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Why Our Mental Health System Is Failing Us with Robert Smith, MD · The Trauma Therapist

0:00
Speaker 1: Welcome to the Trauma THEAPIS podcast. My name is got McPherson.
0:04
Speaker 1: I interview incredible people who dedicated their lives to helping
0:07
Speaker 1: those who've been impacted by trauma. Here we go, So
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Speaker 1: five four, three, two and one, our folks, welcome back
0:16
Speaker 1: to the podcast. Very excited to have us My guest today,
0:19
Speaker 1: Doctor Robert C. Smith.
0:21
Speaker 2: Bob welcome, Thank you guys, looking forward to talking with you.
0:26
Speaker 1: Awesome. So, doctor Smith is a nationally recognized leader in
0:29
Speaker 1: evidence based mental health care and doctor patient communication. A
0:34
Speaker 1: University Distinguished Professor of Medicine and Psychiatry and Michigan State University,
0:39
Speaker 1: doctor Smith developed the first patient centered method to train
0:43
Speaker 1: medical professionals to build strong partnerships with their patients. His
0:47
Speaker 1: expertise and dedication to reforming mental health care make his book,
0:52
Speaker 1: Has Medicine Lost Its Mind? Essential reading for policymakers, healthcare professionals,
0:57
Speaker 1: and anyone concerned about the future mental health care in America.
1:02
Speaker 1: All right, Bob, welcome obviously again to the podcast. Before
1:06
Speaker 1: we get going, and share with the listeners where you're
1:08
Speaker 1: from originally and where you are currently.
1:12
Speaker 2: I right now have retired from Michigan State. I was
1:15
Speaker 2: there from nineteen eighty five on, and I have just
1:19
Speaker 2: recently retired and spent the time writing has Medicine Lost
1:24
Speaker 2: its Mind?
1:25
Speaker 1: Okay, so look, we're going to get into that, but
1:31
Speaker 1: take us back a little bit, give us some context.
1:34
Speaker 1: How did all this start for you? How did you
1:36
Speaker 1: get interested in this field? How did you share the
1:38
Speaker 1: doctor in the first place.
1:40
Speaker 2: Sure, well, that's a strange story. I was raised. I'm
1:45
Speaker 2: actually the sixth consecutive generation of physicians in my family,
1:49
Speaker 2: and my dad was what they call then a general practitioner.
1:54
Speaker 2: But I was raised to be a professional athlete. My
1:59
Speaker 2: dad was very and athletics and wanted wanted me to
2:02
Speaker 2: be a professional athlete, and so hung I always assumed
2:06
Speaker 2: i'd be a doctor. There was no pressure on it,
2:10
Speaker 2: I guess subliminally and unconsciously there probably was. But in
2:15
Speaker 2: any event, I did not grow any bigger than I
2:20
Speaker 2: am right now, which is five ten and one seventy.
2:23
Speaker 2: And that didn't cut or sport all sports, but especially football.
2:29
Speaker 2: That was a quarterback. Oh well, okay, and so I
2:35
Speaker 2: wasn't quite big enough or probably not good enough either.
2:40
Speaker 1: Well, okay, so you're you're obviously pursuing athletics, were you
2:46
Speaker 1: pursuing athletics at Michigan.
2:48
Speaker 2: State, No, No, I would. I went to the University
2:51
Speaker 2: of Iowa, and I even went out there. I was
2:56
Speaker 2: too small, but this is the time they were ranked
2:59
Speaker 2: from one in the country nationally, and still decided I
3:04
Speaker 2: couldn't get a scholarship. They saw that I couldn't make it,
3:08
Speaker 2: but I didn't. So I went out anyway as a
3:10
Speaker 2: walk on, and after about two weeks I thought I
3:14
Speaker 2: was going to get literally get killed. Out there. They
3:19
Speaker 2: would have exercises where people stood about fifteen yards apart
3:24
Speaker 2: and just ran at each other. I did that one
3:27
Speaker 2: day with a guy that waited about two eighty and
3:30
Speaker 2: I said, this is it. There's gotta be a better way. Wow.
3:36
Speaker 1: Okay. So at some point you segued into getting more
3:41
Speaker 1: serious about medicine.
3:43
Speaker 2: Yeah. Yeah. Then I went to medical school and so on.
3:48
Speaker 2: I'm in and then went into practice and found that
3:53
Speaker 2: I was not prepared for all the mental health problem.
3:56
Speaker 2: I'm an internal medicine, I'm a primary care doctor. And
4:01
Speaker 2: went into practice and found I was not at all
4:04
Speaker 2: prepared for all the mental health issues and just emotional
4:08
Speaker 2: issues that people had. And long story short, I worked
4:15
Speaker 2: on that while I'm in practice, learned to listen better
4:18
Speaker 2: and so on and talk with people and had some
4:21
Speaker 2: success that even after six seven years doing that, it
4:26
Speaker 2: dawned on me I just didn't know enough about diagnosis
4:29
Speaker 2: and management. And so I then went back to the
4:31
Speaker 2: University of Rochester and took a fellowship and what's called
4:34
Speaker 2: biopsychosocial medicine, and I got some psychiatry training there and
4:40
Speaker 2: also primary care and mental health, and I was done it,
4:46
Speaker 2: as I said, at Michigan State from nineteen eighty five on,
4:50
Speaker 2: and I focused on how best to conduct primary care
4:56
Speaker 2: mental health in others, what does the primary care doc?
5:00
Speaker 2: And we developed using randomized control trials, we developed evidence
5:06
Speaker 2: based methods for how the doctor should communicate and best
5:12
Speaker 2: establish a relationship. Then in a couple other studies, we
5:17
Speaker 2: developed a primary care mental health care model, which shows
5:24
Speaker 2: how to teach and to conduct primary care mental health.
5:30
Speaker 2: And with that in mind, the whole idea was to
5:35
Speaker 2: better train primary care doctors in mental health. And we
5:41
Speaker 2: taught that and extensively to our residents at Michigan State
5:46
Speaker 2: and they did tremendously well. So we showed doctors can
5:50
Speaker 2: learn this, and indeed they're interested in it, and also
5:56
Speaker 2: it benefits their patients, and we showed this in randomized
5:59
Speaker 2: control trial. The discouraging thing that came about was that
6:06
Speaker 2: I and there are many thousands of people like me
6:10
Speaker 2: in medicine saying the same thing. We need better mental
6:14
Speaker 2: health care. The discouraging thing is that medicine doesn't do
6:18
Speaker 2: anything about it.
6:20
Speaker 1: They have all I mean, let me just interduct you, sure,
6:22
Speaker 1: because you're saying a lot of things. I want to
6:26
Speaker 1: squeeze more out of Sure. So you talked about when
6:30
Speaker 1: you first started, you realize that you weren't prepared for
6:35
Speaker 1: the mental health issues that were coming up. Why, I mean,
6:39
Speaker 1: of all the doctors out there, and granted that, I'm
6:41
Speaker 1: sure there are others who were interested, why did this
6:44
Speaker 1: particular topic get you so much?
6:49
Speaker 2: It was it was the problems I had with it.
6:53
Speaker 2: Patients would come in. I didn't know what to do.
6:56
Speaker 2: They're one and this is in has medicine lost its mind?
7:00
Speaker 2: That really was a turning point for me. She had
7:03
Speaker 2: metastatic breast cancer, lots of pain in the back and hips.
7:09
Speaker 2: I had no clue what to do with her. She
7:11
Speaker 2: was like, why am I crying all the time? Why
7:14
Speaker 2: can't you do something for me? What do you want
7:16
Speaker 2: to do? What's our next step? And I was just frozen.
7:20
Speaker 2: And I liked her. She was a nice, wonderful woman,
7:24
Speaker 2: but she was anxious and she made and I got
7:28
Speaker 2: anxious because I didn't know what to do to help her. Basically,
7:32
Speaker 2: all I would ever come up with is I do
7:35
Speaker 2: another test. I did an X ray or something like that.
7:38
Speaker 2: I knew it didn't do her any good, but it
7:40
Speaker 2: was just it was kind of bought me time. And
7:43
Speaker 2: I was just woefully inadequate and managing her. And I actually,
7:49
Speaker 2: quite frankly, was relieved when she died, but it didn't
7:54
Speaker 2: last long. And this is this was the turn event.
7:58
Speaker 2: Her husband came into my office about two weeks later.
8:02
Speaker 2: He hurried in, dropped a book on my office on
8:07
Speaker 2: my desk, and hurried out on the way out, saying,
8:11
Speaker 2: here's a diary she kept. I thought you might be
8:13
Speaker 2: interested in it. Wow, And it was replete with comments
8:18
Speaker 2: about me and my care. The young doctor doesn't seem
8:22
Speaker 2: to know what to do with me. The young doctor
8:25
Speaker 2: doesn't seem to care. All the young doctor does is
8:28
Speaker 2: order tests. The young doctor da da da da da.
8:32
Speaker 2: And there were multiple references like this. I was just
8:36
Speaker 2: absolutely shocked, and that was what kind of woke me
8:39
Speaker 2: up to my own personal inadequacies and quite frankly, lack
8:46
Speaker 2: of preparation. And it turns out it's quite like many
8:52
Speaker 2: other primary cure doctors. Excuse me one thing, sure, sorry,
9:05
Speaker 2: And it turns out it's like almost all other primary
9:08
Speaker 2: care doctors. We're not prepared for these kinds of patients.
9:11
Speaker 2: I'm sure she was depressed, but I had no idea
9:14
Speaker 2: how to diagnose it or what to do with it.
9:18
Speaker 2: And after that, I mean, this really bothered me for
9:22
Speaker 2: two or three weeks in there, just it was in
9:25
Speaker 2: my soul, as it were. And I gradually, of course,
9:29
Speaker 2: came out of that and resolved that, tried started doing
9:34
Speaker 2: things different. So I started listening to patients differently and
9:38
Speaker 2: actually had some success. People liked it, and I had
9:41
Speaker 2: good relationships with them, became a little more empathic. But
9:45
Speaker 2: I didn't really know how to do that, and I
9:47
Speaker 2: had no idea how to diagnose depression and drug addictions
9:52
Speaker 2: and what to do with it. These frightening panic attacks
9:56
Speaker 2: that would bring people into emergency rooms and so on,
10:00
Speaker 2: and long story short, I decided to leave practice and
10:05
Speaker 2: go back and take additional training at the University of
10:08
Speaker 2: Rochester and so called biopsychosocial medicine. And I did some
10:13
Speaker 2: psychiatry training while I'm there, but I'm an internal medicine doc,
10:17
Speaker 2: primary care anon, a psychiatrist, but I've got extra training
10:20
Speaker 2: in mental health. And it was then going to Michigan
10:24
Speaker 2: State that we did all the stuff that I was
10:27
Speaker 2: talking about. But that's kind of how I got into this.
10:32
Speaker 1: When you did your fellowship, what were some of the
10:35
Speaker 1: things you learned there that kind of lit you up?
10:41
Speaker 2: The crucial thing is learning how to interact with patients previously,
10:47
Speaker 2: and this is what most doctors are taught. Yet today
10:50
Speaker 2: doctors just go in and start asking questions about physical disease,
10:54
Speaker 2: where's the pain, where does it radiate, what medicines you're taking,
10:57
Speaker 2: and so on. They never asked the patient how they're doing.
11:02
Speaker 2: And this is this is where I became aware of
11:05
Speaker 2: what is now called patient centered interviewing practices. And if
11:11
Speaker 2: there is a fairly complicated technique that is required to
11:16
Speaker 2: do that, it isn't It isn't a matter of just
11:19
Speaker 2: being a nice, respectful person. There are actually skills that
11:23
Speaker 2: are required to do it, and they're often counterintuitive. For example,
11:28
Speaker 2: let the patient have some control of the interaction. I mean,
11:33
Speaker 2: that's that's hard for us type A personalities. And it
11:37
Speaker 2: came to the fore when I was in training and
11:40
Speaker 2: that you've got to relinquish some control of the patient
11:43
Speaker 2: if you're going to do this right. And still it
11:46
Speaker 2: ended up it takes even less time than it did
11:49
Speaker 2: the former way I interviewed, but that was not apparent
11:52
Speaker 2: to me at the time.
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Speaker 1: I would imagine two that one of the reasons why
11:59
Speaker 1: that's not done commonly is it could take a lot
12:06
Speaker 1: of time.
12:08
Speaker 2: Well, it takes talking to patients takes a lot of
12:13
Speaker 2: time for untrained doctors, and that's what happened to me
12:17
Speaker 2: in practice. And I would try to relate and do
12:21
Speaker 2: the right things, but I didn't know how to interview.
12:24
Speaker 2: I didn't know the skills of interviewing, and so I
12:27
Speaker 2: asked questions, but they would go nowhere and so on,
12:30
Speaker 2: and it did take a lot of time. Once howeveryone
12:34
Speaker 2: learns to do again, patient centered interviewing. Once you learn it,
12:39
Speaker 2: it takes no more time than it does in an
12:43
Speaker 2: ordinary other type of interview and in fact, it's been
12:48
Speaker 2: demonstrated that it takes less time over time, and then
12:53
Speaker 2: there is patients feel heard. They don't keep coming back
12:56
Speaker 2: with the same things, right.
12:58
Speaker 1: Right, right, all right. So let me just remind everyone
13:02
Speaker 1: we're speaking with doctor Robert Smith. His book is called
13:05
Speaker 1: has Medicine Lost Its Mind? Why our mental health system
13:09
Speaker 1: is failing us? And what should be done to cure it?
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Speaker 1: All right, Bob, So give us a little bit about
13:16
Speaker 1: this process, and then I want to ask you more
13:21
Speaker 1: broadly about the book. What does this interviewing process look.
13:25
Speaker 2: Like, oh, the patient centered interview? Yes, well, it basically
13:32
Speaker 2: means keeping your own issues to yourself. In other words,
13:39
Speaker 2: I may want to know about chest pain, shortness and
13:42
Speaker 2: breath or diarrhea or whatever, but let the patient bring
13:47
Speaker 2: it up. Set an agenda and let the patient start out.
13:52
Speaker 2: Tell me more about the back pain you've had, but
13:57
Speaker 2: let them unfold that using so called patient centered skills
14:03
Speaker 2: like silence like that, it allows people to come forth.
14:08
Speaker 2: You're not interrupting them, or tell me more about the pain,
14:12
Speaker 2: and they will and lost my job. Tell me more
14:16
Speaker 2: about losing your job, and if that story will go
14:19
Speaker 2: on for a little bit and eventually the pinnacle of
14:23
Speaker 2: the pasion centered interview who is emotion and eventually you'll
14:26
Speaker 2: get a story that sounds like there ought to be
14:29
Speaker 2: some emotion there. This guy has lost his job, his
14:33
Speaker 2: wife's out of work. What's the emotion going? And you say, so,
14:37
Speaker 2: how does all this make you feel? Now you've got
14:40
Speaker 2: the emotion, this is where you want to be to
14:43
Speaker 2: establish the relationship. And you hear that out a little
14:46
Speaker 2: bit and you then address the emotion. Everybody says, be empathic,
14:52
Speaker 2: address emotion, but nobody tells you how. And here's how
14:58
Speaker 2: we developed and this is comes out of these randomized,
15:01
Speaker 2: controlled trials. You've had to systematize it to do it,
15:05
Speaker 2: and it works highly effect even it's very individual, it's
15:08
Speaker 2: very unique to be empathic. Let's just say this guy says, well,
15:14
Speaker 2: I'm really upset and angry because my boss said I
15:19
Speaker 2: would keep the job and I didn't. Okay, so he's anger.
15:23
Speaker 2: You've got some expressing anger. You name it, you understand it,
15:28
Speaker 2: you respect it, and support and naming is how I
15:31
Speaker 2: can see that makes you upset. I understand Respect then
15:37
Speaker 2: is you've been through a lot with this, appreciate your
15:40
Speaker 2: telling me about this. Support is let's work on that together. Now,
15:46
Speaker 2: you typically don't use them all four at once like that.
15:49
Speaker 2: It sounds kind of canned. He's just one or two
15:52
Speaker 2: at a time. But you used them repeatedly. Maybe the
15:56
Speaker 2: first time you might say, oh, that's in a tough
15:58
Speaker 2: time for you. Let's work on that thirty seconds later, Oh,
16:02
Speaker 2: I understand how you get it thirty seconds later, and
16:06
Speaker 2: tell me more about how you felt then, and you
16:09
Speaker 2: keep developing that and that basically is the patient centered interview.
16:16
Speaker 2: And then as part of that, with most patients, that
16:19
Speaker 2: doesn't take more than a minute or two. It sounds
16:21
Speaker 2: like it takes longer than it does. They don't only
16:23
Speaker 2: take them in two and then you make a transition.
16:26
Speaker 2: You still find out. Now you mentioned you had diarrhea,
16:30
Speaker 2: tell me when that started. When medicines you're taking any
16:32
Speaker 2: pain with the DA DA DA, all the things you
16:34
Speaker 2: would ask about diarrhea. So nothing gets lost. And when
16:40
Speaker 2: one learns how to do this, it's quite efficient, doesn't
16:43
Speaker 2: take any more time than otherwise. It takes, however, significant
16:49
Speaker 2: amount of skill in trainers and a significant amount of
16:54
Speaker 2: time for the learners to learn it. And when we
16:58
Speaker 2: at Michigan State would teaching residents and students, ordinarily you
17:04
Speaker 2: would start out in role play they learned some of
17:07
Speaker 2: the basics of how to do this and then using
17:10
Speaker 2: it with patients and after two or three experiences with
17:14
Speaker 2: either a real patient or a simulated vision, they can
17:17
Speaker 2: start getting the hang of it. But it basically takes
17:19
Speaker 2: being supervised eight or ten times in doing this, which
17:24
Speaker 2: is what we did with our residents. They all were
17:26
Speaker 2: very good at it, but it takes supervise eight or
17:29
Speaker 2: ten times. That's a lot of time and a lot
17:32
Speaker 2: of training that goes into it, and quite frankly, medicine
17:36
Speaker 2: doesn't do that.
17:37
Speaker 1: Yeah, yeah, wow, I love this. I mean, this is
17:42
Speaker 1: obviously very much like therapy, provide the therapeutic skills it is.
17:49
Speaker 1: But what is so interesting, as I hear you speaking,
17:52
Speaker 1: is I could just imagine the rapport that's built, the
17:58
Speaker 1: trust that's exactly which in and of itself allows so
18:02
Speaker 1: many other doors to open up. Right and correct me
18:07
Speaker 1: if I'm wrong here, But generally speaking, we in our
18:11
Speaker 1: culture here at least in the United States, we don't
18:14
Speaker 1: think of doctors doing this, not at all. In fact,
18:17
Speaker 1: we think of doctors not doing this at all. They're
18:23
Speaker 1: not right, So is medicine changing.
18:29
Speaker 3: Not really Okay, I'd like to tellnalogy that the analogy
18:36
Speaker 3: of the giant cruise ship trying to turn.
18:38
Speaker 2: It's taken forever. It's taking a long time. Medicine, in fairness,
18:47
Speaker 2: does teach interviewing in most medical schools now, but it
18:56
Speaker 2: never gets carried on. Is typically taught the very first
18:59
Speaker 2: year in medicals, and of course there's four more years
19:02
Speaker 2: to go and four more years of residency after that,
19:05
Speaker 2: so it was long washed out because it does not
19:08
Speaker 2: get reinforced. And in fact, the culture of medicine often
19:14
Speaker 2: will tell people trying to use it, don't talk to
19:18
Speaker 2: patients about that touchy feely stuff. Were interested in real
19:21
Speaker 2: disease like cancer and things like that, And so it
19:25
Speaker 2: not only is not reinforced, it is actively discouraged oftentimes,
19:31
Speaker 2: and so there's a long long way to go.
19:35
Speaker 1: Well, when you first developed interest in this, Bob, were
19:39
Speaker 1: you at any time disinclined to pursue this? Did you
19:44
Speaker 1: ever feel like what am I doing? Why am I
19:47
Speaker 1: this is quite frankly, this is stupid? Why am I
19:50
Speaker 1: wasting time on this? And what did colleagues.
19:52
Speaker 2: Think on the interview or on mental health? Well? Both, Oh,
19:58
Speaker 2: people thought I was nuts to leave. Oh they couldn't
20:02
Speaker 2: believe it. Why would you be interested in all that stuff?
20:06
Speaker 2: Oh no, I was making good money, went back to
20:10
Speaker 2: making next to nothing. But oh no, I never had
20:15
Speaker 2: the second thoughts. I can remember when I got to
20:18
Speaker 2: Rochester and put on that white coat. I somehow I
20:22
Speaker 2: knew I was on the right track. And even though
20:25
Speaker 2: I had loved practiced, and the people I worked with
20:27
Speaker 2: I loved have primary care, but I was not quite
20:33
Speaker 2: in the right place. And so this I knew I
20:35
Speaker 2: was in the right place. No, I never I often
20:39
Speaker 2: say I make a fourth as much money and now
20:41
Speaker 2: as I did in practice, and I'm four times as happy.
20:45
Speaker 1: So let's talk about the book. Has medicine lost its mind?
20:49
Speaker 1: Why did you write it?
20:51
Speaker 2: I wrote it because in spite of the fact that
20:57
Speaker 2: I and thousands of others minority within medicine keep telling
21:01
Speaker 2: medicine they need to improve mental health care, and we
21:04
Speaker 2: know how, we can tell them exactly what to do.
21:07
Speaker 2: It's all there. It's just a matter of doing it.
21:10
Speaker 2: In spite of that, medicine does nothing. And that's why
21:15
Speaker 2: I just had just go public, as it were. And
21:19
Speaker 2: this is shocking your viewers, listeners will be very perhaps
21:24
Speaker 2: even frightened by what I'm going to say. But primary
21:28
Speaker 2: care doctors like I was in practice, and like every
21:32
Speaker 2: other one is now conduct seventy five percent of all
21:36
Speaker 2: mental health care in the US. The problem is, as
21:40
Speaker 2: you've just heard me say about myself, we're not trained
21:45
Speaker 2: for this. And the downside of that is just incredible.
21:52
Speaker 2: Doctor prescribed opioids. Untrained doctors not trained in using opioids
21:57
Speaker 2: or in pain are causing fifteen to seventeen thousand overdosed
22:04
Speaker 2: deaths per year, two hundred thousands since this opioid epidemic began.
22:11
Speaker 2: Another example, forty eight thousand suicides a year. Half of
22:18
Speaker 2: those see their doctor in the month before they commit suicide,
22:23
Speaker 2: but doctors aren't trained, so they don't have a clue
22:26
Speaker 2: of what to do with it. Many of those can
22:28
Speaker 2: be saved. We're talking in the thousands of people, guy,
22:34
Speaker 2: Let's now talk in the millions of people. There's something
22:38
Speaker 2: like one hundred or nearly one hundred million people in
22:42
Speaker 2: the US with major mental disorders, seventy five percent of
22:47
Speaker 2: whom are cared for by untrained primary care doctors. And
22:51
Speaker 2: when these doctors do not recognize depression, anxiety, addictions, common
22:57
Speaker 2: mental health problem when they don't reckonize and treat them, divorce,
23:04
Speaker 2: job loss, school failure, addiction, incarceration, homelessness, and on and
23:11
Speaker 2: on the lisc go. There is a tremendous downside for
23:15
Speaker 2: millions of people. It's not the doctor's fault. They're not trained.
23:21
Speaker 2: And if you ask any one of them, they'll tell
23:23
Speaker 2: you what the problem is. Bob. One of them told
23:26
Speaker 2: me today, there's no psychiatrist in my town. What am
23:31
Speaker 2: I supposed to do? An other one says, you know,
23:35
Speaker 2: there's two or three psychiatris, but it's thinks nine or
23:37
Speaker 2: ten months to get somebody into ESUM. And so the
23:41
Speaker 2: problem is everybody thinks psychiatry is somehow going to take
23:45
Speaker 2: care of mental health. They see only twelve percent of
23:49
Speaker 2: all mental health asients, and oftentimes that's only one visit.
23:53
Speaker 2: Psychology sees another twelve to fifteen percent. But that's why
23:59
Speaker 2: seventy five percent is with untrained primary care docs like me.
24:06
Speaker 2: Answer is simple, train the doctors who provide the care,
24:10
Speaker 2: but medicine doesn't do it. Has medicine lozed his mind?
24:14
Speaker 2: That's where the title comes from. And so that is
24:19
Speaker 2: the issue. That's where the book comes from the idea
24:23
Speaker 2: is that medicine is not going to change. It has
24:28
Speaker 2: been hearing people like me say this, and as they say,
24:32
Speaker 2: thousands of others, a significant minority in medicine say this.
24:36
Speaker 2: They need to change, but they don't do it. It's been
24:38
Speaker 2: going on since the seventies. A gust institute like the
24:43
Speaker 2: Institute of Medicine, National Academy medic have said this, they
24:47
Speaker 2: don't do it. Training is no different than it ever was.
24:50
Speaker 2: Doctors receive no more than two percent of total training
24:54
Speaker 2: time in mental health care, even though it's the most
25:00
Speaker 2: common health condition they see in practice. How could medicine
25:04
Speaker 2: do something this stupid? Has Medicine Lost his Mind? So,
25:09
Speaker 2: in any event, that's why I am going public with it.
25:14
Speaker 2: And medicine's just completely refractory, and there is evidence that
25:19
Speaker 2: refractory institutions can be changed by books like Has Medicine
25:26
Speaker 2: Lost His Mind? Rachel Carson wrote Silent Spring and blew
25:31
Speaker 2: the whistle on the chemical industry, who was polluting everything
25:35
Speaker 2: that touched this led angered the public. First they got
25:42
Speaker 2: to their politicians. The politicians formed what today is the
25:45
Speaker 2: Environmental Protection Agency, the EPA. It's why we don't have
25:50
Speaker 2: ddt in our water. Ralph Nader wrote, unsafe at any speed.
25:57
Speaker 2: He inflamed and angered the public. They found out that
26:01
Speaker 2: the automobile industry had seat belts but didn't want to
26:05
Speaker 2: put them in cars because they were afraid it would
26:07
Speaker 2: cost them too much money. That led to similar political moves,
26:11
Speaker 2: and that's why you have seat belts in your car today.
26:16
Speaker 2: Has medicine lost its mind will do the same thing.
26:20
Speaker 2: It will inform the public. They will become angry about
26:24
Speaker 2: how poor their mental health care is and insist the
26:29
Speaker 2: politicians make change. And the thing the politicians will do
26:35
Speaker 2: this is what's in mental health in them? Has medicine
26:38
Speaker 2: lost its mind? They will set up a federal commission,
26:42
Speaker 2: presidential commission, congressional commission, something like that to investigate medical
26:48
Speaker 2: education for its scientific principles one and number two, if
26:56
Speaker 2: it is meeting the health care needs of the population.
27:00
Speaker 2: It's clear that it is not with all the terrible
27:03
Speaker 2: mental health care going on. But they will also find
27:09
Speaker 2: that medicine in its current structure is functioning in a
27:13
Speaker 2: non scientific way. And here's how all sciences at the
27:22
Speaker 2: last beginning back in the sixteenth seventeenth centuries adopted reductionistic
27:29
Speaker 2: approaches to their science, which means just looking at one
27:32
Speaker 2: part of the science as opposed to all the parts
27:35
Speaker 2: of it. All sciences, starting in about nineteen hundred have
27:42
Speaker 2: scrapped that approach for a systems approach, which looks at
27:46
Speaker 2: all parts of the problem, not just one, and how
27:50
Speaker 2: they interact. Only medicine continues to look at just one
27:57
Speaker 2: part of its science, physical disease part. It ignores the
28:03
Speaker 2: person part, the very person they're taken care of, the
28:06
Speaker 2: psychological part, and the social part, their environment. It ignores that.
28:13
Speaker 2: And this is what this commission will find that will
28:17
Speaker 2: then lead to requirements. And this is top down. Medicine
28:22
Speaker 2: is not going to change on its own. And well
28:23
Speaker 2: there will then be top down recommendations for how medical
28:28
Speaker 2: education needs to change.
28:30
Speaker 1: Wow, you've already got to figure it.
28:32
Speaker 2: Out, yep. So I'm committed.
28:36
Speaker 1: So this book is for the lay audience.
28:39
Speaker 2: This is for the people, for the public, because it
28:42
Speaker 2: should be read by professionals too, but it's intended for
28:45
Speaker 2: the public.
28:47
Speaker 1: Okay. So for let's say we have a lot of
28:52
Speaker 1: mental health clinicians, therapists of all kinds listening to this.
28:57
Speaker 1: What do you think they would get out of this.
28:59
Speaker 2: Book, I think mental health clinicians will find be very encouraged.
29:09
Speaker 2: In addition to recommending more training of psychiatry, I also
29:15
Speaker 2: recommend the active inclusion of psychology and other mental health
29:20
Speaker 2: counselors into medicine. They now lie completely outside of medicine.
29:25
Speaker 2: How this ever happened, I don't know, but they should
29:28
Speaker 2: be brought into medicine and integrated as part of this training.
29:36
Speaker 2: I can't say enough about how effective psychology and other
29:40
Speaker 2: counselors have been in when I was in practice, and
29:45
Speaker 2: so I think they can be encouraged by this. More broadly,
29:51
Speaker 2: I think they will be encouraged by this systems approach
29:57
Speaker 2: that I'm describing, whereas you you take all parts of
30:01
Speaker 2: the problem, not just one part of it. This is
30:06
Speaker 2: what many of them already understand and practice. This is
30:10
Speaker 2: not new news to anyone, and so this medicine needs
30:18
Speaker 2: to make a radical new change, and I think this
30:23
Speaker 2: is what's exciting about. This change is possible, but it
30:27
Speaker 2: cannot come from the bottom up.
30:30
Speaker 1: Well, all right, Bob, what's the best way for people
30:32
Speaker 1: to learn more about you and the book?
30:36
Speaker 2: And the best place to go is my website. Robert C. Smith, MD,
30:42
Speaker 2: and don't forget the MD. Robert Smith is a very
30:45
Speaker 2: common name and you'll never find me just using that,
30:49
Speaker 2: So it's Robert C. SMITHMD dot com. Go to that
30:55
Speaker 2: and you will find plenty of information in the book.
30:58
Speaker 2: You will find my social media you on there, follow
31:01
Speaker 2: me on there if you would like. We'd love to
31:03
Speaker 2: have you. And you'll also find on the landing page
31:10
Speaker 2: a box that says act Now. This is where you,
31:15
Speaker 2: as an individual can become involved. There is a letter
31:20
Speaker 2: in there which requests a federal commission just like I've described,
31:29
Speaker 2: and email addresses to the President, the Surgeon General, the
31:33
Speaker 2: National Academy of Medicine, you're congressperson, and your senator are
31:38
Speaker 2: provided in there. All you need to do is plug
31:41
Speaker 2: the two together, put the email address in, and paste
31:44
Speaker 2: the letter in and send it. This is the way
31:48
Speaker 2: individuals can have an impact on changing things. People need
31:54
Speaker 2: to be angry about how bad their mental health care is.
32:00
Speaker 2: This is the way to operationalize that.
32:03
Speaker 1: Awesome, all right, We'll have that linked up at the
32:05
Speaker 1: show notes page here at the Trauma Therapist podcast dot com. Uh,
32:09
Speaker 1: doctor Smith, awesome, so inspiring. Love to have you back
32:13
Speaker 1: at a later date. It seems like there's a lot
32:16
Speaker 1: to talk about. Thanks so much for being here.
32:19
Speaker 2: Thanks for having me, love talking did
32:21
Speaker 1: You all right,