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Diagnoses: More Harm Than Good? With Dr. Stu Law pt. 1 · Why We Do What We Do

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  Speaker 1: You're listening to Why We Do What We Do. Welcome
• 0:16
  Speaker 1: to Why We Do What We Do. I am your
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  Speaker 1: questioning common practices host, Abraham.
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  Speaker 2: And I'm your potentially anti-DSM host, Shane.
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  Speaker 1: We are a psychology podcast. We talk about the things
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  Speaker 1: that humans and non-human animals do, and sometimes we bring
• 0:33
  Speaker 1: people with us to help us on that journey to
• 0:35
  Speaker 1: talk about things that we maybe shouldn't do so much,
• 0:38
  Speaker 1: no mo. But if you're joining us for the first time,
• 0:41
  Speaker 1: then welcome. Hope that you enjoy what you hear in
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  Speaker 1: this discussion. And if you're a returning person, then welcome back.
• 0:47
  Speaker 1: And thank you for finding your way to us once again.
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  Speaker 1: And either way, if you'd like to support us, you
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  Speaker 1: can do that by joining us on Patreon, leaving us
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  Speaker 1: a rating and review, like, subscribe, and tell a friend.
• 0:57
  Speaker 1: I'll talk more about those things at the end of
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  Speaker 1: this discussion.
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  Speaker 3: Hey.
• 1:00
  Speaker 1: You could also name a diagnosis after us if you'd
• 1:02
  Speaker 1: like to. Don't do that, actually. That would not support us.
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  Speaker 1: Take it back. Don't do that. Either way, hey, if
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  Speaker 1: you are listening to this on the day that it publishes,
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  Speaker 1: it is August 26th. So happy Congressional Startup Day. I'm
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  Speaker 1: not sure I want to know what that means.
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  Speaker 3: Who knows?
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  Speaker 2: It's just start your own Congress, I guess.
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  Speaker 1: Okay.
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  Speaker 2: It is Make Your Own Luck Day.
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  Speaker 1: And you can do that by celebrating Musical Yoga Day.
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  Speaker 3: Sure.
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  Speaker 2: And then it's also National Cherry Popsicle Day.
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  Speaker 1: And maybe related, National Dog Day. Oh, those aren't related.
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  Speaker 1: I'm sorry. Again, undue. I need to stop connecting dots
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  Speaker 1: to things that should not be connected.
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  Speaker 2: It's like that scene in It's Always Sunny. It's you're
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  Speaker 2: the Pepe de Silva. You're like the red yarn everywhere.
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  Speaker 2: You're freaking out like Charlie Day. It's great. It's National
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  Speaker 2: Toilet Paper Day. Also, don't connect that to Dog Day
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  Speaker 2: or Cherry Popsicle Day.
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  Speaker 1: But you can use that toilet paper to celebrate Tug
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  Speaker 1: of War Day because it's also that.
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  Speaker 3: Sure.
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  Speaker 1: Short game.
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  Speaker 3: Yeah, yeah, yeah.
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  Speaker 2: Real quick game. You can also tie Toilet Paper Day
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  Speaker 2: to Willing to Lend a Hand Wednesday.
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  Speaker 3: Oh, no.
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  Speaker 1: Yikes.
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  Speaker 2: If you've ever been stuck, you know.
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  Speaker 1: Jeez. It is Women's Equality Day. Something to not make
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  Speaker 1: jokes about, I guess.
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  Speaker 3: Yeah.
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  Speaker 2: It's also Be Kind to Humankind Week. Indeed.
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  Speaker 1: It's Break Safety Week, as in you can break something safely.
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  Speaker 1: You can stop slowly to break safely. You can take
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  Speaker 1: a break and do so safely. But it's spelled B-R-A-K-E,
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  Speaker 1: so there's that.
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  Speaker 3: Yeah.
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  Speaker 2: It's National Safe at Home Week.
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  Speaker 1: Do not leave. Zombies will get you. It is World
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  Speaker 1: Water Week or Water World Week. I think we just
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  Speaker 1: got the words in the wrong order.
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  Speaker 2: Yeah, it's Waterworld Week. It's celebrating the masterpiece that is
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  Speaker 2: Waterworld starring Kevin Costner and his gills.
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  Speaker 1: Oh, man. For those of you our age, that will
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  Speaker 1: make sense. And for those of you younger than us,
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  Speaker 1: unlikely you've seen that film. That's okay.
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  Speaker 2: Treat yourself.
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  Speaker 1: Treat yourself. Yeah, go check it out for a blast
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  Speaker 1: of 90s. We don't need to keep talking about holidays, though,
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  Speaker 1: because that's not why we're here. Instead, we're taking on
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  Speaker 1: a different question, a different discussion, and introducing our guests today.
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  Speaker 1: But before I do that... I'd like to do a
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  Speaker 1: little bit more setup and intro here, but am I
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  Speaker 1: missing anything or is there anything you'd like to add
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  Speaker 1: before we begin our topic, Shane?
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  Speaker 2: No, I don't think so.
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  Speaker 1: Okay, let's start with the fact that a significant number
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  Speaker 1: of professions, I don't know what proportion or anything, but
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  Speaker 1: there are a lot of people. There's a lot of
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  Speaker 1: people in a lot of jobs and a lot of
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  Speaker 1: spaces who have as their primary or maybe secondary or
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  Speaker 1: some part of the realm of things that they do,
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  Speaker 1: they have an objective to solve problems. I would argue
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  Speaker 1: that a lot of professions, that's kind of all they
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  Speaker 1: do is solve problems. But that's okay. There's a lot
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  Speaker 1: of solving problems is something that is part of work
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  Speaker 1: that we do as people. And that usually means that
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  Speaker 1: the first step is identify problem. Usually through some kind
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  Speaker 1: of process of diagnosis. You can think of it like
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  Speaker 1: a mechanic. They figure out what's wrong with your car.
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  Speaker 1: They get a diagnosis first, and then they're going to
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  Speaker 1: move forward with that afterwards. So there's a lot of
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  Speaker 1: different spaces this shows up. But that is like step
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  Speaker 1: one of problem solve maybe is identify problem.
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  Speaker 2: Yes, and diagnostics can help triage issues and direct treatment
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  Speaker 2: or intervention in some way. Like that's usually what they're, it's,
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  Speaker 2: you've got the diagnosis as a result of the diagnostics
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  Speaker 2: that guide or give you guidance to where to go next.
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  Speaker 2: But diagnoses can also be incorrect, misleading and create more problems.
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  Speaker 3: Yeah.
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  Speaker 1: So like there's, there are pros and cons here. There's
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  Speaker 1: maybe there's, there's benefits in this system. And arguably some
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  Speaker 1: of these, some of the systems that use the diagnostic
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  Speaker 1: process use it to a greater effect than others. And
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  Speaker 1: there's probably a spectrum around which this is there's use
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  Speaker 1: utility in doing these kinds of things. That sort of
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  Speaker 1: brings us to introducing our guest here. This is probably
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  Speaker 1: our most frequently recurring guest. We're happy to have him back.
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  Speaker 1: This is Dr. Stu Law, who's joined us in the
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  Speaker 1: past in various episodes, as I just alluded to. You
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  Speaker 1: can go check those out if you're particularly persuaded by
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  Speaker 1: his charm and charisma today. But yeah, Dr. Stu Law,
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  Speaker 1: tell us a little bit about yourself.
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  Speaker 3: I am a behavior analyst, kind of straddling the line
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  Speaker 3: between behavior analysis and clinical psychology. So I spent a
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  Speaker 3: good chunk of my training in a lab accompanied by
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  Speaker 3: a bunch of very behavior analytically minded clinical psychologists. And
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  Speaker 3: we studied things like something we're going to talk about
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  Speaker 3: a little bit, I hope. Ideonomic analyses, ideo meaning starting
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  Speaker 3: at the level of individual and then nomic meaning leading
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  Speaker 3: to broad principles. And then I am the developer of
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  Speaker 3: a behavioral assessment called Generate. which is like a skills
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  Speaker 3: assessment or a skills inventory kind of approach to human wellness.
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  Speaker 3: So we get a sense of what people can do,
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  Speaker 3: and then we compare them to some outcome that they
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  Speaker 3: tell us about. So that's one of the things that
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  Speaker 3: kind of makes it a little different from other assessments.
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  Speaker 3: We don't say like, here's normal kids and here's your kid.
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  Speaker 3: Your kid wants to be normal, right?
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  Speaker 1: Right.
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  Speaker 3: There's a lot of talk in the field right now
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  Speaker 3: about indistinguishability as a goal, ascent-based treatment, getting people generally
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  Speaker 3: on board with the things that you're doing with and
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  Speaker 3: to them. And we think we have some technological things
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  Speaker 3: that can help practitioners support them in that journey.
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  Speaker 1: So this is kind of its own diagnostic tool.
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  Speaker 3: Yeah. I mean, in a sense, we're leading the way
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  Speaker 3: as to like where we want this thing to go
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  Speaker 3: and how we want psychology of the future to look
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  Speaker 3: now that we have, again, as we'll talk about, like
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  Speaker 3: a lot of new technologies and tools at our fingertips
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  Speaker 3: that I think have historically been unavailable to us.
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  Speaker 1: And for those who are interested in looking it up,
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  Speaker 1: it is not spelled the way you might look to
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  Speaker 1: spell generate G E N A R E T E.
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  Speaker 3: Yeah.
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  Speaker 1: I'll say that one more time. G E N A
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  Speaker 1: R E T E. And, and you have essentially rolled
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  Speaker 1: this out. I'm understanding with there's like a website and
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  Speaker 1: like a workbook that will guide you through conducting this
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  Speaker 1: assessment and that sort of thing.
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  Speaker 3: Yeah, and our kooky name, we didn't reach the conclusion
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  Speaker 3: that we needed a bad spelling of a real word, likely.
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  Speaker 3: I think that's a term that I tend to try
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  Speaker 3: to avoid. But the origin was just too good. We
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  Speaker 3: couldn't help it. So our name comes from gen or
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  Speaker 3: genesis or the origin of and then a rate. It's
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  Speaker 3: pronounced other ways, but it's a Greek word that means
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  Speaker 3: to reach self-fulfillment or like a metaphorical peak. So we
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  Speaker 3: thought it was a really nice way to orient people
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  Speaker 3: to like, hey, we're.
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  Speaker 4: Doing this as one a little bit differently.
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  Speaker 3: And it has to do with notions of self-fulfillment, reaching
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  Speaker 3: purpose in life and those kinds of things.
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  Speaker 1: Nice. All right, well, we have a lot to unpack
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  Speaker 1: in this discussion. So I'm sure there'll be opportunities to
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  Speaker 1: continue to bring in what you have developed as it
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  Speaker 1: relates to this type of assessment. And I think we've
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  Speaker 1: more or less teed up our topic today. But I
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  Speaker 1: want to make sure we're actually sort of setting the
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  Speaker 1: stage here in a way that allows us to move
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  Speaker 1: forward cogently with this conversation and not having people feel
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  Speaker 1: particularly lost. Because I started this by talking about diagnoses.
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  Speaker 1: And then we sort of talked about diagnoses. can sometimes
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  Speaker 1: be not the most productive direction to go. And there's
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  Speaker 1: a variety of reasons for that that we'll get into.
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  Speaker 1: And so really the purpose of this discussion is as
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  Speaker 1: it relates to diagnosis for things like mental health, you
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  Speaker 1: can maybe make the argument that that could be a
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  Speaker 1: separate category from like behavioral concerns or that maybe people
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  Speaker 1: would think of those as being separate things. But the
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  Speaker 1: point being that there is a diagnostic label, a diagnostic
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  Speaker 1: system that is applied to behaviors of people, and that
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  Speaker 1: that system has, while it has been around for the
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  Speaker 1: better part of a century, what does it continue to
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  Speaker 1: contribute to our understanding of human behavior? What pitfalls do
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  Speaker 1: we see? And what can we do moving forward? thinking
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  Speaker 1: about the impact that this has for humans, broadly speaking,
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  Speaker 1: for our profession and other psychologists, maybe more specifically, the
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  Speaker 1: sort of debate set up here is like, do diagnoses
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  Speaker 1: do more harm than good?
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  Speaker 3: Yeah, that is the setup, I think. It's one that
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  Speaker 3: you kind of baited me into.
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  Speaker 4: Yeah. A little bit.
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  Speaker 3: But it's noteworthy that, you know, it feels a little
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  Speaker 3: anti-science to go against kind of this mainstream way of
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  Speaker 3: looking at things. But hopefully we'll set forth some things
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  Speaker 3: that don't feel like we're trying to take the like
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  Speaker 3: anti-vax path.
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  Speaker 4: You know what I mean?
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  Speaker 3: Sure. This was kind of the focus of our lab
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  Speaker 3: in the entirety of kind of my graduate career.
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  Speaker 4: And I think we make some good points.
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  Speaker 3: We try to back it up with good science and
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  Speaker 3: point to very pragmatic solutions and where we can go
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  Speaker 3: next and how we've maybe demonstrated that as much as
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  Speaker 3: it Sounds really cool to apply medical models to psychological problems.
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  Speaker 4: That comes with some baggage.
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  Speaker 3: I think that's a fair stance to take. Maybe that
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  Speaker 3: it didn't do more harm than good. That's a high bar,
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  Speaker 3: but it definitely comes with some baggage. Okay. I agree.
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  Speaker 1: And I kind of want to try to, as much
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  Speaker 1: as I can make myself do this, be the devil's advocate,
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  Speaker 1: be the voice of the denier, the doubter, the skeptic
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  Speaker 1: who might hear this and think like, I don't like
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  Speaker 1: what this guy says. I don't like it. I think
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  Speaker 1: he's wrong. Even though I think I'm probably not going
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  Speaker 1: to feel that way internally, I want to try and
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  Speaker 1: be the voice of the audience who might. So I'm
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  Speaker 1: going to try and challenge you where I maybe see
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  Speaker 1: opportunities for doing so.
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  Speaker 4: Okay.
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  Speaker 1: And not out of anything other than love, you know,
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  Speaker 1: but for the purposes of this discussion. But let's go
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  Speaker 1: ahead and start then with the first thing to make
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  Speaker 1: sure we're all on the same page about is what
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  Speaker 1: is the diagnostic system for mental health? A system, but
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  Speaker 1: we also have a specific system that we can talk about. Yeah.
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  Speaker 3: So I think it generally is probably not going to
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  Speaker 3: be surprising to people to hear that the prevailing strategy
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  Speaker 3: in clinical psychology for the past couple of decades, maybe
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  Speaker 3: since the 80s even, has been to take the medical
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  Speaker 3: model and study psychology in the same way that we
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  Speaker 3: tend to understand medical mysteries. So your job as a
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  Speaker 3: psychologist is to identify syndromes. So step one is to
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  Speaker 3: kind of identify some class of symptoms that hang together.
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  Speaker 3: And then as scientists, what we've generally tried to do
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  Speaker 3: is create protocolized treatment packages that then address those syndromes.
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  Speaker 3: So step one, identify signs and symptoms that hang out together,
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  Speaker 3: identify them as common sense syndromes. And then step two
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  Speaker 3: is to identify packages, treatment packages that are evidence-based that
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  Speaker 3: fit those syndromes.
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  Speaker 4: So the DSM is kind of the most common one that.
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  Speaker 3: Many are familiar with, but there are others that are
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  Speaker 3: kind of competing it. So the World Health Organization has
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  Speaker 3: the International Classification of Diseases, which is sort of a
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  Speaker 3: competitor for the DSM that some people have turned towards,
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  Speaker 3: in part because it's kind of an open secret, not
• 12:41
  Speaker 3: to get ahead of our skis, but it's kind of
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  Speaker 3: an open secret that even people who've written the DSM
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  Speaker 3: are terribly thrilled with some of the things that are
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  Speaker 3: coming out of it.
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  Speaker 1: Very fair.
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  Speaker 4: But in short..
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  Speaker 3: In short, not to be demeaning to this approach, but
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  Speaker 3: we've tended to call it protocols for syndromes.
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  Speaker 1: Very fair. I should have warned you ahead of time.
• 13:00
  Speaker 1: I'm going to intermittently and sneakily throw in some random
• 13:04
  Speaker 1: segue to an ad. So step one, step two, and
• 13:07
  Speaker 1: step three is ads. Sure. All right, we're back. We've
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  Speaker 1: just started unpacking sort of what a diagnostic system is
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  Speaker 1: with respect to understanding and talking about mental health, behavioral health,
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  Speaker 1: those sorts of things. And as you said, essentially, just
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  Speaker 1: saying this slightly differently, we actually did an episode a
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  Speaker 1: long time ago. People could check out if they're interested
• 13:37
  Speaker 1: about diagnosing mental health conditions where we sort of just
• 13:41
  Speaker 1: walk through the history of systems that have attempted to
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  Speaker 1: do something like this. And we talked about the ICD,
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  Speaker 1: talked about the DSM, some of the iterations it's been
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  Speaker 1: through and various approaches that have been taken to trying
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  Speaker 1: to handle this. And there's also others in other parts
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  Speaker 1: of the world that kind of do their own thing
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  Speaker 1: with it. But yeah, it is like we observe a
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  Speaker 1: thing that people are doing. We decide that's a thing
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  Speaker 1: that they maybe shouldn't be doing in some capacity. And
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  Speaker 1: then we say, we're going to call that something. There's
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  Speaker 1: a problem here. That problem needs a label. I want
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  Speaker 1: to call it the thing. And then, as you said,
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  Speaker 1: from there, there's often... figuring out what we're going to
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  Speaker 1: do about it becomes the protocol. But first we want
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  Speaker 1: to call it something. So when someone does these behaviors
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  Speaker 1: and someone else does some behaviors, I'm going to say
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  Speaker 1: those look close enough that we're going to call those
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  Speaker 1: the same type of things. We're going to call that
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  Speaker 1: one bipolar and that one's bipolar or whatever. That's sort
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  Speaker 1: of broadly how people have approached this idea of thinking
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  Speaker 1: about classifying behaviors in a way that we would relate
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  Speaker 1: them to this idea of mental health is just sort
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  Speaker 1: of what do we see What do we call that
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  Speaker 1: thing that we think we shouldn't be seeing that we
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  Speaker 1: maybe should do something differently about? Because presumably those classes
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  Speaker 1: of behaviors are– the concern is that they're pathological, that
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  Speaker 1: they're adverse and that there's something wrong with them and
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  Speaker 1: that that means something wrong for the individual. And I
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  Speaker 1: think in many cases, you have a fairly strong case
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  Speaker 1: for having said that because this is someone who might
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  Speaker 1: be hurting themselves or hurting other people a lot. and
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  Speaker 1: that they're doing things that are pretty unambiguously adverse to
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  Speaker 1: their overall well-being. But other things, I think, much less
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  Speaker 1: clear in the extent to which it's something that is pathological.
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  Speaker 1: And maybe we don't need to go all the way
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  Speaker 1: down that rabbit hole, but let's instead pivot to what
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  Speaker 1: problems this system was supposed to address. Why would we
• 15:27
  Speaker 1: even want to develop this in the first place? Yeah.
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  Speaker 3: So one of the things that we commonly cite when
• 15:33
  Speaker 3: we're approaching this issue, this is I don't even know
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  Speaker 3: if it's famous, but in my book, I've probably heard
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  Speaker 3: this quote a thousand times.
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  Speaker 4: And it's Gordon Paul.
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  Speaker 3: He has this sort of infamous question. He says the
• 15:47
  Speaker 3: purpose of psychological treatment and the approach that we're taking
• 15:51
  Speaker 3: is to determine what treatment by whom is most effective
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  Speaker 3: for this individual with that specific problem under which set
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  Speaker 3: of circumstances and how does that come about? So all
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  Speaker 3: of those questions are what we are trying to accomplish
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  Speaker 3: when we take the syndromal approach to psychology. That is
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  Speaker 3: the problem we're trying to solve. So what treatment should
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  Speaker 3: we deliver? Who's going to deliver it? For what problem?
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  Speaker 3: And then under what set of circumstances and who's allowed
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  Speaker 3: to do it? So all of those kinds of questions
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  Speaker 3: are the kinds of things that in psychology, I would
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  Speaker 3: say we have spent years. the vast majority of our
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  Speaker 3: time and effort trying to solve.
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  Speaker 1: Yeah. And yeah, thinking through the fact that this is,
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  Speaker 1: as I was pointing out earlier, like there are people
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  Speaker 1: who are doing things that are fairly unambiguously difficult. They're
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  Speaker 1: maybe creating situations where they are not able to participate
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  Speaker 1: very fully or meaningfully in whatever part of society they
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  Speaker 1: find themselves in. It could be taking care of themselves.
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  Speaker 1: It could be taking care of others. Again, there could
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  Speaker 1: be active harm that's coming to them. Or they're like
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  Speaker 1: struggling to participate in a way that we typically expect
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  Speaker 1: that most people will be able to participate. And you
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  Speaker 1: could certainly make the argument that this is a systems problem.
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  Speaker 1: It's like we have systems that are just not designed
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  Speaker 1: to accommodate a wide range of ways that different humans
• 17:14
  Speaker 1: show up in the world. And I think that's a
• 17:16
  Speaker 1: point that's very true. And then there's also like the
• 17:18
  Speaker 1: fact that people do legitimately experience distress. Like they're legitimately reporting,
• 17:24
  Speaker 1: I wish that I could think about this or handle this.
• 17:28
  Speaker 1: psychological experience I'm having in a more practical way.
• 17:31
  Speaker 4: Yeah.
• 17:32
  Speaker 3: I think one of the advantages of the system is
• 17:34
  Speaker 3: it's a really nice shortcut. I think there are other
• 17:38
  Speaker 3: ways to this solution, but you know, it's a really
• 17:41
  Speaker 3: nice way to create systems of care and identify the
• 17:45
  Speaker 3: need for care and identify the need for compassion. And
• 17:48
  Speaker 3: just like a understanding of where a person's coming from,
• 17:51
  Speaker 3: because if somebody is coming to you and saying, I
• 17:54
  Speaker 3: need help, And I recognize that I need help. And
• 17:57
  Speaker 3: there are times where I might not say that out loud,
• 18:00
  Speaker 3: but in my more sober and taking the sort of
• 18:03
  Speaker 3: broadest sense of the word in my more sober states
• 18:06
  Speaker 3: of mind, like I recognize that I'm not in a
• 18:08
  Speaker 3: good space and I need somebody to help intervene, even
• 18:13
  Speaker 3: if it's, you know, at times.
• 18:15
  Speaker 4: Something that I might resist. And so, yeah, setting oneself
• 18:19
  Speaker 4: up for How.
• 18:21
  Speaker 3: Do we identify a clinical threshold where those things happen?
• 18:28
  Speaker 1: Okay. So I think, at least for me, this feels
• 18:31
  Speaker 1: like this has adequately set the stage for sort of
• 18:33
  Speaker 1: why the system began to exist in the first place.
• 18:36
  Speaker 1: Is there anything, Shane, that you feel like you'd like
• 18:38
  Speaker 1: to see that I maybe missed or would like to
• 18:40
  Speaker 1: add to this before we start talking about what issues
• 18:44
  Speaker 1: have maybe been created by this same system?
• 18:47
  Speaker 3: No, no, no.
• 18:47
  Speaker 2: I'm really excited to get into this because I feel
• 18:49
  Speaker 2: like as somebody who trained in a clinical psychology space
• 18:54
  Speaker 2: prior to behavior analysis, I'm really excited to kind of
• 18:57
  Speaker 2: get into this and like really unpack this a little
• 18:59
  Speaker 2: bit more. Cool.
• 19:01
  Speaker 1: Anything else for you Stu in terms of unpacking like
• 19:03
  Speaker 1: the premise for the system existing to begin with?
• 19:08
  Speaker 4: No, I don't think so. Yeah.
• 19:10
  Speaker 1: Okay. All right, so let's start, I think, digging into
• 19:15
  Speaker 1: what kind of issues were going to be created by
• 19:18
  Speaker 1: such a system. And I think you could argue in
• 19:20
  Speaker 1: a lot of cases where there's any kind of diagnostic
• 19:22
  Speaker 1: system that there are some issues that are going to exist.
• 19:25
  Speaker 1: The medical model certainly has its own issues. and that
• 19:28
  Speaker 1: they've been Yeah, absolutely. Yeah.
• 20:03
  Speaker 3: So one of the things that the system has struggled
• 20:07
  Speaker 3: to do is find specific syndromes. So identify syndromes, diseases, disorders,
• 20:16
  Speaker 3: things that are very orderly unto themselves. So one of
• 20:20
  Speaker 3: the things you might say is that the DSM has
• 20:23
  Speaker 3: suffered from underwhelming specificity. So kind of famously, PTSD can
• 20:29
  Speaker 3: be made up of any one of 636,120 symptom combinations.
• 20:36
  Speaker 4: So if you were.
• 20:39
  Speaker 3: To take things that are not psychologically medical, like the
• 20:45
  Speaker 3: flu or, you know, gout or something like that, signs
• 20:51
  Speaker 3: and symptoms tend to lump together in a much more
• 20:54
  Speaker 3: orderly fashion and with much more specificity such that when
• 20:58
  Speaker 3: you go to the doctor, they have a pretty good
• 21:01
  Speaker 3: sense of.
• 21:01
  Speaker 4: Like, oh, that's X, Y, Z. So. this is not
• 21:06
  Speaker 4: the case.
• 21:06
  Speaker 3: So like a sign or symptom might be like, you're
• 21:09
  Speaker 3: not eating, you're lethargic, right? Things like this, you know,
• 21:13
  Speaker 3: the signs and symptoms, the sheer number of possibilities and
• 21:16
  Speaker 3: combinations are dizzying. And that is problematic from a perspective
• 21:23
  Speaker 3: of trying to, you know, identify order in these spaces,
• 21:27
  Speaker 3: because if somebody comes to you and they say, I'm
• 21:29
  Speaker 3: not eating, I yelled at my kid the other day.
• 21:32
  Speaker 4: I'm irritable. I'm not sleeping.
• 21:36
  Speaker 3: And then you have somebody who has none of those
• 21:38
  Speaker 3: signs and symptoms and you're giving them the same diagnosis.
• 21:40
  Speaker 3: There is some degree to which that happens in medicine.
• 21:43
  Speaker 3: For example, you might have the flu and you might
• 21:45
  Speaker 3: have a kind of stomach issues, whereas somebody else might
• 21:49
  Speaker 3: have a really bad headache or something like that. But
• 21:52
  Speaker 3: generally speaking, When we are trying to diagnose the initial
• 21:58
  Speaker 3: onset of something for which we have a treatment, we're
• 22:02
  Speaker 3: doing so in a way where the signs and symptoms
• 22:05
  Speaker 3: hang together a lot better than they do in the
• 22:07
  Speaker 3: psychological world.
• 22:09
  Speaker 1: You know what's wild about that number that you threw out?
• 22:11
  Speaker 3: 636,120.
• 22:11
  Speaker 1: That's how many episodes we've got?
• 22:14
  Speaker 4: Boy, that'd.
• 22:18
  Speaker 1: Be quite the coincidence. If you were to just Google
• 22:21
  Speaker 1: how many words there are in the English language, the
• 22:23
  Speaker 1: estimates range from 170,000 to a million. And this is
• 22:26
  Speaker 1: like toward the million side of that. Like there are
• 22:32
  Speaker 1: more symptom combinations than one of the estimates for the
• 22:35
  Speaker 1: number of words in the English language. I was like,
• 22:37
  Speaker 1: I'm not sure that I know 636,120 words and I
• 22:39
  Speaker 1: have a pretty big vocabulary. So that's a lot. That's
• 22:44
  Speaker 1: a big number.
• 22:45
  Speaker 4: Yeah.
• 22:46
  Speaker 3: And, uh, you know, and it's noteworthy that This isn't
• 22:50
  Speaker 3: just like on paper. It's possible that people have different
• 22:54
  Speaker 3: signs and symptoms for the same diagnosed syndrome, right? So
• 23:00
  Speaker 3: it could be the case that there's a whole bunch
• 23:02
  Speaker 3: of them or a whole bunch of pathways that never
• 23:04
  Speaker 3: get used, but that we don't think is the case.
• 23:08
  Speaker 3: So there's examples where people with major depression... So they
• 23:12
  Speaker 3: did a study where they evaluated 3,700 of them, and
• 23:16
  Speaker 3: there were 1,030 unique pathways inside of that.
• 23:21
  Speaker 4: So people are using all of the pathways.
• 23:24
  Speaker 3: So it's not just that there's signs and symptoms that
• 23:27
  Speaker 3: could exist, but they seldom come up. All of those
• 23:30
  Speaker 3: different pathways are being used, and people are showing up
• 23:33
  Speaker 3: in many different ways.
• 23:36
  Speaker 4: And it's being called the same thing.
• 23:38
  Speaker 3: Right.
• 23:38
  Speaker 4: You know, just in terms of trying to create a system,
• 23:40
  Speaker 4: it creates some problems.
• 23:43
  Speaker 1: I would presume based on that, like, yeah, like over
• 23:47
  Speaker 1: a thousand people who have not one thing in common
• 23:50
  Speaker 1: with one another, who all have the same diagnoses, not
• 23:53
  Speaker 1: like symptomatically, not one thing in common, the exact same diagnoses.
• 23:57
  Speaker 3: Yeah.
• 23:58
  Speaker 1: And that sort of speaks to like, how descriptively accurate
• 24:02
  Speaker 1: or useful could this be if it is the case
• 24:05
  Speaker 1: that like, again, there's just no overlap with the things
• 24:09
  Speaker 1: we've used to identify a diagnosis, split that many different ways.
• 24:14
  Speaker 1: Is that really the same thing going on for each
• 24:17
  Speaker 1: person in that situation?
• 24:19
  Speaker 2: It seems unlikely.
• 24:20
  Speaker 1: Yeah.
• 24:21
  Speaker 3: Well, and if you were to look at therapeutic approaches
• 24:24
  Speaker 3: as therapeutics, so think about medical interventions and these things
• 24:30
  Speaker 3: aren't designed to get rid of the virus or to
• 24:35
  Speaker 3: alleviate something correctly, but rather to provide some relief, right?
• 24:40
  Speaker 3: So put ice on your knees or take a warm
• 24:44
  Speaker 3: bath or put some vapor rub on your chest or whatever.
• 24:48
  Speaker 3: It's going to be really hard to recommend those things
• 24:51
  Speaker 3: if those signs and symptoms are very different, right? So
• 24:55
  Speaker 3: If somebody were to have an upset stomach and you're.
• 24:57
  Speaker 4: Like, VapoRub, you have the flu, VapoRub, and that's going
• 25:02
  Speaker 4: to immediately make them hurl. Well, now you've got some problems.
• 25:06
  Speaker 3: And I tend to think that a lot of psychological
• 25:09
  Speaker 3: signs and symptoms, we need specificity on the signs and symptoms.
• 25:13
  Speaker 3: And often we are looking at the signs and symptoms
• 25:16
  Speaker 3: and we're trying. So if somebody is not sleeping, it's
• 25:19
  Speaker 3: probably a good idea to get them some intervention or
• 25:22
  Speaker 3: some plan or some organizational things around like, okay, here's
• 25:26
  Speaker 3: how we get you to sleep. And here's how we,
• 25:28
  Speaker 3: you know, so it's, you know, it's, it's kind of
• 25:32
  Speaker 3: three things, right? One is these signs and symptoms don't
• 25:35
  Speaker 3: hang together. This is how it occurs in the real world.
• 25:39
  Speaker 3: And those signs and symptoms are the things that we generally.
• 25:44
  Speaker 4: As psychological professionals are looking to treat on the forefront.
• 25:48
  Speaker 4: So that creates quite the headache. I tend to think.
• 25:53
  Speaker 1: Ads create quite the headache.
• 26:02
  Speaker 2: It's so funny because I was thinking about this from
• 26:04
  Speaker 2: just the idea and kind of thinking about the perspective
• 26:06
  Speaker 2: of what people generally do with the diagnosis, right? So
• 26:10
  Speaker 2: you've got all these symptoms and you've got all these
• 26:13
  Speaker 2: combinations of symptoms that make it kind of disorderly in
• 26:19
  Speaker 2: what is described as an orderly system. I'd be curious
• 26:21
  Speaker 2: about whether or not what people are doing is they're
• 26:24
  Speaker 2: not really looking at the symptoms and they're, or they're
• 26:27
  Speaker 2: not even looking at the title or the diagnosis. What
• 26:30
  Speaker 2: they're doing is they're going, the minute they get that label,
• 26:34
  Speaker 2: they're assuming that that's causal or they're, they're assuming that
• 26:37
  Speaker 2: there is like, oh, like that's where it's coming from. Like,
• 26:40
  Speaker 2: so when you hear major depression, you go, it's not
• 26:42
  Speaker 2: like what is happening. It is, oh, there it's major depression.
• 26:46
  Speaker 2: So now I know, I know where that's coming from.
• 26:48
  Speaker 2: I know the beginning stages are like the, you know,
• 26:50
  Speaker 2: the focal point of where to intervene. Which I'm sure
• 26:53
  Speaker 2: is happening, but I think that that's what I'm kind
• 26:54
  Speaker 2: of noticing is like people are going, they're conflating label
• 26:58
  Speaker 2: versus cause, I think, when they hear that.
• 27:01
  Speaker 3: Yeah, and I think if, you know, eventually I'm going
• 27:04
  Speaker 3: to deviate from my receipts and that's one of the
• 27:07
  Speaker 3: ones that I have personally is.
• 27:09
  Speaker 4: It tends to feel like.
• 27:11
  Speaker 3: These things are treated as causal entities and that to me,
• 27:15
  Speaker 3: and just in pop psychology, that is a lot of damage.
• 27:18
  Speaker 3: Even if it doesn't trickle up to professionals and professionals
• 27:22
  Speaker 3: can identify, you know, hey, this is not a causal
• 27:25
  Speaker 3: entity and we still have.
• 27:27
  Speaker 4: To ask good questions. If that were the case, then
• 27:29
  Speaker 4: I don't think that it is.
• 27:30
  Speaker 3: I do think a lot of professionals take these as
• 27:32
  Speaker 3: causal entities rather than descriptive entities.
• 27:36
  Speaker 4: Mm-hmm.
• 27:37
  Speaker 3: Even if that were true at the level of the population,
• 27:39
  Speaker 3: that would create quite some headaches for us. But I
• 27:41
  Speaker 3: tend to think it's true both at the level of
• 27:43
  Speaker 3: the population and many, many practitioners take them as causal entities.
• 27:48
  Speaker 3: But disorder, which many of these things are, they're not
• 27:54
  Speaker 3: designed or intended to be causal structures. This just means
• 27:58
  Speaker 3: there's typically order, which I kind of disagree with that notion,
• 28:02
  Speaker 3: that there is order in people's lives. I think people
• 28:07
  Speaker 3: are different, and we'll talk about that more later. But
• 28:11
  Speaker 3: disorder just means we're finding that there's not a lot
• 28:15
  Speaker 3: of order. And that is not intended to be a
• 28:20
  Speaker 3: causal structure that moves and grooves things, that it doesn't
• 28:24
  Speaker 3: push and pull things.
• 28:26
  Speaker 4: It's circular, right? I'm sure you guys have talked about.
• 28:28
  Speaker 3: Things like that before, but I tend to think a
• 28:31
  Speaker 3: lot of diagnoses are treated circularly in that fashion. Mm-hmm.
• 28:36
  Speaker 1: Yeah. Actually, maybe our second episode ever was about like
• 28:39
  Speaker 1: circular reasoning. I have to imagine, yeah.
• 28:43
  Speaker 3: Yeah.
• 28:43
  Speaker 1: I beat this drum many times and I will continue
• 28:45
  Speaker 1: to do so. And I'm realizing I'm doing a terrible
• 28:47
  Speaker 1: job disagreeing with you about things. I'll try to do better.
• 28:49
  Speaker 1: But it's like we see someone doing some behavior and
• 28:54
  Speaker 1: we're like, I'm going to call that behavior X. And
• 28:56
  Speaker 1: then someone's like, why is that behavior happening? Like, because
• 28:58
  Speaker 1: of X. I'm like, yeah, but you just You just
• 29:01
  Speaker 1: called it that. You just made up a name for it.
• 29:02
  Speaker 1: You're like, I'm going to call it X. And now
• 29:04
  Speaker 1: you're saying that's the reason they're doing it. That's not
• 29:06
  Speaker 1: the reason. They're just like, all you've done is call
• 29:09
  Speaker 1: it a thing. And now you're assuming that that has
• 29:11
  Speaker 1: some causal, that that name somehow is making that happen.
• 29:15
  Speaker 3: Yeah.
• 29:15
  Speaker 1: You can see the carryover from like medical where it's like,
• 29:17
  Speaker 1: why am I throwing up all over the place? Oh,
• 29:20
  Speaker 1: because you have cancer in your stomach. And like, oh,
• 29:22
  Speaker 1: so that's making me throw up everywhere.
• 29:24
  Speaker 3: Yep.
• 29:25
  Speaker 1: And so that diagnosis does tell you what the cause
• 29:28
  Speaker 1: of the symptom is. in those cases. But when we're
• 29:31
  Speaker 1: talking about the psychological things, again, you're just sort of
• 29:33
  Speaker 1: applying a name to a cluster of hundreds of thousands
• 29:36
  Speaker 1: of symptoms, apparently in some cases, and then saying that like...
• 29:40
  Speaker 1: that's the thing that we're observing. And then now also
• 29:43
  Speaker 1: assuming that that's the cause when all you've done is
• 29:45
  Speaker 1: label a cluster of symptoms. And that, yeah, that causal thing,
• 29:48
  Speaker 1: I agree, is it's a stick in the craw thing
• 29:50
  Speaker 1: for me where I'm just like, ugh, that's terrible.
• 29:55
  Speaker 4: I'll be you for a minute and do your job
• 29:58
  Speaker 4: for you.
• 29:59
  Speaker 3: And I would say, you know, like that label, despite
• 30:03
  Speaker 3: and that method and that way of doing things does
• 30:06
  Speaker 3: provide a way forward potentially.
• 30:09
  Speaker 4: Right.
• 30:09
  Speaker 3: Like it provides, I mean, one of the things that's
• 30:11
  Speaker 3: really kind of self-evident is that it generally provides a
• 30:14
  Speaker 3: sense of.
• 30:15
  Speaker 4: Relief, right? Like at least I have a name for
• 30:17
  Speaker 4: this thing.
• 30:18
  Speaker 3: Right.
• 30:19
  Speaker 4: And that in the medical world is a very common experience. Like,
• 30:23
  Speaker 4: I went to.
• 30:23
  Speaker 3: Doctor to doctor, and even if it's terminal cancer and
• 30:26
  Speaker 3: there's no way forward, at least I know what this
• 30:29
  Speaker 3: thing is, right? At least I have a word for it,
• 30:32
  Speaker 3: and at least I have some closure. I can find
• 30:35
  Speaker 3: communities of people who are experiencing similar things, and having
• 30:39
  Speaker 3: those words and labels, it's not entirely without utility, right?
• 30:44
  Speaker 3: you know, having words and labels for things can be
• 30:47
  Speaker 3: a tremendous relief. It can provide, you know, closure in
• 30:51
  Speaker 3: a sense, you know, and I think those things are useful,
• 30:54
  Speaker 3: useful elements of what we're doing here. It does have
• 30:58
  Speaker 3: the unfortunate side effect of some of the baggage that
• 31:02
  Speaker 3: comes with that, right. Of, you know, I can't because
• 31:05
  Speaker 3: I'm depressed.
• 31:06
  Speaker 4: I can't because I have ADHD. I can't because, and.
• 31:10
  Speaker 3: That fusion with that thing, can be problematic, but it
• 31:14
  Speaker 3: can also not be problematic.
• 31:16
  Speaker 4: It can be part of your identity, part of how
• 31:18
  Speaker 4: you move forward.
• 31:19
  Speaker 1: I'd argue that's problematic, but that's okay. I appreciate you
• 31:27
  Speaker 1: being your own devil's advocate when I wasn't going to be.
• 31:30
  Speaker 2: I do appreciate him being the devil's advocate and then
• 31:32
  Speaker 2: you disagreeing with him while he was being the devil's advocate.
• 31:35
  Speaker 2: There's something really special about that. Yeah.
• 31:39
  Speaker 3: True.
• 31:40
  Speaker 4: We're role swapping. Yeah.
• 31:44
  Speaker 1: Yeah. All right. I've been outlining again several of these issues,
• 31:47
  Speaker 1: which I think is great. And one of them being
• 31:50
  Speaker 1: the fact that there's this lack of specificity, which has
• 31:56
  Speaker 1: the fact that it is not a very reliable or
• 31:59
  Speaker 1: valid type of system. Like if we're talking about the
• 32:02
  Speaker 1: utility of some kind of assessment being reflected in its
• 32:05
  Speaker 1: ability to be reliable or valid. with that many issues already,
• 32:10
  Speaker 1: it lacks those two criteria for being useful. And in
• 32:14
  Speaker 1: addition to that, there's another one that definitely stands out
• 32:16
  Speaker 1: to me as a common thing that people have both
• 32:21
  Speaker 1: criticized about this, but also really latched onto as an
• 32:25
  Speaker 1: important feature of their diagnoses is this comorbidity. And for
• 32:29
  Speaker 1: those people who don't know that term, it means that
• 32:31
  Speaker 1: like this diagnosis tends to also happen more with this
• 32:35
  Speaker 1: other diagnosis. It's like, if you have autism, you probably
• 32:39
  Speaker 1: also have ADHD or something like that. You know, like the,
• 32:42
  Speaker 1: the things, or you might, there's like, there's a, there's
• 32:44
  Speaker 1: a rate at which they co-occur frequently enough with each other.
• 32:48
  Speaker 1: And I, and I sort of pointed out at one
• 32:50
  Speaker 1: point in, uh, in one of our discussions where I
• 32:52
  Speaker 1: was like, all right, if you've got 99% of your
• 32:55
  Speaker 1: people with dyslexia also have ADHD, let's say I'm like,
• 33:01
  Speaker 1: To what extent are those different things? I mean, if
• 33:05
  Speaker 1: you feel like there's that much overlap, where do you
• 33:08
  Speaker 1: draw the line? And obviously, most things aren't that high.
• 33:10
  Speaker 1: But the point being that it is the correspondence, the
• 33:15
  Speaker 1: rate at which two diagnoses tend to hang together, which
• 33:18
  Speaker 1: is surprisingly high in the diagnostic space with respect to
• 33:23
  Speaker 1: mental health and behavioral health specifically.
• 33:25
  Speaker 3: Yeah. Yeah, I mean, if you just think about that
• 33:28
  Speaker 3: inside of the medical model again, it's something that doesn't
• 33:31
  Speaker 3: really happen.
• 33:32
  Speaker 4: Unless there's like a mechanistic... If then, right? Like, so
• 33:38
  Speaker 4: if you're not eating, you might experience these other signs
• 33:41
  Speaker 4: and symptoms, but the notion that you have the flu
• 33:44
  Speaker 4: and therefore you have a 80% likelihood of being like
• 33:49
  Speaker 4: diagnosed with scurvy, right?
• 33:54
  Speaker 3: Like that's not how diagnoses work in the medical world,
• 33:57
  Speaker 3: but I tend to think, and I think there's good
• 34:00
  Speaker 3: evidence to show that that is how things work.
• 34:03
  Speaker 4: Inside of the psychological medical model.
• 34:06
  Speaker 3: If you're diagnosed with one thing, the chances of being
• 34:09
  Speaker 3: able to, you go to a different psychologist and you
• 34:11
  Speaker 3: get diagnosed with something completely different or, or even just
• 34:17
  Speaker 3: people getting diagnosed with things in general. Like I think,
• 34:20
  Speaker 3: you know, there's kind of this general notion that at
• 34:22
  Speaker 3: some point in your lifetime, if you went into a psychologist,
• 34:25
  Speaker 3: you could get a diagnosis for some kind of thing. Yeah.
• 34:28
  Speaker 3: And these things also span these axes. So inside of
• 34:32
  Speaker 3: the DSM, there's this general notion of like, hype subtypes
• 34:36
  Speaker 3: of diagnoses. Right. And they fall upon one of, I
• 34:39
  Speaker 3: think three axes and that diagnoses span. So like if
• 34:45
  Speaker 3: I'm diagnosed with depression, severe depression, the chances that I
• 34:50
  Speaker 3: qualify for like severe psychosis and things like that is
• 34:53
  Speaker 3: like on the table.
• 34:54
  Speaker 1: Right.
• 34:54
  Speaker 3: And so these things span the axis. It's not just like,
• 34:57
  Speaker 3: If you're depressed, you might also be dysthymic. It's not
• 35:01
  Speaker 3: that kind of thing. It's a lot of other kinds
• 35:04
  Speaker 3: of things. We've seen evidence. I mean, it's not evidence,
• 35:09
  Speaker 3: but anecdotally, you watch TV and they go, were you
• 35:13
  Speaker 3: diagnosed with depression and you started taking an antidepressant and
• 35:17
  Speaker 3: then you started getting manic?
• 35:18
  Speaker 4: Well, guess what? We just uncovered that you're actually bipolar.
• 35:22
  Speaker 3: And this is a different thing and you need a
• 35:24
  Speaker 3: different medication that's going to help your medication not make
• 35:27
  Speaker 3: you bipolar. Right. And so these kinds of things are
• 35:31
  Speaker 3: very common in in this way of doing things. If
• 35:36
  Speaker 3: you have one thing, the chances of being able to
• 35:38
  Speaker 3: say you have something different is very high. The chances
• 35:41
  Speaker 3: of during your lifetime, us being able to slap some label,
• 35:44
  Speaker 3: if not multiple labels on you is very high. And
• 35:47
  Speaker 3: if these things are disorders in a medical sense, that
• 35:52
  Speaker 3: ought not be the case. It's at least inconvenient for
• 35:55
  Speaker 3: that to be the case inside of the system.
• 35:57
  Speaker 2: To be fair, all those people in those commercials seem
• 35:59
  Speaker 2: to be really enjoying those concerts.
• 36:00
  Speaker 4: That's true. That's true. They don't have anything.
• 36:03
  Speaker 3: I mean, I think that speaks to the point that
• 36:04
  Speaker 3: those people have bipolar disorder.
• 36:06
  Speaker 4: What the hell am I doing? Those people are having
• 36:10
  Speaker 4: a great time at a barbecue.
• 36:12
  Speaker 1: I can't even enjoy a jazz routine. Speaking of which,
• 36:17
  Speaker 1: here's an ad for a jazz routine. I was trying
• 36:27
  Speaker 1: to do my job a little bit more as you
• 36:28
  Speaker 1: were talking through this and thinking through like, would someone
• 36:33
  Speaker 1: maybe have the thought that like, okay, but maybe it's
• 36:36
  Speaker 1: the case that just because people have these diagnoses, like
• 36:39
  Speaker 1: they're just more likely to also have these other problems.
• 36:43
  Speaker 1: And so it's good that the system does a good
• 36:45
  Speaker 1: job catching these other problems that these people like might
• 36:48
  Speaker 1: have because it's It just is the case that like
• 36:51
  Speaker 1: if you've got one that can spiral into others or
• 36:54
  Speaker 1: it might mean that you already have a sort of
• 36:56
  Speaker 1: pre– you're sort of already at a higher risk for
• 37:01
  Speaker 1: having more things. And so the system is working by
• 37:05
  Speaker 1: catching all the things you might have.
• 37:07
  Speaker 4: Yeah, I think that's good. good idea, I guess.
• 37:11
  Speaker 3: And I would tend to think that that's kind of true,
• 37:14
  Speaker 3: but I, my approach doesn't adhere to diagnostic systems more generally. Right.
• 37:20
  Speaker 3: So I think if that's the case, cool, we need
• 37:24
  Speaker 3: a new system because the purpose of this system is,
• 37:28
  Speaker 3: is to say you have X, therefore Y is the
• 37:32
  Speaker 3: specific treatment that fits this specific problem. And inside of
• 37:36
  Speaker 3: a system like that, Again, flu tends to lead to scurvy,
• 37:44
  Speaker 3: tends to lead to whatever, is not generally how these
• 37:48
  Speaker 3: things work outside of the psychological medical model. If that
• 37:52
  Speaker 3: is the case, psychological phenomena are weird, and we ought
• 37:57
  Speaker 3: not think of them like medical phenomena because they're different.
• 38:02
  Speaker 3: And this like use case of if you have one thing,
• 38:06
  Speaker 3: it can lead to something else and it can lead
• 38:08
  Speaker 3: to something else. And the dysfunction that you're experiencing in
• 38:11
  Speaker 3: one space leads to it.
• 38:12
  Speaker 4: Then cool. Let's not call it one thing.
• 38:16
  Speaker 3: And let's look at the processes of change that are
• 38:20
  Speaker 3: leading to those diagnostic systems.
• 38:23
  Speaker 1: I do think one of the things that stands out
• 38:25
  Speaker 1: to me as a reason that the same model just
• 38:29
  Speaker 1: doesn't apply very well in the space of psychology is
• 38:32
  Speaker 1: the number of variables that contribute to a set of
• 38:35
  Speaker 1: symptoms medically. And I'm sure some medical doctor is going
• 38:39
  Speaker 1: to disagree with me, but I'm like, it seems vastly
• 38:41
  Speaker 1: smaller than the number of variables that contribute to a
• 38:43
  Speaker 1: psychological phenomenon. Because psychological phenomenon also includes medical phenomenon. It
• 38:48
  Speaker 1: also includes like basic health things, sleep, nutrition. If you
• 38:52
  Speaker 1: have actual like medical issues that might be causing you
• 38:55
  Speaker 1: distress or suffering in other ways. The social things going
• 38:58
  Speaker 1: on in your life, the entire history you have up
• 39:00
  Speaker 1: to that moment that you're in, the context of the
• 39:03
  Speaker 1: moment that you're in, like all these variables that is
• 39:06
  Speaker 1: just there are probably thousands, if not many, many hundreds
• 39:10
  Speaker 1: of times that number of variables all participating in sort
• 39:14
  Speaker 1: of an ongoing evolution of factors that contribute to your
• 39:18
  Speaker 1: experience in any given moment. versus with the medical thing,
• 39:21
  Speaker 1: I'm like, we got cells, we got parts of your
• 39:24
  Speaker 1: body that do stuff, we got diseases that exist, and
• 39:28
  Speaker 1: we can identify those things pretty clearly because we know
• 39:29
  Speaker 1: what they all are, and we can mostly observe them
• 39:32
  Speaker 1: empirically and objectively. And therefore, we can sort of rule
• 39:35
  Speaker 1: in and rule out and make clear delineations between Problem A,
• 39:39
  Speaker 1: problem B. And there's going to be a lot of
• 39:40
  Speaker 1: things that are still ambiguous. Obviously, if we had solved
• 39:43
  Speaker 1: all the medical things, there would be no more medical
• 39:45
  Speaker 1: research because we would have solved all medical things. We haven't.
• 39:48
  Speaker 1: That's still an ongoing thing. But the point being that
• 39:52
  Speaker 1: I don't even know if we'll ever be able to
• 39:54
  Speaker 1: enumerate the kind of variables that contribute to fully to
• 39:57
  Speaker 1: anyone's particular psychological experience in a moment because there's so many.
• 40:03
  Speaker 1: And at some point there's like diminishing returns on how
• 40:05
  Speaker 1: much you can get from that. But the sheer volume
• 40:08
  Speaker 1: of variables is vast, vast, vast. And the likelihood that
• 40:12
  Speaker 1: we can clearly identify what are the relevant contribute factors
• 40:16
  Speaker 1: for this person in this moment with respect to the
• 40:20
  Speaker 1: issue that they're facing seems like distilling that down into
• 40:24
  Speaker 1: any kind of useful label is We'll just never get there.
• 40:27
  Speaker 1: Like the variety of the complexity of variables that could
• 40:31
  Speaker 1: get you there are so huge that like what would
• 40:34
  Speaker 1: be relevant to identify for one person is not going
• 40:36
  Speaker 1: to be relevant to identify for the next person, even
• 40:38
  Speaker 1: if they're having the same experience.
• 40:40
  Speaker 2: Yeah.
• 40:41
  Speaker 3: And again, to your point, I think in the medical model,
• 40:43
  Speaker 3: if you were to see signs and symptoms hanging together
• 40:46
  Speaker 3: for different diagnoses, there's like a clear mechanistic explanation as
• 40:51
  Speaker 3: to why things might be cascading into another process.
• 40:55
  Speaker 4: Into another diagnosis.
• 40:56
  Speaker 3: Right.
• 40:56
  Speaker 4: So sure.
• 40:57
  Speaker 3: You know, your liver is failing because you had an
• 40:59
  Speaker 3: infection and the infection wouldn't like, there's like the doctors
• 41:02
  Speaker 3: will be able to describe like a mechanical process that
• 41:05
  Speaker 3: is occurring.
• 41:05
  Speaker 1: Yeah.
• 41:06
  Speaker 4: But in psychology, I don't think we have that level
• 41:08
  Speaker 4: of precision about.
• 41:09
  Speaker 3: You know, neurochemicals or, or God forbid interactions with environmental conditions. Right. Like,
• 41:17
  Speaker 3: and I think that task becomes really challenging. Like, you know,
• 41:22
  Speaker 3: we can spin a yarn around like, The antidepressant uncovered
• 41:28
  Speaker 3: your bipolar disorder by suppressing one element of it, but
• 41:32
  Speaker 3: the mechanistic reasons for that are not well understood. They
• 41:34
  Speaker 3: don't have people doing neuro studies and looking at, oh, see,
• 41:39
  Speaker 3: since it suppressed the serotonin. it made this other neurochemical
• 41:43
  Speaker 3: shoot up and that's a marker of, it does not
• 41:45
  Speaker 3: work like that. It's just not the same game, but
• 41:49
  Speaker 3: we can spin a yarn around it being the same game.
• 41:52
  Speaker 3: But I think the realities are an organism is in
• 41:55
  Speaker 3: an environment is a complex system and it's really hard
• 41:59
  Speaker 3: to isolate variables in the way that you would need to,
• 42:02
  Speaker 3: that I think are a little more available to us in,
• 42:05
  Speaker 3: in the like medical medical world.
• 42:08
  Speaker 1: Yeah.
• 42:09
  Speaker 3: But those kinds of causal structures, I think I've interacted
• 42:13
  Speaker 3: with them enough and it's a little anecdotal to say,
• 42:15
  Speaker 3: but I'm just like not impressed with how those things
• 42:19
  Speaker 3: come to be. You know, I've studied like psychedelic stuff
• 42:23
  Speaker 3: and I've looked at some neuro correlate correlate stuff and
• 42:27
  Speaker 3: it's pretty crude or like, you know, like the, that
• 42:32
  Speaker 3: neuro chemicals.
• 42:33
  Speaker 4: Do one thing.
• 42:34
  Speaker 3: It, to begin with is a crude understanding of how
• 42:38
  Speaker 3: these things work. So there's a Ted talk. I typically
• 42:42
  Speaker 3: hate Ted talks, but there's a Ted talk by this lady,
• 42:44
  Speaker 3: Molly Crockett, and she talks about neurochemicals.
• 42:48
  Speaker 4: And she talks about basically, she.
• 42:51
  Speaker 3: Did a study looking at the impact of some neurochemical
• 42:55
  Speaker 3: on people's behavior in a very controlled situation. So she
• 43:00
  Speaker 3: made them drink this like orange juice that was filled
• 43:02
  Speaker 3: with neurochemical inducing stuff. And she was getting approached by
• 43:08
  Speaker 3: like chocolate companies, like, Oh, chocolate has tryptophan. And so,
• 43:12
  Speaker 3: and you showed that it makes people more cooperative. So
• 43:15
  Speaker 3: what if we said that our chocolate makes people cooperative
• 43:18
  Speaker 3: and she could not be more, not be more opposed
• 43:22
  Speaker 3: to that kind of thing. So, you know, one really
• 43:25
  Speaker 3: common one, what's the, not serotonin, but, um, dopamine, the
• 43:28
  Speaker 3: one that's supposed to make you moral and get along
• 43:30
  Speaker 3: with people. Oh, in a crude called the love acid
• 43:34
  Speaker 3: been called the it's been called the moral molecule and
• 43:38
  Speaker 3: there's a guy named dr love or something like that
• 43:40
  Speaker 3: who says that the cure for everything is a hug
• 43:43
  Speaker 3: oxytocin oxytocin yeah so oxytocin for example she provides this
• 43:48
  Speaker 3: example is like generally known to make people more agreeable
• 43:53
  Speaker 3: you feel a sense of closeness there's all the all
• 43:55
  Speaker 3: kinds of things like As you progress in your relationship
• 43:59
  Speaker 3: with a romantic partner, you experience less serotonin and more oxytocin.
• 44:03
  Speaker 3: So you feel a sense of closeness with them rather
• 44:05
  Speaker 3: than a sense of euphoria. There's these really crude ways
• 44:08
  Speaker 3: of describing what neurochemicals do, but they are crude. And
• 44:13
  Speaker 3: she uses the example like, actually, oxytocin is kind of
• 44:17
  Speaker 3: dangerous because one of the things that it predicts is
• 44:20
  Speaker 3: that if you have two groups, in-groups and out-groups, and
• 44:24
  Speaker 3: you pit those in-groups and out-groups against each other, and
• 44:27
  Speaker 3: you give one of them oxytocin, they tend towards jealousy
• 44:32
  Speaker 3: and foul tactics against the other, and they tend to
• 44:36
  Speaker 3: hate the out-group a little more. She argues that you
• 44:39
  Speaker 3: could just as easily make the argument that oxytocin is
• 44:44
  Speaker 3: an amoral molecule. There's a guy out there calling himself Dr.
• 44:49
  Speaker 3: Love who says that it's the cure for everything, and
• 44:51
  Speaker 3: it's going to make you fall in love with everybody.
• 44:54
  Speaker 4: But it also makes you more jealous. It makes you
• 44:55
  Speaker 4: more likely to seek revenge.
• 44:57
  Speaker 3: There are studies showing those things as well. These neurochemicals
• 45:02
  Speaker 3: are obviously important with regards to what we do, but
• 45:06
  Speaker 3: I don't think that we've done... the work of understanding
• 45:10
  Speaker 3: them in context to such a degree that we can
• 45:12
  Speaker 3: like prescribe labels as, as to what they do crudely, right?
• 45:16
  Speaker 3: Like they do a lot, they do a lot of
• 45:18
  Speaker 3: different things. And I think she does a really good job. Again,
• 45:20
  Speaker 3: Molly Crockett, uh, she does a really good job of demonstrating.
• 45:24
  Speaker 3: Like I know that's your chocolate will not make people
• 45:28
  Speaker 3: get along with, we're likely to share. Right.
• 45:32
  Speaker 4: That's not what will happen.
• 45:33
  Speaker 3: Yes, you'll have higher levels of oxytocin, but the impact
• 45:36
  Speaker 3: of that oxytocin is not that it may be, but it's,
• 45:39
  Speaker 3: it's probably not that you will share.
• 45:42
  Speaker 1: I'm thinking about the fact that you could arrange any
• 45:45
  Speaker 1: kind of– if you narrow the scope of the question
• 45:49
  Speaker 1: you're asking, you could draw lots of correlations. I'm going
• 45:52
  Speaker 1: to make something up. So everyone who's listening, this is
• 45:55
  Speaker 1: not something– I'm not referencing a study or anything. But
• 45:57
  Speaker 1: let's just pretend you had a study. What if we
• 45:59
  Speaker 1: did a thing where people who had the option to
• 46:02
  Speaker 1: take drugs, first we give them– we just directly inject
• 46:06
  Speaker 1: some dopamine into their brains. And then we see that
• 46:08
  Speaker 1: when we do that, that they actually take fewer drugs.
• 46:11
  Speaker 1: And again, I'm not, I don't even think that's how
• 46:12
  Speaker 1: that would necessarily work, but let's just pretend that that
• 46:14
  Speaker 1: was the situation that like some groups like we don't
• 46:17
  Speaker 1: do anything. The other one, we like give them a
• 46:19
  Speaker 1: direct dopamine hit and then they actually sometimes choose to
• 46:21
  Speaker 1: not necessarily consume drugs. So maybe dopamine then has this
• 46:25
  Speaker 1: like inhibiting factor or this impulse control thing. We use it.
• 46:29
  Speaker 1: But that's just in that one scenario. Then in another scenario,
• 46:31
  Speaker 1: we take someone who's deprived of something or like maybe whatever,
• 46:34
  Speaker 1: we give them a doping hit and then they start
• 46:36
  Speaker 1: seeking out more of the thing. And I'm like, if
• 46:39
  Speaker 1: you ask the question, what happens in this particular case
• 46:41
  Speaker 1: when I manipulate this chemical? And then you broadly average
• 46:45
  Speaker 1: everybody and say like, well, we had a statistically significant
• 46:48
  Speaker 1: change in this group versus this group. You've also not
• 46:51
  Speaker 1: necessarily asked what does it do in a different situation,
• 46:54
  Speaker 1: in a thousand different situations with a variety of different
• 46:57
  Speaker 1: contextual variables. And like, If you're also just taking a
• 47:02
  Speaker 1: statistically significant difference between those things, it's probably not a
• 47:06
  Speaker 1: very powerful significance. It just happened to be the case
• 47:09
  Speaker 1: that they did something a little bit differently over here.
• 47:11
  Speaker 1: And I feel like they've done that similar with mice
• 47:13
  Speaker 1: with oxytocin. They're like, oh, in this particular situation, we
• 47:16
  Speaker 1: gave them more oxytocin, they groomed each other more. But
• 47:19
  Speaker 1: in this one, if we gave them more oxytocin and
• 47:21
  Speaker 1: then we introduced a strange rat, they attacked them more.
• 47:24
  Speaker 1: I'm like, again, I'm not saying that there's an actual experiment,
• 47:27
  Speaker 1: but it's just like if you narrow your scope to
• 47:29
  Speaker 1: just one type of question, you can probably identify some
• 47:32
  Speaker 1: mean some difference relative to another group that didn't have
• 47:35
  Speaker 1: the same variable. But that doesn't tell you very much
• 47:37
  Speaker 1: about any of that. And as much as I love
• 47:40
  Speaker 1: going down the rabbit hole of neurology and the issues
• 47:44
  Speaker 1: we have with the. reductive approach people have taken to
• 47:48
  Speaker 1: try to ask these questions. And not that it was
• 47:51
  Speaker 1: necessarily the wrong approach, but I think that the conclusions
• 47:53
  Speaker 1: are way overstated, particularly the way that they're reported in
• 47:57
  Speaker 1: news and stuff. Returning to the problem of the diagnostic
• 48:01
  Speaker 1: system and it being riddled with ads. All right, we're back.
• 48:13
  Speaker 1: Mostly the TV we watch and the games we play
• 48:16
  Speaker 1: on our phone are riddled with ads for treatments for
• 48:18
  Speaker 1: diagnostic things. All right, the other problem here is you
• 48:22
  Speaker 1: actually started talking about this already, but this is one
• 48:24
  Speaker 1: that I brought up as well that I think is
• 48:26
  Speaker 1: this idea that a diagnostic system... A lot of reason
• 48:30
  Speaker 1: for it to exist is because it'll inform what to
• 48:33
  Speaker 1: do about the problem that you've diagnosed. Like, if I identify, like, oh,
• 48:37
  Speaker 1: your car is not running, oh, well, you have to
• 48:39
  Speaker 1: put gas in it. Like, diagnostic system tells you treatment
• 48:42
  Speaker 1: is put gas in car. Like, whatever the problem is,
• 48:45
  Speaker 1: the diagnosis should... And the vast majority of circumstances, and
• 48:49
  Speaker 1: I'm not even sure I could come up with one
• 48:50
  Speaker 1: where this isn't the case, but it should inform what
• 48:53
  Speaker 1: do you do about this now that you have this label?
• 48:56
  Speaker 1: Like how do you change this moving forward? And that
• 49:00
  Speaker 1: is not a thing that you get with psychological diagnoses.
• 49:05
  Speaker 4: Yeah, I tend to think that's true.
• 49:08
  Speaker 3: And there's studies on it, but there's also a lot
• 49:11
  Speaker 3: of anecdotal evidence. If you stereotype a lot of clinical
• 49:15
  Speaker 3: psychological students' dissertations, what you'll find is like dozens.
• 49:20
  Speaker 4: ACT work for XYZ, right?
• 49:22
  Speaker 3: So I'm an acceptance and commitment person. Nobody has looked
• 49:27
  Speaker 3: at whether Acceptance and commitment therapy works for sibling distress, right?
• 49:32
  Speaker 3: And so I'm going to be the person who breaks
• 49:34
  Speaker 3: the mold and I'm going to go study. What if
• 49:37
  Speaker 3: we applied ACT for sibling distress? And sure as s
• 49:40
  Speaker 3: * * t, it works pretty good. Holy s *
• 49:41
  Speaker 3: * t.
• 49:42
  Speaker 4: Cool.
• 49:44
  Speaker 3: And this is like a stereotypical way of casting, but
• 49:49
  Speaker 3: you know, so that creates one problem, this problem, we
• 49:51
  Speaker 3: call it the billion year problem or purple hat.
• 49:55
  Speaker 4: What is it? Dialectical behavior, DBT, purple hat, DBT.
• 49:59
  Speaker 3: So this creates a problem where we feel like we're
• 50:02
  Speaker 3: trying to fit treatments to syndromes. And we have to
• 50:06
  Speaker 3: demonstrate empirically that every person, Every treatment package fits every syndrome,
• 50:12
  Speaker 3: and that's an unsolvable problem, right? So the idea of
• 50:15
  Speaker 3: purple hat DBT is what if we did DBT for depression,
• 50:19
  Speaker 3: but we all wore purple.
• 50:21
  Speaker 4: Hats, right?
• 50:23
  Speaker 3: And those kinds of questions are everywhere inside of psychological
• 50:27
  Speaker 3: science when we take this approach.
• 50:29
  Speaker 1: So true.
• 50:30
  Speaker 3: And, you know, like I'll walk by posters and read
• 50:32
  Speaker 3: articles and I'll be dismissive of purple hat DBT.
• 50:36
  Speaker 4: Oftentimes, like, you know, you see like, does ACT work? Yeah,
• 50:39
  Speaker 4: it probably does.
• 50:41
  Speaker 3: You know, like it helps a lot of these things,
• 50:43
  Speaker 3: which again, it doesn't bode well for a diagnostic syndrome.
• 50:48
  Speaker 3: It tends to be the case that when you ask
• 50:49
  Speaker 3: the question, does DBT, CBT work? ACT, PBT, FAP, does
• 50:56
  Speaker 3: this work for XYZ psychological problem?
• 50:59
  Speaker 4: It tends to be the case that it does.
• 51:00
  Speaker 3: And it becomes like a self-fulfilling prophecy. There's not a
• 51:03
  Speaker 3: lot of like, you know, there's not a lot of
• 51:06
  Speaker 3: negative findings in that world. And if that's true, that's weird.
• 51:10
  Speaker 3: It would, you know, it'd be like rep and tussin
• 51:13
  Speaker 3: on everything, solves everything, which may be true.
• 51:18
  Speaker 1: That's like how the wellness industry operates. They're like, It's
• 51:22
  Speaker 1: just a new thing.
• 51:22
  Speaker 4: Yeah, yeah, yeah.
• 51:23
  Speaker 1: Yeah, it's like, go get milk thistle and put it
• 51:26
  Speaker 1: in your eyeball, and that will cure whatever ails you.
• 51:28
  Speaker 4: Ginger, man. Ginger fixes everything.
• 51:30
  Speaker 1: Is that the thing right now?
• 51:31
  Speaker 4: Yeah, ginger and horse meat warmer.
• 51:34
  Speaker 1: That's so 2020.
• 51:40
  Speaker 2: And just listen, just to be clear about that, to
• 51:42
  Speaker 2: our folks that are advertisers that are really into ivermectin, listen.
• 51:49
  Speaker 2: We don't want to lose that sponsorship, so we've got
• 51:51
  Speaker 2: to keep the ivermectin sponsorship up. That's what keeps the
• 51:54
  Speaker 2: lights on.
• 51:54
  Speaker 1: And also, f * * * you.
• 51:57
  Speaker 4: Yeah. So, yeah.
• 52:04
  Speaker 3: I mean, you take something as simple as an SSRI,
• 52:07
  Speaker 3: and this is the point where maybe you get to
• 52:10
  Speaker 3: the receipts, but SSRIs... have been demonstrated to have positive
• 52:15
  Speaker 3: impact on obsessive-compulsive disorder, panic disorder, social phobia, bulimia, generalized
• 52:20
  Speaker 3: anxiety disorder, post-traumatic stress disorder, premenstrual syndrome, alcoholism, obesity, aggressivity, dementia,
• 52:28
  Speaker 3: trickle-tail mania, headaches, and migraines.
• 52:31
  Speaker 4: And that's one. Substance.
• 52:34
  Speaker 3: And it's cool that it's having a moderate or mild
• 52:37
  Speaker 3: impact on those things, but it's also odd if those things.
• 52:43
  Speaker 4: Are distinct entities as we might hope they are inside
• 52:47
  Speaker 4: of a syndromal system.
• 52:48
  Speaker 1: Could the solution then be that those are not distinct entities?
• 52:52
  Speaker 4: I tend to think that that's true.
• 52:54
  Speaker 3: Okay.
• 52:54
  Speaker 1: Yes.
• 52:55
  Speaker 4: And I tend to think that we've been asking the
• 52:58
  Speaker 4: wrong question at the wrong level of analysis.
• 53:03
  Speaker 1: Agreed. I mean, I disagree with you, but I don't
• 53:05
  Speaker 1: know why. It's just to do my job.
• 53:10
  Speaker 2: There's something about what you're saying I just can't agree with.
• 53:12
  Speaker 2: I don't know what it is, and I don't have
• 53:14
  Speaker 2: a logical way of saying it, but you know, just, ooh.
• 53:16
  Speaker 4: I don't want to.
• 53:24
  Speaker 1: Yeah. And I mean, I think that makes a lot
• 53:25
  Speaker 1: of sense. Are you sure though, that like act works
• 53:28
  Speaker 1: with people with green eyes? Have you really isolated that variable?
• 53:31
  Speaker 3: I think somebody has done that study. Some exciting student
• 53:34
  Speaker 3: definitely took that on and opened their talk with, but
• 53:37
  Speaker 3: nobody has looked at does act work.
• 53:42
  Speaker 2: I did see that paper and my response was no.
• 53:48
  Speaker 1: Yeah.
• 53:48
  Speaker 3: Yeah. Yeah.
• 53:50
  Speaker 1: No, I think the, to your point, I feel like
• 53:53
  Speaker 1: we're almost gearing up to getting to sort of what
• 53:56
  Speaker 1: do we do with this? How do we move forward?
• 53:58
  Speaker 1: And I don't want to jump the gun too much
• 53:59
  Speaker 1: because I think there are other problems I also want
• 54:01
  Speaker 1: to outline. But it does feel like we're sort of
• 54:03
  Speaker 1: getting at the point that because psychological phenomenon are processes...
• 54:10
  Speaker 1: and not necessarily causal discrete events, that a therapeutic approach
• 54:15
  Speaker 1: is also a process and not necessarily a discrete causal
• 54:20
  Speaker 1: one-time take this pill and call me in the morning solution.
• 54:24
  Speaker 1: It's more complex than that. The variables are ongoing. The
• 54:27
  Speaker 1: effects of treatment are probably cumulative and ongoing. and that
• 54:30
  Speaker 1: it requires a dynamic adjustment as things proceed versus like,
• 54:35
  Speaker 1: you've got worms, let's give you dewormer and get those
• 54:37
  Speaker 1: worms out of you. Problem solved. No more worms.
• 54:40
  Speaker 4: Yeah. And I think, you know, this is a little
• 54:43
  Speaker 4: bit anecdotal.
• 54:44
  Speaker 3: I think we brought some reviews to something so I
• 54:45
  Speaker 3: can speak out of experience at times, but having been
• 54:48
  Speaker 3: in the world of psychedelic assisted therapy and what people
• 54:52
  Speaker 3: are excited about, I think there's.
• 54:53
  Speaker 4: Two sides to this, right?
• 54:54
  Speaker 3: So I don't necessarily agree that that psychedelic assisted therapy
• 54:59
  Speaker 3: is like a revolution in the field right i think
• 55:02
  Speaker 3: it has some promise under some very specific sets of
• 55:04
  Speaker 3: circumstances with some very specific parameters given some very specific
• 55:09
  Speaker 3: sets of assumptions but i think people are really excited
• 55:12
  Speaker 3: about this notion of like i'm a little depressed it's
• 55:15
  Speaker 3: been treatment resistant not a lot of things have worked
• 55:18
  Speaker 3: what if i just go home and get up about
• 55:20
  Speaker 3: it right and i just like take a I'm worried
• 55:27
  Speaker 3: a little bit that the research is going to be
• 55:29
  Speaker 3: distilled to that, right? There's a lot of notions of like,
• 55:32
  Speaker 3: it makes your neuroplasticity more plasticky.
• 55:35
  Speaker 4: So you, and the nodes that don't typically talk to
• 55:38
  Speaker 4: each other, talk to each other.
• 55:40
  Speaker 2: Oops, got your notes.
• 55:41
  Speaker 3: I think those are cool biological correlates, but they're not
• 55:47
  Speaker 3: going to lead you to the path of wellness very reliably.
• 55:50
  Speaker 4: I'll call it right now.
• 55:52
  Speaker 3: Take mushrooms and call me in the morning is not
• 55:54
  Speaker 3: a plan for psychological wellness.
• 55:58
  Speaker 1: Somebody's plan. I mean, yeah.
• 56:00
  Speaker 4: And you see talks like that. I went to a talk. recently.
• 56:03
  Speaker 3: And it was basically like these four PhDs and they
• 56:06
  Speaker 3: all got up in Jamaica and they're like.
• 56:09
  Speaker 4: And then you bark, remember that? And then you threw
• 56:11
  Speaker 4: yourself into the ocean. Like they were just talking about
• 56:14
  Speaker 4: their trip and what they learned and blah, blah, blah.
• 56:17
  Speaker 1: Right.
• 56:18
  Speaker 3: And so I think there's a real tendency to go
• 56:21
  Speaker 3: towards take X and call me in the morning, but
• 56:24
  Speaker 3: really I think it's evident that psychological assisted therapy or
• 56:29
  Speaker 3: psychedelic assisted therapy is much more of a like you're
• 56:32
  Speaker 3: working with your therapy for a long time they don't
• 56:34
  Speaker 3: really see a way forward you're kind of stuck on
• 56:36
  Speaker 3: some language there's something happening where they need you to
• 56:40
  Speaker 3: kind of make a leap right metaphorically speaking and they've
• 56:44
  Speaker 3: had a hard time doing that they're not really sure
• 56:46
  Speaker 3: what to do next and i'm like what if we
• 56:48
  Speaker 3: just get you really turnt up and then we you
• 56:51
  Speaker 3: know have you close your eyes and we prepare you
• 56:53
  Speaker 3: for what's coming so we're like hey i have this
• 56:55
  Speaker 3: idea i'm gonna get you you know to level 10
• 56:59
  Speaker 3: And like a snake might eat you and it's going
• 57:01
  Speaker 3: to be kind of crazy. And you're going to have
• 57:03
  Speaker 3: to like, then, you know, I'm going to give you
• 57:05
  Speaker 3: some tools to kind of like deal with this thing.
• 57:07
  Speaker 3: And then after that, we're going to debrief, we're going
• 57:09
  Speaker 3: to talk about it. We're going to like, yeah, remember
• 57:12
  Speaker 3: when that snake ate you, that was kind of crazy.
• 57:14
  Speaker 3: you know, and like you dealt with it though, you
• 57:17
  Speaker 3: faced it and you were like, it's actually pretty sick
• 57:19
  Speaker 3: inside the snake stomach. And you've, and, um, you know,
• 57:24
  Speaker 3: and that is like, that very much is a process
• 57:28
  Speaker 3: that I'm describing, right?
• 57:30
  Speaker 4: Like it is not if treatment resistant.
• 57:34
  Speaker 3: Depression, then, you know, micro dose or do a hero's
• 57:40
  Speaker 3: dose of some psychedelic substance.
• 57:42
  Speaker 4: And I think, that's where we're going.
• 57:45
  Speaker 3: I mean, I feel a little disheartened to say it,
• 57:46
  Speaker 3: but the tip of that spear is take mushrooms and
• 57:50
  Speaker 3: call me.
• 57:50
  Speaker 4: And I think that sounds like an appealing treatment. Cause
• 57:54
  Speaker 4: I don't, I, the patient don't have to do anything.
• 57:56
  Speaker 3: I just have like, I have a great time. And
• 57:59
  Speaker 3: then I'm going to feel amazing in the morning. And
• 58:01
  Speaker 3: like all the world will be through rose blood glasses.
• 58:05
  Speaker 3: And the reality is like, you know, if that treatment
• 58:09
  Speaker 3: is going to be effective, it's going to be effective
• 58:11
  Speaker 3: in a lot of the ways that other treatments are effective.
• 58:14
  Speaker 3: you have a person who's responsive to the kinds of individual-level.
• 58:18
  Speaker 4: Processes that are occurring. Again, not to get ahead of ourselves,
• 58:22
  Speaker 4: but it's tricky.
• 58:24
  Speaker 1: The way I see an application of something like psychedelic-assisted therapy,
• 58:28
  Speaker 1: which honestly is not fundamentally distinct from other things just
• 58:33
  Speaker 1: like systematic desensitization and exposure-based therapy, is the There's a
• 58:37
  Speaker 1: lot of rigidity. Let's see if we can flex that
• 58:40
  Speaker 1: up by just creating a very novel experience for you.
• 58:44
  Speaker 1: And I think, as you said, we're just sort of
• 58:45
  Speaker 1: the point where it's like, it feels like we're stuck.
• 58:47
  Speaker 1: It's like nothing we seem to be doing is really
• 58:49
  Speaker 1: moving the needle in any particular direction. Something we haven't
• 58:52
  Speaker 1: really done is like, let's just give you a wild
• 58:54
  Speaker 1: experience you've never had and see if that just helps
• 58:58
  Speaker 1: break up some of the stuckness and the rigidity and
• 59:02
  Speaker 1: gives you an opportunity to explore a new set of
• 59:04
  Speaker 1: behaviors that might be a little bit more productive moving forward.
• 59:07
  Speaker 1: That's sort of why I see like if there's utility here,
• 59:10
  Speaker 1: there might be multiple ways that there's utility here, but
• 59:12
  Speaker 1: like in that sort of context of like, let's just
• 59:15
  Speaker 1: get a little more flexible away from this stuckness that
• 59:19
  Speaker 1: you find yourself.
• 59:20
  Speaker 3: Yeah, and I think it points to me to something
• 59:24
  Speaker 3: that is a little related and which is I have
• 59:29
  Speaker 3: higher hopes for psychological science and psychological intervention than we
• 59:34
  Speaker 3: are currently experiencing. I think one of the things that
• 59:37
  Speaker 3: has kind of gone unsaid is like, I'm not thrilled
• 59:40
  Speaker 3: with the state of psychological intervention. And one of the
• 59:44
  Speaker 3: things I would point to as evidence for that is
• 59:47
  Speaker 3: the fact that we're talking about psychedelic-assisted therapy as like
• 59:51
  Speaker 3: a revolution in psychological science, as something that can solve
• 59:55
  Speaker 3: problems that other things can't solve. Those things don't tend
• 59:59
  Speaker 3: to come about inside of intervention sciences that we're happy with.
• 1:00:02
  Speaker 3: You don't have like stark revolutions that can change how
• 1:00:05
  Speaker 3: we approach psychological phenomena forever inside. That doesn't happen a
• 1:00:10
  Speaker 3: lot in medicine. There are things that might, you know,
• 1:00:12
  Speaker 3: excite doctors like now I can do surgery with robots
• 1:00:15
  Speaker 3: and I can be more precise. But the notion that
• 1:00:17
  Speaker 3: like surgery, as you understand it.
• 1:00:20
  Speaker 4: Is no more.
• 1:00:22
  Speaker 3: And now this way, those kinds of revolutions don't come
• 1:00:25
  Speaker 3: about inside of successful intervention sciences. And I feel like
• 1:00:30
  Speaker 3: we talk about a lot of psycho and rediscover, right?
• 1:00:34
  Speaker 3: I mean, this isn't even something that we're discovering. This
• 1:00:36
  Speaker 3: is something that you're rediscovering. I mean, yes, you could
• 1:00:40
  Speaker 3: argue that this is that psychological, that psychedelic assisted therapy
• 1:00:44
  Speaker 3: was kind of strangled in its research crib a little bit,
• 1:00:48
  Speaker 3: but through the intervention of government entities and things like that.
• 1:00:52
  Speaker 4: And I think that's the argument that's being made, but yeah,
• 1:00:55
  Speaker 4: But people kind of studied this before.
• 1:00:57
  Speaker 3: And if it were a really, really effective approach for
• 1:01:01
  Speaker 3: these things, I think we might have detected it by now.
• 1:01:04
  Speaker 3: Because I'm sure that a lot of psychologists in their
• 1:01:07
  Speaker 3: basement were doing this kind of work.
• 1:01:09
  Speaker 4: And it would have come out into.
• 1:01:10
  Speaker 3: The forefront had it been just like a night and
• 1:01:14
  Speaker 3: day kind of experience. And I think it's sort of
• 1:01:18
  Speaker 3: bare saying that as behavior analysts, we expect night and
• 1:01:23
  Speaker 3: day results.
• 1:01:24
  Speaker 4: We expect..
• 1:01:25
  Speaker 3: You know, like this person will fundamentally changed in a
• 1:01:28
  Speaker 3: way that is detectable. And that is like, that is impressive.
• 1:01:33
  Speaker 3: You know, I, I, I don't, I don't think it's
• 1:01:35
  Speaker 3: too humble to say like.
• 1:01:37
  Speaker 4: It's impressed.
• 1:01:38
  Speaker 3: Like people, you know, when I debrief on cases that
• 1:01:41
  Speaker 3: I've worked on, they talk about how different this person
• 1:01:44
  Speaker 3: is and often positive ways. Right. And I don't think
• 1:01:48
  Speaker 3: we're seeing those kinds of results inside of the world
• 1:01:50
  Speaker 3: of psychology.
• 1:01:51
  Speaker 4: I think that's what underlies some of this for me.
• 1:01:54
  Speaker 3: And yeah, You know, you can point to other things
• 1:01:56
  Speaker 3: like how many people are disabled due to some kind
• 1:02:01
  Speaker 3: of psychological well-being problem? They're on Social Security disability. How
• 1:02:07
  Speaker 3: many people were doing that? What percentage of people were
• 1:02:10
  Speaker 3: on Social Security disability for some debilitating mental disorder?
• 1:02:14
  Speaker 4: Back in the fifties and how many people are.
• 1:02:17
  Speaker 3: On social security disabilities for some kind of psychological, you know,
• 1:02:20
  Speaker 3: there's other variables that enter the picture, but I tend
• 1:02:22
  Speaker 3: to think that it's not night and day. I tend
• 1:02:25
  Speaker 3: to think, you know, and there are books that you
• 1:02:27
  Speaker 3: can read that provide more clear evidence of that. One
• 1:02:33
  Speaker 3: of them is the emperor's new drug and then the
• 1:02:36
  Speaker 3: emperor's new drugs.
• 1:02:37
  Speaker 4: And what's the other one? Oh, the anatomy of an epidemic.
• 1:02:41
  Speaker 3: And they point to specific numbers that no, no, the
• 1:02:44
  Speaker 3: rates of social security disability, people who are cannot work
• 1:02:48
  Speaker 3: because of psychological distress, they've gone up. And if we
• 1:02:52
  Speaker 3: were in an effective science of intervening upon these things,
• 1:02:57
  Speaker 3: You could argue like maybe they've stayed the same or
• 1:02:59
  Speaker 3: maybe we're detecting problems that we didn't before. But I
• 1:03:03
  Speaker 3: hold our science to the standard of a stark difference.
• 1:03:07
  Speaker 3: Like this, it should be clear and obvious that we
• 1:03:10
  Speaker 3: are having an impact on the people that we're trying
• 1:03:13
  Speaker 3: to help.
• 1:03:13
  Speaker 4: And I don't know that that's necessarily true.
• 1:03:16
  Speaker 1: All right, Stu, we have talked about what the diagnostic
• 1:03:19
  Speaker 1: system is, some of the problems with it, including the
• 1:03:22
  Speaker 1: underwhelming specificity, the comorbidity, the lack of treatments, or maybe
• 1:03:28
  Speaker 1: the overgeneralization of treatment and sort of dipped our toes
• 1:03:32
  Speaker 1: into treatment. We talked about neurology. We talked about drugs.
• 1:03:35
  Speaker 1: We talked about ads. Okay, we're back. We have been
• 1:03:46
  Speaker 1: having this wonderful conversation here, and I think we're at
• 1:03:49
  Speaker 1: a great point now because there's a lot more I'd
• 1:03:51
  Speaker 1: actually like to continue to unpack. Both of the problems
• 1:03:54
  Speaker 1: of the diagnostic system, but also the future of where
• 1:03:58
  Speaker 1: we could potentially go, where we are going, where we
• 1:04:02
  Speaker 1: would maybe hopefully go instead is the way to put that. Stu,
• 1:04:06
  Speaker 1: can you come back for a second discussion about this
• 1:04:08
  Speaker 1: and talk more about those things?
• 1:04:10
  Speaker 4: I'll check my calendar, but I think I like my chances.
• 1:04:13
  Speaker 3: Yeah.
• 1:04:13
  Speaker 4: Okay.
• 1:04:14
  Speaker 3: All right.
• 1:04:14
  Speaker 1: Very good. Well, let's pause here to come back for
• 1:04:18
  Speaker 1: a part two and continue to unpack this discussion that
• 1:04:21
  Speaker 1: will hopefully give a lot of people some new ways
• 1:04:23
  Speaker 1: to think about this. If you are enjoying this conversation
• 1:04:26
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• 1:04:28
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• 1:04:31
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• 1:04:34
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• 1:04:36
  Speaker 1: I'll read the names of the people who have chosen
• 1:04:39
  Speaker 1: to support us as a special shout-out and thank you
• 1:04:41
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• 1:04:43
  Speaker 1: how it works. So a giant thank you to Mike M., Megan,
• 1:04:46
  Speaker 1: Mike T., Justin, Kim, Brad, Stephanie, Brian, Kiara, Charlie, and Michael.
• 1:04:52
  Speaker 1: We have a new person who joined us. Thank you.
• 1:04:54
  Speaker 1: Happy to have all these people with us. Thank you
• 1:04:56
  Speaker 1: for joining us. We have three Mike or Michaels in
• 1:04:59
  Speaker 1: our group, which is cool.
• 1:05:00
  Speaker 2: Yeah, that's kind of fun.
• 1:05:02
  Speaker 3: Yeah.
• 1:05:02
  Speaker 2: It's almost like Michael's a common name.
• 1:05:05
  Speaker 1: Almost like that. Almost like that. In addition, you can
• 1:05:07
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  Speaker 1: at www.wwdpodcast.com or reach us on the social media platforms,
• 1:05:29
  Speaker 1: and someone will talk to you over there. Also... I
• 1:05:32
  Speaker 1: need to remember that I have a team of people
• 1:05:33
  Speaker 1: without whom I cannot make this podcast. Writing and fact-checking
• 1:05:36
  Speaker 1: from Shane and myself. Thank you for recording with me today, Shane.
• 1:05:39
  Speaker 4: Hey, anytime.
• 1:05:40
  Speaker 1: Our social media coordinator is Emma Wilson, and the person
• 1:05:43
  Speaker 1: who takes all of the sounds that they hear and
• 1:05:44
  Speaker 1: mixes them together into a delicious slurry that is this
• 1:05:47
  Speaker 1: podcast is our god emperor, Penguin Justin, producer extraordinaire. Of course,
• 1:05:52
  Speaker 1: a giant shout-out and thank you to Stu, Dr. Stu Law,
• 1:05:54
  Speaker 1: for coming on and talking to us about this, although
• 1:05:56
  Speaker 1: we'll have you back again for another one of these.
• 1:05:59
  Speaker 1: And then, of course, thank you all for listening. But
• 1:06:01
  Speaker 1: we're actually not done because we're going to recommend some
• 1:06:03
  Speaker 1: things because it's fun to do that. So anything that
• 1:06:06
  Speaker 1: I missed or anything you'd like to add before we
• 1:06:07
  Speaker 1: transition to recommendations, Shane?
• 1:06:09
  Speaker 4: No. So I got a couple.
• 1:06:20
  Speaker 3: One is the Emperor's New Drug that I mentioned, the
• 1:06:24
  Speaker 3: Emperor's New Drugs.
• 1:06:24
  Speaker 4: Okay.
• 1:06:25
  Speaker 3: And..
• 1:06:26
  Speaker 4: The Anatomy of an Epidemic. Nice little airport books. Good reading.
• 1:06:32
  Speaker 3: They talk about the first and second wave of psychotropics
• 1:06:38
  Speaker 3: that I think it's fair, but it paints a picture
• 1:06:42
  Speaker 3: of ineffectiveness, I tend to think.
• 1:06:45
  Speaker 4: And if you'd like to.
• 1:06:46
  Speaker 3: Read ahead for the next episode, there's a book called
• 1:06:52
  Speaker 3: called Beyond the DSM and then Learning Process-Based Therapy by
• 1:06:56
  Speaker 3: Hoffman and Hayes. Hoffman is a German psychologist. He's a
• 1:07:01
  Speaker 3: big deal over there. He gets a lot of big grants.
• 1:07:04
  Speaker 4: And then Dr. Stephen Hayes is my former advisor.
• 1:07:08
  Speaker 3: And those will prepare you for the discussion that we'll
• 1:07:11
  Speaker 3: have next week if you feel so inclined.
• 1:07:15
  Speaker 1: Perfect. So that was learning process-based therapy, the anatomy of
• 1:07:20
  Speaker 1: an epidemic, and there was the end of the DSM.
• 1:07:23
  Speaker 4: Beyond the DSM.
• 1:07:24
  Speaker 1: Beyond the DSM. The end of the DSM.
• 1:07:29
  Speaker 2: Or the index.
• 1:07:30
  Speaker 4: And then The Emperor's New Drugs.
• 1:07:33
  Speaker 1: Perfect. All right. Four books that you can read within
• 1:07:36
  Speaker 1: the next seven days to be prepared for this. And
• 1:07:40
  Speaker 1: then you're going to have to recommend some more things
• 1:07:42
  Speaker 1: next time. So... Could you add that list?
• 1:07:45
  Speaker 4: I'll be prepared for that.
• 1:07:47
  Speaker 3: All right.
• 1:07:47
  Speaker 1: Very good. Shane, what are you recommending today?
• 1:07:50
  Speaker 2: So I am right now obsessed with and maybe it's
• 1:07:54
  Speaker 2: maybe it's my midlife crisis. But, you know, originally I
• 1:07:57
  Speaker 2: was going to go to school to open a recording
• 1:07:59
  Speaker 2: studio and to be able to do that. And so
• 1:08:01
  Speaker 2: now I'm kind of leaning into like home studio production stuff.
• 1:08:04
  Speaker 2: And recently I got this like fun little toy. It's
• 1:08:07
  Speaker 2: the Akai Mini MK3 MIDI board. It's a little piano.
• 1:08:12
  Speaker 2: It's got like a drum pad on it. And it's
• 1:08:15
  Speaker 2: really a lot of fun to play around with, especially
• 1:08:17
  Speaker 2: if you have like the right software to plug it into.
• 1:08:19
  Speaker 2: If you've never played around with like a MIDI board,
• 1:08:21
  Speaker 2: it's just basically just like you can turn your typing
• 1:08:24
  Speaker 2: keyboard into a MIDI board. It's just basically like a
• 1:08:26
  Speaker 2: bunch of hotkeys that make different sounds and stuff like that.
• 1:08:29
  Speaker 2: And so this one's shaped like a tiny little piano.
• 1:08:31
  Speaker 2: It's super portable. I was able to pack it in
• 1:08:33
  Speaker 2: my suitcase and bring it with me to Denver recently
• 1:08:35
  Speaker 2: and then play around with it. And I use a
• 1:08:37
  Speaker 2: software called Ableton that allows you to plug in different sounds,
• 1:08:41
  Speaker 2: different noises, and then your keyboard does all the things
• 1:08:44
  Speaker 2: that you want it to do in all the different ways.
• 1:08:46
  Speaker 2: So it's a lot of fun to mess around with
• 1:08:47
  Speaker 2: and explore and just kind of like, just be goofy
• 1:08:50
  Speaker 2: with if you like to kind of record stuff at home.
• 1:08:53
  Speaker 2: So it's a lot of fun. Fun.
• 1:08:56
  Speaker 3: Yeah.
• 1:08:57
  Speaker 1: Very cool, all right, so this is the, uh, well,
• 1:09:00
  Speaker 1: actually I'm gonna go through and list all the things
• 1:09:01
  Speaker 1: after we've talked about them. So people remember I'm recommending
• 1:09:03
  Speaker 1: an album. We've been in this renaissance. I've mentioned this
• 1:09:06
  Speaker 1: a few times. I've just, like, all these bands that
• 1:09:09
  Speaker 1: I've loved for so long are just putting out new stuff,
• 1:09:11
  Speaker 1: and some of them at prolific rates. But a band
• 1:09:15
  Speaker 1: I like for a long time is called Protest the Hero.
• 1:09:17
  Speaker 1: They're a very technical, very fast, very... Technical and fast.
• 1:09:24
  Speaker 1: They're like kind of like vaguely in the middle punk ish.
• 1:09:27
  Speaker 1: There's a lot. It's mostly melodic. Like there's not a
• 1:09:30
  Speaker 1: lot of sort of the screaming vocals that some people
• 1:09:32
  Speaker 1: struggle with, but they're a Canadian based band. They just
• 1:09:35
  Speaker 1: recently put out an album maybe a month or so
• 1:09:37
  Speaker 1: ago called Within. And it's great. I mostly have enjoyed
• 1:09:42
  Speaker 1: everything they've put out. But this one actually did feel
• 1:09:43
  Speaker 1: like it had some kind of newer ways to approach
• 1:09:46
  Speaker 1: some of their stuff. Some of it felt like kind
• 1:09:48
  Speaker 1: of a return to form to older things. Some of
• 1:09:50
  Speaker 1: it felt totally fresh and new. All of it I liked.
• 1:09:52
  Speaker 1: So if you're into very fast, very technical sort of
• 1:09:56
  Speaker 1: virtuoso type music, then Within by Protest the Hero is
• 1:10:00
  Speaker 1: something I think most people will be able to get
• 1:10:01
  Speaker 1: on board with in some capacity. All right, so that's
• 1:10:04
  Speaker 1: the album Within by Protest the Hero, the AK, AKI, MPK, Mini, MK. Oh,
• 1:10:09
  Speaker 1: my God. When you were talking about MIDI things, I
• 1:10:11
  Speaker 1: think they just throw a bunch of letters and numbers
• 1:10:13
  Speaker 1: into a bowl and then just pull them out, and
• 1:10:14
  Speaker 1: then that's what they call it.
• 1:10:15
  Speaker 2: Yeah, yeah, yeah, yeah, yeah. Especially AKI.
• 1:10:18
  Speaker 1: AKI Pro.
• 1:10:18
  Speaker 2: Yeah, but their stuff is cool, yeah.
• 1:10:20
  Speaker 1: Okay, and then learning, so four books, Learning Process-Based Therapy,
• 1:10:23
  Speaker 1: The Anatomy of an Epidemic, Beyond the DSM, and The
• 1:10:25
  Speaker 1: Emperor's New Drug. Check those out if you are interested
• 1:10:28
  Speaker 1: in doing so. Otherwise, we'll catch you next week, hopefully,
• 1:10:32
  Speaker 1: and we will continue to follow up this discussion. Are
• 1:10:36
  Speaker 1: we good to wrap it up there, Shane?
• 1:10:37
  Speaker 2: Yeah, that feels good.
• 1:10:38
  Speaker 1: All right, see you all next week. Thank you for listening.
• 1:10:40
  Speaker 1: This is Abraham.
• 1:10:41
  Speaker 2: And this is Shane.
• 1:10:42
  Speaker 4: I'm Stu.
• 1:10:43
  Speaker 2: We're out.
• 1:10:43
  Speaker 3: Bye.
• 1:10:45
  Speaker 4: You've been listening to Why We Do What We Do.
• 1:10:47
  Speaker 3: You can learn more about this and other episodes by
• 1:10:50
  Speaker 3: going to www.wwdpodcast.com.
• 1:10:54
  Speaker 2: Thanks for listening, and we hope you have an awesome day.