Tony Mantor: Why Not Me ? - Dr Laitman: A Fathers Journey to Transform Schizophrenia Recovery

Episode Date: March 4, 2026

Empowering Mental Health: Dr. Robert Laitman's Journey with Psychotic Illnesses and Clozapine Therapy In this episode Dr. Robert Laitman, an internal medicine specialist with substantial experience in treating serious mental illnesses such as schizophrenia and bipolar disorder. Dr. Laitman shares his deeply personal journey of treating his son, Daniel, who developed schizophrenia 20 years ago. He discusses the challenges of finding effective treatment, the benefits and intricacies of Clozapine therapy, and the need for a comprehensive, empathetic approach in mental healthcare. His advocacy for early and assertive management of psychotic illnesses, combined with cognitive enhancement and family involvement, aims to transform the lives of those affected by serious mental conditions. He emphasizes the importance of demanding the best treatment options for loved ones, which significantly improve long-term outcomes. Meet Dr. Robert Layman Personal Journey with Schizophrenia Challenges in Treatment Managing Side Effects Cognitive and Behavioral Approaches The Importance of Early and Effective Treatment Overcoming Systemic Obstacles Final Thoughts and Takeaways INTRO/OUTRO: T. Wild Mantor Music BMI The content on Why Not Me: Embracing Autism amd Mental Health Worldwide, including discussions on mental health, autism, and related topics, is provided for informational and entertainment purposes only. The views and opinions expressed by guests are their own and do not reflect those of the podcast, its hosts, or affiliates.Why Not Me is not a medical or mental health professional and does not endorse or verify the accuracy, efficacy, safety of any treatments, programs, or advice discussed.Listeners should consult qualified healthcare professionals, such as licensed therapists, psychologists, or physicians, before making decisions about mental health or autism- related care.Reliance on this podcast's contents is at the listener's own risk. Why Not Me is not liable for any outcomes, financial or otherwise, resulting from actions taken based on the information provided. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Welcome to Why Not Me, embracing autism and mental health worldwide, hosted by Tony Mantor. Broadcasting from the heart of Music City, USA, Nashville, Tennessee. Join us as our guests share their raw, howful stories. Some will spark laughter, others will move you to tears. These real-life journeys inspire, connect, and remind you that your 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 Mantor. Welcome to Why Not Me, embracing autism and mental health worldwide.

Joining us today is Dr. Robert Laytman, who is a distinguished physician with extensive expertise in internal medicine, where he has built a strong foundation in diagnosing and treating a wide range of complex medical conditions. Specializing in serious mental illness like schizophrenia and bipolar disorder, he seamlessly blends his medical precision with compassion, making him a trusted leader in addressing patients' complex needs. He has a wealth of information for us. So before we dive into our episode, we'll be back with an uninterrupted show right after a word from our sponsors. Thanks for coming on. Oh, sure.

No, it's my pleasure. You know, thanks for having me. I mean, this is something near and dear to my heart. It's great to have you here. Could you share with our listeners a bit more about what you do? I am a internal medicine specialist. I was trained in nephrology and geriatrics, but for the last 20 or so years, I've devoted my practice as well as my wife, who just walked out the door, to taking care of people with psychotic illnesses.

And the reason I'm doing that is because my son, 20 years ago, developed schizophrenia. And we just didn't find adequate care. We thought there's tremendous nihilism in the psychiatric community. We were told, for instance, more than the loss of your son and your expectations. And I just didn't find that to be an acceptable solution. Yes, I think that's very understandable. So when you decided to take this on, what confronted you? What were some of the bumps in the road, so to speak? Well, initially, the biggest bump was actually my wife. And she's right because, you know, again, we're both physicians.

You're not really supposed to take care of your own. But I pointed out to her that I'm not traditional. I've been taking care of my mother and father because I was, as I said, a nephrologist and gerontologist. and, you know, and I've done a pretty decent job of that. In fact, my dad ended up living 101, as I already mentioned, and my mom lived in 99. And I said, look, I'll make every attempt to find good care for Daniel. But after we started to read the literature, and we kept going and being referred to one psychiatrist after another, we never found anyone, first of all, for the first year or so, actually six months, that was willing to prescribe Clausebee.

Finally, we met Lou Opler, who wasn't thinking, patients at the time and he referred us to another physician. But it was still going to be another year for Clauseapine. This guy was reasonably said, yes, I'll consider it. Let me fix Daniel's regimen because by that time he was already on three antipsychotics. I was chomping at the bit for my opportunity to take care of him. But I deferred because again, you're not supposed to take care of your own traditionally. Eventually, he got to the point where it was, you know, just he needed to be on Clausepeen. and we finally prevailed on the treating psychiatrist distartum. When you finally had the psychiatrist change its mind, what happened next?

Over time, it got to the point where it was so difficult, and fortunately, we've made the prescribing of clausapine easier, easier because we've gotten rid of the requirement for the blood. But back then, it would take me hours every week just to get Daniel's supply of clazepine. I'd have to call up, get it approved by the insurance company, make sure I had the blood work, and I even had my own in-office lab. And then I would send the results to the psychiatrist waiting for him to write the prescription because for the first 26 weeks back then, it was weekly. And I just, I got tired of it. You know, and I found it a situation almost guaranteed to fail because he wouldn't give

more than the absolute number of pills that Daniel was on. So I just eventually just took over. And it was much easier after that. You know, I wrote for adequate amount of medication. I did the required blood work. It was much easier because I had the blood work right in front of me. I took steps out of the way. Yeah, that sounds like it was very much easier.

Were there any other issues that you had to deal with? Also, the lack of knowledge on how to prescribe clausapine correctly. So six months into Daniel's illness, he developed a sizable aspiration pneumonia, an abscess on his lung, because no one, didn't really talk to us or explained how to take care of the excessive salivation that comes with Klospine. So we ended up treating them with IV antibiotics at home. My wife and I took turns putting an intravenous in every single day, sending him to school, taking the IV out, putting a new IV in. And 28 days later, we had him with clear lungs. And in the meantime, we started to treat the salivation.

So it became very apparent to me that if you're going to use Klospin correctly, because I kept reading and reading about it, and all the terrible side effects, which is why people weren't using the drug. That is a big question. How do you handle the side effects? Because one thing can lead to another, and then all of a sudden it could get out of control. Every one of these side effects is predictable. You can get predictable pharma, you know, pharmacology, just using pharmacology, for instance, with the excessive salivation, we took care of that, doing the simple things, propping his head up, obviously, and making sure that we, diminished the salivation using just a we used something called a epitroprium nasal spray and we would just

scort it under his tongue at bedtime that diminished the salivation and aspiration no longer became a problem yeah that's great were there any other side effects or anything else that you was concerned about also as you start on claus bean the heart rate goes up again normal physiology so we would put them on a very low dose of a beta blocker and that took care of that and you just go down the side effects weight gain almost universal with claus bean why allow it you know unfortunately clausopine has effects on appetite it's very something called antihistaminic and anticholonergic so it actually stimulates greatly stimulates appetite you know it's not the kids being a pig the kid is almost driven to eat so what do you do you give them metformin it's not

that hard. And these days, we're really well equipped because we do the injectables, which Daniel did not require. And of course, the beauty of this, where Daniel was really sick and at his worst was almost catatonic, he got better in terms of his ability to comprehend, to think, to participate in his own care, something that would make you happy, Tony. He started to actually watch his diet. And now has become basically a pescatarian, not a vegetarian, but a pescatarian. And he exercises. regularly. And that obviously, you know, helped his health almost as much as all the other medicines that we typically add, you know, to assist kids. Yeah, that's great. It's all about the end results. Now, this was 20 years ago. Has anything changed, the medication, the way you look at it,

just the overall procedures that you use compared to 20 years ago? We've expanded as the medications and we've expanded our approaches. So we really emphasize the diet and the exercise right away. And we do a lot of cognitive enhancement treatment. Anything you can do to improve their ability to think and to participate in care makes everything else get better. So we always talk about top-down control of your psychosis. So psychosis is not only delusions and hallucinations,

but there's a very strong component that, is cognitive and that is also the negative symptoms, the inability gets started. And working on those cognitive symptoms allows the person become more aware. So let's say they're still having auditory hallucinations. That's a processing problem. They're actually hearing those voices in their brain. But if you can improve their cognitive abilities, they can recognize that as being internal and therefore not listening to voices. And also as their cognition improves and often, you know, get more involved in social situations,

because what it takes, the most difficult thing anyone ever does in terms of cognitive abilities is social interaction, especially with multiple people. You need a lot of processing speed. So that tends to be diminished in these illnesses. These are all great points. Now, what did you do with your son? How did you approach that with all these things that you've just mentioned?

So with Daniel, we did a lot of cognitive enhancement treatment, did a lot of exercise, that all of these things improved cognitive ability. So there's the feedback as far as the medicines. And also we did cognitive behavioral therapy because once you can think about your own thoughts, you have a thought that one tenant, and I'm sure you've heard this before, because you've been doing serious mental illness before, you say never challenge a delusion. because the delusion is a fixed false belief. Yes, I have definitely heard that.

Well, actually, with psychosis and form cognitive behavioral therapy, you can start to edge onto the delusions and start to challenge them. As you're doing that, they're more in touch with reality and their abilities improve. So that's what we're using more of. In terms of the medications, you know, the medications for clausapine side effects, they're old. one of the modalities that we use a lot of for the salivation that's relatively new is we use good old Botox. Really?

Yep, botcholino toxin. So you can go to an ear-nose-and-throat doctor or a neurologist typically that specializes in taking care of Parkinson's patients because they have problems with the salivation and they'll often have aspiration. You just inject the salivary glands. You start low dose. Everyone's individual. These doctors are really adept at this.

Basically, Botox lasts as long as the salivary clans, and they turn over about every 90 days or so. So you go to your nose and throat doctor and you get injected every three months. And that's really important if you're doing claustisone, because as it turns out, aspiration and pneumonia is probably the most dangerous thing about clausapine and that you really have to pay attention to. Did you have any issues at first with him agreeing to do any of this? one of the issues I've heard from several different people is when someone is in psychosis, they are unwilling to take any help, get any help, and they just don't want any help. So how did you deal with that? Was that an issue at all? Anasognosia, now we were fortunate. Daniel was 15 when he got sick, which is the bad prognosis, right?

The earlier you get sick, usually the worst of prognosis, that's why we were told, you know, more than the loss of your child's expectations. Of course, that did. not turn out to be true. We'll talk a little bit more about that. But fortunately, we were able to get guardianship, which we did, which we maintained to this day, have never used it. Because Daniel has always been aware of his illness. He skipped clausapine once one time by mistake. He just missed it and he felt horrible the next day. That was enough for him. So he's always been aware of his illness. Adisagnosia is a really interesting condition. So we always talk about unawareness of the illness, but it's actually more complicated than that. So Daniel does have some anisagnosia,

because when you're talking about anisagnosia, it's actually also refers to your ability to self-assess, and people with psychosis are notoriously bad at self-assessment. He underestimates some of the things he can do, and grossly overestimates some of the things that he can do. And that remains a problem. You always have to work on his self-esteem. And, you know, this affects everyone. It also affects their ability to interact with other people because they will not get a good read what we call theory of mind. They don't usually understand exactly what someone else is thinking. Can you expand on how they view that and how they interact that way? They will, if they're very psychotic at the time and their self-esteem is more, you know, they're going to look at someone

and they're going to interpret, you know, their interaction in a very negative fashion. ideas of reference. They're going to hear something and that's walking by. The other person may have been in the conversation completely unattached and not even aware of the patient, but the patient say, that person just said, I'm fat and I'm terrible. It's a real cognitive problem, you know, Anisagnosia. It's interesting. It does get better over time. So Clauseapine, the one nice thing about it is it changes the trajectory of the illness. And a lot of kids who have had, really terrible anisicidos where they've absolutely no concept that they're sick and think everything is hunky dory and why would I ever take any medicine have over the years gotten to

accept clausapine. So the beauty of clausapine is it quiets your mind as opposed to deadening it. And if you follow kids that have been on clausapine and you've got them unestablished doses, the acceptance rate with clasobine is in the high 80s. Now, if you look at our data, we have at one year, and we now have over 200 patients, clausopine, our acceptance rate is in 94%. Yeah, no, so it does. It does get better over time. And if it doesn't, and there are a lot of kids that are so sick, then we use court-mandated

treatment. So that's the ultimate way of getting past anisognosia. Not where I start. I usually start with, you know, Javier Amador's approach, reflective listening, you know, empathizing, trying to agree with them, partnering with what they want. But sometimes that doesn't work. And you don't want to, you know, these are illnesses that need to be treated. It's a brain illness. You know, if you had someone like grandma with Alzheimer's disease and she didn't want to take her insulin because she said she doesn't need it anymore, there wouldn't be a second thought. Of course you'd give her insulin. And And the same applies to this population. Yes, absolutely. We have to find a way to take care of everyone. Here's an unfortunate but interesting fact. I've spoken with those that are autistic and those that deal with serious mental illness.

One common thing they both have told me is some have taken up to 10 years to get their life completely figured out. Yeah, that's what I'm trying to stop. So we have an approach, you know, called Ease. I wrote a paper with a guy by the name of Matry Keshavant. who loves acronyms. E is early because all these illnesses and all these psychotic illnesses are, to a certain extent, genetically based, neurodevelopmental, and when not appropriately treated neurotterterative, we know that untreated psychosis or poorly treated psychosis leads to loss of brain.

Petri Naserlos for what you'll call it chair, I guess, chair, president, probably president of the APA, I always likes to say that psychosis is like a slow-moving stroke and you lose about 1% of your brain per year. Early treatment with the most effective medication, that's all I'm proposing is the way to go. I mean, no other field would this be controversial? And Lassapine is the only drug that has the FDA indication for resistant schizophrenia and loosely defined as, you know, people that have failed to other antipsychotics without really getting even close to their former status. It's the only drug that will work in any significant percentage. There's always the anecdotes where someone does get better because there's literally trillions of ways to get the psychosis.

But if you look at statistics, it's well less than 5% will be successful in any other drug. Whereas with Klozabine, just by Klausbean alone, that group will get 50 to 70%. So a decade's ridiculous. because people have failed earlier than that. I can't argue. I don't have the data argue that if you get started on another antipsychotic that's not as difficult to manage because claspine is a lot of work. You have to manage the side effects. Some of the antipsychotics really don't have appreciable side effects.

And if they return to their former status, they go back and they are fine. I can't argue with using that. That makes perfect sense. You are a strong advocate for this. What are your thoughts? Would I do that? No. And the reason is because usually that same group will respond to a very low doses of clauspeed,

which then will have less side effect. And we know clozapine is, as I said, distinctly useful at changing the trajectory of the illness. And we don't know if these other drugs will hold them. Because what you've also heard, I'm sure, is, oh, that drug used to work great. And then it stopped working because it's a partial response. And I don't take this with tremendous. his data because the data really doesn't exist. The very first treatment, but I would use clausapine and I have used clausine right at the inception of illness if I could. Daniel, it turned

out it was a year and a half before he started clausapine. So you have strong beliefs that is just as good to start out right from the very start. We've had people start much earlier. I just started a fellow with bipolar with psychosis within two weeks, the start of his illness few months ago, and he's on a tiny dose of clauspeed with no side effects. And I've done this multiple times with other people. I'm in the literature, unfortunately, not many other people are doing it. There's a study that's coming out that Dr. McCabe in King's College in England that's going to repeat a lot of this in first episode psychosis programs. But it's also very interesting, your point about the 10 years. The most successful first episode psychosis program,

are the programs that quickly go on to Clause speed. And this is just a paper that just came out also, King's College in England. You know, this is the wave, I believe, of the future, and we're starting to get more and more inertia. Ten years is way too long. Yes, I definitely agree there. You lose brain.

And, you know, the recovery, you can still get really good recovery, but it's never quite. I shouldn't say never, but it's almost never what it is complete, because there's never and never, as I keep finding out. Okay, you've been doing this a long time.

No matter what's going on, there's always a bump in the road. What's one of the bigger challenges you've had to face then you've kind of finally figured it out and moved forward? You know, I haven't figured it out yet because probably the biggest challenge is engaging the psychiatric community. And that's something that we're still working on and getting an adequate workforce to basically take care of these kids. Probably the biggest obstacle besides that is the finances of it all. It's a lot of

work. And I think that's also why it's really tough to engage people because treatment of serious mental illness is very undervalued. Again, I made a very good livelihood when I was a phrologist. And, you know, I'm working just as hard doing, taking care of psychotic individuals as an internist, but I'm actually making about a third of the amount that I was making back then. And most of it is not insurance-based. Insurance will not pay for that. So at this point, yeah, I think our biggest obstacle is the inability of the insurances to recognize the value in treating serious mental illness with a comprehensive wraparound

approach and pay for it. Because, you know, it's great. So I live in Upper Westchester, Northern Westchester, right on the border with Connecticut in Westchester County, right next to Fairfield in Greenwich, Connecticut. You know, I'm Bedford. It's a beautiful area. It's incredibly affluent. I'm probably one of the poorer people that live there. And I am not poor by any estimation. So we have that group that will pay. And they paid literally hundreds of thousands of dollars for inadequate care. So we've started something called Doramine the last two years to get, you know, get this is the biggest problem around access to our treatment plans. And how can I get access at a reasonable cost? Well, we decided we would use nurse practitioners because they're a little more economical than physicians. You know, the rates are lower and their income expectations are lower because they don't come with the half a million dollar loan from medical school that most of the early psychiatrists come out with them. So I don't blame the

psychiatrist for wanting to be paid. No, absolutely. They spent a lot of money in college and they want to get paid. So how is it all working and how are you training them? So we've started with this group and I've trained for nurse practitioners. Three are employed right now. I supervise them regularly. I've got the two original founders who had worked for a firefly in

Athena Health in roles of, I think, chief technical officers and the cheap operating officers in those roles. But they had loved ones with serious bent on this. So this is more their passion. They understand the finances and we are

slowly trying to get and slowly getting insurance companies to value it. And they're valuing it probably too low. And we are far from a profitable enterprise effect. We're still on the bleeding money side, but we're starting to see more and more and also because we have the data. And the reality is it all comes back to our health care system, right?

So private insurance is if you do poorly, you can't afford to pay the premium. You go to another insurance company. If there was a universal care, you would see that just treating people with klozapine, and they've looked at this in the VA system, they've looked at this in a Medicare and Medicaid environment, they've looked at this in England, is a tremendous cost savings because instead of the revolving door of hospitalizations, it costs more to use klausopine, it's true. As an outpatient, the drug itself is dirt cheap,

and you stop the hospital, and that's the usual cost. So coming into my practice, the year before, 94% of our individuals, 94, 93, actually. Sorry, I don't want to exaggerate. We're in the hospital at least once. And most of those were multiple times. After coming into the practice, we've only had 15% go back in the hospital. And that extends from one year to as long as 15 years. So much longer periods of time. So the revolving door stops and expenses go down. With the expenses going down, the revolving door stopping, you would think that would be a situation everyone would love. The problem is getting all the individual payers on board. That's our probably biggest bump in the road, you know, because it's the affordability issue. People come to me

and, you know, if you can afford it, great, that's wonderful. And then they can get care. I've trained these NPs. I supervise them. They do a great job. My wife and I are over 200 patients. We're personally, and I always like to put this on our podcast, not taking any new patients because I'm 68 years old. And I think my mission right now is to take care of who I've got and train other people because this approach works. Oh, let me finish my approach. Ease. So early use of Klosby, A is assertive management and a wraparound service, not only giving medicine, but we talked about before. Diet, exercise, cognitive behavioral therapy, socialization. I have these kids come to my house, normalizing relationships, taking it out of the medical.

environment. The worst part of the people will tell you is what's the worst part of the psychosis is the loneliness, the being alone, the isolation. So we really work on that. And then slow. When you introduce your medicines where you titrate off another medicine, take your time. It really does help tremendously with the side effects and also slow because as you already mentioned, right, it takes 10 years sometimes for people to get to me. Guess what? It's going to be a slow, long, road. I always tell people it's not a sprint, it's a marathon. And then E, engagement. We engage everyone. We don't only engage the patient. We try to engage the family. Often the families are left out of the cure of serious mental illness. And that's just a sin. Or as I like to say,

sorry about my Judaism, Ashanda, which is even a bigger shame. And you know, you got to engage. You got to use all the resources you possibly can. And you should never let HIPAA, you know, something that gets in the way. Again, coming back to the anisagnesia, I've had kids tell me, don't talk to my parents. You know, I'm not permitting it. HIPAA actually gives the doctor permission to use his best judgment when the patient is, as we would say, not of their right mind. So if you think the patient is clearly in psychosis and you have met the family and they're not toxic and some families are, then sometimes I don't say it. I mean, again, there's no absolute, but most families are out there trying to help their kid. And I engage the family. Yeah, that makes total sense.

In closing, what do you think is important that our listeners hear on what you're doing and what they need to know? So, as I said, the nihilism and psychiatry, the belief that, you know, your kid's life is over. Well, my son is, you know, a stand-up comic, which, of course, most people with schizophrenia are, you know, has a decent career in New York City and has finally engaged the serious mental illness community because they need to see. So we were just at an event in Vallejo in California, I think it's south of San Francisco. And Daniel would get up and did a 20 minute set of stand-up comedy. Then we showed our movie, which is into the light meaningful recovery, a little plug for that. And then I do my usual talk. And the sponsor said, now you know

what schizophrenia can look like. That's what people have to understand. It's not easy. It really is not easy, but again, any other illness, you would use the most effective treatments. You pull out all the stops. Schizophrenia kills people. Psychosis kills people. The suicide rates are up around 5%. Osphi reduces up by 90% or so. I don't want to exaggerate again. You know, long-term survival. The Fin 20 study, the entire Finnish population, where they have actually a national health care system in a national database. So they have less than 6 million people. They have 62,500 people with psychosis.

And they followed them for 20 years. People not on antipsychotics that have psychosis, 46% had passed away, almost 50% mortality. People on a non-Klazepine-based antipsychotic, almost 16%. Oh, no, no, no, it's 16%. 25.8% died. And then with clausapine, it was 15.8%.

Still not perfect by any stretch of the imagination, but a hell of a lot better. So my message is, don't settle. It's not good enough. Demand. If your kid is great on whatever antipsychotic they're on, fine, but keep an open mind. As I said, these illnesses tend to progress. Demand the best treatment.

That's all I'm asking. And that is a clausopine-based regimen. Coming out in the next few months will be our fifth edition, and it's going to be an extensive disposition. I've gone through each book. At first, I just wrote it for the general public. But each edition, I've kind of increased references and made it not only for the general public, but also for the physician.

We've expanded the book originally to this little thing that was 100 pages. Now it's about 500 pages, probably too long. So it's meaningful recovery from schizophrenia and serious mental illness with Klosby. That'll be the fifth edition. It'll be out before the end of the year. And you share that with your treating psychiatrist. That's it. Just demand the best for your kids.

all I'm saying. Absolutely. Well, this has been great. Great conversation, great information. I really appreciate you taking the time to join us today. Oh, Tony, thanks so much. Thanks for taking the time with me. 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 why not me.world. One last thing, spread the word about why not me. Our conversations, our inspiring guests that show you are not alone in this world.