychotic.
Actually, I do a teaching thingwith patients.
I used to do it with my forensicpatients, my guys there at
Kerrville State Hospital.
I would teach them aboutpsychosis.
I would start with, what ispsychosis?
And the ones who already knewthe answer would say the right
(18:49):
answer.
But it was sort of a trickquestion.
I'd say, what is psychosis?
And the answer is psychosis is asymptom.
SPEAKER_00 (18:56):
Wow, that makes sense.
SPEAKER_01 (18:58):
It's a symptom of something.
Whether it's because I have abrain tumor or because I'm doing
too many drugs or because I haveschizophrenia, it's a symptom of
something.
Psychosis is a symptom, andhallucinations and delusions are
the common forms of ormanifestations of psychosis.
So schizophrenia is aneurological disorder with
neurological symptoms, includingneuropsychological decline,
(19:21):
delusions, hallucinations, uh,can include disordered thinking,
disordered behavior, and alsoanasygnosia.
And then I talk some aboutanzygnosia.
SPEAKER_00 (19:31):
How do you define that to people that don't
understand it?
SPEAKER_01 (19:35):
So when I talk generally about what agnosias
are in neurology, becausethere's a variety of agnosias.
And then when I talk about whatanasygnosia is, because
anasygnosia is not unique toschizophrenia, present in other
disorders as well.
And one of the common ones thatpeople can relate to is
Alzheimer's disease.
So I'll ask people, do you knowanybody with Alzheimer's?
Did they know they hadAlzheimer's?
(19:57):
And then they usually say no andthey'll say, Well, that's
anasygnosia.
And the same thing applies topeople with schizophrenia, and
then they get it.
SPEAKER_00 (20:04):
Wow, that's impressive.
SPEAKER_01 (20:05):
The people with schizophrenia don't necessarily
get it, but it depends on howthey're doing.
Because there are fortunatelysome people with schizophrenia,
with treatment, with effectivemedication, some insight
returns, and that's a blessing.
You know, take as much advantageof that as possible and kind of
cram as much education andrapport building into that time
of lucidity as possible ifthat's how the course of the
(20:28):
illness proceeds in response tothe medication.
But yeah, schizophrenia,neurological illness with
neurological symptoms.
So here's a little bit of aquestion for you.
SPEAKER_00 (20:37):
Okay.
SPEAKER_01 (20:38):
How many homeless people have you run into that
have Alzheimer's disease?
SPEAKER_00 (20:42):
To my knowledge, that would be none.
SPEAKER_01 (20:44):
How many homeless people have you run into who
have multiple sclerosis?
SPEAKER_00 (20:48):
Again, that would probably be none.
SPEAKER_01 (20:50):
Which can also be accompanied by anasygnosia.
Yeah, if you look atneurological disorders, you
don't see a lot of those, youknow, sleeping under the bushes
because the law says they canchoose to be there.
Going back a ways, I've longthought it to be unfair that a
person who is psychotic anddoesn't know she's afflicted
(21:11):
because of dementia is handleddifferently from somebody who is
psychotic and has anasgnosia andis unable to function normally,
but they're in their 30s.
So it's okay for that person whohas a similar level of
neuropsychiatric debility toconsign themselves to sleeping
under the bushes because theyquote unquote choose to be
there.
(21:32):
I don't know.
It's you know, there's therecent executive order
encouragingreinstitutionalization, and I've
got mixed feelings about that.
But on the other hand, there aresome people who don't need to be
sleeping under bushes anymore.
SPEAKER_00 (21:45):
Yes, I agree.
And hopefully something likethat would be enough ammunition
to get our legislators involved,make some new laws, and help
these people out that need thathelp.
SPEAKER_01 (21:56):
I remember a conversation I had with a uh
legislator.
I Actually, I was involved for awhile trying to keep a state
hospital open in SouthwestFlorida and it was slated for
closure.
It was back in the 90s.
Went up to Tallahassee a coupleof times.
One of the times I went up, I Ispoke with a guy who used to be
my boss.
He was a physician who became aFlorida legislator.
And I asked him that questionabout, you know, why is it that
(22:17):
grandma with dementia, we takebetter care of her than the
30-year-old who's hiding fromthe lasers under the bushes and
uh in the park.
And he was kind of a blunt guy.
I won't use all of the wordsthat he used.
Okay.
But he said, it's because wecare about grandma, but we don't
give a blank about the ladyunder the bushes.
(22:37):
So working in jails, working inprisons, I see from that
perspective how broken thingsare on the civil side because
they come to me.
SPEAKER_00 (22:46):
Yeah, I cannot disagree with you at all.
What do you think is importantthat people hear?
They may be well versed onschizophrenia and exagnosia, or
they may not.
They may not have encounteredanyone, but yet they're hearing
what you have to say.
What is important for them toknow and understand about this
(23:09):
subject?
SPEAKER_01 (23:10):
Personally, based on my experience with families and
to some extent with thepatients, reframing the illness
to be a neurological illness.
It's a neurological illness.
It's the old dementia precocks.
It still is.
The illness has always been withus.
And think in terms of how wouldyou manage a person with a
dementia, and would you just letthem sleep under the bushes?
SPEAKER_00 (23:33):
Yeah, I agree.
That is a great point to make.
I think one of the biggestissues that I've seen since I've
been doing this is that everyonehas their thoughts on what they
think it is.
Because of that, I try and usethe word perception because
everyone can have theirperception on what they think it
is, but usually the reality issomething completely different.
(23:57):
So I don't like to use that wordstigma anymore because I think
people have to learn andunderstand, or at least try to
understand, so that way theymight have a little empathy for
what others are actually goingthrough.
This way, when they hearsomething about serious mental
illness or anxygnosia, at leastthey'll have a comprehension of
(24:18):
what people are talking about.
I really think the way that youput it across is really good.
SPEAKER_01 (24:23):
Yeah, anzygnosia is a neurological symptom.
You know, you can see it withdementia, you can see it with
certain strokes, you can see itmultiple sclerosis.
Any number of other neurologicalafflictions can have that
anzygnosia, which is theinability to know that one is
afflicted.
I had a friend of mine who, thisis a common one, I had a friend
of mine who had a uh a densestroke affected half of his
(24:47):
body.
And as can happen with that kindof a stroke, he no longer knew
that part of his body existedanymore.
And so he had what's called hemineglect.
He functioned as if that part ofhis body didn't exist anymore,
and it caused problems for him.
That's a form of anasygnosia.
SPEAKER_00 (25:04):
I think that's a great analogy.
You are one of the first peopleI've spoken with that has
brought out anasygnosia in thiskind of context, and I think
it's just a great way of puttingit across.
With this kind of thoughtprocess, it might just change
the way people think aboutthings and perceive them.
SPEAKER_01 (25:24):
Yeah, it's it's not a willful denial of the illness.
It is flat out an inability tosee.
It's like a person who'scolorblind.
They're just certain colors thatcan't be seen.
SPEAKER_00 (25:36):
Yeah, that is so true.
I think you've got a great lookat things, and I think all the
stories that you've heard acrossyour career has helped you bring
this to the light for everyone.
SPEAKER_01 (25:47):
That's uh and that's what attracted me originally to
psychiatry was the ability tohear people's stories.
SPEAKER_00 (25:53):
Yeah, both good and unfortunately some that weren't
so good.
SPEAKER_01 (25:57):
It's been a lot of change in the profession.
Uh a whole another conversation.
SPEAKER_00 (26:02):
Yeah, I'm sure.
Now that brings up anotherinteresting point.
You've moved around and done somany different things.
Along the way, you've also seenso many different things from
your different jobs that you'vedone.
Now, instead of talking aboutthe people you've helped, how
has this helped you?
How have you seen yourselfevolve from the early days to
(26:22):
today?
SPEAKER_01 (26:23):
Well, you know, I thought I knew something when I
finished my psychiatry residencyin 1992.
I was a smart feller, and uh andthen life happened.
And I've had a few decades oflife since then, including uh
substantial hardships, personalhardships on my own end that
I've had to recover through.
(26:43):
And uh that and having to learnthat, having to learn from other
people who have had hardship whodon't necessarily have college
educations, but learn by theirexample.
You know, I'm an alcoholic, I'min recovery, and I've had to
learn from other people how tolive life.
And that actually works out hasworked out much better than I
(27:04):
could do on my own.
SPEAKER_00 (27:06):
Yeah, lots of times life gives us more knowledge
than college ever would.
Well, this has been a greatepisode.
Lots of good conversation, lotsof good information.
I really appreciate you takingthe time to join us today.
SPEAKER_01 (27:24):
Yeah, I appreciate you interviewing me.
SPEAKER_00 (27:26):
Oh, it's been my pleasure.
Thanks again.
Thanks for taking time out ofyour busy schedule to listen to
our show today.
We hope you enjoyed it as muchas we enjoyed bringing it to
you.
If you know someone who has astory to share, tell them to
(27:48):
contact us at why notme.world.
One last thing spread the wordabout why not me.
Our conversations, our inspiringguest, the Joe.
You are not alone in this world.
Welcome to Why Not Me, Embracing Autism and Mental
Health Worldwide.
Hosted by Tony Mirator.
Broadcasting from the heart ofMusic City, USA, Nashville,
Tennessee.
Join us as our guests sharetheir raw, powerful stories.
Some will spark laughter, otherswill move you to tears.
(00:30):
These real life journeysinspire, connect, and remind you
that you're never alone.
We're igniting a global movementto empower everyone to make a
lasting difference by fosteringdeep awareness, unwavering
acceptance, and profoundunderstanding of autism and
(00:52):
mental health.
Tune in, be inspired, and joinus in transforming the world one
story at a time.
Hi, I'm Tony Mantor.
Welcome to Why Not Me, embracingautism and mental health
worldwide.
Joining us today is David Hager,who interestingly never planned
(01:14):
on becoming a psychiatrist.
He started college at Texas AM,dreaming of a white coat for
four-legged patients set onveterinary medicine.
But somewhere between anatomylabs and late-night soul
searching, the human mind pulledharder than any animal heart
ever could.
He pivoted, earned his MD atUTMB Galveston, completed his
(01:35):
psychiatry residency, and movedforward from there.
He then walked into stateprisons in Florida and Illinois
where the patients were humanbut often treated as less.
His journey is outstanding andhe has so much information to
give us today.
So before we dive into ourepisode, we'll be back with an
uninterrupted show right after aword from our sponsors.
(01:57):
Thanks for coming on.
SPEAKER_01 (01:59):
Yeah, this is interesting.
It's a first uh first-timeexperience for me.
SPEAKER_00 (02:04):
Well, that's good.
I do not think there'll be anyproblems.
I think the most important thingis getting it started.
So let's do that.
If you would introduce yourselfand tell us what you do.
SPEAKER_01 (02:14):
Oh, I'm David Hager and I am a psychiatrist.
SPEAKER_00 (02:18):
Okay.
Now, the big question (02:19):
what led you to go into psychiatry?
SPEAKER_01 (02:24):
Well, I didn't uh I didn't plan on psychiatry.
I went to Texas AM to be aveterinarian.
SPEAKER_00 (02:30):
Okay, I safely can say I didn't expect that.
SPEAKER_01 (02:34):
Yeah, it's actually more difficult to get into vet
school than medical school.
SPEAKER_00 (02:39):
That's interesting.
SPEAKER_01 (02:40):
Yeah, it is.
It's just a it's a numbersthing.
So I applied in my sophomore,junior, and senior years of
college to vet school.
And then that that last time Ialso applied to med school
because I realized uh there's acouple of things.
One is the veterinarians I wasworking with all of a sudden
they wish they had gone tomedical school.
And then I realized the mainreason I wasn't going to medical
(03:03):
school or considering it isbecause my father wanted me to
go to medical school.
Anyway, wound up in medicalschool, was accepted to three
med schools, and I got a thirdalternate spot that time to the
vet school.
Yeah, so uh went to UTMB andGalveston.
After going through the thirdyear, which is the usual round
of clinicals, I had it boileddown to surgery or psychiatry.
SPEAKER_00 (03:27):
Okay.
SPEAKER_01 (03:28):
Psychiatry was unexpected.
What I liked about psychiatrywas listening to people's
stories.
SPEAKER_00 (03:34):
Yeah, I get that completely.
And those stories can get prettyintense.
They can, yeah.
I guess my question is, how doyou deal with that?
From a standpoint of someonethat wants to help someone, I've
been told all my life that I'm afixer because I like to help
people.
In your scope of work, fixingmeans helping people.
And sometimes when you're tryingto help these people, you can't
(03:57):
fix them.
Right.
That can be very frustrating.
So how do you deal with that?
SPEAKER_01 (04:02):
Well, not always gracefully.
I'm a human.
You know, sometimes with uhstiff professional formality,
and sometimes I think more so asthe as my career has progressed
and I've become more human as apsychiatrist, that um I'm able
to listen to people's storieswithout having to be necessarily
(04:23):
strictly a psychiatrist whiledoing so.
SPEAKER_00 (04:26):
Okay.
That makes sense.
Now I'm guessing by doing itthis way, you're able to
hopefully break down somebarriers, which will allow them
to get into a comfort zone withyou, which allows them to tell
you more things that you need tohear in order to be able to help
them.
SPEAKER_01 (04:45):
Yeah, a lot depends on the setting.
How clinical interviews go in acorrectional setting, for
instance, is very different fromhow interviews go in, let's say,
a substance abuse rehab.
Now I had worked for severalyears at a rehab and lots of
stories there.
I can only imagine.
It worked better to be a littlebit more myself in those
(05:07):
settings.
You don't really let people knowmuch about yourself personally
when you're working with uhfolks in a prison or a jail.
SPEAKER_00 (05:16):
Yeah, that makes sense.
SPEAKER_01 (05:18):
Yeah, but one of the ways I I tried to deal with that
to um reduce some of theformality of the interviews was
I actually I wrote a program todo a computer psychiatric
interview before I saw thepatients.
So get through a lot of thestructured stuff beforehand that
(05:39):
I could follow up on during theactual face-to-face interview
and then focus more on the humanelements instead of going
through a whole bunch of rigiddiagnostic stuff that can chew
up a lot of time.
SPEAKER_00 (05:50):
That computer program is such a great idea,
saves a lot of time, I'm sure.
I'm sure you're like everyoneelse that you have a limited
amount of time to give to thesepeople.
SPEAKER_01 (06:00):
Right.
SPEAKER_00 (06:01):
What happens when a patient starts opening up and
digging into some of thesethings that you really need to
know?
And then all of a sudden, thetime's up.
Yeah.
So do you go into overtime?
Do you punch the clock?
What do you do?
SPEAKER_01 (06:17):
Again, that depends on the setting.
You know, in that substanceabuse rehab setting, I had a
schedule.
And you know, patients are kindof notorious for bringing up the
most difficult thing right atthe end of a session.
And there's a tab dancing thatthen occurs.
Um, yeah, hopefully acompassionate tab dancing that
says our time is limited, andand I hope we'll continue to
(06:39):
talk about this the next time wesit down.
Yeah, it's uh that's a toughone.
On the other hand, ininstitutional settings, there's
not so much of a hard timelimit.
It can be a lot more flexible inhow long a particular session
lasts.
SPEAKER_00 (06:54):
That makes total sense.
Are you working with people thatare incarcerated, or are you
still working with people thatneed help with substance abuse?
Or is it a little bit ofeverything?
What's your schedule look likenow?
SPEAKER_01 (07:08):
Well, I'm partially retired now.
SPEAKER_00 (07:10):
Okay.
SPEAKER_01 (07:11):
Yeah.
But you know what I'm doingright now is contract work.
And I'm doing contract workdoing correctional psychiatry
because over the years I havefound that to be the most
interesting work.
SPEAKER_00 (07:23):
Okay.
SPEAKER_01 (07:24):
And the contract work is uh there's other factors
that play into why it works outwell for us at this point, so
that I can work half the yearand still get by.
Tell you a little bit about howI got into correctional work and
what that experience has beenlike.
SPEAKER_00 (07:40):
Yeah, that sounds great.
When did that start?
SPEAKER_01 (07:42):
It's 2001.
I'll tell you that I'm I'm notgreat at running a business, and
I had a practice in SouthwestFlorida, a private practice with
a number of clinicians, and thatfinancially didn't go well.
Yeah, I wound up in a lot ofdebt out of that.
I learned some hard lessons, andthe uh the job that was
available nearby was at aprison.
And I had an interest inforensics already.
(08:04):
I was doing court evaluationsand such, and so I figured it
was a good way to round out orflesh out some of my forensic
experience.
So I started working at thisprison, Charlotte Correctional
in Southwest Florida.
Turns out that's a place thathas a bit of a reputation.
It's it's a tough place.
It's a close management camp onsite, which is a prison within a
prison.
And it also happens to have thecrisis unit, one of the crisis
(08:25):
units and a transitional careunit for people with severe
mental illness or well, peoplewith mental health concerns.
Because it kind of parses outinto a few basic categories in a
correctional setting.
SPEAKER_00 (08:38):
Okay.
Can you expand on that some?
SPEAKER_01 (08:41):
You've got people who are real deal severely
mentally ill.
You've got people who are tryingto make you believe that they're
real deal mentally ill becauseof various reasons.
Either they want specialconsiderations or they want the
medications, or either they wantto take the medications or sell
the medications.
And then there's uh populationthat it's important to manage uh
(09:02):
from a safety perspective, thefolks who are at risk for
suicide.
There are some people who areactually at true risk for
suicide, but you know, ourexperience is that most of the
people who say they're at riskfor suicide are using that
particular process to try tomake a change happen.
So at Charlotte Correctional, Ibegin to appreciate what happens
(09:23):
to people who have severe mentalillness, real deal severe mental
illness.
SPEAKER_00 (09:28):
With that said, does anyone or any particular
situation stand out to you?
SPEAKER_01 (09:33):
I remember this one guy in particular.
You know, I'd go look at theclassification file for people
where I wasn't really sure whatwas going on.
And this one guy I wasn't quitesure.
And I looked through hisclassification file and I saw
his history of arrests, and itwas a whole bunch, it was like
30 trespassing arrests.
Wow.
Yeah.
And then he became, you know, inthe course of me trying to take
(09:55):
care of him, he became floridlypsychotic.
He became, you know, it wasthere was no ambiguity at all.
You know, there was theprogression of people uh for
this person anyway, of um allthese misdemeanors, misdemeanor
arrests, and eventually hefinally got popped with a felony
and he wound up off the streetsfor a longer period of time.
And why he didn't wind up in aforensic psych hospital, it's
(10:18):
just, you know, it's luck of thedraw, it seems.
Probably depends on who hispublic defender was or how well
put together he was at the timeof the hearing.
Real deal people, because ofanasygnosia, they uh they don't
declare themselves.
There was actually there's asemi-appocryphal story out of
one of the big urban jails inHouston.
(10:39):
Remember a colleague telling me,and I'm it fits perfectly.
A Harried, busy psychiatrist wasshowing up for what was
essentially a mental health sickcall, and she saw that there
were there was an impossiblenumber of people to see.
So she had to make a decisionabout who she was going to try
to see and who she wasn't.
So she calls out to them.
She says, Okay, all of y'allhere who have a mental illness,
(11:02):
raise your hand.
So a whole bunch of hands go up.
And she says, Okay, y'all can goback to your cells.
I'll see the rest of you.
SPEAKER_00 (11:07):
Wow, that's um pretty unbelievable, actually.
SPEAKER_01 (11:13):
That's the world of corrections.
I worked at that facility for 15months.
I worked subsequently at thePalm Beach County Jail.
Jail work is very different,it's uh a whole different vibe.
SPEAKER_00 (11:25):
Yeah, I can just imagine.
Now, what happened after that?
Where did you go?
SPEAKER_01 (11:30):
I went up to Indiana.
I was the uh director of themental health services for the
Indiana Department of Correctionfor a while.
We lost that at Rebid.
Working for one of thefor-profit companies, contracts
come and go.
And I subsequently worked at theMarion County Jail and Valuesia
County Corrections in CentralFlorida.
After that, I went on in 2008 toshift from corrections, which
(11:54):
especially in jail work, it canbe difficult.
There's stories around that, butthere are difficult political
stories around that.
And I came back to Texas andworked at Kerrville State
Hospital, which is a primarilyforensic hospital.
It's it's 100% forensic at thispoint.
I used to have a crisis unit,but uh that went away while I
was there.
And it has specialized even morein uh people who are not guilty
(12:18):
by reason of insanity.
So that's pretty much the entirepopulation at Kerrville State
Hospital.
So I worked there for four yearsat one point and then two years
again during the pandemic.
SPEAKER_00 (12:29):
That's quite a path of different scenarios that
you've worked with in.
SPEAKER_01 (12:32):
Working with the forensic population in that
setting, different experience, adifferent system, feel to how
that system works.
But there's the length of stay.
If you look at prisons and youlook at forensic psych
hospitals, there's one commontheme, and that is the length of
stay is much, much longer.
You can debate whether that's agood thing or a bad thing.
(12:54):
For some of the people asdebilitated as they were,
especially at the forensic psychhospital at Kerrville State
Hospital.
Oh my God, some of these peoplewere so low functioning.
There was no other option forthem, really.
Another thing while working atKerrville State Hospital, it was
a sad comment that familieswould make.
A repeated question fromfamilies was, why did my loved
(13:17):
one have to kill somebody to getservices like this?
SPEAKER_00 (13:20):
Yeah, that's a tough question.
And unfortunately, I've heardthat so many times with people
that have been on my podcast.
This podcast has been reallygood to get a lot of information
out there.
Unfortunately, a lot of thisinformation is things that
people just don't want to hearand shouldn't have to hear.
unknown (13:40):
Yeah.
SPEAKER_00 (13:40):
A lot of people will see something that's on TV, they
don't understand it, they don'tknow what it is.
Because of the sensationalism ofthe TV, they will get their
perception of what it is.
Usually it's the wrongperception.
Unfortunately, it's a situationof where the system failed the
(14:00):
person that had the problem.
Before I started addressingserious mental illness and
anesthynosia on this podcast, Ihate to say it, but I had a lot
of the same thoughts.
It truly is sad that you had tocomment on how many people will
say, Why did my loved one haveto do something so bad to get
the help that they need?
(14:22):
What's even sadder is it doesn'tseem to matter which state I'm
talking with, they all have thesame issues.
So I'm interested because youworked in so many different
facilities, you've seen theissues that they face firsthand.
So everyone has a differentapproach.
(14:42):
I'm interested in what yourapproach would be.
What are your thoughts?
How do you think we can makethings better to help people
that really need the help?
SPEAKER_01 (14:53):
Yeah, it's a sad irony that at this point the
criminal justice system does abetter job with accountability.
I hate to use the wordcontainment, but a containment
within a process, whether it'soutpatient or whether it's uh
somebody who's in incarceratedactually, or in a forensic
system, because if they're in aforensic system, forensic
psychiatry hospital, they'restill under the umbrella of the
(15:15):
criminal justice system in someway or another.
So um the civil sector, the wayit works, if somebody with a
severe mental illness doesn'tshow up for an appointment,
well, that person will bereplaced by somebody who does
show up for appointments.
And that tends to be a less sickpopulation.
SPEAKER_00 (15:32):
So what do we do to change that outcome?
SPEAKER_01 (15:36):
My personal take on this is when that person with a
true severe mental illnessdoesn't show up for an
appointment, you go get them.
You go track them down.
And AOT is supposed to be a wayto do that.
And certainly uh programs likeuh sort of community treatment,
those are good programs.
They're not used enough.
And then AOT, I don't think it'sused enough.
(15:57):
And and when I've seen it used,because I did some outpatient
forensic work as well, it's notnecessarily backed up with as
much oomph as it should be.
Like if the person doesn't showup for the psychiatrist
appointment and then doesn'tshow up for the psychiatrist
appointment, and then doesn'tshow up for the psychiatrist
appointment, there'sinconsistency about whether
anybody actually goes to say,hey, how come we're not showing
(16:20):
up for the appointment?
So there's some inconsistency inimplementation of that.
What's the next step then?
So I think beefing up AOT,assisted outpatient treatment.
Um, you know, the original ideawas outpatient commitment, but
the the phraseology was changedto AOT, making assertive
community treatment moreavailable for the real deal
(16:40):
people so that people aren'tlost to follow-up.
And then I have something that'sa little off script.
Okay.
There are other psychiatristswho think along these lines and
neurologists.
You know, historically,schizophrenia spectrum illnesses
have been, they've fallen underpsychiatry.
They just have.
You know what the original termor name for schizophrenia was?
SPEAKER_00 (17:02):
That's something that I do not know.
SPEAKER_01 (17:04):
Yeah, the original name for schizophrenia in the
early 1900s was dementiaprecocks, a premature dementia.
SPEAKER_00 (17:12):
Now that's very interesting on how that's
changed over the years as well.
SPEAKER_01 (17:17):
Yeah, and and that that way of looking at the
illness holds.
The more we learn about it, themore we realize, or I mean it's
accepted, it's a brain-leveldisorder, it's a
neuropsychiatric disorder, it'sa neurological disorder.
In fact, what I tell familiesand patients, I don't say that
they have a mental illness.
You know, people withschizophrenia, I don't say they
(17:38):
have a mental illness anymore.
Because that gets conflated witha lot of other stuff that, you
know, panic disorder is a mentalillness.
Um, drinking too much coffee isa mental illness, apparently,
because it's in DSM, right?
Look at the list of thingsthat's in DSM.
You know, it's a book ofpsychiatric disorders, and
schizophrenia is kind of inthere as well, but schizophrenia
(17:59):
is pretty serious.
SPEAKER_00 (18:00):
Yeah, it is.
And I think that you have agreat way of looking at it and
wish other people would look atit the same way as well.
SPEAKER_01 (18:07):
So I tell families and I talk with patients about
schizophrenia being aneurological disorder with
neurological symptoms.
Helps families to accept itbetter and understand it better,
especially when I point out thatthere is neuropsychological
decline, you know, cognitivedecline, that hallucinations and
delusions are neurologicalsymptoms.
(18:29):
They're not unique toschizophrenia.
There's an enormous, a multitudeof pathways.
Anybody can become psychotic.
Actually, I do a teaching thingwith patients.
I used to do it with my forensicpatients, my guys there at
Kerrville State Hospital.
I would teach them aboutpsychosis.
I would start with, what ispsychosis?
And the ones who already knewthe answer would say the right
(18:49):
answer.
But it was sort of a trickquestion.
I'd say, what is psychosis?
And the answer is psychosis is asymptom.
SPEAKER_00 (18:56):
Wow, that makes sense.
SPEAKER_01 (18:58):
It's a symptom of something.
Whether it's because I have abrain tumor or because I'm doing
too many drugs or because I haveschizophrenia, it's a symptom of
something.
Psychosis is a symptom, andhallucinations and delusions are
the common forms of ormanifestations of psychosis.
So schizophrenia is aneurological disorder with
neurological symptoms, includingneuropsychological decline,
(19:21):
delusions, hallucinations, uh,can include disordered thinking,
disordered behavior, and alsoanasygnosia.
And then I talk some aboutanzygnosia.
SPEAKER_00 (19:31):
How do you define that to people that don't
understand it?
SPEAKER_01 (19:35):
So when I talk generally about what agnosias
are in neurology, becausethere's a variety of agnosias.
And then when I talk about whatanasygnosia is, because
anasygnosia is not unique toschizophrenia, present in other
disorders as well.
And one of the common ones thatpeople can relate to is
Alzheimer's disease.
So I'll ask people, do you knowanybody with Alzheimer's?
Did they know they hadAlzheimer's?
(19:57):
And then they usually say no andthey'll say, Well, that's
anasygnosia.
And the same thing applies topeople with schizophrenia, and
then they get it.
SPEAKER_00 (20:04):
Wow, that's impressive.
SPEAKER_01 (20:05):
The people with schizophrenia don't necessarily
get it, but it depends on howthey're doing.
Because there are fortunatelysome people with schizophrenia,
with treatment, with effectivemedication, some insight
returns, and that's a blessing.
You know, take as much advantageof that as possible and kind of
cram as much education andrapport building into that time
of lucidity as possible ifthat's how the course of the
(20:28):
illness proceeds in response tothe medication.
But yeah, schizophrenia,neurological illness with
neurological symptoms.
So here's a little bit of aquestion for you.
SPEAKER_00 (20:37):
Okay.
SPEAKER_01 (20:38):
How many homeless people have you run into that
have Alzheimer's disease?
SPEAKER_00 (20:42):
To my knowledge, that would be none.
SPEAKER_01 (20:44):
How many homeless people have you run into who
have multiple sclerosis?
SPEAKER_00 (20:48):
Again, that would probably be none.
SPEAKER_01 (20:50):
Which can also be accompanied by anasygnosia.
Yeah, if you look atneurological disorders, you
don't see a lot of those, youknow, sleeping under the bushes
because the law says they canchoose to be there.
Going back a ways, I've longthought it to be unfair that a
person who is psychotic anddoesn't know she's afflicted
(21:11):
because of dementia is handleddifferently from somebody who is
psychotic and has anasgnosia andis unable to function normally,
but they're in their 30s.
So it's okay for that person whohas a similar level of
neuropsychiatric debility toconsign themselves to sleeping
under the bushes because theyquote unquote choose to be
there.
(21:32):
I don't know.
It's you know, there's therecent executive order
encouragingreinstitutionalization, and I've
got mixed feelings about that.
But on the other hand, there aresome people who don't need to be
sleeping under bushes anymore.
SPEAKER_00 (21:45):
Yes, I agree.
And hopefully something likethat would be enough ammunition
to get our legislators involved,make some new laws, and help
these people out that need thathelp.
SPEAKER_01 (21:56):
I remember a conversation I had with a uh
legislator.
I Actually, I was involved for awhile trying to keep a state
hospital open in SouthwestFlorida and it was slated for
closure.
It was back in the 90s.
Went up to Tallahassee a coupleof times.
One of the times I went up, I Ispoke with a guy who used to be
my boss.
He was a physician who became aFlorida legislator.
And I asked him that questionabout, you know, why is it that
(22:17):
grandma with dementia, we takebetter care of her than the
30-year-old who's hiding fromthe lasers under the bushes and
uh in the park.
And he was kind of a blunt guy.
I won't use all of the wordsthat he used.
Okay.
But he said, it's because wecare about grandma, but we don't
give a blank about the ladyunder the bushes.
(22:37):
So working in jails, working inprisons, I see from that
perspective how broken thingsare on the civil side because
they come to me.
SPEAKER_00 (22:46):
Yeah, I cannot disagree with you at all.
What do you think is importantthat people hear?
They may be well versed onschizophrenia and exagnosia, or
they may not.
They may not have encounteredanyone, but yet they're hearing
what you have to say.
What is important for them toknow and understand about this
(23:09):
subject?
SPEAKER_01 (23:10):
Personally, based on my experience with families and
to some extent with thepatients, reframing the illness
to be a neurological illness.
It's a neurological illness.
It's the old dementia precocks.
It still is.
The illness has always been withus.
And think in terms of how wouldyou manage a person with a
dementia, and would you just letthem sleep under the bushes?
SPEAKER_00 (23:33):
Yeah, I agree.
That is a great point to make.
I think one of the biggestissues that I've seen since I've
been doing this is that everyonehas their thoughts on what they
think it is.
Because of that, I try and usethe word perception because
everyone can have theirperception on what they think it
is, but usually the reality issomething completely different.
(23:57):
So I don't like to use that wordstigma anymore because I think
people have to learn andunderstand, or at least try to
understand, so that way theymight have a little empathy for
what others are actually goingthrough.
This way, when they hearsomething about serious mental
illness or anxygnosia, at leastthey'll have a comprehension of
(24:18):
what people are talking about.
I really think the way that youput it across is really good.
SPEAKER_01 (24:23):
Yeah, anzygnosia is a neurological symptom.
You know, you can see it withdementia, you can see it with
certain strokes, you can see itmultiple sclerosis.
Any number of other neurologicalafflictions can have that
anzygnosia, which is theinability to know that one is
afflicted.
I had a friend of mine who, thisis a common one, I had a friend
of mine who had a uh a densestroke affected half of his
(24:47):
body.
And as can happen with that kindof a stroke, he no longer knew
that part of his body existedanymore.
And so he had what's called hemineglect.
He functioned as if that part ofhis body didn't exist anymore,
and it caused problems for him.
That's a form of anasygnosia.
SPEAKER_00 (25:04):
I think that's a great analogy.
You are one of the first peopleI've spoken with that has
brought out anasygnosia in thiskind of context, and I think
it's just a great way of puttingit across.
With this kind of thoughtprocess, it might just change
the way people think aboutthings and perceive them.
SPEAKER_01 (25:24):
Yeah, it's it's not a willful denial of the illness.
It is flat out an inability tosee.
It's like a person who'scolorblind.
They're just certain colors thatcan't be seen.
SPEAKER_00 (25:36):
Yeah, that is so true.
I think you've got a great lookat things, and I think all the
stories that you've heard acrossyour career has helped you bring
this to the light for everyone.
SPEAKER_01 (25:47):
That's uh and that's what attracted me originally to
psychiatry was the ability tohear people's stories.
SPEAKER_00 (25:53):
Yeah, both good and unfortunately some that weren't
so good.
SPEAKER_01 (25:57):
It's been a lot of change in the profession.
Uh a whole another conversation.
SPEAKER_00 (26:02):
Yeah, I'm sure.
Now that brings up anotherinteresting point.
You've moved around and done somany different things.
Along the way, you've also seenso many different things from
your different jobs that you'vedone.
Now, instead of talking aboutthe people you've helped, how
has this helped you?
How have you seen yourselfevolve from the early days to
(26:22):
today?
SPEAKER_01 (26:23):
Well, you know, I thought I knew something when I
finished my psychiatry residencyin 1992.
I was a smart feller, and uh andthen life happened.
And I've had a few decades oflife since then, including uh
substantial hardships, personalhardships on my own end that
I've had to recover through.
(26:43):
And uh that and having to learnthat, having to learn from other
people who have had hardship whodon't necessarily have college
educations, but learn by theirexample.
You know, I'm an alcoholic, I'min recovery, and I've had to
learn from other people how tolive life.
And that actually works out hasworked out much better than I
(27:04):
could do on my own.
SPEAKER_00 (27:06):
Yeah, lots of times life gives us more knowledge
than college ever would.
Well, this has been a greatepisode.
Lots of good conversation, lotsof good information.
I really appreciate you takingthe time to join us today.
SPEAKER_01 (27:24):
Yeah, I appreciate you interviewing me.
SPEAKER_00 (27:26):
Oh, it's been my pleasure.
Thanks again.
Thanks for taking time out ofyour busy schedule to listen to
our show today.
We hope you enjoyed it as muchas we enjoyed bringing it to
you.
If you know someone who has astory to share, tell them to
(27:48):
contact us at why notme.world.
One last thing spread the wordabout why not me.
Our conversations, our inspiringguest, the Joe.
You are not alone in this world.
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