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True health is more than just nutrition, and with that in mind, today’s episode is a departure from our usual topics. My co-host, James Connolly, is taking a deep dive into the field of psychiatry with guest Robert Whitaker.
Robert is a journalist who specializes in investigating science and medicine, especially as it relates to psychiatry and mental health. He is also the editor of Mad in America, an online hub dedicated to rethinking psychiatry in America.
Through his books, podcasts, and online media, Robert calls for change in the drug-based care of mental health that has ultimately failed our society.
Listen in to James and Robert’s conversation as they unpack these (sometimes controversial) topics:
- This history of psychiatry
- Defining schizophrenia
- Moving from episodic to chronic mental illness
- The Social Determinants of Health
- Turning diagnoses into drugs
- The rise in polypharmacy
- The medicalization of childhood
For a more detailed discussion of psychiatry’s modern-day approach to mental health, be sure to check out Robert’s books:
Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness
Mad in American: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill
You can also watch this episode on YouTube: Episode 240: Robert Whitaker
Please note that if you are someone struggling with mental health issues and pharmaceuticals are working for you, please continue taking them and don’t feel shame in this. Life is short, and all people deserve peace and happiness. As serious “questioners,” James and I try to give a voice to those who question commonly held beliefs, and Whitaker is a great example of this. Our goal is to shed light on topics and keep asking questions. If you’re someone who has a different view than this guest, feel free to share, respectfully, in the comments.
Resources:
What is Health?: Allostasis and the Evolution of Human Design by Peter Sterling
Bullshit Jobs: A Theory by David Graber
The Broken Brain: The Biological Revolution in Psychiatry by Nancy C. Andreasen
Adam Urado, MD – Pregnancy and Antidepressants
Invisible Women: Data Bias in a World Designed for Men by Caroline Criado Perez
Connect with Robert:
Website: Mad in America
Facebook: Mad in America
Twitter: @Mad_In_America
Podcast: Mad in America
YouTube: Mad in America
Episode Credits:
Thank you to all who’ve made this show possible. Our hosts are Diana Rodgers and James Connelly. Our producer is Emily Soape. And, of course, we are grateful for our sponsors, Global Food Justice Alliance members, and listeners.
If you believe in making sure that people all over the world should have access to nutritious food, please join my mission through my non-profit, the Global Food Justice Alliance. All sustaining members get early access to ad-free podcasts plus free downloads, and you’ll be helping get healthy protein like meat, fish, and eggs to food-insecure kids. That’s sustainabledish.com/join.
A big thanks to the sponsor of today’s show, LMNT. Do you often suffer from headaches, muscle cramps, fatigue, or sleeplessness? It could be from an electrolyte deficiency, and drinking plain water may not be enough to replenish lost electrolytes. LMNT is a drink mix that has everything you need and nothing you don’t – no artificial ingredients, food coloring, gluten, fillers, or sugar!
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Transcript:
Diana Rodgers, RD
Welcome to the Sustainable Dish Podcast. I’m Diana Rodgers, a real food registered dietitian, author, and sustainability advocate. I co-host this podcast with James Connolly, who was a producer on my film Sacred Cow. I also founded the Global Food Justice Alliance, an initiative advocating for the inclusion of animal-source foods like meat, dairy, and eggs for a more nutritious, sustainable, and equitable worldwide food system. You can check it out and join me at global food justice.org. Thanks again for listening. And now, on to our show.
James Connolly
Good morning. So this is James Connolly with Sustainable Dish’s podcast. So I have this sort of very special life. It’s been really kind of, I have to tell you, Robert, one of the strangest things about this is I’ve recorded three podcasts within the last maybe month and a half or so. One was a German veterinarian who works with camel herders in Rajasthan, in India. And she works with pastoralist societies all across the planet. And then another person was a person who had written a book about Davos, about these sort of 200 or 150 private jets, that all sort of meet up every year in Switzerland and kind of talk about the future of humanity, the super-rich, the ultra-wealthy and everything like that. And I had sort of reached out to my… I really had this like, running list of like, 10 people on the planet, I really, really wanted to talk to you. So I sent it to my intern and it just a hope and a prayer and Robert Whitaker was able to find some time and back to me. I have to say, I’ve listened to probably 70% of your podcast, and I’ve read your book. I find all of this stuff absolutely fascinating and interesting. So let me introduce you. Robert Whitaker is an American journalist and author who has won numerous awards as a journalist covering medicine and science, including the George Polk award for medical writing and the National Association for Science Writers Award for Best Magazine article in 1998. He co-wrote a series of Psychiatric Research for the Boston Globe. There was a finalist for the Pulitzer Prize for public service. His first book, Mad in America, was named by Discover Magazine as one of the best science books of 2002, which is when it came out. Anatomy of an Epidemic won the 2010 investigative reporters and Editors Book Award for best investigative journalism. Thank you so much for coming on today.
Robert Whitaker
Well, thanks for having me. That was quite the introduction. The most flattering thing I’ve ever heard. I have to say a little jealous of you though, when I hear the range of people you’re getting to speak to. What a life to be able to speak to, you know, this wide range of people doing different things. So I think that’s the best thing in life when you get to meet other people, be curious about other subjects. So anyway…
James Connolly
Yeah, it’s really about stories, right? I mean, it’s the only way my memory works is I try to sort of fill a life with stories. And your story is really interesting. I tried to conceptualize some aspects of the way like, because if you look at the history of psychology, you get a sense that it was always moving in this general direction, and that there was a sort of coordinated movement, with very few outliers and critics sort of working against this. And the more you learn about it, there had always been a pushback against the site, the way that psychology had been moving in its myriad different forums over the course of say, the last 140 years or so. And there have always been critics or people who had sort of pushed back on that. But I do feel like in some ways, your book kind of, like created a wave, that allowed for a number of different psychiatrists and psychologists to then sort of feed off of that information, to start to correlate this stuff in a way that the general public could actually start to read into it. Because, you know, everybody’s within their own circle. And, you know, if you’re reading, say, Irving Hirsch’s work on serotonin, and you know, that depression, and a lot of the studies that were done, you’re reading that, you may take that as kind of maybe a one-off. You may think that is something that maybe it’s sort of blip within that structure, but you start to correlate all of these different stories, the history of it, and you start to really come up with a pattern that you call sort of cognitive dissonance like these groups do not want to look at the mirror of themselves and say, Hey, maybe we got this wrong. So I kind of want to start out a little bit with the sort of 19th-century sort of the birth of the history of psychology, maybe they were called alienists at the time, and the sort of understanding of the way that we started to quantify and utilize the idea of different structures like schizophrenia. or depression, and stuff like that. I wonder if you could kind of start out with that?
Robert Whitaker
Well, yeah, there is sort of a long-running narrative or story within this history of psychiatry and psychology. And this is a narrative that really goes to this question, you know, what is normal? And where are we going to decide when there’s sort of craziness? And, of course, you know, and I like to make the reference to Shakespeare, if you read or watch a Shakespeare play or read your Shakespeare, you know, he presents human beings in this very emotional way that we can be… normal people can have these incredibly fierce emotions of jealousy, rage, and that sort of thing. So right away in this field, you start asking is, well, when do people become crazy? When do we assert control over the crazy people? Because does society do that? And also, then once you have those questions in present with you, you’re going to have all sorts of questions of power. Who gets to do… to say that the other people are crazy? Is it? Is it men? Is it people who like in the United States has it basically Caucasian people get to make this definition? And then you have to look at the interests of who are making these definitions. So for example, if it’s medical people, and sort of madness really gets medicalized? Well, there’s a certain strain of a long time ago, but really an English speaking, that goes back to when you had mad doctors. And I think it’s the 17th century, starting to write tense, but it said, the medical people who are going to have the authority over this domain. If that’s the case, they’re going to try to put it into a medical context. These people have illnesses, okay, and then these other people don’t have illnesses, okay, and you’re going to try to draw some line. If you come from a psychological question, it’s a little bit different. It’s, you’re starting to look at how environment also and how family shaped our response to the world and how these experiences shaped the way to the world. And in general, I think, if you take that psychological approach, in general, it leads to a more expanded sort of sense of what is okay and normal and to be expected in human beings. But then the forced perspective, you have as you try to sort through these histories, is the perspective of those who get identified as the other. Because so much of the key is identifying people as the other – they’re not like us. And therefore, they’re sort of a threat to our social stability, or whatever. And what you find is another narrative there that is so powerful. And this is what I tried to weave in to Mad in America, this book is, what is it like to be a person who is identified as the other and therefore treated as the other and often that so often that involves taking away sort of the agency of that person over themselves, including the right to be out in society. And what you’ll find is, there’s different narratives that clash, so often, especially the narrative – those who have been identified as crazy as treated, because so often what they see, and their voice, by the way, is discounted in the medical narrative, theyare unreliable witnesses to themselves, right. But when you actually look at their writings, and also often they’re very insightful about their own lives, and what they see themselves as being defined as the other because they’re just not going along with sort of whatever the mainstream currents are or, for example, if you’re in the 19th century, if you’re a black man after 1865. Now all of a sudden, you’re identified, you know, as someone less than human, so and then you’ll also see a difference. And if we talk about the mad patients, where they see treatments as not as helpful medical things, but it’s things meant to quiet them, make them afraid, you know, restrain them, that sort of thing. And then of course, within this history, we have the, you know, women being identified as to emotional, hysterical. And so I think the point is, this is such a rich subject to understand how narratives get formed, how we think about ourselves, how we think about, quote, the other. So this is what I think. And you what you see is these narratives changing over time to in terms of the medical, psychological narrative, but that’s what makes it such a rich and important subject because it really goes to how we think about human beings. How do you think what, you know, as we move through life that affects us as human beings, what drives some people to sort of have these crazy thoughts and all. So it’s a really rich subject for seeing different histories, or different narratives within history and those narratives changing over time as the larger cultural narratives change as well. So it’s such a rich subject,
James Connolly
As I was reading your book, one of the sort of funny things that kept on coming up because I think you and I searched in different ways, sort of parallel structures that I found there were so many sort of overlaps. And I kept on recalling reading your book that kept on thinking about phrenology. And then lo and behold, I’m looking at the cover, and it’s actually a phrenological head. And so, having studied the history of sort of phrenology, so much of it is really based upon this idea of sort of characteristics of what is the civilizational structure of what is mainly primarily Caucasian people. And so when you would look at the bumps on people’s head, you would look at very specific characteristics, intelligence wasn’t really part of an 18th-century construct of, you know, the way the mind works, characters seem to have been sort of a part of that structure. And so there were specific bumps that were like, the love of the sea and adventure, there was a bump for any number of different things, but most of it was set up around the identity that white people were civilization builders. And so conformity actually mattered a lot to the structure of that head. And so when you looked at the other, which was the other races, any deviation to that performed perfection of that structure was considered to be an ‘other,’ right? And so we tend to think of it as a pseudoscience. Now, at the end of the 19th century, phrenology textbooks had sold five times more than the On the Origin of Species, which had been out for close to 40 years.
Robert Whitaker
I didn’t know that. Wow!
James Connolly
Yeah. I mean, it was… it really informed a lot of the way that we moved into the 20th century, the origins of anthropology, which was, again, a civilizational structure. So you saw this pyramidal form of history that kind of moves up this ladder to the civilization builders. And you can set or see a sort of schizophrenic history in that, right, like, you can see the way that they were building this, but then also building a structure by which they then talked about heredity. They talked about germ plasm, they talked about all of these different things. And so one of the stories you told, which I found really interesting, was this sort of look into encephalitis lethargica some of the symptomatic responses when they’re said… when Kraepelin was studying patients who are actually suffering from disease and say, even syphilis, right, you would look at a number of different symptoms, and then you would associate that with a disease that has then been transferred into the 20th century. So I wonder if you can tell a little bit of that story.
Robert Whitaker
Yeah, sure. So the encephalitis lethargica study. So before the last part of the 19th century, you had basically people classified as insane. And there wasn’t the sort of schizophrenia hadn’t been born yet as its own term – diagnostic term. So towards the last part is this 19th century, there was a researcher named… psychiatrist named Emil Kraepelin, who just followed people. This is in… starting the late 1890s of patients in the hospital, who came into the hospital with psychosis, and what was their long term course. And he noticed that basically, there was two different courses for those who presented with psychosis. One, if they presented with an effect with emotional engagement, they had manic depressive illness, and they generally had an episodic course. In other words, it wasn’t a chronic disorder. They would have a time of mania, they might have a time of depression, but then it would remit and this is the course in nature, not even treated. That was one group of psychotic patients. Now, there was a different group of psychotic patients that presented with a lack of an effect. And he said that group of patients tended to over the long term end up demented – dementia praecox, early dementia. So that was the two different courses they identified the late 1890s. Then, but there was also a viral infection that began circulating at this time that wasn’t initially identified. And once it gets identified, it gets identified as encephalitis lethargica. And I think was around, you know, around 1918, or something that gets identified and what is the course of encephalitis lethargic? Well, you just sort of retreat, you become comatose. You don’t engage with the world, and they all of a sudden had a hard time distinguishing dementia praecox patients from encephalitis lethargica patients, and what becomes clear in retrospective is many of the people or maybe basically all of those people that were dementia praecox had a viral infection. However, by 1920, the sort of American Psychiatric Association didn’t want to give up the schizophrenia diagnosis. And now it shifts and what happens in 1920 they start putting all these people with new onset psychosis into the schizophrenia category, and at the same time, they start saying these people have a genetic defect. Okay? So because we now have eugenics is full-blown. So now because of that, they say we need to keep these people locked up in asylums to prevent them from breeding. Now, once you lock people up in a silence for long term, they tend to have deteriorating courses. So what you see here is a new understanding of schizophrenia emerged in the 1920s of people, even with nuance and psychosis, who in the past, since they present with an effect would have been seen as having just an episodic problem, they get recategorized as having a chronic disorder, okay? And that’s and they need to be… it’s not going to, it’s not going to get better with time. And they need to be kept up because they have these bad genes. So that’s a moment where we, a lot of things come together. 1890s is part of the ability to start identifying viral infections, okay. And what is interesting here is that by 1921, it gets identified, it becomes evidence that they a lot of people with viral infections are getting diagnosed with dementia praecox or schizophrenia, but they don’t want to give up that term. So now, they redefined who has schizophrenia that has, even today, even today, that has implications because schizophrenia is still a term for saying, chronically ill people. They’re going to be ill forever. And actually, if you go back to first episode psychosis, it’s just not true. I hope I answered your question. Or at least…
James Connolly
Yeah. Yeah, and encephalitis lethargica is a really interesting disease. There’s a book called Awakening where they have given them…
Robert Whitaker
Oliver Sacks.
James Connolly
And they had given them medication to people who had been asleep for I don’t know, at this point, maybe 20 years. And they came back awake. And then they had very specific, like, very strange…. You know, they almost had a time distortion, any number of different things. But it was sort of scary, like you could wake these people up, you’d ask them who the President was. You’d ask him their name, they could remember, but if they were left alone, even for a second thing would just fall back asleep. Really scary disease, I think, for a lot of people. And so when you have something like that, people want an answer. And so I think psychology ended up sort of sort of filling in the gaps of that. One of the things you say you say over and over again, is in the book, which was sort of lead us into the 1980s is episodic versus chronic. And those are two terms that I think are really important to sort of highlight at this at this time. Because I do think it’s really important, because we live in a world now, where episodic is now just automatically defined as chronic.
Robert Whitaker
Yeah, this is the big tragedy in society as a whole. And the reason is, because if you look in nature, psychiatric distress disorder symptoms are so often actually, if they’re not tied to an actual illness, like Parkinson’s disorder, or encephalitis lethargy occur, where say, a vitamin deficiency or something like that. They really show up in episodic, particularly, okay, obviously, anxiety comes and goes, depression was always seen as mostly episodic. There was a small group of people they identified with melancholy, that were, the symptoms of depression, were seen as out of proportion to whatever setback had happened in life, whatever the environment was, but that was a tiny, tiny people. And when we think about episodic, one of the beautiful things is that of people’s resilience, to setbacks in life. And also, it’s a philosophy that shows we’re not steady state creatures. We have times when we have difficulties times when we’re better, and that it’s also a recognition that human beings are very emotional, and things like mania. They may be just within the scope of normalcy, so to speak, to have some times of mania, depression, certainly within the scope of normalcy, that sort of thing. And with that thought in mind, and you’ve seen it in nature, by the way, you see it even in what you were talking when we first spoke about the quantification of symptoms, okay, in the 1950s, tried to like set up, you know, frameworks for testing new drugs, and all in diminishment of symptoms. But if you go even go back in the 1950s, you see that like with new onset psychosis, for example, first episode admissions to psychiatric hospitals for psychosis and get diagnosed with schizophrenia at this time, two thirds would be well enough, two thirds of this 80% would be well enough to leave within a year. Now, some people are leaving after one month, two months, three months. And if you look at stay well rates and able to function in society, it was about two thirds of those patients. Five years later, they’re not on disability and they’re just sort of returned to life. What happened was and depression was the same thing. If you look at what people said about depression in the 1970s, at the very height, the NIMH, they said, depression almost always remits on its own, the best thing we can do with antidepressants is maybe speed up that natural healing process. Okay. So, prior to 1980, we had this sense that so often disorders were episodic, if you had a timeout, and by the way, the nervous breakdown word sort of speaks about that, it doesn’t mean that you’re chronically ill. But the time that you had to break down, you need some rest or whatever, you can get back together. But then we reconceptualize things as chronic in 1980. When I say we, I mean the American Psychiatric Association. So now what’s going to say is, oh, depression is a brain disease. Now think about what that does. It’s no longer your reaction to environment setbacks in life, divorce, losing grief, or whatever, it’s something wrong inside your head. And if that’s so and if it’s a chemical imbalance, you’re gonna need treatment forever. So it’s reconceptualized, as a chronic disorder, our society and there was all sorts of, quote, educational programs to convince people of that, and we can talk about that. But think about the last philosophical one, we’ve moved from a vision of human beings as resilient as so often having a difficult time and then getting their lives back to now post-1980. We say, this is a defect within you that is always there. And we even have things saying, Oh, you can diagnose ADHD in a two-year-old as if that’s a permanent part of that individual’s being, so to speak. This is where and what has happened since we’ve reconceptionalized. When I say we, again, this came from the American Psychiatric Association, what has been the public health effect of that? Well, the burden of mental disorders soared. In every country that has adopted this conceptualization outcomes have worsened, because think about this, you’re now predicting it’s chronic. That’s now the statute. So we completely lost sight in this thing of the capacity for people to recover. And that’s where we’re at today. And this is the great, you know, you began James about talking about these cultural changes and these societal changes. Since 1980, we have been living in a culture that psychiatrizes us. The psychiatrization of us. And now since it’s 40 years later, we’ve seen the impact of that the results of that, by the way, entire human history, I don’t think there’s ever been a time where they psychiatrize people this way. They narrow that the what is normal, so greatly. I mean, what do we say to you? What percentage of kids today when they go to college have a diagnosis? It’s 25-30%. What percent of kids access mental health services at colleges? More than 50%. So that tells you how we’ve expanded this sense of something being wrong with people to learn how it’s almost the majority. And it just shows that how that is a that is an artificial construct. It’s not a construct we find in nature, it doesn’t make sense, where you have 25% of your people said to be mentally ill. Now I will say one thing, it may mean that you have to look at society and the structure of society. Why are so many people anxious, unhappy, depressed? It may be a signal like that, like the canary in the coal mine, like, why is it in our society, we have this unbelievable degree of supposedly almost dysfunction related to psychiatric problems.
James Connolly
I have a quote that I picked up years and years ago that I want to get your reaction on. And it’s a from the what is the NIH – the British equivalent of the NIH there are night yeah, yeah, NHS: “So my patients’ presentations frequently bear out the reality that life in the UK is getting harder. The fortunes of the haves and have nots are diverging the fabric of the welfare state thins, employment entitlements grow precarious. The Archbishop of Canterbury calls her economic model broken. Many people receiving a diagnosis of depression might be more authentically seen as carrying generic social suffering. The doctor can do little about the patient’s social predicament, but feels he must do something. And so he prescribes an antidepressant by reflex.”
Robert Whitaker
Yeah, I mean, that’s a brilliant quote. Because, you know, like, there’s all sorts of studies that shows the more unequal societies you get, the more unhappiness you get. And what this is leading to is and thank God it’s finally emerging is something called the social determinants of health. And this even extends… it doesn’t just extend to you know, emotional well being our mental well-being extends to physical health too. And if you see rising levels of emotional distress, rising levels of, you know, there are certain diseases, of course, that are very much socially bound in terms of what foods you can afford that sort of thing. Where do you get your calories? Are you in meaningful work, that sort of thing. And I think we’ve had this time that became so mechanistic to where, you know, diseases are within the individual diabetes is just within the individual depression is within the individual with bipolar, with an individual ADHD. And now thank God, and that is a failed philosophy of being that’s what we know, from a public health level. That’s a failed philosophy of being now can you shift to where you look at these large what… how do we organize our society, because that’s what you’re talking about. What coding is about how you organize your society. And all the evidence shows that first of all, huge disparities in wealth are a problem. You know, there’s a group that’s really had done a survey on this, and it really just lines up, the more inequality, you get the more sort of unhappiness, but also, how does society raise its children? That’s a big thing. You know, how does it encourage curiosity, self responsibility? So a sense of self competence, all those things, then you also have to look at the meaning of work in society? How much does society offer people a chance to do meaningful work things where they go home from work and say, Oh, I did something that makes me feel good. And I’ll give you a simple thing. If I’m a plumber, and I go out and fix a plumbing job, I actually feel pretty good about that. Because I use you know, I have solved the problem. Okay? Solving, but you have so many jobs. There’s a guy named Peter Sterling, who writes about this from an anthropological point of view. If you have jobs that are unrewarded, that what you’re doing, you’re not solving anything that you just wrote, that leads to sort of unhappiness because you just don’t… you don’t feel like you’re being engaged, you’re problem-solving, you’re being your capacity to do things, it’s really being engaged. So what I think is so important is and obviously, access to food, access to exercise, access to sort of social engagement, they’re also important, but they’re important in physical health, physical and mental health are intertwined, no question about it. What that quote is saying is, we need to look at the social determinants of health and 40 years ago, we’ve been putting all these health things inside the individual will fix the individual, it hasn’t worked. So what we need to do is create different social societal responses to nurture our children better, our physical health, better mental health better.
James Connolly
I remember listening to a TED talk that was talking about our administrative states. And he was telling a story about somebody who he works in a hospital and he’s supposed to clean rooms, supposed to move from room to room. He has to quantify the time spent in the room, he has to, you know, any number of different factors that kind of go into his day. And he gets pulled in by a supervisor, he’s like, you know, he said, You didn’t clean room 215, or you didn’t clean room 306 within this timeframe, and he said, Listen, you know, I could have done that. But this was… this is a child who just got into a car accident, 18 year old, his family had just incident, you think I was gonna go into that room and just clean around this funeral at the worst moment of their lives. And so he just wasn’t given the independence of thought to be treated like a human being. So they can make an executive decision at the time because he has to live by these, the standard rules that are kind of put in place to control people. And I think it’s, in many ways, like David Graber wrote a book called Bull *beep* jobs. And he kind of talks about that, you said that there were certain jobs that like you may not know, it’s bull *beep* right. But there are ones that people know. And a lot of them are administrative ones. They’re there to kind of placeholders to hold somebody in place. And it’s so demeaning to the human spirit that you kind of live within this framework where, like, you’re just going in every single day and sort of punching, you know, punching numbers and just looking at the clock. And it’s like, how mind-numbing is that, you know, and then at the end result of that you feel like there we have an organizational system, a cultural system that says there well, there must be something wrong with you. You know, because you’re feeling this way. And it is, you know, it is difficult. I want to push back a little bit. So I wanted… I think the 80s is so important to the way that we understand today. But the 70s is the lead up to that. And the crisis of the 70s had many different elements to it. And I wonder if you can kind of talk to that, because I think the answer to that solution was, you know, was this the seeding of that was in the 70s.
Robert Whitaker
Yeah, absolutely. So you have to ask Why did we get this new conception? Can I just say one thing with this story just to think about how it’s not just mind-numbing, it’s soul-numbing. So that individual as he went about cleaning rooms was actually being attentive to the social engagement of other people. Okay, so and you can see he’s responding to those people socially in that room. But now he’s been just be a robot just do efficiency study. That’s and you know, you have this in the post office, you have it in so many jobs, where you’re just treated like an automaton. So that’s obviously part of the problem right there in terms of a lot of going back to the 70s. It is really important. So why did American psychiatry adopt this disease model? Now, it’s sometimes pitched to us that it was sort of a scientific advice advance, that’s just not true, you have to look at what was going on in society in the 60s and 70s, that led to this. The first was an anti-psychiatry movement that really came out of academia and then was sort of joined by sort of people had been put in mental hospitals. And this was the idea that psychiatrists are not real doctors, and that psychiatry functions as an agency of social control, and it serves the powers that be by saying these people can be put in an asylum and kept there, okay, and that the asylums were really more like, you know, they weren’t agencies of social control, like prisons, okay. That was the first threat. That’s the second threat came because in the 60s, we get an explosion of people doing therapy, counselors, psychologists. So psychiatry, in this… in the 60s sort of had two domains of authority in the United States. And I think this is somewhat true abroad, but really, in the United States was one authority over the mental hospitals. And then in the psychoanalytic sense, it was the strength who’s talking to people in on the couch. So psychiatrists were seen as having the best talk therapy, okay. The problem was, all of a sudden, research didn’t show that their talk therapy was any better than any other talk therapy. So why did you need to go for a psychiatrist for that because it’s more expensive. So that was sort of the second sort of threat to their place in society, their image in society. A third thing came from movies. Think of One Flew Over the Cuckoo’s Nest, which presented this, the psychiatrists as the crazy people, and the people in the hospital really is the, you know, the more sane people. So films are very, so that’s also a threat. They also have a problem that benzodiazepines, which were the first valium and all were the first real popular drugs were addictive. So now their drugs that they prescribe are also seen as a problem in the 70s. And then finally, their diagnoses are come to be revealed sort of as ineffective. There’s a famous study by a psychologist, where he has ordinary people go into mental hospitals, they say they’re hearing voices. Yeah. And as it was reported, was that the staff never… they get diagnosed with schizophrenia, these people stop behaving as if they have anything wrong with them. And they’re never noticed to be normal by the staff. And I forget exactly the name. But the point is,
James Connolly
Is it called a thought experiment?
Robert Whitaker
What’s that?
James Connolly
The thought experiment
Robert Whitaker
Well this is called… Rosenhanz was the guy who did it. It was this famous thing – it is we can’t identify it. We don’t… We can’t distinguish insanity from sanity. So a week after that gets published, basically, the APA says, We got to redo our image. We have all these threats against us. Our future is in doubt. The New York Times writes a thing about the age of anxiety for psychiatry, there were so few people wanting… medical residents wanting to go into psychiatry. So they said to themselves is what is the image in society that has such prestige? Among physicians, it’s the white coat physician who treats in essence, infectious disease or these other known diseases. And remember, we get antibiotics in the late 1940s. And they revolutionized medicine. So and we get better living through chemistry in the 60s. So they want to identify with physicians who treat known medical illnesses. So what they do is now with that in mind that this is there’s a guild interest in mind. They’re gonna say we’re gonna reconceptualize things is brain diseases. Now, the interesting thing is in 1980, they published the third edition of the Diagnostic and Statistical Manual. And it’s presented as this great scientific advance, even among themselves, Oh, now we’re really thinking, you know, medically scientifically, but there were no discoveries behind that reconceptualization what you have is guild impulses behind it. And then what happens is, once they do that, they set out a basically a PR plan to convince the American in public that these are real illnesses. And we get a book called The Broken Brain by Nancy Andreasen. And that’s a big bestseller in 1984. And it’s about this switch from is a psychological problem so often into these are brain disease problems. Now, what’s interesting about that book, if you actually read it, she says these are hypotheses. We hope to prove it in the next few years that we’ll find the genes, we’ll find the molecular problems. But she says oh but the hint is, maybe these are due to chemical imbalances. The point is, or now, by the way, who loves this story? Because DSM3 has like, even though they say these are distinct disorders, I think there’s like 290 diagnosis. And the reason there’s so many, they said, We have to have a diagnosis for everybody who comes in to us just complaining, et cetera. Who loves this? The drug industry loves this. Because the pharmaceutical industry can get approval for drugs for illnesses. They can’t get a drug approved for unhappiness. They can’t get for a drug for a kid, who doesn’t like school. If they can get a drug for the illness of depression, they can get a drug for the illness of ADHD, they realize right away, this is going to expand the market because it’s going to take what previously was seen as normal behaviors within the range of normalcy and feedback and put them into the illness category. And they can see this is going to stir this greatly expanded market. So they begin paying money to the American Psychiatric Association, and to doctors, psychiatrists at academic medical centers, to be their advisors, consultants, etc to sell the story to the American public. So the important part of this is, and by the way, Jeffrey Lieberman was the past president, the American Psychiatric Association, said, I think he’s speaking out. I think DSM3 is the most important book written in the last 50 years. And he didn’t mean, just within psychiatry, he meant within society. And I agree, that book has had the most impact on society, our society developed countries and really around the world than any other book, because it gave us a new philosophy of being a new way to see ourselves, a new way to see our children within this disease framework. And then we were presented with a chemical imbalance story that told us, they had found the molecules that caused all this, they had found the abnormalities. So this changed our sense of self. And the reason it was so profound is it was never true. They never actually found that these distinct chemical imbalances were characteristic of all these things. They never found that there were identity, you know, specific genes, they never validated their diagnostic manual. They never validated that disease model. And this is widely recognized today. It’s all collapsed. But that’s the new world that was born in 1980. And it was born of guild influences, a guild that wanted to present itself in a white coat. And they, as part of that, they wanted to present themselves as making these great scientific discoveries. But unfortunately, they were dealing with the human brain, and the human body, which is the most complex thing ever. And it just doesn’t lend itself to these reductionist ways of looking at it.
James Connolly
And you have a lot of quotes on your website, specifically people head of the Psychological Association, their reaction to I think, a lot of the work that’s been done even just within the last couple of years. But actually, I want to kind of start it, you were giving a lecture a while back, and you said that, when your book first came out, it really did sort of it was considered so radical at the time, could almost not be, in a way sort of engaged within the community, there had to have been a number of different studies and subsequent studies and other books that came out to now we, a decade or so even later, people are starting to really sort of pull back on these threads. So you have a number of different quotes that are kind of used in one of your articles where you said, Well, we always kind of knew that. Well, it’s like it was new, it was part of a, you know, a larger form of understanding of depression. But none of that ever trickled down through, say, pharmaceutical advertisements through the general public. You know, by coincidence, last night, I was just watching a Netflix special as a comedian who had gotten out there. A third of her show is about her diagnosis. She gets treated for bipolar disease. The psychiatrist recommends a benzo. Sorry, I always forget the name of the benzodiazepine that she’s on. She has to stay on that. And, you know, part of the her reasoning behind it is, well now is she because of her psychiatric like, illness, she is now you know, on a Netflix special you know, and she’s dealing with childhood trauma that she’s dealing with the loss of her mother at a very early age. Ah, she’s dealing with any number of different factors that are kind of she’s quite literally on a psychiatric couch, on stage. But that’s sort of one of the interesting parts about the, because pharmaceutical companies can advertise to the American public, which is only allowed in two countries, the United States and New Zealand. They have gotten us to the point we actually do the self diagnosis, right? We go to the doctor, we say, we may have this thing, this DSM sort of quality, and then we get… we medicalize ourselves and then asked for those pills.
Robert Whitaker
Yeah, that’s the brilliant part of the marketing of this whole story is, they have built a way for us. And it became so much part of the sort of discourse in our society today, increasingly, where it wasn’t 50 years ago, you know, this is this just wasn’t as quite, you know, we had a discourse around the Freudian stories, but that was a different discourse. All right. So now we have this new discourse, and people are invited to through the marketing of this, to see themselves within these structures, right. So you’re not happy or you know, your kids not doing quite as well as school. So instead of talking about, Oh, listen, I lost my mother when I was 13, or whatever it might be. And seeing how I dealt with that. It’s like, I must, if I’m feeling these uncomfortable feelings, there must be something wrong with me. And there’s a pill out there that will fix it. That’s the end. That’s what the message is, or there’s no future kid, that sort of thing. And so, yes, people now self-identify within this construct that was sold to us. The problem is, of course, and you alluded to this in what we were just speaking about is the chemical imbalance theory fell apart very early. So that the theory arose in the 1960s, based on what drugs did. So you have an anti psychotic blocks dopamine receptors, they say, Well, maybe schizophrenia is due to too much dopamine, the antidepressant raises monoamine levels, and serotonin is a monoamine. So maybe people with depression have too little serotonin. But if you actually follow the scientific research, when they actually try to see if people with depression, or people with schizophrenia have those chemical imbalances. Right away, they’re not finding it to be so so as early as 1984, the NIMH saying, we’re really not finding that there’s a serotonin nergic abnormality in depressed patients. And here’s the real betrayer. Now, there’s more research on this, by the way, the dopamine hyperactivity story, which basically fell apart in the early 90s, as well. In 1998, I think it was the American Psychiatric Association’s own textbook said, the low serotonin theory is dead. We’ve looked at all these things, we haven’t been able to find it that there’s this abnormality in depressed patients. And then in that chapter, they even said, and the theory was always sort of dumb, because there’s no reason that the mechanism of disorder is the opposite of what the treatment does. So it’s dead and buried in 1998. And then there’s other pronouncements in psychiatric textbooks, like in 2000, it’s just not real. So within psychiatric research circles, it was abandoned by really the late 1980s. But it had been such a great way to sell this new model, they kept selling it to the public. The drug companies did, because they knew it was a way to sell drugs. But the American Psychiatric Association kept proposing it as well, because it was again a way to sell sort of the discipline as one that’s making these great advances in care. And that we are people solving it – a chemical imbalance. And so for example, in 2005, the American Psychiatric Association put out a press release based on a survey and it’s a great news. One, people used to think that depression would pass, you could go to your priest or you know, your friend and pass now they understand. It’s a chemical imbalance, like 85%. Now, the only problem is, sometimes they think that non-psychiatrists can fix chemical imbalances. What they need to really know is that we are the people that fix chemical imbalances in the brain. So even as their own literature was saying, that’s not true. That’s why we’re presenting it to the public and the website up until like, five, six years ago talked about drugs that fix chemical imbalances in the brain. And of course, all these other medical websites did as well. And this is part of the tragedy. You can look at drugs and try to understand what ways they might help people or not help people with the spectrum of outcomes is but if you have a society using drugs on a false basis, that they fix something that known as wrong way that’s a real betrayal number one, of course. It’s a story that gets people to stay on their drugs. But finally, it’s also you can see why drugs that are prescribed according to a false understanding probably are going to become problematic in society with their adverse effects and their effects over the long term. But the biggest harm done from that story is that it changed how we see ourselves, changed how we see our kids. And you gave a story of someone on, you know, a podcast, and on stage. And I think, by the way, I’ve seen that play going back a while, people now see themselves as damaged or abnormal in that way, forever. This is a new sense of self. As opposed to, you know, I’m an old guy when I was growing up, we had, you know, people were screwed up, including yourself, okay? And bullies and anxiety, people and that sort of thing. And, you know, you have people who say, I’m feeling suicidal, well, we sort of felt okay, that’s what happens to people too. All that was in the realm of normalcy. Okay. And we were sort of like an existential view of life, that, you know, people suffered people experienced difficulties. But it was part of the normal human journey, and it was part of the human journey of growing up. And now that has changed, you get, you get diverted into these diagnosis patterns. And that’s a real loss to society. And it’s a real loss to kids or young kids.
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James Connolly
Do you mind if I share a personal story?
Robert Whitaker
No, no, please do.
James Connolly
So this is two… I met my future wife about four months before September 11. And we just been dating for about a month. And my mother had been psychologically abused by my father for, you know, 20 years. As his health deteriorated, he got worse and worse. And so she had taken sort of brunt of a lot of his anger and frustration and his pain and all that other stuff. I had come home one day and found that she had overdosed on pills and discovered her. And it was suicide attempt that we just… we ended up kind of discovering afterwards. And there’s always an incredible amount of guilt associated with that I should have tried to get her out earlier. But there was just an incredible amount of anger and guilt that you’d sort of turn inwards on yourself. I tried to break up with Amy, you know, after this happened, I knew her for a month. Right? I knew her for a month at this point. She said I’m not going anywhere. Right. And fast forward. About three months later, she worked in World Trade Center 1. And so we had known each other for about three months. I was supposed to go study an art program in Florence. And we were going to try to figure out how to make our relationship work, going back and forth. I was going to be gone for close to two years. And September 11 happened and I moved in with her that day. She was she worked for Kenneth Fitzgerald, which lost…
Robert Whitaker
The one… Yeah, so many people. Okay, yeah.
James Connolly
And just through just completely random events, she just wasn’t there that day, they normally had a seven o’clock am meeting. They had canceled the day before, because two people had been laid off. And so she just wasn’t there that day. And so, you know, for us, our relationship was two of the most traumatic moments of anybody’s life, sort of cobbled together within a four month period. And she was working 18 hour days to help to rebuild the company. She was head of Media and Communications for the company. So she was, you know, front facing with all of the traumas of fear that dealing with families. We were both volunteering to kind of work for all of that. But I’m also still dealing with my mother, and trying to get her out of the house and any number of different things. And I remember going to the doctor and talking to them about everything that I’m feeling. And she’s like, Well, I think you have anxiety. Here, take this medication. Robert, I’m just like, you know, at the time, I didn’t know how to relate to the absurdity of that, right. I mean, an international crisis of, you know, that we’re still living through plus a once in a lifetime, total trauma in my own life. And she’s like, well, you must have some sort of chemical imbalance and here, take this pill. And I understand what she was doing. She was doing the same thing as the British Medical Journal would have done, right. She doesn’t know what to say, you know. You’re not sleeping, you’re dealing with all of this stuff. You’re, you know, going through incredible amount of emotion. And so for two years, I was on that medication. And with the birth of my son, part of the reason why I ended up getting off of it was the day that he smiled for the first time… it was probably gas who knows. He smiles for the first time I felt nothing. So it just had taken away everything right. It had taken away the highs and you take away the lows. And it was a really difficult situation for me to deal with because then I had to sort of pull myself off of it and pulling yourself off of this medication is not easy. And you detail incredible stories in your book of people who realize and through interviews on your podcast of people who have been medicalized since they were teenagers, medicalized since their, you know, had gone through some degree of trauma in their life. And realizing that putting people on this medication, keeping them on that for a long period of time fundamentally changes so much of who you are. So I wonder if you can kind of talk about that. And then, you know, because I do think these things are not benign.
Robert Whitaker
No, no, no, no, this. I mean, first of all, the absurdity of the response to you and your wife now. It’s just beyond comprehension, in a way, you’re both dealing with, I mean, her thinking must be so hard at this time, her emotional instinct, you’ve lost… not only have you lost… you lost people, but there’s that whole sense of like, why wasn’t I there, you know, this sort of thing, then you have this whole sort of relationship with your mother that is, you know, fraught with difficulty. And the idea is to put you on a benzodiazepine. And so there’s a couple of things you… I hear these stories all the time, and by the way, often, in reaction to setbacks, or difficulties in life much more minimal than what you’re talking about. You know, the worst. You know, if you actually look at sort of just a little setback in life, a little unhappiness: I don’t really my wife bothering me or my kids talking too much or whatever. It is a defining moment in life. It’s like, you know, the road in the woods that now splits. Because there’s a couple of things when you go down that path of medicalization. Number one, frankly, you no longer often have the same emotional responses, energy to bring to bear on what you need to do. So you’re sort of knocked out from being able to really sort of move forward. That’s number one. Number two, it does change your brain. Your brain, because it’s such an increase has so many feedback mechanisms, it’s going to try to compensate for your being on the drug. And it basically, if say, for an antidepressant raises serotonin, your own brain is going to dial down in serotonergic machinery. Now that has a couple of things. That’s why you have so much trouble coming off, your brain has become used to this drug. And by the way, it’s changed your brain in sort of profound ways. Because serotonin doesn’t act on its own. There’s all sorts of feedback loops. Three neurotransmitter systems. So now you’re going to have trouble coming off. Benzos are really difficult to come off. SSRIs are going to give you trouble coming off. And now so often, when you have trouble with doctors say, Oh, see, this is why you need to be on the drug. It’s proof of the chemical imbalance store. So what happens is, you said it’s not benign. What happens is we have a society now that takes a moment of difficulty, and sends people down the mental illness path or the drug, the medicated life path, and thinking about something like 20 to 25% of Americans that are older than 12, now take a psychiatric drug on a daily basis. So that’s how many people who’ve been shunted down this path. And what you find with that path long term is physical impairments, okay, or physical difficulties, whether it be weight gain, some sexual impairments, so often, a lot of emotional blunting happens. The amazing thing is you actually see a worsening on the whole, a quantification of the symptoms themselves, and some of the offensive cognitive decline. So what you see is we have a society with a story that takes difficult moments in life – your story is of a very difficult time in life between the two of you. I don’t know what happened to Amy whether she was put down this medicalization… medicalized path, but we have a way of thinking that since so many people down this medicalized path, and yes, I hear all the time from people who have medicated at age five, at age 12. And they feel they lost their life when they… for those that eventually are able to get off or come out of that sort of narrative. They feel they had their childhood stolen from them. And you know what else they feel they had stole from? The chance to sort of deal with their difficulties as children and to sort of grow and socialize and make something of themselves on their own – having that chance to fail so to speak, to suffer through difficulties. So they talked about that. Your story is a personal anecdote that writ large tells how you managed to get on and you managed to get off because you said I should be thrilled to death that see… I should just have a surge of elation when I see my son smile because that it’s such an extraordinary thing to see a new being come to life and smile right? I mean it’s knock you down elation when you see it. I have some grandchildren. And I just saw when he was six months old, smiling, I thought this is the greatest thing in life. And now you as a father can’t experience that joy. Well, at least you had the wherewithal to say, I need to get on. But it was hard, right? I bet it wasn’t easy after two years on those drugs.
James Connolly
Now, I mean, you do find you’re in many ways, you’re a stranger to yourself. And, you know, I think for me, the wisdom of it was that, you know, pain is a tool. And so psychological pain, dealing with a lot of this stuff, and then having those hard conversations, it forces you to move and to, you know, if you’re in a dead end job and you’re feeling the pain of that. The pain is telling you that you’re living in an environment that is not associated with who you are. And that’s environmental stressors, it’s any number of different things associated with that. And sort of blunt that pain means that you end up in a place that is just as painful. It’s just you’ve created a sort of neuropathatic response to it. And, you know, but the pain is still there. Right. And I think that that is it took me going through all of that, and then finding myself, refining myself afterwards to to also deal with like, I had to find out what made me happy. You know, they were there a whole other associated parts of that. Just childhood trauma, and seeing my parents go through years and years of, you know, their reaction to my father’s reaction to everything was just blunt force trauma, which is anger. You know, and so you have to work through a lot of that stuff. One of the things I want to…
Robert Whitaker
Can I say something real quickly, James?
James Connolly
Yeah.
Robert Whitaker
This actually shows up in the research literature, what you’re talking about. So there was a big study, a six year study of depression by the NIMH. And so they take people who have the same sort of baseline characteristics. And now they follow them for six years and look for those who get treated. And those who do not. Those who get treated actually had a decline in their social status over at the end of six years, and were much more likely still often chronically depressed. Those who avoided treatment actually, they saw that they were first of all, many of them got divorced. They actually had elevated their status, their earning status because exactly what you’re saying is they took that pain, and they made changes in their life. That’s what they saw. That was a sixth generation. And by the way, in the 1970s, with psychotic patients, they did a study of the same sort. What happened at the end of one year to people who medicated versus those who did not medicate? Well, those who weren’t medicated with antipsychotics had better outcomes, okay? They were actually less likely to still be suffering from psychotic symptoms. And they were much, much more socially engaged. So they asked people, what was it like to go through your psychotic episode without antipsychotics, and here’s what the people told them. It was horrible. It was painful. I was suffering. But here comes the but in retrospect, I’m glad I had the opportunity to do so because that was what enabled me to change and to sort of come to a different space. And the researchers at that time said, when we blunt emotions, even in psychotic episodes, maybe we’re taking away a tool that these people need in order to come out of this in a different place. So that actually shows up in the research literature. So your experience of what you talked about this? In fact, you can find it in a scientific literature. So sorry about stopping you there. But…
James Connolly
No, no, one of the things I found really interesting, and I wanted to kind of talk to you about and I don’t want to forget it, the mixing of a lot of these drugs. What I found kind of interesting, you’re… there’s one story in there where they were you were talking about somebody had been hospitalized and diagnosed and how they keep on sort of moving these things, dosages percentages, different drugs, you move from benzodiazepines to anti-psychotics, you start to mix those together. I mean, they can’t possibly know how these drugs are interacting in the brain. I just wonder if you can kind of talk about that. It’s just so fascinating to me.
Robert Whitaker
Polypharmacy is just a story of a profession that’s lost its way. Guys, there’s no study anywhere that shows multiple drugs like four or five drugs as beneficial, none of these different types and part of the irony of course, is one drugs trying to do one thing and then you have another drug that’s doing the other thing. They’re actually at cross purposes say anti-psychotics and so first of all, why did it develop… it developed actually because the first drug causes adverse effects. So they, instead of saying, well, that’s a problem. Now they tried to give a drug to like counter that. It also comes up because the first drug doesn’t work. Okay, so maybe the antidepressants really not lifting it so well. It will numb people out with the anti-psychotic and you got this sense within the profession. That we are quote psychopharmacologists and they sort of adopted a personality of like, I call it a witch doctor person personality. It’s like mixing potions and you’re supposedly the one that can mix up a potion with four or five drugs that finally hits the right target. But really what you see over and over again, in the narratives that people who do this, once they go down the polypharmacy route, next thing you know, they’re searching through all sorts of drugs. And why? Because when you’re on four or five drugs, it’s hard to have any sort of stability and capacity to respond well. And so really, when you hear about polypharmacy, that’s a broken discipline. Because literally, if the first drugs not working, maybe you should take it away, as opposed to just add. And we had a crazy case in Massachusetts recently. Not crazy. It’s a tragic case. A really tragic situation. It’s an extreme case. But when you see the polypharmacy because by the way, often people use polypharmacy now, right? From the start, you go to a mental hospital, you often come out with three. There’s a woman named Lindsay Clancy. She was a delivery and labor nurse at Massachusetts General Hospital, was known as a consummate caregiver. This is a really tragic story, but it’s now in the news. So when she has her third, with her first two children, she had had some bouts of postpartum depression. Now the third one last May, she has a child and she’s managing it, okay, she’s managing it with health reasons. Okay, doing yoga. She’s not sinking into postpartum depression. However, in September, she starts becoming anxious because your maternity leave is ending. And going back to this job with three kids is sort of anxiety provoking. And this is the story in the news. Well, then, on January 24, she killed her three kids. She strangles them. And we’re now hearing three different narratives: the prosecution saying she’s just an evil person. So but how did someone that was a consummate caregiver become an evil person? The medical story is she had postpartum depression or postpartum psychosis. And so the disease made her do it. But then you wonder what she was getting treated, did she have treatment resistant? And then a defensive point of view is they came out with her regimen of drugs: 13 psychiatric drugs, anti-psychotics, benzodiazepines, antidepressants, all mixed up, and Ambien, all mixed together. So the person who created this, who did this horrible thing, and then she threw herself out the window, she survived. She was hearing command hallucinations is what it was. Well, all we do know is this. If you’re on 13, psychiatric drugs, it’s meant to change your brain. It’s meant to change how you experience the world. And there’s no evidence anywhere that 13 psychiatric drugs is going to be of benefit to you. So the mere thought that you could put someone on 13 psychiatric drugs, and cycled through all these drugs, just shows the insanity of polypharmacy because there’s no way that that possibly is going to help this woman cope with life, respond to life, be able to be… and her husband, of course was complaining to the psychiatrist, my wife has become a zombie on this polypharmacy. So yeah, we hear this all the time. It’s like, initial prescription as part of that road that’s now taken so often leads to poor performance. And when you’re on poly…, were you ever… did you ever get on polypharmacy?
James Connolly
No.
Robert Whitaker
Okay, well, you’re coping pretty well. But that’s a really, that’s a road that is really taking you deep into a life as a mental patient.
James Connolly
Yeah. Like, I don’t even know where to go with that story. I mean, you had recently a podcast that was talking to a doctor who was talking specifically about a lot of the interaction of these medications with it during pregnancy, which I just thought, you know, and the one of the things I really appreciate about your podcast is the level to which there is nuance, right? If people are suffering, if they are on these drugs, if they become pregnant, what is a way to interact with these medications that somebody has been on, so that the consumer is the mother and the parents are aware of the interaction so that that is happening in? I do find it? I don’t know. I mean, there is just so much to deal with. There’s a level of complexity, that is really hard for us to even move around. I have a nephew who’s been on, you know, a mix of cocktails since he was four years old. And I don’t know what to do with it. I mean, I just think that the medicalization of childhood, the way that they were even just… the DSM and the pharmaceutical companies have been able to medicalize everything to do with… especially boys, right. So boys can’t… I have spent a decade teaching nutrition education and public schools, many in the inner city schools. So we worked with kids who were on or below the poverty line, who, specifically schools that we that we wanted to work with, a lot of kids are medicated. But they’re also dropped off at like 730 in the morning, and are picked up at six o’clock at night. And the parents are both working and you know, the… in many different ways they’d sit in a classroom all day long. The schools are great schools. They try to get the kids moving as much as possible, but within the academic scope of what you’re supposed to do, sitting a boy down for, you know, 11 hours, 12 hours a day, and then expecting him to be able to pay attention is just absolutely absurd. So I wonder if you can kind of talk a little bit about that sort of, medicalization of childhood, and then some of the aspects of that.
Robert Whitaker
I think the medicalization of childhood is one of the great… it’s just the harm done is almost unimaginable. So, you have… you take a four-year-old and now you’re saying they need to be medicated for the rest of their life? What is that going to do to that child’s that… it’s really that child’s ability to learn, that to engage socially, to play sports, self conceptions, that moment, when you diagnose that four year old or six year old, you’re sending their life down a different path, which takes them away… now, I’m not religious, okay, but I’m going to use a religious description, their God given right to experience the world with their full faculties and try to make something of themselves and suffer the slings and arrows of childhood. Now, going to your description of our schools, that idea that boys and girls can sit in a classroom for 11 hours, or just sort of, in this controlled environment is insane. It’s completely divorced from any understanding of what childhood should be. And like and who young boys or young girls are, you know what young boys and girls love to do. They love to play. They love to make games. And that’s how they socialize. That’s how they form bonds, they move around. They’re not built to sit in a chair for hours on end. And here’s someone you know, to do whatever the instruction might be. So you know, it’s interesting. One thing you’re talking about nutrition. I know there have been programs in certain schools where instead of teaching nutrition, they teach kids to cook.
James Connolly
Yeah. That’s what we did.
Robert Whitaker
What’s that? Is that what you guys do?
James Connolly
Yeah, yeah, yes.
Robert Whitaker
Now teaching people to cook as you learn a skill, that’s a very different thing. And you’re active, you’re learning about food, you’re learning about nutrition, by the way, so now people are up on their feet too. They’re not sitting in a chair. Well, that’s a good exercise. And I know usually kids love learning that exercise, and they take that home with them. So rather than blaming the kids, this is us as a society, what’s our responsibility? Is it to build schools that are consonant with what childhood is like? Or is it to create schools that supposedly make these kids good automatons when they grow up, you know, able to do whatever job in whatever and fit the sort of capitalistic structure of our society? We’re talking to people need to work and all this sort of thing? What’s our obligation? Well, in my opinion, the first obligation of any society is to create a world that nurtures children in ways that stirs their curiosity, their self-confidence, their ability to engage socially apart from us. And what this tells you all the anxiety that we have all the diagnosis we have of our kids, all this sense of not being competent, that we see in many of our young kids. That’s not their failure. That’s our failure to nurture our children in a way or to organize our society in a way that nurtures children. And that is a grievous, grievous reverse failure of our society. It’s tragic. And it really is robbing children of their right to be, the right to learn, grow up, socialize, play, make mistakes, be assholes, you know, have all sorts of emotions running through you that, you know, you can’t hardly control that’s growing up. We’re not letting them be in this way. And it is so incredibly tragic and wrong and harmful from my point of view. And no society in human history has done this before – medicate their kids to this degree. And one final thing about Adam Urado and the pregnancy story. Yeah, listen, people do suffer. That does and they do struggle, and they struggle in our society during the prenatal period, the postpartum period. We’re actually coming out with a story about this as well. There’s two different problems. There are Adam’s talking part of the problem is people women come in with… become pregnant on the medication. Now you’re really with a dilemma in a way because it’s quite clear that antidepressant exposure during pregnancy does raise risks of some sort, for fetal development, that’s well recognized. But then coming off those drugs can be very difficult as well, and expose people to withdrawal effects and rebound effects. So one of the thing that Adam talks about is, how do you talk about people with this, that arrive on the drugs and try to manage it and it isn’t a one size fits all. And I do appreciate that. But this shows how the fact that we have so if you would have been around in 1985, what percentage of women used were exposed to antidepressants during pregnancy have any idea? One in 300. Now, it’s 8%. Because of this whole medicalization of life and stuff, but it does present a problem in pregnancies, people are that way, but we know we have this fetal risk. Now, the other thing is, though, you don’t also see studies that show sometimes people get newly prescribed antidepressants, you don’t see that that actually diminishes, quote, the depression and in prenatal women or even postpartum. And why is this? Because what are they really struggling with? Struggling so often with a society that doesn’t give them material and social supports that they need. So if you ask women who are pregnant and struggling, or new mothers to talk about, well, I need more social support. So I may if I may have material needs, I can’t feed my baby. And maybe you know, I can’t even get transportation to go someplace. So really, that distress you’re seeing in our society, this also fits with kids. Maybe we need to change how we or what sort of supports we give to those people become pregnant mothers and fathers. And you know, for example, in Sweden, they give mothers and fathers extended leave. Well, the minute they do that it shows that really relieves a lot of the distress. So what I’m trying to say is this whole medicalization of life, it blinds us to seeing social determinants of health, and how can we change the environment to better fit our kids to better help people become pregnant in the first year, which are difficult years? And you know, we don’t we medicalize things we say the problems always in the individual, the kid or the woman? What we need is to say, as a society, how is it? How are these problems reflective of how we organize our society? That’s a very different question.
James Connolly
Yeah, yeah. And, you know, there’s a wonderful book called Invisible women. And it talks a lot about sort of economic determinants of just for females in society, children, I do… like we build kitchens for men. You know, the average height of a woman is, you know, within this. Yeah. So we have, we have these envisage with this invisible sort of patriarchal structure that really just defines our society, women are typically the caregivers, they take care of older, take care of grandparents to take care of parents. We will plow roads, you know, so that men can get to work. But women typically take public transportation within cities. And so we don’t shovel sidewalks as much. So the injury rate among women is actually higher, you know, any number of different determining factors are kind of part of that just sort of keep this economic system going. Amy’s company has maternity leave and paternal leave, you know. You can work from home, you know, they have the ability to be able to do that. But she sets it up as a structure, a basic structure of the company. And why does it… why is it set up that way, because most of the people who work there are women, you know, and so it’s just a completely different way of sort of moving, and it’s a highly successful company with, you know, some really dynamic ideas of, you know, changing debt structures, credit card rates, you know, paying back student loans, any number of different economic incentives to sort of move through these sort of FinTech companies so that people aren’t just paying interest rates for the rest of their lives on. But it… because it’s so diverse, racially diverse and gender diverse in many different ways. You actually, the whole structure changes. And so it’s just a really interesting concept. I don’t want to go too far off onto that stuff, but it does… I mean we sort of pathologize motherhood. I do think that we live 99% of our existence as hunter gatherers, and newborn babies and babies are shared amongst a larger group of people. I think postpartum depression is, you know, a pathology that arises because we do expect a couple to raise a child, and it’s just in, like you said, never before in human history, has that actually been the norm. And so, you know, they’re just so many sort of elements in them… I’m just rambling at this point.
Robert Whitaker
I think what you talked about with what Amy does, that’s what we need. So rather than we keep going, there’s… you’re here to talk, oh, we’re going to find this chemical effects depression. We’re going to find this chemical that a new drug with postpartum depression is caused and God knows what an injection… that’s just going down the same rabbit hole. And what Amy’s talking about or doing her company is reorganizing the whole social structure that people exist in, right. And the problem is, that’s great for that company. But it’s the single mother who’s in a service job, does she get the leave? In other words, we don’t have a such a larger societal response to this that extends these sorts of, you know, supports to a whole population. So I think sort of as an incubator lab, what they’re doing is fantastic. It’s something we need to have a political process that takes that information, and extends it to us as a society as a whole.
James Connolly
There, there’s a story about I was reading a few years back, so I’m gonna get some of the details wrong of it. In the 70s, Canada had instituted a sort of pilot program for universal basic income. They’d taken a small rural town, it was a single commodity crop town, so probably rapeseed or something like that. But you know, the sort of 1970s, you could have a structure built off of like one export products, where you’d have doctors and diners and, you know, shops and every kind of small town America. And so they instituted a universal basic income. It wasn’t… it wasn’t a lot. And it was the program was cut off by a change in administrations that happened within the Canadian government. And a lot of the research was sort of buried, it’s kind of left. So recently, people started to kind of pull it out. Universal Basic Income, it’s become a kind of a new idea, resurrected idea. And so what they looked at was a number of different factors that had an effect. One is you didn’t have to live in a toxic work environment, you could find another job, you could leave. So you weren’t held into a system of penury that wouldn’t ever allow you to get out of it. So people left jobs and asshole employers gone. And there were whole numbers, divorce rates went down, Maternal and Child Health went up, rates of autism went down – any number of different factors that were not associated with income, right? And economic model, all of these different multifactorial, things started to change, everything got better, you know, and so, of course, they’re just got rid of it. But I do think that that is the level of stress is indivisible stressor in our society. And we know this, right. We know your IQ will actually go down percentage points if you have outstanding bills. We know that, you know, if you’re living sort of paycheck to paycheck, there are whole numbers of different factors that don’t… aren’t, wouldn’t have been associated with. You know, like, if we want to build a happy society, if we want to build something that looks like an ideal shining city on the hill, we have to think about these things in multifactorial ways.
Robert Whitaker
Yeah, you know, if I remember that study we’re talking about or that experiment, didn’t they find it the people in fact, they left jobs, but they then… they have some time even to do some schooling and stuff, and then moved into sort of higher level jobs. So that was one of the things. So it benefited the society as a whole. But, you know, the sort of time away, some support gave them was you say new opportunities. They could leave the toxic job, but if I remember, right, it’s not just a sort of move to, at a lateral level, necessarily to a job sort of equal pay or whatever, they moved up this. Yeah, I my frustration is, you know, this whole goes to, like, sort of neoliberal world we live in. You know, just it’s like, we’re dominated by sort of these economic ideas that somehow it’s sort of a Darwinian story. And it really is that I don’t know, everyone’s supposed to make their own way. And if they’re having difficulties, that’s their problem. It’s just, you know, and one of the things you’re talking about, we have a lot less class fluidity than even I think in the UK and stuff. And in other words, what class you’re born into what percentile etc. It’s much harder to rise from one level to the higher level this because we have this myth that it’s so easy to sort of make something of yourself and move into the sort of better off classes, but actually, you don’t see that much movement anymore. So people who grow up in difficult situations into ones where they’re now sort of flourishing economically, I mean, it happens, but it’s just not to the degree we want to believe it’s possible.
James Connolly
Yeah. And, you know, I think that brings us sort of full circle in our conversation, because we, you know, 19th century had the rise of Darwinian ideas. And then social Darwinism kind of took over, that moved very quickly and swiftly into eugenics and social control, and the idea of sort of innate qualities such as IQ, you know, measurements of intelligence that were considered to be many ways, like static thing you’re born, you know, all of the structures are still part of that sort of Darwinian idea. And whether or not Charles actually had any relationship with it, his nephew, really wanted to build something that was sort of based off of that. And I do think it is an element of social control that takes away, you know, the individuals ability to sort of understand this stuff, you know, in it’s sort of an interesting way to kind of come full circle and to say, thank you for your time. Really appreciate… I really do appreciate your work. It’s amazing.
Robert Whitaker
Thanks, James. It’s been a real pleasure talking to you. So it really was a joy to be here with you today.
James Connolly
Yeah, I’ll put your website and your podcast and everything like that in the show notes, and get people to sort of come to your book. I do think it’s a like you said, the DSM very important book, this one – Anatomy of an Epidemic…
Robert Whitaker
That may be the biggest compliment I’ve ever heard.
James Connolly
Anatomy of an Epidemic Magic Bullets, Psychiatric Drugs and the Astonishing Rise in Mental Illness in America by Robert Whitaker. Thank you so much.
Robert Whitaker
Thanks for having me. Real pleasure.
Diana Rodgers, RD
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