WEBVTT - Is the DSM...BS? 0:00:08.520 --> 0:00:11.360 This is the Anxiety Bites podcast and I am your host, 0:00:11.520 --> 0:00:18.200 Jen Kirkman. Welcome to another episode of Anxiety Bites. I 0:00:18.239 --> 0:00:22.160 am your host, Jen Kirkman. Today my guest is Sarah Fay. 0:00:22.320 --> 0:00:26.000 She has a new memoir art called Pathological The True 0:00:26.040 --> 0:00:30.160 Story of Six Misdiagnoses. So today's I was a kind 0:00:30.200 --> 0:00:31.760 of a thinker. Or maybe it's not. Maybe it was 0:00:31.840 --> 0:00:34.479 just something for me to wrout my brain around. At 0:00:34.520 --> 0:00:39.720 first I read Sarah's book. I loved it. And you know, 0:00:39.800 --> 0:00:41.840 at first, if you just said to me on paper, 0:00:42.640 --> 0:00:45.560 you know, hey, there's a book out on this person 0:00:45.600 --> 0:00:48.400 says that the d s M, which is how all 0:00:49.120 --> 0:00:52.919 um mental health diagnosis is, they come from the d 0:00:53.000 --> 0:00:55.440 s M, and it stands for the Diagnostic and Statistical 0:00:55.480 --> 0:00:58.560 Manual of Mental Disorders. And I've known of the d 0:00:58.720 --> 0:01:01.320 s M my my whole adult life, that have been 0:01:01.360 --> 0:01:04.759 in therapy. It's what therapist used to diagnose you. So 0:01:05.120 --> 0:01:08.000 you may say I have this symptom of that, they 0:01:08.000 --> 0:01:09.440 may look it up in their little book the d 0:01:09.560 --> 0:01:11.920 s M and say, oh, well that's a clinical depression 0:01:11.959 --> 0:01:16.160 or that's a generalized anxiety disorder. A lot of times 0:01:16.520 --> 0:01:20.040 a talk therapist will use it because there are codes 0:01:20.120 --> 0:01:23.000 in the book. So they'll say, okay, so you're coming 0:01:23.040 --> 0:01:25.839 into talk about your family, now would you say that 0:01:25.840 --> 0:01:29.679 that's causing you more depression anxiety? You know, And then 0:01:29.680 --> 0:01:35.320 they'll put the code for your diagnosis on some kind 0:01:35.360 --> 0:01:38.000 of super bill and it gets sent to insurance, and 0:01:38.160 --> 0:01:41.440 if your insurance covers you to see a therapist for 0:01:41.520 --> 0:01:45.039 anxiety and depression, then there you go. You're going to 0:01:45.040 --> 0:01:49.280 be covered. So it originally came about as a way 0:01:49.280 --> 0:01:51.080 for doctors to communicate with each other, and then it 0:01:51.160 --> 0:01:54.720 sort of became the the manual for how to diagnose people. 0:01:56.880 --> 0:01:59.440 And I've heard comments here and there from professionals that 0:01:59.520 --> 0:02:01.640 like the d s M. You know, it's just it's 0:02:01.640 --> 0:02:06.360 not the dictionary, if that makes sense. It's not totally accurate, 0:02:06.360 --> 0:02:11.240 it's not set in stone. It's it's it's guesswork, and 0:02:12.360 --> 0:02:18.520 there are a lot of diagnoses that could fit you. 0:02:18.520 --> 0:02:21.480 You can have a bunch of symptoms from different things. 0:02:21.600 --> 0:02:25.360 It doesn't mean you have that disorder per se. And 0:02:25.360 --> 0:02:27.120 then it doesn't mean if you are diagnosed with one, 0:02:27.160 --> 0:02:29.480 that that your doctor is right necessarily, and it doesn't 0:02:29.480 --> 0:02:32.000 mean that you're going to have it your whole life. 0:02:32.000 --> 0:02:36.120 So in a way, getting a diagnosis can be helpful 0:02:36.160 --> 0:02:41.040 because you don't just feel like I'm just I guess crazy, 0:02:41.240 --> 0:02:43.560 you know, and no help for me. I mean having 0:02:43.560 --> 0:02:46.160 a name for something. I think it's so helpful. You go, well, 0:02:46.320 --> 0:02:48.680 there's a name for this, then other people must have 0:02:48.680 --> 0:02:51.120 experienced it, and there's experts out there who can help me. 0:02:52.200 --> 0:02:56.600 But then as you get a little more practiced or 0:02:57.360 --> 0:03:00.960 grown up, or further along in your recovery from whatever 0:03:01.800 --> 0:03:06.359 mental disorder you're going through, you might start to think 0:03:07.080 --> 0:03:09.120 this seems like a very narrow definition. I don't do 0:03:09.200 --> 0:03:11.200 I really have this? Or is it more this? Or 0:03:11.280 --> 0:03:13.640 is it you know that kind of thing. And so 0:03:13.680 --> 0:03:17.079 that's why I sometimes get nervous thinking about doing episodes 0:03:17.120 --> 0:03:19.800 like this. When I when I decided to do this episode, 0:03:19.800 --> 0:03:23.320 I thought, I hope I do this right, because I 0:03:23.400 --> 0:03:26.320 don't want to sound like good conspiracy theorists or make 0:03:26.400 --> 0:03:30.560 Sarah sound like one, because nobody is saying, oh, mental 0:03:30.560 --> 0:03:33.440 health issues, they're not real. That's literally not what anyone 0:03:33.520 --> 0:03:35.680 is saying. But I know, if you're doing the dishes 0:03:35.840 --> 0:03:39.160 or driving and sort of half listening to this, who 0:03:39.200 --> 0:03:41.360 knows what you might hear. But I just want to 0:03:41.360 --> 0:03:43.880 make sure on my end that I've been very clear 0:03:45.560 --> 0:03:48.080 that what we're talking about in this episode, there is 0:03:48.120 --> 0:03:51.880 this manual called the d s M. And while mental 0:03:51.880 --> 0:03:59.520 health illnesses are real, the way that many things in 0:03:59.560 --> 0:04:03.840 the book are diagnosed maybe sometimes inaccurate. You may get 0:04:03.840 --> 0:04:06.440 an inaccurate diagnosis. It doesn't mean that like all doctors 0:04:06.440 --> 0:04:08.920 are bullshit. That's not what I'm saying. And Sarah and 0:04:08.960 --> 0:04:12.400 I very much believe in mental illness. We've both had it. 0:04:12.440 --> 0:04:15.600 We very much believe in psychiatry. We both go to psychiatrists. 0:04:15.600 --> 0:04:18.479 But we're just saying this book has its flaws, and 0:04:18.520 --> 0:04:20.120 she just wants to bring that out into the open. 0:04:20.160 --> 0:04:22.720 I mean, there are bigger issues at play. I means 0:04:22.760 --> 0:04:26.919 sometimes people use the d s M two market their antidepressants, 0:04:27.000 --> 0:04:30.120 you know, and sometimes the d s M maybe used 0:04:30.160 --> 0:04:35.200 by well meaning people who may accidentally over diagnose someone. 0:04:35.279 --> 0:04:38.720 So it's just kind of shining a light on this 0:04:38.880 --> 0:04:41.080 thing that that if you're in therapy, you may have 0:04:41.240 --> 0:04:43.880 heard referenced, oh, the d s M. And if you're 0:04:43.880 --> 0:04:47.160 anything like me, sometimes you hear something and you might 0:04:47.160 --> 0:04:49.200 not know a lot about something, and so you figure 0:04:49.200 --> 0:04:50.840 out they know what they're talking about. The d s 0:04:50.960 --> 0:04:54.839 M sounds pretty uh, you know, the Diagnostic and Statistical 0:04:54.880 --> 0:04:57.760 Manual of Mental Disorder sounds pretty on the up and 0:04:57.839 --> 0:05:00.880 up to me. And we're not saying it's a you know, 0:05:00.920 --> 0:05:03.720 some dark, shadowy group. It's like, it's just not accurate. 0:05:04.480 --> 0:05:08.479 And so I talked to Sarah today about her new book, which, 0:05:08.480 --> 0:05:12.040 by the way, again is called Pathological. It is out 0:05:12.160 --> 0:05:14.320 right now. You can get it wherever you get books. 0:05:15.880 --> 0:05:18.720 It's been called a powerful memoir, a deeply compelling person 0:05:18.760 --> 0:05:21.719 and a fantastic writer. Pathological will make you passionate about 0:05:21.720 --> 0:05:25.120 improving the way we handle mental health. And again you 0:05:25.160 --> 0:05:27.039 can get it wherever you get books. A little bit 0:05:27.040 --> 0:05:28.920 about Sarah Fay, the author. She is an author and 0:05:28.960 --> 0:05:32.040 an activist. Her writing appears in many publications, including The 0:05:32.040 --> 0:05:36.840 New York Times, The Atlantic Time Magazine, The New Republic, McSweeney's, 0:05:36.880 --> 0:05:39.560 The Believer, and The Paris Review, where she has served 0:05:39.600 --> 0:05:42.960 as an advisory editor. She's currently on the faculty at 0:05:43.000 --> 0:05:47.200 Northwestern University in DePaul University. She's the founder of Pathological, 0:05:47.200 --> 0:05:51.080 the movement of public awareness campaign devoted to making people 0:05:51.120 --> 0:05:55.880 aware that mental health diagnoses are invalid and largely unreliable, 0:05:56.200 --> 0:06:00.200 and a full recovery from mental illness is possible. So 0:06:00.279 --> 0:06:04.160 I will link to Sarah's website and her book in 0:06:04.440 --> 0:06:08.760 the show notes, and I hope you enjoy our very 0:06:09.320 --> 0:06:13.560 nuanced and rather how do you conversation about this thing 0:06:14.200 --> 0:06:20.400 called the d s M? Before I ask you the 0:06:20.560 --> 0:06:24.839 six diagnoses you've had in your lifetime, let's define pathological 0:06:25.400 --> 0:06:28.840 or let you define it. I'll listen. So we were 0:06:28.839 --> 0:06:31.760 worried about that, my editor and I actually just because 0:06:31.839 --> 0:06:34.400 it's not that common of a word. It's used in 0:06:34.440 --> 0:06:38.440 psychiatry circles a lot, but knots and medical circles. But 0:06:38.480 --> 0:06:42.960 it's essentially medicalizing a condition, any condition. It doesn't have 0:06:43.040 --> 0:06:46.680 to be psychiatric, it could be anything. So when we 0:06:46.760 --> 0:06:51.080 pathologize the human condition is what psychiatry is often accused of. 0:06:51.360 --> 0:06:56.839 We're talking about calling the emotion anxiety the disorder anxiety, 0:06:57.400 --> 0:07:00.760 and it's confusing because they're the same name. And with depression, 0:07:01.120 --> 0:07:04.880 so we're calling the disordered depression the same as the 0:07:04.920 --> 0:07:10.480 emotion of depression. And so, what are the six diagnosis 0:07:10.640 --> 0:07:13.840 diagnoses that you've had in your life? As you write 0:07:13.880 --> 0:07:16.840 in your book pathological, that you said you have received 0:07:16.880 --> 0:07:18.880 since you were twelve years old or beginning at the 0:07:18.880 --> 0:07:23.320 age of twelve. Yeah, So I was first diagnosed with anorexia, 0:07:23.520 --> 0:07:27.560 and then it progressed. I had a little break um 0:07:27.600 --> 0:07:31.680 in terms of diagnosis, so I was basically was out 0:07:31.720 --> 0:07:34.920 of danger in terms of anorexia, no longer going to 0:07:34.960 --> 0:07:38.440 the hospital by the time I was about sixteen. But 0:07:38.560 --> 0:07:41.160 then I had kind of that lag in college that 0:07:41.200 --> 0:07:44.160 a lot of women have, which is you're you're eating horribly, 0:07:44.360 --> 0:07:48.240 but enough that you're gaining weight anyway, So you know, 0:07:48.320 --> 0:07:51.040 so I had that and then UM, and then in 0:07:51.080 --> 0:07:54.320 my twenties, I was in a relationship that was just 0:07:54.480 --> 0:07:58.400 really positive and I did really well there for a while. 0:07:58.480 --> 0:08:01.280 And I talked about this in my book. He's now 0:08:01.440 --> 0:08:04.640 a chef and was a fantastic cook, and he really 0:08:04.680 --> 0:08:07.520 taught me to love food. UM. A lot of people 0:08:07.560 --> 0:08:10.360 who read my books say the second chapter is a relief, 0:08:10.400 --> 0:08:13.680 because the first chapter is so you know, dramatic with 0:08:13.720 --> 0:08:16.600 my anorexia, and then the second chapter is all about 0:08:16.640 --> 0:08:19.400 this boyfriend, Chris, and how great our life was together. 0:08:19.480 --> 0:08:23.280 It didn't last, and so I then went into sort 0:08:23.320 --> 0:08:27.600 of a lot of anxiety, a lot of UM, definitely 0:08:27.600 --> 0:08:32.200 dipping into hypochondria, relying on alcohol to self medicate, and 0:08:32.240 --> 0:08:34.480 I talked about that in the book. But finally when 0:08:34.520 --> 0:08:38.720 I moved to New York, it really started to uh 0:08:38.880 --> 0:08:42.360 reach more of an acute phase. And so I was 0:08:42.400 --> 0:08:46.319 diagnosed at generalized anxiety disorder by my primary care physician 0:08:46.360 --> 0:08:49.200 in New York and given valium, which I quickly became 0:08:49.679 --> 0:08:52.560 I wouldn't say addicted, but I was definitely relying on 0:08:52.679 --> 0:08:55.640 it um. And then when I was in New York 0:08:55.679 --> 0:08:58.680 as well, my cat passed away. My cat died. Cat 0:08:58.720 --> 0:09:00.560 people out there will be able to relate to this, 0:09:00.640 --> 0:09:03.760 but I was devastated. She had been mine for sixteen years. 0:09:03.840 --> 0:09:08.280 And so I really went into a very deep depression. 0:09:08.559 --> 0:09:12.199 And I had been battling with depression anyway, but turned 0:09:12.200 --> 0:09:15.720 to exercise UM to try to relieve it. And I 0:09:15.760 --> 0:09:18.720 was running so much in New York and running over 0:09:18.720 --> 0:09:21.120 what we called the five Bridges, so we would do 0:09:21.200 --> 0:09:24.640 all the bridges in you know, in Manhattan and Brooklyn 0:09:24.720 --> 0:09:27.480 and Queens and so anyway, So I was running to 0:09:27.520 --> 0:09:30.439 such a degree and I went to a therapist. A 0:09:30.679 --> 0:09:33.520 friend insisted that I go, and I received the diagnosis 0:09:33.520 --> 0:09:37.760 of major depressive disorder after the thirty minute consult, and 0:09:38.360 --> 0:09:42.280 she said I should be on antidepressants right away. I resisted. 0:09:42.360 --> 0:09:44.480 I was the kind of person who wouldn't take aspirin. 0:09:44.720 --> 0:09:46.600 I mean, I was just like, no, no, no, no, no, 0:09:46.720 --> 0:09:50.160 I'm natural, and so I YO good and I meditated 0:09:50.520 --> 0:09:54.880 my Chinese herb and I just kept getting worse and 0:09:54.920 --> 0:09:57.160 I kept getting worse, and so eventually I went to 0:09:57.200 --> 0:10:01.600 get my PhD in Iowa, and I ended up going 0:10:01.640 --> 0:10:04.600 to my primary care physician there. He diagnosed me first 0:10:04.600 --> 0:10:08.160 with a d h D, then obsessive compulsive disorder, and 0:10:08.200 --> 0:10:11.600 then obsessive compulsive disorder and a d h D with 0:10:12.360 --> 0:10:17.440 anxiety and depressive elements, which sounds like a nice cocktail 0:10:17.559 --> 0:10:20.680 or something. I don't even know what that is. And 0:10:20.840 --> 0:10:23.240 it got it got quite bad at that point, and 0:10:23.280 --> 0:10:26.520 then I started to become suicidal and was really just 0:10:27.320 --> 0:10:30.960 went into crisis phase for about I guess it would 0:10:30.960 --> 0:10:35.400 be nine years. And then I was diagnosed with bipolar disorder. 0:10:35.600 --> 0:10:40.480 And so that's where my final diagnosis ended up. And 0:10:40.960 --> 0:10:43.160 I mean, it's a much longer story obviously it's a book. 0:10:43.280 --> 0:10:49.199 But so finally I was extremely suicidal. I had been 0:10:49.240 --> 0:10:53.360 put on and taken off so many medications. Um antipsychotics 0:10:53.440 --> 0:10:57.360 had terrible AVer's reactions, including a caathesia, which is this 0:10:57.559 --> 0:11:00.400 terrible side effect where you feel like you're calling out 0:11:00.440 --> 0:11:04.360 of your skin. You can't stop moving. It's it was awful. 0:11:04.480 --> 0:11:07.880 And so I had a falling out with my psychiatrist 0:11:07.920 --> 0:11:10.080 at the time, and I went to a new psychiatrist 0:11:10.120 --> 0:11:12.719 that my sister found. My sister and my mother and 0:11:12.760 --> 0:11:15.400 my whole family. They're the heroes of this book, no question. 0:11:15.520 --> 0:11:18.319 I was so lucky to have them. And I went 0:11:18.360 --> 0:11:22.839 to this new psychiatrist and he we had our quick, 0:11:22.920 --> 0:11:25.080 you know, back and forth twenty seven minutes, and I 0:11:25.120 --> 0:11:28.200 waited for him to proclaim whatever he thought my diagnosis was, 0:11:28.280 --> 0:11:30.800 or give me a new diagnosis. And he looked at 0:11:30.800 --> 0:11:32.880 me and he said, I don't know what you have. 0:11:33.720 --> 0:11:38.400 And my whole world changed. And I was walking down 0:11:38.480 --> 0:11:41.760 Chicago Avenue in Chicago, and it was winter, it was 0:11:41.840 --> 0:11:44.320 really cold, and I just thought, no one knows what 0:11:44.400 --> 0:11:47.400 I have, none of you do. And so then I 0:11:47.440 --> 0:11:49.440 took it on myself and I just said, I'm going 0:11:49.480 --> 0:11:52.679 to find out everything about mental health diagnoses, their history. 0:11:53.080 --> 0:11:55.280 Who thought of these where did they come from? What 0:11:55.360 --> 0:11:57.840 lab were they discovered in? And so I just wanted 0:11:57.880 --> 0:12:00.760 to know everything. So I ended up going into this 0:12:01.000 --> 0:12:03.760 deep research phase and that's what my book is. It's 0:12:03.840 --> 0:12:06.800 my story, but I also bring in all the information 0:12:06.920 --> 0:12:09.040 that I want other people to know to save them 0:12:09.040 --> 0:12:12.120 from going through what I went through. So I have 0:12:12.240 --> 0:12:15.880 two quick follow up questions. One is was it because 0:12:15.920 --> 0:12:19.360 you had been diagnosed so many times? Was it weirdly 0:12:19.480 --> 0:12:21.720 freeing to have someone say I don't know what's wrong 0:12:21.760 --> 0:12:24.960 with you? And secondly, normally I would do this like 0:12:25.040 --> 0:12:26.880 kind of at the end of the episode, but tell 0:12:27.000 --> 0:12:30.320 us now how you would diagnose yourself, Like what do 0:12:30.400 --> 0:12:34.760 you have now and how do you handle it now? 0:12:34.800 --> 0:12:36.880 I'm glad we're talking about it now because I always 0:12:36.920 --> 0:12:39.959 want to preface that even though and we'll talk more 0:12:39.960 --> 0:12:42.720 about this, but the diagnoses we receive, all the mental 0:12:42.760 --> 0:12:45.360 health diagnoses, and when we talk about the d s M, 0:12:45.520 --> 0:12:47.720 that's just the manual they come from. It's just a 0:12:47.800 --> 0:12:52.480 book and that's where everything we're given, you know, originates 0:12:53.160 --> 0:12:57.560 we talk about those are invented categories. And I didn't 0:12:57.559 --> 0:13:00.839 say that actually, but Thomas Insel, who the former head 0:13:00.840 --> 0:13:02.360 of the end I'm and i m H, which is 0:13:02.400 --> 0:13:05.320 the National Institute of Mental Health. He said that, so 0:13:05.360 --> 0:13:08.000 a lot of sort of our most prominent psychiatrists and 0:13:08.080 --> 0:13:12.120 researchers have been warning us about the invalidity of these diagnoses. 0:13:12.160 --> 0:13:14.720 So even though I say that and I agree with them, 0:13:14.800 --> 0:13:17.240 not that they need me to agree with them, but 0:13:17.960 --> 0:13:21.400 that mental illness is very, very real. I had one, 0:13:21.640 --> 0:13:25.040 There's no question. I used to say I have or 0:13:25.120 --> 0:13:29.520 had one. UM. But they are no D S M diagnosis, 0:13:29.559 --> 0:13:32.079 No mental health diagnosis has been proven to be chronic. 0:13:32.200 --> 0:13:36.120 Mental illness is not chronic. UM. And that same Thomas 0:13:36.200 --> 0:13:38.920 in Soul, who is someone I really really admire. Um, 0:13:38.960 --> 0:13:42.480 he just came out with a book that basically says, UM, 0:13:42.520 --> 0:13:45.200 it's kind of an apology for focusing so much on 0:13:45.240 --> 0:13:49.040 the biomedical model or this idea that our mental health 0:13:49.080 --> 0:13:53.640 diagnoses are biological and therefore chronic. UM. When he was 0:13:53.920 --> 0:13:56.040 during his time at the n I m H and 0:13:56.160 --> 0:14:00.880 instead of really providing for people and providing care for 0:14:00.920 --> 0:14:04.560 those especially most in need with serious mental illness. UM. 0:14:04.600 --> 0:14:06.920 But he's now come out and said, no, mental illness 0:14:06.960 --> 0:14:11.000 is chronic. We can fully recover. And so I see 0:14:11.040 --> 0:14:13.880 myself as an example of someone who had a serious 0:14:13.920 --> 0:14:18.679 mental illness. UM. I had to three technically UM, and 0:14:19.000 --> 0:14:21.640 I have fully recovered. And I want other people to 0:14:21.680 --> 0:14:24.400 know that they and their children and their teenagers can 0:14:24.400 --> 0:14:30.720 fully recover too. So that's where I am. Now we'll 0:14:30.760 --> 0:14:39.520 be right back. The d s M is the Diagnostic 0:14:39.560 --> 0:14:44.200 and Statistical Manual of Mental disorders, and it does exist 0:14:44.880 --> 0:14:48.360 and it is a thing. But your book is about 0:14:48.440 --> 0:14:51.760 how we need to take another look at that because 0:14:52.080 --> 0:14:57.040 it's used to diagnose patients. And you know, there's psychiatry 0:14:57.080 --> 0:14:59.880 and their psychology, right, so I see a talk there 0:15:00.040 --> 0:15:02.800 fist they do not prescribe medication. I do have a 0:15:02.800 --> 0:15:06.640 psychiatrist who prescribes medication. So mostly it is the psychiatrist 0:15:06.680 --> 0:15:09.480 who prescribe medication that use the d s M. My 0:15:09.680 --> 0:15:13.760 talk therapist uses it to get a reimbursement on my 0:15:13.840 --> 0:15:16.800 health insurance. You know, if if she doesn't indicate what 0:15:16.840 --> 0:15:21.760 we're talking about, it's not considered something that my health 0:15:21.800 --> 0:15:26.200 insurance would reimburse me for. So it's really about a 0:15:26.240 --> 0:15:29.400 bunch of coding, right, so that payments can be handled. 0:15:29.400 --> 0:15:31.760 I mean, it's almost this kind of it's like the 0:15:31.840 --> 0:15:36.320 least healthcare it's like the least mental health care thing, right, 0:15:36.360 --> 0:15:39.400 It's not um ooei gooey and some kind of like 0:15:40.040 --> 0:15:44.960 loving warm blanket of a book. It's just codes and things. 0:15:45.080 --> 0:15:50.680 And so in your book you're talking about how it's 0:15:50.680 --> 0:15:54.200 not fully accurate and it's just kind of made up. 0:15:54.280 --> 0:15:56.080 But that can be challenging, I'm sure for people to 0:15:56.080 --> 0:15:57.920 hear you say no, but I have this, and it's like, 0:15:57.920 --> 0:16:00.440 we're not saying you don't have a thing. Can you 0:16:00.480 --> 0:16:02.880 tell us just you know, we'll get into it deeper 0:16:02.920 --> 0:16:06.160 and deeper, but like overview, what is it? What is 0:16:06.200 --> 0:16:08.040 the d s M, what's it supposed to be for? 0:16:08.960 --> 0:16:12.560 And what is it really? You know, the underbellue of it? 0:16:13.360 --> 0:16:16.360 You know you asked this is This was all incredibly 0:16:16.400 --> 0:16:19.400 threatening to me. So it was a relief in some ways. 0:16:19.480 --> 0:16:21.360 But I would if you had taken away some of 0:16:21.400 --> 0:16:24.000 my diagnoses, I would have wrestled due to the ground. 0:16:24.040 --> 0:16:27.160 I mean, I was so identified with them and I 0:16:27.200 --> 0:16:29.840 thought that they helped. I've since read, you know, and 0:16:29.880 --> 0:16:33.360 looked at studies, and they've actually found that people who 0:16:33.440 --> 0:16:37.320 believe there's a biological cause to their diagnoses have more stigma, 0:16:37.520 --> 0:16:41.080 more self stigma, mor shame and are more hopeless about 0:16:41.080 --> 0:16:43.600 their diagnoses. So that's kind of interesting just to keep 0:16:43.600 --> 0:16:46.840 in mind. But not everybody is, and I respect that. 0:16:46.920 --> 0:16:51.040 I mean, there are some communities that are really um 0:16:51.080 --> 0:16:54.400 emboldened by their diagnoses, that really come together. The autism 0:16:54.440 --> 0:16:57.920 community is a great example, and that's a diagnosis that 0:16:58.000 --> 0:17:01.560 to me is like you know, mean, there's complications with 0:17:01.600 --> 0:17:03.640 the Aspergers and all of that, but we won't go 0:17:03.680 --> 0:17:07.720 into that, but the and what I really do want 0:17:07.760 --> 0:17:10.040 to explain to all your listeners and thank you again 0:17:10.080 --> 0:17:12.680 for having me on. This is such a great opportunity 0:17:12.680 --> 0:17:16.640 that all I want is not to take away anyone's diagnosis, 0:17:16.760 --> 0:17:19.680 because that felt right for me, not to identify with one. 0:17:19.720 --> 0:17:22.399 Though I still very much identify with having a mental illness. 0:17:22.440 --> 0:17:25.720 I still take meds, I still see a psychiatrist. I 0:17:25.760 --> 0:17:28.240 will always take meds because I'm pretty sure my body 0:17:28.320 --> 0:17:30.520 is dependent on them. And I have no shame about that. 0:17:30.560 --> 0:17:33.439 There's no I don't need to be psychopharmacologically pure to 0:17:33.520 --> 0:17:37.280 be well. Um, that's just how you know, it's complicated. 0:17:37.320 --> 0:17:40.560 We're kind of in a sticky thing. So for me, 0:17:40.720 --> 0:17:43.719 I think everyone has to make their own decision. Do 0:17:43.760 --> 0:17:45.960 they want to keep their diagnosis. Do they want to 0:17:46.160 --> 0:17:48.280 identify with it completely? Do they want to take it 0:17:48.320 --> 0:17:50.240 with a grain of salt, use it for what it's worth. 0:17:50.359 --> 0:17:56.520 And I'll explain why. So the reason is that, you know, 0:17:56.560 --> 0:18:00.479 we really have this luxury right now because the d 0:18:00.600 --> 0:18:03.520 s M has in some ways. As I said, it's 0:18:03.520 --> 0:18:06.320 a book, that's all it is. When someone said to me, 0:18:06.359 --> 0:18:09.960 you have bipolar disorder, I imagined, you know, microscopes and 0:18:10.040 --> 0:18:13.080 people in lab coats making tests and deciding who has 0:18:13.119 --> 0:18:17.159 bipolar disorder. The problem with d s M diagnoses is 0:18:17.200 --> 0:18:20.520 that there is no biological marker for any of them. 0:18:20.600 --> 0:18:23.960 What that means is there's no test. So we often 0:18:24.000 --> 0:18:27.000 like to say mental illness is the same as physical illness, 0:18:27.119 --> 0:18:29.399 and that comes from a really good place, which is 0:18:29.440 --> 0:18:31.520 we need to respect it the same, we need to 0:18:31.600 --> 0:18:33.680 honor it the same. We need to have mental health 0:18:33.760 --> 0:18:37.480 days if we need them, absolutely, but they aren't the same. 0:18:38.040 --> 0:18:41.879 With the exception of dementia and rare chromosomal disorders that 0:18:41.920 --> 0:18:46.000 are in the d s M, no single diagnosis can 0:18:46.119 --> 0:18:51.600 has an objective reality. They're dependent completely on self reported symptoms, 0:18:52.160 --> 0:18:58.159 totally subjective, and a clinician's opinion totally subjective. And that's 0:18:58.280 --> 0:19:00.840 the that's the issue with the d A SUM. It 0:19:00.920 --> 0:19:05.880 started in nineteen fifty two that doctors came together, Um well, 0:19:05.960 --> 0:19:09.320 I should say members of the American Psychiatric Association came 0:19:09.359 --> 0:19:12.680 together to create a manual that doctors could use to 0:19:12.800 --> 0:19:16.200 better communicate with each other. And what's kind of fascinating. 0:19:16.320 --> 0:19:21.040 You talked about therapy and psychology versus psychiatry. So once medical, 0:19:21.760 --> 0:19:24.800 the d s M became away. In the third edition, 0:19:24.800 --> 0:19:28.080 it's had seven editions where it gets revised and more 0:19:28.119 --> 0:19:32.520 diagnoses are included. Never are they taken out, but more 0:19:32.600 --> 0:19:35.359 and they're were fined and the wording has changed. The 0:19:35.480 --> 0:19:38.320 third edition was really the turning point, and that was 0:19:38.400 --> 0:19:41.480 when a guy named Robert Spitzer, who again was very 0:19:41.520 --> 0:19:44.720 well intended. I'm totally pro psychiatry, by the way, so 0:19:44.720 --> 0:19:48.119 so everybody knows um. And so he was a psychiatrist 0:19:48.240 --> 0:19:53.040 and was just bent on making psychiatry a respected medical field. 0:19:53.560 --> 0:19:56.320 And it wasn't because they didn't have the proof. Again, 0:19:56.480 --> 0:19:58.399 and so he's the one who came up with the 0:19:58.640 --> 0:20:02.159 symptom lists. So when you get depression, you have to 0:20:02.200 --> 0:20:05.600 have five of nine of these symptoms. Now when I 0:20:05.680 --> 0:20:10.720 got the major depressive disorder uh, you know diagnosis, I thought, okay, 0:20:10.720 --> 0:20:13.679 well this is scientific, like this is medical, you know, 0:20:13.760 --> 0:20:18.160 of course, and then in my research as I went through, UM, 0:20:18.240 --> 0:20:21.399 it was it's completely arbitrary. So Robert S. Fitzer has 0:20:21.480 --> 0:20:26.159 quoted it's a it's a fascinating and penetrating and frightening quote. 0:20:26.160 --> 0:20:28.680 But he was asked why you have to have five 0:20:28.720 --> 0:20:33.399 of nine symptoms to receive a major depression diagnosis, and 0:20:33.400 --> 0:20:35.720 he said, well, we were sitting around the table. We 0:20:35.760 --> 0:20:38.200 went around and we said how many do you think 0:20:38.240 --> 0:20:40.560 we should have? And six just seem like too many 0:20:40.640 --> 0:20:46.240 and four too few. They were completely arbitrary. Yeah, and 0:20:46.359 --> 0:20:49.919 we still have the five. Um. Now again, you know, 0:20:50.720 --> 0:20:53.000 the d s M is useful. We use it so 0:20:53.080 --> 0:20:56.280 you mentioned to get you know, so therapists can be reimbursed. 0:20:56.320 --> 0:20:59.800 We use those diagnostic codes and we use we use 0:20:59.840 --> 0:21:03.280 it for legal matters. We use it for when we're 0:21:03.280 --> 0:21:06.320 trying to when people need educational services. You needed to 0:21:06.320 --> 0:21:08.880 file for disability. I don't want to throw it out 0:21:08.880 --> 0:21:11.639 the window. I mean, I don't think it's totally useless. 0:21:12.200 --> 0:21:16.280 What I'm really hoping for is full transparency. I just 0:21:16.359 --> 0:21:18.960 want everyone to know what they're really getting and then 0:21:19.000 --> 0:21:21.600 we can make more informed decisions about our mental health 0:21:21.640 --> 0:21:24.440 and decide because I think there were times, like you said, 0:21:24.480 --> 0:21:28.240 there were times in my life where for me, the 0:21:28.280 --> 0:21:33.000 diagnosis tended to become self fulfilling prophecies. Um. And so 0:21:33.160 --> 0:21:36.640 I see where they were very unhelpful, but they were 0:21:36.680 --> 0:21:40.439 also helpful. Ultimately I did get well, and I couldn't 0:21:40.440 --> 0:21:43.879 have done that without the doctors I saw. Um. But 0:21:44.280 --> 0:21:47.600 just going to another point about the d s M. 0:21:47.760 --> 0:21:50.919 Psychiatrists aren't the only ones who use it. And this 0:21:51.000 --> 0:21:53.960 is what's really different and kind of fascinating too, in 0:21:54.040 --> 0:21:59.919 that of antidepressant prescriptions are coming from primary care physicians. 0:22:01.200 --> 0:22:06.439 Five of my six diagnoses. Yeah, I didn't love reading 0:22:06.440 --> 0:22:10.000 that because I think that's five of my sixth name 0:22:10.080 --> 0:22:16.760 from primary care physicians. And what's what's really needs to 0:22:16.800 --> 0:22:19.199 be noted about that is they came from men in 0:22:19.320 --> 0:22:24.240 white coats in hospitals, so wearing. I mean, I had 0:22:24.280 --> 0:22:26.840 every reason to believe that it was as valid as 0:22:26.840 --> 0:22:30.720 a cancer diagnosis. Um. But again this this sort of 0:22:30.880 --> 0:22:33.160 you know, the and then the other thing about it 0:22:33.200 --> 0:22:37.280 is we use the terminology. So this one theorist has 0:22:37.359 --> 0:22:41.919 called it the psychiatrization of language and of culture. Like 0:22:42.000 --> 0:22:44.800 the d s M is a really powerful work of culture. 0:22:44.880 --> 0:22:48.760 We diagnose each other, teenagers are diagnosing themselves on social media. 0:22:49.400 --> 0:22:54.000 We're really we use it even more perhaps than physicians. 0:22:54.040 --> 0:22:55.920 I mean, it's just such a huge part of our 0:22:55.960 --> 0:22:59.200 world that I just want everyone to know what these 0:22:59.240 --> 0:23:04.000 things really are. Right in describing things, I always get, Okay, 0:23:04.040 --> 0:23:06.120 I really want to be sure that this isn't coming 0:23:06.119 --> 0:23:10.200 off as like, you know, secretly occult like and like scientology, 0:23:10.240 --> 0:23:13.280 like anti Zechia drine like that DSM all bullshit. It's 0:23:13.320 --> 0:23:16.280 like no, no, no, we're just literally telling you they're 0:23:16.359 --> 0:23:20.440 kind of guessing at stuff. And if a diagnosis doesn't 0:23:20.440 --> 0:23:22.800 feel right to you or you don't want to identify 0:23:22.880 --> 0:23:26.280