Translator: Tanya Cushman Reviewer: Peter van de Ven
So 16 years ago,
I was working nights as a stand-up comic.
And I'm not going to lie:
right now I'd much rather be holding the microphone in my hand
than having it strapped to my face like some nerd doing a TED ... Talk.
(Laughter)
Comedy is full of crazy highs and lows.
Some nights you feel like you own the world.
I got to perform at Red Rocks.
I got to work sold-out shows
with people like Chelsea Handler, Dave Chappelle and Jimmy Fallon,
with crowds so hot
it's like they were eating out of my hand.
But other nights,
those are what comics call "hell gigs."
Like a three-lane bowling alley in Douglas, South Dakota,
(Laughter)
where the sound of the townies playing pool in the back room
pretty much drowned out the smattering of laughs
I was getting from the nine drunks half-watching my show,
sleeping in my car
because the Motel 6 they put me up in was so infested with bedbugs.
Yeah, all for a whopping 200 bucks.
And believe me, back then,
that barely covered my bar tab, much less gas for the drive home.
(Laughter)
But even when it sucked, the comedy life was amazing
because I was getting paid to make people laugh.
And best of all, it provided the perfect cover for my misery.
You see, a lot of people don't realize
there's a huge difference between being funny and being happy.
I was really funny.
And I was really miserable.
Lot of comics I knew were the same way.
Night after night, we'd go on stage and tell drunken stories
about how much our lives sucked and how miserable we were,
and people laughed.
They didn't know we were serious.
I vividly remember one night.
I did three shows at the Comedy Works in downtown Denver,
and I killed each one.
And then I went home,
got drunk and spent the rest of the night researching ways to kill myself.
Eventually it got so bad that I wrote a note and picked a date.
And then I bought a gun.
Thankfully, a neighbor saw me crying, and intervened.
She saved my life.
It's crazy how close I came.
But what's even crazier
is that almost dying by suicide wasn't my rock bottom.
My rock bottom came
when I tried to access care in our snarled mental health system.
Long wait list, yeah.
(Audience)
You've been there.
Long wait lists, misdiagnoses,
medications that made me feel worse instead of better.
Hell, I even had a shrink fall asleep on me in the middle of our session
(Laughter)
and then have the nerve to ask me for my copay.
That was my rock bottom.
And I'm not the only one.
Right now in the United States,
80% of people with a mental illness don't get adequate care for it.
See, this is our mental health system -
on a good day.
It's a simple case of supply and demand:
more cars than the highway can handle,
more patients than our system can treat.
We wait until someone's dangerously sick,
and then we scramble to find them care in a system that's already overwhelmed.
And if you need inpatient help?
I'm sorry, but sometimes your best bet is to just go to the airport,
fly somewhere else.
It can be that bad.
So what's a solution?
Just build more clinics and train more providers, right?
Well, it turns out that's kind of like addling lanes on the highway:
it will ease congestion for a short period of time,
but then, as more people start to drive,
it gets worse than before.
It's something that urban planners call "induced demand."
And as we get rid of stigma
and that remaining 80% tries to access care in the system,
it's going to get a lot worse.
Now, don't get me wrong.
We have amazing providers, and we need lots of them.
But just building clinics and training providers?
That's not going to solve anything.
We cannot clinic our way out of our mental-health-access problem.
After I got diagnosed with type II bipolar disorder
and I got the medication and therapy that I needed,
I eventually co-founded the National Mental Health Innovation Center
to test new ways to make mental health services of all kinds
more accessible to everyone -
when they need it and before they need it.
Now, we had a suspicion that technology might be able to help.
Now, technology has always been viewed as the enemy of mental health.
But what if that was wrong?
What if technology could be part of the solution?
And then one day, we got a call from an unlikely source,
the Department of Corrections in Alaska.
(Laughter)
They said, "We're struggling with a number of issues
related to mental health in our prisons.
Do you think you guys can help?"
What?
Alaska?
Prison?
Yeah, I had been to Alaska,
but I sure as hell had never been in a prison,
and I was really content to keep it that way.
(Laughter)
But then, as fate would have it,
not ten months later, I'm standing there with two of my colleagues
outside of the Spring Creek maximum security prison
in Seward, Alaska.
Now, Alaska in the wintertime is really cold,
it's really windy and it's really dark.
I mean, I'm talking like hour-of-sunlight-a-day dark.
And all of that messes with your mood and your sleep.
People stay inside more and they socialize less,
and it can make you violent or even suicidal.
So what you do if your environment makes you violent and suicidal?
You move, obviously.
(Laughter)
Not so simple when you're in prison.
In prison, oftentimes,
the staff have to resort to things like sedating medications,
or even worse,
the use of solitary confinement to control inmate behavior.
We thought that meditation might be able to help.
It's effective at regulating mood,
it can help ease anxiety
and it can help control aggression.
But it can be hard to learn and even harder to stick with.
And getting a bunch of inmates to meditate every day?
Yeah, that was going to be a tough sell.
I mean, Alaska is a long way from Boulder.
(Laughter)
But VR can help.
In virtual reality,
your brain processes the virtual image much like it does a real image:
the image in the headset stimulates your visual cortex,
the headphones stimulate your auditory cortex
and the hippocampus organizes everything spatially.
The resulting sense of presence
effectively tricks your brain into thinking that you're actually there.
In VR, you can meditate anywhere you want to:
on the beach,
by a beautiful waterfall,
in the woods.
Hell, you can even meditate on the moon if that's your thing.
(Laughter)
So we presented our hypothesis to the commissioner,
that by using VR, inmates could escape to a beautiful place
and meditate more effectively.
They liked the idea.
Well, except for the word "escape."
(Laughter)
So we're standing in the common area,
and the superintendent points to the gymnasium and said,
"Hey, there's a couple of inmates in there, waiting to come out.
Why don't you go in and explain what we're going to do?"
So I walked in all cool and confident
only to discover that at the Spring Creek Correctional Facility,
a "couple inmates" apparently means 20.
Yeah, and I mean, look at me, this chubby nerd, alone with 20 inmates,
yeah, who pretty much spend every waking minute doing chin-ups.
Any one of them could have broken me like a toothpick.
So, instinctively, I'm just looking around the room, scanning,
trying to find the exits in case I have to make a run for it.
And then I remembered: a duh, it's a prison.
(Laughter)
So instead, I just said the dumbest thing I've ever said in my life:
"Hey guys, how's everybody doing today?
You all ready to have some fun?
Okay, show of hands,
how many people here have tried virtual reality?"
Half of them had been in since VCRs were a thing.
But one by one, they came in to try meditating and VR,
and it was incredibly powerful.
One of the first guys to try it told us he had been in for nearly 40 years.
We put the headset on him,
and for two minutes, he was transported to a beautiful, sunny mountainside.
When he took the headset off,
he had tears welled up in his eyes,
and he said, "I forgot what free felt like."
Another guy told us that the total sense of peace and calmness that he felt in VR
was something he had never experienced in prison.
Today, we're using virtual reality
to help inmates meditate, in three prisons in Alaska,
on a pilot study.
(Applause)
Eventually, we hope to integrate more personalized content.
Imagine how powerful it would be if we could crowdsource video
that would allow inmates
to meditate in a place that they have a deep emotional connection to.
A native inmate could meditate in the Inuit village where he grew up
or even participate in traditional ceremonies, using 360 video.
We believe that over time, this program can help us
lower the use of sedating medications and solitary confinement.
(Applause)
But what about recidivism?
You know, that whole revolving door on prisons?
Over 70% of inmates who get released from prison
will commit another crime and go right back.
Prisons have tried a lot of different things to lower those rates,
but nothing's had much of an effect.
One of the inmates I was talking to
told me a story about how unprepared he was for life on the outside
when he got released 10 years earlier.
He explained that in prison, your personal space is everything.
It's all you got.
So if somebody violates yours or you violate somebody else's,
there's consequences,
prison consequences.
I didn't ask him what prison consequences meant,
but I'm pretty sure it wasn't a good thing.
(Laughter)
So he gets out, and his dad takes him Christmas shopping at Walmart.
Yeah, you see where I'm going with this.
Christmastime at Walmart is the very definition of mayhem.
They go in, and it's packed, and everybody's rushing around,
and they're knocking stuff over,
and they're pushing and shoving and rolling back prices,
and eventually, they're bumping into him.
Everybody - kids, grownups,
hell, probably even the greeter, for all I know -
and they're bumping into him and nobody apologizes.
Nobody stops to say, "My bad."
They just keep going.
And he snapped.
Prison consequences.
He beat the shit out of some guy.
Now, anybody who's ever been to a Walmart at Christmastime
has on some level wanted to punch somebody.
(Laughter)
I get it.
But unlike the rest of us, this guy actually did it.
He had just gotten released, and he went straight back to prison.
Now, if you've been in prison for, say, 30 years,
basic tasks that we take for granted -
like crossing a busy street
or using the self-checkout at the grocery story
or going on a job interview -
they can trigger fear, panic and anxiety.
If you have a crippling phobia like fear of spiders,
your therapist might use a technique called "exposure therapy."
You might start out talking about spiders and what they look like.
Maybe in the next session, they have you draw a spider.
And eventually, before you know it,
you can have a live tarantula sitting in the palm of your hand.
By gradually exposing you to the thing that you're afraid of,
you can learn to overcome that fear.
Well, it's simple enough with spiders, but what if you have a fear of flying?
Good luck trying to find a therapist
that will go to the airport with you every week.
But in virtual reality,
you can go to the airport, get on a plane, take off and land -
right in your therapist's office.
And multiple published studies have shown
that it can be just as effective, or even more effective,
than traditional exposure therapy.
And it can cost less, take less time and be made more personalized.
So if VR works to help people overcome their phobias,
it made sense to try it out as a platform to help inmates close to being released
learn skills to make that transition to life on the outside
easier and less traumatic.
Right now, we're working with a New York-based startup firm
to pilot test a series of VR experiences
that enables inmates to learn critical skills to thrive on the outside,
things like resolving domestic conflict
or dealing with a job interview
when the interviewer is grilling you about your time in prison,
or resolving conflict when someone bumps into you in a bar
or a Walmart.
Now, the reason I'm telling you about our work with prisoners
is that very often,
prisoners have some of the worst access to mental health services.
So if a solution works for them,
there's a good chance it'll work for the rest of us.
And it is.
Right now, doctors are using VR to de-stress in between patients.
Patients in hospice care
are using it to check items off their bucket list before they die,
and kids in hospitals are using it to manage pain
without high doses of medication.
(Applause)
These are my sons, Mark and Sam.
There's a genetic component to bipolar,
so I know that there is a better-than-average chance
that one day one or both of them will develop it,
and that scares me.
I also know that people with untreated bipolar
have a suicide rate that's 30 times higher than the general population.
That scares the shit out of me.
But prevention, early intervention and quick access to great care
can lower those rates.
And that's what motivates me to turn that fear into solutions.
Technology isn't the enemy of mental health;
it's a scalable solution.
I know because we're seeing it work,
and in this way, we can make life better,
for me, for Mark and Sam, for inmates in Alaska
and for everyone else caught in that bumper-to-bumper traffic.
Thank you.
(Applause)