Stefan Molyneux, host of Freedomain Radio, interviews Dr. Daniel Carlat about his new book 'Unhinged: The Trouble with Psychiatry - A Doctor's Revelations about a Profession in Crisis' www.danielcarlat.com
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| Hi everybody, this is Stefan Molyneux from Freedom Main Radio. | |
| This is an interview with Daniel J. Carlatt, MD, Associate Clinical Professor of Psychiatry at Tufts University School of Medicine. | |
| He is the Editor-in-Chief at the Carlatt Psychiatry Report, a monthly newsletter on psychopharmacology, widely read by psychiatrists and nurses in the United States. | |
| He received his undergraduate education at the University of California at Berkeley, where he graduated in 1983 cum laude and Phi Beta Kappa. | |
| He received his medical degree at the University of California in San Francisco and went on to complete a residency in psychiatry. | |
| At Massachusetts General Hospital in Boston from 1992 to 1995. | |
| He was chief resident of the MGH inpatient psychiatry unit in 1995. | |
| He has recently released the book, Unhinged, The Trouble with Psychiatry, A Doctor's Revelations, about a profession in crisis. | |
| The links will be below the video and in the notes for the podcast. | |
| Hi everybody, it is Stefan Molyneux from Free Domain Radio. | |
| I have Daniel Carlatt on the line and thank you so much for taking the time and thank you for writing the book Unhinged. | |
| I thought it was a very, very interesting read. | |
| I thought very humanely put together and very humanitarianly expressed, if I can use that phrase. | |
| Oh, well thank you, Stefan. I tried to write a book that was understandable to the general public and I tried to avoid as much of the psychiatric jargon As possible so that people could really have a feel for what it's like to go through the training process and to actually work as a psychiatrist. | |
| So you have some I think very fascinating things to say based on a couple of revelations you had about some of your patients. | |
| What in a nutshell is the problem that you perceive with psychiatry at the moment? | |
| At the moment the problem is that when you go to see a psychiatrist Many people assume that they're going to get a kind of holistic or integrative treatment approach, meaning not just medications, but some attempt to do some kind of psychotherapy. | |
| And not all people, but some people are still shocked when they make an appointment with a psychiatrist and they have somebody asking them a lot of questions over the course of an hour with a clipboard writing down answers. | |
| At the end of the hour, rather than setting up a plan for psychotherapy, there is often talk about a medication. | |
| More times than not, at the end of the typical first hour, so one hour after meeting a new patient, most psychiatrists will write out a prescription. | |
| To deal with whatever psychological problem the person is enduring. | |
| And that kind of fragmented care where the psychiatrist writes the prescription and then refers the patient off to a different worker, a different clinician for the therapy, is problematic. | |
| And that's kind of where we have come to over the last 20 years, even though It's not a situation that we really want. | |
| Even psychiatrists don't really want that situation. | |
| And I think it's an interesting statistic that you talk about in the book that there's only one out of ten practicing psychiatrists currently does any form of therapy, and I would imagine those aren't exactly the youngest psychiatrists on the block who may have been trained sort of in the 50s and 60s. | |
| Yeah, I mean, and I think it's probably that statistic is a little misleading. | |
| I mean, I would say that Probably somewhat more than one out of ten psychiatrists do some form of therapy. | |
| But I think the key take-home message from that statistic and some of the others is that the vast majority of psychiatrists see themselves as being psychopharmacologists rather than psychotherapists. | |
| And a psychopharmacologist really is seeing a patient for an hour or so at the beginning and then Seeing them for 15 to 20-minute sessions every month, every two months, sometimes as infrequently as every year for follow-up sessions with the expectation that anything that's being missed by the medication is being taken up during therapy with a social worker or a psychologist. | |
| And that is quite a departure from, of course, the original goal of psychiatry, which, you know, if you look at it sort of mid to late 19th century, the idea that, I mean, of course, there was the original biological drivers trying to find, as you mentioned in the book, syphilis was considered to be one of the breakthroughs in the understanding of mental illness as having biological origins. | |
| Then there was a phase of, you know, the traditional way that people look at psychiatry, that there's a guy with a goatee, you know, and you're lying on a couch and he's asking you about your mother in strangely accented Austrian or German. | |
| And then it sort of swung back, as you've pointed out in the sort of 80s and 90s, it swung back very much towards the biological model, which came out of some success rates that were perceived for SSRIs, but also because there was a frustration, if I understand your argument correctly, there was a frustration with some of the limitations of existing talk therapy. | |
| Yes, and there's still a lot of psychiatrists out there with the goatees asking questions in whatever accents they're asking questions in, but I think the difference is that the results of that asking question and listening to answer process is very different now from what it used to be. | |
| Now when we're asking our questions, we're looking for patterns in the responses that give us a hint that there's a biological underlying disorder That is amenable to medication. | |
| Whereas in the past, we were asking these questions in order to understand whether there was something wrong with the patient's life, with the patient's relationships, with their work life, with their ambitions, with their goals, that they may not even understand. | |
| Something that is holding them back from fulfilling their dreams. | |
| And that used to be a perfectly legitimate Question and type of hypothesis that a psychiatrist would go through. | |
| Now it's very rare. | |
| It's extremely rare to have a psychiatrist see his or her job as coming up with ideas for how a patient can improve their lives other than through the medication route. | |
| Right. And so the elusive goal of happiness, and it's elusive because sometimes the moment we grab it, it appears to be sort of an electric soap bubble that disintegrates in our hands. | |
| But the old argument from philosophy was, as Socrates put it, or Aristotle, was reason equals virtue equals happiness. | |
| And if you have a deficiency in happiness, it's due to a deficiency in virtue or a deficiency in rationality. | |
| And that is to some degree... | |
| I mean to characterize it very broadly the way that some of the old-school psychology or psychiatry used to work and then the medical model came along and you had said sort of treating an underlying biological condition that seems to be a very elusive thing to pin down in the statistics and in the literature as you point out what is being treated remains very very murky to say the least. | |
| It does. We do know that what some of our medications do we do know that there are Neurotransmitters, neurochemicals in the brain, most famously serotonin, norepinephrine, dopamine. | |
| Most people have heard of these, have talked about them. | |
| They enter the public vocabulary very quickly, you know, and maybe you're a little bit low on your serotonin, you need to take your Prozac to up your serotonin. | |
| People talk that way. | |
| And yet, when you really look at the research, we don't understand The underlying biochemistry of any of the disorders that we treat. | |
| While our medications may increase levels of neurotransmitters, we really have no idea whether it's that increase in levels of neurotransmitters that's actually causing whatever symptomatic improvement that we're seeing. | |
| Maybe that doesn't matter, and there are certainly other medical professions. | |
| Neurologists who treat migraines don't necessarily understand how migraines work, and yet they have imitrex and various medications that treat them well. | |
| You can go down the line through other medical specialties where something similar is true, but there's no other specialty like psychiatry where literally every single disorder that we treat, we have only the most primitive understanding of the underlying pathophysiology. | |
| I think Sometimes we tend to oversell our knowledge and by overselling our knowledge, we tend to make it seem okay to ignore the psychotherapy piece of treatment. | |
| Right, because of course the devil's advocate position would be that somebody, a neurologist who's treating a migraine doesn't prescribe talk therapy at the same time but it seems that most psychiatrists will prescribe medication plus talk therapy which really does cloud the efficacy of the medication if what is going on is efficacy through the talk therapy. | |
| Do you think that's a fair point? Yes, well and certainly in other fields of medicine it's less likely for talk therapy to be efficacious and effective such as for migraines. | |
| Occasionally it will be, occasionally it won't. | |
| In psychiatry, we have plenty of very large, randomized, controlled, double-blind, gold-standard research trials showing that psychotherapy does work very well for many of the conditions. | |
| In some cases, it works just as well as medications. | |
| In other cases, psychotherapy works even better. | |
| Post-traumatic stress disorder, obsessive compulsive disorder come to mind as being examples of that. | |
| And then in other cases, medications clearly are the treatment of choice. | |
| But psychiatry is unique in the sense that we have these two alternative treatments that the psychiatrist could theoretically do, both of which are often equally effective. | |
| And yet, the psychiatrist is choosing, based on his or her training, based on reimbursement, based on a lot of factors, to use only one of the possible treatments and is turfing the other treatment to someone who usually has less training or different training. | |
| In the case of psychologists, they often have just as much training, but it's just a very different kind of training. | |
| Right, and just off the top of my head, and I'm certainly not trying to say that psychiatrists are driven only by economic factors, but as everybody knows who's studied any economics, people do respond to incentives, as you say. | |
| An hour per patient versus 15 minutes per patient gives you significant gains. | |
| And also, of course, if you do not have relationships with pharmaceutical companies, there's a fair amount of income in the psychiatric profession through relationships to psychiatric drug manufacturers. | |
| And also, I would assume that it's a little less volatile to say to somebody, take a pill rather than, you know, you need to deal with your relationship with your mom, you know, to pull a cliche out of my armpit in some sort of way. | |
| Are there any other factors you think that are drawing people more towards drugs than talk therapy? | |
| Well, part of the factor is that we listen to our patients and people do talk with their feet and people are making appointments to see psychiatrists because often they know that they're going to get a medication and people are busy. | |
| They're working hard. They don't necessarily have time to fit in a psychotherapy session a week. | |
| into their schedule that may include exercise, spin classes, taking their kids to soccer practice, etc. | |
| It is sometimes much more convenient to take a pill if the pill works. | |
| Personally, I have no problem with that. | |
| If we at some point in the future were able to find a pill to solve all psychological problems, In a very meaningful way, I don't mean just a Band-Aid approach that just temporarily solves the problem, but in a meaningful way. | |
| I see no inherent disadvantage to that, but we certainly aren't at that point now. | |
| Just to answer your question, it's multifactorial. | |
| It's not just that the psychiatrists are greedy doctors wanting to make money. | |
| Some of them are, some of them aren't. | |
| And it's not just that the pharmaceutical company is pushing us to prescribe more drugs, but it's also the consumers that are finding, gee, it's really convenient to wake up in the morning, brush my teeth, pop a pill in my mouth, and have my depression stay at bay rather than have to deal with psychotherapy. | |
| And I can certainly agree with that. | |
| I mean, if there was a pill to give us a six-pack, how many of us would do a thousand crunches a week? | |
| Exactly. You know, absent side effects, I can certainly understand that argument. | |
| Life is hard enough, right? | |
| Yeah, life is hard enough. | |
| Now, the two factors that would argue against that, in my opinion, is one that there are, of course, side effects. | |
| And some of the side effects can be pretty negative, particularly if you add medications to counter side effects. | |
| And as you say, the people can end up on a cocktail of up to half a dozen or more. | |
| Different medications, the long-term effects of which are not exactly well known or studied at the moment. | |
| That's the one aspect. | |
| And the second is, I'm not sure how many patients... | |
| I think this is the case that you bring up in the book. | |
| I'm not sure how many patients or potential patients are really clear on the fuzziness or non-empirical scientific backing for the efficacious nature of these pills. | |
| Right, and those are two... | |
| There are two large topics, each of which could probably form the basis for an entire show, but they're important. | |
| When patients come in and they are prescribed a medication, they may be told by their doctor about the potential side effects, but it's one thing to be told about them. | |
| Or it's one thing to see on a TV commercial the long absurd list of side effects that always include, you might die on this medication, but that's very rare. | |
| But then it's another thing to actually experience them and the side effects are so unpredictable in my experience. | |
| You know, I could prescribe the medication to somebody and it could be experienced by them as taking a vitamin C tablet without absolutely no side effects whatsoever. | |
| But on the other end of the spectrum, I could prescribe what would be considered to be a benign medicine, a Prozac-like medication that usually doesn't cause any side effects, and they could call me back the next day and tell me that they are so agitated that they're jumping out of their skin and that they are on their way to the emergency room to get treatment for it. | |
| Most people fall somewhere in between, and the most common is A side effect is some sort of sexual problem affecting 50% to 70% of patients who take the most common types of antidepressants. | |
| Not a life-threatening side effect, but kind of a life-deadening side effect for a lot of patients. | |
| Yeah, I would say that the depression must be pretty bad for people to prefer sexual dysfunction to that degree because that's a pretty important source of pleasure in life. | |
| Yes, of course. And there are definitely people that experience the lack of sex drive or the lack of the ability to perform sexually and decide that they're willing to pay that price. | |
| But there are others who may not even realize that there are options. | |
| And because of the nature of the very quick visits these days with doctors and psychiatrists, there are many cases where a depression might be treated perfectly adequately by a few weeks of therapy or even watchful waiting because sometimes depressions go away on their own. | |
| And in those cases of therapy or just waiting it out, of course, there aren't any side effects at all. | |
| Right. Or you could get into beneficial lifestyle things like diet and exercise which have been proven fairly efficacious in treating some milder forms of depression and end up with better life habits overall rather than pills and so on. | |
| Exactly. I think the problem is that there are very few incentives for psychiatrists to do anything other than to prescribe a medication because that's what they've been trained to do. | |
| If your only tool is a hammer, everything looks like a nail as the cliche goes. | |
| I think that is a problem. | |
| That is a continuing problem in my profession. | |
| I'd like to Ask a little bit about some of the stuff which is troubling to the layperson, even the fairly amateur layperson like myself, which is, you may or may not want to speak about this, but some of the off-label prescriptions towards children that have not gone through FDA approvals or the long-term health effects on kids. | |
| I think, as you point out in the book, 5% of children and 10% of adults are on antidepressants. | |
| 5% of children are on some sort of SSRIs. | |
| I mean, it seems like it's a stretch for some of the stuff for adults, given the lack of a biological test or basis for what is claimed to be an illness. | |
| But I think with regards to children, that's where I think there's a lot of recoiling in general society as a whole. | |
| And it may be just a lack of information. | |
| I don't want to, you know, lead a witch hunt where... | |
| There's better information, but it does seem that there's quite a lot of, not exactly experimentation, but quite a lot of, you know, let's medicate and see for kids without the long-term effect study on health. | |
| Yes, and that is the case for treating children for a range of problems, not just depression, but also increasingly for attention deficit disorder and for bipolar disorder or other Severe disorders where children are so troubled that they literally cannot function and they suffer violent outbursts toward others or toward themselves. | |
| Now, those are really serious cases. | |
| These are children that really need treatment. | |
| Often the non-medication approach just is not available to them because It's much more time-intensive to understand the situation of a child and to treat them than it is for an adult because you're having to talk to parents and teachers and social service agencies and whatnot. | |
| So that is one of the incentives for the medication option to come up when we are treating children with severe conditions. | |
| And you're quite right to say let's not go on a witch hunt because I've certainly treated children with meds. | |
| Plenty of very skilled colleagues in child psychiatry that try to minimize their use of prescription medications but find many times that they work very well and they also try to either do therapy themselves or find the proper combination of treaters, therapists, social workers to do the right kind of treatment for children. | |
| But I think You know, in the sense that we are acutely aware of the vulnerability of children, it does cause society a great deal of discomfort to hear statistics like, you know, there's a 40-fold rise in the diagnosis of bipolar disorder in children, which was one of the statistics over the last 10 years, one of the statistics that I talked about in the book. | |
| And when you have more and more children, especially young children diagnosed with a serious condition like bipolar disorder, They are inevitably going to be prescribed serious medications like antipsychotics, lithium, Depakote, which are anticonvulsant medications. | |
| All of these meds have potentially quite harmful side effects and some of the side effects are even worse in children such as obesity on antipsychotics than they are in adults. | |
| It's a tough problem. | |
| It's a nuanced problem and the solutions, I think, are to be very thoughtful as clinicians in treating children. | |
| Right. I mean, one of the things that, you know, theoretically could be a tragedy is, I mean, with sort of family disintegration, increased poverty, you know, fewer resources available to children, the atomization of extended family, which is less childcare availability, deterioration of the environment in public schools, you know, which makes children more restless and so on. | |
| It just seems to me, and again, this is completely amateur opinion hour, so I apologize if I'm treading on any professional toes, but it just seems to me that it could be quite tragic that rather than trying to deal with things, which no psychiatrist would be able to do, of course, as an individual or even as a community, when we're looking at the sort of familial dysfunction as a whole, which is resulting in destructive or negative behaviors, to say, well, you know, here's a pill, rather than trying to tackle the whole thing, which would be a full social effort. | |
| Again, I'm not sort of trying to pin the whole thing on psychiatrists, but We don't know for sure yet, but it would be a tragedy if that were the case. | |
| Yes, indeed. I would agree with that. | |
| Now, again, I'm sort of trying to present the psychiatrist's view of issues, which I don't want to speak for general society, but a ridiculous thing to try and do, but some rumblings that I've heard among the laypeople about the DSM-5, which I guess is coming out in a year or two. | |
| That there seems to be some misunderstanding or confusion about the nature of the DSM, which is the statistical diagnosis. | |
| Sorry, why don't you give me the full phrase because it escapes me at the moment. | |
| Oh yes, that is the Diagnostic and Statistical Manual of Mental Disorders. | |
| Right. And this is not based or is very rarely based on sort of objective biological medical science but is voted on, which is not to say completely irrelevant, but is voted on by a group of psychiatrists and has a few hundred, and I think that's going to expand to some degree, a few hundred disorders that people have to meet a certain number of, I guess, Criteria for having sort of low or high ratios of sort of minor depression or major depression. | |
| You talk about, you know, sort of average shyness versus social anxiety disorder and so on. | |
| I wonder if you could talk a little bit about the process by which that is being expanded and some of the controversy even within the psychiatric community about that manual. | |
| Well, yeah. I mean, one of the big controversies that has been ongoing is that if you look at the history of the manual, which was first published back in 1952 the number of mental and psychiatric diagnoses has increased progressively so that there were about a hundred in 1952 in 68 when the next version came out there were a hundred and eighty or so and it kept going and then the current version DSM-IV has approximately 300 Different diagnoses in it. | |
| So, people scratch their heads and say, you know, from 1950 to now, could we really have gone from 100 mental disorders to 300 mental disorders and how could that have possibly happened? | |
| Clearly, over the course of those 50 or 60 years, people haven't changed greatly in their brain chemistry. | |
| So, there's something arbitrary going on and you're quite right. | |
| I mean, Over the years, as we gain better understanding of people and as we learn about the different kinds of problems that they face, psychiatrists have done epidemiological research where they simply find out how many people have certain symptoms and they've come up with what they would call more sophisticated ways of describing suffering so whereas we used to just think of a something called anxiety neurosis in the 1950s which sort of was a catch-all category for anybody who was nervous now we talk about panic disorder as opposed to obsessive-compulsive disorder as opposed to generalized anxiety disorder and phobias and so on and so forth so there are now eight or nine different anxiety disorders and that's not necessarily a bad thing I mean I think that's That mirrors scientific progress and more sophisticated classification in medicine and in other fields, | |
| and that's kind of how science operates. | |
| But people become uncomfortable when it seems clear that we are making what appear to be arbitrary decisions about names of disorders, and these decisions can have pretty large implications when it comes to treatment. | |
| If you happen to change the diagnostic criteria for, say, bipolar disorder or depression from one manual to the next, that can mean that many millions of more people are diagnosed with that disorder than used to be diagnosed. | |
| Of course, that comes with implications for medications or therapy and psychiatric disability payments and whatnot. | |
| I think that's one of the big criticisms. | |
| And that's a real criticism, but I think that critique can go a bit too far. | |
| Right, right. And yeah, people are, I guess, concerned that normal human functioning can at some point become pathologized and medicated for, you know, profit. | |
| Again, I'm not trying to sort of imply that psychiatrists are driven by profit, but there is that sort of issue. | |
| And of course, there is the state as well, right? | |
| So there are hundreds of dollars that are presented to school boards for every child who's on medication. | |
| And that may, again, it's hard to know, but that may skew people's decision making when it comes to that. | |
| When a system is flawed, I think public schools in the United States in particular can be viewed as pretty flawed. | |
| When systems are flawed, oftentimes, of course, children are the easiest to change, so to speak, because they have the least power. | |
| And rather than try and improve school functioning or that, they may have some incentive to say, well, the issue is biochemical. | |
| Would it be unfair though, and I'm sort of going to the limits of criticism as far as I understand it, that I've seen some criticisms of psychiatric diagnosis to say that until the science can establish a biological route for the issues, and it may be hazy, it may be imperfect, a lot of these diagnoses, as you point out in your book, overlap. | |
| Would it be unfair to characterize these as helpful metaphors rather than scientific classifications? | |
| Well, I believe that they are scientific in the sense that if you have a diagnosis such as schizophrenia, let's say, it is scientifically possible to identify a series of symptoms that seem to cluster together in certain individuals who are unable to function in their lives. | |
| And I don't think it's unfair or necessarily unscientific to come up with a scientific sounding name like schizophrenia and apply that name to people who appear to cluster together symptomatically and who appear to benefit from similar kinds of treatment. | |
| I wouldn't really call that a metaphor but of course in choosing schizophrenia I'm sort of choosing the most biologically based quote-unquote sort of disorder that we treat so I think there is some science to that but There's been much more criticism about things like social anxiety disorder, | |
| where we're really treading a fine line in some cases between normal shyness and an actual disorder. | |
| There's been books written about social anxiety disorder versus shyness, and that's one of the very hazy sort of diagnoses that we do have to be careful of so that when someone comes into my office and says that they feel uncomfortable in crowds or that they blush or have anxiety symptoms when they come into a party where they don't know anybody, | |
| I have to be very careful not to pathologize something that might be a normal human experience. | |
| I, too, feel uncomfortable going into large rooms where I don't know anybody. | |
| Many people have that experience. | |
| Do we have to be put on Paxil or Celexa or Zoloft for that experience? | |
| And I think that's where the skill of being a psychiatrist comes in. | |
| You have to resist the temptation to pathologize and resist the temptation to over-medicate and to really ask the patient Is this a disorder that is causing you so much distress that we really should call it a disorder and that we should really treat it because possibly this is not something that we need to treat? | |
| Yeah, it could just be called what we used to call a personality, right, which has a wide combination of strengths and weaknesses. | |
| I'd like to give you the opportunity, if you could imagine that you could skywrite a manifesto for your profession, which I know is a... | |
| Let's talk about grandiosity, shall we? | |
| But let's say that you could write a manifesto for your profession. | |
| Obviously, you have some criticisms. | |
| Where is it that you would most like to see the discipline of psychiatry go, and what habits would you most like to encourage in your fellow psychiatrists moving forward? | |
| Well, I would like us to seriously re-examine whether it makes sense for all psychiatrists to go through eight years of medical school, followed by medical internship, followed by psychiatric residency. | |
| And that really is the training for a psychiatrist. | |
| And when you really look at what I and most of my colleagues do on a day-to-day basis, we only use a very small fraction of the Medical training, the training in cardiology, the training in how to set broken limbs in delivering babies. | |
| We use almost none of that. | |
| And yet what we really do use is stuff that we hardly receive any training in at all, which is psychology and psychotherapy. | |
| So I've made a case for us to think about reforming our training So that we sort of reverse engineer. | |
| We look at the skills that we need, that we use on a day-to-day basis, and then we think about what kind of training do we actually need in order to be able to actualize those skills with patients? | |
| And wouldn't it be nice to create a program like that where you would have an ideal mental health clinician who would be able to prescribe medications and do the psychotherapy and really understand the patient well enough to know When it's time to maybe stop a medication and move to psychotherapy rather than going along with the type of treatment that we feel now is so normal and we seem to have accepted which is the split treatment or fragmented treatment where I will do one thing and I will have someone else who is trained somewhere else to do something else. | |
| So I've really advocated for a college of psychiatry which is different from medical school and psychiatric residency it would be more like a four-year program after college where you would you know you would graduate from college you would find you you'd be somebody as many many college grads are very interested in psychology and therapy and the brain and you'd be able to go to a four-year graduate program called psychiatry colleges of psychiatry where you would learn equally the skills of psychology and psychotherapy and psychopharmacology And you would also learn enough medicine to be able to understand when you need to refer somebody to a primary care doctor or an endocrinologist for a thyroid problem, | |
| but you wouldn't necessarily learn how to treat all those problems because in actuality, when was the last time you saw a psychiatrist do a physical exam or treat a medical problem? | |
| It happens very rarely. | |
| Right, right. Well, I think that would certainly be very interesting. | |
| And it is, I think, quite tragic that psychiatrists don't get as much training in therapy or in talk therapy as they could, because it's not something you want to try and invent on the fly, because you don't want to mess with people's heads without sufficient training. | |
| And so I think that's another reason why it's a little easier to reach for the prescription pad, which is less risky, less controversial, and which you, of course, have had much more experience doing so. | |
| I also want to give you the chance to give people who listen to this show your contact information on the web, your websites, your book, and to make sure that people who want to pursue this knowledge further have a good place to go. | |
| Sure. The book is called Unhinged, The Trouble of Psychiatry. | |
| I think the best way for people to find me on the web is to Google the name Carlat, C-A-R-L-A-T. And that will enable you to, you know, to click on my The Car Lab Psychiatry blog, The Car Lab Psychiatry Report, and to learn more about psychiatry. | |
| Much of the information that I publish on the web is free, you know, to anybody. | |
| So it's not as though you need to purchase a membership or a subscription. | |
| You can just read about it and learn more. | |
| I had a little trouble finding it in electronic format, though I did eventually find it through Kobo. | |
| Do you have any plans for an audiobook? | |
| I didn't see one in my travels. | |
| I don't know. | |
| As far as Unhinged goes, which is published by the Free Press and Simon& Schuster, Have their own plans, and I don't know what it is. | |
| Well, why would they tell you? I mean, you're only the author. | |
| I mean, why would you be kept in the loop? | |
| I mean, I know that it's available on Kindle, as most books are, but I did understand that there were some problems with accessing the audio version of it, but I believe that they had fixed that or that they were trying to fix that, so let's hope that they have. Well, thank you so much for your time. | |
| I really do appreciate some of these clarifications. | |
| And again, I would recommend the book. | |
| It is a very interesting reading, and I certainly do appreciate the personal stories of patients in your own life, which I think throw a little bit of salt in and leaving up the occasionally dry subject matter through no fault of your own. | |
| And I really, really highly recommend it. | |
| It's a very, very enlightening read. | |
| And thank you so much for your time. Well, thank you, Stefan. |