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July 14, 2019 - Freedomain Radio - Stefan Molyneux
01:01:02
Anatomy of an Epidemic - The Explosion of Mental Illness in the West
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Hi, everybody. It's Stefan Molyneux from Freedomain Radio.
I have Robert Whitaker.
That's with one T. Don't get mistaken like I did.
He's written a number of books, the one that I've just finished, which literally blew the hair off my head, which will make sense to you, Robert, when you see the video.
Anatomy of an Epidemic, Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America.
Thank you so much for taking the time.
Thank you for having me. It's a pleasure to be here.
Well, one of the things that I noticed on reading the book was...
I was almost waiting for the outrage, and it felt like you were building the case so meticulously, it really was like watching a cathedral go up in fast motion, that you were building the case very patiently and very slowly, and was that your experience when you were researching and writing the book?
Because it seems at the beginning you didn't know where it was going to lead, and then by the end I felt all the pieces really did come together.
Yeah, the book I really was set to investigate a mystery, a puzzle.
And when you set out to investigate a puzzle, you don't know where it's going to lead.
And I hoped I was writing the book in a way that brought the readers along And, you know, in terms of their mind, so they can investigate this puzzle with me, so to speak.
And I was really quite surprised the way it all came together.
I really was. And it's one of these things, you know, writing a book takes a long time.
And so I'd get through one part and I'd see, you know, a new piece of the puzzle emerge and then I'd move on to the next chapter.
And I was really quite astonished how things kept falling into place in terms of Sort of trying to solve the puzzle.
And it really does read like a Dan Brown thriller, and it is that gripping.
And also, I found it quite emotional, particularly hearing some of the stories of what had happened to the people.
And I'm sure that was your experience, of course, tenfold on meeting them.
And it also was surprising to me the degree to which, I mean, a lot of puzzles, a lot of mysteries have ambivalence and ambiguity, but there didn't seem to be a lot of it.
There didn't seem to be a lot of counter evidence.
Were you surprised at that, or is that an accurate reading of your experience?
Yes. Let's just explain this to your readers.
One of the things I was looking at is how do medications shape long-term outcomes of major mental disorders, schizophrenia, anxiety, bipolar, depression, and then also look at what's happening to kids long-term.
One of the first things I tried to do was find out the evidence that shows that the medications are improving the long-term course of these disorders.
Of course, we would expect that there would be that evidence.
The first surprise really is that there isn't.
In other words, even those who are very much believers in this paradigm of care and promote it will say, listen, when it comes to long-term evidence, we just don't have any, which is really a rather startling admission after 50 years of using the medications that there's no evidence that surfaced in whatever types of research they've done that shows they're improving outcomes.
You talk about the lack of ambivalence.
It's not like you have a body of evidence out here saying that the medications are sort of worsening long-term outcomes and making things more chronic when you look at the long-term perspective and you have another body of evidence over here sort of contradictory saying, no, this is where it shows the evidence that we're improving long-term outcomes.
Instead, when you try to find the pro side of the story, by pro I mean those that support the common wisdom, There's this instant admission that we don't have that evidence.
By the way, that has been sort of confirmed in response to the book.
As you know, and we can talk about this, the book does challenge conventional wisdom.
It says, listen, science doesn't support conventional societal beliefs.
That's a book and a conclusion that upsets a lot of people and a lot of moneyed interests.
And so there has been some individuals, basically psychiatrists who take money from pharmaceutical companies who said, oh, Whitaker's wrong and sort of attacked me.
But what's interesting, in those attacks, nobody has been able to point to evidence saying, and here's what he missed in terms of compelling evidence showing that we're improving long-term outcomes.
And my favorite sort of review of this sort, someone was, some psychiatrist was writing in on one of these forums sort of criticizing me and saying, Listen, we wouldn't have to listen to Whitaker and these sort of attacks if we just had some evidence that our drugs improve long-term outcomes.
And the funny thing, of course, is he didn't see how that was so revealing.
And he's right.
If there were compelling evidence, then a book like mine wouldn't be out there.
Well, it would be impossible to miss because it would stand out against all of the other trials and long-term studies that prove quite the opposite.
So in the book as a whole, I guess you were starting with the challenge, which is we have these cures, which you would expect as cures would be, to make mental illness better, to have either more prevention or quicker cures or better longer-term outcomes.
And yet, when you compare The data on institutionalization and long-term outcomes from before the introduction of either first or second round mental health pills, you found, of course, that it's much worse.
The numbers are staggering.
1,100 or so people a day being permanently or semi-permanently disabled and ending up on SSDI or SSI rolls.
It's truly astonishing when you compare it, of course, to the degree of incarceration and the longevity of mental problems before these were introduced.
Is that the central mystery that the book is attempting to examine?
Well, exactly, and that sets up the puzzle, right?
So the puzzle is this, and it's just what you are setting out here, is in conventional histories of psychiatry go like this.
A drug called chlorpromazine, which in the United States was marketed as Thorazine, arrives in asylum medicine in 1955, and that kicks off a psychopharmacological revolution, this great advance in care.
So then we get antipsychotics, and listen to the word, antipsychotics, which means as if they're an antidote to psychosis, much like antibiotics.
It sounds like a polio vaccine, which you know is of course designed to prevent.
So it sounds like it's directly targeting something.
There was no evidence of any of that.
None of that.
But the story is that that's the story we're led to believe that they fix chemical imbalances, which is in this model of being an antidote to a known pathology.
We get antidepressants and anti-anxiety agents, etc.
And then we get a second generation that's supposed to be even better than the first generation drugs.
Normally, when you get this sort of medical leap forward, this pharmacological revolution, you see the burden that that illness takes on society, it'll decrease, or at least the outcomes of individuals so afflicted will get better.
For example, your polio vaccine, well, you get the polio vaccine and you no longer have people getting polio.
Even if you have the insulin for diabetes metaphor, maybe we have more diabetes because of dietary problems now, but people used to die from diabetes.
Now, of course, they live with it.
They live fairly good lives with diabetes, but what you see within this First of all, the puzzle is raised is, as the psychopharmacological revolution has unfolded, instead of the overall burden of mental illness in our societies going on the decrease, it's been skyrocketing.
As you mentioned, here in the United States, there are 1,100 people per day Now, going on to disability due to mental illness, and that's about 850 adults, 250 children.
That's an astonishing number.
The number of adults on disability was around 1.25 million in 1987.
When 2007, that number had grown to about 4 million, and that's when I was doing the research for this book, when I was starting this puzzle.
Now we're over 4.5 million, so it just keeps going up.
And one of the other things that I've discovered since I wrote the book was this burden of mental distress and the number of people on disability is climbing dramatically in country after country as they embrace the use of psychiatric drugs.
So you see the puzzle. The puzzle is, why is the psychopharmacological revolution unfolded as we get these drugs that supposedly treat a pathology?
Has the burden of mental illness skyrocketed so much?
Not just any mental illness, disabling mental illness.
People not able to work because of mental illness.
Then that brings you into the investigation of that puzzle as well.
How do medications shape long-term outcomes?
When you start looking at that, that's where the surprises really start coming to the forefront because what you do see, and I know your listeners are going to find this a bit odd, but it's definitely there.
As this happens, I mean, excuse me, as you look at the research, what you find time and time again is the research says, when you look at long-term outcomes, we're increasing the chronicity of these disorders.
That's what's surprising.
And what's surprising is this research shows up all along the way.
It shows up in the beginning of this 50-year history, and you'll actually see in the 70s, psychiatric researchers going, oh, we have a problem.
These drugs, whether they be antidepressants or antipsychotics, while they may be effective in ameliorating a target symptom over the short term, we seem to be getting more chronicity.
People are relapsing more frequently.
It seems like their stay-well periods are shortening.
Then the next thing you get, and this is why The way the puzzle fits together is so remarkable.
You'll see these red flags go up in the 70s.
Are we increasing the chronic disease disorders?
Then you'll actually see people come forth with a biological explanation for why they think the drugs are having this sort of paradoxical long-term effect.
I use paradoxical because over the short term, they do seem to be at least somewhat effective on a target symptom, but you get a different view over the long term.
And they actually come up with a biological explanation.
That's for the clinical things they're seeing.
So that's the second part of the puzzle.
Then you'll see naturalistic studies where you'll have modern studies where you'll have one group that goes off the medication.
You follow them long-term.
You follow the second group that basically complies with medical advice and stays on the medication.
And time and time again, you see it's the off-medication group that does much better and so forth.
And you just see this puzzle coming together in that way time and time again.
Yes, and I really was surprised to see the degree to which, as I say, 30 years ago, the supersensitivity psychosis theory, and I'd like you to mention a little bit about that, that how much information was there beforehand?
And, of course, when you look at the facts that before schizophrenics were regularly tanked up with these medications, you had 65% of first-episode schizophrenics could be discharged within 12 months.
And the majority of those discharged would not be rehospitalized in follow-up periods of four and five years.
And, of course, they didn't have the cognitive declines.
They didn't get the facial tics.
They didn't get all of the other health issues, as you say in the book.
It's between 15 and 25 years cut off the lifespan of people in this track.
I mean, it's staggering the degree to which this was known for many decades.
And, I mean, outside of your books and other work that's been done, it's simply not part of the common calculus in society.
Right. You know what you're getting here, too, is the way in which our society has become deluded.
And really, it's a really sort of remarkable societal delusion.
Take the schizophrenia story real quickly.
The concept of schizophrenia goes all the way back to the early 1900s, even a little bit to the late 1800s with a Swiss psychiatrist, a German psychiatrist named M.L. Kreppelin.
He looked at all his psychotic patients in his hospital and he divided them into two groups.
He had one group that showed up.
They presented with psychosis, but also they showed some affect, some emotional engagement.
If you actually go back to Kreplin, that group got better long term.
There was a second group of psychotic patients that were very dilapidated.
They were withdrawn. They had trouble making willed movements.
It was just that smaller group of psychotic patients that didn't do well long term.
Now, what becomes clear in history is that group of patients that Emil Kreplin saw, many of them actually had a viral illness called encephalitis lethargica, but that virus had not been identified at that time.
The virus gets identified around 1917, and once that virus gets identified and doctors start recognizing this presentation as a viral story, the definition of schizophrenia changes, actually.
I know this is confusing.
Anyway, it was that group of patients, that psychotic group that presented with a lack of effect that had a bad long-term outcome.
Kreplin found that if you present with effect, with emotion, that's a good outcome.
The confusion arises because after the virus is identified, then schizophrenia gets a new definition and basically it's just seen as psychosis and doctors say, aha, remember schizophrenia has a bad outcome.
But that was a different group of patients.
So what I did in this book is trying to understand is, well, if we look at how were people diagnosed with schizophrenia faring, say, in the decade prior to the introduction of chlorpromazine, you have this extraordinary surprise.
And you find that, as you said, 60-70% would be discharged from mental hospitals in 12 to 18 months.
And then when they would follow those cohorts five years later, about the same number would be discharged.
A percentage would be living independently in the community.
About a third just wouldn't be, quote, schizophrenic anymore.
They'd have no symptoms. But the employment rates were above 50%, and we completely forget that sort of relatively decent outcome.
Now, going forward with the story that you were talking about, supersensitive psychosis, when people sort of You're right.
In the 1970s, after about 20 years of these first-generation antipsychotics, you see the leaders in the field going, oh my goodness, people are relapsing more frequently than before.
That's number one. Number two, they said, listen, we have discovered how our drugs work, the first-generation antipsychotics, and they work by blocking dopamine receptors in the brain.
They thwart this dopamine transmission.
What they had also come to see was that in response to that blockade of dopamine transmission, the brain tried to up its dopaminergic system.
I don't want to get too technical here, but basically the neurons put out more dopamine and the neurons that received the messages increased the density of the receptors for dopamine.
Don't be alarmed of details.
I have a pretty smart audience.
It's sort of technical stuff.
Now they said because the brain is trying to compensate for the brain's presence, The brain is super sensitive to psychosis, and as a result of this brain change, you have two things.
When people come off the medications, they're now more vulnerable to relapse than if they had never been on the medications in the first place.
That's number one. But two, even if they stay on the drugs because of this brain change long term, they're vulnerable to what's called tardive psychosis, in which the psychosis sort of settles into the brain and becomes more permanent.
That's the early 80s.
And so by the early 80s, researchers were saying, the drugs do something.
Here's how they act on the brain.
In response to the drugs, the brain is modified in this way.
And when we have this modification, the brain is now more vulnerable to psychosis than it would be in a normal course of, quote, the illness.
In other words, you were...
Increasing or exacerbating the underlying biological vulnerability to psychosis.
And you even see researchers going, and when this happens, symptoms can become more severe, more debilitating.
So yeah, it shows up in the 1980s, and then what happens is that the only way to put it is that American psychiatry entered into a partnership with the drug companies in which they decided they'd sell a certain story.
That was a story of drugs that fixed chemical imbalances and a story of great advance.
They had to sweep under the rug this type of research that was showing this paradoxical outcome.
I'm sorry, just to mention what you talk about, I think, in the book, which is kind of chilling, is the degree to which psychiatrists in the 70s, and you mentioned that I think only 4% of residents were heading into psychiatry because it was becoming somewhat discredited, and also they were facing a lot of competition in talk therapy, which is what they were focused on at the time, from social workers and psychologists and just regular old therapists.
And so, in a sense, they reached for the prescription pad because it was the one rent-seeking differentiator that they had from all of these other people who were able to provide very similar services.
So, in a sense, to keep their income, to keep their prestige, they really had to go to the prescription pad.
Is that a fair assessment of what you found?
Yeah, absolutely. As we're going through this story, you see these worries arise in the 70s, and it's even more than worries, sort of a confirmation of what's going on.
And it happens in depression as well.
So why don't we keep on hearing about it?
And why didn't psychiatry keep on doing research to flesh out this paradoxical long-term effect?
Well, it goes to what you're talking about now.
And that gets us into this explanation of the monetary factors that control psychiatry's storytelling.
And here's that story. So up in the 1970s, you know, psychiatry had its Freudians, it had some engagement in talk therapy, etc., A couple of things were happening.
One, there was a lot of anti-psychiatry movement during the 70s, which was sort of treating psychiatry as sort of an agent of social control.
So that made them a bit unpopular.
There were some presentations of psychiatry in the media, sort of the crazy shrinks as well.
But more important was this.
There was a big boom in sort of the therapy marketplace.
There were a lot more psychologists offering therapy.
There were social workers.
So now all of a sudden psychiatry, those giving talk therapy or doing psychoanalytic therapy, found themselves in competition with psychologists, social workers, right?
So just in terms of the marketplace, they're now competing with people that can undercut their price, so to speak.
So they say to themselves, what can we do To give ourselves an advantage in the marketplace, and it's quite obvious.
They have prescribing powers.
These other groups do not.
So to give themselves an advantage in the marketplace, they have to make sure their prescribing powers have a value.
Now, the other thing you referred to is, the other thing was in the 1970s, is psychiatry was seen as not a real medical.
They weren't real doctors, so to speak, right?
And their therapies weren't seen as very effective.
And so medical residents weren't choosing to go into psychiatry either.
So you hear this stuff in the 70s among psychiatrists saying, you know, we're in a fight for our survival.
You know, psychiatry is in a crisis.
And the way they resolved those dual crises, which was that some residents didn't want to become psychiatrists and also the marketplace competition, is they came up with DSM-3, Diagnostic and Statistical Manual 3, in which they declared to the world, Mental disorders are brain disorders, just like heart disease or cancer, etc.
And then they began setting up a PR arm, the American Psychiatric Association, to start telling this story.
And part of that PR machinery was to tell about how great the drugs were and how they fixed chemical imbalances and How they were making these great advances.
And that PR story now gets funded in part by the pharmaceutical companies.
Because you can see that the storytelling interests now are completely aligned.
And we can go from there.
But yeah, what happened was in 1980, the American Psychiatric Association said, we will tell a story of brain diseases.
We will tell a story of our drugs that are very effective.
Welcome to my show!
And then the final part of the storytelling was pharmaceutical companies in the 80s began hiring American academics, in other words, psychiatrists at academic medical schools to be their speakers, advisors, consultants.
And once that happened, once that joining happened, and once academic psychiatry began serving physicians, As speakers for the pharmaceutical industry, we began to get this extraordinarily distorted story.
We placed our trust in academic psychiatry to be the honest storytellers, but instead they were telling a story to benefit the growth of a pharmaceutical market.
And I mean, there was such a fundamental discrepancy in the story, which is easy to see in hindsight, though I think not many people were aware of it at the time, which is if somebody says, this is a disease like cancer, like heart disease, like diabetes, then the next logical thing would be, okay, well, what's the physical test for it?
Because those other diseases have blood tests, have blood sugar tests, they have ways of finding out whether they're there or not.
And of course, in the DSM-1 through, I guess, the 5 that's coming out this year, There's zero physical tests for any of this.
They're all metaphors. They're all stories.
They're checklists. There's no actual test, so it's hard to see how it can be categorized as a physical ailment.
I came to this completely as an outsider, but this is one of the first sort of illogical parts of this whole story that just sort of makes you shake your head.
You'll hear time and time again, biological psychiatry, mainstream American psychiatry will say, these are brain diseases like heart, etc., And our drugs are like antidotes to brain diseases.
So even before you get to the markers, okay, then what's the pathology?
Okay, what's the evidence that they're brain diseases?
And then they'll quickly say, well, we don't know that yet.
So you go, well, then how do you know they're brain diseases?
Oh, we do. And they'll say, well, we do these MRIs or whatever, and we see these little differences.
But it's not just that they don't have Blood tests, and frankly, those are markers, and if you actually did identify the pathology, you could probably develop those tests.
They don't know the pathology, if such a pathology is to be found, for any major medical disorder.
That's the start of this whole delusion, this sort of illusion that...
Sorry, just to interrupt, you said they don't know the markers for any major medical disorder.
Sorry about that.
Sorry, that's important. Sorry, sorry.
No, for any major mental disorder, you're right.
They do not have a diagnostic test, right?
Well, the reason they don't have a diagnostic test is because they don't know the pathology.
They have an identification. And they've tried.
Because, right, they'd say, okay, well, if we restrict or expand dopamine receptors, then clearly we're fixing something.
They would try and find any differentiation between people who presented with these ailments versus those who didn't in dopamine or in serotonin or anything through the spine, and they couldn't find anything.
So they would have these theories which have been repeatedly disproved.
And you think that would give them some humility, but apparently money smells better than cures.
You know what? I shouldn't be laughing, but this really is amazing.
In other words, they raise something, like the chemical imbalance story.
Let's say people with depression have low serotonin.
They don't find it out to be true, but then it's not like the humility doesn't enter at that point.
They just move on to the next brain story, and there's this whole If you go back to the history of mental illness, the pathology of mental disorders is always just about to be discovered.
They're always just on the verge of finally identifying the pathology.
It's like waiting for Godot.
It just seems to never happen.
You're right. The new thing is They're moving on to new stories about what causes depression and what causes schizophrenia.
Now they're starting to talk about genes because the serotonin and the dopamine didn't pan out.
They're actually moving beyond the genes.
If you really follow this, we went from the dopamine, serotonin, that fell apart even though the public don't really notice it.
Then they moved to some sort of genetic disorder.
But the latest is, well, it's probably not exactly genetics.
It's epigenetics. Genes plus environment is the key.
In other words, we can throw so many variables in it that you can never untangle anything.
That's basically it.
When you say epigenetics, I mean, what happens is the way the human beings are built is that our genetic expression changes in response to environment.
In essence, we're all creatures of epigenetics.
I mean, you and I are different than we might have been based on what environments we grew up in, what experiences.
It gets you again into this, I don't know, sometimes it's just such a maze of illogical pronouncements sometimes.
There are two environmental factors, one of which I think you dealt with fairly openly in the book, and the other one I sort of had to read between the lines, and I certainly don't want to put anything in the book that isn't there, but I wondered if I could get your thoughts on it.
Sure. We're good to go.
Sometimes these drugs lead to mania, lead to worse than schizophrenia outcomes.
But I thought it was interesting that it could be people's experimentation with illicit or mind-altering substances that might lead them to an emergency room or something wherein then they're diagnosed with some mental illness and put on these drugs which can begin to disrupt and harm the brain.
That seemed quite important.
I wonder if you could talk a bit about that.
We really do need to talk about this, even though in some corners it's not too politically correct.
If we try to understand the bipolar boom, so bipolar, what used to be called manic depressive illness, used to be a fairly rare disorder.
You'd see annual prevalence in adult populations of 1 in 3,000, 1 in 5,000, 1 in 10,000.
There's an investigator in the UK, David Healy, says it may be as low as 1 in 100,000.
Well, where are we today?
Well, in the US, we're at about 1 in 50.
So, at the very least, that's like a hundredfold increase in prevalence, which asks the question, where are all the bipolar patients coming from?
Is it just a diagnostic change?
Well, if you survey, if you look at a group of people today who are diagnosed with bipolar, You will find that the entry gate, the entryway into that diagnosis for 25%, 30% will be illicit drugs.
They've been doing marijuana.
Marijuana is much more powerful today than it was 30 years ago.
Or hallucinogens or cocaine, that sort of thing.
I think the tragedy here is that What has happened is, so they'll have a bad reaction, or they'll get a psychotic episode, a manic episode in response to, say, illicit drug use, and instead of being treated for drug-induced psychosis or marijuana-induced psychosis or marijuana-induced mania or whatever,
They're given a diagnosis, a mental diagnosis, a bipolar disorder, etc., and then once they get that diagnosis, which is said to be a chronic, lifelong disorder, now they're put on other psychoactive drugs and that begins sending them down this very problematic path.
So what you see quite clearly in the research literature and in various parts is that for youth who are doing a lot of marijuana, Or other illicit drugs, they are putting themselves at risk, at increased risk, and I would say in some ways at considerable risk of ending up with a diagnosis like bipolar.
And if they get that diagnosis, their life can be very difficult.
And by the way, when I talk with people today about people diagnosed with schizophrenia, they'll say more than 50% of those People came in through the illicit drug route.
That was their gateway to that diagnosis.
Oh, is that right? Wow. Yes.
Wow. I didn't realize that, by the way.
Yeah, and this is a way where you get these dominoes, and I was really struck by this.
This is a heartbreaking story of the girl who was given a sort of anti-bedbedding pill, which entered into a spiral where she became, I mean, not quite catatonic, but certainly nonverbal, and where you just get these, I mean, I want to say like a marijuana-induced psychosis is a minor thing, but relative to Where they go from there in the system, it's a relatively minor thing.
Just how it's like a spider and a fly in a web in a sense, that there's a little thing that starts it and then it just goes from there where it can consume decades or somebody's entire life in this system.
Yeah, this is the real tragedy and you see this tragedy over and over again when you...
So I interviewed maybe, I don't know, somewhere between 75 and 100 people about how they ended up in the system and all.
A story I hear so frequently was exactly that.
They had this momentary crisis often brought on by use of drugs.
In a second we'll talk about illicit and legal drugs.
They end up in this crisis and if that crisis had been treated as a crisis instead of as a sign that they're ill for life, that crisis could have abated and they could have gone on with their sort of ordinary life.
But instead, we have a system that converts that crisis into chronic patienthood, so to speak.
That's really one of the messages in the book.
The story you're talking about, let's just distinguish a couple of things here.
A moment ago, we were talking about illicit drugs.
Illicit drugs, you can have a bad marijuana, cocaine.
I usually illicit because marijuana historically was seen as an illegal drug.
It's sort of changing into quasi-legal.
Anyway, marijuana, cocaine, hallucinogens, they can stir an emotional response, a psychotic response that can put you in a bad state.
But that doesn't mean you're bipolar.
It doesn't mean you're schizophrenic, so to speak, or have schizoaffective disorder.
And if they were just treated for that momentary thing, then they could be put back on a path to a normal life.
But what happens? So many of them get the diagnosis, then they get other drugs, next thing you know they're on a medication cocktail, and now they're down this life as a patient.
But then that's one sort of pathway that exists in our society today.
The second one is related to what can happen to kids.
So we didn't used to medicate childhood.
It used to be quite rare to put children on psychoactive drugs.
But now we're putting them on antidepressants, stimulants, antipsychotics, etc.
That modifies the brain.
And the one heartbreaking story you're talking about, there was this young girl who was going off to camp.
And she'd had a bedwetting problem for whatever reason, some sort of anxiety, so the doctor put her on an antidepressant.
That made her sort of manic and aggressive.
And rather than understanding that the child is having a known possible reaction to an SSRI, next thing you know the doctor is saying she has bipolar.
Then she gets on antipsychotics.
And then eventually she just keeps deteriorating under this avalanche of psychopharmacology.
And that girl today, who's in her 20s, is mute.
She's just stopped. She's just stopped interacting with the world.
I think it was after her last break, they put her on 13 different brain meds in a couple of days.
And as her mother said, they just fried her brain.
Yeah, just fried her. And she's just gone to the world.
Now, that's an extreme case, but you have a lot, a lot of youth today who get put on these legal drugs, prescribed drugs, antidepressants, stimulants, and certainly the antipsychotics.
They deteriorate once they're on the drugs.
On the antidepressants, they may have a manic episode, a psychotic episode.
Stimulants, you can have a psychotic episode, a manic episode.
In both instances, they move into the bipolar camp.
If you put these kids onto antipsychotics, they often have a lot of metabolic problems and they have some cognitive decline.
We really have a system that can take children who are suffering from momentary problems and convert them into mental patients.
That's what we have now.
The same thing can happen with adults.
You can be an adult, say, 19, 20, 21, 25, and take an antidepressant.
You can have a manic episode in response to an antidepressant.
Next thing you know, you can end up in the bipolar camp.
We're sort of awash in our society in psychoactive drugs, whether we call them legal or illegal, prescribed or non-prescribed.
The truth is, psychoactive drugs Can stir a lot of variety of responses, but mania and psychosis are two possible ones, and when you get those, boy, you're now on a path to a diagnosis, and when you get the diagnosis, often then it comes with two, three, four drugs, and now your life's really changed.
Yeah, your brain has changed and the stories of some of the people trying to get off of these psychoactive drugs were just terrifying.
The degree of symptomatology was so extreme where they would have visions, homicidal rages, suicidality, I mean, to the point where it was so hard.
And they found, was it benzodiazepines?
Within two weeks you can become addicted and significant percentages of people, even in the trials, had a very hard time getting off these drugs or couldn't get off them at all.
Yeah, listen, the benzo trap is remarkable.
It's sort of an extreme example of really the trap that exists with all these drugs.
And I was really shocked by this, both in my interviews and actually that it was documented.
And the story is really quite simple.
When you start taking one of these prescribed drugs on a daily basis, your brain adapts to its presence.
It's modified by the presence of the drug.
Because of that modification, when you try to go off, your brain isn't as it was before.
It can lead to all sorts of withdrawal symptoms.
The benzos turn out to be particularly severe, but you see withdrawal symptoms really with all the drugs.
Maybe stimulants are the least, but there's withdrawal symptoms from stimulants too.
I think the importance of this is this.
It means that initiating treatment is a profound event.
It's not just an easy thing.
You can take it for a while and then go off.
You initiate treatment, you stay on for a while, and then maybe even if you want to come off, you may find it very difficult to do so.
And now, next thing you know, you're taking the drugs on a regular basis.
And the damage can be permanent, which is really the most chilling sentence, I think, that comes out of that.
Well, yeah, I think with all of the...
With antipsychotics, it's pretty good evidence that after three, five years, you get sort of a cognitive decline that sets in and becomes somewhat pronounced.
But what's surprising is you see cognitive decline set in with long-term use of Benzodiazepines, that's quite clear.
You'll even see some signs of cognitive decline with use of SSRIs after, say, six months.
You'll see some memory problems, that sort of thing.
If you had an informed consent that said to a person about to start an antidepressant or a benzo saying that if you end up on this drug long-term, there's a good risk of cognitive decline.
People might assess that differently, but it's really there with the benzos.
It's definitely there with the antipsychotics, and it is there with the antidepressants too, and I think that would surprise many people.
And there is, I mean, there are a couple of other factors I just wanted to get your comments on.
The first seems to me that the problem must be described, of course, as those who pay do not prescribe and those who prescribe do not pay.
I mean, if I went to a doctor and the doctor was hitting me with a bill for a couple of hundred dollars a month in pills, I would damn well want to make sure that they were effective.
And I would ask for all of that data.
But in a sense, if it gets diluted either to the state or to insurance companies through state-mandated mental health coverage, it seems like there's less of a barrier.
Now, of course, if the doctor had to deduct the cost of the medications that he was dispensing from his own profits, and people said, well, I want this...
This drug, then he would be much more likely to say, you know, ah, you know, the studies are really not that great for this, you know, why don't you try exercise and diet change, which as you point out is more effective than drugs or even drugs plus therapy.
It seems that there's a dilutionary mechanism at work when it comes to that basic cost.
The one woman you talked about, I think she was in a wheelchair, who was going to be $200,000 worth of profit to drug companies.
But because nobody in particular pays that, in a sense, and nobody can really identify that cost, it seems that's much more of a slippery slope, if that makes any sense.
Oh, this is a great, great, great, great point.
First of all, the cost is borne by society in many ways.
First of all, the cost of paying for the pills is either paid...
In the United States, 60% of psychoactive drugs are paid for by the federal government.
Federal or state governments, sorry about that.
Virtually all the rest is paid for by insurance companies.
And in the insurance companies, I think it was in the 60s or 70s that psychiatrists lobbied the state to make sure that mental health coverage was included, whether people wanted So even that is subsidized by the majority of people who don't use it.
You've got two different things here, really important points you've made out here.
If people had to pay out of their own pocket for antidepressants, antipsychotics, would they be doing so?
We wouldn't have this market.
There's an old joke that says this, what's the difference between illegal drugs and prescribed psychoactive drugs?
Well, the old joke is that people will pay out of their own pocket for the illegal ones, The prescribed ones, they can be sort of coerced to take them and told to take them.
People would not be paying $10 a pill for an antipsychotic pill, trust me.
This is a market that can boom only in a subsidized form where other people aren't paying.
Let's say there was some reimbursement system for $200 for a visit to your doctor.
But the prescription had to come out of that $200.
You can be sure they would be prescribing something other than, say, antidepressants left and right or antipsychotics left and right.
They would be prescribing stuff which didn't cost anyone anything, i.e.
diet and exercise, or it didn't cost much.
Yeah, absolutely. They'd be prescribing some healthy things as well.
So that's the first part of the cost, being born Not in a market-based way.
When you don't have market forces in any way contributing to supply and demand, you can end up with these artificial situations.
The other cost that you're talking about is, who bears the cost of the fact that someone ends up on disability?
What you'll see with a lot of these people, They have all sorts of other health problems and they become big users of Medicaid and Medicare services for secondary problems, obesity problems, other physical problems related to the adverse effects of the psychoactive drugs.
On the other hand, all too tragically, they're probably not going to make much use of Social Security because they're not going to live that long.
Oh, well, that's true. We have, at least in the United States, people are dying 25 years earlier than normal.
And really, it's worse than that.
If you see... Well, I shouldn't say worse than that.
What they're finding is...
Now, people are getting put on cocktails at age 15, 20, etc.
How long are those people going to live?
You're actually seeing since the arrival of the atypical antipsychotics and the use of drug cocktails, a lot of people dying in their 40s.
So, the problem of early death, I think, is going to become even more extreme in the years to come.
I'm sorry, I interrupted you when you were about to bring up the other point around the finances.
I hope I haven't derailed you too much.
No, no, no, it's okay.
Actually, I was just going to say, there's even some sort of macabre humor among patient groups saying, well, the fact we're dying early, it saves the government some money, sort of as if it's a eugenic policy.
Yeah, the burden that this explosion of mental illness, quote, mental illness is taking on our society, it's increasing number of people on disability.
If you take the kid who hits age 18 and has sort of been on disability already or been given a diagnosis of bipolar and this goes on to disability when they hit age 18, that 18-year-old is going to cost society somewhere between two and three million dollars at today's values over the course of their lifetime of care.
And that's not even counting the last revenue that could have occurred had they been working and paying taxes or producing something of value otherwise.
Exactly. So we lose someone who could be a...
You know, someone contributing taxes and next thing you know, they're put into this thing where they increase the cost of caring for those who can't care for themselves.
That's a huge burden, the increasing disability roles.
Add in the healthcare that is involved.
The money spent on drugs So the government in the United States pays for about 60% of all psychoactive drugs, prescribed drugs.
And the market here is about $40 billion a year.
So that's $25 billion a year that the government is paying for psychiatric drugs.
But that's just the beginning of the toll that this epidemic of mental illness is taking and this epidemic of increasing number of people on disability.
It's becoming a real Fiscal anchor on state governments and federal governments.
On state budgets, you'll see that spending on mental health services and for people on disability, it's one of the real pressures on state government.
Well, and it's really upwardly sticky because you could make an argument, well, okay, if there are jobs and someone loses welfare benefits, they can go get a job.
But if these people are mentally semi-capacitated or semi-incapacitated, then making the argument that they should just go out and start flipping burgers rather than taking disability seems like a tougher argument to make from a compassion standpoint.
Yeah, listen, I think people get trapped in this system, right?
I mean, because... You know, you get on disability, then you're told you have to take the drugs pretty much to keep your disability payments and to be in compliance and that sort of thing.
And especially if you're on antipsychotics, half the time you're sleeping until 10 in the morning.
So there's a lot of barriers to getting off disability once you're I think you have a lot of really innocent people, so to speak, who end up trapped in the system where they had a crisis, they had some traumatic time in their life,
they had some difficult period and next thing you know we really have this powerful force for converting them into lifelong customers of drugs and many of those who become lifelong customers end up in the disability system.
It's just a broken, broken It's a broken way for a society to respond to eruptions of emotional distress, difficulty in their midst.
That's all I'm saying. It's a self-defeating way to respond.
Many, many years ago, probably around 10 years ago when I was first sort of interested in this topic, I read a little bit on things like ADHD and Ritalin.
And one of the things that I remember reading, this was many, many years ago as I mentioned, that kids who were with their dads actually became relatively symptom-free.
And that sort of started me thinking a little bit about the degree to which we've really messed up.
As a society, the family is very different than it was, say, two generations ago.
It's close to 60% of American children are not growing up with two parents.
And, of course, we're a two-parent species.
And it's hard to think that that doesn't have some effect on the degree to which children are lacking, particularly boys, lacking impulse control, certain kinds of socialization.
And that sort of breakdown of the traditional nuclear family would seem to me to have some way of starting people down this road.
It obviously doesn't lead them down the whole road, but that to me would be an indication of one reason that people should look into rather than drugs as to why children may be, quote, less better behaved than they used to be.
You know, this is so obvious, right?
It's so, you know, it's such common sense.
I mean, we all do know that to be healthy, You know, our environments matter.
And as children, we need safe environments.
And two parents really are an important part of that environment that helps us, you know, learn how to behave and do well.
But what do we do now when we don't provide kids with that environment?
We blame the kid and we say, look, this kid has a brain disease, has ADHD, and has to be medicated for life.
I mean... Instead of looking at the way our society is put together and saying, what can we do to change society so we raise healthier children and give them what they need to hit adulthood so they are able to control behaviors and growing up is difficult.
Instead, when kids in these difficult environments show behavioral problems, We label them defective in essence, right?
We say ADHD is a brain disease.
It's really sort of cruel.
It's like a double whammy, right?
It's not like, for instance, it's not like the fact that schools are getting worse and worse, and particularly as they focus less on that which is engaging to boys.
There can't be any problem with the teaching.
There's only such a thing as a learning disability.
There's no such thing as a teaching disability.
But we always, as a society, tend to blame those who are the most helpless, and that does tend to be the kids.
And I just wanted to sort of point out that that does seem pretty tragic.
And I don't want to keep you all on all afternoon, but I did have one last...
And it was touched on in your book, I think a little bit obliquely.
One of the stories that you had was the story of Jessica, who at the age of two was hitting and biting other kids and ended up on these meds.
I think you met her when she was about seven.
A couple of pages later in the book, you mentioned that her father had to go to anger management for his own rage issues a couple of years back, which I guess would be when she was very young.
And again, when I sort of look at dysfunction in the children, my first impulse, you know, as an admitted amateur, my first impulse is to look at the template or modeled behavior on the part of the parents.
And I was wondering if you saw that, because right at the end of the book, when you were talking about the really powerful studies and outcomes on schizophrenia patients in Lapland, one person, one of the investigators, or one of these, I think it was a psychiatrist, said, I wrote something that I thought was very, very powerful.
He wrote, he said, it is almost impossible for anyone meeting with these patients' families to not understand why they had difficulties in life.
They're not ready to be adults and we can help with this development.
I thought, to not meet these people, not these people, but he was talking about their families and sort of parental modeling, child abuse, dysfunction within the family.
Again, that would seem to me to be the first, it may not be the only place, of course, but the first place to look.
That doesn't seem to be happening anymore.
I was wondering if you could talk about why that would be the case.
Because again, that just seems like an obvious first place to look.
Yes. Part of this story we're talking about does get us into a philosophy of being.
How do we grow up?
How do we learn to control our behaviors?
What this psychiatrist was talking about is human beings organize themselves in response to others.
You can't organize yourself in isolation.
And we do learn behaviors from those around us, adults and all, and whoever's around us.
We model our behaviors off of other people and we learn to control our behaviors in response to clues, cues, etc.
So why, when we have kids that are having difficulty or individuals that are having difficulty, why don't we look to that larger environment?
Because probably there's some dysfunction going on in the environment.
In the past, present, etc.
I think it goes to a couple of things.
One is increasing corporatization of American life.
How can I put this?
A view of life as consumers and not as much...
I'm getting off here.
The point is, it's like a philosophy based on...
Shallow, greedy materialism would serve you at the moment.
Thank you. I was trying to be nice about this.
No, look, I mean, the average house size has doubled over the past 20 or 30 years.
Is it absolutely necessary? Is it better to have children who are latchkey kids coming home to a bigger house with nobody in it?
Of course not. Exactly.
So people often don't limit their acquisition for the sake of their relationships.
I'm sorry, I don't mean to jump in, but if you were trying to be delicate, that would be my take.
I was trying to be delicate, you got it exactly right.
And that's part of this corporatization of life is we have a way to make profits from difficult times.
In other words, one of the things that did happen when we got DSM-3, that's 1980, and when the APA says We're going to start calling all sorts of emotional distress brain diseases.
Boy, it set up a great model for the creation of a market.
And as you know, in our society, what corporations try to do is they try to create customers, they try to create markets, and they like to keep their customers.
And one of the beauties of this system of care, this drug-based system of care, and thinking about emotional distress and difficulties In a pathological sense, it works beautifully from a profit-making point of view.
Because what happens? You take that crisis, you take that difficult emotional moment, Since we have this new view of things and rather than deal with the complexity of family relations and the time that may take to sort of fix those things and also larger societal things about how do we build healthier societies,
you pathologize that moment, you put that person on a drug, their brain changes, now they have trouble getting off the drug and often they need a second drug We're good to go.
Even from psychiatry, it puts them in a position to have that customer returns for their drug adjustments, etc.
It works from a capitalistic point of view.
In 1987, we were spending about $800 million in the United States on psychiatric drugs.
Now, we're spending $40 billion a year on psychiatric drugs.
A 50-fold increase in the market.
That, from a capitalistic point of view, is a success story.
As you point out with the introduction of some of the earlier drugs in the 80s, Eli Lilly went from a $10 billion market cap to $90 billion with $3.5 billion distributed as internal profits and salaries and bonuses.
The caveat that this is not exactly a free market environment.
In fact, it's in many ways more of a fascistic model of the privatization of profits and the socialization of costs, extreme socialization of costs.
Yeah, it makes a lot of people a lot of money.
Yeah, that's the way. It does make a lot of people a lot of money.
It makes stockholders happy.
It makes the people at the top of those companies very rich through stock options, etc.
You have to realize that.
Parents who may have not been optimal parents get to avoid guilt or change if they can just chalk it up to some chemical in the brain.
Well, that is an element of this.
It really is. You can trace this with the rise of an organization called NAMI, National Alliance on Mental Illness.
Now, there was probably some unfair, under the old Freudian ideas, there was the schizophrenic mother, Cold mothers make schizophrenics.
It's not fair and it's not true in many cases, but they wanted to get out of that sort of blame, and I understand that.
When that group formed, they were really eager to embrace a no-fault model of psychosis, so to speak.
The problem is That family relations...
And I'm not saying the mothers are to blame or anything like that, but family relations matter in emotional distress and in psychosis.
They just do. Yeah, they do.
And again, it's not the only place to look, but it would be one of the first places.
But there's a lot of people who feel better if it's an illness.
And again, some of them may be inadvertently not great parents.
Some of them may have been malicious or malevolent parents, but there is a...
Okay, so it's just like an ailment that happens to be there and we can deal with it.
But unfortunately, of course, if it is environmental and relational, which is what I think the researchers in Lapland were talking about, I thought it was fantastic how they talked about that psychosis is relational.
It is not within the brain.
and how the person who has the psychosis is the one who's acting out dysfunction within the environment.
And by the environment, I would assume they mean pretty much the direct family.
So there's a lot of relief if you can chalk it up to some biochemical thing and take a pill.
But of course, if it is environmental, that environment doesn't change to the point where it could really positively change the outcome.
And of course, the person, as you point out in the book, who's on the meds doesn't learn so much alternate coping mechanisms, which is another reason why they tend to stay stuck and then they get addicted.
And people try to take them off the drugs and they relapse and they say, oh, well, they had relapsing because the drug was working and now we're taking it away.
so it's not like a diabetic.
Oh, it's just all too awful.
Now, listen, I really want to make sure because I know that you've got a lot of great resources on the web and I'm also going to link it with your permission to a couple of the public talks that I watched that you've given and I really want to compliment you.
Your public speaking style is given the topic, it's more gentle than I think I could muster.
Even with a lot of downers.
So I think that's really, really to be admired.
But what are the resources that you've made available or that you find valuable for people to learn more about this?
You know, with the caveat that we don't want to go down necessarily the Tom Cruise route, as you point out, the Scientology, the backlash against psychiatry didn't exactly help the dissemination because it gave a convenient scapegoat to dismiss the criticisms.
But what are the good resources that you have made available that you find useful?
I just relaunched MaddenAmerica.com, which is my website based on the title of my first book.
And to make more resources available.
And one of the resources people will find on that site, madinamerica.com, is they can go back to the actual studies I cite in Anatomy of an Epidemic or my first book, Mad in America, and therefore they can read the actual studies and they can see what I'm writing about here.
And they can see that this is mainstream science documenting this This story I tell in Anatomy of an Epidemic.
And what's been great about that is I've had researchers now sort of stunned.
I'll give a talk, or they'll read the book, and sort of stunned by the research I pulled together.
And then they go on the site, they review it all, they grapple with it, and their minds get changed.
I'm seeing this happen sort of over and over again.
So that's one of the resources that they'll find on Mad in America is you can go to the source documents.
And I think ultimately the question is how do we change this?
How do we as a society sort of remedy what's going on now and do a better job of helping people in distress and all?
And I think what really the challenge is is for us as a people to become better informed.
And so we'll become aware of what the long-term outcomes literature says.
We'll become aware that the chemical imbalance story is a marketing story.
It's a story used to sell drugs, but it's not a scientific story.
And then if we as a people, as a society, can become informed in this way, I think we can have a new dialogue that will maybe put some resources into therapies that help families I think that's the sort of moral responsibility that If we want to change this,
that we as a society have, and I hope more and more people will accept that responsibility.
Well, I felt so too. And I thought that the chapter on solutions, and particularly, I'm not going to give away the ending of the book, which absolutely gave me goosebumps.
And I really, really want to thank you for the work that you're doing.
I mean, I know it's very, very powerful what it is that you're doing.
I think that the patience and the steadfastness with which you'd gathered the evidence and put it forward has certainly made a comfort of me and I'm sure of the many, many people who are reading the book.
So thank you so much. And thank you so much for your time today.
Well, thank you for having me, and thanks for a great interview.
It was really a real pleasure.
All right. Take care, Robert. Thanks.
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