David Hager: Understanding Minds: From Vet Schools to Mental Health Advocate

Summary

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Tony Mantor: Why Not Me?

Episode Summary: “David Hager: Understanding Minds—From Vet Schools to Mental Health Advocate”

Release Date: March 18, 2026
Guests: Dr. David Hager (Psychiatrist)
Host: Tony Mantor

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Episode Overview

This episode dives deep into the life and work of Dr. David Hager, a psychiatrist whose journey began with dreams of becoming a veterinarian but evolved into a passionate career advocating for better understanding and care for those with severe mental illnesses, including schizophrenia. Dr. Hager recounts his unique path—from vet school rejections to work in prisons and psychiatric hospitals—shedding light on the realities, systemic failures, and stigmas surrounding mental health. Through engaging anecdotes, grounded insight, and a touch of vulnerability, the conversation centers on reframing mental illness as neurological disease and offers practical, humane perspectives on policy and treatment.

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Key Discussion Points & Insights

1. The Unconventional Journey to Psychiatry

• Background: Dr. Hager initially aimed for veterinary school ("went to Texas A and M to be a veterinarian” [06:25]) after multiple applications but pivoted after observing veterinarians’ regrets and his father's medical aspirations for him.
• Unexpected Switch: “What I liked about psychiatry was listening to people's stories.” — Dr. Hager [07:29]

2. Listening, Humanity, and Breaking Down Barriers

• Approach Evolution: Early in his career, Dr. Hager was more formal, but over time embraced a more human connection with patients.
  • “As my career has progressed and I've become more human as a psychiatrist, I'm able to listen to people's stories without having to be necessarily strictly a psychiatrist while doing so.” — Dr. Hager [08:02]
• Varied Settings: Contrasts being “a little bit more myself” in substance abuse rehab with the necessity of greater formality in correctional settings [09:05].
• Innovation: Developed a computer program to handle rigid diagnostic questions so he could “focus more on the human elements” in interviews [09:18].

3. Challenges in Correctional Psychiatry

• Why Correctional Work?: Circumstances led him from failed private practice to prison psychiatry.
• Three Populations Identified in Prisons [12:41]:
  • Severely mentally ill (the “real deal”)
  • Malingerers (those feigning illness for perceived benefits)
  • Inmates at risk of suicide (with varying levels of actual risk)
• Memorable Anecdote: On distinguishing genuine mental illness:
  • “A harried, busy psychiatrist...calls out: ‘all of y'all here who have a mental illness, raise your hand.’ So a whole bunch of hands go up and she says, ‘Okay, y'all can go back to your cells. I'll see the rest of you.’” — Dr. Hager [15:03]
• Observations: Correctional and forensic settings provide more consistent, long-term (if imperfect) care for the most impaired individuals [16:33].

4. Systemic Failures and Ironies

• Access Gaps: Families often ask: “Why did my loved one have to kill somebody to get services like this?” — revealing the tragic threshold for accessing adequate help [17:21].
• Perceptions vs. Reality: Sensationalized media leads to misconceptions about mental illness (stigmatization vs. “perception” as the real issue) [17:21–18:54].
• Critical Flaws: Dr. Hager asserts the criminal justice system, ironically, has more accountability for mental healthcare than the civil sector—missed appointments in the community often result in lost follow-up for the sickest [18:54–19:33].

5. How Can the System Improve?

• Assertive Community Treatment (ACT) & Assisted Outpatient Treatment (AOT):
  • “My personal take...when that person with a true severe mental illness doesn’t show up for an appointment, you go get them, you go track them down.” [19:36]
  • “AOT...is not necessarily backed up with as much oomph as it should be.” [20:25]
• Consistency and Follow-Through: Emphasizes need for “beefing up” AOT and ACT for “real deal people” so they aren’t lost or under-treated [20:27].

6. Reframing Schizophrenia: A Neurological, Not ‘Mental,’ Disorder

• Historical context: Schizophrenia was once called “dementia precox” — a premature dementia [21:05].
• Breaking Stigma: “Schizophrenia is a neurological disorder with neurological symptoms—including neuropsychological decline, hallucinations, delusions...” [22:08]
• Educating Families & Patients: Reguarly reframes schizophrenia as neurological, not psychological, aiding acceptance and understanding [22:08–22:57].
• Understanding Anosognosia:
  • “Anosognosia is not unique to schizophrenia...one of the common ones people can relate to is Alzheimer’s disease.” [23:36]
  • “People with schizophrenia don’t necessarily get it...but there are, fortunately, some people with schizophrenia with treatment, with effective medication, some insight returns, and that’s a blessing.” [24:06]

7. Unfairness in Society’s Compassion

• Legislative Perspective: “It’s because we care about grandma, but we don’t give a [damn] about the lady under the bushes.” [25:56]
• Double Standard: Society would never let someone with Alzheimer’s “sleep under the bushes,” yet people with severe mental illness often end up homeless due to lack of intervention [25:46–27:11].

8. Personal & Professional Growth

• Lifelong Learning: “I thought I knew something when I finished my psychiatry residency...and then life happened.” [30:23]
• Vulnerability: Shares personal recovery as an alcoholic, learning from hardship and others’ experiences, sometimes outside academia [30:23–31:06].
  • “Life gives us more knowledge than college ever would.” — Tony Mantor [31:06]

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Memorable Quotes (with Timestamps)

• On Why He Chose Psychiatry:
  “What I liked about psychiatry was listening to people’s stories.” — Dr. David Hager [07:29]
• On Humanity in Psychiatry:
  “I’m able to listen to people’s stories without having to be necessarily strictly a psychiatrist while doing so.” — Dr. David Hager [08:02]
• On Correctional Mental Health:
  “You’ve got people who are real deal severely mentally ill. You got people who are trying to make you believe that the real deal mentally ill...and then there’s a population...at risk for suicide.” — Dr. David Hager [12:41]
• On Systemic Irony:
  “At this point, the criminal justice system does a better job with accountability...than the civil sector.” — Dr. David Hager [18:54]
• On Stigma & Perception:
  “I try and use the word perception because everyone can have their perception on what they think it is, but usually the reality is something completely different.” — Tony Mantor [28:00]
• On Anosognosia:
  “Anosognosia is a neurological symptom...it’s not a willful denial...it is flat out an inability to see...it’s like a person who’s colorblind.” — Dr. David Hager [29:24]
• On Learning from Hardship:
  “I’m an alcoholic. I’m in recovery, and I’ve had to learn from other people how to live life...” — Dr. David Hager [30:23]

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Timestamps for Key Segments

• 06:15 — Dr. Hager introduces himself and recounts the pivot from veterinary to medical school.
• 09:18 — Describes creating a computer program to streamline psychiatric interviews.
• 11:43 — Begins correctional psychiatry career; stories from Charlotte Correctional.
• 13:34 — Anecdotes on discerning genuine illness vs. manipulation in prisons.
• 17:21 — The tragic threshold for accessing psychiatric care (families’ heartbreaking question).
• 18:54 — The criminal justice system’s paradoxical role in mental healthcare.
• 21:05 — Explains schizophrenia’s neurological basis; introduces “dementia precox.”
• 23:36 — Defines anosognosia and analogies to Alzheimer’s and stroke.
• 25:56 — Candid legislator quote: societal priorities.
• 30:23 — Dr. Hager discusses personal evolution and lifelong lessons.

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Episode Takeaways

• A Call for Policy Change: The system’s failures are interconnected, with accountability and assertive outreach desperately needed in the civil sector to prevent the criminalization of mental illness.
• Reframing for Compassion: Emphasizing that serious psychiatric illnesses are as neurologically rooted as Alzheimer’s reframes public perception and can reduce harmful stigma and increase advocacy.
• Personal Stories Matter: Both for practitioners and the community, the practice of listening—to patients’ stories, to families, and even to one’s own journey—lays the foundation for real change and empathy.

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(End of summary)

Transcript

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[Tony Mantour]

It does seem to me that there is some awakening of a desire to act together to solve problems where they are.

[Dr. David Hager]

You know, I am a believer in

[Tony Mantour]

America and it's worth fighting for.

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Join me Wednesdays on YouTube or wherever you get your podcasts.

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[Dr. David Hager]

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[Tony Mantour]

Welcome to why Not Me Embracing Autism and Mental Health Worldwide hosted by Tony Mantour, broadcasting from the heart of Music City usa, Nashville, Tennessee. Join us as our guests share their raw, powerful stories. Some will spark laughter, others will move you to tears. These real life journeys inspire, connect and remind you that you're never alone. We're igniting a global movement to empower everyone to make a lasting difference by fostering deep awareness, unwavering acceptance, and profound understanding of autism and mental health. Tune in, be inspired, and join us in transforming the world one story at a time. Hi, I'm Tony Mantour. Welcome to why Not Me, Embracing Autism and Mental Health Worldwide. Joining us today is David Hager, who interestingly, never planned on becoming a psychiatrist. He started college at Texas A and M, dreaming of a white coat for four legged patients set on veterinary medicine. But somewhere between anatomy labs and late night soul searching, the human mind pulled harder than any animal heart ever could. He pivoted, earned his MD at UTMB Galveston, completed his psychiatry residency and moved forward from there. He then walked into state prisons in Florida and Illinois where the patients were human but often treated as less. His journey is outstanding and he has so much information to give us today. So before we dive into our episode, we'll be back with an uninterrupted show right after a word from our sponsors.

[Talkspace Host]

This podcast is sponsored by Talkspace.

[Talkspace User/Testimonial]

Last year I went through many different life changes. I needed to take a pause and examine how I was feeling in the inside to better show up for the ones who need me to be my best version of myself.

[Talkspace Host]

When you're navigating life's changes, Talkspace can help. TalkSpace is the number one rated online therapy, bringing you professional support from licensed therapists and psychiatry providers that you can access anytime, anywhere.

[Talkspace User/Testimonial]

Living a busy life, navigating a long distance relationship, becoming a first stepfather, Talkspace made all of those journeys possible. I could speak with my therapist in the office. I could speak with my therapist in the comfort of my home. I was never alone.

[Talkspace Host]

Talkspace works with most major insurers and most insured members have a $0 copay. No insurance, no problem. Now get $80 off your first month with promo code space80 when you go to talkspace.com match with a licensed therapist today at talkspace.com save $80 with code [e-mail] has the news been getting you down?

[Megan McCardell]

I'm Megan McCardell and I'm here to help. I'm the host of a new show from Post Opinion called Reasonably Optimistic and it's an antidote to the pessimism that's riddling America right now. Every Wednesday I'm going to talk to people who see a path forward.

[Tony Mantour]

It does seem to me that there is some awakening of a desire to act together to solve problems where they are.

[Dr. David Hager]

You know, I am a believer in

[Tony Mantour]

America and it's worth fighting for.

[Megan McCardell]

Join me Wednesdays on YouTube or wherever you get your podcasts.

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[Tony Mantour]

Thanks for coming on.

[Dr. David Hager]

Yeah. This is interesting as our first. First time experience for me.

[Tony Mantour]

Well, that's good. I do not think there'll be any problems. I think the most important thing is getting it started. So let's do that. If you would introduce yourself and tell us what you do.

[Dr. David Hager]

Oh, I'm David Hager and I am a psychiatrist.

[Tony Mantour]

Okay. Now the big question, what led you to go into psychiatry?

[Dr. David Hager]

Well, I didn't. I didn't plan on psychiatry. I went to Texas A and M to be a veterinarian.

[Tony Mantour]

Okay. I safely can say I didn't expect that.

[Dr. David Hager]

Yeah, it's actually more difficult to get into vet school than medical school.

[Tony Mantour]

That's interesting.

[Dr. David Hager]

Yeah, it is. It's just. It's a numbers thing. So I applied in my sophomore, junior and senior years of college to vet school. And then that last time I also applied to med school because I realized there's a couple things. One is the veterinarians I was working with also, they wished they had gone to medical school. And then I realized the main reason I wasn't going to medical school or considering it, is because my father wanted me to go to medical school. Anyway, wound up in medical school, was accepted to three med schools, and I got a third alternate spot that time. To the vet school. Yeah. So went to UTMB in Galveston. After going through the third year, which is the usual round of clinicals, I had it boiled down to surgery or psychiatry.

[Tony Mantour]

Okay.

[Dr. David Hager]

Psychiatry was unexpected. What I liked about psychiatry was listening to people's stories.

[Tony Mantour]

Yeah, I get that completely. And those stories can get pretty intense.

[Dr. David Hager]

They can, Yeah.

[Tony Mantour]

I guess my question is, how do you deal with that from a standpoint of someone that wants to help someone? I've been told all my life that I'm a fixer because I like to help people. In your scope of work, fixing means helping people. And sometimes when you're trying to help these people, you can't fix them.

[Dr. David Hager]

Right.

[Tony Mantour]

That can be very frustrating. So how do you deal with that?

[Dr. David Hager]

Well, not always gracefully. I'm a human, you know, sometimes with stiff professional formality, and sometimes I think more so as my career has progressed and I've become more human as a psychiatrist that I'm able to listen to people's stories without having to be necessarily strictly a psychiatrist while doing so.

[Tony Mantour]

Okay, that makes sense. Now, I'm guessing by doing it this way, you're able to hopefully break down some barriers which will allow them to get into a comfort zone with you, which allows them to tell you more things that you need to hear in order to be able to help them.

[Dr. David Hager]

Yeah, A lot depends on the setting. How clinical interviews go in a correctional setting, for instance, is very different from how interviews go in, let's say, a substance abuse rehab. Now, I had worked for several years at a rehab and lots of stories there.

[Tony Mantour]

I can only imagine it worked better

[Dr. David Hager]

to be a little bit more myself in those settings. You don't really let people know much about yourself personally when you're working with folks in a prison or a jail.

[Tony Mantour]

Yeah, that makes sense.

[Dr. David Hager]

Yeah. But one of the ways I tried to deal with that, to reduce some of the formality of the interviews, was I actually I wrote a program to do a computer psychiatric interview before I saw the patients. So get through a lot of these structured stuff beforehand that I could follow up on during the actual face to face interview and then focus more on the human elements instead of going through a whole bunch of rigid diagnostic stuff that can chew up a lot of time.

[Tony Mantour]

That computer program is such a great idea. Saves a lot of time. I'm sure. I'm sure you're like everyone else that you have a limited amount of time to give to these people.

[Dr. David Hager]

Right.

[Tony Mantour]

What happens when a patient starts opening up and digging into some of these things that you really need to know, and then all of a sudden the time's up.

[Dr. David Hager]

Yeah.

[Tony Mantour]

So do you go into overtime? Do you punch the clock? What do you do?

[Dr. David Hager]

Again, that depends on the setting. You know, in that substance abuse rehab setting, I had a schedule and, you know, patients are kind of notorious for bringing up the most difficult thing right at the end of a session. And there's a tap dancing that then occurs, hopefully a compassionate tap dancing that says our time is limited. And I hope we'll continue to talk about this the next time we sit down. Yeah, that's a tough one. On the other hand, in institutional settings, there's not so much of a hard time limit can be a lot more flexible in how long a particular session lasts.

[Tony Mantour]

That makes total sense. Are you working with people that are incarcerated, or are you still working with people that need help with substance abuse? Or is it a little bit of everything? What's your schedule look like now?

[Dr. David Hager]

Well, I'm partially retired now.

[Tony Mantour]

Okay.

[Dr. David Hager]

But, you know, what I'm doing right now is contract work. And I'm doing contract work doing correctional psychiatry, because over the years, I have found that to be the most interesting work.

[Tony Mantour]

Okay.

[Dr. David Hager]

And the contract work is. There's other factors that play into why it works out well for us at this point. So that I can work half the year and still get by. Tell you a little bit about how I got into correctional work and what that experience has been like.

[Tony Mantour]

Yeah, that sounds great. When did that start?

[Dr. David Hager]

It's 2001. I'll tell you that I'm not great at running a business. And I had a practice in southwest Florida, a private practice with a number of clinicians, and that. That financially didn't go well. I wound up in a lot of debt. Out of that, I learned some hard lessons. And the. The job that was available nearby was at a prison. And I had an interest in forensics already. I was doing court evaluations and such, and so I figured it was a good way to round out or flesh out some of my forensic experience. So I started working at this prison, Charlotte Correctional in southwest Florida. Turns out that's a place that has a bit of a reputation. It's a tough place. There's a close management camp on site, which is a prison within a prison. And it also happens to have the crisis unit, one of the crisis units, and transitional care unit for people with severe mental illness or, well, people with mental health concerns, because it kind of parses out into a few basic categories in a correctional setting.

[Tony Mantour]

Okay, can you expand on that? Some.

[Dr. David Hager]

You've got people who are real deal severely mentally ill. You got people who are trying to make you believe that the real deal mentally ill because of various reasons, either they considerations or they want the medications, or either they want to take the medications or sell the medications. And then there's a population that it's important to manage from a safety perspective, the folks who are at risk for suicide. There are some people who are actually at true risk for suicide. But, you know, our experience is that most of the people who say they're at risk for suicide are using that particular process to try to make a change happen. So at Charlotte Correctional, I began to appreciate what happens to people who have severe mental illness. Real deal, severe mental illness.

[Tony Mantour]

With that said, does anyone or any particular situation stand out to you?

[Dr. David Hager]

I remember this one guy in particular. You know, I'd go look at the classification file for people where I wasn't really sure what was going on. And this one guy, I wasn't quite sure. And I looked through his classification file and I saw his history of arrests and it was a whole bunch. It was like 30 trespassing arrests.

[Tony Mantour]

Wow.

[Dr. David Hager]

Yeah. And then he became, you know, in the course of me trying to take care of him, he became floridly psychotic. He became, you know, it was. There was no ambiguity at all. You know, there was the progression of people for this person anyway, of all these misdemeanors, misdemeanor arrests, and eventually he finally got popped with a felony and he wound up off the streets for a longer period of time. And why he didn't wind up in a forensic psych hospital, it's just, you know, it's luck of the draw, it seems. Probably depends on whose public defender was or how well put together he was at the time of the hearing. Real deal people, because of Anna's agnosia, they. They don't declare themselves. There was actually, there's a semi apocryphal story out of one of the big urban jails in Houston. Remember a colleague telling me, and it fits perfectly. A harried, busy psychiatrist was showing up for what was essentially a mental health sick call. And she saw that there were. There was an impossible number of people to see. So she had to make a decision about who she was going to try to see and who she wasn't. So she calls out to them, she says, okay, all of y' all here who have a mental illness, raise your hand. So a whole bunch of hands go up and she says, okay, y' all can go back to your cells. I'll see the rest of you.

[Tony Mantour]

Wow, that's pretty unbelievable, actually.

[Dr. David Hager]

That's kind of the. That's the world. That's the world of corrections. I worked at that facility for 15 months. I worked subsequently at the Palm Beach County Jail. Jail work is very different. It's a whole different vibe.

[Tony Mantour]

Yeah, I can just imagine. Now what happened after that. Where did you go?

[Dr. David Hager]

I went up to Indiana. I was the director of the mental health services for the Indiana Department of Correction for a while. We lost that at Rebid, working for one of the for profit companies. Contracts come and go. And I subsequently worked at the Marion County Jail and Volusia County Corrections in Central Florida. After that, I went on in 2008 to shift from corrections, which especially in jail work, it can be difficult. There's stories around that, but there are difficult political stories around that. And I came back to Texas and worked at Kerrville State Hospital, which is a primarily forensic hospital. It's 100% forensic at this point. Used to have a crisis unit, but that went away while I was there. And it has specialized even more in people who are not guilty by reason of insanity. So that's pretty much the entire population at Kerrville State Hospital. So I worked there for four years at one point, and then two years again during the pandemic.

[Tony Mantour]

That's quite a path of different scenarios that you've worked within.

[Dr. David Hager]

Working with the forensic population in that setting. Different experience, a different system. Appeal to how that system works. But there's the length of stay. If you look at prisons and you look at forensic psych hospitals, there's one common theme, and that is the length of stay is much, much longer. You can debate whether that's a good thing or a bad thing for some of the people as debilitated as they were, especially at the forensic psych hospital at Kerrville State Hospital. Oh, my God. Some of these people were so low functioning, there was no other option for them really. Another thing while working at Kerrville State Hospital was a sad comment that families would make. A repeated question from families was, why did my loved one have to kill somebody to get services like this?

[Tony Mantour]

Yeah, that's a tough question. And unfortunately, I've heard that so many times with people that have been on my podcast. This podcast has been really good to get a lot of information out there. Unfortunately, a lot of this information is things that people just don't want to hear and shouldn't have to hear. A lot of people will see something that's on tv, they don't understand it, they don't know what it is because of the sensationalism of the tv. They will get their perception of what it is. Usually it's the wrong perception. Unfortunately, it's a situation of where the system failed. The person that had the problem. Before I started addressing serious mental illness and anosognosia on this podcast, I hate to say it, but I had a lot of the same thoughts. It truly is sad that you had to comment on how many people will say, why did my loved one have to do something so bad to get the help that they need. What's even sadder is it doesn't seem to matter which state I'm talking with. They all have the same issues. So I'm interested because you worked in so many different facilities, you've seen the issues that they face firsthand. So everyone has a different approach. I'm interested in what your approach would be. What are your thoughts? How do you think we can make things better to help people that really need the help?

[Dr. David Hager]

It's a sad irony that at this point, the criminal justice system does a better job with accountability. I hate to use the word containment, but containment within a process, whether it's outpatient or whether it's somebody who's incarcerated actually, or in a forensic system, because if they're in a forensic system, forensic psychiatry hospital, they're still under the umbrella of the criminal justice system in some way or another. So the civil sector, the way it works, if somebody with a severe mental illness doesn't show up for an appointment, well, that person will be replaced by somebody who does show up for appointments. And that tends to be a less sick population.

[Tony Mantour]

So what do we do to change that outcome?

[Dr. David Hager]

My personal take on this is when that person with a true severe mental illness doesn't show up for an appointment, you go get them, you go track them down. And AOT is supposed to be a way to do that. And certainly programs like sort of community treatment, those are good programs. They're not used enough. And then aot, I don't think it's used enough. And when I've seen it used, because I did some outpatient forensic work as well, it's not necessarily backed up with as much oomph as it should be. Like, if the person doesn't show up for the psychiatrist appointment and then doesn't show up for the psychiatrist appointment and then doesn't show up for the psychiatrist appointment, there's inconsistency about whether anybody actually goes to say, hey, how come you're not showing up for the appointment? So there's some inconsistency in implementation of that.

[Tony Mantour]

What's the next step, then?

[Dr. David Hager]

So I think beefing up aot assisted outpatient treatment, you know, the original idea was outpatient commitment, but the phraseology was changed to aot making assertive community treatment more available for the real deal people so that people aren't lost to follow up. And then I have something that's a little off script.

[Tony Mantour]

Okay.

[Dr. David Hager]

There are other psychiatrists who think along these lines, and neurologists. You know, historically, schizophrenia spectrum illnesses have been. They've fallen under psychiatry. They just have, you know, what the original term or name for schizophrenia was.

[Tony Mantour]

That's something that I do not know.

[Dr. David Hager]

Yeah. The original name for schizophrenia in the early 1900s was dementia precox, a premature dementia.

[Tony Mantour]

Now, that's very interesting on how that's changed over the years as well.

[Dr. David Hager]

Yeah. And that way of looking at the illness holds. The more we learn about it, the more we realize, or, I mean, it's accepted, it's a brain level disorder, it's a neuropsychiatric disorder, it's a neurological disorder. In fact, what I tell families and patients, I don't say that they have a mental illness. You know, people with schizophrenia. I don't say they have a mental illness anymore because that gets conflated with a lot of other stuff that, you know, panic disorders, a mental illness. Drinking too much coffee is a mental illness, apparently, because it's in dsm. Right. Look at the list of things that's in dsm. You know, it's a book of psychiatric disorders. And schizophrenia is kind of in there as well. But schizophrenia is pretty serious.

[Tony Mantour]

Yeah, it is. And I think that you have a great way of looking at it and wish other people would look at it the same way as well.

[Dr. David Hager]

So I tell families and I talk with patients about schizophrenia. Being a neurological disorder with neurological symptoms helps families to accept it better and understand it better. Especially when I point out that there is neuropsychological decline, cognitive decline, that hallucinations and delusions are neurological symptoms. They're not unique to schizophrenia. There's an enormous multitude of pathways. Anybody can become psychotic. Actually, I do a teaching thing with patients. I used to do it with my forensic patients, my guys there at Kerrville State Hospital. I would teach them about psychosis. I would start with, what is psychosis? And the ones who already knew the answer would say the right answer. But it was sort of a trick question. I'd say, what is psychosis? And the answer is, psychosis is a symptom.

[Tony Mantour]

Wow, that makes sense.

[Dr. David Hager]

It's a symptom of something. Whether it's because I have a brain tumor or because I'm doing too many drugs or because I have schizophrenia. It's a symptom of something. Psychosis is a symptom. And hallucinations and delusions are the common forms of or manifestations of psychosis. So schizophrenia is a neurological disorder with neurological symptoms, including neuropsychological decline. Delusions, hallucinations can include disordered thinking, disordered behavior, and also Ana's agnosia. And I talk some about Ana's agnosia.

[Tony Mantour]

How do you define that to people that don't understand it?

[Dr. David Hager]

So when I talk generally about what agnosias are in neurology, because there's a variety of agnosias, and then when I talk about what Ana's agnosia is, because anosognosia is not unique to schizophrenia, present in other disorders as well. And one of the common ones that people can relate to is Alzheimer's disease. So I'll ask people, do you know anybody with Alzheimer's? Did they know they had Alzheimer's? And then they usually say no. And they'll say, well, that's Ana's agnosia. And the same thing applies to people with schizophrenia. And then they get it.

[Tony Mantour]

Wow, that's impressive.

[Dr. David Hager]

The people with schizophrenia don't necessarily get it, but it depends on how they're doing, because there are, fortunately, some people with schizophrenia with treatment, with effective medication, some insight returns, and that's a blessing. You know, take as much advantage of that as possible and kind of cram as much education and rapport building into that time of lucidity as possible, if that's how the cross, the. The course of the illness proceeds in response to the medication. But, yeah, schizophrenia, neurological illness with neurological symptoms. So here's a little bit of a

[Tony Mantour]

question for you, okay.

[Dr. David Hager]

How many homeless people have you run into that have Alzheimer's disease?

[Tony Mantour]

To my knowledge, that would be none.

[Dr. David Hager]

How many homeless people have you run into who have multiple sclerosis?

[Tony Mantour]

Again, that would probably be none, which

[Dr. David Hager]

can also be accompanied by Ana zognosia. You know, if you look at neurological disorders, you don't see a lot of those risks. You know, sleeping under the bushes because the law says they can choose to be there. Going back a ways, I've long thought it to be unfair that a person who is psychotic and doesn't know she's afflicted because of dementia is handled differently from somebody who is psychotic and has Ana's agnosia and is unable to function normally, but they're in their 30s, so it's okay for that person who has a similar level of neuropsychiatric debility to consign themselves to sleeping under the bushes because they, quote, unquote, choose to be there. I don't know. It's. You know, there's the recent executive order encouraging reinstitutionalization, and I've got mixed feelings about that. But on the other hand, there are some people who don't need to be sleeping under bushes anymore.

[Tony Mantour]

Yes, I agree. And hopefully something like that would be enough ammunition to get our legislators and involved, make some new laws and Help these people out, that need that help.

[Dr. David Hager]

I remember a conversation I had with a legislator. I actually was. I was involved for a while trying to keep a state hospital open in southwest Florida. And it was slated foreclosure. It was back in the 90s. Went up to Tallahassee a couple of times. One of the times I went up, I spoke with a guy who used to be my boss. He was a physician who became a Florida legislator. And I asked him that question about, you know, why is it that grandma with dementia, we take better care of her than the 30 year old who's hiding from the lasers under the bushes and in the park? And he was kind of a blunt guy. I won't use all of the words that he used. Okay. But he said it's because we care about grandma, but we don't give a blank. Yeah. About the lady under the bushes. So working in jails, working in prisons, I see from that perspective how broken things are on the civil side, because they come to me.

[Tony Mantour]

Yeah. I cannot disagree with you at all. What do you think is important that people hear? They may be well versed on schizophrenia, Ania. Or they may not. They may not have encountered anyone, but yet they're hearing what you have to say. What is important for them to know and understand about this subject.

[Dr. David Hager]

Personally, based on my experience with families and to some extent with the patients, reframing the illness to be a neurological illness. It's a neurological illness. It's the old dementia precox. It still is. The illness has always been with us. And think in terms of how would you manage a person with a dementia and would you just let them sleep under the bushes?

[Tony Mantour]

Yeah, I agree. That is a great point to make. I think one of the biggest issues that I've seen since I've been doing this is that everyone has their thoughts on what they think it is. Because of that, I try and use the word perception because everyone can have their perception on what they think it is, but usually the reality is something completely different. So I don't like to use that word stigma anymore because I think people have to learn and understand, or at least try to understand, so that way they might have a little empathy for what others are actually going through. This way, when they hear something about serious mental illness or anosognosia, at least they'll have a comprehension of what people are talking about. I really think the way that you put it across is really good.

[Dr. David Hager]

Yeah. Anosognosia is a neurological symptom. You can see with dementia, you can see with certain strokes, you can see it. Multiple sclerosis. Any number of other neurological afflictions can have that anosognosia, which is the inability to know that one is afflicted. I had a friend of mine who. This is a common one. I had a friend of mine who had a. A dense stroke, affected half of his body. And as can happen with that kind of a stroke, he no longer knew that part of his body existed anymore. And so he had what's called hemi neglect. He functioned as if that part of his body didn't exist anymore, and it caused problems for him. That's a form of ana's agnosia.

[Tony Mantour]

I think that's a great analogy. You are one of the first people I've spoken with that has brought out anosognosia in this kind of context. And I think it's just a great way of putting it across with this kind of thought process. It might just change the way people think about things and perceive them.

[Dr. David Hager]

Yeah. It's not a willful denial of the illness. It is flat out an inability to see. It's like a person who's colorblind. There are just certain colors that can't be seen.

[Tony Mantour]

Yeah, that is so true. I think you've got a great look at things, and I think all the stories that you've heard across your career has helped you bring this to the light for everyone.

[Dr. David Hager]

And that's what attracted me originally to psychiatry, was the ability to hear people's stories.

[Tony Mantour]

Yeah. Both good and, unfortunately, some that weren't so good.

[Dr. David Hager]

There's been a lot of change in the profession. It's a whole nother conversation.

[Tony Mantour]

Yeah, I'm sure. Now, that brings up another interesting point. You've moved around and done so many different things along the way. You've also seen so many different things from your different jobs that you've done. Now, instead of talking about the people you've helped. How has this helped you? How have you seen yourself evolve from the early days to today?

[Dr. David Hager]

Well, you know, I thought I knew something. When I finished my psychiatry residency in 1992. I was a smart feller. And then life happened. And I've had a few decades of life since then, including substantial hardships, personal hardships on my own end that I've had to recover through and that. And having to learn that. Having to learn from other people who have had hardship, who don't necessarily have college educations, but learn by their example. You know, I'm an alcoholic. I'm in recovery, and I've had to learn from other people how to live life, and that actually works out. It's worked out much better than I can do on my own.

[Tony Mantour]

Yeah, lots of times. Life gives us more knowledge than college ever would. Well, this has been a great episode. Lots of good conversation, lots of good information. I really appreciate you taking the time to join us today.

[Dr. David Hager]

Yeah, I appreciate you interviewing me.

[Tony Mantour]

Oh, it's been my pleasure. Thanks again. Thanks for taking time out of your busy schedule to listen to our show today. We hope you enjoyed it as much as we enjoyed bringing it to you. If you know someone who has a story to share, tell them to contact us at WhyNotMe World. One last thing, spread the word about why not me? Our conversations are inspiring guests that show you are not alone in this world.