"Churchill was also bipolar. There is a reason that evolution perpetuates mental illness" | Israel today

Dr. Zvi Fishel, you started studying medicine at the age of 18, and also the world of mental health you have been living around since that time, against the background of your family story

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When my sister was 21 she had schizophrenia, she became psychotic and was hospitalized.

We lived in Ashkelon at the time, and we would travel to visit her at Eitanim Hospital, in the Jerusalem mountains.

Today we talk about the stigma, and I can say that the stigma has been with me ever since.

At the time, it was a complex experience, hiding the disease, for example. "

The Blue Chair: "Churchill was also bipolar. There's a reason evolution evolves mental illness."

Did you suspect that the disease was likely to break out?

Were there any early signs of this?

"No. My sister was a handsome, quiet and shy girl. I thought to myself - 'What happened here, how did things get so bad?' "Biological".

When and how did you actually realize she was psychotic?

"At first she said that at work she was harassed, in what seemed like normal problems; so she went to a psychologist, who at one point referred her to a psychiatrist. This incarnation took time. "She slept at night and the world was very strange to her, a feeling of synonymy. It was a scary time. One Saturday we went for a walk to freshen up, and just before leaving I went home, alone, and burst into tears. I suddenly realized that from now on things would not be the same."

Not a simple story.

"It's not simple, but this story was also my opening to the world of psychiatry. Since then, you could say that I have lived in the closed ward, for about 30 years."

Geha Hospital, Photo: Efrat Eshel

And I guess you saw quite a few cases in it, difficult plays, but for a period in the style of the corona - not sure you prepared. There is no doubt that the plague created a rather unique situation in the national landscape: at the beginning of the plague they estimated that about 10 percent of the population would need psychiatric treatment, but the facts on the ground beat the forecasts.

"We are learning about a 20 percent increase in anxiety, depression and addictions. As part of the civilian cabinet, a cabinet of experts, we found that the treatment of mental injuries as a result of the epidemic will cost NIS 3 billion: psychiatric treatment, including medication, psychologist appointments and more. "With the Ministry of Health, we have launched a three-person online treatment program that will allow for the organization and development of therapeutic directions, without the need for a Form 17 or a psychiatric diagnosis. Unfortunately, even the 10 million were not fully utilized because the campaign was not budgeted.

But on the face of it, all your problems were supposed to come to an end: the budget discussions ended with a decision to increase the health budget by two billion shekels, of which about 500 million shekels will be allocated to mental health. That is, 20 percent for psychiatry.

"First, the CBS surveys indicate that about 20 percent of the population experienced distress, but only about four percent applied for treatment - and a third of them turned to private service. If a person goes to private service when he has no capacity, because the public service can not meet his need - it is a failure of the state. This is one proof that we are not prepared.

"As for the NIS 500 million, 400 of which are intended for renovation and maintenance of buildings. This is a one-time sum that will be spread over seven years between 12-11 hospitals. This is not a reform of the mental health system. It will not reduce overcrowding or prevent congestion. "About 80-70 million of the amount is intended for other things - rehabilitative communities, emergency mental health services, etc. Also regarding this amount, I wonder who will take care of its implementation and if it will not be directed to other places."

What does it mean to be routed to other places?

"When Moshe Kahlon was finance minister, I met him at seven, where he told me that a billion shekels had been transferred to us for construction. I told him I did not know about it, and he emphasized that it was already the second billion he was transferring. For that, a billion shekels came out as instructed by the Minister of Finance and disappeared. So when I am told 480 or 500 million I do not jump for joy.

"This story is also the reason why we decided to file a petition to the High Court on behalf of the Medical Association, with the Reichman University Law Clinic, to define a minimum living space in a room of patients in a psychiatric hospital. If the court defines it as 6 or 8 square meters per patient "He will have to realize this, and that may nail the huge budget increase that must be given to the mental health system, and decades have not been given."

Closure in Tel Aviv, in 2020,

Will a budget increase help prevent suicides in wards, such as that of the girl who ended her life at the Ma'ale HaCarmel Mental Health Medical Center?

"It is our job to do our best to prevent suicides, but unfortunately we can not prevent them completely. No one knows and does not publish the tens of thousands of people in the year we prevented their deaths.

When the defense mechanisms disappeared

These days we are facing a new variant that creates stress and may even bring in more patients meeting the system. To what extent is it expected to deepen the problems in the mental health system?

"At the beginning of a new wave and against the background of the flooding of mental illness, resources must be allocated immediately to increase the treatment capacity of the mental health system as a whole. That there is also a danger of death, and later the fear focused on public order - people got into debt and some were given a sort of label of ‘non-essential’. It is appealing and discouraging. Now, if the situation does develop into a wave, we will continue to see the extremes of disgust. "

Do you recognize a difference between the general public and those hospitalized in mental health hospitals when it comes to the impact of the corona? Were the anxious, psychotic, and obsessed hospitalized less harmed because the outside world affirmed their inner experiences?

"In the hospital the level of anxiety was at a low, fairly normal level. Because we discharged patients in wards, relatively drastically, there was peace and quiet, less overcrowding and violence. I recognized more anxiety, and the aggravation of their condition. "

Among the general public, the plague has confronted us with our limited control over our lives, with the discovery that stronger forces of us operate in the world.

What did it do to people?

"You defined it correctly. As human beings we have defense mechanisms that characterize us, and to a large extent these have been taken away from us during this period. We like life to be relatively predictable, to get out of the routine when it suits us, and suddenly everything has changed. New .There is some sense of acquired helplessness.

"Sometimes it reminds me of the movie 'Lost in Tokyo' - another world where it's not clear how to behave, nor is it clear what might improve your feeling. To deal with it, many people have crashed into drugs, gambling, porn, violence, breakups and divorces."

From the movie "Lost in Tokyo", Photo: IMDB

These are phenomena that have revealed the crack in the human psyche, and it is interesting to understand what the definition of this crack is - is it the crack that contains the fear of death, the loss of control?

"It started with the fear of death. Psychoanalyst Melanie Klein talked about the anxiety of the island, the fear of destroying the mind and body. Klein went on to worry about losing the object and his love, followed by the control anxiety, the anal anxiety we are in today. We are less anxious about our lives. "It is not clear to us how we will manage."

Do you find in uncertainty also certain advantages?

"I would say that 70 percent of people cope well with the plague and can even make interesting and positive changes in their lives. People have changed careers, devoting more time to family and found freedom in the chaos, and also the way to look at the world more broadly."

Psychoanalyst Donald Winnicott would say of your words that the corona helped us connect to our true self.

"To connect with the true self both internally and externally; both to our inner parts and to the cosmos, to our greater layer. If we were terribly focused on race, competitiveness, achievement and relationship, we were suddenly allowed to breathe, stop, think, look in and out, and connect ourselves to parts More authentic. "

Let's talk for a moment about a specific target population that was emphasized during the epidemic - the population of children and youth.

Next Tuesday (7.12, Zappa Tel Aviv), there will also be an Israel Mental Resilience Conference, which will deal with the "silent epidemic" of youth.

"In child and youth clinics, waiting times have always been high, and now they're even higher. And why? While adults are more accustomed to coping, children still have difficulty doing so, along with the fact that their life routines have changed dramatically: they do not go to school, zoom changes relationships. People go in and out of isolation. These things do not allow for the establishment of any kind of infrastructure, a sense of lack of human tissue that protects you, which is a safety net for you. For us adults the safety net is more durable, and for children it is still delicate, built. "Again and again, and it's challenging. That's why we see more anxiety, behavioral disorders, ADHD, mood disorders, and children who have difficulty returning to school after breaks, closures and holidays."

In terms of company development - to what extent has the corona been a milestone in the development and change of society?

"The question is how many more consequences do we have ahead of us, and the answer will be revealed later. Unfortunately, I am not convinced that the manifestations of solidarity we saw at the beginning of the epidemic will continue to hold. "Although there are faint cries of concern about them as well, it is possible and should have been done differently."

The charisma of schizophrenia

At the beginning of the conversation we talked about the stigma towards mental illness.

Do you recognize an improvement in the subject?

"I recognize a positive move in the form of opening up the mental health world to the media. It allows people to understand what a mental illness is, and understand the human diversity in which we live. But unfortunately I still see the use of the 'crazy' character in the media, commercials, cinema. People do not understand it hurts. It puts people more and more into the depths of their closet. "

The human diversity you mentioned, the one related to mental illness, is almost an evolutionary necessity.

There is a reason that evolution perpetuates mental illness.

"Evolution preserves psychiatric diseases for thousands of years, because they are essential for the continuity of the human race. It is therefore not at all certain that these diseases will disappear one day. If you will, evolution does not preserve, for example, depression per se, "In the normal distribution of the population, there will be people who will say, 'Let's not leave the village today, because it is dangerous.'"

Is there a relevant example of this?

"Churchill was bipolar. At the Munich Conference, when the West thought it was possible to reach a diplomatic agreement with Hitler - he was depressed, and he was also the only one who could see the danger, because we as humans do not always want to recognize it. Then he became Lamani, was elected prime minister and marched Britain along with the rest of the Western world to victory in World War II.

"You see, extremism is not for its own sake, but for the preservation and strengthening of the middle. Schizophrenia also has elements of leadership, messianism, charisma, creativity. Without mental illness we would lose critical and important elements in our human being. Now do you understand why psychiatry is the most interesting profession there is? ".

Winston Churchill (Archive), Photo: Getty Images

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