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117. The Power of the Placebo Response in Mental Health · Radically Genuine

• Welcome to the Radically Genuine Podcast. I am Dr. Roger McFillin. Wanna wish everybody a happy New Year 2024, especially to our loyal listeners. We wanna thank you so much for your willingness to share our episodes, five-star ratings, even better, writing a review. Feedback is critically important to us. You can go to drmcphillan.com and you can find ways to contribute. Bye. giving us some very important information and feedback on our episodes, even suggesting future topics. And if you're a potential guest out there, it's another way for you to contact us. Sean, happy new year to you. Happy new year, brother. Welcome back. Now there's a topic that I've been willing to address in greater detail because I recently posted a sub stack on this. It's called the power of placebo response in mental health. I also put out a tweet on X, a post on X, kind of reflecting what informed consent should look like for an antidepressant. And you see there's a lot of misconceptions about the placebo response. I know that some people are interpreting it as almost like it's all in your head and your experience is not valid. I think we should probably talk a little bit more about what the placebo response in mental health actually entails. But more importantly, how can we harness some of the powers of the placebo response, not just to improve our health and wellbeing, but also potentially to improve aspects of our society, not to mention our general healthcare system. So it is a bit of a controversial subject because the way it's communicated in the United States is it's a comparison. for a drug that we're trying to determine if the drug is effective. And so it's almost like some ways communicating that placebo in itself has no mechanism of action, no quality. So your comparison is to an inert substance. But I actually think that's probably a poor way to conduct trials. I think it's important to have trials, but I think ultimately don't we want to compare treatments to already existing treatments? Yeah. Like for me, if I was going to test a antidepressant drug, right? If I was going to market it as antidepressant, I would have a placebo group, but I'd also have like an exercise lifestyle group. I might have a traditional psychotherapy, talk therapy group. Might even have other things like community support and religious services or something to that nature. So I would want to have it to comparison to other things that make life kind of fulfilling. but I get these negative responses sometimes. Can you read your post on X? Yeah, I will. Let me just go to it. This is more about informed consent. So the date that I posted this was on the 27th of December. So you can go back to this post. And I stated if informed consent for just one SSRI, which is what our antidepressants are generally, is an SSRI. If it was accurately provided to an adult, this is what would be included. So if your doctor actually sat down with you and spoke to you about risks and benefits of this particular drug, this would be included. Instead, what usually happens is you enter a medical center in the United States and you blindly sign a document without reading it or anyone explaining it to you. before you're even examined, so before anyone even knows what you're there for, and you actually attest that you understand it and agree with it. In fact, in a lot of ways, you're relinquishing your rights, and this is their legal version of informed consent. But informed consent should include risks, benefits, and alternatives, while at the same time respecting your medical freedom. So if I was king of the world and everyone had to do the right thing, This is the things that I would have included as part of informed consent for an antidepressant. Number one, this drug has not been adequately evaluated long-term, most studies are six to eight weeks. That's important. That's a scientific fact. Since most people are on the drug for more than eight weeks, they have to know that they are being experimented on. We don't have any scientific evidence to suggest it's safe or effective, even though most doctors are. recommending it to be on it for a year. Number two, depression is a construct, not a disease. And thus there is nothing biological the drug is correcting. Now people can get into nuanced discussion about what is a disease, the body at disease. But what I'm saying is there is nothing that is identifiable or measurable to correct depression instead of an umbrella term, kind of a larger construct. with multiple factors that would contribute to it. In fact, the psyche, traditionally, includes the spirit, right? Separate from the mind. Your condition will likely improve with six months without any treatment. The majority of depressive episodes do not last longer than six months. Without treatment, it's something like 54% in some trials. I mean, that's no treatment at all, doing nothing, resolves itself in six months. People should know that. So let's work our way backwards here. Excuse me. So if I went to a doctor and the doctor said that I'm expected to be on this drug for a year, I would say, well, why wouldn't it resolve itself prior to six months? It's a good question, right? Yeah, that's an important decision to make. Do I wanna be on something for a year or do I want to, is the severity so low that I can just, for the most part, wait this out? Yeah, so people, if you value medical freedom, they should be provided that opportunity. You can come and continue to see me watchful waiting, right? Or you can choose some other support psychological interventions that exist without doing an invasive pharmaceutical. So it's just important that they know that, hey, still the majority, not everybody, but even when we do these studies, more than half are gonna completely resolve this within a six month period. There is no clinically relevant advantage. This drug will provide above a placebo pill. And this is what I was getting a little bit of resistance on. So what do I mean by clinically relevant advantage? That doesn't mean the placebo has no effect. And it doesn't mean the drug in itself would have no effect. There is an effect. It's just the drug itself doesn't have a clinically relevant advantage over the placebo. So what that means is there is a portion of people in the 30 to 50% range have a clinically relevant response to an inert substance, a dummy pill. Physiological response. Well, I mean, it's included physiologically, right? So when we talk about these outcome measures in depression trials, they're talking about agitation, they're talking about mood, they're talking about sleep. They're talking about aspects that are felt in the body. So yes, fatigue. So what I'm saying is that if you were not told whether you received the placebo or the drug and you believed you received an antidepressant drug. People get better. And the addition of the drug itself is not large enough to say that it has a clinically relevant response above that placebo. Okay, so that's important. Informed consent, you should be provided that information. Basically what we're suggesting is if we give you this pill and you really feel better, we can't distinguish it from the belief that you expect to feel better. Can I, I haven't read your post on X, but just trying to speculate on some of the responses or the thoughts about what placebo may be interpreted as, is that they were, nothing was wrong in the first place, you were making it all up and I gave you a sugar pill and you claim that it made you better, therefore nothing was wrong with you in the first place. Is that what people think placebo is? I'm afraid some people may interpret it that, and they may interpret that the drug has no other additional qualities. It's a psychoactive substance. So you take the drug in itself, you generally feel something. I mean, and that's the challenge with doing these drug trials is blind is broken. It's because the doctors and the patients themselves know they were given the substance. Okay, they were given the pharmaceutical. So. If anyone has any additional experience outside of the placebo response, it usually is a form of emotional numbing or blunting. Number six, taking this pill will at least double the risk of becoming suicidal. That's in comparison to placebo, right? That's people who were not suicidal previously, because they tend to take them out of the drug trials, the suicidal people, becomes suicidal from taking the drug. So we know the drug itself. more than doubles the risk. That's important to note. That's adult trials. That's just adult. We think it's actually probably higher in clinical reality for people under the age of 25. It is significant. In fact, there's a black box warning. When the government puts that black box warning on there, it's pretty serious because really, they don't wanna do that. They have their own interests. Number seven, there's a risk to permanent sexual dysfunction. Fact. Number eight, your depression can worsen substantially amongst a number of other adverse reactions. Please see this list, so you just hand somebody the list because there's a lot of them. That's informed consent, you need to know that. Number nine, how you experience depression is unique to your experience and cannot be compared to anyone else. There are a multitude of physical, emotional, historical, spiritual, cultural, and behavioral factors that contribute to your experience. In order to fully understand those and provide you the help you need, it would require time with a professional. Therapies that provide that support and time will be more beneficial in the long run and have less risks. I'm putting this into informed consent because this is what our science informs us. This is not my opinion. This is what our science informs us. There are not many people who would go out there and say, you know, spending therapy, although problems exist with that as well. And I've been talking about that, but the risks are less. And if there's going to be a majority of people who are just going to get better in six months anyway with nothing, obviously we're preventing harm. They should be aware of alternatives. Those were, oh, and number 10. Any response that could be perceived as helpful in the short term likely includes emotional numbing. This should not be confused with an antidepressant effect as other emotions are blunted and presents with the potential for negative consequences as well. So it sometimes gets communicated by these doctors that emotional blunting is somehow beneficial or experienced positively. A lot of people don't experience that positively. You know, to be completely detached or numb from your emotions has consequences. It has consequences within your family, with relationships, with your work, and can influence decision-making. Yeah. I remember Dr. Joseph Witt-During was in here and he and his wife would often do their own study. You know, they would take one of the drugs cause they wanted to see what the feeling was like, how it affected them. And, and he had mentioned his, I don't know, I can't recall what drug he was on, but he was definitely emotionally detached, removed and just didn't care. Yeah. And I hated it. Yeah. His wife said I hated you on it. I just don't see that as antidepressant. I see it as emotional blunting. Yeah, you're like a zombie. Yeah. But I don't communicate it as antidepressant. Peter Bregan, who's a physician. He published the antidepressant Factbook in 2001. And he wrote, quote unquote, when it came time to approve Prozac, the combined efforts of the drug company and the FDA could not come up. with even one good study that unequivocally supported the value of Prozac in comparison to placebo. Which means they then had to break their own rules. The FDA decided to break their own rules. It gave approval to Prozac based on its marginal effectiveness when in combination with other drugs. Most people don't know that, including doctors. Because Prozac induced agitation, anxiety, and insomnia. these tranquilizing drugs to reduce those symptoms with patients. Prozac was in reality approved as a combination drug. Prozac plus sedative. Addictive tranquilizers such as Valium and Dolmine were used, but medical professionals and the public were never told. So the question is, if people on the placebo do get better, then what is happening there? See, I kind of talk about that as the dirty little secret that exists in this field. Sometimes those conversations I have privately with physicians who in some way, in their own mind, can justify the use of antidepressants because of that placebo response, because they've been told so many times that the harms are minimal. My concern here is the problem with anecdotal evidence. So we do have a responsibility, an ethical one, to communicate accurately with people. So doctors are pretty infamous for saying, it's got to work because I observe it in my clinical practice. My patients report getting better. So let's run through some quick calculations. 2020 census, there was approximately 260 million adults in just the United States. 260 million. Data published by the CDC from 2015 to 2018 indicated that over 13% of adults used an antidepressant drug in 30 days, the past 30 days. So obviously it's very reasonable to assume that current figure is likely much higher. with estimates closer or exceeding 20%. But let's take the conservative approach. If we're just using that number of 13% of 260 million, that equates to approximately 34 million people who used an antidepressant drug in a 30 day period. So assuming that there was just a modest 30% response rate to a placebo, although it's likely much higher, this implies that at least 10 million people are going to report experiencing an antidepressant effect from a dummy pill. So if you just gave them a dummy pill, they're gonna come back to the doctors and say, thanks doc, I feel better. It's a lot of people. And that's very, very conservative, right? It's actually much higher in reality. So when doctors confidently claim, I believe the antidepressants help some people because I've witnessed it in clinical practice, it really does expose a critical gap. in evidence-based evaluation of mental health interventions. It's not very scientific. Those people are experiencing a known placebo response. They were never told. So every day in the United States, we expose millions of adults to known adverse drug reactions, all in pursuit of a response that we could achieve through other means. Now consider what we're doing to children. where the known placebo response is even higher. Right? Yep. So are we supposed to assume we are in a just medical system with medical freedom and informed consent when we know natural recovery exists within six months, more than half of the people are not gonna experience that episode anyway. That's without any treatment intervention. So Sean, when I make the statement that actually going into the mental health system is likely to worsen your condition, that is not me being outlandish. That is my assessment of the actual data and research that exists in the course of my field over 25, 30, 40 years. I don't enjoy saying it. I would prefer not to have to say it. I'm much more interested in talking solutions. So let's talk about what this means for us. If a placebo is that powerful. What does it actually mean? There's a lot of things we don't understand about the human body and mindset. I think there's a lot of things we just don't understand about our experience. So... The idea we are creators of our own reality. How's this gonna say that question is the idea of mindset. You know, going into something and saying, this is what's gonna make me better, or like nothing's worked for me. I would imagine those two mindsets have an effect on whether or not you're more maybe capable of experiencing the placebo effect. Well, it goes back to, we have the capabilities of healing ourselves. Yes. And what is the power of self limiting beliefs when we have a self limiting belief? What impact then does that have on our entire experience, including at levels of ourselves? Yeah, right. Are ourselves impacted by our own idea of reality of our own consciousness? So, you know, what were we talking about before you came on here, we were talking about you how often you have a cold or get sick. I refuse to accept that I may or may not have a cold at this moment. Well, I'm gonna leave that up to our listeners. That's the reality. Who can hear your voice? That's the reality you want to put out there. You're forcing your reality upon my reality. Well, listen, there are some things where we have to reality test. Cough, fever, stuffy nose, change in voice. No fever, no cough. This is just my normal masculine radio voice. The truth of the matter is, I do acknowledge, there's probably no one that's more genetically closer to me than you. And the mailman. You get, you're always fighting off a cold or something, right? But you have this idea of sickness in your mind, right? Well, if my toddler gets sick, I'm going to get sick. I actively seek out his germs or virus because I know it's only going to make me more resilient. if I continually expose myself to what he's exposed to. But it's not working, right? Well, just give it time. But the question I bring in is not one to kind of talk about your colds. It's the idea of belief, consciousness on immune system and our cells and how our body reacts in response. These are things that modern medicine has not really been able to harness to our advantage. You see these published in major medical journals, like where someone with stage four cancer was told that they were, there was one published study where a gentleman who just had the spreading cancer, I don't know the exact kind, was told by his doctor that this drug is going to eliminate your cancer. This is going to be really helpful to you. And gave him the wrong drug. Gave him. the placebo really had no quality at all and the gentleman has recovered, right? We see this anecdotal evidence all the time where he's believing he's going to heal, no more cancer, and then they tell him that they gave him the placebo and then the cancer returns, right? These are areas of medicine. the mind-body connection, that we can only begin to speculate its power. I'm a personal believer in the more that you create fear, the more you create sickness. And so when you continuously send messages to human beings, a culture, that you're at risk, that you can get this, that you are susceptible, that you are weak, that you need me, my product. to prevent this disease, you are actually claiming into a consciousness, claiming into reality that idea of sickness. And the people who attach to that more strongly are in a sick-based mindset. That's why I call it the sick care system. It's all about thriving financially off of people being ill and managing their symptoms. It is collectively creating a consciousness. Now, none of this might sound crazy to a lot of people, but listen, placebos are effective. They're more effective in pain and mental health than anything. So let's go back to the idea of a placebo working in mental health. Why would it work for a percentage of people in a drug trial? Well, who are the type of people who are generally gonna enter a drug trial anyway? someone who does externalize mental health, to believe that there is something inherently wrong with them. Maybe they are diseased, maybe they have a chemical imbalance. They are more likely to be influenced, at least in the short term, to a pharmaceutical, especially if that pharmaceutical is labeled antidepressant. Right, so you have this disease called depression, and I have a drug that is its antidote. It is anti. I'm a doctor, I have a white coat, you're in a trial. This person believes strongly in the allopathic medical model, in modern medicine, in science, they strongly believe it. If I take this, I'm going to feel better. That expectancy, that belief changes the way they view themselves. powerful. It's the same thing with the concept of suicide. When someone is suicidal, they have a belief about the future. Because human beings have this tremendous capability to tolerate pain and distress in the short term when they believe it is temporary, when it can be resolved, when they can get through it. When somebody believes that they're in tremendous pain and that pain is not going. that there is a life of suffering and they are only going to be a burden to others. That increases hopelessness and that is probably our best predictor of someone who's going to complete suicide. But remember, even that is an idea. That is still an idea that they've created in their minds. That's not to invalidate the suffering and the pain that might exist in the moment, but that suffering, that pain is exacerbated. by the idea that it will be prolonged. In the same manner in which if I told somebody their pain would be gone in seven days, they would immediately start feeling better because the idea has now changed. So how do we utilize this? We have to be aware of the realities of which somebody has created. That can only be done through their story. Yeah. How do you, how do you get that out of? Well, people do for the most part want to be understood as a psychologist who conducts therapy or probably any medical professional if they had the time would attest to the idea that someone wants to be understood. They want to feel connected. They don't wanna feel alone. And they're very aware of how hopeless that they feel. And so if there's ways that we can allow a person to tell their story in a manner in which we can understand it and learn about who they are and be able to understand those beliefs, the ones that are driving a lot of the misery of their existence or the reality. And that's not to deny that bad things happen to people and trauma happens. And there are people who are victims to that. But we would just say that anyone who's experienced trauma cannot live fully anymore and is prone to being depressed and suicidal the rest of their life. That's not the case. We know things like post-traumatic growth. We know people can recover from all that. Like these are important things. So let's identify some practical strategies to leverage the placebo response for enhancing mental health treatments. And this can be done in any setting. The first is you'd have to boost expectations. If another way to talk about the placebo response is expectancy, how can you do that in an ethical way? So how about this? When communicating to clients, what if we emphasize that emotional challenges such as depression and anxiety are temporary and valid reactions to problems that can be faced and And you combine that with expressing your belief in their capacity to overcome these challenges. What we know about the placebo response and belief in that in itself will improve outcomes. And coming from me, this is what I believe because I witnessed it. I'm not making it up to get a better outcome. I've observed it. I witness it, I see it. So you set their expectations for the mindset shift to focus on getting better or feeling better. And it's true. Everything is temporary. Tell me one thing that's not temporary. Everything's temporary. Everything's temporary, including emotional suffering. And we can contribute to, or we can relieve suffering in our life. We do have that power. You might need to be with a professional or someone who understands it, right? Which is part of my problem with the mental health system is you're going to get a lot of brainwashed clinicians who aren't even taught to be able to think this way, philosophically, spiritually, looking to actually, you know, how people do improve. No, they're in the drug model. You have a disease, I'm gonna give you a pill, right? Which brings me to number two, don't communicate depression, anxiety as a disease. That's harmful because when you present depressed mood and anxiety as a disease, it alters how an individual interprets their experience. Framing these conditions as disorders can evoke a mindset that suggests a medical solution is required to fix what is broken. So if you label thoughts and emotions as disorder, symptoms of an illness, people will view themselves as inherently flawed. Would that be the opposite of a placebo effect? Because if a placebo effect is basically a benefit or an improvement, would it then be nocebo? Like, are you framing things in a way that they could actually have a negative effect because of how you've positioned it? I believe so. Leave that up to our listeners too, right? If you tell somebody they're inherently diseased, that they're flawed as a human being, something within them is broken. What do you think the impact is gonna be on them? First of all, there's gonna be a lot of externalization of their struggle or their suffering, a lot of invalidation too. Because imagine, and I see this all the time, those who were victims to like childhood abuse and neglect. and then inevitably struggle as they move into adulthood and they're given these pseudoscientific labels and put on drugs. What an invalidating pseudoscientific harmful intervention. So conversely, if you validate their experience as a normal and expected reaction to adverse events and improve their ability, to cope with and respond to what has happened to them. You're in essence enhancing self-efficacy, which we know is crucial in any mental health treatment. Someone has to learn to believe in their own abilities to respond to what life is going to bring. Now, going back to we are creators of our own reality, this is not in any way to invalidate that someone who grows up in environment where they are abused or neglected or have faced trauma experiences, that's a powerful impact on their life, right? Their understanding of what the world is different from the person who did not experience that. And that's what generates stress and fear becomes a survival mechanism, a part of your growth, part of an effective therapy that is going to help somebody kind of heal and even thrive in life is to be able to create an existence or reality that is not under constant threat to create love in your life, to create relationships, to actually learn from what happened to you, including the development of empathy and caring, and even maybe making life-changing choices in careers or in other aspects of your life that help improve the lives of other people. So, again, the idea of what your world is going to be and is created internally within all of us. So, we know we have to be very careful of communicating this in biomedical terms. It's not accurate. and it can be potentially harmful. But what if instead we decided to prescribe new behaviors? Okay? Tell me more. What does that mean? So in reality, there's a lot of behaviors, I think, that embody antidepressant qualities, okay? We've talked a lot about them. Sun exposure, exercise, gratitude journaling, meditation, prayer. They've demonstrated efficacy in enhancing mood, right? But I'm inclined to believe that the impact of those behaviors would be limited unless the individual truly believes in their potential efficacy. So. In essence, a lot of the effect might be placebo. Right, so if you tell me to do a 20 minute walk every morning in the sun, but I don't believe that's gonna do shit, I'm probably not gonna feel better. If you ask me to do gratitude journal, and I think that's a bunch of bullshit, now life fucking sucks and now you just want me to think better, not gonna work, right? It's not gonna work. That doesn't sound like gratitude. Right? That's the power of beliefs. Right? So these things are important. But if you can get someone to believe that there is value to it, and you just assign or prescribe these new behaviors as having an antidepressant effect, just like you would a pill, then you know you're going to capture a large percentage. of people who are going to get that boost because of that belief. It can really enhance someone's expectations. So before we've done anything, we've just incorporated some science, natural recovery, boosting expectations, changing the way we communicate with what is happening, and prescribing new behaviors. Tell me that in itself for everyone who is asking me to provide solutions. Tell me that in itself isn't a significant improvement in what we're currently doing. Yeah, without any adverse reactions. Exactly. They're actually all health promoting. They're all mindset promoting. And then the last one I said, which would be not actually the last one, this is four out of five that I've actually put in this article, advocate for nutritional interventions. So although I personally believe that nutritional interventions have anti-depressant effects, I think there's science behind it. Cause a lot of people have nutrient deficiencies, but I actually believe Sean, the one reason why I don't get sick and you do is because of two things. Raw milk, kefir and liver. Maybe, or maybe that's just what you think and therefore it's affecting your mindset. I don't really like the taste of liver, but every time I- Oh it does. Every time, my dogs. Yeah that's right. My dogs love liver, but every time I eat liver, I believe I am taking the antidote to illness. And when I drink my raw milk kefir every morning and then I add my raw honey with it's antiviral qualities, I believe I am protecting myself. That is like a shield. So there's two things I do differently than you. And if you really believed in those two things, I wonder if that can make the difference. I believe my cup of coffee in the morning gives me all the energy I need to fight off everything. Okay, you choose to suffer. So if, listen, if we would, I'm talking about things that could be done in our in our own sick care system, right? Our primary care system. If we respond differently and we actually use science instead of pharma propaganda, how about advocating for nutritional interventions? And we could say, hey, we've noticed that there's some, nutrient deficiencies here that exist, including vitamin C and a number of other key nutrients that If you would just eat these foods on a daily basis and cut out this, we think it's going to have a mood boosting effect. Even if it isn't the foods, the belief is going to have a positive impact. Why don't we utilize it? The last one here is actually the quality of the practitioner. Do you know the quality of the practitioner influences whether that person heals, both in medical and psychological research? So characteristics like empathy, friendliness, competence, communicating competence. They favor the formation of a positive expectation. Caring and warm. patient practitioner interactions actually enhance therapeutic value of clinical encounters when patients' positive expectancies are actively encouraged and engaged. So bedside mirror is important for physicians and improved outcomes. I mean, it's just so clear to me. that what we do in the current practice of standard mental health care causes harm with unmistakable and observable outcomes. And we have this wealth of information that is just so misrepresented. Remember when Dr. Brett Deakin was in here and we were talking about clinical studies and there was a study in Pennsylvania and one in Virginia and there was significant outcomes at the one location. Because I think I asked the question, like, how do you, when you're doing a clinical trial on, let's say, cognitive behavioral therapy, how do you factor in the person that you're sitting across from and their degree of effectiveness? And he actually brought up that one study. It may have been the POTS study. No, it was, I think he was referring to the treatment of pediatric OCD. Is that POTS? Yes, that is the POTS study. Okay. Yep. And I think it was comparing Duke and Penn. There was a university level. So yeah, it was the, it was so University of Pennsylvania. And I think, you know, they believed it had something to do with the degree of exposure in which it was provided. Pennsylvania kind of University of Pennsylvania kind of being a hub for exposure based treatments for anxiety disorders. So yeah, I mean, there's a lot of factors that influence it. So like the beliefs of maybe the, the practitioners in the pen in Duke study didn't go didn't push their clients all. But it could be so many other things like I could sit across from somebody and tell if they're confident and they believe in what they're telling me or if they're you know, maybe second guessing every single word that comes out of their mouth like you can you can feel a degree of confidence from the person sitting across from you. If you're a client in a therapy relationship like and you almost have that feeling I would imagine in the first 15 minutes of sitting down with somebody at that first initial evaluation, whether or not that person might be able to help you or not. It's one of the most important factors in the development of a therapeutic alliance. That's also misrepresented for clinicians who aren't very scientific. They think it's all about the relationship dummy, but they don't understand what contributes to the relationship. You're not friends. When you go to see a therapist, a psychologist, you're not... choosing, it's not like choosing a life partner. It's not choosing a friend. You can get that from friendships. It's belief in the competency. Do they have the capabilities to actually help me? Um, and that's important, right? Yeah. And if you're a therapist and you don't believe that you have the skill set or you're, you're still learning or you're still developing, or you haven't been exposed to many clients that must come through, especially early on in your, in your career. There's no doubt it does. Yeah. If you're, if, if you're uncertain, right. Cause you ask clients sometimes to do very challenging and difficult things. Yeah. Is, is Dr. Roger McPhillan more effective today versus Dr. Roger McPhillan in 2013? I sure hope so. Shouldn't we all expect that? Yeah. In fact, you want to be better than who you were last week. Yeah. Right. You actually want to look back at yourself five, 10 years ago and like cringe. If you're experiencing that in life, you're growing. You're evolving. I cringe all the time at myself. Yeah, I do too. Like you and me. Listen, I want to get back to that tweet I sent. Okay. Because when I did talk about there is a clinically relevant advantage this drug will provide above a placebo pill, Dr. Joseph Witt during Who I Respect, and he was on our podcast, he's a psychiatrist, he's doing some great, great work. He responded, he said, I think this is tricky. Having taken an antidepressant, it is very obvious it has a clear drug effect. He's right. And that you're not, we're not denying it by saying that the drug effect doesn't outperform a placebo. So that's what you mean by the blinds are broken in studies because you know when you're on the drug. Yes. So it's somewhat what's called, in other words, an enhanced placebo effect. Once you really know what you're getting, the placebo response is a little bit stronger, which makes any of the difference. But in my, what I'm sharing with people is there's, you can create a statistical difference in a study without it being clinically relevant. He wrote, it was also clear to me that for some people the drug effect might make them feel quote unquote better. for example, blunt, severe, anxious emotions. However, what was also clear to me was that blunting people out long-term is a terrible strategy to help them due to the waning long-term effects, and also you're not actually helping with the root cause. I'll go a step further. I would say blunting of emotions is not only a terrible strategy. Is this him talking or you now? This is me. Okay. I'll go a step further. Blunting of emotions long-term. It's not only a terrible strategy, it's extremely harmful and opposes a lot of what we know about recovery from emotional conditions. Feeling is actually good, right? Now, I understand that when negative emotions are quite intense, it's very hard to perceive it that way. But when we change how we view it and we're assisted in a manner to respond more effectively, including tolerating distress, it becomes temporary. But when you drug somebody, you're basically just creating drug dependence. To me, it's no different than getting hooked on weed, getting hooked on alcohol. Right? That will blunt emotions too. No one's going to argue that that's therapeutic. In fact, people argue that is harmful. So he says that blunting people out longterm is a terrible strategy to help them due to the waning longterm effects. And also you're not actually helping with the root cause. I always found arguments about it being no better than a placebo confusing because in aggregate that is shown in the data, but two, it flies in the face of most people who take these meds and notice there is a clear effect. So he's kind of confusing. blunting with what we talk about as an antidepressant effect or a therapeutic response. I also feel that most people when they hear this, that it's no better than a placebo equated to. There's no drug effect and what they're experiencing is just in their mind, which is not true. Yeah. So I want to be clear on that. No, you take the drug. It's got consequences. Yeah. Right? As Dr. Adam Urato says, chemicals have... consequences. You take any drug, there's an effect. Drugs are chemicals. Chemicals have consequences. Yes. So it is not saying that. What we're saying is that the effect is more due to what they believe it has or will do than actually anything the drug is doing any mechanism of action. Right? That belief is that belief is powerful and it should be utilized in treatment. Okay. So even if even though I believe my liver My beef liver is providing me with a power pack of nutrients and my raw milk kefir is doing amazing things for my gut microbiome, which consequently is then enhancing my immune response, strengthening my immune system, just like going to the gym and lifting weights makes me stronger. I can't tell you for sure that's the case, but my belief in it, my belief in it can and does make that the case. Let's not demonize it. Let's understand more of the powerful qualities that we have. Can you, do you understand all of you out there, how powerful you are, what you can choose to create? I love the idea of viewing life as a creation. Right now we're creating. Sean, you and I, the radically genuine podcast, we created it from nothing. It did not exist. Zero. to the top 1% in global downloads. To me, that is one of the reasons why we live. Now, we all can say, we create, we create human beings. Think about the power of that. We have, we create lives. Well, women do. We just have like 10 seconds of a role in that. What does that mean? Poor wife. We raise them. We help raise them. So no, the creation of that, right? But we also create things in our. in our minds. So the idea of radically genuine had to first start, had to be created. An episode had to be created. The preparation. Everything is created initially in our own minds and then it is manifested into this physical reality. So that's why I believe at some point human beings will choose to no longer create war. They will not collectively as a solution. So once you choose to collectively not accept something, it cannot be manifested as real. Did you get it? Say it again. War is collectively accepted. and it is created. The idea of war, the idea of separation, the idea of justification of killing another human being is collectively communicated, articulated, generated into the physical reality. Imagine a day where humanity advances itself, goes beyond the illusion of separation, and no longer collectively creates that. Same thing with sickness. And that's why when I don't think people really understand when I sign off on some of my tweets with resist, what I mean. What do you mean? So let's take informed consent, okay? We all go into the hospital or our primary care doctor, not me, because I don't go there. Might have to at some point in my life, I assume I will. But maybe I won't have to. But we go in there for any type of intervention, right, for yourself or for your kid. And you do have to sign an informed consent sheet without reading it. Doesn't have to be verbalized? I don't know. I mean, they legally get away with it, right? So what for me legally and ethically should be provided is different than what exists, right? So let's imagine we all just said no. That's not what informed consent is not signing a paper. So I can't sue you. No, signing a paper quickly, that's 15 pages and I can't read right now. That is not informed consent. So we resist. Same thing with handing over the PHQ-9, right? If the only reason the PHQ-9 exists is because people are willing to take it. If people weren't willing to take it, then it doesn't exist. You hear me? Yeah. Mass COVID vaccinations without it being tested on a human population, without a randomized control trial, and then people losing their jobs if they exercise medical freedom. Based on nothing, nothing scientifically, only experts, quote unquote experts, generally bought and paid and influenced, communicating to a general public, creating it into reality. What if we resist? There's more of us than you. There's more of us than you. We don't have to do things that don't make sense. We don't. True. The only way they become part of our collective reality, creation, is we just blindly accept it. What if we all chose not to accept? They're forced to have to change. That's why it is up to us. Not the top 1% of the 1%, we know what they're going to do. They benefit off your illness. They benefit off of controlling you. They benefit off your idea and our idea of illness and sickness. There's a reason why We're only one of the remaining countries that has fluoride in the water. They're not dumb, they know, right? So that's what I mean by resist. And it doesn't mean obviously being violent, it's like a non-violent, I just choose not to think that way, I choose not to live that way, I choose not to follow your rules for rules sake. Our problem is the rule followers. The rule followers are the problem. If you give control over to the authority, and you, become submissive, well, I'm not going to blame the authority. They're going to do what they're going to do for their own self-interest. It's up to us. That's hopefully part of the mission in the new year here is a spread of information, but also supporting our individual rights, supporting everybody's power, their ability to be able to resist bullshit. And that's the only way change can be made. Don't do things because you're told. Don't do things because you value it. That is freedom. And I'm gonna close it on this because it doesn't mean you have to agree with me in everything. As Sean said earlier, that doesn't mean everyone who disagrees with you, Roger, is because they're brainwashed and you're not. I agree with Sean. We weren't recording when I said that. That's right. Instead, What we should do is respect medical freedom. And that's really, really important. that I can agree with. People need to make their own decisions, not just take somebody else's dissenting viewpoint as an order. It's about having critical thought, looking at things yourselves. Informed consent is actually weighing the positives or negatives of any situation, not just about SSRIs. It's about every intervention that exists. If this is what I believe, if you choose a medical intervention, because you understand the risks, and believe that any potential benefit is worth that risk, then I support your right to make the choice. That's what medical freedom is. But if you're never informed of the risk, those risks are minimized or even denied, you're gaslit, and any potential benefit is inflated or highly exaggerated, that's criminal behavior, that's a criminal action. Resist it, but when doctors do it in mass, because that's how they're trained. The doctors are the criminals. Although we can't do anything about it, obviously, because they're not even gonna see you unless you sign that stupid thing. We all have to mass resist. You have to mass resist taking the PHQ-9. Don't let your kid take it, right? That's an easy one. That's a small step. If you have your annual checkup and there's nothing wrong with your kid and there's nothing wrong with you, and you get that email that says, fill out all these forms prior to going to the doctor's office, you can just choose not to take the PHQ-9 and they go, oh, you haven't filled out your PHQ-9. And then you go, I'm not depressed. Yeah, I had a client, I'll protect this client's privacy, but... saw a psychiatrist to get off all the drugs that were making her feel horrible, right? And to the doctor's credit, he's willing to do all of that and taper that person off probably faster than what I want, but you know, the person's informed. But he had to make his final sales pitch, right? To who? The client. Okay. For drugs. Oh. This one. Even after the decision was, I wanna get off these drugs? This one was for medical cannabis. wanted to sell this client weed. Why? Because that's what they do. They only know how to give you a drug. Is this a psychiatrist or a physician? Psychiatrists are physicians. I know, but I'm just trying to- Instead of primary care? Primary care. Yeah, no, this is a psychiatrist and in the practice they also sell weed. Like 20 years ago that would sound ridiculous. Wait, your doctor's trying to sell you weed? Hold on. But for a condition that obviously not going to benefit from it, just trying to get this person on a drug. Don't lose that customer. It's insane, I think, that we've just collectively claimed all this into our realities and we accept it as truth. Anyway, so power. Placebo effect is not merely a benchmark for comparison in clinical trials. This is a tool. that we could harness to aid patients in their natural healing or recovery, or that we, the individual, can utilize to heal ourselves.