Speaker 1: This is the Anxiety Bites podcast and I am your host,
Speaker 1: Jen Kirkman. Welcome to another episode of Anxiety Bites. I
Speaker 1: am your host, Jen Kirkman. Today my guest is Sarah Fay.
Speaker 1: She has a new memoir art called Pathological The True
Speaker 1: Story of Six Misdiagnoses. So today's I was a kind
Speaker 1: of a thinker. Or maybe it's not. Maybe it was
Speaker 1: just something for me to wrout my brain around. At
Speaker 1: first I read Sarah's book. I loved it. And you know,
Speaker 1: at first, if you just said to me on paper,
Speaker 1: you know, hey, there's a book out on this person
Speaker 1: says that the d s M, which is how all
Speaker 1: um mental health diagnosis is, they come from the d
Speaker 1: s M, and it stands for the Diagnostic and Statistical
Speaker 1: Manual of Mental Disorders. And I've known of the d
Speaker 1: s M my my whole adult life, that have been
Speaker 1: in therapy. It's what therapist used to diagnose you. So
Speaker 1: you may say I have this symptom of that, they
Speaker 1: may look it up in their little book the d
Speaker 1: s M and say, oh, well that's a clinical depression
Speaker 1: or that's a generalized anxiety disorder. A lot of times
Speaker 1: a talk therapist will use it because there are codes
Speaker 1: in the book. So they'll say, okay, so you're coming
Speaker 1: into talk about your family, now would you say that
Speaker 1: that's causing you more depression anxiety? You know, And then
Speaker 1: they'll put the code for your diagnosis on some kind
Speaker 1: of super bill and it gets sent to insurance, and
Speaker 1: if your insurance covers you to see a therapist for
Speaker 1: anxiety and depression, then there you go. You're going to
Speaker 1: be covered. So it originally came about as a way
Speaker 1: for doctors to communicate with each other, and then it
Speaker 1: sort of became the the manual for how to diagnose people.
Speaker 1: And I've heard comments here and there from professionals that
Speaker 1: like the d s M. You know, it's just it's
Speaker 1: not the dictionary, if that makes sense. It's not totally accurate,
Speaker 1: it's not set in stone. It's it's it's guesswork, and
Speaker 1: there are a lot of diagnoses that could fit you.
Speaker 1: You can have a bunch of symptoms from different things.
Speaker 1: It doesn't mean you have that disorder per se. And
Speaker 1: then it doesn't mean if you are diagnosed with one,
Speaker 1: that that your doctor is right necessarily, and it doesn't
Speaker 1: mean that you're going to have it your whole life.
Speaker 1: So in a way, getting a diagnosis can be helpful
Speaker 1: because you don't just feel like I'm just I guess crazy,
Speaker 1: you know, and no help for me. I mean having
Speaker 1: a name for something. I think it's so helpful. You go, well,
Speaker 1: there's a name for this, then other people must have
Speaker 1: experienced it, and there's experts out there who can help me.
Speaker 1: But then as you get a little more practiced or
Speaker 1: grown up, or further along in your recovery from whatever
Speaker 1: mental disorder you're going through, you might start to think
Speaker 1: this seems like a very narrow definition. I don't do
Speaker 1: I really have this? Or is it more this? Or
Speaker 1: is it you know that kind of thing. And so
Speaker 1: that's why I sometimes get nervous thinking about doing episodes
Speaker 1: like this. When I when I decided to do this episode,
Speaker 1: I thought, I hope I do this right, because I
Speaker 1: don't want to sound like good conspiracy theorists or make
Speaker 1: Sarah sound like one, because nobody is saying, oh, mental
Speaker 1: health issues, they're not real. That's literally not what anyone
Speaker 1: is saying. But I know, if you're doing the dishes
Speaker 1: or driving and sort of half listening to this, who
Speaker 1: knows what you might hear. But I just want to
Speaker 1: make sure on my end that I've been very clear
Speaker 1: that what we're talking about in this episode, there is
Speaker 1: this manual called the d s M. And while mental
Speaker 1: health illnesses are real, the way that many things in
Speaker 1: the book are diagnosed maybe sometimes inaccurate. You may get
Speaker 1: an inaccurate diagnosis. It doesn't mean that like all doctors
Speaker 1: are bullshit. That's not what I'm saying. And Sarah and
Speaker 1: I very much believe in mental illness. We've both had it.
Speaker 1: We very much believe in psychiatry. We both go to psychiatrists.
Speaker 1: But we're just saying this book has its flaws, and
Speaker 1: she just wants to bring that out into the open.
Speaker 1: I mean, there are bigger issues at play. I means
Speaker 1: sometimes people use the d s M two market their antidepressants,
Speaker 1: you know, and sometimes the d s M maybe used
Speaker 1: by well meaning people who may accidentally over diagnose someone.
Speaker 1: So it's just kind of shining a light on this
Speaker 1: thing that that if you're in therapy, you may have
Speaker 1: heard referenced, oh, the d s M. And if you're
Speaker 1: anything like me, sometimes you hear something and you might
Speaker 1: not know a lot about something, and so you figure
Speaker 1: out they know what they're talking about. The d s
Speaker 1: M sounds pretty uh, you know, the Diagnostic and Statistical
Speaker 1: Manual of Mental Disorder sounds pretty on the up and
Speaker 1: up to me. And we're not saying it's a you know,
Speaker 1: some dark, shadowy group. It's like, it's just not accurate.
Speaker 1: And so I talked to Sarah today about her new book, which,
Speaker 1: by the way, again is called Pathological. It is out
Speaker 1: right now. You can get it wherever you get books.
Speaker 1: It's been called a powerful memoir, a deeply compelling person
Speaker 1: and a fantastic writer. Pathological will make you passionate about
Speaker 1: improving the way we handle mental health. And again you
Speaker 1: can get it wherever you get books. A little bit
Speaker 1: about Sarah Fay, the author. She is an author and
Speaker 1: an activist. Her writing appears in many publications, including The
Speaker 1: New York Times, The Atlantic Time Magazine, The New Republic, McSweeney's,
Speaker 1: The Believer, and The Paris Review, where she has served
Speaker 1: as an advisory editor. She's currently on the faculty at
Speaker 1: Northwestern University in DePaul University. She's the founder of Pathological,
Speaker 1: the movement of public awareness campaign devoted to making people
Speaker 1: aware that mental health diagnoses are invalid and largely unreliable,
Speaker 1: and a full recovery from mental illness is possible. So
Speaker 1: I will link to Sarah's website and her book in
Speaker 1: the show notes, and I hope you enjoy our very
Speaker 1: nuanced and rather how do you conversation about this thing
Speaker 1: called the d s M? Before I ask you the
Speaker 1: six diagnoses you've had in your lifetime, let's define pathological
Speaker 1: or let you define it. I'll listen. So we were
Speaker 1: worried about that, my editor and I actually just because
Speaker 1: it's not that common of a word. It's used in
Speaker 1: psychiatry circles a lot, but knots and medical circles. But
Speaker 1: it's essentially medicalizing a condition, any condition. It doesn't have
Speaker 1: to be psychiatric, it could be anything. So when we
Speaker 1: pathologize the human condition is what psychiatry is often accused of.
Speaker 1: We're talking about calling the emotion anxiety the disorder anxiety,
Speaker 1: and it's confusing because they're the same name. And with depression,
Speaker 1: so we're calling the disordered depression the same as the
Speaker 1: emotion of depression. And so, what are the six diagnosis
Speaker 1: diagnoses that you've had in your life? As you write
Speaker 1: in your book pathological, that you said you have received
Speaker 1: since you were twelve years old or beginning at the
Speaker 1: age of twelve. Yeah, So I was first diagnosed with anorexia,
Speaker 1: and then it progressed. I had a little break um
Speaker 1: in terms of diagnosis, so I was basically was out
Speaker 1: of danger in terms of anorexia, no longer going to
Speaker 1: the hospital by the time I was about sixteen. But
Speaker 1: then I had kind of that lag in college that
Speaker 1: a lot of women have, which is you're you're eating horribly,
Speaker 1: but enough that you're gaining weight anyway, So you know,
Speaker 1: so I had that and then UM, and then in
Speaker 1: my twenties, I was in a relationship that was just
Speaker 1: really positive and I did really well there for a while.
Speaker 1: And I talked about this in my book. He's now
Speaker 1: a chef and was a fantastic cook, and he really
Speaker 1: taught me to love food. UM. A lot of people
Speaker 1: who read my books say the second chapter is a relief,
Speaker 1: because the first chapter is so you know, dramatic with
Speaker 1: my anorexia, and then the second chapter is all about
Speaker 1: this boyfriend, Chris, and how great our life was together.
Speaker 1: It didn't last, and so I then went into sort
Speaker 1: of a lot of anxiety, a lot of UM, definitely
Speaker 1: dipping into hypochondria, relying on alcohol to self medicate, and
Speaker 1: I talked about that in the book. But finally when
Speaker 1: I moved to New York, it really started to uh
Speaker 1: reach more of an acute phase. And so I was
Speaker 1: diagnosed at generalized anxiety disorder by my primary care physician
Speaker 1: in New York and given valium, which I quickly became
Speaker 1: I wouldn't say addicted, but I was definitely relying on
Speaker 1: it um. And then when I was in New York
Speaker 1: as well, my cat passed away. My cat died. Cat
Speaker 1: people out there will be able to relate to this,
Speaker 1: but I was devastated. She had been mine for sixteen years.
Speaker 1: And so I really went into a very deep depression.
Speaker 1: And I had been battling with depression anyway, but turned
Speaker 1: to exercise UM to try to relieve it. And I
Speaker 1: was running so much in New York and running over
Speaker 1: what we called the five Bridges, so we would do
Speaker 1: all the bridges in you know, in Manhattan and Brooklyn
Speaker 1: and Queens and so anyway, So I was running to
Speaker 1: such a degree and I went to a therapist. A
Speaker 1: friend insisted that I go, and I received the diagnosis
Speaker 1: of major depressive disorder after the thirty minute consult, and
Speaker 1: she said I should be on antidepressants right away. I resisted.
Speaker 1: I was the kind of person who wouldn't take aspirin.
Speaker 1: I mean, I was just like, no, no, no, no, no,
Speaker 1: I'm natural, and so I YO good and I meditated
Speaker 1: my Chinese herb and I just kept getting worse and
Speaker 1: I kept getting worse, and so eventually I went to
Speaker 1: get my PhD in Iowa, and I ended up going
Speaker 1: to my primary care physician there. He diagnosed me first
Speaker 1: with a d h D, then obsessive compulsive disorder, and
Speaker 1: then obsessive compulsive disorder and a d h D with
Speaker 1: anxiety and depressive elements, which sounds like a nice cocktail
Speaker 1: or something. I don't even know what that is. And
Speaker 1: it got it got quite bad at that point, and
Speaker 1: then I started to become suicidal and was really just
Speaker 1: went into crisis phase for about I guess it would
Speaker 1: be nine years. And then I was diagnosed with bipolar disorder.
Speaker 1: And so that's where my final diagnosis ended up. And
Speaker 1: I mean, it's a much longer story obviously it's a book.
Speaker 1: But so finally I was extremely suicidal. I had been
Speaker 1: put on and taken off so many medications. Um antipsychotics
Speaker 1: had terrible AVer's reactions, including a caathesia, which is this
Speaker 1: terrible side effect where you feel like you're calling out
Speaker 1: of your skin. You can't stop moving. It's it was awful.
Speaker 1: And so I had a falling out with my psychiatrist
Speaker 1: at the time, and I went to a new psychiatrist
Speaker 1: that my sister found. My sister and my mother and
Speaker 1: my whole family. They're the heroes of this book, no question.
Speaker 1: I was so lucky to have them. And I went
Speaker 1: to this new psychiatrist and he we had our quick,
Speaker 1: you know, back and forth twenty seven minutes, and I
Speaker 1: waited for him to proclaim whatever he thought my diagnosis was,
Speaker 1: or give me a new diagnosis. And he looked at
Speaker 1: me and he said, I don't know what you have.
Speaker 1: And my whole world changed. And I was walking down
Speaker 1: Chicago Avenue in Chicago, and it was winter, it was
Speaker 1: really cold, and I just thought, no one knows what
Speaker 1: I have, none of you do. And so then I
Speaker 1: took it on myself and I just said, I'm going
Speaker 1: to find out everything about mental health diagnoses, their history.
Speaker 1: Who thought of these where did they come from? What
Speaker 1: lab were they discovered in? And so I just wanted
Speaker 1: to know everything. So I ended up going into this
Speaker 1: deep research phase and that's what my book is. It's
Speaker 1: my story, but I also bring in all the information
Speaker 1: that I want other people to know to save them
Speaker 1: from going through what I went through. So I have
Speaker 1: two quick follow up questions. One is was it because
Speaker 1: you had been diagnosed so many times? Was it weirdly
Speaker 1: freeing to have someone say I don't know what's wrong
Speaker 1: with you? And secondly, normally I would do this like
Speaker 1: kind of at the end of the episode, but tell
Speaker 1: us now how you would diagnose yourself, Like what do
Speaker 1: you have now and how do you handle it now?
Speaker 1: I'm glad we're talking about it now because I always
Speaker 1: want to preface that even though and we'll talk more
Speaker 1: about this, but the diagnoses we receive, all the mental
Speaker 1: health diagnoses, and when we talk about the d s M,
Speaker 1: that's just the manual they come from. It's just a
Speaker 1: book and that's where everything we're given, you know, originates
Speaker 1: we talk about those are invented categories. And I didn't
Speaker 1: say that actually, but Thomas Insel, who the former head
Speaker 1: of the end I'm and i m H, which is
Speaker 1: the National Institute of Mental Health. He said that, so
Speaker 1: a lot of sort of our most prominent psychiatrists and
Speaker 1: researchers have been warning us about the invalidity of these diagnoses.
Speaker 1: So even though I say that and I agree with them,
Speaker 1: not that they need me to agree with them, but
Speaker 1: that mental illness is very, very real. I had one,
Speaker 1: There's no question. I used to say I have or
Speaker 1: had one. UM. But they are no D S M diagnosis,
Speaker 1: No mental health diagnosis has been proven to be chronic.
Speaker 1: Mental illness is not chronic. UM. And that same Thomas
Speaker 1: in Soul, who is someone I really really admire. Um,
Speaker 1: he just came out with a book that basically says, UM,
Speaker 1: it's kind of an apology for focusing so much on
Speaker 1: the biomedical model or this idea that our mental health
Speaker 1: diagnoses are biological and therefore chronic. UM. When he was
Speaker 1: during his time at the n I m H and
Speaker 1: instead of really providing for people and providing care for
Speaker 1: those especially most in need with serious mental illness. UM.
Speaker 1: But he's now come out and said, no, mental illness
Speaker 1: is chronic. We can fully recover. And so I see
Speaker 1: myself as an example of someone who had a serious
Speaker 1: mental illness. UM. I had to three technically UM, and
Speaker 1: I have fully recovered. And I want other people to
Speaker 1: know that they and their children and their teenagers can
Speaker 1: fully recover too. So that's where I am. Now we'll
Speaker 1: be right back. The d s M is the Diagnostic
Speaker 1: and Statistical Manual of Mental disorders, and it does exist
Speaker 1: and it is a thing. But your book is about
Speaker 1: how we need to take another look at that because
Speaker 1: it's used to diagnose patients. And you know, there's psychiatry
Speaker 1: and their psychology, right, so I see a talk there
Speaker 1: fist they do not prescribe medication. I do have a
Speaker 1: psychiatrist who prescribes medication. So mostly it is the psychiatrist
Speaker 1: who prescribe medication that use the d s M. My
Speaker 1: talk therapist uses it to get a reimbursement on my
Speaker 1: health insurance. You know, if if she doesn't indicate what
Speaker 1: we're talking about, it's not considered something that my health
Speaker 1: insurance would reimburse me for. So it's really about a
Speaker 1: bunch of coding, right, so that payments can be handled.
Speaker 1: I mean, it's almost this kind of it's like the
Speaker 1: least healthcare it's like the least mental health care thing, right,
Speaker 1: It's not um ooei gooey and some kind of like
Speaker 1: loving warm blanket of a book. It's just codes and things.
Speaker 1: And so in your book you're talking about how it's
Speaker 1: not fully accurate and it's just kind of made up.
Speaker 1: But that can be challenging, I'm sure for people to
Speaker 1: hear you say no, but I have this, and it's like,
Speaker 1: we're not saying you don't have a thing. Can you
Speaker 1: tell us just you know, we'll get into it deeper
Speaker 1: and deeper, but like overview, what is it? What is
Speaker 1: the d s M, what's it supposed to be for?
Speaker 1: And what is it really? You know, the underbellue of it?
Speaker 1: You know you asked this is This was all incredibly
Speaker 1: threatening to me. So it was a relief in some ways.
Speaker 1: But I would if you had taken away some of
Speaker 1: my diagnoses, I would have wrestled due to the ground.
Speaker 1: I mean, I was so identified with them and I
Speaker 1: thought that they helped. I've since read, you know, and
Speaker 1: looked at studies, and they've actually found that people who
Speaker 1: believe there's a biological cause to their diagnoses have more stigma,
Speaker 1: more self stigma, mor shame and are more hopeless about
Speaker 1: their diagnoses. So that's kind of interesting just to keep
Speaker 1: in mind. But not everybody is, and I respect that.
Speaker 1: I mean, there are some communities that are really um
Speaker 1: emboldened by their diagnoses, that really come together. The autism
Speaker 1: community is a great example, and that's a diagnosis that
Speaker 1: to me is like you know, mean, there's complications with
Speaker 1: the Aspergers and all of that, but we won't go
Speaker 1: into that, but the and what I really do want
Speaker 1: to explain to all your listeners and thank you again
Speaker 1: for having me on. This is such a great opportunity
Speaker 1: that all I want is not to take away anyone's diagnosis,
Speaker 1: because that felt right for me, not to identify with one.
Speaker 1: Though I still very much identify with having a mental illness.
Speaker 1: I still take meds, I still see a psychiatrist. I
Speaker 1: will always take meds because I'm pretty sure my body
Speaker 1: is dependent on them. And I have no shame about that.
Speaker 1: There's no I don't need to be psychopharmacologically pure to
Speaker 1: be well. Um, that's just how you know, it's complicated.
Speaker 1: We're kind of in a sticky thing. So for me,
Speaker 1: I think everyone has to make their own decision. Do
Speaker 1: they want to keep their diagnosis. Do they want to
Speaker 1: identify with it completely? Do they want to take it
Speaker 1: with a grain of salt, use it for what it's worth.
Speaker 1: And I'll explain why. So the reason is that, you know,
Speaker 1: we really have this luxury right now because the d
Speaker 1: s M has in some ways. As I said, it's
Speaker 1: a book, that's all it is. When someone said to me,
Speaker 1: you have bipolar disorder, I imagined, you know, microscopes and
Speaker 1: people in lab coats making tests and deciding who has
Speaker 1: bipolar disorder. The problem with d s M diagnoses is
Speaker 1: that there is no biological marker for any of them.
Speaker 1: What that means is there's no test. So we often
Speaker 1: like to say mental illness is the same as physical illness,
Speaker 1: and that comes from a really good place, which is
Speaker 1: we need to respect it the same, we need to
Speaker 1: honor it the same. We need to have mental health
Speaker 1: days if we need them, absolutely, but they aren't the same.
Speaker 1: With the exception of dementia and rare chromosomal disorders that
Speaker 1: are in the d s M, no single diagnosis can
Speaker 1: has an objective reality. They're dependent completely on self reported symptoms,
Speaker 1: totally subjective, and a clinician's opinion totally subjective. And that's
Speaker 1: the that's the issue with the d A SUM. It
Speaker 1: started in nineteen fifty two that doctors came together, Um well,
Speaker 1: I should say members of the American Psychiatric Association came
Speaker 1: together to create a manual that doctors could use to
Speaker 1: better communicate with each other. And what's kind of fascinating.
Speaker 1: You talked about therapy and psychology versus psychiatry. So once medical,
Speaker 1: the d s M became away. In the third edition,
Speaker 1: it's had seven editions where it gets revised and more
Speaker 1: diagnoses are included. Never are they taken out, but more
Speaker 1: and they're were fined and the wording has changed. The
Speaker 1: third edition was really the turning point, and that was
Speaker 1: when a guy named Robert Spitzer, who again was very
Speaker 1: well intended. I'm totally pro psychiatry, by the way, so
Speaker 1: so everybody knows um. And so he was a psychiatrist
Speaker 1: and was just bent on making psychiatry a respected medical field.
Speaker 1: And it wasn't because they didn't have the proof. Again,
Speaker 1: and so he's the one who came up with the
Speaker 1: symptom lists. So when you get depression, you have to
Speaker 1: have five of nine of these symptoms. Now when I
Speaker 1: got the major depressive disorder uh, you know diagnosis, I thought, okay,
Speaker 1: well this is scientific, like this is medical, you know,
Speaker 1: of course, and then in my research as I went through, UM,
Speaker 1: it was it's completely arbitrary. So Robert S. Fitzer has
Speaker 1: quoted it's a it's a fascinating and penetrating and frightening quote.
Speaker 1: But he was asked why you have to have five
Speaker 1: of nine symptoms to receive a major depression diagnosis, and
Speaker 1: he said, well, we were sitting around the table. We
Speaker 1: went around and we said how many do you think
Speaker 1: we should have? And six just seem like too many
Speaker 1: and four too few. They were completely arbitrary. Yeah, and
Speaker 1: we still have the five. Um. Now again, you know,
Speaker 1: the d s M is useful. We use it so
Speaker 1: you mentioned to get you know, so therapists can be reimbursed.
Speaker 1: We use those diagnostic codes and we use we use
Speaker 1: it for legal matters. We use it for when we're
Speaker 1: trying to when people need educational services. You needed to
Speaker 1: file for disability. I don't want to throw it out
Speaker 1: the window. I mean, I don't think it's totally useless.
Speaker 1: What I'm really hoping for is full transparency. I just
Speaker 1: want everyone to know what they're really getting and then
Speaker 1: we can make more informed decisions about our mental health
Speaker 1: and decide because I think there were times, like you said,
Speaker 1: there were times in my life where for me, the
Speaker 1: diagnosis tended to become self fulfilling prophecies. Um. And so
Speaker 1: I see where they were very unhelpful, but they were
Speaker 1: also helpful. Ultimately I did get well, and I couldn't
Speaker 1: have done that without the doctors I saw. Um. But
Speaker 1: just going to another point about the d s M.
Speaker 1: Psychiatrists aren't the only ones who use it. And this
Speaker 1: is what's really different and kind of fascinating too, in
Speaker 1: that of antidepressant prescriptions are coming from primary care physicians.
Speaker 1: Five of my six diagnoses. Yeah, I didn't love reading
Speaker 1: that because I think that's five of my sixth name
Speaker 1: from primary care physicians. And what's what's really needs to
Speaker 1: be noted about that is they came from men in
Speaker 1: white coats in hospitals, so wearing. I mean, I had
Speaker 1: every reason to believe that it was as valid as
Speaker 1: a cancer diagnosis. Um. But again this this sort of
Speaker 1: you know, the and then the other thing about it
Speaker 1: is we use the terminology. So this one theorist has
Speaker 1: called it the psychiatrization of language and of culture. Like
Speaker 1: the d s M is a really powerful work of culture.
Speaker 1: We diagnose each other, teenagers are diagnosing themselves on social media.
Speaker 1: We're really we use it even more perhaps than physicians.
Speaker 1: I mean, it's just such a huge part of our
Speaker 1: world that I just want everyone to know what these
Speaker 1: things really are. Right in describing things, I always get, Okay,
Speaker 1: I really want to be sure that this isn't coming
Speaker 1: off as like, you know, secretly occult like and like scientology,
Speaker 1: like anti Zechia drine like that DSM all bullshit. It's
Speaker 1: like no, no, no, we're just literally telling you they're
Speaker 1: kind of guessing at stuff. And if a diagnosis doesn't
Speaker 1: feel right to you or you don't want to identify
Speaker 1: by it, just no the truth behind it, which is
Speaker 1: it's not chronic. And I all this to say that
Speaker 1: when I first I went to therapy for depression, and
Speaker 1: I believe at that time all the undiagnosed, all the
Speaker 1: all the moods and behaviors I had from childhood to
Speaker 1: teenagehood with undiagnosed panic disorder and anxiety put me into
Speaker 1: a depression because I was so confused and so lonely
Speaker 1: about it, and then I just, you know, had feelings
Speaker 1: like a person. And I do believe there was depression.
Speaker 1: I do believe my chemicals in my brain were altered
Speaker 1: because of the way I was behaving and thinking for
Speaker 1: years and in order to start exploring that. It was
Speaker 1: so overwhelming that I'm glad I had talked therapy and
Speaker 1: my first Prozact prescription. But I'm saying all that to
Speaker 1: say when I first went to get diagnosed and I
Speaker 1: went to a psychiatrist who prescribes my talk therapist, I said,
Speaker 1: you probably have a chemical imbalance. And I remember thinking,
Speaker 1: oh my god, Like that's a big That is like
Speaker 1: someone saying you cancer, right, or not even cancer, because
Speaker 1: cancer can go away with chemo, Like, but someone saying
Speaker 1: you have an enlarged heart, or you know, you're one
Speaker 1: of your kidneys is failing, you need it removed, You're
Speaker 1: gonna have one kidney. I mean, it was like a
Speaker 1: chemical imbalance that that sounds very final. And so then
Speaker 1: when I went to the psychiatrist, I honestly thought, I
Speaker 1: think I went on a lunch hour at my day
Speaker 1: job when I was just twenty one, and I I
Speaker 1: remember saying to my boss, I don't know if I'll
Speaker 1: be back today because I have this appointment. How long
Speaker 1: it's going to be. I thought I had to go
Speaker 1: through all this testing. I thought I'd be hooked up
Speaker 1: to monitors my brain and taking my blood and were
Speaker 1: they going to have to shave part of my head
Speaker 1: to get in there? I mean, why would I not
Speaker 1: think that, you know? And when it's fifteen minutes later,
Speaker 1: I'm out of the office with a prescription and I
Speaker 1: was told I had a chemical imbalance? How how did
Speaker 1: they know? And then and I went, Okay, I guess
Speaker 1: I must be so obviously depressed that they can see
Speaker 1: through my eyes that I I mean, I I didn't
Speaker 1: go that's weird. Why did how did they know? It's one?
Speaker 1: And the calcal imbalance theory, which is now the chemical
Speaker 1: imbalanced myth, has been disproven. It's been debunked, and so
Speaker 1: there are some things to keep in mind. And I
Speaker 1: know this gets so confusing, which is why this is
Speaker 1: great to talk about. And I none of this, by
Speaker 1: the way, none of it. I mean one reason I
Speaker 1: went along with so much for thirty years was that
Speaker 1: I believed in the chemical imbalance theory. The media reported it,
Speaker 1: celebrities talked about it. My therapist told me that was true.
Speaker 1: My doctor has mentioned it. I mean, why wouldn't we
Speaker 1: believe it. They used to say, you know that it
Speaker 1: was you know, you have two low levels of something, right,
Speaker 1: so dopamine serotonin, as you said. And they found no
Speaker 1: consistency among people with depression or schizophrenia with any of
Speaker 1: the neurotransmitters or any of that. So the chemical imbalance
Speaker 1: theory has been debunked. Now does that mean that it
Speaker 1: isn't something going on in your brain? Probably not. We
Speaker 1: don't know. And so what has happened Thomas insul I
Speaker 1: just interviewed him, So that's why I keep referring to him.
Speaker 1: I had that honor. So I'm like star struck. Some people,
Speaker 1: it's the card actions. For me, it's like the former.
Speaker 1: But he his new book is really great, and he's
Speaker 1: he's thinking of it as a researcher and researchers are
Speaker 1: an out trying to think of it more as a
Speaker 1: circuit board, like a computer circuit board. That's the metaphor
Speaker 1: they're using now. And so but none of that has
Speaker 1: been proven either, And so what I think that does
Speaker 1: for us. Where that leaves us is we don't know.
Speaker 1: And when my psychiatrist said to me, I don't know,
Speaker 1: it was just then it was my choice. I wasn't
Speaker 1: forced to believe something that wasn't true. What bothered me
Speaker 1: was the I don't want to call it lying, because
Speaker 1: I don't know if those people didn't know the truth,
Speaker 1: they didn't do their research, they weren't up to date,
Speaker 1: or if they were actually wanted to believe it. I
Speaker 1: don't know, but certainly there are a lot of people
Speaker 1: still talking about the chemical imbalanced myth and using that
Speaker 1: to really get people to take their mental health seriously.
Speaker 1: And what I love about your show that you do
Speaker 1: is you just investigate. You just ask questions and try
Speaker 1: to get at anxiety as a disorder versus anxiety as
Speaker 1: an emotion. And I didn't. I couldn't have told you.
Speaker 1: I couldn't have identified any of my emotions for the
Speaker 1: thirty years. I don't know. I mean I could have
Speaker 1: hit happy, and I probably could have hit sad, But
Speaker 1: other than that, I mean, I did not. And I
Speaker 1: went into I was in a partial hospitalization program and
Speaker 1: we were in a group therapy session and we got
Speaker 1: an a motion wheel with all the colors. You know,
Speaker 1: it's got a hundred emotions around it. I was stunned.
Speaker 1: I was like, there are all of these. I mean,
Speaker 1: how could you possibly know any of these? So, going
Speaker 1: back to what you were saying, I think it's really important.
Speaker 1: I would have been very well served. And I did
Speaker 1: do cognitive behavior behavioral therapy and dialectical behavioral therapy. As
Speaker 1: I said, I meditated, but it would have been very
Speaker 1: helpful for me to learn about emotions, like what are they,
Speaker 1: what do they feel like? How do I process that? Well? Kay,
Speaker 1: tinue the interview on the flip side of a quick
Speaker 1: message from our sponsors. Where my anxiety began was really
Speaker 1: a phobia flying, and then it became a phobia of heights,
Speaker 1: and then kind of fear or fear of panicking and
Speaker 1: all that. But I didn't have the luxury of having
Speaker 1: too many emotions when I was going through all of that,
Speaker 1: so I didn't really learn how to emotionally regulate. So
Speaker 1: as I got older and the phobias went away, I
Speaker 1: wasn't very regulated emotionally, and sometimes getting a diagnosis of
Speaker 1: a d H D. Oh, well, I'm not hyperactive and
Speaker 1: I can I can pay attention. Oh well, no, it's
Speaker 1: different new women. It's more about emotional regulation. And then
Speaker 1: it leads me to read about that, and then I think, yeah,
Speaker 1: I just I do identify with this. Okay, great, what
Speaker 1: can I do but it? And then I do something
Speaker 1: about it. With each thing I've conquered, I get to
Speaker 1: say I don't really have that thing anymore or you know.
Speaker 1: And then because it's just the kind of person I am,
Speaker 1: I'm just kind of always seeking joy and so nothing
Speaker 1: gets in my way of that. And if I want
Speaker 1: to take a day in lamb bad all day because
Speaker 1: I just I don't know what's going on, but I can't.
Speaker 1: I just can't whatever insert whatever I'm like, I can't
Speaker 1: today I will do that. But I have, especially since
Speaker 1: starting this podcast, been less I define things so that
Speaker 1: people quickly understand what I'm saying. I've tendency towards a
Speaker 1: d h D. You know, I didn't see towards anxiety
Speaker 1: or panic. But in general, it's all just becoming one
Speaker 1: big soup now, which is sometimes I'm having certain emotions,
Speaker 1: and sometimes I have reactions about how I feel about
Speaker 1: those emotions. They may not be reactions anyone can see,
Speaker 1: but they may just really affect me that day. So
Speaker 1: I'm looking back and going, I don't even think I
Speaker 1: ever had depression. I just really don't, you know. Um,
Speaker 1: I think I was just underwater for a while trying
Speaker 1: to figure things out, and it was very overwhelmed. And uh,
Speaker 1: but it's just been it's been fun to take a
Speaker 1: ride and and just sort of be I have the
Speaker 1: luxury of being able to look at things differently, and
Speaker 1: you know, and so that's what I liked about your
Speaker 1: book is that it's really just about you finding yourself
Speaker 1: amidst all these diagnosis that you received. And my favorite
Speaker 1: part of your book and I'm going to have to
Speaker 1: now read this person's books. I've never heard of him,
Speaker 1: but um, I'm just reading from a quote that I
Speaker 1: wrote down Randolph. Ness is good reasons for bad feelings.
Speaker 1: Insights from the frontier of evolutionary psychiatry. Um that anxiety
Speaker 1: was necessary, you know, dating back to our primitive selves.
Speaker 1: But we don't live in a state of threat all
Speaker 1: the time, and so those thoughts are natural, but they're
Speaker 1: no longer useful. But they're not a sign of a
Speaker 1: disorder or a disease. And you know, I think what
Speaker 1: we need to get to. So if we look at
Speaker 1: the d s M and how like you mentioned a
Speaker 1: d D. Well, first of all, I just wanted to say,
Speaker 1: listening to you and my own experience being given so
Speaker 1: many different diagnoses, there's something wrong with the diagnostic tool
Speaker 1: that we're using. It shouldn't be that easy to slap.
Speaker 1: I don't go to the diet you know. I don't
Speaker 1: go to my yearly, my annual exam physical and get
Speaker 1: like cancer and then be told, now you got tuberculosis,
Speaker 1: you know. I mean, it just doesn't right. You know,
Speaker 1: there's something wrong with the diagnostic tool that we're using.
Speaker 1: And part of it is that is again why it's
Speaker 1: not valid. The d s M DSM diagnoses. They overlap,
Speaker 1: so the diagnoses are not what's called discrete disease entities
Speaker 1: fancy word for just saying that they don't exist by themselves.
Speaker 1: So you can see a d h D in this person,
Speaker 1: and you can see, you know, anxiety in the same person.
Speaker 1: In one study of um or half of the people
Speaker 1: who had been diagnosed with schizophrenia were reassessed and given
Speaker 1: diagnoses of anxiety and mood disorders. Those are incredibly different diagnoses.
Speaker 1: They should not be that easy to reassess and just
Speaker 1: be doing that and and so the problem is that
Speaker 1: these are really invented symptom lists and they're doing the
Speaker 1: best that they can. And I am getting to the
Speaker 1: evolutionary psychiatry. But the other problem is with that we
Speaker 1: have an imperfect tool. So you have clinicians and mental
Speaker 1: health professionals trying to diagnose. But the reliability of these
Speaker 1: diagnoses is also very very low. So like generalized anxiety
Speaker 1: disorder has a reliability score of point two on his
Speaker 1: scale of zero to one. Like that's really bad, So
Speaker 1: like you've got a chance of actually having him. But
Speaker 1: all this is to say that doesn't mean anxiety isn't real. Again,
Speaker 1: it's just that the labels that they're using don't hold
Speaker 1: up um. And so there's the validity factor and then
Speaker 1: the reliability factor. And so where that left me was, Okay,
Speaker 1: how am I going to think about my emotional life?
Speaker 1: How I going to think about my mental and emotional life?
Speaker 1: And then I read in this book and my father
Speaker 1: and I read it together, and um, my dad is
Speaker 1: eighty and he's just very funny. Now he's like being
Speaker 1: in a book club with him is takes like two sentences.
Speaker 1: You know that. That's a long we talked about the book,
Speaker 1: but it stayed with me for a long time. And
Speaker 1: what I loved about what he was saying is my
Speaker 1: brain wasn't some dark, mysterious land of freud where everything
Speaker 1: was beyond my ability to understand it and I had
Speaker 1: to go to a therapist to understand myself and they
Speaker 1: knew me better than I knew myself. And but it
Speaker 1: also wasn't some horrible like chemical craziness where things were
Speaker 1: going off and misfiring and I couldn't control it. It
Speaker 1: was just that I have this really powerful primitive part
Speaker 1: of my brain. I have crippling anxiety still and I
Speaker 1: feel it. And I think, first of all, I think
Speaker 1: those of us with anxiety really badly. We are the
Speaker 1: people you wanted on your team in the on the belt,
Speaker 1: like we were the people who were seeing lions everywhere.
Speaker 1: We're just like lions. We're looking ahead. We're like, even
Speaker 1: if it's not there, what if it were, Let's let's
Speaker 1: role play what to do. Exactly like I am, I
Speaker 1: am fully the person you wanted in your primitive clan.
Speaker 1: I just was, and so I kind of take solace
Speaker 1: in that. And I just realized, Okay, we're answering email.
Speaker 1: It's okay, we're not on the belt. There isn't a lion.
Speaker 1: And I also love his his description I didn't understand.
Speaker 1: Anxiety made a lot of sense and the evolutionary model,
Speaker 1: but depression was like, well, what's the advantage of that,
Speaker 1: because remember, evolution is designed to keep you alive, not
Speaker 1: to make you happy. It's not what's best ran. It's
Speaker 1: just to keep us going. So that's why we're not
Speaker 1: happy the time. We're not designed to find happiness. We're
Speaker 1: designed to survive. The human condition is not happiness. It's yeah,
Speaker 1: it's just it's just being here. Yeah, that's it, and
Speaker 1: it serves so. Yeah, and depression, he says that there's
Speaker 1: some belief that that depression is actually just the body's
Speaker 1: way of resetting from being high high, high on you know,
Speaker 1: ratcheted up on anxiety. And that made a lot of
Speaker 1: sense to me, having been diagnosed with manic depression or
Speaker 1: what's called bipolar um that you know, I had very
Speaker 1: you know, I had high highs and low lows, and
Speaker 1: that when someone said, oh, that could have been a cycle,
Speaker 1: that was just natural or part of the way we function.
Speaker 1: That is interesting to me because I didn't want to
Speaker 1: see everything as being the result of my diagnosis anymore.
Speaker 1: I really think at one point my body was like, please,
Speaker 1: we I don't know how to stop you from panicking,
Speaker 1: m because you're not doing anything about it. So I
Speaker 1: think I'm just gonna depress you physically, you know, And
Speaker 1: I just I couldn't get out of bed. And once
Speaker 1: I handled my anxiety and like got tools, the depression
Speaker 1: didn't come back. And I've always said, I really think
Speaker 1: it was like a respite, my body just saying time
Speaker 1: to sleep now, because you've just been so jacked up.
Speaker 1: And I think also when you look at it that
Speaker 1: way in terms of serious mental illness, so there's any
Speaker 1: mental illness, and then there's serious mental illness and an
Speaker 1: am I versus an SMI, So s m I S
Speaker 1: are basically defined as they're not any disorder, but it's
Speaker 1: essentially bipolar schizophrenia, major depression with suicidality, sometimes severe PTSD,
Speaker 1: but anything that really um you are at the point
Speaker 1: where you cannot function or live independently. And so I
Speaker 1: couldn't live independently for five years. I was living with
Speaker 1: my mother, and I was very lucky to have that resource,
Speaker 1: because that's why people are on the street and in jail,
Speaker 1: because they don't have a resource like that where they
Speaker 1: can go. And any mental illness is the rest of it.
Speaker 1: And it's not that that's any less important, but it
Speaker 1: is a very those are very different. But when you
Speaker 1: think of someone in crisis, someone with a serious mental illness,
Speaker 1: you think about your brain as being programmed to just
Speaker 1: look for danger. That's just gonna it's just gonna keep
Speaker 1: going and keep piling on itself and and creating more
Speaker 1: and more of that and entrenching the person. And so
Speaker 1: it's it doesn't surprise me that I got worse and
Speaker 1: worse and worse and really just eventually couldn't come out
Speaker 1: of it. But I did well. I really did love
Speaker 1: that story you told about um autism and then as
Speaker 1: Burgers being entered into the d s M and then
Speaker 1: taken away and the community the aspiece were like, excuse me,
Speaker 1: you know, and I actually do know people with autism
Speaker 1: and with Asperger's. To me, it's two totally different things.
Speaker 1: I can I can tell I mean, I really I
Speaker 1: was shocked to see that and the reasons for it
Speaker 1: were kind of ridiculous. Can you can you tell us
Speaker 1: about that? Feel like that really illustrates this D s M. Yeah.
Speaker 1: I mean part of my experience, uh, what I talked
Speaker 1: about in the book and just my life is that
Speaker 1: while I was going through all this, I also was
Speaker 1: encountering and I've always been, you know, taught, and so
Speaker 1: i was a writer and residence in the New York
Speaker 1: City public schools and I ended up being assigned off
Speaker 1: into special education classrooms and then suddenly I was the
Speaker 1: autism go to person, and so I was always going
Speaker 1: into classrooms with students with severe autism, and I mean
Speaker 1: severe autism. So these are classes with about maybe six
Speaker 1: to eight children, many of them have a private nurse
Speaker 1: that you know, not private, and that they're wealthy. These
Speaker 1: were in very very marginalized communities in South Bronx and
Speaker 1: the South Brooklyn, and so I really got to know
Speaker 1: what that what that type of autism is. And as
Speaker 1: you're saying, Asperger's is a totally different thing. So when
Speaker 1: we had the two diagnoses of autism and Aspergers, what
Speaker 1: they found was that a lot of the resources that
Speaker 1: we're going to people with Asperger's, which this isn't a
Speaker 1: very thorough definition of it, but Asperger's is slightly more
Speaker 1: high functioning than autism, and I should define what autism is.
Speaker 1: So autism literally means interiority, like a loneness and when
Speaker 1: there's a kind of cut off from not necessarily reality
Speaker 1: in the sense of hallucinating, but there's a kind of
Speaker 1: separation with the world. And so autism was in the
Speaker 1: d s M. It was defined by mutism, so it
Speaker 1: was people who were non verbal. And then the diagnosis
Speaker 1: just what they call loosened, and so suddenly mutism was
Speaker 1: dropped from it, and then all that allowed for all
Speaker 1: these other people to receive a diagnosis of autism. And
Speaker 1: the way they tried to sort of counter that or
Speaker 1: work with that was to create aspergers which was a
Speaker 1: higher functioning if you want to call it, version of it,
Speaker 1: although again that's you know, not a great way of
Speaker 1: describing it because it's more complicated than that. But so
Speaker 1: when they found that the sources were going to the
Speaker 1: higher functioning students often it was educational services, uh, they
Speaker 1: decided to they created the Autism spectrum. Now that was
Speaker 1: also created, so Asperger's was dropped completely from the d
Speaker 1: s M. That was also part of the d s
Speaker 1: M is moving towards this idea of a spectrum. So
Speaker 1: instead of having all these different like generalized anxiety disorder
Speaker 1: and social anxiety disorder, they're trying to go toward a
Speaker 1: spectrum of diagnosis that has its own problems. But so
Speaker 1: that's what happened. But a lot of you know, the
Speaker 1: people Asperger's, people with Aspergers, did find that they suddenly
Speaker 1: did not have a diagnosis, and that was they really
Speaker 1: there was an uproar about it. That's pretty rare though
Speaker 1: that a d s M diagnosis has dropped more often
Speaker 1: than not. I mean, when we started the d s
Speaker 1: M had a hundred and twenty eight diagnoses. We now
Speaker 1: have five hundred and forty one if you count sub types,
Speaker 1: and um, every kind of avenue to get the diagnosis,
Speaker 1: and so you'd be hard pressed to go into any
Speaker 1: clinicians or mental health professionals office and talk about your
Speaker 1: fears or your deepest even desires and not get a
Speaker 1: diagnosis at this point. Um, So it's just and again
Speaker 1: it's this idea of like you talked about a d
Speaker 1: h D or what they did was they dropped the
Speaker 1: H from a d h D, and you'll notice sometimes
Speaker 1: it's called a d D and sometimes it's called a
Speaker 1: d h D. But what they do is they dropped
Speaker 1: hyperactivity as a criteria, so you could be inattentive type
Speaker 1: and that created what was called the false epidemic of
Speaker 1: a d h D. Then they also included adult a
Speaker 1: d h D, which had never existed before, so they
Speaker 1: just created it. It was not a real thing. So
Speaker 1: basically you have all you had was a d h
Speaker 1: D and you had to be hyperactive. Suddenly they dropped
Speaker 1: the H and you can be hyperactive, but you don't
Speaker 1: have to be. That doesn't quite make sense, but you
Speaker 1: can just be unattentive and then you suddenly have and
Speaker 1: before you had to be, you know, you had to
Speaker 1: be in childhood. It was a child you know, childhood disorder.
Speaker 1: And then suddenly adults can get it too. So that's
Speaker 1: the kind of thing that happens in the revisions of
Speaker 1: the d s M and why it's so heavily criticized,
Speaker 1: but also why it's so problematic for all of us.
Speaker 1: I mean, we're all in this together. I don't think
Speaker 1: any psychiatrists, well there's hubrists and kind of you know,
Speaker 1: arrogance certainly out there, but I don't think any psychiatrist
Speaker 1: is around walking walking around. Well there is one I
Speaker 1: know that is, but walking around like you know, we're
Speaker 1: doing a great job. This is great. I mean what
Speaker 1: someone asked me if I've gotten a lot of pushback
Speaker 1: from psychiatry, and I've gotten none. I have gotten Actually
Speaker 1: everyone has said yeah, we know, and thank you. Like
Speaker 1: that's that's all I've received. And it feels great. I mean,
Speaker 1: it's wonderful because it gives me a lot of hope.
Speaker 1: Anxiety bites will be right back. After a quick little
Speaker 1: message from one of our sponsors. You said, you know,
Speaker 1: according to the d s M, if grief lasted more
Speaker 1: than two months in quotes called uncomplicated bereavement, it became
Speaker 1: a major depressive disorder despite no changes to the grief symptoms.
Speaker 1: So suddenly it's like, now, just because it's been two months,
Speaker 1: you've major depressive disorder, but you don't have any new symptoms.
Speaker 1: And and then you said the bereavement really only seemed
Speaker 1: to count the loss of human death. I mean, it
Speaker 1: wasn't your house burned down, you lost your job, you
Speaker 1: had to break up, not even a pet dying, And
Speaker 1: so that's where I've heard a mythology. I've heard it
Speaker 1: from psychiatrists that oh, yeah, so if you're going through
Speaker 1: a grieving of any kind, if it lasts more than
Speaker 1: six weeks, you have tipped over into depressive disorder. Now
Speaker 1: you have depression. Yeah, looking back, it doesn't make sense because,
Speaker 1: first of all, our culture isn't set up to have
Speaker 1: any time for grieving. So if we had to grief
Speaker 1: and it did last longer than six weeks, maybe I
Speaker 1: don't know, but it just seems so arbitrary. Well who
Speaker 1: does that help, though, Like, who is this helping? Well,
Speaker 1: the grief disorder it's now called prolonged grief disorder. They
Speaker 1: have a new the newest revision of the d s
Speaker 1: M came out this month. I'm not sure if they've
Speaker 1: released it yet, but it's out in March and the
Speaker 1: UM So they've now created prolonged grief disorder. So basically,
Speaker 1: people have been working for many, many years, for decades
Speaker 1: to try to get the berieve Man exclusion removed because
Speaker 1: they want everyone to be able to get a depression
Speaker 1: diagnosis now to take out the criminal like evil element.
Speaker 1: Why do they want that I believe the people doing this.
Speaker 1: First of all, the d s M has been designed
Speaker 1: to diagnose as many people as possible. That's what it's
Speaker 1: designed for. That's what they want because they believe they're
Speaker 1: doing a service. The problem is we're over diagnosing and
Speaker 1: and they're they're not always doing a service. Now does
Speaker 1: that mean someone doesn't meet the arapy? No, But do
Speaker 1: they need a diagnosis. That's that's where we get into it.
Speaker 1: So the brievement exclusion was dropped, and now they've created
Speaker 1: so anyone can receive major depressive disorder diagnosis regardless of
Speaker 1: what losses they're experiencing. And and again, like you said,
Speaker 1: we're totally disregarding the problem with the d s M
Speaker 1: is it disregards context. So if my house is burned
Speaker 1: down and I am grieving, I have depression. I mean
Speaker 1: that's you know, or if I lose my job or
Speaker 1: whatever it might be. But they've created prolonged grief disorder
Speaker 1: and that says that if you grieve longer than one year,
Speaker 1: you have a mental illness um and that and what's
Speaker 1: what's really too bad about this is that in their
Speaker 1: press releases, the American Psychiatric Association, which if you want
Speaker 1: to talk about benefiting. They make hundreds of millions of
Speaker 1: dollars off the d s M. It is in their
Speaker 1: best interest for it to be a cultural, you know,
Speaker 1: kind of presence among us and for us to use
Speaker 1: these diagnoses. And what they've done in their press releases
Speaker 1: as they talked, they really have capitalized on um everything,
Speaker 1: so meaning the pandemic, talking about how many people have
Speaker 1: lost loved ones. They also talked about natural disasters, they
Speaker 1: talk about you know, so they're really kind of what's
Speaker 1: called and this is where it does get sinister, but
Speaker 1: marketing the disorder is what it's called, and it's something
Speaker 1: that drug companies have done for a long time. And
Speaker 1: so and this is anxiety is really interesting in this respect.
Speaker 1: Anxiety has been kind of I don't know, victim of this,
Speaker 1: I almost want to say, because it's obviously not anxiety's fault.
Speaker 1: But when so a drug company creates Glaxo Smith Klein,
Speaker 1: the drug company creates Paxel, the antidepressant and s SR
Speaker 1: and they did it. They actually came up with it
Speaker 1: in so it was after the Prozac had made a
Speaker 1: splash and they just Prozac stole its thunder. So basically
Speaker 1: what they had to do was find something else to
Speaker 1: say that Paxel could fix. And so what they did
Speaker 1: is they went through the pages of the d s
Speaker 1: M and they found an obscure diagnosis called generalized anxiety disorder.
Speaker 1: One percent of the population that was obscure. Yeah, one
Speaker 1: percent of the population had it. It was like, you know,
Speaker 1: no one really you know, it was basically insignificant. And
Speaker 1: what they did, and this is actually brilliant, they marketed
Speaker 1: the diagnosis of generalized anxiety disorder, not Paxel, And so
Speaker 1: they hired a PR firm. They also create fake at
Speaker 1: patient advocacy groups UM and they also fund patient advocacy groups.
Speaker 1: So basically, then the media is reporting on it, and
Speaker 1: they get some sort of prominent doctor from Columbia University
Speaker 1: or wherever to say, yes, this is a terrible diagnosis
Speaker 1: and all these people have it but they don't know it.
Speaker 1: And then what happens is once they've got the approval,
Speaker 1: Glaxo Smith Klein swoops in and says, hey, Pexel can
Speaker 1: cure generalized anxiety disorder that now eight or fifteen or
Speaker 1: eighteen percent of the American public has, depending on the
Speaker 1: statistic you believe, and the same thing happened with social
Speaker 1: anxiety disorder, and it was also Glaxo Smith Klein. I
Speaker 1: mean they're not the only ones. Other pharmaceutical companies like
Speaker 1: up John and Fiser have done the same thing. Fiser
Speaker 1: did it with PTSD and up John did it with
Speaker 1: O c D. So this idea of marketing the diagnosis again,
Speaker 1: it's it's a little bit wrong to say that pharma
Speaker 1: creates diagnoses in the sense of they don't actually stand
Speaker 1: at the door and pay the people writing the d
Speaker 1: s M to create a diagnosis. And it's not made up.
Speaker 1: There is anxiety either, is PTSD. Yeah, but they're just
Speaker 1: saying it's like they're finding their brand. You know, the
Speaker 1: d s M is such a weak diagnostic tool that
Speaker 1: it can be used for all these terrible purposes and
Speaker 1: in all these terms, in all these sort of really
Speaker 1: dangerous way. This is the problem, um and sadly I
Speaker 1: don't think it's hopeless. But the new edition of the
Speaker 1: d s M that's just come out, they had a
Speaker 1: decade the last edition came out in so nearly a
Speaker 1: decade to fix the problems that were with the d
Speaker 1: s M. Controversies had erupted a lot of attention was
Speaker 1: paid to it, and they haven't fixed one. And so
Speaker 1: I really feel like the reason why I wrote the
Speaker 1: book was it's not going to come. Change won't come
Speaker 1: from psychiatry, it won't come from the A p A.
Speaker 1: And it won't come from the d s M. It
Speaker 1: has to come from us. And that's why I wrote
Speaker 1: Pathological and why I want everyone. I want us to
Speaker 1: be empowered. I want us to be able to say, hey,
Speaker 1: I know about the d s M, and now let's
Speaker 1: talk about the diagnosis you're giving me and what that
Speaker 1: means and what treatment I should have. Well example, this
Speaker 1: whole notion like we are having a mental health crisis
Speaker 1: in this country, and honestly, just on I can't explain
Speaker 1: it on a bizarre level in my body. When I
Speaker 1: hear that, I go, We're not. And I and I
Speaker 1: see people having to get duct tape on airplanes. I
Speaker 1: I see more insanity than I've ever seen in my life. Um,
Speaker 1: and so it's wild that I'm not running around going
Speaker 1: we're having a major mental health moment in this country.
Speaker 1: It's something, but it's not all these undiagnosed people. And
Speaker 1: I interviewed this professor about trauma, and he said, we're
Speaker 1: not having a mental health crisis, we're having a chronic stress.
Speaker 1: And I there was this, even though I agree with him,
Speaker 1: there was this like, oh, don't say that, you know,
Speaker 1: I don't want anyone to get mad because we've all
Speaker 1: kind of bought into it. And I'm like, well, you
Speaker 1: know that. But I it's like, well, if we understood
Speaker 1: what chronic stress really did to people, we wouldn't be
Speaker 1: so offended that we're calling it that instead of mental
Speaker 1: health crisis. Like chronic stress is not we're not meant
Speaker 1: to deal with it, and we don't deal with it well.
Speaker 1: But it is like, I do not think there's millions
Speaker 1: of people with undiagnosed this or that. I think I
Speaker 1: don't know what it is, Like, what do you think
Speaker 1: is happening? Well, it's such an interesting phrase. And I
Speaker 1: really do blame the media a lot, so I I
Speaker 1: say in my book, I don't blame anyone except the
Speaker 1: d s M. I blame a book, but I and
Speaker 1: I do, but the media. I'm just I'm a writer,
Speaker 1: so I think about words and the power of words,
Speaker 1: especially the written word. And so what's interesting about what
Speaker 1: you're saying is we do have a mental health crisis
Speaker 1: in the sense that people with serious mental illness are
Speaker 1: ending up on the streets and in jails. Cook County
Speaker 1: is our largest. Cook County Jail, which is not far
Speaker 1: from where I live, is the largest mental health facility
Speaker 1: in the country. That's a crisis. That is absolutely a
Speaker 1: mental health crisis. What's happening otherwise really isn't like you're saying.
Speaker 1: I mean, what's interesting about the diagnosis of anxiety and
Speaker 1: how it changed over the additions of the d s M.
Speaker 1: Is it used to be in the third edition you
Speaker 1: had to have unrealistic and excessive worry. They removed unrealistic
Speaker 1: the word unrealistic in the next adition and in the
Speaker 1: subsequent editions, and excessive, So all you have to do
Speaker 1: is worry. I mean, think about what that changes. And
Speaker 1: when we think about the pandemic. None of what's going
Speaker 1: on is unrealistic or excessive given what we've just been through.
Speaker 1: Is it ideal? No? Do we want it? No? I mean,
Speaker 1: and I do think that. You know, we don't know
Speaker 1: what stresses or what the relationship of it is to
Speaker 1: mental illness, but I mean, there's certainly could be points
Speaker 1: at which stress can drive you too, you know, an
Speaker 1: extreme of mental illness. We don't know so that that
Speaker 1: is possible. But really, I think we're all coping with
Speaker 1: this very extreme, excessive somewhat. You know, it is realistic
Speaker 1: to be terrified that you're going to get you know,
Speaker 1: to be terrified of journs, and to be you know,
Speaker 1: hear annoid of the government, given what's going around and
Speaker 1: how you know, in the silos of social media and
Speaker 1: that sort of thing. You know, it's not actually I mean,
Speaker 1: this is what we're living in and we aren't making
Speaker 1: things up. How did you get yourself out of the
Speaker 1: situation where you're you're living with your mom? You've got
Speaker 1: all these diagnoses, What did you do? I mean, I
Speaker 1: was extremely suicidal? Um I really did you know? At
Speaker 1: one point? I definitely was a lot. My mother was
Speaker 1: on suicide watch for four years. I mean, it was
Speaker 1: a lot to ask of her. So I did end
Speaker 1: up moving out and I got much much worse before
Speaker 1: I got better, and my sister. Again, my family was
Speaker 1: just a lifeline for me. So I cannot imagine someone
Speaker 1: who doesn't have that support system. But I had, you know,
Speaker 1: a place, and I had people to support me. And
Speaker 1: I had a purpose, and so I started writing this book. Um,
Speaker 1: and I don't really look at writing is healing, but
Speaker 1: it gave me a purpose, and all right, as a writer,
Speaker 1: I do not either, so it's not healing. But so
Speaker 1: I did have those things. I say in my book
Speaker 1: that it's not a typical mental health memoir mainly because
Speaker 1: I'm questioning a lot of what we take for granted
Speaker 1: in terms of what mental health diagnoses are, but also
Speaker 1: because I don't have the answer. And so all I
Speaker 1: know is that we don't We don't tell people that
Speaker 1: they can fully recover. We tell them they the best
Speaker 1: they can hope for is remission and managing their symptoms.
Speaker 1: And that is simply wrong. And my you know, I
Speaker 1: have no data to back this up. But if we
Speaker 1: want to lower the suicide rate, start being honest with
Speaker 1: people that not that mental illness isn't chronic and that
Speaker 1: there's hope. Because when I was suicidal, I had no hope,
Speaker 1: I had no future, and so someone had no one
Speaker 1: had told me. Everyone told me they were chronic. Until
Speaker 1: I saw the I don't know psychiatrist Dr Are. He
Speaker 1: was the only one who was allowed me to think
Speaker 1: of the future. So that really helped. I suddenly started
Speaker 1: thinking of the future. Once I stopped identifying with the diagnosis,
Speaker 1: then I stopped attributing all my really low lows and
Speaker 1: anxiety and you know, everything that I was feeling to
Speaker 1: a diagnosis, and instead it was just what I had
Speaker 1: to manage um. And then, to be honest, I mean
Speaker 1: up until Thomas Insel's book came out, and he is
Speaker 1: a man with so much authority and has my total respect.
Speaker 1: When he said mental illness isn't chronic, I felt like,
Speaker 1: oh my god, I can now really say it, and
Speaker 1: I can say it to other people. I feel comfortable,
Speaker 1: you know, for me to say, I couldn't tell other people, yes,
Speaker 1: it's not chronic without you know, anything to back it up.
Speaker 1: But although there's no proof that they are chronic, but
Speaker 1: there's At the time, there was nothing there for me
Speaker 1: to really rely on. So that has helped tremendously. But
Speaker 1: I don't think we know what healing looks like yet.
Speaker 1: We don't know what recovery looks like because we haven't
Speaker 1: given it a chance, and that hasn't been our priority.
Speaker 1: Our priority has been looking at trying to prove that
Speaker 1: their brain diseases quote unquote and trying to prove this
Speaker 1: and prove that, and what we need to start doing
Speaker 1: is healing and caring for people and getting them full
Speaker 1: recovery and to know that. And that's pathological the Movement.
Speaker 1: That's why I started it. UM. My book, you know,
Speaker 1: gives readers everything they need to know wrapped up in
Speaker 1: a really good story. But I wanted also kind of
Speaker 1: actionable steps because I can't offer an elixir, I can't
Speaker 1: offer you a magic bullet, and so Pathological the Movement
Speaker 1: is just a public awareness campaign to let people know
Speaker 1: that mental illness is not chronic and you can fully recover,
Speaker 1: and that D s M diagnoses are not valid and
Speaker 1: largely unreliable. And all this is as I said, the
Speaker 1: exception is dementia and rare chromosomal disorders. But and what
Speaker 1: I asked, or not what I asked, but what I
Speaker 1: hope we can do is ask three questions when we
Speaker 1: or someone we love receives a diagnosis, which is of
Speaker 1: the mental health professional or clinician, is this diagnosis valid
Speaker 1: and or unreliable? Um. The answer to the first one
Speaker 1: is no, it's not valid. And the answer the second
Speaker 1: one is it depends in terms of reliability, um, and
Speaker 1: then has this diagnosis been proven to be chronic? And
Speaker 1: the answer is no? And then what does that mean
Speaker 1: in terms of the treatment that you're suggesting. Now, I'm
Speaker 1: not good about asking my doctor's questions. I'm very medical
Speaker 1: professionals have great authority over me, so I don't really
Speaker 1: I'm not really assuming people will actually ask these questions.
Speaker 1: But we'll ask them of ourselves and we'll think about them,
Speaker 1: and that will walk into physicians offices and mental health
Speaker 1: professionals offices with power and they will have to kind
Speaker 1: of rise to the occasion and be more transparent with us.
Speaker 1: Do you have your to go box with you? Are
Speaker 1: you ready for the takeaways? If you want to read
Speaker 1: the takeaways or look at takeaways from past episodes, you
Speaker 1: may go to Jen Kirkman dot com and then click
Speaker 1: where you see that it says anxiety Bites. Will also
Speaker 1: put the link directly in the show notes. But here
Speaker 1: are the takeaways from this episode. The word pathologize means
Speaker 1: to medicalize a condition, any condition, and not just a
Speaker 1: psychiatric one. All mental health diagnoses come from the manual
Speaker 1: known as the d s M, the Diagnostic and Statistical
Speaker 1: Manual of mental disorders. Many prominent psychiatrists and researchers have
Speaker 1: warned about the invalid diagnoses in the d s M.
Speaker 1: Even though mental illness is very real. Mental health diagnoses
Speaker 1: in the d s M are focused on the biomedical model,
Speaker 1: or the idea that mental health diagnoses are biological and
Speaker 1: therefore chronic. But no DSM mental health diagnosis has proven
Speaker 1: to be chronic. Studies have shown that the people who
Speaker 1: believe there is a biological cause to their diagnosis have
Speaker 1: more self stigma, more shame, and are more hopeless about
Speaker 1: their diagnosis. The problem with d s M diagnoses is
Speaker 1: that there is no biological marker for any of them,
Speaker 1: which means there is no test saying that mental illness
Speaker 1: is the same as physical illness comes from a well
Speaker 1: meaning place, meaning that we need to respect it the same.
Speaker 1: But with the exception of dementia and rare chromosomal disorders
Speaker 1: that are in the d s M, no single mental
Speaker 1: health diagnosis has an objective reality like a physical illness
Speaker 1: in members of the American Psychiatric Association came together to
Speaker 1: create the d s M, which is the manual that
Speaker 1: doctors could use to better communicate with each other. The
Speaker 1: d s M has had seven editions where it gets
Speaker 1: revised and more diagnoses are included. Sara Pha's goal is
Speaker 1: not to throw out the d s M, but to
Speaker 1: have more transparency around this manual so that people can
Speaker 1: make more informed decisions about their mental health. Sometimes agnosis
Speaker 1: can be helpful, but other times they can lead to
Speaker 1: self fulfilling prophecies of antidepressant prescriptions are coming from primary
Speaker 1: care physicians and not psychiatrists who prescribe medication. The d
Speaker 1: s M has been designed to diagnose as many people
Speaker 1: as possible. It's designed to be doing a service, but
Speaker 1: the problem can be that doctors are now over diagnosing,
Speaker 1: which ultimately does people a disservice. Thanks for listening to
Speaker 1: this podcast. If you would like to give it a
Speaker 1: five star review, and please do, I would like you to.
Speaker 1: I don't care what you like. I want you to
Speaker 1: um go on over to Apple Podcasts or Spotify. Those
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Speaker 1: more reviews I get, the more people find this podcast.
Speaker 1: It's a very simple algorithm, So do that for me
Speaker 1: and send me an email Anxiety Bites Weekly at gmail
Speaker 1: dot com. Tell me what you love about the show.
Speaker 1: You can give some anxiety tips that you have that
Speaker 1: you use that you want to share with your fellow listeners,
Speaker 1: And you can ask me any questions that you want
Speaker 1: and I may answer it on an upcoming listener email episode.
Speaker 1: Thanks again for listening and remember anxiety bites, but you're
Speaker 1: in control. For more podcasts from my heart Radio, visit
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