To other countries command we support cancer research. In fact, theyre would not be a Clinical Trial program in europe except that we set it up, and operating office in belgium and got them all going, and now they do well. But the Cancer Institute set that up. People who have made major discoveries have done it with us dollars. And that was the big point. We did not know where the cure might come from and therefore we should not restrict the grants just to the United States. [applause] thank you. I would like to thank the dr. Very much for this amazingly informative and everyone had lots of good questions. I hope you will come up and meet with our speakers and thank you for coming. [applause] cspan washington journal live every day with news and policy issues that impact you. Coming up thursday morning executive director and president and ceo of the Truman National security project on the us policy in the fight against Jihadist Terrorism and they will examineit will examine how migration and immigration policies play a role in the conflict. And Associated PressHomeland Security reporter talked about the us Security Posture in the wake of the belgium attacks and look at the status of Syrian Refugees already in the us and those who wish to come here. Be sure to watch beginning live at 7 00 a. M. Thursday morning. Join the discussion. For this year student camera contest students produced documentaries telling us the issues they want the candidates to discuss. Students told us the economy, equality, education and immigration were all top issues. Congratulations to all winners and every weekday in april starting on the 1st one of the top 21 winning entries will air at 6 50 a. M. Eastern. All the winning entries are available for view online at student camera. Org. Book tv. When itune in on the weekend usually it is authors sharing new releases. Watching the nonfiction authors on book tv is the best television for serious readers. On cspan they could have a longer conversation delve into their subject. Book tv weekends, they bring you author after author after author. The work of fascinating people. I love book tv and then a cspan fan. Now discussion about psychiatry and the treatment of Mental Illness. Jeffrey lieberman is the author of shrinks, and history of psychiatry. He spoke at the Alexandria Center for life science of new york. This is just over an hour. Thank you so much, and i would like to welcome you to the Alexandria Center for life science. The alexandria ctr. , new yorkcenter new york city is new yorks 1st and only premier life science campus providing the citys leading pharmaceutical club i attack, and Academic Research institutes with stateoftheart commercial lab space and unparalleled amenities. Our urban campus is an integral part of the citys life science ecosystem that designed to foster innovative collaboration among new yorks world renowned academic and medical institutions preeminent scientific talent, toptiertalent, toptier Investment Capital and the broad and diverse commercial life science industry to speed the translation of new life science discovery from bed to bed side. The largest and leading developer uniquely focused on collaborative science and Technology Campuses and aaa innovation cluster locations with campuses all over the country in the life science up, cambridge massachusetts, san francisco, san diego. Ten years ten years ago there was little commercial life science or new york city, and now we are proud to be part of the citys vibrant echo system and in the past few months over a halfa half dozen new Life Science Companies havent started out of new york institution, truly amazing how far we have come in such a short time. But alexandria not only built Laboratory Building sql important to us, weus, we build collaborative life science ecosystems through our thought leadership programming and events like this one tonight. And a bringing the Life Science Community together around issues that have the potential to accelerate the development of lifechanging treatment for patients who need them most. In 2011 the chairman and founder of alexander Real Estate Equity founded the alexandria summit as a way to bring together aa Diverse Group of Key Stakeholders across the life science continuum to address the most Critical Issues and drug discoveries, developments, and global health. We. We have had eight alexandria summits, including one last january dedicated to neuroscience and both our speakers tonight participated. An important signature of the summit is the voice of the patient, and bob boorstin delivers an opening keynote about his life with bipolar disease. Mental illness is more common than you think. Wanted for people experience it in a given year. Of that, one in 17 live with a serious mentala serious Mental Illness such as major depression, bipolar disease, or schizophrenia. Diseases and disorders pose one of the greatest facing us today, one that has been the temple for an enormous social and economic consequences. Depression or bipolar disease affects more than 400 million. The social and economic costs are staggering, severe mental disorders of an estimated to cost society 2. 5 trillion worldwide. Without a better understanding of the brain and more effective treatment for Brain Disorders promise to continue to destroy patients and their families, undermine health systems, and pose a great burden to the global economy. It is imperative that we Work Together to increase public and private funding and Development Centers renovation and research and Drug Development and to continue to increase emphasis on Public Awareness about these diseases. We believe there are solutions to be found and that we bear responsibility for convening conversations and actions that could lead to solutions. We are honored to host this event tonight and grateful for our Ongoing Partnership with jeff and bob and as we all work to decrease stigma and to improve health care for those with Brain Disorders. Tonight i would like to introduce bob bob boorstin and doctor jeffrey lieberman. I will start with bob on the far left, Senior Vice President of the Albright Stonebridge group,group, a leading commercial diplomacy and Global Strategy Firm based in washington dc. With a 25 years of experience and private government and nonprofit sectors well worked at google and public policy, ran the National Security programs at the center for american progress, dc think tank, continues to advise fortune 500 executives, served in the National Security council, the treasury, and state departments trying the state departments during the clinton administration. Since 1987 when he was diagnosed with bipolar disease, bob has been an outspoken advocate for people with Mental Illness and has worked closely with leading advocacy groups. Inin the Clinton White house he helped to advance policies that guarantee parity, coverage for Mental Illnesses, medical professionals, families, and patients across the us, europe, and africa. And to my near left ii would like to introduce doctor jeff lieberman, chair of psychiatry at the department , chair of the Psychiatry Department at Columbia University in the past president of the American Psychiatric association. Just work has advance the understanding of how the physiology and treatment of schizophrenia and related psychotic disorders and has authored and coauthored over 600 papers, he has written or edited 11 books on Mental Illness, psychopharmacology and psychiatry and is the recipient of Many National awards. In 2000 he was elected to the National Academy of Sciences Institute of medicine, and during his term as the president of the American Psychiatric association he actively contributed to government policy and legislation including the Mental Health parity and addiction equity act, the Patient Protection and Affordable Care act, the families of Mental Health crises act and was a visible spokesperson to the media on Mental Illness and psychiatry. And recently in this last year he published shrinks, the untold story of psychiatry which we will discuss here tonight. When we finish the dialogue and there we will move outside for a book signing and cocktails. I will turn it over to you bob. Thank you very much. Thank you for coming this evening. Honored to host this dialogue and also with my colleagues. A long career in academic psychiatry, treat patients and Mental Health care, developing and being perceived, it seemed to be incomprehensible that people , and when you think about it, Mental Illness affects a minimum of 20 percent of the population , that you throughout Human History the barriers to treatment were lack of knowledge and effective treatment. Twentyfirst century now the barriers are lack of awareness, stigma, shame, and lack of access. And so something much more poetic. What was it . It was pariahs the palace of medicine. [laughter] is better. Thats what they said. It was enough to try to provide an idea. Let me now turn it over to my friend in addition to his professional accomplishment is one of the most interesting and admirable people that i know. Thank you very much. I am here tonight for two reasons. I am a big admirer, and you should be, too. He survived a year survived a year plus as president of the American Psychiatric association. Those of you have any relation to the field of psychiatry should know that is one of the most difficult jobs in the country, to survive the battles. Second reason i am here is because i could not pass up the opportunity for role reversal. For almost 30 years now i have said and psychiatrists office and bask questions. Now i get i get to ask the questions, if only for an hour. I promise not to not incessantly and say, and how do you feel about that . Were going to talk about his book and a few of the issues and Mental Health right now, but before we cracked the cover let me start with the big question, people talk a lot about the term Mental Health or Mental Illness. How do you define it . Was it really include . It is a set of disorders it can to how we think about respiratory disorders, cardiovascular disorders, gastrointestinal disorders. Lungs,lungs, heart, stomach. Yes. Just translating. Any organ of the body, the brain is so complex and requires three to cover it. The most highly evolved in the Animal Kingdom and mediate the mental function of cognition. So based on that Mental Illnesses and the purview of psychiatry encompasses what are traditionally thought of as Mental Illnesses, depression, bipolar disorder, schizophrenia, anxiety, eating disorders, dementias, also the intellectual or Developmental Disabilities adhd, learning disabilities, and the addiction. These are all affecting the same real estate mentor in the brain and are disturbing these mental functions. That is an expansive definition. I would simply say everybody has something that qualifies. I picked up the newspaper this morning, for the young people here, this is a newspaper. Screaming. Are we perhaps experiencing . We talked about the military. And he can be a real problem. It is not analogize a normal behavior as critics say. There was a book that former friends and colleagues thought were formal, these greedy psychologists were coming up with a diagnosis. So that is actually untrue. The notion which was popular in the heyday of psychoanalysis, being analyzed like having Plastic Surgery today. It is dispelled, line between an illness and what is not. Everyone has socalled issues. You talk about screening, my answer is what took you so long. The most common mental disorder in terms of frequency in the world. The World Bank Says that by 2020 the 2nd most expensive illness. By 2030 it will be the 1st why wouldnt we screen for it . Women who are preorpre or post part of wellness psychiatric condition, most commonly depression. Why wouldnt it be prenatal care . The other is the elderly. Geriatric is very common. The highest suicide rate of any demographic is elderly males. So we do diabetes screening, hypertension, why not depression screening . All right. After all, that is why work here. My cards on the table. A subject close to my heart but also because it is one of the few non memoir and psychiatry that is approachable and is approachable he written. Absolutely. [laughter] darwin when he wrote his command there have been others. This book has the medical and personal and it. The other thing i like about it is you till it like it is and lets start with that. Reading the interpretation get you thinking about having a career in psychiatry, but at the same time you by no means go easy as at certain points in the book he seems like a villain. Youre right, ended up stranding psychiatry and intellectual desert the most dramatic crazes endured. I guess my question is how do i get it right. A lot of adventures or discover, great ideas, fields are works, the produce cost problems employer that neurologist, study disorders essentially related to the brain, and at the time the scientific of the brain and conditions associated with it. Anorexia, psychosis, depression. And Research Methodology that was available to people was in that kind. And just by his own observation of people coming to his office, this, that, and imagination, no theory of the mind. And his theory of the mind is that the mind was involved, not like some unitary phenomenon. Podium of the mind. There is a process and some disturbances could cause you to feel like you are paralyzed, feel like you are constantly fearful, in great danger, cause you to feel depressed, came up with a way of trying to understand this. They still use the idea of the conscious and unconscious, readily available to us. Had the idea of rationalizing, denying things. The idea of conflicts, impulses and desires and constraints. So these were seminal. Seminal for einstein and darwin. The 1st was he never allowed his theory to be objective testing. Loyalty and obedience. He began to apply his theory. Severe Mental Illness. The reality is, there are many aspects that are very useful and effective that had virtually nothing to do with these disorders, autism , some horrible, horrible things. The refrigerator, homosexuality, the father, and these things were not only untrue but i think the legacy, those that came after. Someone who went through analysis, delusional breakdown, have a psychoanalyst, i kind of relate to that. Referring your book as psychiatry is a step style of medicine. Legitimate science and yet your book is full of descriptions of cures and ideas that could legitimately be called illegitimate. Use of forest the title i section of the book fairly harsh. So two questions for you to answer. How much of psychiatrys image and the stigma problem can be laid at the foot of psychiatry and people who claim to be in 2nd to you think that stigma was inevitable . Given the crazy complexity . I think it is about 60. Gets us through. Due to the social environment in which has evolved. What, i mean, by that is psychiatrists started out like every other document. Midwives and bone doctors, cardiac cardiologists, dermatologists, everything. They were one of the 1st. The American Psychiatric association is the oldest professional medical association. It was called the association of medical pilots and superintendents, took care. But what happened was Scientific Research provided from evidentiary basis, others began to take off, surgery, techniques, instruments, infectious disease, pasteur, and within the field of psychiatry you can see tumors, strokes, the tangling of dementias, there was no basis to it. The theory was so compelling intellectually that psychiatry became enthralled with it. Training of my supervisors, they would joke about how they had gotten everything they learned in medical school and just did not need any of it. Everything was focused on psychology of the minute psychotherapy. And so actually really went overboard. The 1st nobel prize for psychiatry was given. He would take the blood of soldiers tropical areas take their blood and injected in and he did that, someone gets the fever the symptoms are temporarily improved. That sounds barbaric. It actually did not improve. Individuals had tertiary syphilis in the syphilis produced psychosis, susceptible to hypothermia and died in better. Then they had the infamous lobotomy. The sounds barbaric. The reality is the portuguese neurologist was desperate. But nevertheless legacy haunts them. A little more complicated. Humanity looks to medicine to relieve people of pain. Smallpox, tuberculosis, polio, it is only when you name it that you containment. And people look to psychiatry to do that and it did not deliver. There is one other thing i think is important and distinctive, the illnesses that affect the parts of the brain the government behavior and mental function are so intimate so that if you are not you, what you think is in an accurate reflection of your circumstances of reality that it shakes the foundations of your ability to understand and it was and is difficult for people to suspend beliefs. And this is the essence of delusion, that it is a false belief. No one can talk them out of it. So anxiety is due to an unwarranted exasperation of fear. Your press because of what your life is like. It is harder to accept that. How does someone in the military say. And that is why the military over a century after shellshocked. Develop an effective treatment for ptsd. Now we have advanced from these difficult and workable cures to a period of the age of psychopharmacology. The age in which theyre is a general consensus, people think about psychiatry as a combination of talk therapy. In the case of most Mental Illness you can actually make a difference. It is not cured by any means helpful and put them on a regiment. Do you think it remains as much an art as a science . There is an equation or proportionality to science. Maybe that will be forever. I think probably they wont be medicines will not be consistent, even with that kind of medicine. And more than any other discipline it has is an integral part of it makes me think about it, the patient experiences, have a baby with your obstetrician, anything, your cardiologist, neurologist, dermatologist, healthcare financing the way that it is, the aspect of it gets short shipped. It always will be felt. Take a pill and call me today, basically part and parcel the psychiatric treatment, talk therapy, pharmacology, medication, neural modulatory therapy. The most obscene example is like shock therapy. Now we have magnetic stimulation, direct current stimulation, thinking that many disorders or circuit based. A pill altering the transmitter activity may not be the most effective way to stabilize an overactive or obsessivecompulsive disorder. I would say it is highly likely that what this represents is an over activation of neural circuits where record gets stuck, the same words over and over. Keeps reverberating and you cannot stop. With parkinsons disease you can magically kind of work with that. These kind of approaches will be helpful with circuit based. How do you do it . Electrodes. So these three different modalities and all of these are potentially usable. I think it is important to say, mental disorders, interpersonal aspects are more interval than others. All right. Lets stay on interpersonal. In your book you give a number of studies. Why dont you share with us the case of someone with whom you succeeded, think you might . Well, i mean, forever. I mean, a good friend of ours who is a elegant, attractive, sophisticated woman who suffers from depression. So she said, im being good. She stopped. She subsequently relapsed. She could not get better. She lived in the city. The world and went theyre and did not get better. The hospital was beside himself. They called, he transferred her, treated her, a fair amount for a long period of time, but is now gallivanting around the world, extraordinarily exciting. Happy as a clam. And that probably would not have happened without modern 21st century psychiatry. Being able to avail themselves of that. The book starts out. These are all real stories. Elena, the daughter of a famous celebrity became psychotic command drop out of school. Premium ship better. She relapsed. A happy ending of the story. The other hand you dont succeed with everybody. The minority of people. Things that did not work out like that. One that probably resonates the most. A big, strapping guy a big blow, thoughts of killing himself. And the treatment, he was better in three months. Usually you get symptomatic remission. The issues of relapse. But he did not want any of it. Pre viagra. And i relented to allow him. And usually they call you are come back and tell you. He never did. One night i remember coming home and getting a phone call saying you patient is in the emergency room. What happened was he took an overdose. He could not do it on his own and his wife didnt know the other, i just like to tell you, one of the most intimate ties and devastating conditions his personality disorder. Causing them to have tumultuous relationships and every psychiatrist knows treating people with severe forms of this, there was a patient in the icu there for an overdose that treated felt put her in for an order in early 20s, tracheostomy tried multiple medications. It really made a lot of progress. This didnt work out too well. So 20 years later the book came out. Suicide of suicide. And i get this email come i i read your article about the suicide of robin williams. Between the ages of 50 and 30, severely mentally ill. One of those times and took a large overdose. I clearly remember how much you helped me. If we did not see it that way. However eventually the treatment i was able to get myself together, got married , enrolled in Nursing School and graduated valedictorian. I look back at just how mentally ill i was andnever a thought it could turn out so well. This kind of thing just did not exist anymore. It is just because they cant find it and dont have access to it. Im going to ask the folks here to pass out cards for questions. They are in the folders. Caught in front of you. While people do that lets go the personal to the political. Talk about a couple of issues that have been raised. In the news 1st we talk about the president ial campaign. The candidates are the campaign . Of all the years i have been involved i can also say this is the one or more candidates need more than ever before. I guess we should be positive and constructive. I will ask you, if you have time with the president what would you suggest aside from increasing funding radically comeau what would you suggest he or she do to improve the lives . Well, actually, i had an opportunity to do Something Like this very recently. I was invited to meet with the chief had policy advisor to one of the candidates. The upshot was, you should make Mental Health care of his signature issue of the campaign. And then upon election was called to panel a blueribbon committee to develop plans to reform the Mental Health care system and financing, the best section. Even though it is not something identified, like Global Warming is a key issue. Everyone experiences but no one wants to talk about it. The good news is with a lot of things, als, alzheimers, pancreatic cancer, there is not much that can be done. But for the vast majority of mental disorders we already have enough to make a huge difference. We just dont provided in an accessible way. The only way that this kind of gets the attention of the media this when there is Mass Violence put into it. And these are like the tip of the iceberg. The glaring social pathologies whether homelessness, people in prison, rising rates of Domestic Violence or Mass Violence that is occurring, suicide the suicide rate is not gone down over a century. So you dont take it seriously. Suicide is not a random event. 90 of90 percent of the people commit suicide have a preexisting mental disorder. There is a story in the news recently, this navy seal who committed suicide after ptsd , having been in tours of duty and lost kylix. It is really a lack of social political will. So you know what is the motivation for a political candidate . Is how much harm. Now you are seeing people in Congress Actually not restrain access to firearms because they want to stay there and are now turning the Mental Illness and health is a solution and proposing to poor money and to Mental Health treatment, lots and lots in a relative way. And i find myself conflicted because for a long time i have been on the side of fighting for more money for Mental Health care. So even though some of us feel that the reason behind this is not guns but Mental Health, a false pretense to nonetheless showed up and accept the fact we may get more money out of it. You spend more time in washington than i have. Lucky me. Ninetytwo years theyre may be cynical. Overstate the cynicism of what drives behavior. So the president had a series of executive actions couple of weeks ago. What is it the government is interested in . Mass violence and military suicide and ptsd. Other than that, no one cares. Four different bills in congress right now. They are all motivated by newtown connecticut and violence. Some had really good stuff, but they are still slugging their way through the legislative process. Something to be done in response to addressing address the violence perpetrated to some degree by people with Mental Illness the government issued a series of executive actions. Restrict access to guns, not against that, stricter background checks, put money in the background check system, but then he said we will focus on mentally ill people. Two ways. Put money in. Thats good. The other way is to have background checks be linked to have your ever hospitalized for psychiatric or Mental Illness or if your on Social Security disability for Mental Illness, that will be moved into the National Background check system. That is solely targeting people with Mental Illness. The biggest risk factor for crime is substance abuse. There is in their, shut up and accept the discrimination. What is the money going to do . Explained that. So the va system, the government doesnt provide healthcare. Theres no health care system. Disenfranchised. And they Fund Services and states to provide services. It is an agency that is anti medicine, anti science and funds Wellness Programs instead of treatment of the mentally ill. The budget is just wasted. If you go on the website and you look under it is 265 different types of treatment, there is not one medication institute. How can that be . How does the government allow that . This is like an antipsychiatry agent within the federal government that is spending 3. 6 million per year. They dont put the money there. This is like donald trump is getting popular because of this frustration. I will remind you someday of your comment of president trump. There is a question from pat, he or she, i think it it is a sheet from the clear handwriting, asked you to talk about a diction in american psychiatry for helping remove the stigma to bring about more treatment. Dual dual diagnosis i guess is the fancy term for these kinds of things, talk about it, addiction is clearly growing. And that is a medical phenomenon meta cultural phenomenon. First, diction historically was not recognized as a disease and that is to our shame and discredit. The psychological flaw. Medical profession did nothing. All they self help groups developed to their credit to try to help people and they have. The kind of Family Medicine became engaged, we have a very good scientific basis for understanding how addictions develop. What we know is that probably 50 of addiction start with people have some sort of psychiatric disorder who are selfmedicating and in the course of doing so they become addicted. Thats a dual diagnosis. Some people have simply constitutional, genetic vulnerability to addiction. In other words you take 100 people people and expose them to different substance, not everybodys going to have the same motivation to repeat use until they become dependent on it. It varies. But what happens is after you use it, it changes your brain. So if you break a bone, and ankle and it heals, it doesnt always necessarily heal a strong as it was or if you start exercising and doing things on it before it is fully healed. The brain changes as a result of the addictive substance. It is how to identify people who may be at high risk but also how to reverse those effects in individuals who have been addicted to the scientific challenge. And now i think we have the problem and focus in a way to conceptualize the problem, the issue is getting enough funding for research and getting people to be able to access treatment. Unfortunately the the access to treatment is the problem. You have your addiction that is out here over there, that are faithbased a treatment but are not necessarily in the standard academic medical center. If you go through the treatment for alcohol or prescription opiate or anything at the same time you go for treatment for depression and anxiety, you cant necessarily build the two different types of treatment. So there is this bureaucratic but theres no question, why is it growing . Well i think there are a lot of questions about that, one is is you have all lot of discretionary income, we have a culture which is encouraging feelgood and you have other things that are more mysterious statistics that just came out a few months ago based on a study by these two economists that promote survival and longevity of humanity, particularly in developed countries like the United States and it slowly Getting Better and better and were living longer and longer. One group which is declining this middleage was that out all about . There must be a cultural factor that is encouraging them to be engaging in these selfhelp behaviors. Are thinking that baking is one of the four basic food groups. That too. This is a noncontroversial question. In your catalog of brain function you did not list gender, transsexualism is one of the extreme contributions sees regarding the categorization of Mental Illness. To have have a position in this controversy . Gender, Sexual Identity and Sexual Orientation is again, to talk about fundamental issues that are fairly neglected. The whole biology of Sexual Identity and orientation has been virtually unstudied. It is something that we now are coming to appreciate simply because social policy is to the point where we recognize and also are becoming more accepting of this. But the area while lgbt issues, whether it it is related to social tolerance, insurance benefits, samesex marriage, childrearing, it has progressed enormously into the same Time Healthcare to address these issues is not progress that far but we, columbia have established a provision that have established a hell gender sexuality and development of the Knowledge Base scope of Healthcare Services specifically for the constituencies and are now tempting to be developed. We are at a very rudimentary stage of this. You could lament the fact that it has been stigmatized for so long. On the other hand, it is moving away production. We have another question, no name attached. Our new Mental Illnesses been discovered . Where are they clustered into existing like depression, bipolar, etc. , et cetera . Thats an interesting question. I would say theres probably not new ones, for example the group virus, who here heard of the zika virus before this year . Or evil, aids . New illnesses do develop i do not think were going to be discovering many new disorders unless i think what were going to see is like peeling the on onion. And how we named them is another matter. I think therell be a greater specimen of specification diagnostically and also with the ability to use either biomarker driven treatment and much greater specificity of treatment. Will end with a personal question that is directed at me but the both of us will answer. John asks, what advice would you give to young professional with bipolar who also wants to be, this is in, as successful as you. The advice that i would give to anyone who has an illness like bipolar and is trying to advance in the professional world is pretty simple, be as open as you can, the law does not permit employers to ask people about their Mental Illnesses during job interviews. I make it a practice of always telling someone afterwards, after i have been hired who has not had the sense it to google my name and find out that i am sick in the head, that i had this problem, this illness and that it might require me to miss a day of work now and again. And its better that im at home and on those days instead of the ce boffiause i promised them i will be a very poor influence on those days and they really dont want me around. I would also suggest that you have routine, routine seems to be very helpful for people with depression and manic depression including exercise. I guess in the political era i would tell you to work for progressives. Because they tend to be just a little more open minded about these things than others. I will turn it over to doctor to have the last word. I just add to that, just go get good treatment. These are manageable illnesses. You people with susceptibilities to different conditions weathers cardiovascular, co lead colitis, and others and they are