Ep. 157: Roy Richard Grinker - Truly, Nobody’s Normal!

Sucheta Kamath: Welcome to Full PreFrontal exposing the mysteries of executive function. As you have heard me speak again and again, this podcast is fueled by three specific goals. One is to understand and explain the nature of executive function, the role of prefrontal cortex. And really to think about ways to connect individual experience to larger context of the world in which we operate. The second is to really help the future self, which tends to be this nebulous, confusing, vague entity. But everything we do today can serve the betterment of the future self. And we also need to recognize that we are in a company of many, many, many current selves, who are also trying to better their future selves. So, living in a collaborative way, we can make life better for all. And the third is to really create a personal playbook that can allow individuals to achieve success, in spite of the challenges that we experience. And also coming come to terms with the fact of reality that we all have challenges. Well, that's why this podcast is going to be particularly spectacular, because my guest has specialty in the area of understanding. Normal, if there is anybody normal, I just wanted this as, as I set this up, it reminded me of a of an experience I had, I had gone to visit a cousin of mine and growing up in India, we had rooftops and you could stand on the rooftop and get a little aerial perspective or aerial glance at the community or the world around you. And I happen to be at the time around 10:30 in the morning, where typically, moms have sent the family off, you know, particularly stay home moms, and they are done with their breakfast and even lunches and they're getting ready to kind of do their little chores around the house. But if there was a child with disability that mom would be kind of taken care of. So, there was a grown, maybe 18-19. I couldn't tell but a young boy with definite disability and she was giving him bath. And instead of giving bath in the bathroom, she had, she had looked like she had a habit of taking him to the rooftop, because it was really difficult to contain him. And from far Of course, I was young. I didn't understand what was going on. But definitely, it was embarrassing for all three of us when we locked eyes, because she was not expecting anybody watch this little private encounter with dealing with an adult grown man who is her son, and she's giving him bath. And the young man also was embarrassed, and I was embarrassed to have seen something supposedly private. What was so, clear to me that she he was much bigger and taller than her. He was flailing but it was not done with anger. And she was getting hit in the face. She was completely drenched, wet. And he was resisting, even though I don't think he was resisting. Anyway, the reason I share that that was my first encounter in in life where I was aware that people have to manage people who appear to be unmanageable. But I don't think that lady had brought that son outdoors to the park, or ever taken him with her shopping. I bet particularly knowing from what particular context I came from he ever had invitation to be part of something larger. So, definitely a feeling that was invoked in all three of three of us was shame. So, with that experience, I just want to you know, my work is as a rehab specialist, as a speech language pathologist always has been we're helping people. And one of the things that I have worked hard is to really meet lock eyes when people are bringing their most private matters. And with that, welcome. I would love to welcome Dr. Roy Richard Grinker. He is a professor of anthropology and International Affairs at the George Washington University in Washington, DC. He was born and raised in Chicago where his great grandfather great grandfather and father worked as psycho analyst. He graduated from Grinnell College and then eventually went on receiving a social anthropology degree, PhD at Harvard University. He has authored many books, including the book that we will be focusing on is nobody's normal, how culture created the stigma of mental illness. And finally, he has many accolades that we would love to talk about. But he is a 2008, recipient of the National Alliance of mental illness can award for outstanding contributions to the understanding of mental illness. So, I bet his great grandfather and his father will be very proud of bridging the cultural impact of mental health if he was not, has not worked with individual patients. So, welcome to the podcast. How are you today?

 Roy Richard Grinker: I'm good. Thanks for having me. The story you told, was very rich, I feel like I, I want to talk about it. It's not my story. It's your story. But I, but it's, can I say something about it?

 Sucheta Kamath: Please do. And you know, it's so, funny. I have never told this story to anyone, except when I read your story when you work as a volunteer at 16? And how? And maybe you can share that and tell us what do you think about this story? And yes, there has been a lot of shame around people who are different, at least the community that I grew up with. So, I would love to know what you were thinking about it?

 Roy Richard Grinker: Well, the thing that I was thinking about, and I'll get to the story that you mentioned in a moment, was that whatever we see who we see from a particular perspective, had you not gone up to the roof, had your neighbor not gone up to the roof, you would never have seen this. And so, visibility and understanding the diversity of human behavior requires that we take different perspectives. There's an old story about the anthropologist, French anthropologist Maurice Greil, who always wanted to have different perspectives. And so, he had his assistants hold his ankles while he peered over the tops of cliffs to look down and see how things were happy. What would things look like if he was looking down on people. I mean, the story tells us how much he trusted his assistance, of course, but it also tells us that there is no pure vision, we always see from a particular place, and our world structures, our vision, whether it's the sign on the road that says that this is the scenic outlook, this is this place, you should look or the cardinal directions on the top of, you know, the Empire State Building, this is east, this is West, and so, on. And so, part of nobody's normal, is about how our world has structured the way in which we look at other human beings. And the argument of the book is that the ongoing stigma of mental illness isn't because of a lack of education or ignorance or, or lack of awareness. It's because we have get to really come to terms with how our world has structured how our cultures have structured the way in which we judge other people. And I had a similar experience to yours when I worked at a psychiatric hospital when I was a teenager. And I happened to see a patient there who was one of my classmates. And I was pretty much raised to think that mental illness was just a typical part of human life that most people at some point in life will have a mental illness. And so, I was quite stunned, when all hell broke loose. And there were all these phone calls the principal, her parents, my parents, what was going to be done with the fact that I had witnessed the fact that this person had a mental illness. And it was really at that time that I first understood the extra burden of a mental illness that is, first the condition itself. And second society's treatment of it, society's negative valuation of it. Think of how much suffering and how much hard work goes into dealing with that stigma.

 Sucheta Kamath: And first of all, I think that that was kind of I mean, I felt for your younger self, who got yelled at for just happenstance, witness, a young classmate to be admitted to a hospital. That was nothing to do with you trying to, you know, kind of peek into somebody's private life at all. But I think the strong reaction, as you write wrote there that it kind of compounded her suffering, who was already in a mental Institute to get treatment, who now has added burden of having to tackle this knowledge that somebody my peer, my contemporaries saw me. So, you know, I think that was one of the fascinating and most profoundly meaningful thing that I got from your book, that instead of thinking that mental illnesses are made up, or everybody's sick, your book actually kind of does the Goldilocks effect, you know, there. It shows that there is a long-standing historical evidence that says, mental illnesses have been there with us since the dawn of time, or maybe as long as humans have had their bodies, their brains and their culture. But you also kind of show where the stigmatization began, where we began to look down upon things. And so, before we jump into it, can we maybe just kind of define two concepts So, what is the concept of culture? You're an anthropologist and, you know, hold the universe has depended on anthropologists to define definitions of culture and Williams Oh, well, I think there's been a debate in was debate in the beer field about what the culture it's it is. So, is it culture a category or aspect of social life? Or is it a system through which we connect and build and create symbolic meaning? And is culture something you learn? Or is culture just something you land, and you become part of the culture like how should people who are listeners may not have ever thought about tackling mental illness from the lens of culture. So, maybe we get to talk about that. 

 Roy Richard Grinker: The anthropologist Clyde Kluckhohn once published a book called The Concept of Culture, in which he gave 150 different definitions of it. So, Oh, God, so, it's short. But I think the one of the things that I would emphasize, especially in the context of this book, is that what we should think of, when we think of culture is that which is not nature, that is not, you know, ingrained in us somehow instinctually we are not hardwired to be mentally ill, we are not hardwired to stigmatize others, we're not hardwired to believe in this or that God, or practice this, or this, or that kind of marriage system, or to love this or that kind of person. It is culture that teaches us those things. And so, what I find particularly empowering about the concept of culture, is that if we made it, we weren't born with it. But if we made whatever phenomenon we're talking about, then we can also change it. And it explains as well, the fact that there's so, much diversity, that there are places in the world where loving someone of the same sex is considered part of normal, and there are parts of the world where it's considered abnormal. That's because culture makes it. And so, we can often look at other places in the world. And we find that kind of diversity. And it helps us to reflect critically on our own lives. So, many people think that anthropology is the study of other cultures. And that's true, but it is, that's only half the story. The other half is the study of other cultures, to come home, and see our own world in a new light, and to look critically on it as something that we've made, and therefore we can change.

 Sucheta Kamath: Yeah, and I think that, you know, the invisible ness of the culture, maybe the reason that you may not even understand the impact it has on you, you know, Roy Baumeister, who has been a guest on the podcast said that culture has guided nature, and human nature was designed in part to be capable of culture. So, that inter relational ways to think about culture is a thank you for clarifying that. So, my, my second question is then stigma. And, and also, the notion of norms. The minute we talk about large bodies of collective bodies of humans navigating their relational, you know, the way they relate to each other, we need some invisible rules that guide us. And then if we take them too far, then they can kind of restrain us, but if they we don't have any rules, then we it'll be chaotic. So, there must be some responsibility that culture plays in self-regulation or executive applying your executive function. Do you see that connection?

 Roy Richard Grinker: Yeah, you know, we, we have. We do have a nature of course. And as the as one of my former teachers, Mel Connor put it, you know, nature holds culture on a leash, but it's a very, very long leash, to give a lot of freedom. And one of the things we did develop through human evolution, was the ability to feel anxiety, to pay attention to things that are going are potentially dangerous to us. And that's a normal healthy thing to be anxious. Right? If I did not have anxiety, I would not look both ways before across the street. So, it's good to have

 Sucheta Kamath: It's a motivational system. Yes, yes, very essential.

 Roy Richard Grinker: Yes, exactly. And to be able to pay attention, and have sustained attention at risks in the environment, but then the question becomes, well, who are we afraid of? And why are we afraid of them? And sometimes we're afraid of things not because they affect us in terms of our survival, but in terms of things that are symbolically important, like prestige, and status, and honor, and so, on. And so, we come to apply a lot of these cognitive capacities, to two things that really aren't a matter of survival. They're, they're a matter of, of culture and what you referred to before as symbolic meanings. So, I tell the story and nobody's normal of the great child psychologist Erik Erikson, who had a child with he and his wife, Joan had a child that was born with Down syndrome. In the 1940s. At the time, they didn't use the word Down syndrome, the word was Mongoloid idiot. And the birth of this baby Neil frightened him so, much. He was so, terrified that having a child with a disability would tarnish his reputation as an expert on quote, unquote, normal child development, that they he and his wife sent this boy Neil to an institution, a residential institution, and when they came home, they told their children and their friends and family that there was the baby had died at birth. And so, this boy, and then man lived his whole life without his family even knowing that he is brothers and sisters knowing that he existed, because there was so, much shame involved.

Sucheta Kamath: Unbelievable.

Roy Richard Grinker: Yeah, terrifies you think there's only, you know, only 70 years ago.

Sucheta Kamath: And you write that they will they the child, there was no picture of this child. And here's a child psychiatry, I mean, just the juxtaposition position of these, you know, the dissonance. I mean, I know, you know, the, I don't even know what that that must have meant to the parents, I'm sure they experienced a great deal of agony. But I think what I love is you talk about that. One of the things that is very powerful in the way you write about this is you I am quoting you, you said stigma isn't in our biology. It is in our culture. It is a process we learn from within our communities, and we can change what we teach. And so, definitely in 1940s, when that little boy was born, the culture did not empower. Dr. Erickson. So, tell us a little bit about stigma. And what does stigma play any role in how we regulate ourselves? Or is it just a mindless process, and until we examine it, then only it can be changed.

Roy Richard Grinker: The stigmas really complex, right, which is why I wrote the book, because we use the book. So, we use the word so, loosely, that we often don't stop to think about all its definitions, and all its various types, and its historic, its history. But when you're born and raised in a, in any community, you internalize those values. And so, you actually don't need somebody to say to you, oh, you're sick, or you're different, or your whatever you're, you know, somehow cognitively incapacitated, or you're, you're a bad person, you can do it all by yourself, because you've internalized those values. And so, there are many people who have mental illnesses, particularly those that involve what society perceives as a lack of self-control, a lack of impulse control, like conditions that involve psychosis, or difficulty with impulse control with say, substance, use of substances, alcohol and drugs, were, those are the most stigmatized disorders, because they, they really are an affront to the values that we have created over the past few 100 years of individual self-control. So, stigma is not something that is separated from our culture. Right. So, the stigma of mental illness in Nepal could be that it is a sign that you have bad karma, or a sign that your family is somehow impaired. Whereas stigma, mental illness in the United States, may be stigmatized as you having a lack of self-control. So, every society can stigmatize we're the ones who put it off, but it does so, in various in very different ways. Right, we used to stigmatize being African American in a different way than we do. Today we used to stigmatize homosexuality differently than it is today. And so, as culture changes as history changes, we, we, we, you know, we do things differently. I start the book with the phrase, the past is a foreign country, you know, they do things differently than.

Sucheta Kamath: I love that. I have a whole lot of quotes by you, by the way, they're just incredible ways that you explain, you know, as I was thinking further, one of the things that struck from struck was my first reflection was that is poverty, the first true defect. And yeah, you know, culture seem to somehow seem to abandon the poor thinking that there's something wrong with in being poor. And then it justifies itself from why exclusion is allowed. And of course, then we can talk about the evolution of capitalism, but, but definitely, I see lots of wrongs. In the way poor behave, even eating food is considered a bad behavior. You know?

Roy Richard Grinker: If you go back to the first asylums that were built in Europe, in the 1700s, in, in France and in England, for example, if you go back then you find that the people who were brought to asylums weren't necessarily people who were poor. But they were people who didn't conform to the ideals of capitalism. Because the ideal human being was one who was autonomous didn't depend on others. I mean, if you were a dependent in a rich family, you know, you were as inadequate as a dependent in a poor family. And so, the first asylums were actually comprised of just a hodgepodge of people who are unclassified and unset, and not separated. So, you had in a similar asylum, you'd have someone who, who was mentally ill and didn't work, someone who had a physical disability and couldn't work, someone who was a beggar a popper, a criminal substance abuse, or a sex worker, whatever it was, they were all lumped together and only when scientists for the first time had all of these people living together in these asylums, could they start to typologize them and separate them. But so, I would say instead of poverty, it's, I would go back to the mandate of the first asylums, which was to house the idol. So, it wasn't just it wasn't really poverty, but it was the idol. Now, when we look at mental illnesses over the course of the last couple of 100 years, yes, mental illness is associated with poverty. Because people who are poor are more vulnerable, they're more vulnerable to trauma, poverty, in itself is a trauma. There is a cascading complex relationship between mental illness, a kind of downward drift that psychologists and sociologists refer to, that creates poverty. There is just ethnic and racial discrimination. So, I think it's more important to take, you know, that intersectional view, that gender, race, wealth, whether you're urban or rural, whatever, you know, all of these different factors kind of come together. But they come together with the common theme, that disability is the inability to be auto, the autonomous, responsible, productive individual, that capitalism dictates.

Sucheta Kamath: Got it. So, I think that idea that one's capacity to partake in and serve the workforce goes into determining the worth and value of an individual.

Roy Richard Grinker: Yeah, I think it's not to take a it's not to take a position that capitalism is bad, or that capitalism created mental illnesses. But it is true that capitalism created the conditions in which, under which we could think about mental illnesses differently. Think about what we value and what we don't value normal and abnormal are really variants of the good and the bad, right? what we what we think is good and what we think is bad. And we define good and bad, normal and abnormal, according to what we're looking at. If we get back to the roof top example of the perspective, right? You were looking at one roof top right, I tell the story and nobody's normal of the millions of dollars put into scientific studies to produce the care a set of characteristics of what the normal American man was. Right? And at Harvard University, the researcher picked as their, their sample, the Harvard freshmen male class, right. And so, normal became the whatever the Harvard male freshmen class was, which you can imagine it was, it was male and white and privileged. And that that becomes normal. So, it's wherever we look, you know, it's, it's, it's a, it's our vision. And one of the reasons to that I, I talked about Neil Erikson, Erik Erikson son with down syndrome, not having a photograph of him is because we, we like to keep the variability of human behavior, invisible, often.

Sucheta Kamath: Yeah. And, and that is a really true, inhuman way of treating that. Because if you don't see, then your belief is that the little that I see must be so, out of the norm, that then you begin to see why are you experiencing you know, so, actually, it's, it's so, interesting. So, I, when I was eventually came into 10th grade, and started tutoring a young girl in the neighborhood. And she, she was known as a blue baby. So, of course, she had asphyxia at the time of her birth, and she developed this speech impediment, and she appeared slow. So, her speech was very deliberate what I would now call dysarthria. And she was she had learning disability, and, and so, out of pity, I know the reason why mom, my mom said, You, I should go and help her out a pity, like, oh, poor thing, you know, like poor family kind of thing. Once I sat with her, she was a math genius. She had fantastic mathematical ability; nobody had spent time with her to even give her that credit. She had language difficulties now that my speech language pathology had, but it's of course, hindsight. And I was blown away by her capacity to hold intelligent conversation, I wouldn't have given a time of the day if this forceful introduction was not made. And eventually, when I went to college, I supported myself by tutoring kids, because I love just loved kids. And what I found, guess who's getting tutored anybody that these are not really abnormal. These are people who are just not fitting a typical way of learning. And so, what we are doing is we are kind of somehow putting that burden back on those people to find ways we haven't normalized this experience, which is terrible.

Roy Richard Grinker: So, I think that what you're saying is absolutely true. And by the same token, the visibility of those differences, is what is helping to reduce stigma, particularly with people on the autism spectrum. And to, um, to permit people to live lives that are very different than the ones that their ancestors lived. You know, if you took Elon Musk, who was recently on Saturday Night Live and say, what's that? Yeah. And he said, He's the first person, you know, with Asperger's to host the show. So,

Sucheta Kamath: Rather, one who accepted it, he said, yes, who publicly accepted. 

Roy Richard Grinker: Now, as you know, were you to just sort of blind you know, put him in a double-blind kind of interview. Um, he might do very poorly in that interview. He may be, you know, he has a little bit of a physical tic, where he rolls one of his shoulders, he has a very difficult time speaking empathically probably in an interview, we talked mostly about himself and not really have the social skills, and probably would do terribly in the interview, and he would leave the interview and the interviewer would never know that he just, you know, interviewed somebody who was, you know, brilliant, and an innovator. And so, what we're finding is that the best ways that organizations are helping to reduce the stigma of people with developmental disabilities and mental illnesses, now is by coming up with new creative interview processes, new hiring practices, that do not derived from pity. They do not derive from charity; they derive from an increased acknowledgment that innovation and creativity comes from cognitive diversity. And that so, when I interviewed people at JPMorgan Chase, when I interviewed people at the cybersecurity company, DSC, they, they said, look, you know, we are, we're here to make money. We're not, we're not, we're not here to say, oh, we're going to do a nice thing and bring this autistic person into our workforce. No, we're going to bring autistic people into the workforce, because they have a different way of looking at the data, and they're going to help us. Of course, those you know, there have been hiccups in one case, JPMorgan Chase, the autistic workers were doing so, well that they were done with their jobs really fast, faster than their non-autistic peers. And they didn't know, they didn't have the social skills to ask for more work. So, they sat around looking bored. And all their performance report said not working hard. Because, right, but, but anyway, this just gets back to the, to the point that there are ways to reduce stigma. If we take a different perspective on people's abilities and disabilities, and we all have, you know, my own executive functioning, I have a great difficulty, I have great difficulty switching from one-on-one working on one thing to working on another because I get hyper focused. And if I'm working on something, and then my, my daughter, or my wife says, hey, can you help grab this, you're taller? Can you grab this thing from the shelf? It's like, how can you do this to me? When I'm in the middle of working on something, and I can't get out of it, um, we all have our strengths, and our challenges. And the question is, can we adapt those strengths to things that give us meaning, or help us feel successful, and my hyperfocus has made has been very adaptable for me as a professor, because I can sit and really focus on writing a book, or writing an article intensively now, I can't get taken away from that very easily. Um, but at least I'm in a profession that accommodates it.

Sucheta Kamath: You know, this reminds me, first of all, thank you for that hyperfocus because your brilliant work needs to be written, condensed into some nuggets that we can digest and really think and reflect particularly in the field that we are in, you know, when you talk about healthcare professions, I think there is such urgency to define or categorize a disability so, that you can inform a plan or intervention or whatever you want to call it. But sometimes I see a lot of rigidity. And one of the things I love in my field, particularly my work with traumatic brain injury, is we call it functional rehabilitation. That means really providing help where the need is not normalizing anything. Because let's say if somebody is speaking with a stutter, or somebody who has difficulty writing, why teach writing, if they can actually learn to dictate and become type their emails by dictating, so, a functional retraining is to really determine the context. And to determine the context, then you really need to take inventory or, or develop, do a deep dive into the way people live. And that part is something greatly joy joyous to me. What I see though, in education, there's a true dilemma. And I'm wondering how you think about how to educate a classroom of neurodiverse children, which teacher looks at teaching as classroom management, because she's managing varied levels of attention, and varied levels of intention. And it's a terrible setup.

Roy Richard Grinker: Because, you know, it's just not the best even in special education. You know, I have a daughter who she was diagnosed with autism when she was just over two years old. And she's struggled, you know, throughout her life with social skills and developing language and so, on. And we have in special education, you have this word, the Individualized Education Plan,

Sucheta Kamath: IEP, yet it's never really individualized. You know, it's, it's been learning is all group learning to be?

Roy Richard Grinker: Well, it's how can the individual be assimilated into the norms of the classroom? Right? Um, and, and that's another thing that varies tremendously from culture to culture. So, there's a wonderful set of studies by Sarah Harkness, and Charles Super, who are at the University of Connecticut. And they've done these studies on how teachers and parents to think about children with the same characteristics in different cultures and so, they looked at kids with what would be diagnosed as Attention Deficit hyperactive disorder, right. So, ADHD, and they found that the kids with a particular high level of hyperactivity in Sweden were seen as difficult. Kids with that same level of hyperactivity in Italy. We're seeing as curious and active Wow. And so, um, and, uh, kids in some other countries who are hyperactive, were seen as easy because you didn't have to tell them what to do, because they're going to do what they're going to do. I mean, so, the same kids, right, but very, very different experiences. And then we see this also, not just across cultures, but across history. In nobody's normal, I tell the story of a boy named Patrick Feral, who is now a man, he's like 28 years old, whose uncle had autism and exactly justice as Patrick does. Same symptoms, like same symptom profile. But Raymond, his brother, his uncle, lived his whole life in the basement of his mother's house, never went out, didn't know how to use public transportation, never held a job, had no friends, no one in the community knew him, he was hidden away, Patrick does Special Olympics goes to the local community pool. He volunteers at the library. He knows how to use public transportation. He has a paid job, part time filing papers at a congressman's office. And he's just enmeshed in a whole series of activities and networks that we never would have seen before. Because in the past, people said, Oh, this person's just incapable. Let's just shut them away. And we now say, wait a minute, everybody has strengths and weaknesses. Where can this person be? integral? How can this person be integrated into community life and achieve a meaningful life for himself or herself?

Sucheta Kamath: I love that story. Because in addition to not only like, absolutely opposite lives, these two related people in the lifespan of maybe 40 years, have complete different new experience. But I love the story of Patrick's friend who goes to college, and you say, can you share that? Because I think that's where, what, like people who are hungry to normalize everything should really, really pay attention to that, because our lives are richer because of our association with people who are different. So, yeah, yeah.

Roy Richard Grinker: So, um, Patrick had these two friends who were, you know, what, you know, you would call neurotypical, they had no and, and far as I know, they had no, no one disability, no disability, no mental illness, whatever. They were neurotypical, and they never hung out with Patrick, with their other neurotypical friends, but they did hang out with Patrick by themselves. And what Patrick's mother told me was, they didn't make Patrick normal. But they made it normal to be friends with Patrick, right, and to develop a relationship. And when one of these girls, Julie went to college, and she was telling a friend about her friends back home, and she mentioned Patrick, and the person said, you have a friend with autism. And she looked at the person because she knows she lived in his very insular, fairly insular life in suburban Maryland. And she looked at this, this person in college, he said, you know, like, how can you not have a friend with autism? And I'm really just seeing so, much that's positive. I'm, I, I've, on occasion been accused of being a Pollyanna. But I'm just I'm just really optimistic. I look at Patrick versus his uncle, look at my daughter. And what's happened to her, I write about this in the book, from, you know, her birth 1991. To today, in terms of how we've changed our views around disability, when you're Oh, Naomi Osaka comes out and says that she's had this depression, when Prince William, Prince Harry, Lady Gaga, other celebrities come out and they talk about their struggles. This is just music to my ears, because it's not to say, I'm not saying I'm glad they're having struggles, right. But it is that 

Sucheta Kamath: They were having anyways; they're talking about it.

Roy Richard Grinker: Right? I mean, everybody's going to, we're all going to have struggles. And it's not just celebrities. I mean, this stuff. I think celebrities are important, but it kind of trickles down. Right? There's the student who comes out in front of my classroom and says to everybody at the first day of class to 200-300 students. Hi, I'm so, and so, I have Tourette's disorder, I might say something out of the blue, it might surprise you. It might even be offensive. I'm really sorry. I'm working, you know, to control it, whatever. I don't think that person should apologize. But the person is advocating for himself. Um, when the student says to me that the best day of her freshman year was when she was diagnosed with ADHD. Like, why because for the first time, nobody saw our you know, as peep somebody saw her as other than lazy, you know, or stupid when people take ownership when people advocate, when they make the make humanity, the truth of humanity visible, then whatever they do, whether it's an autism or depression, it is a tide that is going to raise all boats.

Sucheta Kamath: And I really liked the comparison you made that we have quite found our rhythm in when it comes to physical illnesses such as common cold, if I say if I'm blowing my nose in front of you, you won't say, Oh my god, what's wrong with her? You know, and if I tell you that, you know, I just have to, I don't know, I have to go for dialysis, that the language is there, you understand the process, you don't think there's something wrong with me or it's my fault. And you're seeing it, and you document this journey of psychiatric disorders that somebody can willingly say, you know, I just completed feeling blue. And instead of writing songs about it, and never talking about actually feeling blue it might be good to show the range of common cold of psychiatric condition to you know, severe illness that requires treatment. What are the things I did with? 

Roy Richard Grinker: Yeah, I was just going to say, I mean, I think you're totally right, we're making a lot of progress. And I liked your use of the word sort of getting our rhythm. We have a long way to go. Right. Um, we have gotten to the point where we compliment people on their eyeglasses, use, oh, I love those glasses. That's to display a vision impairment, right? It's a disability. We don't yet compliment people on their hearing aids, we probably most people don't compliment someone on their wheelchair. We haven't gotten to that point yet. But we have gotten to the point where we understand that to be human, is to exist on a variety of different spectrums. And there are times when you go over into an area where you need help, you deserve help. So, at what point does, you know being shy, become being so, introverted, that you can't function in society? At what point does sadness become depression? It's like a color spectrum, right? Sometimes you guys,

Sucheta Kamath: I love that comparison, when you said, you know, yellow and orange are next door neighbors, but you really don't have a defining line that is yellow, stop being yellow. Now it's orange, it's a little bit of that

Roy Richard Grinker: The way to figure that out is do you, you say, uh, well is Have I gone over? You know, am I so, anxious that I can't go to work anymore? Okay, you know, that now you need help.

Sucheta Kamath: Functional limitation, right? 

Roy Richard Grinker: It is not to say that you are a bad person to be branded, as you know, with an anxiety disorder, but you have to have a diagnosis to the treatment. But just, you know, increasingly, when people think about our existing on a spectrum, it's an invitation to say that we are all the same, we are all human, and we are going to be on that spectrum somewhere, somebody at some time, who's just got, you know, sort of typical healthy anxiety will become so, anxious that something doesn't go right in their life. Maybe it's a relationship or something else, or, or sadness becomes something that is some, such a significant depression, that it's defined as clinical. There are functional impairments. And you should, and you should get help. But, um, you know, I tell the story at the very end of the book, of the importance of visibility and of taking ownership of one suffering and one struggles, because if you do so, other people will recognize that in themselves as well. And I tell it through the story of Hester Prynne, you know, the Scarlet Letter, the very, you know, the 18... I don't think people expected at the end of a book on mental illness to be reading about The Scarlet Letter, the, the letter A that, that this character has to wear on her blouse as a punishment for adultery. Right. But she, there's this amazing book, I'll read the passage to you,

Sucheta Kamath: I would love I was going to say, would you please read that to our audience? This will be their impetus to actually get the book and read it. Yes, please.

Roy Richard Grinker: Because I mean, I think it's an interesting passage, because it's, it's about when you are open. Other people then not only see themselves in you but respect you. And, and so, I think, anyway, I just read it. Yes, there's a remarkable passage at the end of Nathaniel Hawthorne's 1850, The Scarlet Letter, when, after a long absence, Hester Prynne returns to the scene of her crime. As a punishment for adultery. She had worn an embroidered Red Letter A on her breast. But after all those years, not even the harshest judge would force her to continue wearing it. She decides if her own free will to keep it fastened to her blouse, because the narrator tells us quote, "The Scarlet Letter ceased to be a stigma, which attracted the world scorn and bitterness and became a type of something to be sorrowed over and looked upon with awe, yet with reverence to the village now saw her as a source of comfort and strength, not as a person stained with sin. When people suffered the dreary burden of a heart, especially in matters of love or misplaced passion, they visited her cottage for counsel, they knew Hester would understand their pain." The goal of the punishment was to marginalize Hester. But by claiming adultery for herself, as if, with the pride of a 21st century LGBTQ advocate who has reclaimed the word queer from the bigots, she makes the letter a mark of dignity and experience, rather than of shame. Um, I mean, it could go on. But the point that I'm making is that the places where we're really seeing the diminishment of stigma is where people say, I'm, I am not going to allow someone else to define me. I'm going to define myself the way I want to be defined. I'm well into it. And that's, that requires a lot of power. And it requires bravery. For children, it requires good role models and teachers and parents who teach people to advocate for themselves.

Sucheta Kamath: And you know, you have done that for your daughter, I can tell the stories you tell about her even her speech she gave in front of 3000 students. Yeah, that was so, touching to me.

Roy Richard Grinker: Well, that was an amazing moment, because you could see stigma appear, and then disappear within a matter of minutes. So, she was the first student with a disability to ever be asked to give a speech at her high school. And at her graduation, and there were 3000 people in the audience. And when she started to give the speech, she has an unusual voice and an unusual rhythm to her voice cadence. Yeah. And she, it's so, interesting, because, you know, in the verbal kids in the past, never got speech therapy, you know, 20-30 years ago, because they're like, oh, they could speak. So, kids with Asperger's, you know, they weren't getting speech there. Anyway, so, Isabel starts, and she's got this unusual rhythm and syncopation, and there were a lot of these kids and their families, of course, who didn't know Isabel, in such a big school, and she was in a lot of self-contained special ed classes. And you could hear whispers, you could hear murmur, I write that murmurs, those are the sounds of stigma. And then she gets to, they're wondering, you know, who is this person? Why is she speaking in such a strange way? And then she gets to a point in her speech, where she says, people with autism like me, and the room quiets down. And all of a sudden, it quiets down, because she's no longer bizarre or weird or enigmatic, oh, she's someone with autism. Now I understand. I have a framework, I have a framework that advocates, and scientists and others have helped to de stigmatize over the past 20 years or so, and then I've learned either as an adult or as a child is something that is a spectrum that can be all the way from somebody who needs you know, residential care, but it could also include Elan Musk. And now I get her now I understand her, and she finishes her speech, and she gets a standing ovation. And this is the point that it is visibility that decreases stigma, and it is invisibility and secrecy that causes stigma to exist.

Sucheta Kamath: And you know, in that moment, when you said the, from my executive function lens, you know, that murmur that whisper the snicker is a cultural nudge, to self-regulate, go away, don't, don't proceed, because you're going to make a fool of yourself. Because these are the kinds of invisible self-regulatory nudges we are sending. And that requires a lot of courage for her to stand above it. And well to proceed, pushing the shade the minute you have, and that's the power in I don't want to use the word label, but power in using a symbol, you know the word that captures the condition and then that condition which if you have a reference and context, you can accept it. And she doing it is so, powerful. You know, one of the things in my executive function training work or the therapy, if you may call it is I have students prepare a letter, a letter they can send to their teachers and their peers if they dare, if they wish. It's not essential, but the practice of disclosing who you are and what your challenges are in the way you want to define it, you may notice me sometimes late being late, I apologize for being late. But that's not because I don't care, because I must have run into a snag. And that kind of difficulty is really critical for us to share with everyone.

Roy Richard Grinker: So, one of the kind of ironic things about the pandemic has been that some people with disabilities, particularly autism, who work so, hard to kind of manage, and try to figure out their social skills and how to react to people and how not to be teased or seem to be on, you know, weird or unusual, that they have actually done better socially, at home, because they don't have to work so, hard at school emotionally. And they, you know, they come home from school and be so, exhausted that they just have to, they can't do anything. But now, people I mean, I'm not saying that the that the people with disabilities have done better in the pandemic, because lots and lots of people have done terribly, and there's been lots of kids who benefited from school, and the structure of school and the and special education and so, on, have really lost a lot of functional skills as they've been at home. But there is a portion of people who are aware of those murmurs and know, when people are shaming them, and they've, they've felt even more social at home, because you know, we're all struggling socially on zoom, you're kind of leveled the playing field a little bit. So, you know, we have to clarify, we have to go slow, nobody knows when to interrupt or how to speak and when to, to listen, and when to mute your mic or not. So, in some ways, that's actually been a little bit of a help to some people who have different cognitive and social skills.

Sucheta Kamath: You know, what I would like to see change to reduce the burden on so, to speak, this neurodiverse children, particularly children, as we put them through educational experiences, is the parents really amplifying their acceptance of diversity, because the bullying and teasing and you know, picking on people who are awkward, different, and their value is diminished, based on a particular set of skills, which are over emphasized, which is, again, is the horror show for every teen who is, you know, you being popular, or staying popular is a risky business. And but that that particular age of evolution over emphasizes that social appearance and personal appearance. And I wish that can something we do, we do a better job, you know, as a community when my kids were growing up. Because I worked with children on spectrum and adolescent on spectrum, I had two role models, or as a model I would use to kind of give them opportunity to interact. And so, we had a young boy who was 11-12, and my boys were 11-12. And younger one was 10. And so, he was obsessed with, he was on the spectrum. He was obsessed with merry go round, no, Ferris wheel, I guess. And he knew all the stats about it, every single thing and so, so, we, as a socializing activity, we would go, I would take him out and ask my children to accompany and tell him, tell them to interact with him. And I cannot tell you how beneficial it was for my children, let alone him. He had the opportunity to be with some accepting children his age who were accepting, but my children had this incredible insight into working with somebody with Tourette's and somebody would severely ADHD, somebody who's just odd and awkward, and their ability to be seen with people. And not feeling shame that I know this guy, or I know this girl was real therapy I feel they received and now you know one of the things my friends tell me about my children is they're so, they're so, human is the best way they can describe my children. But I feel what they are doing is they have incredible level of acceptance of the difference. And but I wouldn't have known this to do as a parent if I did wasn't in this field. So, I really appreciate you kind of talking through the stories and really nudging us. So, my last question for you was this really profound insight that you bring, which is you say that historical transformations are rarely the product of deliberate action. They're result of multitude of factors that act in concert to shape our beliefs and behaviors, often without ever being aware of what is happening until it has already happened. And so, this knowledge that you laid out a history through since Middle Ages, I feel people even in my business, you know, people who are in helping professions have no historical perspective. And I feel unless and until you read about history, you will never understand that this personal evolution and cultural evolution go hand in hand. So, do you have any thoughts about how we can shape people's understanding of cultural hold through some proper education, and not needing specialization such as becoming, you know, PhD in anthropology or undergraduate degree in something? How can we bring that into the normal understanding of our own suffering?

Roy Richard Grinker: I think it's really important for us always to, to question why things are the way they are? Do they have to be that right? You think about how many you use a metaphor of marble. So, there's more somebody find some marble, in the hills of Tuscany. And you can only do certain things with that marble. I mean, it's got its limitations. You can sculpt it in certain ways, because it's really soft. But it can also break, because it's so, soft. But it is up to us to decide whether or not that piece of marble is going to become a bathroom floor, or a grid column, or Michelangelo's David, but it's the same raw material, but we could do whatever we want with it. And we need to question those things. When we, when we see somebody critical of, of somebody who is transgender, you need to say, well, why is that, that somebody would be critical of this, and when and anthropology helps, because we can look around the world. And we can find many communities in which being transgender has a role in society. It's not necessarily stigmatized. One of the examples I give in the book is from my work in Namibia, where the same human being this man named Tom, so, I write about love, the clinic has schizophrenia. But in his village, he's the innocent victim of supernatural malevolence. And so, when we see how other cultures operate, we then can gain insight into the constructed nature of our own. And we can say, so, the way we're doing things isn't the way that we have to do things. It's not the only way or the right way, or the normal way. There are societies in which women are sexual aggressors, ideally, like the maneuver more in, in New Guinea, and men are passive. So, we know that we can have we can have different sorts of gender relations. We know that there are societies in India, where they're an Indonesia, where there are three, four or five different genders. And we know that even 150 years ago, we had no concept of homosexuality. There were people who committed, you know, crimes, which were same sex, sex, but it wasn't didn't brand, the person as a particular kind of being a homosexual. In fact, homosexuality doesn't even enter the Oxford English Dictionary until 1976. Because what was judged before was the act, not the person. So, when we look at all of this difference, we come back to our own society and we say, okay, now I'm going to change it. And I know I can change it, because the world exists as an incredibly diverse set of beliefs and practices. Some places are more diverse than others. India's far more diverse in the United States, right? Yes. One of my professors used to say nothing's indigestible to India, by which he meant that you could come up with almost any cultural practice. And there probably be some you can imagine that there's some place where you can fit it in India. But that's I'm sorry, I'm rambling but I'm...

Sucheta Kamath: No, you're not. I'm tracking you.

Roy Richard Grinker: I'm just wanting I'm wanting to say that in answered your question that what we need to do is understand the power we have the power we have to create.

Sucheta Kamath: And you know, raise those people children are next generation to recognize that power that your question you must become the questioning person, and not the person who complies or learning doesn't mean you imply, you know, it's funny about you mentioned India. So, in India, when you do a Puja, or like auspicious ceremony, you need at least 13,000 items, okay? But the hack is, you can use five rice grains and substitute rice grain for everything. So, you need all those things, or you need nothing. So, one of the things I feel like cultural flexibility I have learned is by simply growing up in India, so, I was blessed to witness our ways, all different ways to live and not live, and be criticized for it or be completely accepted for it. And one small thing about the marble analogy that you gave a metaphor, it's so, funny, there's a book I recently read called from marble to flesh, the biography of Michelangelo's David and the, the stone or from the quarry was identified and was thought to be defective and was left aside for 150 years, it was only Michelangelo decided to make a David out of it. When other all the sculptors had said pass, it's imperfect. So, I just love that story. That ties back into actual Michelangelo's choice when it comes to David. So, as we end our fantastic conversation, I would just love to know what has influenced your thoughts or in other any book recommendations you can make for our audience, so, they can expand their own thinking about things?

Roy Richard Grinker: Well, of course, of course, I want to tell you tell people that my book is available.

Sucheta Kamath: Of course, in addition to your book, of course, it's a brilliant book.

Roy Richard Grinker: It's available on audio, as an audio book, as well, and then Kindle and it's going to be published in a number of languages by the end of the year now the number of foreign languages. But

Sucheta Kamath: Congratulations, by the way,

Roy Richard Grinker: I've really found incredibly inspirational, the work of Steve Silberman, his book Neuro Tribes to really understand the way in which people who self-identify as neuro diverse have helped to shape the way in which we understand human differences, particularly cognitive differences. It's an amazing book, Neuro Tribes. And then the other is Andrew Solomon's, Far From the Tree, which is a huge book. But because each chapter is about something different, where somebody has a child is very different from them might be child with dwarfism, a child who's it was a deaf child whose blind child whose criminal child has autism. with autism, you can read each of these chapters kind of in isolation to each other. And it's so, inspiring because we really see the power of love and the resilience when a parent or parents have a child who is not what they imagined. And well and how they how they deal with the expectations that are both personal and cultural, and the realities that sometimes the child falls far from the tree.

Sucheta Kamath: Well, thank you for those amazing recommendations. I'm really grateful for your time today. And we will be linking we'll be linking your book and show notes in this podcast. So, listeners, thank you for joining me today. If you love what you hear, please share, please Like us on our Facebook and Instagram and, and certainly write us a review. Thank you, again, for being here with me on Full PreFrontal. Let's continue to expose the mysteries of executive function and really determine all that superpower within us needs to be harnessed. And we need to keep cultural context in mind. So, thank you. Thank you, Richard, for being with us. 

Roy Richard Grinker: Thank you