PBS NewsHour Weekend anchor and Amanpour and Company contributor Hari Sreenivasan hosts a new panel discussion with filmmakers Todd and Jedd Wider and psychiatrist and former president of the American Psychiatric Association Carol Bernstein about mental illness, homelessness and other issues raised in the film.
-Todd and Jedd Wider, Dr. Carol Bernstein, thanks for joining us.
So the Wider brothers, I ask, how did you find this story?
What inspired you?
-The inspiration for the piece came from an experience I had.
I came home one night and found a homeless man in my foyer.
He had broken into the house I'd live in.
And it was a cold February evening a number of years ago, and it was snowing and he was destitute.
And I started talking to him and he said, 'Look, I'm cold, I had no place left to go, and I just, I'm sorry I broke in, but I didn't take anything. I just, I'm freezing,' you know?
So I said, 'Okay, well, let me -- let me call the police.'
And the NYPD came and talked to him and they said, 'What do you want to do?'
And I said -- You know, he hadn't taken anything and it is what he said, he was just freezing, you know?
So they said, 'Do you want to press charges?'
And I said, 'No, I'd like to have him brought to a shelter.
I wouldn't press charges if you just bring him to a shelter up the street.'
There was a shelter 15 blocks away.
So they put them in the back of the car, and I watched a couple blocks later as the light stopped and the door opened, and out he bounded into the snow and disappeared into this cold February night.
But three months later, he reappeared and he was on a plastic chair sitting in front of this building.
And he sat there for what seemed like seven days and seven nights, you know, he never left.
Any time I went in and out, he was there.
And I started to call the police and they came, they would speak to them and they left him there.
And finally after, you know, the 10th time I called the NYPD, they sent the community rep to talk to me, and she said, you know, 'Why do you keep calling us?
What are you doing?' -'You're the problem' -Yeah. But in fairness, she said, 'Look, we talked to him.
He's not -- he's not harming himself, he's just sitting there.'
I said, 'Well, he is harming himself.
Obviously he's psychotic and he --' And I'm a physician also, as well as a filmmaker -- And I said, 'Clearly he's harming himself.
He's not eating and he's covered in urine.
He needs to go to a hospital to be treated in, you know, through the psych E.R. clearly.'
And she said, 'Well, we can't do that.
This is not a law-enforcement problem.
This is a problem for our society.
If you want to change that, change the society.'
And I thought about what she was saying and I thought, 'I think she's right.'
I mean, this is not -- this is not primarily a law-enforcement problem.
To me, as a surgeon, it's akin to letting a person who has an open wound bleeding all over the place just walk out of the emergency room into the street.
-Jedd, you know that Todd feels this way about this.
You start to look into the story and what -- Where's the light bulb that goes on in your head that says there's something more to be done here?
-Well, you know, I mean, Todd had experienced, um, what -- what -- what he did with that homeless man.
You're on your way to work, and you're literally stepping over people, and, you know, the problem with that in our society is that the more you do that and the more often you see these people on the streets homeless without a place to go, a large percentage of whom are mentally ill... These people who, um, are brothers, they're sisters, they're daughters, they're sons, they have their own lives -- you step over them and after a while, they just become faceless, they become nameless and you become conditioned to seeing these people.
And so for us this issue resonates because we're in a city where there is a crisis.
We, uh, after Todd's experience and after experiencing what we've experienced here in this city, realized that this was an issue we wanted to focus on.
-Dr. Carol Bernstein, explain what was going on with Linda Bishop.
What's wrong -- what was wrong with her?
-Well, I know what was said in the film, um, the issue of what specific psychiatric diagnosis she had.
You know, one would really want to interview her and know for sure to find out.
What was said was that she had bipolar illness with psychotic features.
Uh, this particular form of bipolar illness is a very difficult one to treat.
There are many patients who have bipolar illness who won't wind up like Linda, who do have periods where their mood is elevated or their mood is depressed, but they don't become psychotic or delusional, which she did in the case here.
But the challenge is the fact that these are disorders that affect how people think and how they observe things and how they understand things.
And then when that abuts up against the issue of somebody's right to be who they are and where they are, we have a conflict in society.
And in the '50s and early -- way before that -- most patients like this were warehoused, where they're just put away and isolated from society and then you don't have to see them.
And there was a tremendous movement as we began to find some treatment for these disorders to deinstitutionalize people and have them live in the community and provide them with treatment there.
Unfortunately, the hope and the expectation from the societal standpoint that we would have treatments available in the community really has not come to pass the way we need it to be.
And as a result, we have a situation where we don't want to be warehousing people who could be functioning more as members of society, but we don't have appropriate treatments and facilities available to them so that they can function.
-Todd, there are sections of her diary and the narration in this film where she sounds logical, clear-headed.
When you were reading through these sections, what went through your head?
Obviously you know the end result of this, but there are several flashes of normalcy here.
-This type of illness, as Dr. Bernstein was alluding to, bipolar with psychosis, you have intermittent lucidity, periods of intermittent lucidity.
And she was highly intelligent, she had studied art in college, was a very involved, engaged human being, had a great sense of humor, liked to cook, loved food.
And the diary is littered with references to recipes to food, to sort of humorous anecdotes, to music that she liked to listen to, you know, just like any other person, any other human being that would appear 'normal.'
But of course, as the diary progresses further and further, and she's not on medication and she's literally starving to death, and I think her psychosis accelerates as she gets worse.
-Dr. Bernstein, what could that hospital have done differently?
This threshold for involuntary commitment is different on a state-to-state basis.
-Yes, that's correct. -Right?
Are all hospitals rethinking this and saying perhaps we should add conditions to this, or is that an encroachment on individual or patient rights?
-Well, I actually share the concerns of both Todd and Jedd.
I mean, you look at what happened to this woman and I think it's -- it's really terrible, and I think we've become so concerned about being litigated against that it makes it challenging for people to do what they think is right.
It is surprising, I could say shocking, to me that a hospital would discharge someone without a plan, without notifying anybody of what's going to happen.
I don't know what was -- I don't want to second-guess what the treatment team was thinking at the time.
You know, if it were up to me, we would certainly want to be sure that there was a plan in place, that there was someone that would know what was gonna happen, even if the judge had determined that she was free to go on her own recognizance, clearly somebody should have known.
-What are judges, what are doctors looking for?
Is it a threat to yourself, a threat to others?
-In most states it's clear that if somebody presents a clear and present threat to themselves or to someone else, that they can be kept against their will in a hospital or hospitalized involuntarily.
In some states that can extend to care for yourself.
30 and 40 years ago, people were detained, um, almost willy-nilly without, so there were great concerns and we certainly knew about abuses of the political system to incarcerate people who are not mentally ill.
So there was a lot of concern in this country about making sure that people's rights were preserved.
But in New York State, and I can only really speak to New York State here, you can have two physicians determine that a person is of sufficient threat to themselves and that may be that they're not going to care for themselves, and that they aren't going to eat properly, and that they could be diabetic and wind up in a diabetic coma because they're not taking their medication properly, that could be reason to keep somebody involuntarily.
And you need two physicians to make that determination, doesn't have to be two psychiatrists, it just has to be two physicians, but different states will have different thresholds for that.
-It seems like the legal system is waiting for some harm to have happened almost.
I mean, with the cases that you're describing of the individual that broke into your house, you know, was that the flag that could have actually gotten him into one system or another?
But if -- if the situation is, 'Well, she doesn't seem like she's a threat to herself, let her go.
It's her right to live how she wants to live.'
-See, I would argue that we -- we have had a tendency to err on the protection of 'civil liberties' at the cost of life itself and quality of life.
And, I mean, Linda Bishop may have died with her civil liberties intact and not infringed upon, but she's dead, so what was the point of this whole exercise, frankly, you know?
I would argue that in the absence of a free mind, um, there is no free will, you know, she was unable to exercise free will because her mind was not free.
So you can't even make that argument in her case.
-There are structural abuses that we tried to get away from, and perhaps you're describing and you're illustrating a scenario where the pendulum has swung too far in the opposite direction, so what's the happy medium?
How do we create a scenario where we can prevent the Linda Bishops of the world from walking into that farmhouse or at least getting help somewhere in between and, two, making sure that individuals have the rights, and those rights are not trampled on?
-I think that's the very serious, difficult question that our society faces.
Uh, I mean, clearly, you know, you look back to the '50s, the pendulum was clearly all the way to the other end of the spectrum, right?
I mean, we're living in a 'One Flew Over the Cuckoo's Nest,' you know, period of time.
Um, and, but today, you know, you look where we are today, where we have accorded so many civil liberties to the patient that, you know, to -- to repeat the phrase, I mean, we have patients who are dying with their rights on, which is clearly the case with what happened with regard to Linda.
Privacy is important.
It's critically important.
It's certainly critically important in a free and democratic society.
It's the basic foundation, one of the basic foundations of our society.
So that has to be preserved.
But what is the appropriate medium?
And there has to be an injection, to Todd's point, of common sense in an analysis that -- that's made.
So when a doctor, a physician, looks at the case of Linda and says, 'Okay, she's taking up a bed.
She's refusing to be treated.
There's really nothing more that we can do for her,' you don't discharge her to homelessness, which is essentially what happened.
She was discharged to homelessness.
-Of course you can't weaponize institutionalizations.
I mean, this has to be done from a place of kindness.
I think most caregivers in the United States, in the mental-health space, are good-natured and basically good people that are trying to help others.
-I have felt that there really is a tension between, uh, the medical profession and the legal profession.
Uh, you know, I think, and that's partly what we're struggling with because what we need to do in medicine is use our judgment, which is what Todd -- Todd and I are both physicians, we talk about that.
And good judgment says you notify the family, but we become so afraid in the context of lawsuits that people are afraid... -If that doctor had called her sister, they would have opened themselves up to a lawsuit.
-Well, that's the fear.
Now, what I would say, what I don't know, and we talk about this a lot, is how often do we get sued for saving somebody's life?
I mean, I don't think that happens a lot, but it's certainly something that people are concerned about all the time in these hospital settings.
So the right thing to do would've been to notify the family that she was being discharged at the very least.
-I want to get to this other interesting thing that I think was in the film that was a culture question.
The fact that she made it all the way down to New York City, was basically on the pile at 9/11, walking around with a flag, there's a story done about her, the individual that you have in the film that interacts with her, he says, uh, that she told him that she was homeless, she told them that she had a daughter, and that he didn't want to pry.
But it's just that -- that just kind of stuck with me that we've somehow got to a place where, whether it's someone sitting next to us on the subway, or on your porch, or someone we're in contact with, we feel like there's a distance, that there's a disconnection of humanity here, that somehow she interacted with people all day, but we didn't feel like we could go that extra step and say, 'Are you really -- If you're homeless, can I help you?'
-I think you make a very good point about the fact that we're all so afraid to really reach out to other people and that's -- It's indicative of what you're talking about with the homeless and what's happened to all of us.
Everybody's afraid to say something.
I mean, you know, the old adage now, 'If you see something, say something.'
And I think -- I think it is really important.
I think it's something that we have an obligation to do as people and as a society.
And everybody's just becoming more and more frightened of doing or saying anything.
They shouldn't infringe, they shouldn't say, 'Are you homeless?
Can I help you? What's going on?'
-I think the reality is that many people just don't know what to do, how to help, you know, and they've heard stories of, you know, providing money maybe feeding a drug habit, so that may really not be helping them.
So what is proper help?
So part of it, I think, is educating the public.
You know, there's an educational component, which I think is critical in trying to tackle this issue.
-One thing I wanted to ask -- what's an outpatient commitment order?
-So an outpatient commitment order is an order by a judge where there's a determination that the patient needs treatment even if they don't want to go for treatment, but they don't require treatment in the most restrictive setting, which is in the hospital.
That's a determination that the judge makes based on testimony from the patient and from the physicians, And again, depending on the judge, there are mental-health courts, they'll pay -- They try to pay attention to the doctors, I do think, in most cases.
But in states like New York, where there are outpatient commitment laws, the patient can be 'committed' to outpatient treatment, which means they are mandated to go for regular treatment in the community, but they are not required to go into the hospital.
And there are teams -- we have mobile crisis teams -- that can go and assess them and bring patients in and make sure and check and make sure that they're going to get the treatment that they need.
And I think that started about 20 years ago.
It's been very successful here in New York.
-We're almost out of time here, so let's go sort of a quick round of closing thoughts.
Let's start with you.
Doing this process, talking about the film now, thinking about it, what has it taught you?
-You know, it's taught me, I think, a very serious sense of -- of -- of, uh, of empathy.
I'd learned about Linda from the diary that she had written, her own words.
Um, she was intelligent, she was artistic, she was poetic, she was full of life.
She was a mother, she was a sister, she was a daughter, and, you know, through her own words, you know, I learned through -- especially the words where she was extremely lucid -- that, you know, she was severely mentally ill, but she was full of life.
And so, for me, it's awakened myself to viewing people who are, I think, in similar situations, people on the streets, um, or people not on the streets.
And I've viewed them in a very different way since really learning about Linda, um, and I think, you know, in our society where mental illness is so stigmatized, um, uh, for me, it's -- it's -- it's awakened me to the humanity of these people and the importance in viewing them, um, as -- as -- as human beings and nothing other than that.
-Todd? -I mean, for me, I think, you know, I, I took away -- Certainly, I knew this before, but, you know, mental illness is an enormous problem that we face in the United States and around the world.
And it takes a huge toll on our country economically, but also sort of psychically and spiritually, I think.
And I would hope that in our country, we could view mental illness as an illness.
It is an illness that is very treatable, and it should be treated and accepted like any other illness.
I would argue for a much more proactive interventional approach than the approach that we're currently pursuing in the United States, and I think we're seeing the unfortunate sort of by-product of our -- of our, in a sense, willful, uh, sort of ignoring of this problem and sort of neglect, frankly.
We're seeing that the by-product of the neglect of this problem all around us every day.
-Well, I think what's really important, what I'm deeply grateful about both personally and professionally, is that you do show the humanity of people with mental illness.
I think people are afraid of the mentally ill.
I mean, people who are suffering from mental illnesses, which are very treatable, um, they're the -- they're the disorders of the very things that make us human, they're disorders of feeling, and they are disorders of thinking.
And people are very frightened when they see that happening to someone else and they forget that they're human and they're people and they're people just like the rest of us with wishes and hopes and dreams and feelings, and they have a chronic illness just like other people have chronic illnesses in our society.
And to the extent that we can help the general public understand that these are diseases that can be treated, that people deserve treatment, and that we can treat them, I think it's really important, and I think a film like 'God Knows Where I Am' is a really important step in that direction.
And I want to thank you both for having the courage and the interest to put that together.
-Thank you. -All right.
Dr. Carol Bernstein.
Todd Wider. Jedd Wider.
Thank you all.
-Thank you very much. -Thank you.
-And thank you for watching.