Head Inside Mental Health
Todd Weatherly, Therapeutic Consultant and behavioral health expert hosts #Head-Inside Mental Health featuring conversations about mental health and substance use treatment with experts from across the country sharing their thoughts and insights on the world of behavioral health care.
Head Inside Mental Health
From Crisis to Independence: The Marathon of Mental Wellness with Dr. Mark Komrad
Dr. Mark Komrad, distinguished Fellow of the American Psychiatric Association and author of "You Need Help!: A Step-by-Step Plan to Convince a Loved One to Get Counseling" returns to our show to walk us through the progression from acute mental health crisis to meaningful independence. He explains why residential treatment often works better than outpatient care during severe episodes, and what "success" looks like at each stage of recovery. For parents supporting adult children with mental illness, he offers a powerful framework for understanding when and how to encourage independence despite the "gravity of regression" that pulls families back into old patterns.
Whether you're or a loved one is facing a first psychiatric crisis or have been navigating this journey for years, this conversation offers both practical guidance and genuine hope. Dr. Komrad's compassionate insights help listeners recognize that recovery isn't linear but follows a "jagged line" of biology rather than the smooth parabola of physics—with ups and downs that are normal parts of the healing process. Join us in our conversation to discover how to better support your loved one while preparing them for meaningful independence.
Hello folks, thanks for joining us on Head Inside Mental Health, featuring conversations about mental health and substance use treatment with experts, advocates and professionals from across the country sharing their thoughts and insights on the world of behavioral health care. Broadcasting on WPVM 1037, the voice of Asheville, independent commercial free radio. I'm Todd Weatherly, your host, therapeutic consultant and behavioral health expert Weatherly, your host, therapeutic consultant and behavioral health expert. It's my pleasure today to welcome back to the show. Author of you Need Help a step-by-step plan to convince a loved one to get counseling, dr Mark Comrade. Dr Comrade appears widely on TV, radio and podcast to discuss topics of psychiatry. He has been the host of a nationally syndicated weekly call-in radio talk show about psychiatry, comrade on Call, and regularly appeared on the medical talk show Sunday Rounds, a call-in show broadcast to over 40 million listeners around the world. Dr Comrade was elected by his peers to the prestigious American College of Psychiatrists and named as a Distinguished Fellow of the American Psychiatric Association. He's also voted one of Maryland's top mental health practitioners by Baltimore Magazine, as well as one of the top doctors in Baltimore. He earned his MD at Duke Medical School and trained in internal medicine and psychiatry at Johns Hopkins, where he is on the teaching faculty. He's also clinical assistant professor of psychiatry at the University of Maryland, tulane and LSU. He was an attending psychiatrist in the Treatment-Resistant Psychotic Disorders Unit at Shepherd Pratt Hospital for 15 years, where he continues to train residents in psychotherapy and psychopharmacology. Dr Comrade, welcome back to the show, thank you. Thank you so much.
Speaker 1:Sent your book to many of my clients, so here's a good question that fits into the middle of some of this I'd love to hear your answer about, which is you've got folks that their level of acuity is pretty high, they're having a lot of symptoms and everything else, and one question you'll get but they're maybe not in the hospital yet. They're having symptoms, they're having delusions, they might even be having some psychosis, but they're sitting in the living room watching TV, trying to calm down, doing PRNs of some kind of medication that's keeping them calm for the moment. But it comes and goes, and so parents will ask me just today I got to ask this question is there a way for us to do this in an outpatient setting? My answer is typically it's a risk. I don't want to say no to things. There have been times when it's been successful. But, moreover, residential environments are far more effective at med management and stabilization and so on and so forth. What's your answer to that question as a psychiatrist?
Speaker 2:Yeah, I think it depends on how much the treatment intensity can be flexible and dial up. So, for example, sometimes but my goal always with my patients is to try to minimize hospitalization, and so there are many ways that I do that that involve increasing my treatment intensity. So for some people I may have to see them several times a week. Sometimes, in a really acute situation, I may see people every single day. A couple of times in my career I've been known to see people twice a day in the course of a day Telephone contact. These days, of course, you can have telehealth contact as well.
Speaker 2:So all of those are methods by which, if a clinician is willing and available which is a whole other discussion to be able to increase and titrate up what a clinician can do in that kind of a setting. And of course I may be making med changes every day under those kind of circumstances. So it's kind of an intentional outpatient paradigm. And then of course we have IOP centers and day treatment centers where people go at least five days a week for four to six hours at a time in a group setting. That's a hospital-like setting, except you don't spend the night in the hospital, you come back each morning and you go home each afternoon and they get not just the attention of an individual psychiatrist there but they get group therapy and nursing and so forth and that's often a very reasonable intermediate way of dealing with unstable and acute situations.
Speaker 1:And when I see somebody like that I'll ask them to. Maybe you should get a companion or somebody, at least for the first little while, to just give you some support at night.
Speaker 2:Right. Well, if that's necessary, if that's possible, it depends you have to have a certain level of psychological sophistication and experience in dealing with people who are so acutely symptomatic from psychiatric disorders to be able to be a companion. And I think that in general you know just having somebody sit with them who may not really understand illness, know what to say, that doesn't have any clinical training at all, Even if it's training on the level of, you know, peer support specialist, which is a whole training level itself, or a mental health coach, sometimes that's insufficient and it's tricky when you're dealing with overnight problems. That's generally an indication that you're ready for an inpatient level of intensity.
Speaker 1:A lot of times, it's parents doing this role, of course.
Speaker 2:And that's exhausting.
Speaker 2:And the thing about, say, inpatient treatment is you've got shifts, you know shifts, so you know staff put in eight hour shifts so that they're refreshed and they're not exhausted, and sometimes you know it takes three shifts of support and attention to be able to get somebody through the night and through several days as well.
Speaker 2:So I think once you're getting into that level, it may well be that this sort of intensive outpatient approach, whether it's in an individual office or in a partial hospital, day hospital setting, may not be sufficient. So now to go back to the issue of what constitutes success, in other words what would be progressive goals in the course of treatment. So as you get beyond the acute phase into sort of the subacute phase, if you will, which is where things are no longer extremely unstable but a person is still symptomatic, the goals become first rather close to home, to reestablish a person's capacity for self-care and some reasonable degree of independence. So their activities of daily living, hygiene, diet, sleep and the ability to be able to have at least some basic levels of interaction with other people that are effective and meaningful are, you know, more subacute goals. And once you can establish that, so that's a level of success in that phase. Sobriety.
Speaker 1:That's the other one that seems to pop up for me sobriety.
Speaker 2:Absolutely sob, so forth. So to be able to maintain some equilibrium between things that are needed and things that are not needed as a level of self-care is, you know, a very important subacute goal at that point. Then, as we go out further, then we start to think about it's our time mark.
Speaker 1:Now you think like if you were to give it a general average, you go out further past the subacute level.
Speaker 2:So I would say several weeks, several weeks. Then we start to get into the issue. Then we start to get into the issue, let's say, you know, between three and six, three and eight weeks. Then we start to look at goals that I would call reintegration. Reintegration into the worlds of the two worlds in which Freud originally said we all have to function, which is the world of work and the world of love. Both of them define broadly right the world of productive, contributory activity, whether that's around the house or outside of the house, and the world of interpersonal relationships with people that care about you and people you care about. So reintegration would involve things like if a person has been so ill that they have to stop school, right, getting them back into class, stop work, getting them back into work. And it may be a part-time thing at first. Sometimes you may have to take off a fair amount of time, sometimes it's longer than eight weeks, but getting back into being a participant in the environment in which you live, environment in which you live, whether that's your family or your family of origin, your family that you've created with a spouse or significant other. Care for others, not just care for yourself, whether that be children or a spouse or, you know, a parent that requires care, return to work and gradually also returning to any avocational interests or vocational interests, by the way, that could be volunteer work, that could be you know, hobbies and pastimes, something you know, even as simple as you know, the capacity to read books again, to keep up with the news again. So that is sort of the reintegration phase, and there we may be talking about some months Again, if all is going well, if the treatment relationship is sustained, the treatment plan is sustained, both the things that you should be putting into your body and the things you shouldn't be putting into your body, and so forth. So then, after the so that's a success there.
Speaker 2:Then, in the much longer term, or much longer term goals that people have in their lives, goals that may take months or some years to be able to achieve, to be able to mount a life that's a full, meaningful life, with things such as building a career, taking a training course or going to school and getting a degree and, you know, graduating and being able to get into the job market and develop a career, developing significant relationships with developing circles of friends and maintaining circles of friends. Obviously, different people can achieve different amounts of these things, but these are certainly at least this is the domain of goals that we're talking about includes these different things being able to have a significant adult relationship, if you're an adult of an intimate relationship, develop a family, if that's one of the goals that you have in your life, and to really maximize independence. And if you haven't already achieved it, in which case it would be rehabilitation. Like, say, for example, being able to drive. If you had been able to drive and, by virtue of being acutely ill, you've lost the ability to drive, then regaining the ability to drive would be a rehabilitation. Achieving things that you've not achieved before in your life goals, maybe because you haven't been alive long enough in your life goals, maybe because you haven't been alive long enough or because your illness has derailed you from achieving those, such as getting your driver's license for the first time, such as going to college for the first time, such as starting to date for the first time, that those would be called habilitation as opposed to still do rehabilitation. So the habilitation goals are, you know, in that sort of final phase, or you know at the top of the pyramid, and a lot of those things involve self-sufficiency and independence. Of course all of these are ideals, right.
Speaker 2:But frankly, in my work as a psychiatrist, what I practice is I am thinking in terms of all of those different levels and I am taking the journey with my patient. I mean, at this point I've been in practice for 35 years, 36 years so I have. You know there are a number of patients that were growing old together, you know, and how long we're going to be together is going to depend on which of us dies first. But so I've seen patients now through all of these different phases. Of these different phases, you know, some more robustly than others, and each person's success of course has to be reckoned in terms of the nature of their particular illness, their resources, their limitations and so forth.
Speaker 2:Not necessarily everybody is going to want or even be able to achieve, I don't know, the college degree and things like that, but I'm always thinking when I settle in with a patient it's not okay, I'm here to treat your symptoms and once we minimize your symptoms, we're done. Or once we minimize your symptoms, you can come back and see me, you know, twice a year, so I can make sure your symptoms remain minimized and we don't have to make any changes and we'll sit together for a half an hour, maybe an hour, and I'll see you again, you know, in six months. That's not the way that I work Now. Not everybody has to work that way. Sometimes you can basically collaborate with, you know, psychiatrists can collaborate with other kinds of therapists, other kinds of programs and so forth, who can continue to shepherd people along with those particular goals.
Speaker 1:They've got that real-time exposure to their clients so that you get the information right.
Speaker 2:And I do. I collaborate with many of those other kinds of resources, especially people like you and the kinds of things which we are grateful yes, not as grateful as I am for you and what you guys do, but I'm always thinking, I'm always thinking ahead, I always want to. I mean, I'm kind of like a coach, if you will, who is expecting a little more out of their athlete. You know what's the next level. How high can we put up the jump bar? Next, can we raise it another inch? And? And kind of looking ahead, not just to what my patients have accomplished so far.
Speaker 2:But okay, where do we go from here? Back to Latin quo vodis? I like to work. That's why I went into psychiatry. I didn't go into psychiatry just to prescribe an antidepressant. Make sure that you're sleeping and eating and have your energy and have your sex drive and all Okay. Next, that's people you know and there's a role for that, I suppose. But if a primary mental health treater isn't doing that, then you need to add on additional resources to begin to tend to those other phases in this journey of success that we've been talking about.
Speaker 1:Yeah, the saying this is a marathon, not a sprint applies quite well to the scenario involved in mental health recovery.
Speaker 2:Although I do want to say that it's going to require periodic sprinting, though that's absolutely correct, there's one step backwards, two steps forward, and when they take the step backwards, that requires a sprint to be able to return to the marathon, you end up needing the hospital.
Speaker 1:It feels like a sprint for sure. And you know, of course, my experience with parents of you know, usually parents of children. Sometimes it's a spouse or partner or a sibling.
Speaker 2:And you typically work with adult children right.
Speaker 1:Parents of adults. We cover the full range. I do primarily adults and focus a lot on older adults these days, which is why you know you get a family that calls you and their son or daughter is 35 years old and they've been struggling for a long time. They've gone back into the hospital, and this question comes up a lot because you know families have been through what I call the gauntlet Multiple hospitalizations, failed treatments, apartments torn up and cars wrecked and even jail sentences and things like that. They want to know.
Speaker 2:I was going to say welcome to my world, but we're both in the same world.
Speaker 1:We live in the same world, or at least aspects of it, for sure. And you know the thing that they. I get why they want to know, I get why this is important to them. First of all, they want to know if recovery is possible. I think you and I would celebrate and join in the answer that, yes, recovery is possible and I would celebrate and join in the answer that, yes, recovery is possible At different levels.
Speaker 2:People, can achieve and sustain. You know, not just recovery, but fulfillment. And let's look at the difference between recovery and fulfillment. Yes, Right, yeah, I mean these major mental illnesses that we're talking about. They're chronic diseases, Right? So the outcomes are not typically cures. They're significant improvements, a well-managed stability, well-maintained life and a maximization of the potential within the limits that the condition may impose.
Speaker 1:Right, and so they're like how long is it going to take? You know when does, and maybe this is the place where you can provide some insight. That is what I try to tell them. You know, let's find the right thing to do and let's do it for long enough, because everybody's answer is a little bit different. But in your mind, you know you live on the side of the world where crisis and urgency is happening. You're staying involved with your clients at levels that I would hope to see as many psychiatrists out there in the world emulate. You set the gold standard, in my opinion. Psychiatrists out there in the world emulate you set the gold standard, in my opinion, when you've got folks who are in long-term recovery.
Speaker 1:Sometimes it's not a timestamp, sometimes it's like you say, these domains, if you will, of recovery, they've got a job, they've got the license back, they've gotten these things, these aspects of life In your mind. What is this marker? Where it's like it, the? The comparative analogy is when a kid's learning to ride a bike, when you can let go of the bike, when a person's in mental health recovery from from a fairly acute condition. In your mind, what are the markers that say, hey, this person might be ready to to do this on their own a bit. It's not that we can't attend to this illness anymore. It's more that, as parents I can sleep at night, I can breathe a little easier they're looking for this relief. It's like where is this place in the future that could exist, and how do we know that it's happened? What kind of answer would you give to a parent asking you that kind of question?
Speaker 2:I think it depends, and it depends on sort of what are the specific nature of the problems that the person is having. I think most people recognize the difference between an acute exacerbation and an acute illness, right, and a much more, you know, stable phase, although it might involve different levels of functioning. I think it's very important for thinking about parents that the healthy developmental trajectory of all organisms, human beings included, is separation and individuation, right. So we start off literally as part of our mothers, right, and we gradually grow away from mothers and with fathers or father substitutes figures help doesn't even have to be male and, you know, gradually achieve independence, unlike many other mammals.
Speaker 2:Our phase of dependency is very, very long. You know. It's not like a calf who can get up and stand on its legs, you know, within a matter of hours. You know it takes a whole year, you know, to start to become a toddler and begin to even start toddling away. Plus, having to be acculturated in our incredibly complicated society requires a long period of independence and education and guidance and mentorship until people are launched.
Speaker 2:And you know, especially as society becomes increasingly complex, we're seeing that that period has become more protracted. We're seeing that that period has become more protracted. There's now sort of a new phase of development that we're coming to recognize, at least in the US of you know, sort of early adulthood that maintains a lot of still dependency on parents financially, sometimes residentially, based on the state of the economy and other resources that may be increasingly hard to get, as well as, frankly, sort of the general tide of mental health that characterize our youth these days, which I think is not quite the same as it used to be in their parents' and grandparents' time, probably for understandable, legitimate social societal reasons that make the world, you know, a much more difficult place to navigate than it used to be.
Speaker 1:I have one of those, those, those, those residentially dependent young adults.
Speaker 2:So I know what you're talking about, yeah, and I, I'm in, I'm in the last phase of that, you know, with with my congratulations my 20, 27 year old, right? So I think that that. So parents certainly need to allow for the fact that that there's a normal trajectory there, but to always be keeping a thought out for how independent and self-sufficient is a person able to be and to try to create opportunities for maximizing that when possible, little by little, and not giving in to the temptation, the understandable parental temptation, to make it easy as possible for your child. I mean, there's a thin line to walk there. There's a Goldilocks zone. If you will, not too much, not too little, right, just right, in which you know, in making opportunities for self-sufficiency, you know, not driving your kid everywhere, no-transcript you will begin to get the proper sensation that all parents, hopefully, are eventually able to get, that your bird can begin to fly a little bit, and it's not an all at once thing, right, it's a gradual thing and it may only be able to be limited in a way. So I think one of the things that's especially important at a certain point is to start to think, because we parents we're not going to be around forever, so we start have to start to think about all right, if, if we're going to need to be involved, how involved do we need to be and what? What is the succession plan? So one of the things that I often have to really push families for and I do work with families is let's think about a little bit more independence in residence to be able to see if we can move your adult child into a situation that's not a huge step, like going off to live alone in an apartment by yourself.
Speaker 2:It's often not the next step, if it's even an eventual step in case management come in or a group residential situation or a therapeutic community that the kinds of which you know you're very connected to, but to begin to move that their offspring along in that level of self-sufficiency. Because depending on a case manager or a residential treatment staff is a step forward than depending on a parent. And that you might say, well, what's the difference? They're going to depend on me and they depend on them, and isn't it the same thing? It is not the same thing, because the inherent gravity of regression that happens with the parent is something that you know is is endemic to the parent-child relationship, for all parent-child relationships.
Speaker 2:Forget about whether mental illness is involved. I mean, you know, when I go home, you know my mother you know is worrying, am I worrying have a sweater? You know picking lint, you know off my shirt, you know she falls back in, you know, to the role of mothering me. You know my food and things like that. So I mean, that's, that's, that's endemic to the parent.
Speaker 1:I love that expression the gravity of parental, gravity of regression. Gravity of regression, my goodness Well, and you know the I. I'm really glad you bring it back to kind of stages, stages of natural development for human beings and and looking at you know whether they've got mental illness or not. You're looking at it from the standpoint of let's give them opportunities to express independence, and a little bit at a time, so that they can get accustomed to it and not be what they call now the lawnmower parent, which is to mow everything down, out and get out in front of your child and mow everything down. I've heard helicopter, haven't heard lawnmower. Lawnmower parent, that's the new one.
Speaker 1:So, at any rate, when you've got a child who suffers from mental illness, of course and I'd love to know you know I have what I say and I think you and I look at families in very similar ways.
Speaker 1:I think you and I look at families in very similar ways One, compassion as a parent and two, compassion as a parent who has a child who's suffering from something. And you know there's a lot of this reasoning that well, I don't want to let them go, I don't want to kind of give them these chances at independence, even though they're mild ones, even though they're really probably going to be successful at it. Because what happens if you know what happens if they fail? What happens if because what's happened if they failed in the past obviously has been maybe they end up in the psychiatric hospital or they've got these things that it's pretty disastrous what's happened. And yet it's still important that they take these steps. How do you give parents comfort when they're asking about this kind of tension they have in giving their child stabs at independence so that they can become better?
Speaker 2:Yeah, every parent remembers helping their child learn to walk right and seeing them fall down and get up and have maybe the skinned knee and so forth. So we all, as parents, have had experience with stumbling and failing. So we're not new to that challenge, even in these very complicated, more adult situations. So I think first bringing people back to their experience, their competence that they have developed in earlier stages of development can help them grasp the essential ideas here and to see that they themselves are capable of tolerating some setback, some fallback. Secondly, I think that you know I like to.
Speaker 2:Often I take my whiteboard and I draw on the whiteboard two figures. One is this smooth parabola and the other I draw is a jagged line that goes up, squiggly line that goes up. And I say that first figure is physics. The second figure is biology. That's great Physics and although I guess if you look at the micro level the baseball is bouncing around a little bit through the air, but for the most part it's a much smoother trajectory.
Speaker 2:But biology is inherently variable, built to have a certain amount of resilience against environmental perturbations. So that you know it's. You know part of what it means to be warm-blooded. Right, the temperature can go up a little bit, it can go down a little bit. Right, the blood pressure can go up a little bit, it can go down a little bit. That kind of dynamism is actually part of the adaptive nature of biology in general.
Speaker 2:Sometimes, when I do that and, by the way, when I draw the squiggly curve, I show it going up right and I say you know, this is think of the stock market. Right, the stock market which, by the way, is a biological phenomenon. Right, it is a epiphenomenon of human beings and human activities and human minds. It's not a phenomenon of physics or geology, it's a biological phenomenon. So you know, let people understand that some to and fro, some steps forward, some steps backwards is actually normal. It's a normal part of living and of being alive. So that you don't want to control things so tightly that, because what you're expecting is your loved one to be a baseball right Rather than-.
Speaker 2:Some perfect projected version of development right, a living being, having bad days, having setbacks, having bumps in the road whatever metaphor you want to use is actually very important, because we all experience them and you need to let your loved one being able to experience some of that, which means how to, you know, contain your panic when you see this isn't a good day compared to yesterday. So how to distinguish the difference between bumps in the road and true, authentic relapse is one important thing that we talk about, and to be able to look at the big picture and not to examine your loved one with a microscope. How are you feeling today? How are you feeling tonight? How are you feeling today compared to this morning? Now, right, right, how are they behaving Now? Let's take a look at the trajectory of, you know, weeks and months and even years. So to have a more high altitude, look just like you know you shouldn't watch your stock portfolio too closely, right, right, you need to have the big picture. So that's another principle that I utilize in terms of this, and I think that to also recruit your loved one into the vision of progress and independence, because I think that in everybody, even if you're ill, even if you are dependent, I think there is a natural inherent force of growth, a natural inherent instinct towards individuation, right. And so to really ally with and collaborate with your loved one about what are they wanting as sort of the next level of self-sufficiency and independence, and to negotiate that with them and to have choices available for them, I think is quite important.
Speaker 2:And then, finally, I really do think that the most optimal treatment for people with serious, major mental illness is to have, if possible and I think everybody should be working on their loved ones to make it possible to be in a collaborative relationship with the treaters, to be able to have an open communication.
Speaker 2:I mean, I don't talk behind my patient's back, but I.
Speaker 2:I mean just today I had a big family meeting with a wonderful young man with severe schizophrenia who's done marvelously, but I had the parents in to talk about you know what our progress has been and so forth, and we have an open door and they know that they can let me know if they have concerns.
Speaker 2:If necessary, from time to time we may have to have a meeting together as a family, if not just to check in sometimes, you know, to deal with, with setbacks. So I think that that knowing for parents to know that they have support from the treatment team or the the treater is, is really optimal, as well as other supports, peer support, such as national alliance on mental illness, and uh for their support groups, for families and their family to family course, which, I'm happy to say, most of them now actually have my book on their bibliography list for the families, because that's a context in which the need for that often comes up. So having the wisdom from other families that are struggling with some of the same things and to have that kind of support system is also very important. So other people who can hold your hand, so to speak, when you start to get panicky, that you know things are going off wire.
Speaker 1:Well, you know, right after I send people a copy of your book, of course I send them, you know, a link to rat planning, which I'm sure you're familiar with, but you know, in short, it's, you know, it's a mechanism for saying, hey, what does your life look like when it's going well, what does it look like if things are starting to shift or you're having some issues or symptoms again? And if it gets to a certain point, what do you want us, your family, your loved ones, the ones who are close to you, how should we support you and what do you want us to do about it?
Speaker 2:Well, that's the whole philosophy, if you will, of advanced directives. Of course yes, which, by the way, in some jurisdictions actually has some legal teeth to it. I mean, we have in Maryland, we do have a mental health advance directive where, when you're well, you can specify what you want to have happen if you get ill again. You know, yes, I would like to be forced to take medications and so forth. You can rescind it, but there's a certain waiting period, you know, if you want to rescind it. So you can't just rescind it on a dime. So some states, some jurisdictions have some legal infrastructure for that. But at least on an informal basis, to do that as a family I think can be very helpful. Do you want to say for the listeners here what that link is for that?
Speaker 1:for the listeners here what that link is for that. Oh yeah, it's plenty wr and our wrapp plan. You can, if you google that I'll put a link in the description, of course, so that people can follow it. But, um, wellness recovery action plan is the name of the, and you hit google and it'll give it to you pretty quickly. So, um, but I, you know also um, and then this is not flattery I definitely send many and multiple families copies of your book. Mine recently got damaged, so I'm going to need another signed copy, if you don't mind.
Speaker 2:Um, um, put it in the mail later today.
Speaker 1:Right, but, um, you know the I think that the biggest challenge for a lot of families and this is especially true, so something I'll get you to give a final comment on here families who are experiencing acute psychiatric symptoms with their loved one probably a child for the first time.
Speaker 1:And this is, you know, there's this grand disillusionment that happens. So, you know, even today, with a family that's been going through this with you know, almost a decade with their family member, well, eight years. And you know I said, look, he's coming home from the hospital, he's going to go into treatment and everything else, don't bring him back home. Everything else. Don't bring him back home. They, because it's just like you say, the, the gravity, the gravity of the, the dependence is, is real and it's just a person goes right back into the same old thing, it's. This is the time for this individual to launch. And mom comes back to me she says I know what you're saying is true, but it was just, it was heartbreaking and so hard to hear.
Speaker 1:When you've got families that are experiencing their loved ones, a young adult, they're having psychiatric symptoms. They've gone for their first, you know, psychiatric hospitalization. It's clear that they're suffering from, say, schizophrenia or bipolar disorder with psychotic features or delusional thoughts. What comfort do you try to offer them at that time? It's a terrible situation for anybody to be faced with, but as a doc, you've done this so many times. What, what do you?
Speaker 2:say, yeah, well, uh, I. First of I remind them that this is an illness and, like any illness, we have 21st century state-of-the-art treatments for this and sometimes those treatments can be remarkably effective, just as if you know, if we were talking about, you know, your family member having a cancer. Right Now, obviously nobody can guarantee any, you know, an outcome, but we can be very optimistic that we have so many different tools at our disposal now that you know we didn't have even 20 years ago, you know, let alone 50 years ago, that can really create, you know, very, very good outcomes. Secondly, like any disease, some diseases have, you know, better natural histories than others. Some individuals have better natural histories than others. So we don't have to think of worst case scenarios, you know, just like with the cancer, we don't have to think about, you know, the 20% of people who don't live more than five years with this right, we can look at the 80% of people who you know are doing fine at five years. So let's not hang the crepe for this one particular person until we've had a chance to see what is the specifics of their illness manifestation and what kinds of state-of-the-art medications and other treatments not just medicines, of course, therapies, rehabilitation resources can be brought to bear. So there's always a lot of hope. Also, the earlier that you can get started with these things the better. So for first breaks, you know, I say well, the good news is you guys have gotten here, you know, at first as early as possible. You know I've had some people who didn't show up for treatment until you know, know they've been ill for 15 years and that's.
Speaker 2:You know, the prognosis is much different when you allow these things to smolder for a while and indeed kindle for a while like a fire to, especially for things like bipolar disorder. The more relapses you go through, the more severe those relapses are. The more frequent those relapses are, the longer the relapses will last and the less responsive they are to medications. So, and kind of like a fire, you know it starts to burn at the edge of the curtain and the longer you let it burn, pretty soon you know the whole curtain's on fire, it's engulfing things, it's on fire and you're into a five-alarm fire.
Speaker 2:And by the way, I talk about this with patients very early on, about kindling, about why getting with treatment and sticking with treatment can affect the entire course of this disease for years to come. And we know this is a relapsing illness and if you stop the treatments of various sorts and let this relapse that it's going to grow, it's going to kindle. But the good news is that you can minimize that, you can change the trajectory of what's going to happen for the next three decades by what you do now, early in the course of the illness, and sticking with it. So that also, you know, gives you a sense of control, some control over the future. So I explain that to patients and their families.
Speaker 1:And the. You know I had this another client and this is just this past week and they wanted to maintain and say well, you know, every time this happens he goes to the hospital and things go terrible and so on. Eventually he's going to get the point Like eventually he'll learn that his pattern is one where he, if he doesn't stay on his medications to take care of his health, he ends up here and I said, actually it's quite the opposite. Largely it gets worse, it doesn't get better, because the longer they go in it's like setting the brain on fire and the longer they go untreated the insight doesn't get better, it gets worse and the brain doesn't catch on it. The delusion gets thicker and persistent and and everything else I said you've really got it.
Speaker 1:If you can take care of this as early as you possibly can and with long, with, with sustained treatment, you know, and consistency on not just medications but all the other care components that a person should engage in after a longer period of time, that's when they start to get it. They start to not want jeopardizing their life, community and and friends and family and jobs and other things, and jeopardizing those becomes more important. It becomes that's the important thing to them. They wouldn't jeopardize that, whereas before they had nothing. There's no consequences because they have nothing, because they don't have any stability in their life. So, at any rate, it's it's a.
Speaker 2:It's a tough message to give to parents. It's not a mere tautology to say the longer you can stay well, the longer you can stay well, that's right, absolutely it's.
Speaker 1:You know it boils down to the most simple phrases, doesn't it? Dr Comrade, it's just a pleasure to talk to you and hear you and your years of experience speak. I'm so honored to have you on the show and return to the show. I hope that you can, we just continue this conversation and you can join us again. You're not. You're not on the. Let us know where you are. You know if you're going to be on the radio again, or you're going to be on TV again, or at least a at least a Demi celebrity at this point for sure, you know. So let us know where you are a legend in my own mind, but I thank you so much for being with me today.
Speaker 1:Um, this has been head inside mental health with todd weatherly. Dr mark comrade joins us. Dr mark comrade, thank you.
Speaker 2:Thank you so much. I always enjoy talking with you, todd, and we'll see you soon. Thank you for all that you do for me. You're welcome. I'm out. Thank you, bye. I feel so lonely and lost in here. I need to find my way home. I feel so lonely and lost in here. I need to find my way home.
Speaker 1:I feel so lonely and lost in here. Bye.