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126. Anatomy of the teen mental health crisis · Radically Genuine

• Welcome to the Radically Genuine podcast. I'm Dr. Roger McFillin. The toxicity of our culture creates sickness of mind, body, and spirit. To believe you can ingest more poison to feel well is the delusion that's currently being sold. As we record here today, it's March 17th, 2024. Happy St. Patrick's Day. Happy St. Patrick's Day. It is about four years since the institutional lockdowns. in response to the COVID pandemic. What we have been observing in clinical practice, in my opinion, is the result of more rapid shifts in Western culture that have undoubtedly influenced the mental health crisis for teens. I'm not going to say that our current mental health crisis is due to the COVID lockdowns. I'm going to, and I think more accurately say that just exacerbated some... current problems that were existing. For me, the shift in presentation over the past 10 years has been quite dramatic. In fact, I do believe we are at a crisis point that requires a transformational shift away from some of the fundamental institutions that I believe are primarily responsible for the rapid decline in mental health. Those fundamental institutions can include our public education system. pediatrics and the psychiatric industrial complex, mainstream media, government oversight and the continued fragilization of Generation Z through parenting advice that has created a culture of fear where parents have lost control over the use of technology in their own homes. To discuss what we are observing in our community, which I believe is a representative sample of the greater United States. I want to welcome Dr. Riz Ahmad, who's a clinical psychologist who specializes in the treatment of adolescents and who's also the clinical director here at Center for Integrated Behavioral Health. Dr. Ahmad, welcome to the Radically Genuine Podcast. Dr. Riz Ahmad (02:09.586) Thanks for having me. It's a topic particularly passionate about. I'd say about 80% of the clients I've seen over the past 10 years have been teens and kind of a focus in the age of 12 to 16, disproportionately teenage girls. Sean (02:26.179) Yeah, I really do believe we're going to kind of do an autopsy of Western culture and American society that has led to this crisis. We've addressed it previously on the radically genuine podcast. The astronomical rise in adolescent females who are on psychiatric drugs have been psychiatrically hospitalized or engaging in non-suicidal self-injury reporting depression, anxiety, ADHD, and a number of other adverse emotional reactions. Many parents are at a loss. They're following what is standard advice, and what they're seeing is their kids are worsening. I think we start this podcast off Riz by just kind of talking a little bit about how we have decided to kind of address this crisis through a specific program we are running. And I'll let you kind of introduce that and I'll jump into. Dr. Riz Ahmad (03:22.798) sure. What we're running in our program is a dialectical behavior therapy program for adolescents and their families. And you've talked on the podcast and other episodes, I think, about what DBT is. But it was a treatment that was originally created for adults with multiple presenting issues related to intense emotion dysregulation. So could be suicidality, self-harm, substance use, impairment at work, relationships, etc. And what we're seeing is that in adolescence, you can have a version of that at a younger age that if nothing else changes, would develop into those difficulties as an adult. So these are often teens who are struggling with those multiple presenting issues. It could include things like school refusal, family dysfunction, relationship issues, obviously cutting, which has been much more prominent in the last 20 years, I'd say. It could be issues that are exacerbated by social media and other things that I think we'll get into today. These kids are often the ones who have entered our mental health system through various pipelines, whether it's through school and school assessment that has led to recommendations for parents to take their kids to the emergency room, be evaluated, possibly partials and hospitalizations. or through outpatient therapists that they saw for various difficulties and sometimes a referral source to the emergency room or hospital ends up that way. But very often a history of persistent hospitalizations, these parents are often even more confused because they've been through treatment after treatment after treatment and things haven't gotten better. They put a whole bunch of time, energy, effort at great expense to try to make things better. And so what we're running in our center is a treatment that's meant to have a longer-term outlook. That it's less about just putting out fires in the crisis, but having ways of responding to crisis in ways that make sense from what is this teen learning, what is the family learning, how is this sustainable for well-being. So the program itself includes a few components. Dr. Riz Ahmad (05:47.49) DBT group. That one is based off of dialectical behavior therapy for adolescents. That's the work of Dr. Rath, Dr. Miller from the behavior tech group. So it's modified on that and kind of focusing on skills that we think are most beneficial to teens. And at the same time, parents receive a whole different level of support. That there's a group that you're running that I know you can speak more to, Dr. McPhillan. But that group is meant to be something where parents have access to coaching parents are really trained and taught how to have the permission to parent again and How to do so in ways that are gonna be more effective at helping promote Learning how to manage intense emotions for their for their teens So the hypothesis is really that if we can create a lot of change within their environment in their parents at the same time In the family and in the home that you're more likely to see sustained improvement rather than the answer being a revolving door of hospitals or residential or being removed from your home or your life. Sean (06:57.639) And we've decided to modify the original DBT for Adolescents program, which was six months with the parents and the teens together in one skills training group, providing coaching calls to teens receiving individual therapy. And I think one of the things we did observe when we were running the original treatment was that so much depended upon the adherence of the parents. You know, the parents who were fully committed to kind of modeling the skills, changing their response. uh, in the home environment and kind of supporting the development of new ways of coping, we saw a positive reaction when the parents weren't fully bought in and they challenged to kind of respond differently, you know, and I'll talk about the challenges of responding in new ways to problem behaviors, but those who weren't fully committed, we didn't really see any dramatic changes. And, uh, we decided to modify this program and it's currently a research study where there is a pretty strong emphasis on 16 weeks of parent training, behavioral parent training for the parents. So DBT does have four modules, their core mindfulness skills, distress tolerance skills, emotion regulation skills, and interpersonal effectiveness skills. In the DBT for adolescents, there's a walking the middle path, which is really kind of a dialectical skill building, dialectical philosophy, and definitely used for parenting. But for our program, it is the parents who probably get the majority of the support. Not only do they have the 16 weeks of training, they have the ability to have their own individual sessions and telephone coaching consultations as needed. So I'm the one who has providing that training and that support, and we're trying to get the parents to model the skills. It's quite difficult if you have a dysregulated teen whose dysregulated problem behaviors are kind of being reinforced. Reinforced basically means that we increase the likelihood it's going to occur by a reaction from the parents. So let me give you a great example. A parent wants to institute a consequence Sean (09:17.883) refusing to go to school or some other problem that exists in the home and they're trying to limit or restrict the cell phone, which is a much bigger issue, which is a phenomenon that exists today that has dramatically shifted in the past 10 to 15 years. And I think we're at a heightened state of phone addiction right now. But you would see something like maybe the kid screaming, calling names, highly dysregulated. which then escalates to potentially a suicide threat or even non-suicidal self-injury cutting themselves in front of the parents. The parents then in a state of fear know nothing else but maybe to turn to the mental health system. This could be taking their child to a emergency room in response to the crisis. Or in other situations where it's maybe not as life-threatening, they respond with more nurturing. and care and the kid is able to maintain their phone. So ultimately what you see is that behavior, that response to high level emotional escalation then reinforces high level emotional escalation. Bottom line, the behavior works, right? So one of the ways that we learn to regulate intense emotions is we have to be able to adapt to our environments, right? In some ways we have to be punished for not being effective. We have to do some deep introspective work ourselves and learn how to adapt in order to get our needs met. And what we're seeing is at least a subset of a generation of teens who are unable to successfully regulate those emotions to get their needs met. And in fact, I would argue in a lot of ways, the environment is responding in a way that actually leads them to continue utilizing these behaviors. Bottom line, it gets their needs met, whether it be in school. whether it be at home and in some situations with their peer group. And so we're trying to change the environment. We can change the home environment with working with the parents and coaching them on how to effectively respond. What we cannot really do is change a public school system that responds ineffectively to these problem behaviors. I will say things that Sean (11:44.631) might seem a bit hyperbolic, but I think the evidence suggests, and will ultimately show, that what I'm going to say fits the facts of what we're facing in culture. How we're responding, both in public schools, through some of the expert culture from our medical system, and in many mental health centers. is exacerbating the problem. It is making it worse. And they don't even know that they're making it worse. And that's part of the challenge, I think of today's podcast is we're going to have to do a little bit of reverse engineering, we're gonna have to deconstruct our culture and how we got here, and really take a look at how our culture, our environments are reacting to emotion dysregulation that is maintaining the problems. that exist and without dramatic change, we're just going to see an increase in mental health problems. So I'm going to pose the first question to you, Riz. Maybe you can kind of describe some of the things that you are seeing in clinical practice with teenagers right now. Teenagers who are certainly COVID kids, you know, whether they are in middle school or high school, we can describe them as COVID kids because they're their educational system, the way that they interacted was severely disrupted for, you know, probably at least a year. And then there's ongoing disruptions that continue to exist based on, you know, maybe policy changes or the way that we now respond, uh, in, in United States culture to, uh, various kinds of forms of like pseudo crisis. So what are some of the things you're, you are observing, uh, in clinical practice with teens? Dr. Riz Ahmad (13:37.282) So I want to go back to one thing first and I'll talk a little bit more about that, which you mentioned how sometimes the kids' behaviors are controlling the parents' reactions or they're reacting in some way to get their phone back if they lost a privilege and they immediately calm down when they're given the privilege back. And it can seem like that that's something that is getting the teens' needs met. they're reacting in a way to get their needs met. But I'll say that doesn't feel good in the long run, even to the teen. For a teenager to be in control of a parent's reactions in that way, and for a parent to not be able to parent, ultimately, I think is more anxiety provoking for a teen to see that you have that kind of power and influence in ways where people are walking on eggshells around you. Your grown adult parents are walking on eggshells around you. I don't think that feels good. And to constantly be, for example, on your device because they're so afraid to take it from you, that can be stressful the way it's used often. When it's used in a way where I can't be away from it, if a few minutes go by someone's going to be upset with me for not responding back or using it in ways that just create more agitation, stress, fear. This isn't a happy teen who's being reinforced for... for their behavior. Sean (15:04.719) In fact, I want to add to that, I do believe teens crave structure and limits. It's a period of rapid developmental shifts and uncertainties for a teen. And it's really important for them to know where the guardrails are. And with so many challenges that exist in life, I think they really do desire having a degree of predictability. And I think we see that in our research, developmental child psychology research is that when there's a adequate degree of structure and predictability, that tends to foster a sense of well-being, self-esteem, and confidence that is necessary to take adequate risks in life. Dr. Riz Ahmad (15:50.45) and unpredictability from a rational place, a well-intentioned place, a caring relationship, you know, that I think helps overall. But in terms of what's coming in and what I'm seeing clinically, I agree with what you said earlier that the COVID pandemic and lockdowns, it's not like that created the struggles, but it certainly did exacerbate a lot of the struggles that teens Dr. Riz Ahmad (16:19.534) pockets and trends of things that I've seen. There's certainly the teen who was doing very well before the pandemic was maybe very engaged in their community, in their school, maybe was active in sports, seeing friends quite often. And at a sensitive developmental period had all of that pulled away very quickly and was more in a home environment where there wasn't much to their days. The- maybe spent more time in their room and to themselves. Parents chalked it up to just typical teenage behavior and what else are we gonna do? That's what we're all doing in the house right now. And that could have gone very many different ways. For many teens, that will be, well, it will be a depressing day. And to adjust to that back to being out, some really struggled with that. If you're seventh grade, eighth grade years, looked like an entirely virtual setting. And then here you are in ninth grade and let's start freshman year of high school going in. And then when you feel anxious going in, let's have responses where you're pulled out of school early or you're not helped with, coached through handling some of the difficulties that you might experience being there. There's a subset that really struggled with the adjustment. back to life as a whole when they weren't before. I think in addition, during that time period, you lose a sense of your identity. If all those things that you were involved with that gave you meaning and purpose, a lot of them ended, then who you are and what you're about, you kind of get the rug pulled out from under you. And you don't have the benefit of decades of being on this earth where maybe if Roger, you decide to fire Sean tomorrow, you're going to be able to do that. He would be able to kind of lean back and go on other life experiences. And he knows who he is more, his values. He might be able to adapt and adjust in different ways. But if you're taking a team where that's all they know about who they are and who they've been, you remove those things that give meaning and purpose, there's gonna be other ways of trying to figure out who you are and make social connections, which is one major part of trying to figure out who you are, especially when you're a teenager. Dr. Riz Ahmad (18:42.954) So some of the subset of people I'm seeing are those who struggled with that transition of trying to answer that question of who am I after a lot of those things got pulled away. Now, some of them got pulled into things like disordered eating became a bigger part of who they were. And it gave them some sense of control, some sense of identity. We know those numbers really went up during the pandemic lockdowns. Some teens may have ended up going on social media looking for connections in different ways. And especially if there was inadequate monitoring and they're usually more savvy than their parents are, may have found connections from the worst kind of places. So I'm seeing teens who were involved, for example, in being groomed, maybe connected with other teens around being mentally ill. Dr. Riz Ahmad (19:40.03) sexually promiscuous kind of videos or exchanges that were meant to promote a sense of connection and being wanted, finding your place. There's just an increased vulnerability to that and some ran into that. So it's varied. I think there was an increased vulnerability to so many things, especially if you don't have structure and support. And whether it was during the time or there was the adjustment to the time. Right now, I think we're still seeing some of the repercussions from what was exacerbated during that time. Sean (20:17.807) Now we see that this is disproportionately affecting adolescent females. Well, first question is why do you think that is? And then is there a certain type of a certain personality, a certain um, characteristic of person that you're seeing that is more likely to be, you know, coming into our center, you know, seeking this specific form of treatment because of a lot of the other failed therapies. Dr. Riz Ahmad (20:45.302) So this ends up being a big question that you might have to rein me in because it could go in so many different directions. I think if we take a step back, the number of women compared to men, girls compared to boys seeking mental health services is bigger across the board in all ages. Right? And so there's a piece of it that has to be asking... what's going on as a society that more females are struggling in that way with their mental health than men are. And to me, to answer that question by saying the numbers just indicate they have more mental illness, they are more depressed than men are, and it must be that they carry this diagnosis and illness, to me that's the most invalidating thing you can say to to any woman because that the whole, which is what drives me crazy about the anti-stigma movement, right? It's that it's trying to explain things through that diagnosis and let's normalize it. And yet what it's saying at the same time is that this problem you're having is because of an illness you have. Let's ignore the context in which women live. Let's ignore the context that teenage girls experience and how that is likely influencing more struggles and feeling more miserable. So two. To get to teenage girls, I think we have to ask, what is it like to be a teenage girl in our society? What's it like to be a middle schooler and a high schooler in our society? And this may be a surprise to both of you, but I've never been a teenage girl. So what I have to do is learn from my clients and learn from the kinds of things they're telling me. Sean (22:29.424) Hehehehe Dr. Riz Ahmad (22:38.322) So what's happening for teenage girls? I'll open that up with a few ideas and maybe we can discuss. But one thing that we know is that teenagers in general, there's more hormones at play, there's more at play physically. There are going to be more issues and changes around things like physical things, how much sleep they're getting, what's their nutrition like, all those factors the social context that they're in, there is a lot more attention to teenage girls on appearance, on weight, on things that are quite superficial and not going to lead anyone to feeling good about themselves and living a life worth living if they're putting too much focus on it. And I don't think this is just a small portion of teenage girls. Dr. Riz Ahmad (23:38.09) near impossible, I think, for someone to go through the experience of being a teenage girl in our society and not develop some version of body dissatisfaction. It's impossible. You just, all the messages you get from your peers around you, from even adults, from TV, from media, from social, you're going to get that. And I remember watching like the Taylor Swift documentary, for example, because a lot of my teens are Big in the Taylor Swift, so I'm learning as I go. And one of the things that she talked about at one point, it was a scene where she was in the car going from one place to another, was just the stress that she experienced around her body. And if she had anything that looked too big, stomach, et cetera, she would feel the pressure to be skinnier and fit a certain body type. And yet if she did that, then it would be that her, you know. her ass wasn't big enough, it was too flat, and then she would make up, there would be other comments that would be related to that. And she just talked about this impossible bind that teenage girls end up being put in and the attention that gets paid to it. So I think that's one piece of it that's huge, something that as men we don't really go through. Sean (24:55.511) Yeah, that's, that's so important. I think we can at least stop there and identify a causal factor with social media. So that is one thing that we were seeing increasing leading up to the pandemic was the amount of eyes on specific social media platforms, and how that is correlated with body dissatisfaction, and low self esteem. which certainly manifests itself into mood and anxiety related problems. So let's identify first the culprits. What are the apps that teenagers you find are most utilizing? And what is the content that they're exposed to? Dr. Riz Ahmad (25:43.246) So one major culprit, I would say, is Snapchat. And the way that Snapchat works, for those who aren't familiar, is that a lot of the communication is through video and photos. And a lot of that communication isn't necessarily to a select group that you're connected to or friends with. It's just open to the public. And you can direct message some people as well. And that content, once you put it out there, Snapchat also has it often disappear shortly after the other person sees it. And I say disappear, but quote unquote disappear, nothing really disappears. People can easily take a screenshot on their phone of any content that they see. And it's really this illusion of privacy or confidentiality. It'll just be harder for parents to find. after it's posted. That content is basically whatever grabs attention. Whatever gets a response from the other person is going to be reinforcing. And if you think about who's being reached out to, and the content is just photo and just video for first encounters, it's really going to put pressure on appearance, sexual, over sexualization, that content is going to get the most attention and not just the most attention, but the kind of person it's going to get the most attention to from is likely the kind of person you least want to be giving attention to your teenager. Sean (27:31.123) So I got a question. Does this come, are there two spectrums to the type of reaction that's happening? If let's say this, the teen girl doesn't fit, uh, maybe the profile of what society thinks is beautiful. Does that lead to then increased bullying? And then also on the other side with like online predators, are they just being exposed to those type of people? So they're getting reactions, both positive and negative, which kind of keeps them engaged in the app. Dr. Riz Ahmad (28:00.234) It's a lose-lose, right? I remember hearing about some research where it was looking at how well do people do developmentally and socially based on when their birthday was during their school year. So you may, for example, have a teen who was maybe born in September, October, and maybe on the older end for their grade. And on the other hand, Sean (28:01.702) Yeah. Dr. Riz Ahmad (28:27.246) summer birthdays, maybe younger for their grade. And it was saying, who does well better overall because a year of developmental difference is actually quite a bit of difference at that age. And the finding was that boys, the older you are, the better socially adjusted you tend to be. You tend to be more emotionally developed, you tend to be more physically developed in a way that gets positive attention from peers, maybe seen more as like the leader. Sean (28:36.168) Mm-hmm. Dr. Riz Ahmad (28:57.318) in your class or among your peers. And for girls, it was the opposite. The older you were, likely the more sexually developed you might be, the more physically you might get attention from others. Either way, it's harmful. If it's positive attention, it's just about your appearance, then that becomes one of the most important things. If it's negative attention about your appearance, well then that becomes one of the most important things. Sean (29:15.645) Mm-hmm. Sean (29:26.099) And the other app we want to throw in here is Instagram, because I think this intersects with Snapchat. So Instagram is a powerful social media platform because it presents pictures and reels that, the more provocative, the more likes you're going to get. And you see that this like is almost like a, it's like when you're pulling down on a slot machine and you hit it, right? It's this constant reinforcement, this dopamine hit of approval. And it's that seeking out social approval through likes that has really become addictive. And the, these teens are, and even, you know, young adults, when they post a story, they're kind of obsessively checking who is looking at their story. They know who liked them, who didn't like them, which is insane to me. right, the amount of time that would have to be put in and to remember. Because a new, a phenomenon that I've seen over the past decade was like in the dating scene where a teenage girl would be in session, maybe talking about her boyfriend and someone liked his picture. And liking his picture was somehow like some violation of a social norm that is like close to cheating. And it was really hard for my older self. to be able to grasp an understanding of this, right? By hitting a heart or a like on a social media app was akin to cheating. And it was interpreted and experienced as such a violation and so painful that was a wake-up call for me about how fragile a lot of this generation was and how hooked they were into screens because of how emotionally stimulating. it is. And then when you have the pictures that are through filters, and they're creating this content, where these, these women who are Instagram models, and social influencers are promoting their bodies in a way that creates that social norm, that ideal body image. So imagine being a young developing teenager in adolescence, and Sean (31:50.843) What is natural anyway is to experience that body dissatisfaction, those challenges with your developing body and your own appearance. And you were in constant comparison with these social influencers, these filtered out pictures, this idealized form of beauty that doesn't really reflect how that person looks at, you know, in real life, you know, at 10 o'clock at night when you're looking in the mirror before you go to bed or when you wake up in the morning. You know, this realistic kind of version of what people look like has become completely distorted. And now that's internalized by a developing teenager who sees nothing else, who views themselves as ugly in comparison to what that norm is. Dr. Riz Ahmad (32:38.622) And I think it allows people to connect in ways that I think are ultimately self-defeating in ways that weren't available before. So when I think back on school, you can probably always remember certain cliques that existed in middle school, high school. You're probably not surprised I was in the nerdy clique, but I know, I know, shocking. Sean (33:04.659) Thanks. Dr. Riz Ahmad (33:08.07) But you know, among the clicks, there were likely clicks of those who enjoyed like darker things, you know, enjoyed dressing up in more kind of goth, maybe the black nail polish, maybe the skull and crossbones, the metal and, you know, that's great. It's just a way of expressing themselves and connecting and it was kind of counterculture. There are ways to connect on things on social media that are now outside of. the public eye, other people are not really aware of. You can connect in ways with people who are glorifying disordered eating. You can connect in ways where people are posting videos of how to around disordered eating, how to around cutting. As much as some of these platforms try to police in some ways and pull things down. There are no ways they can pull things down fast enough to what's being generated. And there are tags that will direct people to content that users are aware of that haven't been policed or found yet. So without some monitoring, it's very easy to find connections that way. And I'm running into more and more teens who sometimes during the pandemic, sometimes afterwards. started to connect with others because they talk about cutting together. They've shared photos with each other of their cuts. There have been a glorification of being depressed in some ways and you kind of have to talk and present that way to be accepted in it. Suicidalities talked about openly in a way that is pulling for the other person to respond a certain way. And then you're even more attached to your phone. I can't be away from it. I can't leave my friends hanging. I need to be available and there for them. Otherwise, what if it's gonna harm their mental health? Sean (35:15.611) Which brings up a transition into this next causal factor. So if we're identifying as social media tends to breed self-esteem problems, body dissatisfaction, a number of things that are going to disproportionately affect adolescent girls, I would say that one impacts this social anxiety that makes school very challenging. And entering into school with that degree of social anxiety into a culture that pathologizes it. So you made a pretty good point, Riz, about what happened in the aftermath of the pandemic and trying to reintegrate into society and reintegrate back into the school system, especially if you're like a middle schooler and now you're entering into high school. Something that we can all look back and just say, it's a rite of passage, it's something normal, you feel really anxious when you... transition into new areas of your life, whether it's going from middle school to high school or high school to college or starting new jobs, all these things are so normal. But we now live in a culture that seems to pathologize the expected pathologize the normal. And another social media app that we haven't spoken about is TikTok. And there are trends right now on TikTok around self diagnosis. And you're referring to these greater communities around pulling for these labels to define them. and to self-diagnose. So now these teens are experiencing what you would be expected if your face is in social media, to the extent it is, with all those problems that are associated with social comparison and the normal developmental transitions. Now it's viewed through a lens of a psychiatric illness. They're actually speaking the lingo. They know the words, they know the diagnoses. I have this, I have that. and they're actually describing the DSM symptoms to people in their lives. It could be a school teacher personnel, like a guidance counselor or school psychologist. It could be their pediatrician, their parents, or going in to see a mental health professional. They're not really describing who they are. That's a dramatic shift from when I first started doing this work. You get to know a person. Now, Sean (37:39.075) It's almost like it is this version of them that's been constructed by some outside influence and they are reporting symptoms in the manner in which they're learning it in school and on TikTok and through media and through the internet and they're presenting this new identity and to me, there's a lot of incongruence between what they're saying and what I'm seeing. So... The depressed teen, if we look at a lot of these teens that are coming into the program, they're not the traditional depressed teen that I saw 20 years ago. That existed when I worked in the middle school. Describe that depressed teen. The depressed teen that I would work with in my younger days, whether I was working in the schools, where I was in my training as a psychologist, even what I saw in the psychiatric hospital, was more of what the traditional lethargic... extremely low mood, self-deprecating, low motivation, low motivation, fatigue, intense sadness. And I think that profound intense sadness is what you would feel energetically, as the therapist. I would absorb it, I would feel they were just sad in their minds, they were sad in their bodies, they were sad in their spirits, and they created a version of themselves. That was so, so negative. And what I'm experiencing from working with the parents and what I think you're observing teens, with these teens Riz, is maybe a different version of this. Dr. Riz Ahmad (39:22.766) Yeah, I think it's, I'm not seeing that persistent chronic state, like, you know, I guess somewhat pejoratively, this is the Eeyore kind of vision that people get. But it's more intense experiences of disruptive emotions that might be more, more brief, more time limit, more reactionary to something that just occurred, perhaps. Sean (39:36.928) Yeah. Dr. Riz Ahmad (39:51.262) difficulty tolerating that distress and a behavioral response comes out of that. So I would say if I was going to describe the teens who typically enter like our DBTA program, if we take a step back, they are the teens who are more just naturally emotional, the people who are more the feelers, the empaths, the creatives, the artists. the storytellers, just some of the people who add the color to life, they're that theme. And I think we also need to, when we talk about how there's more women than men who are being labeled as mental illnesses, I think that's because we have a society and a culture that largely will preferentially invalidate people who are more emotional or are expressing more emotions. We're not. not terribly far removed from the times of calling that hysteria and thinking of women as being hysterical because they tend to be the ones who experience emotions more strongly. And now take those women as teenagers who don't have as much of the wisdom and experience to manage those emotions well. And there you go, you know, perfect recipe for more of them being diagnosed in that light. So they tend to be kids who are in that realm of things, but the responses are more that... Dr. Riz Ahmad (41:20.926) say we take the social end of things and we talk about the social anxiety and social sensitivities, it may be someone who is so socially sensitive that they're going to read very much into someone, for example, reading their message but not responding to their message. And they're masters in knowing what it means to be unread to see like... conversation where someone says K instead of giving a fuller description of what they have saying okay and giving an explanation. And so they're more prone to read into things very much and then start to have these beliefs about how other people feel about them or how they feel about themselves. And the reactions are more based in that. It's not this like chronic state of being. It's more these these more intense acute disruptions. I guess I would put it that way. Sean (42:20.211) I, um, do you ever watch key and peel? Did you watch it back in the day? Was it on? Uh, I don't know if you ever were ever exposed to it. There was a great skit. It was key and peel both at home texting back and forth and the reactions and the way that they were communicating. It's, it does a great job of, of providing an example of how interpretation can get totally misconstrued. It was, it's hilarious. I'm going to find the link to it. I'll include it in the show summary. You have to watch it because. You know, you can text somebody like if you want to, and the reaction is like, if you want to, if you want to, but that's not how he was saying it. It's just fantastic. I'm going to share it. So these are the things that we're seeing in the psychiatric industrial complex. These kids don't meet typical criteria for depression or anxiety, but they're going into the system and are quickly being labeled depressed, anxious and ADHD. But it sounds like they're just reactive. Is that it? Well, I think we do have to understand what is actually happening. So there is an emotional sensitivity and reactivity that occurs, right. And you'll see the worst of the medical professionals start throwing out the word bipolar disorder. But reactivity is just, it's just a teenager thing. Well, it's a little bit more severe than that. So I mean, we can't just say it's an it's an normal behavior. But we do believe it does have to do with both a biological and social interaction. So maybe it is somebody who's just much more interpersonally sensitive and really derives a lot of self-value from the approval of their peers. And that's always been the case. And maybe they're like more naturally inclined to be artistic or introspective and experience their emotions intensely. And then you combine it with really what's happening in society right now is exposure to that social media. And you know, the opportunities that they have to experience social rejection are just increased exponentially. And that's a very extreme challenge for parents because if we've decreased face-to-face social interaction and we've dramatically increased this digital world, this virtual world that they're engaging in, we're disconnected from reality more, but the teens, especially these teens, their social world is that phone. That is how they are engaging. So then not being involved in that social Sean (44:48.455) world through that phone, they experience FOMO, the fear of missing out. And then that's the anxiety that you know, that they're starting to that they're presenting with fear of missing out socially, you know, combine that with the appearance and social related anxieties that they have, you know, they, they can like want to avoid school the next day based on a text interaction, or something that occurred like the evening before. And the parents aren't necessarily privy to those experiences, but they've lost such control. over that technology that the teen sleeps with the phone. So I was like looking at some data leading up to this, it's like 66% of kids fall asleep with that phone. And they actually wake up to check it. And so think about what that is doing to sleep disruption amongst other things, but it's just a reflection of how addictive that device is. So they're being labeled as depression and anxiety and ADHD and they're going into a system with the worst of our medical professionals and less than an hour, 45 minutes, sometimes less than 15 minutes. They're given these pseudoscientific labels and they're prescribed a series of mood and mind altering drugs. An SSRI, a potentially a mood stabilizer and a stimulant, you know, almost like the series of uppers and downers to developing brains. Um, and they're interacting with a school environment. So Riz, I do want to transition into, you know, what you're observing, uh, about What has the previous treatment been? How are the school environments, medical doctors responding to these teens? What advice are the parents getting? All of this prior to them ever receiving help at Center for Integrated Behavioral Health. What are you getting? And then I'll share what I'm seeing from the parent's perspective. Dr. Riz Ahmad (46:38.454) Sure. So I mentioned some of the pipelines to people getting into the mental health system. And pipeline feels like the appropriate word because it very much does feel like widgets on a conveyor belt as opposed to like a deeper contextual understanding of the person themselves. But very often it does start in the school. And... In the school, there are various ways that a kid can be flagged as having mental health concerns that leads them into that pipeline. One is that many schools have kind of like a safe to say reporting system where a teen can report another teen that they're concerned about. They're concerned about them self-harming, them talking about suicide, that they seem depressed, and they can anonymously make a post. which will lead to that kid being usually meeting with the counselor and having a brief, I'll say assessment, which I'll describe in a little bit more detail, to try to get a sense of what's going on and to intervene. There's a piece, there's a big piece of that I think is very challenging and puts school professionals in a horrible position, kind of a position where there's no winning here. And I just talked to someone last week who worked at a high school in our local area and was tasked with doing this. And she was given often about 15 minutes to meet with the team. You're meeting with them at one particular point in time, meaning that Your point of contact is just a teen often at their most dysregulated state without any other context. You don't often know what's been going on in their life over the past weeks to months. There's very little to no parent involvement in that evaluation, so you don't have that perspective from the outside on what's been happening. And very often what it ends up being is checklists. Dr. Riz Ahmad (48:53.634) Kind of symptoms that are looked through to see is this going to be a problem where they're going to refer and recommend What's referred to as a higher level of care which I've come to not like as the as a term but what those evaluations typically look like is a semi-structured or structured kind of interview not very conversational often and you go through kind of a checklist of different things and These might be things people might be familiar with for suicidality. Is there a plan? Is there an intent? Is there thoughts? Is there accessibility? Based on those responses, however they're given at the time, typically if anything is flagged and it's usually quite sensitive because there's more, it's fear driven. If we're going to be honest, it's more fear driven of we don't want anything bad to happen, we want to make sure the kid's okay. These things are. It is sensible the place it's coming from, but the evaluation is so brief, so non-contextual that it's going to be near impossible to have a clear image of what's going on. So when there is anything flagged, which happens a lot, parents are usually called then and told that they need to take their teen to the emergency room to be psychiatrically evaluated for what their teen is reporting on the questionnaires or saying. Dr. Riz Ahmad (50:20.398) can't return to the school until an evaluation is done. And a professional says that they're safe to return back to school. In the worst cases, parents will be threatened with children and youth being called if they don't follow through on doing what is being suggested to seek an evaluation. So parents will typically then bring their teen to the emergency room. And now we run into. a little bit of stage two of the mess that we're in. We move from a counselor who is being put in a position to evaluate very briefly. And by the way, this is not their training typically either. When someone becomes a school counselor, it does not make them an expert in psychotherapy and that kind of assessment intervention. They are often more trained in school counseling. So more. possibly adjustment type things, academic things, helping with learning differences and learning in the classroom, like that's their cup of tea. So they're being put in this position to really assess and provide recommendations that are outside the scope of their expertise, which is not fair. It's not fair to them either. We go to the emergency room and now we put a whole new class of professionals in this position that is outside their scope of expertise. to make an assessment and make more recommendations. So we're talking emergency room staff might be a psychiatrist, might be in other medically trained personnel. And they are given that assessment that you talked about Roger, could be 45 minutes, could be an hour. I've heard it be as little as 15 minutes. I've also heard it be something where the parents aren't really included in that evaluation. They're not asked a whole lot of questions. They're not told what's going on. very often. So I'll speak some to what I hear from where we are in the Lehigh Valley. And I like you, I'm going to assume and extrapolate that this is probably not the only place in the country this is happening, although you hope there are places that are doing it more ethically. But brief evaluations. Again, we're talking spot evaluations. This is one point in time. They know nothing about this kid's history and context. Dr. Riz Ahmad (52:43.126) There's no way you get that information in an hour even of one meeting. Uh, very often other treatment providers are not contacted. It's rare that I'm, I don't think I've ever been contacted by. Emergency room personnel, uh, even if I've been meeting with a kid for a year, uh, I often have to be the one to reach out when I hear from the parents to try to have some coordination of care. But I think that happens a minority of the time. Often there is no inclusion of. Anyone else involved in kind of a treatment team collaborative way, it's a decision made in the emergency room. So you take that point of time evaluation and the diagnoses are given very freely and very readily, often just from interview. I've seen bipolar disorder diagnosed in 15 minutes of a meeting, one point in time, which I think is criminal. There's no way to diagnose a chronic condition, let alone for pediatric in a 15 minute interview that the parents weren't even involved with. Sean (53:51.427) And to jump in there, there really isn't a pediatric bipolar disorder. Like even if we wanted to go to the pseudoscientific nature of a DSM, they don't list it as that when manic depressive illness, bipolar one disorder has emerged traditionally it's in much later adolescence and, uh, you know, a lot of the times it's a misunderstood drug reaction. So. Just to get an idea how unethical and how unscientific this entire process is, because the fear conditioning that exists here and the coercion is these medical professionals, these psychiatrists, these psychiatric nurses are communicating to their parents that their kid has a serious mental illness. So outside any contextual variables, they don't even gather history. It's like they don't even care. Like, why are you feeling the way you're feeling doesn't even matter anymore to these psychiatrists. Like what happened that led up to this crisis event is inconsequential to them. It's a, it's a checklist of symptoms. And then they're, um, they're trying to determine if this is depression or anxiety or ADHD or bipolar disorder, as if they're completely clueless to the fact that fucking book has no scientific validity and they're making things up as they go along. That's why I've lost complete faith in the psychiatric. because how can you be so ignorant? How can you be so limited? Right? And unfortunately, that's exactly what we're experiencing. So then the parents come out of these environments and they assume that there's, you know, these doctors wear the white coats and some of them wear the stethoscope. I don't know if they've ever used a stethoscope, but you know, they have the veneer of a scientist. because that's what the white coat traditionally has meant, that there's science involved. There's no evaluation in that manner. And these parents are concerned and they'll say, well, you know, I had this great aunt on my mom's side who had bipolar disorder. And then there's the miscommunication of genetics, right? And so now there's this more fear provocation, my dysregulated teen, regardless of the cause. Sean (56:08.091) has this genetic inborn brain illness that's been passed down from our ancestors. And it's unbelievable how they can go outside the bounds of ethics to be able to start communicating their propaganda. And that's what it comes down to is propaganda. So now you're right into them, you're right into this system where the teen is being spoken to as if they're ill. The parents are told that their kid is ill. And now they have a crisis event where they have to now accept the treatment. And you're in a hospital setting where generally injured or broken people are going. So there's that association as well. I mean, I've had, I've had teenagers, uh, you know, threatened suicide to control their parents, to be able to be on the phone in a particular night so they can talk to their boyfriend and then go into a hospital, take it all the way and you know, leave on three psychiatric drugs. when that wasn't even a legitimate threat. And that's the other thing we're gonna have to get to in this podcast is kids have learned to threaten suicide as a weapon. And it's almost like sacrilege to say this out loud, oh my God, if someone says they're suicidal, well then they're suicidal, right? Because that's the fear we have as professionals. God forbid you invalidate that response. But that's the shift and that's the change that I've seen over the course of my career, the difference between a depressed kid who is literally contemplating their life versus the one that's using it as a weapon both on social media and to their parents in order to get the things that they want. And that's the legitimate challenge that we're saying. So I'm going to take it back to you, Riz, because you did a really nice job of communicating step by step what is happening in the mental health system. Dr. Riz Ahmad (57:57.098) Yeah, and to speak to that point of suicide, it's obviously I think the sensitivity is to teen suicide does occur and is a serious thing. But it's saying that every situation where anything related to suicide or self-harm is brought up is that, that's the misconception. And if we treat everything as that whenever there's any suicidal statement made, self-harm statement made, etc. even gesture actions, without taking the time to understand why that is happening, then we are going to make the problem worse. We're going to be using the same hammer on everything, and it's going to be the wrong tool. And that hammer is not even maybe the best analogy, because often what's used is the sledgehammer when you're trying to remodel and hang up a painting. probably not the best thing that you want to be doing. So if we take it a step further for what the interventions typically look like. So we're at the emergency room and diagnosis has now been given, in my opinion, the way it's been given, the amount of time speaks to a level of arrogance, of this confidence in saying this is what's occurring with your team, the one you've known for 15 years of your life, their entire life. I'm going to tell you this is bipolar disorder after meeting with them for this small window of time or major depressive disorder, whatever it is. And then typically the referrals are an inpatient setting, an inpatient hospitalization, a partial hospitalization or a residential treatment. And if it's suicidality and self-harm... I'd say those are the most common things because there is this conception that this teen is so ill that they are not safe to go home. They need to be under a 24-7 kind of watch where professionals can be around them to make sure that nothing bad occurs, again, fear-driven. And they're so ill that they're going to need what you were talking about, which is an average of I'd say at least two. Dr. Riz Ahmad (01:00:18.931) if not three or four different things that they need to start. Sean (01:00:25.255) And you know, as a reminder, these drugs that they're taking, they're experimental, number one, because they have never been studied in combination. They're often approved for adults and then off-label, prescribed to teens. It's like these mad chemists who are adding this drug, increasing it. All of these which have a myriad of significant side effects that affect mood and presentation. And when you're talking about a developing adolescents, we know they're even more vulnerable to the problematic adverse reactions of psychiatric drugs. So what we're seeing in clinical practice is like increased agitation and mood problems, sleep problems, more outbursts. And they're brought back to the psychiatrist who is increasing dosages, stopping abruptly one drug, adding another. It's basically this cocktail of these drugs. under the disguise that they're legitimate scientifically, they've been established, even in a basic SSRI is completely miscommunicated to the families. Never, and when I say never, I mean, I can't identify one time where I asked a parent if they were provided full informed consent, where the range of potential adverse consequences for these drugs were communicated to them in a cost benefit way. and they could make an informed decision. Maybe 10% are aware there's a black box warning for an SSRI, that's probably at best 10%. And so they completely misunderstand the next subsequent months after the hospitalization and after this psychiatric treatment. Because in more cases than not, the situation worsens. It certainly doesn't get better because you're never actually dealing with what the problem is to begin with. And as it worsens, it's getting then misunderstood as a worsening mental illness and not the drug reactions themselves, which generally adds in more severe diagnoses. Right? It maybe it starts with depression, anxiety, but then it's like, it's upped to like a bipolar disorder or something more serious. And by the time they get to us and they Sean (01:02:48.187) they're referred to the program, it's almost like the local community throws their hands up in the air. And we're almost like a last resort, you should try them. And then we get the bad reputation, in particular me. When I start talking about the drugs as being the issue. And so sometimes I'll get lambasted on social media, or there'll be negative reviews. Dr. Riz Ahmad (01:03:04.558) I'm going to go ahead and close the video. Sean (01:03:16.215) Not because I'm telling the parents abruptly stop their psychiatric drugs. I'm way too educated on that, of course. We do podcasts and speak to experts about this. But I start telling them about the adverse consequences, the experimental nature of what's happening with their teen for the first time. And of course there's going to be a reaction to that. Now I tell them how dangerous it is to abruptly stop these drugs. There's gonna have to be a... a plan with an educated prescriber who can slowly taper them off the drugs. But now we're just introducing the understanding of what started with something that could have probably been treated much more effectively and would have at another point in time in history has now been treated so poorly and not just by the psychiatrist, but also in the mental health therapies that they're in. So another thing that I think we need to speak to is there are... What is the exposure of therapy that these parents, these teens are receiving prior to us being able to evaluate the situation? And I think this reflects probably 90% of the therapies that are being provided. Dr. Riz Ahmad (01:04:26.29) So this is where I become allergic to the term higher level of care. So I'll start there with someone who's been recommended inpatient, partial, residential. The idea of higher level of care has a really positive connotation to it. There will be more support, there'll be more professionals there who are for your team. You're giving them the best, more is better, supersize your care. The actual, I think, translation of it would be more invasive, more risky level of intervention. I think that's what higher levels involve, more restrictive interventions. So when it comes to that level, when a kid enters through the emergency room and enters into that system, I can kind of put the experiences that I've been told by the teens I've seen in a few boxes. There are some teens who... who appreciate and like the experience of having been in the hospital or in a partial program. And before we say that that's success, we have to ask ourselves why, what are they like about those experiences? So I asked them, and I wanna learn more about what it's been like. And across the board, there's kind of a few reasons that tend to distill out of that. One is the same kind of teen who's struggling, likes having the diagnosis, may like pieces and find affirming pieces of the hospitalization or residential or partial. So a diagnosis while scientifically providing no validity, we said already the DSM, there's just a checklist, it's just agreement by a group of people, it's not actually anything that's backed by research. completely ignores context and what's going on and life is more complicated than that. Sean (01:06:26.451) And all those diagnoses overlap each other. So you can be diagnosed any one of those at any given time. Right? The same symptoms overlap each other. Dr. Riz Ahmad (01:06:34.178) They make no sense, no explanatory power whatsoever. Although they have this illusion of providing an explanation of what's going on. You just put a name on it. You didn't really do anything. You just put a name on it. So a teen who values having that diagnosis, part of what might be valuable about it is it can affirm one's pain. It can be validating that what I'm feeling is real. See, it has a name. It has a name that has some power and some legitimacy. or seems like it does behind it. So there's a way that can help not only feel say, more self validated that this is real, but also a way of communicating to everybody else. So everybody else can know that it's real, that I'm having a hard time, that I'm struggling, all that seems true or is true. So there's that piece of it where being in an environment like that can feel even more confirming about that. And if someone's really struggling to figure out who they are and what their identity is, it's not great. It's kind of a poison pill, but it is an answer to say my identity is based around that I'm mentally ill or I struggle with depression and ADHD. It's a ground to stand on and to feel validated and connected with a community, including the community of peers who also have similar diagnoses that are going to be there in the inpatient residential partial setting. And so overall, the most positive thing I hear is not about, I learned a lot there that helped me because when I asked what they learned, I don't really get much of anything. It was mostly a respite from what was going on in their lives. And they talk about the other kids they met and how they could talk to them feel connected. have a community many might keep in touch after they leave. But is that actually getting better and improving or is that more connecting and reinforcing problems that will continue once they get back into their lives? Sean (01:08:41.327) Yeah. And when you communicate this concept of mental illness, as if it's like pervasive and chronic, it's externalized. It's like it's outside of one's control. And then so any behavioral challenge or any aversive emotion is now directly correlated to this condition that was kind of created. That's become this illusion. I'm anxious because of my mental illness. I can't do my homework because of this. I can't go to school today because of my mental illness. It's a complete reality. That's been that's been created. So no longer it is, hey, I've struggled under these conditions for what I need to overcome this. It now becomes, from a parent's perspective even, well, they're disabled. And is in some ways, I mean, this is what's been a real shift in American culture somewhat rapidly, because I think in previous generations, like struggling was met with shame and guilt even. But it's almost as like there's this social reinforcement to having this disability status around mental illness. Dr. Riz Ahmad (01:09:44.374) There will be some circles where it's almost competitive. It is competitive whoever has Been through the most shit and the more severe your diagnosis The more severe your quote-unquote trauma The the more you're looked up to the more you're the more your value the more status you have the more Of that attention and reinforcement from peers you might have Sean (01:10:11.891) And that's concerning because now you're traditionally, you're taking a client who comes into you with a desire to feel better, desire to live better with some degree of motivation. And now you're starting to see young people come in with the incentive to maintain the psychiatric diagnosis and treatment. Therapy being part of it, but they almost view it as lifelong. So you just come into therapy, just to kind of talk about your troubles, and then receive some validation, some nurturing, and some support by a kind professional in front of you who will affirm this mental illness diagnosis. And that's not what happens when you see us. It's not what's going to happen when you see Dr. Ahmad and it's not the perspective that I'm gonna share with parents, and we actually stand out. It sounds crazy, but we actually stand out and we're the minority now. So there is a vulnerability to attack since we kind of discredit those concepts. What have you seen in that regard? Dr. Riz Ahmad (01:11:34.146) there's going to be an attachment to those views on themselves for some. Cause like I said, if, if you've based your identity around some of those things, then to threaten that is to threaten the very core of how they now believe who they are and their right to experience the suffering they are. And it almost comes across as this message that it's invalidating that you don't, you don't struggle, you don't suffer. And that's not at all what we're trying to say. So it takes some care to it. But I would say the approach that is taken when they meet with me and when they meet with you is you take the time to build a conceptualization that's more detailed and more nuanced. So I get to know this teen's life in more context and understand why they might have been feeling the way they were when they self-harmed or. when they said that thing to their parent or in their school that got them into the emergency room. And so by the time I'm talking to them about that understanding, it most of the time makes more sense to the teen themselves. And I don't know if this is the case when you talk to parents, but it's sometimes in my experience too, it's almost like it gives them permission to go back to the common sense of, yeah, this explains it a lot better, a lot clearer. a lot more accurately, there's more nuance and explanation behind it. So in the best cases, there's an openness to that. And it's because it's just more factual information. And it just is more, I think, intuitive for what we know about how life works and how our mood and emotion works than the myth we've been told to reduce it all down to an illness or a brain problem or none of these things that make any legitimate sense. So I'd say there's often openness and when there's really not openness, I have to think about how attached has this person become to this identity and why. Sean (01:13:42.167) And when I work with the parents, I'm going to say it's probably like a 60-40 split. About 60% of the parents know exactly what I'm talking about right away. And against their better judgment, follow the recommendations of the psychiatrist or the school. Some of them out of fear of repercussions. For example, being viewed as a parent who's neglecting the mental health of their child. some fear conditioning. Would you rather have a child on medicine who's in the hospital and safe or a dead child? Things like that. Or in the worst case scenario, there's a threat to call child protective services. So against their better judgment, they just follow along with some blind hope that maybe they know something that they don't. But it's against their better judgment. Inside they know that it doesn't fit and they're scared. but they go along with it anyway. About 40% are still in the illusion of it all. They attach to it in a similar way that their kids are, that they believe that there's these illness exists and we have drugs that help them, or they'll start spewing some of the lingo. Well, you know, what we're told, it's a tool that's going to help them. It's gonna turn down the dial on the volume of intensity of emotion. It might help them focus more. They won't feel as negative, as an intense emotional reaction. And then they'll learn the coping skills in therapy. You know, and then you can, you know, use some basic like reasoning and logic and just say, well, what have you observed so far? You know, and that's where you can really begin to engage people because the logic of the situation informs them that no, nothing has really changed. In fact, it's worsened. But in some, a percentage of those 40 might say, well, we think it's a little bit better. And I'll say, well, based on what evidence? Since you first started that, there's been two subsequent hospitalizations. They're on their eighth different psychiatric drugs. They continue to self-injure. They're unable to go to school. Where is it better? Sean (01:16:02.191) And that's some of the brainwashing that has occurred. Are these parents that actually go through the therapy or they're meeting with you to determine whether or not they wanna go into the DBTA program? Well, they've been referred. Yes. And they're doing the evaluation process. And so Riz and I are determining whether they're open to it, whether they're the right fit. They've already been in the mental health system. So do they stay rooted in that belief over the course of those 16 weeks? Sean (01:16:33.411) Well, it's a good question. Um, I do believe I'm influential in the 16 weeks of being able to influence them because we have had a lot of positive feedback after going through the 16 weeks. And most, um, are open to like reconceptualizing things and starting to take the steps to get them off those drugs and not seeing them, their kids as lifelong, you know, mental illness. There are some probably like 60% are like right on board right away. And that's when we tend to see the kids end up doing the best. Okay. But they're still at the end of the 16 weeks, these kids are still on the same drugs that they were on, you know, six months ago, 12 months ago. And it's just, it's still fear, right? Cause they're going to that doctor's appointment. But is that a, is that a, a result of maybe how long the kids have actually been on the medication that to then get them off the drugs is going to take? No, because they haven't started the process yet because they're still listening to the psychiatrist and they sometimes they say some insane things that are not based on any evidence like you might be working with somebody in like May, right. And they'll say, well, you know, we don't want to do all these med changes over the summer. Or you might be seeing them in August and they'll say, well, we don't think it's right to transition them to school without the support. of the med, right? They continuously talk about it in terms of medicine, right? And I have to kind of communicate that there's nothing medicinal about it. There's nothing being corrected. They're being drugged. So it's fear. It's so much fear, right? And some of them are just stuck between, you know, this new information that they're getting for the first time and then what they're getting when they go to the doctor's office. And a lot of parents are just compliant. Dr. Riz Ahmad (01:18:07.522) Mm-hmm. Sean (01:18:31.631) and they've been learned to trust the medical authority and to go in and to disregard a medical recommendation is kind of frowned upon in United States culture. That's changing and it's changing dramatically because the loss of trust in the medical experts during COVID, post-COVID and what's kind of been highlighted as far as institutional fraud and corruption is quite dramatic. But I mean, it really does still continue to influence how many people... respond. But I think our training is just so reasonable, common sense. And the return to common sense is like pulling them out of the illusion. Dr. Riz Ahmad (01:19:02.354) And then. Dr. Riz Ahmad (01:19:13.814) I was gonna say that this illusion isn't a new one in some ways, you know, because I remember you'd learn about the history of psychology the history of psychiatry in particular and There are some things that just seem fantastical and crazy Right like the fact that when people were struggling emotionally we thought drilling a hole in their head would be the best way to Provide them relief and treatment and if we go back medically, you know the idea that putting a leech on someone's body and covering them with leeches that will be curative and you know whenever you hear about those things or read about them the initial reaction is one of incredulousness and kind of like it's funny how bad that sounds now. It's funny how ridiculous that sounds and then you write about and then you go deeper and How does that even come to be? You know, you think like if I live during that time Sean (01:20:02.483) Barbaric. Shock treatments? Lobotomies? Dr. Riz Ahmad (01:20:13.026) how would I actually be okay with going along with that and accepting that as the norm when most people did. It was the universally practiced thing. And lobotomies aren't even that long ago. We're talking like, for me, my parents' lifetimes still happening around that time. So that power of legitimacy to a coat and a hospital and you can create what you believe is research to support it, but- takes digging deeper in ways that people aren't going to see all the flaws in it. That the amount of power and illusion that has been going on longer than the Wizard of Oz and everything else. Sean (01:20:53.563) And what's different now, and this is scary, is psychiatry traditionally was involved with a very small percentage of the population. You know, they previously would have been identified as the insane or the mentally retarded. It was a subset of American society that couldn't integrate. And that allowed for all these experimental treatments to flourish because of how they were dehumanized. But where we are now is psychiatry is involved with close to 20% of the population in some regard. It might not always be a psychiatrist, but it is a medical professional using psychiatric treatments, a psychiatric drug. So it's much more mainstream, which just has meant that it has increased the number of people who identify as a psychiatric disorder. What used to very much deviate from the norm to a very small extent. Like a small percentage of people has now been inflated to such normal aspects of the human experience. It's been completely distorted for generations and now even impacting the parents. Generation X right now and some millennials, I mean, we're the last ones standing who can kind of communicate the insanity of this. And... if we continue to fall under these illusions of medical legitimacy, then we're going to distort what it means to actually be human. Life is hard. And a lot of these things these teens are being diagnosed and treated for now would have never occurred at a previous time. And that's not a progressive viewpoint where we're actually improving the medical care. So people are getting... taken care of and getting the help that they wouldn't have gotten previously. No, everything's worsened and the statistics show it. So we're taking normal reactions and we're pathologizing them and we're putting them into the psychiatric system with a group of people who sees everything as mental illness, you know, they, they really have a difficult time in any way articulating what would be, you know, an expected adjustment. So I don't think they have a good grasp on what is, uh, you know, the human lifespan and the challenges that exist. Sean (01:23:16.695) anyone can probably look back in their lifetime and see a period where they have, you know, acted or responded in ways maybe they regret or were emotional struggles because we don't normalize it, we don't talk about it. So the school systems, for example, could have taken a different path. You know, when we see the role of social media and phone addiction, and the control it's taking over our, our children. and the impact it's having on especially developing girls that we spoke about before, instead of education, under normalizing the reactions, trying to improve people's reactions to it, we now live in a fear-based culture where it's automatically labeled and thrown into the psychiatric system. So digging through some of this research on phone addiction, I mean, we can go back to 2007, 2010, 2012, 2014. The concept of screen related time when it starts to exceed two hours has detrimental effects cognitively, emotionally, physically, even on growth, sleep disturbance, the central nervous system. And so ask, and Riz, I'll throw this out to you. I don't know how often you're asking your teens to... demonstrate their average phone usage, their screen time. But I'm doing this now with adults and asking parents to do the same. And if I get a teenager, of course I'm asking that same question. Do you know what I'm actually observing in clinical practice? The amount of time that eyes are on that screen. Dr. Riz Ahmad (01:25:04.494) throughout number as a guess, but I'm getting anywhere from like eight to 12 hours sometimes. Sean (01:25:10.151) what I'm getting. I can't remember the last time under eight. You know, globally, though, cell phone addiction, we're not one of the worst countries. Like if you go to the Asian countries like Malaysia, I think Korea, and even like Saudi Arabia, those were the ones that have the highest addiction of cell phone usage. So there's something culturally happening here that is contributing more towards the mental health crisis for adolescents. That's not happening in those countries. So all those other factors that you've spoken about have to be making a bigger contribution to what's going on. I can't speak to the legitimacy of your data right there. Well, the phone is just one device. So like the phone actually exacerbates it. But if you're talking about like things like TikTok and the way that culturally we're responding towards normal struggles of adolescent and putting a label on them, I don't believe those are happening in other countries, which is probably why they may generally have a lower self-reported maybe identification with like depression and anxiety. Yeah, I mean, I really don't know. All I know is there's it is impossible for someone who is facing that phone for minimum of eight hours a day to feel good at all. Right. And that is the that's at the expense of everything else right where your attention goes your energy flows. You are not moving your body. You are not engaging. You are not. You're not reading, you're probably not playing a sport, you're not interacting with people face to face. Completely agree. And like, when you start talking about solutions to all this, it starts with managing screen time right away. I started seeing the pacifying toddlers with an iPad back when my kids were young. And I was calling it out, you know, at that time, there's just no path where a... a kid can develop to tolerate distress and regulate their emotions when they're being pacified through stimulation, because the world is not always stimulating. And we have to be able to direct our attention into creative and social and physical outlets as a way of managing, you know, what we feel and what we experience and to develop effectively. And parents have become lazier. I mean, I just, you got to call it out. Sean (01:27:34.075) where it is. You know, it is criminal for a kid to have access to that phone eight hours a day, 12 hours a day, 66% of kids can be able to go to sleep with that phone. Forget about what the EMF is doing to them and the radiation and what we're talking about. But that is something that they're able to just sit in their bed with at 11 o'clock at night. And we reap what we sow in that regard. I remember when I was in And there's cultural factors here. When I was in my doctoral program or my master's program, there's all this stuff that was being pushed about over scheduling kids. Over scheduling, right? I mean, what are they gonna do? Let's look at where we're at in modern society. If they're not involved in sports, they're not involved in the arts, music, they're not engaged socially in their community. What do you think they are now doing? You know, if those are not scheduled in... as part of a plan to raise your kid. Things that are very pro-social. What are the, what do you think the detrimental effects of those things are? Over-stressed? Come on. We survived. We survived in my household based on two things. Sports for my son and my daughter and the arts for my other daughter and how important academics were pushed. They had to sit at that kitchen table for... what amounted to at least an hour and just did homework. There was no screen time, nothing was focused and you had to do that before you got off to practice that day. There was no time to be in that phone, no time. And that's how you're gonna have to raise your kids, that there is no access. The moment you get access to that phone, it is like making a deal with the devil because it is addictive, they want it all the time, they want that. over playing, being outside, meeting with, it is like a drug. And that is a major, major problem. Wait till, you know, when these parents try to institute controls around it with a 16-year-old, it is chaos. I mean, police are being called. They're destructive. I'm doing these coaching calls. Removing a phone is leading to destruction of property, cutting themselves, threatening to kill themselves, and to run away. Sean (01:29:59.439) It has that level of engagement on the brain. It hijacks their brain. So what is the appropriate response in that situation? Because we started off talking about how those type of behaviors are sometimes reinforced because they get the attention. So what does a parent do? Parents have to get control back over their homes. You know, you see all this nonsense out there with gentle parenting and bullshit. You know, parents need to be parents. They're authority figures in your home. If you're not an authority figure in that home that they listen to. then you've already lost control. But in that specific situation, if a child's cutting themselves and like destructing of property. Yeah, obviously, that's everything's gotten too far at that point, right? So we're trying to talk about and you know, I could do a whole show on how I'm coaching parents to respond. But we're trying to talk about solutions. You have a three year old, you know, this is directly to you. This is the parents of five year olds, 10 year olds, the 10 year old, the parents who want to get their 10 year old the phone right now because everyone else is doing it. The last thing you want to do is do what everyone else is doing. Folks, like we need radical change. Dr. Riz Ahmad (01:31:00.942) Thank you. Dr. Riz Ahmad (01:31:06.822) And some of this stuff, I think, is coming from a generation that maybe more so, definitely more so than the current one, was parented by some hard asses. You know, the my way or the highway kind of attitude because I'm the parent kind of thing. And the kid's perspective may have been very little taken into account for things. And so I get the reaction, but the pendulum swings too far at some point. And to... to say something like screen time's gonna be limited. And I think it's also like, we need to pay attention also beyond quantity to the quality to the way it's being used. So, having some awareness of how is ours, how are social media apps being used? What kind of photos or posts are they making? What kind of attention is being garnered by that? What are they learning about themselves? It needs to be some level of oversight on the how. But that firmness and that boundary and that parenting, it does not have to be done in a mean way because why it's being done is for the wellbeing of that kid who is not gonna have the ability. Sean (01:32:19.927) Mean way, mean way. I mean, I have to reframe to them what love is. Like the idea that a taking a phone away is abusive is being articulated in our current culture. I find that completely insane. Given the detrimental effects of that device, a parent feeling guilt for taking away a phone. as if it's something that they deserve to have. They're like vital for their survival. Vital for their survival. I have to change the mentality around it for them. I'll communicate, listen, it requires a high degree of responsibility around this device. Imagine what they're exposed to from pornography to the use of all these apps to the outside world, to information that is outside of your values and control. to texting kids that could be at any point at night, just imagine the degree of responsibility it takes to manage your life. So it's something that has to be earned. So view that as something that is, not something that they automatically deserve as a right in their lives, but rather something that they have to demonstrate responsibility to. And even there, it's going to be under restrictions because we're seeking out balance that exists in their life and their development. And I think the best parents are approaching it that way. They can be firm and loving. You know, two things can exist at the same time. In fact, I would say being firm is a loving response, right? Because you care more about their wellbeing than anyone else. Some of these kids, they make these threats and you're such a horrible parent, I'm gonna have no friends because of you. And the parents feel bad and give into it as if they are somehow like restricting their social world. They like feel for their kids in that regard. they feel completely controlled by a teenager. And that's a disruptive home. Sean (01:34:17.699) We have hope. It feels like it's getting worse. Dr. Riz Ahmad (01:34:27.278) tend to be an optimist, you know that about me in some ways. And I think, I think there's a, there's a quote that my wife has on her board and she's involved in an animal rescue. And the quote says, to know is to suffer to act as to no peace. And I feel that way with some of these things that if we're talking about all these various influences, like, the mental health system. And we can go into even more detail about what does it do to a teenager to believe that they are mentally ill, they are a separate category of human that is mentally ill. And when they have that feeling, that's a symptom that they're having. When they have that thought, they can't trust anything about their mind. Their mind is a damaged broken. mind and experience to someone who's trying to form an identity. What that does over the course of years and it being legitimized by adults and hospitals and parents. You asked about hope and I'm painting a bleak picture, but that impact is so huge that if we're having conversations like this, if we're spreading messages like this that can tear apart kind of a... a house of cards of mental illness, then if you take that down, well, that opens up a hell of a lot of new opportunity. If parents are receiving information to be able to use common sense and parent again, and be firm in ways that are caring, because it just makes sense, your team can't make the decisions around some of these things, including around psychiatric drugs, by the way, because I've often heard parents say, Well, what do you think to their 12 year old about change the medication, increase the dosage, stay on it. Decisions that a 12-year-old, a 14-year-old, a 16-year-old should not be the one making and being deferred to. Sean (01:36:35.847) How did that's such an important point. I don't know how we've gotten there. When I've talked about the adverse effect of these drugs and giving them information, how this could be, you know, a problematic kind of variable in trying to restore health for their kid. I have seen parents scared to tell their kids that we're going to start taking away the psychiatric drug. And I just, I would say, what does that tell you about the situation you're in? Well, she really believes that the drug helps her. Okay, well, you're an adult, what are you seeing? Everything's worse. But she believes it. It's just, it's fear of, of parenting. It's fear of the kids' reactions. It's, it's, it's treating children like they're these porcelain dolls with no resilience or no capability to handle the word no, um, or to, uh, to be able to put in appropriate age related boundaries and limits. And I don't know how we've gotten there culturally. I think it's been a kind of been a slow burn, you know, over decades that have been pushed in American media and has been pushed in a culture of fear by the medical establishment. I mean, parents are really believe that they fuck up their kids and they're really scared of doing it. And they think about any terms of like their kids experiencing distress that they're not doing well. And, uh, you know, that's part of the brainwashing that has occurred. That, you know, distress is mental illness. And that's where we have to make some changes. Dr. Riz. Dr. Riz Ahmad (01:38:16.426) And it is helpful to have validity and truth on our sides. You know, the outcomes that the kids who are coming in have been through that approach and gotten worse. The vast majority of kids and families that go through the DBTA program make substantial improvements. So that in itself is something that I think can perpetuate in understanding and a learning and a spread of a. of a message. So to some extent, the way that the way that leeches are in our past, the way that lobotomies are in our past, I do have some hopefulness that this way of approaching mental illness can ideally one day be in our past. Sean (01:39:01.415) I do believe we're in a culture war. I feel that way. You know, I feel like, you know, when I start posting things on social media, or writing what I'm writing, or speaking on a podcast, what I'm speaking, as reasonable as I know this sounds to the listening audience, we put ourselves like subjected to these negative comments and these reactions as we're as if we're invalidating people's pain. or we're discounting true medical conditions that are established by science, like we're the crazy ones. And that's the extent of brainwashing that has occurred in our culture, that it's really hard to pull people out of the illusion. And it doesn't matter the degree of misery that persists. Like, and that, and that's the thing you see, you see this from, you know, from even adults. who are still attached to that diagnosis and have been on these drugs for so long, the idea that they exist as someone without them is so foreign and we sound like the crazy ones. I think it's a fight worth fighting for. And if there is going to be hope, there has to be a mass awakening. And I don't know how we start turning the medical professionals around. you know, so many are indoctrinated into that system that they see drugs as healthcare. And, you know, what is it, like 75% of the curriculum is funded in some regard from the pharmaceutical industry? Yeah, the solution is keeping them out of that hospital system. Yeah. You know, some of the hardest part is when you do have a medical professional as the parent. Yeah, yeah, I didn't consider that. Who comes in for these evaluations, right? Dr. Riz Ahmad (01:40:51.534) Mm-hmm. Sean (01:40:57.639) But they're here. So clearly it hasn't been working if they if they truly believe that the system they're a part of is the solution. Then wouldn't they just stay there? But when it's not working, and they're removing themselves from it, then what's the barrier? Why? Why are they having a hard time believing their own action? Yeah, it's a good question. I mean, I'm You know, there's often a lack of depth in this. Yeah, okay. You know, there's just a lack of depth. I guess it depends on what type of doctor they are. They have such a broad knowledge base. They're relying upon so many other resources to guide them with protocols and things like that. Yeah, I mean, remember what their idea of science is, is what's in the published literature. And, you know, we've had these conversations on here about how much of the public, the literature that they're exposed to is either one fraudulent, or certainly it's misrepresenting the data that's actually there. So there's just a limited knowledge base, but if the blind trust is still there, that we're the beacon of scientific supremacy. And so getting past that, and remember when you're a doctor, you hold a very prestigious standing in American society. So the idea that to actually be open to alternative evidence is probably much lower. And that's a problem I think we have with psychiatrists. Although their actual training is less than clinical psychologists, they go through the medical school, but their residencies in psychiatry are limited. Many don't do a fellowship, but if they do, it might be in neurology and psychiatry. Their evaluations are limited. I mean, we've talked to psychiatrists on here. I mean, what do they have like a rotation or two in psychotherapies? You know, they're working these hospital settings, it's all emergency medicine. And so it's just quick labels, quick drugs and You know, it's unfortunate, I just, I'm feeling less and less hopeful. I because I just see things as worsening. And one of the reasons I feel that is because what's getting strengthened is the hospital based system. I think the Affordable Care Act has eliminated the private practitioner. And so the sick care system that exists in the United States continues to expand to meet the Sean (01:43:20.231) the needs of the Affordable Care Act. The American people were lied to about that. That was the first war on independent science and independent doctors. And so we've lost it. Now they have to follow protocol. They're not independent. In order for them to keep their jobs working in the hospital systems that exist, they have to follow those protocols. They're also completely overwhelmed. So when you only have eight minutes, you only have 10 minutes to work with somebody, that's the efficiency of... that kind of approach. And I can't believe psychiatrists are in demand to the extent that they are. Like people can't get in for three to six months. Even some that are like under the care of a psychiatrist and you want to work with starting to successfully taper, they can't get an appointment for three months. That's because the sick care refers to the sick care system. You know, you go in and the doctors say, okay, you're going to go see this psychiatrist and that's mental health care. And that's why you see we're just getting more sick and more sick. Well, I think we did a great job today of highlighting the problems and what we're seeing in clinical practice. I think this might be eye opening to a lot of our listeners, and I hope this gets shared because I'm not really sure that the general public is aware to the extent that this is what we're seeing and this is our future generation. These people are entering college in the workforce and the numbers are increasing dramatically. The percentage of those who are identifying with these mental illness diagnoses are increasing exponentially. and we are faced as a society with what do we do? How do we respond to a generation who is incapable, actually incapable right now of being able to cope with the realities of living, who are phone dependent, addicted to that, and are living in this alternative social media construction? We're in a bad spot. Sean (01:45:37.159) Final words, Dr. Riz? Dr. Riz Ahmad (01:45:41.17) Yeah, I think as bad a spot as we're in, I think if people rely on some of their intuition of what they know is related to wellness and kind of work through your own myths, question things much more than maybe been questioning things. Maybe that's not your audience, maybe it's beyond that too. But things like that help us feel physically well. We know some of these things for ourselves and they're not drugging of our teens. That's not what's gonna lead a teen to growing up and feeling well. The things that they need socially in their lives, the boundaries that they might need and you can't developmentally expect them to put on for themselves, family connection, meaning, purpose. There's a chance to return to humanity and the things we know that lead to fulfillment for humanity. or kind of a hope what I can refer back to. And I think parents have a lot of influence in being able to create an environment that fosters that for their kids. Sean (01:46:50.483) One final word, folks, it's not ADHD. It's conditioning by screens to only hold on to one thing for a very short period of time before scrolling onto the next. It's completely ruins your ability to stay present and to focus for more than a short period of time.