TEDxUCLA 2015: Beyond the Box

Rebranding our shame

by

About Adi

Adi Jaffe is a nationally recognized expert on mental health, addiction and stigma. He lectures in the Psychology department at UCLA and is the Executive-Director and Co-Founder of one of the most progressive mental health treatment facilities in the country - Alternatives Behavioral Health. Dr. Jaffe’s work and research focus on changing the way Americans think about, and deal with mental health issues. He is passionate about the role of shame in destroying lives and aims to greatly reduce the stigma of mental health in this country.

Transcript

I want to start you off with an experiment today, but this isn’t one of those fancy ones with beakers like we got earlier. This just takes us.

And so I’m going to give you a second to look at what you see in front of you and just come up with what word or label you’d describe me with. Okay? You feel like you got it? All right.

In August of 2001, I woke up in a hospital bed. Now, pretty much anytime you come to a hospital bed, it’s been a bad day, right? But when you don’t know how you got there, really bad day.

So I’m laying there trying to figure out what happened. How did I make it into this bed? And who are all these people walking around me? And all of a sudden I realize that my right leg is throbbing and agony and I can’t touch it for some reason.

And I’m trying to sit there, I’m thinking, I’m hazy, and all of a sudden I remember that I was riding my motorcycle earlier that day. I was riding in Beverly Hills, and I remember that somebody had cut me off without signaling. You’re all shocked. Beverly Hills? No signaling? But I swear it happened. And I was trying to get around the car without hitting oncoming traffic and I didn’t make it.

And then I remember that while I’m laying on the ground, I’m consumed with worry. And the only thing that I can think of being worried about while I’m lying in the bed is my mom. My overprotective Jewish mother was sitting about 40 feet that way right now, and her voice saying something like, “I would have never let this family leave Israel if I knew you were coming out here on motorcycles.” But that’s it, that’s all I had.

And so I’m laying there: pain, you know, painkillers coursing through my veins, not really knowing what’s going on. And then my ADHD kicks in and I start worrying. I go, well did somebody even call my mom? Does she know that I’m here? And I think I had a DJ gig that night. Did my assistant call to cancel? I have no idea what’s going on.

And so all of a sudden, I’m not focusing on the leg. I’m not focusing on anything else. And things start coming into focus. And I realize that’s not a doctor sitting next to my bed. That’s not even a nurse. That’s a cop. And the reason I couldn’t touch my leg is because I’m actually handcuffed to the bed. And now it’s a really, really, really bad day.

And all this, and I start remembering more, because I wasn’t just driving my motorcycle through Beverly Hills that day. I was riding my motorcycle with a half a pint of coke in my jacket. See, for the last three years that I was a student here at UCLA, I was using and selling what I’m pretty sure all of you here would consider a pretty massive quantity of drugs, and I was out delivering. And I had a strange feeling the cop found the coke.

Now, just to speed up a little bit to how we got to today. I ended up going to court, not surprisingly, being sent to rehab, spending about a year in jail, got out, got into graduate school, got a Ph.D. in psychology here from UCLA, started writing for a bunch of nationally syndicated websites about addiction, opened up my own treatment center, and I’m on a TEDx stage giving a speech.

Okay, I’m pretty sure that while I was giving that talk, you got to fill in some details about me you didn’t know when I started. But you don’t get to cheat, you’ve got to use that label you had at the beginning. And I’m going to put up some of the labels you might have come up with throughout this story. I don’t know how many of those you had before, but I have a strange feeling that a drug-dealing Jewish motorcycle-riding professor was not exactly the label you had originally picked.

And yet, having dealt with this for the last 15 years of my life, I know which labels in my life stick out. I hear this — sometimes every day, sometimes multiple times a day — many times people use this as a compliment. “You should be so proud. You’ve overcome so much.” You know, stuff like that.

Well, I’m usually too polite — I’m sort of polite in general — but what I’m usually too polite to tell those people that I’m here to tell you today, it’s exactly those sorts of statements that have been the biggest obstacle to my success in life until today. And the reason is they normally reveal what people like that think about people like me with labels like that.

See, branding is a massively powerful thing. It’s a reason why marketing executives make millions and millions of dollars. It’s a reason why people like my mother-in-law, who don’t know the difference to be in a first down and a touchdown, watch the Super Bowl every single year. And it’s the reason why if I gave you the choice between a BMW or a Honda, you know in five seconds which car you want to pick, even if you’ve never sat in either kind.

And for messages like that to be as powerful as they are, there’s gotta be a core truth. I mean, let’s be real. The BMW is probably going to be a little more luxurious, but is it really the Ultimate Driving Machine? I mean, probably not, right? And while messages like that about cars aren’t going to change or ruin anybody’s life, I’m here to tell you that it’s exactly that sort of messaging about people who have mental health issues that keeps them from getting the help they need and thriving in life.

And I know that not just because of the personal story I shared with you at the beginning. I know because for the last twelve years of my life, I’ve dedicated my life, I’ve made it my obsession to study addiction. And in 2010, here at UCLA, I conducted a study to see why is it that almost nine out of ten people with addiction issues don’t even ask for help? I wasn’t really surprised, but I was really depressed to find out that 75 percent, three out of four of our participants, identified shame, stigma, or the inability to share their problem with other people as a primary barrier.

So now I wanna ask you — and you can be honest because I’m not going to tell you to share with anybody — what’s the worst and lowest point you’ve ever been at in your life?

Maybe you drove after having a few too many drinks at the bar, but you made it home safely and nobody knew. Maybe you really struggled with depression when you were in college after a really bad breakup, but you made it out without antidepressants or weekly visits to the psychologist. Maybe, let’s be real, this is LA, you even experiment with a little bit of cocaine here and there before going to a bar or a club or something like that, but nobody ever found out. You never got in trouble and everything’s okay.

Would your life be better, in this moment, if you’d been officially caught and labeled? Alcoholic, clinically depressed, or drug addict?

See, we need labels in our lives. We need labels to help us figure out what groceries to buy, what car to drive, and what school to go to. In that way, all labels are brands and they help us deal with the world around us.

The thing is, we do relatively well when it comes to physical labels, but when mental health is at issue, we really, really struggle. And we struggle because we seem to think that there’s this direct connection, a certain label comes with a specific amount of dysfunction.

So if you’re depressed, you just don’t get out of bed. You have ADHD, you do poorly in school. Or if you’re a drug addict, you leave every other responsibility and you let it fall by the wayside because getting high is the most important thing in your world.

So the reality is that these are simple statements, they make sense. We like attaching simple statements like this, but they’re wrong and there’s a cost to that. And the cost, the human cost of the fact that in the 21st century, mental health labels are one of the clearest bastions of shame that we have.

But again, come on. Every single person in this room right now has dealt with insecurities, neuroses. You felt depressed or anxious at some point in your life. But the moment your symptoms cross the threshold into a diagnosable disorder, suddenly you’re a walking condition. You’re not even a person anymore. Your treatment is based more on how you’ve been categorized and less and who you are. In that way, these labels, while serving as shortcuts to the truth, they eliminate any sense of nuance that we have.

And I can show you a really clear example of what that ends up looking like, because I told you, I struggle with ADHD, I obviously have some addictive tendencies if you know me, and this is a scan, a scan of my brain, a brain scan for me. I want to show you what that compares, like to somebody who’s come to my clinic before and also has been diagnosed with ADHD and has some addictive tendencies. These don’t look at all the same, do they?

And knowing that about the two of us, you wouldn’t expect our ADHD to manifest in the same way, even with the same label. You see, we can do the best job that we want to in terms of determining causes and underlying reasons for conditions and putting together these labels, but the reality is that mental health as a field is in a constant state of reevaluation and refinement.

And these labels, they’re approximations. And so when we deal with people as if we know everything about them because of a label that somebody applied to them, we run a risk of dealing with a concept, not a person.

Some of you are sitting here and saying, “Okay, that’s good to know, but who cares? I mean, don’t kids with ADHD get extra help in school? And since they do more poorly, shouldn’t we applaud that?”

To answer that question, I want to tell you about a group of kids in an elementary school in California. At the beginning of the school year, these kids will — you know, not these kids — but the kids in the experiment took the regular battery of tests that kids in California take. But then researchers went to their teachers and told them that a specific subset of these kids had been identified by this exam called the Harvard Test of Inflected Acquisitions. And they were told to expect great things from these kids, this year in particular.

At the end of the year, when these kids’ IQ scores were compared to the rest of the student body, they were indeed found to have grown their intelligence by as many as 15 IQ points more than the rest of the students.

Well we’re at UCLA, so you’re smart crowd and you’re following along and you know, there’s a catch. There was never any such thing as a Harvard Test of Inflected Acquisitions. Those students were chosen completely at random. And yet the teachers, acting on a false belief, somehow cause an actual increase of as many as 15 IQ points. That’s huge. But by doing that, they left some of the other students to fall relatively behind.

Or let’s look at studies that show us that African-American students underperform on tests when they’re specifically told that they will explicitly measure their intelligence, but that that exact difference disappears if the same questions are just presented as manipulations in an experiment. But the difference shows right back up with a simple act of making the students check a box indicating the racial category.

These aren’t issues of ability. These are issues of expectation. And the fact is that these kids know that they’re expected to underperform in certain contexts, so they do.

And if you’re not entirely convinced yet, I want to introduce you to the albino rat. Animals like this are used in neuroscience and genetics research all the time to do things like run mazes, press levers, et cetera.

But what if I told you that just by labeling some of the animals as bright and others as dull, researchers were able to create a difference of 50 percent in the time it took them to run a maze?

Think about that for a second. That literally tells us that the subjects we care about don’t even need to understand the labels we place on them. And yet we can impact their performance just by our own preconceptions.

Think of what that means for people every day in life and how you end up judging people, and now tell me how sure you are that kids with ADHD underperform in school only because of their own disorder.

Because I can tell you this, look, my ADHD is a struggle to me in many ways. I mean, I can’t plan to save my life. You think it’s funny, but I literally almost missed this talk. I get frustrated and bored really, really easily. And as you can tell from my pacing, I can’t stand still for five seconds.

But in other ways, my ADHD is a real asset. I’m an out-of-the-box thinker even when there’s a lot of pressure to conform. I’m the guy you want when multitasking is at hand, and I’m super driven so I can’t rest on their laurels of small accomplishments when I see a bigger prize out there. If you think about it for a second, my ADHD is probably part of the reason I’m here right now.

The different people that I’ve relied on for help in my life — my assistants, my colleagues — on the flip side are kind of obsessive-compulsive a little bit? They love making lists. They check my schedule three or four times. They want to know how we get from point A to B to C before we get started, which is crazy to me. But together we’re perfect. Just like the balanced relationship I have with my wife, who’s calm and centered and the only person who can actually take my anxiety and balance me out somehow.

So what’s the message here? Am I trying to say that we should completely eliminate labels? No, that’s not what I’m saying. We need labels to help us understand the world. But we have to start getting comfortable with a much more nuanced and complex version of these labels.

I mean, look, every disorder has levels. And subcomponents of the exact same disorder can be useful in one context and detrimental in another. It’s up to us to introduce the world to the attributes and the potential of the people who’ve been labeled and stop considering them dysfunctional.

If you’re one of those labeled like me, I’m urging you here and now, right now, to take back ownership of what’s been placed on you. Take what fits, throw away the rest, build your own brand. You might just find that your disorder is your biggest gift.

If you know somebody who is labeled — and every single one of you here right now does — I’m asking you to start taking responsibility for them as well. Consider what it means for your daughter to have ADHD and which parts of it actually match her. What can your husband possibly achieve, even though they’re an addict?

That simple act of careful consideration would get you to know them better, might have you start finding strength that you’ve been completely ignoring, and more importantly, you putting in that effort might be the ray of sunshine through the clouds that they need to overcome.

Because, look, I’m not unique in overcoming my difficulties. At best, I’m unique in being so public about them and not succumbing to the shame that I myself feel every day.

I’m here because my name is Adi, but I’m not an addict. I’m not an ADHD sufferer. I’m way, way more than all those things. And I don’t expect failure for myself. I expect success. Fuck shame. And even though I’m pretty sure that you’ve learned a little bit about me and your perception of me has changed the last 15 minutes, I hope you don’t hold that against me. Thanks.

Josh: So he’s not kidding. I almost had a heart attack. I pulled his mother aside, I’m like, “Do you know where your son is? He’s supposed to go on right now.”