Faydra Aldridge: As we all know, television and film predominantly portray people
Faydra Aldridge: with schizophrenia as young white men. And yet in real life,
Faydra Aldridge: schizophrenia is not as seen on television, especially for women.
Faydra Aldridge: Men typically show symptoms of schizophrenia at a younger age
Faydra Aldridge: during their late teens or early twenties. But some women
Faydra Aldridge: with schizophrenia don't develop the disease until later on in life,
Faydra Aldridge: sometimes not being diagnosed until their forties. And while a
Faydra Aldridge: lot more needs to be done around women and serious
Faydra Aldridge: mental illnesses, scientists are still seeing how illnesses like schizophrenia
Faydra Aldridge: can impact men and women differently. So what does this mean?
Faydra Aldridge: Does this affect women getting an accurate diagnosis or accessing care?
Faydra Aldridge: And what about the additional stigma or discrimination that women
Faydra Aldridge: may face? We are going to cover all of these
Faydra Aldridge: questions and much more with today's guest, Dr. Araba Chintoh. Dr.
Faydra Aldridge: Chintoh is an assistant professor at the University of Toronto
Faydra Aldridge: in the psychiatry department. She's also a researcher and clinician
Faydra Aldridge: with a particular interest in treatment of resistant schizophrenia. And
Faydra Aldridge: looking at the gender differences when it comes to diagnosing
Faydra Aldridge: and treating mental illnesses. Dr. Chintoh, thank you for joining
Faydra Aldridge: us today. Welcome to the podcast.
Dr. Araba Chintoh: Thank you very much. I'm looking forward to it as well.
Faydra Aldridge: Dr. Chintoh research has shown that psychosis affects men and
Faydra Aldridge: women equally and occurs across all cultures and all socioeconomic groups.
Faydra Aldridge: But as we just talked about, illnesses like schizophrenia seems
Faydra Aldridge: to affect women at a later age than men. Why
Faydra Aldridge: do you think that is?
Dr. Araba Chintoh: The general feeling is that there's a protective effect of
Dr. Araba Chintoh: estrogen that impacts women after puberty differently to men. The
Dr. Araba Chintoh: peak that we see in men for their first episode
Dr. Araba Chintoh: of psychosis is in that kind of 18 to 24
Dr. Araba Chintoh: year range. And for women, it's about 4 to 6
Dr. Araba Chintoh: years later. So women will become ill in their first episode,
Dr. Araba Chintoh: 22 to 28, 30 years old. So it's meant to
Dr. Araba Chintoh: be a protective effect of the estrogens.
Faydra Aldridge: And so with this protective effect of estrogen, I'm curious then,
Faydra Aldridge: what are your thoughts on taking estrogen replacement and compensating
Faydra Aldridge: for that decreasing estrogen?
Dr. Araba Chintoh: I'm glad you asked. My thoughts are what has been
Dr. Araba Chintoh: the answer? And the reality is there is some evidence
Dr. Araba Chintoh: that shows, okay, maybe we can use these selective estrogen
Dr. Araba Chintoh: receptor modulators, SERM, S-E-R-M for short. There's some evidence to show
Dr. Araba Chintoh: and some studies. There is a bit of a change
Dr. Araba Chintoh: around symptoms and in others there aren't. So if I summarize,
Dr. Araba Chintoh: we don't have enough yet to say every single woman
Dr. Araba Chintoh: who has schizophrenia. When you get older and you're hitting
Dr. Araba Chintoh: menopause and you're losing estrogen or some other hormones, let's
Dr. Araba Chintoh: give you these. But is it a place to look
Dr. Araba Chintoh: where the light is kind of bright? Yeah. Definitely.
Faydra Aldridge: And now, Dr. Chintoh, I'd like to take a moment
Faydra Aldridge: to listen to a clip. We are going to be
Faydra Aldridge: hearing from a woman talking about her evolving mental health
Faydra Aldridge: diagnosis since 1995.
S3: When I first had depression in '95, and my doctor
S3: just was like, 'You're just depressed. You just need antidepressants.'
S3: Just saying that 'You're in a mood' kind of thing.
S3: Not being heard and not being really looked at in
S3: a holistic type of let's look at all the factors here,
S3: not just the depression. Then you can't just treat it singularly.
S3: You have to treat it and look at the whole
S3: picture like, what's the past trauma, what's the current trauma,
S3: what's the routine in this person's life, what their support
S3: system like, or what are they self-medicating with and all
S3: those things? Because I don't think you can just throw
S3: a pill to someone and say, 'Take this and you'll
S3: be fine. Call me in a week.' That's ridiculous. And
S3: that's what I felt that the doctor that I saw
S3: in Calgary, he missed the boat entirely. And then my
S3: life unraveled.
Faydra Aldridge: So based on your experience as a clinician and a researcher,
Faydra Aldridge: what are your thoughts on what we just heard? Do
Faydra Aldridge: you think gender does play a role in getting a
Faydra Aldridge: diagnosis for a mental illness?
Dr. Araba Chintoh: 100% it does for a number of reasons are women
Dr. Araba Chintoh: tend to present in atypical ways early on. I don't
Dr. Araba Chintoh: mean fantastical, but women will talk about emotions or impacts
Dr. Araba Chintoh: in relationships in a very different way than that kind
Dr. Araba Chintoh: of concrete. 'I just heard a voice', or 'I think
Dr. Araba Chintoh: it's a CIA or that kind of thing.' And so
Dr. Araba Chintoh: it's almost natural to lead towards this kind of mood,
Dr. Araba Chintoh: picture or mood, a diagnosis. And part of the piece
Dr. Araba Chintoh: that we spoke about around are women coming to the
Dr. Araba Chintoh: illness later in life. And even if it's just four
Dr. Araba Chintoh: years later, if you think about yourself at 18 and
Dr. Araba Chintoh: you think about yourself at 22, for many people, they've
Dr. Araba Chintoh: gone through some post-secondary education or even have just worked
Dr. Araba Chintoh: in been out in the world more. And there's a
Dr. Araba Chintoh: real key piece around what you learn in those transitional forming,
Dr. Araba Chintoh: self identifying years that help in self preservation. And so
Dr. Araba Chintoh: if a woman comes and complains of things that sound interpersonal,
Dr. Araba Chintoh: that sound kind of mood related, and they're functioning much
Dr. Araba Chintoh: better than the average 18 year old who just drops
Dr. Araba Chintoh: off and is hearing voices, then I think those are
Dr. Araba Chintoh: some of the reasons why that kind of missed diagnosis happens.
Faydra Aldridge: So, Dr. Chintoh, what is the fallout from that kind
Faydra Aldridge: of experience?
Dr. Araba Chintoh: The negative pieces to that are those stigma pieces? 'Oh,
Dr. Araba Chintoh: she 's just, she's being melodramatic. Oh, she's hysterical. Oh.' That
Dr. Araba Chintoh: kind of thing. I definitely think that that happens. And
Dr. Araba Chintoh: I think it's really easy to feel and think that
Dr. Araba Chintoh: we're in a hospital and emergency department. And when we
Dr. Araba Chintoh: see people returning with similar complaints but not really great,
Dr. Araba Chintoh: function about like, you know, what am I meant to do? Oh,
Dr. Araba Chintoh: it's very, very easy to think, oh, they're just being melodramatic.
Dr. Araba Chintoh: And so that really impacts women. And the peace around
Dr. Araba Chintoh: that clip that hit me was that this woman talked
Dr. Araba Chintoh: about her life unraveling after that. Part of the problem
Dr. Araba Chintoh: about not getting that diagnosis right at the get go
Dr. Araba Chintoh: is what we call duration of untreated psychosis.
Faydra Aldridge: What does this mean and what's the impact of having
Faydra Aldridge: untreated psychosis.
Dr. Araba Chintoh: The longer period of time that you have this psychosis
Dr. Araba Chintoh: and it's not being treated. It has a really negative
Dr. Araba Chintoh: impact on your outcomes, on what you can do, on
Dr. Araba Chintoh: how you can recover, on what you can achieve later
Dr. Araba Chintoh: on in your life. And there's all different kinds of
Dr. Araba Chintoh: reasons that you may go with a longer duration of
Dr. Araba Chintoh: untreated psychosis, but we know that the impact is negative.
Dr. Araba Chintoh: And my only other caveat to that is that sometimes
Dr. Araba Chintoh: the diagnosis isn't clear upfront. And it's not I mean,
Dr. Araba Chintoh: I love schizophrenia. This is my jam and these are
Dr. Araba Chintoh: my people. But it's not a small thing to make
Dr. Araba Chintoh: a diagnosis of schizophrenia. And so in as much as
Dr. Araba Chintoh: I hear her almost desperately needing to have know what
Dr. Araba Chintoh: that was at the outset, sometimes the picture isn't clear.
Dr. Araba Chintoh: And to move down that route and to move down
Dr. Araba Chintoh: that medication piece and some of those other things, and
Dr. Araba Chintoh: even the stigma that is attached to schizophrenia, it's not
Dr. Araba Chintoh: a small thing. And so I sense two families all
Dr. Araba Chintoh: the time. So that was definitely wrong. And I don't
Dr. Araba Chintoh: know what it is, and I'm going to stand by
Dr. Araba Chintoh: you and you get to come through here for as
Dr. Araba Chintoh: long as it takes to figure it out. So right now,
Dr. Araba Chintoh: we don't know.
Faydra Aldridge: As we mentioned earlier, Dr. Chintoh , you have a particular
Faydra Aldridge: interest in treatment resistant schizophrenia. So first off, what is that.
Dr. Araba Chintoh: Here in particular in Canada? This categorization is for someone
Dr. Araba Chintoh: who has tried and not responded to at least two
Dr. Araba Chintoh: antipsychotic medication. So say, for instance, that you, Faydra, develop
Dr. Araba Chintoh: the symptoms of this illness. We start you on a medication,
Dr. Araba Chintoh: we get you up to a good dose. You're on
Dr. Araba Chintoh: it for a good enough chunk of time where we
Dr. Araba Chintoh: know that if this medication we're going to work, it
Dr. Araba Chintoh: would be working by now. We still have symptoms, you're
Dr. Araba Chintoh: still in distress, you're still bothered by it, but you
Dr. Araba Chintoh: switch to another medication. We get you up to that
Dr. Araba Chintoh: good dose. We have you on it for a good
Dr. Araba Chintoh: enough chunk of time where we know that if your
Dr. Araba Chintoh: symptoms were going to respond, then they would have responded by
Dr. Araba Chintoh: now and you're still in distress and you're still not. Well,
Dr. Araba Chintoh: Then we categorize you into what we call treatment resistant schizophrenia.
Dr. Araba Chintoh: That little explanation was important because there's a next medication
Dr. Araba Chintoh: that we use, and if they move straight to Clozapine ,
Dr. Araba Chintoh: then they will tell you the changes that that makes.
Dr. Araba Chintoh: But many of them will tell you, well, no, I
Dr. Araba Chintoh: tried this and this and then this. And then this.
Dr. Araba Chintoh: And then this and then this. And so that's one
Dr. Araba Chintoh: of the research pieces for me. But the other research
Dr. Araba Chintoh: piece for me is around what that recovery looks like
Dr. Araba Chintoh: for people. I always say psychiatry is the unwanted step.
Dr. Araba Chintoh: Child of medicine and schizophrenia is the unwanted stepchild of psychiatry.
Dr. Araba Chintoh: This is just a marginalized group of individuals and the
Dr. Araba Chintoh: ones who don't respond to treatment, who have ongoing challenges,
Dr. Araba Chintoh: whose illness impacts all those areas of their life. That's
Dr. Araba Chintoh: where I found myself both advocating for and trying to
Dr. Araba Chintoh: understand and seeing if there are ways that I can
Dr. Araba Chintoh: use my skill set to change the trajectory of their lives.
Faydra Aldridge: Thank you for that explanation. And when it does come
Faydra Aldridge: to the differences between men and women, what are the
Faydra Aldridge: differences in the outcomes of treatment resistant schizophrenia?
Dr. Araba Chintoh: The short answer is we don't know. That's the short
Dr. Araba Chintoh: and scientific answer. And so I work with a few
Dr. Araba Chintoh: gurus in this schizophrenia area. And when I started to
Dr. Araba Chintoh: develop this interest and move my energies more into the
Dr. Araba Chintoh: area of women with severe and persistent mental illness. And
Dr. Araba Chintoh: then we would sit down and talk about just our
Dr. Araba Chintoh: general questions that we asked in treatment resistant schizophrenia. The
Dr. Araba Chintoh: number of occasions where my mentor said to me, I
Dr. Araba Chintoh: actually don't know what that difference looks like. And then
Dr. Araba Chintoh: between men, I don't know actually what those outcomes are
Dr. Araba Chintoh: for cause of pain between men and women. I'm not
Dr. Araba Chintoh: actually sure what that dose range looks like or what
Dr. Araba Chintoh: the side effect profile looks like. So there was a
Dr. Araba Chintoh: lot of we don't know which on the one hand
Dr. Araba Chintoh: is quite disappointing. But for someone like me who's a
Dr. Araba Chintoh: researcher at the launch of her career, it's very exciting.
Dr. Araba Chintoh: And forming a nice scaffold of questions to ask and
Dr. Araba Chintoh: answers to help, to be able to provide people.
Faydra Aldridge: So the women we heard earlier talked about her life unraveling.
Faydra Aldridge: Based on your experience as a clinician? What is the
Faydra Aldridge: impact of having untreated psychosis?
Dr. Araba Chintoh: Traditionally, we feel like women with schizophrenia do better. There's
Dr. Araba Chintoh: a number of papers that women tend to do better
Dr. Araba Chintoh: with all different types of treatment, and at the outset
Dr. Araba Chintoh: they look a bit better. They are a bit more
Dr. Araba Chintoh: functional for some of those reasons that we spoke about.
Dr. Araba Chintoh: But what we're starting to realize now is that when
Dr. Araba Chintoh: you look later on the first 1 to 3 years, sure,
Dr. Araba Chintoh: women look better at five, ten, 15 years, or women
Dr. Araba Chintoh: with schizophrenia actually don't do well.
Faydra Aldridge: I can't help but wonder, is it the role of estrogen,
Faydra Aldridge: why there is a delayed diagnosis for women and potential outcomes?
Faydra Aldridge: Or you think it's some societal views of females?
Dr. Araba Chintoh: Oh, can I choose both? Because I'd like to choose both.
Dr. Araba Chintoh: So in terms of the illness unveiling itself and the
Dr. Araba Chintoh: time that it does right now, the richest place to
Dr. Araba Chintoh: look for that answer and we're focusing on estrogen here
Dr. Araba Chintoh: comes in a basket of other hormones. But estrogen is
Dr. Araba Chintoh: the key one. And I harp on that for a reason,
Dr. Araba Chintoh: because we know the childhood psychosis or very young psychosis
Dr. Araba Chintoh: is a very small group, but we don't see a
Dr. Araba Chintoh: difference in age difference there. So that helps us realize
Dr. Araba Chintoh: that maybe there is this effect of estrogen when it
Dr. Araba Chintoh: starts to come. And it's not even just sustained estrogen,
Dr. Araba Chintoh: because as we know, as women are cycles and the
Dr. Araba Chintoh: way that the hormones have it is pulsatile. And so
Dr. Araba Chintoh: it's not just a blanket disfiguration in your skin and
Dr. Araba Chintoh: cream forever and you'll be okay, because what happens indigenously
Dr. Araba Chintoh: within our bodies is pulsatile. So, yes, I think there
Dr. Araba Chintoh: is something there around that protective effect of estrogen before
Dr. Araba Chintoh: the brains that are vulnerable to schizophrenia develop it.
Faydra Aldridge: But what about the societal piece, including the views towards
Faydra Aldridge: women overall.
Dr. Araba Chintoh: This societal piece, it's both good and bad. And so
Dr. Araba Chintoh: we spoke a bit about the stigma of the ways
Dr. Araba Chintoh: in which this is just you being melodramatic. And so
Dr. Araba Chintoh: you don't get this diagnosis of schizophrenia. You're probably just
Dr. Araba Chintoh: a drama queen. But also and this is key for women,
Dr. Araba Chintoh: and I feel it particularly as a racialized woman as well.
Dr. Araba Chintoh: We don't stop. We have families, we have work, we
Dr. Araba Chintoh: have partners, we have aging parents. We don't stop. We
Dr. Araba Chintoh: point to the needs of other people before us and
Dr. Araba Chintoh: we get it done. We could be bleeding on the
Dr. Araba Chintoh: streets and we still get it done. We still make
Dr. Araba Chintoh: the dinner for the children. We're still there for our
Dr. Araba Chintoh: aging parents. We're going to this and we're doing that.
Dr. Araba Chintoh: And so some of that delay in developing the illness
Dr. Araba Chintoh: allows women to get to a place where they then
Dr. Araba Chintoh: have those commitments and relationships. And I see this all
Dr. Araba Chintoh: the time. I have older women coming in to the
Dr. Araba Chintoh: clinic or into the emergency department and saying, oh, well,
Dr. Araba Chintoh: they're like this. They said, 'Well, they were always a
Dr. Araba Chintoh: bit weird or bizarre', or they always had some of
Dr. Araba Chintoh: those thoughts. Or the women will say, 'Yeah, I've always
Dr. Araba Chintoh: had those voices or whatever. And somehow now that the
Dr. Araba Chintoh: kids have left the house, now that I'm divorced, now
Dr. Araba Chintoh: that my parents have passed, then it takes over' and
Dr. Araba Chintoh: then they stop. And so that stigma and that societal
Dr. Araba Chintoh: pressure and expectation and that role that women feel in society,
Dr. Araba Chintoh: it is profound. And it all, I think, impacts the
Dr. Araba Chintoh: timing of when the illness maybe overcomes people.
Faydra Aldridge: You're listening to Look Again: Mental Illness Re-examined. A podcast
Faydra Aldridge: brought to you by the B.C. Schizophrenia Society and B.C.
Faydra Aldridge: Partner organizations. I'm your host, Faydra Aldridge . This podcast would
Faydra Aldridge: not be possible without the support of the community. From
Faydra Aldridge: the bottom of our hearts, we want to thank you
Faydra Aldridge: for caring about serious mental illness and everything that's around it. Together,
Faydra Aldridge: we truly can make a difference. We'll come back to Look Again:
Faydra Aldridge: Mental Illness Re-examined. I'm Faydra Aldridge and I've been speaking to Dr.
Faydra Aldridge: Chintoh about the differences, similarities and the issues women face
Faydra Aldridge: when diagnosed with a serious mental illness like schizophrenia. So, Dr. Chintoh,
Faydra Aldridge: I've read in the 1970s and the 1980s, women were
Faydra Aldridge: left out or underrepresented in many clinical trials of psychiatric drugs,
Faydra Aldridge: and that a lack of inclusion in these studies has
Faydra Aldridge: made obviously prescribing the correct doses for drugs just that
Faydra Aldridge: much more difficult and may put many women at greater
Faydra Aldridge: risk for negative side effects. So there was a lot
Faydra Aldridge: to unpack there.
Dr. Araba Chintoh: As I mentioned, I've done a number of years of
Dr. Araba Chintoh: post-secondary education. I wrapped up my Ph.D. in 2008 before
Dr. Araba Chintoh: I went off to medical school. And the entirety of
Dr. Araba Chintoh: the work that I did in my Ph.D. was based
Dr. Araba Chintoh: only on male breast, because specifically we didn't want the
Dr. Araba Chintoh: complications of the estrus cycle. So the seventies and the
Dr. Araba Chintoh: eighties are not that far in the past. But 2008
Dr. Araba Chintoh: and my lifetime is also not that far in the past.
Dr. Araba Chintoh: And I share that story because I think for people
Dr. Araba Chintoh: who don't know science, that is real. We like to
Dr. Araba Chintoh: be simple. We like to get quick and easy answers.
Dr. Araba Chintoh: We don't want to complicate things. That's how we do
Dr. Araba Chintoh: things in science. The conversation now is around systemic racism.
Dr. Araba Chintoh: And for me, it goes a little bit further than that.
Dr. Araba Chintoh: Like God, like the ways in which the system was
Dr. Araba Chintoh: built for us to create science. And I just believed
Dr. Araba Chintoh: it and bought it and organized my research so that
Dr. Araba Chintoh: I wouldn't say, look, I am a woman, 50% of people. You
Dr. Araba Chintoh: know what I mean? And I didn't even question it
Dr. Araba Chintoh: at that time. So what's my response to that? Oh, yeah.
Dr. Araba Chintoh: And now that I am growing, I am progressing. I
Dr. Araba Chintoh: am seeing people. I am in a position where I
Dr. Araba Chintoh: can now question what is it? Because that's really it.
Dr. Araba Chintoh: We're 2022 now, nut this past few years have really
Dr. Araba Chintoh: helped me understand is that you now get to question
Dr. Araba Chintoh: all of what is.
Faydra Aldridge: And I just love your energy and I can feel
Faydra Aldridge: your enthusiasm coming in the microphone. So what is the answer, Dr. Chintoh?
Faydra Aldridge: What can we do to make a change? So we
Faydra Aldridge: no longer just have male rats in our clinical trials
Faydra Aldridge: so we can view women differently and realize that there
Faydra Aldridge: are differences between men and women when it comes to
Faydra Aldridge: negative side effects of drugs, when it comes to prescribing
Faydra Aldridge: the correct doses.
Dr. Araba Chintoh: Well, I know what I'm doing. I am building a
Dr. Araba Chintoh: research program that looks at all of these life stages
Dr. Araba Chintoh: of women, specifically in severe and persistent mental illness, because
Dr. Araba Chintoh: that's where my heart lies. So I can understand exactly that.
Dr. Araba Chintoh: So when you come to me, Faydra, and you say
Dr. Araba Chintoh: I am a 30 something or a 50 something or
Dr. Araba Chintoh: a 70 something woman, and this is my experience, I
Dr. Araba Chintoh: can now say, 'Okay, well, you know what? This is
Dr. Araba Chintoh: what we see are the patterns in women of your
Dr. Araba Chintoh: age with your experience.' Because right now what I say
Dr. Araba Chintoh: is 'This is what I see in the patterns of
Dr. Araba Chintoh: this illness broadly.' And I know that that research is
Dr. Araba Chintoh: based largely solely on men. I want to be able
Dr. Araba Chintoh: to fine tune the care that I can give to
Dr. Araba Chintoh: you and others based on your personal features. You know,
Dr. Araba Chintoh: we talk a lot about personalized health care, and this
Dr. Araba Chintoh: for me is the piece. The other piece and this
Dr. Araba Chintoh: is a piece that I don't know that I can fix,
Dr. Araba Chintoh: that I hold so dearly is that I want to
Dr. Araba Chintoh: say our system is broken because it just makes it
Dr. Araba Chintoh: seem like I'm pooh poohing everything, but our system is broken.
Dr. Araba Chintoh: We need to catch our women at stage one. So
Dr. Araba Chintoh: when women say, actually, I think I might be a
Dr. Araba Chintoh: bit off. Let's get them in then, and let's cut
Dr. Araba Chintoh: it off at the pass so we don't end up
Dr. Araba Chintoh: with severe and persistent mental illness if we don't have to.
Dr. Araba Chintoh: What are the things that we can do early on
Dr. Araba Chintoh: in the same way to screen early, that we don't
Dr. Araba Chintoh: end up with kind of stage four cancers? What we
Dr. Araba Chintoh: do it, how our system is set up is only
Dr. Araba Chintoh: for the sickest of the sick. And in some ways, sure,
Dr. Araba Chintoh: because I am a psychiatrist, I am a specialist. My
Dr. Araba Chintoh: service should be reserved for the sickest of the sick.
Dr. Araba Chintoh: And still there is nothing else to catch everyone else.
Dr. Araba Chintoh: And so when you ask what can we do to change?
Dr. Araba Chintoh: We need to change the system. And if it takes
Dr. Araba Chintoh: the plight of women for people to look at the
Dr. Araba Chintoh: system differently and say it's not just working because people
Dr. Araba Chintoh: can't get care, it's not working because it's based on
Dr. Araba Chintoh: a model that isn't fit for care. That's what we
Dr. Araba Chintoh: can do.
Faydra Aldridge: Absolutely. So as a clinician and a researcher, what? Do
Faydra Aldridge: you think we can do to get people early on
Faydra Aldridge: in the beginning stages of their journey?
Dr. Araba Chintoh: This is my question. This is what I'm trying to
Dr. Araba Chintoh: build right now, is to understand what are the pieces?
Dr. Araba Chintoh: And my history is psychopharmacology. I love drugs. I love
Dr. Araba Chintoh: the brain. I love how it impacts behavior. And that,
Dr. Araba Chintoh: for me, was my answer to that problem. I'll have
Dr. Araba Chintoh: the medication for you. And as I work more and
Dr. Araba Chintoh: more people, I realize this is much, much broader than that.
Dr. Araba Chintoh: And our medications, while they are the cornerstone of our treatment,
Dr. Araba Chintoh: are also limited. And so that's exactly what I'm trying
Dr. Araba Chintoh: to figure out right now, is what are the pieces?
Dr. Araba Chintoh: So if you are now, I don't know, 18, 12,
Dr. Araba Chintoh: 16 coming into me and your parent or your caregiver
Dr. Araba Chintoh: or your sibling says something's not quite right. What are
Dr. Araba Chintoh: the pieces that I need to glean out of your
Dr. Araba Chintoh: history that make me say, Actually, you know what? She's
Dr. Araba Chintoh: probably going to be okay. Let's just watch and see
Dr. Araba Chintoh: or let's keep a close eye on this woman or hey,
Dr. Araba Chintoh: let's intervene right now. And what are those interventions? That's
Dr. Araba Chintoh: exactly what I'm trying to build. So the short answer is,
Dr. Araba Chintoh: I don't know, but I'm trying to find out.
Faydra Aldridge: So based on your experience as a clinician, what role
Faydra Aldridge: does trauma play for women versus men when it comes
Faydra Aldridge: to diagnosing and treating a mental illness?
Dr. Araba Chintoh: That's a big one and it's a big part of
Dr. Araba Chintoh: what we spoke about earlier, making it easy to dismiss
Dr. Araba Chintoh: a woman's concerns as melodrama or whatever. I don't know
Dr. Araba Chintoh: if your listeners will know that we kind of speak
Dr. Araba Chintoh: about in psychiatry, kind of the big key trauma is
Dr. Araba Chintoh: versus the little things or the big things would be
Dr. Araba Chintoh: child abuse, sexual abuse, overt neglect. Even smaller things, bullying,
Dr. Araba Chintoh: that kind of thing. But all of those traumas have
Dr. Araba Chintoh: an impact on women. And we know, at least in
Dr. Araba Chintoh: terms of what they report. Women with psychosis, of course,
Dr. Araba Chintoh: those things more often. And yet, how well do we
Dr. Araba Chintoh: target our services to help explore and process and move
Dr. Araba Chintoh: past that trauma? I mean, I work in the largest
Dr. Araba Chintoh: mental health and addictions research and clinical setting in Canada,
Dr. Araba Chintoh: and you come to me video and you go somewhere
Dr. Araba Chintoh: else through drama. And how am I not integrating that?
Dr. Araba Chintoh: I'm aware of it now. And so I spend some
Dr. Araba Chintoh: time with my patients. And yet our model isn't one
Dr. Araba Chintoh: that's always holistic to treat the person in front of us.
Dr. Araba Chintoh: And so I guess it does answer your question because
Dr. Araba Chintoh: I think that it is important to recovery. I don't
Dr. Araba Chintoh: know that I can change the traumas that people have had,
Dr. Araba Chintoh: but I can definitely have a hand in helping them
Dr. Araba Chintoh: navigate it and come through it, not to forget about it,
Dr. Araba Chintoh: not to pretend like it never happened, but to help
Dr. Araba Chintoh: them grow through it and understand the role that played
Dr. Araba Chintoh: in their lives and to help them move through it
Dr. Araba Chintoh: and hopefully past.
Faydra Aldridge: Now, you talked about the important role that medications play.
Faydra Aldridge: Let's talk about the difference between men and women when
Faydra Aldridge: it comes to responding to those medications.
Dr. Araba Chintoh: That's a great question. So some of the research will
Dr. Araba Chintoh: show you that women do better. And so the assumption
Dr. Araba Chintoh: is that they respond better to the medications. And there's
Dr. Araba Chintoh: some of the work that looks at that and ties
Dr. Araba Chintoh: it into that piece around the estrogen or the hormones, and that
Dr. Araba Chintoh: says maybe, actually women do respond better. A piece of
Dr. Araba Chintoh: that has to do with the way some of our
Dr. Araba Chintoh: medications are in our body. And so women have more
Dr. Araba Chintoh: fat cells than men. The medications can accumulate in fat
Dr. Araba Chintoh: cells in men. And so it may look like women
Dr. Araba Chintoh: are responding better, but it could be that there's more
Dr. Araba Chintoh: of the medication hanging around in the women than men.
Dr. Araba Chintoh: But then there's that other piece around. Actually, maybe women
Dr. Araba Chintoh: aren't responding better, but are doing better. And that has
Dr. Araba Chintoh: to do again with all of those pieces, those societal pieces,
Dr. Araba Chintoh: those roles that women feel that force them to function
Dr. Araba Chintoh: despite their symptoms.
Faydra Aldridge: And I'm going to end with a pretty big question, Dr. Shinto.
Faydra Aldridge: What policy changes at a societal level do you think
Faydra Aldridge: could make both diagnosing and treating women more equitable?
Dr. Araba Chintoh: Oh, so for me, it's around that piece about mental
Dr. Araba Chintoh: health being health. And it speaks a bit to those
Dr. Araba Chintoh: feelings that I have around the system being broken. Again,
Dr. Araba Chintoh: we didn't create our system in a way to give
Dr. Araba Chintoh: people the care that they need. And I realize to
Dr. Araba Chintoh: find a psychiatrist is very difficult. There are few of
Dr. Araba Chintoh: us and we are overrun and does all of mental
Dr. Araba Chintoh: health care need to be through psychiatrists? Are there ways
Dr. Araba Chintoh: that our policies can change to support other mental health practitioners?
Dr. Araba Chintoh: So it's not just those who can afford to pay
Dr. Araba Chintoh: for psychotherapy, social work and dementia and that kind of thing,
Dr. Araba Chintoh: or you have to be completely downtrodden and on the
Dr. Araba Chintoh: streets before you get there. Is there a way that
Dr. Araba Chintoh: we can bridge those gaps? I would like to see
Dr. Araba Chintoh: policy changes that open our eyes to the types of
Dr. Araba Chintoh: care that people need and have the services and support
Dr. Araba Chintoh: the services to meet that.
Faydra Aldridge: Dr. Chintoh, I could talk to you for hours. You
Faydra Aldridge: are obviously extremely passionate about what you do and truly
Faydra Aldridge: making a difference. So thank you for everything that you
Faydra Aldridge: do and for walking the journey with every single person
Faydra Aldridge: that you see in their families that has a severe
Faydra Aldridge: and persistent mental illness. Thank you.
Dr. Araba Chintoh: Well, I thank you. And I thank them for helping
Dr. Araba Chintoh: me along my learning path.
Faydra Aldridge: And a huge thank you to you, our audience, for
Faydra Aldridge: joining us for this episode. Together, we can change the
Faydra Aldridge: narrative around mental illnesses like schizophrenia and end the many
Faydra Aldridge: myths and the stereotypes that we spoke about today. If
Faydra Aldridge: you have any questions or any comments, tweet us @
Faydra Aldridge: BC Schizophrenia and to get our latest episodes, be sure
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Faydra Aldridge: to podcasts. And here's another podcast you may be interested in.
Faydra Aldridge: Fireweed is a podcast brought to you by the British
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Faydra Aldridge: And they're back for a season two follow. Host Bianca Rego,
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Faydra Aldridge: Listen to Fireweed wherever you get your podcasts. We hope
Faydra Aldridge: you join us next episode. Talk to you soon.
S3: This podcast is brought to you by the BC Schizophrenia
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S3: Use Information. Where a group of non-profit agencies providing good
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S3: their mental well-being. The BC Partners members are Anxiety Canada,
S3: BC Schizophrenia Society, Canadian Institute for Substance Use Research, Canadian
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