my talk today is about cycles and
t-shirts specifically about three cycles
and for t-shirts the first cycle that I
will talk about today is that of
children’s mental illnesses children are
happy are carefree and that’s how we
think of our own childhood and the
childhood of those around us and yet
children’s mental illnesses are real are
common in our treatable conditions let
me start with a real part anxiety
disorders addiction autism those are
just three within the letter a and I
could continue through the 32 letters of
the alphabet telling you the enormous
amount and diversity of these disorders
the toll that they take on children and
their families they are quite real and
they have a lifelong impact they are
common again we tend to think of the
part of the rainbow when we think of
childhood of sunny days of carefree
wonderful days and yet we know that
approximately one in five children in
New Haven in America and across the
world have some form of the serious and
impairing mental illness
one in five these are our children these
are the children in our communities so
these are not rare conditions even
though many tons are unspoken they’re
not visible but they’re there they’re
very palpable now I’m not here to talk
about the rainy day and rain on your
parade this is a day of celebration and
excitement so I’m here to talk also
about the fact that they’re not only
real and they’re common but indeed
they’re treatable there’s a lot that we
can do for these conditions and what we
have in our toolkit today as mental
health professional
he’s really extraordinary I personally
have had the privilege of dedicating my
professional career to diagnosing
treating these conditions and to helping
individuals and their families affected
by let me tell you a little bit about
myself before I do so I’ve already
covered the first cycle and that’s a
cycle of children’s mental illnesses now
let me tell you a little bit about
myself as I mentioned I am a child and
adolescent psychiatrist I was born and
raised in Mexico where I went to medical
school and I have been privileged in my
training and education after University
in Mexico I had postgraduate training in
Miami at Harvard and then 20 years ago I
came for my first and only job out of
training here at Yale I’ve been very
fortunate Yale has been a wonderful
community and as I have grown
professionally my day job I direct an
inpatient unit for some of the most ill
children the proverbial tip of the
iceberg when we think about the severity
of these disorders not only have I been
able to do this as a clinician taking
care of in divet individual children and
families but my blessings have been many
my cup virtually has veritably runneth
over I have been able to be the editor
of a leading journal I have edited
textbooks both in English and in Spanish
I have been able to be involved at the
American level at the international
level traveling the world to help
children and their families with mental
illness but the time that I was 45 I had
an endowed chair I was a full professor
of this magnificent institution by the
age of 45 I had arrived I was here my
life was full I was counting my many
blessings what could possibly be wrong
and yet
there was something there was something
that I couldn’t put my finger on but I
found out at that time that my t-shirts
didn’t fit and these are the first two
t-shirts that I mentioned I knew that
something was not right because of my
t-shirts now in some sense I am talking
about actual t-shirts but more
importantly I’m talking about
metaphorical t-shirts you see as an
academic in a medical school of this
great university I was commonly asked
what t-shirt do you wear now that
question came from well-meaning friends
and colleagues who are trying to say
what is the focus of your career
what are you specializing in yes we know
that you’re a child psychiatrist fill in
here engineer architect musician you’re
a child psychiatrist but what is your
specialty and what they meant by that is
one of two t-shirts what is your focus
what is the what that you are studying
or what is the how what is the method
through which you’re studying it and you
see these t-shirts didn’t fit right
first of all because I liked everything
and when you like everything you can’t
focus on something narrow and academics
force you in some way to focus on
something that that didn’t get right so
throughout my career have worn many an
ill-fitting t-shirt trying this
diagnosis and that diagnosis this
condition that condition didn’t feel
right similarly that of a method of how
you do that how do you approach a
condition I tried things like crunching
big datasets
I dabbled in brain image in genetics in
some of the many medical wonderful tools
that we have our disposition today to
treat this illnesses that I mentioned we
don’t only or don’t just use medication
and talk therapy the two main things in
our toolkit but we also have the power
of the genome of brain imaging
big data artificial intelligence I
couldn’t bring any one of those I like
them all and of course this made me feel
like a dilettante like wanna be like an
imposter I found out that I was in good
company and it wasn’t the only person
feeling imposter syndrome at this August
University he was a pretty common
condition and here I was diagnosed
Titian that I am after all my doctor
making diagnosis and I felt that I had
arrived at the diagnosis my t-shirts do
not fit I was in an uncharted part of my
life indeed I was lost I couldn’t find
the coordinates in my career those
coordinates that put the what and the
how the focus and the method you know
was really lost uncharted that was my
diagnosis however that didn’t quite tell
this story because having figured that
out and come to peace with it being
comfortable with that there was still
something wrong there was still
something ill-fitting and I realized
that that sense of Uncharted was not
only a geographic being lost but it was
a physical being on unease the symptoms
that I identified first of all were
these reverberating loops of thinking
that went nowhere
thinking cul-de-sacs not particularly
grim thoughts just thoughts that didn’t
go anywhere and kept on repeating
themselves another symptom is that I
couldn’t clear my mind I couldn’t just
think of nothing and get into that
proverbial Zen quiet space I couldn’t do
it and the third symptom was an unease
that then became an ache that became a
pain it was somewhere around here was
somewhere in my chest somewhere in my
abdomen I didn’t know what it was but it
was with me day in and day out things
started to feel and move slowly and I
didn’t know what was going on
now in some ways I should have been able
to diagnosis right away not only because
my professional career is dedicated to
diagnosing these very conditions not
only because I have lectured and talked
about these conditions but because these
conditions are ripe in my own family and
indeed in myself
they have been years before my family
tree lights up with people’s dealing
with these conditions and I recognized
that many years ago I had as well but it
took me more than a year to actually
recognize these symptoms and to put them
together I was depressed I had
depression and I haven’t been able to
diagnose it from the time that I made
that diagnosis till the time that I
picked up the phone to get treatment was
another interminable time and picking up
that phone call that phone to make that
first call was one of the hardest things
that I’ve ever done but I did and I’m
happy to tell you that Here I am the
happy recipient of the very pills that I
prescribed the happy recipient of the
talk therapy that I give and I’m fully
recovered and I’m happy and I’m doing
well and depression is way back in the
rearview mirror of my life and it’s a
wonderful thing so that’s a second cycle
the cycle of my own mental illness the
cycle of my own depression the cycle of
me now there was a third thing that held
me in addition to medication and talk
therapy and that was a bike a cycle
before I tell you that let me go back in
time a little bit I was born in Mexico
City as I mentioned I was born in 1966
and by 1970s you can see the swinging
Columbia this was a bicycle and for
those of you who are not familiar that
is a banana seat that’s how I learned to
ride a bike in a banana seat and this
next photograph is not of me personally
but by the high fashion statement of the
color you can see that it could have
been me
1970s vintage bell-bottoms this was a
time a great time to be alive and this
was a great banana seat to ride now I
remember I remember viscerally the first
time that I got this bicycle my first
bike without little wheels and I
remember my father who was not
particularly athletic I don’t know that
he knew how to ride a bicycle but he
gave me this gift and I was so excited
and I can remember getting unto that
banana seat and my father pushing me am
I saying poppy poppy don’t let me go
don’t let me go I can do this I can do
this
and as I turn around guess what he had
let me go and I was moving I was flying
in that sense of independence of being
in two wheels untethered wonderful it’s
one of the strongest memories that I
have my childhood that sense of
independence I didn’t become a great
cyclist in fact it took almost 40 years
so I wrote a bicycle again but I did and
this is the third cycle I’ve talked
about the cycle of mental illness and
children about the cycle of my own
mental health and this was a third cycle
in fact it was about breaking the cycle
I tried to find a way of breaking those
two cycles for children for myself
through this cycle in with all through
serendipity a friend of mine Michael had
bought himself a big bike as part of his
midlife crisis and he said come let’s go
I hadn’t ridden a bike in 40 years but
as soon as I got there I felt that I was
a seven-year-old boy in Mexico City
riding again I was hooked I was in love
and that was a great part of what helped
me to get out of this cycle of my own
depression and I would say that it’s the
strongest part that keeps me afloat
these days now I wanted to put all of
this together and I didn’t know how to
do it but I thought that there was a way
and this leads to the third shirt
t-shirts are something that you wear
underneath but a jersey is something
that you put out that you fill something
that tells a bit of your affiliation to
a team and here we move from a t-shirt
to a Jersey
because he sees we tell our young people
to focus on what it is that you want to
learn what technique the what and the
how what we don’t tell them what hadn’t
been told to me but what I came to learn
is that it’s not only about that that
that you want to do but that if you open
your ears you will call you will hear
the calling of your team you will listen
and find that there’s something to be
given now the team that I’m talking
about here was a team of child
psychiatry children’s mental health but
it was also very concretely Team USA see
I’m originally from Mexico but I became
a naturalized citizen I love this
country and I wanted to embrace this
country in what it had given back to me
in us how you listened and I listened I
knew that there was a big need out there
and need to give back to children and
need for me to give back to my country
to understand it and this is the effort
[Music]
over the span of two and a half months I
covered fifty two hundred miles
I just turned 52 so that seemed to be
fortuitous about a hundred miles a day I
climbed over two hundred and twenty
thousand feet of vertical elevation and
I’m happy to tell you that we raced over
a quarter of a million dollars
so about $1 per foot money that will go
to Children’s Mental Illness these are
some of the statistics of this wonderful
bike ride through which I got to know
this wonderful land through which I was
able to give back and I guess that as I
think of that third jersey I think of
this iconic photograph iconic as part of
my trip Here I am at the country’s first
National Monument that’s a Devil’s Tower
monument the Theodore Roosevelt
inaugurated as a First National Monument
so it certainly is fitting for my USA
Jersey to be in this beautiful special
place but I’m also wearing my Yale
Jersey and I feel very proud to be part
of this community so I had heard some
calling from Yale from the u.s. from
child psychiatry that was wonderful
this photograph in some ways is iconic
to me because my children tell me poppy
you never smile showing your teeth in
fact you’re a very bad smiler you might
be a good child psychiatrist but you
don’t know how to smile people smile
showing your teeth and that and yet you
smile like this that’s not a real smile
but when we look at the photographs of
your trip across the country there’s
perma-grin all over you such as here and
that is wonderful now it’s great to be
able toward this Jersey this third
jersey there were the first two t-shirts
there’s the t jersey of the where and
the whom are gonna be the people you
surround yourself with and yet there’s a
fourth and final jersey because there’s
something wrong with this at the end of
the day this jersey existed before I
came along
Yale University existed before I came
along
and that yellow jersey certainly was
around so I would say in closing that as
you think of your own career and you
think of your what is your focus your
how you’re gonna do it you’re where and
whom is gonna be your team those are the
three t-shirts that you need to figure
out but there’s a fourth one and it’s a
fourth one that we’re not told much
about and of course that’s the t-shirt
or the jersey that doesn’t yet exist
it’s a Jersey is a t-shirt that you will
create for your own self I was very
fortunate to be able to put this one in
literally to create a shirt of my own
I’ll break the cycle that was wonderful
this is not your Jersey this is probably
not my last Jersey but it’s something
that I created and I invite you all to
think of that now if you feel uncharted
and lost and you don’t know how to do it
I would give you two prescriptions first
tried to find out where your skill set
is and intersected with service and that
is probably a good place it certainly
was for me the skill set of child
psychiatry and the skill set of service
of giving back to my community
or in the words of the Christian
theologian crystal power
think about your deep gladness the deep
gladness that I had in my banana seat
for example and the deep hunger out
there in the world try to intersect that
deep gladness with that deep hunger in
that is where your vocation lies and
there I would suggest is where your own
very t-shirt may be thank you very much
[Applause]
[Music] you