1 00:00:02,880 --> 00:00:05,760 Speaker 1: Welcome to Wellness on Mass. In the US, nearly one 2 00:00:05,760 --> 00:00:09,160 Speaker 1: in nine children have been diagnosed with some form of ADHD, 3 00:00:09,560 --> 00:00:12,560 Speaker 1: a number that has steadily risen over the past two decades. 4 00:00:13,119 --> 00:00:16,160 Speaker 1: Is this better recognition and access to care or are 5 00:00:16,200 --> 00:00:20,639 Speaker 1: we medicalizing normal human behavior? Joining me is doctor cm 6 00:00:20,800 --> 00:00:24,919 Speaker 1: to Mimi, a child and adolescent psychiatrist known for challenging 7 00:00:25,000 --> 00:00:29,240 Speaker 1: the mainstream media psychiatric models. Doctor to Mimi questions whether 8 00:00:29,320 --> 00:00:34,760 Speaker 1: labels like ADHD truly reflect underlying biology or whether culture, 9 00:00:35,000 --> 00:00:39,120 Speaker 1: environment and expectations play a much larger role than we're 10 00:00:39,120 --> 00:00:42,920 Speaker 1: willing to admit. Now, this is a very thoughtful nuance conversation. 11 00:00:43,200 --> 00:00:47,680 Speaker 1: It's not about denying anyone's suffering, but about asking better questions. 12 00:00:47,760 --> 00:00:50,360 Speaker 1: So let's get into it with us today on Wellness 13 00:00:50,400 --> 00:00:54,400 Speaker 1: on Mass we have British consultant child and adolescent psychiatrists 14 00:00:54,400 --> 00:00:58,680 Speaker 1: and psychotherapists in the UK National Health Service. Doctor cm 15 00:00:58,840 --> 00:01:00,600 Speaker 1: to Mimi, thank you so much, so much for joining 16 00:01:00,680 --> 00:01:03,279 Speaker 1: us today, Matt, I have so many questions for you. 17 00:01:04,600 --> 00:01:07,560 Speaker 2: Thank you so much for inviting me. Although just a 18 00:01:07,560 --> 00:01:12,280 Speaker 2: little correction, I've recently retired from the National Health Service. 19 00:01:12,680 --> 00:01:16,200 Speaker 1: Well then formally of the National Health Service, but still 20 00:01:16,640 --> 00:01:18,679 Speaker 1: pretty big title that you once carried. 21 00:01:19,680 --> 00:01:23,280 Speaker 2: Yes, Yes, and more than three decades worth of working 22 00:01:23,319 --> 00:01:24,800 Speaker 2: in public services. 23 00:01:25,640 --> 00:01:28,440 Speaker 1: So can we dive right in because some of the 24 00:01:28,440 --> 00:01:31,520 Speaker 1: things that you've critique, you know, if you were here 25 00:01:31,720 --> 00:01:35,880 Speaker 1: in the United States, you would be branded almost like 26 00:01:35,959 --> 00:01:39,560 Speaker 1: a charlatan because you're pushing against kind of what the 27 00:01:39,600 --> 00:01:45,039 Speaker 1: mainstream media narrative is regarding the traditional psychiatric diagnoses, especially 28 00:01:45,440 --> 00:01:48,240 Speaker 1: ADHD and autism. Can you talk a little bit about. 29 00:01:47,960 --> 00:01:51,960 Speaker 2: That, as the scientist in me is quite confused about 30 00:01:52,200 --> 00:01:57,160 Speaker 2: why looking at the evidence and analyzing the evidence turns 31 00:01:57,200 --> 00:02:02,360 Speaker 2: you into somebody who is concerned it controversial. To me, 32 00:02:02,480 --> 00:02:05,840 Speaker 2: the controversy is the other way around when we create 33 00:02:06,120 --> 00:02:10,919 Speaker 2: concepts and we practice what I think is upside down science. 34 00:02:11,639 --> 00:02:14,720 Speaker 2: In upside down science, while in proper science, what you 35 00:02:14,800 --> 00:02:17,920 Speaker 2: do is you come up with a hypothesis. You assume 36 00:02:18,000 --> 00:02:23,800 Speaker 2: your hypothesis isn't true until you can show with verifiable 37 00:02:23,919 --> 00:02:28,679 Speaker 2: data that your hypothesis is true. You don't start by 38 00:02:28,720 --> 00:02:33,360 Speaker 2: assuming your hypothesis is true and then expect other people 39 00:02:33,720 --> 00:02:37,520 Speaker 2: to come and show data that the hypothesis isn't true. 40 00:02:37,560 --> 00:02:41,120 Speaker 2: That's what I mean by upside down science. So I've 41 00:02:41,160 --> 00:02:44,400 Speaker 2: looked at all the evidence. And I've been following this 42 00:02:44,440 --> 00:02:47,920 Speaker 2: for a while, ever since my time as a train 43 00:02:48,000 --> 00:02:50,680 Speaker 2: each other an ad Lesson psychiatrist, when I was asked 44 00:02:50,720 --> 00:02:54,880 Speaker 2: to join a consultant in a project looking at the 45 00:02:54,919 --> 00:02:59,840 Speaker 2: prevalence of ADHD for us a new concept. This was 46 00:02:59,880 --> 00:03:03,960 Speaker 2: in the mid nineteen nineties, coming into the UK to 47 00:03:04,000 --> 00:03:05,960 Speaker 2: look at the prevalence for this. And I went and 48 00:03:06,000 --> 00:03:10,280 Speaker 2: did this big literature review of the existing literature at 49 00:03:10,280 --> 00:03:13,880 Speaker 2: the time and had this horrible feeling that the more 50 00:03:13,919 --> 00:03:17,959 Speaker 2: I read, the less I came to think about, well, 51 00:03:18,360 --> 00:03:21,440 Speaker 2: what the hell is this thing being called ADHD. Surely 52 00:03:21,440 --> 00:03:25,040 Speaker 2: you're not telling me ADHD is simply the behaviors that 53 00:03:25,080 --> 00:03:28,200 Speaker 2: you're describing. But all these papers seem to be assuming 54 00:03:28,280 --> 00:03:32,480 Speaker 2: that ADHD, which is basically a description of behaviors like 55 00:03:32,600 --> 00:03:37,000 Speaker 2: hyperactivity and impulsivity, and the assumption was this was a 56 00:03:37,160 --> 00:03:43,720 Speaker 2: verifiable condition, that these behaviors point to some sort of 57 00:03:44,680 --> 00:03:47,680 Speaker 2: neuro developmental in other words, something to do with the 58 00:03:47,680 --> 00:03:51,720 Speaker 2: development of the nervous system, that it was primarily genetic, 59 00:03:51,920 --> 00:03:54,920 Speaker 2: and that it could be diagnosed, and that it is 60 00:03:55,320 --> 00:03:59,680 Speaker 2: likely to link to some sort of brain difference or abnormality. 61 00:04:00,040 --> 00:04:02,680 Speaker 2: So I could see from the start of this new 62 00:04:02,720 --> 00:04:05,920 Speaker 2: concept that there was something missing in terms of the 63 00:04:05,960 --> 00:04:10,360 Speaker 2: scientific basis for that. So I've been following that literature 64 00:04:10,960 --> 00:04:14,920 Speaker 2: and the research ever since. Then over the last three decades, 65 00:04:15,880 --> 00:04:18,880 Speaker 2: I've been writing about it, and I write about it 66 00:04:18,920 --> 00:04:23,279 Speaker 2: again in my latest book, Searching for Normal, because what 67 00:04:23,360 --> 00:04:27,279 Speaker 2: I've seen happening is what I predicted many decades ago, 68 00:04:27,680 --> 00:04:31,760 Speaker 2: which is, when you develop a concept that has know 69 00:04:32,240 --> 00:04:35,680 Speaker 2: what I would consider empirical anchor, in other words, it 70 00:04:35,760 --> 00:04:41,120 Speaker 2: doesn't start with some sort of objective, verifiable basis in 71 00:04:41,160 --> 00:04:48,440 Speaker 2: our biology. Then and if the definition of these conditions 72 00:04:48,720 --> 00:04:53,280 Speaker 2: are simply descriptions, and all descriptions are subjective in nature, 73 00:04:53,960 --> 00:04:57,320 Speaker 2: then one of the things that's going to happen, particularly 74 00:04:57,440 --> 00:05:01,839 Speaker 2: if society goes through phases where there is more distress 75 00:05:01,880 --> 00:05:08,120 Speaker 2: around more insecurity, alienation, and so on, then what's going 76 00:05:08,160 --> 00:05:12,240 Speaker 2: to happen, or what's likely to happen, is these concepts 77 00:05:12,400 --> 00:05:16,200 Speaker 2: are very vulnerable to being expanded. And what we've seen 78 00:05:16,279 --> 00:05:25,240 Speaker 2: happen with concepts like ADHD, autism, depression, anxiety is the boundary. 79 00:05:25,279 --> 00:05:29,360 Speaker 2: Not only the boundaries have expanded, but the whole parameters. 80 00:05:30,040 --> 00:05:33,960 Speaker 2: So they've gone through what I call a mutation of constructs. 81 00:05:34,200 --> 00:05:38,239 Speaker 2: So if you look at ADHD, for example, it starts 82 00:05:38,279 --> 00:05:42,760 Speaker 2: off as a very rare condition, and originally it was 83 00:05:42,800 --> 00:05:47,080 Speaker 2: called something like hyperkinetic disorder, and it focused on levels 84 00:05:47,120 --> 00:05:51,720 Speaker 2: of activity. It was considered largely developmental in nature. In 85 00:05:51,760 --> 00:05:56,279 Speaker 2: other words, the expectation was most children would grow out 86 00:05:56,320 --> 00:05:59,800 Speaker 2: of most of the behaviors that define it. And what 87 00:05:59,800 --> 00:06:04,800 Speaker 2: we see then happen is it expands firstly horizontally, so 88 00:06:04,880 --> 00:06:09,120 Speaker 2: it starts to include different behaviors. So attention comes into 89 00:06:09,120 --> 00:06:14,040 Speaker 2: the picture, so the idea of attention deficit becomes quite important. 90 00:06:14,720 --> 00:06:18,960 Speaker 2: So it expands into new behaviors. It further expands in 91 00:06:19,080 --> 00:06:23,440 Speaker 2: terms of the severity of these behaviors, because remember the 92 00:06:23,640 --> 00:06:26,400 Speaker 2: types of behaviors that we're talking about. If you look 93 00:06:26,440 --> 00:06:30,360 Speaker 2: at a list of behaviors for the diagnosis of something 94 00:06:30,480 --> 00:06:36,000 Speaker 2: like ADHD, you'll see statements like often squirms with their 95 00:06:36,000 --> 00:06:39,200 Speaker 2: hands or their feet, Well, how often is often? What's 96 00:06:39,200 --> 00:06:41,880 Speaker 2: the unit of squirm? How much movement do you need 97 00:06:41,960 --> 00:06:44,400 Speaker 2: to have a unit of squirm? How many units of squirm? 98 00:06:44,640 --> 00:06:47,640 Speaker 2: And so on. The whole thing is subjective. So this 99 00:06:47,800 --> 00:06:52,120 Speaker 2: expansion goes from a rare condition to about considered to 100 00:06:52,160 --> 00:06:56,159 Speaker 2: about three to five percent of children. Then it expands 101 00:06:56,520 --> 00:07:01,760 Speaker 2: vertically by going into the concept of adult ADHD. So 102 00:07:01,880 --> 00:07:04,960 Speaker 2: at some point the idea that most children grow out 103 00:07:04,960 --> 00:07:07,880 Speaker 2: of it starts to disappear and it starts to be 104 00:07:07,920 --> 00:07:12,200 Speaker 2: talked about as a lifelong condition. Again, these changes are 105 00:07:12,240 --> 00:07:15,920 Speaker 2: not coming about because there's been new evidence about the biology. 106 00:07:16,520 --> 00:07:20,560 Speaker 2: But it's still being called genetic even though those evidence 107 00:07:20,600 --> 00:07:24,800 Speaker 2: about genetics are missing. It's still being called neurodevelopmental, even 108 00:07:24,840 --> 00:07:29,280 Speaker 2: though nobody can find what that neurodevelopmental bit is. So 109 00:07:29,360 --> 00:07:34,080 Speaker 2: it expands into adulthood, and then it takes another mutation. 110 00:07:35,440 --> 00:07:38,720 Speaker 2: In the last five to ten years. In particular, a 111 00:07:38,760 --> 00:07:42,760 Speaker 2: new concept comes in again without any biological evidence to 112 00:07:42,840 --> 00:07:47,120 Speaker 2: back this, and this concept is masking, So the idea 113 00:07:47,200 --> 00:07:51,480 Speaker 2: that you have the symptoms, but because you're good at 114 00:07:51,560 --> 00:07:55,360 Speaker 2: hiding them in public, people don't see it, and it's 115 00:07:55,440 --> 00:07:57,720 Speaker 2: just when you get home and you know you can 116 00:07:57,760 --> 00:08:00,960 Speaker 2: relax that all of these so called sit symptoms come out. 117 00:08:01,280 --> 00:08:04,880 Speaker 2: And the concept of masking enables ADHD to make another 118 00:08:05,000 --> 00:08:11,680 Speaker 2: expansion beyond its traditionally mainly male based diagnosis, towards more 119 00:08:11,880 --> 00:08:15,200 Speaker 2: women getting the diagnosis. So this becomes the biggest growth 120 00:08:15,280 --> 00:08:17,960 Speaker 2: area and for all sorts of reasons, and I go 121 00:08:18,040 --> 00:08:21,040 Speaker 2: into some of them in my latest book, Women have 122 00:08:21,280 --> 00:08:25,240 Speaker 2: been the when it comes to adulthood, women have been 123 00:08:25,360 --> 00:08:29,840 Speaker 2: the main psychiatric customer base. Now you can think about 124 00:08:29,880 --> 00:08:33,520 Speaker 2: all sorts of sociological reasons why that might be and 125 00:08:33,559 --> 00:08:37,440 Speaker 2: what sort of social pressures women find themselves under. But 126 00:08:37,960 --> 00:08:41,440 Speaker 2: if you can get into the market of where women 127 00:08:41,640 --> 00:08:45,160 Speaker 2: are your customer base, you've got an enormous market to 128 00:08:45,240 --> 00:08:46,000 Speaker 2: expand into. 129 00:08:46,080 --> 00:08:48,920 Speaker 1: So you're listening to Wellness and mass, we'll be right 130 00:08:48,960 --> 00:08:54,880 Speaker 1: back with more. You know, in the United States, about 131 00:08:54,880 --> 00:08:57,880 Speaker 1: twelve percent of children are being diagnosed with ADHD. That 132 00:08:57,960 --> 00:09:01,360 Speaker 1: number goes up to fifteen percent in kid Now you 133 00:09:01,800 --> 00:09:04,000 Speaker 1: kind of laid out for us, you know, the expanded 134 00:09:04,040 --> 00:09:08,280 Speaker 1: diagnostic criteria and other confounding factors that may have contributed 135 00:09:08,520 --> 00:09:12,680 Speaker 1: to this increase. But we're now also kind of getting 136 00:09:12,679 --> 00:09:16,040 Speaker 1: into the weeds of potentially I mean, obviously the mothers 137 00:09:16,080 --> 00:09:19,960 Speaker 1: are the ones who are most often seeking for said 138 00:09:20,040 --> 00:09:24,080 Speaker 1: children when they're suspicion of ADHD. And so do you 139 00:09:24,200 --> 00:09:28,120 Speaker 1: think that there is some sort of manipulative marketing or 140 00:09:28,280 --> 00:09:30,720 Speaker 1: even a level of deception. What do you think is 141 00:09:30,720 --> 00:09:34,320 Speaker 1: the impetus behind some of this rise, not necessarily the 142 00:09:34,320 --> 00:09:36,760 Speaker 1: broaden diagnostic criteria, but do you think that there's more 143 00:09:36,760 --> 00:09:40,760 Speaker 1: of a nefarious something behind it in terms of whether 144 00:09:40,880 --> 00:09:44,000 Speaker 1: it's the pharmaceutical companies or something else. 145 00:09:45,160 --> 00:09:51,000 Speaker 2: So in the West, we live in economies that are 146 00:09:51,040 --> 00:09:59,400 Speaker 2: based around markets and the selling of things. What's happened 147 00:09:59,800 --> 00:10:03,200 Speaker 2: is what I have termed the growth of what I 148 00:10:03,240 --> 00:10:08,199 Speaker 2: think of as now a mental health industrial mental health 149 00:10:08,240 --> 00:10:14,760 Speaker 2: industrial complex, because it turns out that, particularly when society 150 00:10:14,880 --> 00:10:19,479 Speaker 2: becomes more insecure and there's a greater level of distress, 151 00:10:20,360 --> 00:10:25,640 Speaker 2: that distress can become a source of profit. And it's 152 00:10:25,720 --> 00:10:29,760 Speaker 2: kind of not a conspiracy theory, but more just the 153 00:10:29,800 --> 00:10:34,880 Speaker 2: machinery of our economics means that once you find certain 154 00:10:35,160 --> 00:10:40,280 Speaker 2: conditions seem to attract a lot of attention from the population, 155 00:10:40,559 --> 00:10:42,400 Speaker 2: a lot of people are going to make money. So 156 00:10:44,360 --> 00:10:48,000 Speaker 2: I think if I was to point the fingers at 157 00:10:48,040 --> 00:10:53,080 Speaker 2: the culprits, my starting point would be certain strands of 158 00:10:53,200 --> 00:10:58,679 Speaker 2: academic psychiatry who've created this concept using upside down science. 159 00:10:58,800 --> 00:11:02,080 Speaker 2: And this is where the controversy should be. Shouldn't be 160 00:11:02,120 --> 00:11:04,680 Speaker 2: with people like me who are pointing these things out. 161 00:11:05,040 --> 00:11:08,040 Speaker 2: It should be with the people who've promoted concepts out 162 00:11:08,040 --> 00:11:12,439 Speaker 2: of thin air, essentially without the backing of a solid 163 00:11:12,720 --> 00:11:17,640 Speaker 2: scientific evidence space, and continue to perpetuate these These are 164 00:11:17,640 --> 00:11:23,280 Speaker 2: the modern snake oil sellers, and the pharmaceutical industry is 165 00:11:23,320 --> 00:11:27,240 Speaker 2: probably the best known bit that saw great profits to 166 00:11:27,280 --> 00:11:32,400 Speaker 2: be made from if you like, turning emotional distress into 167 00:11:32,440 --> 00:11:36,920 Speaker 2: a source of profit. But as these concepts grow, what 168 00:11:37,480 --> 00:11:42,040 Speaker 2: seems to happen is that psychiatric diagnoses are not really 169 00:11:42,080 --> 00:11:46,439 Speaker 2: diagnoses because they describe things, they actually don't point to causes. 170 00:11:46,880 --> 00:11:50,520 Speaker 2: They have no explanatory power within them. But what they've 171 00:11:50,520 --> 00:11:54,560 Speaker 2: become is brands. So I think of psychiatric diagnoses these 172 00:11:54,640 --> 00:11:58,200 Speaker 2: days as brands, and with these brands come all sorts 173 00:11:58,200 --> 00:12:04,160 Speaker 2: of sources of profit, very expensive assessments to a pharmaceutical, 174 00:12:04,360 --> 00:12:10,320 Speaker 2: to therapies, to influencers, podcasts, magazines, books, you name it. 175 00:12:11,080 --> 00:12:15,600 Speaker 2: You see a whole range of products grow around these concepts. 176 00:12:16,600 --> 00:12:20,360 Speaker 2: The danger is if we don't recognize what's going on 177 00:12:20,559 --> 00:12:26,400 Speaker 2: here and we fall into the fantasy that these psychiatric 178 00:12:26,559 --> 00:12:31,480 Speaker 2: brands are actually diagnoses. In other words, they offer explanations 179 00:12:31,800 --> 00:12:34,880 Speaker 2: what tends to happen because they are better thought of 180 00:12:35,120 --> 00:12:39,640 Speaker 2: as commodities. What tends to happen with most commodities, is 181 00:12:39,679 --> 00:12:44,559 Speaker 2: that they give you a temporary feeling of my life's improved. 182 00:12:44,679 --> 00:12:47,600 Speaker 2: But after a while, a lot of commodities you want 183 00:12:47,640 --> 00:12:50,120 Speaker 2: the next one, or you want a better one, or 184 00:12:50,160 --> 00:12:54,040 Speaker 2: they're not quite working. So what I've seen is a 185 00:12:54,120 --> 00:12:57,560 Speaker 2: process whereby people once they enter into this way of 186 00:12:57,679 --> 00:13:01,000 Speaker 2: thinking about what's going on in their life. Thinking in 187 00:13:01,040 --> 00:13:04,719 Speaker 2: psychiatric terms, is they might start out with a diagnosis 188 00:13:04,760 --> 00:13:08,520 Speaker 2: of for example, ADHD. Few years down the line, they 189 00:13:08,559 --> 00:13:13,320 Speaker 2: start wondering about, well, that doesn't explain everything. They find 190 00:13:13,360 --> 00:13:18,319 Speaker 2: themselves getting another diagnosis, say autism. A few years later, 191 00:13:18,920 --> 00:13:23,760 Speaker 2: there might be another one, say obsessive compulsive disorder. And 192 00:13:23,960 --> 00:13:29,920 Speaker 2: along the way they're accumulating other associated things. They're consuming books, podcasts. 193 00:13:29,960 --> 00:13:33,319 Speaker 2: But they might also have started on medication, and that 194 00:13:33,400 --> 00:13:36,800 Speaker 2: medication tends again according to the evidence, it doesn't lead 195 00:13:36,840 --> 00:13:40,719 Speaker 2: to long lasting improvements. So they might have got more medication, 196 00:13:41,320 --> 00:13:44,120 Speaker 2: another one, higher doses, and so on and so forth. 197 00:13:44,320 --> 00:13:47,400 Speaker 2: So we've got a whole system that seems to be 198 00:13:47,559 --> 00:13:51,960 Speaker 2: geared to creating patients rather than helping people move on 199 00:13:52,080 --> 00:13:56,120 Speaker 2: in their lives. I've seen, I mean, in this country, 200 00:13:56,160 --> 00:13:59,120 Speaker 2: it's not quite as bad, but it's still getting that way. 201 00:13:59,200 --> 00:14:05,240 Speaker 2: I've seen sixteen year olds come to clinic who've already 202 00:14:05,280 --> 00:14:11,960 Speaker 2: got a diagnosis of ADHD autism OCD, PTSD anxiety disorder, 203 00:14:12,440 --> 00:14:17,640 Speaker 2: and they're coming to the clinic because now they and 204 00:14:17,720 --> 00:14:22,040 Speaker 2: their parents are convinced that there's actually something more going on. 205 00:14:22,680 --> 00:14:25,680 Speaker 2: They're wondering that there's something that has been missed all 206 00:14:25,720 --> 00:14:28,720 Speaker 2: these years, and so now they're wondering, does this person 207 00:14:28,800 --> 00:14:32,560 Speaker 2: have a bipolar disorder? And so they're already on multiple 208 00:14:32,600 --> 00:14:36,000 Speaker 2: medications and they're thinking they need another one. This is 209 00:14:36,160 --> 00:14:43,280 Speaker 2: where it leads us. So our consumption of psychopharmaceuticals, of diagnoses, 210 00:14:44,000 --> 00:14:47,880 Speaker 2: of therapies, of all sorts of things that related to 211 00:14:47,920 --> 00:14:52,400 Speaker 2: this idea of mental health is just going up and 212 00:14:52,480 --> 00:14:53,120 Speaker 2: up and up. 213 00:14:53,640 --> 00:14:56,480 Speaker 1: What do you make of I'm sure it's hard to 214 00:14:56,560 --> 00:15:00,600 Speaker 1: miss some of the conversation with the United States HHS 215 00:15:00,600 --> 00:15:04,560 Speaker 1: Secretary RFK Junior, and a lot of the talk about 216 00:15:04,560 --> 00:15:08,560 Speaker 1: the rise in autism spectrum disorder diagnoses specifically within the 217 00:15:08,640 --> 00:15:11,600 Speaker 1: United States he's attributing to in California, I think I've 218 00:15:11,600 --> 00:15:14,080 Speaker 1: heard him say numbers as high as one in thirty 219 00:15:14,160 --> 00:15:17,920 Speaker 1: kids have some form of autism, And here there's been 220 00:15:17,920 --> 00:15:20,760 Speaker 1: a lot of conversation as to a singular cause for that. 221 00:15:20,960 --> 00:15:23,520 Speaker 1: My personal belief is there's not a singular cause for that. 222 00:15:23,760 --> 00:15:27,400 Speaker 1: But as we've kind of discussed, a broadened diagnostic criteria, 223 00:15:27,760 --> 00:15:33,240 Speaker 1: but also largely influenced by our environment, the foods we're eating, 224 00:15:33,360 --> 00:15:37,720 Speaker 1: the microplastics being consumed, the pollution in our air so much, 225 00:15:37,760 --> 00:15:40,880 Speaker 1: and so forth. What do you make of the proported 226 00:15:41,120 --> 00:15:42,920 Speaker 1: rise in autism. 227 00:15:44,160 --> 00:15:47,920 Speaker 2: The biggest cause of the rise in autism is the 228 00:15:47,960 --> 00:15:52,880 Speaker 2: culture of diagnosis. It is caused by psychiatry and certain 229 00:15:52,880 --> 00:15:59,400 Speaker 2: branches of academic psychiatry promoting a broader idea of autism. 230 00:15:59,400 --> 00:16:02,720 Speaker 2: So autism is interesting in some ways because it starts 231 00:16:02,720 --> 00:16:06,360 Speaker 2: its life towards the end of the Second World War 232 00:16:06,920 --> 00:16:11,200 Speaker 2: as a very rare condition. So the original condition was 233 00:16:11,240 --> 00:16:14,960 Speaker 2: thought to affect about zero point, not one to zero point, 234 00:16:15,000 --> 00:16:18,920 Speaker 2: not four percent of children. You're talking about, very rare condition, 235 00:16:19,520 --> 00:16:24,200 Speaker 2: and they nearly all had significant learning difficulties. So these 236 00:16:24,200 --> 00:16:28,800 Speaker 2: were the site type of individuals who were unlikely to 237 00:16:28,880 --> 00:16:32,320 Speaker 2: be able to live an independent life. They were always 238 00:16:32,600 --> 00:16:39,280 Speaker 2: likely to require considerable amounts of care and support educationally, clinically, 239 00:16:39,640 --> 00:16:44,840 Speaker 2: and socially throughout their lives. But the concept has expanded 240 00:16:44,960 --> 00:16:48,760 Speaker 2: so much that we've gone from this type of group 241 00:16:49,040 --> 00:16:52,160 Speaker 2: who are likely to end up, as you know, residents 242 00:16:52,200 --> 00:16:55,800 Speaker 2: in support homes, right up to the richest man in 243 00:16:55,800 --> 00:16:58,880 Speaker 2: the world. Elon Musk, I mean that is the full 244 00:16:59,000 --> 00:17:04,679 Speaker 2: spectrum of human functioning, if you like. So the concept itself, 245 00:17:04,960 --> 00:17:08,880 Speaker 2: I think has now become so diluted that it doesn't 246 00:17:08,920 --> 00:17:12,040 Speaker 2: really tell us anything about the persons who are getting 247 00:17:12,040 --> 00:17:17,399 Speaker 2: the diagnoses, and therefore it's impossible to start disentangling potential 248 00:17:17,520 --> 00:17:24,040 Speaker 2: causes because the biggest driver of this rise has nothing 249 00:17:24,080 --> 00:17:26,480 Speaker 2: to do with our environments, has nothing to do with 250 00:17:26,560 --> 00:17:29,640 Speaker 2: our genes, and has a lot to do with an 251 00:17:29,680 --> 00:17:36,680 Speaker 2: expansion of a concept. It does interact with changes in 252 00:17:36,800 --> 00:17:41,880 Speaker 2: the types of social roles that people are expecting, particularly 253 00:17:41,920 --> 00:17:46,160 Speaker 2: as we moved from a more industrial society where people 254 00:17:46,200 --> 00:17:52,000 Speaker 2: worked in factories where to the more service sector and 255 00:17:52,119 --> 00:17:56,640 Speaker 2: consumer facing where the demands are on people to have 256 00:17:56,760 --> 00:18:00,760 Speaker 2: certain types of people's skills. So you could an argument 257 00:18:00,840 --> 00:18:04,800 Speaker 2: together that it reflects that type of shift in our 258 00:18:05,000 --> 00:18:09,879 Speaker 2: economic in the types of economic activities that are desirable. 259 00:18:10,040 --> 00:18:13,600 Speaker 2: That makes it more likely that people who who have 260 00:18:14,200 --> 00:18:17,480 Speaker 2: you know, the diversity of quirks in the way we 261 00:18:17,560 --> 00:18:21,720 Speaker 2: interact socially, it might make it harder for some people 262 00:18:21,960 --> 00:18:25,480 Speaker 2: to get on. But at the same time, as we've 263 00:18:25,520 --> 00:18:30,400 Speaker 2: seen with a whole host of people who are considered 264 00:18:30,400 --> 00:18:33,200 Speaker 2: to be at the top of their game in sports, 265 00:18:33,320 --> 00:18:36,920 Speaker 2: in culture, in industry, who are coming out and saying, 266 00:18:37,080 --> 00:18:39,320 Speaker 2: you know, a whole load of celebrities have come out 267 00:18:39,320 --> 00:18:41,920 Speaker 2: and said that they have or they're considered to have 268 00:18:42,119 --> 00:18:46,600 Speaker 2: a autistic spectrum disorder. So even that doesn't seem to 269 00:18:46,840 --> 00:18:50,359 Speaker 2: so I think we've ended up with a whole narrative 270 00:18:50,880 --> 00:18:54,840 Speaker 2: that lacks any empirical basis. It's like floating in some 271 00:18:55,200 --> 00:18:59,840 Speaker 2: abstract space where we're talking about are we over diagnosing 272 00:18:59,840 --> 00:19:04,280 Speaker 2: our underdiagnosing? No, it's the culture of diagnosis. These are 273 00:19:04,280 --> 00:19:05,399 Speaker 2: not diagnoses. 274 00:19:05,680 --> 00:19:08,880 Speaker 1: More coming up on Wellness Unmasked with doctor Nicole Sapphire. 275 00:19:12,320 --> 00:19:15,119 Speaker 1: So in your book Searching for Normal, you know that 276 00:19:15,240 --> 00:19:18,520 Speaker 1: is obviously a very complex term. You know, what, how 277 00:19:18,560 --> 00:19:21,239 Speaker 1: do we get to that that level of normal? How 278 00:19:21,280 --> 00:19:24,640 Speaker 1: do we move from here? I find myself myself living 279 00:19:24,680 --> 00:19:28,720 Speaker 1: in a very polarized society where if you say anything 280 00:19:28,800 --> 00:19:32,040 Speaker 1: other than if you if you make the claim that 281 00:19:32,200 --> 00:19:36,119 Speaker 1: autism has increased because of an expanded diagnostic criteria, which 282 00:19:36,320 --> 00:19:40,080 Speaker 1: from my opinion is the most obvious. Same with ADHD, 283 00:19:40,160 --> 00:19:42,320 Speaker 1: and same with anxiety, and same with the majority of 284 00:19:42,320 --> 00:19:45,800 Speaker 1: our mental illness. You know, I am immediately ostracized by 285 00:19:45,840 --> 00:19:49,040 Speaker 1: one half of the population saying that that's not true. 286 00:19:49,240 --> 00:19:52,240 Speaker 1: It's you know, specifically, you have to say that vaccines 287 00:19:52,280 --> 00:19:54,159 Speaker 1: cause it all or else this one group will be 288 00:19:54,240 --> 00:19:57,280 Speaker 1: very upset with you. But on the other hand, you know, 289 00:19:57,400 --> 00:20:00,760 Speaker 1: I do. I do look around our environment and I 290 00:20:00,880 --> 00:20:04,679 Speaker 1: wonder if there is some more than just the expanded 291 00:20:04,760 --> 00:20:08,760 Speaker 1: diagnostic criteria. And I find sometimes it's very difficult to 292 00:20:08,840 --> 00:20:11,320 Speaker 1: move forward in this conversation, like how do we get 293 00:20:11,359 --> 00:20:14,800 Speaker 1: to that level of normal and move forward from where 294 00:20:14,840 --> 00:20:15,160 Speaker 1: we are? 295 00:20:16,440 --> 00:20:19,199 Speaker 2: So the key word, I think in the title of 296 00:20:19,200 --> 00:20:25,520 Speaker 2: my book is searching, because in some ways I'm unpacking 297 00:20:25,800 --> 00:20:28,760 Speaker 2: all the assumptions that we have behind the idea that 298 00:20:28,800 --> 00:20:31,600 Speaker 2: there is a normal. Where do we get our ideas 299 00:20:31,600 --> 00:20:34,320 Speaker 2: for a normal? Our ideas for what we consider to 300 00:20:34,359 --> 00:20:38,160 Speaker 2: be normal have been shrinking, But maybe the whole concept 301 00:20:38,200 --> 00:20:42,560 Speaker 2: of normal, because by definition, we're all pretty unique. Diversity 302 00:20:42,920 --> 00:20:46,280 Speaker 2: is the nature of the human condition. Trying to boil 303 00:20:46,440 --> 00:20:52,720 Speaker 2: us down into single dimension identities to me is highly 304 00:20:52,760 --> 00:20:56,320 Speaker 2: problematic because we're made up of multiple different things that 305 00:20:56,560 --> 00:21:02,200 Speaker 2: define us. From our background, from our family, from our nationality, 306 00:21:02,720 --> 00:21:08,480 Speaker 2: our religion, our politics, our profession. Identity is not something. 307 00:21:08,800 --> 00:21:11,440 Speaker 2: So one of the things that I've seen happening is 308 00:21:11,520 --> 00:21:16,680 Speaker 2: that the mental health industrial complex has kind of merged 309 00:21:16,800 --> 00:21:21,800 Speaker 2: with the whole identity politics movement. So people have started 310 00:21:21,840 --> 00:21:26,920 Speaker 2: to identify and see as an important part of who 311 00:21:27,000 --> 00:21:31,240 Speaker 2: they are when they get a psychiatric diagnosis. So it's 312 00:21:31,320 --> 00:21:35,320 Speaker 2: kind of social status shifted, and this is partly the 313 00:21:35,359 --> 00:21:39,080 Speaker 2: reason why people get so upset if you're saying, do 314 00:21:39,160 --> 00:21:43,920 Speaker 2: you know what? These are? Not diagnoses? They don't explain anything. 315 00:21:44,240 --> 00:21:50,879 Speaker 2: They are labels, and labels come with potential harms that, 316 00:21:50,920 --> 00:21:53,760 Speaker 2: if you're not aware of them, what you think might 317 00:21:53,800 --> 00:21:57,600 Speaker 2: be liberating to you in a few years time, start 318 00:21:57,640 --> 00:22:01,160 Speaker 2: a process of capturing you of in And I think 319 00:22:01,200 --> 00:22:06,040 Speaker 2: it's up to us to point this out because our 320 00:22:06,080 --> 00:22:10,280 Speaker 2: culture is kind of running away with concepts that I 321 00:22:10,359 --> 00:22:16,840 Speaker 2: think are potentially disabling and harmful to us as individuals, 322 00:22:16,920 --> 00:22:19,840 Speaker 2: but also to us at a population level. 323 00:22:20,080 --> 00:22:23,200 Speaker 1: So from the individual, so I'm a mother of three boys, 324 00:22:23,280 --> 00:22:27,000 Speaker 1: from the individual listening to this podcast, like a mother 325 00:22:27,160 --> 00:22:30,560 Speaker 1: who either has a child who has maybe been labeled 326 00:22:30,600 --> 00:22:34,520 Speaker 1: nerdivergent or they're grappling with does my child have ADHD? 327 00:22:35,040 --> 00:22:37,399 Speaker 1: What's your advice to that mom listening? 328 00:22:38,560 --> 00:22:42,760 Speaker 2: Well, everybody has to try and figure things out for themselves, 329 00:22:43,400 --> 00:22:47,520 Speaker 2: and sadly, unfortunately, sometimes if you're going to if your 330 00:22:47,920 --> 00:22:50,840 Speaker 2: child needs extra help, and if you're going to going 331 00:22:50,920 --> 00:22:53,880 Speaker 2: to get extra help, you sometimes need to go down 332 00:22:53,920 --> 00:22:56,679 Speaker 2: these paths. That's just a sad reality. But if you 333 00:22:56,720 --> 00:22:59,680 Speaker 2: do find yourself going down the path of labeling or 334 00:22:59,720 --> 00:23:03,159 Speaker 2: get a label like that for your child, then hold 335 00:23:03,200 --> 00:23:07,000 Speaker 2: it lightly. Do you not see it as lifelong? Because 336 00:23:07,000 --> 00:23:10,400 Speaker 2: it isn't you know plenty of people. One of the 337 00:23:10,440 --> 00:23:14,600 Speaker 2: truths about growing up is that change is inevitable. All 338 00:23:14,680 --> 00:23:17,040 Speaker 2: sorts of things about you, from your body to the 339 00:23:17,080 --> 00:23:20,720 Speaker 2: way you experience your emotions, to your friendships, to your 340 00:23:20,760 --> 00:23:24,360 Speaker 2: ambitions and so on, they will change. So don't get 341 00:23:24,480 --> 00:23:28,640 Speaker 2: drawn into this idea that you've got some fixed, lifelong problem. 342 00:23:28,800 --> 00:23:32,679 Speaker 2: And the other thing I would really caution against is 343 00:23:32,960 --> 00:23:37,960 Speaker 2: getting drawn into what I call concept creep. Whereas the 344 00:23:38,080 --> 00:23:41,680 Speaker 2: language and concepts that came out of the clinical setting 345 00:23:41,800 --> 00:23:45,440 Speaker 2: have sort of leaked out, and people now talk about 346 00:23:45,600 --> 00:23:50,600 Speaker 2: things like masking, they talk about meltdowns, they talk about 347 00:23:50,800 --> 00:23:55,879 Speaker 2: disregulated emotions, and all of these sorts of things go 348 00:23:56,000 --> 00:24:01,520 Speaker 2: back to ordinary language, because when you start using mystifying languages, 349 00:24:02,040 --> 00:24:05,600 Speaker 2: it might disempower you as a parent. You might start 350 00:24:05,640 --> 00:24:08,240 Speaker 2: to think that knowing how to help your kids grow 351 00:24:08,320 --> 00:24:11,840 Speaker 2: up is an incredibly complicated thing, and it needs multiple 352 00:24:11,920 --> 00:24:14,239 Speaker 2: experts to tell you this or that, and all of 353 00:24:14,240 --> 00:24:17,080 Speaker 2: these things might get in a way of the more 354 00:24:17,160 --> 00:24:21,320 Speaker 2: important things, which is a relationship, your relationship with your children, 355 00:24:21,520 --> 00:24:25,120 Speaker 2: just that basic thing of you know, loving them them, 356 00:24:25,200 --> 00:24:28,679 Speaker 2: knowing you love them, not being afraid of conflict, not 357 00:24:28,760 --> 00:24:32,960 Speaker 2: being afraid of guiding them. All those things might become 358 00:24:33,119 --> 00:24:36,359 Speaker 2: a lot more harder to do if you've sort of 359 00:24:36,600 --> 00:24:41,879 Speaker 2: farmed out your capacity to influence your children as they 360 00:24:41,920 --> 00:24:44,240 Speaker 2: grow up. To a professional class. 361 00:24:45,119 --> 00:24:47,600 Speaker 1: Well, I love that advice and doctor Tamimi, I'm so 362 00:24:47,760 --> 00:24:50,920 Speaker 1: glad that you came on Wellness and Mass. Anybody who 363 00:24:51,240 --> 00:24:54,080 Speaker 1: found this conversation as interesting as I do. You have 364 00:24:54,119 --> 00:24:56,480 Speaker 1: to pick up a copy of Searching for Normal, a 365 00:24:56,520 --> 00:25:00,560 Speaker 1: new approach to understanding mental health, distress and NeuroD diversity. 366 00:25:00,600 --> 00:25:03,520 Speaker 1: It just came out this last year. It is very 367 00:25:03,720 --> 00:25:07,359 Speaker 1: informative and it just it just allows you to change 368 00:25:07,359 --> 00:25:08,679 Speaker 1: the way you think about something. 369 00:25:09,280 --> 00:25:12,679 Speaker 2: Well, thank you very much for inviting me. I've enjoyed 370 00:25:12,680 --> 00:25:15,800 Speaker 2: our chat and I do think these are very important 371 00:25:15,800 --> 00:25:18,000 Speaker 2: topics for us to be engaging with. 372 00:25:18,320 --> 00:25:22,040 Speaker 1: This conversation is exactly why wellness on mass exists. Whether 373 00:25:22,119 --> 00:25:25,199 Speaker 1: you agree with doctor Tumimi or not, his work and 374 00:25:25,280 --> 00:25:28,199 Speaker 1: opinions forces us to pause and ask are we helping 375 00:25:28,240 --> 00:25:31,280 Speaker 1: patients or are we just simply labeling them? Are we 376 00:25:31,359 --> 00:25:35,159 Speaker 1: treating root causes or are we just managing symptoms? And 377 00:25:35,400 --> 00:25:38,480 Speaker 1: is there a level of deception when it comes to 378 00:25:38,960 --> 00:25:43,879 Speaker 1: the pharmaceutical market. Mental health is real. Suffering is absolutely real. 379 00:25:44,280 --> 00:25:48,040 Speaker 1: But how we define, diagnose, and treat that suffering matters. 380 00:25:48,080 --> 00:25:51,159 Speaker 1: And it's especially true for our children. My hope is 381 00:25:51,200 --> 00:25:56,080 Speaker 1: that today's discussion encourages curiosity, critical thinking, and just better 382 00:25:56,160 --> 00:26:01,560 Speaker 1: overall conversations between patients, parents, dot com, whoever's involved in 383 00:26:01,560 --> 00:26:04,040 Speaker 1: that conversation. You've heard me say it once, You're going 384 00:26:04,080 --> 00:26:06,160 Speaker 1: to hear me say it a million times. I don't 385 00:26:06,160 --> 00:26:09,359 Speaker 1: think anybody knows their children better than their parents. And 386 00:26:09,400 --> 00:26:12,160 Speaker 1: so while it's important to get other people's opinions. At 387 00:26:12,160 --> 00:26:14,280 Speaker 1: the end of the day, all you can do is 388 00:26:14,359 --> 00:26:17,000 Speaker 1: take the information that you're given and you make the 389 00:26:17,040 --> 00:26:20,160 Speaker 1: decision that's right for your child. If this episode made 390 00:26:20,200 --> 00:26:22,640 Speaker 1: you think, please be sure to share it with other peoples. 391 00:26:22,720 --> 00:26:26,080 Speaker 1: If it challenged you even better, I'm doctor Nicole Saffire. 392 00:26:26,200 --> 00:26:28,840 Speaker 1: This is Wellness Unmass. Thank you so much for listening 393 00:26:28,840 --> 00:26:32,800 Speaker 1: to Wellness Unmass with doctor Nicole Saffire on iHeartRadio. You 394 00:26:32,840 --> 00:26:35,399 Speaker 1: could also find us on Apple Podcasts or wherever you 395 00:26:35,440 --> 00:26:37,120 Speaker 1: get your podcasts. I'll see you next time.