Jan. 12, 2016 - Freedomain Radio - Stefan Molyneux
01:14:46
3175 Myths and Facts About Antidepressants | Robert Whitaker and Stefan Molyneux
The recent book, Psychiatry Under the Influence - co-authored by Robert Whitaker and Lisa Cosgrove - investigates the actions and practices of the psychiatry establishment and presents it as a case study of institutional corruption. Stefan Molyneux and Robert Whitaker discuss the state of psychiatry, the dangers of antidepressants, the lack of science supporting the benefits of selective serotonin reuptake inhibitors (SSRIs), the dangers to unborn children when pregnant mothers consume these medications and other shocking information which the general public does not yet understand about these commonly used drugs.Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform - co-authored with Lisa Cosgrove: http://www.fdrurl.com/Whitaker-PUTIAnatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America: http://www.fdrurl.com/Whitaker-AOAAMad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill: http://www.fdrurl.com/Whitaker-MIARobert Whitaker has won numerous awards as a journalist covering medicine and science, including the George Polk Award for Medical Writing and a National Association for Science Writers’ Award for best magazine article. In 1998, he co-wrote a series on psychiatric research for the Boston Globe that was a finalist for the Pulitzer Prize for Public Service. Anatomy of an Epidemic won the 2010 Investigative Reporters and Editors book award for best investigative journalism. For more on his work, please check out: http://www.robertwhitaker.org and http://www.madinamerica.comFreedomain Radio is 100% funded by viewers like you. Please support the show by signing up for a monthly subscription or making a one time donation at: http://www.freedomainradio.com/donate
He is an award-winning medicine and science journalist who makes me feel like I just don't have quite enough awards.
He's the author of Mad in America, Anatomy of an Epidemic, which we talked about a little while, about two or three years ago, I think.
And the new book, which you simply, simply must read.
I mean, whether you're involved in psychiatric meds or not, chances are at, you know, 20% of the adult U.S. population, you know someone who is.
Need to get the facts.
Psychiatry under the influence, institutional corruption, social injury, and prescriptions for reform.
RobertWhitaker.org and MadInAmerica.com, where, of course, you can sign up for a subscription to help him out.
And thanks a lot, Robert, for taking the time today.
Thanks for having me.
It's a real pleasure being back.
Alright, so let's start at the beginning.
In the beginning, there was, I guess in the 50s, when the first drugs to treat psychosis and so on came out, there was a A theory that developed and was propagated in the 80s, as you point out, by the American Psychiatric Association, this sort of chemical imbalance hypothesis.
And this is what most people, I think, still currently, 70, 80, 90% of Americans still believe this.
What's the history and what are the issues with this hypothesis?
I think this is really important to understand because really what this book is about psychiatry and the influence is how we as a society have organized ourselves around a false story.
A story that is pitched to us as a story of science but when you actually review the science you don't find it to be true.
And the chemical imbalance story is at the heart of that false story.
Now, just the context for why this story really began to be promoted to us and when it was promoted.
So in 1980, the American Psychiatric Association publishes the third edition of its Diagnostic and Statistical Manual, and this is a profound change for our society when they do it.
Prior to this time, if you look at Psychiatric explanations for the distresses we have, etc.
And in their own manuals, they talked about really a lot of psychological causes, there were Freudian ideas, and the number of disorders that were really thought to be basically biological diseases.
That was a very small number.
What the American Psychiatric Association did in DSM-3, they said, we're going to reconceptualize psychiatric distress and we're going to conceptualize depression, anxiety, whatever might be the problems that we face, mania, etc., as diseases of the brain.
We're going to conceive of them as the same way we think of cardiovascular problems as diseases, diabetes as a disease, etc.
They're putting a stake in the ground saying, this is what we are going to hypothesize are the problems of psychiatric disorders.
But right away, they begin, they being the American Psychiatric Association, begins wanting to sell this new model to us.
And as they begin to sell this new model, what's at the heart of this new story?
It's that researchers are discovering that depression, anxiety, and these other schizophrenia are due to chemical imbalances in the brain, And that soon enough we begin to hear that we have drugs that fix those chemical imbalances like diabetes for insulin.
Now that is a story of tremendous psychiatric progress, research progress.
Think about this.
They are telling us, the American Psychiatric Association is telling us that they've identified the very molecules that are amiss and cause depression.
And not only that, they now have drugs that fix that molecular imbalance, right?
That chemical imbalance.
Well, that would be one of the great, great medical advances of any time, right?
Given how complex the human brain is.
And that's what we began hearing in the 1980s.
Sorry to interrupt, but when I first began to hear this stuff, given that my particular bent or interest is in philosophy, which is clear and rational thinking, and I was, of course, quite seduced by the Freudian model of unconscious conflicts and failures to adapt to society and so on, and when this information first came out, I felt like a complete jerk.
In other words, I felt as if I had been ascribing epilepsy to demonic possession.
You know, in other words, that we had been putting disordered thinking or child abuse or trauma or some sort of aspect of something when in fact it was just like diabetes, easy to treat, a chemical imbalance, and it was a real pushback, a very strong pushback, I thought, against the talk therapy.
And I wonder if you could mention a few things...
That were at play that caused this transition, the degree to which psychiatry was, as they felt at least, under siege with facts and evidence and some of the reporting that was going on at the time.
You know, I really find it fascinating that that's how you felt.
Think about this.
We do know that the environment changes our mood, our feelings, trauma, etc.
So all our common experience tells you that that's true, right?
And we all also know that our minds are confusing places.
We don't understand all our emotions.
So whether all the Freudian sort of ideas are correct, forget that.
Do we have unconscious impulses?
We know that's true, right?
Well, also, I mean, sorry, it's not like society is perfectly rational and a failure to adapt to society is always indication of mental dysfunction, you know?
I gotta think your average German in, say, 1938 who successfully adapted to that society would not be called the paragon of mental health, but that's a topic for another time, perhaps.
Exactly.
I mean, the idea of adapting to society is a sign of a healthy mind.
That's a big question, right?
But all of a sudden they pitch, and we'll go over to the real question, but they pitch this new story that this is scientific advance and you people are stuck in the old ages, the middle ages, and we now have, no, these are brain diseases.
And they even, in the mid-90s, they often said to people, critics of this new model, they're flat earthers.
That was the way they put down this criticism.
Deniers!
Heretics!
You're so far back, you think the Earth is flat.
It's a pretty brilliant thing.
So how did this come about?
Because of course there wasn't science to support it, that's what you find.
It came about because in the 1970s, psychiatry did feel, as a field and as a trade association, American Psychiatric Association, that theirs was a field under siege.
They were fighting for their survival.
So why?
Well, you had an anti-psychiatry movement coming out of academia, actually, that was saying, you're acting more, to psychiatry, you act more as an agency of social control rather than a medical discipline.
So they had that.
They had ex-patients that were saying, Listen, we don't even want your therapies.
And going to psychiatric hospitals is like being put in prison.
It's a violation of our civil rights.
And you know what?
We don't like your drugs either, especially your antipsychotics.
So we had patients rebelling as well.
Then you had insurance companies saying, We have no evidence that your form of therapy, I'm talking about talk therapy here, is any more effective than what social workers or psychologists or others are doing, so why should we pay for this more expensive medical therapy?
We had movies like One Flew Over the Cuckoo's Nest that held up psychiatrists as characters to be ridiculed almost.
And then finally we had an experiment by Rosenham out of Stanford University in which he set students in the psychiatric hospitals and they showed up at the door and they said, listen, I'm hearing this word, this voice in my head that says thud.
And that's all they said, thud.
Well, they were all admitted into the hospital.
They were all then diagnosed with schizophrenia.
And then once in the hospital, these people reported they were no longer really treated as human beings.
They'd ask what time it is, people would ignore them, that sort of thing.
Well, when this was published...
Oh, and sorry, there's a little part in your book where you mention that only their fellow patients knew that they were Faking it.
In other words, the experts who trained for half a dozen or a dozen years had no idea they were faking it.
But their fellow patients were like, good scam, man.
I'm behind you 100%.
Fantastic.
Can you take me with you?
Yeah, that was part of the embarrassment that the mad patients knew that these people were implants, imposters.
They weren't really crazy.
After that, within a week or so after that paper was published, the APA convened a meeting and said, what are we going to do?
How are we going to restore our image?
Okay?
They've got all these challenges to the legitimacy.
And at the heart of it is an insecurity.
That even other doctors say, you guys aren't real doctors.
Not like internal medicine doctors.
So there's an inferiority complex here too.
And so what do they say?
We need to put on the white coat.
We need to present ourselves as doctors, like infectious disease doctors or internal medicine doctors, because that is an image that is so respected as an image of science and credibility in American society.
And they said also this.
If we look at this field of competition for all these patients now, and remember psychiatry used to have as its domain this psychiatric hospital.
Then World War II, they expand their domain, and we get all this sort of the walking wounded, and we have a lot of competition for this.
Psychologists, social workers, counselors, people providing alternative forms of therapy.
Who's going to have...
And priests.
And priests, of course.
Sure, historically, priests, ministers, etc.
But who's going to have domain over this much larger group of patients?
And they thought, we need domain over this.
We need authority.
And they said, what gives us our advantage in the therapeutic marketplace?
What can we do that those psychologists can't do?
Well, of course, it's prescribing privileges.
That's what's going to save us.
And in order to really make prescribing privileges valuable in the marketplace, well, then if you have diseases of the brain, right?
If things get categorized as disease of the brain, depression, anxiety, what's going to be the frontline therapy?
Pills.
Right?
Because pills are going to knock down the symptoms of that disorder.
So they saw a medical model as a way to restore A, their image in society, and B, to basically enhance the value of their prescribing privileges.
So what you see behind DSM-3, the formation of DSM-3, is not a scientific advance into understanding the biological causes of these things.
But rather very much a professional need or a professional, you know, there were incentives that would benefit psychiatry to adopt this new model.
Okay, fine.
And if you actually read DSM-3, they do say these are hypotheses and we do not have information that they've validated this new conception.
But right away, what you see now, there's going to be a big separation between what is told the public and what their own science is showing.
Well, and as you point out, sorry, in the DSM-III, in the formulation of it, the original idea was to not include things that were not empirically validated, and that kind of went by the wayside when they started finding out how poor the empirical data was for any of these hypotheses.
Yeah, this is really important.
There was a scientific impulse from this coming out of a group at Washington University that said, well, what do we know about these disorders in DSM-1 and DSM-2?
And by the way, there was research that had been done that showed that the existing categories weren't reliable.
In other words, you go to one doctor, you get one You got another, you get another one.
That was an embarrassment too.
So there was this group at Washington University said, okay, we really don't know anything about these different disorders.
Let's search the research literature and see if we can find 15, 18 of Sort of different types.
And now we'll study those types and we'll see, do they have different long-term courses?
Are there genetic associations?
So really, the scientific impulse was to group people into these different 15, 18 categories, study them to see if, in fact, you could validate different psychiatric disorders.
That's a valid impulse.
I agree with that impulse.
But even they're saying is, boy, the information we have now is so limited.
But what happens when they start to actually create the DSM-3 categories, they say, wait a minute, we have to have a diagnosis for everybody who comes into our office because if it's a disease, we need to be able to give a diagnosis for reimbursement.
And they just began making these things up willy-nilly and ended up with something like 200, I forget, 95.
And now these are all going to be presented as discrete disorders in essence, right?
Well, you can see the ludicrous nature of this sort of at the beginning where you have people sitting around the table going, well, I say, we'll call this diagnosis, let's even say attention deficit disorder, which is one of the new ones.
Well, what are the symptoms?
How do you make the diagnosis?
Well, if you tap your fingers too much.
Seems like you're on the go too much.
There was no testing of what should the symptoms be.
They just decided it willy-nilly, but that's not how it was presented to us.
Well, there was also, sorry, but there was, of course, as you describe, a phase where they said, we're going to go out and debug and validate and make sure that these are correct, but then the methodology seemed a little squirrely, to put it mildly.
You really read this book closely.
Thank you.
I got the big print.
Now they come up with these categories.
They want to present themselves.
Part of this presentation is to themselves.
They want to convince themselves this is a great scientific advice.
Advanced, excuse me.
So, for any diagnostic manual to be useful, it's supposed to have, in medicine, two qualities.
It's supposed to be reliable and it's supposed to be valid.
Reliability means I go to two doctors, same symptoms, I get the same diagnosis and then whatever that diagnosis is, it's real.
It's about some real disorder and that disorder has been validated as a disease or, you know, cancer, that sort of thing.
So, the previous Manual is seen as neither reliable nor valid, but once they come up with DSM-3 categories, they now want to show that it's reliable.
So they do these reliability tests, and they come out and say the Kappa scores, which is a measure of how reliable are, are fantastic, this great advance.
When they present this to themselves, they say, well, we solved the reliability problem And now future research will solve the validity problem.
But if you actually dig into the reliability trials, they were not scientific at all.
And in fact, even the reliability scores had to be manipulated in terms of to describe them as very good.
So at this very beginning moment, We see reports about how reliable those trials are of DSM-III categories.
But when you actually dig in and look at how the trials were conducted and try to find out what the data is, you find that it's just not there even to support this initial reliability claim.
So right from the beginning we get this mismatch between what psychiatrists telling itself and the public, the liability problem is solved, and then you find that the reliability trials First of all, they were conducted in a non-scientific manner and B, even the Kappa scores were not that good.
Kappa being a measurement of diagnostic agreement.
So that's if you present the same kind of symptoms that two disparate psychiatrists will come up with the same diagnosis, and they were pretty poor, and the source data has never even been released for independent verification or the usual mass, right?
Yeah, and whenever they've tried to replicate those initial studies, once they had DSM-3 and they did some reliability studies, the CAPA scores were terrible.
So you're right.
We have actually not actually seen the data.
They weren't replicated.
So in fact, right from the beginning, we have this false foundation for this new way to conceive of ourselves and of psychiatric disorders.
And by the way, Jeffrey Lieberman, a past president of the APA, has said that this is the book, the SM3, that changed everything.
It's the most important book published in the last 50 years in the United States.
And he's not just talking about psychiatric books.
He's talking about any book.
I agree with him.
This book, in the way you said, Stefan, you said, listen, this changed my thinking about what's going on in our brains.
And we had this new reductionist model, sort of this mechanistic model of the human brain.
That's a profound thing to change how you view yourselves and how we view children, what to be expected of children and all this.
And what you see right away is we're beginning to change ourselves, our philosophy of being around a false scientific story.
And, you know, we'll get to the corruption part in a second, but even at this point, you know, in reading the book, some suspicions began to float up in my mind.
Insofar as you say, you know, that the model was, of course, the mental hospital, which is where you'd put people like this, and this is where the majority of psychiatrists, or a significant proportion of psychiatrists, Did their thing, and they were getting about $9,000 a year.
Now, of course, to my younger listeners, this is back when $9,000 could actually buy you something.
So, they were getting about $9,000 a year, and then when the first antipsychotics were found, they pumped people full of this and released them out into the street.
We'll get to the long-term effects, sort of the two-year follow-up studies in a sec.
These people are now out in the streets and causing problems, as it turns out that this stuff doesn't work very well or even has negative effects in the long run.
But they're making $20,000, $22,000 or more As private practitioners prescribing pills rather than the $9,000 they were making as being in charge of a psychiatrist in charge of a mental hospital.
So this sort of drug and release program puts a lot of unstable people out into society combined with the new capacity to prescribe pills.
Really jacks up their income.
And it seems to me, whatever we may say about institutional corruption later, that this first part was, you know, people are encroaching upon our territory.
They're poaching our patients.
They're cheaper.
The insurance companies prefer them.
Their outcomes are as good, if not better.
So we're now going to fence this off with a big giant wall of prescription pads, keep these people to ourselves, and make up a methodology that justifies it.
It's hard for me, at least, you know, to escape that perception of what was going on this time period.
Yeah, there's no question.
Once you get the, quote, the first antipsychotics, Thorazine and Haldol in the 50s, and then we get Valium and Librium, that sort of thing, psychiatrists who really embraced the prescribing of these drugs versus talk therapy, all of a sudden they could make much more, and that data is quite clear.
So they now have an obvious financial self-interest to believe in these medications and to promote the regular use of them.
And right away, in psychiatry, in the 1950s, you start to see these splits.
In which you do have some older sort of psychiatrists adhering to Freudian ideas.
Or you also have a branch that's really a social psychiatry branch that thinks that so much distress arises from racism and that sort of thing.
But there's also a biological group.
And the biological group is the one that's going to ascend to power.
One of the reasons they ascend to power is their model.
That, as you say, brings the most financial benefit to the individual because a prescriber, how long does it take?
15 minutes?
We have the 15-minute med check.
Well, that's a lot better than spending an hour talking to somebody and getting basically the same reimbursement for the 15 minutes that you get for the hour of talk.
It's quite clear that that's an impulse that's going to lead to this model as well.
And I think for corruption there usually is a push and a pull.
I mean we'd all like to make a million dollars a minute.
It's just that at least I find maybe you're different that the market does not exactly bear my particular preferences.
It does not take them to heart.
Unjustly and unfairly I would argue.
But I think that there's also a giant sucking sound of a pull in society.
Because of course when people are mentally ill or dysfunctional in their thinking or emotions, One argument, of course, and it's a fairly old argument, goes back to the idea that, you know, they've been traumatized.
Maybe they had incest.
We had Dr.
Gabor Maté on the show who talked about his drug addicts having had a history of sexual abuse and so on.
So if trauma is a symptom of crimes, particularly against children in society, or as people would say, racism or sexism and so on, or classism, then it seems to me that society would love the biological explanation because that way...
People who've done bad things to their children get off the hook, so to speak.
They can say, oh, well, I'm no more responsible for this than for, you know, the kind of diabetes that doesn't come from lifestyle or the fact that you're short or whatever it is.
And I think that that pull also, people find it quite relieved because, you know, Freud, as you know, when he began uncovering instances of childhood sexual abuse in Vienna, was really playing with fire because when you start talking about the maltreatment of children in society, well, there are a lot of parents out there who don't like that or even teachers or whoever.
So I think, at least my theory is, you know, and you don't really deal with it directly in the book, but I'm curious what your thoughts are, whether there was a pull that's a huge relief in society to say, oh, it's not that we're treating people badly, there's just a biological problem.
You know, this is really interesting.
So I don't think that the fact that it gives a free pass basically to us, right?
It gives a free pass to society.
You don't have to worry about social injustices or poverty, that sort of thing.
On a more intimate level, we do know that families can be quite stressful and we do know that family situations, especially if they're functional traumatic, you know, they leave an imprint on people and there's no question.
You know, go ask, go interview 100 people who've been hospitalized and have a diagnosis of schizophrenia or bipolar.
You will hear a lot of stories of trauma and you will hear many, many stories of difficulties rooted in family situations.
I don't think it was the impulse.
I don't think that impulse to absolve ourselves as a society or like remove the family from possible blame was a cause of DSM-3.
But once DSM-3 was in place, now all of a sudden the pharmaceutical companies and the American Psychiatric Association In essence, are going to exploit that advantage of this new model because it does absolve people of any responsibility, society and families, to help promote this model.
And you can see this when NAMI forms, the National Alliance on Mental Illness forms, by mothers of, you know, Whose children have been diagnosed with schizophrenia.
Under the Freudian theories, we had the schizophrenic mother, which the mother is being blamed.
But now under this new model, it's just dopamine.
It has nothing to do with what happened to them in family.
The dopamine levels are amiss.
It has nothing to do with treatment or how that child was raised.
So NAMI really embraced this new model because it absolves the family.
And the pharmaceutical companies and the APA, as NAMI begins to form in the 1980s, say, aha, this can really lend this new model a lot of moral authority because who wants to go against mothers of distressed children?
So this became what you're talking about.
It became something to exploit as they advanced this model.
And then finally, it did fit with sort of Reagan politics as well because if so much of social distress, depression, anxiety, mania, psychosis is rooted in chemicals of the brain quite apart from how society operates, That also absolves society of trying to make itself a more socially just society.
And even think about with foster care kids, which gets into a racial angle and all.
Today, once you have this new model, it's not that the foster kid really was born into a family that couldn't take care of him.
They get diagnosed with a mental illness today.
They have oppositional defiant disorder or they're bipolar, etc.
So now we say the problem is the kid, which means that we say to the foster kid, here, take these pills, antipsychotics, and we no longer have a social responsibility to build a nurturing environment for that, you know, foster care kid.
That's an example also, I think, how it absolves up as a society of doing better by, you know, People have been traumatized, kids have been traumatized, or even build better schools.
And then there's this chilling Soviet parallel, not to take the metaphor too far, but of course in the Soviet Union under Lenin, and in particular of course under Stalin, there was this argument that said, what?
You're not happy under communism?
You must be insane!
And they would actually like drug people and put them in mental institutions for a failure to adapt to what was, to put it mildly, a somewhat dysfunctional system.
And to a minor sort of shadow cast by that greater evil, I wonder the degree to which reforms of crumbling schools and bad teachers and, you know, incompetent administrators has been held back by the argument that, well, if you're a kid not succeeding in school, can't possibly be the school's fault, can't possibly be society's fault.
You must have a chemical imbalance and must be drugged.
And that very approach assumes, of course, that the institutions are perfect and all deviations are the Yeah.
No, I think you're reminding your listeners of this Soviet parallel is very actually telling.
It's appropriate.
Because, as you say, in the Soviet Union, if you objected to the ruling powers, you were, and especially did it vociferously, you could be put in psychiatric hospital, declared mad, and forcibly medicated with antipsychotics.
That's a power structure retaining its power, right?
Asserting its power.
Now, let's go to our schools.
A lot of our schools are bad.
I mean, just think about some of these environments today.
The kids have to be in the damn school so long, right?
We've cut gym.
We've cut playground.
We've cut music.
We've cut art.
We make them take these tests all the time.
I mean, and then you send the kids home, and they have homework for two, three hours.
I mean, I don't know who has set up this idea of a school day, but it's someone who was never a kid, obviously.
But the point is, now when kids rebel against that, they can't take it, it's not the school's fault, right?
The power structure says, no, it's the kids' fault and we'll give them a stimulant so they don't move around as much, etc.
There is a parallel there.
It's a powerful institution, an institution of the state Putting the blame on the individual who's not adapting to what I think many people would say is a, for many schools today, a bizarre form of how you're going to educate your young.
I mean, the hours these kids spend sitting in chairs, could you do it?
No, no.
It's sort of like if I'm a comedian and I go up and I'm really not funny, it doesn't solve the problem if I administer laughing gas to the audience.
They may laugh, but that does not make me a funny person.
No, that's really good.
It actually makes me kind of sadistic.
Yeah, yeah, that's really good.
But this does fit that same model.
It's a problem with the kids.
It's chemistry.
Fixer chemistry with stimulants or whatever it might be.
It completely changes where we place the problem.
And look to find solutions.
Right, right.
Now, you recently wrote in your blog, I'm going to read you this paragraph, and I'll give you all the space you need to make this case, because I get that this is very surprising to a lot of people who've sort of got the mainstream view.
You wrote, when I wrote Anatomy of an Epidemic, one of my foremost hopes was that it would prompt mainstream researchers to revisit the scientific literature.
Was there evidence that any class of psychiatric medications, antipsychotics, antidepressants, stimulants, benzodiazepines and so forth provided a long-term benefit?
Now, epidemiologists at Columbia University and City College of New York have reported that they have done such an investigation about antipsychotics.
And their bottom line finding can be summed up in this way.
Psychiatry's evidence base for long-term use of these drugs does not exist.
Now, of course, Anatomy of an Epidemic was a fantastic book, which we talked about last time.
So it looks like at least you've got some dominoes in motion and the results that are returning, I would imagine, are not hugely surprising to you.
No, they're not surprising at all because, of course, I did the same search of the literature that these researchers from Columbia University have done, and you just cannot find evidence that antipsychotics improve long-term outcomes, functional outcomes, social outcomes.
It's just not there.
So when they said it's just not there, now they were surprised by this, right?
You can, if you read the paper, they're like, how could it be that after 50 years or 60 years of these drugs, we don't have this evidence?
Obviously psychiatry wasn't looking too hard as who's the answer to that on functional outcomes and all.
But yeah, so anatomy of an epidemic came out in 2010 and actually the dominoes are falling left and right.
So we have this paper about antipsychotics, we just don't have long-term evidence we're doing better.
We have Martin Harrell giving an update on his long-term study of psychotic patients and every time he publishes a new paper it's stronger about how the unmedicated patients did so much better.
We have people writing now about it looks like antidepressants really are depressive genetic agents over the long term.
There was a Spanish review of stimulants that said, look, the long term outcomes with these drugs are not good.
They should be used minimally and for shorter periods of time as possible.
So you see one class of medications now where the researchers themselves, and I do think that they were prompted in part by anatomy to make these investigations.
I know the Spanish group basically followed up on anatomy.
These Columbia University people said they were prompted by me.
And in six years, every bit of evidence on this question has been of this type.
Uh-oh, we don't have the evidence.
And if we look too hard, we're finding actually evidence of harm.
So in that way, the scientific literature actually is filling up more and more with, hey, trauma does count.
Social experiences count.
Poverty counts.
Poor school counts.
And that, in fact, we do not have evidence that these drugs provide a long-term benefit and we can catalog more and more harms.
So scientifically, this DSM-3 model has completely collapsed, or is in the process of completely collapsing.
We know that we can talk about this, that the chemical imbalance theory was never...
It never panned out.
In fact, they didn't find that chemical imbalances cause depression, schizophrenia, that sort of thing.
And now when we look to the side of the equation, are these drugs helping people long-term?
We're not finding that either.
So that whole scientific structure scientifically is collapsing, but it's not collapsing in the public mind.
Witness the ever greater use of these medications.
Right.
Okay, so there's two points about that.
And the one point is one of the biggest overarching points that you've obviously spoken about and wrote about in Anatomy and touched on in the new book, which is...
If this medical breakthrough occurred, and you liken it to penicillin, you know, when penicillin comes into the market, then bacterial infections are dealt with much more effectively, fewer people die, and that's how you know.
When diabetes is treatable by insulin shots or insulin supplements, then you get less negative effects from diabetes and so on.
That basic question, we found and solved the chemical imbalance that leads to mental illness Where do you think that should have, according to these prime models, taken society?
Well, if it were true, if this was the problem with depression, this was the problem with psychosis, mania, anxiety, we should be a very happy society and a very functional society, right?
Because we wouldn't have this distress Say with depression that makes us less functional than normal, psychosis clearly less functional, less employable, that sort of thing.
We should have sort of a society that It's doing quite well functionally.
In other words, the burden of mental illness in our society should have diminished greatly.
We should see facts.
We should have fewer people disabled by mental illness.
We should have our kids, when they go to college, not needing to go to counselors and that sort of thing because their brain chemistry would be fixed and so forth.
We would just see that Depression would take a lesser toll, psychosis would take a lesser toll, mania would take a lesser toll, etc., etc., lost workdays, and all the data is exactly the opposite.
The burden of mental illness with different age groups and across societies that have adopted this paradigm of care, it has risen and risen dramatically by all measures.
Well, I just want to pause on that because when they came up with a polio vaccine, the prevalence of polio went down and almost vanished.
This is not even a neutral.
Like a placebo would be like neutral and it hasn't really changed.
But there is something going on where it seems like the association between the application of these brain medications is actually serving to increase and debilitate mental health in the long run.
Is that a fair way to characterize it?
Yes, it is.
And I think you need to add one thing in.
The diagnosis of certain states as mental illnesses and treatments is really helping to fuel this boom of disability and burden.
And the best example of this is related really to what we call depression, anxiety, etc.
So up until 1980, go back to the Greek times, it was understood that depression that was situational was just normal.
You lose somebody, you lose a job, you get divorced, that sort of thing, family difficulties.
These are not illnesses of the brain, and it was also understood that, let's say you have a depressive bout, you lose somebody.
It was going to be episodic, and you were going to recover from that with time, right?
But with DSM-3, they said, we don't care about your situation.
We don't care about your life events.
We just have these physical symptoms.
Are you sleeping?
You're feeling suicidal, whatever it might be, that can get you a diagnosis of depression as a brain illness, okay?
So now we have a new way for you to think about you and for you to think about yourself.
And now you're saying, like, I'm ill, right?
And then I learned I have this brain chemistry that's abnormal.
I have to take this drug for life.
Well, that is a conception.
That is a path that puts many people onto long-term disability, lower cognitive functioning, physical problems, etc.
So, yes, going back to your initial point is when you have like penicillin for bacterial infections, those bacterial infections are tamed.
I mean, it was one reason we won World War II because the wounds no longer cause people that.
Polio vaccines.
I mean, polio went away, right?
And by the way, the Edward Shorter, a historian of psychiatry, he's the one who uses the penicillin analogy.
He says, the introduction of chlorpromazine was as profound a leap forward as the introduction of penicillin in infectious medicine.
But instead, what do we see?
Well, mental illness, the problem of mental disorders in our society has skyrocketed.
It's so pervasive now.
And look at our returning veterans now.
What do we hear about our returning veterans from Iraq and all?
The disability rates among the returning veterans are quite high.
Suicide rates are quite high.
Well, they are being treated with PTSD. They're being treated with drugs, etc.
So here's just another little isolated example of a response to Individuals who undoubtedly saw things, especially with the repetitious tours, that were very, very difficult.
And I'm not saying they don't need help readjusting to society, but this sort of pathologizing of them, of so many of our returning soldiers, is not showing out to be a great benefit.
Right.
One of the challenges of medicine as a whole is that because the human body, and in particular the human brain, is so complex.
This is why you need double-blind experiments.
There are spontaneous remissions.
There's self-reported stuff.
I mean, it's really hard to tease out, for some things, the cause and effect between medicine and health.
And one of the arguments that's put forward is, well, look, these people are sad.
We put them on these You know, 12 weeks plus later, they feel happier, so we keep them on the medicine, and then by golly, don't you know, when we take them off that medicine, They crash.
So clearly, that's how it would work.
Well, my diabetes is really bad.
I'm on the insulin.
Great.
If they take me off the insulin, my symptoms return.
How is that not a good chunk of evidence for the efficacy of these drugs?
Well, that is seen as the efficacy.
You know, the fact that you relapse so often when you come off the drugs is seen as evidence why you need to stay on.
So you take away the drug, the disease returns.
And that's how it's been presented to us.
Well, really, the model that needs to be thought of here is any addictive drug model.
So you go on heroin or you go on OxyContin or some drug like that, what happens is your brain adapts to the presence of that drug, right?
And then when you remove the drug, what you're really seeing is a withdrawal response because your brain has been changed by it.
Now, with the addictive drugs, we say you crave the drug, right, when you come off it.
Well, maybe with an SSRI or an antipsychotic, it's not that you now crave that drug, but nevertheless, you're having all these new symptoms, these new feelings, mental states, physical states.
Well, we actually do know those are withdrawal symptoms.
We've known this really since the late 70s with the benzos and even with the antipsychotics by the early 1980s, but this is part of this institutional corruption.
Once this became known, and it was even fleshed out, here's what happens.
You go on an antipsychotic.
It blocks your dopamine receptors.
What does your brain do?
It increases your dopamine receptors.
So now you have a brain like this.
Brain acts as a brake on dopamine.
Your brain puts down the accelerator.
Now you go off the drug.
You take away the brake.
It's not like you're now back in your normal pre-drug situation.
You have this change in your brain.
You've got this accelerator on dopamine activity, and this is why they realized in the early 1980s you were seeing all these severe relapses upon drug withdrawal.
So psychiatry, once I get this, is presented with a real conundrum.
Maybe we have some drugs that relieve symptoms over the short term.
But once they're on, the person adapts to the presence of the drug, and now you've got two long-term possibilities.
Coming off is going to be difficult, but then when we look at our long-term outcomes for people who stay on, we see a lot of chronicity, increased function, so that's not good as well.
So psychiatry has this conundrum.
What are we going to do with this information?
Well, here's the institutional corruption.
What do they do?
They basically embrace the story that protects their interests, which is, say you go off the drug, the disease returns.
That is a story which they promote to people that protects their financial interests and their professional interests.
But science is telling us a different story.
And any institution, a medical specialty, what's its actual obligation?
It's not to itself.
It's not to its financial interests.
It's to us as patients.
But that's the corruption.
When faced with such difficult information as this, They chose to protect their own interests and their own financial interests and the interests of the drug companies and not do their duty to the public to tell us this very sort of upsetting information.
That's the heart of the corruption.
Right.
Now, we haven't really talked much about the drug companies as yet, but the degree to which they began to enter the psychiatric What is the story behind that?
How did that wend its way through the profession?
Yeah, so one of the things we looked at in this book, Psychiatry Under the Influences, what were the economic influences that became present once they adopted DSM-3?
I'm talking about the American Psychiatric Association.
Well, once the APA conceives, conceptualizes all these problems of living now as diseases, who's standing on the sidelines cheering?
The drug companies.
Because now they have a market.
The walking wounded now become a market for their drugs.
So what happens really quickly?
One, they start funneling money to the APA for all sorts of things.
Educational campaigns, advertisements in their journals, even when they're looking for lobbying efforts, they're just going to funnel money to the APA like crazy.
And just to give you an example of this, I've got to remember the data.
But in 1980, I think the annual revenues of the American Psychiatric Association were something like I think it was 64 or 65 million.
I only say that because I just finished reading that part last night.
That's what it becomes in 2008.
It's like 65, 75 million.
But at the start of this, it's only like 10 million.
So what we see is this growth in revenues that's coming from the pharmaceutical companies, right?
Now, the second thing is, beginning in 1980, the American Psychiatric Association makes this change that is what enables or It really facilitates this capturing of academic psychiatry by the pharmaceutical industry.
Prior to 1980, pharmaceutical companies were not allowed to sponsor scientific symposiums at the American Psychiatric Association's annual meeting.
They could have their exhibits, that sort of thing.
But what the APA decided in 1980, American Psychiatric Association said, whether it be, you know, who might, whatever company, Eli Lilly, etc., you want to sponsor a scientific symposium?
You can pay us to do this at a breakfast, lunch, or dinner, okay?
And now you can hire academic psychiatrists to get those presentations.
So everybody there, they don't think they're getting an advertisement from Eli Lilly or whoever it might be at Janssen.
They think they're seeing now the world leaders, experts, saying what is the latest science.
However, now what happens?
Now we have drug companies actually paying people to give those talks from Harvard, Stanford, Johns Hopkins.
And those talks become rehearsed and do you think the pharmaceutical companies are paying them to be critical of drugs?
Of course not, right?
So now all of a sudden we have these leaders known as thought leaders, key opinion leaders that are going to start working for pharmaceutical companies as advisors, consultants, speakers, do their research, etc.
And we get academic psychiatry that becomes captured by pharmaceutical companies.
By the late 1990s, when the American, excuse me, when the New England Journal of Medicine sought to find an expert who could review the efficacy of antidepressants, they wanted to find someone who didn't have ties to pharmaceutical companies.
They basically couldn't find it.
And then when they went to the depression experts, they found that they had ties to like 20 different companies, 15 different companies.
And when now, thanks to Senator Grassley's inquiry a few years ago, we're not talking little money.
We're talking about people who are getting paid $100,000, $200,000, $300,000, $400,000 a year to be thought leaders for these companies.
So this is one of the corrupting influences.
Pharmaceutical companies start paying the academic psychiatrists to conduct the trials, set the diagnostic guidelines, do the CME work, write the psychiatric textbooks, write the clinical practice guidelines, do the drug trials.
So we have a science Right, right.
And then in 2008, that began to change.
And I think that was due to a congressional investigation that they began to back off, I think, from some of these sponsored events by the pharmaceutical companies.
Is that right?
That's true.
And why did the APA do that?
Because, basically, their credibility with the public was being so compromised by Grassley's investigations—it was by Senator Charles Grassley— Who was basically saying, look, your profession has been bought by a pharmaceutical company.
And that was a real black eye for them.
So they did back off.
Okay?
So now we might say, hey, we've arrived at the promised land.
The solution's in hand.
There's less financial ties between the APA and pharmaceutical companies and individual psychiatrists and pharmaceutical companies.
Because a lot of them did cut their ties.
So that's good.
But what...
What interest, what economic interest still remains to support this biomedical model, this biological model?
Well, the profession itself has a vested interest in this, right?
Because this is the story they've told us.
This is the story that allows them to present themselves to American society as doctors in white coats.
This is the story that gives prescription privileges a monetary value.
And finally, it also is what gives their authority, that the DSM is still the place that Where they assert authority over cataloging disorders as well.
So they need this biological model to say, A, we didn't lie to you for 35 years and there's reason for us to have this authority.
So how are you going to neutralize that economy of the influence we say?
because that's the bigger problem here is psychiatry as a medical specialty is invested in telling a certain story that benefits its own interests.
They now have a history of telling that story for 35 years.
And now how do they say to the American public, whoops, that story was really false all these years if you really look at our science.
And now how do we go forward and, yeah, still give us authority over this domain of your lives?
Well, wouldn't they basically vanish in a media shower of lawsuits?
I mean, once they admit that this is false and that they've known this is false, I think that would be a big challenge.
There is another aspect.
There are two other players as well, of course, which you can expand on.
One, of course, is the government, which by providing financial resources to people who are disabled, whether according to these drugs or something else, has at least, I mean, it's not like people take these drugs to make money, but it takes away some of the direct pushback.
You know, if I'm paying, I don't know, $500 or more a month for some particular treatment, I'm going to care whether that treatment works or not.
And so I think that by displacing some of the financial pushback from the general population, I think that's softened the blow.
And of course, parents who are desperate and on welfare, if their kid gets on these drugs, they can get some additional medication.
And the insurance companies as well.
I mean, part of me says, okay, well, if I'm an insurance company executive, In some alternate universe where I've been very bad in a prior life, if I'm some insurance company executive, then why would I want to cover these issues if the data doesn't support that they're helpful?
And in which if people pursue these kinds of medications, it might end up even worse for me in terms of long-term disability.
Those are both really good questions.
And let's start with the insurance and come back to the government.
Well, let's start with the bigger things.
The point is, we as a society organize ourselves around a story, right?
Which was a story of brain chemistry, these things.
And as part of the story is, we as a society now are being kinder to people, right?
We are setting up this disability system.
We used to put them in hospitals, supposedly.
But now we have this kinder system.
We support them and we're nicer to them as well.
And insurance companies, of course, say, okay, and we'll pay for this, these pills, etc.
And it became, they were covering certain diseases.
So this becomes the story.
Now, I'm an insurance company, okay?
Do I have any financial incentive really to cut costs?
Well, I mean, in a free market environment, if you're funding, or if you're paying for medications that provide negative benefit, I would assume that you'd say, well, we don't cover that mental health stuff and we can cut your premiums in half.
Yeah.
Listen, maybe if we really have a free market in insurance, we would have something like that.
But in the regulated market we've had for so long, maybe it's changing now, basically insurance companies said, listen, these are our costs to cover what you're telling us to cost, and then we get 20% above that.
Oh, they may be mandated because I know that insurance companies, first of all, they're not allowed to compete across state lines, I think, in the U.S. And also, they have a lot.
Everyone who has a particular ailment wants to lobby the government to make sure that the insurance companies cover that ailment so that they can socialize the cost of their ailments.
So maybe there's a mandate from the state to cover these things.
Yeah, so I think there's mixed impulses within insurance companies.
On the one hand, I think insurance companies so often are protected in the way they operate because they're mandated to provide these things, and then they look about what it costs them, and yeah, they try to negotiate deals with HMOs, that sort of thing.
But so much, in essence, what they're doing is, well, here's the cost, and then we get something above that.
So the fact that you have people that are costing, you know, you have this increasing burden of mental illness expense, it doesn't really hurt your bottom line necessarily.
Now I will say this, a while back I was invited to do a presentation to the Pharmacy Benefits Association and also a big HMO in California, the one you can immediately understand, and both of them were saying this is, our costs are going out the window for these psychiatric drugs, and they were also noticing this, you put someone on an SSRI, you know, you look at their level of utilization Of health resources in the five years before they were on the SSRI and now you look in the next five years.
They go up dramatically and it's not just the cost of the pill, it's they have other complications.
So you have a variable come on and all of a sudden we have higher utilization of mental health resources.
That is a bit of an impulse to, you know, change your thinking around your mental health care.
But insurance companies They exist within a larger narrative.
So does the government too.
And that larger narrative has been these are diseases.
We got to expand coverage.
That's what a decent society does.
And of course we have pharmaceutical companies lobbying, you know, government to make sure there's Medicare and Medicaid coverage for these drugs.
About 60% of spending on psychiatric drugs is covered by Medicare and Medicaid.
So I guess the point of this is, on the one hand, we can, as a society, look and say, mental illness is increasing, right?
The burden.
But rather than look at the treatment, it's much easier to say, well, maybe there's some other stresses that was under-recognized, under-treated before, and not try to challenge this larger narrative, which does produce a lot of benefits.
The narrative, in essence, is supporting a whole industry that has sprung up.
Right?
There's homes, there's all sorts of providers, there's, I mean, I think that what is it today, healthcare costs are about 18% of the gross national product, something like that, that we spend?
I don't know what the mental health is, but industries itself then become self-perpetuating, right?
And we have a narrative that has built up an industry, and it's really hard on a public level to challenge that narrative.
Does that make any sense?
Yeah, no, it does.
And I was just sort of thinking, because insurance companies, let's say you've got a lot of diabetics, and you suddenly say, hey, we're not covering insulin anymore.
That would be catastrophic PR. I mean, protesters and, you know, the evil...
Horned capitalist monocle evil guys or whatever.
And so if there is this narrative, and of course if these people are physically dependent upon these drugs, then pulling back on that coverage would create a massive, I guess, PR backlash, to put it mildly.
Not to mention the fact that people might have significant negative health consequences.
If those drugs are pulled out of their system by not being covered anymore without any transition or management.
And as soon as they say, well, with transition, with management, you'll end up a lot healthier.
That runs right up against the pharmaceutical companies and the drug, sorry, and the psychiatrists as well who would mount a campaign against that.
So yeah, I guess if I was an insurance executive, I'd just go get another latte.
Yeah, that's what you do.
I mean, you have to say, how do societal narratives get fashioned?
Who drives a societal narrative?
And in the United States, clearly, there's some financial reasons for narratives we have.
Pharmaceutical companies, turn on your TV, look at your magazines.
They've been driving this narrative for a long time.
And you have a medical profession that is also driving this narrative.
And government just sort of gets in line with the narrative, I think.
And then a government that wants to see, as you say, and insurance companies that they want to see as sort of kind, helpful, caring, they don't really want to challenge a narrative that like saying maybe less treatment would be better or different types of treatment.
Something that's come up more recently is this antidepressant use during pregnancy.
And especially the SSRIs, the selective serotonin reuptake inhibitors, and association with autism in exposed children.
So I've got notes here.
So one study found the use of these SSRI antidepressants during pregnancy was found to increase the risk of autism spectrum disorder by 87%, which, you know, again, the odds are small, but, you know, a near doubling of the odds is somewhat significant.
And, of course, more than 13% of women are currently using these SSRI antidepressants during pregnancy.
Pregnancy, and this may go somewhere to, I mean, there's of course increased diagnosis and increased awareness, but I wonder if this goes some way towards explaining the rather shocking rise in autism spectrum disorders over the last couple of decades.
Well, the rise in autism spectrum disorder, I'm not quite sure I understand the standard.
I think there's many causes, and I don't understand all of them.
Partly it is a diagnostic thing, an expansion of the diagnostic boundaries.
I don't know if I can say that the SSRI use is...
I would say the SSRI use might be contributing to that rise, certainly as a contributory cause.
But I think there's a larger issue with SSRI use of SSRI in pregnancy.
Yes, they increase the risk of autism, but they increase the risk of a lot of problems.
So you see a lot of preterm delivery problems with SSRI use.
You see withdrawal problems in the babies.
In other words, they're become adapted to the presence of these drugs as well, and then all of a sudden they're born, and they can go into these crying jacks.
Now, if you believe animal research, it's even more problematic.
So serotonin, as you know, how does the human brain form during fetal development?
Cells have to migrate, right?
There's this incredible migration that happens to cells as the cells line up in cortical layers.
Well, at least, if you give a rat, a pregnant rat, I think they're called a dam, an SSRI during pregnancy, and then you look at the rats that are born, Their brains are not organized normally.
Their cortical layers are not normally.
And they hit all sorts of landmarks then, if you don't sacrifice, you just fall.
Those rats hit all sorts of developmental landmarks late.
So, one of the worries here is, does SSRI usage in pregnant women, in some ways, hinder normal cellular organization in the brain?
Which would be a profound thing to do.
Now, it might sound alarmist, but I think we actually know that toxins, chemicals that pass the blood-brain barrier and get in, they're going to alter fetal development, or they certainly can.
So, there's a psychiatrist, not a psychiatrist, no BGYN, a doctor named Adam Yarato, who's really been sounding this alarm.
And Matt and American may go with him to urge to see if the FDA will put a black box warning on SSRI use in pregnancy because you're talking, what did you say, 13%?
So that's about one in every seven, one in every eight babies being born to a woman who used SSRIs while they were pregnant.
By the way, the problem might be particularly acute during that first three months.
So you're on an antidepressant.
You're not pregnant.
You get pregnant.
The fetus starts, you get this cellular organization in the brain and because serotonin is a signaling molecule that helps the cells know where to migrate to, you could be disrupting that and maybe it shows up in an extreme way with autism spectrum increasing that risk.
But one of the worries is maybe you're just preventing sort of the full potential of that fetus by this.
I mean, I think this is a huge, huge issue.
But now we can go back to the institutional corruption.
What psychiatry has promoted is the idea, oh no, the danger is if you come off, by the way, because depression itself is so damaging to the fetus.
Now you dig into those studies and they don't That story...
I'm sorry, that blows my mind.
That made no sense to me.
I mean, there's a lot about psychiatry, it doesn't make a lot of sense to me anymore.
But the idea that you're sad and that affects fetal development, I... Yeah, that's conceited.
The real risk is sometimes presented is that somehow the risk is that, well, maybe not fetal development, although I think I read that, but that the real risk to the baby is that you'll be born to a depressed mother.
And that actually is going to be more harmful to that newborn, and as they grow up then...
Any sort of exposure to the drug itself.
But here's the thing, if you, and Adam Yorato has really done this well, and we're putting this up on Mad in America.
If you look at studies that look at depressed women on meds versus depressed pregnant women off meds, you get more problems in the babies, fetal development, and babies born to the women on meds.
But we're talking about, we're comparing depressed cohorts, all right?
So that clearly tells you that there's a problem with The drug exposure itself.
But why don't we hear about that?
Well, so many of the experts telling us otherwise have ties to the makers of antidepressants.
Well, it's kind of ironic to me that the FDA, which got its first real founding out of the thalidomide scared in the 1960s, which, sorry, thalidomide, for those who don't know, was a morning after, like, a morning sickness medication that was, I think, first taken in Europe and then And there were a small number of pretty significant fetal abnormalities that came out of that.
But the numbers were tiny relative to any potential, any of these potential numbers we're talking about here.
And that's how it kind of got its start.
And the fact that even though it got its start supposedly defending medications which adversely affect fetal development and now it's not maybe hesitant about putting these warning labels on is ironic to say the least.
Yeah, I think it's part of like you're seeing an FDA that has...
Lost its teeth, so to speak.
It's sort of been captured in some ways by financial influences as well, including pharmaceutical influences.
We can get into why that is so, but yeah, I think the political environment is such that the FDA is really, really hesitant to put a black box warning on drugs and pregnancy.
I think it's too bad.
I think, again, what's our societal obligation?
It's to the defenseless.
Well, it's to the social good, right?
And the social good is to have, when kids are being born, to be as healthy and as full of potential as possible.
So if we have something that in fact is Maybe increasing the risk of autism, which they certainly do, but also if we have this worry about, hey, it just may be, and now the kids are hitting landmarks, even the kids that we don't see as impaired, but they hit landmarks like verbal development, physical development later, isn't that a problem for us as well as a society?
It's a problem for the child, but it's a problem for us as a society as well, because we want to have as healthy We want our children to be as healthy as possible, and yet we may have an agent that is impairing many kids, at least in some small manner.
Right.
So just two more questions, and I really, really appreciate your time.
This is information that I will work to the bone to get out into the world.
So, since you wrote Anatomy of an Epidemic, what have been the biggest scientific developments that have forwarded or pushed back against your thesis?
You know, I wish I could have a really good coherent answer to that because of course you'd expect that, right?
I mean, basically anatomy challenges this whole narrative.
Honestly, I haven't seen a good response, a good scientific response.
So what the response has been has been an attack on me personally.
Oh, I cherry-picked my data, for example, okay?
Well, if I cherry-picked my data, all you have to do is show the data I missed, okay?
Now, you talked about a study by Columbia University that said, hey, we read Whitaker's book and we were alarmed by it.
Well, I think actually they set out to disprove me.
I think they set out to find the cherry-picked data and the data I missed.
And what did they say?
We can't find it either.
Okay?
So, I haven't been presented with studies that said, here's what you missed.
Okay?
That's one way to do it.
It's just say, you cherry-picked your data.
Second is, I haven't been confronted with anybody who said, you miss cited the results that we did.
A third thing goes around the Martin Harrell study.
Martin Harrell was the University of Illinois researcher who's been studying long-term psychotic outcomes, schizophrenia outcomes.
In a way, I was in a vulnerable spot in 2010 because Harrell, when he published his own data, and I reported this, said, it's not that the drugs are making matters worse.
It's just that there's this people with a better prognosis who are getting off and that explains the difference.
Okay?
So he sort of spun it.
That's what he gave his own explanation.
And I remember when I interviewed Harold in 2009, I said, but that's not what your data shows.
Every subset, no matter how you group them, over the long term, it's the medicated group that does the worst.
The poor prognosis, the good prognosis.
And at that time he said, you don't understand really the politics of this.
I was told publishing this would be bad for psychiatry.
Wow, you know, when somebody responds to a data analysis with political considerations, haven't they basically just conceded the entire debate?
Yes, and here's what's so interesting.
Harrow has now published papers.
So what happens is the critics of Anatomy said, Whitaker misrepresented Harrow.
This was an example of how I didn't get the data right.
I didn't publish the results right.
Because what I did in Anatomy said, yeah, this is what Harrow says, but here's the data.
Well, Harrow has now written papers citing me, saying, you know, I think Whitaker's right here.
And actually, he pointed out to us where we were wrong with that explanation.
And in fact, all these groups had worse outcomes.
Well, I must tell you that when it comes to challenging the powers that be, that kind of vindication is as an oasis in the desert.
You stop, you bathe, you taste, you refresh your camel.
That is a good story to hear.
And, you know, we had a randomized study now where the unmedicated patient, that's the wondering study.
So what has happened is...
There just hasn't been a critique of anatomy.
That has the effect of saying, Whitaker was wrong, and here's our evidence that we're improving long-term outcomes.
It just hasn't happened.
Instead, we're getting all this evidence that, yeah, we really have a problem with long-term use, so much so that you have some mainstream researchers saying, why do we get such chronicity?
And now they're pointing out the fact that the drugs induce these changes, the opposite of what is originally intended.
So they're coming up now with a biological explanation for why their drugs fail over the long term.
So, that is sort of an acknowledgement, again, where people in the know are saying, you know what, this is the problem, and things are falling apart.
But you know what my favorite response is?
It's been this.
Oh, we've known all along that many people did better off medications.
We've known all along that not everybody with a psychotic disorder needs to go on the medications.
We've always known the selected use models the best.
We've known that, and that's how we even practice.
You even hear this.
We don't keep our patients on antipsychotics all the time.
Why did Whitaker say this?
Well, that's nonsense because ask anybody who's got a schizophrenic diagnosis if they can find a psychiatrist who will taper them off.
It's really difficult to do.
I wish I could give you a better thing.
Here's where they showed me wrong.
Here was the thing that really made me nervous.
It's been remarkably absent of that sort of information.
Yeah, and it's certainly, in getting the data, I sort of have this image in my head of when I was a kid, I used to have this old TV that did the flip.
You know, people don't know the flip anymore, but the old cathode rate tubes, the picture would sort of go up and down.
And what did I know about fixing TVs other than thump?
That's kind of...
And especially since this stuff started in the 50s and then peaked in the 70s and 80s, before, I think a lot of the really...
Illuminating kind of brain scans and topographies and fMRIs and all of that came about they really were claiming Victory by thumping a TV without really knowing much about its innards and that always left me to be somewhat It led me to be growingly skeptical or at least open to counter arguments because I mean the brain is the most complex thing in existence That we know of and we don't really have much of a clue how it works You know, I I put two batteries into a stake.
I don't get a human being We know what's going on.
And the idea that we know how to undo the effects of childhood trauma with a pill just seems beyond magical at this point.
Yeah, you know, the hubris in that is just remarkable.
I mean that, as you said, you take this, human beings are so incredibly complex.
The brain is so incredibly complex.
Our reactions to environmental difficulties are so incredibly complex and variable.
And the idea that some little pill that messes up with your re-uptake of serotonin or blocks dopamine receptors would be the solution and that you've made this great advance.
I mean it's really remarkable the sort of like Poverty of philosophical thinking that allowed this narrative to take hold.
If you really look at DSM-3 and the story, trauma doesn't count, family situations don't count.
It's like a worldview presented by people who have never read novels, have never been to the theater, never seen a Shakespearean play, haven't read poetry.
Even haven't read religious tracts.
I mean, go read the Bible, Old Testament.
I mean, they're filled with homicidal impulses and all.
It's ahistorical.
We suddenly got this, during the era of the brain, we suddenly got an ahistorical conception of how we are formed.
And that we're this reductionist, these molecules determine who we are.
And it's so...
Apart from any presentation of the human being I've ever seen before.
Oh, you go from One Day's Journey into Night to Hamlet to you name it.
And, you know, you don't sit there in the audience saying, boy, you know, a couple of SSRIs in this play would be like really, really boring.
All right.
So let's get to the last question and end on the note of optimism, joy, reform, solving problems.
So...
Institutional corruption, major financial interests, arguably, of course, as you put forward, I think a great case in the book, wending their way through the psychiatric approaches.
And, of course, having...
We haven't even talked about DSM-IV, DSM-V, where you get this multiplication of analogies and language you can apply to people in order to drug them in perpetuity, which is basically a license to print money at the expense of human sanity.
But what...
If people want to recognize, oppose, fight, expose, whatever it is that they feel motivated to do upon getting this information, reading through your books, what are your suggestions about reforms or things that people could advocate that would help?
I think people need to be informed about the science as much as possible.
So they need to inform themselves of this critical psychiatry worldview, this counter-narrative, and of the science behind it.
Because if you just sort of go on your gut instinct and you enter a discussion, you say, well, I don't think that's true.
If you can't back it up when you're sort of trying to support a counter-narrative, you're going to lose that sort of discussion.
But I really think the only big solution, and I do think it's happening, is that we see we've had this false narrative.
And that we can now embrace a different narrative.
It's sort of the narrative you're talking about.
Trauma does count.
It does count.
How we raise our kids counts.
Families count.
Poverty counts.
Racism.
You know, all these things count in terms of how we, our well-being and all.
So, I think what happens is we were sold this false narrative.
More and more people are finding out it's not true.
In other words, when you look into science, there is, the chemical, the fact that the chemical imbalance story is falling apart, that's a big deal.
Thank you.
So my advice to people is try to become informed about what science is really saying.
Did the chemical imbalance theory pan out?
No, it did not.
What do we know about the causes of mental disorders, the biological causes?
Not much.
What do we know about human resilience, the capacity of people to recover from trauma, the capacity of people to recover from setbacks in life?
Well, if you look on the resilience side of things, humans can be extraordinarily resilient.
So I think the answer is, how can we replace that false narrative with an informed discussion about what we do know?
And of course that informed discussion is going to have a lot of humility to it because, what did you say?
The brain is so mysterious.
But we also know how, as part of that new discussion, we do know how do people keep well?
How do you keep well?
Well, it's important to have meaning in life, right?
It's certainly important to love someone, have somebody to love you, have a social environment.
Eating does make a difference.
Diet does make a difference.
Exercise makes a difference.
So if we can remind ourselves about how do we rebuild a resilient society and have a new narrative, I think that's really the ultimate goal and people need to become informed about the science if possible.
It'd be wonderful if mental health practitioners, particularly those of the biological model, would just Stop making things up.
I think that's a good thing in life in general.
Just don't make things up endlessly.
It's demonic possession.
It's humors.
Let's solve it with ice cube, bath water.
Let's put people in a coma.
Let's do frontal lobotomies.
It's like...
Maybe you just stop making things up and actually go to the science.
And what seems to be the best science at the moment is kindness and time, you know, and exercise.
Because as far as I've been able to tell, I've had some experts on here as well, Robert, talking about there's no particular talk therapy that has been proven to work.
In any particular way, the presence of talk therapy versus the absence is a difference.
But if you get a good therapist of whatever school, you'll be doing well.
And if you exercise and eat well, over time, the majority of negative discomforts or discomforts with regards to states of mind tend to abate over time.
And running to doctors is more likely to get you in quicksand than it is to get you out of it.
And so yeah, my basic thing is, you know, hey, how about we just stop making things up, admit that we don't know, and start to work from the data on upwards.
But You know, as a philosopher, I'd say that asking people to stop making things up seems to be a rather tall order for a lot of people.
You know, there's that old saying that says it is hard to convince a man of something when his very livelihood depends upon him not being convinced of it or not understanding it.
So, yeah, there are some challenges.
But, of course, the facts are the facts and the truth.
However, laborious does eventually win out.
And I certainly, certainly appreciate the time and effort that you have put into and the care and, and I might add, the quality and enjoyable writing that you've put into making these issues comprehensible to lay people.
RobertWhitaker.org.
Madinamerica.com.
The book is Psychiatry Under the Influence, Institutional Corruption, Social Injury, and Prescriptions for Reform.
I don't believe there are any subtitles that say, stop making things up!
But, you know, perhaps in the next edition.
And Anatomy of an Epidemic, we'll put links to all of this below.
