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Diagnoses: More Harm Than Good? With Dr. Stu Law pt. 2 · Why We Do What We Do

0:03
Speaker 1: You're listening to Why We Do What We Do. Welcome
0:15
Speaker 1: to Why We Do What We Do. I am your
0:18
Speaker 1: diagnostic and statistical host, Abraham.
0:21
Speaker 2: I'm your just-read-four-books-in-the-last-seven-days host, Shane.
0:25
Speaker 3: That's probably true. We are a psychology podcast.
0:28
Speaker 1: We talk about the things that humans and non-human animals do,
0:32
Speaker 1: and this is a sequel of sorts, part two. We
0:35
Speaker 1: are following up last week's discussion about the caveats to
0:40
Speaker 1: a diagnostic system of psychological and mental and behavioral health.
0:45
Speaker 1: We'll get into a recap here in a moment. But
0:47
Speaker 1: if you're joining us for the first time, then welcome.
0:48
Speaker 1: I hope you enjoy what you hear in this discussion.
0:51
Speaker 1: We did, as I mentioned, record a part one. We'll
0:53
Speaker 1: do our best to recap that so you feel prepared
0:56
Speaker 1: for part two, whether or not you were here. But
0:58
Speaker 1: I do recommend checking that one out so you have
1:00
Speaker 1: some of the foundations to help you be able to
1:02
Speaker 1: access everything we're going to discuss in this part two.
1:06
Speaker 1: But I can't tell you what to do. You're going
1:07
Speaker 1: to do what you're going to do, and that's fine.
1:09
Speaker 1: If you weren't here for the last time and it's
1:10
Speaker 1: your first time ever joining us, then hopefully you still
1:13
Speaker 1: feel like you get something out of this. And if
1:14
Speaker 1: you're a returning person, then welcome back. Thanks for following
1:17
Speaker 1: all my instructions like a good little student. Either way,
1:20
Speaker 1: you are here. It is September 2nd. So happen Bison
1:24
Speaker 1: 10 Yell Day. And that is one of those like
1:28
Speaker 1: mad gab type things.
1:30
Speaker 4: Yeah.
1:30
Speaker 3: Bison, B-I-S-O-N hyphen 10 space yell, Y-E-L-L day.
1:37
Speaker 4: Yeah. Yeah.
1:38
Speaker 3: Did it.
1:38
Speaker 2: I'm not going to celebrate that. It's calendar adjustment day.
1:42
Speaker 4: Okay.
1:43
Speaker 3: It is global talent acquisition day.
1:46
Speaker 2: God, you know, that just reminds me that like, I
1:49
Speaker 2: can't stand HR language, like the, like corporate language. Like,
1:53
Speaker 2: like when people talk about synergy, I'm just like, ugh, gross.
1:56
Speaker 2: I don't like it. It's national blueberry popsicle day.
2:00
Speaker 3: Some synergy there. I like it.
2:02
Speaker 4: Yeah. Ugh.
2:03
Speaker 1: National No Patrick Day. So if you're a Patrick or
2:06
Speaker 1: you have a Patrick in your life, get out. Mm-hmm.
2:09
Speaker 2: Go on, get. I read that that was also specific
2:12
Speaker 2: to SpongeBob.
2:12
Speaker 3: Oh, that makes more sense.
2:14
Speaker 2: It's Pierce Your Ears Day.
2:16
Speaker 3: Okay, check. It is Spalding Baseball Day. Oh, cool. Good.
2:21
Speaker 3: Brands getting their own day. That's what we need more of.
2:24
Speaker 2: Yeah, yeah, yeah. Sponsored holidays, of course. It's VJ Day.
2:27
Speaker 3: Let your mind go where it will. It is World
2:29
Speaker 3: Coconut Day.
2:30
Speaker 4: Yes, it is.
2:31
Speaker 2: Yes, it is.
2:32
Speaker 4: All right.
2:33
Speaker 1: Those are the days, because it's holidays, and that's fine.
2:35
Speaker 1: That's the thing that we do, and it's not that important,
2:37
Speaker 1: but we do it anyway. And welcome, and you're welcome,
2:39
Speaker 1: and thank you, and all of that. So as I said,
2:41
Speaker 1: we're talking about, well, we're talking about diagnoses. More broadly,
2:45
Speaker 1: just diagnoses with respect to psychological and mental health. So
2:49
Speaker 1: we have a guest on with us. His name is Dr.
2:51
Speaker 1: Stu Law, and I'm going to give him a chance
2:53
Speaker 1: to speak in just a moment. But I'll start with
2:55
Speaker 1: a quick recap of what we talked about last time.
2:57
Speaker 1: And Stu, you can also jump in with this as
2:59
Speaker 1: we go. So that probably means I should introduce you now. So, hey, everyone,
3:02
Speaker 1: this is Dr.
3:02
Speaker 4: Stula.
3:03
Speaker 3: I'm back.
3:04
Speaker 4: I'm here to work. I looked at my calendar and
3:06
Speaker 4: moved things around.
3:07
Speaker 3: Here I am.
3:11
Speaker 4: Perfect.
3:11
Speaker 3: Thank you.
3:12
Speaker 1: We appreciate you being here for round two. Stu is
3:16
Speaker 1: a behavior analyst. He has developed his own assessment tool.
3:20
Speaker 1: He has worked in this field for a very long time.
3:22
Speaker 1: He has worked with a lot of people of various
3:24
Speaker 1: spectrums with diagnoses themselves and in various capacities and supporting
3:29
Speaker 1: roles to help them. And largely also, he's done a
3:31
Speaker 1: lot of administrative roles as well and sort of been
3:35
Speaker 1: sort of a rulemaking type of guy. in various capacities.
3:38
Speaker 1: And he's also our most frequently occurring guest. I'm pretty
3:41
Speaker 1: sure that we've ever had. He's like a adjunct faculty
3:44
Speaker 1: part of our team here. Yeah. I think, I think
3:48
Speaker 1: I've earned that.
3:49
Speaker 4: I'm in one out of every, what, like 140 episodes
3:51
Speaker 4: or something like that.
3:53
Speaker 3: Yeah.
3:53
Speaker 4: Yeah. And that humor, humor is a banger. It was
3:58
Speaker 4: so funny. Yeah.
3:58
Speaker 1: I remember the, How does the Sean Connery shave is control.
4:06
Speaker 1: It's a thinker, you know, you have to anyway. So
4:18
Speaker 1: going back to a quick recap of what we discussed
4:20
Speaker 1: last time, just beginning with the fact that like solving problems,
4:23
Speaker 1: identifying and solving problems is a huge thing that a
4:25
Speaker 1: lot of professions do in psychology, in the psychology space, clinical, behavioral,
4:30
Speaker 1: what have you. There is also a diagnostic system very
4:34
Speaker 1: commonly used in the United States called the DSM or
4:37
Speaker 1: the Diagnostic Statistic Manual of Mental Disorders. And then there's
4:40
Speaker 1: an international one called the International Classification of Diseases, or
4:43
Speaker 1: the ICD, and various tools other than that that exist.
4:47
Speaker 1: And essentially what they do is they take clusters of
4:50
Speaker 1: behaviors that people do, and then they give them a label.
4:53
Speaker 1: And then that label is then sometimes used to inform, well,
4:57
Speaker 1: it's not really used to inform treatment, but people might
4:59
Speaker 1: think that it is. It gives people an identity sometimes.
5:02
Speaker 1: It maybe has the helpful benefit that some people feel
5:05
Speaker 1: like at least now they know.
5:07
Speaker 3: There's a name for their thing. It is a known thing.
5:11
Speaker 1: They are not an outlier that exists outside of the
5:14
Speaker 1: normal human experience. We've identified that their problem is a
5:17
Speaker 1: problem other people have had, therefore unity and all is
5:20
Speaker 1: well in the world. But there's also problems with this
5:24
Speaker 1: diagnostic system that we've identified, one being that it has
5:28
Speaker 1: a huge issue with being specific enough that we feel
5:35
Speaker 1: like we can reliably identify a particular diagnosis because there
5:41
Speaker 1: are so many variations and overlapping symptoms that you might
5:45
Speaker 1: have many, many thousands of people at the same diagnosis
5:48
Speaker 1: with zero overlapping symptoms.
5:51
Speaker 4: Yeah. The goal ideally is to do like an, if then,
5:54
Speaker 4: if this, then that, but it's hard to do that
5:57
Speaker 4: inside of psychological wellness, unfortunately.
6:00
Speaker 3: Yeah.
6:01
Speaker 2: If then, then ego.
6:02
Speaker 4: Yeah.
6:04
Speaker 3: Then id.
6:05
Speaker 1: Second major problem that we identified was this idea of comorbidity,
6:10
Speaker 1: which is just the extent to which if you have
6:12
Speaker 1: a diagnosis, it might overlap with another diagnosis.
6:16
Speaker 3: And there are these rates of, like, some are as
6:19
Speaker 3: low as.
6:20
Speaker 1: A small percentage, 15% of the time or something, if
6:23
Speaker 1: you have this diagnosis, you might also have this diagnosis.
6:26
Speaker 1: But some of them are as high as 80% or 81%.
6:29
Speaker 1: If you have this diagnosis, there's a very high likelihood
6:31
Speaker 1: you'll also meet the criteria for this other diagnosis.
6:34
Speaker 3: And that paints this picture that we.
6:38
Speaker 1: Maybe don't have a very good handle on, are these
6:41
Speaker 1: things different enough from one another to call them different entities?
6:46
Speaker 1: And also goes back to the lack of specificity as
6:48
Speaker 1: an issue to bring in here.
6:51
Speaker 4: Yeah, and it's not just as simple as, like, if
6:53
Speaker 4: you have a depressive episode, then you have a major
6:55
Speaker 4: depressive episode, or you might have bipolar disorder. It's also
6:58
Speaker 4: detecting things like psychosis or schizophrenia or things that may
7:02
Speaker 4: seem unrelated at first blush. And that is problematic. And I.
7:08
Speaker 1: Don't want to throw anyone specific under the bus, but
7:10
Speaker 1: people who have said like they heard some initials for
7:14
Speaker 1: a diagnosis without knowing what it is and said, yes,
7:17
Speaker 1: that sounds like me. Where it was like there's ADHD
7:21
Speaker 1: and then like maybe OCD and they're like, oh, that one.
7:24
Speaker 3: I think I have that one. I'm like, what is that?
7:25
Speaker 3: And they're like, I don't know. I don't know.
7:29
Speaker 1: We know what that is here, but the name sounds
7:33
Speaker 1: good enough to be appealing to feel like I would
7:37
Speaker 1: like to align my identity with these letters because it
7:41
Speaker 1: makes me feel good. The third problem we identified here– well,
7:43
Speaker 1: there's obviously other issues to unpack with why someone would
7:46
Speaker 1: want to do that. But the third problem we identified
7:49
Speaker 1: here is the fact that there's a very broad– application
7:55
Speaker 1: of treatments that seem to work for very, very different
7:57
Speaker 1: sets of symptoms. And it's sort of the, if I
8:00
Speaker 1: get someone high, they'll feel better. And therefore that is
8:03
Speaker 1: a relevant treatment for all disorders type of thing. I
8:05
Speaker 1: think maybe at some point in the past, I think
8:08
Speaker 1: we impact like weighted vests as a thing. And I'm like,
8:11
Speaker 1: it will make someone move less because it's heavy and
8:16
Speaker 1: covers their body and restricts their movement. But that doesn't
8:20
Speaker 1: mean that it's in any way addressing the conditions that
8:23
Speaker 1: led to whatever behaviors you felt like you needed to address.
8:26
Speaker 1: And people put those like thunder vests on dogs. And
8:29
Speaker 1: I'm like, it is uncomfortable. It forces them to... It
8:31
Speaker 1: restricts their movements. So they might look calmer, but whatever
8:36
Speaker 1: it's doing to them is probably not the thing you think.
8:39
Speaker 1: It's not a magical vest that just cures anxiety or
8:42
Speaker 1: something like that.
8:43
Speaker 3: It's just.
8:44
Speaker 1: When you wrap someone's body in something, they move less
8:48
Speaker 1: and then they don't move as much. And then that's
8:50
Speaker 1: what happens. And it has nothing to do with the
8:52
Speaker 1: fact that you've like actually treated anything. And that's sort
8:55
Speaker 1: of what happens, I think, with many of the drugs
8:57
Speaker 1: that are prescribed for conditions here is the like you
9:00
Speaker 1: give some a drug that makes them feel better. maybe
9:03
Speaker 1: more placated or just generally calmer or whatever, and feel
9:08
Speaker 1: like you have addressed a symptom, but all you've really
9:10
Speaker 1: done is just reduce the frequency and intensity of some
9:14
Speaker 1: of their behaviors. And then without, it goes a little
9:17
Speaker 1: bit into a rabbit hole about psychedelic assisted treatment, which
9:19
Speaker 1: seems like it's trying to go essentially the same direction
9:22
Speaker 1: that other medicines have gone. That is the like, eat
9:25
Speaker 1: these or, you know, drink this ayahuasca and then like,
9:28
Speaker 1: you'll be cured tomorrow of whatever ails you sort of thing.
9:31
Speaker 1: And again, So that's, I think, what we covered in
9:34
Speaker 1: the last entire discussion. Is there anything that I missed
9:37
Speaker 1: you feel like we need to make sure people are
9:38
Speaker 1: up to speed with?
9:40
Speaker 2: No, I think that feels pretty good. That feels right.
9:43
Speaker 3: Anything for you, Stu?
9:44
Speaker 4: No. Sounds right. Okay.
9:46
Speaker 1: Is there anything I missed in my preamble we need
9:48
Speaker 1: to address?
9:49
Speaker 3: I don't think I mentioned, did I mention Patreon?
9:51
Speaker 1: You can support us on Patreon, leave us a rating review, like, subscribe,
9:53
Speaker 1: tell a friend, any of that sort of thing.
9:56
Speaker 4: Didn't do that. Now you did.
9:58
Speaker 3: Okay. Well, those are things that can happen.
10:00
Speaker 1: I'll talk more about those at the end of this
10:02
Speaker 1: discussion anyway. So stick around until then to hear the
10:04
Speaker 1: fun part where I try and sell you something. Actually,
10:06
Speaker 1: I will preface this now. The very fun part is
10:08
Speaker 1: at the end, we're going to recommend some things. It
10:11
Speaker 1: might be related to our topic, but it might not be.
10:13
Speaker 1: And that'll be fun either way. So you can check
10:15
Speaker 1: that out. But let's go ahead and get into our
10:17
Speaker 1: discussion today. We're picking up where we left off. There's
10:19
Speaker 1: a few more things we'd like to outline as some
10:22
Speaker 1: of the issues we see plaguing the diagnostic system for
10:27
Speaker 1: mental health things, for psychology.
10:29
Speaker 4: Yeah, I would say that generally the idea of this system,
10:36
Speaker 4: and this is a little shady, right? It's a little gray.
10:40
Speaker 4: is this notion that we have a list of disorders
10:43
Speaker 4: in the DSM, and when things get really specific, when
10:47
Speaker 4: the mechanisms get very clear, and the treatments get very if-then-y,
10:52
Speaker 4: when we reach that point, we tend to elevate disorders
10:55
Speaker 4: into diseases, right? So... The purpose of the DSM to
11:00
Speaker 4: some extent was for these disorders to become orderly enough.
11:04
Speaker 4: We are playing this game of like laws versus thesis or,
11:07
Speaker 4: you know, like theses can be really powerful. They can
11:10
Speaker 4: do so like disorders. It's not to some things can
11:13
Speaker 4: stay disorders and that's fine. But generally speaking, the purpose
11:17
Speaker 4: of these things was to elevate them to a disease.
11:19
Speaker 4: And the first thing that comes to mind is like,
11:21
Speaker 4: are we comfortable calling them diseases? Right. Part of the
11:24
Speaker 4: reason I'm providing all this like autoclidic, upfrontness is it
11:30
Speaker 4: feels gross to call a lot of these things diseases
11:33
Speaker 4: right mitch hedberg has a joke and it's like you
11:37
Speaker 4: have alcoholism and that's a disease and he's like yeah
11:40
Speaker 4: but it's the only disease you can get yelled at
11:42
Speaker 4: for having and i think that speaks to kind of
11:47
Speaker 4: the nature of the disconnect in calling things diseases and
11:52
Speaker 4: i'll be okay with that disorder feels like a safe
11:54
Speaker 4: space but There is an extent to which we would
11:58
Speaker 4: like for these things to be orderly enough and hang
12:01
Speaker 4: together enough and have signs and symptoms and effective treatment
12:05
Speaker 4: packages enough that we say, if this, then that. And
12:08
Speaker 4: we know the mechanisms of change well enough that we
12:11
Speaker 4: elevate that thing to the level of a disease. And
12:15
Speaker 4: that has never happened for a single thing inside of
12:17
Speaker 4: the DSM. That is not a thing that has happened.
12:21
Speaker 4: Because we don't understand the mechanisms well enough, and these
12:25
Speaker 4: systems have the problems that we've discussed previously. Fair.
12:29
Speaker 2: Yeah, or it's better explained through medical means, right? So
12:33
Speaker 2: something that might show up, like when DSM has anything
12:37
Speaker 2: that has to do with a neurological disorder... Like, ultimately,
12:40
Speaker 2: that could be tied to some, like, medical event or
12:44
Speaker 2: something that's a little bit more concrete than, like, let's
12:46
Speaker 2: say major depressive disorder, which is a little bit more
12:48
Speaker 2: nebulous and a little bit more complex, or PTSD, like
12:50
Speaker 2: we mentioned in the last episode. Like, you know, if
12:52
Speaker 2: somebody who has Parkinson's, like, there are neurological, there's a
12:56
Speaker 2: neurodegenerative component to it. Like, at the very least, there's
13:00
Speaker 2: something there that's a little bit different than what we
13:03
Speaker 2: see in other parts of the DSM.
13:04
Speaker 4: And I would, you know, Alzheimer's disease, right? Like it
13:08
Speaker 4: has that manifestation and we slap that label to it.
13:11
Speaker 4: Whereas many of these other things are either syndromes or
13:13
Speaker 4: disorders and those don't have the same level of specificity
13:17
Speaker 4: and precision. Right. As one of their features.
13:21
Speaker 3: Ads in a podcast are a disease.
13:23
Speaker 4: Yeah.
13:31
Speaker 3: Okay, we're back.
13:31
Speaker 1: I kind of wanted to ask you then, so what
13:33
Speaker 1: we've been discussing just before the ad break was this
13:35
Speaker 1: idea that like in diagnostic models, if it gets specific enough,
13:39
Speaker 1: it's elevated to this place of disease. And in your mind,
13:44
Speaker 1: do you think that would be like a reasonable objective?
13:47
Speaker 1: Like it would be good if we did, in fact,
13:51
Speaker 1: create a diagnostic system that could elevate psychological phenomenon that
13:55
Speaker 1: were pathological and assuming that was a thing to like
13:59
Speaker 1: disease status.
14:00
Speaker 4: I mean, if something had that level of precision, then yeah,
14:04
Speaker 4: it would be cool. But the reality of the situation
14:06
Speaker 4: is that nothing yet has that level of precision. We
14:10
Speaker 4: don't have that if then kind of relationship between the
14:14
Speaker 4: signs and symptoms and the treatment path. And so if
14:18
Speaker 4: something were that simple, I think so Alzheimer's might be
14:20
Speaker 4: a good example. Like it is elevated to a disease
14:24
Speaker 4: and it's because the mechanisms of change and things that
14:28
Speaker 4: you can adjust and the things you can do about
14:30
Speaker 4: it are very well known. If that were the case
14:33
Speaker 4: inside of psychological research for other things like depression or
14:38
Speaker 4: obsessive compulsive disorder, then we, I'd be cool, you know,
14:44
Speaker 4: but it has to demonstrate that it is, it's doing
14:47
Speaker 4: the thing that diseases do. And that it's well known
14:50
Speaker 4: enough that we can officially call it that. And so
14:52
Speaker 4: it's not my favorite thing to call these things diseases.
14:54
Speaker 4: But if it makes sense, I mean, I'm not trying
14:57
Speaker 4: to do a behavioral treatment for Alzheimer's, except that those
14:59
Speaker 4: kind of work for the most part. Like environmental manipulation
15:03
Speaker 4: is one of the more effective things you can do
15:05
Speaker 4: inside of that system until we can kind of. manipulate
15:09
Speaker 4: the mechanisms inside the brain and the myelin or whatever's
15:13
Speaker 4: going on there. That's not my area. But one of
15:16
Speaker 4: the things you can do in behavior analysis is manipulate
15:19
Speaker 4: environmental factors to make the probability of psychological distress lower
15:24
Speaker 4: and do things like when they eat, leave the plate
15:29
Speaker 4: out with empty food and forks. So when they say,
15:31
Speaker 4: I haven't eaten yet, there's something in the environment that
15:33
Speaker 4: tells them that they have. You know, little things like
15:36
Speaker 4: that are really effective interventions and they operate at the
15:39
Speaker 4: level that we as behavior analysts are kind of used to.
15:43
Speaker 4: But generally speaking, I don't have much to say about like,
15:46
Speaker 4: you know, is there a drug that can, you know,
15:49
Speaker 4: do what X, Y, Z that helps the brain stay
15:52
Speaker 4: healthier longer, helps people remember things. But if that ends
15:56
Speaker 4: up being the case, I'm happy to ride that train.
15:59
Speaker 3: Do you think we'll get there?
16:00
Speaker 4: I do not think we will get there with anything. No.
16:06
Speaker 4: I think it's possible that we have new definitions and
16:09
Speaker 4: we have a new way of going about things and
16:11
Speaker 4: we have diagnostic labels that look very unfamiliar to us
16:17
Speaker 4: as they are now. And there's a different process of
16:20
Speaker 4: arriving at the conclusion that this is potentially a disease
16:24
Speaker 4: or something like that. But the way of going about
16:26
Speaker 4: that would have to change in my mind fundamentally.
16:29
Speaker 1: Yeah, I also feel like I could see the fact
16:34
Speaker 1: that we might not need to get there. If there
16:38
Speaker 1: are approaches that we can take that don't require any
16:42
Speaker 1: kind of label because they are maybe focused on the
16:47
Speaker 1: variables and processes relevant to each individual person, then that
16:51
Speaker 1: process of providing support as needed with respect to the
16:55
Speaker 1: kinds of things that are needed for that person in
16:58
Speaker 1: their situation then why would we continue to pursue the
17:03
Speaker 1: classification portion of this if we already have something that works?
17:08
Speaker 1: I could see it being the case that we never
17:12
Speaker 1: even try and get to that level of precision in
17:14
Speaker 1: diagnoses because we wouldn't need to. But that's sort of
17:19
Speaker 1: tangentially related to something that I also see as a
17:22
Speaker 1: fundamental foundational issue with the diagnostic system, which is that
17:28
Speaker 1: it essentially says there is a scope of human behavior
17:33
Speaker 1: that is normal. And outside of those things, it is
17:37
Speaker 1: not normal. And therefore, it is pathological. And therefore... it
17:41
Speaker 1: requires or could benefit from a diagnostic label. And I
17:46
Speaker 1: would argue that there just is no such thing as normal,
17:49
Speaker 1: such that we can compare one person against an archetype
17:52
Speaker 1: of normal and then say they deviate from this, therefore
17:56
Speaker 1: that's bad.
17:57
Speaker 4: Yeah, I would tend to agree with that notion. And
18:00
Speaker 4: I would say that demonstrating that is probably what I've
18:05
Speaker 4: spent my career to date doing, looking at individual level
18:09
Speaker 4: processes and trying to identify ways to take what we
18:13
Speaker 4: see at the individual level and then bring it to
18:16
Speaker 4: the level of the population. So I would tend to
18:20
Speaker 4: agree with the notion that normal is a weird idea.
18:24
Speaker 4: It's kind of a weird construct. And it doesn't often
18:29
Speaker 4: fit as cleanly as we've given it credit to do.
18:35
Speaker 4: So a lot of the ways in which you've been
18:37
Speaker 4: measured psychologically in your life through education and psychology is
18:41
Speaker 4: comparisons to normal. Some examples would be in education systems,
18:46
Speaker 4: we often have percentiles. So you're in the X percentile
18:50
Speaker 4: of XYZ math skills or whatever. And these things are
18:55
Speaker 4: supposed to kind of spin us into action, right? I
18:58
Speaker 4: don't know about y'all, but one of the, you know,
19:00
Speaker 4: my friends and family don't tend to rely on my
19:03
Speaker 4: expertise to for a lot of things, but when they have,
19:06
Speaker 4: it's been, my kid is not meeting some developmental milestone
19:11
Speaker 4: that they were supposed to hit. I'm a little worried.
19:13
Speaker 4: I want you to like run a quick assessment or
19:15
Speaker 4: refer me to somebody or do something that kind of
19:18
Speaker 4: like is in your area of expertise. The thing that
19:21
Speaker 4: flags for them is some kind of like developmental milestone
19:25
Speaker 4: that's not being met, not enough words, not crawling in time,
19:29
Speaker 4: not using the, you know, whatever those things are that
19:32
Speaker 4: has tended towards, People calling me up and sort of
19:38
Speaker 4: asking for my expertise. And in every one of those cases,
19:42
Speaker 4: it has ended up being a nothing bird. Sort of
19:44
Speaker 4: somewhat luckily, right? But person not crawling in time, not
19:48
Speaker 4: a big deal. And so. that, again, is the kinds
19:53
Speaker 4: of experiences I've had that lead me towards this way
19:56
Speaker 4: of seeing things that these things are developmental processes that
20:00
Speaker 4: occur at the level of the individual and they don't
20:02
Speaker 4: occur at the level of the population as we've kind
20:06
Speaker 4: of studied them to date for the most part. Yeah.
20:09
Speaker 1: And I do think I pointed out in the last discussion,
20:12
Speaker 1: I guess it's to be my own devil's advocate here,
20:14
Speaker 1: pointing out that like, there are obviously psychological experiences that
20:20
Speaker 1: people have that they identify as distressing. Like I'm having
20:26
Speaker 1: a problem. I would like to, I would like to
20:28
Speaker 1: not be having this problem anymore. And I think we
20:30
Speaker 1: can readily identify some things that are like, wow, this
20:33
Speaker 1: person's like actively harming themselves. actively harming other people, that
20:37
Speaker 1: definitely seems like this is worth addressing in some capacity.
20:40
Speaker 1: And so it's not to say that there is no
20:44
Speaker 1: benefit to identifying where things are not working in someone's
20:48
Speaker 1: best interest, or if they've self-identified that, or we see
20:52
Speaker 1: that there is active harm coming to others and be like,
20:55
Speaker 1: all right, there are behaviors that are happening here. We
20:57
Speaker 1: really need to consider how we might intervene so that
21:00
Speaker 1: we can reduce the amount of harm that's happening to
21:02
Speaker 1: these other people. And That there's utility probably in identifying
21:07
Speaker 1: those things when they happen. Whether or not that's best
21:10
Speaker 1: done by giving it a pathological label, I think, is
21:14
Speaker 1: up for debate. But identifying that there are situations that
21:18
Speaker 1: we are going to experience distress. We might experience distress
21:22
Speaker 1: so much so that we stop eating, stop sleeping, stop
21:26
Speaker 1: taking care of ourselves. And that understanding that that level
21:29
Speaker 1: of distress is something that we would like to address
21:33
Speaker 1: for ourselves and have a more productive experience with it
21:37
Speaker 1: is a valid position for people to take, that they
21:40
Speaker 1: would like to have that relief. And again, whether or
21:43
Speaker 1: not the system accomplishes it, I would argue, is hit
21:46
Speaker 1: or miss. But the fact that there's sort of an okay,
21:53
Speaker 1: in the middle of the bell curve, okay way to be,
21:56
Speaker 1: and when you go out away from that, you're starting
21:58
Speaker 1: to merge into like, this is now something that we
22:01
Speaker 1: need to change about who you are because you're not
22:04
Speaker 1: in the middle of that bell curve anymore. You're a
22:06
Speaker 1: little too autistic for us, so let's go ahead and
22:09
Speaker 1: get after that and make sure we get you to normal.
22:12
Speaker 1: Or you're a little too whatever the problem might be.
22:15
Speaker 1: We're going to pathologize the sort of normal range of
22:18
Speaker 1: human experience. And I think going back to the milestones
22:21
Speaker 1: is a really good one. It's like, oh, you didn't
22:23
Speaker 1: pick up reading by first grade. You probably have dyslexia. No.
22:28
Speaker 1: It might be that you have contacted insufficient reading instruction
22:31
Speaker 1: up until this point, and that maybe all we need
22:33
Speaker 1: to do is provide better reading instruction and then you'll
22:35
Speaker 1: be fine. It also could be that you have like
22:38
Speaker 1: a visual issue. So let's make sure we look and
22:40
Speaker 1: see if your eyes are doing the things that we
22:42
Speaker 1: would expect eyes to do. Other than that, like the
22:45
Speaker 1: pathologizing of normal human experience, I think definitely gets under
22:49
Speaker 1: my skin when I see people who are treating it
22:52
Speaker 1: as if like Yeah, I've heard someone say they're like,
22:54
Speaker 1: this person, I was questioning someone's self-diagnoses.
22:57
Speaker 3: They applied to themselves.
22:59
Speaker 1: And someone was pushing back at me saying like, well,
23:01
Speaker 1: I think they would know if they think differently from
23:02
Speaker 1: other people.
23:03
Speaker 3: And I was like, they know how other people think?
23:05
Speaker 1: Oh my God, we need to make them emperor of
23:07
Speaker 1: the planet because nobody has ever done that before. So
23:11
Speaker 1: you have to know how other people think to know
23:13
Speaker 1: that you think differently from them. And if you know
23:14
Speaker 1: how other people think, then you are millions of light
23:17
Speaker 1: years ahead of where the rest of us are, us
23:19
Speaker 1: mere mortals on this planet. So like, that's just not
23:22
Speaker 1: a thing you can do because nobody thinks in a
23:24
Speaker 1: particular way. Everyone's got their own sort of experience here.
23:28
Speaker 1: There's no normal by which you could say that I
23:30
Speaker 1: know that I'm different from everybody else. I'm like, no,
23:32
Speaker 1: you don't, because everybody else is different from you and
23:35
Speaker 1: from each other.
23:35
Speaker 4: Yeah, I think it bears kind of tracing the history
23:39
Speaker 4: of this a little bit. Way back in like the 1600s,
23:43
Speaker 4: they were using one of the first applications of average
23:47
Speaker 4: was somebody who was trying to position the stars. They
23:52
Speaker 4: were doing like celestial measurements and they found that it
23:55
Speaker 4: was actually really helpful to get multiple observers and then
23:59
Speaker 4: average the results from multiple observers. It was a way
24:02
Speaker 4: to like. lower in individual variation, right? It was actually
24:07
Speaker 4: a pretty effective way of looking at stars. Not too
24:10
Speaker 4: far after that, there was a guy named Sir Francis
24:13
Speaker 4: Galton who took the idea of averaging people and he
24:17
Speaker 4: applied it to human beings for the first time that
24:20
Speaker 4: I'm aware of. And to some consequence, I would argue,
24:25
Speaker 4: what he did is he would take soldiers and he
24:28
Speaker 4: would measure the circumference of their chest, for example, or
24:32
Speaker 4: their shoulder width. And then he would get an average
24:35
Speaker 4: for those for like the average soldier. And then he
24:40
Speaker 4: took this extra step. And this extra step is very important.
24:43
Speaker 4: And this is embedded in a lot of the ways
24:45
Speaker 4: that we see psychology today. He took the extra step
24:48
Speaker 4: to say, average is the best, right? If you're in
24:51
Speaker 4: the middle of the bell curve, you are the, you're the,
24:55
Speaker 4: you're the best soldier we got.
24:57
Speaker 2: And I can't believe you use bad words.
24:59
Speaker 3: And consequently, we believe them.
25:02
Speaker 4: And also, if you are too far from the average,
25:05
Speaker 4: you are deviant. And this way of measuring people, one,
25:10
Speaker 4: it's not concerned with the level of the individual. It's
25:12
Speaker 4: concerned with the level of the population. And that has
25:16
Speaker 4: huge implications for how we measure things psychologically. So one
25:20
Speaker 4: of those is that when we concern ourselves with the
25:22
Speaker 4: level of the population, it's really hard to get away
25:26
Speaker 4: from the notion that we are trying to manipulate the
25:31
Speaker 4: population level, right? So... If we were to take Galton's
25:37
Speaker 4: logic to its conclusion, we would say all these people
25:40
Speaker 4: who are deviants need to get out. They need to
25:43
Speaker 4: be out of my and probably need to be subjected
25:45
Speaker 4: to some kind of like terrible lifestyle or maybe even
25:49
Speaker 4: like punishment. Right. Or or as has been logically the case,
25:54
Speaker 4: not to be traumatic about this thing, but need to
25:56
Speaker 4: be selected out of the population.
25:58
Speaker 1: Yeah.
25:59
Speaker 3: Or forced to listen to ads. All right, we're back.
26:08
Speaker 1: Sorry, I very callously interrupted an actual wonderful point that
26:13
Speaker 1: you were making.
26:13
Speaker 3: I was on a roll, yeah. You were so on
26:16
Speaker 3: a roll, and I interrupted it. I am the roll destroyer.
26:19
Speaker 1: The conversation being that the idea that if there's an average,
26:22
Speaker 1: that the average is the best and that deviating from
26:25
Speaker 1: the average is not only mean that like the further
26:28
Speaker 1: away from the average, you get the worse you are,
26:30
Speaker 1: but that like eugenics comes into play.
26:32
Speaker 3: Maybe we shouldn't have those people at all.
26:35
Speaker 4: Right.
26:35
Speaker 3: Yeah.
26:35
Speaker 4: I think that is something that kind of logically follows.
26:39
Speaker 4: And that is a very pervasive idea in a lot
26:44
Speaker 4: of psychology. It's hidden. And it's sort of tucked away.
26:48
Speaker 4: So one example that I would point to is early statisticians.
26:51
Speaker 4: So like the guy who invented T-tests and ANOVAs and
26:56
Speaker 4: all that kind of stuff. A lot of the major
26:59
Speaker 4: statistical models that we use today in psychological research. Do
27:03
Speaker 4: you know what they were professors of?
27:04
Speaker 3: Math, I would guess.
27:07
Speaker 4: Eugenics. They were professors of eugenics. They were in the
27:12
Speaker 4: eugenics department.
27:13
Speaker 1: Hmm.
27:14
Speaker 4: Their job was to select humans out and select and
27:20
Speaker 4: find ways to make humans better fits for the kinds
27:24
Speaker 4: of society that we want to build. And you could
27:27
Speaker 4: make the argument that a lot of American psychological and
27:30
Speaker 4: statistical models from the early days were cited by the
27:33
Speaker 4: Nazis as like, look, there's scientific evidence that we need
27:38
Speaker 4: to push away from these people and we need to
27:41
Speaker 4: select a better population. And I tend to think that
27:46
Speaker 4: although that logic is obviously not as consequential, I think
27:51
Speaker 4: it's clear that schools, they're not trying to make your
27:54
Speaker 4: kid the best kid that your kid can be. It's
27:57
Speaker 4: really easy to fall into a pattern of your kid
28:01
Speaker 4: is not average, is not normal, and is going to
28:04
Speaker 4: be selected out in some ways of our society in
28:08
Speaker 4: the way that we know it. It's not our job
28:10
Speaker 4: to make them something new or something different. It's our
28:13
Speaker 4: job to identify what they are and make a decision
28:17
Speaker 4: about where they belong. I think a lot of our
28:20
Speaker 4: efforts inside of those domains do that. I think that's
28:24
Speaker 4: true of psychological research as well. I think this notion
28:29
Speaker 4: that there are people who are normal and there are
28:31
Speaker 4: people who aren't is something that I reject. I don't
28:36
Speaker 4: know that I'm it feels so ubiquitous as to be
28:41
Speaker 4: anti-science to say that, right? It feels like average is
28:44
Speaker 4: so much everywhere. And I would point to, yeah, it
28:49
Speaker 4: wasn't before like 1800s when some guy said average is ideal.
28:56
Speaker 1: Yeah.
28:56
Speaker 4: You know, and that, that kind of logic is everywhere.
28:59
Speaker 4: Like the average face is the most beautiful face, right?
29:02
Speaker 4: We've all heard that.
29:03
Speaker 3: Um, Yeah.
29:05
Speaker 4: And most of the kinds of assessments that we use,
29:08
Speaker 4: both in psychology and education, the whole purpose is to
29:11
Speaker 4: see how you stack up to other people. Yeah. In
29:14
Speaker 4: some way. And that is the thing that I question.
29:19
Speaker 4: And I think, as we'll talk about, we maybe are
29:22
Speaker 4: in a position to question more than we ever have.
29:26
Speaker 1: It's wild, too, to me to think about this whole...
29:29
Speaker 1: The whole idea of the average, because when they even
29:31
Speaker 1: if you were to take and I know exactly the
29:33
Speaker 1: thing you're referencing and when they did the thing where
29:35
Speaker 1: they built the pilot cockpits to fit the average pilot.
29:40
Speaker 1: and there is like, they took like 10 measurements of
29:43
Speaker 1: them and took the averages to build it. And they're like,
29:45
Speaker 1: all right, how many pilots do we have meet all
29:48
Speaker 1: 10 of these average measurements that we've got for what
29:51
Speaker 1: the average pilot is? And in all of the US
29:55
Speaker 1: Air Force, the number of pilots that met all 10
29:58
Speaker 1: averages was was zero. Matter of fact, the number of
30:02
Speaker 1: pilots you could admit get to make even three of
30:04
Speaker 1: those averages was like vanishingly small. It was like 10
30:08
Speaker 1: or something. And so it's like the average doesn't exist.
30:11
Speaker 1: It just, it just doesn't. And that's, that's assuming that we,
30:15
Speaker 1: that there's any utility whatsoever. And even averaging those particular dimensions,
30:19
Speaker 1: like maybe there are others that are, that you could
30:21
Speaker 1: average as well. And like the more you choose to
30:22
Speaker 1: include anyway, point being that like, there's just no such
30:25
Speaker 1: thing as like, a way to be human that is
30:29
Speaker 1: like the right way that we can identify as sort
30:32
Speaker 1: of the archetype. And we measure everything against that archetype
30:35
Speaker 1: as appealing as that might be to some people, which
30:38
Speaker 1: is essentially the crux of the eugenics argument is the like,
30:41
Speaker 1: there is an archetype. There's like a sort of perfect
30:43
Speaker 1: ideal to get to. And the correct argument against that
30:47
Speaker 1: is nope.
30:49
Speaker 4: Yeah, I mean, there is no ideal pilot, right? And
30:52
Speaker 4: when you design the cockpit around the average pilot, you've
30:55
Speaker 4: been ensured that it fits nobody. And that's the reason
30:59
Speaker 4: that our cars, even something as simple as our cars,
31:03
Speaker 4: that don't have such high demands on our ability to
31:07
Speaker 4: maintain a position and... hold ourselves grounded, right? And operate
31:12
Speaker 4: and reach all the things that we need to reach.
31:14
Speaker 4: We have all these levers and pushes and pulleys that
31:17
Speaker 4: allow us to move the seat forward, to lean forward,
31:19
Speaker 4: to move the steering wheel up. We have all these
31:22
Speaker 4: ways to adjust. And that's something that we didn't know
31:25
Speaker 4: at first. We were designing cockpits and planes around the
31:29
Speaker 4: average pilot and finding that that led to disastrous results.
31:33
Speaker 4: And now when you fly a jet, it takes like
31:36
Speaker 4: three days to get your helmet fitted. right. Or like
31:39
Speaker 4: two weeks, it's like some absurd amount, like just to
31:42
Speaker 4: have a helmet that like won't move at all on
31:45
Speaker 4: your head, that process takes like weeks.
31:48
Speaker 1: Right.
31:48
Speaker 4: So just something as simple as like, you know, how
31:52
Speaker 4: do we get this helmet in a way that you
31:53
Speaker 4: can see all the things that you need to interact with?
31:56
Speaker 4: You can interact with all the systems and it won't
31:58
Speaker 4: jostle when you're going Mach six, like that in and
32:03
Speaker 4: of itself is a measurement process that takes a very
32:05
Speaker 4: long time.
32:06
Speaker 1: Can you imagine if like, let's say, I'm looking at
32:10
Speaker 1: myself here and like looking at my glasses. I'm like,
32:12
Speaker 1: can you imagine if like an ophthalmologist took all of
32:15
Speaker 1: the prescriptions of everyone in the world and created average glasses?
32:18
Speaker 4: Yeah.
32:19
Speaker 1: And I was like, all right, if you're having trouble seeing,
32:21
Speaker 1: just get our average glasses.
32:23
Speaker 3: That will probably, that'll work for you. I'm like, first
32:25
Speaker 3: of all. No one is going to be able to
32:27
Speaker 3: use these.
32:28
Speaker 4: Right.
32:28
Speaker 1: And second of all, what an insane approach to a
32:31
Speaker 1: take to like vision of like, oh, we're just going
32:35
Speaker 1: to take this prescription that definitely doesn't fit you and
32:38
Speaker 1: just recommend that across the board. Yeah.
32:40
Speaker 4: And I think one thing that would be really fun
32:42
Speaker 4: and interesting. It's like imagine, this is difficult to imagine,
32:46
Speaker 4: but let's think of songs as processes for a second.
32:50
Speaker 4: Now imagine just the average song from beginning to end.
32:53
Speaker 4: It would probably just be one note. I don't really
32:55
Speaker 4: know how this would work, but it would just be
32:57
Speaker 4: some middle note.
32:59
Speaker 2: Yeah and it would probably be like an e which
33:02
Speaker 2: is like just like a nice nice clean you know
33:05
Speaker 2: like it'd be terrible.
33:07
Speaker 4: And so imagine like playing that for somebody and looking
33:09
Speaker 4: at them expectantly like isn't this we average the top
33:14
Speaker 4: 300 songs of all time and what we got is
33:17
Speaker 4: just an e going on for three isn't it great
33:22
Speaker 4: isn't this a great song.
33:23
Speaker 3: Feels like we're headed that direction sometimes.
33:25
Speaker 4: It does. That's how it feels to me often when
33:28
Speaker 4: we're talking about population level problems as though they are
33:32
Speaker 4: at the level of the individual. And this is not
33:36
Speaker 4: just like us being implicit about these things or like
33:40
Speaker 4: having a sense of them. It's not entirely anecdotal. There's
33:44
Speaker 4: this thing, I don't know if you've gotten to this
33:45
Speaker 4: point in this whole thing, but there's this thing called
33:48
Speaker 4: the ergodic theorem. Not yet. And the ergodic theorem is,
33:51
Speaker 4: was formulated in the 1930s by a bunch of physicists.
33:54
Speaker 4: And basically what they were looking at was like, if
33:57
Speaker 4: we release a gas into a known space and we
34:01
Speaker 4: calculate some statistical model for when it will occupy that
34:04
Speaker 4: space and how many molecules will be in a given section, blah, blah, blah,
34:08
Speaker 4: Can we then do some subdivisions? So like what if
34:11
Speaker 4: we do just the first quarter or we just look
34:14
Speaker 4: at this cluster of molecules? And they ask the question, like,
34:17
Speaker 4: does our broad statistical model predict these subsets? Right. I'm
34:23
Speaker 4: probably bastardizing that a little bit. I'm not an expert
34:25
Speaker 4: in statistics, but this is kind of a rough idea
34:27
Speaker 4: as I understand it. And they found, no, you cannot.
34:31
Speaker 4: And it's because, unless two things are met. One, each
34:36
Speaker 4: of those molecules is identical. So to give you some
34:39
Speaker 4: sense of how identical, say for a couple of the
34:43
Speaker 4: noble gases, most molecules are not similar enough that they
34:46
Speaker 4: are considered ergodic in the world of physics. And the
34:50
Speaker 4: other is that they are unchanging. They are forever the
34:53
Speaker 4: same entity. And so we can apply averages to individuals
34:58
Speaker 4: when they are ergodic, right? When they are exactly the same.
35:03
Speaker 4: And again, say for a couple of noble gases, not
35:06
Speaker 4: many things are ergodic and then they are unchanging. And
35:10
Speaker 4: then you can apply the logic, does what's true for
35:12
Speaker 4: the population apply to the level of the individual? So
35:15
Speaker 4: how many people do you know are unchanging and are
35:18
Speaker 4: identical to their neighbors in their population. And not just
35:21
Speaker 4: like I have a twin that wouldn't, there's no way
35:24
Speaker 4: that's going to cut it.
35:25
Speaker 3: Right.
35:26
Speaker 4: People are not identical in any way, shape or form.
35:30
Speaker 4: And they are also not frozen. We are dynamic processes. Right.
35:35
Speaker 4: And so I tend to think as human behavior as
35:37
Speaker 4: a dynamic process. And I, So when we say we
35:43
Speaker 4: saw if we collected a bunch of people, we got
35:46
Speaker 4: 500 people, and we tried to see is acceptance and
35:49
Speaker 4: commitment therapy a good therapy for depression? We got 250
35:56
Speaker 4: people over here. We gave them ACT. We got 250
35:59
Speaker 4: people over here, and we gave them treatment as usual
36:02
Speaker 4: or some kind of placebo therapy. We find that ACT
36:06
Speaker 4: is statistically significantly better than treatment as usual. And so
36:11
Speaker 4: we're confident saying that one of the best evidence-based treatments
36:14
Speaker 4: for depression is ACT. You cannot then say, my aunt
36:19
Speaker 4: has depression, therefore ACT would be an effective intervention for her.
36:22
Speaker 4: That violates math. Your grandma is non-orgotic. And just the
36:30
Speaker 4: way that you can't predict certain levels of individual process
36:34
Speaker 4: when it comes to molecules, you cannot predict that your
36:37
Speaker 4: grandma or your aunt will be responsive to ACT. That
36:39
Speaker 4: is not how this works. And so it's pretty rare
36:44
Speaker 4: that you have an argument inside of your science that
36:46
Speaker 4: is just like pointing to math and saying like, no,
36:50
Speaker 4: but this is that kind of thing. If you want
36:53
Speaker 4: to select at the level of the population, cool. If
36:56
Speaker 4: that's your area of interest, cool. I don't think that
36:59
Speaker 4: that's what psychology is. I think psychology is operating at
37:03
Speaker 4: the level of the individual to make changes within the
37:05
Speaker 4: individual lifespan. And that's a different game. And if you
37:09
Speaker 4: want to play that game, you got to play by
37:10
Speaker 4: the rules. And the rules are humans are not.
37:13
Speaker 1: I was gonna make a joke about like the people
37:16
Speaker 1: in the white house being ergodic.
37:21
Speaker 4: Similar processes. Okay.
37:24
Speaker 3: Yeah.
37:26
Speaker 4: Similar reinforcers. Yeah. They've also selected kind of a unique population, right? Like,
37:33
Speaker 4: I mean, populations being treated as the same. It's just,
37:36
Speaker 4: crazy on its face in my opinion yeah when we
37:40
Speaker 4: do these studies and we say this population no matter
37:42
Speaker 4: what kinds of controls we put in place people opt
37:44
Speaker 4: out of your study people elect into your study for
37:48
Speaker 4: certain features that they have and so like no that's
37:52
Speaker 4: not your there's no way to just be like this
37:54
Speaker 4: is a population and therefore we can treat every member
37:57
Speaker 4: of that population that's the same that's not how it
37:59
Speaker 4: works unfortunately.
38:01
Speaker 3: Very good points i will say that ads are ergodic
38:12
Speaker 3: All right, we're back.
38:13
Speaker 1: I want to continue moving us forward because there's a
38:14
Speaker 1: lot we still need to unpack here. And I think
38:16
Speaker 1: one of the things I'd like to really get into
38:18
Speaker 1: is because I think we've identified problems with the system
38:21
Speaker 1: as a whole and like sort of at the foundational level.
38:24
Speaker 1: But there's also like specific problems that the system of
38:28
Speaker 1: diagnoses have introduced that It's worth getting into a little
38:33
Speaker 1: bit as far as why the sort of central thesis
38:37
Speaker 1: we're making here. And I've been careful to not billboard
38:41
Speaker 1: this so heavily because I'm not even sure what I'm
38:43
Speaker 1: going to call these two episodes yet that are coming out.
38:47
Speaker 1: The thesis here, the debate set up is diagnoses do
38:51
Speaker 1: more harm than good. And we're sort of taking the
38:53
Speaker 1: like arguing for the notion, if you will. And there
38:56
Speaker 1: are definitely people who would argue against. But given that,
38:59
Speaker 1: what are the harms that we've seen come out of
39:01
Speaker 1: the system? Just like the system itself riddled with all
39:04
Speaker 1: kinds of problems at a foundational level, but also what
39:07
Speaker 1: problems that we've seen emerge out of the process of
39:10
Speaker 1: using this diagnostic model for psychological and mental health.
39:14
Speaker 4: A tendency towards eugenic level selection, I say, is probably one.
39:18
Speaker 4: Even inside of behavior analysis has generally done a good
39:22
Speaker 4: job of shirking these tendencies. Behavior analysts tend to favor
39:28
Speaker 4: single-subject designs. Our challenge is actually kind of unique in
39:31
Speaker 4: that we've had trouble trickling up what we find at
39:34
Speaker 4: the level of the individual to the level of the population. right?
39:38
Speaker 4: Like we, I have a lot of posters and I
39:41
Speaker 4: studies like this one time I worked with this one
39:42
Speaker 4: guy and it was really hard and we had to
39:44
Speaker 4: figure a bunch of shit out. You know, that's maybe,
39:47
Speaker 4: maybe what my poster should be called is like the
39:49
Speaker 4: one time I worked with this one guy and it
39:50
Speaker 4: was really hard and we had to figure a bunch
39:51
Speaker 4: of shit out.
39:52
Speaker 3: That's a good title.
39:54
Speaker 2: It's every study.
39:57
Speaker 4: But like nobody gleans anything from this because the things
40:00
Speaker 4: that they have to figure out are not the same
40:02
Speaker 4: that other people have to figure out. And, you know,
40:05
Speaker 4: as an example, one of my colleagues did a study
40:09
Speaker 4: on precision teaching that applied to dancing. And boy, howdy,
40:12
Speaker 4: is she asked a lot like, how do I teach
40:15
Speaker 4: people how to dance? And her answer inevitably is like,
40:17
Speaker 4: I don't know. Like, I don't know anything about teaching
40:21
Speaker 4: people how to dance. I know how to teach the
40:22
Speaker 4: people that I taught to dance, to dance. Right. And
40:25
Speaker 4: that is a very different question. So I have a
40:27
Speaker 4: process that keeps you earnest and keeps you in touch
40:29
Speaker 4: with the data and keeps you responsive to the things
40:32
Speaker 4: that are occurring at the level of the individual. But
40:34
Speaker 4: I don't have like a step one, show them how,
40:37
Speaker 4: how to put tamp dance and shoes on or like,
40:40
Speaker 4: you know, like that's not how this works. And it's
40:42
Speaker 4: kind of an interesting exercise. And that kind of question is,
40:46
Speaker 4: we are not immune to inside of behavior science, especially
40:49
Speaker 4: as we kind of fold into the medical model, right?
40:53
Speaker 4: You see a lot of questions like, I have a
40:54
Speaker 4: guy with Down syndrome that I need to teach how
40:56
Speaker 4: to read. How do I do it? And you're like,
40:59
Speaker 4: I don't know. Like, I don't have any clue. I
41:02
Speaker 4: don't know this guy. What is he like? What is
41:04
Speaker 4: he not like? What are the things that are showing
41:06
Speaker 4: up in terms of his repertoire? How does, how are
41:08
Speaker 4: his relational operant skills? Like there's about a million questions
41:12
Speaker 4: that I need to get to before I can make
41:14
Speaker 4: a recommendation for you. But I think, this general notion
41:17
Speaker 4: of like, if I have some sort of diagnosis, some
41:19
Speaker 4: sort of label, some sort of thing, there should be
41:21
Speaker 4: a Y to that X. And I think that just
41:25
Speaker 4: generally getting in the water that this is not how
41:28
Speaker 4: that works might be a good first step.
41:31
Speaker 3: Yeah, I think that makes a lot of sense.
41:32
Speaker 1: And yeah, I think as you said, and we're getting to, again,
41:35
Speaker 1: sort of the potential future direction that would be helpful
41:39
Speaker 1: is looking at it as not the what is the
41:42
Speaker 1: protocol that works for all people, but what is the
41:44
Speaker 1: process by which you identify what somebody needs? And then therefore,
41:48
Speaker 1: how do you sort of triage next steps to provide
41:51
Speaker 1: support as needed? But continuing on with the problems that
41:55
Speaker 1: we see here, talk to me about biological determinism here. Yeah.
41:59
Speaker 4: So I tend to think that the DSM and this
42:03
Speaker 4: way of looking at things lends itself really well to
42:06
Speaker 4: biological determinism as evidenced by like, we generally kind of
42:11
Speaker 4: like the idea that there's a medication that'll fix the syndrome, right? Like,
42:16
Speaker 4: although I think if you walk that through to like,
42:19
Speaker 4: what if I'm experiencing psychological distress because the environment super sucks,
42:24
Speaker 4: that feels kind of dystopian for me, right? Being happy
42:27
Speaker 4: in a, in a gnarly environment is not an ideal scenario, right?
42:34
Speaker 4: Like I think maybe there are ways to find wellness
42:37
Speaker 4: or to, We know one case example that I have
42:41
Speaker 4: is I have a colleague who was approached by Amazon
42:46
Speaker 4: to provide values orientation training to Amazon drivers. And so
42:52
Speaker 4: could they provide mindfulness training to Amazon drivers to allow
42:58
Speaker 4: them to better experience discomfort and ride out that discomfort
43:02
Speaker 4: and be better, more effective delivery drivers? Potentially. Do we
43:08
Speaker 4: want to do that? Maybe not, right? Do I want
43:13
Speaker 4: to make sure that people are cool experiencing high levels
43:17
Speaker 4: of distress for not a lot of pay? That doesn't
43:19
Speaker 4: sound like the business I want to be in. And
43:22
Speaker 4: so I think really quickly... When we take this like
43:26
Speaker 4: biologically deterministic approach, we pigeonhole ourselves in a way that
43:32
Speaker 4: we're not, we tend not to be aware of like
43:34
Speaker 4: the context in which things are occurring. And so I've
43:37
Speaker 4: been calling behavior analysis as interactively deterministic. So like I
43:41
Speaker 4: don't escape determinism. I think everything we do and say
43:45
Speaker 4: is determined to some extent. And the notion of free
43:48
Speaker 4: will is kind of a goofy idea. It's not that
43:50
Speaker 4: it exists or doesn't exist. It's just kind of a
43:52
Speaker 4: weird construct. But I do so at the level of
43:57
Speaker 4: interacting with the environment. It's not my biology determines my actions.
44:00
Speaker 4: It's my biology meeting the current environment given this history
44:04
Speaker 4: of reinforcement is what determines what I do, which is
44:07
Speaker 4: a complex system of interaction. But I arrive at the
44:10
Speaker 4: same conclusion. People deserve compassion. People deserve love and they
44:14
Speaker 4: deserve effective treatments. And I just so happen to reach
44:18
Speaker 4: the conclusion that you're doing what you're doing for a
44:22
Speaker 4: good reason. with different units of analysis, but it's hard
44:26
Speaker 4: to get there.
44:29
Speaker 3: Yeah, yeah, absolutely. For sure. That makes a lot of sense.
44:31
Speaker 1: And then, you know, I think briefly the fact that like,
44:35
Speaker 1: there's all kinds of side effects that come when, sorry,
44:37
Speaker 1: when you get into things like when we're using drugs
44:40
Speaker 1: as the approach, the side effects, the tolerance that builds,
44:43
Speaker 1: the like lack of predictability that we get from some
44:46
Speaker 1: of the effects of some of these drugs. The fact
44:48
Speaker 1: that sometimes what happens is because of the effect, the
44:51
Speaker 1: side effects of a drug, you then need more drugs
44:53
Speaker 1: to deal with those side effects and then more drugs
44:55
Speaker 1: to deal with the side effects of those drugs. And
44:57
Speaker 1: so you end up just taking a glass full of
45:00
Speaker 1: pills every day, where 80% of them are counteracting the
45:04
Speaker 1: effects of the others. And so the dependence, the pharmaceutical
45:08
Speaker 1: model here, the money that's spent on these things, and
45:11
Speaker 1: the fact that we do all of that, and then
45:15
Speaker 1: are we actually solving the issue? Or have we just
45:19
Speaker 1: created some different issues?
45:21
Speaker 4: Yeah, and I would tend to say, and some of
45:23
Speaker 4: the books that I recommended last week will provide more
45:26
Speaker 4: specificity as to this question, but I think the answer
45:29
Speaker 4: is no. I'm not overwhelmingly impressed with those approaches to
45:33
Speaker 4: psychological distress. One of the other issues that occurs with
45:37
Speaker 4: this kind of medical model and if biological disorder than
45:41
Speaker 4: biological solution is we tend to develop really quick tolerances
45:46
Speaker 4: to psychotropics. So if you've ever worked with somebody who's
45:50
Speaker 4: older and has been on psychotropic since they were younger,
45:53
Speaker 4: they tend to be on some amount of lithium or
45:56
Speaker 4: some psychotropic drug that would like kill an elephant. And
46:00
Speaker 4: it's because very, very quickly we develop drug tolerances. I
46:04
Speaker 4: think in that last episode you talked about what if
46:06
Speaker 4: we just pump you full of serotonin? Well, if you
46:08
Speaker 4: do that to people for long enough, their body stops
46:12
Speaker 4: producing serotonin. Your body says like, oh, we got enough
46:15
Speaker 4: of that. We don't need to make it anymore. And
46:17
Speaker 4: then you kind of arrive at this problem of, well,
46:20
Speaker 4: if you stop now, your body has forgotten how to
46:23
Speaker 4: produce it, to put it really loosely. And that creates
46:26
Speaker 4: a bunch of problems, but also if it experiences really
46:28
Speaker 4: high levels of it for long enough, then your body's
46:31
Speaker 4: going to respond to it differently and reach a new equilibrium.
46:35
Speaker 4: And that presents a lot of nasty challenges for people
46:37
Speaker 4: who are trying to solve psychological problems with biological solutions.
46:42
Speaker 4: It's really hard. And you know, you know, Some of
46:45
Speaker 4: the emperor's new drugs would talk about that as the
46:48
Speaker 4: revolving door of psychological emergencies, right? So even when we
46:52
Speaker 4: have things that are well managed in the short term,
46:54
Speaker 4: eventually you hit a point where like that drug's not effective.
46:57
Speaker 4: It's not doing what it should. We got to figure
46:59
Speaker 4: out the new doses. We got to figure out. what's
47:02
Speaker 4: going on. And also like your lifespan is shortened by
47:05
Speaker 4: these substances as well. And having worked with a lot
47:08
Speaker 4: of older adults who have been on a lifetime of
47:10
Speaker 4: these drugs, I can tell you, and it's just kind
47:14
Speaker 4: of known that one of the, one of the challenges
47:16
Speaker 4: in getting people to take these drugs is that the
47:18
Speaker 4: side effects are horrendous and they are not short term.
47:23
Speaker 4: I mean, I have seen somebody eventually pass away due
47:27
Speaker 4: to tardive dyskinesia. So they choked to death on their
47:30
Speaker 4: own tongue. I have worked with a guy who the
47:34
Speaker 4: byproduct of his psychotropic drug was eternal thirst, which is
47:40
Speaker 4: like a Greek torture. I mean, this guy had to
47:45
Speaker 4: be one-to-one supervision for no other reason than if he
47:48
Speaker 4: was left alone with liquids, he would drink himself to
47:50
Speaker 4: death and had to be line of sight as a
47:53
Speaker 4: function of that. If you left him alone with a
47:55
Speaker 4: toilet full of urine, he would drink it until he was...
47:59
Speaker 4: that thirst was linked.
48:00
Speaker 2: Until his stomach exploded.
48:01
Speaker 4: Yeah. And that to me, you know, those are personal
48:05
Speaker 4: experiences I've had. I'm not speaking to data and things
48:08
Speaker 4: like that. But just in my experience, it's really challenging
48:13
Speaker 4: to solve contextual problems and things that I look at
48:17
Speaker 4: as the individual meeting their current environment by just focusing
48:21
Speaker 4: on biological solutions. And I tend to think that the
48:24
Speaker 4: DSM system and the way that we've housed psychological wellness
48:29
Speaker 4: as protocols for syndromes has led us to this conclusion
48:32
Speaker 4: that if this syndrome, then this protocol, often this substance,
48:37
Speaker 4: and that will solve our problems. And I don't think
48:39
Speaker 4: that it's been a very fruitful way forward, to say
48:43
Speaker 4: the least.
48:44
Speaker 1: That's a really good way to tie it all back
48:45
Speaker 1: together is just coming back to the fact that it's like,
48:48
Speaker 1: Someone might say, well, the drugs aren't the diagnostic system's fault.
48:51
Speaker 1: And I'm like, yeah, but it kind of is because
48:54
Speaker 1: that's how we got to the point where we decided
48:56
Speaker 1: to use those drugs is because we had a diagnosis
48:58
Speaker 1: and decided that there are these drugs that are used
49:00
Speaker 1: for this diagnosis because we're treating this as if this
49:02
Speaker 1: is the medical thing.
49:05
Speaker 3: Like there's a thing to deviate.
49:07
Speaker 1: And then, of course, there's always the issue that I
49:09
Speaker 1: raised before of just like. are we just sedating people
49:12
Speaker 1: or are we actually treating something that's actually helpful for them?
49:16
Speaker 1: And I tend to think that a lot of the time,
49:20
Speaker 1: and I don't know what percentage, but enough of the
49:22
Speaker 1: time to raise concern, we're just sedating people. And then
49:25
Speaker 1: that has us feel good about the outcome because they're
49:28
Speaker 1: at least very chill and not.
49:30
Speaker 4: I mean, yeah, there's enough studies on ADHD medications to
49:35
Speaker 4: tell us that The kids don't learn more. They just
49:39
Speaker 4: don't piss off their teacher as much. Right. The medication
49:42
Speaker 4: is not for them. It's for their teacher and it's
49:44
Speaker 4: for the system that supports them. And yeah, I think, yeah,
49:48
Speaker 4: that I've, I've definitely seen a lot of like, this
49:52
Speaker 4: person is good when sedated and it's easy to fall
49:54
Speaker 4: into that pattern.
49:55
Speaker 3: Um, when you're part of that system, here's an ad
49:59
Speaker 3: for methylphenidate.
50:07
Speaker 1: Okay, so we didn't realize as we were recording this
50:10
Speaker 1: how long this conversation was going to go. So we're
50:14
Speaker 1: interrupting here future Shane and Abraham, Shane-braham, if you will.
50:19
Speaker 2: Shane-braham.
50:20
Speaker 1: To segue this so that what we can do is
50:21
Speaker 1: we can actually split this second discussion into two different
50:25
Speaker 1: episodes because otherwise it's just very, very long. And so
50:28
Speaker 1: what we're going to do is we're going to cut
50:30
Speaker 1: this one off here and the next week we'll come
50:31
Speaker 1: back for a part three to finish up our discussion
50:35
Speaker 1: with Dr. Stula about diagnoses and considerations around diagnoses, caveats
50:41
Speaker 1: therein and that sort of thing. As I said, we
50:44
Speaker 1: didn't know when we were recording that, that at this
50:46
Speaker 1: point in the discussion that we were going to go
50:49
Speaker 1: another like full length discussion. We're going to do our
50:52
Speaker 1: normal wrap up here.
50:53
Speaker 2: Dr.
50:53
Speaker 1: Stu Law did not know this when we were doing this,
50:55
Speaker 1: although we did at the very end talk about that
50:57
Speaker 1: being a possibility. And then what we're going to have
51:00
Speaker 1: to do is then do a new introduction for the
51:02
Speaker 1: second half where we're just going to have to cut
51:04
Speaker 1: into where we interrupted this one. And just we want
51:06
Speaker 1: to keep these manageable sort of in their length and whatnot.
51:09
Speaker 1: We always try and keep everything around an hour or
51:11
Speaker 1: a little less than an hour long. rather than go
51:13
Speaker 1: very long. We've gone very long before in the past,
51:15
Speaker 1: but I think the preference is that we keep these
51:17
Speaker 1: around sort of an hour or less in their time.
51:21
Speaker 1: And we went way past that. So this one should
51:24
Speaker 1: be right around 50-ish minutes, I think. With that being said,
51:27
Speaker 1: we'll go ahead and wrap this one up now. But
51:29
Speaker 1: I want to do our sort of final ending things
51:31
Speaker 1: we always do at the end of a discussion, including
51:34
Speaker 1: some new recommendations, because we're here and it'd be sad
51:36
Speaker 1: to just miss an opportunity to do that sort of thing. So,
51:40
Speaker 1: if you'd like to support us, you can join us
51:41
Speaker 1: on Patreon. Leave us a rating and a review. Like, subscribe,
51:44
Speaker 1: and tell a friend. I mean, those are always things
51:46
Speaker 1: that you can do. You know, as many stars as
51:48
Speaker 1: you can leave. If you're feeling generous, leave a review.
51:50
Speaker 1: All of that's very helpful. I would also like to
51:53
Speaker 1: shout out our Patreon supporters. So, if you go over
51:55
Speaker 1: to Patreon, which is a subscription membership service where you
51:58
Speaker 1: get some extra stuff that's, like, just for people who
52:01
Speaker 1: support us.
52:02
Speaker 3: We get early episodes, ad-free episodes.
52:04
Speaker 1: And at the end of our full-length discussions, I'm going
52:07
Speaker 1: to read your name to say thank you to all
52:09
Speaker 1: of those people. So a giant shout-out and thank you
52:11
Speaker 1: to Mike M., Megan, Mike T., Justin, Kim, Brad, Stephanie, Brian, Kiara, Charlie,
52:16
Speaker 1: and Michael for being wonderful Patreon supporters. If you, listener,
52:21
Speaker 1: I did not say your name and you'd like to
52:23
Speaker 1: be on that list, head over there. You can support
52:25
Speaker 1: us and then you can be on that list. And
52:26
Speaker 1: that's a way to do that sort of thing.
52:28
Speaker 2: Yes, please do. We love the support.
52:31
Speaker 3: We do love the support.
52:32
Speaker 1: Thank you so much to my team of people running
52:34
Speaker 1: and fact-checking from Shane and myself. Thank you for joining
52:36
Speaker 1: me today, Shane.
52:37
Speaker 2: Hey, thanks for having me.
52:38
Speaker 1: Our social media coordinator is Emma Wilson, and the person
52:41
Speaker 1: who has stuck with the job of having to chop
52:43
Speaker 1: these things up into multiple episodes and slice not one,
52:46
Speaker 1: not two, but three people's vocals, messy vocals, all together
52:50
Speaker 1: and try and make them sound like a podcast, and
52:52
Speaker 1: he does so with aplomb, is Justin.
52:55
Speaker 3: Thank you, Justin, for your wonderful work.
52:56
Speaker 4: You're beautiful. Indeed.
52:59
Speaker 1: If you'd like to tell us your thoughts on anything
53:00
Speaker 1: we have said so far, you can reach us directly
53:02
Speaker 1: by emailing us at info at www.podcast.com or reach us
53:08
Speaker 1: on the social media platforms. Is there anything that you'd
53:11
Speaker 1: like to add or that I forgot before we do
53:12
Speaker 1: our recommendations?
53:14
Speaker 4: No.
53:15
Speaker 3: All right. Let's recommend some things.
53:17
Speaker 4: All right.
53:27
Speaker 2: So I am recommending an album from a group. I
53:30
Speaker 2: say group. This is a solo artist. The album is
53:34
Speaker 2: called High Remembrance, and it is from a band called
53:38
Speaker 2: Unwed Sailor. Which, by the way, what a great name
53:41
Speaker 2: for a band.
53:41
Speaker 3: Yeah, solid.
53:43
Speaker 2: So this band has been around for quite some time,
53:46
Speaker 2: since 1998. Really, it's just kind of like... Good post-rock
53:51
Speaker 2: instrumental types of stuff. It sounds like it's primarily written
53:56
Speaker 2: with like bass forward types of riffs and stuff in mind,
54:00
Speaker 2: but super interesting. And every album that he's put out
54:02
Speaker 2: has been pretty unique, pretty different. And it's all him. Now,
54:05
Speaker 2: he always brings in some musicians to come in and
54:07
Speaker 2: help with, you know, some of the writing and some
54:09
Speaker 2: of this stuff. But he's always been kind of the concept,
54:11
Speaker 2: this guy named Jonathan Ford, you know, so he's been
54:14
Speaker 2: in some other bands as well. But it's like if
54:16
Speaker 2: you like shoegazy stuff, if you like quiet instrumental stuff,
54:18
Speaker 2: good background stuff, some of it's louder, some of it's quieter.
54:22
Speaker 2: High Remembrance is a little bit quieter. Little Wars, which
54:24
Speaker 2: I think is a really great album from them, is
54:26
Speaker 2: a little bit louder. Faithful Anchor is another one that's
54:29
Speaker 2: really good, and that one is quieter, more in line
54:32
Speaker 2: with this. But I don't know. Super interesting stuff. I
54:35
Speaker 2: think if you like that type of thing, you'll enjoy it.
54:38
Speaker 2: It's worth a listen.
54:39
Speaker 4: Okay.
54:40
Speaker 3: Unwed Sailor High Remembrance. Very nice.
54:44
Speaker 4: Mm-hmm. Yeah.
54:45
Speaker 3: What's his name again?
54:46
Speaker 2: His name is Jonathan Ford, but he plays most of his, this,
54:49
Speaker 2: this stuff that he plays under Edward Taylor is like,
54:52
Speaker 2: when you look up on what Taylor, it's going to
54:53
Speaker 2: come up.
54:54
Speaker 4: Okay.
54:54
Speaker 3: So don't look for Jonathan Fjord.
54:56
Speaker 4: Yeah.
54:56
Speaker 2: Don't look for Jonathan Fjord.
55:00
Speaker 1: All right, I'm recommending a TV show that just wrapped
55:04
Speaker 1: its ninth season.
55:06
Speaker 3: So Rick and Morty is a fun one. Again, not
55:09
Speaker 3: for everybody.
55:10
Speaker 1: They have gratuitous violence, a lot of existential crises, a
55:14
Speaker 1: lot of disregard for human and animal life.
55:16
Speaker 3: It is a cartoon.
55:18
Speaker 1: And they do not necessarily care about ending episodes in
55:22
Speaker 1: happy ways. They often will have episodes end in kind
55:26
Speaker 1: of dour, sad ways. Leave you feeling like, well, that
55:30
Speaker 1: was a bummer type of stories.
55:32
Speaker 4: Yeah. Yeah.
55:33
Speaker 3: And I think they do it really, really well.
55:37
Speaker 1: So Rick and Morty season nine just wrapped in July
55:40
Speaker 1: of 2026.
55:41
Speaker 3: I really enjoyed it.
55:43
Speaker 1: It really, it continues to stay the Rick and Morty
55:46
Speaker 1: course in a way that's I think very enjoyable. So
55:50
Speaker 1: if you're into that sort of thing, go check out
55:51
Speaker 1: Rick and Morty season nine. if you're already watching, like,
55:54
Speaker 1: I think you're going to like it. If you're not,
55:56
Speaker 1: if you haven't watched it before and this is your
55:57
Speaker 1: first time, you'll be in for a bit of a shock.
56:00
Speaker 3: I think for what.
56:01
Speaker 1: This show is doing, they've set up a lot of
56:03
Speaker 1: things in previous seasons that, um, that like you wouldn't
56:07
Speaker 1: necessarily know going into it.
56:10
Speaker 3: That makes sense.
56:10
Speaker 1: Like for example, Rick has a portal gun that he
56:13
Speaker 1: can create a portal to any place in any dimension
56:16
Speaker 1: and any universe anywhere.
56:18
Speaker 3: And that leads to a lot of hijinks.
56:22
Speaker 1: And, um, there have been many episodes just about the
56:25
Speaker 1: portal gun. So yeah, which is actually, there's another one
56:28
Speaker 1: in this, in this season. So if you don't know
56:30
Speaker 1: that going in, it might be like, what is even
56:32
Speaker 1: happening in this? So they have a lot of like
56:33
Speaker 1: alien species and different dimensions where it's like every possible
56:37
Speaker 1: version that could possibly exist does exist. So in some dimensions,
56:41
Speaker 1: Rick and Morty are actually bees and some of them,
56:43
Speaker 1: they're slugs and some of them, they're cats and some
56:45
Speaker 1: of them, they're clouds, like whatever, like, They exist in
56:49
Speaker 1: every conceivable form. They're out there in one way or another.
56:53
Speaker 1: So there's an infinite number of them. And so that
56:56
Speaker 1: does have them sometimes treat their lives as being quite expendable.
57:00
Speaker 4: Right.
57:00
Speaker 3: So.
57:01
Speaker 1: Warning going into it, this is kind of adult themed
57:03
Speaker 1: language and violent depictions and use of drugs and sex.
57:07
Speaker 3: It's like all there.
57:08
Speaker 4: Yeah.
57:09
Speaker 3: But great show nonetheless. Anyway, that's all. I'll leave it
57:11
Speaker 3: at that. Rick and Morty season nine is really good.
57:14
Speaker 3: So check that out.
57:15
Speaker 1: And then also Unwed Sailor is the artist with High
57:17
Speaker 1: Remembrance being the album.
57:20
Speaker 3: And those are recommendations. Is there a, we get to
57:22
Speaker 3: wrap it up there?
57:23
Speaker 2: Uh, yeah, that feels good.
57:24
Speaker 4: Perfect. All right.
57:25
Speaker 3: So we will come back with a part three.
57:26
Speaker 1: As I said, we're going to jump right in the
57:27
Speaker 1: middle of that conversation because we did not segue in
57:30
Speaker 1: any way to us having a transition. So it'll be
57:32
Speaker 1: a little abrupt. We apologize for that. Um, but I
57:35
Speaker 1: think it was worth it to have these sort of
57:36
Speaker 1: stand on their own in that way. So I'll come
57:39
Speaker 1: back next week for that wrap up.
57:41
Speaker 3: Yes. This is Abraham. This is Shane. We're out.
57:44
Speaker 4: Bye y'all. You've been listening to Why We Do What
57:47
Speaker 4: We Do. You can learn more about this and other
57:49
Speaker 4: episodes by going to www.wwdpodcast.com.
57:54
Speaker 3: Thanks for listening, and we hope you have an awesome day.