Speaker 1: I think sometimes our conversation the reason why it goes
Speaker 1: to pill shaming and big pharma is bad, which you
Speaker 1: know that's a deserved reputation that they have, is that
Speaker 1: we're skipping the real problem, which is that DS and
Speaker 1: diagnoses are too easy to receive and are being given
Speaker 1: out too easily. Welcome to the one you feed. Throughout time,
Speaker 1: great thinkers have recognized the importance of the thoughts we have,
Speaker 1: quotes like garbage in, garbage out, or you are what
Speaker 1: you think, ring true, and yet for many of us,
Speaker 1: our thoughts don't strengthen or empower us. We tend toward negativity,
Speaker 1: self pity, jealousy, or fear. We see what we don't
Speaker 1: have instead of what we do. We think things that
Speaker 1: hold us back and dampen our spirit. But it's not
Speaker 1: just about thinking. Our actions matter. It takes conscious, consistent,
Speaker 1: and creative effort to make a life worth living. This
Speaker 1: podcast is about how other people keep themselves moving in
Speaker 1: the right direction, how they feed their good wolf. Thanks
Speaker 1: for joining us. Our guest on this episode is Sarah Fay,
Speaker 1: and author and activist. Her writing appears in many publications,
Speaker 1: including New York Times, The Atlantic, Time magazine, and she's
Speaker 1: also on faculty in the English department at Northwestern University.
Speaker 1: Today's Sarah and Eric discuss her newest book, Pathological, The
Speaker 1: True Story of Six Misdiagnoses. Hi, Sarah, Welcome to the show. Hi,
Speaker 1: thank you so much for having me. I'm such a
Speaker 1: huge fan. As I was saying, well, I'm so happy
Speaker 1: to have you on. We're going to be discussing your book, Pathological,
Speaker 1: The True Story of Six Misdiagnoses. But before we do
Speaker 1: that will start like we always do with the parable.
Speaker 1: In the parable, there's a grandparent who's talking with their
Speaker 1: grandchild and they say, in life, there are two wolves
Speaker 1: inside of us. There are always a battle. One is
Speaker 1: a good wolf, which represents things like kindness, bravery, and love,
Speaker 1: and the other is a bad wolf, which represents things
Speaker 1: like greed and hatred and fear. And the grandchild stops
Speaker 1: and thinks about it for a second and looks up
Speaker 1: at their grandparents says, well, which one wins, and the
Speaker 1: grandparents says, the one you feed. So I'd like to
Speaker 1: start off by asking you what that parable means to
Speaker 1: you in your life and in the work that you do.
Speaker 1: I've thought so much about this and it makes me
Speaker 1: think of mental health, but not in the way you
Speaker 1: might expect. So a mentally healthy person, someone with mental
Speaker 1: health sees two wolves and actually sees, you know, the
Speaker 1: wolf giving quote unquote good emotions and the wolf giving
Speaker 1: quote unquote bad emotions or transferring them, and can choose
Speaker 1: between them and can feed one or the there. And
Speaker 1: my experience of mental illness is that it was not
Speaker 1: that concrete. It was a confluence of emotions at all times,
Speaker 1: and they got confused, and they often cascaded over me,
Speaker 1: and I couldn't have a command over them, so that
Speaker 1: it felt as though at times both wolves were like
Speaker 1: eating me, or I was sending them off, or I
Speaker 1: was chasing them, or they were chasing me, And so
Speaker 1: it was almost the wrong scene. That mental illness really
Speaker 1: brings about a lack of self awareness that I was
Speaker 1: striving for at all times. But I didn't have the
Speaker 1: self awareness to be able to choose one of the
Speaker 1: wolves and feed them at the time. And I have
Speaker 1: that now, which I am so grateful for. Yeah, you
Speaker 1: define somewhere, you said, this is how I define mental illness.
Speaker 1: Mental emotional and behavioral responses that don't correspond to reality.
Speaker 1: And render the person acutely dysfunctional. And I think that
Speaker 1: ties to what you just said, which is that our mental,
Speaker 1: emotional and behavioral responses don't really correspond to reality we
Speaker 1: can't see clearly exactly, and those are very different from
Speaker 1: DSM diagnoses. So the diagnoses, the mental health diagnoses that
Speaker 1: we receive, come from the Diagnostic and Statistical Manual of
Speaker 1: Mental Disorders otherwise known as the d s M. And
Speaker 1: that's a book. And I didn't know that at the time,
Speaker 1: and when I found that out that our diagnoses do
Speaker 1: not come from scientific discoveries, do not come from medically
Speaker 1: on high, but that they come from this book. And
Speaker 1: I started researching that book because I'm a journalist, and
Speaker 1: found out that the book and its diagnoses are determined
Speaker 1: by a group of mental health professionals based on their
Speaker 1: opinions and their theories and little else, so not hard data,
Speaker 1: and they're really hypotheses of trying to categorize our mental
Speaker 1: and emotional lives, but not anything to necessarily rely on.
Speaker 1: The Other thing about d s M diagnoses is that
Speaker 1: they can't define dysfunctional, and that's what a d s
Speaker 1: M diagnosis is really supposed to rely on what's the
Speaker 1: level at which someone is categorized as dysfunctional. The distinction
Speaker 1: between mental illness and d s M diagnoses is that
Speaker 1: serious mental illness in particular which I had or have,
Speaker 1: means really losing the ability to function independently and in
Speaker 1: an inability to live independently. I couldn't live independently for
Speaker 1: five years, and there is an extreme situation happening. And
Speaker 1: that doesn't mean that all of us don't suffer in
Speaker 1: our mental and emotional lives. We do. And the d
Speaker 1: s M has attempted to really encapsulate and try to
Speaker 1: essentially diagnose as many people as possible and give them
Speaker 1: a d s M disorder. So let's back up a
Speaker 1: little bit from that for a second. But were diagnosed
Speaker 1: with six different things over the course of your life,
Speaker 1: tell us what those were. I was diagnosed with anorexia
Speaker 1: when I was twelve. Then I was diagnosed with anxiety
Speaker 1: disorder when I was in my twenties, and major depressive
Speaker 1: disorder also in my twenties. When I was in my
Speaker 1: thirties and in a doctoral program, I was diagnosed first
Speaker 1: with attention deficit hyperactivity disorder, then obsessive compulsive disorder. And
Speaker 1: then finally I was diagnosed with bipolar two and then
Speaker 1: bipolar one. So my diagnoses though also between obsessive compulsive
Speaker 1: disorder and bipolar one. I was also told that I
Speaker 1: had depressive and anxious elements, is what they called it.
Speaker 1: So again giving me comorbid diagnoses is what they're called.
Speaker 1: And so what you're saying about a mental health diagnosis
Speaker 1: is they all come from something known as the d
Speaker 1: s M five, the Diagnostic and Statistical Manual Total Disorders,
Speaker 1: as you said, and they're based on opinion. They're not
Speaker 1: based on like, oh, I can do a lab test
Speaker 1: and find this thing out. I can do an X
Speaker 1: ray or a cat scan or any number of other
Speaker 1: things where I can sort of confirm a diagnosis. Although
Speaker 1: we can do this with I think certain types of
Speaker 1: dementia right postmortem we can sort of go yep, okay,
Speaker 1: it was Alzheimer's right. But everything else there's no there's
Speaker 1: no marker for it. So what we're doing is the
Speaker 1: psychiatry community is going, all right, this is what are
Speaker 1: people we think are best qualified to do this? Think
Speaker 1: roughly with these look like, how many diagnosis do we
Speaker 1: have now in the d S M. Five. What's difficult
Speaker 1: is that it depends how you count them, which says
Speaker 1: a lot about the arbitrary nous of the books. We
Speaker 1: should be able to say definitively, but we started with
Speaker 1: one eight in the d s M one and now
Speaker 1: have five hundred and forty one diagnoses, actually five hundred
Speaker 1: forty two with the new edition of the D s
Speaker 1: M which is coming out in March. So you were
Speaker 1: diagnosed with six different things. Now you're clearly not saying
Speaker 1: that you weren't suffering mental illness during those periods, but
Speaker 1: you also sort of reject the diagnosis. Tell me a
Speaker 1: little bit about that journey for you and how that
Speaker 1: fits together in your mind now, And going back to
Speaker 1: what you were saying, D s M diagnoses lack validity
Speaker 1: and reliability, and validity means, as you were saying, that
Speaker 1: they have an external reality outside of self reported symptoms
Speaker 1: and the opinion of a clinician. But docent diagnoses don't
Speaker 1: exist outside of that. So, as you said, there's no tests,
Speaker 1: no X ray, nothing we can do to prove a
Speaker 1: person has the diagnoses, diagnosis, or that the diagnosis even
Speaker 1: exists in objective reality. The other thing about them is
Speaker 1: that they aren't what's called discrete disease entities, and all
Speaker 1: that means is that the symptoms overlap. So the reason
Speaker 1: I received six different diagnoses, and the reasons so many
Speaker 1: people receive different diagnoses is because the diagnoses aren't solid,
Speaker 1: they aren't stable as categories. And when I say they
Speaker 1: were hypothetical, there's a really disturbing story about Robert Spitzer,
Speaker 1: who is the architect of the d s M three
Speaker 1: that was in and it was really the addition that
Speaker 1: pushed us toward the brain looking at mental illness or
Speaker 1: mental dysfunction in the brain, not the mind, and not neurosis,
Speaker 1: but disease. And when he was asked why major depressive
Speaker 1: disorder you had to have five of nine symptoms, he said, well,
Speaker 1: we just went around the table and everybody thought that
Speaker 1: the six just sounded like too many and four sounded
Speaker 1: like too few, and that is the same diagnosis we
Speaker 1: have today. So to say that their arbitrary reliability is
Speaker 1: what the d s M hoped to rest on after that.
Speaker 1: So once they said yes, we have no validity, and
Speaker 1: psychiatry completely admits to this. I mean you could ask
Speaker 1: any psychiatrists and they would tell you. Thomas Insel, who
Speaker 1: was the director of the National Institute for Mental Health,
Speaker 1: came out and said DSM diagnoses have zero percent validity,
Speaker 1: and Stephen Hyman, who was also director at the n
Speaker 1: i m H, said that the d s M is
Speaker 1: an absolute scientific nightmare. So again I'm just quoting them
Speaker 1: and these this is what I discovered as a journalist
Speaker 1: when I was really trying to crawl out of my
Speaker 1: time at my darkest and so reliability though, is basically
Speaker 1: saying that two different clinicians can see the same patient,
Speaker 1: possibly at the same time, and come up with the
Speaker 1: same diagnosis. And the reliability scores of d s M
Speaker 1: diagnoses are atrociously low, and they have also fudged how
Speaker 1: the scoring is done to make certain diagnoses acceptable. So,
Speaker 1: for instance, generalized anxiety disorder, which is one of the
Speaker 1: most commonly diagnosed disorders, which I received, has a reliability
Speaker 1: score on a scale of zero to one of point
Speaker 1: to and the only ones that score point seven are above.
Speaker 1: As you mentioned, our dementia and rare chromosomal disorders which
Speaker 1: can be biologically proven. As you said, you alluded to
Speaker 1: something there, which is this sort of back and forth
Speaker 1: in the psychiatric community between sort of a mind neurosis
Speaker 1: model or a brain disease dilemma, like which is it right?
Speaker 1: Which reminds me a little bit of the nature and
Speaker 1: nurture debate, to be honest, it's got a hint of
Speaker 1: that to it. Which the answer, I believe pretty firmly
Speaker 1: is very clearly both. Right. There's clearly an element of
Speaker 1: both going on here. But you say that, you know,
Speaker 1: psychiatry has been wrestling with this for a long time. Yeah, absolutely,
Speaker 1: for at least a century and a half, if not longer.
Speaker 1: And so the ds M three where we moved towards
Speaker 1: brain and disease psychiatry, and Robert Spitzer really wanted the
Speaker 1: discipline to be treated as a legitimate medical field. You know,
Speaker 1: they do have m d s and they did want
Speaker 1: psychiatrists to be treated the same as physical doctors or
Speaker 1: general medicine. And they were getting away from neurosis to
Speaker 1: the point that they removed the word from the d
Speaker 1: s M between the d s M two and the
Speaker 1: d s M three. And there's nothing wrong with that,
Speaker 1: but what's fascinating, So from until now we've really been
Speaker 1: pushing the brain disease model and we've told people that
Speaker 1: they are caused by a chemical imbalance, that diagnoses like
Speaker 1: major depression are caused by a chemical imbalance. Of this
Speaker 1: country still believes that the chemical imbalanced theory is true.
Speaker 1: It is completely a myth. It is absolutely not proven,
Speaker 1: and it was debunked about twenty years ago. But the
Speaker 1: d s M is so much a part of our
Speaker 1: cultural lives that we have taken up certain aspects of
Speaker 1: it and moved away from the truth. In many ways,
Speaker 1: the mind has always troubled psychiatry. But what's wonderful is
Speaker 1: Thomas Insol, who I mentioned, who as a former director
Speaker 1: of the n I m H has a book coming
Speaker 1: out and in it he says we were essentially mistaken
Speaker 1: in pushing the biological model and leaving out the social
Speaker 1: elements and aspects that so come into play. And for
Speaker 1: him to say that, I mean, he had spoken out
Speaker 1: about the d s M very strongly, but for him
Speaker 1: to write a whole book about it, it's really wonderful
Speaker 1: to think of that psychiatry. That's that's a very big
Speaker 1: move and a huge manacopa for psychiatry to give us.
Speaker 1: And so it makes me very hopeful because a biological
Speaker 1: answer it was funny you were talking with Johann Harri
Speaker 1: and he mentioned cruel optimism and in many ways, you know,
Speaker 1: giving a simplistic answer to a complex problem. D s
Speaker 1: M diagnoses and the idea that they're biological is a
Speaker 1: simplistic answer to a complex problem. That's right, and it
Speaker 1: really it helps. It allows us to leave out social
Speaker 1: you know, social injustice and economic inequality that leads to
Speaker 1: poor mental health. Yeah, it's much safer to say. I mean,
Speaker 1: I I don't even know what the right term to
Speaker 1: call some of this stuff is. I sort of like
Speaker 1: the term syndrome because it indicates there's lots of causality.
Speaker 1: You know, I look at myself and I have had
Speaker 1: what would look like depression, right, I've been diagnosed with depression.
Speaker 1: I have been treated for depression. I have what quote
Speaker 1: unquote feels like depression. But cause wise, I mean, I'm like,
Speaker 1: who knows. I mean, it could be so many different factors.
Speaker 1: It's almost impossible to unwind, you know, like what all
Speaker 1: causes these very complex things? And I agree with you.
Speaker 1: When you sort of start to see multiple things that
Speaker 1: all have the same symptom profile, you go there's something
Speaker 1: maybe that we're not understanding here. There was a Jen's
Speaker 1: Hopkins study that looked at patients diagnosed with schizophrenia and
Speaker 1: they were reassessed by another clinic and half of them
Speaker 1: were given diagnoses mood disorders or anxiety. Now, schizophrenia with
Speaker 1: psychosis and anxiety and major depression, those should not overlap
Speaker 1: to the point that fifty of people you know are
Speaker 1: being reassessed can't tell them apart exactly. I've good a
Speaker 1: question about the chemical imbalance theory. Is it that it's
Speaker 1: been debunked or is it just simply that we have
Speaker 1: no evidence to say whether that's happening or not. We
Speaker 1: haven't been able to prove that there's a chemical imbalance
Speaker 1: going on. It very well could be. We just don't
Speaker 1: have evidence to say this is what it is. Specifically,
Speaker 1: is that accurate exactly? And the thing about the chemical
Speaker 1: imbalanced theory is that the reason why it's been debunked
Speaker 1: that theory it was always the theory to begin with,
Speaker 1: when you know it was when it originated, it had
Speaker 1: not been proven and then was brought to us, but
Speaker 1: we tended to believe it wholeheartedly. The thing is, there
Speaker 1: are far too many neurons we have. There's no consistency
Speaker 1: in terms of you know, which subjects are depleted in
Speaker 1: in certain you know, dopamine or serotonin. None of that
Speaker 1: has been proven. But whether or not mental illness exists
Speaker 1: in the brain and is caused biologically, I believe that
Speaker 1: that's possible. I'm on medication and I love my medication,
Speaker 1: and I would not be well without my medication, and
Speaker 1: so and I see a psychiatrist and I respect him greatly.
Speaker 1: So clearly there's something that could be biological. But what
Speaker 1: Thomas Insel said is that we will never find it
Speaker 1: with d s M diagnoses because they're hypothetical. So we'll
Speaker 1: never prove the chemical and balanced theory or biology of
Speaker 1: a d s M diagnosis, but possibly mental illness right right,
Speaker 1: And I think you get into the it's both kind
Speaker 1: of thing, because you know, I mean, ultimately, it does
Speaker 1: seem at some level we are a bag of chemicals, right,
Speaker 1: and electrical fire rings, you know, because we can go
Speaker 1: in and we see through brain injury like you do
Speaker 1: that to that part of the brain, and oh god,
Speaker 1: well that's not so good. Right, So there's clearly a
Speaker 1: biological underline. And I often say, like, okay, so maybe
Speaker 1: it is. Let's say it's it's certain neurochemicals. I don't
Speaker 1: know exactly what they are. I can affect those sort
Speaker 1: of more directly by taking a medicine, and we're going
Speaker 1: to talk about medicine a little while, but I think
Speaker 1: I also affect them when I climb on that exercise
Speaker 1: bike over there and ride really hard, or when I
Speaker 1: talk to a friend, or like, all these things are
Speaker 1: at the most based biological level. Changes are happening in
Speaker 1: our neurochemistry based on things we're doing. So one way
Speaker 1: to work with it is directly with the chemicals themselves.
Speaker 1: But frankly, everything we do is affecting that sort of thing.
Speaker 1: So again that's why I always end up with the
Speaker 1: very profound like it's it seems like it's got to
Speaker 1: be both exactly and the only danger to me about
Speaker 1: the biological explanation, well, there are many dangers, but one
Speaker 1: I think we've we've we've incorporated it and have come
Speaker 1: to leave it far too ardently. But what's really difficult
Speaker 1: about it is when we say it's biological, the either
Speaker 1: insinuation or actual outright telling is that these diagnoses are chronic.
Speaker 1: There is no evidence to suggest that any diagnosis is chronic.
Speaker 1: I went for a walk with a friend of mine
Speaker 1: and her fifteen year old daughter was diagnosed with major
Speaker 1: depressive disorder and she was put on an antidepressant, and
Speaker 1: my friend said, she's going to have this for the
Speaker 1: rest of her life. I don't know what I'm gonna do.
Speaker 1: She's not gonna be able to go to college. We
Speaker 1: have to reassess. And I said, there's no proof that
Speaker 1: she will have it for the rest of your life,
Speaker 1: but we're believing it. And so one thing I really
Speaker 1: call for in my book and the reason why it's
Speaker 1: something I wish I had had, which is everything that's
Speaker 1: in my book, it's an exit strategy. So when you
Speaker 1: see a mental health professional or your primary care physician
Speaker 1: who diagnosis is really giving out. The most diagnoses are
Speaker 1: primary care physicians, you are given an exit strategy, meaning
Speaker 1: here's what we're going to try a treatment, here's what
Speaker 1: we're gonna do when your symptoms abate, not if, but
Speaker 1: when yes, Because imagine if we told cancer patients you're
Speaker 1: gonna have cancer for the rest of your life, and
Speaker 1: how much recovery would we see, how much you know,
Speaker 1: there'd be no cure agreed. Yeah, And I think the
Speaker 1: other thing that the medical diagnosis has caused that is
Speaker 1: problematic is the idea a we've got primary care physicians
Speaker 1: diagnosing instantly with very little knowledge and handing out psychoactive chemicals.
Speaker 1: But secondly is the idea that again if we just say, well,
Speaker 1: this is just a brain thing, if you take this pill,
Speaker 1: it's okay. But again, my experience with mental illness or addiction,
Speaker 1: or and looking at countless other people, is the best
Speaker 1: way to get better is sort of a holistic approach
Speaker 1: to lots of different things. It might involve a medicine,
Speaker 1: it might involve certain lifestyle changes, it might involve talk therapy.
Speaker 1: But when we just go here's your pill and you
Speaker 1: go on your way, we're not really addressing what could
Speaker 1: be many of the underlying factors that you mentioned social factors, right,
Speaker 1: but we've also got just lifestyle fact I mean, there's
Speaker 1: so many different things. And that's always what I've thought
Speaker 1: is problematic about this primary care physician and over prescribing
Speaker 1: is that we're taking a very simplistic view of something
Speaker 1: to me that seems to be extraordinarily complex. It took
Speaker 1: until I was in my forties to see a psychiatrist.
Speaker 1: All of my diagnosis came from primary care physicians. That's
Speaker 1: any to me. It is because so much of when
Speaker 1: we talk about these things, we tend to attack psychiatry,
Speaker 1: and there good reason to attack psychiatry in some ways.
Speaker 1: But I think primary care physicians diagnosing is really a
Speaker 1: huge problem. As you said, it's just they have very
Speaker 1: little training, as you mentioned in giving out psychiatric diagnoses,
Speaker 1: and that training all exists on typically impatient the most
Speaker 1: extreme cases. So seeing people, as you said, for fifteen
Speaker 1: minutes and giving them a diagnosis is it should be unacceptable.
Speaker 1: At the same time, I understand they're trying to do
Speaker 1: it to give people access to care. That's right, that's right.
Speaker 1: The motivation behind it right, right. It seems to me
Speaker 1: that what you've got is we've had a little bit
Speaker 1: of an overcorrection, right, which is like we're way over here,
Speaker 1: and mental illness is incredibly stigmatized and it's this really
Speaker 1: awful thing. Nobody wants to talk about it, nobody wants
Speaker 1: to be diagnosed with it. To the other extreme, which
Speaker 1: is like we'll walk into your doctor. I mean every
Speaker 1: time I go to the doctor, I get like an
Speaker 1: eight question quiz I know now better than to you know,
Speaker 1: Like I just answer fine, fine, fine, fine, fine, fine,
Speaker 1: because I just don't really want to get into it
Speaker 1: with my primary care physician. Right, but I get again
Speaker 1: what we're trying to correct for, but it feels like
Speaker 1: we overcorrected. And this all reminds me of any reference
Speaker 1: it in your book a little bit how we diagnose
Speaker 1: alcoholism and how we talk about alcoholism, because alcoholism got
Speaker 1: labeled a disease that was a vast improvement from moral failing. Right,
Speaker 1: it was a vast improvement from moral failing. And when
Speaker 1: you start to really break it down, you go, Okay,
Speaker 1: this doesn't really quite make sense to think of this
Speaker 1: as a disease in the classical sense, because again we're
Speaker 1: diagnosing it based on like, here's twelve questions. How do
Speaker 1: you answer the twelve questions? If you have seven, you're
Speaker 1: own alcoholic? If you have five, how do you do?
Speaker 1: You know? I mean, it's not a real thing that
Speaker 1: you can diagnose. And yet we made great strides by
Speaker 1: at least moving towards we're moving away from moral failing.
Speaker 1: But now we've gone, you know, all the way to
Speaker 1: it's just biology and that seems like we overshoot the mark.
Speaker 1: And the other thing that's happened really the destigmatization of
Speaker 1: mental illness has backfired. And what's ended up happening is
Speaker 1: that some diagnoses are socially acceptable and some art so
Speaker 1: anxiety depression, a d h D not a problem. Yes,
Speaker 1: you know, those are acceptable, They're common. No one's going
Speaker 1: to It's not that you wouldn't be stigmatized. I'm not
Speaker 1: trying to lessen that or feel the stigma of that.
Speaker 1: But then you have schizophrenia and Schizzo effective disorder, and
Speaker 1: the stigmatization of that. Studies have shown of those diagnoses
Speaker 1: has increased. So we really have kind of the have
Speaker 1: and the have nots, and unfortunately those are also the
Speaker 1: people in need of the most care. Alan Francis, who
Speaker 1: was the chair of the d s M four task Force,
Speaker 1: had a great quote or a very telling quote. He
Speaker 1: said essentially that those who don't need the most care
Speaker 1: are getting the most care to their detriment, whereas those
Speaker 1: who need the most care aren't getting it. And certainly
Speaker 1: when we look at our prisons and jails, that's absolutely
Speaker 1: happening and our homeless population. I'd like to pivot a
Speaker 1: little bit and talk about diagnosis in its positive and
Speaker 1: negative senses, because I think getting a diagnosis it can
Speaker 1: go either way, right, it can be a really positive
Speaker 1: thing in that we're able to sort of get help.
Speaker 1: We're able to go, oh, gosh, okay, what's wrong with me?
Speaker 1: Someone might know something about it. There can be real
Speaker 1: benefit to diagnosis, and we know that we can become
Speaker 1: associated with the diagnosis. We can take on that diagnosis.
Speaker 1: We can it's so strongly identify with that diagnosis that
Speaker 1: it makes a sicker. So in your mind, what's a
Speaker 1: reasonable way that someone might think about navigating that so
Speaker 1: that they get the benefit out of a diagnosis without
Speaker 1: getting the negative pieces of it. That's what happened to me.
Speaker 1: I identified so strongly with each diagnosis I was given,
Speaker 1: and I talked about it in the book, how easy
Speaker 1: it was to slip into that. I don't think there's
Speaker 1: anything wrong with that, necessarily, if I had known the
Speaker 1: truth about the diagnosis that I was identifying with. I
Speaker 1: believe they were biological. I believe they were caused by
Speaker 1: a chemical imbalance. I believe they were chronic. Every single
Speaker 1: one I was told that they were chronic. I was
Speaker 1: told that my life had shortened when I was diagnosed
Speaker 1: with bipolar one, and then I would likely become suicidal again.
Speaker 1: And so I was really fed misinformation. And so if
Speaker 1: we didn't have so much misinformation out there, I don't
Speaker 1: think it would be a problem. And to your point,
Speaker 1: the autism community that diagnosis is incredibly powerful for them.
Speaker 1: It bolsters them, It brings them together, and they rally together,
Speaker 1: and they very much identify with it and are very
Speaker 1: proud of it. So I don't see a problem. You know,
Speaker 1: that's an example where it's really working. On the other hand,
Speaker 1: what we have is a lot of people identifying with
Speaker 1: diagnoses who don't know all the facts about them, and
Speaker 1: whose children are getting these diagnoses, and teenagers are getting
Speaker 1: these diagnoses, who could, like me, then go through life
Speaker 1: and see life through a lens of diagnosis. So when
Speaker 1: I started, you know, my editor asked me, you know,
Speaker 1: why didn't you question these diagnoses, like after four or five,
Speaker 1: And I said, because I just never thought to question them,
Speaker 1: for one thing. We tend not to question our doctors
Speaker 1: for another. And then also I just was used to
Speaker 1: getting diagnoses. I was just used to them changing. I
Speaker 1: thought this we were getting to the bottom of something, right.
Speaker 1: But to your point to just that we can talk
Speaker 1: about mental health without talking about diagnoses. Going back to
Speaker 1: the parable, I could not manage my emotions. I could
Speaker 1: not process them. I couldn't have told you what happiness
Speaker 1: felt like, or joy, or depression or anxiety. Those physical
Speaker 1: sensations in my body just overtook me, and my thoughts
Speaker 1: just were running a million miles a moment. And so
Speaker 1: I remember being I was in a partial hospitalization program
Speaker 1: and we were all sitting in a room for group therapy,
Speaker 1: and they gave us the motion wheel, you know, the
Speaker 1: colored motion wheel that you have with all those emotions,
Speaker 1: and there were must have been a hundred and I thought,
Speaker 1: oh my god, I don't even know too I can
Speaker 1: tell you what to feel like in my body. So
Speaker 1: I think we can really move towards teaching our children
Speaker 1: and teenagers and ourselves. How do you process emotion? How
Speaker 1: do you identify emotion? Yeah? Yeah, I think the thing
Speaker 1: with diagnosis, that's interesting because diagnosis of alcoholic or addict
Speaker 1: I think in a lot of ways saved my life,
Speaker 1: and then that complete identification with it is what caused
Speaker 1: me to sort of move out and away from twelve
Speaker 1: step programs. In the beginning, it felt incredibly liberating to
Speaker 1: be like, oh, I know what this is. Other people
Speaker 1: are sharing some or stories. Oh my goodness, there's a path.
Speaker 1: But after a while there's something in twelve step culture
Speaker 1: which is this idea that, like, there's an alcoholic personality.
Speaker 1: You know that ten years sober, you're still sick. You know.
Speaker 1: After a while, this constant sort of delineating between what
Speaker 1: we were like and what normal people were like. And
Speaker 1: I was like, I know a lot of normal people,
Speaker 1: and I don't think we're that different. Yeah, I get sad,
Speaker 1: they get sad, I get envious, they get envy, Like
Speaker 1: we have these common emotions. And so for me, ultimately
Speaker 1: then I sort of went, well, that diagnosis, that identity
Speaker 1: that I am an alcoholic, it's not that I shed that.
Speaker 1: I don't even know what I would call it. What
Speaker 1: I know is drinking is probably a very bad idea
Speaker 1: for me. That's sort of it, you know. And I
Speaker 1: always get tripped up on words like, you know, am
Speaker 1: I an alcoholic or was I an alcoholic? Or And
Speaker 1: I ultimately don't think it matters. But I didn't want
Speaker 1: that to be one of my primary identities, you know.
Speaker 1: And I find identity fascinating because it can be a
Speaker 1: very liberating thing to have an identity. We can talk
Speaker 1: about people who make an identity switch, who go, you
Speaker 1: know what, I've just know I'm not the kind of
Speaker 1: person who smokes, and that helps them not smoke, So
Speaker 1: they are identifying as a non smoker. Helpful, right, But
Speaker 1: we can also as you were doing. You can identify
Speaker 1: now as an anorexic, and you start learning about what
Speaker 1: anorexics do, and without knowing it, you're subtly starting to
Speaker 1: mimic exactly. And for me it didn't help ever, because
Speaker 1: I definitely got worse with each diagnosis um And I
Speaker 1: think that if I identified with it again, knowing the
Speaker 1: truth about them, with a little bit of skepticism, just
Speaker 1: going in and not thinking, okay, these are permanent, this
Speaker 1: is actually something I need to identify with to get well.
Speaker 1: And I had the option to choose, I might have
Speaker 1: done everything the same. I don't know. But what's interesting
Speaker 1: to me too is I absolutely identify as someone with
Speaker 1: a mental illness, and I say, you know, I either
Speaker 1: had or have because we don't know if they're chronic.
Speaker 1: I don't believe that they are. I believe and other
Speaker 1: psychiatrists have said, I'm fully recovered. It's not recovery. I'm
Speaker 1: not always going to be I'm fully recovered, and if
Speaker 1: I'm wrong, I'm wrong, and I'm okay with that. But
Speaker 1: where it's helpful to have some identity attached to mental illness,
Speaker 1: for me, one is I don't want people to be ashamed,
Speaker 1: and I want to be an example of being very
Speaker 1: I'm very proud that I survived what I survived and
Speaker 1: what I talked about in the book. So I definitely
Speaker 1: don't want to, as you say, shed that identity necessarily.
Speaker 1: The other thing to your point about not drinking is
Speaker 1: that I live a very structured life. I did not
Speaker 1: become normal and now I can go party, you know.
Speaker 1: I mean, I go to bed at the same time,
Speaker 1: I wake up at the same time. I don't drink,
Speaker 1: I don't smoke, I don't do drugs. You know. I
Speaker 1: know that I have fragile kind of maybe may not
Speaker 1: be the right word, but I have a fragile system,
Speaker 1: and I have a very very strong but also uh
Speaker 1: you know, sort of again fragile mind, and I have
Speaker 1: to take care of myself and that's okay with me. Yep, yep, yeah.
Speaker 1: I think it's so interesting to go, all right, well,
Speaker 1: I have a mental illness because I'm not functioning well
Speaker 1: and yet to go like well, you know, like in
Speaker 1: your case, well, okay, what is it? Is it anorexia?
Speaker 1: Is it major depressive disorders? It anxiety? Is it a
Speaker 1: d h D? To be able to go? I don't know.
Speaker 1: The exact word doesn't matter. What I do know is
Speaker 1: that I figured out through medicine, through lifestyle changes, through
Speaker 1: working with my mind, learning to use emotions differently. I
Speaker 1: figured out how to work with this in a way
Speaker 1: that I am functional now. And those three words I
Speaker 1: don't know are so powerful, and that's what saved my life.
Speaker 1: I was and this is the kind of awakening moment
Speaker 1: in my book, which is that I was suicidal. I
Speaker 1: had run out of medication. My psychiatrist, who was also
Speaker 1: my therapist at the time, he and I had had
Speaker 1: a falling out. He wouldn't renew my prescription because I
Speaker 1: told him I wanted to see someone else. I didn't
Speaker 1: have a psychiatrist, and my sister found one for me,
Speaker 1: and I went to see him and we had our
Speaker 1: twenty seven minute session, and I waited at the end
Speaker 1: of it for him to christen me some either the
Speaker 1: same diagnosis by polar one or a new diagnosis. And
Speaker 1: he looked at me and he said, I don't know
Speaker 1: what you have. And my life changed and it was
Speaker 1: just I thought, no one knows what I have. And
Speaker 1: that's when I started really as a journalist, investigating all
Speaker 1: of this and trying to find out the truth. Yeah,
Speaker 1: let's talk about medicine for a second, because you are
Speaker 1: on meds that help you. I am on meds for
Speaker 1: depression that have helped me. You say that there's two movements.
Speaker 1: One is the sort of common movement, which is like,
Speaker 1: you know, you show up at your doctor, you get
Speaker 1: given a medicine. And then there's another movement that says, hey,
Speaker 1: that's all wrong, like you shouldn't be taking medicine. That's
Speaker 1: very anti medicine. And I find again both extreme, sort
Speaker 1: of problematic. So talk to me a little bit about,
Speaker 1: you know, how you view all of that. Yeah, it's
Speaker 1: such an interesting aspect of all of this. When I
Speaker 1: was antorectic when I was twelve, they weren't prescribing to
Speaker 1: antorectics at the time. So I did not go on
Speaker 1: psychotropic drugs until I was in my thirties, so I
Speaker 1: was very late coming to it given the number of
Speaker 1: diagnoses that I received, and I was completely against it.
Speaker 1: I did not want to take medication. I was someone
Speaker 1: who wouldn't take aspirin, So I was very anti mainly
Speaker 1: because I'm very sensitive to drugs, and so I just thought,
Speaker 1: what is going to happen? But I believed a lot
Speaker 1: of the sort of mythology that my personality was going
Speaker 1: to change or something like that. But I became so
Speaker 1: desperate as many people do, that I ended up going
Speaker 1: on an S s R I and an antidepressant, and
Speaker 1: so now I'm on a cocktail of several drugs. I
Speaker 1: don't know if I'm on them because my body is
Speaker 1: dependent on them, or if they are working for me.
Speaker 1: I tried to go off, and my withdrawal was absolutely awful.
Speaker 1: I mean, I was prescribed many many drugs and including
Speaker 1: antipsychotics and and everything, but trying to go off my
Speaker 1: antidepressant was beyond brutal. And I will never try again.
Speaker 1: It's just not worth it. And so that's another thing
Speaker 1: that I talked about in my book, which is that
Speaker 1: they never tested ss R eyes or antidepressants in terms
Speaker 1: of withdrawal. You know, initially they did. They were meant
Speaker 1: to be on for three to six months, not ten years,
Speaker 1: and I've now been on them for twelve years. So,
Speaker 1: as you were saying, the other camp is medication is
Speaker 1: bad and the withdrawal community, which I think I have
Speaker 1: a lot of probably too much judgment about, but they
Speaker 1: were very instrumental in me feeling like I should go
Speaker 1: off medication and that medication is bad and I can
Speaker 1: do it myself, and that's very destructive. It was so
Speaker 1: dangerous and I do not recommend anyone even try it
Speaker 1: without medical supervision. It's just and find a doctor who
Speaker 1: will do it with you. But it's dangerous. So but
Speaker 1: that withdrawal community I think is missing the mark. Pell
Speaker 1: shaming isn't helping anyone. This has gotten so confused and
Speaker 1: we didn't know and we got diagnoses and we went
Speaker 1: on medication, and now we don't know if we can
Speaker 1: go off. So yeah, yeah, yeah, my story is very similar.
Speaker 1: I was put on antidepressants in I don't know, maybe
Speaker 1: early thirties and have been on them more or less since,
Speaker 1: which is twenty plus years. I have made a few
Speaker 1: attempts at points to go off of them. Some were
Speaker 1: very well planned and others were very poorly planned. But
Speaker 1: the most recent one was not that long ago. I'm
Speaker 1: going to guess I don't know, three years maybe, And
Speaker 1: I did it incredibly slowly, like six months, kind of slowly,
Speaker 1: like taper, incredibly slow. And I didn't have withdrawal. I
Speaker 1: got off of them and it wasn't like I felt awful.
Speaker 1: But over time, the best way I know how to
Speaker 1: describe it is, I just started feeling like I increasingly
Speaker 1: was carrying a heavier and heavier weight, like everything just
Speaker 1: increasingly got more difficult because nothing has changed in what
Speaker 1: I'm doing. I'm taking care of myself in the same way.
Speaker 1: I'm doing all the things I know that I've done
Speaker 1: that treat my depression, and it seems to be back.
Speaker 1: And then I would go back on the meds, and
Speaker 1: I'm like, what cheez. All of a sudden, I feel
Speaker 1: like a normal person again. I feel like myself again,
Speaker 1: and like you, I don't know, is that because I've
Speaker 1: been on them so long that my body has simply adapted,
Speaker 1: or you know, is it that I actually need them?
Speaker 1: And I'm at the point where I'm like, you know,
Speaker 1: at this juncture, it doesn't seem to matter. The side
Speaker 1: effect profile for me is so low. They don't bother me.
Speaker 1: They caused me no problem, and it does seem that
Speaker 1: I function at a higher level. And so that's kind
Speaker 1: of where I've landed with them for now, is and
Speaker 1: I'm on very low dose ss r S. I'm on
Speaker 1: a fraction of the dose I used to be on.
Speaker 1: But and I don't know whether in the future I'll
Speaker 1: be like, well, let me try it again. But at
Speaker 1: this point I feel pretty at peace with like this
Speaker 1: is what works for me. I am too, and I'm
Speaker 1: I'm on relatively high levels. And a psychiatrist assures me
Speaker 1: that they aren't dangerous and that I can be on
Speaker 1: them for the rest of my life without a problem.
Speaker 1: Of course he doesn't know that, and no one exactly.
Speaker 1: I don't have a I don't have a problem with it.
Speaker 1: And in the sense that this is what happened for
Speaker 1: whatever reason, and again, you know, if this is part
Speaker 1: of my journey through mental illness, and that I don't
Speaker 1: have one anymore, and I still need to exercise and
Speaker 1: I still need to eat right and sleep and take
Speaker 1: my meds. Yes, and plus we don't know how they work.
Speaker 1: And that's the slightly alarm and part of it is
Speaker 1: we don't know how they work. But yeah, like you,
Speaker 1: I just always refer to as I like, I sort
Speaker 1: of throw the kitchen sink at it, right, Like, meds
Speaker 1: are part of it, as is exercise and eating well
Speaker 1: and sleeping well and talking to people I care about
Speaker 1: and doing things that matter, and like, you know, there's
Speaker 1: a whole approach that works. But to be in a
Speaker 1: place where I would say I am functioning at a
Speaker 1: pretty high level, I'm generally, you know, a pretty content
Speaker 1: and happy person, I'm like, let's just not rock the boat.
Speaker 1: Let's just go thank you, thank you. You know, all right,
Speaker 1: I'm happy to be here. You know, let's carry on.
Speaker 1: And we're dealing with the repercussions or we're still feeling
Speaker 1: the repercussions of psychiatry's move to a biomedical model and
Speaker 1: not approaching it in a way that said, Okay, we
Speaker 1: have to take a holistic view of this, and yes,
Speaker 1: you might want to take you know, use medication, you
Speaker 1: may not, or if you do use medication, let's talk
Speaker 1: about these things as well, and let's talk about the
Speaker 1: side effects and that you may not ever be able
Speaker 1: to go off of it. I mean, I was so
Speaker 1: desperate at the time that if someone had told me
Speaker 1: all the facts and he still have taken it, Yep, yeah,
Speaker 1: me too. I Mean when I first went on, I,
Speaker 1: like you, was like, I don't want to do it.
Speaker 1: I was relatively newly sober. The idea of getting on
Speaker 1: a drug did not feel right, and I was like, Okay,
Speaker 1: I'm gonna do everything that I hear about that could
Speaker 1: possibly help. That isn't drugs, right, And if I do
Speaker 1: all that and I still feel this bad, I'm going
Speaker 1: to wave the white flag. And that's exactly what happened.
Speaker 1: I was like, I'm exercising right, I'm eating right, I'm sleeping,
Speaker 1: I'm going to five meetings a week, I'm taking St.
Speaker 1: John's War. I mean, I've tried it all and I'm
Speaker 1: still suffering, you know. And again, I think that's always
Speaker 1: the approach that I think is wise, Like start with
Speaker 1: the minimum intervention you can do, and you know, okay,
Speaker 1: try exercising. It might do it right, It might do it.
Speaker 1: Then you end up at a point where you're like,
Speaker 1: all right, nothing else is working. Okay, why suffer? Why
Speaker 1: suffer needlessly? You know, if there's a way they can help.
Speaker 1: But but again, as we said earlier, I think what
Speaker 1: we've gotten to culturally is we start with a medical intervention.
Speaker 1: That's the starting place for a lot of people, and
Speaker 1: we start with a diagnosis first. So I think sometimes
Speaker 1: our conversation, the reason why it goes to pill shaming
Speaker 1: and big pharma is bad, which you know that's a
Speaker 1: deserved reputation that they have, is that we're skipping the
Speaker 1: real problem, which is that d s M diagnoses are
Speaker 1: too easy to receive and are being given out too easily.
Speaker 1: And if we can start there and going at the
Speaker 1: d s M like I attack a book, not anyone
Speaker 1: in particular, because I think we're all in this together,
Speaker 1: and it's it's kind of a mess right now. On
Speaker 1: a personal level, you've sort of described what we as
Speaker 1: people can do, and we're giving a diagnosis. You know,
Speaker 1: we can question it, we can ask more questions, we
Speaker 1: can do all that. How do we reform something like
Speaker 1: the d s M. I mean, I don't know whether
Speaker 1: you could argue it's better than nothing, but it's something
Speaker 1: certainly our health care system is modeled around like you
Speaker 1: need a diagnosis in order to get care, to get
Speaker 1: your insurance to pay for I mean, there's this thing
Speaker 1: is so pretty quickly and deeply entrenched. So where forward,
Speaker 1: I think there are answers, and I think what tends
Speaker 1: to happen is this idea that you need a diagnosis
Speaker 1: to get care. That's true absolutely. At the same time,
Speaker 1: fewer and fewer clinicians are taking insurance, so that's happening
Speaker 1: at the same time. And so I do believe that
Speaker 1: the d s M is not going to be reformed
Speaker 1: anytime soon. And the reason for that is that the
Speaker 1: latest full text revision is coming out in March, and
Speaker 1: they have only added one diagnosis, made pretty much text
Speaker 1: level changes, and have done nothing to rectify the mistakes
Speaker 1: of the past. So I think it's really the onus
Speaker 1: is on us. We need to create the change. We've
Speaker 1: been waiting for psychiatry to do it, and it's not happening.
Speaker 1: So the reason why I wrote this book and why
Speaker 1: I want this book to be out there and read
Speaker 1: by as many people as possible, and for the Pathological
Speaker 1: the movement, which I started a public awareness campaign to
Speaker 1: bring that all of this to light is because if
Speaker 1: we know, if we patients and the parents of patients
Speaker 1: know the truth, the mental health system will change, and
Speaker 1: it will change for the better. Clinicians will suddenly be
Speaker 1: put on the spot. They'll have to tell the truth.
Speaker 1: And you know, I think that there is a lack
Speaker 1: of transparency. I would like to think no one is
Speaker 1: intentionally lying. There are some, but those are you know,
Speaker 1: those are just the bad apples, and I think that
Speaker 1: for the most part, everyone has good intentions in trying
Speaker 1: to give care as best they can. One other defense
Speaker 1: of the d s M or you know, clinical practice
Speaker 1: and mental health professionals is that the d s M
Speaker 1: is really flawed and I don't even use it, and
Speaker 1: that scares me more than anything because then that means
Speaker 1: literally you are getting a random diagnosis based solely on
Speaker 1: someone's a in But they use it as a defense,
Speaker 1: as if to say, see, I'm better than this. But
Speaker 1: very few clinicians are trained to do something like that,
Speaker 1: And how can you partially use the diagnoses but not really.
Speaker 1: What's also interesting is when mental health diagnoses started to
Speaker 1: come into play, they were to be used by doctors,
Speaker 1: so it was a way for doctors to communicate, and
Speaker 1: this is something my psychiatrist and I were talking about.
Speaker 1: They were never meant for patients, and they were never
Speaker 1: meant even for patients to know what they had. And
Speaker 1: so I have a diagnosis. My psychiatrist has changed it
Speaker 1: three times since I started seeing him. I don't know
Speaker 1: what it is. I don't want to know. And it's
Speaker 1: that same idea that he uses it. Our doctors may
Speaker 1: use it, but you know, we're identifying with them in
Speaker 1: a way that they were never meant to be used.
Speaker 1: Let's change gears a little bit, and I want to
Speaker 1: talk about a recent article you wrote about what our emotions. Actually,
Speaker 1: that wasn't the title that. I think the title is
Speaker 1: more about who invented emotions. I'm less interested in the
Speaker 1: history of it than I am in talking about, like,
Speaker 1: what the heck are they? I never knew. If someone
Speaker 1: had asked me in my twenties, my thirties, my early forties,
Speaker 1: what is an emotion? I could never have told you.
Speaker 1: And finally I learned they are vibrations in our bodies.
Speaker 1: And when someone told me that, I thought, really, that's
Speaker 1: so wild. And so the question is, do you think
Speaker 1: that emotions are responses to thoughts or thoughts are responses
Speaker 1: to emotions. Personally, I think we have a thought first, because,
Speaker 1: as I say, evolutionary psychiatry has been very helpful to
Speaker 1: me that I have a primitive brain that is constantly
Speaker 1: trying to protect me and saying warning, warning, warning about
Speaker 1: everything when there is not deadly danger for the most part,
Speaker 1: and then I have a rational brain. But for the
Speaker 1: most part, the emotions that I'm having in my body
Speaker 1: are responses to my primitive brains firing off of thoughts. However,
Speaker 1: many supposedly we have six thousands, some say sixty, but
Speaker 1: I've heard it's really only six thousand in a day,
Speaker 1: and that is all emotions are, Yet we fear them.
Speaker 1: I'm terrified of anxiety. It's just a vibration in my body.
Speaker 1: It's a vibration in my chest. It doesn't make me
Speaker 1: fear it any less. But now what I've learned to
Speaker 1: do is to sit with it. And I'm not a
Speaker 1: meditator in the sense that meditation can have adverse reactions,
Speaker 1: particularly for people who are not mentally stable, and that
Speaker 1: has been my experience with meditation. But to try to
Speaker 1: feel the emotions in my body I'm able to do that.
Speaker 1: I can be directed and have success with something like
Speaker 1: that of being present. I mean, what are emotions to you?
Speaker 1: How do you think of them? Well, it's interesting because
Speaker 1: you get into what's an emotion, what is a feeling?
Speaker 1: You know, what is a thought? And I've been toying
Speaker 1: with the notion that thoughts and emotions maybe aren't as
Speaker 1: separate as we try and label them as, because you
Speaker 1: don't seem to get one without the other. We're trying
Speaker 1: to break it apart. But my experiences they co arise.
Speaker 1: You know, which comes first. I don't know. I'm a believer.
Speaker 1: It's actually it can be both ways. I certainly know,
Speaker 1: like I could have a thought like, oh, my partner
Speaker 1: doesn't love me, and suddenly I feel lousy. We all
Speaker 1: understand that direction. But there are days that I wake
Speaker 1: up and I feel lousy, and it feels like all
Speaker 1: my thoughts get filtered through the lousy lens. And so
Speaker 1: it seems to me that it's bidirectional, which then led
Speaker 1: me to go, well are they separate? So I've been
Speaker 1: thinking along the lines of one of our spiritual habits
Speaker 1: intensive we've been talking about it. I've been using the
Speaker 1: label emotional storm and saying that it's actually a bunch
Speaker 1: of things arise. There's that, Yes, you have thoughts, you
Speaker 1: have bodily sensations, you have what we would label as
Speaker 1: a feeling sad angry. Almost always there's some urge to
Speaker 1: do something, and those things all co arise. And if
Speaker 1: we can be as you said a little bit more like,
Speaker 1: all right, they feel overwhelming when they're all put together,
Speaker 1: but if I can sort of tweez those things apart
Speaker 1: a little bit, it starts to feel a little bit
Speaker 1: easier to work with. So that's kind of my thought.
Speaker 1: I love that, and I think for someone like me,
Speaker 1: I do need to sort of not pick them apart
Speaker 1: in a negative way, but part them and to see, Okay,
Speaker 1: there are circumstances. There's a situation, an event, something, and
Speaker 1: it's neutral, it's just neutral, and then I have a
Speaker 1: thought about it, and then I have an emotion, and
Speaker 1: those could be simultaneous. I mean, I agree that they
Speaker 1: could go back and forth, and that we're just so
Speaker 1: instinctual that things are happening like that, and then there's
Speaker 1: an action that I take and then there's a result,
Speaker 1: and so this is you know, not something I came
Speaker 1: up with. But you know, it's a very basic way
Speaker 1: of seeing the world and our mental and emotional lives,
Speaker 1: and it just makes sense to me, and it helped
Speaker 1: me slow things down a little bit. Yeah, I'm really
Speaker 1: intrigued by a question that I've been asking, you know,
Speaker 1: people I have on the show about which is It
Speaker 1: seems there are broadly sort of two ways of working
Speaker 1: with difficult thought slash emotion. And I'm oversimplifying, but one
Speaker 1: is it's very cognitive behavioral therapy. It's right, let me
Speaker 1: go in and let me look at the validity. Is
Speaker 1: it true? Is it? You know? Is it always that way?
Speaker 1: Am I seeing black and white thinking? I try and
Speaker 1: sort of get in there and wrestle with the thing
Speaker 1: a little bit, right. The other approach seems to be
Speaker 1: just step back and let it be. It's more the
Speaker 1: mindfulness bay acceptance and commitment therapy. You know, you start
Speaker 1: pulling on one thread and you know, you're wrestling with
Speaker 1: a yarn ball. And what I think is interesting is
Speaker 1: I actually think they're both very useful ways to approach it.
Speaker 1: The question I'm really interested in is when is one
Speaker 1: more effective than the other, And how would you know
Speaker 1: I guess maybe it's just you try, you know. I
Speaker 1: think having both of them and our tool kid is helpful.
Speaker 1: But I do sort of see that split. I see
Speaker 1: it in Buddhism. I can see like a certain threads
Speaker 1: of Buddhism that are like, you know, wholesome, unwholesome thoughts
Speaker 1: go in, pull the weeds out, you know, and other
Speaker 1: aspects of Buddhism that are like just step back, let
Speaker 1: it be. I see cognitive behavioral therapy versus acceptance and
Speaker 1: commitment therapy. I sort of see that split there. So
Speaker 1: that's kind of what I've been thinking about with that
Speaker 1: stuff lately. That's been really interesting me. I've tried all
Speaker 1: of that. So with my partial hospitalizations and all of that,
Speaker 1: I did CBT act all of them and um DBT
Speaker 1: and but I also for that, like you, I tried
Speaker 1: to meditate it out of me. I meditate it down
Speaker 1: and yoga it down. And I mean I did ashtanga
Speaker 1: for twenty years, and I you know, studied with Dinat
Speaker 1: Han and I studied with Byron Katie. And those are
Speaker 1: the two sides of the coin that you're really talking about.
Speaker 1: Byron Katie is all about questioning your thoughts that diknat
Speaker 1: Han is really more about like letting them go by.
Speaker 1: And I think in answer to your question, I kind
Speaker 1: of think or one way and I'm not good at this,
Speaker 1: but as you were talking that it's better to watch
Speaker 1: them go by and step back when you can't affect
Speaker 1: the result, when you really have no control over the situation.
Speaker 1: And if you can ask can I really even do
Speaker 1: anything about this, then let it go and step back?
Speaker 1: But if you can, then maybe it's worth going in
Speaker 1: and poking around and seeing what am I thinking and
Speaker 1: what's the result I'm producing, what's the result I want
Speaker 1: to produce? Yeah, I often say I think that the
Speaker 1: serenity prayer is one of the sort of like most
Speaker 1: foundational things to you know, finding emotional mental wellness. Can
Speaker 1: I do something or not? And it sounds like it's easy,
Speaker 1: but it's not. That's the hard part is like when
Speaker 1: when we talk about it, we're like, well, you know,
Speaker 1: I can't control the weather, and uh, I can control weather.
Speaker 1: I brush my teeth right, Yeah, those are obvious ones.
Speaker 1: That life is far more complex, which is why the
Speaker 1: serenity prayer says, and you know, please, I could really
Speaker 1: use the wisdom to know the difference, because that's what
Speaker 1: it takes. It takes discernment and wisdom to know the difference.
Speaker 1: But I agree with you. I think that's so foundational,
Speaker 1: and I think it's a little bit addictive almost to
Speaker 1: try to change things you have no impact on. I mean,
Speaker 1: I will just spin on it and and just try
Speaker 1: and and the less effect I can have, the more
Speaker 1: I tend to ruminate about it and try to have
Speaker 1: an effect. So it's almost like a I don't know,
Speaker 1: it's like a dog with a bone or something, and
Speaker 1: you just want to go at it and add it
Speaker 1: and add it. Some of it I think depends on
Speaker 1: your personality type, right, Like there are people who are
Speaker 1: that way. They're very tenacious, like I'm going to hang
Speaker 1: onto it forever. I think I fall a little bit
Speaker 1: more into the other category, which is like effort, like
Speaker 1: which is not exactly helpful either. When there's situations that
Speaker 1: you probably should do something about, you know, I probably
Speaker 1: shouldn't just say, well, you know, I'm going to have
Speaker 1: a tax bill this Year's nothing I can do about that,
Speaker 1: Like I need to engage, you know. So I think
Speaker 1: knowing where you fall can really be helpful with that
Speaker 1: I think you just nailed the two sides of the spectrum.
Speaker 1: I'm talking about Byron Katie on one and Tick not
Speaker 1: Han on the other. Would you say that you find
Speaker 1: both those tools useful at different times? So I studied
Speaker 1: Byron Katie for about five years. I went to her school,
Speaker 1: I worked at her school. I mean I was deep
Speaker 1: into the work and with Tick not Han, i studied him.
Speaker 1: I also had the amazing opportunity to interview him. It
Speaker 1: was incredible. Both came into my life at different times.
Speaker 1: And again, I'm not sure I write about other people
Speaker 1: in my book as well, because I wasn't the only
Speaker 1: one going through this. Meaning one young man I interviewed
Speaker 1: he was diagnosed with schizophrenia and he did transcendental meditation.
Speaker 1: It exacerbated his symptoms and he ended up stabbing another
Speaker 1: student at the college he was at and the student died. Um.
Speaker 1: So you know, meditation isn't always good for everyone. We
Speaker 1: tend to prescribe it as a pass as you know,
Speaker 1: just this innocuous thing. It was very detrimental to me
Speaker 1: and both types of meditation. So you know, Katie's work
Speaker 1: is very much a meditative practice of questioning. But someone
Speaker 1: with a loose hold on reality. I don't mean to
Speaker 1: make myself sound like that, but even now, you know,
Speaker 1: I don't write fiction anymore because I'm just I'm lucky
Speaker 1: I'm here and I need to imagine another world. But
Speaker 1: but with Katie, if you're always questioning your thoughts and
Speaker 1: you don't know where to stop, you're gonna end up
Speaker 1: in a very very dark place, which is where I
Speaker 1: would or just questioning all reality. I remember I was
Speaker 1: doing the work so much during the day that I
Speaker 1: thought I could see through my body, you know. It
Speaker 1: was not good for my mind. And then to meditate.
Speaker 1: I would love to be the kind of person who
Speaker 1: can meditate in the tick, not Han style or you know,
Speaker 1: zen or anything like that. My thoughts have always been
Speaker 1: too powerful, and I don't want to give them that
Speaker 1: much power. But I am that that that kind of
Speaker 1: no direction at all. It's not something that I want
Speaker 1: to try to do anymore. I tried for years and
Speaker 1: years and years. I mean, Eckert totally. I tried to
Speaker 1: feel my inner body lying on the floor of my
Speaker 1: living room, and it gave me panic attacks. Yeah, I
Speaker 1: think that's really interesting. You did write your article about
Speaker 1: interviewing tickno Han, and now he's one of those people
Speaker 1: I would have loved to have talked to. And you
Speaker 1: described in the article you're kind of saying what you're
Speaker 1: saying now, which is like, hey, meditation can not always
Speaker 1: the right thing. It's got lots of challenges. And yet
Speaker 1: when you met tick Han, you basically said, like, the
Speaker 1: guy was blowing. Oh he was incredible, And I was
Speaker 1: not mentally in a place. I mean, this was I.
Speaker 1: I did all of this during the thirty years that
Speaker 1: I was in the mental health system, and I wish
Speaker 1: I had been where I am now to meet him
Speaker 1: and to be able to take more advantage of it.
Speaker 1: But he was incredible and just as as you said,
Speaker 1: he glowed. And it's such a cliche. I mean, he
Speaker 1: floated into the room and he just seemed to have
Speaker 1: this piece about him. And he looked so young. I mean,
Speaker 1: he was easily in his eighties and he looked sixty maybe,
Speaker 1: And of course I would love to have that kind
Speaker 1: of piece. I also respect him so much because of
Speaker 1: engaged Buddhism that he doesn't you know, he does believe
Speaker 1: in really engaging in social justice, and certainly he his
Speaker 1: last book which is also with my publisher, and and
Speaker 1: just on climate change and how we all have to engage.
Speaker 1: And I feel the same about mental health. We have
Speaker 1: to change the mental health system. It's not going to change.
Speaker 1: I think your article in these talks about meditation are
Speaker 1: interesting because Buddhism points to this disillusion of self as
Speaker 1: ultimate liberation, and you're describing that for some people is
Speaker 1: not a liberating experience but an absolutely terrifying experience. And
Speaker 1: a lot of spiritual teachers will say, of course you're afraid,
Speaker 1: but you go through that and on the other side
Speaker 1: is peace. But you're saying, on the other side of that,
Speaker 1: for some people a psychosis. You know, it's called the
Speaker 1: Dark Night, and there is actually an organization started by
Speaker 1: a woman I'm I'm forgetting her name now, but where
Speaker 1: she's collecting experiences of people for whom meditation has either
Speaker 1: you know, sparked psychosis or sent them into such a
Speaker 1: dark place that they felt they might never come out
Speaker 1: of it. And again, it's just that we tell ourselves
Speaker 1: and in the cultural conversation, meditation is good. It's good
Speaker 1: for everyone. I thought there was something wrong with me
Speaker 1: that I couldn't do it, or that I was just
Speaker 1: not trying hard enough. And I only later found out
Speaker 1: about people like Shooty for whom transcendental meditation. You know,
Speaker 1: it's it's set off his already fragile mind, or again fragile.
Speaker 1: I don't like that word, but you know what I'm
Speaker 1: saying that that you know a mind that you can't
Speaker 1: question reality. I believe if you aren't in a place
Speaker 1: that's somewhat mentally healthy. Yeah, it's kind of like saying,
Speaker 1: run a marathon when you haven't run in twenty years. Yeah,
Speaker 1: that's not going to go well. It makes me think
Speaker 1: a little bit. I mean, this is going in a
Speaker 1: direction we don't have time to go in. Which is
Speaker 1: the next mental health craz is psychedelics. You know, talk
Speaker 1: about an area that is fraught for people who have
Speaker 1: mental illness, right, because we're saying, on one hand, it
Speaker 1: helps mental illness, it can help with depression, it can
Speaker 1: help with My experience with psychedelics has been very much
Speaker 1: what you said. When I'm in an okay place. You know,
Speaker 1: in the past, they were very powerful and illuminating things.
Speaker 1: When I was in a dark place, it was terror.
Speaker 1: My stupid brother convinced me on the night of my
Speaker 1: grandmother's funeral. This is a long time ago, right, We're
Speaker 1: talking thirty years ago, on the night of my grandmother's
Speaker 1: funeral to take I don't know whether he took mushrooms
Speaker 1: or lst. I don't know which it was, but I
Speaker 1: knew it was a bad idea. I knew it, and
Speaker 1: he convinced me the entire night. My recollection is him
Speaker 1: outside the window laughing like to me, which sounded like
Speaker 1: the devil, and me laying on a bed feeling like
Speaker 1: I was being crucified for eight hours like I mean,
Speaker 1: it was truly a horror experience. And so I think
Speaker 1: to your point, this idea of question in reality, which
Speaker 1: can be a really powerful thing to do. I'm very
Speaker 1: focused on that as my own spiritual practice, but I'm
Speaker 1: coming to it from what feels like a place of strength,
Speaker 1: you know. I do see how it could be truly
Speaker 1: terrifying to just nothing has any meaning. Oh, okay that
Speaker 1: depending on where you are, that's either like, oh, that's
Speaker 1: really profound and could really be liberating, or I mean,
Speaker 1: we're not all Byron Katie. We're not all going to
Speaker 1: sit around and have the world come to us to
Speaker 1: want us to have us help them question their thoughts.
Speaker 1: But I try to be open to all mental health
Speaker 1: treatments because again, I think we're just in a place
Speaker 1: where whatever works for you, it's worth trying. At the
Speaker 1: same time, I agree, I think that psychedelics and marijuana
Speaker 1: as as some sort of answer to this, just because
Speaker 1: I know someone who had a psychotic break from marijuana
Speaker 1: and he is still told that he has bipolar and
Speaker 1: he's convinced, no, I don't, it was just from smoking
Speaker 1: pot that that happened. So I worry too, I really do.
Speaker 1: And then the other part of this is my understanding
Speaker 1: is the Buddha never meant for lay people to meditate.
Speaker 1: It was strictly monks only. And so then you're in
Speaker 1: a protected space. You're in the monastery, you don't use money,
Speaker 1: you don't you know, you aren't having sex. You are
Speaker 1: in society, and so you are able to question reality
Speaker 1: in a way that is protected. And so unless I
Speaker 1: have that protection, I'm going to just be l a person. Well,
Speaker 1: there is there's certainly some wisdom in that, but I
Speaker 1: think what you just said a couple of minutes ago
Speaker 1: is probably ultimately the most important thing to me, which
Speaker 1: is you've got to find what works for you. What
Speaker 1: I think is so important also is if you're struggling
Speaker 1: with mental illness, like I think it's just so important
Speaker 1: to say, like, don't give up. You may not have
Speaker 1: found what works for you yet, but you might, you
Speaker 1: know you might, and so carry on. You know. In
Speaker 1: a A we say keep coming back. And I think
Speaker 1: that's so important because all we're saying is like you
Speaker 1: may not get this the first time, right, but you're welcome,
Speaker 1: come on, keep trying, keep trying, you know. Now, I
Speaker 1: think the thing we should be saying is sometimes you
Speaker 1: need to try something other than a instead of just
Speaker 1: keep coming back here. You may need to go somewhere else,
Speaker 1: but the spirit of hey, I'm going to keep looking
Speaker 1: for an answer, I think is so important. Absolutely, And
Speaker 1: I mean it took me six diagnoses, so you know,
Speaker 1: keep trying, and I did almost in my life. I
Speaker 1: don't want anyone to have to go through that. You know.
Speaker 1: One thing I was very careful about in my book
Speaker 1: is not to attack psychiatry because that leaves people without hope.
Speaker 1: And I had one particular, very dangerous psychiatrist. I had
Speaker 1: some irresponsible primary care physicians, but I had one that
Speaker 1: was extremely well intended who gave me three of my diagnoses.
Speaker 1: But he was very well intended. And I had a
Speaker 1: psychiatrist who helped me save my own life. So there's
Speaker 1: just going to be a lot out there, and I
Speaker 1: think we need to start, you know, again with the
Speaker 1: d s M and the pages where these diagnoses are
Speaker 1: coming from. Yeah, so we'll have links in the show notes,
Speaker 1: but tell people about the movement that you're working on
Speaker 1: and the three questions people can ask themselves about diagnosis
Speaker 1: where do they find that? And again links will be
Speaker 1: in the show notes, but I'll let you just give
Speaker 1: it to everybody here. So it's www. Dot pathological dot us,
Speaker 1: and it is Pathological the Movement. And I realized that
Speaker 1: in my book, I really, you know, use my experience
Speaker 1: because I think it's one that many many people have
Speaker 1: shared or their loved ones have shared, and then give
Speaker 1: them all the information I wish I had sort of
Speaker 1: wrapped into it, but that I hadn't given really clear
Speaker 1: action steps for people because it's a memoir and it's really,
Speaker 1: you know, a narrative and supposed to be that. So
Speaker 1: I started Pathological to movement and the three questions are
Speaker 1: is my diagnosis valid and or reliable. And the answer
Speaker 1: to the first is no, definitively, And the answer to
Speaker 1: the second is it depends um. And then the second question,
Speaker 1: which is so important, is it has my diagnosis been
Speaker 1: proven to be chronic? You know? No? And then the
Speaker 1: third question, what does that mean in terms of me,
Speaker 1: my diagnosis and the treatment you're suggesting and that I
Speaker 1: hope will open up, you know, a different conversation. At
Speaker 1: the same time, when I was going through what I
Speaker 1: was going through, I could not have asked those questions.
Speaker 1: There's just no way. But if I had been thinking
Speaker 1: about them, That's really what I want from the movement
Speaker 1: is just to have us thinking about them, because then
Speaker 1: we're going in eyes wide open, and I think that's
Speaker 1: what's important, is to have eyes as wide open as
Speaker 1: you can, as much information as you can. And yes,
Speaker 1: sometimes we crawl across the door to to get help
Speaker 1: and we just take what we can get. But I
Speaker 1: do think this is a very important conversation. And the
Speaker 1: thing you said earlier that resonated and then I do
Speaker 1: need to wrap up, was really thinking about talking with
Speaker 1: your person who's helping you about an exit strategy, you know,
Speaker 1: like how are we monitoring this, How are we going
Speaker 1: to determine whether I should keep doing it? What's this
Speaker 1: look like longer term? So that people don't necessarily end
Speaker 1: up in a place where you and I are where
Speaker 1: we're going, Well, I don't know if I really need
Speaker 1: them or if my body is just depended on it.
Speaker 1: Over twenty years of doing this, again, you and I
Speaker 1: are in good places. I'm not saying like you could
Speaker 1: be in a far worse place, but I do think
Speaker 1: would have liked to have had that conversation at year
Speaker 1: two or year one or year three instead of your
Speaker 1: twenty Especially in medications, some medications, not all, but you know,
Speaker 1: antidepressants have have a pretty productive profile when you're taking
Speaker 1: them for three to six months and then going off
Speaker 1: of them and you're not having the same dangers. And again,
Speaker 1: the other issue that comes up so much in terms
Speaker 1: of dysfunction is how long are your symptoms lasting? And
Speaker 1: at what point does it become too long? Because intermittent
Speaker 1: depression is actually a part of the human experience, right, Yes, Well,
Speaker 1: why don't you and I stick around in the post
Speaker 1: show conversation for a couple of minutes, because I'd love
Speaker 1: to talk about that because I think, you know, wrestling
Speaker 1: with Do I have depression or do I just have
Speaker 1: a normal, melancholy kind of temperament is a really interesting question.
Speaker 1: So listeners, you can get access to the post show conversation,
Speaker 1: ad free episodes, all kinds of other good stuff at
Speaker 1: when you Feed dot Net slash Join Sarah, Thanks so
Speaker 1: much for coming on. I absolutely loved reading the book.
Speaker 1: I've loved this conversation. I think it's a really important
Speaker 1: thing to get out in the world, and I'm glad
Speaker 1: you're doing it. Thank you so much for having me.
Speaker 1: It's such a privilege. If what you just heard was
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