Latest / Radically Genuine / 162. A Method To The Madness? Mental Illness From Disorder to Design w/ Justin Garson

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162. A Method To The Madness? Mental Illness From Disorder to Design w/ Justin Garson · Radically Genuine

• Roger K. McFillin, Psy.D, ABPP (00:01.329) Welcome to the radically genuine podcast. am Dr. Roger McFillin. When someone breaks their leg, the treatment is clear. Set the bone, apply a cast, and then it's just time. Wait for healing. But what happens when we try to apply the same model to the vast spectrum of human consciousness and behavior? For decades, we've been attempting to treat mental health quite like a broken bone, identifying symptoms making diagnoses, prescribing treatments. We've created an elaborate system of categories and labels, turning every variation in the human experience into something that needs to be fixed, assuming there is something broken. The result? A society where one in five adults are prescribed psychiatric drugs, where children who don't fit neatly into educational molds are given diagnosis and drugs. before even provided other opportunities for exploration of where their strengths lie. It's where feeling profound sadness after losing a loved one or ending a relationship can even be classified as a disorder if it lasts too long. In our quest to help, we've pathologized the very essence of the human experience. We now know this very idea is actually making things worse. This is obvious. And every statistic, health metric, will demonstrate that that is true. In fact, everything is much worse. What has become the norm is actually preventing people from understanding their experiences in a way that could lead to genuine healing and growth, preventing progress in responding to human suffering in ways that actually advance humanity. Today, we're going to explore a radical idea that what we call psychiatric disorders might not necessarily be Roger K. McFillin, Psy.D, ABPP (02:03.805) broken brains requiring medical intervention, but rather deeply rooted patterns of human adaptation. Patterns that in different contexts might even be valuable or keep somebody alive. To have this discussion today, it's a gentleman who I've been a big fan of. He's a must follow on X. His name is Justin Garcin. He's a professor of philosophy. at Hunter College and the Graduate Center City University of New York. He is the author of Madness, A Philosophical Exploration, 2022, and The Madness Pill, The Quest to Create Insanity and One Doctor's Discovery that Transforms Psychiatry that's forthcoming. He also writes for Psychology Today on different paradigms of mental illness, and I know he publishes in other platforms as well. Justin Garcin, I want to welcome you to the radically genuine podcast. Justin (03:07.35) Roger, thank you so much for having me. I've been a fan for a while, so it's really just an honor to be here. I appreciate it. Roger K. McFillin, Psy.D, ABPP (03:15.185) Yeah, as I said before we came on here, I think you and I really do share some philosophical foundations and, you know, I'm, hopeful that we can get into many different directions that can serve the, the audience. So many people often asking, okay, well, what are the, what's alternative approaches? But I think it's important to understand you first, from what I have read, there are some, you know, distinct personal experiences that have shaped your academic interest in mental illness. Justin (03:43.522) Sure, absolutely. So yeah, I've had a lot of mental illness in my family, as I'm sure many of your listeners do. In the 1970s, my dad was diagnosed with paranoid schizophrenia. And what's fascinating about that is that he was actually working under the American president, Richard Nixon, at the time. And he formed the delusional belief that he was being spied on, that maybe his phone was bugged. apartment was bugged. And of course, we now know that Nixon was famous for spying on his staff. And that raises philosophical questions in its own right about delusions versus rational suspicions. at any rate, in the early 70s, he was able to get to a psychiatrist and say, I don't want you to give me drugs. I want to talk this through, but I don't want drugs. The psychiatrist said, okay, we're not going to give you drugs. They were able to talk things through. and he was able to get better. In the 1980s, he was re-diagnosed with bipolar disorder. Some doctors had it as schizoaffective disorder. But as you know, by the mid-80s, we were in the grips of this disease model, this dysfunction-centered model. The idea of going to a psychiatrist and a psychiatrist saying, I agree, I will not give you drugs, that would have been considered medical malpractice at the time. So he was regularly hospitalized, he was drugged, really impacted his ability to think clearly, impacted his ability to work and ultimately took a real toll on his physical health. So I always grew up wondering, know, what would the alternative have been? What would have been some alternative ways of thinking about my dad's problems? And then in the... 90s, I was diagnosed with depression, put on an adolescent psychiatric ward for six weeks. That was probably about what insurance companies would reimburse. So incredibly, you'd be there four weeks, six weeks, and then they decide that you were just fine. But this was right at actually the height of the Prozac revolution. So if you were diagnosed with depression, you were told this is a chemical imbalance in your brain, you were put on Prozac. Justin (06:09.172) And I don't know if that helped me or not. It probably helped me not so much the drug itself, but the belief that somebody knew what was going wrong and somebody knew how to fix it. I think that was a very powerful belief. And at the time, just as a side note, people weren't put on drugs like Prozac for years at a time. That's not at least how I remember it. I remember being told, you're going to be on this drug for about six months. It's going to fix the synaptic imbalances in your brain. and then we're going to get you off the drug. So it was more common at that time to think of it as a temporary fix. But I'd never heard any alternative to these disease centered, drug centered, disorder centered models. And then I'll just tell you about this last part. I got to graduate school for philosophy and I came across this book called Why We Get Sick. And it was written by a... psychiatrist and an evolutionary biologist. It's a wonderful book. And the point that they make in that book is that a lot of the things that we think of as diseases or disorders really aren't. They're actually, from an evolutionary point of view, they're designed mechanisms that are trying to help you. They're designed mechanisms that are trying to help you navigate the problems of life. an example is fever. Before about 1700, fever was generally thought in the West as a terrible disease. this patient is hot. What are we going to do about the heat? We've got to drug it. We've got to, you know, purging and bleeding and vomiting and all kinds of barbaric things. Around 1700, there's a group of doctors who thought, well, wait a minute, hold on. What if fever is actually nature's designed mechanism that's supposed to help you fight off? disease and not the disease itself. That changed everything about how we think about fever. So in this little book, Why We Get Sick, the authors suggest, you know, we think that depression and some of the things that we call mental illness work exactly the same way. They say, for the most part, depression is not some kind of a chemical imbalance or a disease or disorder. It's your brain's designed signal that something Justin (08:30.858) in your life is not going well and needs more attention. And I thought, well, wait a minute, if this is true, everybody needs to know about this because it means we've been doing depression all wrong instead of bombarding it with pills. What we should be doing is stopping and saying, okay, what is your depression a response to? And so that's how I got into this. I got fascinated with this idea that what if a lot of the things that we think of as diseases or disorders are actually functional, adaptive, from a biological point of view, purposeful? And then how can we get that paradigm out there? I think that is an alternative that we've been lacking. Roger K. McFillin, Psy.D, ABPP (09:20.399) in all my years working with people who are suffering and distress or what we label as depression. And that's important to know that the idea of depression is just that it's an idea. It's something that we use to try to understand what someone may be going through. I am curious, reflecting back now on your teenage years, what do you attribute the causes of your depression at that time? Justin (09:26.38) Mm-hmm. Justin (09:47.916) I mean, that's a huge question, but it started when I was about 15 years old. didn't want to leave my room. I didn't want to get out of the house. I didn't want to go out and do anything. And I attribute it to just such ordinary and mundane teenager problems, know, problems of going to a new high school, feeling like I didn't know anybody. feeling like I couldn't make any friends, feeling like I didn't know how to connect to people and relate to people, feeling like everybody else was out there having fun and I'm not, you know, I'm struggling to make friends, dating was out of the question. So when I look back at it, I think, okay, this was pretty run of the mill. Teen. problems. And then you pointed out earlier, what is it? Something like one in five people are now on psychiatric drugs of various kinds, not just the antidepressants. But I really do wonder how much of this is just people grappling with really difficult situations. And, you know, from this evolutionary point of view, they would say, yeah, so your brain is trying to tell you that something is seriously wrong. And I just You can't get into this, well, what if I had been given these alternative messages? How might my life have been different? I don't regret how my life went. I don't regret any of my experiences. They've all contributed to who I am today, but I do sometimes wonder what might have been different if somebody had sat down with me and said, Justin, your depression is not a brain disorder. It's not anything going wrong. with your brain, there's no defect or gene problems. This is a perfectly natural response to the kinds of problems that you're facing in life. I think I might have been given the kind of strength and optimism to say, okay, let's confront some of these problems and let's tackle some of these problems rather than thinking, okay, something's wrong with my brain, but thank goodness for these doctors and their pills and their... Justin (12:08.726) psych wards because they're going to fix whatever the problem is. Roger K. McFillin, Psy.D, ABPP (12:12.209) Yeah, I mean, it's, I think it completely changes the outcome. If you would look at struggle in life or an episode such as that as potentially transformative, because I don't know if we're sitting here on this microphone, if you're, if you would be doing the work that you're doing, which I think has the potential to really, create widespread change to improve the way that we think about mental health. If you didn't go through something like that yourself. And so I think there's like a wide angle lens that you can step back and see our lives as these journeys. And within these journeys, there's trials and there's tribulations and we fall down and we struggle. And it's within that process that we actually create and grow stronger. And so this meaning making that's attached to what, what a person goes through is, it's certainly, you know, much more beneficial than saying, Hey, it's outside your control. You know, it's something, it's a genetic mishap, unfortunately, you know, in the, in the in biology and in evolution. You just got the bad deck of cards. So sorry. Justin (13:12.918) Yeah, absolutely. And this is, as you pointed out, this has been shown. So a good friend of mine, when I wrote the madness book, a psychologist, the University of Minnesota reached out to me and he said, I'm so grateful you wrote this about function and dysfunction, framings of depression, because I've been working with my patients in exactly this regard. And what he did, this was incredible to me, he did an actual experiment where he got together about 800 people who had some experience with depression. And he said, you know, how does this actually affect people telling them that their depression is a brain disorder versus telling them that their depression is their brain's wake up call? It's trying to get them to see something going on in their lives needs to be changed. he did this whole experiment where 400 Roughly 400 people, he said, we now know that depression is a chemical imbalance in your brain, but fortunately it can be dealt with by various kinds of methods. Here's some resources for exploring these. Other half of the people, he said, we now know that depression is actually far from being a disease. It's your brain's wake-up call. It's your brain trying to tell you that there's something in your life that's not going well and needs more attention. Fortunately, there are resources for dealing with it. Here are those resources. What he found is that when he told people that their depression was a signal that something in their lives was going wrong, they felt far more optimistic about getting better. They felt far more optimistic about going to therapy and working through those problems. They felt less stigma. They felt more able to share with other people their mental health problems. So this is... I mean, I think it's important people know everything that we're talking about. This has all been demonstrated or is in the process of being shown that these messages really help people. And as you said, when I look back at my own life and I look at all of the struggles with my dad and then my own struggles with depression and then the psych ward and the drugs and how people responded to that. Justin (15:31.872) I do take this meaning making perspective. say, okay, all of that was part of what I'm doing now. And it's all, it's all part of what's become my kind of academic purpose and mission. That's a very healing perspective to take on. Roger K. McFillin, Psy.D, ABPP (15:52.155) psychologist work that you just mentioned is that Hans Schroeder Justin (15:55.34) That is, yes. Yeah, he's doing incredible work and he's doing a lot of variations. We just met up last week at a conference and he's doing a lot of really fascinating variations on this kind of theme. One of the things I'll just say real quickly, because I'm so excited about it. A lot of people sometimes question, they say, okay, the problem is when we look at... depression or low mood as biologically caused. And what he's showing in his research is that there's nothing particularly harmful or stigmatizing about telling somebody that their low mood or their depression has its source in your brain. That's not stigmatizing. What's stigmatizing is specifically this message that there's something going wrong in your brain. If you tell somebody, yeah, your depression is actually It's your brain's wake-up call to try to get you to look at something in your life. People feel optimistic about that. it's not, there's nothing inherently wrong with presenting it as a biological brain-based phenomenon. What's wrong is presenting it as a dysfunction, as an example of something broken inside of you. Roger K. McFillin, Psy.D, ABPP (17:15.025) tried to get Hans Schroeder onto my podcast to discuss these things and he turned me down. Maybe you can have conversation, see what he's afraid of. Justin (17:19.316) Okay, well... Well, maybe he has his own reasons. don't know. Roger K. McFillin, Psy.D, ABPP (17:26.462) Because I think this is really important work that he's doing that we have to talk more about. So let's go back to that. I think we would probably advance conversations if we could separate mind from brain. So I mean, we talk about it like as if we just have this knowledge that the brain emits consciousness. And I think we're starting to get some pretty innovative research that suggests that's that's not Justin (17:28.322) Yeah. Yeah. Roger K. McFillin, Psy.D, ABPP (17:51.801) necessarily the case. And when if I look back at you at 15 years old, you know, there were things that were going on in your life, then in itself that right now you kind of report them to be normal developmental challenges, nothing necessarily stands out that you were you were facing, but you do retreat inward to your own mind. And in our own minds, we are creating a reality. Justin (17:52.023) Hmm. Roger K. McFillin, Psy.D, ABPP (18:16.665) And certainly at 15 and many adults too have a difficult time being able to separate between, you know, what is our mind and what is actually real. We're kind of actually living by, you know, how we perceive the world to be. So we have these ideas about who we are, how others are going to treat us. The mind creates stories. There's the meaning making, there's judgments. We go back in the past, we fixate on certain things that are like somewhat painful. Justin (18:27.203) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (18:43.469) And then we kind of generalize it to other circumstances and we're developing the sense of self and that's, you know, that exists within the mind. But when we say it's emitting from the brain, it's very easy for someone to say or come to the conclusion that I do have a brain disorder. And in fact, the National Institute of Mental Health devotes billions, I think over $40 billion have been really dedicated to try to identify brain biological substrates, correlates, origins to this so it can be treated biologically. But what's your understanding of that differentiating brain from mind? Justin (19:25.388) Yeah, I mean, it's a huge question. The way I see it... Everything stems from our brain or has some foundation in our brain, our love and anger and pleasure and anxiety and just being able to perceive the world. Raise my hand. mean, all of that is the brain and the nervous system. It's all based on that. But saying that is almost trivial. It's like, well, that doesn't communicate anything about the source or the meaning. of my experiences. So I think a lot of, know, sometimes talk to a psychiatrist who will say, well, Justin, you know, everything is based on the brain. Everything stems from the brain. Your mind is just a part of your brain. And I respond as a philosopher, I respond by saying, yeah, of course, but that's telling me literally nothing. It's like saying my raising my hand has to do with my brain. Well, of course it has to do with my brain. It seems to me, that's what I was just saying about Han's work, that the real... thing that I want to fight against is not so much the idea that your brain is implicated in all of your physical and emotional well-being, but specifically this idea that mental health problems, know, low mood or anxiety or having difficulty focusing or forming weird beliefs that you can't get anybody else in your culture to accept. I mean, to me, the problem is the idea that these stem from some kind of a Justin (21:05.986) dysfunction or defect or disease. So it's that disease centered framing that I really want to fight against. Justin (21:18.55) At the same time, I do think that we don't fully appreciate how much power that our thoughts have, how much power our beliefs have, how much... Justin (21:34.316) how powerful they are in our general sense of overall health. just, I've been dealing with this thing recently where I've been feeling very fatigued a lot. And I think, boy, you know, maybe is it my, I need to be taking more vitamins or getting more sleep or, you know, is my just aging hormones. I'm immediately thinking about the potential biological causes. of fatigue and only recently realized my fatigue is effectively me telling myself I'm not up to the challenges of life. I have a lot of things going on and as we all do, I have a lot of different challenges as far as work and family and writing and traveling. And there are times when I just get into this mindset where, you know, I'm, I can't do it. I'm not up. to all of these challenges. And I genuinely believe that that sense of fatigue, can't, boy, how am I even gonna get through the day without five cups of coffee? I genuinely think that that fatigue is really, it's not so much, mean, sleep and vitamins and hormones. Obviously all that plays some role in mood, but it's... It's more, okay, what am I believing about myself that's leading me to experience this kind of fatigue? Roger K. McFillin, Psy.D, ABPP (23:10.269) Yeah, I mean, I'm absolutely fascinated by the impact of the mind on the body, which is what you're referring to, not necessarily, you know, which is different from the other way around the impact of the body or onto the mind or the brain onto omitting consciousness, behavior and emotion. Because I'm not so sure everything stems from the brain. And, and that's a very reasonable viewpoint from, from materialism in its viewpoint of Justin (23:15.468) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (23:38.713) of science and the use of science, but I don't know if I'm going to take us off topic on this. I'm going to bring up two areas of study that exist that aren't well known that would create problems with the idea that everything is emitted from the brain. One right now is the study of nonverbal autistics. Not many people know this and I would... Justin (23:56.546) You Justin (24:02.551) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (24:07.035) really encourage everyone to listen to this podcast called the Telepathy Tapes. Absolutely fascinating. It's blown my mind. What they've discovered and actually known quite for quite some time, but it's really withheld from mainstream science and mainstream American culture. The media doesn't in any way highlight these things is that they have discovered that nonverbal autistics are telepathic. They can read minds. And how do they know that? Very controlled experiments where these nonverbal autistics can type their answers to questions. So they're not speaking, but they've learned language and they can type and they answer the questions and they can tell what someone else in another room is actually thinking. They can tell numbers that are popped in their heads. Parents of these nonverbal autistics have known this for quite some time, but they're just not really heard. The strange things that we're learning about this is these nonverbal autistics also can type their answers in like 10 different languages. So tell me how a nonverbal autistic in Atlanta learned Mandarin, never taught Mandarin, but knows Mandarin and can write in Mandarin. I'll step back another fascinating thing about these studies, and this should be blowing people's minds, is these nonverbal autistics from around the world are reporting the same thing. They're meeting with each other on a hill. Not physically, of course. They're tapping into a consciousness, and they are meeting with each other on what place where they call the hill. So like, a nonverbal autistic in Italy can speak to the same situation that a nonverbal autistic in Los Angeles is experiencing. this is mind-blowing in how we think about consciousness. The other aspect is the studies of near-death experiences. So consciousness continues to exist when the brain is not functioning. And those who have died or you know clinically dead identified by physicians have continued their consciousness continues to experience other things. Right? Roger K. McFillin, Psy.D, ABPP (26:23.719) So I do think we're somewhat limiting ourselves by saying things everything emits from the brain because we might be limiting possibility. You know, we only know what we know. We don't know what we don't know. And that's what we're not really good at that as human beings. Like we're not very good at accepting these uncertainties and what goes on beyond the five senses or the metaphysical or anything beyond that quantum reality, quantum physics. Justin (26:49.952) Well, I mean, first of all, that's fascinating. Just for the record, I mean, I've come into philosophy with such a kind of modern materialist mindset. So I'm skeptical. I will dig up these reports that you're talking about and look at it. But I mean, I am going to look at it, but just for the record, I'm skeptical. I've always had this very, you Roger K. McFillin, Psy.D, ABPP (27:08.568) The telepathy tape. It'll blow your mind. Justin (27:19.04) materialist. And that's why I said when somebody says, you know, depression has to do with your brain. I always respond by saying, well, of course it has to everything has to do with the brain, you know, that what is what's new and you're you're taking it this really kind of interesting, new kind of spiritual, non materialist direction where you're open to telepathy and near death experiences. But let me just say even even from the perspective of somebody who's naturally very skeptical of that. I want to be open-minded, but I have this background that just says, well, wait a minute, modern science and its materialist outlook is just the foundation for everything. I've been talking to people who have been taking more spiritual perspectives on what we call schizophrenia, on what we call delusions and hallucinations or voice hearing in particular. And even if you're like me and you're like, well, I don't know if I believe that or not, I'm open-minded, I'm not sure if I believe that, I can see that we are denying people very powerful meaning-making frameworks as far as coming to terms with those kinds of experiences. And so there's this amazing research, you've probably seen it, an anthropologist named Tanya Lerman, L-U-H-R-M-A-N-N. And what she's been showing is that the experience of hearing voices differs tremendously in different countries. So she's done this work in the United States, in Ghana and in parts of India. And more recently, some anthropologists have done this in parts of rural China. And what they've shown is this. In the United States, when people hear voices, and not just hearing voices in the sense of falling asleep, but hearing voices in the context of schizophrenia, we tend to think of that as a brain defect. And correspondingly, we tend to experience those voices as being hostile, Justin (29:30.75) as being intrusive, as being critical, as driving you insane. I need to get away from these voices. Whereas in parts of where they've done this research, in parts of Ghana, India, China, voice hearing in the context of schizophrenia, people tend to believe that voices are associated with either spirits or deceased ancestors. And when people have those cultural framings, the experience of hearing voices tends to be far less distressing and the actual content of the voices tends to be far more helpful. You think about it, if I believed that these voices were the voices, if the only cultural framework that I had to make sense of voices is these are departed ancestors or these are spirits who want to communicate something to me, generally going to see them as beneficial and helpful and wanting to give me guidance. And one thing that I think about a lot with those observations is that if that's true, then psychiatry is doing a real disservice to people. I mean, it's a profound ethical problem. If the way that I'm framing your experience of voice hearing by saying, it's a disease, it's a defect, but don't worry, we have the pills. If that very framing is changing the content of the voices, the emotional tone of the voices, your relationship to the voices, then I'm ethically culpable for some of these negative outcomes. And I think that psychiatrists... are not taking this ethical responsibility seriously, but need to. I guess skeptical as I am of, know, look, there's just the physical universe and that's it. Don't tell me about, skeptical as I am of spiritual framings, I do see that we are depriving ourselves of a very powerful meaning-making framework. Justin (31:52.554) in taking this very kind of blithe disregard from. Roger K. McFillin, Psy.D, ABPP (31:56.103) Yeah, very well said. And I think you bring up a very important ethical question. If we look at it scientifically, we would say that other cultures who do take a different framework and understanding hallucinations and delusions have better outcomes, better recovery, higher functioning, returning to real important aspects of their life with relationships and work. And we're under a collective delusion in Western medicine, that the idea that it is something that is broken within the brain that can be treated with Justin (32:05.496) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (32:25.061) anti-psychotic drugs is scientific progress. And it reflects the greatest that science has to offer as far as achieving stability. It's so ingrained into our cultural lexicon. You'll watch movies and so forth. You'll just hear like, he's crazy because he's off his meds. Right? It's like that associated. It's like you're on meds, you're sane, you're off these drugs and you've completely lost all sanity. And it doesn't fit an actual scientific narrative from from Japan to Africa to indigenous cultures or so forth. So I absolutely believe that the manner in which we're going to frame it, and this is how I apply it to my work as a clinical psychologist, I work with trauma survivors and some of those traumatic experiences have been extremely severe and very difficult to be able to return to functioning and living after going through something so horrific of obviously, fear will overtake that person and that, I guess it's almost a, you know, the survival mechanism really of fear is what kicks in. And so their mind or their reality is about survival. And certainly, yeah, that activates biologically within us, we have to keep this body alive and the mind and the body are connected just like that. But when we do begin to start shifting perspectives, Justin (33:46.231) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (33:52.955) when we don't look at maybe a hallucination as something that's a reflection that, you know, that they're mentally ill, but rather this adaptive mechanism for survival and even overcoming it. When we step back and we take even spiritual looks at what that person may go to, what I see is that the distress around the delusion decreases. then the frequency of it and it becomes actually episodic. It's almost telling us like there's something for us to learn from this. And how can we learn from it and how can we use it to grow? That's why I like to think about, you know, struggles, whatever they may be as transformational. And if they're in other traditional or indigenous cultures, you know, you might have an elder or somebody that is within your tribe. that we'll actually see that as some gift, like you're tapped into some spiritual energy. And so, yeah, people have various views on spirituality and so forth. Although I think 85 % of people identify with some sense of a God or source, like there's something ingrained with us in human beings that say, there's something bigger, there's something greater, there's something beyond this. I think we can even tap into like, quantum reality, quantum physics, and what we do know about science that we all can agree on. So right now, how are you and I looking at each other? Where are you located right now? Justin (35:24.149) I'm here in New York. Roger K. McFillin, Psy.D, ABPP (35:25.339) You're here in New York, I'm in Bethlehem, Pennsylvania. So we're about an hour and a half away, not too far away, but we're instantaneously communicating with each other. So we've tapped onto some frequency that exists that allows us to have this to happen. Same thing with if we're going to listen to music, right? There's a frequency that we've tapped into. We can't see it. It's not there, but it's affecting our physical reality. So how are we then to say as reasonable, rational and open-minded Justin (35:27.733) not tooth. Roger K. McFillin, Psy.D, ABPP (35:55.27) people that there isn't another frequency that a human being can tap into. And doing that leads them to experience sound, voices, messages outside of what we experience. Now, this is well known mediumship, for example, there's actually well grounded science in telepathy. There's this ability to tap into energy. that is as solid of a foundation of science as is there the identification of the flu. But why, but we would ignore that and we would speak about it in skepticism because we can't observe it, but we don't observe radio waves or the internet or EMF that's coming from our devices or 5G. Like there's a lot of things we can't see that affect us, correct? Yeah. Justin (36:44.696) Sure. Yeah, I mean, it's a deep philosophical issue. Why should we be closed off to the prospect of realities that we cannot see with our five senses, given the kinds of things that you talk about with the near-death experiences and people taking DMT and having these experiences of spirits coming in and out of portals and the experience of people in other cultures where there's much more of a spiritual framework for making sense of life. And that, you're not gonna convince me probably in the next half hour or hour that I have to change everything about the way that I think about reality. But I do want to grant you that these... One thing I like about these kinds of evolutionary biological framings is that they show, even if you take a skeptic, even if you're kind of skeptical of non-material realities, and even if you're, even if you take this kind of robust materialist Darwinian point of view, even if I stubbornly stay within that point of view and say, Roger, I don't want to hear about spiritual realities, it's all just the brain. There's still ways of getting to the same kinds of conclusions. There's still ways of saying, look, even if you take this kind of conventional biological evolutionary point of view, you can still converge on the same message that what we call depression is an adaptive signal trying to tell you to look at something. What we call, hallucinations can be an adaptive a wake up call that the problems that we talk about under the, know, ADHD or dyslexia or some forms of autism could be alternative cognitive styles with their own strengths and benefits that are no better or no worse in the sense of being inherently disordered. So as I see it, one thing I really like about the evolutionary Justin (39:07.906) kinds of framing is it's almost like a device to help, even for people like me who are kind of materialistic and skeptical, it's kind of a device to help shift perspectives and get us to that more, let's see some of these problems as functional, as adaptive, as purposeful, and let's think about how we can make meaning out of them. And the things that you're saying remind me of the, I think the movie, the documentary, Crazy Wise. I don't know if you've come across that. It's an incredible documentary. John Reed is one of the people that they talk to in these. But they follow a couple people who have been diagnosed with schizophrenia and are coming to these spiritual understandings. of their hallucinations and delusions, what the doctors call hallucinations and delusions. And it's a very powerful story. And it's showing exactly this, that we really have, in the West, we've really abandoned certain kinds of framings that are helpful and important. Roger K. McFillin, Psy.D, ABPP (40:29.467) Yeah, I think you brought us some really important points earlier about how the psychiatric framing of mental illness in itself could be creating more harm than good. So I want to poke some more holes, I think, into not only our framing of mental illness, but the treatment of it. You had this great post on X a little while back where it was a thread. And I'm just going to read the first part of it. Anyone who spent time on a psych ward Justin (40:40.92) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (40:58.321) gets the basic mechanics. You're forced to comply with low level frustrated and often sadistic staff. Reasonable outbursts against your treatment are seen as signs of pathology and used as grounds for drugging and more confinement. That was your first part of it. that experience or then the entire thread. in my opinion, was one of your best arguments for shifting from a disease model to one of potential function and adaptation. Because the post represents some of my greatest concerns about a perceived medical authority, and then how they can manipulate an understanding of science that actually supports inhumane tactics for controlling behavior. And in a greater perspective, from like a government perspective, it can support, you know, authoritarian control. it could discredit those who resist or dissidents or, you know, political adversaries by labeling them as mentally ill. So the entire concept of mental illness can be used as a weapon that is waged against somebody. And I think that is and does happen in our Western culture. The easiest way to describe it is when you see a victim of abuse or a victim of trauma, a rape victim, somebody who, you know, is in a domestic violence situation, right? And then their reactions themselves are pathologized as like borderline personality disorder or bipolar disorder. Justin (42:32.566) Yeah, I I mentioned to you that when I was 16, I was hospitalized for four weeks and I was on Prozac for several months and I got better somehow through the reassurances that it was a brain problem and they could fix it with the medication. But I think also just being with a group of kids my age who were having similar problems and realizing, okay, this is actually pretty normal stuff that I'm dealing with. One real negative outcome of that experience, I believe, despite the fact that in some ways it looks very positive. Okay, I had this experience of depression, went on the pills, the hospital. I got better. Despite the kind of day-to-day violence of being in a psych ward, the day-to-day invalidation. I think the absolute worst outcome of that experience for me was this haunting sense of always self-questioning, always wondering, you know, do I want to do that or is that my brain, is that my disorder? You know, should I go to graduate school for philosophy or should I do this other kind of thing or should I do something different? I always had a profound sense of almost like my basic capacity as an agent to set goals, to make choices and to take action in the world had somehow been destroyed by the belief that there was something wrong with my brain, that my brain wasn't working right, that my desires, my thoughts, my perceptions of reality were flawed and incorrect. And what I'm seeing now And it's terrifying. Back then, there was a very, very small, I mean, this is the early 90s, a very small proportion of teenagers would be hospitalized or drugs. That was still considered pretty extreme. Now you have a situation where, what is it, one in five American college students, I believe, are on antidepressants. I don't know exactly what the numbers are for the general. Justin (44:53.074) youth population, but you have a whole generation of young people who, and it's unmistakable, you see it all the time, and I can see it clearly because I experienced it and I know it when I see it, you have this whole generation of young people who feel this sense of invalidation. Well, I don't know, I had this idea, but maybe it's a stupid idea and maybe it's just my brain kind of freaking out, maybe it's just because I haven't been on my meds, you know, I've been feeling really like maybe I don't want to pursue college. Maybe I should go do a volunteer work in Africa. But that's probably that's probably just my my my depression or it's probably just my lack of focus in life or it's probably some other. And this psychiatrized language has so gripped them that I genuinely worry that there's a basic sense of agency. that's been lost, a basic sense of I perceive my world relatively correctly. Sometimes my perception of the world can be distorted by bias, we all know that, but my perception of the world is generally correct and the desires that I have are generally worth listening to and pursuing. And if you don't have that belief, if you don't think that your ability to perceive the world is generally correct and that the desires that you have are generally, sorry, I think because genuine and I keep seeing that and so I'm having trouble saying the word generally, if you don't think that you perceive the world correctly or that your desires are valid, then you're just going to shut down. You're going to... want somebody else to come along and tell you, Justin, here's what you need to be doing. You need to get your college degree. You need to pursue a job and you need to settle down and raise kids. You're going to be totally susceptible to being controlled by other people if you do not have a basic sense of your own agency. And I think at the most fundamental level, that's what these disease framings are taking from us. They're robbing us of a sense of agency. it's Justin (47:09.844) Again, it's unmistakable. You see it all the time, the sense of, don't know what I should do, not just because I have a lot of options and I'm young and the world is wide open to me, but because I don't trust my basic capacity to perceive the world, to reason about the world, or to trust my desires. Roger K. McFillin, Psy.D, ABPP (47:29.181) So well said, so well said. Let's take it a step further because we're at this unique point in history where mental illness is actually being celebrated online and through social media and like widely adopted as a disability that's beyond one's control. So that's the kind of meaning making, but it provides especially young people, like a sense of identity, community, and in some respects like a. certain rights and privileges. And it's being used as a way to justify any perceived challenge that that person has had to incur, which many of them are just quite normal, developmentally normal. Like, I lost my best friend because of my ADHD. Or like identifying as actually autistic, right? Because they don't pick up on every social cue or they have skills and talents that... incorporate their mind in other ways. But how, you know, how did you think we've got we've gotten to this place? And what are some more consequences of adopting this mental illness as an identity? Justin (48:38.2) Yeah, I I think that's a very serious problem. Again, not wanting to keep going back to my experiences, but in the 90s, there was a sense of, if you got labeled with some kind of mental disorder, I think that you were cynical about it. You just said, yeah, some shrink told me I'm depressed. Some shrink told me I have borderline personality disorder. And there was a kind of identity, but it was an identity of you're probably a troublemaker and some shrink came along and labeled you. But we really, there's a sense of skepticism towards psychiatry. Like what do these doctors know what their labels and their drugs and their little. And what's astonishing to me is seeing Mental disorder labels become an identity, as you said, an identity to be celebrated, the basis of community with other people. And I think that there's a New Yorker staff writer, Rachel Aviv, she wrote this beautiful book called Strangers to Ourselves. it's really about... identity and how psychiatric identities can be harmful in their own right. She talks about how when she was, believe, six years old, she was diagnosed with anorexia and hospitalized for a brief time. And what she says, and it's very profound and moving, is that she was so young, she didn't really understand the concept of anorexia. And she couldn't, she was too young to understand that as a potential identity as serving these needs of identity, community, acceptance, and so on. And she writes that she thinks that's one of the reasons that she was able to recover and move on with her life is because she was too young to even think of this as an identity. And it really raises the question of, once you take this on as an identity, my depression, my ADHD, my borderline, Justin (50:54.102) whatever it is, how does that? You get benefits. You get the benefits of everybody wants an identity. Everybody wants to know who they are. Everybody wants a sense of community. Absolutely, you get those kinds of benefits of identity and community. But at what cost? I think the cost is you're setting up this kind of mechanism to perpetually invalidate your own experiences as we are talking about. And I came across this one thing very recently. That was really upsetting to me. A lot of folks in their 40s now are getting diagnosed with ADHD and they say, you know, I was never diagnosed as a kid. Now that I'm 40, I'm finally getting this diagnosis and I'm finally getting on these drugs, which is fine. But then some of them say something like this. It's tragic that for the last 20 years, my brain wasn't working right and nobody told me that. feel like I want to mourn the fact that for 20 years my brain has been broken. I haven't seen the world correctly and I'm only now discovering it's like, your brain was not broken. It was never broken. You think differently. You process information differently. And, you know, if it benefits you, I'm happy for that. But you shouldn't mourn the last 20 years as if you were deprived of this, the gift of knowing that your brain was pathological or deficient. Roger K. McFillin, Psy.D, ABPP (52:35.535) No, I mean, it's, it's, it's, it's radically insane on its, on its notion. First of all, there's no evidence to suggest such a thing. And most of those people are just responding to taking like Adderall or a stimulant, which if any one of us take us, we're going to have this drug effect of Adderall that might lead us to like a, even a boost in mood or focus for a period of time. And I can certainly see why someone says, because this Adderall works, that means I had this broken brain that Adderall fixed. And you're just taking You know, a form of meth, it's an amphetamine that you're taking and you're responding to that. But the harm to all this is like saying that, all right, if I sit down and talk to an engineer, for example, who really doesn't see the world in the way that I see the world or approach life in the way that I approach life, it's going be very, very hard for the two of us to be able to kind of connect, I think. If you try to give me a job in an engineering firm, then I could view myself as broken. You know, there's something wrong with me. I'm never going to be successful in an engineering firm. You put an engineer and make him a clinical psychologist doing the work that I'm doing. They're going to fail miserably. How is it for us to say one normal aspect of being is the, you know, the correct way to be the healthy way to be, and then dismiss the diversity that exists throughout human history that has, has evolved to this great civilization where we are able to support each other from so many different ways. It's like this mental illness paradigm is shifting our idea of what should be normal. And that normal is you have to fit in this capitalistic society in this particular way. You when you talk, when you read some of the evolutionary aspects of what we label as ADHD, you can see where the real evolutionary advantage could exist in the hunter gatherer. or living in the indigenous culture, for example. So like, yeah, this whole idea in itself is just, you know, insane and it hurts people. Justin (54:36.056) I mean, you raise a wonderful example of how these disease framings are doing more harm than good. So, I mean, we talked about depression and the disease framings, we talked about the voice hearing. When it comes to what we think of as neurodiversity, ADHD, dyslexia, I have a friend who's doing work on dyslexia and what she's showing, Helen Taylor, and what she's showing is that And dyslexia is just one example, but I think similar things can be said about some of the things we describe as ADHD, even some of the things that we describe as autism. What she's showing is that dyslexia is a distinct cognitive style with its own advantages. I always grew up understanding dyslexia is, it's just that's what happens when your brain fails to mature properly. part of your brain that's supposed to enable you to associate shapes and sounds never developed. It's not, there's literally a part of your brain, some neural circuitry that's missing, and that's why you have dyslexia. And what she's shown, and this is, mean, a lot of people are exploring dyslexia, but she's one of, among other people who are showing this. For example, that people with dyslexia are, much better at certain kinds of cognitive tasks. So they're much better recognizing when say a painting depicts an impossible figure like some of the MC Escher staircase. They can recognize immediately, well, wait a minute, that's an impossible figure. Some of them are much better at problem solving. There's evidence that I think up to one third of American entrepreneurs have dyslexia. When you put all that together, what it looks like is that, this is a distinct cognitive style. And if we're willing to speculate about evolutionary history, we could think, you know, what if this actually evolved to benefit groups? What if this actually evolved because the people that we describe as ADHD or dyslexic, they are Justin (56:55.476) looking for new things, they're exploring their environments, they're the ones who are going to be finding the new water holes, they're the ones that are going to be finding the new lands, they're the ones who who's kind of, this kind of drive to explore is what helps communities flourish. And then you think, okay, what are we doing to kids now by telling them that no, this is not a distinct cognitive style that probably had tremendous role back in hunter gather times and probably still has a powerful role today. You are the problem solvers. You are the explorers. You are the ones who are going to be discovering new things and it's our educational systems and the way that they're designed that's kind of creating these problems. There is nothing wrong. Instead, we're telling kids your brain is broken and And you're never going to be able to participate academically in the way that your peers do. But maybe, you know, if we get you on the right drugs, we get you some, some tutors, maybe just maybe if you're lucky, we can get you up to speed with, with, your peers. This is an incredibly, disempowering demoralizing, this is an incredibly disempowering and demoralizing, perspective to take. Roger K. McFillin, Psy.D, ABPP (58:21.915) Yeah, I love that. think it's worth repeating distinct cognitive styles with their unique advantages. I mean, that is so much a more realistic and effective way to frame this. Justin (58:33.289) And let me just say you could still recognize the problem. So my older son was diagnosed with ADHD years ago. And as we talked about it, we could say, okay. you have, that's how I described it, my poor kids, you I say, you you have this distinctive cognitive style with its own strengths, but that doesn't mean you're ignoring the downsides. That doesn't mean you're ignoring the fact that yes, school is, it's harder to focus. It's harder to sit still for six hours a day, but at least there's a sense of we can problem solve together. we can figure out strategies. Yes, our educational system is messed up and I'm still gonna send you to public school and you're still gonna have to deal with that. So I guess I just wanted to emphasize that taking these alternative perspectives on things, whether it's ADHD or depression or voice hearing, you're not glamorizing these, you're not denying that there are real problems. of living and that these, you know, what we call depression or delusions or ADHD, you're not denying that they present real problems in life that need to be solved. sometimes people say, you're just, you know, you're just glamorizing this. And if you only knew how difficult life is, you know, for me with my depression or my ADHD, I say, look, I'm not denying the difficulties at all. that you're having and I want to confront those difficulties and help you work through those difficulties. Roger K. McFillin, Psy.D, ABPP (01:00:19.995) Yeah, that's kind of a red herring because it pulls people away from what the real argument is. We're not invalidating the struggle or the experience. The problems are real. What we're having a conversation around is, well, how can we best help you to be able to adapt and overcome these problems? And so this is how the biological model gets people hooked in. saying, hey, you're sick, just like diabetes, right? It's not your fault. You know, there's nothing that you have done. It's just the way you are and it leads people to, it decreases shame. Justin (01:00:54.092) right and and that's you know That's the reason why some of the kind biomedical models can be so beneficial the first time somebody comes across them. I I really sympathize for these adults who are late diagnosed with ADHD when they're in their 40s, because I think about, what was your life like for the last 20 or 30 years? It might have been something like this. I can't focus, maybe I'm stupid. Maybe I'm lazy. Maybe I'm just not good enough. Why can't you focus? What's wrong with you? I mean, you imagine somebody who didn't have access to any alternative framings at all, except you're lazy or you're stupid or why can't you focus or why are you so impulsive? Why do you always do bad things? And you hit 40 years old and you've been given this message that you're lazy or stupid for 20 years. not recognizing that there is a genuine problem here, that you're not lazy, you're not stupid, that you do have this distinctive cognitive style. Finally, a doctor says, yeah, you have a brain deficiency and we can correct it using this medication. I mean, if I had that experience, I'd probably just burst into tears and think, why didn't somebody tell me this 20 years ago that I just have a brain disorder? I've just been thinking I'm stupid and lazy and there's something wrong with me. I think the problem is that these medical framings are so, to the extent that they are beneficial, they're beneficial only because we don't have access to any alternative framings. Like if that's all you have is you're lazy and stupid and you're bad and you can't focus, or you have this brain disease that we can reverse with drugs, I would happily take the brain disease framing any day. Justin (01:02:51.34) So the question I think we have to face, I mean, you and I and others who are critical of these mainstream perspectives is, okay, how do we get these alternative framings out there? So when a young person finds himself in the situation where it's okay, I have trouble focusing and I'm impulsive and I don't know, my teacher is always getting mad at me and my parents are always getting mad at me, how do we make it so that these alternative framings are on the table. Okay, either I'm lazy and stupid, which I don't think I'm lazy and stupid, or I have this brain disorder that prevents, that hurts my executive functioning somehow, or I have this distinct cognitive style that's just mismatched to our current educational system. Get those out there as soon as possible so that people have alternative ways of making sense. And so we don't have the situation that when you're 40 years old and the doctor finally comes along and says, I see the problem. You have this brain dysfunction. People don't have this experience of finally somebody is giving me an alternative framing other than I'm lazy and stupid and bad. Roger K. McFillin, Psy.D, ABPP (01:04:03.901) Yeah. I have this radical idea and it's about being honest. And I think that if our medical professionals were much more transparent about what we know and what we don't know, as, and if, and if like when science and understanding evolves, we're able to evolve and adapt with it. And we have a general culture where hard science can interact with philosophy and we can see how like medical ethics and Justin (01:04:15.728) Good luck with that. Roger K. McFillin, Psy.D, ABPP (01:04:33.009) materialism in itself can better support humanity and the struggles that exist. And we have this open dialogue where we can have debate back and forth. Then I think we evolve and we get to move beyond power structures that harm people. But the problem comes is those who are in those power struggles or those power structures have a certain stake in it being maintained. And this is what I was originally drawn to your work because your, your work on X has made you quite vulnerable to the psychiatric establishment and those who identify themselves as being, you know, biologically mentally ill and you've gotten really attacked on, on X. And so I want to read some of your, your tweets and I think people can step away here from today's conversation and say, well, this is a really reasonable discussion. So. I'm going to read some tweets and I want to know where people might see that that's unreasonable. And I want to get into a greater kind of cultural back and forth about what's going on with our medical establishment and trust in our society. So I'm to read some of your tweets here. I think it's fascinating that depression is literally just your brain's way of telling you to get out of a bad situation. And we treat it like this demon from hell. How many people have been hurt by being told, you have a terrible disease? I hate the whole idea that someone has in quotes depression or is quote unquote going through a depressive episode. It's so ugly and clinical. You'd never say sounds like you're having an anger episode or quote unquote. have enthusiasm today quote how detached from our feelings do we have to be to talk this way? Here's another tweet. I suppose my thing comes down to this. I don't think mental disorders are like little diseases to be labeled in drugs. I think they're coherent responses to the trials of life or just different and equally valid modes of existence with their own strengths and pitfalls. Here's another one. I think psychiatry robs us of our humanness, depression, anxiety, panic, even psychosis aren't diseases, but very human responses to the problems of life. The answer isn't more pills, but targeting the social forces that make our lives so shit. And the last one I have here is I don't think having a medical degree Roger K. McFillin, Psy.D, ABPP (01:06:57.425) gets you one step closer to understanding mental health and illness. It just generates the appearance of authority, the reassuring illusion that someone in the room knows what is wrong. So obviously this is certainly going to poke the bear of the doctor who lives based on the authority. But all of your tweets here are very, very reasonable. And I recently put out a tweet that said, When I learned about the institutional brainwashing around psychiatric drugs, because I threw myself into the science, especially the chemical imbalance myth and other aspects that drive the drug targeting, it really led me to distrust what else I was missing. What were health authorities telling us that is not true, but they're telling us that is true, which certainly led me to distrust the COVID vaccine and what was happening during that point. Now I widespread question vaccines, when we look at things like the hypothesis around cholesterol and its association with heart disease and all these other things that have been thrown by mainstream science, but certainly support certain industries. Now there's a there's a distrust of the medical authority. And I think we're worse because of it, because we need to be able to trust our doctors that they care about us. And they're doing things in our best interest. And that's been lost. So tell me about your experience. Justin (01:08:02.776) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (01:08:20.827) has been in poking the bear. Justin (01:08:22.634) Yeah, I mean, it's fascinating and Twitter has been a very illuminating for me. At first I thought I didn't think I was being particularly controversial. I thought I was just stating things that, this isn't that it did. Depression is not a disease. It's, your brain's a wake up call and bombarding it with drugs is the wrong approach, but it's, you know, it gives these doctors a sense that they're true professionals in their genuine branch of medicine. I I thought it was saying things that everybody kind of, you know, deep down knew. And I mean, it's been interesting seeing that, wait a minute. This is really, really. challenging the very foundations of this medical enterprise by saying, look, these aren't diseases and these drugs don't work by reversing diseases, but medicine needs to pretend that they do in order to feel like a valid branch of medicine. I mean, you and I might think that those messages are pretty obvious and uncontroversial, but it really is a way of attacking the very cornerstone of the medical enterprise. And you said earlier, something I really appreciated, you said, you know, what if these doctors were just honest with us? What a great world that would be, right? If you got diagnosed with ADHD and doctor said, you know, I have a form of speed. could take, I'm willing to prescribe some small doses of it for you. Justin (01:10:09.976) That could help you with the focus, maybe help you get through the day and get some of your homework done. Why don't we have a conversation about whether we wanna do that? There are gonna be harms, I mean, this is speed, there are gonna be harms, you're gonna be crashing a lot, it might affect your mood negatively, you might feel irritable, but let's just see if it can help you a little bit. Or if a doctor just came along and said, look, here are these drugs. SSRIs, we don't know what the hell they do. We really don't know why they work. Some people, a small percentage of people report getting better in a way that doesn't seem to be explained purely in terms of the placebo effect, but other people have been reporting a host of different side effects, withdrawal symptoms, but it's available. We can try it out. That would be amazing, right? I mean, you could... have an opinion about drugs and say, I'm generally, think drugs are a bad idea, but it would be absolutely incredible if you had that level of honesty. And I think you and I both know you're never going to get that level of honesty that is so totally foreign to the medical enterprise because the medical enterprise works precisely by not letting you know, we have no idea what these drugs do. They affect your mind in all kinds of complex ways. We have no idea what we're doing. Maybe they'll help you. Maybe they won't. The medical profession exists by creating this sense of we have this tremendous authority. We have this tremendous knowledge. We know, even if there are some details we don't yet know, we know roughly that depression and schizophrenia are diseases just like... diabetes and cancer. And we know that these drugs work by correcting the underlying dysfunction. Without that, I think that threatens their sense of being a legitimate medical profession. kind of, if they were that honest, they would kind of sound like just drug dealers on the street. So they can't be honest institutionally speaking. And so one thing I've been... Justin (01:12:30.24) writing about, this is the topic of my next book and it's not going to be out for a while, The Madness Pill, but it's really looking at, how did we get here? I mean, we've always had this medical approach in psychiatry that goes back for thousands of years, but why is it that in the 1970s when my dad was labeled with paranoid schizophrenia, he could go to a psychiatrist and say, I don't want to be on the pills. And the psychiatrist would say, Okay, I agree, I'm not going to put you on pills. We're just going to talk this through. And he was able to get better. And why is it that in the 1980s, that became unthinkable? So some powerful shift took place in the 1960s and the 1970s that it didn't create the medical framework, but it somehow led to its becoming solidified or entrenched or somehow so deeply rooted in our collective consciousness that we can't even, not only can we not see it, but now we celebrate these, we build whole identities in communities around these disorders. And I think that the reason, I think there are a number of different reasons for why psychiatry. just embraced this kind of biomedical framings really, really hard in the 80s. And I think some of those are obvious reasons that psychiatric drugs, pharmaceutical, and it really benefits pharmaceutical industries for people to believe that their problems stem from brain disorders. But I think even when you look past the kind of obvious economic incentives of drug companies, you see a profession that has always felt insecure. You see the psychiatric profession in the 1950s, they were considered a joke by the rest of medicine. In the 1960s, they were considered a joke by the rest of medicine. 70s and 80s, you start getting these drugs and they start looking like other doctors where you come to me with some problems and I give you a diagnosis and I write you a prescription and you go home. So it's not just, think that the reason for the entrenchment of this biomedical Justin (01:14:50.198) model is not just the kind of obvious thing drug companies like it. It speaks to this basic insecurity in the profession itself. And ultimately, coming back to Twitter slash X, I think that's one reason people get so pissed off by some of my tweets where I don't, I'm not even trying to be provocative or controversial. I'm just trying to state what seems obvious to me. I do believe, not to psychiatrize psychiatrists and other mental health professionals, I do believe that it taps into a very basic insecurity about who are we as a profession. Roger K. McFillin, Psy.D, ABPP (01:15:35.101) I think the cruel irony here is you're going to, think history is going to reflect back on psychiatry, which was a, considered maybe a joke from the greater medical community and, you know, their lone responsibility was kind of the manage the behavior of those who were on the fringes of society and couldn't adapt to it. So now being a dangerous profession that created mass, mass harm in such an experimental way and lacked medical ethics. Justin (01:15:53.707) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (01:16:04.891) And that's the danger of where we are. I think when we talk about the adaptive nature of the human psyche, one of the things you see is that many human beings have the ability to deny reality because reality is too painful to even acknowledge. And I think there's a dissonance that's created for, if you've been handing out those prescriptions for SSRIs, even like to young people, children over time, and you learn, that not only does that isn't not helpful, but the range of adverse problems are quite quite severe, including them being fatal. And you reflect back on the number of suicides that you had on your caseload after SSRI. I think that can be very, very difficult for a person to really acknowledge and the psyche takes over. And you find comfort then in the prevailing viewpoint that's been pushed that you're a doctor that you're doing the best that you can and that person just had a mental illness. And it takes me back to when I was in a predoctoral internship, when the physician who was a psychiatrist working there and he lost his sight. So he wasn't able to do the work that he wanted to do, which I think he wanted to be a surgeon. And he had to transition to being psychiatry, you know, and he justified, says, Hey, these are illnesses. And just like a surgeon could lose their patients to a condition. that we weren't able to cure or to help, we're going to lose our clients to suicide or other fatal aspects of being mentally ill. And so then there's always this like justification for it when, you know, when someone starts finding some degree of stability, then what you do is you attribute it to your treatment. And then when the people struggle, you attribute it to the disease. You're just never wrong. Justin (01:17:58.092) Mm-hmm. Mm-hmm. Mm-hmm. Roger K. McFillin, Psy.D, ABPP (01:17:59.505) Like everything works out in your favor and that's a problem with the human psyche. Justin (01:18:05.492) Yeah, and if the pills aren't working, it's because you have treatment resistant depression. It's always the nature of the disease and not the approach, the basic correctness of the approach that we're taking. But yeah, I mean, unfortunately, there was a time when I thought, when I started becoming aware of these alternative framings and these function adaptation kind of framings, and I thought, I need to communicate more with the psychiatrists. about this and I need to present them with these new findings and framework and say, hey guys, this is really incredible. You know, this whole time you've been treating depression. And I genuinely, I was very optimistic that it would be, I mean, it's funny to think about now because I didn't think about the sociological and economic and political ramifications of this as much, but I genuinely thought, psychiatrists, are doctors of the soul. Surely, if anybody would be intrigued and open to these new kinds of framings of depression, depression isn't a disease, it's your mind's wake-up call, it would be the psychiatrist, and I thought that I could make some inroads. And it was only after I had this optimistic, naive take that I started realizing, whoa, wait a minute, you know, this disease model is so deeply entrenched, I'm not gonna get any uptake with the psychiatrist. And as you point out, it's not just, you know, again, the economics and the professional insecurity, but a situation where you have people who for the last 10, 20, 30 years of their lives have been doling out drugs to patients with the belief that they were doing something heroic and helping to cure this disorder or disease. And now 30 years down the road, So a philosopher, but anybody, no matter who has these kinds of critical perspectives, 30 years down the road, you're gonna be receptive to the message that everything you've done is wrong. And actually you've been harming people more with this disease framing. You're not gonna accept that. And so I really have come to the conclusion that I don't want to keep taking my message to psychiatrists. Justin (01:20:29.802) I think it's more important to take it to the general public, to take it to the people who are constantly being labeled and drugged and hospitalized and who are, for whom these categories are becoming part of their very basic identity. Start there, start with trying to get this message out to the public. And I've been, in that respect, just fortunate as an academic, as an academic philosopher to have. some opportunities like through psychology today and other fora to get these messages out to the general public. think, you know, let's start from there. And then hopefully as people start changing, as the general public starts changing its perspective on what we call mental disorder, then the rest of psychiatry will hopefully catch up with that. Roger K. McFillin, Psy.D, ABPP (01:21:26.299) Yeah, I think the, the psychiatrists who are facing that moral dilemma right now are already starting to pull themselves out of mainstream psychiatry and they're tending to adapt into like nutritional psychiatry or the use of other interventions like ketogenic diet. And they're just kind of very slowly pulling themselves out of that, that paradigm while keeping kind of one foot in, you know, that I'm a physician and I'm interested in biology and brain. And I think that's safe, you know, because they're able to kind of talk about, listen, the drugs that we've been providing aren't really that effective. And we're seeing better results by getting them off these drugs and doing these diet interventions. So it's like, that's new. That's a way to say, Hey, we had this tool, but now science has evolved and now we have a new tool. And I think that's the safe way to move from it. And you talked about psychiatrists kind of being the doctors of the soul or, even the doctors of the mind. But really they have seen themselves as the doctors of the brain and that has become and that's the problem. They haven't really been doctors of the soul for quite some time. And now they have these lucrative practices of doling out these drugs and that's going to be very hard to give up. There's just, they have too much invested, way too much invested, unfortunately, but I've kept you for a long time. Just to kind of wrap this up, your upcoming book seems fascinating. The Madness Pill. Just curious when you can predict maybe that will be available to the public. Justin (01:22:57.364) just finishing it now and then when I submit it to the publisher at St. Martin's Press, but it's going to be another probably 18 months after I submit the draft. maybe we could have another, know, if you'd welcome me back on your podcast someday when it maybe when it gets closer to actual publication, we could talk about it more. that it's been a blast to write because it really did stem from this basic question of, how did we get to this medicalized perception and how did, you know, the chemical imbalance language and the brain deficit models, how did those really take over? And so my book focuses on the story of one particular American psychiatrist who I think had an important role to play in it. And it's more, it's less like a lecture and more just a story about his coming into psychiatry and how he stumbled upon these ideas and how he kind of helped to promote it and really inadvertently brought about some of these. Did some good, given what psychiatry looked like in the 60s and also did some harm. But it's been fun to write and it's been fun. I'll just say this, I've had an opportunity to interview for the... for my research, I've had an opportunity not only to do archival work, but to interview some of these psychiatrists who were active in the 1960s. And they have... I'm learning the extent to which, look, Justin, you don't know what we are coming out of in the sixties. We would have patients with schizophrenia who had been in the asylum for decades and we were told to use Freudian psychoanalysis to help them get at their mommy and daddy problems. Justin (01:25:02.454) You know, and you have to understand that when some of these pills came out that enabled people to go home and function well, a lot of us just jumped on board. It's been illuminating to see, I can totally appreciate how in a certain historical time, the drug-centered, disease-centered models would have been seen as so incredibly liberating. And so part of my story is how that initial optimism and even the initial benefit that they might have given us at one time have now been kind of swamped by their own intrinsic harms. Roger K. McFillin, Psy.D, ABPP (01:25:42.715) Yeah, that's a very positive way to frame it. mean, because it is a story of hope. And for many families who are struggling with somebody, a family member who was deteriorating, that idea of optimism, hope, and that we can find something that can help them and stabilize them. I certainly see the value in that. And I'm historically aware of the Freudian revolution and how psychiatry and psychology, I think, did a lot of harm in that context too. Justin (01:25:49.676) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (01:26:10.407) But yeah, I think you make a great point is that we need to continue to evolve and we evolve with analysis and research and these critical conversations and truth, because it's a search for truth. And it's an acknowledgement of where harms have been created, even if intention was pure, even if intention was good. And also kind of stepping back and seeing things globally and understanding how various cultures respond to similar events and situations and how Justin (01:26:16.226) Yes. Roger K. McFillin, Psy.D, ABPP (01:26:40.209) those we can learn a lot from. That's a whole nother topic because I know that there's a number of innovative programs around the world that use meaning making and attachment to nature and peer support and so forth to really make improvements. These are conditions where people can go through something and then recover from it. But that's for the next conversation as well as when this book comes out because I'm fascinated in it. I'm very interested in the history and how we've... Justin (01:27:03.031) Mm-hmm. Roger K. McFillin, Psy.D, ABPP (01:27:08.081) gotten here as a culture because we have to know that in order to get people out. So Justin, why don't you let my listeners know where they can get a hold of you, where they can get a sense of the work that you're doing. Justin (01:27:08.791) Right. Justin (01:27:20.746) You know, I've been maintaining a website. It's justingarson.com and that's where I post anything I've written, say for Eon or psychology today, links to videos, links to some of my academic articles and books. And so I would just go to justingarson.com because that's where you can find everything that you might be interested in as far as my research and my current projects. Roger K. McFillin, Psy.D, ABPP (01:27:52.327) Great. You know, it's a great podcast conversation when the time flies. And for me, it just flew today. I really am grateful, appreciative of such a radically genuine conversation. Justin (01:27:57.112) Absolutely. Justin (01:28:06.498) Thank you so much, Roger. This has been a blast.