Q&A with Wall Scholar, Peter Klein

Get the full story at:

In 2014-2015, UBC journalism students, led by UBC Journalism Professor Peter Klein and two colleagues, travelled to the far reaches of Benin, India and Jordan to report on the untold stories around mental health crises and community-based treatments in these countries.

In this Q&A, Wall Scholar Peter Klein, who is working on building the Global Reporting Centre during his year in residence at the Peter Wall Institute, talks about what it means to do deep, enterprise journalism on the stigma associated with mental illness, and the astounding efforts of everyday people in Benin, India and Jordan who are working hard to help those suffering from mental illness get the treatment they need and regain their dignity in the process.

Klein says that in all three countries, community-based treatments for mental-illness prevail, taking a more holistic rather than clinical approach to treatment.

The Wall Papers (WP): How did you first get into journalism?

Peter Klein (PK): I got into journalism kind of by mistake. When I was in university, I kept switching majors. First I was studying biology, then pre-med and music and math and philosophy and sciences; I kept switching around and realized I wanted to do everything.

I liked the idea of trying to graze a little bit on different topics and that's what originally led me to journalism. Then I realized, fairly quickly, that that's not the best way to be a journalist, because then you really don't know anything. I realized I needed to develop a specialization so then I developed cross-border, enterprise global journalism as my area.

My father and his family were refugees from Hungary and came over during the Hungarian revolution. So I grew up in the US, but didn't speak English when I was little, so I was a bit of an outsider. I never really felt like I belonged anywhere and liked the idea of exploring the world as an outsider, which is kind of what you do as a journalist.

A lot of people with that background end up go into journalism, I find.

WP: So how did you end up in Vancouver?

PK: My wife is from here. She grew up here and part of the draw was family reasons.

Before moving I was living in New York and working for 60 Minutes, but part of me wanted something more than what mainstream journalism was offering. I love 60 Minutes, I’m proud of the work I did there and still occasionally work for the show, but I think all of those programs and newspapers have always been limiting by their very nature.

I think that with all the pressures going on, they're even more limited in their abilities to do the kind of stories I particularly want to do.

They’re risky stories. Sometimes they're physically risky, but more important, they're financially risky, they're editorially risky and, the market doesn't really allow for that level of risk anymore.

When I first got to 60 Minutes I was able to fly to Kenya on a scout to just research a story. That's just not a reality anymore, you can't do that.

So I thought, ‘OK, well, I like the idea of being able to find these innovative forms of journalism, finding new ways of funding it, new ways of practicing it, new ways of distributing it,’ and the university seemed like a good place for that kind of ambition.

UBC is a great university, a world class university, with a very global orientation – not just because we're on the Pacific Rim, but we have students from all over the world, we have some amazing faculty members who do high level scholarship around various issues that touch on the kind of things I like to report on.

WP: So how do you decide on what topics you want to report on?

PK: We have an international reporting class, which we're trying to grow this into a bigger Global Reporting Centre. The class was only funded for 10 years, and we're getting close to the end of the funding.

The idea was always for this to be a pilot for something bigger – the Global Reporting Centre –which not just tries to do this kind of innovation and distribution on a student project level, but on a much larger, more ambitious level.

We have some incredible journalists from all over the world who've signed up to work with us, and news organizations from all over the world have reached out to work with us on projects and want to get ambitious things going.

In terms of coming up with specific ideas for any projects, whether they’re student projects or the bigger Global Reporting Center projects – we have several of those going on – we usually start with what's the unmet need.

Over the last couple of years I’ve made the analogy to funders that what MSF (Médecins Sans Frontières) does with neglected global diseases, we do with neglected global stories. There are a lot of stories out there that just don't get told.

We just did this story on global mental illness and that's a topic that even the medical community isn't addressing, let alone the journalism or policy communities. Even on the medical level there are these urgent needs in lower resource countries. There's HIV, there's cholera, there's multi-drug resistant tuberculosis, there's Ebola. You know, there are all these kind of big issues that need to be addressed urgently. So the longer term and frankly more complex medical issues like mental illness or severe psychiatric disorders end up being relegated and not addressed.

What we end up seeing are cases in countries like Togo, for instance, where there's virtually no health care at all. That doesn't mean you don't have people without mental illness. You're still going to have people with psychosis, you're still going to have people who are suicidal, who are hallucinating, who have all these other symptoms and conditions. So what do you do with that?

In that case, what we saw was people end up taking them to prayer camps and leaving them there because they're desperate. Family members are desperate, and these patients end up being chained to trees for weeks, months and sometimes years.

They’re left there without any medical intervention and the hope that they'll somehow get better, eventually. Hope that prayer might help and eventually they'll cycle out or whatever the case might be.

But that's an example of the level of desperation and level of lack of attention that exists. The fact that virtually no one has ever seen these camps from the outside is indication that there are important stories out there that just don't get told because nobody's telling them, nobody's looking for them.

I often say it's like low-hanging fruit.

We won the Emmy for best investigative journalism. I mean, I don't want them to take it back, but we weren't really doing investigative journalism. We showed up at a dump in Ghana and discovered that there were hard drives there filled with sensitive government information. We went to a dump in China and found horrible environmental conditions, went to waste facilities in India and saw toxic, dangerous things being done. But it was there, you just had to show up, there were no barbed-wire fences we had to climb over.

These are stories that are there waiting to be told, but just people aren't going and telling them.

WP: Several of the mental health professionals you encountered also seemed to be dealing with these untold or ignored diseases.

PK: There were these efforts by a Syrian psychiatrist that realized there was this unmet need in a Jordanian camp that he was in. There were lots of people suffering from Post-Traumatic Stress Disorder (PTSD), children as well as adults, and that nobody was dealing with.

Jordanian children get help from a Syrian psychiatrist for PTSD.

And there he was, a psychiatrist, who understands what they've been through because he himself had been tortured in Syria. So he understands intrinsically what's going on here and he realized he needed to help.

Since he's a psychiatrist, he was approaching it from that medical standpoint.

WP: But lots of other people you encountered seemed to take a religious standpoint when it came to mental health.

PK: Certainly religion and even more than religion, a sort of folklore, plays an important part in mental health treatment, frankly, all over the world – even to some extent here in Canada.

But if you have nothing else, then that ends up being the first and often only line of treatment that you have.

And again, it's not a critique or indictment of it.

In fact I wrote a piece for The Globe and Mail and I made an analogy that what Kadri, the Koranic healer in India who's featured in one of the stories we did, is not unlike what a psychologist does or a therapist does. He gives people who are suffering from some sort of mental health issues a safe space, a place without judgement or stigma, he listens, he gives them advice, he takes them seriously. That's what a psychotherapist does, Kadri just happens to be doing it through a religious context.

WP: Do you feel putting mental illness in a religious context helped people come to terms with it?

PK: Well I think that that's one of the things we saw.

I don't think this was in any of the pieces we cut, but in the Institute for Human Behaviour and Allied Sciences Hospital (IHBAS hospital) – which is perhaps the best mental health hospital in India – which is filled with educated and well-trained psychiatrists and doctors, we saw on more than one occasion doctors who were talking to their patients in very religious terms.

There was a young woman, a teenager, who was suffering from what seemed to be some sort of depression – she was wearing black, all black – and the family believed she had been possessed by a spirit.

Because of that she couldn't be married and it had huge ramifications beyond just the pain that she herself was suffering. It had potentially life-altering implications for her, and if she didn't get married in a traditional Indian way, it would be very bad.

So she came to the hospital and the doctor acknowledged that she had a medical condition and she said, ‘I'm going to give her medication and we're going to treat her in a certain way,’ but there's a lot of stigma to that, so she kind of went along with the interpretation that the family had of the possession.

So, it's interesting that it's better to be possessed by a ghost than it is to be mentally ill.

WP: Did you see any parallels between mental health care there and here?

PK: It's really easy for us here to look at the stories we've done and be judgmental about it.

But, now I'm talking for a moment as an American, we have two million people in prison in the United States. Something like one percent of the population is imprisoned and a lot of people in prison are mentally ill. Now, are they chained to trees? No, but they're locked in a cell. Is that really that much better?

They have a roof over their heads and they're not out in the wilderness, but they're chained up and very often not getting the help they need.

In Benin, people living with mental illness are sometimes brought to "prayer camps" by their families as a last resort, where they are left outside, chained to trees.

There are similar scenarios in Canada, although I think it's far better here.

A lot of people in prison who have mental illness are not getting any kind of treatment and they're essentially locked up and punished for their mental illness. So the optics of it may be different, it looks far more rustic, but it's not all that different in many ways.

So you realize that the whole field of psychiatry and psychology, clinical psychology, are in their infancy. I mean, Freud was alive during my father's lifetime. This is not an ancient science here, it's constantly evolving. If you look at the Diagnostic and Statistical Manual of Mental Disorders, the DSM, it's been revised five times, dramatically revised.

It’s been revised to the point where homosexuality was a mental illness not that long ago. When I was in high school, homosexuality was still categorized as a mental illness in the DSM so it's a constantly evolving science and I think that's part of it as well.

Because there's not a lot of understanding of mental illness, I think that adds to the stigma of it. It is a universal scenario and so every country is dealing with it and struggling with it in its own way.

So I think there's a lot we can learn from how other countries are dealing with it, both negatively and positively.

The other big thing we saw, the common thing we saw in all three countries we visited, was community-based mental health care. That seemed to be a really important part, rather than be this top-down ‘I'm the psychiatrist, you're the patient, I treat you, now go away.’ Having the community be part of the treatment, having a respected elder in the community be a part of it. Like in the slums of Pune, Bapu Trust (an organization in India that offers innovative programs to ease the burden of mental illness in communities) doesn’t take a clinical approach, they take a very holistic approach.

Women working with the Bapu Trust in India visit homes in the slums of Pune.

They don't categorize and say this person is bipolar, this person has schizophrenia, this person has whatever.

They say, this person is suffering a lot, this person is suffering a bit, this person is suffering a little. Someone who's suffering a lot, they'll figure out what kinds of treatments, including medical interventions, but also, like one woman we saw, they got the tea vendor to just be welcoming to her and give her a little bit of tea and give her breakfast. That was transformative, probably more transformative than any Prozac pill would be to a patient – just that sense of acceptance and a safety net in a community.

We saw that in Jordan, we saw that in Benin, it's the community coming together and being supportive of people who are really vulnerable.

WP: Do you think we’ll be seeing more community-based mental health care here?

PK: I'm not an expert in this area so I don't think I'm in a really good position to predict that, but I will say of what we've seen, the trend in other parts of the world is certainly community-based mental health care.

It's effective, it seems to be accepted in many places and it uses existing resources so it's not terribly expensive to do, and it also doesn't require first-line psychiatric medications which are largely unavailable, even in India where they have a vibrant generic industry.

Most places have an antidepressant and an antipsychotic and that's about it. They don't really have a lot of medications in rural clinics and places like that. You're not going to see this highly medicalized approach to it for a variety of reasons, and they don't just have the medications to do it.

WP: What do you hope people take away from this project?

PK: One of the amazing aspects of this project for me was that when we said we're doing something on global mental illness, so many people had a reaction like: ‘There's mental illness in other parts of the world?’

Like somehow this is some sort of mental luxury that we have to be depressed. People think you don't have time to be depressed if you need to be out in the field working in the developing world.

These are medical conditions just like diabetes or heart disease. Of course, there are variations in diabetes and heart disease and all sorts of other diseases around the world based upon diet, genetics and lifestyle, but people all over the world get all those diseases. It’s the same with this whole range of mental illnesses, whether they're environmentally induced like PTSD, which sadly is incredibly common now because there are so many refugees, or if they're neurochemically induced, like schizophrenia.

These conditions are a part of the human condition no matter where you are. To me, that was one of the big learning experiences of this project.

WP: Do you think this realization that mental illness is a global, human condition will help reduce the stigma that surrounds it?

Absolutely.

I was listening to Patrick Kennedy, the former Congressman whose father was Ted Kennedy, the other day. So Ted Kennedy suffered from different types of mental health conditions including alcoholism, and Patrick Kennedy has also suffered from addiction and other mental health conditions. He’s been quite forthcoming about it and even wrote a book about it.

Ted Kennedy was instrumental in passing legislation around mental health care. On one level, he was very supportive of mental health care, but he still had this attitude that it's a flaw in you that you just have to will your way out of it.

Despite the fact that Ted Kennedy was such a leader in this area, he still had a very old fashioned view of it. Patrick Kennedy, being younger and more modern, understands it as a medical condition and I think once you see it as a medical condition, part of the stigma disappears.

Not that long ago, cancer had a huge stigma. Most people didn't think cancer meant you were possessed by some evil spirit – they understood cancer was a medical condition going back a long time – but it was scary because there weren't a lot of cures and it was probably going to kill that person and not in a pleasant way.

Even the attempts to cure it were horrific. Chemotherapy made patients lose hair and throw up, so there wasn't a lot of hope around cancer.

Now that science has improved, nobody whispers about cancer anymore. People wear t-shirts that say ‘I Beat Cancer,’ people go on walkathons for cancer, nobody whispers about cancer anymore and I partly think that's because the science and medicine have evolved to the point where we feel like we can control some of it.

There are still lots of cancers that are not easily treatable, but there's a sense of progress.

I don't think we're quite there yet with severe mental disorders, but we're getting there. I think as that improves and as better interventions are developed and you can actually effectively manage schizophrenia – which some would argue is the most challenging of these psychiatric conditions – I think the stigma will go away.

WP: Is there anything else you’d like to add?

PK: One thing I'll mention that I think is important is – this is gonna sound like PR and it probably is PR, but take it as you wish – that as a journalist, and I've been doing this for 25 years now, is that we try to champion what we call knowledge-based journalism.

It might sound redundant to an outsider, like ‘shouldn't all journalism be knowledge based?’ but of course it's not.

Going back to my original idea of being a journalist on everything – I'll do math journalism one day, then political journalism and then a war correspondent – you can't do everything because then everything will be thin and superficial and you'll be kind of just grazing and never really digging deep into anything.

The nature of doing this kind of journalism, even the best enterprise journalism, is that it's still really hard to delve deeply into the scholarship and the research in an area.

But because we're in a university with this level of expertise, because have the luxury of time, and we don't have to worry about the bottom line, we’re really allowed to delve into the scholarship.

On this project we worked very closely with Dr. Videsh Kapoor, who's the Director of UBC’s Global Health in the Department of Family Practice. She was in our class, virtually every single class, and was in the field with us in India. She called out the students, and frankly the faculty members, when we were veering away from the science or even some of the ethical issues.

So granted, that was an incredible luxury, but I don't think we could've done this project in any other way. It would've been a very different project if we couldn't have tapped into the brain trust that UBC has and that obviously other universities have as well. We were able to tap into it here and really ground our reporting in the science and in the medicine and in the scholarship in a way that few journalists are able to do.

That's the longer term goal of this Global Reporting Centre, to do major enterprise global journalism in partnership with leading scholars.

That's the way we're going to see some really deep journalism.