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[MUSIC]
To me, that's what makes psychiatry the most interesting field
is how does the mind arise out of the brain?
>> I didn't realize that there are parts
of the country where there are very few
psychiatrists and very few options available to people
who have mental disorders such as I do.
And I think that's when I realized that I
wanted to be an advocate for mental health awareness.
For people who don't have accesses to the resources that
I do living in Baltimore so close to Johns Hopkins.
>> Frankly the experience here I believe was
one of the most motivating forces in my life.
It was difficult to come back as a sixth grader and
to have been hospitalized for six weeks in a mental institution.
There were lots of parts to the treatment,
and I've been forever in debt to Johns Hopkins.
>> One of my favorite things to do with medical students during the
clerkship, is to sit with them in Meyer Three in the back activity room.
Where out the window we can see the old Phipps Building, that's right
in front of the brand new medical buildings that have recently been built.
I use this as an opportunity to tell them the story
of the origins of our department and how it began in 1913.
With the Clifford Beers book that inspired
the philanthropy that lead to the Phipps clinic.
In that moment I can show them that, that our department, and the
hospital made a commitment to the psychiatric
care of patients before other departments did.
And really led the way in setting
a standard for excellence that continues today.
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>> Hopkins psychiatry is unique in it's hospital
being founded on the writings of an individual.
Clifford Beers, who was a Yale graduate and had bipolar illness.
Became manic not long after he graduated, went in and out of many state and private
asylums and was treated very, very badly at
that time there was really no effective treatment.
>> One of the reasons that patients
with psychiatric disorders, were stigmatized and isolated was
the fact that most of them were being cared for in farms outside of the city.
And often in places that were
so overcrowded, that mistreatment and chaos reigned.
>> Clifford Beer's story, made the point, that
these are everyday people, that mental illness is pervasive.
It's part of the fabric of society.
And therefore, healthcare needs to start adapting itself,
to the care of the mentally ill, in
the same way that it's adapting itself to
the care of the heart patient, or the diabetic.
>> Out of that came the construction of
the Phipps building, which was designed to be
bright and airy and give people the atmosphere
that would help them recover from their illnesses.
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>> It was the book, A Mind That Found Itself, that played
an important role in convincing Phipps that this area of
medicine was going to be important and that he should help.
>> Therefore, the creation of this new program,
the Phipps Clinic right next to the Johns
Hopkins hospital, making the point that the two
need to be bridged because they are related.
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>> Although Meyer was a wonderful neuroanatomist,
he was also considered the first social psychiatrist.
And he thought that the mission of a
academic psychiatric clinic was certainly for patient care and
for teaching and for research, but he thought that
the clinical mission should have a shape to it.
And the shape he said, should be that
you devote 50% of your resources, then meaning beds.
To taking care of the community in which you live.
And that's one, way to see it.
And the other, he said, 50% of your resources should
be devoted, to what he called special cases, by, by
which, I believe he meant taking care of the toughest
cases we can find in areas where we have expertise.
>> With the appointment of Adolf Meyer as the
first Director of the Department of Psychiatry, Hopkins became
the center of psychiatric education in the United States
and to some extent in the world at large.
Meyer, who had already established what has become the standard
psychiatric examination, began to see that people
came from all over to study with him, and to see
what Hopkins was doing in terms of changing psychiatric care.
With a focus on the person.
That was one of Myers' real contributions, was to think that the level of the
organism at which psychiatrists worked was the level of the person.
Not the brain, but the person as someone in
a setting, in a family setting, in a cultural setting.
The history that he developed, was
tremendously detailed and structured, as was the
mental status examination, something that had never,
really been done in that way before.
>> The idea that, you're going to
be best able to formulate a patient holistically
by spending time talking to the patient,
gathering history, getting collateral from other family members.
Doing that kind of history taking actually helps you build the narrative.
>> By taking such a thorough approach to
the history I think that we're conveying to patients.
You know, how much we value all the
different aspects you know, of, of their lives.
[MUSIC]
>> Our four perspectives were simply attempts to range across
the explanations of genetics and neuroscience, right out
to the understandings of Freud and Jung and, and of Meyer.
And we have these four perspectives, the disease
perspective that says some disorders in consciousness are simply
due to the breakdown of the brain in the same way any disease in a body would.
The, dimensional perspective saying that its interesting, people
differ in their temperaments and in their cognitive powers and in their maturity.
And the behavior perspective, some people are in
trouble be simply because of what they're doing.
And finally the life story perspective.
The story that is fundamental to the Marian idea is that many people are in
distress because of what they've encountered and how
they've dealt with it, and thought about it.
>> When I sit down with a volunteer or a patient,
I'm not talking to a brain disease, I'm talking to a person.
And I'm able to understand also their life
story, how their illness has affected their relationships.
The context of their, habits and their behaviors.
All the things that, I was taught as
a resident to understand, the patient as a whole.
And, and that's, I think, enormously valuable cuz it breaks
us away from thinking of, of psychiatry as checklists of symptoms.
>> I think Dr. McHugh's vision of psychiatry
at Johns Hopkins as having a public education purpose,
a peer education purpose, and that that scholarly
production of written material wasn't just writing research articles.
But was teaching other people what we do.
How do we care for people with dementia and how do we help their families?
I, I think that's something that doctor
McHugh brought here that has made us unique.
And I think that it, it's not just me that's
benefited from that approach with doctor McHugh, I think many other
individuals here have been able to take that idea and
do the same thing in whatever disorder they're an expert in.
[MUSIC]
>> Jerome Frank taught us a very important fact.
He taught us that what is important when looking at different psychotherapies
is not how they are different, but what they share in common.
And that what they share is the importance of the therapeutic alliance between the
patient and the provider, and that is a key ingredient to successful therapy.
>> And, and he understood that we all had that capacity if we realized that
the basis of this was empathy, that to put ourselves in, in, in the patients shoes.
To understand, to the extent we could, what was going on in the patient's
mind to, to, to grapple with them through these things.
And, and, and that kind of, of, of positive regard as,
as Jerry called it, was key to helping patients get better.
It wasn't just giving a pill.
It was actually having a human encounter.
And, and I think to, in my view, that's, that's Jerry's greatest legacy.
>> [MUSIC]
>> Psychiatry is a special field, a practice of medicine really boils
down to one-on-one interactions with human beings, human beings
under altered circumstances, but human beings nonetheless.
>> One of the things that's really different, I think
about our in-patient units, is how amazing our teams are.
>> Because we have these specialty units,
you'll have a team like my mood team.
The social workers, the nurses, the occupational
therapists, we're all doing mood all the time.
>> The scholarship that's offered here by our faculty, by people like Peter
Rabins, Kay Jamison, Ray De Paulo makes, it makes
it exciting to know that these individuals who have developed in
so many areas are there for us almost on a daily basis.
And that we learn really shoulder-to-shoulder with them.
>> And I do really care about each and every patient that I take care of cuz
I like to think that, what if this were my family member or what if this was me?
How would I like to be treated?
And that just stays with me with each person that I talk to.
>> I do very much love what I do.
I think it's important work.
I think, you know, treating these kids at a
young age really can change the trajectory of their life.
And so I do think it's very fulfilling and very gratifying when,
you know, you have a kid who comes in horribly depressed as,
you know, failing and you get them back on track and then
you find out that they get accepted to college and, you know.
It's just, it's, it's really wonderful.
>> Psychiatry has a commitment to understanding all disorders that are
behaviorally based, be the substance
abuse, gambling, *** disorders, eating disorders.
Those are things that are within our realm of understanding.
And we look at the commonalities across
those disorders in a logical, methodical way.
And we research ways to try to better
the outcomes for people who suffer from those disorders.
>> It is only in the last 15 years that I've had residents, applicants come
to me and say that they're committed to
psychiatry because they wanna work with the addicted.
That they wanna work with the under served.
And those were parts of psychiatry that were the hardest to recruit into before.
And now they are the leading edge of what attracts people to them.
>> While we're expected to learn so much, there's
room for questioning, there's room for just natural curiosities.
about, about the field that come up, and,
and this is a place where you're allowed to
engage in that, and, and allowed to ask
that questions, and, you know, see where it goes.
[MUSIC]
>> One of the great strengths of Hopkins psychiatry is A Place may be the
preeminent place in the country where the
tradition of the clinician scientist lives and thrives.
>> I don't think there's any place where the clinicians and the
scientists are either working very closely together or are the very same people.
>> Some of the disorders that were complete mysteries to us 30
and 35 years ago, we now have a very good, understanding for what
the genetic defect is, what protein defect that gene defect produces.
And how that protein, leads to the
kinds of disturbances that the patients experience.
>> Here at Hopkins it just seems like you
don't have those barriers and borders that you do at
other places where people, not even just within the
department talk to each other, but across departments, across disciplines.
Which I think really makes it very unique
and not like any place else in the country.
>> We can make a an impact here because of the, the collegiality and, and level
of enthusiasm, not only within our own department,
but with collaborations across the School of Medicine.
>> One of the greatest things about Hopkins
is that we're doing so much awesome research.
And that was one of the big reasons I decided to come here,
because I wanted to be somewhere where, where we're still looking into all that.
[MUSIC]
>> I'm very, very proud of the fact that Johns Hopkins has become the
number one psychiatry department in America in
the most recent U.S. News and World Report.
I think that number one ranking speaks to, to something very,
very, fundamental and, and that is that Paul McHugh and Ray
DePaulo have, conceptualized, the field of psychiatry.
And formulated an approach to the
field, that really is, the best conceptualization,
the best approach that there is to be found anywhere in the country.
>> Some of our most exciting and novel
work has come directly out of philanthropic gifts.
We have been able to do things that we
would not have even been able to imagine in part
because we've had the kind of money that comes
from philanthropy that's not targeted at something that's already established.
>> It allows me to ask more creative questions.
We have, you know, greater visions that we would
like to pursue outside of just our basic federal funding.
And it really I think helps to move the science forward.
>> Philanthropy isn't only about money, it's about people.
The individual philanthropist very often
develops personal connections with the recipient.
Many of the faculty at Hopkins have close links,
close personal friendships with those who have supported them.
And that kind of relationship is inspirational.
>> I'm forever grateful and I'd like to now help
other people be able to be helped and other children.
Particularly that have similar problems, I'd like to be helpful to them.
>> One of the biggest challenge in psychiatry in our department is
how we can deliver, our big discovery to all over the world.
>> I think that the department of
psychiatry, especially here at Johns Hopkins offers a
tremendous opportunity for all of us to really
make a mark in the history of medicine.
>> The future is truly exciting for psychiatry.
We have the technology, we have the molecular
developments and genetic developments that are on the horizon.
>> We are about trying to understand the basis for
the things that have gone wrong in, in mental life.
Whether their origins are in the brain per se, or
in the culture, or in some interaction between the two.
Over the next 100 years, that's where psychiatry
like every other discipline of medicine needs to go.
But it's not a simple process, and it's and it's
and it but it's neat and it's why we're here.
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