Latest / The You Project / #2236 Nonsense in Psychiatry - Prof. Gordon Parker

Transcript

#2236 Nonsense in Psychiatry - Prof. Gordon Parker · The You Project

• 0:00
  Speaker 1: G'day team, it's Harps, it's Tiff, it's Gordon. We'll call
• 0:03
  Speaker 1: him Gordon. I want to call him Prof, but he's humble,
• 0:05
  Speaker 1: so we're going with Gordon. We'll start with the woman
• 0:08
  Speaker 1: who arrived late, who doesn't normally arrive late, but did,
• 0:12
  Speaker 1: Tiffany Ann Cook. What's your reason? It's because I arrived
• 0:16
  Speaker 1: two times and my name was Craig Anthony Harper on
• 0:19
  Speaker 1: the screen.
• 0:20
  Speaker 2: I was logged into your Zoom account.
• 0:22
  Speaker 1: Well, that's not Gordon's fault. It's not my fault.
• 0:24
  Speaker 2: We're here. We're on time.
• 0:25
  Speaker 1: We're doing what we're meant to. Anyway, I heard it
• 0:28
  Speaker 1: was fashionable to be late.
• 0:30
  Speaker 2: Isn't it? I don't know.
• 0:34
  Speaker 1: There's a thesis for you. There's some research for you.
• 0:40
  Speaker 1: Good morning, Gordon.
• 0:41
  Speaker 2: How are you? Greetings, Craig. I'm pretty well, thank you.
• 0:45
  Speaker 1: Thanks so much for coming to chat with us on
• 0:47
  Speaker 1: the You Project. Where do we find you? Are you
• 0:51
  Speaker 1: at home? That is a very full-looking library behind you.
• 0:54
  Speaker 1: Are you at home or at work or are they
• 0:57
  Speaker 1: one and the same?
• 0:58
  Speaker 2: In study, which is the engine room. It's the engine room.
• 1:05
  Speaker 1: From which all the brilliance comes. Speaking of that, I
• 1:08
  Speaker 1: was thinking, and I mean this with the utmost respect,
• 1:11
  Speaker 1: I was doing a bit of research and you've done
• 1:13
  Speaker 1: some incredible stuff, which I'll mention in a moment, but
• 1:18
  Speaker 1: Am I right in assuming, and I would never do
• 1:21
  Speaker 1: this if you're a lady, but that you are 84?
• 1:24
  Speaker 2: Yes, that's correct. All right.
• 1:27
  Speaker 1: So now I just finished my PhD at 62.
• 1:32
  Speaker 2: Well, I haven't finished.
• 1:33
  Speaker 1: It's being analysed by the reviewers, right? And so everyone
• 1:36
  Speaker 1: makes fun of me because I'm the world's oldest PhD student,
• 1:40
  Speaker 1: which I'm fine with, you know. But then I read your,
• 1:44
  Speaker 1: like I'm reading some of your stuff. I'm watching, I'm
• 1:47
  Speaker 1: listening to podcasts. I'm watching podcasts. I'm looking at things
• 1:51
  Speaker 1: on YouTube. I'm like, how is this dude 84? Like
• 1:56
  Speaker 1: what is, is that, is your brain as objective as
• 2:00
  Speaker 1: you can be your cognitive capacity and your mental acuity
• 2:05
  Speaker 1: and even your mental energy? How is that at 84
• 2:08
  Speaker 1: compared to say 40? Um, It varies across differing spheres.
• 2:15
  Speaker 1: So in terms of my general functioning, my memory is
• 2:19
  Speaker 1: nothing like as good as.
• 2:20
  Speaker 2: It would have been at 40. But as a clinician,
• 2:25
  Speaker 2: I actually doubt whether there's been any deterioration. And there's
• 2:30
  Speaker 2: an interesting phenomenon called the 10,000 hours phenomenon where anyone
• 2:37
  Speaker 2: to acquire a skill requires 10,000 hours. And so they
• 2:42
  Speaker 2: talk about, you know, firemen who will suddenly race out
• 2:47
  Speaker 2: of a burning building because they've got some instinct that
• 2:51
  Speaker 2: the building is going to collapse. And when asked afterwards,
• 2:55
  Speaker 2: why did they do that? They have no explanation, but
• 2:58
  Speaker 2: something's kicked in. Even chicken sexers, all they have to
• 3:02
  Speaker 2: do is to say whether the egg is going to
• 3:05
  Speaker 2: be male or female, take 10,000 hours. So if you're
• 3:08
  Speaker 2: a doctor... and the psychiatrists were all doctors. The 10,000
• 3:12
  Speaker 2: hours phenomenon means that you are laying down progressive improvements
• 3:21
  Speaker 2: in your clinical diagnostic set, and we might get into
• 3:24
  Speaker 2: that topic because I think it's quite fascinating, for decades,
• 3:29
  Speaker 2: and you probably don't reach your peak to about 70.
• 3:32
  Speaker 2: And of course, by then, most doctors have retired. So
• 3:37
  Speaker 2: coming back to me, I doubt whether, I think I
• 3:40
  Speaker 2: probably achieved my clinical diagnostic capacities probably in my early 70s.
• 3:47
  Speaker 2: And I suspect that I haven't lost much of them
• 3:51
  Speaker 2: at this age, which is quite fascinating. But it goes
• 3:54
  Speaker 2: along with my golf handicap being the lowest in my
• 3:57
  Speaker 2: 80s and it has ever been in my life. And
• 3:59
  Speaker 2: there I am boasting immediately.
• 4:01
  Speaker 1: Yeah, well, if I could play golf, I would boast too.
• 4:05
  Speaker 1: What's your handicap? Well, you brought it up. What is it?
• 4:09
  Speaker 2: At the moment it has escalated up to 23.
• 4:14
  Speaker 1: You're still getting around there and doing it in 23.
• 4:16
  Speaker 1: I tell you what, there's a lot of 30-year-olds with
• 4:18
  Speaker 1: a worse handicap than that.
• 4:20
  Speaker 2: Tiff, have you ever played golf? I think I played
• 4:23
  Speaker 2: it once in Vanuatu when I went on holidays with
• 4:26
  Speaker 2: my dad.
• 4:28
  Speaker 1: I think it might be a little too passive for you.
• 4:30
  Speaker 1: I don't think there's– although it can be– golfers can
• 4:33
  Speaker 1: be aggressive. Well, they can get aggressive. Not so much
• 4:39
  Speaker 1: at each other, more at the ball and more at
• 4:41
  Speaker 1: themselves and sometimes at the grass.
• 4:44
  Speaker 2: Or the tree or whatever it is. And so.
• 4:50
  Speaker 1: You're still doing research, Gordon. You're still opening doors. You're
• 4:54
  Speaker 1: still asking questions. You're still exploring new things.
• 4:59
  Speaker 2: How is that?
• 4:59
  Speaker 1: Well, I am.
• 5:04
  Speaker 2: in the field of psychiatry in the way in which
• 5:07
  Speaker 2: I've been handling it for decades. So I've generally produced
• 5:12
  Speaker 2: a book about every 18 months, every two years. So
• 5:15
  Speaker 2: the last book came out in 2025, but at the
• 5:19
  Speaker 2: moment I'm more fixated on trying to get a play up.
• 5:27
  Speaker 2: I've had one play put on in Melbourne and it
• 5:32
  Speaker 2: was actually brought to the Sydney Theatre Company And that
• 5:34
  Speaker 2: was about 15 years ago. So I prepared a play,
• 5:39
  Speaker 2: started that about 10 years ago, and it's called Winston's Gallipoli.
• 5:44
  Speaker 2: So it was all about Churchill and the Gallipoli campaign
• 5:48
  Speaker 2: and the Dardanelles disaster. And basically I was arguing that
• 5:52
  Speaker 2: this was largely due to Winston Churchill's bipolar disorder. And
• 5:57
  Speaker 2: it got so far, but when we had a play reading,
• 6:00
  Speaker 2: I judged it was a bit turgid. So I've changed
• 6:03
  Speaker 2: the title to Winston and Boris and brought in Boris
• 6:07
  Speaker 2: Johnson as the Shakespearean full narrator. And so that's my
• 6:12
  Speaker 2: current objective, to get the play up. Slightly academic, because
• 6:18
  Speaker 2: I'm obviously wanting to provide a strong argument that Churchill
• 6:21
  Speaker 2: had a bipolar disorder, but also another way of actually
• 6:27
  Speaker 2: functioning in the world.
• 6:30
  Speaker 1: Is that part of... what made him a great leader,
• 6:35
  Speaker 1: do you think? Or is it despite it?
• 6:38
  Speaker 2: I think there were two aspects to it. He had
• 6:44
  Speaker 2: an extraordinary capacity to believe in himself with little self-doubt
• 6:50
  Speaker 2: and would press on. And I think that was more
• 6:52
  Speaker 2: personality based. But at times when he went high, he
• 6:57
  Speaker 2: would just proceed without any care of the consequences. And
• 7:03
  Speaker 2: one of the times when he was at his most
• 7:06
  Speaker 2: manic was during the First World War, obviously. And the
• 7:12
  Speaker 2: Germans were invading Antwerp. And to hold them back, Churchill
• 7:17
  Speaker 2: went to Antwerp and he hired a number of Piccadilly
• 7:22
  Speaker 2: buses to drive north, south, east and west. And he
• 7:26
  Speaker 2: had a lot of his recruits marching east, south, west.
• 7:29
  Speaker 2: And he dressed up rather like a line tamer and
• 7:33
  Speaker 2: he was as high as a kite. And the press
• 7:36
  Speaker 2: just scarified him later because so many people died and
• 7:41
  Speaker 2: it only held up the Germans a little bit. But
• 7:44
  Speaker 2: it's a good example where his highs would push him
• 7:48
  Speaker 2: into asserting himself. And at times that actually ended up
• 7:54
  Speaker 2: being a winning scenario. And that occurred in the First
• 7:57
  Speaker 2: World War. In the Second World War, they knew there
• 7:59
  Speaker 2: was something wrong with him. They didn't know it was
• 8:01
  Speaker 2: a bipolar disorder. But every order that he issued had
• 8:05
  Speaker 2: to be checked by a second person in command. And,
• 8:09
  Speaker 2: of course, it was because his bipolar would often take
• 8:12
  Speaker 2: him into these incredibly grandiose, ambitious plans, intriguingly, many of
• 8:18
  Speaker 2: which worked. Yes, yes.
• 8:21
  Speaker 1: Because he was, I mean, he was... complicated and complex,
• 8:27
  Speaker 1: but he was also a genius, like in many ways.
• 8:32
  Speaker 1: It's an interesting combination.
• 8:34
  Speaker 2: He had another capacity, which many bipolar people actually have,
• 8:40
  Speaker 2: and that's the capacity of prescience, to be able to
• 8:46
  Speaker 2: feel certain things in the environment and at times predict
• 8:49
  Speaker 2: the future. So when Churchill was in his early adolescence,
• 8:54
  Speaker 2: he said to his only friend at school, one day
• 8:57
  Speaker 2: I'm going to be a world leader and save everybody.
• 9:01
  Speaker 2: And his friend said, what's going on? There's no great problem.
• 9:04
  Speaker 2: And he said, one day there's going to be a
• 9:05
  Speaker 2: great conflagration and I will be elected to lead the
• 9:09
  Speaker 2: country and I will save the country. And at the
• 9:13
  Speaker 2: age of 23, he wrote his only book of fiction
• 9:16
  Speaker 2: called Savrola, where he describes essentially his own career. a
• 9:21
  Speaker 2: man being brought into command of the forces against a
• 9:26
  Speaker 2: great evil nation, winning the war and then being voted
• 9:31
  Speaker 2: out of office. And he wrote that at the age
• 9:33
  Speaker 2: of 23, completely predicting his career.
• 9:36
  Speaker 1: Well, that was somewhat prophetic, wasn't it?
• 9:40
  Speaker 2: I mean, completely.
• 9:44
  Speaker 1: So in terms of that kind of whether or not it's,
• 9:48
  Speaker 1: I don't know, an ability, whatever it is, but that
• 9:50
  Speaker 1: capacity to maybe foresee something that might happen. you know
• 9:55
  Speaker 1: we talk about um you know uh not in academia
• 9:59
  Speaker 1: but casually or informally we talk about intuition or gut
• 10:04
  Speaker 1: instinct or sixth sense or is there a way to
• 10:07
  Speaker 1: explain that in science not.
• 10:11
  Speaker 2: That i have ever been able to fully understand um
• 10:17
  Speaker 2: Of course, you've got various explanations that are put forward,
• 10:21
  Speaker 2: such as that Celtic people have this capacity to predict
• 10:26
  Speaker 2: the future and to show prescience and so on and
• 10:29
  Speaker 2: so forth. And it remains one of the great mysteries.
• 10:35
  Speaker 2: Another vignette of a woman, a patient of mine with
• 10:38
  Speaker 2: bipolar disorder, she was sitting in a country field on
• 10:40
  Speaker 2: a chair. Yes. And suddenly a voice said to her
• 10:44
  Speaker 2: in her ear, jump out of your chair and run
• 10:49
  Speaker 2: forward right now. She did, and 30 seconds later, a
• 10:54
  Speaker 2: tree came crashing down onto the chair where she had
• 10:57
  Speaker 2: been sitting. Now, I can't explain that, and I've given
• 11:02
  Speaker 2: that story to many people, and I've never had a
• 11:06
  Speaker 2: plausible explanation.
• 11:09
  Speaker 1: Do you think that scientists and researchers and science more broadly,
• 11:14
  Speaker 1: is it can we just coexist with the fact that
• 11:18
  Speaker 1: there's so much stuff that we don't know and that's okay? Like,
• 11:21
  Speaker 1: do we have to have an answer? Can we not go, yeah,
• 11:24
  Speaker 1: that does exist or it seems to exist or it
• 11:26
  Speaker 1: could exist, but we don't know. Like, I feel like
• 11:29
  Speaker 1: a scientist feel a compulsion, no matter what, to have
• 11:33
  Speaker 1: to explain everything rather than go, look, we know this
• 11:37
  Speaker 1: is a phenomenon or we know this exists or we've seen,
• 11:41
  Speaker 1: you know, like with, we had a guy called Professor
• 11:44
  Speaker 1: Jeffrey Redeker who from Harvard who talks about placebos and
• 11:50
  Speaker 1: spontaneous healing. And he's a psychiatrist and a researcher and obviously,
• 11:55
  Speaker 1: and he's like, it absolutely happens, but we don't know why.
• 11:58
  Speaker 1: I mean, that's what he says. He said, I've got
• 12:02
  Speaker 1: now thousands of cases that make no sense clinically. And
• 12:08
  Speaker 1: he's like, I'm a doctor, I'm a psychiatrist, but I
• 12:11
  Speaker 1: can show you. And he's like, the truth is we
• 12:13
  Speaker 1: just don't know how.
• 12:14
  Speaker 2: Well, I think we need both types of scientists. We
• 12:17
  Speaker 2: need those who will say, look, I accept that there
• 12:20
  Speaker 2: are things that are beyond understanding and awareness, and I'm
• 12:27
  Speaker 2: not going to even go there. And then we need
• 12:30
  Speaker 2: a second group, the tenacious people who get a gut
• 12:33
  Speaker 2: instinct maybe, or there is some inexplicable issue that has
• 12:37
  Speaker 2: yet to be understood or recognized or detailed. And they
• 12:43
  Speaker 2: go out in a bloody minded way to chase it
• 12:46
  Speaker 2: right to the end of the earth. So I think
• 12:48
  Speaker 2: we need both groups. Yeah, yeah, yeah.
• 12:51
  Speaker 1: How do we separate between the pure science, the outcome,
• 12:56
  Speaker 1: the data, just the straight information that we get? and
• 13:01
  Speaker 1: egos and personalities and people who want to be right
• 13:05
  Speaker 1: and emotion, because every scientist is also a human with
• 13:08
  Speaker 1: emotions and biases. And I know this is an unanswerable question,
• 13:12
  Speaker 1: but it's just been an interesting journey for me for
• 13:15
  Speaker 1: the last six years, immersing myself in that higher level
• 13:19
  Speaker 1: research going on. This isn't an interest. Academia is an
• 13:23
  Speaker 1: interesting world. Speaking of burnout, we haven't got there yet,
• 13:26
  Speaker 1: but I suspect there's a fair bit in academia. But
• 13:29
  Speaker 1: is it possible to separate all that stuff?
• 13:34
  Speaker 2: People as individuals vary tremendously, and I think it would
• 13:41
  Speaker 2: be impossible to sort of typecast the various characters. But
• 13:46
  Speaker 2: one of the phenomena that really fascinates me in psychiatry
• 13:49
  Speaker 2: is when they get together to come up with treatment recommendations,
• 13:54
  Speaker 2: out of that group think, Most of the time in psychiatry,
• 13:59
  Speaker 2: we get nonsense. So, for instance, at one stage, we
• 14:04
  Speaker 2: looked at treatment guidelines for those with bipolar disorder as
• 14:08
  Speaker 2: articulated by official committees dignified groups, respected people. And when
• 14:20
  Speaker 2: we looked at the guidelines and you think if the
• 14:23
  Speaker 2: guidelines had validity, then every guideline would be compatible with
• 14:29
  Speaker 2: every other guideline. The one would be the first choice
• 14:32
  Speaker 2: and so on. And we found no agreement at all.
• 14:35
  Speaker 2: So what tends to happen is when groups of psychiatrists
• 14:40
  Speaker 2: in particular get together, there's often an alpha male and
• 14:45
  Speaker 2: I'm being sexist here, who would dominate the conversation, dominate
• 14:49
  Speaker 2: the thinking, and generate a zeitgeist, and then everyone falls
• 14:53
  Speaker 2: into line. And one of the quotes I have in
• 14:56
  Speaker 2: one of the books is, everyone agrees to say collectively
• 14:59
  Speaker 2: what no one believes individually. And as a consequence of that,
• 15:05
  Speaker 2: we have a lot of nonsense in psychiatry, including the
• 15:09
  Speaker 2: classification of many mental disorders, the criteria for defining them.
• 15:14
  Speaker 2: And I can go on a treat about my concerns
• 15:19
  Speaker 2: about certain diagnoses that have been generated by the American
• 15:23
  Speaker 2: DSM manual and the serious consequences. Would you like me
• 15:28
  Speaker 2: to extend that? Yeah, no, I would.
• 15:31
  Speaker 1: I mean, I just wrote down the title of the show,
• 15:34
  Speaker 1: which is going to be Nonsense in Psychiatry. So thank
• 15:37
  Speaker 1: you for that little grab. Yeah, please tell us. Okay,
• 15:42
  Speaker 1: so I'll just.
• 15:44
  Speaker 2: Go with one example, the classification of depressive disorders. For
• 15:50
  Speaker 2: hundreds of years, there was a view that there were
• 15:54
  Speaker 2: two broad types of depressive disorders. there was a biological type,
• 15:58
  Speaker 2: and then there was a type where depression came on
• 16:01
  Speaker 2: because of environmental stresses. And even if you go to St.
• 16:06
  Speaker 2: Paul to the Corinthians, there's a quote there of depressions
• 16:10
  Speaker 2: being either from God or of the world. And those
• 16:15
  Speaker 2: that were quotes from God were given that explanation because
• 16:19
  Speaker 2: it was inexplicable. Later, that group was termed endogenous depression
• 16:25
  Speaker 2: because it seemed to come from within, which makes sense
• 16:28
  Speaker 2: if there was a biological driver. And the depressions of
• 16:31
  Speaker 2: the world were more environmental situational depressions. And that model
• 16:37
  Speaker 2: existed for nearly 2000 years. And then in 1980, the
• 16:42
  Speaker 2: diagnostic manual produced by the American Psychiatric Association called DSM-3
• 16:50
  Speaker 2: came out and created a major diagnostic category of major depression,
• 16:57
  Speaker 2: which in a sense totally ignored differing subtypes. So the
• 17:04
  Speaker 2: consequence and the particular criteria for major depression weren't that major.
• 17:10
  Speaker 2: It's a bit like a big psychological sneeze. Now, so
• 17:14
  Speaker 2: many people since 1980, when they go to see a clinician,
• 17:19
  Speaker 2: get told, I know what you've got, you've got major depression,
• 17:23
  Speaker 2: they think, oh, yes, I now know what I've got.
• 17:26
  Speaker 2: But imagine if you went to your doctor and your
• 17:29
  Speaker 2: doctor said to you, I know what you've got, you've
• 17:30
  Speaker 2: got major breathlessness, you wouldn't be particularly impressed because you'd
• 17:35
  Speaker 2: want to know whether you had asthma or pneumonia or
• 17:38
  Speaker 2: pulmonary embolus because you would know that there'd be consequences
• 17:42
  Speaker 2: of that specificity. You get an antibiotic or an anticoagulant
• 17:47
  Speaker 2: or an anti-asthma drug, et cetera. And so what happens,
• 17:53
  Speaker 2: people getting a diagnosis of major depression tend to get
• 17:57
  Speaker 2: the treatment that their clinician received as a practitioner or
• 18:06
  Speaker 2: in their training in other ways. So if you've got
• 18:09
  Speaker 2: major depression and you go and see a GP, you'll
• 18:12
  Speaker 2: get an antidepressant drug. Go and see a psychologist, you
• 18:15
  Speaker 2: get cognitive behavior therapy. Go and see a counselor, you
• 18:19
  Speaker 2: get counseling. Go and see a lady wearing a caftan
• 18:22
  Speaker 2: and you'll get crystal therapy. I know of no other
• 18:26
  Speaker 2: model in medicine where such a nonspecific generic diagnosis leads
• 18:32
  Speaker 2: to all sorts of problems downstream. And so for decades,
• 18:36
  Speaker 2: I've been arguing we need to bring back the concept
• 18:40
  Speaker 2: of melancholy as a biological condition and then have a
• 18:44
  Speaker 2: meaningful classification of the environmental and personality-driven other depressions, and
• 18:51
  Speaker 2: then respect that there are going to be quite differing
• 18:54
  Speaker 2: condition-specific treatments. And the consequences of major depression have been
• 19:01
  Speaker 2: major in terms of drug manufacturing. So for instance, the
• 19:09
  Speaker 2: antidepressant drugs have undergone more randomized controlled trials than any
• 19:14
  Speaker 2: other treatment we have in psychiatry. They've been over millions
• 19:19
  Speaker 2: of people. When you aggregate the data of antidepressants approved
• 19:25
  Speaker 2: by the FDA in America and brought to market and
• 19:28
  Speaker 2: compare them against placebo, then in fact, numerous studies show
• 19:33
  Speaker 2: no difference. And some studies, if they show a difference,
• 19:38
  Speaker 2: it's minimal. And the problem is, not having a single
• 19:43
  Speaker 2: group of people with biological depression getting antidepressants, but bringing
• 19:48
  Speaker 2: into that group people with all other types of depression
• 19:52
  Speaker 2: who are not going to respond to an antidepressant. It
• 19:55
  Speaker 2: would be the same thing if you had a super-duper
• 19:58
  Speaker 2: anti-asthma drug and you wanted to take it to market.
• 20:01
  Speaker 2: You undertook a randomized controlled trial, but instead of having
• 20:04
  Speaker 2: a sample of 100 people with asthma, you had 100
• 20:07
  Speaker 2: people of whom only five had asthma. Your anti-asthma drug
• 20:13
  Speaker 2: were not different from placebo. So the concept of major depression,
• 20:18
  Speaker 2: in my view, around now for over 40 years, has
• 20:22
  Speaker 2: set back psychiatry immensely. It has led to people getting
• 20:25
  Speaker 2: quite inappropriate treatments. It's lazy. It's out of kilter with
• 20:32
  Speaker 2: the rest of medicine where diagnosis drives decision-making.
• 20:39
  Speaker 1: And putting everyone in a bucket, it's like all mood
• 20:43
  Speaker 1: disorders are mental illnesses, but not all mental illnesses are
• 20:47
  Speaker 1: mood disorders, right?
• 20:49
  Speaker 2: True, yep. Yeah, so it's like... And just on mood disorders,
• 20:54
  Speaker 2: some are mental, such as the biological melancholy and psychotic depression. Yeah, yeah.
• 20:59
  Speaker 2: And some of them are environmental, driven by stresses where
• 21:05
  Speaker 2: your self-esteem is attacked and diminished. sometimes by your personality style,
• 21:10
  Speaker 2: which causes you to be at risk of depression. Quite
• 21:13
  Speaker 2: differing types of depression and requiring quite differing therapeutic approaches.
• 21:20
  Speaker 1: So if somebody's listening to this now who really strongly
• 21:24
  Speaker 1: identifies with what you're saying, and we're not throwing anyone
• 21:30
  Speaker 1: under the bus here, we're just talking broadly, but they
• 21:32
  Speaker 1: feel like whatever it is that they've been prescribed with
• 21:37
  Speaker 1: isn't helping significantly maybe at all. I know there's no
• 21:44
  Speaker 1: three-step plan, so let's do one, two, three, but how
• 21:48
  Speaker 1: do we help ourselves? Because, yeah, it scares me a
• 21:53
  Speaker 1: little bit to rock up to see somebody that I've
• 21:55
  Speaker 1: never met that has a certain way of approaching, you know,
• 21:58
  Speaker 1: whatever it is, the condition, and then 15 minutes later
• 22:01
  Speaker 1: I've got a prescription for something and I'm walking out
• 22:04
  Speaker 1: the door or whatever the scenario is.
• 22:06
  Speaker 2: Yep. What can we, as people who, you.
• 22:10
  Speaker 1: Know, we're the ones dealing with the sickness or the,
• 22:12
  Speaker 1: you know, whatever it is, you know, whether or not
• 22:15
  Speaker 1: it's an infection or a broken leg or depression, like
• 22:19
  Speaker 1: how do we help ourselves on top of, you know,
• 22:24
  Speaker 1: using the medical profession?
• 22:26
  Speaker 2: I think obviously people can go on Zoom and look around,
• 22:33
  Speaker 2: but in fact... There are some reputable sites, and obviously
• 22:38
  Speaker 2: this is an issue that has preoccupied me for decades.
• 22:45
  Speaker 2: And we've published a number of books laying out the
• 22:47
  Speaker 2: differing criteria for the differing types of depression. One of
• 22:51
  Speaker 2: the reasons we set up the Black Dog Institute 25
• 22:54
  Speaker 2: years ago was to come up with clear information on
• 22:59
  Speaker 2: the differing types of depression and their preferential differing treatments.
• 23:05
  Speaker 2: We developed a tool called the map, which people complete
• 23:11
  Speaker 2: and a report is sent to their practitioner, which tells
• 23:14
  Speaker 2: the practitioner the most likely type of mood disorder they've got,
• 23:18
  Speaker 2: whether it's bipolar disorder or melancholic or environmental depression and
• 23:23
  Speaker 2: with treatment recommendations. So that's been a big campaign that
• 23:27
  Speaker 2: we've run. And there are a number of other organizations
• 23:32
  Speaker 2: that do the same, but Moving back again to bipolar disorder,
• 23:37
  Speaker 2: if you look at the treatment recommendations by official bodies,
• 23:41
  Speaker 2: the lack of agreement between the different ones is an
• 23:45
  Speaker 2: extremely concerning issue. So for many people, they may be
• 23:51
  Speaker 2: receiving completely inappropriate treatment as a consequence of some of
• 23:56
  Speaker 2: the false models that are out there. So As a
• 24:02
  Speaker 2: psychiatrist and as a contrarian, I've long been campaigning for
• 24:08
  Speaker 2: more precise diagnoses in psychiatry.
• 24:14
  Speaker 1: We had a guy on recently. His name is Dr.
• 24:19
  Speaker 1: Matt Bernstein.
• 24:20
  Speaker 2: Did I get that right, Tiff?
• 24:22
  Speaker 1: Anyway, his area of research, he's a doctor and a psychiatrist.
• 24:26
  Speaker 1: His whole thing is metabolic psychiatry. And not in opposition
• 24:31
  Speaker 1: to normal treatment, but he talks about treating mental illness
• 24:38
  Speaker 1: and different conditions with lifestyle and food and sleep and
• 24:45
  Speaker 1: sunlight exposure and exercise and a whole lot of practical
• 24:50
  Speaker 1: kind of stuff. Not necessarily instead of, but as well as.
• 24:55
  Speaker 1: And his research, he's got some really amazing or getting
• 24:59
  Speaker 1: some really amazing.
• 25:00
  Speaker 2: Outcomes with patients. And I like.
• 25:04
  Speaker 1: That idea too, of just how can I change the
• 25:08
  Speaker 1: biochemistry of my body? How can I change what's happening
• 25:10
  Speaker 1: in my brain? How can I change my emotional state
• 25:15
  Speaker 1: without taking a pill? Is there a protocol I can
• 25:19
  Speaker 1: create for my own life that puts me in a
• 25:21
  Speaker 1: better state and a better place and more creative and perhaps,
• 25:25
  Speaker 1: you know, better energy before I take a pill? You know,
• 25:29
  Speaker 1: so I love that approach as well.
• 25:32
  Speaker 2: Once again, I feel that I'm hearing a Procrustean model
• 25:36
  Speaker 2: where this model is going to be applied to everybody.
• 25:41
  Speaker 2: My personal view is that it will have salience to
• 25:45
  Speaker 2: some individuals and be irrelevant to others. So, for instance,
• 25:50
  Speaker 2: if somebody has a paralysing biological depression, the main thing
• 25:56
  Speaker 2: they need is an antidepressant medication or another physical treatment.
• 26:04
  Speaker 2: After that, there can be some benefit from adjunctive strategies.
• 26:10
  Speaker 2: So even somebody with a biological disorder will get some
• 26:13
  Speaker 2: benefit from talking to a psychologist or a psychiatrist pursuing
• 26:17
  Speaker 2: what psychosocial stresses may be in play as a consequence
• 26:22
  Speaker 2: of their depression. There have been good studies showing that
• 26:26
  Speaker 2: if you give people with biological depression an antidepressant and
• 26:31
  Speaker 2: don't change their diet, and you got another group get
• 26:34
  Speaker 2: the same antidepressant, but get a Mediterranean diet, a proper diet,
• 26:39
  Speaker 2: you get a 20% greater outcome in that second group.
• 26:44
  Speaker 2: So it really does depend in my view on the
• 26:47
  Speaker 2: salience of the condition suggesting that there are maybe extra
• 26:52
  Speaker 2: strategies that need to be put in place. And they
• 26:55
  Speaker 2: will range from getting the person to cease alcohol, changing
• 26:59
  Speaker 2: their diet, losing weight, getting out in the sun to
• 27:02
  Speaker 2: ensure they've got vitamin D, and so on and so forth.
• 27:06
  Speaker 2: But an overall model of giving the package to everybody
• 27:11
  Speaker 2: worries me.
• 27:12
  Speaker 1: Yeah, it's kind of generic. My background is exercise physiology.
• 27:18
  Speaker 1: And prescribing exercise. And so, yeah, it's like everybody wants
• 27:22
  Speaker 1: to get in shape. Well, one, what does that mean
• 27:25
  Speaker 1: for different people? And two, how does that individual body
• 27:28
  Speaker 1: respond to exercise?
• 27:29
  Speaker 2: Which kind of exercise? How much? How hard? How often?
• 27:33
  Speaker 1: And so I could write 100 programs for people with
• 27:36
  Speaker 1: the same goal. but they'll all be different programs because
• 27:40
  Speaker 1: the physiology and the biology and the medical stuff and all,
• 27:44
  Speaker 1: you know, every program that I wrote for, and I wrote, well,
• 27:48
  Speaker 1: I don't know, well, in the tens and tens of thousands.
• 27:51
  Speaker 2: Yeah.
• 27:51
  Speaker 1: You know, that program is written for that individual. You know,
• 27:55
  Speaker 1: you don't reach into the cupboard and pull out program seven.
• 27:58
  Speaker 1: It's like, well, okay, tell me about all your medical issues.
• 28:02
  Speaker 2: Tell me about.
• 28:03
  Speaker 1: How much, tell me about your injuries. Tell me about
• 28:06
  Speaker 1: mum and dad. Tell me what you eat. Tell me where,
• 28:08
  Speaker 1: you know, there's, tell me about your energy levels. Tell
• 28:11
  Speaker 1: me about all your, you know, and your goals and
• 28:14
  Speaker 1: your needs and what seems to work for your body
• 28:17
  Speaker 1: and what doesn't and when you feel good and when
• 28:19
  Speaker 1: do you have more energy through the day, early or late.
• 28:22
  Speaker 1: And then after a significant conversation, then I would prescribe,
• 28:27
  Speaker 1: and even then it's still an educated guess, as you
• 28:30
  Speaker 1: would know, tens of thousands of programs later, I'm still
• 28:34
  Speaker 1: making a high-level guess as to what I think will
• 28:36
  Speaker 1: be appropriate for that body and the person in the
• 28:40
  Speaker 1: body sitting in front of me.
• 28:42
  Speaker 2: Yes, well, I agree entirely. I mean, if we just
• 28:44
  Speaker 2: take a very simple example from medicine, if you've got
• 28:47
  Speaker 2: type 1 diabetes, you're most likely to get insulin. If
• 28:51
  Speaker 2: you've got type 2 diabetes, you're most likely to get
• 28:53
  Speaker 2: weight loss and diet and and exercise and so on.
• 28:57
  Speaker 2: That's a very simple example, but it respects the issue
• 29:00
  Speaker 2: that in medicine it is important to get a finite
• 29:04
  Speaker 2: diagnosis and articulate the specific treatments that are required and
• 29:12
  Speaker 2: have been shown to be beneficial for that particular condition
• 29:17
  Speaker 2: rather than just pushing down some... model that is designed
• 29:23
  Speaker 2: to cover all contingencies.
• 29:28
  Speaker 1: Love it all right now we've got about 25 minutes
• 29:31
  Speaker 1: to go and i want to optimize my 25 minutes
• 29:34
  Speaker 1: with you Would you rather, so your 2021 book, Burnout,
• 29:41
  Speaker 1: A Guide to Identifying Burnout and Pathways to Recovery, available
• 29:44
  Speaker 1: at all good bookstores, everyone. And more recently in 2025,
• 29:48
  Speaker 1: you wrote A Gut Mood Solution, A Groundbreaking Strategy for
• 29:51
  Speaker 1: Managing Bipolar Disorders. If we're going to focus on one
• 29:56
  Speaker 1: of those for now, what would you prefer?
• 29:58
  Speaker 2: I'd prefer to go with both and I'll try to
• 30:01
  Speaker 2: talk fast.
• 30:01
  Speaker 1: All right, let's do that. Of course you do. He's
• 30:04
  Speaker 1: a chatty, Cathy. Tiff, tell everyone what the doc told
• 30:07
  Speaker 1: or the prof told us before we went live. Chat GP.
• 30:12
  Speaker 2: Yeah, chat GP.
• 30:13
  Speaker 1: So Gordon Parker, chat GP. No chat GP, T. He's chatty.
• 30:19
  Speaker 2: All right, so....
• 30:21
  Speaker 1: All right. How long, let me ask you some, and
• 30:24
  Speaker 1: I said to you before we went live, do you
• 30:26
  Speaker 1: get sick of talking about the same stuff? And you
• 30:28
  Speaker 1: said you don't. So I blame you.
• 30:30
  Speaker 2: If you get bored, right? It's your fault. All right.
• 30:33
  Speaker 1: How long is the idea, or the concept of burnouts,
• 30:38
  Speaker 1: as we think about it and research it, how long
• 30:41
  Speaker 1: has that been around?
• 30:43
  Speaker 2: The concept of burnout goes back into very ancient times,
• 30:48
  Speaker 2: around about the 4th century AD. AD, would you believe,
• 30:54
  Speaker 2: when there was an epidemic of monks who basically decided
• 30:59
  Speaker 2: they couldn't perform. They'd wake up one day and they say,
• 31:01
  Speaker 2: the sun's not shining. The sky is no longer blue.
• 31:04
  Speaker 2: I've lost my faith in God. And this was called
• 31:08
  Speaker 2: a cedia. And it was the, at one stage, it
• 31:11
  Speaker 2: was made the eighth cardinal sin. Only later, a couple
• 31:15
  Speaker 2: of centuries later, Pope Gregory joined it together with Trististia,
• 31:19
  Speaker 2: which was depression. to create the seven deadly sins. So
• 31:23
  Speaker 2: the point I'm making is that burnout is not a
• 31:25
  Speaker 2: new phenomenon. It has existed for centuries. But what we
• 31:30
  Speaker 2: are seeing in recent decades is an epidemic. And for
• 31:33
  Speaker 2: the obvious reasons, we are required to be more on
• 31:36
  Speaker 2: the whole time, you know, have our phones available, checking
• 31:41
  Speaker 2: our iPads. So being on the whole time has been
• 31:45
  Speaker 2: a big driver. The issues that I think essentially are
• 31:51
  Speaker 2: How do we best define burnout? And for 40 years,
• 31:55
  Speaker 2: there's been a dominant model saying it just has three symptoms, exhaustion,
• 32:01
  Speaker 2: lack of empathy, and a lack of efficiency or productivity.
• 32:07
  Speaker 2: Of course, the third may just be the result of
• 32:11
  Speaker 2: the first two. So our research and other researchers who've
• 32:15
  Speaker 2: independently pursued how best to define burnout have a richer model.
• 32:20
  Speaker 2: So we give a big tick to exhaustion. Secondly, cognitive disturbance.
• 32:26
  Speaker 2: People say their brain is very, very foggy. And when
• 32:30
  Speaker 2: you read the ancient descriptions of a cheetah, the monks
• 32:33
  Speaker 2: in the desert would say their brain was foggy. Then
• 32:37
  Speaker 2: it's often not a loss of empathy. In fact, some
• 32:40
  Speaker 2: people become even more empathic because they understand what psychological
• 32:44
  Speaker 2: problems can feel like. It's a lack of feeling tone.
• 32:47
  Speaker 2: People don't get much buzz out of anything. Then you
• 32:51
  Speaker 2: get insularity they keep to themselves. And then there's often
• 32:58
  Speaker 2: a set of physical problems. So people can fall over.
• 33:05
  Speaker 2: Arianna Huffington, the head of Huffington Post, she fell over
• 33:10
  Speaker 2: and hit her head. In the book, we describe a
• 33:13
  Speaker 2: professional who couldn't get out of bed for three days.
• 33:16
  Speaker 2: And when she got to hospital, no one in the
• 33:18
  Speaker 2: ED department knew what was going on. Her blood pressure
• 33:21
  Speaker 2: was 60 over 40. Her pulse rate was through the roof.
• 33:25
  Speaker 2: So you get a lot of physical problems. Despite people
• 33:28
  Speaker 2: feeling exhausted, you get insomnia, you get anxiety, you get depression.
• 33:32
  Speaker 2: So that's the clinical description of burnout. And generally, it's
• 33:38
  Speaker 2: seen as a simple stress reaction to workplace stresses. However,
• 33:44
  Speaker 2: there's been, in the last decade or so, greater appreciation
• 33:48
  Speaker 2: that it can also come and hit people who are
• 33:51
  Speaker 2: not in formal workplace positions, but particularly women who are
• 33:55
  Speaker 2: looking after young children who may have problems and or
• 33:58
  Speaker 2: looking after elderly relatives who have problems. And if you've
• 34:01
  Speaker 2: got both, that's called the sandwich generation. Wow. But in
• 34:04
  Speaker 2: addition to that, our model, diagnostic model, respects the model
• 34:11
  Speaker 2: that underpins most psychiatric conditions, that they are diathesis stress disorders.
• 34:16
  Speaker 2: What does that mean? Diathesis means there are predisposing factors
• 34:21
  Speaker 2: and stress means there's a precipitating factor. For most psychiatric disorders,
• 34:26
  Speaker 2: the diathesis is genetic, but for burnout, it's personality. And
• 34:30
  Speaker 2: what we've identified is that people who are most likely
• 34:35
  Speaker 2: to develop burnout are diligent, reliable, conscientious, if not perfectionistic.
• 34:41
  Speaker 2: And that explains why you get the greatest representation in
• 34:45
  Speaker 2: doctors and nurses and lawyers, teachers, and with the biggest
• 34:51
  Speaker 2: group actually being the clergy. These are all positions that
• 34:55
  Speaker 2: demand you are reliable and conscientious. And it also explains
• 34:59
  Speaker 2: why sociopaths never develop burnout because they're not reliable and conscientious.
• 35:08
  Speaker 2: Now I feel like I should get it. So that's
• 35:12
  Speaker 2: our model of burnout and obviously social We have worked
• 35:16
  Speaker 2: away at that and tried to detail the richer model
• 35:20
  Speaker 2: and also come up with strategies for handling it. Most
• 35:24
  Speaker 2: strategies out there for handling burnout say tackle the stressful situation.
• 35:30
  Speaker 2: So people take time off work, have holidays, strenuous exercise,
• 35:36
  Speaker 2: do mindfulness or meditation. Our model says, yep, tick for
• 35:40
  Speaker 2: all of those. But in addition, if there's a predisposing
• 35:43
  Speaker 2: personality style, do something about that.
• 35:49
  Speaker 1: And how do you do something about your personality style?
• 35:52
  Speaker 2: Well, it's very difficult because people who are perfectionistic have
• 35:58
  Speaker 2: great difficulty in changing. So organizations in America have become
• 36:05
  Speaker 2: aware and put a lot of money into getting teams
• 36:09
  Speaker 2: coming in to address the problems and the problems with
• 36:13
  Speaker 2: their particular employees who are most at risk. And so
• 36:18
  Speaker 2: they have to be encouraged to not work the long hours,
• 36:21
  Speaker 2: to take the time off, to turn their phones off
• 36:24
  Speaker 2: at a certain time and to change a number of
• 36:28
  Speaker 2: their habits. But it can be particularly difficult. So in
• 36:31
  Speaker 2: the book, we give an example of a boss who
• 36:34
  Speaker 2: can't delegate anything. He has to check everything for his underlings.
• 36:39
  Speaker 2: And that puts him under constant perfectionistic stress. So the
• 36:43
  Speaker 2: psychologist tells him, you must send out your next load
• 36:46
  Speaker 2: of goods without checking it. He says, it's going to
• 36:49
  Speaker 2: be a disaster. Nothing happens that's disastrous. Then the psychologist said,
• 36:54
  Speaker 2: now you have to send out some goods, but with
• 36:57
  Speaker 2: one of them damaged. Disaster, disaster. What happens? The recipient
• 37:02
  Speaker 2: rings the guy and says, oh, mate, look, we got
• 37:06
  Speaker 2: your goods the other day. There was a problem with
• 37:08
  Speaker 2: one of them. It's not a big deal, just if
• 37:09
  Speaker 2: you wouldn't mind sending it back. Out of that, the
• 37:12
  Speaker 2: guy realised he could delegate. Secondly, his underlings appreciated that
• 37:18
  Speaker 2: he was now respecting them more and not breathing down
• 37:20
  Speaker 2: their neck the whole time. So it needs very hard
• 37:23
  Speaker 2: work generally by a psychologist.
• 37:26
  Speaker 1: Yeah, and also I guess self-awareness on part of the person.
• 37:33
  Speaker 1: It's like I have had... perfectionistic tendencies with some things,
• 37:39
  Speaker 1: but not with others. And it's realizing that, oh, this is,
• 37:44
  Speaker 1: it's like, this is as big a deal as I
• 37:47
  Speaker 1: make it. It's funny because you find some people would
• 37:49
  Speaker 1: be in, say, a similar situation or job with what
• 37:53
  Speaker 1: seems to be similar stresses and stressors and pressures. And
• 37:58
  Speaker 1: in the middle of that, that individual apparently experiencing no
• 38:03
  Speaker 1: version of burnouts and somebody else in an identical situation
• 38:07
  Speaker 1: hypothetically falling apart. And so there's the external stimuli, situation, circumstance, environment, task, role, personalities.
• 38:19
  Speaker 1: There's all that external stuff. And then there's the individual
• 38:23
  Speaker 1: reaction response. And that's going to, again, like the exercise programming,
• 38:29
  Speaker 1: that's going to depend on how that individual responds to
• 38:33
  Speaker 1: things those stimuli.
• 38:35
  Speaker 2: Yep. Agreed. So that's probably my best coverage of the
• 38:39
  Speaker 2: burnout story. All right. Okay.
• 38:42
  Speaker 1: Let's talk about the next one. So let me just
• 38:46
  Speaker 1: replug that book. So that book's called Burnout, A Guide
• 38:49
  Speaker 1: to Identifying Burnout and Pathways to Recovery.
• 38:51
  Speaker 2: More recently, that is last year, A.
• 38:55
  Speaker 1: Gut Mood Solution, A Groundbreaking Strategy for Managing Bipolar Disorders.
• 38:59
  Speaker 2: All right.
• 39:00
  Speaker 1: Let's open that door, Gordon.
• 39:02
  Speaker 2: Well, this was one of the most extraordinary stories that
• 39:06
  Speaker 2: I've heard over my whole career. Jane had developed a
• 39:11
  Speaker 2: bipolar disorder in adolescence. It became very severe in mid 20s.
• 39:16
  Speaker 2: It was bipolar one, which meant she was psychotic. And
• 39:20
  Speaker 2: for eight or so years, for five to 10% of
• 39:23
  Speaker 2: the year, she'd be psychotically manic. So she'd be talking
• 39:27
  Speaker 2: to people out in space. She'd be trying to organize
• 39:31
  Speaker 2: a meeting at the pub for Stephen Fry and Elon
• 39:34
  Speaker 2: Musk at the local country pub on the Friday. And
• 39:37
  Speaker 2: then for 80% of the year, she would be so
• 39:40
  Speaker 2: depressed that she couldn't get out of bed, couldn't feed herself,
• 39:44
  Speaker 2: and would be crawling over her body. and so depressed
• 39:47
  Speaker 2: that she attempted suicide on a number of occasions. She
• 39:51
  Speaker 2: had 10 admissions to hospital, and she was tried on
• 39:55
  Speaker 2: all appropriate medications for bipolar, but did not respond. Her husband, Alex,
• 40:00
  Speaker 2: an ecologist, who was used to, obviously, ecological regions, said, well,
• 40:08
  Speaker 2: maybe there's something going on with her ecological health. functioning
• 40:14
  Speaker 2: and he started reading stories about experiments with rats and
• 40:19
  Speaker 2: where a group of rats, for instance, received feces from
• 40:24
  Speaker 2: depressed adults, humans, and the other set of rats got
• 40:29
  Speaker 2: feces from non-depressed adults. And those who got them from
• 40:34
  Speaker 2: the depressed adults, the rat depression developed. So he said,
• 40:40
  Speaker 2: why don't we do a faecal transplant? So let me
• 40:44
  Speaker 2: back up here. Fecal transplants are essentially where somebody might
• 40:50
  Speaker 2: get faeces from a donor via enemy or a colonoscopy procedure,
• 40:56
  Speaker 2: and that's called a bottom-up procedure, or they get capsules,
• 40:59
  Speaker 2: otherwise known as crapsules, which is a top-down procedure. That
• 41:03
  Speaker 2: has been used mainly for a condition called prostridium difficile,
• 41:10
  Speaker 2: where people who have antibiotics strip their gut and they're
• 41:15
  Speaker 2: at high risk of dying, over an 80% chance of dying.
• 41:18
  Speaker 2: And faecal transplant has been done for that condition with
• 41:21
  Speaker 2: over an 80% success rate for decades. Even one vet
• 41:26
  Speaker 2: told me done for horses in Australia for over 30 years.
• 41:31
  Speaker 2: And it has been also used for a number of
• 41:33
  Speaker 2: other gut conditions like celiac disease and Crohn's disease. So
• 41:38
  Speaker 2: Alex said to Jane, why don't we do a faecal transplant?
• 41:42
  Speaker 2: And so they proceeded. They couldn't afford a gastroenterologist. It
• 41:47
  Speaker 2: was a do-it-yourself procedure, which they recognized the dangers. And
• 41:51
  Speaker 2: we obviously don't want to overplay that. And then after
• 41:55
  Speaker 2: about two months, Jane woke up one morning and felt joy.
• 41:59
  Speaker 2: And she was really worried that she might be going
• 42:01
  Speaker 2: into a high. But it was joy. It came back
• 42:03
  Speaker 2: into her life. She then said to a psychiatrist a
• 42:07
  Speaker 2: few months later, I want to come off my medications.
• 42:10
  Speaker 2: Because on one medication, she'd gained 40 kilograms in six weeks.
• 42:15
  Speaker 2: She was grossly overweight. Psychiatrist was really apprehensive, didn't want
• 42:19
  Speaker 2: it to occur. But she came off all her medications
• 42:23
  Speaker 2: and she's been off them now for nine years. And
• 42:27
  Speaker 2: the reason why, and she has stayed well, no highs,
• 42:30
  Speaker 2: no lows. And the reason why we think she stayed
• 42:34
  Speaker 2: well is that she changed her diet and she changed
• 42:38
  Speaker 2: her microbiome. That is amazing.
• 42:43
  Speaker 1: That is amazing.
• 42:44
  Speaker 2: So this is an incredible story. It's an Australian story.
• 42:51
  Speaker 2: Most medical discoveries come from doctors, but this came from
• 42:55
  Speaker 2: Jane's husband, an ecologist, a naturalist, who did his homework,
• 42:59
  Speaker 2: worked it all out, and thought it was all due
• 43:02
  Speaker 2: to the gut microbiome being disturbed. So what do we
• 43:06
  Speaker 2: think is happening? Basically... feces from a healthy individual, and
• 43:11
  Speaker 2: the Red Cross is a donor site, and there are
• 43:14
  Speaker 2: others as well. Presumably, we think, get down into the
• 43:20
  Speaker 2: lower bar where we have what's called the second brain,
• 43:23
  Speaker 2: the enteric nervous system, and they then send signals up
• 43:27
  Speaker 2: to the brain. Noradrenaline goes up, dopamine goes up, serotonin
• 43:31
  Speaker 2: goes up, GABA goes up, and also immunological pathways are activated,
• 43:36
  Speaker 2: resetting the brain from below. And so I wrote the
• 43:41
  Speaker 2: book mainly detailing the story about Jane and Alex. But
• 43:45
  Speaker 2: in addition, I collected stories from a number of other
• 43:48
  Speaker 2: people who had transplants. Most of them did very well
• 43:54
  Speaker 2: for about three months. And then bipolar tended to come back.
• 44:01
  Speaker 2: But most of them also said, that they never had
• 44:06
  Speaker 2: their recurrent episodes become as severe as the ones that
• 44:10
  Speaker 2: they'd had originally. And so I've got one patient at
• 44:14
  Speaker 2: the moment who's had a fecal transplant. It kept him
• 44:17
  Speaker 2: completely well for, not completely, 80% well for about six months.
• 44:22
  Speaker 2: He's now getting mood swings coming back again. He's getting
• 44:25
  Speaker 2: a fecal transplant. There's a wonderful documentary on Netflix called
• 44:29
  Speaker 2: Hack Your Health, that looks at the gut microbiome and
• 44:33
  Speaker 2: talks about the conditions that fecal transplants are now being
• 44:36
  Speaker 2: used for. And the list is extraordinary. So it's not
• 44:39
  Speaker 2: just gut disorders, but it's for multiple sclerosis. It's for autism.
• 44:46
  Speaker 2: It's for obesity. It's for Parkinson's disease. And I'm now
• 44:52
  Speaker 2: working with a colleague who's exploring it for Alzheimer's disease.
• 44:57
  Speaker 2: And the capacity for us to appreciate how this all
• 45:01
  Speaker 2: works and some of the concerns about it is well
• 45:04
  Speaker 2: illustrated in a case at the end of this documentary
• 45:09
  Speaker 2: where a 23-year-old psychology student says that she had irritable bowel.
• 45:13
  Speaker 2: She decides she'd have a faecal transplant from her brother.
• 45:17
  Speaker 2: She does and she gets acne. She doesn't like acne
• 45:21
  Speaker 2: so she stops and she goes to her boyfriend and says,
• 45:24
  Speaker 2: I want a faecal transplant from you. That happens. The
• 45:27
  Speaker 2: acne goes away but she gains weight and becomes depressed.
• 45:31
  Speaker 2: Her brother had depression. So she goes back to them
• 45:36
  Speaker 2: and depression goes away. She loses weight, but the acne
• 45:39
  Speaker 2: comes back. So gastroenterology conferences these days, 50% is all
• 45:47
  Speaker 2: taken up with the gut microbiome. And so the relevance
• 45:51
  Speaker 2: of the gut microbiome to psychiatry and particularly to nutritional
• 45:56
  Speaker 2: psychiatry is a new zeitgeist. So as I've said elsewhere,
• 46:02
  Speaker 2: I'm getting to the end of my career and my
• 46:04
  Speaker 2: career has turned to crap.
• 46:08
  Speaker 1: Well, I tell you what, Gordon and Tiff, and I
• 46:12
  Speaker 1: know you've got a question, Tiff, we'll get to it
• 46:14
  Speaker 1: because I can see your little question finger.
• 46:16
  Speaker 2: Just poking up there.
• 46:17
  Speaker 1: Not even a question, just a statement. Well, I was
• 46:19
  Speaker 1: going to say if I get a faecal transplant, I'm
• 46:22
  Speaker 1: going to Chris Hemsworth. Who are you? Because if my
• 46:28
  Speaker 1: symptoms are I look like him, I'm in. I'll have
• 46:31
  Speaker 1: one today. What were you going to say, Tiff? I
• 46:33
  Speaker 1: was going to say I interviewed Jane back in 2021, Gordon.
• 46:38
  Speaker 2: Good. Good. Yeah. Amazing. Amazing story. And the couple are extraordinary.
• 46:46
  Speaker 2: And Australian Story did a coverage of them last year.
• 46:49
  Speaker 2: It's called Gut Instinct and it's had a huge pick up.
• 46:54
  Speaker 2: And I've been getting a whole series of vignettes, obviously,
• 46:57
  Speaker 2: from people sending in emails. One really fascinating one was
• 47:01
  Speaker 2: a woman who said she developed cancer of the bowel
• 47:04
  Speaker 2: and eventually had to have her whole bowel resected. And
• 47:07
  Speaker 2: she has a stoma, meaning a bag. And she said,
• 47:11
  Speaker 2: after that, I'd had bipolar disorder for 12 years. I've
• 47:14
  Speaker 2: never had an episode ever since.
• 47:17
  Speaker 1: That's amazing.
• 47:19
  Speaker 2: So here is a model coming into psychiatry. We never
• 47:23
  Speaker 2: saw it coming. And Jane and Alex have been the pioneers. Yeah,
• 47:29
  Speaker 2: it's incredible. So you can appreciate how excited I was
• 47:34
  Speaker 2: to hear that story.
• 47:36
  Speaker 1: Well, Gordon, you are a font of knowledge, obviously. Might
• 47:41
  Speaker 1: I just say, Tiff, how about this? This is the prof.
• 47:46
  Speaker 1: Professor Gordon Parker, AO, is one of Australia's most distinguished psychiatrists,
• 47:50
  Speaker 1: mental health researchers, the founder of the Black Dog Institute,
• 47:53
  Speaker 1: of which he spoke, which does incredible stuff. Congratulations on that.
• 47:57
  Speaker 1: Written just a lazy 23 books, might be more, and
• 48:02
  Speaker 1: more than 1,000 scientific papers. Now, as someone who's beating
• 48:06
  Speaker 1: his chest with two, me, let's just say I have
• 48:11
  Speaker 1: a way to go, Tiff. I have a way to go,
• 48:14
  Speaker 1: and I'm at the starting line. I might have started
• 48:18
  Speaker 1: a bit late. Hey, Gordon, thank you so much. We
• 48:21
  Speaker 1: appreciate you. We'll give both of those books a plug,
• 48:24
  Speaker 1: and we would love to have you back in a
• 48:26
  Speaker 1: month or two if you're– we know you're chatty. Well,
• 48:30
  Speaker 1: we need someone five days a week, and, I mean,
• 48:32
  Speaker 1: I think we're a match made in heaven.
• 48:36
  Speaker 2: Thanks very much, Craig, and thanks, Tiff. It was a
• 48:38
  Speaker 2: pleasure for the interview. Thanks, Doc. We'll say goodbye off air.