From patient to professional
After his own experience of schizophrenia, Daniel Fisher became a psychiatrist to humanize the mental health system and help others find their voice and recover.
By the age of 24, Daniel Fisher, the brilliant son of a brilliant doctor, had an undergraduate degree from Princeton University, a doctorate in biochemistry from the University of Wisconsin, a job at the National Institute of Mental Health and a new wife.
“My life, on the surface, was going better than well,” says Fisher from his home in Cambridge, Massachusetts, where he has practiced as a board-certified community psychiatrist for more than 40 years. “I was kind of a star, in my family and in my field. And I was in an incredible hurry.”
There were reasons for his sense of urgency. As his career was taking flight, his father’s health began to deteriorate due to Huntington’s disease, an inheritable condition that left Fisher anxious over “how many good years I might have left.” An even stronger impetus was his younger sister, who was hospitalized at age 8 with anorexia. Finding a “cure” for her was the reason he switched his major during his sophomore year from history to biochemistry, on the advice of a medical friend of his father’s, who believed the key to understanding mental illnesses lay in the body’s biology and chemistry.
Today, at 78, Fisher acknowledges the cracks beneath what appeared to be a glittering surface: the great “emptiness” he felt inside, the suppression of his emotions, his limited social capacities. So when his wife left him not long after their marriage began and at the height of the tumult over the Vietnam War claiming he “didn’t seem to be in touch with himself,” the prodigy fell into a devastated downward spiral.
Searching for answers, Fisher dove into psychoanalysis, modern dance, radical therapy and contact improvisation, and experimented with marijuana and mescaline. His life separated into two paths: a science nerd by day as he put on a white coat and went to the lab; a hippie on nights and weekends as he donned bellbottoms, listened to Crosby, Stills, Nash & Young and pondered the meaning of life and love.
“All this turmoil brought up so many questions,” Fisher recalls. “Like, what was I doing going to a laboratory when there were so many human problems around? How can I ever find the answers to what’s going on in my consciousness and in a person’s heart? I can never find them in a test tube.”
After a bad trip on mescaline and two nights of no sleep, he had the sensation that there were globes of light in his head and his heart that he simply couldn’t integrate. Then … “Bam! They came together and I went out cold,” he remembers.
He awoke unable to read, unable to fathom what his roommate was doing (shaving), experiencing delusions of death and dying and imagining he was Einstein reincarnated. His terrified family took him to the psychiatric unit at Johns Hopkins, where his father was on the faculty and where he imagined he was being brought in not as a patient, but a doctor. When they showed him a bed, he couldn’t fathom how the ward’s chief psychiatrist could work in such a manner.
Eventually Fisher descended into catatonia, unable to talk, eat or respond, and was treated with a dose of Thorazine that “knocked me out cold for two days.”
This would be the first of four similar episodes of “going into another reality” over the next several years. The second, again precipitated by the loss of a relationship, sent him into catatonia for five weeks and to the Bethesda Naval Hospital – the only place he could be hospitalized because his public health service at NIMH was his ticket to escaping the war draft – for five and a half months.
“I have long hair, I’m a freak, a hippie, I’m anti-war and here I am ‘captured’ by the Navy,” he says. “I was just terrified and it felt like punishment.”
When he had stabilized, Fisher did begin medical school and, still in a hurry, completed it in three years — though not without two other “episodes” of alternate reality. This time, however, he had a psychiatrist— a Ukrainian doctor who been through his own deep suffering during WWI — who was empathetic and empowering. The doctor encouraged Fisher to proceed with medical school (“I’ll be at your graduation”), allowed him to go off anti-psychotic medication that was causing severe side effects and helped his patient believe the schizophrenia he had been diagnosed with was an intermittent, rather than a permanent condition.
“He said, ‘I believe you have the capacity to lead a full life,’” Fisher remembers. “He believed in me. And that’s a very essential part of people’s recovery.”
Today, Fisher prefers not to refer to that time as a period of “mental illness,” but rather as “a challenging experience that was as helpful as it was harmful.”
“I’d had four episodes of going into other than consensual realities, but they were probably necessary for my growth, because I was trapped in a reality that was very oppressive to me,” he says. “I was very fortunate to have friends, family and a therapist who all believed in me. Not everyone is so fortunate. But this period of breakdown can be a breakthrough. And for me, it was a breakthrough.”
He completed his psychiatric residency at Harvard Medical School and Cambridge Hospital, one of the more liberal psychiatric programs in the country. He chose the facility not only because it was eminent and had a reputation for a more humanistic approach, but also because one of the early “ex-patient” advocacy groups, the Mental Patient Liberation Front, was based in Boston.
After reading a San Francisco Bay area publication, the Madness Network News – a newspaper put out by the Network Against Psychiatric Assault (NAPA) — he wrote the organizers, ex-patients and psychiatric survivors Leonard Frank and Wade Hudson, sharing his “lived experience” as well as the fact that he was doing a psychiatric residency. He asked to join their effort. They wrote back to say he was welcome as an “ex-patient,” but not as a psychiatrist.
“They didn’t want to contaminate their movement with any professional, even if that professional had lived experience,” Fisher says. “So once again, I was straddling two worlds. By night I was getting to know all the advocates and change agents, and by day I was expected to hospitalize and involuntarily commit people when I didn’t believe in involuntary commitment.”
Fisher stayed the course, knowing that his knowledge of both sides of the spectrum might help him create the alternative routes to recovery he has dedicated his life to ever since. In 1992 he co-founded the federally-funded National Empowerment Center, where he still serves as executive director, and from 2002-2003 he was a commissioner on the President’s New Freedom Commission on Mental Health. In both capacities, he preached a philosophy that people can and do recover from conditions like schizophrenia and that it is only by being allowed involvement and control over the decisions in their lives that they are able to regain the necessary sense of self to live productive, independent lives.
“The Empowerment Center’s main mission has been to bring hope and the reality of recovery to as many people as possible all around the world,” says Fisher, who, prior to the COVID pandemic, was a frequent speaker across the county. “And they should be looking at the people who have survived and recovered for insight.”
Though Fisher is not opposed to medication when it’s necessary, his treatment focus remains on the human spirit, the need for hope and love, and the support of others who are compassionate, understanding without becoming controlling or enabling. Twelve years ago, those beliefs led him to create “emotionalCPR,” an educational program designed to teach lay people how to assist others through and beyond an emotional crisis.
CPR in this case stands for “connect, emPower and revitalize.” The process involves embracing seven “intentions,” among them, deep listening, an awareness and sharing of feelings without analysis or intent to “fix” and nonjudgmental dialogue to explore ways to return to wellness and connect to community. In his practice, where Fisher freely shares his personal lived experience, he has welcomed a form of treatment called “open dialogue,” that has had great success in Finland. It involves all members of an affected person’s family or close circle coming together as equals to share their perspectives and embrace their own roles in their loved one’s recovery.
While his work with patients and advocates has only underscored for Fisher the value of his psychiatric history, trying to convince the medical establishment that lived experience is as important as traditional pharmaceutical or analytical approaches has mostly been an exercise in futility. Most institutions have firmly rejected sharing Fisher’s philosophy with psychiatric medical students or residents who might embrace a new attitude about recovery, rather than believing mental health conditions are life-long, permanent illnesses.
“I would love to reach them, but they are hermetically sealed,” says Fisher, who has nevertheless been allowed an adjunct professorship at the University of Massachusetts Medical School. “The professionals are so regulated, so frightened that another perspective might come across, they won’t even allow it to be spoken.”
And while Fisher appreciates the “peer recovery movement” that has, in recent years, allowed many more people with lived experience to serve as counselors to those in recovery, he’s frustrated by the “glass ceiling” that stalls many of those peers in entry-level positions.
“Peers can play a role if given a platform and credibility,” he says. “But sometimes, the more successful peers are, the more resistance there is to their advancement. Professionals are threatened by them, and with good reason. Because when you’ve been in those alternative realities, you can reach someone that someone who hasn’t been, can’t.”
Today Fisher continues to profoundly believe that implementing a different belief system about mental health challenges could lead to better outcomes and fuller recoveries.
“Often, we’ve interviewed people about their recovery, about who the people are who’ve believed in them,” he says. “And often, they are not the professionals. I hope one day that the professional training will change so that it doesn’t teach that these are incurable, intractable conditions but that we who’ve had these experiences can be the teacher. Not only that we can be. But that we should be.”