Latest / Radically Genuine / 91. Cured w/ Sarah Fay
Transcript
- some of your points I think are really important and I want to get back to it because it's those who don't use DSM diagnoses. The truth of the matter is that there is there is an air of truth to them right people do get depressed and depressed that depression impairs their functioning and people need support or tools or help. And we have to be able to continue to research and understand all the multitude of factors that lead to why someone might get depressed. And so that could be alcohol use and that could be nutritional deficiencies. It could be metabolic illnesses. It could be environmental trauma. It could be the way they cope. It could be experiences that they just exist in their life where they just feel like there's no way out and they're hopeless in that. And it's a mindset that they're stuck in and it gets. obviously gets even more complicated by the manner in which they respond to it. So I like using the word conceptualization without denying the person's internal experience as real and valid and important and require support and help. Depression is real. It's just not the way we construct it in the DSM. It's not a series of checklists. Each person is so individualized with their own unique experience. And if we don't understand that inner world of the individual, how do we know what to target as professionals? So if I was going back to your 20s, Sarah: Mm-hmm. Sean: there seemed to be a number of things that I likely would have had to target with you. You are prone to retreating into your mind. I think that serves you really well in certain areas of your life, that you can get obsessed on certain subjects. and all your attention and focus can go in there and you produce and create something as amazing as your memoirs. You know, that is, like even when you were writing and you were talking about punctuation, right? Things that, you know, that's the one part, you know, I tried to like read that really quick because I'm more interested in your story. Of course, I'm a psychologist Sarah: I'm out. Sean: and there's all this punctuation. I thought it was brilliant how you brought that in there but it speaks to the obsession of your mind. It's only pathological is if we think about it as pathological, right? If we say that in a certain context, it doesn't fit and there's something wrong or there's something broken with your brain, well, then it becomes pathological. So you would have come in to see me, I would have said, well, you have some gifts, let's utilize your gifts. But it does seem like you're having a difficult time turning off your mind in a lot of situations. And the way you try to quiet your mind, I'm concerned is problematic. going off on those runs, drinking all that wine, right? And it's affecting your body, it's affecting your mind, it's really physical, it's a condition, it's a lifestyle, it's affecting your physiology. Your body is gonna be affected by everything that you're doing. So there was a complexity, and that's without even knowing you personally, I'm sure there Sarah: Yeah. Sean: were other things in your relationships and how you viewed yourself or your place in the world that you had to be able to deal with in that particular time. Of course, it's going to be hard to focus. It's going to be much more difficult to focus when you're deteriorating physically and you view your internal experience as broken and maybe there's some nutritional deficiencies and you're over-exercising and your weight is low and you're drinking too much and you don't know how to respond to what you're feeling. Your brain is going to be different. Your ability to concentrate is going to be impaired. ADHD is just now a construct of those symptoms without actually targeting the cause. So you can go and take a stimulant, but this is the circular kind of reasoning that happens within psychiatry. Like you take a stimulant and then you're, you perk up, you know, maybe increase your energy, your productivity, your focus. And they, oh, well, you must've had an underlying illness, but like without realizing that anyone who takes a stimulant is going to, is really going to have that experience. Sarah: I mean, everything, first of all, I wish I'd seen you. You're just like, it's just what you're talking about and your approach is so refreshing. And I would see you. I would never see another clinician, I don't think again, but just because Sean: I've got an Sarah: I'm Sean: opening. Sarah: sort of, okay, good, good. I'll be out there. But I think, you know, yeah, and just everything you're saying is so, like I just felt myself relaxed when you were talking and I never felt that. when I was going through this, obviously. I just wanna backtrack and say one quick thing about Thomas Insel and Alan Francis, which is that, you know, that you may be right that they are sort of trying to protect their reputations. At the same time, I really feel that the greatest barrier right now that we have is with the public, not that, because... You know, Alan Francis's book, Saving Normal, and Tom Insel's book, Healing, and Chris Palmer's book, those should be numbers one, two, and three on the New York Times bestseller list for the next decade. And they're not. Why? Because people don't wanna hear this. People like psychiatry. They like all of these things. They don't want it rattled. So I guess that's also why I'm more kind of, I don't come out as hard against psychiatry because I don't think it's really the only problem. Like I think that we've got a larger problem to deal with, which is that people have accepted this and internalized it to such a degree that, I'm talking about like my publicists who didn't like what I said in my book. They didn't believe in my book because they had been diagnosed with depression and they had gone, or OCD, and they had been. treated and they didn't think I was right. And I'm like, it's not about being right. It's all just, you know, it's just the truth of the DSM. You know, even Paul Applebaum admits to it. So yeah, I just wanted to say that because I think that it is, that troubles me more than anything right now is that I worry that even if we blew up the system, people wouldn't, they just build it right back up or something, you know, that they are just, I was shocked at how reluctant the media is to put any of us on the air. I mean, they just won't do it. Sean: So why do you think that is? So I just, we started the podcast with this. I created a video on the, on antidepressants for youth. Now I'm very outspoken about the science and I think I know it really well. And when I say I know it really well is that I obsessed over it for years before I started talking about it. Because I could not fathom, I thought I had to be missing something. Because I grew up in the system, I was educated in the system. I had to trust the institution. There's no way this degree of fraud and harm could be intentional. I, cause I believe in people, right? And so when I would look at the data and how the trials were set up and who was on the FDA, for example, and they ended up being hired by the pharmaceutical companies, and I look at the statistical gymnastics that takes place in order to just to get them approved and the side effects and the harms and how they're being minimized. I thought I had to be missing something, right? I Sarah: Mm-hmm. Sean: have to be missing something. Where these prescriptions they're being prescribed at higher rates. Roger, what are you missing? You, they know something that you don't until I realized that there were a lot of people like me around the world who were having the same questions. Some of them were statisticians. Some of them were researchers, some of them were academics. And we just started connecting. And so now I put out a video. just last week and I made it like six minutes long because people's attention spans will only be five to seven minutes on YouTube. And I just review the research, including conclusions from authors around the problematic history of antidepressant research for youth and the adverse consequences and the black box warnings. There's nothing that I said that was out of bounds that's not published. In fact, When I would state a study, I'd pop it up on the screen, right? Sarah: Hmm. Sean: And we'd circle their statements within the research. We had that up on YouTube channel. We had our YouTube channel for probably less than 20 hours. And what Sean, what did they do to our account? Terminated it. They terminated the account. They did not give us a warning. We didn't get any three warning rules. We're appealing it though. They didn't take down. They terminated the entire account. within 24 hours. Sarah: Did they give you a reason? Sean: violating community standards. Guidelines. Guidelines, and this is the same thing that we saw within COVID, when all the other alternative research and the doctors globally around the world, if it in any way interfered with the drug narrative or the vaccine narrative or the authoritarian narrative, it got censored. Sarah: Hehehe Sean: And YouTube is obviously owned by Google, and I see Tom Insull is very connected with Google right now. You know, there is a lot of financial benefit to the identification of mental illness. And I also think there's also potential problems for creating a sense of vulnerability and dependency within a population. And so the manner in which people view their own experience and they label it as disordered or problematic and they need to rely on the help of others is also a shift in society. Because if we do think about how we've evolved and how resilient human beings are by nature. and what we can overcome and what people do overcome. We're not supporting that in society in the same way. Instead, we've taken these constructed labels and we say, take care of your mental health. And then we use words like illness and then we put people on drugs. But people like me who are concerned about the health and wellbeing of young people because of the dangers of both the label and the drug, we are being censored. And... To me, there's something a little bit more nefarious going on when tech can, tech who's also aligned with very powerful people can have that degree of control over a free society. Sarah: If you had to guess what do you think was in the video, like the one or two things that really set it off. Sean: Um, really Sean, I would say it would be the statements I made about the pharmaceutical industry. I would say whoever the moderator is viewed it as possibly being deceptive because as you've already stated, the problem is the public. So, I mean, the one problem I would suggest is this, which is reasonable. If I have to think of a reasonable explanation, is there are a lot of people on antidepressant drugs, a lot of people on antidepressant drugs. And you absolutely cannot just abruptly stop an antidepressant drug. Sarah: Yeah. Sean: And I, you know, I think a lot of people are concerned that some people just can't get off of them because they've been on them for so long. Sarah: me. I mean, what's so interesting to me is, you know, we don't allow recovery to be in the conversation, but I will always be on my, most likely, I will always be on my psychotropic drugs. And that's because I've tried to go off them twice and once I almost died, and I won't try again. And luckily, I have a low side effect profile. But at the same time, I mean, they know nothing about the long-term use of these drugs. And there is some evidence that being on an SSRI long-term for women can affect memory. That terrifies me, you know, but I don't know that I could ever, ever get off these drugs. But I'm not on them in the same way that people use them. So this is just my baseline. This is my normal. I never changed the dosage. I never changed what I'm on. It's just like, this is... sort of where I am, this is my normal right now. And if I went off of them, that would be my normal too, or if I went down, but yeah, but pharmaceutical companies don't realize there are gonna be a lot of people who can't get off their medication. So there's not that much risk. You can let us recover without losing $20 every three months. Sean: Yeah, it's such an important issue because there are people who want to end their life once they stop their psychiatric drugs and then it's communicated as like, well, there's, you know, there's your underlying illness, but they, what the doctors aren't understanding is the severity of dependence that these drugs create because it was communicated for the longest time that these are non habit forming drugs. And I think the reality of this, and there's people doing some really good work on trying to understand tapering. and how Sarah: Mm-hmm. Sean: to be able to mitigate the harm that's endured once you're starting to go off these psychiatric drugs is the tapering process has to go much, much longer than what the doctors are communicating, especially in primary care centers. Sarah: Absolutely, I think if I do try, I will try like over 10 years. That's how Sean: Yeah. Sarah: long I would do it, to be honest. I would just never risk it again. It was too much. And I had a very responsible, it's my psychiatrist now, and we were really titrating very slowly and tried over about a year, but it just got so bad that we just, I won't do it. Sean: Yeah, and we really just don't know who it's going to affect. And there are some people who, and this, this is with any drug, especially within the psychiatric drug community, is there some people just don't experience many adverse effects too bad and are able to get off of them with minimal problems. And Sarah: Mm-hmm. Sean: then there's other people who want to die because it is Sarah: brain. Sean: so horrible. And. Sarah: I mean, Sean: Go ahead. Sarah: the idea that people, you know, and this I heard from my own psychiatrists over and over again, it takes three months to work and you would not feel it immediately. If I forget to take my psychotropic drugs in the morning, cause I like that you don't call it medication, I sort of agree with that. But if I don't, cause I don't think there's anything wrong with me that I need medication right now, this is just my baseline. I can feel it by three o'clock. I mean, I can feel it by 3 p.m. The idea that you don't feel it, that's just, and I know other people who feel this too. I don't think it's just me and my body. Sean: People don't realize that the drug trials there they were like study for eight to twelve weeks You know, Sarah: Yeah. Sean: we have we have people on these things for decades real decades So we're in this unchartered territory and Sarah: Totally. Sean: I think it's one thing I have to say I really do agree with when you're talking about Alan Francis and Tom Insel is that The general public's knowledge of this is probably what's most critical at this point Sarah: Exactly. Sean: and And this is where we do need psychiatrists to be more outspoken. I actually think it's a secret that many of them are still guarding because Sarah: Mm-hmm. Sean: it still maintains Sarah: Yeah. Sean: their value in the hospital based system in, in outpatient world, their, their position in American society is growing when there was a time when they were at risk of going by the dinosaur, like they were going to be a, uh, just a historical marker. And in the technological development of American medical society, because let's face it, if it was going to be a brain condition, we have neurologists for that. Sarah: Right. Sean: And now we're looking at the gut, right? And how important Sarah: And. Sean: gut microbiome is and our environment and stress and diet and building up that important microbiome. We have internal medicine doctors. So there's their place in the medical. community is really threatened when you move away from the DSM diagnosis. Because although there are really strong behavioral treatments that exist, like exposure and response prevention for OCD is one example, or other exposure based treatments around anxiety and depression and the holistic community around depression when you're looking at activity and diet and sun exposure and in cognitive behavioral therapy. There are these, these treatments that are, are safe and they're lifestyle based and they're coping based psychiatries move them themselves away from that development of research based treatments and the therapy world. They're really, I mean, there's only a small minority of psychiatrists that continue to do therapy. Sarah: Mm-hmm. Sean: So like the hospital based systems that exist in our major cities and communities like ours here in the Lehigh Valley. Uh, it's, it's a, it's a typical model, similar to primary care. You're in and you're out, you know, you come Sarah: I'm going Sean: in, Sarah: to go Sean: you Sarah: to Sean: get Sarah: bed. Sean: your, your symptom checklist and you leave with your prescriptions and they check back with you in a month and then there's this. Kind of veil of scientific legitimacy that they can do. They can make these increases or these decreases with these, these drugs. But as teenagers are coming to say to me, and this is real folks, they get to pick their drugs. They'll sometimes they'll lay them out on the table and say, we can go here. We can go here. And you can actually have a choice. And I've heard this more than a multiple amount of times from young, young kids, 16 years old through 21 years old. Um, and, and you know, the truth of the matter is, is that's really how they're making decisions. There's not this strong science base that exists that talks about dosing and combinations of various medications and then this is used for this kind of condition and we have good science to support this. They're throwing things at the wall and that drug centered model that I mentioned before with Joanna Moncrief is they're trying to induce some degree of chemical imbalance, right? Whether it's a sedative quality or it's emotional blunting or something to change that person's experience. Sarah: I mean, you raised so many good points. I so much came up when you were talking, but the throwing sort of spaghetti against the wall aspect of all this, I mean, that's also what we're left with. And I think that's what scares people about criticizing or raising any of these issues. And I do worry about young people. And right now my main focus and what I fear the most, because I think that if we embraced recovery and we brought recovery, into the conversation, it would actually destroy the old model. Because if you can recover, it cannot be biological. Like it cannot be, because you shouldn't be able to change it. Like that just, you know, without some sort of, you know, whatever. But it would definitely, it calls into question what we're calling a mental illness. If it's a mental, if it's an illness at all. The recovery piece is so important. And you have... I mean, we have an office of recovery at SAMHSA and it's just getting no media attention. You've got Larry Davidson, you've got a whole recovery center at Yale, no media attention. I mean, they're really looking at marginalized communities and what does it mean to recover in a community that really doesn't embrace psychiatric care, that is afraid of it, and that people can recover. And again, the media isn't giving us any attention. It's like they don't want to, they don't, I mean, once a narrative gets put in play and it's on social media and everything, no one wants to disrupt it because it's getting clicks and the whole thing. But that to me is the way that we could break in and especially with young people, if they aren't being told that they can recover and that recovery does not mean perfection and it does not mean being happy all the time, my... life in having recovered, because I don't believe I'm in recovery in the way that often it's talked about in the AA community. Like I have recovered, like it's over. And now I am well. Like that does happen. And but my life now is nothing like what I thought it would be. And that's what Cured is really about, is how wrong I was and what I imagined normal. or mental health to look like. Like that I would have a lot of friends and I would be in a romantic relationship and I would like to go to brunch, you know? Like none of those things are true. And none of those things happen. It's a lot of me at home writing with my cats. And essentially it was me learning to create the life I want. And there's nothing wrong with me because I don't like to go out a lot. And there's nothing wrong with me because I get anxious and crowded. with a lot of people, that's not a normal thing for humans to encounter, you know, there's so many things that, so really recovery was so much about finding the life that I wanted, and I could have done this before. So it's been, it's so exciting, but people, you know, we're not offering it to young people, and we're telling them, like I was told, you will have this for the rest of your life. And it's just not true. Sean: That is such a brilliant comment. So you speak to, and we have to think about this technological age that we're in as very unique to our evolution. So many people think that part of the ongoing mental health struggle right now is a mismatch between modern society and what we've kind of genetically evolved to do. So your idea of what a life worth living for you is very unique. philosophize on these type of things, you know, all the time, because we're constantly bombarded with all these messages, whether we're watching a Netflix program or a commercial, or we're exposed to social media. There's this branding and this idea of what should make us happy. Part of it's, you know, American capitalism, and they're trying to sell something, some material good for you. And like, if you can buy this product, then you know, you're gonna be able to find this happiness. So much is around materialism. And I sometimes reflect when I am at peace, when I feel content. And last Saturday, when I was sitting outside on my porch, reading your book, I was, I was at peace. It was contentment. I didn't want to go out and party. I didn't want to be amongst people. Sometimes I don't want to be amongst people at all, but it was just the level of peace, just sitting outside with it, with a good book, sometimes exercising. being around small groups of people, being intellectually stimulated. You have to find the idea of a life that fits who you are. And that does require some understanding of who you are without judgment. Sarah: Yeah. Yes. Sean: I'm not Sarah: And Sean: living. Sarah: that was, Sean: I'm not Sarah: yeah, Sean: living Sarah: go Sean: unless Sarah: ahead. Sean: I have lust for life from Iggy Pop playing in the background. You know, as I go from party to party to party. Sarah: Exactly. It's like someone asked, you know, as a writer, hashtag am writing and someone asked on I am on sub stack and someone was asking, am I really writing unless I've written hashtag am writing on Sean: Ha ha ha. Sarah: social media? But it's so true. I mean, I really had to reevaluate everything that I thought was mental health. And I think that we're being sold mental health in a way that it isn't. When I hear parents talk about their children not wanting to go out or be around other people, not children, but like teenagers, I think, of course, you're a teenager. I didn't want to either. And I don't know that that's not... How do we know that that's necessarily a negative thing? I've always been a solitary. We talk about introverts, but I'm not an introvert. As you can see, I'm very sociable. And if you put me in a room, I can do it. but I'm a solitary and a solitary is not an existence you're allowed to have in this culture without being labeled as weird. And I mean, if we could allow for people not to look other people in the eye, that's a signature of autism. If we just allowed for that, there's no problem. There's just not a problem then. And so much of it is societal. And like you said, so much of it is capitalism. I even think meditation is being sold to us. I mean, meditation was terrible for me. I mean, I had such adverse reactions to it and so many people are prescribing it to others, that this is the panacea for mental health. It's not, it can have terrible reactions for a lot of people. And also now you have to pay for it. Like you have to pay $25 in New York or $75 to sit in a room and meditate. It's like, what is that? Sean: I'm so glad you brought that up because I have all these series of questions around it because I think about it differently than you do. Well, the fact that it's being sold to the American public, I totally agree with you. And it's been it's not a panacea. In fact, meditation can be painful. And depending on who you are, right? In fact, I think it can be painful for a lot of a lot of human beings. So I would predict Sarah, if you and I were because I know you so well because I read your memoir. Sarah: Hehehehehehe Sean: If I was working with you, I would have imagined that meditation in itself would be very, very difficult. And I would have taken it in very, very small steps. So I would have started with the concept of just increasing mindfulness. Because my conceptualization is that you are an internalizer. and that you retreat into your mind and stories are created into your mind. And you could attach to those stories and you retreat in there. I could see with your imagination as a young girl, there's a lot of solace that exists. You're prone to obsession and focusing on things that are really driving your attention. So if we're going to then ask you to meditate, we're taking you out of that. This is where you... where you yourself have been coping, okay? And if we ask you to sit, now you're gonna be paying attention to your emotional experience, your physical sensations, changes that you've detached from. It is going to be observed and experienced with you in particular and others like you as emotional distress and pain or an adverse reaction. So I know you've mentioned like... Sarah: Well, but an adverse reaction, that's different. And this isn't in the book, so you don't know this, but I meditated for years. I practiced yoga. I was in Ashtangi for 20 years. I mean, so all that was going on. I also went to Thich Nhat Hanh's monastery in Plum Village and interviewed him and meditated with him and the whole thing. And so I've done it. But my adverse reaction, and this was a lot of people, it's the dark night of the soul. And so it is disassociation, it was depersonalization, it was very severe, not quite psychosis, but certainly bordering on it. And there have been people who've experienced psychotic breaks from meditation-induced psychotic breaks. I'm forgetting the title of the book, but there's a guy who did great research on this. But, you know, and again, I don't think that's everybody, but we can't, there's this idea that meditation means you're healthy. Like, kind of what you're saying, that then you can manage your emotions. But that isn't where everyone's gonna manage their emotions. I mean, what I've learned, I didn't even know what emotions were. I didn't even know that they were vibrations in your body. I mean, I had to read, and again, I am very cerebral, so a lot of my understanding has come from like Lisa Feldman Barrett and people who, you know, in sort of her book on emotions and, you know, she gets very heady about it, but now I can sit down and like, when I have anxiety, like that's Sodden Pit. Still with me, folks. But now I can experience it, and I can allow it to be there. Last night, sit in my bed, describe it to myself like I'm describing it to an alien, and just watch it move and change. But no one taught me that. So Sean: Yeah. Sarah: I don't necessarily need meditation, but I agree with you that it can be very, it was very uncomfortable at certain points, but then it flipped over. into I think what was dangerous or risky for someone, for me, not for everybody. Sean: Yeah. Sarah: But also the Buddha did say that meditation was for monks only, not laypeople. Sean: Yeah, let me let me clarify on a couple of things because I was going to take this down to a certain path. So even Marshall Linehan, who was a developed dialectical behavior therapy, and so she's melded Eastern philosophy and behaviorism. She speaks to this too, where she talks about mindfulness versus meditation. Sarah: Hehe. Sean: So the mindfulness is the way to connect into the present. And so there are many different ways we can connect into the present in our in our lives. Whether it's the food that we're tasting or like, I think maybe when you were going, going on a run or you're going on a walk or just a conversation, right? The connecting, we are here in this moment in, in a flow state. And so there's ways we can get out of our heads that I think are beneficial to our entire physiology. Now, if I have somebody who is a trauma victim and experiences PTSD, and I have somebody who might disconnect from reality. and meditation retreats them into an alternative world, right? Which can happen, right? Because although I might, I might be able to focus on my breath and stay connected with that sometimes if I'm 25 minutes, 30 minutes into a meditation, I am entering into some brainwave state that is taking me into different places and directions. So, right. There are some adverse consequences to those things, but the concept of being able to get out of our heads and being able to notice and accept our experience is part of that emotion regulation process. Um, but it gets sold to Americans with these apps and these other things that we, we sit there in meditation and we are in a place of calm and we are achieving this higher state of consciousness. And it's just how I, it's just so Western culture, how you take something that has gen, you know, centuries of tradition around it and very important learning and you try to package it. Sarah: Mm-hmm. Sean: And that's what's happening now. When you talk about what is a life worth living, if you are comparing yourself to what you think you should be, that comparison process, that's really problematic because now you're back into your mind, I'm not good enough, there's something broken within me, everyone else is happy, see, I can see it on this phone. The world, this isn't how life is supposed to be and we've lost. our own understanding of what it means to be human. Going through life is painful. It is very, very difficult. Even if you don't have, if you're blessed enough to not have really adverse circumstances, trauma or any of the other horrible painful things that can happen in this physical world, you're still gonna experience loss. You're still gonna experience pain, doubt, the presence of fear. difficulty sleeping. There's no way this is what makes the whole DSM so nefarious is because going through life and being human means you're going to go through episodes. Sarah: Yeah. Sean: And mental health problems are episodic and can be episodic. And that's that recovery, what you're talking about. So I know your message is really important, I think. And I think you're going there and I have to read your book, but you're talking about it has to be individualized, aren't you? and you Sarah: Yeah. Sean: have to know yourself, what makes life worth living for you? And can you develop a value-based life and take steps in that direction, even when it's painful, even when there's struggle? And can you possibly reframe it in your own way of thinking about it, when you are struggling, if you thought about it as this is to serve me in my growth in some way. Does that not then change your entire perception of what it means to live? Sarah: developed or and I got this from someone but life is 50 50. I'm going to feel great 50% of the time and I'm gonna feel like garbage 50% of the time. And so when I do have those moments of, I mean I still get panic attacks. I still have anxiety. I still get you know I still get very sad in that sodden pit. But now it's just part of it. You know it's just part of it and when I don't think there's anything wrong with the fact that I feel that way, it's totally different. It's not any more enjoyable. I mean, we can just all admit that it sucks, but at this, we'd all much rather feel excited and motivated and happy and the whole thing. But that's just not how we're, I love evolutionary psychiatry and that basically what they've sort of, what it taught me is that there's, as you said, homeostasis is the body's kind of. what the body is always seeking. And the mind, I think, is always seeking that too. So if you've spent too much time up, it's gonna go down, so it can just get you to this other place. And I think what people forget is that place is actually what you just described, which is contentment. And I was walking this morning and like that word contentment is so underrated. I should write a book about contentment actually. Because Sean: You should. Sarah: it is, I should, because I had the same experience you were talking about. I was walking this morning and I just felt Like just not even full. It's a weird feeling, but it's contentment. And it's just like, okay, it's not happy. It's not anything to shout about. There are no exclamation points. It's just, it just is. And it's the most beautiful feeling and I love it so much. And so yeah, I think that there is so much to be gained from looking at recovery as. As you said, it's an individual process. It's going to look different for everyone. And that's why it's such a hard sell for the media and for traditional medicine. Because, well, once you say it's individualized, just like if you say, you know, that all psychiatric or mental and emotional pain is individualized, well, they don't know what to do with it. And so there's a lot of work we have to do to bring recovery into the public sort of mindset and change in that way. But the first thing people need to realize is that there's clinical recovery and there's personal recovery. And we used to be in a clinical recovery model, and that meant the reduction of symptoms. Well, symptoms are part of the human experience. Anxiety, depression, even mania, even psychosis. I mean, have you ever had a song stuck in your head? That's a very mild version of Sean: Biggie Pop, Sarah: hearing Sean: Lust Sarah: something. Sean: for Life. Sarah: Now I'm going to have it. Thanks, John. But versus personal recovery is when you are living, you know, you have purpose, you have meaning, you are living in an environment that is safe, that is, you know, fortifying, you know, it has all these facets to it that are very individualized. And I'm the one who says if I've recovered, not my clinician. And that is, I think very, some people think that's dangerous because of anasognosia. you know, this idea that you don't know that you're really sick, which people said that I didn't know at times. I knew how sick I was. There was no question. Sean: Sean throws that Sarah: And how, Sean: at me all the time. Sarah: right? But my understanding is that anosognosia is extremely rare and it happens in cases of acute psychosis and that's about it. I mean, my experience with people is that mental and emotional suffering, they may not talk about it, but they know it's there. I mean, very few people don't know it's there. And so... Yes, we know when we're not well, and we know when we're well, and it's gonna look different. Sean: So we've transitioned to talk about your new memoir, Cured, which is available Sarah: Yeah. Sean: in your sub stack link in our Sarah: Yes. Sean: show summary. Everybody click through, you can read it. You're making it available for free Sarah: Yes. Sean: for the next year. So do that now, sign up. I think what you're touching on is the idea of when it comes to recovery, accepting what your version of it is. Sarah: Yeah. Sean: What was, can you talk about that journey and is it Sarah: Mm-hmm. Sean: in your memoir? Sarah: Yes, it's all, so what my memoir is, much like Pathological is my story of 25 years in the mental health system, and there's also the strand of the DSM and everything I wish I'd known about the DSM I give to readers. And then there's a strand on my obsession with punctuation, which is... I just said is a little odd. Even the reviewers didn't know what to do with that. Like the New York Times was like, and then there's this part on punctuation. Like we don't even know. There's no punctuation in Cured, you're safe. So Cured is really just my, sort of my journey of recovery, mental health recovery, but it's also a history of the recovery movement. And then the other thing I give people is all the tools that I used and all the methods that really helped me through recovery. So to give you an example of one of those is self-talk. It was not something I had ever been taught before, but the way I spoke to myself was like a very mean fifth grade girl. You know, like I was really mean to myself. No one was as mean to me as I was to myself. And I really had to practice being nice to myself and speaking to myself in a way that was respectful that I would never have spoken to anyone the way I spoke to myself. So that's kind of one tool. And I talk about Ethan Cross's book called Chatter that, you know, and he goes into depth into that. But the recovery movement being a movement that started in the 16th century. We've been recovering from mental illness for over 300 years, but no one talks about it. So I track the whole recovery movement and how it's been. how it really took hold after deinstitutionalization in the 1960s, because although that was a disaster, it did free a lot of people to have a voice and talk about how wrongly they had been treated, but also that they had recovered. And that they weren't being allowed to recover because one thing we know is that... Institutionalization is the worst condition and it does not encourage recovery. Being in the community does. Now we don't have the resources to help people in our communities right now, so that's not really working. But then my journey of recovery, really I did it in secret. So the same psychiatrist I had who said, I don't know what you have, he mentioned this patient that he had who was diagnosed with schizoaffective disorder. who had come to him and that she was now fully recovered and executive at Google. And I was like, no, first of all, Sean: gonna Sarah: no one's Sean: need Sarah: ever Sean: a name. Sarah: mentioned the, yeah, Sean: We're gonna need a name Sarah: exactly. Sean: because we have a problem with our YouTube account. Sarah: Yeah, exactly. Yeah. But I want, you know, I, my sort of attitude was, no one's ever mentioned that anyone can recover. So people don't recover from mental illness and certainly not schizoaffective disorders. And they don't become executives at Google. They have like miserable lives, even though they were or something. And so I was so scared that people would tell me that I couldn't recover, including him, that I really did it in secret. And as I said, there was, you know, I was at my sort of worst point and I knew either I was going to get well, I was not gonna be in maintenance anymore. I was either gonna get well or I was gonna end my life. And those were the options at that point. And so what I started to do was really think about, instead of managing my symptoms, I started to manage my health. And like, what did that mean? And so I stopped thinking of myself as a sick person. I stopped thinking of myself as broken. And instead I looked to the future. It was not about the past anymore. And I was no longer. Really even, I mean, I was seeing my psychiatrist, but I wasn't seeing a therapist. So I wasn't very much in the mental health sort of system. And for me, that was helpful because I needed to get outside of it. So I wasn't thinking in those terms. And so once I got away from that and I stopped seeing myself as broken, I started to build a life. And part of that was finding an environment. I mean, I talk about, I lived in an apartment that, I talk about this in pathological too, but I lived in an apartment that looks out onto a brick wall. And one thing they know is, well, first of all, that's not even that bad. Some people are living in terrible environments that cannot possibly fortify any type of mental health. I mean, it just cannot. But even just that, they did a study and people in hospital rooms. And those that looked out onto a tree recovered faster than those who looked out onto a brick wall. Sean: Yeah. Sarah: And so just that idea of like, even if you can see a street and you know people are there, it's a, you know, there's a difference there and how well you'll heal. So I started to again, research recovery and looked into that. But what I outlined in the book too is all the mistakes I made so other people don't have to. I thought I needed a romantic relationship. It was a disaster, as you can imagine. I've I had a long term one long term relationship, but it's not my preference. I don't really like being in a couple. I love my own company and I love being alone and I don't have any desire for it. I don't know what you know, I don't need a label for that. It's just how I am and that so I had to kind of go into this very desperate. relationship where I wanted, I thought, okay, if I can be with him, it means I'm okay. It means I've recovered. And what I realized was it was making me worse. And so I left that behind and I kind of learned, wait, this is who I am. This is what I want. And same thing with being social. I thought I have to have a lot of friends and I have to go out all the time and I have to be social. And I realized I hate that. I just Sean: Mm. Sarah: don't. want it and I don't like it. It's not my preference. And so I got to accept this is what I like to do. Now I make concessions because I love my family. My family does certain things and I want to be with them. And so I've chosen, yes, I will do those things. Like that is okay with me to be with them. But they were my choices and I want doing them because otherwise it means that something's wrong with me. I'm doing them because I want to be with my family. My mother's 80. my father's 82, I wanna be with them and make them happy. And it makes them happy to go to musical theater. So I go to musical theater. So I take people through that all the while sharing tools. But one thing that was so helpful for me was getting a cat and having, I now have two of them, but that was, again, emotional support animals, but I made a mistake. I thought the animal was supposed to comfort me. No, Sean: Mm-hmm. Yeah. Sarah: actually, the therapeutic quality is that I take care of them. So this is someone who couldn't take care of herself, who's now taking care of two little creatures who are very demanding. And so just those things that created, you know, and then also sharing with people that recovery is different for everybody. And it's it should be and we're going to have to bring it to the forefront so that clinicians start talking about it. My call is that recovery should be mentioned in every single conversation with a mental health professional or any physician or clinician that talks about mental health as should an exit strategy. So meaning we're gonna put you on these medications for now in three months we're gonna check in and then this is the strategy we're gonna take to get you off of them. That's the whole process. Like that should be de rigueur. Like that's what we do automatically in every situation. And then people won't end up like me. Now, some people will take medications long-term. Okay, you know, again, we're throwing spaghetti against the wall, we don't really know. Although there's pretty good evidence that medication is best in acute cases and that's it. But yeah, so trying to get recovery into that first conversation that people have. And then just letting the public know that it's possible. Sean: You made me think of something. So you're, you're talking about how you're viewing yourself more positively. And I had read your, um, your piece in 2019 on suicidal ideation. And Sarah: Mm-hmm. Sean: as I read it, I felt so completely uncomfortable. Um, it was, it made me like a little anxious as I was reading it, but, um, the one thing that stood out is you kept on throwing out the word that, uh, you are one of the lucky ones and, Sarah: Mm. Sean: um, it had so many layers within the piece about. social and then also just about survival and I'm curious if you wrote that Before this period or is or after like is it is that how you viewed yourself then or how you view yourself now? Sarah: That was actually how I viewed myself then. I wrote that piece in real time during a suicidal episode. Sean: Wow, Sarah: Yeah, Sean: I felt it. Sarah: it's pretty intense. Yeah, it's a really intense piece. And I did not know what I was doing. I mean, in the sense that the editor I sent it to called to make sure I was okay. Like, Sean: Mm-hmm. Sarah: you know, I mean, it really did have that. Even though I didn't say that in the piece, it was very, it's very obvious, you know, in that. And I wanted to document what it's like, you know? People think it's this, you know, that suicidality, people don't understand it. Like, yes, you can be fine one second and then slip back into it. I mean, you know, that, well, we didn't know anything was wrong. Well, that's understandable, but that doesn't mean something isn't wrong. And just this, it's very dull. Like people don't understand the suicidality it's portrayed in TV and in movies is this like very dramatic situation. It's extremely monotonous and dull. Like it's just painful is what it is. And one thing I describe in this book is just what it's like to them be in crisis. So when that suicidality goes into, sort of like a psychiatric crisis at that point, when you're very close and how different that is. And that's for me, it was like being in a prism, like everything just closes in and the world doesn't exist anymore. So often, people think, I wish I could have, done something or why didn't they call or whatever it might be. But like the world doesn't didn't exist for me. Like I didn't have a family. There was no one to call. And the only reason I was OK is that the therapist in one of the outpatient programs that I had been in sat down with me and my sister and we came up with an emergency plan. And that was, you know, literally it was step by step. It was get up. get your phone, press your sister's number, wait for her to answer. I mean, it was that, like baby steps. It wasn't call me if you need me. It was literally, and somehow that got into my mind and I did it and my sister answered. But even if she hadn't, we had the emergency plan, keep calling, keep calling, just keep calling. And she did answer and then we had other aspects of it. I would go, basically I would... take a clonopin to knock myself out. But that was at the time when I was still on that kind of medication, but, or drug, drugs. And I would just write, fill out this sheet. And basically it was just biding me time, answering questions until the clonopin kicked in. And then I would sleep through the night and inevitably, or most of the night, and I would be okay. So like that is in there again, just trying to give people an emergency. plan. One reason why I really wanted to write Cure and one reason why my agent and I decided to make it available on Substack. For people who don't know, Substack is a new media platform. It is amazing. Many journalists from the New York Times and the Wall Street Journal and elsewhere have gone there because we are tired of the media always publishing the same stories, not giving a voice to people like me and others. Although I shouldn't say that much of the media has been very generous with me, but so is you go on there. So we'll have the link in the show notes. And basically what you'll do is you'll just enter your email address. If you're not comfortable, you can just press no thanks and you can read all of cured online. You can also put your email address in and you'll get a chapter every week. So that's the way it's working where it's called serializing it. But my agent and I decided to do it because books, one, take two years to come out. So I didn't want to wait two years. And then we're also using it basically to show proof of concept, basically to show publishers who really don't know how to read a market. And so sometimes we'll not publish important books to say to them, look, I got 30,000 subscribers. That's like way more than any book usually sells. And then, you know, to push the book through and have a better chance for it to come out. hopefully in two years when recovery is much more in the mainstream. Because the thing about books, which my agent informed me of, is that books don't start movements. They don't start social movements. They can only reflect on them. Sean: Hmm. Sarah: And it's only grassroots platforms like Substack that can start a movement. And so that's what I'm hoping to do with this. Sean: Great. We've kept you so long. We're certainly into Sarah: Oh. Sean: part two here, but you've been here Sarah: I'm sorry. Sean: two hours basically for us talking and it's been an enlightening conversation. I just love some of the things that you just said and I have a number of my clients in mind who I hope are listening to some of the things that you are basically saying about your recovery model and that process that you went through. There's a statement that just kept sticking in my head, where your attention goes, your energy flows. Sarah: Yeah. Sean: And when you start to break away from the idea of being broken or disordered and started knowing yourself better and what you need, need that then your energy begins to flow in a new direction. And there's a, there's a wisdom here to everything that you're saying. Sarah: And this really circles back to what you were saying about illness and the word illness and how that can be. I mean, one thing, the metaphor that I use in the book is a very unpopular one, but that it's like a broken bone that you can fully recover. And when a bone breaks, as it recovers or once it has recovered, the point of the break becomes the strongest part. And I love that. Like, yes, maybe I had broken, but I'm so much stronger now. you know, and, you know, people don't like that because they think that metaphor because they think it trivializes, you know, mental and emotional suffering, and I don't use it in that way. But I use it to describe recovery because if you've broken a bone, everyone's going to heal differently. You might have a little like knobule on your, you know, on your skin or something. And some people, if it's a broken leg, you might need, and I also break my foot while I was recovering, so that's why it comes into play. So that's in the book, but some people might have a limb. Some people will recover completely and run marathons after that. Some people will always use a cane. I mean, there are different levels. So it's not to say, and again, I've been, people have pushed back against this and said to me like, Ooh, you shouldn't tell people they can recover, you know, that that's, that's not good. It's going to make people feel inadequate or it's going to give them quote unquote, false hope, like no false hope. You know, that it's only dangerous or difficult if you don't give someone the chance to recover. to recover or even give them the possibility. That's cruel, not giving them hope of recovery. But recovery will look different ways. As I said, it doesn't mean you don't suffer, and it doesn't mean you don't feel awful. I mean, that is part of the human experience, but you are functional in the life you've created. I'm not functional trying to be an executive at Google. That would not have worked. Thank goodness. I do not want to be an executive at Google, but in the life I wanted. And so part of that, it really took a peeling back of the pressures I felt, you know, to be the ultra successful writer or whatever it might be, you know, that I had to look at what is really important to me. And it's surprising how important my cats are. It's just truly surprising. Sean: There's a lot about what you're saying is about attaching purpose and meaning to one's life. And as Sean knows, I'm kind of on my own unique spiritual journey and thinking about life in lots of different ways. And one of the things that I'm just learning as I begin to get older is that you begin to really reflect back at other periods in your life where, when you were in it and at that time, it felt like hell or it was just a horrible, difficult period, but it shaped you. And where you are in creation at this stage doesn't occur without having to go through some of those challenges. And I look at where you are right now and what you're creating. It doesn't, what our conversation right now doesn't exist. The book doesn't exist. The influence that you will have and are having, it's not created without your suffering. So if there's some meaning that can be attached to suffering for people who are in a lot of pain in the moment, maybe you don't know it now, but there will be a time where that experience. serves you in your own unique journey, your own development, whatever that is. And it doesn't mean that you have to write an Apple best book or a book that is just renowned like yours is, but you could be creating something just as beautiful in a different way, nurturing a relationship, a connection, some way that you're serving others, serving the community. We have to be able to think about creation in new ways. And As an artist, you're a creator. Um, but there's a number of different ways that I think people create this podcast, this conversation is, is created. The, the great Saturday that I had outside reading your book, that joy, that intellectual stimulation, that piece was created by your hard work. And the one thing you learn as you're on kind of a spiritual journey is how we're all connected and Sarah: Yeah. Sean: all of us in some way as humans, we are just we are connected. Your pain is my pain is his pain in some way we can all understand it. Even if we didn't go through it in the same way we have human empathy. Even when we're walking down the street and we see somebody who might be homeless and has these adverse conditions and might be struggling emotionally, mentally, we can feel it if we allow ourselves to. And the more we become consciousness and society, we don't evolve. We Sarah: Mm-hmm. Sean: evolve out of empathy. And with mental health, we've developed the conversation. Sarah: Mm. Sean: And your book, your contribution evolves the conversation. And that's how it happens. We have to break through old models. Because when they become something that is that becomes the, the lone understanding and experience of everybody. And then there's a system around it and industry or institutions benefit from it. It's very challenging to progress from that, from that point, because there's going to be so many vested interests in maintaining that belief system. I think podcasts like this book, like yours, the work that you're doing on all the different conversations, it's about kind of breaking through those ceilings that are created and it's creating new ways of thinking. So this is going to reach thousands of people. Your other conversations have reached thousands of people and it spreads. You know, it Sarah: Uh-huh. Sean: changes thought and it changes the experience. And that is how change is going to occur. So, Sarah: Yeah. Sean: I just want to thank you so much for an enlightening conversation. You took so much time with us and we really do appreciate it. There was so many brilliant insights. I do honestly want to recommend this book. When I say it's a quick read, it's... Well, you're very talented writer. I mean, this is what you do. And so you, you have a way of constructing your words in a way that's. You can create the story in your mind. It's easily read. Um, and you're interested in how it progresses. Like you become connected to you as a character, but you're not a character. Um, so I do encourage people to check out the book, um, anywhere else that people can find you, Sarah, if they want to learn more about you. Sarah: Well, part of my evolution has been realizing that I don't like social media. So I will I am on Instagram. It's mostly my cat videos. So please do. They get like 15000 views. They're huge. Sean: Hahaha. Sarah: They're huge on social media. So you can find me there at Sarah Faye author, but really come to Substack. I know it's new for people, but I really encourage you to subscribe to Cured, mainly because, again, it's free. It doesn't cost you anything. And it will show, help us show publishers that yes, this is important, this is necessary. So if you can send your friends and everyone, you know, there so that we can bring mental health recovery to everyone who needs it and deserves it. Sean: Sarafaye, thank you for a radically genuine conversation. Sarah: You're so welcome. Thank you.