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In this episode, Trevor is joined by Rick Wolthusen, MD, founder and co-director of On the Move e.V. This non-governmental organization is focused on building mental health infrastructure in communities where it often does not exist.
Rick shares with us how mental health is misunderstood in Africa. Misconceptions surrounding mental health in Sub-Saharan Africa include that witchcraft is thought, more commonly than most would anticipate, to be the cause of brain-based illnesses.
Trevor: Okay. Okay. All righty then. You are listening to Mindful Things. Yes, you are. You are. You’re listening to Mindful Things. I’m your host, Trevor Chamberlain. Welcome new listeners. Welcome returning listeners. On today’s episode I’ll be interviewing Rick Wolthusen.
Rick is an MPP candidate, and McCloy fellow at the Harvard Kennedy School. This is pretty amazing. In 2013 Rick founded On The Move e.V. Their vision is to create environments where people can openly discuss mental illness. Rick and his team have, in the last couple years, been bringing their program to Africa in both the areas of Kenya and Ghana, and a documentary, a short documentary was done on his team, and their work there in those locations. We’ll include a link to the documentary in the show notes.
How’s everybody doing? I haven’t talked about my cat in a while have I? It was about a year ago when I was crying on this very podcast about how much I missed my cat because she couldn’t stay in the apartment where I was at, the temporary living situation that I had. She’s doing great now. We have a new home, a nice place. She’s doing really well, just took her in for her one-year checkup. She’s one-pound overweight. Can you believe that crap? One pound. It’s not so much that I have her on a diet, and just I’m watching how she eats. I’m watching the amount, and taking, and adding, and kind of fluctuating, and trying to work with her appetite as it fluctuates instead of just loading a standard amount of crunchies in her bowl every morning, and every evening, but she’s doing really well. I didn’t know what age she was when I got her. She was either three or four when I got her, and that was in 2015, so she’s either seven or eight now. She’s become quite a lap cat, and if she doesn’t get her lap cat time at night, she gets pretty angry. When I have to get up, if I want to use the restroom, or go refill my water, or get a cup of tea, or something like that she does not like that.
I’ve been cutting back on cannabis. I have no idea where that came from. In the past four weeks I’ve only smoked once. It has nothing to do with the whole uproar over vaping. That’s how I was primarily in-taking cannabis was through ... Well, let me clarify, recreational cannabis. I was taking in through vaping. Me stopping has nothing to do with that, and I don’t plan on quitting. I think I just needed a break, had cotton brain every day. I don’t know. I think my body or brain needs a break. It’s all right. I don’t really care for it. It is what it is. You got to take a break. Too much of anything, you know? I sleep better. I eat less. That’s good. Lost some weight. It’s an okay thing. I’m thinking, thinking about exercising again. Careful, I know thoughts like that could actually lead to doing it, but you guys know where I stand on exercise. It’s great. It’s great for your mental health. I just have no interest in doing it whatsoever. One day, maybe, but I hope you’re all doing well.
I think the last intro I did was quite a downer, so I’m going to try and keep it a little light, and actually just not waste any time, and go right into Rick’s interview.
He’s a fascinating guy who at a very young age is doing really incredible things on an international scale. What was I doing around his age? I was trying to get my film career off the ground. I was drinking way too much. I was kind of a mess, wasn’t really contributing to the betterment of society, or my fellow neighbor at all, so it’s really impressive what Rick is doing, and I hope you enjoy this interview.
I’m trying to follow you around. You’re in school right now?
Trevor: You’re at Harvard.
Rick: Yeah, the Kennedy School.
Trevor: What are you doing at the Kennedy School?
Rick: Doing public policy.
Trevor: Yeah, and you have, what? A year left in that.
Rick: A little less, I’m graduating next May.
Trevor: Yeah? Congratulations.
Rick: Thank you.
Trevor: Public policy, when I was in college you went for graphic design, and history.
Rick: I think you can just as you can study whatever.
Trevor: Obviously you want to influence processes, possibly laws, and what are you aiming at specifically? I’m assuming it’s mental health, right?
Rick: Yeah, it’s definitely mental health. What I’m mostly passionate about is to see how local partners, local structures can actually come up with their own ideas, implement what they think is the right way forward, implement locally, feasible solutions, implement stuff they have been already doing, and just like partner with more institutions on the ground, and then shape the policy around these activities. Instead of saying, “Okay, I’m sitting in Accra. I’m sitting in Nairobi. Let’s make a policy removed from what’s happening in the field.” I think this is why I’m also aiming to be a doctor because once you lose the contact with the patients you lose the contact with what’s happening in reality. Then you will just become a bad policy maker, I guess.
Trevor: Explain that.
Rick: What we see oftentimes, and I only give one example. There are many variations, I guess. When you go to the ministry you have a certain type of psychiatrist, or policy maker I guess who has a certain mindset. Either they are psychiatrist, they are psychologist, they have been trained, and this happens not only in Ghana or Kenya. This happens in Germany and the U.S. as well, but this mindset ... Ministries recruit people who fit into the already existing ministry scheme.
However, that being said it doesn’t necessarily mean that the policies they make are holistic or are seeing the reality on the ground because apart from the conventional view, for example about mental health. There’s a huge chunk, especially in Ghana and Kenya, with nonconventional healers. Now—
Trevor: So, you need to find policy that doesn’t trample over their religious approaches to things because without judging it, it’s still very much ... I watched the documentary again last night, and I could tell that when they spoke of witchcraft, they spoke about it still ... There were some people that talked about it with we’ve kind of moved past this, but it’s still very much a strong belief in the area, and I want to get to this later, to disregard it would be just another example of old school colonialism, which is go in there, and disregard their culture, and get them onboard with us.
Rick: Yes, and what’s interesting about this question is on one hand I think the way forward is to work with the communities to see what resources they have, what they want to do, what they think the solution is. This is a way where you can really have a bottom up approach. Then you can draft policy.
I’ll give you an example. In Kenya currently the health has devolved to the counties, and it’s only Maquany County close to Nairobi, and Kasumo County where I work. These two counties now have a mental health secretary, and they’re on their way to draft their own mental health policy. The way the mental health policy is drafted, and this is how I come in because I give technical assistance to the government, is we are not sitting at a desk. We move from what’s happening on the ground, but the way we are drafting the mental health policy is a yearlong process. We have started with mapping out the mental health ecosystem just to know who the players are apart from your obvious ones, the government hospitals, the private hospitals, but what about NGO’s, what about traditional healers, what about spiritual leaders. We know these players have a big stake in mental health.
Moving on from this mapping we start with focus group discussions on the village level. There are 35 villages, or in Kenya they call them wards, but we’re moving from these wards to focus group discussions on a sub-county level. Then we move to the county level, and eventually the whole aim of this exercise is to come up with a theory of change, which is very specific to Kasumo County, and not potentially not specific to Nairobi County, or not specific to Maquany County, or any other county, but eventually based on this theory of change we will be able to draft a Kasumo specific mental health bill. Instead of doing it the other way around, and saying, “Okay, let’s draft a mental health bill, and then let’s see how people implement it.”
Trevor: And install it.
Rick: Exactly. There is so much at play at the same time, right? The obvious one is mental health policies where you say, “Okay, the U.S., is it funding mental health policies, or is it not funding mental health policies, the UK, what about Germany?” If you look at the funding situation it seems like it’s mostly the UK for example funding in countries like Kenya, like mental health in Kenya or Ghana, not so much U.S., not so much Germany. So, this is the first interesting question, like what’s happening here. Why are there only a few players, international players, funding mental health?
Trevor: And why specifically the UK?
Rick: Why specifically the UK, right, and what we see is there is a relationship between how active the discourse in your own country is about mental health, and the UK is exceptionally good.
Rick: The Royal family, they have a mental health foundation with the, what are their names, Harry and William, I guess. I’m not a royal expert.
Trevor: Neither am I.
Rick: I was hoping to get your expertise here.
Rick: Both of them are, to some extent, suffering from a mental health condition based on their personal experiences. The discourse about mental health in the UK is just a big thing, especially compared to Germany or the U.S. The U.S., obviously there’s also a lot of discourse, but more so on a let’s talk level, not so on a let’s do it level.
What’s interesting about this though is now if the UK government, and this is what, for example, what we see in Ghana is funding most of the activities, mental health activities in the country. Now, what is the incentive for the government from Ghana to also start funding health policies, or mental health policies. There’s no incentive at all, and so this is concerning. This not only happens with mental health, but then for example you look at what the U.S. funds, or Germany funds. They fund HIV. They fund tuberculosis. They fund Malaria. Again, there’s no incentive for the government to step in, and fund other health policies at all. What’s interesting about it is that the Ghanaian government, if you talk to people, they will tell you right away. When we fund health projects, we are not going to win the next election, and this is mostly because people who are voting for the politicians want to see immediate change. But especially mental health policies, they’re not causing an immediate change. If someone is effected by a mental health condition who has been untreated for years, and years, and years, then this person is not going to recover within a year, within two years, within a feasible timeframe, four to five years, whenever the next election is.
This is why government’s saying, “No, let’s not spend money on these things.”
Trevor: It’s a long game, and right. We’re very short-sighted right now.
Rick: Yeah, and I think what’s interesting about it, to bring it back to your original question about how to mediate between conventional healers, and nonconventional healers, these terms per se are kind of arbitrary, like what do we consider to be conventional. Is the westernized standard to be conventional, or if I work in Ghana and Kenya is it traditional standard to be conventional?
Trevor: That’s a very good question.
Rick: Let’s just say there are two groups of people, like conventional, nonconventional without assigning the groups. What’s interesting about it is now if you listen to the government in Kenya, to the central government, they will tell you, “Okay, one way of how we can implement mental health, and make sure people go to the hospital is we make traditional healers illegal.” That’s certainly something you can do with a policy background. If you do policies, you can make them illegal. However, what will happen is they will go underground. Now their activities cannot be regulated anymore. Two, you cannot strip them off of their social value systems. They have grown up in this society, and one of the reasons that people don’t go to the hospital in the first place is because they don’t consider mental health to be a condition which needs treatment in a hospital setting. This policy is not going to help at all because people, even if they have a mental health condition, you take away the traditional healers they wouldn’t have anyone to go to because they don’t think hospitals are the way to go.
From this aspect it becomes clear that we cannot only do policies removed at an office desk, but we actually need to be in the communities to understand what’s happening and why. The same as in the U.S., I guess.
Trevor: If you come in with your own policy, and just run rampant over a community’s core beliefs you might have just messed up that area for decades to come because the stories will pass down to the next generation, “Oh, we’ve had mental health services come here before, and it was a mess.”
Rick: Yeah, right.
Trevor: If you screw this up, and not listen to them, or not take in their side you could really jeopardize having future services there for a long, long time.
Rick: I think this not only happens from an outside perspective. What happens if I come in, and implement these policies, which we don’t anyway, but the question is also what happens if the government does the same, the local government, the national government, but not so much with the aim of helping people, but more so with the aim of one receiving international funds. For example, if you sign a human rights declaration, and then you want funding from outside, and you don’t fulfill your human rights requirements people will say, “As long is conditional. As long as you do not take care of the human rights, we will not give you the funding.” So, to do something for the sake of doing something, but not because they buy into it. But, even if they buy into it, and they do something it doesn’t necessarily mean that the government in Nairobi implements what is found most useful in the counties. Does the government of Nairobi, of Kenya necessarily have an incentive to do something which is considered to be okay in a counties? No, because they want to be reelected, and they do stuff in the counties where they think they get the most votes, but if you want to be cynical you can say, “They don’t care about counties where they know they are going to lose anyway.”
I think the same happens in the U.S. You make polices attractive to the people you think. You tailor your policies specifically to the people you think who will vote for you, or potentially might want to vote for you. You’re not tailoring it to people who are already lost, like you cannot vote for them.
Trevor: I have a far more cynical answer to that, but yes. The way you said it is the way it’s supposed to be done, yes. That’s the nice way.
Let’s give the audience a bit of exposition here. In Germany you started a group called, and correct me, it’s called On The Move e.V.
Trevor: And what On The Move e.V. did was that you went to two locations. You went to Ghana and Kenya. Did you bring mental health resources there, or were you trying to get an on the ground assessment of what the situations were in those two areas?
Rick: We started with the mental health assessment primarily because I was doing some of my medical internships in Ghana, and in Kenya. The way how I got into mental health in Ghana and Kenya in the first place was by working with my attending at the hospital. Actually, he went there four times by now. I went to Ghana more often, but I worked with this attending for four times, and at some point, I realized we never, ever see people with mental health conditions. This was just impossible, so eventually I was asking him. You have to know. This attending was very caring. He even paid the hospital bills for some of his patients. He buy medication. He was the founder of the hospital. When I asked him this question, like “why do we never ever see people with mental health conditions?” His answer was along the lines, they don’t deserve treatment.
It was back in 2012 when he gave me this answer. Thankfully at the same time he was just telling me if you want to learn about mental health you can just go to Accra, the capital city, and go to one of the mental health hospitals. Ghana only has three mental health hospitals, so I was like one out of three. When I went there I don’t want to sound, or make it sound like an efficiency perspective, but it just that human rights abuses, like people being locked away, people chained up, people being chemically, and mechanically restrained, sometimes even tortured to death, and in their own urine and feces. This is what—is all about.
I did not go back and say, “Oh, we need to do X, Y and Z” because I just didn’t know what’s happening. At the same time in 2012 Ghana passed a mental health act, which is basically if you look at the history of mental health policy in Ghana it’s very progressive, and forward. The law is very good, and yet the way how it came into existence was there was some influence from WHO, intentional NGO’s, local NGO’s receiving funding from outside—
Trevor: I want to stop you real quick. The NGO’s, non-governmental?
Trevor: Organizations, what are ... They philanthropists? Are these people with money that are emotionally invested? Is this a question I should not be asking? What are they?
Rick: In the mental health ecosystem in Ghana most of the NGO’s you see, and they’re actually only two or three who are doing mental health work, came into existence through the support of DFID, which is the UK agency for international development. They receive most of their funding from DFID even up today. It’s also DFID that funds most of the mental health activities in Ghana. That being said, there’s an external factor here, which needs to be considered. However, what’s really compelling about them is that they are made up of patients with lived experiences.
Trevor: That’s what I was looking for.
Rick: Yeah, there are some patients with lived experiences. There are medical professionals, whoever wants to engage in the mental health field is obviously welcome to join. But, now it’s impressive. The Mental Health Society Ghana has about 3,500 to 4,000 people with lived experiences, and they’re organized.
The downside is that they’re not operating in whole country. The downside is also that their modules don’t necessarily apply to the counties, or districts where they don’t work in.
Trevor: If I read correctly you have one specialist for every 100,000 people. This is not something that can go countrywide yet when they can barely even make a dent in their own area.
Rick: Exactly, yeah. Now, the question is, and obvious solution is, “Okay, let’s train more psychiatrist. Let’s train more mental health nurses.” This is the reflex you see when you talk with people on the ground, or international stakeholders, and yet I do believe this is not fully reflecting what people want, and what the system can handle.
To answer your question, no. We didn’t go there and say, “Okay, here are our five solutions to your New Hampshire problem.” I have to say as an international NGO we even considered to go to Ghana or Kenya. For us at the beginning it was a decision, a deliberate decision we made, but we had a lot of discussions with our local partners if we should go or not because what is an international NGO doing in Ghana.
Eventually we saw, and this happened because I was talking to a lot of people, and understanding the mental health ecosystem in KATO South District quite well, that there are a lot of people with good ideas, but they are not connected, not working together. What’s happening is they were individual people. What we really wanted to do as an NGO is to strengthen the civil society engagement, and civil society stakeholders within the field of mental health. Our aim is not to then say, “Okay, once you are strengthened here are the policies you need to implement.” But our aim is to strengthen them up to a significant threshold where we basically say, “Okay, now we see there is a civil society engagement.” Now, if they decide they don’t want to have mental health care that’s one decision we have to respect. If they decide to want to have mental health care, then what is the way forward? They tell us. We are happy to provide technical assistance, but we are not the ones who are saying, “Okay, you need X, Y and Z.” They come up with their own ideas, and this happened in Ghana, and in Kenya.
In Ghana last year was a patient advisory board, which started. We had an NGO starting. In Kenya we have now a network of 25 NGO’s within six counties operating on the issues of mental health. They’re doing their own work. We are only giving technical assistance. Basically, this is very counterintuitive to what NGO’s do because NGO’s always step in when government fails.
For us it’s like we’re kind of doing the same. We’re stepping into a power vacuum. No one takes care of those who are abused, or the people who are mentally challenged, like and have these negative impacts in their lives, but only up to a point where we make ourselves redundant. Then we are happy to leave. Most of the NGO’s are not happy to leave. They are making local partners depending on them. I think this is something what we see in the NGO space over, and over, and over again unfortunately, not only in the NGO space, also in the developing space.
Trevor: What was the name of ... I ask because I’m embarrassed to say I don’t know how to pronounce it. What was the name of the documentary?
Rick: Obuongo Edhano
Trevor: Is that available to watch online anywhere?
Rick: Yeah, it’s on YouTube.
Trevor: It’s on YouTube?
Trevor: Could you send us the YouTube link, and could we put it in the show notes maybe, so people can watch it?
Trevor: I watched it last year when you came here and did a presentation. I watched it again last night. One thing that I liked is that you, specifically, took an educational approach to it, and you started with the brain. You went to schools, but you also went and spoke to what I understand were religious leaders, and respected leaders in the communities to talk about the brain. You did this thing. It was a very simple but effective approach is that you put a sticker on the wall. You made them touch their nose, and touch the sticker, touch their nose, touch the sticker. Then you had them put on a pair of glasses that shifted their view. Then had them do it again, and they were unable to do it. It was to illustrate that, hey. I just played a trick on your brain. It’s a very simple example, but I see how it’s a way to get in the door, and around that mental illness isn’t ... It doesn’t mean that your god is angry at your, or you’re cursed, or something like that. It’s just a trick of the brain. It was very, very smart, and from the point of view of the video it looked like it was effective.
Did you find that to be effective all the time, or did people accuse you of using some sort of magic trick?
Rick: I should say there are many different educational approaches you can take to raise awareness—
Trevor: Okay, that was just the one that was shown in the documentary.
Rick: Right, and in general I think we focus on the brain as you said. I think we had a reason why we did, and I will just explain this in a minute, but in general I think if you want to create awareness there are so many ways that you can create awareness about mental health. McLean is taking one approach. Then other NGO’s in the U.S. are taking a different approach. In fact, in Germany we are taking a different approach to raise awareness. I think we’re adjusting it to the cultural context.
Again, with the approach we take, it is not us telling people about mental health, but actually they come up with their own answers and solutions. The reason why we decided to talk about the brain rather than about mental health is because there is a generic interest about the brain, how it works, how you can be more productive, how you can handle stress, so just by numbers, and just by looking at curiosity, and thirst for knowledge. If we compare these two options people would always go to the brain talk, and they would never, ever go to a talk about mental health. Again, because people don’t consider mental health to be a medical issue, so why would they come to a medical talk about mental health.
When you talk about the brain one of the things we do, as you described, was about plasticity, and flexibility, and the learning brain, so people understand, “Oh, our brain”. The way it is it’s not set in stone. We can actually change it, which for most of the people is an insight they never had. They think once they are born the brain is just pretty much what is it, and you cannot really shape it. That’s the first important message people learn and understand, I guess.
What’s also interesting about it is that for example we’re talking about neuroanatomy and we make them understand the brain has different parts. Some of them make you see. Some of them make you hear. Some of them make you move. Then people all of the sudden start asking questions around, for example, hallucinations. They say, “Okay, you just tell me the brain makes you see, or the brain makes you hear. Now there’s someone in our community who’s looking around all the time, and he or she is pretending that he or she’s seeing things which we cannot see, or the same with hearing things. Now, is this a brain sickness?” Then, yes, you can say, “We call it hallucinations, but you don’t need to say this because that’s not what they care about.” But what they care about is the fact that the brain, just as any other organization, is susceptible to disease. Again, this is like fitting into our overall NGO approach. We are not giving the answers, but we are giving information, and then people deduce the answers from the information.
It’s also interesting about this model, and I think we are well aware with the modules we don’t want to biologize mental health because, yes. There is a huge—
Trevor: You do, or you don’t?
Rick: We don’t. I did a lot of research with Daphne Hall here in Boston on issues of imaging genetics, and emotional learning, and with college students, and so on. I’m a big believer in the biology of mental illness. And yet, when we go to countries like Ghana and Kenya I think it’s very important to acknowledge that we have to look at mental illness not only through a medical lens, but more so through a cultural sensitive lens, and ecological lens, and so on.
Trevor: You have to.
Rick: These modules help us on one hand to make people understand there’s an organ in your body, which is susceptible to disease. If it gets sick you need to take care of it, just as when your lungs get sick you need to go and see a doctor. When your stomach gets sick you go and need to see a doctor, so do the same when the brain gets sick.
On the other hand, we are well aware. We don’t want to overstress the biological model where we say, “Mental health is only like a biological pathology.” If you see care, then you will be fine because this approach will disappoint people eventually. Obviously, this is not what we are going for, but I think what we are trying to do is we’re adding a different perspective apart from the spiritual perspective, the traditional perspective. You saw this in the documentary. People say it’s running in my blood. It’s my grandmother who did something wrong.
Trevor: Yeah, they actually said that it’s in the blood, like not even as a symbolic statement. They believe that there is something physical in the blood. Now, there is even a western idea that it can be passed down biologically. However, I think they’re definition was very literal. There’s a demon in the blood that gets passed down.
Rick: Exactly. I think we are trying to integrate the medical information with the information people already have. Let’s say you have a 100 people. Probably 10 of them say what you tell me, the medical perspective. That’s absolutely not true. I don’t believe in it. That’s fine. If it’s a spectrum you have 10 people on the other side who say, “Oh my God, this is the explanation I was waiting for. I always knew what people say in our communities is not true, but I also didn’t know what else it is, but now you gave me an explanation.”
Then you have 80 people who say, “Okay, I was learning something, but I don’t necessarily buy into it’s only a medical disease, but I also understand it has a huge cultural component.” Even in the U.S. it has a cultural component. There is nothing like inheritability of 100%. None of the mental disorders is if you have a gene you have it or not, no. Schizophrenia is the highest of 80%-ish, so there’s always this environmental component, this cultural component.
What’s also interesting is even within one country you can have conditions which in one part of the country are considered to be abnormal, and abnormal being just pathological, and some condition to be considered normal. In a different part of the country you have the opposite, and so you see there’s a huge cultural component to it. People I believe this was one of the studies from Arthur Kleinman who is a psychiatrist anthropologist, and I believe it was Alaska where people after they lose someone they love, they will hear their voices for weeks, and weeks, and weeks. If you are not culturally sensitive then you would say, “Okay, after a couple weeks, a month, this is a psychosis. These are hallucinations. If you have different symptoms in addition to hallucinations you might be diagnosed with a psychosis, or at least you have some kind of hallucinations.
However, if you understand the cultural sensitive context then you say, “No, this is considered to be normal.” I think we have to be well aware of this, and we don’t want to give them the biology knowledge for them to just use this as the only truth, but with just any one perspective.
Trevor: Use this, and let’s not give you any context, right. Exactly. I don’t know if it was on purpose, and this is probably feeding into my own fears, and agendas with mental illness, but there’s an interview with a man in the documentary. He was talking about mental illness, and he’s like, “It’s growing.” He’s like, “I’m seeing more examples of this every day.” Then I’m a film maker who used to work in documentaries, so I understand how it works. After he says that there’s a cut to some telephone lines, some telephone cables. That could have just been an establishing shot, or it could have been, because there was a point where you could see that people had cell phones, and the shot of the telephone lines. I didn’t know if it was saying that maybe the pressures of industrialization, and digitalization of cultures—
Rick: Yeah, you know what’s interesting about it is, I’m currently am taking one of the classes at the School of Public Health. It’s called Foundations of Global Mental Health. Recently we not only had lecture about online, the social media, technology, and the influence on mental health, and obviously a lot of research is pinpointing to, yes. It increases your likelihood to some extent, but really who is affected, how long do you have to spend on the phone, what content do you have to see. There’s a lot of biases, and the studies are not quite clear up to now, I guess. Again, this is a generalization, which I should not make for different diseases. There’s a stronger relationship for other diseases, but the actual lecture I wanted to talk about was one from Doctor Becker who is working in Fiji for many, many years now. Basically, she is specializing in eating disorders. What she found is there was a rapid increase in eating disorders in Fiji once they had television.
Trevor: I knew you were going to say it. I knew it.
Rick: It’s so obvious, right?
Rick: You can see the actors, and actress, all slim. Then what’s interesting about this though is they didn’t just watch it and say, “Oh, we want to be slim”, but what the reasoning was is like, “Okay, the actor made it. The actor is slim, so if I want to make it in life, I have to be slim.”
This is obvious explanation, and yet I’m asking myself ... Yes, I buy into this, but isn’t the actual question why the culture, the traditional values are not resistant enough to the influence of westernized media, or to the influence of westernized ideas. Yes, you can say they influence you, and that’s fine. But, why in the first place is the system not stable enough to counteract these influences? I think that’s a question we always forget in this context, and I see the same in Kenya where people just say, “Yeah, there is a relationship. We need to stop it”, but where exactly does this relationship come from, and is it really applicable. What’s happening with the traditional value system?
Trevor: I have a theory.
Trevor: That relates specifically to television, or movies as a film maker myself. I think the language of cinema, the mise en scene, the combination of music, and editing, and cinematography. People are going to find this ridiculous, but when you’ve studied it as long as I have, and you look at it as a language, it’s a very powerful language.
Trevor: It’s very influential, and I believe it can cut through a lot of things.
Rick: Right, which I buy into. The study I want to see then though is, okay. You showed us in Fiji. Now show this in two or three other cultures. Let’s see if it has the same effect. At the same time, you can measure strength of traditional system. I really love this idea because, you’re right.
Trevor: But the thing is, is that advertisers know we would localize it for that area, so instead of using whatever’s the hit song here in America they would use a type of music that’s specific to that area. They would use color schemes, and expensive clothes that are related to that area. You always localize it.
Rick: Interestingly though, this is what happened in the second wave, but in the first wave it was only the whatever was shown in the U.S. It was shown in Fiji. This is so interesting because why are people so vulnerable to TV shows which are coming from the U.S. I think this would be just an interesting thing to study.
This is like, again, you have a good idea. Doctor Becker’s research is fantastic. I’m just thinking about the applications about it in Ghana, and in Kenya. If we studied the same now what do we make out of it, and again. Looking at the strength of traditional belief systems, and value system is just so important, not only in terms of your mental health, but obviously also in terms of democracy, and policy, and the role of traditional, the kings, and the queens, and the chiefs, and the elderly. It’s just super interesting to look at this intersection between policy, health, and then the wellbeing of the community, I guess.
Trevor: Maybe even if it’s the visual language of cinema, film, TV, even though it may come from outside cultural influences maybe the message of your life will be better with this approach, or your life will be better with this product is universal. Maybe it is. Maybe it’s just advertising in general, just the onslaught of advertisement.
Rick: Yeah, it’s super interesting. Again, this question applies too. This is a very specific context I gave, but then again, how do you even want to evolve social media now? What’s happening in the social media forums? How can you understand what’s really going on? Is it really affecting your brain? To what extent? It’s really challenging.
The thing is in the U.S., it’s even more challenging.
Trevor: Right, that’s the discussion right now with 4chan, 8chan, Reddit, all those forums is that what is happening when you leave people who have similar backgrounds, and similar values, I guess. What happens when you let them build their own quiet societies, quiet to us because we don’t know what’s going on, on these boards? Why are we suddenly surprised when we find out that some of them might be rooted in violence and hate?
Rick: Then the question is, is it because of the social media they use, or is it because they are now operating in silos, like cutting ties with the existing value system, or in the society system, I guess.
Trevor: I’ve always thought that we got to go back to the core word, the internet, or net, or networking. There’s one person in Burbank, California who may have these beliefs in hate, but nobody around them does, but then they find somebody in—
Trevor: Yeah, Massachusetts. Now there’s two, and between the two of them they might find somebody in Arizona. Then all of a sudden there’s 20. 20? You can do a lot with 20.
Rick: Absolutely, and what’s interesting about it, takes life from reality to a different reality, and so it’s just like very interesting to see is the same happening now in Nairobi, or in Kisumu, or in Accra already. Or, are people mostly using phones to just communicate? I’m not sure. I haven’t studied it, and I don’t want to make any uneducated guesses, or generalizations. But, it’s definitely one of the questions we encounter over, and over again.
And yet, on the other side we also have to say technology is just helpful in terms of there is one NGO in Ghana called—where they send you a brief survey, five questions. It’s free text messaging where you answer five questions of the PHQ9, which is just a questionnaire where you screen for symptoms. Then they call you back, and they hook you up with a service provider in your region if there is someone. Obviously, there are advantages, and disadvantages. In Ghana, in KATO South district for example, or Kenya, in Kasumo we’re still figuring out with our local partners, like what is the right approach to using technology, or to think about technology.
Trevor: I want to back way up. You’re a young guy.
Rick: Thank you.
Trevor: You’re a young guy.
Trevor: You’re trying to have an effect on two different coasts in Africa. Why you? Don’t you just want to stay home, and get drunk, and play video games like everybody else? You’re doing a hard, difficult, amazing work, so where does this come from?
Rick: I would slightly rephrase the question. It’s not why me, but why we. There’s my NGO. There are local partners, and what—
Trevor: Yeah, but we need to talk about you here. We’re interviewing you young man—
Rick: That’s true, but really gives me a lot of motivation, inspiration are two things. One, some of my friends, from Ghana for example, I’ve originally met them in the mental health setting, and I’ve seen them developing over the last couple of years. We have been working in Ghana. One of them is now a nurse. One of them is now a teacher, so these are amazing stories, and they’re inspirational. I think you can say, “Okay, you’re doing all this work”, but really what’s happening is I’m a part of a team of network as you just said. We are all having a similar mission. This is just very inspirational, especially I love to work with young, talented people. They are all over the places where we work, in Germany, in U.S., in Ghana, and in Kenya. They’re just ... I’m incredibly thankful for the opportunity.
Why me also is I just have an interest in global mental health.
Trevor: Right, but where did that come from, Rick?
Rick: The global mental health interest?
Trevor: Yeah, you grew up in Germany. Where is this drive to reach ... You could have stayed in Germany.
Rick: That’s true.
Trevor: But now you’re tackling Africa.
Rick: It’s true. Originally it began when I was in high school. I thought, “Oh, my town is too small. I want to move on.”
Trevor: What town did you grow up in?
Rick: Hoyerswerda. It’s a very small town in Saxony, like the state where Dresden’s also the capital of, and very removed, kind of rural. I mean not rural. There’s like 40,000 people by now.
Trevor: Got you.
Rick: Anyway, at some point I was like, “Okay, I want to move on.” I moved to Dresden, which has about 600,000, about the size of Boston. I was very happy for the first two, three years. I was still happy to stay there, but I was like, “Okay, I’m missing something, some stimulation, some inspiration.” Eventually I decided to go to Boston for my medical research. Up to day, Boston is just my favorite city because there’s nothing you cannot do here in Boston. There’s always some talks you can go to, people you can talk to. That being said, I don’t want to keep myself too busy, or I don’t want to distract myself, but the inspiration I can give to some of my partners in Ghana, and Kenya. Sometimes I get the inspiration myself from just being in Boston, from being abroad.
Eventually I also started traveling more, went to Ghana from America—
Trevor: I’m smiling because I find Boston to be the ... I love it here. I grew up around here. I find to be one of the craziest cities.
Rick: It’s true, crazy in its own way, I guess.
Trevor: That’s why I’m smiling. I’m not laughing at you. It’s just like, “All right, different people.”
Rick: I know, very different people.
Eventually I started traveling. I just love being in different cultural settings. I always stay with local people. I get to know the culture. I learn the language now in Ghana, like one of the languages at least. This just makes me happy on one end because I’m just learning, constantly learning, and I’m stimulated. On the other hand, it’s because just get a lot of inspiration from talking to people, traveling, our modules in Ghana, and Kenya. They now have a network between the two of them. They inspire each other. I can take things we do in Ghana to Kenya, and vice versa. I can take them from Germany. I think by now I’m a German by passport, and I’m German no matter what, and I feel German, but I also feel just home in the world. I just love to travel. This just happened through my medical internships and being abroad.
Trevor: That’s great. The world has ... Actually all different areas of the world, they have their own specific view on mental health, and you’ve seen how it’s viewed in certain areas of Africa, be it Ghana or Kenya. What are the differences, and is there anything that’s similar?
Rick: Yes, I think by no means I’m an expert in the mental health, in the world. As you said, I would need to focus on Germany, U.S., Ghana and Kenya where most of my experience is. I think there’s a similarity, and obviously there’s a varying degree, but people don’t necessarily understand mental health as something they need to take care of in the first place. If something at all there’s firefighting, but people don’t necessarily understand they are always, every single day, every hour, every minimum on the spectrum between mental health and mental illness. I think that’s very interesting that people just don’t have this understanding, and don’t take care. How would you, or why would you take care of your mental health if you don’t understand that’s something you have.
What’s interesting though, one of the differences is that what we see in Ghana and Kenya are oftentimes people don’t come. You cannot take the DS, or the SED channel, or the DSM5 and say, “Okay, here are my 10 boxes I need to check to diagnose” because oftentimes people present with somatic symptoms rather than with the other symptoms, the ones we use here in the U.S.
For example, if someone comes with the depression in Ghana, and I think this is very similar to not necessarily in terms of depression, but in terms of mental illness, how it presents itself in China, there’s a lot of somatization. People would come and say, “Oh, I can’t sleep. I have muscle ache. I have pain headache”, and that’s it. They wouldn’t say, “I feel sad.” They wouldn’t fulfill any of the criteria, and so if you’re not trained you wouldn’t necessarily be able to pick these up.
I think this is one of the main differences, the way mental health diagnosis manifest themselves. Again, people not only don’t believe that mental health is a condition which needs to be treated in hospital, but just these symptoms per se would make you go to hospital, just you have muscle ache. This is also contributing, and if you go to the hospital the first thing which you would do in these kinds of settings is to treat for malaria, or to test for malaria because these symptoms are very similar to malaria symptoms. There is a difference. It’s less obvious in Ghana, and in Kenya than it is for example here in the U.S. and Germany. I think this is one of the main differences I can see, and obviously, yes. Mental health, there’s a similarity, has a huge cultural aspect in all societies. The cultural aspect is definitely extended in Ghana, and in Kenya by a more profound, traditional belief system, and spiritual belief system. Explanations you wouldn’t necessarily find here in the U.S., or in Germany. No one, I shouldn’t say no one, but almost no one will tell you here in the U.S., or in Germany, “Oh, it’s something which is caused by witchcraft.” You find it, and no matter what.
People might be psychotic to tell you, but they wouldn’t believe per se that this is only witchcraft causing it.
Trevor: One thing that I did find similar in the documentary is that you’re interviewing a mother whose son suffered from a mental illness. This is getting to my next question, is that the stigma’s the same all across the board. Stigma seems universal. She talked about how because of her son her neighbors shunned her. She lacked friends. The stigma of mental illness is a universal language, which brings me to you were walking through Logan Airport a few years ago, and you saw our Deconstructing Stigma, the big, what would you call it?
Trevor: Yeah, exhibition. That’s the word I was looking for.
Rick: You’re welcome.
Trevor: Our big DS exhibition. From there you thought to reach out to us, and that’s how we got connected. Then how did that connection, how did that flourish to our involvement, and Deconstructing Stigma’s involvement with Ghana and Kenya?
Rick: Let me start by saying stigma can be viewed through many different lenses. There’s the psychological lens, sociology lens, and so on. Stigma always has a function. We not only need to look at the person who’s stigmatized, but also at the person who stigmatizes. Oftentimes you see it’s a power game. It’s a power play, and you oftentimes see if you stigmatize people this is one way of taking away benefits. If you say—
Trevor: Well, actually it’s why the world is stigmatizing poor Greta right now for having, what is she? She has—
Trevor: Yeah. The first thing out the bat to discredit her is that she suffers from ADHD, so we shouldn’t listen to her.
Rick: This happens in public. This happens more privately, and this happens certainly in policies. A lot of countries up to now just stigmatize against people with mental illness, not necessarily for the sake of stigmatizing, but also for the sake of cutting their ability to access social policy benefits. Actually, this is an idea which goes back to the colonial past. Ghana in 1888 had Lunatic Act imposed by the British Colonialists. What happened is it’s institutionalized care, and it also made mental health illegal to some extent, so people were thrown into a jail, but they were not thrown into a jail for treatment. They were thrown into a jail because they, British Colonialists, wanted to make sure they have public safety and order. The reason for stigmatizing is also to help create public order and safety. The reason to treat people if something at all was not to help people, and to make the society mentally healthy, or healthy, and physically healthier, but the reason why the Colonialists did it was to make sure that people can work on their business, so the Colonialists can exploit, and extract a lot of resources. That’s just like in terms of stigma.
I think there are different reasons why people stigmatize, but that’s definitely a story we have to keep in mind.
Now, when I came back from, I don’t even know, I think San Francisco, and I saw the Deconstructing Stigma exhibition at Boston Logan Airport, I was very interested in just one, the way the numbers were presented. They were lining up with quotes from some I guess famous people, like some people had to say something about it, which is good, and most importantly about patience because I think this is the most powerful testimonial you can get, if you have people with lived experiences. I, to myself was thinking, “This is such a cool thing to do in Ghana, and Kenya as well, not only for the sake of creating awareness, and giving people who have been stigmatized, and will have been unheard for many years, decades, and centuries, to give them a voice in society.” But also, what I really think is interesting about Deconstructing Stigma is that it has the potential. If we collect stories from many different countries, from many different continents, eventually we might be able to go back, and see how people tell their stories, what they tell, how they tell it, why they tell it. Then just start making comparisons.
Not like saying, “We can deduct any meaningful interventions from it” where we say, “Okay, this is the way how people stigmatize in a few Sub Saharan West African countries versus this is how people stigmatize in Latin America, versus people in Australia”, but I’m just thinking to myself how powerful it could be to read stories from all over the world, and see there are a lot of similarities. There are differences, and where do these differences come from, and why are the similarities the same.
What we did in Ghana and Kenya was also we collected patient stories, mostly in KATO South District, and in Kisumu County we are displaying them in public now, but the idea would be to extend this exhibition to a few more districts, and counties in Ghana and Kenya to get a full picture, and understand what’s going on from a patient perspective.
Trevor: When you brought DS to Ghana and Kenya there was still an issue with people were participating, but they didn’t want their actual names used, right?
Rick: Right. I think this tells us two stories. One, from a way how Deconstructing Stigma was set up. We obviously we’re talking to patients, their caregivers. They had to sign. They have to understand your risk and benefits, but we’re also talking to the government structures, and to NGO structures, and to human right offices just to make sure we are doing the right thing, the culturally sensitive thing. What’s interesting though is that we got a lot of backlash from an institution, which you would expect you would not get any backlash from, which is the Mental Health Authority. The guy who was in charge for the region—
Trevor: That’s a great name to get backlash from, the Mental Health Authority.
Rick: Just today I don’t want to bring it down to names, but just the name authority tells you what they do. Instead of it could be mental health leadership, but let’s not get into this now. Also, writing one of my papers this semester about this, so if you’re interested I will happy to share it with you.
Trevor: Yeah, please do.
Rick: ... at the end of the semester.
Rick: The guy was basically we were explaining the concept. Patients were happy. Caregivers were happy. Medical professionals were happy. Everyone was happy even the Human Rights Commission with the way we are setting it up. Well, this guy who was in charge for the region was saying that he does not want patients to show their face because the people don’t have any insight. They don’t have any capacity to make decisions. Once they have a mental illness they have a mental illness for their life, and so they don’t have any legal capacity. This shocked me. This is a guy who is in charge for the Mental Health Authority for this district. This is how he thinks about his own clients.
That being said, we couldn’t show the faces of the patients. In Kenya we actually people were more open about it. We left the decision to them. We said, “If you want to show your face that’s great. If you don’t want to show your face that’s okay too.” Because of the stigma some people decided to not show their face, and in Ghana, and in Kenya we actually were only able to use initials, and not like any identifying information because of the stigma. As much as people and patients are ready to contribute to the social change they also don’t want to suffer and be the ones who experience negative consequences because of participating. While we have to be respectful, we also really appreciate their willingness to make a social change happening.
Trevor: The stigma out there, it doesn’t just stay within the realms of mental health conditions. It all, like a brain injury could be stigmatized, a brain condition could be, cerebral palsy could be stigmatized. It’s all out there. It’s all under the same umbrella.
Rick: It’s all under the same umbrella. Epilepsy is the same. What’s really interesting is if you think about this from a more, for example, witchcraft point of view, or one of the models of explanation, I guess. Whatever people perceive or they see, mental illness can be visible, but oftentimes it’s not visible at all. As soon as someone is starting to have an epileptic attack, or cerebral palsy, they have some body movements which are not expected, and it really looks from the outside like—
Rick: Yes, exactly. The witch is now in the body and causing these symptoms. The same with mental illness, and this is why they fall under the same category. In fact, in Ghana epilepsy is treated by mental health care providers, and it comes with the same stigma than with any other mental illness.
Trevor: From what I understand patients that are treated at On The Move e.V., Some of them also end up working there at the clinic. How does that further their development, not only with their own treatment, but maybe how they maybe share their experiences, or try and destigmatize the issue with their family or communities?
Rick: I think all our activities, we basically do prevention. We do treatment. We do rehabilitation. All our activities aim to empower the patients to get a voice in society. Part of it was the Deconstructing Stigma campaign, but part of it is also patients joining us, and actually leading the awareness campaign, so brand awareness you saw in the documentary. Patients are also now doing it, sharing their own stories. The treatment part, patients are also doing active case search now. Rehabilitation part, we have a clinic called Home of Brains where basically we offer vocational training. As part of the vocational training we employ people. We pay for the medication up to six month. It really depends on the severity, and how long someone has to stay, but the idea is after the six month people are able to go back into real life, and find a job, be able to take care of themselves financially, and so on.
This financial independence now gives most of the patients, first of all, the opportunity to also engage in mental health activities in the district. This per se, which means they go into communities. They can talk, gives them some kind of meaning, and purpose in life because after having been silenced for years, and years, and years, now they can contribute to this cause, of educating society.
At the same time what happened at Home of Brains is that one of our patients, whose also now the nurse I was talking about before, he is actually now working as a nurse at Home of Brains two days a week as a nurse. Then on the weekends he is still there to entertain kids, and educate about the brain, and whatnot, but he also organizes the patient advisory board, and self-help groups in the district. All of a sudden people come together, talk about their experiences, talk about even simple things like side-effects. It’s not simple, but something people could not have talked about with anyone before. This again, per se, just the self-help group, this feeling, “I can make a change. I can do something for my community. I can help people who are affected” gives a lot of people sense and purpose in life.
Trevor: What’s interesting is that even here in, not just Boston but even here in the States, people are even put off by the word mental health. They won’t attend an event that the word mental health, the word wellness, the hot word right now, which is another umbrella term, could mean yoga for crying out loud, but that seems to be the same issue in Ghana, Kenya. It seems to be an issue everywhere. What is it about how we word things?
Rick: I think mental illness, when you say, “Let’s talk about mental illness” already implies you have a disability. It’s about disease versus illness experience. Disease is just like pathology, and illness experience really what is the personal experience of an illness. If you say wellness that’s the opposite. You don’t do wellness because you feel ill, but you do wellness to take good care of yourself, and to do something good for you. Obviously, that’s one of the things I think which can contribute. Second thing is in terms of how you perceive illness, like your explanations of health and illness will contribute. There in Ghana, and in Kenya as well as in people in the United States. We see mental health is not an issue one talks about because your upbringing told you not to talk about private issues. Opening up, talking about mental illness is a very private issue, so people hold back no matter where they are. They have just this experience. This is not something we can talk about. This might happen in some families, which have more rigid family structures, traditional belief systems, more than others. Obviously, it also depends on how many people are affected. Are you personally effected? How many people in your environment are effected? Have you had any experience with treatment?
It will help you to understand that mental illness is just one other form of illness. Yet, I want to say I think one of the reasons in the U.S. also why we see differences are related to structural violence. People who systematically don’t have access to healthcare services, again, don’t necessarily come to something which they didn’t have access before because they say, “The system failed me for the longest time. Now why should I go to something that the system is now offering.” Talking about structural violence—
Trevor: That’s a fantastic point.
Rick: Even in the Boston area, you think that Boston is a great city. You have Mass General Hospital. You have McLean Hospital. You have all the Partners hospital. You have all the research institutions, but the life expectancy between certain parts of Boston, like Back Bay, mostly white people. It’s about 90 years. Life expectancy in parts of Boston where you have a lot of people of color is about 60 years. There’s a difficult of 30 years life expectancy, and a lot of it is related, not all of it, but a lot of it is related to structural violence. Structural violence meaning that people are systematically denied access to healthcare services.
If you’re denied access to healthcare services, you also don’t want to go to mental health care services.
Trevor: Especially mental health where it’s so stigmatized.
Rick: I’m not entirely sure about the interaction between structural violence, the privacy part we just talking about, the wildness versus the illness aspect, and the disability aspect, perceiving illness as a disability, but I think these are at least a few of the things where people are more likely to show up when you talk about wellness in comparison to let’s talk about mental illness. But, I’m happy to learn more about this one as well.
Trevor: Before we wrap up this very, very dense episode, is there anything else we should talk about?
Rick: I think one of the things I’m really curious about, and really interested in is looking at the scalability of mental health policies, or mental health in general. I think—
Trevor: The scalability?
Rick: Yeah, let me go back to Ghana and Kenya.
Rick: When we look at one district, and let’s say we talk about malaria medication, or malaria diagnostics. You’d have one district with 100 people today. Tomorrow you want to do two districts, so if you need 10 test kits one day, and you say, “Okay, district two also has 100 people. Let’s say then we need about 20 for two districts.” It’s an easy fix. It’s a technical fix. You only need money to buy these test kits. However, with mental illness it is not as easy. You cannot just say, “Okay, this policy works here, or this medication works here. Now let’s apply this here” because, again, it has this cultural aspect, so I’m really wondering about what is it about a scalability. How can we scale up mental health polices? We’re working on it. I think what my NGO is trying to do at this point is to come up with a handbook, which really lines out cross-cultural strategies, how to improve mental health activities in a district, in a community without increasing dependency on foreign stakeholders. Obviously, I’m super interested to hear from people who have done similar work, who have scaled up mental health projects in a meaningful way where they really still see impact, and it’s still culturally sensitive.
If that’s something listeners of the podcast are willing to share, I’m more than happy to learn about this.
Trevor: Rick, before we wrap up if you don’t mind just a tiny piece of unasked advice.
Trevor: You’re doing a lot of great work out there. My only recommendation is take a day off here and there from saving the world, and eat a pizza, and play a video game, and take a mental health day for yourself, okay?
Trevor: So that we can look at the long game here, and you don’t burn out so early. Take a mental health day for yourself, and seriously that’s not to mock you. You’re doing amazing work. I’d hate to see you burn out.
Rick: Absolutely, every Wednesday night I sing in a choir. That’s my mental health time. I love to sing concerts. I love to go to operas, so there’s a lot of these things happening as well.
Trevor: That’s good.
Rick: It’s just very much with talking with people, and this is happening every single day. I think what you’re saying is so valuable because oftentimes people just get lost, and you just get sucked into the system, but it’s so important to also understand your own mental health comes first. Then you can only take care of other people, so I really appreciate your advice.
Trevor: Thank you, Rick.
Rick: Thank you, too. Have a good day. “Nkekea nenyon” This is what we say in Ghana. Have a good day, “Nkekea nenyon”. To show off a little bit with my new language skills.
Trevor: Walk me through it.
Rick: Mm Keka-
Trevor: Wait, go ahead.
Trevor: Nenyo. Mm keka nenyo.
Rick: You say yo.
Rick: That’s it.
Rick: Okay, thank you.
Trevor: Thank you.
All right, what did you think of that? Rick is a really great guy. He needs to learn how to rest. He works a little too hard. Thanks to those who have been reaching out, and rating us, and sending us feedback. I really appreciate it. We’re starting to plan something for the one-year anniversary. I don’t know. Gears are turning. Discussions are about to happen. I’ll let you guys know when we’ve got something in the books. A lot of talk of the Joker movie, and mental illness. I’ve seen it, and yeah. I have a lot to say. I have a lot to say. I don’t think now’s a good time. I think we’re actually going to try and make it an actual episode about it. We’ll see. I don’t know. I think the peak of the discussion around the film has happened already. It’s starting to get a little quiet, so I think we might wait for the home video release in a few months, but I don’t know. We’ll see. I liked it. I’ll say that. I liked it quite a bit. I was surprised.
This is all I’ll say about it right now. I do not think it is the call to violence that everybody claims it is, and I absolutely do not think it demonizes mental illness. The film’s not subtle, but I think it says some real dark truths about it. Let me clarify. Not things that I necessarily agree with, but I certainly empathized with. You can empathize with a mentally ill person that does bad things. I’m not saying you can sympathize with them, but you can empathize. It’s not a dangerous thing to do. It has no bearing on you as a person. Understanding what somebody’s going through is no grounds to judge yourself, or judge anybody else on. It’s no different than the film that Patty Jenkins made in the early 2000’s called Monster with Charlize Theron about, I can’t remember the woman’s name. It starts with an A. Aileen Wuornos. I totally understood why she became the person that she did. Now we’re talking about a comic book villain, but still. I understood why. Nothing wrong with understanding. There’s nothing wrong with it. Two weeks? Two weeks, two weeks. We’ve been late on a few. We’re working on that, but two weeks. Two weeks.
Trevor: Thank you for listening to Mindful Things, the official podcast of McLean Hospital. Please subscribe to us, and rate us on iTunes, or wherever you listen to podcasts. If you have any suggestions for special topics, or future guests email us at firstname.lastname@example.org. And don’t forget, mental health is everyone’s responsible. If you, or a loved one are in crisis the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.
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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.
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