Latest / Radically Genuine / 111. The Medicalization of the Human Condition w/ Brett Deacon, PhD

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111. The Medicalization of the Human Condition w/ Brett Deacon, PhD · Radically Genuine

• Sean (00:02.29) Welcome to the Radically Genuine Podcast. I am Dr. Roger McFillin. Folks, we live in dangerous times. Medicalizing the human condition involves affixing diagnostic labels to various unpleasant or undesirable feelings and behaviors, even when these experiences are intrinsic to the human condition and represent normal and anticipated responses to trauma or stress. Many Americans and those under the umbrella of the pharmaceutical empire and Western allopathic medicine unquestionably assume that psychiatric diagnoses represent legitimate and distinct medical illnesses. This belief is deeply ingrained in our culture, reinforced by the widespread acceptance and promotion of diagnostic labels and psychiatric drugs. The entire field has been hijacked by special interest, pushing a biomedical understanding of emotions, thoughts, and behaviors. The results have been nothing less than disastrous. In fact, we've simply lost common sense. Emotions have transitioned from valid messages designed to serve our growth and reflect needed change to disease states outside of one's control. Sadness has been replaced by depression. Millennials and Generation Z proclaim, I have anxiety, I have ADHD. The psychotherapy field has grown exponentially. yet the quality of care has decreased dramatically. Therapists are graduating master's programs, pushing propaganda and being taught DSM diagnosis and sending their clients for psychiatric drugs at any sign of emotional distress. Completely ignorant of the scientific, philosophical, historical and spiritual understandings of the human condition, we are at a point where a revolution must take place to reclaim the next generation. Sean, it was in 2013 when I first read the article, the Biomedical Model of Mental Disorders, a critical analysis of its validity, utility, and effects on psychotherapy research by Dr. Brett Egan. There was actually an entire publication around this subject through, I think it was the behavior therapist around that time. That's so weird, because I just read it in 2023. It's new to you. Sean (02:28.594) But it became mandatory reading at Center for Integrated Behavioral Health. And we used it within our training because it was the first time I was exposed to mainstream academics really kind of stepping out of line, to be honest with you, and kind of speaking out about what everyone just accepted to be some advancement in mental health. And when you look into the research, everything that we're talking about now, you know, go back 10 years ago, it certainly took a lot more courage to put yourself out there. And well, we're 10 years later now, and we have this opportunity to speak with the author of this paper and deep dive into some of the profound shifts that have occurred in Western societies. We want to welcome to the podcast Dr. Brett Deakin, who is an associate professor and of clinical psychology program at the University of Melbourne, Australia. Yes, at the time he was at the University of Wyoming. Now he finds himself in Australia. There's got to be a story there. He received his PhD in clinical psychology at Northern Illinois University and completed a postdoctoral fellowship at the Mayo Clinic. Since then he has worked as an academic for 15 years, a full-time private practitioner for five. He has two primary Sean (03:47.33) Publications, which include, Exposure Therapy for Anxiety Principles and Practice, the second edition, published in 2019 by Guilford Press. The second concerns psychiatry's biomedical model of mental illness. Bread is published on the efficacy of antidepressants, publication bias and antidepressant trials, the effects of perceiving one's depressive experiences from a biomedical lens, and the validity and societal effects of the biomedical model. Brett, welcome to the radically genuine podcast. Brett Deacon (04:22.594) Thank you, it's a pleasure to be here. Sean (04:25.562) It's really great to connect with you, but I first want to learn more about you. First of all, what brought you to Australia? Brett Deacon (04:34.354) Quite simply, quality of life. 10 years in Laramie, Wyoming was wonderful. I loved living in Laramie, but 10 years, I think was sort of enough. And I had a seven and nine year old, and I think we were looking for a change of scenery for a variety of reasons. And I had previously done two speaking tours in Australia the couple of years before I left. And I spent a lot of that time thinking, man, I could live here. this place is really nice. And so when I decided to go on the job market as a kind of mid-career associate professor, first of all, there wasn't much available in the United States for a mid-career person, but there were a number of positions available in Australia. And I recall asking my wife, what do you think about submitting an application? And she said to my surprise, no, go for it. I'd love to live in Australia. So. Next thing you know, I found myself in Wollongong as an associate professor there and I've been in Australia ever since, for about 10 years now. Sean (05:37.85) I'm really jealous of you right now because we're just talking before we came on air, the clocks were turned back and it gets dark around what five o'clock and oh boy, it's like one of those things that's dark in the morning. It's dark when you leave work. It's just depressing. The lack of light just affects me. It affects a lot of people and we're just walking into this period of increased darkness. And I saw it with my clients today. It just affects your mood and so forth. flip side of all this. Just what's the weather like in the winter though? I'm considering a move to Australia. Tell me about the, tell me the winter there. To spring. Brett Deacon (06:16.726) All right, so well, I live in Melbourne, which is sort of renowned for the worst weather of any major city in Australia. That said, you can golf year round. That's the best way for me to summarize it. So the winters here would be, you know, the worst part of the winter, highs would be in the 50s. It never gets to freezing, doesn't ever snow. You know, it might be a little more cloudy and windy and rainy, but it's really not bad. And this winter, we basically didn't have one. So, I mean, by American standards, having lived in the Midwest and Wyoming, the weather here is fantastic. Sean (06:52.826) Great. Well, I'm actually interested in the mental health field, the cultural climate in Australia in comparison to the United States. And just if you can do a compare and contrast a little bit. Brett Deacon (07:06.454) Yeah, well, I could talk all day about that because the contrast is quite striking. So in the US, psychologists are doctorable level only and represent, I don't know what the percentage of mental health practitioners would be, but it would be a fairly small minority, right? Most of your therapists are counselors, social workers, marriage and family therapists. And psychologists are sort of the elite. mental health professionals with the research training that enables them to be scholars and scientists, practitioners. Australia is very, very different. First of all, basically everybody here is a psychologist. So there are very few counselors. In fact, counseling is not even a licensable profession here. So there are traditionally, this blew my mind when I moved to Australia, traditionally, you could get a three year undergraduate degree, Sean (07:52.203) Interesting. Brett Deacon (08:04.571) masters. I don't even think it was called a masters, but you could do four years of university training, two years of supervised practice and become a psychologist. So that was... Sean (08:15.374) Does that affect the quality of care? Brett Deacon (08:18.63) Oh, it would have to. It would have to. And so now in Australia, there are two pathways to becoming a psychologist. One is essentially to get a one-year master's degree. That's called a master's in professional psychology. And clinical psychology is a two-year master's degree. And there's one or two years of supervised practice in the real world after you graduate. But there's not a lot of quality control around that. You can get a PhD. or the equivalent of a PsyD here, relatively few people go down that route. And the important thing to note is if you get a PhD in clinical psychology here, you have the same two years master's coursework as everyone else, and usually no additional coursework for your PhD. You're just sort of in a lab doing research. And so... In my opinion, the most highly trained clinical psychologists in Australia are those who got their degrees in the United States because just the level of rigor and training, it's not really comparable. Sean (09:27.406) So you yourself trained cognitive behaviorally and treat anxiety disorders, your expertise in exposure-based therapies and so forth. Is there a dominant kind of orientation that exists and are the movement of like empirically validated cognitive or dialectical behavior therapies, does that exist in the UK? Brett Deacon (09:31.361) Mm-hmm. Brett Deacon (09:52.362) Um, I would say that CBT is still the dominant approach here, but I think, um, Australian psychology is much more eclectic than what I was used to in the U S where, um, at the level of doctoral psychology, I think CBT is the dominant approach. Um, and if you think about it, um, an American doctoral degree in clinical psychology is what minimum five years. And that gives you a lot of time to learn the background philosophy and theory and to take your time starting off in the clinic, seeing a small number of clients with a high degree of supervision for each case, gradually building your expertise, finishing your internship where you're working full time, and then you graduate with a pretty deep knowledge of the theory and practice of the approach. Now, imagine if you had to crunch all of that into one or two years. And you start seeing clients. in the clinic a few months into the start of your first year. So there's a lot that you have to necessarily skip over, and you have to cut kind of straight to, OK, what do I do? What are some skills and techniques? And for me, the real meat of CBT or any therapy, it's the theory, and it's how you use the theory to do case formulation. And you have to know that before you even start to think about what sorts of techniques might I use. And that's the one thing that we really don't have very much time for. So that affects the therapies that people use. And I think as a result, people are more attracted to borrowing skills from this approach and that approach, and it's very common for therapists, if you look at private practice websites that people have. You know, I do ACT and EMDR and psychodynamic therapy and schema therapy and CBT. I think you'd be way less likely to find that among graduates of an American clinical program. Sean (11:42.55) Yeah, yeah. Sean (11:47.938) I think that's also the challenges that we see with master's students in the United States. CBT can be this water endowed version. I call it CBT for Dummies. Actually, there was a book actually published called CBT for Dummies, where there are techniques and interventions that they learn, but without formulation. So they're a really poor job of conceptualizing the case and understanding the mechanisms of action and for when to, you know, implement them. But rather they just kind of a basic version of like trying to... Brett Deacon (12:03.99) Yeah. Right. Sean (12:17.07) change the way you think about situations, regardless of having any really solid for formulation to be able to, to help somebody which, you know, creates higher dropout rates. Brett Deacon (12:29.482) I've always called that CBT light, but same idea. Yes. Yeah. Oh no, this is an interesting thing to me. The dominant approach taught in all the universities around case formulation is the four Ps. Have you heard of the four Ps? Sean (12:32.48) Yeah. Sean (12:45.97) No. I heard about it in marketing. Brett Deacon (12:48.21) Okay, there's probably a lot more out there. So the idea is you take the information you gather during an assessment and you put it into four piles and there are four P's. So there's protective, perpetuating, and of course I'm gonna forget the P's, protective, perpetuating, oh gosh, now I need to Google the four P's, but there's a reason I don't remember them because I'm not a big fan of the four P's. And you're basically, Taking the information you get, and I really like the analogy of every time you gather a piece of information from a client, you sort of have a brick, and you put the brick in front of you in a pile. And case formulation is the process of putting those bricks together to form a house. And in order to do that, you have to have a theory of how bricks come together in order to form a house. Otherwise you just have a pile of bricks, and you don't understand. what it means. And what you do with the four P's is you take the bricks and you sort them into four piles. And you feel like you've constructed a house, but you haven't. You've just sifted the bricks. And so what you and I, Roger, would have learned around case formulation, the functional analysis and really this would have been in-depth way of understanding the mechanisms of action, perpetuating factors. that is not as much of a consideration in the training and practice of psychologists here. And we do the absolute best we can in our clinical program. I think we probably do better than most in hitting that stuff as much as we can within the time available. Sean (14:28.73) So as you probably know, we've been experiencing what could be best described as a mental health crisis in the United States. We can say that COVID was a factor, but we saw even prior to COVID, these dramatic increases in life-threatening behaviors, self-injury, suicides, psychiatric hospitalizations, drug abuse. Brett Deacon (14:40.174) sure. Sean (14:55.39) And we're at a point in a tipping point, I think, in American culture where we have to take an honest look at what is going on culturally within our society, how we're framing and understanding mental health problems and, you know, how do we effectively and safely intervene? I'm curious to know about the culture of Australia. Did you go through a similar mental health crisis during COVID or post COVID? Because I know Australia is pretty well, it's pretty well documented that the measures implemented during COVID were quite restrictive. Brett Deacon (15:29.206) Yes. Yes, I think the story is much the same here. And Melbourne, I think, has the title of the world's most lockdown city. And the lockdown here was, it felt fairly draconian to me, especially with my American psyche thinking they would never get away with this in America, for better or for worse. Americans don't like being told what to do to the extent that I think Australians are a bit more I think that's fair to say. So yeah, the lockdowns here were pretty rough. And thank goodness that time is over. But the declining mental health outcomes in society from the data I've seen here very much mirror that in the US and the UK and Canada and New Zealand, I think the same thing is sort of happening all over. Sean (16:20.642) So you were kind of ahead of the curve on a lot of this. Uh, I just want to go back to your, your academic career, where you were deciding to publish on the biomedical model. What motivated you at that time to kind of take on that degree of responsibility? Cause I, and I want to know if it did it put you on the firing line at all? Because I know just 10 years later, just on social media, you know, and having this podcast and placed on the firing line. Brett Deacon (16:31.523) Mm-hmm. Sean (16:48.57) Still, people are like hearing a lot of these, like these critical questions being asked and some of my reactions, it's almost as if it's new, as if they never heard it before. But you know, we can go back more than a decade, even further than that. There has always been a critical eye. So just take me back into kind of your mindset and where you were at that time. Brett Deacon (17:07.09) Yeah, thank you. It's fun to take a trip down memory lane. There's a lot that stands out when I think about it. And I have to give a shout out to a psychologist who does not get enough credit for being a real trailblazer on this topic, and that is Stanton Peel. And he works within the addiction field, which is, it's sort of a silo within the mental health field. It almost stands a bit separate from it. But... You could argue that the longest standing version of the biomedical model can be found in the AA 12-step philosophy. Step one is to admit you're powerless. And my very first clinically relevant experience was the summer after my junior year in college. I worked at an addiction treatment center that, like more than 90% of those in the US, was based on the 12-step model. And it's all about acknowledging that you have a disease. And based on that acknowledgement, committing to lifelong abstinence and then following the steps. And that was the model. And that same model was applied to the 16 year old kid who got a DUI and the 70 year old homeless alcoholic who'd had alcohol dependence for decades. And I remember my critical thinking alarm was being triggered at that time. I'm like, what the... What's the evidence for this disease, this biological allergy that they keep talking about? You know, like, where is it? And so I started to investigate the science around that. And then I found a book called The Diseasing of America by Stanton Peale. And it was brilliant. I've just found it such a compelling critical thinking refutation of the disease model of addiction, and I sort of went down the rabbit hole from there with regard to the biomedical model. From there, I went to graduate school at Northern Illinois University, and I had a couple of real-world experiences in psychiatric settings that were impressionable. For example, my third year, I think I did a rotation that involved a couple hours a week in a psychiatric hospital, and I had done four or five weeks in a row of one-on-one therapy with a client there. Following week, she wasn't able to attend because she had an ECT, electroconvulsive therapy session. Brett Deacon (19:30.414) And I saw her the week after and she had no idea who I was. And that was very memorable. And so when I got to my postdoc at the Mayo Clinic, which is a hotbed of biomedical, hardcore biomedical psychiatry, I had the background knowledge and the skepticism to be able to, first of all, clearly recognize problematic biomedical paradigm related practices and then trying to think about how to. Sean (19:33.695) Oh, yeah. Brett Deacon (19:58.85) how to handle it. So I saw client after client who got referred to me, who told me the doctor says I have a chemical imbalance, why would therapy help me? And that ended up turning into a research idea, which ended up turning into a study that I was able to conduct a couple of years later when I got to the University of Wyoming. And so a lot of my interests around the biomedical model were directly born from clinical experiences, wondering, what's the impact? when people are told these sorts of explanations, when people believe them, and what would it look like to study that? How could you do an experiment to study that? And I was fortunate at the University of Wyoming to not really be in the firing line because there was nobody holding a gun at me. I was sort of off in kind of a little protected enclave from the healthcare system or from psychiatric colleagues. And I... I took advantage of that freedom to be able to study this and to speak out about it without really worrying about any sort of repercussion. Sean (21:08.566) In 2008, I was, I guess I was a fourth year PsyD student. There was a paper that came out by Eric Turner. It's in the New England Journal of Medicine. It was on publication bias and antidepressants. And he worked for the FDA and I think he was exposed to how many of the studies, how poor quality the studies were and how they just kind of file drawer the studies that didn't work, right? And so you only need. two publications for FDA approval. I think he was appalled. And I read this paper where it basically stated that antidepressants are placebo side effects for the most part. I thought that was going to be on the nightly news. I thought that would be all over American television. I brought it into my doctoral program. This was in the height of the medication era, like this biomedical understanding antidepressants were just... portrayed as kind of life saving. And it's not anything I ever saw, not in my training, not in my previous experience. In fact, I saw quite the opposite. Most people I saw were either nothing was happening or they're questioning if anything was happening other than staying depressed or they were worsening. And so I could not believe at that time that a paper in such a prominent medical journal wasn't just so widely publicized. And so it gave me a lot of information. I think I... My takeaway at that time was, boy, we're really under the iron curtain here. The pharmaceutical industry has so much power and so much influence over physicians because it really did not make a dent at all. Brett Deacon (22:51.815) Yeah. Yes. There's lots to talk about with that. I remember the 2008 Eric Turner paper well, in part because that study kind of scooped one that I was working on writing with similar data. And I was fortunate to be an author of another big 2008 paper. First author was Irving Kirsch, who's really been the main person studying the placebo effect and antidepressants over time. And he wrote this wonderful book called Antidepressants, The Emperor's New Drugs in which he chronicles his research. And one of my proudest moments as a postdoc at the Mayo Clinic was I found my way on the Grand Rounds committee, and I was able to get Irving Kirsch invited to come out. I think I was the only one who knew what was about to happen when he did come out and talk on. The title of his talk was Anti-Depressants, The Emperor's New Drugs. And in the two years I was there, there were at least twice as many people in the audience for that talk as any other. Doctors came from all over the hospital. There were people sitting in the aisles, standing against the walls. And it was sort of like a bomb exploded in the Department of Psychiatry and Psychology. And at the time, it was very controversial to argue that... there's a very strong placebo effect and that the difference between antidepressant and placebo efficacy is small and clinically insignificant. Now, there's scientific consensus that is the case. And even the proponents of antidepressants are left sort of arguing, well, the difference is very small, but it's still really important. And that's kind of where the argument has shifted to. But in 2008, Irving and I and several co-authors, wrote a paper examining the placebo effect in clinical trials of antidepressants submitted to the FDA and basically found that I think placebo duplicated 82% of the antidepressant response and the difference between the two was small and clinically insignificant. This was not a major news story in the US and I definitely noticed that. There was an NPR story about it but I think it wasn't leading a nightly newscast. Brett Deacon (25:06.75) It was the lead news story in much of Europe, interestingly. And the European Association of Psychiatry had sort of an existential threat to deal with because psychiatry really organized itself around antidepressants and their perception as miracle pills. And so the president of the European Association of Psychiatry, Hans-Jürgen Moller, invited Erwin Kirsch to come to the conference in France and debate him on the efficacy of antidepressants. And Irving had a scheduling conflict and couldn't go. So then they asked me. And I said, sure. So here's me like a third year, you know, new assistant professor at the University of Wyoming, debating this guy with 600 publications, you know, in the lion's den in a room of 400 angry psychiatrists about the efficacy of antidepressants. So. Sean (25:43.67) No way. Sean (26:00.986) Tell us about that. Yeah, how did that go? Brett Deacon (26:03.982) Well, there's actually there was an article in Men's Health published by a journalist Paul Scott who was there and sort of described it but it was um It was I think very telling and you know I probably walked away feeling like I won and I'm sure my opponent probably felt like he won But we were sort of arguing past each other in a way And you know, I was arguing essentially the data are the data, you know the clinical trials show the difference is small and clinically insignificant. And we don't even know if that's a true drug effect or it could be breaking of the blind due to side effects that are being perceived. And his argument was essentially, we know from clinical experience that antidepressants are effective. And yeah, no, I mean, that's sort of all you need to know to understand why we're talking past each other. Sean (26:48.514) Yeah, I mean that. I'm sorry. Go ahead. Sean (26:56.99) Yeah, which is so problematic to me. And this is what I've seen. So, Brett, I know you're a scientist, right? And you believe in science. And science is something that we really attest to being like an objective process that plays itself out over time. And you almost have to take a neutral stance on it, right? Like you have to have a devotion to the data because of our inherent biases and the flaws that exist in us and human beings. And you wanna validate your work It's a quest for truth, honestly. Like we're trying to seek out truth. And that's been my problem with the medical field psychiatry in general, is they're always trying to find a way to justify their use of these drugs when the data doesn't fit it. And then it comes back to clinical experience and some of the statements are quite hyperbolic. Like I see it save lives and so forth. And so the question is, how can I not see it save lives? And how do you see it save lives? And so we have to answer the question when it comes to the placebo effect. It's powerful. I mean, I don't think we do a good enough job of really understanding it and communicating it to the general public. But in these trials, and we're only talking about the published data for the most part, right, you're talking about an enhanced placebo effect. Like when someone takes that drug, they know they took the drug and the researchers or the doctors, they know that the drug was taken because it's a psychoactive substance that they feel. And even with that, we're talking about a negligible difference between placebo and an SSRI, one that really given the risks, the suicide risk, self-injury, akathisia, dependency, so if no logical or reasonable person can argue that drug as something that should be widely provided to the American public, there's way, but yet here we are, 2023, and we're just seeing an increased number of people taking this drug. Brett Deacon (29:03.694) Right. You made some really good points there. I want to go back to what I think is a very fundamental issue, which is understanding the inevitable non-preventable cognitive biases that we all have. And, you know, this is one of the things that I'm most thankful for about my education as a clinical psychologist, because, you know, we got beat over the head with the idea of that you are susceptible to all sorts of judgmental biases and this is why we need science because it, you know, when done well, it neutralizes those biases and allows you to actually come closer to understanding the real truth. And so to me, the essence of somebody who thinks like a scientist is humility in the face of these judgmental biases that we all have. And the opposite of that is arrogance and saying, well, I know it's true because, you know, according to my expert judgment, it is. And when I hear somebody make that argument, and the president of the European Association of Psychiatry made that argument very clearly. Like he showed a photo of all of his doctors standing outside the hospital. And the title was, My Doctors Believe in the Efficacy of Anti-Depressants. And I don't think he liked it when I said, that photo could have been taken 70 years ago with the title, My Doctors Believe in the Efficacy of Insulin Coma Therapy. Sean (30:26.507) Nice one. Brett Deacon (30:27.306) because it could have, right? And that's what happens when we set aside science and go with our clinical judgment. And the history of medicine is really the history of treatments that we now recognize to be unsafe, ineffective, or even barbaric that doctors thought were really great back when they were popular. And psychiatry's, it's a standout in that, right? I mean, you don't have to go back that far to when we were doing lobotomies and insulin coma therapies. all sorts of barbaric things. Electroconvulsive therapy is still used. And I was surprised to learn recently that the randomized controlled trial literature around ECT is so small and pathetic and old that it's essentially no scientific value. So I think the fundamental, part of the fundamental issue that we're running into here is the enthusiasm for psychiatric medications like antidepressants, it's not based on a rigorous appraisal of the science, but rather the sort of faith in the greatness of a treatment that you would have seen in the past with lobotomy and things like that. And there's a clear ulterior motive for people to have faith in antidepressants, for example. It makes psychiatrists look like real doctors with real treatments for a real illness. It makes zillions of dollars for the pharmaceutical industry. It puts doctors front and center in the sort of healthcare system of where people go when they feel bad. This is the sort of the near miracle that Prozac ushered in for psychiatry. It finally gave the profession what it was looking for a long time after being criticized in the sort of 60s and 70s for not having real treatments and not having real diagnoses. And as you probably know from Anatomy of an Epidemic by Robert Whitaker, lots of factors came together starting in the 1980s that led the profession of psychiatry to put on the white coat, drape the stethoscope around the neck. Brett Deacon (32:54.706) and really double down on their identity as medical doctors. And the new crop of antidepressants, starting with Prozac and their marketing in the media as miracle drugs and wonder drugs enabled that to happen. And the disturbing thing about the Turner study is that there never was any good science to support them. And so this whole thing and the societal outcomes that have come from it have never been about the science, they're about other factors. Sean (33:24.194) That's been one of the most shocking things for me over the last two years is the exposure to the science part of it and reading some of these numbers and seeing things and how obvious it is to me to realize that the risks outweigh any potential benefit if there is anything whatsoever, but why are we so completely brainwashed? I mean, you're talking about a conversation you had with somebody over in, in Europe in, in a debate forum. Brett Deacon (33:43.778) Mm-hmm. Sean (33:53.486) 15 years ago, but has anything changed? And why hasn't anything changed? Is it just the power of, of the, of the amount of, of money and influence pushing it out? I mean, you're in Australia now. So without any direct to consumer advertising, what are you noticing in terms of differences? I'm curious. Brett Deacon (34:17.938) I, you definitely get saturated with the direct to consumer advertising in the US. We don't have that in Australia. But I don't think it makes any difference, ultimately. Australia is one of the world's most medicated countries, I think even a little bit more so than the US. This is a hot off the presses result from a survey study that a student and I did last year that I want to share with you. So we surveyed about 300 people. who were members of this kind of online survey taking platform in Australia. And we asked them about their beliefs about antidepressants in sort of quiz form. And the percentage of Australians who believe that antidepressants work by correcting the chemical imbalance that causes depression was 89.5. And I just want to linger on that. So we know that's not true. There was a big meta-analysis published last year that put the final nail in the coffin of the sort of low serotonin story of depression. It was always a story. It was never evidence-based. So how did we get to the point in a society with no direct-to-consumer advertising where 90% of people, 9 out of 10 people believe in a false story of depression and antidepressants? That is a lie. Sean (35:37.386) has to be like films and movie, like just the culture of the United States being pushed out globally in the form of like movies and film and, and the power of the medical authority. And that's what exists is that authority bias that we have to trust our doctors no more than us. And so when they start promoting it in the manner it's been promoted in the last 30 to 40 years, you know, obviously, that's something that becomes the into the zeitgeist of the entire culture. Western culture, Western societies. But if 90% of the people believe it, I mean, they're not all going to their doctor to talk about depression. I mean, what's the percentage of people on antidepressants in Australia? It's, it's got to be less than the United States or actually I shouldn't say that. Maybe, you know, Brett Deacon (36:24.782) I think it's slightly higher, actually. It's like one in seven, something like that. But here's the thing, a couple of thoughts. Number one, if you look at sources of information about mental health, popular, mayoclinic.com and sort of WebMD, and there are Australian equivalents, you're gonna go on there, you're gonna read about the chemical imbalance theory. And... Sean (36:26.695) Oh, okay. Brett Deacon (36:52.374) And so it's being promoted in all sorts of ways. You know, these patient advocacy groups that are sort of astroturf groups for pharmaceutical companies. They're promoting it. And so the fact that we don't have direct to consumer advertising doesn't mean that people aren't being inundated with it. And when they go to their doctor, can't tell you the number of clients who have seen their family doctor and then come to me. And you know told me the doctor says I have a chemical imbalance and so, you know, I'm taking this medication now But I really wanted to just see you and do psychotherapy and now I'm in this interesting position of you know what do I say to the client about the fact that their doctor was just You know had given them a false story and deceive them into taking a medication that the research shows They probably won't benefit from But you know Roger coming back to what you were saying. I think the medical profession is a huge part of why this has happened. In Australia, the way the health care system is organized, you can access a Medicare rebate, a government rebate, to see a psychologist. Somebody wants to see me, they can get a rebate for $135 per session. Otherwise, they might be paying $200 out of pocket or something. So people are very motivated to get the rebate. And in order to get it, you have to first see a general practitioner who is a psychologist. Assesses you, diagnoses you, and then writes a referral for you to come and see me. And they have lobbied, the profession of medicine has lobbied very hard to be in that role, the central role of managing mental health. And of course, when many people see their GP, they're offered a prescription, you know, whether or not they went there for that. And one thing that I've come to believe is doctors in general are Sean (38:23.235) Mm. Brett Deacon (38:44.326) incapable of prescribing psychiatric drugs responsibly. You just can't do it. And right here in Australia, we have a clinical practice guideline for depression that says antidepressants are not the recommended first line treatment unless the person has severe depression. In reality, clients with mild distress are given antidepressants constantly. So, Roger. Sean (39:06.038) Yeah, in the United States, over 80% of the drugs are prescribed in primary care. And primary care doctors do not have the expertise to assess and adequately treat mental health related problems. I don't know in the context of the appointment in Australia, but the average appointment time in the United States is like eight minutes. So obviously it's void of any context and even trying to put a designation onto depression, tell me what's severe. You know, that is completely arbitrary. I mean, you can use something like a Beck depression inventory and get an idea, but I can have somebody my idea of severe depression is different than I think a lot of people's idea of severe depression. And so now some people just label it as intensity of distress, not necessarily impairment of functioning and the degree in which, you know, somebody might take their own life or the prolonged nature of the condition, the chronicity of the condition. So You know, the challenges here that exist is that the conflict is undeniable. You know, at this point that an entire profession of mental health professionals, psychiatrists, psychiatric nurse practitioners, they, their, their entire role in the healthcare system is now only to prescribe drugs. So you, in any way you begin to promote the science around that and start talking about the dangers, that's a lot of people losing their jobs. because they do not have any other adequate skill set to be able to manage these conditions. They just have now assumed a position in Western medicine that is one that should have never occurred. We've way too many psychiatrists. It was one of our podcasts with a psychiatrist recently. Really, their niche was a small subset of the chronic mentally ill, one that we didn't have good treatments for, but there was management of them. Now they're part of the American culture. Now they are identifying distress. Mental health is no longer stigmatized. In fact, everybody's seeking out help, at least in the United States. And it's a fear-based culture too, Brett. So for example, taking the EPPP, you'll have a question on there that says, if someone's experiencing moderate to severe depression, you know, what's your next steps? And I mean, you're supposed to refer to a physician. If anyone's having moderate to severe depression, moderate severe depression, I mean, we're talking about DSM. Sean (41:29.782) categorical diagnoses, you know, more than two weeks, struggling with something in a moderate way is enough to be able to send somebody to a doctor. Some people are fearful they'd lose their license. So as a psychologist, you're supposed to refer somebody to a physician if they are experiencing depression. Aren't they there for you to for you to work together on overcoming it? Well, you know, there's ethics in our profession. And so someone like me who's well versed in this, then, you know, obviously I'm making clinical decisions that I think are best aligned with the patient, their goals, and as well as the scientific literature. But generally speaking, most people who are providing care in the United States are master's level professionals who don't have that science-based education. And they work in clinics and hospital-based systems where that is just what mental health treatment is. Brett Deacon (42:21.246) Right. I think the vast majority of people working in the healthcare system have no idea what the science actually shows about psychiatric medications. In particular, the doctors. You know, like all of these clinical trials, you know, demonstrating lack of efficacy and adverse effects and we haven't even gotten to the publication bias and the ways in which clinical trials are designed. at every turn in order to show an advantage of the drug as opposed to being a kind of more true scientific test. I think in my experience, the psychiatrist I've worked with would be the most defensive around acknowledging the possibility that there are some issues in the relevant science. And great example off the top of my head. The STAR-D study. The largest. most expensive federally funded clinical trial of depression treatment ever was touted. You probably are aware of this. This has been a really well chronicled on the Madden America website, was touted as showing that when given multiple opportunities to have a go at evidence-based treatment, 67% of people eventually respond to depression treatment, mainly with antidepressants. And look, look how effective treatment is. That's how the study was marketed. And when you look at the actual data from the study that hasn't been fraudulently presented, the actual number is 3%. And so what we have here is scientific fraud, and these papers should be retracted. And Robert Whitaker has led the charge to get the main Stardee publications retracted from the scientific journal in which they were published, and the journal has ignored this. And I think that says a lot about the state of openness to the science. And, sorry, go ahead. Sean (44:25.05) That's the thing with science is like science is always supposed to be trying to when you have like a theory or like a hypothesis like you're trying to prove yourself wrong. But I feel like everything now is like trying to prove yourself right. Brett Deacon (44:36.65) Right, and Roger, I want to go back to what you said. If you put all of your eggs, all of your eggs in the medication basket, what are you left with if that turns out not to be evidence-based? It can't not be safe and effective. Otherwise, you're out of a job. Sean (44:59.746) Yeah, I opened this up by saying we live in dangerous times. I mean, just looking at the COVID era right now, there were, there was certain medical authorities who took ownership of the science. If they stated it, it is science, right? And, you know, we see this in the field of medicine is they, they believe that they know the science, they really don't. Most practitioners don't even understand the research design or don't even read the paper. They rely just on. the authors conclusions. And a great example of this is recently, I don't know if you're aware of this, Brett, is that Lexapro, E. sitalapram was just recently approved for children as young as seven for anxiety. And in the paper, there was a sixfold increase in kids becoming suicidal after taking the drug in comparison to the placebo group. What are the authors conclusions? That Lexapro is safe. and tolerable and that's scientific misconduct. And from a moral perspective, an ethical perspective, I don't know how somebody can author that type of study. We're talking about children here and come to that conclusion. John Aynitis is another gentleman out of Stanford University has done a lot of this kind of research about how much poor quality the research is and how the conclusions don't fit the data. So we're in a broken system. where we're saying we're evidence-based and we're relying upon the literature. And a doctor will do a Google search really quick to try to prove your point wrong, but know nothing about what's actually within the paper. See, this is a prestigious academic. This was in this journal. Here is the conclusions. You're wrong, I own the science. And somehow we've given the physicians that authority in our society. So unless there's a reclamation of all this, unless we become more educated and stand up against this machine, then we're going to continue down this path. Brett Deacon (47:00.654) Yeah, great points all. I'm familiar with that Lexapro paper. And it sounds like exactly the sort of paper that would be written by a ghostwriter hired by the company and with some key opinion leaders having their name slapped on the publication to lend the appearance of credibility. The ease with which drugs get approved by the FDA when any reasonable analyst looking at the data would say this drug is not suitable for approval, that's another issue. Sean (47:09.956) It was. Brett Deacon (47:30.926) You know, I'm thinking back to our training as clinical psychologists and what I remember was early on you learn about your judgmental biases and How to recognize them take ownership of them which lends a sense of humility and then you learn why science is important But you also learn Over a period of time how to Deconstruct a research paper how to vigorously critique it how to do your own research. And so the nice thing about that training is we're not reliant on somebody writing a blog summary of a research paper to tell us what it actually shows. We can read it ourselves and say, wait a minute, as you've done, this design is problematic or the interpretation's problematic. And I think that level of knowledge allows us to have a sense of healthy skepticism around research. And I think part of the problem in medicine is that training is not part of the standard training of medical doctors. Now, they might know how to do a study. I remember when I was at the Mayo Clinic, there were many psychiatrists who also had a PhD. And the way they got their PhD was to take six months and do a study. And that would allow them to get a PhD tacked on to their MD. But it's a completely different level of training where I think you sort of get the veneer of of scientific knowledge without the underlying most important fundamentals in knowing how to think like a scientist. And you know, add a dose of arrogance in there and you sort of get the kind of dialogue we have around this. Sean (49:12.794) Brett, how old are you? Brett Deacon (49:14.53) 49. Sean (49:15.97) We're similar ages. I'm 47 years old. So you have actually seen the transition that has taken place in American culture, Western cultures, right? You've seen it where psychiatric drugs were not really a part of our medical system at all to where we are right now. I'm interested in kind of opening the discussion to learning more about what you believe to be the impact now on generations who've been exposed to this and its influence on the rising rates of mental illness. Brett Deacon (49:53.334) question. I think what's changed, lots of things have changed over time, but now I think the mindset is, are you feeling a bit anxious or depressed or stressed? You should go talk to your doctor and go on some medication. And if we rewind 30 years ago, I don't think people thought that way. Sean (50:16.802) They didn't. Brett Deacon (50:18.33) And so something has fundamentally changed in our psyches. And I happen to believe that the pharmaceutical industry psychiatry partnership has resulted in one of the most successful marketing strategies in this history of civilization. And it's literally changed the hearts and minds of society. And it's shifted us from, first of all. construing our own experience as just part of life and not necessarily indicative of anything wrong with you let alone a chemical imbalance or You know your brain not working properly and You know if you were going to do something about it 30 years ago going to a doctor and getting a prescription Wouldn't have been on your short list and so lots of things there have changed and I mean I'm Persuaded by the evidence laid out in the book anatomy of an epidemic that psychiatric drugs actually cause, at the societal level, longer-term harm and directly worsen outcomes. Sean (51:24.962) Yeah, I don't think we talk enough about its impact on coping. I remember in my doctoral program at a professor said, you know how I, I self identify, I identify as an expert in coping. And so previously we would understand maybe our emotions as pretty strong indicators that something was wrong in our life, right? And many people would use that to their advantage either maybe have to face something that you're afraid to face, maybe transition in life or listen, you just feel down and depressed and there's reasons that you're feeling down and depressed. What shifted through this chemical imbalance marketing lie is people would just assume that they feel things without any source. I can't even tell you how often people come into my office and say I feel anxious for no reason or I feel depressed for no reason. And it doesn't, it takes, you know, less than a session to be able to just walk them through all the valid reasons why they're feeling sad or, or. Brett Deacon (52:12.342) Yes. Sean (52:21.51) anxious, right? And so, but that's been like a conditioning, a cultural conditioning to believe that what I'm experiencing is outside of my control. It's like somehow genetic or I'm broken. And that has just had such a negative impact on how generations view the human experience. Brett Deacon (52:38.542) I could not agree more. I think that's so absolutely essential to all of this. Basically what we're talking about is context has been eliminated from consideration, which is ridiculous because I think everybody knows that context is really important. Even people who believe the chemical imbalance theory, if you were to ask them, does depression just fall out of the sky or is it related to stuff that's happening in your life? I think people would say that it is related. But somehow we've been convinced to ignore the context. I'm feeling bad, must be something wrong with me. I'm gonna go to my doctor and get a medication. I mean, I think of, gosh, the years that I was in full-time practice were so eye-opening. I had a young man who was, in his teenage years, starting to acknowledge that he was gay. And he lived in a fundamentalist religious family which is relatively unusual in Australia compared to the US. His parents had three... exorcisms performed on him when he was a teenager to cure him of his gayness. And it didn't work. And they sent him to the doctor and the doctor told him that his depression was caused by chemical imbalance in his brain and had him take a medicare. I'm like, if that context is, that unbelievable context is considered irrelevant to the experience of depression, you know, society has just gone off the deep end. Sean (54:07.562) It's such an insanity. I don't understand how anyone can believe it. Sometimes I can imagine what if like some alien advanced life form came down and listened to how we talked about these things. They'd think we're all nuts. I don't understand how a doctor can convince themselves of such nonsense that you could just state the manner in which you feel is nothing at all related to the context of your life or the situations that exist. I mean, don't they have some background in biology? and evolutionary biology, you know, that there's a function to these emotions we've adapted for a reason. It's like they've, we've lost common sense and it's such a dumbed down way of thinking. It's so reductionist, so rudimentary. I don't know how so many people bought into Brett Deacon (54:51.822) Well, let's put the blame squarely where it lies. Psychiatry's DSM. Psychiatry's Diagnostic Manual. To me, this is gonna sound like a provocative claim. I actually think the DSM-III might be the most influential book of the 20th century in terms of the impact on society. So prior to the DSM-III, we had the DSM-II, which... wasn't taken very seriously, that was sort of written when psychiatry is more psychoanalytically dominated, but if you look up depression in DSM-II, you'll find depressive neurosis. And what do they mean by neurosis? They mean reaction. And depression was considered to be a reaction to things that were happening in your life and things that were happening in your mind. And the great leap forward for psychiatry in DSM-III was a theoretical diagnosis, which is touted as good because it's not, you know, we don't have to say depression is due to things that psychoanalysts say or behaviorists say, we just describe the symptoms. But they're all devoid of context, entirely devoid of context, intentionally devoid of context. And so what we now have in the DSM, with the exception of PTSD, are descriptions of psychological problems without any consideration of their context. I would guess that when they go to their doctor to get help with depression, their doctor considers the context of their life to be completely irrelevant. I don't think a lot of people would suspect that. I think common sense tells us that context is actually really important, but what the DSM says is context is irrelevant, and that frees up doctors and psychologists to make diagnoses if a person ticks DSM boxes. what they're experiencing makes complete sense given what's happening in their life. And, you know, wouldn't reasonably indicate anything wrong with them, but rather an understandable reaction to bad things happening. That's just not what the DSM says. Sean (57:00.75) So have they taken it one step further now? Meaning like prolonged grief disorder. You have the name of the context is in there. Now it's saying the suffering that you're going through right now, you don't need to do that, it's unnecessary. So now any type of feeling, even if there is context to it, they're just saying like, you don't have to feel that way. Here, you can just take this and your feelings will go away. Brett Deacon (57:28.966) Right, well that is an example of one of the few diagnoses that does have context built in along with PTSD acute stress disorder But even there you're only allowed to have an understandable reaction within certain parameters. It can only last for so long You know, like I wouldn't presume to be arrogant enough to tell someone. All right, you've been grieving enough at this point It's now mental illness Sean (57:52.878) I think it's six months here. Is it six months? Well, let's face it, right? It's ridiculous. The pharmaceutical industry is beholden to their shareholders. And they do a lot better when you can increase your customer base. And they realize that. They're smart enough to know that. If more people are assigned depression, if more people are assigned with an anxiety disorder, if we can identify more people with ADHD, more with bipolar, we sell more drugs. So one thing that all human beings and all likelihood are gonna experience at some time that it's collectively normal is the experience of grief and loss. We are social beings, we attach to each other, the loss of somebody has a profound impact on us. So now you are really increasing your customer base if you can now disorder grief. If you can create a medical condition that says the way you're grieving, it's too long and it's too intense and it's atypical to what is normal for other human beings. This is now a medical condition. Brett Deacon (58:55.106) Let me add one layer on that. I agree with everything you said. I don't think people often appreciate how valuable iterations of the DSM are to the pharmaceutical industry because what happens over time, thresholds for diagnoses get lowered, which increases the number of people. Bipolar is one of the best examples that comes to mind. So you wanna sell more mood stabilizers. Let's invent hypomania. which only lasts for three days. The DSM-5 Mood Disorders Task Force consisted of nine experts, all of whom were psychiatrists, six of whom had active financial conflicts of interest with pharmaceutical companies at the time they were deliberating the DSM-5, three of whom had been paid to conduct clinical trials of antidepressants for grief. And guess what diagnosis they invented for the DSM-5? Sean (59:55.182) Yep, that's it. Right there, that's it. Brett Deacon (59:57.43) Yeah, so they're a bit of a Trojan horse, you might say. Sean (01:00:01.754) I had this as a kind of list of questions for you because I wanted to take a step further. If we know these categorical lists of symptoms are really problematic, they're pseudoscientific, they're not valid, and they've created pathologizing normal and medicating normal, where do we go as far as a categorization of mental health problems? some way to communicate with each other diagnostically. So just carry us your thoughts on what would be a better system. Brett Deacon (01:00:39.062) Ha. That's always where we get stuck. Because that's a really difficult question to answer. What would it look like for us to have a diagnostic system that is free from the fundamental problems associated with diagnosis? I have trouble wrapping my head around that. Because you can't really have a diagnostic system without, first of all, invoking this notion of normal. and then having diagnoses that catalog ways in which people deviate from that. But what if the concept of normal is inherently BS, right? And that's one thing that I really appreciate about acceptance and commitment therapy, for example. There are other approaches that are like it, that are based on the premise that, you know, we all have weird stuff going through our minds all the time. You know, this notion, there's this construct called healthy normality, which basically says that the natural state of a human being is to be happy and content at all times, regardless of what's happening in your life. And if you're not, there's something wrong with you. And then the question is, well, which is it? Is it generalized anxiety disorder? Is it major depressive disorder? And that's the role of the DSM. But what if happy normality is a myth? What if life involves... ups and downs that we all experience, which are very much tied to what's happening in your life. You know, what if suffering through a day at school, having to sit at your desk and listen, you know, to boring lectures is just inherently boring and leads your attention to wonder and makes you fidget? Like what if what if that doesn't mean there's anything wrong with you? What if that's just the nature of life? This is one of these fundamental things that I think has changed over, you know, from 30 years ago prior. Back then, I think people didn't endorse healthy normality as much, and they understood that life is hard and suffering within sort of a normal amount is just part of life for all of us. And that doesn't mean there's anything wrong with you. You need to go to your doctor or get diagnosed. That's more for more kind of serious, perhaps unusual types of issues. And I think that's changed. So what would a diagnostic system look like? Brett Deacon (01:03:04.554) My best answer, and I'm evading a direct answer to your question, I don't have an alternative diagnostic system. My alternative is not diagnosing, and rather understanding each of us individually in the context of our lives and our history and the meaning that we make of it. And what we're talking about is formulation. And this is what I would argue is best practice with any client. And we try to see them as an individual. And we look at a formulation by considering all of these factors. And an interesting thing happened when I stopped thinking in biomedical terms, when I stopped using diagnostic language, when I stopped using words like symptom, is that people with major depressive disorder disappeared from my office. I just didn't see them anymore. They stopped coming. Now, I saw people who felt depressed, but what I saw walking through the door was a case formulation, not the diagnosis. It fundamentally changed the way I thought about things, and I think I helped a lot of clients fundamentally change the way that they thought about things. And to me, that's the preferred alternative to diagnosis, but it doesn't serve some of the purposes that diagnoses serve. in society. Sean (01:04:27.182) So we had Dr. Jessica Taylor in here talking about the trauma informed approach. So it was kind of her first attempt at replacing the diagnostic statistical manual. Yeah, I mean, it's, I think it's the attempts to depathologize. Like to his point, I just put out a tweet, which he reminded me, I said, on this tweet, I said, what's the difference between someone with major depressive disorder requiring drugs, and someone struggling to cope with an event in which they need time to reflect process and consider new ways of coping? And then I said, nothing. It completely depends on who's listening and framing the struggle. Yeah. Right. And so I've spent a lot of time thinking about this because obviously we know there's something called obsessive compulsive disorder that can be very impairing, right? There's something called bulimia. That's very impairing. And we sit with people get so depressed that they want to kill themselves or they're so anxious, they don't want to leave their home and we want to be able to communicate that is impairing. Brett Deacon (01:05:01.602) Right. Sean (01:05:26.722) that there's help, there's therapies that can assist them, and we have to communicate it in a way that gives them some semblance of understanding about why things happen the way they are. So that's like, I think something on a dimensional approach is important. And when we can think about something through adaptation, that along the way, that there's something that can be normal and adaptive based on certain conditions, and then it can become somewhat impairing or pathological. So a great example of this is, let's say somebody was broken into and assaulted in their home, okay? And for a while, they're not sleeping at night, and maybe they have a knife that they keep under their pillow or they don't even sleep in their bed, they sleep in their corner or something like that, right? Where there's such an intense fear reaction that they are now trying to just protect themselves. They're in survival mode, right? So in the short term, we would say, well, yeah, that would make sense, you were just in danger. But in time, when that event has passed, they're in relatively safe conditions and they continue to act as if they're under imminent danger or risk, well, then that creates real impairment in one's life. It's difficult to function that way, to work, to love, all the things that make life worth living. So if we can communicate to people that some things have a function initially and they can make sense, and then it becomes a problematic way of coping, then we can intervene. Same thing with obsessive-compulsive disorder, right? Having fear and entering into certain behaviors to try to protect yourself or minimize anxiety as a way of functioning, to feel in control, and to do certain things, in some contexts really work. And then it can become something that really impairs your ability to live freely. And now it's problematic. Instead of medicalizing it and making up something that says it's something biological we can't test for, we don't understand, and we don't have any science around it, why don't we just communicate something that can really help somebody? And that's the building and the skills. Brett Deacon (01:07:30.986) Yeah, very, very well said. I agree. And this gives me a chance to make what I think is an important point. And I try to keep this in mind in my role here as an educator for clinical psychology students who have to learn about diagnosis. And a really important point is to know what a diagnosis, a DSM diagnosis is and is not. Most importantly, they are descriptive only, not explanatory. and 90% of people in society, I think, don't think of them that way. So, major depressive disorder simply says that a person is feeling depressed and has, you know, five out of nine symptoms. It doesn't say why. Most medical diagnoses, the diagnosis is a diagnosis of the cause of the symptoms. And... There's this sleight of hand that's happened where mental disorder diagnoses have been marketed to the public as explanatory. You're feeling depressed? Well, the cause could be that you have major depressive disorder, you know, which is a real illness caused by chemical imbalance. And so, you know, people want to know, is my kid acting this way because he has ADHD? If someone asks that question, they misunderstand the fact that the ADHD diagnosis says nothing whatsoever about why a person has those symptoms. And so you can use obsessive compulsive disorder. I use that frequently as just sort of a linguistic shorthand, like a nice, quick and easy and well-understood way of describing a type of problem. And it's a descriptive label for a type of problem. And it's arguably useful because we can find people who have that type of problem and then study the effectiveness of different therapies and find evidence-based interventions, which is all good. And we can stay out of trouble relatively speaking. If we make clear that this diagnostic label is just a descriptor, it's not a thing. This is the important point. It's not a thing that you have like a tumor. A tumor is an actual thing you have. ADHD is not. It's a metaphor. It's a metaphorical thing. But, but people, you know, people take the metaphor literally. And of course they would because it's been marketed as a literal thing. Sean (01:09:36.732) Yeah. Brett Deacon (01:09:55.01) very, very vigorously, and that's what the biomedical model is. It's essentially taking metaphorical illnesses and pretending that they're real illnesses. Sean (01:10:04.194) So people aren't catching ADHD at the daycare centers? Because I heard there was a spread and epidemic out there. So many younger people are now, you know, acting like they're three and four year olds. My three year old, as soon as he started going to school, his hyperactivity just skyrocketed. Yeah, I've noticed that. Yeah. Brett Deacon (01:10:25.232) Yeah. All right. Go ahead. Sean (01:10:27.995) I think that's I think it's brilliant and I'm always looking for content for my social media post. ADHD is not something you have. I mean and that's how everybody kind of describes it now. Brett Deacon (01:10:38.218) Yeah. Well, you said you actually used the phrase earlier, Roger, and I caught it because I've tried so hard to police my vocabulary around this. And I catch on things that I used to say and that other people say, I catch it really quickly, whereas before it would have just gone by me. So like, I have anxiety. People, you know, would you say that without thinking? But what does that mean? What's the difference between I'm feeling anxious? and I have anxiety. It's descriptive versus explanatory. I have anxiety means it's like saying I have a tumor. There's this thing, this real thing that I have. And people are encouraged to think that way. And I mean, heck, like there are, in the public schools, kids are now getting mental health specific education that encourages them to think that way. Like my daughter, when she was in high school, there was a special four session mental health awareness campaign that people came in. and deliver where she learned that depression is a real illness just like diabetes. And the thing is no one can tell you what the illness is. No one. Because there's no scientific evidence for it. So this is all assumptions. And that's one of the really pernicious things here. Psychiatry doesn't actually have to prove the biological illness because they can just assume it philosophically. Sean (01:12:02.39) Yeah, Brett, to be honest with you, I'm kind of down on humanity because you just realize how many people say things without thinking, without knowing, and almost like we are like trained like parrots. I mean, so many things are just communicated as truth and they just assume it's truth. They act it as truth. They claim it as truth. They live it as truth and it becomes everyone's truth. And we're supposed to follow these rules. So you know, I... say things on podcasts and certain media say things there's no such thing as ADHD, you know, because it's not, it's a social construction. You know, there's no disease, ADHD, although doctors will try to identify some biological cause. They'll try to use junk science to state some brain related condition that influences it, but people don't understand they're being victimized. They are... That ADHD epidemic that exists right now is a bunch of people who are being victimized. We have phone dependence, video game dependence, we have metabolic illness, we have just normal diversity of human beings and they're trying to capture a large group of that for their own financial purposes and they don't understand they're a victim. Brett Deacon (01:13:23.034) Right. I think of I had a former colleague who had a sign on her door that said ADHD is real. And this is one of these areas in mental health where there's some controversy around the validity of the diagnosis. And the people who work in that area and are proponents of the diagnosis have sort of adopted the posture, this is a real thing. And if you. don't acknowledge that, then you're basically a flat earther. And it's interesting. On my bookshelf over here, I have evidence-based treatment manuals for lots of diagnoses, including ADHD. And if you flip it open, the very first section of the manual is on how ADHD is valid. And you have to agree with that before proceeding to the treatment. You have to accept that you have this thing that's real, and then the treatment is about. treating that thing. And to me, part of the disagreement or confusion comes around this central topic, which is psychological problems are real, but mental illness does not exist. And like that's in a nutshell, that's my take on it. Obviously, all the experiences that are chronicled in the list of symptoms in the DSM-5 are real experiences that people have. And so, Roger, when you said ADHD is not real, that doesn't mean that you're arguing that some people don't act in a hyperactive manner or don't experience an attention. And the problem is if you say ADHD is real, people might look at you like you're a flat earther, like, oh, really? Are you trying to say that kids don't fidget in class? Like what's wrong with you? But that's not what you're saying. Sean (01:15:10.082) Yeah. No, it goes back to explanatory value. So attention to problems are real. Hyperactivity that could create problems in a classroom or on a sports field or even in behavioral problems at home are real. It just provides us no explanatory value. Is it nutrient deficiencies? Is it, are your concentration problems due to being a worrier? And there's a lot of cognitive interference? Are you just simply need to be outside more? It doesn't tell us anything. Is there another medical illness? So like using it's a lazy diagnosis, right? And it stops further investigation. It's problematic. Brett Deacon (01:15:50.41) Right, if you think of it in explanatory terms, it shuts down the conversation about what the context is. And that, in fact, though, is extremely convenient for the profession of medicine in the pharmaceutical industry because it just slots you right into your doctor and your prescription. And so it's not an accident that there's this conceptual confusion around descriptive diagnoses being understood by the public as explanatory. That's not an accident. Sean (01:16:15.222) Absolutely not. I mean, it's part of the sick care model. You know, we're not really restoring health or well being what we're doing is we're just treating sickness or creating diseases. It's a multi trillion dollar industry at this point. And so you know, I was, was it was listening to a podcast, his name will come to me. But he basically said that if a percentage of the American public actually started making real changes and improve their health, that our economy would fall. That's how much the US healthcare, our economy is held up by the sick care system. Yeah, our healthcare system is the number one GDP. Is it GDP? I guess you would put it there. The number one, the largest right now in the United States, which is scary to think about. Yeah. I mean, in the area that we live in, you drive down the major highway. And their physicians are on billboards. So like they're, it's very strange. Yeah. They're, they're promoted as like their superheroes or their professional athletes. And, but I pointed out to you, that's a retention strategy. They want to keep those doctors instead of having them go elsewhere. It's also part of that medical authority we were talking about earlier. I mean, I'm, I'm always surprised. about how in the allopathic medicine world, how limited they are in their scope and being able to treat a lot of the conditions that are affecting the American public. Diabetes, obesity, metabolic illness, gastrointestinal problems, emotional behavior problems, so forth. Yeah, if we have to restructure a knee because of a torn ACL, you know, pretty darn good at that kind of stuff. Brett Deacon (01:17:47.734) Right. Okay. Brett Deacon (01:18:05.998) Right. Sean (01:18:08.986) Do you have a question? Brett Deacon (01:18:10.446) No, I was just going to make a comment, but go ahead. Did you read the book Sedated by James Davies published within the last couple of years? Sean (01:18:12.644) No, no, go ahead. Sean (01:18:22.198) I follow him on Twitter, and so I'm aware of his work. I've also seen some of his YouTube videos, but I haven't read the book. Brett Deacon (01:18:30.678) Okay, he makes, I think, a really compelling argument that essentially there's been a societal shift and you can trace it back to Reagan and Thatcher, kind of coming into power and ushering in this new kind of neoliberal moral ideology, which is more sort of in favor of rugged individualism and locating people's mental health issues inside of them. And that his argument is essentially that this is extremely convenient within a late-stage capitalist system To say, you know, are you dealing with income inequality and housing and affordability? Uh, and that's making you feel bad. Well, you must be mentally ill go to your doctor Your doctor will give you a sedating medication now get back to work And we won't bother to make society change in ways that will take money out of the pockets of you know the uber rich in order to to create the sort of improved social conditions that would make people less mentally unwell. Sean (01:19:37.834) It's an interesting deep dive to get into it at that level, because it was also during the Reagan administration where direct to, I believe, no, it wasn't the Reagan administration for direct to consumer. It wasn't until late 90s that was allowed to happen. Yeah, but there was a number of things that passed in the 80s that really allowed the pharmaceutical industry to push drugs to market. So like really the FDA became less about safety and efficacy and more about getting drugs to market as quickly as possible. Brett Deacon (01:20:07.255) Yeah. Sean (01:20:08.274) One final question, because we've kept you so long, and it's been a great conversation. I just want to get, since you have been a researcher, I do want to get your opinion on the current state of therapy and therapy research, where we've come out of this era of the empirically validated treatments, manualized-based treatments. And what we see is there's a dissemination problem. They're not really widely applicable. to a lot of complex situations that we see in direct clinical practice. And many people, even though there's incredible principles that I think we've learned through research, most of the general treatment community dismisses them. And most people are not getting what will be considered evidence-based therapies. And in turn, I think there's a communication or marketing problem that exists with them. The way that they're understood is poor. It doesn't represent how I implement them with a with a flexibility, but fidelity to the principles with a structure, but and also a compassion and allowance for things based on the client's needs in a collaborative way. It's just miscommunicated. Where do we go now? What do you think the current state is? And where do we have to advance the research? Brett Deacon (01:21:27.842) Yeah, great question. And it's good to have a historical perspective on that because I remember the days of evidence-based treatment manuals for DSM diagnoses being considered that's sort of the peak version of the practice of our profession. And the academics who promoted them, and I used to be one of those people, we were strong cheerleaders of the idea that clinical practice should involve the use of these manuals, but practitioners didn't use them. And so there was this sort of dynamic of, you silly, stubborn practitioners, why aren't you using our manuals? That's what you should be doing. And then I went into full-time practice and I didn't use the manuals either. And one of the reasons why is in the real world of practice, you have what, 50 minute sessions, maybe once a week. And the treatment manuals are often designed. to have hour and a half long, two hour sessions that occur once or twice a week for 15 to 20 sessions. And just the structure of the delivery of the manual does not look like the real world format in which we deliver therapy. And in Australia, the Medicare system, this is profoundly relevant to this topic. If you... want to get that Medicare rebate, which most people do, they go to their GP, get a referral to see a psychologist, you get 10 sessions per year, that's it. And after the sixth session, you have to go back to the GP, report on how therapy is going, and get the GP's permission for the last four. So you get four hour long sessions. And if you were to ask yourself, how many of those empirically supported treatment manuals could you follow with fidelity? within 10 sessions per year, the answer is probably almost none. Maybe like the specific phobia one or something, but that probably would be about it. So you couldn't even use the manuals in practice if you wanted to. And so instead, where I see things going, and fortunately, CBT has evolved over time, more toward process-based CBT. And the emphasis there is on core principles, you know, philosophy, theory, formulation. And then rather than... Brett Deacon (01:23:50.234) you know, pulling out a manual for a disorder, we have evidence-based procedures for types of issues. So exposure for example, exposure for anxiety being a good example. And when I do exposure for anxiety, I don't pull out a manual and follow it in lockstep, I follow the principles. And you know, you can do that in six sessions, you know, as best you can. And so that's where I see us sort of going is... more flexible use of evidence-based principles. And the key still being, are people actually using the evidence-based procedures in a sensible way based on the theoretical understanding of them and delivering them with reasonable fidelity. And that's probably still likely to be an issue, just like not using treatment manuals was an issue. But that's where I see things going. It's, I'm sure it's harder to study the effectiveness of therapy once you detach it from diagnosis, right? Because now each client is sort of getting their own individually tailored treatment package, and it's not standardized and it's harder to study it in an internally valid way. Sean (01:25:10.574) that I was thinking of another question as well. Like when you do randomized controlled trials for modalities or certain types of approaches, you know, how do you factor in the individual sitting across from the client? Doesn't that have a big part in the impact or the result? Brett Deacon (01:25:30.242) How do you factor in client? Sean (01:25:32.479) the psychologist sitting across from the client, I would think that the individual that you're that is applying that modality, there's a certain that's because you're not aware of treatment manuals. I am not aware of yeah, treatment manuals, they're standardized almost like a step by step and you do it with them. Okay. Brett Deacon (01:25:46.666) Yeah. Yeah, well, yeah, so the answer is that's very rarely looked at. I think of, to me, one of the more interesting studies in the whole outcome literature is the pediatric OCD treatment study, the POTS study. And it was for, you know, for kids with an OCD diagnosis. And they got either exposure therapy or Zoloft or the combination. And it was done at two study sites, University of Pennsylvania and Duke University. And the crazy thing was outcomes for exposure at Penn were more than four times better in terms of effect size than at Duke. And they were following the same manual. So the therapists there were doing something very different than the therapists at Duke, even though they were following the same manual. And essentially, It was described to me by one of the people in charge of the study that the therapist at Duke might have had the client touch the door handle. That's exposure. And a therapist at Penn might have had a client eat a sandwich off the bathroom floor. That's exposure. But one is much more challenging and, as a result, likely to be therapeutic than the other. And so that sort of clusters of therapists doing it differently than others. And I saw a conference presentation once that even among the ERP therapists who had seen five or more clients, some were two, three times more effective than others. And what I wanna know is, what are those two therapists doing, who are getting these massive levels of improvement across their clients that are different from the other therapists? That's what I wanna know. And so it would be neat for us to do more research on that. Sean (01:27:41.454) Fascinating. Especially when it comes to OCD, I think that's an interesting comparison between the two schools that were providing the study. I'd never heard that before. But Jonathan Grayson, I believe his name is, is an OCD expert and really speaks to OCD being driven by intolerance for uncertainty. And some of the exposures he does really pushes the envelope, right? Most therapists aren't willing to go as far as he goes. And I would say that he just creates a stronger therapeutic outcome because of his own tolerance for uncertainty and emotions. And that's one of the things that you can never, it's very difficult to measure in a therapist is their own, their own fear, their own intolerance for uncertainty, their own distress tolerance. A lot of, in my years of supervision, one of the things I find is a lot of therapists afraid of a client's emotions. Afraid to... kind of provoke them or go there, you know, in a way that you need to go there sometimes as a therapist. So definitely with communication style, just the way that you're, you're the way that you're communicating these things to us right now, the way that you're delivering it, it's more receptive to it because it's so conversational. But if it's a manual based and someone's like, kind of checking off boxes and just saying the things they need to say, that wouldn't impact me at all. Yeah, I'd be disconnected from it. So true. Brett Deacon (01:29:04.194) Well, I mean, now we're talking about my other area of research. I studied like therapist reservations about exposure therapy, which were quite common. Therapist believes that anxious clients are fragile, need to be treated, you know, in a protective manner lest they break like a piece of spun glass. That's Paul Neal's great metaphor. And so exposure, I think, is in an area where the therapist's own stuff gets directly translated into the therapy and affects the client. for better or for worse. And that coming back to the POTS study, that example of what exposures would you choose for a client who has a contamination fear? I'm sure the answer to that has a lot to do with your own comfort level or lack thereof with dirty things. And Jonathan Grayson has no issues with uncertain situations, I'm sure. And as a result has no problem. exposing clients to really intense, uncertain related situations, whereas other therapists are too squeamish and would never do that. Surely that gets directly translated to client outcomes. Sean (01:30:12.63) Yeah. Listen, Brett, we have kept you for 90 minutes. I could probably talk to you for five hours. So there's so many, there's so many different subject areas that I'm writing down for us to get you back in another time. And you know, it opens up just our ideas for future podcasts. But before we close, I don't know if you're on social media or your work is public. Is there any way that people can take a look at the work you're doing? Or is there anything you're putting out there? Brett Deacon (01:30:20.454) I can absolutely. Brett Deacon (01:30:27.203) I love that. Brett Deacon (01:30:43.858) Probably the best place for that at the moment, I don't have much of a social media presence, would be the University of Melbourne has a find an expert page that all staff members have. So if you just Google Brett Deakin University of Melbourne, that'll, you know, probably take you to one of the top hits being my find an expert page. And that's where I post updates on the work I'm doing. And you can see the stuff that I've published in the past. Sean (01:31:11.226) Great. It's interesting. We do have a audience in Australia. Yeah. We're now pulling up the data right now. I'm curious what the percentage was. We, uh, we're in the top 1% global downloads. So although most of our, I think 70 some percent is probably a United States audience. We got about 25% outside the United States or more 25, 30% outside the United States. Definitely. We had an audience from, from down under. We did. Um, it's, it's not loading right now. I think, um, my bandwidth is being used for the, the riverside recording. Brett Deacon (01:31:18.268) Oh yeah. Sean (01:31:41.022) But it was in the single digits. Here we go. We're up three and a half percent. Okay. Yeah. So we're going to get people out there who are listening to this from Australia. Brett Deacon (01:31:50.326) Congratulations on the success of your podcast. That's amazing. And for you to have a podcast that is that successful, that covers these sorts of topics, just makes me, gives me hope for the future of humanity, honestly. Sean (01:32:05.586) I agree and I think it represents kind of an awakening that's starting to happen worldwide. You know, 10 years ago when you first, when you published that paper, you know, it, we really didn't make much of a movement in being able to challenge these ideas, but post COVID where we, you know, we're kind of, we were subject to some of the corruption. I think it's much more aware. people are much more aware of the corruption that exists. And there's also a global community of harmed patients from psychiatric drugs. And so really starting to challenging a lot of these ideas that people just accept it as truth. But it does start with people like you, Dr. Deacon. I mean, it's, you know, some of your early work shows, you know, courageousness, you're, you know, your willingness to have those difficult conversations, to put a paper out there. You know, we really do, you know, appreciate you being a trailblazer here. And I know there's been trailblazers before you. I'd have to look at... the work of Stanton Peel, for example, but I just wanna say that your paper has made a difference. It made a difference here at our center that we're, one of the things, just so you know, one of the things that we have here is we have position statements that when people come here, we have position statements on the efficacy of these drugs and we work with people getting off the drugs and we're trying to change the language we use even on our website. We're trying to instigate real... positive change to help people get better and it started with, you know, with some of your very important work. So really appreciate it. Brett Deacon (01:33:37.138) Thank you very much. That's, yeah, that's really grateful to hear that. And like congratulate you on doing some incredible work. I'd actually love to be able to check out those position statements. Are they available on your website? Sean (01:33:50.606) We haven't put it on the website. We have them actually in our lobby. And so, and all of our therapists, of course, communicate it to the population. But I'll send you a copy of what we started with under the age of 25 children and adolescents for antidepressants, because we felt like that was a population that needed to be saved and protected, especially given the research. So, Brett Deacon (01:33:54.699) Okay. Brett Deacon (01:34:14.414) That's great. Sean (01:34:17.11) You know, we're doing our part here. People are coming in here, they're given the information and we're working with medical professionals to slowly taper off their drugs. Listen, I could get into the weeds with you about exposure therapy and like inhibitory learning processes and so forth and how the drugs negatively impact that, just the presence of it. We could get in the weeds with your areas of expertise, which we'll do another time. But I wanna thank you for a radically genuine conversation. Brett Deacon (01:34:45.43) Thank you, it's been a pleasure.