My Mental Health Heroes of the Year - 2009

My true heroes in mental health are those whose efforts never come to our attention, yet change lives: A mother who battles indifferent clinicians and bureaucrats on behalf of her kid; a volunteer who arrives early to turn on lights and arrange chairs and greet visitors; a doctor who refuses to give up on a patient, a postgrad research assistant laboring tirelessly on peasant wages; a middle manager who sticks his neck out on a risky hire; a patient who falls down seven times and gets up eight ...

My choices here are confined to the public realm, and are restricted by my limited awareness - a fact which may have excluded worthy candidates but hardly diminishes the accomplishments of those cited here. Further, they all got started toiling in obscurity. Thus, even though I am singing praises to a select few, I urge you to think of this piece as a tribute to all our mental health heroes.

Without further ado ...

Public person hero of the year - Barack Obama. No question about it. This man has put it all on the line in support of the proposition that the government serves all the people and not just the privileged few. We may not get the health care reform we need, but thanks to the President’s heroic efforts it appears we will get a much better deal than the rotten one that insurance companies, death panel nutjobs, and various enemies of the people tell us we should shut up and be grateful for.

Internet hero of the year - Katherine Stone. Katherine’s blog Postpartum Progress is a must-read on a normal day. In May, she outdid herself with a Mother’s Day Rally for Moms' Mental Health, featuring an all-star line-up of “warrior mother” guest bloggers whose contributions cast a bright light on a dimly-lit area of mental illness.

Soon after, in July, Katherine publicly scolded the editors of Time Magazine “for allowing an article on a topic that they clearly knew so little about to be published,” then rallied fellow advocates and experts in a letter to Time. Of all things, in its Person of the Year issue, Time singled out Katherine’s letter as one of its “Letters of the Year” of 2009.

Research hero of the year - David Braff MD. Think of this as homage to all of those brilliant individuals who have dedicated their lives to figuring out new ways to improve ours. Earlier this year, Dr Braff of UCSD received the prestigious Warren Award from the International Congress of Schizophrenia Research. In his Award lecture, I heard Dr Braff discuss “endophenotype,” a field he has pioneered and which is revolutionizing psychiatric research.

Endophenotype allows researchers to investigate an outward feature (phenotype) such as psychosis by looking at underlying phenomena, such as the inability of the brain to filter out sensory stimuli. Today's thinking-outside-the-box translates into tomorrow's practical applications. As this blog says, "Knowledge is Necessity."

Advocate hero of the year- Kathi Stringer. The reason you have probably not heard of Kathi is that she is smart rather than loud. Loud is the unfortunate tendency of mental health advocacy and it has gotten us next to nowhere. For years, Kathi, who is based in Riverside, CA, has quietly championed quality improvement (QI). For years, hardly anyone listened. This year, people are listening.

Kathi comes from a machinist background, where things need to be done right. As an example, if aeronautics refused to apply QI, we would constantly have planes falling out of the sky. QI, which is well-known in every aspect of manufacturing and services, including health, is ignored in mental health. But, as Kathi explains, nearly all the standards we need to improve mental health services are already codified into law and in contracts. We just need smart advocates to act as vigilant watchdogs. Then change can happen, and happen fast.

This summer, at a NAMI CA conference, I heard Kathi lead a workshop on QI. You could have heard a pin drop.

Media hero of the year - “The Soloist.” The movie, based on Steve Lopez’ book of the same name, recounts the real-life relationship between journalist Lopez and homeless music prodigy Nathaniel Ayers. Unlike “Shine” and “A Beautiful Mind,” which end triumphantly on major chords, “The Soloist” concludes on an uneasy note. Rather than the hero-outsider making it in “our” world, we must come to terms with the outsider choosing to remain firmly planted in his. In doing so, we are forced to face our own fears and ignorance.

My guess is that as recently as a few years ago, even the most informed amongst us would not have been ready for this. The fact that the movie met with the success it has is a tribute to our ability to change.

Recovery hero of the year - Abraham Low Self-Help Systems (ALSHS). Recently, Recovery Inc changed its name to Recovery International, then merged with the Abraham Low Institute, which resulted in its present name. Recovery Inc was founded in 1937 by neuropsychiatrist Abraham Low (pictured here), who espoused the radical idea that - with the right cognitive skills and peer help - patients could recover from even severe mental illness. Some 600 self-help groups exist worldwide.

In its new incarnation, ALSHS is retooling to reach out to a wider audience. Stay tuned  ...

My profound appreciation to this year's heroes, both the ones mentioned here and all those who in their own ways are making our world a better place.

Tooting From Greater LA - II

I'm at the NAMI CA conference in Torrance. Above is a seven-second video I shot last night on my iPhone.

That's Nathaniel Ayers you're looking at and listening to. Nathaniel Ayers is "The Soloist," whose life is recounted in Steve Lopez's book of the same name and in a movie of starring Jamie Foxx and Robert Downey Jr.

Mr Ayers was a cellist attending Julliard when he experienced a major psychotic break. He wound up in LA's notorious Skid Row where he lived homeless for more than two decades. Mr Lopez, a columnist for the LA Times, discovered him on the streets playing a violin with two strings. What began as a reporter-subject relationship developed into a bond far greater. Steve was able to convince Nathaniel to move into public housing, but had some lessons of his own on how delusional thinking doesn't just apply to those with mental illness. In the end, Steve had to learn to accept Nathaniel for who he was rather than what he would like to turn him into.

Anyway, here we were, sitting down to dinner, when Nathaniel, with no introduction, got up on stage and started playing. Adlibbing. Very much Bach-inspired, but very free form with no breaks for a good 30 minutes.


After dinner, we were told we were going to view an incompleted and shortened documentary, "The Chorus," about life on LA's Skid Row. I braced myself to be bored out of my mind for the next hour, only to encounter the most incredible experience ever from nine years of attending mental health conferences.

The documentary followed six or seven Skid Row residents for several months. Gradually, we got to know these individuals and identify with them. We laughed, we cried, we got outraged, filled with hope, were swept off our feet and hit in the gut.

Then the lights came on and the people responsible for the video and some of the cast, along with Nathaniel Ayers, got up on stage. The image here is from my iPhone. I hope I get the name right here. This is Linda, who was also an extra in "The Soloist" and one of the star attractions in "The Chorus." She is belting out - and I mean really belting out - a Gospel tune.

The documentary is simply too good not to find a distributor. When it comes out, trust me, "The Chorus" is a must-see. As I said, the documentary and the live cast and crew experience, together with Nathaniel Ayers, constituted my most incredible experience in nine years of attending mental health conferences.

The Soloist - Hollywood Gets it Right

At age 11, it was evident that Nathaniel Ayers had a special gift. Beethoven was his idol. The cello was his passion. He attended Julliard on a music scholarship. He was on the cusp of realizing his dream ...

In 2005, LA Times columnist Steve Lopez happened to encounter a middle-aged homeless man playing a violin with two strings. Intrigued, Lopez pulled out his recorder and started asking questions. The homeless man's name was Nathaniel Ayers. He had attended Julliard ...

Two separate worlds. We see a homeless person - a stinking, babbling, and potentially menacing annoyance that we cross the street to avoid. What we don't see is someone's precious son or daughter. Someone who may have attended school with us. Someone who may have been doing well in school, was dating, looking forward to college.

Someone not too different than you or me.

Then - out of nowhere - catastrophe. The brain quits, no longer cooperates. Someone's world - theirs - falls apart, disintegrates.

Same individual. Two worlds.

But in the just-released film "The Soloist," we also see two people from their respective separate worlds, seeking common ground. The movie stars Robert Downey Jr as Steve Lopez and Jamie Foxx as Nathaniel Ayers, based on the book of the same name.

Lopez' major problem in life seems to be racoons infesting his lawn. For Ayers, rats scuttling across the patch of sidewalk he rests his head on is a mere minor annoyance. Lopez tries to help. He uses a cello - with all its strings, you might say with strings attached - as bait to lure Ayers into a shelter on LA's notorious Skid Row.

Ayers responds positively to his new environment, but then worlds collide. Lopez naively assumes that Ayers can be helped simply by being medicated, but soon receives the education of his life. You see: Ayers may hear voices, he may have difficulty perceiving reality, he may have problems figuring his way around in our world. But to integrate him into our world, first one has to meet him on his own terms in his.

This is the essence of humanity. Appearances are deceiving. Strip away the surface stuff, strip away the preconceptions, strip away judgment and pre-judgment, and there stands a human being, proud, dignified.

There is Ayers - mighty, like a rock - telling Lopez in no uncertain terms where to get off with his paternalistic do-gooderism. The scene is highly disturbing. Ayers has successfully stood his ground - in his own world - but at what price?

This is not going to be one of those movies, we realize, where the person with severe mental illness gets a concert hall gig at the end (as in "Shine") or wins the Nobel Prize (as in "A Beautiful Mind"). This is all about scaled-down expectations and baby steps, and eventually Lopez wises up by embracing Ayers as his equal and by validating his reality.

For now, it is enough that Ayers is living indoors and off the streets and playing music. We may mourn a life lost and a dream shattered. But "The Soloist" forces us to come to terms with the fact that Ayers himself does not necessarily share that view.

We are learning, all of us.

Call it a conditional healing, an uneasy acceptance, the type of ambiguous conclusion that Hollywood notoriously refuses to trouble itself with. This time, it is different. I loved "Shine." I loved "A Beautiful Mind." But our understanding has come a long way since then. We have matured and so has Hollywood. An uplifting ending would have been a slap in the face to all of us. Hollywood has acknowledged this, and in so doing has met us on our own terms in our own world, the same world - it turns out - that we share with Nathaniel Ayers.

This is a terrific and complex movie, bound to stir both your passions and intellect in equal measure. Please - please - round up a crew of friends and head out to the cineplex.

Now Playing: The Soloist

On Friday, "The Soloist" went into general release. The movie, starring Jamie Foxx and Robert Downey Jr, is based on a book of the same name by LA Times columnist Steve Lopez. The book and movie chronicle the unlikely friendship forged on Skid Row between Lopez and Nathaniel Ayers, a gifted cellist who lost his mind to schizophrenia while attending Julliard.

I will be seeing "The Soloist" with a friend on Sunday, and plan to have a review here for Monday. In the meantime, here is a random sampling of newspaper reviews:

NY Times: The film is imperfect, periodically if unsurprisingly sentimental, overly tidy and often very moving. It works hard to make you feel good, as is to be expected, even as it maintains a strong sense of moral indignation that comes close to an assertion of real politics.

SF Chronicle: "The Soloist" finds success in one area, however, in director Joe Wright's subjective depiction of schizophrenia as experienced from inside an afflicted person's mind. In several memorable sequences, Wright creates a soundscape of imagined voices, all competing for attention, and through subtle, imaginative camera work, he conveys the dislocation of a person receiving reality through a distorted and frightening filter.

Chicago Tribune: We get only a drive-by sense of who Nathaniel Ayers, the former Juilliard music student plagued by undiagnosed schizophrenia, really is underneath the agonized surface. The film's poster lets you know who the movie's about: It's about the star Los Angeles Times writer Steve Lopez, played by Robert Downey Jr., whose influential columns on Ayers and his downtown L.A. skid row existence led to huge readership, political reform, a book deal and a movie sale.

Minneapolis Star Tribune: "The Soloist" is pitch-perfect, a sensitive rendering of challenging social and emotional themes. What could have been a maudlin exercise in sentimentality — the unlikely relationship between a homeless street musician and a Los Angeles Times metro columnist — becomes a soul-stirring tribute to the power of music and the importance of friendship.

***

When it comes to raising public awareness, Hollywood has no equal. For a short time at least, the general population will be receptive to our message and we're fools not to take advantage of it. So I urge you, please see the movie. Then tie in whatever pet beef you may have about living with your illness to the movie and start advocating. And then advocate some more ...

"The Soloist" trailer

Skid Row, Schizophrenia,The Soloist

Last week, the LA Times reported that College Hospital in Costa Mesa, 40 miles south of LA, "dumped" Steven Davis, whom they had diagnosed with schizophrenia, bipolar, and schizoaffective, outside of Union Rescue Mission located along LA's infamous Skid Row.

Literally, the hospital loaded him into a van, drove him 40 miles north, and dropped him on the street. This is what they call a "dump." College Hospital dumped Steven Davis the way some people dump their excess garbage in shopping mall dumpsters - surreptitiously, with hopefully no one watching.

But the Union Rescue Mission was watching, and when they complained, the van returned - and dumped Steven outside another shelter.

The city attorney reported that College Hospital was responsible for dumping 150 mentally ill in this fashion over 2007-2008. Steven Davis was a key to the city attorney's office making its criminal case. As part of a settlement, the hospital will pay $1.6 million in penalties and charitable donations.The hospital denies any wrongdoing.

In case you are experiencing deja vu, Michael Moore's 2007 documentary, "Sicko," showed security cam footage of a 63-year-old homeless and disoriented woman, Carol Reyes, wearing only a thin hospital gown, dumped in front of the same Union Rescue Mission by Kaiser Permanente's Bellflower Hospital.

Criminal charges were filed against the hospital's officials, and Kaiser paid a large settlement. LA authorities have been cracking down on dumping.

Doing something about Skid Row is far more problematic, an approximate 4x4 square block area where 7,000 to 8,000 homeless - many of them with mental illness - sleep on filthy streets, conveniently out of sight and out of mind to the rest of the world.

On April 24, Hollywood will be giving the area a lot more visibility. That is the day of the much-anticipated release of "The Soloist," starring Jamie Foxx and Robert Downey Jr, based on a book of the same name by LA Times columnist Steven Lopez. The book and movie chronicle the unlikely friendship forged on Skid Row between Lopez and Nathaniel Ayers, a gifted cellist who lost his mind to schizophrenia while attending Julliard.

We see only the homeless. But Nathaniel's story is all too typical. Think of schizophrenia as a developmental disease. Kids are leading normal lives. Then - at say age 17 - something happens. One minute they're doing well in school and looking forward to college. Then they start acting a bit strange. Then - bam! - all at once, they are robbed of their minds, their humanity - everything.

Just like that it's over. The illness has a poor outcome, made much poorer by our appalling health care system and the unconscionable way our winner-take-all society turns its back on people they view as losers.

I'm sure "The Soloist" will bring this out loud and clear. I loved "Shine." I loved "A Beautiful Mind." I'm sure I will be profoundly moved by "The Soloist." But if nothing changes for the better in this country as a result, then there will be no feel-good ending.

The Soloist trailer.