Working Weekends At A Psych ER Dr. Julie Holland ran the weekend shift at Bellevue's psychiatric emergency room for nine years. In her new memoir Weekends at Bellevue, Holland describes the patients she encountered — from the manic to the criminally insane — and the reasons she eventually left the job.
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Working Weekends At A Psych ER

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Working Weekends At A Psych ER

Working Weekends At A Psych ER

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For the rest of the hour, a look inside the emergency room at the world's most famous, big city psychiatric hospital. For nine years, psychiatrist Julie Holland was in charge of the psychiatric emergency room at Bellevue pulling the weekend shift. From Saturday night through Monday morning, she'd be in charge of evaluating the full spectrum of patients, from the manic to the depressed, to the suicidal, the psychotic and the fakers. And she decided who got to stay and who had to stay and who was sent away, maybe from being - because they were a faker. She has written about her experiences in a new book called "Weekends at Bellevue: Nine Years on the Night Shift at the Psych ER." And she joins us here more to talk about it. Welcome to SCIENCE FRIDAY.

Dr. JULIE HOLLAND (Author, "Weekends at Bellevue: Nine Years on the Night Shift at the Psych ER"): Thanks for having me.

FLATOW: And you know, there is so much interesting stuff in this book, but you start out with a bang about the story about this guy in Times Square who was barking like a dog.

Dr. HOLLAND: Yeah. And this was back in the '90s. I know there was another patient sometime more recently, but this was a guy back in the '90s. It turns out this happens every once in a while that somebody gets naked in Times Square. He�

FLATOW: But they're not barking like a dog. A lot of people naked�

(Soundbite of laughter)

FLATOW: �in Times Square on New Year's Eve�

Dr. HOLLAND: Right. Exactly. That's how you could tell apart the ones who need to go to Bellevue from not, right?

(Soundbite of laughter)

FLATOW: Right.

Dr. HOLLAND: Yeah, actually, he told me he was barking to prove he wasn't a dog. So you can understand the kind of conversation we were having. It's a lot of - he's pretty illogical. He was in the middle of a manic episode - but really interesting patients. So I - you know, the reason why I started the book with that chapter is because at the end of our interview, he gets very upset that I'm going to admit him, and he's like: So you just decide who's sane and who's insane? You know, and that's your job, and you're the judge. And I was like: That's pretty much my job, yeah, you're in, you're out. That's what I did.

FLATOW: And you must take that very seriously.

Dr. HOLLAND: You know, I take - taking away somebody's civil liberties I take very seriously, yeah. So I really, I would tend to err on the side, I think, of discharging because I don't want to do that to someone. But it was really - the bottom line is about safety, you know, and if it wasn't safe to let somebody go, then I didn't.

FLATOW: How long does it take you to make a diagnosis like that? Did you have to make an instant one? You say, he's in�

Dr. HOLLAND: I don't have to make an instant one, but you know, there are plenty of times where instinctually, I kind of know immediately from hearing the story what I'm going to do. But I would hear the story from, you know, from the police or from the ambulance driver, and then I would talk to the patient, and if at all possible, I would talk to anyone who knew the patient. There have been psychiatrist's family members, employers, all of that information would help me sort of make a decision about what to do, but sometimes I didn't have much to go on. Sometimes, the patients couldn't talk.

FLATOW: They couldn't.

Dr. HOLLAND: And with this guy, he talked up a blue streak, but he wouldn't give me any phone number for his parents. So I didn't have anything else to go on but him.

FLATOW: Was that a pretty typical night at Bellevue?

Dr. HOLLAND: There was never a typical night at Bellevue, and that's what I loved about that job. It was never the same thing twice. I never knew what I was going to get myself into. All I knew was that, you know, 15, 16 hours later, I was going to walk out the door and hopefully be in one piece. Nothing typical, though. I loved it. I mean, it was very unpredictable, and it was often very entertaining. It was a lot of fun to work there.

FLATOW: Yeah, well, as someone who is a born and bred New Yorker myself, I mean, Bellevue was the place that we knew where people went. They went, right?

Dr. HOLLAND: You go - when you lose your mind, you go to Bellevue. So what would happen because of that is - you know, it's sort of in the national psyche. It's like our national asylum, and I would get people coming - you know, they would take a bus from Missouri because they started to hear voices, and they'd say, you know, I thought I should be at Bellevue. I was going crazy. So we would really get them from all over. And also the police would bring us cases from all over because they knew we could handle it.

You know, the hospitals are supposed to be divided up by catchment area, but we would definitely get them from all five boroughs.

FLATOW: Is that right? Yeah, and how do you decide if someone's faking it? And why would they be faking it?

Dr. HOLLAND: Well, it's a big part of the book actually, was my having to deal with people who are faking it. In psychiatry, they're called malingerers, and there's a lot of reasons why you could fake being mentally ill, but the main reason was just to get off the street. You know, a lot of these guys are addicts or alcoholics, and they're homeless, and it's cold, and it's miserable on the streets. And it's always nicer if you can be in the hospital with a warm bed and three meals a day. So a lot of times they would come in and say, you know, I'm hearing voices to kill myself and others, or something - a lot of times it was like a line that sounded rehearsed, where you know they just heard it in the jails or the shelters, this is what you have to say.

FLATOW: Well, I'm hearing voices that say I have to take a break.

Dr. HOLLAND: Okay.

(Soundbite of laughter)

FLATOW: Believe me, I hear these voices all the time.

Dr. HOLLAND: Let me give you my card.

(Soundbite of laughter)

FLATOW: Talking with Julie Holland, author of "Weekends Bellevue: Nine Years on the Night Shift at the Psych ER" Our number, 1-800-989-8255, 1-800-989-8255. We're - fact is stranger than fiction that you'll see on these ER shows. So stay with us. We'll be right back after this break.

(Soundbite of music)

FLATOW: I'm Ira Flatow, and this is SCIENCE FRIDAY from NPR News.

(Soundbite of music)

FLATOW: You're listening to SCIENCE FRIDAY from NPR News. I'm Ira Flatow. We're talking with Julie Holland, M.D. She doesn't like to be called Dr. Holland, right?

Dr. HOLLAND: Not so often.

FLATOW: You say only your mother.

Dr. HOLLAND: Right. Only my mother calls me Dr. Holland, right.

FLATOW: She's author of "Weekends at Bellevue: Nine Years on the Night Shift at the Psych ER." Our number 1-800-989-8255, and just a reminder again that - and I say this every time we have a specialist on - we cannot diagnose and treat your illness here today. So don't ask Dr. Holland to do that because it's unethical and it's unethical for me - well, I'm just not going to ask her to do that. So try to keep it to general questions.

Our number, 1-800-989-8255. You can tweet us @scifri, @-S-C-I-F-R-I, and in Second Life, you can find our SCIENCE FRIDAY island over there.

Let's talk about the fakers because you say that that is a central part of your book, and it is, people faking to get in.

Dr. HOLLAND: Yeah, you know...

FLATOW: And you go punched out once.

Dr. HOLLAND: I did. I got punched, and you know, it was somewhat deserved, I believe. You know, one of the sort of trajectories in the book is that when I start out, I'm very empathic, I'm very sensitive, and if I hear sad stories, I get sort of welled up. And so pretty early on at Bellevue, I started to develop a very thick skin and this sort of tough demeanor where, you know, nothing would get to me, and nothing would phase me, and I've seen it all. And I got a little sort of hardened and then a little confrontational. And it's not always completely therapeutic with these guys.

FLATOW: Tough love.

Dr. HOLLAND: Yeah, well, you know, the fakers, you really, you've got to weed them out. They can't be admitted. They really wreak havoc when they do get onto the ward, and it's my job to make sure they don't get on. I mean, we call them sharks. They're very predatory.

So we had this one guy who - you know, I was very sure that I was lying, and I said to him, you know, some of the doctors here think that you may be feigning your symptoms. And he said feigning? And I said faking. And then he punched me in the face. And I'd never been punched in my life, and you know, I was really interested by the physics of it. I mean, there was - really, there was heat, and there was vibration, and it pushed me backwards. It was like a white light got generated. It was very interesting to me. And I ended up pressing charges, actually, and he went to Rikers for four months. And when he got out, I got a phone call telling me that he was coming out, and I was a little concerned because - what he told the police in his statement was I wanted to hit the doctor. I hope I got her good. And my fear was that he didn't get me good enough, and he was going to come back, and he knew, you know, he knew where I was. So, you know...

FLATOW: The lesson learned here?

Dr. HOLLAND: The lesson - what ended up happening was I learned that, you know, I need to be more therapeutic and less confrontational and that, you know, even though they're faking, there's something very wrong in their lives if they're at the point where they're pretending to be mentally ill to get off the street. And so I could at least sort of address, look, you know, what's going on in your life that it's so chaotic and, you know, is it because of drugs or alcohol, or what has gotten you to this place where your best option is, you know, to try to sell it to a psychiatrist to get into the hospital.

FLATOW: How many patients a night did you see, or potential people brought in?

Dr. HOLLAND: The psych ER at Bellevue sees about 9,000 a year. I don't know, maybe 20 or 30 a night. I mean, it would really depend on the night. I mean, it could have been more than that.

FLATOW: Let me ask you this question that I want to ask doctors all the time.

Dr. HOLLAND: Right.

FLATOW: Do you see more on a full moon?

(Soundbite of laughter)

Dr. HOLLAND: You know, they say that you see more on a full moon. I didn't necessarily experience that, but seasonally, I believe that we would see more people in manic episodes in the spring and summer and more people in depressed phases in the fall and winter. And I know in my private practice I absolutely see that. I mean, you know, I have a busy season, which is like November through February, when the clocks change, and it's darker, and everyone's crashing and calling me. And then in the spring and summer, nobody wants to see me. I go on vacation. Everybody wants to put me off until September. So I really believe that people have a seasonality to their moods. Full moon I'm not as sure.

FLATOW: Loss of the sun, a seasonal disorder, do you think?

Dr. HOLLAND: Yeah, no, I think that we're - you know, we're light-sensitive mammals. So - and I think the clocks changing really screws us up. It's good for business, but I think it's bad for everybody else.

FLATOW: But yet you spent nine years of this - should I call it abuse? Did you feel abused?

Dr. HOLLAND: No, no.

FLATOW: You were tough.

Dr. HOLLAND: I loved it. I mean, I thought it was a great job. And you know, the other thing was I got to sleep a little bit. I mean, I was doing an overnight shift, and I was in charge. There were doctors underneath me. So I could kind of go to sleep for three to five hours. So it was a good gig for me, you know. But I think the reason I lasted nine years - I lasted longer than any other doctor there, and I really think it was because I only worked weekends, and I had all week off to recover.

I mean, the joke that I make in the book is, you know, it's like childbirth. You forget the pain. You know, Monday morning, I was fried and exhausted, but by Saturday afternoon, I was, you know, I was ready to get back in there and do it again.

FLATOW: William(ph) in Birmingham, Alabama. Hi, William.

WILLIAM (Caller): Hi, how are you doing?

FLATOW: Hi, go ahead.

WILLIAM: My question is: I know everybody has tough moments in their jobs, and sometimes they come across things that are difficult. My question is: Has she ever had a patient or patients that have made her think twice about wanting to go on? And if she did, what was it that she did to overcome that?

FLATOW: Yeah, what made you quit?

Dr. HOLLAND: Well, I have to say what made me quit is kind of dull, you know. It's just, you know, my schedule changed. I had - over the course of those nine years, I got married, I had two children, and by the time one of them was entering into kindergarten, we decided to be in the city during the week and go away on the weekends. What I had been doing for years was that I had been working on the weekends, but we had a house in the country where we'd go during the week. So we decided to be at the house on the weekends, which meant I couldn't work at Bellevue on the weekends.

So I just opened - you know, I had a private practice that had been opening. So it was a very non-dramatic. I mean, that's one of the problems when you write a memoir is that it's true, and I didn't have, like, a big car-chase scene at the end or anything. You know, I just had - so I left my job, you know...

FLATOW: Didn't end with a bang but a whimper.

Dr. HOLLAND: You know, I worried - my opinion, if you're going to write a book is you have to start with a good ending, and then if you've got a good ending, okay, then you can write a book. So I was worried that the ending is a little anti-climactic, but people tell me that it was satisfying because I tied up all the loose ends.

FLATOW: But there were no nights, there were no patients where you said if I've got to put up with this?

Dr. HOLLAND: There was, actually. We saw a lot of prisoners, and that was one of the things that started to get less and less pleasant. You know, when I first started out, we were only seeing prisoners from two boroughs, Manhattan and Bronx. But halfway through my tenure, we were seeing them from all five boroughs, which more than doubled how many prisoners were coming in.

What we did at Bellevue, we did something called a pre-arraignment evaluation. If somebody was arrested but they looked like a psych patient, or they were taking antidepressants or had any sort of psychiatric history, or they were altered in any way, they would bring them by Bellevue to be - to make sure they were okay to be alone in the cell.

And those numbers steadily increased over my time, and I was dealing with more kind of cops-and-robbers stuff. I mean, the ER looked like a precinct half the time when I walked in, and at some point, there was talk that we were going to start to get the female prisoners, as well, and that's when I was sort of like, all right, well, if that happens, I'm out of here because I can't - it's too many. There was just - you know, it was getting too sort of forensics oriented.

FLATOW: How close to reality is "E.R." or any of those TV shows?

Dr. HOLLAND: Well, I used to watch "E.R." religiously, and I thought it was very realistic. "Grey's Anatomy" also, I feel like, is fairly realistic in terms of its medicine and in terms of sort of the social interactions between the doctors. What I feel like is a little less realistic is "House," actually.

FLATOW: Oh, well. That's gone off the deep end a little bit.

Dr. HOLLAND: That's not one that I watch as much.

(Soundbite of laughter)

Dr. HOLLAND: But I'm like a junkie for medical shows. I love medical dramas.


Dr. HOLLAND: Yeah.

FLATOW: Well, that's why they're so popular.

Dr. HOLLAND: Right.

FLATOW: 1-800-989-8255. Let's see if we can get a few more phone calls in here. Let's go to Dave(ph) in Phoenix. Hi, Dave.

DAVE (Caller): Hi, how you doing?

FLATOW: Hi there.

DAVE: I was just wondering. This - actually tomorrow morning, 6 a.m., we're all getting up for a 9:30 graduation of my daughter down at U of A down in Tucson.

FLATOW: Congratulations.

DAVE: She'll have her degree in psychology, her bachelor's degree, and it sounds like you've got a pretty interesting work career so far, Julie. And I was just wondering if you had any suggestions for her. Does she need to go on and get her master's, Ph.D.? And what areas would you suggest she go into? You know, I'm thinking financially because I'm the dad, but you've got to think about interesting, too, for your career.

Dr. HOLLAND: Right. Well, one thing I often tell people that are interested in psychology is it's not that hard to get, you know, to get your M.D. and be a psychiatrist. You know, it takes about seven years to get your Ph.D., your clinical Ph.D. in psychology. It takes four years to get your M.D. So I always encourage people to go ahead and be a psychiatrist. I think in terms of how long it takes you to get out and what kind of money you make when you get out and the quality of life - I mean, I'm - I think things are pretty good for me. The other thing I think is to be a physician's assistant, which is a pretty quick way to get out into the field of medicine.

FLATOW: Talking with Julie Holland, author of "Weekends At Bellevue: Nine Years on the Night Shift at the Psych ER." We've been, you know, having a lot of fun with the terminologies, about how you talked about crazy people versus sane people that you diagnose. But there seem to be a lot of people out on the streets these days who need psychiatric help.

Dr. HOLLAND: Yeah, but you know what makes it harder to figure out? Is everyone's talking on their cell phones, but they're not holding a phone up to their ear. So everybody is starting to look a little crazy now.

(Soundbite of laughter)

Dr. HOLLAND: You know, in the old days, you could very clearly tell who was talking to themselves and gesticulating wildly. Now I get fooled all the time by these Bluetooth devices. I'm always, like, looking in someone's ear to figure out if they're a patient or not.

There are more homeless mentally ill every year, and the recession has really filled the shelters, and the shelters are completely overstuffed. So I believe that there are more people on the street. I was in Grand Central last month, about midnight, and there were a lot of homeless mentally ill people sort of shuffling around.

FLATOW: Why are they out there?

Dr. HOLLAND: Well, they're in Grand Central because it's warm.

FLATOW: But why are they on the streets, I guess, anywhere?

Dr. HOLLAND: Well, I mean, I try to address it in the book, but it's very complicated. I mean, what happened basically, there were a lot of people in state institutions. They were institutionalized, and then when the medications became more effective a lot of people thought that they should be deinstitutionalized, taken out of the state hospitals and put into sort of adult homes or group homes or community facilities. So they did. They shuttered a lot of the state hospitals. A lot of these patients left. But the group homes and adult homes, they never really materialized because everybody had this kind of not-in-my-backyard mentality. Nobody wanted them there.

So it was back in the, I think in the '60s that we really started to have a homeless mentally ill problem. And it's a huge problem. And also the prisons are full of patients that really should be with doctors, not behind bars.

FLATOW: They're being warehoused.

Dr. HOLLAND: They are being warehoused. You know, a lot of other countries do it differently. Definitely in Asia they do it differently, where they really -instead of putting all the patients together in clumps, they sort of keep them dispersed in the communities and with their families and having menial jobs, so that their, sort of, aberrant behavior gets diluted among everybody.

But what we do here is we put them all together and we clump them together, where they feed off the insanity of each other and they don't necessarily modify or learn, you know, healthier ways to behave.

FLATOW: So what's the solution?

Dr. HOLLAND: I don't know that I have a grand solution. I...

FLATOW: But you're closer than anybody else.

Dr. HOLLAND: Well, I do feel like at least in the prisons there needs to be much stronger psychiatric support. I mean, I can't tell you how - you know, so many patients we saw who'd like been arrested for jumping a turnstile or something. But, you know, they were sick, they were schizophrenic.

FLATOW: I mean, what would happen to them?

Dr. HOLLAND: They end up in Rikers.

FLATOW: And then they go right back to prison.

Dr. HOLLAND: So you know, what I would see a lot is patients sort of bouncing from shelter to prison to hospital to prison. You know, maybe they would get in a state hospital for a while, but then they'd get discharged. So it's a pretty bad system.

FLATOW: Mm-hmm. 1-800-989-8255 is our number. Let's see if we can go to the phones again and go to Joe in Cedar Hill, Missouri.

Hi, Joe.

JOE (Caller): Hi, good afternoon. I love your show.

FLATOW: Thank you.

JOE: I have a question. I worked in the hospital environment for many years. I supported technical infrastructure along with psychiatrists in other medical professions. And I noticed that - my observation was that it seems like insanity might be contagious.

FLATOW: You're shaking your head, yes.

Dr. HOLLAND: Well, I mean, this is sort of what I'm talking about, with the idea that when you put everybody together, you end up with everyone being sort of sicker. And somebody just asked me this recently if I thought that depression was contagious. And there, you know, there are recent studies that show that if you are lonely, then your friends are lonely. And if you're depressed, then your friends are depressed. So I do think there is some element of contagion. I think, you know, we're empathic creatures. And primates are very social and empathic. You know, it's like Bill Clinton, you know, I feel your pain. So...

JOE: I was referring to the psychiatrist actually catching it.

FLATOW: The psychiatrist catching it?

Dr. HOLLAND: Well...

JOE: Yeah. I mean, most of them seem to be sort of (unintelligible)

Dr. HOLLAND: Well, you know...

JOE: At least from a observation of...

Dr. HOLLAND: There are many physicians who would probably agree with you that, you know, compared to other doctors, the psychiatrist may have more sort of psychopathology themselves.

FLATOW: Alright. Joe, thanks for calling. 1-800-989-8255 is our number. We're talking with Julie Holland, author of "Weekends at Bellevue" on SCIENCE FRIDAY from NPR News. I'm Ira Flatow.

Do they seem a little wackier...

Dr. HOLLAND: I hate - you know, I don't want to betray my people. But you know, one of the things that they sort of say about psychologists or therapists or psychiatrists is that they tend to have a patient in their family if not that they're one themselves. So...

FLATOW: And you talk about being in therapy in the book.

Dr. HOLLAND: I do. I mean, for about a third of my time at Bellevue I was in therapy. It's - you know, psychiatrists at some point really should undergo psychotherapy. And when I was in my training, I kept coming up and I was like, you know, I don't have time. It cost too much money. But once I had this job, I really had enough free time...


Dr. HOLLAND: ...and enough money that I couldn't justify not doing it anymore. So I finally did go into therapy and it was very, very helpful for me.

FLATOW: Did your two pregnancies change the way...

Dr. HOLLAND: Yeah. I mean, I think between my three years of therapy and, you know, delivering two babies and nursing two babies and then 9/11, I mean, all of those things really cracked my shell. I mean, I couldn't be this butch tough girl anymore. It was impossible.

So I ended up going sort of back to the empathic, you know, let's say I was the den mother instead of the warden.

FLATOW: Was this all talked out through your therapy (unintelligible)

Dr. HOLLAND: Yeah. I'm - you know, when I got punched in the face, that was a really good place to start...

(Soundbite of laughter)

Dr. HOLLAND: ...with the therapy. What was great was that my therapist, I went to her because my colleague had gone to her - my colleague at the psych E.R. And so she had kind of heard it all before and she knew the drill and she knew the kind of defenses I would come up - you know, she - I think - I was wondering if she was like, oh God, here we go with the taunting of the prisoners again. You know (unintelligible) like have your heard this? Are you bored with this? But it was very good for me that my friend Lucy had been to the same therapist.

FLATOW: Do you ever figure out why you were attracted to this line of work?

Dr. HOLLAND: Well, I have always been interested in insanity. I mean, it's always intrigued me. And from - I was a little kid and my parents would take me into Boston, and I would see these people walking down the street, talking to themselves, picking through the garbage. And I could - I always noticed them. I noticed that they had this way of walking like pelvis first. And I just became very interested, like, what's wrong with them? I was always interested in the brain.

And growing up in the '70s, I was fascinated by drugs. Things like PCP and LSD and how like a tiny little bit of something could completely turn your world inside out and upside down. I was very interested in how drugs altered perception and how insanity altered perception.

So I, you know, I was one of those kids who like had Psychology Today subscriptions in high school and things like that. I was always, if I did a report, it was always like on the brain or on schizophrenia or something. I was really, from a young age, very interested in that. And I was also a kid who liked to live on the edge and swim in the deep end and take chances and, you know, somewhat ballsy. So the psyche ER was really a good fit for me in terms of my demeanor.

FLATOW: And so when this - this was a challenge to you to then go work at Bellevue and something you wanted to take on.

Dr. HOLLAND: Yeah. I mean what was great, you know, soon as I knew - I'd heard about Bellevue, I was just - you know, I was watching Barney Miller and I was like 12 years old or something, you know? And there was some crazy prisoner and they're like, take him to Bellevue. And I was just like, where is this magical place where they send the crazy people, you know? How can I get there? As soon as I could get a job there, I did. I mean, right out of residency, that's where I went.

And you know, what I say in the book is that, you know, I thought I knew what crazy was and then I came to Bellevue, like I had always sought out - I had done research in schizophrenia and I was, like, pulling schizophrenic patients to do research and I was interviewing people who are hallucinating for the this other study. I was always looking for, you know, sort of the most out there person. And when I got to Bellevue I found them. And so that's where I stayed. I mean, it was - there's a level of sort of pathology there that I'd never seen anywhere else.

FLATOW: We're going to take a break and come back and talk lots more with Julie Holland, author of "Weekends at Bellevue," nine years on the night shift at the psych ER. Our number: 1-800-989-8255. Stay with us. We'll be right back after this break.

(Soundbite of music)

FLATOW: You're listening to SCIENCE FRIDAY from NPR News. I'm Ira Flatow. We're talking with Julie Holland, author of "Weekends at Bellevue," nine years on a night shift at psych ER. Our number is 1-800-989-8255. Let's go to the phones. Let's go to Katie in Cincinnati. Hi, Katie.

KATIE (Caller): Hi there. I love your program.

FLATOW: Thank you.

KATIE: Thanks for taking my call. I'm really interested in this subject, and I've actually been a caregiver for people with mental disabilities. For the last year or so I was at a camp this summer for people with schizophrenia, bipolar, autisms, different illnesses or diseases. And I think that many of our historically renowned geniuses are later said to have had a mental illness, and nowadays it seems like people are so afraid of being different that they turn towards pharmaceutical relief for what was perhaps considered, you know, a normal symptomatic reaction to life and the mystery of it.

And I think that people with mental disabilities are one of the largest minority groups, but they're also the most stigmatized and isolated. So I'm wondering how much sensitivity, Dr. Holland, did you put in to the terminology, using words like sick or people having lost their minds, when approaching a person with an alternative perception, and what chance do you think people who have been labeled crazy have in being integrated in viable parts of our society?

Dr. HOLLAND: Well, certainly when I was talking with a patient, I would never use the kind of words that I would use, you know, to discuss them, I guess, or to write about them. You know, I write about this a lot in the book. You know, you raise a couple of issues. I mean, one is the sort of the over-medicalization right now in America, which is just getting worse and worse. There's no question.

There's a book coming out next year called "Manufacturing Depression" that does a really good job sort of breaking down what's been going on with that. And also the interaction of genius and bipolar in particular, which is very strong. So you know, basically every patient that I would speak to who is psychotic would have a broader worldview than I did.

And I would really try to learn from them and appreciate what they were talking about. I mean, there was this one patient I love. I always remember, he said, you know, we're all part of this big experiment and, you know, we're all under this microscope. And you know what the eyepiece of the microscope is. And he looked up and he said, it's what you call the sun.

You know, I loved that. I love thinking about that, thinking that that's his perception, and that's why I kept working there. I was always hearing interesting things like that. A lot of people when they're in a manic episode and they get very religious, they almost act like somebody who's having a psychedelic experience, like tripping on acid, where they'll say things like, you know, it all make sense now and, you know, everything is connected and we're all one and that we're all just one organism. And I always like thinking that way and thinking about that. And there's something very artistic about not only the content of what they would say, but how they would say it. I mean, a lot of times with someone's psychotic, their speech is like poetry.

FLATOW: Mm-hmm. Katie, does it bother you to hear when Dr. Holland talks about it? Do you think she's being too flip and when she said losing their minds and things like that?

KATIE: I think it's problematic just in a sense that there are, like you said, a lot - there's a lot to learn and there's a lot that people with mental disabilities have to offer. And a lot of times they do become more of a novel sort of genius that they do have a mental disability and yet also are really good at art or have very good poetry. And then it's sort of like, well, if you have a mental disability but you are good at art, then you're genius and so it's okay you have a mental disability. So there's a problem there. But then there's an also a problem in saying that they have almost no worth by saying that they are crazy or that they have lost their minds.

I think there's a lack of spirituality in general in America and the rest of the world perhaps where we can't accept a different type of perception without feeling uncomfortable in some ways. I do think it's problematic.

FLATOW: All right.

Dr. HOLLAND: Yeah. I mean, there is a whole chapter in the book that I call "Waiting for Laces," because, you know, when the patients came in to Bellevue, they had to, sort of give up everything, like shoe laces or belts or things like that. And when they were sort of deemed sane and allowed to be discharged, there was - they had to sit and wait for their things back.

And so I have chapter called "Waiting for Laces" where I talk about how we in America, because we're so afraid of any sort of altered state ourselves, we really stigmatize and sort of shun and turn our backs on the mentally ill, and they're treated very badly in America. So I do feel like I'm very sensitive to that and I wrote about that.

FLATOW: All right, Katie, thank you for�

KATIE: Thank you.

FLATOW: �the phone call. 1-800-989-8255. What's next for you? You're in private practice now, right?

Dr. HOLLAND: I am. I mean, I was in private practice all through my Bellevue years, but my practice slowly grew, so - I'll tell you, since 9/11, it's very easy to have a practice in psychopharmacology in New York City because everyone is just getting more and more comfortable with the idea of medicating themselves. And...

FLATOW: Yeah, we should throw away - psychiatrists are just throwing drugs at...

Dr. HOLLAND: Yeah. Well, that's - I mean, that is really what I do for a living, is I do psychopharmacology. My patients are in therapy. They have therapists, but they come to me to figure out whether they need medicine and what sort of medicines will help them.

But I also spend a lot of time encouraging people to exercise or meditate or, you know, read �The Power of Now,� or whatever I can do. Like once they're sort of coming and they're getting their medicines, I really try to talk them into other ways of feeling better. And I'm very into sunlight and being outside and being in nature, which I think is very therapeutic.

I guess what I'm working on now is I'm editing a book actually on cannabis, and not just the recreational use of cannabis but talking about medical marijuana.

FLATOW: "The Natural Mind� all over again?

Dr. HOLLAND: Yeah. It's funny because...

FLATOW: Andrew Weil's book, remember?


FLATOW: You're not old enough to remember that.

Dr. HOLLAND: I absolutely remember Andrew Weil's book.

(Soundbite of laughter)

Dr. HOLLAND: And he actually blurbed the Bellevue book.

FLATOW: Right.

Dr. HOLLAND: And I interviewed him for the cannabis book and interviewed him for my book that I did on MDMA, the drug Ecstasy. I'm a huge fan of his. And it's funny because I - after I finished the cannabis book, I would like to write something called natural mood, which is about how if we can integrate ourselves more with nature, that we would really be healthier.

I think one of the problems right, now especially in New York City, you know, we're all just sort of jacked into screens and we don't get out very much in terms of sun or air.

FLATOW: Right. Right.

Dr. HOLLAND: And we certainly don't go take a walk in the woods and just remember that we're on a living, breathing planet. So I think it's really important for us to sort of get more integrated with nature and be more in touch with what's natural for us as primates.

FLATOW: Right. I personally - I've said this. I've been walking the streets of New York for almost 60 years - the streets are meaner now. Do you notice that? I mean, people are less civil to each other.

Dr. HOLLAND: Yeah. And I think, you know, everyone's on their cell phones or their iPods. I mean, nobody is even looking at you or smiling or saying hello. I mean, you know, I live in a small town now. I moved out of the city a year ago. You know, people say hello and stop to talk. And it's like oh my God!

FLATOW: They make eye contact.

(Soundbite of laughter)

Dr. HOLLAND: What's going on here? Yeah. I mean there's a lot of kind of, you know, banging into each other with backpacks on subways and things like that. And I do think that the recession right now is really wreaking havoc on people's moods.

FLATOW: And ...

Dr. HOLLAND: There's a lot of society. But I also feel like since 9/11...

FLATOW: I was going to say.

Dr. HOLLAND: ...the anxiety level absolutely went...

FLATOW: Yeah. But there was a cohesiveness right after 9/11.

Dr. HOLLAND: There was. It was lovely. That's gone.

(Soundbite of laughter)

Dr. HOLLAND: Those days are gone.

FLATOW: And so are we seeing more people unable to cope with the mean streets showing up at Bellevue and other places?

Dr. HOLLAND: Well, I have to say, I haven't been at Bellevue now since 2005, so I don't know what's going on in terms of, you know, if they're seeing more, if they're numbers are higher or things like that.

But I have - I am at no lost for private practice patients, that's for sure. I mean people are really miserable and depressed and anxious in huge numbers for many reasons.

FLATOW: 1-800-989-8255. Let's go to Derek in Spring Lake, Michigan. Hi, Derek. Derek, are you there? Three, two, one.

Dr. HOLLAND: Not so much.

FLATOW: Strike three. Not so much. Let's see if we can go to someone else. 1-800-989-8255. Let's go to - I have to read over my glasses. When you get this old, you have to read...

DR. HOLLAND: You need trifocals.

FLATOW: I do, and I tried them. I couldn't get those three little...


FLATOW: Patrick in San Francisco. Hi. Welcome to SCIENCE FRIDAY.

PATRICK (Caller): Yeah. I would like to ask your host a question.

FLATOW: Sure. Go ahead.

PATRICK: Oh, yeah. I wanted to know what she thought of why the reason that schizophrenic people hear - when they hear voices, why is it always an evil bent to what they're told to do?

Dr. HOLLAND: Right. Well, I would tell you that it's not always evil. I mean, you know, you're watching movies or TVs shows, but if you actually talk - if you actually interview 100 hallucinating patients - as I was lucky enough to do in medical school - some of them are just hearing a commentary, oh, now, she's picking up her coffee cup; oh, now she's licking her lips, like a very boring, banal narrative commentary on everything that's going on.

Other people are just hearing a single word repeated over and over. Or they hear indistinct mumbling that they absolutely can't make it out at all. Or they hear the voice of the devil or - you know, I had a real interesting patient when I was a medical student who kept hearing over and over again prove your worth, prove your worth. And he interpreted this to mean Buddha wanted to know if he could be a good disciple. And he felt that the best way to prove his worth was to bite off his fingertips to prove just how dedicated he was to being a disciple.

So here, you know, prove your worth could mean anything. But he is a sort of delusional framework of how he interpreted it.

That said, some people do hear, just, you know, the world kill, kill over and over again or they hear the voice of the devil. And some patients learn not to listen to the voices or not to do what they say. But one of the things that I will always ask somebody who is hallucinating or has hallucinated is do you do what the voices say? Do you do what they tell you to do? It's very important for me top figure that out. And if somebody tells me they're hearing the voice of their dead mother saying join me, I get worried because most people do what their mom says, you know?


Dr. HOLLAND: So it's not just what you're hearing, it's the delusional framework that you put it in. It's the meaning that you ascribe to what you're hearing that can create dangerousness.

FLATOW: Working in the circles of New York psychiatry, do you ever run into other luminaries like Oliver Sacks...

Dr. HOLLAND: You know, I completely monopolized Oliver Sacks at a party not too long ago.

(Soundbite of laughter)

Dr. HOLLAND: And somebody - I mean, we were just talking about drugs and psychosis, it was all so interesting. He's fascinating and he's interested in a lot of the same things I am. And there's some psychedelic research going on that he's very interested in. And somebody finally kind of pulled my elbow. It was like, could someone else talk to Dr. Sacks now? So yes, I have had the pleasure.

FLATOW: Yeah, he's specializing now. He talks about so many interesting things. He's now into music.

Dr. HOLLAND: Yeah.

FLATOW: Do you get patients - do you see patients with music or musical ability like he talks about or? Or I hear music or I'm better at music or...

Dr. HOLLAND: Right. You know, I'm a musician, so I'm very, very interested in anything to do with music, so I love that he did this book.

It's, you know, a lot of times, if you get somebody that's having sort of formed hallucinations of music, it's more of a neurologic diagnosis than a psychiatric diagnosis. So he is probably getting a lot more of that than I am.

FLATOW: Mm-hmm. What would you - if you could do anything, and I mean you could move anywhere and do anything, work anyplace, besides what you're doing in your private practice, what would you like to do?

Dr. HOLLAND: I would like to do MDMA research.

FLATOW: Explain what that is.

Dr. HOLLAND: Well, MDMA is a chemical term for a drug called Ecstasy. And there are some really interesting MDMA research going on now where they're giving ecstasy to people who have post-traumatic stress disorder, and they're having very intense therapeutic experiences. Basically, you can use MDMA as a catalyst to make psychotherapy go deeper and go faster and be more effective and more efficient.

And that's something that I'm very - I'm the medical - what's the word? I'm a medical director. There's some research going on that I am sort of making sure is medically safe.

FLATOW: Chief cook and bottle washer.

Dr. HOLLAND: No. I mean, there's somebody who's doing the research...

FLATOW: Right.

Dr. HOLLAND: ...and then there's me sort of looking over their shoulder to make sure everything is kosher.

FLATOW: Right. You're like the investigational committee person.

Dr. HOLLAND: So I'm very interested in MDMA research, and there are some interesting psilocybin research going on, which is giving magic mushrooms to people who are dying of cancer to help them sort of make peace with the fact that they're dying. So psychedelic research, in general, is very interesting to me. And my - the area that I'm particularly interested in is to see whether MDMA may give respite to people with schizophrenia, give them some relief from their symptoms for a short period of time.

There's a lot of anecdotal evidence that it might have some effect. And it would be interesting to study this, but it has to wait, for many reasons.

FLATOW: I'm Ira Flatow. This is SCIENCE FRIDAY from NPR News, talking with Julie Holland, author of "Weekends at Bellevue." Do you think we haven't done enough, paid enough attention to these out-of-the box kinds of therapies?

Dr. HOLLAND: Yeah. I mean, I just - you know, I think FDA has been really great recently at allowing these studies to go forward. I mean, you know, there's such an interaction of science and politics. And when George Bush was in charge, things were not moving very well. But the FDA was still pretty open to - you know, my big complaint now is with medical marijuana. I just think there are way too many roadblocks.

FLATOW: Mm-hmm.

Dr. HOLLAND: You know, the government is keeping cannabis at schedule one, which is saying that it has no potential for medical use. But they're not allowing any research to go forward to show that it absolutely has medical applications, so that's kind of frustrating.

So I do think, you know, when you're talking about ecstasy or psilocybin, which is mushrooms, or marijuana, I mean, these are all schedule one drugs, but they have the potential to be useful in the field of psychiatry and in fields of medicine. And what would be nice is if they were in a slightly lower schedule where we could do research more freely and we could see whether they have some benefits.

FLATOW: Isn't there some research that shows that ecstasy can cause Parkinson's?

Dr. HOLLAND: Absolutely not. I mean, that's a really persistent mythology. There's a drug called MPTP, which causes Parkinson's. And people confuse MDMA with MPTP, understandably so. And they came out, right - both, like, in the mid-'80s...

FLATOW: Right.

Dr. HOLLAND: ...people discovered MPTP caused Parkinson's, and you were seeing all these on, like, televisions. "Donahue," do you remember "Donahue" was on the air?

FLATOW: Oh, yeah.

Dr. HOLLAND: You know, you'd see these videos of these guys with horrible Parkisonism because of MPTP, but they were also on the same show talking about designer drugs. So designer drugs like MPTP and MDMA, people got very confused and assumed at Ecstasy causes Parkinson's. It's probably the most persistent myth besides...

FLATOW: Really?

Dr. HOLLAND: ...besides that it drains your spinal fluid, which is another myth.

FLATOW: I hadn't heard that one.

Dr. HOLLAND: So I mean, one of the things in this book that I did on Ecstasy, called "Ecstasy: The Complete Guide," was I had a list of all the myths and like the myth busters. So Parkinson's was like number one.

FLATOW: But this is - these are - all these drugs you mentioned are so tied up with politics...

Dr. HOLLAND: Very much so, yeah.

FLATOW: ...that to get them onto, you know, to the investigational drugs and things.

Dr. HOLLAND: You know, it's in the same - I think it's the same sort of fear, where people are afraid of going crazy and they're afraid of insanity, they're afraid of these psychiatric patients - they're also afraid of these drugs that create altered states.


Dr. HOLLAND: We have tremendous fear about losing control and losing our minds and never coming back. And so I think that a lot of our drug policies are really fear based, more - and they're definitely more so than medicine based.

FLATOW: Mm-hmm. All right, well, thank you very much for taking time to be with us today.

Dr. HOLLAND: It's my pleasure. Thanks for having me.

FLATOW: And good luck in your private practice. Dr. Julie Holland is a psychiatrist specializing in psychopharmacology. She ran the Bellevue Psych ER on the weekends for nine years. Her book is called "Weekends at Bellevue: Nine Years on a Night Shift at the Psych ER." If you're looking for a gift, a book, this is a great one for the holiday season. It's terrific reading. Very easy, very interesting to read. Thank you again...

Dr. HOLLAND: All right, thanks.

FLATOW: ...for taking time to be with us.

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