good evening everyone. and welcome to the strand bookstore. my name is nancy basswiden i'm owner of the strand along with my dad, fred bass who usually can be found in the buying desk in the main floor.

90 years ago, my grandfather benjamin bass founded strand on fourth avenue around corner he was an area that was known as book row. it ran from about the 1880s to about the 19 -- 70s and at its height 48 bookstores. today we're still run by the, my family. we're soul survivor of decades of big box stores, amazon, ebooks, and a we hold our 18 miles of books of new, rare, and old. and tonight i am delighted that we're going to hear a trulying inspiring story from the hallings of the psychiatric ward right here in new york city. when a mentally ill inmate is too sick to handle, they are sent bellevue hospital psychiatric prison ward.

doctor elizabeth ford read about her experiences in this new memoir, sometimes amazing things happen. this is a place where problems in our society faces with the incarcerated and mentally ill come together and then as doctor ford pointed out last night in the daily show, amazing doesn't always mean good. this i'm delighted that this important book is already number one on thumb biography best seller list. [applause] so here to introduce dr. ford is owen doctor howard owen who worked along side dr. ford in the department of psychiatric psychiatry at nyu school of medicine and sits on the board of directors at fountain house and tell us about fountain house in a couple of minutes. i want to say how much i do

admire most of your work you work in one of the most challenging careers possible. caring for those in our country that our country often abandons join me in welcoming dr. owen to the strand. [applause] >> right i want to thank -- i want to thank you and the strand for being here for this event. there are two reasons why i'm here, the first is because i'm a very old and dear friend of elsz ford. and second is because -- i'm also an old friend of fountain house. fountain house is not as old as the strand. it was -- it was first established in 1948 by a group of people who had been patients at the rockland

rockland state hospital. and they came back to new york city and wanted to create a place for themselves where they wouldn't be shunned and stigmatized where they would have their own place. one of the main problems for people who suffer from serious mental illness is that they often feel lost and that -- they have no -- they have no place at all everyday society. fountain house on 47th street provides the place of people with serious mental illness. it's a place to form strong relationships, a place to pursue meaningful work. a place to pursue your education and a where you're valued for what you can do and whether focus is on health and wellness and not on symptoms and illness. so that the ultimate aim of

fountain house is to help people sure view their goals to be able to thrive in society. if you're not familiar with this, we have a table over here that has -- two that can tell you about fountain house if u you're interested. now, unfortunately, many people with serious mental illness don't thrive in society as we all know -- many of them end up being homeless on the street, and ultimately, many end up in jail as only place that we have left to take care of them. the book that here to talk about tonight experts -- where mental health professionals struggle to help people with serious mental illness and very difficult and stressful circumstances. being in jail is extraordinarily stressful experience for anyone and -- to be mentally ill simply adds

to the impossible conditions. so i'm going to be introducing you tonight to a person who is one of -- who is as true a reformer as anyone you'll ever meet. someone who is devoting her career to working to improve the mental health care for people in our correctional system. elizabeth ford is the chief of psychiatry for correctional mental health services for new york city from new york city health and hospital corporation. also a clinical associate professor of psychiatry at ny rks school of medicine. now, since -- since the act of the event that are described in the book, as the very end of the book elizabeth describes how went on to a new job which is her current position where she's the chief of psychiatry for the

jail. when she first told me sha she was -- taking this job -- i was worried i thought of riker's island as a place that grinds people down it and burns them out and i never had ambition to actually go work there. so you know, i was concerned. and if it turns out perhaps i shonts have been so worried. i can say without exaggeration that i don't know anyone who -- could be better suited for the kind of job that she has at this point. she's only been to riker's island for a relatively short time. but they've it already she's already accomplished quite preasing things there to improve the quality of care for the -- mentally ill people who are in jail. now book tells the story up to this point in her career about the development of a young

psychiatrist working in first in the bellevue hospital emergency room, and then in the psychiatric prison ward on the 19th floor of bellevue. and it takes you through all of the trials and failures and hard won battles of the early stages of her career as a psychiatrist. now i want to go back first -- first time i ever met elizabeth i was at that time as a i am now part of the, part of the faculty of the division of bellevue in nyu. this is the point this is the point in the book -- where she had had finished her specialty training in psychiatry and was starting and was starting her -- treens forensic psychiatry fellowship. the first time i met elizabeth i was impressed.

and it wasn't just that she was a very smart and well trained and very energetic young psychiatrist, it was there was another quality which -- struck me very early on. and that was -- she was fierce. what i mean by that is -- she was fiercely determined wherever she saw someone getting rod deal or particularly when she -- when she saw mentally ill people who were not getting proper treatment, she -- she had the fierce determination that something should be done about this. to correct the situation. think of the wonderful scene in the second alien movie. [laughter] with the alien about to grab the little girl and sagni weaver gets inside of this mechanical robot machine with a two arms --

and she's going to take out the alien. [laughter] that's elizabeth. [applause] now about when you read are the book, you'll learn about many different battles she fought medical record to improve patient care or for just simply basic human rights for people who were many the jail in the hospital. but this brings us, brings me to -- the second characteristic which is maybe even more important than the first. that is -- the pact that when elizabeth decides to fight for something, she doesn't go into the mode of us against them. the unfortunate usual approach that people have to fighting -- where you caricature the opponent so that you can beat them up.

instead, she looks at what's wrong with the system? and comes up with ideas about how the system might be changed or how we might try to do something differently and then brings all of the people in who can be persuaded to give it a try and to collaborate and actually improve things. now you'll see examples of this also in the book. there's no doubt that there's some bad actors in this book, and not all of them are jail inmates. there are some people in the system who actually need to be removed. but the other thing that you'll see in the book is the respect and appreciation that elizabeth shows toward people in the corrections department and -- in particular individual correction officers who are good people and who are actually try

their best to do the right thing and people that you can collaborate with. now, this -- this brings me to the last characteristic which is really by far the most important in which i think is main, the mn heart of this this book. and that is elizabeth's tremendous empathy for people who -- for many of us and many people in society, people who are considered the lowest of the low with with a drag of society that that is people with serious mental illness who are also criminals. now, it's very important that we not quite wash this and look at the patience as if well maybe they're really nice people. in fact, many of the, many of the patients are people who have done quite horrific awful things

whose behavior may be quite obnoxious and that's the reality that we're dealing with. so this is -- this is the problem for the psychiatry. when early in your career about when you're being trained as a psychiatrist, one of the first things you're taught is that you're supposed to approach the patient -- with a -- with a attitude of new neutrality which means -- among other things what that means is, your job is to help the person with their problems. not to impose your moral views or your values on them. >> and of course in most of the practice of psychiatry, maintain it. maintaining this kind of neutrality is not that difficult. because afterall, most people

don't do horrific things. however qhb you come into the criminal justice system, you have to deal with that problem. think, for example of a person who drives the car up on the sidewalk up 7th avenue and runs over and kills the young woman and -- and sends 20 other people to the hospital. what would it be like to have to be that person's doctor? went back to 19 -- 1981 when mark david chapman killed john lennon and then is was sent to bellevue hospital this was -- this was before doctor ford's time. but he was sent to bellevue hospital to the prison ward as a patient. think about difficulty of being the psychiatrist who supposed

to -- have this man as your patient. now, it is one thing to say to yourself as a psychiatrist, i'll try to maintain my acronymty i can do a careful prescription and prescribe medicine if necessary and restrain my feelings and -- not show the contempt or rage are or hatred that i might feel for this person. but here's the question and this is the question that is really the heart of this book. how do you manage to bring yourself to actually care about about that person? i think again if you read the book you'll see that dr. ford has answered that question and made it clear how -- it's possible to -- it's possible to care inspite of awful things that you have to

deal with. now, with there are, there are stories this this book that are heroic and other stories that are just mundane. heroic stories are the time that the psychiatric staff -- in the prison ward had to manage and take care of the patients to a lock down to 19th floor during hurricane sandy. the hospital was flooded -- the main electrical power went out and elevators didn't work. the phone service went out. the toilets didn't work. and there was no regular food service. and -- and psychiatric patients were locked into the 19th floor. to get to where the patients were -- they -- there were a few days they were

really very heroing and difficult for the patients and the staff. dr. ford at one point was bringing boxes of peeps to the hospital that had to be carried up to the 19th floor so there would be something to eat. which is that the staff succeeded in getting all of those patients out safely into other hospital it is and didn't lose the single patient. the more mundane coif story the one i really like is the time that dr. ford decided that the patients deserved to have decent clothing to wear when they -- had to go downtown to the criminal court to appear in front of a judge. this -- in other words -- and this to me represents a sort

of basic human dignity issue. the concern was patient didn't have to shuffle down in front of the a judge wearing hospital pajamas and you know also read in the book about how that was accomplished. now, i want to close with a qo quotation and since this is the strand, it's a quotation from herman melville. the reason i'm doing this is because i want to make the point that this is a -- this is a true book. melville said the truest of all books of solomon's book of ecclesiastes because it was made out of the fine hammered steel of whoa -- he went on to say that -- if a person dodges hospitals and jails, and has walk fast to get

past graveyards, that person is not fit to sit down with unfathomably wondrous solomon and then he says this, "there's a cat skill eagle in some souls that can alike dive down into the blackest gorges and soar out of him again and become invisible in the sunny spaces. ♪ so i would submit to you that this, this book certainly does not hesitate to take you right into the hospital and the jail. and the author is certainly a person who has gone down into the blackest gorges an again is still able to soar up into the sunny spaces and, in fact, you can even see this depicted on cover the book. so for all of these reasons i'm suggesting to you -- read this book. [applause]

thank you howard, and nancy thank you very much. so i'm very humbled by this and very thankful to be here, was also told that reading from my book might be too boring but i'm going to try it anyway just for a few minutes so if gets too much just raise your hand and we'll continue. but i -- very much enjoyed the writing experience. it was very -- cathartic for me and a way to metabolize a lot of stories that i theard from patients and things that i saw and personal experiences. and so i do want to just read a little bit about it and then hopefully field whatever questions you have, any of them, fine i not answer them all here as action but i'll try. and also to start -- just to let you know that the

characters in this book with the exception of me are all -- deidentifyed, not only the names have been changed but many times i've changed ethnicity. shft criminal charge situation diagnoses it's extraordinary important to me to protect the confidentiality of my patients and a actually probably biggest barrier in my id is about whether to even publish something like this. but -- it became pretty clear to me after a about a decade of this work that -- the pieces that were public published in academic journal and policy discussions that were happen hadding -- in the headlines and on the tv shows -- i don't think were getting right to the root of some of the challenges and we're leaving behind the people. not just the patients but also the staff who really work in this environment. and -- i do fight sometimes fiercely, and it seemed like if there was

anything that i could do to further humanity of the discussion, then i needed to do it. and this book is that result. it is also a book that is a narrative. i wanted to initially just write pieces about the patients but then my very wise editor and publisher informed me that i really needed a narrator and that was going to be me. so it did turn into a memoir -- and the patients are very much a apartment of my life and my staff who i have worked with who are absolutely incredible have been key to that. it does also mean that the story is -- it's very lard excerpt out them because they're part this have narrative so try to introduce a little bit of what i've wrote and give you just a bit from authors note to try to help set the stage. >> from most doctors working behind bars with patients whom others see as criminal ares inmates, even bodies is not very appealing. the barriers to relieving suffering can be overwhelming and the reward can seem few and

far between. i've come to see my success as a doctor not by how well i treat mental illness. but by how well i respect and honor my patients humanity no matter where they are or what they have done. the world described in this book both the hospital and the jail it serves are heartbreaking at times, inpure rating at others and always compelling these world can shape live of patient, live and staff and hardening and traumatized version of themselves. characters this this book including me have all been exposed and transformed in various ways. while some of the stories involve behavior by clinical staff and officers that may seem callus evenrcruel, every action and word should be seens in the context of the whole system. a complicated tangle of court, jail, laws, unions, bureaucracy and public opinion that struggle to support the men and women --

>> you won't hear their descriptions but for reference cynthia is a medical student a composite and officers in here and a few patients that have been introduced prior in the book. and this is leading up i'm just about to start a group therapy session on one of the forensic units at bellevue room is on northeast corner of the unit overlooking east river expansive views make it seem larger than it is. a broken tv, and a still

functioning stereo sit tucked in one corn oar. locked closets along one wall that hold art, music, and exercise equipment used in some of the other groups. the closet doors are decorated with patient art. depicting scenes like family reare unions, broken hearts, and hopeful messages about getting out of jail. some of the pieces are from a coloring become and others are originals that in different circumstances could be hanging in a gallery. one second officer sanders i say as cynthia she's the medical student i quickly shove two oblong tables and arrange ten plastic chairs around edges. i do a quick scan pick up a newspaper, and loose staple from the floor and then walk over to let the patients in. most of them are strangers to me. but i recognize at least one. it has jamiel patient who was literally trying to get out of his own skin. and who after he was released threaten this one of the nursing tech when is they ran into each other on the streets. seeing his face brings become his whole history in in an

instant history i had tucked into the far recesses of my mind. he looks at me with a big smile as he enters the room. hey, dock how are you doing? ah, jamiel i say in response. my smile just as big. he's put on weight and taken a shower. and his skin looks perfectly intact. and just sorry as a side note so this -- gentleman suffered from -- terrible schizophrenia and early in my treatment with him and my introduction to him, he is this beautiful black man and he was convinced he was white and he was peel off his skin in attempt to prove that he was white. and so here i was seeing him years later. looking actually in a jail -- so not wonderful situation. but certainly looking healthier. jamiel laughed, oh, yeah except i'm back in here again. but this is the last time dr. ford. i promise. i don't tell him how many times i've heard that one before. everyone takes chair. some patients up close to the table and others pressed against

the wall as far away from the conversation as possible. it is very calm and ordered. a hefty black patient in a did you rag pulls chair from me and waits for cynthia to sit down before he takes chair. cynthia and i sit at opposite toandz work off each other and contain what emotions percolate up from the discussion. she begins to speak first. good morning gentleman. welcome to the group. this is called dealing with jail. and we talk about anything that you would like to share or think is useful to discuss about surviving in jail with mental illness. let's go through the rules and some introductions and then we'll get started. a couple of patients recite group rules not very different from those in community meetings and then we begin introductions. i'm dr. jackson, a psychiatrist, says cynthia, and antoine mumblings to patient next to her. jamiel, tyrone i need to talk about medicine it aingt working. okay tyrone we'll tab that separately when group is over says cynthia motions to next

patient. arthur, campbell -- i'm dr. ford also a psychiatrist i say. sir, what's your name is i asked the last patient one of the wall flowers who has his head hung low i'm not sure he knows i'm talking to him. arthur taps him on shoulder, you, man what's your name is? the patient looks up briefly and then looks quickly back down again. you don't have to say your name id add by any time krowpt to jon us at the table come over. we don't hear from him during entire group but he's looking around as if he's follow the conversation. so, says singt cynthia floor is e open anything have anything you would like to share. in a unite so noisy it it can be about anything hoping they'll break are the awkward silence. a minute slowly ticks by before i open my mouth. i know it is hard to talk about stuff in a group like this, especially when you're in jail. did you know people with mental illness stay at riker's island

twice as long on same charge as those without mental illnessesome or they end up this box which is solitary confinement more frequently and stay in the box longer? or that they get beat up more often? how cow you make it through a place like that -- you got to man up says arthur. no way to avoid fighting you have to figure out what's worth -- what you can do or what can be done to you. it's that simple. yeah that's true campbell chimes in. he's young. comparedded to it others in the group. .. i'm still surprised he isn't yelling and threatening. he may still be psychotic hence the admission to the hospital by these holding it together well for thisgroup. i used to fight all the time about anything.

didn't no one disrespect me but man i'm tired from all that fighting. just keeps getting me back in the box. many setting the future the way for jamal, so sorry he mumbled softly i didn't mean to interrupt rate i'm so sorry. hey man it ain't no big deal chuckles jamal. so kind of beyond just really sorry to enter out. the mall and i are equally puzzled by manny's comments. did anyone else have an experience they want to share? tyrone asked about his medication and cynthia. the conversation turns to drugs now call when tyrone begins talking about getting arrested for smoking a blunt. everyone except the wallflower patient had something to say about drugs. may i say something minor asked many during apart from the discussion. sure. i don't mean to take up everyone's valuable time in the group that i know i don't deserve it.

thank you so much for listening to me speak. jamal size since frustration. you are a fine man, just talk. thank you, thank you. it's just that i struggled with alcohol for so long almost 40 years now and i've been sober since getting locked up. i hope so badly i could stay clean when i got out. seems to be more comfortable now and continue talking. he tells us about being whipped against the wall like a 7-year-old when he didn't do a good enough job cleaning up the mess from his father's party the night before. one morning many drank one of the classes of leftover orange juice not realizing it was mixed with vodka. one is hung over father found up he whipped many until blood seeped through his shirt but many said it didn't hurt as much that time because he was tipsy from alcohol harm than not he drank as much alcohol as he could get his hands on. thank you for letting me share said many. i know i'm not worth your time. i wrote these words and i'm

still getting a little tearful. many says jamal leaning forward in his chair so he could see him cruelly you are worth it. you have mad courage. just hang on and keep going one day at a time. that's all you got to do. jamal looked like he was about to cry. no one accepts a psychotic patient named jamal and never offered kind words for it and want an tyrone uncomfortable with this expression of emotion but campbell nods in agreement. yeah man you just have to take a one day at a time. think about all those days you survive the ready. i glanced at cynthia to see if she's appreciating what's going on in front of her. her eyes are wise and wet with amazement. we are witnessing a pivotal moment for manny a collective responsibility to care for someone else and no one wants it to end. so i chose that because first of all it is short enough and also i hope that it shows the potential and in my mind started

amazing things that can happen. this is a group of people all of whom have been incarcerated with the exception of one drug crime violent offenses and they also had serious mental auma said they came together in this setting and collectively helps this 40-year-old man and talked about very significant things in its history. that moment and i won't talk about the rest of manny's trajectory but he was at least engage in treatment when he was released from custody. that may not seem like a huge deal but in this world any of those little things are pretty phenomenal. so thank you very much. i would love to hear some questions and just have a discussion and thank you for being interested in this topic. oh, okay. [applause] questions?

>> he's if you have a question or would like to start a discussion please raise your hand. >> if you had a wish list of anything that society could do to help psychiatric patients what would be on the top three of your list? >> i have thought of that question and come up with 25 different topics. from my perspective as a psychiatrist one of my first hopes and wishes would be really for the psychiatric and mental health providers in the community to really practice what we are all taught which is to listen non-judgmentally to our patients and to approach them with as much empathy as we can drum up. i work with patients for whom sometimes it is very hard to feel that way and i've worked in

the public system outside of the jail as well where it really is not only public perception that is problematic. it can also be the psychiatrist or providers biases and assumptions and misconceptions about behavior that can be destructive. i want us as a community to reflect on that and to think about it. i would love to see decisions made about systems changes coming from the bottom up so feedback from patients and consumers and staff rather than some of the top-down policy approaches that happen. i sometimes miss what can be tiny but critical details and how a plan or a program works. what would be my third?

that's probably like one, two and 10. >> hi i have two questions. thank you so much for coming here, both of you. that was really amazing and very interesting. my first question is logistics about which patients ended up at bellevue and how that worked and my second question is i am a psych resident and even from my two years in psych residency i see how it's jaded. some of my co-residents say it's something that really seeps into your care of all patients especially looking at the population so how do you speak to other psychiatrist about that? >> one relatively easy question and also there are some people in the audience who still work at bellevue, colleagues of mine. i have not been at bellevue for

a couple of years but i will tell you what i remember about people in there. deference again it's at bellevue street basically two different kinds of patients. they're all in the criminal justice system. the first group are those arrested by the police and have not yet seen a judge so they've been picked up on the street and they are at some point between the actual arrests and the time and the police are sometimes the defense lawyer will bring the men because they think they are too sick to go in front of a judge. they are pre-arraignment and at least at the time i was there that made up about a quarter of the patient population. they are all men by the way and they are ages 16 and older although in several years and will be 18 and older which is good and then the other 75% or so are male patients from rikers not from the jail system who abari been charged with a crime, many of them not convicted and

they have serious mental illness for the most part or serious dangerous behavior. usually you have to have both of those so mental illness and you have to be significantly dangerous to yourself or other people. because those criteria it is hard to be in that unit if you are safe and doing well. i think that's one thing to keep in mind in reading this book, this is a timely representative example of people with mental illness in the criminal justice system. bellevue nationally is quite unique in terms of having this hospital system. that's how people get in their just like any other hospital and emergency room staff will assess whether the patients meet the criteria for getting into the hospital which can lead to your second question which is decisions about mission or not. the new york state laws are very doctor friendly. there's a lot of discretion in terms of how you can define

mental auma's and so the decisions in the emergency room hopefully our objective is sometimes can be by how afraid whether they have had an experience with a patient in the past whether there is some sort of threat or physical interaction that happens. i don't know there are studies about this but i'm deeply curious about socioeconomic factors that may have played into that in assumptions and biases. to your point about how hard it is to work and particularly in the public health system and psychiatry system in new york city it's not unique to jail it is extraordinarily noble work and very challenging. taking care of parents who need, they need so much and forever reason have not been provided for a given or taken what they need to be healthy and i think

it can be very hard for someone, it's very hard for me sometimes to be sitting in front of someone who has asked you to essentially fix everything in their life in that moment and to do it quickly. it's an extraordinary task that no one can do. i myself fell helpless in that situation when i feel help was i start to get angry and then i start to get angry at the person in front of me for being so needy and why are they coming to me and don't they know i can't fix everything. at least for me if i experience that enough overtime and working it through it can be very destructive. collectively the psychiatric clinic talk about the resident collectively it's the psychiatric training staff are not in some way talking about them as a group or be mentored and nurtured about the real

phenomena that happens and you really run the risk of feeling ashamed about it and angry about it and that's unfortunately gets played out with core patient care. i think everybody probably has an individual thing that will work for them but the first is with got to talk about. i don't know there's a human being alive who thinks everybody is wonderful and doesn't have feelings about them when they need them. >> any questions? i will do my best to get to you. >> i have a question about how do you feel being a woman in this career and jobs? how do you think that affects your work and how do you affect

the results? >> that's a good question. when i started in this work there weren't so many women in the field. there are thankfully more now since i started this 17 years ago. i think anybody regardless of their gender orientation or anything can be empathetic and caring and be a phenomenal doctor so i don't think it matters that you are a man or woman. i do think particularly in the jail setting there is a little bit of a code. you don't hit a woman which i have felt sometimes makes me safer. i think sometimes i'm -- fooling myself that i'm safer. i work with men and their sort of a respect for the mother figure, a respect for the girlfriend, the baby mama the women who are brought children into the world.

alternatively however sometimes they are deep-seated angry feeling so whether i seem like a mother or not i am automatically almost a mother figure despite being a woman can i find that anonymously helpful because it can bring up a lot of things to talk about with the patient and many of them have conflicted if not negative relationships with their moms. some of them have wrote wonderful relationships. that unfortunately is not as common as i would like. i do write about in the book the whole issue about being pregnant and dealing with that. i felt like i was pregnant or postpartum 18 straight months when i was on the unit there. for the most part the patients were very protective and kind and always were asking me what i needed even if they couldn't get many thing and there was one patient who would escort me wherever i was going.

he was lovely and before i was showing he was not very lovely to me that all of a sudden i became this woman who could give birth to life and i became something different for him. there were also patients who were very very scared of me leaving and abandoning them. i have now learned that once you deliver a child what you want to do is hit the shift. now i actually see their worry is a little bit more realistic than what i thought initially. i also never thought, and i think it continues to be a male-dominated field forensics and psychiatry. whether there were barriers for me. and i haven't. i'm also the older child of a diplomat and psychologist. i feel like that combination has allowed me to feel like i can do

whatever i want even though frankly i know that i can't. [laughter] thank you. >> another question. >> hi. how do you feel about mental health care and especially since mental health care will be affected by the current political climate? >> that's a good question. i also work for new york city now so i weigh in about new york city. anything political regardless of who is running our country that pushes tolerance more to the back burner that leads to shifts in health care towards less coverage rather than more. at least what appears to be leading to criminal justice policies that are more stringent and strict like mandatory sentencing.

any leadership that heads in that direction is going to be highly problematic. >> one other question back here. >> i am a grown-up psychiatrist for the last 35 years from oklahoma. i had a comment first of all about being a woman in the forensic field. oklahoma locks up more women than anyplace in the world. we have the largest incarceration of women anywhere in the world. that's a comment. right now what i do for work is i see people on federal probation and i've done this for a number of years. what i see with people is family

trauma, drugs or alcohol in my case is a big problem. a horrible problem to me is isolation. i see so many people. i start guy recently who had been in isolation for nine months. he talked about being out of the cell for one to three hours a day. i saw a man not too long ago who'd been in isolation for a year and a half which to me is torture. i don't know the answer to this because if you were loose in the community and you were in the prison community or county jail setting it's because you are violent or he's been involved in gangs or in some situations you are going to be killed in your community.

do you have any ideas about how what does not isolate people and cause more trauma because i see people so traumatized who are on probation. >> i isolation i think you are referring to solitary confinement. so anything that restricts people to that degree is not helping. there is no question. i do think there are ways to address that and i currently work in a new york city jail system at rikers island and despite some bumps in the world and the political stuff that's goes on the restrictions on solitary confinement, the regulations to solitary confinement have become so much more significant such that people cannot be in for more than 30 days which is important. two years ago people were serving 800 day sentences in solitary. it can be done.

the trick is to make sure that you are replacing that was something that the officers will buy into because this is a system. it's not a health care system. to criminal justice system and whatever my personal feelings are on what jails and prisons should be they exist as they are right at this moment. no change will be effective or helpful without the buy-in of the corrections staff and in my experience they have to be okay. for many of them solitary confinement is much safer. not for the patients but for the staff. i do think it's naïve that people are not considering their own in these kinds of decisions. the critical pieces to make sure there is something in place that they can understand and appreciate and what you get at rikers island is one unit that sort of switched the dynamic from one of punishment to

positive rewards and every time someone does a good thing they get a reward and everybody was locked out. there is no isolation even the patients serving long sentences. and the violence was cut in half. it was a much calmer unit but it took about six months see if this kind of thing worked. the way, the things i think may be helpful are trying small issues and then trying to grow that into the system. but it's very complicated and people feel very strongly about solitary confinement. everybody should be in there and of course nobody and unfortunately i don't think we are going to find a solution of which is stay on either end of the spectrum with this issue so thank you. >> we have time for one last question. >> is there an official partnership between -- in rikers

island? >> that's an excellent question that i don't know. >> really appreciate everything you have brought here this evening. >> maybe one last short one. >> could you say something about first of all -- really fabulous and i really enjoyed it. i wonder if he could say what it was like working with some of the guards in the unit. >> the first thing i learned is they are not called guard. their correction officers and i'm going to go off on a tangent here but language is extraordinarily important. it's important in anything but particularly in the system and the words you choose to show mom mom -- how much respect you have

for people you are around. that was an early thing for me to learn. officers are the ones who are around the patient more than anybody else. it's different in the hospital than in the formal jail system because there are many more hospital staff and nursing staff around also in the hospital and the jail is much more just officers. i went into the work thinking that, i mean this is embarrassing to say but whatever it's all self revelation i suppose. i thought people became corrections officers begins they want to beat people up. i wrote about those who showed the kind of work had it in for the inmates. this was some way to act out aggression that it happened to them, something and i have completely done a 180 on that, 100%. that happened in my time at

bellevue. i actually haven't talked to anybody for whom this is not true that officers go into this work because they actually want to help people and their different ways and approaches to helping people. some of them feel like they are helping the community at large because they are keeping these dangerous criminals out of the streets. some of them are born-again social workers and like they really feel they will be able to have them, provide treatment. we can't walk away from you and those kinds of things and there are some officers for whom it's a source of great pride to be part of this paramilitary organization. they call themselves new york city's boldest and i think they are proud of that. what happens and it's very troubling to me. i feel like there has to be a

next step somewhere. what happens the officers and what happens to the health staff overtime is in the scary broken system all that good stuff shifts and i mentioned it a little bit in the beginning. people change when they are chronically afraid and when they are chronically angry and when they are mistreated and don't feel supported and when they are not paid enough, all of these things shift the way you behave. if that's not tempered in some way can really run amok. i really have found i wasn't always a compromiser by the way. actually my husband would disagree with you that i'm a compromiser but what i have learned is that we actually share a lot of things. we basically want people to be safe and we may have different approaches to that but if we can share that goal and work together in our different ways to get that everyone is happier.

when the health staff is safe they are great doctors so we have to find that shared ground. >> thank you all for your questions and dr. ford thank you so much. >> you're welcome. thank you so much for having me.

>> i was inspired to write this book by a very strange kind of policy that we had in philadelphia which was our public transportation authority. he used to require everybody that bought a monthly pass had to have a gender marker either an for male f for female on their past. this created a lot of what i call sex identity discrimination and in particular one transgender woman was a friend of mine in activist in philadelphia brought a lawsuit against the company for gender identity information. when she offered her f marked paths she was turned away.

the individual city can't use this because in my opinion you are not a woman. so she brought back a pass with an m sticker on it and the same thing happen. you are not a real man. this got me thinking you know in that case it's pretty clear that there is no legitimate reason to have sex identity marked on a pass to get on a bus. the city of philadelphia took steps to remove this identity from the bus passes. eventually the city got rid of it but it never stopped them from discriminating against charlene or anybody else and gender identity. and what about other things like driver's licenses passports of birth certificates. are they necessary?

>> would the sans the trump campaign was this long-standing tension between conflicts within the capitalist economy between big guys some little guys and so on and as the candidate trump got a lot of mileage out of taking the side of the smaller folks and not might be workers who lost jobs or companies that are on the smaller side and can't compete with these big global interests. as president we see a little bit of a shift in that two somewhat more traditional conservative positions which are really quite in favor of global trade and the export-import bank so i think it

is a great example. it's also an example of something that to be honest runs their mouth american business history which is profound conflict between these interests. i think we have a tendency in the way we talk about the policies in business today to assume that the major conflicts are between business and non-business, business and society or business in the public interest movement or the environment or workers and while those tensions certainly are real there is a lot of long history of different industries trying to use the government as a tool to secure their own benefit against others. in this book for example i take the story all the way back to the colonial or early national period when you have debates between jeffersonian farmer's who wanted free trade across the atlantic clashing with people

like alexander hamilton who wanted to protect northern factory owners through tariffs and other legal actions. a lot of similar type debate today. smaller interest versus larger role -- larger global ones. speak good afternoon everyone. good afternoon. what a privilege and what an honor it is to welcome everyone to the sixth annual robert d terrell prize for literary excellence in history. in addition to our special guest his extended family, one of his grandchildren and distinguished members of the class of 53 who were here to cheer his classmate on and never let him forget