Latest / Radically Genuine / 106. We Need Way Less Psychiatrists w/ Psychiatrist Dr. Josef Witt-Doerring

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106. We Need Way Less Psychiatrists w/ Psychiatrist Dr. Josef Witt-Doerring · Radically Genuine

• Welcome to the Radically Genuine podcast. I am Dr. Roger McFillin. Sean, before we introduce our guest for today, I actually wanna read kind of an open letter he recently posted on social media. Oh, great. Dear psychiatric and family medicine colleagues, it's time to acknowledge we've let good mental health care become completely derailed by industry commercial influence. We all wanted to do good initially, but much like the frog in boiling water, we've slowly come to accept a completely broken system that has over-medicated millions. It's easy to rationalize our role in this broken system. I know because I made the same excuses myself for many years. I've told myself things such as, medications are better than nothing in a system with limited However, over time, I started to believe the evidence in front of my own eyes rather than the one-sided story of psychiatric success that was blasted out in journals and conferences. The truth that you know deep down, but many are afraid to admit, is that medications are not better than nothing. In fact, sometimes the best thing you can do is to honestly tell a patient who's depressed. that there is no drug that is going to help them and that you wish you could do more but can't and that you wish the mental health care system truly supported people, but it has mostly set up to dispense meds rather than help people with the support and resources. They actually need to thrive. The truth is that telling people medications are going to help when you know for damn sure they aren't going to do anything to fix them and Majority of normal life problems like financial stressors or relationship problems that contribute to depression is simply misleading. And at worst, prescribing in these situations is just going to make people dependent on medications and exposing them to side effects. Sean (02:20.246) I don't really have an easy solution to the mess we've gotten ourselves in. And I know many of us remain financially dependent on a system that is simply painful to work in because of the near absence of actually therapeutic or social support resources. But what can I say? If there is an action we can take, well, what I can say is there is an action we can take every day that will slowly start to fix this. Become more comfortable telling patients that we don't have the solutions to their problems, especially when the issues causing the depression clearly won't be fixed by blunting their emotions with antidepressants. I get it, this sometimes might help some people, but most of the time it doesn't. Somewhere along the lines, meaningless diagnostic categories like major depressive disorder somehow convince doctors... that we had all the solutions to solve universal human problems that made up these diagnoses with pills. Come on. We know this is bullshit for the majority of people. This small step is the first in undoing this massive cluster we've gotten ourselves into. Sounds like somebody with ethics and integrity. I thought the same thing. I thought it was fairly diplomatic as well. I mean, it beats some of my. posts which say, hey, listen, put your hands in the air, put them behind your back, back away from the prescription pad, you sociopath, I want you in jail. Right. And so sometimes I say those things to gather attention. And I'm hoping this diplomatic approach by our guests can, you know, allow others to kind of take a step back, honestly, look at what we're doing, and begin to be honest with the public. So I do want to introduce our guests today. Josef Witt-Doerring (03:56.142) Mm-hmm. Sean (04:17.814) His name is Dr. Yosef Witt-During. He's a board certified psychiatrist. You might not have thought he was a psychiatrist potentially, right? By, you know, calling out his own tribe. This with a, with a specialization in identifying and treating psychiatric adverse drug reactions, Dr. Witt-During has had the privilege of helping Josef Witt-Doerring (04:28.934) More like Scientologist, you know? Yeah. Sean (04:42.862) patients with litigation related to psychiatric drug injuries, thanks to his prior experience as a medical officer in the Division of Psychiatry at the FDA. There he analyzed emergent adverse drug reactions and proposed modifications to drug labeling, giving him a unique perspective on the risks and benefits of psychiatric interventions in both the short and long term. In 2020, he co-founded a private practice dedicated to assessing and treating patient suffering from these reactions and has since become a trusted expert. in the field, particularly when it comes to severe withdrawal injuries. He also hosts the life unless meds podcast. Dr. Wood during his worked at numerous pharmaceutical companies and clinical research and drug safety positions, bringing valuable experience from both the regulatory and clinical settings of his practice. He completed a fellowship in psychiatric drug development at Janssen research and development and Drexel college of medicine, not too far from us. as well as his psychiatric residency at Baylor College of Medicine. You're going to notice his accent. His medical degree is from the University of Queensland Medical School in Australia. Dr. Yosef with during welcome to the radically genuine podcast. Josef Witt-Doerring (05:57.538) Thank you so much for having me. I'm excited to be here. Sean (06:01.21) You're going to get yourself kicked out of the club. You keep talking like this. Tell us a bit about your background. I want to know your story, where you're from, why you got into psychiatry. Josef Witt-Doerring (06:06.798) Yeah. That's it. Josef Witt-Doerring (06:18.226) Yeah, yeah, good question. I'll give you kind of like the brief version of it is, me, just like a lot of other people out there, I mean, we have something, some things are harder than others. And honestly, I grew up, I think, struggling to connect with people, you know, in some ways. And so, when I look back at my teenage years, I was really into reading Josef Witt-Doerring (06:47.666) when you notice some things are easier for other people and you struggle with them, I turned to books. And so I came into it in that way and that always sort of yielded dividends. I found that empowering to kind of read those things and eventually end up in medical school. And I thought, what a great way to combine my love for psychology, philosophy, self-help. you know, with medicine, you know, I'll go into psychiatry. This will be great. This will be exciting and interesting. And as shortly after I joined psychiatry residency, I realized that was not what I had signed up for. But in fact, I had, you know, walked into completely unfamiliar territory. And it was just, there was little sort of interest in more, you know, psychotherapeutic interventions and different things like that. It was just drug dispensing. And that really sat... It just felt wrong, you know, for a long time. And I practiced in the system. I probably did it for about two and a half years or something like that throughout my residency, you know, wanting to, you know, be a good team player and wanting to be easy to work with, you know, wanting to do right by my, you know, my mentors and my colleagues and kind of go with the flow. But something in there was always sort of telling me that, you know, what was happening was wrong, you know, that there was something just not that we weren't really helping people. And so eventually I became more outspoken about it and actually ended up in a lot of conflicts with attending psychiatrists and things like that. And I thought about quitting, had to go to professionalism meetings and things like that. And it was around about then that my wife told me to sort of just pull your head in, this is not the right time to be saying these things, like just get it done. And so I did that and I kind of went with the flow. and I survived residency and I did have, and I'm not going to say it was all bad, because I actually had some pretty decent professors who did see that I was struggling and who did see that I was very interested in side effects and things like that. And they gave me outlets to go to conferences and do publications and things like that. And that kind of kept me going. Josef Witt-Doerring (09:06.286) Um, you know, I left my, my training to saying, yeah, there's a lot of problems with psychiatry, but you know, I'm going to, you know, I'm going to go to, you know, I'm going to go to the FDA, you know, I'm going to go and figure out, you know, why we're missing these things, how, how drug side effects are analyzed, how they're communicated to the public. And so I went there and spent some time there. You got paid essentially no money. I think I was getting paid like something like $120,000 a year, which is probably about half as much I could have made. been making in clinical practice. And this was very apparent to me and my family, especially because we had a young kid at the time. And so like many do, I eventually went to the pharmaceutical industry. And I mean, that jump was pretty significant. I know when I signed my sign-on package, and you may find this kind of unbelievable, but my sign-on package with the stocks and everything was getting close to $700,000. And this was someone who was just Sean (10:04.728) Ow. Josef Witt-Doerring (10:06.554) a couple years out, most of it stock, and eventually that kind of crated and the salary was closer to $300,000. But initially it was like, wow, let's talk about one hell of a carrot. And so I was in industry and then I was working in drug safety. And I worked for a cancer company, I also did a little bit of work for a psychedelic company as well. But the whole time this was going on, I had started a practice with my wife. and we were doing deep prescribing. And essentially I just got sick of not being kind of honest with what was going on, a lot of the problems that I was seeing around me. And you can't be honest if you're in the industry, just like anyone who's ever worked in a corporate setting before, it's like, you gotta be a team player. You gotta kind of be easy to work with. Otherwise you're gonna make more work for yourself and things are gonna be different. Things are gonna be difficult for you. And so I eventually just got to the point where I'm just like, I'm sick of not. I guess, speaking my truth and what I'm seeing and I said, I'm done. And then we just went full force with the private practice. This was at the start of the year and, you know, launched the YouTube channel and the podcast and everything, and now we're solely focused on deep prescribing. So that's, I mean, that's kind of my background in a nutshell. Sean (11:21.882) So you, you dealt with the same nightmares that I dealt with. I mean, literally waking up in the middle of night conscious, you know, having a crisis of consciousness and having to make a determination on what kind of steps you have to take in your career, do you accept what you're being told and continue to move forward practicing in a way that is generally communicated as evidence-based or do you step outside of what is the conventional treatment? Josef Witt-Doerring (11:25.326) Mm-hmm. Sean (11:51.498) and start speaking out against some of these harms. And so you've made a decision to follow your ethics and honor and integrity. I'm curious to know what the reaction is from psychiatrists around the country, just like how your colleagues respond to you. Because there's, around the world, it's kind of discussed as an anti-psychiatry movement. And I hate that term, I think that's... Josef Witt-Doerring (12:17.878) Mm-hmm. Sean (12:20.734) absolutely the wrong type of wording that we should do. I think there's a real, there's a place for ethical psychiatry. But what kind of reaction are you getting from colleagues? Josef Witt-Doerring (12:29.87) This will surprise people. Privately, people reach out to me and they say, I'm really loving the stuff that you're posting on Twitter. You know, these are people that I trained with. At least two of them have said that they're really enjoying the social media content. I mean, they're not saying similar things, but yeah, I think people feel it. I mean, most of the flak I cop on Twitter, Sean (12:37.193) Hehehehe Josef Witt-Doerring (12:53.074) is usually from people who have misinterpreted what I'm saying. They're more patient groups. And then there's a couple other academics out there that don't like the way I phrase things. But I actually haven't gone head to head with any psychiatrists. I kind of welcome the content. If someone tries to come at me, I am trying to invite them to talk to me live on an interview, because I think that would just be exciting for... social media. I mean, that's what we're doing. I mean, we're trying to make engaging content that explores psychiatry. And so I'm kind of looking for people to come and pick a fight with me and take issue. I think it would be entertaining for the audience. Sean (13:33.742) which is exactly what I have been looking for. I haven't been able to have anyone take me up on that. Usually what happens is they make their statements on Twitter, I invite them on, and they say it'll never walk into that as if it's going to be something that they're not provided an equal voice. But honestly, what it comes down to, Dr. Yosef, is the data. Josef Witt-Doerring (13:40.706) Mm-hmm. Sean (13:56.942) The actual sound science is on the side of the person who is going to be critical of the psychiatric drug movement and its role in our general culture. The harms are substantial. Now, um, you know, I like to bring you on because I also, you know, think you're reasonable and you've done some great videos that kind of have this middle path approach and you, I think you reasonably provide a cost benefit analysis of psychiatric drugs and their use. Because whenever you speak out about something like this, someone's always gonna go to the opposite end of the dialect and bring up an extreme situation, right? That exists. Someone might be very manic. Someone might be aggressive, a danger to themselves, or others experiencing delusions or other forms of psychosis. And we do have to have a way to at least intervene. medically in situations like that, but that's not what you're speaking out against. What are you speaking out against? Josef Witt-Doerring (15:01.954) Probably the easiest way to come at this is, yeah, I'm not against drugs. I mean, drugs are drugs. You know, there's a use case scenario for all of them, including things like ECT, from my perspective. What I'm speaking out against is how they're used. And so it's about the information that people hear about the drugs and... I guess how safe they are, you know, and how little of a deal they think it is to use some of these medications. That's what I'm really speaking out against. I think there's just complete misinformation about the benefit and risk of these drugs. And we put people who have normal life problems on drugs that cause dependence and side effects and are gateway drugs to other things. I think it's just absolutely horrific. You may have seen another post I put out lately, I don't know, but I was talking about how we used to lobotomize people and we look back at this barbaric time in psychiatry, but I see it happening now. I mean, the damage is far more wide now than it ever was with things we've done in the past. And I mean, that's how big of a deal I think it is in terms of the over prescription and just the lies that we've told people about these drugs. So drugs are okay. There's a use scenario for all of them. It's how we use them. That's the problem. Sean (16:22.554) Family medicine, primary care. I think statistics show over 80% of psychiatric drugs are prescribed in those settings. From your background, especially within the pharmaceutical industry, how have we evolved to a point where physicians who do not have expertise in this area are prescribing the amount of psychiatric drugs that they're currently prescribing? Josef Witt-Doerring (16:24.747) Mm-hmm. Josef Witt-Doerring (16:48.766) Yeah, it's interesting. I mean, we've managed to, you know, and this kind of goes to the open letter that you read at the start where we, it's like we've almost convinced, we've convinced these family medicine doctors that, you know, these are, you know, well understood disorders, things like, you know, diabetes, you know, we're just going to be rebalancing the chemistry and it's just like giving a diabetic some insulin. And And so they go away and they say, oh yeah, this is fine. You know, I'll give them the scale, I'll give them the drug and then we'll keep on tracking them. And that's all I need to do, it's fine. And if anything turns up, it's their underlying condition. And you know, it's not a big deal. I think if we were honest with our family medicine doctors and we really gave them the information about, hey, you know, this is no small feat. I mean, we're messing with someone's brain chemistry, we're inducing emotional blunting. Sure, there can be a therapeutic element to that in some people, but there's also a lot of collateral damage that happens. You can really mess up someone's relationship. You can make them disinhibited. You can make people ignore their children when they're coming to them and they're having problems because they're too blunted to realize. And so I think if you start really giving people the information that they should know about using these drugs safely, I think some of them would probably opt out. They say, you know what? I actually don't have the time to oversee something that's this important and that has this many potential consequences in your life. But yeah, we managed to convince them that they could do this work easily, just with like a scale. And so that's what I think has happened. And there's also been this big campaign where frequently we're telling everyone, depression, mental illness, it's underdiagnosed, under-treated. you know, this is coming from really, really high up, from celebrities, from politicians. And so I also think they feel this almost social pressure that they need to go along with this because of all the messaging that they hear. Sean (18:46.074) What I have a hard time with is trying to understand the mindset of a practicing physician because this seems so obvious to me that you are, you're providing a mind and mood altering drug and sometimes to young people developing brains with pretty severe consequences. How haphazardly they prescribe this drug and minimize the risks. makes no sense to me on how otherwise really smart people could make such errors in judgment. Take me into the mindset of the physician in Western society. Josef Witt-Doerring (19:29.25) So, you know, something that I think happens is a lot of these, you know, this idea that drugs alter your brain chemistry, you know, and that could be therapeutic or it could be negative, I think is the intuitive way that a lot of people think about just drugs in general, alcohol, cannabis, whatever, you know, all of that. That's how people come into it. I think we actually have a training system that makes people dangerous. Because instead of describing the drugs in this way, like it's a therapeutic blunting, and be careful about maybe some of the positive things it's gonna take out in their life. We start telling them that there's these biological things that are happening. The old one is rebalancing brain chemistry, but I see the chemical imbalance sneak in a lot of other areas. You'll often hear about antidepressants, they increase BDNF, brain derived neurotrophic factor, where... we're helping the brain become more plastic. And so that's, we pull people away from a very correct and intuitive way of thinking about drugs and kind of say, yeah, no, and tell them that there's like a brain problem. And so that's, you know, if I go through the mind of a practicing clinician, that's what I think they're thinking sometimes. They're like, oh, maybe this is increasing the BDNF, you know, because I heard this in a conference. and it's really gonna help them overcome some of the things. I think that's one rationalization. But the other one is like the whole incentive structure, which we could talk about. I mean, we're not incentivized to really get people well in this, especially in the US. I mean, it's fee for service. I mean, if we can get, the more people we can treat and the less amount of time, that's how we get paid by insurance companies. And so. Gosh, isn't it a lot easier to just have someone come in, oh, I'm depressed, I'm sad. Option one is, tell me what's going on in your life. What are the problems you're facing? Let me really kind of get into that and understand it. And let's wait and let's kind of bring you in a couple of times a week for the next month so I can be there with you. That's one way of doing it. But the other way is, oh, you've hit threshold on the PHQ-9. Josef Witt-Doerring (21:49.046) we'll just try this medication, it's safe and effective. You just shut the whole thing down right there. And so I think there's, yeah, they've been misinformed, but also I think the incentive structure is set up where it's just, it's kind of easier for people to just treat the depression like that and then feel like they're helping them, but they're really helping themselves because it's just. you can just check off the box. Oh, I've treated their depression and kind of move on. Sean (22:23.114) It's, um, it makes me think of, um, during the, uh, the opioid crisis, they had the, um, the, uh, the, what was the pain was like another vital sign that when doctors, if they ignored pain, they could actually be under a malpractice, um, suit. And it makes me think like that's what's happening right now in primary care settings is they're forcing every doctor to apply this PHQ nine. And if somebody comes up high, you know, that might show that there's some depression that to not. Josef Witt-Doerring (22:23.306) It's Blake. It's really Blake. Josef Witt-Doerring (22:35.182) Mm-hmm. Sean (22:52.378) do an intervention that they're only trained to do, which is to write a prescription, they're concerned that they could potentially have something come down on them if something happens to this, this client of theirs, it's a, it's a problem that I don't know if there's any solution for. Josef Witt-Doerring (23:10.379) Yeah, yeah, I mean it's... I think, you know, when you talk about screening, it's like, you know, we could talk about it, you know, is this really a bad thing that we're screening people for depression in primary care offices? You know, it's starting a conversation. Doesn't that sound reasonable? Wouldn't you want that, you know, you have a conversation with your doctor about depression? And it does sound reasonable, but the place where these screening instruments kind of fit in, it's... I mean, it's almost, it's part of the marketing campaign. And if you kind of walk through all of the steps, it's like, okay, first you have, like, you've got to convince the population that they might have a brain disorder and they might have depression. And so you go and fund NAMI, DBSA, you know, all of these kinds of groups. They go to the politicians and they say, hey, you know, we're really suffering from depression, we need more resources. You know, it's under diagnosed and you just hear it and it just gets hammered and hammered and hammered. And so people hear this in the news and in the media, they hear very favorable sound bites about medications. And so they go, okay, that's what this is. And then one day they're sad, and they go to the doctor and they see the screening instrument and they go, okay, well, I'm going to fill it out. And the final piece of the marketing where it's like, why doesn't this lead to like a good outcome? It's just that the medical literature has just been completely hijacked. by pharma. And so, I mean, everyone who's ever been to a doctor and talked about a mental health problem, they know that person is not walking out of that family medicine appointment with some comprehensive plan, with counseling and social services and things like that. It's just not profitable. Our system's not set up that way. And so, when you've kind of rigged the system where it's just like very kind of transactional healthcare with just the dispensing of drugs, that's when all of these things kind of... Josef Witt-Doerring (25:10.806) really take on like a sinister element because like, is it really bad to fund, you know, NAMI, you know, to talk about the hardship of depression? You know, is it really bad to do screening instruments? But when the end of that funnel is just drugs, you know, and a lie about the cause of mental illness that makes people just want to take them, that's when things really get nasty. Sean (25:32.042) Also, add on to that Sean, to your point is the role of the major medical organizations. I had a conversation with a pediatrician. He's following guidelines from the American Academy of Pediatrics. And the American Academy of Pediatrics are very clearly within their guidelines minimizing the negative effects of an antidepressant for a teen, and they're over-valuating any benefits. If you follow the stream of money, they are They are funded by the pharmaceutical industry, biotech, and other conflicts of interest, which seems like there's a lot of shell groups that are just kind of developed through the pharma industry, where people benefit from their stock, and their nonprofits. And this doctor said to me, and I know I went into the guidelines, I'm probably one of the few people that actually read the background literature to support that guideline, because I I know the literature pretty well. We've certainly had so many people on this podcast, some from the FDA, people who know the, the literature and some of the fraud that took place in the trials. Very, very clearly. They cherry pick studies. And now this doctor, this pediatrician who is dealing with a suicidal or depressed teen in front of him, he said to me, Roger, what am I supposed to do if that teen walks out? of my office and ends up dying by suicide. And I didn't follow these guidelines. I'm going to lose my license. Even if I have concerns about the harms of an anti-depressant drug, my license is at risk if I do not follow that guidelines. Josef Witt-Doerring (27:12.986) Yeah, that's... I think a lot of people feel that pressure that you talk about, you know, when so much of the medical literature is stacked in that way to show the benefits, it's like that. But, you know, the thing especially with populations under age 25 on the antidepressants, it's like, you know, everything is always shown that they increase the rate of suicidal behavior above and beyond. more so than if you just gave them the placebo. And so it's just, I mean, the whole idea of like giving antidepressants to people under age 25 just seems completely absurd to me. I don't even know how, like why we accept that they have a marketing authorization for that. Like they, sure, they lower depression on the Ham D or the Madras scale or these primary, you know, these surrogates. for what depression is, but on the outcome that actually matters, you know, like a suicide attempt, they increase the rate. And I want that just to like kind of sink in, you know, really just like sink in for everyone listening here. You make more people suicidal under the age of 25 by giving them the drug. How does this have an indication from the FDA to use this? And I think it's like mainly an American thing, because I don't think they do this in Europe. I don't think they do it in the UK. I actually... It's like an American thing that you can give these drugs to children with an FDA indication. It's just, it's insane. And I know, I'm going to play devil's advocate. I'm going to jump on the other side and say, you know, Joseph, aren't there some people that you might want to do this cautiously with, you know, if everything else didn't work, just knowing that risk and just saying you're going to monitor it? Sure. But if you're going to do that, I mean, it should be something like, you know, when you take accutane, because it causes birth defects, they make you sign a contract. Like we're talking about a level of risk mitigation that is, it's not just like your doctor can just say, I'm gonna write you a script. They make you go and log on to like a database and like sign a contract that you really understand it. I mean, they seriously would need to be like that level of like awareness for the kid and for the parent. Like the stroke could make you agitated and it could push you into suicide. Like it's, but yeah, I mean, I think they used like. Josef Witt-Doerring (29:37.727) Like one out of 100 people under the age of 25 on these drugs, I think, should be taking them. I think the other 99, I think they've been completely misled. Sean (29:47.802) And that's where my anger is. And for people who see some of the things that I do on social media, why I'm so provocative because I'm at a loss. I've done everything I could have done in my community. I've developed a practice where we have a position statement and we inform families and individuals of the risks. We talk about how important it is to slowly taper off the drugs in a responsible way. We do not have physicians who understand the tapering process. We do not have physicians who understand the risks. I'm often portrayed to some of these families and to our greater region as somebody who is on the fringe and is withholding life-saving drugs from young people, and it's a very challenging situation that we're in because the level of ignorance is so high. And informed consent is a legal and ethical imperative. And I've done the work myself, doc. I, uh, I tried to argue the other side. I tried to convince myself that in a risk benefit analysis, SSRIs can have some value in some situations, even though I haven't personally observed it. Josef Witt-Doerring (31:10.85) Mm-hmm. Sean (31:11.086) that it's made any major difference in anyone's quality of life. I've always kind of taken the stance, well, there's somebody out there, I'm missing something, maybe in some situation. And you know, possibly there is somebody is so obsessive, compulsive, they can't leave their house. And this angelic effect has some kind of positive indication to be able to kind of slow down this obsessive thinking to start taking steps in some direction. But overwhelmingly, these drugs are prescribed to young people having normal mood variations, breakups, challenges in life. I continuously see giving these drugs to young people and then inducing self-injury, irritability, and suicidal thinking when it wasn't there previously. And I've come to the conclusion that Antidepressants and using that word is one of the most lucrative scams and criminal Sean (32:19.226) criminal behaviors that we can probably look back historically that has ever existed in the healthcare system. I think it rivals the tobacco industry's marketing of cigarettes. Josef Witt-Doerring (32:33.046) Mm-hmm. Yeah, totally. I'm with you there. I think I tweeted recently, I likened it to how we used to ram spikes into people's brains, you know. The use of these things, it's just, it's horrid and you know... There's so much of the problem is just who has the louder microphone. And yeah, you've got pharmaceutical companies and they can really just like blast, hey, these antidepressants safe and effective, yada, yada. But it's like you said, all of these ways that they can make people worse. And I wrote a textbook chapter on this, all the ways antidepressants make people suicidal. Yeah, they can make people suicidal by inducing akathisia, you know, this kind of chemical restlessness and dysphoria. And then there's the, you know, everyone knows about blunting. Sorry, sorry, everyone knows about mania. But then there's like, like baked actually into the quote unquote therapeutic effect, which I think is the most prominent effect that these drugs have on people is emotional constriction. Even with that effect, there's something about that can induce suicide. Because what if one of the things that was keeping you alive was actually that you didn't want to upset your family, you didn't want to upset your friends, and there was these things that were holding you back from doing it. And now you take a drug that essentially, you know, your life is still a mess because they haven't really addressed it, but you're more blunted. You give, you know, you care less about the things that actually made you want to live. And so that's like... when the drug is actually working in the typical way. And so we never, you know, I was never taught about this. This is why I was writing a textbook chapter on it about all of the different like psychological effects of the drug and how they can be negative. It's just, it's crazy. No one's not, no one ever hears about this. Sean (34:35.526) Um, my, my jump in roger, um, the one thing that I find very interesting about you is I sense like you have this internal conflict about you, your entire your career, when you went to school, uh, the critical thinking, the doubts you had, and then your career path, which is, is even more interesting when you went to the FDA and then you went to the pharmaceutical companies, was there a personal objective you had as you chose that path? to maybe right some wrongs and what ended up happening that led you to where you are right now in terms of starting a practice for de-prescribing. Josef Witt-Doerring (35:08.182) Hmm. Josef Witt-Doerring (35:16.686) Yeah, so I mean, you know, these things are always kind of complicated. I mean, you know, going to the FDA, my wife was pissed because she knew it paid poorly. And I was just like, I need to do this now because I'm never going to do it again. And I just, I wanted to know what was going on behind the doors, you know, like, why was it that I was reading, you know, David Healy and Robert Whitaker and all of these, these guys who I really admired during my training and kind of kept me going like, why were these problems being missed? Like what the hell is happening? So I went there just to investigate and then eventually, yeah. Sean (35:51.765) And what was your key takeaway from that experience? Josef Witt-Doerring (35:55.71) My key takeaway from that experience is that the FDA is asleep at the wheel. Sean (36:01.73) How long were you there for? Josef Witt-Doerring (36:02.058) Yeah. One year. Yeah. Sean (36:04.85) one year. Are they asleep or is there active corruption? You see some of the kind of revolving door between the FDA and then also then obtaining jobs afterwards with pharmaceutical companies. Josef Witt-Doerring (36:23.918) I love that you asked me this question because I think when you're on the outside looking in you always, I think we have a tendency to think that there's something really malevolent going on, especially if there's massive harms. But I really love talking about this and I love thinking about this. Most of what happens there is really normal social dynamics that I think would be very intuitive and understandable to anyone who is in a corporation. So the first thing that I'm going to bring up is that... The doctors at the FDA, I mean, they're just like regular doctors from academic settings, you know, who are usually they've had a go at being an investigator and going on a tenured professor track and they've decided that that's not for them, you know. It's hard getting grants for the type of research they're interested in. They go to the FDA, they say, I love clinical research, I'm going to go there and serve the public in that way. But because you come out of these academic settings where... Essentially, all of the well-funded good ones, they're all built off pharmaceutical money, because that's how you become a professor and a prestigious university. You run clinical trials, you generate a lot of publications, you send out press releases about being on the cutting edge of drug research. And so we have doctors going to the FDA who are already kind of marinating in this same kind of biological psychiatry perspective, thinking about things in this way. They're going to conferences and they're hearing from speakers who are talking about just the benefits of the drugs. You know, they're also hearing things that are saying, you know, the suicidality on antidepressants, it's controversial, you know, all of the sound bites and the talking points that the pharmaceutical industry wants doctors to have. They've been just like any other doctor going through training. They kind of marinate in that stuff. And so then you're in the FDA. And, you know, you want to be a reasonable person. And everything that you've ever heard is that, oh, there's these groups out there and they have an agenda against medications. They're trying to stigmatize mental illness. They're trying to shame people. They're trying to, you say, they're these old school people that just think people need to pull themselves up by their bootstraps there. And so they've heard all of these ideas. And so they generally tend to take that perspective. Josef Witt-Doerring (38:48.114) and they say, you know, we need to protect people from themselves, you know. And so there's that one side of it. So one side is that you enter it already kind of set up just like the rest of the doctors are and evaluating things through a similar lens. But then the other thing is just structural within the FDA. So there was something called the PEDUFA Act. It was an act of Congress. I think it came in the early 90s. But around about this time, pharmaceutical... companies were upset because the FDA didn't have enough manpower at the time and they were having to wait a long time for drug applications to be reviewed. And clearly this cost them millions of dollars, especially if a patent is expiring. And so Congress managed to put together a law that allowed the pharmaceutical industry to actually fund a lot of the FDA's activities. They called it the PDUFA Act. And along with that funding, you know, they were able to hire a lot of people, but there was a stipulation in there where it said, if we're going to give you this money, you need to make sure that you complete all of your new drug applications. These are the applications for a drug to go on the market. You need to do them within nine months of when we send them to you. And, you know, if we want to run a new investigative study, an IND, to just investigate where the drugs doing something. you need to review that protocol within 30 days and let us know if we can move forward. Again, there's nothing that I think sounds really sinister about that on face value. Sure, if we give you something, we want you to help us with our business objectives and be quick. But the way this kind of played out in my experience in the FDA was that all of our metrics that management looked at were all about how quickly we were doing these activities, the new drug applications and the INDs. And so we would be getting safety reports coming in to us from the studies, from the clinical trials of, you know, people with schizophrenia and depression becoming suicidal shortly after starting the drug. There was no oversight on the evaluation of these patients. They just turned up in our inbox. We would just like look at them and we'd say, okay, this happened. And you'd have a choice there. When you would get this thing in your inbox, you could dig into it, ask a lot of questions, say, you know, what are the alternative explanations? Josef Witt-Doerring (41:10.826) you know, was there something characteristically strange about this that might make you think it's a drug reaction? But because no one's paying attention to that, you know, what happened most of the time and, you know, was that it's just like, I have like all this other work to do, I'm just going to say that this was due to the underlying condition because no one's checking this work, you know, this is not a metric, this is not anything that my boss is going to look at, there was no supervision on all the other work, you know, the NDAs, the INDs, group committees, team leaders looking at them. And so you have this perversion of what the medical officers are doing in there, where it's just like, we're just essentially helping pharma with their objectives and just kind of disregarding safety. So, yeah, so there's that and just, this is probably no surprise to your audience, but FDA and pharma, they go to all of the same conferences, they listen to all of the same talks. And so they're just kind of digesting this information that is mostly pharmaceutical generated because it's very difficult to write scientific articles and put together conference talks. But if you're well-resourced and you're a pharmaceutical company, you can make all of that happen. And so they just wanna be pleasing. And this is why I said it's very relatable to people. It's like, if you marinate in that kind of soup of like, just... I guess misinformation eventually, you don't want to go against the flow. You want to be seen as reasonable, as scientific, as easy to work with. And so yeah, they're also really poorly paid as well. So part of it is also just like, I need to go to like my moonlighting job, you know, and I'm not going to like dig into this. I mean, it's kind of disgusting, but that, yeah, that's what I mean when I say they're asleep at the wheel. There's multiple... systemic things happening in there that make them a really poor watchdog for safety. Sean (43:03.53) Yeah, that I don't know if you ever saw the movie, the big short, it's back on Netflix again. So I rewatched it and I think they do an excellent job showing how that translates into another industry, which would be, you know, the banking and finance and the sec, right? There's that whole scene when they're in Las Vegas and they're just all hanging out together and they all work together. And they, anybody at the sec wants to get a job in investment banking because that's where the money is. And then that's kind of where your career took you. Josef Witt-Doerring (43:17.332) Yeah. Sean (43:31.298) but I want to believe that your intentions were still in line with where your critical thinking was, but you saw that it was kind of like an upstream battle at the FDA. So you went to the pharmaceutical industry for what objective? $700,000. No, put the money aside and the family stuff. But I feel like that was probably a motivating factor. But you still had these... Josef Witt-Doerring (43:49.522) Yeah, yeah, um... Se-se-se-seven... Yeah. Josef Witt-Doerring (44:00.683) Yeah. Sean (44:01.043) personal objectives within you that you wanted to get answers on. Josef Witt-Doerring (44:05.054) Yeah, for sure. What I will tell you is when I was at FDA and when I was in industry, I mean, I was... really shutting down that part of my brain that was having a lot of these problems because I kind of had to do that when I was going through psychiatry training because I was just getting in trouble. You know, I was just, I was at the point where it was just like, if I didn't shut up, you know, you know, bad things were going to happen to my career and my family. I mean, no one's going to hurt me, but I would have had a hard time, you know, finding a job without residency. And that was the same at the FDA and it was the same within the pharmaceutical industry. And I really had to dissociate. apart from it and just be like, hey, I'm here to learn because like I know deep down that like, I'm on like a larger mission here and at least coming into these settings and seeing what's happening, you know, behind the doors. I mean, maybe there was a part of me at one point where I'm like, maybe I'm going to change things at the FDA, maybe I'm going to change things in the company, but you just don't have that power. And I mean, being in the pharmaceutical industry was interesting as well. I mean, there would be I was working, I'm not going to say the names of the companies, but I was working on the safety of a product and they had an issue with, let's just say a reproductive issue. And this was one of the important safety issues with the drug. And we were saying, a lot of clinicians are having, a lot of the clinicians that are running this clinical trial, they're wondering what they should tell young women who are going to take this drug. And this is such a big deal. obviously young women, fertility problems, things like that. Like, maybe we should put out a manuscript. And I'm like, yeah, this is a great idea. You know, we're going to put out a good manuscript that's going to help people with that risk benefit decision and really help clinicians use this drug better. And our chief medical officer, you know, in the call was just like, you know what, we don't want to make this a bigger deal than it is. You know, like, you know, essentially said something along those lines, you know, the stuff's going to be in the label. Josef Witt-Doerring (46:10.882) what's the point of making a manuscript about this? I don't wanna blow it out of proportion. I don't wanna dissuade people away from getting the treatment that they really need. And so they would always come back with some bullshit excuse. And it's like, obviously there's never an excuse in the company when they wanted to publish something about, oh, this is the effectiveness of the drug or some academic has found maybe some other use for the drug in a different population or something like that. all of those things were green lighted, you know, get that information out there to the public, but with safety issues, it was always an uphill battle. I mean, it's the same way. I mean, you're not going to expect McDonald's to, you know, put out a publication saying, hey, you know, we found substandard sanitary conditions in some of our, you know, restaurants and things like that. No one, that's just not how companies work. But yeah. Yeah. Sean (47:01.138) No, it's bad business. And that's what you need the FDA for. Yes, you do. You have to have those regulatory agencies that protect the greater public. Josef Witt-Doerring (47:10.495) Mm-hmm. Sean (47:11.018) It was 2007 when I was in my doctoral program and a paper came out, which I thought was going to be a seminal paper at that time. Actually, I thought I'd be watching it on the nightly news. And it was called selective publication of antidepressant trials and its influence on apparent efficacy. It was published in the New England journal of medicine. And the lead author was Eric Turner. Eric Turner was an FDA officer somewhere. I don't know his exact position, but he, he kind of Josef Witt-Doerring (47:32.267) Mm-hmm. Josef Witt-Doerring (47:38.25) Division of Psychiatry, because I used to read his reviews. Yeah, yeah. Sean (47:39.786) in the division of psychiatry, he was appalled by, you know, how so many of these trials that didn't demonstrate efficacy were just kind of put in the file drawer. And so, you know, he ultimately kind of comes to the conclusion that antidepressants are nothing more than placebos but with severe side effects. And the fact that never became mainstream news at that time was really a wake up call for me. It was a wake up call about the power of that industry and how you just don't go against it and I don't know what Eric Turner is doing now, I've seen him pop up on various documentaries, but he seems like he is a man of principle and, uh, you know, he had to speak out against his profession, but you're right. If you don't have something set up in your career to be able to take care of yourself independent of industry. then you are really at risk. Josef Witt-Doerring (48:43.082) Yeah, especially if your family gets used to that income, you know, that's, uh, that's, uh, definitely making things more difficult for your, for yourself, um, for the sake of, I guess, your values and principles. And, and I know it because I've thought about a lot of these things and, you know, things would have been a lot more straightforward for me. I guess things would, my life would have been pretty easy if I stayed in industry. Let me put it that way, apart from, I guess, hating myself, you know, inside. Sean (49:12.958) And then possibly having to provide them with your firstborn. And you know, what other deal you make with the devil. But anyway. Rumble still skin. I heard you on another podcast as I was doing research for this one, that both you and your wife, your wife who is also a psychiatrist, experimented with Zoloft yourself. And I thought this is just a fascinating story if you're willing to tell it. Josef Witt-Doerring (49:13.086) Yeah. Josef Witt-Doerring (49:21.056) Yeah. Josef Witt-Doerring (49:25.121) Yeah. Josef Witt-Doerring (49:33.486) Mm-hmm. Josef Witt-Doerring (49:40.574) Yeah, yeah, we, I mean, we experiment with a lot of psychotropics. I mean, we experiment with lots of psychedelics. I mean, if there was something out there, I mean, that's, and this is the thing, people think we're crazy for talking about this. I mean, I was treated like I was crazy in my residency when, you know, I was talking about trying the psychiatric medication. It's like, you should, you know, if you're prescribing these medications, you should take all of them. Um, and so, I mean, we've taken like, you know, Antidepressants, trazodone, metazapine, you know, stimulants, benzodiazepines. But yeah, so the story with the antidepressants was, you know, a colleague of ours was taking Zoloft, lots of psychiatrists take psychiatric medications. I think practically half my class, maybe even 60 or 70% were all on psychiatric medications. Sean (50:29.21) explains a lot. I'm just kidding. Josef Witt-Doerring (50:30.446) Yeah, well, I mean, they're so bored into it. Yeah, yeah, yeah. They're so bored into the system, right? You know, into that, that thing. But yeah, so that, I mean, we had them, we had access to them. It was really easy. And so yeah, we took them. Yeah, we both went on Zoloft, and just to kind of see what it was like. And I mean, my wife had mood elevation was what was what happened to her. And so she took it for like three or four days. And, um, I mean, it was like she had taken like a Molly or something like that. You know, we were hosting like an interview for candidates coming to our program and she was just like the life of the party and which was like buzzing around the place and she couldn't sleep that night. And so she didn't sleep for about two nights. And then she eventually stopped because she was just like, there's something like not quite right about this energy level. Um, and so she's yeah, hypomania, you know, she definitely had a more stimulant. Sean (51:22.914) Would you say that it induced mania? Or hypomania? Josef Witt-Doerring (51:29.622) like effect to the medication, which we both recognized. And short lived, yeah, she stopped and it went away. But I kept on going because I wanted to give it like a good month. And so I think I'd been on, you know, I started on 50 of Zoloft and then after about a week, I went to 100. This is a lot faster than you should do it, but I was just impatient. I just wanted to see what was going to happen. I had the typical response. You know, I was emotionally blunted on it. And I You know, there's something almost kind of comfortable about kind of sinking into that, into that place of just stillness. It was quite a, for me, it was quite a dissociative experience as well, where I kind of felt like there was this, this pain that kind of dropped down between me and the world. And I was separated from it. And I wasn't just rattled by things anymore. I mean, my friends at school, my friends in residency, you know, who I was talking to this about, they were just like, man, you need to get off this stuff. I like you more, you know, when you're not on it. Because I think I was too, I don't want to say serene. I think I was, I guess people say it like zombified. I was just distant, you know? And, um, but I kept on going because I'm like, just want to see what, you know, I want to see what this like, this is like people say sometimes takes a while for the full drug effect to kick in. And then, um, my wife started complaining and this was like the interesting thing because, um, Josef Witt-Doerring (52:54.598) I would just kind of be just sitting down doing my own thing and she would be talking to me complaining about something, you know, just the usual stuff that happens in your relationship. I probably made a mess of the kitchen or something like that and she would be talking about that or maybe it was just, you know, we hadn't gone on a date for a while and, you know, and she needed to tell me something. She needed to talk to me about something important and I just did not care. You know, she would be yelling at me like, or not yelling, like nagging, you know, there would be like this nagging going on where in the past I would have been kind of up there, Hey, let's like talk about this. Let's like figure it out. I could just like tune it out. I was just like, you know, what's this bullshit she's saying pretty much. And, um, she hated it. And that's why we stopped the experiment. Eventually. She's just like, I hate you when you take this medication. You don't, you're not a tune to me anymore. Sean (53:45.626) There's such a wide range of effects with these drugs, you know, and that's what's really important because they can affect one person one way and then another person has a completely different experience. One of the things that I'm communicating is that emotional detachment that you experienced. And we also share a paper here in our training program that it negatively affects empathy. That that experience is an antidepressant and we don't want to communicate that as antidepressant. In fact, our emotions are really necessary and really valuable. And that was one of the challenges I had throughout my training as a psychologist, because I felt like I was developing expertise in emotion regulation. Everything I was learning about the effects of exposure-based therapies, cognitive behavioral therapies, neuroscience labs on inhibitory learning models of fear extinction, how important it was to experience emotions fully. in order to learn how to regulate that. And it speaks also to this, the natural resilience of all human beings. We've gone through traumatic histories throughout our evolution and we're still here. You know, here we are. We have this capacity to be able to really cope with tragedy and trauma. And part of that is the collective experience of our emotions and a shared experience of love and connection and grief and loss. And it's not really until probably the last 30, 40 years, where this psychiatry model aligned with the pharmaceutical companies, where it is a medical allopathic experience where we begin to start talking about these commonly experienced emotions in terms of symptoms that have to be decreased. And that's one of the largest challenges, I think, that we're facing as a culture, is that we've become emotionally illiterate. and that we judge normal ranges of emotions. And that's not in any way to diminish suffering because emotional pain is hard. And some people do have to learn how to regulate emotional suffering and pain. So it doesn't become a chronic depressive episode or anger or fear. But the manner in which we speak about it in our culture, I believe is harmful. And I do believe that modern psychiatry is culpable in that. Josef Witt-Doerring (56:05.026) Mm-hmm. Josef Witt-Doerring (56:11.518) Yeah, no, definitely. I mean, there's no shortcut to regulating your emotions. I mean, because... At least now, I mean, to me, it's more clear than ever. I mean, these drugs do not help people long term. I mean, they mess them up. And another story I could tell you about is when I was taking Xanax for a couple months and what that did to me emotionally and the weird obsessive anxiety that developed. I mean, I think that these things, like I think, you know, when Robert Whitaker, you know, wrote Anatomy of an Epidemic and he was talking about... his hypothesis that these drugs could induce a chronicity of symptoms or a worsening of symptoms, it's been completely in line with what I've seen. And so, I mean, we really don't have, I mean, there is no other option than to figure out how to deal with your emotions, because, you know, taking the drugs for them long term, it's going to lead you to a dark, it's going to lead you to a bad place. I mean, there's very few use case scenarios for that. It's a mess. Sean (57:20.506) I'm interested in how you communicate to patients because I know that not only do you really work on safely tapering clients off of psychiatric drugs, but there is med management and I'm sure as a trained psychiatrist, there are some selective situations where you're going to manage the risk benefit profile and communicate to your clients. So I want to address some of the severe risks that's associated with SSRIs. I know you're aware of some of the same scientific literature. Josef Witt-Doerring (57:24.046) Thanks for watching! Sean (57:50.094) demonstrating that they increase risk of suicide, self harm and violence. I listened to your great interview with Dr. David Healy, who is a renowned expert, former pharma insider on this issue. And I think we can all agree that people just are not adequately informed of the risks. Thus the ethical and legal standard for informed consent is not often met for people who prescribe these drugs. So how do you describe the risks to people? and address this issue of suicide and violence if you believe there could be some, at least short-term, benefit. Josef Witt-Doerring (58:26.206) Yeah, yeah, so pretty matter of factly, and I'd love for you to kind of challenge me on some of these things. But to me, okay, so. One, you know, I'm so different from a lot of psychiatrists in the US, the prescribing guidelines have them as like a first line treatment. I mean, to me, it's only for the people with the most severe depression and anxiety usually, and more so anxiety, kind of obsessive ruminations getting to the point where like maybe they're agoraphobic or they can't leave their home and, you know, these are people where they've attempted to address any other alternative explanations for it, whether it's dietary changes or, you know, cognitive therapies. Or maybe, I mean, sometimes you just use these medications because the patient can't do those things. They don't have access to them. And it's just like, this is, you know, you're making an informed decision about it. So in terms of the risks, if I was talking to a patient about this medication, you know, I would say, yeah, these drugs, they can make people feel worse. You know, I don't like, I mean, I'll tell people they increase the risk of suicide, but I think the most straightforward way to explain this to people is, there's a proportion of people and it makes them feel more agitated and depressed. If this happens to you and it's coming out of the blue and it's not, doesn't seem like it's anchored to stresses in your life, you need to stop the drug immediately. I think that's the easiest way to explain that risk. That one actually doesn't bother me that much because I watch my patients very, very closely and I communicate with them a lot. So that one stops. I mean, if you pick up on that one, you stop the drug, the better in two days, sometimes a little bit longer, but quickly. The problems with tolerance and dependence, again, not as concerning for me. I mean, and this is my bread and butter. I help people with this. If I can bring someone down off a drug in a slow way, that's okay. That's most of the time, the majority of the time, they're going to be just fine. The one that I have a real difficulty with is PSSD. And this was the one that really kind of changed. Josef Witt-Doerring (01:00:35.33) things from me, you know, that really kind of pushed it over to the like, I'm almost never going to use this drug because what I would have to tell someone is there's a chance that this drug is going to make you worse permanently, you know, or for several years if you do this. There's no way I can tell you whether you're going to get this risk. And so you're going to have to weigh this against, you know, how you're feeling now and what may be just a very modest improvement in your condition. So with something like PSSD, I mean, it really, really makes it hard for me to feel comfortable prescribing antidepressants unless the person is just completely debilitated by depression and anxiety. Sean (01:01:21.134) Do you believe this has the opportunity to create longterm harm for a developing teenager who's still trying to determine their own, you know, their own identity, their own sexual development, can it permanently impair that? Josef Witt-Doerring (01:01:35.87) Yes, I think so. Yeah. Sean (01:01:38.222) And these are some of the things that I've just been killed for on social media, because there are situations that, you know, people come into my practice, like a 20 year old who has been on an SSRI for 10 years, and they identify as asexual and they were never warned of the risks and their, their identification with asexual is they never developed any sexual attraction or any libido for by their sex and they don't see anything necessarily wrong with it because when they started the drug, they were prepubescent. I mean, they don't even really understand it, but there is an emotional detachment to them and they've identified with this asexuality as if it is something a part of them. And there's a lot of offense taken when you bring up the possibility that this is drug induced. Josef Witt-Doerring (01:02:16.407) Mm-hmm. Josef Witt-Doerring (01:02:33.978) I mean, if we're going there, we'll talk about the transgender issue as well, because I think that one is right there with it as another place where these drugs can be playing a role. If you're a young man, you're 13, 14, 15, and you're on these medications and you've never developed sexually, and you're just like, why aren't I attracted to women like all of my friends are, and I'm just not feeling anything, the amount of content that's out there that's talking about, I guess, the transgender movement, To me, like, I mean, if you're vulnerable and you're confused and you're wondering why things aren't working out for you the way they're working out for your friends and you're having depression and anxiety, you can start to think that as well. I mean, yeah, so you can start to identify as asexual. I think it can really kind of grease the wheels for you to start thinking, you know, maybe I'm actually the wrong gender as well. And I mean, I've talked to a lot of people with PSSD now. I think I've probably spoken to about 10 of them and One of my interviewers, Simon, interviewees, Simon, talked to me about how he thought he was gay. He had been previously very interested in women, able to enjoy sex, and he would be with gorgeous girls that he just knew he would be attracted to and would be having all of these problems with like erectile dysfunction, and he did not know it was from the drug, and he thought he was gay. I mean, you can think about what that does to someone and how confusing it is. So yeah, do I think it can completely mess with someone's sexual identity? I mean, yes, and especially so if they're taking it prepubescently and they never really know what normal sexual desire is for them. I think it can be catastrophic. And I mean, that's only the start of it. Think about the emotional development. that and the emotional regulation that you have to go through between being, I don't know, 13 to maybe like 30. I mean, these are the years where we're really learning about our emotions and how to control them and about the emotions of other people. And if you blunt someone through that period of time where most of that emotional development and empathy is really developing, I mean, you can mess someone up, you know, for a lot of their life. I mean, I have people coming off medications. Josef Witt-Doerring (01:04:56.274) who are learning this stuff at age 35, at age 40, who've never, they've never felt these things, so they've never really had to deal with them. I mean, it's the saddest thing ever. I mean, it's exciting because they're doing it, but part of me is just, I mean, it's devastating. Sean (01:05:13.794) think this is the dirty little secret that exists in our society. The impact that these drugs have on developing adolescents, as well as the number of mass shooters and school shooters that were on multiple psychiatric drugs, and it's certainly not a public position. It's not something that people feel comfortable speaking about publicly, but it demonstrates, you know, the actual power of the pharmaceutical industry because of their role in funding. the media through advertising dollars, but you can go into court documents. And, uh, you know, you can, through the discovery process, if you're, if you're willing to dig deep enough and to see where the public records exist, you can, you can read some of the horrible testimony, you know, about what has happened to, you know, these teenagers who, you know, lost their minds for the, for the lack of a better word that started with an initial drug in the mental health system. Josef Witt-Doerring (01:06:11.394) Did you watch the interview I did with David Healy talking about James Holmes? I don't know if that was the one you saw. Yeah. He interviewed him. I mean, that was, you look at the photos of James Holmes, like in the courtroom with the bright red, the bright orange hair. how is he not manic? And I mean, David talks about how the legal defense team, these were public defenders, these not high powered lawyers or anything like that. They simply chose to go with the insanity defense because they thought it would be too much of a hurdle to try and make a case that the drug had made him manic. And I think that was mainly because of public opinion. And they were just like, the public's not going to buy some story about like a drug. this being a drug and juice side effect, people aren't going to want to see James Holmes as a victim after what this has happened. They just dropped it, they say the optics are bad. We're going with the insanity defense. It's crazy. Sean (01:07:07.094) It is crazy. And, um, you know, you, if you're willing to speak outside of, outside of the lines that have kind of been painted for us, which I think you're doing now, which I started to do about two years ago, it's very easy for you to be painted as an extremist who is hyperbolic. But the truth of the matter is there's a lot of research behind the scenes that we do, there's a lot of clinical experience that we have that we've had to resolve the conflicts between. you know, what is being presented to most people, what we've been taught versus what we are experiencing. You know, it's not something that I wanna do is get deep into some of these court documents or talk to some of these guests that we've had who've revealed horrific tragedies like losing a daughter, you know, for suicide after a drug induced reaction or a husband like Kim Witzak losing Woody. You know, these stories, they're, they're painful, but they need to be told. And cause that's the only way we're going to be able to progress as a society. And unfortunately right now it is entirely in the hands of the practicing physicians. And in American culture, the medical authority is powerful and we need courageous physicians to be able to communicate truth. So people can be more informed. The families. The patients that are coming into my practice, they are not informed. They are just accepting because the doctor told them that this is some life-saving medicinal treatment that is going to help them with their mental health and they are completely unaware of the risks are hearing it for the first time from me. Josef Witt-Doerring (01:08:55.347) Mm-hmm. Josef Witt-Doerring (01:08:59.302) I mean, this stuff has been known for like a long time, you know, and it's just, I mean, some doctors are hearing about the risks for the first time. I mean, one of the most powerful things that I saw was a story about psychiatrists who had psychiatric drug injuries. It was on Medicaiding Normal. They interviewed a Scottish psychiatrist. They also interviewed Mark Horowitz and they had Nicole Lamberson on there, who's a physician assistant. And you know, these are all people kind of... You know, went through the system, kind of bought the same things. They were doing all of this and completely unaware of the dangers of the drugs. And I mean, that was their practice. I think to me, that was the moment where I'm just like, Oh shit, you know, this is like, this is some really, this is a really powerful marketing campaign. If you can, if you can dupe the people who are doing this, um, day in day out. Sean (01:09:52.666) That's the frustrating thing for me is I think the only people that are aware are the ones that have been harmed or someone they care about has been harmed. So when we talk about this knowledge being out there for a long time, no one really does become aware of it until it's too late. So it's almost like you need to educate the public to, uh, when they're in a situation where something's being recommended to them, give them the strength and the empowerment to say, no, thank you. You know, not yet. Like there's gotta, there's gotta be some type of, you know, first line of Josef Witt-Doerring (01:10:19.576) Yeah. Sean (01:10:22.218) of defense that when there is a situation that's presenting itself, it doesn't go to a pharmaceutical first. Do you want to know some of the realities of this doc? And I've been meeting with parents that they're told by the prescribing physician, especially if it was a hospitalization, that if you don't consent to your child to take this drug, we're going to call child protective services. Josef Witt-Doerring (01:10:52.286) Yeah, I mean that's straight up just like an abomination to threaten, to pressure someone into essentially giving their child a drug that makes them more suicidal on average. I mean... No, I mean it's horrific. Sean (01:11:03.766) I have no idea how that's legal. Sean (01:11:10.23) And I do have to look into that because I don't know how that is legal. How a physician in that position can almost mandate a medical intervention. Like a child endangerment situation. It has to be, it has to be presented in that way, but that is a complete deviation from the science. Josef Witt-Doerring (01:11:30.442) Yeah, I mean, the doctors, they just think that, yeah, you know, this has an indication for depression. This person is depressed. Like, why would it have a prescribing indication for this if we shouldn't use it? I mean, the truth is it shouldn't, you know, because it makes people more suicidal on average than it helps. So I don't even know why the FDA let them let that one get through. But it's, I mean, this happens all the time. Rob. Wipond, he talks a lot about this in his book, but I've also seen this, Rosie was a young girl with PSSD from Australia who I spoke to. And if we want to talk about psychiatric coercion, she developed PSSD, she complained about it to her physicians, and they said that she was having a severe delusional disorder. She was a hypochondriac. They hospitalized her, and they wouldn't let her leave. until she took medication. They kept on interpreting her, her refusing to take medications and her concerns about what the drugs had done to her as signs of her illness. And so essentially she just started taking drugs again that, from a similar cost that had damaged her because she needed to get out. I mean, it's, I mean, there's a lot of really kind of like, I'm talking like actual like horror show, like stranger than fiction. Like if you're going to write like a horror novel about something that would happen to someone, you know, to take a drug and be lied to and be told that it was safe and then to be essentially chemically castrated and then just hospitalized. Actually, I talked to another guy, this happened to another one of my guests, an Indian doctor, sorry, not a doctor, an Indian guy who was hospitalized for three months for this involuntarily hospitalized for because they thought he was delusional. I mean, the stuff is so bad, like what is going on out there. Yeah, so it doesn't surprise me that you heard from a parent that they threatened CPS on her if she didn't make her do it. Sean (01:13:32.674) Which is the danger of this. And if the medical authority becomes too strong in a particular country without any checks and balances, especially from the legal perspective, then it can become an arm of the government. So just imagine one way to control a political opponent or somebody who speaks out against a large corporation that has power is for you to devalue that person. And one way to devalue is to call them crazy. And the medical authority can easily assign that label because it lacks any objective medical testing. It becomes the opinion of an individual. And it's very, it's, you can, you can see the slippery slope of to, of to denying that person some specific rights due to a lack of insight into their own mental illness that leads them to be a danger to somebody, to themselves or someone else. you can really assign anything the label of delusion. It's a belief. And if you want to characterize that belief system as delusional, let's just think about the COVID crisis, for example. If you denied that the mRNA vaccine was going to prevent COVID and it would save lives, and they could easily call you a crazy person, an anti-vaxxer who's anti-science. and therefore you're a danger to others. So it's not that slippery of a slope and we can see how we can walk down that path. Josef Witt-Doerring (01:15:06.346) Mm-hmm. Yeah, I did, you know, I work. You know, I have a kind of an ongoing friendly and professional relationship with David Healy. And so I interviewed a lot of the people who had these vaccine injuries, you know, Maddie and everyone that went down to Washington to talk about how they were drug harmed. And it was just that, you know, they were pressured, they were coerced into taking medications, some of taking these shots, you know, pressured because they couldn't work their job or, you know, they couldn't go to school or things like that. And Yeah. And then they developed like permanent neurological damage afterwards. I mean, what a nightmare. Um, you know, and yeah, I don't know. I mean, I felt, I mean, same thing happened to me. I had to get the shots at the time when they came out as well, uh, to keep on working and thank God I was okay. But I mean, David Healy essentially, like, they tried to run him out of his job because he wouldn't get the shot. Um, and. And so yeah, there's tremendous pressure to just go along with these treatments that can be, it really can just be like Russian roulette, whether you're going to get lucky or whether this is going to really cause long lasting damage. Sean (01:16:21.018) I think a lot of people who were aware of the pharmaceuticals history with lying and fraud was very difficult to trust that a rush to market vaccine couldn't potentially harm people, especially for a condition that was so relatively mild or even nonexistent for young and healthy people. To be forced to have to do that under some disguise. of scientific legitimacy and of protection was so nefarious. I was never going to let any of my kids get that. I had a daughter who was at university, and I was going to remove her from school until some things changed. It's just it was just a real challenge. We've we started the podcast during that time and Sean and I would get into it. Because he wasn't aware of all this what he knows now because it wasn't part of his His field of study wasn't part of his day-to-day work. He just accepted the narrative. And that's how easy it is just to be able to absorb marketing as truth and then to blindly trust people in authority. And it's been one of the, I think it's one of the primary challenges of our time. Each generation tends to have to face some really difficult point. in their own lives and have to make decisions, whether it's been a world war or even having to immigrate to another country, leaving your family, just for survival, just for freedom. And I do think that we are in a precarious time in Western society. There's a lot of transformation and there's a lot of division. And the only way that we're going to be able to kind of reclaim a medical system, a healthcare system that is acting in the best interest of its people is through an honest dialogue, discussion and promotion of facts around the harms of the allopathic medical model and being able to introduce new alternatives. So I do want to just conclude on today's conversation, maybe a little bit more optimistically, kind of Josef Witt-Doerring (01:18:41.678) sure. Sean (01:18:42.51) from your perspective, the future of psychiatry, where psychiatry can have a positive role in our society, where we can reclaim new truths, and we can evolve through this period of time of a lot of medical misinformation, and a psychiatrist can be a trusted member of the medical system and our culture. How do we get there? What does it look like? Josef Witt-Doerring (01:19:07.598) Um, wow. Um, you know, where to begin with this one? I mean, like, you know, as I said in the tweet at the start, I don't have any easy answers for this. I think it's. I like, I think we need to come back to, to what Joanna Monkrieff's work is all about, which is the drug centered model of treatment. I think that's the first step. Recognize that we are using poisons, you know, we, you know, we're using these drugs just for like a chemical effect on someone's mind. and that in very specific situations, it may be helpful. Whether it's mania, acute psychosis, that's dangerous. From my perspective, I mean... I think that's totally okay. I mean, if you don't have a safe place to put someone to like work through a manic episode or an episode of psychosis and you need to give them medications, that's fine. So, I mean, I think we need way less psychiatrists. I think we need probably like I don't know, like 2% of what we have now, because the group of people out there who I think actually need the medications is really like 2% of what is getting the medications right now. And so really scale it back. Yeah, it's out of control. I think when you start looking at these drugs more as just chemicals that you're taking to... Sean (01:20:14.892) interesting. Josef Witt-Doerring (01:20:29.474) to cause a potentially therapeutic effect. It would really also bring down the maintenance, the maintenance use of the drugs, so the ongoing use, because if you tell someone, yeah, this is gonna have a blunting effect on your mood, and you really tell them it could have pros, it could have negatives, they're gonna wanna get off it pretty quickly, but so many people just take them long-term. Even the mood stabilizers and the antipsychotics, and they're just like, oh, it's rebalancing me in some way. I mean, long-term use of any psychiatric drug is, should always be questioned. I like, you would hear like things in your training, like, Oh, if you've had like three psychotic episodes or something like that, you need to be on long-term antipsychotic medication. I mean, that's like a lot of, a lot of shit. Um, you know, it like just needs to be managed on an, as on a, on a person to person basis, if you're going to do that. And so I think. people need to learn to have a much more flexible approach to using these medications. Yeah, people get psychotic, people become manic. There's going to be some people who need long-term therapy, long-term drug therapy, but I think it needs to be way less algorithmic and really looking at it from this drug-centered approach. So yeah, I'm going to stop there. What do you think about that? Sean (01:21:45.474) No, I'm really in favor of John Moncrief's approach to this. I think it's science-based, it's safe, it's ethical, and it speaks to some of the reasonable arguments for psychiatric medications as a medical intervention in a crisis situation to try to stabilize somebody who's really suffering. Josef Witt-Doerring (01:21:47.73) Yeah. Josef Witt-Doerring (01:22:06.95) Tell me about your perspective as well. What do you see as the way out of this? Because I want to hear your thoughts on like, how do we get out of this cluster? Sean (01:22:15.478) I think anything it's radical honesty. And we have to kind of reclaim a relationship with people who are trusting the mental health system. And to do that, you have to be radically open about the harms that have been created, why it occurred. So that's why conversations like this are so important because we kind of do a deep dive and try to investigate how did we get to this point so we can prevent it again. And we have to be able to have... bring back nuance, reasonable discussion, and an ultimate respect for individual freedom and people's rights to be able to make informed decisions. Somewhere along the line, medical professionals believe they have to have the answer for everything. And it's turned into be this like quick fix. And the human body, the human mind, the life that we live, it's so complex. And I think psychiatrists can have a critically valued position as medical professionals working on the front lines with people who have psychiatric presentations. And there's a lot we don't know. There's a lot of undiscovered medical illness or a range of medical problems that present themselves psychiatrically, where a psychologist or any therapist does not have the training or the expertise to be able to identify that or recognize that. So the time spent with a psychiatrist has to be prolonged. It cannot be 15 minute evaluations. It has to be a relationship over time to understand psychiatric symptoms and presentations and context, as well as gathering all the necessary information that can help give us an informed understanding of what is leading that person to present in the way that they're presenting. And I need to have medical professionals that I can trust. I need to have medical professionals who I can trust that can be ethical. They can investigate. They can be able to provide informed consent, go over risks and benefits while also understanding the unique needs of somebody who's in an episode. And I don't have that in my community. There's nobody I can trust. Josef Witt-Doerring (01:24:28.609) Yeah. Josef Witt-Doerring (01:24:33.126) You know, and everyone thinks I'm never going to need a psychiatrist, but it's like, Hey, what's going to happen when your parents get older? You know, what's going to happen if they develop dementia and they start having some behavioral problems and, and you're doing everything you can to kind of keep them in your home or maybe you have a child who has autism, like a severe autism or a behavioral problem. These are really hard things to navigate and you don't choose when those things happen and. And I also see a lot of psychiatrists working in that space as well, because that's, you know, yeah, obviously it's nice if everyone could have like a caretaker who could like watch them and redirect them and things like that. But the reality is, you know, when you really have these kind of these bad states, it's with behavioral problems. Sometimes the medications are the only thing keeping people with the families and, you know, not like shipped off to some kind of home. So it's really hard. really sympathize with that. I feel the same way. If I needed to send someone to a psychiatrist, I have no idea who I would find to do that. It's that bleak. Yeah. I want to ask you something because curious about this, to me, I would think that maybe, you know, psychology, you know, the would speak up against some of this because I mean, after all that your trade is helping people get better, ideally without medications. I mean, that's what you guys do. What, what happened? Why, why, why such a, you know, why roll over and just like cede your territory to the biomedical model? What, what's, how does that happen? Sean (01:26:10.958) think it's two things. One of it generally is personality of the psychologist generally. So I think with clinical psychologists, generally from a you know, personality perspective, they're not ones who are going to challenge authority. They are helpers, you know, designed to be healers there tend to be very empathic for the most part, those who aren't are working in academia. And academia is a public or parish kind of environment. And We've really taken on the medical model in itself too. So I'm a cognitive behavioral psychologist, board certified in behavioral and cognitive psychology. It's a very empirical method, not that dissimilar from how drugs came to market. So a lot of these CBT treatments are relatively short-term and symptom focused. So in order to be considered kind of an evidence-based treatment in the healthcare system in an allopathic environment, and to be able to connect with the medical community within the field in which we work, clinical psychologists had to also achieve a degree of credibility and psychotherapeutic interventions had to be able to achieve scientific relevancy. And it just, I don't think you survive or you could not survive in the system without being able to speak the language of the physician. I graduated from Philadelphia College of Osteopathic Medicine. It was a PsyD program, clinical psychology program in health psychology. And so we were, we learned to do quick consults, to speak the language of a physician, to work in healthcare systems, to be a part of the medical community. And so a lot of the things that you spoke about as well, it's just that you begin to adapt to the culture and environment in which you exist. and you speak the same language, you receive the same training, and therefore, mental health conditions are primarily biological ones. And we've just advanced as a culture in that manner. And then to ignore that biological medical model would be to be unscientific. And it's to be able to challenge it, you have to have a degree of confidence and you have to be willing to challenge authority and ask difficult questions and not everyone's willing to do that. Josef Witt-Doerring (01:29:11.17) You know, one of the things, you know, we talk about, you know, what's the future of psychiatry? Um, and I think in there is the future of, um, you know, therapy, counseling, all of these things. I mean, I remember when I was at the VA, you know, in order to get someone an appointment with a psychologist, it would be like, like two, two months out, you know, and then they would see them for 45 minutes every 30 days. And it was, there was this feeling, you know, where it's just like, oh, this is better than nothing. I'll just give them the meds because. there's not a lot of investment in this. Like, are people talking about that in your space? Like, you know, our services are so, you know, so scaled back and the support of therapies are so, you know, not accessible. Like, we need to have more therapists, have more availabilities. I mean, are these conversations that are happening? I wonder about that, because I do also think that, you know, family medicine doctors would prescribe less drugs if they could just... say, oh, you know what, like there's a great place, you know, they just down the road, they get people in within two weeks. They're going to see you like every week and, you know, it's covered by insurance. Like what's. Sean (01:30:22.358) I believe a lot of the treatment out there is poor, not just from psychiatrists, but also from the day to day counselor or therapist. Now, I'm trained from a model of that there can be really valuable, short term, cognitive and behavioral treatments for some of the most severe conditions. And I've seen the success. I've been able to you know, work with the self-injurious and suicidal teenager, the PTSD victim, uh, severe eating disorders, you know, bulimia, anorexia. But there is a, there's a, there's a way that you're going to have to work with somebody that is not, it's, it doesn't come from a model of person-centered counseling or psychodynamic therapy. You have to be able to work from a model of being able to build somebody up to cope more effectively. And we have a dialectical behavior therapy treatment center here. And I think it's one of the most effective treatment modalities, but it's very difficult to learn and it's very difficult to put into practice how many psychologists or therapists are willing to be on call for coaching calls. How many therapists are willing to work with someone who's so severely cut themselves right in front of you. How many people are willing to take on a severe anorexic client? So we've been overwhelmed in the system with what's called the worried well. And a lot of therapists just take those cases because they're safe. It's someone who's kind of generally neurotic and worried a lot and they come in and they meet with you and they're functioning at a kind of a moderate level and they're just reviewing their lives with them. The people who really need the help are actually kept out of the system. And because there's not enough people who have the specialty and the skill to be able to work with them. Josef Witt-Doerring (01:32:21.334) Would you say it's like, um, you know, the, the dearth of psych, of psychologists and accessible people to help with these more things like the, you know, DBT trauma relational problems is just that it's, um, it's not financially worth it for them, you know, that it's, it's very hard to do, you know, it's, it's full on. You have to be on call and they're just simply not making enough money from it. And obviously these things are not scalable, you know, it's a lot easier to give someone a pill, you know, that's. It's a scalable business model, you know, something like DBT. Um, it probably costs a lot more, you know, for, for that kind of hands on care. I mean, and so I think, I mean, is it a money thing? Is that what you think is going on? Yeah. Sean (01:33:04.698) I'm going to bring yeah, I'm over here. I'm nodding my head to you because I've only been on this side of the business for two years, two and a half years. And I can see how broken the system is. And throwing more bodies at it as a solution is not the solution. You actually really do need some skilled clinicians that can do these type of treatments. But you're right, the business is not set up to reward the effort going in there. You know, Roger touched on the fact that those who really duly Josef Witt-Doerring (01:33:11.692) Yeah. Sean (01:33:34.21) do truly need to help are not getting it because the system's overwhelmed by divorces and people in poor relationships. But the business side of it with insurance reimbursement, you look at CPT codes, uh, psychiatrists get reimbursed a hundred percent for a CPT code. But then you have psychologists maybe getting a percentage of that. We'll say like 85%. And then you have social workers and masters level people only getting maybe like 60%. So the incentive for an education is not to go into psychology, it's to go into psychiatry because of the way that the insurance reimbursement is you could come out making over $200,000 instead of making, you know, 80 or $90,000 and working your ass off with people that are really draining emotionally, cause you're spending an hour with them talking through the worst trauma instead of spending 15 minutes with somebody and giving them a prescription and walking away. the incentive, it needs to transition from a reimbursement system to a value based system. So those that are really being in a horrible situation where they're using up a lot of the healthcare system, they're using lots of medications, if you're able to deprescribe them, improve their overall health, there's less utilization of the medical system and those doctors are reimbursed a significant more for successful outcomes. Josef Witt-Doerring (01:34:33.514) Yeah. Sean (01:35:03.802) We are an insurance based practice, we accept insurance. And we were struggling financially because we were, we are working with some of the more severe conditions. We're the only DBT program in our region. And I had to threaten to leave the network of a major insurance company, which had all the data. They told us that we had the best outcomes in the state of Pennsylvania. And state of Pennsylvania is a really big state. And about those outcomes, which are meaningful to them, are how quickly patients come in, and they get their first, second, third appointment. And then the rate of hospitalizations, our percentage of clients that have to be hospitalized after they come into the Center for Integrated Behavioral Health is negligible, absolutely negligible. And that's because we have treatment programs that are designed to prevent hospitalizations. Josef Witt-Doerring (01:35:34.062) Mm-hmm. Sean (01:36:00.638) And we have therapists who are trained to be able to provide treatments that help people who have severe emotion dysregulation, while the rest of the community does not have that. But we get paid the same, we get reimbursed the same as the therapist who is seeing somebody just dealing with normal life stressors. Josef Witt-Doerring (01:36:24.697) not incentivized to really help people through that model. Sean (01:36:27.794) No, you're not. And for an outside person that doesn't work in the mental health field, you look at this and they go, this makes zero sense. It's like a, a neurologist who works on, you know, the most horrible, you know, brain related illnesses are like, uh, you know, doing brain surgery and then a car mechanic getting paid the same amount of money. Josef Witt-Doerring (01:36:47.31) Yeah. And you know, I'm sure if they, it's really hard to do these studies where, where you look at the patient over like five, 10 years, because the person who gets you a DBT program versus the person who ends up on Lamyctal or lithium or something like that, because they get misdiagnosed as having bipolar when they're really having personality, personality disorder type issues. It's If you teach someone the DBT program, they're going to be a lot cheaper for that insurance company over the long run without a doubt, you know, all of the medical problems, the drugs cause, but I don't, I mean, I don't even know if it's, you know, if it's possible to do a kind of a study like that over that length of time, that would really highlight that, Hey, we, we actually need to invest more money upfront at really solid psychological services, because if we don't like. This person's gonna have diabetes and we're gonna be amputating a leg in 15 years or something like that. Sean (01:37:46.902) I told the woman from the insurance company, it was a president. I told her that five to 10 minute conversations that I have on a random Saturday night at 11 o'clock at night, save you 100, hundreds of thousands of dollars, because this is, these are the patients that would be going to the emergency room and then being psychiatrically hospitalized. But from a DBT model, we're trained to be able to respond to that, but they're also being treated with skills. So we're coaching them on how to respond in high intensity emotion and we're preventing crises. Now that's a model that we don't have in the United States. The one hour or 45 minute, 50 minute psychotherapy session once a week is an antiquated model and it doesn't help a lot of people. I understand there's a lot of people on social media who proclaim the value of psychodynamic therapy and I'm sure it is effective in a lot of different situations. but it really tends to be a treatment of access where people are generally functioning fairly high. But I'm working with somebody who is in acute crises in an outpatient facility trying to get really good care with family members that don't know how to respond anymore. And it's a high stress environment. It requires a different skillset. You have to have, you have to be confident. You have to be able to know what to say to be able to talk people down off the ledge, literally. And so my previous background, I was working in the juvenile justice system. I was in psychiatric hospitals. I was in in-home family, uh, family services while I was getting a doctoral degree, and so that honed my skills and that strengthened me to be able to be confident in being able to deal with some of the most challenging situations. That's not trained in my doctoral program. That wasn't trained by supervisors. And so if you just do the, the type of therapy that is typically supervised or that you learn in academic environments, then I think it fails a lot of people, unfortunately. Josef Witt-Doerring (01:39:57.458) You know, another thing that's come into my mind, and I wonder if you could reflect on this, is that maybe for a lot of psychologists, they like having the psychiatrist there, because if someone's in acute crisis, instead of answering that call, they say, you know what, we need to get you in to see a psychiatrist. And then anytime they say anything about being suicidal, instead of working with it, they say, You're no longer appropriate for outpatient care. We've sent you to a psychiatrist. It hasn't helped time to go to the emergency room and they can just kind of punt it up the line and just say, I've done my, I've done my job. Sean (01:40:29.118) It's a diffusion of responsibility. And we see it all the time. And in fact, it's getting much, much worse. It, the, the mental health crisis that exists is not only due to poor medical care. Uh, it therapists are driving this. Therapists have a, a much lower tolerance for distress and uncertainty that at any point in in our history because they're scared of litigation. They're scared to be able to really be present with somebody who is suicidal. Everything turns into protect the license of the individual and get them into a higher level of care. But our outcomes are very, very clear. Once you psychiatrically hospitalized somebody, you are increasing the risk of a completed suicide, unfortunately. And I know there are some situations where there really, there's imminent risk and danger, there's nothing you can do, and that period of safety for 24, 48 hours or longer might be necessary, but we're hospitalizing way too many people out of fear and poor skill. Josef Witt-Doerring (01:41:44.062) Is that something that really hangs over the heads of most psychologists? Like you guys, do you learn this in your training? Like this was an instance where, you know, they didn't refer to psychiatry. And as you can see, like this person ended up paying hundreds of thousands of dollars. Like, is that, like, is that a real, like, is it really something that plays out visibly like this, this failure to send to psychiatry or send to the emergency room? Sean (01:42:11.63) Well, it's kind of through fear, it's communicated to you as meeting a legal and ethical standard. So I think it's important to understand your limitations and have your boundaries of competence, knowing what your boundaries of competence are. At the same time, if you are not aware of the limitations of the system, you just continuously make recommendations that create harm. only based out of that fear that something could happen to you legally. When you take your when you take your EPPP, your board exams, things of that nature, you know, it's they're going to ask you questions about, you know, your collaboration with a medical professional. And so it is part of a standard of care that is part of the training. And I do I do believe you have to have that type of collaboration with medical professionals. You just have to have, you have to be able to have a role in this where you communicate things from your perspective. You're a part of a team, not diffusing responsibility to another professional. Josef Witt-Doerring (01:43:19.218) Yeah. Sean (01:43:23.094) Yeah, I would say that's where sometimes lack of experience comes into play. Cause if you're a younger clinician or you've somebody who only been working for three or four years, when you encounter somebody who's in a suicidal situation and I'm not a clinician, but if they're saying things that makes them appear suicidal, I think that fear comes in. And then when you talk to a psychiatrist, you look at them as the authority in that situation, instead of looking at yourself as a partner, trying to come up with the right solution. Josef Witt-Doerring (01:43:51.146) Yeah. Sean (01:43:56.066) Good discussion. Glad you asked those questions. I think they're, they're important. Josef Witt-Doerring (01:44:02.958) Mm-hmm. Yeah, yeah. Because it's really like a system-wide thing. I mean, there's so many areas. You know, when I have you over on my show, Roger, I'm going to talk to you all about how we can fix the psychology profession and all of those. I just cannot wait. Yeah. Sean (01:44:23.01) I have a lot of thoughts. I think you build it into children at a young age, that resilience, that strength, that ability to overcome struggles and adversity. Yeah. I mean, there's things that I call pop psychology that have become so present in American culture. You know, people who have no business being on American television, communicating to American parents about this pop psychology that kind of fits this capitalistic model of materialism. You know, there's some things that we just have to kind of go back, you know, in history that we've learned. You know, that was the interesting, one of the interesting quotes from our last doctor that was on Dr. Stulman. He said, some, you know, sometimes I think it's, it's my job just to remember things that other people forgot and then communicate it to them. And he was talking about medicine and you know, it's the same thing with just human resilience and coping. You know, there's no doubt that I think as a, as a culture, uh, we are becoming, Josef Witt-Doerring (01:45:07.895) Hmm. Sean (01:45:19.726) for lack of a better word, you know, just a little bit more soft and having a difficult time meeting the demands and challenges of life. Jonathan Haidt wrote that very critical book, which was The Coddling of the American Mind. So there's been a lot of cultural and kind of systemic factors that have led to a fear-based culture where there's a failure to launch and a lot of younger people are struggling to cope with day-to-day. challenges that exist. Life is hard. Life is really, really difficult and challenging. And we're not doing a very good job of preparing people to meet the demands of modern society. Josef Witt-Doerring (01:46:01.659) You know, another thought comes to mind before we, you know, you know, that I want to get in here just on this interview, because I think it's interesting is, what do you think of the, where do you see the role of psychiatric medications, you know, having, having been on the, on your side and seeing things unfold? I mean, you know where I stand on all of this. What's your take on all of it? Sean (01:46:26.266) I see it as emergency medicine. Rare, short term, and for purposes of stabilization, and with to the best of one's ability providing informed consent. But when it's emergency medicine, sometimes there's situations where the individual can't consent and we certainly understand that, but it should be rare, it should be short term. And we then should be considering all the alternatives to help. Josef Witt-Doerring (01:46:28.426) Yeah. Sean (01:46:55.342) be able to restore a person out of an episode. Because a lot of these conditions, I think, historically have been episodic. Some data on bipolar disorder or manic depressive disorder, dating back to like the 1950s. And this is out of like Robert Whitaker's journalistic work that 85% of hospitalizations for a manic episode were only one episode. It wasn't always a chronic condition. And we've seemed to turn an episodic condition into chronic conditions when we started managing them with psychiatric drugs. Josef Witt-Doerring (01:47:35.574) Mm-hmm. Yeah, completely. I mean, the whole idea of maintenance therapy for bipolar disorder, I think people just think it's this given that you need to be on it long term. But I mean, the way I've been treating bipolar back when I was doing that in private practice was just during the acute manic episode, quickly weaning them off and waiting for them to stabilize. But Yeah, I definitely think we make it more chronic. People on Twitter, they hate it when I talk about bipolar disorder. You know, I'm kind of always going after that one. It's the one that's the most misdiagnosed. People really don't like what I have to say about bipolar. Sean (01:48:15.33) Because I think that's the piece of our culture where they have identified with a diagnosis and unfortunately it can sometimes justify really bad behavior. Uh, I can't tell you how many situations where, you know, I've met a man or a woman who cheated on their spouse or acted erratically in some way, and they used a psychiatric diagnosis as justification for that behavior when, you know, I know it doesn't fit the trajectory of that condition. Um, and there were other reasons for it and that's what happens when they become mainstream. Josef Witt-Doerring (01:48:46.006) What's that like for you? Yeah, yeah, yeah. I was going to say in your practice, I mean, have you found yourself in the position where you've had to, um, challenge someone's psychiatric diagnosis when it's been part of their identity? And, um, you tell me about how that goes. Sean (01:49:04.694) Well, you know, it all depends on the assessment, right? So if I don't have an established relationship with somebody, you know, it's very gently starting to build a new way of looking what they're going through validation and support. The biggest challenge for me is if it's a younger person, you know, a teenager and the entire family has bought into the label. Like for example, I just did an evaluation where a 14 year old is labeled bipolar disorder. And there's nothing about the presenting problems that represent that kind of trajectory or that understanding. We don't have really good data that bipolar disorder emerges at 14 years old. What you're just seeing is emotion dysregulation that exists to legitimate stressors and trauma that has happened occurred within the family. and that emotion dysregulation or the threats of suicide get mislabeled by a medical professional as bipolar disorder, the teen can jump onto that diagnosis, achieve like a disability status, align with other people in a bipolar community, attain a mental illness diagnosis and use that in school environments or with their friends for any time that they... kind of fly off the handle or say or do something that, you know, hurts others. They can go back and say, it was my mental illness. It wasn't me. And that's really damaging because, you know, you're working against a frame that a medical professional has set up and they don't always understand the danger of that, the repercussions of that. The family changes the way that they respond to their own kids, they parent in fear. and they see everything as their mental illness. And the only way that they're going to be able to be assisted is we change the drug or up the dose and we find that magical cure, you know, the exact new drug and the right dose that exists. And that's the challenges that occur in my job currently. And that's why you see me outspoken. This is what I deal with every day. So I'm trying to kind of wake everybody up for what's going on. Josef Witt-Doerring (01:51:14.482) Yeah. Josef Witt-Doerring (01:51:22.702) Great, thanks. Thanks for sharing that. That's where we're going to go as well when we chat over on my show. I cannot wait. Yeah. Sean (01:51:28.694) Yeah, we have a lot to talk about. We'll definitely continue this conversation on your podcast. So at this point, I just want to thank you for the work that you're doing. I certainly respect anyone who's going to stand outside the bounds of what they've been taught and have the willingness to challenge the conventions of their profession. It always puts you at risk. But I think you're doing. you're doing the right thing. And I think it's we need more medical professionals to be able to be this outspoken as you are, because it as when a psychologist does it, it's easy for them just to attack my profession that I don't have the training. But as people as what I'll tell people is I'm on calls like this all the time, you know, I'm talking to experts from around the world. And we're having conversations like this. And there's a lot of people out here hearing these conversations. And I know they save lives because we get the emails. You know, get the emails that these conversations allowed me to look further and have critical conversations with my child psychiatrist or my psychiatrist. And I've learned so, so much. And that's why this podcast has been in the top 10 on the Apple charts at various times, you know, we're proud of that growth because we're having these type of conversations and I hope episodes like this get shared. So we're right back on the top 10 of the Apple charts and this becomes more. Josef Witt-Doerring (01:52:42.424) Wow. Sean (01:52:53.558) mainstream. I think people are going to walk away from this conversation, that it was three people on a call who care about the people we serve. And these are nuanced conversations. There's critical analysis, but there's empathy and compassion. And we're trying to first and foremost, you know, protect people from harms that the system are going to create. So, Dr. Joseph, I really do appreciate your time. Where can people find you, get a hold of your work. You're putting a lot of stuff out there, I think, which is really informative. Josef Witt-Doerring (01:53:30.35) Sure, yeah. Okay, so the best... You know, the first thing, you know, on the topic of potentially saving lives is, you know, we're launching a coaching program. Essentially, it's an educational program on how to do complex drug tapers anywhere in the world with any doctor of your choice. You know, it's really about educating the patient to be the most informed about the best practices in drug tapering, even if you're on five different medications or if you're on one. If you have protracted withdrawal, if you don't have it, it covers everything. And so that's gonna be at perfectaper.com. And so that's if you're interested in doing a complex drug taper with our staff. You know, we oversee it. We're gonna be overseeing it with weekly calls and this is getting launched in October. So really soon. As for a lot of my content. I'm most active on three platforms. So it would be TikTok. So that's just my name, Yosef Witt-During and then also YouTube, that's Witt-During Psychiatry. And then on Twitter, I think it's Yosef Witt-During as well. We're also on Spotify and on Apple podcasts as well. So we're kind of all over the place. Sean (01:54:51.774) Dr. Josef Witt-During, we want to thank you for a radically genuine conversation. Josef Witt-Doerring (01:54:56.114) It was, yeah. Thanks for having me.