Latest / psychophobia* podcast / Episode 08 Part I: When Treatment Becomes the Problem - How modern psychiatry lost the human being

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Episode 08 Part I: When Treatment Becomes the Problem - How modern psychiatry lost the human being · psychophobia* podcast

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What if the institutions designed to help us understand the
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human psyche are
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SPEAKER_00: actually afraid of them?
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Hosted by Dr.
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Michael Montgomery,
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this podcast explores the uncomfortable questions.
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Together we'll examine how the mental health systems meant to
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heal us instead
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SPEAKER_00: perpetuate cycles of dependency.
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SPEAKER_00: Welcome to the Psychophobia Podcast.
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So,
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to fill disclosure,
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I was so keen to have things pocket for you coming on.
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SPEAKER_03: You are episode eight.
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SPEAKER_01: Okay, great.
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SPEAKER_03: So it's literally taken me to now to have the confidence to have you on.
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SPEAKER_03: Jesus, Michael.
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SPEAKER_03: No,
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SPEAKER_03: I'm going to be honest,
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SPEAKER_03: it's too important to me and I just wanted to make sure it was right,
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SPEAKER_03: yeah.
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So the format is,
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it's kind of like us in the pub and just basically jump in.
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So usually how I start is I'll show you something and then ask
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you to comment,
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okay?
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SPEAKER_03: Okay.
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SPEAKER_03: So I'm going to show you this and you tell me what you think.
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SPEAKER_01: It looks like a tachy cam.
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SPEAKER_03: A yellow taxi cab and perhaps a New York taxi cab?
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SPEAKER_01: Yes, yes.
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SPEAKER_01: Well, of course it stirs memories right away.
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SPEAKER_01: I mean, I drove a cab at night in New York for six years.
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SPEAKER_01: And during that time, it really felt it became my identity.
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SPEAKER_01: It was the way I interacted with the city.
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SPEAKER_01: But also,
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SPEAKER_01: in terms of my sense of self,
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SPEAKER_01: it was a very powerful,
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SPEAKER_01: profound,
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SPEAKER_01: life-shaping experience.
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SPEAKER_01: And for many years,
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SPEAKER_01: whenever I returned to New York City,
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SPEAKER_01: I was always looking for the cab I had driven.
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SPEAKER_01: The cab I had driven was called Oz Taxi, 6K40.
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SPEAKER_01: I still remember it all these years.
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SPEAKER_01: But it was...
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SPEAKER_01: It was a really life shaping,
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but also a great way to learn about a city and also to have a
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certain perspective
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SPEAKER_01: of,
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SPEAKER_01: you know,
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SPEAKER_01: working class guy.
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There's hardly anything more working class than driving a cab
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and sort of seeing
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SPEAKER_01: the different strata of
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of New York filtered through,
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you know,
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your lens of who you were driving.
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And the point of this is you would be driving people that were
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fairly wealthy,
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SPEAKER_01: but you'd also be,
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SPEAKER_01: I drove at night.
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SPEAKER_01: I drove it from five o'clock at night to five in the morning.
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And you know,
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in the wee hours of the night,
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you're getting a totally different clientele.
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SPEAKER_01: But anyway, I actually really loved it.
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SPEAKER_01: I think it was,
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SPEAKER_01: um,
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SPEAKER_01: I don't know if loved is actually quite the right word,
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SPEAKER_01: but it was a formative experience.
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SPEAKER_03: Well,
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SPEAKER_03: you know,
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SPEAKER_03: I haven't been able to get it out of my head ever since you told me,
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but you left an important piece of context out and that was
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when you were driving,
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SPEAKER_03: at what year?
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SPEAKER_01: Yeah, I was driving when New York was really a pretty rough place.
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I was driving from 1978 to 1984,
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you know,
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you had the crack epidemic happening.
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SPEAKER_01: Now I have to say it was, in its own way, it was a little bit romantic.
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SPEAKER_01: Because it was a raw, raw city at that time.
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I suppose I'm not supposed to say this,
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but you had prostitutes on the streets.
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SPEAKER_01: There were corners where people were selling drugs,
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SPEAKER_01: heroin,
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SPEAKER_01: whatever it might be,
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SPEAKER_01: crack,
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SPEAKER_01: et cetera.
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SPEAKER_01: There was a fair amount of crime.
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I mean,
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I was stuck up a couple of times and I had other difficult
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moments.
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SPEAKER_01: Uh, so that time was, was a time when New York was, how to put it?
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SPEAKER_01: It was struggling.
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SPEAKER_01: In many,
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SPEAKER_01: many ways,
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SPEAKER_01: but it's also so alive,
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SPEAKER_01: so diverse,
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SPEAKER_01: so filled with energy and excitement and clubs and that sort of thing.
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SPEAKER_01: You know,
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SPEAKER_01: I go to New York now and it seems tame,
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SPEAKER_01: all these sort of brand name stores and that sort of thing.
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Back in 7884,
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you had a lot of just mom and pop stores,
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that sort of thing.
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SPEAKER_01: Um, and it was a real competition.
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SPEAKER_01: This is really interesting.
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SPEAKER_01: So I didn't have a radio.
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SPEAKER_01: I was just cruising the streets,
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SPEAKER_01: which meant as you cruise the streets,
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SPEAKER_01: you were constantly in competition with other cabs for whoever,
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SPEAKER_01: you know,
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SPEAKER_01: hailed you,
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SPEAKER_01: that sort of thing.
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SPEAKER_01: It was quite a vigorous 12 hours.
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SPEAKER_01: Let's put it that way.
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SPEAKER_03: It's fascinating.
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SPEAKER_03: And the other detail that I was struck by was there was no partition?
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SPEAKER_01: No.
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SPEAKER_01: So what happened is this was, this I think is key to my experience.
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When I first started driving for a union shop and they always
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had the partitions
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okay and now the partitions supposedly were protecting you from
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any sort of harm or
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at least limiting that but it also actually separated you from
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the passengers
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because you know there was this thing you didn't have as much
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conversation with
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them though but there were also people who had medallions that
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were individually
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SPEAKER_01: owned
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SPEAKER_01: The cab that I eventually drove for the longest time, he owned one cab.
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SPEAKER_01: And they were not required to put him in a medallion.
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SPEAKER_01: And during the day,
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he liked to drive without the partition because it was just a
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way to be more in
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SPEAKER_01: touch with the passengers.
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SPEAKER_01: Not only did I not have a partition, I had bucket seats.
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SPEAKER_01: So it was really vulnerable.
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What was nice about that was it really did encourage to have
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conversations with the
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SPEAKER_01: people in the back.
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SPEAKER_01: It said the passengers who picked up.
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So it was a much more less lonely thing to be driving without
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the partition and
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SPEAKER_01: much more sort of
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visceral in terms of how you're experiencing the town,
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but it did lend itself to problems.
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I mean,
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I could tell you,
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I got stuck up twice,
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once a gun in my head,
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once in my side.
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SPEAKER_01: I had people, one person tried to strangle me.
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I had another person just start banging me on the top of the
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head because at three
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SPEAKER_01: in the morning,
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SPEAKER_01: you're getting some wild people,
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SPEAKER_01: you know?
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SPEAKER_01: So it was a mixed bag.
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SPEAKER_01: Um,
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SPEAKER_01: but it made driving a cab without having a partition all that more,
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SPEAKER_01: much more alive,
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SPEAKER_01: much more sort of really feeling the night,
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SPEAKER_01: so to speak.
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SPEAKER_03: And,
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SPEAKER_03: and well,
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SPEAKER_03: when you told me I just images of,
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SPEAKER_03: you know,
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SPEAKER_03: like movies of like the warriors or a taxi,
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SPEAKER_03: it's probably.
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SPEAKER_03: Yeah.
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SPEAKER_03: Taxi driver.
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SPEAKER_03: Yeah.
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SPEAKER_01: That came out, I think while I was driving Robert De Niro, right?
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SPEAKER_03: But everything you said,
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SPEAKER_03: it made sense of the story,
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SPEAKER_03: your story that we'll get into,
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SPEAKER_03: but you know,
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SPEAKER_03: it was a surprise,
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but it wasn't a surprise because I think you care very deeply
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about people and I
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SPEAKER_03: think you need to care about people to be a new taxi driver.
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Yeah,
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you know,
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you do,
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but it also gives you an appreciation for the underdog,
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for the outcast.
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SPEAKER_01: Okay.
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SPEAKER_01: Because the person who's not part of the sort of regular society,
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SPEAKER_01: so to speak,
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SPEAKER_01: which is,
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SPEAKER_01: of course,
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SPEAKER_01: is the movie about the taxi driver.
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SPEAKER_01: But it gives you this feeling of being an outcast.
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SPEAKER_01: And you know, Michael, I wasn't really raised to be an outcast.
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SPEAKER_01: That really wasn't my trajectory in life.
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SPEAKER_01: It almost was a choice to become an outcast.
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But what was so important is,
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if you want to talk about the work I've been doing now is
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SPEAKER_01: It does help you appreciate people who are excluded,
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SPEAKER_01: people who are looked down upon,
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SPEAKER_01: people who are not part of the mainstream.
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SPEAKER_01: It was really instructive in that way.
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SPEAKER_01: And just last thing here is within my own personal world,
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SPEAKER_01: the family I was raised in,
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SPEAKER_01: this was seen as like a real leap into failure.
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I wasn't really expected to become a taxi driver in New York
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City for six years.
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It made me think of George Orwell's book,
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Down and Out in Paris and London.
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SPEAKER_03: Where he literally is down and out in Paris and he's washing dishes,
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SPEAKER_03: but it gives such an insight into survival,
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SPEAKER_03: resilience,
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SPEAKER_03: worlds that perhaps we haven't fully been in ourselves.
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SPEAKER_03: And he had gone to Eaton,
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SPEAKER_03: so he had some sort of public schoolboy education,
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SPEAKER_03: but yeah,
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SPEAKER_03: he literally was writing from the trenches.
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SPEAKER_01: I think anybody who has had a little bit of time in a down and out job,
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SPEAKER_01: they remember it well and they will find it instructive.
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SPEAKER_01: I mean,
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SPEAKER_01: I also,
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SPEAKER_01: during this time before I was a taxi driver,
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SPEAKER_01: I was a night clerk at a SRO hotel,
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SPEAKER_01: single room occupancy hotel.
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And that was a hotel in New York City for people who had come
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out of prison,
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SPEAKER_01: drunks,
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SPEAKER_01: hookers,
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SPEAKER_01: that sort of thing.
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It was part of that down and out experience,
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which in essence,
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I was chasing for a time.
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SPEAKER_01: For yourself or to understand?
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SPEAKER_01: I think I was doing it for two things.
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SPEAKER_01: One, to understand.
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SPEAKER_01: To expand my,
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SPEAKER_01: you know,
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SPEAKER_01: interaction with the world,
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SPEAKER_01: with society,
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SPEAKER_01: expand and who I interacted with.
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SPEAKER_01: But also as a,
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I think a challenge to myself to see how I would fare in these
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situations and how I
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SPEAKER_01: would respond and,
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SPEAKER_01: and what I become.
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SPEAKER_01: And even what I, here's the thing.
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SPEAKER_01: Go back to the,
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SPEAKER_01: when I was a night clerk,
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SPEAKER_01: when you're a night clerk,
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SPEAKER_01: so I would be on from 11 o'clock at night to seven in the morning.
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SPEAKER_01: And a lot of people would come down and talk to me.
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Girls who were prostitutes,
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alcoholics,
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people out of prison,
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they all had stories,
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right?
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And if you don't hear their stories and you don't have an
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individual telling you
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SPEAKER_01: that story,
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it's so easy to sort of discount people who have fallen in this
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way or have had
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SPEAKER_01: these difficulties.
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But when you have an individual at three in the morning telling
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you the story,
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SPEAKER_01: It's just a human being now who's in a certain situation, right?
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SPEAKER_01: And you see them now as an individual.
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SPEAKER_01: You can be empathic.
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SPEAKER_01: You can say that the story they tell has meaning for you as well.
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SPEAKER_01: You're not just listening.
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It's starting expanding your understanding of how people move
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through the world.
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SPEAKER_01: And I felt very fond of those people.
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SPEAKER_01: In the hotel.
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SPEAKER_03: It was,
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SPEAKER_03: it was,
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SPEAKER_03: it was,
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SPEAKER_01: it was,
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SPEAKER_01: um,
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there was a little community and the day people would be
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outside drinking,
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SPEAKER_01: you know,
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SPEAKER_01: and you could share a beer with them,
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but it was a way to expand my horizons in terms of who was in
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my social world.
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And I mean,
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you,
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you must've really been taken by because you ended up working
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in Attica.
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SPEAKER_01: Yeah.
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SPEAKER_01: So the,
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so basically if you want to put all this together is after I
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got out of college,
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SPEAKER_01: I wanted to like sort of kick around.
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SPEAKER_01: And,
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SPEAKER_01: but in other words,
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I wanted to experience things that I hadn't experienced before
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in terms of the down
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SPEAKER_01: and out as an,
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SPEAKER_01: as a nice sort of analogy.
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So one thing I did is I worked in a hotel,
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single room occupancy hotel in New York.
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SPEAKER_01: And then I did spend a couple of years working in Attica prison.
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SPEAKER_01: Now this was in 1977.
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SPEAKER_01: And this was after the Attica riots.
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The Attica riots were a seminal moment in prison history in the
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United States
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SPEAKER_01: because the prisoners took over the prison for a while.
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SPEAKER_01: They held guards as hostages.
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SPEAKER_01: And then when the prison was retaken, a number of people were killed.
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SPEAKER_01: Now,
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SPEAKER_01: this is common when you have propaganda from the government,
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SPEAKER_01: they blame that on the prisoners.
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SPEAKER_01: But in fact, later investigations showed
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It was the National Guard that ended up killing a lot of people
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as they came in to
12:47
SPEAKER_01: retake the prisoner.
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SPEAKER_01: It may have been the state police, I can't quite remember.
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SPEAKER_01: But anyway,
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Attica at this time had a reputation of being the toughest
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prison in all of New
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SPEAKER_01: York State and also one of the toughest prisons in the country.
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SPEAKER_01: Murderers, people on death sentences, life sentences, that sort of thing.
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SPEAKER_01: Now I was brought in
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SPEAKER_01: As part of a reform effort after that prison uprising.
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And the idea was that I would run a tutoring program where I
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would take prisoners
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with high school degrees and train them as tutors to help those
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who couldn't read
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or didn't have high school degrees learn to read and get their
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high school degrees.
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SPEAKER_01: Now, again, I was young.
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SPEAKER_01: This was how I was like 20.
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SPEAKER_01: What was I when I first went in or 23, something like that.
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SPEAKER_01: And naïve.
13:38
SPEAKER_01: Okay.
13:38
SPEAKER_01: And suddenly you're,
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SPEAKER_01: and what,
13:41
what was really interesting about this job is it really was
13:44
seen as a program for
13:46
SPEAKER_01: the prisoners that they would feel proud of.
13:48
SPEAKER_01: Okay.
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SPEAKER_01: And I was enabling a prison, a prisoner run program for education.
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SPEAKER_01: Now I arrive as a very naive kid, right?
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SPEAKER_01: This is not my milieu that I've grown up with,
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SPEAKER_01: because of course the people in there really grow up.
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SPEAKER_01: You know the movie, the series, The Wire?
14:10
SPEAKER_03: Yeah.
14:12
SPEAKER_01: Okay.
14:12
SPEAKER_01: That's who you're really getting there.
14:14
SPEAKER_01: You're getting like kids from New York that have grown up within sort of
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SPEAKER_01: communities that are selling drugs,
14:20
SPEAKER_01: that sort of thing.
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SPEAKER_01: So, when you're from the outside, this is really key, I think, Michael.
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SPEAKER_01: That group is seen as an awful group of human beings, right?
14:32
SPEAKER_01: Maybe they've committed murders or whatever and that sort of thing.
14:36
But now you're in the prison and you're meeting these people as
14:38
individuals.
14:39
SPEAKER_01: And many of them you'll find are very smart.
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SPEAKER_01: They're not maybe well educated,
14:44
SPEAKER_01: but very smart,
14:45
SPEAKER_01: very capable of language,
14:47
SPEAKER_01: very sort of warm,
14:49
SPEAKER_01: empathic,
14:50
SPEAKER_01: fun to be with.
14:52
SPEAKER_01: Okay?
14:53
SPEAKER_01: And with a sense of loyalty, to be honest with you.
14:56
SPEAKER_01: Now,
14:56
SPEAKER_01: there were some really bad people in Attica,
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SPEAKER_01: but that's not really who I interacted with because,
15:02
SPEAKER_01: you know,
15:03
I was working with people who wanted to be tutors and wanted to
15:06
get an education
15:06
SPEAKER_01: and that sort of thing.
15:08
SPEAKER_01: But again, here's what was instructive about this.
15:12
SPEAKER_01: It was a real lesson to me that as you grow up in certain environments,
15:15
SPEAKER_01: you end up with stereotypical thinking about others,
15:18
SPEAKER_01: okay?
15:18
People of other races,
15:20
people of other classes,
15:21
people from other parts of the country.
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SPEAKER_01: And now you have an opportunity to be with them in a different way,
15:27
SPEAKER_01: and now you see them in a different light.
15:30
And one of the things you saw with so many of the people in
15:33
prison in Attica is like,
15:35
SPEAKER_01: You know,
15:35
SPEAKER_01: they were raised in environments where the,
15:38
SPEAKER_01: as one person said,
15:39
SPEAKER_01: the economic opportunity that presented itself was selling drugs.
15:43
SPEAKER_01: That was the economic opportunity.
15:45
SPEAKER_01: So of course they followed that.
15:48
SPEAKER_01: And what you saw was,
15:50
SPEAKER_01: you saw how your place in life,
15:53
SPEAKER_01: your culture,
15:54
SPEAKER_01: where you were born,
15:55
SPEAKER_01: shaped your decisions you could make,
15:57
SPEAKER_01: your opportunities you could have.
16:00
SPEAKER_01: And I have to say, I really came to
16:04
SPEAKER_01: Enjoy so many of the men during my time there.
16:09
SPEAKER_01: And again,
16:09
SPEAKER_01: it was breaking down my stereotypes,
16:13
SPEAKER_01: my understandings that sort of maybe I came forth as I grew up.
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SPEAKER_01: And it made me see people outside of those stereotypes,
16:25
SPEAKER_01: which is a great thing to have happen to you.
16:28
SPEAKER_03: Well, I think it speaks to the man that you are.
16:31
SPEAKER_03: Not everyone may have interpreted it that way.
16:34
SPEAKER_03: They might have gone in a different direction.
16:38
I'd be fascinated to know how many people in America under 40
16:42
have heard of the
16:43
SPEAKER_03: Attica prison riot.
16:46
SPEAKER_01: Oh, that is interesting.
16:47
SPEAKER_01: Because of course, at a time it was such an event.
16:50
SPEAKER_01: I mean, such a big thing happened.
16:54
SPEAKER_03: I'm still traumatized watching the documentary.
16:59
SPEAKER_01: Yeah, the documentary's amazing.
17:00
SPEAKER_01: It's powerful.
17:01
SPEAKER_01: I mean, Attica was quite the place.
17:03
SPEAKER_01: I mean, I could go into Attica.
17:04
I mean,
17:06
there was people that would always have shotguns as people
17:09
moved around.
17:10
SPEAKER_01: So it was an armed facility.
17:13
SPEAKER_01: I would say most people under 40 have not heard of it.
17:16
SPEAKER_03: Yeah.
17:16
SPEAKER_03: Which means,
17:18
SPEAKER_03: um,
17:20
there's important parts of history that are missing from
17:23
people's knowledge base.
17:26
SPEAKER_03: Yeah, for sure.
17:27
SPEAKER_03: This is the big question, I guess.
17:32
Part of my reason for asking some of this background is because
17:36
I think it really
17:38
SPEAKER_03: gives people a sense of who you are in terms of compassion,
17:44
SPEAKER_03: your patience,
17:45
SPEAKER_03: your natural born investigative journalist mind.
17:52
But what is of great interest is how does someone like this
17:55
become a menace to society?
17:57
SPEAKER_01: You're talking about me?
18:00
SPEAKER_01: Yeah.
18:01
SPEAKER_01: As a menace to society?
18:05
SPEAKER_01: That's a great question.
18:07
SPEAKER_01: It's a fair question, right?
18:09
SPEAKER_03: No, it's a good question.
18:11
SPEAKER_03: To give the context, the previous
18:14
Head of the American Psychiatric Association referred to you as
18:18
a menace to society.
18:21
How do you reconcile what you just told me to get into a point
18:26
in your life where
18:27
SPEAKER_03: that is how you refer to me such a public figure?
18:30
SPEAKER_01: Well,
18:31
SPEAKER_01: if I were going to be buried and have a gravestone,
18:33
SPEAKER_01: I think I would put that on my gravestone.
18:36
SPEAKER_03: Well,
18:37
SPEAKER_03: I will say,
18:38
SPEAKER_03: and before you explain,
18:40
I'd like to thank you for being a menace to society and I know
18:45
for a fact that
18:46
there are thousands and thousands upon thousands of people who
18:51
would like to thank
18:52
you for being a menace to society and the influence that you've
18:55
had directly or
18:56
SPEAKER_03: indirectly on improving their care,
19:00
SPEAKER_03: how they're seen,
19:01
SPEAKER_03: how they're treated and how they're thought about.
19:04
SPEAKER_03: Maybe you want to explain.
19:06
SPEAKER_01: So there is this connection.
19:08
SPEAKER_01: There is a connection here, Michael.
19:10
SPEAKER_03: Yes.
19:11
So you just had me speak about experiences where I found merit
19:18
in the stories of
19:19
SPEAKER_01: people who are usually discounted.
19:21
SPEAKER_01: Prisoners,
19:22
SPEAKER_01: people living,
19:22
SPEAKER_01: you know,
19:23
SPEAKER_01: ex-prisoners,
19:24
SPEAKER_01: alcoholics,
19:26
SPEAKER_01: younger women who ended up in prostitution,
19:29
SPEAKER_01: that sort of thing,
19:30
SPEAKER_01: okay?
19:31
SPEAKER_01: And during these different experiences we've talked about,
19:37
SPEAKER_01: I appreciated their stories, life stories, okay?
19:40
SPEAKER_01: And to me they had authenticity.
19:42
SPEAKER_01: They counted.
19:44
SPEAKER_01: And they were worth listening to.
19:46
So I was doing a series for the Boston Globe on abuses of
19:51
psychiatric patients in
19:52
SPEAKER_01: research settings,
19:53
SPEAKER_01: okay?
19:55
And it came up that one of the things is,
19:58
it was about people diagnosed with schizophrenia.
20:01
SPEAKER_01: This was 1998.
20:03
SPEAKER_01: When I called up the experts, they told me,
20:07
SPEAKER_01: Oh, schizophrenia is due to too much dopamine, okay?
20:11
SPEAKER_01: And that's why the drugs fix that dopamine imbalance.
20:14
SPEAKER_01: They block dopamine like insulin for diabetes, okay?
20:17
SPEAKER_01: That was a story that I was told.
20:20
SPEAKER_01: And then I,
20:21
SPEAKER_01: so then I asked the people,
20:22
SPEAKER_01: I said,
20:22
SPEAKER_01: but lots of times patients don't like those,
20:26
SPEAKER_01: these drugs like Haldol and antipsychotics.
20:29
SPEAKER_01: They say it makes them like zombies.
20:32
And the researchers said,
20:33
oh,
20:33
that's because they lack insight into their illness.
20:36
SPEAKER_01: They don't know these drugs are good for them.
20:39
SPEAKER_01: Okay.
20:40
SPEAKER_01: Fine.
20:40
That's what the professionals were telling me,
20:42
the experts were telling me.
20:44
So then I called up people with this diagnosis and including a
20:47
group called Mind
20:48
SPEAKER_01: Freedom,
20:48
SPEAKER_01: which had its roots as a psychiatric survivor group.
20:51
SPEAKER_01: And I asked them about this.
20:53
SPEAKER_01: I said, why don't you like the drugs?
20:58
SPEAKER_01: Okay.
20:58
SPEAKER_01: And they said, listen,
21:00
SPEAKER_01: First of all, you need to do some research.
21:02
SPEAKER_01: These drugs aren't fixing a chemical imbalance.
21:05
Second,
21:05
we'll direct you to some research that shows they're shrinking
21:08
our brains.
21:09
SPEAKER_01: And third, we'll show you that it does make us like zombies.
21:13
SPEAKER_01: It removes the capacity to fill the world.
21:16
SPEAKER_01: So now, all of a sudden, I had two stories, okay?
21:20
SPEAKER_01: I had a story from the experts
21:24
Saying that it's like we talked about schizophrenia that it was
21:27
due to a dopamine
21:29
imbalance too much dopamine they needed the drugs like insulin
21:32
for diabetes and the
21:33
reason they didn't want to stay on the drugs is because they
21:37
lacked insight into
21:38
their illness okay but now when I talk to a lot of people who
21:41
didn't want to be on
21:42
SPEAKER_01: the drugs
21:43
SPEAKER_01: They gave a very different explanation of how the drugs made them feel.
21:47
SPEAKER_01: Didn't make them feel normal.
21:49
SPEAKER_01: Made them feel like, you know, like zombies.
21:53
SPEAKER_01: Sometimes they couldn't read.
21:55
SPEAKER_01: They would have shakes.
21:56
SPEAKER_01: They'd have Parkinsonian symptoms.
21:59
SPEAKER_01: When I was talking to David Oaks,
22:00
SPEAKER_01: he said,
22:00
you've got to look at this research that shows that it actually
22:02
shrinks our brains
22:04
SPEAKER_01: and find out where we actually are seen to have too much dopamine.
22:10
SPEAKER_01: So they had a different narrative, okay?
22:12
There was the narrative of people with lived experience and the
22:14
narrative from the
22:15
SPEAKER_01: people with the professional degrees,
22:19
SPEAKER_01: the academic psychiatrists.
22:21
SPEAKER_01: Now, the reason that I then wrote a book called Mad in America was
22:27
I was open to believing or to at least examining the validity
22:33
of this patient's story,
22:34
okay?
22:34
SPEAKER_01: What were their story?
22:36
SPEAKER_01: Did it have some validity?
22:37
SPEAKER_01: Did it have some reason behind it?
22:40
SPEAKER_01: And what I found when I did Mad in America was that,
22:44
SPEAKER_01: in fact,
22:44
SPEAKER_01: the dopamine imbalance story had pretty much been discredited by 1998.
22:51
and that if anything outcomes for people with schizophrenia
22:53
were worsening,
22:55
SPEAKER_01: okay,
22:56
SPEAKER_01: so I had two narratives and what I found frankly was there was more truth
23:01
with the narrative from those with lived experience than the
23:04
narrative that was
23:04
SPEAKER_01: being told to me by the people with power,
23:07
SPEAKER_01: with prestige in our society.
23:09
SPEAKER_01: Now,
23:10
all those other experiences is what made me open to hearing
23:13
this story when I
23:14
SPEAKER_01: interviewed people with this diagnosis,
23:16
SPEAKER_01: okay?
23:16
SPEAKER_01: Because I wasn't going to discount their lived experience.
23:19
I wasn't going to discount how the drugs affected their lives
23:25
and how they reacted to it.
23:26
SPEAKER_01: So it made me open to that.
23:28
Now I became a menace because in essence what I found was there
23:32
was more merit in
23:34
terms of which was actually more consonant with the actual
23:36
science with the story
23:39
being told by those being treated as opposed to those who were
23:42
doing the treating.
23:44
SPEAKER_01: Okay,
23:44
SPEAKER_01: so now I told a story saying,
23:47
SPEAKER_01: look it,
23:48
your own science is not supporting the narrative you're telling
23:50
to the public.
23:51
SPEAKER_01: Okay?
23:53
SPEAKER_01: And once you challenge a narrative
23:57
SPEAKER_01: that is being pitched to the public by academic doctors, etc., right?
24:04
SPEAKER_01: They're not going to be happy with you,
24:06
especially if in your telling of the story you can make a
24:10
scientific case of their
24:12
SPEAKER_01: own science that undercuts their narrative,
24:14
SPEAKER_01: which is what I did.
24:16
SPEAKER_01: And that's why I became seen as a menace.
24:20
But it's a hell of a thing to label somebody when they're just
24:28
asking for more
24:30
SPEAKER_02: attention to the data,
24:33
SPEAKER_02: right?
24:34
SPEAKER_02: I mean, it's fair to say, and you can tell me, there was no agenda there.
24:39
My understanding of it was you were perplexed by some of the
24:43
data you were reading,
24:44
SPEAKER_02: particularly in developing countries as well.
24:47
SPEAKER_02: Is that right?
24:49
SPEAKER_01: Yeah, this is really important.
24:51
SPEAKER_01: So I did have these two narratives, okay?
24:54
SPEAKER_01: But then I came upon two.
24:56
So the conventional narrative is that we were making great
24:59
progress in treating,
25:00
SPEAKER_01: quote,
25:00
SPEAKER_01: schizophrenia,
25:01
SPEAKER_01: right?
25:02
We discovered that the chemical that caused the problem,
25:05
we had drugs that fixed that.
25:07
SPEAKER_01: That's a story of great medical progress.
25:09
And of course,
25:10
this is after the atypicals come,
25:12
these breakthrough medications.
25:14
SPEAKER_01: That's a story of great medical progress, right?
25:17
But then what happened was while I was doing that series for
25:20
the Boston Globe,
25:21
SPEAKER_01: I came upon two types of studies that belied that narrative of progress.
25:26
SPEAKER_01: One was,
25:26
the first was a research paper done by psychiatrists at Harvard
25:31
Medical School,
25:33
SPEAKER_01: Ross Baldess-Larini and others.
25:34
These are people with great prestige and they looked at
25:37
long-term outcomes for
25:39
schizophrenia patients in the US and other Western countries
25:41
and what did they
25:42
SPEAKER_01: conclude?
25:43
SPEAKER_01: That outcomes had actually declined since 1975 to 1994,
25:47
SPEAKER_01: longer term outcomes for schizophrenia patients,
25:51
and were now no better than they had been in the first third of
25:53
the 20th century.
25:55
SPEAKER_01: Well, that's a wow moment, right?
25:57
SPEAKER_01: That belies that narrative of progress.
26:00
SPEAKER_01: Then I found this study done by the World Health Organization.
26:03
SPEAKER_01: They had twice done studies.
26:06
cross-cultural studies that compared outcomes in three quote
26:08
developing countries,
26:09
SPEAKER_01: India,
26:10
SPEAKER_01: Colombia,
26:10
SPEAKER_01: and Nigeria,
26:11
SPEAKER_01: to outcomes in the US and five other quote developed countries.
26:16
SPEAKER_01: One was five years in length and one was two years in length.
26:19
SPEAKER_01: And I think the first one was the five-year study.
26:21
Everybody was diagnosed by,
26:23
this was conducted by the World Health Organization.
26:26
SPEAKER_01: Everybody was diagnosed by Western standards.
26:30
SPEAKER_01: And what they found in this first study,
26:32
SPEAKER_01: listen to this,
26:33
SPEAKER_01: that the outcomes were best in the developing countries,
26:36
SPEAKER_01: particularly India and Nigeria.
26:39
And the outcomes were so different that the World Health
26:43
Organization investigators
26:44
SPEAKER_01: concluded that living in a developed country is a strong predictor.
26:48
SPEAKER_01: You won't have a good outcome if you're diagnosed with schizophrenia.
26:51
SPEAKER_03: Okay?
26:53
SPEAKER_01: So now again, this is belying that narrative of progress.
26:56
SPEAKER_01: So I called up people and I said, why are outcomes better?
26:59
SPEAKER_01: The experts,
26:59
SPEAKER_01: I called them,
27:00
why are outcomes better in India and Nigeria than the United
27:03
States with all our
27:04
SPEAKER_01: modern medicine?
27:05
SPEAKER_01: Oh,
27:05
SPEAKER_01: they said,
27:06
SPEAKER_01: it's not that the medicine is the problem,
27:08
SPEAKER_01: it's that the social factors,
27:10
SPEAKER_01: we don't support people right and stigma and all this sort of thing.
27:13
SPEAKER_01: So they placed the blame outside their medical treatment.
27:18
SPEAKER_01: So then I looked at the second such study because after the first one,
27:22
SPEAKER_01: the World Health Organization investigators said,
27:25
SPEAKER_01: Well, they floated a hypothesis.
27:28
SPEAKER_01: Maybe the reason for the better outcomes in the poor countries,
27:33
SPEAKER_01: the developing countries,
27:34
SPEAKER_01: is that the patients were more medication compliant.
27:36
SPEAKER_01: They didn't resist taking their antipsychotic medications.
27:39
SPEAKER_01: Now that's a valid hypothesis.
27:42
SPEAKER_01: If the medications are seen to be so key to long-term good outcomes,
27:47
SPEAKER_01: then medication compliance should lead to better outcomes,
27:49
SPEAKER_01: right?
27:50
So they measured medication usage in the second study and
27:54
here's what they found.
27:56
SPEAKER_01: In the country,
27:57
SPEAKER_01: specifically in India and Nigeria,
27:59
SPEAKER_01: which had by far the best outcomes,
28:01
SPEAKER_01: they used the drugs acutely,
28:03
SPEAKER_01: but not chronically.
28:04
SPEAKER_01: They didn't keep people with schizophrenia on the medications long term.
28:08
They used them to stabilize during the acute period,
28:10
but then they didn't maintain it.
28:13
So what you saw in the WHO studies was much better outcomes
28:18
where they used the
28:19
SPEAKER_01: drugs acutely,
28:20
SPEAKER_01: not chronically,
28:22
SPEAKER_01: Whereas the thought in the developed countries,
28:25
SPEAKER_01: the U.S.
28:25
SPEAKER_01: was,
28:26
oh you need to stay on these drugs for light because they fixed
28:29
the chemical
28:30
SPEAKER_01: imbalance.
28:30
SPEAKER_01: That's the narrative.
28:32
SPEAKER_01: So those two studies completely belied a couple things.
28:36
SPEAKER_01: One,
28:36
SPEAKER_01: the narrative of progress,
28:38
SPEAKER_01: but two,
28:39
SPEAKER_01: apparently was the very thing I had been told,
28:42
people have to stay on these medications because they're fixing
28:44
a chemical
28:45
SPEAKER_01: imbalance,
28:46
SPEAKER_01: didn't show up as true in the World Health Organization studies.
28:50
So now if you really want to,
28:51
if you want to say how I exited that time,
28:54
I had this in my mind.
28:57
SPEAKER_01: I had come into that series a believer in the conventional narrative.
29:02
SPEAKER_01: We're finding out these mental disorders are due to chemical imbalances.
29:05
SPEAKER_01: We have drugs that fix them in the great progress.
29:07
SPEAKER_01: That's how I entered that study, doing that series for the globe.
29:11
Then I heard another narrative from people with lived
29:13
experience,
29:14
psychiatric survivors.
29:15
And now I dig into the science and the very first thing I'm
29:19
finding is two studies
29:21
that completely belie that narrative of progress that I was
29:24
hearing from academic
29:26
SPEAKER_01: experts.
29:27
SPEAKER_01: And that's why I basically got a
29:31
A contract to write a book that looked at the treatment of the
29:33
seriously mentally
29:34
ill from colonial times until today and during that thing I
29:37
kept comparing what is
29:39
the narrative being told by the practitioners compared to the
29:42
narrative being told
29:43
by those with lived experience and where do you see where is
29:50
science siding with
29:52
these two narratives and over again there was science actually
29:55
was siding with the
29:56
narrative being told by the people with lived experience the
29:59
patients as opposed to
30:01
SPEAKER_01: You know, the treaters, the psychiatrists.
30:05
SPEAKER_01: And so I think this is really important.
30:07
SPEAKER_01: I did not come with an axe to grind.
30:11
SPEAKER_02: Which is,
30:12
SPEAKER_02: I think if the medication worked in all cases as well as it was claimed,
30:20
SPEAKER_02: you probably wouldn't be doing this work at all.
30:23
SPEAKER_03: Not at all.
30:25
SPEAKER_03: No.
30:25
SPEAKER_02: I think this is a very important point that people forget.
30:27
SPEAKER_02: It's like
30:29
SPEAKER_02: Especially people at the front lines, they want anything to work.
30:34
SPEAKER_02: It's not that they're against,
30:35
SPEAKER_02: it's like if it worked and there are times when it does work,
30:40
SPEAKER_02: right?
30:40
SPEAKER_02: But I think it's the way it is administered is really under question.
30:47
SPEAKER_02: But,
30:48
SPEAKER_02: you know,
30:48
SPEAKER_02: when I was doing a little bit of deep diving into your work,
30:52
SPEAKER_02: I think your work got stronger because you got pushback.
30:57
SPEAKER_02: You got challenged on being selective,
31:01
SPEAKER_02: on some of your arguments,
31:02
SPEAKER_02: and I think you came back each time with very,
31:07
very robust evidence-based arguments against what I thought
31:13
were pretty spurious
31:14
SPEAKER_02: and quite personal attacks,
31:17
SPEAKER_02: which is a classic.
31:19
SPEAKER_02: When you don't like the message, you go for the messenger.
31:21
SPEAKER_02: Has it made you stronger?
31:24
SPEAKER_02: Has it made you bitter?
31:24
SPEAKER_02: Has it made you
31:27
SPEAKER_01: Yeah, of course, Michael.
31:29
SPEAKER_01: It's really great when you're challenged.
31:31
SPEAKER_01: I loved it when I would be challenged.
31:34
SPEAKER_01: Because,
31:35
SPEAKER_01: you know,
31:36
SPEAKER_01: the second book I wrote was Anatomy of an Epidemic,
31:38
which expanded this story about whether this disease model of
31:43
care was really
31:43
SPEAKER_01: working for us and how medications affected us over the longer term.
31:48
SPEAKER_01: What were the forces governing the narrative that was told to society?
31:52
SPEAKER_01: But when you challenge a conventional narrative, right?
31:55
SPEAKER_01: When you say,
31:55
SPEAKER_01: oh listen,
31:55
SPEAKER_01: think,
31:56
SPEAKER_01: actually this narrative,
31:58
SPEAKER_01: this disease model narrative isn't rooted in science,
32:00
SPEAKER_01: it's more of a marketing narrative,
32:02
and actually we're getting worsening outcomes and worsening
32:05
public health outcomes.
32:08
SPEAKER_01: When you do this, you try to be as comprehensive as you possibly can be.
32:13
SPEAKER_01: Like the first thing you want to do,
32:14
SPEAKER_01: like an anatomy of an epidemic,
32:16
SPEAKER_01: what is the evidence cited for long-term use,
32:18
SPEAKER_01: okay?
32:19
Can you find studies that show that you're improving long-term
32:23
outcomes with this form of care?
32:26
SPEAKER_01: On the whole, we're always talking about aggregate outcomes, right?
32:29
SPEAKER_01: And so that's the first thing you do.
32:31
SPEAKER_01: And you would find with antipsychotics and antidepressants, they couldn't
32:35
SPEAKER_01: They don't have that evidence.
32:38
SPEAKER_01: What they would cite as evidence is,
32:39
SPEAKER_01: well,
32:40
SPEAKER_01: listen,
32:40
if you take people who are stabilized on antipsychotics and you
32:44
take half off right
32:45
SPEAKER_01: away,
32:45
SPEAKER_01: the group that has taken off right away relapses at a higher rate.
32:49
SPEAKER_01: And that was seen as, well, the drugs prevent the return of relapse.
32:53
But there's all sorts of problems with that design and that
32:56
sort of thing.
32:57
SPEAKER_01: And it's not really telling you how people are functioning.
33:00
SPEAKER_01: So anyway, the point was
33:04
SPEAKER_01: When I did this,
33:05
SPEAKER_01: I did always want to understand why,
33:07
SPEAKER_01: what is the evidence for their belief system,
33:09
SPEAKER_01: okay,
33:09
SPEAKER_01: what they tell us.
33:10
SPEAKER_01: That's the first thing you try to do.
33:13
SPEAKER_01: And then you try to go through the science and say,
33:15
SPEAKER_01: well,
33:15
SPEAKER_01: what do we know about,
33:16
SPEAKER_01: say,
33:16
SPEAKER_01: the long-term outcomes over time,
33:18
SPEAKER_01: the history,
33:18
SPEAKER_01: the studies that have been done.
33:20
SPEAKER_01: And there you're really trying to follow NIMH studies,
33:22
SPEAKER_01: okay,
33:23
SPEAKER_01: the best studies you can find,
33:24
SPEAKER_01: or World Health Organization studies.
33:26
SPEAKER_01: And you come up with a narrative, you come up with a story.
33:30
SPEAKER_01: Now people are not unhappy, you publish that.
33:33
And they say,
33:33
that guy's biased,
33:34
he's selective stuff,
33:36
that sort of thing.
33:37
SPEAKER_01: That's great.
33:39
SPEAKER_01: Because now you can say, what did I miss?
33:42
SPEAKER_01: Let me see what I missed.
33:44
SPEAKER_01: And if they're just attacking you,
33:45
you can see in fact the hollowness of their attack because they
33:48
can't cite research
33:51
SPEAKER_01: that I actually missed.
33:54
SPEAKER_01: Okay.
33:54
So anytime you're challenged,
33:57
it's not just a matter of defending yourself.
33:59
It's becoming more secure,
34:01
secure in the story that you have told that,
34:04
yeah,
34:04
you got it right.
34:06
SPEAKER_01: And so, and also by the way, so first there was Mad in America.
34:10
SPEAKER_01: Now I,
34:11
SPEAKER_01: after I wrote Mad in America,
34:12
SPEAKER_01: I never had a single actual researcher say I miss cited their stuff.
34:17
SPEAKER_01: Okay.
34:18
SPEAKER_01: Never happened.
34:19
SPEAKER_01: Not by the researchers themselves.
34:22
SPEAKER_01: You might have someone saying,
34:23
SPEAKER_01: oh,
34:23
SPEAKER_01: this guy's biased and that sort of thing,
34:24
SPEAKER_01: but they couldn't point to where I miscited research.
34:28
Now,
34:28
in the anatomy of an epidemic,
34:29
there are hundreds of studies cited,
34:31
okay?
34:33
A hundred of things they could point out where maybe I was
34:36
biased or not presenting
34:38
SPEAKER_01: the data right.
34:39
SPEAKER_01: And this is really interesting.
34:41
SPEAKER_01: So, they couldn't do that except they tried to hang on me on one study.
34:47
SPEAKER_01: It was a study by Martin Harrow and Thomas Jobe.
34:50
SPEAKER_01: It's a naturalistic study, it's not a randomized study.
34:53
SPEAKER_01: And Heroin-Jo found that over the long term,
34:56
the recovery rate was eight times higher for schizophrenia
34:59
patients off medication
35:01
SPEAKER_01: than those who are medication compliant,
35:03
SPEAKER_01: okay?
35:03
SPEAKER_01: NIMH funded.
35:06
SPEAKER_01: Now, it is a naturalistic study, that sort of thing.
35:10
SPEAKER_01: I presented it as a naturalistic study.
35:12
And even in Anatomy of an Epidemic,
35:14
they said,
35:15
well,
35:15
at the very least,
35:16
and quoting Heroin-Jo,
35:19
is that it lends itself to saying we should be using these
35:22
drugs selectively,
35:23
SPEAKER_01: not one size fits all.
35:25
SPEAKER_01: But nevertheless,
35:25
SPEAKER_01: they attacked me by saying that I misunderstood this study because it was
35:30
SPEAKER_01: naturalistic.
35:32
SPEAKER_01: Well,
35:32
SPEAKER_01: the great thing was,
35:34
SPEAKER_01: with this study,
35:35
SPEAKER_01: is I went back to Harold and Job and said,
35:37
SPEAKER_01: I know you're not initially blaming the drugs as causing this worse,
35:41
SPEAKER_01: But look at your own data.
35:42
You find that those with a good prognosis with schizophrenia
35:45
who got off drugs did
35:46
SPEAKER_01: better than those with good prognosis schizophrenia who stayed on.
35:52
SPEAKER_01: Bad prognosis who got off did better than bad prognosis on.
35:58
SPEAKER_01: Those with milder disorders who got off did better with,
36:00
SPEAKER_01: you know,
36:01
SPEAKER_01: if you broke it down,
36:01
SPEAKER_01: mild disorders on.
36:03
SPEAKER_01: And then I said, here's the thing I don't, I think that's most revealing.
36:09
People with milder psychotic disorders at baseline who stayed
36:14
on had worse
36:16
SPEAKER_01: long-term outcomes than people with schizophrenia who got off.
36:21
SPEAKER_01: Now that doesn't make sense, right?
36:23
Unless the drugs are actually worsening long-term outcomes in
36:26
the aggregate.
36:28
SPEAKER_01: So Harrow and Job actually went back to their own data and said,
36:33
Whitaker actually showed us something about our own data we
36:36
need to investigate.
36:37
SPEAKER_01: And they said Whitaker was right.
36:39
SPEAKER_01: Okay.
36:41
SPEAKER_01: So why did this make me stronger?
36:43
Because this was the moment of they were trying to attack me,
36:48
saying I got things wrong.
36:50
SPEAKER_01: And once it was actually investigated by the researchers themselves,
36:53
it's like Whitaker pointed out something about our own data
36:57
that we were missing
36:57
SPEAKER_01: initially.
36:59
SPEAKER_01: So to your point, Michael, I think
37:03
SPEAKER_01: It's really great to be challenged.
37:05
SPEAKER_01: Okay.
37:06
SPEAKER_01: You want to be challenged.
37:08
SPEAKER_01: You want to go sort of through that, you know, that difficulty.
37:13
SPEAKER_01: And,
37:13
SPEAKER_01: but what has happened is because here it is 16 years later,
37:19
SPEAKER_01: after,
37:19
SPEAKER_01: um,
37:20
SPEAKER_01: I published anatomy of an epidemic,
37:24
SPEAKER_01: the research data just keeps getting stronger and stronger and stronger.
37:28
SPEAKER_01: And, and, and that has made me more secure.
37:34
that I have told a story and have done this with Mad in America
37:38
with all the new
37:39
research that we're constantly putting up that does provide
37:44
society with more
37:45
SPEAKER_01: informed consent.
37:47
SPEAKER_01: Individuals with informed consent.
37:49
And frankly,
37:50
it is changing the narrative some,
37:51
but that's the most important thing is
37:55
SPEAKER_01: Am I serving the purpose of providing society,
37:58
SPEAKER_01: practitioners,
37:59
SPEAKER_01: family members,
38:00
people themselves with informed consent about what science is
38:03
telling us about how
38:04
SPEAKER_01: these medications affect people?
38:07
So I think that's a great signpost for I think distilling down
38:17
decades of work.
38:20
SPEAKER_02: Why is informed consent such a threat and a challenge to the system?
38:26
And I'm thinking of the recent attempt by veterans to put a
38:31
bill through about
38:33
SPEAKER_02: informed consent for their own care and my understanding of it.
38:36
SPEAKER_02: I think we're still working on it, but initially it got
38:42
SPEAKER_02: Why is that so threatening to ask for informed consent,
38:45
just to know the benefit of the studies that were conducted
38:52
over years that perhaps
38:53
SPEAKER_02: weren't available in the early introduction of some of these medications?
38:59
SPEAKER_02: Why is that such a threat, do you think?
39:02
SPEAKER_01: Well, it shouldn't be a threat, of course.
39:05
If you really have treatments that do clearly have evidence
39:09
that the benefits
39:11
SPEAKER_01: outweigh the risks,
39:13
SPEAKER_01: then you're going to welcome informed consent.
39:15
And by the way,
39:15
of course,
39:15
informed consent is actually a legal obligation.
39:19
SPEAKER_01: I'm going to take a little bit of a detour here just for a second.
39:22
SPEAKER_01: Remember, I came this as a journalist, right?
39:25
SPEAKER_01: Yeah.
39:26
SPEAKER_01: As a journalist,
39:27
my job is not to tell to the public a narrative that the
39:31
powerful want to be told,
39:34
SPEAKER_01: but in fact,
39:34
SPEAKER_01: to provide society with informed consent,
39:37
SPEAKER_01: okay?
39:38
Then people can make their own decisions about using the drugs
39:40
and that sort of thing.
39:42
SPEAKER_01: Now, why is it such a problem in psychiatry?
39:45
SPEAKER_01: Because a couple things.
39:48
SPEAKER_01: Informed consent
39:50
SPEAKER_01: would not tell of a known pathology, okay?
39:53
SPEAKER_01: Because we just don't know,
39:54
SPEAKER_01: you know,
39:55
SPEAKER_01: the whole chemical imbalance story was never,
39:57
SPEAKER_01: it never panned out.
39:59
SPEAKER_01: So now we're all of a sudden at the very beginning is,
40:01
SPEAKER_01: we don't really know what are the causes of these things,
40:04
SPEAKER_01: okay?
40:05
SPEAKER_01: That introduces a moment of doubt.
40:07
Now how about,
40:08
let's look at the short-term efficacy of say antidepressants.
40:12
SPEAKER_01: Do they in clinical trials, when you do a mental analyses,
40:17
SPEAKER_01: Do they provide,
40:18
does the reduction in symptoms for those in the drug arm versus
40:21
the placebo arm,
40:22
SPEAKER_01: is that difference of such a degree that it amounts to at least a minimum
40:27
SPEAKER_01: clinically important difference?
40:28
SPEAKER_01: In other words, something people would see.
40:30
SPEAKER_01: It doesn't.
40:32
SPEAKER_01: Okay?
40:32
On the HAMD scale,
40:33
the difference is so small,
40:35
it's not seen as clinically important.
40:38
And that's even though the trials are biased by design,
40:40
that sort of thing.
40:42
SPEAKER_01: So you've got that problem.
40:43
SPEAKER_01: By the way,
40:44
SPEAKER_01: with antipsychotics,
40:45
if you look at the new antipsychotics coming to market when
40:47
they do trials,
40:48
the difference in separation between reduction of symptoms on
40:51
the pan scale with
40:52
the drug versus placebo does not rise to the level of a minimum
40:56
clinically
40:57
SPEAKER_01: important difference.
40:57
SPEAKER_01: People don't realize that, even with antipsychotics.
41:00
SPEAKER_01: But now, what do you do with informed consent?
41:03
SPEAKER_01: You first have to look at,
41:04
SPEAKER_01: you should talk about,
41:05
SPEAKER_01: you know,
41:06
SPEAKER_01: what is the chance you'll get a benefit,
41:08
SPEAKER_01: right?
41:10
SPEAKER_01: And look at NNTs for example, number needed to treat.
41:13
SPEAKER_01: With antidepressants it's like seven,
41:15
SPEAKER_01: you got to treat seven people to get one additional benefit.
41:18
That means the other six are suffering the adverse events
41:20
without a benefit.
41:23
SPEAKER_01: Then you got to look at the adverse events with antidepressant,
41:26
SPEAKER_01: sexual dysfunction,
41:27
SPEAKER_01: gastrointestinal problems,
41:29
SPEAKER_01: insomnia,
41:31
also long term there's a sense that they can induce a sort of
41:34
tar dysphoria.
41:36
The reason it's so threatening is if you look at psychiatric
41:39
drugs and you look at,
41:41
SPEAKER_01: I know people who have developed informed consent forms based on this,
41:47
SPEAKER_01: people wouldn't
41:49
SPEAKER_01: People wouldn't be so willing to take these drugs.
41:53
SPEAKER_01: And that information contradicts,
41:56
it belies the narrative that psychiatry has told to the public
42:02
over the past,
42:04
SPEAKER_01: whatever it is,
42:05
SPEAKER_01: 45 years,
42:05
that these drugs are safe and effective and helpful and they've
42:08
been proven to be
42:09
SPEAKER_01: so in clinical trials and side effects are minimal.
42:13
SPEAKER_01: That is just not a story that is consistent with the research literature.
42:17
SPEAKER_02: So,
42:19
SPEAKER_02: I came at it from a very different angle.
42:21
SPEAKER_02: My angle was walking onto a psychiatric ward as a
42:30
SPEAKER_02: Clinical social work intern and not believing my eyes.
42:33
Coming from a business background with no qualifications in the
42:38
field and basically
42:40
SPEAKER_02: going,
42:41
SPEAKER_02: what the fuck are we doing to these people?
42:45
Seeing people who physically looked one way prior to hospital
42:50
and then three months
42:50
SPEAKER_02: later transformed,
42:52
SPEAKER_02: not for the better,
42:53
SPEAKER_02: physically overweight.
42:57
SPEAKER_02: Tremors,
42:58
just a range of problems and I had no agenda other than can we
43:04
not do better than
43:05
SPEAKER_02: this?
43:07
Are we honestly saying that this person must take this
43:09
medication or you're going
43:11
SPEAKER_02: to force them to go back to hospital?
43:13
Are you really saying to me that electric shock treatment is
43:16
the best thing that we
43:17
SPEAKER_02: can do,
43:18
SPEAKER_02: even if in the short term it has some sort of impact?
43:24
I was horrified and I came across Artie Lang in book form and
43:30
his take was these are not the
43:34
SPEAKER_02: Side effects of the medication.
43:36
SPEAKER_02: These are the effects of the medication.
43:38
SPEAKER_02: And then I went to Malaysia and in Malaysia,
43:43
SPEAKER_02: before I went to Malaysia,
43:44
SPEAKER_02: I thought,
43:45
SPEAKER_02: you know,
43:45
SPEAKER_02: a little bit of conspiracy about big pharma and whatnot.
43:49
And I went to Malaysia and I observed big pharma managing all
43:54
points of information
43:55
SPEAKER_02: for individuals and families.
43:58
And then I had a transformative experience because I realized
44:01
this is just business.
44:02
SPEAKER_02: This is a new market.
44:04
SPEAKER_02: We're going to market to it.
44:05
SPEAKER_02: We're going to expand.
44:06
SPEAKER_02: We're going to target children.
44:08
SPEAKER_02: We're going to target geriatrics.
44:09
SPEAKER_02: It's just business until you put the human back in.
44:13
SPEAKER_02: It's a bit like the opioid crisis.
44:16
We're just trying to get numbers until you put the human back
44:20
in and then there's tragedy.
44:22
I heard a comedian recently,
44:23
I think her name was Ruby Sinek,
44:25
she said that
44:27
SPEAKER_02: Psychiatric medication,
44:29
SPEAKER_02: she was put on Lexapro when she was a teenager,
44:32
SPEAKER_02: and she said it took away her suicidal thoughts,
44:36
SPEAKER_02: but it also took her capacity to have an orgasm.
44:40
SPEAKER_02: So she describes it as, it's not science, it's magic.
44:45
SPEAKER_02: You know, Rumpelstiltskin would say, magic comes with a price, right?
44:50
SPEAKER_02: So it's like,
44:52
SPEAKER_02: Often they will talk,
44:54
SPEAKER_02: if you take ECT,
44:55
SPEAKER_02: they don't actually know why some of those effects happen.
44:58
SPEAKER_02: Some of these medications,
44:59
SPEAKER_02: they don't know why they're doing what they're doing,
45:03
SPEAKER_02: but some of the side effects are severe and brutal and life-changing.
45:10
SPEAKER_02: And I think my issue is we don't respect medication.
45:16
To respect medication,
45:16
you need to know what it does,
45:19
both of benefit and the negative.
45:22
SPEAKER_02: It's kind of why I'm using this word pharmakon,
45:24
SPEAKER_02: this Greek word,
45:26
SPEAKER_02: you know,
45:26
SPEAKER_02: it's both a poison and a cure.
45:28
SPEAKER_02: And I think you and I,
45:30
SPEAKER_02: I think it's fair to say,
45:31
SPEAKER_02: correct me if I'm wrong,
45:33
SPEAKER_02: we're not medication abolitionists by any means.
45:38
SPEAKER_02: We recognize that for some people,
45:42
SPEAKER_02: particularly in the short term in crisis,
45:44
SPEAKER_02: it can be life saving.
45:46
SPEAKER_02: But we're talking about what are the longer term implications and also
45:52
Not having it as first point of call so a real rub here when we
45:56
talk about
45:57
psychosis every person I've ever met with first episode
46:01
psychosis it's never been
46:04
an issue right and it's rarely led to medication but the rub is
46:09
nearly every one of
46:10
SPEAKER_02: those people I've seen outside the normal system
46:14
SPEAKER_02: So it's been,
46:15
SPEAKER_02: for example,
46:15
I've been living in another country and I get a phone call at
46:20
three in the morning
46:21
SPEAKER_02: from a fellow expat who says,
46:23
SPEAKER_02: I think my wife's losing her mind or my son's getting into it.
46:27
SPEAKER_02: Can you come and see them?
46:28
SPEAKER_02: So it would be a first part of call would be me.
46:35
And I'm going to engage with that in perhaps a different way
46:39
than an ambulance
46:40
SPEAKER_02: arriving,
46:41
SPEAKER_02: a fire truck,
46:42
SPEAKER_02: a police car.
46:45
SPEAKER_02: It's more an environment of holding and normalization and helping someone
46:52
SPEAKER_02: understand that it's okay.
46:54
SPEAKER_02: This is a temporary experience.
46:56
SPEAKER_02: It's probably stress related.
46:59
SPEAKER_02: The people I see now have been the whole way through the system,
47:03
SPEAKER_02: maybe forcibly admitted,
47:08
SPEAKER_02: forcibly given medication,
47:11
SPEAKER_02: possibly assaulted in hospital.
47:14
SPEAKER_02: or bullied in hospital have no trust for the system whatsoever.
47:19
So it's nearly a very,
47:21
very different presentation than first episode,
47:26
first contact psychosis.
47:28
SPEAKER_02: And of course it has a heavy iatrogenic core to it.
47:36
SPEAKER_02: Middleton said a couple of years ago,
47:38
SPEAKER_02: you know,
47:39
SPEAKER_02: with psychosis,
47:40
SPEAKER_02: and I use that term broadly to mean sort of any elevated state,
47:45
SPEAKER_02: it's not so much the experience,
47:46
SPEAKER_02: but how everyone around you responds.
47:50
SPEAKER_02: And I think that that's quite powerful.
47:52
SPEAKER_02: And probably the biggest response is the medication in the short term.
47:59
You know,
47:59
people refer to you as the father of the movement,
48:02
which I think is fair.
48:05
SPEAKER_02: And,
48:05
SPEAKER_02: you know,
48:06
SPEAKER_02: again,
48:06
I don't think we can express enough gratitude to what you've
48:10
done and what you've
48:11
SPEAKER_02: created.
48:11
SPEAKER_02: But where are we, Bob?
48:14
SPEAKER_02: You know, you've dedicated decades.
48:17
SPEAKER_02: I've been working on it for decades.
48:18
SPEAKER_02: Where are we today?
48:20
SPEAKER_02: And what is the message that we really need to try and communicate?
48:25
SPEAKER_01: That's a really good question.
48:28
SPEAKER_01: Just to circle back just a bit,
48:31
SPEAKER_01: the problem is we got a form of care that was driven by two impulses.
48:35
SPEAKER_01: One was pharmaceutical money, building markets, okay?
48:39
And of course,
48:40
with their financial prowess,
48:42
they can really shape narratives.
48:45
SPEAKER_01: The second problem was we had a guild,
48:47
SPEAKER_01: American Psychiatry,
48:48
SPEAKER_01: that wanted to present itself as treating diseases of the brain.
48:53
So they also had a narrative that fit in with the
48:55
pharmaceutical narrative,
48:56
and they adhered to that narrative even when their own science
48:59
didn't support it.
49:01
SPEAKER_01: And the problem is,
49:02
SPEAKER_01: and I just want to go back to the drugs,
49:04
SPEAKER_01: just because the drugs don't fix a chemical imbalance,
49:07
SPEAKER_01: you can still have a question about best use of drugs,
49:10
SPEAKER_01: right?
49:10
SPEAKER_01: For whom and for how long, right?
49:13
SPEAKER_01: And then at what doses.
49:14
But that got lost because once they got into this chemical
49:17
imbalance story,
49:17
SPEAKER_01: it was,
49:18
SPEAKER_01: oh,
49:18
SPEAKER_01: you got to take these drugs for life.
49:20
SPEAKER_01: And the second thing is,
49:23
SPEAKER_01: It's such a tragedy what you're speaking about.
49:26
Because with this narrative we have now,
49:28
you have a first time of difficulty.
49:31
SPEAKER_01: Call it a psychotic break, maybe a manic episode.
49:34
SPEAKER_01: You're now diagnosed with a chronic mental illness, basically, right?
49:39
And you basically go down this path where you're going to be on
49:42
drugs for the rest of your life.
49:43
SPEAKER_01: And we know that comes with all sorts of impairments.
49:47
But what you saw in Malaysia and all is so often these are
49:50
episodic problems,
49:51
right?
49:51
SPEAKER_01: People would have a time of difficulty.
49:54
So we have a form of care that transforms what could be
49:57
episodic problems into
49:59
SPEAKER_01: chronic conditions.
49:59
SPEAKER_01: And that is so tragic.
50:03
SPEAKER_01: So where are we today?
50:04
SPEAKER_02: Can we just pause on that?
50:05
SPEAKER_02: Because I think that is huge.
50:06
SPEAKER_02: Just say that again, would you?
50:09
SPEAKER_01: We have a form of care
50:11
SPEAKER_01: that transforms what so often could be episodic difficulties into chronic
50:18
SPEAKER_01: conditions,
50:19
SPEAKER_01: into chronic lifelong conditions.
50:21
SPEAKER_02: So you sort of- I would concur.
50:24
SPEAKER_02: It's very reductive and simple, but I would concur.
50:28
SPEAKER_02: I mean, that's a powerful, powerful statement.
50:32
And it's going back to those first episodes that I experienced
50:36
that they weren't
50:37
SPEAKER_02: such a big deal.
50:39
You know,
50:39
we all get into difficulty,
50:42
you know,
50:42
at a greater or lesser extent.
50:45
SPEAKER_02: Sorry,
50:45
SPEAKER_02: I just wanted to reinforce that because I think it's,
50:47
SPEAKER_02: you know,
50:47
SPEAKER_02: you distill it down to something that's deeply important.
50:52
SPEAKER_01: And by the way,
50:53
SPEAKER_01: what we have with the open dialogue people in Northern Finland,
50:56
when they reconceived it not as a chronic disorder going back
50:59
to the 1990s and
51:00
SPEAKER_01: didn't immediately medicate everybody.
51:02
SPEAKER_01: What were their five-year results?
51:04
SPEAKER_01: They did a lot of psychotherapy, family work, etc.
51:07
SPEAKER_01: What were their five-year results with first-episode patients?
51:11
80% at the end of five years were working or back in school and
51:14
asymptomatic,
51:15
okay?
51:16
In other words,
51:17
they had a time of whatever you want to call it,
51:19
schizophrenia or psychosis.
51:22
SPEAKER_01: There was like 15 to 20% of those first episodes for whatever reason.
51:28
SPEAKER_01: went down a more chronic course.
51:31
But if you were to talk to the people who were involved in that
51:33
going back to the
51:34
SPEAKER_01: early 1990s,
51:35
SPEAKER_01: they said,
51:36
by not immediately medicating and seeing it as more of a
51:41
manifestation of the
51:42
SPEAKER_01: disruption in their own life,
51:46
We re-imagined what was possible and sure enough,
51:50
so often these were episodic problems,
51:51
okay?
51:52
So that's exactly,
51:54
that's like a scientific confirmation of what you're saying,
51:57
okay?
51:57
SPEAKER_01: And they did this for study after study.
52:01
SPEAKER_01: Where are we today?
52:04
SPEAKER_01: On the one hand, there's a reason for optimism.
52:07
SPEAKER_01: The chemical imbalance story has fallen apart.
52:11
There's acknowledgment that the diagnoses in the DSM have not
52:14
been validated as
52:15
SPEAKER_01: real diseases,
52:17
SPEAKER_01: okay?
52:18
SPEAKER_01: So,
52:19
SPEAKER_01: and there's,
52:20
you can go into the research literature and people are
52:22
admitting we don't have any
52:23
SPEAKER_01: evidence we're improving long-term outcomes.
52:25
SPEAKER_01: Now,
52:26
SPEAKER_01: the researchers who have done this by and large seeking to sort of defend
52:30
SPEAKER_01: psychiatry,
52:30
SPEAKER_01: they don't want to say we're doing harm as if there's equipoise.
52:35
SPEAKER_01: But they can't,
52:36
they admit they can't come up with evidence that they're
52:39
improving on the long,
52:40
SPEAKER_01: sort of the natural capacity to recover.
52:43
SPEAKER_01: And there's a man named Nasser Ghami,
52:45
SPEAKER_01: who's a very famous psychiatrist,
52:47
SPEAKER_01: mood disorders guy,
52:48
SPEAKER_01: who wrote a paper a couple years ago looking at this.
52:51
SPEAKER_01: Do we have any evidence that these drugs improve long term outcomes?
52:54
SPEAKER_01: He said no.
52:55
He sort of said lithium may be different because it reduces
52:58
suicide in his opinion.
53:00
SPEAKER_01: But he said because of that we should be using these drugs
53:03
SPEAKER_01: in as low a doses as possible and as short a time as possible.
53:08
SPEAKER_01: Now that's a big change from keep people on these drugs for life, right?
53:12
SPEAKER_01: He's including antipsychotics by the way.
53:15
So,
53:16
I think we have,
53:17
we know the drugs,
53:18
we know the DSM disorders haven't been validated.
53:21
SPEAKER_01: Chemical imbalance story has fallen apart.
53:24
SPEAKER_01: We know that outcomes, long-term outcomes are not good.
53:28
SPEAKER_01: By the way,
53:28
SPEAKER_01: the head of JAMA psychiatry,
53:29
SPEAKER_01: Dost Unger,
53:30
SPEAKER_01: published a piece,
53:31
SPEAKER_01: I think it was last year,
53:32
SPEAKER_01: saying,
53:32
SPEAKER_01: we have to admit that outcomes have worsened in the last time,
53:35
SPEAKER_01: last 20 years for those with major disorders.
53:39
SPEAKER_01: The burden of mental illness is going up.
53:41
You have people at the World Health Organization who are
53:43
calling for a revolution,
53:44
SPEAKER_01: former Special Rapporteur for Health.
53:48
We need a revolution away from this disease model and look at
53:53
the social determinants of health.
53:56
SPEAKER_01: So, in many ways, the narrative is changing.
54:00
SPEAKER_01: Okay?
54:00
SPEAKER_01: Moving away from this disease model, seen as a failed model.
54:05
SPEAKER_01: And that opens the door for a new way of thinking about things,
54:07
SPEAKER_01: where you do pay attention to the social determinants of hell.
54:11
SPEAKER_01: Okay?
54:11
SPEAKER_01: That's good.
54:13
And honestly,
54:13
I believe Mad in America has played a role in that shift in
54:17
that narrative.
54:18
SPEAKER_01: Okay?
54:20
SPEAKER_01: But, have things changed in terms of actually what happens to people?
54:28
SPEAKER_01: Do we have first,
54:29
SPEAKER_01: when people come in with the first episode of psychosis,
54:32
SPEAKER_01: they come to an emergency room.
54:34
Are they given a chance to sort of have a time of psychosis or
54:38
are they medicated right away?
54:40
SPEAKER_01: They're medicated right away.
54:42
And then when they're discharged so often increasingly they
54:45
might even be on an AOT
54:46
and assisted outpatient treatment order that requires them to
54:49
take antipsychotics.
54:52
SPEAKER_01: So what is happening is within the world of science,
54:58
SPEAKER_01: the research circles,
55:00
SPEAKER_01: there is this admission that things haven't worked out.
55:04
But that message in generally is not informing practice and
55:08
it's actually not
55:09
SPEAKER_01: really getting out to the population as a whole.
55:13
SPEAKER_01: Our use of antidepressants keeps going up,
55:15
SPEAKER_01: the medicating of kids keeps going up,
55:18
SPEAKER_01: that sort of thing.
55:19
We can talk about the veterans and informed consent because
55:23
they were asking for
55:24
SPEAKER_01: informed consent and they can't even get it.
55:27
SPEAKER_01: But you're asking the key question, Michael, where are we today?
55:31
Where we're at is where one narrative of science that was
55:34
pitched to the public
55:35
SPEAKER_01: beginning in 1980,
55:36
SPEAKER_01: it's collapsed.
55:38
SPEAKER_01: Wherever you look,
55:39
SPEAKER_01: there's acknowledgement that it's collapsed,
55:42
SPEAKER_01: which opens a door to a new conception,
55:44
SPEAKER_01: a new paradigm of care.
55:45
SPEAKER_01: But prescribing practices,
55:48
SPEAKER_01: treatment practices,
55:50
SPEAKER_01: they've maintained the same,
55:51
SPEAKER_01: and if anything,
55:52
SPEAKER_01: they're just
55:53
SPEAKER_01: becoming more and more dominant.
55:55
The medicating of kids,
55:57
keeping the people on antidepressants,
55:59
that sort of thing.
56:00
SPEAKER_01: So there's a real mismatch between what the science is saying,
56:04
SPEAKER_01: where we are,
56:06
SPEAKER_01: and the practices that are being done.