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The mental health industrial complex · Cultural Wars | America Out Loud News

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  Really, if we've learned anything from these past couple of years, my call and our again to answer that.
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  I'm Dr.
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  Randall Bach here to unpack myths, explore innovations, and give you actionable insights into the world of medicine and health.
• 0:45
  And to that end, today I'm honored to have with us psychologist and psychoanalyst, Dr.
• 0:50
  Eric Green, whose name came to my attention when I independently came up with the same term that was the title of his article, the mental health industrial complex.
• 1:01
  I was writing about the gross expansion of mental health diagnoses after the initiation of something called mental health parity.
• 1:09
  But I took an interest in Dr.
• 1:10
  Green's article and his basic underlying premise.
• 1:14
  And I'll quote one line.
• 1:16
  During my time there, I observed the clinic functioning as a manufacturer of the quick fix by means of administering medications.
• 1:24
  This is a West Philadelphia clinic where people only showed up when the psychiatrists were there for medication management.
• 1:30
  Otherwise, the waiting room was fairly empty.
• 1:32
  So that term, the mental health industrial complex, rang a bell for me.
• 1:37
  So Dr.
• 1:37
  Green, welcome.
• 1:38
  And tell us a little bit about yourself and how you came upon that article and what the intent is and how it was received.
• 1:44
  Sure, I was working in mental health.
• 1:47
  Um excuse me in Philadelphia.
• 1:51
  And I usually write as a way to understand situations I'm in and found the situation that I was in in the mental health care system and in that part of Philadelphia to be pretty troubling.
• 2:06
  And I decided also as an offshoot of my dissertation, which looked at the ways in which social determinants impact mental health, to construct a paper that was more specific to the community clinic and the place that I was working to bring out some of these more difficult theoretical concepts, such as the impact of money on mental health, the impact of racing class on mental health.
• 2:32
  And that was the main purpose of the paper.
• 2:36
  So how long had you practiced and where were you practicing at that time?
• 2:40
  So at that time, I was practicing in a community clinic in West Philadelphia.
• 2:46
  I was pre-licensed, so still an intern, still trying to get my hours, also still trying to get my bearing about where I best fit within the mental health field with all of its you know possibilities.
• 2:59
  And this was just one of the sites that I happened to work with uh as a community mental health clinic.
• 3:05
  And uh I was seeing patients under the supervision of a licensed uh psychiatrist, and was pretty upset with the firsthand experience of the community clinic that I was in.
• 3:19
  And I also knew that it wasn't specific to that clinic at a sort of broader context in which a clinic like that could exist that I found difficult and troubling to make sense of.
• 3:32
  And what were the parts that were troubling for you?
• 3:34
  I mean, I I just as a I mean, I've done a lot of different things in my medical career, but at one point a thousand years ago or so, and I think it was like uh 1980s, I worked at Columbia Point, uh, which is in Dorchester Boston area.
• 3:50
  Um, and it was the first uh public public housing, I guess, in the country, it was the first community health clinic so for um in the country, and it was kind of rough.
• 4:00
  Um, I don't know if the same demographic is what you're talking about.
• 4:03
  I was doing general medicine as opposed to psychology or psychiatry.
• 4:06
  Um, but what are the kind of things that that you saw there?
• 4:09
  What were the things that kind of like set off your radar um for yeah?
• 4:15
  Well, I mean, just to give sort of a lay of the land, it was a uh a very sort of low-income neighborhood, mostly black people, most of the people in the clinic were white, uh, most of the therapists.
• 4:26
  There were there were a handful, you know, it's probably to be fair, it's probably mixed.
• 4:30
  Um the the rhetoric, I think what sort of hit me hardest in the beginning was just the rhetoric that went on in the office outside of earshot of the patient.
• 4:39
  There was lots of racist and classist comments going on um about the patients coming in without a real, I thought, critical analysis of the way in which race and class impact, you know, mental health and behavior.
• 4:53
  So it felt explicitly racist and classes and explicitly um damaging to the patient population.
• 5:04
  So you know, I I read I read the article and I um saw some of the comments and whatnot.
• 5:09
  You know, there's a little bit, uh, I don't know if you ever come across the book, uh The House of God, um, it's written by the pseudonymous uh Samuel Shim.
• 5:18
  Eventually he got uncovered, and he's a psychiatrist.
• 5:21
  I forget his actual name, but we read that book in medical school and residency, and it's um it's a laugh a minute.
• 5:28
  It's kind of the catch 22, I don't know that book, uh, the you know, black comedy, um Joseph Hiller about the war.
• 5:35
  You know, when you're not that the situations are identical, but when you're under stress, uh people get a kind of a battle uh mentality rolling together, you know, if they say stuff, do stuff.
• 5:44
  I mean, uh, you know, I try not to, you know, there's his um Hanlin's razor, uh, which is you know, never a tribute to malice what might be explained by stupidity, and my friend has a correlary never looking at stupidity what might be attributed to laziness.
• 5:59
  So, you know, you know, things get said under you know, kind of battle conditions, whatever people might feel certain way.
• 6:06
  And and you know, just to play the devil's advocate here for a second, you know, these people are obviously working in a place like that.
• 6:12
  I mean, they're you know, maybe have choices of being other places, and you know, there might be frustrations.
• 6:17
  I mean, what was kind of their mindset?
• 6:19
  Are they like, you know, some supremely bad people across the board, or what were they, you know, if you had to be their defense attorney, what would what would you say in their cases?
• 6:28
  I I don't know, I'll try to answer that.
• 6:30
  But I to your point, I think that's right.
• 6:32
  I think that everybody under the conditions, whether patient or doctor or therapist is suffering a certain amount of fatigue and a certain amount of exhaustion, where a very basic or primitive mentality comes out, which is us versus them.
• 6:46
  And we are all banding together as therapists, as practitioners, and for some reason the enemy is basically the patient, and things are said that probably are outside the the sort of general discourse that goes on in this person's life.
• 6:59
  It's a more extreme version of that.
• 7:00
  So I think that's right.
• 7:01
  And I think I walked into the situation a little bit naive, sort of in my mid to late 20s at the time and didn't have a lot of experience in community mental health to start.
• 7:09
  So I think part of it was just a shock of getting used to that.
• 7:12
  And you know, the counter-argument is shouldn't mental health be one place in which some of this kind of mentality gets cured, where we, the practitioners were also falling to the prey of the same symptoms that the patients were suffering from, which is the pressures of you know, being overworked, underpaid, the pressure of the community, the pressure of you know, uh uh um psychiatry and prescription medication, and also the pressure of a kind of weak mental health model to make sense of people's suffering.
• 7:45
  So, how have, you know, I guess what were the conditions that people came in for?
• 7:51
  What were the complaints they had?
• 7:52
  Uh, what were the things that might have come up?
• 7:55
  And and how could they have been treated differently, say?
• 7:58
  Yeah, I mean, I I again it's sort of as I made the last point.
• 8:02
  I really think it's a failure in the mental health model.
• 8:05
  Um, I think the practitioners are following the letter of the law for that mental health model, and the psychiatrists are prescribing medication in accordance with what the model determines to be true for mental illness, which is that causes are because of um poor brain chemicals or some sort of personality flaw or childhood trauma.
• 8:28
  And so practitioners are following this model and going along with what they know to be true, and yet somehow it's not actually curing or alleviating the suffering of a lot of people.
• 8:38
  So in this community mental health clinic, there's a broad range of mental health diagnoses as you would expect pretty much anywhere, which is that a small portion has more psychotic end of diagnosis, whether it's schizophrenia or bipolar one or something, and then if you're you know, sort of you know, less severe conditions, anxiety disorders, uh, depressive disorders, and kind of everything in between.
• 9:01
  So you you're seeing a broad range of people, but I think the the tricky part is that what never gets addressed is one, the model that we're using to try to make sense of people's illness, and also the social conditions that these people are living under the clinic two living, sort of operating under these conditions, which impacts people's ability to sort of make sense of their suffering.
• 9:24
  Yeah, yeah, it's uh tricky thing.
• 9:26
  So, how's that translated?
• 9:28
  I mean, first of all, I guess we can stick with the article.
• 9:30
  What was the reception uh and and how did it um play out and or change things either for you or there?
• 9:38
  Well, I'll I'll start with the first question, which is the reception.
• 9:42
  Um that paper was my first experience with the politics of publishing.
• 9:49
  And I could not get it published.
• 9:52
  It probably took me four or five years to find the right publication.
• 9:56
  I had publications that would agree to it and then reject it the day before publishing that happened.
• 10:00
  Twice.
• 10:00
  I presented it at seminars where it caused all kinds of fights and conflicts in the room.
• 10:07
  I realized it was kind of a hot topic.
• 10:08
  It doesn't seem like a hot topic now, but when I first was writing it, um, you know, uh sort of mid to late aughts, 20 aughts.
• 10:20
  Um, it was a hot topic.
• 10:23
  So basically during critical social analysis to explain mental health issues.
• 10:27
  And it people didn't like it.
• 10:28
  It it was too disruptive, it was problematic.
• 10:32
  I honestly didn't think that it was going to be, but in any case, it took about four or five years to find its home.
• 10:37
  And the Journal of Humanistic Psychology, again, thank goodness that it was around, pretty much agreed to there were very few edits they needed it to be made, and they they published it pretty much straight away.
• 10:48
  Uh, did your uh colleagues get to read it and/or comment or so forth, or were you long gone from the era?
• 10:56
  No, I mean, the truth is most outside of the journal of humanistic psychology, most of the attention that it received were in fields like anthropology and social psychology.
• 11:07
  It didn't really have a home, so to speak, within the literature of mental health.
• 11:14
  And my thinking is because anthropology and social psychology and things like that and sociology are looking at more broader contextual problems that impact people's lives, and psychology is more focused on the sort of so-called internal lives of people and less sort of focused on the ways in which these sort of social determinants construct this so-called internal life that people complain about.
• 11:38
  And so since then, I mean, you left that milieu.
• 11:42
  Um, and that's then did that become the kind of template for your practice, or how did how do things change for you thereupon?
• 11:49
  I mean, I had a number of crises.
• 11:51
  I wanted to leave the field.
• 11:53
  I thought it was too myopic.
• 11:54
  I thought it was too abusive.
• 11:55
  I thought it was too small.
• 11:57
  I didn't like the models.
• 11:58
  I tried to get out.
• 12:00
  Um, in fact, I did get out and I floundered for a while and realized I better figure out how to make it work.
• 12:06
  Um, both because I was starting a family and because I was tired of you know being really poor.
• 12:13
  Um, and so I just thought I need to figure out how to make this work.
• 12:17
  And what I ended up realizing, and it was sort of implicit in my work since the beginning was I was really at home in psychoanalysis.
• 12:23
  So I had loved studying Freud.
• 12:25
  I love studying young.
• 12:26
  I'd love studying their students like James Hillman and Jacques Lacan.
• 12:29
  And I needed to take up that work as the basis for my practice, and that's where I am today.
• 12:37
  So, you know, I I'm familiar with only to the slightest degree with uh Jacques Lacan.
• 12:46
  But you know, how does that play out?
• 12:48
  I mean, yeah, I assume you're not seeing that same kind of clientele and um not the same kind of problems.
• 12:54
  There are I people I imagine who have wherewithal to find somebody who you know with whom they would like to uh coalesce and find leadership and so forth, I guess, for their mental issues of a particular type.
• 13:08
  I mean, how does that word of mouth happen or say?
• 13:11
  So I mean, I've sort of established myself within the field within the community in Los Angeles as somebody who works, you know, in psychoanalysis in a particular brand of psychoanalysis, tending towards more difficult patient population.
• 13:25
  So I usually get referrals from people in the network, which is like, you know, I don't know how to work with this person, you know, would you sort of do some introductory calls to see if we'd be a good fit?
• 13:33
  So that's one way.
• 13:35
  Another way is there really aren't a lot of people that practice in this style anymore.
• 13:39
  So, you know, I'm I'm found just because there's you know, there's really not a lot of competition.
• 13:45
  Um, and people are looking for things beyond the mental health model to address their suffering.
• 13:51
  Um, so a lot of folks come after they've gone through the mental health model and the mental health field, and they realize that it hasn't, you know, helped them in any way.
• 13:59
  And so they're looking for alternative sort of styles and psychoanalysis is really in opposition to mainstream mental health and in opposition to psychiatry.
• 14:07
  So it's kind of a third um style, if you will, of working with suffering.
• 14:13
  So I was at uh I was in Vienna last year, and uh obviously stopped at the uh Sigmund Freud uh house and museum.
• 14:21
  Um are you a Freudian?
• 14:24
  Uh was Freud a Freudian?
• 14:25
  Uh where do things go?
• 14:28
  You know, what's what's the general tool that you use uh for psychoanalysis and how do people gauge their success and or uh progress and you know how you know are you working on your own feelings and sensibilities, or are you kind of following some kind of framework and lattice work of of you know growth and achievement?
• 14:46
  Yeah, I mean, well, there's certain conditions that have to be in place in the work in order for the work to be sustained.
• 14:51
  So it's it's less a sort of let's just go with this and see what happens and much more careful and uh maybe even calculating style of working.
• 15:01
  Um I think the the primary the the sort of genius of Freud was is through the course of his work, and of course, he sort of touched upon a different things like childhood trauma and you know uh um you know sexual abuse, things like this as the primary cause of people's suffering today.
• 15:20
  And he sort of says, look, you know, there's some truth to that, but also something else is happening.
• 15:24
  So you know, we can't avoid having those discussions and unearthing people's suffering from the cause of childhood, but also there's an additional thing happening.
• 15:33
  And I think again, the genius of Freud is that he recognized that there was something inherent to the way in which people talk about themselves, and the way in which language impacts um mental health that needs to be addressed.
• 15:45
  And so he's he's trying to through the course of his work, and I think Lacan is probably his best student who picks it up, is basically says we have to sort of separate somebody from the way in which they talk about themselves to see how language impacts mental illness.
• 15:59
  And there's really no other practitioners there doing that.
• 16:02
  Even the ego psychologists or the ego psychoanalysts of the United States are really looking at the way in which they can strengthen and support ego functioning, which is counter to what Freud and then Lacan and even Jung and Hillman uh ended up doing in their careers, which is to undermine and get away from ego, ego strength.
• 16:22
  Right.
• 16:23
  So uh for our listeners, you maybe we could just define what that is ego strength and uh how do we know who has it and doesn't, and how do the people kind of self-uh report to you?
• 16:35
  Uh they're not going to come in and say, I don't have ego strength.
• 16:37
  I mean, what are the kind of complaints you get and before you come up with that?
• 16:41
  And then again, what's the scaffolding or how to get it out of the well?
• 16:44
  Yeah, I mean, you know, there's there's a lot of ways in which people define this thing called ego strength or what an ego is.
• 16:50
  Um, you know, mainstream mental health talks about social and occupational functioning.
• 16:54
  They go, you know, this person's ability to perform in their community, both in interrelationships and in employment.
• 16:59
  However, they define that sort of are the two big markers for sort of ego strength, so to speak.
• 17:04
  So if someone's having severe sort of work-related issues and relationship issues, then we'd say, you know, maybe their ego strength isn't so great.
• 17:12
  That tends to be the very general brush stroke of mainstream mental health.
• 17:16
  Freud had four different definitions of ego, but the one that sort of stuck out to me, and the one that I work with is that he talked about ego as a sort of image that gets projected onto a body.
• 17:25
  So, for example, when you look in a mirror and you see yourself, and it's not quite yourself, it's an idea of yourself that sort of overlays with you know whatever the reality is behind it.
• 17:34
  So there's an imaginative feature or an envisioned feature of the way in which we think of ourselves.
• 17:39
  And for Freud and the way in which I work, that's the ego.
• 17:43
  So anytime we talk about I, any time we refer to our self-narrative, any time in which we talk about our own likes and desires and so on and so forth, for the most part, that's the way in which I imagine and work with ego.
• 17:57
  I was in Athens uh a few weeks ago, and uh little tiny bit of Greek I picked up, I you know, it's interesting the word for oneself, I yeah.
• 18:08
  Do this is is ego, you know, that is uh the term along with obviously psyche and psychology, logos of the word and a lot of a lot of um stuff coming coming up in Greek, insofar as we can understand things, you know, you have to, you know, I I know I understand the um the alphabet.
• 18:26
  So it's you know, once you sound things out, it's kind of funny how many of these um psychological terms are are there sitting kind of in plain view, um, you know, in signs, whatnot in Greece.
• 18:36
  Anyway, side note.
• 18:37
  Um, but that's I did so I did find the ego there, but it was just everyone saying I this and I that's and beyond.
• 18:45
  Um Greece, that's right.
• 18:50
  Say it, go ahead.
• 18:51
  I said you could find the ego in Greece, both historically and you know, as a development in the literature for Freud, for sure.
• 18:58
  So on that thought, we're gonna take a quick break.
• 19:00
  Uh I had a vacation in Greece, and we're gonna take a brief vacation from this story, but stick around with us for our second segment with Dr.
• 19:07
  Eric Green.
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• 21:42
  So we're back for our second segment with Dr.
• 21:44
  Eric Lane and our discussion of the mental health industrial complex upon which independently I come upon writing an article on mental mental health parity, as I mentioned earlier.
• 21:56
  Um the idea that it kind of embedded in the 90s perhaps, but became um uh emblazoned into law in the 2000s that you know your um your brain uh would get the same treatment as a strain or a sprain.
• 22:13
  So if you broke your ankle, uh that was always covered, uh historically.
• 22:17
  Uh but if you felt sad, uh that wouldn't be, you know.
• 22:20
  I mean, if you heard voices and you were going to kill yourself, yes.
• 22:24
  Um, but a lot of things kind of between those two uh situations of normalcy and severe psychosis were not covered.
• 22:30
  So a lot of uh malaise and behavioral issues and whatnot.
• 22:33
  And and once that happened, and you know, it's kind of a chicken and egg kind of thing, but I think I know who the chicken, which is the anyway.
• 22:40
  The the uh once mental health parity became enshrined, and insurance companies had to follow that dictum.
• 22:47
  Um, and lo and behold, all you know, people you know, basically everybody started having mental health issues.
• 22:53
  Um I I was thinking, well, you know, this is kind of like the mental health industrial complex.
• 22:58
  And the term originally was from Eisenhower, and he called it the military industrial complex.
• 23:02
  And he he came from the military part of it, and he obviously wanted to politics became president and whatnot.
• 23:07
  But he he was frightened, as it were.
• 23:09
  I don't think he was man eatily frightened, but you know, he did D-Day and all that, but um he was frightened that there would become this apparatus to keep sending money to military stuff, excessive of the actual need thereof, because it would create its own demand and people would get um kickbacks and all that kind of stuff, and they would, you know, Congress humans would start sending money over and whatever.
• 23:32
  And so hilarity would ensue.
• 23:34
  And I'm not necessarily wrong about that, and the term's been applied in other avenues, but you know, when I was doing um my own uh pieces on kind of methadone, uh how you know the the narcotic paradigm uh was overturned in the 60s and 70s and was the it was disease, um, medicalized um and and treated.
• 23:54
  And as soon as that happens, uh guess what?
• 23:56
  You know, a lot more revenue goes to that area of of work, you know, of work.
• 24:01
  So addictionology was not really a thing.
• 24:03
  There were no people, you know, clinics, whatever, uh, that were getting federal funding or state funding, whatever.
• 24:08
  And then there were in that grew.
• 24:10
  And then the same kind of thing has happened, like the four A club.
• 24:14
  Um, you know, there's addiction, autism, ADHD, anxiety, and then just for giggles, I I I've you know, like the sexual dysmorphia you could call autogonophilia, just make another A out of it.
• 24:26
  Um five.
• 24:28
  And all those things have just hugely grown under the um under the heat lamp uh incubation of of money being thrown that way.
• 24:36
  And so, you know, I that I I came across your article because that was the term war.
• 24:41
  So I'm just wondering what are your thoughts about that term, the mental health industrial complex, and what is it, if anything, has it gotten better, worse, still there?
• 24:49
  And uh, do your you know, thoughts uh have they changed, evolved, whatever.
• 24:53
  Yeah, no, I appreciate that.
• 24:54
  So I'm gonna sort of speak about it a bit differently than you know.
• 24:57
  It sounds like we have different sort of funds of knowledge about this.
• 24:59
  I'm just gonna narrate it the way I understand it, which is you know, there was there was uh there's competing uh treatment methodologies that are arising throughout the 1900s about how to cure people.
• 25:09
  You have this experimental psychology about humanistic psychology, you had psychoanalysis, you had you know what turns out to be the sort of cognitive behavioral folks, and there's these crises that occur over the the course of a century.
• 25:20
  And somewhere in the 70s, 60s, 70s, 80s, it's very clear that what's emerging as a sort of victor and you know, the popular treatment model is cognitive behavioral therapy.
• 25:31
  Well, cognitive behavioral therapy has done very well, if you can say very well, is it's um operationalized mental health issues.
• 25:40
  So by that I mean it's given very specific criteria uh that one can be diagnosed with a given condition, even if that condition is sort of amorphous historically and isn't really grounded in anything, but it does a really good job of you know, systematizing and classifying and giving specific criteria to diagnosis.
• 25:59
  And what works really well about that is within the scientific community, or rather the medical community, now we have identifiable features that everybody sort of can agree upon to give somebody a diagnosis.
• 26:10
  Where prior to that there were so many different, again, competing models and theories and so on and so speak, that it was all sort of up in the air.
• 26:16
  So you have this increase in the publication and pages of the DSM, which is our sort of Bible of diagnosis from the the original DSM, which was basically two classifications, dementia pray cocks, and uh uh um uh manic, was it like manic depression or something like that?
• 26:35
  You know, it's this is a hundred-page manual in the course of a hundred years, it goes from a hundred pages to eleven hundred pages.
• 26:41
  So there's a lot of questions there.
• 26:42
  In any case, the DSM3 changes to the DSM4, and all of a sudden there's this explosion of of uh sort of fixed terms or operite operationalized terms that fit very neatly in the medical model, and therefore uh can be prescribed more easily.
• 26:58
  So, whether it's anxiety or ADHD or really now autism is really sort of taken over in that way.
• 27:04
  Um, although the sort of how much medication is like a weird thing happening with um the involvement of psychiatry with with autism, but certainly with anxiety disorder, ADHD.
• 27:16
  Um, these were things that the pharmaceutical companies could now sort of hang their hat on and throw a ton of money into research and development for pills because the cause of suffering, at least for psychiatry in a lot of ways, is there's a brain chemical problem.
• 27:30
  And there's no sort of guarantee that that in fact is true.
• 27:33
  There's a lot of um correlative studies that show that there's changes in sort of brain chemicals with people who have these diagnoses, but there's no cause, there's no causation for it.
• 27:44
  Um so in any case, you have these uh um uh mental health and medical models sort of you know, uh overlapping, finally are meeting or coming into some sort of sort of agreement, and then the you know, the psychiatry are really the the pharmaceutical companies creating pills to to so-called cure them.
• 28:03
  And you know, it's in my practice for the most part, you know, there's some exceptions.
• 28:08
  I do think that medicine does help some people uh for a mental health.
• 28:11
  So I'm not completely um uh I'm not like uh uh medical abolitionist or something like that in terms of pharmacy.
• 28:20
  I do think that there's a place for it, but it's so over-prescribed and overused that for my practice and the way in which I practice.
• 28:26
  I encourage people, and I say it very transparently to come off of or reduce the amount of medication that they're on, especially because they're still continuing to seek mental health treatment, and the medication that they're on doesn't seem to be really helping the thing that they're complaining about.
• 28:39
  Yeah.
• 28:40
  So it cuts both ways.
• 28:42
  Um, I had a patient uh some time ago, it's probably almost 30 years ago, and he was a single guy, and I think of limited intelligence.
• 28:54
  Um, and he lived with his elderly mom, and she mostly took care of him.
• 28:59
  Um but he was pleasant and jovial, and um I don't you know his his work was very sketchy as you know, minor things like delivering newspapers and stuff like that.
• 29:12
  Um day, uh apparently he you know, he was just always kind of it's kind of if you remember kids, you know, some of them were skipping all the time and happy and singing a song.
• 29:22
  He was like that.
• 29:23
  He was a very pleasant um uh not intellectual guy.
• 29:29
  And um, and apparently one day he was kind of walking uh alongside cars and you know, took a little bit of a turn into the street, got hit.
• 29:39
  Um, and wound up at you know, one of our vaunted local hospitals and actually the house of God, uh, the book I mentioned earlier, you know, refers to Mass General Hospital.
• 29:49
  Um because that's the way people see themselves there.
• 29:52
  They see them as emissaries of God, did except they're just a little bit more important than God.
• 29:56
  So it's kind of a step down become the house of God.
• 29:59
  But uh he went.
• 30:00
  Wound up there and um uh I don't know somehow he got a psychiatry ward and and they they found him and he came the next time I saw him was you know some time later, like six, eight months later, and you know, zombies are a you know, not real thing, um, and it's not a real term, but he was kind of a zombie.
• 30:19
  He um, you know, he had like uh, you know, spittle coming down the corner of his mouth.
• 30:24
  Um, you know, he had really hard time forming sentences.
• 30:28
  Uh he used to be jovial, you know, as it were, or flippant or funny, whatever, friendly and smiley, that kind of stuff.
• 30:34
  And there was none of that.
• 30:35
  It was very bland affect.
• 30:37
  And you know, clearly he was on antipsychotics and whatnot.
• 30:40
  And um, you know, they had a diagnosis.
• 30:44
  Now it was between him and his mom, um, and I'm sure she had some kind of power of attorney over him, whatever.
• 30:50
  But um, you know, it was just a different thing.
• 30:53
  I mean, this is a very extreme case.
• 30:55
  Um, but it was vivid because you know, was he helped?
• 30:59
  I'm not sure he was.
• 31:01
  Um, I don't think he was psychotic before, but you know, the avenue by which people get their treatments tend to be over.
• 31:09
  There's very few get under treatment.
• 31:11
  Once you're in the the realm, once you're in in the um there's a you know, in football, they have like in the grasp.
• 31:17
  You know, what is a catch?
• 31:18
  What is not a catch?
• 31:19
  And you watch that kind of stuff.
• 31:20
  And once you're in the grasp, you don't seem to get out of the grasp.
• 31:24
  And this is the thing, this is kind of my little pet peeve about methadone and whatnot.
• 31:27
  Because I I was tapering people, you know, taking four months to taper people, kind of very, very, very gradually slow and whatnot.
• 31:34
  Um, but I had loads of people come in with methadone histories of 10, 15, 20 years, and um, you know, kind of a lifetime of treatment, and that is also kind of a the zombie effect.
• 31:44
  People have this very you know, laggard thing.
• 31:48
  And and as I'm I'm sure I can come up with a question, but I can just ask you what are your impressions about that.
• 31:53
  And I assume that's not really the type of person you see regularly, whatnot.
• 31:57
  But you know, speaking of treatment and or potential overtreatment, what are your uh conceptions of what's going on?
• 32:02
  Those examples fit within manage a management.
• 32:07
  That we there are no cures anymore.
• 32:09
  Uh, there's no way to get rid of these problems, but what we can do is is manage them endlessly.
• 32:13
  And I see that on my end.
• 32:14
  People come in, they go, Well, I'm depressed, I have depression, I have anxiety, and I know there's nothing I can do, but like I can exercise and eat right and sleep right, and then I sort of manage it through the course of my my lifetime, and I can take various medications and so on and so forth.
• 32:27
  And I think that's part of the problem.
• 32:30
  The model has excluded what used to be called the cure.
• 32:34
  And people laugh about it.
• 32:35
  They say they go, There's no such thing as a cure.
• 32:37
  And there's well, there is.
• 32:38
  I mean, it may not be in the way in which we conceive of it, which is like you see a perfectly happy person, totally well adjusted and so on and so forth, but there's ways in which to lessen or reduce or even get rid of in some cases a lot of the so-called mental illnesses that people are walking into an office with that I see regularly.
• 32:55
  Um, you know, again, you you have to the model has to shift to account for sort of an understanding of what we mean when we use these words cure and mental illness and so on and so forth.
• 33:05
  But that's it's possible.
• 33:07
  Medication can sort of just run its course through someone's lifetime and they can be convinced that this is sort of the best treatment we have out there available.
• 33:15
  And it's just not true.
• 33:18
  Yeah.
• 33:19
  Well, you know, the answer to every question on earth is it it depends.
• 33:22
  You know, it depends who it is.
• 33:24
  Because I mean, it's it's not like picking out uh jelly beans, um, have that the candy counter, you know, you have certain flavors, and they're always pretty much the same.
• 33:32
  You get a watermelon one that's always kind of tastes like watermelon.
• 33:34
  Humans don't really fall uh into categories so neatly.
• 33:38
  I mean, there's a joke that people fall into two.
• 33:40
  And I I think that's the conflation of the medical model with the mental health model that in medicine in a lot of ways, and you can correct me if I'm wrong, I don't know too much about it.
• 33:48
  But if you have a broken arm, it's a broken arm, and there's ways in which to fix it, or if you have a disease and there's cures for it, then you apply the medicine so it's cured.
• 33:56
  But mental health is a lot more amorphous.
• 33:59
  The the model doesn't fit.
• 34:01
  It's a very awkward, cumbersome, I think unreliable general model that's used in mental health today.
• 34:08
  It doesn't fit the way in which sort of you know, mainstream medicine would fit with diagnoses and cures and stuff like that.
• 34:14
  So let me ask you a kind of a side long question.
• 34:18
  Um how much of the things that you might be seeing uh and or you know, are not say the egregious cases of manic depressive or uh psychosis, one type or another, um, whether delirium, um, um schizophrenia, that kind of stuff.
• 34:35
  So let's say the kind of the mildly anxious to more severely anxious OCD, that kind of stuff.
• 34:41
  How much of these things are say a spiritual crisis?
• 34:44
  Um how many people, you know, so I'll just put a straw man argument up for a second.
• 34:48
  You know, the Amish, the Amish, the orthodox, um, whatever religion, you know, Orthodox Jews Orthodox uh who are say practicing, you know, Christians went up, um, whichever type, Roman Catholic Orthodox itself and title.
• 35:02
  Um, you know, they they Mormons uh they tend to uh you know have fewer uh psychological problems.
• 35:09
  Obviously, you know, there's less drug use.
• 35:11
  Um, there's less self-medication, there's less self-harm.
• 35:15
  So if you look at the you know, standard um gene uh genetics of the Mormons, say in the you know, Midwest and far west and whatnot, they don't differ that much from the other people around.
• 35:25
  But the the the drug use, the suicide rate, uh, all those kind of um indices are much lower uh amongst the people going to church.
• 35:34
  Um and you know, there's the there's times in my life when um I've sought out um you know uh a psychologist uh for family issues and whatnot.
• 35:44
  We've had some tensions uh with the kids and this and that here and there.
• 35:47
  Um and and at other times um I've I've talked with somebody uh religious, and it's like you know, I I don't, you know, I I've got my quirks and whatnot.
• 35:56
  I don't think I'm a psychologically um diagnosable per se any more than the next guy.
• 36:01
  Um but how much do you think is that we can find the psychology field could find something, I'm sure.
• 36:09
  That's their job.
• 36:12
  Yeah.
• 36:14
  The guy from the KGB, Lavrente Beria, Stalin's man, you know, he said, uh show me the man, I'll find you the crime.
• 36:20
  Yeah, so so you know, there's probably a little bit of that, you know, if there's business attached to it.
• 36:25
  Um, but but to get to the point, you know, how much are we having say a spiritual crisis uh where people don't have say the cohesion, they don't have the community, they don't have uh the cohort, they don't have the family, um, the collective or whatever that you know kept people kind of aloft.
• 36:42
  I don't think people really like to think that much.
• 36:44
  I think people are happiest.
• 36:46
  Um, you know, they go to a rock and roll concert, there's a thousand people there, we're all kind of swaying to the music and jumping up and down at the same time.
• 36:53
  That's very happy.
• 36:54
  You know, people do a lot of things that um, you know, if they're in a group situation, they can kind of subsume um themselves into the crowd.
• 37:02
  Um, and and and a lot of the other conversely, a lot of what people have for psychological issues seems to be from loneliness, which is his own, you know, kind of slow poison.
• 37:12
  Uh, anyway, there's a lot there to unpack.
• 37:14
  I don't know if you want to touch any of that.
• 37:16
  Uh yeah, I mean, so this is like a um it's it's not that question about the failure of community or the destruction of community has been a question that I don't think has been specific to the mental health field philosophers, sociologists have been taking this question up for a really long time as the sort of um I'm not really prepared to give an answer to that, but just talking off the top of my head, you know, as as um technology is increased as um people were able to move away more as um quality of life increased increased a lot of ways, people became more and more isolated, more and more um willing to rely on the creaturely comforts that are provided to each individual as opposed to relying on communities to perform you know some sense of security and safety.
• 38:08
  You know, people could get their own apartment and they can get their own stuff and they could feel a sense of creaturely comfort in that.
• 38:13
  And I think that there is a spiritual, you know, um you know, offset to that sort of behavior.
• 38:20
  And a lot of people talk about it, that sense of self-alienation and community alienation as it were uh as a um as a variable that impacts mental health.
• 38:27
  And I think for sure that's true.
• 38:29
  I think a way to address it with people you're working with is just simply to ask, which is you know, are you know, in in light of how difficult it is to form community today, are there ways in which you're doing it?
• 38:41
  That worked for you.
• 38:43
  Um some people take it up religiously.
• 38:45
  I'm a little bit um you know, hesitant to start talking about the word spiritual just because of all the various meanings that it has today and the way in which people use it, but maybe as a moral question or as a question of just feeling connected to a larger community.
• 39:01
  I think those are important questions to ask people when they come in.
• 39:04
  Um again, how they solve them for themselves is really up to them, but it it should be something that I think is addressed within uh you know the the course of the conversation.
• 39:14
  So with that, we'll take our second break and come back for our third segment with Dr.
• 39:19
  Eric Green discussing the mental health industrial complex.
• 39:24
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• 41:14
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• 41:17
  America Outloud dot news.
• 41:19
  Liberty and justice for all.
• 41:34
  If you'd like to catch up a little bit on my discussion of mental health parity, you can find my article in Brownstone.org, The Hidden Cost of Mental Health Parity.
• 41:43
  And that piece was adapted from my substack called Parity, uh Mental Health Empire of Good Intentions, uh Compassionate Mandates Overburden the System.
• 41:52
  And my Substack is Randoctor.
• 41:58
  And I also have a new piece on the Daily Skeptic, which I think you should read and discuss called The Truth About Autism and Vaccines doesn't suit either side.
• 42:08
  But that's another day, another discussion.
• 42:10
  And I'd like to welcome back for our third segment, Dr.
• 42:13
  Eric Green.
• 42:15
  So Dr.
• 42:16
  Green.
• 42:17
  So on a personal basis, you know, how did how did you arrive at this as opposed to being say uh gas station attendant or uh HVAC with Pyraman or um I don't know, windows and doors, uh, you know, uh CPA, um, lawyer, you tell me.
• 42:35
  I don't know.
• 42:36
  I don't know the answer to that question totally.
• 42:38
  I mean, I had that there were certain people that had enormous impacts in my life that sort of changed the direction um of where I was going.
• 42:47
  Um had a high school history teacher who uh was a PhD philosopher um who changed the course of my life.
• 42:57
  I had various um professors in graduate school that sort of changed the course of my life.
• 43:03
  I I for whatever the reason was, I was just curious about things.
• 43:07
  I wanted to learn about stuff.
• 43:08
  I wanted to understand human nature.
• 43:10
  Um I had certain sort of traumas myself that I wanted to work out and and figure out and understand.
• 43:15
  And I I think that the what are now called the depth psychologists of Freud and Young and their sort of students and cohort and so on and so forth, were the folks who are taking up those sorts of questions, and those are distinct categories of questions than the experimental psychologists and the CBT people are asking, which is how do we operationalize people and turn them into uh, or should I say, how do we understand them through a pathological lens so that we can come up with a diagnosis and then treat the diagnosis?
• 43:43
  And for me, there's a loss of humanity there.
• 43:45
  You're no longer talking to a person, now you're talking to a diagnosis.
• 43:48
  Um, and so I was I I don't know.
• 43:51
  I don't know answer that question.
• 43:53
  I just was curious, and sort of my fate, I guess.
• 43:57
  So you mentioned you have kids.
• 43:58
  Would you recommend this for kids for your kids?
• 44:02
  Recommend which.
• 44:03
  I don't know, your field of work.
• 44:06
  No, uh, I don't uh I wouldn't push it on them.
• 44:12
  Um, you know, I think everyone has their own sort of path, so to speak, whatever that may mean.
• 44:16
  And it's my job to sort of help them figure out what's sort of best suited to them.
• 44:20
  Um, you know, I had a series of conditions growing up that I'm sure contributed to me sort of asking more outside questions and stuff like that.
• 44:28
  And you know, if they want to take it up on their own and they feel like that's a path they want to go and it uh it comes from their own desire, then sure I can help them with it, but I wouldn't impose it on them, no.
• 44:38
  That's funny.
• 44:39
  So speaking, getting back to kind of um the mental health industrial complex.
• 44:46
  Um is there one?
• 44:49
  And and how do we go about fixing that?
• 44:51
  I mean, you know, uh I you know, we take it for granted that certain things are there once they're there.
• 44:57
  Uh it's very hard to peel away benefits once people have them.
• 45:00
  I'm not sure that people in the aggregate.
• 45:04
  I'm sure individuals can can make their own cases, but in the aggregate, whether we as a society are better off now that we have so-called mental health parity, and a lot of things that might have been shrugged off or you know, I'm sure, you know, a lot of brush this off, get up and get back in the play kind of stuff.
• 45:22
  You know, we have more of say of a victim um cachet.
• 45:26
  So people can get literal benefits, you know, SSDI and so forth for certain diagnoses you get carry certain type of diagnosis you can get a thousand dollars a month, uh disability as a as a as a minor and more uh as a as an adult.
• 45:41
  Um and so you know, one of my suspicions is part of the autism diagnosis growth has been fueled by um the application of that title for people who are saying marginally this or that.
• 45:55
  Um, but you know, there's that guy, Garrett Marsh from Saturday Night Live probably precedes you, but you know, his baseball player and these like baseball has been very bad to me.
• 46:04
  You know, has this mental health parody um been good to the psychological andor psychiatric uh industries and indices and created you know something that is really awesome for them, but not so much for uh the substrate, the people themselves who may or may not be better off, you know, getting seen chronically for things that you know maybe they should have just brushed off and moved beyond.
• 46:29
  Like how much you know the additional um you know uses there to being told you have ADHD or OCD or anxiety, whatever, as opposed to, you know, say you know, 50 years ago or whatever the number you want, or some different country currently like China today, uh, does not have the same kind of reward system for diagnosis.
• 46:47
  They have fewer of them, you know.
• 46:48
  They they probably have similar number of vaccines, maybe not quite as many as we do.
• 46:52
  Uh, I don't think it's really vaccines either, but you know, they have like one-third the autism rate that we do.
• 46:58
  And people are not, you know, they don't talk about that kind of stuff.
• 47:00
  They want to kind of move beyond it.
• 47:02
  Um, so you know, there's a probably probably a question there too.
• 47:06
  Um, but I guess the basic question would be are we better off now that we have all these mental health conduits and treatment plans and whatnot, and kind of conversely would be better off with less.
• 47:20
  Yeah, I mean, those are big, these are really big questions.
• 47:23
  Um I'm not exactly sure the entry point to try to answer, so I'll just start talking.
• 47:28
  Um first I actually actually want to go back to something you said about uh the example you gave about the kid who was put on you know, uh, antipsychotics and sort of came out of a zombie or you know, had the uh what was it called?
• 47:42
  The Thorazine shuffle or whatever.
• 47:44
  Um, the the the sort of darker side of the argument is you know, psychiatry and to a large extent mental health in general turns people into docile bodies.
• 47:55
  So this is a term from Foucault.
• 47:57
  Um, you know, friends phenomenon's own way is making sort of the same observation that psychiatry and mental health are basically being used as an arm of the state to keep people sort of dumbed down and sort of stupid or inward looking and you know, to stop um you know, causing uproar and and anger and and sort of social unrest.
• 48:20
  It's it's a sort of a way of uh controlling a population.
• 48:23
  And you know, there's there's a lot of texts out there sort of going over that topic.
• 48:27
  Jonathan Metzel wrote a book called Protest Psychosis, which talks about the way in which you know there is a change in the diagnostic criteria for schizophrenia during the civil rights movement, went from sort of like this inward-looking, docile negative symptoms of schizophrenia to the more positive ones of like outrage and so on and so forth, as it means to sort of control the black outrage in the 60s.
• 48:48
  So that's an example.
• 48:49
  But today, sort of this broader question, an entry point.
• 48:54
  Autism, I mean, autism is such a sort of strange, you know, again, sort of category of diagnosis, because you know, if you if you were to read the history, if you were to read the the various iterations of the DSM, you'd see how the diag the criteria for the diagnosis changes pretty radically.
• 49:15
  I mean, uh back in the day it was originally a psychotic disorder, which I sort of conceive of it that way too, not in the sense of like a madman screaming on the street, but someone who is really just self-contained with within their own imagination has a hard time sort of stepping out that into some sort of basic reality, um, or at least agreed upon reality.
• 49:32
  Um, but then it it became a pervasive developmental disorder sort of lumped in with that, sort of a bunch of other sort of organic brain development problems that occurred for children over time.
• 49:42
  And then it became a communication disorder.
• 49:44
  So people looked at it of the way in which, you know, how folks with autism talk.
• 49:48
  And now it's it's you know, in the from the DSM3 to the DSM4, it was a couple pages.
• 49:52
  Now it's, you know, pages and pages and pages of explanation of what it is and so on and so forth.
• 49:58
  And so it raises, you know, everybody.
• 50:00
  Is looking for and trying to find a reason uh to explain their set of problems with those diagnoses.
• 50:07
  So they look to ADHD for their kids and they look to autism uh for their kids in particular to help explain the way in which a kid is struggling.
• 50:18
  And I specialize in working with families with you know challenge so-called challenging kids.
• 50:22
  And that's normally the case.
• 50:23
  They want a diagnosis to help explain, you know, uh why so and so is having problems.
• 50:29
  And and the truth is, even if you give them the diagnosis, which may bring some kind of relief.
• 50:34
  Finally, we found the reason that little Timmy is having trouble with blah, blah, blah, blah.
• 50:38
  The course of treatment after is kind of fucked up.
• 50:40
  They put them on a ton of meds, or they go to all these various treatment people, and the the mantra that's told back to them is like, well, we can't cure this, but it's just management over time.
• 50:50
  They have you have to learn to live with it, and you have to learn to blah blah blah.
• 50:53
  And before you know it, there's no guarantee that three, five, ten years down the line that there's been a lot of change for little Timmy.
• 50:59
  Now, in some cases, it really is.
• 51:01
  I've seen um kids that have come into my office, and I'm I look at the found man and I go, there's probably a developmental issue here that needs to be addressed by a psychiatrist or somebody in the medical community.
• 51:12
  This is not purely a psychological problem.
• 51:14
  And it's very clear that that's true.
• 51:15
  But for the the large part of the population, folks are clamoring to explain why their kids aren't normal.
• 51:25
  And the truth is kids are usually fine, it's usually the parents.
• 51:29
  It's either their anxiety that's pouring out onto the kids or their own desire that's being pushed onto the kids, or you know, a desperation to explain why your kid isn't the you know the best or the most normal or whatever.
• 51:42
  Yeah, so there's there's a lot of just sort of like collective undoing.
• 51:45
  You know, it's it's a hard thing to pin down.
• 51:48
  You know, it's like the the model.
• 51:50
  I just turn to the model and the way in which the model issues issues explanations as the problem because people are coming in saying the right things.
• 51:59
  They're going, look, you know, my kid is doing X, Y, and Z, only likes three kinds of food, and he only has two friends, and you know, he's he does this thing where he flaps his hands, he must be autistic.
• 52:09
  And I go, Well, little Timmy's three, and maybe give him some time, or little Timmy's eight, and maybe he's maybe shy as a word, whatever it is.
• 52:18
  Um, but the model is leading people to believe that these things are in fact true when they're just sort of interpretations of one possibility of uh among others.
• 52:26
  Yeah, no, I agree.
• 52:27
  You know, there's um uh the joke in medicine.
• 52:31
  If you I mean, this before there was Tamil flu, I think, which actually works, but the the long ago joke in medicine was if you treat the flu, it takes a week.
• 52:39
  If you leave it alone, it takes seven days.
• 52:41
  Um, so uh there's kind of the aspect I I gave you one quick anecdote.
• 52:48
  Um, my older son, they wanted you know, he's kind of like when young he he had you know some issues or whatever, but he was also in an open classroom.
• 53:00
  It was Montessori, so they had kids from different ages in the same class.
• 53:04
  And at one point, uh, it's not quite the ADD thing, but um teacher came up to me, and we're cash paying customers, obviously.
• 53:10
  It's Montessori.
• 53:11
  So they always think think there's gonna be more.
• 53:13
  And she's like, Oh, uh my name is Renee, I'm a speech therapist, and I would like to have your son start speech therapy.
• 53:20
  I'm like, um, why is that?
• 53:23
  And um, and the answer was, oh, because he uh, you know, he says uh uh he says lello instead of yellow.
• 53:34
  And I'm like, um, well, you know, I think his uh major speech problem is that he's he's too tall.
• 53:41
  And she looked looks at me like I'm I'm crazy and probably the way the same way you are, and she's like, Well, no, she explains the whole thing again to me, you know, that he needs this, so yeah.
• 53:52
  Well, I think his problem is his major speech problem is his height.
• 53:55
  And again, she's looking at me like I'm an idiot.
• 53:57
  She's like, Well, I'm I'm sorry, what?
• 53:59
  So, well, let me ask you a question.
• 54:00
  How old do you think he is?
• 54:02
  She's like, six.
• 54:03
  And so, well, he's just about to turn four.
• 54:06
  She's like, Oh my god, he's so tall.
• 54:08
  Like anyway, my my work here is done.
• 54:12
  You know, she was putting him in this context of a different age group, and she had expectations and whatnot.
• 54:16
  And and over time, you know, things work out.
• 54:18
  He's got his own podcast, he speaks fine.
• 54:20
  Uh, he's got big words, and he wants to, and little ones, you use them all fine.
• 54:24
  Not as there's no speech issue, never was.
• 54:26
  And similar things happened with uh the ADD kind of thing.
• 54:29
  There were teachers, you know, who wanted him to be on treatment.
• 54:32
  They want him to be on medication, and a lot of times that's to solve their own need.
• 54:36
  And uh, you know, I said one anecdote really quickly.
• 54:39
  Uh, the second one, um, you know, I didn't want to put him on medication.
• 54:42
  They're like, well, he's not, he's having trouble writing stories and putting things to you know, pen to paper.
• 54:47
  And I mentioned this in another interview, but you know, I had this is before like smartphones and whatnot.
• 54:52
  And so I had dictation back then, so I had a little handheld transcribing thing, um digital, and we walk around the block.
• 55:00
  I'd say, Oh, you know, what about what about that book you just read?
• 55:02
  What about the book report on Harry Potter?
• 55:04
  Whatever.
• 55:05
  It's like, what about what did you like?
• 55:06
  What would you and he would he dictate the whole thing?
• 55:09
  I would transcribe it for him, and I'd give him all his notes, and he would take that and then work it into a story.
• 55:14
  And then after he did that first one, teacher like called me to the class and like, uh, you got to stop writing his reports for him.
• 55:19
  Like, I'm not doing any of them.
• 55:22
  And I told her what we had done.
• 55:23
  She's like, Oh my god.
• 55:24
  Well, his writing got so much better because he wasn't writing anymore.
• 55:27
  He was he was you know talking.
• 55:28
  We were walking around the block with a dog, and he'd talk about stuff, and that was his writing, but they nobody had to like made that connection for kids, and not everyone's supposed to sit.
• 55:36
  We not all we're not really like robots, we can't necessarily do things on command, but over time, you know, things work them their way out.
• 55:43
  If you have some patients for these things, I don't think we necessarily do or have that that much.
• 55:47
  Um sorry for the anecdotes there, but the anecdote is crucial because I think what fits so nicely about that anecdote is the way in which the general public perceives problems, and when there is a disruption or a complication in somebody's presence, it's the other person that's the issue.
• 56:05
  And this power dynamic between teacher and student, the kid's the problem, and the kid needs to be fixed, and the way in which the kid is having a problem is that they talk funny, so they need to go to a speech therapist to get fixed.
• 56:17
  And it, you know, I had the same thing with my daughter.
• 56:19
  She was she wasn't even potty trained yet.
• 56:22
  She was fair enough.
• 56:24
  So kind of rounding out the hour.
• 56:25
  I'd like to give you the floor.
• 56:26
  Um, and spare you from my over talking.
• 56:29
  But uh, any any uh final thoughts about um I don't know things people could take home, lessons they can learn from you.
• 56:37
  Some takeaways.
• 56:39
  Uh I hadn't thought about that.
• 56:41
  Um people need to do their reading, people need to, you know, sort of question the mental illness is mental health and and psychology is not an objective science, just like you know, like objective sciences are.
• 56:56
  It's not, and so they're they're you know, I think it's incumbent upon people and parents and families and schools, even to research the ways in which our current mental health model and our current educational model is not necessarily the way things have to be.
• 57:09
  And they should call those things into question.
• 57:11
  I think that's probably the best takeaway that I could could offer.
• 57:15
  Excellent.
• 57:16
  Well, thank you so much, Dr.
• 57:17
  Green.
• 57:18
  I appreciate it.
• 57:18
  Thank you for having me back on.
• 57:20
  That's all for today.
• 57:22
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• 57:26
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• 57:29
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